"Universal"-ness is just one dimension of health care costs. What about the malpractice liability environment in other countries, for example? What about the attitudes towards end-of-life medicine? What about medical tourism to America for advanced care? How much of the cost savings for universal health care is a result of saying no to procedures?
Insisting that moving to a single-payer system is the only solution is very one-dimensional thinking.
It can also be said that drug companies use Americans to make their profits and sell to other countries for the best they can get, we could well be paying for an unfair portion of the "real" cost and other countries are only doing better because we're paying the bill.
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I'll switch to talking about something entirely different to expand on the last point. You'll often see people arguing about how the US has the highest military budget, higher than the next N countries combined.
The thing is, we're providing security for those next N countries, and the world as a whole. Many of those N countries are NATO allies who would have to spend a whole lot more if the US didn't. And also by making real war outside regional and civil conflicts impossible for the whole world with military dominance.
In other words, in an American military spending blackout, the game would change and everyone else would be spending a whole lot more. We couldn't simply reduce our defense spending to something comparable without significant consequences.
> How much of the cost savings for universal health care is a result of saying no to procedures?
My personal opinion is that we should absolutely say no to a lot of scenarios when it comes to single payer. That and we should absolutely stop providing care in the worst cases if there is a strong likelihood that the patient will not make it out alive. We spend way too much in the last six months of a patient's life holding on to every last bit of hope grasping to keep their heart beating. I've heard doctors express frustration about this as well.
> In other words, in an American military spending blackout, the game would change and everyone else would be spending a whole lot more. We couldn't simply reduce our defense spending to something comparable without significant consequences.
Consequences for us too. We have to keep spending to maintain the status quo.
I mean I get that there are certain common goal costs that we contribute perhaps a little more than our tab but it isn't nice to point it out like this. At the end of the day, we aren't spending on our military prowess to be charitable. I'm not an expert so it is likely that some cost saving would be possible. I'd welcome efforts to do that.
With medicine, I think a single payer should be able to negotiate with manufacturers and suppliers to keep costs low.
We have to rethink end of life care for humans. I'm very willing to sign a medical release form that says pull the plugs if my treatment will cost over $10M regardless of who pays for it.
But that's a different topic. This current issue with epippen is a simple issue of rent seeking. There is no way anyone could side with the company of this one. I hope that the spotlight means their efforts will fail.
Are you suggesting we spend more than we can get away with hoping the slimeball companies will reinvest their profits into R&D?
>My personal opinion is that we should absolutely say no
We don't disagree that there's a problem: medically fighting to the last breath should be replaced by gracefully accepting the end at the appropriate time (for both cost reasons and for the quality of life at the end for the patient, etc.)
We do disagree on how. If you want to make progress on that front we should have education and cultural growth around accepting death and doing what's best at the end for doctors, patients, and families. We shouldn't have a bureaucrat forcing the decision on anyone.
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>This current issue with epipen is a simple issue of rent seeking
It's not an issue of rent seeking specifically, but abusing government granted monopolies (patent protection, trademark protection, forcing schools to buy, etc)
> Are you suggesting we spend more than we can get away with hoping the slimeball companies will reinvest their profits into R&D?
No, the high cost of R&D and slimeball behavior are often intermixed, but separate issues. I'm suggesting that a whole lot of the money for expensive drugs is actually going towards R&D. Lots of foreign countries are getting steep discounts and not paying equal shares because the drug companies are taking the path of least resistance. They can get funded in America more easily so they don't fight as much in places that are more difficult to win.
America couldn't magically get the foreign prices because the R&D money wouldn't appear from anywhere else. America's prices go down but the rest of the world's prices go up to meet in the middle ... or a lot less drug research happens (or a bit of both)
There are lots of things happening, and a lot of the problems are due to lacking regulation. What can get patented and for how long is wrong; more research should be publicly funded with stipulations that the results are free to society; drug approval mechanisms need to be more efficient; some barriers between national drug markets need to be broken down (you should be able to sell across borders between economically equal nations)
There are a lot of things which could lead to a healthier medical environment which aren't being done. We've got some small reforms out of the way, but there are still huge inefficiencies.
If you're scared about being told "no", don't be - you're more than welcome to purchase additional private insurance in a single-payer system to cover whatever you want. It's not a particularly uncommon job perk in the UK.
Our single-payer system covers a pile of things that low-end insurance often doesn't in the US as it is, so most people are happy with it.
Insisting that moving to a single-payer system is the only solution is very one-dimensional thinking.
It can also be said that drug companies use Americans to make their profits and sell to other countries for the best they can get, we could well be paying for an unfair portion of the "real" cost and other countries are only doing better because we're paying the bill.
---
I'll switch to talking about something entirely different to expand on the last point. You'll often see people arguing about how the US has the highest military budget, higher than the next N countries combined.
The thing is, we're providing security for those next N countries, and the world as a whole. Many of those N countries are NATO allies who would have to spend a whole lot more if the US didn't. And also by making real war outside regional and civil conflicts impossible for the whole world with military dominance.
In other words, in an American military spending blackout, the game would change and everyone else would be spending a whole lot more. We couldn't simply reduce our defense spending to something comparable without significant consequences.