# Is universal health care inevitable in the US? **URL:** \ **Category:** In My Humble Opinion\ **Created:** [January 29, 2012, 4:10am UTC](https://boards.straightdope.com/t/is-universal-health-care-inevitable-in-the-us/611056 "2012-01-29T04:10:28Z")\ **Posts on this page:** 15\ **Page:** 1
**Author:** ![2ManyTacos](https://avatars.discourse-cdn.com/v4/letter/2/3da27b/32.png) [@2ManyTacos](https://boards.straightdope.com/u/2ManyTacos)\ **Post date:** [January 29, 2012, 4:10am UTC](https://boards.straightdope.com/t/is-universal-health-care-inevitable-in-the-us/611056/1 "2012-01-29T04:10:28Z")
I mean, nevermind the health care reform bill that’s being challenged right now and whether you agree or disagree with that. Do you think that universal health care will inevitably come to the US, or if not, how close do you think the US will ever get to having UHC? Assuming the ACA is carried out completely (and not whittled away before it even takes effect), access to health care will certainly increase in this country but it still won’t be universal. For my own two cents, I think it’s doubtful that true UHC will ever come to the US, and even if it does it’ll be on a state-by-state basis and not nationwide. Just take a look at what has _already_ happened as evidence of that; Massachusetts’s system obviously served to influence HC reform at the federal level, Vermont is poised to have the nation’s [first single-payer HC system by 2017,](http://motherjones.com/politics/2011/05/vermont-single-payer-health-care) and California’s SB 810 single-payer HC bill [is gaining traction again (it actually passed before but good ol’ Terminator vetoed it).](http://californiaonecare.org/) ---
**Author:** ![Mdcastle](https://avatars.discourse-cdn.com/v4/letter/m/958977/32.png) [@Mdcastle](https://boards.straightdope.com/u/Mdcastle)\ **Post date:** [January 29, 2012, 7:22am UTC](https://boards.straightdope.com/t/is-universal-health-care-inevitable-in-the-us/611056/2 "2012-01-29T07:22:54Z")
I’m not sure “Universal Health Care” is the correct term. We do have universal health care in that people aren’t dying of appendicits because there’s no hospital. I’ll use the term single payer as presented in the links. The Massachussetts carrot and stick model (get help getting health insurance and get fined if you don’t) worked well enough that it’s being applied nationally. Similarly single payer has never been tried before to my knowlege, so if it works in Vermont it may also become a national model. (The main problem I see is the fine for not having insurance should be many thousands of dollars, not $695, to completely eliminated the uninsured) Another thing that might work in the favor of single payer is the Health Care Reform starts to disengage the model of employer sponsered health care by setting up exchanges where individuals can buy policies, subsidized by the government. Large business must pay a fine if they don’t provide coverage, but some very, very large companies (I’ve heard names mentioned at work but of course I can’t say who) are thinking about just paying the fine and sending their workers to the government subsidized exchanges. If the public option were still there we would of course be a lot closer, but just disengaging companies is the first step. If we have single payer, most likely the actually processing will be contracted to private companies just like Medicare and some Medicaid is now, so private insurance companies will loose their marketing and underwriting departments for example, but will still keep employees in operations to process claims for the government. ---
**Author:** ![Lord\_Feldon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lord_feldon/32/341_2.png) [@Lord\_Feldon](https://boards.straightdope.com/u/Lord_Feldon)\ **Post date:** [January 29, 2012, 9:02am UTC](https://boards.straightdope.com/t/is-universal-health-care-inevitable-in-the-us/611056/3 "2012-01-29T09:02:04Z")
I’d like to think so, but I’d bet that a lot of people thought that it was inevitable in 1948, and most of them are dead now. ---
**Author:** ![Balthisar](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/balthisar/32/2825_2.png) [@Balthisar](https://boards.straightdope.com/u/Balthisar)\ **Post date:** [January 29, 2012, 1:31pm UTC](https://boards.straightdope.com/t/is-universal-health-care-inevitable-in-the-us/611056/4 "2012-01-29T13:31:42Z")
Not inevitable, because we have a supreme court that enforces the constitution. State-by-state will be the way we go, backed by federal funds. Kind of like the seat-belt law; it’s not federal, just, you know, arm-twisted. ---
**Author:** ![2ManyTacos](https://avatars.discourse-cdn.com/v4/letter/2/3da27b/32.png) [@2ManyTacos](https://boards.straightdope.com/u/2ManyTacos)\ **Post date:** [January 30, 2012, 1:13am UTC](https://boards.straightdope.com/t/is-universal-health-care-inevitable-in-the-us/611056/5 "2012-01-30T01:13:13Z")
So are you saying that UHC is fundamentally unconstitutional in this country? ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [January 30, 2012, 1:58am UTC](https://boards.straightdope.com/t/is-universal-health-care-inevitable-in-the-us/611056/6 "2012-01-30T01:58:51Z")
You can have universal health care w/o single payer. France doesn’t have single payer but their system is supposedly the worlds best. Will we have a more and more universal system? I think so. 1. Health care is becoming unobtainable to more and more middle class voters. As long as health care was unobtainable to the poor, the middle class really didn’t care. Now that the middle class is having serious trouble getting health care they want the system changed. 2. A true single payer system will save a lot of money and adopting it for the cost savings aspect could become more important than the ideological or moral arguments for it. Vermont’s system will cost 24% less than the status quo over the next 10 years. Nationwide single payer would save 400-500 billion a year. There is a massive financial stake in a meaningful single payer system that uses streamlined administration, bulk purchases, comparative effectiveness research and negotiations of fees. A state that is going broke could save money by switching to a well run single payer system. > **[William Hsiao's single payer proposal for Vermont - PNHP](https://pnhp.org/news/william-hsiaos-single-payer-proposal-for-vermont/)** > > Statement by William C. HsiaoVermont State LegislatureJanuary 19, 2011Although advocates of the pure single payer model will find some problems with this report on a reform proposal for Vermont, there is very good news in this analysis. The report... California could save $344 billion over 10 years with a well run single payer system. [http://www.pnhp.org/facts/single\_payer\_system\_cost.php?page=all](http://www.pnhp.org/facts/single_payer_system_cost.php?page=all) 1. Most diehard conservatives are older (the average talk radio and fox news viewer is in their late 60s) while most people born after 1978 are a lot more liberal on the concept of a welfare state. Each year more and more Limbaugh fans die of old age and are replaced by young people who are more open to a social safety net. As a wag (pure guess on my part), probably a million or so ultraconservative voters die of old age and are replaced by younger people who are more open to concepts like UHC. By the 2020s millennials will make up 40%+ of the electorate. 2. As health care becomes more expensive you may see employers try to decouple from being the ones who pay the bulk of health care costs. All in all, yeah I see it happening. But it’ll be 10+ years. ---
**Author:** ![thelabdude](https://avatars.discourse-cdn.com/v4/letter/t/dc4da7/32.png) [@thelabdude](https://boards.straightdope.com/u/thelabdude)\ **Post date:** [January 30, 2012, 3:31am UTC](https://boards.straightdope.com/t/is-universal-health-care-inevitable-in-the-us/611056/7 "2012-01-30T03:31:42Z")
I don’t see many Americans favoring letting people die because they can’t afford medical care. Some form of UHC will come. However to avoid bankrupting the country, we need fundamental reform of the current system. Somebody besides the doctors must decide which procedures are worth doing. Generalizing from a few cases is very dangerous. I had a heart stent put in at about $50,000 2 years ago. I currently have found an alternative to what might be an even more expensive procedure. So studies show people on medication alone have no more heart attacks than ones getting stents, and with one, I take a pilltainer full of statins plus high dollar Plavix. I looked at the procedure my doctor wanted me to have done and debated whether dying of cancer woudl be better. My need doctor is proposing extensive outpatient work that those having the quality of life threatening surgery have to have too. OK, 2 cases, but 100% of my major interventions look like boondoggles, wallet surgery. After my stent, my doctor said I needed cardiac rehibilation. I ask why since I could do sustained, strenous exercise before th estent. He said, ‘‘Don’t worry about it, Medicare will pay for it.’’ Yes, we need UHC. We also need more questions about what is worthwhile. More HMO’s and HSA’s? Obamacare only means extending the current dysfunctional system. ---
**Author:** ![Mdcastle](https://avatars.discourse-cdn.com/v4/letter/m/958977/32.png) [@Mdcastle](https://boards.straightdope.com/u/Mdcastle)\ **Post date:** [January 30, 2012, 3:43am UTC](https://boards.straightdope.com/t/is-universal-health-care-inevitable-in-the-us/611056/8 "2012-01-30T03:43:03Z")
Just to throw out an idea, has anyone figured out how much we could save if we went to single provider as well as single payer? After all, the same reasons having private insurance adds to the costs (duplicated overhead, money spent on advertising, highly paid CEO, etc) is also true of private doctors and hospitals Also private doctors and hospitals have much less incentive to control costs than private insurance companies. ---
**Author:** ![Trinopus](https://avatars.discourse-cdn.com/v4/letter/t/2bfe46/32.png) [@Trinopus](https://boards.straightdope.com/u/Trinopus)\ **Post date:** [January 30, 2012, 4:47am UTC](https://boards.straightdope.com/t/is-universal-health-care-inevitable-in-the-us/611056/9 "2012-01-30T04:47:03Z")
> [@Mdcastle](#): > > Just to throw out an idea, has anyone figured out how much we could save if we went to single provider as well as single payer? . . . As I understand it, one of the advantages of a two-tier public/private system, like Canada’s or Australia’s, is that it preserves incentive. Rich people gladly pay extra for nicer care – private hospital rooms instead of suites or wards, etc. – and the taxes on this helps subsidize the public program. It combines the best of the “free market” and “socialism” both! The rich retain the benefits of being rich…and everyone else gets helped out by the taxes they pay. So…a single provider system might not be as financially admirable as a two-tier system… ---
**Author:** ![Rachellelogram](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/rachellelogram/32/8689_2.png) [@Rachellelogram](https://boards.straightdope.com/u/Rachellelogram)\ **Post date:** [January 30, 2012, 5:53am UTC](https://boards.straightdope.com/t/is-universal-health-care-inevitable-in-the-us/611056/10 "2012-01-30T05:53:40Z")
Yes, it’s inevitable. But on what timeline, I wouldn’t dare to say. ---
**Author:** ![Balthisar](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/balthisar/32/2825_2.png) [@Balthisar](https://boards.straightdope.com/u/Balthisar)\ **Post date:** [January 30, 2012, 10:59am UTC](https://boards.straightdope.com/t/is-universal-health-care-inevitable-in-the-us/611056/11 "2012-01-30T10:59:06Z")
> [@2ManyTacos](#): > > So are you saying that UHC is fundamentally unconstitutional in this country? No. Implementing it on a national level would probably be. Even PPACA (which is state by state in many regards) is being challenged, and some of the provisions are likely to struck down. Even Canada isn’t universal; it’s several different provincial systems. Well, it’s universal in that everyone in the nation is covered by _an_ insurance plan, but it’s not one, giant, nationalized health system. ---
**Author:** ![2ManyTacos](https://avatars.discourse-cdn.com/v4/letter/2/3da27b/32.png) [@2ManyTacos](https://boards.straightdope.com/u/2ManyTacos)\ **Post date:** [February 1, 2012, 4:23pm UTC](https://boards.straightdope.com/t/is-universal-health-care-inevitable-in-the-us/611056/12 "2012-02-01T16:23:27Z")
Well, California’s single-payer health care bill was [killed on the Senate floor yesterday.](http://californiaonecare.org/sb-810-killed-on-the-california-senate-floor/?utm_source=twitterfeed&utm_medium=twitter&utm_campaign=365+Ad+Campaign) As a CA resident, I can definitely admit to being upset about that. What does that mean going forward? My guess is that the ACA will be implemented here and slowly work to disengage us from the stupid system we have now. As another poster indicated, I definitely foresee Vermont’s system being replicated across the more liberal states if it’s successful. I’m definitely a bit bitter right now though lol. ---
**Author:** ![Tastes\_of\_Chocolate](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/tastes_of_chocolate/32/3232_2.png) [@Tastes\_of\_Chocolate](https://boards.straightdope.com/u/Tastes_of_Chocolate)\ **Post date:** [February 1, 2012, 10:11pm UTC](https://boards.straightdope.com/t/is-universal-health-care-inevitable-in-the-us/611056/13 "2012-02-01T22:11:20Z")
> [@Wesley\_Clark](#): > > 1. As health care becomes more expensive you may see employers try to decouple from being the ones who pay the bulk of health care costs. This is my best guess as to how UHC will come about. The large employers (who also happen to be large political donators) will see their healthcare costs skyrocket, making it harder to compete globaly. They will pressure politicians to “do something to something to save American jobs.” ---
**Author:** ![Mekhazzio](https://avatars.discourse-cdn.com/v4/letter/m/b38774/32.png) [@Mekhazzio](https://boards.straightdope.com/u/Mekhazzio)\ **Post date:** [February 1, 2012, 10:35pm UTC](https://boards.straightdope.com/t/is-universal-health-care-inevitable-in-the-us/611056/14 "2012-02-01T22:35:46Z")
If your goal is to maximize the average level of health care for minimum cost, single payer is the rational solution. The US will eventually come to admit that, kicking and screaming all the way, and then ten years after the fact, wonder why there was ever a fuss about it. ---
**Author:** ![Tim\_T-Bonham.net](https://avatars.discourse-cdn.com/v4/letter/t/46a35a/32.png) [@Tim\_T-Bonham.net](https://boards.straightdope.com/u/Tim_T-Bonham.net)\ **Post date:** [February 2, 2012, 1:03am UTC](https://boards.straightdope.com/t/is-universal-health-care-inevitable-in-the-us/611056/15 "2012-02-02T01:03:09Z")
> [@Mekhazzio](#): > > If your goal is to maximize the average level of health care for minimum cost, single payer is the rational solution. The US will eventually come to admit that, kicking and screaming all the way, and then ten years after the fact, wonder why there was ever a fuss about it. That’s how Canada’s system came into being. One province started it first, it was very successful, and businesses in the nearby provinces started to move there to gain the advantage of lowered health care costs for their employees. So the nearby provinces had to enact their own single-payer system to compete (and because their voters saw how well it was working, and demanded the same), so it eventually spread nation-wide. Which is why the Canadian system is still run by each province, rather than a ‘national’ system. (Except that they do have national groups coordinating things so they work together well.)