A public option with no frills basic care would be available for everyone. However, private insurance plans would be available for folks who want to pay.
That’s how it works in the UK. Sure, it’s not perfect but it’s a whole lot better for people who aren’t rich and it just speaks to the morals and values of the culture and sense of real fundamental community. Not everything in life should be a money making scheme
Our country has similar system to UK. Rich people don't pay a lot of money into public healthcare, and they usually end up using a mix of public and private healthcare.
So public healthcare does end up benefiting all by being so much efficient and cheaper through it's scale.
It's kinda like... we have one company providing water utilities in our town. Everybody is using it, rich and poor.
IF we had ten companies providing utilities, laying ten different pipes under each road, everybody would be worse off.
Sure, but well educated, socially mobile, and financially stable healthy employees are dramatically more difficult to control and have leverage over. That’s the trade off they want to keep.
Also, the educated workers creating new things for them to profit on is a pipe dream. Most people are far too lazy to do it even with education. You’re looking at a small minority of people in that group.
Not to mention most of the techbros came from educated upper middle class families and basically destroyed the old giants like Xerox and Kodak. Just like Cronos after usurping his father Uranus, they fear the upstarts just like they themselves were upstarts.
TDLR; kick the ladder before anyone else climbs it.
Both of these are correct (you and the parent commentby /u/RainbowDarter). I think the narrative that businesses or the rich don't want a better healthcare system is wrong. I think basically everyone in the US wants a better healthcare system, including insurance companies. Businesses know that a healthier, more mobile workforce would be more productive.
The problem is that we can't agree what that looks like, how it should work, how we get there, or who pays for it. And frankly, I don't think almost anyone posting about this actually understands why the US system is as bad as it is.
Most people seem unwilling or unable to understand the core basic problem - all healthcare systems must ration and therefore all systems must have a gatekeeper. If no gatekeeper is chosen, the gatekeeper becomes wait times and congestion at the point of getting actual non-emergency care (and sometimes even emergency care!). Most systems (but not all) attempt to make doctors the gatekeeper, but doctors are a very leaky and bad gatekeeper.
Bernie's proposal for example is flat out unworkable. It would be the most inclusive and generous system on earth with absolutely no gatekeepers in the system.
When it comes to the question of "ok, what do we adopt" there at at least a dozen different examples of better systems, each with tradeoffs and some clearly better than others, some of which can't actually work unless we change something else structural about the US (Usually our entire education-debt pipeline).
Most people simply want to blame insurance company profits or CEO pay - insurance companies are our primary gatekeeper - which is just flat out mathematically wrong, and provably so. They're not even remotely large enough to close the gap we observe.
The left's position is that the rich can just pay for the system. But there is no UHC system out there paid for by the rich when you compare our current tax structure against other developed nations. We already tax the rich at among the highest tax rates in the world in California, Portland, and NYC, around 51%-56% after stacking each layer not counting sales tax/VAT or personal property taxes. Top-end tax rate choices are a competitive comparison market, so there's no room to raise them much further without destroying the economy that attempts it. So where does the money to pay for the UHC systems in other countries come from? Higher taxes on the middle class. This is true in EVERY country I have looked at, and the areas that attempted to do this in the 60's and 70's like NYC and Sweden(70's and 80's) had to drop their top end tax rates dramatically to stop the economic bleeding.
Similarly the right's position is that free markets and pricing power can solve the allocation problems of healthcare just like it does in almost every other industry. They're wrong - healthcare has extremely inelastic demand and is a superior good - demand goes UP when incomes go up, regardless of prices.
This is why we're stuck with the worst system in the world. The only way to fix this system is for people to learn about and start being honest about the tradeoffs. And the solution for the US? We have to move our gatekeeper. Insurance companies are a very bad gatekeeper.
We could easily port over ANY universal system and it would be so much better.
But instead we get teeth gnashing and concern trolling trying to be hidden in long, seemingly thoughtful diatribes from shills for the current system that’s killing Americans.
Enough with this fake worry bs. The current system is directly responsible for the number one cause of bankruptcy and is killing hundreds of thousands of Americans AND is making our lives more miserable day-to-day.
Correct me if I'm wrong, but Capitalists don't want worker mobility, nor do they care much about "the economy" being productive. They care about themselves. More worker mobility means that labor can move from company to company more easily, a boon for the laborer and a bane for the employer. It shifts the power in the relationship towards the workers, which is no something employers are going to want, even if it really does lead to greater profits down the road.
I think this is something that gets missed a lot by economists. What is good for the individual capitalist is sometimes bad for a capitalist economy.
This is a good example. Every employer would love a financial ball and chain to keep their employees from quitting and reducing turnover.
But low worker mobility is bad in a capitalist system because it reduces the free flow or labor to where it is best suited.
Similarly, individual employers in a sector hate regulation, but regulation can be a positive to enforce competition and keep sectors from being monopolized.
There is a general assumption that everyone working toward their own best interest will lead to greater outcomes. But you run into an issue where what is good for individuals to do is not good for a the whole. Or that returns could be greater in the long run but people have to worry about the next quarter and don't really care about the profits in 10 years time.
It's a problem with Capitalism as an idealized system with actors working perfectly rational vs Capitalism as it actually works in reality with real humans who are prone to all sorts of irrational thinking.
Yeah, they love no regulation until they get big enough then it’s heavy regulation that creates a system of little to no competition thanks to high barrier of entry.
Similarly, related to this point of healthcare, a big company can easily provide ‘benefits’ to workers that handcuff them while smaller competitors cannot. With universal health care, that’s one more thing off the table (HUGE THING) that could allow more movement to build actual competition through joining smaller companies or starting their own.
Yeah but efficiency is not a goal of any capitalist. Profit is. The ideal situation for a capitalist is as a monopoly rentier. Likewise they probably prefer more serf-like conditions over a fluid labor market.
Not to mention companies would have to pay people more in the long run. They wouldn’t be paying health insurance and people would be more willing to job hop or quit and not work for an extended time off working if they didn’t have to worry about losing health insurance
from a capaitalist point of view, if the workers aren't forced to stay at a job to keep their health insurance, they can start competing businesses, unionize and demand better pay, or take jobs with better salaries...
What does someone who purchased private healthcare get in the UK that the average Jane or Muhammad doesn’t get? There’s a class warfare argument these days in the US that essentially boils down to wealthy people shouldn’t be able to get better care simply because they have more money.
I view it as a basic tenant of class solidarity that the rich should not simply be able to 'opt out' of public institutions in favor of exclusive private ones. Want little Timmy to go to a good school? We'll, you'd better be invested in improving public ones. Want good health care? Then you'd better support the system that everyone uses
There’s a solid argument in what you are saying but I tend to be interested in where people think a line, if any, can be drawn that allows for the wealthy to either receive are at a minimum have a chance of better outcomes. If healthcare is all paid for, what could a well off person vested in the system pay for that a less well off person isn’t entitled to? Same for education, food, housing, privacy, security etc. The areas where wealth could and should provide advantages is extensive. Is any advantage due to wealth acceptable?
I don't see any problem with the rich driving a supercar instead of a camry, living in a mansion instead of a 1bd apartment, or boating on a yatch instead of a dinghy. Anything the free market can better provide (defined by unrestricted supply and elastic demand), I'm totally OK with them using their money to get a better experience.
What I'm not OK with is them advocating to cut property taxes because Jr goes to private school, defunding transit cause they never use it, or water treatment because everything they drink goes through a fancy whole house reverse osmosis system
Requiring people to pay taxes that fund good public services is a good, popular idea. Maintaining a hard line on that funding is a good idea that we should continue to fight for, amid calls to give up on trying to raise revenue.
Requiring people to use the public service and banning a private version of that service would be a very eccentric strategy that has not nearly as many precedents throughout the world, and little evidence that it actually improves the likelihood of solidarity.
> Requiring people to use the public service and banning a private version
Nobody is suggesting that. People are asking for equity. You don't have to use it. You can still use alternatives. What people are asking for is to pay their fair share into society that everyone else is.
I disagree, based on the comment thread I was responding to:
> There’s a class warfare argument these days in the US that essentially boils down to wealthy people shouldn’t be able to get better care simply because they have more money.
followed by
> I view it as a basic tenant of class solidarity that the rich should not simply be able to 'opt out' of public institutions in favor of exclusive private ones.
This is presented in contrast to a system where a wealthy person uses a private version of that service, and therefore does not support the public one.
The commenter's argument suggested that without wealthy people using the public service, the solidarity to maintain funding of the public service would disappear. The only way to set up a system that maintains that definition of "support" would be to require wealthy people to use the public service, which could only be accomplished by banning private versions of that service.
> This is presented in contrast to a system where a wealthy person uses a private version of that service, and therefore does not support the public one.
If this metaphorical person doesn't want to participate in society, they can leave. Clearly, they have the means to do that. So just go. They are a minority and society, that wants equity, is getting real tired of being told what to do. A 9:1 battle usually doesn't have good outcomes.
M4A is single-payer; NHS operates clinics and pays for it. US Medicare doesn't operate them, just pays for them (vs. the VA systems, which is govt-owned).
I make under $50k a year and I’m more than happy to pay more in income tax if I’ll see a return on it in the form of government services or government subsidized services/products that provide cost reduction in my daily life. If I have to pay 3% to Medicare instead of 1.45%, I’ll happily do that if it means my health insurance is cheaper. Same with housing programs like Section 42 or Section 8 or privately-built-publicly-subsidized construction of housing. I’ll take a few thousand less in the standard deduction for any of that. And I think most people would be willing to as well.
To be clear I don’t disagree with the idea that there needs to be some type of public care option in the US but what you’re saying is quite obvious.
Assuming you make exactly 50k you’re saying that you’d be willing to pay an additional ~800 bucs a year if your health insurance was cheaper. Which like, yeah, of course you would, you’d save money lol.
I made about $41k gross last year, and I’m probably on track to make somewhere between $45-46k, although the math i did says I should be around $48k when averaging everything out.
Well yeah, someone is gonna save money and someone is gonna pay more. People without insurance will lose money because you can’t save on insurance if you’re not paying for any, but ideally it means they’re either getting their health taken care of or they’re not stiffing doctors offices and hospitals for services provided, which saddles everyone else with that debt in the form of higher insurance premiums.
Also, for the record, I probably wouldn’t save money on health insurance because my employer-sponsored plan is ridiculously good for the cost. The company might save money or pass those savings on to us if they do choose, but I’m happy with my plan. $15 co-pays for visits @ $180/mo including life, dental, disability, and $5k deductible? I’ll take that any day. But we need to take care of others and potentially the debt we’ve incurred in no small part to healthcare and healthcare subsidies. So I’m willing to pay more if need be to take care of it, so long as I don’t get screwed over too bad.
why would I trade? I've made so many sacrifices to get the millions that I'm worth today... I'm not going to give any of it to people who don't deserve it
> A public option with no frills basic care would be available for everyone. However, private insurance plans would be available for folks who want to pay.
That is viable and might be good policy but that won't save $1 trillion a year. The savings from the study assumes a system where everyone is on Medicare and providers (hospitals, doctors offices) get Medicare rates aka less money.
we have an example of that already... it's called the Veteran's Affair, and we literally have veterans committing suicide in VA parking lots because they keep getting their care denied
Because the VA is chronically underfunded, poorly managed, and too bureaucratic. Tricare is also one of the biggest budget items for DOD, and it’s been increasing for a while.
Choosing not to do something because it might not be perfect is not a reason not to do something. Nirvana fallacy has been pushed on this as a negative for decades and yet the alternative is to continue the broken system that exists today.
So the argument boils down to "since it's broke, and we can't find a perfect alternative, leave it broken while complaining that it's broken but doing nothing to fix it." "Stupid" is the most generous I can be with that line of argument.
It’s not guaranteed to not happen, but veteran care is heavily regulated by statute and rules. Ideally, in M4A, you don’t have a plethora of regulations, making oversight relatively simple because you focus on less rules to follow and can catch the fraud quicker, theoretically. The point is to not be so bogged down in regulatory red tape because that costs money to oversee and navigate. The amount of red tape placed in front of soldiers and veterans is part of the problem as well. Obviously nothing is guaranteed to function, but it’s worth a shot at this point. I’m not looking for a perfect system, I’m just looking for a better one.
That’s what happens when you create a bunch of rules and regulations and statutes surrounding things. The only way for M4A to work properly is to have loose regulations over care, but strong enforcement against those that violate the basic rules.
Right, but the issue is that private health insurance actively hoses people in catastrophic cases with denials that providers and members then have to waste energy fighting. Tail risks are still screwing people over even when they pay for coverage.
what I'm hearing is that you WANT to give control of your healthcare to these same Republicans that will absolutely defund your healthcare services in order to start more needless wars
I'm a bigger fan of the non profit public option available to all. Single Payer isn't practical here. a) Many people actually say they like their current insurance plan (they think it's inexpensive because they directly only pay a fraction of the actual total insurance premium through their job), b) we're not going to throw millions out of work by eliminating all these insurance and admin roles.
Granted if we could build an insurance system from scratch, single payer could be better, but that's not the situation here.
We can still drop Medicare eligibility to age 55, add hearing, vision, and dental to it too.
Very likely indeed. And then when these for profit insurers migrate over to AI bots denying your claims based on "unnecessary care," I can see people really getting upset over it.
I think this is the only solution that makes sense.
On a separate note a friend of mine is pregnant and I asked her how much it was going to cost and I don't remember if it was 5,000 or $15,000. But even with insurance she said that she was going to be down at least that much money. The crazy shit. She works at a children's hospital so she should have pretty much the best insurance available and it's her place of work where she will be delivering the baby.
How is it that expensive to deliver a baby in 2026?!?
No wonder people are having less kids. If people specifically politicians want people to have more babies, make it free to have babies. Cover children with free healthcare until they're at least 18 years old and have them covered no matter what with pretty decent coverage and that will alleviate 90% of the crazy costs with having a child. People will be much more willing to do it if you make it cheaper at the very original starting point.
I'm over 40 years old and she's going to spend more just to have a baby than I've ever paid for a single car in my life. That seems crazy to me.
> Cover children with free healthcare until they're at least 18 years old
"All kids are eligible for Medicaid" is an idea i've seen thrown around in health policy circles that would be a stupidly easy policy to implement compared with large-scale reform, and have enormous upside with little downside.
The crazy shit is if you're going to cover new and expecting mothers and children. And the elderly. That's pretty much all of the costly parts of society statistically. The rest of the people tend to pay in without taking much.
So if you get to the point where you're covering children and the elderly through government programs, Medicare for all is an easy next step. And I think that's probably why so many people would be against covering children because the obvious next step is to include the people that actually pay into the program without using it much which essentially means borderline universal healthcare
One issue that has to be addressed is cost. Before we can provide basic care to people via are taxes, we must get cost under control. There are at least 10 different drivers of cost so it will be extremely difficult to
There's no healthcare system that frees us from the need of deciding what gets covered and how much gets paid for it. Around ten years ago, the NHS made the decision to stop covering a bunch of pain treatments because it was determined they didn't have evidence of effectiveness. But that's a problem in a lot of pain medicine - there's tons of procedures that work for some people and other people get absolutely nothing from. In total, that amounts to "little evidence of effectiveness", but the people who had been feeling better the procedures were really mad about that! That happen's a lot in pain med because we don't have a great understanding of pain from a theoretical level and the placebo effect is extremely strong. For other subfields, there just a lot of grey area around exactly what kind of treatment regimens are appropriate for which patients, especially when you have things like off-label usage.
So the difficult parts of setting up a public system really is determining who should get what covered. To include everything that isn't cosmetic would be a different approach than any country anywhere uses, and would cost a fuck of a lot more than what's analyzed in this paper
realistically, if it's truly Medicare for all, many would need it: Medicare doesn't cover a lot of things. I've long felt that the term "Medicare for All" was kind of a bad one, and probably not what its proponents want: my dad just had to pay $1800 out of pocket for a procedure not covered by Medicare, and something like half of Medicare recipients feel compelled to carry supplemental private insurance due to gaps in Medicare coverage.
so if it's truly Medicare for all, then there's still plenty of space for private coverage, and in many cases would be required.
medicaid and medicare, I feel like they also can't negotiate? or something like that, where they can't set what they would pay and the comapnies gouge them too
there are many, i don't have a list. my dad's procedure was for some injection to help his back, i don't know the specific details.
there's a reason over 40% of people on Medicare have secondary private insurance: it's to cover gaps, and because Medicare itself has no out of pocket maximum.
you bring up a good point: Medicare does cost a lot. but it's telling that despite how much Medicare costs the government, individuals still need supplementary insurance to cover personal costs of healthcare. unfortunately Medicare tends to create the worst of all worlds: increased taxpayer burden, inflated coverage costs, and it doesn't even cover the whole costs of everything.
It’s a secondary insurance. It’s built in to save cost bc many of the old guard that retired with pension and covered insurance for life kept that insurance. 80/20.
Funny that you are so hell bent on this one example ruining everything but you don’t even know what the denial was
>Funny that you are so hell bent on this one example ruining everything but you don’t even know what the denial was
I'm not sure you understand the angle I'm coming from here. I'm not even necessarily criticizing the thing they want, i'm just saying that Medicare, as it exists today, doesn't seem to operate in the way that they want universal healthcare to operate. Therefore i'm not sure it's the model they should aspire towards.
sorry this doesn't make any sense at all, I think the only way to help every day Americans with their healthcare is to send another $7 billion to our greatest ally Israel.
It’s still not enough. I know, let’s cancel a ton of social and research programs that keep Americans safe and healthy! If the laid off scientists and doctors complain, denounce their expertise so maybe they will leave for other countries, because we certainly won’t need them anymore.
Funny anecdote about food for kids in school. About 85% of Illinois qualified for reduced/free lunch so in 2015 or 16 they tried just making it free for everyone state wide…without raising taxes. Schools got flooded with complaints about meal quality, quantity, and lack of options. They immediately went back to the previous system the following school year.
Dumb parroting of dumb speaking points. All Israel aid over the last 20 years wouldn't pay for two weeks of US medical spend. I would cut Israel aid (and I guarantee more overall aid than you would). However, it's not even the top 20 of pools of misspent funds.
Genocide is the intent to destroy in whole or in part a national, racial, ethnic or religious group through means such as: killing members of the group, causing serious bodily or mental harm, etc.
What part of what is happening in Gaza is not a genocide? Be specific.
Research from institutions like the Council on Foreign Relations indicates that roughly $106 billion of the total funds ($195 bn) directly support Ukraine's government, military forces, and economy. The remainder covers U.S. military operations in Europe, intelligence, and replacing U.S. weapon stockpiles.
Money to Ukraine is the single most cost-effective way for the US (and Europe) to grind down one of their most important nuclear threats today, while also putting a strain on the authoritarian axis of the world today. You have to be completely detached from reality to not see the minuscule amount of money spent on Ukraine relative to the overall defense budget as the best bang for your buck the DoD has probably ever achieved in terms of strategic objectives (especially considering the Iran war currently).
Oh, and it's nice to punish and deter aggression by imperialistic dictatorial megalomaniacs in the heart of Europe, if you care at all about human rights and peace.
First order on the moral aspect: If you cannot see a difference between giving money to Ukraine, attacked unprovoked by an imperialistic enemy of the West, and giving money to genocidal, constantly destabilising the ME for its own gain Israel, then please get your heart checked.
On the strategic side: Russia is a much larger current threat to Western interests, considering it actually has nukes and there is an actual chance they would attack the Baltics or other European countries.
Not necessarily, and in any case I'm not saying western culture is the important part. It's an ally to the West, that shares our values, and that is being attacked by our enemy. We massively stand to gain by assisting Ukraine right now.
If you don't have an actual point then this discussion is pointless.
It's a democratic country that is keen to join NATO/EU currently at war with the EU's most immediate military threat that is also a brutal dictatorship engaged in an unprovoked war of aggression
No. I don't think we should support any religious ethno-state. It goes against the very principles this country was founded on (see: separation of church and state).
I was not quiet at all, Israel came to me in my dreams and told me that $200 bn should go to them instead. I screamed this at the top of my lungs at my local Chick-fil-A and they called the police on me because they are antisemitic.
Extreme Nationalism: The nation or race is viewed as supreme above all else. (check)
Dictatorial Rule: Power rests in a single, all-powerful leader with no real public checks. (not checked)
No Democracy: Free elections, free speech, and individual human rights are rejected. (check - ask the occupied folks if they get to vote or participate)
Militarism: Military strength and violence are praised as ways to show national power. (Big check)
Censorship: Media, schools, and culture are strictly controlled by the government. (check)
Ukraine doesn't have a PAC meddling in U.S. affairs that got an MOU signed requiring a baseline of $3.8 billion spent on their defense per year.
Also, you leave out the little detail that they were invaded by one of the largest strategic rivals to the U.S. And that by supporting Ukraine, we've seen the decimation of the Tu-95 fleet, and directly enabled the destruction of years of Russian military modernization.
And, that most of that money has made its way to DoD contractors regardless of whether it is allocated to Israel or Ukraine.
Hold on now, what about spending another 60-100B on a war with Iran that we can't get out of because our admin is so beholden to Israel's refusal to let this thing die.
If Medicare for All covers more people and removes more out-of-pocket costs, demand for healthcare will rise. At the same time, a large share of the projected savings comes from paying doctors, hospitals, and drug companies less. Lower reimbursement can reduce supply, especially over time through staffing, investment, and provider participation.
There is no public good that results from low demand for health care. A shocking percent of Americans avoid the doctor, especially 64 year olds on the cusp of receiving Medicaid. Unless, of course, you consider it a public good when folks drop out of the workforce and die a preventable death.
There are many reasons why we don't have a single payer system and that is definitely one of them. But I simply don't think our country can afford a true M4A system.
Nobody goes to the doctor for fun. When you say "demand will rise", you actually mean "people who need medical care will finally go".
Preventative healthcare is significantly cheaper than waiting for conditions to become so awful that people finally go to the doctor after it's a crisis. Treating people at the beginning would literally be cheaper.
> Nobody goes to the doctor for fun. When you say "demand will rise", you actually mean "people who need medical care will finally go".
This is not correct. Healthcare demand is extremely inelastic plus it is a superior good. As incomes rise, demand rises, even ignoring price increases, and there is no limit to this demand. Every single healthcare system on the planet has a gatekeeper of care. Those who did not consciously choose their gatekeeping (like Canada) end up with wait lists (at specialists i.e. the treatment point for nonemergency care) as the gatekeeper. For the same funding level, those who consciously chose a gatekeeping process end up with shorter wait times, like the Netherlands and Denmark.
> Preventative healthcare is significantly cheaper than waiting for conditions to become so awful that people finally go to the doctor after it's a crisis. Treating people at the beginning would literally be cheaper.
This is all true, but the differences here are nowhere near large enough to solve the problem or deal with the demand problem that you pretended isn't real. The demand problem & the allocation problem (i.e., the gatekeeper) is the core unsolved problem of every healthcare system in the planet. Ours just happens to have the worst solution to it.
Rural hospitals have fewer patients in general, and a high proportion of their patients have Medicare or Medicaid. They don't get enough private insurance patients to make up for the loss.
Sure, it's not just rural hospitals, and hospitals can obviously fail for other reasons. I was just giving one common example of a type of hospital that's struggling.
Steward Hospitals failed because they sold their real estate to a REIT to get cash to fund an expansion. They were then paying really high rent to the REIT and couldn't afford it.
The ones closing are either rural (and thus have few patients) or have populations that are disproportionately old or poor. The ones doing well have lots of patients with private insurance.
Medicaid rates can be "very low". Medicare rates are just "low"
This can be fixed by increasing Medicare rates in a Medicare for all system but then that will eat up most or all of the $1 trillion a year savings from the study
Not necessarily, a lot of the costs associated with Healthcare are the People who skip out on the bill because they can't pay. If everyone is paying, it allows you to accept less. Also the biggest costs that would change are for medication.
Commercial insurance reimburses at 200-300% of Medicare rates and depending on sub specialty, is around 40-50% of total claim volume.
Probably conservatively a 50% reduction in revenue on single digit margin business.
All claims being reimbursed at Medicare rates would lead to a wave of bankruptcies, retirements on day 1 while also creating a massive fraud incentive.
Being able to bill people that currently don't pay would make a huge difference to hospitals:
Hospitals treat every emergency, and very often the toughest (read: most expensive) cases are people coming in with severe life threatening conditions due to years of neglect, mental health issues, or drug addiction. Festering sounds with insane infections or covered in worms, advanced stages of cancer, full blown AIDS, antipsychotic medications interacting with antibiotics you want to give, unplanned pregnancy, often a combination of more than one of these. None of these people pay in the current system but they would be covered by a single payer, which means that hospitals gain a new, and above all fair, source of income, so that their everyday middle class Joe Schmoe treatment doesn't have to carry the cost of these cases.
What's more, the poor would no longer be discouraged from seeing a doctor for financial reasons (hospitals treat only emergencies), so these severe cases would be caught much sooner, saving the entire system a lot of money.
The non payers at hospitals would not go away but it would be reduced. Its estimated 15-20% of non payers currently are non citizens and its higher in California, Texas and Florida.
Contrary to popular belief, non-citizens pay into social security and health insurance through their workplace, so that they contribute positively to the income side while being unable to draw from social security.
The other effect is prevention: getting everyone to see a doctor for five minutes once a year without fear of surprise bills means fewer expensive surgeries because at early stages, many issues can be handled with cheap medication instead.
> Contrary to popular belief, non-citizens pay into social security and health insurance through their workplace
Some do, some don't tho. It is a fact that a disproportionate amount of unpaid care at hospitals is due to non citizens (both illegally here and legally here)
> while being unable to draw from social security
The vast majority of immigrants here legally are not stuck in status purgatory. They will get to a point where they can collect on Social Security and Medicare (and also potentially need based aid like Medicaid)
All of that is correct but the numbers on those things are small.
/u/Wrenchinspokesby and /u/kp1233 are correct that Bernie's plan would drastically increase demand while cutting supply; extremely long wait lists would become the gatekeeper of care.
Any system must have a gatekeeper of care. Pretending we don't need one like Bernie's plan, or pretending doctors can do it (very leaky and bad gatekeepers) like many UHC systems results in huge wait lists.
The are more than twenty different approaches to choose from for how to deliver universal healthcare in Europe alone, more if you include developed nations like Canada, some of which have long wait lists, while others don't. All of them are significantly cheaper than US healthcare (38th in the world by outcomes btw, worst value for money by far).
The dichotomy of "keep the current system or bread lines" that you are invoking simply doesn't exist in the real world.
You didn't address the cost of delayed preventative care, and made a bunch of predictions without bothering to offer a mechanism, let alone evidence.
Doctors from Europe love studying cases from the US because they get to see diseases at advanced stages that are caught much earlier where they come from, a long time before they lead to an outsized burden on the healthcare system, not to speak of the immense human tragedies that are caused by the way the US delivers healthcare.
> The are more than twenty different approaches to choose from for how to deliver universal healthcare in Europe alone, more if you include developed nations like Canada, some of which have long wait lists, while others don't. All of them are significantly cheaper than US healthcare (38th in the world by outcomes btw, worst value for money by far).
Correct.
> Doctors from Europe love studying cases from the US because they get to see diseases at advanced stages that are caught much earlier where they come from, a long time before they lead to an outsized burden on the healthcare system,
Also correct. The US subsidizes worldwide HC research, and we also provide immensely important cost - value data that other countries can't get effectively since they've removed cost from their market forces. But again, this gap is much too small to explain our problem.
> The dichotomy of "keep the current system or bread lines" that you are invoking simply doesn't exist in the real world.
I didn't say that. I'm trying to make people be honest about the choice that must be made. Because half of the population is only being honest about one side of the choice and the other half is only being honest about the other side of the choice. They're both wrong and they're both correct about different things.
> You didn't address the cost of delayed preventative care
It's a real cost. But it's small, much too small to close the gap in our cost/quality of care.
> and made a bunch of predictions without bothering to offer a mechanism, let alone evidence.
No one else offered any evidence in this thread, why single me out? And I'm happy to explain the mechanism or provide some evidence, but the question is so big that unless you narrow it, the posts explode. I can't answer everything unasked objection in one reddit comment.
I have a solution system proposal I've been working on for awhile. It's just damned hard to get people to listen and even explaining it takes a lot of time.
I'll be honest, this just sounds like 'death panels' fear mongering, albeit way more coherent and less sensational. We have pre-auths, we have primary care providers than provide managed care, we have systems of 'gatekeeping' already. Almost no one in the US has the luxery to pick their services based on timeliness as it is. They have a network with one specialist in it and they get a visit when they get one. Certainly though we need to get rid of the caps on doctors and possibly shorten or streamline the process of allowing internationally trained doctors to practice in the US as well. This would help with supply.
> I'll be honest, this just sounds like 'death panels' fear mongering, albeit way more coherent and less sensational.
I'm sorry that it sounds like this, but I'm not sure how to get people to be honest about the problem. Foreign UHC systems aren't magic, they just streamline our worst parts, but they have their own flaws. The core problem is that healthcare has an extremely inelastic demand curve AND it's a superior good - as incomes rise, demand for healthcare rises, which is not the typical demand curve for most products. These are objectively measured in economics.
> Almost no one in the US has the luxery to pick their services based on timeliness as it is.
This is not true, this is just naive. Our system is selected by patient pressures based on outcome because the demand is inelastic. Timeliness is a part of outcome choices. If an higher-end employer were to take a good healthcare plan and swap it for a high-friction, delayed-care healthcare plan, they'd lose a significant percentage of their best employees very quickly. This is part of why employer plans are so much better than ACA market plans with more choices, better networks, and PPO options.
For bottom-barrel employers, this might be true, but it's also true of many other UHC systems. It's one channel of the gatekeeping that must happen.
> They have a network with one specialist in it and they get a visit when they get one.
This simply isn't true of most employers especially near the top, especially in populous areas. It's true of employers in the middle and bottom and especially in rural areas where there are very few specialists, but that's a common problem to all healthcare systems. In the Sapnish healthcare system you not only don't get to choose your specialist, you can't choose your PCP, and you also can't change it. In rural Canada the choice is either you go to the single specialist nearest you (with a very long wait time) or you go veeeerry far on your own dime and time to someone else, likely with a long wait time. It also used to be this way in Finland for a long time.
> Certainly though we need to get rid of the caps on doctors and possibly shorten or streamline the process of allowing internationally trained doctors to practice in the US as well. This would help with supply.
Agreed on the caps for sure. And also agreed on the international channel, but if we do this, there is a quality tradeoff. If we do this and also utilize a system where lower quality doctors and higher quality doctors are treated equally, the system will have problems. Price differences and wait times are how this is difference is normally solved.
> Comparing doctors offices triaging people for service to
Going to a GP in Canada and getting a referral to a specialist over 400 days away is not "triaging." It's the gatekeeper resurfacing because they refused to place it anywhere else. And yes, the 90th percentile wait times for hip replacement, knee replacement, or neurosurgery are that high, and they used to be higher - years of reforms have brought it down a little.
You either be honest about the problem, or the problem resurfaces elsewhere. Ignoring it or pretending it isn't real doesn't solve anything.
People act like no one ever thought of any of this shit, no they are thinking of it. I don't personally know the answers because I have a life. But El Sayed literally wrote a book on it and many other People have as well.
Well it would be nice if they enlightened us mere mortals. Because the Yale study being blasted everywhere sure doesn’t. In fact they just model the full reimbursement differential as “savings” without any impact on the system beyond that ie the plainly obvious provider and deliver side response to that change.
5 seconds of Googling suggests we would move to a capitation structure instead of service billing. It's how HMOs already work except everything is in-network now. Basically the doctor's office or hospital gets based on overhead costs for the patient on a monthly basis. Patients that need more care would get a higher amount.
The most annoying thing to me is that instead of saying 'this seems like out would be a problem, I'm not sure how we would solve this but there's probably a solution if we look for one since virtually everywhere else somehow manages it.' So often someone points out one thing, claims it's insurmountable because they never bothered to look into it at all, and say it just can't be done despite clear evidence to the contrary. We got to the fucking moon, we can figure out healthcare.
Exactly, the cost reduction in the billing systems, the removal of uninsured patients, the greater economic activity of healthy workforce, and the reduced burden on small businesses allowing for their growth and proliferation would allow the hospitals to make up that reduction. Just simplifying the 'peer review' and approval process that insurance companies force clinics to go through would be a significant enough cost reduction to make it competitive. We live in a world where doctors are setting up self-pay groups that only do a monthly subscription that's cheaper than the employee portion of the cost of insurance, because insurance adds so much additional cost to their practice to manage and the hassle of not letting them make the best decisions for their patient.
This is like good infrastructure design, on the surface, restricting straight sections of roads sounds like a stupid expense, but when you consider the reduction in accidents, EMS roll cost, car insurance costs, adding those expensive curves that help keep drivers focused is cheap and pays dividends. The issue is those are 2nd and 3rd order savings and most people struggle at understanding 1st order effects, if it's not 'see, hear, touch, feel' thinking, they can't understand it.
This is only about 1% of the cost drag on the system. It's not as large as you might think. Medicare underpaying for procedures (subsidized by the private market picking up the slack) is a much larger number.
Administrative waste in the claim-denial-appeal loop is far larger still.
Single payer system works ok if there's significant out of pocket costs, you're absolutely right that if a medicare for all push removed copays it would overwhelm the healthcare providers. Rationing would quickly be implemented and people would go untreated sometimes for a lengthy time.
>Rationing would quickly be implemented and people would go untreated sometimes for a lengthy time.
As opposed to now where hundreds of millions of Americans avoid going to the doctor because of cost. You can't threaten us with "healthcare will be rationed" when Americans already ration their healthcare more than any other developed country.
Highly depends on where you are and your plan. Really good plans I’ve been on I’ve been able to choose any doctor I wanted to practically, have out of network covered, and rarely had to wait long for procedures or things like MRIs.
Not saying costs are not out of control or that Medicare for all as an option is bad. Just saying not everyone experiences rationing.
Nah, doctors already see an outrageous number of complex pts compared to decades past. The big change would be you need a lot less billers and coders and other admin staff who spend their day fighting with insurance companies
> Nah, doctors already see an outrageous number of complex pts compared to decades past.
Yes but US doctors see fewer patients while working longer hours. That's documentation, coding, and insurance appeals.
> The big change would be you need a lot less billers and coders and other admin staff who spend their day fighting with insurance companies
This is correct but you're drastically understating the problem by pretending it stops there and goes away if we just remove the insurance companies. We have to fight with insurance companies because insurance companies are the US' gatekeeper of care. If you simply remove them and don't consciously put a new gatekeeper of care in place then demand explodes and wait lists for the actual nonemergency care needed become the new gatekeeper. This has happened in most foreign UHC systems, and the only solution is to consciously place the gatekeeping somewhere else.
The solution is that we consciously move the gatekeeper. Don't pretend it isn't real or that insurance companies are simply causing problems without actually playing an important role. They're causing problems because they are our gatekeeper. They're just very bad at that role.
I'm fairly sure the M4A bill addresses this directly and streamlines much of these processes to match what you'd see in countries with more efficient insurance systems. For example, it intends to do away with prior authorizations
As opposed to the comment I replied to with its copious evidence?
Google is free and easy. Pick the source that resonates with you most. They all say the same thing—the billing/compliance requirements for Medicare are so onerous and reimbursement rates are so low that many providers don’t want to deal with it anymore.
If government-reimbursed healthcare was so much simpler and easier for providers, we wouldn’t have a growing number of practices that opt out of the program completely.
Nice job adding zero value to the conversation, dingus.
The doctor's themselves may not, but the practice still does. This is overhead cost that can be done away with. There are some administrative duties that doctors do get bogged down with though, like priori authorizations, which M4A intends to do away with
That math is so outrageously made up. The better argument is that not having national medicine is a huge gamble for each person. If you get unlucky and get sick you go bankrupt. If you don't, you save money on taxes.
It's also a huge gamble for the country. A healthy country is a more productive one. It's kinda nuts that food service workers are both not likely to have access to healthcare and often can't afford/are allowed to take off sick.
First, this is a preprint that has not been peer-reviewed. The authors reach the $1 trillion figure by assuming all of the following happen simultaneously:
The fraud number is especially questionable. It assumes a unified claims system would eliminate almost $300 billion in fraudulent billing based largely on Taiwan’s experience. But the cited Taiwan research did not find that 8% of healthcare spending was eliminated through fraud prevention alone. It examined several reforms together, including global budgets, price controls, standardized billing and utilization controls.
Secondly, this does not take into account the massive demand increase that will inevitably take place once everyone is covered. You will have people who haven't been to the doctor in years, decades even, all go in for care. That is a good thing in theory but will absolutely put a massive strain on hospitals and dramatically increase hospital cost (more staff, equipment, supplies, drugs, etc).
For comparison, CBO found that single-payer could produce anything from $700 billion in annual national savings to $300 billion in additional spending, depending on the plan’s benefits, reimbursement rates and cost-sharing. And even if every assumption were correct, federal taxes would still have to rise by trillions because private premiums, employer contributions and state healthcare spending would be transferred onto the federal budget. “The country might spend less overall” is not the same as “the government can provide it without enormous tax increases.”
To your second point, isn't this increased strain both temporary and a good thing? We should see demand go up for primary care and specialists, and go down for emergency rooms, since that's where people who were delaying care often ended up. Then after a while of people getting proper treatments and preventative care, overall demand should level out and decrease.
While sure it's a strain, it's significantly more efficient for things to get caught early or prevented than for people to go to the hospital with issues only after they're too bad to ignore.
Personally though, I'm fine with costs being higher if that means everyone is actually getting the healthcare they need. I'd much rather my taxes go towards that than many other things.
I agree that getting people needed care is a good thing, even when it raises utilization. Where I disagree is the assumption that the strain would necessarily be temporary or that preventive care would eventually cause total demand and spending to fall.
Removing premiums, deductibles and copayments would not just clear a temporary backlog. It would permanently lower the cost of using healthcare to zero at the point of service. That means people would continue using more primary care, specialist care, diagnostic testing, prescriptions and elective procedures than they do now. Some of that represents important care people currently go without, but it is still a permanent increase in demand.
Earlier treatment can prevent certain expensive emergencies, but preventive care does not universally save money. Some interventions do, but screening millions of people also identifies more conditions requiring testing, monitoring, medication and sometimes lifelong treatment. That can improve health and save lives while still increasing total spending.
The shift away from emergency rooms is not guaranteed either. When people gain comprehensive coverage, they gain better access to primary care, but they also become more willing to seek emergency care because they are no longer worried about the bill. Meanwhile, training additional physicians and specialists takes years, and cutting everyone’s reimbursement to Medicare rates could work against expanding that supply. That is why CBO projects that demand could grow faster than capacity, resulting in longer waits and unmet demand even as more care is delivered overall.
I actually think your last point is the strongest and most honest argument for universal healthcare, you are willing to pay more so everyone receives care. That is a value judgment. My objection is to claiming we can provide significantly more care, eliminate nearly all cost-sharing, avoid capacity problems and somehow guarantee $1 trillion in annual savings.
Medicare for All may be morally worthwhile even if it costs more. But if that is the case, supporters should make that argument honestly instead of insisting that every difficult tradeoff will eventually disappear.
The psychological safety of knowing that you can get basic health care, and not avoiding doctor visits because they are too expensive, also contribute to making people happier and healthier.
Actually it's not. You can easily see what a UHC system in the US would cost by scaling up any of the dozens of other systems that other countries run to our size and comparing. The gap shrinks once you adjust for wage and COL differences, but it's still substantial. Our system is quite simply inefficient.
Why/where? Because every HC problem forms a claim-denial-appeal loop. Every doctor visit becomes a risk of either denial problems or malpractice problems and requires substantial documentation from doctors. US doctors are higher paid, work more hours, but see less patients. US doctors order more testing - but do we actually end up healthier from it? No, our average outcomes are slightly worse than UHC systems.
In addition, as others have pointed out, trapping people in jobs via healthcare hurts the efficiency of the whole economy. A mobile workforce sorts into job roles better, earns higher wages, and delivers more productivity and quality. And is happier.
Our system sucks because it's very badly designed. We must disconnect healthcare from employment. That requires UHC one way or another. We need to get rid of the inefficiencies in order to accomplish that, which means the gatekeeper of care must move.
Well, it certainly assumes a lot of things. Also, a lot of the savings comes from the fact that providers would get paid Medicare rates aka get less money
I just want to make sure you're aware that the US spends 2-3x more per capita on healthcare than every other developed country. Cutting 1 trillion in spending would still very solidly leave the US as the country spending the most on healthcare.
You know that’s because we give out medical innovations and medicines to Europe cheap since they would just steal the IP otherwise right? The US subsidizes most of the worlds health and medical research via this
>you know that's because [blatantly factually false statement], right?
Looking at a list of medical patents filed per capita, the US isn't some crazy outlier, and countries like the UK, Israel, Switzerland etc actually have higher rates of filing medical patents.
>since they would just steal the IP otherwise right?
Source: your ass. Western countries have incredibly strong intellectual property rights.
Also, let's say I accept your premise (which I 100% don't lmao). The US currently spends 2-3x more per capita on healthcare than every other developed country. Unless you think literally 100% of that higher cost is because of R&D (which would make you factually wrong), then if you think the R&D spending is worth it, we can literally keep spending the same amount on R&D while cutting back on everything else leading to American healthcare being 2-3x more every other country.
Like, y'know, being able to cut a trillion in spending while still being very much #1 in the world for per capita healthcare spending.
Now is the time to do it, we have so many telemedicine and self-diagnosis devices but no reasons to implement them because of private insurance.
Many visits in love a tech, then a nurse, and quick overview by a doc, and then a practiotioner. The more layers of care, the more they get a skim off the top.
Single-payer will cut that out and more people will get basic diagnostic care that leads to less hospitization and chronic disease.
> We can't even have interstate insurance competition. That would drive so much competition.
This is a hugely misleading statement that was deliberately been driven by conservatives in the 2008-2016-ish era, and I'm not sure if you're one of the people who got misled or you actually agree with the Obama-era republicans
I still haven’t seen a single politician come up with a way to raise the tax revenue necessary to fund this, and until that happens, it’s hard to take seriously
Even Sander’s attempt at funding it only covered around half of the cost
China funds their universal healthcare for 1.4Billion people with 1.2 Trillion $, which is roughly %6 of their GDP, goverment only pays for %20 of it.
Rest is recieved from employers who pay the insurance on the payroll tax and out of pocket minimal payments you make on visits. Instead of going and buying overpriced and low quality insurance, employers would buy goverment insurance which would fund the entire thing.
Its insane for you to think the richest country ever in history cannot afford healthcare while every other nation on earth can.
Except when the state agency represents the people, you wouldnt have to worry about if your insurance was gonna stick you with a bill that instantly bankrupts you, and state can collectively bargain for much cheaper prices.
There is a reason every country pays 1\4 th the price for AMERICAN drugs, except Americans.
It very much does take into account cost savings. What it actually doesn’t take into account is that we’d almost certainly have to slash provider costs (which, the US has by far the highest in the world) which presents its own issue.
Right, but that doesn’t answer the question of how we fund a single payer system, unless your solution is for people to still pay premiums and deductibles
If the government is the payer, then they need to fund it through tax increases. Which means you need specific policies to raise an additional $3 trillion per year
They would pay less per month as a tax than what they currently pay in premiums. That’s how it works everywhere else in earth. What are you not understanding? This product is cheaper and better everywhere else. What do you think those other countries do? Do you think that’s magic?
What are you not understand? I’m not talking about if it’s more or less, I’m saying you need specific tax policies to raise the revenue. No politician seems to be able to actually come up with a way to do it
Jesus. The premiums people are paying now account for the money that would be used for the tax. They would pay the tax INSTEAD of the premiums. How do you think this works everywhere else?
What tax?? That’s my entire point, which you don’t know because you clearly haven’t read my comments. Congress cant just create $3 trillion out of thin air, they need an actual plan for how to raise those taxes
>how this works everywhere else
There’s very few examples of universal single payer systems, but they operate from substantially higher taxes on everyone
Because no one wants to admit it would take large tax increases mostly on the middle class, and even taxing every billionaire down to $0 won't pay for it
But the middle class would end up with more money in their pocket at the end of the day because they already pay through the nose for crappy private insurance. It's more cost effective to pay for M4A through taxes than to give insurance company shareholders and executives a big cut for no reason.
Most admit that, Sanders himself has for decades. The thing studies keep showing is said tax increase would be less than the monthly premiums were already forced to pay, while additionally removing out of pocket expenses and surprise costs like out of network shenanigans. So taxes go up slightly, and healthcare expenses fall more than said increase, we all save money, everyone is covered and can enjoy the true freedom that brings.
It really doesn't matter at all if this happy joy joy take is true (which I do have my personal skepticism), before you get into more complicated takes like what I saw below, here is the stone cold truth:
M4A is Dead. on. Arrival. because the crusade against taxes has won for good in the US.
IFFFFF we do get a 2029 Democratic presidency, considering where we're at at this time, I'll just be straight up real with y'all, it's not coming with a big enough trifecta for the "big economic populist slanted change" that y'all are crying for. The likelihood is near 0 you'll see taxes raised significantly, therefore the majority of an economic populist slanted agenda would be dead, period.
Now maybe I'm wrong on where I think we stand! (which includes being more doubtful on a Dem presidency coming next than y'all) Perhaps a huge market and economic bubble pop is incoming and you will get a lefty populist president in '29 with 54 Dem senators or so.
I just don't think it's likely. If we get a Dem presidency, it'll be with too small of a trifecta to do anything outside of minor changes, and really, I think it's more likely that you get the true doom type stuff to verify maybe in 2029 and shortly beyond, if it's going to at all.
I'd argue where we're at currently makes universal healthcare a necessity rather than something unlikely. What Trump and Republicans have done these past 10 years is so beyond the bounds of what is acceptable and tolerable that the time has come to swing the pendulum left, and hard. Universal Healthcare is one of the most important demands, but it is not the only one. Its time to put our feet down and fight for what's right, and we are going to have to prosecute Trump and every traitor in the current regime to the fullest extent of the law. They will not be an obstruction to progress; they'll be locked up (otherwise our republic is already lost). The counter revolution will be bloodless if the right allows it.
Hate to break it to you bud, but again, it'll be a miracle if you get 10-20% of what you want in 2029-2032, which is what my long, rambling post gets info.
So basically, to sum up my stance, the Republic is already lost for good in your book.
If we do what I suspect and essentially have 2019 play out next year for starters and have nothing serious play out like a 2008 or something 2020 esque for the next Presidential year, the absolute maxout scenario for Dems is a presidential win with no breathing room in the Senate for 2028. In that world, there is plentiful room for new Manchins and Sinemas to block major tax hikes and there will absolutely "not" be any kind of prosecutions (don't think you see impeachment done again either).
That's not to get into that if we don't get a major negative event for 2028, it'll be much more of a bear of a challenge than you may think to dispatch the Republican that year.
Insane that the largest economy in the world can't figure out the funding for this but 70 other countries can. Almost like the tax revenue isn't the problem.
There are like 5 countries in the world with a universal single payer system, and none of them are as expansive as the proposed US single payer system would be
I don’t have an answer to your question directly but I believe a good chunk of the problem you envision will be taken out by law mandated caps.
So it’s not let’s raise the equivalent of what Americans and their employers pay today in tax. It’s let’s raise a fraction of that. When the per head or per family number is much more manageable it might become a lot easier for employers to be mandated to cover it in full.
Notice the key word that keeps repeating is mandated. There is no free market/capitalism solution to this problem.
"Now", while we have the whole government in the hands of evil Rs and they are planning to tamper with elections? Really Bernie? Could everyone in DC and the democratic party maybe direct your attention to our immediate problem?
This study has not been peer reviewed, and makes unsubstantiated assumptions that undermine its credibility.
The report claims that by offering free medicare for all, the $5 trillion in spending on private health insurance to cover the 310mm people currently using private insurance will fall to $4 trillion, and all of that gets captured as "savings".
What the report does not account for is the incremental costs of providing the healthcare services through Medicare for the additional 62mm people (20% of 310mm people) that is implied would be on medicare. Medicare currently covers about 70mm people, so the enrollment would almost double but the report assumes no incremental costs.
The report also presumes free medicare will save 114,000 lives, but how does that happen? The report presumes that the mortality rates for people without health insurance mysteriously increases, and all of those incremental deaths are saved by medicare. So more people magicly start to die, except free medicare rides to the rescue.
This report is incredulous and dishonest, and Bernie continues to be a sideshow Barker for failed socialist agendas.
Stop reposting this fraudulent socialist propaganda every hour.
> We estimated the mortality effect of universal coverage using an attributable-fraction framework, in which the observed deaths in each age group arise from the current mix of insured, uninsured, and underinsured individuals of that age, with mortality rates dependent on insurance status.11 We then calculated the deaths that would be expected if the entire population were adequately insured.
Is this where you got the idea that the death rate mysteriously increases? Because they used the word "arise"?
Wow you’re a bit mad that the fascist haven’t crushed the socialist eh? Is everything socialist propaganda for the likes of you? Guess let’s keep our healthcare tied to employment, that works out so great for us. There is no and will never have any socialism in the US, but keep crying wolf.
Literally almost every other country has it. You act like it’s some pie in the sky idea. If countries poorer than the US can do it, we can too. The businesses and the insurance companies don’t want you to believe that so they put out propaganda after propaganda.
....and it will cost more, not have the outcomes they promise, and result in degraded service overall. I believe there has to be a more rational system than what we have, but let's not lie about the potential impacts just so we can expand mediocrity to all.
Medicare is not some well run and efficient service providing quality care.
Bot propaganda for losers. The best example of aligning the planets would "save" 5-10% from admin costs. That's assuming that for the first time ever, our government becomes efficient and keeps fraud/waste/abuse in check. Frankly, these are embarassing positions to take.
Even if this works as planned, that is still $13,500 in healthcare spend per citizen, per year. Not exactly the amount the cult insinuates. We'd also lay off hundreds of thousands of people, add to doctor shortages, and also see many other changes that "no one could have expected" (that everyone saw coming).
It's also nonsense that the amount of care required plummets because people are now proactively managing their health instead of going to the emergency room. None of that is rooted in any fact. Some people just don't like going to the doctor period. Many people take poor care of their health. Free care undoubtedly will lead to MORE visits. Good luck getting government to put appropriate "limits." To add further insult to injury, the "free healthcare cult" pretends we won't give free care to all of the people of the world.
>The best example of aligning the planets would "save" 5-10% from admin costs. That's assuming that for the first time ever, our government becomes efficient and keeps fraud/waste/abuse in check
Wut. Medicare ALREADY has half the administrative overhead as the private market.
It is not going to happen in US. The biggest problem is that companies can charge whatever they want. The main reason our healthcare, in Europe, is cheaper, is because the government is the one negotiating and setting prices for drugs and treatments. They have groups of experts, who review costs, add a reasonable profit and that is a price roof for the companies to compete over contracts, usually multi year ones.
I mean, making a vial of insulin costs 2-4 dollars. In Europe this vial is sold for 9-15 dollars. In USA it's around 98+ dollars.
This would require a complete paradigm shift in the USA away from prioritizing corporate profits over anything else. Who knows, maybe Trump will bring such a change. When the empire falls and crumbles, people can seize the opportunity.
> The biggest problem is that companies can charge whatever they want.
This is not the biggest problem. The biggest problem is that the US forces insurance companies to be the system's gatekeeper but they are very bad at that role. Every HC need must go through the claim-denial-appeal loop which results in massive administrative costs and less doctor time per patient (since they are spending it on documentation, coding, and appeals).
> This would require a complete paradigm shift in the USA away from prioritizing corporate profits over anything else
All healthcare corporate profits from any source in the US healthcare system are less than 6% of what the US spends on HC. The problem isn't the profits, the problem is the gatekeeper is in the wrong place and must be moved (as a conscious choice, not by pretending a gatekeeper isn't necessary, otherwise wait lists become the gatekeeper of care).
As a conservative, I’d be willing to give it a shot with hard sunset clauses if it causes wait times to go up and doesn’t save 1 trillion dollars. I think most would be willing to try it but if it ends up like Obamacare and can’t be repealed while it fails then it’s a hard pass for me.
$40T in fiscal debt, $360,000 per taxpayer. Ya ya Socialism and everything but stop spending money. Stop giving away money to billionaires and turning America into an oligarchy. And yes, the capitalists have to go they are gross, but spending more money isn't the answer.
Saving lives is not gonna win votes from the MAGA cabal, unfortunately. If you have been paying attention since ICE was formed, it would have been obvious.
I think it’s interesting that private companies provide healthcare. You think they would want the public option. Healthcare seems like such a pain for them to handle.
How would you unwind the current system? Healthcare accounts for a huge chunk of the US’s output. I can’t see it happening, at least not in one fell swoop. It would have to be done in small bits over a long period of time.
Medicare is not free. People still pay enrollment fees. Also you still need to buy additional insurance for dental, eyes and prescriptions. If you have higher risks you should consider a rider to cover hospitalization as Medicare is major medical that covers 80 % . So there is less unwinding. And more need for regulation and auditing of medical insurance companies and providers.
We should measure amount of lives saved in the unit "9/11s". We continually blow up the middle east for multiple trillions of dollars due to a single 9/11.
Meanwhile, 50 9/11s happen per year and somehow nobody gives a shit. American lives just don't matter to our government. They didn't when the world trade center was hit, and they don't matter now.
The only reason we spent decades "avenging the victims of 9/11" is because a lot of people in the military industrial complex made a boatload of money off it!
Our government didn't even want to pay out pennies to the injured and dead 9/11 first responders!
Election year drum beating but what has Bernie done for US lately? Bernie Sanders' most recent primary-sponsored legislation enacted into law as a standalone public law is the
Veterans' Compensation Cost-of-Living Adjustment Act of 2013
, which was signed into law on November 21, 2013 (Public Law 113-52
>Opponents have questioned how such a system would be financed, its potential impact on taxes, provider reimbursement, and the broader healthcare industry.
Medicare is one of the best federal health programs for those 65 and older. Medicaid offers some coverage but pays low reimbursement rates to providers. To provide a universal healthcare system, everyone needs to pay higher taxes. We can't get everyone on the same page let alone have a civil discussion. Politics has been so polarized that you can't get anything done without a bipartisan support.
Medicare is forcing providers to be underpaid and if providers don't have enough payers not on government healthcare they often go into financial stress sometimes so much so that they shut the doors.
I am a partner at an office-based private practice in a surgical subspecialty. If we had 100% Medicare we would go out of business. In addition to leading to a shortage of healthcare providers in our specialty, it would also increase costs for the system because the reimbursement for office based services (like ours) are extremely low compared to a hospital based system, and all the care would now be absorbed by the hospital system which can charge 2-4x as much for the same services.
Literally why are health insurance companies reaping in mega profits for a service the govt can easily do for the people. Usually the benefit of capitalism is innovation, but what innovation do we possibly need in this industry.
I feel even more strongly for auto insurance as well, since that's legally required to drive
Edit #2: again, not sure if it bots or high schoolers who haven't developed reading comprehension responding to me but I will try one more time. It is political suicide to make a change that would eliminate nearly 1 million jobs, even if it is healthy in the long run. That's why it won't happen. It's really weird to me that if you propose an argument it means you must support that argument. I don't. Just being a realist.
Not going to happen.
Even though that $1 trillion is waste, to remove of that waste would equal the loss of hundreds of thousands of middle class jobs. There are over 700k Americans employed by the health and medical insurance industry. When you include people employed on the clinical end who deal with admin and insurance appeals etc, you are talking about well over a million Americans who have a job because of the current system. Obviously not everyone of them would be immediately out of work, but a large majority would suddenly be unemployed. The labor market generally kinda sucks but healthcare related spending (including insurance and admin spending) is largely propping up the sagging labor market month after month. To "eliminate $1 trillion of waste" would mean the loss of a staggering amount of jobs which would put us into an immediate recession. It is not going to happen.
Edit: not sure why are making arguments towards me like I'm suggesting we continue the status quo just to save jobs. Read my comment again. I'm saying Medicare for All is NOT going to happen and this is why. Whether or not it should happen is a different question entirely.
Exactly the right response. Our world is burning because chuds in Appalachia can’t move on from their shit legacy coal mining jobs and big business can’t quit oil. Progress requires sacrifices. Always has always will.
No, the point is we will lose a ton of jobs AND still not save any money on healthcare. It's ok though, these kinds of failed policies never have to be held accountable.
I know your talking points. The ones that ignore how much more we pay in salaries, obesity, drugs, malpractice insurance, litigation, and on and on. But keep regurgitating the bottom line only.
The entire current health care system is a failed policy. The US spends twice as much per capita on health care than the next nation and has worse health outcomes on almost every dimension than other developed nations. How can we keep looking at this and say everything is A-Ok?
I love how the opponents of Medicare for all have one response which is that the jErBs supporting a clearly doomed and failed system are so sacred they can never be disrupted for the long-term health of society. Brilliant.
You think your question is a gotcha, but the answer is the same as it is whenever large swaths of Americans lose their jobs - "fuck em". In the disaster scenario you're hand-wringing about at least those people will have healthcare
This is exactly what I'm saying. People who have jobs because of the current waste in the system are going to be shit out of luck. This will almost certainly tip us into a recession. Not saying it shouldnt be done, just that--realistically-- it won't.
And I'm saying that asking or answering that question has never been a concern of American capitalism. "Fuck em, let them die" is a complete answer. Whenever anyone gets laid off, they either get other jobs or don't, they either survive or don't, and the system doesn't care which and never has.
In the framing of that consistent systematic interaction with workers, the answer has always been - go ahead and destroy sectors of the economy and let the chips fall where they may. At least (in my opinion) the benefits of having a public option or whatever they decide would vastly outweigh the pain to the workers of the "healthcare" industry.
Bernie covered that in his MFA proposal 6-7 years ago:
(4) TEMPORARY WORKER ASSISTANCE.—For up to 5 years following the date on which benefits first become available as described in section 106(a), up to 1 percent of the budget may be allocated to programs providing assistance to workers who perform functions in the administration of the health insurance system and who may experience economic dislocation as a result of the implementation of this Act.
... its not like an American President already did that back in the '30's .... I swear the second a competent leader states the obvious some rich, privileged piece of human garbage starts shaming them for killing jobs and stunting job 'creators.'
Those were different circumstances, and you misunderstand me, I’m all for socialized healthcare but it will only work if the job losses can be addressed beforehand in some meaningful way.
They’ll survive … on account of their health insurance. And they can take their time finding a job they enjoy while not worrying about going bankrupt over a hospital visit.
Sweet so they’re going to live in the waiting room until they find consistent income? And I guess the hospitals will also need to provide 3 meals a day. Otherwise not sure how these people will live off “health insurance “ as you say…
Wait what? By that logic it is also good that 100k people a year are dying because of this system since we wouldn’t have jobs for them anyway /s And let’s gloss over how you honed in on the $ before mentioning the health outcomes.
Money you save in one area isn’t gone. Depending on who gets it back (government, private businesses, or consumers) it gets fed back into the economy through investments in other areas generating jobs or through consumption which, you guessed it, also creates jobs.
Obviously a wholesale change would have to be managed well and not be an overnight change. But justifying a wasteful system for both health outcomes and money by saying it keeps jobs is one of the more novel ways I’ve heard of.
I mean health outcomes ARE measurably worse in the US compared to other countries. Easiest one to visualize is life expectancy.
On average people in the US live 2-3 year less than people in other developed countries.
That means per generation (80 years) across a population of 350 million people, we lose about 8-13 million lifetimes of life which if you calculate that per year of life of that generation (80 years) results pretty much exactly in about 100-160k of fewer lives lived per year (I’m actually myself surprised at how closely that matches the number in the article).
These outcomes tend to normalize when you factor in the obesity rates in America. U.S. negative outcomes are heavily weighted (thehehe) by the average American being so much more overweight than peers in similar countries, especially our youth.
Obesity is one factor, but so is lack of preventative care for obesity related diseases, drug overdoses, gun deaths, car accidents, suicide, high inequality, lack of health care access, and so on that are all worse than other rich nations. Nobody is (or should be) saying that life expectancy is only due to lack of healthcare, but even obesity itself is a health issue that can be addressed in various ways (and we’d incentivize the government to do so by internalizing the costs of obesity): more preventative counseling, early intervention, obesity treatments paid for by insurance, and then outside of that taxes on certain types of unhealthy food, higher standards for school food, urban planning to encourage more movement etc. All of this would be incentivized if we internalize the costs of such conditions instead of remaining a country that is (commendably) very good at reactively treating conditions.
There's no sense debating this. You're just here to recite speaking points. Everyone who "compares" health to other countries ironically has no interest to truly compare. They're here to cherry-pick the best propaganda.
Compare the US in terms of obesity, physical activity, diet, etc. to all of your utopia countries. It isn't the hospital system keeping people alive longer.
Right, cherry picking a large group of countries that roughly represent our peer group in terms of economic wealth available to deal with the problem. The points you list ARE health issues (obesity, diet, physical activity) that get addressed in other systems in a proactive way rather than a reactive way. We are excellent at dealing with things reactively because the whole system is set up that way: you get paid for dealing with the shitty condition at the end of it, not for doing the prevention beforehand. In a single payer system no one can hide anymore from that cost or try to profit from it and you reset the incentives.
I’m not reciting talking points and if I am inadvertently, let me know where from so I can learn more.
And if you think I’m wrong then point to where you think so and maybe I’ll learn something new from it. That is what a discussion is.
And were are all these jobs? Like I said, the labor market is mid to sucky depending on the month and healthcare spending is keeping the economy alive. Saying "oh they will just find new jobs!" is cope. No different then the sentiment I was hearing about coal miners just need to learn to code. Realistically it is not going to happen.
If we ran our economy this way (and thank god for a lot of it we don’t) we’d be stuck in the Middle Ages.
Even if I were to entertain this argument: the first thing you’d see is an increase in jobs for all the consultants that would be hired to help manage this transition. Not that I’m a fan of it.
And how old are you if you think the current job market is terrible? Capitalism lives off of boom bust cycles and there will be a few more in our lifetime to go through and there have been lots in the past. We had an insanely hot job market for parts of the last decade despite, checks notes, jobless coal miners.
Pick your example of coal: what was your proposal then? Keep employing people in an industry that is not competitive, unhealthy for those people, and long term bad for all of us on many dimensions? I don’t really understand what you are trying to say the solution is.
Wasting money and health indefinitely will be the end at some point. We have to keep moving forward and get better at creating better lives and using our resources most efficiently.
And lastly: there is a trillion dollars available. Do you know how much money that is? Do you know how much of a safety net you could build for affected people while we manage this transition? Even if every health admin lost their job, you could give each of them a million dollars and have money left to spare.
How this could be viewed as anything other than an opportunity is really really hard to understand.
Congratulations. You’ve found step two of this project. So are we aligned on step one being that a cheaper system that improves health outcomes is worthwhile pursuing? If yes, then I agree, let’s figure out how we roll it out so it doesn’t leave hundreds of thousands of people in financial ruin.
First of all, many of those jobs would move to processing the new Medicare for all, they don't just evaporate, secondly you phase it in over time, no huge shock. Thirdly, doing something that kills over a 100,000 people a year just for 'jobs' is unethical as hell.
You are so concerned about displaced jobs but how is it any different than any other disruptive technology? Automation is set to put most truck drivers out of business. AI is leading to tens of thousands of engineer job losses per month. Hell, AI may put most of those insurance jobs out of business anyway. Sorry, but I'm not shedding tears over insurance folks, especially insurance executives, losing their jobs so that everyone has access to medical care.
Private health insurance can still exist in combination with Medicare for all. It might shrink that industry but it would better for the population as a whole. Just putting all the lawyers that try medical bankruptcy cases out of business would be a net positive for everyone.
> There are over 700k Americans employed by the health and medical insurance industry. When you include people employed on the clinical end who deal with admin and insurance appeals etc, you are talking about well over a million Americans who have a job because of the current system.
That is a concern that Medicare for all would displace those jobs.
AI is almost certainly going to replace a lot of these workers regardless. We are not quite there yet, but hospitals and insurance companies alike will do anything they can to cut expenses.
Universal Healthcare is a basic human right no matter how much the oligarchs and their lemmings desperately claim otherwise. If the US cannot guarantee this basic human right, it does not mean that Universal Healthcare is any less of a basic human right; it would mean the US has become a failed state. We all deserve better.
It has been defined explicitly as such since 1946 by the WHO and codified in the 1948 universal declaration of human rights. I'm afraid you're 80 years too late to make that fraudulent argument, old sport.
That’s not WHO it’s the UN. universal health care is not mentioned at all. For health care, the most relevant part is Article 25, which says everyone has the right to an adequate standard of living for their health and well-being. It doesn't say free.
additionally, the us hasnt ratified the udhr and the UN is a garbage organization
Universal Healthcare is supported both by the WHO in their constitution and by the UN in numerous instances as well as in Article 25 of the universal declaration of human rights:
"1. Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection."
Neither I nor the declaration said free, you did.. We pay taxes and get universal healthcare coverage. It's not that hard to understand lol.
In the US it actually is treated as a basic right. If you go into the emergency room with zero health insurance, they are legally obligated to treat you.
Universal Healthcare is not a basic human right, you could correctly say that access to healthcare is a right but that doesn't mean doctors are required to treat always. Could the USA afford single payer healthcare, probably but not without raising taxes on everyone. Most people don't realize that the current system of socialized healthcare for poor people is what is bankrupting those that can pay.
Health care is in fact treated as a basic human right in the US. If you go into the emergency room, they are legally obligated to treat you.
Health care cost coverage is not a basic human right in the US and it's why the US has the highest medical bankruptcy rate in the world. To the vast majority of the world, the very concept of going bankrupt due to medical costs would baffle them.
Same model that said Y2K was going to end computers. Same model that said the planet was going to end in 10 years for the last 30 years from global warming.
You understand that a tremendous amount of global work was put into preventing Y2K right? You also understand a tremendous amount of work has been put into preventing climate change right?
You seem like someone who simply gets mad at things they don’t understand. Have some humility.
I don't know of one climate scientist that predicted the "planet was going to end" much less in 10 years. That's just a strawman argument.
The predictions made in the early 1980's have all proven accurate. They were based on different assumptions of how society attacks the problem. E.g., do nothing, do some, do a lot. We're inline with their prediction of "do some". They also predicted what would happen and it wasn't global extinction nor the "end of the planet". It was things like displacement, shrinking areas where food can be grown, disrupted growing cycles, rising sea levels, shrinking glaciers etc.
Do you want hyperinflation? Because we already have had hyperinflation under Medicare. When hospitals only receive 80 cents for every dollar invoiced to the state, and they legally cannot sue, then they raise prices on all other services relating to insurance to cover the missing 20%. This is why some facilities do not accept Medicare and why those that do are more likely to close down. They cant raise prices fast enough to cover the missing 20%.
If we expanded this system to everyone, then prices would soar because hospitals would continue to receive only 80% they invoice.
The best way to lower costs immediately would be to remove state payments for insurance all together since they can never reach 100% of payments invoiced.
A much better system that can replace Medicare would be state assistance with direct hospital invoices. Instead of the state assisting middle insurance companies, they instead would directly assist consumers. People can absorb missing 20% of payments much easier than a multi million dollar hospital organization can, the latter leads to rising prices while the other leads to lower consumer spending, which can much more easily be absorbed.
Edit: downvotes are not a rebuttal to raw mathematical facts lol
Why, we can go further! Let's get rid of all the hospitals too. Think how much money we'd save! /s
We need a system that does the following:
Covers everyone regardless of employment
No one goes bankrupt over medical costs
Medicare for all is the best solution to achieve that. States cannot do this on their own. Expecting people to comparison shop hospitals and services is untenable. When you are dying of a stroke, you have no time to comparison shop. For critical services involving inelastic demand, market driven systems produce poor outcomes. For optional services involving elastic demand, they work great.
What are you talking about? Even people who are covered in this new program would still be comparison shopping to their approved hospital. What kinda made up world are you talking about? Just saying its the best does not refute the math behind hospitals not receiving full invoices from the state. If expanded, it would only increase rates for all services to cover hospital budgets.
In the system I suggested, it covered both of those goals. We do not need medicare to achieve them.
> Even people who are covered in this new program would still be comparison shopping to their approved hospital. What kinda made up world are you talking about?
In many areas of the country, there is only one hospital within reasonable driving distance. Second, most people do not comparison shop hospitals. Some do, sure. However, the vast majority of people do not. Third, it is more than just the hospital. It's the surgeon, the anesthesiology, its the nurses. One of the big issues people hit now is that they go in for an operation and while the hospital is in-network, the staff that treat you are not. That would go away in Medicare for all.
> Just saying its the best does not refute the math behind hospitals not receiving full invoices from the state. If expanded, it would only increase rates for all services to cover hospital budgets.
That isn't clear. One system for processing payments to providers would significantly reduce costs. Adding the State into the mix doesn't necessarily improve that situation.
> In the system I suggested, it covered both of those goals. We do not need medicare to achieve them.
How exactly is everyone covered in your scenario? How are medical bankruptcies ended?
The American people have consistently shown they cannot vote for it to make it happen proving the American people do not deserve it. Bernie is correct but the American voting public is not on board.
The study hasn’t been peer reviewed yet, but here’s how they arrive at the “$1T saved” number.
Start with available data on total healthcare expenditures across the entire economy: $5.2786T in 2024. They exclude DOD, VA, and Indian Health Service expenditures on healthcare. They cut out “pharmaceuticals administered as part of service provision” and consolidate it with the former services.
They then take the estimated total cost of services rendered but not compensated (unpaid bills). They estimate that at $51.7B. That puts the total expenditures at $5.3302B.
Here’s where they start subtracting: they estimate $100B could be saved by people getting regular, accessible primary care instead of relying on emergency/urgent care. Topline? $5.2302T
Then, they subtract what the savings would be if you paid all providers at (unsustainably low) Medicare rates: $295.6B. Topline now of $4.9347T
They subtract the estimated savings from setting pharmaceutical prices at the prices in the closest comparable high-income countries: $377.5B. Topline: $4.5571T
Then, subtract the savings from consolidating the administrative apparatus of insurance and billing departments into the federal government: $286.3B. Topline: $4.2708T
They subtract the savings from a unified claims system, which would reduce fraudulent billing (which they claim saves about 8% based on other countries that switched to single payer): $285.7B. Topline: $3.9851T
They add in an expected uptick in insurance usage by uninsured or underinsured individuals: $197.7B. Topline: $4.1827T
They then add in universal dental coverage: $54.7B. Final topline: $4.2374T
For the record this would be what the government is now responsible for paying, which includes Medicare/Medicaid. In 2025, we spent ~$2.2T on healthcare as a government. We’d need to increase the healthcare budget by a little over $2T to cover those estimated numbers.
It’s also a huge ask to force providers to accept Medicare/Medicaid rates. There’s a reason why it’s hard to find a doctor that accepts Medicaid at this point depending on where you’re at. The reimbursement rates are unsustainable for many providers.
The system in Canada was thoroughly abused by the Liberal government until they broke it. They made it available to millions of foreigners in exchange for votes. Now it is broken beyond repair and the government is literally murdering its own citizens to save money. About 75,000 Canadians have been killed under the MAID system. Emergency wait times are over 24 hours and people literally die waiting to see a doctor. If you have cancer the wait list is a year. This happens in most countries because politicians will sacrifice anything for easy votes. Then you pay a fortune in taxes for a broken, useless system that put you at the last end of the line. Beware. Politicians are the worst of the worst.
🙄. Recently went on vacation with a Canadian couple that was shocked to learn what an American pays for an equivalent system. They also did not really understand how access to care works. If you live in the middle of nowhere your access is limited. This is true and getting worse in the United States. You also don’t really understand that immigrants using healthcare is not the problem. Those same immigrants are paying taxes and into your healthcare system. I get that you want your racism to be true, but it really is not true.
Then argue it and make him look foolish. Telling someone to kill them selves doesnt fix anything. It just kills conversation.
We live in a world of extremes and its boring to listen to both sides tell name call and not debate points. I am glad you recovered, but this is a pointless path that doesnt help or move the needle. Its the worst part of the internet and social media.
Feel free to vote me down, but this is what is killing conversation and making everyone nihilistic or apathetic.
at some point WE are going to vote to put illegals on SSI and medicare just to watch old libs squirm 😂 a $300 a month SS check sounds good to me. i won't even file for it 😂
Leadership doesn’t want to save lives. It’s more profitable to provide chronic treatment & have some deaths each year. Plus, they just can’t wait to mechanize everything with robots & AI, & then we peasants aren’t just an inconvenience; we’re actually stealing wealth that could be theirs. They want less of us.
Must be election time again??? Another politician selling hope for votes but accomplishes nothing! You didn’t push this or any of your other glorious ideas while your own party was at the helm! You expect people to believe the current administration would bother to bat an eye at anything you say??? You people have already sold out of all of your ocean front properties in Arizona!
charvo | 6 hours ago
A public option with no frills basic care would be available for everyone. However, private insurance plans would be available for folks who want to pay.
_lippykid | 5 hours ago
That’s how it works in the UK. Sure, it’s not perfect but it’s a whole lot better for people who aren’t rich and it just speaks to the morals and values of the culture and sense of real fundamental community. Not everything in life should be a money making scheme
PunkPirate56364 | 5 hours ago
Our country has similar system to UK. Rich people don't pay a lot of money into public healthcare, and they usually end up using a mix of public and private healthcare.
So public healthcare does end up benefiting all by being so much efficient and cheaper through it's scale.
It's kinda like... we have one company providing water utilities in our town. Everybody is using it, rich and poor.
IF we had ten companies providing utilities, laying ten different pipes under each road, everybody would be worse off.
RainbowDarter | 5 hours ago
From a capitalist point of view, healthy workers are more productive.
BlueBonneville | 4 hours ago
Additionally, from a Capitalist point of view worker mobility would make the economy more productive.
RainbowDarter | 4 hours ago
And education. Educated ~~slaves~~ workers create new things for capitalists to profit from.
Our current crop of "elite" are really some of the dumbest possible.
butlerdm | 4 hours ago
Sure, but well educated, socially mobile, and financially stable healthy employees are dramatically more difficult to control and have leverage over. That’s the trade off they want to keep.
Also, the educated workers creating new things for them to profit on is a pipe dream. Most people are far too lazy to do it even with education. You’re looking at a small minority of people in that group.
Exciting-Emu-3324 | 39 minutes ago
Not to mention most of the techbros came from educated upper middle class families and basically destroyed the old giants like Xerox and Kodak. Just like Cronos after usurping his father Uranus, they fear the upstarts just like they themselves were upstarts.
TDLR; kick the ladder before anyone else climbs it.
EconEchoes5678 | 3 hours ago
Both of these are correct (you and the parent commentby /u/RainbowDarter). I think the narrative that businesses or the rich don't want a better healthcare system is wrong. I think basically everyone in the US wants a better healthcare system, including insurance companies. Businesses know that a healthier, more mobile workforce would be more productive.
The problem is that we can't agree what that looks like, how it should work, how we get there, or who pays for it. And frankly, I don't think almost anyone posting about this actually understands why the US system is as bad as it is.
Most people seem unwilling or unable to understand the core basic problem - all healthcare systems must ration and therefore all systems must have a gatekeeper. If no gatekeeper is chosen, the gatekeeper becomes wait times and congestion at the point of getting actual non-emergency care (and sometimes even emergency care!). Most systems (but not all) attempt to make doctors the gatekeeper, but doctors are a very leaky and bad gatekeeper.
Bernie's proposal for example is flat out unworkable. It would be the most inclusive and generous system on earth with absolutely no gatekeepers in the system.
When it comes to the question of "ok, what do we adopt" there at at least a dozen different examples of better systems, each with tradeoffs and some clearly better than others, some of which can't actually work unless we change something else structural about the US (Usually our entire education-debt pipeline).
Most people simply want to blame insurance company profits or CEO pay - insurance companies are our primary gatekeeper - which is just flat out mathematically wrong, and provably so. They're not even remotely large enough to close the gap we observe.
The left's position is that the rich can just pay for the system. But there is no UHC system out there paid for by the rich when you compare our current tax structure against other developed nations. We already tax the rich at among the highest tax rates in the world in California, Portland, and NYC, around 51%-56% after stacking each layer not counting sales tax/VAT or personal property taxes. Top-end tax rate choices are a competitive comparison market, so there's no room to raise them much further without destroying the economy that attempts it. So where does the money to pay for the UHC systems in other countries come from? Higher taxes on the middle class. This is true in EVERY country I have looked at, and the areas that attempted to do this in the 60's and 70's like NYC and Sweden(70's and 80's) had to drop their top end tax rates dramatically to stop the economic bleeding.
Similarly the right's position is that free markets and pricing power can solve the allocation problems of healthcare just like it does in almost every other industry. They're wrong - healthcare has extremely inelastic demand and is a superior good - demand goes UP when incomes go up, regardless of prices.
This is why we're stuck with the worst system in the world. The only way to fix this system is for people to learn about and start being honest about the tradeoffs. And the solution for the US? We have to move our gatekeeper. Insurance companies are a very bad gatekeeper.
emp-sup-bry | an hour ago
We could easily port over ANY universal system and it would be so much better.
But instead we get teeth gnashing and concern trolling trying to be hidden in long, seemingly thoughtful diatribes from shills for the current system that’s killing Americans.
Enough with this fake worry bs. The current system is directly responsible for the number one cause of bankruptcy and is killing hundreds of thousands of Americans AND is making our lives more miserable day-to-day.
This is a fucking crisis.
kyled85 | 4 hours ago
And give workers more flexibility, which is not what many business owners want.
TheGreatDay | 4 hours ago
Correct me if I'm wrong, but Capitalists don't want worker mobility, nor do they care much about "the economy" being productive. They care about themselves. More worker mobility means that labor can move from company to company more easily, a boon for the laborer and a bane for the employer. It shifts the power in the relationship towards the workers, which is no something employers are going to want, even if it really does lead to greater profits down the road.
artbystorms | 2 hours ago
I think this is something that gets missed a lot by economists. What is good for the individual capitalist is sometimes bad for a capitalist economy.
This is a good example. Every employer would love a financial ball and chain to keep their employees from quitting and reducing turnover.
But low worker mobility is bad in a capitalist system because it reduces the free flow or labor to where it is best suited.
Similarly, individual employers in a sector hate regulation, but regulation can be a positive to enforce competition and keep sectors from being monopolized.
TheGreatDay | 30 minutes ago
There is a general assumption that everyone working toward their own best interest will lead to greater outcomes. But you run into an issue where what is good for individuals to do is not good for a the whole. Or that returns could be greater in the long run but people have to worry about the next quarter and don't really care about the profits in 10 years time.
It's a problem with Capitalism as an idealized system with actors working perfectly rational vs Capitalism as it actually works in reality with real humans who are prone to all sorts of irrational thinking.
emp-sup-bry | an hour ago
Yeah, they love no regulation until they get big enough then it’s heavy regulation that creates a system of little to no competition thanks to high barrier of entry.
Similarly, related to this point of healthcare, a big company can easily provide ‘benefits’ to workers that handcuff them while smaller competitors cannot. With universal health care, that’s one more thing off the table (HUGE THING) that could allow more movement to build actual competition through joining smaller companies or starting their own.
wild_exvegan | 3 hours ago
Yeah but efficiency is not a goal of any capitalist. Profit is. The ideal situation for a capitalist is as a monopoly rentier. Likewise they probably prefer more serf-like conditions over a fluid labor market.
akacarguy | 4 hours ago
Unfortunately we’re in the maximizing wealth extraction from the system phase, not the invest in our people phase of capitalism.
RainbowDarter | 4 hours ago
They're eating their seed corn when they should be tending their garden.
Mysterious_Help_9577 | 3 hours ago
Not to mention companies would have to pay people more in the long run. They wouldn’t be paying health insurance and people would be more willing to job hop or quit and not work for an extended time off working if they didn’t have to worry about losing health insurance
GB10VE | 43 minutes ago
from a capaitalist point of view, if the workers aren't forced to stay at a job to keep their health insurance, they can start competing businesses, unionize and demand better pay, or take jobs with better salaries...
emp-sup-bry | an hour ago
If you remove birth control of multiple forms, you get a rotating cast of ‘next worker up’ desperate to take that spot when one falls.
A capitalist view would also want open borders but they made their devils bargain with the religious fanatics do they go with forced birth instead
Miserable-Bridge-729 | 3 hours ago
What does someone who purchased private healthcare get in the UK that the average Jane or Muhammad doesn’t get? There’s a class warfare argument these days in the US that essentially boils down to wealthy people shouldn’t be able to get better care simply because they have more money.
alpacaMyToothbrush | 3 hours ago
I view it as a basic tenant of class solidarity that the rich should not simply be able to 'opt out' of public institutions in favor of exclusive private ones. Want little Timmy to go to a good school? We'll, you'd better be invested in improving public ones. Want good health care? Then you'd better support the system that everyone uses
Miserable-Bridge-729 | 2 hours ago
There’s a solid argument in what you are saying but I tend to be interested in where people think a line, if any, can be drawn that allows for the wealthy to either receive are at a minimum have a chance of better outcomes. If healthcare is all paid for, what could a well off person vested in the system pay for that a less well off person isn’t entitled to? Same for education, food, housing, privacy, security etc. The areas where wealth could and should provide advantages is extensive. Is any advantage due to wealth acceptable?
alpacaMyToothbrush | 2 hours ago
I don't see any problem with the rich driving a supercar instead of a camry, living in a mansion instead of a 1bd apartment, or boating on a yatch instead of a dinghy. Anything the free market can better provide (defined by unrestricted supply and elastic demand), I'm totally OK with them using their money to get a better experience.
What I'm not OK with is them advocating to cut property taxes because Jr goes to private school, defunding transit cause they never use it, or water treatment because everything they drink goes through a fancy whole house reverse osmosis system
Unhelpfulperson | 56 minutes ago
Requiring people to pay taxes that fund good public services is a good, popular idea. Maintaining a hard line on that funding is a good idea that we should continue to fight for, amid calls to give up on trying to raise revenue.
Requiring people to use the public service and banning a private version of that service would be a very eccentric strategy that has not nearly as many precedents throughout the world, and little evidence that it actually improves the likelihood of solidarity.
sleeplessinreno | 42 minutes ago
> Requiring people to use the public service and banning a private version
Nobody is suggesting that. People are asking for equity. You don't have to use it. You can still use alternatives. What people are asking for is to pay their fair share into society that everyone else is.
Unhelpfulperson | 34 minutes ago
> Nobody is suggesting that.
I disagree, based on the comment thread I was responding to:
> There’s a class warfare argument these days in the US that essentially boils down to wealthy people shouldn’t be able to get better care simply because they have more money.
followed by
> I view it as a basic tenant of class solidarity that the rich should not simply be able to 'opt out' of public institutions in favor of exclusive private ones.
This is presented in contrast to a system where a wealthy person uses a private version of that service, and therefore does not support the public one.
The commenter's argument suggested that without wealthy people using the public service, the solidarity to maintain funding of the public service would disappear. The only way to set up a system that maintains that definition of "support" would be to require wealthy people to use the public service, which could only be accomplished by banning private versions of that service.
sleeplessinreno | 30 minutes ago
> This is presented in contrast to a system where a wealthy person uses a private version of that service, and therefore does not support the public one.
If this metaphorical person doesn't want to participate in society, they can leave. Clearly, they have the means to do that. So just go. They are a minority and society, that wants equity, is getting real tired of being told what to do. A 9:1 battle usually doesn't have good outcomes.
sziehr | 4 hours ago
It’s more humane is what you’re looking for.
spikeofspain77 | 4 hours ago
Also in Oz. Private health insurance costs (if I recall correctly) around $200/mth.
matastas | 2 hours ago
This is closer to the German system than the UK.
M4A is single-payer; NHS operates clinics and pays for it. US Medicare doesn't operate them, just pays for them (vs. the VA systems, which is govt-owned).
Beautiful_Finger4566 | 2 hours ago
how much taxes do the poor pay in the UK?
because the bottom 48% of Americans pay $0 in Federal income taxes
that's my biggest complaint... the biggest users expect people like me to pay for everything
Zeddo52SD | 2 hours ago
I make under $50k a year and I’m more than happy to pay more in income tax if I’ll see a return on it in the form of government services or government subsidized services/products that provide cost reduction in my daily life. If I have to pay 3% to Medicare instead of 1.45%, I’ll happily do that if it means my health insurance is cheaper. Same with housing programs like Section 42 or Section 8 or privately-built-publicly-subsidized construction of housing. I’ll take a few thousand less in the standard deduction for any of that. And I think most people would be willing to as well.
Dougdimmadommee | an hour ago
To be clear I don’t disagree with the idea that there needs to be some type of public care option in the US but what you’re saying is quite obvious.
Assuming you make exactly 50k you’re saying that you’d be willing to pay an additional ~800 bucs a year if your health insurance was cheaper. Which like, yeah, of course you would, you’d save money lol.
Zeddo52SD | an hour ago
I made about $41k gross last year, and I’m probably on track to make somewhere between $45-46k, although the math i did says I should be around $48k when averaging everything out.
Well yeah, someone is gonna save money and someone is gonna pay more. People without insurance will lose money because you can’t save on insurance if you’re not paying for any, but ideally it means they’re either getting their health taken care of or they’re not stiffing doctors offices and hospitals for services provided, which saddles everyone else with that debt in the form of higher insurance premiums.
Also, for the record, I probably wouldn’t save money on health insurance because my employer-sponsored plan is ridiculously good for the cost. The company might save money or pass those savings on to us if they do choose, but I’m happy with my plan. $15 co-pays for visits @ $180/mo including life, dental, disability, and $5k deductible? I’ll take that any day. But we need to take care of others and potentially the debt we’ve incurred in no small part to healthcare and healthcare subsidies. So I’m willing to pay more if need be to take care of it, so long as I don’t get screwed over too bad.
emp-sup-bry | an hour ago
Would you trade your situation in life for theirs?
Beautiful_Finger4566 | an hour ago
why would I trade? I've made so many sacrifices to get the millions that I'm worth today... I'm not going to give any of it to people who don't deserve it
Tribe303 | an hour ago
Why do you think poor people use healthcare more? That's not how medicine or healthcare works at all.
You don't want them to have something you have, so you can look down on them.
Beautiful_Finger4566 | an hour ago
let's look at the numbers... in 2025, we put $1T in Medicaid to cover 84M people, or about $12k per person
compare that to the average expenditure for someone on private insurance which is around $7.5k
so either poor people use more in healthcare, or Medicaid is woefully inefficient
probably both
AstralVenture | 2 hours ago
Medicare for Alls bars private insurance companies from offering the same services.
morbie5 | 2 hours ago
> A public option with no frills basic care would be available for everyone. However, private insurance plans would be available for folks who want to pay.
That is viable and might be good policy but that won't save $1 trillion a year. The savings from the study assumes a system where everyone is on Medicare and providers (hospitals, doctors offices) get Medicare rates aka less money.
Beautiful_Finger4566 | 2 hours ago
we have an example of that already... it's called the Veteran's Affair, and we literally have veterans committing suicide in VA parking lots because they keep getting their care denied
Zeddo52SD | an hour ago
Because the VA is chronically underfunded, poorly managed, and too bureaucratic. Tricare is also one of the biggest budget items for DOD, and it’s been increasing for a while.
Overtons_Window | an hour ago
> Because the VA is chronically underfunded, poorly managed, and too bureaucratic.
Which is guaranteed not to happen with medicare for all because?
StrebLab | an hour ago
Trust me bro, it is totally going to work this time.
Csquared6 | 45 minutes ago
Choosing not to do something because it might not be perfect is not a reason not to do something. Nirvana fallacy has been pushed on this as a negative for decades and yet the alternative is to continue the broken system that exists today.
So the argument boils down to "since it's broke, and we can't find a perfect alternative, leave it broken while complaining that it's broken but doing nothing to fix it." "Stupid" is the most generous I can be with that line of argument.
Zeddo52SD | 43 minutes ago
It’s not guaranteed to not happen, but veteran care is heavily regulated by statute and rules. Ideally, in M4A, you don’t have a plethora of regulations, making oversight relatively simple because you focus on less rules to follow and can catch the fraud quicker, theoretically. The point is to not be so bogged down in regulatory red tape because that costs money to oversee and navigate. The amount of red tape placed in front of soldiers and veterans is part of the problem as well. Obviously nothing is guaranteed to function, but it’s worth a shot at this point. I’m not looking for a perfect system, I’m just looking for a better one.
emp-sup-bry | an hour ago
Jesus Christ do you think there’s a difference between someone getting care around the absolute horrors of war and my daughter getting a broken arm?
It’s an absurd false relationship.
Overtons_Window | 33 minutes ago
Calm down.
Beautiful_Finger4566 | an hour ago
yup... that's exactly what happens when you socialize something
Zeddo52SD | an hour ago
That’s what happens when you create a bunch of rules and regulations and statutes surrounding things. The only way for M4A to work properly is to have loose regulations over care, but strong enforcement against those that violate the basic rules.
emp-sup-bry | an hour ago
Luckily the 30% refusal rate of UHC a bit ago worked so great, right?
Do you want to pay for healthcare at as close to cost as possible or with 50 middlemen in there all harvesting profit? Which is more efficient?
Beautiful_Finger4566 | an hour ago
I want people to pay for their healthcare directly, with insurance only covering catastrophic cases
we don't expect car insurance to cover oil changes, or home insurance to cover a broken refrigerator
HughManatee | 6 minutes ago
Right, but the issue is that private health insurance actively hoses people in catastrophic cases with denials that providers and members then have to waste energy fighting. Tail risks are still screwing people over even when they pay for coverage.
emp-sup-bry | an hour ago
Yeah going through the horrors of needless war thanks to republicans and me having a sinus infection is definitely the same thing.
Beautiful_Finger4566 | an hour ago
what I'm hearing is that you WANT to give control of your healthcare to these same Republicans that will absolutely defund your healthcare services in order to start more needless wars
GuidetoRealGrilling | 5 hours ago
And that always been part of the argument for it, but the opponents of it get too much money from the insurance lobby
jarena009 | 5 hours ago
I'm a bigger fan of the non profit public option available to all. Single Payer isn't practical here. a) Many people actually say they like their current insurance plan (they think it's inexpensive because they directly only pay a fraction of the actual total insurance premium through their job), b) we're not going to throw millions out of work by eliminating all these insurance and admin roles.
Granted if we could build an insurance system from scratch, single payer could be better, but that's not the situation here.
We can still drop Medicare eligibility to age 55, add hearing, vision, and dental to it too.
Blowfish75 | 5 hours ago
AI is almost certainly going to put the majority of these insurance and administrative employees out of work anyway.
jarena009 | 4 hours ago
Very likely indeed. And then when these for profit insurers migrate over to AI bots denying your claims based on "unnecessary care," I can see people really getting upset over it.
SoylentGrunt | 4 hours ago
But not the owners,,,,,,
No_Internal9345 | 2 hours ago
We can just outlaw the for profit insurance industry.
leathakkor | an hour ago
I think this is the only solution that makes sense.
On a separate note a friend of mine is pregnant and I asked her how much it was going to cost and I don't remember if it was 5,000 or $15,000. But even with insurance she said that she was going to be down at least that much money. The crazy shit. She works at a children's hospital so she should have pretty much the best insurance available and it's her place of work where she will be delivering the baby.
How is it that expensive to deliver a baby in 2026?!?
No wonder people are having less kids. If people specifically politicians want people to have more babies, make it free to have babies. Cover children with free healthcare until they're at least 18 years old and have them covered no matter what with pretty decent coverage and that will alleviate 90% of the crazy costs with having a child. People will be much more willing to do it if you make it cheaper at the very original starting point.
I'm over 40 years old and she's going to spend more just to have a baby than I've ever paid for a single car in my life. That seems crazy to me.
Unhelpfulperson | 52 minutes ago
> Cover children with free healthcare until they're at least 18 years old
"All kids are eligible for Medicaid" is an idea i've seen thrown around in health policy circles that would be a stupidly easy policy to implement compared with large-scale reform, and have enormous upside with little downside.
leathakkor | 3 minutes ago
The crazy shit is if you're going to cover new and expecting mothers and children. And the elderly. That's pretty much all of the costly parts of society statistically. The rest of the people tend to pay in without taking much.
So if you get to the point where you're covering children and the elderly through government programs, Medicare for all is an easy next step. And I think that's probably why so many people would be against covering children because the obvious next step is to include the people that actually pay into the program without using it much which essentially means borderline universal healthcare
Electrical_Review_81 | an hour ago
One issue that has to be addressed is cost. Before we can provide basic care to people via are taxes, we must get cost under control. There are at least 10 different drivers of cost so it will be extremely difficult to
raymonst | 24 minutes ago
aka medicare for all who wants it
Electrical_Review_81 | 4 hours ago
I would be okay with this - but I mean absolutely no fucking frills
alpacaMyToothbrush | 3 hours ago
The only things I'd exclude are those that are cosmetic
Unhelpfulperson | 41 minutes ago
There's no healthcare system that frees us from the need of deciding what gets covered and how much gets paid for it. Around ten years ago, the NHS made the decision to stop covering a bunch of pain treatments because it was determined they didn't have evidence of effectiveness. But that's a problem in a lot of pain medicine - there's tons of procedures that work for some people and other people get absolutely nothing from. In total, that amounts to "little evidence of effectiveness", but the people who had been feeling better the procedures were really mad about that! That happen's a lot in pain med because we don't have a great understanding of pain from a theoretical level and the placebo effect is extremely strong. For other subfields, there just a lot of grey area around exactly what kind of treatment regimens are appropriate for which patients, especially when you have things like off-label usage.
So the difficult parts of setting up a public system really is determining who should get what covered. To include everything that isn't cosmetic would be a different approach than any country anywhere uses, and would cost a fuck of a lot more than what's analyzed in this paper
IchmagschickeSachen | 3 hours ago
That’s basically how it works in Germany and it’s a billion times better than “healthcare” in the US.
JackDostoevsky | 3 hours ago
realistically, if it's truly Medicare for all, many would need it: Medicare doesn't cover a lot of things. I've long felt that the term "Medicare for All" was kind of a bad one, and probably not what its proponents want: my dad just had to pay $1800 out of pocket for a procedure not covered by Medicare, and something like half of Medicare recipients feel compelled to carry supplemental private insurance due to gaps in Medicare coverage.
so if it's truly Medicare for all, then there's still plenty of space for private coverage, and in many cases would be required.
InternetImportant911 | an hour ago
Medicaid and Medicare is the biggest expense in Federal budget over 2 trillion, what procedure not covered by Medicare
GB10VE | 41 minutes ago
medicaid and medicare, I feel like they also can't negotiate? or something like that, where they can't set what they would pay and the comapnies gouge them too
JackDostoevsky | an hour ago
there are many, i don't have a list. my dad's procedure was for some injection to help his back, i don't know the specific details.
there's a reason over 40% of people on Medicare have secondary private insurance: it's to cover gaps, and because Medicare itself has no out of pocket maximum.
you bring up a good point: Medicare does cost a lot. but it's telling that despite how much Medicare costs the government, individuals still need supplementary insurance to cover personal costs of healthcare. unfortunately Medicare tends to create the worst of all worlds: increased taxpayer burden, inflated coverage costs, and it doesn't even cover the whole costs of everything.
emp-sup-bry | an hour ago
It’s a secondary insurance. It’s built in to save cost bc many of the old guard that retired with pension and covered insurance for life kept that insurance. 80/20.
Funny that you are so hell bent on this one example ruining everything but you don’t even know what the denial was
InternetImportant911 | 33 minutes ago
Yes most European country so called Universal health care also require secondary insurance for some coverages
JackDostoevsky | 27 minutes ago
>Funny that you are so hell bent on this one example ruining everything but you don’t even know what the denial was
I'm not sure you understand the angle I'm coming from here. I'm not even necessarily criticizing the thing they want, i'm just saying that Medicare, as it exists today, doesn't seem to operate in the way that they want universal healthcare to operate. Therefore i'm not sure it's the model they should aspire towards.
TurningTheCorner26 | an hour ago
Medicare Part B, for example, only covers 80% and has no out of pocket max.
Unable-Goat7551 | 3 hours ago
It’ll never happen because companies want people dependent on them for health insurance. Take that away and suddenly employees have too much power
massenburger | 3 hours ago
Here's a link to the actual study: https://www.medrxiv.org/content/10.64898/2026.07.22.26358689v1.full.
Note that this is a preprint and this study has not yet been peer-reviewed.
Inner_Opening5497 | 5 hours ago
sorry this doesn't make any sense at all, I think the only way to help every day Americans with their healthcare is to send another $7 billion to our greatest ally Israel.
mcwap | 5 hours ago
It’s just not enough… a tax break for the richest of the rich will surely result in a a huge ROI for the middle and lower classes!
djprofitt | 5 hours ago
It’s still not enough. I know, let’s cancel a ton of social and research programs that keep Americans safe and healthy! If the laid off scientists and doctors complain, denounce their expertise so maybe they will leave for other countries, because we certainly won’t need them anymore.
o08 | 5 hours ago
Food for kids in school. That costs a fortune and helps no one I know that can vote.
butlerdm | 4 hours ago
Funny anecdote about food for kids in school. About 85% of Illinois qualified for reduced/free lunch so in 2015 or 16 they tried just making it free for everyone state wide…without raising taxes. Schools got flooded with complaints about meal quality, quantity, and lack of options. They immediately went back to the previous system the following school year.
Sufficient-Bid1279 | 5 hours ago
It will trickle down…..any day now…..any day I tell you /s
fenrsulfr | 3 hours ago
When you think it's raining it's actually cicada piss.
Das_Geek_Meister | 5 hours ago
Better raise taxes to help pay for this for those people making less than $30k because they're the ones who will benefit the most from this.
/s just incase
LickCunts | 5 hours ago
Also government contracts for those poor billionaires who work so hard!
Super_Mario_Luigi | 5 hours ago
Dumb parroting of dumb speaking points. All Israel aid over the last 20 years wouldn't pay for two weeks of US medical spend. I would cut Israel aid (and I guarantee more overall aid than you would). However, it's not even the top 20 of pools of misspent funds.
PangolinPalantir | 5 hours ago
Doesn't really matter. There are a billion more productive and moral ways to spend the money than using it to prop up a genocide.
Hell, burning it to make s'mores would be better.
Edit: In case anyone needs to see this.
Genocide is the intent to destroy in whole or in part a national, racial, ethnic or religious group through means such as: killing members of the group, causing serious bodily or mental harm, etc.
What part of what is happening in Gaza is not a genocide? Be specific.
Super_Mario_Luigi | 3 hours ago
You are entitled to your opinion.
That doesn't mean it is meaningful propaganda on the healthcare stage
HarmfuIThoughts | 3 minutes ago
You could use a more direct source to back up you claim https://www.ohchr.org/en/press-releases/2025/09/israel-has-committed-genocide-gaza-strip-un-commission-finds
ElonTaco | 5 hours ago
There's no genocide in Gaza.
HarmfuIThoughts | 4 minutes ago
https://www.ohchr.org/en/press-releases/2025/09/israel-has-committed-genocide-gaza-strip-un-commission-finds
A UN panel has stated that genocide is happening. I believe the only major body left to declare this is the ICJ, its investigation is ongoing
PangolinPalantir | 4 hours ago
Sure bud. Keep telling yourself that.
ImmortalPoseidon | 5 hours ago
You were very quiet when giving $200bn to Ukraine. In any case, that’s not how this works either. So you’re wrong twice.
Usakami | 5 hours ago
Research from institutions like the Council on Foreign Relations indicates that roughly $106 billion of the total funds ($195 bn) directly support Ukraine's government, military forces, and economy. The remainder covers U.S. military operations in Europe, intelligence, and replacing U.S. weapon stockpiles.
RashmaDu | 3 hours ago
Money to Ukraine is the single most cost-effective way for the US (and Europe) to grind down one of their most important nuclear threats today, while also putting a strain on the authoritarian axis of the world today. You have to be completely detached from reality to not see the minuscule amount of money spent on Ukraine relative to the overall defense budget as the best bang for your buck the DoD has probably ever achieved in terms of strategic objectives (especially considering the Iran war currently).
Oh, and it's nice to punish and deter aggression by imperialistic dictatorial megalomaniacs in the heart of Europe, if you care at all about human rights and peace.
ImmortalPoseidon | 3 hours ago
So essentially the same thought process as Israel/iran?
RashmaDu | 3 hours ago
No, not at all?
First order on the moral aspect: If you cannot see a difference between giving money to Ukraine, attacked unprovoked by an imperialistic enemy of the West, and giving money to genocidal, constantly destabilising the ME for its own gain Israel, then please get your heart checked.
On the strategic side: Russia is a much larger current threat to Western interests, considering it actually has nukes and there is an actual chance they would attack the Baltics or other European countries.
ImmortalPoseidon | 3 hours ago
I'll try to address this stuff individually lmao. Are you suggesting Ukraine is a representative of western culture?
RashmaDu | 3 hours ago
Not necessarily, and in any case I'm not saying western culture is the important part. It's an ally to the West, that shares our values, and that is being attacked by our enemy. We massively stand to gain by assisting Ukraine right now.
Do you have an actual point?
ImmortalPoseidon | 3 hours ago
What values of ours do they share?
RashmaDu | 3 hours ago
If you don't have an actual point then this discussion is pointless.
It's a democratic country that is keen to join NATO/EU currently at war with the EU's most immediate military threat that is also a brutal dictatorship engaged in an unprovoked war of aggression
ImmortalPoseidon | 3 hours ago
So the value they share is democracy? Is that it?
I'm trying to find your rationalization for dishing them blank checks over any other "ally" cause they aren't even officially an ally.
You say they share our values, but they don't.
So what is it? Aside from "sticking it to Russia" what is the purpose of helping them over Israel?
spaztwelve | 3 hours ago
Uh...the thought process would lead us to giving money to the Palestinians, since they're the ones being invaded.
ImmortalPoseidon | 3 hours ago
So your solution is to enrich organizations that pray for our death?
spaztwelve | an hour ago
No. I don't think we should support any religious ethno-state. It goes against the very principles this country was founded on (see: separation of church and state).
Inner_Opening5497 | 5 hours ago
I was not quiet at all, Israel came to me in my dreams and told me that $200 bn should go to them instead. I screamed this at the top of my lungs at my local Chick-fil-A and they called the police on me because they are antisemitic.
ImmortalPoseidon | 5 hours ago
lol. I’m sure you did!
BroughtBagLunchSmart | 3 hours ago
Giving money to fight fascist invaders in Ukraine = good
Giving money to fascists to do ethnic cleansing in Gaza = bad
Thank you for coming to my very basic ted talk about good things are good and why bad things are bad.
ImmortalPoseidon | 3 hours ago
Fascist = everything you don't like
Thanks for coming to mine!
spaztwelve | 3 hours ago
Core Ideas of Fascism:
Extreme Nationalism: The nation or race is viewed as supreme above all else. (check)
Dictatorial Rule: Power rests in a single, all-powerful leader with no real public checks. (not checked)
No Democracy: Free elections, free speech, and individual human rights are rejected. (check - ask the occupied folks if they get to vote or participate)
Militarism: Military strength and violence are praised as ways to show national power. (Big check)
Censorship: Media, schools, and culture are strictly controlled by the government. (check)
Ding, Ding, Ding! We have a winner!!!
24Seven | an hour ago
The vast majority of the money we spent on Ukraine never left US shores. It went to defense contractors to build munitions and equipment.
RaceOld9 | 5 hours ago
Ukraine doesn't have a PAC meddling in U.S. affairs that got an MOU signed requiring a baseline of $3.8 billion spent on their defense per year.
Also, you leave out the little detail that they were invaded by one of the largest strategic rivals to the U.S. And that by supporting Ukraine, we've seen the decimation of the Tu-95 fleet, and directly enabled the destruction of years of Russian military modernization.
And, that most of that money has made its way to DoD contractors regardless of whether it is allocated to Israel or Ukraine.
ElonTaco | 5 hours ago
If you don't think Ukraine is lobbying the US you're ignorant as hell.
BroughtBagLunchSmart | 3 hours ago
Private MAGA account named after a fascist white supremacist supports Israel and Russia. SHOCKED I SAY!
ElonTaco | 3 hours ago
Read my description, it's making fun of Elon, fucking idiot.
RaceOld9 | 4 hours ago
Didn't say they weren't, I implied they didn't have the same influence as AIPAC. You're ignorant as hell if you believe they do.
ElonTaco | 3 hours ago
is the spoopy big AIPAC in the room with us right now?
WindwardSnow | 2 hours ago
I appreciate this comment and I’m sad that it’ll get removed by mods
NicKaboom | an hour ago
Hold on now, what about spending another 60-100B on a war with Iran that we can't get out of because our admin is so beholden to Israel's refusal to let this thing die.
kp1233 | 5 hours ago
If Medicare for All covers more people and removes more out-of-pocket costs, demand for healthcare will rise. At the same time, a large share of the projected savings comes from paying doctors, hospitals, and drug companies less. Lower reimbursement can reduce supply, especially over time through staffing, investment, and provider participation.
HaloFever117 | 5 hours ago
There is no public good that results from low demand for health care. A shocking percent of Americans avoid the doctor, especially 64 year olds on the cusp of receiving Medicaid. Unless, of course, you consider it a public good when folks drop out of the workforce and die a preventable death.
Content-Fudge489 | 4 hours ago
Unfortunately that's the selfish attitude so many have and the reason we don't have M4A.
Jmoney1088 | 2 hours ago
There are many reasons why we don't have a single payer system and that is definitely one of them. But I simply don't think our country can afford a true M4A system.
Ok-Bug-5271 | 3 hours ago
>demand for healthcare will rise.
Nobody goes to the doctor for fun. When you say "demand will rise", you actually mean "people who need medical care will finally go".
Preventative healthcare is significantly cheaper than waiting for conditions to become so awful that people finally go to the doctor after it's a crisis. Treating people at the beginning would literally be cheaper.
EconEchoes5678 | 2 hours ago
> Nobody goes to the doctor for fun. When you say "demand will rise", you actually mean "people who need medical care will finally go".
This is not correct. Healthcare demand is extremely inelastic plus it is a superior good. As incomes rise, demand rises, even ignoring price increases, and there is no limit to this demand. Every single healthcare system on the planet has a gatekeeper of care. Those who did not consciously choose their gatekeeping (like Canada) end up with wait lists (at specialists i.e. the treatment point for nonemergency care) as the gatekeeper. For the same funding level, those who consciously chose a gatekeeping process end up with shorter wait times, like the Netherlands and Denmark.
> Preventative healthcare is significantly cheaper than waiting for conditions to become so awful that people finally go to the doctor after it's a crisis. Treating people at the beginning would literally be cheaper.
This is all true, but the differences here are nowhere near large enough to solve the problem or deal with the demand problem that you pretended isn't real. The demand problem & the allocation problem (i.e., the gatekeeper) is the core unsolved problem of every healthcare system in the planet. Ours just happens to have the worst solution to it.
Beautiful_Finger4566 | 2 hours ago
look at the illegal immigrant population in the US... they absolutely do go to the ER for something as simple as a headache
the homeless go for 3 hours of a bed and a sandwich
it's to the point where I've learned to avoid certain hospitals because the wait is so long due to people who don't need or deserve the care
The_Real_BenFranklin | 5 hours ago
Many hospitals would close if every patient was Medicare - the rates are very low.
jerkularcirc | 4 hours ago
*would need to get rid of useless administrative bloat reduce executive salaries and keep the essential provider staff
spaztwelve | 3 hours ago
But...why are many hospitals closing anyway? Doesn't seem like a Medicare problem.
Moccus | 3 hours ago
Rural hospitals have fewer patients in general, and a high proportion of their patients have Medicare or Medicaid. They don't get enough private insurance patients to make up for the loss.
spaztwelve | an hour ago
Uh...Steward Hospitals in Massachusetts comes to mind (just one of may hospital systems in trouble)? Ain't rural, bro.
The_Real_BenFranklin | an hour ago
What’s their patient pop look like? If all the people with good insurance and money go somewhere else that’ll cause the same issue.
Moccus | 41 minutes ago
Sure, it's not just rural hospitals, and hospitals can obviously fail for other reasons. I was just giving one common example of a type of hospital that's struggling.
Steward Hospitals failed because they sold their real estate to a REIT to get cash to fund an expansion. They were then paying really high rent to the REIT and couldn't afford it.
The_Real_BenFranklin | an hour ago
The ones closing are either rural (and thus have few patients) or have populations that are disproportionately old or poor. The ones doing well have lots of patients with private insurance.
morbie5 | 2 hours ago
Medicaid rates can be "very low". Medicare rates are just "low"
This can be fixed by increasing Medicare rates in a Medicare for all system but then that will eat up most or all of the $1 trillion a year savings from the study
HarmfuIThoughts | 9 minutes ago
M4A provides global budgets to supplement hospital operations
M00n_Slippers | 5 hours ago
Not necessarily, a lot of the costs associated with Healthcare are the People who skip out on the bill because they can't pay. If everyone is paying, it allows you to accept less. Also the biggest costs that would change are for medication.
Wrenchinspokesby | 5 hours ago
Commercial insurance reimburses at 200-300% of Medicare rates and depending on sub specialty, is around 40-50% of total claim volume.
Probably conservatively a 50% reduction in revenue on single digit margin business.
All claims being reimbursed at Medicare rates would lead to a wave of bankruptcies, retirements on day 1 while also creating a massive fraud incentive.
CrayonUpMyNose | 5 hours ago
Being able to bill people that currently don't pay would make a huge difference to hospitals:
Hospitals treat every emergency, and very often the toughest (read: most expensive) cases are people coming in with severe life threatening conditions due to years of neglect, mental health issues, or drug addiction. Festering sounds with insane infections or covered in worms, advanced stages of cancer, full blown AIDS, antipsychotic medications interacting with antibiotics you want to give, unplanned pregnancy, often a combination of more than one of these. None of these people pay in the current system but they would be covered by a single payer, which means that hospitals gain a new, and above all fair, source of income, so that their everyday middle class Joe Schmoe treatment doesn't have to carry the cost of these cases.
What's more, the poor would no longer be discouraged from seeing a doctor for financial reasons (hospitals treat only emergencies), so these severe cases would be caught much sooner, saving the entire system a lot of money.
Ketaskooter | 3 hours ago
The non payers at hospitals would not go away but it would be reduced. Its estimated 15-20% of non payers currently are non citizens and its higher in California, Texas and Florida.
CrayonUpMyNose | 2 hours ago
Contrary to popular belief, non-citizens pay into social security and health insurance through their workplace, so that they contribute positively to the income side while being unable to draw from social security.
The other effect is prevention: getting everyone to see a doctor for five minutes once a year without fear of surprise bills means fewer expensive surgeries because at early stages, many issues can be handled with cheap medication instead.
morbie5 | 2 hours ago
> Contrary to popular belief, non-citizens pay into social security and health insurance through their workplace
Some do, some don't tho. It is a fact that a disproportionate amount of unpaid care at hospitals is due to non citizens (both illegally here and legally here)
> while being unable to draw from social security
The vast majority of immigrants here legally are not stuck in status purgatory. They will get to a point where they can collect on Social Security and Medicare (and also potentially need based aid like Medicaid)
EconEchoes5678 | 2 hours ago
All of that is correct but the numbers on those things are small.
/u/Wrenchinspokesby and /u/kp1233 are correct that Bernie's plan would drastically increase demand while cutting supply; extremely long wait lists would become the gatekeeper of care.
Any system must have a gatekeeper of care. Pretending we don't need one like Bernie's plan, or pretending doctors can do it (very leaky and bad gatekeepers) like many UHC systems results in huge wait lists.
CrayonUpMyNose | 2 hours ago
The are more than twenty different approaches to choose from for how to deliver universal healthcare in Europe alone, more if you include developed nations like Canada, some of which have long wait lists, while others don't. All of them are significantly cheaper than US healthcare (38th in the world by outcomes btw, worst value for money by far).
The dichotomy of "keep the current system or bread lines" that you are invoking simply doesn't exist in the real world.
You didn't address the cost of delayed preventative care, and made a bunch of predictions without bothering to offer a mechanism, let alone evidence.
Doctors from Europe love studying cases from the US because they get to see diseases at advanced stages that are caught much earlier where they come from, a long time before they lead to an outsized burden on the healthcare system, not to speak of the immense human tragedies that are caused by the way the US delivers healthcare.
EconEchoes5678 | 2 hours ago
> The are more than twenty different approaches to choose from for how to deliver universal healthcare in Europe alone, more if you include developed nations like Canada, some of which have long wait lists, while others don't. All of them are significantly cheaper than US healthcare (38th in the world by outcomes btw, worst value for money by far).
Correct.
> Doctors from Europe love studying cases from the US because they get to see diseases at advanced stages that are caught much earlier where they come from, a long time before they lead to an outsized burden on the healthcare system,
Also correct. The US subsidizes worldwide HC research, and we also provide immensely important cost - value data that other countries can't get effectively since they've removed cost from their market forces. But again, this gap is much too small to explain our problem.
> The dichotomy of "keep the current system or bread lines" that you are invoking simply doesn't exist in the real world.
I didn't say that. I'm trying to make people be honest about the choice that must be made. Because half of the population is only being honest about one side of the choice and the other half is only being honest about the other side of the choice. They're both wrong and they're both correct about different things.
> You didn't address the cost of delayed preventative care
It's a real cost. But it's small, much too small to close the gap in our cost/quality of care.
> and made a bunch of predictions without bothering to offer a mechanism, let alone evidence.
No one else offered any evidence in this thread, why single me out? And I'm happy to explain the mechanism or provide some evidence, but the question is so big that unless you narrow it, the posts explode. I can't answer everything unasked objection in one reddit comment.
I have a solution system proposal I've been working on for awhile. It's just damned hard to get people to listen and even explaining it takes a lot of time.
M00n_Slippers | 2 hours ago
I'll be honest, this just sounds like 'death panels' fear mongering, albeit way more coherent and less sensational. We have pre-auths, we have primary care providers than provide managed care, we have systems of 'gatekeeping' already. Almost no one in the US has the luxery to pick their services based on timeliness as it is. They have a network with one specialist in it and they get a visit when they get one. Certainly though we need to get rid of the caps on doctors and possibly shorten or streamline the process of allowing internationally trained doctors to practice in the US as well. This would help with supply.
EconEchoes5678 | 54 minutes ago
> I'll be honest, this just sounds like 'death panels' fear mongering, albeit way more coherent and less sensational.
I'm sorry that it sounds like this, but I'm not sure how to get people to be honest about the problem. Foreign UHC systems aren't magic, they just streamline our worst parts, but they have their own flaws. The core problem is that healthcare has an extremely inelastic demand curve AND it's a superior good - as incomes rise, demand for healthcare rises, which is not the typical demand curve for most products. These are objectively measured in economics.
> Almost no one in the US has the luxery to pick their services based on timeliness as it is.
This is not true, this is just naive. Our system is selected by patient pressures based on outcome because the demand is inelastic. Timeliness is a part of outcome choices. If an higher-end employer were to take a good healthcare plan and swap it for a high-friction, delayed-care healthcare plan, they'd lose a significant percentage of their best employees very quickly. This is part of why employer plans are so much better than ACA market plans with more choices, better networks, and PPO options.
For bottom-barrel employers, this might be true, but it's also true of many other UHC systems. It's one channel of the gatekeeping that must happen.
> They have a network with one specialist in it and they get a visit when they get one.
This simply isn't true of most employers especially near the top, especially in populous areas. It's true of employers in the middle and bottom and especially in rural areas where there are very few specialists, but that's a common problem to all healthcare systems. In the Sapnish healthcare system you not only don't get to choose your specialist, you can't choose your PCP, and you also can't change it. In rural Canada the choice is either you go to the single specialist nearest you (with a very long wait time) or you go veeeerry far on your own dime and time to someone else, likely with a long wait time. It also used to be this way in Finland for a long time.
> Certainly though we need to get rid of the caps on doctors and possibly shorten or streamline the process of allowing internationally trained doctors to practice in the US as well. This would help with supply.
Agreed on the caps for sure. And also agreed on the international channel, but if we do this, there is a quality tradeoff. If we do this and also utilize a system where lower quality doctors and higher quality doctors are treated equally, the system will have problems. Price differences and wait times are how this is difference is normally solved.
M00n_Slippers | 2 hours ago
Comparing doctors offices triaging people for service to UHCs bullshit is a joke.
EconEchoes5678 | 49 minutes ago
> Comparing doctors offices triaging people for service to
Going to a GP in Canada and getting a referral to a specialist over 400 days away is not "triaging." It's the gatekeeper resurfacing because they refused to place it anywhere else. And yes, the 90th percentile wait times for hip replacement, knee replacement, or neurosurgery are that high, and they used to be higher - years of reforms have brought it down a little.
You either be honest about the problem, or the problem resurfaces elsewhere. Ignoring it or pretending it isn't real doesn't solve anything.
morbie5 | 2 hours ago
> Commercial insurance reimburses at 200-300% of Medicare rates and depending on sub specialty, is around 40-50% of total claim volume.
It isn't 200-300% in most hospitals when you average everything out. For private practice doctor's offices it could potentially be that bad tho
M00n_Slippers | 5 hours ago
People act like no one ever thought of any of this shit, no they are thinking of it. I don't personally know the answers because I have a life. But El Sayed literally wrote a book on it and many other People have as well.
Wrenchinspokesby | 5 hours ago
Well it would be nice if they enlightened us mere mortals. Because the Yale study being blasted everywhere sure doesn’t. In fact they just model the full reimbursement differential as “savings” without any impact on the system beyond that ie the plainly obvious provider and deliver side response to that change.
M00n_Slippers | 4 hours ago
5 seconds of Googling suggests we would move to a capitation structure instead of service billing. It's how HMOs already work except everything is in-network now. Basically the doctor's office or hospital gets based on overhead costs for the patient on a monthly basis. Patients that need more care would get a higher amount.
The most annoying thing to me is that instead of saying 'this seems like out would be a problem, I'm not sure how we would solve this but there's probably a solution if we look for one since virtually everywhere else somehow manages it.' So often someone points out one thing, claims it's insurmountable because they never bothered to look into it at all, and say it just can't be done despite clear evidence to the contrary. We got to the fucking moon, we can figure out healthcare.
1776FreeAmerica | 4 hours ago
Exactly, the cost reduction in the billing systems, the removal of uninsured patients, the greater economic activity of healthy workforce, and the reduced burden on small businesses allowing for their growth and proliferation would allow the hospitals to make up that reduction. Just simplifying the 'peer review' and approval process that insurance companies force clinics to go through would be a significant enough cost reduction to make it competitive. We live in a world where doctors are setting up self-pay groups that only do a monthly subscription that's cheaper than the employee portion of the cost of insurance, because insurance adds so much additional cost to their practice to manage and the hassle of not letting them make the best decisions for their patient.
This is like good infrastructure design, on the surface, restricting straight sections of roads sounds like a stupid expense, but when you consider the reduction in accidents, EMS roll cost, car insurance costs, adding those expensive curves that help keep drivers focused is cheap and pays dividends. The issue is those are 2nd and 3rd order savings and most people struggle at understanding 1st order effects, if it's not 'see, hear, touch, feel' thinking, they can't understand it.
EconEchoes5678 | 2 hours ago
This is only about 1% of the cost drag on the system. It's not as large as you might think. Medicare underpaying for procedures (subsidized by the private market picking up the slack) is a much larger number.
Administrative waste in the claim-denial-appeal loop is far larger still.
Ketaskooter | 3 hours ago
Single payer system works ok if there's significant out of pocket costs, you're absolutely right that if a medicare for all push removed copays it would overwhelm the healthcare providers. Rationing would quickly be implemented and people would go untreated sometimes for a lengthy time.
Ok-Bug-5271 | 3 hours ago
>Rationing would quickly be implemented and people would go untreated sometimes for a lengthy time.
As opposed to now where hundreds of millions of Americans avoid going to the doctor because of cost. You can't threaten us with "healthcare will be rationed" when Americans already ration their healthcare more than any other developed country.
Redwolfdc | 9 minutes ago
Highly depends on where you are and your plan. Really good plans I’ve been on I’ve been able to choose any doctor I wanted to practically, have out of network covered, and rarely had to wait long for procedures or things like MRIs.
Not saying costs are not out of control or that Medicare for all as an option is bad. Just saying not everyone experiences rationing.
politicsranting | 5 hours ago
But also doctors will be able to put in less admin time as coding/billing will get far simpler. Allowing them to see more patients over time.
Logical_Adagio_7100 | 5 hours ago
Nah, doctors already see an outrageous number of complex pts compared to decades past. The big change would be you need a lot less billers and coders and other admin staff who spend their day fighting with insurance companies
EconEchoes5678 | 2 hours ago
> Nah, doctors already see an outrageous number of complex pts compared to decades past.
Yes but US doctors see fewer patients while working longer hours. That's documentation, coding, and insurance appeals.
> The big change would be you need a lot less billers and coders and other admin staff who spend their day fighting with insurance companies
This is correct but you're drastically understating the problem by pretending it stops there and goes away if we just remove the insurance companies. We have to fight with insurance companies because insurance companies are the US' gatekeeper of care. If you simply remove them and don't consciously put a new gatekeeper of care in place then demand explodes and wait lists for the actual nonemergency care needed become the new gatekeeper. This has happened in most foreign UHC systems, and the only solution is to consciously place the gatekeeping somewhere else.
The solution is that we consciously move the gatekeeper. Don't pretend it isn't real or that insurance companies are simply causing problems without actually playing an important role. They're causing problems because they are our gatekeeper. They're just very bad at that role.
Wrenchinspokesby | 5 hours ago
Medicare still has plenty of coding requirements and this work isn’t being done by doctors
Background-Depth3985 | 5 hours ago
lol Medicare’s charting and coding requirements are just as bad, if not worse, than private insurance.
Medicare/Medicaid also denies procedures and treatments just like private insurance.
Tell me you know nothing about healthcare without telling me you know nothing about healthcare.
HarmfuIThoughts | 14 minutes ago
I'm fairly sure the M4A bill addresses this directly and streamlines much of these processes to match what you'd see in countries with more efficient insurance systems. For example, it intends to do away with prior authorizations
Whiteelefant | 2 hours ago
Nice job claiming shit with nothing to back it up
Background-Depth3985 | an hour ago
As opposed to the comment I replied to with its copious evidence?
Google is free and easy. Pick the source that resonates with you most. They all say the same thing—the billing/compliance requirements for Medicare are so onerous and reimbursement rates are so low that many providers don’t want to deal with it anymore.
If government-reimbursed healthcare was so much simpler and easier for providers, we wouldn’t have a growing number of practices that opt out of the program completely.
Nice job adding zero value to the conversation, dingus.
Super_Mario_Luigi | 5 hours ago
Doctors spend maybe 5 minutes a day on billing
HarmfuIThoughts | 11 minutes ago
The doctor's themselves may not, but the practice still does. This is overhead cost that can be done away with. There are some administrative duties that doctors do get bogged down with though, like priori authorizations, which M4A intends to do away with
rhetoricalimperative | 2 hours ago
The supply of medical professionals is capped by Congress. We stop that too
helloeveryone500 | 5 hours ago
That math is so outrageously made up. The better argument is that not having national medicine is a huge gamble for each person. If you get unlucky and get sick you go bankrupt. If you don't, you save money on taxes.
True-Crimes | 4 hours ago
In fairness, one of the authors is Sanders's healthcare advisor. He says it, she "models" it, he quotes it as the next viable path to M4A.
PangolinPalantir | 5 hours ago
It's also a huge gamble for the country. A healthy country is a more productive one. It's kinda nuts that food service workers are both not likely to have access to healthcare and often can't afford/are allowed to take off sick.
Remote-Resource1172 | 4 hours ago
Did you read the study by Yale researchers that is the basis for this article?
Jmoney1088 | an hour ago
First, this is a preprint that has not been peer-reviewed. The authors reach the $1 trillion figure by assuming all of the following happen simultaneously:
The fraud number is especially questionable. It assumes a unified claims system would eliminate almost $300 billion in fraudulent billing based largely on Taiwan’s experience. But the cited Taiwan research did not find that 8% of healthcare spending was eliminated through fraud prevention alone. It examined several reforms together, including global budgets, price controls, standardized billing and utilization controls.
Secondly, this does not take into account the massive demand increase that will inevitably take place once everyone is covered. You will have people who haven't been to the doctor in years, decades even, all go in for care. That is a good thing in theory but will absolutely put a massive strain on hospitals and dramatically increase hospital cost (more staff, equipment, supplies, drugs, etc).
For comparison, CBO found that single-payer could produce anything from $700 billion in annual national savings to $300 billion in additional spending, depending on the plan’s benefits, reimbursement rates and cost-sharing. And even if every assumption were correct, federal taxes would still have to rise by trillions because private premiums, employer contributions and state healthcare spending would be transferred onto the federal budget. “The country might spend less overall” is not the same as “the government can provide it without enormous tax increases.”
PangolinPalantir | an hour ago
To your second point, isn't this increased strain both temporary and a good thing? We should see demand go up for primary care and specialists, and go down for emergency rooms, since that's where people who were delaying care often ended up. Then after a while of people getting proper treatments and preventative care, overall demand should level out and decrease.
While sure it's a strain, it's significantly more efficient for things to get caught early or prevented than for people to go to the hospital with issues only after they're too bad to ignore.
Personally though, I'm fine with costs being higher if that means everyone is actually getting the healthcare they need. I'd much rather my taxes go towards that than many other things.
Jmoney1088 | an hour ago
I agree that getting people needed care is a good thing, even when it raises utilization. Where I disagree is the assumption that the strain would necessarily be temporary or that preventive care would eventually cause total demand and spending to fall.
Removing premiums, deductibles and copayments would not just clear a temporary backlog. It would permanently lower the cost of using healthcare to zero at the point of service. That means people would continue using more primary care, specialist care, diagnostic testing, prescriptions and elective procedures than they do now. Some of that represents important care people currently go without, but it is still a permanent increase in demand.
Earlier treatment can prevent certain expensive emergencies, but preventive care does not universally save money. Some interventions do, but screening millions of people also identifies more conditions requiring testing, monitoring, medication and sometimes lifelong treatment. That can improve health and save lives while still increasing total spending.
The shift away from emergency rooms is not guaranteed either. When people gain comprehensive coverage, they gain better access to primary care, but they also become more willing to seek emergency care because they are no longer worried about the bill. Meanwhile, training additional physicians and specialists takes years, and cutting everyone’s reimbursement to Medicare rates could work against expanding that supply. That is why CBO projects that demand could grow faster than capacity, resulting in longer waits and unmet demand even as more care is delivered overall.
I actually think your last point is the strongest and most honest argument for universal healthcare, you are willing to pay more so everyone receives care. That is a value judgment. My objection is to claiming we can provide significantly more care, eliminate nearly all cost-sharing, avoid capacity problems and somehow guarantee $1 trillion in annual savings.
Medicare for All may be morally worthwhile even if it costs more. But if that is the case, supporters should make that argument honestly instead of insisting that every difficult tradeoff will eventually disappear.
just_stretching | 4 hours ago
No no, see he declared it though
FreelyFound | 4 hours ago
The psychological safety of knowing that you can get basic health care, and not avoiding doctor visits because they are too expensive, also contribute to making people happier and healthier.
EconEchoes5678 | 3 hours ago
Actually it's not. You can easily see what a UHC system in the US would cost by scaling up any of the dozens of other systems that other countries run to our size and comparing. The gap shrinks once you adjust for wage and COL differences, but it's still substantial. Our system is quite simply inefficient.
Why/where? Because every HC problem forms a claim-denial-appeal loop. Every doctor visit becomes a risk of either denial problems or malpractice problems and requires substantial documentation from doctors. US doctors are higher paid, work more hours, but see less patients. US doctors order more testing - but do we actually end up healthier from it? No, our average outcomes are slightly worse than UHC systems.
In addition, as others have pointed out, trapping people in jobs via healthcare hurts the efficiency of the whole economy. A mobile workforce sorts into job roles better, earns higher wages, and delivers more productivity and quality. And is happier.
Our system sucks because it's very badly designed. We must disconnect healthcare from employment. That requires UHC one way or another. We need to get rid of the inefficiencies in order to accomplish that, which means the gatekeeper of care must move.
tpounds0 | 2 hours ago
I believe this is just an updated price tag based on a peer reviewed 2014 study from the same research institute.
morbie5 | 2 hours ago
> That math is so outrageously made up.
Well, it certainly assumes a lot of things. Also, a lot of the savings comes from the fact that providers would get paid Medicare rates aka get less money
Ok-Bug-5271 | 3 hours ago
>That math is so outrageously made up
I just want to make sure you're aware that the US spends 2-3x more per capita on healthcare than every other developed country. Cutting 1 trillion in spending would still very solidly leave the US as the country spending the most on healthcare.
Morbius2271 | an hour ago
You know that’s because we give out medical innovations and medicines to Europe cheap since they would just steal the IP otherwise right? The US subsidizes most of the worlds health and medical research via this
Ok-Bug-5271 | 9 minutes ago
>you know that's because [blatantly factually false statement], right?
Looking at a list of medical patents filed per capita, the US isn't some crazy outlier, and countries like the UK, Israel, Switzerland etc actually have higher rates of filing medical patents.
>since they would just steal the IP otherwise right?
Source: your ass. Western countries have incredibly strong intellectual property rights.
Also, let's say I accept your premise (which I 100% don't lmao). The US currently spends 2-3x more per capita on healthcare than every other developed country. Unless you think literally 100% of that higher cost is because of R&D (which would make you factually wrong), then if you think the R&D spending is worth it, we can literally keep spending the same amount on R&D while cutting back on everything else leading to American healthcare being 2-3x more every other country.
Like, y'know, being able to cut a trillion in spending while still being very much #1 in the world for per capita healthcare spending.
phrozen_waffles | 3 hours ago
Now is the time to do it, we have so many telemedicine and self-diagnosis devices but no reasons to implement them because of private insurance.
Many visits in love a tech, then a nurse, and quick overview by a doc, and then a practiotioner. The more layers of care, the more they get a skim off the top.
Single-payer will cut that out and more people will get basic diagnostic care that leads to less hospitization and chronic disease.
Edit: in love > involve
Beautiful_Finger4566 | 2 hours ago
fun fact: due to government regulations, a doctor in Kansas can't treat a person in Kansas City, MO
until we fix regulations like that, prices will remain high
phrozen_waffles | 49 minutes ago
We can't even have interstate insurance competition. That would drive so much competition.
Unhelpfulperson | 5 minutes ago
> We can't even have interstate insurance competition. That would drive so much competition.
This is a hugely misleading statement that was deliberately been driven by conservatives in the 2008-2016-ish era, and I'm not sure if you're one of the people who got misled or you actually agree with the Obama-era republicans
Obvious_Chapter2082 | 5 hours ago
I still haven’t seen a single politician come up with a way to raise the tax revenue necessary to fund this, and until that happens, it’s hard to take seriously
Even Sander’s attempt at funding it only covered around half of the cost
Sweet_Bridge_3001 | 5 hours ago
China funds their universal healthcare for 1.4Billion people with 1.2 Trillion $, which is roughly %6 of their GDP, goverment only pays for %20 of it.
Rest is recieved from employers who pay the insurance on the payroll tax and out of pocket minimal payments you make on visits. Instead of going and buying overpriced and low quality insurance, employers would buy goverment insurance which would fund the entire thing.
Its insane for you to think the richest country ever in history cannot afford healthcare while every other nation on earth can.
Obvious_Chapter2082 | 5 hours ago
What you describe isn’t single payer healthcare though, and it’s funded similarly to how the US already funds the current system
Sweet_Bridge_3001 | 4 hours ago
Except when the state agency represents the people, you wouldnt have to worry about if your insurance was gonna stick you with a bill that instantly bankrupts you, and state can collectively bargain for much cheaper prices.
There is a reason every country pays 1\4 th the price for AMERICAN drugs, except Americans.
EconEchoes5678 | 2 hours ago
China has substantially more wealth and income inequality than the US. It's not the beacon you think it is.
Beautiful_Finger4566 | 2 hours ago
doctors in China are some of the lowest paid in the country
we messed our system up by adding so many regulations to becoming a doctor that it costs $300k in student loans and 7 years of education to become one
get the government out of healthcare and the prices will naturally drop
Sweet_Bridge_3001 | 2 hours ago
Brother every nation except America lets their goverment handle their healthcare and the prices are LOW.
It takes a new level of delusion to say "Its not me who is wrong, its everyone else." while data shows you are the only one with this problem.
Beautiful_Finger4566 | an hour ago
yes, this is strictly a US problem
we need to get rid of the regulations that raise healthcare prices
that means getting the government OUT of healthcare
SockDem | 3 hours ago
Yeah, and it would cost us roughly ~$45T over the next decade for a population of 340m.
Are you forgetting that costs are also higher here?
Sweet_Bridge_3001 | 2 hours ago
Cost might be higher but so is your GDP. %6 would amount to 1.9 Trillion, and that doesnt take into account the population difference.
That 45T doesnt take into account collective barganing.
SockDem | 2 hours ago
It very much does take into account cost savings. What it actually doesn’t take into account is that we’d almost certainly have to slash provider costs (which, the US has by far the highest in the world) which presents its own issue.
freerangestrange | 5 hours ago
We’re already funding it now with insurance premiums. We pay more money per person for healthcare than anywhere else on earth
Obvious_Chapter2082 | 5 hours ago
Right, but that doesn’t answer the question of how we fund a single payer system, unless your solution is for people to still pay premiums and deductibles
If the government is the payer, then they need to fund it through tax increases. Which means you need specific policies to raise an additional $3 trillion per year
freerangestrange | 4 hours ago
They would pay less per month as a tax than what they currently pay in premiums. That’s how it works everywhere else in earth. What are you not understanding? This product is cheaper and better everywhere else. What do you think those other countries do? Do you think that’s magic?
Obvious_Chapter2082 | 4 hours ago
What are you not understand? I’m not talking about if it’s more or less, I’m saying you need specific tax policies to raise the revenue. No politician seems to be able to actually come up with a way to do it
It matters because the way you fund it can have extreme negative impacts
And for what it’s worth, not a single country in the world has a single payer system as expansive as what is currently being proposed in the US
freerangestrange | 4 hours ago
Good lord. The premiums are the tax!!!!
Obvious_Chapter2082 | 3 hours ago
A single payer system can’t have consumers paying premiums. Do you know what single payer means?
freerangestrange | 3 hours ago
Jesus. The premiums people are paying now account for the money that would be used for the tax. They would pay the tax INSTEAD of the premiums. How do you think this works everywhere else?
Obvious_Chapter2082 | 2 hours ago
>for the tax
What tax?? That’s my entire point, which you don’t know because you clearly haven’t read my comments. Congress cant just create $3 trillion out of thin air, they need an actual plan for how to raise those taxes
>how this works everywhere else
There’s very few examples of universal single payer systems, but they operate from substantially higher taxes on everyone
Whiteelefant | 2 hours ago
I'd happily pay $4,000/yr in taxes to not have to pay $6,000/yr for health insurance that doesn't kick in until I pay $10,000 and resets every year.
"Won't someone think of the heath insurance executives!!!"
Emergency-Style7392 | 5 hours ago
Because no one wants to admit it would take large tax increases mostly on the middle class, and even taxing every billionaire down to $0 won't pay for it
Calm_Situation_1131 | 2 hours ago
But the middle class would end up with more money in their pocket at the end of the day because they already pay through the nose for crappy private insurance. It's more cost effective to pay for M4A through taxes than to give insurance company shareholders and executives a big cut for no reason.
mrtrololo27 | 4 hours ago
Most admit that, Sanders himself has for decades. The thing studies keep showing is said tax increase would be less than the monthly premiums were already forced to pay, while additionally removing out of pocket expenses and surprise costs like out of network shenanigans. So taxes go up slightly, and healthcare expenses fall more than said increase, we all save money, everyone is covered and can enjoy the true freedom that brings.
95Daphne | 4 hours ago
It really doesn't matter at all if this happy joy joy take is true (which I do have my personal skepticism), before you get into more complicated takes like what I saw below, here is the stone cold truth:
M4A is Dead. on. Arrival. because the crusade against taxes has won for good in the US.
IFFFFF we do get a 2029 Democratic presidency, considering where we're at at this time, I'll just be straight up real with y'all, it's not coming with a big enough trifecta for the "big economic populist slanted change" that y'all are crying for. The likelihood is near 0 you'll see taxes raised significantly, therefore the majority of an economic populist slanted agenda would be dead, period.
Now maybe I'm wrong on where I think we stand! (which includes being more doubtful on a Dem presidency coming next than y'all) Perhaps a huge market and economic bubble pop is incoming and you will get a lefty populist president in '29 with 54 Dem senators or so.
I just don't think it's likely. If we get a Dem presidency, it'll be with too small of a trifecta to do anything outside of minor changes, and really, I think it's more likely that you get the true doom type stuff to verify maybe in 2029 and shortly beyond, if it's going to at all.
mrtrololo27 | 4 hours ago
I'd argue where we're at currently makes universal healthcare a necessity rather than something unlikely. What Trump and Republicans have done these past 10 years is so beyond the bounds of what is acceptable and tolerable that the time has come to swing the pendulum left, and hard. Universal Healthcare is one of the most important demands, but it is not the only one. Its time to put our feet down and fight for what's right, and we are going to have to prosecute Trump and every traitor in the current regime to the fullest extent of the law. They will not be an obstruction to progress; they'll be locked up (otherwise our republic is already lost). The counter revolution will be bloodless if the right allows it.
95Daphne | 3 hours ago
Hate to break it to you bud, but again, it'll be a miracle if you get 10-20% of what you want in 2029-2032, which is what my long, rambling post gets info.
So basically, to sum up my stance, the Republic is already lost for good in your book.
If we do what I suspect and essentially have 2019 play out next year for starters and have nothing serious play out like a 2008 or something 2020 esque for the next Presidential year, the absolute maxout scenario for Dems is a presidential win with no breathing room in the Senate for 2028. In that world, there is plentiful room for new Manchins and Sinemas to block major tax hikes and there will absolutely "not" be any kind of prosecutions (don't think you see impeachment done again either).
That's not to get into that if we don't get a major negative event for 2028, it'll be much more of a bear of a challenge than you may think to dispatch the Republican that year.
Gizmuth | 3 hours ago
Insane that the largest economy in the world can't figure out the funding for this but 70 other countries can. Almost like the tax revenue isn't the problem.
Obvious_Chapter2082 | 2 hours ago
There are like 5 countries in the world with a universal single payer system, and none of them are as expansive as the proposed US single payer system would be
confusedguy1212 | 4 hours ago
I don’t have an answer to your question directly but I believe a good chunk of the problem you envision will be taken out by law mandated caps.
So it’s not let’s raise the equivalent of what Americans and their employers pay today in tax. It’s let’s raise a fraction of that. When the per head or per family number is much more manageable it might become a lot easier for employers to be mandated to cover it in full.
Notice the key word that keeps repeating is mandated. There is no free market/capitalism solution to this problem.
Beautiful_Finger4566 | 2 hours ago
National VAT of 20%
it's how Europe funds it
it's about time that poor people actually pay their fair share
AuntRhubarb | 3 hours ago
"Now", while we have the whole government in the hands of evil Rs and they are planning to tamper with elections? Really Bernie? Could everyone in DC and the democratic party maybe direct your attention to our immediate problem?
phteven1989 | an hour ago
The pro life crowd should love this right? …right??
Why is the pro life crowd (maga, right wing, conservative, etc.) not rushing to vote for a system that would… check notes…. SAVE LIVES!?
Probably because they’re not actually pro life. They’re pro birth
Alone-Supermarket-98 | 4 hours ago
This study has not been peer reviewed, and makes unsubstantiated assumptions that undermine its credibility.
The report claims that by offering free medicare for all, the $5 trillion in spending on private health insurance to cover the 310mm people currently using private insurance will fall to $4 trillion, and all of that gets captured as "savings".
What the report does not account for is the incremental costs of providing the healthcare services through Medicare for the additional 62mm people (20% of 310mm people) that is implied would be on medicare. Medicare currently covers about 70mm people, so the enrollment would almost double but the report assumes no incremental costs.
The report also presumes free medicare will save 114,000 lives, but how does that happen? The report presumes that the mortality rates for people without health insurance mysteriously increases, and all of those incremental deaths are saved by medicare. So more people magicly start to die, except free medicare rides to the rescue.
This report is incredulous and dishonest, and Bernie continues to be a sideshow Barker for failed socialist agendas.
Stop reposting this fraudulent socialist propaganda every hour.
tpounds0 | 2 hours ago
> We estimated the mortality effect of universal coverage using an attributable-fraction framework, in which the observed deaths in each age group arise from the current mix of insured, uninsured, and underinsured individuals of that age, with mortality rates dependent on insurance status.11 We then calculated the deaths that would be expected if the entire population were adequately insured.
Is this where you got the idea that the death rate mysteriously increases? Because they used the word "arise"?
Oryzae | 2 hours ago
Wow you’re a bit mad that the fascist haven’t crushed the socialist eh? Is everything socialist propaganda for the likes of you? Guess let’s keep our healthcare tied to employment, that works out so great for us. There is no and will never have any socialism in the US, but keep crying wolf.
Alone-Supermarket-98 | an hour ago
I'm open to all solutions, but this is not a solution, it is an ideological fantasy, built on bad math, whimsical presumptions, and lies.
It is an amateurish political policy that will result in worse healthcare services and increased costs.
Oryzae | an hour ago
Literally almost every other country has it. You act like it’s some pie in the sky idea. If countries poorer than the US can do it, we can too. The businesses and the insurance companies don’t want you to believe that so they put out propaganda after propaganda.
Alone-Supermarket-98 | 10 minutes ago
....and it will cost more, not have the outcomes they promise, and result in degraded service overall. I believe there has to be a more rational system than what we have, but let's not lie about the potential impacts just so we can expand mediocrity to all.
Medicare is not some well run and efficient service providing quality care.
Super_Mario_Luigi | 5 hours ago
Bot propaganda for losers. The best example of aligning the planets would "save" 5-10% from admin costs. That's assuming that for the first time ever, our government becomes efficient and keeps fraud/waste/abuse in check. Frankly, these are embarassing positions to take.
Even if this works as planned, that is still $13,500 in healthcare spend per citizen, per year. Not exactly the amount the cult insinuates. We'd also lay off hundreds of thousands of people, add to doctor shortages, and also see many other changes that "no one could have expected" (that everyone saw coming).
It's also nonsense that the amount of care required plummets because people are now proactively managing their health instead of going to the emergency room. None of that is rooted in any fact. Some people just don't like going to the doctor period. Many people take poor care of their health. Free care undoubtedly will lead to MORE visits. Good luck getting government to put appropriate "limits." To add further insult to injury, the "free healthcare cult" pretends we won't give free care to all of the people of the world.
Ok-Bug-5271 | 3 hours ago
>The best example of aligning the planets would "save" 5-10% from admin costs. That's assuming that for the first time ever, our government becomes efficient and keeps fraud/waste/abuse in check
Wut. Medicare ALREADY has half the administrative overhead as the private market.
Usakami | 5 hours ago
It is not going to happen in US. The biggest problem is that companies can charge whatever they want. The main reason our healthcare, in Europe, is cheaper, is because the government is the one negotiating and setting prices for drugs and treatments. They have groups of experts, who review costs, add a reasonable profit and that is a price roof for the companies to compete over contracts, usually multi year ones.
I mean, making a vial of insulin costs 2-4 dollars. In Europe this vial is sold for 9-15 dollars. In USA it's around 98+ dollars.
This would require a complete paradigm shift in the USA away from prioritizing corporate profits over anything else. Who knows, maybe Trump will bring such a change. When the empire falls and crumbles, people can seize the opportunity.
YesMaybeYesWriteNow | 4 hours ago
Yes, Bernie is asking for a complete paradigm shift. No, Trump is going to continue protecting corporate interests.
Usakami | 4 hours ago
If this is the type of reply I get... I really don't know why this sub requires 140+ characters.
EconEchoes5678 | 2 hours ago
> The biggest problem is that companies can charge whatever they want.
This is not the biggest problem. The biggest problem is that the US forces insurance companies to be the system's gatekeeper but they are very bad at that role. Every HC need must go through the claim-denial-appeal loop which results in massive administrative costs and less doctor time per patient (since they are spending it on documentation, coding, and appeals).
> This would require a complete paradigm shift in the USA away from prioritizing corporate profits over anything else
All healthcare corporate profits from any source in the US healthcare system are less than 6% of what the US spends on HC. The problem isn't the profits, the problem is the gatekeeper is in the wrong place and must be moved (as a conscious choice, not by pretending a gatekeeper isn't necessary, otherwise wait lists become the gatekeeper of care).
Evening-Ad-6968 | 2 hours ago
As a conservative, I’d be willing to give it a shot with hard sunset clauses if it causes wait times to go up and doesn’t save 1 trillion dollars. I think most would be willing to try it but if it ends up like Obamacare and can’t be repealed while it fails then it’s a hard pass for me.
hard-workingamerican | 2 hours ago
$40T in fiscal debt, $360,000 per taxpayer. Ya ya Socialism and everything but stop spending money. Stop giving away money to billionaires and turning America into an oligarchy. And yes, the capitalists have to go they are gross, but spending more money isn't the answer.
ClubSoda | 2 hours ago
Saving lives is not gonna win votes from the MAGA cabal, unfortunately. If you have been paying attention since ICE was formed, it would have been obvious.
glencoe606 | 49 minutes ago
I think it’s interesting that private companies provide healthcare. You think they would want the public option. Healthcare seems like such a pain for them to handle.
BluCurry8 | 12 minutes ago
Private companies purchase health insurance policies from insurers, they rarely self insure.
Emily_Postal | 39 minutes ago
How would you unwind the current system? Healthcare accounts for a huge chunk of the US’s output. I can’t see it happening, at least not in one fell swoop. It would have to be done in small bits over a long period of time.
Plus the lobbyists won’t let it happen.
BluCurry8 | 13 minutes ago
Medicare is not free. People still pay enrollment fees. Also you still need to buy additional insurance for dental, eyes and prescriptions. If you have higher risks you should consider a rider to cover hospitalization as Medicare is major medical that covers 80 % . So there is less unwinding. And more need for regulation and auditing of medical insurance companies and providers.
derperofworlds1 | 27 minutes ago
We should measure amount of lives saved in the unit "9/11s". We continually blow up the middle east for multiple trillions of dollars due to a single 9/11.
Meanwhile, 50 9/11s happen per year and somehow nobody gives a shit. American lives just don't matter to our government. They didn't when the world trade center was hit, and they don't matter now.
The only reason we spent decades "avenging the victims of 9/11" is because a lot of people in the military industrial complex made a boatload of money off it!
Our government didn't even want to pay out pennies to the injured and dead 9/11 first responders!
Chriskipp077 | 7 minutes ago
Election year drum beating but what has Bernie done for US lately? Bernie Sanders' most recent primary-sponsored legislation enacted into law as a standalone public law is the Veterans' Compensation Cost-of-Living Adjustment Act of 2013 , which was signed into law on November 21, 2013 (Public Law 113-52
TGAILA | 5 hours ago
>Opponents have questioned how such a system would be financed, its potential impact on taxes, provider reimbursement, and the broader healthcare industry.
Medicare is one of the best federal health programs for those 65 and older. Medicaid offers some coverage but pays low reimbursement rates to providers. To provide a universal healthcare system, everyone needs to pay higher taxes. We can't get everyone on the same page let alone have a civil discussion. Politics has been so polarized that you can't get anything done without a bipartisan support.
Ketaskooter | 3 hours ago
Medicare is forcing providers to be underpaid and if providers don't have enough payers not on government healthcare they often go into financial stress sometimes so much so that they shut the doors.
StrebLab | an hour ago
I am a partner at an office-based private practice in a surgical subspecialty. If we had 100% Medicare we would go out of business. In addition to leading to a shortage of healthcare providers in our specialty, it would also increase costs for the system because the reimbursement for office based services (like ours) are extremely low compared to a hospital based system, and all the care would now be absorbed by the hospital system which can charge 2-4x as much for the same services.
electrorazor | 3 hours ago
Literally why are health insurance companies reaping in mega profits for a service the govt can easily do for the people. Usually the benefit of capitalism is innovation, but what innovation do we possibly need in this industry.
I feel even more strongly for auto insurance as well, since that's legally required to drive
StrebLab | 6 hours ago
Edit #2: again, not sure if it bots or high schoolers who haven't developed reading comprehension responding to me but I will try one more time. It is political suicide to make a change that would eliminate nearly 1 million jobs, even if it is healthy in the long run. That's why it won't happen. It's really weird to me that if you propose an argument it means you must support that argument. I don't. Just being a realist.
Not going to happen.
Even though that $1 trillion is waste, to remove of that waste would equal the loss of hundreds of thousands of middle class jobs. There are over 700k Americans employed by the health and medical insurance industry. When you include people employed on the clinical end who deal with admin and insurance appeals etc, you are talking about well over a million Americans who have a job because of the current system. Obviously not everyone of them would be immediately out of work, but a large majority would suddenly be unemployed. The labor market generally kinda sucks but healthcare related spending (including insurance and admin spending) is largely propping up the sagging labor market month after month. To "eliminate $1 trillion of waste" would mean the loss of a staggering amount of jobs which would put us into an immediate recession. It is not going to happen.
Edit: not sure why are making arguments towards me like I'm suggesting we continue the status quo just to save jobs. Read my comment again. I'm saying Medicare for All is NOT going to happen and this is why. Whether or not it should happen is a different question entirely.
sdmc_rotflol | 6 hours ago
Should we have not used cars because it put horse trainers out of a job too?
MagicPoocean | 5 hours ago
Exactly the right response. Our world is burning because chuds in Appalachia can’t move on from their shit legacy coal mining jobs and big business can’t quit oil. Progress requires sacrifices. Always has always will.
Super_Mario_Luigi | 5 hours ago
No, the point is we will lose a ton of jobs AND still not save any money on healthcare. It's ok though, these kinds of failed policies never have to be held accountable.
sdmc_rotflol | 4 hours ago
You know pretty much every other 1st world country already does this, right?
Super_Mario_Luigi | 3 hours ago
I know your talking points. The ones that ignore how much more we pay in salaries, obesity, drugs, malpractice insurance, litigation, and on and on. But keep regurgitating the bottom line only.
ludi567 | 5 hours ago
The entire current health care system is a failed policy. The US spends twice as much per capita on health care than the next nation and has worse health outcomes on almost every dimension than other developed nations. How can we keep looking at this and say everything is A-Ok?
MagicPoocean | 2 hours ago
What about the jErBs!!!!
Super_Mario_Luigi | 3 hours ago
I agree completely. However, I'd bet we both disagree on what that means and what the next steps are
ludi567 | 3 hours ago
Maybe, but can only speculate without knowing what you think the right next steps are. What do you think we should do about it?
MagicPoocean | 2 hours ago
I love how the opponents of Medicare for all have one response which is that the jErBs supporting a clearly doomed and failed system are so sacred they can never be disrupted for the long-term health of society. Brilliant.
Y3sandkn0w | 5 hours ago
And where pray tell will the hundreds of thousands of suddenly unemployed persons find work in short order to sustain them?
Hairy-Dumpling | 5 hours ago
You think your question is a gotcha, but the answer is the same as it is whenever large swaths of Americans lose their jobs - "fuck em". In the disaster scenario you're hand-wringing about at least those people will have healthcare
StrebLab | 5 hours ago
This is exactly what I'm saying. People who have jobs because of the current waste in the system are going to be shit out of luck. This will almost certainly tip us into a recession. Not saying it shouldnt be done, just that--realistically-- it won't.
Y3sandkn0w | 5 hours ago
No I’m genuinely curious as to how suddenly hundreds of thousands of unemployed people will survive while searching for/training for new jobs.
Hairy-Dumpling | 4 hours ago
And I'm saying that asking or answering that question has never been a concern of American capitalism. "Fuck em, let them die" is a complete answer. Whenever anyone gets laid off, they either get other jobs or don't, they either survive or don't, and the system doesn't care which and never has.
In the framing of that consistent systematic interaction with workers, the answer has always been - go ahead and destroy sectors of the economy and let the chips fall where they may. At least (in my opinion) the benefits of having a public option or whatever they decide would vastly outweigh the pain to the workers of the "healthcare" industry.
blacktickle | 5 hours ago
Figure it out like the rest of us
Y3sandkn0w | 5 hours ago
Brilliant idea, you should be in charge of the country with such logical thinking.
blacktickle | 5 hours ago
Keeping this shitty system is definitely not the answer
Y3sandkn0w | 5 hours ago
Neither is laying off hundreds of thousands of people without a means to support them until they are resettled.
-JustJoel- | 3 hours ago
Bernie covered that in his MFA proposal 6-7 years ago:
(4) TEMPORARY WORKER ASSISTANCE.—For up to 5 years following the date on which benefits first become available as described in section 106(a), up to 1 percent of the budget may be allocated to programs providing assistance to workers who perform functions in the administration of the health insurance system and who may experience economic dislocation as a result of the implementation of this Act.
v3gas21 | 5 hours ago
... its not like an American President already did that back in the '30's .... I swear the second a competent leader states the obvious some rich, privileged piece of human garbage starts shaming them for killing jobs and stunting job 'creators.'
Y3sandkn0w | 5 hours ago
Those were different circumstances, and you misunderstand me, I’m all for socialized healthcare but it will only work if the job losses can be addressed beforehand in some meaningful way.
MagicPoocean | 5 hours ago
They’ll survive … on account of their health insurance. And they can take their time finding a job they enjoy while not worrying about going bankrupt over a hospital visit.
EdLesliesBarber | 5 hours ago
Sweet so they’re going to live in the waiting room until they find consistent income? And I guess the hospitals will also need to provide 3 meals a day. Otherwise not sure how these people will live off “health insurance “ as you say…
Y3sandkn0w | 5 hours ago
What jobs? How long will it take to get said jobs? How will they afford to live in the meantime while searching for/training for new jobs?
I’m all for socialized healthcare, but the idea of implementing it in short order is unrealistic.
MagicPoocean | 4 hours ago
Judging by these responses the Russian bot farms seem to be working overtime. Maybe data centers will need more humans to keep them up and running?
ludi567 | 5 hours ago
Wait what? By that logic it is also good that 100k people a year are dying because of this system since we wouldn’t have jobs for them anyway /s And let’s gloss over how you honed in on the $ before mentioning the health outcomes.
Money you save in one area isn’t gone. Depending on who gets it back (government, private businesses, or consumers) it gets fed back into the economy through investments in other areas generating jobs or through consumption which, you guessed it, also creates jobs.
Obviously a wholesale change would have to be managed well and not be an overnight change. But justifying a wasteful system for both health outcomes and money by saying it keeps jobs is one of the more novel ways I’ve heard of.
Super_Mario_Luigi | 5 hours ago
100,000 people per year are not dying because of our system
ludi567 | 5 hours ago
I mean health outcomes ARE measurably worse in the US compared to other countries. Easiest one to visualize is life expectancy.
On average people in the US live 2-3 year less than people in other developed countries.
That means per generation (80 years) across a population of 350 million people, we lose about 8-13 million lifetimes of life which if you calculate that per year of life of that generation (80 years) results pretty much exactly in about 100-160k of fewer lives lived per year (I’m actually myself surprised at how closely that matches the number in the article).
EdLesliesBarber | 4 hours ago
These outcomes tend to normalize when you factor in the obesity rates in America. U.S. negative outcomes are heavily weighted (thehehe) by the average American being so much more overweight than peers in similar countries, especially our youth.
ludi567 | 3 hours ago
Obesity is one factor, but so is lack of preventative care for obesity related diseases, drug overdoses, gun deaths, car accidents, suicide, high inequality, lack of health care access, and so on that are all worse than other rich nations. Nobody is (or should be) saying that life expectancy is only due to lack of healthcare, but even obesity itself is a health issue that can be addressed in various ways (and we’d incentivize the government to do so by internalizing the costs of obesity): more preventative counseling, early intervention, obesity treatments paid for by insurance, and then outside of that taxes on certain types of unhealthy food, higher standards for school food, urban planning to encourage more movement etc. All of this would be incentivized if we internalize the costs of such conditions instead of remaining a country that is (commendably) very good at reactively treating conditions.
Super_Mario_Luigi | 3 hours ago
There's no sense debating this. You're just here to recite speaking points. Everyone who "compares" health to other countries ironically has no interest to truly compare. They're here to cherry-pick the best propaganda.
Compare the US in terms of obesity, physical activity, diet, etc. to all of your utopia countries. It isn't the hospital system keeping people alive longer.
ludi567 | 3 hours ago
Right, cherry picking a large group of countries that roughly represent our peer group in terms of economic wealth available to deal with the problem. The points you list ARE health issues (obesity, diet, physical activity) that get addressed in other systems in a proactive way rather than a reactive way. We are excellent at dealing with things reactively because the whole system is set up that way: you get paid for dealing with the shitty condition at the end of it, not for doing the prevention beforehand. In a single payer system no one can hide anymore from that cost or try to profit from it and you reset the incentives.
I’m not reciting talking points and if I am inadvertently, let me know where from so I can learn more.
And if you think I’m wrong then point to where you think so and maybe I’ll learn something new from it. That is what a discussion is.
StrebLab | 5 hours ago
And were are all these jobs? Like I said, the labor market is mid to sucky depending on the month and healthcare spending is keeping the economy alive. Saying "oh they will just find new jobs!" is cope. No different then the sentiment I was hearing about coal miners just need to learn to code. Realistically it is not going to happen.
tacotrader83 | 2 hours ago
Half those jobs will be gone because of AI soon anyway
ludi567 | 5 hours ago
If we ran our economy this way (and thank god for a lot of it we don’t) we’d be stuck in the Middle Ages.
Even if I were to entertain this argument: the first thing you’d see is an increase in jobs for all the consultants that would be hired to help manage this transition. Not that I’m a fan of it.
And how old are you if you think the current job market is terrible? Capitalism lives off of boom bust cycles and there will be a few more in our lifetime to go through and there have been lots in the past. We had an insanely hot job market for parts of the last decade despite, checks notes, jobless coal miners.
Pick your example of coal: what was your proposal then? Keep employing people in an industry that is not competitive, unhealthy for those people, and long term bad for all of us on many dimensions? I don’t really understand what you are trying to say the solution is.
Wasting money and health indefinitely will be the end at some point. We have to keep moving forward and get better at creating better lives and using our resources most efficiently.
And lastly: there is a trillion dollars available. Do you know how much money that is? Do you know how much of a safety net you could build for affected people while we manage this transition? Even if every health admin lost their job, you could give each of them a million dollars and have money left to spare.
How this could be viewed as anything other than an opportunity is really really hard to understand.
Y3sandkn0w | 5 hours ago
The solution is giving money to the hundreds of thousands of suddenly persons until they are resettled in a new field of work.
ludi567 | 5 hours ago
Yeh with the trillion dollars that are being saved…right?
Y3sandkn0w | 5 hours ago
Maybe? I don’t know, I just know that laying off that many people without a viable solution in place is going to have repercussions.
ludi567 | 5 hours ago
Congratulations. You’ve found step two of this project. So are we aligned on step one being that a cheaper system that improves health outcomes is worthwhile pursuing? If yes, then I agree, let’s figure out how we roll it out so it doesn’t leave hundreds of thousands of people in financial ruin.
thereisnospoon_1999 | 5 hours ago
Lol, most of the administrative people would be hired to administer a MFA system….we would lose parasitic execs and reduce marketing costs…so win/win?
Logical_Adagio_7100 | 5 hours ago
Agreed. So we should also ban AI, which is already costing hundreds of thousands of jobs, right?
spicyflacco | 5 hours ago
This dumb logic, is why we don’t have it and have waste.
M00n_Slippers | 5 hours ago
First of all, many of those jobs would move to processing the new Medicare for all, they don't just evaporate, secondly you phase it in over time, no huge shock. Thirdly, doing something that kills over a 100,000 people a year just for 'jobs' is unethical as hell.
Y3sandkn0w | 5 hours ago
This at least seems like a viable solution.
24Seven | 2 hours ago
You are so concerned about displaced jobs but how is it any different than any other disruptive technology? Automation is set to put most truck drivers out of business. AI is leading to tens of thousands of engineer job losses per month. Hell, AI may put most of those insurance jobs out of business anyway. Sorry, but I'm not shedding tears over insurance folks, especially insurance executives, losing their jobs so that everyone has access to medical care.
Private health insurance can still exist in combination with Medicare for all. It might shrink that industry but it would better for the population as a whole. Just putting all the lawyers that try medical bankruptcy cases out of business would be a net positive for everyone.
StrebLab | an hour ago
Can you point to where in my comment I said I was "concerned about displaced jobs"?
24Seven | 59 minutes ago
> There are over 700k Americans employed by the health and medical insurance industry. When you include people employed on the clinical end who deal with admin and insurance appeals etc, you are talking about well over a million Americans who have a job because of the current system.
That is a concern that Medicare for all would displace those jobs.
Blowfish75 | 5 hours ago
AI is almost certainly going to replace a lot of these workers regardless. We are not quite there yet, but hospitals and insurance companies alike will do anything they can to cut expenses.
mrtrololo27 | 4 hours ago
Universal Healthcare is a basic human right no matter how much the oligarchs and their lemmings desperately claim otherwise. If the US cannot guarantee this basic human right, it does not mean that Universal Healthcare is any less of a basic human right; it would mean the US has become a failed state. We all deserve better.
Key-Organization3158 | 4 hours ago
It's not a basic human right. You can't just stamp your feet and insist that it is. A right can't entitle you to other people's labor.
RecipeNo101 | an hour ago
You have the right to remain silent.
Anything you say can and will be used against you in a court of law.
You have the right to an attorney.
If you cannot afford an attorney, one will be provided for you.
mrtrololo27 | 4 hours ago
It has been defined explicitly as such since 1946 by the WHO and codified in the 1948 universal declaration of human rights. I'm afraid you're 80 years too late to make that fraudulent argument, old sport.
bill_gonorrhea | 4 hours ago
That’s not WHO it’s the UN. universal health care is not mentioned at all. For health care, the most relevant part is Article 25, which says everyone has the right to an adequate standard of living for their health and well-being. It doesn't say free.
additionally, the us hasnt ratified the udhr and the UN is a garbage organization
mrtrololo27 | 4 hours ago
Universal Healthcare is supported both by the WHO in their constitution and by the UN in numerous instances as well as in Article 25 of the universal declaration of human rights:
"1. Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection."
Neither I nor the declaration said free, you did.. We pay taxes and get universal healthcare coverage. It's not that hard to understand lol.
24Seven | an hour ago
In the US it actually is treated as a basic right. If you go into the emergency room with zero health insurance, they are legally obligated to treat you.
FatherVic | 2 hours ago
You don't have a right to someone else's resources or time.
This has to be provided by something/someone.
Having the government pay for it means that the "right" is necessarily enumerated and not guaranteed.
Ketaskooter | 3 hours ago
Universal Healthcare is not a basic human right, you could correctly say that access to healthcare is a right but that doesn't mean doctors are required to treat always. Could the USA afford single payer healthcare, probably but not without raising taxes on everyone. Most people don't realize that the current system of socialized healthcare for poor people is what is bankrupting those that can pay.
24Seven | an hour ago
Health care is in fact treated as a basic human right in the US. If you go into the emergency room, they are legally obligated to treat you.
Health care cost coverage is not a basic human right in the US and it's why the US has the highest medical bankruptcy rate in the world. To the vast majority of the world, the very concept of going bankrupt due to medical costs would baffle them.
TurtleBoxer_AllDay | 4 hours ago
Ah. It's not "save a trillion", it's "take a trillion away from rich people benefitting from the current system". And we can't have that, can we.
PresentGarlic1528 | 6 hours ago
Same model that said Y2K was going to end computers. Same model that said the planet was going to end in 10 years for the last 30 years from global warming.
This is a bunch of BS!
MrP1anet | 4 hours ago
You understand that a tremendous amount of global work was put into preventing Y2K right? You also understand a tremendous amount of work has been put into preventing climate change right?
You seem like someone who simply gets mad at things they don’t understand. Have some humility.
24Seven | an hour ago
I don't know of one climate scientist that predicted the "planet was going to end" much less in 10 years. That's just a strawman argument.
The predictions made in the early 1980's have all proven accurate. They were based on different assumptions of how society attacks the problem. E.g., do nothing, do some, do a lot. We're inline with their prediction of "do some". They also predicted what would happen and it wasn't global extinction nor the "end of the planet". It was things like displacement, shrinking areas where food can be grown, disrupted growing cycles, rising sea levels, shrinking glaciers etc.
BrittanyBrie | 6 hours ago
Do you want hyperinflation? Because we already have had hyperinflation under Medicare. When hospitals only receive 80 cents for every dollar invoiced to the state, and they legally cannot sue, then they raise prices on all other services relating to insurance to cover the missing 20%. This is why some facilities do not accept Medicare and why those that do are more likely to close down. They cant raise prices fast enough to cover the missing 20%.
If we expanded this system to everyone, then prices would soar because hospitals would continue to receive only 80% they invoice.
The best way to lower costs immediately would be to remove state payments for insurance all together since they can never reach 100% of payments invoiced.
A much better system that can replace Medicare would be state assistance with direct hospital invoices. Instead of the state assisting middle insurance companies, they instead would directly assist consumers. People can absorb missing 20% of payments much easier than a multi million dollar hospital organization can, the latter leads to rising prices while the other leads to lower consumer spending, which can much more easily be absorbed.
Edit: downvotes are not a rebuttal to raw mathematical facts lol
24Seven | an hour ago
Why, we can go further! Let's get rid of all the hospitals too. Think how much money we'd save! /s
We need a system that does the following:
Medicare for all is the best solution to achieve that. States cannot do this on their own. Expecting people to comparison shop hospitals and services is untenable. When you are dying of a stroke, you have no time to comparison shop. For critical services involving inelastic demand, market driven systems produce poor outcomes. For optional services involving elastic demand, they work great.
BrittanyBrie | an hour ago
What are you talking about? Even people who are covered in this new program would still be comparison shopping to their approved hospital. What kinda made up world are you talking about? Just saying its the best does not refute the math behind hospitals not receiving full invoices from the state. If expanded, it would only increase rates for all services to cover hospital budgets.
In the system I suggested, it covered both of those goals. We do not need medicare to achieve them.
24Seven | an hour ago
> Even people who are covered in this new program would still be comparison shopping to their approved hospital. What kinda made up world are you talking about?
In many areas of the country, there is only one hospital within reasonable driving distance. Second, most people do not comparison shop hospitals. Some do, sure. However, the vast majority of people do not. Third, it is more than just the hospital. It's the surgeon, the anesthesiology, its the nurses. One of the big issues people hit now is that they go in for an operation and while the hospital is in-network, the staff that treat you are not. That would go away in Medicare for all.
> Just saying its the best does not refute the math behind hospitals not receiving full invoices from the state. If expanded, it would only increase rates for all services to cover hospital budgets.
That isn't clear. One system for processing payments to providers would significantly reduce costs. Adding the State into the mix doesn't necessarily improve that situation.
> In the system I suggested, it covered both of those goals. We do not need medicare to achieve them.
How exactly is everyone covered in your scenario? How are medical bankruptcies ended?
Barack_Odrama_007 | 4 hours ago
The American people have consistently shown they cannot vote for it to make it happen proving the American people do not deserve it. Bernie is correct but the American voting public is not on board.
Zeddo52SD | 2 hours ago
The study hasn’t been peer reviewed yet, but here’s how they arrive at the “$1T saved” number.
Start with available data on total healthcare expenditures across the entire economy: $5.2786T in 2024. They exclude DOD, VA, and Indian Health Service expenditures on healthcare. They cut out “pharmaceuticals administered as part of service provision” and consolidate it with the former services.
They then take the estimated total cost of services rendered but not compensated (unpaid bills). They estimate that at $51.7B. That puts the total expenditures at $5.3302B.
Here’s where they start subtracting: they estimate $100B could be saved by people getting regular, accessible primary care instead of relying on emergency/urgent care. Topline? $5.2302T
Then, they subtract what the savings would be if you paid all providers at (unsustainably low) Medicare rates: $295.6B. Topline now of $4.9347T
They subtract the estimated savings from setting pharmaceutical prices at the prices in the closest comparable high-income countries: $377.5B. Topline: $4.5571T
Then, subtract the savings from consolidating the administrative apparatus of insurance and billing departments into the federal government: $286.3B. Topline: $4.2708T
They subtract the savings from a unified claims system, which would reduce fraudulent billing (which they claim saves about 8% based on other countries that switched to single payer): $285.7B. Topline: $3.9851T
They add in an expected uptick in insurance usage by uninsured or underinsured individuals: $197.7B. Topline: $4.1827T
They then add in universal dental coverage: $54.7B. Final topline: $4.2374T
For the record this would be what the government is now responsible for paying, which includes Medicare/Medicaid. In 2025, we spent ~$2.2T on healthcare as a government. We’d need to increase the healthcare budget by a little over $2T to cover those estimated numbers.
It’s also a huge ask to force providers to accept Medicare/Medicaid rates. There’s a reason why it’s hard to find a doctor that accepts Medicaid at this point depending on where you’re at. The reimbursement rates are unsustainable for many providers.
QuasiQwazy | an hour ago
The system in Canada was thoroughly abused by the Liberal government until they broke it. They made it available to millions of foreigners in exchange for votes. Now it is broken beyond repair and the government is literally murdering its own citizens to save money. About 75,000 Canadians have been killed under the MAID system. Emergency wait times are over 24 hours and people literally die waiting to see a doctor. If you have cancer the wait list is a year. This happens in most countries because politicians will sacrifice anything for easy votes. Then you pay a fortune in taxes for a broken, useless system that put you at the last end of the line. Beware. Politicians are the worst of the worst.
BluCurry8 | 8 minutes ago
🙄. Recently went on vacation with a Canadian couple that was shocked to learn what an American pays for an equivalent system. They also did not really understand how access to care works. If you live in the middle of nowhere your access is limited. This is true and getting worse in the United States. You also don’t really understand that immigrants using healthcare is not the problem. Those same immigrants are paying taxes and into your healthcare system. I get that you want your racism to be true, but it really is not true.
WeekendAtMadoffs | 6 hours ago
Ending medicaid would save $1 trillion too and keep our doctors pay intact!
If CA and NY want to be in the sick drug addict storage business that's fine with them.
s0berR00fer | 6 hours ago
Society would be better if you walked into the ocean and never left. You’re clearly uneducated and addicted to Fox News
agingnerds | 5 hours ago
This response is what is wrong with reddit. This is gross. Try attacking the argument and not tell a person to end their life. This is disgusting.
Lemp_Triscuit11 | 5 hours ago
As an addict in recovery, I don't think it sounded any more gross than what he responded to
agingnerds | 4 hours ago
Then argue it and make him look foolish. Telling someone to kill them selves doesnt fix anything. It just kills conversation.
We live in a world of extremes and its boring to listen to both sides tell name call and not debate points. I am glad you recovered, but this is a pointless path that doesnt help or move the needle. Its the worst part of the internet and social media.
Feel free to vote me down, but this is what is killing conversation and making everyone nihilistic or apathetic.
WeekendAtMadoffs | 5 hours ago
I don't mind the insults 😄
at some point WE are going to vote to put illegals on SSI and medicare just to watch old libs squirm 😂 a $300 a month SS check sounds good to me. i won't even file for it 😂
Kurichan77 | 5 hours ago
Leadership doesn’t want to save lives. It’s more profitable to provide chronic treatment & have some deaths each year. Plus, they just can’t wait to mechanize everything with robots & AI, & then we peasants aren’t just an inconvenience; we’re actually stealing wealth that could be theirs. They want less of us.
bearsheperd | 4 hours ago
Republican and capitalist democrats read this headline and see “save 114,000 poor people’s lives and take 1 trillion from insurance companies a year”
GizzH | 2 hours ago
Must be election time again??? Another politician selling hope for votes but accomplishes nothing! You didn’t push this or any of your other glorious ideas while your own party was at the helm! You expect people to believe the current administration would bother to bat an eye at anything you say??? You people have already sold out of all of your ocean front properties in Arizona!
LogicGate1010 | 4 hours ago
Tobacco related illnesses puts an unbearable burden on the healthcare system financially and otherwise.
What about converting tobacco farm land and manufacturing facilities into something more beneficial to people’s health and wellbeing?
It might be helpful if Sen. Sanders launches a tobacco awareness campaign.
https://www.cdc.gov/tobacco/campaign/tips/resources/data/cigarette-smoking-in-united-states.html