[bitcurious]

> To some extent this has helped with health insurance. Each year I get a check back from my insurer saying they didn't spend enough on my care vs my premiums.

This has baffled me ever since Obamacare was first passed - it seems that each year the insurance companies have an incentive to drive up the cost of healthcare, since that’s how they earn more money in absolute terms. Is it not so?

[nradov]

That is so, to an extent. But it's balanced against employer demands to hold down medical costs because they pay most of the bills. If your HR department can save 5% on employee medical costs by switching from Blue Cross to Cigna next year they'll absolutely do it.

[gunian]

Any idea why Obamacare didn't follow the European model? Other than the freedom argument

People on HN always talk about European health insurance seems like an easier route than to murder people lol

[umanwizard]

First of all there isn’t one “European model”, every country in Europe has its own system.

To answer the substantive point, it’s extremely difficult to pass substantial laws in the US due to the structure of its political system. The mandatory coalition of the president + 60% of the senate + 50% of the House of Representatives is a much higher bar than any other democracy. So laws aren’t written to be optimal policy, they are written to satisfy this extremely high coalition requirement — Obamacare in particular was very fundamentally weakened from some of the more expansive initial proposals to address the concerns of one or two senators and get them on board.

[gunian]

but people always talk about how insurance is guaranteed in europe something must be working if gunning down a CEO is pro the people wouldn't copying one of the European countries be even more pro the people?

what makes senators hate something that is pro the people? wouldn't that give them better ratings? I come from a dictatorship so sorry if this is a dumb question

[hb-robo]

There is an unlimited amount of potential financial gain from American politics, both in lobbying and campaign financing. It is also widely true that the candidate with the most money spent in a campaign is heavily favored to win the election, with the exception of the presidency which is more contested. Now consider that in the 2020s the richest people now have more money than God.

The short of it is that you can get anyone you want in office, to do anything you want even if it directly opposes their constituency, as long as you spend enough money on them to get them in office, buy their vote, and keep their PR afloat.

Gilens and Page (2014) found that "average citizens and mass-based interest groups have little or no independent influence" on American government policy: https://www.scienceopen.com/document?vid=e4797592-9d73-4f2b-...

Worth noting that this paper saw pushback for many years after the fact but measurably, its conclusion has been true since its release.

[mercutio2]

Murdering people is not pro anything.

The answer was already given: it was politically infeasible to pass a single payer variant in the US. And it’s not clear it would have been good even if it had been feasible.

[gunian]

Sentiments on Luigi seem to put him on the same level as Rosa Parks or Jesus Christ if not higher both on HN and Reddit but that is ancedotal

Could you say a bit more about the politics? this is very fascinating idk much about insurance or politics

This may be super simplistic but Europe, if you look at it at a high level, is as diverse as US states if not more because a lot of places have multi party systems instead of a two party system with comparable diverse interest groups and comparable GDP etc

What did they figure out to have insurance that the US can't? Or doesn't want to?

[umanwizard]

> What did they figure out to have insurance that the US can't?

Not sure how I can say it more clearly. Most European countries have a functioning political system where it is easy (or at least possible) to pass necessary laws. The US doesn’t.

[selimthegrim]

Senators have to spend $$$ to get elected

[int_19h]

Simply put, a lot of people in US are genuinely convinced that European-style universal health insurance means that they'll be worse off than they are today. This myth is maintained by agitprop from right-wing sources that tells them about "death panels" and multi-year waiting queues (while conveniently forgetting to mention that all these things also exist in US, with the only difference that you can avoid it if you have enough money).