What does the failure for states to implement single-payer healthcare tell us about the viability of implementing it at a federal level?
Nothing at all. The Federal government already has a single-payer health care system. It’s called Medicare. You need to be age 65 to enroll. It works great. By most indications, it’s the most successful insurance plan in the United States.The question should be, how do we pay for Medicare for all. Like most issues in the United States, it’s a false debate. If we had a single payer, universal health care system we wouldn’t all be paying so much for private insurance through our employers or as individuals. The money saved from the private market, which is far less efficient and more restrictive than Medicare, would simply be deployed to fund Medicare for all. At the same time, the power of a single payer would force savings throughout the health care delivery system, from doctors and hospitals to pharmaceuticals.Which is, of course, another reason why so many groups, focused solely on their own best interests rather than the country’s, are opposed to federally provided, universal health care for all.
How do other countries afford single-payer health care when the US cannot?
I suggest you read Krugman’s Conscience of a Liberal or similar more recent comparative literature on the cost of healthcare in the developed world. The systems in the UK, Canada, France, Germany etc vary but they all get better health outcomes for less money than the United States.Since I’m British I’m most familiar with the NHS. You will hear that it is expensive and in deficit and has high administration costs, which is true partly because of the rising costs of care and partly because of under-funding. It still gets equivalent health outcomes for citizens at about half the price of the American system. [Culturally we are not so different so this is an acceptable comparison, even if the UK is a much smaller country.]This is partly because there is no profit motive and a strong drive to provide the best possible care within a fixed budget. The NHS also benefits from an economy of scale and has the power to keep prices lower when it negotiates for supplies and drugs etc. So the NHS gets a lower price for essentials than the US system. I can’t speak to doctor and nurses salaries, but they are probably lower also. The UK also has a body that decides which services and drugs are covered and includes an assessment of cost and effectiveness. This means less waste, overcharging and unnecessary procedures (such as elective cesarean births). Now compare that with the inflated prices in the US and burden of administration negotiating over prices and payments and you begin to see just part of why ‘single payer’ is not just cheaper but more cost effective.No system is perfect and I’m certainly not saying the NHS is without problems - there are imbalances in coverage and the system can be slow to introduce new treatments BUT nobody is too poor for treatment whether for cancer, a chronic condition or an emergency. Having a baby is not a financial risk, prescriptions for essential medicines don’t cost a fortune, you can’t be denied care because of a ‘pre-existing condition’ etc etc etc.I hear the Canadian system is similar. The French and German systems are different but work well with less money than the US system. What is lacking in the US, in contrast to these comparable systems, is the political will to prioritize health outcomes and coverage over the insurance, pharmaceutical and provider markets, and their ‘right’ to make a profit.