I forget where I read it recently - they said the 3 largest lobbies in the US are health/medical, defense, energy. According to this article, which do you think spends the most?
Healthcare - more than the other 2 combined. IMO, there’s a good part of the answer - whether you want to call that monied interests, failure of democracy, or what.
Look at who is making the money in healthcare - it ain’t the doctors and nurses. Truly a sorry situation.
It is the OP that is making comparisons, I’m just asking if it is a fair comparison. Is there a specific reason to assume the health care industry isn’t effected by economies of scale? Now if we want to bring the Japanese system into this discussion, we’ll have something of an intermediate between the USA and France. As far as I can tell, the quality of care is about equal for those with insurance, and the ACA has brought an equivalent percentage of the respective populations under this condition. So if the OP says the USA system is a cluster-fuck, then that means the Japanese system is a cluster-fuck as well?
The only difference is cost.
Then we’re comparing non-profit companies with for-profit companies and I’m not sure that’s completely fair. I think you’re misunderstanding all the words you’ve added to my statements.
To be clear, my own opinion of the USA health care system is that I refuse to participate in any way, shape or form. It’s just not that expense to buy a round trip airline ticket to France
If single-payer in the US will make health care costs go down like it works in Canada, why didn’t implementing multi-payer in the US make health care costs go down like it works in Germany?
The best we can hope for is that health care costs will only increase as fast as they are doing in the rest of the industrialized world, because the factors that are increasing costs are the same in the US as everywhere else. The US is starting from a higher baseline of spending, therefore costs will always be more.
Regards,
Shodan
Pardon my hijack here but, as a Canadian, I sort of agree with this. Ours isn’t great but it’s not terrible either and I would certainly rather have what we have than what the US has. Ours isn’t as wonderful and magical as some people might suggest; I find it odd that some arbitrary (to me) decisions were made when it was being designed back in the '50s or early '60s. For example, why isn’t dental health not considered part of healthcare. Why aren’t prescription drugs (out of hospital) not. For those items, and a smattering of others, you had better be fortunate enough to have good benefits packages.
I think one problem in Canada is that, whereas “socialism” appears to be a dirty word in the US, wrt health care, privately funded health care is a dirty word to many Canadians. It is an interesting conundrum.
Personally I think it is due to a couple reasons. One is that the US has a very anti-statist mentality which makes it hard for the state to get involved to address issues in our health system. You constantly hear people complain about how all our problems are due to too much government interference. The problem is that the private market is unable to drive down medical costs. If it were we wouldn’t be in this mess.
Also we are a very race and class conscious society. Any attempt to improve things like health care is immediately portrayed as taking resources away from middle class and working class whites and giving those resources to non-whites and the poor. That makes it very hard.
The reality though is that even. College educated whites who plan their lives still get ground up in the gears of our health system. Twenty years ago when only the poor and non-whites got screwed we didn’t care, but now almost everyone who doesn’t make six figures can lose everything if they get sick. I think that will result in some changes to the system, at least I’d hope. We can’t keep our system indefinitely. Basically, people like a government run welfare program, so they have to convince themselves that it isn’t welfare and that it isn’t government runm
Fwiw here in the US Medicare is our version of Canadas Medicare but it only applies to those 65+ or with end. Stage renal disease. Medicare is a well respected program, so people like the ones above have had to create a narrative to rectify it with their beliefs. They either claim Medicare isn’t a government program (it is) or they claim they paid more into it than they took out (not true unless you make paid about 200k in Medicare taxes).
Because the money that was spent bought a wonderful creation, an-all American, anti-socialist, rugged individualistic John Wayne of a healthcare system. It wasn’t just politicians and lobbyists, it was creative advertising - people emotionally invested in a concept wrapped around the American flag a a time when that was really important. You don’t believe in our healthcare - why do you hate America?
Fwiw, my own view is it was only after the internet became widely used that questions started to be asked. Until then, media was neatly tied in to the scam.
So invested were some people during the ASA town hall debates - even uninsured working class people - they pretty much feared socialists over running Washington. See Fox News.
It seemed to be not unrelated to Malboro Man.
Most of that gap is from Medicare, people get about three times more from the program than they pay into it. Social security is largely equal in payouts vs taxes. Ie, almost all of that 244k spending gap comes from Medicare.
What a complete and utter load of horseshit. Good grief. :rolleyes: How about we look at the history which everyone seems to handwave away:
So, TL&DR, our system evolved over something like a century or so with little changes and tweaks to fix issues or problems or perceived deficiencies in the system. It had nothing to do with wrapping flags or the ‘Malboro Man’, and instead had to do with building a system that would work from basically nothing. Our healthcare system is older than some countries at this point and has been ingrained into our society for longer than anyone has been alive by now. It was and is a compromise and patch work system that has worked good enough for the majority. It would be a major change for the US to go another route at this point, which is why, realistically, small but hopefully meaningful changes can or could be made to move us to a better system eventually. It’s unreasonable to think we could or would scrap the entire thing and make a radical shift, even if our European buddies have made what THEY evolved work better…it helps that most of them didn’t start at the same place we did with what we have and also that their governments allowed for fundamental structural changes to be done. Ours doesn’t since no party ever gets enough backing at all levels to do whatever they want and ram through something that fundamental. If we COULD do that sort of thing then Social Security would have been fixed long ago, as well as several other programs that we have that evolved by that have structural issues that could be changed if one party could simply change things by fiat.
Many wealthy nations didn’t develop their uhc systems until the 1970s onwards. So they would have. Much the same history of private insurance groups. I don’t see why that is a barrier. There is no reason we can’t expand public health by allowing buy in options for Medicaid, Medicare or the VA on the exchanges.
You can have a system based on exchanges like the aca. Switzerland and the Netherlands have exchanges to buy private insurance that are much like the aca exchanges. However they spend 8 and 12% respectively of gdp on healthcare vs 18% in the US. The real problem is our health care is brutal, inhumane and costs twice as much as any other nation. Nobody is serious about changing those facts anytime soon sadly.
Thanks XT. Is the insurance-through-employment thing common outside of the US?
No, up_the_junction is correct. As Wesley Clark points out, many universal health care systems are relatively recent and emerged after private insurance systems had become well established, just as they became established in the US. The difference is that the US never successfully dealt with the fact of how God-awful the system is. You’re probably right that the structure of the federal government makes it especially challenging, but there’s a lot more to it than that. Medicare, after all, did get enacted, though there was tremendous ideological opposition to it.
The problem in the modern era is that the health care provider industry wrongly perceives UHC as a threat, while the health insurance industry correctly perceives it as a huge threat to their profitability and even a potential existential threat to their very existence, and both groups have very powerful lobbies, primarily the AMA and AHIP, respectively, AHIP being one of the most powerful lobbies in Washington and a huge source of public FUD and disinformation about UHC and single-payer.
In Canada single-payer did not arise as the kind of fundamental structural change you describe, as it did in the UK. It started as basically a social experiment in the province of Saskatchewan that focused only on hospitalization coverage and grew to provide full universal coverage. Both the AMA and the US health insurers came over and fought tooth and nail against the Saskatchewan initiatives, knowing that its success would set a terrible precedent back home, and propagandizing all manner of doom, death, and destruction (and possibly the end of civilization!) if “socialist health care” was enacted. What actually happened, of course, is that the tremendous success and popularity of that system promoted its adoption by other provinces, and only later did it become structurally established as national policy in the form of federal health transfer payments and the principles of the Canada Health Act. Today the US is faced with an arguably even more conservative AMA and an indisputably much more powerful health insurance lobby in the form of AHIP, and even larger and more powerful health insurance corporations, all of whom jointly – in concert with the insidious and virtually unlimited influence of money in politics – pretty much dictate federal health care policy, and no doubt have the same influence at the state level.
The “anti-statist” mentality in the United States didn’t just grow in the soil. It was created through a very effective campaign of propaganda in the mid-20th century.
Show me an example then of a nation that had a similar history and evolutionary system such as we did and successfully switched to a single payer or UHC type system. You mentioned Canada, but their history is really nothing like ours. Here is the wiki on healthcare in Canada:
So, no…he wasn’t correct and the reason our system is as fucked up as it is has nothing to do with waving flags or iconic cowboys smoking cigarettes…nor, really, does it have anything to do with the modern Republican party. You could make a case it’s STAYED that way because of them, but then what do you expect, since Republicans are conservatives who are almost always opposed to change by definition.
I think that you are talking about a symptom here, not the root cause of why our system is what it is. Those entrenched insurance companies and vested interests came about because of how our system evolved, and I know of no other country that had such a history with their healthcare. Feel free to provide an example of something even vaguely similar that had so long to entrench and because so ubiquitous in another nation such as it has in the US. Canada didn’t ever have anything like what we have today, and their system went from very limited coverage to experiments in something very much like UHC in first one province and then in most…and on a much smaller scale (there were states in the union that had greater populations than Canada did in the '40s).
I know none of you want to admit that the US is different than any other nation, and that it’s all stupidity and Republican stubbornness that has kept us from the promised land of UHC or single payer, but I think it’s more complex than that simplistic outlook and that the real key is the history of where it came from and how we got to where we are today. If there was a quick and easy fix, if we could just do what the Europeans or Canadians or every other civilized nation has done we’d have done it by now. Saying that it’s all the Republicans fault is like saying we COULD build a bridge across the Atlantic connecting the US to Europe if only there wasn’t all that damned water in the way. 
I guess the period of entrenchment we’re talking about is the late 40s and 1950s - reds under the bed, McCarthyism, etc. Fwiw, the British system was adopted after WW2 and the public kicked out Winston Churchill in a landslide (who supported the existing private system) to get UHC.
Obv a lot of countries were remade after WW2.
And what was it prior to that? How did the ‘private system’ actually work? How long had it been in use? I honestly don’t know, and a quick Google search such as what I used to find the history of healthcare in the US and Canada STARTS with NHS and doesn’t go into any details about what came before or for how long.
The US was and is in a different place than post WWII Britain, so, like most (or even all) of the other examples of other nations going from whatever they had before to something like UHC or a single payer system it doesn’t really show a road map in how the US would get there from where WE are, especially considering how our political system works (or doesn’t work) compared to those other nations that adopted it.
That’s not making a real comparison. You described the build up of the American system from the 19th century but hop right in to mid 20th century when the kernel of universal coverage started in Canada. You haven’t shown that their initial conditions in the 19th century were very different. Don’t you think people were dying in factories and on railroads in Canada? Do you assume there were no company doctors before UHC?
Eta: and I’m not denying there were probably distinct differences and I’d like to help out but having trouble finding anything definitive on who paid what back then.
You have to look at where our system forked from their system (and pretty much everyone else system). We incorporated more and more our healthcare with our employment (as we did most everything else…EVERYTHING ties into employment in one way or another, including social security). Canada, like the UK went from the sort of nebulous healthcare we all seemed to have to something like UHC right in the 40’s (just like the UK did…in fact, there is probably some sort of correlation there since Canada is part of the common wealth and has ties to the UK). Sure, in Canada they didn’t do it across the board, but the seeds were planted there and it didn’t take long for all the other provinces to get on board. We in the US didn’t go that route, and now we’ve had 6 decades where the current fucked up system has become more and more entrenched and accepted as the norm.
As for countries that have recently adopted UHC or some sort of single payer system, from what I recall most already had the seeds of such a system in their own history and evolution of healthcare…or they had nothing at all (some sort of nebulous quasi-healthcare system that never worked very well). Like I said, if anyone has an example even vaguely similar to the US since the 40’s I’m certainly willing to look…I’ve never seen anyone give a good example that we could say ‘yeah, they were like us and they did it just 10 years ago!’ or something similar. Canada and the UK (and France and Japan…the only one’s I know kind of well from earlier debates) weren’t anything like the US then or now, nor do or did they have similar political systems that would allow for the adoption of such a system that would be such a departure from what we’ve had for so long.
Actually my feeling is that the difference that matters between the U.S. and other countries is there was a strong public concensus that health care was more right than privelege and a strong central government to implement it. I remember talking with older people years ago who mentioned one of the selling points of UHC was to take the burden off of companies but I guess that dog didn’t hunt amongst American industrialists.