{"id":163202,"date":"2025-08-25T18:40:27","date_gmt":"2025-08-26T02:40:27","guid":{"rendered":"https:\/\/lukeford.net\/blog\/?p=163202"},"modified":"2025-08-25T23:24:51","modified_gmt":"2025-08-26T07:24:51","slug":"is-it-time-for-americans-to-get-some-socialized-medicine","status":"publish","type":"post","link":"https:\/\/lukeford.net\/blog\/?p=163202","title":{"rendered":"Is It Time For Americans To Get Some Socialized Medicine?"},"content":{"rendered":"<p>America&#8217;s healthcare systems seems absurd. It could surely be done better. What do you think about a base level of socialized medicine for all American citizens akin to what England and Australia have along with private options for those willing to pay? I suspect Trump would be down for this if he could get it passed. <\/p>\n<p>For years, I bought into Dennis Prager&#8217;s nonsense about <A HREF=\"https:\/\/lukeford.net\/blog\/?p=147484\">the bigger the government, the smaller the citizen<\/a>. Now, even though my inclinations are towards small governments and free markets, I don&#8217;t see a correlation in reality between the size of the government and the size of souls. <\/p>\n<p>So what would it cost to have Aussie-style socialized medicine?<\/p>\n<p>ChatGPT says:<\/p>\n<h2>Short answer<\/h2>\n<ul>\n<li>Federal \u201csticker price\u201d: roughly $18T\u2013$34T over 10 years depending on design. Urban Institute\u2019s bookends: \u201csingle-payer lite\u201d (covers legal residents with some cost sharing) adds about $17.6T to federal outlays; an expansive version with richer benefits\/no cost sharing adds about $34.0T. <a href=\"https:\/\/www.urban.org\/sites\/default\/files\/2019\/10\/14\/comparing_health_insurance_reform_options_from_building_on_the_aca_to_single_payer.pdf\">Urban PDF<\/a> \u2022 <a href=\"https:\/\/www.urban.org\/research\/publication\/incremental-comprehensive-health-reform-how-various-reform-options-compare-coverage-and-costs\">Urban explainer<\/a><\/li>\n<li>Mercatus estimate for the Sanders-style bill: +$32.6T federal over 10 years. <a href=\"https:\/\/www.mercatus.org\/system\/files\/blahous-costs-medicare-mercatus-working-paper-v1_1.pdf\">Mercatus working paper<\/a> \u2022 <a href=\"https:\/\/time.com\/5352950\/medicare-trillions-bernie-sanders\/\">Time summary<\/a><\/li>\n<li>Total national health spending (not just federal) could fall a bit or rise a bit. Urban shows national spending down under \u201clite\u201d but up under the expansive version; CBO says it depends on benefits, payment rates, and admin savings. <a href=\"https:\/\/www.commonwealthfund.org\/publications\/issue-briefs\/2019\/oct\/comparing-health-insurance-reform-options-building-on-aca-to-single-payer\">Commonwealth brief on Urban modeling<\/a> \u2022 <a href=\"https:\/\/www.cbo.gov\/publication\/55150\">CBO single-payer design report<\/a><\/li>\n<\/ul>\n<\/section>\n<section>\n<h2>What that implies for taxes<\/h2>\n<p>To finance on the order of ~$30T, credible menus include: ~32% payroll tax, or ~25% income surtax, or ~42% VAT, or some mix\u2014remember these replace most premiums and out-of-pocket costs. Clean summary: <a href=\"https:\/\/www.crfb.org\/papers\/choices-financing-medicare-all\">CRFB overview<\/a> and the detailed PDF <a href=\"https:\/\/www.crfb.org\/sites\/default\/files\/managed\/media-documents2022-02\/March2020_Choices_for_Financing_Medicare_for_All.pdf\">here<\/a>.<\/p>\n<\/section>\n<section>\n<h2>Would quality of life improve?<\/h2>\n<ul>\n<li>Medical debt and bill anxiety: Americans owe an estimated ~$220B in medical debt. Eliminating premiums\/deductibles (as in most M4A designs) directly attacks this. <a href=\"https:\/\/www.healthsystemtracker.org\/brief\/the-burden-of-medical-debt-in-the-united-states\/\">KFF\/Health System Tracker<\/a><\/li>\n<li>Financial stress and mental health: The randomized Oregon Medicaid experiment found coverage virtually eliminated catastrophic out-of-pocket costs and reduced depression and financial strain. <a href=\"https:\/\/www.nber.org\/programs-projects\/projects-and-centers\/oregon-health-insurance-experiment\/oregon-health-insurance-experiment-results\">NBER summary<\/a> \u2022 <a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMsa1212321\">NEJM paper<\/a><\/li>\n<li>Access and affordability vs peers: The U.S. ranks last among high-income countries on overall health system performance, with especially poor affordability; universal systems have far fewer cost-related access problems. <a href=\"https:\/\/www.commonwealthfund.org\/publications\/fund-reports\/2024\/sep\/mirror-mirror-2024\">Commonwealth Fund report<\/a> (PDF <a href=\"https:\/\/www.commonwealthfund.org\/sites\/default\/files\/2024-09\/Blumenthal_mirror_mirror_2024_final_v2.pdf\">here<\/a>)<\/li>\n<li>Mortality: Coverage expansions like Medicaid are associated with fewer deaths; scaling to universal coverage points in the same direction. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/22830435\/\">Sommers et al., NEJM 2012<\/a> \u2022 <a href=\"https:\/\/www.thelancet.com\/journals\/lanpub\/article\/PIIS2468-2667%2821%2900252-8\/fulltext\">Lee et al., Lancet Public Health 2022<\/a><\/li>\n<\/ul>\n<\/section>\n<section>\n<h2>The tradeoffs (no sugar-coating)<\/h2>\n<ul>\n<li>Utilization will jump when prices and cost sharing fall. Without added capacity, some waits lengthen. CBO: demand would likely rise faster than supply if payment rates drop and cost sharing goes to zero. <a href=\"https:\/\/www.cbo.gov\/system\/files\/2022-02\/57637-Single-Payer-Systems.pdf\">CBO 2022 illustrative options<\/a> \u2022 <a href=\"https:\/\/www.cbo.gov\/publication\/55150\">CBO 2019 design report<\/a><\/li>\n<li>Savings assumptions are make-or-break. Big system savings require: provider prices nearer Medicare than today\u2019s private rates, drug price negotiation, and real admin simplification. Urban\u2019s \u201clite vs enhanced\u201d shows how these knobs flip total spending. <a href=\"https:\/\/www.commonwealthfund.org\/publications\/issue-briefs\/2019\/oct\/comparing-health-insurance-reform-options-building-on-aca-to-single-payer\">Urban\/CF brief<\/a><\/li>\n<li>Who pays changes. Households\/employers likely pay far less in premiums and out-of-pocket, offset by broader taxes. Distribution hinges on the financing mix you pick. <a href=\"https:\/\/www.crfb.org\/papers\/choices-financing-medicare-all\">CRFB<\/a> \u2022 PWBM scenarios <a href=\"https:\/\/budgetmodel.wharton.upenn.edu\/estimates\/2020\/1\/30\/senator-sanders-medicare-for-all-s1129\">here<\/a>.<\/li>\n<\/ul>\n<\/section>\n<section>\n<h2>Context to keep in mind<\/h2>\n<p>The U.S. already spends a lot: $4.9T in 2023 (17.6% of GDP). M4A mostly shifts who writes the check, not whether the nation spends on health care. <a href=\"https:\/\/www.cms.gov\/data-research\/statistics-trends-and-reports\/national-health-expenditure-data\/nhe-fact-sheet\">CMS NHE fact sheet<\/a> \u2022 <a href=\"https:\/\/www.healthaffairs.org\/doi\/10.1377\/hlthaff.2024.01375\">Health Affairs 2025<\/a><\/p>\n<\/section>\n<section>\n<h2>Bottom line<\/h2>\n<ul>\n<li>Federal ledger impact for a true \u201cMedicare for All\u201d: roughly $25T\u2013$35T over 10 years depending on scope and payment rates. Benchmarks: Urban \u201clite\u201d +$17.6T; Urban \u201cenhanced\u201d +$34.0T; Mercatus +$32.6T. <a href=\"https:\/\/www.urban.org\/sites\/default\/files\/2019\/10\/14\/comparing_health_insurance_reform_options_from_building_on_the_aca_to_single_payer.pdf\">Urban<\/a> \u2022 <a href=\"https:\/\/www.mercatus.org\/system\/files\/blahous-costs-medicare-mercatus-working-paper-v1_1.pdf\">Mercatus<\/a><\/li>\n<li>Systemwide spending could be a bit lower or a bit higher than status quo depending on the knobs (prices, benefits, admin). PWBM shows initial national spending drops of 8\u201316% in scenarios with lower provider prices\/overhead; Urban shows national spending goes down under \u201clite,\u201d up under \u201cenhanced.\u201d <a href=\"https:\/\/pwbm.squarespace.com\/s\/Estimate_Senator-Sanders-Medicare-for-All-S1129.pdf\">PWBM PDF<\/a> \u2022 <a href=\"https:\/\/www.commonwealthfund.org\/publications\/issue-briefs\/2019\/oct\/comparing-health-insurance-reform-options-building-on-aca-to-single-payer\">Urban\/CF brief<\/a><\/li>\n<li>Quality-of-life upside is real: far less financial fear, fewer people skipping care, and likely better population health\u2014if capacity and implementation are handled. <a href=\"https:\/\/www.healthsystemtracker.org\/brief\/the-burden-of-medical-debt-in-the-united-states\/\">Medical debt data<\/a> \u2022 <a href=\"https:\/\/www.nber.org\/programs-projects\/projects-and-centers\/oregon-health-insurance-experiment\/oregon-health-insurance-experiment-results\">Oregon experiment<\/a> \u2022 <a href=\"https:\/\/www.commonwealthfund.org\/publications\/fund-reports\/2024\/sep\/mirror-mirror-2024\">Commonwealth Fund<\/a><\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>America&#8217;s healthcare systems seems absurd. It could surely be done better. What do you think about a base level of socialized medicine for all American citizens akin to what England and Australia have along with private options for those willing &hellip; <a href=\"https:\/\/lukeford.net\/blog\/?p=163202\">Continue reading <span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"footnotes":""},"categories":[220],"tags":[],"class_list":["post-163202","post","type-post","status-publish","format-standard","hentry","category-health"],"_links":{"self":[{"href":"https:\/\/lukeford.net\/blog\/index.php?rest_route=\/wp\/v2\/posts\/163202","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/lukeford.net\/blog\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/lukeford.net\/blog\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/lukeford.net\/blog\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/lukeford.net\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=163202"}],"version-history":[{"count":5,"href":"https:\/\/lukeford.net\/blog\/index.php?rest_route=\/wp\/v2\/posts\/163202\/revisions"}],"predecessor-version":[{"id":163207,"href":"https:\/\/lukeford.net\/blog\/index.php?rest_route=\/wp\/v2\/posts\/163202\/revisions\/163207"}],"wp:attachment":[{"href":"https:\/\/lukeford.net\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=163202"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/lukeford.net\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=163202"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/lukeford.net\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=163202"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}