I had a health crisis in France (opens in new tab)

It's not just that the costs of getting healthy are taken care of.

Here in austria free, yearly "health checkups" are offered to you by every doctor. Meaning, when you go there because of a cold, he will tell you that you ought to do a checkup every year, which include blood tests, psychological screening for alcoholism and other individualized tests like prostate cancer for men.

It's just convenient to use the system. I even had multiple MRIs and dozens of XRays after minor sport injuries just to be sure.

Let me add a tiny bit of gloom. The healthcare situation is degrading. International context and other factors (big hospitals getting old, trying to reallocate geographical duties, merge/rebalance with other hospitals) are at play. The Healthcare employees are starting to complain a bit too often for it not to be worrying.

About U.S. what saddens me is the natural reflex toward individualism and self responsibility being a better moral value than mutualized health as in France. I wish they could have a more balanced POV on things.

> Moreover the treatment that a low-income and high-income citizen receives is very similar, so there is a lot less social discrimination.

Can you expand on this? I don't know where I could take my money and receive better medical care than someone totally indigent. If anything, the experience as a poor person is better: my friend has had a kid and two major surgeries in the past year, plus regular checkups, and has paid nothing as she is on Medicaid. I see the exact same doctors, but I get a flurry of bills that come months after my visit, multiple bills for the same thing, and have to evaluate what's legitimate or if I need to argue and I end up spending a lot of money out of pocket due to the craze for high-deductible health plans - even though my premium is over 20k/year and I am still paying taxes to support Medicaid and Medicare!

I mean, I guess the ultra-rich can buy their own doctors, or visit special superstar doctors, but I feel like that's probably universally true. But my feeling in the US if that if you qualify for Medicaid, you are actually better off than someone in the middle class - for example, I broke a bone early this year and I didn't bother going to the doctor because I didn't want to spend hundreds of dollars for something medical care couldn't do much about anyway - but if I had Medicaid, I could just go and not worry.

On the subject of the ACA, the best thing it did was expand Medicaid eligibility, though unfortunately due to the Supreme Court decision some states were able to refuse the expansion. I'm not really convinced the rest of the bill really advanced us much in the right direction. If only one of the carriers on the exchange was a public option...

> Obama was going in the right direction

Can you expand on this?

I've heard many critics of Obamacare (that say it doesn't actually work that well in reality), and in general, it seems that it was only tackling a part of the problem. In Europe, you usually have a single payer, single buyer and single executor (or at least each of those is very regulated, so there's less chance for exploitative monopolistic behaviour than in the US).

> Europe has better life expectancy,

Diet has a lot more to to about that than medical care.

Remember when Obama was elected? Businesses were complaining ever more strongly about double digit percentage increases in health care insurance costs for their employees. Saying, 'we can't stay in business, compete, if this keeps up.'

The Affordable Care Act was not proposed as some "left", "socialist" initiative. Mainstream America as a whole -- including the "conservative" side, business, etc. -- was clamoring for some sort of effective control on health care costs.

Then, the Republicans made it a political issues. They "lost", and they weren't having any. All their rhetoric and obstruction, not of a "liberal", spendthrift proposal, but of a middle of the road plan that would provide, per their worry, a perceived "win" to the "other side."

Once the ACA was passed -- in its further compromised form -- they did their best to kill it via the budget process / spending, which is a separate activity under control of the legislature (House and Senate). Facets written into the law, such as adjustments to control insurance losses during an initial, transitory period (the demographics and so costs of the newly enrolled not being known in advance), simply were not funded.

That America doesn't have fair, cost-effective, productivity enhancing health care, is a function of political self-interest. And, in a Democracy, said politics are tied back to the electorate, however imperfectly.

Republicans lied about health insurance. People bought the lie. Now we are living it -- ever more.

P.S. Not to mention, blocking actual cost-controlling measures at every chance.

By the way, for all the complaint by insurers about their "losing money" on the ACA, as I understand it, they've seen significant savings due to the ACA in their traditional, employer group plans. Are those mentioned and factored into the rhetoric about the ACA?

Health care in the U.S. is indeed in crisis. At this point, it comes down to a simple trope: If you're not part of the solution, you're part of the problem.

The ACA bashing pols are simply part of the problem. Witness their inability to offer up an alternative of any substance.

P.P.S. In other words, I don't give a flying f-ck whether you are "left" or "right". You make progress towards solving the problem, or you don't.

And, I see it both as a economic and structural problem, and as a moral problem. A "moral" Right that is content to leave its fellow citizens suffering when resources and remedy are at hand (and this country can certainly afford them, in the dollar amounts estimated, if it makes the decision to), is not moral. It is merely hypocritical -- at best. I might contemplate using the word "evil".

Regarded by who as one of the best? I'd like to see how far down that ranking the NHS is now.

Britain spends about 20% less than France on healthcare per capita. The British National Health Service is ruthlessly efficient, for better and for worse; it's really good at keeping people alive cheaply, but it's terrible at everything else. Efficiency inevitably means that resources are spread as thinly as possible, that equipment is used until it disintegrates, that hospitals are purely functional production lines for medical procedures.

British people have both a strong sentimental attachment to the NHS and a strong aversion to taxation. They're willing to overlook the flaws of the service if it means they don't have to pay more for it. I can't say it's an unreasonable position.

http://data.worldbank.org/indicator/SH.XPD.PCAP

France was ranked 1st in the world by WHO. The UK was ranked 18th. But France was also fourth in the world in per capita expenditures.

So they have socialised health care and they also fund it very generously.

https://en.wikipedia.org/wiki/World_Health_Organization_rank...

Well ever since Thatcher i get the impression that the UK has been trying to dismantle the NHS. Supposedly one of the first things done in Scotland after getting more internal autonomy was to reverse the changes from back then.

In the UK (Wales) I got to see a hospital, a relative-in-law was terminally ill. The hospital was like a knock off slaughterhouse with thick dust everywhere and blood stains on the walls that stayed for weeks. After that I decided to get a check up every time before I go to the UK to not need the hospital there. I hope not all hospitals are like that there.

I guess it can be attributed to work conditions of health care professionals in both systems. May be they are better paid and not overworked and hence have a better attitude towards patients under their care as a result.

Yep, this happened to me last year as well.

- Severe diarrhea accompanied with excruciating abdominal cramps (hot knife w/ twisting, etc)

- Call ambulance. Taken to Saint-Anne within 15 minutes.

- Given IV fluids, pain-killers and anti-spasmatics

- Released one hour later; was able to walk home (I live near Denfert-Rochereau)

- Total time in care: 2 hours. Total bill: 0 (after reimbursements).

Say what you will about France, but they care for their own.

The system in France is very different from the system in the U.K. Instead of having a national health service that employs the doctors, they have a system a lot like Obamacare, but with national price controls.

For details on the French system see The Healing of America by T.R. Reid. It also covers the U.K. and several other countries.

> I had a similar experience earlier this year in the U.K., and the contrast was significant - in the U.K. one feels like an irritation and an inconvenience. "Bloody hell, what's a patient doing here? This is a hospital!".

I'm 50. I remember what London was like way before Labour first got into power.

Lets look at today. Immigration is way out of control. London has probably 10 million people? It's busting at the seams.

I even travel to the south near the beach. Waiting for a doctor there? Sometimes up to a month.

I can remember when I would call a doctor and be seen the next day. Not any more.

The reason for the attitude is that doctors and nurses are at breaking point. I'm sorry if the down voters don't like hearing this but it's true.

Incidentally I voted to leave. But I think it's too late. We should have left before Labour got into power with Tony Blair. Like the Democrats in the US, they wanted immigrants from all over to change the political landscape and keep them in power. Regardless of native population.

There's another way to look at it that I don't think the USA will be ready to understand any time soon: Universal health and education are (key parts of) freedom.

You can even put a market spin on it: None of the risks involved in starting a small business in Australia have to do with health care for myself, or for people who might consider joining my small business as employees.

I've never felt as if I'm giving up autonomy or surrendering to the yoke of the state or whatever. Public universal health care gives me freedom. From and for so many things.

> For us Europeans, we don't even think that free healthcare, free education ( university included ) , and free state support when things go wrong is a right.

Many people in the UK fear for the life expectancy of the NHS. It's featured in the media very often. Ditto welfare benefits.

We pay for dental care and prescriptions. Hospitals and health centre are closing left, right and centre. Benefits are being slashed in cruel ways. Many have private health care through their employers. Kids are leaving University with £40,000+ loans now.

:(

>> free education ( university included )

keep in mind that this is not a given in all EU countries. In the UK (still an EU country, though not for long) one has to either get a student loan from the British state, or cover their own tuition fees.

not to ruin your idealism (I agree with your sentiment) but university is not free in large parts of Europe (it is generally cheaper than US though).

> free education ( university included )

La Fac is one of the worst places to get an education though.

In France you pay 0 % taxes for the first 9.700 € of income, then 14 % for everything up to 26.791 €, then 30 % for everything up to 71.826 €, then 41 % for everything up to 152.108 € and 45 % for everything beyond that [1]. Hence 23 % effective tax rate sounds reasonable for an average income of around 50.000 €. The tax system in many European countries is similar btw, as is the health system.

[1] https://fr.wikipedia.org/wiki/Bar%C3%A8mes_de_l'imp%C3%B4t_s...

Income tax, however, doesn't cover social security. That's covered by the taxes an employer pays, and those are larger than 23% (but also contain other taxes). It's all detailed on pay slips. https://fr.wikipedia.org/wiki/Bulletin_de_salaire

It's probably tiered, like in many other EU countries. In UK for example you don't pay any tax on the first 10k earned, then 20% on anything between 10k and 40k, and then 40% on anything above 40k. I think there's a tier above it as well, but I'm not 100% sure. I know France has more tiers and they are more aggressive(80% being the highest I think?)

Different countries have wildly different tax strategies. Sales tax, property tax, corporate tax are some avenues that may make up the difference here. Belgium in particular IIRC draws a large portion of its tax revenue from income taxes

Because income tax isn't the whole story. The French also pay social charges: ~8% on salary (and, unlike income tax, no relief on the first €9.700); ~15% on capital income (e.g. a house sale, investments etc.). Employer's also have to contribute to employee's social security (~13%). So, total tax revenue is closer to ~45% of gross salary (excluding TVA tax levied on purchases made with your net income). See: http://www.cleiss.fr/docs/regimes/regime_france/an_a2.html

Long story short: the level of care is fantastic but it costs the country a fortune and there's huge waste within the system (seen it first hand). Note too: most French also pay for private health insurance to augment the default level of state care (for things like dentistry work, optician etc.).

So it ain't cheap but if I had a serious condition there's no place in Europe I'd rather be to have it treated.

Income tax is not the only tax.

>How comes this number is that low?

A low income person in the US can pay effectively 0%. Your percentage in most countries depends heavily on how much you make.

I wondered about that as well, I pay like 40%...

"annual income tax", which is "impôt sur le revenu" in french, is irrelevant here, it doesn't fund the social security system.

Infant mortality is also 75% higher in the US compared to France: https://www.cia.gov/library/publications/the-world-factbook/...

The fundamental problem to solve, though, is getting money back out of medicine. American doctors get paid ridiculous amounts more than doctors in other developed nations. If you want affordable medicine, then medical salaries are going to have to take a hit, so you can afford more staff overall.

An example of how much money is in the system: I was talking to a nurse in the US whose adult son had a series of mental illnesses. She was going to see a specialist neurologist about one of them. "Why not ask him about all of them?", asks I. Turns out that in the US, it's quite common for specialists to specialise into a single syndrome, and will happily reject similar things in their field that aren't their specialty. I was horrified - here are people that take a decade and a half of training, all to become a glorified lookup table. I used to work in a neuro lab myself, and while I could see a motor neuron specialist perhaps referring on a brain problem to someone more suitable, the idea that any of the doctors would only take patients with a single, prediagnosed syndrome... was just alien.

But in the US you can do that, and get ridiculous amounts of money for it.

> The US spends more per capita on health care than other OECD countries, even ones with universal public health care:

Sure, but the French social security system (la secu) is completely bankrupt and survives only because France continues growing its national debt. NO matter how you look at it, all these health systems are not sustainable anywhere on Earth.

Isn't insurance already paying for others, if nothing happens to you?

I-don't-want-to-pay-for-others != I will not insure my health.

US health system needs competition more than socialism [1].

[1] https://mises.org/blog/lack-epipen-competitors-fdas-fault

EDIT: A really good comment from link above.

Mark S - https://mises.org/blog/lack-epipen-competitors-fdas-fault#co...

The culprit in virtually all health care or drug price gouging outrages is insurance and "free" taxpayer money. Americans want someone else to pay for their health care -- the insurance pool, Medicare, Medicaid, the VA, the hospital (if they are indigent). Drug makers know that someone else (not the patient) is paying for the drug, that payee has no economic incentive to minimize costs, and so drug makers do not care or have an economic incentive to control their costs or limit their prices. Somebody else is paying, so who care what the drug costs. Insurance companies pass costs along in the form of escalating premiums, so they have no incentive to control costs (especially in the Obamacare environment where health insurance providers are exiting the market leaving the remaining firms with a monopoly); giverment health programs have virtually unlimited access to taxpayer money (and, in the end, money printed by the Fed), so they have no incentive to control costs; health care providers also know that the patient is not paying the bill, so they have no incentive to prescribe or investigate more afforadable alternatives.

People never ask "So, what does this drug/treatment cost?" but rather "Do you accept my insurance?"

But only if it's called socialism. If it can be called something else, then it will be accepted. In my experience, US citizens (not all, obviously; I'm massively generalising) have been conditioned to be against things labelled socialism, but the level of economic and political knowledge amongst the general public is such that if you don't call something socialism, it is judged on its own merits without people realising.

It's not socialism, it's the normal way to do healthcare in a first world democratic society. Most first world countries are not socialist, but have a proper health system like this.

Who knows, if someone pitches this to Donald Trump and calls it "TrumpCare" he may be vain enough to push it all the way :)

> Does France really have that low tax rate

No, its much higher than 23% as claimed by the author. At least in the 30 or 40% depends on your level of income. Its also fair to say that there is a large amount of households in France that pay no taxes at all.

The thing to look at is total taxation as a portion of GDP.

https://en.wikipedia.org/wiki/List_of_countries_by_tax_reven...

In the US, that's 26.9%. In France it's much higher, at 47.9%.

here in NZ I pay the high 30% marginal rate (that includes social security) and get mostly free health care. Drugs have a low co-pay, we have one organisation bulk buying for the entire country

The difference of course is I'm not paying for a bunch of cowboys who invade other countries at the drop of a hat

There's several taxes. The tax he talks about is what you pay based on your revenues (with several ties, like in the uk). In france we receive what we call a 'salaire brut' which is a salary on which the employer already payed some taxes (which are quite high if i'm not mistaken). On this 'salaire brut' some taxes are automaticaly taken (including some for healthcare), then you obtain what we call 'salaire net', which the money that you get into your account. On this 'salaire net' you still have to pay income taxes (the next year for the previous for the moment, it my change to be taken immediatly on your salary, like in the uk).

I don't know, altogether how much taxes we pay. It varies depending your salary, your job or location (farmers have a different healthcare for exemple). Including everything, If i remember well, an employee cost twice his salary to the employer. A salaire net is something like 2/3 of the salaire brut. Income taxes depends of your income. In comparison with european countries, I think that it's mainly the employer part of taxes that are high.

>There is little evaluation of physician so picking a hospital is very much a lottery, unless you know insiders who will tell you where to go and not to go.

There are always variations, obviously but in general we have pretty good doctors AFAIK. If anything we don't have enough of them. I'm not sure how it relates to the article though, would a more liberal system improve the average quality of hospitals? Are US hospitals and doctors offer better service that the french ones? I'm really asking, I honestly don't know about that.

>The system runs a massive financial deficit.

It's still pretty massive but it's steadily shrinking these past few years, although parts of it might be caused by degrading the service slightly.

The government plans for a balanced budget in 2017, although the opposition says it's not completely true: http://www.publicsenat.fr/lcp/politique/budget-securite-soci...

This article gives a good overview of the situation as far as I can tell: http://www.lemonde.fr/financement-de-la-sante/article/2016/0...

>Like many centralised etatic system (and particularly in France), friends in the right places, political affiliation and freemasonry are more important drivers for a career than medecine.

What does that even mean? You went full tinfoil here. Whose career are you talking about anyway? Do you have any source?

> The system runs a massive financial deficit.

French person here. Although the deficit of the healthcare system is often pointed at by the media, it is far from "massive". From [1] translated in English:

"This budget is in deficit, (...) but this deficit is far less than the budget of the State. In 2011, the deficit of the Social Security represented 2,66% of its total budget (11,7 / 440,8 billions €) compared to 45% for the State budget (92 / 200 billions €)."

I'm not saying that it's OK to have a deficit because the State deficit is bigger. But we should keep orders of magnitude in mind (the French budget would be in super-duper-massive deficit then?). Plus, as you can also see in [1], the deficit is shrinking since 2010 and getting close to zero.

Yes, there are some optimizations possible in the French Social Security. I can't find the source anymore but the cost of running the public Social Security is lower, in percentage, than French private healthcares (if my memory is right its 8% vs 25% of the total budget of each organization) It is not hard to imagine that economies of scale play a major impact for this.

[1] https://fr.wikipedia.org/wiki/Budget_de_la_S%C3%A9curit%C3%A...

You know what also runs a deficit? Your gym membership. Going to the movies. Eating at restaurants.

Sometimes things cost money. I imagine that keeping the country healthy is a plus.

Not to say that making improvements isn't a bad idea, but a cost-centric view on things almost always ends in bad decision-making. Decisions based on revenue generation, instead of the "real" objective (keeping people healthy).

I supported Jeremy Corbyn, so I am also way more socialist than you average Brit, but the answer to "Why should I pay for someone else's healthcare?" is actually quite simple - human decency.

Do you really want people to actually DIE? I hope not and that you'll rather pay "for someone else's healthcare" than to see them suffer and if YOU are ever bad on your luck and need the help, I'll gladly pay for your healthcare if you need it, because I know that you paid into the system when you could and now we're just paying you back.

I am already paying taxes for a lot of things that I may not want to anyway, like overbudget defense spending, over the top salaries for MPs, failed research, government websites that cost way more than they should and other initiatives that nobody asked for, financial support for hugely profitable multinationals etc. etc. - if I am paying for that, OF COURSE I'll pay into a system that will help a human being when they need it and be confident that I or my family members can expect the same, should it ever come to it.

It always seemed to me that in the U.S. they're fed up with having to pay for an excessive budget, yet they always blame the wrong part of it for their high taxes - don't blame healthcare spending, blame the way it's implemented, blame the fact that over 50% of your tax dolars is spent on the military, blame the failed, overbudget F-35 project etc. etc. DON'T blame Flint residents who don't even have access to clean water - where's the logic in that?

>"Why should I pay for someone else's healthcare?".

>and I don't really have an answer to that. Why indeed?

Because you don't know what is going to happen in the future. One day you may wind up broke and be diagnosed with a serious illness. And what about any children you may have. Wouldn't you like to know that they will receive care after you are dead no matter what is going on in their life?

Your virtue signaling trivializes a vastly difficult issue. The immensely complex question remains, putting aside the problem of organizing a massive state system, of how you balance non-infinite resources with never-ending demand continually extended by medical advances of which people naturally enough wish to take advantage? Given no financial constraints, you don't have to be a socialist to assent to free health treatment for all comers.

I think it's interesting to ask why people separate themselves from other people, I.e. people who are sick and possibly dieing, who need help.

Something I read on hn a while ago involved trying to place others who have had bad things happen to them in mental categories apart from oneself, to not have to deal with the possibility of bad things happening to yourself without any reason. E.g. a traffic accident, cancer etc.

With traffic accidents, is very instructive to see that people will reflexively think that the persons involved did something wrong, this removes the need to accept that life isn't safe and that our behavior often has little influence at all on wether bad things happen to us. I think it's the same with healthcare. The defense mechanism is: they got sick so they must have lived unhealthily - granted, there are a lot of things your behavior can influence: cardiopulmonary disease, some forms of cancer but not all of the tragedies of health that can befall you are in any way under ones control. By sticking together we can shoulder the burden of the few that didn't have any blame on their fate.

Seriously. The quote from the article:

>> In the end, this entire ordeal set me back about 1,300 euros, or $1,455. I sometimes wonder how my health crisis would have played out had I returned to America instead of deciding to stay in Paris more than 20 years ago.

In the U.S., it's likely they would have died; or at least gone $100,000+ in debt - if they could have even qualified for that much credit.

I can understand not covering things like lung transplants for lifetime smokers, or other similar "meh it's their own fault" situations. But when it comes to treating the health of citizens who are not severely at fault for their conditions, there should be absolutely no cost to the individual. Taxes should be enough to handle this, without one's own insurance being part of the equation.

$30,000 is a very European estimate. It costs between $90,000 and ~$200,000 out of pocket in the US for a bypass surgery. Probably more for the guy in the article given the extreme nature of the situation/complications that arose.

I don't think "the cost skyrocketed out of control". The cost is simply reflective of the leverage the health care provider and all the middle men in between hold against the patient.

It's just that in other countries you have the government setting up a monopsony and dictating costs and salaries.

I don't see how charging $30k for a heart bypass is unreasonable for somebody making $50k/year.

High charges of low cost items are because of the amount of free care hospitals provide. I'm a physician in South Carolina and I take care of a tremendous number of fully employed people with no health insurance. Those of us with insurance pay for those without by paying higher costs. This gentleman would have probably received the same treatment in the US (at least at my facility) and received a $300,000 bill, of which he would probably never pay (bc he cannot). That artificial aortic graft sewn in probably cost the hospital $1500. It doesn't receive that for free. Nor does it expect the 7-8 people in the operating room or the post operative care to work for free. My hospital has an operating profit of less than 1% mainly because it provides so much free care. All I have to do to take care of a patient is declare it an emergency and there is no stopping of whatever care I feel is necessary to care for the patient, e.g., a newly diagnosed cancer patient. This, I believe, is true throughout the USA. And most of the people I take care of have jobs, but no insurance. Ask how many people that clean hotel rooms have insurance. How about people that work call centers? That, plus monopolist practices of the pharmaceutical industry and you have high costs.

And if you want physicians to make 100k - 150k, don't expect me to work 80+ hours a week, not including call. Attorneys give me $500 / hr for consultations, but in my real job I make $80 / hr, but just work a ton more hours a week (no overtime bonus, tho). I don't get sick days. I don't get vacation days. When I don't work, I don't get paid. When I was in private practice, when I didn't work, I not only didn't get paid, but still had to pay rent / malpractice / insurance / electric / employees which was about $5000/week for me. So taking a week off cost me lost revenue and $5000/week. Medicare pays $600 for taking out a gallbladder. Do the math to see how many have to be done to take care of the bills.

That said, even single-payer systems as the ones in Western Europe can have this exact same problem. Like when Region Stockholm / Stockholm County (Responsible for Health Care and Public Transport) in Sweden bought supplies like support socks for 6000 SEK/pair (~645 USD) [1].

I'm guessing - but I do not think it's a good thing when people who make the purchasing and oversight of things are far away from the actual practitioners. It leaves a lot of room for different kinds of shenanigans, fraud and sub-optimal choices. I think that applies regardless if you're for Private or Public health care.

[1] http://www.svt.se/nyheter/lokalt/stockholm/landstinget-kopte...

For one operation I had, I was given a turkey sandwich to eat in the recovery room before they would let me leave. Two slices of wonder-bread, one slice of turkey. $36 on the itemized bill that was sent to my insurance.

It's nuts.

As a matter of fact, I'm very surprised he had to pay anything at all. 1300 euro for hospital bed and food? This should be completely free.

It seems to me that, as a society, to choose for a longer waiting list and uglier waiting room it's a small price to pay in exchange of healthcare for everybody.

About the decreasing quality: there is a clear pattern where, you cut financing of public resources and, then, you can show how bad they work and how best a private system would be.

The eye doctor thing always confused me. I would have to call 2 months in advance to get a routine eye check! What??

It feels like it's purely because of government limiting the number of optomitrists. It reeks of some doctor's association lobbying the education ministry to keep the incoming number low (there's a hard limit set by the gov't on the amount of people who can study medicine).

For comparison, in Tokyo I can walk into any optometrist office without an appointment and just wait 15 minutes or so

Well, Medicare (health insurance for people 65+) is not that different, and is essentially a federal single pay program. (Though they don't pay salaries, but on care provided like regular insurance).

The military health system (for veterans, the VA) mostly have their own facilities, but don't have the best reputation (and have had some scandals recently... https://en.wikipedia.org/wiki/Veterans_Health_Administration... )

Medicaid (for poor people) is managed at the state level, and is 50% federal funded (and each state has different income limits for who is covered)

All three of the above make up roughly half of all US health care spending. At the state level, some states have additional programs and subsidies, like https://en.wikipedia.org/wiki/Massachusetts_health_care_refo... and Obamacare tried to create something similar for all states with uniform availability and coverages along with subsidies (and penalties for people who voluntarily decline to purchase health insurance).

https://en.wikipedia.org/wiki/Patient_Protection_and_Afforda...

So yes, it's a complex kinda mess...but there are too many stakeholders in the current system for it to be easily changed.

My impression (as a European) of the US system is that in practice what we have with individual states here in Europe + EU isn't possible in the US, since the federal government taxes are proportionally so high, compared to what individual EU members contribute to the EU.

Thus while individual states could implement their own health care system, it would have to be on top of everything that's federally mandated, which they're already paying for. The tax burden would be outrageous, so it just doesn't happen.

It's also odd to see other Europeans dismiss the argument many Americans have for a smaller federal government, while in practice that's pretty much what we have over here in the EU. Could you imagine a EU-wide single-payer health care system? It would be a complete disaster.

So in that sense I wonder if the better solution for the EU would be to roll back all federal health entitlements (Medicare etc.) and just implement this completely on the state levels, then states like California and the like could have European-like single-payer health care systems, while perhaps other states would opt for different systems.

This is a topic that has come up on HN so many times that I have lost count. I have come to the conclusion that the US milieu is so dogmatically against any alternative that the standards of a proof that they will demand to be acceptable far outstrips the standards that they will demand of other things. This is the diametric opposite of preaching to the choir. Ultimately its them who gets handed the shorter end of the stick. Some are rich enough that it does not affect them as much. What intrigues me is the behavior and rationalizations of those who cannot escape the adverse consequences. Forget drug and hospitalization pricing for the moment, just the institutionalized control (cartelization) of the license to practice medicine is a tell tale sign.

Its the same in Canada, it's not because it appears free that they don't run for profits. Health care is a massive public spending and shows when you look at the taxes you (or your employer) pay

allowing the government to negotiate for the best price would be a start

You're exaggerating. I've gone to or with multiple emerg visits in Quebec, none even the most critical issues, and have rarely had to wait for more than a few hours, including diagnosis and treatment. If you go to the wrong hospital at the wrong time, it can be worse, but not to the level you indicate, and sometimes it's faster.

There are sometimes long very wait times for non critical scheduled tests, which is a problem.

The real problem is people with chronic conditions who will have to dedicate much more of their life to their health, which is dangerously demoralizing and a career killer, but I am not sure that's much different in other parts of the world.

VAT is 20% in France, and the biggest source of income for the State. But social security has a separate budget and is not paid by taxes, but by special levees on salaries and income.

I agree. The general standard is good (my wife's experience of giving birth here was much better than my sisters'in the UK) and if you have the money you can choose to pay more for comfort or convenience.

"And this is the major reason why our politics suck IMO. We have one side of the table that is 100% more government because government is awesome, one side that is 100% less government because government sucks, and nobody is arguing that we should be making government more efficient. And so we never get nice things. "

Well, that'll continue happening as long as you force it to be one giant pie. If you let people choose in the first place, then you can have your nice things. You just have to pay for them yourself along with those individuals that agree with your viewpoint. And the rest of us will have to choose to either join you, or do it some other way.

All arguments eventually lead to choice. Freedom and consent are fundamental properties of a libertarian belief system. We don't get to throw those out just because it'll be efficient. You could argue that it's efficient to just execute all repeat-criminals, but we don't do that because of fundamental human rights that are completely separate to the concept of pragmatism and efficiency.