7 Reasons Why Universal Healthcare Won’t Work in the US

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In one of last week’s posts, Could You Afford an $1875 COBRA Payment Every Month?, reader John touched on single-payer health insurance in a comment. I confessed that I’m coming around to the idea. But I’ve been doing some thinking since the comment exchange, and have come to the conclusion that universal healthcare won’t work in the US.

Don’t get the wrong idea – while I think that it could work just swell in theory, it’s the execution where I think it will fall apart. I was able to think of seven reasons why universal healthcare won’t work in the US. None of them require too much thought to imagine.

1. The Already High Cost Base of US Healthcare

According to the Centers for Disease Control (CDC), US healthcare costs reached $3.2 trillion – that’s -rillion with a “T”, not a “B” – in 2015. That represented a 5.8% increase over 2014, as well as a 17.8% share of the entire US economy. It works out to be $9,990 per person. All future projections see these numbers rising faster than the growth of the economy.

That’s a bunch of numbers, but I want to focus on the 17.8% of the US economy that healthcare consumes.

According to the Organisation for Economic Co-operation and Development, the average percentage of total gross domestic product (GDP) consumed by the average developed country in the world is just 8.9%.

That figure is for 2013, but having researched this information over the years, that percentage has held throughout the years. It’s the US where the percentage is rising most dramatically on a year-to-year basis.

Here’s the problem with that statistic…Europe and Canada are managing universal healthcare systems at about half the cost of the US on a per capita basis. As most of us know, costs don’t scale the way other relationships do. Too costly is too costly, and there’s no way around that.

To roll out a universal healthcare system with the type of cost structure that currently exists in the US would doom the system to failure from the very beginning. The US healthcare system is simply too bloated to be scaled back and managed. As well, the entire industry functions on the assumption of ever higher revenues. It will take years to reverse that dynamic, under the assumption that it’s even possible.

2. Doctors Will Exit the Field

7 Reasons Why Universal Healthcare Won’t Work in the US
7 Reasons Why Universal Healthcare Won’t Work in the US

One of the biggest reasons why universal healthcare won’t work in the US is that there’s no way it can work without severely restricting reimbursements to healthcare practitioners. We can look to Medicare and Medicaid as examples of this process already in motion.

As well, government being government, it won’t just fund healthcare, it will regulate it. Or more precisely, it will over-regulate it, to the point of exhaustion and failure.

I saw firsthand how the regulation process works. When I was in the mortgage business, I watched as the government encouraged overly aggressive lending practices, in the name of increasing homeownership. But when it was obvious that strategy was doomed to failure, they went too far in the other direction, and virtually shut down the industry.

When government gets involved, processes turn into convoluted flow charts. Government tries to address all ills and potentialities, and in the process it creates built-in conflicts and gray zones. Just look at the federal tax code for guidance. And while we’re at it, just look at Obamacare. It will be considerably worse with universal healthcare.

As doctors begin to realize that their incomes are being reduced, and their day-to-day operations are being closely monitored and controlled (I mean, much more than they are already), we’ll see a mass exodus from the profession.

It will likely take the form of early retirements, and fewer students going to medical school (and less willing to take on the six-figure debt levels needed to attend). The end result will be fewer doctors, and still higher fees for the services that are available.

3. The High Cost of Malpractice Insurance

This is something I learned about firsthand when I was working in public accounting. Accounting firms work with a lot of medical practices, and you get to see the expense side of a doctor’s existence.

It’s often true that the single biggest expense the practice has is malpractice insurance. We’re not talking a few thousand dollars a year here – it can easily be well over $100,000 per year, per doctor.

You can bet your house and your bank account that Congress is not going to do anything to limit malpractice litigation. That ruling body is comprised primarily of lawyers, and there’s no way to get them to support any kind of restrictions. Just look at all of the commercials for ambulance chasers on daytime TV. It’s big business, and it’s one of the primary drivers of the legal industry in the US.

No matter what anyone thinks, we can’t have universal healthcare without serious tort reform. If it doesn’t happen, and universal healthcare is still implemented, that’ll be another major reason contributing to doctors exiting the field.

4. The Uniquely American Pay-any-Price Mentality

America is the land of the unlimited. For the first nearly 200 years of our existence as a nation, we had abundant everything. Abundant land, workers, markets, energy, food – you name it.

Back in the 1960s, then President Lyndon Johnson even promised we could have it all. It was the guns-and-butter promises that we could both maintain the welfare state at home (his “Great Society”), while carrying on the Cold War against the Soviet Union and fighting the war in Vietnam.

It’s been the mentality in America ever since. A big part of it is supported by the monetary system, which probably not one American in 100 actually understands. The United States government issues the US dollar. It serves as the global reserve currency, which is to say that virtually every other currency in the world is tied to the dollar. This gives the US the “exorbitant privilege” of paying its foreign obligations in its own currency.

It’s also the reason why we have inflation

All countries in the world create inflation by printing money. It’s the kind of thing that you can do easily with paper and digital money. But the more money that’s put into circulation, the higher prices eventually become.

Americans became very comfortable with the unspoken reality that our government can pay any price. Sure, about every two years we’re treated to a political battle over cutting the budget, but it’s really just theater. Neither party is going to balance the budget, because it doesn’t matter. The government can print or borrow as much money as it needs for whatever it wants to do. Whatever treasury debt the government can’t sell in the open market, will be purchased by the Federal Reserve, which is empowered to literally print money out of thin air.

The point is, Americans have become very comfortable with this arrangement. The sky’s the limit, and that’s what we expect from the healthcare industry. We want the best health care money can buy, and we want as much of it as we can get. At the same time, our expectation is that we won’t have to pay for it.

That’s a recipe for disaster. Government is careful to maintain pretty inflation numbers. But should we get universal healthcare, it’s entirely possible that the financial printing presses will be rolling. When that happens, not only will we be paying higher prices for healthcare, but also for everything else we need to buy.

That brings up Reason #5…

5. Taxes Will Explode

While the government loves some inflation – it’s even a stated target of the Federal Reserve – they don’t want too much of it.

Too much inflation means that the government loses control of the currency. And lots of bad political and economic outcomes can result from that. As a result, you can count on your taxes going higher after universal healthcare is implemented. And a lot higher at that.

Medicare is already costing the country $675 billion on an annual basis. Medicaid is costing $574.2 billion per year. That’s a total of about $1.25 Trillion per year.

Now imagine if the federal government has to cover all $3.2 Trillion of the US healthcare system – or whatever inflated number that will be in the future. That means that the government will need to raise an additional $2 trillion to cover those costs. Rest assured they’re not going to print and borrow $2 trillion per year just so that everyone can have cheap healthcare.

No, they’ll raise taxes — substantially

Currently, total federal tax revenues run at about $3.25 trillion. If we add an extra $2 trillion to the government’s expenditures, that will mean that the government will need to collect roughly 62% more in taxes than they are right now.

And that’s just to keep the current budget deficit from going any higher than it is right now.

Imagine that your taxes are going up by 62% so that you can have government-funded health insurance. And not just your federal income taxes, but also the FICA tax, including the half of that tax that your employer pays on your behalf. Do you still want that deal?

I’m pretty sure that I don’t. And we haven’t even factored in future increases in healthcare spending, or the negative effects that the next recession will have on government revenues. What it all means is that the numbers above are the best case scenario. Things can probably only get worse, not better.

6. Any US Universal Healthcare System will NOT be Based on the European or Canadian Models

The US recently was ranked #11 out of 11 countries for quality of healthcare. I’m always dubious about these international ratings, because the pattern seems to be that they intentionally attempt to make the US look bad. But that doesn’t mean that we don’t have a lot to learn from other countries and how they operate.

But that’s the problem. Americans have always viewed themselves as something unique under the sun. We tend to think of all things foreign as being corrupt, and completely unworkable within the context of the American system.

But given what a wreck we’ve turned our healthcare system into, we could use a lot of instruction from foreign countries. After all, they’re able to provide universal healthcare at about half the per capita cost that we do. That means something big that we’re choosing to ignore.

Unfortunately, it’s unlikely that we will look at the universal healthcare systems in other countries for guidance. Instead, we’ll come up with our own convoluted system that pretends that no other universal strategy has ever been successfully implemented.

It’s been said that a giraffe is a horse designed by Congress; my guess is that any universal healthcare system devised by the US government will look a lot more like a wounded giraffe than a healthy horse.

7. Medicare will be the Likely Model for Universal Healthcare in the US

Rather than rely on universal healthcare models currently working in Canada and Europe, it’s far more likely that we’ll get a system that will be based largely on an expansion of the existing Medicare system.

Just like the health insurance that most of us carry now, Medicare doesn’t pay all of your medical bills. For example, under Medicare Part B, you must pay 20% of outpatient services costs, after you pay your annual deductible. For this reason, many people who are on Medicare also maintain a Medicare supplement, that pays the costs that Medicare doesn’t. There’s a premium for that as well.

Translation: don’t assume that universal healthcare will mean the end of premiums!

In fact, there is a monthly premium of $134 per person for Part B coverage, and possibly more for Part D (prescription drug coverage). And remember, these monthly premiums are not factored into the current portion of the FICA tax that’s used to pay for Medicare. It’s an additional cost to participants.

An expansion of Medicare to the general population would almost certainly include these premiums, in addition to higher income taxes. And that’s before factoring in the additional costs that will occur when the 74 million people who are currently enrolled in the Medicaid program are rolled into the national plan with its upgraded benefits.

And worth noting is the fact that some healthcare providers don’t want to even participate in the Medicare program, because of limits on reimbursements for services. How an expansion of the program to universal level will play out in this way is open to debate.

Closing Thoughts…

Don’t get the wrong idea, I’m not looking for ways to torpedo the idea of universal healthcare. I’m even glad that John brought the topic up. Given the high COBRA payments that my family is currently paying each month, as well as the fact that I’m self-employed, we would certainly benefit from a universal system – maybe more so than most families.

In addition, I’ve often thought that universal coverage would make it much easier for people to change jobs or go into business for themselves. Universal coverage would mean they wouldn’t have to worry about losing employer subsidized coverage.

For all of those reasons I’d love to see a workable universal healthcare system implemented in the US. But based on the realities of the current system and common expectations, I think it’s likely that we’ll get something that’s even more dysfunctional than what we have now.

What are your thoughts on universal healthcare? Canada and Europe have it, in fact most countries in the world have it – but do you think that it can work in the US? And if so, how could it overcome the seven problems I’ve listed?

( Photo by juhansonin )

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51 Responses to 7 Reasons Why Universal Healthcare Won’t Work in the US

  1. Great analysis, Kevin. I’ll relate to a couple examples why you are right that single payer won’t work here. First. when my in-laws had Alzheimer’s I was on an internet support group that included a lot of Canadians. They related that when looking for a facility to care for their loved one. Apparently the government would pick up the cost but also chose the facility based on which one had a vacancy first. It might be the worst facility and it might be hundreds of miles from their family. The only way to avoid that problem was to be self-pay which, as you can imagine often was cost prohibitive. Secondly, too many people who would ordinarily not bother going to the doctor, might now go with every sniffle or bruise, a practice my in-laws did until they got ALZ because as much as medical need, it became their social network. They looked at it as free because their insurance premiums and Medicare was taken out of their benefit checks so they rarely received a bill for out of pocket expenses.

    What is usually not mentioned in arguments in favor of single payer is the confiscatory tax rates in countries where it exists. For example, Norway has a tax rate in excess of 70%. If you make a million a year, maybe you can afford that, but if you are making #40K a year, that doesn’t leave a lot for rent groceries and utilities. And finally, from a cynical point of view, do you really think that the care will not be rationed on a basis of how costly the treatment is, age of the patient, likely outcome of the treatment or even the political party affiliation of the patient. Just look at the IRS targeting conservative organizations and individuals. Enough said.

  2. Hi Kathy – You’re hitting on points I hadn’t thought about, and I’m glad you did. I think universal will be a giant boondoggle if it’s ever implemented. Your point about rationing is one I hadn’t even considered but it could easily be Reason #8. I think we’re heading toward rationing anyway, but under a universal system there will be no appeal. Govt will say NO and that will be the end of it. It will happen as soon as they hit a budget crisis, then all bets are off.

    Good point about people abusing the system too. A lot of people have that “I’m gonna get mine” mentality whenever someone else is paying the bill. It’ll be that way with universal healthcare. The greed at the feeding trough is disgusting, and that will certainly be the case here. I’ve seen it with people on public assistance. They get in line for every benefit, rather than trying to improve their circumstances with a healthy dose of DIY. We certainly don’t need any more of that.

  3. The tax rate increases you talk of will also be on those currently paying taxes. Not the ones that will be the biggest beneficiaries of universal coverage/care. The weight on our backs will be even heavier to bear. What was it that Margaret Thatcher once said? Oh yeah…”The problem with socialism is that you eventually run out of other people’s money.” Also consider that most countries with universal care have higher tax rates as you pointed out, and much smaller populations than the US. For instance, there were roughly 32 million people in the US that did not have coverage prior to AHCA that are now covered. That is 8 million more than the entire population of Australia. And lest we forget, quality of care will be nothing like it is today (not even close). Think lengthy wait times to visit your primary care (measured in weeks if not months instead of days). Waiting for a hospital bed, waiting for ER care. All of it will dramatically increase. But hey, it’s worth it right? I mean if you don’t have any coverage today, you have nothing to lose, and the more you can get, the better right? Congress will promise the world to get the votes, and then either not deliver, or bankrupt the country in the process.

    I too believe the health care system needs drastic overhauling, but handing the reigns entirely over to the government is absolutely the worst decision that could be made. Reform the system from within. Reduce costly regulations that cut other insurers out of markets. Allow insurers to compete for business across state lines, making insurance more portable and cost effective. Tort reform is a MUST! Stop using the US as the private R&D piggy bank for all these drug companies that charge 500% more for drugs here than in other countries. Consider direct care options with local doctors and providers (think co-ops). There are other solutions that don’t involve overbearing Uncle Sam making your every decision for you!

  4. Hi Patrick – I hadn’t even considered how the tax burden would be concentrated on the shrinking base of people who actually pay taxes. That’s a good catch and another brilliant reason why Universal coverage won’t work in the US. I’m afraid our healthcare system is to fat to be reformed in any meaningful way. Now we can only sit back and take bets as to when it will blow up and be replaced by a system that’s remotely workable.

  5. Nice article, I new Obamacare was a farce, I never could find the real numbers, Google loves to hide things like this. Too bad we could not get this out to the masses so maybe they would stop freaking out about the cancellation of such a bad plan. The middle class has been killed by it and I think that is exactly what they wanted to happen.

  6. I completely agree with you Rick, Obamacare was set up to fail so it could be replaced by universal coverage. As I wrote in the article, I don’t see that working here either. Our healthcare system is entirely chaotic, and no one wants to give anything up to make it more equitable. Basically, it can’t work in a country where people are so delusional that they think they can have unlimited healthcare at zero cost, and unlimited ability to sue. It’s almost as if healthcare represents the culmination of America’s greatest social ills.

  7. Well said. I also dislike the entire “preexisting conditions” since a majority of our preexisting conditions are due to our own actions, diet, smoking, drinking etc. We should not have to supplement your bad habits. I believe if you have a BMI of over 40 and or you smoke or drink like a fish you should pay more and not just a little but a lot more, If you keep getting speeding tickets your car insurance goes up. I go out to eat and I watch people that are obviously 75-100 pounds over weight eating a full plate of garbage and all I can think is that why my insurance rate is so high. We have become a nation that our own actions no longer have consequences, it is other peoples fault and our governments responsibility to fix it.

  8. Just because a family with a combined income of $90,000 can afford the monthly premiums Universal Healthcare would incur, doesn’t mean a poor family that only brings in a combined total of $30,000 can. I mean, imagine the worst case scenario were to come true, is the government going to force these people out of a house into prison just because they ran out of money? I know some people don’t like to hear it but companies like walmart and mcdonalds believes in paying their workers the lowest minimum wage they can get away with in every state. Most of these workers are dependent on food stamps just to survive.

  9. Hi Jake – I agree on all fronts. Personally, I’d love it if we could get a workable universal care program going. I just don’t see it working for all the reasons cited in the article. First and foremost, I don’t see “The System” ending the healthcare gravy train by capping spending. Nothing that’s been done thus far has even attempted cost control, and we have to believe there are entrenched reasons why that’s happening.

  10. As far as Social Security and Medicare go, it wouldn’t be a drain on the US, if presidents and Congress didn’t borrow from ithe funds. Why shouldn’t people above $112,000, continue to pay into both Social Security and Medicare? My and my husband’s pre-existing conditions are not from a bad lifestyle. I had 2 tumors of the spinal cord that disabled me from my accounting job. My husband had stage 4, advanced, metastatic cancer with none of the factors that cause it.
    I agree with some of the points made: tort reform, and doctors not going into the profession because of limited income. We’re having the best luck with Medicare and a great supplement. We haven’t argued about what is covered and what isn’t with our insurance company.

  11. Hi Nancy – I’ve heard the Medicare/Medicare supplement mix is just about the best health insurance package there is. But I wonder what it will look like in 5 or 10 years. As far as borrowing from the trust fund, government wants money wherever it can get it, enough will never be enough. The trust fund itself was always a sham because it’s always been invested in US Treasury bonds, which means the government raised taxes to pay for a phantom trust fund that was always being used to pay for government borrowing from the day the trust fund was established. Put another way, there is no trust fund. If the government has to start tapping the phantom trust fund, they’ll have to borrow from the marketplace or the Federal Reserve to pay off the T-Bonds.

    One other point, there’s no longer a ceiling on Medicare taxes, only the retirement fund, so that avenue has already been partially taken. I agree with you though, a lot of people have health conditions that are none of their fault. I think the medical industry exaggerates the effects of behaviors on cancer. Cigarettes yes (who doesn’t know putting smoke in your lungs is toxic???), but as far as the others (eat this, don’t eat that) I highly doubt it. A certain number of people are going to get cancer, which is also true in animals – and they’re certainly not eating junk food and coconut oil and the other oft-mentioned suspects.

  12. Whether or not we WOULD take from other countries models is a key factor… Why wouldn’t we? Instead of writing defeatist articles about “why we can’t do it”… How about trying to think of ways we can, and promote that. Speak against the bloated American attitude and recommend that we try to learn from other countries that are making it work. Find ways we can implement that into our system. Yes, there are likely to be issues and problems to which we will have to come to a solution, but that’s how it is with any change… and we definitely need a change. The costs of medical care in this country have become insane! So much, so, that we’re all convinced that “health insurance is a good/necessary thing”… so we pay thousands of dollars a year into something that doesn’t necessarily help enough… even with insurance, the bills can stack to unaffordable rates, and deters people (like myself) to seek medical care if/when they feel they need it… and people are DYING because of it.

    Why the hell anyone is against universal health care, in this insane country of inflated medical costs and increasing number of people dying due to inability to pay those costs, just blows my mind…

    Yes, regulating costs will affect the income of medical care providers, and yes, that will likely make a lot of them quit… but all I hear when I hear that is it will weed out those whose motivations are purely financial, and make room for those who sincerely care about helping people… which, to me, sounds like a system where you’d receive BETTER care.

    Also, about the debts being racked up from the education, is why there’s talk about “free education”… I’m not sure how that would work, but many of the schools are about making money, and prestige, etc.. rather than caring about educating people… Again, I admit I don’t necessarily know all of the obstacles we would face in trying to implement that kind of system, as well, but just as in anything, we start with a goal, and we work towards it. We face obstacles and come up with solutions to overcome them. All the “can’t do” talk is just frustrating.

    Also, with free health care, there’d be no need for insurance. Insurance companies are born from a system of inflated health care costs… and without the health care costs, the need for insurance would be null and void. Hence, the money we all (mandatorily) put into health insurance could be reallocate towards the system of universal health care.

    Again… I admit I don’t know exactly the best way to go about it, and the answers to every obstacle we might face… but we never know that. When the emancipation proclamation was passed, they couldn’t have thought of every possible issue that was going to arise, and have the solution for it… we see something as wrong and we fix it… focus on the goal and come up with workable solutions for obstacles we face, in the process. One good way to start WOULD be to look to our fellow countries and how they’re making it work and try to implement that here, as best as we can…

    All this article is, is a big “can’t do” attitude to something that NEEDS to happen. People are dying because they’re afraid to, or can’t afford to, get the proper medical care because of the insanely inflated medical costs in this country. You don’t even get TO the hospital and you’re already facing hundreds, sometimes thousands, of dollars in costs for the ambulance ride, alone.

    This system isn’t working. We need to find a better way.

  13. I agree the current system isn’t working Brian, but we’re not ready for universal coverage. Mind you, I’m not against it. But the current bloated structure, and the status quo attachment to it will make universal unworkable. Before we can get to a universal system, the one we have needs to unwind. I don’t see that happening through the legislative process. More likely, economics will force change. Things will likely get messy in the interim. But there seems to be no public or political consensus beyond finding more money to keep the current bloated system going.

  14. Oh yeah, doctors will leave the field. Never mind the study that said a majority of healthcare professionals want universal healthcare

  15. Hi Tyler – What they want and what they’ll get are two very different outcomes. My guess is most want universal because they THINK it will keep the gravy train flowing. But if we go to universal, the government will gradually reduce reimbursements, just like they’re already doing on Medicare and Medicaid. That’s the part that will send them to the exits.

  16. That’s actually not a bad idea Brian. If nothing else, it would scale the problem down to a more manageable level. The only problem I have is that Vermont and Massachusetts have largely done that, and they have the highest health insurance premiums in the country. It’s got me wondering if a centralized system is even the solution. Maybe we need to go back to a fully private system, but then we’ll have the issue of how to cover the sick and handicapped that no one wants to cover? No matter how you look at it, health care has turned into a hydra with no easy solutions. It just has too many fire breathing heads to battle.

  17. I think each state running there own healthcare is the only way to manage this. If our government in each state can come up with a system that is not tax heavy it would be a up to each state to pay for this and I think you could come to a more reasonable solution.

  18. There are solutions out there, but it’s a matter of dealing with the status quo/inertia factor, plus public perceptions(unlimited, cost-free care). Any solution that’s remotely workable will 1) take the big money out of healthcare, 2) result in some kind of rationing, and 3) involve shared funding between the state and the consumer. If I’m not mistaken, most countries with universal coverage have a split between government coverage and a private supplement, much like Medicare. But that’ll be a band-aid if the cost spiral isn’t reigned in. And that’ll most like involve some sort of limit on the amount of care we can get. NO ONE wants to tell the consumer about this part!

  19. I agree well said. Do you have any input on a state run program? What do you think the taxpayers should pay? I lived in Germany for some time the income tax there was over 50% and now is just under at 48%. I don’t think we as a country are ready for this kind of increase.

  20. That kind of tax rate sounds about right with universal HC added to the mix. My own thinking is a tax rate that high would collapse the economy. It’s a road we probably don’t want to go down. What I see is in a few years we’re going to be forced into major, involuntary changes. The system we’ll end up with will look very different than what we have now, and not be nearly as generous. This could have been prevented, but no one in authority has wanted to act on it. I give Obama credit for requiring insurers to take people with health conditions, and eliminating higher premiums for it. If we ever go back to that, it’ll be a death sentence for millions. Still, I see care options contracting. Costs are already at unsustainable levels.

    I don’t mean to sound so down about this, but sometimes we as individuals, families and nations pass the point of no return. That’s exactly where I think we’re at right now. It sucks, but reality is what reality is, regardless of any happy faces we want to put on it, or denials we want to engage in. There’s usually a fix out there “somewhere”, but when the can gets kicked too far down the road you eventually run out of options. Whatever changes are made going forward are highly unlikely to be pleasant. This is now akin to trying to stop a run away train, and that usually ends in a crash.

  21. Every advanced country in the world has universal health care, including Australia,Canada,China,Japan, Russia, Israel, France, Germany…basically every country on earth. Except for places like Afghanistan,Haiti,Syria…oh, and America. How the hell are we on that list??? Is it lobbyists? Citizens United? American’s are being fleeced by the pharmaceutical companies and insurers! Who does our government work for???

  22. Hi Dan – I’ve never heard anyone put it the way you did, but it’s a stark reminder that we have a lot of fundamental issues in this country. We missed the “window” to implement universal coverage at least 30 years ago when the cost structure was reasonable. They’re out of control now, and nobody in a position of power wants to end that gravy train. It’s deemed too important to the economy to mess with it.

  23. I like to know where they think they derive their power from to takeover healthcare at the federal level and make private insurance illegal. Time to bring back the Constitution and the tenth amendment into this conversation.

    The American people don’t want it despite whatever they say about polls. The narrative of those polls fall apart when banning private insurance and taxes are brought into the conversation. Real empirical evidence of single payer referendums like we had here in Colorado in 2016 are being ignored. Single payer got slaughtered 79% – 21% despite Hillary winning the state by 5%.

  24. That would all matter David, except that the powers that be don’t have much interest in what the people want. What you wrote, “Time to bring back the Constitution…” says it all. If the Constitution were functioning as it should, none of this would be happening. But Dick and Jane Q. American no longer think it matters. All they want is low cost or free benefits. You can’t fix that.

  25. First, I have never heard anyone say “Privatized health insurance would be illegal”… so that seems to be a straw-man at first. There just would be no one who needed/wanted it. So it would just become obsolete.

    Secondly, I didn’t know about the 10th amendment (like many probably don’t), but I looked it up. It says that any power not given to the federal government in the US Constitution, would thus go to the state and/or people. Which, yes, that could be a case against federal government controlled healthcare, as it wasn’t stated in the Constitution that the government should have control or say so in that field… HOWEVER… I think people should stop looking at the US Constitution as though it were some bible or something… that it can and should never be changed (there’s a reason they’re called amendments). I don’t think altering it should be done lightly, but it should be amendable/correctable where we see flaws in it… and whereas I don’t necessarily entirely disagree with the 10th amendment, I would think when/if something of dire importance, like that, comes up, we should be willing and able to adjust accordingly.

    Thirdly, I don’t get why you people insist upon arguing against it. We pay out the ass in insurance costs, and they STILL don’t cover so many things, and we STILL have to pay extra when we go in, as well as the deductible, and go into debt even with the privatized insurance. Privatized insurance fails, and it’s because it’s privatized. They are only interested in their profits, at your expense. So, basically, people against it are arguing to shoot themselves in the foot. It’s baffling.

    Lastly, I understand the “fears” of what “big bad government” might do… which all the more imposes that we should be more involved with the government, to vote good people in who would have pure motives.. and if you don’t think there are any, then YOU could run and try to make the change from within… but no… let’s just keep things how they are, where so many people can’t get health care, and others are afraid to get the care they need, out of the fear of the excessive debt they’d incur.

  26. Hi Brian – I get what you’re saying, but the problem with universal coverage is that it’s better in theory than it is in reality. I personally would love nothing better than universal coverage. It would free people to quit jobs, start businesses, and even take sabbaticals. All that’s good. I just don’t trust how will turn out. As the saying goes “a giraffe is a horse designed by Congress”. This one has the potential to be something much worse and more complicated and costly than the elegant giraffe.

    The problem we have with the private system is that it isn’t entirely private. In fact, no major systems in the US are entirely private. What we have is private insurance, closely regulated and limited by federal law. The ACA has already seriously constrained competition on healthcare exchanges. They’ve also set profitability limits, that cause insurance companies to pay ever higher claims, without fighting the price spiral. All that comes from the feds, so I can’t wrap my head around giving them complete control, when they can’t even properly manage partial control.

    Some good has come out of the ACA. Obviously, a person can’t be decline for a health condition or charged a higher premium as a result. But as the subsequent cost of health insurance has exploded that’s primarily responsible for the tens of millions who are still uninsured. It does little good to have guaranteed insurance if you can’t afford it.

    The other issue, as I pointed out in the article, is that the cost of healthcare in the US is already too high to accommodate a universal system. We’re paying twice per capita for health insurance as other industrialized countries. Adding another $2 trillion per year to the existing cost of Medicare and Medicaid will increase the federal budget by 50%. All things being equal, it means taxes will go up by 50%.

    In the end, the question is do you want to pay for health insurance through exorbitant premiums, or through exorbitant taxes?

    No one has an answer to that question, nor do they get into the nuts and bolts of the math. What we would need to have happen is a plan submitted with a thorough description of the benefits and costs, as well as what benefits we’ll have to give up to get truly affordable coverage. No politician wants to talk about that, and I don’t trust them to do it.

    The easiest thing for a politician or a leader to do is to follow the “let them eat cake” path. But as Ross Perot used to famously say “the devil’s in the details”. Whether we like it or not, a program as large as universal healthcare is going to have a lot of devils. And probably more than most of us are willing to accept.

    Call me cynical, but I believe nothing constructive can be done about the current healthcare situation until the industry experiences a price collapse. It’s simply not affordable of these levels, whether we pay for it through heavily government regulated private insurance or through a universal plan.

    This isn’t really a for or against situation. We’d all love to have it in theory, but we also need to be justifiably skeptical. Especially when we consider that Medicare is already in deficit and Social Security is projected to run dry by 2034. Do we trust the same people to efficiently manage universal healthcare? Again, I’m unappologetically skeptical.

  27. Again, this is a fear-based defeatist attitude.

    The regulations on privatized industries were (as far as I understand it) supposed to prevent excessive inflation of medical costs. With that boot on the private industries necks, they still find ways to raise costs to buff profits. What do you think would happen if you lift that boot off of it?

    Also, a note about the ACA. I’m certain you’re aware of this, as you seem to pay attention (which I commend), but that was a Republican plan, mostly… and was “the best Obama felt he could do”.. and he’s stated that he knew it wasn’t the greatest, but it at least got a lot of people coverage that couldn’t get it before. I commend his intent in trying to be compromising, to an extent… and his looking at the bright side… but it was still a plan originated by the Republican party… which is obvious in it’s nature of obligating people to participate in that privatized system, or pay a fine. Sure, they can’t turn anyone down for pre-existing conditions, but they also have an essentially forced customer base. It was crap, and not enough. What Obama really wanted was a single payer system. The ACA is just all he thought he could get, in facing resistance from the Republican party.

    About your questions about which people would prefer, unless I’m mistaken the polls have already been taken, and the universal healthcare is preferred by a vast majority (I think 70%) of the people.

    Also, people keep arguing that it’s free, but it isn’t. It costs, but at least the amount paid towards it covers it all, and you don’t have deductibles, etc. to worry about. Which is a MUCH preferable system than what insurance provides.

    Finally, the thing I said about people getting more involved in the government is happening… and something we should have been doing all along, anyway. The government is an essential part of our society, and if we don’t like something about it, we should fix it.

  28. I think we’re going to have to agree to disagree. If you ask me do I want universal healthcare – period – I’ll say yes. But if you ask “Do you want universal healthcare if your taxes will go up by 50%”, I’ll have a different answer. I suspect most would. No one is considering the current fiscal state of ship either. We have an $800 deficit in a growing economy with no universal plan. Now they’re rolling out a $2 trillion infrastructure bill. If we add another $2 trillion PER YEAR for universal coverage (and I think I’m being wildly conservative), where is the magic money going to come from? How much deficit can we afford before the dollar collapses? $1 trillion? $2 trillion? $3 trillion. The other choices are to tax the economy into oblivion, or print the money, causing a runaway inflation.

    Yes, it’s defeatist, because all the options are ugly. Sometimes there is no answer, and I think we’ve boxed ourselves into that situation. But it doesn’t matter what you or I think, because it’s likely to be a centerpiece issue in the 2020 elections. But as the saying goes, “be careful what you wish for, you’re wish might come true”. My prediction: the plan will merge Medicare and Medicaid, it will be more expensive than anyone believes it will be, and it won’t provide the benefit levels its supporters hope it will.

    I know Medicare worked in the 1960s, despite the detractors. But the 1960s were a very different time. Costs were much lower relative to incomes, and the fiscal ship of state was under better control. This will likely be one of those cases of history rhyming, but not repeating.

  29. When you say “go up by 50%”, are you talking about 50% of the current tax %, or like going from 25% to 75%?

    If it’s the latter, that’s a HUGE strawman (I guess unless you’re talking about the proposed 70% marginal tax rate for anything in excess of $10million/yr… and you are making more than that…of which case, I don’t agree with that proposed plan, and am not entirely convinced it is necessary).

    If it’s the former, (I could be wrong… I’ll sit down anddo the math, based on my income, but) the difference could likely break even, if not cost less, than what most pay for privatized health insurance right now… in which case people would not really be financially affected, except it would be an improvement, because they wouldn’t have to pay the deductibles, copays, etc… so the increased taxes don’t really scare me like they do you (as long as they’re used for what they say they will be used for… which we all would be watching like a hawk)… so there’s SOME source of that money.

    Also, they’re talking about reallocating funds from the “bloated” military funds, including pulling out of places we should not be, and which are costing us trillions (I think they said it was trillions)… there’s another source of money.

    Also, I do support an added tax bracket for $10million/yr. I don’t necessarily agree with 70% (I think that’s a bit much… and I don’t know how they came to that number as being necessary. If you look at Bernie’s tax plan, it’s actually lower. Still a bit much, but a lower starting point and it would likely come down in the planning process)… but that would still be an added source of income to not only cover the proposed plans, but to help reduce the deficit. So long as we make sure people are actually paying their share of taxes, which we definitely need to do. Hell, it MAY be possible that, even without the tax bracket, making sure they pay their share of taxes would be a substantial amount of income.

    I understand the options are ugly, but we are living in option 1 and it isn’t working, and option 2 (lifting the boot and the hands off approach) is actually WORSE and scarier than option 3 (universal healthcare). Plus, I’m certain there were nay-sayers before the 60’s, saying it would never work, and crying about having to pay more taxes, yet it worked, and it wasn’t “the end of democracy”… and there were DEFINITELY nay-sayers before the emancipation proclamation (that actually went to war over “states rights” (submitting to the claims that THAT’s what it was actually about)), saying it couldn’t/shouldn’t be done… and maybe you’re right and we’re “in a box”… so what do we do? just cry about it, or try to get out, and do something about it?

    I’m curious. What is the proposed alternative to universal healthcare as a solution, to ensure EVERYONE can get the healthcare they need, without having to spend the rest of their lives in debt for it? One that actually helps everyone (or the vast majority of the people), as opposed to just these corporations?

  30. The current federal budget is $4 trillion+. Medicare/medicaid is $1.3 trillion. Total healthcare costs in the US are $3.5 trillion+. A universal plan would need to make up the difference of $2.2 trillion. That would increase the federal budget – already in deficit – by more than 50%. Taxes would have to follow. I don’t use “strawman” arguments, I analyze hard numbers. It worries me that people talk about healthcare like it’s an emotional issue and the problem is the bogeyman doesn’t want to give it to us. I ask the question, how are they going to give it to us? That part is always foggy. And I wish I was as optimistic as you that the military will be cut. I’ve been hearing that one for decades and it never happens. Just like they never cut anything else. Spending money is power in government; no politician is going to vote to cut their own power.

    The basic problem I have isn’t universal healthcare, but human nature. Politicians want more power, and citizens want more benefits at lower cost or even free. The Romans ran that scheme (bread and circuses) for centuries, and it’s still being done now.

    If the final plan was a Medicaid (not Medicare) equivalent plan for all (with higher taxes), and the option to buy a private supplement, would you support that proposal? Because whatever they talk about on the campaign trail, that’s likely to be what we’ll end up with. And it may take 10 years to implement, if a major recession doesn’t slow it down. Also, I just don’t see the politicians putting the gravy train health insurance companies out of business. At a minimum, a window for full on private coverage will be made available to the rich, and that will keep upward pressure on prices.

    For what it’s worth Brian, I hope I’m dead wrong about all this. But after you’ve seen a bunch of unsavory stuff you can’t un-see it. I hope you can appreciate that. Unfortunately, the system isn’t as fair, benevolent, efficient or well-intended as we like to believe. And as the saying goes, the road to Hell is paved with good intentions.

  31. On average, the health insurance costs for single people was $440/mo in 2018. $1,168 for families, but we’ll just focus on the lower amount for now. With the projected 156.97 million people employed, full time in 2019, if we calculated based on every employed person just paying the average lower amount (single people), that would be @$829 billion. That’s negating the difference of what people paid for family coverage, which would make that number go up… So, just for arguments sake, I’ll round it up to $1 trillion (which is likely conservative.. and I couldn’t find numbers on how many of each group (family payers and single payers) there were… but anyway). That’s about half of the difference you were talking about in and of itself.

    This is negating reallocation of excessive funds from other unnecessary places, to this, the extra tax bracket for annual income made in excess of $10 million… AND whatever hopefully successful effort to reduce the costs of healthcare.

    This is also just me, average joe, sitting down and crunching numbers… it seems plausible. However, from what I’m hearing, there are people who have access to “better numbers” than I do, who not only say it’s possible, but that implementing universal health care WILL save the country money on healthcare. How much of that $3.6 trillion in health care costs were inflated costs that could’ve been brought down?

    I agree that “just printing more money” is not a good idea.

    As far as the final plan, I don’t know. I would say I support anything that ends up with everyone being able to get the proper medical care they need, without having to worry about incurring massive debt to do so… and I don’t think that would do it… so I would say no. It might be what we end up with, and I suppose any change for the better would be good, but I don’t believe I would (or anyone should) ever be satisfied until the system works for everyone. It may be a utopian ideology, but it’s not impossible.

    I understand your concerns about politicians… which I have shared throughout the years… which is why I say people would need to be more involved to try to help fix it… let’s get BETTER people in there… and it seems like that is happening… Hell, I would be silent about this if I didn’t believe it was possible, and/or that there were people in positions where they CAN make a difference, actually trying… (albeit with resistance from nay-sayers who just want to defuse any attempt at real change with fear-mongering… motivations? well, likely those leading the charge have some financial interest in doing so… most of those listening, are likely just afraid of trying. buying into the narratives of those who benefit from things how they are.)

    Perhaps I would end up being wrong, and those who seem to be trying to make a real change that will help make the place better for everyone, will just end up being more of the same… if that’s the case, I’ll likely be right there with you… and nothing would have changed. Or maybe things will get worse and we’ll have to recover… but at least we’d have tried. Things as they are, are not working, except for the few. Most of us are essentially their pawns.

    and, yes, I wish more people were as optimistic as I am… Optimism is not necessarily antithetical to realism (although pessimists disagree)… history has proven that change for the better is possible… and most every change throughout history that has been for the better, was likely considered “radical” and was met with no small amount of resistance… but was nonetheless successful in improving how things are.

  32. Brian, I have. Kamala Harris said it and then walked it back and so has Sander’s.

    As for changing the Constitution, the amendment process is there and I never said it shouldn’t be amended to allow the feds their authority. But since it hasn’t been changed since the Bill of Rights was ratified as it pertains to this issue, it’s still a state issue. Having said that, the reason the Bill of Rights was demanded to be part of the Constitution or it wouldn’t have been ratified was the fear that they gave too much power to the feds with clauses like general welfare and commerce. National HealthCare and other warm and fuzzy programs are the conduits to the dangerous concentration of power the Founders feared and the impetus behind why the Constitution was written in the manner it was. To prevent it.

    States are free to experiment if they wish. So far no takers. Interesting, since our states are similar in size to the countries of the EU, who despite a common currency and the free flow of labor and capital do their own healthcare.

  33. Your total cost of $1 trillion is seriously low ball. Does it include the employer portion, or is it just what the employee pays? Plus what about the out-of-pocket – that’s in the hundreds of billions (and growing). If it’s only $1 trillion this would be workable. But that number doesn’t jive with the total expenditures of $3.5T, of which $1.3T is being paid by Medicare/Medicaid. Basically, we’d have to triple those programs. Meanwhile we’ve got a government that has no clue what a balanced budget looks like, even before adding the extra healthcare costs to the current budget.

  34. I think you misunderstood the calculation. that trillion dollars was just calculating and estimation based on the number of people working, if they all paid the amount a single person paid for insurance, by the average. it’s definitely low because many likely pay for a family plan. that’s why I rounded it up. but that’s just saying if that amount was put into universal health care, it would count towards bridging that $2t gap… and that wouldnt be the only thing that was done… but that, alone, would get us at least halfway there, based on your calculation… which if the health care costs could go down (like I believe they could) then that lowers the gap.. and additional rebudgeting efforts could cover the remaining (if any is left) then go towards something else we could use, like “free” advanced education, reducing the deficit, or replenishing social security.

    and I understand about the government budgeting issues… to which I say let’s get better people in there… or better advisors, to help the idealists.

    i’m sorry I haven’t responded to the other thing yet. haven’t had a chance to read it. I will. i’m not ignoring your points.

    overall though, i understand how you feel, and how seeing so much crap can be discouraging, but, imo, we cant stop trying, or get complacent in our desire to make things better.

  35. I see what you’re saying, the $1T reduces the $2.2T shortfall. It does make a difference. But it also makes the point that at $2.2T in tax increases will overwhelm the $1T savings in premium payments. Not sure the people will go for that. We have to remember, at the core people think universal will give them unlimited healthcare for free. It’s that human factor at play again. Everyone’s ready to sign up when they think they can get something for nothing.

  36. David (I had to look again… I sometimes lose track of to whom I am talking. I thought your response was Kevin’s at first.)

    In “Brian, I have”, I’m not sure what you’re talking about. You have what? I looked through my previous response and I don’t see where I asked if you have done something. (I am long winded and a lot was said between now and then… so it’s possible it’s in there somewhere that I’m overlooking).

    I don’t know much about Kamala Harris, but from what I have heard, she’s not someone I would want in office. I can’t remember, specifically, what it was she did/said/stood for, but it didn’t leave me with a good impression… As far as Sanders… what did he say then “walked back”?

    I know you didn’t say you shouldn’t change the constitution, but when someone brings up “x amendment” or whatever, as though they deem it as set in stone, and it would be blasphemous to touch, that’s what I object to. I concede that it was likely an inference issue on my part.

    I understand the “fear” everyone has about government, but these programs are still something I believe should be rights. This all brings me to think about pre-civil war discussions… where there were people arguing that slavery should be outlawed, and all slaves should be freed, and people would argue “that’s too much power to give to the feds. It is (and should remain) a state issue.”. I personally don’t like this divisive state mindset. We are one nation and the laws that govern should be universal. Also, as far as states not “experimenting” with the issue… We pay FAR less in state taxes than federal taxes, so they have a LOT less money to work with… so on a state level, that definitely seems more implausible… so it’s no wonder no state has done it yet. Also, just because something IS currently a state issue, by the logic of the current state of the constitution, doesn’t mean it should remain that way.

    Kevin, (in regards to your latest response),

    You’re still working on the assumption that we would have to increase taxes to meet the entire $2.2T difference… negating reallocation of funds from other unnecessary areas of the budget, the extra tax bracket (if you look at Bernie’s proposed tax plan, it actually adds 2 tax brackets. One for the $2-9.9M/yr and one for $10M+/y), and ensuring that people actually pay their taxes… as well as the effort to reduce health care costs. I only did the calculation for the insurance premiums to demonstrate, according to how the plan is, how it would impact the average working person, financially. Other areas are already being paid for through the current tax rate.

    I also don’t know why you keep going back to the “something for nothing/free” argument, when it’s been established that we WOULD be paying for it… it’s just instead of it being paid for through privatized insurance companies (which some, likely a good chunk, of that money just goes towards profit, and doesn’t actually go towards health care), it gets paid to a fund in that is protected by the government (which is made up of a group of people WE can do something about being in power… unless the election process is a complete farce, in which case all of this is moot anyway… so I go on the assumption/hope that it is not), and used completely for the healthcare.

    People who would get “free health care” (benefit from the program without having to put into it) are the same people who benefit from Medicaid/Medicare now… which are people who can’t afford insurance costs, and/or are unemployed (for whatever reason… and I think it disingenuous to act like they’re all just lazy bums… there are some, I’m sure, and there would be people who try to abuse the system, but many who have it actually need it… and some need it who don’t have it)… and I, personally, don’t mind that the money I’m putting into it is going to help people in need. I’m actually glad of it… and for the people who are dismissive of those people… well… that’s all the more reason I think we’d need to do it through taxes, rather than relying on the generosity of the collective people.

    Also, and back to the point, this would actually help people who WOULD BE paying for it. Working people like you (I assume, no offense meant) and me… who pay for insurance, but still don’t get the healthcare we need out of fear of the exorbitant debt we’d incur… With a universal health care program, the care providers would be getting paid up front, so we wouldn’t have to worry about paying more if/when we need to use it… but it’s still not free.

  37. Brian – You wrote “…and I think it disingenuous to act like they’re all just lazy bums…” – I’m sure that’s just an limitation of a written comment in that you likely mean that in the most general sense (as yes, there are people who believe that), but please don’t associate me or any of my comments with that belief. I’ve never written that in this comment thread or anywhere else. I’m not trying to be confrontational, I just want to clear the air on that point.

    But back to the subject at hand…I think we’re going to get universal coverage, but I hope as much as you that it works splendidly. But I don’t think that’ll be the case. The title of the article is 7 Reasons Why Universal Healthcare Won’t Work in the US, not 7 Reasons Why I Don’t Want Universal Healthcare to Work in the US. I’ve come to understand that there’s a wide gap between promises/good intentions and outcomes. Without benefit of a crystal ball, my prediction is that we’ll get universal coverage, but it’ll be short-lived. Also, remember it all depends on the state of the economy. If it tanks, all bets are off. Heck, we can’t even pay current national expenses now without borrowing money. That’s a bad sign.

  38. I understand. I inferred it from the logic of “people want something for nothing” as meaning “they aren’t willing to work to pay for it”… which is often the picture painted in refutations against things like universal health care, free college, etc… I should have clarified that, prior to jumping to that conclusion. I apologize.

    And I concede the difference between the article topic and the topic of whether or not one wants it. I think I conflated your statements with Dave’s, who seemed to be saying he didn’t WANT it to work, because he doesn’t want a big government (which is a common narrative), and you made statements about not trusting the government… So I conflated the two. However, you did state (multiple times) you weren’t against the idea of it, and I just glossed over it… so for that, also, I apologize.

    I also submit that it COULD go wrong, if we aren’t careful in how we proceed in the effort… but it’s also likely that, initially, it will have some negative impacts from which we will have to recover, even if we do it right. Adjustments (both coarse and fine) would need to be made as problems arise… but we don’t wait until we have all the details worked out, to try to make changes that need to be made. There would always be nay-saying and resistance… and, as I THINK I have demonstrated, even with my limited access to accurate numbers, that it is achievable and worth trying. If you’re right, and we DO get universal health care, then I also hope I’m right and it works out.

    Just like when the slaves were freed, it made life harder for those who owned slaves, and there were other issues of people who were unhappy with the legislation (obviously, and we are still “fine tuning”, to put it lightly), but it was still the right thing to do.

    Unlike you, though, I’m not yet convinced it’s going to happen (as much as I hope it does). First thing is we’d have to get someone in office to actually make it happen. I’d love to believe that’s a given to happen, but then… well… Trump got elected. I don’t know WHAT to expect to happen now. …but even IF we get someone who is a proponent of it, I am afraid compromises will be made and we’ll get some watered down version of it, that is in some ways crap (like the ACA) and people will say “See. I told you so!”… I hope I’m wrong about that.

  39. The basic problem here is coming up with a consensus. First, there’s no consensus whatsoever as to how this should go down. Everyone has their own idea of what universal healthcare will look like, but ultimately we’ll have to come up with a compromise plan. Compromise means most people don’t get what they think they’re going to. The second issue is a consensus – under the longshot assumption we can reach it – will actually build a better mousetrap. Like you said, the plan we get is likely to be watered down. Based on every other plan we’ve ever had in any direction, it’s likely to have major flaws. Will those be fixed, or will we simply have to learn to live with them?

    I’ll be the first to agree, and I’ve already made clear in previous articles, the current system is a wreck and it isn’t working. But at the same time, I have serious doubts that any replacement plan can come along that will do much better. The forces behind exorbitant healthcare costs are more powerful than any of us realize. And with 18% of the economy comprised of healthcare, the politicians are hesitant to do anything that will degrade a major driver in the economy. Then there’s the backdoor deal issue, which we pretend doesn’t exist, but probably drives more of the political process than any of us are comfortable admitting to. A lot of powerful people stand to lose much with a universal system. They have a lot of influence, and are not likely to roll over quietly, or simply go away.

    When I was a younger man, I too was highly optimistic. But the more I’ve seen of life, and the more I learn about history, the more I realize how human systems are driven by shadowy forces. With a combination of optimism and naïveté, we try to pretend that isn’t the case, particularly in modern America. But it’s just as true here as it has been throughout history and across many different nations and empires. What I’ve come to realize is that if a system is dysfunctional, it’s not an accident. It’s that way because somebody wants it that way, because they gain from the dysfunction. They’ll dig in and defend it, even if there’s a better way that will benefit more people.

    Of course, it’s the very same reason why the military won’t be cut, nor will any other government projects deemed to be wasteful. There’s an army of powerful, influential movers and shakers, as well as a substantial rank-and-file entrenched behind every program. Reducing them, or worse – eliminating them – has become impossible. To put it another way, we’re not the democratic system we like to believe we are. That’s why change seems so elusive. Instead, Band-Aids are placed across gushing wounds, and reform is declared successful.

    It’s just mankind’s happy little way, and it isn’t new.

  40. To recognize and acknowledge the problem, yet do, or promote doing nothing about it, is not only pessimistic and defeatist… it’s part of the problem. You’re poisoning the well of minds against progress and the betterment of our nation and world.

    It would be akin to someone saying “I’m against slavery… and I recognize this system is extremely bad, but I don’t believe we will ever really do anything about it… too many people in power serve to benefit from it, and have politicians in their pockets, so… well, we need to just suck it up and live with it”. I’m certain there were a chunk of people like that, but I am glad they were not prominent enough to stop that change from happening.

    History has PROVEN that change can happen, and it’s done by people that someone like you would call “optimistic yet naive”. I can understand how life can drive someone to get like this… obviously I can be as pessimistic as you, with my fear of getting the watered down version of it… but I don’t promote a do-nothing mindset, as you seem to. If you see something wrong… whether it be with your personal life, an appliance, or the world… you do something about it, or change WILL never likely happen.

    Even if we get a watered down version of it, it’s at least a step in the right direction. ACA was shit, but at least it’s motivating people to try to find BETTER solutions (except for those who don’t want it to happen, and will fight against it, because they are benefiting from peoples detriment… like the slave owners did).

    If you want to spend the rest of your life doing nothing, and just leaving things how they are… that’s fine. but I don’t see why you feel the need to get online and voice your pessimism to the world, and try to bring them down with you. I might understand it if you, in recognizing the problem, had what you deemed to be a ‘better’ solution, and wanted to propose that… but just to nay-say a solution that is out there that COULD help…

    I am not young… and I have noticed a lot of “the same”, but I also know change HAS happened, in spite of nay-sayers trying to push against it… and that leads me to believe that it can get even better, and I support efforts to try. We ALL should, unless we just want to keep things how they are. but why the hell would you? If your tv is broken, wouldn’t you take strides to get it fixed or replaced, or would you just sit there and look at a blank screen?

    I’m sorry if I repeated myself a bit there… but I just don’t get people like that. The core of your issue seems to be just a negative attitude… I can understand it on a personal level, but I don’t see the benefit in trying to drag people down with you.

  41. Brian the problem here is perception. I’m not being defeatist or pessimistic or poisoning anyone’s minds by virtue of the fact that I disagree on universal healthcare. It’s my right to disagree, at least for as long as we have rights. You go with the assumption that universal WILL work and it WILL be better. Not all of us agree. I’m not opposed to it, but I obviously have less faith in the political process than you do. Turning this around, it scares me to death that so many people are so willing turn even more power and fiscal control over to an already all-powerful government.

    Alexander Fraser Tytler was credited with the following (though there is debate about the actual source) It (democracy) can only exist until the majority discovers it can vote itself largess out of the public treasury. After that, the majority always votes for the candidate promising the most benefits with the result the democracy collapses because of the loose fiscal policy ensuing, always to be followed by a dictatorship, then a monarchy.

    Those of us with the longer view worry about such things. I realize how precious American democracy is, but also how it’s been eroded in the past 50 years in the name of the “greater good”, which is always a subjective concept. Over the years I’ve had to tell my kids many times that they aren’t as free as they think they are (or as the education establishment propagandizes them to believe), and that they aren’t as free as I was when I was their age. Once freedom and democracy go they’re gone forever. We can’t take that lightly. As Americans, we’re not supposed to take it lightly. People gave up their lives to establish and preserve it. But instead, freedom is assumed to be a given of the American system, and we spend most of our debates talking about benefits and security. You won’t get a benefit without giving something up, and that something will almost always be more costly than supporters assume. And it isn’t always in the form of money either. One price I can see is rationing. When budgets get tight, care levels will be cut. And with healthcare then being by far the largest single item in the federal budget, don’t be surprised if the cuts are substantial.

    When there’s only one payer – a government agency – there’s no freedom of choice. I try to project what that will be like. I’m not sure proponents do.

  42. So, basically you were full of it saying that you want it to happen… as the truth is you don’t want it to happen, because you see it as exacerbating “a big federal government”.

    Also, let’s throw in your stipulations as to what it means “to be an American”… so anyone who disagrees with you “is not a true American”, or “is not doing their due diligence as an American”.

    As far as whoever Alexander Fraser Tytler is… I don’t know who he is, nor do I care. I also don’t agree with anyone who deals in absolutes.

    I don’t take it lightly. I even said that we should be careful as we make changes, but we NEED to make the changes. I also don’t take lightly people blowing smoke up my ass, and trying to make me out to have misinterpreted their intention, only to find out that I was right. Whether or not you are right to worry about “a big bad government” is irrelevant to the point that you ARE against universal healthcare because you feel it gives “the feds” too much power… to the contrary of what you said you’d like. Which makes it seem like your saying “I’m all for it, man.” (paraphrasing) is just pandering to try to lure people into your antithetical crap.

    The “threat” to democracy is not the implementation of social benefits. We implemented social security, yet democracy is still there. We implemented medicare/medicaid, yet democracy is still here. The thing that most threatens democracy is the few big money interests controlling the government through back-scratching tactics under the guise of “donations”, and likely other “fundraising events”. That’s what the system is like, now… and people like you, with your fear mongering, pessimism and nay-saying, perpetuate it by trying to convince people that “this is the best we can do”. To that, I, and many others (thankfully), call bullshit.

  43. So, let me understand – anyone who doesn’t agree with you is an extremist and you spew out inferences that were never made. I’ve made a reasoned case, both in the original article and in my comment responses to you. My opinions aren’t wrong, they’re just different from yours. Is that unacceptable? If so, that’s the most extreme position of all. If I were the extremist you claim me to be, would I even entertain your counter position?

  44. I don’t want to beat this thread to death, but just to refute the idea that I’m opposed to universal healthcare based on ideology or doctrine, I want to go back to the numbers.

    The most popular universal plan currently being promoted is “Medicare for all”. I expect to see that on bumper stickers throughout 2020, representing each of the 37 or whatever Democratic candidates for president. So let’s take a look at how this might play out financially, for anyone who thinks it’ll be a less expensive option.

    The current monthly premium on Medicare is $134. Having a supplement has become a virtual necessity, to cover the large expenses Medicare won’t. A cheap supplement at 65 will cost at least $200. Right there you have a combined individual cost of $334. That’ll be nearly $670 for a couple. If we extend that to a family of four, it’ll go to over $1300 per month. That’s roughly the cost of purchasing a plan on the healthcare exchanges right now. Translation: maybe some money is saved on out-of-pocket costs, but none will be saved on a monthly basis.

    But then we have to look at the higher tax burden that will result from adding about 275 million more people to the Medicare plan. We can roughly estimate that at about $2 trillion, which means both federal income taxes and FICA taxes will rise by at least 50%. And that’s on top of the Medicare and Medicare supplement premiums everyone will need to pay.

    But there’s also a major X factor. The reason why Medicare has succeeded up to this point is because it’s a system in which 100% of wage earners contribute to the plan, while only about 15% of the population get the benefit. What will be the outcome of full participation by 100% of the population in the benefits? We can’t even measure that.

    My fundamental problem with the whole concept of universal healthcare is that it can’t work absent drastic cost reductions. No one has a plan for that, only theories. Yes, the current system is totally inadequate. But from where we sit today, converting over to universal will be akin to rearranging the deck chairs on the Titanic. To meet the rising costs, taxes will increase, Medicare premiums will increase, and you can rest assured Medicare supplement premiums will increase. That will quickly become the next new Big Healthcare issue.

    Already, those $200 monthly Medicare supplemental premiums will rise to something like $500 per person by age 90. That means a 90-year-old is paying $634 per month for health insurance when the Medicare premium is added in. A 90-year-old couple is paying $1268 per month. It’s an unaffordable burden for a couple on a fixed income, and who are probably draining assets to survive.

    The only solution to the healthcare crisis will be drastic cuts in costs. Until a politician, group of politicians, or a political party put forth a serious plan for how that’s going to happen, talking about whether the current system or a universal plan will be better is nothing more than idealistic chatter.

  45. Kevin – like so many others who want to throw up their hands and maintain the status quo, you mislead people about the costs. We now spend on average $10,000 per person per year on healthcare. The premiums we pay to private for profit companies are basically taxes. We pay almost twice as much with our system than other countries do. Single Payer would save billions. Maybe greed and ignorance will stop progress, but facts are facts.

  46. Hi Bernard – And the higher taxes and Medicare and supplement premiums will be taxes as well. How would single payer save any money? All I ever hear on that front is “we’re going to cut fraud and waste”. Like cutting the military, I’ve been hearing that all my life. When does that change finally come about? No one has explained, or seems to want to explain, how universal will cut costs. The emphasis is always on creating better funding, not cutting costs. I’m not misleading anyone. Before we implement a change of that magnitude, the cost cutting mechanism has to be in place. It’s like cutting taxes without cutting spending, another time honored misdirection that never seems to be resolved.

    I don’t see universal working until costs can be brought down to levels seen in other countries. The problem isn’t how we pay for it, but how much we pay for it, and that’s the root problem that needs to be fixed. Do you trust the politicians to implement those cuts? And in a healthcare system well accustomed to being on the receiving end of “pay any price”, how do we ween them from that addiction without causing drastic cuts in personnel and services?

    Everyone says “let’s try this (universal), it’s got to work”. No it doesn’t. And why the name calling with “greed and ignorance”? And as far as facts are facts, I think I’ve laid out plenty of them in this article and in my comments.

  47. First, I never called you an extremist. I called you a liar. I may have been wrong to do so, but you started off saying you’re not against it, but it wouldn’t work financially… but when I diffuse that, you switch to “but we can’t trust the government”, and when I address THAT, you revert to “it can’t work financially”… and I don’t see it ever ending… the bottom line is, regardless of how much you say you would want it, you obviously don’t, because if I prove you wrong or fallacious in thought on one point, you’ll just revert back to the other.

    So you say you want it, but apparently don’t, which makes you a liar, as far as I can tell.

    Secondly, stop with the bullshit “am I not allowed to disagree? it’s just an opinion” shit like I’m saying “that’s not allowed”. opinions vary, but some are better and more logically founded than others, and thus can be wrong. acting as though opinions are all equally plausible and valid is just a stupid argument and obvious ploy to get someone to back off, when you feel logically backed into a corner.

    this is not the same as “which color you like best”… this is a situation of YOU wanting to dissuade people from making efforts to improve our society, and my trying to encourage attempts to improve it. I even conceded that maybe there’s a better plan out there, by asking you for an alternative solution, to which you responded “I have serious doubts that any replacement plan can come along that will do much better.”… which is another way of saying you think this is likely the best we can do… and you said that right after admitting that the system, as it is, is shit… which means you’re against change and for keeping things how they are. aka “keeping the status quo”…

    If I’m right in calling you a liar (as it seems I am) then it’s no longer worth spending any more time going down this rabbit hole with you.

  48. I’m not calling you greedy and ignorant, but there are plenty of greedy people making obscene amounts of money from the current system – and they have done a masterful job of spreading misinformation and lies to keep the status quo in place because it serves them very well.
    Medicare has been proven to be less costly than private insurance. It’s costs have grown more slowly year over year than private insurance. They are admittedly very large, but nothing compared to the 10-20% premium increases we’ve seen from private insurers. Second, Medicare’s administrative costs are about 4% vs 12-15% for private insurers. If you don’t believe me I suggest you research it. Obamacare has been a disaster in my opinion – forcing people to pay billions of dollars to private for profit insurance companies and channeling billions more in government money to them without any price controls oe profit or cost limitations was a very bad idea.

    We have fewer doctors and hospital beds per capital than most other industrialized countries. Our life expectancy, infant mortality, and other measures are behind other countries. Europeans aren’t that much healthier than we are, they drink and smoke more than we do, in some cases much more.

    Costs will be saved when there is one single payer of healthcare like their is in National Defense. The complexity of hundreds of insurers/payers with each having their own contracts and rules with tens of thousands of unique providers is one of the main reasons why costs are out of control. I also don’t think companies should make record profits from the misery and desperation of people. This chart says a lot about the problem.

    https://www.athenahealth.com/insight/expert-forum-rise-and-rise-healthcare-administrator

  49. Thank you for that clarification on greedy and ignorant Bernard. I agree with you about the obscene profits being earned. In the end, it really doesn’t matter what any of us think, including me. I think we’re going to get universal after the next election, though it will take several years to fully implement. But it’s almost certainly going to be a hybrid system, and much more costly than most of us think. The hybrid part is what worries me most. It means we’ll still have premiums to pay to private insurers. Most countries in the world have a hybrid system, most obviously France, UK, Australia, Singapore and Sweden. We have that now with Medicare, and I doubt it will change. Other countries have mandates where you purchase coverage from cooperatives or private companies. Given that the private portion is already out of control here, plus the tax increase to insure all citizens under a public base system is likely to cause a cost squeeze.

    If US healthcare costs are at $3.5 trillion, and projected at $6 trillion by 2027, we’re going to pay for that whether it’s through taxes or premiums. I agree, admin costs might be lowered, but I’m not entirely convinced either. No one seems to want to touch the cost of healthcare, and that’s the part that makes me cynical. Unlike many, I don’t have faith that the cost spiral will be worked out in the details. The ACA promised lower costs and failed miserably. And I know you used the example of national defense as achieving cost efficiencies, but I have to dispute that. $200 million fighter plains, $2 billion combat ships $4 billion subs and $13 billion aircraft carriers are another perfect example of how single payer isn’t working.

    BTW, one of the base reasons I’m pessimistic about universal is that there are already problems with Medicare. The program’s trust fund is projected to run out of funds by 2026 after which benefits will need to be cut and taxes raised. If we can’t successfully (meaning fiscally) manage the current limited Medicare program, how can we expect it to work when it or a parallel system is expanded to the whole country?

    And for what it’s worth, both the Social Security and Medicare trust funds are an illusion. Both are filled with “special issue Treasury bonds” that need to be sold to pay for current expenditures. That just moves debt from one pile to another, which isn’t a trust fund except in name only. And what happens when more treasuries need to be sold than the world can or is willing to absorb?

    No one addresses these questions, they just say “we need universal healthcare”. I can’t support a massive legislative change that has so many unanswered questions.

  50. Note to Brian – Your comments will no longer be approved on this topic. When you must resort to name calling (liar) and using obscenities (sh&% and bullsh&%), it’s no longer a debate among reasonable people. I won’t tolerate that kind of response against myself or any other participants on this site. I’ve entertained your comments when they were reasonable, even if I disagree. But if we’re at an impasse, which clearly we are, we must agree to disagree. I’m not going to “convert” you and you won’t do the same to me. I can respect that, but your last comment, which I did not publish, shows you can’t live with that.

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