This is one of the fortunate things about living in the UK. I live in a crappy part of London but the hospital is good and 100% included in my tax.
Through my wife's 2x emergency c-sections, a broken arm, my physically disabled daughter, an eye socket infection thanks to a mosquito bite, an umbillical hernia operation and an ingrown toe nail, its been perfect and cost no excess, insurance begging or legal intervention.
I'm not afraid to call an ambulance in case it costs money.
I consider myself a libertarian and I still support public health insurance.
I grew up in Canada and spent time living in the states. I don't agree with most government expenditure, but I have no problem paying taxes for healthcare.
There are much more wasteful things governments spend our money on.
The problem with government funded health care is what you can't see. True market based competition leads to lower prices and greater innovation in all observable areas over time. That would mean more access for more people in the case of health care, but instead with deep government intrusion for decades, we have seen ever increasing prices and sluggish innovation.
Libertarian philosophy has a lot to do with a belief in sound market principles. Why should all that go out the window for health care?
The problems facing health care today, in my view, are largely a result of the free market being trampled on. People who don't really understand market principles will tell you the exact opposite, that health care has been nothing but a free for all, totally unregulated. Do you believe that?
It sounds like you might generally agree with libertarian ideas and some research on scholars like F.A. Hayek and Ludwig von Mises might help focus your libertarian perspective.
Hayek doesn't fit in well with most Libertarians nowadays. From his "The Road to Serfdom":
There is no reason why, in a society which has
reached the general level of wealth ours has, the
first kind of security should not be guaranteed to
all without endangering general freedom; that is:
some minimum of food, shelter and clothing,
sufficient to preserve health. Nor is there any
reason why the state should not help to organize a
comprehensive system of social insurance in
providing for those common hazards of life against
which few can make adequate provision.
and
Where, as in the case of sickness and accident,
neither the desire to avoid such calamities nor the
efforts to overcome their consequences are as a rule
weakened by the provision of assistance – where,
in short, we deal with genuinely insurable risks –
the case for the state’s helping to organize a
comprehensive system of social insurance is very
strong. There are many points of detail where those
wishing to preserve the competitive system and those
wishing to super-cede it by something different will
disagree on the details of such schemes; and it is
possible under the name of social insurance to
introduce measures which tend to make competition
more or less ineffective. But there is no
incompatability in principle between the state’s
providing greater security in this way and the
preservation of individual freedom.
To the same category belongs also the increase of
security through the state’s rendering assistance
to the victims of such ‘acts of God’ as
earthquakes and floods. Wherever communal action can
mitigate disasters against which the individual can
neither attempt to guard himself nor make provision
for the consequences, such communal action should
undoubtedly be taken.
Post that in many Libertarian forums nowadays and you'll be called a leftist or statist.
I won't debate whether healthcare is better via the market model or socialized.
I try to pick my battles. In order to affect change, I personally want to focus on the what is clearly and rationally broken in our current economic model (which are plentiful in our society).
I'm yet to be convinced that a pushing for a market-based model is ideal for healthcare in the USA given almost everything I've read about how healthcare is operating in other countries.
But these analogies in Europe, Canada and the USA are all in the context of a mixed economy and not pure-state or pure-markets.
Therefore, what I would debate between given the option of having center-left healthcare (Canada/Europe) vs center-right healthcare (USA), I would most certainly support center-left; while simultaneously fighting to reduce government in most other areas.
I have a similar political mindset, but I'm afraid to apply the label "libertarian" to myself because it conjures images of Rand-following Objectivists who believe tax is theft and externalities don't exist. I wish there were another name for that quadrant of the political compass that had less connotations.
My libertarian cube mate calls me a progressive libertarian. Which I believe describes me literally, although the term has all the feel of that other marketing term, "compassionate conservatism." Still, I think it's pretty close, as a literal term.
This applies directly to the conditions of workers in the US. The kind of uninsured workers we discuss on this board are young and healthy. The bad outcomes are rare. But they do happen. If you expect your young coders to work without benefits and little pay, you should know the risks you have placed on them.
This story was flagged off the homepage almost as soon as it appeared. I don't see it anywhere in the first five or six pages of results, logged in or logged out.
I don't love the political tone of this article. But while on the topic of healthcare, did any of you guys have an amazing time getting healthcare for your companies?
We found it was quite a bit of work, especially multi-state.
Talking to entrepreneurs in other countries, not having to deal with healthcare for employees really let them focus on their product and their company, and not how to insure a small growing team across state lines.
Libertarians and socialists agree that having employers provide health insurance is a staggeringly idiotic system. Libertarians would replace it with individual policies, and socialists would replace it with single payer. I favor the former (with subsidies for people who can't afford it due to poverty or preexisting conditions), but either would be much better than what we have now.
Unfortunately the average voter wants both "free" healthcare, and doesn't want the government running it, so every employer ends up being an insurance broker as well.
Right now we have neither - not sure why we couldn't have both. "Single payer" with adjunct private policies for those who want more than what the basic system provides.
Obamacare increases the burden on employers, and generally prohibits high-deductible health insurance policies that are actually insurance (as opposed to comprehensive policies which cover minor and predictable expenses). It's probably still better than the status quo, but it means we lose the option of going with a plan that's actually good like Wyden-Bennett (http://en.wikipedia.org/wiki/Healthy_Americans_Act).
We still have yet to see what comes of it in 2014. I'm not hopeful, but the foundations have been laid for much worse that produced reasonable results.
it isn't without risk either. as a small company, your insurer can drop you at any time if you start to get too expensive. though this is wildly illegal, if you confront them about it, they know you're a small company with razor thin margins and even if you win a multi-year lawsuit with them, you'll need other insurance in the meantime. so, they say "yeah well we'll see you court", and leave you with 1.5 weeks to get a new insurance policy for your employees...
Is this article against debt collectors, or politics that make paying for medical treatment one's own responsibility?
There is at least one lady who makes a living by suing telemarketers that violate the law. There are individual cases of people suing debt collectors for violating the law. Here is one recent case:
http://consumerist.com/2012/10/12/disabled-vet-says-debt-col...
Perhaps someone can come up with a business idea that will put debt collectors in check?
The article is against the absurd health system the US is running. A business idea to put debt collectors in check is not even a bandaid for this problem. There are very legitimate ways people are being screwed in this country. The title is literal and true; it should be very easy to spot how screwed things are when "Suicide in Cheaper"
I remember one call I did in the middle of winter a few years ago - cardiac arrest, on the side of the road. Got there and the guy was frozen and long dead.
He was across the street from the hospital. The ER entrance was about 40 yards away, just up a little hill.
That may have had nothing to do with money though. Maybe he just didn't make it.
I had a cousin in a rural town who drove himself to the hospital 40 miles away in the middle of a heart attack. Because there wasn't anybody else. He could easily have ended up the same way.
Nope. It's one of those little towns in western Pennsylvania where there are no jobs and the young people move away as soon as they can. By now the average age must be over 60. There must be about 50 people living there, though there were thousands a few generations ago when it was an oil town. In theory there are ambulances that cover the county, but there's really no point in waiting 40 minutes for the ambulance to get there so you can wait another 40 minutes as they drive back.
Anyway, he probably could have gotten a neighbor to drive him. Not sure why he didn't. Most likely the neighbors were drunk, since once hunting season is over that's what passes for entertainment. Not that they don't get drunk while they're hunting. Probably the only thing worse than driving yourself to the hospital during a heart attack is having your drunk neighbor crash the car in which you're having a heart attack.
The funny part of the story is he got someone to call ahead so the hospital was expecting him. He gets to the emergency room and the ER nurse (there's only one) says "Have a seat. We have an emergency case coming in any minute." He sits down wondering what kind of shape you have to be in to bump a heart attack patient. But he figured after 40 minutes he was still alive, so it probably wasn't going to kill him. He's kind of a stoic guy, too, so he didn't protest. Just sat down.
Five minutes later the nurse runs back into the waiting room with wide eyes, points at him and says "It's you!"
If you see any, be sure to alert the community. I was all caught up in this touching article about how disgustingly backwards any non-universal healthcare system is. Sorry, but providing basic free healthcare is no more a political issue than adopting the metric system or providing clean drinking water.
Just because there are a handful of countries that still try to justify their backwards ridiculousness under the thin veneer of "politics", much like those who try to take civil rights away, doesn't mean this isn't a settled issue for 99% of the world and fair game to discuss.
I would love to see the responses to a Muslim extremist who pops into the comments on an article about stoning an adulterer to death to mention that "we should probably be avoiding politics".
Something tells me other commenters would tear his head off, and rightfully so. Just because you can find a place that's still ridiculous enough to try and defend the practice doesn't instantly make it an untouchable political issue.
Other issues that are way more important than hacking and startups:
* Wars.
* Human rights.
* The fact that people die of hunger.
And yet, those are all not really on-topic for this site either.
It would be extremely easy to crowd out all the 'on topic' stories with things that are vastly more important "in the grand scheme of things", yet it would ruin the nature of this site.
Articles about stoning women are also, IMO, off topic, so the problem with the 'muslim extremist' simply shouldn't happen.
(BTW, I much prefer the health care situation here in Italy than in my native US, but discussing it is just not what this site is about.)
RE: the article not being "intellectually gratifying".
The situation sounds enormously distressing but the author's writing style isn't overwrought at all.
Even on a purely intellectual level, this is a devastating rebuttal of the point that "nobody dies from lack of health insurance". On the level of common decency, what is wrong with treating the people in the story as regular human beings with social ties, rather than some sort of people in the abstract?
If you find an article that "gratifies one's intellectual curiosity" on those topics then please submit them. Don't conflate HN with only startup news. It has never had that restriction, it's more of a primary focus.
HN is not /r/StartUps. There are no hard rules here on specific content, only community consensus via voting and occasional hands-on moderation.
There's nothing whatsoever 'intellectually gratifying' about this article. It's a way to tug at people's emotions in order to attempt to sway their opinions.
And I say that as someone who agrees with the point of the article.
I disagree. Tugging at emotions and learning something aren't mutually exclusive. As someone who lives outside of the US, I had never envisioned this scenario before. It's jarring every time, and you never really wrap your head around the horrible possibilities.
Of all the problems I'm aware of with the US healthcare system, I never thought of someone refusing life-saving treatment because their kids would have to deal with the bill. Deferring treatment, sure. But I figured if you're dead, you're dead.
The fact that they chase your relatives for the bill after you die is really disgusting and something I hadn't thought about until this article painted that picture for me, and now I'm involved in multiple discussions about it.
I actually do see articles in the above veins often, and they are very interesting and appreciated. They often get called off topic too, but the guidelines for HN clearly allow them and actually encourage them.
This comment is an excellent example of why we don't want articles like this on HN. Quotes like this are pure garbage and have no place in any place of intellectual discourse:
how disgustingly backwards any non-universal healthcare system is
backwards ridiculousness under the thin veneer of "politics", much like those who try to take civil rights away
Regardless of how you feel about universal healthcare, it's not true that it's a settled issue for 99% of the world (even within the countries that have it), that it's remotely the same as taking away civil rights, or that there's no discussion to be had about the economics and policy implications of universal healthcare.
But like a lot of other issues, this is apparently one of those things that makes people on both sides get pants-on-head stupid and start insulting the other side and accusing them of pure malice. There are plenty of places for you to vent about this (/r/politics would love you), but HN isn't it.
The other poster stopped acting like a mature adult, and I do feel this is entirely out of place on HN, but hey, I've been up for 20 hours so why not.
Food is pretty much already included. Food stamps, soup kitchens, etc. Almost nobody in the US or any other first world country will die of hunger without options to abate it. I wouldn't mind having everyone in a country just get a foot stipend from taxes though. While I am traditionally libertarian, I have this strange thing about the fundamental belief one of the reasons we erect society and prosperity is to attempt to eliminate the inherent inequalities and mortalities born into our existence.
I live in PA, and I know there is an electric subsidy on households below the median per capita income. I'm pretty sure if you went unemployed you could get an electric rate around 1 cent a kilowatt, which is around 20% the normal rate.
Healthcare is an outlier, in that if (by circumstances beyond your control) you need others to save your life, without health insurance you are basically getting a free bankruptcy card. And there goes any credit for anything for a decade at least. If your house is on fire, the fire department will come and attempt to extinguish it and save your life without footing you a bill. Police don't charge you for their emergency services.
So should those whose houses burn have to pay the bill for firefighters putting it out? (fire insurance on the house is independent of it, and I mean that instead of everyone paying taxes to cover the costs of fires, individuals pay when they possess something firefighters need to be called for).
An excellent example of how the government can help those in need, without taking over the entire industry. I've yet to see a reasonable explanation of why something similar couldn't work with health care.
It's impossible to misunderstand you. You're so clearly a republican/libertarian American trying to draw me into a carefully constructed argument as to why I should deny something the rest of the world decided long ago is a basic human right.
Sorry, not interested. I also am not open to discussions on switching Canada to the imperial system, instituting Sharia law, re-enslaving black people, or any other ridiculous throwbacks. The rest of the world has moved on, feel free to join us whenever you get your act together.
Please stop or leave. These kinds of name-calling and rude attacks on people that you disagree with are completely unbecoming and counterproductive to any rational discussion.
I don't have rational discussions about settled issues such as the above, much like my example topics. Just like if someone asked me "Why do blacks have all these rights?" I just simply won't entertain the thought long enough to form an argument, I'm just going to write you off.
I don't see any name calling, unless you consider "American", "Republican" or "Libertarian" to be insults. My reply had a snide tone, however that was completely intentional and I stand by it. If you feel it's a negative contribution to the community overall then you're more than welcome to to downvote me and the discussion will naturally die out.
However I'm not going to "stop or leave" because of your melodramatic plea.
I've already discussed my motivation and justification with you at length. If you feel I'm not contributing, just downvote and move on please. Follow your own advice and flag the article without promoting further discussion.
If you feel this is the wrong topic for HN, you're only fanning the flames by continuing to discuss it with me. I'm also not sure who "we" is. I'm a member of the HN community too, thanks. My account is over 1k days old.
So if you mean "me" then just say so. Don't try to disguise your motivations as those of the community, which incidentally has upvoted this and not flagged it for removal overall.
No, you're apparently going to just hurl insults, which does nothing but entrench both sides. Thank goodness that someone had the foresight to make a rational argument for civil rights at some point, or we'd still be contending with that issue as well. Hearts and minds, and you're doing nothing for either.
What insults? Quote one, because I have no idea what you're talking about.
> Thank goodness that someone had the foresight to make a rational argument for civil rights at some point...
How is trying to placate racists "foresight" exactly? Also, which "rational argument for civil rights" got you? I can picture you, all riled up and ready to be a racist...
...then someone tells you a black guy invented x and you have to sit down for a moment and re-think your philosophy on life. Give me a break.
Sorry for not being clear; I was talking about the abolition of slavery and the height of the civil rights movement, which occurred long before I was born. I agree that it's pretty ludicrous today to have a discussion about why different races deserve equal rights under the law. But you're treating universal healthcare as being on the same level in terms being a settled issue, and it's not.
I find it incredibly offensive that you equate someone believing that non-universal healthcare might be better economically for larger groups of people to someone thinking that enslaving black people is ok. Actually, I find it almost impossible to believe that you think they're equal. Do you seriously not recognize that there is substantial debate in the field of economics about this?
Mostly I just find it disappointing that you apparently can't do anything in defense of your ideas other than sling mud, because you lack either the ability or the inclination. You claim it's the latter; I'm happy to take you at your word, but I'd still prefer you not do it here.
> I find it incredibly offensive that you equate someone believing that non-universal healthcare might be better economically for larger groups of people to someone thinking that enslaving black people is ok.
Good, maybe you'll think about it for two seconds then.
> Actually, I find it almost impossible to believe that you think they're equal. Do you seriously not recognize that there is substantial debate in the field of economics about this?
Nobody is debating this outside the US, much like Libertarianism, it's something that only exists in the dreams of those so far-gone to the right in the US that they don't know which way is up.
> Mostly I just find it disappointing that you apparently can't do anything in defense of your ideas other than sling mud
You aren't even partially aware of what name-calling or slinging mud are. I haven't once insulted anyone here. Nor have I attacked a poster.
I wrote off my interest in the argument entirely because to me, it's a settled issue akin to slavery. That's offensive to you?
You taking offense is offensive to me. We're talking about a basic human right everyone except the US has agreed upon and you're going to throw an economic argument at me? Yeah, go ahead and be offended all you want. It's pretty clear here who has empathy and who doesn't.
So provide examples. What other developed nations still haven't introduced universal healthcare of some form and are seriously debating maintaining that quality standard?
I don't think you can actually separate discussion of health care (even though its a political hot button) from discussion of running a small business, given the challenges in getting insurance as an individual or for the employees of a small business. Honestly, in the U.S., one of the major things that turns me off from working on a small start-up is the health insurance situation. Even if you're ok now, then the chance of a double whammy (job loss plus development of a pre-existing condition that makes it hard to regain insurance) is non-negligible and you can end up in the bad situation where you have no job, health problems (maybe even precluding work), and no way to get back into the health insurance system.
If you're lucky enough to maintain continuous employer coverage, you're ok, or if you have enough free cash that you can maintain COBRA or individual coverage, then you're probably ok for some time, but that isn't always the case.
I can't quantify how much this biases people towards working for established companies with good health plans and job security versus risky companies, but it must be a pretty large effect - it certainly would make me think twice about taking a job at a startup, versus, say, Google.
Marco of Instapaper had most of one of his recent podcasts on this subject. As a non-US listener I was surprised at the cost. It is jaw droppingly expensive to get health insurance. Surely the inefficiency in the system alone is a strong argument for almost any other system? The years lived per dollar spent graphs usually get busted out about now.
According to the economist Dean Baker, if the US spent the same amount as other industrialized countries do on health care, it would have huge budget surpluses right now.
It's political but I don't feel everything like this should be left to "other sites". It reminds me about someone complaining that all too often Silicon Valley and techies at large only tend to focus on "bread and circus" projects. Articles like this remind me to at least think about "Is there any way I can build something to help make something like this better or cheaper?" Can anyone of us fix stuff like this with tech?
> Debt collectors can't legally go after anyone but spouses (and in some states not even that) in a case like this, unless it was the kids/grandkids that signed the hospital admissions. This does not stop unscrupulous debt collection agencies from trying however, and many people do not understand their legal rights. (Also, families can be put in the position of supporting the person who is trying to pay the debt, which is a whole other ball of wax.)
In England the debts belong to the debtor. When they die their estate pays any debts. If the estate has no money then the creditors don't get paid.
They can go after the spouse because in most states (maybe all of them) your debts are your spouses debts and vice versa.
I knew a guy in California that was gritting his teeth the entire six month waiting period for a divorce because his soon-to-be ex was maxing out her credit cards, getting more credit cards and maxing those too.
Unfortunately for her the rules change a little once you file for a divorce even if it isn't final.
The research doesn't really support this. People without insurance are much more likely to die in the E.R. once they get there, even after controlling for relevant health factors.
I guess I can see how they could control for differential access to preventative care resulting in ER visits with worse outcomes, or dilution by people with insurance visiting the ER with less serious problems... Even how they could control for early treatment in an ambulance vs a drive in.
But I'm interested in how they controlled for hesitance to go in the first place delaying treatment? Same condition, but you spent an extra half hour deliberating before going.
Even when health care is free people will still refuse. Former volunteer EMT from Australia read the post expecting the normal straight out refusal. People would refuse treatment, relatives wring hands, but at least you could start talking about having them certified insane. That always worked except for one case were we started the process and it dawned on the gentleman that he would rather go to hospital than be labelled mad. People would also want to avoid some hospitals and with little choice we would take them further and a fair part of the time they would have a worsening of the chest pain or worse still, arrest. Glad we didn't have to worry about hospital bills. Would be really frustrating to have to remove equipment/treatment, drive away and hope for a worsening.
Why is Y Combinator focused on relatively young entrepreneurs? [1] Because they have fewer worries about health care and similar long term costs. If health care costs were not an issue, one major barrier for older entrepreneurs would be removed.
[1] YC selects for younger people: they need to be willing to relocate for 3 months, work on a high-risk project for most of their waking hours, and otherwise dedicate their lives to success. Does PG keep stats on age of founders? Age of successful founders? Any correlation?
Sometimes it's better to just die. Or so I've been told. And unless you haven't experienced the dark that some unfortunate people do, you nor I can really say otherwise, can we?
His reasons were not due to a lack of a will to live, but due to a desire not to harm others through burdening them with his debt. An ambulance ride alone can cost upwards of $800 in the US.
I agree. Death is always an option, and sometimes it's the best (equivalently "least bad") one. Despite the title, the article actually argues from the point of view that death is never an option. This is a harmful black-and-white view. If you assign effectively infinite disutility to death then you can no longer say, for instance, that a painful death is worse than a painless one. Surely we can all agree that this is the wrong way to go about decision-making.
Let the government do all the nice things it must naturally do for society, and you will find youself in Gulag, where everyone has a job, and housing, education, entertainment and healthcare are all free and equal for everyone.
Yeah, it's certainly like that in other countries with universal healthcare, although their state media does a good job covering up the fact they've enslaved the population. /s
Through my wife's 2x emergency c-sections, a broken arm, my physically disabled daughter, an eye socket infection thanks to a mosquito bite, an umbillical hernia operation and an ingrown toe nail, its been perfect and cost no excess, insurance begging or legal intervention.
I'm not afraid to call an ambulance in case it costs money.