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by theptip
1958 days ago
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Worth noting that "public health insurance" ("single payer" or "public option") is different than "public healthcare" ("socialized medicine"); I'm advocating for the former, not the latter. If I'm following you correctly it seems like you're analyzing the public healthcare option, which is a much more substantial change. I agree with your point that you'd need to dramatically overhaul the regulatory framework to implement socialized medicine (i.e. the government opening clinics), but I think you would need to do significantly less work if the healthcare delivery remained privatized. Of course in both approaches you could reduce healthcare costs by reforming liability laws. The main decision in my opinion is between true "single payer" (i.e. private health insurance is not permitted for services covered by the public insurance) and "public option" where private insurance can compete with the public option for coverage on core services. The details here are pretty complex and there are options all across the spectrum in the EU to compare; e.g. Germany has a hybrid approach where below a certain income you must take the public option, and above the threshold you can buy private coverage. Canada has a true single-payer system it seems (though you can supplement for additional coverage that the core single payer system doesn't cover). Etc. (See for example https://www.griffinbenefits.com/blog/how-does-healthcare-in-... for a bit more detail). Either way there's extremely high support for some sort of public option in the US; it's around 80% supporting medicare for everyone who wants it, and that reduces to something like 60% if you ask specifically about "medicare replacing your insurance" i.e. true single payer. > How does end-of-life care/cost compare in Europe with the US? I'm not familiar with those numbers, would be interested in comparisons if anyone has data they can link. I'd guess at low confidence that it's better in the EU, since they are more likely to use utilitarian measures like QALY for allocating healthcare spending, and that framework should discourage excessive end-of-life care expenditures. |
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I just don't see how we get there in the US. According to the World Bank, the US spent 16.89% of GDP on healthcare vs 11.43% of GDP in Germany.
That difference in spending represents billions in revenue and millions of jobs. The businesses capturing that revenue and those workers will not give up their livelihoods because the German model is more efficient.
Healthcare spending in the US is a massive political force and I see nothing on the horizon that will take it on in any meaningful way. We've discussed Obama's ACA plans many times on this site.
The realist in me says that uneven outcomes and health emergencies bankrupting families is actually a stable political outcome. E.g. Most people have no fear of medical bankruptcies - simply because it hasn't happened to them. So a politician promising a solution to medical bankruptcy isn't going to win votes. Instead that politician is inviting opposition from the medical industry. By the time someone faces medical bankruptcy it is too late for systemic change. They just go bankrupt.
From a game theory perspective, we would all collectively benefit from a better distribution of medical spending and insurance. Channelling that collective will is nearly impossible because the motivation for change doesn't become obvious until you have to pay $5K/month for medicines to survive.
Motived, ethical political leaders could do it. But you don't reform 17% of GDP spending without risking your political future, speaking fees, or board seats.