Trumpcare is the best Advertisement for Nationalizing Insurance

By Juan Cole | (Informed Comment) | – –

The sadism and greed of the American Republican Party was on full display Thursday, as the House GOP voted to destroy Obamacare and remove the coverage for pre-existing conditions (50 million Americans suffer from them). Oh, this sabotage is camouflaged, but the way Trumpcare would work would make health insurance too expensive again for the 40 million people who were uninsured in 2008. People will be shifted into pricey high-risk pools. Ending the individual mandate would ensure that healthy young people were exempted from having coverage, making it impossible to establish pools so private insurers can cover pre-existing conditions or chronic ones and still remain in business.

Apparently what the old white men of the GOP minded most of all about Obamacare was that it removed from the more racist states in the union the ability to shield rich white taxpayers from paying to keep the children of minorities alive. (Their image of the situation is anyway false; half of those living below the poverty line are white).

Here are some of the countries that are better than the US Republican Party:

President Hassan Rouhani of Iran has pledged universal health coverage in Iran by 2018. The GOP is always going on about how Iran is the world’s major sponsor of terrorism (this is not true), but even these bloodthirsty ghouls apparently are better than US Republicans inasmuch as they want to make sure poor children don’t have to just die for lack of money to pay for treatments.

Then there is China, where the government has successfully covered all 1.3 billion citizens. The Republican Party has made its way in the world by promising that if some businessmen are allowed to get fabulously wealthy that will lift all boats. What they said Thursday is that there are 40 million boats they won’t be lifting. But now the Chinese Communist Party has shown that it really can lift all boats.

Given the serious commitment of the Chinese Communist Party to green energy and meeting the goals of the Paris Accord, and the way in which it has lifted over a billion people out of poverty and given them universal health care, it seems obviously a superior party to the American GOP if you don’t happen to be a billionaire. It used to be boasted by the US Republicans that they provided an increased standard of living as well as democratic freedoms, but they don’t seem nearly as committed to either of these goals as Beijing is.

It is not clear why there is private health insurance. There are some things that the market does poorly and should be nationalized, as is the case in most advanced countries. The electric grid is another. The American myth that all government enterprises are inefficient and monopolistic ignores the fact that most large corporations in the US are de facto monopolies and are not particularly efficient.

The one percent who profit from health insurance will also try to tell you that government health care takes forever to see you. America’s privatized system also can take a long time to see you. Anyway, nationalizing health insurance would not stop people from going to a private hospital and paying out of pocket if they wanted to.

Here are the countries with a single payer system, which is defined this way “The government provides insurance for all residents (or citizens) and pays all health care expenses except for co-pays and coinsurance. Providers may be public, private, or a combination of both.”

Norway 1912 Single Payer
Japan 1938 Single Payer
United Kingdom 1948 Single Payer
Kuwait 1950 Single Payer
Sweden 1955 Single Payer
Bahrain 1957 Single Payer
Brunei 1958 Single Payer
Canada 1966 Single Payer
United Arab Emirates 1971 Single Payer
Finland 1972 Single Payer
Slovenia 1972 Single Payer
Luxembourg 1973 Insurance Mandate
Italy 1978 Single Payer
Portugal 1979 Single Payer
Cyprus 1980 Single Payer
Spain 1986 Single Payer
Iceland 1990 Single Payer

None of these countries is bankrupt. In fact, health care costs in these states are lower than in the United States and in many of them health statistics are superior to those of the US. Spain, Iceland, the UK, Portugal and Italy all have a life expectancy higher than the US.

Over a dozen other advanced countries have a two-tier system: “Two-Tier: The government provides or mandates catastrophic or minimum insurance coverage for all residents (or citizens), while allowing the purchase of additional voluntary insurance or fee-for service care when desired.”

Many two-tier countries also have lower health care costs and better health statistics than the US.

The US is the only advanced economy where millions are left without health insurance and are one illness away from bankruptcy and one paycheck away from dying or seeing their children die.

Even developing countries like Ecuador have quadrupled spending on health care and have markedly improved the lives of those living under the poverty line.

Raw American capitalism hasn’t increased the average wage of the average worker since 1970. It apparently can’t provide universal health care insurance to Americans. It is time for the American public to realize it is being taken for a ride. There are several industries that need to be nationalized. The electrical grid and some utilities are on the list, in order to fight climate change. But really, the only proper response to the vicious brutality that is Trumpcare is to punish the insurance companies who bought and paid for the congressmen that voted it in, by just having the government take over their industry.


Related video:

h/t Chris Hayes, All In @MSNBC

Bernie Sanders 2020: “Donald Trump Admits Single-Payer Healthcare Is Best”


45 Responses

  1. I certainly agree about single payer: Medicare For All! (Disclosure: two of my children are practicing M.D.s.)

    However, the existing utility structure is adequate, I opine. We just have to provide incentives for turning off carb dioxide emissions producers. Those more informed than I opine that a tax on carbon dioxide emissions will suffice.

  2. Trump is pictured next to an Australian PM whose country spends less than 10% of its GDP on health care – compared to near 17% in the US. The Australians have the world’s 4th longest life expectancy – 27 places above the US and lose 3.8 infants per 1000 compared to 6.5 in the US.
    Those commie Aussies and their evil nationalized health care!

    • As one of the commie Aussies let me just point out that our health care does cover all Australian citizens and residents but it isn’t nationalised. Local doctors have their own businesses but when they treat a patient they have the option of charging the Australia’s universal Medicare which pays them a standard fee or charging a higher fee to the patient who can then get a refund of the standard fee from Medicare. Australians have the option of using only Medicare cover or buying private cover which enables them to be treated at private hospitals. But the Government hospitals which don’t charge for their services are world class, they just don’t guarantee such frills as free TV and a private room. And yes, as stated, our system costs about half as much as the US system and gets much better results.

      • I’m curious about details. Maybe there’s a link or you could comment more about Australia. What’s the incentive for the private hospitals and doctors if the public option is better than just adequate? What I’ve seen abroad in these two tier systems is that the public service is strictly limited to a what is genuinely necessary, with nothing elective. There are other problems as well, but it may have more to do with the integrity of the systems in developing countries versus a place like Australia.

        • If your medical problem is urgent and serious- heart attack, severe injuries – a system such as in Australia would treat you immediately in a public hospital. For chronic conditions such as a hip transplant, you need to go on a waiting list. This is where private hospitals come in – by paying health insurance you jump the queue and don’t have to wait for those more needy to be treated first. Sometimes it could be a long wait and impact your quality of life so hospital waiting lists are frequently issues in election campaigns. Health insurance in a two tier system is very modestly priced as the public health system does much of the heavy lifting.
          Maybe Rais could correct me as my country’s health system has both similarities and differences to Australia.
          What really surprises us foreigners is, in a world where over 30 developed countries have created their unique health systems, Americans seem totally uninterested in adapting ideas from outside.

  3. Mark your calendar May 4, 2017 the day Trump said…..”You will now see your premiums start to come down!” This statement reminds me of Trump’s grandiose claim made in his inaugural address….”Inner city crime stops right here, right now!” To which Samantha Bee responded “Did we just elect Batman?”

    In that the bill has only passed the house and senators such as Lindsey Graham are scoffing at the speed in which Trump’s henchmen pushed the bill through the House, I don’t think we’ll see Trumpcare anytime soon.

  4. ” It is time for the American public to realize it is being taken for a ride. ” Not so: Not unlike Nazi Germany, the American public is subjected to the massive brain washing propaganda of the MSM monopoly that manufactures “popular consent” and keeps away dissent.
    If President Trump was really tough he would brake the MSM monopoly to allow true political discourse in the Republic.

    • Yes indeed. It occurred to me this morning that what has happened in some sectors is something roughly akin to a self-imposed totalitarianism among some media consumers in this country. What do I mean by that?

      I could tell you a million tales of people who only watch FOX, but to relate just a single anecdote: Recently my mother-in-law was back east visiting an old friend – someone who in the 70s helped her on the path to becoming a feminist and an advocate for women’s rights. Now she is an exclusive consumer of FOX and a fan of the Orange Menace. My mother-in-law tells me that FOX is on 24/7 in the house.

      One of the key aspects of totalitarianism, if we follow Hannah Arendt’s discussion, is the inescapability of the message until it literally infiltrates one’s marrow (to paraphrase her admittedly much longer, much more complex discussion). This appears to have happened with FOX viewers. They will never break free of such messaging. I understand the FOX is not the exclusive problem – CNN and the networks, including NPR and PBS, have long since lost me.

      Yet given the popularity of FOX and its feeding of deeply self-indulgent anger, it has a particularly large target on its butt. By the way, I have been wary of thinking of us as in any way shape or form totalitarian, thinking that we are more akin now to an illiberal democracy or skirting authoritarianism.

      But some – too many – in our country have isolated themselves and partnered themselves with powers that do not support their interests. The irony is that these people would be the first to somehow imagine that their ultimate value is freedom. It is an irony that Tacitus would have adored.

      • It seems glib to say it, but I think TV fills a large cultural, and maybe even a psychological void, in the US.

        Having left the alienating, automobile culture, and having lived in pedestrian cities for the several years now, the difference is stark.

        Fox, especially, mainlines a sort of simplistically plausible source of moral indignation to these alienated souls, which stimulates lifes that have been becoming increasingly barren and futile. And its messages are delivered in the background by TV, passively, slipping by whatever critical thinking capabilities may exist. At a minimum, it will succeed in creating the all-important framing of issues, against which reality is going to have a tough, tough fight.

        • The combination of TVs and automobiles encouraged the breakup of work-based (and thus class-conscious) communities to become a White flight to the suburbs. Then the resulting long commutes caused an opportunity for the recently-marginalized radio stations to go into demagoguery-for-profit every rush hour (which became Rush hour). That created the suburban audience base for Fox News.

    • There is no monopoly on news.

      This site is a fine example and there are a large number of similar news sources around the world. With the global communication system we have now, it is easy to find reality if a person looks for it with an open and curious mind.


      The PROBLEM is most Americans have no desire to learn all the ugly truths about life in the USA, especially since much of reality CONFLICTS terribly with the myths that people believe and it is extremely mentally painful to have to discard myths.

      People would rather live with their delusions than take the energy and mental pain of dealing with reality.

      Lots of psychological studies have show just how gullible humans are which is why Fox news and conservative talk radio can make so much money by telling constant lies.

      The problem is NOT the MSM, but the basic laziness of the news consumers who just want their bias and myths confirmed and not have to make any changes in their lives – that is allow the to go through their delusional lives instead of having to use energy to deal with reality.

  5. On 9/11 a terror attack killed 3000 Americans. The repeal of the ACA, if realized, is estimated to cost 43,000 lives a year. Fill in the blanks.

  6. The US does not have universal healthcare because not enough people realize that the GOP, which some take to be a concervative party, is actually quite reactionary in terms of the ideology they are trying to push onto the masses.

  7. Mexico, Single Payer healthcare, December 2011. When I went on vacation at the beach in Mexico in January 2017, I caught an upper respiratory illness . I went to the hospital. I was charged $3.50 for seeing a doctor (15 minute wait without an appointment) and $31 for medicine which included an antibiotic. Tell me which country provides medical care for all? The US or Mexico?

    • As of a few years ago the US life expectancy was on par with Mexico, with the difference being cost. Things may have changed since 2011 but your point remains.

    • That’s interesting. You know that illegal immigration from Mexico collapsed after 2008; it’s largely an issue of Hondurans and Guatemalans passing through and Asians overstaying their visas.

      Is it possible that Mexico’s single-payer system is the most effective tool in keeping people in Mexico – more than all our deportations and threats?

  8. Liz

    @realDonaldTrump said Australia has better insurance than we do, its shameful

  9. The list of countries with single payer is very useful Juan.

    On the subject of abusive monopoly corporations, there is Microsoft, with a near monopoly on software used in our workplaces. Each new operating system they put out is worse than the previous, and Microsoft tries to force adoption of the new systems.

    Then there are applications software such as
    Excel and Word, loaded with dysfunctional features which are not corrected in new versions.

    Nationalize Microsoft? That will not be necessary if we can find a way to regulate them, to hold them accountable to users who need software we can work with, but who have few if any choices in the marketplace (because of Microsoft’s monopoly).

    • But you won’t (usually?) die because of being cornered into using bad software. Healthcare should be understood as a basic human service, like a utility; same goes with the net neutrality.

    • Actually Microsoft does NOT have a monopoly and Windows 10 is very excellent and far better than the alternatives. And yes, there are two technically mature alternatives to Windows – Linux (FREE!) and MacOS. Your company is NOT forced to use Windows, but made a business decision to purchase from Microsoft.

      The situation is the same for office packages. There are many alternatives to MS office and some are even FREE – LibreOffice, OpenOffice, Google Doc, WordPerfect, etc.

      To see just how many choices you have go to

      link to

      In reality there are a lot of “hidden” cost to using alternatives to Microsoft that most people do not consider when they complain about MS.

  10. Barbara Burch

    You obviously haven’t read what’s being proposed re: premiums, deductibles and pre-existing health coverage, have you?

    • Not to mention that Obamacare worked perfectly well in Massachusetts. It was in states where the GOP deliberately sabotaged it that it did not.

  11. Healthcare should not be a business. In fact just like separation of church and state, we shouldn’t have business running the country. I’m not against supporting a right to have freedom of religion, just like I feel a country must support it’s business entities, but work towards what’s good for the commons. Our corporations have all gotten to big, and this behemoth of business is America’s downfall.

    • You’re being too broad with that criticism. Health care is a business, as is nearly every other activity that humans engage in.

      Doctors, nurses and the staff need to earn money to survive too. They’ve got to pay for their upgraded training too.

      Eventually, the hospitals need to be torn down and replaced. During the lifetime of that building, it needs to be cleaned and repaired/upgraded. All of that costs money.

      What shouldn’t be a thing is not being able to see a doctor because you can’t pay for it.

      Do the healthy ‘pay’ for the sick people in a civilized society? Since we started to live in caves, we have.

      If you wanted to use the old religious argument, just remind Cain that he’s his brother’s keeper. :)

      • Of course, business practices like accounting must be harnessed to manage the operations within any industry as complex as medicine, and is there even another industry of its complexity?

        The problem is that the efficiciecies of this industry are not kept in check by overly lauded free-market mechanisms and medicine is not just another marketplace, where it possible for a consumer to apply theoretical rational expectations to their purchase practices.

        Instead, it is an industry that has grown by its inefficiencies, and paid for them by gouging people with no choice but to pay WHATEVER price is demanded of them, and which is rarely ever known beforehand.

        Of course, as well, there’s nothing in the above you didn’t already know, right?

        The question is how to get out of this hole, given the people and parties that profit from this system, and how its inefficiencies are so integrated into the overall economy.

      • Yes, of course, it’s a business, but we need to take the profit motive. The books have to be balanced, but insurers shouldn’t be upping it’s profit margins and satisfying shareholders at the expense of our health.

        The elephant in the room in discussing affordability of healthcare, is the priority of items in the budget. If we cut back our nonsensical defense budget, including the three trillion for recent wars, we quickly find the money for healthcare.

        • What you don’t want to do, were it conceivably possible, is just cave in to the current healthcare industry, making it affordable with defense dollars. They’d just soak up those dollars as well.

          There either has to be a genuinely functioning market, which is inherently impossible due to the vital nature of its services, or regulate it like an essential utility: a single payer system allows provides that control and balance. And variations of that basic solution are in every other developed country in the world.

  12. Let’s not forget the nearly $600 billion in tax cuts in the AHCA. Nothing could make this moral monstrosity clearer. Nickel and diming over $8 billion that everybody knows won’t begin to cover the otherwise uninsurable while this huge tax reduction looms over the next decade! Put the GOPpers who claim everyone will be covered to the test:
    place half the tax cuts in a ten year escrow account to cover
    cost of high-risk pools, with the balance distributed back to those who paid the taxes at the end. Watch them scream like stuck pigs. They know that not a dime would come back.

  13. The sadism and greed of the American Republican Party was on full display Thursday, as the House GOP voted to destroy Obamacare and remove the coverage for pre-existing conditions (50 million Americans suffer from them).

    That the house Republicans could be so brazen in this morally corrupt act should be of greater concern than voting for the AHCA itself. Flaunting their contempt for millions of people who are at risk of being in need of healthcare is evidence of moral decadence in Congress and a sizable segment of the American people willing to go along with this proto-fascism.

    From another angle it doesn’t say much for the intelligence of those among the American people who vote these despicable people into Congress.

    Unfortunately, the Democratic party is little, if any, better.

    • it is nothing to do with voter intelligence. The GOP congressmen were elected by a fourth of their district and with money provided by big corporations. Gerrymandering and voter suppression laws and Tuesday workday voting hours ensured that millions were disenfranchised. It is de facto oligarchy, not democracy.

      • Juan: I was referring specifically to the people who voted for these wretches, not to the American people in general. If Paul Ryan’s district consisted of his house, Scott Walker’s house and mine and this district was gerrymandered so that my family couldn’t vote, then the choice and responsibility falls on the Ryan and Walker homes for electing Reichsfuehrer Ryan

    • The Dems are not perfect in many respects, but I doubt that those in need of cancer treatment, women in need of access to health care, migrant farm workers afraid to harvest my neighbor’s strawberries, or (to anthropomorphize) polar bears, care too much for this sort of argument. Again, Dems are not perfect, but they are not a complete wrecking crew.

      Moreover they have a party structure in place. I would argue that it is time for people such as myself and Mr. Bodden to run for political office as Dems, true to conduct a semi-hostile take-over of the party, and rebuild it from within into a strong Left party as it should be and into an opposition party of the sort that we deserve.

      • I would argue that it is time for people such as myself and Mr. Bodden to run for political office as Dems, true to conduct a semi-hostile take-over of the party, …

        Give me a call, Grumpy. I would be honored to serve as your vice chair of the DNC.

  14. Look at Israel which compels all citizens and residents to procure insurance. Why cant that be done in the US?

  15. Re/paper work. I got ill in London, went to MD, told him I was only there for a couple of months and offered to pay cash. He said don’t be silly,you can enroll in the national health plan. I asked, won’t that be a lot of paper work? and got the classic reply, ‘stop at the desk on.your way out. So I told the desk I have to enroll in the national health plan. I was handed a card on which I wrote, as directed, my name,address, phone #, and date of birth.
    And that was it. Here in the USA, I have to do much more paper work when my MD sends me across the hall for a blood draw.

  16. You are misinformed about China, where health care very much operates on the principle of “no money, no honey.” (You can even buy organ transplants.) Taiwan’s national health insurance is more like what you have in mind.

  17. For low-income people, the AHCA is much worse than simply a return to pre-ACA days. It severely cuts funds for Medicaid. Two thirds of seniors in nursing homes depend on Medicaid. We can’t allow any compromise that includes cuts to Medicaid. Six million seniors use Medicaid as well as Medicare.
    The ACA Medicaid expansion was a huge expansion of single-payer. Trumpcare will reverse that and also cut into the aid poor people have been getting for decades.

  18. “It is not clear why there is private health insurance”

    Oh, that’s an easy one, Juan. The industry spent more than $40 million last year on lobbying. Here’s the breakdown by Open Secrets (link to which tracked 717 lobbyists working on behalf of the industry.

    • The question is, why did our private industry get to this position of power, while counterparts in Europe and Japan caved in to universal coverage mandates by reorganizing as non-profits or going out of business? Any government can be lobbied or even bribed (Asian governments are routinely bought), but only in America are businessmen so brazen and self-righteous in assaulting the democratic will, yet so certain of support from a large faction of the voters.

      • USA culture of “rugged individualism” that has been part of the USA myth since the 1700s

  19. Further to the comment on Taiwan above, I am an ex-pat kiwi who has been living in Taiwan for 27 years. The National Health Service here is exemplary, being available for foreigners living here on work visas as well as locals. Dental appointment: $6USD fee (no extra charges for cavity or basic dental work), with the balance to the dentist being reimbursed by the system. Doctor’s appointment: same price generally at local clinics, with medicines included free under that charge! 99% of the citizens (23million) covered, with everyone given a National Health ID Card. A two-tiered system exists, with private insurance. Fees incurred for operation costs etc., can be refunded from private insurance, plus a basic coverage under the public system (National Health Insurance Scheme).

  20. One of the ongoing tragedies in the UK is that the Conservative government has been hell bent on destroying the NHS through privatization creep and chronically underfunding it. I’ve experienced both health care systems, and it’s maddening that the government wants to adopt a US style, market friendly approach to health care (likely by entrenching a two tier system by watching the NHS implode to the point where people lose faith in it and migrate to private insurance). Most British people simply don’t understand how US health care works, even under the ACA. British friends of mine were under the impression that if you had health insurance in the US, everything would be free or at least, affordable. They were shocked to hear the truth. It’s insane that in the UK we have a cabinet minister for health, Jeremy Hunt, who has co-authored books calling for the NHS to be replaced by a US style insurance system. Depressing. . .

  21. I saw an article by James Carville where he conducted a focus group of self-identified Tea Partiers a few years ago. The position of these ordinary citizens was that Obamacare, like social programs in general, were an evil bribe to corrupt childlike minorities into voting Democratic. So their hostility had nothing to do with whether universal healthcare could work or not – they did not care. It was euphemized in the usual self-serving bullshit about “rescuing” Blacks, et al. from the welfare “plantation” by forcing them to have to work for the most menial benefits… because surely all Real Americans had jobs that came with the privilege of health coverage. Or were White enough to belong to an Evangelical church wealthy enough to bail them out from a medical bankruptcy. They genuinely demand that people who fail to conform to their sacred Way of Life suffer, regardless of the practical consequences for the entire nation.

    They don’t care how bad the employers’ insurance is in practice as long as it’s a privilege that distinguishes them from parasites. They don’t care how bad the whole system is as long as it symbolizes them as being more self-reliant than other societies. So any facts about these problems are denied simply because they don’t care that they are true. It is highly ritualistic, like the right-wing obsession of punishing deviance despite any proof that gentler approaches are more effective (drug treatment instead of Drug War, midnight basketball instead of threatening disgruntled Black kids with police bullets, sex education instead of abstinence education). As long as we carry out the rituals of obedience, a wrathful Jehovah will magically reward our nation with manna falling from economic heaven.

  22. Note that we have over 100 years of medical data and we KNOW very accurately HOW MUCH medical activity will take place in the USA and that while we can some what effect that usage rate, the change is incremental, not large over time.

    While we can not guess exactly which human will have which medical event, we KNOW with great detail that X number of humans will have Y medical event within any given year.

    So what we are really arguing about is how to PAY for all the medical events the totality of Americans will have.

    Right now, Americans have CHOSEN for largely racist and delusional reason to have the system we have which cost almost TWICE as much as the next most expensive system on earth rather than do the logical thing of combining the best practices of all the other healthcare systems. That is, the USA could cut its medical costs in half overnight by eliminating the current system, but they will not because it will be against the USA culture.

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