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I strongly question the insurance-based model for healthcare expenses.
One of the things that makes insurance work is that most people never need to use it. Life insurance stops being a thing (in almost all cases) when people retire - and most people make it to retirement. Car and home insurance are things most people pay for every year and yet use maybe once in a lifetime. Many people go on vacation every year for almost their entire lives and yet never file a single travel insurance claim. One third of physicians have been sued according to malpractice claim firms, but this is across a 40-year career - perhaps one in every sixty or seventy years as a doctor will they be (on average) required to use their malpractice insurance, if that. Most ships never sink. Most buildings never burn down. Most planes never crash.
Health insurance is different.
Many Americans, especially in old age, file health insurance claims most or all years. This is not what the classic insurance model is designed for, especially given the cost of some healthcare, which is why the US has created so many ‘workarounds’ that twist the provision of insurance to ameliorate the fundamental fact that health insurance makes no sense. These include Medicare (for a certain vast class of people no insurer could afford to insure) and Medicaid (for another vast class of people no insurer could afford to insure, just for a different reason). It’s why employers have to contribute to health insurance as a stealth tax, because otherwise many people would not be able to afford it. What is the difference between a system in which the government taxes companies by forcing them to pay for employees’ healthcare and then directly pays for the unemployed’s healthcare, and a classic single payer system? Multiple providers which are never really competitive because of an opaque pricing structure.
As with college tuition, the state has created a monster with no cost control, because the government backstops the most expensive treatment for a growing percentage of the population with unlimited “free” money. In a way, the US already has nationalized healthcare, just like it nationalized college education, it’s merely been nationalized in an extremely inefficient way.
I live in a country with a mediocre public healthcare system, in which almost every doctor and nurse is directly employed by the government in a full time capacity. But the NHS isn’t bad because it’s the NHS. It’s comparatively much cheaper than almost any other first-world healthcare system in a country populated primary by Europeans (can’t compare to eg. Singapore or Japan where people are much healthier and the culture is different). The NHS sucks because everything is done for the cheapest price possible, there’s been no economic growth in 20 years, and British GDP / capita is half of that in the USA, because Britain is poor. Its mediocrity is for the most part a consequence of the British economy, which is poor for largely unrelated reasons.
But I increasingly think the model, or maybe at least the Australian or Swiss semi-public models, could be successfully exported to the US. The usual criticisms of universal healthcare are already rendered bullshit by the American system. Homeless psycho scumbags already get millions of dollars in free healthcare in the US subsidized by the middle class taxpayer that they never pay back, it just gets taken from them in a slightly different way. The NHS isn’t really more “socialist” than the US system at all, because working people are still paying for everyone else in the same way. Old people (by far the most expensive demographic) already get free single payer in America. In fact, the US system is arguably even more unfair, since it costs much more as a percentage of GDP than the British system, which given usage statistics means middle class Americans are relatively redistributing more of their wealth to the old and poor in healthcare costs than many Europeans are.
One thing I've heard (correct me if I'm wrong) is that European health systems like the NHS are more than capable of saying no to unnecessary treatment.
The worry is that we lack that ability in the U.S. As a result, we'd end up with all the monstrosities of our current system with even fewer checks on costs. That was certainly the system that Bernie Sanders was proposing during his campaigns.
The necessary increase in taxes could cripple the US economy as well, making us like Britain in more ways than one.
As usually, it comes down to government effectiveness. When the government is effective, it unlocks all sorts of wonderful societal gains: high speed rail, nuclear power, great health care, etc... But when our government is broken and corrupt, more money just equals more waste.
The last few decades have seen government services in the U.S. erode, not due to lack of money but due to lack of competence. In theory, a single-payer system could reduce costs. In practice, it won't. Not with our current government.
In a way, this is part of the problem. A lot of conservative and libertarian criticism of nationalized healthcare is about people being “denied treatment” - almost always terminally ill children who have no hope of survival, brain dead people who will probably never come out of a coma or be non-vegetative, and other cases where the US spends millions of dollars on someone unnecessarily. See the furore about QALYs and death panels. With insurance, premiums can just go up next year, and employers and individuals will just have to pay. Insurers have no real incentive to even negotiate drug costs downward.
The British government is no less easily persuaded by public mawkishness about grandma needing care than the American government is. It is cost pressure and cost pressure alone that forces this kind of pragmatism on the NHS because managers know what the budget for next year is going to be for the entire healthcare system, and increases have to be directed approved by Parliament, the same way defense spending has to be approved by Congress. There’s limited obfuscation, if the industry needs 10% more money next year congressmen have to put their name to that increase. If they don’t, then the system has to cut costs whether it wants to or not.
Maybe you know, but how much chronic illness does the UK wrestle with compared to the US? About the same?
A while ago I went down this rabbit hole about how to combat childhood obesity, and the scourge of associated diseases it causes, assorted advocates are recommending Ozempic as a first line of defense instead of diet and exercise. Because psychopaths are employing HAAS or woke -ISM language to imply diet and exercise is unfair, but Ozempic for toddlers is "equity".
So I sit and I ask myself, does a NHS in the American context make this worse or better? My gut reaction is worse. These people have wormed their way into every level of government policy crafting in a way that has proven (as yet) impossible to uproot. I can't shake the feeling that if we had an American NHS they'd be reporting parents to child services for feeding their kids vegetables instead of pills.
Or take trans kids, an issue I am 1000% against. By and large it's fiat accompli as medical licensing boards have been weaponized, and if even ideologically critical doctors don't toe the "affirm affirm affirm" party line, they lose the livelihood they went into massive college debt and sacrificed over a decade of their life to achieve. All the same, does this get better or worse with an American NHS? My gut is it gets worse. Which is paradoxical as the UK NHS effectively banned the practice of transing kids. But my read on the beliefs of the PMC that would be in charge of an American NHS say the outcome would be the complete opposite.
Because it actually matters what people make up an institution. And presently, I wouldn't trust the federally employed PMC to manage my health. As the groundswell of support for RFK Jr shows, they've done a shit job in their already limited capacity the last 50 years.
Maybe in 4 years, or however long it takes to restore trust in institutions and non-partisan science, my thoughts on this will change. I want to believe things will be different this time around. But I am also prepared for disappointment.
Puberty blockers for under-18s banned indefinitely, published just three hours ago. Strange to see a country as culturally close to the US as the UK, to deviate so greatly from the policies of the Metropolis. Maybe Arjin is right, and that transexualism, unlike other minority sexual ideologies, will not achieve permanent victory.
Wes Streeting is an openly gay man and has (like a lot of the Labour cabinet) a fairly consistent record of being pro-LGB and trans sceptic. This is often framed as a matter of "they want to make gay kids trans instead of letting them be gay". Trans activists often frame this anti-trans attitude, the one area of an agenda which the country has otherwise enthusiastically embraced, as being due to the tabloid press. I have to say I agree, the media which has been broadly pro-refugee, gay rights etc. (with the only dissent coming sporadically from the Sun and Express) has been in near lockstep over the trans issue, at least since the Tavistock scandal. Even the Guardian publishes regular TERF-y op eds. Why? Honestly no idea, I mean the outrage stuff clearly sells, but it isn't as if the politicans are all anti-woke, just specifically on this issue.
Far out speculation: there might be a link to the fact that the Conservative party activist wing and MPs are incredibly homosexual from top to bottom, as is Fleet Street. They legalised gay marriage so have their credentials with the LGB crowd already, rather than in the US where it tends to be either LGBT rights OR anti-LGBT. Something there..?
It's interesting speculation, but generally the LGB organisations have taken up the T mantle, and this is no different in the UK (with Stonewall being a strong proponent of trans issues).
Two plausible-ish reasons I've seen come up to explain it are:
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