Note from CM: We are going to close comments. I want to thank everyone who contributed today to a good discussion. Thanks for keeping things civil. Each of you have given the rest of us something to think about. We aren’t going to solve anything today, but discussions like this are essential. I encourage and challenge you to take whatever you are learning on this subject and write your congressional representative with your opinions about what he/she should do.
• • •
My vocation is in health care. Though I was in congregational ministry for years, even then I had an interest in the complementary “ministries” of spiritual/pastoral care and health care. The summaries of Jesus’ own ministry in the Gospels are wholistic as well:
Jesus went throughout Galilee, teaching in their synagogues and proclaiming the good news of the kingdom and curing every disease and every sickness among the people. (Matthew 4:23)
My wife is a nurse. I’ve always enjoyed visiting people in hospital and health care settings and when they were laid up or shut in at home for health reasons. I found joy in talking with doctors and health care professionals, feeling that we were partners in the work of providing care for people so that they might find healing and health in any number of ways.
When we began taking mission trips in the 1990’s, they were medical mission trips. Doctors and nurses joined our teams and while some of us focused on singing, testifying, and preaching, they held clinics and worked with local health care professionals in the towns and villages we visited.
I am passionate about health care. I am fortunate to work for an organization with a CEO who understands that this work is about serving our community to enhance health and well being and not to make huge profits for shareholders. The doctors who have served my family and me with our health needs have had this same spirit of public and personal service. We chose them largely for that very reason, and when we had to change doctors, it was often because they stepped away from doctoring because they either felt couldn’t function with integrity in the system or because they had family concerns of their own that required their compassionate presence and attention.
It is from this sacred, vocational, public service perspective that I view health care. If I had been more gifted and understood more when I was younger, I might have pursued a path of missionary medicine or service with an organization like Doctors without Borders.
As you might imagine, I have strong feelings about what is happening in Washington these days.
However, to me, the current debate is only part of a much bigger problem of not recognizing health care in the terms I have outlined above.
Instead we have invested it with all kinds of political buzzwords and concepts such as “freedom,” “the free market,” and an intrinsic distrust of “the government” and “socialism.”
As a result, we have one of the most expensive, wasteful, inefficient, and ineffective health care systems in the world. Tens of millions of people remain uninsured and without proper access to good health care. Administrative costs are outrageously high. The system is hopelessly complex and notoriously bad at what it’s supposed to do. Study after study shows U.S. health outcomes to be mediocre at best and in some cases, appalling bad.
As a Christian whose vocation is in the field of health care, this situation is intolerable to me.
See this 2014 study, for example, which found that the U.S. spends more than ten other industrialized countries but comes in dead last with regard to health outcomes.
What would I, as someone whose vocation is in health care and who is passionate about health care, want in an ideal health care system?
- Universal health care, with fair access for all people, including free choice of doctor and hospital for all, not as a privilege for the few
- Simplified, efficient, and cost-effective administration
- Private doctors, hospitals, and health care professionals continue to provide care.
In my perspective, the only answer that makes any sense going forward is one that provides universal health care with a single-payer system, sometimes called Medicare for all.
Here is the description of such a system by Physicians for a National Health Program:
Single-payer national health insurance, also known as “Medicare for all,” is a system in which a single public or quasi-public agency organizes health care financing, but the delivery of care remains largely in private hands. Under a single-payer system, all residents of the U.S. would be covered for all medically necessary services, including doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs.
The program would be funded by the savings obtained from replacing today’s inefficient, profit-oriented, multiple insurance payers with a single streamlined, nonprofit, public payer, and by modest new taxes based on ability to pay. Premiums would disappear; 95 percent of all households would save money. Patients would no longer face financial barriers to care such as co-pays and deductibles, and would regain free choice of doctor and hospital. Doctors would regain autonomy over patient care.
Here’s a link to bill HR 676, the single-payer bill that is in Congress today.
One thing I’ve never understood is why economic conservatives aren’t out there leading the charge for this kind of system. Single-payer universal health care would be the greatest boon to business this country has ever seen. Can you imagine what businesses, large and small, could do with the extra money they would have by not having to provide health benefits for their employees? How many people would consider starting up new businesses if they didn’t have to negotiate the huge hurdle of providing health benefits to prospective workers?
This is why Warren Buffet once called health care “the tapeworm of the American economy.” It sucks life and vitality out of the business sector.
At any rate, there are literally hundreds of angles to this discussion.
I want to open it up to you today and have you state your opinions and arguments.
As we do, please remember what this site is all about. I am not primarily interested in marking off my political territory here and demonizing anyone who disagrees. In the realm of civic engagement there is always room for people of goodwill to come at things from a variety of angles and perspectives and to have vigorous discussions. As long as we are all committed to the common good, I have no problem with that.
And I am most interested, as a Christian, in trying to understand how something like the way we seek the health and well being of our families, our neighbors, and our communities grows out of a Jesus-shaped perspective on life.
So please listen well and seek wisdom in what you say. Don’t start calling people names or treating them with disdain. If that starts happening, comments will be deleted without explanation or apology.
The Internet Monk Archives 
We are going to close comments. I want to thank everyone who contributed today to a good discussion. Thanks for keeping things civil. Each of you have given the rest of us something to think about. We aren’t going to solve anything today, but discussions like this are essential. I encourage and challenge you to take whatever you are learning on this subject and write your congressional representative with your opinions about what he/she should do.
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I was thinking of that very line earlier today.
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One big problem I see with the system we’ve had for years now is that the [potential] patient is not the customer. The employer is. Medical costs are what they are because insurance companies will pay for them. They pay for them because they know employers will pay for high premiums. Employers get away with paying high premiums because they know that they are a labor cost that causes an invisible (to the employee) reduction in wages. And, employees are willing to sacrifice salary to get coverage. Coverage is viewed by employees as critical because of high medical costs that they would have to pay for themselves without coverage, which is partially fueled by hysteria of what will happen to you without coverage. And employees already have the mindset that somebody else owes them medical coverage, which is their employer. And the employers that can offer the best deals with such a system in place are the large corporations because they can get better volume discounts. Small businesses, self-employed and unemployed people have difficulty getting coverage. The political parties don’t help either because they tend to cater to various groups of corporations in the system, which already benefit from the system.
It is a never ending cycle where there is no incentive to cut costs anywhere by anybody involved. No matter the solution, until this is changed it will only get worse. My 2c adjusted for inflation.
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You must mean Medicaid.
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Awesome Rick.
[ Unrelated to you ]
This optimist accidently fell off the top of a 30 story building and was heard to say passing the second floor on his way down, “So far, so good.”
I’m not an optimist about future events outside of eternal residence with God after I die.
But down here, we’re just waiting for the next train wreck.
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Small as they are, they’re easy to keep clean.
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Kind of you, Rick.
D.
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Yes indeed.
D.
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“…because of the billing difficulties and payments that don’t cover costs.”
Problems that would go away with a single payer system and elimination of Chargemasters.
Dana
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To Seneca and AF (and any others here who’ve presented the minority viewpoint and I might’ve missed)…
I commend you on sharing your opinions today. I, for one, appreciate seeing other perspectives and viewpoints. I was once a member of an online gaming community (~100 members) in which I was the sole Christian voice, so I know how it feels to be one of the lone voices of what you believe to be truth. I know you’ve been called “trolls” here the past (maybe even today), but I personally appreciate your presence and hearing viewpoints that I might not agree with.
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HUG,
College education is turning into a big business now, too. Since we were in the CSU system, the number of middle managers has exploded. Department Chairs aren’t allowed to do that work anymore; specialist jobs have been developed for administrators to fill. It’s those salaries that are contributing the most to inflationary prices in education. Meanwhile, my son with an Master’s and nearly 7 years of teaching experience can only look forward to getting a tenured job at the university level if he can get a PhD.
Dana
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Had a brilliant Dr. that moved to Texas for exactly the reason you call ‘bullshit.’ Best Dr. I ever had. Her husband is a cardiologist. They both closed their practices and started over in Texas.
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AF,
Go to Wikipedia and look up “Chargemaster”. This is one of the huge reasons why health care costs are so high. Chargemasters are unregulated in most states, therefore, people already can’t look at the prices, because there is no incentive for the medical bureaucracies to make their inflated prices transparent to consumers even now.
Yes, taxes would probably be a bit higher, but would mostly offset the inflated prices plus co-pays and deductibles we already shell out, not to mention the charges hospitals have to recover – from the rest of us – in order to pay for care they give to uninsured people. I’d be happy for the wealth to be shifted – out of the hands of corporations and into the hands of health care providers, most of whom are compassionate and competent people. They, too, are frustrated because of the restrictions on the time and care they are allowed to give, which have developed within the present system. For +25 years I worked in the industry as a medical transcriptionist and I know how it is “on the ground” for doctors, as well as patients. The most experienced and compassionate doctor I ever worked with told me the answer to the health care mess is a single payer system.
I would be glad for my taxes to be increased to pay for a system such as Chaplain Mike has described – which preserves choice of health care providers. The German system also preserves choice with regard to insurance providers, who are very tightly regulated. Most of the time, regulation is not a bad thing – it prevents abuses.
Dana
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“…if we did care we would do the things nearly every other industrialized nation does. We need to get over the notion that Moral Persuasion has all that much traction in American politics, it doesn’t. We are a nation that admires ruthlessness; we idolize our robber barons, if they are the railroad and oil tycoons of old or the techno-playboys of today’s Silicon Valley. Why else do we spend so much time listening to all the absurdist nonsense that spills out of Elon Musk’s mouth?”
True this.
Dana
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AF, I am dumbfounded at the total blind faith in government to magically solve these problems that is rampant in this thread. Having dealt with the Social Security administration and the various welfare programs in California, I can tell you government oversight and management leaves much to be desired. Talk to anyone dependent on the VA for healthcare. Sounds a lot like mob rule to me. ‘We all need this so you are going to give it to us, and damn you too.’ Explain away the costs, gloss over the bureaucratic mess it will become, and cloak it in the righteous rhetoric of ‘rights’ and ‘Christian Duty.’
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As Stephen notes below, the reason those conservatives aren’t leading the charge is because they would lose their profits. In addition those in Congress who are in the pockets of the insurance, hospital corporation and pharmaceutical industries ( some Democrats too) would lose those contributions, and thus perhaps their incumbencies.
The current system is madness. Bismarck’s administration constructed the German system +100 years ago so that the workers would not take to the streets in violent rebellion. Is that what it’s going to take to knock some sense into our legislators? I hope not.
Dana
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+1
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It is if you believe very deeply in The Fall and Original Sin.
Or hold to special types of charismaticism that argue that “by his stripes we are HEALED”.
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Again, the result of a Gospel of Personal Salvation and ONLY Personal Salvation.
“I Got Mine” combined with “You’ll get Pie in the Sky when you Die”.
“So what if I rack him ’til he die? For I shall have Saved His Soul.”
— “The Inquisitor”, Mark Twain’s Connecticut Yankee in King Arthur’s Court
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Besides athletics, I cannot believe the “Student Centers” and “Student Unions” you find on colleges today. Compared to what I remember from Cal Poly in the Seventies, they seem to have ALL the amenities of an upscale galleria plus a high-end cruise ship. Even the foodservice isn’t a cafeteria but a fast-food court just like a mall. As long as you stay there racking up student loan debt, you have free access to all these recreational amenities you’d never be able to afford on the outside. And those have got to cost.
Question: Is student loan charged like a debit/credit card swipe these days, where you never see the money going through your hands? If so, that’s a known tactic to maximize impulse spending — swipe and you get the goodies without seeing the money flow out, swipe swipe swipe swipe swipe swipe…
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+1
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Because what does it matter if they die if their Soul is Saved(TM)?
More fallout from the Gospel of Personal Salvation and ONLY Personal Salvation.
And the GOP as God’s Own Party.
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Plus Communism is NOT de facto evil. It’s extremely Christian at it’s core.
Insert jab about original sin, I’ve heard that one before. Insert jab about no true ‘utopia’ until Jesus returns, shut it, I was told to pray THY KINGDOM COME. Insert jab about whatever, just shut up.
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I mean, and I hate to use this word, but you’d think a fundamental part of being a Christian is WANTING for everyone to have adequate care for their health and well being. It’s believers who lack even that desire, despite all the challenges and problems, that baffle me.
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“Then they should die and reduce the surplus population.”
— Ebenezer Scrooge, at the beginning of “A Christmas Carol”
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The market cost of healthcare you need to survive is all your money plus whatever future lean on your income the hospital can get.
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Whoever’s in POWER, of course.
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Christiane, the bottom 48% of taxpayers pay no federal income tax at all. The top 10-12% pay 70% of all income taxes paid. This ‘unfair tax breaks for the rich’ is at best an oversimplification and at worst a misrepresentation.
Adam, this country is going deeper into debt every year. The deficit is larger than our yearly GDP. Asserting that we are not going broke is magical thinking. Period.
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Then burn out your conscience with a white-hot iron and become a Sociopath.
Because Sociopaths Always Win.
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You mean effectively FREE health care for life, No Matter What?
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Yes but this is through the channel that Medicaid patients are less healthy in general, which is what you would expect.
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The facts do not bear out your opinion. Canada is a growing G7 economy with less debt than the US and we have had Medicare (Single Payer) for 50 years.
I dare you: Go to a poor neighborhood and start telling people that according to you, if they get cancer, or other conditions that require costly care, you think they ought to be left to die. Or go bankrupt, loose everything to hopefully survive. Look them in the eye when saying that. Oh, and maybe tell them about Jesus and how wonderful the GOP is too.
There are real people out there, my friend. Real people.
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“When we look at health care: do we see it as a human right?” There is a problem with this line of thought. A person wishing to become a Dr. must sacrifice 8 to 12 years of their life in school and medical residency. They spend between $500,000 to $1 million. Once they graduate they spend however much to establish and office and a practice. How is access to their education, labor, and investment a right? You can mandate universal healthcare, but it becomes a game of diminishing returns. Cap salaries and put price controls in force and those considering medicine will ‘reconsider.’ The best Dr. I ever had, and her husband, who is a heart surgeon, left very lucrative practices here in So Cal because of the regulations, and started from scratch in Texas. She told me that universal health care would ruin medicine in this country. She said that’s why there are so many Pakistani and Indian Dr.’s. It’s still a good deal for them because their cost of education is much less.
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Slippery slope fallacy. Recognizing that medical resources are a special case that should not be solely regulated by the marketplace does not lead as a fait accompli to communism, no more than recognizing errors in scripture leads to “Then the whole book is worthless and should be thrown away!” (televangelist angrily motions as if hurling Bible onto stage [without actually doing so, because then as everyone knows the divine lightning would come down and strike him dead and he would go to hell forever and ever]).
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I don’t have a recommendation.
What will happen we will have some kind of inadequate health treatment for the poor and disadvantaged [social medicine ] and the wealthy will have a different, better health care. It’s the way of the world
C.M., I have Medicare with all the options – a great deal for me, a lousy deal for the government. Medicare is very costly for the country but everybody is afraid to take anything away from the seniors – who represent a significant voting block.
I’m thrilled to have it, I don’t think it can continue however.
Stuart said
StuartB says:
March 13, 2017 at 4:22 pm
I think a deeper question should be asked.
What sort of Christian would want to deny men, women and children health care, food, stability, a roof over their head, any of these things?
ANSWER: I don’t think any Christian wants to deny any of those things. But sooner or later as seen in the history of mankind, those precious things WILL be denied as currency becomes worthless, there is no electricity, you can’t get transportation, you find yourself struggling to get food and decent water to drink.
I’m not a survivalist; but sooner or later we’re Venezuela.
Do any of you think that really can’t happen?
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Would you support repealing the Emergency Medical Treatment & Labor Act of 1986? Then, hospital emergency rooms would not be required by law to treat all patients who come through the door, regardless of ability to pay, and the market would decide who received treatment and who didn’t, and who lived and died as a result. The result would be an enormous decrease in the price tag of healthcare in the U.S., since many people use emergency rooms as their primary care, having no other recourse, and unpaid for emergency room care is very costly. We all pay indirectly for the expensive use of emergency rooms as primary care, and it’s one of the things that make healthcare in the US so costly.
I think the idea of revocation of the Act is morally appalling. But unless you support repealing it, you are saying that our limited medical resources are not to be divvied up among the populace only, or even primarily in certain cases, on the basis of the ability of the patient to pay, either by himself or by being a subscriber to healthcare insurance. Once you allow that exception, you are saying societal decisions about who should and should not receive health care should be based on factors beyond the ability of patients to pay. In which case it behooves you and all of us to find a way to distribute healthcare to those who cannot afford it by ways other than emergency rooms, since this is a highly inefficient and expensive means of delivery that inflates the cost of healthcare in the US for everyone.
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Of course it would be nice to have more options, but a human body and a life is not a car. If I have a crappy, old car it would make sense to go super cheap on insurance since a fender bender would render the car a total wreck in insurance terms and not worth fixing. Not so with a human being.
If I have cheap car insurance and I wreck my car and the insurance won’t cover the costs, and I can’t afford a new car, I have choices: take public transportation, save up enough money over time to get a new car, bum a ride off a friend until I figure out the best option, or just stay home. If I get sick and not enough health insurance for treatment, I’ll likely die.
If people get to choose only certain items for coverage, rare disease coverage will be so cost prohibitive that only the very wealthy will have it, if it’s available at all, because so few would want it. If it’s based on lifestyle choices, it gets tricky. Suppose you get lung cancer but are not a smoker? Do you get a discounted cancer coverage for that? If so, do you then have to prove you aren’t a smoker? What about heart disease? Do you have to prove your high cholesterol doesn’t come from genetics but diet? What if you have a family history of depression? Do you pay more for mental health coverage than someone whose family has no history of it? Suppose you didn’t take coverage for mammograms, or colonoscopies, or any preventative screenings, but then develop the disease? Do you pay double for, say, cancer coverage because you didn’t get routine mammograms?
Certainly, if health insurance worked like car insurance, we’d have more choices. We’d likely pay more as well. But healthcare is not like auto care. If my car has an issue that is too costly to fix for what the car is worth, I can get a new car. Are the worth of our lives to be determined by how much it costs if we get too sick?
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And who decides what life choices are bad, and to what degree they should impact their rates?
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There will always be rich and generous people.
There will always be poor and selfish people.
There will always be good people in government.
There will always be bad actors in government.
There will always be good people in business.
There will always be bac actors in business.
How much of your money will you give to the government to provide for the common good?
10%? 30%? 50%? 80%?
Why not all of it?
Education, transportation, health, fire, water, police are all for the public good. Why not food? We all need to eat. Probably be better overall if we were all on a healthy diet. Be a good idea for someone to tell us what to eat and how much to exercise. Clothing? we should all be clothed. Housing? Yeah, that too – we should all have that.
Let’s just pool all our money and let the powers that be (gov’t or some other agency of the people’s choice) provide for all our needs.
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Breaking news headline from Washington Post:
https://www.washingtonpost.com/powerpost/obamacare-revision-would-reduce-insured-numbers-by-24-million/2017/03/13/ea4c860a-0829-11e7-93dc-00f9bdd74ed1_story.html?hpid=hp_hp-top-table-main_cbo-430pm%3Ahomepage%2Fstory&utm_term=.81d2511a0f7c
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The biggest problem there is that the demographics that “exclusively use” a particular test/surgery/procedures may not be, overall, able to afford it.
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My doctor friends (admittedly a small sample) speak of taking a minimal number of medicare patients – because of the billing difficulties and payments that don’t cover costs.
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You should. Who pays for it is another question. You still had access to get the screening – either by lying and having the ins. company pick up the tab or paying for it yourself. No one denied you getting the screening.
Wouldn’t it be nice if you would have more options on what insurance you could purchase? Then you could choose what would or would not be covered.
You could choose an option where all screenings are covered or one where you pay for some things yourself.
Think auto ins – some people pay for the collision and comprehensive components and some don’t. Some pay for roadside assistance and towing – some don’t.
Point is that auto ins companies have figured out ways to segment components of ins. Health ins. companies would do a similar thing. It would be in their best interest and we would end up with more choices.
Some would pay more and some less. Depending on what they wanted covered and their life choices (think bad auto drivers).
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Getting sick is not a sin.
If you’re going to make an argument, at least start with a credible premise.
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#3 is my biggest concern as well.
I agree – Critiques on both sides show signs of fear tactics and often greatly exaggerated.
“only means to transparent costs.” Why do you think this?
When I think of industries that have transparent costs I think of those that have many players in the market – grocery, auto sales, retail. What I don’t think of is my local electric or gas company, or my local cable monopoly.
A quick internet search and you can see prices on elective type procedures – dental whitening, liposuction, some plastic surgery. If these folks can provide better transparency, it can be done by you Gen doctor.
Do you think if there is a single payer, that will cause people to change and start looking at prices? It generally only happens when there real out of pocket costs that the consumer sees and has to pay.
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One who hadn’t paid too much attention to what the OT prophets, John the Baptist, the Apostlea James and John, and Jesus had to say on the matter?
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Why is it the “best” prospect? You outlined many of the issues and many are related to Fed / State regulations. Why / How does it become best to let that bureaucracy run it?
A better system would include getting employers out of the mix. If the pay and tax incentives from the Gov’t were removed, employers would find a way to get out of the health ins. part real quick. Image a system where people could purchase health insurance like car insurance – I’d like this piece (catastrophic) and that piece (coverage for annual exams – no deductible), but not another one (maternity care because I am a 50+ year old male).
Look at the demographics and you can see start to see how a single payer (gov’t coerced system) will end up being a massive wealth shift from young to old.
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I think a deeper question should be asked.
What sort of Christian would want to deny men, women and children health care, food, stability, a roof over their head, any of these things?
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Canadian researchers testing something – yes, there are always some examples of this. Why is it, though that most (not all) medical advances come via private companies? This is almost always the case – regulated / monopoly type industries do not innovated – look it up in a basic economics textbook.
Let them die? Interesting response to my comment re: unlimited wants and limited resources. Your response does nothing to change that fact. We (the world, if you will) have to make choices regarding how much of our resource pool to devote to health care vs other wants/needs. We can reallocate resources, but who gets to choose how?
You are very right to say that single payer is not a magical solution.
I am of the opinion that it would be worse than what we have now or could have if so many Gov’t regulations were removed.
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Interesting bit on the history of Canadian medicare – which started right here in Saskatchewan:
http://www.cbc.ca/history/EPISCONTENTSE1EP15CH2PA4LE.html
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Exactly.
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I am in Canada. I have a friend who had signs of a stroke. She was taken by ambulance, had an MRI quickly and they discovered a problem. She was in surgery within hours. She is out and recovering.
I remember when medicare was introduced in the 1960s. In the 50 years since then wherever I have been I have generally seen the system respond quickly to serious issues. I have twice been bumped from surgery for a minor issue because of major events that arose in the hospital. I do not consider that a horror story.
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What I seem to be hearing from the naysayers is that Europe, Canada, Australia and New Zealand somehow managed to figure out national health care systems but USA can’t.
We can put a man on the moon, send spacecraft to fly by other planets with incredible accuracy, but can’t solve problems that nations who don’t even have an auto industry can solve.
Somehow I think the problem is ideological, not technical.
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I’m done trying to reason. As long as the attitude is “they’re taking MY money out of MY pocket”, this conversation is at a standstill.
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Wouldn’t it be nice if the church simply paid for everything? [ The church doesn’t actually make money, it takes money from people for “the common good.”] OF COURSE it would be nice if we had life on a platter without effort or work. But within the bounds of reality, can that ever happen? No. There will always be rich and selfish people, there will always be seriously poor people. Churches always promise they will change that; somehow it never quite happens.
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So why not apply your argument against Highways (actually, all roads)? Water treatment? Police? Fire Brigade? Etc etc. Why the big red line before Healthcare?
And before you try and add other things – I am actually interested in the specific distinction between healthcare and these other things. After all, healthcare is a common good, and all need it – just like roads etc.
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Seneca of course you’re thinking of utopia. It’s the logic of your statement. Everything has to work perfectly for you or it’s a complete failure. Well no, no one is offering you paradise. Just a system that can be demonstrated to work over against one that can be demonstrated not to work.
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Ditto! I went through the same transition – life is much better on the Winning side than on the Right side.
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Who gets to decide what it medically necessary? Right now, it’s your insurance company and before the ACA, they could simply stop paying when your bill got too high to suit them or completely kick you off their rolls.
A number of years ago, I had insurance that did not cover colonoscopy procedures unless it was medically necessary. It would not cover a routine screening. My sister, a nurse, said it was very important to have the procedure but when I told her my insurance wouldn’t pay, she simply told me to lie to my doctor and tell him I had seen blood in my stool. Suddenly, the colonoscopy would magically be medically necessary! So, who was really making the decision about my medical care? The doctor and me? No, the insurance company.
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Oscar there are answers to all your questions. Remember the vast majority of Western industrialized nations (as well as Japan and Israel) have been doing national health care successfully for decades. This is not some freakish wild-eyed notion being pushed by drug-addled hippies.
The reason you don’t ever hear any rational discussion in this country is that most of our politicians profit from insurance company and medical industry contributions. These vested interests are riding a gravy train with biscuit wheels.
Health care is something we ALL need. Insurance is based on the idea of shared risk. So why not pool ALL our resources and ALL share the risk?
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So, other than “I don’t like government” and “No freeloaders in the system”, what are your actual recommendations on what to do with this mess?
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I also disagree fundamentally with your view of representative government. I pay my taxes to support an administrative system (govt) that is tasked with overseeing the public welfare and the common good. If I think that system could be used to provide better health care for all Americans, I will advocate for that and support it with my tax dollars. The govt won’t be “taking” anything away from me. Sure, there are probably 1000 things the government funds that I disapprove of, but that’s because other citizens and their representatives have had their way. At least with a democratic govt system citizens have recourse and the possibility of changing things. What power do any of us have with regard to the insurance companies?
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I don’t hear these kinds of complaints about Medicare. It is not a perfect system (an impossibility) but overall it works, and with substantially lower administrative costs than the convoluted private insurance system.
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Rudyard Kipling said it much better than I.
And that after this is accomplished, and the brave new world begins
When all men are paid for existing and no man must pay for his sins,
As surely as Water will wet us, as surely as Fire will burn,
The Gods of the Copybook Headings with terror and slaughter return!
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I don’t give utopia a passing thought. Governmental healthcare or education will never be particularly good. I don’t care who is president, I don’t care who the congress critters are; It will just be sub-standard. This isn’t a political statement, it just a statement of fact.
Wouldn’t it be nice if the government simply paid for everything? [ The government doesn’t actually make money, it takes money from people for “the common good.”] OF COURSE it would be nice if we had life on a platter without effort or work. But within the bounds of reality, can that ever happen? No. There will always be rich and selfish people, there will always be seriously poor people. Governments always promise they will change that; somehow it never quite happens.
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A mentor pointed out to me recently that I get too hung up on being right as opposed to winning. It made a lot of sense and put so much of my life into context, even from a young age. I was so concerned about ‘being right’ that I never tried hard to excel or make money or get a good job or study harder or anything, because being right was more important.
I’m working as hard as I can to fundamentally change my thinking in life. Because I’m sick and tired of losing.
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Horrible solution. Sure we wait here (Canada), but urgent cases / dire cases are seen immediately. The proposal above would mean that as soon as a poor person has a serious problem, they are better off shooting themselves immediately.
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AF,
I think #3 would be my biggest concern. Who decides what is “experimental”? Would the uncertainty of whether something will be considered “experimental” and therefore not “covered” destroy innovation and the creation of new drugs/procedures?
None of these concerns are unique to single payer though. Not that it’s without flaws, but I think a lot of the critiques leveled at single payer (ex. it’s socialized medicine, government death panels) are fear tactics at worst, and are often grossly mischaracterized.
Ultimately, my understanding of “single payer” does not eliminate “choice” or (see Medicare advantage plans and Medigap?) or a mechanism by which people actually pay for their benefits. Single payer, I think, is the only means to transparent costs.
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A modest proposal:
Single payer primary care. Let people buy insurance to see specialists – or pay cash.
Federal government pays tuition/debt for physicians going into primary care.
This allows a standard of care nationwide while giving people options who want to go beyond what the government budgets for. (I hear the horror stories of people in Britain and Canada waiting for months for the kind of treatment we can get quickly here.) This allows folks to pay for their own care, and/or solicit funds from friends for advanced care.
(not related but maybe kind of: My primary care doctor is moving to a conciege practice the end of next month, so I’m looking for options. )
Thoughts?
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> the ones in the red states who will lose their health care voted for someone
> who promised to get rid of it
I can explain this. Those who make the argument that these people voted against their own self-interest are missing the point. Memory is long, and humans remember grievances, they nurse them. They pass them on to their children. For better or worse.
I am in Michigan – which in the 1970s and into the early 1980s was a Deep Blue state.
Rewind with me to 1970 – 1980 in a small town in Michigan. Times are tight, but pretty good. The town is on a highway and a railroad. There is a lot of agriculture, some natural resources, and light industry.
Passenger trains are rare, but the Greyhound comes about six times a day. So if you are elderly or cannot afford a car you can still get to medical services, the colleges, etc… in the city about 40 miles south.
But there is a difference. The trains stopped at a station. With a platform, a roof, a bathroom. Now you stand in the corner of the convenience store parking lot, with only the guardrail separating you from the highway traffic. There is not even a sign to indicate the bus stops there. But you can see the tracks and the location of the old rail station as you stand there.
*PAUSE* – look at that image – see it. See the VALUES encoded in that image. In this Deep Blue state.
Now the state DOT can get a bunch of federal money to build an interstate, that goes along its way about a mile west of the town. That is Billions of dollars – Billions with a “B”. Having spent all that money, and seeing all those shiny new tractor trailers … maintaining the grade crossings of that railroad is going to cost us several Million (with an “M”, 1/100th of a “B”) dollars. Lets not do that. Better to rip up the tracks, a scraper will pay us for them.
So the traffic goes around. And the railroad is gone. The elevator closes. The gravel pit closes. The large potato farms relocate to the west [potatoes are heavy and bulky – trucking them a long way doesn’t make sense]. Next goes the elevator. Then the lumber yard. Everyone [WHO CAN!] is driving ~40 minutes each way to a job somewhere else. With the commercial properties shuttered tax revenue for the village and schools plummet.
Nobody wants to stand in the parking lot waiting for a bus – and that bus costs money – remember that plummeting revenue. So instead of coming six times a day, it comes twice, then once, then …. not. Oh, and the convenience store that doubled as a bus stop – that also closes.
Those people in that village, who *HAD* infrastructure, and wealth, fought all those changes. Often loudly. And all those things happened anyway – in a Deep Blue state, owned by the party that has their best interests at heart.
They got sold out for a slab of concrete – sold out by men in blue.
And they remember.
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“Healthcare is for Closers.”
“I Got Mine,
I Got Mine,
I DON’T WANT A THING TO CHANGE
NOW THAT I GOT MINE!”
— Glenn Frye, “I Got Mine”
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Your poor American relative should have been born a Trump or a Government Bureaucrat. That’s what it’s come down to.
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But that never stops those from waving their nonsmoking or Veganism or whatever they do that you don’t as a Magick Shield against cancer.
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I’ve come to check my inbox to see what types of spam I’m getting. Especially the “Hot Investment Tips — The Money Will Come in In Buckets!” types. They’re usually a good indicator of the next economic exploitation, and I think I got a lot of those for Health Insurance companies when the ACA went through.
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> do we see it as a human right?
No.
I see it as good economic policy. Rights rhetoric will no get you very far in the United States.
Someday, if we recover from the current austerity fetish, a functional health care system might be saleable on good old pragmatics.
I don’t know if you ever read Granola Shotgun – but I am pretty close to his take on things. Paraphrasing him: America is not a moral nation, never was. America does not care about the poor, it never did. America does not care about minorities, it never did. If you are poor or colored in America you were always screwed. All this is demonstrably true – if we did care we would do the things nearly every other industrialized nation does. We need to get over the notion that Moral Persuasion has all that much traction in American politics, it doesn’t.
We are a nation that admires ruthlessness; we idolize our robber barons, if they are the railroad and oil tycoons of old or the techno-playboys of today’s Silicon Valley. Why else do we spend so much time listening to all the absurdist nonsense that spills out of Elon Musk’s mouth?
We will get further with good policy by making the case why it is good policy, rather than insisting it is the right-thing-to-do.
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Notice he doesn’t say that he will save the day or help fix it. Just “Republicans”.
His hands are clean.
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President Trump joins the Internet Monk discussion with this morning’s tweet:
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More recently, Merrick Garland was help up by Republicans as a good Supreme Court candidate whom Obama would never nominate. Until Obama did, at which point Garland was persona non grata.
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Suzanne, people of that opinion, especially church-going ones, need to be careful not to sound like they’re advocating natural selection, survival of the fittest, Darwinism. They might be shocked if we put it to them in that language.
And we should remind them, gently, that not everybody who catches cancer was a heavy smoker, or had an abortion, or is a homosexual. Some of our ailments are simply in the category of, “Who sinned, this man or his parents, that he was born blind?”
Church-goers are supposed to know that stuff.
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there comes a point where ‘free market capitalism’ reaps more suffering and death in order to provide heaven on earth for the top one percent economically, and that point is where we have forgotten we are human and we have become cogs in some machine sending profits ever upward . . . . . .
the latest tax breaks favor the wealthiest among us and no one is surprised
the ones in the red states who will lose their health care voted for someone who promised to get rid of it . . . . . I just don’t understand ???
does anyone understand this???? (or was it a case of ‘whatdaya mean Obamacare was the same as my ACA ?’)
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The problem, to me, is similar to the problem with our nation’s education system: it’s not actually geared toward education (or health care). It’s all about the money. Look at how much money goes into athletics at our nation’s colleges and universities. Meanwhile, almost every student comes out of four years of academics HUGELY IN DEBT!!! Our young adults are SADDLED with years of debt.
Likewise, I see American health care similarly: it’s all about the money. Young doctors are saddled with school debt that will take YEARS to work off while established doctors need to pay for insurance in case they’re sued. These costs get passed along to the average person. Meanwhile, the drug companies run the “fix it through pills” mentality and they seem to be in semi-collusion with doctors AND the government in perpetuating their industry and the costs associated with it. All these costs ALSO get passed along to the average person.
And forget about the costs associated with an ambulance ride (anyone ever had one of those? ever seen the bill?), a day-long hospital stay, or even what would seem like a simple MRI!!!
Two things I’d like to see from our NEXT president (since I don’t believe we’ll see it from Trump): take on the cost of higher education so that our young people don’t enter “real life” so heavily burdened by debt, and figure out a way to SLASH the costs of medical services!
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The health care that covers our Congress would be great for the whole country. Take out the profit-seeking middle men who suck up all the $$$$$ and grant as little care as they can get away with, if not sometimes outright denying claims that prove legitimate later in courts.
This will anger many people, but it is a look at how this insurance-for-profit got started:
The Church ran the first hospitals . . . . . no money was charged and the clergy often encountered contagion and death: it is said that when the black plague first struck in Europe, the clergy were on the front lines of caring for the stricken, and it is estimated that almost 80 % of clergy perished from the contagion because of their commitment to the sick and dying.
When we look at health care: do we see it as a human right?
Or do we see that if someone can’t or won’t ‘pay’, they should be left to die?
The answers will tell you what kind of country we have become. May God have mercy.
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It is true that dealing with Health Ins. companies can be frustrating and cumbersome (same with auto ins. – maybe universal auto coverage would be good too?). How is dealing with the SS administration? What about the reports of veterans dealing with the VA?
The thing is, it’s not just dealing with health insurance – it’s federal health regs, state health regs, employer payment regs and paperwork, HMO paperwork, specialists, ad infinitum ad nauseam.
To put it bluntly, the best prospect for reform is simply to reduce the number of bureaucracies to deal with in health care, to one. And yes, the government would have to handle it – and to those who don’t like that, I must point out that we don’t live in some imagined Jeffersonian agrarian society anymore. People in poor health are a drag on the entire system – not to mention the fact that they are made in the image of God and all, and are therefore entitled to some rights and dignities, even if you have to pay for it in some small degree.
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If you don’t work you don’t eat!!
But the inverse, if you work you should be able to eat, isn’t true.
It’s Biblical! ™
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“6 – single payer / monopoly in an industry almost always means less innovation (think phones as an example). ”
Canadian researchers are testing the first Ebola vaccine.
“At the end of the day we have unlimited wants and limited resources. Even for health care.”
So – let them die? I mean, it is “their fault they are poor so they must suffer!:?
“4 – who pays for this? I keep hearing this will be just a small increase in taxes…. Something I am forced to pay. What if I think some health care service is not necessary – or one that I prefer to not be forced to pay for?”
Ah, you’d rather have a few unnecessary wars right?
Seriously, single payer is not a magical solution. Lots of difficulties. The point is that it may very well be a BETTER solution.
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Thanks Obama!
In this case, Michelle.
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Easy.
One is Commanded by God on pain of Hellfire;
the other is merely Secular (and they’re just lazy Moochers anyway).
And it’s not gonna matter ’cause It’s All Gonna Burn (any minute now).
i.e. A Perfect Storm.
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AF, I would encourage you to go to the Physicians for National Health Care site that’s linked in the post. What you read there may not convince you, but I think they address many of your questions.
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“just what happens…”
“nature taking its course…”
“In’shal’lah…”
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Moochers and Producers.
Who Is John Galt?
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I can.
It goes against their REAL Scriptures:
“A EQUALS A!
OBJECTIVE TRUTH!
A EQUALS A!
WHO IS JOHN GALT!
A EQUALS A!
A EQUALS A!
A EQUALS A!”
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I’ll play along for a bit as well….
CM Says – 1.Universal health care, with fair access for all people, including free choice of doctor and hospital for all, not as a privilege for the few
2.Simplified, efficient, and cost-effective administration
3.Private doctors, hospitals, and health care professionals continue to provide care.
1 – What does “Fair access” even mean? Someone in rural Idaho must have the same access to a trauma center/hospital as someone in NY City (or pick your large urban area). How would this even work? Someone in the big metro area can get to a trauma center in 15 minutes. Would we need these 15 minutes from everyone? Or do we “ration” them somehow so that everyone is only 1 hour away – cause that is the best we could do for very rural areas.
2 – simplified, efficient, cost effective – let the government do it ’cause that’s what they are good at.
It is true that dealing with Health Ins. companies can be frustrating and cumbersome (same with auto ins. – maybe universal auto coverage would be good too?). How is dealing with the SS administration? What about the reports of veterans dealing with the VA?
Perhaps some (much?) of the issue is really related to gov’t regulations of the health ins. industry.
3 – who gets to decide what is medically necessary? A single payer means the Gov’t gets to decide. You need a knee replacement? At what point will the “single payer” deem you too old for this? How about a heart valve replacement? Medically necessary? Maybe not if you are over 85 – you won’t live long enough anyway.
4 – who pays for this? I keep hearing this will be just a small increase in taxes…. Something I am forced to pay. What if I think some health care service is not necessary – or one that I prefer to not be forced to pay for?
Like – neo natal care centers – they are very expensive and the outcomes and quality of life for these young ones is often not as good as it is for most people. Could / would some gov’t agency need to make choices between one type of service and another to cover?
Should believers be wanting a system that forces (more typical terminology is “coercion by gov’t threat”) people to do “what is right?” Going down this path is never ending as there is a never ending list of “what is right.”
5 – universal health care with no cost to the consumer sounds great in theory (kind of like a utopian society). But, it is known that at lower costs, people use more of a good/product. People will start using the system for things they don’t need to which will ultimately lead to doctors spending their valuable time on less valuable services – unless we ration this by wait times or something else.
6 – single payer / monopoly in an industry almost always means less innovation (think phones as an example). How will health care be any different?
At the end of the day we have unlimited wants and limited resources. Even for health care.
Who decides how the necessary tradeoffs get made is a tough question. Top down from a single payer decision? Or bottom up from millions of individuals?
AF
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Romneycare?
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And yet we can work and strive towards everybody having everything.
Thy Kingdom come…
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I actually just watched these back to back last night. I think John Oliver does a good job summing up both ACA and this new version.
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Yes, Eeyore.
My well off, church going sister-in-law recently told me that she is tired of paying for people who don’t eat right and take care of themselves.
I assume she means people like a friend of mine’s 20 something daughter who was diagnosed with Type I diabetes in 8th grade, or my brother, also diagnosed with Type I at age 19, or my 58 year old cousin who just lost her job and is a breast cancer survivor. This is just my family but I guess in her world, they are simply a drag on society.
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Number 4 is, not to put too fine a point on it, bullshit, pushed by parties with their own agendas.
The claim that doctors are forced to order unnecessary tests relies on dissembling about how medical malpractice law actually works. One defense in such a lawsuit is that the doctor followed accepted practice. Indeed, this is an ironclad defense, if you have the facts on your side. If the doctor ordered the tests that accepted practice called for, given the information available to him at the time, he is in the clear.
So why do we constantly hear about all these expensive unnecessary tests being ordered? Partly it seems to be urban legend among medical professionals who don’t bother to educate themselves on how medical malpractice law works. That is the most innocent explanation. Less innocent is that the fee-for-service payment structure incentives them to perform unnecessary tests, since they then get paid for having done this. A cynic might suspect that this goes a long way toward explaining why they don’t educate themselves on the subject. Finally, there are the hacks simply lying to push their political programs. As always, cui bono?
But this is all theory. What about in practice? Several years ago, Texas capped payouts on medical malpractice suits, justifying this on the basis of controlling healthcare costs. How did that work out? Costs rose more quickly than the national average. Medical malpractice lawsuits, it turns out, have essentially nothing to do with healthcare costs. But if you have the wrong leg amputated, be sure to have it done outside Texas.
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Because they had no or poor care prior to the surgery? Etc. Seems more like an argument for the poor health of Medicaid recipients then anything inherent within the program itself.
By themselves those are meaningless statistics.
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The system we have now was built so that it would ultimately fail, and it IS slowly sinking, so that universal, or single payer, health care could be put forward.
Doesn’t that sound a bit… well… conspiratorial? Is that the impression you meant to give?
If the government proscribes what kind of health care its people should have will it also mandate what fields prospective physicians can enter? How about how much they should be paid? And what about WHERE they should practice?
We have numerous examples of single-payer systems already in Europe? How do they do it? Do any of their systems engage in this level of micromanagement? IOW, is this an established pattern, or are you speculating?
With governmental mandates that ALWAYS means more paper work and more bureaucracy, i.e., more hidden costs
As opposed to the streamlined unbureaucratic system we have now?
How will this grand scheme be paid for?
We’re already paying through the nose, by various means, for what we’ve got now. Surely by combining what we’re paying out of pocket already as individuals and businesses, plus what the government is spending already, we could come up with *something* that wouldn’t be too burdensome?
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Hippie punching. Never underestimate the importance of hippie punching in right wing politics. In its modern form, so-called conservatives would abandon a position they had themselves been advocating, if Obama adopted the position.
And of course there is the eternal favorite, cui bono? The insurance companies support the ACA because it keeps them in the loop, protecting their profits. Single payer cuts them out of the loop. This explains why Obama was able to get the ACA through, while a clearly superior single-payer version was dead in the water.
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> I believe that could be a good thing.
+1,000
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Okay, I’ll play along…
1) The system we have now, Affordable Care Act, was built so that it would ultimately fail, and it IS slowly sinking, so that universal, or single payer, health care could be put forward. And this is good?
2) If the government proscribes what kind of health care its people should have will it also mandate what fields prospective physicians can enter? How about how much they should be paid? And what about WHERE they should practice? After all, isn’t it true that some areas are suffering from a LACK of doctors practicing general medicine?
3) With governmental mandates that ALWAYS means more paper work and more bureaucracy, i.e., more hidden costs, which brings me to…
4) How will this grand scheme be paid for? Already the average person surrenders 30-50% of their income to taxes, unless you are in the low income bracket, that is. What, or WHO are we going to tax in order to pay for an entitlement that will be larger than ANY other area of government?
I NEVER hear any rational discussion on these questions, only partisan bickering, charges and counter charges, and outright lies. Who can we trust to give us the REAL truth? The New York Times? Fox News? And if you think that either of those two institutions are reporting with a minimum of bias, well then, we are in trouble indeed!
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Seneca you obviously didn’t actually read the study.
Take Aways
Purpose of the studies was to show that
payer status is a predictor of risks of
surgery faced by patients
Purpose of the studies was not to show,
and does not show, that the Medicaid
program negatively affects patient’s health
Despite higher risk profiles, Medicaid
patients may do better than uninsured in
many surgical populations.
The stats are in – if you compare health care markers like cost and overall health in the countries with national health care systems they beat us hands down. Of course if you’re looking at some other factor than cost and result I’d like to know what it is. Sure we are a rich country with high technology. As a result there are advanced procedures available here and nowhere else. But for the day to day maintenance and procedures that most people will need in the course of their lifetimes there is no comparison.
Most of the people who are opposed to national health care are opposed for ideological reasons. They’re agin’ it because they’re agin’ it. And it’s not like our politicians have carefully weighed the options and come to a thoughtful conclusion – they count up the insurance company and health industry campaign contributions and then vote their conscience!
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Simple answer: they’re not true economic conservatives.
I’m of the opinion that Obamacare is really a plus for the Republicans. It pumps up the insurance companies, which are really banks by another name, and it’s something to blame upon the Democrats.
I don’t think the new Republican plan will be much better. It still pumps up the insurance companies, while perhaps restricting certain claims that the right wing find odious. The Republicans may be shooting themselves in the foot by creating another monster and having nobody to blame but themselves.
Until we get the insurance companies out of the loop, health care is going to remain very expensive. With an insurance system, first we have to pay to finance it (the bureaucracy of the insurance companies, from the local agents in their downtown offices to the CEO salaries to the quarterly dividends of the shareholders) and then we have to pay for the health care itself. It could well be that we’re paying double what needs to be paid. Does anybody have a breakdown on these relative costs?
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Sure I agree, everybody can’t have everything. But who is asking for everything? We just need a decent health care system. Something that just about every other industrialized nation in the West has managed to accomplish but us. Are you saying we can’t do better than Finland? Are you saying the French and the Swiss are smarter than we are?
Hmmm…now that I think about it…
They have better health care results overall, they pay less, they have higher standards of living, lower infant mortality rates…
Yeah you’re right, forget it. It would never work.
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Imagine a United States where people could leave their jobs and start a new business if they didn’t have to worry about health care. How many people would leave their jobs immediately and start new businesses or become self-employed? It could be the biggest restructuring and revitalization of our economy since the Industrial Revolution. I believe that could be a good thing.
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No no no!!! Good health care (like a good education) is a reward for financial success!!!
I mean if you let every Tom, Dick and Harry have access to good health care and good education they might start getting bright ideas. They might start thinking they run the place. They might start thinking the government should work for them!!!
And then where would we be?
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“One thing I’ve never understood is why economic conservatives aren’t out there leading the charge for this kind of system.”
Partly because it’s accepted practice — that’s just the way things are. But I think a lot of it is that capitalism and the profit motive are just too embedded in our culture. And how can I pursue my own profits if I’m supporting a system that limits yours?
We see this in so many other areas. Pastors are unwilling to hold other pastors accountable, because if one is accountable then all are. So if I hold Pastor X accountable for his plagiarism or Pastor Y for his financial “irregularities,” or require Pastor Z to sit it out for more than 6 months or a year for his infidelity, what might I be held accountable for next year? And how can we reign in ridiculous jury awards when we’re all hoping someday we might win the lawsuit lottery ourselves?” So the question becomes; If I allow your ability to make a profit to be limited, will I be next?
Ultimately capitalism and profits are sacred cows in this country, the elephant in the room that nobody is willing to address, and as long as that situation prevails we’ll never see meaningful health care reform.
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Well, here is a link to a PDF where the study’s authors explain the results…
Click to access 102113_No4a_Kron_MIRC.pdf
I do a lot of digging into research and academic studies in my line of work, and I cannot emphasize this strongly enough – DO NOT REPEAT DO NOT TRUST WHAT THE MEDIA SAYS ABOUT ANY SCIENTIFIC STUDY. I recall to your minds a comment I made on one of Geologist Mike’s Thursday posts last month, about the sensationalizing/dumbing down process that happens to all scientific reports in the process of their being disseminated through the media. If your primary source of what a study says is a partisan news outlet, RUN DO NOT WALK to the original report and see what it actually says for yourself.
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it makes the position(s) intellectually comprehensible.
Especially if the position is taken with the soothing coating of “They wouldn’t be in that situation if they just got up off their lazy tuckus and got a real job like me.”
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> Ununderstandable Configuration
I wonder if it is that not-doing-something cannot be immoral – that is “just what happens”, “nature taking its coarse”. But taking an action can be immoral; such as fetal termination or euthanasia. Letting someone starve is not, morally, the same as shooting them? It is a very coarse moral construct – but it makes the position(s) intellectually comprehensible.
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A link would be appreciated, seneca, so that your conversation partners could check it out.
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> I just don’t understand it.
But that has been an Ununderstandable Configuration for some time.
From an economic perspective – with a rapidly aging demographic – would it not be a sound investment to keep people economically productive for as long as possible? One doe not need Morality to make the case – the mathematics clearly affirms that the The-Most-Effective-Thing-To-Do happens to also be The-Right-Thing-To-Do. If someone doesn’t like touchy-feeling-liberal-nonsense they can just follow the numbers! 🙂
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> way to implement a mandatory exercise program
That is being tried in many small and creative ways at the state and local levels. Such structuring build rules to move parking as far away from the destination as reasonable – you are gonna walk. Evidence indicates these little things can add up to results. The threshold for getting Americans to exercise *”more”* is ludicrously low; like really really low, as in “Rejoice! They walked 75 feet!” low. Yeah.
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U.V.A. STUDY
Despite all of these adjustments, surgical patients on Medicaid were nearly twice as likely to die before leaving the hospital than those with private insurance.
Patients on Medicare were 45% more likely to die than those with private insurance; the uninsured were 74% more likely; and Medicaid patients 93% more likely. That is to say, despite the fact that we will soon spend more than $500 billion a year on Medicaid, Medicaid beneficiaries, on average, fared worse than those with no insurance at all.
[ BUT universal health coverage sounds so good ]
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> the richest country in the world still can’t or won’t
It is solidly “won’t”. Americans have an austerity fetish; we love to believe we are broke – which is straight-up crazy.
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I just heard a conservative talk radio host interviewed about the Republican plan. He said that, yes, about 15 million people will lose out and maybe the state they live in will help, maybe not, and that older people will pay a lot more than they do now, but overall, it’ll be good. In a nutshell, those 15 million people don’t matter, really.
The radio host also praised Trump’s Supreme Court choice, I assume because of the belief he will help roll back abortion rights.
I don’t understand how you can be so against abortion but then not worry much about 15 million people who will likely lose ability to access healthcare and as a result, may die. I just don’t understand it.
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I went and did a little reading before posting; Atlantic, Forbes, the Economist, etc. It seems that the US spends about 35% more on health care than other industrialized nations without receiving any discernible benefit in outcome. Four things seemed to be driving the overage: 1) high administrative costs, 2) drug branding and FDA rules allowing this 3) US medicine relies more heavily on more expensive treatments delivered by more expensive specialists 4) a litigious society causes doctors to order unnecessary tests in order to avoid lawsuits.
A sane health care policy would take care of #1. There probably isn’t the political will to take care of #2, since most people wrongly believe that branded is more effective than generic. #3 is where a lot of the burden on the patient comes in. Insurance companies usually pay far less for a procedure than a specialist (and the specialist’s adjuncts) want too receive for it. #4 is self-explanatory, and highly volatile.
Simple transparency in the cost of health care services would go a long way to alleviating this mess, but the confusing labyrinth of providers and costs for just about anything health-related seems to be a feature, not a bug, useful for maximizing profit at patient expense by multiplying the number of entities competing for their share of the patient’s dollar. Hurt and sick is a bad time to require free-market based comparison shopping and the necessary shrewd negotiation.
If I could rule by ukase like Nicholas I, we’d probably have some sort of government-funded tiered single-payer system, more competition in provider training, and less litigation. I’d also find some way to implement a mandatory exercise program, mandatory sane eating program, and subsidized tobacco cessation/substance abuse progtrams
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True as far as it goes. But we could apparently do a lot more for a lot more people than we are now…
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I am a Canadian and now I am having to deal with a poor American relative facing serious neurosurgery. I find it absolutely inconceivable that, given a life threatening ailment, which requires immediate surgery, we are having to worry hugely about how to pay huge dollars for the surgery. Here in Canada we may not have the “best” of everything medically but there is at least coverage for everyone, regardless of your financial circumstances. As a reluctant participant in the American medical system I am disgusted and angry that the richest country in the world still can’t or won’t and obviously will not in the future provide essential services free to its citizens. Market capitalism and individualism taken to a sad and horrible end. As a nation you should be ashamed.
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The irony is that people shout loudly about “independence” and “self-sufficiency” in this day and age – an age where we are all dependent upon a vast infrastructure of agriculture, manufacture, transportation, power, etc that we have no control over and we could never sufficiently replicate for ourselves even if we were millionaires. You want “self-suffiviency”? Look to the Unabomber.
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> Either of those two assumptions should take up a solid decade’s worth of discussion
Yep. Very similar experience here. And the odds you are going to get anywhere in those discussions? I have gotten reasonably good at accepting that… the hardest thing to get over is that OTHER PEOPLE ARE HEAVILY SUBSIDIZING THE VERY PEOPLE WHO MOST ARDENTLY HOLD THESE VIEWS… and the refusal to recognize that…. Breath. Breath. Ok, I’m good. How wicked is it that part of me enjoys that some of those subsidies are about to disappear? Not a part of myself I am proud of; it is going to really hurt for a lot of people.
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I don’t think either the ACA or the proposed replacement deal with the root problems Chap Mike outlined above. Do you agree with the universal health care solution outlined in the post? If not, why not, and what is your proposed solution?
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Robert, And Obamacare and its costs worked so well it’s bankrupt.
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From my discussions with people, it essentially boils down to “I don’t want to pay for others’ procedures, especially if I don’t like those procedures” and/or “Only people who deserve it (i.e. have a job, are US citizens) should get health care”.
Either of those two assumptions should take up a solid decade’s worth of discussion concerning their ethical and moral underpinnings.
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It’s similar to the debate about gun rights in this country. Data and facts don’t matter. The commitment to a certain model is not a matter of rational deliberation, but of passions and rights. The bodies piling up at the door are not considered germane to the subject.
Neither do I have any hope, with regard to either health care or gun rights.
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> Sign me up for the system you are describing,
+1. But I have no hope in the regard
“””One thing I’ve never understood is why economic conservatives aren’t out there leading the charge for this kind of system.”””
From the access/transportation/mobility corner of the world I often ask myself the same kind of question. My only conclusion is that “economic conservatives” are somehow mislabeling themselves, because they are not that. I do know that such a label means the person is not interested in discussion of data, results, costs …. Sad. I have no answers.
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Oddly resistant to political memes fact of life- Everybody can’t have everything; especially when it comes to healthcare.
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The one that the Republican Party is trying to push through right now I think of as the “Let Them Eat Cake” Healthcare Plan.
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Sign me up for the system you are describing, CM, and not for the one the Republicans are pushing right now.
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American health care is 18% of our economy. 12% of Canada – single payer. Problem is Americans are more interested in personal freedom than common good, and we are very capitalist. We believe competition should fix this. Of course we all know there is no competition in our health care system – no prices are listed, and none of us want to hunt around for the cheapest ER after being hit by a pie truck. So we are at the mercy of an over- priced health system that bankrupts our family and friends with bill after bill after bill.
We need to look elsewhere – Germany and Switzerland are very capitalistic countries, that use multiple competing insurance companies which are carefully regulated to provided “real coverage” to everyone, with profits limited to ~8-10%. these countries spend ~1/3 less than we do. And they are Christian countries. Germany has had universal coverage for over 100 years. You don’t see them coming to the USA for a knee replacement or heart surgery.
Finally, back to my first point – Americans value freedom. I suspect we all know people who are just counting down the years until they get Medicare and can quit their unhappy jobs. Many working Americans have no freedom to quit their jobs and start their own company or are afraid to change jobs because of health issues in their family. So many working Americans have lost freedom to indentured servitude for health care insurance.
Health care “coverage” – real coverage is a freedom issue.
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