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GnarfGnarf parent
There are three things a nation needs to accept about universal health care:

(1) It’s expensive (2) Everybody has to pay (3) The government’s gotta run it

gosub100
Computers and software used to be extremely expensive about 30 years ago, yet private industry advanced the state of the art and brought the prices down.

There seems to be very little talk about making medical education cheaper and more accessible. Why wouldn't it be cheaper if we had more MDs and nurses? What if we made it easier to become an MD ?

The insurance system is a cartel and they are greedy. However the regulations (upheld by the government) enable it.

aerostable_slug
We've done that to some extent via the legal enablement of nurse practitioner and physician assistant led care. Of course, largely speaking all they do is supervise the recording of patient metrics and prescribe drugs in label-consistent ways, but that often works out reasonably well for the patient. When the patient needs specialty care then the NP or PA simply punts them into the winds of referrals and insurance justifications.

I'm not sure there's any realistic way to enhance the availability of specialists. You can't 'stub' your way through providing the care of a skilled gastroenterologist by substitution with a NP, though PAs in specialty care are becoming common.

gosub100
Why not open more medical schools? And eliminate the matching system? If you want to be an ____-ologist, here is the list of requirements. Meet the requirements and you are the ___ologist. Not whether or not a practice group likes you, or your parents knew which colleague to talk to. Don't allow the supply of MDs to be constrained.
pkaye
The bigger restriction is number of residency positions which has been limited by government funding constraints. Also you need sufficient skilled doctors to train these residents. There is also the issue of physician burnout and preferences of doctors to be specialist vs being in primary care. So what often happens is foreign medical grads apply for these kind of roles. Also foreign medical doctors have a couple of requirements to work in the US. Get their foreign degree reviews to meet requirements, pass the US medical exams and finally they have to redo their residency even if they have significant experience. Some of this is largely controlled at the state level. Some states are considering loosening the residency part to a shorter period for primary care position for foreign doctors that are willing to work in underserved areas. I know California is also reducing restrictions on foreign dentists.
Spooky23
Because your congressman gets lots of donations from doctors and hospitals. Doctors like to drive fancy cars.

In places with Catholics, you usually get the bishops advocating for the local Catholic hospital system.

gosub100
So government (my congressman) IS the problem! Thanks for reinforcing what Reagan said 40 years ago.
wredcoll
Sure, but what these types of people fail to understand is that the only way to solve the problem is also government.

It turns out the real world is a big complicated messy place and there's rarely a simple answer like "delete government!"

Spooky23
Ironically, your guy Reagan was paid and supported by the AMA to fight “socialized medicine” and increasing the number of doctors in the 1960s.
esseph
This cult of personality in American politics is such a curse.
Spooky23
It really is. I’m not a fan of Reagan’s politics, but I respect his point of view.

But the weird deification of him, now displaced by the new guy’s cult of personality is so awful and toxic. He’s either a giant among men or a demon, and both positions are wrong.

gosub100
I think the weirdness is the recent condemnation of him by the far-left. They are shitting on a guy who has been dead for 20 years. It's absolutely bizarre. It seemed to start about 2020 out of the blue.
satyrun
Health care is so different though because the market doesn't work.

If you are facing death, no one wants the off brand, budget cancer treatment. No one is going to shop around for the best value cancer treatment.

If you have a heart attack, no one is going to call around for the best price on the ambulance.

It is like a luxury market. People shop around for the best doctor/treatment with no regard at all for the price.

So it is like complaining that a luxury service market is expensive.

The only way around this is a completely state run health care system that you have no choice.

throwawayqqq11
Without relgulation, the profit seekers would remain in power and the same applies to more medical staff.

The insurance system is a profit seeking institution, that functions as intended. Why dont you talk about that BURNING aspect?

gosub100
You didn't address a single thing I said
bluGill
Government does not have to run it. Gokernment needs to ensure it is run well but there is no reason they have to run it.
reactordev
Oversight doesn’t work, look at the finance markets.
bluGill
works very well there - don't confuse imperfection for not working.
vjvjvjvjghv
It works in other countries
gruez
>The government’s gotta run it

But there are plenty of countries with functioning healthcare systems that are private? The Swiss, for instance. Moreover depending on what counts as "government’s gotta run it" (paying for it? administering it? actually providing care?) you can argue that the German or even Canadian systems aren't government run, at least to some degree.

mike_d
In the Swiss system the private insurance companies are required to be non-profits. The government sets the standard for care and coverage and all the companies can do is compete on price.

Basically what Obamacare was originally intended to be before they had to compromise to get it passed.

k4shm0n3y
Who were they compromising with? The Congress had large Democrat majorities in both houses during the ACA legislative process.
votepaunchy
The 60th vote was Ted Kennedy who died in office and a Republican was elected to fill the seat, forcing passage of an earlier bill.

https://en.m.wikipedia.org/wiki/2010_United_States_Senate_sp...

zacherates
They were trying to get Republican votes so that the law would be bipartisan. In the end it passed on a party line vote, so maybe the compromises were a mistake...
SpicyLemonZest
The parties weren't yet ideologically sorted. The Democratic majority included dozens of members of the Blue Dog coalition, a conservative group who (among other things) didn't support healthcare reform.
Alive-in-2025
Also the us Congress is blocked by the senate needing 60 votes/supporters to reach cloture on every single bill, except the once per year thing that got the bbb passed. So it's very easy to block the other side. https://en.wikipedia.org/wiki/Reconciliation_(United_States_...
phatfish
All the Democrats bought by the private health insurance companies I assume.
vjvjvjvjghv
Democrat senators Lieberman and Baucus mainly torpedoed it. And Pelosi refused to get republicans on board.
vondur
I've heard good things about the Dutch system of healthcare and that it may be adoptable to the US. I'd totally agree that healthcare corporations become non profit like Kaiser here in the US. They aren't perfect, but they seem to be better than the their for profit competitors.
nothrabannosir
Dutch system and original Romney care (and early versions of Obama care) had a lot in common. Health care providers are private, insurance companies private, gov dictates a basic list of treatments which count as "basic care" and must be covered by insurance, sets max deductible / copay etc, insurance companies are not allowed to refuse any customers, everyone must have insurance, if you can't afford it gov will pay for your insurance.

Afaik that's the gist of it. The ACA has been maimed on various fronts (e.g. the mandate "everyone must have health insurance" is no longer practically in effect), but it originally started out very similar. Far more than to, e.g., the UK's NHS which is fundamentally quite different.

olddustytrail
So why don't we see Republican Americans advocating to adopt the Swiss system which provides universal coverage at a lower per capita cost?
dayjah
If you only ever look at the way a system works at a specific point in time you only observe it at that point in time.

America has had multiple attempts at solutions for healthcare over the years, each started with good intent and then waylaid by various causes to produce what we have right now.

A sibling comment mentions political compromise to pass the ACA, as an example of this.

Another example is that HMOs were started with inherent goodness, but got “corrupted” (in my mind) by profit seeking.

To directly answer your question: a core tenet of the Republican tent is minimal government involvement in day to day lives of the citizenry. Ergo, the Swiss system won’t work because it involves a lot of bureaucracy. Republicans link bureaucracy to cost, and feel this is not an appropriate use of tax payers dollars.

The holes in this political doctrine are not part of my answer here fwiw. Please no “but…” comments to that end :)

fnordpiglet
To be fair the tenet is minimal involvement in the day to day operations of the economy and maximal involvement in the day to day lives of the citizenry.
dayjah
I do find the ironies in political platforms quite beautiful. I also love how they provides endless fodder for largely fruitless internet discussion ^_^
MontgomeryPy
In speaking with my republican father in law on his opposition to universal healthcare, it dawned on me that he views it as a sort of zero sum game. If he has healthcare today, and then universal healthcare offers it to folks that don't have it today, it is a loss for him.
wredcoll
Something I've run into in similar situations is the "moral necessity of punishment", sort of a reverse just-world fallacy.

"There are people not good enough for health care and helping them would violate this natural order".

kasey_junk
It’s absolutely the case that public health coverage will benefit some people who make bad health decisions at the cost to some of those who make good decisions (or the decisions themselves must be made by a central authority).

That doesn’t make it the wrong policy decision. Lots of systems we happily manage with similar dynamics. But I don’t think denying that basic fact is the right path forward. The moral hazard is real and worth acknowledging.

3 More Comments →
fnordpiglet
This is going to be the ultimate issue if we do achieve some sort of post scarcity world where human labor is redundant. The idea that it’s not someone’s fault their indenture is unnecessary let alone a moral failing deserving of punishment is foreign to a lot of American thinking. The puritanical labor is godly mentality combined with the long term warping of anti Soviet propaganda is going to lead to some serious wide spread suffering that would take what should be the greatest achievement of man kind and turn it into a scourge.
Spooky23
Obamacare was a replica of Romneycare, which was implemented in Massachusetts. It was the republican approach of leveraging private enterprise and encouraging consolidated medical networks.

The difference now is the republicans have changed, and nuanced issues are just not welcome on the platform of a party following a cult of personality.

daveguy
They were advocating for it before Obama tried to get it done. It was implemented in Massachusetts and termed "Romneycare" as Mitt Romney was the governor. Once Obama tried to implement it, it was government overreach and had to be watered down to get consensus. Personally I think we should have a govt option along side others, but all healthcare should be nonprofit (as in the Swiss model). Profit extraction is antithetical to healthcare.
Loughla
Because it's any amount of government spending for one. And for two (this one is more of my opinion than the last one) the US has a problem where we, as a culture, view poor people as somehow morally or ethically broken, which is what causes them to be poor. Therefore, we shouldn't spend money that could positively impact them, regardless of its overall benefit. I got mine, so anyone can, but as the cultural zeitgeist.
vjvjvjvjghv
Almost nobody in US politics who talks about something doesn't understand it or thinks it through. That's for people on the left and and on the right. They just repeat talking points that are given to them by wealthy party donors.
LocalH
Because Republican Americans tend to overwhelmingly think "government bad, private business good". Even the "small-c conservatives".
vjvjvjvjghv
Although they think government is good at controlling their version of morality.
vjvjvjvjghv
(1) is not correct. The US spends more than other nation per capita on health care

(3) isn't correct either. It needs to be regulated in some way. Government doesn't have to run it. I think it should be treated more like a utility

byryan
Your first point doesn't mean that universal health care in the US would not be expensive. It definitely would, not that the USG couldn't afford it, but it wouldn't be cheap.

Agree with your second point.

bradleyjg
It’s not a matter of acceptance. We can’t accept the cost of anything consistently growing at a rate faster than GDP. That’s just math, not ethics or political choice theory or anything else. Health care cost growth is going to slow one way or the another.
reactordev
Watch what happens to the GDP if they don’t tackle the health care problem. You think it’s expensive now? Negotiating drug prices isn’t going to solve the problem. Having “health insurance” isn’t going to work when an AI decides whether your illness warrants saving you.

You all need to think about what’s going to happen to you when you can’t move anymore. Will you have enough money? Triple it. Maybe 6x it. Only the rich will be able to live healthy unless you’re diligent about your own health or strike it rich in an IPO.

toomuchtodo
But growth is also going to slow due to demographics, and this is unavoidable. Are we going to prioritize caring for humans? Or line goes up? Because line goes up is going to hit the demographic wall eventually.

https://www.mckinsey.com/mgi/our-research/dependency-and-dep...

https://www.cato.org/cato-journal/spring/summer-2018/demogra...

https://www.cato.org/commentary/clear-eyed-look-our-demograp...

https://www.sas.upenn.edu/~jesusfv/Slides_London.pdf

fnordpiglet
It has more to do with demand than being anything. Demand for healthcare is highly inelastic. If the price of Pokémon’s grew faster than GDP consistently we would be fine. But if the price of a necessity for life does, we will not be fine.

This is why life necessities are often treated as a public responsibility. Health care is one of the few that is treated as a luxury.

wredcoll
What part of the cost of healthcare involves providing profits for middlemen?
cowcity
Americans are perfectly conditioned to instinctively and aggressively deny all three. :(
dayjah
Hey now. America is a broad spectrum of people — some of us are heretical and believe governments have a role in everyday life, some of us believe the opposite.
cowcity
Nitpick all you want, but what I said is exactly right and you probably know that.
tiahura
This isn’t about health care. Please read the article.
i80and
Elder care and memory care are under the umbrella of healthcare.

That they're nonsensically broken out as a separate insurance category is intrinsically linked to the problems the article describes

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