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> (a) We have universal healthcare for those without income: Medicaid.

> (b) We have universal healthcare for those over 65: Medicare.

In varying ways, both of these programs have large gaps and do not achieve "universal" coverage for the groups they claim to be for.

For instance, when it comes to Medicaid, there is a lack of actual, physical access to care facilities for those without transportation options or a lack of ability to take sick time at work. Many rural areas have severe doctor shortages. There are many others.

> (c) Discussing healthcare reform is not considered "far left," there is significant debate about how to do this and how to pay for it across the spectrum. So far relatively left politicians have gotten the most airtime about this, but it is discussed broadly.

US pays more than most European countries do for healthcare on almost any comparable measure, per-capita, adjusted for life expectancy / outcomes, and many others. Switching to a multi-payer system with basically a variant of a public option, ironically similar to what Germany and a few other European countries have, seems like a pragmatic short-term choice. Unfortunately this isn't a popular solution on either side of the aisle.

> please consider that the US is not analogous to Germany. California is analogous to Germany.

That statement is not true at all.

I give you that California has about half of Germanys population, but it is not a country. California is a State. Germany is a country and the membership in a political union like the EU does not make it a state.

The population is not a match, but States in the US are by design far more autonomous than "provinces" in other countries. When the original 13 states formed the US they thought of it much in the same terms that member states of the EU think of themselves today - not an identical arrangement, but very similar in spirit.

California (and the other US States) have their own labor laws, their own environmental standards, their own transportation and energy departments, their own distinct safety net programs, even their own militaries! (aka the "national" guard)!

Further, the Federal Government is specifically limited via the 10th Amendment to only those powers which are enumerated to it. By default, legal power is held by the states, not the federal government. This is very unusual.

Every "country" has a different mix of systems and different degrees of local autonomy, but US States are at the very high end of local authority while the federal government is at the low end. Thus, comparing some European nation to the US Federal Government is often misleading as it implies that the US federal government even has the power to do things that a European nation can do, which is frequently not the case, or else is greatly complicated by needing state participation and approval.

Germany is a Federal Republic and so is the USA. Germany has states as well.

I grant you that they are different forms of federal republic, but the point that California is not a country stays the same.

I don't care what kind of power the federal government of the United States has or doesn't have. That is a problem for the US to figure out for themselves.

I don't think that when people compare European nations to the US that they are speaking about the US federal government specifically or imply anything about the power of the US federal government. What is more likely is that they are asking why the people of the USA have not archived what people of other countries take for granted. The fact that this would have to be archived via state or federal government is a detail at best.

If you want to enact political change then the legal structure of the government is most definitely not a “detail at best.” Consider gun rights, for example. Due to the Second Amendment, every level of the US government is greatly limited in its ability to enact gun control. To change this requires not a mere majority vote in congress, nor even a supermajority in the senate, but a constitutional amendment which much clear both houses of congress AND be ratified by 3/4 of the states!

These details matter, and they are important specifically when talking about public policy matters and trying to advocate for change.

Back to my original point, there is nothing stopping any US state from adopting universal healthcare, but it’s not clear if the federal government even could if it wanted to (see Medicare expansion and how many states have chosen not to opt in!). Thus if you want to make comparisons to the “things that Europeans take for granted,” it is often more productive to look at what individual US states do and can do, rather than obsess over the federal government. Trivializing that is just a road to getting nothing done.

From his argumentation it is clear that he lacks geography knowledge at all. Beginning with this, it is hard to discuss.

Geography isn't even consistently taught in the US. Americans don't seem to care about it, they are busy eating their donuts and sipping their mountain dews, despite having a huge GDP and $ per capita... a declining age expectancy that matches third world countries.

That "universal healthcare" existing in the US doesn't work and for many Americans that rely upon it is hell. The whole system is extremely inefficient and expensive. Go read on that and you'll see it is a concept so wrong that even third world countries have better health care than the US.

No, the US isn't analogous to the EU. You don't live in the only federalist country in the world.

Your comment can only make me believe you have had a horrible geography education, my only advice is to try to fix it. Learn about the political systems that exist in the world, the countries, their GDPs and peculiarities about their land. Otherwise it is pointless to discuss.

> (a) We have universal healthcare for those without income: Medicaid.

There are tens of millions of people who are eligible for Medicaid under the ACA, but they live in states that never expanded Medicaid under the ACA so they can't sign up for it.

Also, if someone makes more than $12k to $17k a year as an individual in a state that expanded Medicaid, they're no longer eligible for Medicaid.

Yes, which is why I only claimed that we do have care for people without income. re: states not opting in, I couldn’t agree more, hence my emphasis on State-level action being more important than federal when discussing US domestic policies.