Medicare, the little socialized medicine we do have, is unusable if you go abroad too. No vouchers, no treaties with foreign healthcare systems, no tax exemptions. You will pay in to Medicare your whole life and be required to burn air fuel flying back to the US to redeem any care whatsoever. The worst part is that often it stills ends up cheaper with medical tourism or getting local care.

I don't think that's a reasonable criticism of Medicare. Most other countries with universal healthcare do require you to be in the country to get that care. Europeans don't get much benefit from their universal healthcare when they leave Europe for example.

The EU is not a nation state, yet roaming in Europe between nation states they get universal healthcare. As do visitors from treaty nations outside the EU.

There are no good bilateral health treaties with the USA For a reason. As an Australian, I have private health cover for longterm services like physio, optical and dental services. For life threatening emergencies I go public and can do so in bilateral treaty countries.

That's how I understand the problem. Happy to be corrected.

I had Medicare on a temporary visa in Australia and had to go to the ER. I don’t think I ever got any bill at all. It was really amazing all the way around.

The contrast made me feel ashamed to be an American, to be honest. I grew up in poverty, and have internalized not going to the doctor for any reason besides an actual, literal life threatening emergency. My folks were volunteer firefighters and first responders, as we lived in an isolated rural area on dirt roads, so we were the closest emergency services, now that I think of it.

I’m back in USA now, and I still have to live that way, as I’m unemployed and trying to start a business. I have no assets and am nearly homeless. It’s no American Dream for everyone.

I wrote a bit about my Australian medical emergency here:

https://news.ycombinator.com/item?id=29719451

My healthscare is an admittedly unusual one, but it applies globally - with a single country exempt. I can get treatment in Sri Lanka, Greece, Moldavia, North Korea, Ghana or Iran and they will cover it. But not the US as ithat system is the most broken and most expensive in the world.

Canada's system doesn't cover you once you leave the country. Well, Ontario (each province is different), will give you $30/day if you're hospitalized but nothing more.

I wonder how much this is because the mostly likely country for you to visit from Canada, is the USA.

I don't think it's odd that a universal system covers you only in your own country. The EU is an exception being an economic zone with free travel.

NHS in the UK doesn't cover you when in Canada for example.

I think it's fairly common for two sane systems near each other or that otherwise have a lot of exchange to ink reciprocal agreements:

https://www.mfat.govt.nz/en/countries-and-regions/australia-...

It's insane that it took Obamacare to finally push for the rollout of electornic health records. Before this, less than 20% of hospitals were doing it:

https://techcrunch.com/2016/07/27/how-president-obama-shaped...

EMRs have been a handout of a fistful of dollars from actual doctors, to the software industry.

Its insane that anyone would think that politicians could be wise and mandate something that an entire industry rejected, and have never needed since the advent of medicine.

Result. Doctors spend time on screens instead of, seeing patients.

The emr is basically an accounting system for insurances to receive claims in a format they can process.

Anyone that tells you otherwise is making money from selling an emr to you or doesnt work in healthcare

Yes but rich people in the US live far longer than the average american. We have to keep that dream alive, the dream that if you just work hard enough and/or buy enough lottery tickets anyone can live a long and healthy life. And access to company-provided healthcare is almost as important to workers as thier wages. Fear of losing healthcare motivates workers to work harder. Take that motivation away and they might quit or demand more money. The stock market cannot afford that sort of hit.

A fully socialised healthcare system a la Canada won’t fly in the USA (this is obvious?). There are models eg in Australia where there is pretty good socialised care, and also a private system where you either pay up or have private health insurance (with a lot of extra costs). It kinda works, and gives some choice to the user. There biggest problem with this system is that private healthcare isn’t a great business, and the hospitals and insurance companies often struggle. They also don’t provide anything near parity with public healthcare. The most complex and sophisticated care still happens in the public system, which in turn means that the best doctors still want to work in the public system as well.

>A fully socialised healthcare system a la Canada

Is the canadian healthcare system even "fully socialized"? It's single payer, sure, but there's still private practitioners/clinics/providers.

>There biggest problem with this system is that private healthcare isn’t a great business, and the hospitals and insurance companies often struggle. They also don’t provide anything near parity with public healthcare. The most complex and sophisticated care still happens in the public system, which in turn means that the best doctors still want to work in the public system as well.

I've heard the opposite about public/private healthcare, at least in germany. Apparently there, the public insurance pays a pittance and is regulated, whereas with private insurance they can charge the market rate.

Very limited private services in Canada AFAIK.

Life expectancy is a crappy way to measure how effective your health care system is. It's way to blunt a tool and has many confounding factors that have nothing to do with your healthcare system.

Anyone trying to picture a US “universal healthcare”, I want you to think back to your last trip to the DMV. The experience dealing with almost any aspect of our government is fraught with paperwork, delays, forms to fill out, “oh you want this other department” circular loops. You can put up with this torture for the “privilege” to drive a car, but you don’t get to force me to deal with this so I can get healthcare when/how I want to.

A while ago I went to an endoscopy clinic, and there was a woman crying and pleading with the secretary because her husband has cancer and couldn’t get treated on the day of his appointment because some medicaid paperwork didn’t go through regarding his diagnosis and thus medicaid wouldn’t approve the procedure yet.

Instead of telling people to make dishonest comparisons to unrelated bureaucracies, I’d recommend that they instead find someone who has actually used Original Medicare[0] (not Medicaid, which is a different thing) if they want to know what it is like to use Original Medicare. The amount of bureaucracy on the patient side is basically zero.

My personal experience with Original Medicare + Medigap has essentially been this:

Step 1. Need some health service. Step 2. Go get the health service. Step 3. There is no step 3, unless the provider fucks up and tries to bill the Medigap insurer as the primary insurer—which is a problem caused by the existence of private primary insurers, not Medicare.

And with private insurers, this:

Step 1. Need some health service. Step 2. Check if the provider is in-network. Step 3. Check if the facility is in-network. Step 4. Check if the service is covered by the insurance. Step 5. Submit a prior authorisation or else the insurer won’t pay anything at all. Step 6. Get denied for some asinine technicality. Step 7. Appeal and submit more documentation until they finally capitulate. (Also, you’re doing this while very sick.) Step 8. Triple-check with the facility that they are only going to use in-network doctors for things like anaesthesiology. Step 9. Go get the health service. Step 10. Get a half-dozen gigantic bills in the mail.

There are certainly issues with Medicare, but I can’t think of any that aren’t the result of for-profit insurers or government abolitionists doing everything in their power to make the system intentionally terrible.

[0] As mentioned in the article, Original Medicare is parts A & B. Part C—Medicare “Advantage”—is the government hand-out to private insurers.

I'm no fan of our current healthcare system, but your description of dealing with private insurance is very much at odds with my experience. It has always been very simple and easy for me. (Doctors are a another story)

I never had a problem either until you try to anything outside of the ordinary. My wife needed some special treatment it was a nightmare to get approved I wasted hours on the phone to be told that the procedure was through another insurance company my company hired for this special procedure. They made so many mistakes I had to call once a week. At one point I had a 4 way conference call between both companies and a special hr person from my company to get this shit sorted out.

That is what pushed me to socialized healthcare private insurers can get fucked.

There are a lot of factors that determine how hard private insurers are to deal with—the kind of plan you have, the type and intensity of care you need, and the quality of the providers in your area/network—so experiences will vary significantly. I am genuinely glad it has not been so bad for you, and I’d love to say my experience with private insurers is the outlier, but unfortunately I suspect it is the other way around.

Every US-based friend or family member of mine has at least one horror story about a surprise bill, a Kafkaesque nightmare of denials and prior auths, being unable to afford their medications or doctor visits, unrealistically low annual visit limits (Depressed? No more than 12 visits per year to a therapist should cure that!), “copay accumulators”, and on and on. The podcast An Arm And A Leg[0] offers a disturbingly wide variety of stories of this bullshit and all the things you have to learn just to protect yourself from getting completely screwed in America’s privatised health care system.

It’s endless, and it’s exhausting, and it’s even more exhausting when folks like the OP show up to make baseless claims that government-run care is somehow going to be like going to the DMV because they’ve swallowed this “government is the problem” bullshit. I’m not going to sit here and say governments are infallible, or that Medicare is perfect, because they aren’t and it isn’t. But do you know which insurance plans in the US have the highest patient satisfaction ratings? The government-run ones[1]!

[0] https://armandalegshow.com/

[1] https://www.insure.com/health-insurance/health-insurance-sat...

Sounds like dealing with private insurance, as well. With the added benefit of getting bankrupted, even if insured.

"Anyone trying to picture a US “universal healthcare”, I want you to think back to your last trip to the DMV. " - I think the truth in this, is the USA needs to solve the meta problem of having well-run government systems, before it can attempt universal healthcare. For various reasons, while the USA is excellent at many things, its poor compared to other countries, at running public services. It seems like a self-fulfilling prophecy to me. Americans don't believe gov't can run things well, therefore they don't even try, therefore it doesn't happen. When Ronald Reagan famously said the 9 scariest words were "I'm from the gov't and I'm here to help" , that message would have landed flat and made no sense to Europeans and Canadians, but in the USA that fits with people's experience. One big thing is the lack of an independent civil service in the USA. If I understand correctly, in the US when a new administration comes in they effectively fire all the managers and put their own people in charge. Whereas in the UK for example, there's an independent civil service who operate by a code of unbiasedly serving whatever administration is in and implementing their policies. While this means that sometimes there same people in their career implement one thing, then roll it back, then re-implement it, as governments change, and this may sound inefficient, in practice this means the public services carry on running reasonably well despite the wins and crazinesses of certain politicians that come and go.

>> I want you to think back to your last trip to the DMV.

I made an appointment and it was quick and easy, but I do agree some government services are painful and slow.

>> because some medicaid paperwork didn’t go through regarding his diagnosis

Medicaid budgets are almost always in flux, which creates service disruptions.

From 2020:

https://www.salon.com/2020/05/16/as-millions-lose-insurance-...