The main thing that needs to be addressed is that the US spends about twice as much as it needs to on healthcare - spend per person per year in the US is US$10,000 (18% of GDP), while in Australia it's A$7,4000. (7.6% of GDP)

How much of this spend is government funded? In the US it's 42%, while in Australia it's 69%. So there's not as much contrast between them as we might think.... **

Even a country like Australia with universal public healthcare has a significant private sector industry (31% of all care!) consisting of insurers and private providers who primarily exist to help patients avoid lengthy wait lists on elective procedures, so all the doomsayers who say that "single payer" will kill the industry are patently incorrect...

** the Australian number doesn't include tax rebates on private health insurance while I think the US one does something equivalent, so it's not directly comparable, but the value of those rebates are only A$5 bil per year, so at most this bumps this to 70%.
posted by xdvesper at 1:34 AM on April 30, 2019 [10 favorites]

This. I'm American in Australia and its not that it's free (it's not) it's that the system is streamlined and usable and costs are kept under control. It's reversed from the US - instead of applying for Medicare everyone starts there automatically and the fee is sliding scale (taxes). If you want an upgrade, you can.

Fwiw, we've never bothered with private insurance here but use private clinics anyway - it just means we pay the difference (the copay) instead of the insurance company. It's usually about $35.

The US has free public school, public libraries... I don't get why this is so hard (well, follow the money - hard eye roll). Public school here in Australia isn't free.
posted by jrobin276 at 2:22 AM on April 30, 2019 [21 favorites]

The Netherlands model has been considered as a natural model for the US to move to, since it too relies on private insurers. The major differences are that they must accept everyone, prices are regulated and, if you can't pay then the state steps in to cover the costs.
posted by vacapinta at 3:34 AM on April 30, 2019 [7 favorites]

Public school here in Australia isn't free.

Really? Isn't it compulsory, though?
posted by entity447b at 3:37 AM on April 30, 2019

Several nations do compulsory non-free education. If you can't pay you get government help.
posted by sotonohito at 3:45 AM on April 30, 2019

The US has free public school, public libraries...

And our "fiscal conservatives" are working hard to privatize or eliminate those things. Because America is exceptional!
posted by Kirth Gerson at 3:46 AM on April 30, 2019 [10 favorites]

Universal health care has some intangible benefits beyond just being cheaper that aren't immediately obvious. For example, a centralised body that is responsible for citizen's health from cradle to grave is generally motivated to fund preventative medicine as a means of saving money, which is also widely held to be more effective. Another example is that disadvantaged populations tend to suffer more from infectious diseases, which may have consequences to an advantaged population living alongside them despite their access to healthcare. In terms of epidemics, your health partially depends on those around you.

The example of intangible benefits most important to me is a bit complicated to explain, but goes like this: Universal healthcare is essentially a form of social insurance that helps mitigate the perceived risk of poor health or disability, and this (I believe) helps reduce some of the discrimination towards these groups. Employers, for example, might be reticent to hire a homeless person because of the poor state of health they may be in, or hire a disabled person because of the perceived risk that their pre-existing condition will lead to complications. When those risks are being underwritten by a reliable single insurer, I believe that employers may be a little less likely to fire someone with poor health, or more likely to hire someone with a pre-existing condition.

In the UK where I live, there have been generations of people living with the NHS and attitudes have changed accordingly. The employment rate for working-age disabled people here is about 51%, where for comparison in the US it's about 30%. Those figures are not directly comparable due to the other factors involved, but the magnitude of the difference is clear and universal healthcare is almost certainly the difference.
posted by Eleven at 3:47 AM on April 30, 2019 [23 favorites]

When we moved from Virginia (DC area) to Canada everyone was like oh but the taxes. I spent years patiently explaining that my take home pay went up even with some dollars at the highest bracket in Canada. The combination of adding HI premiums, deductible, state and local taxes was just too hard for some people and yelling 46%!!!!!!!!! was just easier.

We experienced the best and worst of both Canadian and American Healthcare. (uninsured hospital visits, ambulances, 2 babies) and I'll tell you this: people who have an opinion that the American way is better have not experienced Canadian Healthcare and Canadians who complain are suffering from "it used ta be" syndrome. It crushed us and leaves me literally full of daily anxiety to leave the Canadian system when work brought us home to the USA.


Other interesting anecdote. I'll never forget my first and only Australian healthcare experience. I was there for a 3 week trip and ran out of prednisone and ventolin (I don't take regularly and had an asthma thing there). I was in big trouble and went to a pharmacist hoping maybe I could work out a faxed prescription from home or something. He patiently explained how prescriptions worked, checked my empty bottles, asked a few questions and filled both for a hilariously small amount of money compared to my health insurance provided ones back home. I walked out just plain stunned. Like, OHHHHH this is how healthcare is supposed to work.

(edit for clarity)
posted by chasles at 4:54 AM on April 30, 2019 [19 favorites]

I have lived through the UK system (34 years) and the Canadian system (9 years) and now the US system (4 years).

Anyone that thinks the US system is in any way good is flat out wrong and simply cannot have experienced or understood the single payer system. *Can* it produce great healthcare? Sure. Does it do so? Fuck no. It's just a terrible, costly, clanky system with huge, huge unnecessary overheads (the sheer volume of staff and deliberately confusing insurance and payment admin for instance) is just..... hilarious. Well it'd be hilarious if it wasn't about my health.

It is also, compared to both systems and accounting for tax for single payer systems MIND FUCKINGLY expensive. The only people I know who have no issues with the healthcare system are either in well paying jobs or are otherwise very wealthy. Surprise surprise. The system doesn't just make the poor suffer, but also the 'normal income level' people (ie anywhere around maybe $60k down).
posted by Brockles at 5:13 AM on April 30, 2019 [22 favorites]

I did some basic math on moving from UK to US some years ago, and added up tax/NI on the UK side, and state/fed taxes, SS, insurance premiums, etc., on the US side, and it was about the same proportion of income in both cases. (This was partly because many people, on meeting me, would say "Oh your taxes in the UK are awful"). US health costs have gone up, so it's probably more in the US by now.

And yes the health care system in the US sucks. In terms of time, most people I have to interact with in the system are employed (uselessly) to reduce or deny claims. I presume there is an equal number of people somewhere employed (uselessly) to inflate them. Gah.
posted by life moves pretty fast at 5:21 AM on April 30, 2019 [2 favorites]

In the US, the main issue is that some people don't want to pay for "those" people. Just look at the comments at NYT. And part of the messaging has to be that they already do, and that it is more expensive and has worse outcomes when you do it the American way, with terribly ill poor people arriving at emergency rooms when they need expensive care, rather than getting good care early on when there are more possible ways to treat them.

That said, yesterday in my car I heard that every single human in this world "pays" between 2-300 dollars for military, depending on how you calculate it. And practically, 300 million Americans pay more than half of that, compared to 6 billion humans. Even though the US has the world's most expensive healthcare system, it can afford it, and then more. I sense part of the populist promise Trump seemed to make was to cut down on military spending and improve healthcare instead. He has done the opposite, and people should be reminded of that.
posted by mumimor at 6:50 AM on April 30, 2019 [8 favorites]

Decoupling your health insurance from your employer also has obvious advantages. For the worker, I mean - with single-payer, you don't have to stay with a shitty job just to keep your coverage.
posted by Mary Ellen Carter at 7:07 AM on April 30, 2019 [16 favorites]

It is also, compared to both systems and accounting for tax for single payer systems MIND FUCKINGLY expensive. The only people I know who have no issues with the healthcare system are either in well paying jobs or are otherwise very wealthy. Surprise surprise. The system doesn't just make the poor suffer, but also the 'normal income level' people (ie anywhere around maybe $60k down).

Yah, exactly. As one of those "under 60K" folks, my share of my not-shitty employer provided health insurance that comes out of every paycheck is over half of what I pay in Federal, state, city, Social Security and Medicare taxes combined. Add in the share my employer pays and it's above the tax total.

Of course we should consider health insurance premiums as "taxes", and that's exactly why conservatives are so terrified of "Medicare-for-all" or whatever actually becoming a reality - the very minute a program lurches into existence millions of people are going to see a bump in their take-home pay, and the program will be locked in forever. Regardless of whatever noise they make about "paying for 'those' people" and "But TAXES", even the folks who carry "Get Your Government Hands Off My Medicare" signs will want to keep that money in their pockets.
posted by soundguy99 at 7:09 AM on April 30, 2019 [13 favorites]

Another "intangible benefit" of the UK's socialised healthcare system: it makes silicon valley style startup capitalism work better.

The UK is a poor environment compared to the USA for raising VC if you want to found a startup, but the existence of the NHS means that people with families, disabilities, or in middle age can join a startup with no risk to their healthcare situation other than the long hours and possibility of their employer running out of cash at the end of the month.

I speak from experience: in 1997 I joined a startup (subsequently went public successfully, now a subsidiary of Mastercard). At 33 I wasn't quite the youngest of the first people on the ground, but the two who got there before me were in mid-thirties and forties respectively. We had experience on our side (which is probably why the company survived initial growth pains and then the dot-com bust).

This is in stark contrast to the USA where only young people or the rich can afford to take the risks associated with starting a new company.

Lack of socialised healthcare reduces opportunities for social mobility and risk-taking entrepreneurial opportunities. It's good for capitalism. No irony there ...
posted by cstross at 7:28 AM on April 30, 2019 [21 favorites]

The WaPo just had a look back at the failure of Vermont's Green Mountain Care, Why Vermont’s single-payer effort failed and what Democrats can learn from it. Basically Gov. Peter Shumlin says the costs were too high and that hard things were too hard.
posted by peeedro at 7:33 AM on April 30, 2019 [2 favorites]

Universal health care has some intangible benefits beyond just being cheaper that aren't immediately obvious.

One you don't exactly refer to directly is the precarity that comes with incomplete networks and incomplete coverage. In a crisis, you don't shop around, and your private insurance's coverage may be dismayingly partial on that astonishingly expensive ambulance ride and emergency care (which are likely out-of-network). Almost all Americans, even the ones who think they are doing well, are one medical crisis away from financial ruination.
posted by jackbishop at 7:36 AM on April 30, 2019 [7 favorites]

This out-of-network thing is completely insane. I had an emergency room visit, which United Health Care paid for (after a $150 copay). Then I started getting bills from an "emergency physicians group." UHC hadn't paid them, because while the hospital was in-network, the doctors' group was not. How was I supposed to know that, and even if I did, what could I do about it? "No, please have some different ER doctors attend to my heart attack, these guys are out-of-network." UHC did eventually pay them (mostly), but I had to agitate for it.

I hope you're all going to get single-payer. I'm not likely to survive the current clusterfuck.
posted by Kirth Gerson at 7:53 AM on April 30, 2019 [4 favorites]

What dismayed me is that in my attempt to get a new doctor for my mother I have discovered that "a lot of places" now no longer take Medicare. I feel a little like a German who missed the note about "first they came for the.....then they came for us" as I was well aware that actually getting treatment under medicaid can be a real challenge as not that many doctors, especially certain specialties, accept it here in Oregon but never thought about rioting.

I have long contended that medical reform in the USA is going to require people both low and high getting their Ox gored and that is a huge obstacle to change. I also worry that this fact makes motivates certain interested parties to make the existing public pay systems as lousy as possible in order to galvanize opposition to them from the medical community.
posted by Pembquist at 8:25 AM on April 30, 2019

As a Canadian in California my take home pay is about the same as back home. Mentally I consider health insurance part of “taxes” even though they’re not.

The difference is the hassle - copays, deductible, what this charge doesn’t make sense call the company etc. What a waste of time.
posted by St. Peepsburg at 8:54 AM on April 30, 2019 [3 favorites]

Also it baffles me how corporate America has packaged any consolidation of healthcare as an attack on liberty and choice. And people drink the kool-aid! I see how liberty and independence is woven into the fabric of the culture but jayzus keerist how can people so adamantly advocate against their own interests? It’s positively teenage “you’re not gonna tell me what to do!” meanwhile those who stand to profit from it massage their hands.
posted by St. Peepsburg at 9:05 AM on April 30, 2019 [3 favorites]

mumimor: In the US, the main issue is that some people don't want to pay for "those" people. Just look at the comments at NYT. And part of the messaging has to be that they already do, and that it is more expensive and has worse outcomes when you do it the American way, with terribly ill poor people arriving at emergency rooms when they need expensive care, rather than getting good care early on when there are more possible ways to treat them.

This is really how it looks from the outside. I think the main thing is, because of the way people are billed for healthcare in the US, many think they're only paying exorbitant amounts for their own medical care. And some people are absolutely fine with that because they'd rather pay huge amounts themselves to ensure somebody "undeserving" isn't getting something "for free." They're less concerned about personally saving money and more about not supporting the collective, because horror, socialism!

I do see this same attitude in Canada about other public goods, but our health care system seems to be something most run-of-the-mill conservatives are reluctant to change too much. I'm praying that sheer force of habit coupled with reflexive horror and fear of the US healthcare system will prevent ours from ever being completely dismantled. But stranger things have happened. It certainly doesn't pay for any of us outside the US to get too smug and complacent.
posted by hurdy gurdy girl at 10:47 AM on April 30, 2019 [1 favorite]

Reminds me of this post from 2 weeks ago:


American workers effectively pay some of the highest taxes in the world but don't get much in return.

By looking at "non-tax compulsory payments" (NTCPs) like employer health insurance premiums, Matt Bruenig has found that American workers pay far more in taxes compared to European countries often derided by Americans for having prohibitively high taxes. But unlike those European countries, America does not offer universal welfare programs like free healthcare, advanced education, or family leave:
posted by bleep at 10:58 AM on April 30, 2019 [9 favorites]

There is also a persistent fantasy among white people that there’s another, secret welfare system they’re excluded from and no amount of saying there isn’t seems to convince them.
posted by The Whelk at 1:55 PM on April 30, 2019 [18 favorites]

Just responding to the Australian public school costs comment above, public schooling to year 12 is available at nil cost to all citizens and permanent residents.
Some visa types for ex-pat workers here need to pay school fees.
Almost all public schools charge a “voluntary” contribution fee.
My son’s school has a diverse economic population, charges $50 p.a. And about 2/3rds of families pay.
Friends at an academically selective school in a prosperous suburb pay the $1000 p.a. contribution requested, so it does vary. I don’t know what percentage pay it, but I feel it is the norm.
For comparison, annual fees at a ritzy private high school are circa $25,000.

Back to healthcare, I pay plenty of tax to support Medicare, and my partner works in a public hospital midwifery ward. I am very happy with the level of care offered generally (except that our Medicare does not cover dental), and am routinely impressed by my partner’s stories of the level of care mothers and babies receive at no charge, such as urgent helicopter transport to a top tier hospital and mobilising on-call teams of obstetrics staff after midnight should a woman need urgent intervention.
This is at a hospital with fewer than 250 babies delivered annually, and reinforces to me the quality of healthcare you get when the driving priority is getting people better and keeping them well.

Irritatingly, 15 years ago, the conservative government introduced a surcharge tax that applies to people earning above average full time incomes if they do not supplement their public care with private insurance. The rationale was to take pressure off the public system by incentivising use of private care.
All it really does for many people is push them to take out junk insurance they never claim on, because the cheapest policies are about $500 p.a. And the tax starts at around $800 p.a.
Worse, the government subsidises 30% of the private policy. It is truly the worst snout-in-the-trough arrangement, but is supported by wealthy people who also see their platinum level care insurance subsidised by 30%.

It would be much, much better if everyone just paid a little more tax, with no government support for private care operators.
posted by bystander at 2:18 PM on April 30, 2019 [7 favorites]

Anyone that thinks the US system is in any way good is flat out wrong

That's not true, the US system is fan-fucking-tastic in some specific ways, most of them involving either getting into cutting edge trials or being really rich. Ignoring this will not make it easier to improve or change the ways it doesn't work.
posted by the agents of KAOS at 2:29 PM on April 30, 2019 [1 favorite]

There is also a persistent fantasy among white people that there’s another, secret welfare system they’re excluded from and no amount of saying there isn’t seems to convince them.

My half-sister was in a serious car accident recently, resulting in thousands of dollars in medical bills for very little actual care. Not surprising. In telling me this, my dumbfuck middle-of-America father (who i was not raised with, i’m happy to say) went on a rant about how the “illegals” (he also used the term “wetback” at one point) would have gotten that all paid for as required by some law, with the implication that the same program is not available to poor white U.S. citizens (as my half-sister is).

I’m sure it’s a garbled retelling of how poor people use emergency rooms where they can’t be turned away for care, but at this point i don’t even bother to engage in discussion with him other to suggest that doing some research should be able to show if that is true or not (which he insisted it was).
posted by D.C. at 4:09 PM on April 30, 2019 [1 favorite]

bystander: "Just responding to the Australian public school costs comment above, public schooling to year 12 is available at nil cost to all citizens and permanent residents.
…
Almost all public schools charge a “voluntary” contribution fee.
My son’s school has a diverse economic population, charges $50 p.a. And about 2/3rds of families pay.

And in most cases that goes towards buying/keeping current things like class/lending sets of textbooks, etc, in lieu of buying them for every subject each year. As my partner's school puts it in their info booklet:

"Students participating in the Student Resource Scheme will be provided with all textbooks, resources and materials required for each subject."

That sort of thing that was once the domain of school P&C fundraising (which has dwindled for various reasons over the years) & government funding (which has been reduced severely in that same time).

It's a bit more than $50pa at her high school - more like $150~$260 per year - and $120 per year for the attached primary school (plus things like instrumental & senior-level shop/hospitality/arts subject cop an extra fee of $40~$100 per year) - but that covers all subjects for the year. Yes, that's a difficulty for some - particularly in the diverse but fairly-low socio-economic area her school is in - but being public schools they're open to everyone, so there's a large amount of discretion available to accommodate families who'd genuinely have trouble with it.

Still, I remember my senior-level high school textbooks coming to nearly $300 per year, and that was almost 40 years ago. So it's not that bad a deal; certainly cheaper than buying textbooks.

The public school fees here in Qld are generally higher than other states (for complicated historical tax reasons: c.f. the introduction of the GST) - so I'm not doubting bystander's numbers at all, or trying to make a case that it's not always so rosy. More that I'm pointing out that, even at the higher end, they're still not at the level that a blanket statement like "Public school here in Australia isn't free" might lead you to believe.
posted by Pinback at 5:03 PM on April 30, 2019 [1 favorite]

That's not true, the US system is fan-fucking-tastic in some specific ways, ...... or being really rich.

That's what makes it shit, though. That it is only good in 'some specific ways'. It's terrible precisely *because* of your point.
posted by Brockles at 6:30 PM on April 30, 2019 [4 favorites]

To clarify - my point was 'the system' is crap. Just having a few bits of it being any good is why 'the system' is bad. because it MUST be judged as a whole.
posted by Brockles at 6:31 PM on April 30, 2019

Thats a fair point, but I didn't understand it at all from your first comment.
posted by the agents of KAOS at 7:08 PM on April 30, 2019

the US spends about twice as much as it needs to on healthcare ...
How much of this spend is government funded? In the US it's 42%, while in Australia it's 69%. So there's not as much contrast between them as we might think....

If you're going to compare the spend, you also need to look at the outcomes. Do that, and you'll find that the US system spends approximately twice the amount for much poorer outcomes overall.
posted by HiroProtagonist at 7:33 PM on April 30, 2019 [2 favorites]

Also it baffles me how corporate America has packaged any consolidation of healthcare as an attack on liberty and choice. And people drink the kool-aid! I see how liberty and independence is woven into the fabric of the culture but jayzus keerist how can people so adamantly advocate against their own interests? It’s positively teenage “you’re not gonna tell me what to do!” meanwhile those who stand to profit from it massage their hands.

I am baffled that the counter message isn't about how single payer and other approaches to universal health care give you MORE choices. If all doctors are participants, all doctors are choosable.
posted by Altomentis at 12:21 PM on May 1, 2019 [1 favorite]

But I want to choose WHO I give half my paycheck to, and I don't mean the representatives I vote for, I mean the greedy corporate monolith whose nameless call center reps decide if I live or die!
posted by bleep at 1:14 PM on May 1, 2019