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Comment by crazygringo | Hacker News Reader

> 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?

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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...

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.

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