You miss much in your understanding @feddo and do little to actually sell ‘universal care’ … or single payer as it is called.
The one thing at least with the UK tax structure that I like, is that far more people have skin in the game on the frontend. The unfortunate flip side of that is the numerous benefits and lax control that a skilful fraudster can and do take advantage of on the back side.
People in the UK get a £11500 deduction… That is it, nothing else… no mortgage tax credit, no local tax exemption… If you earn over £11500 per year you are taxed at 10% ( 10% being the bottom of the scale.
You also get taxed on money you make over £155 per week (£8,000 per year approx) at a 12-14% rate for ‘national insurance’ (this is what funds the NHS… plus appropriations from elsewhere… always appropriations from elsewhere) So anyone earning £8000 pounds a year will pay a 12% tax for the privilege of the NHS service which is well below what is considers the poverty level for one person. The up side is that almost everyone funds the NHS… the down side is that everyone thinks that they own the NHS and any and all services they desire.
People will also pay counsel tax on a banded scale depending on the house you live in (the occupier, not the owner) which pays for local services. This varies by council but a rule of thumb for the least expensive homes is about 5% on top of rent.
Long stories short, the people of Britain are heavily taxed and the NHS is never happy in its budget.
Yes there is private insurance in the UK… but if you are on the lower end of the earning scale you really don’t have the option for the supplementary care because you can’t opt out of the NHS. Even with private health care which acts more like a toll road than a particularly exceptional upgrade in care, people still travel to the US for specialty care that just does not exist in the UK…
I find your acceptance of a two tier medical system interesting… I don’t think you have that opinion with respect to public education or indeed the internet. The argument here of course is that the private sector is nothing but a drag on the NHS when those ‘resources’ could be used to make the NHS better. An argument that always occurs once a state run operation faces competition from the private sector and is sure to evolve in the US should single payer become a reality.
Additionally even with private insurance your prescriptions in the UK while considerable greater than the £8 charged by the NHS will cost, on average, 3 times less than in the US. Going back to the subject of just what or who supports the R&D that brings innovative medicine to ‘market’. The power to negotiate drug prices down in all of these smaller markets does not harm R&D that much… doing in the US, it will destroy it…
Again your examples of Hong Kong and Singapore are very small densely populated areas. Even in the UK where the entire landmass will fit into the eastern third of Texas, all but a very small fraction of the population can catch a convenient bus or request ambulatory service to get to and from the hospital. That is an absolute impossibility in the US.
This of course brings us back to do your really want a worldwide system that gives everyone full access to some care or access to a system that is innovative and forward looking with respect to research… research that involve considerable expense and very real risk?
Of course this is the bottom line and you know it… regardless of how the market could actually bring down costs (if people would quit talking about insurance), the entire purpose of the ACA was a hook, plan and simple. It was never meant to last but it was meant to create the beginnings of a new entitlement mentality and as long as the prime and only statistic used to measure its relevance is ‘number of people insured’ (regardless of how many can actually pay a deductible), no other plan could ever compare to the ACA… except for single payer. Barring the election of someone like Trump it would have easily been replaced by the next ‘repair’ leading us closer to single payer.
The problem is that democrats aren’t up for the hard work… government and money can fix everything. It has not occurred to the left that it was the private sector that gave the world modern medicine in the first place. Not unlike most entitlement programs, it solves an immediate vote getting need but isn’t really serious about addressing the underlying problem.