It would be a small problem to provide socialized health care in Boston or San Francisco relative to West Virginia, for example. It would be a bigger problem to provide equivalent care. It is a bigger problem still to handle the bureaucracy to provide optimal care based on the problems each see.

I want socialized health care, but I don't pretend it is merely an issue of will.

You can always find something that's different, of course. Scale shouldn't matter, but the US is less densely populated than all those European countries. Canada doesn't count because 90% of the population is crammed against the southern border.

In one respect, these are very difficult problems, so you're right that it's not just an issue of will. In another respect, they have been solved, so we know it can be done. In that sense, is it not just an issue of will? If you decide to do it, and you put sufficient resources behind it, you know it can be done. If you're not doing it, it's because you ultimately don't want to.

And yet it does. Try administering all the various socialized healthcare systems in Europe strictly from Brussels. Get back to me when the whole thing has become a shambles.

> If you decide to do it, and you put sufficient resources behind it, you know it can be done.

The point isn't "can it be done" but rather "can it be done efficiently" because right now the spending in the US is only about 2x as bad as anywhere else. Shameful and embarrassing for sure! But the problem is largely one of economics, not will. Maybe we socialized and costs go down 50%, or maybe they only go down 20%, or maybe they go up 30%. There's no way to know until we try it.

As far as I can tell there's been no country thus far that's done socialized healthcare with the kind of genetic diversity that the US has. The US has sizable populations of people from all over the earth, so we have the "good fortune" to have to specialize in basically every genetic condition, predisposition, etc. That absolutely does increase costs.

I'm not saying that the healthcare model that the US has is optimal, or even good. But to suggest that it can't get any worse is to show a prodigious lack of imagination.

Imagine that everything is the same as it is right now, but that insurance companies manage to get the various 80-90% payout laws overturned and start paying out at only a 50% rate. That means premiums nearly double in very short order.

Or maybe a new law that really makes the electronic records requirements stick gets passed, but it's done in such a poor fashion that all of our records end up getting sold to bankers, who then figure out a way to make bets on people (ala Walmart's life insurance "scandal") and then the insurance companies get wind of this and start dropping people once their bank calculated risk profile gets too high.

See, look! It's that easy.

I was trying to preempt the inevitable "but things are so bad here in the US, surely making any change would be an improvement!" argument that always seems to get trotted out the second healthcare gets discussed.

And you seemed to be making that argument, in the very beginning.

> They accomplished it because they wanted to, and we don't because we don't.

If you truly can't imagine any possible way in which healthcare in American could get worse, then I really do stand by my statement. Further, I would suggest that you actually can imagine how it could be worse, but you're pretending that you can't to make a point. And if we're going to do that, then point willfully ignored.