Should the US adopt a single-payer health care system?

[Frodo]

No, a Bismarck system is both more efficient and more likely in the current climate.

^^^^^^^

While I believe in universal health care, I don't have quite the same, uncritical (almost touching) faith in government that my more leftist friends share.  

 

[Frodo]

Something to bear in mind.

[Frodo]

The brief window of opportunity we had of having a single-payer system on par with the National Health Service in Great Britain was in the immediate post-war years.  We missed it.  And there is nothing to suggest that such a window will open again in the immediate future, not with the suspicious -almost paranoid- attitude of the American people toward their government (if you were a census worker or with the civil service, you'd know), which hasn't improved after six years of this administration.  

Considering how painful and difficult it was to pass Obamacare, not to mention its lingering unpopularity, introducing single-payer would meet an even worse reception from the American people, already suspicious of government overreach with Obamacare.  

Single-Payer is dead on arrival.  Count on it.  

[Frodo]

Any criticism of the ACA needs to acknowledge that it improved a system that was and still is in a state of prolonged collapse under the weight of an aging population, technological improvements, and increasingly unmanageable hospitals.

That said, American health care remains a byzantine, inhumane, unsustainable, and expensive mess. It's even more byzantine now, but the ACA addresses the rest of those nasty adjectives to varying degrees.

Single payer would have been more difficult - i.e. impossible - to pass. But it would be easier to defend. The chief problem with the ACA is that only a handful of people understand the law, and that was before the Supreme Court and the Obama administration decided that they would be amending it on the fly. Accordingly, people have a poor sense of how they've benefited and intense anxiety about what they might lose. The law has also become a convenient excuse for doctors, employers, and insurance companies. Patients rarely know any better when whatever human jackal they're dealing with tells them that Obamacare is why their deductible is going up, why they'll have to wait months for knee surgery, or why they are losing their coverage.

The great political tragedy that underlies this dispute is that we are unwilling to trade a system that offers great care for a few, good care for most of the rest of us (albeit accompanied by uncertainty, financial headaches, and stress), and little or no care for the rest for a system that would guarantee good care for everyone.

There are alternative health care models that offer universal coverage, you know.  This isn't an either/or situation.  It just so happens single-payer has that sex appeal among progressives (especially here) that Bismarck apparently doesn't.

[Frodo]

"Bismarck" style health care is essentially what the ACA gives us, with subsidized, heavily regulated, for-profit insurance companies in the place of not-for-profit sickness funds.

What you described in your first post here is most certainly not Bismarck, because if Obamacare was truly based on the Bismarck model, it wouldn't have the problems you mentioned.  Unless you are suggesting that citizens in Germany and Switzerland are suffering for lack of a single-payer system.

  

[Frodo]

Voted Yes because I think it's the most straight-forward way to deal with the problem, I think healthcare access is a right, and I don't think it should be the responsibility of an employer to provide healthcare access, or the responsibility of the person to go buy it at this point.

If single-payer is so wonderful, then why are countries like Sweden moving away from it?

"Bismarck" style health care is essentially what the ACA gives us, with subsidized, heavily regulated, for-profit insurance companies in the place of not-for-profit sickness funds.

What you described in your first post here is most certainly not Bismarck, because if Obamacare was truly based on the Bismarck model, it wouldn't have the problems you mentioned.  Unless you are suggesting that citizens in Germany and Switzerland are suffering for lack of a single-payer system.

What are the chief differences, other than what I've already specified?

Unlike those two countries, we don't set prices for health care services and products (i.e. prescription drugs), and let drug companies and hospitals decide whether or not they want to participate.  Instead, we let insurers do the negotiating.  And since they are so weak (because they are so fragmented), they use the benchmark set by whatever Medicare is paying, and add a percentage on top because they lack the power to strike similar deals.