Both in rich and poor countries, universal health care brings huge benefits • Hacker News Board

Re: Both in rich and poor countries, universal health care brings huge benefits

#441

Post by coryfklein » Wed, May 02, 2018, 6:28 PM UTC

ordinaryperson wrote: post #18

Universal health care is a euphemism for the poor and sick getting their medical care subsidized by the wealthy and healthy. Morally, caring for the sick seems like the right thing to do, but it's like when I hear Bernie Sanders call for "free college education": he doesn't mean free, he means the wealthy subsidizing it for others. Universal health care implies just distributed costs, but the focus should be on bring…

> Universal health care is a euphemism for the poor and sick getting their medical care subsidized by the wealthy and healthy.

Correct me if I'm wrong, but the wealthy and healthy (who have health insurance) are already paying for the poor and sick, aren't they? Hospitals can't deny care to the poor and sick, so they inflate the costs of the wealthy insured to compensate for the poor's ER visits.

Universal health care would mean moving more ER visits to a primary care physician in a clinic, effectively _reducing_ the overall burden that the healthy and wealthy pay.

Re: Both in rich and poor countries, universal health care brings huge benefits

#442

Post by SamReidHughes » Wed, May 02, 2018, 6:29 PM UTC

rogerb wrote: post #358

mistermann wrote: post #253

Earlier quoted context omitted.

The underlying reasoning for universal healthcare is based on a principle, does this principle end at the US border, which I'm told is just some arbitrary, meaningless line right? If it's not clear, my tongue is firmly in my cheek as I say that, but where it isn't in my cheek is when I'm telling you some people don't just buy your simple pro-universal-healthcare argument wholesale, especially when you refuse to defen…

I live in the US and I pay taxes in the US, so yes - healthcare for US citizens/residents paid for by US/citizens residents ends at the borders. If there is a better, more efficient system that is morally right (i.e. provides basic healthcare for it's citizens) than universal healthcare I would like someone to propose it ?

That's a nice saccade you've made from "you are a terrible person" to "healthcare ... ends at the borders."

Universal healthcare would be great if it was cheap and covered everything.

Re: Both in rich and poor countries, universal health care brings huge benefits

#443

Post by chimeracoder » Wed, May 02, 2018, 6:29 PM UTC

ScottBurson wrote: post #430

chimeracoder wrote: post #189

Earlier quoted context omitted.

> No, because it's free, but 1/3 of Medicare recipients opt to receive their coverage through private insurers that typically add on additional coverage They don't simply add on coverage; they replace it. Most people on Medicare Advantage don't opt for coverage above what Medicare itself can provide - they simply receive their benefits from a private entity instead of Medicare, because Medicare provides such a bad ex…

You've repeated this claim in several places so I'll just link to my rebuttal: https://news.ycombinator.com/item?id=16979565 While you may have a good argument against a "single-manager" health care system, this doesn't seem like an argument against a single- payer system. In fairness, I guess a lot of existing universal-coverage systems, such as the UK's NHS, are also single-manager (someone will correct me if I'm m…

> I guess a lot of existing universal-coverage systems, such as the UK's NHS, are also single-manager (someone will correct me if I'm mistaken), but the very existence of Medicare Advantage shows an alternative possibility. I think that, far from being an argument against single-payer, it shows how single-payer can be made to work even better, through premium subsidies (and, I would guess, reinsurance for catastrophic losses) to private insurance companies, for those who are willing and able to pay additional premiums for better care.

I don't think you understand how Medicare Advantage works. There's really nothing about it that suggests a single-payer system would work. The premiums are not subsidized. (Reimbursements are, but that's a separate matter.)

Medicare is the fullest extent to which people can legally opt out of Medicare, short of claiming religious exemptions (rare), working for a foreign government while in the US (rarer and legally questionable for citizens), or surrendering US citizenship altogether (drastic). Medicare Advantage outperforms Original Medicare on the top performance indicators (medical outcomes, cost, patient satisfaction), though underperforms the same exact private insurers on those same metrics, despite the latttermost also being saddled with the burden of subsidizing Original Medicare reimbursements.

If you still want to advocate for single-payer healthcare on philosophical grounds, okay. But from an empirical standpoint, Medicare is not the place to look for data to support that stance.

Re: Both in rich and poor countries, universal health care brings huge benefits

#444

Post by willvarfar » Wed, May 02, 2018, 6:30 PM UTC

fastball wrote: post #302

willvarfar wrote: post #120

In these kinds of discussions I like to promote this interesting TEDx talk: https://www.youtube.com/watch?v=A9UmdY0E8hU "Where in the world is it easiest to get rich?" Spoiler: the talk shows that statistically the Nordic countries lead the world in millionaires and billionaires / capita, and in rags-to-riches. The talker offers the opinion that this is because its of the strong social safety net, education and healt…

Or maybe it's the very high resource/population ratio? The petroleum sector accounts for 40% of Norway's exports. Fishing is 10% (!) of Norwegian exports. Both of these things have an incredibly high extraction efficiency in the modern era. It would be nice to believe it's the social safety net, but I don't think that hypothesis is backed up with much evidence. The much more obvious reason is staring Scandinavia in t…

Sweden, without oil and without much fishing, is also doing really well per-capita etc.

On the ground, the welfare state approach seems the plausible explanation.

And how will Norway do post-oil? Really rather well, it seems, because of its sovereign wealth approach which contrasts strongly with eg the Texas approach.

Re: Both in rich and poor countries, universal health care brings huge benefits

#445

Post by conanbatt » Wed, May 02, 2018, 6:30 PM UTC

monocasa wrote: post #421

conanbatt wrote: post #409

Earlier quoted context omitted.

Is Medicare twice as efficient as private healthcare?

It's not a great comparison for a lot of reasons (not least of which the first being that Medicare is legally not able to negotiate drug prices), but despite all of that, yes Medicare is dramatically more efficient.

Medicare is the core of all regulatory and pricing issues in the healthcare space. And if medicare were expanded to the entire population of the us, its expenditures could be 40-45% of gdp.

Re: Both in rich and poor countries, universal health care brings huge benefits

#446

Post by conanbatt » Wed, May 02, 2018, 6:31 PM UTC

Frondo wrote: post #332

conanbatt wrote: post #283

Earlier quoted context omitted.

> "Taxes == get fleeced" ... no. Or, at least, not as a matter of course. Maybe some taxes are bad, or unfair, but we can judge each tax on its merits. Sure. I pay private healthcare and i also pay a medicare tax. Im already getting fleeced for a service I don't use. > "Government program provides worse services" ... no. Or, at least, not as a matter of course. Maybe some things the private sector does better? But a…

Paying taxes isn't getting fleeced. I can tell you feel passionately about this, but your feeling that you're being ripped off by your taxes isn't going to translate well to any sort of workable policy.

Workable policies that levy taxes abusively are not workable policies. Its institutional exploitation.

Re: Both in rich and poor countries, universal health care brings huge benefits

#447

Post by knieveltech » Wed, May 02, 2018, 6:37 PM UTC

SamReidHughes wrote: post #428

knieveltech wrote: post #344

Earlier quoted context omitted.

I am not currently actively or passively ignoring anyone's injuries. I'm a trained first responder, registered organ donor, and actively lobby my local, state, and federal government for universal healthcare and robust international humanitarian aid. It is instructive to note that two attempts to shift goalposts and distract with trivia have been made while nobody seems willing to take a crack at what is a very simpl…

You haven't helped care for my injuries. Lobbying for international (paid for by others) is like calling a taxi when you've got an injured man by the road and telling the cabdriver to deal with it.

You intentionally confuse turning a blind eye with limited ability to render aid, further attempting to obfuscate the central question. Again I am not that easily distracted. Last time, for the cheap seats, what criteria make ignoring others' injuries a moral choice?

Re: Both in rich and poor countries, universal health care brings huge benefits

#448

Post by 0xfeba » Wed, May 02, 2018, 6:37 PM UTC

jkingsbery wrote: post #349

slantedview wrote: post #69

Earlier quoted context omitted.

Fun fact that most Americans don't know: We _ALREADY_ spend more than enough on healthcare as a nation to fully fund healthcare for everybody. It's just that, unlike in other countries, our current system routes that spending to various for profit entities that don't involve actually providing care. tldr; Lack of funding is not a legitimate argument against providing healthcare to Americans.

While true, in healthcare, a lot of the incentives that for-profit entities experience are put in place by the government. For example, a lot of the economics around pharma are driven by patent laws.

And who lobbied for those patent laws?

Re: Both in rich and poor countries, universal health care brings huge benefits

#449

Post by ScottBurson » Wed, May 02, 2018, 6:39 PM UTC

chimeracoder wrote: post #443

ScottBurson wrote: post #430

Earlier quoted context omitted.

You've repeated this claim in several places so I'll just link to my rebuttal: https://news.ycombinator.com/item?id=16979565 While you may have a good argument against a "single-manager" health care system, this doesn't seem like an argument against a single- payer system. In fairness, I guess a lot of existing universal-coverage systems, such as the UK's NHS, are also single-manager (someone will correct me if I'm m…

> I guess a lot of existing universal-coverage systems, such as the UK's NHS, are also single-manager (someone will correct me if I'm mistaken), but the very existence of Medicare Advantage shows an alternative possibility. I think that, far from being an argument against single-payer, it shows how single-payer can be made to work even better, through premium subsidies (and, I would guess, reinsurance for catastrophi…

I already quoted from medicare.gov [0], but I'll repeat: Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans.

How is that not a premium subsidy?

[0] https://www.medicare.gov/sign-up-change-plans/medicare-healt...

Re: Both in rich and poor countries, universal health care brings huge benefits

#450

Post by aninhumer » Wed, May 02, 2018, 6:41 PM UTC

Consultant32452 wrote: post #433

aninhumer wrote: post #425

Earlier quoted context omitted.

It's only coercive when we're talking about the means to survive. If you offer someone a choice between death or some action, you are coercing them to act. And I don't think that "ceases to have a useful meaning". I think it just doesn't let you argue that your system is better based on absence of "coercion".

I don't believe for a second that you understand the word "coerce" to be limited only to situations of life and death. Do you or do you not believe that doctors in the UK are coercing the government by demanding a fair salary in exchange for the lifesaving services they provide?

>I don't believe for a second that you understand the word "coerce" to be limited only to situations of life and death.

I don't think it's necessarily limited to that, but I do think all such situations are coercive. Whether someone is having a gun pointed at them, or being denied healthcare, they are being coerced. That said, I do think most coercion does ultimately amount to the threat of death or suffering, even if it becomes very indirect in practice.

>Do you or do you not believe that doctors in the UK are coercing the government by demanding a fair salary in exchange for the lifesaving services they provide?

Trying to evaluate the actions of individuals in a wider system is not very helpful. Are the doctors being coercive? Yes. But they're also being coerced in turn by the individuals they rely on for survival (i.e. the people they buy food from) so it's hard to ascribe blame. It's the system as a whole which is coercive.

And this is my point. Both market based healthcare and state provided healthcare rely on coercion to function, so you can't distinguish them morally on that basis.

The only hypothetical system I know of that would actually be free of coercion would by something like anarcho-communism, where people have free access to the means of survival, and it is produced by people's free choice to work for the benefit of others. But I'd guess you think such a system wouldn't work.