From a European perspective, the long battle to provide reasonable health care to the poor and middle America seems strange.
Why are schools State funded but Hospitals and Health Care are not?
Partly because America used to be much more left wing. And partly because it’s unlikely that we could have even functioned as a major industrialized nation without state funded education, while not funding health care just results in “expendable” people dying and their money being transferred to the richer echelons of society in the process.
What a horribly accurate answer!
I just do not understand how the same people who expect a free education from local school boards are so set against state funded health care. The two opposing ideas seem very difficult to square.
Well, there is a persistent movement to dismantle out public schools, as well.
Universal education gives the individual a foundation to earn a living. It’s a finite expenditure that places responsibility for self reliance on the individual. Universal health care ends up rationing health care for the poor and middle class. Private health care is more beneficial for the poor and middle class but rations it for the the near poor and those with pre-existing conditions. The wealthy in both systems have the resources to bypass either system.
Free public education appears to have greater positive externalities than free public health care.
Poor people getting sick and dying doesn’t cost the middle and upper classes nearly as much as poor starving people who are incapable of supporting themselves or contributing to GDP but are quite capable of crime and riots.
Also, arguably, poor health care doesn’t impact your ability to make an informed decision at the polls. Poor education does, and so is much more tightly relevant to a functional democracy.
That said, I’m pretty strongly in favor of providing reliable public healthcare. I just don’t think the two things are comparable on a macro level.
Well said. I was going to type a couple of paragraphs to state what you succinctly said in your second sentence.
All the other answers given so far are wrong. Interesting, but wrong. It’s not a deliberate decision anyone has made; the public education systems and the private healthcare systems developed along different tracks because they aren’t really related entities. You have to bear in mind that the US never suffered much from WWII, so it never developed the post-war consensus and similar political third rails that led to the creation of the European welfare states.
So, anyway, the reason we have public education and for-profit medicine is because you can make money off the latter. You can make money off the former, too, at the postsecondary level, but not off kids. So nobody tries.
There is far more rationing of health care for the poor under the US system than under any socialised medicine system.
The reason is simple: people are stupid, and afraid of change.
Until recently, the medical system had worked pretty well for the majority of middle class people,( and all of the upper class people) …so everybody just got used to it.
Medical care was non existant until about 100 years ago , and when it developed, it happened to do so as privately funded businesses, not state-funded. And for the first 70 years of its development (say, 1910 to 1980), the private system worked well for most people. So, like the educational system, people just want to stick with what they are used to.
I’ve always joked that the biggest problem was just in the language. Americans are afraid of state funded health care, because of the language used to describe it. The politicians should never have tried to use words like “reform” or Obamacare", because that scares people. And they certainly could never dare to use words like “the french system , or” the European system", or even “the British system” of health care, because that would insult American pride.
So what’s the answer? It’s simple… Just adopt the Canadian system, and proudly call it that. Americans aren’t afraid of Canada!
A place with rugged mountains, huge trees, macho lumberjacks and tough guys on horseback*…now that’s something that Americans can feel comfortable with.
*well…you would have to make television ads showing the Mounties without those silly red jackets. That way, you could trick Americans into thinking the Mounties were real cowboys. And cowboys carry guns. And guns are the American way.
Gosh—if you put a few guys holding guns on television to talk about it, a new, government-funded health care system would seem downright patriotic.)
I blame World War II. During the war there was a wage freeze. However, companies could still lure in workers by offering them more perks. So employer-funded healthcare became the norm.
Exactly. Not only can you make money off health care treatment, there is a great deal of money to be made insuring people so they can actually afford to get treatment if they get sick. So whenever you have people making a lot of money, they tend to be very resistant to changes that will cut into their bottom line.
Ordinary conservative middle class people are against state funded health care because they believe the Republican narrative that their taxes are going to pay for undeserving poor people.
Because health care has always been a way that companies hold employees in serfdom. I know people who don’t change jobs simply because they cannot afford for their family to not have the heath insurance their employer provides. This has been supported by the left wing in an erroneous idea that the system helps the blue-collar worker at the expense of the bourgeoisie. It is also supported by the right-wing in the social darwinism that the more successful you are, the more priviledges you should get. I busted my ass and spent a lot of time money and energy getting a bachelor’s degree and my teaching credential. Right-wing thinking says why shouldn’t I be rewarded for being a professional with subsidized health insurance?
Also, education does not fit well with a cost-benefit analysis. What is the true value of an educated citizenry? Is it $10,000 per person? $150,000? Is it 20% of the GDP? On the other hand, insurance is all about cost-benefits in that is it worth $10,000 to keep you alive? As much as the left-wing doesn’t want to admit it, it does make economic sense to let homeless people die in the streets rather than spend money to make them healthy*. And as much as we as a society don’t want to admit it, we love to place blame and hold people accountable for what we perceive to be a personal failure. Have a mental illness? Snap out of it. You’re poor? Work harder or go back to school.
Lastly, and as far as I am aware very few policy makers see this relationship, is that the success of health insurance has actually ruined the health care system for poor people. Medical prices are outragous simply because the assumption has always been that deep pockets of insurance will pay for it**. Also, there is no independent oversight for cost vs care. How else can you explain that in the early 90’s when I had a badly infected ingrown toenail the doctor charged me $300 to confirm it was infected and never treated it. How is it that my son was told on the phone by a Blue Cross advice nurse to go to the emergency room right fucking now for a broken tooth (it was Sunday night) and $250 (our part after insurance) later they couldn’t do anything since they weren’t DDSs? BC’s reaction? We didn’t have to take the nurse’s advice if we didn’t want to. In another thread related to health care, I priced out an MRI machine and figured out if it were used once a day for 3 years (or something like that), the cost to the customer would be like $80 for am MRI scan. How much would you pay for a scan in real life? In other words, unlike universal education, universal health care is not necessary if the policy makers just provided some oversight and cost controls making healthcare the proper cost for people without insurance.
- Based on the current practice in the health care field that focuses less on primary and preventitive care and more on curing you when sick.
** Hence making insurance expensive. It is a positive reinforcing cycle.
Would that be a larger ration than they have now, or a smaller one?
Did you include the cost of powering the machine, the cost of servicing it, and the salaries of the operators and interpreting radiologists?
Even if that doubles the cost, how much do scans cost the average person? I can’t remember exactly what my original machine and assumptions were so I redid it just for you.
MRI machine = $1 million
Used twice a day everyday for 5 years = 3652 uses
$273.82 per use.
I would worry if service cost on a machine were that high with less than 4000 service cycles and a quick search shows an MRI operator would make $20-30/hr. Let’s say we double the machine cost for service/electricity/labor. So now it costs $550 per use and I think my number of service cycle is low which would bring the average cost down even more.
A few websites give the average cost of an MRI at about $3000. Let’s say the hospital wants to make a healthy 20% profit. That means the cost of the whole MRI test is $2500. If you do not pay for the radiologist separately, that means the radiologist interpreting the MRI cost almost $2000 for that one diganosis and the hospital is STILL making 20% on that.
Now I will accept if someone in the healthcare field says my assumptions are wrong, but I just can’t believe without further data that an MRI really costs the hospital thousands of dollars.
I see what your problem is. $3,000 is crazy talk. The Medicare reimbursement rate for an MRI angiogram of the neck, with and without contrast - essentially, the most expensive procedure you can perform with an MRI - is $796.48. The rate for an MRI of the lumbar spine without contrast (which I’d guess is the most common one) is $431.94.
If you look at the pre-fee schedule rates for MRIs done in hospitals, you’ll occasionally see wacky prices like $2,500, but (1) hospitals charge more for nearly everything, because they have to, and (2), nobody actually pays those prices. Insurance will pay about $800 (give or take $200 depending on the local usual and customary fees), and uninsured people will pay about $1000.
You mean the current system does. With private insurance only, the poor have less access than the middle class, who have less access than the rich. Universal access *reduces *that problem, it doesn’t create it.
To answer the OP, it’s the same old story about monied interests (the American Medical Association and the insurance industry, mainly, with the Republican Party as allies) having strong enough lobbies to overcome threats to their revenue streams from the less-financed, more-diffuse popular movements favoring them. It also helps that the subject is one on which people are easily confused and can be easily frightened, allowing the entrenched interests to generate opposition that seems real with only a small amount of demagoguery and lies. The “socialized medicine” scare campaign for which the AMA hired Ronald Reagan as a spokesman worked for decades, since it brought up connotations of Communist tyranny that only American “freedom” to direct one’s onw health care could oppose. Never mind that being tied to a particular employer rather than move on or start your own enterprise, and being susceptible to financial ruin if you happen to get a major illness, is the very *opposite *of freedom; that only shows how effective the campaign has been for decades.
Universal education, by comparison, has never had a major organized opposition, and there has never been a wide-scale campaign of lies to establish the notion that lack of education is in any way a good thing except in regard to slaves or, to a quieter extent, segregated minorities. Besides, industry needs workers smart enough to do a job, and is happy to let the public pay for it for them.
You have to look at it in the context of how our private health care system grew up and why it is the way it is. Doesn’t seem so hard to me to understand when you look at how and why it is what it is…and why it’s different than what the Europeaans have.
We didn’t build our system following some sort of over all plan…it evolved into what it is, and it’s worked well enough for decades that folks are confortable with it the way it is. We didn’t start out to build a socialized school system and then screw the poor with a privatized health care system, despite what you and Der seem to think. Again, it evolved this way, and it’s a system that’s been in place more than half a century now…and has worked reasonably well for the majority of people in this country. It has short comings and flaws, obviously, but so do most health care sysmes to one degree or another. It’s only fairly recently that the system has started to break down…which is why people are finally starting to demand changes and agitate for reform.
For the middle class too. I speak as someone with extensive experience of both the British NHS and of living in the USA with various flavors of what is, there, considered fairly good, middle-class-level insurance coverage. In most respects the NHS covers me better (and involves a lot less hassle).
The notion that health care is not rationed, and quite sharply rationed, for the middle-class (and even the moderately wealthy) insured in the USA is completely without foundation.