While I'm a proponent of universal healthcare, it does have some negatives.
I am no big fan of the American healthcare system but I don’t think any country (don’t bring up Switzerland and Singapore as examples, they are too small and don’t have the diversity, size and complexity of the US) has demonstrated an ideal healthcare model.
Why would health care be harder to scale up in terms of the size of a country than, e.g. the military or the fire brigades?
As for diversity... I don't buy it for your specific example. Switzerland has:
- Four official languages.
- A federal system with similar levels of decision-making devolved to the cantons as to the US states
- 11 political parties significant enough win seats in the parliament
- High levels of immigration: 30% of the population are immigrants.
The reason Switzerland shouldn't be brought up is that the health care system isn't particularly good, just different. In particular it's the second most expensive in the world.
The worst?
HN is one of the few forums that repeatedly leaves me speechless.
Even during Covid lockdowns that Sydney is going through at the moment, I can get a GP appointment this week with a 5 minute travel time.
We have a health system delivered by the States of our commonwealth, enormous distance to cover and extremely high health outcomes.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7292524/
"Long wait times have become a defining characteristic of the Canadian health care system. In 2016, the Commonwealth Fund ranked Canada last among 11 countries surveyed on wait times for specialist care.1 Roughly one-fifth of Canadians report being negatively affected by wait times, citing experiences of stress, anxiety, pain, lost income, delays in diagnosis and treatment, duplications of tests, and deterioration in their conditions."
I don't know what op meat by "basic check up". When i injured my knee i was referred to an ortho by my GP who then did a "basic checkup of my knee" to diagnose an mcl tear.
Also op said "basic check up" which you disingenuously changed to "basic health check up" which sounds like a generic health check.
Hard to tell from this what else falls under "knee replacement" category of urgency. I personally know ppl who traveled to india to get a root canal. Weird to dismiss it as " deliberate propaganda campaign " and link to npr article with no actual statistics.
I don't think this is completely true. That greatly depends on the population. Regardless of single payer or private insurance, it's the underlying mentality of the people, or restrictions placed by the plan (which people then complain about). Many people think they have coverage, so they might as well use it. This can happen extremely often and for minor things. Think people going into the doctor or urgent care because they have cold symptoms (for less than a week) and want antibiotics. Most people want the easiest, most beneficial thing, like why diet and exercise when you can just take a pill for your type 2 diabetes, cholesterol, or blood pressure?
People don't think about costs during the most costly parts of life - end of life care. People want doctors to do "everything" to extend a person's existence, even if the outcome isn't likely to result in extended life. When the system does make choices about who to treat or how to treat, there is generally some public backlash (like NY letting many elderly die because they thought they needed to save the ventilators/beds for younger covid patients).
It's the views and intelligence of society that dictate behavior-based costs. This includes what restrictions are placed on both supply and demand sides.
I think this is not realistic, and it's the opposite of my experience in relation to all the people I've known.
I know far more people that _should_ go to the doctor and don't, or do it after a long time (sometimes too long) rather than people who go to the doctor's too much.
I actually can't think of anybody that goes to the doctor "too much".
I've known only one case of person going to ER for simple cold symptoms (excluding the epidemic problems), as one is going to briefly checked, then made to wait for a very long time.
That example I gave about wanting antibiotics for a cold was something I've seen in real life, multiple times. There are hypochondriacs and other people who do go too often. They even have a code/name for people like that to let other doctors know by reading the file. I personally know of a guy who would call 911 just to get a ride in an ambulance. Eventually they stopped responding to him.
I do know people who probably should have gone to the doctors sooner too. I don't know that many of them, but it's possible they are more common in other areas.
"I've known only one case of person going to ER for simple cold symptoms"
I said urgent care. Urgent care is not the same as the ER. I know of people who go to the ER just for the free ride (Medicaid transportation provisions).
Do you have anything backing up that assertion?
I've been to the hospital feeling rotten on more than one occasion, and the doctor has said "You have the flu. Antibiotics won't help. Go home and get some rest." The doctor has no incentive to prescribe me drugs I don't need. There's always a few shitty doctors at clinics/hospitals who will over-prescribe, but the health care system has an incentive to find and stop those doctors- they're wasting taxpayer money.
Meanwhile in the US, the doctor would be financially incentivized to request a chest x-ray and prescribe whatever drugs might be helpful "just in case", fearing a lawsuit for doing too little and fearing their employer being mad at them for not up-selling to bring in more money.
I don't see how changing the healthcare system would implicitly change the torts. Medicare and Medicaid haven't changed that.
I also don't see how the single payer system would prevent over prescription or unnecessary treatment. These also occur under Medicare and Medicaid, as does substantial fraud.
For one, people are using Stanford for the name and presumed quality of care (see tweet about price being much higher than other hospitals). That's shows patients are willing to spend more for treatment there. If you want to dig deeper into the cost, then we would need to know why the price is listed that high, as it is likely a mistake (also speculated in the tweets). It's not really a good idea to compare anecdote that is suspected to be a mistake against an unspecified cost in another system (implied by parent).
Americans are all too ready to blame their individual selves for problems caused by the state and capital. A lot of people from other countries would make their voices heard.
Although this isn't by coincidence either. The government has been feeding this individual responsibility line with various forms of propaganda mixed with racism to the people. It's also been silencing anyone who dared to question the underlying system entirely.
Reminder that the FBI sent letters to JFK aimed to getting him to kill himself.
MLK Jr? Or maybe there’s more to the JFK story than I know…
Uh...what else do you suggest that sick people should do? Be irresponsible and go to work or something?
The point is that people decide when they need care, and some of those people are idiots.
And if I don't know that something is cold, I don't assume it's cold.
https://slatestarcodex.com/2020/04/20/the-amish-health-care-...
Edit: why continue to downvote without comments?
You had mentioned hospitals being incentivized to reduce costs. They could do that by avoiding sick patients. Or not treating sick patients.
Some “providers” already have this business model.
Also, it’s all but guaranteed hospitals would seek to increase revenue by providing non medical services at high expense.
$2000/meal. $500/night parking. $500 for a hospital gown.
America needs to address its weak administrative state, underfunded and under-qualified civil service, and overall shitty public sector before taking on a massive project like this.
It takes a special kind of delusion to believe that when every single country in the world that has a public health system is in fact not worse than the US system.
I think a large part of the problem is that Americans are brainwashed from birth to believe that the "Free Market" will solve all problems, and that it is superior to public systems 100% of the time.
As an America this is a very sad thing for me to say. But the basic mechanisms of government are failing.
If raising my taxes by $10k eliminates that, I’m extremely ok with it.
The cost of US healthcare is 2-3x the cost of healthcare in the rest of the developed world - counting both public and private spend - and with very similar outcomes.
https://www.npr.org/2019/11/01/775339519/heres-how-warren-fi...
> Warren bases her plan off of a recent analysis from the Urban Institute, which estimated that under current law, Americans would spend $52 trillion over the next decade on health care — that includes many types of spending, from employers, individuals and all levels of government.
> Warren's plan estimates that total health costs could be held to $52 trillion and that $20.5 trillion in new federal spending would be necessary.
Like with schools (where America also pays more and gets less), most spending in the healthcare system is payroll. An American nurse makes twice what a UK NHS nurse makes. The idea that we can cut those costs meaningfully is laughable.
As would I, if there's a $15k savings. Is there any data to support that?
You mention costs in other countries. How do salaries, taxes, and cost of living compare as well? It seems that many places have lower cost of living, which seems to influence prices for any number of services.
From a patient perspective or system perspective?
"Health care costs about 50/month if you have income."
That's what is billed. What do the systems actually cost on a per patient basis adjusted for population risks (like obesity)?
There's some kind of horrific cost disease going on in America. Sure, the insurance doesn't help, but it's not the main problem. The cash price - with a discount - for me to get the five-minute opinion of a nurse practitioner is $125-$150. Self-insured companies are paying 20k+ in premiums for an employee's family health insurance plan.
This is reflected in the fact that a lot of hospital systems in the US are already publicly owned! Taxpayers in much of the US are already paying directly to built facilities and pay doctors and nurses for anything their billing doesn't cover. (Not even counting the VA system.) 64 million Americans are on Medicaid, about 20% of the population; [1] 18% of Americans are on Medicare. [2] (There's some overlap, so those aren't strictly additive.) More Americans than Canadians are already the beneficiaries of public health care! And Medicare/Medicaid is already the one of the biggest US government expenditures. [3] Whatever natural incentives are in place are already there. It may be the case that specific government policies are partly responsible for hamstringing cost-cutting, but I see no reason to believe those policies and worse ones wouldn't perpetuate themselves.
There's a lot of factors driving the crazy costs in the US. Unfortunately, I don't see a reason to believe single payer would do anything but mildly slow the rise, unless combined with a lot of very unpopular policies.
[1] https://www.cms.gov/newsroom/fact-sheets/medicaid-facts-and-... [2] https://www.statista.com/statistics/200962/percentage-of-ame... [3] https://datalab.usaspending.gov/americas-finance-guide/spend...
Personally, I would like to see the government use the VA to demonstrate what level of care and overall experience the public can expect if switching to a single payer or other government involved system. Most of us that have any knowledge of their workings would not be too optimistic about US government expanding their role in the general system. It's such an embarrassment.
I honestly haven't heard anything good about the VA other than it's free (but was really earned through service). The good care tends to be at what I would call the active duty facilities, like Walter Reed and Bethesda.
why is this? Here in Chicago all govt run institutions are out of money with out of control budget overruns. eg: public transport( CTA) , usps ect. Not to mention pensions/pension debts which have spiraled out of control.
Any evidence to the contrary is met with “but my freedom”, idk how to fight back against this
I would not call that I hate the whole Canadian system, but parts of it for sure. Especially the ones when they let you wait for months for some things. Some people died because of it. All because the guvvamint only allows for so many procedures per period allowed. The rest does not fit into budget.
However you will find enough of deaths in the US that can be attributed to a lack of money as well.
Depending on how one gets sick the may hate Canadian system or the one in the US.
When the candidate “with a plan” estimates that single payer wouldn’t reduce costs, does it take a “massive disinformation campaign” to convince people that, by the time all is said and done, costs would go up significantly?
It does not occur to them that in a single-payer system, the incentive on everyone is to find ways to lower the cost of healthcare, while in a privatized healthcare system the incentives are reversed. And examples like this twitter post show the result of those incentives.