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I see astronomical figures like $2T and I wonder how anyone can seriously entertain the argument that the US cannot afford free health care for all of its citiz

I see astronomical figures like $2T and I wonder how anyone can seriously entertain the argument that the US cannot afford free health care for all of its citizens.

ng12 7y ago
The US gov certainly can afford it but they'll pass the bill on to taxpayers all the same.
- jtbayly 7y ago
  There is literally no other way to do it. The government gets its money through taxes.
  - ng12 7y ago
    Or we could spend less on the military. If they need to raise taxes to pay for it they can't afford it.
    - jtbayly 7y ago
      I think you're missing my point. The money still comes from taxes, which come from taxpayers, no matter what. Saying that the government can afford it is saying that we can afford it. The government doesn't have any money except ours.
      - ng12 7y ago
        I'm not saying it doesn't. The grandparent's point was that the gov could spend the some of the $T it spends on the military on healthcare. My point is the gov is much more likely to fund healthcare through new taxes than to spend less on the military.
spamizbad 7y ago
We have a tremendous appetite for risk when it comes to intervention. And we're extremely caution and austere when it comes to "investing" in our own citizenry. It's also amusing how we become extremely obsessed with who "deserves" government money, establishing kafkaesque means-testing protocols, but have little issue handing out billions of taxpayer money to non-citizens in foreign countries.
- LarryDarrell 7y ago
  Like the sudden urgency to throw 700,000 off food stamps with work requirements.
  - umvi 7y ago
    You can literally only make additive changes to social programs if you don't want to make people mad. Any change perceived as subtraction will make people scream and you will be made out as a tyrant grinding the faces of the poor even if you are trying to simplify, consolidate, make more efficient, close loopholes, etc.; it doesn't matter. Just look at France.
    - spamizbad 7y ago
      We've successfully made numerous cuts to social programs with no negative consequence. Like, what was the political cost of 1990s welfare reform? Well, President Clinton was re-elected by a landslide and the Republicans who helped champion the bill won control of the House.
- cjf4 7y ago
  Military spending is less than a quarter of the budget. Medicare/caid is 55% more than the defense budget, to say nothing of social security or other domestic spending. These may not be the right allocations, but domestic spending is hardly "austere".
  - spamizbad 7y ago
    Not quite. The military budget itself is really just a base operating budget. Developments towards research, weapon systems, and even wars themselves can and are funded separately.
tantalor 7y ago
I think the serious argument is whether US can afford not to do something. US didn't have to invade Afghanistan, but it did. US doesn't have to provide free health care, and it probably won't.
TuringNYC 7y ago
One-off pallets of cash stories aside, most of these "re-building programs" are contracts that go out to US corporations (e.g., Bechtel, Halliburton, etc.) -- and are essentially corporate giveaways or corporate welfare. Of course we can afford free health care for our citizens in the US -- but our leadership favors corporate welfare over citizen welfare and that is unfortunate. Corporate welfare is also welfare, it just doesnt get evenly distributed across US citizenry. You need to drive around McLean Virginia and see the houses to see the types of places where the money ends up. On a side note -- many of the giant figures are not cash that we literally give from US coffers, but loans to these countries that come right back to companies in the US. The loans have a side "benefit" in that the loans allow us to dictate affairs overseas via loan covenants we can relax for this or that. If the loan cannot be repaid, only then it comes from US coffers (but the money never really went overseas, it just got re-distributed in the US.)
- r00fus 7y ago
  So basically, corruption. Related: Confessions of an economic hitman
- GVIrish 7y ago
  > Of course we can afford free health care for our citizens in the US -- but our leadership favors corporate welfare over citizen welfare and that is unfortunate. I think that's dramatically underselling the American voter's role in all of this. Many, many Americans balk at the prospect of raising taxes to pay for universal healthcare. But those same people shrug indifferently to the enormous costs to sustain the US military and the tremendous costs of campaigns such as Afghanistan. So yes there is a whole segment of American politicians who are working hard to carve out tax cuts for billionaires while having not a care for the millions without healthcare. But I find that a lot of people are actively opposed to the government 'taking over healthcare' or they're scared of the price tag for universal healthcare. They're part of the reason we don't have it.
  - magduf 7y ago
    >I think that's dramatically underselling the American voter's role in all of this. Many, many Americans balk at the prospect of raising taxes to pay for universal healthcare. But those same people shrug indifferently to the enormous costs to sustain the US military and the tremendous costs of campaigns such as Afghanistan. I think that's dramatically understating these American voters' role in this and their reaction to anything that can be dubbed "socialism". They happily vote for candidates who push for enormous "corporate welfare" to defense contractors, and scream bloody murder if anyone suggests using any public money at all to pay for someone else's healthcare. American voters are getting exactly what they're voting for. >They're part of the reason we don't have it. They are the reason we don't have it. As I frequently like to remind people, every nation gets the government it deserves.
zionic 7y ago
Free healthcare does not exist (unless you enslave doctors and nurses). What you want is taxpayer subsidized healthcare, which is certainly on the table.
- minikites 7y ago
  Have you actually encountered anyone advocating for the former or is that just a bizarre strawman?
  - friedman23 7y ago
    I mean communists generally advocate that wage labor is equivalent to slavery.
  - bluGill 7y ago
    Yes, most people are in some form. Of course they don't realize it, they just want free and cannot think through the consequences of what they are asking for. Free health care is easy to explain. How do you pay for it isn't, and it gets harder when you have to figure out how much to pay the bureaucrats needed to make it work. Solving the problem of health care costs getting higher is a hard problem. I haven't seen any solution that accounts for all the external factors. I doubt we even know them.
    - jsight 7y ago
      > Yes, most people are in some form. Of course they don't realize it, they just want free and cannot think through the consequences of what they are asking for. I see people say this about other people all the time, but I honestly have yet to meet someone who legitimately expects health care to be 'free'. They all realize that it just means paid by taxpayers. Which tax payers? That varies...
    - Frondo 7y ago
      I don't believe anyone is suggesting enslaving doctors and nurses, any time, anywhere. (I'll adjust this if you now come back and say you believe medical professionals should be enslaved as a form of national health care.) The discussion always assumes they will be compensated, and as is pointed out often, the question is how.
brians 7y ago
That’s over twenty years. So $100B/year. There are 0.3B of us. So that’s $3000 per person per year. That’s about what my employer pays for a BCBS elite HD-HSA PPO for my group of relatively young, affluent, healthy tech workers in Boston. It doesn’t come close to covering all of it. There are 3M nurses and 1M doctors in the US. That $100B/yr could pay each $25k in salary, and cover no equipment. Let’s say we want to pay nurses $150k and doctors $250k, good middle class salaries comparable to tech incomes. You need $700B per year. That’s not impossible to find at https://www.usgovernmentspending.com/US_fed_spending_pie_chart https://www.usgovernmentspending.com/US_fed_spending_pie_cha..., and I think we should—but it’s not obvious how to do so or what to sacrifice.
- Spooky23 7y ago
  You have to think beyond the accounting. Think of the opportunity cost. Many people stay at their jobs because of healthcare. Period. Either they don't want to lose it, or don't want to lose some aspect of it. How many startups aren't started? How many dreams aren't filled? How much value isn't created?
- zaroth 7y ago
  $100B/year divided by 0.3B equals $333 per year. That’s not enough for one full monthly premium payment on the ACA exchanges. However, the average ACA subsidy per person on the marketplace varies tremendously by State, but is typically well above $333 per month. https://www.kff.org/health-reform/state-indicator/average-monthly-advance-premium-tax-credit-aptc/ https://www.kff.org/health-reform/state-indicator/average-mo...
- AQuantized 7y ago
  I don't think nurses are going to be earning an average of $150k/yr under any system.
- simonh 7y ago
  The 100B/year would be as well as current health spending, not instead of it. What would the additional costs of universal health care be, and would 100B/year cover it? Currently about 27m Americans do not have health insurance. 100B would yield about $3,700 per person which is probably about enough to do it.
merpnderp 7y ago
$2T over 18 years is $111B/year or about 3% of US yearly healthcare budget. If the US could somehow magically switch to a Swiss style healthcare system, that amount would pay for about 4% of the US yearly healthcare budget.
space_fountain 7y ago
2T is indeed a big number but its dwarfed by the cost of healthcare. Keep in mind that's over 18 years. We spend more than that every year in the US. Apparently Warren's plan calls for 20.5 trillion in spending over the next decade and that's with some optimistic assumptions on cost reduction. None of this necessarily means we shouldn't do it. Healthcare is expensive, but certainly many countries do have more of the cost covered by the government, but you can't see a big number and assume that was paid and assume it would pay for healthcare
AndrewKemendo 7y ago
As a point of reference 2T over 18 years is ~111B/year. The plan Warren is suggesting which I think would closest fit the definition of "free health care for all" - though not perfectly [1] would be 59T over 10 years or 5.9T/year. Note also that the way these programs are funded is very different [2]. Things in the "Mandatory" funding category like Social Security and Medicare aren't funded year to year, but are ongoing expenses that you have to change entitlement laws to make changes to, so they are incredibly hard to change. The Department of Defense is funded out of the "Discretionary" category which can change from year to year and is based on a different process which is not subject to the same laws. [1] https://www.vox.com/2019/11/1/20942587/elizabeth-warren-medicare-for-all-taxes-explained https://www.vox.com/2019/11/1/20942587/elizabeth-warren-medi... [2] https://www.newamerica.org/education-policy/topics/federal-education-legislation-budget/federal-education-budget/federal-budget-process/mandatory-and-discretionary-spending/ https://www.newamerica.org/education-policy/topics/federal-e...
- Joeri 7y ago
  Wow, US gdp is “only” 20T, so at 6T almost a third of the economy would be healthcare. Checking your link it seems the warren campaign is aiming for 5T, which is still a quarter. Already a fifth of the US economy is healthcare and that is absurdly higher than every other country, which typically don’t go over 10% of gdp.
  - atombender 7y ago
    In the UK, the NHS — which some people admittedly consider to be chronically underfunded — was about 7% of GDP [1] in 2018. Norway's is about 10.5% [2] (2016), and increasing by about 2% a year. [1] https://www.ifs.org.uk/uploads/R143.pdf#page=20 https://www.ifs.org.uk/uploads/R143.pdf#page=20 [2] https://www.ssb.no/nasjonalregnskap-og-konjunkturer/statistikker/helsesat/aar/2017-03-13 https://www.ssb.no/nasjonalregnskap-og-konjunkturer/statisti...
RobertRoberts 7y ago
A quick Google search seems to indicate it would cost over $3.2T a _year_ to give free medical to everyone. This is from someone (Sanders) that wants to make this happen. https://www.bloomberg.com/news/articles/2018-07-30/study-medicare-for-all-bill-estimated-at-32-6-trillion https://www.bloomberg.com/news/articles/2018-07-30/study-med... https://www.factcheck.org/2018/08/the-cost-of-medicare-for-all/ https://www.factcheck.org/2018/08/the-cost-of-medicare-for-a...
- flatiron 7y ago
  at least i would assume that would stay in the country and circle around our economy. its kinda like we took this 2T and lit it on fire. doesn't seem to have helped anyone
  - RobertRoberts 7y ago
    That is a valid point one way, huge multinational corps got paid.. but so did all the soldiers and employees of those corps (that are American). And the medicare budget would also give a huge slice of cash to different massive corps... So, the difference may not be much... But consider it's the cost of the entire war every single year, that's just insane at any level. I think the only solution is to lower the actual costs. No where else in the world does it cost so much. Something is fishy...
paulintrognon 7y ago
The US already spends more than most countries with free healthcare systems. The healthcare problem in the US has little to do with money...
ykevinator 7y ago
You don't support the troops
fmajid 7y ago
Make universal health care profitable for Halliburton and then it will happen.

I see astronomical figures like $2T and I wonder how anyone can seriously entertain the argument that the US cannot afford free health care for all of its citizens.

ng12 7y ago

The US gov certainly can afford it but they'll pass the bill on to taxpayers all the same.

jtbayly 7y ago
There is literally no other way to do it. The government gets its money through taxes.
- ng12 7y ago
  Or we could spend less on the military. If they need to raise taxes to pay for it they can't afford it.
  - jtbayly 7y ago
    I think you're missing my point. The money still comes from taxes, which come from taxpayers, no matter what. Saying that the government can afford it is saying that we can afford it. The government doesn't have any money except ours.
    - ng12 7y ago
      I'm not saying it doesn't. The grandparent's point was that the gov could spend the some of the $T it spends on the military on healthcare. My point is the gov is much more likely to fund healthcare through new taxes than to spend less on the military.

spamizbad 7y ago

We have a tremendous appetite for risk when it comes to intervention. And we're extremely caution and austere when it comes to "investing" in our own citizenry. It's also amusing how we become extremely obsessed with who "deserves" government money, establishing kafkaesque means-testing protocols, but have little issue handing out billions of taxpayer money to non-citizens in foreign countries.

LarryDarrell 7y ago
Like the sudden urgency to throw 700,000 off food stamps with work requirements.
- umvi 7y ago
  You can literally only make additive changes to social programs if you don't want to make people mad. Any change perceived as subtraction will make people scream and you will be made out as a tyrant grinding the faces of the poor even if you are trying to simplify, consolidate, make more efficient, close loopholes, etc.; it doesn't matter. Just look at France.
  - spamizbad 7y ago
    We've successfully made numerous cuts to social programs with no negative consequence. Like, what was the political cost of 1990s welfare reform? Well, President Clinton was re-elected by a landslide and the Republicans who helped champion the bill won control of the House.
cjf4 7y ago
Military spending is less than a quarter of the budget. Medicare/caid is 55% more than the defense budget, to say nothing of social security or other domestic spending. These may not be the right allocations, but domestic spending is hardly "austere".
- spamizbad 7y ago
  Not quite. The military budget itself is really just a base operating budget. Developments towards research, weapon systems, and even wars themselves can and are funded separately.

tantalor 7y ago

I think the serious argument is whether US can afford not to do something. US didn't have to invade Afghanistan, but it did. US doesn't have to provide free health care, and it probably won't.

TuringNYC 7y ago

One-off pallets of cash stories aside, most of these "re-building programs" are contracts that go out to US corporations (e.g., Bechtel, Halliburton, etc.) -- and are essentially corporate giveaways or corporate welfare. Of course we can afford free health care for our citizens in the US -- but our leadership favors corporate welfare over citizen welfare and that is unfortunate. Corporate welfare is also welfare, it just doesnt get evenly distributed across US citizenry. You need to drive around McLean Virginia and see the houses to see the types of places where the money ends up. On a side note -- many of the giant figures are not cash that we literally give from US coffers, but loans to these countries that come right back to companies in the US. The loans have a side "benefit" in that the loans allow us to dictate affairs overseas via loan covenants we can relax for this or that. If the loan cannot be repaid, only then it comes from US coffers (but the money never really went overseas, it just got re-distributed in the US.)

r00fus 7y ago
So basically, corruption. Related: Confessions of an economic hitman
GVIrish 7y ago
> Of course we can afford free health care for our citizens in the US -- but our leadership favors corporate welfare over citizen welfare and that is unfortunate. I think that's dramatically underselling the American voter's role in all of this. Many, many Americans balk at the prospect of raising taxes to pay for universal healthcare. But those same people shrug indifferently to the enormous costs to sustain the US military and the tremendous costs of campaigns such as Afghanistan. So yes there is a whole segment of American politicians who are working hard to carve out tax cuts for billionaires while having not a care for the millions without healthcare. But I find that a lot of people are actively opposed to the government 'taking over healthcare' or they're scared of the price tag for universal healthcare. They're part of the reason we don't have it.
- magduf 7y ago
  >I think that's dramatically underselling the American voter's role in all of this. Many, many Americans balk at the prospect of raising taxes to pay for universal healthcare. But those same people shrug indifferently to the enormous costs to sustain the US military and the tremendous costs of campaigns such as Afghanistan. I think that's dramatically understating these American voters' role in this and their reaction to anything that can be dubbed "socialism". They happily vote for candidates who push for enormous "corporate welfare" to defense contractors, and scream bloody murder if anyone suggests using any public money at all to pay for someone else's healthcare. American voters are getting exactly what they're voting for. >They're part of the reason we don't have it. They are the reason we don't have it. As I frequently like to remind people, every nation gets the government it deserves.

zionic 7y ago

Free healthcare does not exist (unless you enslave doctors and nurses). What you want is taxpayer subsidized healthcare, which is certainly on the table.

minikites 7y ago
Have you actually encountered anyone advocating for the former or is that just a bizarre strawman?
- friedman23 7y ago
  I mean communists generally advocate that wage labor is equivalent to slavery.
- bluGill 7y ago
  Yes, most people are in some form. Of course they don't realize it, they just want free and cannot think through the consequences of what they are asking for. Free health care is easy to explain. How do you pay for it isn't, and it gets harder when you have to figure out how much to pay the bureaucrats needed to make it work. Solving the problem of health care costs getting higher is a hard problem. I haven't seen any solution that accounts for all the external factors. I doubt we even know them.
  - jsight 7y ago
    > Yes, most people are in some form. Of course they don't realize it, they just want free and cannot think through the consequences of what they are asking for. I see people say this about other people all the time, but I honestly have yet to meet someone who legitimately expects health care to be 'free'. They all realize that it just means paid by taxpayers. Which tax payers? That varies...
  - Frondo 7y ago
    I don't believe anyone is suggesting enslaving doctors and nurses, any time, anywhere. (I'll adjust this if you now come back and say you believe medical professionals should be enslaved as a form of national health care.) The discussion always assumes they will be compensated, and as is pointed out often, the question is how.

brians 7y ago

That’s over twenty years. So $100B/year. There are 0.3B of us. So that’s $3000 per person per year. That’s about what my employer pays for a BCBS elite HD-HSA PPO for my group of relatively young, affluent, healthy tech workers in Boston. It doesn’t come close to covering all of it. There are 3M nurses and 1M doctors in the US. That $100B/yr could pay each $25k in salary, and cover no equipment. Let’s say we want to pay nurses $150k and doctors $250k, good middle class salaries comparable to tech incomes. You need $700B per year. That’s not impossible to find at https://www.usgovernmentspending.com/US_fed_spending_pie_chart https://www.usgovernmentspending.com/US_fed_spending_pie_cha..., and I think we should—but it’s not obvious how to do so or what to sacrifice.

Spooky23 7y ago
You have to think beyond the accounting. Think of the opportunity cost. Many people stay at their jobs because of healthcare. Period. Either they don't want to lose it, or don't want to lose some aspect of it. How many startups aren't started? How many dreams aren't filled? How much value isn't created?
zaroth 7y ago
$100B/year divided by 0.3B equals $333 per year. That’s not enough for one full monthly premium payment on the ACA exchanges. However, the average ACA subsidy per person on the marketplace varies tremendously by State, but is typically well above $333 per month. https://www.kff.org/health-reform/state-indicator/average-monthly-advance-premium-tax-credit-aptc/ https://www.kff.org/health-reform/state-indicator/average-mo...
AQuantized 7y ago
I don't think nurses are going to be earning an average of $150k/yr under any system.
simonh 7y ago
The 100B/year would be as well as current health spending, not instead of it. What would the additional costs of universal health care be, and would 100B/year cover it? Currently about 27m Americans do not have health insurance. 100B would yield about $3,700 per person which is probably about enough to do it.

merpnderp 7y ago

$2T over 18 years is $111B/year or about 3% of US yearly healthcare budget. If the US could somehow magically switch to a Swiss style healthcare system, that amount would pay for about 4% of the US yearly healthcare budget.

space_fountain 7y ago

2T is indeed a big number but its dwarfed by the cost of healthcare. Keep in mind that's over 18 years. We spend more than that every year in the US. Apparently Warren's plan calls for 20.5 trillion in spending over the next decade and that's with some optimistic assumptions on cost reduction. None of this necessarily means we shouldn't do it. Healthcare is expensive, but certainly many countries do have more of the cost covered by the government, but you can't see a big number and assume that was paid and assume it would pay for healthcare

AndrewKemendo 7y ago

As a point of reference 2T over 18 years is ~111B/year. The plan Warren is suggesting which I think would closest fit the definition of "free health care for all" - though not perfectly [1] would be 59T over 10 years or 5.9T/year. Note also that the way these programs are funded is very different [2]. Things in the "Mandatory" funding category like Social Security and Medicare aren't funded year to year, but are ongoing expenses that you have to change entitlement laws to make changes to, so they are incredibly hard to change. The Department of Defense is funded out of the "Discretionary" category which can change from year to year and is based on a different process which is not subject to the same laws. [1] https://www.vox.com/2019/11/1/20942587/elizabeth-warren-medicare-for-all-taxes-explained https://www.vox.com/2019/11/1/20942587/elizabeth-warren-medi... [2] https://www.newamerica.org/education-policy/topics/federal-education-legislation-budget/federal-education-budget/federal-budget-process/mandatory-and-discretionary-spending/ https://www.newamerica.org/education-policy/topics/federal-e...

Joeri 7y ago
Wow, US gdp is “only” 20T, so at 6T almost a third of the economy would be healthcare. Checking your link it seems the warren campaign is aiming for 5T, which is still a quarter. Already a fifth of the US economy is healthcare and that is absurdly higher than every other country, which typically don’t go over 10% of gdp.
- atombender 7y ago
  In the UK, the NHS — which some people admittedly consider to be chronically underfunded — was about 7% of GDP [1] in 2018. Norway's is about 10.5% [2] (2016), and increasing by about 2% a year. [1] https://www.ifs.org.uk/uploads/R143.pdf#page=20 https://www.ifs.org.uk/uploads/R143.pdf#page=20 [2] https://www.ssb.no/nasjonalregnskap-og-konjunkturer/statistikker/helsesat/aar/2017-03-13 https://www.ssb.no/nasjonalregnskap-og-konjunkturer/statisti...

RobertRoberts 7y ago

A quick Google search seems to indicate it would cost over $3.2T a _year_ to give free medical to everyone. This is from someone (Sanders) that wants to make this happen. https://www.bloomberg.com/news/articles/2018-07-30/study-medicare-for-all-bill-estimated-at-32-6-trillion https://www.bloomberg.com/news/articles/2018-07-30/study-med... https://www.factcheck.org/2018/08/the-cost-of-medicare-for-all/ https://www.factcheck.org/2018/08/the-cost-of-medicare-for-a...

flatiron 7y ago
at least i would assume that would stay in the country and circle around our economy. its kinda like we took this 2T and lit it on fire. doesn't seem to have helped anyone
- RobertRoberts 7y ago
  That is a valid point one way, huge multinational corps got paid.. but so did all the soldiers and employees of those corps (that are American). And the medicare budget would also give a huge slice of cash to different massive corps... So, the difference may not be much... But consider it's the cost of the entire war every single year, that's just insane at any level. I think the only solution is to lower the actual costs. No where else in the world does it cost so much. Something is fishy...

paulintrognon 7y ago

The US already spends more than most countries with free healthcare systems. The healthcare problem in the US has little to do with money...

ykevinator 7y ago

You don't support the troops

fmajid 7y ago

Make universal health care profitable for Halliburton and then it will happen.