We've spoken here before about our positive experiences with Canada's single-payer regional healthcare system. The only complaint about the system that has been confirmed is that certain elective surgical procedures (e.g., ACL repair) require waiting times that all agree are too long; but even here concrete efforts are underway (see, e.g., here) to rectify the situation.
Meanwhile, wait times for elective surgeries are the least of the concerns of several of my friends and family back in the States. Some have gone for years with no insurance (a few of the 47 million), unable to afford either premiums or needed treatment for ailments considerably worse than an ACL tear, but making too much to qualify for Medicaid; some have stayed in jobs they hated primarily in order to retain insurance covering a preexisting condition; one spent months on endless paperwork fighting against company goons whose primary job was evidently to find ways of denying rightful claims. Relatedly, health insurance is no defense against debilitating medical debt:
A recent study by Harvard University researchers found that the average out-of-pocket medical debt for those who filed for bankruptcy was $12,000. The study noted that 68 percent of those who filed for bankruptcy had health insurance. In addition, the study found that 50 percent of all bankruptcy filings were partly the result of medical expenses (14). Every 30 seconds in the United States someone files for bankruptcy in the aftermath of a serious health problem.
In retrospect it was crazy to think that a for-profit system would result in efficient, humane, high-quality care. But who knew that it would be as bad as it is? And who knew that socialized single-payer systems would be as good as they are? In any case, the evidence has long been in, and continues to be confirmed by countless stories (see, for example, this story and comment thread). So why does the U.S. continue along the clearly worse path? In this fascinating article Jill Quadagno discusses the history (1945-1996) of efforts to implement national health care in the U.S., and argues that U.S.ers have powerful stakeholder groups---notably, the AMA and private insurance organizations---to thank:
The United States is the only western industrialized nation that fails to provide universal coverage and the only nation where health care for the majority of the population is financed by for-profit, minimally regulated private insurance companies. These arrangements leave one-sixth of the population uninsured at any given time, and they leave others at risk of losing insurance as a result of normal life course events. Political theorists of the welfare state usually attribute the failure of national health insurance in the United States to broader forces of American political development, but they ignore the distinctive character of the health care financing arrangements that do exist. Medical sociologists emphasize the way that physicians parlayed their professional expertise into legal, institutional, and economic power but not the way this power was asserted in the political arena. This paper proposes a theory of stakeholder mobilization as the primary obstacle to national health insurance. The evidence supports the argument that powerful stakeholder groups, first the American Medical Association, then organizations of insurance companies and employer groups, have been able to defeat every effort to enact national health insurance across an entire century because they had superior resources and an organizational structure that closely mirrored the federated arrangements of the American state. The exception occurred when the AFL-CIO, with its national leadership, state federations and union locals, mobilized on behalf of Medicare.
Of course, it's not exactly news that powerful lobbies have been at work here. But the details are new (to me) and very illuminating: how physicians desiring professional autonomy teamed up with hospitals and insurance companies just long enough to shoot themselves in the foot; how post-war anti-Communist/Socialist propaganda led unions---the natural pro-single-payer lobby---to give up the fight for national health care and instead focus on fringe benefits; how the focus on benefits in turn led to the AFL/CIO's successfully lobbying for Medicare (basically, so they wouldn't have to worry about negotiating benefits for retirees); and much more.
A friend was asking the other day why someone should favor Edwards over Clinton or Obama for the Democratic nomination. That powerful medical stakeholder groups are the primary barrier to socialized national health care in the U.S. provides one very good reason; for Edwards is a former trial lawyer who was brilliantly capable in putting these very sorts of groups in their place (see here for some illustrations). That said, while Edwards advocates universal health care his proposal is a hodge-podge of measures still taken within the for-profit framework... a far cry from the single-payer proposal Ted Kennedy introduced in 1971. Too bad!