6 ms·

Universal healthcare is supported by something like 60 or 70% of Americans. Don’t be fooled by those trying to make it into a party issue. Agreed, it’s crazy.

Universal healthcare is supported by something like 60 or 70% of Americans. Don’t be fooled by those trying to make it into a party issue. Agreed, it’s crazy. Making healthcare contingent on employment is barbaric but aligned with other practices (like W2 tax withholding) where the government effectively deputizes your employer to enforce the civic contract.

onesociety2022 1y ago
I would support universal healthcare if I think the government is actually capable of reigning in the avg healthcare costs of an American. I’d bet the $800/mo eyedrops this poor lady is relying on don’t cost that much in any other country (and I don’t mean poor countries - I mean in other rich countries like Japan, Singapore or Australia). So when she switches to Medicare as soon as she turns 65, how much are the US taxpayers paying for these eyedrops? It’s just wealth transfer from US taxpayers to the US medical industry complex. So I fear “Medicare for All” would simply mean we pay even more taxes than we already do now and the US government will keep spending insane amounts of money on healthcare as compared to every other developed nation in the world with no better outcomes.
- cornholio 1y ago
  I think there is credible research that US drug costs are primarily the result of a fragmented market and lack of collective bargaining. So a single buyer regime will by itself lower the prices since manufacturers will be forced to compete among themselves based on price and an objective metric of the therapeutic benefit - as opposed to marketing and the best sales network and "conference" benefits the prescribing physicians. For example, if the generic option reduces the burden of disease by 10 DALYs and costs essentially ~0$ it will be fully covered, any other patented option with a 15 DALY average benefit will be covered up to a financial ceiling given by the total funding available and the extra 5DALY benefit it brings. A patented option that does not fit that ceiling will require patients to pay from their pocket, therefore cratering sales, therefore strongly incentivizing the pharmaceutical company to lower the price to fit the ceiling. This is how other advanced countries lower spending on drugs without infringing on intellectual property - by forcing all manufacturers of all drugs for all diseases to compete on price, or risk selling basically nothing in that country until their patents expire. Since the marginal production cost of drugs is close to zero, it' always better to have some sales at some lower prices instead of no sales at a very profitable price.
  - onesociety2022 1y ago
    The question is why haven’t they already done this type of cost control with existing Medicare? People aged 65 and over are incredibly lucrative for Big Pharma and medical industry as a whole because by definition they will incur a lot of medical problems due to their age and need a lot of medication. So it’s a lucrative segment of the market that they can’t afford to lose. So the US govt should be in a great position to negotiate on costs but it doesn’t look like they have done much at all. I think in a way Americans are actually subsidizing pharmaceuticals for consumers in other countries because pharmaceutical companies are willing to sell the same product for less to them because as you said their marginal production costs are minimal and they have already recuperated a great return on their R&D investment from American consumers.
    - cornholio 1y ago
      Both can be true at the same time, the American market can subsidize research for the rest of the world, and one source of this subsidy could be US public programs leaving substantial cash on the table for big pharma. Another perspective is that this extra spending is more closely correlated with global pharmaceutical profits and the spending by these companies for their US sales and lobby apparatus (which influences Medicare prescribing physicians just as well), and much less with actual fundamental research and clinical study spending required to bring these drugs to market. So it's relatively speaking "wastage" compared to direct medical research spending - perhaps through a global research institution funded by major economies. Hey, we can dream. As to why would Medicare leave these untold billions on the table, I don't know the details of how they decide what to treat, but it's a very tricky political problem. Once you start to deal with things like DALYs, QALYs and micromorts, you are plowing straight into the "death panels" controversy. So all pharma has to do is refuse to play ball, continue to sell most of their products into the open market, and watch their Madicare centralized buyers quickly fold. You can only force Pharma to play if you institute a national monopsony; a single program, even a big one, can't possibly work since by acquiescing they would threaten profits in the rest of the market. For the same reason, a single US state could not go at it alone, pharma would just refuse to sell to that state at the imposed ceilings; it needs to be a nation wide program.
cornholio 1y ago
"Medicare for all willing to pay 10% of taxable income" seems like a way to sneak universal healthcare through the political backdoor. It will initially have a funding shortfall due to adverse selection (it will attract primarily people with low incomes, high risks or both) but you would gradually move all public subsidies towards that program and remove all incentives, tax credits and rate protections from those who choose the free market option, and when just a minority still hangs on to the private providers, you make the 10% health tax mandatory to all. The way I see it, you will never wrestle away the trillion dollar bone from the mouth of the US healthcare industry, but you can make it wither away indirectly by creating a better universal system and dismantling the status quo. It's not like Europeans are forbidden the option of private insurance, it's just that it can't take hold and grow to control a significant part of the spending because everyone can see it's not the solution that will save you when you will get really really sick.
- AstroBen 1y ago
  Australia has a medicare levy of 2% taxable income - and last time I did the math I'd pay an equal amount in tax there as I do in the US Seems ridiculous the US doesn't have it
  - thunky 1y ago
    A huge number of Australians (over half of the population) also pay for private insurance. https://www.commonwealthfund.org/international-health-policy-center/countries/australia https://www.commonwealthfund.org/international-health-policy...
    - therealpygon 1y ago
      Sounds like a good choice then. 2% for a basic level of care for everyone seems awfully reasonable. We are already paying roughly 1.5% for medicare with most people not being eligible.
  - tharkun__ 1y ago
    Does it? Let's look at another country that has "great universal health care". Let's look to Europe, that's always "up there", right? For statutory or public health insurance, you pay for your insurance through social contributions, the rate of which is 14.6% of the income as determined by the Federal Ministry of Health for 2024. https://www.germany-visa.org/insurances-germany/health-insurance/cost/ https://www.germany-visa.org/insurances-germany/health-insur... Pretty sure that's up but let's assume 15% of income.
valianteffort 1y ago
>60 or 70% of Americans polled* I certainly don't want it and nobody I know that actually understands the real cost does either. Every single nation that provides socialized healthcare is hopelessly strained by its cost, and the service has suffered as a result. The system relies on eithe dramatic reductions in the cost of healthcare or a positive birthrate to sustain it. Nobody I know in socialized healthcare systems has good things to say about it when they actually need it.
- cam_l 1y ago
  The US has the most expensive healthcare costs per capita in the OECD, and the poorest health outcomes on average. You might think that this is merely because so many people in the US are not covered at all. But even when you account for people who are covered, the results are mixed at best. With the US performing slightly better in some areas, but much worse across the board. I also know a few people who have moved back from the US, even though they had health insurance, just to receive better socialised medical care in their own countries. I also know of a who went to the US to get cancer treatment. None of that means anything really. The number of people you know and their uninformed attitudes are statistically insignificant.
- JojoFatsani 1y ago
  Could say the same thing about interstate highways or the military though
- primax 1y ago
  I'd recommend you listen to the consumer's of those systems, instead of American pundits talking about them. Our system in Australia is absolutely fantastic, and far cheaper in taxes than you'd think.
  - valianteffort 1y ago
    How much do you pay as a percentage of your salary in taxes? In total of course. I pay 30% in taxes for federal and state. House is paid off but taxes is about 3% my salary. My insurance is more than I need (I don't use it at all) and cost me less than 2% of my salary. You can keep your socialized system, we are doing more than alright here mate. I got plenty of friends in Europe, England, Canada, and Australia all complaining about the same thing, wait times for care. I can see my doctor for basically anything inside of a couple weeks.
readthenotes1 1y ago
Between medicare, medicaid, Tricare, chips, etc around half the people in the United States are already on some sort of government supplied medical insurance. Getting to 60% for for such a deal shouldn't be too hard!
- Yeul 1y ago
  Even in America letting people die is a bridge too far so Reagan came up with a solution: no socialist health-insurance but anyone can walk or crawl into an emergency room and see a doctor. It is the most expensive and inefficient system but at least it's something.
  - mindslight 1y ago
    That something is one of the foundations of the rot we're dealing with today. Hospitals having to absorb those costs as overhead is a large motivation for the dynamic whereby they send fraudulent bills that you then need an "insurance" company to negotiate down for you. Politicians love such unfunded mandates because they magically assert the problem is solved while not increasing the budget at all. But they create a humongous drain on the economy (those resources come from somewhere), and are ultimately a form of regulatory capture.

onesociety2022 1y ago

I would support universal healthcare if I think the government is actually capable of reigning in the avg healthcare costs of an American. I’d bet the $800/mo eyedrops this poor lady is relying on don’t cost that much in any other country (and I don’t mean poor countries - I mean in other rich countries like Japan, Singapore or Australia). So when she switches to Medicare as soon as she turns 65, how much are the US taxpayers paying for these eyedrops? It’s just wealth transfer from US taxpayers to the US medical industry complex. So I fear “Medicare for All” would simply mean we pay even more taxes than we already do now and the US government will keep spending insane amounts of money on healthcare as compared to every other developed nation in the world with no better outcomes.

cornholio 1y ago
I think there is credible research that US drug costs are primarily the result of a fragmented market and lack of collective bargaining. So a single buyer regime will by itself lower the prices since manufacturers will be forced to compete among themselves based on price and an objective metric of the therapeutic benefit - as opposed to marketing and the best sales network and "conference" benefits the prescribing physicians. For example, if the generic option reduces the burden of disease by 10 DALYs and costs essentially ~0$ it will be fully covered, any other patented option with a 15 DALY average benefit will be covered up to a financial ceiling given by the total funding available and the extra 5DALY benefit it brings. A patented option that does not fit that ceiling will require patients to pay from their pocket, therefore cratering sales, therefore strongly incentivizing the pharmaceutical company to lower the price to fit the ceiling. This is how other advanced countries lower spending on drugs without infringing on intellectual property - by forcing all manufacturers of all drugs for all diseases to compete on price, or risk selling basically nothing in that country until their patents expire. Since the marginal production cost of drugs is close to zero, it' always better to have some sales at some lower prices instead of no sales at a very profitable price.
- onesociety2022 1y ago
  The question is why haven’t they already done this type of cost control with existing Medicare? People aged 65 and over are incredibly lucrative for Big Pharma and medical industry as a whole because by definition they will incur a lot of medical problems due to their age and need a lot of medication. So it’s a lucrative segment of the market that they can’t afford to lose. So the US govt should be in a great position to negotiate on costs but it doesn’t look like they have done much at all. I think in a way Americans are actually subsidizing pharmaceuticals for consumers in other countries because pharmaceutical companies are willing to sell the same product for less to them because as you said their marginal production costs are minimal and they have already recuperated a great return on their R&D investment from American consumers.
  - cornholio 1y ago
    Both can be true at the same time, the American market can subsidize research for the rest of the world, and one source of this subsidy could be US public programs leaving substantial cash on the table for big pharma. Another perspective is that this extra spending is more closely correlated with global pharmaceutical profits and the spending by these companies for their US sales and lobby apparatus (which influences Medicare prescribing physicians just as well), and much less with actual fundamental research and clinical study spending required to bring these drugs to market. So it's relatively speaking "wastage" compared to direct medical research spending - perhaps through a global research institution funded by major economies. Hey, we can dream. As to why would Medicare leave these untold billions on the table, I don't know the details of how they decide what to treat, but it's a very tricky political problem. Once you start to deal with things like DALYs, QALYs and micromorts, you are plowing straight into the "death panels" controversy. So all pharma has to do is refuse to play ball, continue to sell most of their products into the open market, and watch their Madicare centralized buyers quickly fold. You can only force Pharma to play if you institute a national monopsony; a single program, even a big one, can't possibly work since by acquiescing they would threaten profits in the rest of the market. For the same reason, a single US state could not go at it alone, pharma would just refuse to sell to that state at the imposed ceilings; it needs to be a nation wide program.

cornholio 1y ago

"Medicare for all willing to pay 10% of taxable income" seems like a way to sneak universal healthcare through the political backdoor. It will initially have a funding shortfall due to adverse selection (it will attract primarily people with low incomes, high risks or both) but you would gradually move all public subsidies towards that program and remove all incentives, tax credits and rate protections from those who choose the free market option, and when just a minority still hangs on to the private providers, you make the 10% health tax mandatory to all. The way I see it, you will never wrestle away the trillion dollar bone from the mouth of the US healthcare industry, but you can make it wither away indirectly by creating a better universal system and dismantling the status quo. It's not like Europeans are forbidden the option of private insurance, it's just that it can't take hold and grow to control a significant part of the spending because everyone can see it's not the solution that will save you when you will get really really sick.

AstroBen 1y ago
Australia has a medicare levy of 2% taxable income - and last time I did the math I'd pay an equal amount in tax there as I do in the US Seems ridiculous the US doesn't have it
- thunky 1y ago
  A huge number of Australians (over half of the population) also pay for private insurance. https://www.commonwealthfund.org/international-health-policy-center/countries/australia https://www.commonwealthfund.org/international-health-policy...
  - therealpygon 1y ago
    Sounds like a good choice then. 2% for a basic level of care for everyone seems awfully reasonable. We are already paying roughly 1.5% for medicare with most people not being eligible.
- tharkun__ 1y ago
  Does it? Let's look at another country that has "great universal health care". Let's look to Europe, that's always "up there", right? For statutory or public health insurance, you pay for your insurance through social contributions, the rate of which is 14.6% of the income as determined by the Federal Ministry of Health for 2024. https://www.germany-visa.org/insurances-germany/health-insurance/cost/ https://www.germany-visa.org/insurances-germany/health-insur... Pretty sure that's up but let's assume 15% of income.

valianteffort 1y ago

>60 or 70% of Americans polled* I certainly don't want it and nobody I know that actually understands the real cost does either. Every single nation that provides socialized healthcare is hopelessly strained by its cost, and the service has suffered as a result. The system relies on eithe dramatic reductions in the cost of healthcare or a positive birthrate to sustain it. Nobody I know in socialized healthcare systems has good things to say about it when they actually need it.

cam_l 1y ago
The US has the most expensive healthcare costs per capita in the OECD, and the poorest health outcomes on average. You might think that this is merely because so many people in the US are not covered at all. But even when you account for people who are covered, the results are mixed at best. With the US performing slightly better in some areas, but much worse across the board. I also know a few people who have moved back from the US, even though they had health insurance, just to receive better socialised medical care in their own countries. I also know of a who went to the US to get cancer treatment. None of that means anything really. The number of people you know and their uninformed attitudes are statistically insignificant.
JojoFatsani 1y ago
Could say the same thing about interstate highways or the military though
primax 1y ago
I'd recommend you listen to the consumer's of those systems, instead of American pundits talking about them. Our system in Australia is absolutely fantastic, and far cheaper in taxes than you'd think.
- valianteffort 1y ago
  How much do you pay as a percentage of your salary in taxes? In total of course. I pay 30% in taxes for federal and state. House is paid off but taxes is about 3% my salary. My insurance is more than I need (I don't use it at all) and cost me less than 2% of my salary. You can keep your socialized system, we are doing more than alright here mate. I got plenty of friends in Europe, England, Canada, and Australia all complaining about the same thing, wait times for care. I can see my doctor for basically anything inside of a couple weeks.

readthenotes1 1y ago

Between medicare, medicaid, Tricare, chips, etc around half the people in the United States are already on some sort of government supplied medical insurance. Getting to 60% for for such a deal shouldn't be too hard!

Yeul 1y ago
Even in America letting people die is a bridge too far so Reagan came up with a solution: no socialist health-insurance but anyone can walk or crawl into an emergency room and see a doctor. It is the most expensive and inefficient system but at least it's something.
- mindslight 1y ago
  That something is one of the foundations of the rot we're dealing with today. Hospitals having to absorb those costs as overhead is a large motivation for the dynamic whereby they send fraudulent bills that you then need an "insurance" company to negotiate down for you. Politicians love such unfunded mandates because they magically assert the problem is solved while not increasing the budget at all. But they create a humongous drain on the economy (those resources come from somewhere), and are ultimately a form of regulatory capture.