The risk of involving private insurers (which I agree is a feasible option if properly managed) is that, under the tremendous pressure that will be brought to bear by the insurance lobby and their Republican friends, it will be insufficiently regulated (ETA: along the lines of what @Dewey_Finn posted just above). Regulation means removing any kind of monetary or health discrimination and ensuring uniformity. You’re probably right that “uniformity” is a toxic word in American culture, but the reason it makes so much sense in the context of health care is that it simply means “everybody needs health care at some point, so everybody should get it, with no conditions or limitations attached”. Anything else means some people get better health care than others, according to arbitrary criteria that usually involve money.
And that kind of thinking will seriously undermine the potential for cost savings. The single-payer ideal, which is indeed achieved in most countries, is that everyone has the same health card, everyone gets the same health care from their provider of choice, and patients never deal with paperwork and never pay anything at the point of service. The farther it strays from that ideal, the more bureaucracy and the less the efficiencies and cost savings.
In the worst extreme, it’s the system you have today. I fear that a more moderate solution, in order to get political support, will still end up being a multi-tiered health system in which you get the health care that you or your employer is willing to pay the premiums for, micromanaged case by case by for-profit insurers with an eye on the bottom line. If this is what it turns out to be, it will be pretty much like today’s system except with a patchwork of special provisions that attempt to cover the gaps for those who might otherwise be left uninsured. This is vastly different, vastly more complex, and vastly more costly than the basic principle of “everybody gets health care, period, without conditions or cost”. It’s much like the way Medicare, America’s answer to single-payer for seniors, turned into one of the most staggeringly complicated bureaucratic quagmires I’ve ever seen in health care.
If the only option for the US is to have a complicated multi-tiered UHC that is vastly more expensive than anywhere else in the world, that’s still better than no UHC. But it’s just such an appalling, unproductive waste.
Any path we come up with will still leave us more expensive than the Swiss, who are the most expensive in Europe (I think). And it’s because of the reasons you and others have laid out, i.e., politics, lobbying groups, etc. But hopefully we can cut the gap some, while covering all. Once we get everyone covered, I’m hoping the focus on cost containment becomes more robust…
However, I have a feeling we’re going to take a step back before we take two steps forward. Biden passed legislation that really helped strengthen the ACA subsidies. However, it gets sunsetted in 2 years unless congress re-ups on it, which I don’t see happening with the GOP. So, I wouldn’t be surprised if we saw an increase in uninsured & higher costs before the Dems can get back in power and take another whack at the problem again.
Once we get into “two steps forward” mode again, my opinion is there are two paths:
Medicare for Whoever Wants It, with private insurance still offered. But it would be like a Public Option. Bernie wanted Medicare For All. I don’t see that ever happening. But we can maybe make Medicare a default for people that want it, and then people that want to supplement or opt-out with Private can do so (I think the Germans & Australians have a certain % that go with Private only, although my memory might be failing me there).
Keep mostly what we already have, and make another hard push at “ACA on STeroids”.
Both options would keep private insurers in business, and while there would be some disruption, it could be manageable, unless politics hijacks it (again).
The stupid thing is that Medicare Advantage plans were intended to lower health care costs, not increase them. It’s like how Intuit and H&R Block lobby to prevent the government from developing a system to simplify income tax filing, because that would threaten their profits.
The NHS charges £9.65 per prescription, though many people are exempt and those with numerous prescriptions who aren’t exempt can substantially reduce the cost by buying an annual fixed-cost certificate.
Regardless, would you rather owe £9.65 for a prescription (about USD $12.10) or would you rather owe the co-pay on the $117,000 average cost of heart surgery, after thousands in deductibles. If you’re not sure of the answer, check out the article below.
Insurance industry lawyer: “Fraud is such an ugly word, what with that a and u right next to each other. We prefer to call it “predictive diagnosis”. In essence, we’re treating the patients in advance.”
Plus any legal penalties will be dwarfed by the money gained.
This is too common in America. Hasn’t happened with me, although I’m one of the luckier people. I have very good insurance through my employer. Many people end up going bankrupt, even with insurance. The ACA actually helped that somewhat, but not enough.
And Republicans will pretend that the reason we have these issues is BECAUSE of the ACA. They will pretend that everything was great prior to the ACA…So, we still can’t address the underlying issues, because 50% of our political ecosphere is lying about the underlying causes.
I’ve been with the same company for 25 years, and we a family with significant medical issues. So far, it’s been OK, and we haven’t had any trouble. I know not everyone is like me. But there are millions who are like me in the US. The problem is the inequity. Some of us have great insurance, and others don’t.
I hope you continue to be happy with it, but great insurance is only great right up until it isn’t. The difference with UHC here is that assured coverage for medically necessary procedures is written into federal law (Canada Health Act) and reaffirmed by provincial law (Commitment to the Future of Medicare Act, 2004). Whereas all a private health insurer needs to deny a big claim and make your life hell is a plausible excuse.
In several of our previous discussions of this topic, I’ve mentioned my “Medicare for Most” plan, which would gradually expand Medicare coverage, with the eventual goal of covering everyone.
I think this addresses the worst of the “How do we get from here to there” problems. It takes a fairly long time, so no one feels like they’re being rushed into some untested waters, and it gives the companies time to gradually scale back their activities, or move into new areas of business, without sudden massive lay-offs. It also builds on both young people and old people who already qualify for at least some government-funded health coverage, so they’re already used to the idea, and won’t freak out at being asked to change.
It would take a long time to gradually march the lower and upper ages together to the point where the whole system covers everyone. But it’s not like anything else is happening overnight. I have always wondered why we can’t have a universal program for kids, like a “Medikids”. That would be a good start, IMO.
The thing we have to contend with is that most Americans want the ability to have private insurance. They want choices. There have been polls, where “Medicare for All” is popular but a “Public Option” is more popular. That’s why incremental/gradual approaches are most likely the better way to make it happen. So, I think the spirit of what you’re talking about, if not the exact letter of it, is good. Gradually more and more public options on the table…
Point taken. Our insurer has never played hardball us, but that’s a possibility in our system. In my own case, I think that as long as I’m with my current employer, I’m good, although I realize that’s not guaranteed. Also, if I lost my job and needed to find coverage elsewhere, that could be tricky. Post-ACA, it wouldn’t be a lost cause, but I could still have a problem.
Yes, and they have some of the best healthcare in the world.
So, once you are treated, the payment isn’t your problem. But there is still pressure on doctors to avoid “too much” treatment, it’s just less visible to patients.
Every system has gatekeepers that are preventing some people from getting some care they want.
Our system sucks. But moving to UHC doesn’t magically give us everything we want.
Again, there will never be infinite money available, so someone has to do at least some kind of cost-benefit analysis. I don’t want that person (via their employer) having a profit motive to deny care.
“If there’s money in the budget, it’s covered” should be the default, and for the vast majority of patients, that’s how it works out.