[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.