> Countries with single-payer healthcare spend massively less on it per % of GDP than the United States with its pro-profit healthcare system
Countries with universal coverage through other-than-single-payer systems do this, too. (every OECD country other than Mexico and the US has universal coverage -- but not all of them through single-payer -- and every OECD country spends massively less per GDP, let alone per capita, on healthcare than the US does; to the extent that many of those that do have public single-payer universal systems pay less in GDP for that than the US does considering public costs in the US alone, without considering the slightly-higher private costs in the US.)
But those systems tend to look like a "single-payer donkey with a free-market tail stuck on." The government decides the content of the basic packages, funds them for the poor, etc. If that sounds exactly like the ACA, you're correct, but you may have missed a very subtle and very important distinction -- take a closer look.
A friend of mine ran across this in Switzerland. It has a nominally free-market system, but when he moved there, he ended up automatically enrolled in a plan without doing anything at all. He was remiss in reading and translating all his mail upon moving there, and after some months of inaction: 1) he was signed up to a default insurance plan; 2) which was partially subsidized based on his estimated income; and 3) he was billed for the remainder. Nominally private-sector, but still quite state-supervised. There is a minimum standard for plans, you must have one, and subsidies ensure that everyone can afford it. Unlike Obamacare, the "must have one" part is not enforced by fining you $700 on your taxes, either, but rather by actually signing you up for one.
This is how vehicle liability insurance works in Sweden. You must have it, and if you don't, the government will just sign you up for a government-run default insurance pool and bill you for it. Certainly beats having to have "uninsured motorist insurance"...
Well, in the first case you're actually enrolled in a health-insurance plan, whereas in the second case you aren't. This solves many problems; for example, everyone who visits a doctor's office or hospital can be assumed to have insurance coverage, so those institutions aren't left with the mess of what to do with uninsured patients.
> But those systems tend to look like a "single-payer donkey with a free-market tail stuck on."
I wouldn't use either of the terms "single-payer" or "free-market" in describing systems in which there are multiple private sector health insurers (payers), and it is mandatory for individuals to purchase a plan from one, with highly regulated plan provisions and operations.
They don't much look like "single-payer" anything, and don't very much look like any "free-market" bit has been stuck on (there is a market component, but its not free.)
> If that sounds exactly like the ACA, you're correct
The ACA is similar in outline, but the differences aren't particularly subtle (the ACA's isn't universal; the poor, elderly, and disabled -- rather than being subject to the mandate and operating through the same market, potentially with a public subsidy, instead are directed to one [in some cases, both] of two completely separate public insurance systems, etc., etc., etc.)
1 - using buying leverage to negotiate prices, something republicans owned by the drug and device industry specifically banned (see eg [1])
2 - rationality about end of life care, which we spend a lot of money on -- 20%+ off the top of my head. As many doctors have shared, they often choose not to aggressively treat terminal illnesses and focus on quality of life. Unfortunately (remember Sarah Palin's death panels, and let's all thank John McCain for bringing that snowbilly grifter to the national stage), attempts to do things like pay doctors to sit down with patients and have end of life conversations, explaining what is happening have been successfully yet stupidly fought off. Whereas when doctors talk about how they die, they often chose to undergo very little treatment [2,3]
Almost all medical professionals have seen what we call “futile care” being
performed on people. That’s when doctors bring the cutting edge of
technology to bear on a grievously ill person near the end of life. The
patient will get cut open, perforated with tubes, hooked up to machines, and
assaulted with drugs. All of this occurs in the Intensive Care Unit at a
cost of tens of thousands of dollars a day. What it buys is misery we would
not inflict on a terrorist. I cannot count the number of times fellow
physicians have told me, in words that vary only slightly, “Promise me if
you find me like this that you’ll kill me.” They mean it. Some medical
personnel wear medallions stamped “NO CODE” to tell physicians not to
perform CPR on them. I have even seen it as a tattoo. [2]
This doctor summarizes his choices as
my physician has my choices. They were easy to make, as they are for most
physicians. There will be no heroics, and I will go gentle into that good
night. [2]
A different article
Research shows that most Americans do not die well, which is to say they do
not die the way they say they want to — at home, surrounded by the people
who love them. According to data from Medicare, only a third of patients die
this way. More than 50 percent spend their final days in hospitals, often in
intensive care units, tethered to machines and feeding tubes, or in nursing
homes. [3]
There is almost always something that a doctor can do, but patient comfort is approximately priority F.
More typical was an almost eighty-year-old woman at the end of her life,
with irreversible congestive heart failure, who was in the I.C.U. for the
second time in three weeks, drugged to oblivion and tubed in most natural
orifices and a few artificial ones. Or the seventy-year-old with a cancer
that had metastasized to her lungs and bone, and a fungal pneumonia that
arises only in the final phase of the illness. She had chosen to forgo
treatment, but her oncologist pushed her to change her mind, and she was put
on a ventilator and antibiotics. Another woman, in her eighties, with
end-stage respiratory and kidney failure, had been in the unit for two
weeks. Her husband had died after a long illness, with a feeding tube and a
tracheotomy, and she had mentioned that she didn’t want to die that way. But
her children couldn’t let her go, and asked to proceed with the placement of
various devices: a permanent tracheotomy, a feeding tube, and a dialysis
catheter. So now she just lay there tethered to her pumps, drifting in and
out of consciousness. [4]
And finally -- you should read all of [5], though it's heart-wrenching -- many terminal patients don't want to be aggressively treated when outcomes and the experience are fully explained. A close family member had to make similar choices and chose to die at home. The surgeons and oncologist where happy to keep going, but he was dying, and nothing the doctors could do would change that. They could only prolong for another couple months the inevitable, at the price of excruciating pain, repeated surgeries, and drugs that made him feel terrible. He chose to die at home. And not only is this far more humane, but far cheaper.
Countries with universal coverage through other-than-single-payer systems do this, too. (every OECD country other than Mexico and the US has universal coverage -- but not all of them through single-payer -- and every OECD country spends massively less per GDP, let alone per capita, on healthcare than the US does; to the extent that many of those that do have public single-payer universal systems pay less in GDP for that than the US does considering public costs in the US alone, without considering the slightly-higher private costs in the US.)