How often do you use your car insurance? Fire insurance? That's because insurance is designed to never be used, by most people. Health insurance has been unfortunately recast into comprehensive health care, with disastrous results. But the system is very entrenched now.

http://www.theatlantic.com/magazine/archive/2009/09/how-amer...

EDIT: I still really like the Australian system and wouldn't be upset if we started incorporating some of the ideas it contains. I just wanted to point out that for at least this one case the Canadian situation isn't quite as bad as it would appear.

Canada's private health care insurance is very broad, and while you aren't necessarily incorrect about anything you are only giving part of the picture.

The "Employer sponsored" extended health coverage you are referring to is Group Insurance. It is a form of insurance that can be offered to all people aligned to an entity (employer, trust, association, etc) that removes the requirement for personal health questionnaires and medical assessments. The coverage you are offered by your employer as "mandatory" is guaranteed to you so long as you remain connected to the entity in question. There is a huge advantage to this and this is the reason it has become the de-facto standard for private insurance in Canada.

Of course the trade off is that the entity qualifying as a "group" needs to have an overwhelming percentage (often 100% if it is small) participating in the plan to mitigate the risk. Insurance breaks down if the only people buying it are high users.

That said, Private Insurance (i.e. not Group) is most certainly available and affordable in Canada. With private insurance however your rate is going to be based on your own individual heath assessment and life situation. That means that while your Extended Health rates might be lower, as a single 30 year old male your Life Insurance rates will be higher than a Female's, for instance.

Overall, for a majority of people Group Insurance has the benefit of spreading the fluctuating lifetime rates out so that they are predictable and more equitable. You aren't going to be 30 forever, after all.

People can and do waive their employer sponsored insurance all the time (with the exception of participation minimums). In addition, employers have started to introduce "flexible" group insurance that allows limited plan choices, based on fixed credits.

Not much beyond that is fixed in these group plans, so the variance in plans, costs, and overall benefit to the employee from one employer to the next can be huge. It is an effective enticement to have a good benefit plan, hence the interview question. There is also nothing at all forcing an employer to offer any extended coverage.

Personally, I think Canada is right on the money with regards to how we handle private health care services and insurance. Keep in mind that self management also presents a fair amount of improperly covered people. People are simply too ignorant of the situation. At least under an employer sponsored plan a trained professional is designing a plan that meets as many of the needs of the employer's workplace as they feel is required.

In other words, Kaiser is great if a big company that employs you is making sure you're covered.

My point is that Kaiser vs. Health Canada isn't an apples/apples comparison.

Wait times for specialist visits that are not life threatening are just as long in the US as in Canada.

There is a persistent myth in Canada among people who have never had to get in depth medical care in Canada and the US that the Canadian system makes you wait until you are dying but in the US you just wave some bills and you see the specialist that day.

(US) Mother-in-Law has to schedule months (4-6) in advance for colon cancer screening because they find polyps every time, not just because of age. Cost - IIRC ~$50 with insurance.

(Canada) Father complained about shortness of breath walking to work (Wednesday), saw his doctor (Thursday), was checked in to the hospital that day, had a angioplasty. (Saturday). Why? Was life threatening. Cost - $150.

I'll take Canadian health care over the US squeeze for money every time.

Sounds like a great way to die from esophageal cancer.

I also got my specific medication for free. In the U.S. without insurance it would've cost me over $75k. Thankfully I had insurance.

Healthcare in the U.S. seems amazing except when you aren't fortunate enough to have a great health insurance.

1. Insurance companies can invest payments from young people to cover costs when those people are older.

2. Not everyone gets old and sick. Healthy people who die in car accidents contribute much more than they take out.

3. While many people get old and sick, medical costs vary significantly and aren't very predictable for a given individual.

4. People are risk-averse. They would rather pay $1,500 every year than have a 1% chance of losing $100,000 in any given year. This is true even though 0.01 * $100,000 = $1,000 expected loss per year.

Your argument may work for old-age care, where the cost of care for most people soars off the charts for last-ditch, cutting-edge efforts to stay alive. But there is no reason the insurance model can't work for most of the population.

While I don't doubt that there ARE Canadians who travel to the United States for medical treatment, I'd be curious as to the percentage of the population.

Growing up in both countries, I can say with certainty I had less hesitations in the Canadian system. In America, I worry all the time about switching jobs and figuring out healthplans. In Canada, I always assumed that I'd be covered in some form.

Your stats about Canadians is total BS.

"£12.7bn computer scheme to create patient record system is to be scrapped after years of delays" http://www.guardian.co.uk/society/2011/sep/22/nhs-it-project...

Instead they outsourced to people who outsourced to people...

"Accenture; Computer Sciences Corporation, or CSC; Fujitsu and BT. They were known as local service providers, or LSPs. BT and Fujitsu picked a US software firm, IDX, to work with, while Accenture and CSC both picked a British software company called iSoft. iSoft who offered a software system called Lorenzo, a program that had "achieved significant acclaim from healthcare providers”.

"However, the program was not finished..."

"CSC had to continue on its own, while the other two providers, BT and Fujitsu, were having their own problems. They were trying to implement American software, which is not such an easy thing to do in a British hospital, because American hospitals rely on billing for each and every activity and do not, conversely, expect to have to handle waiting lists."

http://news.techeye.net/business/nhs-it-debacle-debated-in-p...

Most of the things the article talks about amount to adding efficiency to the public system, something that no one would protest. Nowhere in the article does it talk about the public system collapsing and serious discussion over switching to a private system. As far as public debt goes, Canada's debt is not great, but it is certainly nowhere near most other Western nations, so the whole "public health care is a recipe for inordinate amounts of public debt" doesn't seem to be true either.

I wouldn't say that I'm a full blown MMT'er but over time the arguments make more and more sense, and I haven't been presented with many credible counter-arguments yet.

2. The more your choices impact the lives of others (making yourself chronically ill and sucking up expensive medical resources, driving at 100mph in the rain), the more costs your bad choices impose on other people. Government is the agency we delegate some of our individual autonomy to in order to deal with such systemic problems. The alternative is everyone suing everyone else all the time.

3. I'll tell you the downsides: there are waiting lists for some procedures that are in high demand. There are about as many industrial disputes as before. Everybody blames the government for everything (like a tiny country hospital shutting down, nurses' pay, availability of some experimental treatment of unknown efficacy). A commonly-voiced fear is that if healthcare is cheap then everyone will crowd up doctor's waiting rooms all the time. This doesn't happen, because other than a tiny number of hypochondriacs nobody likes going to the doctor unnecessarily, for the same reason that most people don't engage in recreational dentistry.

The fact is that healthcare can't clear like a normal market for three reasons: a) there are genetic factors that you have no ability to control or predict that can make you sick unexpectedly; b) you typically don't have a choice about when you get sick so you can't defer your healthcare spending accordingly; c) most participants in the market are woefully under-informed because they don't have any kind of medical degree, and price theory demands market transparency for all participants in order for equilibrium to emerge and vendors to be price takers. What we have instead is a monstrously inefficient and unresponsive form of monopolistic competition, in which part of your healthcare costs go towards billboards and TV commercials for goods and services whose efficacy you are incapable of judging properly, massive layers of incomprehensible administration, and heads-I-win-tails-you-lose pricing that royally shafts the individual consumer in insurance and care markets.

The government already "runs your life" by dictating speed limits, acceptable levels of toxins in your foods, safety standards for cars, etc. You're freaking out about things that don't matter.

You know what the downsides to public health care are? Fewer jobs in the insurance industry. You also won't be able to expedite your care by paying a premium, everyone gets roughly the same treatment. For 99% of the people out there, this is a non-issue.

2) This is a naive line of reasoning. The (socialist) FDA already stops you from buying food with lead in it. The (socialist) DMV forces you to wear a seat-belt and wear a motorbike helmet and the (socialist) Police stop you beating people up on the street whenever you want.

You are basically saying you don't want "big government" to tell you want you can't do, even though those rules and limitations would make your society better for everyone overall. Everyone's happiness would go up. This is very selfish and shortsighted.

3) It's very simple. Everyone is equal. A billionaire is treated the same as a homeless person. A strongly classed society (like America) does not like this idea, because Americans define success as "better than other people". Public healthcare would take away this distinction.

I'm not so sure private insurance companies and hospitals are all that "efficient" either, but define "efficient" first. Private insurance companies are motivated by making a profit, and the easiest way to do that is to take in money, but pay out as little as possible.

There's very little competition in insurance, as 'the market' is primarily larger employers, so insurance companies by and large cater towards the needs of their biggest customers.

We need to get rid of employer-provided health care benefits, and focus on getting people to buy it directly themselves. This will bring more market forces to bear, getting more companies to compete for our business, not the employers', and perhaps we can then talk about 'efficiency' and having that be something positive for end recipients of health care.

I know I will be pushing for change towards less and not more freedom. It makes no sense that you have to pay for my reckless high-risk behavior such as jumping out of a second floor window "for shits and giggles".

Another thing in particular that I want to call out attention to is food. If I retarded enough to eat nothing but McDonalds every day for a year, why should you just not let me die? Why should you pay for my surgery? If you are going to pay for it, over time you will gravitate towards a "high-risk fee" on activities that are just plain dumb.

Let's increase taxes on cigarettes, alcohol, (and implement new ones on ecstacy, marijuana, and all drugs... I don't know how that's possible without legalization but there is no way I am paying for someone rehab for something that has not been taxed)

The idea is that nobody should have to pay for someone else's high risk activities. Over time, the high risk activities will become expensive enough. Money will be a driving force that will drive people towards a better lifestyle. Think about it. Money will be a force for good for once.

Just take McDonalds. People say McD is a cheaper to healthier food. If a McD meal is a dollar and causes a health maintenance fee of twenty dollars, what do we do? We tack that twenty dollars to the cost of the meal. Bam! The McDonalds meal is now $21. That $2.49 price tag on the celery at Aldi's is suddenly not so expensive by comparison.

Yes, there are downsides but if enough people are annoyed you will get real reform. Please don't do anything stupid like the last time when conservatives tried to "starve the beast"[1]. We have solid evidence that starve the beast does not work.

[1]: https://en.wikipedia.org/wiki/Starve_the_beast

Based on the US's position as highest per-capita spender on healthcare + the underwhelming quality of care that $$$ gets you, more gov intervention seems like a pretty valid thing to look into.

2) Please explain.

3) Probably because a wider availability to care and an overall increase in average quality of life is a good, if not great thing for a society.

2) You mean besides whether you have to work for a BigCo to have health coverage.

3) You mean besides every discussion about public health care that has ever happened on Hacker News.

2) You can say the same for private industry.

3) The downsides are taxes. Expand the existing government payer system with minimal logistic cost. Remove the tax burden from employees (or employers passing it on to same) and watch the economy flourish. The biggest risk is to private insurance, which will never fully recover. Some may opt for the nonprofit model.

1) Private health insurers haven't been able to run anything efficiently as long as I've been alive. My premiums go up by double digit percentages every year because "costs" keep increasing, but at the same time, insurers' profits go up by double digit percentages every year. It seems like this is simply a money transfer to health care executives.

2) The more private companies run our lives (especially something like healthcare), the more they will be able to dictate our choices (what we eat, risky behavior etc). Oh wait... corporations already do dictate what we eat, what sort of medicine we use, where we work, how we communicate, how we move around, what we wear...The only difference between corporate control and government control is that we actually have some say in how the government controls us because at the end of the day we control the government.

3) I haven't seen on person that supports privated health care tell me the downside. I know they exist and we need to know the risks and talk about them openly before we stick with such a horrible system.

But anyways, the downsides to public health care: cafeteria health care (i.e., standardized treatments) which is good for most patients but not for the few who have nonstandard variations of ailments; higher taxes; less personalized care as a consequence of standardized treatments; potentially reduced choice of health care provider(s) (but if the entire system is UHC this may not be the case); potentially longer waits for medical treatment that cannot be handled in a day (i.e., anything that cannot be handled outpatient or by nurses or nurse practitioners).

And the downsides to private health care: all of the above, plus: risk of claim denial for valid claims (though admittedly less of a risk now as a consequence of numerous state and federal laws cracking down on claim denials); double-digit increases in premiums every year despite no corresponding increase in costs (this is actually happening, and has been happening, every year for the past decade); reduced choice of health care providers (which is actually the case now, i.e., in-network vs. out-of-network); ruinous medical bills; unnecessary tests and treatments; private health information being shared with "business partners"; inadequate medical facilities as a result of lack of capital investment due to premiums being redirected to marketing or executive retention.

It turns out the downsides of a private health care system outweigh the downsides of a public health care system, since you have all of the same downsides but the additional downsides that come with a profit-seeking business. And as history has amptly demonstrated, cost-cutting is not one of the benefits of a private health care system (costs are cut in a way that benefits the insurer's profits, but in ways which are detrimental to the insured).

> Our system is the final consequence of people who want safety guaranteed by the government.

That's quite a statement and I expect you intended unjustifiable hyperbole. Yet, for a moment, let's jump down the rabbit hole of political philosophy debate.

There are no guarantees in life (aside from death) and on this we agree. Accepting this fact does not require us to be a slave to it; however. As a parent, for example, I could tell my children, life isn't fair, go out and buy your own dinner, but I chose not to. I chose to create a household that in intentionally does not simulate the harsh realities of nature.

Likewise, I decide to live in a community in which we reject the idea that we are all barbarian animals, fighting for scarce resources in a dog-eat-dog world. Instead, we chose to compromise, pool resources and worth together to create the living environment to which we aspire.

This model extends naturally to government. Indeed it is the source from which government springs. Government is the cooperation of the community to reject the harsh world in which we live and try to create a better one. We often fall short. Yet in some ways, we achieve some victory over cruel nature. We establish security from enemies with our armies. We build and protect common goods such as roads and parks.

Now at some point, we quickly start to diverge in what everyone in the community wants. Some of us believe its in our benefit to fund the education of all of our next generation. And some of us believe that it would be in the benefit of the community that all would have equal access to some form of medical care. We believe that we are a rich enough, prosperous enough community, that we can afford to ensure even the poorest among us need not worry whether or not they can afford medical care. We do not believe the government is required to coddle us. We do not believe the government will solve all our problems or eliminate all disease. Instead, we want to live in a society which cares enough for one another that we fund health care for all members.

That's the philosophical difference. Not some delusional guarantee of safety or a misplaced sense of entitlement. It's an aspiration of a better world and a rejection of idea that we are enslaved into the brutal nature in which we find ourselves.