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A Preview of DuckDB v2.0

https://duckdb.org/2026/08/17/duckdb-20-highlights
228•ibotty•2h ago•33 comments

AI-Generated GitHub Copilot “Autofix” Allowed Compromise of Snowflake's Jira

https://www.wiz.io/blog/red-agent-snowflake-copilot-cicd-bug
110•galnagli•2h ago•46 comments

Launch HN: Speko (YC S26) – OpenRouter for Voice AI

https://speko.ai/
30•abdik•1h ago•9 comments

GPT 5.6 Sol is the best "vision" model OpenAI ever released

https://blog.roboflow.com/openai-gpt-5-6/
191•plurby•4h ago•100 comments

How to disable or avoid intrusive AI

https://www.librarian.net/notoai/
81•ColinWright•2h ago•25 comments

Incident with Github.com

https://www.githubstatus.com/incidents/zkxwbgr0cnmx
113•SpyCoder77•3h ago•618 comments

How to put 170 atoms in an atom

https://signoregalilei.com/2026/08/02/how-to-put-170-atoms-in-an-atom/
42•surprisetalk•2h ago•4 comments

Ask HN: Alternatives to GitHub

191•dhruv3006•2h ago•124 comments

Olo (Color)

https://en.wikipedia.org/wiki/Olo_(color)
62•inigyou•5d ago•7 comments

Apple's App Tracking Transparency treated its own apps better than rivals

https://www.bundeskartellamt.de/SharedDocs/Meldung/EN/Pressemitteilungen/2026/08_17_2026_Apple_AT...
167•nyku•2h ago•57 comments

Qwen 3.8 27B is excellent, but it defaults to overthinking things

https://simonwillison.net/2026/Aug/16/qwen-38-27b/
710•bilsbie•16h ago•332 comments

Show HN: Sokoban AI Solver

https://mkornreich.me/projects/sokoban/
41•enjoyyourlife•3h ago•29 comments

How I developed an Am29000 C compiler and web browser

https://nanochess.org/am29000_c_compiler_web_browser.html
32•nanochess•20h ago•4 comments

Anthropic's ‘watermark’ text adulteration in Claude is a perversion of writing

https://daringfireball.net/2026/08/anthropics_watermark_text_adulteration_in_claude_is_a_perversi...
611•ropbear•18h ago•538 comments

How to ship a database every day

https://turbopuffer.com/blog/control-plane
30•tarunnnp•2h ago•2 comments

Show HN: Learn Flags Quiz

https://flagquizzes.com/
15•artiomyak•2h ago•6 comments

On AI regulation and messaging

https://twitter.com/DarioAmodei/status/2088758816376807762
193•jacquesm•14h ago•391 comments

Show HN: Desktopcolors.com – A museum for solid background colors of classic OS

https://desktopcolors.com
96•vlowrian•8h ago•37 comments

Show HN: Saggar, a Mac terminal that keeps sessions and your attention organized

https://saggar.marginalutility.dev/
9•mcclowes•2h ago•1 comments

How Go detects struct copies with sync.noCopy

https://func25.dev/posts/go-sync-nocopy/
47•func25•4d ago•44 comments

A third world engineer responds to “RISC-V: They should have known better”

https://rvembedded.com/blog_post/12/
590•Narishma•23h ago•304 comments

Universal Health Coverage Could Save $1T and 114k Lives a Year, Yale Study

https://ysph.yale.edu/news-article/universal-health-coverage-could-save-one-trillion-dollars-and-...
194•karakoram•54m ago•241 comments

Online clinics and influencers are promoting Cialis as a longevity drug

https://www.npr.org/2026/08/17/nx-s1-5928263/cialis-viagra-tadalafil-longevity-heart-health
72•brandonb•3h ago•49 comments

Mexico crackdown on coastal development

https://yucatanmagazine.com/mexico-crackdown-on-coastal-development/
76•untiledsource•4h ago•15 comments

Linear algebra done right

https://linear.axler.net/
193•the-mitr•11h ago•69 comments

Reticulum – Decentralized Mesh Network

https://reticulum.network/
194•sudo_cowsay•16h ago•65 comments

The only known trebuchet casualty in history

https://arstechnica.com/science/2026/08/meet-the-only-known-trebuchet-casualty-in-history/
30•Tomte•2h ago•8 comments

Judge relying wholly on AI in order is covered by judicial immunity, court rules

https://reason.com/volokh/2026/08/17/judges-allegedly-relying-wholly-on-ai-in-order-is-covered-by...
25•delichon•2h ago•25 comments

AGI-64 Brings Sierra Adventures to the Commodore 64

https://meanhamster.com/news/agi-64-brings-sierra-adventures-to-the-commodore-64
118•erickhill•14h ago•17 comments

How do I permanently disable random Google Photos popup to backup photos? (2024)

https://support.google.com/photos/thread/256212140/how-do-i-permanently-disable-google-photos-pop...
199•dt3ft•3d ago•138 comments
Open in hackernews

Universal Health Coverage Could Save $1T and 114k Lives a Year, Yale Study

https://ysph.yale.edu/news-article/universal-health-coverage-could-save-one-trillion-dollars-and-114000-lives-every-year/
194•karakoram•54m ago

Comments

karakoram•54m ago
>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.
jonplackett•42m ago
$1 trillion less profit.
garbawarb•41m ago
That would be a massive hit to our GDP.
nemomarx•40m ago
Think of all the insurance jobs that would be hit, too. Unfortunately we've bloated the healthcare industry to have a lot of employees
panzagl•35m ago
Somehow I doubt there would be fewer jobs in healthcare if the government takes it over.
bensyverson•40m ago
Just think about the boost to our GDP by having healthier consumers who live longer, don't go into medical bankruptcy, and continue to buy stuff.
triceratops•39m ago
Not necessarily, over the long-term. That's $1 trillion more in disposable income.
ovi256•38m ago
Not at all. Reducing a cost means the payer can spend the money on something else
brainwad•38m ago
Presumably not; the same national income would just be redistributed from shareholders to insurees (or shareholders of companies that pay for employee health insurance).
karakoram•36m ago
In all seriousness, this would be a massive stimulus to the economy. Americans are consumers at heart. All the money saved on insurance and/or other healthcare related costs would then be spent elsewhere.

Cars, clothes, TVs, Labubu dolls. People will use the savings to buy things. In massive quantities.

arkh•18m ago
There is also some indirect bonus: if people's healthcare is not tied to their employer then it's easier to look for a new one. Also if the system is done well, then many companies would lose the incentives they currently have for not giving full-time employment.
oa335•29m ago
https://en.wikipedia.org/wiki/Parable_of_the_broken_window
dgellow•21m ago
Are you implying you would decide to sacrifice citizens health for a few GDP points, a somewhat useful but oversimplified metric that doesn’t reflect anything tangible?
dsr_•40m ago
$1 trillion more efficient in allocation of resources, freeing up money for consumer spending on everything.
johndevor•30m ago
Are you saying the government is an efficient allocator of resources?
bobson381•27m ago
it's that it's 1 Trillion less in incentivized middlemen. A la Graeber.
no-name-here•26m ago
Per the study we are discussing -- as well as the results from every single other developed country I believe? -- more efficient when it comes to healthcare, yes.
GolfPopper•20m ago
The government does not have the peverse incentive of putting private profit above all other concerns.
johndevor•15m ago
The government is just corrupt politicians and lobbyists. You're fighting to give them more money and power.
jkestner•4m ago
ovi256•39m ago
Not profit, just income
secabeen•36m ago
And most of that income is salaries to existing healthcare administrators. Quickly ending the employment of the people working those jobs would be a significant shock.
cityofdelusion•35m ago
Not really. Private health insurance would still exist alongside for the more wealthy (including nearly everyone on HN) that doesn’t want to wait a year for their public system MRI. Same thing that plays out in other countries. The U.S. already has a form of this in so-called concierge / premium providers too. Lots of profit to be made.
intuitionist•31m ago
This isn’t true of the Medicare for All Act, for what it’s worth. That would ban private insurance altogether. Personally I think that’s a bug, not a feature, but if you’re very concerned with fairness then you probably think the opposite.
loeg•29m ago
If private health insurance was allowed, UHC would be stillborn. It only works if providers don't have better options than medicare reimbursement rates.
no-name-here•19m ago
> It only works if providers don't have better options than medicare reimbursement rates.

1. A number of other developed countries have UHC while also allowing a private system as well - what is unique about the US that other countries' existing approach couldn't work here?

2. Less importantly, in this world where everyone has medicare, but a smaller fraction have private coverage, your argument is that the existing healthcare providers would choose to give up most of their (medicare) patients? If so, why wouldn't providers choose to stop serving medicare patients under the pre-2026 system, where giving up medicare patients would be a far smaller loss than in a world where everyone has medicare?

a-posteriori•
RajT88•24m ago
$1 trillion less middle-men.
consensus1•14m ago
Total profits for US health insurance companies in 2025 were $50 billion. The other $950 billion has got to come from cutting:

1. money to providers

2. overall healthcare consumption

3. bureaucratic redundancy and waste

1 is going to piss off medical providers. 2 is going to piss of the general public. 3 is going to piss off the 20 million healthcare industry workers who are not direct care providers. So pick your poison. This is why it will never pass.

chaps•10m ago
Have you ever dared to dream of something that sounds impossible but isn't?
jandrewrogers•22m ago
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.

larkost•10m ago
Please cite and explain what those significant issues are. As it is your post is a "trust me bro", and is not contributing to the conversation.
devindotcom•7m ago
"known" by whom, and documented where? if you're going to just parachute in and say this paper by domain experts is dead wrong, at least link to what you believe shows this to be the case.
Someone1234•5m ago
> result is known to have significant issues.

So well known you neglected to state or cite them? I'd invite you to do so now.

lapcat•44m ago
This is why it doesn't happen: politicians get bought.

"Jeffries co-sponsored Medicare for All legislation between 2013 and 2021, but in August 2026, he stated he shifted his stance and stated that he no longer supports or co-sponsors the proposal." https://en.wikipedia.org/wiki/Hakeem_Jeffries#Healthcare

brainwad•41m ago
This could equally be explained by wanting to be perceived as more moderate/centrist. Which would make sense for someone in a leadership position.
lapcat•28m ago
> This could equally be explained by wanting to be perceived as more moderate/centrist.

I don't think anyone perceives a flip-flopper as anything except unprincipled. There's nothing "moderate" about corruption.

juiceland•40m ago
Universal healthcare doesn’t happen in the US because a certain subset of the American population would rather have worse health outcomes than guarantee abortions, HIV prevention, and gender-affirming care.

Also, ~150M people with employer coverage plus seniors on Medicare fear disruption more than they value expansion.

nemomarx•39m ago
You can easily drop those from a universal healthcare system - look at the NHS and gender affirming care across the pond. So it can't only be that part - I think it's wanting the undeserving to not have healthcare.
myfavoritetings•42m ago
How much would it save if you account for the fact that half of congress would sabotage it in to oblivion?
konaraddi•42m ago
Link to the preprint https://www.medrxiv.org/content/10.64898/2026.07.22.26358689...
digitalsurgeonz•40m ago
Quite weird to see such a study from Yale, Yale is the heart of the capitalistic western empire, and it exists to serve the oligarchy and the capitalists. So then what gives ? perhaps the person working on this report is still an innocent person and has not yet seen the reality of his situation :)
basch•37m ago
or that trillion in health care isnt going into the oligarchs pockets, and could be..
t-writescode•34m ago
The last time we got similar results in the data (but not the text) was a Koch-backed study that a bunch of economists reviewed and went “so you’re saying we’d save 2 Trillion over 10 years relative the alternative?”

https://pnhp.org/news/the-mercatus-analysis-of-bernie-sander...

afavour•40m ago
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.

poncho_romero•38m ago
In what world is the Republican Party pro entrepreneur/small business enough to make these rhetorical questions meaningful?
fhdkweig•34m ago
When they make campaign promises, they go to small towns and talk about "Main St" businesses. Not sure why anyone believes them at this point (for the reasons you mention), but it is what they campaign on.
dboreham•22m ago
Oh dear. They make those statements for the benefit of people who don't own small businesses, but are "low information voters".
jvanderbot•34m ago
I think republicans could get behind some measure of portable health plans between employers. What they could not get behind is universal, in the sense of "everyone living in USA" health care footed by the US Government. The objection would be about centralization of health care funding and about, you know, who would get the benefits.
ilamont•39m ago
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.

xhkkffbf•18m ago
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.
solaarphunk•39m ago
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.
t-writescode•37m ago
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?”
aidenn0•35m ago
PT? Luxury! My daughter had PT referred by her pediatrician, then the insurance didn't pay all of it and when I asked the insurance company for the EOBs they said they were not allowed to give them to me because it would violate my daughter's privacy.
bcrosby95•20m ago
Our insurance paid for the bill from my wife's surgeon but spent 8 months refusing to pay for literally anything else, including the anesthesia. They said it was "medically unnecessary".
poncho_romero•36m ago
What about them? The Canadian healthcare system has better outcomes than the American healthcare system in several areas. Most simply, Canadians live longer.
nxm•
jvanderbot•38m ago
We've been down this road. ACA was predicated on studies like this, to no avail (it turns out).

I'm of the opinion that, if your solution requires perpetual majority control of legislative, executive, and judicial branches, your solution is in fact a campaign slogan.

I'm not saying that this is what is happening now, but I am saying that calls for universal health coverage, no matter how correct and well supported, are going to probably face the same obstacles they did last time, so we need new coalitions and implementation proposals if we're going to give it a go again. It has to be different enough that those who would oppose it right after the inevitable pendulum swing do not want to.

_heimdall•31m ago
These types of studies, and the goals they aim to support, always frustrate me as solving a surface-level problem rather than root cause.

The problem with US healthcare isn't who pays for it, its how damn expensive it is. As always there are multiple factors at play, my list would include corruption, lack of legal accountability/responsibility, and a population that is much less healthy than reasonable.

Go after any one of those and we'd make a lot more headway than trying to ram through a universal, government-run healthcare or insurance program. And yes, such a program could impact the above topics, but it doesn't have to and could make any of them worse.

loeg•30m ago
Americans just consume a lot of healthcare services. Any substantial cost savings requires providing less healthcare service.
quacked•28m ago
That's not necessarily true; fewer limitations on who is allowed to provide health service and manufacture medicine and health technologies would also drop prices. Competition in healthcare is very, very difficult because it's often illegal to compete.
ixtli•35m ago
This doesnt need yet another study. Instead of narrating the problem we should figure out whats actually stopping it. And people saying the ACA was universal health coverage or even an attempt at it should stop intentionally derailing this discussion.
nsxwolf•28m ago
Democracy is the biggest obstacle to universal healthcare in the US.

A lot of people do not want it, and you've thus far failed to make them want it.

RajuChacha108•35m ago
Government provided healthcare ? NO.
throw1234567891•29m ago
Right? What, are you all commies?
whimsicalism•35m ago
I'm honestly curious how we square this with the only experimental evidence we have on cost-sharing in the US, like the Oregon Medicaid Study and the RAND study which showed no impact on mortality or really any physical health outcomes at all.
loeg•26m ago
UHC proponents are just excessively optimistic about impact on health outcomes.
aidenn0•33m ago
I've become so cynical that I think even if universal health coverage would be passed, since it almost certainly would be run by the executive branch, it would become just another political football to be fucked with every 4 to 8 years.

Just think, if we had universal health care in the US today, the MMR vaccine would not be covered by it!

greenpizza13•32m ago
The US is far too broken for such a thing to ever come to be. Politicians are bought and paid for, and the impact on the insurance companies and their profits make this impossible.

US legislators will never, ever, ever put the needs of the people above the needs of corporations, not as long as corporations can wield their massive wealth as "free speech" in the form of lobbying and political donations.

Sounds nice, though.

whimsicalism•30m ago
I'm earnestly curious what the alternatives to CU look like and what that would mean for for-profit companies like The New York Times?
consensus1•23m ago
Nobody, including congress, gives a rat's ass about insurance companies and their profits. The truth is that someone has to approve or deny healthcare. Every universal system does it too, but by government policy instead of corporate decision. After the CEO of United Healthcare was gunned down in the streets for doing that thankless job do you think congress is saying to themselves "hey, maybe we should get into that business"?
googaar•19m ago
Man I wish I could downvote a comment. This is what you’d see on Reddit.

“Thankless job” is a crazy way to describe United Healthcare.

No one cares about insurance companies and their profits?? This doesn’t even make sense, so many people rely on insurance and many stakeholders profit off the American insurance system.

whimsicalism•18m ago
You would never see content like that on Reddit as it is far outside of the political valence there.
b3ing•32m ago
Won’t happen the big players make too much money the way things are, and that is more important than people’s lives or for our country
loeg•31m ago
What UHC proponents never honestly admit is that these headline figures require incredibly optimistic assumptions and also much more rationing of care than our current model. We spend a lot on healthcare because we consume a lot of services. To save money, you have to buy fewer services. Yes, you can squeeze providers a little bit ("Medicare-level payments to providers" -- which they will absolutely hate, by the way), and you get another little bit by disposing of insurance provider profit margins ("reduced administrative overhead"). But the vast majority is coming from rationing, which people hate. And it would also cost massively increased taxes on the middle class, which voters also hate.

"Fewer avoidable emergency department visits and hospitalizations" -- sheer optimism. "Less fraudulent billing" -- no reason to believe this would be true. There could be even more fraudulent billing! Medicare fraud has been a big problem, and solutions are largely reactionary.

AlfredBarnes•30m ago
.....yeah
ConceptJunkie•28m ago
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.
jayess•28m ago
Who's gonna tell the doctors and nurses that they get a 50% pay cut?
qaq•19m ago
Do they need to get a 50% paycut? Dealing with insurance companies takes a ton of time and resources.
Lord-Jobo•14m ago
You think they’re getting so much money from out current system that cutting out insurance companies would result in a 50% reduction in their pay? Have you ever looked up the size of the health insurance sector here?
dotcoma•27m ago
Yeah, but how much would it cost in profits?

That's the only thing that matters in Amerika.

dboreham•26m ago
Ok but it doesn't save the donor class anything, so it won't happen.
brandonb•24m ago
I'd like to believe this, but the study makes a bunch of really hasty assumptions.

The authors derive the $1T number from $1.3T in total cost savings and $304B in incremental spend (incremental spend is due to insuring more people). The $1.3T in cost savings come from five big buckets: lower pharmaceutical prices, Medicare-level payments to providers, reduced administrative overhead, less fraudulent billing, and fewer avoidable emergency department visits and hospitalizations.

The buckets themselves don't necessarily survive much scrutiny.

Take "Medicare-level payments to providers". Hospitals have an operating margin of 2-5%. Medicare pays 50% less than private insurance. So doing this would require either layoffs, cutting salaries for doctors/nurses/etc, or both. This may well be the right decision for society as a whole--that's a big part of the debate here--but there's not necessarily a free lunch.

The line item of "fewer avoidable emergency department visits and hospitalizations" assumes greater insurance coverage leads to greater access to primary care. It's true that great primary care prevents hospitalizations, and can be a net cost saving under certain assumptions [1]. But, we're actually in a primary care shortage. Existing insurance payments for primary care are low enough that private practices are going out of business and fewer residents are going into family medicine. Cutting rates (the paragraph above) would make this worse.

For "less fraudulent billing," a lot of people in the industry believe that Medicare has a large amount of undetected fraud. That's unfortunately the flip-side of reduced administrative overhead. The authors assume an 8% savings here, but the 2003 paper they cite uses the word "fraud" only twice and doesn't give a number.

Healthcare reform is hard.

[1] Reasonable breakdown on the economics of advanced primary care models: https://olearykm.medium.com/the-cost-equation-for-new-primar...

bpt3•24m ago
There are many studies from reputable sources (one being the CBO) that say it would result in almost no savings or potentially even higher costs, just like there are many studies like this one that say there will be massive savings with no reduction in quality of care.

I support universal health care, but each side just lobs whatever data supports their position at the other without any real thought. Most people in support of a universal health care system seem to be completely unaware that the vast majority of households are happy with their current coverage (whether they should be or not isn't relevant really) and are not looking for someone who claims to know better to "improve their medical care" through a entity (the US federal government) that is generally not known for improving almost any situation it interacts with.

I personally would like to see Medicare opened up to the public as an option. It's simple, doesn't require anything of anyone who doesn't want to participate, and should be a reasonable test for the claims of cost savings. If it's truly a better option, people will move to it. If not, then the conversion will not happen.

Barring some sort of catastrophic financial or medical event, there is a 0% chance that anyone can make a radical change to the status quo.

calvinmorrison•23m ago
Baumol's cost disease is the simple answer. until healthcare stops improving outcomes and or we reduce labor cost will go up
Taikhoom10•23m ago
Bro nothing is free, if the goverment pays for all of us, then it is our own money being used for that, we have the most liberal tax code in the world, we spend the most in healthcare.
richwater•21m ago
There is already a healthcare program run by the US government and it's called Veteran Affairs. Veterans can't even access the care they need resulting in almost twice the risk of suicide.

I'll pass on mandated, outlaw-private-insurance government healthcare, thanks.

Aunche•20m ago
People talk about policies like they're something like can be picked up off the shelf at supermarket. If you could take the policies and Sweden copy-paste them to the US, then sure, we could save $1T and a hundred thousand lives. This would be a very difficult thing to replicate if you're a country without any existing healthcare system. It is impossible in a country with an extremely mature healthcare system, which accounts for nearly 20% of GDP.

No politician is going to want to deal with the fallout of massive layoffs or millions of people having their coverage changed (e.g. no free chiropractor appointments or GLP-1s for weight loss), especially since the Democrats suffered one of the worst Congressional losses in US history the year the ACA was passed. There are ways to make this transition less painful, but the only people interested in health policy are those who make money from healthcare, so you generally only see solutions that involve throwing money at the problem. We need regular people to develop an understanding of health policy or else we'll end up with a policy that merges the worst parts of a planned economy and capitalism even more than today.

th0raway•19m ago
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.

peyton•7m ago
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.
gryfft•18m ago
I wonder how many people would be on board for a program to make Medicare available for free for households making over $100,000 annually with 1-3 children.

We're talking about families that are provably not lazy or sucking up handouts: taxpaying citizens with beautiful, healthy children. The job creators and professionals driving America, securing their future and their children's future.

If the government were to focus on these first-class citizens, who knows what could be accomplished once the drag is taken off the system of the useless eaters and the welfare queens.

fragmede•15m ago
That's a very funny way of looking at the world.
gryfft•4m ago
Many people feel that winners should be rewarded and losers should be punished.

Systems thinkers may try to push notions of connectedness in societies, and moralists may try to push notions of universal equality of human dignity, but in the end, both are overwhelmingly outnumbered by tribal thinkers, who wish to harm the outgroup at absolutely any cost.

rohan_•16m ago
How on earth have administrative costs been soaring when there have been so many healthtech startups propped up in the past 10 years to bring down the cost of administration?

Also - given the rate of AI progress, shouldn't we see this cost go to zero essentially.

hathawsh•13m ago
Last time I joined a discussion about US health care on HN (years ago), the picture looked bleak: secret chargemasters in every hospital, no realistic way for patients to compare options because the options are too complicated, and lots of people still falling through the cracks.

I can't help but think the picture looks very different now. There is growing awareness that chargemasters can not be secret. LLMs offer a way to overcome the complexity of choosing options, opening doors for real competition. I sincerely hope we can take advantage of this changed landscape to provide better care. Universal health care remains an interesting possible direction, but I now have hope that we can do a lot better within the existing laws.

lettergram•8m ago
Ah yes, the claim free money would save lives!

The truth is once systems like this are implemented they change the dynamics of the study and as such could hurting lives.

As a simple example, the biggest cost to the healthcare system in the US is dialysis. Many of those folks already have health issues, and by both dialysis and for all the issues that caused the need for dialysis in the first place is a massive strain. The direct cost of dialysis is $33B annually [1], but indirectly is probably at least another doubling.

Further, the way the government has imposted monopolies in the space already has caused costs to balloon. While making it "universal" could mean the government gets control, and can limit the explosion. It can also could result in weird incentives like Canada, where they're promoting MAID.

[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC8729831/

etchalon•7m ago
It will never not be funny that whenever universal health coverage comes up, Americans will act as if it's some impossible task that wouldn't solve any problems when the rest of world seems to have sorted it out just fine.
DrScientist•6m ago
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?

The government is more directly accountable to me. The only way I have to influence what insurance companies do is through the government.
johndevor•1m ago
You can switch insurance companies, no?
consensus1•1m ago
The perverse incentive of the politician / general / bureaucrat to favor their personal interest over the public interest is identical to the perverse incentive of the CEO to favor his personal interest over the same.

I would argue the government case is actually much worse because at least the CEO has the feedback mechanism of revenue because the company <> customer relationship is entirely voluntary on both sides. The public vote is supposed to restrain the government in the same way, but in practice it seems to be much less effective in restraining politicians than the customer is at restraining companies.

grim_io•18m ago
If that wasn't the case, DOGE would have found any waste worth looking at.

It was not for a lack of motivation or a lack of cut-throat pursuit, consequences be damned.

timcobb•29m ago
They don't care about this stuff
hx8•20m ago
The non-healthcare sectors of the economy do.
3m ago
What are you proposing happens to providers who freely contract with patients at rates above Medicare reimbursement?
kennywinker•18m ago
Having the machine capacity to get non-urgent MRIs in hours is part of why US healthcare is so expensive. Anyway, the average (again for non-urgent MRIs) where I live in canada is 9 weeks, which is i am sure skewed due to the rural population. In the city it’s like half that.
strictnein•8m ago
Yep, in the US my wife had to wait a day. She could have gotten it the same day, had her injury been a little worse.

There's this idea that there are no upsides to the American system, only downsides.

mmooss•29m ago
There's also a racist element (I know that's a politically incorrect word here, but such things happen). People don't want to fund services to the lazy ______s - fill in one or more of many groups toward whom hate is promoted.

When a similar bill was voted down years ago, someone I was with laughed and said, 'no way were we paying for healthcare for the Blacks'. It fits the divide and conquer strategy to divide poorer people with hate so that they don't unite and vote for all these things - why do you think leaders promote hate?

nsxwolf•25m ago
Another way of looking at is that some people are concerned about what happens to limited "free" healthcare resources when you simultaneously oppose any controls on immigration.
triceratops•37m ago
One of two major political parties, and the one that currently holds all 3 branches of federal government, has labelled it un-American and communist. And yet you point the finger at...a Democrat.
lapcat•31m ago
> the one that currently holds all 3 branches of federal government

The key word here is "currently". When did Democrats ever propose or pass single payer when they were in power?

Moreover, when the leaders of both parties are opposed to single payer, how in the world do you expect it to ever pass? Jeffries wants to be Speaker of the House after the midterms. If he's opposed to single payer, then there's no hope for it.

The majority of Democrats support single payer. That's why I'm pointing the finger at a Democratic leader. I don't expect Republicans to support single payer. What I expect is for Democrats and Republicans to have opposing views, not the same views.

triceratops•25m ago
> Moreover, when the leaders of both parties are opposed to single payer, how in the world do you expect it to ever pass?

I don't. However, if I were a betting man, I'd bet on the Democratic leadership to come around well before the Republicans. Not least because a significant, non-zero fraction of their politicians are already in favor of it (compared to the other side, which has close to zero).

Without a 60-strong majority in the Senate, which must necessarily include some Republicans, it'll never happen. So ultimately Republicans are the bottleneck.

lapcat•15m ago
> I'd bet on the Democratic leadership to come around well before the Republicans.

Jeffries was already around. He supported single payer but now rejects it, so he's moving backward.

> Without a 60-strong majority in the Senate, which must necessarily include some Republicans, it'll never happen.

Democrats had 60 during Obama's first term. They'll always find a rotating villain to oppose it, Joe Lieberman, Joe mansion, etc. Anyway, the filibuster can be eliminated. In 2013 Democrats eliminated the filibuster for most nominations, and in 2017 Republicans eliminated the filibuster for Supreme Court nominations.

triceratops•13m ago
> Democrats had 60 during Obama's first term. They'll always find a rotating villain to oppose it, Joe Lieberman, Joe mansion, etc.

So what do you propose? Is there a 3rd party that has a reasonable chance of doing it?

Maybe if you flip a few Republicans (to supporting UHC) it might go easier. It'll give their leadership something to think about at least.

mmooss•35m ago
There are many reasons Jeffries might change positions; why do you say the reason was that he was bought? Is there evidence?

Many Democratic politicians are moving away from progressive positions, including Ocasio-Cortez. They seem to be following the old (and failed) Democratic Party tactic of moving to the center to get elected.

lapcat•23m ago
> why do you say the reason was that he was bought? Is there evidence?

Look at his health PAC contributions over time:

https://www.opensecrets.org/profiles/hakeem-jeffries/us_cong...

dboreham•21m ago
People of color?
jvanderbot•15m ago
I doubt POC would be the main issue. I do think immigration status would be front and center. They do overlap, but not entirely.
spicymaki•32m ago
That wing of the Republican Party does not exist anymore, they are now centrist Democrats.
strictnein•12m ago
They used to be, before Trump and the MAGA clowns destroyed the party. So prior to 2015 or so.
RajuChacha108•34m ago
If you could say Universal Healthcare only for MAGA white people Republican Party will get behind it. Especially if there is some opportunity to commit large scale fraud.
jalapenoj•29m ago
I suspect Medicare will be defunded once enough non-Whites are on it.
theappsecguy•34m ago
The party in the pocket of BigCorp, that party...?
hilariously•34m ago
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.
etc-hosts•32m ago
The Parties and Capital have multiple tools for disciplining Labor, health insurance tied to your employment status is one of the more effective ones.
jkestner•31m ago
BigCorp gives money to politicians and gets to depress worker wages because they can't leave — sounds perfectly sane to tie your insurance to your employer under capitalism.
ChicagoDave•30m ago
The original universal healthcare plans were promoted by the GOP until Hillary got involved and it became a political football.
bluecalm•29m ago
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.

mikestew•26m ago
A more sane world, you say? How about the Nixon administration, where Nixon proposes a universal healthcare system to Congress?

https://kffhealthnews.org/news/nixon-proposal/

cactacea•10m ago
> 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.

31m ago
6 month median wait time for treatment, as in the case now in Canada, is not something I'd trade the American system for.
shigawire•21m ago
The difference is wealthy people get the care immediately in the US while the poor can go to the ED and get a bankruptcy.
otherme123•15m ago
I also feared this, until I read that some US citizens avoid going to the doctor until it is unbearable. Take this examples: here in Spain you go to the doctor because you think that mole is slightly bigger than past year. They point you to the dermatologist in january 2027, a terrible 6 months waiting. In the US a lot of people thinks "hey, doesn't look that bad, and it could cost me $5,000". Five years pass, and now the mole is five times bigger, it bleeds and... well, it is a full blown melanoma: you get to the dermatologist 1 day after consultation, yet is too late.
hbn•21m ago
I'm 29 and when I was a kid, getting a family doctor used to be an easy task and if you needed to see your doctor you could get in that day. Now all the doctors are so overworked, they're fleeing to America where they can get paid a reasonable wage for a reasonable amount of work. If you can even get a family doctor, if you want to book an appointment, they'll ask you which day you'd like 4 months from now.

My mom's been dealing with an issue with her lungs for the better part of the past year, and trying to get help through any of the intended methods just gets her put on a 2 year wait list. At this point her plan is to pay tens of thousands of dollars out of pocket to see a specialist in America.

The current generation of elderly Canadians now having lived a long life spent most of that life in an entirely different Canada. My generation is going to die on a waitlist.

skuzye•35m ago
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.
otterley•32m ago
This is frequently true in the USA as well. My provider's dermatology department is pretty backed up and couldn't make me an appointment for an excision until November. Fortunately it's not urgent.
nxm•29m ago
Do you have any more evidence than this anecdote - pretty much any specialist is available this week in my area. Did you check ZocDoc?
otterley•25m ago
I'm a Kaiser member, so I have to use their providers. The same restriction would hold for any HMO that has a closed provider list.

You should see how long their surgery departments are backed up!

dpkirchner•18m ago
Are all of those specialists "in-network"? Have you tried contacting them to see if they truly have availability? It's common for providers (or the insurance carrier), at least in my area, to claim they take new patients when in fact they do not.

(For those not in the know, out of network means costs to the patient are much higher).

ElProlactin•15m ago
https://healthjournalism.org/blog/2024/08/in-the-u-s-wait-ti...

https://www.chiefhealthcareexecutive.com/view/hoping-to-see-...

ZocDoc isn't reflective of availability as a whole. It has a lot of depth in certain areas, like dentistry, dermatology, and primary care, and less in other specialties. Many of the providers are not physicians, they're NPs and PAs. Perfectly qualified for certain kinds of issues but not others.

ZocDoc is also, obviously, working only with the providers who are willing to pay for new patients, such as newer practices trying to build a patient base. An established practice that is booked out for the next two months obviously isn't going to use such a service.

Finally, you're not considering insurance and continuity of care.

So yeah, in an urban area, you can probably find someone to see you sooner than later if they're in network or you can afford to pay, and you're okay with seeing someone you might never see again or with whom there might not be continuity of care.

slibhb•18m ago
Anecdotes aside, here's some data:

https://benchmarkcanada.org/Governing_Healthcare-Wait-Times....

The US does far better than the UK and Canada.

otterley•15m ago
That's AI slop published by a think tank, not to be trusted. It's not primary source data.
slibhb•7m ago
I'd love to see some other data. But afaik it's basically not contested that the US has shorter wait times than the UK and Canada
otterley•4m ago
I agree with the main point. The thing is, in the US, wait times are a function of how much you're willing to spend. You can always pay for priority. But most people won't pay more, and the reality is that most healthcare systems have far less provider supply than demand, particularly in dense urban areas where most people live.

According to a family member who's a physician and university professor, things are about to get a whole lot worse: the current administration is constricting the pipeline of the next generation of physicians by cutting off the NIH grants that pay medical residents' salaries.

linsomniac•10m ago
Agreed, it was 2-3 months wait to get to see an ENT for me last year. My daughter's regular eye check identified a problem and it's 3 months to get her into an eye specialist to review it.

Somewhat related: a couple years ago my spouse had cancer, and the doctor could do surgery either 5 days after our insurance was changing companies, or 2 months after that, those were the next two openings. The insurance said that if we proceeded with the surgery, without the new insurance company giving us approval, but they couldn't start approving it until the insurance started, and the pre-approval from the other company didn't give us anything. We finally decided to go ahead with it and take on the risk of ~$70K if it was denied. Which we decided to do rather than my spouse spending a few months worrying. Turned out that was a really good call, because when they did the surgery it turned out that instead of the expected slow growth, it was actually growing extremely fast. That was probably the difference between it being fatal and it being treatable.

The US system is far from smooth.

FireBeyond•28m ago
Hah, even with "platinum" healthcare in the US, urology referral, 4 months. "You should start PT immediately" after a car accident, "we can see you in 5 months".

"Oh, your septum is deviated ~90% on the right. Surgery? No, first you need to go on these nasal sprays for a few months so we can decide they didn't reshape the cartilage in your nose before your insurance will decide whether they want to "allow"[1] surgery."

[1] Insurers will always say, and have won in court, saying "We don't allow or deny anyone any care they need. We are just saying we won't pay for it."

jayess•25m ago
I got my urology referral last week and had an appointment this morning...
otterley•12m ago
Lucky you. Maybe they had a last-minute cancellation, or you live in an area in which supply of urologists exceeds demand.
cpuguy83•25m ago
The US is not much different. We don't have a wealth of specialists available to see people right away.

I've flat out been rejected from a specialist because they had no availability at all. I actually tried again and got to be seen, but an appointment is months out, always.

BeetleB•15m ago
> If you need to see a specialist, you regularly have to wait months, assuming you can even get a referral in the first place.

Two months can be a luxury. With my insurance in the US, it usually takes longer for me to see an in-network specialist. For my kid, it has often taken over 6 months.

Of course, none of these were urgent, so it was fine. If it really was urgent as deemed by a medical professional, I likely could get a quicker appointment.

But my friend, who has even worse insurance, developed a condition and was having trouble getting a diagnosis. He got referred to neurology, and none of the in-network specialists had an appointment for over 2 months. His condition made it hard to sleep every night (averaging about an hour of sleep a night). Due to the lack of sleep, he couldn't function at work. Took a leave of absence, got a plane ticket to go to a relative's country, got to see a neurologist the next day, got treatment that day and had his first good night of sleep in a long time.

Lost his job because of it, though. Unsure what his medical insurance situation is while living on welfare...

triceratops•35m ago
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.
t-writescode•32m ago
No.

For a lot of people it very much doesn’t. And the cost is very prohibitive for people getting any care at all when insurance doesn’t cover it, so they end up not getting necessary care and then ending up on disability for life.

A healthy population *makes money for taxes and buying things*, too.

triceratops•31m ago
> For a lot of people it very much doesn’t.

It was a rhetorical question. I'm aware it doesn't.

intuitionist•34m ago
The private option is medical tourism to Buffalo or whatever.
dbspin•32m ago
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.
slibhb•27m ago
Canadians can (and do) just cross the border and use private US health care. The vast majority of them live near the US border.
Tepix•29m ago
So the government provided healthcare covers everything then? If not, you cannot legally get it by paying for it by yourself? Curious.
jplrssn•21m ago
My understanding is that a clinic or hospital can’t legally charge you for a procedure that’s universally available through the provincial healthcare system.

So you’re free to pay for anything else if you want.

dev_daftly•27m ago
They have also started recommending patients just kill themselves too
ses1984•26m ago
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.

cgh•16m ago
Yes, roughly 30% of health care in Canada, from dental care to cosmetic surgery, is privately funded.
a_square_peg•26m ago
I think the tradeoff is that in the US, on average one gets to spend about $4000 more per year and live about 3 years less when compared to Canada.

https://commons.wikimedia.org/wiki/File:Life_expectancy_vs_h...

jandrewrogers•12m ago
The differences in life expectancy are due entirely attributable to vehicular accidents, homicide, and life style factors. It has nothing to do with medical care.
zulban•23m ago
There's problems with every system, but as a Canadian, it doesn't sound like you know anything about our health care.
al_borland•23m ago
My dad, in the US on Medicare (one of the government funded systems), was denied a test. Because we have the option and had the money, he went and got the test himself on his own dime. That kicked off a series of events that led to a quadruple bypass, avoided an impending heart attack, and likely added many years to his life and his ability to remain and functioning member of society.

While I love the idea of never having to think about health care costs for a variety of reasons, I do like that some services are available to anyone with a wallet and not locked behind government controlled gates.

apothegm•20m ago
The availability of universal healthcare does not preclude the availability of privately paid healthcare as well.
otherme123•21m ago
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.

GreenPlastic•14m ago
This is what is never mentioned. Quality of care, access to cutting edge treatments, timely access to care are never discussed when moving to universal healthcare. There are examples of private and public systems out there, which would be a much better model.
BarryMilo•3m ago
The number of ridiculous claims in this thread...

First off, all Canadian provinces are different. Here in Quebec, there is a absolutely a private option. Not everyone likes that it exists, but most people seem to like having that option.

Canadians live better for longer on average (for cheaper healthcare overall). Any other metric is just a misguided attempt to justify the US status quo, which has nothing going for it unless you're rich.

whimsicalism•22m ago
You're actually talking about the same problem. Competition in healthcare is heavily restricted by stuff like certificates of need because there is little cost-sharing with utilizers so you get overutilization & induced demand. This is Roemer's law [0]. A large part of the reason for competition restrictions is because of a hacky attempt to control overutilization without direct cost-sharing.

0: https://en.wikipedia.org/wiki/Roemer%27s_law

t-writescode•27m ago
Citation needed (per capita please).

Given that people constantly, literally AVOID care because they can’t pay for it until it’s such an absurd problem that it’s very, very expensive, I struggle to believe this, at all.

And money amount doesn’t matter in this evidence because, again, Americans regularly avoid care until it’s catastrophic because they literally can’t afford it and/or have to wait for insurance to meet a certain harm level threshold where it literally can no longer be argued (emergency care)

SoftTalker•21m ago
I think a citation is needed for "Americans regularly avoid care ... because they can’t afford it."

I think there are other reasons, e.g. they don't like doctors, or it's too inconvenient, or waiting times are too long. I have good insurance and haven't seen a doctor in probably 20 years.

I know people who are visiting the doctor for every sore throat, ache and pain or sneeze and sniffle, and that's not me at all.

TimorousBestie•15m ago
Here you go, a recent survey: https://www.jgwentworth.com/resources/medical-emergency

> The survey showed that over nine in ten (92%) of insured respondents had delayed or avoided medical care because of concern about cost.

> In fact, 95% of those surveyed said a medical emergency would likely put them into serious debt even with insurance.

SoftTalker•9m ago
An unexpected car replacement would put most people into serious debt. And there's no insurance for that.

People get so hung up on the idea that they should have to pay for health care, when you have to pay for every other necessity in life.

bpt3•21m ago
The people who avoid care they need because they can't afford it are a very small portion of the population that gets an outsized share of attention on the issue.

Until public healthcare advocates understand this and make actual attempts to convince the majority of people who are satisfied with the current system that there are benefits, the status quo will remain.

expedition32•4m ago
Half the population does not vote. This is the problem socialists have- how do you get the underclass to exercise their power against the bourgeois?
tmgldn•1m ago
I'm not convinced that your assumption that they are a very small portion of the population holds up, but I only have the same anecdotal evidence you likely have.
th0raway•6m ago
The wonders of American healthcare really mean that it's all more expensive, and at the same time, more is consumed, because so much of what is paid is done past deductible. If you look at so many standard of care situations vs, say, Spain, the American system will do a whole lot more. Even for preventive care: For instance America wants colonoscopies every 10 years from 45. Spain will give you a non invasive fecal test every 2 years, and only consider colonoscopies after the test is positive. Every time I send my american prescribed intervention list, given my symptoms, to my family members working in the Spanish public caresystem, they look at it with their hair on fire. Very different standards. You might think US insurance is restrictive regarding what needs to be done, but most public care system are significantly more restrictive than that. It'll be for better reasons, instead of defaulting to no on everything, but ultimately still far more cautious regarding their spending.

So we fail both ways at the same time: We avoid interacting with the medical system, but when we do, far more is done, at far higher price per intervention, so we end up with more interventions for the same outcome, even though we avoid doctors more!

dboreham•25m ago
In some cases they are provided healthcare services without a choice, so they're not really "consuming" those services. E.g. tests that don't change outcome but do cover a provider from a legal risk.
hx8•23m ago
> The problem with US healthcare isn't who pays for it, its how damn expensive it is

Saving $1,000,000,000,000/yr is directly addressing how damn expensive it is.

_heimdall•3m ago
(1) we don't know the claims of the study will be accurate if implemented and (2) we would need studies modelling cost savings of alternative approaches to actually compare anything.

Obamacare made wild claims about cost savings as well. That didn't work out for many reasons that could show up again with another universal healthcare push.

nsxwolf•21m ago
We never attempted to solve the issue of distorted price signals that occur when customers aren't the ones paying for something. We're still charging $600 for a bag of saline.
jtbayly•9m ago
Especially when the buyer and seller are the same huge monopoly entity, but the payer is “somebody else,” the incentives are completely perverse.
Retric•20m ago
No, it’s not a question of who pays for it but who benefits.

You could have universal health with zero additional spending by the US government, but all that administrative overhead is someone’s income.

QuercusMax•13m ago
Companies don't hesitate to lay people off when their jobs aren't needed. I don't see why these parasitic insurance companies need to stay in business.
hnlmorg•20m ago
The point of nationalisation is to address those underlying concerns. But it’s fair to say that in practice, nationalisation doesn’t always solve those problems.

The problem is you either need to regular or nationalise. And neither of those are particularly “American”.

giantg2•18m ago
"The problem with US healthcare isn't who pays for it, its how damn expensive it is."

And also how much is required. I bet a study investigating how much money and lives could be saved by reducing obesity would have 2x numbers

larkost•13m ago
I agree that this proposal would not solve all of the problems; absent more changes you would still see the creep up of healthcare costs at too high a rate. But slashing $1 trillion off of a $5.3 trillion costs is a pretty big bite of the apple. Even if you go with the more conservative $663 number, that is still a great first step. And both of those numbers are after adding the costs of covering currency uncovered people. So we are collectively getting more for significantly less money.

It does this by eliminating a very inefficient layer of our current system (insurance companies), and by having there replacement for that (the government) negotiate on drug prices (how much savings there is the reason there are two estimates). Currently insurance companies almost have a negative incentive to push down drug prices (their profits are limited to a percentage of total spending, and most large companies are pushing against that limit).

Most of the cost control pressures in our current system come out of Medicare/Medicade, and this would widen that out to the whole system. That in turn would wedge open the door to pushing on the other drivers of the cost spirals: hospital administration, new expensive drugs that are not worth the additional costs, doctor salaries ballooning, and the broken system between malpractice insurance and dysfunctional enforcement against malpractice.

SpicyLemonZest•9m ago
It's extremely challenging to go after high costs in the current system, because the doctors who charge them are popular and the insurance companies who pay them are hated. There was a 2024 story that stuck in my mind (https://www.npr.org/2024/12/05/nx-s1-5217617/blue-cross-blue...) when Anthem tried to negotiate down the rate of certain anesthesia procedures; the public was absolutely outraged, successfully demanding that Anthem must back down and accept whatever the doctors feel is the appropriate pricing model.
bcrosby95•5m ago
I have a strong dislike for the industry as a whole. There's too many ridiculous situations I've been subject to, along with hearing of some from my friends.

My favorite was a friend who had to deliver her child, alone, in a hallway, because they forgot about her. And the hospital billed her for it. LOL.

hintymad•4m ago
> The problem with US healthcare isn't who pays for it, its how damn expensive it is

Exactly! There's so much paperwork that a doctor sometimes need two assistants just for the paper work. There's so much cost for independent practice that increasingly more doctors end up joining big hospitals. Charges with and without insurance have a huge difference. Just to name a few.

Tepix•31m ago
> if your solution requires perpetual majority control

I think once universal health coverage is established, it amounts to political suicide to try to take it away again.

TimorousBestie•28m ago
I don’t think “political suicide” exists anymore.
shigawire•25m ago
We still have Social Security for now. Entitlements are sticky for better or for worse.
warkdarrior•18m ago
Social Security in its current form will be gone within two years. Instead you will be required to pay a contribution (just as you are now) but the money will be managed by a private company who will charge fees and provide no guarantees. Current retirees will get to keep the current arrangement, everyone else will be moved to the privately managed Social Security option.
cogman10•21m ago
We still have Medicare, Medicaid, and social security. Even though each program has been weakened, none of them have been abolished and they can all be restored.

Heck, we still have SNAP, even though it's almost universally hated by republicans.

nozzlegear•20m ago
It doesn't exist for politicians who hitch their wagon to Trump and MAGA; their base rewards loyalty. For everyone else, political suicide is still very much a thing (see the various conservative republicans who've chosen to go against Trump over the years and have been cast out in favor of new loyalist challengers).
saghm•14m ago
> It doesn't exist for politicians who hitch their wagon to Trump and MAGA; their base rewards loyalty.

These are the same ones who currently would be able to repeal the ACA tomorrow if they felt like it. You're essentially asserting that the reason they aren't is that they like the policy, and I don't think it's crazy to expect more justification for a claim like that if you want people to find it compelling.

saghm•17m ago
We're talking about healthcare, so you're essentially claiming that the reason the GOP has failed to repeal the ACA despite numerous opportunities is because they actually like the policy, not because they're afraid of the political fallout. Can you elaborate more on when and why you think that happened?
krapht•23m ago
Yep. Nobody has repealed Medicare, for example
hx8•22m ago
Social Security is another great example.
mapt•29m ago
"If your solution requires addressing the slow-burn civil war, your solution is just a campaign slogan".

Essentially, all solutions require addressing the slow-burn civil war, which is today capable of of subsuming any issue. Not a single policy issue can realistically be addressed while the rabid 800lb gorilla is in the room. That gorilla is not Trump, that gorilla is Heritage, Fox News, Koch, et al.

epistasis•29m ago
ACA has saved tons of lives. Due to the intense opposition, it was not structured in a way that could save money, but rather structured in the way that it could get through congress.

Additionally, as somebody who was around pre-ACA, I can not tell you how much better, in every single way, the post-ACA healthcare world is. Pre-existing conditions? Access to healthcare as an individual? These are life-changing possibilities, especially for entrepreneurs.

There's a very clear type of fallacy you are engaging in here that only works in politics: you're taking a vague general idea X, ignoring all particulars, and then lumping an idea Y together as if they identical and that any change in that general direction of Y could ever be different than what happened with X. There's no intellectual rigor or honesty in that sort of thinking, yet it somehow pops up throughout all of politics.

strictnein•22m ago
> ACA has saved tons of lives

It was the Medicaid expansion that has been cited as saving lives [0]. An expansion that has almost nothing to do with the rest of the ACA.

> "There's a very clear type of fallacy you are engaging ... There's no intellectual rigor or honesty in that sort of thinking"

So you're claiming that the person who posted that is not only falling into a fallacy, but they are neither intellectually rigorous or honest? I think you're reading a lot into their comment which seemed pretty benign, but possibly contrary to your viewpoint?

[0] https://news.uchicago.edu/story/new-research-shows-medicaid-...

epistasis•19m ago
> An expansion that has almost nothing to do with the rest of the ACA.

That's a very strange assertion, it's literally "the ACA medicaid expansion" and was a key part of the whole thing.

I'm saying most political argumentation is dishonest and not intellectually rigorous, and that's what the comment was doing. It wasn't arguing based on facts or data or actual specifics, but rather according to vague political ideologies.

That's one reason that I believe politics are discouraged on HN. It turns off our brains and we start using less interesting or useful ways of thinking.

czgov•15m ago
Your linked to article does not demonstrate what you claim it does. Your reasoning is wrong.

Medicaid expansion was a big part of the ACA.

strictnein•6m ago
> "Findings suggest Medicaid expansion under the Affordable Care Act saved about 27,400 lives between 2010-22, including among younger adults."

> "Their findings show that Medicaid expansions led to a 12% increase in enrollment and significantly reduced mortality—not just among older adults, but also younger ones, who accounted for nearly half of the life-years saved."

Huh? Did you read it? My point was that we could have just expanded Medicaid to achieve this.

blitzar•2m ago
> we could have just expanded Medicaid

Laws need votes.

mcphage•4m ago
> Medicaid expansion was a big part of the ACA.

Well see, first you narrowly define the ACA to be "everything that didn't help"...

lvl155•21m ago
Let’s be honest, it was DOA. Even Gruber admitted to it later. The whole thing was basically a scam.

Edit: I will never understand why people think ACA was so great. It was a bad policy because they couldn’t get it through whole. They passed it with all the compromises that made it DOA. You can’t fix something when you are still in denial about it being bad. ACA is not a transition to universal healthcare when you allowed massive consolidation in the space with some of the biggest companies in this country. Good luck deconstructing that mess.

jvanderbot•19m ago
Keep in mind, I made no value judgement on ACA at all, just suggested that we learn about its opposition and, as you rightly point out, the difficulty of passing such legislation that can last over time.

I agree that "To no avail" could be read as "was worthless" to an adversarial reader, but trust me when I say it was meant as "which didn't save it from being opposed and stripped over time". As in "the studies and facts don't move the politics"

It should be obvious the messaging is oppositional along party lines. Every chip away at ACA makes it a worse program, and is celebrated by half the electorate. This is a core problem with the legislation. A second iteration on top, or in place, would have to learn from this and work to make the program stickier.

slg•18m ago
>Additionally, as somebody who was around pre-ACA, I can not tell you how much better, in every single way, the post-ACA healthcare world is. Pre-existing conditions? Access to healthcare as an individual? These are life-changing possibilities, especially for entrepreneurs.

The failures and politicization of the ACA have caused us to be a little too dismissive of its successes and popularity.

Protections for pre-existing conditions and allowing children to stay on family plans until 26 in particular have made an incredible difference in a lot of people's lives and are wildly popular. So much so that it would be close to political suicide to try to remove them as evidence by Republicans controlling all three branches of government including both chambers of Congress and there is no serious talk of repealing them.

There is belief among a lot of its supporters that universal healthcare would have a similar wave of support if enacted and that the opposition is mostly irrational political arguments rather than people's true feelings about an actual policy. This is why the "ACA" polls higher than "Obamacare" despite those being two terms for the same legislation.

jtbayly•17m ago
I lost my individual healthcare plan, and I couldn’t afford the new ones. Remember when they said you could keep your plan? Yeah, that’s the one I lost.
QuercusMax•14m ago
There was never a guarantee that you were going to keep your plan anyway, was there? Insurance companies are changing plans from year to year.
jtbayly•4m ago
The plan was cancelled because of ACA requirements. I had had it for several years prior. Yes, plans change, but this was different.
czgov•13m ago
Would you have been able to keep your plan under the system before ACA? There’s a lot of context missing in your comment.
th0raway•16m ago
No system that saves money can pass in congress: that's the real problem that we cannot actually avoid. Forget pressure from large companies: So many of US costs come from very high salaries, and a lot of bureaucratic positions that don't exist elsewhere. Every dollar we pay goes to someone, and it's not just some random mogul here or there that will be OK anyway. Reform that really lowers prices means loss of jobs, which them will be blamed on the politicians who signed the bill into law.
sys32768•15m ago
Pre-ACA, I could afford family insurance. My family premiums went up ~$500 a month post-ACA, while the coverage worsened.

My afib ER trip three years ago cost me $7k out of pocket even though I left the hospital still in afib.

Today in my 50s, my deductible is now $8,500. My partner doesn't have insurance because she's not poor enough or rich enough.

We had an insurance rep come to my work last year who said after ACA they had some people whose premiums went up 900%.

So yeah, ACA is better in your world, but not in mine.

unnamed76ri•5m ago
Yep. We were promised it would save us money. Instead, healthcare care costs skyrocketed thanks to Obamacare.
yieldcrv•15m ago
Republicans finalized things to address medical costs and chiseling at hospital billing - regulations promulgated during Democrat regimes - so I would say there is bipartisan consensus for the actual arguments, if people listened to the actual arguments instead of seeing a no-vote as an opposite nonsensical ideology.

This has been one of the opposition points - don't just give a handout to insurance companies without addressing their billing practices

The original ACA did not have consensus for some of the proposals to address the billing practices such as existing and new state healthcare programs having collective bargaining. And yeah I think the original ACA was unworkable, compromise is taught as a good thing to children in this country, but it just means "the wrong answer".

The tweaks now, alongside the original democrat led ACA, alongside the parts that were stripped out I think could have better consensus

does need a rebranding though.

The only that will actually lower costs in our society is healthy people. And right now, everyone is unhealthy and not doing preventative measures due to expense.

cactacea•12m ago
> These are life-changing possibilities, especially for entrepreneurs.

I would quit my day job and completely focus on my side business if I didn't have to worry about healthcare.

etchalon•9m ago
I was wondering one day why it seemed like so many YouTubers were Canadian.

The "well of course" moment took me a day longer than it should have.

hombre_fatal•3m ago
I also think about people stuck in bad relationships who would get to leave.
toomuchtodo•3m ago
Part of the reason why there is no effort to fix this, to keep you a slave to a job that provides healthcare. Can always bail to a developed country with healthcare if you want to realize this dream earlier than whenever the US will achieve the outcome (and your life situation supports doing so).

https://news.ycombinator.com/item?id=47161587 (expat resources for those potentially interested)

https://relocateme.substack.com (a product of andrewstetsenko here, no affiliation, I just like resources that can help humans achieve their success criteria)

expedition32•12m ago
The real problem with universal healthcare is that it immediately completely eradicates religious charity.

Any single mom who works as a stripper can go see a doctor who doesn't have the slightest inclination to judge- you're just a number in a government database. Everyone's getting free shit no questions asked.

edoceo•1m ago
Where is the problem here? Religious charity exists in places with universal healthcare.
saulpw•27m ago
ACA is not Universal Health Coverage. So this would be different enough. And you don't need perpetual majority control, only sensible politicians for about a generation (like FDR/Truman/Eisenhower/JFK) to lock in a popular entitlement.
apothegm•23m ago
Sensible politicians? In the US? In this era? For a _generation_???
strictnein•17m ago
FDR and "sensible" is always funny to me. The sensible politician that imprisoned Japanese Americans, destroying the lives of 120,000 of our fellow citizens.
boutell•25m ago
This is exactly the argument that gave us the Affordable Care Act. It was literally a republican plan from Massachusetts. It was supposed to be broadly acceptable and that's why it was implemented with a billion compromises.

But the Republicans called the Democrats commies anyway and refused to participate. And that has been their playbook ever since. That is what they are going to do, no matter what we propose.

So we may as well propose actual universal healthcare. But I agree with you that we need to create strong majorities to keep it in place until it reaches the kind of momentum it has in Canada or Sweden and opposition to it becomes a practical impossibility, like opposing social security.

Maybe someday we can have a system where losing health insurance isn't a motivation for not starting a company. Our current system is a complete disaster for entrepreneurial capitalism.

lvl155•24m ago
You mean obstacles from politicians who took money from the healthcare industry. That’s how we ended up with PPACA and they used it to justify massive cost increases and consolidations. They passed that junk to save face and now healthcare is far worse. But we “closed” the donut hole, right? Quite literally made everyone worse off and no one wants to talk about it. I still can’t believe they allowed payors such as UNH to buy up everything without ANY proper investigations during that period.
saghm•22m ago
I mean, the original plan for what became ACA was single payer. They didn't have the votes from the moderate democrats though, which is why the "private plans on public exchanges" became a thing instead.

You're not wrong at at least for the forseeable future, single payer does seem untenable politically, but I'd argue that dismissing studies like this on the basis that it needs solved before debating it on its merits is circular, because the only plausible political objection to a policy like this is financial. If you reflexively claim that nothing without broad consensus appeal at a given point in time is worth discussing, you're essentially arguing in favor of freezing our public policy to whatever the current public opinion is today. I don't think you need to go very far back in history to see some pretty striking examples of why that would be undesirable.

czgov•20m ago
George Bush Sr. made a deal with Democrats to raise taxes and cut spending. Ever since then the Republican strategy has been to oppose pretty much anything a Democratic President proposes. The ACA was a Republican healthcare idea and they didn’t support it because a Democrat proposed it.

There are only two realistic possibilities. Get a Republican to propose some sort of national healthcare or have Democrats fully embrace socialized medicine and not give a shit what Republicans say or think. If it gets implemented quickly enough then getting rid of it will be very difficult to do. People won’t give up free at the point of usage healthcare once they try it out.

saghm•7m ago
> There are only two realistic possibilities. Get a Republican to propose some sort of national healthcare or have Democrats fully embrace socialized medicine and not give a shit what Republicans say or think.

It's worth keeping in mind that Eisonhower's cabinet argued against the idea of giving the polio vaccine away for free on the basis of it being a "backdoor to socialized medicine". We're over seven decades past the point where it makes sense to give a shit about what anyone says about "socialized medicine".

dominotw•20m ago
can someone tell me this. Right now level of care is rationed by type of insurance you can afford. eg: northwestern in chicago downtown is inaccesible to ppl below certain income level.

In universal everyone has access to every hospital ? Why would someone go to lower level hospital if they can go to northwestern. Now the acess to best hosptials is gated by a queue?

I am not saying this is right but ppl who already have access to northwestern its in their best selfish interst to oppose universal?

i am just countering the point that "ppl opposing it are merely brainwashed by foxnews or are stupid" .

saghm•2m ago
> Now the acess to best hosptials is gated by a queue?

I mean, yes? Literally the same principle we all learned in kindergarten for how to make access to something fair. You didn't get to skip the line in lunch because your parents had a better job than someone else either.

iAMkenough•19m ago
> If your solution requires perpetual majority control of legislative, executive, and judicial branches, your solution is in fact a campaign slogan.

Describes everything the GOP offers as “solutions.” Theirs tend to strip rights while Democrats tend to provide rights.

We’re still waiting on the GOP’s “concepts of a plan” for healthcare promised on the last campaign trail.

fitsumbelay•3m ago
> I'm of the opinion that, if your solution requires perpetual majority control of legislative, executive, and judicial branches, your solution is in fact a campaign slogan

So you'll never vote GOP again. And you tacitly agree with Trump's repeated claim that conservatives will stay in the minority unless they _reform_ election rules -- https://www.theguardian.com/us-news/2020/mar/30/trump-republ.... Vote suppression and the "perpetual majority control of legislative, executive, and judicial branches," is Republican stated aim since the late 60s/early 70s when their party began its creep into permanent minority status

> It has to be different enough that those who would oppose it right after the inevitable pendulum swing do not want to

What does this even mean? ACA was based on a GOP-governor-in-a-blue-state's successful implementation of HCR. Everyone loved it until Obama loved it, then the highly organized GOP minority hated it, fight it, wasted ~20 years claiming insanely to have a better solution they knew they never had nor will have

Back when Nancy's daughter Alexandra Pelosi used to make mini-doc shorts for the intolerable Bill Maher she made one about southern white Americans' opposition to ACA. She interviewed one fellow -- perpetually unemployed, alcohol/drug/legal problems etc -- who came well out of his chest against Democrats, socialism, The Gubmint and all the other typical lefty stuff that Fox News mentors him and so many others on. Then we find out he's on welfare. Then we find out he's on Medicare/medicaid. Pelosi's like "What?? Wait a minute ... I thought you didn't like this government stuff. Why're you all over it" and mans goes "WELL I DESERVE IT!!!"

Let's just call anti-UHC arguments what they are: wet bullshit from private healthcare industry stakeholders and the uninformed partisans who repeat Trumpist mantras

strictnein•13m ago
> "Man I wish I could downvote a comment"

I mean, you can do that here. The system just restricts what you can do until you've spent more time commenting.

jgwil2•1m ago
[delayed]
iambateman•22m ago
When I was a kid, my parents would say “with that attitude, you’re right.”

We can and should expect a lot out of the people around us and especially the ones who choose civil service.

Our grandparents ended slavery, got votes for women, established a merit-based civil service, fought fascism, passed equal rights legislation, and created the most dynamic large economy in history.

We have problems, too, but we are not powerless to fix them.

ctoth•16m ago
You notice this?

It's literally everywhere. So much negativity. Sometimes I wonder how much is enemy action and how much is just depression or some other mental illness.