Obstacles to Socialized Healthcare

I think the biggest single obstacle in the way of socialised health care in America is ideological rather than technical or economic. In Britain, the NHS is enormously popular, and has been since it was set up in 1948. The reason for that popularity is not its efficiency (though it's more efficient than the American system), but the fact that it provides equal health care to everyone, no matter what their relative social or economic status. It is, in principle, free at the point of delivery. The rigid semi-feudal class system in Britain means that the British people have never lost sight of equality as a social goal to aspire to, and as a moral ideal. Because of the perceived equality of opportunity in America (which does not exist to anything like the same extent in Britain), the assumption is that the poor deserve to be poor - they aren't smart enough, or didn't work hard enough, or something. The British do not make that assumption - there are too many examples of stupid aristocrats and intelligent workers for that assumption to stick. Somebody's wealth or social status has no connection with their level of intelligence or how hard they work. To apportion health care - which their lives may depend upon - on the basis of wealth or social status (which is what a privatised health care system does) is therefore perceived in Britain as a terrible injustice, and essentially immoral. In America, it is perceived as entirely just and entirely moral. Until that ideological barrier is overcome, there's no point debating the relative economic merits or demerits of a privatised or socialised health care system - socialised health care was not adopted in Britain because we thought it would be more efficient, but because we thought it would be more just.