I'd gladly pay the increased tax rate if I didn't have to deal with all the BS that surrounds using health insurance; in/out of network, deductibles, companies trying to get out of paying, etc.

It's good to hear from someone that's experienced another system. I would rather have that system than one that caters to the big corporations and corrupt officials. ObamaCare just shifted the burden of the uninsured directly onto the tax payers, through subsidies, from the insurance companies and hospitals that billed higher for it. It's a BS system that allows the Obama administration to look at statistics and say, "Wow, look at how many people are insured now!"

I've been unemployed for 9 months and now have to pay the individual mandate for 6 of those months. I think the Supreme Court was bought or blackmailed on that one. We need a system, but not this one and it can't be opt-in or get fined! Maybe a sales tax would work.

I think the main opposition to single payer in the USA is that it's counter to some of the bedrock principles the country was founded on, such as freedom, independence, limited government and personal responsibility.

"Personal responsibility" is not a founding American principle. There's no Federalist Paper dedicated to "personal responsibility." Indeed, "independence" and "personal responsibility" along with "individualism" were retconned into American history during the settlement of the West.

Moreover, "limited government" in the context of American founding principles refers to the allocation of responsibilities between states and the federal government, not the overall scope of government.

There is, in fact, a principled originalist argument for universal healthcare. First, it has always been assumed that the states have the power to provide for the welfare of their citizens, as well as to police their behavior and morals. The states are, in that regard, decidedly not "limited governments" of "enumerated powers." State-level universal healthcare is contrary to no founding principle.

Second, the Commerce Clause was incorporated into the Constitution to allow the federal government to solve what we today would recognize as economic collective action or free-rider problems. At the time it was aimed to address the collective action problem of free trade. It's good for the United States as a whole, but individual states have a short-term incentive to erect trade barriers. The purpose of the Commerce Clause was to allow the federal government to counter-act those short term incentives. Precisely the same problem exists with state-level universal healthcare. Even if most people in a state want it, they can't enact it because it's too easy for people from neighboring states to free-ride on those services. The Commerce Clause is thus properly invoked for resolving that problem at the federal level.

Vermont looked into single-payer insurance within the state borders, but AFAIK they abandoned the idea after seeing the estimated price tag. I think it would be great if some state tried implementing this, some state tried implementing a Singapore-style free-market solution, etc., and we got to see what worked.

> Precisely the same problem exists with state-level universal healthcare. Even if most people in a state want it, they can't enact it because it's too easy for people from neighboring states to free-ride on those services.

How so? If you are a resident, you get "free" care. If not, you get a bill. Is this not how Canada works WRT Americans who need to use the Canadian health system?

Say Arizona doesn't have universal healthcare, and California does. Someone gets cancer, so they move to California. Under the privileges and immunities clause, California generally cannot say "hey, you just moved here, so here is a bill." Consider also a company that doesn't like the extra taxes used to support universal healthcare. So they hop across the border to Arizona, and continue selling to California customers. California cannot, without violating the Commerce Clause, say "hey, you get the benefit of selling to healthy Californian consumers but you moved just to evade the tax that pays for it, so here is a tariff on your products."

The Constitution imposes an open market on commerce and movement within the United States. The Commerce Clause exists to give the federal government the power to address the economic issues that arise as a consequence of that.

America (disclaimer: I'm a US citizen, born and raised) has this delusion of rugged individualism, that everyone should pull them up by their bootstraps. In reality, everyone who is successful is simply taking advantage of those who came before them, and shared infrastructure (both the physical an economic types).

I don't see Americans adverse to Medicare, which is essentially single-payer for anyone over 65. Why does being under 65 mean you should die in the street without healthcare?

Single payer is cheaper/more efficient than our current system. We just need to find the political will to implement it, and cut the legs out from anyone attempting to stymie that change who is currently profiting from the status quo.

Because your earnings ability declines. And dying in the street is a 100% myth.

Medical bills are the leading cause of bankruptcy in the U.S.

http://www.nerdwallet.com/blog/health/medical-bills/nerdwall...

On the other hand, medical bankruptcy is reality.

That's what real insurance is for, currently known as "catastrophic insurance", and unfortunately being outlawed.

> freedom Why is it counter to freedom? The USA might be the only country on the planet with a definition of freedom that idiotic.

Personally I think it's the combination of anti-socialism brainwashing and the "I got mine so screw you" attitude too many people have.

At least 1/3 of the US population, probably closer to half, is pretty serious about not wanting much government involvement in personal affairs. I'm left of center but that sentiment doesn't seem crazy or crazy to associate with freedom.

It's amusing they don't want government involvement with personal affairs, but they have to deal with endless private companies meddling in their lives, taking tons of money, denying their claims, denying them coverage, etc. etc.

It's okay when a private company declines their healthcare claims. But if the government does it? SOCIALISM!

That sentiment is not crazy.

Associating a working health care system with the government interfering with your life and impinging on freedom is completely insane.

There's also some degree of moral judgment involved. It would be much easier to sell single-payer to Americans if coverage was denied to lifestyle illnesses. It's easier for the American ethos to swallow charity for the poor sap who got brain cancer from an errant cosmic ray than for the obese chain-smoker with type II diabetes and lung cancer.

There is a long history of Puritanical thought running in American culture, in which personal virtue is reflected in outcomes.

On that basis you'd also have to exclude coverage for injuries from almost any sport or exercise activities done "by choice"

It goes way further than that. How about people who have children (again a choice) as that also increases health expenses. Living in areas with more sun (let's call that a choice too) means more likelihood of skin cancer. Those people using private cars rather than public transport are also more likely to be more severely hurt in more accidents. Someone engaging in "bad behaviour" like smoking may have higher health costs at the end of their life, but their lifetime total costs may be lower because their life ends quicker than healthy people having a longer end of life period. (And the smokers paid more tax, collected less social security etc.)

Realistically all legal choices and activities have to be covered, or you would be arbitrarily victimising certain groups.

The personal responsibility riff gets really problematic when you are faced with things like alcoholism or venereal diseases. People certainly have a choice to keep alcohol consumption down practice safe sex &c. But it's a reality that some people catch STDs or drink too much even though they should not, and these things have a way of affecting more than the afflicted individual.

And food deserts are a very real thing. If you live in one of those you haven't even much of a choice regarding obesity.

Why does that argument get applied to healthcare, and not to education? Those bright yellow government provided schoolbuses painted National School Bus Glossy Yellow aren't paid for out of educational transport insurance copays, you know...

I live in Texas, and I am increasingly seeing that argument applied to education was well.

It does (vouchers).

Vouchers are a mechanism for diverting government funds to individually chosen (government accredited) education providers. They aren't comparable to employer funded private 'insurance' programs. In healthcare terms they more resemble Medicaid. They're hardly an example of rugged individualism.

Author here: My father and ex husband were both career military. I was married long enough to still be entitled to medical coverage through the military system. We briefly dealt with insurance and copays and all that when he was a recruiter stationed someplace without a military base. Other than that, I have had an experience of medical care closer to what many Europeans experience. I would be all for the US finding some means to institute government paid universal coverage. But I think that health insurance is too entrenched in the system for such hopes to be realistic any time soon. I think that is why the ACA chose the unfortunate path it chose: the transition directly from what we had before Obamacare to a European style solution is too harsh to be politically viable.

Maybe someday the US will get on board with providing a better solution. In the mean time, direct primary care is a legal loophole in the ACA that cuts out the middleman. Perhaps if it grows enough, we can eventually move towards something more civilized.

Thank you for commenting.

I fully agree - I'd like to see single-payer tomorrow, but that's as much of a cultural as an economic change and as you point out there are large entrenched interests in place already; the ACA is a flawed by still necessary beachhead onto that economic territory. If I thought it could all just be improved by fiat I'd be urging people to vote for Bernie Sanders, but I'm not - having a beautiful ideal is mind does not automatically provide the tools and resources required to attain that vision, a problem which seems lost on many of his supporters.