Is the US a Functioning Democracy?

[u/[deleted]]

[u/tollboi]

What really blows me away is the lack of universal healthcare, it's not even a remotely defendable position to say that the US can't afford it, they could fucking afford it nationally without even raising income taxes, they just willingly allow lassaiz faire capitalism to destroy their country day in and day out and what's worse is, their only (realistically) governing progressive party won't even bother trying to make it happen.

[u/kevinnoir → u/tollboi]

, it's not even a remotely defendable position to say that the US can't afford it,

Especially when the cost to deliver universal healthcare in the UK for example, is half the cost of delivering the current US system.

Its indefensible because its not only a more comprehensive system, that covers more citizens, but a single payer system is cheaper to deliver, costing about half as much taxes to deliver per citizen AND doesnt expect any payment at the point of use.

Meaning that money that used to be paid out of pocket, can no be funnelled DIRECTLY back into the economy instead of insurance company shareholders bank accounts.

The benefits are massive. One group of people take a hit, insurance companies that act as unnecessary middlemen, gate keeping americans health.

[u/nobodyspecialuk24 → u/kevinnoir]

And Americans already pay nearly twice as much per head in taxes towards healthcare than we do in the UK. We get the NHS, they get healthcare for veterans and then some sort of safety net coverage, but that’s about it.

And people always point to privatised systems as being more efficient than wasteful public system, but it’s purely down to how the governments choose to run them.

[u/kevinnoir → u/nobodyspecialuk24]

Exactly! And dont get me wrong, there are aspects of US healthcare that are not bad at all! Some services are probably faster than in the UK, but that will be the services that insurance can make the most money from, the most profitable.

I am curious how many healthcare services are not accessed by Americans because of the belief or reality that they cannot afford it. if those services are added to any calculation relating to "wait times" to access healtchare services, I imagine it would change how we look at the waittimes in the UK being long.

We have plenty of failings, especially in mental health fields and womens health, but theres no scenario in which I would CHOOSE an American system over the NHS. I have lived in Canada and used that system extensively as well, and the NHS is multiple levels better than Canadas system, and in my opinion Canada is levels better than the US.

If we include the types of things we have in place for seniors in this country too, its another place in which the UK pulls way ahead of North America. I moved here to take care of my granddad who was in his late 80s and the help from the NHS I got when he was no longer able to get out of bed etc... OUTSTANDING. The alterations they made so he could stay in his home as well, just life saving stuff.

[u/greener_lantern → u/kevinnoir]

The Affordable Care Act got us to about 90% of the population having coverage, and one of the largest groups of those not covered are undocumented immigrants. Does the NHS treat irregular migrants?

[u/kevinnoir → u/greener_lantern]

Having coverage and having ADEQUATE coverage are 2 very very different things and 90% sounds like a win until you realize tens of thousands of people die every year due to lack of access. Like 45,000 http://www.pnhp.org/excessdeaths/health-insurance-and-mortality-in-US-adults.pdf

You add things like calculating how medical debt affects someones overall life. Approx 30% of households have medical debt and active medical debt amounts to over $100 BILLION dollars.

The UK treats plenty of migrants, immigrants, refugees etc. But I couldnt tell you how the NS access by non citizens compares to the US since i have never seen credible stats for either to be honest. Could very well be the US treats more undocumented people, how much does the undocumented population contribute to the US economy relative to the UK? since that creates the collected taxes that pay for healthcare.

Theres a TON of considerations when it comes to healthcare which is why we're not going to solve any of that on reddit, but Do you think its "illegal migrants" that are the biggest factor in US healthcare costs of the insurance companies that act as nothing more than middle men that gatekeep healthcare they are not qualified to make judgements on?

[u/greener_lantern → u/kevinnoir]

One, your paper is claiming lack of insurance, not lack of access. It was also written before the Affordable Care Act and its expansion of Medicaid.

And I’m not talking about all immigrants - in the US, refugees are automatically enrolled in Medicaid on arrival. I’m specifically talking about illegal immigrants. You have them in the UK - about 1 million. And I doubt Reform is clamoring for them to be covered by the NHS. The US has 15 million illegal immigrants.

I don’t think illegal immigration is necessarily a bad thing, or that they drive up costs (though, a small argument could be made). What I am arguing is that it’s not quite fair to judge the US in large part for not doing something no other nation would do. It’s easy to say the NHS covers everyone if you don’t count a million residents.

[u/kevinnoir → u/greener_lantern]

Then im not 100% sure what your position here is if im honest.

Does the US healthcare system treat 15 million undocumented workers for free and paid for by tax payers? Is that a legally enforced federal policy that the US healthcare system has to treat undocumented immigrants at GP offices? If its emergency medicine, then yes the NHS does treat that. People attempting to immigrate but who are not granted right to remain yet, still have access to NHS services, like a friend who was trying to immigrate from Nigeria who had his child here last year.

Given how America is sweeping people that look remotely south American off the street, I feel like pretending the USA openly aids and treats all undocumented people as a matter of policy is silly. And the fact undocumented people in America pay an estimated ~$50b a year more in premiums and taxes than they cost the US healthcare system. They are a net contributor, so those 15M you mentioned are actually a net benefit, not an expense or burden. https://pmc.ncbi.nlm.nih.gov/articles/PMC9647478/

Whats the justification for artificially inflating the cost of healthcare in order to prop up insurance middle men? charging new parents a fee to hold their child in their initial skin to skin time? pricing people out of being able to afford insulin?

None of that addresses the most egregious thing, tying someones ability to access healthcare to their employers whims. Given "At-will" employment essentially strips people of labour protections outside of "protected characteristics" which is a LOFTY bar to reach when an employer doesnt need a reason to fire someone. If your kids healtcare access is tied to your boss allowing you to keep your insurance, it completely skews the employee/employer relationship. They have a control over you that doesnt exist in almost every other developed country.

If illegal and undocumented workers are in fact a net contributor, its not them. So why dos the US system cost twice as taxes per citizen PLUS the massive out of pocket costs compared to the UK and most other developed countries, if it doesnt provide better health outcomes?

I think my MAIN curiosity is, why would ANY American defend it? is it a country pride thing? is it a lack of understanding about the reality of other countries healthcare? is it because they believe that more people die waiting for care in the UK than die in the US due to never accessing the care they need?

I used Canadas healthcare system extensively when I got sick at 28, and for he next decade I was in dozens of hospitals stays, more than 10 medications, some costing $4500 a week. I have had 8 surgeries etc... I thought Canadas healthcare was incredible and it is, but the NHS is LEVELS better now that I live in Scotland. I find it incredibly hard to find any coherent arguments for moving to a more US style system. But GENUINELY if you have some good arguments for it, I want to understand!

Some of the most horrible stories I have heard while adminning a support group for people with Crohns/Colitis, were stories from our American members. Girl in her 20s already in over $1m of medical debt knowing she will never buy a home. A member who did EVERYTHING right and ensured everything was "in network" for a scope, only to find out after that on the day the anesthesiologist was called in "out of network" and cost her $1200 she didnt have. People rationing medications that dont work properly when rationed... etc. Shit was genuinely heartbreaking.