Two practical points.
1)
Once you decide that people won't be allowed to die if they don't have money or insurance the only remaining question is how to provide that medical care at the lowest cost.
We require hospitals to provide care to anyone who comes in the emergency room, regardless of their ability to pay. But this care for the indigent is anything but free. The hospital has to recover these costs by increasing their fees for those who can pay.
As a practical matter this means that these costs for the indigent are paid by the health insurance companies in inflated fees for the sick who have insurance. This results in higher premiums for both the healthy and the sick who have health insurance.
There is no escaping that the young and the healthy have to pay for the indigent, the old and the sick. And we have chosen the most expensive way to pay for the indigent, the old and the sick.
Having the insurance companies pay for the indigent care through inflated fees is the most expensive way possible to pay for this indigent care because any costs that are paid by the health insurance companies are increased by the insurance company's "loss ratio." Every dollar paid to the health care insurance companies in insurance premiums buys only 80¢ of medical care. And this is a maximum, the insurance companies claim that this is not enough, they want to keep more than 20¢ of every dollar in premiums that they charge.
This also makes owning a for profit hospital very profitable if you can somehow limit the number of poor people who come through the door of your emergency room. You get to charge the prevailing rate in the area as if you treated a lot of indigents without the costs of treating a lot of indigents.
The easiest way to limit the number of indigents that you have to treat is by location, location, location. Put your hospital in the wealthy suburbs where most people have insurance, in a location away from mass transit and freeways.
This leads us naturally to the second practical point.
2)
Medical care in the US is the most expensive in the world because it relies the most on for profit entities to deliver it.
This is the gorilla in the room that no one dares to voice out loud. The entire approach of conservatives to the question of the delivery of medical care is that the private, for profit market through competition can do the best job of delivering high quality, low cost medical care. But it is abundantly obvious that the opposite is true, relying the for profit motive delivers the most expensive medical care.
In 1970 the US, as a percentage of GDP, had about the same medical cost per person as the other industrialized nations. Move forward to pre-ObamaCare and the medical costs per person is twice as much as the average cost in the industrial nations.
Only two things changed over this nearly forty years in the US relative to the other industrialized countries. The increased degree of the for profit motive in health care and a massive increase in the volume of federal and state government regulations covering medical care.
In 1970 medical care was largely the job of non-profits. Hospitals were owned and run by charities or governments. Individual and small group insurance, the kind of insurance bought by businesses who were too small to self-insure, were provided by the large, non-profit, community rate based insurance companies, that is, Blue Cross-Blue Shield. Medical doctors accepted that they had to treat some patients who were poor for free or at reduced cost, the latter including the elderly under Medicare.
(Under Medicare doctors accepted lower fees for rapid, unquestioned payment. In 1970 this added up to much more than the doctors had received before Medicare treating the elderly because so many of elderly then were indigent who were treated for nothing.)
All of this changed as health care slowly evolved, with the enthusiastic support of conservatives, into for profit businesses.
Conservatives pretty much explained that the second point, the massive increase in government regulation, is the reason for the massive increase in medical costs and why the miracle of competition had not worked its magic on medical costs. But for this to be true the massive increase in costs would had to of followed after the writing of the regulations. But the regulations were written in virtually every case to address observed abuses to gain increased profits. That is, the abuses and the increased profits from the abuses preceded the regulations.
To say that the regulations caused the increase in costs is the same as saying that the laws against theft and murder caused the theft and the murders. Which would be insane. The theft and the murders were the reason that the laws were written. The transformation of the medical sector into for profit businesses were the reason that the massive amount of regulation had to be imposed on the health care business.
