I’m far from an expert on the US health care system, but from what I’ve read, in quite a few states it could work precisely the opposite in some cases; people who currently qualify for Medicaid who would need a huge income jump to be able to get sufficient insurance to cover the same thing, so have to carefully tune their underemployment level to keep eligibility.
There’s also the people who avoid seeing doctors because they can’t afford the co-pay or just plain don’t want to think about the possible costs until what could have been a perfectly treatable issue turns into something serious and lifelong, ruining their future employment prospects.
I’m currently trying to up my qualification level in my 30s, meaning I’m only working a few hours a week while I’m on the course. I live in England; I can do that without worrying about health costs, and hopefully I’ll be far more employable at the end.
What I don’t get is if someone, or if a number of people are content to just eke out a living doing odd jobs, and “just don’t want to be a contributing member of society”, why is that such a horrible thing? Less competition for the available jobs for the rest of us.
As long as a young person doesn’t do drugs, drink, steal, or panhandle, but can make a go of a scanty work lifestyle by choice, why is that terrible? Let them loaf, or goof off, or live off the land.
Isn’t this basically the “broken windows” fallacy? Except instead of “breaking a window causes employment”, it’s “overly expensive healthcare for jayrey causes employment”.
Drinking and recreational drugs in moderation would be fine. But addiction to those things would be extremely expensive to fund on such a lifestyle without stealing or panhandling. Not to mention a burden on publicly funded health care.
Why no panhandling? Sorry, all those positions are taken. In other words, I cannot walk down the street without being accosted for a handout, and it’s annoying. If you can live off the grid without pestering me for change, that’s fine. But otherwise, find a job.
Yes, but not in the way that you think. The people staying in the workforce for the insurance are largely people like you who are either close to retirement or perhaps second income families. When they stop working they don’t become ‘unemployed,’ they become retired or stay-at-home parents. That doesn’t impact unemployment, though one could argue that they could be productive members of society and in a society that has full employment it could be a problem, but realistically there will be someone else to take that job.
The way that it DOES encourage unemployment is by reducing the number of people working in healthcare. We can just run some quick comparisons. The US has about 18 million healthcare workers for about 320 million people, so roughly 5.6% of the population. The UK has about 2.3 million healthcare workers for 66 million people, so about 3.5% of the population. Canada has about 1.7 million workers for 37 million population, so 4.5%. This is a normal trend. Countries with National Healthcare systems have fewer people working in them. The US has tons of healthcare workers. We like to point at pharmaceuticals and tests as the problem with US healthcare costs, but the elephant in the room is personnel costs. We just have a TON of workers in healthcare. Healthcare has largely surpassed manufacturing as the gateway to the middle class. One of the ways that national healthcare systems are able to keep costs low is by having fewer employees and paying them less.
For some reason, this is a controversial claim, but it shouldn’t be. That’s largely how every company in the world keeps costs low. Low costs are either due to higher productivity (meaning one person providing more) or lower wages. Everything else is nibbling the edges. This reality is what is really preventing a Medicare-for-all system. Politicians KNOW that Medicare-for-all will result in either fewer employees or lower wages and likely a combination of both. There is zero doubt that if such a program were to pass, the opposing party within two years would have an army of people talking about how they were laid off or how they had to close their practice and how rural areas no longer have doctors etc. etc. Of course, that might be a good thing if we could have cheaper healthcare, but it’s politically dangerous. You have to rely on the electorate to understand that you can’t have your cake and eat it too and that’s not typically the mindset of the American voter.
I think the concern is that basically these people choose to live their indolent lifestyles and then when some kind of adverse event happens, there’s an expectation that either everyone else foots the bill, or something dire happens to them.
Basically their choice to be indolent ends up being irresponsible if you can’t handle the consequences, which seems to be the case.
I mean, I don’t much care if some guy chooses to be a beach bum and not actually work for a living, instead of doing like everyone else and getting a job.
But if that’s his choice, my expectation is that he’s also willing to accept the consequences of that choice, such as no health insurance, shelter insecurity, food insecurity, etc… You can’t have it both ways and want to be a slothful lump, and then expect everyone else to bail you out because you *chose *to be a slothful lump and something bad happened.
People have a number of needs. Health care is one of them. But there’s also food and housing. So nobody’s going to choose to be unemployed just because they get free health care. They’ll still work to cover their other needs.
But I’ve said before that I feel a public health care system would lead to economic growth. Our current health care system ties people to their employer. I’m sure there are thousands of people who would like to start up their own businesses but hesitate to do so because it would mean giving up their health care. A public health care system would remove that worry and lead to the opening of a large number of new businesses, many of which would succeed and become employers in turn.
I don’t think it’s controversial at all that a single payer system will result in fewer administrative jobs; that’s a feature, not a bug. But an aging population is creating a need for an ever greater number of health care workers, or at least those who work directly with those in need of services. The economy will adjust.
We have a tendency in this country to be overly concerned with the few who might game the system instead of looking at the far greater number of citizens who will benefit by a policy.
I support universal healthcare but I don’t believe there is any chance that providing universal health care will reduce demand for health care overall as a result of the situations you describe. This is just a myth that universal health care supporters spin because it sounds like we can have our cake and eat it too. It makes it seem like it will be easy to provide universal health care while simultaneously reducing our overall medical expenses. I don’t think that will happen. In today’s system, there are some people whose disease will progress from easily treatable to expensive because of lack of affordable health care, so our current system wastes some resources on them. But there are many other people who avoid treatment for diseases and then just die very cheaply because its too late to do anything for them. There are also people who avoid treatment for routine things like colds, influenza, broken toes, minor infections, etc. who don’t seek care at all due to lack of affordable health care. Then there are people sklpping routine exams who feel fine but who would discover little treatable things if they were to go to the doctor. Under a universal health care system, all these people will start getting treatment, increasing demand for health care.
In economic terms, if you lower the price of something, you will increase the quantity demanded of that thing. Universal health care lowers a person’s cost of doctoring and so they will see the doctor more. I happen to think more doctoring for sick people is a good thing, which is why I support universal health care.
Does this mean that there are fewer doctors and other direct medical care workers in universal healthcare systems? I would expect there are generally roughly the same or more. How does universal health care affect medical providers’ efficiency? How many of those additional people in the U.S. work in the financial administration parts of health care, including at medical insurance companies and medical billing? Universal healthcare reduces the need for those jobs (though it certainly doesn’t get rid of them entirely and it merely moves others to the government).
I think it’s human nature to care about fairness & equality. “What do I get?” is less important than “Am I getting less than others?” In fact, it’s not just humans.
I suggest what’s unique about the US is that we don’t trust the government to manage the system in a fair way.
The US actually has a relatively small number of doctors, but everything else it has in high amounts. More nurses, more therapists, more technicians. US doctors get paid significantly more than doctors in pretty much every other country in the world and so there is a financial incentive to outsource their work to cheaper labor. The US created Physician Assistants to do much of their work and we have a ton of them while in other countries, they don’t really have any (US has 150 thousand PAs, UK has 850 physician associates) The same with nurse practitioners (US has 270 thousand and the UK doesn’t quite track them, but somewhere around 5 thousand) We’ve shifted doctor’s work onto a myriad of other people that we can pay less (Although they still get paid a lot, a nurse practitioner averages 113k in the US, a GP in the UK makes 118k. In Sweden and Norway, physician specialists only make 75k and GPs make 66k.)
There is a valid criticism that the US has too many administrative jobs (although that is probably cold comfort to the laid off desk receptionist or appointment scheduler or database administrator.) We also have too many of every job (Too many is of course an opinion, merely in comparison to other countries.) The bottom line is that Healthcare is 18% of our GDP and it needs to be closer to 10 and that’s a heck of a lot of money that needs to be drained from the system and if you think you’re going to get it by laying off billers and insurance agents then you’re deluded. An NHS style system would hit everyone. Again, this isn’t necessarily a bad thing, but you need to know that there are trade-offs and it would bring a lot of pain to a lot of people.
No, it’s not just you. I spent the last 15 years of a career successfully running my business, which I would never have dared to do without UHC. Which raises an additional further point - I was available to provide (other, bigger) businesses with as much expertise as they wanted to buy. I gather that Nava is in a similar situation; as no doubt are many others. The fact that we are successful suggests that we are needed. Is there a measurable adverse effect on the US economy (ultimately down to lack of UHC) because businesses can’t just buy as much expertise as they want (or at least, not easily) and are caught between having to hire or do without the expertise? Or is the price of consultant expertise simply driven up by lack of supply, to create further problems?
If you are paying people to dig holes and fill them back up, you aren’t really helping your economy. If we’ve created a bunch of busy-work for people to do that could produce the same services with less labor, we shouldn’t perpetuate our hold-diggers. We should find something meaningful for them to do.
I wasn’t advocating against national health care, but pointing out why people might have a problem with someone who “just doesn’t want to be a contributing member of society.”.
But you’re right- people tend to worry far too much about the rare edge cases.