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- Hacker News
- As I understand it - ~30% of US federal spending is on health care.
In the UK it's about 20%.
Yet apparently the UK is mostly nationalised under the NHS, while in the US there is huge additional spending on private insurance.
Can somebody from the US explain to me how that's the case and why American's still put up with it?
by DrScientist - We hate it and are more and more powerless to change it every day. The parties are entrenched and swing districts are becoming increasingly rare. Those competitive districts that remain are flooded with unlimited campaign funds from big business and plutocrats, thanks to Citizens United.by remyp
- US federal budget is 23% of GDP, while UK is 44% of GDP. You can't compare fractions of the fractions directly. (Total spend is something like 11% vs 18% GDP.)by loeg
- Since when has a government projection of costs ever been in any way realistic? The estimates for the costs of Medicare when it was established were low by a factor of 10.
- The mortality numbers in this paper appear to be extrapolated from an observational study of 9,000 cases from 1988-1994. That paper distinguished between "privately insured" and "not privately insured". This paper distinguishes "adequately insured", "underinsured", and "uninsured", and applies the original paper's hazard numbers to everybody but the "adequately insured", with a coefficient modifier for the "underinsured" that they came up with themselves.by tptacek
- Universal Health Coverage has a lot of other benefits:
1. It detaches health insurance from the employment market. This means those minimum wage walmart jobs just became more feasible, or any low end job really, since their is no pressure to provide "benefits" anymore. This would seriously lubricate the labor market, because the friction to providing, taking, and changing a job is reduced.
2. It ends a bias for group plans. If you are poor or are a trades worker and need to buy insurance outside of a group plan, you are going to be in an expensive high risk pool.
3. Its a benefit we can fund socially with taxes that will immediately have a positive impact on lower income workers, as well as poorer regions of the country (e.g. red states).
by seanmcdirmid - There have been studies like this for decades, going back to at least the Clinton administration.
And nothing will come of it. Too many entrenched interests, regulatory capture, and lobbying + political donations.
by ilamont - If spending drops by $1t, it will come out of someone's paycheck. Yes, some are greedy folks who will be just fine making 20% less a year. But many will be nurses or hospitals or some combination of providers.by xhkkffbf
- What about quality of care tradeoffs? In Canada, for example, you are forced to use the government system, and if it doesn't deem you important enough, there is no private option.by solaarphunk
- The private option is medical tourism to Buffalo or whatever.by intuitionist
- I don't know about Canada, but here in Spain you have both. You have public health guaranteed, but many people also have different levels of private coverages, usually to get quicker appointments.
As I understand Medicaid, it would just be open Medicaid for 100% of the US population regardless of the income, remove Medicare (they are now under Medicaid), leave the private sector as it is. Do you think Medicaid is too slow, too low quality, too terrible in general? Pay for private insurance, but you can still go to Medicare if needed.
by otherme123 - Does American private insurance pay for everything? And if you say "but they can pay out of pocket", well Canadians can come to America and pay out of pocket too.by triceratops
- Same here in the UK. If you need to see a specialist, you regularly have to wait months, assuming you can even get a referral in the first place.by skuzye
- There are private options for lots of things in Canada, depending on the province.
Without data on what proportion of people are denied and what the consequences are, this isn’t a good faith argument.
On the flip side, cases that would get care in Canada are denied in the USA by private insurance. Private options are far outside the means of most people.
by ses1984 - Is this quality improvements including or ignoring the 30-ish percent rejection rate of the most popular healthcare system, including such gems as insulin and pre-authorizations refusing surgery for necrotic tissue when “maybe they could PT it, have you tried?”by t-writescode
- Interesting. In every European country I know of, the private option is still available. Just vastly cheaper and more beneficial due to having to compete with a public option which covers basic necessities, surgery etc.by dbspin
- Most of the problems of the US system aren't really a matter of who pays, but the fact that so much is paid for services, at every level. Any really significant savings, cutting bureaucracy and pressuring providers to make costs resemble those of other developed countries, are taking money out of someone's pocket. Many hundreds of thousands of them, if not millions. This makes any significant reform very difficult, as those people vote, and will know exactly who made them worse off, even if the country in general was made much better off.
Read The Logic of Collective Action by Mancur Olsen. It wasn't written thinking of healthcare. but anyone looking at the US healthcare system will see that what is going on is stacks upon stacks of collective action beating overall societal efficiency, over and over and over again, in such a way that it's basically in none of the decision makers best interest to actually increase overall efficiency.
by th0raway - It’s also geographically distributed. Substantially all congressional districts count a healthcare system as a top-5 employer. Those 70k/yr butts-in-seats admin jobs are occupied by voters, making them difficult to eliminate nationally. You’d have to go down to the state level at least to get anything done.by peyton
- >A single-payer universal health care system could cover every American, save more than 100,000 lives a year, and still cost $1 trillion less than the system it would replace, according to a new preprint study led by researchers at the Yale School of Public Health.by karakoram
- $1 trillion less profit.by jonplackett
- FWIW, the methodology that produced this particular result is known to have significant issues. The claimed effect disappears after correcting for them. It also isn't the first time that these authors have published similar studies with these issues. They are not a credible source.
Universal health coverage may save lives and money but this study doesn't provide actual evidence for it.
- In a more sane world the Republican Party would be in favor of universal health coverage. How many potential entrepreneurs stay working at BigCorp because they need the health benefits? How many small businesses are crushed by the cost of providing healthcare to their employees? It would be great for business to remove any involvement they have in personal healthcare.
But I suppose they are the party of big business, not the party of business in general.
by afavour - The party in the pocket of BigCorp, that party...?by theappsecguy
- Decoupling health insurance from your job and going single payer are separate things. You can have one without the other. You can have a very healthy system with private insurers (like in Switzerland) and you can have completely dysfunctional single payer system (like in Poland and I guess many other countries).
Main problems are elsewhere: doctors gatekeeping the market, lack of transparency when it comes to pricing, regulation making it impossible to compete for smaller players etc.
by bluecalm - > In a more sane world the Republican Party would be in favor of universal health coverage. How many potential entrepreneurs stay working at BigCorp because they need the health benefits?
Oh hi. That is me.
by cactacea - Republicans are the party of pulling up the ladder behind you.
They don't give any shits about free market economics or struggling entrepreneurs. They care about protecting their own money.
And it isn't about big business; that's the Democratic Party. It is about hoarding wealth and gaining more.
by dualvariable - The original universal healthcare plans were promoted by the GOP until Hillary got involved and it became a political football.by ChicagoDave
- A more sane world, you say? How about the Nixon administration, where Nixon proposes a universal healthcare system to Congress?by mikestew
- In what world is the Republican Party pro entrepreneur/small business enough to make these rhetorical questions meaningful?
- The Republican party is not a Conservative party, its a Reactionist party of capital, so generally anything that threatens the interests of capital will be absolutely crushed.by hilariously