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I think the evidence is quite clear that universal health care reduces aggregate costs, but the public cost in aggregate is enormous. 1. This means large new t

I think the evidence is quite clear that universal health care reduces aggregate costs, but the public cost in aggregate is enormous. 1. This means large new taxes for everyone. For those on lower incomes, they might end up better off. For those on middle-upper+ incomes, they will unequivocally end up paying more. 2. The U.S. already has unbelievably high deficits and debt. This would make that worse without significant spending cuts elsewhere, and without very large new taxes. And before someone says "just tax the rich!", even if every billionaire in the U.S. had all their wealthy confiscated today, it would barely cover U.S. federal spending for *one year.* Then the party's over and the government collapses. "Just tax the rich" is an absurdly superficial position. European taxation is broad and deep. Everyone pays high tax - even those who do not earn much. 3. U.S. society is built on rugged individualism. Acceptance of immigrants under the premise that they will work hard and contribute. For this reason, U.S. success at integrating immigrants is better than anywhere else in the world, by a wide margin. Our issues re immigration in Europe are numerous and unbelievably contentious. Should the U.S. become a "welfare state," like European countries, it would no longer have a natural filter for immigrants. It would realise the type of immigration that we get in Europe, where for many groups, a majority refuse to work - for life. For this reason, it would require a MUCH tougher filter on immigrants - much more so than what the current administration is doing. I do not see the U.S. materially reducing spending in other areas, including the military. I do not see general public support for large taxation increases across the board. I do not see public consensus on strict new immigration requirements and enforcement. For these reasons and more, I do not think public health care is a realistic prospect for the foreseeable future.

bhelkey 2mo ago
> universal health care reduces aggregate costs, but the public cost in aggregate is enormous. This means large new taxes for everyone. If the US could spend healthcare dollars as efficiently as the UK, the US could pay for a single payer healthcare system covering every resident using only existing Medicare + Medicaid spending. Is the US willing to reduce the price of healthcare? I observe a large appetite in congress to increase the visibility into US healthcare spend. I observe rather more limited effort spent to use this data to reduce the aggregate costs (e.g. negotiating drug prices [1]). The math: The US spends $2 Trillion dollars on Medicare + Medicaid a year [2][3]. $2 Trillion dollars / a population of 342.7 million [4] = ~$5800 per resident per year. NHS (UK's universal healthcare system) costs ~£3,500 or ~$4800 per person per year [5]. [1] https://www.kff.org/medicare/key-facts-about-medicare-drug-price-negotiation/ https://www.kff.org/medicare/key-facts-about-medicare-drug-p... [2] https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet https://www.cms.gov/data-research/statistics-trends-and-repo... [3] https://www.kff.org/medicaid/medicaid-financing-the-basics/#870ed126-45c3-4465-8b9a-ae0eea487dcf https://www.kff.org/medicaid/medicaid-financing-the-basics/#... [4] https://www.census.gov/popclock/ https://www.census.gov/popclock/ [5] https://www.bbc.com/news/articles/cwy7zvp5xrqo https://www.bbc.com/news/articles/cwy7zvp5xrqo
- Gareth321 2mo ago
  I think you did not understand my comment, and that is perhaps my fault. To be explicit: 1. Universal health care reduces the total cost of healthcare across the nation. If the bill is $x now, the total cost would be $x-0.2 (or whatever). 2. This is EXTREMELY expensive FOR THE GOVERNMENT. They would need to either raise taxes considerably (broadly and deeply, as in Europe), or deficit spend. For some people, the increased taxes would be offset by not having to buy health insurance. For some people, they would be spending more.
  - bhelkey 2mo ago
    Potentially I am misunderstanding you. My point is that we already pay $2 Trillion dollars for existing single payer healthcare (Medicare/Medicaid). I think it's fair to call that extremely expensive. You say that universal single payer healthcare would have a huge price tag, my point is that we are already paying a huge price tag ($2 Trillion) but just not getting universal single payer healthcare as a result of this spending. My point is that we could have universal single payer healthcare without raising taxes if it cost less than or equal to ~$5800 per person per year. UK spends ~$4800 per person per year on their single payer healthcare. Note: This just considers existing taxes spent on existing single payer healthcare. This doesn't consider other healthcare spending. The majority of the US get's their insurance through employment-based plans. Some pretty reasonable percentage buy their plans directly through the marketplace. And some pretty reasonable percentage don't have health insurance.

bhelkey 2mo ago

> universal health care reduces aggregate costs, but the public cost in aggregate is enormous. This means large new taxes for everyone. If the US could spend healthcare dollars as efficiently as the UK, the US could pay for a single payer healthcare system covering every resident using only existing Medicare + Medicaid spending. Is the US willing to reduce the price of healthcare? I observe a large appetite in congress to increase the visibility into US healthcare spend. I observe rather more limited effort spent to use this data to reduce the aggregate costs (e.g. negotiating drug prices [1]). The math: The US spends $2 Trillion dollars on Medicare + Medicaid a year [2][3]. $2 Trillion dollars / a population of 342.7 million [4] = ~$5800 per resident per year. NHS (UK's universal healthcare system) costs ~£3,500 or ~$4800 per person per year [5]. [1] https://www.kff.org/medicare/key-facts-about-medicare-drug-price-negotiation/ https://www.kff.org/medicare/key-facts-about-medicare-drug-p... [2] https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet https://www.cms.gov/data-research/statistics-trends-and-repo... [3] https://www.kff.org/medicaid/medicaid-financing-the-basics/#870ed126-45c3-4465-8b9a-ae0eea487dcf https://www.kff.org/medicaid/medicaid-financing-the-basics/#... [4] https://www.census.gov/popclock/ https://www.census.gov/popclock/ [5] https://www.bbc.com/news/articles/cwy7zvp5xrqo https://www.bbc.com/news/articles/cwy7zvp5xrqo

Gareth321 2mo ago
I think you did not understand my comment, and that is perhaps my fault. To be explicit: 1. Universal health care reduces the total cost of healthcare across the nation. If the bill is $x now, the total cost would be $x-0.2 (or whatever). 2. This is EXTREMELY expensive FOR THE GOVERNMENT. They would need to either raise taxes considerably (broadly and deeply, as in Europe), or deficit spend. For some people, the increased taxes would be offset by not having to buy health insurance. For some people, they would be spending more.
- bhelkey 2mo ago
  Potentially I am misunderstanding you. My point is that we already pay $2 Trillion dollars for existing single payer healthcare (Medicare/Medicaid). I think it's fair to call that extremely expensive. You say that universal single payer healthcare would have a huge price tag, my point is that we are already paying a huge price tag ($2 Trillion) but just not getting universal single payer healthcare as a result of this spending. My point is that we could have universal single payer healthcare without raising taxes if it cost less than or equal to ~$5800 per person per year. UK spends ~$4800 per person per year on their single payer healthcare. Note: This just considers existing taxes spent on existing single payer healthcare. This doesn't consider other healthcare spending. The majority of the US get's their insurance through employment-based plans. Some pretty reasonable percentage buy their plans directly through the marketplace. And some pretty reasonable percentage don't have health insurance.