Comment by rafabulsing
21 days ago
The scale argument is thrown around a lot as a justification for why the US couldn't possibly implement universal healthcare. The elephant in the room that I'm always surprises at how rarely it's mentioned in these discussions is Brazil, which is a huge country of comparable size (both territory and population wise), and it manages to make UHC work even though it's also a much poorer country.
It's not perfect by any means, but it's definitely much better than nothing. So the US should absolutely be able to at the very least match that, but really most likely it should be able to do much better. That it doesn't is very much a choice.
The elephant in the room is that in every other sphere, scale is the solution, not the problem. The US should find it easier to implement UHC just because of its scale. More tax dollars, more average outcomes, more resources for outliers, more incremental money for research into rarer conditions. That 10x smaller countries like Canada do it effectively is an indictment of America's inability to do it.
America doesn’t do it for political and cultural reasons. It has absolutely nothing to do with scale, economics, or America’s “inability” to do it. Americans (unfortunately imo) have consistently chosen not to do it by not electing politicians who have pledged to do it.
Let’s face it, America can’t do it for corruption reasons.
The current healthcare system is working perfectly (and by that I mean lucratively) for the 0.01% in control of the political system.
Did Brazil start with a Byzantine kluge of private and public providers and intermediaries? Genuine question, not snark.
I think the US would prefer a UHC if we were starting from a blank slate. The difficulty is mapping a path from what we have now to that.
> I think the US would prefer a UHC if we were starting from a blank slate. The difficulty is mapping a path from what we have now to that.
Do you remember when Republicans went on and on about how "Democrats rammed through the ACA without a single Republican vote"? As if that represented a problem on the Democratic Party side, and not the Republican one? Despite the similarities to models proposed by Republicans in the past, and the relative conservative step it represented from "Byzantine kludge of often poor-to-no-coverage" to "something with a higher floor"? That's how hard it would be to find a Republican to "prefer a UHC if we were starting from a blank slate."
It's important not to underestimate the distrust of government services and regulation of any sort of the Republican base. The conservative media - talk-radio, then cable, then social/podcasts - has been intentionally undermining the credibility of government services at every opportunity for 40 years. And the politicians hamstring and sabotage whenever they get a chance to try to make sure that services offered in the US are sub-par compared to elsewhere.
It's a well-oiled machine running a cycle that keeps people focused on anything else but the services they actually use all the time so that cognitive dissonance can't creep in. (Granted, sometimes, when necessary to acknowledge those things, they'll fall back to making it clear that YOU earned/paid for the things you use, but those other gross poor people are just freeloaders.)
It's like with abortion - for decades "overturning Roe V Wade" was what Republicans said they wanted to do. And people kept trying to convince themselves "oh they don't really mean that, they wouldn't do that actually anymore." Take their word on it about wanting to tear down government services.
> It's important not to underestimate the distrust of government services and regulation of any sort of the Republican base. The conservative media - talk-radio, then cable, then social/podcasts - has been intentionally undermining the credibility of government services at every opportunity for 40 years. And the politicians hamstring and sabotage whenever they get a chance to try to make sure that services offered in the US are sub-par compared to elsewhere.
This is partly what I was getting at when I said the culture of the US is different and the scale is much larger than European countries. It's not just geographically larger, but it's politically and ideologically broader too. If you have a wonderful idea like UHC, you need to make it work with liberals, conservatives, and everyone in between. Like it or not, a universal healthcare or Medicare for all plan is either going to be DoA in Congress, or a considerably watered-down and Americanized version if it has any hope at all of getting enough senators to pass it without first seeing massive electoral college reform in this country first.
That is the scale of the US. You can't assume that an idea that's well-liked and popular in another country is going to be popular and well-liked here.
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> The difficulty is mapping a path from what we have now to that.
It's difficult, but not as difficult as it's often presented to be, as long as you're okay with giving the finger to a relatively small number of wealthy health industry executives.
That depends on who "you" is. Quite a few people in Congress are ok with doing that, but not anywhere near enough to get anything passed. Look at the GOP side of the aisle and you'll essentially find no one willing to do that. Not to mention they are just simply ideologically opposed to the concept of government-provided universal health care.
And that, is the difficulty. Sure, I agree that it wouldn't be too logistically difficult to implement universal healthcare in the US. But that doesn't matter when more than half the country has been propaganda'd into not even wanting it in the first place.
Hell, I expect that there are a ton of Medicaid and Medicare recipients in the US who would tell you that they think government-provided, single-payer healthcare is a bad idea, when that's essentially what they have, to some degree.
> Did Brazil start with a Byzantine kluge of private and public providers and intermediaries? Genuine question, not snark.
That's what it still has.