I am a U.S. citizen. Yes, cost is a huge issue. We would not have to rip out private insurance, but we would probably have to regulate pricing, which is how it works in Germany. Folks should be welcome to buy supplemental insurance as they do with Medicare. There's basically four models[1] for providing health care, and the US has all of them:
The Bismarck model like Germany with multiple payers, but they are non-profit and pricing is regulated. Doctors and hospitals are private, and there is still supplemental private insurance. Financing is a combination of employer and taxes, where the government takes over the employer portion if the person is unemployed. This is sorta what the U.S. has for those with employer subsidized health care except for the insurers being for-profit and unregulated pricing.
The Beveridge model like in the U.K. financed through taxes and where the government provides care. This is so-called socialized medicine. In the U.S. we have this system for veterans in the form of the V.A.
The national health insurance model, with private doctors and hospitals but the government is a single-payer. Canada. Medicare.
And lastly, out-of-pocket.
We use all of these in the U.S. and it's insane.
We could in theory adopt a Bismarck system. Force the insurers to be non-profit. Make everyone work off Medicare pricing. Supposedly existing Medicare pricing is too low. Fine, let the doctors and hospitals negotiate that with Medicare. Allow supplemental insurance for those who want it.
MFA polls badly when you ask Americans what if they had to give up their current insurance. But I think this is misleading. Of course it's going to poll poorly if you ask someone to give something up. That's basic loss aversion. Turn the question on its head and ask a bunch of 65+ year olds how they'd feel about giving up Medicare in return for their Medicare withholdings back to buy their own private insurance. Guessing that wouldn't poll too well.
I don't think MFA is necessarily the best option. Americans value choice. But it seems to be the universal care option with the most political momentum right now. I'll take it. But I'd be happy with a Bismarck-type system too.
As long as people are covered it would be a good start (I won't bother engaging further on the single payer/private insurance/hybrid systems, not enough room and not the right forum)...it just scares me to hear the game plan to get there is political pressure after a critical mass of people are uninsured. I know that is not attributable to you, and you seem optimistic we get there anyway, I hope you are right.
One last thing I will note, is there are all kinds of hidden costs through other insurance that hopefully would come down under a single payer (maybe even under a public/private hybrid like Medicare Part D) , take car insurance one reason premiums and deductibles are so high is because a lot of that goes towards personal injury claims (medical costs). The same can be said for odd things like homeowners insurance for example. A lot of these insurance policies people already pay for in some ways supplement health care coverage.
Well in response to my questions about why people want to divorce insurance from employment before universal care becomes a law/right/option, one commented answered:
>>Having a critical mass of uninsured people is the foundation we need to resolve the healthcare crisis in America.
The Bismarck model like Germany with multiple payers, but they are non-profit and pricing is regulated. Doctors and hospitals are private, and there is still supplemental private insurance. Financing is a combination of employer and taxes, where the government takes over the employer portion if the person is unemployed. This is sorta what the U.S. has for those with employer subsidized health care except for the insurers being for-profit and unregulated pricing.
The Beveridge model like in the U.K. financed through taxes and where the government provides care. This is so-called socialized medicine. In the U.S. we have this system for veterans in the form of the V.A.
The national health insurance model, with private doctors and hospitals but the government is a single-payer. Canada. Medicare.
And lastly, out-of-pocket.
We use all of these in the U.S. and it's insane.
We could in theory adopt a Bismarck system. Force the insurers to be non-profit. Make everyone work off Medicare pricing. Supposedly existing Medicare pricing is too low. Fine, let the doctors and hospitals negotiate that with Medicare. Allow supplemental insurance for those who want it.
MFA polls badly when you ask Americans what if they had to give up their current insurance. But I think this is misleading. Of course it's going to poll poorly if you ask someone to give something up. That's basic loss aversion. Turn the question on its head and ask a bunch of 65+ year olds how they'd feel about giving up Medicare in return for their Medicare withholdings back to buy their own private insurance. Guessing that wouldn't poll too well.
I don't think MFA is necessarily the best option. Americans value choice. But it seems to be the universal care option with the most political momentum right now. I'll take it. But I'd be happy with a Bismarck-type system too.
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3596027/