Comment by shimman
5 hours ago
Number one expense for SMB is healthcare, providing a nationalized healthcare service would likely unlock trillions in value (imagine what Americans would do if they got $200-500 more per paycheck?).
Instead we are forced to watch some of the wealthiest companies on the planet burn money for fun because apparently the government is "wasteful."
What a crock of shit.
The U.S. spends more money on education per student than any OECD country other than Norway and Luxembourg. Yet it gets quite mediocre results. Why do you think the U.S. will be able to do public health care in a more cost efficient way than it does public education?
I favor universal health insurance, but you’re going to pay more, not less. European countries didn’t flip some magic switch where they saved a bunch of money by just “cutting out the profit.” They do it through measures like the UK NHS setting the standards of care, so in a malpractice lawsuit the entity that says what the doctor ought to have done is the same entity that bears the cost of unnecessary tests and procedures. Efficiency is also achieved by aggressively rationing providers such as MRIs, keeping health worker salaries low, etc. There is no stomach to do any of that in the U.S.
>European countries didn’t flip some magic switch where they saved a bunch of money by just “cutting out the profit.”
They sort of have with pharmaceuticals (which to be clear is only maybe 10-15% of overall healthcare spending) by having the government negotiate drug prices nationally, instead of having individual insurers negotiate. This has monopsonistic effects, which really does cut the profit margins of drug manufacturers substantially. Of course, in many ways, they’re free riding on drug discovery funded by profits made overseas (particularly in America) but it does result in appreciable savings.
Yes, good point. That’s one of the switches that will have to be flipped.
Primary Education (K–5): The U.S. spends 21% of its GDP per capita per student. This is exactly in line with the OECD average, which is also 21%.
Secondary Education (6–12): The U.S. spends 23% of its GDP per capita per student. This sits just slightly below the OECD average of 24%.
We spend only 5% of our GDP on food, which is much lower than other OECD countries. Does it mean we are starving?
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If you want to adjust for cost levels in different countries, you’d use a PPP adjustment: https://www.visualcapitalist.com/ranked-education-spending-p...
The U.S. is at $20k, well over the OECD average of $15k. O my Austria, Norway, and Luxembourg are higher.
The U.S. system is neither fish nor fowl, there is more spending per capita than other countries' public systems and endless amounts of red tape because instead of one government bureaucracy you're also dealing with the insurance networks, the providers, etc. I certainly don't think it'll be automatically cheaper, but one can't help but think that the current system encourages hop-ons that exploit the inconsistencies and convolutions. It's like one big nightmarish parody of public–private partnerships.
But our publicly run systems are full of inefficient bureaucracy and red tape, too. Why shouldn’t we assume our public healthcare system would be operated the same way as the public school systems in Chicago, New York, or Los Angeles?
Moreover, there is a massive amount of overcare that americans aren’t willing to confront. My wife’s grandmother had a stroke at 87 and was airlifted from rural oregon to a hospital in portland. She had only 3/4 of her lungs after having cancer in her 60s. The doctors wanted to do an intensive intervention, which didn’t happen only because she refused and died peacefully the next day. My parents are on medicare and they just wander into the ER every time their blood pressure goes too high. I took my 7 y/o son in for a black eye after he ran into a table. The doctor looked at him, concluded there was almost no chance of internal bleeding, but ordered an MRI (or CAT scan, I forget which) “just in case.” We got one and the results within 90 minutes because we just have million dollar machines lying around “just in case.” My daughter went to get her retainer at a small dental office in exurban Maryland, and the office had four people working at the checkin desk. I think this practice has only three dentists total.
America’s “customer is always right” culture means it will be politically impossible to roll back any of this.
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There is zero evidence we would pay more for healthcare under medicare for all, what a bunch of neoliberal nonsense.
The idea that a for-profit system is more efficient than say medicare is hilariously out of touch. Medicare is one of the most popular programs in the country (like >80% from overall public, >90% from active users). There is no reason to deny such a program from the vast majority of Americans, unless you stand to profit from it.
Medicare is cross-subsidized by private health insurance: https://chatgpt.com/s/t_6a5838016cf88191bce90f346ee16ab6
Our healthcare system has its flaws (to put it mildly), but nationalized systems have their own. I know people who don't have primary care because they live in a country with a nationalized healthcare service and their government, in its infinite wisdom, chose not to allocate enough doctors to their town.
How would nationalized healthcare get funded other than shifting that 200-500/check towards… nationalized healthcare?
When you cut out the insurance middlemen and pharmaceutical companies driving up record profits at the expense of care you can get pretty far with less in taxes
Insurance companies make like 2-4% hardly breaking the bank here. Pharmaceutical companies make a lot of money, but the US also funds most drug development which other countries freeload off of. US healthcare workers get a state enforced shortage to drive up their wages thanks to residency limits, but nobody ever wants to look at that.
If you can't tell I am extremely pessimistic about the changes of universal healthcare improving on our current system. And to be clear it's universal, not unlimited.
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The big 7 U.S. health insurers made $55 billion in profits in 2025. Pharma industry profits on U.S. revenue was about $100 billion. Total U.S. healthcare spending in 2025 was $5.7 trillion. Cutting insurer and pharma profits out of the equation entirely would reduce spending by 2.7%.
I support universal health care. But most of its proponents are suffer from innumeracy and magical thinking. It’s very scary to me that we’d put these people in charge of health care reform.
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You cut out the insurance middlemen but you introduce government bureaucracy.
There's absolutely no way the government operates more efficiency in this space.
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