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

#361

Post by mattmanser » Wed, May 02, 2018, 4:48 PM UTC

conanbatt wrote: post #177

Pharylon wrote: post #134

Earlier quoted context omitted.

Disingenuous? You think people arguing that it's immoral for someone to die because they were born poor are not actually sincere in their argument? Tell me, what is my evil ulterior motive? Do I actually just want to increase taxes for the hell of it?

Of course its not a sincere argument: I believe that you can believe it, but its insincere at least to yourself to say that the reason healthcare should be universally provided through government is for the poor. If you cared for the poor the argument is to make food stamps for healthcare services, not universal. Universal is also for yourself. So yes, it is disingenuous to say that which is best for your is also bes…

Your argument makes no sense.

It's like garbage collection, it's just something the government provides as a service to all citizens.

Whether it's regressive or progressive entirely depends on the tax used to pay for it. If everyone has to pay exactly the same, it's regressive, as poor people are impacted much more than rich people. If it's a proportion of income, it's progressive.

In the UK our national insurance, which pays for our universal healthcare, social welfare and pensions, is actually a regressive tax, it's 12% on the first £46k you earn, then 2% after that (something like your first £6k is actually tax free). I don't know why people don't make a bigger deal out of this given that the NHS is suffering at the moment.

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

#362

Post by ebalit » Wed, May 02, 2018, 4:48 PM UTC

aninhumer wrote: post #315

Frondo wrote: post #277

Earlier quoted context omitted.

Taxation is not violent coercion by the state and it is disingenuous to describe the former as the latter.

I would argue it is coercive, but so is the property system underpinning the market in the first place. Adding a redistribution element to a system of private property doesn't introduce violent coercion, it merely changes how it is being used to allocate resources.

As Adam Smith wrote: "Civil government, in so far as it is instituted for the security of property, is in reality instituted for the defense of the rich against the poor, or of those who have some property against those who have none at all."

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

#363

Post by monocasa » Wed, May 02, 2018, 4:52 PM UTC

chimeracoder wrote: post #330

monocasa wrote: post #258

Earlier quoted context omitted.

I mean, sure, the defunding started in the early 80s with Reagan, but we only started to see the effects of that in the past 20 years or so. And sure, I blame the neoliberal third way Democrats as much as the Republicans. Their whole "let's move the party right and follow the Republicans" really muddies the waters here.

> I mean, sure, the defunding started in the early 80s with Reagan, but we only started to see the effects of that in the past 20 years or so. The problems with the VA date back to the 60s, although they've accelerated in the last couple of decades. > And sure, I blame the neoliberal third way Democrats as much as the Republicans. Their whole "let's move the party right and follow the Republicans" really muddies the…

First off, the VA isn't as bad as you're making it out to be.

https://www.rand.org/news/press/2016/07/18.html

"Quality of Care in VA Health System Compares Well to Other Health Settings"

A lot of the bad press around it's deficiencies are because it, as a public institution, publishes a lot of information that the private healthcare system isn't required to publish.

And yes, having been from Newt Gingrich's district, and seeing the failed 1994 HEART act, that ended up being turned into Romneycare, and then morphed into the ACA (in order to steal the Republican's thunder in 2012), yes I do blame the right wing for the current state of healthcare.

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

#364

Post by sykh » Wed, May 02, 2018, 4:52 PM UTC

ibeckermayer wrote: post #360

clarkevans wrote: post #94

Earlier quoted context omitted.

> It seems the public interest is subordinate to private interests and often times with immoral consequences. This perspective of public vs private interest is rather puzzling to me -- it's more a matter of short-term vs long-term thinking. In the long-term, it's in the private interest of those having sustainable companies to have a broad base of educated and healthy workers to employ. The short-term interest of any…

My problem with you isn’t that you want to fund long term interests, my problem with you is that you want to force me to fund your idea of long term interests with your preferred long term fund (i.e. whatever our moronic legislators can cook up). It’s not about the goals, it’s about the coercion.

Isn’t this part of being a member of a society? Sometimes laws and goals of society don’t align with yours. So advocate for your goals and participate in society.

Sometimes one decides to leave the country because the misalignment of goals becomes intolerable. But there is no substitute for a properly functioning government. At least not at our current level of our collective psychology.

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

#365

Post by mrhappyunhappy » Wed, May 02, 2018, 4:53 PM UTC

kalleboo wrote: post #227

adaml_623 wrote: post #4

Just going to throw this out there. Non universal health care is analogous to half the roads in a city being toll roads. Society can still function and you can mostly get to where you're going but it's not close to efficient.

Interestingly I live in a country (Japan) where all the highways are privatized and made into toll roads. Driving 3 hours to the next big city over costs nearly as much in gas+tolls as taking the high-speed rail (which takes half the time). To me for transport making costs transparent actually makes things more efficient. We still have universal healthcare though.

Also in Japan here. Healthcare definitely has issues here but overall positive for the entire nation. I was at first shocked by tolled highways everywhere but id you think about it it’s actually a brilliant move to encourage more rail transport which works out for everyone.

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

#366

Post by SilasX » Wed, May 02, 2018, 4:53 PM UTC

Pharylon wrote: post #73

austincheney wrote: post #51

When the issue of universal health care comes up with regards to US policy I often see those emotional arguments pulling on the heart strings. Unfortunately, this is a distraction. I know this sounds cold, but it comes down to money. Healthcare in America is expensive. The problems appear to be commonly identified by various forms of research and including things like pricing inefficiencies of drugs, malpractice insu…

I don't think emotional arguments are a distraction, they're the whole point. This is a moral issue. Other countries manage to have universal healthcare and it doesn't break the bank. In fact, they spend less per person. The fiscal argument is the distraction.

"It is morally wrong that someone can die from X because they're poor" is a fine point to make. There's nothing wrong with moralizing in that sense, IMHO.

The problem is when you add "And therefore the presence of profit making entities must be the cause". That inserts a moral argument as a substitute for identifying the core problem. I think that's the kind of error you're making here:

>Other countries manage to have universal healthcare and it doesn't break the bank. In fact, they spend less per person.

True, but there are differences other than the universal coverage. The same things that lead, in the US, to bureaucratic bloat and 700% markups on saline, may very well also torpedo those systems!

I think it's a reasonable point for the parent to criticize the kind of moralizing that doesn't attempt a legitimate root cause of why health care spending is so ineffective in the US.

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

#367

Post by SilasX » Wed, May 02, 2018, 4:55 PM UTC

slantedview wrote: post #69

austincheney wrote: post #51

When the issue of universal health care comes up with regards to US policy I often see those emotional arguments pulling on the heart strings. Unfortunately, this is a distraction. I know this sounds cold, but it comes down to money. Healthcare in America is expensive. The problems appear to be commonly identified by various forms of research and including things like pricing inefficiencies of drugs, malpractice insu…

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.

But that also means that if you could fix the cost bloat, it would be much easier to provide universal coverage, and that trying to do the latter before addressing the former is bound to fail.

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

#368

Post by soru » Wed, May 02, 2018, 5:00 PM UTC

edanm wrote: post #107

arcticbull wrote: post #44

Earlier quoted context omitted.

There's some serious mental gymnastics going on here to justify that the US spends 2x the next country per capita on health care expenditure and still doesn't manage to pay for all its citizens. Especially when the federal government has already taken all its worst customers (the old) and thrown them into a socialized pool (medicare) without anyone to balance out the risk. Wasn't there a writeup recently that wealth…

> There's some serious mental gymnastics going on here to justify that the US spends 2x the next country per capita on health care expenditure and still doesn't manage to pay for all its citizens. I'm not exactly sure what you mean by this. The US does spend a lot more, and doesn't cover everyone. If I understood the parent post, (part of what) it's saying that the US needs to focus on lowering costs, because otherwi…

> The US does spend a lot more, and doesn't cover everyone.

The US does spend a lot more, _because_ it doesn't cover everybody.

The use-value of private health care in the the US is:

- delta (getting treated, slow painful death and/or bankruptcy)

whereas most places it is more like:

- delta (private room in fancy building, non-private room in an oldish building)

If you were a salesman, and you sold the first product for less than 5x the price of the second, you would deserve to be sacked on the spot. How could a profit-seeking economic system be so inefficient that it would fail to extract a large portion of that value from the customer?

> he US needs to focus on lowering costs

Why would a profit-seeking system seek to lower costs when high costs led to higher prices that still get paid? Any CEO suggesting such a thing would be sacked by the board the same day.

Do the math; costs are about 3x what they should be, but 85% of the market still pays them. 3 * 0.85 > 1 * 1.0.

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

#369

Post by chimeracoder » Wed, May 02, 2018, 5:00 PM UTC

monocasa wrote: post #363

chimeracoder wrote: post #330

Earlier quoted context omitted.

> I mean, sure, the defunding started in the early 80s with Reagan, but we only started to see the effects of that in the past 20 years or so. The problems with the VA date back to the 60s, although they've accelerated in the last couple of decades. > And sure, I blame the neoliberal third way Democrats as much as the Republicans. Their whole "let's move the party right and follow the Republicans" really muddies the…

First off, the VA isn't as bad as you're making it out to be. https://www.rand.org/news/press/2016/07/18.html "Quality of Care in VA Health System Compares Well to Other Health Settings" A lot of the bad press around it's deficiencies are because it, as a public institution, publishes a lot of information that the private healthcare system isn't required to publish. And yes, having been from Newt Gingrich's district,…

> First off, the VA isn't as bad as you're making it out to be.

From your own link, which is a press release by the firm which sponsored the research:

> Researchers say there were few studies [included in this meta-analyis] to evaluate equity, efficiency and patient-centeredness, and that the quality of the available studies vary.

Incidentally, those are three of the four main issues for which people typically criticize the VA.

In other words, that meta-analysis more or less confirms that the VA probably does well at the things people already knew it was good at doing, without looking into any of the areas where it's known to have problems.

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

#370

Post by TimJYoung » Wed, May 02, 2018, 5:02 PM UTC

sykh wrote: post #6

When a person gets a life threatening disease they ought not worry about whether or not their treatment will leave their family in penury. This is especially so in a nation as wealthy as the U.S. The American healthcare system is immoral and I hope it drastically changes. Americans need to change their underlying notions of what it means to be a society. An author was once made fun of for suggesting that it takes a v…

Back in 2004 when John Kerry was running for POS (that's President of the United States, he-he), he had a great idea (that I'm sure came from elsewhere, but a good idea is a good idea). The US government would become the "insurer of last resort" and cover catastrophic claims above a certain amount:

http://www.washingtonpost.com/wp-dyn/articles/A16748-2004Jun...

For his efforts, he was practically called a "Commie" by the Republican party, despite the fact that the proposed mandates were fairly mild and the plan worked within the existing employer-provided health insurance system. It was a good crack at the ~20% of the population that accounts for the majority of healthcare spending, and eliminates the possibility of someone losing their home and savings because of a serious illness. Plus, I'm sure that the levers could be tweaked a bit to get better outcomes.