Europeans do pay much less (though: for roughly the same outcomes --- probably the same outcomes if you control for wild SES variance across the US).

You can search for more reports, because they do vary based on methodology. But the median hospital in the US makes between -1% (yes, negative, they lose money, because a huge percentage are non profits) and 4% depending on the source.

When the hospital charges you $37 for an aspirin, that singular pill might have a crazy profit margin in isolation. But your entire treatment could very well be losing the hospital money.

In my own anecdotal experience, the one hospital I know enough details about to comment on specifically, had something like 85% of patients costing the hospital more money than the hospital made. It was entirely funded by the relatively small number of people who had the “right” insurance and had the “right” procedures done.

Eg Kaufman: https://www.vizient.com/insights/reports/national-hospital-f...

Audited financial statements of all kinds of hospitals, both non-profit and for-profit. Here’s data from Moodey’s a credit rating agency: https://www.chartis.com/insights/hospital-margins-trend-high... (“This month, Moody’s credit rating agency released its annual not-for-profit and public healthcare median financial report for 2024, showing that overall hospital performance continues to improve. The median operating margin increased from 0.5% in 2023 to 1.5% in 2024.”).

The $37 for an aspirin offsets huge costs elsewhere for (non-NP) nurses, receptionists, janitors, orderlies, etc., who can’t bill directly to medicare.

Insurance pays the higher of their negotiated rate or the billed charge. Medical facilities set their billed rates so high that they’re guaranteed to be higher than all negotiated rates, ensuring that they get paid.

When you see $37 aspirin on the line, nobody actually pays $37 for it. The billed amount is replaced with whatever insurance rate is allowed for that. If someone is cash paying they get a large discount.

The billed items also have to cover everything. It’s not directly $37 for the aspirin, or the $5 or whatever allowed coverage it ultimately gets billed it. That had to cover the facilities, the salaries of the pharmacy staff who reviewed the request and dispensed it, the staff who inventory and order the medications, and the cost of billing insurance.

The only part that nationalized health care would change are the allowable billed rate and maybe the administrative overhead of billing different insurances. Even nationalized health care systems have admin overhead though.

You can think of it like when you have to pay $11 for a single glass of wine from a bottle that the restaurant paid $10 for. You’re not just paying for the liquid, you are paying into a big bucket of charges that all need to add up to more than the cost of the supplies, staff, building, and everything that goes into running it. The margin on individual products doesn’t make the entire operation profitable.

Hospital billing practices are often terrible or even fraudulent, but stories about the $37 aspirin are generally misleading. Most hospital claims and bills are actually coded around day rates and DRGs, so even if the aspirin shows up as a line item it doesn't actually impact the patient's financial responsibility or the amount allowed by their health plan. (I'm not trying to defend such a confusing system, just explaining how it works.)

Ever hear of loss leaders? Some parts of a typical hospital make money while others lose it hand over fist. The overall margin isn’t across the board, it’s after everything hopefully balances out.

ER’s for example are money pits, but society really needs them.

https://www.definitivehc.com/resources/healthcare-insights/h...

Hand-waving numerous details, but - That $37 isn't the price in the hospital's gift shop. It's n=1 pricing, hand delivered to your bedside by a nurse with a whole hierarchy of higher-level medical & admin staff behind her, and documented out the wazoo. Aspirin could be free & unlimited at the hospital pharmacy's receiving dock, and it wouldn't affect the @bedside price.

Hospitals, now that private equity is involved, do this weird cost shifting accounting BS with shell companies etc, as such their books aren’t straight forward and the 2-5% thing is likely greatly underestimated given the amount of understaffing PE has driven in that space and how much gouging there is from PBM etc.

The US has top-tier cancer survival-after-diagnosis outcomes. We spend too much to get there, and other countries in our cohort would "argue" that we get those numbers in part by diagnosing earlier and that our outcomes are broadly similar, but if you're going into these debates with "the US private health care system causes cancer deaths", that's a pretty rebuttable argument.

Not the parent, but here's one source: https://www.vizient.com/insights/reports/national-hospital-f...

There are many others as well.

FWIW, your experience doesn't seem contradictory to the operating margin claims.

Your experience seems to be that hospitals are run very inefficiently, implying that if they were run efficiently that their operating margins would be much higher than 2-5%. That may be the case, but that still means the Yale paper's claims don't make sense (unless they also propose some mechanism by which to suddenly force all hospitals to start operating efficiently).

But I'm also skeptical of your claim that hospitals are leaving a huge amount of operating margin on the table. IME, very little can be explained by "everyone is stupid." Would I be surprised if a given hospital was run very inefficiently or if a given hospital had a particular poor CIO or administrator? Not in the slightest. Would I be surprised if ALL hospitals were run by idiots who were leaving 10% operating margin on the table? Yes, I would be.

Yes, but there's a difference between finding out whether P=NP and some of the brightest geniuses in the country actively opposing you.

The US spends more than 16% of GDP on health. The UK around 11%.

Shrinking US health expenditure by 3% of GDP while roughly maintaining health outcomes is eminently, obviously doable.

This is broken window fallacy. The $1T not wasted on healthcare inefficiencies would be spent/invested on other things, creating jobs there. Yes, there would be churn because a good number of people involved in the bureaucracy of private health insurance would lose their job and possibly their career. But these things get smoothed out. Social supports (should) exist to dampen the effects of such churn and keep the economy agile.

The money doesn't vanish. It stays in the hands of people. People who would spend it on other things, feeding it into the wider economy instead of the pockets of a small number of corporations. There's zero reason to think this would result in anyone rioting except maybe insurance company CEOs.

> these are about rebuilding an entire economy, a painful process.

"Sorry kids, can't turn off the Orphan Grinder 9000, there's a whole supply chain behind it that would have to restructure."

Well it wouldn't "vanish". The $1T savings (if produced) that were once spent on healthcare would instead be spent on anything else.

This seems a lot like the parable of the broken window but for inefficiency rather than destruction per se.

I mean there's flavors of contributions to gdp. Spending money on make work for people digging holes still counts. I wouldn't mind 1 trilly being freed up for more effective use. I imagine we could get pretty good returns on it just paying it against the debt as a simple idea, effectively a tax cut.

Are you saying that most hospitals have 50% profit margins, of which 90% are paid to the chairman leaving only a thin margin? That seems difficult to believe.

They may have 4.2% margins knocked down to 4% by exec comp but I don't see that how that fact would change OPs point.

No, fraudulent billing is the natural predator of insurance companies. You have this backwards.

Billing and insurance ("BIR") is reported at around 8.5% of revenue --- admin isn't just BIR, as you note. But replacing private insurance with Medicare doesn't drive BIR to zero; Medicare is also a claims-based system. Estimates are that you'd cut BIR by somewhere around 30-40% (of 8.5%).

Most of the savings in these kinds of reports simply comes from paying doctors less (or delivering fewer procedures, which is also a problem we have.)

Every country with nationalized healthcare systems has lower wages for clinicians. So the notion that this wouldn't lower salaries is just ludicrous. That might be an acceptable trade-off but let's not pretend it doesn't exist.

In practice what we would see under a single-payer system is that many doctors would opt out and shift to a cash payment model. So the shortage of doctors would get even worse for patients who can't afford to pay out of pocket.

>Additionally, as somebody who was around pre-ACA, I can not tell you how much better, in every single way, the post-ACA healthcare world is. Pre-existing conditions? Access to healthcare as an individual? These are life-changing possibilities, especially for entrepreneurs.

The failures and politicization of the ACA have caused us to be a little too dismissive of its successes and popularity.

Protections for pre-existing conditions and allowing children to stay on family plans until 26 in particular have made an incredible difference in a lot of people's lives and are wildly popular. So much so that it would be close to political suicide to try to remove them as evidence by Republicans controlling all three branches of government including both chambers of Congress and there is no serious talk of repealing them.

There is belief among a lot of its supporters that universal healthcare would have a similar wave of support if enacted and that the opposition is mostly irrational political arguments rather than people's true feelings about an actual policy. This is why the "ACA" polls higher than "Obamacare" despite those being two terms for the same legislation.

I agree with you about the ACA (as an opponent of single-payer). Prior to the ACA, members of my immediate family were uninsurable on the individual market --- not insurable at a higher rate, not insurable with exclusions, but literally uninsurable: their only options were employer-provided group coverage or state catastrophic safety net coverage programs. The twist: neither has any chronic health conditions. The underwriting refusals were based on symptoms reported in previous engagements with the health care system.

> These are life-changing possibilities, especially for entrepreneurs.

I would quit my day job and completely focus on my side business if I didn't have to worry about healthcare.

Before I went indie, prior to ACA requirements I researched private insurance and found plans for around $3K. This year I’ll pay over $20K for a bronze plan for my family. 700% increase in less than a decade. Aetna left the marketplace input state and no pediatrician in a 10 mile radius takes the most cost effective ACA plan. The pediatricians we found are actually just GPs who have training in pediatric medicine, but we bring in the only minors they see. This is in a top-5 market based on population.

All of the providers have consolidated. I don’t know if ACA affected that or not, but wait times for checkups went from later this afternoon to sometime 6 months from now.

Part of my experience is going from corporate health insurance to marketplace, but in the past 5 years, ACA plans have consistently gotten worse and more expensive while service for those plans has gotten significantly worse in almost every way.

Who is it better for?

No system that saves money can pass in congress: that's the real problem that we cannot actually avoid. Forget pressure from large companies: So many of US costs come from very high salaries, and a lot of bureaucratic positions that don't exist elsewhere. Every dollar we pay goes to someone, and it's not just some random mogul here or there that will be OK anyway. Reform that really lowers prices means loss of jobs, which them will be blamed on the politicians who signed the bill into law.

I lost my individual healthcare plan, and I couldn’t afford the new ones. Remember when they said you could keep your plan? Yeah, that’s the one I lost.

Pre-ACA, I could afford family insurance. My family premiums went up ~$500 a month post-ACA, while the coverage worsened.

My afib ER trip three years ago cost me $7k out of pocket even though I left the hospital still in afib.

Today in my 50s, my deductible is now $8,500. My partner doesn't have insurance because she's not poor enough or rich enough.

We had an insurance rep come to my work last year who said after ACA they had some people whose premiums went up 900%.

So yeah, ACA is better in your world, but not in mine.

Keep in mind, I made no value judgement on ACA at all, just suggested that we learn about its opposition and, as you rightly point out, the difficulty of passing such legislation that can last over time.

I agree that "To no avail" could be read as "was worthless" to an adversarial reader, but trust me when I say it was meant as "which didn't save it from being opposed and stripped over time". As in "the studies and facts don't move the politics"

It should be obvious the messaging is oppositional along party lines. Every chip away at ACA makes it a worse program, and is celebrated by half the electorate. This is a core problem with the legislation. A second iteration on top, or in place, would have to learn from this and work to make the program stickier.

ACA also greatly increased costs. As an entrepreneur at the time, insurance premiums increased 25% overnight for the same plan. Many people had similar experiences.

That the ACA forced a large number of people to pay a lot more for literally the same product is not a good outcome for those people. Too many people try to pretend this didn't happen.

Let’s be honest, it was DOA. Even Gruber admitted to it later. The whole thing was basically a scam.

Edit: I will never understand why people think ACA was so great. It was a bad policy because they couldn’t get it through whole. They passed it with all the compromises that made it DOA. You can’t fix something when you are still in denial about it being bad. ACA is not a transition to universal healthcare when you allowed massive consolidation in the space with some of the biggest companies in this country. Good luck deconstructing that mess.

Republicans finalized things to address medical costs and chiseling at hospital billing - regulations promulgated during Democrat regimes - so I would say there is bipartisan consensus for the actual arguments, if people listened to the actual arguments instead of seeing a no-vote as an opposite nonsensical ideology.

This has been one of the opposition points - don't just give a handout to insurance companies without addressing their billing practices

The original ACA did not have consensus for some of the proposals to address the billing practices such as existing and new state healthcare programs having collective bargaining. And yeah I think the original ACA was unworkable, compromise is taught as a good thing to children in this country, but it just means "the wrong answer".

The tweaks now, alongside the original democrat led ACA, alongside the parts that were stripped out I think could have better consensus

does need a rebranding though.

The only thing that will actually lower costs in our society is healthy people. And right now, everyone is unhealthy and not doing preventative measures due to expense.

The real problem with universal healthcare is that it immediately completely eradicates religious charity.

Any single mom who works as a stripper can go see a doctor who doesn't have the slightest inclination to judge- you're just a number in a government database. Everyone's getting free shit no questions asked.

>ACA has saved tons of lives.

The ACA has killed a whole lot more lives than it has saved by causing healthcare costs to spiral up.

If you begin with something that is obviously incorrect and trivially debunkable, perhaps that's indication that you should review your priors.

> ACA has saved tons of lives

It was the Medicaid expansion that has been cited as saving lives [0]. An expansion that has almost nothing to do with the rest of the ACA.

> "There's a very clear type of fallacy you are engaging ... There's no intellectual rigor or honesty in that sort of thinking"

So you're claiming that the person who posted that is not only falling into a fallacy, but they are neither intellectually rigorous or honest? I think you're reading a lot into their comment which seemed pretty benign, but possibly contrary to your viewpoint?

[0] https://news.uchicago.edu/story/new-research-shows-medicaid-...

> The problem with US healthcare isn't who pays for it, its how damn expensive it is

Saving $1,000,000,000,000/yr is directly addressing how damn expensive it is.

This paper is based on numbers from the CMS NHE. Here are those numbers summarized (up to 2023):

https://nationalhealthspending.org/

I haven't finished reading the paper and have no opinions on it (other than that most successful universal systems aren't single-payer) but if we start from actual numbers the discussion will be better.

> The problem with US healthcare isn't who pays for it, its how damn expensive it is

Exactly! There's so much paperwork that a doctor sometimes need two assistants just for the paper work. There's so much cost for independent practice that increasingly more doctors end up joining big hospitals. Charges with and without insurance have a huge difference. Just to name a few.

The point of nationalisation is to address those underlying concerns. But it’s fair to say that in practice, nationalisation doesn’t always solve those problems.

The problem is you either need to regular or nationalise. And neither of those are particularly “American”.

"The problem with US healthcare isn't who pays for it, its how damn expensive it is."

And also how much is required. I bet a study investigating how much money and lives could be saved by reducing obesity would have 2x numbers

We never attempted to solve the issue of distorted price signals that occur when customers aren't the ones paying for something. We're still charging $600 for a bag of saline.

Americans just consume a lot of healthcare services. Any substantial cost savings requires providing less healthcare service.

I have a strong dislike for the industry as a whole. There's too many ridiculous situations I've been subject to, along with hearing of some from my friends.

My favorite was a friend who had to deliver her baby, alone, in a hallway, because they forgot about her. And the hospital billed her for it. LOL.

No, it’s not a question of who pays for it but who benefits.

You could have universal health with zero additional spending by the US government, but all that administrative overhead is someone’s income.

It's extremely challenging to go after high costs in the current system, because the doctors who charge them are popular and the insurance companies who pay them are hated. There was a 2024 story that stuck in my mind (https://www.npr.org/2024/12/05/nx-s1-5217617/blue-cross-blue...) when Anthem tried to negotiate down the rate of certain anesthesia procedures; the public was absolutely outraged, successfully demanding that Anthem must back down and accept whatever the doctors feel is the appropriate pricing model.

I agree that this proposal would not solve all of the problems; absent more changes you would still see the creep up of healthcare costs at too high a rate. But slashing $1 trillion off of a $5.3 trillion costs is a pretty big bite of the apple. Even if you go with the more conservative $663 number, that is still a great first step. And both of those numbers are after adding the costs of covering currency uncovered people. So we are collectively getting more for significantly less money.

It does this by eliminating a very inefficient layer of our current system (insurance companies), and by having there replacement for that (the government) negotiate on drug prices (how much savings there is the reason there are two estimates). Currently insurance companies almost have a negative incentive to push down drug prices (their profits are limited to a percentage of total spending, and most large companies are pushing against that limit).

Most of the cost control pressures in our current system come out of Medicare/Medicade, and this would widen that out to the whole system. That in turn would wedge open the door to pushing on the other drivers of the cost spirals: hospital administration, new expensive drugs that are not worth the additional costs, doctor salaries ballooning, and the broken system between malpractice insurance and dysfunctional enforcement against malpractice.

Yep. Nobody has repealed Medicare, for example

I don’t think “political suicide” exists anymore.

FDR and "sensible" is always funny to me. The sensible politician that imprisoned Japanese Americans, destroying the lives of 120,000 of our fellow citizens.

Sensible politicians? In the US? In this era? For a _generation_???

It was pretty close until republicans pulled back Medicaid.

> There are only two realistic possibilities. Get a Republican to propose some sort of national healthcare or have Democrats fully embrace socialized medicine and not give a shit what Republicans say or think.

It's worth keeping in mind that Eisonhower's cabinet argued against the idea of giving the polio vaccine away for free on the basis of it being a "backdoor to socialized medicine". We're over seven decades past the point where it makes sense to give a shit about what anyone says about "socialized medicine".

They had 59 votes from Democrats for the public option, not single payer. Public option is to let people choose either a non-profit government insurance plan or private insurers. They needed 60 votes to break a Republican filibuster. Joe Lieberman (Ind-CT) said he would filibuster the public option but would vote for the ACA without it.

> Now the acess to best hosptials is gated by a queue?

I mean, yes? Literally the same principle we all learned in kindergarten for how to make access to something fair. You didn't get to skip the line in lunch because your parents had a better job than someone else either.

You notice this?

It's literally everywhere. So much negativity. Sometimes I wonder how much is enemy action and how much is just depression or some other mental illness.

Sadly so much of that, people are actively trying to undo it.

> thankless job

His annual compensation was over $10 million.

> someone has to approve or deny healthcare. Every universal system does it too, but by government policy instead of corporate decision

That's another lie you've been told and believed.

With Universal Healthcare the government just provides the funding. Medical decisions are made by Doctors.

Man I wish I could downvote a comment. This is what you’d see on Reddit.

“Thankless job” is a crazy way to describe United Healthcare.

No one cares about insurance companies and their profits?? This doesn’t even make sense, so many people rely on insurance and many stakeholders profit off the American insurance system.

When they make campaign promises, they go to small towns and talk about "Main St" businesses. Not sure why anyone believes them at this point (for the reasons you mention), but it is what they campaign on.

That wing of the Republican Party does not exist anymore, they are now centrist Democrats.

I think republicans could get behind some measure of portable health plans between employers. What they could not get behind is universal, in the sense of "everyone living in USA" health care footed by the US Government. The objection would be about centralization of health care funding and about, you know, who would get the benefits.

They used to be, before Trump and the MAGA clowns destroyed the party. So prior to 2015 or so.

… in Massachusetts. New England Republicans are not the bulk of the party, and that’s not all bad - remember, the phrase was “banned in Boston”, not “banned in Bakersfield”.

Bill Clinton was a once-a-century skilled politician, but if you translated his policies without his extreme personal charisma to today it’s unlikely he would make it through the Dem primaries.

The insurance companies had substantial input to the specific text of the ACA. I'm not sure how you can imply the ACA was not a BigCorp bill when BigCorp wrote it.

It's also well known from leaks that the first Obama administration selected his cabinet using recommendations from Citigroup.

I think it’s because Americans been taught that were democracy, not a federal system, but that’s exactly where we expect to do these kinds of reforms. The federal government could reasonably set certain regulatory requirements. The states would need to make sure that any provider within it conforms to the federal levels, you know like auto manufacturing and exhaust emissions. Seems doable. Unfortunately we’re gonna have to wait for the boomers to die because they’re the ones that have gotten theirs and they’ve screw everyone else. Also, unfortunately, the millennials are gonna have to take it on the chin like we have for so much else and realize there is going to be some lost jobs.

$1 trillion more efficient in allocation of resources, freeing up money for consumer spending on everything.

$1 trillion less middle-men.

Not profit, just income

Not really. Private health insurance would still exist alongside for the more wealthy (including nearly everyone on HN) that doesn’t want to wait a year for their public system MRI. Same thing that plays out in other countries. The U.S. already has a form of this in so-called concierge / premium providers too. Lots of profit to be made.

Total profits for US health insurance companies in 2025 were $50 billion. The other $950 billion has got to come from cutting:

1. money to providers

2. overall healthcare consumption

3. bureaucratic redundancy and waste

1 is going to piss off medical providers. 2 is going to piss of the general public. 3 is going to piss off the 20 million healthcare industry workers who are not direct care providers. So pick your poison. This is why it will never pass.

That would be a massive hit to our GDP.

"known" by whom, and documented where? if you're going to just parachute in and say this paper by domain experts is dead wrong, at least link to what you believe shows this to be the case.

> result is known to have significant issues.

So well known you neglected to state or cite them? I'd invite you to do so now.

Please cite and explain what those significant issues are. As it is your post is a "trust me bro", and is not contributing to the conversation.

Canadians can (and do) just cross the border and use private US health care. The vast majority of them live near the US border.

Yes, this is what I find a little odd about the US proposals. I've lived in UK and Spain and in both they have great free public healthcare for everyone, and if you (or your employer) want to layer private insurance on top you can. Wouldn't that be a much more appealing proposal to Americans?

PT? Luxury! My daughter had PT referred by her pediatrician, then the insurance didn't pay all of it and when I asked the insurance company for the EOBs they said they were not allowed to give them to me because it would violate my daughter's privacy.

Yes, roughly 30% of health care in Canada, from dental care to cosmetic surgery, is privately funded.

This is frequently true in the USA as well. My provider's dermatology department is pretty backed up and couldn't make me an appointment for an excision until November. Fortunately it's not urgent.

> If you need to see a specialist, you regularly have to wait months, assuming you can even get a referral in the first place.

Two months can be a luxury. With my insurance in the US, it usually takes longer for me to see an in-network specialist. For my kid, it has often taken over 6 months.

Of course, none of these were urgent, so it was fine. If it really was urgent as deemed by a medical professional, I likely could get a quicker appointment.

But my friend, who has even worse insurance, developed a condition and was having trouble getting a diagnosis. He got referred to neurology, and none of the in-network specialists had an appointment for over 2 months. His condition made it hard to sleep every night (averaging about an hour of sleep a night). Due to the lack of sleep, he couldn't function at work. Took a leave of absence, got a plane ticket to go to a relative's country, got to see a neurologist the next day, got treatment that day and had his first good night of sleep in a long time.

Lost his job because of it, though. Unsure what his medical insurance situation is while living on welfare...

That's not at all unusual in the US. My dad saw a neurologist for chronic severe headaches. It was very common for us to go to an appointment, have the doctor request a follow up appointment in 3 months, then be told during checkout that the earliest available time was in 5-6 months.

The US is not much different. We don't have a wealth of specialists available to see people right away.

I've flat out been rejected from a specialist because they had no availability at all. I actually tried again and got to be seen, but an appointment is months out, always.

Hah, even with "platinum" healthcare in the US, urology referral, 4 months. "You should start PT immediately" after a car accident, "we can see you in 5 months".

"Oh, your septum is deviated ~90% on the right. Surgery? No, first you need to go on these nasal sprays for a few months so we can decide they didn't reshape the cartilage in your nose before your insurance will decide whether they want to "allow"[1] surgery."

[1] Insurers will always say, and have won in court, saying "We don't allow or deny anyone any care they need. We are just saying we won't pay for it."

No.

For a lot of people it very much doesn’t. And the cost is very prohibitive for people getting any care at all when insurance doesn’t cover it, so they end up not getting necessary care and then ending up on disability for life.

A healthy population *makes money for taxes and buying things*, too.

The differences in life expectancy are due entirely attributable to vehicular accidents, homicide, and life style factors. It has nothing to do with medical care.

The availability of universal healthcare does not preclude the availability of privately paid healthcare as well.

I'm 29 and when I was a kid, getting a family doctor used to be an easy task and if you needed to see your doctor you could get in that day. Now all the doctors are so overworked, they're fleeing to America where they can get paid a reasonable wage for a reasonable amount of work. If you can even get a family doctor, if you want to book an appointment, they'll ask you which day you'd like 4 months from now.

My mom's been dealing with an issue with her lungs for the better part of the past year, and trying to get help through any of the intended methods just gets her put on a 2 year wait list. At this point her plan is to pay tens of thousands of dollars out of pocket to see a specialist in America.

The current generation of elderly Canadians now having lived a long life spent most of that life in an entirely different Canada. My generation is going to die on a waitlist.

6 month median wait time for treatment, as in the case now in Canada, is not something I'd trade the American system for.

Can you reconcile this with skyrocketing Canada to US medical tourism?

My understanding is that a clinic or hospital can’t legally charge you for a procedure that’s universally available through the provincial healthcare system.

So you’re free to pay for anything else if you want.

That ~25% is compounded at every step of the way. 25% of your doctor's office. 25% of the insurance company. Plus don't forget the brokers, which are almost all overhead effectively. 25% of pharmacy. 25% of drug companies.

The people providing actual healthcare end up being a minority in the system.

Cool system.

That's literally the premise of the report. The savings comes from getting Medicare's current rate sheet for every patient in the entire market.

You're being dishonest if you claim otherwise. UK brain surgeons get paid less than a Walmart general manager in the United States, let alone a like for like comparison.

Look no further than the UK, with 24 month waiting lists, the shunning of experimental treatments (many high profile kill decision cases) and skyrocketing costs.

In the UK, a brain surgeon is paid less than the General Manager of a single Buc-ees Gas Station location in the United States. Absolutely diabolical.

No, they are excessively optimistic about the financial outcomes. Healthcare should not bankrupt people.

precisely.

You can easily drop those from a universal healthcare system - look at the NHS and gender affirming care across the pond. So it can't only be that part - I think it's wanting the undeserving to not have healthcare.

There's also a racist element (I know that's a politically incorrect word here, but such things happen). People don't want to fund services to the lazy ______s - fill in one or more of many groups toward whom hate is promoted.

When a similar bill was voted down years ago, someone I was with laughed and said, 'no way were we paying for healthcare for the Blacks'. It fits the divide and conquer strategy to divide poorer people with hate so that they don't unite and vote for all these things - why do you think leaders promote hate?

> This could equally be explained by wanting to be perceived as more moderate/centrist.

I don't think anyone perceives a flip-flopper as anything except unprincipled. There's nothing "moderate" about corruption.

> why do you say the reason was that he was bought? Is there evidence?

Look at his health PAC contributions over time:

https://www.opensecrets.org/profiles/hakeem-jeffries/us_cong...

> the one that currently holds all 3 branches of federal government

The key word here is "currently". When did Democrats ever propose or pass single payer when they were in power?

Moreover, when the leaders of both parties are opposed to single payer, how in the world do you expect it to ever pass? Jeffries wants to be Speaker of the House after the midterms. If he's opposed to single payer, then there's no hope for it.

The majority of Democrats support single payer. That's why I'm pointing the finger at a Democratic leader. I don't expect Republicans to support single payer. What I expect is for Democrats and Republicans to have opposing views, not the same views.

Many people feel that winners should be rewarded and losers should be punished.

Systems thinkers may try to push notions of connectedness in societies, and moralists may try to push notions of universal equality of human dignity, but in the end, both are overwhelmingly outnumbered by tribal thinkers, who wish to harm the outgroup at absolutely any cost.