I agree. My wife's company offers better insurance than mine so I had always been on hers and declined the insurance offered by my company. Her company just implemented a policy stating that if the spouse is eligible for insurance through their own employer there would be a $200 per month surcharge for them electing to use her companies. I understand where her company is coming from but I think we as a nation (US) can do better.

>but I think we as a nation (US) can do better.

No, we can't. If we could, we would. Things are like this because we want them to be like this: it's reflected in how we vote. We've had candidates pushing for "Medicare for all", universal healthcare, etc., and who gets elected? The candidates promising to go the other direction. Clearly, American society and its voters do not want this.

People evolve. So do their opinions and beliefs.

Just because Universal Healthcare didn't catch on the first time doesn't mean it's dead forever.

It'll happen eventually. Maybe in 4 years, maybe in 40.

Maybe you're willing to wait 40 years for people to evolve, but I'm not. There's better places to live.

In reality, the uninsured avoid going to the doctor until its an emergency and then they go the the ER and rack up tens of thousands of dollars worth of medical bills for a problem that if treated proactively by an initial doctor visit could have been resolved with a $15 bottle of antibiotics or something similar.

The poor person obviously cannot afford that bill so the provider eats it and the result is increasing costs for everyone else. So unless the solution is just to let the poor and their children die, providing everyone with access to health care would probably be a net benefit. Not to mention universal health care would provide for incredible bargaining power meaning drugs such as insulin would not cost an individual hundreds of dollars a month.

Everyone with new health insurance is not going to go all at once, I doubt there will be any significant increase in wait time to see a doctor. Finally, people are not units of exchange, they are people and poor or rich they deserve at least a shot at a decent life for them and their family and universal health care goes a long way towards providing that.

>So unless the solution is just to let the poor and their children die

This is exactly what Americans like briandear want, and the political tug-of-war between people like him and people like you is much of why the US healthcare system is the mess that it is.

I'd say briandear proved my earlier point completely: Americans do not want anything like universal healthcare, and no, we really can't do better (by your definition of "better"). Too many Americans are like briandear for that to happen.

Since I can't reply directly to briandear's comment now that it's flagged, I have to ask, why is his comment flagged and now unreadable? He didn't write anything about the rules there that I could see. He expressed an opinion that some people might not like (I certainly find it repulsive), but it's an honest opinion, and I think reflects a large portion of the American electorate, as evidenced by how they vote. Trying to hide this isn't helping.

> With price-based rationing, those that generate more value have easier access to scarce care resources than those who generate less value.

No, it just means that people who are rich can afford healthcare and those who aren’t can’t.

> It’s logical, but politically tough because those that generate little value outnumber those that produce high value — and those low value people vote.

Should they not?

It's only logical if the only value you put on people is someone's ability to pay for things, and assume that that is somehow linked to their ability to "produce" for the betterment of society. The argument really falls down at the extremes - is Jeff Bezos really worth millions of times more to society than one of his workers? Does being born rich automatically make you more valuable?

>Does being born rich automatically make you more valuable?

In the minds of many Americans, yes. We even have many mega-churches here whose doctrine states that rich people are rich because God loves them more. This is why American Evangelical Christians overwhelmingly support Trump.

If we're deciding importance based on signifigant societal value I'm fairly sure almost every poster on HN would not measure up.

> an electrical engineer is more useful than an unemployed cashier.

And then we jumped into the Randian deep end. Peace, I'm out.

It's not a XOR proposition. That's why it's called "the public option". If you want alternative health care to what's provided by the government, you can pay for it.

Too late. Reagan brought in universal health care when he made it illegal for emergency rooms to turn back patients.

Nikolai Tesla died poor

  Maybe some poor don’t get the best care quickly

  an electrical engineer is more useful than an unemployed cashier

  low value people

Well, I mean, it's rare for someone to be so upfront with their blatant sociopathy, so thanks for that I guess.

  It’s logical

ah, that ol' dogwhistle

While I disagree with briandear, I don't find it sociopathic. (It's like the PG said - be aware of what the Taboos/unspeakable ideas are in society.)

I live in Canada as an immigrant, love it here, would never move, and USA health/insurance system frankly baffles me, even having lived there for a year previously. Don't even remotely understand why people put up with sheer complexity and opaqueness.

But I appreciate people like the GP [briandear] that eloquently and clearly help me understand alternative perspectives different to my own. I think it's a very valid, very core discussion of values and goals: is it equal care for all, or do we prioritize it? And I agree with GP [briandear] that shying away from this core discussion muddles the issue. Sometimes it feels like USA builds ever more complex systems to mask the goals and direction of its health care system, rather than a simple system that would fess up and do whatever it's meant to do efficiently :-/

Ad hominem. Attack the idea not the person. Just because someone has a different view than you doesn’t make them a sociopath.

This is one of the main pain points of health insurance policies in the US that makes it nearly impossible to see if you're getting true value. A monthly premium, a copay per visit, a deductible, co-insurance/cost share and out of pocket maximums. Then factor in potential fees from an employer.

All of that aside, it's impossible to know how much you're actually going to visit the doctor aside from chronic ailments.

"declined the insurance offered by my company."

don't know how it is in the US, so this may look uninformed, but are you getting extra $$$ added to your salary, equivalent to what the employer was paying for the insurance?

Not typically, but it's possible that someone might be able to negotiate this with their bosses.

Typically people opt out of company insurance because of one of the following reasons: It's cheaper for them to find services through the marketplace (extremely uncommon, but possible), They have superior insurance through a spouse or family member, they feel that the insurance they're provided with isn't sufficient and they would prefer to purchase better insurance themselves.

No, I don't get the difference. The company keeps what it would pay towards my insurance but I don't have anything deducted from my check for what would be my share of the insurance either.

Edit: My wife though pays more for her company insurance as they would need to insure me as well.

It's not the norm, but I was once offered a job where if I declined health insurance they'd pay me the difference - it was a 4 person company.

The USA spends more than double the OECD average(1) in 2014, but is 28th in the world in OECD life expectancy(2) in 2016.

Personal commentary:

As someone from New Zealand, who moved to Canada, I still don't understand why people would want the responsibility of their employer and themselves to choose what health coverage they want in life, especially when employment tenure can be upended so easily.

Yes I know, USA has funky research and new drugs and whatever, but as a whole, it doesn't seem like a particularly efficient system. So if it's not efficient, what's its objective? For me it sounds like prioritising medical providers to extract the maximum amount of revenue from captive customers, in a scheme where all the prices are similar so it's not a monopoly, but none of them are cheap, so it's nearly like a cartel.

Citations: (1) https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

(2) https://en.wikipedia.org/wiki/List_of_countries_by_life_expe...

If you don't buy into the price rationing argument (I don't) then there is no objective other than enriching the incumbents, it's simply a legacy system. Incremental changes around the margins excepted nothing's going to change until something drastic upsets the apple cart.

It isn’t the employers size as much as it is the group plan risk pool. Employees are better risks than people who have to resort to individual pans. Also, employers don’t pay taxes on what they spend on health insurance, individuals do.

But also that's _if_ you can find coverage. The markets are so screwed up in some states that it's a nightmare of trying to find something you can actually get.

Yes, here in Seattle the cheapest plan on the Obamacare market is $14K/year with a $15K deductible for a family. However low income families can qualify for subsidies.

Sounds like a good reason to not have a family. Seriously: people should stop doing that until our leaders can make our society so that having kids isn't such a burden. If this means society dies out, then we're getting what we deserve, since we choose these leaders.