US Politics. Obamacare. What’s the problem?

What is behind the resistance to a compulsory universal health insurance program in the US? I do not always understand US politics, but I am really lost on the health care issue. The US spends amost twice as much per capita on health as most OECD countries. It has more people without any health insurance at all, and certainly no better health outcomes than these other countries.

While I would not recommend that the US adopt Canada’s ideologically hamstrung “same poor service for all” health system, there are plenty of examples in Europe of countries with public health schemes with more flexibilty than Canada’s, and more private initiative and more choice, and which cost less than both Canada’s and the US system as per this table. They also have shorter waiting periods than in Canada.

Why is a compulsory universal health insurance program a bad thing for most people?

After all, we fund schools publicly. Yes we should allow more private delivery of educational services, allow more choice and dismantle the public quasi monopoly in education. But why not fund it publicly? Society does need some cohesion and some programs where people benefit from helping each other. I fail to see the downside.

14 comments on “US Politics. Obamacare. What’s the problem?


A big thing is not having the freedom to opt out. I don’t have health insurance, don’t want it, and can’t afford it right now. I want the freedom to take care of my own health my own way by my own means. I don’t believe medicine should be a go to for everything. I would rather spend the money I would be forced to pay for health insurance on better food.


Because we cannot borrow enough Chinese money to fund both the military-industrial complex and fund health care at the same time.

Ehhh…and you expect a concise answer to this? Haha.In short, because ignorance, that’s why. Most Americans really don’t know much about other countries and haven’t traveled much if at all, so they really don’t understand just how much better some countries do other things which means they don’t think that there <i>is</i> a better way to do it at all and when you confront them with evidence that shows that there is this messes with their "we’re the best" mentality they’ve been brainwashed into believing ever since they were a child which creates dissonance and they have to get rid of that dissonance somehow so they start coming up with all sorts of silly, but imaginative (I’ll give them that), bullshit. You’d be amazed the things they believe, my parents actually believe that the health care system in Canada and most European countries is severely inferior to the one here and that you’ll be waiting months and months to get treatment for even potentially life-threatening illnesses.That, and there are some really selfish, self-centered people who are that way because they were raised that way: this is the dark side, the nasty negative side-effect, of the very strong independence mentality in the U.S.–granted, it does do a lot of really good things, but it has its downsides and this is one of them. You definitely have a good number of people, a lot of them libertarians, who simply don’t want to pay for anyone else’s stuff. It’s best known as the "I’ve got mine" mentality, i.e. "I’ve got mine so screw you".It’s complicated, it’s very, very complicated. But we are progressing…slowly, but surely, we are progressing, and dragging the backwards ones along with it, kicking and screaming, haha.Cheers,Andrew


The rich in America have convinced the poor that it’s not about healthcare – it’s about ‘freedom’ like the poster above me. So by you entering into national health insurance you will lose your freedom to choose plus you will have to pay for the health insurance of freeloaders who don’t work. The rich of course do not need this healthcare system and they will be better off without it since they will not have to pay more taxes or offer their employees healthcare. You probably read about how at the Republican national convention they actually clapped when someone suggested that a healthy person who can’t afford healthcare should be left to die.The rich in American are a crafty bunch, the poster above even admits that as for healthcare "can’t afford it right now." I hope she does not get sick, then perhaps her mind will change very fast.


My objection is mainly based off of the Constitution, but understanding that most people do not know or care about the constitutional arguments, I’ll only give my opinion based off of the personal reasons. It is very difficult to not be subject to this requirement. Yes, if it is more than 8% of one’s gross income with subsidies/employer contributions, one is exempt. It’s hard to know how many people will really be exempt in 2014, but I think most would probably be under the requirement. In doing the math, it is very possible that as the income moves up, it is less expensive to pay the tax than to purchase insurance. The only numbers I have heard about the expected cost of insurance is around $3,400 a year. I do not know how accurate that is, but it sounds realistic, and will only increase in the next few years. Personally, I graduated with a law degree and have around $200,000 to pay back in student loans. I really can’t afford $3,400 a year for something that will most likely go unused (in case anyone is questioning that, I graduated in 2011, and the former reality of six-figure or upper five-figure attorneys no longer exists). Now, I would have purchased emergency only insurance, but there would be no point in doing that if I would just be fined anyway. It’s also fairly ridiculous to force insurance companies to cover adults on their parents’ insurance. Now, if it makes me any more credible that I have had health situations, I’ve had a broken foot, back injury, and chest pains, and never received treatment. I realize others probably disagree with that, but many injuries or illnesses do not require the intervention of a doctor. I want to emphasize that I do not believe I am invincible; I am only making an economic decision based on my finances, and that situation excludes purchasing something I will not use except in a real emergency. As far as "prevention," after seeing family members have great anxiety over a false positive result, I have no interest in participating in those measures. I do hope the ACA does what it’s intended to do. The problem is the cost of healthcare itself; insurance just increases to keep up with it. Perhaps this truly was the best option, and I hope others are able to benefit from it. It’s not about "my" good; it’s about the good of the general welfare, and I hope that this is the right answer. Thank you, Mr. Kaufmann for allowing me to post my lengthy opinion, and I hope I was not out of line in doing so.


The rich in the U.S. aren’t numerous enough to win the elections that provide control of the rule-making mechanism by themselves, so they combine with/buy off the much more numerous poor and middle classes by offering what they really want – the (supposed) ability to control other people’s behavior. (The rich and educated certainly don’t worry about such controls extending to their own behavior, off course.) So we come to expect promises to fulfill such desires as required prayer in the classroom (preferably a prayer from one’s own religious tradition – certainly no Native American or Muslim should expect to hear anything familiar.) No teaching of evolution in the classroom. The "below-the-belt" issues of abortion and gay marriage have earned more votes for Republicans than promises to balance the budget and cut spending. In the case of health insurance, as has been mentioned, what is being offered is the ability to think well of oneself (for being lucky enough to have a job that provides health insurance) and poorly of others (decent, hard-working people already have insurance, right?)The link of health insurance with a job is an historical accident, BTW – during WWII, wages were controlled but workers were scarce, so companies started offering health insurance – cheap at the time – as a benefit to attract what workers there were available. Now it’s an established tradition, and being defended for no other reason in some cases. The North (settled from northern Europe, industrialized, educated) won the Civil War, but has had to accommodate Southern (rural, – etc.) views ever since. If it weren’t for ending slavery, it seems at times like this that it might not have been worth holding the country together.


The claim that the U.S. doesn’t have significantly better health outcomes when it comes to treatments is false. U.S. cancer survival rates are better across the board. We have the best cancer treatment and research facilities in the world (Sloan Kettering, Cold Spring Harbor Laboratory, U Texas, etc.) Most breakthroughs in biomedical research come out of the United States. I know because my work is linked to these industries and I deal with it on a daily basis. I am also an expert in the history of biotech and biomedical science over the past 30 years. I have never understood the argument that since the U.S. spends more than any other country per capita then therefore we must get state-provided healthcare. First of all, this is a non-sequitur. Secondly, we spend more because the care is better. You pay more for a Mercedes than you do for a Toyota. The reason that places like Canada and the UK pay less is because services are capped and prices are controlled, thus leading to shortages, long waiting lines, banned medications, etc. It’s not that Canadian or English doctors are idiots; it’s that they’re not allowed to practice, essentially.Many Americans resist such systems precisely for these reasons. We also resist because we already have an entitlement culture in which people expect everything to be paid for by the government (i.e., working people) and the track record on politicians providing anything of value is not very good. Glib talk about "the rich" is a bunch of nonsense. Whenever I hear people say that "the rich" are the ones preventing "universal healthcare" in America I know I’m talking to someone who has no idea what he’s talking about. "Universal healthcare" seems to work in smaller, ethnically and culturally homogenous societies like Norway and Sweden. Hey, if it works for them I’m glad. But in the United States, where politicians have used "multiculturalism" to play everyone off against each other and create a paranoid, balkanized culture based on greed and entitlement, such a system would never ever ever work. THAT’s why we’re skeptical.


I’ve noticed a lot of arrogance above. "Americans are stupid" and those typical stereotypes. This is because people don’t know enough about the issues to debate, so they resort to insults and conspiracy theories about "the rich," etc. Try walking into the Cato Institute, the Hoover Institution, or similar American think tanks and challenge someone to a debate on health policy, and see how stupid Americans are. Walk into Pfizer or Merck and see how stupid Americans are. Look at the list of Nobel Laureates in chemistry, physiology and medicine for the past 30 or 40 years and see how stupid Americans are.These aren’t "real" or "typical" Americans, you say? Now you’re committing the No True Scotsman fallacy. For that matter, the average hick redneck is, trust me, no fool. There are these myths floating around among know-it-all "progressives" that those who disagree are merely backwater idiots who have been brainwashed into a false consciousness by "the rich." The average American knows his financial situation well. He knows exactly what’s going on and is actually very well informed. He certainly knows what’s better for him than the "progressive," who simultaneously insults that person while, in the same breath, demanding that he pay for the progressive’s healthcare.

For me it comes down to a couple basic points:1. There are few things that work better in the US when implemented by the national government, than they do (or would) at a state government or private level. Quick examples for me are the Department of Education and Department of Agriculture.2. Once something launches as a federal program it is almost impossible to decrease, eliminate or substantially change, even decades later when the needs of the country have completely changed. Examples again are the DOE and DOA above. These were both started decades ago, have not accomplished their original missions and have not adapted their goals to the country’s current needs, yet there is almost no chance they will be eliminated or substantially changed. Other examples are Social Security, Medicare and Medicaid which are in dire need of change, but are not likely to be changed even though these programs were developed 50 years ago or more.I understand how many people prefer a more "social" government contract with the people, and it may be right for their countries, however, the current program will be a mess in the US.As an aside, the cost of healthcare in the US, our biggest problem in terms of healthcare, was not addressed in the new health care plan.Universal healthcare is a laudable goal for the US and there are ways it could be properly achieved. A federal program, however, is not the answer.

Steve Kaufmann

Two facts still stand out. On the one hand, the US spends considerably more on health care than other countries in the OECD. On the other hand Americans are not healthier, do not live longer, and a significant percentage of the population has no insurance and can be reduced to bankruptcy by a catastrophic illness. In addition, health care is a major burden on companies. I still believe that universal health care coverage is practical, and also creates a sense of solidarity in a country. The practical details need to be worked out, and there are many examples of such systems, and as I said, Canada is not the model I would copy.


"On the one hand, the US spends considerably more on health care than other countries in the OECD. On the other hand Americans are not healthier, do not live longer, and a significant percentage of the population has no insurance and can be reduced to bankruptcy by a catastrophic illness."1. As I wrote above, spending more on healthcare doesn’t indicate a faulty healthcare system. You pay more for a Cadillac than for a Ford Pinto. Other countries spend less because they have price controls. Costs do NOT equal prices, which is why there are long waiting periods, as in Canada.2. Life expectancy is not a good indicator for a healthcare system either. If I choose to eat cheeseburgers and smoke cigarettes everyday of my life (which many many Americans do), this has zero bearing on whether the healthcare system delivers. On cancer survival rates, we outrun every other country. 3. Low-premium, high deductible catastrophic plans are available in the United States, but in certain states they’re not because the government mandates a minimum level of coverage, thus driving out low cost plans. Part of the problem is that the government has helped to destroy the insurance market while making everyone think it’s a free market. "I still believe that universal health care coverage is practical, and also creates a sense of solidarity in a country. The practical details need to be worked out, and there are many examples of such systems, and as I said, Canada is not the model I would copy."1. You must live in the United States to understand how deeply destroyed this country is, and no such large program would be possible or ever create "solidarity." Solidarity works in Norway, where everyone is of the same ethnicity, culture, and the population is small. In America, left wing multiculturalism has created entitlement and hatred, not solidarity.2. A comprehensive locally run healthcare assistance program would be best, run concurrently with a totally free private system. This has the best chance of working. I’m not against publicly provided healthcare, but I am against a) mandatory state socialist systems and b) misconceptions and falsehoods about the current American system.


To expand on my last point, believe the United States should:1. Leave healthcare to state and local governments2. Completely deregulate the healthcare and insurance markets by, to give one example, allowing insurance providers to sell across state lines, which they currently are NOT allowed to do.3. Abolish the HMO Act, which has distorted prices and subsidized failed insurance programs.4. End corporate welfare so insurance companies have to deliver instead of getting propped up5. At the same time as allowing market forces to drive down insurance and medical costs, create local or state healthcare assistance programs that provide care or coverage to whoever wants it. BUT: do not interfere with the private market. This way, if the state provided care is not good, people have the choice to opt out and go to the private market. This will create a bifurcated system in which choice, freedom and security are preserved across the board.6. Make the tax that pays for the public program voluntary, so that people can vote with their dollars and stop paying if the state continues its multicultural race baiting and giving care based on racial quotas, which, trust me, it would do and has already talked about

Steve Kaufmann

Robert,1. Yes health care should be a state responsibility, as it is in Canada.2. It is not obvious to me that the US system is worth the extra. Waiting periods in Canada are a condemnation of the Canadian system, not of universal coverage. France and Sweden, for example, do not have these waiting periods.3.Private delivery, private additional health coverage , yes absolutely and that is where the Canadian system falls down.4. Canada is not so different from the US, in that people come from all over. I still believe in the importance of solidarity amongst citizens and that is why I am totally opposed to the ideology of multiculturalism, of "celebrating the differences"

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