At the end of the day, it's a philosophical difference. I see people in Sicko, or read any of the thousands upon thousands of horror stories (like the ones in the article) and my stomach turns. I find situations like that downright amoral, so I think having to pay higher taxes for UHC is great value.

OTOH, opponents look at the same people and start to get mad that these people should get "something for nothing", that their tax dollars are used to help people that may have made bad choices.

Call me a pessimist, but I don't think this will turn out well for you guys. Any bill that is passed will be very watered-down and if the republicans get back into power before American UHC gets ingrained in the social fabric, then they'll do their best to kill it or cripple it.

All anecdotal arguments aside, the premise that more government is the only avenue for reform (held by yourself and other "progressives") is why both sides can't seem to agree on anything more than the idea that reform is needed. Around 40% of the American health care system is already managed by the government. The idea that we have a free market health care system that is failing the less fortunate in our country is downright false.

In Obama's current plan, there are plenty of free market solutions to expand coverage and bring down costs that are being ignored and avoided (some due to lobbyists and special interests and others by, IMO, power-hungry politicians with a deeper, anti-capitalist agenda). Furthermore, there are plenty of examples of unintended consequences from prior government policies (with good intentions) that have created some of the problems we have today. Without going into the specifics or giving your last sentence a serious thought, I would just like to say this: Both sides (for the most part) have good intentions so let's not paint each other as evil.

Here's a good place to start to understand the other side: http://online.wsj.com/article/SB1000142405297020360920457431...

More specifically, if you make a mistake in the market for a new MP3 player, you just have a crappy MP3 player and you're out a couple hundred bucks or so, and you buy a different brand next time. If you make a mistake buying health insurance, and only discover that your policy does not guarantee you the right to continue purchasing insurance at your existing rate when you are diagnosed with an illness, it could result in bankruptcy or even death.

So you understand the hesitancy to trust unregulated market forces when the issue is literally life and death.

But, for the most part, I am skeptical of any kind of central planning. I believe the federal government should stay out of things like health insurance. If Washington didn't help create the current environment where we rely so much on employer-based health insurance, maybe we would have individual health savings accounts and costs wouldn't have gotten so out of control because individuals would actually care what they were paying. And, in turn, hospitals would actually care what they are charging (i.e., competition).

I mean, just read the Wikipedia page on HSAs to get a feel for how complicated one tiny part of our system is http://en.wikipedia.org/wiki/Health_savings_account. I don't feel comfortable having this system reformed so quickly (especially when these bills aren't being read!). So much of the motives behind the current movement are purely political. I would rather take it slow and have a real, honest look at the problems from both sides.

I think the ultimate obstacle is that we perceive America to be as free market as it gets, but that notion is, in reality, so far from the truth. This belief seems to render any free-market approach to reform as "out-dated" or "pro status quo".

Sorry if I got off-topic. I've been trying to keep my political thoughts off of HN for too long. :)

I believe the federal government should stay out of things like health care.

The government's not trying to provide health care. It's trying to provide health insurance, which the private market has shown itself to be incapable of providing for 50 million Americans.

And again, I don't believe you can blame private insurers for that. The government is largely to blame for rising costs.

(BTW throwing that figure around opens up a whole 'nother can of worms, but I'll not go there)

There are certainly things the government could do to reduce costs though, like reigning in lawsuits through tort reform. Ironically I think having the government provide insurance for a lot of people will reduce costs as well. The government has way less overhead and doesn't care about making a profit. I know that sounds counter intuitive but think about it from the standpoint of costs to the consumer.

I like Mankiw's thoughts on the public option: http://gregmankiw.blogspot.com/2009/06/whats-point-of-public...

More than anything stories like this (or the ones about Canada) are scare tactics to support a political agenda. The fact still remains, a hospital in the U.S. by law CAN NOT turn away a patient for financial reasons. No one is dying on the street for lack of health care. At the same time Canada generally manages to take care of the great majority of its citizens without killing them by making them wait.

Bottom Line: The U.S. system has problems but so does the system in Canada, the U.K. and elsewhere. What we in the U.S. need to be doing is looking for a third option.

My uncle lives in Texas, (I love Texas Btw :P ) and he had some serious issues with his spleen. It took him about a month to get his surgery(including consults), he is fine now but still requires continuing monitoring.Cost to him and his family with his insurance coverage ~40K.

I honestly hope that everyone everywhere(not just in the US) gets free and available healthcare.

While there might be some hybrid model in the middle somewhere that may work. I think dealing with a teired model of healthcare will leave people who can only get the public healthcare the shaft.

The only things that stood out as being broken was the doctors' paranoia of being sued.

I can object to things on a philosophical level and still use them. We become reliant on programs that should have never been created in the first place.

So it'll be sort of like the postal system. If you want to use Fedex or UPS, you can, if you want uber cheap you can go with USPS, but you don't see Fedex or USPS out of business do you?

If the gov plan uses taxpayer money, it doesn't necessarily mean that private insurance will fail. And this is because there will be some who will want the higher quality private insurance. The fact is the richer you are the more you will pay for even modest upgrades. So those who can afford private insurance will still have a reason to go for it. This is evidenced by what TomOfTTB said above who said there are stories of Canadians who fly to the US for health care right? And it's true private insurance will get hit hard by this, but they will probably not all die out. In fact private insurance companies are probably the main driver of the opposition.

http://gregmankiw.blogspot.com/2009/06/whats-point-of-public...

It's a damn good thing I was lucky enough to have the opportunities in life that helped me get a job where not going to work for a month was OK. If I'd had a slightly less flexible situation, I would have been totally over the barrel. You cannot walk with two sprained ankles, but it's not considered a temporary disability either.

Cuz, along with universal healthcare, we're missing worker protection laws too.

On that note, you "hear" about people dying while waiting for surgery in Canada, but where's the evidence?

I don't think the stigma of a lazy person is really associated with not being able to afford health care. I think it's generally understood that even a diligent individual may have a hard time paying for health care in our system. Basically all this plan is proposing is shifting more tax dollars to subsidize health care like we have it subsidizing the post office.

I think there are two primary groups against this: rich people that are financially invested in the current health care system somehow, and middle and sub middle class people who do not believe in people getting "something for nothing"

US 16%

UK 8.4%

Public spending on healthcare (% of total spending on healthcare)

US 45%

UK 82%"

The most interesting thing about this, is that the U.S. government is spending about the same percentage of GDP on healthcare as the U.K. government. So, throw out the entire private health insurance system in the U.S., and we would still be spending roughly the same amount of GDP on health care as the U.K.

So the real question then becomes, why can we not get the same health care system as the U.K. for the money our government is already spending?

That's a good starting point for this whole discussion, I think.

One thing that has been frustrating me most is the persistent argument that Americans have treatment outcomes that are subpar. Infant mortality rates and life expectancy measures are of limited utility when comparing wealthy countries.

Concerning infant mortality, different countries count infant deaths differently, leading to over and under statements. Concerning life expectancy, Americans live lives that are relatively unhealthy when compared people in other countries. It is not a giant intellectual leap to conclude life style can account for the life expectancy gap.

Concerning actual treatment outcomes, America typically leads they way. We have a higher incidence rate of many diseases but the best treatments if you view the outcome-to-incidence rates.

Furthermore (anecdote warning), as someone who had a rare disease that still lacks any curative treatment, I have personally met a lot of foreigners. They were all seeking treatment in the US because we are pioneering most of the advances. Why? Because there is good money in it.

This is dubious in and of itself - what evidence do you have? But also, there have been a number of studies which quantified, to various degrees the effect of hospital infections, medical errors and similar things - and these real, honest-to-god quantitative studies show that these are significant cause of death in the US - any relation to the lower life expectancy in the US? That's further puzzle but we're got pretty strong evidence.

And, I would agree that US leads in pioneering treatments for rare disease. That doesn't solve that other problems here.

Health spending per head

  US $7,290
  UK $2,992

  US 2.4
  UK 2.5

This is the only real problem. It will cost the US twice as much as it costs other countries to provide healthcare for everyone.

The US can't, or can barely, afford that.

Reduce the cost to be on par with the UK and watch the entire debate fall away. I think something like 80% of people in the US have health insurance. If you dropped the costs just a little, it would be easy to cover the final 20%.

How much of that money goes to doctors vs how much of it goes to insurance companies, middle-men, lobbying, trial lawyers, billing and debt collection and what have you?

http://women.timesonline.co.uk/tol/life_and_style/women/arie...

The fact that healthcare are so expensive in America are numerous. The limited supply of doctors due to medical cartels, patents on drugs, overusage of the system by medicaid users, insurance companies being used for paying everyday medical cost, and more.

But in Canada and other places where social medicine or universial health care exists, there has been rationing of improtant services. It is also where capital structures simply rot.

I believe wealthy nations' medical system are going to crash and burn decades from now because government deemed healthcare too improtant to regulate or control, never mind the consquences of unintended effects from regulations.

The only solution is to return control of the healthcare to individuals, which are embodied in a free market. Only individuals have any chance to find a solution where centralized regulatory power and decision makers fails miserably.

What's all this talk of crashing and burning?

Really, the free market and the individual as the fundamental unit of society rarely act in the best interests of the society as a whole. That's why many governments provide centralised healthcare. They can essentially take all the money (as taxes) that would have been spent on health care or insurance in a given year, and use it to build hospitals and medical facilities that the public own. The public then gets to use these facilities that they paid for at no cost, or at a heavily subsidised rate. If more people need more health care, taxes go up, and more hospitals are built.

It's a surprisingly efficient way of doing things. Much more so than having lots of private companies, each with shareholders demanding profits be returned on top of something as basic as healthcare.

It's remarkable how our historical examples of this efficiency are so often ignored by all. I mean, consider how the soviets of the USSR succeeded in making that nation an economy to be reckoned with. And Chairman Mao's great leap forward was able to engineer a populace that succeeded in its grand goal of vaulting beyond the waste of the capitalist West. If only the industry of South Korea could prosper in the way that Kim Jong Il has guided his people into a paradise of plenty, then all Korean people could join hands in brotherhood.

If that's the level of discourse you are sinking to, you are a sad example of what is happening to this country and this site. You should be ashamed of yourself.

Right at the moment, the cost of health care and health care administration is crippling the American economy, it prevents many people from taking entrepreneurial risks because they can't afford to jeopardise their health coverage. The cost of health coverage and care and the financialization of the housing market are two of the factors most responsible for the disappearance of the middle class in this country. And if you're worried about the United States falling prey to disastrous political ideology the lack of a stable middle class is a far greater risk factor than socialized medicine.

The crux of the debate is whether the system should be centralized more or move toward individual human actors, whether these system could do better than the other, or whether it is something in between.(Ethical and political views are another story)

I believe the pundit was arguing that the most extreme example clearly demonstrate the fallacy of using central planning to do resource allocation.

Swedens, Denmark, and Canada are mixed economies which make it difficult to discern the effect of free market economies versus socialist system.

You understand the the US is atypical in the way that it treats health care? The implication that pretty much the rest of the western world is communist because they ensure that everyone has access to at least some kind of health care is completely insane. You're using the "labelling it" technique, which is essentially, "If I can give a name to the thing I'm arguing against, then it's wrong!" (see what I just did there?)

A legitimately elected government providing services that its citizens may choose to use or not use is not communism. It's also not nazism or the boogeyman.

See, I would consider healthcare a much more basic service than a huge standing military, but nobody seems to question that that should be government-operated. The USSR also had a 100% government-operated military! Wow, so does China! And North Korea! And Iran! My word, the USA must be the most terrible country on earth!

You seem to have a strange definition of communism, as well as the history of nazism. Rather, you seem to be buying into the American propaganda that "democracy is the great good".

A pure implementation of communism is necessarily democratic. Think about it. If all goods, and all production, are controlled by the body of people, then everything must be done by consensus.

And you'll recall that in Germany, Hitler was democratically elected to power, and later assumed complete control again by election.

You understand the the US is atypical in the way that it treats health care?

You're just using the eight-year-old's "but johnny gets to stay up late" technique. And the answer is the same: just because one party does something really has not connection to whether it's the right thing for a different party to do.

Anyway, the problem here politically is that the treatment of disease will immediately become politicized. In fact, it is already. People with mundane diseases will plod along, without any real progress made in cures.

But diseases having real political constituencies -- AIDS/HIV is the big example -- will get enormous research, despite the fact that they account for a relatively small portion of the populace. Today, AIDS gets many times more funding per-sufferer than does, e.g., breast cancer.

Today the government is the largest single funder of healthcare. But once they crowd out other actors, the entire medical profession will be political. That means that treatments will be put onto the approved list, and research dollars will be allocated, as a way of pandering for votes.

This isn't an abstract fear: the government does this immediately upon getting involved. For example, look at the recent GM takeover. Despite Obama's claims (continuing to this day) that they don't want to micro-manage GM, Congress immediately set out preventing measures to make GM financially viable, such as closing dealerships. Local car dealerships are a surprisingly powerful constituency, and they get the bureaucrats working in their own interests in no time.

I was being ironic and parroting the sentiments expressed in the post I replied to, which implied that my assertion that there are gains to be made by centralised government providing basic services was akin to Mao's "great leap forward" and various other things generally considered "communist". I cited Nazism just to invoke Godwin's law and make the utter preposterousness of the argument evident. Basically, the post I was responding to made the leap from "elected government providing services to citizens" to "THAT'S COMMUNISM/TERRORISM/-ISM-ISM!", which is patently absurd.

I used the "democractically elected" argument to differentiate from a totalitarian state that removes the freedom of choice from its citizens. I'm not making any value-based statement about that, rather I'm just providing a point of reference, considering that all of the countries we were referring to with government-provided healthcare are "western democracies" in the very traditional sense.

> You're just using the eight-year-old's "but johnny gets to stay up late" technique. And the answer is the same: just because one party does something really has not connection to whether it's the right thing for a different party to do.

Once again, I was responding to the tone of the post, which seemed to suggest that the entire world would crumble if they went down this path. I was simply countering that the US is one of the few countries that doesn't provide healthcare in the way I described, which suggests that it's likely that it would succeed in the US in the same way that it has succeeded elsewhere.

It's a particularly arrogant brand of exceptionalism that would suggest that something that the rest of the developed world does is somehow totally unsuitable for implementation in the US. I mean, is the suggestion there that the US is completely different from other countries with similarly-structured economies and demographics?

> Today the government is the largest single funder of healthcare. But once they crowd out other actors, the entire medical profession will be political. That means that treatments will be put onto the approved list, and research dollars will be allocated, as a way of pandering for votes.

> But diseases having real political constituencies -- AIDS/HIV is the big example -- will get enormous research, despite the fact that they account for a relatively small portion of the populace. Today, AIDS gets many times more funding per-sufferer than does, e.g., breast cancer.

There are not necessarily efficiencies of scale in medical research. Providing 10 times more funding will not provide a cure 10 times faster. Also, the general umbrella of "cancer research" almost certainly gets more funding than HIV/AIDS research. I'm not a medical professional, but I assume that significant advances made in one sub-field of cancer research are likely to have impacts within many other sub-fields (in terms of increased understanding or promising treatment/prevention avenues).

> Today the government is the largest single funder of healthcare. But once they crowd out other actors, the entire medical profession will be political. That means that treatments will be put onto the approved list, and research dollars will be allocated, as a way of pandering for votes.

That sounds like a problem with a particular instance of a government, not with governments everywhere. Most scientific and medical research funding in any country I've lived in is administered by a reasonably apolitical body consisting largely of senior members of relevant research communities. Policy makers then provide strategic direction to these bodies by setting priorities and earmarking some funding. It's really not as though political entities are governing the entire process. It's more likely that policy analysts are looking at diseases and demographics, and managing limited funds on the basis of where it can be best spent.

Not that I'm saying research funding models are perfect. In fact, they are completely bonkers. But they are not completely bonkers because of high-level political intervention.

Finally, I know I'm going to regret asking, but what is the "real political constituency" of HIV/AIDS that makes it different from any other disease with a similar number of sufferers and similar treatment/prevention options?

As for how health care is different from everything else, it's very expensive sometimes, and society has kind of decided that everyone deserves a basic level of care regardless of the ability to pay. By that I mean people will generally respond negatively to a statement such as "If you can't afford it, you can't expect to receive treatment when you break your arm." In contrast I think it's pretty reasonable to say "If you can't afford it, you can't have a car."

I don't think the government should run a health care monopoly, but there are significant flaws in the market system that require government intervention in many cases, and health care is certainly one of them.

So you are comparing food to insurance. Maybe part of the problem here is that people keep conflating government insurance with government-run health care. They are not the same. What's happening here is that the government is seeing a product that the private market is not providing, but society has deemed desirable for everyone to have. That's a pretty clear prescription for a government option (like USPS).

"Starvation insurance" is indeed a bad idea. So is "insurance" for routine care. It costs a relatively predictable amount of money to have a routine annual blood test and physical. Why can't I just pay that money myself, instead of paying an insurance company to pay that money for me? And if I can't afford it, instead of having the government set up an "insurance" company to buy me doctor visits and a dental plan, why can't they just give me vouchers for that too? Save the "insurance" for stuff that actually makes sense to insure against--things like hospital visits and so forth.

Even in a socialist system, scarcity still exists.

The free market have an obvious mechanism and it is called profit and loss.

Private health care rations treatments based on ability to pay.

I know which rationing system I prefer - for both ethical and pragmatic reasons.

If that's the definition of universal health care, no country I know has it, because there is no country I know of that has successfully banned cosmetic surgery.

Still, take birthmark removal: it's purely cosmetic, in a sense, but it makes such a difference to peoples' quality of life psychologically that it totally should be on the NHS if you ask me.

I guess the determinant of whether or not we're actually ready to move into the next stage is whether or not technology has advanced enough to make health care cheap enough to be supported through the government. Of course on the other hand if we don't make this push we may not even have the incentive to make healthcare cheaper. So in other words, we have to create some irritation to make health care less scarce, just as we have to irritate a wound to have it heal faster. Obama's plan may be that irritation. If the plan strains the national budget then we will be more inclined to figure out how to make health care cheaper, and as a result a nonissue. I mean most other first world nations have nationalized health care so it's about time to make that push right? So that basically explains why we should move towards that direction.

So as my response relates to scarcity, the plan allocates resources better by taxing the wealthier americans more. But we can't hope to support this plan by constantly creating better allocations. Obama's plan is assuming that we're at a point where medical care is cheap enough to be supported by allocating a little more from the wealthy.

An insurance company will allocate health care based on profit, the government will (hopefully) allocate it based on need, and that's where we're aiming to go to make it a nonissue for Americans (and everyone in the world ideally).

They paid for them, but there's no cost?

I see what you mean, but you see what I mean, too, no?

Please, approach the debate with some sensibility or an eye to analysis. This isn't a debate of ideologies, this isn't Marx vs. Smith, this is real people trying to get real health care, and not being able to.

That $600 is right around my total Unemployment Compensation. So yeah, I've little interest in debates on ideologies. I doubt any of the windbags above would be interested either if they had to decide between providing healthcare insurance for their family or paying their mortgage.

Never underestimate the kindness of strangers and don't be ashamed to let your doctors know your situation. Offer to trade services, presumably your reading HN so you can work with computers. I know a good number of doctors who get a lot of severely discounted home maintenance services from folks who got free or reduced payments for care.

But above all don't ever hesitate to sacrifice the mortgage payment for the sake of your children. They come first. You can swallow your pride and keep the mortgage and bank wolves away from the door for a good period of months by knowing a bit about the law.

I agree with you about ideology. This "healthcare" debate is really about a lot of issues boiling over in our society and it's not really a debate or discussion. There seems to be no common sense left.

Except for all the free healthcare in numerous other countries, you mean?

The class warfare angle is the rich and upper middle class simply don't want to pay for the poor.

The financial angle is health care industry is a big business in America and it makes lots of people money.

The religious angle is that some modern medical procedures conflict with their religious views and they don't want to pay for them.

It really goes back to the core political divide in America of small government vs. big government. The two ideologies are pretty evenly matched in popular opinion so progress is slow.

Every time you put measures in place to stop people getting something their not entitled to, you make a compromise between the percentage of people you stop vs the pain you inflict on those who are entitled.

Eg - DRM. The harder it works to make sure no one can copy something, the more pain it inflicts on those who've purchased the item legitimately. At some point you need to decide that you're willing to let a certain number of people get away with something to ease the pain on everyone else. Where you draw the line is the difficult bit.

I think that's what's happening here, but there's a certain demographic who are so determined to make sure that absolutely no one gets any sort of free ride/handout that they're willing to take the risk that they too will be disadvantaged. Instead of deciding that for the benefit of most people a few may receive a free ride, they'd rather members of their own demographic face the possibility of bankruptcy and/or death at the hand of your insurance companies.

Like I said, I honestly cannot understand this mentality.

Ironically, I have read (forget where, sorry) that many of the people protesting an overhaul are elderly people who receive public healthcare. The reason is that they are afraid it will mess up their current plan, which they like.

Politics can be very strange.

Most interesting were the life expectancy numbers, which if I remember correctly, are skewed in the U.S. due to violent death. Taking out the chance that you're going to get shot in a liquor store holdup, the life expectancy numbers are very close, perhaps even showing an edge for the U.S. (I don't have a link closeby, sorry)

In fact, looking at life expectancy worldwide and spending, it looks like people are living to about the same age in the industrial world regardless of the type of health care program they have. This, of course, doesn't address quality-of-life issues.

If people live about the same amount everywhere, then why does the U.S. spend twice as much? And that money spent across the board. In other words, it's not that public health care has any cost effectiveness to it, Americans everywhere are spending twice as much.

If I had to guess, I'd say it comes at the end of life -- a huge amount of medical expenses go into that last six months. If you cut those expenses off and made them more managed (rationed?) I bet you'd end up with very similar figures.

At the end of the day, if you make health care into something that you go to a politician to fix, you do a lot of interesting things to a democracy. Now might be a good time to think those through, instead of just pointing out how broken things are (they are broken) I favor an immediate, simple solution without government control that tries a few simple changes instead of a complex, intricate solution that few understand and fewer could fix if it didn't work. Do simple things repeatedly and fail often. Don't engineer a paperwork version of a nuclear submarine and then expect to be sailing it around the world next week.

And the two do mix, when you get shot in the liquor store but you don't die suddenly healthcare is very much in play, it might even remove that potential violent death from the statistics.

Along those lines, another well-quoted stat is infant mortality rate, which also drives down life expectancy. But in the U.S., premature babies are routinely saved much earlier than elsewhere in the world. This means that lots of premature babies are more often lost too -- thereby making the infant mortality rates look like something from a third-world country.

You can't manage something unless you measure it, but you can't measure it unless you define it. I'm perfectly happy with a very high infant death-rate and a slightly lower life expectancy rate now that I understand the definitions. But a common understanding is a key component of discussion.

So now every time somebody trots out those same old tired stats we have to have the same conversation over and over again. It's like the old myth that paying money for prevention saves money in the long run -- lots of stats sound reasonable and seem to make a simple point but don't mean what people think they mean.

That's not a good situation.

None of the numbers are comparable because of all this, it is a big mess. The error bars would have to be drawn so wide as to make any comparison essentially meaningless.