A large portion of those millions of jobs are not contributing to human progress. We don't flip the switch overnight, but in my opinion, a sane government should have announced decades ago,

"Hey, we're going to do away with this private health insurance business in 10 years (or whatever!). We are accepting applications to help us with the new plan, and otherwise, you should begin thinking about what you will do after we complete this transition. Here are some resources that we are providing to help you figure that out."

As for unhealthy Americans I don't have much of a solution to offer. Sugar Tax? Maybe. I don't know what else. Just don't be idiots, people! Take care of your bodies! Get off your asses and do something! It's frustrating, because I don't feel like I'm really part of the problem.

I also don't really think that Americans being unhealthy should prevent us from moving on. There is nothing hidden about the blight of Private Health Insurance. It's governed by greed, and it's obvious. It's already socialized, because some 10-20% of my paycheck goes to health insurance for my family, and I almost never use it at all! Meanwhile, my oldest child has a chronic condition and is almost 100% covered by a State funded health insurance program (and I'm very thankful for that)! We're part of the way there already! The system is broken, and I find there are few topics on HN that I have a stronger opinion about.

> It would mean millions of jobs lost, what are those people going to go do?

This is legitimately one of the biggest issues with single payer, and absolutely worth talking about. Our grossly inefficient system has created many layers of administrative bureaucracy that would have to be shed and that's not going to be an easy problem to solve.

> Defund the craziest, largest military in the world and you wouldn't pay for 10% of the single payer health system.

The CBO scored 5 different variants of a single payer system and found that 4 of them would reduce overall healthcare expenditures[0], so even if taxes were increased to pay for single payer, those increases would theoretically be less than the current amount we spend on healthcare because of the lower administrative overhead. Lots of policy people have done research on this, it's simply not true that a single payer system is just out of the realm of possibility.

> If your endgoal is single-payer healthcare in the USA. Step 1 is getting Americans healthy again and I think we have hit a roadblock.

I fail to see the correlation here, Americans don't want single payer because there are powerful political voices that frankly tell some serious fibs about it (see your own comment above about the viability of single-payer). The food supply is a serious issue as well, but this is like arguing that everyone in the US just needs to start making six figures and that's how we'll end poverty. That's just not reality.

0: https://www.healthaffairs.org/do/10.1377/hblog20210210.19024...

  >  It's very expensive to the american people

doesnt a single payer system also presume single-buyer/negotiator for prescription drugs which would lead to vastly cheaper costs all around?

> The reason the USA can't fathom going to single-payer system is because Americans are so unhealthy.

> If your endgoal is single-payer healthcare in the USA. Step 1 is getting Americans healthy again and I think we have hit a roadblock.

American's are unhealthy, yes, but the real problem with healthcare in the US is the cost of healthcare, first and foremost [1].

Single payer could at least negotiate prices down, but does not go far in enough IMO. I am pretty much a hardcore free market fundamentalist, but healthcare should have no space for profit motive.

Obamacare was, for a lack of a better word, a joke. More or less, it was (publicly and privately) funded expansion of the current system. Case in point, in order to subsidize the higher healthcare cost for older Americans, Obamacare (stupidly) forced healthcare on younger people via the individual mandate, effectively shifting the premium costs to younger people in order to pay the healthcare costs of older, less healthy people. There were other dumb problems, too. Yes, it did save lives in the short term but did fuck-all for fixing the system - the main problem being (again) costs.

[1] https://www.washingtonpost.com/opinions/fareed-zakaria-curbi...

US pays more for healthcare than any other developed nation and gets the worst service. This is just a bunch of talking points I see repeated a lot. With single payer we can actually save money as a nation.

bit of a catch 22, USians are unhealthy in part because adequate healthcare is out of reach because of its cost

No, Americans are unhealthy because the vast majority of them eat like crap, are lazy, and are fat as hell as a consequence. That's not a healthcare issue.

If more of our doctors cared about people more than money, and kept nutritionists on staff, it might make a dent in things. So I find that it is a healthcare issue. Here, on HN, and in the industries that many of us work in, we have a lot of knowledge and understanding about our own bodies and the care of them. But a large portion of the populace lack that! For some people, nutritional advice would fall on deaf ears, but there are some people as well who, if told by a true expert, "Here is a diet plan. If you follow it closely you won't be so out of breath when you go upstairs. Your ankles and knees won't hurt constantly. You'll be able to keep up with your grandkids better. You'll live longer (on average!)."

If told they would actually do it, and improvements would be made.

That might be one (fairly expensive) strategy to address it. But the rest of the world doesn’t avoid the US problem because they’re all seeing nutritionists all the time.

I won't argue that the US is at the top but there are many other developed countries following behind. I think education is definitely a part of it.

Much of the world is better educated in general. Much of the other ones don't have the problem/luxury of too much to eat.

Something started in the 70s and I’ve never seen a good explanation of what it was. But you can see in the stats that obesity hit an inflection point in the mid-1970s, started going up and has never looked back. Now we’re at 80% overweight and 40% obese and still rising.

Pinning it on willpower or individual choices seems way off base. Something system-wide happened here and it’s crazy that we don’t know what it is.

In the middle ages, only royalty and elites were fat because they were the only ones who had access to the abundance of food that made it possible. It was seen as a good thing to be fat. Hell, in today's society the "Health At Any Size" movement portrays morbid obesity as no big deal at best, and a good thing at worst.

> But you can see in the stats that obesity hit an inflection point in the mid-1970s

This is about where mass production of hyper-processed foods hit critical mass of cheapness and availability.

Americans have easier and cheaper access to nearly infinite amounts of food that middle age kings could only dream of.

My bet is that a significant chunk of this is the push of populations out of cities and into car-focused suburbs. Matches up quite well timeline wise as second-order effect of the post-war suburban boom.

Comments like yours are just not helpful or productive. There are definitely lazy people all over the world but I think what you said is more of a symptom than a cause. When entire communities are generationally stuck in a trap of eating highly processed foods for how easy/cheap they are it can be difficult to escape. But of course it's a lot easier to go the uneducated simpleton route and just say they are lazy.

If you're 300+ lbs, you are lazy, period. Sugar coating it isn't doing anyone any favours.

I am sorry for you.

A staggering amount of money thats spent in the healthcare industry is directly due to Americans unhealthy lifestyles, primarily obesity and its secondary symptoms.

"edit/ welp stepped in it. Highly downvoted. sorry everyone, guess not allowed to discuss this one."

You are downvoted not because it's not allowed to discuss this but because it doesn't make sense. You can't explain the regular overcharging of hospitals with an unhealthy population. Neither can you explain why an MRI costs ten times as much as in other countries.

We already spend over $3.8 trillion per year on healthcare in the US… using a single-payer system would probably not be more expensive than that