It’s unclear to me why the American government doesn’t change the laws and create a new system more like a European one. I don’t think hating any of the players makes sense. Those that set the rules are ultimately responsible.
>It’s unclear to me why the American government doesn’t change the laws and create a new system more like a European one
Because the regime decisions in the US. are much defined by the corporatocracy and lobbyists interests rather than the people's. Some further readings/videos on that:
Well, that gets us into the question of the influence of money on American politics. The incumbent players make a ton of money from the current system, and they use a lot of that money to lobby to maintain the system, and the system is responsive to their money. Made worse by Citizens United, but it's been a problem for a long time.
Combine this with a distrust of government that is encouraged by many of those same interests and you have, well, us.
Voters still control the ballot box, and have rejected single payer propositions. When polled, they say they want healthcare reform, but hate every option when they are described to them.
Yeah. There's a lot of fear-based marketing aimed at getting people to reject single-payer. It seems effective.
A lot of our voting seems to suffer from the "but it won't happen to me" fallacy, whether that be about health care and medical debt, conditions in jails, climate change, social services, etc. with the irony being that it often happens to most people in the long run.
It is extremely hard to get people to agree on any one alternative. Any system has pluses and minuses, and it's easy to scare people away from any particular choice.
It took superhuman effort, a once-in-a-lifetime political opportunity, and some outright shenanigans even to get the Affordable Care Act passed. It was a very minor tweak to the existing system, and half the country viewed it as an apocalypse. The political party that passed it ran away from it in the next election, and got massacred. But now that it is law, it too is nearly impossible to alter because the alternatives all terrify people.
At least making insurance available for people with pre-existing conditions was a pretty big win for some. And the penalties for just passing on it are pretty small. However, as I wrote elsewhere, Medicare is still expensive if you recently had a high-ish income. It's been perfectly fine insurance for me so far but it's probably what many would consider unreasonably expensive.
Isn't it just that there's too much money and too big an industry (with lobbyists and campaign contributions)? People are not happy with the system but they're less dedicated to pressuring politicians than companies who depend on the status quo.
We all also hate the overly complex tax system that obliges individuals to calculate their own taxes and get penalized if they do it wrong, but tax preparers like Intuit can kill efforts to simplify it. I think in general we all hate some subsidies but recipient industries are effective in lobbying to preserve them. Etc etc.
Scroll down that article to see that for the last 21 years of revisiting it by every legislative body, it always ends "Died in Committee". Every 2 years, some new representatives get elected, and yet it still dies. The proposal doesn't even make it out to the House floor to officially vote on.
Why? A lot of vested interests in keeping the current system. (Aka "money".)
The intuition is to think only the greedy health insurance companies are against it. But doctors' associations and many American workers with decent health insurance from their employers are against it too.
Doctors often are compensated for the money they bring to their hospitals by the treatments they prescribe. That is, there is an incentive for doctors to prescribe costly treatments because they will net more payments from insurance raising hospital revenues.
Surveys show that a majority of Americans support a single national government program for healthcare. The reason this does not exist is because it has become increasingly easy to distract people with wedge issues and make them focus on what divides them, rather than what unites them.
The root of the problem is that American health insurance is employer-sponsored so you don’t get to choose your carrier and your employer can choose entirely because of bribes if they so choose. As such, the vaunted American invisible hand doesn’t get to play its part.
> The requirement to have 60/100 votes in the senate makes it almost impossible to pass anything except the most uncontroversial bills.
The filibuster is not enshrined in the Constitution. It's only a Senate rule that could be abolished at any time via a simple majority vote in the Senate. The Senators have chosen not to abolish the filibuster.
> makes it almost impossible to pass anything except the most uncontroversial bills
It's actually worse than this.
Popular bills, like the Dreamers Act, become political footballs. Neither party wants to pass it while the other party is "in power" (in the minds of the electorate), and they want to keep it around as a bargaining chip, campaign promise, etc.
So the bills that get 60 votes aren't just uncontroversial, they're usually not even meaningful to voters.
Also fun rotation in jobs. Work on one side and then have expertise to work on the other. And wise-versa... Unless you are true idealist, which will get steered out, why would you ruin the good thing going on...
>I don’t think hating any of the players makes sense. Those that set the rules are ultimately responsible.
If it were legal in certain circumstances to kill someone and take all their stuff, you'd hold the people who arrange for those circumstances to arise as often as possible for the purposes of plundering from their former neighbors blameless because "they're just playing the game"? What if it were torture instead of just murder? Does there ever come a point when a person is responsible for their actions?
> Does there ever come a point when a person is responsible for their actions?
This is it right here. People have been holding out for an answer to that question and I think they are learning every day the answer is no. People can't watch families like the Sacklers inflict untold harm on the population and then get away with a fine less than what they made inflicting that harm, and come away to believe the system works, and that rich people's "due process" is the same as the rest of ours.
If I murder 1, 10, or 100 people I go to jail for life or get the death penalty. If I make a business that murders half a million people by pushing pills and I make a billion dollars doing that, absolute worst case scenario I get a relatively small fine compare to my earnings, and I continue the rest of my life in luxurious freedom. And that's only IF the issue goes to trial after I exhaust my endless resources to massage the justice system by choosing the venue, the judge, and the jury.
Lifetime jail and death isn't even on the table. I guess until now that is... maybe that changes the cost/benefit analysis in boardrooms. Maybe they need to start estimating the likelihood their decisions are so immoral they will actually radicalize their customers to murder them. Because it seems like that possibility doesn't even cross their minds and they feel they can race to the bottom with no repercussions except a fine.
I'm not asking about whether the legal system will hold someone responsible. I'm asking whether they are culpable, ethically speaking. The whole "don't hate the player; hate the game" thing seems to just be a total abdication of responsibility. Of course incentives shape behavior, but saying that only the incentive structure is to blame serves the interests of no one but the sort of person who would do absolutely anything they can get away with that makes them a buck and then insist that it wasn't bad because someone else would've done it if they hadn't.
In the American political system currently the reward for passing a large piece of legislation, even one which eventually becomes popular, is to be voted out at the next midterm elections. So why bother? Don’t worry about legislation, just tweet.
but which European system? in Poland we go private otherwise we wait two years (so you can die without a debt). In Sweden you need to pay for a doctor appoitnment. Netherlands you cover first few hundreds euros. Every country is little different.
Many European countries were able to implement universal healthcare without much of a fight because their economies were utterly devastated after WW2, along with their health care systems. (An exception that proves the rule: France nationalized its private insurance companies that survived the war.) So there weren't really any stakeholders arguing for the old system - notably this is not just hospitals and insurers, patients are also stakeholders. One problem with the US is that "universal healthcare" is popular in the abstract, but "we're gonna take away your BCBS plan and put you on Medicaid" is extremely unpopular.[1]
The US is actually closer to the Canadian example, though Canada started earlier and doesn't have a Big Pharma burden. But like the US, Canada is a hybrid private-public system with a lot of provincial variation. There wasn't a Canadian federal health law until the 80s, after 20 years of patchwork provincial laws, and Canada continues to have big gaps and inequities (e.g. mental health coverage is quite a bit worse in Canada than the US, dental isn't covered, and people on work visas get screwed). A large majority of Canadians have supplementary private insurance. So I think the US will get close to the Canadian system via slowly pushing up the Medicaid eligibility line and eating away at private insurance, and not a big sweeping law.
[1] "Medicare for all" is dishonest, it has to be Medicaid for all. But for classist political reasons nobody wants to say that.
Because the European market based insurance models like the ones in the Netherlands and Germany are completely redundant bureaucracy without any actual market mechanism, and Americans are typically above that kind of nonsense. Americans want choice, but that necessitates having choice.
I can't tell if you're serious or sarcastic, but you can get private health insurance in all European countries, and an important thing the "redundant bureaucracy" does is negotiate and/or control pricing, which keeps the overal healthcare cost down.
One of the issues with healthcare in the US is that every actor other than the patient benefits from higher cost and worse service. It increases revenue and decreases cost for healthcare providers, for pharma, and, importantly, also for insurance companies. There is no competition to improve service and decrease costs.
I don't know what you are talking about, but I have lived in both the Netherlands and Germany and in both instances, you have a "choice" of insurance providers, but the list of services and the pricing is mandated by law. There is virtually no difference between being with one insurer compared to the other, except for whom will process your application and handle the money. In that respect it's just a bunch of useless added bureaucracy compared to an NHS-style system with just one country-wide insurer.
Like I said, you can get private health insurance in both the Netherlands and Germany. Basic service is mandated by law, and will be the same across all providers, but you can get any additional insurance you want.
I do agree that it makes more sense to have basic healthcare covered by a single national government program, rather than mandating basic coverage and allowing private insurance companies to "compete" by offering the same mandatory coverage as each other. If that's specifically what you're referring to by "useless added bureaucracy", then I agree.
Somewhere along the way a firmware bug was discovered in the American psyche that judges whether or not something is “capitalism” by whether or not there are “companies” involved, but is completely insensitive to whether or not “competition” is involved: this is how you get a Vox piece that includes “private industry” and “legally allowed to negotiate prices” in the same paragraph but lacks “fucking ridiculous”.
The pharmaceutical companies have patents on the drugs and so they rent seek. The hospitals have geographic locations and generally don’t get built across the street from each other. The pharmacies are owned by the same parent companies as the insurers.
But somehow you can take this mess of central committee grift and pay some CEO 8 figures a year and now comrade, now we are doing the capitalism. We are rocking and rolling.
It’s also illegal to build new hospitals without permission, even if you have the demand and ability to build one across the street from the existing one.
There are MANY firms who would love to open discount clinics across the street from a bunch of existing medical centers and out-compete them on price and service and eat their lunch; anyone who has used the american medical system knows what a low bar that is to clear. The problem is that in most cases the supply of doctors is capped by law and the ability to open new hospitals and clinics is restricted, so prices remain astronomical and service remains terrible, just like your other public utilities.
Somehow this government-mandated lack of competition is blamed on “free market capitalism”.
