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> The US doesn't have one healthcare system, it has 50+ This is a fact that people, non-US but also many US Americans ourselves, have a really hard time in und

> The US doesn't have one healthcare system, it has 50+ This is a fact that people, non-US but also many US Americans ourselves, have a really hard time in understanding. The vast majority of laws are left to the states. It's just incredibly hard to get national laws, and as a consequence, we have relatively few national laws. For example, there isn't a national standard for murder, there are 50+. Well, there is one if you commit the murder in a post office, but outside the post office, you're in the other 50 definitions. It's a miracle even the half-baked ACA got passed in this context.

cogman10 3y ago
> It's a miracle even the half-baked ACA got passed in this context. Federal law trumps state law. And, in fact, we do have 3 national healthcare implementations, Medicare, Medicaid, and Vertaren Affairs healthcare. Socializing healthcare could be done easily under the commerce clause of the constitution, but that doesn't happen because it's not popular among elected officials (it's only popular among the most progressive Democrats, for everyone else it's a no). ACA was so half baked and all over the board because there was a lot of carve outs to win over centrist Democrats. A much simpler "Medicare for all" could be implemented simply by changing the Medicare statute's enrollment age to 0. The reason national laws are so hard is the filibuster in the Senate and the fact that Republicans are pretty much universally opposed to expanding government healthcare. It's got nothing to do with there being 50 states.
- cityofdelusion 3y ago
  This is overly-simplified. I’ve worked in healthcare IT, specifically billing and coding. The reforms needed are much, much more than simply setting Medicare’s enrollment age to 0, especially with the thousands of pages of weird exclusions and conditions enshrined into Medicare over the years. Also this is slightly pedantic, but your examples are NOT national health systems. The closest thing in the U.S. is military medicine, which is (mostly) federally funded with doctors working for and paid by the government.
  - cogman10 3y ago
    > This is overly-simplified. Not really. The comment I was responding to argued there couldn't be a national healthcare system in the US. I wasn't arguing that those systems are perfect. > The reforms needed are much, much more than simply setting Medicare’s enrollment age to 0 Agree > especially with the thousands of pages of weird exclusions and conditions enshrined into Medicare over the years. I agree to an extent. The thing is, healthcare is messy regardless. I simply could not imagine any healthcare payment system that wasn't fairly complex to code out. > Also this is slightly pedantic, but your examples are NOT national health systems. The closest thing in the U.S. is military medicine, which is (mostly) federally funded with doctors working for and paid by the government. Agree, and honestly if I had my way I'd nationalize healthcare top to bottom. Capitalism is a race to the bottom with healthcare. There's no real incentive to produce quality (you have a captured market). That incentive is to raise prices as high as possible and cut staff as lean as possible.
    - snapetom 3y ago
      > argued there couldn't be a national healthcare system in the US. That is an strange and reactionary misconstruction. My whole comment was talking about the misunderstanding of US Federalism. Healthcare was a flippant comment as an example in the closing sentence.
- snapetom 3y ago
  > Federal law trumps state law Where do I dispute that? > The reason national laws are so hard is the filibuster in the Senate and the fact that Republicans are pretty much universally opposed to expanding government healthcare. It's got nothing to do with there being 50 states. That's a very narrow historical view. Look at any landmark laws passed that have significance on an average person's life - ACA, 2008 Bank Bailout, Patriot Act, AWB. They are few and far between compared to other Western democracies.
  - cogman10 3y ago
    > Where do I dispute that? I probably read too much into your earlier comment, but it seemed like your discussion of state laws meant national ones would be harder to pass. To the rest of your comment. Federal laws have been historically a lot easier to pass, the gridlock of DC is (semi) recent history that started around the 90s. Regan kicked the Republicans down a path of deregulation and privatization of the gov. Bush Srs loss from "no new taxes" started the "never compromise" attitude of Republicans. Newt Gingrich codified that under Clinton. And with Obama we saw basically the end of any sort of major across the isle legislation. I don't know why you are saying this is a narrow view. From roughly Eisenhower to Regan, major federal laws were fairly common. national highways, NLRB, social security, Medicare, EPA, CCC, OSHA, various federal law enforcement, etc. These all have pretty high impacts on day to day life.

cogman10 3y ago

> It's a miracle even the half-baked ACA got passed in this context. Federal law trumps state law. And, in fact, we do have 3 national healthcare implementations, Medicare, Medicaid, and Vertaren Affairs healthcare. Socializing healthcare could be done easily under the commerce clause of the constitution, but that doesn't happen because it's not popular among elected officials (it's only popular among the most progressive Democrats, for everyone else it's a no). ACA was so half baked and all over the board because there was a lot of carve outs to win over centrist Democrats. A much simpler "Medicare for all" could be implemented simply by changing the Medicare statute's enrollment age to 0. The reason national laws are so hard is the filibuster in the Senate and the fact that Republicans are pretty much universally opposed to expanding government healthcare. It's got nothing to do with there being 50 states.

cityofdelusion 3y ago
This is overly-simplified. I’ve worked in healthcare IT, specifically billing and coding. The reforms needed are much, much more than simply setting Medicare’s enrollment age to 0, especially with the thousands of pages of weird exclusions and conditions enshrined into Medicare over the years. Also this is slightly pedantic, but your examples are NOT national health systems. The closest thing in the U.S. is military medicine, which is (mostly) federally funded with doctors working for and paid by the government.
- cogman10 3y ago
  > This is overly-simplified. Not really. The comment I was responding to argued there couldn't be a national healthcare system in the US. I wasn't arguing that those systems are perfect. > The reforms needed are much, much more than simply setting Medicare’s enrollment age to 0 Agree > especially with the thousands of pages of weird exclusions and conditions enshrined into Medicare over the years. I agree to an extent. The thing is, healthcare is messy regardless. I simply could not imagine any healthcare payment system that wasn't fairly complex to code out. > Also this is slightly pedantic, but your examples are NOT national health systems. The closest thing in the U.S. is military medicine, which is (mostly) federally funded with doctors working for and paid by the government. Agree, and honestly if I had my way I'd nationalize healthcare top to bottom. Capitalism is a race to the bottom with healthcare. There's no real incentive to produce quality (you have a captured market). That incentive is to raise prices as high as possible and cut staff as lean as possible.
  - snapetom 3y ago
    > argued there couldn't be a national healthcare system in the US. That is an strange and reactionary misconstruction. My whole comment was talking about the misunderstanding of US Federalism. Healthcare was a flippant comment as an example in the closing sentence.
snapetom 3y ago
> Federal law trumps state law Where do I dispute that? > The reason national laws are so hard is the filibuster in the Senate and the fact that Republicans are pretty much universally opposed to expanding government healthcare. It's got nothing to do with there being 50 states. That's a very narrow historical view. Look at any landmark laws passed that have significance on an average person's life - ACA, 2008 Bank Bailout, Patriot Act, AWB. They are few and far between compared to other Western democracies.
- cogman10 3y ago
  > Where do I dispute that? I probably read too much into your earlier comment, but it seemed like your discussion of state laws meant national ones would be harder to pass. To the rest of your comment. Federal laws have been historically a lot easier to pass, the gridlock of DC is (semi) recent history that started around the 90s. Regan kicked the Republicans down a path of deregulation and privatization of the gov. Bush Srs loss from "no new taxes" started the "never compromise" attitude of Republicans. Newt Gingrich codified that under Clinton. And with Obama we saw basically the end of any sort of major across the isle legislation. I don't know why you are saying this is a narrow view. From roughly Eisenhower to Regan, major federal laws were fairly common. national highways, NLRB, social security, Medicare, EPA, CCC, OSHA, various federal law enforcement, etc. These all have pretty high impacts on day to day life.