What will it take to get universal healthcare in America?

I grew up in the American system of 'for-profit' medicine. It worked. It never didn't work. I got the surgery I needed. I always got to see a doctor when I was sick.

A lot of talk about the disfunction in the American system misses the point that it is functional. We don't have millions of people dying on the streets because they can't get health care.

We do spend a colossal amount on healthcare here, and there are definitely improvements that could be made. But we also have one of the least healthy populations on the planet.

Realistically to transition the USA to a socialized system you need to make the current system collapse. You won't succeed in major changes to a functional entrenched system like we have now.

I disagree. Canada did it along with many others. We have to convince people that healthcare is a basic human right, and it is. I (metaphorically) should not go broke because I need surgery or any other health service. We need to see the divorce between medicine and profit.

Not just that it's a human right, but then to what extent that it is. That societal agreement on what treatments should be covered is where most of the contention lies. We could adopt the views of the Amish and it would be relatively low cost, but that would likely raise many objections about "letting people die".

https://slatestarcodex.com/2020/04/20/the-amish-health-care-...

Do you know any doctors, personally? They aren't kindles. We can't have uighur slaves crank out an infinite number of them on a moment's notice.

Best way to get over this "basic right" business is to be a gainfully employed taxpayer with a sick kid in an american emergency room, and have to wait in line behind a slew of 300lb obesoids (mostly on medicaid) w/ (preventable!) diabetic complications.

And before someone goes, "but Europe!", I repeat that Europe is only a car or two behind us on the entropy train, and I say this with bitter sadness.

I'm married to one who does their level best to be a thorn in the system. When we married, we were polar opposites with regards to medicine. Now, parity, finally. I know many others besides. Some are opposed to anything that would take a penny from their bank accounts. Others, increasingly, see things as I do. Europe has many troubles, but half my family still live in Europe and they report nothing untoward medically other than our shared pandemic misery. In fact, they are normal, everyday people and have already received the vaccine. Not so much here...

Why stay here then?

It is interesting to me how taking on "the white man's burden" to civilize africa and the orient is a passé and cancellable offense, while undertaking it against the Great American Redneck isn't. If Europe is more civilized, and you want civilization, why not leave Bubba unmolested in his own natural habitat?

I could easily go back to Europe. But we are employed here. I did look at Finland and their tech-hiring program a bit back during the pandemic, but they ended it. America is just short-sighted. For all the good things here, there is so much that is simply broken and for no good reason other than "NIH". If I could convince my spouse to move to Finland or Norway, I would do so in a heartbeat, but with 11 years as a doctor here, and with kids... I've been given the green light if I can make it work, and trying I am. I'd like Americans to have access to quality healthcare, great schools, and the lot, but apparently they don't want it because it's "socialist". The percentage of taxes that would be raised is still far less per person than anyone pays monthly for health insurance.

Everything is connected, our blessings and our curses are joined at the hip, and the average american voter understands these interconnections better than nearly every outsider.

Attributing it all to stupid-americans-and-their-prejudice-against-socialism is as much a disservice to yourself as it is to them.

I could illuminate a few of these connections here, but I would be swiftly pig-piled and banned, so you will have to discover them for yourself. Good luck!

edit: Actually, publish and be damned! We had a great many Germans at a chemical plant in the southeast--always telling us how stupid and backward our country was. UNTIL! the waves of refugees came. Now those same Germans fall over themselves apologizing to us. "We didn't know!"

As a Canadian who experienced urgent care in the US on a trip, no one with money would advocate for the Canadian system. The US system is mind blowingly good compared to the Canadian system. If the US could price in the externality of people who aren't covered by charging the wealthy even more, it would be way better than adopting the Canadian system.

Is this whistleblower just propaganda then? https://news.ycombinator.com/item?id=25540015

You don't even need to look as far as Canada to see what single payer healthcare implementation will look like in the US. Hospitals in the US that disproportionately serve populations on Medicaid/Medicare are notorious for their poor quality and consistent underfunding.

You need enough people making univeral healthcare a priority issue. Then you also need those people to agree on what that system should look like (the models vary greatly). There are likely some complaints about the system that you say worked. Everyone has different experiences.

Right now, both "sides" agree that costs are out of control, but generally disagree on what reforms to make. This is the case for many other subjects in politics - the sides might agree with the problem but disagree on the cause or solution.

I think the system has stopped really listening to the people and to the concerns of the other side. It seems both parties try to win full control of the government to ram through whatever their party wants rather than work together. Part of this could be that we have handled most of the common topics and now we are left with the urban vs rural topics/solutions. If you look at the other developed countries you talk of, the urbanization ratios are higher than in the US, so basically one side has won out over the other (in general).

Lobbying itself is not a bad thing that should be outlawed. It shouldn't involve money from corporations in my opinion. You do have groups that lobby on behalf of individual members. I don't see a problem with that, if the money is not from corporations.

> Right now, both "sides" agree that costs are out of control

No, they don't. They both might agree with that statement, but they don't actually mean the same thing by it, so there is no actual agreement in substance. Which is a primary cause of the disagreement over solutions: there is a disagreement about the problem (behind which is also a disagreement about basic values.)

"Right now, both "sides" agree that costs are out of control, but generally disagree on what reforms to make. This is the case for many other subjects in politics - the sides might agree with the problem but disagree on the cause or solution."

No, repeating it with additional italics doesn't make it less wrong.

Both sides may sometimes use the same words to describe the problem, but they don't agree on what the problem is; the words have different meanings when different people use them.

This is also true (and much easier to illustrate) with illegal immigration, where “both sides” agree that “illegal immigration” is a problem, but for one the problem is immigration outside of the current legal rules (or maybe even immigration generally), and for the other the problem is the current legal rules creating illegal status for certain immigrants who are not otherwise viewed by that side as undesirable.

Using the same words for a short description of the problem does not mean agreeing on what the problem is.

"... the sides might agree with the problem but disagree on the cause or solution."

On the case of healthcare (the topic at hand), the statement is correct. Claiming it's wrong and then switching the topic is not a valid argument. The fundamentals of the immigration issue are completely different (can both sides say illegal immigration is the problem like they can for healthcare costs? No, Democrats will say immigration law is the problem.). You seem to be missing the difference of what is a shared or agreed upon problem vs conflicting cause and resolution views.

> On the case of healthcare (the topic at hand), the statement is correct.

No, it's not.

One side thinks that the total cost to individuals for a broad interpretation of medically necessary care relative to individual income is too high, but isn't primarily concerned about total cost of care except insofar as that limits the solution space for the first problem.

Another side actually does largely agree on that (though has a slightly greater, but still ssecondary, concern about aggregate costs) but disagrees with the first about solutions (in part because of the secondary concern), but those two sides are most commonly viewed as part of the same side (roughly the progressive and centrist wings of the Democratic Party.)

A third side believes that aggregate costs of services are too high, but isn't particularly concerned with how those costs are distributed between the recipient of services and others [1] or relation of cost of consistent baseline level of care to individual income.

There are a few more sides as well, most of which would agree with the “costs are too high” formulation, with even more different interpretations of which specific costs are too high, and what “too high” means.

[1] That understates the case a bit; much of this group actually has a fairly firm ideological preference that actual costs be concentrated on the direct recipient of care.

Could it be that years of lobbying against "socialized" medicine influenced public perception? https://news.ycombinator.com/item?id=25540015

I am not 100% sure if a full Universal HealthCare will work in the US even though in general, I am a general supporter of ANYTHING different than we have now so I will be willing to try it. But my ideal solution will be something like:

- Get rid of insurance companies for EVERY visit to the doc/hospital. Make prices transparent and available OTC for anyone to compare between various practices. It is kinda like car insurance if you think about it. I can bet that if we had to involve insurance companies for things like oil change, premiums would skyrocket and not to mention the overhead of the middleman. Let people pay cash for general stuff. For those who can't pay at all, see below.

- Govt. should insure everyone for catastrophic illnesses to start with. This is where we all pool in a bit from our taxes for the greater good. I however do think that we should limit this to serious illnesses like cancer etc.

- Based on level of income, Govt. should also insure/subsidize poor/low income groups for general visits, procedures etc etc. May be a small CoPay type stuff. But no major bill. High income folks don't get this Govt. Benefit (kinda like Food stamps ?).

- Did I already say get rid of middlemen Insurance Companies for basic stuff ? Ok good.

- Private insurance should still exist but let them compete in a real free market. If someone wants to buy private insurance as additional supplement, no problem. Just don't force me to use an insurance company just because I want to go talk to a doctor for 30 mins.

- Get rid of all the crap like In network, out network, Deductible blah blah. Keep it simple. Get rid of filing an insurance claim for EVEEEERY thing. I got to a doc, I can pay Cash. I am done. Boom. No need for crazy billing systems and figuring out who will send me a bill.

Lets do this ?

I like it. Esp. price transparency. AHA and the Trump admin have been fighting over that in the courts. Not looking good for the AHA at the moment:

https://www.policymed.com/2020/07/district-court-upholds-hos...

For a more actionable take on how (from a policy perspective) the US might get to a progressive health insurance system, I highly recommend this lecture from Ian Shapiro: https://www.youtube.com/watch?v=kqm8T_FNnog.

The series is somewhat lengthy, but he takes the important step of enumerating all of the challenges and political/economic/cultural forces that have stymied attempts so far, then proposes a very concrete and incremental path forward that should minimize the aforementioned pitfalls. Given how much we like to argue about what "should" be done in legislative politics on these online fora, I found his breakdown of why these "shoulds" often don't materialize to be very insightful.

The US has universal healthcare. If you're poor or elderly, you have access government provided insurance. If you're near poverty, you have access to government healthcare subsidies. For everyone else, it's illegal to not participate in an insurance plan.

"for-profit medicine" is a gross mischaracterization of US insurance. Half of US healthcare expenditures come from the government and a significant portion the other half isn't even "for-profit" e.g. the largest private insurance provider in the US by far is literally a not-for-profit organization.

What will it take? Time.

If you wait long enough...

* There will be universal healthcare

* The police will not be permitted to use deadly force

* Landlords will not be able to evict tenants for any reason whatsoever

* Colleges will not be able to discriminate based on aptitude or demonstrated performance

In short, if you wait long enough, all the "wants" of the Left will be achieved. It will happen whether Republicans or Democrats are in charge, but voting in Republicans slows down the process just a bit.

Thank you for your reply. I think getting no-cost healthcare for children would be the thin edge of a wedge. Once people realize the savings, they will be demanding it for all. Chinks in the armour is how it starts.

Children are incredibly cheap to insure. That's why we have medicaid (no-cost) and CHIP (very low cost).

Exactly. Groups that cost the most are near end of life and have costly chronic conditions pervasive in that age group. Children are a relatively healthy group that require comparatively little payout.

That's what medicare is for--to blow ~$100k on giving grandma a few more months of living death.

Yeah. The Amish seem to have an interesting take on this. I think this difference also brings up the point that if we have universal health care, the entire nation would have to agree on the terms and conditions of that system, which tends to contradict with the history beliefs of the US.

https://slatestarcodex.com/2020/04/20/the-amish-health-care-...

If you qualify. I make too much to qualify for "assistance", but my insurance is ridiculously high and every year (I do shop around) they ask for more and offer less and less. "If" is the biggest word in the dictionary. The issue is divorcing medicine and profit. Healthcare is and always will be a basic human right. I would be OK with starting incrementally, say, I buy health insurance and I pay NOTHING ELSE EVER, no matter if I stub my toe or I need a quadruple bypass. The issue is also one of the insurance companies coming between me and my doctor. We know what's best for me, not the insurance company. I've been fighting this battle for 20 years and I'm more disgusted with each passing year. I now know how to fight it on an individual level as far as getting debt forgiven, etc., but no one should have to live like this.

Have you checked your state's CHIP program? The income limitations are usually very generous, and the networks are usually far better than medicaid.

Yeah, I was going to say this. The limit in my state for a family of 4 is like $80k for partial assistance and $50k for it being free.

What? Why would any of these things happen just because of time?

It's a religion: "the right side of history," and all that

Not just time, but also demographics. Most issues today are urban vs rural. Urbanization tends to increase over time, moving us further on progressive topics. You can see this most clearly on gun rights in countries that hit 80% urbanization under similar representative governments.

probably going to get in trouble for this one, but it proves your point:

https://www.reddit.com/r/PoliticalHumor/comments/glco4u/2040...

I was actually going for this one. There's a lot more red than blue, but there's more people under the blue area. It's pretty fragmented, especially the blue areas. So it wouldn't divide cleanly.

https://external-preview.redd.it/soNxegi7UWdcVDUWYf_WcSI8SXe...

Most of the blue spots in flyover country are ethnic spoils rather than urbanization.

A civil war.

If civil war does occur, I would expect it to set back the adoption of this (and most other) policy creation and implementation.

I'm saying there would have to be a civil war because half the country sees little daylight between European style universal healthcare and communist totalitarianism. States threatened to secede over the ACA, and that was far from "universal healthcare."

The only way we can have true progressive/social democratic policies in the US is if that half is no longer a part of the country and no longer able to sabotage attempts to implement those policies when they gain power.

It would be easier to divide the country if it were truly at the state level. If you look at the voting map by county though, it would not be feasible to really divide the nation by based on political ideology. I don't see how a civil war would really result in an undivided end-state.

After seeing people rise up in armed protest over being asked to put a mask on and maybe not stand so close to one another during a pandemic - in part because they felt it was part of an authoritarian power grab - I just don't see how we can come to the political and cultural unity that would be necessary. We either have to separate, willingly or forcefully, along mutually opposed political lines or else deal with a permanently crippled, self-sabotaging republic.

You forgot the 3rd option. Wait until the US hits about 85% urbanization. One party will predominantly control the government and the other group will be marginalized.

Europe is not ahead of us in progress. They are behind us in entropy. What you are witnessing here, as ugly as it is, is the future of all westernized countries, for it is implicit in our shared value systems.

And if you really dig into it, modern healthcare, regardless of who pays for it, is a scam. They harm nearly as often as they heal. By many accounts, medical error is the 3rd leading cause of death in developed countries. Prescription opiates in the US were blamed for the recent reduction in our life expectancy. Statisticians (good ones, at least) will verify that the 20th century leap in life expectancy was primarily due to hygiene (distantly followed by antibiotics). All of the other interventions are noise in comparison.

Don't even get me started on oncology. Ivan Illich wrote a book decades ago detailing many of their swindles. Most of it still rings true today.

Politically Europe is ahead of us. Most of it is driven by urbanization ratio in the population. Once you pass about 80% urbanization under representative governments like ours, one side always wins. The reason we have the infighting is because we are near, but not at, that juncture. We also have the internet for fake news, etc that was not prevalent when those other countries reached this juncture.

As someone who has been on both sides of the spectrum, I guarantee that the New York Times swallowing urbanite is in an unreality bubble every bit as pernicious (if not more so!) as the ones inhabited by the most unrepentant of foxnews boomers.