No, you’re not.
You found one article which supports your assumptions and insist we argue against them! But the authors don’t belong to the Dope!
If your entire contribution to this thread is linking to a single NY Times article, then thank you, you work here is done. :rolleyes:
Actually, both survinga and XT in the past have made cogent arguments why UHC is more difficult in the US, tied to the American system of federalism and separation of powers.
Whether a constitutional system that prevents the people from adopting a certain social benefits policy is a good thing or not is another debate.
Thank you for the comments. Yes, I’ve made a variety of arguments about our political system, and how I think that will impact (likely negatively) any attempt at a one-size-fits-all healthcare system. I’ve also talked about public opinions, and I’ve talked about my own situation. This thread though is the first time I’ve actually researched at any depth the M4A cost estimates that are out there. It makes me even more skeptical about the Sanders/Warren plans.
And as I’ve laid out in previous threads, I would like to see the US go down the path of implementing the ACA properly, the way it was originally envisioned, with all states taking the Medicaid Expansion, with a real individual mandate, with subsidies that cap the cost as a % of income for all income levels, and with states that truly to outreach. I think a strengthened ACA would greatly enhance the US healthcare system, and get us to UHC without throwing out everything else.
In other words, you are, in fact, for universal health coverage but you disagree with others on the details and how to get there. Would that be a correct summation?
Yes. My arguments are against going to full single-payer, or what’s called in the US “Medicare For All”. I would like to keep the basic structure of what we have, which includes private and public insurance, and make enough changes to the ACA so that it can finish the job it was drafted to do.
The ACA has done great things for the US, lowering the uninsured rate from 18-20% to about 8%. If red states would finally embrace it, and if Republicans would stop sabotaging it, the ACA could use a few technical fixes to get us to full UHC.
I do not support getting rid of my private insurance and doing single-payer. That’s what I argue against in general. And I’m not some hick who’s never been outside the US. I’ve seen other countries with UHC, and I know how various systems work. The US way is via a properly designed ACA, in my view.
…but in the past you’ve advocated for a “properly designed ACA” that still allows people to fall through the gaps. It wasn’t universal. Under what you proposed, millions still wouldn’t have coverage, correct?
You still can’t admit your premise was wrong.
…why would I admit my premise was wrong when my premise wasn’t wrong?
I think a properly designed ACA would get us to full UHC. I think it might take a few rounds of tweaks. We need to set the price points better, with the right mix of subsidies and penalties to get it down to a full million uninsured. And then another round to get the holdouts, maybe some “invincibles” who don’t think they need insurance. Part of it, too, is getting every state under the Medicaid expansion, which is slowly trickling in…
But ultimately, everyone gets covered.
…what if those “invincibles” are simply people that can’t afford insurance?
Can you guarantee that under your scheme posters like **MissTake **won’t end up with 80K in medical bills sitting on their table?
Invincibles are people who are young and don’t think they need insurance. They’re healthy, and see no reason for it, because they don’t go to any doctor and are too immature to think through possible contingencies (car wrecks, for instance, or broken arms/legs from playing sports). The way to get them into the system is a strong mandate penalty.
As for people who truly can’t afford it, that’s the point of making the subsidies richer. They phase out too quickly currently. The right way is to lift the 400%FPL cap on subsidies, and set formulas such that health insurance premiums are maxed as a % of your income, so that middle-class people aren’t priced out of the market. Also, if all states accept the medicaid expansion, the way the law was originally written, then the poor can qualify for Medicaid. That would answer your question.
I went back and read that post from MissTake. The irony here is that her lack of insurance seems to be a bureaucratic issue tied up with medicare…that’s right, medicare, which is single-payer for above 65. I would really hate it if Medicare became the basis for all insurance in this country. Above all else, let’s not allow that to happen.
…a strong mandate penalty…that’s a financial penalty right?
I’m not quite sure you understand how this “Universal Healthcare” thing works.
This isn’t universal. Financial penalties don’t take you on the path to universality.
What about people that don’t qualify as “poor” even if you increase the cap but still can’t afford insurance?
So this is a guarantee that under your scheme posters like MissTake won’t end up with 80K in medical bills sitting on their table? Its a yes or no question. MissTake has coverage. Yet still has to deal with a massive medical bill. Does your scheme still allow for that to happen?
I’m advocating for Universal Healthcare, not for “Medicare became the basis for all insurance in this country.” Because insurance is not healthcare.
I didn’t say that financial penalties take you to UHC. But they are a part of a 3-legged stool. To get to UHC using an ACA type-mechanism, you need to require people to buy (mandate), require companies to sell (community rating), and you need to subsidize so that insurance is affordable. This has been implemented in other countries with success. The ACA has the 2nd leg of the stool, and part of the 3rd leg, but is missing the first.
You’re not advocating for UHC. You’re advocating for single-payer, which is a type of UHC. I’m advocating for UHC that’s accomplished by a different method. There are different ways to get to UHC. I think I understand that better than you do…just like I understand that single-payer in the US might result in more costs, whereas you don’t (or at least, you won’t admit it)…
Your data for this conclusion is, I find, cherry picked, and inconclusive. It has missed or ignored many parts of single payer that result in savings. I remain unconvinced by your single example.
I will agree with you that moving the USA to a single payer system will not be easy - it will be painful. Primarily because there is a wealthy industry that does not want this. And there are major political donors within this industry. It’s hard to change when there is a huge industry fighting any change because it will mean the end of their cash cow.
I linked to an article with 5 studies, 3 of which think the costs will go up, 2 which think they will go down. That’s not cherry-picking. Now, any of those studies might be wrong. But someone needs to point out these studies on this board, because others assume costs will go down in the US as a default without really looking at our situation critically. The premise of many arguments on this board just assume lower costs, which makes for a flawed argument.
Yes, we both agree that politics will make it hard in the US to ever have single payer, or any type of UHC at all. Politics is the root of our problem.
…your plan for UHC includes financial penalties.
That means you don’t actually get UHC.
UHC, as I’ve told you before, is underlined by the premise that it is both:
Universal and
provides healthcare for all.
If your system has financial penalties and if your system allows you to not take part: it isn’t universal. It isn’t universal healthcare.
If you don’t have a system which is properly mandatory (like with Germany) then you don’t have Universal Healthcare. Allowing people to opt-out means you don’t have Universal Healthcare. You aren’t getting to UHC using an ACA type-mechanism. Millions would still not be covered.
I’m sure if we were to closely examine any countries that have allegedly implemented this system we will find that it isn’t exactly the system that you advocate at all.
I am too.
I’ve been crystal-fucking-clear I’m advocating for UHC.
Except your method has gaps. You acknowledge that those gaps exist. Your method is not universal.
And your way isn’t a way to UHC.
I don’t think that you do.
Except I’ve already conceded that the US might be so extraordinarily uniquely incompetent that they might be unable to do what everyone else in the world has been able to do for decades. I know perfectly well that only America could stuff this up. I’ve admitted that America, who currently pays double what everyone else in the world does yet can’t provide healthcare for everyone, would be the only country in the world that wouldn’t be able to do this relatively simply thing. American exceptionalism. Only America wouldn’t be able to do this.
JohnT has run the numbers (from your cite) and concludes that if the numbers held true in the worst case scenario it would cost an additional $35.00 per person to introduce a healthcare system that would cover everybody. Lets for the purposes of this debate assume that figure is correct. $35 and nobody gets 80K bills. $35 and nobody gets bankrupted and everyone gets coverage.
You wouldn’t get behind that system? You think that your system, a system that still allows for medical bankruptcy and won’t cover everyone and actively punishes people that either choose or unable to take part in, you think that system would be better?
($35 per person per week. FYI.)
I’ve been following this thread without comment, mostly because I am not in the healthcare industry, and I don’t have any significant stories to tell. I do want to thank the posters who have been willing to get in the weeds and put numbers to things, because you’ve prompted me to do some math myself.
My wife and I are in our mid-50s, healthy, with no emergent concerns. My wife is a senior partner at one of the Big 4 professional services firms, so we are financially well-off. If you’d asked me last week if we had good health insurance, I would have said, “sure,” mostly out of ignorance. Now, I would have to say, “I don’t know,” because we haven’t stress-tested it. I honestly don’t have a good idea of what would happen were one of us to have a serious health event.
Thanks in particular to JohnT. When I have a few spare hours soon I’m going to do some analysis like what he’s done up-thread to see if I can game out worst-case scenarios and prepare as best we can.
And, I know this is not a great argument, and a little trite, but whenever I hear people arguing that European-style UHC won’t work in the US, I have to ask what it is about the US that makes us so uniquely incompetent. Honestly - if virtually every other modern, affluent country can achieve this, why can’t we, particularly if you think that America is the greatest country ever?
That has always been my question. Yes, there are surveys that say most Americans are happy with their health insurance. That’s good, I’m glad as a neighbour to hear that.
But I’ve always wondered: have surveys been done of Americans who have had major health events (motor accidents, cancer, other serious issues). Are they still happy with their health insurance? As you say, have they stress-tested it? Stories like MissTake’s, and the study cited earlier, raise this question. Because the satisfaction rate in general is one thing. The satisfaction rate of people who have to actually rely on their insurance for a major health-care event is something else. Do they match up?