I read somewhere that half a trillion a year[1] would be saved by single-payer. It's probably an exaggeration, but even if its an order of magnitude too high... sounds good to me.
[1] http://www.pnhp.org/sites/default/files/docs/2012/Dollars%20...
Polls show the majority of Americans have favoured a single-payer system now for decades. This was the case under Reagan even, and still is today.
This shows the degree to which the US is not in fact a true democracy, but more of an oligarchy. However things can change if there is enough public pressure. People just need to be organized.
Disclaimer: I work in big pharma research (nothing to do with pricing)
People say this money is being wasted but it's going somewhere and these people will fight for keeping it.
The downstream economic effects of an 8% contraction would be nuts.
http://us.spindices.com/indices/equity/sp-500
There are a lot of middle men that would get absolutely crushed or go out of business if single payer were passed. Others would have to slash margins in order to meet whatever cost cutting is needed.
Besides, the way DC works, there would be plenty of time for markets to adjust, short-sell, etc.
I don't have the figures in front of me, but I think public health indicators (maternal mortality rates, for instance) suggest we aren't getting great ROI on the extra 8% we spend.
Based on my understanding, that contraction in the pharmaceutical industry would put money back in the hands of the middle to lower income brackets who are currently impacted most. And given that the velocity of that money is higher for them than it is for the upper classes, it would theoretically lead to higher consumer spending, and growth, for the economy.
We also need to revisit end of life care. I see so many commercials for drugs that offer 9 months of life vs 6 months of life for existing treatments and there is little to say the quality of life is maintained. We can't afford to spend $100Ks for elder people with some kind of aging related cancer to have 3 extra months in hospice care. People can buy with their own saving but we need to unburden the system.
Single payer or similar universal coverage systems would be the safe (dare I say conservative?) bet, since we have tons of examples of systems like that working well in countries similar to ours while saving lots of money per-capita over our system. Looks like an easy win.
Messing with our regulations and hoping the market fixes things might work, but it's more of a gamble.
I'm somewhat of the mind that the government couldn't possibly do it worse than it's being done now. However, looking at the constant issues with VA healthcare, I'm not sure of my opinion either.
Billionaires from around the globe fly to the Mayo Clinic in the USA. Why seek medical care in the USA? It spends more on the things that are good for the rich.
You forget lawmakers reaping various lobbyist benefits, which is one reason why not much changes. Two sides bicker for a while to satisfy their constituencies, then compromise by doing nothing.
As far as not having bipartisan support, the republicans did get concessions but really didn't seem to want to contribute and haven't really tried to do anything on their own while they were in charge (unless you can point to a reasonable proposal that was shot down by the left). On top of that, claims that the recent proposals were as secretive or anti-bipartisan as the ACA don't seem to hold up [0].
I can't present a truly objective truth that I think will convince you, but there are a few misleading things about the ACA that make it seem more unstable than it really is. Overall I think one basic failing is that the penalty for being uninsured is too low, causing to few healthy people to enter the market that essentially subsidize the unhealthy (which is pretty much how all insurance works at some level). Insurance companies were essentially promised tons of new customers who could offset the fact that they now have to offer plans that actually have coverage (and therefore cost them more). Because of this, they are largely still making money but less money than they were and want. This means they don't have much incentive to make the ACA work and might actively work to destroy it to continue making record profits in an unsustainable way [1]. Not only that, but some of the premium increases come from uncertainty around whether the ACA will continue [2], or whether the government will continue to make subsidy payments that were promised [3].
I don't expect any of this to convince you but hopefully it makes my arguments seem less opinionated. I think about it the same way I think about software, I cannot imagine having to design and build such a system with the adversarial system we have knowing that you have to do it in a couple years and the other party is going to work against you and then try to dismantle the system after you are gone. Expecting to not have to have to make changes over time to fix unforeseen problems seems totally unreasonable to me.
[0] http://www.snopes.com/aca-versus-ahca/ [1] http://www.latimes.com/business/hiltzik/la-fi-hiltzik-aetna-... [2] https://www.nbcnews.com/health/health-care/obamacare-uncerta... [3] https://www.usnews.com/news/us/articles/2017-07-29/trump-thr...
I agree with you that the penalty for being uninsured is too low if you want to build a sustainable system. However, had a more realistic penalty been put in place from the start, there is no way that it would have passed in its existing form. I'm also very much against younger people having to subsidize something that for the most part they get little to no value from.
As far as insurance companies go, the law was by and large a handout to them by providing them a captive audience that did not exist before and an excuse to raise premiums on everyone else. If you create a law that binds consumers to companies and do not provide adequate protections to consumers in the process, this is what you get. Just like the fees, had these protections been in place from the start, there is no way that the law would have passed as it.
My whole beef with it is that there were enough glaring flaws in the law and not enough buy-in from everyone that there was real sustainability and repeal risk. If you pass laws that are knowingly flawed that affect this many people, you are being dishonest and I don't think you deserve points for good intentions in light of that.
Not only will I lose here, but the future you will lose here as will the future everyone on the planet. Healthcare needs don't just exist in the present.
https://www.quora.com/Which-country-develops-the-most-effect...