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I'd suggest not to use the model of centralistic and rather socialistic nations like France as a model for the US. Not that I don't like that model, I just don'

I'd suggest not to use the model of centralistic and rather socialistic nations like France as a model for the US. Not that I don't like that model, I just don't think it's a good fit. Instead look at Switzerland for example. Leaving foreign politics away it almost seems like a shrunken down version of the US, both politically and economically, with just a few major differences: * even more locally organised. County sized administrations have about the same independence as US states. * instead of spending our (similar) tax rates on the military, it is spent on superb health care (imagine a souped up version of Obamacare with regulated prices), schools and a social net. Look at the numbers though - I think it works, that is, innovation and the economy in general are strong thanks to a more stable middle class (that doesn't experience negative social mobility due to health care problems and overpaid schools plus gets an influx from people at the poor end that make it by means of a helping hand at child age). * and no, I would argue Switzerland is not significantly less diverse with about 30% immigrant population. We have about the same proportion of backwards rightwing pseudo conservatives as a counterreaction, but they are bound to a political system that makes getting absolute majorities in the parliament near impossible (and also relatively useless alone thanks to referendums that serve as a moderation tool). See also again the difference in how middle class is kept going, which makes a Populist power grab much less likely.

adventured 9y ago
We could redirect 50% of our military spending to single payer and it would not even remotely fix our problems. That amount of money would make single payer work in just California (ie 10% of the nation). We probably need to be spending $200+ billion more just on our existing medicare + medicaid + VA health systems as it is. People that keep saying things like that about military spending, don't seem to understand that the biggest problem the US has, is for single payer to work millions of Americans are going to have to lose big time, to the tune of a trillion dollar cut affecting millions of incomes & jobs that feed off the system bloat. You either need to come up with trillions of dollars in new funding to do single payer, or you need to tell millions of Americans they're going to be fired and or take big pay cuts (plausibly both). I agree, there are better systems than France. My only reference to France, is about competitive salaries in the healthcare industry. Wages in that industry have to come down by a lot to match comparables in eg France, Germany, UK. When people talk about single payer re the US, they focus on drug prices and insurance industry costs. They ignore that essentially every cost in the US system is inflated, including routine labor and dozens of side connected feeder industries (everything from saline supply to the cost of hospital beds to labor costs in elderly care). Most of the cost bloat in the system is made up of salaries for workers such as nurses, doctors, hospital workers, admin and health insurance employees. You could slash pharma costs nearly in half in the US and only save ~$150 billion of the $1 trillion we have to cut out of our costs to get cost competitive again. Every one of these cuts will have substantial economic consequences; cut pharma in half, lose a million high paying jobs directly & indirectly that support the tax base that pays for the single payer system (ie you have to figure out how to replace that; which would occur, but it'd take lots of time). That said, the way the US is actually going to go, is we're going to do a slow mediocre drift into single payer, through gradual expansion as the existing convoluted system fails one tier after another (essentially failing up the economic chain; the middle class will gradually all be pulled into government healthcare by necessity as the system collapses). Maybe out of desperation they'll use medicare as the platform, since the politicians in Washington DC can never agree on anything it's most likely our result will be to use something that already exists and just enlarge it.
- m_mueller 9y ago
  Again, broaden your view a bit. Switzerland has a very similar health care system with a similar cost structure and a similarly strong pharmaceutical lobby - just vastly better outcomes.
- Retric 9y ago
  US government spends more per person on heathcare than Canada. So, we could use their system for essentially zero extra cost per year post transition. The difference is US heathcare makes people rich, where US social security for example does not. This waste does not translate to better care just vastly more waste. The VA hospital system is a US example demonstrating vastly lower costs with similar outcomes. Scale that to say all of Medicare + all government workers and costs drop enough to cover vastly more people. Now add in other programs like the Ryan White AIDS program which covers ~300,000 people with very high cost care and the supliments to Rural heathcare systems etc and heathcare would look very different and cheaper.
  - adventured 9y ago
    > US government spends more per person on heathcare than Canada. So, we could use their system for essentially zero extra cost per year post transition. I've made that point numerous times in this thread. I think you're missing my point: the US has to slash a trillion dollars in expenses out of its system. That trillion dollars consists of jobs & people's income & tax base loss. It is not a zero cost transition, it's a massive cost transition. You're talking about it as though it would occur in a vacuum, it would not. The VA system is not an example of lower costs. You're wrong, it's more expensive than both the private sector and medicare: http://dailycaller.com/2014/06/02/report-va-health-care-has-highest-adjusted-costs-in-nation/ http://dailycaller.com/2014/06/02/report-va-health-care-has-...
    - Retric 9y ago
      Your comparing heathcare spending while ignoring age differences making that analysis meaningless. 4 to 40 year olds don't spend much on healthcare. Veterans are by definition old. Further the UA is often covering the most expensive care such as hip replacements, the fact that it's a lower percentage of costs is a result of efficiency of the VA and waste in the rest of the system. As to lowering costs, economically spending money on heathcare billing vs Rail is only different because Rail provides long term value. As long as total spending is unchanged there is no reason to suspect economic harm.

adventured 9y ago

We could redirect 50% of our military spending to single payer and it would not even remotely fix our problems. That amount of money would make single payer work in just California (ie 10% of the nation). We probably need to be spending $200+ billion more just on our existing medicare + medicaid + VA health systems as it is. People that keep saying things like that about military spending, don't seem to understand that the biggest problem the US has, is for single payer to work millions of Americans are going to have to lose big time, to the tune of a trillion dollar cut affecting millions of incomes & jobs that feed off the system bloat. You either need to come up with trillions of dollars in new funding to do single payer, or you need to tell millions of Americans they're going to be fired and or take big pay cuts (plausibly both). I agree, there are better systems than France. My only reference to France, is about competitive salaries in the healthcare industry. Wages in that industry have to come down by a lot to match comparables in eg France, Germany, UK. When people talk about single payer re the US, they focus on drug prices and insurance industry costs. They ignore that essentially every cost in the US system is inflated, including routine labor and dozens of side connected feeder industries (everything from saline supply to the cost of hospital beds to labor costs in elderly care). Most of the cost bloat in the system is made up of salaries for workers such as nurses, doctors, hospital workers, admin and health insurance employees. You could slash pharma costs nearly in half in the US and only save ~$150 billion of the $1 trillion we have to cut out of our costs to get cost competitive again. Every one of these cuts will have substantial economic consequences; cut pharma in half, lose a million high paying jobs directly & indirectly that support the tax base that pays for the single payer system (ie you have to figure out how to replace that; which would occur, but it'd take lots of time). That said, the way the US is actually going to go, is we're going to do a slow mediocre drift into single payer, through gradual expansion as the existing convoluted system fails one tier after another (essentially failing up the economic chain; the middle class will gradually all be pulled into government healthcare by necessity as the system collapses). Maybe out of desperation they'll use medicare as the platform, since the politicians in Washington DC can never agree on anything it's most likely our result will be to use something that already exists and just enlarge it.

m_mueller 9y ago
Again, broaden your view a bit. Switzerland has a very similar health care system with a similar cost structure and a similarly strong pharmaceutical lobby - just vastly better outcomes.
Retric 9y ago
US government spends more per person on heathcare than Canada. So, we could use their system for essentially zero extra cost per year post transition. The difference is US heathcare makes people rich, where US social security for example does not. This waste does not translate to better care just vastly more waste. The VA hospital system is a US example demonstrating vastly lower costs with similar outcomes. Scale that to say all of Medicare + all government workers and costs drop enough to cover vastly more people. Now add in other programs like the Ryan White AIDS program which covers ~300,000 people with very high cost care and the supliments to Rural heathcare systems etc and heathcare would look very different and cheaper.
- adventured 9y ago
  > US government spends more per person on heathcare than Canada. So, we could use their system for essentially zero extra cost per year post transition. I've made that point numerous times in this thread. I think you're missing my point: the US has to slash a trillion dollars in expenses out of its system. That trillion dollars consists of jobs & people's income & tax base loss. It is not a zero cost transition, it's a massive cost transition. You're talking about it as though it would occur in a vacuum, it would not. The VA system is not an example of lower costs. You're wrong, it's more expensive than both the private sector and medicare: http://dailycaller.com/2014/06/02/report-va-health-care-has-highest-adjusted-costs-in-nation/ http://dailycaller.com/2014/06/02/report-va-health-care-has-...
  - Retric 9y ago
    Your comparing heathcare spending while ignoring age differences making that analysis meaningless. 4 to 40 year olds don't spend much on healthcare. Veterans are by definition old. Further the UA is often covering the most expensive care such as hip replacements, the fact that it's a lower percentage of costs is a result of efficiency of the VA and waste in the rest of the system. As to lowering costs, economically spending money on heathcare billing vs Rail is only different because Rail provides long term value. As long as total spending is unchanged there is no reason to suspect economic harm.