It’s unclear to me why the American government doesn’t change the laws and create a new system more like a European one. I don’t think hating any of the players makes sense. Those that set the rules are ultimately responsible.
Because the regime decisions in the US. are much defined by the corporatocracy and lobbyists interests rather than the people's. Some further readings/videos on that:
[0]: https://harpers.org/archive/1960/10/the-politics-of-medicine... (The Politics of Medicine)
[1]: https://www.youtube.com/watch?v=RoHq6dBpxYU (The Lobby)
[2]: https://chomsky.info/20100124/ (The Corporate Takeover of U.S. Democracy)
[3]: https://chomsky.info/20110407-2/ (The State-Corporate Complex)
Combine this with a distrust of government that is encouraged by many of those same interests and you have, well, us.
A lot of our voting seems to suffer from the "but it won't happen to me" fallacy, whether that be about health care and medical debt, conditions in jails, climate change, social services, etc. with the irony being that it often happens to most people in the long run.
It took superhuman effort, a once-in-a-lifetime political opportunity, and some outright shenanigans even to get the Affordable Care Act passed. It was a very minor tweak to the existing system, and half the country viewed it as an apocalypse. The political party that passed it ran away from it in the next election, and got massacred. But now that it is law, it too is nearly impossible to alter because the alternatives all terrify people.
There have been various attempts and proposals to change the system.
An example of one attempt among many is called "Medicare for All Act": https://en.wikipedia.org/wiki/Medicare_for_All_Act
Scroll down that article to see that for the last 21 years of revisiting it by every legislative body, it always ends "Died in Committee". Every 2 years, some new representatives get elected, and yet it still dies. The proposal doesn't even make it out to the House floor to officially vote on.
Why? A lot of vested interests in keeping the current system. (Aka "money".)
The intuition is to think only the greedy health insurance companies are against it. But doctors' associations and many American workers with decent health insurance from their employers are against it too.
Why? And why?
The requirement to have 60/100 votes in the senate makes it almost impossible to pass anything except the most uncontroversial bills.
The filibuster is not enshrined in the Constitution. It's only a Senate rule that could be abolished at any time via a simple majority vote in the Senate. The Senators have chosen not to abolish the filibuster.
It's actually worse than this.
Popular bills, like the Dreamers Act, become political footballs. Neither party wants to pass it while the other party is "in power" (in the minds of the electorate), and they want to keep it around as a bargaining chip, campaign promise, etc.
So the bills that get 60 votes aren't just uncontroversial, they're usually not even meaningful to voters.
[0] https://www.cambridge.org/core/journals/perspectives-on-poli...
If it were legal in certain circumstances to kill someone and take all their stuff, you'd hold the people who arrange for those circumstances to arise as often as possible for the purposes of plundering from their former neighbors blameless because "they're just playing the game"? What if it were torture instead of just murder? Does there ever come a point when a person is responsible for their actions?
This is it right here. People have been holding out for an answer to that question and I think they are learning every day the answer is no. People can't watch families like the Sacklers inflict untold harm on the population and then get away with a fine less than what they made inflicting that harm, and come away to believe the system works, and that rich people's "due process" is the same as the rest of ours.
If I murder 1, 10, or 100 people I go to jail for life or get the death penalty. If I make a business that murders half a million people by pushing pills and I make a billion dollars doing that, absolute worst case scenario I get a relatively small fine compare to my earnings, and I continue the rest of my life in luxurious freedom. And that's only IF the issue goes to trial after I exhaust my endless resources to massage the justice system by choosing the venue, the judge, and the jury.
Lifetime jail and death isn't even on the table. I guess until now that is... maybe that changes the cost/benefit analysis in boardrooms. Maybe they need to start estimating the likelihood their decisions are so immoral they will actually radicalize their customers to murder them. Because it seems like that possibility doesn't even cross their minds and they feel they can race to the bottom with no repercussions except a fine.
The US is actually closer to the Canadian example, though Canada started earlier and doesn't have a Big Pharma burden. But like the US, Canada is a hybrid private-public system with a lot of provincial variation. There wasn't a Canadian federal health law until the 80s, after 20 years of patchwork provincial laws, and Canada continues to have big gaps and inequities (e.g. mental health coverage is quite a bit worse in Canada than the US, dental isn't covered, and people on work visas get screwed). A large majority of Canadians have supplementary private insurance. So I think the US will get close to the Canadian system via slowly pushing up the Medicaid eligibility line and eating away at private insurance, and not a big sweeping law.
[1] "Medicare for all" is dishonest, it has to be Medicaid for all. But for classist political reasons nobody wants to say that.
Is it actually true that European systems are better?
One of the issues with healthcare in the US is that every actor other than the patient benefits from higher cost and worse service. It increases revenue and decreases cost for healthcare providers, for pharma, and, importantly, also for insurance companies. There is no competition to improve service and decrease costs.
I do agree that it makes more sense to have basic healthcare covered by a single national government program, rather than mandating basic coverage and allowing private insurance companies to "compete" by offering the same mandatory coverage as each other. If that's specifically what you're referring to by "useless added bureaucracy", then I agree.
The pharmaceutical companies have patents on the drugs and so they rent seek. The hospitals have geographic locations and generally don’t get built across the street from each other. The pharmacies are owned by the same parent companies as the insurers.
But somehow you can take this mess of central committee grift and pay some CEO 8 figures a year and now comrade, now we are doing the capitalism. We are rocking and rolling.
There are MANY firms who would love to open discount clinics across the street from a bunch of existing medical centers and out-compete them on price and service and eat their lunch; anyone who has used the american medical system knows what a low bar that is to clear. The problem is that in most cases the supply of doctors is capped by law and the ability to open new hospitals and clinics is restricted, so prices remain astronomical and service remains terrible, just like your other public utilities.
Somehow this government-mandated lack of competition is blamed on “free market capitalism”.
Lower taxes and employer-sponsored health care is cheaper than single payer and higher taxes
https://www.commonwealthfund.org/publications/issue-briefs/2...