There are currently a couple of threads in GQ concerning UHC in the US. For those pro-UHC advocates I would like to see the realistic costs for a full implementation of UHC in the US, who it would cover (I assume everyone), how it would work (could you go in any time for anything? What would the limits be?) and how, realistically, it would be implemented give our current system. How long would it take? When could we realistically expect to HAVE universal coverage? What would the initial startup costs be (I assume it would be huge initially and then tapper off somewhat)? What would be the yearly cost to the country once it got rolling?
I’m not looking necessarily for Clinton’s plan, or Obama’s plan…I’m looking for a realistic view of how it would ACTUALLY work, not how some politician is attempting to spin it to the American people in the hopes of getting elected. Additionally, I’m not really interested in how it works (or doesn’t work) in Europe or Canada or anywhere else. The US isn’t Europe or Canada or anywhere else. American’s don’t think the same way as folks in Europe…and they don’t think the same as us. How would UHC work in AMERICA?
Horseshit. The cultural differences between (Anglophone) Canada and the U.S. are not by any means profound – which is not surprising; Canada is an American colony, not a British colony; it was hardly inhabited by English-speakers at all before the American Revolution, but it was settled by United Empire Loyalist refugees from the 13 colonies, and, in the following decades, by large numbers of Yankee immigrants.
Any system that can work there will work just as well here.
Please don’t hijack the thread BG. If you want to make the highly unlikely case that Americans are just like Europeans but with different accents start your own damn thread. Just answer the CORE questions I’m asking, ehe?
Thanks muchly…
(BTW, ‘horseshit’ is MY trademarked saying…come up with one of your own! :))
This is an intriguing little thought experiment I’d love to try out. There are two pretty big questions, though, that we need to work out first:
Do we keep private hospitals, or do we convert the mall to public institutions? (Essentially, do we just create public insurance, or do we make a public health system?)
Do we include tort reform to reduce malpractice costs?
The hows of a transitional period to UHC in the U.S. is certainly an interesting avenue for discussion. I’m sure somewhere out there is a heavy document summarizing the means and methods of all the other countries which converted to some form of UHC and then goes on to extrapolate what the author(s) see as the best route for its adoption in the U.S. Some policy wonk/sadist will be able to cite it any day now.
I don’t see the implementation of actual UHC in the U.S. as a remote possibility for several decades, if ever. But perhaps with Democratic leadership we could see a schizoid chimera which has the worst of both worlds with the advantages of neither, all the while funneling federal largess to the private interests in the fav five of Congress. So there’s that to look forward to.
You know, I started a thread just recently, because it did seem to me that the outlines of a conservative-liberal convergence on healthcare were visible. And nothing in that thread really dissuaded me from that view. The nice thing about the plan I sketched out was that it could be implemented quickly, and cost the government nothing out of pocket.
Does that thread go any way toward answering the question?
Disclaimer: I haven’t put a lot of research or analytical thought into this idea, but it makes a whole bunch of sense in my head.
Why can’t we just expand Medicare to include anyone who wants it? If cost is a big concern, we can always make people pay premiums on it adjusted to their income level. Or even make people above a certain income pay co-payments. Nothing extravagant, but something to deter people from abusing the system (which is what the detractors will inevitably focus on). As long as we make it more affordable and inclusive than private insurance, it would be a lot better than what we have now.
Of course the private insurance companies would bitch about it because they would potentially lose a lot of customers to publically subsidized health insurance. Well, that’s when market forces would kick in and force them to be more competitive. Maybe, instead of taking advantage of desperate people, they could start offering more incentives and benefits rather than putting people through the ringer.
I think the limiting parameters are going to be[ul][li]UHC is supposed to cover more people than are covered today[]Most people in the US who are covered by private insurance are happy with their plan (cite available on request), and are therefore not likely to be happy with a plan that covers less and/or costs them more[]the federal government does not have a good track record overall when comparing cost-cutting against analogous programs in the private sector (see US Post Office vs. FedEx)[/ul]So I would expect that giving everyone in the US roughly the same coverage as the insured do now will cost more, not less, than we are spending overall. I do not expect that the insured middle class is going to be pleased with reductions in their coverage so as to extend coverage to the non-insured. [/li]
Increased coverage means increased demand. Increased demand means a rise in prices. Ergo, UHC will increase upward pressure on health costs.
Americans want three things from their health care - [ul][li]They want the best care available[]they want it available to everyone, and []they want it at a reasonable cost.[/ul]They can get, at most, any two of those three. [/li]
If we are serious about UHC, we as a people will have to accept some form of rationing. It will probably be de facto rather than overt, but health care costs will continue to rise unless and until we are willing to say, “Yes, if we spent enough money, we might be able to save your baby, or your grandma. But we aren’t going to. We are going to let her die, in order to save money.” And we will have to stick to that decision, regardless of how cute or sympathetic or white the dying victim is.
No, you can’t have an MRI for your knee.
It’s been twenty-four hours since you gave birth, Mrs. Johnson - this is a hospital, not a rest home, so get out.
You don’t need to see a specialist - you’ll just have to live with it.
To me it’s obvious that there is currently tremendous waste in the system because of insurance.
Industry creates things, tangible objects.
Doctors make a specific contribution, visible changes in health that people want.
But everyone working for an insurnace company is just overhead. Waste, creating noting of value and consuming resources.
At one time, people paid for their own medical services and that waste didn’t exist.
And family doctors were not wealthy, and they would make house calls.
You might have noticed…there have been some changes. Doctors today have access to VERY expensive diagnostic tools, for instance. They have access to exotic drugs and to advanced surgical procedures today as well. Things that your little home town doc wouldn’t have even dreamed about…let alone been able to afford. Are you seriously suggesting that it would be better to go back to that model? And if not…well, where do you think that all those shinny new EXPENSIVE tools that todays doctors use come from exactly? The good medical fairy?
Actual industry instead of the “service” industry?
I’m not convinced that economically, UHC would lead to a better outcome, although the total health of the nation’s people would probably increase. But let’s not pretend that health insurance is not a drain on the productivity of the economy in general.
In other words, if we had UHC, yes, we’d have government oversight taxing our productivity. But it’s an open question whether the resources the government spends will be greater than those the insurance industry does.
Which isn’t different from the current setup. If you want treatment beyond your insurance coverage, you still have to pony up, correct?
UHC would at least see to it that all got some sort of coverage. The rich and very rich would still travel first-class, but at least we could get the poor and the unlucky a berth in steerage, rather than leave them standing on the quay. (That was a rotten metaphor.)
Calling what UHC does “rationing” smacks of scare tactic.
I think of limited coverage as a form of rationing.
Or realism. I want to avoid any hint of the notion that we can get something for nothing.
The US is not Canada or Europe. We pay more now, we would pay more under UHC.
But if insurance companies pay too much in overhead, it cuts into their profits and they have a built-in motive to reduce it. There isn’t nearly as much incentive for the government to cut overhead - they never go out of business. IYSWIM.
