This is actually the reason why I'm a proponent of the US Federal government doing far _far_ less. Things like Healthcare and other safety net things (along with most other things) should be done at the state level, and the the fact that European nations, which are near universally poorer than all US states, are able to do these things, are the proof that this would work.

I'm convinced that the federal government doing more and more things is the root cause if the increasing toxicity of American politics. The further removed a populace is from their representatives the less control they have and the worse they feel. Everything should always be done at the most local level that it is possible to do it. Some things have to be done at a relatively high level, but Americans have increasingly been jumping straight to "this is a job for the federal government" when very often state, or even city governments in some cases, would be perfectly capable.

> which are near universally poorer than all US states, are able to do these things

What do you mean that the countries are poorer? Are you just thinking about the gross salary people get per month, or is there something else in this calculation?

The fact that people get health care, parental leave, can freely move between countries, able to afford having a child, have emergency services that arrive relatively quick and all those things mean that a country is not poor, and the countries that don't have those, are "poorer", at least in my mind. When I think "poor country" I don't think about the GDP, but how well the citizens and residents are protected by ills.

I know you've made a handful of comments all to this effect throughout the thread, but it's really not helpful in this particular comment chain. Yes, we know your quality of life in Europe is great. Yes, we know life is more than just GDP. "What we mean that the countries are poorer" is obviously GDP in this comment chain, and this comment chain is not disputing your quality of life, it's pointing out that we (collectively) have the money to have that quality of life here in the US, too.

But thats a flawed metric. How much cash do you need saved to send 2 kids to university in US vs typical Europe, without burdening them for their best years of life with crushing debt? How much is left afterwards? How much after acquiring some long term illness with expensive treatment or being in bad accident? Don't think that due to being young this ain't your concern, all elders have messed up health in many ways. Retirement. And so on. These are direct costs and its all about money. Ie US couple with teens just about to go to college with say 500k are same or poorer than similar family in Europe having say 200k savings, or will be after few years. Or maybe not, depends.

I'd say its uncomparable directly, or very, very hard. You can say visit both places and walk around and see the general state of the country and its people, compare capitals. This is where money is spent (or not).

Not going into happiness, stress levels, depression/anxiety and meds consumption, obesity levels or longevity, that would be too easy I agree. Although this is also money related, more than anything else.

80% of US college grads have debt under 30k. Despite the bleak picture painted, servicing that interest at say 7% is $175 a month, or about 3.5% the average salary of a new grad.

This pales in comparison to some of the elephant in the room ways most common ways to go broke, which is to say get something like a child support judgement against you (20% pretax, like 26+% post-tax in middle income brackets) or have an alimony payment (these conveniently don't generally show up in bankruptcy statistics because they are not dischargeable). Medical debt can at least be discharged in bankruptcy.

The federal government has no constitutional authority to provide universal health care, per the 10th amendment which leaves an extremely narrow constraint of enumerated powers to the federal government and the rest left to the people and the states.

However, the feds already siphon about as much tax as the populace can bear just on accomplishing what it is allowed to do, so there is basically nothing left for the states to implement these kind of measures.

Yes, if the states were to take over many of these things, obviously federal taxes would need to dramatically decrease (luckily, the vast majority of federal spending is doing the things that I think states should do anyways, so you'd be simultaneously dramatically decreasing federal taxes and federal spending).

You couldn't just have the states take over these responsibilities and have nothing else change. My suggestion is in fact a pretty radical change in how the US federal government works. I'm not under any illusion that this is likely to happen. The ratchet of power unfortunately only goes in one direction.

Our GDP would drop several percent if we fixed our healthcare system. Part of why we look richer on paper is that we light a lot of money on fire for exactly nothing.

Not really. That money didn't appear out of thin air. It would be lit on fire for some other purpose instead.

Ah, there’s always zero-sum competition for housing to eat up any excess that might otherwise go to savings. That’s true. Money gets freed up across the board, you spend it on housing or lose ground in the housing competition. Good ol’ red queen’s race.

The American government spends an incredible amount on healthcare already. If it were competently administered, it would already be enough money to cover universal healthcare.

It's the cost of procedures/medication

Example: https://worldpopulationreview.com/country-rankings/cost-of-i...

And why, in free market land, is a buyer of services and medication, not allowed to negotiate prices?

Which buyer are you referring to? Consumers paying cash can negotiate as much as they want, and often secure large discounts. Commercial health plans also negotiate hard with their network providers, although some of them play unethical tricks with PBMs to artificially inflate prescription drug prices. Medicare and Medicaid don't really negotiate with providers, they just set rates by arbitrary fiat and providers can take it or leave it. Medicare does have some statutory limitations on how they can negotiate drug prices, though.

Its the cost of keeping American doctors living in mansions big enough to house a whole village.

Which doctors? Some specialists do quite well but many primary care physicians earn less than software developers, especially once you account for education expenses and ongoing mandatory professional expenses. What is the correct amount for them to earn anyway?

The ones in my town, I know where they live, up by the lake.

Where should they be living? You seem to be upset about something but you're not making any sense.

> why, in free market land, is a buyer of services and medication, not allowed to negotiate prices?

Because W Bush decided to forbid that while simultaneously forcing the fed'gov to pay for it

"we need to pay face value because big companies need the money for their R&D" was the discussion years ago IIRC. it's BS, but that was the narrative.

Above all it's great example of why we'd do well to drop our quasi-religious fetishization of GDP as an indicator.

Who is fetishizing GDP? I've never seen public policy be set based on the goal of maximizing GDP to the exclusion of all else. You're arguing against a strawman.

then prices will decrease and thus GDP will be lower, isn't it?

We already do have universal health care for the most expensive groups to insure (lower income households and the elderly), and technically have it for everyone in that hospitals aren't allowed to deny life saving care to anyone regardless of their ability to pay (which is expensive, short sighted, and quite inadequate overall).

Adding the rest of the population to the existing public insurance system would not cost much financially, but it would be a political catastrophe for whatever party implemented it if it didn't go well.

In short, I don't think anyone seriously argues the US can't afford universal health care, but the real and perceived risk of change is seen as too great politically.