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I'm not American and grew up (and work) in Western Europe. Everyone is born, and, at some point, will get sick and die. Why does each of these cost tens or hun

I'm not American and grew up (and work) in Western Europe. Everyone is born, and, at some point, will get sick and die. Why does each of these cost tens or hundreds of thousands of dollars? I've heard American doctors at conferences describing their system as "the worst imaginable". Every American I know hates their system. It costs a lot more, has worse outcomes and shovels money and privilege towards the rich. Why don't you change it? What are the reasons why moving to a single payer system is so bad? Denmark has the same system as the NHS, puts more money into it than the Brits do, and has some of the best health outcomes in the world. If a politician seriously suggested copying them -- with an income tax deducted at source with employee and employer contributions -- what would happen?

alistairSH 2y ago
Combo of the truly wealthy buy politicians AND many professionals and union employees have employer-subsidized health plans AND 100 years of “socialism bad!” messaging from the political right.
afthonos 2y ago
Everyone hates “the system”, including the people in it. But every party of the system is perfectly fair and reasonable for the people benefitting from it, even if they hate every other part. So every part of the system will have people fighting for it—and if you try to change the whole system, the entire system will fight you. It’s an equilibrium, even if it’s obviously far from optimal.
- potato3732842 2y ago
  And it has only gotten worse with time. https://www.statista.com/statistics/184968/us-health-expenditure-as-percent-of-gdp-since-1960/ https://www.statista.com/statistics/184968/us-health-expendi... That's 20% of the country that will be less well off if you "fix" healthcare in any meaningful way and the overwhelming majority of them will fight tooth and nail to prevent that from happening. That is a hell of a minority to overcome when the issue is one of personal economics (i.e one everyone will experience directly, not some abstract social policy thing that people will ignore as long as their lives are good), dare I say basically impossible in a democracy. (yes I know I'm assuming that the healthcare industry is a cross section of the country, no I don't care if that isn't 100% accurate)
- htk 2y ago
  Excellent comment, succinctly summarizing how a systems thinking perspective translates the monster of health care in a large system of interconnected parts, each with its own stakeholders. Trying to change a single part triggers a reaction from everyone. Tough ecosystem to change. But, at the same time, seems to be the one needing change the most.
- kfarr 2y ago
  There's an old essay "Meditations on Moloch" which is an exploration of themes around why humans create systems with destructive outcomes even when no individual wants them: https://slatestarcodex.com/2014/07/30/meditations-on-moloch/ https://slatestarcodex.com/2014/07/30/meditations-on-moloch/
  - hallway_monitor 2y ago
    This is a really good read. It talks about all kinds of systems which become their own entity. Nobody likes them. They make things worse for everybody. But somehow we get trapped in these downward spirals and there’s seemingly no way out.
  - n4r9 2y ago
    Surely some people do actually want suffering, or at the very least are indifferent to causing suffering to advance their goals? I don't feel like there's some weird paradox, but rather that the system makes it too easy for sociopathic types to rise to the top.
    - kfarr 2y ago
      I think this is related to fundamental attribution error. The system is messed up and therefore attracts messed up people in leadership positions, not the other around.
      - n4r9 2y ago
        I guess I miscommunicated the thrust of my argument. It seems to me that the paradox presented in the linked article hinges on an assumption that "nobody wants" there to be suffering. This seems flawed to me. There are plenty of people - some of whom are in positions of great power - who are content to generate a large degree of suffering in order to advance personal goals. This is currently very clear in Ukraine and Gaza. But it applies equally well to people that drive shady mergers and acquisitions at the cost of the consumer, or people that push drugs at the cost of addicts' health and relationships. It's not "nobody wants this", but "sufficiently many people are sufficiently apathetic to continue this state of affairs".
- WarOnPrivacy 2y ago
  > every party of the system is perfectly fair and reasonable for the people benefitting from it This observation has value. However, if we hold it exclusively in mind we might lose focus of how prioritizing consumers strongly benefits society.
londons_explore 2y ago
> Why don't you change it? I suspect because nobody can agree on what the new replacement system should look like.
- Ylpertnodi 2y ago
  There are several functioning examples in Europe, 'they' could take a look at.
  - School-Cotton 2y ago
    Who is “they”, exactly? What specific group of people do you think is in charge of the system and should do this?
    - ashoeafoot 2y ago
      We, the people ?
      - School-Cotton 2y ago
        The US isn’t a pure direct democracy with referenda on every topic, so what does that mean, concretely? Who specifically should take what action?
  - ernst_klim 2y ago
    Like where? UK system is collapsing under underfunding and misallocation, German system is crumbling under terrible lack of personell with raising (already high) costs with lowering quality and increasing waiting times (up to infinite where mamologs and psychiatrists simply take no new patients in many cities). Basically in all thirst world countries trend is negative unless and experience is frustrating unless you are rich with good private coverage. At least that's my experience.
    - ceejayoz 2y ago
      > UK system is collapsing under underfunding and misallocation Fifteen years with the "let's privatize everything!" party will do that, yes.
bgnn 2y ago
not an American, but it seems to me that the reason is purely ideological. They like a small state, especially the federal government. This would give too much power to the government. The idea of federal government providing care for citizens is not acceptable to people. Now, weird thing is this doesn't work for the military somehow.
- cjbgkagh 2y ago
  The US should not be used as an example of a small government. Some people in the US may profess to wanting a small government, but they definitely don’t have one. Haven’t run the numbers but I would suspect the US government is the largest government in human history.
  - ashoeafoot 2y ago
    You goto seperate the imperial machine of world policing (paid in the dollats used and held by the world for trade)from the government managing the citizens of the us (parially paid in taxes by the citizens)
  - travisgriggs 2y ago
    I’m not sure how one would define “the size of government” but the ILO says differently at least: https://worldpopulationreview.com/country-rankings/public-sector-size-by-country https://worldpopulationreview.com/country-rankings/public-se... (Wikipedia has a similar page, but not as navigable imo) I scroll through a lot of European countries before getting to the US at 13.4%. I think the healthcare (and other) systems suck because they are complex. There are two ways to hid information: lock it up (lack of transparency) OR dilute it amongst noise. The latter is what complex systems of whatever do. Complex systems create opportunity for those with enough resources to locate and exploit eddies of wealth in the system. While those without the time and resources to spend understanding the complex system just decry it because it is too difficult to understand.
    - cjbgkagh 2y ago
      Well clearly absolute staffing numbers would work, but I would go by absolute money spent. I think it's ironically reductive to simplify a complex problem to a general problem of complexity. I'm not sure what your point is, we appear to agree that the system is corrupted and that there is regulatory capture. My point is that the US government shouldn't be used as an example of a small government in general and for healthcare specifically. Even if I was to agree that the US should adopt an European healthcare system I don't see how to uncorrupt the existing system to enable that to happen. This notion that a government takeover will take the money out of the system and diminish opportunity for greed is fanciful.
School-Cotton 2y ago
> Why don’t you change it? Who do you think should change it, exactly? You’re making the classic mistake of assuming the US works like the average European country: a functioning democracy where if something makes sense, politicians will promise it in their manifestos, and then implement it once they get elected. In reality the US works completely differently and is not a functioning democracy. Making any major reform in any area is, to a first approximation, impossible.
- GiorgioG 2y ago
  As an American born to European immigrant parents I can assure you that the grass is not always greener on the other side. All systems have problems. I say this as the parent of a child with a chronic illness (t1d) who is extremely frustrated with our health(insurance)care system.
  - School-Cotton 2y ago
    Not everything is better about Europe than the US, I agree (and the extent to which this is true depends on where in Europe you’re talking about - Bulgaria is not much like Switzerland). But one of the things that I think is unambiguously better (at least in highly developed Northern and Western Europe) is the quality of democratic institutions and their responsiveness to the people’s will. In the US, it is structurally almost impossible for Congress to legislate meaningfully, so effectively no one is in charge.
    - GiorgioG 2y ago
      At very least the French and Italian people would disagree (I’m French and Italian). Seems like folks across Europe were pretty upset with the number of asylum seekers and the problems that followed their migration into Europe in the last couple of years. Their governments didn’t seem to give much of a shit and that’s led to more right-wing support.
    - kstrauser 2y ago
      As an American watching Brexit and other self-owns pouring out of the UK, I’m not completely sold on this. If our system is insane — and it is — I’d say it’s a family disorder we inherited.
asdf6969 2y ago
> Why don't you change it? There is no general “you” with agency. The few people who have the ability to change it have no incentive to do that.
- ashoeafoot 2y ago
  80% majority in a democracy can not change whatever they want? Or.. the ideology people inhalate is so strong ,it hacks democracy itself?
  - betenoire 2y ago
    agreeing to change and agreeing how to change aren't the same thing at all though
  - mystified5016 2y ago
    Your core mistake is assuming that America is a democracy. It is not. It has been very efficiently designed to strip as many people of their political voice as possible. Our major elections are literally engineered to give insane advantages to whichever party is currently in power
  - blactuary 2y ago
    Most people know the overall system sucks, but they also think their insurance is mostly fine because they haven't had to use it very much (which is simply definitional, 80% of costs come from 20% of people). And so people fear the unknown. They would like something better but fear giving up what they have right now for something they haven't experienced. It is also a deeply personal issue, and has so many entrenched interests. Health care spending is 1/3 of our economy.
    - DangitBobby 2y ago
      Any evidence that "most people" are given a voice into actual systemic change? I haven't been given an opportunity to vote for a candidate that actually wants to change our healthcare system, personally. Obama helped many people, but his moves did not really attempt to solve the problems of insurer inefficiency and grift, and instead codified their position as gatekeepers.
thrillgore 2y ago
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liontwist 2y ago
> Why does each of these cost tens or hundreds of thousands of dollars? Because money is just a tool for allocating resources. And having well trained people with equipment ready to attend to every person in that situation requires a lot of resources. I’m not justifying our systems inefficiency - let’s just be clear that medical care costs a lot of money. So the challenging political question is how to manage access and costs (often devolves into rationing) and who should pay for it.
- liontwist 2y ago
  Note that what constitutes healthcare is culturally defined. Different groups have varying expectations of procedures which is then conflated with other services. When my baby was born my wife and I stayed in the hospital for two nights during which we received constant checks and meals. I was ready to go because my baby was healthy and I knew it was expensive. Is this level of service required medical care? I don’t think so. Many choose to have a medical professional at home to help with a delivery for a day or so. If it is deemed required, how many nights should be offered? I’m sure people with a bad home environment would stay as long as they could. If we set a hard cap of a few days, that’s also bad because some babies need to be at the hospital and it’s very helpful to have that. Alternatively imagine if the beds are occupied who don’t really need to be there and then a new baby needs to be born?
- jack_h 2y ago
  > Because money is just a tool for allocating resources. > often devolves into rationing Just to expand upon what you're saying a bit; most people don't view things in such terms which I think is unfortunate. You often see discussions about waiting times in single payer healthcare systems and cost in more free-market systems. The fact of the matter is that if demand is greater than supply you must ration the supply somehow. Prices are one way but not the only way. Waiting lines, by need, randomly, etc... are all valid rationing mechanisms as well. What I've noticed is that when people don't view this is a resource allocation problem they are able to always see the greener grass somewhere else. They see the lack of treatment of a person or group of persons as a failing of their system where those people would have received treatment in a different system that uses a different rationing mechanism. The issue is that in a different system there would still be people who don't receive treatment, they would just be different people. By not viewing it as a resource allocation problem I think it gives the appearance that there is a perfect solution and that its just political will halting its implementation.
_fat_santa 2y ago
> Why don't you change it? What are the reasons why moving to a single payer system is so bad? The best way I can describe our healthcare is that it's freakishly complicated, so complicated that pretty much every argument made by any side at any given time is both correct and incorrect. For your example about single payer, with that scheme costs will likely be much lower but on the flip side, we also would not get immediate access to care (that is you can't attend a doctors appt within 72 hrs of scheduling) and we also would not get access to the latest and greatest drugs and therapies because those are always expensive and SP schemes typically do not cover that. Now with that said is single payer good or bad? Well it all depends on who you ask. If you ask a 20 something that just visits the doctor once a year for a checkup and maybe calls into urgent care once every few years when the get the flu or food poisoning, that person will be all over the moon about a single payer system. Now contrast that with someone in their 50's or 60's that has pre-existing conditions, sometimes chronic conditions, and needs constant care and access to the latest drugs. Well for that person single payer is dogshit and won't cover half their needs. And that is the essence of the problem, two sides with vastly different needs from the healthcare system and a government that has to make one decision that will somehow satisfy both parties, even though that could really never happen. You're either going to pick the 20 year old and screw over grandma or you're gonna pick the grandma and screw the 20 year old.
- tomrod 2y ago
  I mean, call a spade a spade. Single Payor can have programs set up to specifically address specific issues, like turnaround time to see a GP when sick (e.g virtual visits to clear up demand that can be routed that way). Whereas the disjointed system the US currently "enjoys" STILL has GP rationing -- and worse, whole specialties disappearing or otherwise rejecting a payor because it sucks. It's bogus that "single payor won't cover people in 60s/70s with chronic needs." That is 100% a policy decision. Versus the entrenched broken system we have now, where often needs are covered despite urgency.
- quasse 2y ago
  > For your example about single payer, with that scheme costs will likely be much lower but on the flip side, we also would not get immediate access to care (that is you can't attend a doctors appt within 72 hrs of scheduling) I am curious, why is this accepted as a "given" of single payer health care? I know it's a a problem in Canada and Britain, but those systems seem to be victims of something between neglect and outright political sabotage. As a side note, my partner is currently about half way through a two month wait to see her GP in the good old US of A (on United Health Care). I would love to only have to wait a few days.
cute_boi 2y ago
https://slatestarcodex.com/2014/07/30/meditations-on-moloch/ https://slatestarcodex.com/2014/07/30/meditations-on-moloch/ > The implicit question is – if everyone hates the current system, who perpetuates it? And Ginsberg answers: “Moloch”. It’s powerful not because it’s correct – nobody literally thinks an ancient Carthaginian demon causes everything – but because thinking of the system as an agent throws into relief the degree to which the system isn’t an agent.
- HDThoreaun 2y ago
  The problem is that not everyone hates the current system. Doctors in the US are paid exceptionally well because the system limits their supply. They can admit the system is horrible while also benefitting themselves. Healthcare is 17% of US GDP so there are huge incentives to not change anything from the people collecting that money.
Workaccount2 2y ago
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- kaikai 2y ago
  This is just as true for the European systems in the comment you’re replying to as it is in the American system. The problem is political.
  - Workaccount2 2y ago
    The problem with the European system is that it is contingent on the American system keeping the status quo. Without high prices in the US, European governments can't negotiate for the same lower prices. The US is a goldmine for medical corporations, which the EU gets to ride on the coat tails of.
    - convolvatron 2y ago
      you're suggesting that the entire difference in cost/benefit between the US and EU model is due to research and development? that seems wildly unsubstantiated. the google blurb puts it at 6% of US spending, but its unclear how much of that is actual research and how much is product development and marketing.
      - SpicyLemonZest 2y ago
        Not “due to” in the sense that that’s where the money directly goes, but concerns about slowing medical innovation are one of the big arguments that are raised against reform proposals in the US. In Europe, my understanding is that this is broadly not a concern and few health systems take fully incentivizing new therapies as a design criterion.
      - s1artibartfast 2y ago
        It is true for emerging technology such as drugs and devices, but doesnt figure in for most healthcare like getting a broken bone fixed or childbirth.
rscho 2y ago
Health culture in the US and Danemark are complete opposites. I mean how common people think about the system, and their expectations. Americans basically do not want to pay for anyone else than themselves. Europeans expect a strong social safety net, and accept higher taxes. So, you can't apply the danish system in the US. It would be anathema for a large part of the US population.
- Yeul 2y ago
  This is the crux. Rich people in Europe have "noblesse oblige". Yes you have to pay for your neighbour who is on welfare and a drug addict. Deal with it.
  - vladgur 2y ago
    The problem is that in the US we also pay for our neighbors who are on welfare and drug addicts. Welfare -- my 30%+ federal income taxes Medicare -- my income is taxed for it. MediCal(California only) - my 10%+ state income taxes. Uninsured/homeless goes to emergency room and hospital writes it off -- my 30%+ federail income taxes and my 10%+ state income taxes City spends millions on homeless -- my 10% state income taxes and probably a bit of my property taxes. On top of it, thousands per year of monthly medical insurance premiums for family of 3, thousands per year of "deductibles" before insurance kicks in. This cannot be better than just paying high taxes and receiving high benefits for it.
    - unyttigfjelltol 2y ago
      While technically true, hospital sticker prices actually are extreme because hospitals try to impress insurers with gigantic discounts off a fictitious base price, which no one pays except the unfortunate middle class person who finds themselves in an emergency without adequate health insurance.
      - bojangleslover 2y ago
        This is critical. I get these "Explanation of Benefits" from United, and they always show some enormous sticker price with a "discount." Something is clearly whack with these discounts. It would be too much credit to call it "financial engineering". Do you know who mostly benefits from these (basically) fraudulent "discounts"?
maxerickson 2y ago
The payment model probably isn't the biggest problem with the US system. My belief is that it's the relatively complicated regulation of capacity (federal and state regulations on facilities and providers), which pairs poorly with government programs that increase access to care with direct subsidies. We should train lots more providers and eliminate barriers to entry (so for instance, if someone wants to open an MRI suite, let them).
- nradov 2y ago
  I generally agree, but many states don't have certificate-of-need rules blocking new imaging centers and those states don't seem to have significantly lower healthcare costs. The most immediate bottleneck on producing more physicians is lack of federal government funding for residency programs. Every year there are students who graduate from medical school with an MD but are unable to practice medicine because they don't get matched to a residency program (some do get matched the following year). At one point the AMA lobbied Congress to limit the supply of doctors but some years back they reversed that position. So far Congress hasn't acted. https://savegme.org/ https://savegme.org/ The other thing we can do to increase the supply of providers is to rely more on physician assistants and nurse practitioners for primary care. There may be some reduction in care quality but it's good enough for routine treatments and patients will just have to accept that. Real physicians should be reserved for more complex cases.
  - mindslight 2y ago
    > There may be some reduction in care quality but it's good enough for routine treatments and patients will just have to accept that. Real physicians should be reserved for more complex cases. Every efficiency idea is ultimately just used as an excuse to make the system worse and worse. As it stands "real physicians" are already mostly phoning it in, because their attention has been sliced up into 10 minute slivers by "insurance" companies. I'm not saying that NPs or PAs are going to be worse than that (in fact individual NP/PAs can be more engaged than individual MDs!), but it's still galling to be on the receiving end of negative-sum cost optimization - "our next appointment with a doctor is in four months, or you can see a PA next month". The sweeping reform we need is to drastically introduce actual market dynamics into the industry. This applies regardless of the payer structure - the entire industry needs to be moved from cost-externalizing negative-sum interactions towards cost-internalized positive-sum interactions. Imagine having actual supply and demand for doctors and hospitals funding their own residency programs rather than a set number of government funded residency slots.
giantg2 2y ago
The questions that I like to ask first when comparing systems to the US is, what is Denmark doing to reduce/prevent obesity and drug use, and what does elder care look like? There are certainly things that could change in the system, and it would be great to see what practices other countries have for some of our biggest cost drivers.
- JusticeJuice 2y ago
  I can't speak for Denmark, but I can speak for New Zealand, which has similar spend, and similar results (compared to the US). I wrote a thesis about healthcare software in uni, but as part of that I interviewed a bunch of people across the NZ healthcare industry, and learnt a lot about it. A big efficency for NZ is 'pharmac', which is essentially a country-wide medicine subsidizer, and supplier. It's a government entity which figures out how much of a certain drug the entire country will need for say a month, then goes and buys it, in bulk on the international market. Making such a large purchase gives them really good bargining power, and they'll buy generic versions. Not all drugs are pharmac covered, but most are. It means there's not much profit margin for drug supply in the system. The system is setup into 'district health boards'. Their job is to manage the health of everyone in a geographic area, and this means both in hospitals, and in primary care (your local doctors office). Because of this, they see the cost of their entire system, and are incentivised to optimise the care overall, as opposed to say a private hospital, and a private doctors office optimising their individual businesses. One way this manifests, is putting a big focus on getting people to go to primary care, instead of hospitals. Hospitals are the most expensive thing in the system turns out, so they'd much perfer people get to a primary care doctor sooner, before something becomes an issue that requires hospitalization. So they're incentivised to keep doctors visits cheap, and accessible. This comes into play quite a lot with elderly care, they make up a huge amount of primary care visits - but if they don't become hospital visits, that's great. You mentioned drug use. That's an interesting one as that's a government-wide issue, not just a healthcare issue. It affects poverty, education, emergency housing, the economy as a whole. There's been a big focus on public education, and actually ad campaigns about tabacco and alcahol, trying to make them seem really un-cool. And it's sort of been working, smoking rates are down, I'm not sure about vaping rates though. Meth is a big issue in NZ, but opiate/painkiller abuse is uncommon (compared to the US). One general point though, is there's not much profit oppertunity for companies in the system. As the majority of money comes from the government, the funding is very standardized. Running a doctors clinic or say a pharmacy is just like running a small business, with the same oppertunities. There just isn't huge 'startup' oppertunities to find a killer product and turn a huge profit. Profit isn't taken at every point of the supply chain in care. NZ's system has flaws, but overall I'm really pleased with it, and glad that we have it.
mightyham 2y ago
Our healthcare system is complicated by the fact America has much larger wealth disparities and more complex regulations stemming from a republican government with disparate laws among the states. Also the baumol effect: America has a significantly more developed tech and finance sectors compared to Europe which inflates the cost of less productive service based industries like healthcare. The system can't be "just changed" because it's a very complex issue with a lot of entrenched interests. There has to be sufficient political will at the top levels of government that simply doesn't currently exist (in either the Democrats or Republicans).
mystified5016 2y ago
A couple of things. We've spent the last three generations systematically deconstructing our public education system while certain billionaires raid our journalism and social media businesses. Fully half of America actually and fully believe any lie put in front of them by someone with enough power (money) and who says it scary enough. Americans don't want universal healthcare because then "bad" (read: not-white) people will have it. That's it. Giving something to the benefit of everyone is untenable evil because it's "communism". If you weren't lucky enough to be born into a social class that already has socioeconomic benefits, you simply don't ever deserve to have those things. This country has spent the last half century pillaging the commons and masterfully convincing just enough of the population that it's a good thing, actually. Why don't we just change things? Because we no longer own the government. Several billionaires own the government. Democratic change is next to impossible because the game has been rigged so well for so long and nobody with any power has any interest in fixing it. The US government no longer exists to serve the needs of the people, it exists solely to funnel the maximum possible amount of money from the working class to the ultra elite
Eumenes 2y ago
Why would I trust what Denmark does? This was Denmark's Minister of Health, a severely obese woman: https://en.wikipedia.org/wiki/Maggie_De_Block https://en.wikipedia.org/wiki/Maggie_De_Block
- s1artibartfast 2y ago
  She's alive isn't she?
- DangitBobby 2y ago
  Anecdotal. Maybe I should compile a list of terrible US healthcare anecdotes so I can share 10 for every 1 I see here.
- AnnikaL 2y ago
  Maggie De Block is a Belgian government official, not Danish.
namuol 2y ago
> Why don't you change it? Bribery is legal. https://en.m.wikipedia.org/wiki/Citizens_United_v._FEC https://en.m.wikipedia.org/wiki/Citizens_United_v._FEC
xiphias2 2y ago
Healthcare is incredibly complex because currently all technologies we have just make living longer exponentially more expensive with every added year. But one thing is clear: it's easy to improve the nutrients that people in the USA take. Whenever I travel in to USA, in the airports I can't even find a simple salad or any real food, even though I can see lots of pictures of salads, which drives me crazy. Last year I went through Atlanta airport, I bought a hamburger because they didn't have literally any other food at 10pm, and I thought I would just throw away the buns and eat the salad + maybe the meat (depending of the ingredients). Then I looked at the ingredients and it was like 50 things that I didn't even know what they mean. It didn't smell or taste like food at all, so at the end I found 1 year old nuts in my bag that my mom packed a year earlier, and I ate that.
- vladgur 2y ago
  While you are right and you have to work(and pay) to find good food in the US, I would not use airport food as a signal of nutrition availability anywhere in the world
  - xiphias2 2y ago
    I think airports are great reflections of culture of a country, because that's the first thing a visitor from another country sees, but I had other experiences in USA, where I felt that some of the reataurants just shouldn't be allowed to exist. I'm from Hungary, a country with 4x smaller average salary, and you can be sure that nowhere would the thing that they sold me without shame in the airport would be considered food, do it's clearly not a money problem. I believe RFK Junior understands how seriously USA food culture is behind compare to the available money and hope he does something about it.
dfxm12 2y ago
All of our systems are made by and for the rich. Not the doctors and certainly not the patients. This isn't limited to healthcare. When I say all systems, this includes government who make laws for lobbyists (who represent big business, like the insurance companies) and this also includes the media who ridicule the idea of socialized healthcare & the politicians who back it for all Americans as childish, impossible to pay for & socialist (as if that's a bad thing), among others. Even the political parties will withhold support from the few candidates who are realistically trying to make this happen. Against these odds, our current healthcare system is very unpopular [0], and if you put it to a vote, we would probably get a more sane healthcare system, but again, realistically, it's not up to us, unless, over the course of ~6 years we constantly show up to both primary and general elections and vote for representatives who support it, and leave the corporate backed candidates in the dust. 0 - https://news.gallup.com/poll/4708/healthcare-system.aspx https://news.gallup.com/poll/4708/healthcare-system.aspx
- DangitBobby 2y ago
  Curious what drive-by down voters actually have to say about this. The entire block of text seems at least mostly true. I think it's fair to say the assumption that the USA is a functioning democracy is at the very least up for debate.
Sohcahtoa82 2y ago
> What are the reasons why moving to a single payer system is so bad? Half the country (or at least, half the voters, which is only like 2/3rd of the country because so many don't vote) believes in rugged individualism and a Just World. They see single payer as their tax dollars going to paying for someone else's health problems that they caused themselves. In other words, they'll complain about their dollars paying for a smoker's lung cancer treatment or an overeater's diabetic treatment. They think everyone's health problems are their own and don't want to pay for it. The fact that when they pay for health insurance but don't make claims means their money goes to other people is completely lost on them.
serjester 2y ago
Any single payer system would significantly impact American's ability to choose their doctors, specific drugs, and procedures. Just look at the difference between dealing with an MRI for an injured knee in the US vs Canada - you're going to wait much longer in Canada. Americans really value choice and access, so they resist anything that hints at “rationing.” As a result, costs keep climbing, and there’s an insane amount of money tied up in administrative overhead. For anyone looking for a nuanced perspective on this, I highly recommend Peter Attia's interview with Saum Sutaria (McKinsey's formed healthcare lead).
- makeitdouble 2y ago
  Even in Canada you can pay more to get better or faster care. You'll always have overpriced options that by definition won't be worth it for people who can wait, and you can shop around the world if it's not an super emergency and you're really willing to spend. If that doesn't resonate, it's the same as schooling: you can have good and cheap public schools accessible to everyone, and private schools that will cost 5~20x more but provide a significantly different education.
- makeitdouble 2y ago
  > For anyone looking for a nuanced perspective on this, I highly recommend Peter Attia's interview with Saum Sutaria (McKinsey's formed healthcare lead) The taste I got of it (introduction bit) https://youtu.be/QqrpFICtqpQ?si=iqrhOc6lvELGuzvV https://youtu.be/QqrpFICtqpQ?si=iqrhOc6lvELGuzvV A definition of insurance that doesn't seem to understand how randomness can be upon the group instead of the individual. A person in his situation can't be so grossly misunderstanding pooling risk over a population. I've skipped here and there among the multiple videos to get a better feeling of the whole interview, but to be blunt that perfectly fit into the stereotype of a guy coming from McKinsey.
- AngryData 2y ago
  Americans don't have to wait, if they can pay enough money to make other people wait, usually through having superior insurance. And this is anecdotal but my own father had to spend 3 months in 24/7 heart afib as he waited for his thyroid to be removed. And that is with every doctor knowing for a fact that having afib is both damaging to the heart and may result in a deadly heart attack at literally any moment. But because his insurance isn't as great as other people's insurance, he has to wait in line with all the poor saps while people with money get treatment within hours or days. The idea that American's get better and more immediate healthcare is only true for people with money.
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Aloisius 2y ago
> I've heard American doctors Physicians are largely why the US doesn't have single payer. They've been funding a massive influence campaign against government health insurance and most cost containment efforts for nearly a century under the guise of "protecting patients" (in reality protecting their pocketbooks). https://citationsneeded.medium.com/episode-134-the-80-year-pr-campaign-that-killed-universal-healthcare-a63d0af24519 https://citationsneeded.medium.com/episode-134-the-80-year-p...

alistairSH 2y ago

Combo of the truly wealthy buy politicians AND many professionals and union employees have employer-subsidized health plans AND 100 years of “socialism bad!” messaging from the political right.

afthonos 2y ago

Everyone hates “the system”, including the people in it. But every party of the system is perfectly fair and reasonable for the people benefitting from it, even if they hate every other part. So every part of the system will have people fighting for it—and if you try to change the whole system, the entire system will fight you. It’s an equilibrium, even if it’s obviously far from optimal.

potato3732842 2y ago
And it has only gotten worse with time. https://www.statista.com/statistics/184968/us-health-expenditure-as-percent-of-gdp-since-1960/ https://www.statista.com/statistics/184968/us-health-expendi... That's 20% of the country that will be less well off if you "fix" healthcare in any meaningful way and the overwhelming majority of them will fight tooth and nail to prevent that from happening. That is a hell of a minority to overcome when the issue is one of personal economics (i.e one everyone will experience directly, not some abstract social policy thing that people will ignore as long as their lives are good), dare I say basically impossible in a democracy. (yes I know I'm assuming that the healthcare industry is a cross section of the country, no I don't care if that isn't 100% accurate)
htk 2y ago
Excellent comment, succinctly summarizing how a systems thinking perspective translates the monster of health care in a large system of interconnected parts, each with its own stakeholders. Trying to change a single part triggers a reaction from everyone. Tough ecosystem to change. But, at the same time, seems to be the one needing change the most.
kfarr 2y ago
There's an old essay "Meditations on Moloch" which is an exploration of themes around why humans create systems with destructive outcomes even when no individual wants them: https://slatestarcodex.com/2014/07/30/meditations-on-moloch/ https://slatestarcodex.com/2014/07/30/meditations-on-moloch/
- hallway_monitor 2y ago
  This is a really good read. It talks about all kinds of systems which become their own entity. Nobody likes them. They make things worse for everybody. But somehow we get trapped in these downward spirals and there’s seemingly no way out.
- n4r9 2y ago
  Surely some people do actually want suffering, or at the very least are indifferent to causing suffering to advance their goals? I don't feel like there's some weird paradox, but rather that the system makes it too easy for sociopathic types to rise to the top.
  - kfarr 2y ago
    I think this is related to fundamental attribution error. The system is messed up and therefore attracts messed up people in leadership positions, not the other around.
    - n4r9 2y ago
      I guess I miscommunicated the thrust of my argument. It seems to me that the paradox presented in the linked article hinges on an assumption that "nobody wants" there to be suffering. This seems flawed to me. There are plenty of people - some of whom are in positions of great power - who are content to generate a large degree of suffering in order to advance personal goals. This is currently very clear in Ukraine and Gaza. But it applies equally well to people that drive shady mergers and acquisitions at the cost of the consumer, or people that push drugs at the cost of addicts' health and relationships. It's not "nobody wants this", but "sufficiently many people are sufficiently apathetic to continue this state of affairs".
WarOnPrivacy 2y ago
> every party of the system is perfectly fair and reasonable for the people benefitting from it This observation has value. However, if we hold it exclusively in mind we might lose focus of how prioritizing consumers strongly benefits society.

londons_explore 2y ago

> Why don't you change it? I suspect because nobody can agree on what the new replacement system should look like.

Ylpertnodi 2y ago
There are several functioning examples in Europe, 'they' could take a look at.
- School-Cotton 2y ago
  Who is “they”, exactly? What specific group of people do you think is in charge of the system and should do this?
  - ashoeafoot 2y ago
    We, the people ?
    - School-Cotton 2y ago
      The US isn’t a pure direct democracy with referenda on every topic, so what does that mean, concretely? Who specifically should take what action?
- ernst_klim 2y ago
  Like where? UK system is collapsing under underfunding and misallocation, German system is crumbling under terrible lack of personell with raising (already high) costs with lowering quality and increasing waiting times (up to infinite where mamologs and psychiatrists simply take no new patients in many cities). Basically in all thirst world countries trend is negative unless and experience is frustrating unless you are rich with good private coverage. At least that's my experience.
  - ceejayoz 2y ago
    > UK system is collapsing under underfunding and misallocation Fifteen years with the "let's privatize everything!" party will do that, yes.

bgnn 2y ago

not an American, but it seems to me that the reason is purely ideological. They like a small state, especially the federal government. This would give too much power to the government. The idea of federal government providing care for citizens is not acceptable to people. Now, weird thing is this doesn't work for the military somehow.

cjbgkagh 2y ago
The US should not be used as an example of a small government. Some people in the US may profess to wanting a small government, but they definitely don’t have one. Haven’t run the numbers but I would suspect the US government is the largest government in human history.
- ashoeafoot 2y ago
  You goto seperate the imperial machine of world policing (paid in the dollats used and held by the world for trade)from the government managing the citizens of the us (parially paid in taxes by the citizens)
- travisgriggs 2y ago
  I’m not sure how one would define “the size of government” but the ILO says differently at least: https://worldpopulationreview.com/country-rankings/public-sector-size-by-country https://worldpopulationreview.com/country-rankings/public-se... (Wikipedia has a similar page, but not as navigable imo) I scroll through a lot of European countries before getting to the US at 13.4%. I think the healthcare (and other) systems suck because they are complex. There are two ways to hid information: lock it up (lack of transparency) OR dilute it amongst noise. The latter is what complex systems of whatever do. Complex systems create opportunity for those with enough resources to locate and exploit eddies of wealth in the system. While those without the time and resources to spend understanding the complex system just decry it because it is too difficult to understand.
  - cjbgkagh 2y ago
    Well clearly absolute staffing numbers would work, but I would go by absolute money spent. I think it's ironically reductive to simplify a complex problem to a general problem of complexity. I'm not sure what your point is, we appear to agree that the system is corrupted and that there is regulatory capture. My point is that the US government shouldn't be used as an example of a small government in general and for healthcare specifically. Even if I was to agree that the US should adopt an European healthcare system I don't see how to uncorrupt the existing system to enable that to happen. This notion that a government takeover will take the money out of the system and diminish opportunity for greed is fanciful.

School-Cotton 2y ago

> Why don’t you change it? Who do you think should change it, exactly? You’re making the classic mistake of assuming the US works like the average European country: a functioning democracy where if something makes sense, politicians will promise it in their manifestos, and then implement it once they get elected. In reality the US works completely differently and is not a functioning democracy. Making any major reform in any area is, to a first approximation, impossible.

GiorgioG 2y ago
As an American born to European immigrant parents I can assure you that the grass is not always greener on the other side. All systems have problems. I say this as the parent of a child with a chronic illness (t1d) who is extremely frustrated with our health(insurance)care system.
- School-Cotton 2y ago
  Not everything is better about Europe than the US, I agree (and the extent to which this is true depends on where in Europe you’re talking about - Bulgaria is not much like Switzerland). But one of the things that I think is unambiguously better (at least in highly developed Northern and Western Europe) is the quality of democratic institutions and their responsiveness to the people’s will. In the US, it is structurally almost impossible for Congress to legislate meaningfully, so effectively no one is in charge.
  - GiorgioG 2y ago
    At very least the French and Italian people would disagree (I’m French and Italian). Seems like folks across Europe were pretty upset with the number of asylum seekers and the problems that followed their migration into Europe in the last couple of years. Their governments didn’t seem to give much of a shit and that’s led to more right-wing support.
  - kstrauser 2y ago
    As an American watching Brexit and other self-owns pouring out of the UK, I’m not completely sold on this. If our system is insane — and it is — I’d say it’s a family disorder we inherited.

asdf6969 2y ago

> Why don't you change it? There is no general “you” with agency. The few people who have the ability to change it have no incentive to do that.

ashoeafoot 2y ago
80% majority in a democracy can not change whatever they want? Or.. the ideology people inhalate is so strong ,it hacks democracy itself?
- betenoire 2y ago
  agreeing to change and agreeing how to change aren't the same thing at all though
- mystified5016 2y ago
  Your core mistake is assuming that America is a democracy. It is not. It has been very efficiently designed to strip as many people of their political voice as possible. Our major elections are literally engineered to give insane advantages to whichever party is currently in power
- blactuary 2y ago
  Most people know the overall system sucks, but they also think their insurance is mostly fine because they haven't had to use it very much (which is simply definitional, 80% of costs come from 20% of people). And so people fear the unknown. They would like something better but fear giving up what they have right now for something they haven't experienced. It is also a deeply personal issue, and has so many entrenched interests. Health care spending is 1/3 of our economy.
  - DangitBobby 2y ago
    Any evidence that "most people" are given a voice into actual systemic change? I haven't been given an opportunity to vote for a candidate that actually wants to change our healthcare system, personally. Obama helped many people, but his moves did not really attempt to solve the problems of insurer inefficiency and grift, and instead codified their position as gatekeepers.

thrillgore 2y ago

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liontwist 2y ago

> Why does each of these cost tens or hundreds of thousands of dollars? Because money is just a tool for allocating resources. And having well trained people with equipment ready to attend to every person in that situation requires a lot of resources. I’m not justifying our systems inefficiency - let’s just be clear that medical care costs a lot of money. So the challenging political question is how to manage access and costs (often devolves into rationing) and who should pay for it.

liontwist 2y ago
Note that what constitutes healthcare is culturally defined. Different groups have varying expectations of procedures which is then conflated with other services. When my baby was born my wife and I stayed in the hospital for two nights during which we received constant checks and meals. I was ready to go because my baby was healthy and I knew it was expensive. Is this level of service required medical care? I don’t think so. Many choose to have a medical professional at home to help with a delivery for a day or so. If it is deemed required, how many nights should be offered? I’m sure people with a bad home environment would stay as long as they could. If we set a hard cap of a few days, that’s also bad because some babies need to be at the hospital and it’s very helpful to have that. Alternatively imagine if the beds are occupied who don’t really need to be there and then a new baby needs to be born?
jack_h 2y ago
> Because money is just a tool for allocating resources. > often devolves into rationing Just to expand upon what you're saying a bit; most people don't view things in such terms which I think is unfortunate. You often see discussions about waiting times in single payer healthcare systems and cost in more free-market systems. The fact of the matter is that if demand is greater than supply you must ration the supply somehow. Prices are one way but not the only way. Waiting lines, by need, randomly, etc... are all valid rationing mechanisms as well. What I've noticed is that when people don't view this is a resource allocation problem they are able to always see the greener grass somewhere else. They see the lack of treatment of a person or group of persons as a failing of their system where those people would have received treatment in a different system that uses a different rationing mechanism. The issue is that in a different system there would still be people who don't receive treatment, they would just be different people. By not viewing it as a resource allocation problem I think it gives the appearance that there is a perfect solution and that its just political will halting its implementation.

_fat_santa 2y ago

> Why don't you change it? What are the reasons why moving to a single payer system is so bad? The best way I can describe our healthcare is that it's freakishly complicated, so complicated that pretty much every argument made by any side at any given time is both correct and incorrect. For your example about single payer, with that scheme costs will likely be much lower but on the flip side, we also would not get immediate access to care (that is you can't attend a doctors appt within 72 hrs of scheduling) and we also would not get access to the latest and greatest drugs and therapies because those are always expensive and SP schemes typically do not cover that. Now with that said is single payer good or bad? Well it all depends on who you ask. If you ask a 20 something that just visits the doctor once a year for a checkup and maybe calls into urgent care once every few years when the get the flu or food poisoning, that person will be all over the moon about a single payer system. Now contrast that with someone in their 50's or 60's that has pre-existing conditions, sometimes chronic conditions, and needs constant care and access to the latest drugs. Well for that person single payer is dogshit and won't cover half their needs. And that is the essence of the problem, two sides with vastly different needs from the healthcare system and a government that has to make one decision that will somehow satisfy both parties, even though that could really never happen. You're either going to pick the 20 year old and screw over grandma or you're gonna pick the grandma and screw the 20 year old.

tomrod 2y ago
I mean, call a spade a spade. Single Payor can have programs set up to specifically address specific issues, like turnaround time to see a GP when sick (e.g virtual visits to clear up demand that can be routed that way). Whereas the disjointed system the US currently "enjoys" STILL has GP rationing -- and worse, whole specialties disappearing or otherwise rejecting a payor because it sucks. It's bogus that "single payor won't cover people in 60s/70s with chronic needs." That is 100% a policy decision. Versus the entrenched broken system we have now, where often needs are covered despite urgency.
quasse 2y ago
> For your example about single payer, with that scheme costs will likely be much lower but on the flip side, we also would not get immediate access to care (that is you can't attend a doctors appt within 72 hrs of scheduling) I am curious, why is this accepted as a "given" of single payer health care? I know it's a a problem in Canada and Britain, but those systems seem to be victims of something between neglect and outright political sabotage. As a side note, my partner is currently about half way through a two month wait to see her GP in the good old US of A (on United Health Care). I would love to only have to wait a few days.

cute_boi 2y ago

https://slatestarcodex.com/2014/07/30/meditations-on-moloch/ https://slatestarcodex.com/2014/07/30/meditations-on-moloch/ > The implicit question is – if everyone hates the current system, who perpetuates it? And Ginsberg answers: “Moloch”. It’s powerful not because it’s correct – nobody literally thinks an ancient Carthaginian demon causes everything – but because thinking of the system as an agent throws into relief the degree to which the system isn’t an agent.

HDThoreaun 2y ago
The problem is that not everyone hates the current system. Doctors in the US are paid exceptionally well because the system limits their supply. They can admit the system is horrible while also benefitting themselves. Healthcare is 17% of US GDP so there are huge incentives to not change anything from the people collecting that money.

Workaccount2 2y ago

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kaikai 2y ago
This is just as true for the European systems in the comment you’re replying to as it is in the American system. The problem is political.
- Workaccount2 2y ago
  The problem with the European system is that it is contingent on the American system keeping the status quo. Without high prices in the US, European governments can't negotiate for the same lower prices. The US is a goldmine for medical corporations, which the EU gets to ride on the coat tails of.
  - convolvatron 2y ago
    you're suggesting that the entire difference in cost/benefit between the US and EU model is due to research and development? that seems wildly unsubstantiated. the google blurb puts it at 6% of US spending, but its unclear how much of that is actual research and how much is product development and marketing.
    - SpicyLemonZest 2y ago
      Not “due to” in the sense that that’s where the money directly goes, but concerns about slowing medical innovation are one of the big arguments that are raised against reform proposals in the US. In Europe, my understanding is that this is broadly not a concern and few health systems take fully incentivizing new therapies as a design criterion.
    - s1artibartfast 2y ago
      It is true for emerging technology such as drugs and devices, but doesnt figure in for most healthcare like getting a broken bone fixed or childbirth.

rscho 2y ago

Health culture in the US and Danemark are complete opposites. I mean how common people think about the system, and their expectations. Americans basically do not want to pay for anyone else than themselves. Europeans expect a strong social safety net, and accept higher taxes. So, you can't apply the danish system in the US. It would be anathema for a large part of the US population.

Yeul 2y ago
This is the crux. Rich people in Europe have "noblesse oblige". Yes you have to pay for your neighbour who is on welfare and a drug addict. Deal with it.
- vladgur 2y ago
  The problem is that in the US we also pay for our neighbors who are on welfare and drug addicts. Welfare -- my 30%+ federal income taxes Medicare -- my income is taxed for it. MediCal(California only) - my 10%+ state income taxes. Uninsured/homeless goes to emergency room and hospital writes it off -- my 30%+ federail income taxes and my 10%+ state income taxes City spends millions on homeless -- my 10% state income taxes and probably a bit of my property taxes. On top of it, thousands per year of monthly medical insurance premiums for family of 3, thousands per year of "deductibles" before insurance kicks in. This cannot be better than just paying high taxes and receiving high benefits for it.
  - unyttigfjelltol 2y ago
    While technically true, hospital sticker prices actually are extreme because hospitals try to impress insurers with gigantic discounts off a fictitious base price, which no one pays except the unfortunate middle class person who finds themselves in an emergency without adequate health insurance.
    - bojangleslover 2y ago
      This is critical. I get these "Explanation of Benefits" from United, and they always show some enormous sticker price with a "discount." Something is clearly whack with these discounts. It would be too much credit to call it "financial engineering". Do you know who mostly benefits from these (basically) fraudulent "discounts"?

maxerickson 2y ago

The payment model probably isn't the biggest problem with the US system. My belief is that it's the relatively complicated regulation of capacity (federal and state regulations on facilities and providers), which pairs poorly with government programs that increase access to care with direct subsidies. We should train lots more providers and eliminate barriers to entry (so for instance, if someone wants to open an MRI suite, let them).

nradov 2y ago
I generally agree, but many states don't have certificate-of-need rules blocking new imaging centers and those states don't seem to have significantly lower healthcare costs. The most immediate bottleneck on producing more physicians is lack of federal government funding for residency programs. Every year there are students who graduate from medical school with an MD but are unable to practice medicine because they don't get matched to a residency program (some do get matched the following year). At one point the AMA lobbied Congress to limit the supply of doctors but some years back they reversed that position. So far Congress hasn't acted. https://savegme.org/ https://savegme.org/ The other thing we can do to increase the supply of providers is to rely more on physician assistants and nurse practitioners for primary care. There may be some reduction in care quality but it's good enough for routine treatments and patients will just have to accept that. Real physicians should be reserved for more complex cases.
- mindslight 2y ago
  > There may be some reduction in care quality but it's good enough for routine treatments and patients will just have to accept that. Real physicians should be reserved for more complex cases. Every efficiency idea is ultimately just used as an excuse to make the system worse and worse. As it stands "real physicians" are already mostly phoning it in, because their attention has been sliced up into 10 minute slivers by "insurance" companies. I'm not saying that NPs or PAs are going to be worse than that (in fact individual NP/PAs can be more engaged than individual MDs!), but it's still galling to be on the receiving end of negative-sum cost optimization - "our next appointment with a doctor is in four months, or you can see a PA next month". The sweeping reform we need is to drastically introduce actual market dynamics into the industry. This applies regardless of the payer structure - the entire industry needs to be moved from cost-externalizing negative-sum interactions towards cost-internalized positive-sum interactions. Imagine having actual supply and demand for doctors and hospitals funding their own residency programs rather than a set number of government funded residency slots.

giantg2 2y ago

The questions that I like to ask first when comparing systems to the US is, what is Denmark doing to reduce/prevent obesity and drug use, and what does elder care look like? There are certainly things that could change in the system, and it would be great to see what practices other countries have for some of our biggest cost drivers.

JusticeJuice 2y ago
I can't speak for Denmark, but I can speak for New Zealand, which has similar spend, and similar results (compared to the US). I wrote a thesis about healthcare software in uni, but as part of that I interviewed a bunch of people across the NZ healthcare industry, and learnt a lot about it. A big efficency for NZ is 'pharmac', which is essentially a country-wide medicine subsidizer, and supplier. It's a government entity which figures out how much of a certain drug the entire country will need for say a month, then goes and buys it, in bulk on the international market. Making such a large purchase gives them really good bargining power, and they'll buy generic versions. Not all drugs are pharmac covered, but most are. It means there's not much profit margin for drug supply in the system. The system is setup into 'district health boards'. Their job is to manage the health of everyone in a geographic area, and this means both in hospitals, and in primary care (your local doctors office). Because of this, they see the cost of their entire system, and are incentivised to optimise the care overall, as opposed to say a private hospital, and a private doctors office optimising their individual businesses. One way this manifests, is putting a big focus on getting people to go to primary care, instead of hospitals. Hospitals are the most expensive thing in the system turns out, so they'd much perfer people get to a primary care doctor sooner, before something becomes an issue that requires hospitalization. So they're incentivised to keep doctors visits cheap, and accessible. This comes into play quite a lot with elderly care, they make up a huge amount of primary care visits - but if they don't become hospital visits, that's great. You mentioned drug use. That's an interesting one as that's a government-wide issue, not just a healthcare issue. It affects poverty, education, emergency housing, the economy as a whole. There's been a big focus on public education, and actually ad campaigns about tabacco and alcahol, trying to make them seem really un-cool. And it's sort of been working, smoking rates are down, I'm not sure about vaping rates though. Meth is a big issue in NZ, but opiate/painkiller abuse is uncommon (compared to the US). One general point though, is there's not much profit oppertunity for companies in the system. As the majority of money comes from the government, the funding is very standardized. Running a doctors clinic or say a pharmacy is just like running a small business, with the same oppertunities. There just isn't huge 'startup' oppertunities to find a killer product and turn a huge profit. Profit isn't taken at every point of the supply chain in care. NZ's system has flaws, but overall I'm really pleased with it, and glad that we have it.

mightyham 2y ago

Our healthcare system is complicated by the fact America has much larger wealth disparities and more complex regulations stemming from a republican government with disparate laws among the states. Also the baumol effect: America has a significantly more developed tech and finance sectors compared to Europe which inflates the cost of less productive service based industries like healthcare. The system can't be "just changed" because it's a very complex issue with a lot of entrenched interests. There has to be sufficient political will at the top levels of government that simply doesn't currently exist (in either the Democrats or Republicans).

mystified5016 2y ago

A couple of things. We've spent the last three generations systematically deconstructing our public education system while certain billionaires raid our journalism and social media businesses. Fully half of America actually and fully believe any lie put in front of them by someone with enough power (money) and who says it scary enough. Americans don't want universal healthcare because then "bad" (read: not-white) people will have it. That's it. Giving something to the benefit of everyone is untenable evil because it's "communism". If you weren't lucky enough to be born into a social class that already has socioeconomic benefits, you simply don't ever deserve to have those things. This country has spent the last half century pillaging the commons and masterfully convincing just enough of the population that it's a good thing, actually. Why don't we just change things? Because we no longer own the government. Several billionaires own the government. Democratic change is next to impossible because the game has been rigged so well for so long and nobody with any power has any interest in fixing it. The US government no longer exists to serve the needs of the people, it exists solely to funnel the maximum possible amount of money from the working class to the ultra elite

Eumenes 2y ago

Why would I trust what Denmark does? This was Denmark's Minister of Health, a severely obese woman: https://en.wikipedia.org/wiki/Maggie_De_Block https://en.wikipedia.org/wiki/Maggie_De_Block

s1artibartfast 2y ago
She's alive isn't she?
DangitBobby 2y ago
Anecdotal. Maybe I should compile a list of terrible US healthcare anecdotes so I can share 10 for every 1 I see here.
AnnikaL 2y ago
Maggie De Block is a Belgian government official, not Danish.

namuol 2y ago

> Why don't you change it? Bribery is legal. https://en.m.wikipedia.org/wiki/Citizens_United_v._FEC https://en.m.wikipedia.org/wiki/Citizens_United_v._FEC

xiphias2 2y ago

Healthcare is incredibly complex because currently all technologies we have just make living longer exponentially more expensive with every added year. But one thing is clear: it's easy to improve the nutrients that people in the USA take. Whenever I travel in to USA, in the airports I can't even find a simple salad or any real food, even though I can see lots of pictures of salads, which drives me crazy. Last year I went through Atlanta airport, I bought a hamburger because they didn't have literally any other food at 10pm, and I thought I would just throw away the buns and eat the salad + maybe the meat (depending of the ingredients). Then I looked at the ingredients and it was like 50 things that I didn't even know what they mean. It didn't smell or taste like food at all, so at the end I found 1 year old nuts in my bag that my mom packed a year earlier, and I ate that.

vladgur 2y ago
While you are right and you have to work(and pay) to find good food in the US, I would not use airport food as a signal of nutrition availability anywhere in the world
- xiphias2 2y ago
  I think airports are great reflections of culture of a country, because that's the first thing a visitor from another country sees, but I had other experiences in USA, where I felt that some of the reataurants just shouldn't be allowed to exist. I'm from Hungary, a country with 4x smaller average salary, and you can be sure that nowhere would the thing that they sold me without shame in the airport would be considered food, do it's clearly not a money problem. I believe RFK Junior understands how seriously USA food culture is behind compare to the available money and hope he does something about it.

dfxm12 2y ago

All of our systems are made by and for the rich. Not the doctors and certainly not the patients. This isn't limited to healthcare. When I say all systems, this includes government who make laws for lobbyists (who represent big business, like the insurance companies) and this also includes the media who ridicule the idea of socialized healthcare & the politicians who back it for all Americans as childish, impossible to pay for & socialist (as if that's a bad thing), among others. Even the political parties will withhold support from the few candidates who are realistically trying to make this happen. Against these odds, our current healthcare system is very unpopular [0], and if you put it to a vote, we would probably get a more sane healthcare system, but again, realistically, it's not up to us, unless, over the course of ~6 years we constantly show up to both primary and general elections and vote for representatives who support it, and leave the corporate backed candidates in the dust. 0 - https://news.gallup.com/poll/4708/healthcare-system.aspx https://news.gallup.com/poll/4708/healthcare-system.aspx

DangitBobby 2y ago
Curious what drive-by down voters actually have to say about this. The entire block of text seems at least mostly true. I think it's fair to say the assumption that the USA is a functioning democracy is at the very least up for debate.

Sohcahtoa82 2y ago

> What are the reasons why moving to a single payer system is so bad? Half the country (or at least, half the voters, which is only like 2/3rd of the country because so many don't vote) believes in rugged individualism and a Just World. They see single payer as their tax dollars going to paying for someone else's health problems that they caused themselves. In other words, they'll complain about their dollars paying for a smoker's lung cancer treatment or an overeater's diabetic treatment. They think everyone's health problems are their own and don't want to pay for it. The fact that when they pay for health insurance but don't make claims means their money goes to other people is completely lost on them.

serjester 2y ago

Any single payer system would significantly impact American's ability to choose their doctors, specific drugs, and procedures. Just look at the difference between dealing with an MRI for an injured knee in the US vs Canada - you're going to wait much longer in Canada. Americans really value choice and access, so they resist anything that hints at “rationing.” As a result, costs keep climbing, and there’s an insane amount of money tied up in administrative overhead. For anyone looking for a nuanced perspective on this, I highly recommend Peter Attia's interview with Saum Sutaria (McKinsey's formed healthcare lead).

makeitdouble 2y ago
Even in Canada you can pay more to get better or faster care. You'll always have overpriced options that by definition won't be worth it for people who can wait, and you can shop around the world if it's not an super emergency and you're really willing to spend. If that doesn't resonate, it's the same as schooling: you can have good and cheap public schools accessible to everyone, and private schools that will cost 5~20x more but provide a significantly different education.
makeitdouble 2y ago
> For anyone looking for a nuanced perspective on this, I highly recommend Peter Attia's interview with Saum Sutaria (McKinsey's formed healthcare lead) The taste I got of it (introduction bit) https://youtu.be/QqrpFICtqpQ?si=iqrhOc6lvELGuzvV https://youtu.be/QqrpFICtqpQ?si=iqrhOc6lvELGuzvV A definition of insurance that doesn't seem to understand how randomness can be upon the group instead of the individual. A person in his situation can't be so grossly misunderstanding pooling risk over a population. I've skipped here and there among the multiple videos to get a better feeling of the whole interview, but to be blunt that perfectly fit into the stereotype of a guy coming from McKinsey.
AngryData 2y ago
Americans don't have to wait, if they can pay enough money to make other people wait, usually through having superior insurance. And this is anecdotal but my own father had to spend 3 months in 24/7 heart afib as he waited for his thyroid to be removed. And that is with every doctor knowing for a fact that having afib is both damaging to the heart and may result in a deadly heart attack at literally any moment. But because his insurance isn't as great as other people's insurance, he has to wait in line with all the poor saps while people with money get treatment within hours or days. The idea that American's get better and more immediate healthcare is only true for people with money.

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Aloisius 2y ago

> I've heard American doctors Physicians are largely why the US doesn't have single payer. They've been funding a massive influence campaign against government health insurance and most cost containment efforts for nearly a century under the guise of "protecting patients" (in reality protecting their pocketbooks). https://citationsneeded.medium.com/episode-134-the-80-year-pr-campaign-that-killed-universal-healthcare-a63d0af24519 https://citationsneeded.medium.com/episode-134-the-80-year-p...