The public displays overwhelming frustration with the American healthcare system, perceiving it as profit-driven and inefficient. Many citizens advocate for reforms that ensure equitable access to affordable healthcare, drawing comparisons with more successful models from other countries. There's a strong call for competition and choice, but also moral pleas for comprehensive coverage for vulnerable populations. The discussion is marked by skepticism towards both government and market-driven solutions, indicating a deep polarization in opinions on how to achieve meaningful reform.

Government Officials

Healthcare Providers

Insurance Companies

Patients and Advocacy Groups

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"Look well into thyself; there is a source of strength which will always spring up if thou wilt always look.": Marcus Aurelius

maodiran

Former U.S. Medicare auditor here.

The biggest problem is the grossly inflated rates on each provider's chargemaster, a consequence of how insurance originally handled provider reimbursement.  The provider generated a bill after rendering services, which was submitted to the insurance company. The company paid it in full with minimal review.  This caused two major changes in behavior.  First, patients stopped examining their bills.  They weren't paying the bills, so they stopped considering it "their" bill.  Second, the providers began raising their prices at a rate greater than inflation. If the insurers were going to pay the bill in full without pushback, why not?

This continued until the insurers felt an economic pinch and started pushing back.  Unfortunately, their initial efforts weren't well thought out (this is a recurring theme - insurance became linked to employment because Congress and FDR thought they could manage the economy through legislation, and nothing weird would happen).  The insurer's first effort was to start paying a percentage of charges, which provided a perverse incentive for the providers to accelerate the rate at which they raised their prices.

At some point, LBJ decided that the government needed to be an insurance company, too.  Medicare regulations were generally well-intentioned, but didn't grasp all the facts on the ground.  They required a single chargemaster - everybody gets charged the same rate, regardless of insurer or insurance.  They prevented the discounting of charges to patients, but allowed "contractual allowances" for insurers, granting the Medicare program the equivalent of MFN status, so that the government always had the best "contractual allowance."

This did a couple of things, mostly unfortunate.  First, the single chargemaster ensured everybody would be billed the inflated rate.  This, combined with the inability of providers to provide discounts for private payers, screwed anyone without insurance.

Job-related health insurance was an accidental by-blow of FDR's attempt to freeze wages and prices during the Second World War.  However, he and Congress thought it was a neat idea and gave the expenses associated with providing this perquisite favorable tax treatment.  The providers jacked up the prices to the point that they have little relation to the cost of providing the services.  The government then "locked" those elevated charges in place through Medicare regulations.

LBJ's getting the government into the health insurance business will make getting out harder.  

The providers will fight red tooth and claw against taking a haircut via "Medicare for All."  Medicare is the least remunerative program, with the possible exception of Medicaid.

The insurers won't be enthusiastic, either.  Being an insurer pays better than being a Medicare intermediary.

The patient community will likely balk after they get Medicare for all, since part of the reason there will be cost savings is that the Medicare program is technologically conservative - they are slow to cover new technologies.

I don't imagine letting the government "wave its wand" over the problem one more time is going to solve the problem, especially in the current polarized political environment.

Wyndeward

To reduce the cost of healthcare you’d really have to get some really basic single payer system that covers anyone who wants it’s basic needs. That is to say, everyone has a baseline level of coverage that at least will not bankrupt you if you absolutely need the doctor for whatever reason, and, at best, can cover regular doctor’s visits. Couple this with more health insurance that you can purchase separate from your government plan to cover more or get you better doctors, lower wait times etc. would be a great starting point as those insurance companies would have to compete with a baseline and the most affected of our society would be helped too. However, the cost is something that is highly debated, along with the problem of should states get allotments of money to give insurance or should the federal government step in and give it directly to the citizens of the union. Who’s to say? 

But one things for sure, that system that exists in the UK is by far the worst system I’ve ever had the displeasure of interacting with when I needed help for a few medical issues when I was living in England. Also, my wife is from the UK and she has gotten no help and the help she has gotten, she had to fight tooth and nail for.

Kind-Extent-9284

The things that will work the best are two programs that are already working. Direct Primary Care and upfront pricing. As far as everything else, insurance and government assistance can be reserved for expensive situations and emergency situations. That won't solve everything but it is the best plan we have without real leadership.

brinerbear

A capitalist system would be the best, but we don’t have a capitalist system.  In an effort to “improve” healthcare, we changed the buyer from the patient to the insurance company which corrupted the whole system.  

I think we need pure capitalism for “healthy” Americans, and a Medicare type system, indexed off the capitalist system but subsidized by the government, for those with severe and chronic health issues. 

In all cases, the insurance system needs to be more like car insurance.  You pick the provider (no networks).  The provider has the responsibility to argue your case to insurance to get them to pay.  You are simply held to a deductible. 2 deductibles: one for max out of pocket for the year, and another for max per instance.  Rates will be reflective of deductibles.

Affectionate-Bite109

Any government assistance of any kind ever becomes the new zero in every equation. It becomes the bottom. At the same time it also becomes the one thing that people that refuse to work flock to they want it for free and they want it now.  

The socialized medicine path always is the exact same thing offer the bare minimum of care. Tell the masses it’s free. Hope and pray that somebody else does the R&amp;D that you can just steal a copy.

guppyhunter7777

I need to have a reasonable approximation of much something costs before I have it done.


Only in healthcare am I unable to find out the cost of a service ahead of time. 

GoonOfAllGoons

Deregulation and patent reforms. There are so many hoops to jump through that being a doctor, being a nurse, running a hospital, running a pharmacy, running an insurance company.... It's so expensive, you need on-staff experts in medical law experts, and it stifles market competition; the main driver for cost reduction. Insurance companies have so many laws on how and where they offer insurance and many were clearly put in place to ensure the existing providers don't have to worry about new companies starting up and stepping in and undercutting their profits. And with the way the patent system is set up it's really easy for companies to exploit and keep drug costs artificially inflated.

No I'm not saying to cut all laws and turn the industry into the wild West. What I am saying is that at this point we need to go through the laws with a buzzsaw to remove the laws that were clearly put in place to insulate current businesses/practices.


And if we are going to spend tax payer dollars, I have a hot take: how about we have a tax refund that people can get back each year for maintaining good health and maintaining a healthy lifestyle, especially around BMI?

StoicNaps

We have a hybrid system, The ACA and private insurance.

Unable-Expression-46

No. It’s completely unfair competition when one side has to worry about being a profitable business and the other doesn’t and just prints more money when they need it because government.

shouldhavekeptgiles

I would take the V.A. model and expand it to all people in every state. It is superior to to Medicare and Medicaid in that the V.A. controls costs directly as it employs doctors directly.

As far as controversial issues - states would make their own rules on abortion or trans related care.

Thats what I would do if I were dictator for a day.

neosituation_unknown

I would be fine trying that. I am more than okay with universal healthcare. I just don’t want healthcare to become so cheap that no one wants to become a doctor or nurse. We need some competition. 

But we sort of do have a hybrid system. Millions are on government healthcare while millions are on private. It all goes through the same companies. 

My healthcare is really, really cheap as a young person. Like $30 a paycheck cheap. $200 visit to the ER is just not worrisome to me. $69 doctor visit is fine. $10 for a prescription is cheap to me. It feels easy to get my moneys worth. 

If I was 70 and paying $4000 a month for everything I’m sure my opinion would be do whatever possible to make it free. Which is why we have and spend so much on Medicare.

Jeeblitt

Talking about healthcare reform without tackling legal reform is futile, as costs won't drop a penny without a complete overhaul of the legal system.

New-Conversation3246

The biggest reform is to get rid of employer-controlled healthcare.  

All citizens and legal residents should have a voucher to purchase private healthcare insurance.  Employment has nothing to do with it.  Consumers are in control and insurers must compete for business licenses like auto insurance.

hgqaikop

I would support a universal catastrophic coverage plus screenings.

uisce_beatha1

It’s hard to know of course but ending the you-can-enroll-anytime provision could create big shocks. 

I don’t think this has been studied extensively, at least not in public. The only example I could find [was from 2015.](https://www.urban.org/sites/default/files/publication/74561/2000522-More-than-10-Million-Uninsured-Could-Obtain-Marketplace-Coverage-through-Special-Enrollment-Periods.pdf?utm_source=chatgpt.com)

robbyslaughter

CaliJaneBeyotch

13. **FINALIZED:** **Self attestation of income is no longer permitted.**

So this will be an issue for new "early" retirees. IRS Tax records will show previous income that's no longer valid! . How can future 2026 income be proved if you have not yet stated taking distributions?  I've been looking around, but can't find this fact being talked about anywhere?

Wmacky

Will there be any way to determine how these changes might effect us before November?  I have a new job opportunity and it includes healthcare.  I am currently self employed and my only option is ACA.  Knowing my options for next year and how they might change would help me determine if I should accept the employment opportunity that includes healthcare.

Honest_Rule_8007

Maybe I’m too optimistic but I think the next president is going to be either a democratic socialist or at least someone who leans heavily that direction. People are going to want big change after seeing how many people this regime has harmed and killed. I think universal healthcare, or at least an expanded Medicare system and healthcare reform, will be ours if we can oust this regime. 

(At least these are the things I tell myself to prevent myself from spiraling in the doom of all this.)

Individual_Crab7578

Probably. Even if we do come back from this it will take a lot to get to even where we were prior, IMO. Not to mention the brain drain happening ATM because doctors and scientists are leaving the country.

Sad-Specialist-6628

The current healthcare system in this country personally brings me a lot of stress and I also wonder this. I feel like there is so much going on right now that tackling this issue has definitely been put on the back burner. I voted in my states democratic primaries a few weeks ago and only one of the six candidates for lt governor even mentioned healthcare in their platform. It was really disappointing and it's starting to feel kind of hopeless that health insurance is going to keep controlling ourselves.

TFA_hufflepuff

I feel like these cuts will break things so badly that we won't be able to do anything but radically overhaul everything. Maybe that's the tiny seed of optimism that hasn't been squeezed out of me.

new-beginnings3

Healthcare in the USA was terrible even before this administration. It needs a complete overhaul &amp; not to be politicized. Healthcare and coverage for it / the people of this country has long been a large issue &amp; needs to change.

CityIslandLake

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Sure, I'd like to see reform, but towards a system with less involvement by the government, not more. Get rid of aca minimum coverage requirements so people can actually buy catestrophic coverage. Get rid of pre-existing condition requirements that force insurance rates through the roof for most to lower them for a few. Completely rework fda approval processes so that competition doesn't get drowned by regulatory costs that only giant companies can cover, and sometimes aren't even required to. Overhaul patent law so that companies can't just monopolize entire treatments.

DieFastLiveHard

US healthcare is broken!  Has been for a long time.  Obama care only highlighted the fractured parts.  

We should not have to go broke paying for emergency surgery or an ER visit even with employer sponsored commercial insurance . Deductibles of $1.5k at the cheapest, out of pockets at the cheapest of $7k maximums others at 20k are ridiculous.  

My last employer I was paying over $500 every two weeks for insurance for myself and my wife.  $1000 a month For two fucking people!  Then I still had an fsa or Hsa the deductibles and OOP.  

All of this to line health insurance CEO’s and healthcare CEO’s pockets.  Healthcare needs to be taken away from for profit corporate greed and run state by state.  I will gladly pay a tax if we all have healthcare and I never see a bill.

1nt2know

Yes. I want people to actually have options if they don't get health insurance from their employers because if they don't they're usually SOL

baselesschart39

Yes, but almost certainly not reforms that you'd be likely to agree with. 

&gt; I find it odd how government funded healthcare options over in the US seem to get widescale pushback from conservatives

Why do you think that's odd? American Conservatives tend to be classical liberal supporters of free market economic systems.

jub-jub-bird

Yes

Nationalize health insurance

Switch it to a value-based care system

Increase clinical payments to fully compensate hospitals (currently lose 20% on every patient)

Make up extra spending by lowering pharmaceutical payouts and adding pigouvian taxes on unhealthy foods

Decrease costs by improving health through higher food and environmental standards

Drag vision and dental under the health umbrella (dentists and optometrists will have to forget their 200-year-old grudge)

Keep copays for nonchronic visits like france

Crib from either France to have a sliding scale of percentage compensation or from Japan to basically just have deductibles

Lamballama

Easy.

Because most Americans actually like their health insurance. Reddit Progressives do not represent reality.

https://www.ahip.org/news/articles/new-poll-strong-majority-of-americans-satisfied-with-employer-provided-health-coverage#

And:

“Sens. Bernie Sanders and Elizabeth Warren may not like private health insurance, but many Americans do.

Some 71% of Americans rate their private coverage as “excellent” or “good,” according to the latest Gallup poll, released Monday.”

https://amp.cnn.com/cnn/2019/12/09/politics/gallup-private-health-insurance-satisfaction

No_Adhesiveness4903

I would support universal healthcare if we banned abortion.

random_guy00214

Do it state by state. Everyone attacked Romney about Romneycare, but saying that what Mass wants and forcing something on the entire nation are entirely different, was one hundred percent correct.

[deleted]

Yes. And I am annoyed that conservatives defend an over regulated, corrupt, and anti free market system because they don't know how to solve problems anymore. 

We don't have to support a system where we spend the most per capita on healthcare in the world, and receive some of the worst outcomes. We don't have to support a system rife with corruption that serves special interests first, and provides healthcare second.

In my opinion, the best way forward would be emulate Switzerland's system. They have private healthcare that is administered on a state level. The federal government ensures a minimum standard, and a portion of taxes go into an individual health savings account. If someone has exhausted their account and can't afford to pay, the rest is subsidized. 

That seems to be the most compatible for the US, and would certainly be an improvement over the current system.

Skalforus

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Reform implies government regulation. And it is my sincere belief that there is no potential government regulation in America that could have bipartisan support.

jadedflames

I think Americans have to be honest in that a lot of us have unhealthy habits that end up being extremely expensive to treat. Subconsciously (or openly) folks don't want a system that *might* force them to, for example, eat less sugar or take more walks.

formerrepub

One interesting one I read or I should say heard about was banning employer based insurance plans.  The logic is this.  If competition drives down prices.  Then having an insurance plan based on an employer group effectively removes one of the aspects that drives down costs by having less competition via plans that are available.  If you did away with this, you add 160 million more people into the public healthcare space needing insurance.  Which then changes it so that all insurance companies are competing in the market for those plans.  People might not like this but it does make sense in that aspect.  If you couple that with reforms on and regulations and shape it to be more similar to how Germany and Switzerland operates it could be a win.

Wermys

Probably none. The views of each side are polar opposites on the subject. More regulation vs less. I don’t see a compromise happening.

bones_bones1

More healthcare subsidization for anything related to childbirth and children's medicine. Demographic collapse and declining birthrates are bipartisan issues. Democrats have an interest in expanding healthcare coverage, but Republicans would largely be the beneficiaries of this because they generally have more children. I think it would be an easy sell to Republicans when you frame it as a matter of strategic national interest, and as an issue of maintaining our native population stocks in the face of increasing immigration.

lesubreddit

I’m Canadian so a bit biased. 

Part of what I see is democrats not willing to fight to turn 30% approval into a higher number. 

Our universal healthcare is wildly popular. It’s a winning issue. But democrats don’t seem to think they can change public opinion, so they don’t bother. 

Bernie being popular should be a sign that a younger and more polished politician could become very popular if they embraced Medicare for all. It’s just no one has.

nazbot

Consider that money is speech in the US. Those with more money have more "speech" or influence with politicians. The health care insurance agencies and big Phrma have a lot more speech than any citizen and they are dead set against any reforms that cut into their profit margin.

billpalto

Healthcare, and bipartisan support.....hmmm.....

A new system under which everyone is fully covered for all medical expenses,  and which somehow costs the people and the government almost nothing.  That should do it!

/S

davethompson413

The only way republicans would accept a European/Canadian style SPS would be if ‘those…um, people’ didn’t get it. 

For any given value of ‘those’.

paleotectonics

None that would be any good. Too many  people think they can just wave the Magic Wand Of Government and get something for free. As long as that belief persists, nothing good can come out of government reform efforts.

hblask

Call considering Americans are willing to celebrate the death of a health insurance CEO. Replacing the for-profit health insurance industry with a non-profit national Health Care service. 

One that allowed some variation between the states and did not require abortion funding is probably the best option for a health insurance reform that people on both sides of the political aisle in the general public could agree with. 

The problem is that the people in charge would never go for it. As they're in the pockets of trillionaires and the only thing they're rich black more than compassion is imagination

XxSpaceGnomexx

Can we please stop prioritizing bipartisanship. The only time it actually happens is when they want to screw the American people.

96suluman

I think the failure is seeking bipartisanship with a group not interested in negotiating in good faith.

When it came to economics, the Trump campaign don’t care that economists overwhelmingly torched his economic plan (tariffs will save us) saying that it will make the economy worse.

Trump didn’t care. Trump was talking to the dumb American voter that doesn’t listen to those “elitist economists”. 

Being right is secondary to winning. Winning is the primary goal. And democrats can’t help people if they don’t win.

So whatever plan makes sense to dumb people is the way to go. Shout it from the rooftops. Blame republicans for wanting to keep the current health insurance status quo. This is such an opportunity that democrats are wasting.

“WE WANT TO FIX YOUR HEALTHCARE. REPUBLICANS AND TRUMP WANT TO KEEP THE CURRENT SYSTEM. THE CURRENT SYSTEM IS THE WORST HEALTHCARE SYSTEM IN THE DEVELOPED WORLD. THOUSANDS GO BANKRUPT EVERY DAY DUE TO MEDICAL DEBT. REPUBLICANS DONT WANT TO SUPPORT CHANGING IT. THEY DONT WANT TO SUPPORT YOU. WE SUPPORT YOU.”

Shout it every day on every news channel from now until 2026.

BotElMago

Screw federal healthcare.  Implement universal healthcare in blue states, with reciprocal coverage between states that have coverage.  Tie coverage to 5-ish years of residency to avoid "healthcare tourism".

mypoliticalvoice

After comparing healthcare systems across various nations, I believe only Germany's model is viable for the US. Insurers exist, but they're all regulated and are non-profits. Its impossible to abolish and upend the current insurance corporate landscape, so instead the goal should be to reconfigure them to fit the welfare needs of the country.

illegalmorality

Medicaid Expansion 

The biggest issue a lot of Americans have with healthcare is that it’s Byzantine and run by out of touch healthcare companies. Obamacare has allowed each state to create Medicaid programs to help give low income individuals bare minimum healthcare services with the federal government reimbursing and helping fund a portion of it as long as the programs hit some metrics. 

These Medicaid programs should be expanded to cover the gap and provide a defacto Public option for state residents. 

Instead of Medicare a federal government healthcare agency we’d have 50 separate Medicaid state government programs that would be held accountable by their state residents and the federal government.

LuigiTheTweak_eth

Anything short of the elimination of the private health insurance industry and a new robust and militant government entity tasked with negotiating medical costs and having the ability to strike back at companies that act maliciously ... wouldn't be enough.

DreamingMerc

Healthcare Gulags and public suicide booths.  Work off your medical debt at 7.25 an hour, minus food and lodging. Require the medical prisoners to wear a pink jumper and encourage the public to spit on them. Also gas vans for the recalcitrant unemployed who won't use the suicide booths.

batlord_typhus

I can see legislation pushing the burden of out-of-network doctors on the hospital and insurance companies instead of the patient. You can read endless stories about how the patient is in an environment where everyone is in-network except for that one individual. And that one individual never reveals it and its only found out after the care is done. Literally poisoning the well. Once hospitals and insurance have to pay for this, I guarantee a major improvement in patients insurance billing.

Can we please stop prioritizing bipartisanship. Because the only time it tend to happen is when they want to screw people.

When politicians try to do bipartisanship for good reasons. The elites will claim it’s the horseshoe theory.

Medicare for all is a MAGA Republican proposed it.  

(Which highlight the hypocrisy of republicans).

Sands43

I believe a tiered Medicare system. A basic tier for adults who are not working. Just enough to keep you healthy so you can get a job. A mid tier for all kids and working adults and their spouses. A top tier that you buy into to get front of the line status for treatment, after triage and better rooms in hospitals and the most cutting edge medical treatments. This top tier generates money to offset everyone else's cost.


I think this would work well in the US. A punishment for people who don't work and something extra for the rich. I don't think a truly equal system for everyone would work here, not when you need Republicans to sign on.

Accomplished_Fruit17

New proposals for healthcare reform are being debated in Congress, focusing on expanding access and reducing costs for Americans.

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