More interestingly, can the US political system ever enable an evidence-based debate around it?
From the other side of the pond, it feels like debates end up being emotional rather than scientific.
(I’m a Brit and love the NHS with a passion but would not claim that it’s without flaw. Neither would I claim that we necessarily have more reasoned debates about issues here...)
I honestly think the reason the US is slipping so much is because their political system never seems to have evidence-based debates around anything.
Worse, they have absolutely no interest what-so-ever in comparing their country and how it's actually functioning to other Developed Countries for the purposes of improvement. In fact, I genuinely don't think they care to improve anything, at all.
Americans are not all of the same opinion. They do not all use the same arguments which have the same faults. In this they are like all people everywhere. Also, their political parties do not all employ the same arguments with the same faults. Arguing that everyone has the same faults is both-siderism. It is a counsel of despair. In fact, each party will use facts and international comparisons when doing so supports their preferred policy.
The Democrats have been quite fond of international comparisons in support of their efforts to improve healthcare. I struggle to find a topic on which Republicans prefer facts to mythology but they certainly grab onto a fact when it supports what they want to do. They can recognize and employ a good argument if it presents itself.
If you hear someone making a stupid argument, regarding health care or whatever, nine times out of ten it is not because they desire a worthy thing and are too stupid to get it but because they desire an unworthy thing and are crafty enough to recognize a plausible cover story. You can recognize this happening when someone drives for a constant goal but changes arguments as suits the moment. Republican arguments for lowering taxes fit this pattern as do arguments for not doing anything about climate change.
It isn't the stupidity of politicians, or even their voters, that explain American policy. It's disharmony within the nation mixed with political institutions that expect people to work toward a common purpose.
I don't hold out much hope for reasoned debate to help things though - who can form a reasonable opinion about ~6% of GDP directly managed by the Department for Health? I certainly can't.
A more fair system could be quite a bit worse for people currently in positions of influence, and that's what's going to make it hard. That's how we got Obamacare in the first place - incremental improvement for some, trying not to screw it up for the most consistent voters - and even it's coming close to voter revolt-driven rollback.
If you want meaningful change I'm convinced it's going to have to come from the Sanders-style wing. The mainstream Democratic and Republican parties are too aware of how good they've got it, and at whose expense that comes, currently.
On both sides of the pond, we need to break the false dichotomy of UK vs US. Our systems are almost diametrically opposed, but they get vastly disproportionate mindshare and airtime. In any debate about NHS reforms, people will inevitably hold up the US as a cautionary tale and vice-versa, but hardly anyone raises Germany or Australia as a workable middle ground. This false dichotomy also dominates the debate over gun control.
Healthcare Triage did an excellent series of videos summarising the strengths and weaknesses of various international healthcare systems. I can highly recommend it to anyone on either side of the pond who is thinking about how their healthcare system could be reformed.
https://www.youtube.com/watch?v=ylsO0VVy29U&list=PLkfBg8ML-g...
https://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/
That's kind of where it loses me. We already have a system very similar to single-payer for our veterans and it is notoriously inefficient, bloated, and unpopular. What many are clamoring for in the US is already being tried in the US and failing exactly the way opponents claim it will.
Evidence that it works well in other countries is worth considering, but it in no way proves such a system would work well here. It'd probably work well in states that are similarly culturally homogenous (like Vermont or New Hampshire), but the discussion always seems to be at the federal level.
I think what we need is more freedom for experimentation. Pick maybe a city or county and make it eligible to sidestep all of the federal and state regulations and build/create their own. Some will undoubtedly shoot for a libertarian approach while others might imitate the NHS. See how the costs and outcomes compare. Gather more evidence in a more relevant way.
London is culturally diverse. Moreso than any US city. And its NHS seems to be working ok.
A nationwide system in the US would be covering far larger and more diverse areas.
It's incorrect to say that the English NHS is a monolithic thing. It isn't.
The NHS is regional. It's split into regions by "clinical commissioning groups". There are 32 CCGs in London. These are independent from each other, and from the rest of the UK.
http://officelondonccgs.org.uk/what-is-clinical-commissionin...
> Clinical Commissioning Groups (CCGs) were created following the Health and Social Care Act (2012), replacing Primary Care Trusts on 1 April 2013. They are clinically-led statutory NHS bodies responsible for planning and commissioning health care services in their local area. There are currently 207 CCGs in England.
> The National Health Service (NHS) is the name used for each of the public health services in the United Kingdom – the National Health Service in England, NHS Scotland, NHS Wales, and Health and Social Care in Northern Ireland – as well as a term to describe them collectively.
Emphasis on that last part.
The Scottish NHS has nothing to do with London.
But even within only the English NHS, what happens in say Bristol has nothing to do with London.
My point stands: London is more diverse than anywhere in the US, and the various NHS CCGs in London are doing okay.
This is just getting boring as you argue pointlessly over semantics.
UK: Covered collectively by the NHS, which has its own branches.
England: A part of the UK that has 55 million people and its own branch of the NHS. It is racially 85% white and 7% Asian.
London: A big city in England with a population around 9 million.
The number of people in London is much smaller than the number of people in all of England, and all of the UK. Yet, England (as shown above) is quite racially homogenous (typically a good indicator for being culturally homogenous). That a single city exists in a sea that is culturally homogenous (that you feel like is "doing okay") does not mean that if all of England or the UK's population were more diverse, there would be no problems.
Nobody is arguing that the system would collapse the moment it encounters a single diverse area, so your point is irrelevant.