by zackmorris | 2025-08-05 17:43:12+00:00
Sorry for my late reply.

I believe that the US healthcare crisis started in 1973 when Nixon signed the HMO Act, which had the effect of tying health insurance to employment:

https://en.wikipedia.org/wiki/Health_Maintenance_Organizatio...

The alternative would have been some kind of single-payer option where US tax dollars would fun Medicare and/or Medicaid for all. Here is an explanation I found:

https://medicaiddirectors.org/resource/understanding-managed...

This differs from a public option, which would be a generic insurance offered by the government at a substantial savings over private:

https://www.currentaffairs.org/news/2019/07/why-a-public-opt...

A public option likely would be 20-50% less expensive than private due to the 80/20 rule and the fact the European healthcare is about 1/2 the cost of US healthcare, so a current $400/month plan might be $200-320/month:

https://www.aeaweb.org/research/regulating-health-insurers-a...

https://nashbio.com/blog/healthcare/the-healthcare-divide-pr...

Unfortunately Obamacare (Romneycare) forced everyone to get insurance or face a tax penalty mandate, which was lifted by Trump in the Tax Cuts and Jobs Act of 2017:

https://www.ehealthinsurance.com/resources/affordable-care-a...

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Knowing these facts, what's really going on? Two things:

* Obamacare did little to address the natural monopoly aspect of healthcare, so costs exploded

* Republican concerns about government overreach into our private lives (knowing our info and determining who receives care) and negative impacts on private health industries have not been heard

Natural monopolies are things that everyone needs, such as water, sewer, trash, electricity, education, healthcare, etc:

https://en.wikipedia.org/wiki/Natural_monopoly

Meaning that eventually running a capitalist system results in 1 or 2 companies controlling the entire market and charging whatever they wish, since high cost of entry prevents competition. Without competition, there is no supply and demand curve to counteract price increases. In other words, whoever controls the water can sell it at any price. Or insulin, or Epipens, or Hepatitis C treatments.

The only way to bring costs down on a natural monopoly is through regulation. Society chooses which firm(s) will supply the good or service, and how much it will cost. Overages are paid through subsidies, which can be high, but are at least under public review, unlike when private industry controls a market.

These are the reasons why healthcare got so expensive. But the meaning behind it, that's more nuanced.

The US is very into individual responsibility. Our belief is that a strong citizenry ensures a strong nation. Because we defeated not just fascism in WWII, but the rise of socialism and communism during the Cold War. Our privately funded athletes beat state-funded athletes in the Olympics. Our private industry runs more efficiently than (for example) national construction projects in Russia and China which built cities that nobody lives in. We have our own pork barrel projects, but they tend to be limited by public scrutiny, unlike in communist nations.

The US is also very into privacy. We have medical privacy laws like HIPAA which may not exist with state-funded medical care. Now, this is a half-truth, because Europe has arguably the same or better privacy than we do. Because there is little incentive to sell medical information there, unlike here.

What it really comes down to is that people who are used to paying through the nose for US health insurance after a lifetime of hard work aren't ready to see others receive it for free through the government. They don't want someone determining how long they have to wait for care, or if they receive it at all. They perceive government red tape as making health providers even more expensive or putting them out of business. As in, why would doctors go to medical school merely to be paid little more than teachers and other public servants? Yes, privacy may be impacted with single-payer. But in the US, the answer is usually about $$$.

Sadly, this debate has resulted in the lose-lose we see today: rising costs with no backstop, and threatened privacy due to regulatory capture by health companies which have misaligned incentives and are too big to fail.

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My solution to this political impasse would be a gradual transition to single-payer healthcare (probably Medicare for All) on an opt-in basis, either at the state or individual level. Knowing that taxpayers who opt in may pay a higher rate for a time to supplement those on private insurance. Until enough people are in the single-payer system that it becomes self-evidently better and the majority switch to it. Similar to private school vouchers, except going the other direction: public healthcare vouchers.

People could still buy private insurance to supplement Medicare for All and go to the front of the line. I don't like it, because I believe that healthcare is a human right that shouldn't depend on money, but this is America. If someone has the money to pay doctors overtime, then it probably makes little economic sense to stop them.

Medical research should go back to the previous university/publicly funded model. So grants would be available for companies pursuing billion dollar cures for cancer and other diseases which diminish quality of life or its duration. Then medications would be sold at close to wholesale price. This eliminates the current problems where pharmaceutical companies sell treatments instead of cures, that tend to start out very expensive.

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Sorry this got so long. I believe that you'd receive a similar summary from an LLM, and that without this context, a debate would fall into dogmatic attacks that lead nowhere.

Edit: fixed small typos.