3 ms·

Let’s turn that question around: It scales relatively well from countries with less than 1 million to countries with more than 80 million people, with the same

Let’s turn that question around: It scales relatively well from countries with less than 1 million to countries with more than 80 million people, with the same variations in population and geography (although to be honest I don’t understand why race or culture would make a difference to a healthcare system). So why wouldn’t it scale further? Is there some fundamental limit at 100 or 200 million that would make it impossible?

TeMPOraL 7y ago
Note that as long as you keep the bureaucracy mostly at state level, the argument of scale doesn't apply to the US - seen from the state level, the US is really just 50 small countries in a federation.
- beat 7y ago
  That's a far, far better statement of the problem. We have a system that is subject to both federal and state law. But I'm not convinced that it's a total explanation, either. Necessary but not sufficient.
  - arcticbull 7y ago
    It’s how Canada works too. Federal minimum requirements (the Canada Health Act) implemented at the provincial level.
simongr3dal 7y ago
Race and culture being varied shouldn't be a propblem neither should having a big population size. I think having differing regulation in each and every state is the thing that will create complications. Just as abortions aren't outlawed federally, I think making sozalized healthcare equally available will perhaps be similarily difficult as it is to make abortion equally available.
- mikem170 7y ago
  >I think having differing regulation in each and every state is the thing that will create complications. And having one federal system creates corruption - a one-stop shop for lobbyists. Do you really want congress and the president deciding on budgets for various illness, prescription costs, what is covered, etc?
  - simongr3dal 7y ago
    I'm not arguing that having more things regulated federally or having a completely federally regulated America is going to be better. It seems like you think of lawmakers and lobbyists as adversarial, not necesarily untrue, but it it is hard to argue in any direction since they will always be working against you to their benefit. I was pointing out that this is what makes America "varied" compared to other countries and it will introduce complications and variations in how a healthcare system is going to work for it's citizens if they do try to mimick Canada, UK, etc. I would also hope that the hospitals have a bit more autonomy and they aren't hamstrung by congress deciding they aren't allowed to spend more than 5mn on sedatives or some other really narrow and specific budget.
arcticbull 7y ago
And further you needn’t scale it beyond 30 million if you leave it to each state to build a system that meets federal minimum requirements, which is what Canada does.
mikem170 7y ago
I'm 100% opposed to federal health care, but would be in favor of letting the states do whatever they want. How about that? Like you said, small countries already do this. When 2/3 of the states can agree on a system then we make it federal. This is more like what Sweden does, their counties finance and administer health care according to agreed upon federal standards. The U.S. government has already made a huge mess out of health care- the biggest in the world it appears. I don't trust them. We've already been screwed by industry lobbyists. They need to take a back seat and let the states run with this for now. As per our constitution. I am 100% in favor of various plans at a state level. Vermont was going to do single payer before Obamacare. That's what I want to see. States will copy successful systems, and an amendment can eventually be passed once enough states agree on a federal system.
- krupan 7y ago
  So if one state offers free health care for all, how do they avoid the freeload problem? When I lived in Washington near the Oregon border, we Washingtonions loved shopping sales tax free in Oregon. What prevents us all from going to Vermont as soon as we get cancer and overwhelming their system?
  - mikem170 7y ago
    That would seem to be a concern, but it didn't stop Massachusetts from implementing Romneycare, nor Vermont from passing a single payer system, nor NY and California making plans for the same. It was happening before the feds got involved. Besides the fact that is how it's supposed to work in this country. The constitution doesn't give the fed the power to regulate health care. That is supposed to require an amendment, which requires something more than a 51% majority because it is a big deal.

TeMPOraL 7y ago

Note that as long as you keep the bureaucracy mostly at state level, the argument of scale doesn't apply to the US - seen from the state level, the US is really just 50 small countries in a federation.

beat 7y ago
That's a far, far better statement of the problem. We have a system that is subject to both federal and state law. But I'm not convinced that it's a total explanation, either. Necessary but not sufficient.
- arcticbull 7y ago
  It’s how Canada works too. Federal minimum requirements (the Canada Health Act) implemented at the provincial level.

simongr3dal 7y ago

Race and culture being varied shouldn't be a propblem neither should having a big population size. I think having differing regulation in each and every state is the thing that will create complications. Just as abortions aren't outlawed federally, I think making sozalized healthcare equally available will perhaps be similarily difficult as it is to make abortion equally available.

mikem170 7y ago
>I think having differing regulation in each and every state is the thing that will create complications. And having one federal system creates corruption - a one-stop shop for lobbyists. Do you really want congress and the president deciding on budgets for various illness, prescription costs, what is covered, etc?
- simongr3dal 7y ago
  I'm not arguing that having more things regulated federally or having a completely federally regulated America is going to be better. It seems like you think of lawmakers and lobbyists as adversarial, not necesarily untrue, but it it is hard to argue in any direction since they will always be working against you to their benefit. I was pointing out that this is what makes America "varied" compared to other countries and it will introduce complications and variations in how a healthcare system is going to work for it's citizens if they do try to mimick Canada, UK, etc. I would also hope that the hospitals have a bit more autonomy and they aren't hamstrung by congress deciding they aren't allowed to spend more than 5mn on sedatives or some other really narrow and specific budget.

arcticbull 7y ago

And further you needn’t scale it beyond 30 million if you leave it to each state to build a system that meets federal minimum requirements, which is what Canada does.

mikem170 7y ago

I'm 100% opposed to federal health care, but would be in favor of letting the states do whatever they want. How about that? Like you said, small countries already do this. When 2/3 of the states can agree on a system then we make it federal. This is more like what Sweden does, their counties finance and administer health care according to agreed upon federal standards. The U.S. government has already made a huge mess out of health care- the biggest in the world it appears. I don't trust them. We've already been screwed by industry lobbyists. They need to take a back seat and let the states run with this for now. As per our constitution. I am 100% in favor of various plans at a state level. Vermont was going to do single payer before Obamacare. That's what I want to see. States will copy successful systems, and an amendment can eventually be passed once enough states agree on a federal system.

krupan 7y ago
So if one state offers free health care for all, how do they avoid the freeload problem? When I lived in Washington near the Oregon border, we Washingtonions loved shopping sales tax free in Oregon. What prevents us all from going to Vermont as soon as we get cancer and overwhelming their system?
- mikem170 7y ago
  That would seem to be a concern, but it didn't stop Massachusetts from implementing Romneycare, nor Vermont from passing a single payer system, nor NY and California making plans for the same. It was happening before the feds got involved. Besides the fact that is how it's supposed to work in this country. The constitution doesn't give the fed the power to regulate health care. That is supposed to require an amendment, which requires something more than a 51% majority because it is a big deal.