a reply to: musicismagic
Comparing Japan to the USA is about as fair as comparing Norway or Iceland. Socialized medicine works there because of demographic pressures that
just aren't the reality here. They are a far more homogenous society in terms of socioeconomics, culture, an overall personal health. Their
workforce participation numbers mop the floor with ours, meaning that they have more people working and able to pay taxes towards the system.
Furthermore, the makeup of their economy is much closer to what ours was in the 60's, with a literal army of midlevel white collar workers and an
incredibly strong working class base of well-compensated industrial workers and tradesman, rather than what we have today with a dwindling middle
class, an essentially dead industrial class, and a working class that is overwhelmingly comprised of low-skill, low-wage service sector workers. On
top of that, their population is far, far healthier than ours, with a better diet, more physical activity, and the incredible longevity to show for
it, with none of the HUGE socioeconomic-driven variation between diet and long term health that our country has.
What that means is that their population uses far less health resources than ours does, and is in a much better position to actually pay for the
resources that they use. Furthermore, they don't have the problem that we do where the bottom two quintiles are the sickest and often times rack up 7
figures in healthcare expenditures without putting 1/10th of that into the system over their lifetimes due to poor diet and poor self-care leading to
snowballing chronic conditions. So it's relatively easy for someone with the demographic balance and cultural/self-care homogeneity of Japan, Norway,
or Iceland to throw together a national system that provides good care to everyone at a cost that they all are OK with paying.
The demographic makeup of 2010's America, on the other hand, is precisely why an elegant solution such as Japan's is nigh-on impossible. So we can
A: A good system that is reasonable but shunts low-income consumers to free clinics and safety-net hospitals and rationed care at private hospitals;
B: A system that provides mediocre, if not awful care to everyone that is at least relatively affordable;
C: A system that provides good care to everyone and ends up being horrifically expensive;
But the USA, as it exists today, can't have all three.
The only other option is to get people back into the workforce, working manufacturing/industrial/trade jobs, completely change the diet/lifestyle
choices of the lower class, and embark on a demographic manipulation program to slow the birthrate among those most likely to consume far more in
healthcare resources than they will ever come close to paying into the system. I'm pretty doubtful that any of that is even feasible, much less is
actively going to happen.
So my hunch, as a healthcare provider, is that we're going to try a mix of B and C, as we are right now, and that it will fail spectacularly, causing
us to drift back towards option A, because that's honestly where the US was in 1980, before HMOs, EMTALA, etc sent the healthcare system into the slow
death spiral that it's still in today in terms of escalating costs that nobody seems to be able to afford. It wasn't equitable, for sure, but at
least the system operated in a state of sustainable, if somewhat dysfunctional equilibrium.
edit on 24-3-2017 by Barnalby because: (no reason