Edit: I missed the part where this was a list of excuses that had been heard. I was too hasty to reply. Disregard the following.

1) I'd just like to say the DMV in Oregon is an incredible experience. It certainly doesn't have to bad. I've experienced it in Georgia, which was awful. But health care now is a massive problem. I've had to change health care providers six times in the last two years because of it being tied to employment.

2) Because it's actually cheaper to have single payer. It's huge leverage in negotiation. It will catch things quicker in more people, which means better outcomes and less dire (and expensive) treatments.

3) In Germany you can get supplemental medical insurance on top of your national Healthcare which can get you better care. Additionally there are still private practices.

4,5,6) Compared to the rest of the world the US does indeed pay dramatically inflated prices, which has a depressive effecton the finances of the less wealthy. If you're saying you'd rather people (like those waiting for Medicare to get diagnosed) suffer so you can be richer, well... at least you are honest.

I explicitly said these are not my statements but rather arguments I’ve heard (sometimes vehemently) from people opposed.

I apologize. The topic is personal to me, and I was seeing red. I'll edit my comment and step away from HN for a bit.

Single payer can be cheaper. It doesn’t actually mean it will.

Georgia had a bad spell back before some new rules for new drivers came into effect, but it seems to have cleared up.

Good list of objections I've heard. The people who say #1 will never get on board. The DMV is a state-level agency, and people have plenty of good (maybe not great) experiences with government agencies like Medicare, USPS or SSA. That's more of a talking point for opposition parties who oppose central government altogether.

#2 isn't a serious objection, because the math is pretty clear that almost everyone winds up spending less.

#4-6 are intractable and come down to the population having the will to overcome objections from capital and doctors. I do think that doctors and nurses are gettable if we bring down the costs of malpractice insurance and education so that overall take home doesn't suffer.

In my experience trying to sell the idea, the biggest impediment to real progress is #3, though I am certain I have a local bias. That's the issue that keeps the knowledge working class separate from the labor-working class. I haven't come up with a good answer other than accommodating them by allowing first-class treatment for those with money and second-class treatment for everyone else. Not the most altruistic answer, but probably the most achievable. No one with premium healthcare now is going to risk it, and that's an important political block.

2 is a serious objection because while a government administered program promises to be cheaper in aggregate, it will almost surely not be cheaper for every individual/household, especially if you intend for or expect people to supplement or replace the government insurance with private insurance on top of the public option to get back to the level of the insurance they have today.

You could argue that 4-6 aren’t real objections either because most people aren’t in those fields either.

In the US the cost of healthcare is so ridiculous that underwriting the system and bargaining as a unit for things like equipment, disposables, and pharmacy will save the entire system billions of dollars of overhead/profit/graft (depending on your viewpoint) that currently go mostly to insurance companies and private equity healthcare groups. At some point you will be right that the harm outweighs the good for a sizable group, but we aren't there today.

> You could argue that 4-6 aren’t real objections either because most people aren’t in those fields either.

Way more money and influence though.

> Way more money and influence though.

Bingo. 50 million poor people have less lobbying clout, ie dollars, than the medical or pharma industries.

It’s no coincidence that the ACA provided for money for insurance, without actually increasing the supply of actual medical care. Increasing insurance increases demand, provides a way for the existing industries to get paid, and overall raises the cost of care.

Now had they had a lick of sense and simply spent the same amount of money on setting up clinics (ie supply side), you’d see a drop in prices as existing providers would have to compete with a lower cost option.

regarding #2, the math isn't necessarily clear at all. I actually have no idea how much my health insurance costs. my employer isn't required to fill that box on my W-2, so they don't. I'm mostly convinced that the average cost would be lower, but governments in the US do seem to have an incredible ability to waste money.

In California it's about $500-600/mo for a "Gold" level PPO plan for a 20-30s individual through CalChoice Small Business pool. Bronze level plans are usually in the high 200s to low 400s. HMO plans are usually about $100-150 a month cheaper than PPO. Vision and dental are another $20-50/mo. Spouse roughly doubles the cost, and kids add more to it, but I don't remember the exact amounts.

Keep in mind that even with the Gold level plan you are still subject to network restrictions, paying copays, deductibles, and you have an OOP maximum of several thousand dollars.

Big companies can get better rates than individuals or smaller companies and businesses get to write off the expense, whereas individuals (mostly) can't. It's only the governments' fault insofar as they haven't done something about this already. The rules were written to enable corporate profits, not quality, cheap healthcare. Even as a small business owner, trying to offer healthcare was brutal just from the sheer expense of it. It's almost hard to justify unless you have kids or a chronic condition, but you never know when catastrophe will hit, so the market is fairly price-inelastic.

Well, my insurance for a family of four cost slightly more than 10,000 last year (both employer and employee sides). You could triple the amount I paid into Medicare in exchange for Medicare covering everyone and I and my company would come out ahead. There has never been a year where I have been paying for insurance that it has not grown faster than inflation.

You can estimate it from this table NJ publishes:

https://www.nj.gov/dobi/division_insurance/ihcseh/ihcrates20...

Add or subtract 10% based on your cost of living compared to NJ.

People with good salaries and benefits will presumably see their taxes increase by a couple orders of magnitude more than the peanuts we are currently paying for care. Our employers will save, but not necessarily share that with us. I still think it’s the right thing to do, but it’s obviously going to wreck me personally given my SWE salary.

2. The US federal government already spends about as much on healthcare per capita as countries where it is free at the point of use. You’re currently getting massively ripped off so insurance CEOs can buy another yacht.

3. All civilised countries have private healthcare as well as public. If you really want to pay more to avoid waiting lists and fancier wards, you can do so.

# 2 is what gets me. There seems to be some rather odd idea here that having any portion of ones taxes go to supporting people who can't afford health insurance otherwise, even if it means that people would pay less overall for healthcare, is somehow more unfair than having each person take the personal risk of bankruptcy due to an expensive illness. There also seems to be some thinking along the lines of not having a "choice in the market" if we're all covered by the same system as if the market really provides much of a choice now.

The people without healthcare are not the ones driving this conversation. It is not about this at all.

It's important to note that a lot of why people think the federal government isn't good at doing things is because ideologues (from both parties) make it less efficient and more painful for no practical reason. That is sometimes called "starving the beast", or "means testing".

> I’m already paying for healthcare for my family and we’re struggling to get ahead; why would I want to pay for healthcare for others as well?

This one is my favourite because it’s literally how insurance works.

Actually insurance is even worse because you’re also paying for insurance company profits (and advertising, etc.)!

In an insurance pool the other members subsidize you just as much as you subsidize them. Government healthcare could work that way in theory! But making government the administrator of a traditional risk pool is a boring technocratic argument. The substance of universal healthcare is a one way subsidy from higher earners to lower earners.

7. I'm a private medical insurance company. See #4

8. I'm a privately owned hospital. See #4

Overheads in the US are pretty ridiculous, and lobbying gets 5 through 8 incredible ROI.

In addition to all of these reasons, we have tribal affiliation. Health care for all has been spun as socialism for so long that real progress here seems utterly intractable. Even if you could convince politicians that your list of reasons don't add up, they'd still look you dead in the eye and tell you that it won't happen because their constituents would come for their heads.

But have a look at other countries, e.g. Scandinavia, UK. Public healthcare doesn't need to be bad. And it doesn't exclude the possibility of private healthcare.

> Scandinavia, UK. Public healthcare doesn't need to be bad

Here's an article from 2018 (Pre-COVID) claiming the NHS has 4.3 Million people in it's operation backlog with over half waiting for more than one year[1]. That sounds outrageous, and a massive step backwards from what most in the US have today (even with low tier health insurance plans).

I do not know why this is the reality in nations with Universal Healthcare, but the UK is not alone.

I constantly hear anecdotes about people waiting 6+ months for minor operations in the UK (corroborated by this article and others), and how the wealthy/elites of Canada fly into the US for treatments.

Why is it that Universal Healthcare seems to universally turn into massive backlogs and poorer service?

I'm also not convinced we need some new "Universal" system in the US. Everyone in the US already does have access to healthcare (Medicare/Medicaid/Private). The only difference is above a certain income level you're expected to shop for your own. I much rather prefer that instead of it coming out of my paycheck in another mandatory tax without choice of provider.

[1] https://www.theguardian.com/society/2018/jul/13/nhs-operatio...

I live in a country with tax-paid medical (and dental, vision, everything necessary, with some minor exclusions) - they basically take 12.92% of your pretax earnigs for medical + ~30eur extra.

I pay a lot of money for those services, but i get really shitty service for some of those - eg. dental. I see a dark caries spot on my tooth, and basically if I'm good enough to eat (not too much pain), my waiting time is ~6months+ (pre-corona time, probably a lot longer now). I can go to a private dentist and get a filling, but I have to pay for the service. There is no way to either opt-out of eg. dental, or to get a part of the service paid by our national insurance (eg same price as the insurer would pay a government assigned dentist, you just pay a difference). We have a bunch of papers with a bunch of words promising <30 day wait times, but in practice, the wait time are huge.

Yes, if you cut your arm off, they will fix you, but the dental (and many other branches) are pretty bad.

My understanding is that post 2008, Dental and eye care in UK has been cut, and going private is the norm.

Its is bot representative how NHS treats injuries, failing organs, etc.

That being said my experience with Czech system of mandatory insurance has been better.

Dental insurance of any kind is pretty rare in the US. Large employers may offer this to their employees, but even then it’s a situation of very high coinsurance for any procedure of substance, and covered procedures are limited. So however bad your national dental system may be, it at least provides some baseline option for everyone — including the poor, the homeless, the jobless, and employees of small businesses alike.

Let me be more frank, it is a scam and nothing more than prepayment for cleanings and X-rays in the vast majority of cases. The only time I have not paid with cash is when I was on Medicaid.

"they basically take 12.92% of your pretax earnings"

Could you clarify this? Is the 12.92% your entire tax burden or the extra amount for medical? If the former, I currently pay $92 a month for health and dental insurance. I made nearly 250K last year. 12.92% of 250K is $2,691 per month. That's .. quite the difference.

Many European countries have a high health insurance tax rate, but capped to a certain income.

Eg. Germany has a 14.6% rate for health insurance[1], but capped at 56,250 EUR of income, thus making it capped at 8,212.50 EUR annually, or 684.38 EUR monthly. Still a lot more than your $92 a month :)

[1]https://taxsummaries.pwc.com/germany/individual/other-taxes

> $2,691 per month

per year, I suppose.

> I constantly hear anecdotes about people waiting 6+ months for minor operations in the UK

Emphasis on the "minor operations". Things are prioritised by need and urgency, so naturally you end up with a long tail of non-urgent, minor operations.

> how the wealthy/elites of Canada fly into the US for treatments

There's a reasonable argument here that the US system has advantages for the wealthy. Generally however this is seen as undesirable.

> Everyone in the US already does have access to healthcare

There's several issues with this statement. The first is that 32.8 million people (12% of the population) were uninsured in 2019[1]. The second is that even if you have health insurance on paper, it's generally prohibitively expensive to use, only kicking in once a deductible is reached that will bankrupt you regardless (40% of Americans can't cover a surprise $400 expense [2] and these deductibles can run into several $1000). The reality for many is that if they're sick, they tough it out because going to a doctor may cause them financial ruin.

> above a certain income level you're expected to shop for your own. I much rather prefer that instead of it coming out of my paycheck in another mandatory tax without choice of provider.

I'm not sure what your experiences have been, but the only context where I've been able to "shop for my own" provider was when an employer happened to offer one of two providers in their available plans, which wasn't always. Functionally I had almost no choice in my health insurance coverage short of specifically finding a job that offered what I wanted, which given my priveliged position as a software engineer would be possible but would be laughable for most professions. Functionally, my health insurance was a mandatory tax without a choice of provider, it just wasn't a tax paid to the government.

I should also note that I now live in Australia, where we have a universal public system where I am still able to choose my doctor and other care providers. In fact, I feel that I have far more choice here than I ever did while living in the US.

[1] https://www.cdc.gov/nchs/fastats/health-insurance.htm [2] https://www.cbsnews.com/news/nearly-40-of-americans-cant-cov...

I grew up in the US, moved to Canada. Saw a friend wait like 6 months to get an ACL replaced. Poor guy could hardly walk for that time. I've known two people who were told to get an MRI for various reasons... the wait on that is 6-9 months too. One good reason to get an MRI: internal bleeding following a concussion can kill you in days, and a CAT scan won't rule it out. But apparently that isn't a good enough reason to skip the line.

Like the US, about half of Canadians are strongly opposed to taxes. Our health care system is about as good as it can be, with the budget we have for it.

> Emphasis on the "minor operations". Things are prioritised by need and urgency, so naturally you end up with a long tail of non-urgent, minor operations.

How long do you wait for eg. a tooth filling? Or if you notice a dark spot on the skin, to get it checked up by a dermatologist? So the minor things, that can get messy real fast if you dont deal with them fast?

Obviously it would be better to have minor needs met as well. But the point is that when you say “I now have to wait too long for minor things, therefore healthcare for all is bad”, you are implying that you would prefer that you got treatment for a minor condition than someone else got treatment for a major condition.

If the main argument against nationalized healthcare is that so many more people can get healthcare that your minor condition gets bumped down in priority... well yeah, the point is that many more people can get treatment for major problems!

The problem with minor conditions is, that you still have to pay for them. You pay for dental, but don't get the service.

I pay insurance for my car (it's mandatory here - the mandatory part only covers damages on other peoples cars when you're the guilty one). I also pay (extra) for windshield repair, and when a small rock on the highway breaks my windshield, i go to one of the preaproved service centers (or do the paperwork to do it somewhere else), get the glass replaced, and go home after ~30 minutes.

I also pay for dental in my mandatory government insurance (no way to opt-out), and when i see a dark spot on my tooth, i call the government dentist, and they tell me to come in six months, at 11.30am on a tuesday. I could wait that long, but by that time, my tooth could get worse, and a simple drill-drill-fill-fill might end up as an extraction or worse. So basically, I either have to pay for a private dentist to do it (full price, not just the difference in price compared to a government dentist), or wait six months and risk it. Either way, i pay for dental, that I don't get.

Same for eg. dermatologists... find a spreding dark spot on the skin.. wait six months+ (probably more now, due to the plague), or pay 70eur and get it checked out the next day. Wait six months, and a simple burn-off could be cancer.

But thats how taxes work: i pay for schools, and i dont have kids, i dont get a rebate I were to homeschool kids or send them private.

I pay for roads and i dont have a car, i don't get a rebate if i walk. Etc.

Those are not the same.

Bad teeth impacts you and you alone.

On the other hand, your nation, state, city, employer, etc are all run by people who were educated in this country. You directly benefit from roads every time you buy goods from any business, etc.

It's absolutely the same, has COVID taught you nothing about what happens to an economy when an diseases are out of controll?

Do you think disease ridden population carrying ringworms earns well, shows up for work reliably and are good customers?

If healthcare was left to free market completely, we'd see return of The Plague!

You cannot transmit your tooth rot to anyone else.

> If healthcare was left to free market completely

What evidence of this do you have? Because, in the US, healthcare largely is free market and we do not have the return of any plague or anything similar. In fact, it's free markets that bore out the vaccination the world is using to fight the current pandemic.

They are far more similar than you give them credit for.

Part of the reason healthcare is so expensive in the US is because people cannot afford to get preventative care and so they wait until they are basically dying and then go to the emergency room. If they couldn’t afford $100 to see a doctor before, they can’t afford the $100k the hospital will bill them so they just go bankrupt and the hospital loses it all. The hospital covers these expected delinquent accounts by charging more to people with insurance. The insurance covers these higher costs by charging higher premiums. You are already paying for other people, you’re just doing it the expensive way because there’s so many for-profit organizations in between you and those other people.

I'm definitely for universal healthcare, but one of my worries is the unfairness of an opaque system. Imagine if i'm waiting 3-6 months for an operation as I am for a COVID vaccine (true story!)

Our vaccine deployment differs by state, city, county. 30yos are getting vaccinated in a bordering state while 64yos are not getting vaccinated 20mi away. It depends on who you know, luck, bureaucracy, and how lucky you are with your particular county. I'm in Virginia now and no vaccine opportunity yet. Five miles away in Maryland my friends have received the vaccine.

Imagine this for every dental implant, sprained shoulder, etc.

I'm pretty sure universal healthcare works, but i'm not sure how to get our country to the point where it is at least fair for everyone.

A word about waiting for minor surgeries:

As another has said, these are minor. It's OK to wait.

It isn't like you are going to be out of a job or out of much money: A safety net helps with it. So you are sitting at home or at work on light duty while waiting, depending.

As a counterpoint, I have far from "premium" insurance, and can see my doctor for any reason nearly always within a week, and have had multiple "outpatient" surgeries booked/executed within 3 weeks.

I'm not sure arguing minor surgeries can wait for 6 months-1 year+ is a good thing. If the system cannot handle both minor and major operations within a reasonable amount of time, then something is very wrong.

"Minor" could be that you have a dark spot on your skin that you'd like to get checked out. If it's cancer, waiting 6 months could mean death for you. Sure, minor could also be getting some help for some mild dermatitis. The problem is when those things are lumped together.

... But it isn't, though.

Minor, in general, is something that plagues you, yet waiting for surgery isn't going to be an issue. Foot surgery, for example, might fall under this. Waiting won't take complications.

For skin cancer checks, though, you can go to your family doctor. (I have to get skin cancer checks due to a medicine I'm on). If they find anything worrysome, sometimes they can remove it in-office or get you to the correct person in a timely manner. You know, because doctors know that some skin cancers spread quickly (others aren't that serious).

Minor actually means minor. It doesn't mean waiting to see if you die.

Why are you arguing waiting for a year or longer for any procedure is ok?

That doesn't sound ok to me... and objectively is a massive step backwards from what we have in the US today.

In the US today, no matter if you have zero income, little income, or high income - you can see a doctor promptly and have any procedure performed within a month of less.

Scandinavia is OK, not what many people in the US would call great. My uncle had prostate cancer, was basically put in hospice to die. He was kept comfortable and it was a nice place, but he was in his 70s and basically written off. And I'm not even saying that's the wrong approach. His life expectancy was in single-digit years at that point regardless, so why spend a lot of money on low probabilites of success? But a lot of people in the US think that every effort should be made, no matter how hopeless the situation or how much it costs.

People are afraid of government 'death panels' while completely ignoring the fact that such panels definitely exist now, but they are opaque. Try arguing with the insurance company when they've decided to deny your coverage.

the blame is delegated to a number on an excel spreadsheet ¯\_(ツ)_/¯

A long while back, my brother worked for a local "non-profit" health insurance company. Same part of the building as some of the lawyers. They'd brag amongst themselves in the break room about the various ways they'd managed to avoid responsibility for paying a big claim. He ended up quitting his job because he couldn't stomach working in that environment.

It's really easy to reason like that when you are not the one that needs treatment.

Otherwise I am pretty sure 100% of people will think that every effort should be made.

Having seen all four of my grandparents go through their end of life, I came to the conclusion that we treat our pets with more compassion than some of what our elderly (or terminally ill) fellow human beings must endure.

I don’t think every effort should be made, at least not in every case. I don’t think every effort should even be offered in many cases.

I don’t know the exact line for me, but if there’s no reasonable prospect for 3 months of out-of-hospital life, maybe palliative care is the most humane thing. In some cases, active intervention should be able to be requested by the patient (with reasonable oversight).

It’s not primarily for money reasons, but a shocking percentage of healthcare dollars are spent in the last 1 month of patients’ lives. Some of that is intensive care for patients after trauma or other acute incident and that care should continue. But a large part of that is spent on futile efforts, what one surgeon friend of mine called “warm autopsies”.

It's not that it doesn't need to be bad, but a lot of people don't trust the federal (or their state) gov to do it well

I am an immigrant from a socialist, ex-communist country in the Balkans, where socialized medicine is the norm, as is having really good doctors. The few times I’ve had to go to the doctor there, either to be seen myself or to help my grandmother, was an awful experience. I’ve had to spend 2 weeks going from office to office until I could finally get an appointment (just an appointment!) for my almost-blind grandmother, for a simple cataract procedure.

The procedure was scheduled ONE YEAR from the time of appointment, which meant she was blind in one eye for a whole year.

That’s the absurdity of a socialized system.

Everyone already knows the absurdities of this system here so I’ll skip that part of my rant.

This issue is so polarizing, it occurred to me - why don’t we have a medicare-type system (call it m4a) for those who want it, and not for those who don’t? It’s about a 50-50 split anyway.

The catch is, if you don’t pay tax for m4a, you can’t use it.

This way, those who are concerned about “paying for others and receiving inferior service” don’t have to, and those who can’t or don’t want to deal with a privatized system are free to use it.

I have a few thoughts on this:

- If the waiting times are too long, then ultimately it's a supply issue which can be solved by increasing supply (i.e. more funding). Of course, this is obviously easier said than done but it's not really an inherent problem of the system.

- What would your grandmother do in a situation with a privatized system and she couldn't afford surgery? This isn't theoretical: this happens in the US all the time. While I agree that being blind for a year is not acceptable, it's only in certain positions of privilege in the US in the current system where you would even be treated and again is more inherently about funding than it is about an inherent fault of a socialized system.

- I think that if you don't force everyone to pay in the system and allow for private healthcare, people (and politicians!) don't have incentive to improve the system because they can just take private insurance and ignore a languishing public system. The public system doesn't have to be bad, but creating a two-tier public/private system incentivizes people to not care about public healthcare.

The issue is that of incentive, to put it bluntly.

What is the incentive of a medical provider to provide The Best Care Possible, when they know for sure there is no competition? You end up with a system whose only raison d’etre is to continue working as little as possible with no real progress.

Yes, not being able to afford it is obviously a bigger issue than being blind for a year. In this case, she had the option to go to a private surgeon and get it taken care of for much more money.

As for your last point, in a socialistic type of service, “progress” serves to elect public officials. In a capitalistic service, “progress” serves to make more money. Both of these approaches have their flaws; however, I would argue that progress is faster and service of higher quality when a government is not involved. The gov’t advantage is that it’s “cheaper” and thus more accessible to everyone.

As a commenter posted below, I think we have a critical mass of folks (half the country, basically) who would be willing to go the public route. I really have to think this through, though, bc it would create some interesting incentives to sign people up to one or the other.

Well, that means that poor people will likely have a large incentive to buy in, while the upper 5-10% would opt for private insurance rather than paying additional income tax. Unfortunately, the poor and middle class probably will not be able to fund a well functioning level of health insurance by themselves.

I’m not entirely sure this is the case. I suspect (but can’t prove) it’s mostly split among party lines, with an equal pool of wealth between them.

That is, there are plenty of rich Democrats that could bankroll this.

> This issue is so polarizing, it occurred to me - why don’t we have a medicare-type system (call it m4a) for those who want it, and not for those who don’t? It’s about a 50-50 split anyway.

I've been thinking about this a lot myself lately too. It seems like there is critical mass for the people who want universal healthcare, so why can't we make it happen? It doesn't seem that unreasonable to set up a dual system where people who want their taxes to pay for healthcare can get it, and the rest can make their way with the private insurance companies. Win/win.

The difficulty would probably be in keeping the tax pools separate. And deciding at what point someone paying into the single payer system gained permanent eligibility even when unemployed. Things like that.

Probably because people earning less than average will want to be in the shared pool, and people earning more than the average will want individual insurance schemes.

A dual system where we chose to have our tax dollars go where we want... why stop at healthcare? If I don't want my tax dollars to go to... say the military? Can I defund the federal flood insurance because I feel we need to disincentivize living on the coast as sea levels raise (and personably live 900' above sea level)?

Having individual discretion over what tax dollars goes to leads to an unmanageable mess for those trying to actually create a budget. Additionally, sometimes a national priority and the hard choices that goes with that means having taxes spent on things that aren't necessarily popular with the entirety of the electorate.

The control over the budget comes (in theory) with voting on a house member who aligns with your goals for the budget. Yes - in theory.

> A dual system where we chose to have our tax dollars go where we want... why stop at healthcare?

I think a bit of differentiation could be good, but I draw a distinction here. You get to choose among choices available to you. So unless "not paying for the military" was an option written into law by congress, you could not select that option. And it would be unlikely to be offered, for many reasons, not the least of which is that everyone benefits from the military just by virtue of living within the borders of the US.

I don't think it should be a menu where each citizen gets to select from a huge range of options. I think for some things that would work, but there are many things too fundamental to let people opt in and out.

I would contend that everyone/society benefits from having the population, as a whole, being healthy.

More people who are able to be productive members of the workforce, better mental health from improved financial security, and less cost from preventative rather than responsive treatment.

That also gets to the heart of the problem - not everyone recognizes the benefits that I've suggested from a more universal healthcare system.

I would also contend, that I don't see the benefits from the level of military spending that we have.

I see healthcare as a special case, though (the rule about exceptions becoming the rule, notwithstanding).

The healthcare system is interwoven with rules and regulations. For instance, we already have tax rules depending on your yearly FSA/HSA contributions, tax deductions based on how much money is spent, and most importantly the Obamacare rule that one must have insurance or suffer penalties. Would another exception break the system?

My main concern here is: what happens if someone who isn't paying for insurance ends up at the hospital?

First of all, does the hospital delay care until they can verify that the patient has insurance? What if it's an emergency?

If the hospital doesn't delay care, and afterwards the patient is found to not have insurance, they'd be billed right? What if they can't pay it, and they default? How does the hospital make up for that loss?

Under the current system, I believe the hospital eats the cost, and adjusts their rates accordingly, so the insured end up footing the bill Anyways. A socialized system formalize this, and distribute that cost across everyone instead of just the people who pay for insurance/healthcare.

I could throw in "glorious regulatory capture" making healthcare for all a cash bonanza for some companies as our taxes spiral ever upward.

> 1. I don’t want my healthcare to be provided by the same people who brought me a lifetime of experiences at the Department of Motor Vehicles.

The public option still doesn't create that situation because its health insurance. They still aren't going to be healthcare providers.

> 2. Healthcare is expensive. I’m already paying for healthcare for my family; why would I want to pay for healthcare for others as well?

You already are through Medicare, Medicaid, and the Hospital System. In the articles example, you have people waiting until 65 to get more expensive surgical intervention that is less likely to preserve their life due to the wait.

> 3. Good healthcare is expensive and I can afford and buy the best health insurance. I don’t want the best to be unavailable to me and my family because we’re all on a “just OK” government system.

Under a public option system, you'd still be able to buy private insurance. No one is banning this.

I think its misguided because the quality of insurance doesn't guarantee the quality of doctor and frankly, unless you are a specialist in their field, its unlikely you'll be able to accurately gauge the quality of care you receive. I've known plenty of people in the profession of manufacturing dental implants/equipment who thought they could judge the quality of their dentists and failed miserably to the point of needing to switch dentists due to poor workmanship.

> 4. I’m a medical professional and think that I will make less money under a government-provided system of care.

Alright, how do you feel about lowering the federal tax rate for me personally? Not everyone else, just me.

Seems a bit unreasonable when phrased that way doesn't it?

> Under a public option system, you'd still be able to buy private insurance. No one is banning this.

Sounds a lot like "if you like your doctor, you can keep your doctor."

>"if you like your doctor, you can keep your doctor."

Which was always a stupid line because it's not "your" doctor, it was never your doctor. It was your insurance's doctor. If you get a new job and "your" doctor isn't in the insurance network, they're no longer your doctor.

> Under a public option system, you'd still be able to buy private insurance. No one is banning this.

Of course not. A public option obviously implies there is a private option. But a public option isn't the only thing being suggested. This was in the Medicare For All draft bill that Sanders introduced:

> SEC. 107. PROHIBITION AGAINST DUPLICATING COVERAGE. (a) IN GENERAL.—Beginning on the effective date described in section 106(a), it shall be unlawful for— (1) a private health insurer to sell health insurance coverage that duplicates the benefits provided under this Act; or (2) an employer to provide benefits for an employee, former employee, or the dependents of an employee or former employee that duplicate the benefits provided under this Act.

You can say "well, he's only one senator and he got toasted by Biden in the primary anyway", but he's a very influential and powerful figure and it's unfair to say that nobody is suggesting banning it.

People who argue #2 might simply not understand how insurance works.

If the insurance is fixed price (eg. pay $X and get $Y services), then yes. If it's a tax, you pay percentage of what you earn, and if you earn above average, you'll also be paying above average insurance rate but still getting average service.

With health care, average is just what health care is. Being rich shouldn't get you better actual health care. Cancer is cancer. A broken bone is a broken bone.

Everything else is bells and whistles. Want to pay to get that MRI next week instead of in two months? Fine. Want to pay for an fancy room? Fine. You still get the same health care, though. Even if you pay more tax

> Being rich shouldn't get you better actual health care.

Why not? If the healthcare is perfect, then there's no need to pay for better helathcare... but if it's not (eg. long wait times, outdated procedures,...), if someone pays to get a dentist tomorrow (instead of waiting 6monts for a government one), why not?

Being rich shouldn't mean that you get better health care because your net worth doesn't make you a more deserving human than someone poor. Being poor doesnt mean you should suffer or get substandard care.

And to be fair: I have socialized medicine, but I only got that lucky in my 30's after I moved from the US. I don't have long wait times for a doctor's appointment: Non-urgent has more wait time. (And it's OK: It doesn't matter if I have a cervical cancer screening tomorrow or in 2 months). I can get into the dentist urgently if needed.

If I need to wait for 6 months to get a surgery, it means it isn't urgent and there is a safety net to get me through. IF you don't have a safety net, wait times are cruel. All that said, there is a private option here and folks do pay to skip some wait time - I'm generally against this as again, your net worth shouldn't determine whether you get care due to humanity and all - but I'm fine with folks paying for general bells and whistles. Sure, have a fancy room with fancy food if you want.