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> If you aren't doing anything about it, the problem is you.

What do you expect me to do about it? I live in a reliably blue area and it's Republicans who are blocking things like a single-payer system.

So what exactly are you suggesting? Uproot my life and go move to a swing state so I can vote Democrat there?

Because short of that, I don't know what. And the country is so culturally divided, it's not like there are many swing voters left who can even be convinced anymore. Republicans just don't want health care reform, so what are we supposed to do?

A single-payer system doesn’t seem like a magic fix to me at all. At best, a single payer could, at least in principle, wield enough market power to improve the overall system.

Just look at Medicare. Medicare has enormous market power, but it uses that power in more or less absurd ways and does not optimize patient outcomes or its own expenditures particularly effectively.

It sure works in a bunch of other countries. I don't think there's anything special about the US that it wouldn't.

And it enables things like optimizing for patient outcomes that can't be achieved with private insurance.

The thing that is unique to the US is the level of corruption. Politicians are 100% beholden to corporate interests and nothing else. America’s dominance is entirely reliant on industry, so nothing can be done to upset the big corps.

Is corruption actually worse in the US than in countries with single-payer? I doubt it. Let's stop making excuses for ourselves and get it done.

Maggie Thatcher, who I don't pretend to love, once said (IIRC what I read, paraphrasing), 'Ask military leaders if something can be done, and they'll give you a hundred reasons that it can't. Tell them it will be done and ask how, and you'll get a hundred solutions.'

Adjourn the 'can-we-will-we-it's-so-hard' meeting, and convene the 'how' meeting.

> Is corruption actually worse in the US

Yes, in particular America has by far the largest pharmaceutical and medical devices industries in the world, so politicians in other countries have no particularly strong incentive to prioritize healthcare profits over wellbeing. Ask a thousand healthcare economists why healthcare in the US is so expensive and 99% will have this in their top 3 answers.

> Tell them it will be done and ask how, you’ll get 100 solutions

Here’s the solutions: demographic shifts due to death, labor strikes, or violence. Voting in 2024 isn’t one of them. I will still vote because it’s easy and makes some minuscule difference, but there is no mainstream political will for change here.

I just wanted to say thanks for that perspective -- I've often wondered what made the US so "different" from other developed countries in not having single-payer, and had always assumed the root cause was a cultural frontier-settler-independence attitude.

I never thought about the fact that we have a domestic pharmaceutical and medical devices industry, that's present in a way that's unique to the US. That's a factor you don't get in Spain or Norway or Australia. Very enlightening -- TIL!

> What do you expect me to do about it? I live in a reliably blue area and it's Republicans who are blocking things like a single-payer system.

So why did single payer healthcare fail in Vermont and California? European countries the size of Maryland manage to run their own universal healthcare systems. Why can’t states where democrats outnumber republicans 2:1 do the same?

Because you'll get the same issue as with the homeless, people from other states will come over to mooch on the better services. This has to be handled at a national level in order for it to succeed.

Legally, I’m not sure that’s true. I think discriminating against out of staters for health insurance could well meet the compelling interest standard of Shapiro v. Johnson, similarly to how states are allowed to discriminate against out of state students for public universities. And if it were challenged, I suspect the current Supreme Court wouldn’t be so inclined to further extend the broad “right of travel” found in Shapiro.

Putting that aside, the theoretical prospect that states would have to accommodate out of state moochers doesn’t seem to be the actual reason that the California and Vermont universal healthcare efforts failed. It seems like those programs failed because voters don’t want to pay for it.

If they're homeless, they aren't 'paying' into a single payer system, regardless of it being at the State or Federal level. People that pay little to no taxes 'mooching' off the taxpayer funded services is exactly the concern of many that oppose universal healthcare.

Considering many large companies self-insure their employees' healthcare, it seems unlikely that simply expanding the scope of who is covered is going to make the whole plan work.

You're right. You're helpless. Is that what you want to hear? Is that what you say at work? Is that what you tell your kids when they have a problem? Take step back - this response is beneath us; it's making ourselves victims.

I could spell it out concretely, but the problem is the approach, the attitude, that talking like helpless victims is somehow ok. It's completely irresponsible - an abdication of our responsibilities to ourselves, our communities, our country, and future and past generations. Change that, and you won't need me to tell you what to do, you'll be busting at the seams with ideas and drive.

Imagine where we'd be if past generations adopted this helplessness. Imagine Washington, Jefferson, and the rest, facing the British empire. Imagine FDR, Churchill, MLK, and so many more. That's who we need to live up to. I've never heard them talk like Americans today.

> I could spell it out concretely

Well please do then.

There are lots of people with drive on the Democrat side -- look at everything Bernie inspired, for example. There's ideas and drive aplenty. Look at the optimism that propelled Obama into office. And then look at how little he was able to accomplish, compared with what he hoped to. Look at how he discovered that Republicans wouldn't work with him, no matter how bipartisan he tried to be.

Because Republicans have drive too, in service of their own ideas -- ideas which are diametrically opposed to all of that. And they have the votes to block anything meaningful.

So again, please spell it out concretely. How do you propose to overcome the power that Republicans currently wield? I'd love to hear your thoughts spelled out -- your effective political strategy here to get the votes.

The only advice is: Get up and start working, start thinking and focusing on solving problems, start organizing and winning. Any leader, any manager, anyone with life experience can tell you: If I do it for you, then nothing has changed.

Yes, Republican Party political tactics - pretty consistent since at least 2000 - have been effective. Why would they stop until someone stops them? Did you think those power-brokers, the vested interests, would make it easy? That is the nature of politics. It's not an exception; that's life; the enemy will fight.

FWIW, Obama avoided confrontation; he never confronted them and stopped them. Same with Hillary Clinton, same with Biden, same with most of the Dem congressional leaders. Why would anyone, except the most brain-dead or blind, follow leaders who won't even stand up for themselves, who exhibit cowardice when confronted with even the most vile, absurd foes?

And against them, you have the truth, good faith, good health and finances and everything else on your side. It couldn't be easier, in may respects.

I've said way more than enough. It's really an absurd situation. Stop talking to me and get to work.

So, you've got zero effective political strategy.

Just a bunch of empty exhortation and generic advice.

Sorry but that's not helpful. A little bit of advice back to you: the world is a much more complicated place than you seem you to think. The real world isn't a morality play where simply having "the truth" and "good faith" makes it so it "couldn't be easier" to win. That's the movies. That's fantasy. Not real life.

> you've got zero effective political strategy

That's you. You keep asking me to do your work. I've got plenty of ideas, energy, direction, and action.

So no actual advice then...

The absolutely best (and most impactful) thing you can do as an individual is to _not pay the damn debt_ to the hospital.

The illusion of impact by writing to your congressman is really just that, a proverbial carrot in front of the donkey of democracy.

> The illusion of impact by writing to your congressman is really just that, a proverbial carrot in front of the donkey of democracy.

This is the hopelessness I'm talking about in the GP. It was edgy and clever to despair, but it's really for losers. Let's get serious; people are dying, democracy is dying; our predecessors managed to achieve great things and there's no excuse for us to sit on the sidelines and whine.

I don't disagree with your fundamental message, but as a non-American watching from the sidelines, what are you doing in a practical sense, other than whining on an internet forum?

I am certainly not whining! :)

The question is what do we do about it? It sounds like you’re suggesting we can vote our issues away, but the voting and primary system is also corrupt.

The only way forward is to leverage our economic power (by forming unions or organizing a general strike). That’s the leverage we have against power, but ultimately a lot of what that looks like is lying down and doing nothing.

> The politicians against healthcare reform are well-known

Who are they specifically?

Just vote them out. The medical system is the only issue that matters. /s

We get to pick from the politicians that the DNC and the RNC allow us to pick from.

The answer is the majority of the Republican party and their electorate, but just saying that will get you a barrage of downvotes on HN and other similar forums.

We get the system we deserve..

Well we got Democrat-led reform and it’s arguably worse.

I generally vote Democrat, but there is no American political party putting serious support toward a sensible healthcare system.

It was top billing in Democrat policy for decades, from Clinton through Clinton, and Biden did some too. Top billing in Republican policy was to oppose it and undermine it - remember the endless, pointless, virtue-signaling votes during Obama's administration by Congressional Republicans to kill Obama's healthcare plan. Remember he got it through on the slimist margin, through procedural maneuver, with (no? one?) Republican votes.

Organize and get the ball rolling. What are the problems? How do we solve them? You're not a customer or a victim; you tell them what they should be doing. Don't worry, most politicians will do anything to get some votes!

> Remember the endless…

I remember how the ACA was essentially a giant gift to the insurance industry, and that despite being mandated in most states, only increased the insurance rate by a few percent. Oh, and the vast majority of the increase in insurance was health plans with a $10000+ deductible. I remember how medical debt bankruptcies continued to climb after it was passed.

> Don't worry, most politicians will do anything to get some votes!

Before they get votes, they have to win the money primary. Then we get to decide which technocrat or self-funded billionaire candidate sounds nicest to our ear.

It’s time to stop thinking you can vote your way out of this. Our leverage is our labor.

> EDIT: People need to stop debating whether they are powerless, and the 999 ways they are powerless, the hopelessness of powerlessness - and start posting solutions.

Well since you're the one claiming the problem is us, which is a pretty bold accusation -- what's your solution?

If you're making accusations that we're not doing enough, what are you doing then?

Very curious to hear.

That's a common comeback - and again, it's doing nothing, spinning wheels, talking on the sidelines. The distractions are endless, but there's only one thing to do - get in the game.

It's entirely fair to ask what you are doing if you are exhorting others to action.

It's fair, but it's a waste of time. It's fair to pick your nose, but not responsible to your community, the people who built it, and the people who will come after you.

Deflecting the question while simultaneously insisting others act without questioning ("it's a waste of time," apparently to ask questions) is an act of hypocrisy. Show us that you practice what you preach - and make no mistake, you are preaching.

You worry and complain about everything but actually doing something. Let's gooooooooo!

> generations of Americans and other democracies have managed to get things done.

That's how we got here in the first place. Generations of Americans doing it the American way.

Stop blaming other people. It's us, you and me.

Yeah but now we're hopped up on adrenochrome and too busy with our Satanic rituals to do anything.

One can blame politicians and corporations all they like, but the simple fact is that >50% of the country (and significantly more than that when accounting for skewed political representation) does not want the system to change, because to them any alternative is "socialism".

... US government-run "socialism".

Because we all know how well they run all the other programs, especially if you've dealt with healthcare they already run (military and VA).

I'd imagine people would be clamoring for socialized medicine if they fixed the VA to be a shining example.

And yet Medicare has a 94% satisfaction rate.

Sure, once they pay their tax for decades, pay their premiums and copay, and buy their supplimental private insurance (not to mention facilities diffusing some costs through higher price setting of private parties). It's not a bad system, but you can't really scale a system that takes decades to fund and requires all these other costs. Especially since this conversation is about debt to medical facilities which can still occur under Medicare (or be forced onto Medicaid). Yes, supposedly it would save the US $2 trillion over 10 years, although there is some debate on that.

Edit: why disagree?

The VA may suck. But compared to 90% of private insurance, it’s amazing.

That has not be the experiences I've heard of from just about anyone who has had both.

Compared to a PPO plan? Definitely has been what I’ve seen.

Distances to the VA can be far for many. It can be extremely difficult to be seen by another facility/provider. It can be difficult to get/use your benefits in general. PPOs are basically the same type of restrictions, only the facilities tend to be held to higher state standards.

A lot of veterans live in rural areas. Far more than you’d expect. Anecdotally, literally 100% of all the ones I know, but definitely not all.

If you compared normal insurance and care options where they are at (especially considering their income level) to VA care, it’s actually quite good. Especially if you know how to treat them more like an HMO and work the system.

Private rural medical care is… not great.

And usually requires a lot of travel. And unlike the VA, is rarely in a single facility.

Generally everyone bitches about it though, because that’s how the military works anyway. And yes there are often (changing) systematic issues, though they often get fixed.

Are there better options? Yes, especially if you’re high income and can afford a higher tier private plan, and/or live in a higher population density area where facilities and standards of care can afford to be higher. That is not a typical situation for most Veterans though, for many reasons. And not a typical situation for a lot of the population either.

No it’s because socialism isn’t the only alternative and half the country wants to use it as an excuse to enact socialism, just like they want to use literally every other issue as an excuse to enact socialism.

To me the medical system is the worst of both worlds. It’s heavily regulated in favor of the businesses (insurance/hospitals) and gives the illusion of competition when in reality “networks” exist to ensure there is no actual competition. I think either full on socialism or fully free market would be a huge improvement.

> I think either full on socialism or fully free market would be a huge improvement.

Demand for healthcare is about as inelastic as it gets. And inelastic goods make for inefficient markets. One doesn't need to be a full-on communist to recognize that markets are not the correct solution to every problem.

Meanwhile, the fact that healthcare is tied to employment in the US has terrible consequences for small businesses and for the efficiency of the labor market. From where I stand, socializing healthcare is the pro-business move.

> >50% of the country (and significantly more than that when accounting for skewed political representation) does not want the system to change, because to them any alternative is "socialism".

As I said, if we can't overcome that absolutely weak, absurd argument, the problem is us (and many others). Let's get to work and stop talking like victims.