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> It’s the same reason why most big corps oppose a national healthcare system in the US: it keeps people locked in to their current positions and has the knock-

> It’s the same reason why most big corps oppose a national healthcare system in the US: it keeps people locked in to their current positions and has the knock-on effect of putting downward pressure on wages and turnover expenses. Is this... true?

me_me_me 7y ago
One thing that has always came true throughout my life is a phrase: "If you don't know why, its money." Why there is no national healthcare - money, someone makes a ton of it by preventing nationalization of healthcare system. Everything that doesn't make sense, has better alternatives (somehow not adopted) always boils down to money :(
- FrankyHollywood 7y ago
  Another reason is people don't like sharing. In democracies the majority of people don't vote for a program where they have to pay for others, even if the net result would be in their advantage. so it's money, and stupidity :)
  - chooseaname 7y ago
    Exactly this. I'm in the South (U.S.) and a lot of people here would benefit from national healthcare, but they continue to vote against it (rather, for politicians who are against it) because "if you don't work for it, you don't deserve it." They're so afraid of the few who would take advantage of it that they're willing to let the many who need it not get it.
    - saiya-jin 7y ago
      Yes it sounds like common mentality in US - "you need to deserve your spot under the sun". This mindset can push society to achieve great things rather effectively (as seen numerous times in the past with US), but it can also mean cruelty to fellow citizens because... usually money, power, status. Everybody for themselves ain't a good model for a healthy society in long run. Way too many predators out there.
    - logfromblammo 7y ago
      I'm a Midwestern transplant into the South, and a significant proportion of the anti-welfare sentiment around here seems to me to be incredibly racist, plastered over with language that has been carefully scrubbed of any mention of race. And that poisons federal politics. The fear is there, but to me it looks like white people afraid that some black people or brown people might earn the same money for the same work, or get equal representation in government. And it's all apparently justified in the politically segregated religious congregations. There's that "if you didn't work for it, you don't deserve it" attitude, but it also combines with "whatever you have, you got because you deserved it" attitude. It's very fatalistic, and completely discounts the possibility that injustice exists in society, and that some humans actively create it for their own personal benefit. It also seems like more of the social bonding activities are inherently organized around pre-existing in-groups and clique-sorting than I remember from more northerly cities. I had been accustomed to events organized around public schools, their intramural organizations, public libraries, chambers of commerce events, and city sports leagues in public recreation facilities--one thing, open to all residents--but in the South, they have entirely different networks organized through churches and private clubs, which are heavily segregated by political views, if not by race. This leads to a lot of information asymmetry, and irrational beliefs or disinformation propagated through channels that are difficult for outsiders to monitor. So white blue-collar workers get propagandized against unions and democratic socialism. They are constantly being lied to, and subjected to rhetorical distractions. Black people go to different churches, so they aren't as politically self-defeating, but they get institutionally disenfranchised instead. Having lived in Chicago, Illinois, I recognize political corruption, and they definitely have it here.
  - deleted 7y ago
    [deleted]
  - levythe 7y ago
    There are plenty of concerns around the reliability of a single payer system or a publicized care system aside from what has already been mentioned. For instance, the sustainable quality of care is brought into question, as is the incentive for continued development in the field. There are reasons to be upset about the current system, but these are two things it undeniably excels at. There is also simply anxiety over giving one of the most if not the most powerful government in the world power over its citizens in such an intimate fashion.
  - jonfw 7y ago
    Forcing somebody else to "share" against their will isn't really in the spirit of sharing.
    - rpiguy 7y ago
      Thank you for pointing this out. Forced sharing is confiscation.
      - zackmorris 7y ago
        I've been thinking lately that half the US could opt out of public healthcare, the rest would subsidize them, and the per-capita cost on the payers would still be less than it is today through private insurance.
        rpiguy 7y ago
        I am actually not opposed to some kind of national health program, but the supply problem (and therefore the price problem) needs to be addressed first. Partially socializing what we have today will only make things worse. Proponents of national healthcare always say that it will lower costs, but unless the government seizes control of everything, doctor salaries, hospital employee pay, etc. cost will never go down. I am not arguing that the government should do all that, in fact it would terrify me. But it should work to increase the supply of healthcare and to create efficiencies and price transparency to drive costs down. Once costs are manageable it will be easier to find a way to guarantee healthcare affordably without crippling the economy or having the government run everything. Of course when a pragmatic approach like the above is offered you always run into the "my mom has cancer now" argument that we just need to do it as soon as possible. It is a hard argument to refute. It is a complex issue.
        zackmorris 7y ago
        I tend to agree, thank you for your thoughtful points. Another thought I've been having is that since medicine is the epitome of a good with inelastic demand, then the government could/should impose rather strict laws about profiteering. For example, maybe a drug could only cost double what a university can synthesize it for, or a minimum of 3 manufacturers would make any drug sold in the US (to ensure healthy competition), or the government could provide generic options for all drugs (as a price stabilizer), something like that. So insulin would essentially be free, and the hepatitis C cure might be substantially cheaper, for example. I realize that this might lead to problems with drug research costs. But, that's really what we should really be talking about here. Separating research cost to some degree from profit in their distribution. And spreading those costs globally somehow so that they don't fall mostly on the US. Maybe incremental measures like these could be adopted over a 5 or 10 year period until private insurance costs are more in line with the public option cost in other countries, and then states could offer insurance plans. Once about 50% have done that, the programs could be made federal. We could still keep private insurance for those who want it, like in many European countries. To be honest, I am personally against these incremental approaches because I have doubts that they'll be adopted, but, you're right that it's a complex issue so I'm open to ideas and hope we can get past the political disfunction and get back to helping people.
- ChrisLomont 7y ago
  >Why there is no national healthcare - money, someone makes a ton of it by preventing nationalization of healthcare system It could also be that things cost money, and taxpayers don't want to pay for some things. The Democrats have decided that the rich must pay for it. Republicans have decided that it's too costly. By splitting the crowd, we have reached an impasse. We could do what every other country has done, and have everyone pay more in taxes to get it, but both sets of votes have blocked it. Dems want European benefits without European taxes levied on the middle class. Reps realize how much these plans will cost and scare people with taxes in general. The end result is people want others to solve their problems instead of accepting the pain and paying for it. It's not companies - it's voters. And it would cost a lot more in the US than anywhere else, and it's no single point of cost added - every part here cost more, from doctor and nurse salaries, to drugs (which are a small part of overall cost), to people wanting more end of life care, and on and on.
  - redblacktree 7y ago
    I'd consider myself a Democrat, and I'm willing to pay more taxes for it. If people take a good look at their paychecks, I think most folks would be better off. Instead of paying (made up numbers) $800/mo to an insurer, you may pay an additional $600/mo in taxes. That's a win. And like someone above said, it makes people less tied to their jobs, which I think all workers should support.
    - chrshawkes 7y ago
      Just curiously asking, how does one pay for it if they don't have a job or lose their job? I think people should be less tied to their employers but how do they get coverage if they have no job? Who is paying for it?
      - redblacktree 7y ago
        Consider the case of my Mother-in-law. She has enough funds to retire, except that she can't afford insurance plans on the open market, (where they are generally more expensive and less effective) so she has to wait until full retirement age when she'll be able to get coverage from her former employer and ultimately Medicare.
- bumby 7y ago
  I think money is only part of it. There's the cliche phrase of "There's Good, Fast, or Cheap, but you only get to select two." Peter Attia put a healthcare twist on this idea. Paraphrasing, it becomes "Access, Quality, or Cost. You only get to choose two." There's natural competing ideas in most any resource constrained environment.
- pattisapu 7y ago
  I like that. Might add a dash of the "prisoner's dilemma." But then I would get carried away with this stone soup and throw in love, honor, culture... ...and then end up back at "I don't know why."
- riffraff 7y ago
  I am not saying the general idea is wrong, and probably it is true in the US. But. You could equivalently say "why is there national healthcare almost everywhere in Europe" and answer "money", reversing your point.
  - y4mi 7y ago
    Not necessarily, because the amount of money the health industries get in every other country is tiny compared to the USA
  - kwhitefoot 7y ago
    The answer is about money not the money itself. It all depends on who controls the money and why. In Europe the state controls it and most citizens are happy with that (not perfectly of course) whereas it is a complete non-starter in the US because 'everyone' has an adversarial relationship with the state.
  - LordDragonfang 7y ago
    Except we know why there's national healthcare in Europe: because it's more cost effective per citizen (economies of scale and collective bargaining for prices with no profit motive), and the US effectively subsidizes research costs. I suppose in a way that is "money", but not in the sense that he meant (ie money directly exerting political power)
RodgerTheGreat 7y ago
Say you or your dependents have a medical condition, and your health insurance is provided by your employer. Your most powerful tool in negotiating with your employer is to threaten to resign. Even with COBRA, paying for your own health insurance can be a substantial burden for many people in the US. If resigning from your job poses substantial risks to your health and life, your employer holds all the cards. A workforce that does not have mobility and security in the essentials of life creates negative externalities for society as a whole. If workers are unable to leave or report workplaces containing unethical or illegal behavior out of concern for their lives, that unethical or illegal behavior is tacitly rewarded with competitive advantage for the business.
- MuffinFlavored 7y ago
  > Even with COBRA Why are COBRA prices as crazy as they are? I pay $200/mo for medical insurance, yet COBRA quoted me $800/mo+ I believe.
  - rpiguy 7y ago
    That is what your employer paid for your insurance. You might be able to get a cheaper plan on Obamacare/ACA. Companies pay large portion of your insurance that you never see. COBRA brings it all to light. There is a movement to count medical benefits as income, which would shed light on this (in fact that was part of Obamacare/ACA, but politicians keep putting it off because they know no wants to pay taxes on their healthcare...)
    - bcrosby95 7y ago
      Yeah, I would be more fine with employer provided healthcare if people had to pay taxes on it. I work at a small company and around the ACA times they told us they were weighing their options: removing healthcare benefits with a corresponding bump in pay (including tax ramifications), or keeping healthcare. At the time they let us know what they were paying, and it was a shitload - something like $18k/year for my family of 3. They ended up keeping healthcare. And now I have a family of 5. No clue what they pay, but I'm sure it's a ton.
deleted 7y ago
[deleted]
staticassertion 7y ago
As someone who has recently quit their job to start their own business, healthcare has been a huge barrier. I'm so, so lucky that I'm healthy enough to go on cheaper insurance and that I have people who can help me navigate the absurdly complex system of plans out there to pick a sensible one. I know lots of other people who are petrified of losing their job because they aren't as healthy as I am.

me_me_me 7y ago

One thing that has always came true throughout my life is a phrase: "If you don't know why, its money." Why there is no national healthcare - money, someone makes a ton of it by preventing nationalization of healthcare system. Everything that doesn't make sense, has better alternatives (somehow not adopted) always boils down to money :(

FrankyHollywood 7y ago
Another reason is people don't like sharing. In democracies the majority of people don't vote for a program where they have to pay for others, even if the net result would be in their advantage. so it's money, and stupidity :)
- chooseaname 7y ago
  Exactly this. I'm in the South (U.S.) and a lot of people here would benefit from national healthcare, but they continue to vote against it (rather, for politicians who are against it) because "if you don't work for it, you don't deserve it." They're so afraid of the few who would take advantage of it that they're willing to let the many who need it not get it.
  - saiya-jin 7y ago
    Yes it sounds like common mentality in US - "you need to deserve your spot under the sun". This mindset can push society to achieve great things rather effectively (as seen numerous times in the past with US), but it can also mean cruelty to fellow citizens because... usually money, power, status. Everybody for themselves ain't a good model for a healthy society in long run. Way too many predators out there.
  - logfromblammo 7y ago
    I'm a Midwestern transplant into the South, and a significant proportion of the anti-welfare sentiment around here seems to me to be incredibly racist, plastered over with language that has been carefully scrubbed of any mention of race. And that poisons federal politics. The fear is there, but to me it looks like white people afraid that some black people or brown people might earn the same money for the same work, or get equal representation in government. And it's all apparently justified in the politically segregated religious congregations. There's that "if you didn't work for it, you don't deserve it" attitude, but it also combines with "whatever you have, you got because you deserved it" attitude. It's very fatalistic, and completely discounts the possibility that injustice exists in society, and that some humans actively create it for their own personal benefit. It also seems like more of the social bonding activities are inherently organized around pre-existing in-groups and clique-sorting than I remember from more northerly cities. I had been accustomed to events organized around public schools, their intramural organizations, public libraries, chambers of commerce events, and city sports leagues in public recreation facilities--one thing, open to all residents--but in the South, they have entirely different networks organized through churches and private clubs, which are heavily segregated by political views, if not by race. This leads to a lot of information asymmetry, and irrational beliefs or disinformation propagated through channels that are difficult for outsiders to monitor. So white blue-collar workers get propagandized against unions and democratic socialism. They are constantly being lied to, and subjected to rhetorical distractions. Black people go to different churches, so they aren't as politically self-defeating, but they get institutionally disenfranchised instead. Having lived in Chicago, Illinois, I recognize political corruption, and they definitely have it here.
- deleted 7y ago
  [deleted]
- levythe 7y ago
  There are plenty of concerns around the reliability of a single payer system or a publicized care system aside from what has already been mentioned. For instance, the sustainable quality of care is brought into question, as is the incentive for continued development in the field. There are reasons to be upset about the current system, but these are two things it undeniably excels at. There is also simply anxiety over giving one of the most if not the most powerful government in the world power over its citizens in such an intimate fashion.
- jonfw 7y ago
  Forcing somebody else to "share" against their will isn't really in the spirit of sharing.
  - rpiguy 7y ago
    Thank you for pointing this out. Forced sharing is confiscation.
    - zackmorris 7y ago
      I've been thinking lately that half the US could opt out of public healthcare, the rest would subsidize them, and the per-capita cost on the payers would still be less than it is today through private insurance.
      - rpiguy 7y ago
        I am actually not opposed to some kind of national health program, but the supply problem (and therefore the price problem) needs to be addressed first. Partially socializing what we have today will only make things worse. Proponents of national healthcare always say that it will lower costs, but unless the government seizes control of everything, doctor salaries, hospital employee pay, etc. cost will never go down. I am not arguing that the government should do all that, in fact it would terrify me. But it should work to increase the supply of healthcare and to create efficiencies and price transparency to drive costs down. Once costs are manageable it will be easier to find a way to guarantee healthcare affordably without crippling the economy or having the government run everything. Of course when a pragmatic approach like the above is offered you always run into the "my mom has cancer now" argument that we just need to do it as soon as possible. It is a hard argument to refute. It is a complex issue.
        zackmorris 7y ago
        I tend to agree, thank you for your thoughtful points. Another thought I've been having is that since medicine is the epitome of a good with inelastic demand, then the government could/should impose rather strict laws about profiteering. For example, maybe a drug could only cost double what a university can synthesize it for, or a minimum of 3 manufacturers would make any drug sold in the US (to ensure healthy competition), or the government could provide generic options for all drugs (as a price stabilizer), something like that. So insulin would essentially be free, and the hepatitis C cure might be substantially cheaper, for example. I realize that this might lead to problems with drug research costs. But, that's really what we should really be talking about here. Separating research cost to some degree from profit in their distribution. And spreading those costs globally somehow so that they don't fall mostly on the US. Maybe incremental measures like these could be adopted over a 5 or 10 year period until private insurance costs are more in line with the public option cost in other countries, and then states could offer insurance plans. Once about 50% have done that, the programs could be made federal. We could still keep private insurance for those who want it, like in many European countries. To be honest, I am personally against these incremental approaches because I have doubts that they'll be adopted, but, you're right that it's a complex issue so I'm open to ideas and hope we can get past the political disfunction and get back to helping people.
ChrisLomont 7y ago
>Why there is no national healthcare - money, someone makes a ton of it by preventing nationalization of healthcare system It could also be that things cost money, and taxpayers don't want to pay for some things. The Democrats have decided that the rich must pay for it. Republicans have decided that it's too costly. By splitting the crowd, we have reached an impasse. We could do what every other country has done, and have everyone pay more in taxes to get it, but both sets of votes have blocked it. Dems want European benefits without European taxes levied on the middle class. Reps realize how much these plans will cost and scare people with taxes in general. The end result is people want others to solve their problems instead of accepting the pain and paying for it. It's not companies - it's voters. And it would cost a lot more in the US than anywhere else, and it's no single point of cost added - every part here cost more, from doctor and nurse salaries, to drugs (which are a small part of overall cost), to people wanting more end of life care, and on and on.
- redblacktree 7y ago
  I'd consider myself a Democrat, and I'm willing to pay more taxes for it. If people take a good look at their paychecks, I think most folks would be better off. Instead of paying (made up numbers) $800/mo to an insurer, you may pay an additional $600/mo in taxes. That's a win. And like someone above said, it makes people less tied to their jobs, which I think all workers should support.
  - chrshawkes 7y ago
    Just curiously asking, how does one pay for it if they don't have a job or lose their job? I think people should be less tied to their employers but how do they get coverage if they have no job? Who is paying for it?
    - redblacktree 7y ago
      Consider the case of my Mother-in-law. She has enough funds to retire, except that she can't afford insurance plans on the open market, (where they are generally more expensive and less effective) so she has to wait until full retirement age when she'll be able to get coverage from her former employer and ultimately Medicare.
bumby 7y ago
I think money is only part of it. There's the cliche phrase of "There's Good, Fast, or Cheap, but you only get to select two." Peter Attia put a healthcare twist on this idea. Paraphrasing, it becomes "Access, Quality, or Cost. You only get to choose two." There's natural competing ideas in most any resource constrained environment.
pattisapu 7y ago
I like that. Might add a dash of the "prisoner's dilemma." But then I would get carried away with this stone soup and throw in love, honor, culture... ...and then end up back at "I don't know why."
riffraff 7y ago
I am not saying the general idea is wrong, and probably it is true in the US. But. You could equivalently say "why is there national healthcare almost everywhere in Europe" and answer "money", reversing your point.
- y4mi 7y ago
  Not necessarily, because the amount of money the health industries get in every other country is tiny compared to the USA
- kwhitefoot 7y ago
  The answer is about money not the money itself. It all depends on who controls the money and why. In Europe the state controls it and most citizens are happy with that (not perfectly of course) whereas it is a complete non-starter in the US because 'everyone' has an adversarial relationship with the state.
- LordDragonfang 7y ago
  Except we know why there's national healthcare in Europe: because it's more cost effective per citizen (economies of scale and collective bargaining for prices with no profit motive), and the US effectively subsidizes research costs. I suppose in a way that is "money", but not in the sense that he meant (ie money directly exerting political power)

RodgerTheGreat 7y ago

Say you or your dependents have a medical condition, and your health insurance is provided by your employer. Your most powerful tool in negotiating with your employer is to threaten to resign. Even with COBRA, paying for your own health insurance can be a substantial burden for many people in the US. If resigning from your job poses substantial risks to your health and life, your employer holds all the cards. A workforce that does not have mobility and security in the essentials of life creates negative externalities for society as a whole. If workers are unable to leave or report workplaces containing unethical or illegal behavior out of concern for their lives, that unethical or illegal behavior is tacitly rewarded with competitive advantage for the business.

MuffinFlavored 7y ago
> Even with COBRA Why are COBRA prices as crazy as they are? I pay $200/mo for medical insurance, yet COBRA quoted me $800/mo+ I believe.
- rpiguy 7y ago
  That is what your employer paid for your insurance. You might be able to get a cheaper plan on Obamacare/ACA. Companies pay large portion of your insurance that you never see. COBRA brings it all to light. There is a movement to count medical benefits as income, which would shed light on this (in fact that was part of Obamacare/ACA, but politicians keep putting it off because they know no wants to pay taxes on their healthcare...)
  - bcrosby95 7y ago
    Yeah, I would be more fine with employer provided healthcare if people had to pay taxes on it. I work at a small company and around the ACA times they told us they were weighing their options: removing healthcare benefits with a corresponding bump in pay (including tax ramifications), or keeping healthcare. At the time they let us know what they were paying, and it was a shitload - something like $18k/year for my family of 3. They ended up keeping healthcare. And now I have a family of 5. No clue what they pay, but I'm sure it's a ton.

deleted 7y ago

[deleted]

staticassertion 7y ago

As someone who has recently quit their job to start their own business, healthcare has been a huge barrier. I'm so, so lucky that I'm healthy enough to go on cheaper insurance and that I have people who can help me navigate the absurdly complex system of plans out there to pick a sensible one. I know lots of other people who are petrified of losing their job because they aren't as healthy as I am.