Will Universal Healthcare be cheaper for the US?

Author: Mage-CPA ,

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  • Mage-CPA
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    The argument that universal healthcare would be cheaper appears to be a foregone conclusion. Plus, it makes sense, since there should be lower administrative fees.

    However, looking at various data, it is unclear which system is more economically efficient. 

    This is what I have found:
    1. Brand drugs are generally cheaper abroad than in the US (for drugs with available generics, not sure about no alternatives)
    2. Generic drugs are generally cheaper in the US than abroad.
    3. Foreign government have cost/efficiency standards which limit expensive drugs. For example, if a drug is estimated to add one year of life, it cannot cost more than $5,000 per treatment/pill.
    4. Medical procedures cost more in the US, but generally less than twice as much.
    5. Per capita, the US spends about four times more on healthcare than other nations (and a good chunk have no access to healthcare).
    6. Most countries with universal healthcare have about 25% of their healthcare privately funded.
    7. The US has higher success rates of cancer and other costly illnesses.
    8. The US has more costly machines, and also appear to use them more, per capita

    The problem I run into is I cannot reconcile where (or how) money is saved, nor can I compare apples to apples.

    The major problem is identifying what "healthcare" expenses are, and of course, if they are applied evenly for comparison. Only one source I found mentions explicitly research is part of the equation for the US, but it does not say how much that is, if research is more or less than other nations (or even if other nations spend on research), nor if that includes drug companies' R & D.

    I would love to see a breakdown of the US's expenses, along other nations, to get a feel of where we spend more, what can be saved, and the likelihood that savings will occur and the impact of such savings. For example, how much can be saved in admin and how many jobs are lost due to it?

    Other things to consider, because the US is not the same as other nations:
    1. Additional costs due to general unhealthiness of the USA
    2. Additional use of healthcare in the US exempt from other nations, for example, prescription drug abuse and gun shot wounds
    3. Population density - larger swaths of low population areas than other nations
    4. Impact to other nations' costs - the evidence suggests US citizens are subsidizing drug costs
    5. Most medical advancements are from the US, and these advancements cost money, and are likely added to the healthcare price tag. 
    6. Costs associated with drug testing
    7. Use of ridiculously expensive drugs (although this may or may not be higher or lower than other nations)

    All I ever really hear is the broad statement that the US spends more than other nations, which is easily misinterpreted due to its broadness. I attempted to reconcile the numbers, and was off by about $200 billion with making unreasonable assumptions, which is about 10% of healthcare expense. A large gap, but if my numbers were correct, the US will still be spending more than other nations per capita by a noticeable degree, will have to raise taxes by about 30%, and it is unclear just how much is saved.  

    Does anyone know of a source that offers a breakdown of healthcare costs by research, drugs, services, equipment, buildings, and admin and compares them to other nations?

    Of course, the argument for universal healthcare is two-fold - one is cost, the other is "rights", and I am only addressing the former. 
    Personally, I go back and forth, but I am curious as to the legitimacy of the arguments offered.
  • TheDredPriateRoberts
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    --> @Mage-CPA
    we pay more for non generic drugs which essentially subsidizes other countries so they can pay less.  The drug companies have expenses, r.d. very expensive etc etc and they need/want to make money.  imo they generally make enough off the U.S. that they can accept less from other countries and it still is worth while to continue in the business.  If there was no profit in medications the advances would be very slow if non existent wouldn't you think?
    there is a lot of abuse and over use in our health care.  If we had more accountability at every level, including personal/patient, the waste could be cut and money saved.
    Things are over prescribed and tests ordered because of lawsuits or the potential of.  Many other countries don't have the litigation system the U.S. has.
    the billing systems is overly complicated and burdensome to say the least, a whole other issue.
    There is so much room for improvement and cost savings with what we already have, it doesn't make sense to make a whole new system rather than fixing what we already have (many of which are simple fixes)
    Swapping one set of problems for another unknown set probably isn't cost effective or beneficial when what we already have could be greatly improved.
  • mustardness
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    D-Pirates-- "......it doesn't make sense to make a whole new system rather than fixing what we already have (many of which are simple fixes)"
    OMG, believe that one and he will tell ten more just like it.  If it were simple we would not have arrive at Obama Care v Trump Care

    Other countries have single payer or universal and it is ten-fold time less complicated than USA's systems. YIKES!

    ..."List of Countries Offering Universal Health Care Systems
    Australia, Austria, Bahrain, Belgium, Brunei, Canada, Cyprus, Denmark, Finland, France, Germany, Greece, Hong Kong, Iceland, Ireland, Israel, Italy, Japan, Kuwait, Luxembourg, Netherlands, New Zealand, Norway, Portugal, Singapore, Slovenia, South Korea, Spain, Sweden, Switzerland, United Arab Emirates, United Kingdom"...


    ..."The United Nations is advocating for a universal healthcare system for all of its members by 2030.

    ......Several European countries, particularly members of the EU, have embraced the system. However, the United States, which is the world’s largest economy, is yet to adopt the universal healthcare system. Republicans had vowed to repeal the Affordable Care Act (Obamacare) but the party is divided among some who want the whole program to be scrapped, and the moderates who think scrapping the whole program without a better alternative would leave 24 million Americans without health insurance."....

    Universal or single payer is a minimal brainer.  The year is 2020 not 1420 and we have 7 billion people on Earth.
  • TheDredPriateRoberts
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    --> @mustardness
    if you like what other countries do, go live there, any attempt to compare such a complicated issue, with vastly differing countries, laws, citizens etc is like peeing up a rope, or into the wind, go try it.
    the projected numbers by the democrats themselves shows it's not financially sustainable or don't you believe them or the numbers?
  • mustardness
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    --> @Mage-CPA
    D-Pirates or don't you believe them or the numbers?
    Unlike the you I believe in moral fairness, justice and  liberty for all.

    Universal or single payer works better than what we have now.

    A growing divide between rich and poor >< and that is not a long term solution.

    We cannot stop people who want to be free from oppression and poverty lower class >< rich upper class has no long term sustainablity.

    Trumpanzees cannot see beyond their ego based arm-pit of narrow-viewpoint? Why is that? Is it a moral choice?

    <> = fat middle class and that is what humanity should  be working towards. Trumpanzees lack access to the empathy centers.  Why is that?

  • linate
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    the main way other countries save money is by regulating cost. nobody ever talks about it, but if you read a lot about this issue, you will find that to be true. also, other developed countries have on average thirty three percent more doctors than we do. 

    on a general note, remember that we have only ten percent of people without health insurance. would opening up care to them make us suddenly too expensive, or make the lines too long? no, not at only ten percent. especially if we do the logical thing and get more doctors and nurse practitioners, and regulate costs around the edges. 

    in the next post i will post a long page of healthcare policy in a nutshell. you can find other cost saving measures in there, along with points about how other countries can provide healthcare to everyone, at half the cost, with less wait times and better quality. 

    (on the wait times point, we have fewer doctors, and as the Commonwealth study says, longer wait times than almost all the other developed countries)


  • linate
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    --> @Mage-CPA

    here is the link to the info and following that is a copy and paste 


    Affordable Universal Care Information

    "Of all the forms of inequality, injustice in health care is the most shocking and inhumane."
    -Martin Luther King Jr.


    -Every other developed country besides the United States has affordable universal healthcare in some fashion. They have differing degrees of government involvement in the process along with private insurance to various degrees in some countries. 
    -we spend 18 percent of our GDP on healthcare. every other developed country spends not much more than ten percent. if we ran healthcare like any of them, the difference amounts to over a trillion dollars a year. that's the equivalent of cutting people's income taxes in half. you can also look at the break down per capita and come to the same conclusions as bernie always does.
    -Highlighting the need for reform: medicare and other government healthcare in the United States are running out of money, despite the common thinking that our payroll and other income taxes will pay for it all.  The problem is so big, that healthcare is the only thing that could potentially bankrupt the country. The debt clock shows that our current GDP and debt is around 20 trillion, but future unfunded liability from healthcare is around 120 trillion. 
    -There is speculation on what will happen when Medicare runs out of sufficient money to pay its bills. We might reform the system, put it on our debt, or print money to pay for it. 
    -before obamacare, a commonly cited statistic was that over forty five thousand people died a year without healthcare. after obamacare, that number fell. the exact number is disputed by some, but the consensus is that the number is tens of thousands. for instance, there is no shortage of stories of insurance companies that deny or battle coverage while someone is dying of cancer.  
    -Despite paying more than other countries, we have significantly worse health outcomes compared to them, even beyond high death rates. 
    Fact One: The United States ranks 23rd in infant mortality, down from 12th in 1960 and 21st in 1990
    Fact Two: The United States ranks 20th in life expectancy for women down from 1st in 1945 and 13th in 1960
    Fact Three: The United States ranks 21st in life expectancy for men down from 1st in 1945 and 17th in 1960.
    Fact Four: The United States ranks between 50th and 100th in immunizations depending on the immunization. Overall US is 67th, right behind Botswana
    Fact Five: Outcome studies on a variety of diseases, such as coronary artery disease, and renal failure show the United States to rank below Canada and a wide variety of industrialized nations.
    Conclusion: The United States ranks poorly relative to other industrialized nations in health care despite having the best trained health care providers and the best medical infrastructure of any industrialized nation
    -The current healthcare industry causes people to go bankrupt. One in four of your grandparents will go bankrupt trying to pay for healthcare in this country.  Before Obamacare, half of bankruptcies were healthcare related. If an insurance company fights to pay for your cancer care, for instance, you will face not just the prospects of death, but won't receive any government assistance until you're lifetime saving from hard work, become depleted. 
    -The primary way these countries save money is by negotiating and regulating costs (such as drug costs) but some also take out the insurance middleman to reduce administrative costs. 
    -Medicare spends twenty percent less than insurance for any given procedure, and Medicaid reimburses a third less than Medicare. (consider the bigger picture. if we spent a third less than we do now overall, we would be much closer to other countries spending rates)
    -the non-partisan committee for a responsible federal budget gives some examples of reforming Medicare, without cutting benefits, where major savings could be established and medicare become sustainable 
    -






  • linate
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    Insurance companies spend thirty percent on the dollar on profit and administrative costs, while Medicare spends only three percent on administration.  For every doctor, it is not uncommon to see two staff people just to take care of billing. There is also the marketing and legal departments, other issues that are redundant among insurance companies that run up administrative costs. 
    "We have 900 billing clerks at Duke (medical system, 900 bed hospital). I'm not sure we have a nurse per bed, but we have a billing clerk per bed... it's obscene." Reinhardt, Congressional Hearing on Healthcare Reform.
    -The main reason we spend so much is because the healthcare industry charges so much for any given procedure.  The last link lists some things that are not the main problem that are commonly cited, as is also listed later on this page. 
    -Hospitals are a bigger bad actor than insurance companies because they are prone to excessively charging simply because they can.
    -Doctors and other healthcare professionals salaries are included to some extent in the excess.  There is an artificial restriction on the supply of doctors and they earn significantly more than their counterparts in other countries.  There are fewer physicians per person than in most other OECD countries. In 2010, for instance, the U.S. had 2.4 practicing physicians per 1,000 people — well below below the OECD average of 3.1.
    -A, or 'the', major problem we have five percent of patients that cause half our healthcare expenses. this could potentially be regulated by creating a "high risk" category in the industry, where reimbursement is lower. If we reduced that category of expense by half, we should reduce the overall cost of healthcare by a quarter. (think of the GDP numbers, instead of 18 percent, we'd be closer to other countries) Think of the bigger picture- the average that is spent on each of those patients is $40,000 per year. You could hire a doctor to take car of just five of them and his salary would be paid for.  Trying to manage care like that is easier said than done though. So what happens is we end up having the healthcare industry milk each procedure and charge too much overall.   
    -half of people get their insurance through their jobs. a lot of people are satisfied, but not all of them. and there is a general awareness of the waste involved.  
    -here is a public option plan that could cover anyone wanting to join and includes allowing employers to join. this plan, Americare, achieves savings through all the means mentioned above and makes healthcare universal and affordable.
    -here is a dude proposing public options through expanding medicaid and medicare. this sort of pragmatism hasn't been in the media a lot in recent years, but it's slowly becoming more mainstream. the second link illustrates some of the politically infeasible aspects of trying to get to single payer. the last link argues for a medicaid public option.  
    -the above link shows a slight majority of americans support universal care. there is an even higher support when you raise the proposition that it can be cheaper that way too. 



  • linate
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    -universal care doesn't have to be single payer or some form of a public option. switzerland does it like obamacare, yet it's affordable. the main way, as has been discussed, is because of regulating and negotiating with the health industry on costs. 
    -would universal care starve research and development, innovation? this article says not, and it says that we spend around a hundred bilion per year on reseach and development. you can see it's just a fraction of what we spend on our trillions in healthcare. we could double our R and D spending and still cover everyone. 
    -is the problem malpractice costs? if you count premiums and the amount paid by insurance malpractice companies, and the cost of defensive medicine where doctors use procedures they otherwise wouldn't to avoid lawsuits, the amount comes out to less than fifty billion dollars. again, this is a small fraction of the trillions we spend in healthcare.
    -If we keep health insurance to any extent, we need to make them non-profit organizations. Because health insurance in this country is for profit, they are going to do everything in their power to avoid paying your healthcare. Their main motivation is higher profits, not your well-being. Denying claims is just one clumsy way of saving money though; the main way is by avoiding unhealthy people altogether.  In other countries, any surplus funds are directed towards lowering premiums. Some of the countries have a health system like our current Medicare, where basic dental and eye health along with some luxurious arraignments are only covered through supplemental insurance beyond the government basic coverage. 




  • linate
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    -none of the existing proposals are the only methods. some free market types have posited that we could have universal catastrophic care (covering care above a certainly yearly deductible), and something for the poor. the free market would drive down costs for everyone else on non-catastrophic issues that arise. A variation on this theme is they could outlaw non-catastrophic insurance and promote health savings accounts that already exist.  Another variation, if lawmakers wanted to play twisted with poor tax payers, they could give them subsidies before their catastrophic coverage kicks in that they can pocket if they don't use to discourage overuse. (this wouldn't be politically popular and has questionable ethics, too)
    -France is rated number one by the world health organization and has an esteemed tort reformed system. (not that this is the major driver of costs)
    -a universal system probably wouldn't be like the VA, especially in the USA. most countries aren't either. that is where the government is employer of healthcare workers. most universal care proposals only rely on the government at most as an insurer, not as taking over everything.  government as employer like the VA is only the case in the UK, but they don't have significant problems there anyway. the VA isn't as bad as it used to be either as most veterans are happy with their care.  


    Would the USA suffer in the time we wait to see a Doctor?:
    -the idea that we have to wait longer in a single payer system is mostly a myth. according to the Commowealth for most procedures the usa is well below average in wait times. for some specialized care, the usa is towards the top, but still not best.
    -a libertarian who supports french healthcare: "For a dozen years now I’ve led a dual life, spending more than 90 percent of my time and money in the U.S. while receiving 90 percent of my health care in my wife’s native France. On a personal level the comparison is no contest: I’ll take the French experience any day. ObamaCare opponents often warn that a new system will lead to long waiting times, mountains of paperwork, and less choice among doctors. Yet on all three of those counts the French system is significantly better, not worse, than what the U.S. has now."
    -the idea that canadians come here because of wait times is mostly a myth. only 20 for every 18,000 canadians come here on purpose for healthcare. it's not clear why they choose to do so (maybe there's a wait issue, maybe they respect the USA more given its reputation for quality in some areas of healthcare), but it's clear the numbers are miniscule. the atlantic article above does say canada is the only country worse in wait times, so there could be that, so a slight extent. the only reason canadians are worse, though, is because they choose to not fund healthcare as much as other countries or the usa does- a political decision that can be remedied here, and isn't a problem any where else. 

    What can we conclude on wait times?:
    -wait times is mostly a red herring- if we want decent access to doctors we shouldn't limit the supply of doctors like we have in the usa. let the free market work more in this regard.
    -every other developed country is either single payer or has some sort of government involvement majorly. and they all are almost half as costly. most countries to save money by regulating costs. this is probably why specialized care wait times has been hurt some in other countries. but the fact that the usa is not the best in that regards, shows that it can be done better than here and with government involvement that covers everyone. and, all it means is we shouldn't be too gung ho on over regulating specialized care.
    -other countries are like us. to the extent that there are wait times, it's mostly for people who dont need urgent care. the more urgent your situation, the faster you get seen. that's how it's done here too. any delay to the less urgent isn't significant enough to justify all the good points of single payer or a government involved method.
    -there might be some limitation to access if we open up access to doctors to the remaining ten percent of uninsured just by demand going up some, but ten percent more people would not cause a significant shift in outcomes, and most states have less than that uninsured. There would be no lines under a universal health care system in the United States because we have about a 30% oversupply of medical equipment and surgeons, whereas demand would increase less than 10%. and, is it all that moral to make your own care better by denying it to someone else? especially when you can just find a way to take care of them that doesn't really affect you, but you simply choose not to?

  • linate
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    i think having more billing clerks than nurses might just add to our bloated system. reducing the billing invovlved would do a lot to reduce the administrative costs. 

    as you know, a third of healthcare costs are just from administrative overhead. 
  • linate
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    on the cost point here are a couple highlights from the copy and paste above....

    -the non-partisan committee for a responsible federal budget gives some examples of reforming Medicare, without cutting benefits, where major savings could be established and medicare become sustainable 
    would universal care starve research and development, innovation? this article says not, and it says that we spend around a hundred bilion per year on reseach and development. you can see it's just a fraction of what we spend on our trillions in healthcare. we could double our R and D spending and still cover everyone. 
    -is the problem malpractice costs? if you count premiums and the amount paid by insurance malpractice companies, and the cost of defensive medicine where doctors use procedures they otherwise wouldn't to avoid lawsuits, the amount comes out to less than fifty billion dollars. again, this is a small fraction of the trillions we spend in healthcare.
    -A, or 'the', major problem we have five percent of patients that cause half our healthcare expenses. this could potentially be regulated by creating a "high risk" category in the industry, where reimbursement is lower. If we reduced that category of expense by half, we should reduce the overall cost of healthcare by a quarter. (think of the GDP numbers, instead of 18 percent, we'd be closer to other countries) Think of the bigger picture- the average that is spent on each of those patients is $40,000 per year. You could hire a doctor to take car of just five of them and his salary would be paid for.  Trying to manage care like that is easier said than done though. So what happens is we end up having the healthcare industry milk each procedure and charge too much overall.   

  • Greyparrot
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    So you want medicare for all?

  • Greyparrot
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    --> @TheDredPriateRoberts
    In a free market, the cost of healthcare is set at what the market will bear.

    Healthcare in the USA currently is riddled with 3 major monopolies.

    1) Insurance companies in states where there are non-competitive regulations. 

    2) The AMA (the largest most successful labor monopoly in the country)

    3) And the big kahuna, the government monopoly which regulates everything from drugs to hospital size.

    Assuming you can't really do anything about #3 because ...well just because...

    What would you do to break up #1 and #2 monopolies?

  • disgusted
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    --> @TheDredPriateRoberts
    You people pay $20,000 for a procedure that in a developed country costs $2,000. Yeehaw
  • TheDredPriateRoberts
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    --> @Greyparrot
    allow insurances to sell across state lines for starters, that seems like a terrible restriction for costs and increased services.
    develop some common sense criteria for people who want to go to the E.R.  co-pays generally keep people out of the e.r. unless it's really necessary, not so much with medicaid and no pay patients.
    @linate has it right in that waste and abuse needs to be cut.  The billing is so cumbersome, inefficient and unfair really.  But it's purposefully setup that way to frustrate the providers into not billing for everything they can or the insurance rejects the bill because it wasn't coded correctly etc.  Some insurances will pay for let's say a venipuncture while others say it's "bundled" in the office visit.  This is also true with certain procedures and tests.  Anyway I'm sure you can see the issues from the little I have presented from first hand knowledge.  Keep in mind in their infinite wisdom they have farmed out or put out for bid medicaid and medicare administration companies.  Even though it's all medicaid for example, the coverages are not, nor the billing.  It might save the state money by making it more difficult on the providers, difficult enough where the state won't have to pay them for services provided.  This is generally how it works instead of making people responsible and not wasting this resource (healthcare is like any other resource that shouldn't be wasted).

  • mustardness
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    --> @disgusted
    You people pay $20,000 for a procedure that in a developed country costs $2,000. Yeehaw
    Nice try however, you have yet to realize, that ,Trumpanzees have yet to develop the mental abilities  to distingusih 3 zeroes { 000 } from 4 zeroe's{ 0000 } regarding anyuthing Universal or single payer health care. 

    -Despite paying more than other countries, we have significantly worse health outcomes compared to them, even beyond high death rates

    Make USA great again. Install Universal health care on your computer today.

    -The current healthcare industry causes people to go bankrupt.

    And the Trumpanzees shout out....If they went bankrupt then they deserved it. Stop crying for these immigrant loving losers'...

  • Greyparrot
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    --> @TheDredPriateRoberts
    Imagine if McDonalds had 10 people to take your order for food and process your payment. Your Burger would cost 100 dollars. What stops McDonalds from doing that? 

    Now apply the exact same cure to Healthcare.
  • TheDredPriateRoberts
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    --> @Greyparrot
    that's true, however the insurance companies have the power due to lack of competition and government controls, if you don't play their games and do it correctly they don't have to pay you.  Consider some of the least expensive charges like a finger stick blood collection, about $3 I think.  Most insurances don't pay it, they consider it "bundled".  Would it even be worth the paper work, employee time to process such a small about?  If it's not coded correctly or rejected for some other reason, the follow up audit and re-submission certainly isn't worth $3.  Now toss in a few more small charges like that, give the providers a hassle about collecting the payment for them, multiply by many millions and you've saved yourself a ton of money by basically stiffing the providers with the bill.  If you don't do the testing then you are in trouble for a variety of reason which could end up in lawsuits and malpractice.
    this is just one layer of the onion.
  • mustardness
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    --> @Greyparrot
    Imagine if McDonalds had 10 people to take your order for food and process your payment.
    Imagine "The Founder" of McDonalds actually have some moral integrity instead of his "its a rat-eat-rat world" and not steal the franchise from the McDonalds brothers.

    Imagine a world with humanity operates from a moral integrity position 1st and rat-eat-rat world at a mininmum.

    Can a Trumpanzee imagine such a world? No?  I didnt think so.  Why is that?



279 days later

  • Trent0405
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    I believe America is in a situation where whether they move to privatize or government subsidize healthcare, it will make things better. One thing that baffles me is the massive range as to what universal healthcare will cost America. I've heard numbers like 18 trillion and numbers like 1.8 trillion. Obviously 1.8 trillion is very low but I'd like a better idea of it's cost. Government subsidized health care seems too expensive. If America made it's health care expenditures merely 6,000 dollars per person, and with a population of 329 million that's 1.9 trillion dollars in spending. With only 140.5 million America taxpayers that's 23 thousand dollars added to the taxes of the American taxpayer. So healthcare would become more expensive seeing how American healthcare expenditures are 10,000 dollars per person annually.  
  • Dr.Franklin
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    NO 
  • bmdrocks21
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    --> @Trent0405
    I could see myself supporting single payer under a bunch of conditions. (It would not be my first choice, but, like you said, anything would be an improvement at this point).


    They will do random drug tests and if you are found to be using any illegal substance, you lose all privileges. (potentially for life) Some liberals support decriminalizing drugs, which I could be okay with if they don't get "free" health insurance. Those drugs cause a plethora of health issues, which I shouldn't have to pay for.

    Massive junk food taxes. Obesity is a huge reason for increased costs. That is part of the reason that we have huge costs currently- we eat like crap.

    Essentially tax or remove coverage for any excessively unhealthy items.

    Anyway, ideally I would support nationwide insurance competition to break up the oligopolies state insurance companies currently have. Less regulation. Some states force insurance companies to cover things, such as hearing aids. That drives up costs for everyone, and it includes something many people may never need. Private companies have more incentives and more accountability to drive down costs and cover new desirable treatments. 
  • Trent0405
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    --> @bmdrocks21
    They will do random drug tests and if you are found to be using any illegal substance, you lose all privileges.
    Basically agree with all the other points you made other than the junk food tax which I'm not very knowledgeable about. But why this as a action you'd like to take if America adopted free healthcare. 

    I've heard arguments for these mass drug testing efforts for people on welfare, it appears quite to be quite expensive. about $40 dollars to test for drugs like marijuana.


  • bmdrocks21
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    Yeah, but it would be more expensive to treat people with awful health conditions caused by substance abuse. It is a tradeoff and an incentive not to do drugs.

    Well, our intake of fast food, soda, sugar, etc is quite large here. Making these products more expensive through taxes would prevent people from using them and getting fat. That would lower costs quite a bit. 

    I believe in taking these measures mainly because of how taxes work. I hate paying taxes. So, if I have to pay for another person's healthcare, there is no way I will accept having to pay higher taxes because they do drugs and eat artery-clogging junk.