Privatized health care as a person's sole option for care is an absolute dystopian nightmare. Any system that requires balancing human suffering against profitability is inevitably going to optimize for profitability.
The fact that this is even a thing is mind boggling.
All claims being reviewed by big health insurance conglomerates is the antithesis of privatized healthcare. It incorporates the worst part of public healthcare and destroys the best potential benefit of privatized healthcare.
I would say that there can't be any market without the government creating it (what does a contract or deed mean if there's no authority that recognizes it?), so there's a bit of "no true Scotsman" in trying to call it anything else besides a private market.
This is not properly referred to as health insurance. It is a sickness, aging, and death payment plan. There's no such thing as major medical anymore.
It was private healthcare that backed public law forcing minimum coverage. Why? Because their pool was shrinking. They were getting sick people who needed care, but with premiums skyrocketing, what benefit is there for healthy people to buy in?
But I agree that the private for profit health care system is an abomination only made much worse by making it public law requiring we buy into it. Instead of Medicare for all.
What part of public healthcare is incorporated into health insurance conglomerates? And what potential benefits of privatized healthcare are we missing out on?
The person I was responding to was suggesting it was a connection to public programs that made private health programs so stingy in denying claims, and I don't see how your answer gets me any closer to understanding what that means.
I'm also not sure what you mean when there's plenty of other examples. Examples of what? I'm still trying to figure out what the "what" is. Private health insurance companies in America ruthlessly deny claims, this is supposedly because of something about public administration of healthcare, and I'm still waiting for an explanation of how that works.
IMHO in privatized healthcare you are not the patient, you are the customer. As such, you should be having a better "customer journey" than in public healthcare: more immediate test/diagnostics, better experience in the hospital (like a room for yourself). And that's it. As a counterpart, it's not clear you are receiving the best medical attention. And of course you (through your employer) are paying for something that can be denied.
Note: I happen to have private healthcare with Cigna in a country with a reasonably good public health system (Spain, though it varies between different autonomous communities), happy to pay the taxes and will defend that public health systems are a staple of any modern country.
"Being the customer" doesn't matter one bit to most modern megacorps, because people are fungible to them. We constantly hear about big money screwing over little money.
Small-time capitalism is quite good. Make a few millions, sure. I have no problem with that. But when the amounts concerned are in the billions? There needs to be massive oversight and regulation, regardless of the relevant field.
To be clear, we are talking about benefit to the patient; there's lots of reasons concierge doctors may not be the best benefit for society at large. But that's immaterial because this is just one example; if we hadn't gone for the worst possible way to scale private medicine, then there could be better examples.
But the point is that you can't seriously look at concierge doctors and say that public healthcare would be better for those patients! And therefore this refutes any claim that public healthcare is the best system overall.
This is a great example. Alas, I'm pretty sure I disagree.
I am an early adopter of concierge care. It's been tremendous.
I had a bone marrow transplant +30 years ago. Continuity of care has been an ongoing challenge.
From my reading and my own experience, having a patient advocate greatly improves outcomes. Someone who just keeps everything on track. Could be family member, friend, or a nurse / case worker. For me, it's now my concierge doctor. (Over the years, I've served as advocate for other patients many times.)
My current issue with concierge (patient advocates) is that it's rare. Everyone should have this. In times past, it was a family's doctor. But as everyone knows, that relationship is no longer stable, due to how healthcare in the USA has been commodified and "optimized".
Further, according to the research (like what Atul Gawanda has written about), specialty "wrap-around" practices greatly improve outcomes. Like for diabetes, cystic fibrosis, and other chronic life threatening conditions. Most all of a patient's care is done by these multidisciplinary primary clinics. One stop shopping. Instead of bouncing patients around, delegating the coordination and whatnot onto the patients themselves.
Again, thank you for this example. It's an interesting edge case. Today, I think most concierge arrangements are private. Whereas it should be the default, public or private.
FWIW, maybe about 10 years ago, Medicare and the VA had started to adopt the capitation model (preventative care vs fee-for-service). Now I'm curious what they (or any other large orgs) are doing wrt concierge (patient advocates).
> A key component of the free market is the ability to say "no thanks" to an offer to do business.
So a free market in health care is not possible because you can't consider your options and say "no thanks" when you need emergency treatment. Whatever the government does or does not do, you can't really get around the fact that at a moment of crisis health care providers have you in a coercive situation and could charge life changing amounts for care if they were permitted to.
My dad used to tell me there are 2 types of jobs, jobs where you use your hands or intellect to make something more valuable from less expensive constituent parts, and jobs where you skim off the top of people doing #1
> Privatized health care as a person's sole option for care is an absolute dystopian nightmare.
Dont exaggerate. I've lived in 3 European countries and Australia. My American healthcare is easily better than those. Sure I'm lucky to have a good job that pays for it, but you can't say its terrible without looking at how those public systems are really struggling right now.
The article suggests that your health care isn't as good as you think it is. You never know if you'll be one of those cases where they make you fight for every bit of care you get.
Some Americans do get excellent care with a minimum of grief. Others think their insurance is fine while they're healthy and only discover later that it doesn't really cover what they imagine it does. And the difference is entirely arbitrary.
The fundamental problem of health insurance is that you cannot know what you will need, and there is no way to make an informed consumer choice, but your need when you have it is absolute. It's pathologically pessimal as a free market. And you usually don't know until it's too late.
You cannot know what you will need, but to leap from that and say that you cannot make an informed consumer choice is a huge and incorrect leap.
Actuaries know, in aggregate, what specific demographics will need. Insurance companies use those statistics to make profit. The view that consumers cannot make informed choices on healthcare needs is incompatible with the fact that risks are not perfectly and uniformly random. Unless, by “informed choice”, you mean one that is correct in hindsight, in which case, I agree.
> How can you smugly dismiss their point like that?
Because "it's fine if you're rich" is a shitty place to terminate the matter. It's not a useful counterargument in any sense. Of course it's fine if you're rich, that's why people want to be rich. What about, you know, the rest of the planet?
Having lived the opposite, I have to strongly disagree. I lived the nightmare of US healthcare, where my provider decided to stop working in my state, which meant that I no longer had access to any doctors under health insurance despite it being paid for by my company.
The UK was amazing - no questions asked care for my health was a massive improvement over what I had in the US. Free access to a doctor at any time is more life changing that you can think - every health issue I had I could talk to a medical professional and get guidance. Even free mental health care.
Moved to Ireland last year, with a mixed public/private system, and my health is now slipping a bit. Going to a GP, trying to file for reimbursements, and knowing that every time I have a health concern, it will cost me money, is a powerful suppressing force. I miss the NHS.
Do you think your health care experience represents the median healthcare experience in all 5 countries?
If we divide up people into percentiles based on wealth, 25, 50, 75, 95, how do you think people fare in the different countries? How do you think they the median experience is in America?
Totally if you're poor in the USA the healthcare medicaid is OK not great. If you have a little bit of money so dont get medicare its an expensive disgrace.
> Sure I'm lucky to have a good job that pays for it,
That is not where you are lucky.
You are lucky to be healthy enough that you can hold on to that job. Once your health takes a bad turn, and you are unable to work, when you really need your healthcare, that's when you are better positioned to judge the quality of healthcare.
My personal healthcare in Sweden has been higher quality (considering both personal cost and state cost) than my healthcare in US. I have heard complaints the other way of course.
Regardless of our personal experiences, the US spends so an enormous amount on healthcare and gets very little in return by basically all international measurements. Americans who think American healthcare seem to me too insecure to accept that their system is just plain bad. But yes Americans with a lot of money have access to better healthcare than average Americans. That said, this is essentially true in all countries so it's not that relevant really.
Technically, you just need money to pay for it. However, buying the employer’s choice lets you pay for premiums with pre tax funds, and the employer usually subsidizes 70% of the premiums.
So for an individual, it is roughly a $10k per year benefit to get it via employer and for a family of 4, $40k per year benefit.
That's not true. As I discovered when my COBRA ran out recently, finding individual plans that match the coverage of employer plans is very hard or impossible, regardless of how much you're willing to pay.
You’re telling me a mega-corp buying coverage for 10000+ employees might have an advantage in negotiating price that a single “rugged individual” doesn’t?! But that sort of thinking could burst the whole “pull yourself up by your bootstraps” thinking that fuels the American dream! Clearly all individuals (both single citizens and corporate entities)are the same other the law!
I’ve always been able to find the same or similar BCBS plan my employers offer on healthcare.gov. If it has the same metal level (platinum/gold/silver/bronze), it should be the same actuarial value.
In terms of general benefits, maybe. In terms of provider coverage - I couldn't find an individual plan at coveredca.com that was accepted by doctors at Stanford Hospital.
The important question is: have you ever made a large claim for a serious long-term illness? If not, you aren't yet in a position to judge the two systems.
Yeah this is a very common sentiment. I feel like most people in the US haven’t actually talked to someone that has experience with socialized healthcare at scale. I had a German professor that was very clear about just how much better healthcare is in the US.
I am from Germany and agree that US healthcare is very shiny. But once you get sick it’s very easy to get stuck in an extremely expensive bureaucratic nightmare between hospitals and insurances. I prefer the German system where I can go to a doctor or ride an ambulance without the fear of having to pay tons of money.
The German healthcare system was surprising to me. It was affordable, it was fairly honest, and our anecdotal experience was not as good as most experienced we’ve had in the USA.
A few examples for those wondering:
* the total cost for over a week stay was a couple hundred dollars - very affordable!
* certain painkillers banned in the USA were the first line of defense there
* getting very strong pain killers was next to impossible - I think we probably only got it because we were family members of the anesthesiologist, and he knew we needed it. And it took nearly 24 hours of agonized pain before we could finally get them
* nurses are not trained to put in IVs - we needed an MD for that. And the MD had a lot of things to do and we had to wait quite awhile even though there were many nurses around. In the USA, I think most people with the title of nurse can do that
In the US people with the title of nurse can be someone who is highly skilled and is playing an important hands-on role in major and complicated surgeries.
I think some other places around the world use the title nurse for what may be a medical assistant in the US. (No clue about Germany though)
Healthcare in the US can be higher quality, but you never know what you’re going to pay for it.
When I was starting my career, I had to go to an ER that was out of network, I checked with my insurance and they said they would cover it. They decided after all not to honor their word and charged me 10’s of thousands of dollars.
Being young and independent, this was devastating, despite having a good job, good insurance, etc.
I largely credit this with my push to move to Europe, and have never looked back.
Sometimes knowing you can get any healthcare you need without it potentially a bankrupting you is it’s own reward.
"I checked with my insurance and they said they would cover it. They decided after all not to honor their word and charged me 10’s of thousands of dollars."
That's the insanity here. You simply can't protect yourself reliably from overcharging. Hospitals and insurances do whatever they want and good luck to you fixing mistakes. I find it really hard to understand how people can be defending such a system.
As someone who has lived in the US, UK, and NL. I'll happily take the UK (pre-running it at such a budget that it fell apart) or NL systems over the US anyday.
There is no fun surprises like finding out that while your surgeon and hopsital were in-network your anaesthetist was out of network.
Eh. I did in Poland, but, admittedly, it is a poster child of how to do it so badly that people opt for now existing separate private care. It is, however, definitely a negative example of socialized health care.
MRI accessibility is regulated at the state level, which determines the number of MRI machines available to the public. I was able to obtain an MRI while on vacation in Europe without any appointment or referral from a physician. The process was straightforward; I explained my needs to the receptionist, and a technician conducted the MRI. The cost was 180 euros.
My family has received multiple radiology procedures including x-ray, MRI, and ultrasound from private radiology businesses (I.e. not the hospital). They are typically 10x give or take less expensive. Last MRI was $600.
Doesn't help if you are stuck in the hospital. But, it's an option otherwise.
I know it's still not cheap, but I needed an MRI a few years ago and it was $350. Talk to your doctor and let them know you want to pay cash. Mine suggested a place.
Don't get one in the hospital if you can help it. They charge 1-2k because they have a full set of people who can't go anywhere else.
That MRI would probably bill out at >US$ 1000 in most urban areas in the US. I've been billed $300 for a simple shoulder X-ray.
The real kicker is that you generally can't even find out this price until you have the procedure and receive the bill. It's become almost akin to a legal mafia cartel. In my area, a majority of the urologists have become part of a medical group that now dictates pricing for related procedures. Most of the major insurance carriers don't want to pay this pricing so this group is not a covered provider, so finding a urologist that is covered entails sometimes waits of months for an appointment.
It's the worst parts of socialized and for-profit health care assembled into one system.
> The real kicker is that you generally can't even find out this price until you have the procedure and receive the bill. It's become almost akin to a legal mafia cartel. In my area, a majority of the urologists have become part of a medical group that now dictates pricing for related procedures. Most of the major insurance carriers don't want to pay this pricing so this group is not a covered provider, so finding a urologist that is covered entails sometimes waits of months for an appointment.
I find the American healthcare system pretty atrocious, but I've never had issues getting upfront costs when scheduling non-emergency procedures using cash. Then again it's probably been a good 8+ years since I've done that in the US.
The trip to the EU, a vacation, and the MRI itself would be cheaper...
I was actually planning on getting it done on my next trip to China, which is about the same cost wise, and the doctors are good as they see so many people lol
I get a screening in India when I visit some family there. Full blood work, you call in the morning, they come by the house and draw it, results in the next morning. It's faster and cheaper to do that, including the flights, than to try and get this done through my doctor in the US.
Not sure what you mean here. Services like Personalabs or just scheduling straight through Quest Diagnostics cost a couple hundred bucks for blood & urine tests on most things, there's probably a facility near you, and you get your results in a few days. I do it every few years with zero issues.
Though sometimes the price the consumer pays isn't reflective of the true cost.
Sometimes the public health system does buy/subsidize the machine for the provider and a private client isn't charged some chunk of the amortized cost of the machine because the public system (rightly) assumes that 99% of the work is going to be for their residents. The clinic can profitably just charge for their professional/office use.
Here's a Bucharest Romania MRI clinic with tariffs:
I may be completely wrong, but I understand in the US normally people have health care through their employer? so they are not themselves paying the insurer, and cannot change insurer.
If this is the case, then it is no wonder the insurer has no particular care for them. It is the power of the consumer to change provider which gives them influence over the provider.
This is the case, and is, IMO, the central problem with American healthcare. Folks in both political parties argue for or against socialized healthcare, and ignore that a huge amount of the problems could be solved by having an actual free market.
My opinion is that providing healthcare as a benefit should be banned. Employees who have healthcare today should be provided the amount the employer would have spent on health care in wages/salary. The fine details are hard to work out, but I think it is a good starting point.
I agree, an important component though is that insurance premiums are pretax, so you’d need to expand HSAs to be large enough to pay insurance premiums.
> so you’d need to expand HSAs to be large enough to pay insurance premiums
I don't think that's the problem so much as 1) IIRC you simply can't use them for premiums in the first place and 2) you need a high deductible plan to be eligible for an HSA in the first place
Public health care can be similarly dystopian in other ways: Very long wait times due to limited resources, subpar medical care, limited prescription options and drugs, beauracracy.
No matter what society you live, the advice is the same: try not to get sick.
This might be true, but as someone who has lived in the U.S. and Europe I can say utterly unequivocally that I preferred Health Care in Europe. I wasn't even in one of the European countries with a great reputation for Health Care.
Health Care in the U.S. isn't just bad, its outright fucking brutal. An elderly friend of mine recently fell and went to an urgent care where they couldn't get him into the x-ray machine. They told him to go to an emergency room where he waited for _13_ fucking hours with a broken pelvis. I'm basically 100% sure that such emergency room bullshit literally kills people from stress or exposing them to other sick people. You can't even wait in your damn car and just have them text you - they just force you to sit in this horrible room with a ton of sick people for hours on end.
The U.S. Health Care system absolutely fucking blows.
I’m fully insured and have always been well taken care of in the United States health care system. Never wait more than 30 minutes if I were in an emergency room, and usually I’m attended to within 10-15. Doctors appointments are easy to get, never paid much for prescriptions.
If I was in a public system, I’d fear I’d be fighting for attention alongside the general public, so I’m not convinced it would be better.
Don't you think it's a worthy goal to strive for this for all people in your country? Would you really try to block progress towards that goal due to your fear of being treated as they are right now, instead of putting your energy towards nobody being treated that way?
Sincerely, if anyone can explain to me - how can we as a species both have figured out game theory, AND consider this as a position that is in any way acceptable?
The current situation is that the parent poster has preferential healthcare access, and other people that they do not care about do not. The alternative is equal treatment which might mean the same access, or worse access as they are forced to "fight for attention alongside the general public" as they so blithely put it.
Given the option between the status quo, or a change which can only ever be the same or worse for you personally (regardless of the broader impact), of course someone self-centered would choose the former.
The best insurance I've seen in the US is Medicaid.
It's people in the middle who are getting squeezed by HDHPs, mostly not the poor, who have access to Medicaid (exact qualifications vary by state) or Medicare (everyone 65+).
I'm fully insured and healthy but still just paid almost $3000 in deductubles for a single upper endoscopy (common procedure for 40+ folks). Cigna. In Italy last summer I received a dental xray and diagnosis as a walk-in, for FREE.
Just adding that in Lombardy, the region around Milan who have a bad case of parochial wanna-be NYC, local (right wing) government is pushing towards private health care with lavish subsidies for privates and a grossly underfunded public health system. To get an MRI via public you can wait 1k days, invia private is a next-day appointment although you must be ready to pay thousands EUR. frankly it’s obviously deliberate
That's disappointing to hear. My experience was in Brescia. I'm from NYC so I can say that if they're charging thousands of euro for a scan they're right on the money.
Where is the wait only 30 minutes? Every time I've been to the emergency room the wait has been 6+ hours. I think the only way it would be that fast at the hospitals I've been to is if you'd die waiting longer, otherwise it's a long wait.
Everywhere and nowhere it can be 30 minutes. Every competent ER on the planet triages patients. Come in with crushing chest pains and it should be 30 minutes everywhere 99% of the time. Broken arm? You might wait hours if people keep coming in with crushing chest pains.
"Wait" can be defined very differently. Wait time to get triaged by a nurse? An ECG for chest pains? Initial physician assessment? Entry-to-exit? Lab results? Time to X-Ray if needed?
Lots of directives may be in place too. In an efficient system, the nurse is empowered to "order" many procedures that screen out serious things that require immediate physician intervention. Or just to save time like ordering an X-Ray first instead of waiting to see a doctor to order it and then waiting again for it to come back to review.
I've waited less than an hour in New Jersey and Connecticut.
When I still lived in NYC, I resolved that if I needed a hospital but I wasn't in extremely bad shape, I would drive an hour into an adjacent state's ER rather than wait in NYC.
Post COVID hospital in Ohio, limped in with severe ankle sprain, got doctor in less than 15 minutes and out within an hour with splint and crutches. Even got X-Ray.
What city? Most of us in this thread live in larger cities. When I lived in LA and had to go to the ER, the wait was 5 hours and they literally rolled a cart over and made me prepay my insurance deductible (several hundred dollars) before a doctor even saw me. Helped a friend get to the ER in Phoenix and it was about 3 hours.
Only ~8% of people are uninsured so I wouldn't be so quick to distance yourself from being "the general public". Besides, you don't need insurance to be stabilized in an ER that only comes into play after (or if you enter with a non-emergency). 30 minutes is pretty good though, especially if it's the latter type of visit, it'd be about 3x better than the best state average https://www.beckershospitalreview.com/rankings-and-ratings/e.... Specific location and severity have more to do with ER wait times than your insurance. Travel can often be a "spin the wheel" type situation. I'm lucky to have short wait times near where I live but on some work trips I haven't been so lucky.
I am fully insured in the United States. An appointment with my primary for something urgent is typically a week out, if I can't wait a week I am advised to go to an emergency room. An appointment with a specialist, if I can get one, is typically six months out. An average emergency room visit is typically a three hour wait to be triaged, additional multiple hours to talk to someone about my condition.
I live in Massachusetts. I would take a public system over what we have now, no questions asked.
How old are you and what are your insurance premiums and deductibles? Generally the US healthcare system works better the more money you have and the less risk you have.
> I’d fear I’d be fighting for attention alongside the general public
Are you not a part of the "general public"? If it is true that there is a class of people who don't have your advantages and therefore have worse medical care, is that a situation that you see as acceptable?
It always seems strange to me when people argue this about this issue from a hypothetical perspective, when we have a wealth of actual data that we can use to compare health outcomes. We can just look at the results and see what works better!
(TLDR: the US spends much more per capita on healthcare, especially in administrative costs, and has worse health outcomes than most wealthy countries).
> If it is true that there is a class of people who don't have your advantages and therefore have worse medical care, is that a situation that you see as acceptable?
The answer is obviously yes, given that they don't want the "general public" to have the same level of access and make them potentially have to endure any longer waits. Their convenience is more important than the health of others.
People love feeling like they're better than someone else, that's an ideal that's been floating around the US for quite some time. Ingroup outgroup stuff, great way for capital owners to keep the workers fighting amongst themselves and keep the attention where they want it
To me this is similar to being "stuck in traffic" as if it is something that you are experiencing. No, you ARE the traffic. The congestion didn't come to ruin your day. You contributed to it too.
I find it hard to believe you have never waited more than 30 minutes in an emergency room. I can't ever remember waiting less and I've always had pretty good insurance.
ERs, even in US, will triage patients by need, not quality/quantity of insurance. If they're seeing insured ankle sprains before uninsured strokes/heart attacks, they're going to get sued to dust.
As someone who has dealt with many folks suffering from AIDS, I can say that it may even rise to the level of crimes against humanity.
It's a well-known trope (probably proven, but I don't know the studies) that insurance companies routinely delay healthcare to AIDS and other patients with terminal diseases, in the direct hope that the patient dies.
With AIDS patients, there's a big moral component to the diagnoses, and companies can "get away with it," because there's such stigma to the disease, but I have also heard of the same thing happening to cancer patients. In fact, it can sometimes be a matter of life and death. If a treatment is delayed enough, it can change the outcome.
I have been told (but don't know it for a fact) that this is actually the point of the delays, and that the delays are triggered by the diagnosis.
In many cases, delaying payment, also delays treatment. Most patients don't have an extra 500K, floating around, that they can pay the hospital for a procedure, in the hope they get reimbursed. No promise of payment, no treatment.
So that means that refusal to pay is the same as withholding treatment, and these companies know it.
I think that AI is likely to make this worse, as they will probably give these decisions to an AI, thus removing any hope that there may be a caring human in the process that could possibly feel shame.
I moved from a third world country with both socialized and private healthcare, to the United States. I pay vastly more for worse healthcare than anywhere I've lived.
The fact that you, your doctor can agree that a certain procedure is required, only to be denied by a third party with no medical qualification is absolutely dystopian.
I also came to the US from a country with a good hybrid public/private system and my experience in the US had been different.
So I guess it depends on where (city/state) you live and also what type of insurance you have.
Where I live I have access to a SOTA network of hospitals with great technology and some practices amount the best in the world (people come here from other states and even countries for treatment) and I use their own insurance, so it's been great so far, never dealt with any issues having medical care rejected.
I pay $350/month (self employed) and I have a very reasonable deductible, $60 copay to see specialists and many preventive procedures such as cancer and heart disease screenings (which I use), blood work and some PT sessions completely free.
I even get discounts on fitness centers and health tracking apps which helps offset part of the premium.
My shoulder was actually spared from a very invasive surgery thanks to a doctor top of his field (he sees olympic teams) who was able to treat me with only PT.
I don't think I paid more than $1000 out of pocket for everything including several MRIs and multiple visits to his practice, plus several sessions of PT and medications.
It could have been free back in my country, I guess, but I could have also been screwed for life due to an unnecessary surgery.
The article is not about death panels run by doctors, they are run by insurance companies. The doctors in this scenario are workers given bounded instructions on how to operate by the ones running it, without autonomy on how to organize the death panel decisionmaking. It's in the title - the "having" shows who is in control. These are not worker owned cooperatives. Nor are most state owned death panels.
Is American healthcare a patriotic issue or something, that's why criticizing it warrants a "don't come here"? Where the hell does your comment come from?
Americans who are unable to listen to critiques of their system are frankly an embarrassment for the country. Their insecurity is kind of pathetic. They hold us back in development as a nation.
Not everyone came to this nation due to capitalism. My parents partially came here to be free to say whatever they wanted and not disappear, for instance.
It doesn’t mean healthcare is done right; just as using TP to wipe one’s ass is 100 years backward.
I sometimes wish they stayed back, because my own life and theirs would’ve probably been much better in the long run.
You’re always free to go back. Unlike many collectivist countries, we won’t stop you from leaving, or try to force you to do things in general. So it’s not unsurprising that your attempts at forcing others to pay for your things is met with hostility when you and others that share your views don’t even want to face those policies themselves.
> You’re always free to go back. Unlike many collectivist countries, we won’t stop you from leaving, or try to force you to do things in general.
No, I won’t be forced. I’ll just get shouted down by anonymous accounts just like the cancel culture of the left.
You think complacency is patriotism. I actually would prefer to improve my country.
> So it’s not unsurprising that your attempts at forcing others to pay for your things is met with hostility when you and others that share your views don’t even want to face those policies themselves.
“My attempts”? Your response is indeed hostile, but you have it backwards.
My family and I have been directly paying for and subsidizing for your own care and other Federal entitlements for decades.
Your response is also irrational to the core. We collectively pay for law enforcement, the military, highways, etc.
Why is it suddenly taboo to consider whether we’d actually save money if we had a baseline?
Why is the worst of socialized medicine and the worst of market-based medicine an acceptable status quo?
Law enforcement and military exist to prevent you from using force on others, and others from using force against you. You're absolutely correct, I'm in favour of forcing you to not use force on others. The only positive right I believe in is the enforcement of negative rights.
Alternatively, I simply state that we both agree on law enforcement and military but not healthcare, so at a baseline you want to force others to pay for more things than I do.
I don't support the US healthcare system, but I won't support socialized healthcare because of that. The government can follow the rules it enforces onto private companies by operating its own healthcare service without forcing those that did not choose to use it to pay. Problem?
> Law enforcement and military exist to prevent you from using force on others, and others from using force against you. You're absolutely correct, I'm in favour of forcing you to not use force on others. The only positive right I believe in is the enforcement of negative rights
I specifically also mentioned highways. How does that fit into this narrative?
> Alternatively, I simply state that we both agree on law enforcement and military but not healthcare, so at a baseline you want to force others to pay for more things than I do.
I’m already paying for your care, so I’m paying for more than my fair share.
Highways are no different from healthcare. I don't care if the government does them. You use it you pay for it.
You have no idea how much I make, which your claim entirely depends on. You also don't seem to be reading very carefully, I'm stating what I believe should happen. I would like people to be forced to pay for less things. You would like people to be forced to pay for more things. Simple as that.
> Highways are no different from healthcare. I don't care if the government does them. You use it you pay for it.
So you’d pay for law enforcement and a military, but without roads and highways they would be ineffective.
What is your proposal? Do police and soldiers have to pay money for its use?
> You have no idea how much I make, which your claim entirely depends on
And you have no idea whether I’m overpaying for healthcare to subsidize your care.
Those services you’re enjoying now and the professionals you’re relying on? Those are costs far beyond just the single treatment and whatever private insurance you’re paying for.
The government already operates roads. Nothing would change. The people that use it (ie. most people including myself) pay for it. I like the idea that part of the police and military budget be put towards the highways they use.
You made the claim, the burden of evidence is on you. All I said is that you wish people be forced to pay for things they don’t use and I do not, which you conveniently ignored after asking me to address every bit of your comment.
People like you always pull this “indirectly use” argument to justify making people pay for things they do not use. I don’t pay for the gym membership of the delivery guy, this is no different.
> Highways are no different from healthcare. I don't care if the government does them. You use it you pay for it.
…
> The government already operates roads. Nothing would change.
Okay. So we established that you don’t mind if the government runs the roads as long as they pay for it (tolls, gas tax).
I’ll go out on a limb and say that until the Federal stepped in, our road system was haphazard and ineffective. Having standards and an interstate system was crucial, and only possible with government.
Now given that law enforcement and military can incur injuries, can we have an effective law enforcement without the medical support to get them back up when injured or sick?
Now for this portion:
> So it’s not unsurprising that your attempts at forcing others to pay for your things is met with hostility when you and others that share your views don’t even want to face those policies themselves.
Why would you assume the worst ? This goes against Hacker News’ core principles.
> People like you always pull this “indirectly use” argument to justify making people pay for things they do not use. I don’t pay for the gym membership of the delivery guy, this is no different.
I help pay for all of infrastructure, the building safety codes that ensure the gym doesn’t collapse or electrocute me, that the machines aren’t death traps, etc.
It’s great that I don’t have to pay for a membership or other services if I don’t want it, but the foundation that makes these services even possible or reliable costs money.
Having these services on standby also costs money, even if you don’t use it. So yes, I’m already paying more than I’ve ever received in healthcare.
Back to healthcare. What I find frustrating is that your kneejerk reaction is neither unique nor uncommon, yet it
never comes with a workable alternative and solution.
> Very long wait times due to limited resources, subpar medical care, limited prescription options and drugs, beauracracy.
those are all there because the people that created the system did not think paying for it was good enough. it doesn't have to be that way. and even with wait times being long you still eventually get it. in the privatized system if you are poor and have bad health care you don't get it at all.
Ah, yes, have a privatized public sector, use the gained funds to lobby in other countries, pushing a ideology that destroys public sector/services, use the result of ones own actions to push the conversion to more privatized public sector. The ultimate glider gun ideology.
That just shows that the us has good medical treatment for people with essentially infinite money who don't have to worry about cost or insurance coverage so they can bypass the kind of issue the article is talking about entirely.
For normal Americans who actually have to worry about these things, healthcare in the us is a nightmare.
You can't just ignore insurance and judge the us healthcare system based on the best hospitals and doctors when most Americans aren't going to have access to that.
> That just shows that the us has good medical treatment for people with essentially infinite money who don't have to worry about cost or insurance coverage so they can bypass the kind of issue the article is talking about entirely.
No, that shows that even in places with public healthcare, there are issues.
Universal public health care is not the utopia that its proponents religiously advocate for.
> You can't just ignore insurance and judge the us healthcare system based on the best hospitals and doctors when most Americans aren't going to have access to that.
Most Americans have insurance. You can't ignore real data. Are you from the US?
> Most Americans have insurance. You can't ignore real data. Are you from the US?
If you're judging the quality of healthcare based on whether people from the US have insurance or do not have insurance it shows that you're fundamentally failing to understand the type of problem the article is discussing, which in this case is specifically that insurance is broken and insurance companies will refuse to pay for treatment even when people have insurance. The people having Cigna refuse to pay for medical treatments as in the article obviously have insurance or they wouldn't be dealing with Cigna in the first place, so I'm not sure how "real data" on the percentage of americans who are insured could possibly refute that.
> Compared to the rest of the world? It is not.
Yes, US healthcare providers are capable of providing very good care. However, it doesn't matter if the US healthcare providers theoretically provide the best treatment in the world if that treatment is now so expensive and the insurance system is now so broken that a huge percentage of the people can't afford medical treatment even with health insurance (e.g. most americans on bronze/silver health insurance plans).
I think this is something that gets missed in a lot of statistics.
The reality is that once you factor in the insurance system, and not just healthcare providers, the US healthcare system does not look so great anymore for average americans.
The fact that this is even a thing is mind boggling.