I think that both sides of the healthcare debate tend to gloss over a lot of the harder aspects and the tradeoffs that are necessary to move forward with healthcare. As President Trump learned (I think he was actually the last person to learn this), healthcare is complicated. The US has this weird system that is the worst of both worlds. We have a single payer system that just about everyone is in…and it costs a ton. We have a private system that is tied to employment…and it costs a ton. We aren’t willing to put in the regulations necessary or to pick a system because, basically, there will always be people who come out worse in the end. And no one seems willing to suck it up and admit that…probably because if they did, they wouldn’t get elected or re-elected by our often silly voters.
I found this video to be good about talking to the broad issues of WHY we don’t seem to be able to have a national conversation on this topic. It talks about (broadly) some of the reasons why no matter which way we go it’s going to be painful. Obamacare had and has tradeoffs and only addresses one of the issues with healthcare. The Republican plan was similar. In both, there were folks who had less than optimal results. Also, both only addressed a small fraction of people in the US who use healthcare. If anyone is interested, it’s not that long a video. Watch it and if you feel like it, feel free to discuss it and the US healthcare system in general here.
The takeaway line in that video is that voters want to be pandered to.
There’s a deep, irrational current in American society that wants more service than it’s willing to pay for. And government should magically provide those services without cost. Until we get past that the dysfunction will continue.
That’s true EVERYWHERE. Do you think Canadians don’t want lots of service from the government with low, low taxes? Of course we do. We love to bitch the government doesn’t do enough and then shriek at the tax bill like the government just ran over our dogs. That is a common trait of pretty much everyone in the entire world.
We can’t really have a grown-up discussion about any actual tradeoffs in government.
Take spending. The vast majority of peopled polled think that the Federal government should spend less money. But when you ask them about individual things we spend money on, the only one you can get even a weak majority to agree we should cut is foreign aid, which people think we spend about 10% of the budget on, despite actual spending being basically a rounding error.
Part of the problem is that people are pretty ignorant about lots of things, and don’t like making hard decisions.
But I think a considerable amount of it is related to Arrow’s Impossibility Theorem. Simply put: a group of individuals with rational preferences cannot use any ranked voting system to combine them into a set of rational preferences for the group. Provably.
Even if everyone were thoughtful and informed and rational, the group will do some weird things once you start using any voting system to direct its actions.
I think it’s deeper than that. There is a ton of mis-information on both sides of the debate, both about what our system is, what it does and who pays as well as what other countries have (and don’t have), and how it works. Both sides seem to gloss over the parts they don’t want people to look at while emphasizing those that make their arguments look good. And, frankly, the vast majority of Americans simply don’t understand this subject enough to even understand the issues or what other countries have. There is another channel I follow on healthcare that did a series years ago on what the US and other countries have wrt healthcare…if anyone is interested, it’s here. If you actually look at the series and look at the number of people who viewed it and liked/disliked it, it’s sadly very low. People just don’t seem interested in this enough to even do quick little videos on the subject to educate themselves. Which is a shame, because the US spends more than just about every other country on a per capita basis for healtcare…while getting far less than our moneys worth out of it.
He does a good job of covering most of the trade-offs, but he stops short by only going to single payer. Past that is nationalized healthcare, which he doesn’t mention (that I recall).
To me, the foundation of all the issues we have are something I characterized in another thread on this subject. The idea that the number 1 priority of our system, from top to bottom, is not to provide healthcare, instead it is wealth creation. Healthcare is the product, but wealth creation is the priority. He somewhat alluded to that when he discussed the potential impact of single payer throwing a lot of well paid people out of work creating a recession. But that would still leave doctors and hospital systems and drug manufacturers and medical equipment manufacturers and testing labs, etc. etc., all wanting to make good money. They’re used to it now, so they and their lobbying groups expend an enormous amount of resources convincing everyone to keep things the way they are. If we went farther than single payer to a nationalized system, then many of them would lose out also.
So, there are a lot of players deeply committed to keeping things the way they are. They will fight tooth and nail to prevent us from having this mythical grown-up conversation. Because when you stand between a person and their income stream, you better be ready for a fight.
There are some issues with his claim that only 6% get healthcare through the exchanges.
Lots of people got health care via the ACA either from the expansion of medicaid, or keeping people on their parents plans until they are 26. Plus a lot of us who don’t get the ACA get benefits from the ACA. Ending recissions, ending lifetime and annual caps, making emergency care in network, etc.
Then he claims you can’t negotiate the price of medication. THat is wrong too. Sites like pharmacychecker allow you to check various pharmacies (most in Canada) to determine who has the best prices.
In states like California that have made an effort to expand health care under the ACA, the uninsured rate has dropped from 18% before the ACA was implemented down to about 7% now. So expanding coverage isn’t that huge a deal now, in states like CA the insured rate is now 93%. But just because you have insurance doesn’t mean you have care.
The problem with healthcare is most people don’t need much most of the time. About 5% of people use 50-60% of health spending in a given year, which means the other 95% of the public use the other 40-50% of spending. So the vast majority of people aren’t using much health care most of the time, so it isn’t really a priority for them other than paying premiums. Most people don’t need much health care most of the time, so it becomes an abstract concept for them.
A big part of the problem is that when most national UHC systems were created, health care was about 4-8% of GDP. When medicare and medicaid were created in the US, health care was 6% of GDP. Now that our system is 18%, people don’t want to touch a system that large.
The issue fundamentally is that there is no government incentive to lower costs. On top of that, the private market doesn’t have the power to lower costs. We know how to lower costs, but the private sector can’t and the public sector won’t. And that is the main issue with our system.
The reason why we can’t have a grown-up conversation about health care in this country hasn’t gotten anywhere near the reasons - costs and tradeoffs and wanting more than you want to pay for - that you guys, and the guy in the video, are discussing.
When our conversation is at the level of Death Panels!!! and Obummercare is tyranny!!, all I can say is, we’d have to make great progress as a nation just to get to the point where the attempt to have the ‘adult conversation’ stalled out at the point y’all are talking about here.
This is like saying, “I’d make a ham sandwich, but I don’t have any mayo” without noticing that you don’t have any ham or bread either. We haven’t gotten near to the point where the absence of mayo is the stumbling-block.
There actually is no basis for “death panels”, that is something that was made up entirely out of whole cloth by the right in order to try to discredit the ACA.
Some republicans still try to make that claim, but they are laughed at by their own base when they try.