What I don’t think the OP completely understands is that any plan offered by the Democrats is going to be an improvement over what Republicans will offer – which is to simply overturn the ACA and replace it with… nothing.
No more controls on profits. No more protection for preexisting conditions. Back to crap plans offered by insurance companies that basically cover nothing. Employers will struggle even harder to offer good plans for their employees, and god help sole proprietors or unemployed folks who don’t have access to insurance through a group plan.
Here (Vox) and here (Arizona Public Health Association) are a couple good articles that explain it.
Ruling expected from the 5th Circuit just about any day.
QFT, and well said, along with several other excellent recent posts.
Maybe a good way to articulate the fundamental problem with the original post is the following. If a politician in my province proposed a plan to nationalize car insurance, as at least two Canadian provinces have done, I’d be against it and he’d lose my vote. I like my car insurance company and because of my record, they like me. We get along fine and I would hate to lose that relationship, and I think it’s also important to have a choice among competitive insurers. There are differences in how fairly and efficiently claims are adjudicated, how claims affect your record and your premiums, how they evaluate damage and assess write-offs, there are differences in rates, differences in accident forgiveness etc. IOW, it’s insurance, and the many specific policy details vary quite a lot, and I like the one I have.
All of which sounds just like the OP’s logic, except it fails in the case of health care because the OP has the same misunderstanding about health care coverage that most Americans do: they have been misled by the uniquely American health care experience and by industry propagandizing into believing that health care coverage is insurance just like any other insurance, and it fundamentally is not. Conventional insurance through private companies is absolutely the wrong tool for funding health care, like trying to hammer a nail with the handle of a screwdriver. In the single payer system that I know best, the one in Ontario under the terms of the Canada Health Act, the notion of choice in a competitive health insurance market is both non-existent and unnecessary. The “terms of coverage” can be stated in one sentence: all provinces receiving federal money for health care must run a system that covers all medically necessary procedures that are normally performed by doctors and hospitals, without condition or limitations and without cost to the patient. This is the only moral and ethical way to manage human health care, because the alternative is to let people suffer and die because they can’t afford essential medical care.
And given that one-sentence description which basically says if you need medical care you will get it, and it will be provided at no cost by any physician or any hospital that you choose, what possible choices could you need to make? That’s why it’s not “insurance”, but more like a public service that pays for health care, which itself mostly remains in the private sector. So if the OP continues to have access to all of his existing health care providers, with the only difference being that the government pays the bills, what is it that Warren’s or Sanders’ proposal is “taking away”? What they’re taking away is literally a useless bureaucratic middleman.
Most people don’t understand macro-systems. But they do know their own situation. For instance, I know that I’m doing very well with my health insurance here in the USA. I’m aware that about 8% of this country doesn’t have health insurance, and that’s a problem. But 92% does have coverage and most are doing quite well. So, when we talk about overhauling a macro-system, we need be cognizant of the fact that essentially 3 out of 4 people like what they themselves have. That’s one of - not the only - but one of the reasons I like the incrementalist approach: Build on the ACA, don’t throw out private insurance…
We can achieve UHC without throwing away what we already have. Some Dem candidates understand that. Some appear not to understand that.
I agree with you about Republicans and Democrats and how much their lies hurt them. Dem voters hold their politicians to a higher standard. But what I fear is that a jihad against private insurance will alienate independents and people who are persuadable.
I would hazard a guess that you don’t really know how well you’re doing with your health insurance until you really need it. You think you know, you have peace of mind, maybe, but you don’t really know what your insurance company will pay for until you’re confronted with an immediate health crisis that is both urgent and expensive. The urgency of the situation will lead to you making decisions of profound economic consequence without consideration of those consequences because you’ll prioritize the urgency as it relates to your health. It’ll only be after you’ve recovered - assuming you have - that you’ll find out that the ambulance ride and the anesthetist were actually provided by out of network carriers, thereby leaving you stuck with a massive bill.
I’ve heard people say “Oh no, that won’t be me because I’ve read my policy and I already know which ambulance I’ll use, which hospital I’ll go to, which doctor I’ll use, which services I’ll select while I’m in the ER.” I’m like, come the fuck on! Wake up, Americans! Because there’s no guarantee you’ll even be conscious or in a cognitive state that would enable you to intelligently make such decisions, and b)…you shouldn’t fucking have to worry about it in the first place! Isn’t that why you GET insurance ?! Nobody in New Zealand, Canada, the UK, Australia, or the EU has to worry about making these kinds of economic decisions during a health crisis. It’s utterly absurd.
Wow, I’m jealous. I haven’t had a choice of health insurers in decades. I get what my employer decided I can get.
And even if health insurance were the only aspect of a job I cared about (and of course it’s not) there isn’t any real way to shop for a job with better insurance, because they don’t give you the full details of the policy when they offer you a job. If you’re lucky they may tell you which insurer they have negotiated a plan with, but that’s about it.
That being said, I think you would be foolish to vote against a candidate because they promise to eliminate private health insurance in the US, because the odds of any candidate doing that are pretty close to zero.
I’m pro-choice, but I don’t care what my governor’s position is, because my state is not going to outlaw abortion whatever he thinks. I DO care what his position is on the death penalty, where my state legislature is mixed, and the governor could have a large impact.
So, I think you should focus your voting decision on things the possible candidates might actually accomplish. not their pie-in-the-sky promises.
There are about 50 countries that have already tried this experiment. And all of them have lower costs and most of them offer better care by most metrics.
I understand where you’re coming from, but I have to quibble with you a bit, in your description of how car insurance works in Sask. Yes, we have government-mandated car insurance from SGI ("Saskatchewan Government Insurance "). Everyone has to get their basic coverage from SGI.
But that’s just the basic “plate package”, to ensure everyone has the statutory minimum coverage, no funny exclusions or conditions. If you want more coverage than the stat minimum, there’s nothing stopping you as consumer from shopping around getting more coverage from a different insurance company. SGI offers extended coverage as well.
And that’s just what I did: sat down with my independent broker and reviewed the options available to me for added coverage.
And that type of model might work for UHC in the US. If I’ve understood correctly from posters from Australia and New Zealand, i think that sounds sort of like their UHC system.
There aren’t still major diffs between car insurance and health insurance, though. Car insurance is simpler than health insurance. As a consumer, I understand the coverage issues for car insurance better than health insurance. ANd there’s rarely that crisis situation that arises with health care. But still, a basic state package with individual private add-ons could offer a way to UHC. Doesn’t have to be single payer monopoly, so long as the basic package is truly comprehensive.
General agreement here. I think it’s best to consider health care as public service, not an insurance commodity.
Thank you for your concern about whether we Americans are awake or not. I’ve had to use the ER a few times, as well as an ambulance once. No big deal from a cost standpoint, as insurance picked up almost all the cost. I also know people who have the same insurance I have, and who’ve had cancer. They had some out-of-pocket costs, but they were not much.
One thing to keep in mind here is that the ACA has put alot of regs on insurance even that’s not on the exchanges. So, we don’t have as many horror stories as what you’re used to hearing about…Main problem is uninsured. That’s the main item we need to tackle, not all this concern about people like me who have very good insurance and don’t want to lose it.
Even your “very good health insurance” is light-years worse than what Bernie is pitching, which is a sort-of-Canadian Medicaid-for-everybody system.
Remember that Bernie come out of Vermont, which borders Quebec, which has one of the more generous provincial forms of Canadian “socialised medicine.” He has constituents who know what’s possible because it’s right across the border.
Tell me, how much out of pocket would you be if you rang up a million dollar medical bill? Can you handle $200,000?
Most people are quite healthy most of the time, which is why they can be happy even with shitty insurance coverage. For the most part, they aren’t using it, or only a very tiny bit of it.
That’s the problem - people don’t realize how vulnerable they are until it’s too late. And then, well, it’s too late.
You, like almost everyone who is happy with their insurance, are not seriously ill. When you question the seriously ill about their insurance, you get a vastly different picture (PDF). In a recent study of those with serious illnesses, and despite 90% being insured, 53% of the respondents experienced “one or more dire financial consequences related to their care.” 37% reported using up all or most of their savings for medical issues.
Thank you for this, DMC. I’ve seen the stat that most Americans are happy with their insurance and have wondered if that stat includes people who have had a serious health issue. This report suggests it does not.
Something that is quite telling. In these discussions, its always Americans who worry about not having healthcare, not being covered or losing their healthcare.
You never see a European, or Japanese or Canadian worry about not being covered, or losing healthcare. Its medieval, like fear of goblins. I think this is why its easy for those of us not from the USA to assign dishonest motives to Americans who are simply afraid of losing the care they and their families have. Its a very alien mindset, where that is actually a real worry.
Really good summary DMC, I’d recommend everyone read it and pay particular attention to the appendices. The two points you highlight above are the ones that jumped out to me as well and strike me as frankly disgraceful in a first-world nation.
Another beauty is that 23% of the seriously ill were
I actually do have good insurance. Over the past year (cancer) my credit rating took a hit because, although I could afford my part of the bills, the sheer volume I was receiving per week became difficult to manage. These were all for copays, usually $30 or less, but it was very easy to miss some here or there.
Here’s a good example from just this morning of what the OP isn’t seeing, and what many of us are talking about, by CBS News.
Man has severe back pain>goes to doctor>doctor says go to hospital immediately> hospital doctors confirm first doctor’s diagnosis, say he needs surgery right now or he can end up paralyzed>man has surgery>insurance company says the surgery wasn’t medically necessary and they won’t cover it>man gets $650,000 in medical bills.
Sounds like in that case the insurance company should be forced to cough up and if they feel so badly wronged they should take the two doctors to court. Certainly doesn’t seem like the patient is culpable at all.
(ridiculous that it is even a matter of debate of course).
There’s almost certainly a review process for that kind of thing; it’s hard to believe that the insurance company is claiming lack of medical necessity/emergency and having it just stick like that. He should be able to request a third party utilization review if one hasn’t already been done, and if it was there should be a pretty clear indication of WHY it wasn’t medically necessary, complete with the diagnosis and treatment listed, and the guidelines for the typical treatment of that sort of condition. They also should have probably reached out to the original treating provider for their rationale- maybe there was some confounding factor that wasn’t entirely clear from the case documentation.
At that point, he needs to go back to the ER doctors and sue them for negligence or malpractice if they diverged from the accepted treatment guidelines. One way or another, either the ER docs or the insurance company reviewer fucked up, and he needs to get that straightened out.