Repeal or replace?
- Thread starter Diogenes
- Start date
Life is Golden
The Sage
You keep brushing off the ICU example as if catastrophic cases are rare enough to ignore, but they aren’t. One serious illness or accident can wipe out anyone. The average cost of two months in an ICU easily exceeds half a million dollars, and that’s before rehab or follow-up care. Charity care and “cash pay” discounts don’t absorb those amounts. Hospitals write off what they can, but those losses drive up costs for everyone else.
And that’s not limited to trauma. Look at families with hemophilia patients. One child’s annual treatment can exceed $300,000. Without pooled coverage, those families would be bankrupt in a year, and no charity system could sustain that long term.
You’re also ignoring that the ACA didn’t invent insurance—it regulated a market that already existed. The idea was to stop the old practice of dumping the sick, denying coverage, or pricing them out entirely. The current system has plenty of flaws, but pretending that “pay cash or hope for charity” is a solution ignores basic math. Some medical costs are simply too large for individual responsibility to carry.
You might be comfortable betting on your own health, but that model collapses the moment life stops cooperating.
And that’s not limited to trauma. Look at families with hemophilia patients. One child’s annual treatment can exceed $300,000. Without pooled coverage, those families would be bankrupt in a year, and no charity system could sustain that long term.
You’re also ignoring that the ACA didn’t invent insurance—it regulated a market that already existed. The idea was to stop the old practice of dumping the sick, denying coverage, or pricing them out entirely. The current system has plenty of flaws, but pretending that “pay cash or hope for charity” is a solution ignores basic math. Some medical costs are simply too large for individual responsibility to carry.
You might be comfortable betting on your own health, but that model collapses the moment life stops cooperating.
I don't care. My body, my choice. My money, my choice. I won't tell you again what I already told you. Scroll up and read it.
I don't care. If you care about "families with hemophilia patients," find one and pay their bills. Not my monkeys, not my circus.
Since I don't recall saying that "the ACA didn’t invent insurance", you don't have a point.
If you feel responsible for other people's medical bills, pay 'em. I don't.
Yes, I am. What's it to you?
I don't care. I won't tell you again what I've already told you. Scroll up and read it.
Obamacare Fraud, by the Numbers
Obamacare Fraud, by the Numbers
Paragon research has exposed two major problems in the Obamacare exchanges: improper enrollment and zero-claim enrollees.
paragoninstitute.org
Life is Golden
The Sage
That’s fine, you "don’t care." But public policy isn’t built around what one person cares about. It’s built around what keeps an entire system from collapsing. When uninsured patients can’t pay six-figure hospital bills, those costs don’t vanish. They’re shifted to taxpayers, hospitals, and the insured through higher premiums and facility fees. That’s the economic reality, whether you care or not.
You can claim “my money, my choice,” but when your choice drives systemic cost inflation, it stops being just about you. That’s why every functioning healthcare system on Earth, even the ones with more private freedom than ours, pools risk.
As for “families with hemophilia,” that’s not a sob story, it’s a financial fact. Hemophilia treatments cost hundreds of thousands per year per patient. No amount of GoFundMes or “find one and pay their bills” charity can sustain that scale of care. Without pooled funding, hospitals would fold, and treatments would cease.
You’re welcome to gamble with your own health. But when that gamble fails, it’s everyone else who pays the tab. That’s not freedom. That’s freeloading dressed up as independence.
You can claim “my money, my choice,” but when your choice drives systemic cost inflation, it stops being just about you. That’s why every functioning healthcare system on Earth, even the ones with more private freedom than ours, pools risk.
As for “families with hemophilia,” that’s not a sob story, it’s a financial fact. Hemophilia treatments cost hundreds of thousands per year per patient. No amount of GoFundMes or “find one and pay their bills” charity can sustain that scale of care. Without pooled funding, hospitals would fold, and treatments would cease.
You’re welcome to gamble with your own health. But when that gamble fails, it’s everyone else who pays the tab. That’s not freedom. That’s freeloading dressed up as independence.
You don't speak for anyone but yourself. I don't either. I have made my opinions known to our legislators, and I will abide by the results.
Public funding for programs beyond the Veterans Affairs system has ballooned into a fiscal black hole that threatens to bankrupt the United States, driven by unchecked growth, demographic inevitabilities, and perverse incentives that no amount of taxation can sustain indefinitely.
Start with the raw numbers: In fiscal year 2024, federal spending exceeded $6.8 trillion, with mandatory entitlements e.g. Social Security, Medicare, Medicaid, and related health programs accounting for over 60% of the budget, or roughly $4.1 trillion.
These aren't discretionary line items that Congress can trim; they're locked in by law and indexed to inflation, wages, or healthcare costs that can and sometimes do rise faster than GDP.
The Congressional Budget Office projects that by 2035, these programs alone will consume nearly 75% of federal outlays, leaving scraps for defense, infrastructure, or anything else.
Interest on the national debt, already at $1 trillion annually in 2025, will surge as borrowing covers the gap, creating a doom loop where debt service crowds out the very programs it's meant to fund.
Demographics seal the deal.
The Baby Boom generations' retirement has flipped the worker-to-retiree ratio from 5:1 in 2000 to about 2.8:1 today, heading toward 2:1 by 2035.
Social Securitys' trust fund is on track to deplete by 2033, Medicares' hospital insurance fund by 2031, after which payroll taxes cover only 75-80% of promised benefits without massive infusions from general revenue, which is already deficit-financed.
State and local governments mirror this at smaller scales: Public pensions are underfunded by $4-6 trillion nationwide, per Moody's and other analysts, with cities like Chicago and Dallas teetering on junk-bond status because pension obligations grow at 7-8% compounded annually while revenues limp at 2-3%.
The unsustainability isn't just actuarial, it's structural.
These programs create dependency loops: Subsidized healthcare inflates costs (U.S. per-capita spending is double the OECD average), education funding hasn't improved outcomes (NAEP scores flat since the 1970s despite spending tripling inflation-adjusted), and welfare expansions correlate with workforce dropout rates.
Every dollar spent requires borrowing or taxing, but the Laffer curve bites hard. Top marginal rates above 50% (federal plus state) historically tank growth, as seen in post-WWII Europe.
Current U.S. debt-to-GDP sits at 125%, higher than post-WWII peaks when the ratio fell rapidly due to 4%+ growth.
Today's 1-2% trend growth can't outrun 5-7% compound interest plus entitlement creep.
Everything else, from SNAP to student loans to green energy subsidies, operates on infinite horizons with finite resources.
Math is merciless.
Even if we taxed the top 1% at 100% of income (impossible without collapse), it'd covers maybe 40% of the shortfall.
Reforming entitlements means benefit cuts or age hikes, which voters punish politicians for proposing.
Without radical restraint, we're hurtling toward a sovereign debt crisis where bond markets demand 10%+ yields, hyperinflating away obligations or defaulting outright.
Public funding for healthcare beyond the VA isn't just expensive, it's a Ponzi scheme demography has already bankrupted.
The only fiscally sustainable path is sunset clauses, privatization, and devolution to states or individuals before the inevitable crash.
Start with the raw numbers: In fiscal year 2024, federal spending exceeded $6.8 trillion, with mandatory entitlements e.g. Social Security, Medicare, Medicaid, and related health programs accounting for over 60% of the budget, or roughly $4.1 trillion.
These aren't discretionary line items that Congress can trim; they're locked in by law and indexed to inflation, wages, or healthcare costs that can and sometimes do rise faster than GDP.
The Congressional Budget Office projects that by 2035, these programs alone will consume nearly 75% of federal outlays, leaving scraps for defense, infrastructure, or anything else.
Interest on the national debt, already at $1 trillion annually in 2025, will surge as borrowing covers the gap, creating a doom loop where debt service crowds out the very programs it's meant to fund.
Demographics seal the deal.
The Baby Boom generations' retirement has flipped the worker-to-retiree ratio from 5:1 in 2000 to about 2.8:1 today, heading toward 2:1 by 2035.
Social Securitys' trust fund is on track to deplete by 2033, Medicares' hospital insurance fund by 2031, after which payroll taxes cover only 75-80% of promised benefits without massive infusions from general revenue, which is already deficit-financed.
State and local governments mirror this at smaller scales: Public pensions are underfunded by $4-6 trillion nationwide, per Moody's and other analysts, with cities like Chicago and Dallas teetering on junk-bond status because pension obligations grow at 7-8% compounded annually while revenues limp at 2-3%.
The unsustainability isn't just actuarial, it's structural.
These programs create dependency loops: Subsidized healthcare inflates costs (U.S. per-capita spending is double the OECD average), education funding hasn't improved outcomes (NAEP scores flat since the 1970s despite spending tripling inflation-adjusted), and welfare expansions correlate with workforce dropout rates.
Every dollar spent requires borrowing or taxing, but the Laffer curve bites hard. Top marginal rates above 50% (federal plus state) historically tank growth, as seen in post-WWII Europe.
Current U.S. debt-to-GDP sits at 125%, higher than post-WWII peaks when the ratio fell rapidly due to 4%+ growth.
Today's 1-2% trend growth can't outrun 5-7% compound interest plus entitlement creep.
Everything else, from SNAP to student loans to green energy subsidies, operates on infinite horizons with finite resources.
Math is merciless.
Even if we taxed the top 1% at 100% of income (impossible without collapse), it'd covers maybe 40% of the shortfall.
Reforming entitlements means benefit cuts or age hikes, which voters punish politicians for proposing.
Without radical restraint, we're hurtling toward a sovereign debt crisis where bond markets demand 10%+ yields, hyperinflating away obligations or defaulting outright.
Public funding for healthcare beyond the VA isn't just expensive, it's a Ponzi scheme demography has already bankrupted.
The only fiscally sustainable path is sunset clauses, privatization, and devolution to states or individuals before the inevitable crash.
Britain's descent into a fiscal quagmire serves as a stark cautionary tale for any nation tempted by expansive (and expensive) welfare promises, where the seeds of generosity sown in the post-war glow have sprouted into a strangling vine of debt, dependency, and demographic strain.
Since the welfare state's full bloom in the 1940s that ushered in universal benefits, pensions, and the NHS, the tarnished crown jewel of socialized medicine, the UK's public spending has been on a trajectory of inexorable expansion.
By 2025, public sector net debt has ballooned to £2.9 trillion, equivalent to 96.4% of GDP, with projections from the Office for Budget Responsibility warning it could hit 350% within 50 years if unchecked.
This isn't mere overspending; it's a vicious doom loop where ballooning entitlements demand ever-higher borrowing, which in turn inflates interest payments that devour budgets, forcing more borrowing to prop up the very system that's eroding solvency.
The loop tightened inexorably with the welfare state's unchecked growth. Post-1945, programs like universal child benefits and state pensions exploded from modest safety nets into £313 billion annually in cash transfers by 2024-25, representing over 10% of GDP and growing faster than revenues.
These aren't optional luxuries; they're automatic escalators tied to inflation and demographics, consuming 40% of total public spending while revenues limp along at 37% of GDP.
The result? Persistent deficits. £149.5 billion borrowed in the year to March 2025 alone, pushing net interest payments to £105.2 billion yearly, or 3% of GDP, rivaling the entire UK defense budget.
Their interest burden, now their fastest-rising expense, crowds out productive investments, weakens growth (stuck at 1-2% annually), and hikes borrowing costs as bond yields climb to 4.5%. That's the third-highest among advanced economies.
It's a self-reinforcing spiral. More debt begets higher rates, which demands deeper cuts or tax hikes elsewhere, further stifling the economy and amplifying welfare demands in a feedback frenzy.
Enter mass immigration, the accelerant that turned this smolder into another Great Fire of London.
Since the 1990s, net inflows have surged, peaking at over 700,000 in 2023 before modest curbs, importing millions who, on aggregate, drain more from the fiscal pot than they replenish.
These newcomers, often young men with low sill levels, swell welfare rolls: universal credits, housing subsidies, and, when they marry, child benefits, while contributing via taxes at rates 20-30% below natives.
Data underscores the imbalance: immigrants run deficits of £15 billion annually, or £40 million daily, factoring in education for their anchor babies and healthcare strains.
This isn't xenophobic conjecture; it's arithmetic.
With 14 million foreign-born residents by 2025, their net drain exacerbates the welfare bloat, forcing £18-20 billion more in annual spending on services like schools and GPs without commensurate revenue uplift, tightening the debt noose as governments borrow to bridge the gap rather than reform.
Crowning this catastrophe is the National Health Service, the welfare state's supposed "envy of the world," now a bloated monument to fiscal folly masquerading as compassion.
Hailed as a universal beacon since 1948, the NHS devoured £196 billion so far in 2025, nearly a third of public spending, yet delivers rationed misery on an industrial scale. Waiting lists had already metastasized to 7.42 million by January 2025, with 6.2 million unique patients trapped in limbo, breaching the 18-week elective target for 90% of cases (actual: under 60%).
Emergency care? Only 70% of patients are seen within four hours, while ambulance handovers exceed two hours for one in five calls.
The cold ledger exposes the rot. Despite 2.7% real-terms growth to £200.5 billion by 2028-29, below the 3.4% historical norm needed just to tread water the NHS faces a £32 billion decade-long shortfall, demanding £8.5 billion yearly bailouts that vanish into black holes like £13.7 billion maintenance backlogs, £10 billion temporary staffing overruns, and £220 million monthly from delayed discharges due to social care voids.
Strikes and redundancies add £3 billion in unplanned hits, including £1 billion for job cuts the leftist government mandated but won't fund, derailing productivity drives and inflating drug costs via global pressures.
Outcomes? Infant mortality up 10% since 2018, cancer survival lagging 20% behind peers, and per-capita spending double the OECD average for half the results. That's hardly the envy of anyone.
The NHS is an embarrassment of a system where innovation starves amid bureaucracy.
This British doom loop, welfare expansion fueling deficits, immigration amplifying drains, and the NHS as the insatiable core is no anomaly but a predictable pathology of public funding unbound.
Debt spirals toward crisis, growth sputters under the weight, and politicians kick the can, borrowing from tomorrow to paper over today's illusions.
The escape demands slashing entitlements, sealing borders to net contributors only, and privatizing the NHS monolith before it drags the economy under. Anything less is fiscal suicide, dressed in egalitarian drag.
If those numbers seem small to American eyes, let's slice through the illusion.
Britain's fiscal woes aren't some quaint island peculiarity. Those funny-looking "billions of £" aren't' anything that a plucky little island nation can muddle through.
Scale it up, and the unsustainability glares back like a debt collector at midnight. The United Kingdom, with its 69.6 million souls crammed into a landmass the size of Oregon, punches at a nominal GDP of roughly £2.75 trillion in 2025, a tidy sum that sounds robust until you peel back the ledgers.
That's about $3.6 trillion USD, give or take currency wobbles, a speck next to the United States' behemoth economy, clocking in at $30 trillion nominal GDP for the same year, sprawling across a population of 347.5 million, or five times the UK's headcount spread over 40 times the land.
The U.S. isn't just bigger in square miles or square jaws; it's a fiscal colossus where even its profligacy dwarfs Britain's in absolute terms, yet the percentages reveal the same rot eating from within.Now, the revenue side: Britain's government hauls in £1.12 trillion annually; that's 40.8% of GDP. UK taxes already squeeze the average worker harder than a gravel compactor, funding everything and everyone from cradle to grave.
Across the pond, Uncle Sam collects $5.2 trillion in federal revenue, a mere 17.1% of its GDP slice, leaving vast swaths untaxed by Washington (states and localities gobble another 10-12%, but that's devolved chaos for another rant).
Per capita? The UK forks over about £16,100 ($21,000 USD) per person in revenue, enough to make Bernie Sanders whistle, considering America's $15,000 per head federally, buoyed by a broader tax base and less socialist sprawl.
Britain's model isn't something to copy; it's a cautionary warning.
Shrink the welfare spending, or watch the numbers sink the ship of state.
I don't want the sun to set on my country the way that it has on Britain.
Since the welfare state's full bloom in the 1940s that ushered in universal benefits, pensions, and the NHS, the tarnished crown jewel of socialized medicine, the UK's public spending has been on a trajectory of inexorable expansion.
By 2025, public sector net debt has ballooned to £2.9 trillion, equivalent to 96.4% of GDP, with projections from the Office for Budget Responsibility warning it could hit 350% within 50 years if unchecked.
This isn't mere overspending; it's a vicious doom loop where ballooning entitlements demand ever-higher borrowing, which in turn inflates interest payments that devour budgets, forcing more borrowing to prop up the very system that's eroding solvency.
The loop tightened inexorably with the welfare state's unchecked growth. Post-1945, programs like universal child benefits and state pensions exploded from modest safety nets into £313 billion annually in cash transfers by 2024-25, representing over 10% of GDP and growing faster than revenues.
These aren't optional luxuries; they're automatic escalators tied to inflation and demographics, consuming 40% of total public spending while revenues limp along at 37% of GDP.
The result? Persistent deficits. £149.5 billion borrowed in the year to March 2025 alone, pushing net interest payments to £105.2 billion yearly, or 3% of GDP, rivaling the entire UK defense budget.
Their interest burden, now their fastest-rising expense, crowds out productive investments, weakens growth (stuck at 1-2% annually), and hikes borrowing costs as bond yields climb to 4.5%. That's the third-highest among advanced economies.
It's a self-reinforcing spiral. More debt begets higher rates, which demands deeper cuts or tax hikes elsewhere, further stifling the economy and amplifying welfare demands in a feedback frenzy.
Enter mass immigration, the accelerant that turned this smolder into another Great Fire of London.
Since the 1990s, net inflows have surged, peaking at over 700,000 in 2023 before modest curbs, importing millions who, on aggregate, drain more from the fiscal pot than they replenish.
These newcomers, often young men with low sill levels, swell welfare rolls: universal credits, housing subsidies, and, when they marry, child benefits, while contributing via taxes at rates 20-30% below natives.
Data underscores the imbalance: immigrants run deficits of £15 billion annually, or £40 million daily, factoring in education for their anchor babies and healthcare strains.
This isn't xenophobic conjecture; it's arithmetic.
With 14 million foreign-born residents by 2025, their net drain exacerbates the welfare bloat, forcing £18-20 billion more in annual spending on services like schools and GPs without commensurate revenue uplift, tightening the debt noose as governments borrow to bridge the gap rather than reform.
Crowning this catastrophe is the National Health Service, the welfare state's supposed "envy of the world," now a bloated monument to fiscal folly masquerading as compassion.
Hailed as a universal beacon since 1948, the NHS devoured £196 billion so far in 2025, nearly a third of public spending, yet delivers rationed misery on an industrial scale. Waiting lists had already metastasized to 7.42 million by January 2025, with 6.2 million unique patients trapped in limbo, breaching the 18-week elective target for 90% of cases (actual: under 60%).
Emergency care? Only 70% of patients are seen within four hours, while ambulance handovers exceed two hours for one in five calls.
The cold ledger exposes the rot. Despite 2.7% real-terms growth to £200.5 billion by 2028-29, below the 3.4% historical norm needed just to tread water the NHS faces a £32 billion decade-long shortfall, demanding £8.5 billion yearly bailouts that vanish into black holes like £13.7 billion maintenance backlogs, £10 billion temporary staffing overruns, and £220 million monthly from delayed discharges due to social care voids.
Strikes and redundancies add £3 billion in unplanned hits, including £1 billion for job cuts the leftist government mandated but won't fund, derailing productivity drives and inflating drug costs via global pressures.
Outcomes? Infant mortality up 10% since 2018, cancer survival lagging 20% behind peers, and per-capita spending double the OECD average for half the results. That's hardly the envy of anyone.
The NHS is an embarrassment of a system where innovation starves amid bureaucracy.
This British doom loop, welfare expansion fueling deficits, immigration amplifying drains, and the NHS as the insatiable core is no anomaly but a predictable pathology of public funding unbound.
Debt spirals toward crisis, growth sputters under the weight, and politicians kick the can, borrowing from tomorrow to paper over today's illusions.
The escape demands slashing entitlements, sealing borders to net contributors only, and privatizing the NHS monolith before it drags the economy under. Anything less is fiscal suicide, dressed in egalitarian drag.
If those numbers seem small to American eyes, let's slice through the illusion.
Britain's fiscal woes aren't some quaint island peculiarity. Those funny-looking "billions of £" aren't' anything that a plucky little island nation can muddle through.
Scale it up, and the unsustainability glares back like a debt collector at midnight. The United Kingdom, with its 69.6 million souls crammed into a landmass the size of Oregon, punches at a nominal GDP of roughly £2.75 trillion in 2025, a tidy sum that sounds robust until you peel back the ledgers.
That's about $3.6 trillion USD, give or take currency wobbles, a speck next to the United States' behemoth economy, clocking in at $30 trillion nominal GDP for the same year, sprawling across a population of 347.5 million, or five times the UK's headcount spread over 40 times the land.
The U.S. isn't just bigger in square miles or square jaws; it's a fiscal colossus where even its profligacy dwarfs Britain's in absolute terms, yet the percentages reveal the same rot eating from within.Now, the revenue side: Britain's government hauls in £1.12 trillion annually; that's 40.8% of GDP. UK taxes already squeeze the average worker harder than a gravel compactor, funding everything and everyone from cradle to grave.
Across the pond, Uncle Sam collects $5.2 trillion in federal revenue, a mere 17.1% of its GDP slice, leaving vast swaths untaxed by Washington (states and localities gobble another 10-12%, but that's devolved chaos for another rant).
Per capita? The UK forks over about £16,100 ($21,000 USD) per person in revenue, enough to make Bernie Sanders whistle, considering America's $15,000 per head federally, buoyed by a broader tax base and less socialist sprawl.
Britain's model isn't something to copy; it's a cautionary warning.
Shrink the welfare spending, or watch the numbers sink the ship of state.
I don't want the sun to set on my country the way that it has on Britain.
Life is Golden
The Sage
The UK runs a single-payer system with a fraction of the U.S. population. Even at that smaller scale, it struggles with long wait times, rationed care, and chronic underfunding. In short, a shitshow. That’s a preview of what would happen here, only far worse with 330 million people.
That's why we must never copy them. Learn from their mistakes.
I sure hope it's not taxpayer-funded.
View: https://x.com/RogerMarshallMD/status/1988078734029844555?s=20
View: https://x.com/RogerMarshallMD/status/1988078734029844555?s=20
Life is Golden
The Sage
