There's some serious mental gymnastics going on here to justify that the US spends 2x the next country per capita on health care expenditure and still doesn't manage to pay for all its citizens. Especially when the federal government has already taken all its worst customers (the old) and thrown them into a socialized pool (medicare) without anyone to balance out the risk.

Wasn't there a writeup recently that wealth distribution isn't materially distinguishable from luck? [1] Your argument that the healthy/rich subsidize the poor/sick is tantamount to saying the unlucky should fend for themselves. That's an easy argument to make if you're lucky. Your luck may turn at any moment, and then if it does, you're SOL.

Further, if the moral argument falls flat for you, the self-centered argument is that if someone is too poor to get their horrifyingly contagious disease treated until its too late and it spreads to you, you're still sick, and you may still die, cover or no cover. It's why the fire department is socialized -- if the fire spreads to your house, it still burns does it not?

Especially as you argue you're not particularly well off necessary, you should be the strongest advocate for yourself, and therefore, for socialized medicine.

The world is moving there -- at least towards a two-tier system -- and this argument is on the wrong side of history.

[1] https://www.technologyreview.com/s/610395/if-youre-so-smart-...

[EDIT] I also wanted to throw in there the self-centered argument for socialized higher education. If you believe in the value of a college education, then you believe it will increase the productivity of that individual. A more productive individual makes your country more competitive, boosts GDP, moves the markets higher relative to that of other countries. This in turn benefits the wealthy who likely hold equities. Speculative, of course, but the argument seems consistent to me.

> There's some serious mental gymnastics going on here to justify that the US spends 2x the next country per capita on health care expenditure and still doesn't manage to pay for all its citizens.

I'm not exactly sure what you mean by this.

The US does spend a lot more, and doesn't cover everyone. If I understood the parent post, (part of what) it's saying that the US needs to focus on lowering costs, because otherwise, the fact that there is so much spending even now, is going to cause trouble. And more trouble than comparable countries, because the price in the US is so much higher.

I'm not sure if you're disagreeing with this, or what? Do you assume that if the US covered everyone, it would be cheaper? Would be great if you could clarify :)

> The US does spend a lot more, and doesn't cover everyone.

The US does spend a lot more, _because_ it doesn't cover everybody.

The use-value of private health care in the the US is:

- delta (getting treated, slow painful death and/or bankruptcy)

whereas most places it is more like:

- delta (private room in fancy building, non-private room in an oldish building)

If you were a salesman, and you sold the first product for less than 5x the price of the second, you would deserve to be sacked on the spot. How could a profit-seeking economic system be so inefficient that it would fail to extract a large portion of that value from the customer?

> he US needs to focus on lowering costs

Why would a profit-seeking system seek to lower costs when high costs led to higher prices that still get paid? Any CEO suggesting such a thing would be sacked by the board the same day.

Do the math; costs are about 3x what they should be, but 85% of the market still pays them. 3 * 0.85 > 1 * 1.0.

Sure, my bad, in re-reading I can see how this wasn't clear.

I meant along the lines of: I can't see how allowing medicare to negotiate drug prices, letting nurses do more of what doctors do and publishing prices gets the US medical system anywhere close to a 50% reduction in per capita spend, or gets the US any closer to covering 100% of the population. The US should do each of these. Each would make a difference.

What the country needs, though, is real reform.

And also, yes, socialized medicine is dramatically more efficient. Medicare's overhead is only 2% whereas that of private insurance is 18%. Just knocking that off the top would bring the US per capita expenditure much more in line with the OECD.

[1] http://cepr.net/blogs/cepr-blog/overhead-costs-for-private-h...

It wouldn't. Those are 3 examples, just to prove my point about how we seem to focus exclusively on how paying for the cost of care but seemingly don't bat an eye on bringing down the costs, where there seems to be a lot of room for improvement.

If the costs were not so high, paying for it for everyone would not be as difficult to implement.

Centralized systems are more efficient when they're smaller. The bigger a centralized system becomes, the more you need to spend on intermediary layers of bureaucracy that don't actually help achieve whatever goal it is you're going for (in this case, medical care).

The US has ~330 million people. The US has ~13 million undocumented immigrants. The US is the size of Europe. You're not going to magically get the efficiency of European countries 1/10 the size by having single-payer/universal health care.

Imagine trying to have a single health care system for all of Europe. It would not be nearly as efficient as you think it would be.

Does that mean we can't significantly bring down the cost of care in the US? No, we absolutely can. But a national system in the US is never going to be as efficient as any European country's national system. It's impossible to maintain the same level of efficiency when the scale increases exponentially.

If only the United States had some kind of system of geographic administrative divisions similar to the countries that make up Europe...

Right, and states are free to enact single-payer/universal health care for their residents if they so wish. In fact, you might want to look at the Massachusetts health care system.

But implementation at a state level is obviously not what this thread is about.

For a US-wide health care system you need US-wide infrastructure/bureaucracy. This decreases efficiency.

I'm down with this -- this is how Canada's system is run. Each province provides insurance for its residents meeting the requirement to provide a socalized system as defined in the Canada Health Act. States should provide the socialized system, the federal government should mandate a public option exists (either single payer or two-tier) and the basic rules that govern one.

That completely goes against the idea of economies of scale. If smaller organizations were inherently more efficient, mom-and-pop stores would be beating Walmart and people running online stores out of their garage would be beating Amazon.

"Economies of scale" isn't a universal idea that you can apply to literally any industry/sector.

Unfortunately, medicine is not retail. Otherwise are lives would be a lot simpler. Would it be more efficient to introduce Amazon-like policies to medicine. For sure. But unlike Amazon fulfillment centres, you can't just close all the hospitals in a city and build a mega hospital 1 hour outside the city and expect anyone to go along with that.

Pretty much everything that can be "economically scaled" in the medical industry already has been -- the drugs you are receiving to treat X condition in NY and WA are probably going to be from the same company. The MR machines you use in TX are the same brand as the ones used in PA. This means those things are cheaper than they would be if they were being produced by "mom and pop" shops. Economies of scale are already in play. It's all about fixed vs. variable costs.

My point was about admin. When the scale of an organization goes up, the admin costs go up, not proportionally to the value that this admin provides. It's necessary if you want to get bigger, but not proportionally useful. With a national health system, the number of doctors you need will not go down. The number of imaging devices you need will not go down. But the amount of centralized bureaucracy you need WILL go up.

> Do you assume that if the US covered everyone, it would be cheaper? Would be great if you could clarify :)

Yes, that's exactly true. A lot of countries cover everyone, at a far lower cost per capita. Universal healthcare lowers costs. The evidence simply isn't on the side of the libertarian argument. Universal healthcare has been tried, in many, many countries, and it works just fine.

There isn't a single country you can point to, including and especially the United States, that has "free market" healthcare and gets better outcomes at lower cost than universal healthcare countries.

Universal healthcare doesn't necessarily lower costs - countries that have universal healthcare also tend to pay less for healthcare. Correlation does not equal causation, especially since the arrow arguably goes in the other direction here - in other words, the US would have universal health care if our costs were in line with other first world countries. If that second possibility is the case, implementing universal healthcare in the US might be ruinously expensive...

As for better outcomes, I think that depends on how you define "better" - if I'm remembering correctly the US is still at the top for "healthcare outcomes of the rich and powerful". That's a different criteria, and probably the one most important to the people with the ability to cause change - namely, the rich and powerful!

> Wasn't there a writeup recently that wealth distribution isn't materially distinguishable from luck?

Some researchers in Italy created a computer model of human talent and ran a simulation. Not sure you can model talent, but more importantly that argument means no one is really successful, just lucky. Steve Jobs: no talent. Jeff Bezos: no talent. Barack Obama: no talent. All just luck.

> If someone is too poor to get their horrifyingly contagious disease treated until its too late and it spreads to you, you're still sick, and you may still die, cover or no cover

Again, I'm not wealthy, so these taxes would not affect me. But I'm not sure you're correctly modeling transmission vectors for communicable diseases.

> If you believe in the value of a college education, then you believe it will increase the productivity of that individual...This in turn benefits the wealthy who likely hold equities

You're saying rich people should pay really high taxes because poor people getting an education will cause the stock market to go up? Uh...not sure that's how it works.

I believe everyone who wants one should have access to a college education. But just declaring it 'free' and raising taxes on one group doesn't seem like a sustainable strategy.

> Steve Jobs: no talent. Bezos: no talent. Obama: no talent.

I'm definitely not saying that. What I am saying is that their talent had to be coupled with an immense amount of luck, being in the right place at the right time, and things falling in line just right for them.

> Again, I'm not wealthy, so these taxes would not affect me. But I'm not sure you're correctly modeling transmission vectors for communicable diseases.

They would absolutely affect you -- you'd get medical care. It's also not fair to say you don't pay taxes even if your marginal tax rate is 0% as your employer pays ~15% of your salary on top in payroll taxes, and your employer could also be taxed to provide healthcare as some countries do. Even San Francisco follows such a model with Healthy SF.

> You're saying rich people should pay really high taxes because poor people getting an education will cause the stock market to go up? Uh...not sure that's how it works.

A quick google search yielded all sorts of great reading material on how that could work [1], [2] and [3].

Of course correlation is not causation and if you reject that data, the reality is you participate in a society -- would you rather your peers be uneducated or educated? Healthy or sick? Terrible roads or good roads? Drinkable water? On fire? Ultimately those of the highest means have the highest responsibility to that society to give back.

[1] https://www.usnews.com/opinion/knowledge-bank/2015/08/12/edu...

[2] http://siteresources.worldbank.org/EDUCATION/Resources/27820...

[3] https://nces.ed.gov/programs/coe/indicator_cmd.asp

Obviously, I'd like everyone to be healthy and with an affordable education. But our universe is finite and someone has to pay for these services. Just blindly assuming we can tax all wealthy people into total equality seems like a pipe dream to me.

Hence, I'm arguing that instead of just blind wealth transfers from one group to the collective we should focus a lot more energy on bringing the cost of care down.

Just like we should be focusing a lot more energy on bringing the cost of college down.

I don't think we should tax the wealthy into equality, I believe in income and wealth inequality -- its the incentive and reward structure an economy should have. However, it's only moral and right when coupled with a meaningful quality of life for the lowest end, and only when coupled with social mobility. Socialized medicine and the safety net allows for risk taking, allows the poor to build businesses without the fear of death in the event of failure.

Cost of care goes down when you stop wasting money on advertisement, CEO bonuses, and people whose job it is to deny claims. Cost of care goes down when you provide preventative care that's necessary and affordable. When you dont have people without insurance wandering into the ER at the last possible second who could have been treated for pennies on the dollar earlier on. All the data we have on Medicare backs this up, even though its an awful example for reasons I cited above.

Further if you claim that we can't afford to cover everyone, you're going to need to back up your claims because every other country in the OECD would disagree with you.

tl;dr: Income/wealth inequality is a good incentive, when the poor don't die, starve and can live well, and have the opportunity to move up. Socialized medicine enables this.

Just want to point out that part of the reason for larger healthcare spending per capita is probably that healthcare spending is mostly for services and US GDP per capita is 1.5x most other developed countries (excluding small countries whose economy is majority natural resource extraction). In other words, incomes are higher in the US, so health care is automatically more expensive.

You make lots of bad assumptions. But if you are going to get all nihilist about it, go all in. Your wealth is predicated on the government that ensures it’s value. Nothing you “own”, including money, is “yours” except by virtue of the laws and under threat of force from whatever relevant powers exist in your locality be they corporate, military, or organized crime. You benefit greatly from the “power transfer” that enables you to keep your wealth. So your assertion that “wealth transfer”—if that’s the petty way you need to think about it—is fundamentally immoral is exceedingly hollow when it’s predicated on the same government that transfers power to you on a regular basis.

My wealth? Didn't I just say above I'm not wealthy?

Just because the state provides benefits (self-defense, rule of law, etc) doesn't preclude you from ownership rights, not really following your argument there.

Taxing one group and providing the benefits to another is a wealth transfer, however unappealing the idea sounds to you.

How is not favoring selective taxation "nihilist"? If I were a nihilist I'd believe in nothing and favor no taxes at all.

You're passionate, I get it, I want sick people taken care of too, but I don't really see how your arguments add up.

>Just because the state provides benefits (self-defense, rule of law, etc) doesn't preclude you from ownership rights, not really following your argument there.

Its a fundamental different view of reality and especially society. We are animals, we have no rights and not duties. We do what we want. Things like ownership are derived not from some concept of rights, but from power. We combine our power through government, and in doing so grant the ability to own things. Theft is wrong, not for a moral reason, but because we decided to punish those who steal.

This view doesn't completely reject the notion of rights and duties, because we can still use the concept of such to determine how we run our combinations of power. But it does do away with the assumption they inherently exist. It becomes something of a more philosophical question, much like asking does math exist outside of humanity (or any other intelligence that is able to understand the concept of math).

> Universal health care is a euphemism for the poor and sick getting their medical care subsidized by the wealthy and healthy.

You might have a point if the US system didn't cost taxpayers more for worse care. The US government pays more per capita for health care than other systems, but doesn't provide universal coverage.

https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...

Universal coverage provides more levers to control costs.

UHC does provide more levers to control costs, sure. But it's not some huge fix to the underlying problem. One example: https://www.cnn.com/2018/02/10/health/uk-nhs-universal-healt...

I'm from a country that has public health and free college education (Finland).

I much prefer paying bit more in taxes than having to have a bad conscience knowing that a lot of the people living in my country would not have the same options as myself.

I'm not exceedingly wealthy but I make more than the statistical average employee.

Yes, the problem is American universities, like hospitals, are severely overpriced.

There are many reasons for this, but it's easier for Finland to pay collectively for higher education when the tuition is reasonable.

Just like my healthcare argument -- if we could bring down the cost of higher education then subsidizing it for everyone would be less controversial.

You're missing the entire thesis of the article. The thesis is that Finland (et al)'s education and healthcare systems are more efficient because they are socialized. Given one binary comparison between condition A and condition B (Finland vs. US), some causal speculation is justified. Given dozens of such comparisons, all coming out to the same result, your case becomes anti-empirical.

soru's comment on this thread provides one nice rational model that tries to explain why. But the much more important point is that our rationalizations are slaves to the empirical data. Not the other way around.

> Given dozens of such comparisons, all coming out to the same result, your case becomes anti-empirical.

As others in this thread have pointed out, Finland vs. US is not a good comparison, Europe vs the US would be. We can socialize medicine in individual states with good results (see: MA) but US-wide? With 332+ million people? With all the differences in costs of living in different parts of the country?

When the EU rolls out a single-payer system for the entire Eurozone then we'll have something to compare against but the entire nation of Finland has less people (5.7 million) than New York City (8 million) and is a monoculture, to boot.

"When the EU rolls out a single-payer system for the entire Eurozone..."

Basically the national health systems inside EU co-operate not entirely dissimilarly to a european single payer system:

http://www.kela.fi/web/en/european-health-insurance-card

Given that the mishmash of european systems has much wider variance probably than US internal schemes do, I find the argument 'but US is too" complex not entirely convincing.

Given how much of the current scientific and technological context of our civilization comes from the US, and there are lot of single payer schemes working in other countries, I would find the "we don't want to" argument more convincing than "it's too complex for us".

Anyway, I don't know the nuts and bolts of any of the health care systems but generally when political will manifests itself people are capable of all sorts of things if they are within the realm of the laws of physics.

It's not like health care was rocket science. The best bang for buck comes from providing just the cheapest things modern medicine has come with within the reach of all. It's not surgeries and MRI machines and all that capital intensive stuff. A nurse with a basic kit could achieve all sorts of improved health outcomes in his/her patients.

Everytime I see a dicussion of socialized healthcare in the US I remember Firefighters and chuckle. Historically speaking, a couple of years ago, Firefighting in parts of the US was a private enterprise, that meant that, if you did not pay for your firefighting insurance, and your house caught a fire, firefigthers who were there to put down your neighbours fire would let your house burn to the ground.

In one hundred years, society will be laughing at the current system that let's people die, or ruin their life financially because they got Crohns disease and aren't able to pay them or to be attended because they don't have the means to.

It is just that some societies are not as mature as others.

Do you think this is related to Finland being much, much, much more homogeneous demographically than the US?

I was going to say "ethnically homogeneous", but that isn't even the core of the issue. The US has populations with vastly divergent cultural backgrounds and outlooks (there's even a few types of white people); it's harder to argue that Hassidim in NYC should care for Crips in outer LA.

Uh, I have no idea when the concept of perceived fairness brakes down. But that's not the point in the end. Universal services like school and healthcare make sense because they improve the quality of life for everyone.

I suppose the core issue is that there is trust that the public funds are used in proper way.

I don't understand the 'US is too large to X' arguments. I thought the states are sufficiently independent to handle most things distinctively from the federal level. But I don't know enough of how US works to discuss this beyond it looks odd. Couldn't e.g Oregon implement something, and if it works, then other states could just copy the model. From the outside the concept of distinct state level governments sound like they could provide great platform for innovation and experimentation. But maybe they are bogged down in federal legislation and partisan politics?

As a healthy wealthy individual, more than happy to pay for sick people that cannot afford healthcare to become healthy. It is in my direct interest to have as little sick people as possible in the country where I live.

Sure. But what if the costs keep skyrocketing? Say you pay 50% in taxes now -- you cool with 70%? 80%?

Presumably there's a limit to what you're willing to pay.

I am in favor of higher taxes but it's impractical to assume just paying for universal health care at all costs is a viable strategy.

In the US we pay more for less. Our system is nonsensical. Whether it's tax or premiums, doesn't matter, the overall cost is crazy, the system is unfair, and the final quality is low. Just look at life expectancy.

Then do it. Literally no one is stopping you. If every rich person who expressed this sentiment would kick in some real money it might make a difference.

> Universal health care is a euphemism for the poor and sick getting their medical care subsidized by the wealthy and healthy.

Is it? I would have thought it is the commonwealth looking after the people that make it! Surely for countries with large sovereign wealth funds (especially those derived from the country's natural wealth), it makes sense to care for the people for which it is meant to provide!

The whole redistribution lens is a very specific way of looking at things.

In countries with "universal healthcare", there is a big incentive from the organization paying the costs of exams to emphasis preventive care because ultimately, they won't run a deficit every year.

And usually, it has a big bargaining power because its decide if if will reimburse the medicine or not.

See for example : http://www.pmlive.com/pharma_news/france_agrees_lowest_soval...

Similarly, there is a big incentive to reduce tobacco, alcohol consumption and obesity, because it has a big cost shared by everyone paying to the common fund.

So I would say that universal health care has the same incentive to reduce the overall cost, that a multi payer system.

> In countries with "universal healthcare", there is a big incentive from the organization paying the costs of exams to emphasis preventive care because ultimately, they won't run a deficit every year.

Does medicare do that? They stand to profit the most out of preventative care.

There isn't really. In this case, the organization paying the cost has the power to confiscate whatever it needs from the citizens to fund its expenses. They are not operating with the financial motivational pressures of a business or even a non-profit organization.

All of government is a big cost shared by everyone paying into the common fund. That doesn't seem to have created any incentive at all to control spending. Quite the opposite in fact.

> Nurses could do a lot of things doctors do now, and for a lot less money, but MDs refuse to cede any authority

Nurse practitioners are actually increasingly common in the American health care system.

Yes, and I'd love to see them do more. Like a lot of preventative care.

Or obesity -- so many health problems stem from being obese. Surely nurses could help patients develop strategies to eat better and exercise.

>Universal health care is a euphemism for the poor and sick getting their medical care subsidized by the wealthy and healthy.

Have you ever worked in the US healthcare system? I worked for a medical diagnostics lab and spent a couple weeks in our billing department shadowing them at one point, we were writing off a minimum of 100k/day (and that is a very conservative estimate based on the 1 billing person I shadowed) in services for indigent patients.

So the US healthcare model as it stands is a euphemism for the wealthy and healthy subsidizing the poor and sick in an insanely inefficient way.

> So the US healthcare model as it stands is a euphemism for the wealthy and healthy subsidizing the poor and sick in an insanely inefficient way.

Don't really understand this line. The US model itself is a euphemism? What?

I have no doubt that indigent patients get a break from a lot of facilities, but my question would be: why are those services so expensive in the first place? Why is it totally impossible for a person making a reasonable income to pay for a service like healthcare by themselves? You seem to be assuming the costs for your lab are totally normal and legit and wow, isn't it amazing the breaks we give people, but maybe your lab could be charging a lot less than it is for its services?

I don't know obviously, you work there, I don't, I'm just pointing out the underlying issue.

> Universal health care is a euphemism for the poor and sick getting their medical care subsidized by the wealthy and healthy.

Correct me if I'm wrong, but the wealthy and healthy (who have health insurance) are already paying for the poor and sick, aren't they? Hospitals can't deny care to the poor and sick, so they inflate the costs of the wealthy insured to compensate for the poor's ER visits.

Universal health care would mean moving more ER visits to a primary care physician in a clinic, effectively _reducing_ the overall burden that the healthy and wealthy pay.

Insurance is inherently about distributed costs. That's the whole point. People who don't suffer whatever event they're insured for end up paying for those who do.

Exactly. It's also not a tax mandated by the state, which is the key difference between insurance and universal health care.

If America wants to introduce UHC, great, but let's be honest about what it is, and let's understand it's going to be prohibitively expensive unless we bring costs down first.

Would you make the same argument against universal education? Spending on healthcare is not zero-sum, the linked article argues that there is good evidence that universal healthcare increases GDP, benefitting the entire economy.

"Economists at the World Bank used to call spending on health a “social overhead”, but now they believe that it speeds up growth, says Timothy Evans, one of its senior directors."

By your comment then we should get rid of social security and Medicare as well, would you agree?

Uh, what?

Where in my comment did I write the government should provide no financial benefits for its citizens?

No idea where you're coming from with that.

The question is: should the government pay for everyone's healthcare? Universal health care sounds amazing except no one has a plan to pay for it, at least in the U.S. where our system is outrageously expensive.

If your plan is just to tax a small group of earners to pay these astronomical fees, good luck with that.

More realistically we have to bring the costs of healthcare down, but that seems to get little to no attention.

> More realistically we have to bring the costs of healthcare down

Given that places where government pays for everyone's healthcare, in the developed world, get compsrsvle outcomes at much lower per capita and per GDP cost than the US system, I don't see that an idea opposed to universal healthcare so much as a motivation for it.

You're assuming they have much lower costs because of socialized medicine -- that's not necessarily the case.

But my broader point is just that universal health care is not an honest description of what it is, and our costs are so great we're unlikely to ever implement such a wealth transfer.

It's a lot less pie-in-the-sky IMHO to focus on bringing costs down. UHC could help in some ways but it's a broad assumption to make that if say Medicare paid for everything prices would just automatically start to drop.

I've seen people take this view, and their view crumble as soon as they get a life-threatening condition and receive (mostly) free healthcare (in Australia). If I'd been born in the US, I'd be dead by now.