America has the NHS but it's far from universal
Everyone has an opinion on healthcare because nobody wants to die
Health care has been a top issue in almost all of the last elections.
And it is very controversial. "Universal health care" is a commonly proposed solution to these problems. Looking to Europe for inspiration, the NHS is a perfect example (yes, I know the UK is not technically “part of Europe” anymore). Why can’t we have a universal health care system like the NHS?
Universal health care is a noble goal. I think 99% of citizens would agree that making more healthcare available to more people is a good thing. It is a good thing, unless of course it comes at a cost to someone. And since healthcare is produced by other humans, it always comes at the cost of labor from a doctor, nurse or other healthcare practitioner. This is a pie that is hard to grow in a positive-sum way. Especially when you consider the demand for healthcare is inelastic because nobody wants to die. But unfortunately, it is a slippery slope to demand entitlement to something requiring effort and labor from other people.
Medicaid is the NHS but it's not universal
What if I told you the US does have massive social health programs: Medicaid and Medicare. Medicare is for old people and Medicaid is for poor people.
Let’s turn our attention to Medicaid. Medicaid is free, single-payer and taxpayer-funded. Smells an awful lot like the NHS to me.
Let's look at the super high-level economics.
So if you define the NHS as "a taxpayer-funded healthcare system serving 67 million people" then it looks like we also have an NHS in the US. Only with three times the budget per head.
But it's not universal. It's for everyone besides those who pay for it. Those who pay for it don't get to use it.
Why would we not expand Medicaid to cover more than a fifth of the country by spreading the budget thinner—but not so thin that we drop below the gold standard of Europe? We could cover twice as many people on Medicaid while still spending more per head than the NHS.
And then some also pay an age tax (premiums)
Unfortunately it doesn’t stop there. Instead their reward for paying this system is another massive bill in the form of extortionate premiums. These also begin to look a lot like more tax (4). And that's before the deductible. But at least with the deductible—after paying for the NHS that is not for you, and paying premiums to subsidize many others—you actually receive healthcare in exchange for your money.
True universal healthcare would be allowing these people access to the Medicaid which they fund. They would then always free to pay for extra healthcare as-needed ("going private").
Universal healthcare is indeed a noble goal. Let's make it happen.
PS
1. I would like to point out that the US system suffers from cost disease so the "cost per beneficiary" is not fully apples-to-apples.
2. I encourage you to check out this calculator to calculate your "subsidy" for health insurance premiums.
3. I enthusiastically admit there is likely nuance here that I am missing. I just don't think there is enough to really move the needle due to the insane numbers presented above. If it is, let me know how in the comments.
4. The cost for me and my wife (no kids, in our 20s) is $680 a month for a "Silver" plan with an out-of-pocket maximum of $17,400. This is 8.5% of our **gross** income. The probability that we will exceed this maximum is vanishingly small. It scales with income and directly gives back nothing in return. This is starting to look like more tax to me.
5. I am not trying to argue that we should ration healthcare like Europe. I am just trying to get everyone on board with the numbers and how they are mostly just more tax. The why behind these numbers is a bit above my pay grade because I am not a doctor or nurse.