| Single payer / public option would be a great solution. Separating out health insurance from employment at an affordable price would be another. I understand the spectrum of choices from the EU/Germany hybrid to Canada and the UK. 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. |
However I think there is cause for reserved optimism; the ACA moved the Overton Window on this subject. Sanders and Warren made Medicare For All a core part of their platform, and did not get killed for it. Biden supports a public option (Medicare buy-in, not single payer), but that is now the moderate / bipartisan position in terms of voter support.
We will probably not get a single payer solution in this administration, but the public option could capture some of the market, and make further changes more tractable.