As a kid I didn't know much about "government", but I thought surely it must be Police, Firefighters and Medical Professionals.

If you have a siren on your truck, you are government was my thinking. These are all "public goods" and even as a kid with minimal "civics" education (and what I had was pretty much 100% Pro Usa America Is A Christian Nation for those formative years that I'm talking about).

I understood that as a basic. Nobody told me that "no, actually. Despite having sirens, ambulances are not (usually) driven by workers for the government." It wasn't til I lived on my own that I really understood that.

As a consequence of the two intersecting facts that this is in fact a for-profit company and the United States is organised such that this, as with many things, is regulated by the fifty States rather than federally, there's not even a training requirement.

That is, the people driving a police car, fire truck or ambulance might have no training in how to do so properly, despite the (not unreasonable) expectation from the public that they'll perform better and the legal difference in how they are treated when doing so. Some employers might do better, but there's no universal standard.

The results are predictable, excess death and injuries as a result of giving inadequately trained individuals a relatively heavier, more powerful vehicle.

Even if you consider ambulance emergency service should be public service, that "sirens" argument doesn't apply to non-emergency care where you have time to make a selection among private competitors.

If it is non-emergency, why do they need sirens?

To lure sailors to their deaths

Meh, we got Congress to do that already.

Paramedic here. Patients who are stable, we generally transport to the hospital "routine" (no lights/sirens). Similar for inter-facility transport (taking someone from a nursing facility to chemo or imaging).

The only reasons we generally transport "priority" (lights/sirens) is for unstable patients or time critical: acute cardiac or respiratory issues, stroke, hemorrhagic or multi-system trauma, or shock.

But even patients presenting stable can deteriote en route.

As an aside, generally, in most areas, what makes the biggest difference to getting a patient to definitive care in a timely manner is not lights/sirens, nor speed, it's "Opticom" (also known as traffic light pre-empting). Visual (strobe), or occasionally radio that communicates with traffic lights to give us a steady flow of green lights. That coupled with people moving over is the big difference. Speed is just an increased liability (fun fact, most state laws grant emergency vehicle drivers the ability to 'disregard' any road law while operating in any emergency mode, but that comes with a "presumptively at-fault" for any incident that occurs in that mode, i.e. you will be considered at fault unless there's evidence to the contrary).

God forbid we don’t monetize the existence and care of life itself.

We should not. It should be provided unconditionally to anyone needing it. Homo sapiens can do better than letting its pairs who can't pay die (slowly).

And care givers should be very well paid because they have hard jobs and critically important ones.

Making illness profitable creates bad incentives.

> It should be provided unconditionally to anyone needing it.

Correct me if I'm wrong but in many/most countries including the US, hospitals legally will treat emergency patients regardless of whether they can pay or are homeless-levels of broke.

It's not only emergencies. I've heard people in the US hesitate to get cured because they don't have the money.

Like universities?

At least with universities there is a semblance of a free market/competition/choice. I.e. you can compare universities etc. While with healthcare, nobody goes checking for yelp reviews of ambulance companies when they break their leg.

But the government broke the university pricing model by guaranteeing all student loans are practically non-dischargeable through bankruptcy and then double down on their stupidity with forgiving those student loans. The government when led by naive, busy body do-gooders almost always reach the lowest optimal point.

> While with healthcare, nobody goes checking for yelp reviews of ambulance companies when they break their leg.

In most progressive states, ambulance rates have to be set and approved by the Department of Health, at least. While not free market, as you suggest, this is also done for consumer protection (though I'll grant that many will argue that more could be done).

There should be more public university capacity to compete with private university tuition rates. Some things, like health care, may be so shot through with perverse incentives in both for-profit and nonprofit configurations it should just become a public good.

Any comment on the article though?

> well funded public service

There is. The US spends more per capita on socialized medicine than any of the countries that actually have socialized medicine.[0]

[0]https://data.oecd.org/healthres/health-spending.htm

A P.S. for the "but the wait times!" crowd, look at the first chart then check out hospital beds, again per capita[1]

[1]https://data.oecd.org/healtheqt/hospital-beds.htm

What does hospital beds have to do with wait times? Perhaps you have data on that?

Paramedic here. You don't -stay- in the ER. You're either treated and discharged, or stabilized and moved (to surgery, to ICU, admitted). The more beds available, the shorter the ER stay, the less wait time due to throughput.

We are middle of the pack or worse on doctors[0]. We are near the bottom when it comes to how many times we get to visit the doctors we do have[1]. I can't find a high score on anything besides "Potential years of life lost"[2], sad for us that isn't a good thing.

[0]https://data.oecd.org/healthres/doctors.htm

[1]https://data.oecd.org/healthcare/doctors-consultations.htm

[2]https://data.oecd.org/healthstat/potential-years-of-life-los...

Random things like cancer and genetic diseases happen, but an awful lot of disease is caused by personal choice. Drinking, smoking, unhealthy lifestyle, etc. Personal behaviors are the cause of a huge portion of our healthcare costs.

I feel the same way about the recent auto insurance increases being caused by the shopping behaviors of others. Expensive EVs get completely totaled in accidents, and now everyone has to share in these high costs brought on by the choices of others.

The healthcare system is already one of the biggest line items for the US federal budget, yet you can see the largesse and inefficiency. Perhaps we should think very carefully about putting more money into it.

But you’re already paying for other people’s illnesses through insurance with the downside of layers of middlemen taking a profit. At least here in the UK an emergency or cancer won’t bankrupt me, for the rest of it I can choose to get private health insurance if I like or wait for the NHS to work through the queue (which is sadly becoming increasingly common as our government is obsessed with copying what America does).

In the US it is not a necessity. There are private insurance plans with entry restrictions (e. g. you are ineligible if you smoke)

Sure but you’re still paying for people’s poor health. Insurance administration costs, charging insured patients more to cover uncovered patient costs, increased equipment costs due to increasing demand from an increasingly unhealthy population, high doctors salaries because of skills shortages, the list goes on. There is simply no way to isolate yourself from the cost of other people’s health choices.

A fully privatised system gives the illusion of choice and isolation.

Smoking is a preexisting condition just like guzzling ungodly amounts of sugar is, Obama

I promise you, the productivity gains we’ve already gained in your lifetime outweigh any possible impact people might have by eating unhealthily. You can always argue “yeah but we could be bigger and more dominant!!” but at what point does that hit diminishing returns, life-philosophy wise?

It’s really amusing when tech people who have a full understanding of singletons and basic statistics always refer to themselves when making a broader statement about society.

I always wonder why people seemingly can’t apply their experiences beyond themselves when they already do that day to day at work.

A lot of “personal decisions” are consequences of society. Depending on where you are in society, you’re going to sometimes be forced to live an “unhealthy” life.

Beyond that, most medical care are for older folks, so you’re likely not going to notice anything until you are older.

The thing that bothers me with this personal choice thing is, our society basically expects there to always be poverty. Heck the rate of poverty across America has a “healthy” value that we aim to actually keep. Of course that same percentage is going to be leading a more unhealthy life.

Eh, rant over.

> I always wonder why people seemingly can’t apply their experiences beyond themselves

I grew up lower middle class, and I didn't have it easy. I have no idea who my birth parents were. I had an abusive father. I was bullied and beaten relentlessly by the other children that didn't like on-the-spectrum kids. I didn't party like those that abused me, I withdrew into myself and turned that into hard work.

So when I see people [1] wanting me to pay for their choices, I feel used. When I see people demanding way more than I take for myself. It's as if the people that caused my problems are now trying to ride on my back.

Does that help lend perspective for how some people feel about calls to increase taxes to pay for this?

This doesn't mean that I'm unkind, uncaring, or unsympathetic. I just don't think US healthcare or how it is utilized is efficient, and I don't think armchair posturing or giving money to bureaucrats, administrators, or anyone without skin in the game will make it better.

edit: I removed the analogy and replaced it with a personal anecdote.

[1] The comments and downvotes here are probably from wealthy / well-off people on HN

Where's your proof the partying is causing it? Cleaning the house can be far more dangerous if you want to ask my un-sourced opinion.

EDIT The person I replied to edited their post. I'm replying to the argument:

>>> I always wonder why people seemingly can’t apply their experiences beyond themselves

>An analogy: I wonder why my lack of partying has to pay for the partying of others.

What are they demanding that you are not? Everyone wants to be healthy and they want a medical system which helps them get there. If partying is a problem, they should be able to talk to a doctor about it, and it should be paid for as a part of the services provided by society.

> If partying is a problem, they should be able to talk to a doctor about it, and it should be paid for as a part of the services provided by society.

I feel like I'm on an alien planet here. We should pay for people to get lifestyle advice?

This is malinvestment. Put that money into research instead.

Paying for people to get lifestyle advice is a great investment as it reduces both the cost of their healthcare and various externalities associated with living in a society where lots of people are unhealthy.

How much does that cost?

Edit: Why should we pay for this instead of food insecurity, education, research, etc.? Will measured outcomes give us bang for the buck?

Prevention generally costs less than treatment. It’s a great way to save money overall - unless you want to be the person at the restaurant who won’t split the bill because one of your party ordered extra fries.

Your expectations are unreasonable. The medical system is extremely expensive to operate. Highly paid physicians should be reserved for delivering the most complex care.

If consumers need guidance on making healthier lifestyle choices then doctors aren't even the best source. Utilize cheaper professionals for that stuff: therapists, counselors, social workers, dieticians, personal trainers, etc.

You are really extrapolating on what you think my expectations are. I never said everyone is entitled to a 3 hour conversation with a surgeon about the benefits of organic foods on their diets. Do you not discuss your lifestyle choices with your doctor at your yearly physical? That is as far as my expectations went for my previous comment and I believe that should be provided to every citizen of a modern society.

I don't get a yearly physical. While I do get a few periodic screenings there is no proven benefit to a yearly physical for asymptomatic adults.

https://www.ncbi.nlm.nih.gov/books/NBK82767/

When I do see a doctor I don't waste time discussing lifestyle choices with them. Doctors have minimal training in that area and it's largely a waste of time. I rely on physicians for medical issues only. There are far better sources for other topics. Instead of telling us what you believe, stick to evidence-based medicine.

Well that is quite the charmed perspective on life you have, a specialist for every question available when needed. Many don't have the access you do and a yearly chat with their primary care doctor goes a long way for their health.

You're really missing the point or being intentionally obtuse. The people who are better qualified to provide guidance on lifestyle issues are actually less expensive and more accessible than doctors.

A "yearly chat" with a primary care doctor does little or nothing for the health of asymptomatic adults. Did you even read the article I linked above?

And you are trying to make this thread into some win for yourself that it is not. My original point was that life is a common goal of all humans on this planet, for life to continue, you need health. The services to keep people healthy should be provided to all citizens of modern societies at a cost that is spread out across all citizens equitably. That is a point you have yet to address.

Please take the win you did achieve, you identified a dietitian is the right person to talk to about your diet, bravo.

Ah yes those people wanting real healthcare. What entitled idiots. Anyways let's finance another 200 mio yacht for the pharma ceos, they worked hard after all. You might be one of the one day since you work hard...

... I had it tough, therefore others should too? What if those others had it tougher than you? have you apologized to them for having it so much easier?

Or, hear me out, maybe the goal should be for tomorrow to be better than today, or yesterday, and that definitionally means a lot of stuff gets easier.

Complaining as you're doing here is the same as saying "this cancer treatment should be banned because I lost family members to cancer when it wasn't available, and it's unfair for cancer patients today to have it easier than we did"

Also as an addendum because you're pulling the I had it tough card: my parents had me as teenagers, then they were uni students with no money until I was 6 or 7, and I was deaf, had severe asthma, and so was relentlessly bullied due to a lisp I had because, you know, I was deaf until I was 5. We lived in a house that would be better described as a shed - corrugated steel walls and siding, etc we were not anywhere near "middle class". Guess what: I still think people should not have to go through that just because I did.

JFC.

My original post suggests that costs should be attributed to risks.

If you take an outsized portion of health care relative to the rest of society, there's a chance that may be linked to behavioral choice. If you smoke a pack every day, eat two McGriddles every morning, film parkour stunts for your YouTube channel, go to the STD clinic monthly, are an alcoholic, etc.

Society should not be paying for this in the same way it pays for cancer and freak accidents. It's malinvestment that could have been prevented.

Sounds like you want to apply value calculation to people - is this person's life worth the same or more than this other person's? Then they can get healthcare.

And we can see that because you're complaining about, for example, parkour stunts, but not the much more common sports that cause significant injuries.

I get that it's a common desire to say "this person does not deserve to live because I don't like their choices", but like so many other things it turns out that the cost of trying to do this is always more significant than just not assigning value to people's lives, and those policies have a tendency to capture people you don't think it should apply to. Take the various conservative anti-women laws that suddenly became a problem when they interfered with IVF for middle aged white women, despite that being a completely consistent application of the claimed rationale for the law (if an embryo is a live human, then IVF requires murder, but everyone knows an embryo is not a person, the goal of these laws, much like your desire to restrict access to healthcare, is about punishing people for perceived slights).

I might have thought you could also see how the costs associated with many illnesses might contribute to the proportionally higher tax rates on things like alcohol and tobacco in countries with public health services.

But there's more to it than that, you're arguing against a Public Health Service as though your claimed concern about unreasonable costs from bad life choices does not apply to private healthcare+insurance, but that's simply not true. Your insurance premiums are priced to cover the YouTube stunters, the alcoholics, the people playing sports, the people driving, etc just like a Public Health Service. The only difference is that your insurance companies and hospitals are making a profit as well so definitionally cost more as applied to the total economy (a statistic that has been repeatedly shown is that the US spends more on healthcare than countries with PHS, but has lower coverage and worse outcomes). Because the metric for success in a public health service is treatment, the system is optimized to treat the most people. For private health care the metric is income, which means hospitals charge more, and optimize their billing to maximize the amount that can extract from insurance companies (that's why your anesthesia for a surgery is inexplicably billed as a separate procedure), and insurance companies optimize to deny or delay coverage as much as possible.

> Sounds like you want to apply value calculation to people

To behavior. If you buy a sports car, you pay higher car insurance. If you buy a motorcycle, you should pay higher health insurance. If you live riskily or unhealthily, your coverage should cost more and not be averaged out over the less risky.

Risk calculus should be considered with everything. It's essential to extending a home loan, but not when granting a college loan. Decoupling risk leads to bad outcomes.

> but not the much more common sports that cause significant injuries.

I think sports players should pay more for injury insurance. And roofers, loggers, etc. Those costs will be absorbed by their respective industries where the costs are generated.

> this person does not deserve to live because I don't like their choices

I'm not saying that at all, and that's such a cartoon way of looking at this. You walk into a hospital in America and you get treatment. That doesn't mean you don't have to pay for it.

> I might have thought you could also see how the costs associated with many illnesses might contribute to the proportionally higher tax rates on things like alcohol and tobacco in countries with public health services.

I never said do not tax negative externalities. By all means, please do. We should tax drugs too.

> Your insurance premiums are priced to cover the YouTube stunters, the alcoholics, the people playing sports, the people driving, etc just like a Public Health Service.

I would like them to not. I would like to cover my risk profile.

Everyone should cover their own risk profile. That's fair and equitable.

> Because the metric for success in a public health service is treatment, the system is optimized to treat the most people.

It already does this. This is simply about who gets the bill.

If health insurance were priced according to individual risk then a huge swathe of the population wouldn’t be able to afford health insurance (as indeed is still the case to some extent, even after Obamacare). And that’s assuming that you leave Medicare and Medicaid in place - which logically you shouldn’t, according to your line of argument.

How it could be a malinvestment for a society to invest in the health of...its very own constituents, is a nut that I won’t attempt to crack.

Yeah, it’s really amazing I had a republican/now-maga coworker who vehemently opposed Obamacare and said it was unnecessary as people who were risky should shoulder increased insurance costs, and could not understand that my partner literally could not get insurance for any amount, every insurance company was literally saying “you donated a kidney [were healthy enough to donate a kidney] and because you only have one kidney we will not cover you, good luck!”.

It wasn’t even “we won’t cover kidney issues” (ignoring that finding a kidney donor saves insurance companies money) it was a blanket “we will not accept you as a customer”.

To this day the dude thinks Obamacare is bad, and that people should “take responsibility”. (I’m unsure how people born with congenital defects are meant to take responsibility but dudes a maga and thinks a bunch of his coworkers aren’t people so I assume the same applies to people with congenital issues)

> The comments and downvotes here are probably from wealthy / well-off people on HN

This is funny because statistically wealthy people are the ones usually against increases in taxes.

I was born in Iran, so I’ve dealt with my fair share of bullshit. My conclusion from my life is that we are individuals and we are a collective as well. A collective where if there’s a lot of illness in a part of it, it makes us all sick.

Second off we literally do not need more taxes to have proper healthcare in this country. We do not have a money problem, but a politics and policy problem. We have a problem that a lot of people think that by helping others, they’re the ones getting punished.

A healthy society means a society that has more energy and time to work on problems that benefit us all.

May I suggest this, instead of seeing healthcare coverage for more people as a punishment for you, see it as a collective investment to allow people to focus on things that matter.

And, note that healthcare isn’t the point of service by a doctor. It means healthy city design. Healthy subsidies for food (instead of subsidies HFCS for example). It means better public transit. It means actual neighbors and neighborhoods. It means longer weekends.

> Drinking, smoking, unhealthy lifestyle

Make those things expensive and subsidize the health system. And of course don't push people into these things in the first place. The smoking industry for instance should have never been allowed to be that powerful (and maybe smoking would not be such a good thing).

Also make the healthier alternatives cheaper (e.g. healthy food should be cheaper than junk food).

This way, you mostly solve the problem by making people with unhealthy choices fund the heath system they therefore need.

But in any case you can't really think individually: those people with unhealthy lifestyles have probably been collectively making your life better by being part of the society on which you depend for pretty much everything. Who knows, maybe someone you saved by subsidizing their cure will save you from a bus accident tomorrow. It's complex.

Why? To give terrible service and managed by bureaucrats? Or being a leech of the state medical system?

How are the current for-profit hospitals not the same in addition to being hilariously unaffordable?

Basically they have huge monopoly on the opposite side. So they go to niche (eg rich.)

Then let there be separate private hospitals for "the niche".

Regular hospitals should be public.

Very poor unsubstantiated viewpoint. The epitome of socialized healthcare would be healthcare in a communist state. And Cuba, in spite of completely inhumane and unreasonable sanctions imposed by the united states, still beats the US on metrics such as life expectancy. This proves the falsehood of the idea that state-run healthcare is inherently less efficient.

False. Cuba has shorter life expectancy than the USA.

But beyond basic stuff like immunizations, antibiotics, and trauma care, healthcare has a very small impact on life expectancy anyway. Once you have a serious chronic medical condition, even the most advanced healthcare system can generally only give you a few extra years.

What are you talking about, it's there clear as day, cuba beats the US on life expectancy: https://www.macrotrends.net/global-metrics/countries/CUB/cub....

What are you talking about, it's there clear as day, the US beats Cuba on life expectancy:

https://www.worldometers.info/demographics/life-expectancy/

> The current life expectancy for Cuba in 2024 is 79.33 years, a 0.19% increase from 2023.

> The current life expectancy for U.S. in 2024 is 79.25 years, a 0.18% increase from 2023.

Regardless of this whole discussion we're having, I'm confused as to how we're both able to come up with such different numbers from the same source. The above are direct quotes from the website we're both looking at.

And then there's this [1] study, which finds that socialized healthcare beats privatized on life expectancy by about 10 years on average. If you don't like life expectancy as a metric, consider [2]. It compares the US to various other developed countries, the primary difference being that the other countries have socialized healthcare. Private health care loses on all but one of a much wider range of metrics.

Your belief that private health care is in some sense better is pure ideology, and has no basis in reality.

https://www.macrotrends.net/global-metrics/countries/CUB/cub...

https://www.macrotrends.net/global-metrics/countries/USA/uni...

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9653205/

[2] https://www.researchgate.net/publication/358397629_Mirror_Mi...

I never claimed that private healthcare is better. Don't put words in my mouth.

As for impact of various healthcare funding models on life expectancy, you appear to be confusing correlation with causation. The larger point is that healthcare system quality beyond a certain minimum level has only a small impact on life expectancy. It matters far less than lifestyle issues (diet, exercise, substance abuse) and sanitation.

Do you have data to back up the claim that private healthcare out performs public? I don't mean "if I have millions of dollars I can get treated for whatever I want, whenever I want", I mean "if you are an average person, with an average income, and average insurance what is the time to a necessary procedure, and how much will it cost you".

You can always find articles with people complaining about service in countries with actual PHS, but in my experience the same thing applies to US hospitals, with the added fun that your insurance may simply not cover anything so there's no waitlist by virtue of no treatment options, and then even if it does cover it you can still have a huge copay.