Absolutely, except for the wealthy private interests like pharmaceutical companies and insurance.

Polls show the majority of Americans have favoured a single-payer system now for decades. This was the case under Reagan even, and still is today.

This shows the degree to which the US is not in fact a true democracy, but more of an oligarchy. However things can change if there is enough public pressure. People just need to be organized.

Pharma companies don't necessarily lose out with single payer. Consider that the vast majority of drugs prescribed are generics, and most generics (aside from those making headlines) are available pretty cheaply (you can check GoodRx to see real prices). Of course, you might shave a good amount of profit from big pharma by negotiation (if there's a single payer or a few payers, they have a lot of power), but you don't want to stop R&D. How we shift that R&D burden and to whom, I have no idea.

Disclaimer: I work in big pharma research (nothing to do with pricing)

This is very true. Prices might go down under single payer, but more people are covered. Overall, prices may go down, but volume drives overall revenue up.

I have read that the US spends 18% of GDP vs. most other countries spending around 10%. That means the health industry is at risk of losing 8% of GDP which at 18 trillion GDP is around 1.5 trillion.

People say this money is being wasted but it's going somewhere and these people will fight for keeping it.

Pretty much everyone with money in a 401k or any major index fund would suffer catastrophic losses as these are widely invested in various healthcare and pharma stocks.

The downstream economic effects of an 8% contraction would be nuts.

People forget about these unintended consequences. We have to make these changes more slowly. Start by passing legislation to cap cost increases so the job losses and valuations fall more slowly.

We also need to revisit end of life care. I see so many commercials for drugs that offer 9 months of life vs 6 months of life for existing treatments and there is little to say the quality of life is maintained. We can't afford to spend $100Ks for elder people with some kind of aging related cancer to have 3 extra months in hospice care. People can buy with their own saving but we need to unburden the system.

Assuming that it were to happen all at once, yes. But instituting these types of changes would probably take the better part of a decade, or at least several years to phase in.

Based on my understanding, that contraction in the pharmaceutical industry would put money back in the hands of the middle to lower income brackets who are currently impacted most. And given that the velocity of that money is higher for them than it is for the upper classes, it would theoretically lead to higher consumer spending, and growth, for the economy.

I think the comparison to other developed countries suggests that the 8% is inefficiently allocated, and with a more efficient system that 8% spent elsewhere would have economic growth elsewhere.

I don't have the figures in front of me, but I think public health indicators (maternal mortality rates, for instance) suggest we aren't getting great ROI on the extra 8% we spend.

Umm, no I don't think so. I regularly check my IRA and 401k's portfolio and I can't recall ever seeing a lopsided investment in healthcare or pharma like you're saying. And index funds track indices. Is the S&P 500 really dominated to that extent by big pharma?

Second largest sector at 14.7%. Click sector breakdown in the top right.

http://us.spindices.com/indices/equity/sp-500

There are a lot of middle men that would get absolutely crushed or go out of business if single payer were passed. Others would have to slash margins in order to meet whatever cost cutting is needed.

Yes, but the other 85% of the sectors would likely benefit a reduction in costs (i.e. insurance premiums for their employees) that would positively affect their bottom line.

The 8% contraction would be concentrated in a single sector. The money unspent on healthcare would go elsewhere.

Besides, the way DC works, there would be plenty of time for markets to adjust, short-sell, etc.

My take is that any kind of fair renegotiation removing the regulatory capture and the anti-competitive behavior allowed (and in some cases, required) by decades of lobbying would improve the situation. Single payer would work, free(er) market would work, but we're currently reaping the fruits of generations of entrenched political class for sale.

> Single payer would work, free(er) market would work, but we're currently reaping the fruits of generations of entrenched political class for sale.

Single payer or similar universal coverage systems would be the safe (dare I say conservative?) bet, since we have tons of examples of systems like that working well in countries similar to ours while saving lots of money per-capita over our system. Looks like an easy win.

Messing with our regulations and hoping the market fixes things might work, but it's more of a gamble.

There are also examples of free market healthcare working very well, see Singapore.

Singapore has multiple providers, like Germany, but it's not a Free Market (TM) by any means.

There's a lot of people that see the government do an awful job in so many areas (over budget, over time, etc), and worry that the same would happen with healthcare; _"Have you seen how poorly the government handles 'abc'? I don't want them in charge of my health, too"_

I'm somewhat of the mind that the government couldn't possibly do it worse than it's being done now. However, looking at the constant issues with VA healthcare, I'm not sure of my opinion either.

Rich people gain from research, new drugs, new equipment and new procedures. If the system spends more on poor people and common illnesses, it'll spend less on the things that benefit rich people.

Billionaires from around the globe fly to the Mayo Clinic in the USA. Why seek medical care in the USA? It spends more on the things that are good for the rich.

> Who exactly loses here? Rich people in the health industry? I don't get it.

You forget lawmakers reaping various lobbyist benefits, which is one reason why not much changes. Two sides bicker for a while to satisfy their constituencies, then compromise by doing nothing.

Is this not a false equivalency though? I'm not saying either side is perfect, but wouldn't you say one side has done more to try to solve the problem? Can you point out a plan brought to the table by the republican party that hasn't been a total objective disaster that the democrats were unreasonably recalcitrant about? The ACA is/was a good faith attempt to fix some of the issues with our healthcare system. There was tons of negotiation even if the process wasn't perfect, but at least they tried to do something. The republicans only seem to care when they are railing against something else, they haven't (to my knowledge) brought anything useful to the table at a national level within my memory. I'm not trying to be partisan, and I accept that single payer is a huge leap from where we are politically, but the way the ACA has been demonized indicates that one side plays politics with healthcare more than the other.

ACA was shoehorned through without bi-partisan support. It's currently unsustainable from a cost perspective and was widely predicted to be upon passage. Having good intentions does not excuse you from the consequences of your actions. For something as fundamental to our country as healthcare, having a wide buy-in and costs that won't collapse under its own weight is crucial for cost and legislative sustainability.

Those sound like talking points to me and I'm aware that my comments probably sound the same since I didn't present sources for my claims.

As far as not having bipartisan support, the republicans did get concessions but really didn't seem to want to contribute and haven't really tried to do anything on their own while they were in charge (unless you can point to a reasonable proposal that was shot down by the left). On top of that, claims that the recent proposals were as secretive or anti-bipartisan as the ACA don't seem to hold up [0].

I can't present a truly objective truth that I think will convince you, but there are a few misleading things about the ACA that make it seem more unstable than it really is. Overall I think one basic failing is that the penalty for being uninsured is too low, causing to few healthy people to enter the market that essentially subsidize the unhealthy (which is pretty much how all insurance works at some level). Insurance companies were essentially promised tons of new customers who could offset the fact that they now have to offer plans that actually have coverage (and therefore cost them more). Because of this, they are largely still making money but less money than they were and want. This means they don't have much incentive to make the ACA work and might actively work to destroy it to continue making record profits in an unsustainable way [1]. Not only that, but some of the premium increases come from uncertainty around whether the ACA will continue [2], or whether the government will continue to make subsidy payments that were promised [3].

I don't expect any of this to convince you but hopefully it makes my arguments seem less opinionated. I think about it the same way I think about software, I cannot imagine having to design and build such a system with the adversarial system we have knowing that you have to do it in a couple years and the other party is going to work against you and then try to dismantle the system after you are gone. Expecting to not have to have to make changes over time to fix unforeseen problems seems totally unreasonable to me.

[0] http://www.snopes.com/aca-versus-ahca/ [1] http://www.latimes.com/business/hiltzik/la-fi-hiltzik-aetna-... [2] https://www.nbcnews.com/health/health-care/obamacare-uncerta... [3] https://www.usnews.com/news/us/articles/2017-07-29/trump-thr...

Please stop trying to frame everything in a partisan lens ("talking points"). It does not good for anyone.

I agree with you that the penalty for being uninsured is too low if you want to build a sustainable system. However, had a more realistic penalty been put in place from the start, there is no way that it would have passed in its existing form. I'm also very much against younger people having to subsidize something that for the most part they get little to no value from.

As far as insurance companies go, the law was by and large a handout to them by providing them a captive audience that did not exist before and an excuse to raise premiums on everyone else. If you create a law that binds consumers to companies and do not provide adequate protections to consumers in the process, this is what you get. Just like the fees, had these protections been in place from the start, there is no way that the law would have passed as it.

My whole beef with it is that there were enough glaring flaws in the law and not enough buy-in from everyone that there was real sustainability and repeal risk. If you pass laws that are knowingly flawed that affect this many people, you are being dishonest and I don't think you deserve points for good intentions in light of that.

What do you propose as an alternative other than "do it all right the first time magically"? Do you think honestly in a system like ours you can get all the buy in you need and get something passed the first time? I think its easy to criticize from the sidelines but a lot harder to actually do something. I still think it was a real effort to actually fix problems and it did fix some of those problems, it has some economic issues but I think everyone is trying to make a political career out of jumping on it rather than doing the mature thing and trying to make it work (which they didn't do in the first place).

I lose here. I don't work in pharma, but I benefit from a drug developed in the US that is only available and approved for my condition in the US and one other country.

Not only will I lose here, but the future you will lose here as will the future everyone on the planet. Healthcare needs don't just exist in the present.

https://www.quora.com/Which-country-develops-the-most-effect...

I don't quite understand the connection between single-payer and your implication that the drug you need wouldn't exist.