[me_me_me]

One thing that has always came true throughout my life is a phrase: "If you don't know why, its money."

Why there is no national healthcare - money, someone makes a ton of it by preventing nationalization of healthcare system.

Everything that doesn't make sense, has better alternatives (somehow not adopted) always boils down to money :(

[FrankyHollywood]

Another reason is people don't like sharing. In democracies the majority of people don't vote for a program where they have to pay for others, even if the net result would be in their advantage.

so it's money, and stupidity :)

[chooseaname]

Exactly this. I'm in the South (U.S.) and a lot of people here would benefit from national healthcare, but they continue to vote against it (rather, for politicians who are against it) because "if you don't work for it, you don't deserve it." They're so afraid of the few who would take advantage of it that they're willing to let the many who need it not get it.

[saiya-jin]

Yes it sounds like common mentality in US - "you need to deserve your spot under the sun". This mindset can push society to achieve great things rather effectively (as seen numerous times in the past with US), but it can also mean cruelty to fellow citizens because... usually money, power, status.

Everybody for themselves ain't a good model for a healthy society in long run. Way too many predators out there.

[logfromblammo]

I'm a Midwestern transplant into the South, and a significant proportion of the anti-welfare sentiment around here seems to me to be incredibly racist, plastered over with language that has been carefully scrubbed of any mention of race. And that poisons federal politics.

The fear is there, but to me it looks like white people afraid that some black people or brown people might earn the same money for the same work, or get equal representation in government. And it's all apparently justified in the politically segregated religious congregations.

There's that "if you didn't work for it, you don't deserve it" attitude, but it also combines with "whatever you have, you got because you deserved it" attitude. It's very fatalistic, and completely discounts the possibility that injustice exists in society, and that some humans actively create it for their own personal benefit.

It also seems like more of the social bonding activities are inherently organized around pre-existing in-groups and clique-sorting than I remember from more northerly cities. I had been accustomed to events organized around public schools, their intramural organizations, public libraries, chambers of commerce events, and city sports leagues in public recreation facilities--one thing, open to all residents--but in the South, they have entirely different networks organized through churches and private clubs, which are heavily segregated by political views, if not by race.

This leads to a lot of information asymmetry, and irrational beliefs or disinformation propagated through channels that are difficult for outsiders to monitor. So white blue-collar workers get propagandized against unions and democratic socialism. They are constantly being lied to, and subjected to rhetorical distractions. Black people go to different churches, so they aren't as politically self-defeating, but they get institutionally disenfranchised instead. Having lived in Chicago, Illinois, I recognize political corruption, and they definitely have it here.

[levythe]

There are plenty of concerns around the reliability of a single payer system or a publicized care system aside from what has already been mentioned. For instance, the sustainable quality of care is brought into question, as is the incentive for continued development in the field. There are reasons to be upset about the current system, but these are two things it undeniably excels at.

There is also simply anxiety over giving one of the most if not the most powerful government in the world power over its citizens in such an intimate fashion.

[jonfw]

Forcing somebody else to "share" against their will isn't really in the spirit of sharing.

[rpiguy]

Thank you for pointing this out. Forced sharing is confiscation.

[zackmorris]

I've been thinking lately that half the US could opt out of public healthcare, the rest would subsidize them, and the per-capita cost on the payers would still be less than it is today through private insurance.

[rpiguy]

I am actually not opposed to some kind of national health program, but the supply problem (and therefore the price problem) needs to be addressed first. Partially socializing what we have today will only make things worse.

Proponents of national healthcare always say that it will lower costs, but unless the government seizes control of everything, doctor salaries, hospital employee pay, etc. cost will never go down.

I am not arguing that the government should do all that, in fact it would terrify me. But it should work to increase the supply of healthcare and to create efficiencies and price transparency to drive costs down. Once costs are manageable it will be easier to find a way to guarantee healthcare affordably without crippling the economy or having the government run everything.

Of course when a pragmatic approach like the above is offered you always run into the "my mom has cancer now" argument that we just need to do it as soon as possible. It is a hard argument to refute.

It is a complex issue.

[zackmorris]

I tend to agree, thank you for your thoughtful points.

Another thought I've been having is that since medicine is the epitome of a good with inelastic demand, then the government could/should impose rather strict laws about profiteering. For example, maybe a drug could only cost double what a university can synthesize it for, or a minimum of 3 manufacturers would make any drug sold in the US (to ensure healthy competition), or the government could provide generic options for all drugs (as a price stabilizer), something like that. So insulin would essentially be free, and the hepatitis C cure might be substantially cheaper, for example.

I realize that this might lead to problems with drug research costs. But, that's really what we should really be talking about here. Separating research cost to some degree from profit in their distribution. And spreading those costs globally somehow so that they don't fall mostly on the US.

Maybe incremental measures like these could be adopted over a 5 or 10 year period until private insurance costs are more in line with the public option cost in other countries, and then states could offer insurance plans. Once about 50% have done that, the programs could be made federal. We could still keep private insurance for those who want it, like in many European countries.

To be honest, I am personally against these incremental approaches because I have doubts that they'll be adopted, but, you're right that it's a complex issue so I'm open to ideas and hope we can get past the political disfunction and get back to helping people.

[riffraff]

I am not saying the general idea is wrong, and probably it is true in the US. But.

You could equivalently say "why is there national healthcare almost everywhere in Europe" and answer "money", reversing your point.

[LordDragonfang]

Except we know why there's national healthcare in Europe: because it's more cost effective per citizen (economies of scale and collective bargaining for prices with no profit motive), and the US effectively subsidizes research costs.

I suppose in a way that is "money", but not in the sense that he meant (ie money directly exerting political power)

[kwhitefoot]

The answer is about money not the money itself. It all depends on who controls the money and why. In Europe the state controls it and most citizens are happy with that (not perfectly of course) whereas it is a complete non-starter in the US because 'everyone' has an adversarial relationship with the state.

[y4mi]

Not necessarily, because the amount of money the health industries get in every other country is tiny compared to the USA

[ChrisLomont]

>Why there is no national healthcare - money, someone makes a ton of it by preventing nationalization of healthcare system

It could also be that things cost money, and taxpayers don't want to pay for some things.

The Democrats have decided that the rich must pay for it. Republicans have decided that it's too costly. By splitting the crowd, we have reached an impasse.

We could do what every other country has done, and have everyone pay more in taxes to get it, but both sets of votes have blocked it. Dems want European benefits without European taxes levied on the middle class. Reps realize how much these plans will cost and scare people with taxes in general. The end result is people want others to solve their problems instead of accepting the pain and paying for it.

It's not companies - it's voters. And it would cost a lot more in the US than anywhere else, and it's no single point of cost added - every part here cost more, from doctor and nurse salaries, to drugs (which are a small part of overall cost), to people wanting more end of life care, and on and on.

[redblacktree]

I'd consider myself a Democrat, and I'm willing to pay more taxes for it. If people take a good look at their paychecks, I think most folks would be better off. Instead of paying (made up numbers) $800/mo to an insurer, you may pay an additional $600/mo in taxes. That's a win. And like someone above said, it makes people less tied to their jobs, which I think all workers should support.

[jonfw]

> made up numbers

And here lies the problem- you're using made up numbers.

Obviously if we can cut healthcare spending while expanding access while maintaining our contribution to medica innovation, that would be a great thing. People just don't think that it's remotely realistic.

Obamacare wasn't cheap

Medicare and medicaid are very expensive and don't achieve the same results that the private industry does.

Are VA hospitals as good as private ones? Absolutely not- and these are when the government has the opportunity to provide for a demographic that is a small minority of the population and is likely to have bipartisan support.

IMO- the only argument for socialized healthcare is healthcare as a human right. The idea that the government will magically become superior to private industry at spending money is completely unrealistic.

[redblacktree]

You and I may disagree on how effectively-run a government single-payer would be vs. private insurance (and there is no reason to believe they couldn't co-exist), but let's set that aside for the moment.

My intent in making this post was really to call out the fact that, even for those of us lucky enough to have coverage through our employers, we're still paying quite a bit in premiums. So the net effect of public healthcare may be positive, flat or something else, but it isn't just a new tax and reduction in your paycheck. You stop paying a premium and start paying a tax.

[sylens]

It's interesting to me that no candidate has seized on the chance to say that by decoupling healthcare from one's job, one would be more free to take risks in starting their own business

[chrshawkes]

Just curiously asking, how does one pay for it if they don't have a job or lose their job? I think people should be less tied to their employers but how do they get coverage if they have no job? Who is paying for it?

[Gwypaas]

Because it's paid by taxes, everyone has access and since it is taxes it is % of income. No income means access to healthcare but there's no cost associated to it. A median wage essentially pays their own health care, a high wage subsidizes lower income.

As someone living in a country with this what this means in the end is that I have never in my life considered health care as an issue. I.e. having a job living at my parents house, moving away and studying and so on.

[redblacktree]

Consider the case of my Mother-in-law. She has enough funds to retire, except that she can't afford insurance plans on the open market, (where they are generally more expensive and less effective) so she has to wait until full retirement age when she'll be able to get coverage from her former employer and ultimately Medicare.

[notSupplied]

A lot of people don't see/won't look at the cost of healthcare that their employees are already paying. Even fewer would recognize this as effectively the same thing as a tax.

[Ididntdothis]

“The Democrats have decided that the rich must pay for it. Republicans have decided that it's too costly”

When you look back at the last few decades you will see that republicans have decided that rich people should pay an ever decreasing share. the Democrat proposals i have seen don’t even try to roll back to tax rates during or before the Reagan years.

[ChrisLomont]

>tax rates during or before the Reagan years

The tax rates people quote are not usually effective rates; they're marginal rates, and no one really paid them.

The Reagan tax cuts were revenue neutral - they cut the top marginal rates and removed loopholes. During one of them the effective rate on the rich increased slightly.

>When you look back at the last few decades you will see that republicans have decided that rich people should pay an ever decreasing share.

The middle class and poor have seen very big tax cuts. For example, here [1] are effective tax rates from the CBO for years 1979-2005.

The lower quintile went from 8% to 4.3%, effectively halving their tax rate. 2nd quintile 14.3 to 9.9%, 3rd 18.6 to 14.2, third 21.2 to 17.4, highest quintile 27.5 to 25.5.

The top 1% went from 37% to 31.2%.

So, you claim rich do not pay their share? What is their "share"? The lowest 20% pays 4.4%, the top 1% pays 31.2%.

[1] https://www.cbo.gov/sites/default/files/cbofiles/attachments...

[Ididntdothis]

If you compare the share of taxes different groups are paying you also should compare the share of income they are receiving. You should also compare income growth of these groups over the last decades. It’s hard not to come to the conclusion that upper incomes did much better over that period compared to other groups.

[ChrisLomont]

>If you compare the share of taxes different groups are paying you also should compare the share of income they are receiving.

If someone pays 30% of income to tax, raising their income only means they're paying more dollars in tax. 30% is a ratio.

The rich also lost bigger chunks during the downturn.

The middle class is shrinking due to more moving up than down. That doesn't fit your narrative so well, but as far as I can tell, it's true, and has been true for some time. So of course their "share" is shrinking and the "rich" share is increasing - but then you might want to see what happened to the underlying people. After all, the set of rich people (and middle class, and poor) is always in flux.

If you really care to look at the numbers, the top 1% earns around 20% of all income, and pays around 37% of all taxes. The bottom 50% made 12% of all income, and paid 3% of all taxes.

So the top is paying almost 2x the share of taxes compared to their income than the average person, and the bottom half pays around 1/4x.

No matter how you slice it, the top do pay a lot in taxes. It's why the US is rated one of the most progressive tax structures in the OECD.

https://taxfoundation.org/summary-latest-federal-income-tax-...

[me_me_me]

I don't have stake in it so I don't really care, but us tax payer pays more in taxes to support current system, then average EU citizen pays for their public system.

So there is rather large body of evidence suggesting that most likely adopting national health system will result in lower tax contributions and access to 'free' healthcare.

[MuffinFlavored]

> Dems want European benefits without European taxes levied on the middle class.

Could you give a clearer example? Meaning, say somebody makes $40k/yr, $60k/yr, $80k/yr, $100k/yr in America right now, what would their taxes look like if they were at "European" levels?

[ciceryadam]

In general you can check it here: https://stats.oecd.org/Index.aspx?DataSetCode=AWCOMP

Example from Prague, Czech Republic = an average IT position has it's total cost of employment (part is payed pre-brutto salary from the employer side) at 55k USD, take home pay is at 30k USD a year.

- this includes a social insurance (if you are let go, you'll get 750 USD up till 5 months of unemployment, if you go by yourself it'll be around 600 USD, and a promise of 1200 usd a month when you retire)

- health insurance on everything but non-diagnosed plastic surgery (like fake boobs and butcheek implants), dental and optician care

- salary insurance during sickness (has to be certified by a doctor, 1-14 day you get 60% of your take-home hourly salary for every workhour you miss, after 2 weeks this changes to 60% of you gross salary counted for every day of sickness (including weekends), after 30 days of sickness it increases to 66%, after 60 days to 72%)

- and of course tax (around 13% of total cost of employment) that pays for public schools, roads, etc

[MuffinFlavored]

$55k gross -> $30k net means you lose 45% of your income ($25k is 45% of $55k)

For comparison, $55k gross is roughly $43.6k net in Florida for a single tax payer before insurance. Figure $200/mo for insurance (with employer paying the rest), that leaves you at $41.2k net

That's $11.2k/yr more than Prague taxes. What would I be gaining by paying $11.2k/yr more?

https://smartasset.com/taxes/florida-paycheck-calculator#sGj...

[ciceryadam]

and how much is your co-pay?

you lose some (of your income), you win some (safety net, no medical expenses, free schools, higher social mobility). I don't mind to pay a higher share of my income to live in a functional society.

[MuffinFlavored]

> The Democrats have decided that the rich must pay for it.

My only question to that is: what level of rich ($200k/yr? $400k/yr?), and how much must they pay percentage wise, etc.

When will poorer people ever be ok with how much / how little billionaires give? I feel like the mindset is "it'll never be enough".

[saiya-jin]

People would be OK if all their basic needs would be covered. If they didn't get ruined by single complicated health issue. If they knew that social system will help them out a bit in case they lose a job - not too much, just to help them bridge the gaps between jobs. If they knew that their kids are getting a decent education for free. None of this needs to be worlds best, just good enough.

Have this, and you have a satisfied population that won't revolt against rich no matter how little rich pay in their taxes. But from what I read here over and over, US currently has none of this for below-medium/median income.

I think the thing keeping poorer US population from revolt is this common mentality that success comes only from hard work, and if you're not successful, well you just didn't work hard enough. Rags to riches ideal, which as we know is rather a myth due to real social (im)mobility. But repeat a myth a thousand times and it will become a rule.

[bumby]

I think money is only part of it. There's the cliche phrase of "There's Good, Fast, or Cheap, but you only get to select two."

Peter Attia put a healthcare twist on this idea. Paraphrasing, it becomes "Access, Quality, or Cost. You only get to choose two."

There's natural competing ideas in most any resource constrained environment.

[pattisapu]

I like that.

Might add a dash of the "prisoner's dilemma."

But then I would get carried away with this stone soup and throw in love, honor, culture...

...and then end up back at "I don't know why."