3: Don't need health insurance so I'd say that's better.

4: We can chose our own primary doctor from the pool of available GPs. Available just means that some GPs have too many patients on their list already and don't have any slots available. You can switch primary GP once a month (IIRC). I switched a few times until I found one which I liked. Repeated the process when I moved.

5: I can see my GP whenever I feel like it, just need to set up an appointment. If you mean to see a specialist then yeah, I'd need my GP to refer me. Sometimes this can feel a bit unnecessary but mostly it's not a big issue IMHO.

6: If my GP doesn't have time for me, I'd just switch and find one who does.

There's a big group of other issues at play. And universal healthcare in the US would be so massive that you can't compare it to a small country.

You do have health insurance, it's just provided by the government with premiums paid through taxes. When people express the concern that their insurance would get worse, they mean that the insurance provided by the government would be worse than what they currently have. There are a number of different things that people think make plans worse or better, which is a major contributor to the difficulty in having a clear discussion about this.

Yes, I had a line about being taxed quite heavily but deleted it for reasons I've forgotten, and I missed updating point 3.

I don't need to worry about my insurance though, what it covers etc.

One thing I'm way more afraid of with a single payer system (but not necessarily all universal coverage systems) is that if the coverage became worse, I would have no recourse; it would be a monopoly, I wouldn't be able to look for a better competitor. Even worse, it would be a monopoly run by a political bureaucracy, so coverage decisions could become political. For example, coverage for birth control is a very political topic here. I'm certain that the first incarnation of a single payer system would cover that, because it would be set up by the politicians who favor it, but once the system is enshrined, whoever is in power would be able to change it however they think best. Coverage policy could easily become a political football.

Plenty of developed countries like Germany and France have better access to health care (that costs a lot less) while still being multi-payer with private insurances. Although in the US we just seem to only pay attention to Canada and the NHS so universal health care and single-payer are tied together.

Honestly I think people's expectations have gotten much too high about single-payer solving all our problems. Clearly other developed countries have gotten their health care (relatively) in order without doing single payer. And we basically already have single payer for age 65+ and the costs there still aren't nearly in line with everyone else. The US definitely spends much more (as a % of GDP) than everyone else (to not dramatically better results) but single-payer or not doesn't seem to be the key difference.

We also have something similar in the U.S., given that roughly half of medical care is paid for by the government. Medicare sets prices for each CPT code, and they do it through a formula that depends on geography, and something called Relative Value Units.

This is done nominally by the Center for Medicare Services, but they rubber stamp the work of the Specialty Society Relative Value Scale Update Committee, which is a group of doctors appointed by their respective medical societies to decide how much Medicare should pay them. When doctors can simply tell the government how much they should be paid, what do you think is gonna happen?

At my last N employers, I’ve been lucky enough to choose between literally the best HMO in the US (on multiple metrics), and top-end insurance plans from a range of multiple companies (e.g., a $0 annual deductible plan or an HSA + high deductible plan, where the employer’s HSA contribution matches the annual deductible).

The paperwork for the high deductible plan took multiple letters per doctor visit spread over multiple months, and more than doubled the paperwork we had to track for income taxes. This is completely unacceptable.

The HMO is, well, an HMO, we have limited choices of doctors and specialists, but I swipe my credit card when I check in or pick up medicine, and that’s 100% of the paperwork, even for extended hospital stays.

The only people in the US with better health care plans have what I have, and also a personal assistant (or heroic spouse) to abstract away how messed up the system is.

For these reasons, I argue the US health care system has failed all but top <1%, and those people can already afford to fly to Europe and buy specialist care, I don’t see why they won’t be able to do so in the US after the rest of us get universal healthcare.

With that said, having a massive middle man (private health insurance) to act as bloat and added friction on the economy is bad for everyone. You may not be directly affected but you are definitely affected in other ways that aren't as obvious.

I find this sort of thing is common in America. There is always an industry set up as a middle man that needs to get paid.

The Obamacare tax was something like 3%, and only for the extremely wealthy.

In contrast, 33% of US healthcare costs go to insurance overhead, and >17% of our GDP goes to health care, so nearly 6% of the gdp goes to private insurance middle men.

Source on 17%: https://www.statista.com/statistics/184968/us-health-expendi...

Now, the entire federal government is currently spending 37% of GDP (though that includes deficit spending), so you posit that at least ~ 1/6th (6/37) of government spending is some healthcare program.

Source on 37%: https://tradingeconomics.com/united-states/government-spendi...

Medicare and health costs ~ $1T of the government’s $3.8T budget, which is a bit over 1/4th of the federal budget. That does meet the threshold of your claim, but only if much less than half of Medicare spending goes to actual health care.

Source on 1T Medicare, etc spending: https://www.nationalpriorities.org/budget-basics/federal-bud...

This study from 2001 concluded Medicare is about 80% efficient (20% waste): https://www.nber.org/papers/w8395

Note that the 20% Medicare waste number from the NBER study is not apples to apples with the 33% administrative overhead number, since it includes ineffective medical care (and all other wasted spending) that did not improve patient outcomes in the 20%, but the 33% number for insurers only counts useless paper pushing, and not ineffective care, etc, etc.

So, private insurers really are squandering many more healthcare dollars, and are also much less efficient than the federal government.

6% of GDP to private insurance? Math doesn't add up on this back-of-the-napkin math. That's an entire Apple of operating costs every year.

The biggest insurance company, UnitedHealthcare, is worth 200 bill in the market. The gov could buy the big 5 insurance companies with half its yearly medicare budget.

Don't confound paying to insurance and paying to providers!

> So, private insurers really are squandering many more healthcare dollars, and are also much less efficient than the federal government.

I will answer seriously in a second, but for real: how is it so obvious that the private market beats the government on almost anything at any time, even this very government (for example, education) and still, the level of debate is "government is more efficient". Government is never more efficient, because it doesn't care about efficiency.

The comparison of efficiency between medicare and private insurance is grossly misrepresented by Bernie Sanders. First of all, there are some disingenuous numbers: it uses a measure of efficiency of total cost/admin costs, but that skewes severely in favor of medicare bacuse it has an older population that has more expensive treatment. Some economists looked into this and the cost of administration per patient is similar.

Second, a great part of why medicare has less admin burden is that its collections are done through payroll taxes. This means the admin staff is included in other government agencies. This is not a public-advantage, because you can also use payroll taxes to pay for private insurance if you wish so, something that exists in some other countries. ( to my dismay, for the following topic). Another trick here is that medicare collects from everyone and pays for a few. That is a great way to never have to market, administrate or manage people on your plan: you are not going to use it? tough luck. You dont like it? tough luck. You don't have quality coverage in your area? Tough luck.

This trick is so pervasive that even Bernie Sanders claims how medicare patients are so happy: why wouldn't they, the premium they should pay to maintain it is about 1k a month, and they pay 150!

Forth, it is key to understand that medicare offerings are not market competitive. They pay half of what private insurance pays, and there is no way in hell you make that work. Private insurance subsidizes medicare patients, and doctors would abandon the network if they were forced to accept medicare rates.

This is a long topic, but to re-frame the conversation: what makes healthcare in the us expensive is NOT private insurance. Most of the world has private insurance! even Canada! Even France! Spain, Norway, etc. US healthcare is expensive because it is one of the most tight regulated expensive markets in the US.

You might guess right now that I will argue the exact opposite point.

> ou completely left out that Republican Congress specifically denied Medicare the ability to bring in cheaper drugs from other countries and isn't allowed to negotiate drug prices, oh and they've underfunded every single regulatory agency for ages to be able to claim government doesn't work.

Aren't you taking into the calculations that socialized medicine will have the same political risks?

> Why is it that other countries can somehow pay more for the same or better care of their public options and we don't.

The U.S. has a specific regulatory framework that is chaoticly expensive. Regulatory capture is grotesque in the healthcare market, and you can read up what health economists say if you want details. You could aim to do a healthcare reform that just plain reduces the cost of care by 10, 20% easily by just doing less as a government.

> You're never going to have a cheaper private option with a profit motive on anything versus an option that doesn't require a profit motive.

1) Medicare is also more expensive than other countries socialized systems 2) Some of the biggest insurance companies are non-profits 3) The combined market value of the top insurance companies is less than half the yearly Medicare budget.

What people dont get is that private insurance fiercely competes to lower costs, while the government's only effective mechanism is to not pay anything at all. Socialized medicine in the us would usher a new era of Cash pay.

I was going to add to my comment but didn't that: This is all an incredibly privileged mindset. Many people don't start on the same level with the same chances, that we do. It's hard to blame poor choices when it's not a choice.

But at the end of the day that's a big appeal to emotion. The logical argument, is that the current system is a big honking added step in the system that adds nothing but subtracts a lot and whether or not "you've got yours" you are still affected by those who don't. Poor choices or not it's still in your own interest for the people to your left and right to be covered and get healthcare.

For me, since I saw first hand what the healthcare system did to my parents? No one should go through that. They had 'good enough' healthcare and it still financially and physically destroyed them.

You think you have good enough health insurance? You don't.

Not sure why those risks mean I have to get on board with a complete overhaul to something I don’t believe will work, as if that will be less risky.

You say that now, but the reality is much different when it comes down to it.

Like everyone else, you'll scream and cry like a stuck pig when it's your Mother/Sister/Daughter/Son who get unbelievably sick through no fault of their own and die early because of a lack of money.

The system as it exists today is nothing short of disgraceful. It's sad that you just accept it and have no interest in improve it.

I don’t have reason to believe my insurance will suddenly drop coverage when I need it. I don’t think that’s a huge risk.

Your hypothetical world isn’t all that safe either, because when the government says no, that answer is final. There is no other option, there is no other way even if I wanted to pay. That’s just as bad as coverage being dropped, and perhaps much more likely given my faith in the government to do things efficiently these days.

Even for lukemia, or lung cancer? and that's assuming you go to work for the rest of your life. What happens when you get so sick with one of the above you can't go to work and you no longer have insurance?

> Your hypothetical world isn’t all that safe either, because when the government says no, that answer is final. There is no other option, there is no other way even if I wanted to pay

That's simply not true. I've had personal experience in Australia, Canada and the UK, and in each of those systems you can choose to pay for private coverage & care if you so wish. I have never felt the need.

EDIT: Also, I thought of another reason.

You use the word "I" or "Me" 6 times. Does your grandmother have the same "bulletproof" coverage you do? Your nieces and nephews? Your Sister and her husband? How about your distant cousins? How about even your best friends, neighbors, and their loved ones. It's not all about you. Think about how your loved ones will be impacted, because they just might not have the same coverage you do.

There's loads of cases, including one in this thread, about people who thought they were covered but weren't. This is really a bad situation to be in if it happens, and it should worry you every time there's an event. After all, the insurance company has direct interest in not covering you.

Now the government does as well, this is true. But those cases, eg in the UK it's talked about a fair bit, tend to be where there's a judgement that a treat is neither not sufficiently tested to be useable, or simply not worth the cost-benefit, eg it's expensive and only buys the patient a few more weeks of life. So it's true what you say, but it's worth considering what the balance of risks is: a healthcare co that has an interest against you every time, and has been shown to fight, or the government, which normally only denies treatment in rare borderline cases.

I'd say a big part of it is particular to US culture: the healtcare cos have been shown to not be that easy to get money out of. Somewhere like Switzerland also has private healthcare, but they don't compete in the same way. Everyone must have insurance, and you won't be paying out of pocket above some limit. The companies are not famous for screwing everyone, and compete to provide extra service (eg hotel-like rooms when you have a kid).

Arguably their job is to not cover you. Paying actual medical expenses is referred to in the industry as "medical loss". To reiterate: paying for health care is considered a type of loss. Their goal is not your goal.

Are you confident you'll never go through a stroke?