# What are the obstacles to universal health care in the US? **URL:** \ **Category:** Great Debates\ **Created:** [June 23, 2015, 1:08pm UTC](https://boards.straightdope.com/t/what-are-the-obstacles-to-universal-health-care-in-the-us/723232 "2015-06-23T13:08:32Z")\ **Posts on this page:** 20\ **Page:** 3
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [June 23, 2015, 7:42pm UTC](https://boards.straightdope.com/t/what-are-the-obstacles-to-universal-health-care-in-the-us/723232/41 "2015-06-23T19:42:51Z")
> [@Mr\_Smashy](#): > > Yes there are definitely areas for possible efficiencies, but to say that a private system must definitely be less efficient than a government one, without any hard data, is tough to swallow. I didn’t say it _must_ be less efficient. I said our system is less efficient than almost any UHC system we could install in its place. You are a federal contractor. I am, in essence, a healthcare administrator. Our system is utterly broken. Since you asked for hard numbers: [“In 1999, health administration costs totaled at least $294.3 billion in the United States, or $1,059 per capita.”](http://www.nejm.org/doi/full/10.1056/NEJMsa022033) Today, the NHS budget for England is about [$182 billion](http://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/nhs-budget), rising to a little under $220 billion when the rest of the UK is taken into account. That’s to cover every man, woman and child in the UK, or one fifth of the US population. Throw in BUPA’s [total global revenues](http://www.bupa.com/media/1053138/bupa-annual-report-2013.pdf) of ~$9 billion,\* and you have a total UK health expenditure budget of $230 billion. If you want to compare the UK figures to 2015 US administration costs, the disparity is even more bleak. And it’s not like the UK NHS is a byword for efficiency; far from it. It’s a pretty middle-of-the-road system that is fully nationalized. There are far more efficient models for us to emulate. \*BUPA controls 40% of the UK private health insurance market but derives 70% of its revenue overseas, so its total numbers are a reasonable proxy for total UK private healthcare spending. ---
**Author:** ![Cheesesteak](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cheesesteak/32/3694_2.png) [@Cheesesteak](https://boards.straightdope.com/u/Cheesesteak)\ **Post date:** [June 23, 2015, 7:58pm UTC](https://boards.straightdope.com/t/what-are-the-obstacles-to-universal-health-care-in-the-us/723232/42 "2015-06-23T19:58:47Z")
> [@Mr\_Smashy](#): > > but to say that a private system must definitely be less efficient than a government one, without any hard data, Without any hard data? WITHOUT ANY HARD DATA??? The entire civilized world (except for the USofA) has universal health care, and the entire civilized world (except for the USofA) pays FAR FAR FAR less than we do for health care of equal quality. If we paid as much per person as France to have health care, the US Government could cover every single person in the country with health care and spend LESS than the US Government spends TODAY on health care. Completely free taxpayer paid health care for every single person in the country, and taxes would go DOWN. That’s how much more efficient France is than we are. ---
**Author:** ![Bone](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bone/32/407_2.png) [@Bone](https://boards.straightdope.com/u/Bone)\ **Post date:** [June 23, 2015, 8:00pm UTC](https://boards.straightdope.com/t/what-are-the-obstacles-to-universal-health-care-in-the-us/723232/43 "2015-06-23T20:00:34Z")
> [@wolfpup](#): > > It doesn’t work for anyone who’s grossly overpaying compared to anyone else in the civilized world, which is just about everyone. The fact that you’re used to being gouged doesn’t make it any more affordable, nor are the continuing cost increases sustainable. It doesn’t work for anyone who’s ever had a claim denied or treatment downgraded due to costs. It doesn’t work for those driven into bankruptcy from health care costs, the leading cause of personal bankruptcies. It doesn’t work for the uninsured, or for anyone affected by abuse/overuse of ER facilities. Put it all together and it pretty much doesn’t for anyone except the 1%. You’ll have to define how you use the phrase “work” then. If you are asserting that the US healthcare system only works for the 1%, that’s a pretty bold statement. I’ve had a claim denied. I think my health plan works. I’ve paid more than I think is fair, I think my plan works. I’ve been affected by overuse of ER facilities and I think my plan works. Is your definition of what “works” to be the cheapest? Please elaborate. > [@](#): > > Why don’t you ask whether someone might be willing to pay half as much for better outcomes? _That’s_ the reality. The reality is also that costs are increasing so fast and so far out of whack with the rest of the world that the whole system is heading for a complete collapse of affordability. A collapse in the same way Social Security is perpetually heading for a collapse, or some other way? > [@](#): > > Are you seriously suggesting that research and development and innovation in health care _comes from insurance companies_? No. Can you walk me through your thought process that lead you to think that I might be? ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [June 23, 2015, 8:02pm UTC](https://boards.straightdope.com/t/what-are-the-obstacles-to-universal-health-care-in-the-us/723232/44 "2015-06-23T20:02:26Z")
> [@Mr\_Smashy](#): > > Government can be effective, if it throws enough resources at a problem. > > It is almost never efficient. I tend to agree. But let me repeat what I just said in the previous post: “If the government collected community-rated income-indexed premiums from everyone **and just simply paid all medical bills** – the classic single-payer model – costs would be cut in half, everyone would be unconditionally covered, and the insurance industry would cease to exist.” The bolded part is key. Governments may be incompetent, but so is any large complex bureaucracy. But all a single-payer system has to do is pay the bills. I think they can manage that. The simplicity is what makes it work. Does anyone routinely fail to get their social security payments? OTOH, a private insurer’s incompetence is directed to maximizing profit. > [@XT](#): > > Even if that’s true (and I don’t think it is, not entirely), so what? That’s how our system actually works, structurally. When you are the god king of the US and can rule by fiat then you can simply wave your magic fiat wand and impose whatever system you like. Working within OUR system, however, means working within the actual, real world gritty and dirty system of compromise that we have. The fact that the Republican party is against UHC by and large means that you need to work out a compromise with them (and their voter base)…either that or have such a crushing and overwhelming majority opinion that you can go against or around them without worrying about either what they think or the pendulum swinging back at some point and them undoing what you’ve done (or, more likely, watering it down to make an even more confusing mess than we already have). > > Sorry, folks, but that’s the real world we live in and the real system we have. The “real world” is that the insurance industry tells Congress what laws they want passed, and controls public perception about UHC and how health care works in every country in the world. That’s the real system you have. ---
**Author:** ![XT](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/xt/32/456_2.png) [@XT](https://boards.straightdope.com/u/XT)\ **Post date:** [June 23, 2015, 8:15pm UTC](https://boards.straightdope.com/t/what-are-the-obstacles-to-universal-health-care-in-the-us/723232/45 "2015-06-23T20:15:08Z")
[QUOTE=wolfpup] The “real world” is that the insurance industry tells Congress what laws they want passed, and controls public perception about UHC and how health care works in every country in the world. That’s the real system you have. [/QUOTE] Ah, horseshit. 🙂 And even if true (and it is, to some degree, just like it’s not, to another), again, so what? It’s how our system works in the real, actual world instead of the fantasy land world a lot of folks wish it worked in (when it’s doing something for or against things THEY like, of course…but works fine when it’s vice versa :p). But if there was an overwhelming majority of US citizens who wanted and agitated for UHC across the board and on both sides of the political fence it wouldn’t make a fuck bucket of difference what the insurance companies wanted or didn’t want in the end. THAT’S the real world we live in. ---
**Author:** ![Mr\_Smashy](https://avatars.discourse-cdn.com/v4/letter/m/2bfe46/32.png) [@Mr\_Smashy](https://boards.straightdope.com/u/Mr_Smashy)\ **Post date:** [June 23, 2015, 8:15pm UTC](https://boards.straightdope.com/t/what-are-the-obstacles-to-universal-health-care-in-the-us/723232/46 "2015-06-23T20:15:31Z")
> [@Johnny\_L.A](#): > > If the private insurance and for-profit health industries are making mediocre profits, can this not be attributed to their inefficient business practices vs. single-payer as cited above? And if they are incapable of being profitable, do they not, under the Holy Free Market, deserve to fail? No and yes, in that order. Competition drives the lower margins. (that, and increased regulatory costs from Obamacare, along with the mandate to underwrite everyone) ---
**Author:** ![Mr\_Smashy](https://avatars.discourse-cdn.com/v4/letter/m/2bfe46/32.png) [@Mr\_Smashy](https://boards.straightdope.com/u/Mr_Smashy)\ **Post date:** [June 23, 2015, 8:18pm UTC](https://boards.straightdope.com/t/what-are-the-obstacles-to-universal-health-care-in-the-us/723232/47 "2015-06-23T20:18:01Z")
> [@Cheesesteak](#): > > Without any hard data? > > WITHOUT ANY HARD DATA??? > > The entire civilized world (except for the USofA) has universal health care, and the entire civilized world (except for the USofA) pays FAR FAR FAR less than we do for health care of equal quality. > > If we paid as much per person as France to have health care, the US Government could cover every single person in the country with health care and spend LESS than the US Government spends TODAY on health care. Completely free taxpayer paid health care for every single person in the country, and taxes would go DOWN. > > That’s how much more efficient France is than we are. Before Obamacare was passed, 85% of Americans had health insurance, and 86% of them were satisfied with it. Doesn’t sound like the private system is so bad to me. Or to put it another way, if people didn’t like the current system, then single payer could have gotten through the Senate. It couldn’t/didn’t. ---
**Author:** ![Mr\_Smashy](https://avatars.discourse-cdn.com/v4/letter/m/2bfe46/32.png) [@Mr\_Smashy](https://boards.straightdope.com/u/Mr_Smashy)\ **Post date:** [June 23, 2015, 8:20pm UTC](https://boards.straightdope.com/t/what-are-the-obstacles-to-universal-health-care-in-the-us/723232/48 "2015-06-23T20:20:41Z")
[http://www.ahipcoverage.com/2014/01/03/myth-vs-fact-administrative-costs-in-medicare-private-health-plans/](http://www.ahipcoverage.com/2014/01/03/myth-vs-fact-administrative-costs-in-medicare-private-health-plans/) This is interesting. Makes a good case, with fact and data, that much of the ‘administrative overhead’ of the health system is the appetite suppressant on hospital use. “In addition, administrative spending protects against fraud. By some estimates, the Medicare program loses a staggering $60 billion to fraud each year. This amounts to 11 percent of the Medicare budget and would be enough to double Federal spending on primary and secondary education. No private company would ever tolerate this abuse. Imagine the fraud if Medicare covered 300 million Americans.” These findings have been echoed elsewhere. A Heritage Foundation report found that from 2000-2005, Medicare’s administrative costs per beneficiary were consistently higher than those for private insurance, ranging from 5 to 48 percent higher, depending on the year. And according to a BNA study, “Popular comparisons of Medicare and private group health plan ‘overhead’ costs wrongly compare only a part of administrative expenses related to the Medicare program to the whole of private sector administrative expenses for comparable large group health plans.” The report also says that Medicare’s costs for claims administration “are really about the same as claims administration costs in the private large group health plan market.” Moreover, some of Medicare’s general administration costs are expensed elsewhere in the federal budget, and others, like premium taxes, do not apply to the Medicare program. ---
**Author:** ![Cheesesteak](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cheesesteak/32/3694_2.png) [@Cheesesteak](https://boards.straightdope.com/u/Cheesesteak)\ **Post date:** [June 23, 2015, 8:27pm UTC](https://boards.straightdope.com/t/what-are-the-obstacles-to-universal-health-care-in-the-us/723232/49 "2015-06-23T20:27:03Z")
> [@Mr\_Smashy](#): > > Before Obamacare was passed, 85% of Americans had health insurance, and 86% of them were satisfied with it. Doesn’t sound like the private system is so bad to me… You pay twice what other countries pay and only 73% of the country is satisfied, and you think that’s good? 45 million people didn’t have any health insurance, despite us paying 2x what other countries paid to cover everyone, and that isn’t so bad? ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [June 23, 2015, 8:31pm UTC](https://boards.straightdope.com/t/what-are-the-obstacles-to-universal-health-care-in-the-us/723232/50 "2015-06-23T20:31:41Z")
> [@Bone](#): > > You’ll have to define how you use the phrase “work” then. If you are asserting that the US healthcare system only works for the 1%, that’s a pretty bold statement. > > I’ve had a claim denied. I think my health plan works. I’ve paid more than I think is fair, I think my plan works. I’ve been affected by overuse of ER facilities and I think my plan works. Is your definition of what “works” to be the cheapest? Please elaborate. Well, if your definition of “works” is having costs that are off the chart compared to any other country in the world, with often worse outcomes and millions of uninsured, horrendous waste, and a looming crisis of affordability, then it works. Most of us expect better. > [@Bone](#): > > A collapse in the same way Social Security is perpetually heading for a collapse, or some other way? Some other way. The particular way that can be seen in any international comparative chart of health care costs. Mind you, if the government chooses to engage in theft by collecting health care premiums and then misappropriating the funds for entirely unrelated purposes, then health care might have a problem too. But this doesn’t happen elsewhere – indeed the opposite happens: the majority of health care costs are covered out of general revenue. Whereas right now in the US health care costs are indisputably a problem – right now, and getting worse. > [@Bone](#): > > No. Can you walk me through your thought process that lead you to think that I might be? Certainly. Your statement was: “_I also think it would be persuasive if another country were to implement UHC, and have better outcomes across the board, including research and development, and innovation. No one comes close to the US in those arenas._” Apparently you think medical R&D and innovation, or lack thereof, has something to do with UHC vs. private insurance, else why did you make that statement? Whereas I maintain that medical R&D and innovation is the result of various factors and synergies including federal research funding and the existence of various innovative industries including medical equipment and pharma. Perhaps you could walk me through an explanation of what this could possibly have to do with how health **insurance** is funded. As for medical outcomes, by certain criteria in the OECD rankings (including life expectancy and infant mortality) US health outcomes are verging on third-world status. ---
**Author:** ![Bone](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bone/32/407_2.png) [@Bone](https://boards.straightdope.com/u/Bone)\ **Post date:** [June 23, 2015, 9:12pm UTC](https://boards.straightdope.com/t/what-are-the-obstacles-to-universal-health-care-in-the-us/723232/51 "2015-06-23T21:12:33Z")
> [@wolfpup](#): > > Well, if your definition of “works” is having costs that are off the chart compared to any other country in the world, with often worse outcomes and millions of uninsured, horrendous waste, and a looming crisis of affordability, then it works. Most of us expect better. I note you didn’t define how you are using the term “works”. > [@](#): > > Certainly. Your statement was: “_I also think it would be persuasive if another country were to implement UHC, and have better outcomes across the board, including research and development, and innovation. No one comes close to the US in those arenas._” Apparently you think medical R&D and innovation, or lack thereof, has something to do with UHC vs. private insurance, else why did you make that statement? You’re shifting here. You originally interpreted my statement to mean that ‘research and development and innovation in health care comes from insurance companies.’ Now you are interpreting it to mean ‘medical R&D and innovation, or lack thereof, has something to do with UHC vs. private insurance’. I could try to parse the difference, but I’ll probably not be able to tease out what you are trying to say. Let me restate to clarify. The health care environment in the US fosters research and development, and innovation in greater ways than other countries. These things are of signficiant value and should not be discounted when talking about the health care landscape. I would find UHC more persuasive if other countries who have implemeted UHC (the C is for “care”, not insurance) demonstrated success in R&D and innovation. > [@](#): > > Whereas I maintain that medical R&D and innovation is the result of various factors and synergies including federal research funding and the existence of various innovative industries including medical equipment and pharma. Perhaps you could walk me through an explanation of what this could possibly have to do with how health **insurance** is funded. As for medical outcomes, by certain criteria in the OECD rankings (including life expectancy and infant mortality) US health outcomes are verging on third-world status. If the incentive of unlimited profits doesn’t exist, then R&D spending would be negativley impacted yielding fewer innovative products. UHC needs to control costs either by being more efficient, or providing less services, or both. ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [June 23, 2015, 9:35pm UTC](https://boards.straightdope.com/t/what-are-the-obstacles-to-universal-health-care-in-the-us/723232/52 "2015-06-23T21:35:50Z")
> [@Mr\_Smashy](#): > > [http://www.ahipcoverage.com/2014/01/03/myth-vs-fact-administrative-costs-in-medicare-private-health-plans/](http://www.ahipcoverage.com/2014/01/03/myth-vs-fact-administrative-costs-in-medicare-private-health-plans/) > > This is interesting. Makes a good case, with fact and data, that much of the ‘administrative overhead’ of the health system is the appetite suppressant on hospital use. You know that AHIP is a health insurance industry lobbying group, right? They’re not exactly a neutral arbiter on this issue. ---
**Author:** ![Claverhouse](https://avatars.discourse-cdn.com/v4/letter/c/13edae/32.png) [@Claverhouse](https://boards.straightdope.com/u/Claverhouse)\ **Post date:** [June 23, 2015, 9:43pm UTC](https://boards.straightdope.com/t/what-are-the-obstacles-to-universal-health-care-in-the-us/723232/53 "2015-06-23T21:43:52Z")
[QUOTE=watchwolf49] [QUOTE=Cheesesteak] Presuming you are right, the “non UHC” argument is that since Americans are currently paying for the research that allows other countries to free ride on our investment, we should continue paying twice what they pay to ensure the research continues. Given how incredibly angry Republicans get when poor American Citizens get some free food, I find it amazing that they actively defend a system that gives Socialists across the world cheap access to health technology WE paid to invent. [/quote] I think this is true to some degree, as it is also true to some degree that Socialists across the globe rely on US manufacturing as well. It’s nice that Belgium can negotiate a cheaper per unit cost for replacement hips from US makers, but how does Belgium get any replacement hips if no one in the US is making them. If it was cheaper to make them in Belgium, they would. However, if Belgium couldn’t get _any_ replacement hips from the USA, then they _would_ start making them themselves (and sell them to the English for a **BIG** profit). Same with technology, if it wasn’t developed in the USA, then it would be developed elsewhere. [/QUOTE] We elsewhere are pretty resigned at American attempts to believe they invented everything ---- simply because it is so out of sight — but in this case before a belief starts that hip replacements are due to American old-fashioned guts and the can-do spirit, I may as well point out here that they were invented by Sir **[John Charnley](https://en.wikipedia.org/wiki/John_Charnley)**, 1911 - 1982, of Wrightington Hospital in Lancashire under the NHS. Eee, Lad. Also: _In May 1948 he participated in a work trip to the USA, visiting hospitals there together with other young orthopaedic surgeons. The experience caused him to consider the possibility of basing himself in the USA but that country’s restrictions on experimental surgeries were unacceptable to him._ ---
**Author:** ![YogSothoth](https://avatars.discourse-cdn.com/v4/letter/y/8edcca/32.png) [@YogSothoth](https://boards.straightdope.com/u/YogSothoth)\ **Post date:** [June 23, 2015, 10:16pm UTC](https://boards.straightdope.com/t/what-are-the-obstacles-to-universal-health-care-in-the-us/723232/54 "2015-06-23T22:16:49Z")
> [@XT](#): > > Even if that’s true (and I don’t think it is, not entirely), so what? That’s how our system actually works, structurally. I didn’t realize that answering the OP required me to provide not only the answer but a bi-partisan solution. :rolleyes: ---
**Author:** ![Mr\_Smashy](https://avatars.discourse-cdn.com/v4/letter/m/2bfe46/32.png) [@Mr\_Smashy](https://boards.straightdope.com/u/Mr_Smashy)\ **Post date:** [June 23, 2015, 10:20pm UTC](https://boards.straightdope.com/t/what-are-the-obstacles-to-universal-health-care-in-the-us/723232/55 "2015-06-23T22:20:32Z")
> [@Really\_Not\_All\_That\_Bright](#): > > You know that AHIP is a health insurance industry lobbying group, right? They’re not exactly a neutral arbiter on this issue. Fair enough, I’m open to quotes from HuffPo, Daily Kos, or whoever you want to put up there to refute it. ---
**Author:** ![XT](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/xt/32/456_2.png) [@XT](https://boards.straightdope.com/u/XT)\ **Post date:** [June 23, 2015, 10:38pm UTC](https://boards.straightdope.com/t/what-are-the-obstacles-to-universal-health-care-in-the-us/723232/56 "2015-06-23T22:38:25Z")
> [@YogSosoth](#): > > I didn’t realize that answering the OP required me to provide not only the answer but a bi-partisan solution. :rolleyes: How’s it working out without a ‘bi-partisan solution’? 😛 Most of the answers in this thread are answering a completely different question than the one the OP is asking, IMHO. It’s the same old seemingly endless wrangle about whether UHC is good or not good, saves money or doesn’t save money. While that’s an interesting discussion it has little to do with the actual reason we don’t have it here in the US. It’s like saying, in 1920’s America, that blacks should have the same full rights to vote and live and be full citizens without prejudice as whites do. Well duh. They certainly should have. But pointing out why they should or how stupid it was that they didn’t wasn’t going to magically and automatically make it so in 1920’s American…or 1930’s American for that matter. And if someone had waved a magical fiat wand to MAKE it so it wouldn’t have stuck and one party of the other would have fought it, tooth and nail, and they would have had enough voters on their side TOO fight it. To get back to the subject of this thread, pointing out that other countries made or make UHC work isn’t going to magically make it happen in the US either…and even the incremental and small changes Obama and the Dems DID manage to get through has been fought and contested, and at a guess will continue to be fought and contested until there is sufficient shift in across the board public attitude to make it so both parties support it (or don’t feel comfortable enough in their voter base to get in it’s way). People have been yammering about UHC and it’s obvious benefits for years, literally…hell, decades I think. And slowly public opinion has shifted and will continue to shift until, IMHO, one day it will tip the balance and we’ll be there or there will be a huge public call for it on both sides of the political isle. I see it as something similar to the ban on tobacco in public places, gay marriage, the marijuana debate and even civil rights and similar sea changes in public opinion leading attitude shifts that transcend party. In other countries some of this was done by fiat, in others it merely took a simple majority, often of a coalition of parties but sometimes of a single party that got enough backing to push it through. In the US it will take a REAL majority in both parties and a shift in the overall public’s attitude towards UHC (or any other issue where there is a split) to make it a reality. ---
**Author:** ![Nema98](https://avatars.discourse-cdn.com/v4/letter/n/d2c977/32.png) [@Nema98](https://boards.straightdope.com/u/Nema98)\ **Post date:** [June 24, 2015, 12:21am UTC](https://boards.straightdope.com/t/what-are-the-obstacles-to-universal-health-care-in-the-us/723232/57 "2015-06-24T00:21:40Z")
Insurance companies, their business interests and politicians who want to kill any chance of a universal healthcare taking off. Oh and vast ignorance of millions who think it is “socialism” and therefore “evil”. ---
**Author:** ![not\_what\_you\_d\_expect](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/not_what_you_d_expect/32/3246_2.png) [@not\_what\_you\_d\_expect](https://boards.straightdope.com/u/not_what_you_d_expect)\ **Post date:** [June 24, 2015, 2:13am UTC](https://boards.straightdope.com/t/what-are-the-obstacles-to-universal-health-care-in-the-us/723232/58 "2015-06-24T02:13:14Z")
> [@wolfpup](#): > > I tend to agree. But let me repeat what I just said in the previous post: "If the government collected community-rated income-indexed premiums from everyone **and just simply paid all medical bills** – the classic single-payer model – **costs would be cut in half, everyone would be unconditionally covered, and the insurance industry would cease to exist."** Sounds logical to me, but I do have a question about the bolded part. Where do those savings come from? I mean, are we going to have a bunch of unemployed insurance people to worry about or is most of that savings concentrated in the hands of the wealthy? ---
**Author:** ![Muffin](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/muffin/32/4341_2.png) [@Muffin](https://boards.straightdope.com/u/Muffin)\ **Post date:** [June 24, 2015, 2:59am UTC](https://boards.straightdope.com/t/what-are-the-obstacles-to-universal-health-care-in-the-us/723232/59 "2015-06-24T02:59:08Z")
> [@not\_what\_you\_d\_expect](#): > > . . . are we going to have a bunch of unemployed insurance people to worry about . . . . No worries. Just use them for spare parts when performing transplants. ---
**Author:** ![YogSothoth](https://avatars.discourse-cdn.com/v4/letter/y/8edcca/32.png) [@YogSothoth](https://boards.straightdope.com/u/YogSothoth)\ **Post date:** [June 24, 2015, 3:15pm UTC](https://boards.straightdope.com/t/what-are-the-obstacles-to-universal-health-care-in-the-us/723232/60 "2015-06-24T15:15:12Z")
> [@XT](#): > > How’s it working out without a ‘bi-partisan solution’? UHC may be non-existent federally, but we got Obamacare with almost no Republican support. I’d say a bi-partisan solution, ie. before Obamacare, was terrible. It took the Dems using up all their political capital to force Obamacare through. As a result, tens of millions more people have health care. I’d say its working out decently. Given the almost allergic reaction the GOP has to health care, refusing to reform it, refusing to come up with their own solution, on one hand saying it’ll cost the US billions, then when disproven, on the other hand saying they don’t care how much it costs because its the principle of the thing, I have no faith in a bi-partisan solution. The only way we’re going to get better health care is if the Dems win big and ignore the GOP and do it themselves. I’m hoping enough blue states ram it through and show their neighbors how shitty their lives will be without it. Its a decade-long fight, but one only the Dems are willing to wage [Previous page](https://boards.straightdope.com/t/what-are-the-obstacles-to-universal-health-care-in-the-us/723232.md?page=2) [Next page](https://boards.straightdope.com/t/what-are-the-obstacles-to-universal-health-care-in-the-us/723232.md?page=4)