What Americans dont understand about Public Healthcare (YouTube Video)

In My Humble Opinion
1

I wanted to post this video as I found it quite compelling. It’s basically a Europe’s perspective on what American’s don’t get about public healthcare. The target audience who doesn’t get it might surprise you, as I think the automatic assumption would be that it’s conservatives/Republicans who don’t get it. In fact, I think the video gives compelling evidence (that I’ve long held) that it’s AMERICANS, as a whole, who don’t get it, including many Democrats who advocate for it.

The solution he gives for America and Americans is one I totally agree with as well, even though it’s only getting the conversation started. But the conversation we’ve been having is the wrong one. Anyway, watch if you like, comment if you like.

2

What do you feel you learned from this video? I’m maybe 40% through and wondering if the point is later. So far I’m underwhelmed by these “unknown facts” that make it seem like the author is unaware of the American system. For example, he cites the French system as being hugely expensive, citing it as taking up 15% of the French national budget. Of course, the US system takes up 28% of our federal budget, and covers far fewer people. And a quick search shows that France spends a smaller portion of GDP on health care than the USA does.

The earlier portion on the NHS doesn’t really illuminate much - he just calls it terrible without any evidence that it actually is (particularly when compared to the US system).

Maybe it gets better?

3

No, it doesn’t ‘get better’. My main take away from it is that people advocating for a unified federal system don’t take into account the US taxpayer, which was his main point. Things that other countries do to make it work, such as higher taxes and programs to support or even force healthier lifestyles are probably not going to fly very well with US taxpayers. Pointing out that we, collectively spend more on healthcare currently only translates when you take into account that it’s a known quantity to those who live in the US and are used to paying a portion of their salary into a healthcare plan (along with their employer paying a larger portion). All that would be restructured in a real federal healthcare plan, which is going to be a tough pill to swallow, but the tougher pill will be the points he makes wrt things like legislating healthier lifestyles (fat and sugar taxes, for instance).

It’s the structural issues that I think most people who argue about this subject, either for or against don’t seem to get. You don’t seem to get it either, as you are focused on the 15% thing while missing the real point because it seems so obvious that 15% is less than 28% (or whatever the actual figure is). But the thing is, the average US tax payer wouldn’t be getting a huge discount if only we went to universal federal healthcare.

His final points about a better system for us being a state system I think are spot on, but if you didn’t like the video to the 40% point I doubt you’ll finish it, regardless, so no real point. Personally, I didn’t really learn anything new from the video…I knew most of this already, and it aligns with my own thinking so figured I’d link to it. C’est la vie.

4

Well, perhaps that’s true. I think that most health care wonks, or really anyone remotely familiar with the issue, understands that the US system is a combination of federal systems, state systems, and employee/employer shared costs. But really the bottom-line number does matter. Unless you truly believe that the US system is so much better that it is “worth” spending much more of our GDP on health care, then clearly there is something we should be learning from other countries.

I focus on the “percent of budget” number just because he did. Clearly percent of GDP is more relevant. The fact that we spend more to get, at best, the same or marginally better care isn’t really in doubt.

I will certainly follow up with the rest of the video - I could only really watch about half at which point I wanted to check some of the numbers because his points weren’t really landing. I’d be interested in a state-based system (which clearly his talking up of the Scotland plan was leading towards), so we will see how he lays it out. I’d be worried that he perhaps doesn’t quite understand just how “federated” our system is and why individual states trying to enact their own systems without some level of top-down regulations/guidance/funding just won’t work. But I’ll try to remember to pop back in here after I’ve finished.

5

I agree with the video’s point that while most European countries basically agree on the need for shared-risk healthcare, the U.S. is (and has long been) divided on the issue.

The fact that we have insurance companies meddling more in our system makes this division less substantive, and more philosophical (and tribal).

6

I’m a leftist but I try to be open minded. There is endless stuff I don’t understand and could be wrong about.

But that wasn’t a persuasive video

For those who don’t want to watch it here is what they say.

The NHS has some issues, but those are likely due to underfunding. In the UK they barely spend $4000 per capita on health care vs 11k in the US. So the issues with the NHS could be more due to under funding than anything else.

We all know UHC has to be paid for with taxes. That is fine. Taxes aren’t some evil thing, they’re a community engagement and lots of us are fine with them.

We regulate unhealthy things in the US too. We tax alcohol and tobacco. We tax gasoline. Don’t understand why this argument is persuasive.

Yes you would have to pay so fat people can see a doctor. Smokers too. And people with chronic stress. And people with genetic diseases. And people who are vegan athletes who get hit by a car running a red light. Lots of us are fine with all of those things.

It is false to say US politicians don’t have plans. People like Biden, Sanders, etc have plans with funding laid out.

I agree the US is too politically divided for federal UHC at the moment.

I see no reason to think local UHC is better than federal. That is just a conservative talking point. No evidence was presented for this. Medicare is a federal system and it works fine.

Overall proponents of UHC discuss taking our current single payer, federal UHC system (medicare) and expanding it to cover everyone instead of just covering people over age 65. Medicare is well liked by people who use it, it is cheaper than private insurance, it doesn’t screw people over the way private insurance does (although it has coverage gaps). The video never even attempts to address this fact, because it undermines his entire video. Proponents of medicare for all are discussing taking our existing, popular, respected, national UHC program and just expanding eligibility rather than only letting people age 65+ use it.

Also as for unhealthy lifestyle, poor lifestyle does accelerate death but usually not until old age. So if you smoke or are obese yeah you’ll get sick, but by the time you do you’ll probably be over 65 and on medicare anyway.

7

He went into a bit of detail about why he thinks the UHC (in England) is bad and it had zero to do with taxes being ‘some evil thing’, so this seems like a strawman knee jerk reaction, not really relevant to the point he was making. He praised Scotland’s UHC implementation, even though it too is paid with taxes.

We don’t regulate them nearly as much as Japanese or Europeans do. His example of New York and the difference between their attempt at a small change compared to his other examples was pretty spot on to me. Not sure why that wasn’t persuasive.

His point wasn’t that they don’t have plans, it’s that they aren’t planning for or even thinking about the right things. Are you sure you watched the video?? It was pretty short and he addressed all of the things you are bringing up here.

I seriously doubt this guy is a conservative. :stuck_out_tongue: Also, his example of how marijuana has become legal as well as examples of systems he felt were very good in Europe that use similar state oriented systems (such as Germany) explains WHY he feels this would be a better way to go. To me, you are responding to strawman ‘conservative’ arguments that weren’t the thrust of the (short) video.

Again, this was addressed. It adds substantial costs to a system, or, conversely, is what allows you to make some savings on those costs if you lock things down to force the public to be healthier.

At any rate, I just wanted to put the video out there. Your own response doesn’t seem to actually address the video and were more cookie cutter arguments that, ironically were what the guy doing the video was pointing out that Americans don’t get. I don’t really want to debate UHC again here but merely point out where your points diverge from what the video was actually about.

I doubt many on the left or right are going to find this video compelling. I doubt they will be able to watch it and see the mote in their own eye either, or that it will change many minds. To me, it’s a perfect example of how both sides get European healthcare wrong, take away the wrong message, and are pushing (or digging in their heels) on change for healthcare in the US…and fucking up any chance for change that will work in the US and actually give us a better product.

8

I’m going to schedule some time to watch the video, it seems to be just ten minutes. But I did want to address the above.

What other nations to to make it work is tax people less. Not more. Yes, the US is fairly low-tax in terms of developed nations, but other nations tend to offer far more benefits, not just healthcare. The US government spends more money on government healthcare per person than nearly all other nations. That includes nations with lifestyles just as unhealthy as the US.

Sometimes the bottom line really is the bottom line.

9

Which is exactly the way other countries went from “no such thing as a public healthcare system” to “everybody is covered (with variations about whether POD providers are public or private, and about whether the system is single-payer or not”).

  1. No such thing as health insurance, no such thing as public healthcare unless you count charity hospitals as such
  2. Different health insurance schemes are born: some are cooperative, some are non-profit, some are for profit, some are public
  3. Regulations push those schemes which are perceived as less beneficial out of the table while expanding the more-beneficial ones until everybody is covered

No country has gone from 0 to 100% coverage in one decree, and all those which have universal or near-universal coverage have eliminated some sources of coverage which were perceived as inappropriate.

10

The video makes a good point about connecting public health care systems to personal risk-taking WRT individual health. I think this is an important point in the discussion, and we will not take too kindly to “nanny state” ideas and fat-shaming, no matter how good-intentioned.

The one area not covered (and not discussed much in the debate) is why the costs of health care are so high here compared to elsewhere. Mainly, there is the profit motive that everything from hospitals to doctors to medical equipment suppliers to pharmaceutical manufacturers to insurance companies and every single participant has. In other systems there are price controls in place (I think this was alluded-to with England) - if a more heavy-handed approach to pricing were to take place here, those proposals would meet fierce resistance from lobbying groups. I am not sure if industry in France and the UK and elsewhere highlighted in the video has as much sway as here.

Overall, I think the concept of the federal government setting-up a framework for states to develop their own public healthcare systems has merit, if we can get past bumper-sticker politics.

11

There are usually three separate issues that get conflated in these discussions:

  1. Can/do UHC systems work well? (Yes)
  2. Could a UHC system work in the US? (Depends)
  3. Is it possible to get from the current situation to UHC in the US? (Not quickly or easily and with a great deal of well-funded resistance)

One can often observe goalposts pinging rapidly amongst these points during all the various threads we’ve had on this subject, often to counterproductive effect. But that’s the internet for you.

(Also, IIHO the NHS is freaking awesome despite its perpetual undermining by Conservatives and the impact that Brexit is having on it.)

12

With the NHS, you have the might of one buyer against all those pharma companies. They’ve got no one to play the NHS off against, fierce lobbying or not. Hard to lobby in your favour if you have no bargaining chips.

13

The effective tax rate for the average American, if you include their insurance premiums, copays, etc – ie the average out of pocket cost for an American for both government services AND healthcare, which in other countries is included – is 43%.

It sounds like you are the one not taking into account the American taxpayer.

14

The problem is that many states have absolutely no issue with royally screwing their citizens. For example, after a natural disaster, the federal government will share the cost of rebuilding with the states. In California, that means that the feds pay for part of the rebuilding effort while the state pays for much of the rest. In Florida, it means that the state government points and laughs while its citizens can’t properly rebuild because they don’t have the funds.

Now, I live in California. Maybe I should just push for my own state to become a first world country while the rest of our nation can make up its own mind. But, because I am not a monster, and have empathy, I’m not comfortable with the people of Florida dying of treatable illness because their government is gerrymandered to hell and back and cares nothing for its constituents (at least, the ones who don’t donate the big bucks to political campaigns).

15

Quite a mix of good and bad in the video. Very true that politicians have not proposed any honest way to pay for there healthcare schemes. If universal healthcare did come to America, taxes would have to go up alot for everybody. Good points about the American vs European attitudes toward government and personal responsibility.
The bad was that it presented obesity as a failure of willpower and food regulation as the solution. Over the last 40 years obesity in Europe has tripled, whatever the answer to obesity is, we can be sure that Europeans don’t have it.

The solution is the worst part. States have tried to implement universal healthcare, Tennessee, and Vermont. They always fail because in order to pay for them taxes have to be raised to such high levels that any state offering it would have taxes two to three times as high as every other states and people would leave.

The real reason American healthcare has not been changed to a european model is that it would require massive upfront costs for hypothetical savings decades hence. Our political system is not designed for such legislation. The preferred method is to get all the benefits as soon as possible and to pay the costs when current politicians are safely retired.

16

Anyone complaining about taxes going up is either blind, a shill, or duped by one of the above. Yes, your taxes will increase. Unless you are making a fortune, your overall spending will go DOWN because right now, as we speak, you are already spending a FORTUNE on medical costs.

When people say “France spends 10.9%% of GDP on medical care, the US spends 19% (average is 9%)”, or “the US spends $10,224 per capita annually on healthcare, France spends $5,000”…

IT DOESN’T MATTER THAT YOUR TAXES ARE LOWER. THE EXTRA MONEY IS COMING FROM SOMEWHERE. IS IT…

A) Being paid for by the government using a magical source of money that isn’t taxes
B) Being paid for by the big medical corporations, who cover the extra cost out of the goodness of their heart
C) Coming out of the taxpayer’s pocket through premiums, through businesses charging customers more and paying employees less in order to cover health insurance, and through the fact that once you do get sick, the insurance company will do everything in its considerable power to avoid paying you out, instead pocketing the premiums you’ve paid for so long and dropping a metaphorical, steaming turd right on your face.

I will leave it up to the reader to discern the correct answer, but I’ll point out that only one of the three is not entirely stupid.

17

OK, watching the video. The videos posters comment underneath talks about the “social sacrifices that come with public healthcare”. Be interested to learn about that.

1:10. Ok so far, surprisingly accurate and good. “Sicko” was not an in-depth presentation of European health-care systems and the French and British systems are very different.

2:00. A more mixed bag. He skips the part where Tony Blair increased funding for the NHS massively along with his reforms. It is, however, quite true that the NHS does not compare well with most western European systems. (He says “European” which is a bit less accurate.) However it is still severely underfunded compared to other western European systems. In terms results per dollar (or pound) spent it is one of the best in the developed world. I also find it a bit peculiar that he compares it to other European systems, if his goal is to educate Americans. I suspect cherry-picking here. The NHS certainly outperforms the US by a very large margin, and comparing it to better-funded systems obscures the fact. He likes the Scottish system, clearly. But the differences between the Scottish and English systems are fairly small compared to their differences to other systems.

4:00. OK, here it gets bad. He goes on about how Frances system is much better but very expensive and only works because people are willing to pay the taxes for it. This is false. Frances system is fairly average in cost for a western European system. And like all of them, massively cheaper than the US system. If you do it in terms of percentage of GDP you can get France to move up a few places but still not to the top. It is very clear that he is trying to make it sound expensive.

4-5.00: Now he speaks of social sacrifices, burdens upon the individual. “Are the US even willing to allocate 12-15 % of its budget in to such a system” No mention of the fact that the US currently allocates about 27 % of its budget to healthcare. Then he talks about taxes that he says needs to be levied.

5.00 - 8.00: More tax talk, about taxes on unhealthy foods and advertising of such. He talks about how the health of the population affects healthcare expenditure, and pulls out Japan as an example. This is an old fallacy, but he has clearly done his research. If you correlate healthcare spending with public health measures like obesity, alcohol consumption etc, they match for two nations: The US (unhealthy population, high costs) and Japan (Healthy population, low costs). All the other developed nations are all over the place.

The UK have high measures for obesity, alcohol consumption, smoking etc, yet low costs and good longevity. The Nordics have better fitness and higher costs. He pulls out the only nation that fit his postulate, Japan. (In fact, the public health of the population is not without effect to costs, but the effects of the healthcare system is just so much larger that it drowns out the signal). He talks about how he does not want to pay for other peoples lifestyle choices. Does some scare talk about how it would be necessary to deal with American unhealthiness if a public system was to be introduced.

9.00: He pulls out the Bismarck type systems from nowhere. Does not do any comparisons, just states that they would be better. Of course, comparisons would show that they are overall the most expensive systems out there, after the US one. I guess its worth even more taxes than the French type if the systems can be based on insurance companies. He ends with saying that decentralized systems are better because the state does not control them, which in general seems to be a fear pretty unique to the US.

All in all, a pretty basic deceptive video. Criticizes the Uk system for having worse results than the French, criticizes the French system for costing more than the UK. Compares neither to the US and does not mention that both systems beat the US on both costs (by a very wide margin) and results. Pretends the US isn’t already spending more than everyone, tries to pull the old population health = costs fallacy and cherry picks the one nation that fits that. Nothing really new and I don’t really see anything explained.

I am curious what the OP thought the video actually explained, and if anyone actually calls it “Social Healthcare” in the US ?

18

Will the average family’s overall costs go down by $2,500 a year? Because I seem to remember some politician promising something like that sometime before.

No doubt it is true this time, though. Keeping in mind that DOWN means UP, and “you are making a fortune” means “the average family”.

The part about the tax increase I expect is pretty much literally true. Elizabeth Warren is probably lying, and she will increase taxes on the middle class.

Regards,
Shodan

19

To be fair, Obama probably assumed that Republicans in red states weren’t going to actively screw their constituents purely to spite Obama.

But they did. And then they blamed Obama for it.

20

PS: Speaking as a European with some experience of healthcare systems, it is nowhere near my perspective. If you wanted to explain a European perspective on UHC, I’d say its pretty close to the American view of publicly funded K-12 education.