* even more locally organised. County sized administrations have about the same independence as US states.
* instead of spending our (similar) tax rates on the military, it is spent on superb health care (imagine a souped up version of Obamacare with regulated prices), schools and a social net. Look at the numbers though - I think it works, that is, innovation and the economy in general are strong thanks to a more stable middle class (that doesn't experience negative social mobility due to health care problems and overpaid schools plus gets an influx from people at the poor end that make it by means of a helping hand at child age).
* and no, I would argue Switzerland is not significantly less diverse with about 30% immigrant population. We have about the same proportion of backwards rightwing pseudo conservatives as a counterreaction, but they are bound to a political system that makes getting absolute majorities in the parliament near impossible (and also relatively useless alone thanks to referendums that serve as a moderation tool). See also again the difference in how middle class is kept going, which makes a Populist power grab much less likely.
I agree, there are better systems than France. My only reference to France, is about competitive salaries in the healthcare industry. Wages in that industry have to come down by a lot to match comparables in eg France, Germany, UK.
When people talk about single payer re the US, they focus on drug prices and insurance industry costs. They ignore that essentially every cost in the US system is inflated, including routine labor and dozens of side connected feeder industries (everything from saline supply to the cost of hospital beds to labor costs in elderly care). Most of the cost bloat in the system is made up of salaries for workers such as nurses, doctors, hospital workers, admin and health insurance employees. You could slash pharma costs nearly in half in the US and only save ~$150 billion of the $1 trillion we have to cut out of our costs to get cost competitive again. Every one of these cuts will have substantial economic consequences; cut pharma in half, lose a million high paying jobs directly & indirectly that support the tax base that pays for the single payer system (ie you have to figure out how to replace that; which would occur, but it'd take lots of time).
That said, the way the US is actually going to go, is we're going to do a slow mediocre drift into single payer, through gradual expansion as the existing convoluted system fails one tier after another (essentially failing up the economic chain; the middle class will gradually all be pulled into government healthcare by necessity as the system collapses). Maybe out of desperation they'll use medicare as the platform, since the politicians in Washington DC can never agree on anything it's most likely our result will be to use something that already exists and just enlarge it.
The VA hospital system is a US example demonstrating vastly lower costs with similar outcomes. Scale that to say all of Medicare + all government workers and costs drop enough to cover vastly more people. Now add in other programs like the Ryan White AIDS program which covers ~300,000 people with very high cost care and the supliments to Rural heathcare systems etc and heathcare would look very different and cheaper.
I've made that point numerous times in this thread. I think you're missing my point: the US has to slash a trillion dollars in expenses out of its system. That trillion dollars consists of jobs & people's income & tax base loss. It is not a zero cost transition, it's a massive cost transition. You're talking about it as though it would occur in a vacuum, it would not.
The VA system is not an example of lower costs. You're wrong, it's more expensive than both the private sector and medicare:
http://dailycaller.com/2014/06/02/report-va-health-care-has-...
Further the UA is often covering the most expensive care such as hip replacements, the fact that it's a lower percentage of costs is a result of efficiency of the VA and waste in the rest of the system.
As to lowering costs, economically spending money on heathcare billing vs Rail is only different because Rail provides long term value. As long as total spending is unchanged there is no reason to suspect economic harm.
> As long as total spending is unchanged there is no reason to suspect economic harm.
You mean other than the vast dislocation that health industry labor - and two dozen other industries reliant on that spending - would suffer? People taking pay cuts in healthcare, workers losing jobs in pharma & health insurance by the hundreds of thousands (high paying jobs at that). Your premise would only actually work that way in a simulation (and it'd be a really bad simulation, not accounting for anything in the real world), not in reality. In reality, there is dramatic economic friction that occurs when you fire someone and they have to retrain / find a new job, or when you cut their pay to bring costs in line. There are immense short-term and long-term costs to that upheaval, in reality. Such costs include: unemployment costs, job training, long-term unemployment costs, welfare benefit costs, tax base loss until jobs & incomes are recovered. The US economy is growing very slow, where's the evidence it can absorb such losses and then create a million new high paying jobs (simultaneously while automation is about to bear down on just about every category of employment)?
If the VA spent 1/2 as much money and covered 1/6 of the costs while provoviding the same benefit that would be a good thing. This analysis ignores survives provided because the only way to make them look bad is to pretend spending more money is somehow a good thing.
You of course didn't support that claim at all. Most US military spending goes to soldier-related costs. How do you propose to slash that given how dramatically higher the US median wage is compared to Russia? Other than of course to perhaps cut the number of US soldiers in half.
> The single-pay system can be made to work. Others make it work, and a lot cheaper
Of course it can work. It can't work with US costs what they are. You need to go tell US nurses they have to take a 1/3 pay cut, to match up with what nurses in France and Germany are making. Then you need to go tell radiologists that they have to take a 70% pay cut to match up with French radiologists. Then you have to go tell pharma they're getting a 2/3 cut. Then you have to tell average hospital workers they're getting a 20% pay cut. Then you have to close 1/3 of all hospitals. Then you have to substantially expand wait times to match eg Canada, aka rationing the care. Then you have to tell hospital admin they're getting a 50% cut in their budget. Then you have to fire 500,000 people that are employed directly or indirectly in the health insurance industry. Then you have to slash the payouts for all sorts of highway robbery prices in medtech / devices / supplies related to the healthcare industry, which will can hundreds of thousands of more employees. You have to successfully adjust all of that, lower the costs, then figure out how to create new economic growth with the cost savings to re-employ all those lost jobs, wages, taxes (all that lost income tax, which will shoot a hole in the side of social security & medicare/medicaid).
IE you have to find a trillion dollars in savings across dozens of economic segments. Which is another way of saying: a lot of people are going to lose a lot of jobs and income. It's an extraordinarily complicated and expensive problem to resolve without rattling the entire economy to its core.
Oh yeah, then you have to dramatically raise taxes on the US middle class (which pays very little in taxes vs most developed nations) to match up with what countries with single payer systems do; and explain to the middle class that they're going to be better off with socialized healthcare, and that the increased taxes will be off-set by the government healthcare vs the old private insurance approach. Then you also have to significantly raise taxes on the top 25%, which pay most of the taxes in the US.
No problem eh.