Hacker News new | past | comments | ask | show | jobs | submit login
[flagged] Universal health care: will people finally get it?
34 points by kickthemout on March 21, 2020 | hide | past | favorite | 46 comments
The only good thing that can come out of this COVID-19 situation is that people will understand the importance of universal health care here in the US.

Scenario 1: I get laid off, I lose insurance for me and my family, I have to figure out how to find a new coverage, maybe COBRA, pay for it out of my pocket, and eventually try finding a new job. Ah, in case I get the virus and I’ll need to be hospitalized good luck paying the bill...

Scenario 2: I get laid off, I can focus on finding a new job without extra expenses. I get the virus, I go to the hospital and get treated, no bills.

This seems a no brainer to me. Am I missing something?

Disclaimer: European living in the US




I agree with you. This will change the election narrative a lot. Pre-covid, the major issues were looking to be gun control, taxes, and health care. Now it will be just health care and recovering the economy.

In my opinion, universal health care will do more to help the economy than any stimulus package ever could. If people aren't spending so much on healthcare, they will spend it elsewhere. That being said, we will still pay, just through taxes instead of direct costs. Hopefully the system will be made more efficient so that costs decrease from what they are now.


I'm not sure how the USA is going to fund universal health (one that's actually unversal and free like we have here in Europe) care without first having a discussion on taxes. I can't say I'm qualified to have an opinion on it but regardless what the budget in the USA is, the cost of public healthcare all of a sudden could very well be unsustainable without having a federal level tax policy similar to other countries with public heatlh care. Furthermore, the USA as a whole does not have a very healthy population, which means free health care could cause a surge in appointments and treatments. I think it's something that they will have to do sooner or later but the first years (or decade?) would be a test to overcome, and cultural changes would need to kick in before it starts running smoothly.


What I've ultimately discovered is that the only time people enter "Can we afford it?" into the discussion, it's because they're looking for an excuse for it not to happen.

Try taking a close look at how the US budget actually breaks down. It's quite a task since it's an enormous budget. But, if you boil it down to a pie chart, you'll find that we spend an absurd amount on "defense", most of which is wasted. You'll also find that Congress will routinely spend enormous sums of money - in the trillions - on things that aren't health care (e.g. wars & combat, economic bailouts, etc.), without ever asking how it can be afforded, and it doesn't cause the whole system to come crashing down.

It's about priorities, and finding legislators to elect who share the correct ones. I believe that we'll get there, slowly, one funeral at a time.


Currently there is a private tax that people and companies pay: the insurance premium. All Medicare for all proposals have funding plans that include higher taxes or new taxes that essentially pick up this premium in other areas. At least some require that this insurance premium is carried over into salaries ISTR since it’s currently a benefit and should go to your salary.


> Currently there is a private tax that people and companies pay: the insurance premium.

We do that in Germany too. On top of (much) higher income taxes, (much) higher sales tax and plenty of extra taxes on products. Health insurance is "free" as in "you pay ~7% of your income and your employer matches it".

There's no such thing as a free lunch or free healthcare.


And what are the deductibles and co-pays? What are the bankruptcy rates and how many of them are because of medical bills?

Plenty of Americans "have insurance", but if you go (or are taken via an ambulance) to the 'wrong hospital' you're not covered. Even if you go to the correct hospital, but are treated by the 'wrong doctor' you also may not be covered:

* https://www.usatoday.com/story/opinion/2019/09/23/out-of-net...

Do a search for "out of network hospital" or "out of network doctor". So yes, the health coverage in Germany is certainly not "free", but you're actually covered. Just because you pay your premiums in the US does not necessarily mean much.


> And what are the deductibles and co-pays? What are the bankruptcy rates and how many of them are because of medical bills?

Depends on your insurance, but obviously lower than in the US. I don't know what US-insurance companies usually cover, public health care in Germany is so-so, e.g. if you need glasses, they won't pay, so you've have to pay for those yourself.

The US system certainly has plenty of issues, and I'm not saying that European systems aren't superior, I'm just saying that we pay much more. This obviously has a smaller effect in low-income people as their healthcare, social benefits etc will be subsidized by others, but if you're working in a high-skill profession, you'll take home a lot less of your paycheck than in the US.

Unless the high earners in the US are fine with significantly reducing their net income, I don't think you'll find a lot of support.


> I'm not sure how the USA is going to fund universal health (one that's actually unversal and free like we have here in Europe) care without first having a discussion on taxes.

Americans are already paying for it: it's just that their premiums are going to private companies instead of a government agency. The money is coming out of your pocket either way so what difference does it make whether it is labelled as "tax" or "medical bill"? That's just a form of mental accounting.

Also: you can have universal healthcare without the government, single-payer or otherwise. Don't Germany and Switzerland both have universal coverage with private, non-profit health insurance companies?


> Don't Germany and Switzerland both have universal coverage with private, non-profit health insurance companies?

Germany has a dual-system. You get basic coverage with public healthcare, and you get premium coverage with private health insurance providers. Want eye glasses paid for? You need private insurance.

Doctors get a fixed rate for most things, and they exist mostly by treating private insurance patients, because they'll get 2.3-3.5x the rate from private insurance companies, while treating public insurance patients is close to being a net loss.


>the cost of public healthcare all of a sudden could very well be unsustainable

What about Space Force and the increasing military budget every year? How come there is magically money for that?


The USA as a whole does not have a very healthy population

Thing is, the relative health of citizens of the USA tends to vary wildly by region. For instance, people in Colorado are far more likely to be very fit, active, eat healthy, exercise daily, and engage in outdoor activities than residents of, say, Alabama.

That means that free or universal health care, if it comes to pass, will be very unevenly distributed in the USA.


Speaking of that, if free/universal health care does come to pass, is it more likely to be federally or state funded/organised? (I'm European, so please bear with me if that seems like a basic question)


It will be federally funded and state organized (over simplified but that the General idea)


I say this as someone who has maxed out his FEC contributions to Senator Sanders, and have also contributed heavily to a PAC that supports Medicare For All:

Based on primary returns, the electorate is still selfish and not willing to support a candidate who supports Medicare For All. The situation must deteriorate much further before the path to universal healthcare becomes unavoidable.

Based on exit polls, it’s clear the 65+ cohort is who is holding this up (although the 30-44 age cohort is culpable to a lesser extent, at least in the Dem primary).

Disclaimer: I received a few more years with my Mom than I otherwise would have because of the ACA. Universal healthcare is my hill to die on, most especially for my kids.


One way this coronavirus situation forces people to consider universal coverage is that the less fortunate, without health care and means for testing, become an attack vector for the virus towards the more fortunate. This makes universal coverage in the self-interest of the more fortunate, and hopefully they realize cost-efficient.


You give the electorate too much credit. While logical, most people aren’t. They vote their feelings, not facts.

I’ve spoken to several at risk people who have written COVID19 off as a political conspiracy and not a real threat.


I'm optimistic, but can see the case for pessimism as well.


All hope is not lost, but there is much work left to be done.

The trick is to never give up. More likely your opponent does first. The Grand Canyon is a marvel, but the water was what cut through it. Be the water.


Sanderite Medicare for All is a subset of Universal Healthcare. Please stop pretending they see the same thing.


It’s estimated to save 68k lives and $450 billions dollars per year [1]. If you have a better proposal, champion it.

[1] https://www.iflscience.com/health-and-medicine/medicare-for-...


No, push for the most aggressive plan possible. This is the one moment in history you might just get what you want. If you start in the middle they'll argue you down to nothing. Hold firm and tell. Don't ask.


The Sanderite strategy was to insist that there is only one way to do things, which was his way, and everybody else must simply fall in line. It didn't work last time, it didn't work this time.


It works if something happens to enough of the electorate opposing it (about 5k people over 55 die each day, the older you are the more moderate or conservative you skew [vs progressive] per Pew Research). This ignores death spikes from black swan events (COVID-19); they bring about change more rapidly. “Progress occurs one funeral at a time”, apologies to Max Planck.

Just as interracial marriage, womens’ voting rights, the legalization of abortion, same sex marriage, and the slow sweep of marijuana legalization and prison reform come eventually, this too will arrive. We’re just arguing the timeline, which is frankly insane we’re willing to wait so long to save the lives of so many of our fellow citizens.


I'd honestly be surprised if universal healthcare will ever be on the table. Between Trump and Biden, there won't be any discussions.

What could happen is that Biden gets KO'ed by the disease, leaving Sanders the default democratic candidate.


For the non-Americans, what is the difference?


I am a Canadian and we have the exact system Sanders wants in this US. With very few explicit exceptions, private medical insurance is illegal and the government is the only insurer. It is also not possible to pay for or provide supplementary services, ie, if you have to wait 2 months for something, there are no private clinics that can do it in 2 weeks.

Universal Healthcare means everybody is covered and there's many different way to provide such coverage. Canada's is not even a very common approach.


There are numerous private clinics that can get things done fast, and Canadians often use them. Things would be different if the border were closed or if Canadians lived far from it.

Without that easy-to-cross border, the political pressure to allow private clinics would be irresistible. The law would change.


I think there's a lot of good things that can come out of this. Not just healthcare concerns.

It feels like covid might be able to push public opinion on many matters beyond the local minima.

"I've never seen a sky so blue."


In tandem with my other comments elsewhere on this page, I suggest a scenario 0: Use Dave Ramsey's advice (or other similar), and among other preparations have a sufficient savings account (and avoid debt and keep your costs low) so that if you lose your job or other circumstances require, you can sign up for medical insurance which you pay for. Hopefully also you have good family and/or church ties where you help others and they help you, freely, and have built these up over time. While diligently looking for work (even flex/temporary), you maintain these ties and they help you if necessary. I have written extensively at my web site.

Having outside entities manage our lives by force, because of our individual failure to live a prepared, wise lifestyle, causes us to lose freedoms we won in the 1770s. But it is not to late to begin now, and encourage others. There is so much good that we can do, if we are not victims of the advertising industry but instead think, have a direction, worthwhile goals, and humility while we patiently try. It is really worthwhile.

Edit: there are also other very good preparations one can make besides financial, such as basic emergency supplies and long-term food storage (wheat & beans keep well and can keep one alive), rotation, etc, without necessarily digging a bomb shelter. These and being without debt yield peacefulness. Again, more at my web site (no ads): https://lukecall.net send questions freely via the address at the footer.

edit: ps: if downvoting, an explanation could help.


No. It has nothing to do with politics. It is a labor and economics problem that I don’t see the pandemic solving for. Few people in the US who can easily afford health care are willing to advocate for universal health care at their own expense simply because it’s too expensive. This is a problem with health care in the US specifically.

Health care in the US is excessively expensive due to intentional market inefficiencies. There is a lot of research on this. Simply speaking the industry employs too many people. Consider the number of people employed due to medical insurance, medical equipment industry, pharmaceutical industry, medical administration experts, regulation, and so forth. Unless you are willing to kill a large segment of commercial medicine and put many people out of work this industry will remain expensive, and so long as it remains this expensive a universal medical service simply isn’t going to happen.

In the meantime the closest thing to universal medicine in the US is the VA.


No.

We’ll see the same reaction that people had when witnessing extreme weather events: focus on the immediate problem, and refuse to engage with larger issues on the basis that “it’s too political”. For extreme weather events citizens and authorities showed an aversion to discussing “Is it climate change?”, and “How should we deal with climate change?”, etc.


If states want to try this kind of thing, I am supportive, because they can learn from each other as laboratories of democracy. But the US federal government is the wrong organization to attempt it. Having them do it causes a loss of the freedoms we won in the 1770's: freedom from control by faraway people running our personal lives (and badly).

I believe we are obligated to help each other (accountable before God), but not by force, nor by doing it in a way that the elected minority decides, because we lose freedoms that way (via taking more our incomes from us, taking and controlling the results of our work). Better to have freedom to do it even better, privately, or as communities, families, states, etc., when & how we so choose. States can decide otherwise, but no fed gov involvement. That is why we have the constitution that we do -- it is important.


Why a downvote with no explanation?


No. Before I get dismissed as a cynic, it’s not hard to see that the rich and powerful have better resources to protect their interest (by design). Despite our stark realizations that our utter disregard for a collective mentality would have provided immense benefits in hindsight, our country is deeply rooted in individuals. The narrative will quickly change back to the individual level and individualism will not cede. All this will be nothing more akin to a moment of silence at a baseball game. Great moments of togetherness will be forgotten, but those homeruns will exalt players to heros.


Scenario 3: You keep your job and have a mild case.

Never underestimate people's idealogical beliefs even under strain.


I think it's time to realize health is a common interest and not the interest of individuals only.


> Am I missing something?

"Freedom."

Edit: seriously, a lot of objection to this is that it's "socialism" (for some definition of the word/concept), and we all know that socialism is bad. "Just look at what happened in the USSR!"


> This seems a no brainer to me. Am I missing something?

Yes; you're making a judgment based on an exceptional situation (considered a once in a century occurrence).

Note that this a general consideration, independent from the the debate universal health care or not.


> Yes; you're making a judgment based on an exceptional situation (considered a once in a century occurrence)

It's not. We've had at least 4 outbreaks in the past 20 years, and it's only going to get worse because our economies and supply chains are more interconnected than ever, and people are more mobile than ever.


What I get from the testing kit rollout is that the government is massively incompetent and I shudder at the thought of them getting their hands on anything to do with my healthcare.

Make the federal government work and then we can talk.


There is far too much money being made in private medical services and insurance to be able dissuade enough American politicians against the private insurance model.


You’re right in that it is a no brainer and has been for some time: 68,000 people die each year in the US due to lack of healthcare. On top of that it will save the US about $500 billion per year. So it’s right for both moral and fiscal reasons.

But from the perspective of your average politician they just want to get re-elected, and maybe make some extra cash through grift along the way. To do that they get financed by lobbyists that include business interests which are against this. Some that are against it for direct reasons (they’re a health company) some for less direct reasons (they’re a big US business and they like the control employer based health care gives them over their workers).

So few politicians are pushing it. And they don’t have to because in our system so long as they other side doesn’t push it either, they can just give a bunch of weak excuses and it never happens.

Will this pandemic change that? Hard to say. The current Dem front runner has said quite literally that he would veto it. Even if all the hard work was done to get it through the house and senate, all he had to do was sign it into law, he would veto it. So you know where the Dem leadership stand on this, solidly with their donors and against giving people healthcare.

And so far in terms of response we have seen that instead of direct and simple solutions they are focused on creating complicated and means tested solutions that leave out significant chunks of the population including the most vulnerable. (And overall acting incredible slowly given the seriousness of the situation.) So I don’t think if it happens it’ll happen easily.

On the other hand, if Trumps opinion ratings go down and he decides he wants to be remember he may have a crazy brain fart and spurt out an order to give everyone healthcare in this pandemic. It would still be unlikely to happen because the Rep leadership would try to complicate it just as they did the plan to give everyone checks.


The more extreme this virus gets, the more it is in the interest of the candidates to annonuce their support for it. I can just see Trump going for it and spinning a story about how he always wanted that. And what would people say? Go against it?


Edit: after I submitted this, I saw that the thread got flagged. Should I delete this or leave it?

Giving a political answer since the topic is political.

COVID-19 is the first major crisis caused by laissez faire/free market/libertarian capitalism that the US has experienced. We had ample time since SARS in 2003 to be working on a vaccine, but right-leaning politicians have cut federal medical research funding since the 2000s (when I began seeing the connections between tech and politics). See this National Institutes of Health funding graph (NIH in green):

https://www.aaas.org/sites/default/files/2019-06/Disc-1.jpg

Background:

https://www.americanprogress.org/issues/economy/reports/2014...

Here is an article from 2010 on using zinc against coronavirus, when I first realized just how long it's been around:

https://journals.plos.org/plospathogens/article?id=10.1371/j...

So a great deal has been known about the virus for quite some time. But we didn't commit the federal funding to properly address it, because we didn't feel it was a priority, because it didn't affect us directly yet. I watched the same thing as a child when the powers that be actively worked to undermine AIDS research in the 80s because it didn't strike the members of happily married nuclear families.

Before we have the conversation about socializing the vulnerable sectors of our economy, I think we need to get to the heart of why we are so divided politically.

To me, it began when Ronald Reagan said "The nine most terrifying words in the English language are: I'm from the Government, and I'm here to help." That framed subsequent discussions as being between the people and the government, as two separate entities. But the US was founded on We the People. We're the government of the People, by the People, for the People.

Personally, I vote to start breaking down that distinction. I want to see our tax dollars at work again, solving real problems. Not going to pork barrel programs and unaudited black holes in the military industrial complex, and now the pharmaceutical industrial complex. We don't need twelve remedies for diseases of affluence like hair loss. We need hard research done by universities again, to find cures, with real money available immediately to free researchers from spending the entirety of their careers groveling for funds.

The way I see it, the glorification and defense of pure capitalism is misguided. Capitalism is a process, like evolution. It's the default position that groups of people and economies fall back to, like barter. It's a very efficient method for distributing goods and services. But unfettered capitalism eventually leads to crony capitalism, late-stage capitalism, monopoly and oligarchy.

An alternative is humanism. In a situation like this one, where we have to choose between eliminating 2% of our population or losing money in our economy, I would hope that we choose human lives over capital.

I'm aware of the benefits of a good work ethic, doing a hard day's work etc. We don't need to debate the basics of capitalism vs socialism, or point fingers that someone is lazy or getting a free lunch. I'm talking about the meta-level debate about the purpose of the US government and whether we should serve the public again or double down on catering to a small handful of wealthy oligarchs.


I do believe you're missing quite a lot. As western societies become increasingly feminized, many in these societies expect to be cared for and nurtured in much the same way they were by their mothers. Their governments then take on the role as their Other Mother.

The problem with our Other Mother providing health care is that options and competencies will become severely limited due to centralized decision making and lack of incentives for qualified individuals to become physicians, or even to continue practicing medicine.

I believe the individual should share in some of the financial and logistical burdens of their own healthcare. Do I think our Other Mother has a role in providing healthcare? Certainly, but way in the back of the process in support of extreme and extremely chronic cases like transplants, severe injury recovery, advanced diabetes and some others.


The tale of "capitalism / free market is good for providing options and competition" has been debunked time and time again. Look at telcos or nowadays cable providers. Yeah there are several , but they conspire to setup geographic micro monopolies. Same with airlines and computing (Microsoft in the past, Google in the present, apple as well)

That is fine for goods and services that are not essential... but for health? It is a terrible idea now, as it was for firefighting 200 years ago.




Guidelines | FAQ | Lists | API | Security | Legal | Apply to YC | Contact

Search: