Immigration affects this calculation significantly.
If your long game is to be an attractive destination to healthy educated immigrants, investing in the "land of opportunities" mythology has better ROI than investing in universal healthcare.
Sure, but it's not a dichotomy either. I suspect they both have better ROI than average for government spending.
If you want to attract, say, a young PhD with a spouse and kid, the guarantee of healthcare for the family - even if they change jobs - is a huge selling point. Anecdotally at least, I've known several international students who left the US after college for Canada, France, or England and cited this as a factor. (The ridiculous artificial barriers like "go home to file this form and come back" don't help either.) And with non-open immigration, e.g. the Canadian model, there's no special economic burden to this approach.
Maybe that's a good thing. Invite enough educated immigrants, and America will have more people saying "You know what, my country had a saner healthcare system thirty years ago when ordinary people couldn't afford air conditioners. What the hell is wrong with you America?"
(Yes, I'm speaking from my own experience.)
It’s not about the goals, it’s about the coercion.
Sometimes one decides to leave the country because the misalignment of goals becomes intolerable. But there is no substitute for a properly functioning government. At least not at our current level of our collective psychology.
I would assume that if you live on someone’s land, you would agree that their property rights mean you must pay rent, otherwise you must move.
The government is sovereign over the the land of the nation. If you live there, you must pay “rent” in the form of taxes. You aren’t respecting the property rights of the nation otherwise. You can always move.
I believe the same dynamic is at work WRT the concentration of wealth in the US. I understand the short term desire to accumulate wealth. I do it myself. It seems to me that if trends continue, there will be less and less income for the other 99% to spend. (Yes, I'm mixing income and wealth here because I believe that the desire to increase wealth on the part of the wealthy results in downward pressure on income for the rest of us.) In my Econ 101 class they spoke of the velocity of money - how much gets spent. It seems to me that the velocity has to go down as earnings go down and at that point, the ability to accumulate wealth would start to decrease.
(These thoughts ignore the possibility that those who are not wealthy could provoke social upheaval. I don't know if that's a real possibility.)
You can't ensure health unless you have wealth in the first place. You can see that things moved in that order in the past 300 years: the more wealthy a country was, the longer people lived and the better they could face different conditions. The greatest strides against mortality were accomplished long before the welfare state as an expression ever existed.
I actually think a long-term vs short-term view is insufficient. Let's step away from firms and take the case of the rich and the poor individual. For the poor individual it is in their interest in the short and long-term interest to have universal healthcare. For the rich individual, it is in their short and long-term interest to prevent universal healthcare. According to the investment theory of party competition [1] this rich vs poor divide becomes reflected in our politics as both parties vie for the donations of the wealthy.
[1] https://en.wikipedia.org/wiki/Investment_theory_of_party_com...
Not necessarily, although it does depend on the definition of "long-term":
* Reducing ER visits for preventable issues lowers hospital costs
* Higher demand for supplies should lower costs
* A larger market creates stronger incentives to research and address rarer diseases
* Eliminating individual medical debt reduces crime rates, increases education/competition
This perspective of public vs private interest is rather puzzling to me -- it's more a matter of short-term vs long-term thinking. In the long-term, it's in the private interest of those having sustainable companies to have a broad base of educated and healthy workers to employ. The short-term interest of any single firm has a different calculus, but all private companies would benefit from a stronger public education and health system.
The goal of government, in my opinion, is to focus on long-term objectives: ensuring a sustainable healthy and educated population.
It's similar case for education. It's not that I'm paying for someone else's kids school so much as I'm paying so that one day, when I need a smart educated nurse to take care of me... it'll likely happen at a reasonable price because there are so many educated people who have decided to be nurses.