[qwytw]

> companies are immensely profitable

That's not necessarily true. If all the for profit insurance companies reduced their profit margins prices wouldn't go down that significantly. I think it's mainly the extreme inefficiency and much higher labor costs.

[specialist]

> extreme inefficiency and much higher labor costs

Which is mooted with single payer. Roughly 1/3rd of costs eliminated. Last time I checked (mid 2000s). Probably more now.

[qwytw]

> Which is mooted with single payer.

As in doctors, nurses, and other personnel will accept lower salaries because they won't have any choice? I'm not sure that would work in the US.

Also, there are relatively efficient non-single-payer systems in Europe (e.g., IIRC, Switzerland and the Netherlands don't have the equivalents of Medicare/Medicaid). Proper regulation, including price transparency and regulation, would solve most of the main issues and would probably be much easier to achieve than a single-payer system.

A federally imposed universal single-payer system seems to be totally politically infeasible. The best you could hope for is a two-tier system with the government continuing to subsidize for-profit healthcare (including insurance) companies (all extremely expensive treatments covered by the government, but most people who can afford it will continue having private coverage as well).

Wouldn't it be much easier (and possibly more efficient and equitable) to just adopt the Dutch system?

[yurishimo]

The Dutch system is largely private with a very reasonable out of pocket/copay each year. This year, it’s around 450€ per person. In a calendar year, you cannot, by law, be charged more than your premium + this out of pocket max per year. For minors, all coverage is completely free until they turn 18, including comprehensive dental.

Limiting the US spending per citizen to roughly $2k/year per adult seems impossible in the current climate. It should happen but it won’t. If current health spending trends are to be believed, the number of people using less than 2k/yr in services are less than 20% of the population. There just aren’t enough young people in the US to make up for it, and the feds will never get approval to cover the gap.

The only hope I see for US healthcare is to open government funded hospitals and clinics and offer it as another insurance option. They can compete in the market and hope they have enough funding to eventually convince people that they aren’t going anywhere. This will take a lot of capital to weather the first few years of insanity and shenanigans that we will see from traditional insurance companies. Anything less than competition will be lauded as communism (it will anyway, who am I kidding) but for some poor red states, opening a few clinics in rural areas might actually work for them come time for re-election.

I’m saying all of this as an American living in the Netherlands.

[specialist]

> open government funded hospitals and clinics and offer it as another insurance option

Agreed. This or/and some other variant of the public option.

I've been discussing this with local politicos and orgs. Socializing the notion. Most everyone is receptive once it's explained.

Some day I hope to muster the gumption to do my own lobbying.

[specialist]

The 1/3rd savings (off the top) is from eliminating administrative overhead that insurance (claims & billing) imposes.

Administrative burden (makework) on caregivers would be much reduced.