Public healthcare, how would you afford/implement it?

Don't worry, I am asking this question in good faith. I am a big fan of the Universal Healthcare program in my country. So I am not using a cliché to try to dissuade anyone.

There seems to be a lot of misunderstanding about the nature of public healthcare on the internet. Often looking at them in a rosy picture. While ignoring the societal costs or the massive differences between implementations of these public services.

Then there are the costs. You can argue "tax the rich", but ultimately, these programs ARE expensive, and will be paid for by you, the taxpayer, in taxes, regardless of whether you are upper class or lower class. France spends around 12-13% of its GDP on healthcare. Most of that being in the public sector, which is paid for by you the taxpayer. That is a massive economic burden, and is significantly larger than the military budget. In order to make these costs not spiral out of control, the governments have a vested interest in maintaining the health of its citizenry. This manifests in a myriad ways, but mainly through government regulations on what we eat. Japan taxes corporations for hiring fat people who arent losing weight, Denmark taxes fatty foods (red meat, dairy, ect), Sweden taxes alcohol, and the EU impose heavy regulations on foods which is why Soft Drinks in the EU are a lot less sweet than they are in the US.

Which brings us to a cultural point. Most countries that have successfully implemented a Public Healthcare service, are often more on the collectivist side. But how would a system work in a more individualistic country like the US? Where concepts like "Personal Responsibility" and individual liberties are at the core of the country's identity. We have already seen strong reactions towards anything that uproots the status quo. Just look at the hysteria surrounding COVID guidelines, soft drink bans in New York and as of late, gas stoves.

With that said. I do enjoy my public healthcare, and I do believe most countries would benefit from having one, as long as they don't gut it (UK). So I shall ask the question, How will you afford public healthcare in your country?

As a swede, we pay for it via taxpayer money we all pay into. We regulate our food and we invest in our citizen's fitness, so we don't spend excessive money on unhealthy living. Our healthcare is decentralized to reduce bureaucracy, and run by local regions and muncipalities. It is mandated and federally subsidized, but the rest is up to the states. For further improvements, we could definately do things to encourage more daily exercise, such as by phasing out cars, or through fitness programs.

YouTube video with points similar to my own,

We have public healthcare in Canada. It's nice not having to worry about getting a bill when you see the doctor or go to the hospital. The wait times for procedures and referrals can really suck and we get taxed majorly up the ass. The system isn't perfect. I'd be in favour of a mixed system (private and public). Australia has that and I was impressed with their healthcare when I was living there. I was also impressed with how their government negotiate drug prices from pharmaceutical companies. Some of the cheapest prices for the public that I've seen.

There are plenty of ways. You can stop giving trillions to the rich by voting for democrats. That automatically gives you 2 to 3 trillion every 4 to 8 years, then you can tax capital gains properly. You can also have people just pay premiums to the not for profit single payer, much like Bernie and democrats want to allow Americans to buy into Medicare and Medicaid.

If the rest of the world does it, so can we. We just have to stop being gullible and voting for republicans. Their only goals are to unburden the wealthy from taxation and regulation. We’ll never have anything nice with them in power.

@SOedipus: How long do you wait for appointments?

I’m on the East coast of the u.s. I’ll wait an average of 3 months to see a dermatologist, two to three weeks for a primary doctor, and the other might I waited 5 hours in an ER.

My last derm appointment caught a basal cell carcinoma. I had to wait 7 weeks to get it removed.

@tjandmia: I can literally see my dermatologist and PCP the same day usually. ER depends on who's there and time of day. This is in Tennessee.

At least a week or so where I am in Florida.

@joshrmeyer: @joshrmeyer: I don’t believe that at all. In fact, I bet you’re a right winger who is just lying.

I don’t behave that at all. Are you one of those right wingers who pretends the us healthcare system is the best in the world in some misguided attempt to protect the interests of a private company over the needs of the average American?

The rest of the world doesnt do a Single Payer system in a single way. The way it works in the Netherlands differs quite a bit from the way it is done in france, germany, sweden, the UK and Japan. And so on.

This is the issue a lot of europeans such as myself had with Bernie. He sold a single payer system to the US, without any actual elaboration on his plans. Bernie was still a good candidate, but this is one area where he dropped the ball.

Sweden has that too. As do a lot of european countries :)

Ban the people living in the USA illegally from access to any medical services. (Will free up services for americans while discouraging people from coming to the country illegally)

Get rid of all foreign aid, use that money to pay for healthcare for Americans who need it.

Put restrictions on what kind of food you can buy with food stamps. No soda, candy, cakes with food stamps. That money is given to you to survive untill you can get back on your feet, not to get fat and get diabetes so you can be a strain on the medical system.

@Maroxad: Bernie have all the details you would want when he was running for president. It was raising the capital gains tax, as well as raising taxes on the wealthy and everyone else.

He didn't nearly cover enough. He gave vague gestures on how to fund it. But no comprehensive plan.

While you could argue that the rich could pay for it through taxes, the fact of the matter is, such a policy would only last until the Republicans get into the Executive, or legislative branches and immediately start with tax cuts. How then, will the medicare for all plan be funded?

@Maroxad: we’ll, what would happen if republicans screwed it up? They’ve been doing that to the ACA, increasing costs for everyone since 2010. I get your point. 😂

Chop off the head of healthcare's administrative bloat, force medicine cost reduction, and undo the nonsensical price gouging negotiations that happen now in the background between hospitals and private insurance. After all that it practically pays for itself by removing bankruptcies from the state and national budgets and then using what folks already pay into insurance as a standard tax.

If I really had my way we'd also slice the military budget by 75% and tax 90% on billionaires, and we can use the funds to clear any unforeseen cost spikes and improve other areas of wellbeing that contribute to medical cost, like health education and general education, poor infrastructure, and deregulation of hazardous materials.

A publicly funded healthcare was earlier estimated to save about 1/3 of the cost compared to the current system. The money spent on insurance from both employer and employee side are large, the deductible that some people have are insane. Whenever you hear about a single payer system cost is 32 trillion over 10 years or so, just know that the current system will cost 48 trillion in the same time.

Dropping administrative costs will save the hospitals money. I do wonder just how much money is spent on collecting the money for hospitals. Allow the federal or state governments to buy medicine in bulk, that should also bring down the cost for healthcare. (It's my understanding only medicare or medicaid does this today).

This is true, this is why I want every country to employ a public health service :) It is only a matter of how to make a lasting one. That wont be instagutted by the opposition coalition once they get the power to do so.

We don't need another NHS, which was gutted and destroyed by the Tories.

Taxing the rich and churches for starts.

That sounds about same here actually. ER visits depends on severity. Many people here don't have family doctors and hospital is only place to see a physician. Some people wait 8-10 hours. Covid made things worse, a lot of appointments postponed or cancelled, and they're trying to catch up.

Agreed big time on that one. All religious institutions should be taxed.

You'd be surprised how little money local churches actually have. Also those who work for the churches are taxed.

Yup! There is a lot of money the LDS Church has in their vaults for instance. There was even a few huge scandals over it.

For a combination of efficacy, efficiency, expediency, and political reality reasons I'd like to simply open up Medicare and increase taxes accordingly.

Truth be told the first thing we need to address is the obesity epidemic. Stop treating it like a problem some people have that they do to themselves and start treating it like the disease it is. This would quickly (relatively speaking) solve a huuuuuuge burden on our healthcare system.

After that, for starters I'd say we need to have a publicity blitz to undo all the brainwashing that has been done to the American people in terms of capitalism and how things work/could work. Essentially convince people to stop voting against their self- and common-interests.

I mean, it's healthcare...if it can be "free" with little to no negatives, why not vote for it?

I'd focus on just how realistic it would be, how the pros outweigh the cons, and how it's no socialism in the Chinese/Soviet sense, but something the free, flag-waving world does.

After that, I'd try to provide some real-world examples. I'd find people on all sides and spectrums of the political and social system and use them to speak to the benefits.

Policy-wise, I'd do the following:

• Tax the rich. I mean, we already do, so I guess more specifically...patch the loopholes that the rich use to avoid paying taxes.
• Cut military spending by about 5-10%. If the war in Ukraine has taught us anything (not to mention the wars in Iraq and Afghanistan, and frankly most of the wars since WWII) it's that there is no "big bad" any more. We need specialized aspects of our military, but if Russia and China are our biggest threats, we don't need to spend that much on our military. Not even close.
• Establish a branch of healthcare that is mobile. Broken leg? Go to the hospital. Sprained ankle? Ice it and wait for the "mobile healthcare patrol" (or whatever) to show up. No reason to add to the wait in an office when you can have a team come out, bandage you up, and leave in 15 minutes.
• Educate, educate, educate. And educate some more.
  • Mandatory CPR classes in K-12
  • Mandatory first-aid classes in K-12; how to treat seizures, how to treat diabetes, how to bandage a wound, etc.
  • Mandatory nutrition classes
  • Mandatory "home ec" classes: teach kids how to cook, how to turn a protein and some raw vegetables into a soup, how to turn flour, water, and yeast into dough, etc.
• Prevention.
  • Healthier meals in school. The US has an abundance of food, and it's not expensive to eat healthy...it's just cheap to not eat healthy.
  • Some sort of reward system if you're healthy. Tax credits, maybe? If your cholesterol is below X, you get a rebate. If you're weight is in a healthy BMI, you get a rebate. INCENTIVIZE!
  • Etc. etc...

Problem solved right there. Could probably invest anything left in K-12 education as well, start paying teachers a decent salary.

Yeah this too.

"Oh but if we tax churches they'll flee overseas!"

And this is a problem because...? 😋

@tjandmia: Why would I make that up? Maybe in bigger cities it's harder to get into. I'm not right wing or left. As far as healthcare goes, I lean way more to the left than right though.

@joshrmeyer: you’re really asking me why someone would lie? Your story just doesn’t fit with the data and is not typical, which is why it’s easier to doubt than to believe.

They should cut down on military spending and use the money towards health care.

Yeah.. tax people who rely on a collection plate to stay open.

You are already paying 2x as much as the next most expensive healthcare country while getting half as much. Just replace insurance payments with half as high taxes and you are set.

You muricans are so brainwashed by corporate propaganda that it just does not compute for you that universal healthcare is just a tax that would REPLACE private insurance payments and would not have any premiums (or whatever the **** it is you pay extra in order to trigger the insurance compensation) rather than ADD an extra tax to what you already pay.

Next, regulate the dumb for-profit hospitals and stop legalized bribery so that your government would be able to negotiate drug prices, and you could end up paying 1/3 of the current expense while having a better service for every single person.

@mrbojangles25

Excellent and well detailed post.

Yup, remember my old thread about Obesity? This is actually where I was trying to get at in the thread. In most, if not all countries with Public Healthcare Service, treat Obesity as a disease rather than a personal failing. This has been not only shown to reduce healthcare spending, but also well... we see the results. Societies that treat obesity like a personal failing, has the most people succumb to it. So maybe "Personal Responsibility" isn't the solution when it comes to obesity. Instead we should minimize the risk of someone going obese in the first place.

I agree with your policies. Raising tax rates on the rich is unnecessary, and would require the least ammount of political capital to remove, and the most ammount of political capital for conservatives to remove. Patching loopholes on the other hand, should not be met with too much public controversy. Russia has indeed shown a good chunk of the military spending to be quite redundant. But more specifically, we need to look into how money is spent. Especially fighter jets. Why is the Pentagon investing so much in fighter jets, that will most likely... never be used? What enemy does the US have, does the US have any threats, whose air force can even reach US soil? I highly doubt it. Those jets are all about projecting force, not defense. Mandatory Nutrition classes are nice, we have that in Sweden, and it turns out, they were really useful. Especially considering the disinformation I see online. I definatley agree with an incentive structure, there are businesses here in sweden that do just that. And it has been shown to work. A fit workforce is a more productive workforce.

Anecdotal and somewhat related. A co-worker of mine is from the US, worked there for several years. He mentioned that after health insurance through work, his take home pay is by rate bigger in Norway than in US.

@horgen: Oh, absolutely. A family health plan costs about $23k in premiums alone which is a third of the median household income of 70k. That doesn't include out of pocket casts or existing healthcare taxes.

It would save most people a LOT of money.

You're kidding, right? A single person earning 70K here in a year would pay less than 23K in taxes. And you wouldn't have to worry about healthcare costs.

@mattbbpl: For sure. There have also been plenty of studies which show that the US swapping to a single payer system would save a lot of money.

So much evidence in favor of a single payer system, it is pretty much a no-brainer. Which leaves the only 2 questions remaining on how to fund it, and how to implement it to ensure it will survive past a Republican (or Libertarian) administration.

@rmpumper: right. It’s amazing to me how easily my fellowAmericans are fooled by corporations. They trust private corporations they have no control over more than the government they created. It’s astoundingly stupid to want to cut a $1,000 check to a private company every month when you could be paying half that for services you actually have a voice in managing via the government you create.

I don't agree with your first 2 points, but I do agree with this. Those foods are addictive by design and can really mess a person up. The point of welfare programs is to allow people to bounce right back up. But allowing them to wreck themselves with junk food like that, will do tremendous damage. While we are at it, we can also do somethign about the food deserts.

Problem is healthy food costs more money. Perhaps it should be the other way round.

As far as I am concerned, he just referred to candy and sweets. Not so much in actual food. But food stamps should definately prioritize healthy eating if possible, and while they are at it. Do something about the food deserts. Pretty hard to eat healthy if you live in an area where stores pretty much do nothing but stock up on highly processed junk.

Not kidding. 23k is the median. My plan is better than most and costs 29k in premiums.

@Maroxad: I'm a big fan of things like cancer treatment, heart surgery, or basically anything that's life or death to be 100% free to anyone who has paid their taxes.

However, I think self inflicted stupidity should be at least partially covered by the patient. Drunk guy breaking his arm falling off his back porch. or some idiot gets into a fist fight and needs his lip stitched up, etc.

Also, junk food should be taxed more heavily, and the proceeds should be used to subsidize healthy food imo.

If I wanted to fund a system like this, I'd look at the leading causes of hospitalisations and deaths in the US, and then heavily tax any industry linked to those causes.

For example, if gun violence is a leading cause of hospitalisation, then tax the gun industry. Same with alcohol or vehicles or whatever.

The tax burdens would encourage those industries to implement better safety standards (to drop out of the leading causes and thus reduce their tax burden). In turn, this would make the US safer and alleviate pressure on the healthcare system.