# Why this latest healthcare vote? **URL:** \ **Category:** Great Debates\ **Created:** [July 25, 2017, 11:55pm UTC](https://boards.straightdope.com/t/why-this-latest-healthcare-vote/792120 "2017-07-25T23:55:21Z")\ **Posts on this page:** 15\ **Page:** 2
**Author:** ![asahi](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/asahi/32/8693_2.png) [@asahi](https://boards.straightdope.com/u/asahi)\ **Post date:** [July 28, 2017, 1:01pm UTC](https://boards.straightdope.com/t/why-this-latest-healthcare-vote/792120/21 "2017-07-28T13:01:20Z")
> [@Broomstick](#): > > No. > > Much to my heart-felt regret and despair, we have not reached that level of desperation yet. Because we’re that stupid and cruel. I sense that there’s a rethink of this issue - mostly among generational and socioeconomic lines but it’s happening. I think a solid majority of people have no problem with a federal role in expanding healthcare, contrary to republican ideology. What they lack, however, is the confidence that the government - congress and the president - can ever work together to get that done. The real problem on this issue isn’t the attitudes of American voters - they’re open to changes. Unfortunately, though, we’ve been voting the wrong people into office and once there, these “representatives” are making sure they do everything they can to take that power away from people to decide. We’re living in a society that is not only plutocratic economically but also politically. And it’s only going to get worse. The republicans know that their ideas appeal to a limited number of people, which is fine because their constituency, the top 1-5% of the population, controls a significant proportion of wealth and economic activity in this society. Their solution, thus, is to gerrymander, take progressive voters off of the rolls, intimidate those who try to vote, and everything else under the sun. Ours is a system in which grassroots increasingly requires one hell of a lot of effort to effect change. ---
**Author:** ![RickJay](https://avatars.discourse-cdn.com/v4/letter/r/bb73d2/32.png) [@RickJay](https://boards.straightdope.com/u/RickJay)\ **Post date:** [July 28, 2017, 1:40pm UTC](https://boards.straightdope.com/t/why-this-latest-healthcare-vote/792120/22 "2017-07-28T13:40:13Z")
> [@wadsal](#): > > As an outsider, is the U.S. ready to switch to some type of centralised health system funded by an income tax levy… say 2%? There would, in all likelihood, not even be a need to raise income taxes. Americans spend as many tax dollars on government run or insured health care as anyone in the industrialized world. The reason the USA doesn’t get universal coverage from it is that the money is spent very stupidly. ---
**Author:** ![scr4](https://avatars.discourse-cdn.com/v4/letter/s/59ef9b/32.png) [@scr4](https://boards.straightdope.com/u/scr4)\ **Post date:** [July 28, 2017, 1:46pm UTC](https://boards.straightdope.com/t/why-this-latest-healthcare-vote/792120/23 "2017-07-28T13:46:47Z")
> [@wadsal](#): > > As an outsider, is the U.S. ready to switch to some type of centralised health system funded by an income tax levy… say 2%? 2% increase in income tax would bring in about $300 billion a year. That’s about $1000 per year per capita. US health care spending is more like [$10,000 per year](http://www.pbs.org/newshour/rundown/new-peak-us-health-care-spending-10345-per-person/). The government already pays for about half of that (Medicare and Medicaid), but it would take a ~10% increase in income tax to cover the rest. Of course, this may still be a net saving for a lot of people, because they’d be paying this extra 10% tax _instead_ of their current insurance premiums. And income tax can be made progressive, so that the burden on the poor are much less. Still, this requires a significant change that would never happen in the US unless a _massive_ change happens in the power balance between the 2 parties _and_ a massive change in public sentiment. (I think outsiders just don’t understand how much some Americans distrust their own government.) ---
**Author:** ![scr4](https://avatars.discourse-cdn.com/v4/letter/s/59ef9b/32.png) [@scr4](https://boards.straightdope.com/u/scr4)\ **Post date:** [July 28, 2017, 2:44pm UTC](https://boards.straightdope.com/t/why-this-latest-healthcare-vote/792120/24 "2017-07-28T14:44:37Z")
> [@RickJay](#): > > There would, in all likelihood, not even be a need to raise income taxes. Americans spend as many tax dollars on government run or insured health care as anyone in the industrialized world. The reason the USA doesn’t get universal coverage from it is that the money is spent very stupidly. That’s a good point. The US government already pays half of the health care cost of Americans. The UK manages to provide health care for _all_ their people for roughly the same per-capita cost. So why is the US health care system so uniquely expensive? ---
**Author:** ![asahi](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/asahi/32/8693_2.png) [@asahi](https://boards.straightdope.com/u/asahi)\ **Post date:** [July 28, 2017, 4:35pm UTC](https://boards.straightdope.com/t/why-this-latest-healthcare-vote/792120/25 "2017-07-28T16:35:30Z")
> [@scr4](#): > > That’s a good point. The US government already pays half of the health care cost of Americans. The UK manages to provide health care for _all_ their people for roughly the same per-capita cost. > > So why is the US health care system so uniquely expensive? It’s inadequate, mishmash public/private system of coverage encourages people to wait for medical disasters. Socioeconomic inequality more generally probably factors as well. ---
**Author:** ![septimus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/septimus/32/410_2.png) [@septimus](https://boards.straightdope.com/u/septimus)\ **Post date:** [July 28, 2017, 4:51pm UTC](https://boards.straightdope.com/t/why-this-latest-healthcare-vote/792120/26 "2017-07-28T16:51:33Z")
> [@Broomstick](#): > > No. > > Much to my heart-felt regret and despair, we have not reached that level of desperation yet. Because we’re that stupid and cruel. Improved health care availability was a main accomplishment of the Obama Administration and it will be very sad to see this progress reversed. But at this point in the overall unfolding tragedy, this might be almost the least of our worries. ---
**Author:** ![Johnny\_Ace](https://avatars.discourse-cdn.com/v4/letter/j/6bbea6/32.png) [@Johnny\_Ace](https://boards.straightdope.com/u/Johnny_Ace)\ **Post date:** [July 28, 2017, 5:20pm UTC](https://boards.straightdope.com/t/why-this-latest-healthcare-vote/792120/27 "2017-07-28T17:20:30Z")
> [@scr4](#): > > So why is the US health care system so uniquely expensive? Quite simply, free-market capitalism. Too many businesses have too much invested in maintaining the status quo…Big Pharma, the insurance industry, the hospital/health care industry, ancillary service companies, middlemen…the list goes on and on. All in the name of profit. And they own enough politicians to do so. ---
**Author:** ![Euphonious\_Polemic](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/euphonious_polemic/32/3002_2.png) [@Euphonious\_Polemic](https://boards.straightdope.com/u/Euphonious_Polemic)\ **Post date:** [July 28, 2017, 6:00pm UTC](https://boards.straightdope.com/t/why-this-latest-healthcare-vote/792120/28 "2017-07-28T18:00:31Z")
> [@asahi](#): > > It’s inadequate, mishmash public/private system of coverage encourages people to wait for medical disasters. Socioeconomic inequality more generally probably factors as well. Costs of administration for multiple insurance companies. Costs of advertising/competition. Profit is taken out and paid to shareholders. CEO’s are taking an increasingly larger cut.\* Basically, there are a lot more costs that are unrelated to the actual delivery of healthcare, that countries with single-payer simply don’t have. - for example, the CEO of my local health authority makes just over $400,000 CDN (320K US). This is to lead a health authority serving over 750,000 patients, spread out over 35,000 km2, with almost 20,000 employees, 1500 acute care beds, 6500 residential care beds, and a budget of over $2 billion. ---
**Author:** ![Anny\_Middon](https://avatars.discourse-cdn.com/v4/letter/a/bc79bd/32.png) [@Anny\_Middon](https://boards.straightdope.com/u/Anny_Middon)\ **Post date:** [July 28, 2017, 6:23pm UTC](https://boards.straightdope.com/t/why-this-latest-healthcare-vote/792120/29 "2017-07-28T18:23:21Z")
> [@scr4](#): > > 2% increase in income tax would bring in about $300 billion a year. That’s about $1000 per year per capita. US health care spending is more like [$10,000 per year](http://www.pbs.org/newshour/rundown/new-peak-us-health-care-spending-10345-per-person/). The government already pays for about half of that (Medicare and Medicaid), but it would take a ~10% increase in income tax to cover the rest. > > Of course, this may still be a net saving for a lot of people, because they’d be paying this extra 10% tax _instead_ of their current insurance premiums. And income tax can be made progressive, so that the burden on the poor are much less. Still, this requires a significant change that would never happen in the US unless a _massive_ change happens in the power balance between the 2 parties _and_ a massive change in public sentiment. (I think outsiders just don’t understand how much some Americans distrust their own government.) I’m curious – does your estimation of current government expenditures for health care only include direct outlays for Medicare and Medicaid, or does it include lost revenue from the tax deductibility of employer-sponsored insurance? According to [this article](https://www.bloomberg.com/view/articles/2017-07-26/those-pointless-upper-middle-class-entitlements) this is costing us about $165 billion per year. If my math is right, that’s about 5.5% of total health care expenditures. ---
**Author:** ![elfkin477](https://avatars.discourse-cdn.com/v4/letter/e/a9a28c/32.png) [@elfkin477](https://boards.straightdope.com/u/elfkin477)\ **Post date:** [July 29, 2017, 4:02pm UTC](https://boards.straightdope.com/t/why-this-latest-healthcare-vote/792120/30 "2017-07-29T16:02:57Z")
> [@scr4](#): > > So why is the US health care system so uniquely expensive? Part of it is that Americans subsidize drug costs for a great deal of the rest of the world (like [Europe](http://www.ibtimes.com/how-us-subsidizes-cheap-drugs-europe-2112662) in particular). Our government won’t put any caps on drug costs like many others do, so we end up paying far more than our fair share of R&D costs. We also really like shiny new bio-medical machines and spend quite a bit more on them than other developed nations do. ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [July 29, 2017, 4:16pm UTC](https://boards.straightdope.com/t/why-this-latest-healthcare-vote/792120/31 "2017-07-29T16:16:46Z")
> [@Euphonious\_Polemic](#): > > Costs of administration for multiple insurance companies. Costs of advertising/competition. Profit is taken out and paid to shareholders. CEO’s are taking an increasingly larger cut.\* Basically, there are a lot more costs that are unrelated to the actual delivery of healthcare, that countries with single-payer simply don’t have. > > - for example, the CEO of my local health authority makes just over $400,000 CDN (320K US). This is to lead a health authority serving over 750,000 patients, spread out over 35,000 km2, with almost 20,000 employees, 1500 acute care beds, 6500 residential care beds, and a budget of over $2 billion. And then there’s the billing office that each medical practice needs to have. Several people, dealing with different insurance companies, with different forms, claim numbers and computer interfaces. And then there’s the fight when the insurance company denies the claim, which takes additional salary and time. In single-payer, there’s only one set of forms and claim numbers to deal with, and since single-payer isn’t designed to save money by denying claims, like for-profit insurance companies, denial of service is not a big issue. ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [July 30, 2017, 4:23pm UTC](https://boards.straightdope.com/t/why-this-latest-healthcare-vote/792120/32 "2017-07-30T16:23:20Z")
> [@wadsal](#): > > As an outsider, is the U.S. ready to switch to some type of centralised health system funded by an income tax levy… say 2%? It doesn’t have to be centralised. That’s one of the big bugaboos that I’ve noticed whenever the topic of UHC comes up in the American discussion: a distrust of the federal government’s ability to manage healthcare. But you can have a healthcare system that takes relies on the strengths of federalism: the federal government provides the basic ground rules for the system and also funding to those states that opt in, but leaves it to the states to administer the UHC. That’s the federalism model of UHC we have in Canada. We don’t have a centralised health system; we have thirteen different systems, one in each state and territory. The federal Parliament sets the basic rules for how the system operates (universality, portability, etc) and provides block funding to each province and territory that operates its medicare system in accordance with those rules (which is all of them). But the hospitals are under provincial regulation, doctors are independent contractors in their own private clinics, under provincial regulation, and so on. It’s a system that takes advantage of the strengths of federalism: the federal government provides the broad strokes to ensure a national level of UHC and provides funding, but does not attempt to regulate doctors or hospitals. The provinces do, based on local needs and priorities. And in particular, doctors are not government employees, which seems to be another bugbear in the US. They’re private contractors, who run their own clinics, and then put in their bills for services they provide to individuals. ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [July 30, 2017, 4:24pm UTC](https://boards.straightdope.com/t/why-this-latest-healthcare-vote/792120/33 "2017-07-30T16:24:58Z")
By the way, welcome to the Straight Dope, **wadsal**! There’s lots of interesting discussions and interesting people posting here (plus a few dipsticks; it’s in the mission statement 🙂 ). Hope you stick around and find it a fun place to hang out. ---
**Author:** ![Johnny\_Ace](https://avatars.discourse-cdn.com/v4/letter/j/6bbea6/32.png) [@Johnny\_Ace](https://boards.straightdope.com/u/Johnny_Ace)\ **Post date:** [July 30, 2017, 5:10pm UTC](https://boards.straightdope.com/t/why-this-latest-healthcare-vote/792120/34 "2017-07-30T17:10:52Z")
Not satisfied to quit while he’s behind without digging an even deeper hole, Trump’s latest ten-ton weight is threatening to cut off funding for Congressmen’s health care and subsidies for insurance companies unless Murkowski, Collins, and/or McCain give him what he wants. He clearly doesn’t see the difference between ‘letting the ACA die’ (which it’s not clear would happen anyway) and actively killing it. For Congress controlling the purse strings, Trump sure seems to make a lot of funding threats. ---
**Author:** ![TimeWinder](https://avatars.discourse-cdn.com/v4/letter/t/bcef8e/32.png) [@TimeWinder](https://boards.straightdope.com/u/TimeWinder)\ **Post date:** [July 30, 2017, 5:16pm UTC](https://boards.straightdope.com/t/why-this-latest-healthcare-vote/792120/35 "2017-07-30T17:16:06Z")
> [@Johnny\_Ace](#): > > For Congress controlling the purse strings, Trump sure seems to make a lot of funding threats. So far as I can tell, Trump has literally no idea what the powers and limits of the Presidency are. He seems to think it’s some sort of elected dictator. [Previous page](https://boards.straightdope.com/t/why-this-latest-healthcare-vote/792120.md?page=1)