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As much as I disagree with the unbridled spending that has been going on in Washington recently (but is just continuing a trend from the past several administrations), I just don't see any non-selfish reasons why someone would argue against having universal healthcare.

I mean, it's the 21st century! We were supposed to have flying cars and such already, but there's still tens of millions of people in our country that can't get treatment for even minor illnesses (which, untreated, can worsen and bring on deadly complications).

The only thing that I'm afraid of in this case (other than the cost) is that the system becomes too bureaucratic, where most people continue to use private doctors simply because there's too much "red tape" to get treated in a public facility.

I just don't see any non-selfish reasons why someone would argue against having universal healthcare.

How about "my kids can't afford it"

Or "increasing demand while keeping supply constant will NOT lower costs"

Or "I should have the freedom to come up with a million-dollar-per-ill cure for cancer and not have the government take it"

None of these are selfish.

I've got others, if you'd like to hear them.

I never said the costs would be lower. In fact, the cost issue is the only real argument I see against it.

Why not offer incentives (tax breaks, for example) to coerce the system into the right state? For example, if you go to medical school or nursing school and graduate in the top 50% of your class (from any accredited school), you would be automatically reimbursed for the entirety of your tuition by the government. This would create an incentive for more students to become doctors and nurses, which is sorely needed today; at the same time, it reduces the barrier to entry (the cost), creates motivation to do well, and also keeps the price of service (what the doctor charges you) down as well (since they're not having to pay back $200k in student loans).

At the same time, the system should require everyone to get certain tests on a regular basis (e.g. a yearly physical). If you don't take care of yourself at some kind of baseline level (the doctor should be able to tell from your charts), then you will be charged a "surplus" fee since you will be requiring more medical care down the road (e.g. heart disease due to lack of exercise). This would motivate people to get in shape, or at least they'd be paying for the extra costs of their own care. So, essentially, it's free as long as you play your own little part in the system.

On another note, all the people that I've heard argue against UH have all said that they don't want to pay for someone else's healthcare. While I understand where they're coming from (I hold mostly libertarian political views), you have to remember that the 'healthier' our society becomes (due to UH, or simply lifestyle changes, etc.), the "cost" per person is reduced. This is because healthier people are more able to contribute to society, rather than unhealthy people who must survive on the contributions of others.

Setting aside the bureaucratic monster this would necessitate, it just seems completely unAmerican.

How can you square fines for failure to exercise with "life, liberty, and the pursuit of hapiness"?

And where in the Constitution is the federal government given the power to perform these things? Even if it were a good idea, I can't see where it's legal for them to do so.

You would still be welcome to "life, liberty, and the pursuit of hapiness". No one would be forcing you to use said healthcare system, but if healthcare was totally free, what's to stop people from totally trashing their bodies then asking for organ transplants on the public dime?

In such a system, checks and balances need to be in place to keep people from 'gaming the system'. IF you wanted to use the public healthcare, then you should be forced to make some compensation back to the public if you are willfully (by using your right to not exercise, or you want to be a smoker, etc.) causing harm to your body which is then causing you need to need extra medical procedures and costing everyone money!

but if healthcare was totally free, what's to stop people from totally trashing their bodies then asking for organ transplants on the public dime?

I guess the government is the entity to stop us. After all, as you point out, once you start using public money to pay for something that makes it everybody's business, right?

So now the government is concerned with how I choose to totally trash my body, because it has an impact on public health costs.

And what part of this was good, again? Yes, the part where we got free stuff from some magic place. As much as we want!

No, you'd always be able to see a private physician if you wanted to pay for their services out of your own pocket. If you can afford that, then feel free to treat your body however you want. If you're going to be costing everyone else money because of how you're living your life, then you can pay the difference between the extra costs of your healthcare and the baseline amount spent on the 'average' person.

if healthcare was totally free, what's to stop people from totally trashing their bodies then asking for organ transplants on the public dime?

Hell yes, if healthcare was free, I would totally be trashing my body and getting free organ transplants - again and again - I just can't think of a better way to spend my time!

Seriously, what?

Some people think that way, they just don't say it like that. If you smoke two packs a day, drink until you pass out a few nights a week, and eat fried food every day, you're making conscious decisions that are affecting your overall long-term health.

My point was that if you're going to be using the public healthcare system (that everyone is paying for), then you should have to compensate that system for any damage that you purposefully cause to your own body that will drive up the costs of keeping you alive and healthy. If you live a reasonably healthy lifestyle and then get liver cancer because you're genetically predisposed to it, that's not your fault, and so you wouldn't be charged extra for it. If you got liver cancer as the result of living a hard and fast life, then yes, you should be compensating everyone else, or at least seeing a private physician instead.

So what is it about heath care that precludes economies of scale?

Just to run with your nothing is selfish theme which is born of "the fear" whether you are willing to admit it or not.

When was the last cure for a significant disease announced as opposed to a 'treatment' which locks you into a life long drug regimen?

So what is it about heath care that precludes economies of scale?

There is no fixed-cost capital investment that increases health care productivity dramatically. That is to say, the "health care factory" has not been invented yet.

A hospital of 100 doctors is only (roughly) 100x as productive as 100 doctors individually (unlike manufacturing, where 100 assembly line workers >> 100 blacksmiths).

Damn right, where is my flying car!

Seriously though, we are getting to a breaking point on several issues of which health care is just one.

Vested interests have legislative lock ins that create huge barriers to entry for new players.

The avenues for entrepreneurial success get narrower every year.

That's not the American Dream, that is a nightmare.

Creative destruction is desperately needed.

Nobody worth listening to is saying, "Hey, I don't want that guy to have health insurance! I want that guy to die in pain!"

It's just that when you get past the touchy-feely "Nobody should be poor! Everybody should have health care! Why can't we all just get along‽", and down into the real world of economics and finite resources, it's not so easy. It isn't all that hard to create a universal health care system that is worse than the one we have now, and there are all kinds of other issues, too.

You might get me to sign up for health-care vouchers provided from the government if you really insist, but all current proposals seem to just beg for further increasing costs as the health care industry is further isolated from pricing signals and beg even harder for regulatory capture within five years by the already-powerful health care lobby. (The idea that the medical lobby will be defanged by centralizing all the power is so absurd I can't believe anybody who can think the words "regulatory capture" can believe it for more than five seconds without bursting out in laughter.)

Like I wrote in my reply to "DanielBMarkham" above, I've actually heard people say that they aren't paying for someone else's health care, and that they simply don't care what happens to people without it. That's just a personal anecdote, but I'm sure the people who said that to me aren't the only ones out there.

I understand the real-world economics of the problem, but I think the real underlying issue is that many (not all, but a significant) number of Americans have simply become too selfish over the past 100 years or so. Those people simply aren't willing to sacrifice a little bit of their time and money to build a stronger community, because they don't see that they have anything to gain.

I also think that however this thing works out, it's going to become such a bureaucratic mess that it really won't be worth anything except to the most desperate people. The worst part is that we'll still spend the money, and it'll all get funneled away into mega-corporations without any real improvement in anyone's standard of living.

Unfortunately, there just isn't anything you or anyone else is going to be able to do to combat people's "selfishness".

It may not be the way we want things to happen, but nobody is going to be able to convince every facet of the population to give up portions (however small) of their livelihoods to "build a stronger community" for exactly the reason you mentioned: nobody can see that they have anything to gain.

But because insurance works best when the risk pools are largest, and irrational behavior among consumers (ie, spending zero in your 20s and free-riding in your 50s) will prevent those pools from being built organically, this seems like a perfectly sensible place for the government to apply regulation.

Oh, I completely agree on the regulation front - health care in this country is broken right now. I'm not in agreement with the current Administration's plans to fix it, but something needs to be done.

I just think that when people start claiming that "selfishness" is the underlying problem with our broken health care system, they're ignoring the pressures that brought on this "moral decline".

It's really no different than the far-right nutjobs who blame the state of our inner cities on the "laziness" of the people living there.

That's part of what I mean; "I don't want to pay for it" is simply one facet of the limited resource side, just phrased oddly. Moreover, you call it "selfish" but that is leaping to conclusions. Some people really can't pay for others, and the fact is that all of us have limits on how much more we can pay for. I'm not entirely averse to some contribution, but I do have my limits, both to what I'm comfortable with and what to what I can sustain even in theory, and in light of the creation of a system disconnected from price signals and with no particular incentive to stop consuming it's not "selfish" to become concerned; it's just rational.

I think a lot of these people, though by no means all, have far more complicated motivations and opinions than you think, and only a handful are really, truly saying "screw you all". (I think it's nonzero, but that gets into the "not worth listening to" class of people. These marginal people exist for all topics, though it's important to not classify large numbers of people that way.) Most people are not going to eloquently describe their full belief system, anymore than I have my own here, and even if they did, you probably wouldn't listen. (Any more than I would; this is not a criticism.)

I'd like to address the finite resources thing.

The American government has completely failed it's citizens. There should be plenty of money for us to have a vibrant all encompassing economy.

We are the most productive nation on earth per capita. We should be rolling in it.

But it's all gone. To the Caymen Islands, Austria, Switzerland and China. In private bank accounts and foreign government coffers.

That does not even include all them good old American Dollars held by all the drug traffickers or used by all those poor people in countries whose national currency is a joke where the defacto currency is the greenback.

Here's one: I don't want to watch my friends and family get poorer as they pay for my (potential) future illness.

You're afraid health care will become too bureaucratic? Are you familiar with health insurance companies? There's already a bureaucrat between you and your doctor - the fact that he's from the private sector doesn't change that fact.

And private sector bureaucrats have an incentive to deny coverage, purge rolls, etc. - it means greater profits. In the last twenty years, health insurance companies have gone from spending 95 cents of every premium dollar on health care to roughly 80 cents today. Where did that extra money go? Greater overhead and profits. Under a universal system, public bureaucrats wouldn't have the same incentives to deny care.

Just a friendly reminder that before you start spouting cliches about "bureaucrats ruining things" you should ask whether they already have - just not from the government.

Yes, surely the incentives are different. I don't at all believe that the public-bureaucrat incentives are better.

My wife is manager of budget & reimbursement at a hospital, which means that her primary task is working with Medicare and Medicaid officials. I don't think that a day goes by that she's not telling me about some inefficiency in the process. It might be the (literally) reams of paperwork they're required to produce, or unnecessary tests that are necessitated by Medicare rules, or the attitude she gets from the public employees she must talk to. But any time you hear that Medicare is more efficient, remember that because Medicare/Medicaid nearly comprise a monopsony, it's able to push many of its administrative chores onto the healthcare providers.

As an immigrant to the US, it took me years to realize that many Americans stayed in shitty jobs because they were afraid to lose their health care.

I second this personal anecdote. I bet other can say the same. I vague recall a study about this, but google fails me.

You sound like a good guy. I hope you never get sick while uninsured in America.

I too have spent a majority of my life without health insurance. I just haven't been as lucky. The Fear is truly unfortunate, but there's a reason people have it and it's not blind indoctrination.

Me too, and I am sorry for whatever you have had to deal with.

It is an embarrassment that you have had to deal with potentially huge financial repercussions in one of the richest and most technologically advanced countries in the world.

I agree that there are reasons to have the fear. Don't get me wrong, I have Alzheimer's and some interesting cancers in my family history, so I have some of the fear.

I don't exactly know how to phrase this, but did you actually have a choice, either financially or in terms of being true to your desires?

Do you have regrets?

I'm not advocating getting health insurance, exactly, but your life as you know it will end if you get seriously sick or injured. (Exception: if you have millions in the bank you're probably just fine.)

Personally I'm paying for health insurance, but only the bare minimum (rather high deductible). I consider it my rock climbing tax: insurance can give you some freedoms (the freedom to take a bit of extra risk, in this case) as well as take them away.

Not to be rude, but it doesn't look like you have been paying much attention to what Universal Health Care in the U.S. will actually mean.

I legally have to have, auto, workers comp [...]

And now you will legally have to have health insurance.

Insurance sucks. It costs a fortune, health, auto, liability, property, it's all a bad deal [...]

You have a bad attitude, but the health insurance companies won't have to worry about it much longer. You'll be paying up with the rest of the citizen-units.

Well, you thought you wanted Universal Coverage. You got it. Go America! Land of the free!

Yes, I am going to be pissed if we end up with the Massachusetts solution.

Just curious, are you working a job or are you making a go of it with your software biz?

There was never any doubt about what "Universal Coverage" would mean, not to me.

The popular view is that health care reform was about taking care of the American People. My view, health care reform was always about taking care of the health care interest groups (insurance at the top of the list).

I don't have a job, but I pay the bills from contracting, not from Homeschool Day Book. (So far I have not marketed it very well and don't have many sales.)