Do you have any cites for the claim around UHC and racism? Because my understanding is that the doctors, the AMA, came out against UHC because it would control their earnings.
The AMA was already lobbying hard against government involvement in healthcare. But even more influential were Southern Democrats, who held key leadership positions in Congress. They feared that federal health programs, like hospitals receiving federal funds, might require racial integration or weaken their control over local systems that enforced Jim Crow segregation. And they strongly opposed universal healthcare because of this.
The policy problems began with President Franklin Roosevelt’s New Deal, which created America’s first comprehensive federal plans for social services. The New Deal did not include a national health insurance plan, though one was seriously considered before the idea was put aside. Universal health care was scuttled because Roosevelt feared it might jeopardize the entire reform effort, which was tumultuous from beginning to end. To enact New Deal legislation, FDR had to tangle with powerful interests that included those in his own party—Southern Democrats, who did not want African-Americans getting a hand up from the government. “The South’s commitments to a hierarchical racial order,” Ira Katznelson explains in his book, Fear Itself: The New Deal and the Origins of Our Time, “affected the full range of New Deal policies and accomplishments.”
Kaiser is nothing at all like the others.
Not many cover non permanent residents.
Not at place like Kaiser. Its a modest co-pay. Even for my cataract surgery. Even in nations with UHC, some have co-pays.
Federal Civil service- after 5 years you are covered at their rate for the rest of your life. IIRC, may have changed.
That is the only thing you get from Kaiser- or similar companies.
Please correct me if I’m wrong: Kaiser Permanente is vertically integrated, yes? They are a heath insurer, but they are also a healthcare provider: AIUI, they operate hospitals, clinics, etc., which makes them different from most other U.S. insurers.
Do they charge you “only a copay” if you go to a non-Kaiser provider?
Generally you don’t have that option unless it a specialist recommended by your Kaiser physician for something they don’t have in house. It happens and in those cases, yes you’re covered. But it isn’t common, because Kaiser has most sorts of specialists in house - as you say they’re vertically integrated. For example under my ex-employer’s Kaiser plan you are required to live within a certain radius of a Kaiser medical facility (25 miles, I think) to be a member of their healthcare plan because that is where you are required to get your primary healthcare. It’s an HMO and they want you treated at their facilities. My employer in addition to offering the option of a Kaiser HMO plan and Blue Cross PPO actually had to maintain a second HMO plan by contract to give the option of an HMO to people who lived ‘up country’ at remote work sites, too far from a Kaiser hospital to be eligible.
They’re apparently a weird hybrid beast. Part for-profit (the overarching regional medical groups, like Kaiser northern California or Kaiser southern California), part non-profit (the healthcare plans), part mixed-profit (the individual hospitals). They generally rank at or near the top in customer satisfaction relative to their competitors, but they still have many issues and top of the heap in big corporate medical providers is a mighty low bar to clear.
change countries 
Yes, you can get expat insurance plans in other countries that are fairly inexpensive compared to even Medicare part B and other add ons through Cigna or Pacific Cross to name a few. Some only cover the country you are moving to, others are worldwide coverage (except for the US).
But not everyone can do this as it means leaving everything and everyone you know. And if you already have existing conditions it may not be advisable.
Sadly, I think racism is a big part of why UHC has been essentially impossible in America, and also why the social safety net is so shitty.
Doctors in Saskatchewan, when the first iteration of UHC was being debated, felt the same way. Not only that, but the AMA – the American Medical Association, and American health insurers, roared in to Saskatchewan to support the doctors, out of fear that if UHC passed it would unleash a socialist avalanche that could spill over to the US of A.
Well, they were right in one sense. UHC, initially covering hospital care and then later covering all medically necessary services, was so effective and popular that it became a nationally regulated program under the Canada Health Act but administered by each province under its own program. And health insurance companies were essentially told to get the hell out of the country, or else relegate their coverages to supplemental insurance.
But the AMA and health insurers were wrong about the success of UHC in Canada spilling over across the border. It didn’t, for a variety of reasons – the aforementioned racism, a difference in culture with a greater leaning towards “free enterprise”, and most of all, the enormous power of the health insurance lobby.
As for UHC limiting physician income, this is a very complicated topic and one could literally write a book about it. But the reality is that under the private insurance system in the US, health care providers who choose to be in-network have to accept the fee schedule the private insurers are willing to offer, and they then have to deal with constant ongoing hassles with the insurers who are highly incentivized to deny claims. In UHC systems health care providers may indeed receive lower fees, but they also don’t have employ staff to chase down health insurers and deadbeat patients.
The situation is further complicated by the fact that fee-for-service isn’t the only payment model; in Ontario, for instance, physicians have the option of enrolling in Family Health Group (FHG) or Comprehensive Health Care (CCM) or even hybrid payment models. Either way, judging by the cars I see in the doctors-only hospital parking lots, these men and women are very comfortably off. My PCP some years ago was also a family friend, and she lived in a very, very nice upscale neighbourhood. Definitely not visiting a food bank in her Mercedes!
Not a terribly viable option for me I’m afraid 
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In my particular corner, at this particular moment in time, it’s not that bad really. I’m a lucky one - reasonably good partially subsidized pre-Medicare retirement coverage from an employer that I can afford. I just got a new CPAP machine because the old one started flashing a ‘motor life exceeded’ warning, even though it still works perfectly fine. They let me keep the old one to use as a travel machine and sent me a newer ~$1100 model for free. No muss, minimal fuss - I just had to call and inform them and then sign a piece of electronic paperwork over e-mail for the sleep supply subcontractor. It arrived by mail a few days later.
But that’s my plan. My neighbor next door down might have had to pay a $250 co-pay. The person a door down from that might have had to eat the entire cost because their shitty plan doesn’t cover durable medical devices. And the person a door down from that is a grad student trying to avoid paying for insurance they can’t really easily squeeze into their tiny budget by relying on continued good health (i.e. luck) and a bare bones college health clinic.
It’s not that the labyrinthine U.S. system never works. It’s that it doesn’t work for everyone and doesn’t work well for many.
good links, thank you @Wesley_Clark
I believe so.
There is a modest charge if you have to go to a non-Kaiser ER.
Right.
Thank you for the info.
Agree.
I’m glad you have the kind of insurance you prefer.
But as a general matter, many (most?) carriers offer the exact same coverages in both low- and high-deductible versions. The entire difference is upfront premiums versus downstream deductible. As a general matter after the relevant deductible is met, the plans are identical after that.
IME it’s pretty much a wash financially. IOW, if the high deductible plan offers a deductible $5,000 higher than the low deductible plan, the annual premium difference is also very, very close to $5,000. You’ll pay $5,000 extra in your 12 monthly payments to “buy” the lower deductible.
With the result that if you have enough savings or credit that you can afford a $5000 surprise in your annual budget, you’re money ahead to take the high deductible plan and hope to not spend all of the $5,000 of premium savings on deductible that year. It’s a one way bet that you either win or break even. There’s no way to lose.
For a healthy person they’ll for sure pay $5,000 less in premiums every year but maybe spend an extra $500 in deductible over the low-deductible version. And pocket $4,500 in savings. If not every year, then at least most years.
For the unhealthy person who’s destined to spend a lot on healthcare that year, they’ll end up with the exact same total spending by December. It’s just that the higher premium spending on the low deductible plan is probably less visible to them than the higher deductible spending on the high deductible plan would be.
HDHPs have really been mis-sold to the public as some budget choice for folks who can’t afford better coverage. Nope; it’s not that at all. It’s a way to get the same coverage and same care for less annual money. No wonder the carriers are careful to mis-sell this product.
When we were doing open enrollment at work I did a calculation and it was pretty much a wash financially if you use a lot of health care.
The high deductible plan has a lower premium, but also a higher out of pocket maximum.
The low deductible plan has a higher premium, but a lower deductible and a lower out of pocket maximum.
However the HDHP also has an HSA, including an employer contribution. So you get the contribution + tax savings from investing in the HSA. The employer contribution + tax savings from an HSA added up to about $2000 a year when I did the calculation.
The LDHP has an FSA which lets me pay for health care tax free. The tax savings from that are closer to $800.
For someone like me with medium-high medical expenses, they were pretty much a wash financially but I chose the LDHP because it feels more secure. I ignored a ton of health issues in my 20s and 30s, and now that I have good health insurance I’m getting a lot of health care I should’ve gotten years ago.
However if your health care costs are low, the HDHP is the better option. Lower premiums, an employer contribution to the HSA, and tax free investments in the HSA that roll over each year.
Do you know a convenient source for those stats?
Any publicly traded company should publish their basic statistics (Form 10-K).
From there, you can get:
- Net Income
- Total Revenue (or Net Earned Premium)
- Total Medical Claims/Expenses
- Average Number of Members/Subscribers (might be harder to find - might be in a Discussion section, rather than a line-item section)
Profit margin (e.g. percentage of all money that the company keeps as profit) is calculated as Net Income / Total Revenue * 100.
Total average payout per customer is calculated as Total Expenses / Number of Members.
In general, health spending follows a bathtub curve. Nearly all medical expenses go towards infants and the elderly. So if an insurance company can focus on employed adults, then they can basically round up a ton of people, charge them very little, and pay for yearly checkups - a nice, dependable expense. You’re effectively just paying the insurance company to hold your money for you, in between your checkups. The only thing driving up prices are if those people have children.
An honest company, that covers people of all ages or which specifically covers the elderly, should have a higher payout per person (but, likewise, would be asking for more per person).
You’ll need to read through their Discussion and business strategy docs to figure out whether they’re expensive but pay out everything they take in because they’re handling the elderly, or because they cater to millionaires.
Here’s the thing, tho - health insurance companies don’t have to cover the elderly. They are relieved of having to cover a person’s most expensive health years by Medicare (starting at age 65). In fact, health insurance companies make money from the elderly via government contracts. That’s why there is extensive advertising and competition this time of year with Open Enrollment for Medicare Advantage plans. The government (and by extension, all of us) pay for elderly care thru Medicare plans administered by the health insurance companies. The longer you stay alive, someone is making a buck.
No, no , no. medicare mostly pays for itself by special payroll taxes, and by the patients themself by a modest deduction from their Social Security.
Mine does. Since I get relatively cheap insurance thru my retirement, I only have medicare part A, since getting part B, etc would be more expensive than what i pay for myself and my wife.