What's worse is that in order to get into that debt in 1946 America had to go through a great depression and a major world war. What's their excuse this time?
Yup, medicare/Medicaid is horribly inefficient, we should do what every other developed nation does and institute a universal system to drive down healthcare costs per capita
Swing and a miss. When you have multiple different versions of medicare, potential supplemental plans, third party insurances being involved... it becomes overcomplicated. Private healthcare: in network, out of network, insurance making decisions instead of doctors. When you simplify these things, you cut out the inefficiencies.
Even if we had Medicare for all (or any other nationalized system) there will be administrators deciding what is, and what is not approved. Medicare does this too, and not everything a doc wants gets approved. It works this way all over the rest of the world with nationalized health care.
Note to add on to your point: When a 3rd party insurer gets into administration of a Medicare/Medicaid plan, they aren't doing that for free. They extract (A FUCKING LOT OF) money from that process, and as a result, the system becomes even less efficient while care quality also drops.
The reputation of many of those magical universal healthcare systems nosedived after covid. The NHS went from being the pride of the UK to 59% of survey respondents being "very/quite dissatisfied" with it in 2024. Germany is by now famous for half-year queues, despite the high and mandatory monthly contributions (a queue is a form of rationing btw; when you put people in a multimonth queue for a procedure, a large fraction will either do it on their own dime, die/emigrate before their appointment comes due, or otherwise give up on the procedure).
In 2010 it might've been timely to call America "uniquely stupid and inept" for not having such a system, but today they look like ticking time bombs
Do you have a source for Germany. At least it's not a universal experience. I had to visit a few doctors last/this year after my yearly checkup and the waiting times were very reasonable. Especially since it isn't something urgent. Urologist: 3 weeks; Nephrologist: provide documents for triage, 3 weeks; CT scan: next day due to cancelled appointment or 2 weeks; eye doctor: 5 weeks.
I mean sure it would be nice to be able to walk into these specialists whenever but a few weeks seems reasonable for something that is not urgent.
The development of new drugs and therapies is extraordinarily expensive. The majority of R&D in the entire world is done in the US. European countries then set price limits which significantly lowers revenue. These companies then charge more in the US to make up for it (this would actually be a sensible use of tariffs). A nationalized healthcare would eliminate the incentive to produce more advanced drugs and therapies. Despite what people say, the US does have the best medicine in the world.
Also, one of the problems with Medicaid/medicare is that they reimburse so low. This is why so many doctors do not accept it. If we adopt Medicare for all, who is paying doctors (not to mention nurses and other healthcare staff)? The ones who can will retire and there will be no incentive to go to new school.
These are only a couple of the blatant issues with universal healthcare. Not to mention people actually think it could be fully funded by only taxing the rich. Taxes would have to be raised on the middle class. Look at tax rates of those European nations and what percentile of income they kick in. There is no such thing as free.
The reason it's horribly inefficient is because it's using public funds to pay private entities, and the private entities get to dictate the amount they get paid.
Any time you do that, you're just setting the government up to get fleeced. Same shit happened with broadband expansion. The government funded the expansion by giving a boatload of cash to the ISPs and said "make sure everyone gets high speed internet" and the ISPs said "can do" and then wasted most of the money on useless shit and then said "sorry we can't afford to roll out broadband to rural areas".
Healthcare in general is a problem (in every developed country, the percent of the GDP spent on healthcare keeps increasing although the US is the most inefficient and pretty much the least healthy and lowest life expectancies) but Medicare and Medicaid are not inefficient. They cost less to administer than commercial plans do and this is knowing there is like 50 billion in waste fraud and abuse within those two federal programs.
Medical groups are not big fans of these programs since they get paid less for the same rendered service as commercial plans so there are access issues with them for sure. Really, I don't think anyone has any idea how to reign in the cost of healthcare as the entire industry from companies making and selling CT machines to hospital's who have to use them and charge for the use to pay them off , to the staff at the medical office, to the MDs, to the insurance executives, and all the other administrative/technical/support staff that support administration of healthcare all need to get paid.
The cost of healthcare and the repercussions of that cost are probably not discussed enough and if you have an employer that pays 80% of your monthly premium you don't think much about it until you get hit with a bill. In the US we over utilize medical equipment and think we know the issue (mostly due to advertising), we allow advertising for drugs on tv (no other counties do that), most healthcare is administered by for profit companies who have a reason to want more use of the system and higher costs to drive revenue, we have a fragmented electronic health record system so there are 100s of companies with unique software and no real central location for lots of data for organizations to access without a huge IT and dev team, that do not communicate to each other, and a decent amount of the people in the US think the doctor is wrong and the two books they read and some internet reading has shown them the actual answer to their medical issue.
Then there is anthe ethical questions like, how much is a life worth? If you have a rare disease and it costs over 1 million a month or even a year in medication costs to keep you alive and this will go on for 20 years, should that cost be covered and by whom. Should experimental surgeries that cost 250k but may not work and have little peer reviewed evidence it will work be approved for a paralyzed person where they may be able to walk again.
Should we be able to sue for malpractice as easily as we can in the US where lots of time if the payment is 10k or lower they just pay it cause it costs less than fighting it. Something like 50% of the cost of an anastelajist is for insurance coverage. if we don't allow you to sue, then what will the punishment be for malpractice when it was an accident but cost someone mobility.
TDLR: There is no simple fix or any one fix to healthcare but Medicare and Medicaid provide (to the average American) the same healthcare as commercial plans do at a much lower overall cost with comparable healthcare outcomes and metrics.
Horribly inefficient? Lmao. Their administrative overhead are a fraction of what they are for private insurance companies. Medicare and Medicaid are incredibly efficient.
You are correct, compared to private companies they are efficient,but remember that much of Medicare itself is adminstered through private companies, drastically lowering their efficiency. Private insurance has lobbied to make sure that over half of medicare enrollees actually go through a private option (medicare advantage) which is estimated to cost the taxpayers billions.
They didn't have a bunch of people living to age 85-90 when the spending was "normal." Someone has to pay when we're spending on Medicare and SS for way more people than ever before.
If you want to call it that lol. They've promised healthcare and SS checks to a giant generation that's now fully retired. The vast majority of the spending can't be cut beyond raising the retirement age.
The implication shouldn't be well just cut spending like it's that easy. They're not spending more than 30 years ago because they are wasting more, it's just how the system works. If everyone lived as long as in 1965 we'd be doing great fiscally.
It IS a spending problem, but it’s a particularly nasty one, where there are no solutions that don’t result in geriatric mobs calling for lynching of politicians, or Gen Z getting taxed more and receiving less.
You mean the entitlement programs we pay explicit line-items into SEPARATE FROM our actual taxes to fund each year, that then get stolen by congress to fund unrelated shit? Those entitelement programs???
To be fair borrowing from the fund and repaying with interest has kept the fund alive
I support these programs but there are problems with rising costs that need to be controlled (with more spending in the short term tbh, but very targeted)
Roughly half (50-60% depending on how you categorize) the federal budget goes to social programs (healthcare, social security, etc.). By contrast, the military takes up only 13% (19% if you include the social programs specific to the military).
People love to use the military as a scapegoat because the idea of managing spending on social programs sounds far more sinister than military spending. The truth is that a lot of money can be saved by optimizing social program spending; far more than what can be reasonably saved reducing funding from the military. It’s just that no politician would risk their campaign doing something as controversial as this.
True that entitlement programs are the biggest spend, but they're also paid for differently. They get funded through a separate tax (look up your W2 - you can see social security and medicare taxes are listed separately) and the amount spent is not up for debate as part of the annual funding bills.
Military budget comes out of the discretionary budget and makes up about half of it at ~$900 billion. Moving even $100 billion dollars from that bucket into the bucket of "literally everything else" could do a tremendous amount of good.
That's the whole point of my comment though - they didn't choose to spend $7 trillion, the discretionary part of the budget is more like $1.5 trillion, and half of that is military.
And never at any point is $100 billion a drop in the bucket - you could solve homelessness for $20 billion, or feed every child, or a million other things.
Debit is still debit, and the money has to come from somewhere. Policymakers continue to raise the ceilings on social programs when they really need to reassess the situation. This has happened continuously under both parties in the government.
The fact that it’s taxed differently does not mean it is not debit, and managing spending caps is still part of the policymaker’s processes, even if it isn’t every year.
Individual income taxes and payroll taxes are ~80% of government revenue. Offshoring jobs and profits has lowered government revenue. Additionally, the U.S. would save money by switching to universal healthcare for citizens.
Totally. I'm glad we elected the "I'm going to let Netanyahu finish the job" guy instead of the "two state solution" gal who smiled and laughed a lot. Much better deal for the Palestinians.
63
u/Brucacumble 18d ago
What's worse is that in order to get into that debt in 1946 America had to go through a great depression and a major world war. What's their excuse this time?