I’m afraid that a lot of voters feel the same way the OP does and pushing universal health care or medicare for all will bring us four more years of Trump. I know it will.
Regardless if it’s a better approach, people do not like the government taking over something that works OK for most people. That scares them, and this fear will be massively inflamed by the republicans during the general election. It WILL be enough to sway the election.
This is a hijack of the thread, but I’d like to call out the above as the bullshit that it is. Medical costs have gone up because the medical establishment charges a shit-ton of money. Insurance companies aren’t wonderful, but they’re not driving up the costs solely. I recently went to see a specialist for a 5-minute appointment and they billed insurance $3000, with $500 out of my pocket, and insurance paid up the rest. I once was billed $3400 for a four mile ambulance ride, and the insurance company protected me (yes and themselves) by refusing to pay such a crazy sum. The medical establishment gets rich by bilking insurance, with the costs passed to us. Nobody is a hero here, but insurance companies aren’t the only villain.
If health costs are to go down, it’s not only insurance companies that need to feel some pain. Specialists, GPs and the whole industry will need to make less off of all of us to bring down costs, period. This is what’s different in UHC countries.
You need to educate yourself about health care economics because most of this is quite wrong. The last paragraph isn’t entirely wrong but the logic leading up to it is.
There are two main reasons health care in the US costs so much more than anywhere else in the world. One is that each and every individual claim is adjudicated by an insurance company. When you consider the amount of paperwork and administration required to do this, not just in terms of insurance company staff but in every doctor’s office and every clinic and hospital and imaging center and medical lab in the country, it’s an enormous administrative burden that has to be paid for. This simply does not happen in public UHC because it isn’t really insurance in the normal sense of the word, but operates more like a public service whose job is to pay for health care services. But with private insurance, each patient is in effect paying an enormous premium for the “privilege” of having insurance bureaucrats coming between him and his doctor, scrutinizing every claim, in some cases questioning the doctor’s advice, and seeking to reduce or deny every claim. It may be medically counterproductive and barbaric, but it still costs money.
The second reason health care in the US costs so much is that there are virtually no controls over the amount of health care billings, because there’s no one to control them. Insurance companies don’t care much because they just pass the costs on to their captive customers, and indeed insurance companies benefit from high costs because in effect their take is a percentage. The simple way to say this is that doctors and hospitals charge enormous amounts both because to some extent they have to, as in the previous paragraph, and because they can, since there’s no one to stop them. There is also absolutely zero transparency in the process, with crazy variations in fees for the same procedure from the same practitioner, and crazy variations across different parts of the country.
I’ve had cancer surgery, thankyouverymuch, and my employer HDHP is a constant source of education.
Look, I’m not defending insurance companies, I’m scoffing at the notion that they are entirely the whole problem, as asserted in those posts. The medical establishment itself is complicit at best in the cost of medical services and especially prescription costs.
I’m sure you’ve heard of surprise balance billing, or facility fees. These are scams against the consumer, not perpetuated by insurance but by the medical establishment.
Hell, did Martin Shkreli make coin selling health insurance? He did it by gaming pharmacy prices, something that happens on less-ridiculous scales daily. By the medical establishment, not insurance companies.
Again, no heroes here, but arguing this is solely an insurance problem is nuts. It is systemic.
I think the effective and accurate message would be to emphasize how much it doesn’t “work OK” for most people when they actually need it. Drawing people’s attention to headlines like “Cancer forces 42% of patients to exhaust life savings in 2 years, study finds” would help them realize how not-OK that’s working.
Most Americans know that healthcare expenses for any serious condition can easily turn anyone into a pauper. Bankruptcy for medical bills, spending a lifetime’s worth of accumulated assets in order to qualify for Medicaid, stress of recovery exacerbated by massive debt: Americans are frightened of these prospects, and with good reason.
Remind them of how much they really have to be scared of in the inadequacy of their health “insurance” plan—even a plan that they think “works OK”—and they’ll be less focused on nebulous fears of their plan being “taken away” in favor of one that does a better job of really protecting them.
Yes, the problem is systemic, but insurance companies are the proximate cause of the systemic ills. That should be the takeaway from what I described: that the health care system is structured the way it is because it has to be in order for private businesses to provide health care coverage as a business under the insurance model, which, as I have frequently said, is fundamentally the wrong model for health care so it’s broken right from the get-go. The big cost drivers simply do not exist in public UHC systems. When I receive health care services under single payer, my financial responsibility begins and ends when I present my health card. That’s the end of it. There are no forms, no claims processing in the conventional insurance sense, no arguments, no denials, no chasing after insurance companies for payment, and from my POV there are no claims at all and no money is exchanged. The doctor or institution just needs to know what account number to bill, and is assured of full payment. It’s absurdly simple.
To be sure, the US health care system is large and very complex and many specific causes for high costs can be identified, but ultimately they can all be broadly categorized in the manner I described: the high administrative costs of processing claims (and, from the medical provider’s point of view, high costs of collecting payments and of non-payments), and the absence of any meaningful cost controls – all ultimately ascribable to the way private insurance has to operate.
I don’t have the time or patience to re-litigate this whole issue again and, as you say, it’s rather a hijack from the main topic anyway.
That’s exactly what wolfpup says in the very post you replied to:
OK, fair enough. wolfpup, sorry if I was haranguing you. :o
Do you also have a Medicare supplement? Otherwise I dont see how it’s better than most private insurance plans. Which also kind of segues into my broader question…
Namely, why is the word “Medicare” used is all these UHC proposals? I have Medicare myself, and while I’m satisfied with it, it only covers 80% of my health care costs, that remaining 20% is left to me to pay for out of pocket. Clearly, when the term “Medicare For All” is used, it’s not referring to any health care system which leaves the individual needing to pay 20% of their health care costs out of pocket. So what gives? “Medicare” is the term being used when Universal Health Care is what is being discussed. Why?
You seem conflicted about us muricans 
j/k
Walk into any Walmart and there are myriad examples that support the idea that people dont always know what is best for them. It’s not even necessarily a criticism of those people. Sometimes it can be truly difficult to figure out just what is the best choice to make and which ones are best avoided.
The predatory low-cost “insurance” plans that Chronos detailed in his excellent post upthread are a perfect example. I can understand how a person in the right life circumstances might rationally determine that a very low cost health plan, but one that did still cover some basics, would be the perfect fit. And, if what they bought actually was what they believed it was, they most likely would have indeed made the best selection for themselves. But thats the problem, for many of these people, what they thought they were getting was a cheap, no frills health care policy. What they got was a big fat nuttin. Denied, rejected, unapproved, whatever. They bought garbage.
You think we would be the guinea pig?? Well, if so, we’d be the last guinea pig to join the rodentfest.
Kimstu, as superior at communicating than me as normal. 
It would seem to me just flat out telling people they are wrong and feeling no compunction with being smug about the issue, would be counterproductive to reaching your ostensible goals of seeing UHC become a reality here (yes i know you dont live in U.S. but you obviously have an interest in its state of affairs).
This. Perfectly stated.
I was all primed and ready to respond until i read wolfpup say just what i was going to say, only in a way infinitely more erudite and eloquent than what i would have offered up. I agree with his bottom line tho, insurance companies are the reason why medical establishments charge exorbitant prices. Those aren’t prices charged to the patient (well, they aren’t set up to be anyway and typically arent), they are prices charged to a large corporate entity that feels absolutely no pain or suffering, pretty much no matter what they are charged. They just spread those costs out across the millions of their customers in the form of higher premiums. But since the cost is so diffuse among such a large number of premium payers, the “hit” felt by the consumer doesnt stand out as anything other than the reality of what having insurance means.
For example, i have a cushion that i sit on when in my wheelchair. I have an extremely skinny butt and legs, so its a cushion specifically intended to prevent pressure sores (I’d never get a typical pressure sore but thats a different thread). The cushion alone, not including the casing it is housed in, “costs” $650. For a motherfucking cushion. I should be getting top of the line Shiatsu ass massages every time i sit down for that kind of value. The casing for the damn thing is another $100!
But I dont pay for it. My insurance gets billed. They dont give a flying fuck. Heck, it probably behooves them in some way to pay more for things worth much less. It opens the floodgates for gouging the consumer in small, repetitious, untraceable to its source (these overinflated bills of others) ways.
So thanks all you nameless, inadvertent Good Samaritans. You dont know it, but your private insurance helped pay for my ass being comfy when i sit all day errday in my wheelchair. And don’t get me started on my useless standing chair that “cost” $13,000. Thats a lot of money for anyone, insurance company or not, to pay for yet another thing for me to accumulate random crap on. And once again, wolfpup says it so much better.
I would guess that a bigger percentage of the expense of our system is attributable to reason #2. But that’s a guess based mostly on personal anecdote.
I agree that there are ways to get UHC with private insurance, and that many countries have perfectly serviceable systems with private options.
I question whether there are ways to get UHC while keeping private insurance as it works today, where the vast majority is unilaterally assigned (or removed) by one’s boss and paid for with otherwise-worthless company scrip. Any real UHC system with private options would seem to require a conversion of that scrip to cash. But if you do that that, you’re “taking away” half the country’s insurance because employers will just remove themselves from the picture entirely, which is a perfectly good thing but it would be extremely disruptive, and the disruption is what will cause the controversy.
I really, really feel like I’m beating my head against a wall.
Health care coverage in the US does NOT “work OK for most people”. It’s terrible. The actual care is fine - once you access it. What you have to go through to GET it should be criminal.
It “works OK” because most people are healthy. Some might need something long term for high blood pressure or high cholesterol or mild anxiety, but those are cheap to treat and if you have to skip the meds for a week or three due to loss of job/changing medical plan/whatever it’s not going to kill you.
But as all too many people find out, if you have something MAJOR you are screwed. US health insurance is inadequate for cancer, large burns, major trauma… as someone else pointed out, Go Fund Me is full of people with insurance financially broken by out-of-pocket costs. If you’re too sick to work you lose your access to the system.
That is NOT “working OK”. That is horribly cruel, stupid, and broken.
Let me illustrate how US health “coverage” has nothing to do with helping people, and hasn’t for decades.
In the late 1990’s I went to work for a Very Large Health Insurance Company in their long term disability administration area. LTD is an area health insurance companies don’t really like, because it involves paying out money every month for as long as someone lives. Some genius, with an idea the bean-counters loved because the aim was to reduce the caseload and costs, decided to make continuing to receive LTD long-term contingent on all of these people having “90 day plans” for rehabilitation and a road map for how they were all going to get well, go back to work, and no longer cost the VLHIC money.
One letter from a physician stands out in my memory. It was about a blind woman. The doctor was pretty furious, because the VLHIC demanded to know the 90 day plan for restoring her sight and getting her back to work. The doc was pissed because, as he pointed out her eyes had been removed for medical reason. She no longer had eyes. At all. And therefore it was IMPOSSIBLE to restore her sight by any means, the question was stupid and ridiculous, and even cruel. Yet there was paperwork in place to end this woman’s disability check due to failure to comply with a plan for rehabilitation. Which was impossible. It wound up in court, which I’m sure cost the VLHIC more than continuing to issue the woman’s disability checks without the stupid drama.
Because it’s NOT about helping people. It’s about making money. The health insurance companies only make money when they’re “covering” healthy people. If you’re sick they’ll look for any possible way to drop you, or to avoid paying because that’s how they stay in business.
All of you people who think you have “good” coverage, who “like” your current plan - you’re fooling yourselves. You have SHIT coverage compared to most of the rest of the world. We really, really do have terribly ACCESS to the good healthcare that exists in this country. The only reason you don’t know that is because you’ve never had a big health crisis/injury.
No, the average American DOES NOT “know what’s best” in this situation. The average American has been lied to for decades, misled, propagandized, and told black is white. And the average American will never know until it’s too late.
Jesus fuck-mothering christ. That’s obscene. 
Thanks for sharing, and I cannot cosign that last paragraph hard enough. American health care is a disgraceful joke.
Thank you for you anecdotal evidence. Now, let me offer some different anecdotes. I have family members with type 1 diabetes and seizures. We have private insurance through my employer, and we’ve been managing these conditions for years. I have no problems with access to a doctor. The co-pays have been reasonable. I’ve been able to see specialists no problem, and meds have been reasonable. We’re probably a high-cost family. We have had to do a lot of tests over the years. But unlike what is often discussed around here, I’ve had no issues that would cause me to complain.
People in the US who complain about private insurance often tend to ignore the polling around it. And those of us who like our private insurance are not just a bunch of ignorant rubes. We have our own experiences which count just as much as your experiences.
Related to your employement with an LTD company: I would note that LTD is a different type of insurance from basic medical. I’m aware that some LTD companies play games, and it’s disgusting. But it’s not the same as a blue-cross/blue-shield plan, etc. Many of those blues plans, BTW, are non-profits. When people get angry about profit-seeking health insurers, they’re often ignoring the many non-profits that operate in this space.
Yes, that is a lot of people. Some can’t afford it. Some think they’re invincible and don’t need it. Some don’t know they can qualify for it. Some are illegal immigrants.
I think however that we need to remember that there are multiple ways to achieve UHC. Some of them are single-payer. Others are not. They have all been demonstrated world-wide. The US can achieve UHC without doing away with private insurance, and these 28 million people would be covered. The issue isn’t something structural with private insurance (as has been proven in other countries). The issue is politics, and particularly the Republican party.
A few comments. Yes, I also support something that builds on our current system. The ACA was actually structured well, and it’s survived incredible attacks by Trump. It’s too light on subsidies, though. We need stronger subsidies in the exchanges, and we need to reinstate a mandate penalty. If we did all this, more people would come into the exchanges and prices would come down, as it would be a healthier group. Also, it would make it easier for someone who lost their job, as a subsidized policy on the exchange would be available to more people.
As for Singapore, I agree they didn’t want the US system. But they didn’t mind keeping Private Insurance either. They achieved their own version of UHC without going to single-payer.
[quote=“survinga, post:73, topic:840357”]
Thank you for you anecdotal evidence. Now, let me offer some different anecdotes. I have family members with type 1 diabetes and seizures. We have private insurance through my employer, and we’ve been managing these conditions for years. I have no problems with access to a doctor. The co-pays have been reasonable. I’ve been able to see specialists no problem, and meds have been reasonable. We’re probably a high-cost family. We have had to do a lot of tests over the years. But unlike what is often discussed around here, I’ve had no issues that would cause me to complain./QUOTE]
"My Brother Has Cancer, Has Been Fired. Advice?"
Just what i saw on my way back to this thread. I thought this was the appropriate post to plunk it down in, for some reason. (Altho i didnt actually look at the thread itself, im just commenting on the title and timing). 
Whats the surety that this couldnt be you?
Or have a look at my earlier post about Maggie the Ocelot. “Insurance through your employer” is great until you get really ill and either your employer decides you are too much of a drain on the insurance pool to keep around or you simply get too sick to do your job anymore. Ice is never too thin to skate on, until suddenly it is.
And the flip side is that a lot of people who already have health care are going to balk at the cost of building out and providing health care infrastructure in underserved parts of the country; that’s a big piece of this pie nobody’s really talking about. What’s the maximum distance someone is expected to travel in order to avail themselves of universal health care? What about the elderly in small towns who can’t just hop in a car and travel 30 miles? Are we going to require/provide health care providers to go to them?
There’s a lot of downstream consequences people haven’t really thought out about this yet- and a lot of it is somewhat unique to the US- somewhere like a European country rarely has to deal with the sort of wide-open spaces that the US has west of the Mississippi.
I’m not at all against universal healthcare, but I do think it needs to be approached from a rational and pragmatic perspective, not a frantic bunch of appeals to emotion and sympathy.
If we fight this issue in bits and pieces we’ll be another 50 years before we catch up with the rest of the industrialized world.
I’m afraid you’ve fallen for one of the biggest myths in the health care biz. I read a fantastic in-depth study some years ago about the profitability of non-profits and wish I could put my paws on it again. Basically the misunderstanding arises from the notion that being non-profit means they can’t make any profits. Not true. In reality, it’s merely a tax status designation. Non-profits make profits, and they pass them along as reinvestment in the organization, massive payouts to executives and shareholders. As someone in the article noted, “There’s nothing more profitable than a non-profit hospital.”
Here’s a recent article that explain the situation, though not as well as that original one did: Non-profit Hospitals Can Be Extremely Profitable (American Council of Science and Health).
You might want to double-check on the non-profit status of Blue Cross Blue Shield. Most of that conglomerate hasn’t been “non-profit” for years. (Wikipedia)
We agree the ACA was structured well and that it has survived incredible attacks by Trump. I’d go further: It survived despite having been implemented in a way not even close to how Obama envisioned it. Between the way health insurance companies whittled away the public option – central to its ultimate success – and the original failure of red states to accept the Medicaid expansion, plus the 63+ (I forget the actual number) efforts by Congressional Republicans to overturn it, the ACA remains standing. Barely.
I’d like to see the ACA fully implemented and agree it’s a preferable approach to another major overhaul of our health care system – even though I believe Medicare for all is the better system. I think we can merge the 2 ideas, but gradually. And I agree there is a role for private health insurance if they want it. It certainly works in other countries.