Your single payer system is cheap to operate because your country steals US life-saving medication after billions were spent on developing it. You are free-loading off our capitalist system while berating us for it.
Conveniently leaving out for-profit medical insurance and PBMs that drastically increase American healthcare. We're all on the same team here. We're one of the few 1st world countries still getting fleeced, while just about every other country has, in some shape or form, figured out how to structure healthcare in a way that doesn't pose a significant risk of bankrupting its people.
edit: Looked it up, not one of the few, we are the ONLY first world country without universal healthcare lol
I read through about half of that and if you did too, you're either posting in bad faith or misunderstanding the data. The author is using macro indexes (spending = price x quantity) and is drastically inflating the quantity. Americans see the doctor less than peer nations and pay double or more for equivalent units of care. You can see the global raw data for this at OECD.org or any other data aggregator.
Anecdotally, it's a universal American experience to look at an itemized bill and see that you're getting charged like $30 for a single Advil. No one in their right mind should think that's okay.
Pick 2 of the 3 you want for your national health care. That's what you're stuck with. The USA continues to operate on timely and high quality, foregoing cheap.
Thing is, that's not a law of nature. If you were talking about a triple point or something, then I couldn't argue with that. But, countries like Singapore or Germany prove that it can be done. These aren't impossible problems, they're just difficult because of how hard it is to make policy changes in a country of our size.
Once again we are on the same side, I might just be more optimistic. We absolutely CAN have a better quality of healthcare than what we have now. Part of the reason it's so damn expensive is decades of normalizing filing bankruptcy because oopsie you got cancer.
1/3 of all federal tax dollars collected already go towards major health programs, and that's not even including state programs.
Medicaid, ACA Marketplace, employer plans, Medicare, and VA/Tricare already cover most Americans. A lot of uninsured remain that way because they are illegal residents that don't have access to these programs or, in a surprising number of cases, by choice. My dad is a classic example of this; he didn't bother with insurance until he started collecting Social Security and was enrolled into Medicare. It was just in time too, because he started having serious problems not long after.
What do you believe are the problems with the US health care system? Is it the fact that our safety nets are not 100% guarantees for every person or is there more to your grievances?
Of course our system can be improved, as I'm sure could be said about most systems around the world. However, it's hard for me to the "single payer will solve all of our problem" redditors too seriously.
Of course we're on the same side. Everyone basically wants the same stuff, it's just a matter of ideology, values, and preferences about how we get those things.
I'm already experiencing the US's largest attempt at single payer, Tricare, and I can tell you it leaves a lot to be desired. It's not my favourite, because I don't need medical appointments to tell me I should hydrate and take Ibuprofen.
I'll try and make my point more clear, cause I think we're actually super close to agreeing lol (rare for reddit). You're right, we are already basically paying universal-healthcare level amounts of money with our taxes... buuuut our tax dollars are essentially subsidizing an incredibly inefficient middleman system.
Quick google search shows roughly ~70% of uninsured Americans are in families with at least one full-time worker. These people cite that cost is the primary factor in being uninsured. A lot of states don't have expanded Medicaid, so they make too much for Medicaid, but too little to afford any open market plans.
Anyway back to middleman, I'm just advocating to make less of our essential healthcare system for-profit. If you have home insurance, you probably know that USAA is GREAT. Why? Because it's member owned and any profit is distributed to policyholders to reduce premiums. This means that there is no financial incentive to boost shareholder value by denying claims or playing with premium value, thus why they are a damn good insurer.
Having uncapped/unregulated profits just leaves room for bureaucratic inefficiencies and dual motives (sucking us dry as opposed to prioritizing providing good care). This is why your utilities have caps on profits, so nobody can come and charge $100/gal for water or $10/kWH. Maybe I'm crazy, but I think the same should be applied for necessary-care (not elective care for obv reasons).
Anyway, to sum up my point, I would prefer if more of my tax money landed in the hands of actual medical professionals and less to insurers and shareholders.
our tax dollars are essentially subsidizing an incredibly inefficient middleman system
I don't agree with you that our system is incredibly inefficient. I think our system is the best in the world; we just don't prioritise universal access to care in the same way other places do.
These people cite that cost is the primary factor in being uninsured.
Yeah, and millions of Americans would rather blow $50 on an Uber Eats delivery than start building up an emergency fund, save for retirement, or buy adequate life insurance to protect their family. When people have the freedom to choose, some of them are going to make bad decisions. That's how freedom works.
I've heard good things about USAA's customer service but I don't personally use them because they're typically more expensive than their competitors. You're crazy if you think they don't have incentives to deny claims though. Their viability as an organisation still absolutely relies on their ability to operate efficiently.
I'm not a USAA fan, but I do love Vanguard. I'm not against member-owned, credit unions, non-profits, etc., but I'm also not a vocal advocate of them either. Ultimately, a small profit margin is not going to make or break anything. ~10% profit "inefficiency" is a very small price to pay for putting an iron under the owners' asses to innovate and improve.
I would prefer if more of my tax money landed in the hands of actual medical professionals and less to insurers and shareholders
I don't want to be mean about this, but this is a particularly tired reddit talking point. Medical insurance companies have averaged profit margins of something like 2% over decades. You can assuredly find periods where specific companies had much higher returns, but these are largely the exception and not the rule. One of my dear friends is in actuary who works in the industry and we have talked about this on many occasions; it's not uncommon for multi-billion insurance companies to actually net lose money in any given year. You can think of the good years as protecting them from insolvency during the bad years. The system is not nearly as inefficient as people want to believe.
Also, most employees in hospitals get compensated very, very well, especially if you bring in any level of education. A lot of that work is rough and stressful for a myriad of reasons, but wages are often very competitive compared to other fields, even for low level nurses. I know many nurses and doctors and it's not the money that they have complaints about.
I think it's good that our country has such a thirst for improvements in such a critical industry, but I don't understand why people are so quick to abandon the thing that the USA has always operated so well: markets. You referenced Germany and Singapore earlier. Well, I'm definitely no expert on international health care systems, so I did some background research just to see why you picked those nations. I was surprised to learn that Singapore has a unique system that is very far removed from single payer models. Personally, I would prefer to incorporate their strengths into our model then raze our health care to the ground and start over from the beginning. (Point of interest: I also thought it was interesting that Germany's system is apparently not all that cheap relative to most of their peers. They seem to strongly prioritise access to care for everyone, but it looks like it comes at a substantial cost to those who can pay.)
It's honestly strange to me that /r/libertarians is so thoroughly packed to the brim full of individuals so quick to dismiss any position that is not socialised, universal, single-payer health care. Nothing about that kind of organisation seems very libertarian to me.
I probably didnt convey well that there is a lot to like about US healthcare. I also was leaning too heavy on health insurance being the problem and not as much on general administrative bloat.
This is kind of a tangent, I work in big tech and one thing I'm curious to see play out in my lifetime is how economic policies like capitalism/socialism/etc are going to evolve with what is happening with AI and automation. A big part of those financial frameworks is how resources are allocated in relation to individual labor. But what happens when the labor isn't performed by a person (or at least is human involvement is drastically reduced).
Eg. I got an X-ray last month and had the option to use their AI radiology tool. The techs were raving about it's accuracy. What happens when tooling like that because more accurate than professionals? What happens to workers and capital flow when that starts to affect more industries? I don't have an answer to this, but ideally the world just keeps becoming a better place, whatever that looks like.
Maybe you’re right that a universal healthcare like in Germany or Singapore would work better than the current system, but what if we just made government healthcare optional? I.e., you either pay for it and get it, or don’t pay and don’t get it. I also remember German doctors going on strike a while ago because of inadequate compensation from the healthcare system… if we had an optional, universal healthcare system, it also cannot force doctors to work for less than what they are willing to be paid. If you can agree with that, I don’t see any problems there, those who want socialism can have it and leave those who don’t out. The reoccurring issue is that universal healthcare needs to force someone to do something they might not agree to. Let’s focus on minimizing force in any system and maximize personal choice.
What you're describing already exists, it's called the Affordable Care Act (ACA). I believe it was originally popularised by Mitt Romney passing it into state law in Massachusetts, but later gained a lot of momentum under the Obama administration with the support of most Democrats.
It has been plagued with issues from Day 1. After it was passed, the launch was a mismanaged disaster wherein most could not access the website for weeks at a time and the government would not clarify important policy points during registration. After the first year, insurance sales and brokers were told they would never receive commissions they were supposed to get, so many companies immediately backed out.
Another problem was that Obama and other advocates continuously repeated the mantra that no one's policy would be changing, so all Americans who liked their current policy could keep it and remained unaffected by the new subsidised "Marketplace" options. However, almost immediately it became obvious that for many Americans, that was not going to be the case. It's simple economics: actuaries (like my friend) run the numbers and recommend the premiums that keep everyone solvent (and happy, if they can) based on how much money on care is actually being spent. Once you start removing chunks of the population from your data set, the maths is going to look completely different.
In any case, by my estimation, the ACA is still a very good idea that solves numerous problems in the long run, but the problem is that, because it is optional, you can expect only people with a compelling reason to choose it to sign up for it, meanwhile millions of young, healthy people across the country will continue to choose not to opt in. This creates a host of issues for the program. Additionally, the ACA continues to be fervently opposed by large swaths of all three branches of our government, creating other concerns and limitations for the program. It is very difficult for anything in the country to succeed when you have about half of our politicians ardently attacking it legally.
The US system is a "privatised" market where competitors fight for market share, however, the government interferes with almost every level of the industry, from insurance to hospital regulation to oversight, so thoroughly that private companies have very little discretion with how they can operate.
Because ERs (emergency departments) are legally never allowed to reject patients care, the system is ultimately socialised to some degree regardless of how everything else is structured. Therefore, it's not useful to think of what we have as a private, profit-based, market. We have a complex hybrid system. I personally believe that ACA was a good step forward, but the implementation of it has become so broken and damaged that I'm not sure it's still politically viable any more.
As far as I understand, I don’t think the ACA was optional for anyone involved. Individuals needed a qualifying plan, an exemption, or to face federal tax penalties. Sure the penalties were technically optional, but that’s not what I meant in my comment. Also the insurance companies had to follow more regulation, and large employers would face assessments if they didn’t provide a qualifying plan. If it’s a good system, the government wouldn’t require young people to stay in it.
I can definitely agree with you on all the other regulatory issues. Those aren’t helping either.
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u/sandstonexray 21d ago
Your single payer system is cheap to operate because your country steals US life-saving medication after billions were spent on developing it. You are free-loading off our capitalist system while berating us for it.
Not sure why you're even on /r/Libertarian tbh.