[mobilefriendly]

Medicaid spending-- driven by huge federal incentives-- is crowding out state dollars for higher education. Medicaid enrollment has increased 50% in WV in the last decade (while the state population has declined). The US is making a policy choice to funnel more of GDP into a wildly inefficient health care system to support obese and aging populations, instead of funding K-12 and higher education.

[whimsicalism]

We are screwed on healthcare and most of the proposed "solutions" will only make things worse.

We need smart legislation to eliminate global free ridership on medication as well as less insurance, not more (combined with universal catastrophic high deductible insurance a la Singapore's medishield). We also need occupational licensing reform and to decouple healthcare from employment (ie. the politically impossible cadillac tax that Obama tried to push through).

Shielding people more from the true cost of healthcare is the politically popular option but does not improve health outcomes and drives utilization (and thus resource allocation) higher.

[Spooky23]

We’re getting the worst possible universal healthcare at the maximum cost.

In New York, 8 million people or 40% of the population are enrolled.

[evantbyrne]

Medicaid enrollment went way up but federal spending growth remained relatively close to the trend. They didn't even overhaul the system to combat the price gouging that is going on. To me this trial run proves the opposite of your conclusion: the US would be able to afford public healthcare if it adopted an intelligent model. We need to set the bar higher as a society when it comes to social well-being, not pull back on our ambitions.

[naijaboiler]

Or WV's population is getting older and pooree

[lotsofpulp]

In a situation with declining proportion of working age population (and lack of sufficient automation to offset it), one will lead to the other, as more and more of the share of resources from the working population are reallocated to the non working population.

[supertrope]

It's not so much a choice that we take pride in doing but a problem we have boxed ourselves into. Path dependency sucks. The benefit of a republic is that huge political shifts happen over a long period of time. Sharp changes only happen in response to an immediate crisis. Normally the system rewards grafting yet another patch onto the existing system instead of throwing it out and setting an entirely new set of rules.

Medical services became much more effective when physicians accepted scientific methods. Allopathic physicians used state licensing to restrict who could call themselves a physician. Due to post WWII price controls employers offered health insurance. Baby boomers did not grow up with the existence of all the drugs we have or neonatal intensive care units. People are still considered alive after their heart stops beating. Standards of care went up. Health workers' scopes of practice are carefully circumscribed by their license which does not transfer across state lines. The government agreed to pay for the medical costs of the elderly and poor, letting private health insurance skim profits from the lower cost working age population. Attempts to rationalize the system via a National Health Service, single payer financing, or heavy regulations on a universal private insurance market have failed. Instead the ACA just plugged the most egregious pitfalls for Americans and tinkered around the edges to try get everyone insured. Some states have chosen to not expand Medicaid to the detriment of their indigent population and rural hospitals.

If medical costs are to ever stop growing at 6% per annum the end result will likely be due to a combination of price controls, wait times and limits on care to hold down demand, lower health worker pay, free training for health workers, and rationalization of the system to incentivize population wide health. Switching from fee for service to per capita removes the incentive to treat more to generate more revenue. If universal eligibility is achieved that removes the incentive to refuse service to uninsured patients or discharge them ASAP. When outcomes are measured for the health sector as a whole, problems like hospital re-admissions or high co-pays that result in some patients not filling their medication orders get a harder look instead of being a perverse gain for one business and a bigger cost for the rest of us. Right now healthcare is run as a business. Each firm optimizes for the profitability of their link in the chain. The government tries to help those left behind by loading money into the top of the medical-industrial complex without ever making changes to the Rube Goldberg machine within.