I come from a country with ”socialised medicine” and now live in another; but I’m married to a US citizen so have some experience of both sides of this. One thing that I find strange in all of these healthcare discussions is that Americans seem to spend a lot of time and mental energy worrying about the possibility of people getting health care that they don’t deserve - either because they don’t earn enough, or because they aren’t morally upstanding, or because they made lifestyle choices that we don’t agree with.
In countries with socliased healthcare systems (we just call it healthcare by the way) we don’t tend to worry too much about these things. Sure, the system isn’t entirely efficient, and some users cost more than others. But the overall cost of treatment is so much lower than it is in USA - and these edge cases people in the USA seem to worry about so much probably make up a tiny percentage of overall expenditure on health care. If we worry about avoidable health care costs at all it would be to worry about what we can do to avoid the cost of things like gunshot wounds and violence.
But rather than stress over the risk that someone somewhere is getting healthcare they “don’t deserve” we are far more worried by cases where someone was denied treatment they needed becuase they didn’t have cover. This seems to happen a lot in the states, and doesn’t seem to elicit nearly the level of concern that I would expect it to. To be honest though the reality is that we just don’t think about healthcare nearly as much as you guys do - for the most part its there when we need it, and its not something we have to stress about too much.
Sure there are some things that aren’t covered, but you’d probably be surprised as to how little. Where there are issues it tends to be longish waiting lists for elective surgery, or limited availability of extremely expensive experimental treatments. But under the current system in USA lots of people don’t get those anyway. One mistake people often seem to make is to compare a system like NHS that treats everyone, to the best possible healthcare in USA that very few people have.
This overlooks the fact that if I want to top up my NHS cover with insurance that will plug those gaps like waiting lists for non urgent surgery, I can buy very high quality insurance for something like £20 a month for an individual. Why so low? It doesn’t have to cover the cost of treating a road accident, or cancer, or any of the really expensive stuff, as the NHS deals with all of that. Heck, if I didn’t have private cover and really didn’t want to wait a year for say a joint surgery, I could pay out of pocket for private treatment and it would still cost a fraction of the cost it would in USA and would never get to the level of needing to sell my house to cover it, as I have known people in US have to do just to cover co-pays on a serious illness. That to me is unfathomable.
On the question of cost its worth pointing out that the US government alone currently spends more on healthcare than the UK government does - both per capita and as a percentage of gdp. Again, that is ignoring all expenditure on private healthcare, just the amount spent by govt - and we get universal cover for that price. That fact alone boggles my mind (see link below if you don’t believe this!) Of course there is so much inefficiency in the current system that you cant just remove all private spending at once without increasing govt spending, but it certainly shows what is possible and what you can aim for. FYI anecdotally I’d guess the three largest differences making up this gap are: 1. We don’t have all the bureaucracy of billing and insurance companies to cover; 2. Hospitals are usually a few years old and clean but slightly faded, no marble in sight but neither do we feel the need for it; and 3. Doctors are paid like middle class professionals, not rock stars. Think if all Drs got a salary in line with say a teacher or a CPA, instead of a hedge fund manager. But at the same time they don’t have to go into $500k of debt either.
Lastly as to the question of how do you judge the success of a healthcare system this is a problem that’s been pretty much solved. You guys go on about universal healthcare like its a really tough problem with no existing answer, like the Apollo landings. That’s just not true - pretty much every civilised country in the world already has some variation of it. Sure there will be particular difficulties in deciding the best approach for a country as large and diverse as USA, and in implementing it given the existing system and vested interests. But you could start by looking at WHO rankings, which try exactly to gauge the effectiveness of each country’s system and compare them. So there is an existing methodology there you can use to see how well the system works.
Honestly, I think it will be hard to do but once you have made the change you will look back and wonder how you could ever have coped without it, let alone why it seemed so controversial!
https://www.bbc.com/news/uk-42950587https://en.m.wikipedia.org/wiki/World_Health_Organization_ranking_of_health_systems_in_2000