Universal healthcare is supported by something like 60 or 70% of Americans. Don’t be fooled by those trying to make it into a party issue.
Agreed, it’s crazy. Making healthcare contingent on employment is barbaric but aligned with other practices (like W2 tax withholding) where the government effectively deputizes your employer to enforce the civic contract.
I would support universal healthcare if I think the government is actually capable of reigning in the avg healthcare costs of an American.
I’d bet the $800/mo eyedrops this poor lady is relying on don’t cost that much in any other country (and I don’t mean poor countries - I mean in other rich countries like Japan, Singapore or Australia). So when she switches to Medicare as soon as she turns 65, how much are the US taxpayers paying for these eyedrops? It’s just wealth transfer from US taxpayers to the US medical industry complex.
So I fear “Medicare for All” would simply mean we pay even more taxes than we already do now and the US government will keep spending insane amounts of money on healthcare as compared to every other developed nation in the world with no better outcomes.
I think there is credible research that US drug costs are primarily the result of a fragmented market and lack of collective bargaining. So a single buyer regime will by itself lower the prices since manufacturers will be forced to compete among themselves based on price and an objective metric of the therapeutic benefit - as opposed to marketing and the best sales network and "conference" benefits the prescribing physicians.
For example, if the generic option reduces the burden of disease by 10 DALYs and costs essentially ~0$ it will be fully covered, any other patented option with a 15 DALY average benefit will be covered up to a financial ceiling given by the total funding available and the extra 5DALY benefit it brings. A patented option that does not fit that ceiling will require patients to pay from their pocket, therefore cratering sales, therefore strongly incentivizing the pharmaceutical company to lower the price to fit the ceiling.
This is how other advanced countries lower spending on drugs without infringing on intellectual property - by forcing all manufacturers of all drugs for all diseases to compete on price, or risk selling basically nothing in that country until their patents expire. Since the marginal production cost of drugs is close to zero, it' always better to have some sales at some lower prices instead of no sales at a very profitable price.
The question is why haven’t they already done this type of cost control with existing Medicare? People aged 65 and over are incredibly lucrative for Big Pharma and medical industry as a whole because by definition they will incur a lot of medical problems due to their age and need a lot of medication. So it’s a lucrative segment of the market that they can’t afford to lose. So the US govt should be in a great position to negotiate on costs but it doesn’t look like they have done much at all.
I think in a way Americans are actually subsidizing pharmaceuticals for consumers in other countries because pharmaceutical companies are willing to sell the same product for less to them because as you said their marginal production costs are minimal and they have already recuperated a great return on their R&D investment from American consumers.
Both can be true at the same time, the American market can subsidize research for the rest of the world, and one source of this subsidy could be US public programs leaving substantial cash on the table for big pharma.
Another perspective is that this extra spending is more closely correlated with global pharmaceutical profits and the spending by these companies for their US sales and lobby apparatus (which influences Medicare prescribing physicians just as well), and much less with actual fundamental research and clinical study spending required to bring these drugs to market. So it's relatively speaking "wastage" compared to direct medical research spending - perhaps through a global research institution funded by major economies. Hey, we can dream.
As to why would Medicare leave these untold billions on the table, I don't know the details of how they decide what to treat, but it's a very tricky political problem. Once you start to deal with things like DALYs, QALYs and micromorts, you are plowing straight into the "death panels" controversy. So all pharma has to do is refuse to play ball, continue to sell most of their products into the open market, and watch their Madicare centralized buyers quickly fold. You can only force Pharma to play if you institute a national monopsony; a single program, even a big one, can't possibly work since by acquiescing they would threaten profits in the rest of the market. For the same reason, a single US state could not go at it alone, pharma would just refuse to sell to that state at the imposed ceilings; it needs to be a nation wide program.
> The question is why haven’t they already done this type of cost control with existing Medicare
Because drug lobbyists got the law changed to make drug price negotiation illegal. It's called the "noninterference clause". The inflation reduction act allowed some exceptions to this, but I don't expect this to last.
"Medicare for all willing to pay 10% of taxable income" seems like a way to sneak universal healthcare through the political backdoor. It will initially have a funding shortfall due to adverse selection (it will attract primarily people with low incomes, high risks or both) but you would gradually move all public subsidies towards that program and remove all incentives, tax credits and rate protections from those who choose the free market option, and when just a minority still hangs on to the private providers, you make the 10% health tax mandatory to all.
The way I see it, you will never wrestle away the trillion dollar bone from the mouth of the US healthcare industry, but you can make it wither away indirectly by creating a better universal system and dismantling the status quo. It's not like Europeans are forbidden the option of private insurance, it's just that it can't take hold and grow to control a significant part of the spending because everyone can see it's not the solution that will save you when you will get really really sick.
Sounds like a good choice then. 2% for a basic level of care for everyone seems awfully reasonable. We are already paying roughly 1.5% for medicare with most people not being eligible.
Let's look at another country that has "great universal health care". Let's look to Europe, that's always "up there", right?
For statutory or public health insurance, you pay for your insurance through social contributions, the rate of which is 14.6% of the income as determined by the Federal Ministry of Health for 2024.
> There is an income threshold—EUR 5,175 per month or EUR 62,100 (as of 2024), at which the percentage contribution is capped. What this means is that if your income increases, then this percentage remains fixed and doesn’t change with your salary increase.
Germany has a quite progressive tax scheme and the brackets are designed to be complementary, so that as income raises the pension and health benefits are capped while the general income tax grows more aggressively up to a total taxation rate around 45% for high incomes.
This is more than you would pay in the US but it includes both free healthcare for the rest of your life and a livable state pension after 67, and you get those benefits even if worse comes to worst and you suffer an accident, major disability etc. This is powerful social safety net that can't really be compared with what the American federal + state + private insurance offer you in return as benefits for your total tax+healthcare contribution.
If you are self-employed in Germany (i.e. most high earners that earn over 200k) then you pay around 1100-1200EUR/month on health insurance which is more than a family health insurance plan in the US. Moreover, even if you earn only 62000EUR, you pay 1100+EUR/month, which is absolutely ridiculous given other taxes and VAT.
Those incomes are by definition restricted to the top 5% of the general population - of course those top earners prefer not to be enrolled in a socialized medicine plan and prefer market insurance with a nominal price tag that is not proportional to income.
That's the entire point, to establish a social contract where the healthy and successful pay for the healthcare of the less fortunate, can benefit themselves from that social net if their fortune reverse, and deal with the risk they might never be net beneficiaries if they remain healthy and wealthy.
Given the option, high earners would argue that all public spending should be financed by flat nominal taxes, it's not like they personally require more work from the army or the police, or they drive longer distances on public infrastructure.
Does Germany represent the entirety of Europe? The UK, Italy, Denmark, Spain, plenty of others fund their healthcare through general taxes.. why are you focusing on one country?
And to not mis-represent Germany too badly - that 14.6% is split between the employer and employee
You’ll pay 8% of your income (that the French government is allowed to tax, after an additional standard deduction of around $11,000 per person). As a ballpark figure, an individual who has income to declare to the French government of $30,000 will pay around $1,520 a year in healthcare.
However, you are also only reimbursed 70-80% of your costs (depending on what it is), similar to the NA system(s), where your employer health plan may only reimburse a percentage as well but where no 'top-up' exists.
In order to make up the remaining amount in excess of the 70% reimbursement (80% for hospital stays), many French residents opt for private, or “top-up,” insurance. Several options exist, and rates vary from $36 to $72, on average, per month
Between medicare, medicaid, Tricare, chips, etc around half the people in the United States are already on some sort of government supplied medical insurance.
Getting to 60% for for such a deal shouldn't be too hard!
Even in America letting people die is a bridge too far so Reagan came up with a solution: no socialist health-insurance but anyone can walk or crawl into an emergency room and see a doctor.
It is the most expensive and inefficient system but at least it's something.
That something is one of the foundations of the rot we're dealing with today. Hospitals having to absorb those costs as overhead is a large motivation for the dynamic whereby they send fraudulent bills that you then need an "insurance" company to negotiate down for you.
Politicians love such unfunded mandates because they magically assert the problem is solved while not increasing the budget at all. But they create a humongous drain on the economy (those resources come from somewhere), and are ultimately a form of regulatory capture.
I certainly don't want it and nobody I know that actually understands the real cost does either. Every single nation that provides socialized healthcare is hopelessly strained by its cost, and the service has suffered as a result. The system relies on eithe dramatic reductions in the cost of healthcare or a positive birthrate to sustain it.
Nobody I know in socialized healthcare systems has good things to say about it when they actually need it.
The US has the most expensive healthcare costs per capita in the OECD, and the poorest health outcomes on average.
You might think that this is merely because so many people in the US are not covered at all. But even when you account for people who are covered, the results are mixed at best. With the US performing slightly better in some areas, but much worse across the board.
I also know a few people who have moved back from the US, even though they had health insurance, just to receive better socialised medical care in their own countries. I also know of a who went to the US to get cancer treatment. None of that means anything really. The number of people you know and their uninformed attitudes are statistically insignificant.
How much do you pay as a percentage of your salary in taxes? In total of course.
I pay 30% in taxes for federal and state. House is paid off but taxes is about 3% my salary. My insurance is more than I need (I don't use it at all) and cost me less than 2% of my salary.
You can keep your socialized system, we are doing more than alright here mate. I got plenty of friends in Europe, England, Canada, and Australia all complaining about the same thing, wait times for care. I can see my doctor for basically anything inside of a couple weeks.
Having experienced both, and needed both, I certainly have more positive things to say on the socialized version than the privatized version. Does the US system not hopelessly strain people by its cost? Does the US system not require positive rate of insurance payers to sustain it?
I was like you. Then I was left with a surprise $32,000 medical bill that I feel pushed me past my limit. I still haven't recovered my life. My divorce. Missing so much with my kids.
You are OK with peoples lives (500,000 a year) being destroyed in order to 'keep the service good'. And you are OK with the price of good service being over 50% of American bankruptcies being due to medical dept. But who cares if peoples lives are ruined, you have a shorter wait.
When did this country become a country of sociopaths? This isn't working.
I don't know you or give a shit about you. You need to be a man and be accountable for your own life. Why are you expecting others to subsidize your mistakes?
You are weak and your life is the outcome of your own actions. You should have prepare for such a situation if you feared it was possible.
As for all the others, same thing, literally not my problem. You failed your family, why are you blaming the healthcare system.
What is special about healthcare in this regard and where should be draw the line? This argument could be used to justify socializing all kinds of costs, almost anything up to UBI.
I made this argument in a paper I wrote for a college economics class. I had first hand experience with it because I had recently done the math and figured that I would have to stop my flexible contracting job and seek more traditional employment as I was going to lose my parents insurance and the 'open market' option was unaffordable. Ended up being the reason that I dropped out of college.
> Maybe there are millions in America that only keep their jobs for the health benefits rather than starting a 1-2 person business.
I'm not 100% sure about upcoming changes, seems similar from what I can see, but ACA gives an option for this. No job = very low income = you'll qualify for hugely reduced premiums
>I'm not 100% sure about upcoming changes, seems similar from what I can see, but ACA gives an option for this. No job = very low income = you'll qualify for hugely reduced premiums
The premiums are not reduced, at least where I live. What happens is I can deduct those premiums from the taxes paid. But wait, if I have no/little income, I don't pay taxes. And so I get no subsidy.
Medicare is only complicated because private insurance was allowed in. All those extras are killing it too from increased costs.
Medicaid is state run. Some states let private insurance companies run it, some run it themselves. The argument for medicaid for all should also be to bring it all together like medicare.
Hey sorry for the late response. My mother is the medical billing and insurance specialist for a private religious organization. She moves all the nuns from their private insurance to Medicare as they become old enough to qualify.
What I've constantly heard from her is that the standard benefits are enough to cover everything but the private addons advertise they can make it cheaper. But as soon as you sign up, Medicare stops covering parts that private addons do (because the private insurance is now getting money from Medicare). This forces a lock in where you can't really go back.
Also from conferences she has attended, there are experts in the field predicting these private insurances are going to bleed Medicare dry from increased costs. What's happening is they keep adding these benefits that only some of their customers use (like silver sneakers membership?) then telling Medicare their operating costs have gone up and they need more money.
It's silly that believing more government intervention will solve the problem, given that a big reason healthcare became tied to employment in the first place was wage freezes by the government, from which employer sponsored health insurance was exempt.
We're not going to solve it by constraining the supply of healthcare by regulating every aspect of it, and then subsidizing the demand.
It’s not constraining care. It’s a single payer system. Think of there being one insurance company.
This isn’t theoretical. Medicare already has been supporting the most frequent users of the system for decades. It’s a proven system with low overheads.
Yes there’s probably abuse but overall it has high satisfaction from its stakeholders.
I'm talking about the regulatory capture of everything related to health care: medications, credentialing, insurance, etc.
Any regulation imposed on the production of a good or provision of a service is a constraint on the supply. Reducing supply increases costs. I fail to see how the imposition of one insurance company (a monopoly) would improve that.
When Medicare was created, medical care accounted for less than 7% of GDP. It's around 20% now[1]. If you extrapolate life expectancy from before Medicare to now, has that massive increase in spending changed the trajectory at all?
You see the same phenomenon in higher education: we subsidize demand through government-backed loans, and costs and administrative overhead skyrockets.
If people need a job to have healthcare, it gives employers a lot of power. and because superpacs have allowed people with the most money the most say in american elections, the capitalists can just keep wringing people out.
The powers that be don't care at all about thousands of insurance adjusters losing their jobs. But they care very deeply about vaporizing hundreds of billions in shareholder equity.
Our GDP would take a really bad hit if we stopped wasting 10+% of it overpaying for healthcare (a white-collar make-work jobs program—like, god, couldn't we just start up the CCC again? At least they built nice stuff that we're still enjoying... imagine what they could do with 10% or more of GDP!)
I suspect this, plus other ways the US reports sheer waste as GDP to a much higher degree than most peer states, is the main reason folks report the US feeling a lot poorer than second-tier EU countries that on-paper have far lower GDP/capita, even with PPP adjustments. But the fake-healthcare-GDP is probably the single biggest culprit, being absolutely enormous.
Maybe there are millions in America that only keep their jobs for the health benefits rather than starting a 1-2 person business.
It just seems so silly.