[arcticbull]

Let's take it one step further and everyone pays for health insurance out of their taxes according to their means, and the state handles all the billing, negotiation and pricing on their end - and the individual never has to care who's paying and how much. Socialized medicine already covers 40% of Americans between Medicare, Medicaid and the VA. Time to get it to 100%.

The Canada Health Act is a great model. The Feds mandate that the Provinces figure out how to provide everyone a minimum standard of care, and each Province administers a public health insurance program that covers everyone. This would map perfectly to the states.

[mc32]

I'm not sure I would want to go there. "People of means" already pay greater taxes which support government programs. If you think they are not paying enough, raise their taxes, but avoid double taxation.

In other words, I don't think just because I would pay $1000 for a broken arm means I would agree that Bezos should pay $100,000,000 for the same. It would make no sense. It would make sense to close his tax loopholes. Sure.

[arcticbull]

Sorry for the unintentionally charged and hence confusing language there. I just meant via progressive taxation. Something like the Ontario Health Premium [1] which ranges from $0 per year if your taxable income is $20,000 or less, to $900 per year if your taxable income is more than $200,600.

I agree and also do not want what you outlined! :)

I strongly suspect that a socialized medical program in the US would not actually cost individuals any more than they're paying now - it's just that the cost they're paying is hidden behind employer paid premiums. That's just a private tax.

[1] https://www.ontario.ca/page/health-premium

[b9a2cab5]

> I strongly suspect that a socialized medical program in the US would not actually cost individuals any more than they're paying now

The definition of progressive taxation means this is not the case for anyone making more than 100-150k, given current tax brackets.

Medicare already is 1/3 of the federal budget and I can assure you someone making low 6 figures definitely pays more in tax than 3x $900.

[arcticbull]

> Medicare already is 1/3 of the federal budget and I can assure you someone making low 6 figures definitely pays more in tax than 3x $900.

Well the first step is redirecting all the premiums paid by employers on behalf of employees into the federal pot. That should net ~$5500 per taxpayer or an additional ~$1.8T per year. That will sort out the bulk of it with no additional cost visible to individuals.

[b9a2cab5]

That is not the plan put forth by Medicare for All advocates. There is a strong undertone of income redistribution in progressive proposals for single payer.

I would also expect that if the government was taking that money my health benefits would be at least as good as they are now. And I don't think that will be the case. When I was a kid there was a period where I was on California MediCal and I distinctly remember getting glasses with _super_ thick lenses because all MediCal would pay for was the cheapest frames and lenses.

[arcticbull]

> That is not the plan put forth by Medicare for All advocates.

I'm almost 100% confident it is. That money is currently being paid on behalf of individuals to insurers. Take the insurers away that money either goes to individuals and gets taxed, or gets sent directly to the feds. Either way it's a no-op.

> There is a strong undertone of income redistribution in progressive proposals for single payer.

Healthcare is the great equalizer. It's not insurance - everyone needs it and everyone will use it. There's not really a strong correlation between more spend and better outcomes past a certain point. Except in the rarest of cases you can't cure cancer with fat stacks. What offering healthcare does is give low income folks the opportunity to found companies without the fear of death. It dramatically reduces the burden on all businesses and especially small businesses by killing a massive cost center.

> I would also expect that if the government was taking that money my health benefits would be at least as good as they are now. And I don't think that will be the case.

Every healthcare system that ranks above America's is single payer or two-tier socialized. MediCal is set up to be punitive to the poors like all Medicaid programs. A Medicare system isn't. There's a reason not a single AARP member is advocating for eliminating Medicare. What getting everyone on the system does is it makes the political class beholden to the needs of the individuals.

I watched Donald Trump in front a group of older folks literally hug a flag and say he'd do whatever it took to keep the Democrats away from their Medicare. That doesn't sound like a system itching to be upturned does it?

Socialized medicine is no more a partisan issue in most countries than a socialized fire department or sidewalks.

[jollybean]

A few years ago, in Canada, we were paying $4500 per person - and everyone was covered.

The US was paying $5K public per person and $5K private per person.

Meaning - the US is already paying more per capita in public healthcare spending, than Canada, and for that price in Canada - everyone is covered.

This kind of means, the US could literally give all of its citizens 'Canadian Quality Universal Coverage' and literally save a few dollars in public spending, and wipe out the need for private spending.

So 'cost' and 'profit' are different things.

The US HC system is a giant elephant of inefficiency.

This is not a small thing:

'Healthcare' is a 'Pillar of American Decline'. I don't mean that America is falling apart, but rather, it's having less influence in the world.

50 years ago, you went to the Hospital because you were hurt. Now - it's all about aging people who are elderly who see the doctor 20x a year and it's why costs have skyrocketed. It's also when people are the least productive and less likely to be working with good insurance.

HC is a disaster that makes the US a 'much less attractive place to live' for one's entire life, unless one is rich - whereas that was not the case before.

It really needs to be sorted out.

The Media Left, by highlighting Woke issues, instead of things like outrageous healthcare, has completely lost their minds. MSNBC was calling Elon Musk 'racist and misogynist' for his completely benign comments about this giant tax bill. Instead of looking at inequality issues through economic lenses, they're committed to throwing around gender and racial slander. The HC system is a soft, easy target because there are unlimited stories of people getting huge bills, unfair pricing. But you won't see to many stories, because "Sponsored by Phizer".

[erichocean]

> 50 years ago, you went to the Hospital because you were hurt. Now - it's all about aging people who are elderly who see the doctor 20x a year and it's why costs have skyrocketed. It's also when people are the least productive and less likely to be working with good insurance.

Literally 100% of the elderly in the US are already covered by the socialized medicine you seem to be advocating for. It's not optional.

[kwhitefoot]

> a socialized medical program in the US would not actually cost individuals any more than they're paying now

But think of all those insurance company employees who would be out of work!

[zaroth]

I think a great way to do this would be for the government to enter the market with a fixed enrollment and a lottery system.

They can run the program for 3 years for 100,000 people and transparently report all their findings and we can see how it went.

[mc32]

Ok. Yes, that makes sense.

[Karunamon]

Anyone who's had extensive dealings with the VA would be glad to share why they are not interested in single payer. Making that switch will not remove the incompetence, poor staffing lack of care, lack of accountability, and so forth.

Some sane standards need to be drafted and then enforced, hard and fast, before we start mandating how healthcare is paid for.

[arcticbull]

And anyone who has dealt with socialized medicine in the OECD will tell you the exact opposite :) Wholesale reform is needed, and that can certainly be part of the package. However, parceling it out is a great way to achieve absolutely nothing as evidenced by the current morass.

[xyzzyz]

Huh? I have experience with “socialized medicine” in Poland, and, in short, it’s shit.

[arcticbull]

Heh, maybe not the whole OECD but [1] America ranks near the bottom as-is.

[1] https://worldpopulationreview.com/country-rankings/best-heal...

[rascul]

Interesting to look at the population from your link. The United States appears to be doing the best (LPI 2020 ranked 18) out of all the countries with population over 100 million. After Japan (ranked 19) the next closest are China (54) and Indonesia (57). I'm not sure what relevance this might have, I just found it interesting. The CEO rankings show a much different picture.

[arcticbull]

If I had to guess, one is weighting access to care differently than the other. America's system is good but not top tier if you can get it. It's really bad if you can't.

[yes_really]

> and the individual never has to care who's paying and how much

But then nobody cares about how much the government is paying, and you end up with more and more taxes and inflation.

Taxes are increasing. Government debt and inflation are skyrocketing. Can't we put an end to it?

Also the government can't even build passenger rail without wasting absurd amounts of money and having "unexpected delays" in all projects. Why should we trust it to manage everyone's healthcare?

[lmm]

Because every comparable country that has a government-run healthcare system has somehow ends up with it being ~twice as efficient. I get that there's theory that says a private healthcare system should be better at keeping costs under control, but it's not borne out by the evidence.

[yes_really]

"~twice as efficient" is a stretch. They might cost half the price, but they are not necessarily twice as efficient.

Medical treatments and equipments in the US are the best in the world (discounting super small countries). Americans have the highest life expectancy in the world (discounting homicides and transit deaths). Americans can get treatments fast while people in Canada or the UK have to wait for months because the government is rationing treatments.

And we should consider other reasons that explain the costs besides "private system inefficiency": American companies carry the world on medical innovation (so other countries are benefitting from the Free-Rider Problem, and Americans are paying for it). American regulation requires doctors to spend several more years in training than at other countries (in other countries the medical school is usually merged with undergrad). And, finally, Americans just earn more than people in other countries. GDP per capita is 60k in the US, 40k in other developed countries.

[arcticbull]

> Medical treatments and equipments in the US are the best in the world (discounting super small countries).

Not really. They're fine. In line with OECD. And further, America has a number of blemishes such as among the highest maternal mortality and infant rate in the entire OECD. [1]

  ...the U.S. ranks 33 out of 36 Organization of Economic Cooperation and Development (OECD) nations. In 2018, while infant mortality reached an all-time low in the U.S., at 5.9 infant deaths per 1,000 live births, still more than 21,000 infants died. Compared to countries with a similar GDP, the U.S. infant mortality rate is much higher. France and the U.K., for example, have 3.8 deaths per 1,000 live births.

The only area the US really excels is in cancer 5-year survival rates - not because the mortality rate is lower, however, it's about the same as everywhere else. The US just biases towards earlier screenings that do not extend life or reduce mortality.

> Americans have the highest life expectancy in the world (discounting homicides and transit deaths).

Are you sure about that? It doesn't look like that on this chart. [2] Not to mention the US spends dramatically more to achieve that much lower life expectancy than anyone else does.

> Americans can get treatments fast while people in Canada or the UK have to wait for months because the government is rationing treatments.

This is a straight-up lie peddled by the US medical insurance industry. Here's an admission and an apology by a Cigna executive tasked with doing so. [3]

  "Our industry PR and lobbying group, AHIP, supplied my colleagues and me with cherry-picked data and anecdotes to make people think Canadians wait endlessly for their care. It's a lie. And I'll always regret the disservice I did to folks on both sides of the border."

They pulled the same thing when Canada instituted single-payer healthcare in 1962. [4]

> American companies carry the world on medical innovation.

Not really. There are as many European as there are American medical companies in the top R&D spenders worldwide. That's before we factor in government expenditures worldwide.

> And, finally, Americans just earn more than people in other countries. GDP per capita is 60k in the US, 40k in other developed countries.

Now imagine what they could do with an extra $5K per person per year - the difference between what the US and Canadian medical systems cost per capita.

[1] https://www.forbes.com/sites/joshuacohen/2021/08/01/us-mater...

[2] https://ourworldindata.org/grapher/life-expectancy-vs-health...

[3] https://www.npr.org/2020/06/27/884307565/after-pushing-lies-...

[4] https://canadiandimension.com/articles/view/the-birth-of-med...

[yes_really]

The infant mortality rate is based on extremely misleading statistics.

In the US, if a baby is born who can be saved but isn't, their death is reported in the neonatal mortality statistics. But in other countries it is more common for babies in these situations to be counted as miscarriages or stillbirths.

In the US, very low birth weight infants are considered to be alive (because, of course, they are), but in Canada, Germany, Australia, and other countries, a premature baby weighting less than 500g is considered to be already dead, even if it is breathing and has a heartbeat. So they don't have to add it to their infant mortality statistics when their healthcare system fails to save its life.

In fact, since the year 2000, of the 52 surviving babies who were born weighting less than 400g, 42 were born and saved in the US.

Sources:

- https://youtu.be/KEHM3EHUTew?list=PLWu1-TbpoIFJZga03X-Wzf1UH...

- https://www.healthsystemtracker.org/chart-collection/infant-...

- https://www.forbes.com/sites/physiciansfoundation/2016/04/12...

[arcticbull]

The 4th worst maternal mortality rate in the entire OECD too. That would be the mother dying during childbirth. [1] More than double Canada in 2018 and 10X New Zealand. [2] Without getting into your data re: infants (because I do not know enough to do so), I suspect this one's not as easy to hand-wave.

The results of the study carried out in [2] say:

  The U.S. has a relative undersupply of maternity care providers, especially midwives, and lacks comprehensive postpartum supports.

American healthcare is acceptable if you can afford it and a death sentence if you can't.

[1] https://www.npr.org/series/543928389/lost-mothers

[2] https://www.commonwealthfund.org/publications/issue-briefs/2...

[Consultant32452]

When you are imagining single payer in the US, are you imagining it being designed and run by the people who created the current system?

[arcticbull]

People seem to be big fans of Medicare. Of those covered by Medicare 75% say the system is working well, only 22% say it is working poorly. [1]

[1] https://www.kff.org/medicaid/poll-finding/medicare-and-medic...

[Consultant32452]

Thank you for the thoughtful response to my question.

[arcticbull]

What's really interesting is that 60% of people in general (including those already on it) say Medicare is working well for seniors - but when you drill down only to the people actually covered, that number jumps up to 75%. Same source. Seems like a marketing issue?