Can I ask why the U.S. don't want an NHS?

[Fizzielove]

Why don't Americans want an NHS? I just don't get it? Can someone lease explain to this to me?

Because it's a big fat drain on the countries economy.
It costs billions and billions to run.
It really is that simple.
We shall go the same route in the near future.
Lots of people over there are entitled to free healthcare though.

I think it's partly about the 'state' having access to personal information on your health. They feel its an infringement on their privacy.

As Hesterton says - they have a total horror of "socialised medicine" (and fail to see the irony of having a virtually socialised banking system post 2007!). That said - what you do get under the US system is choice (because it's paid for, even if through insurance). Lot of people are afraid of not being able to choose their own doctor and treatment and being forced onto a poor GP/under performing hospital etc

How exactly do you expect us to pay for it?

We are already taxed to the point of barely keeping our heads above water as it is. We cannot afford to pay more. We already have money taken out of our paychecks for company health insurance. The government insurance is more expensive than what the company typically offers unless you make below a certain amount.

So for the people that have good insurance it's like making them down grade from a BMW to a used Subaru, but for more money. People that can't afford it are already subsidized. So it seems pointless to go full NHS from that perspective alone.

We just can't implement it at this point without have a sudden influx of Americans filing for bankruptcy because they can't afford house payments, and we already has a housing bubble pop. Our economy can't handle another.

Because at the top end, they get better healthcare.

There's a very fundamental difference between the US mindset and the European mindset, which I think is often overlooked when we try to understand their attitude to things like nationalised health care and gun control.

In the very broadest of terms the European mindset, even when a Conservative party is in control, is roughly socialist. That's socialist as in "for the greater good of all", so we often accept higher taxation and more state interference in return for an overall fairer society, although this can be at the expense of the individual.

The US mindset is, in contrast, roughly libertarian. They cherish the rights and freedoms of the individual over society as a whole, so any one who attempts to limit individual freedoms, such as the right to own guns, or suggest that people should pay more tax to support a not for profit medical system are seen by many as anti American.

Of course the above boils something huge and complex down to its absolute basics, and there are plenty of Europeans who are more libertarian leaning and Americans who are socialist, but in very general terms it explains a lot about why America is the way it is.

Because if you're relatively healthy and in a stable job you get way better treatment when you do need it via insurance and lower taxes the rest of the time.

Because for whatever reason, silliness about healthcare has become ingrained in American right wing politics.

Obamacare was invented by a republican (Romneycare), so there is very little logical about it.

The NHS isn't the only possible model anyway; few countries have an NHS type healthcare solution (the UK and Canada and .... ???). A social insurance model along European lines would be an alternative. But that would require a sensible conversation about healthcare costs, impossible in the U.S. right now.

From what I've gleaned from various sources over the years there is a massive reluctance to pay for other people's care. Despite the reality they already do - low incomes get government assistance and the nature of any private insurance means you're paying out for others care constantly. Lobbyists also have a massive influence over government which means healthcare is another bargaining chip for funding and election.

I don't know if the nhs in particular would be the best model for them to embrace but the reluctance to consider anything that might be considered socialist is very deeply ingrained in significant portions of the population. Obamacare was significantly watered down and adjusted to get passed into practice.

I've no idea who quoted it originally but I've read it a few times "there's no such thing as a poor American, just a temporarily embarrassed millionaire". The 'American Dream' is a very strong belief and there is a prevailing attitude that poor people just aren't trying hard enough.

All that being said I'm sure it's a very valid point it would be initially very expensive and the economy would take a hit during implementation purely because it is such a massive industry. The insurance companies and people employed to manage billings and negotiations aren't on the government payroll so it would almost certainly damage their employment figures.

Senpai's response is pretty typical of what you'll get if you try to discuss this with an American.

"How do we expect us to pay for it?" Well, the answer to that is "with the huge amount of money you spend on an inefficient healthcare system already".

UK healthcare spending as a % of GDP: 9%
US healthcare spending as a % of GDP: 17%

The Americans spend roughly twice as much on healthcare for a system that leaves substantial numbers of people uninsured.

Same reason they can't sort the gun laws. There is a massive amount of big business money invested in private healthcare, as in arms. They will dress it up any way they can to make it look like it is other than that.

My boss is American. Her answer to this question is 'because people who have decent healthcare don't give a fuck about people who don't.'

The combined lobbying powers of the insurance and pharmaceutical industry, for the most part. They understand very well how to play on the overwhelming American desire for individual freedom.

Also for the very rich, many would rather donate to their local hospital or whatever, and be able to offset that against their tax bill, than pay it up front in taxes.

Americans generally would rather provide for themselves than the state.

Historically, many made a decision to leave oppressive states and have built a country on freedom from state control etc. it's very deep in the American psyche.

And looking at the shower running the state in the UK, I have some sympathy with it! This lot couldn't run a bath let alone my DCs school/my healthcare/ my pension
Pot etc

One of the reasons is that there is a lot of misinformation about healthcare in the US. For instance, most Americans don't know that the per capita cost of healthcare in the UK (public and private) is less than half what it is in the US, which has one of the highest healthcare costs in the world. They don't realise that it is possible to have private insurance to top up NHS provision, which still leaves UK healthcare this much cheaper than the US (for a lot of reasons, such as bulk negotiations with drug companies at the top level and massively subsidised prescription costs on the individual level).

The lobbying of insurance firms has muddied the waters even further.

There are also so many organisational problems (as there are already a number of schemes and organisations that provide free healthcare to various groups, on top of the complexities added by the federal system of government) that an NHS would be impractical in the US.

There are plenty of other reasons, some of them actually pretty good, some of them absolutely terrible and based on nasty fairy tales (who can forget 'death panels'? ) that I actually think a reformed version of the insurance system would be more viable in the US.

They don't want to pay for someone who isn't working hard. And clearly they are not working hard if they can't afford their own health insurance.

Disclaimer: I am American and don't agree with this, but this is the feeling I get from other Americans who are anti-NHS type things.

FWIW I don't think the NHS is working at all for the UK in its current form. Our insistence on clinging to it is blind. Something about it needs to change.

I believe you are more likely to die in childbirth in the USA than the UK. Whatever they are doing, it costs more and appears to be less effective!

I get the impression that a lot of Americans think the NHS is crap. So they're not motivated to pay out for what they see as substandard care.
Not American myself though so I could be wrong.

A more pertinent question might be why we want to persist in being the only country (apart from Cuba) that DOES have a NHS...

Insured people in the U.S. receive the best possible healthcare. It's us that need to change.

I think a lot of Americans believe it's an intrusion into their private lives and takes away choice and freedom. Some of the Americans I know are paranoid about any kind of state controlled entity which impacts on them, even if it's for the better. They equate it with communism.

I love the USA and my American friends but they are fundamentaly very different from the UK and Europe. We share a common language and that's about it, their attitudes to some things are nothing like ours.

The feedback I usually get is "I don't want the government controlling my healthcare" completely missing the fact that a private company is controlling their healthcare for profit. I am American and after 10 years in the UK my family are starting to see the benefits of nationalised healthcare. I think a lot of people of younger generations are less afraid of socialism. Look at the support Bernie Sanders is getting for his presidential campaign. Personally the fear of socialism just baffles me but I am from a pretty liberal state!

It's incredibly complicated, and I can't get my head around the mindset. I think it is mostly down to the cultural mindset over there, combined with considerable financial pressure from insurance companies, pharmaceutical companies etc.

I asked my aunt and uncle (who live in New England) why they're against an NHS. Their reply was that it would cost them more. Bear in mind that this is a couple who pay about $18000 per year in insurance for their family. I have no idea why they think their taxes would go up by more than $18k. It's like arguing with a brick wall!

And it's very true to say that the NHS is far, far from perfect. I have had horrendous experiences at the hands of the NHS. And yes, I have had good ones too. But when all you see in the news are things like the Staffs scandal, the A&E waiting times, the waiting times for operations and treatment, the over-stretched staff and lack of beds, it's not hard to see how an outsider, who's never had to use the NHS, might look at it and consider it practically medieval at times.

There is a lack of will to change and there is also a poor perception of nationalised health services. I don't think anything with regard to nationalised health care will be passed in our lifetimes - it's just not popular enough over there.

I quite liked the Australian system where they have Medicare for emergency medicine. People can choose to top up with private health insurance. If you earn over a certain threshold, you are expected to have private health insurance otherwise you have to pay a levy - this ensures that most high earners will pay for health insurance.
However, they still have long waiting lists. I waited over 6 months for an appointment to see a speech therapist for my child, by which point I was already paying privately. A friends breast reconstruction following cancer/mastectomy was not covered by Medicare as this was not considered essential treatment.