A UHC question

[DrDeth]

@k9bfriender

But, it is a benefit the employer is paying. While you seem to think that the greedy corporations wouldn’t start paying the money that they pay in premiums directly to the employee, many would, as they would like to retain their employees.

You think that people would quit without a raise? I doubt it.

@k9bfriender

There are far too many factors involved to answer a simple yes or no. It would depend on what kind of UHC we have, it would depend on Joe’s income, job, and benefits.

Yes, exactly my point. The fact that there would be an overall net savings does not mean that Joe would save $$, and thus get behind the idea of UHC.

@PatrickLondon

But we know that the answer is to raise taxes, which understanding, mysteriously, rarely translates into voting in a government that will do so. And although at the individual level a fair few people manage to go private to get round those difficulties, it never seems to add up to more than about 10% of total medical activity and certainly never leads to serious demands to abandon the basic principle of the NHS.

Yeah. Sure British NHS is better than no UHC by a long shot, but it is not problem free, like at least one poster here seems to think. I would have no issues with bringing in Brit NHS or the Canadian plans. Not perfect, but they work.

Didn’t Boris promise that Brexit would means a huge increase in funding? Somehow, that never materialized. It is like Right Wing Populists lie to the people to get elected. odd, that.

[puzzlegal]

@k9bfriender

No one said otherwise. However, what was actually said was that, since a large part of the reason that you sue is to cover the healthcare costs incurred by their mistake, such payouts would be substantially smaller, and malpractice insurance would either be less necessary or at least have substantially lower premiums.

I think this is true. Not that med mal would be less necessary, but that it would be cheaper. I also think every other liability insurance would be cheaper. Because a lot of what drives people to sue is needing expensive healthcare to fix the problem. And a lot of what makes juries sympathetic when Joe Sixpack sues is that he desperately needs money to care for his injured child – whether or not the company being sued is actually liable, the jury knows that if they find the company liable, Joe will pay for his kid’s medical care. And otherwise, he might not be able to.

The US has crazy runaway liability costs compared to every other wealthy nation, and i believe the root cause is our lack of healthcare.

[Atamasama]

@DrDeth

But the OP was asking about Joe Sixpack, who gets Medical from his employer at a large discount, due to several factors.

Joe Sixpack is a fictional person so it’s a meaningless question.

That’s not a facetious answer, it’s the correct one. Because the question about “would a specific person save money” is always going to depend on the person and their current situation.

I answered the only valid question, which is whether people overall will pay less, and the answer is yes.

Expecting 335 million individual “yes” or “no” answers is not reasonable.

[Red_Wiggler]

Some unknown amount of employers’ savings under UHC would be offset by (1) having a higher tax liability on their improved profits (a very good benefit to the nation at large) and (2) having to compete in other ways for employees no longer constrained from leaving because of their company health insurance plans.

[puzzlegal]

@Atamasama

That’s not a facetious answer, it’s the correct one. Because the question about “would a specific person save money” is always going to depend on the person and their current situation.

Fine, the real question is “how would it affect the majority of ‘purple’ voters?” That’s a real question about real people. I don’t know the answer, and the answer may depend on stuff we don’t know, it that carries based on what sort of UHC the US implement. But it’s a meaningful question to ask regarding proposals.

[LSLGuy]

I used to be a union official. I was not a face-to-face negotiator who pounds the table, but I was involved in managing those folks and / or advising those folks.

A saying I used to use to frame the situation entering any negotiation was:

Every win-win negotiation is the prelude to a follow-on win-lose negotiation.

The premise of win-win negotiation is that by embracing change on both sides, value can be created from nothing by eliminating inefficiencies or costly externalities. And then the two counter-parties can share in that gain. The pie has been made bigger and both sides’ pieces have also gotten bigger. Which means that both will come out ahead if they can only bring themselves to not psychologically define the other guy gaining as a loss. Sounds great.

But.

My insight was that after a win-win deal is penciled together and both sides think they are happier with the pending new deal than they are under the status quo ante, and both sides have a certain psychological and organizational buy-in to the fruits of their joint labors, the very next thing that happens is the stronger side tries to hog all the value for themselves. And the weaker side, whether weaker in fighting spirit, weaker in raw selfishness, or weaker in coercive power, will find their slice of the pie whittled down the teeniest possible sliver of new growth that will still have them agreeing they’re better off enough to bother signing.

This is a 100% win-lose negotiation, where the total growth in the new larger pie is being divvied between the two parties. Every bite for you is one less for them and vice versa.

The end result is the strong side gets ~90% of the gain, and the weak side gets 10% as a consolation prize for playing. If that. It’s possible for the weaker side to fall in love with having made a deal at all, and end up giving up 110% of the growth in their pencil slice. The new total pie is indeed bigger, but their final new slice of the new pie is smaller than their old slice of the old pie was.

It’s surprisingly easy for an organization that put a lot of effort into getting to a deal to go ahead and sign that loser for real due to internal political or psychological pressures.


With that intro. …
Switching to UHC would be a classic win-win-win for employers, government, and the public as the insurer’s expenses, profits, and obstructionism are eliminated at a stroke.

And 3 seconds after that deal was penciled in, the employers, the government, and the citizens would enter a negotiation to see who gets to keep all that shiny new goodness. Since the citizens are all but unrepresented in Congress versus the interest of the employers and the government spending / budgeting system itself, it’s pretty easy to see who’s going to get the teeniest sliver of the benefits. And perhaps a sliver of negative size.

[eschereal]

@LSLGuy

Switching to UHC would be a classic win-win-win for employers, government, and the public as the insurer’s expenses, profits, and obstructionism are eliminated at a stroke.

Except for that one tiny thing that Red_Wiggler mentioned above, that it would be a tiny it harder for employers, without that one particular incentive.

[DrDeth]

@Atamasama

Joe Sixpack is a fictional person so it’s a meaningless question.

No, it’s not.

Look about half of all Americans work at jobs that get medical coverage. And they are all potential voters. So, you are gonna have to convince Joe or any of the other 150 million some odd Americans that UHC will give them coverage just as good, and wont cost them more.

@puzzlegal

That’s a real question about real people. I

Yes, it is.

@LSLGuy

And 3 seconds after that deal was penciled in, the employers, the government, and the citizens would enter a negotiation to see who gets to keep all that shiny new goodness. Since the citizens are all but unrepresented in Congress versus the interest of the employers and the government spending / budgeting system itself, it’s pretty easy to see who’s going to get the teeniest sliver of the benefits. And perhaps a sliver of negative size.

Yep, and that is why UHC- no matter that it is a good idea- hasn’t gotten massive support.

Many people vote on the “I’ve got mine jack” theory. And it is a legitimate way of thinking about it, even tho, yes it is selfish.

[Chronos]

And yet, somehow, in the rest of the world Joe Sixpack did manage to get a good deal out of it.

[Mighty_Mouse]

@DrDeth

Yep, and that is why UHC- no matter that it is a good idea- hasn’t gotten massive support.

Many people vote on the “I’ve got mine jack” theory. And it is a legitimate way of thinking about it, even tho, yes it is selfish.

No. It’s because self-interested people keep lying about it.

[HoneyBadgerDC]

What are some of the unknown risks of UHC? Less Dr,s? Longer wait times? More people taking advantage of it?? Inefficiency?? ETC

[Dr.Drake]

@HoneyBadgerDC

Less Dr,s?

Why would there be fewer doctors?

Look, I don’t want my physician to be somebody who’s just in it to get rich. And there will always be a steady supply of people seeking to become doctors as long as the employment is secure (which it usually is for highly skilled professionals, except academics these days) and the pay is good (comfortably middle to upper middle class), there will be kids seeking that career, because they’ve heard of it, it’s valued, and they can see what the path to it is.

[eschereal]

@Dr.Drake

Why would there be fewer doctors?

The premise is that it is an extraordinarily difficult and expensive struggle to earn your shingle, so the people who do deserve to be duly compensated (especially so they can pay off that education), and UHC will not be able to provide that. Reducing the cost of medical school (and college in general) is probably a good way to approach that one issue.

[Stratocaster]

@Chronos

And yet, somehow, in the rest of the world Joe Sixpack did manage to get a good deal out of it.

Yes! Why are some treating this like some kind of murky hypothetical?

[PatrickLondon]

I can see that it must seem difficult to achieve without somebody losing something, be that money or agency(=“freedom”). Add to that suspicion of Big Government/bureaucracy (I’ve seen online remarks like “Do you want your medical care run like the DMV”, not that I quite understand why that would be a byword for cumbersome jobsworthery, but it clearly was for some).

Our NHS wasn’t universally approved of before it started: there were a fair few Tories who said it smacked of Nazi Germany, and went on saying it (until they were back in charge, of course).

[Horatius]

@Chronos

And yet, somehow, in the rest of the world Joe Sixpack did manage to get a good deal out of it.

And even if the tax savings don’t end up in Joe’s pocket, he benefits in many other ways, not the least in having a system that actually pays for his healthcare, instead of being hit with deductibles, co-pays, and other fees not covered by whatever insurance his employer chose.

And then there’s the whole “out of network” business that so many people have to deal with. Having to figure out if a particular hospital, doctor or other provider is covered while in the middle of a major health crisis? Doesn’t happen in Canada. I had to go to the emergency room very early in the morning while out of town a few years ago, and my only worry was finding the hospital in a city I wasn’t familiar with. I knew that when I got there, I’d be covered.

There are wins other than financial wins.

[PhillyGuy]

@Horatius

I had to go to the [Canadian] emergency room very early in the morning while out of town a few years ago, and my only worry was finding the hospital in a city I wasn’t familiar with. I knew that when I got there, I’d be covered.

Our No Suprises Act came in effect on January 1, 2022. Now insured Americans can go to any U.S. hospital emergency room with the getting-there (ambulance coverage) qualification in my link.

I would have thought that universal health care, and not having covered patients have to pick between networks, were separate issues. Of course it is possible for one federal bill to cover different health care iissues. But in some of these threads, it is almost like there is an idea that the phrase “universal health care” means creating a perfect national health care system.

I rarely see acknowledgement in these threads of how much progress was made by politicians in Wiashington pushing through the Affordable Care Act and the smaller improvement of the No Suprises Act. The Democrats will always be seen to have failed if the standard is a national health system without annoying features, because they all have weaknesses.

[Son_of_a_Rich]

I realize it wouldn’t be perfect, but I want system where I just give them my card, and that’s it. And when I get home I’m not going to find a bunch of correspondence from all kinds of entities who want to wet their beaks.

[doreen]

@PatrickLondon

I’ve seen online remarks like “Do you want your medical care run like the DMV”, not that I quite understand why that would be a byword for cumbersome jobsworthery, but it clearly was for some

I might not be 100% clear on what “jobsworthery” means , but “run by the DMV” more or less means with no consideration for “customers” and it really applies to many government agencies beyond the DMV. For example, the government agency I used to work at operated on “first come, first served”. This tended to lead to packed waiting rooms, as people would show up before we opened hoping to be first. Management tried to implement an appointment system - but the staff resisted. It was easier for them to just have a bunch of people waiting for them rather than scheduling appointments , having to figure out how long each person’s appointment needed to be, having to decide on May 6 what time you will take lunch on November 6 ( because some appointments are set six months in advance). They didn’t care that the clients had jobs or school or needed to make childcare arrangements - things that are difficult when you don’t know if you will be gone one hour or eight.

They finally complied with appointments when we re-opened after COVID. Most government agencies historically ran like that - some, like the DMV in my state started giving appointments years ago. That’s what people mean about medical care run like the DMV , no consideration for patients - but they somehow don’t realize that happens all the time in the US , too. In clinics and doctors offices , for people with insurance.

[LSLGuy]

@Stratocaster

@Chronos

And yet, somehow, in the rest of the world Joe Sixpack did manage to get a good deal out of it.

Yes! Why are some treating this like some kind of murky hypothetical?

It’s called “path dependency”.

Path dependence

It’s not that we can’t magically be there, it’s that we can’t get from here to there.

The various countries that adopted UHC did so in different times with different political, economic, and technological contexts. They each found a path that worked for them given where and when they started. And some of those paths were plenty controversial when they got adopted or became so along the way during the transition. More than one had a some false starts or half-measures along the way. Both Medicare and the ACA viewed in an optimistic light are the US’s first halting incomplete and wobbly steps in that general direction.

The USA would need to find a path that works from where and when we are now. That’s a tall order.

Here’s a very simple analogy. How hard is it to convert the USA to the metric system of measurement now, versus in the mid 1800s when pretty much everybody else was adopting it? The process is logically the same then or now. But the sheer size and degree of difficulty of that process is vastly harder now in our more filled-in, more settled time.