Another problem with that is that in the eyes of a lot of people, anyone who’s needing that safety net is by definition a freeloader, and making healthcare universal isn’t going to prevent freeloaders, it’s going to enable a shitload more of them to freeload, including people who habitually make poor choices, illegal immigrants, etc…
Nobody freeloads in a UH system. That’s kind of the whole point isn’t it? Do we have freeloaders of the local library? Or of the Fire Department? We all pay taxes, we all get to use the systems funded by that. Where does freeloading enter in?
Can you tell me your dream Health system then? Is it what we have right now?
There are, doubtlessly, some people who would be freeloading in UHC. People traveling in from abroad who don’t have insurance. Illegal immigrants who haven’t paid into UHC. etc. etc.
That’s a semantic trick. The point is that if people are concerned about people getting something for nothing (or for very little) out of today’s healthcare system, they’re going to perceive UHC as enabling MORE of it, not less.
Given that undocumented immigrants pay more into Social Security than they get, and are often afraid to use government services, they’d probably be a net plus to UHC.
From AARP
No. Its the reality of universal healthcare, which is currently working quite well in a number of countries. Unless you think some people freeload off of the police, roadways, and military etc. We all pay, we all benefit from the service. To me it just seems like this is just this fear the right seems to be crippled by that someone somewhere is getting something for free so we all should suffer to make sure that person suffers too. What kind of future does a society that thinks like that have?
Is this the reality in countries with UH now? Have you got any statistics or anything to show this problem exists in any way that is detrimental to their healthcare systems?
I’m sorry but perception is not a cite, nor is it something we should use to craft the best policies for our country. Some people perceiving some possible negative possibilities seems like it would be enough to make sure nothing ever gets done for the rest of time on any issue if we use that standard.
When I need health care in Ontario, I have to pay, because I’m not part of their UHC. (Luckily my company pays for international insurance when we travel.)
You’re still not getting it. I’m not saying that they’re freeloaders.
What I’m saying is that there are a lot of people out there who perceive those who avail themselves of our existing safety net as freeloaders. You could say that those who use the public services disproportionately, both relative to the average AND relative to their income are considered “freeloaders” by a lot of people. Not pulling their own weight, and all that.
If you’re using that logic, then it’s easy to draw the conclusion that any attempt to broaden or deepen that safety net and entice more people to use that safety net in a disproportionate fashion would be encouraging freeloading.
“We all pay, we all use it” ignores the fact that something like 45% of the population effectively pays no income tax (not necessarily payroll tax). Are we to assume that somehow we’re going to increase the tax burden on those folks through higher income or payroll taxes, or is the assumption that we’re going to expect that other 55% to shoulder that load? I can totally see how if the second one is the expectation, that people in that 55% might see the other 45% as freeloading off their nickel.
Obviously the answer depends on whether you mean too much attention relative to its importance as a policy issue or too much attention relative to its importance as a political issue.
As a political issue, it makes sense for the Dems to focus on it because it wins votes.
As a policy issue, it is insane. Nothing that actually happens in the real world depends on internecine policy fights over which version of universal coverage to fight for. Obama and Clinton spent a ton of time on the fight over whether an individual mandate was a good idea. What happened? Obama won and adopted Clinton’s position, for reasons that had nothing to do with voter mobilization or anything that was the result of spending so much time talking about the issue. And healthcare is, at best, the third most important issue for the country–easily behind climate change and shoring up our democracy.
No, you aren’t getting it. What’s the difference between universal healthcare and universal police protection, or universal protection from the fire department, or universal access to roads or the library system? You keep ignoring this point, I would like it to be addressed somehow, or I’m wondering what the point of further discussion on this is.
As I said, perception is not something to craft our government policies over. Perception is imperfect and often wrong. Who do you think those 45% are? I would really like to know who these people are, in your mind. Here is a cite with some statistics:
"The vast majority of non-income taxpayers fall into three categories:
17 percent includes students, people with disabilities or illnesses, the long-term unemployed, and other people with very low taxable incomes. Also included would be people like our soldiers in foreign wars who are exempted from paying income taxes while they are on active duty in a war zone.
22 percent of people who did not pay federal income taxes in 2009 are people aged 65 or older who have modest incomes (and do not have earnings).
61 percent are working people who pay payroll taxes but are not paying income taxes."
Do you think these people should also not be able to use the police, or fire fighters, or roads, or library etc. also, or is this issue only with healthcare?
It’s the transition that’s the key- we already have had the other “universal” things for decades if not centuries. Right now, we have a private system and are talking about going to a public one. THAT is the difference- if someone isn’t paying now, they don’t get anything, and the proposed system basically is that some will not have to pay, but will get the same treatment as someone who did pay. Do you not see how that might torque people and be perceived as freeloading?
Obviously say… 50-100 years down the line after implementation, it won’t be seen that way, but in the period of transition- both before and after the actual implementation date, there will be issues like this.
Are you serious? We live in a democratic society- perception IS reality in a lot of political ways. It doesn’t matter how awesomely scientific and equitable and whatever a proposal really is. What matters is if you can convince the legislators and voters that it is a good idea (or not). And if it’s perceived as being bad, it’s not going to get implemented, regardless of its reality.
Access to health care and health care affordability aren’t given being too much attention, but Democrats are proposing pie-in-the-sky proposals that probably aren’t going to get much love outside their progressive base.
Short of switching to all-out single-payer, I think a better idea is to offer a two-pronged approach that expands a public option and makes it a competitive product while simultaneously regulating the private insurance market. I think strengthening ACA is the way to go, and perhaps one way to do that is to evaluate some of the more “gold standard” health insurance schemes in the country and require that others follow that standard, but also with certain stipulations in place. I think the following would be important points:
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Make it so that insurance companies can’t deny people coverage or claims for any reason.
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No more surprise “out-of-network” bills. Hospitals/care providers must have the responsibility of making sure that everyone in their system is in their network or hospitals eat the costs.
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Mandatory billing transparency with consumer information available before and after treatment.
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Price controls for drugs and services. I use the word “controls” loosely, but at minimum, there should be some sort of regulatory mechanism that discourages outrageously high pricing.
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Expansion of medicaid/medicare to make public options accessible and force private companies to become more competitive.
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Keep the Obamacare marketplace and offer more subsidies
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Maintain the ACA tax for those without insurance
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Insurance companies can vary with their deductibles according to their rates, but they have to agree to pay full cost beyond a certain amount.
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Federal financial assistance (low interest loans, repayment forbearance, tax breaks, etc) for those who can demonstrate financial problems and need.
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Loan forgiveness for medical doctors; incentives for medical practitioners who agree to work in under-served areas.
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Appropriations for medical care facilities in under-served areas.
Good Lord, man. bump isn’t saying people are freeloading. bump is saying that** other people perceive that there are freeloaders. **
I believe the moon landings really happened. I am aware, however, some people believe the moon landings were fake. You do see how those are different things?
This logic has been used to cry about every one of these programs before implementation. Medicare was vilified as the end of America before it was passed and now its immensely popular. Why can’t we learn from history on this stuff? It was wrong then, and its wrong now. I don’t think we should be held hostage by incorrect “perceptions” that a simple history lesson will dubunk. This is why we are falling behind a lot of other countries in a lot of ways. You are literally saying yes it will be fine down the road, but some people will have uncomfortable thoughts during implementation. What hasn’t that been true for? Your arguments here essentially would make it impossible to ever pass any bills or change anything in our society as long as someone, somewhere has a bad perception of it?
Yes I’m serious. What’s funny is that conservatives love to say that we are not a democracy but a republic when liberals point to the popularity of a proposal, but now all of a sudden we are a democracy and we need to listen to (certain parts of) the public opinion (only those with negative perceptions of course)? I guess our form of government depends on how conservatives feel about what is being discussed?
So the perception of many back then was that medicare would be the end of America and a certain path to socialism. Reagan had a famous speech where he posited that “We are going to spend our sunset years telling our children and our children’s children, what it once was like in America when men were free.”
That was wrong then. Obviously. What’s different now? It’s the exact same arguments and they are still wrong. It’s essentially yielding our future to those that are afraid of it and fear all change. We used to have ambition as a country, what happened to that America?
I understand him fine, thanks. But why should those people be the ones deciding our society’s path forward on healthcare? Their perceptions are wrong, they don’t perceive the police, fire dept, roads, libraries in this way, so history tells us this kind of thinking is wrong, but they can’t let it go. Do we let the moon landing fakers decide our space exploration policies? Do we let flat earthers be in charge of … well anything?
Because they vote. Full stop. That’s what you’re not getting- they vote, and they vote in representatives that either vote like they do, or listen to what they say. So their perception matters, regardless of how ignorant it may be. And there is no shortage of ignorant viewpoints among voters on either side of the aisle, that’s for sure.
Unless, you know, you’re proposing some sort of voting qualification. Because that worked real well the first time around.
Yes. I understand how voting works. I’m not sure why these constant accusations that I don’t “get” things are necessary. I think we’re talking about different things. You keep trying to explain democracy as if I don’t understand how elections work. I’m not arguing anything to do with how elections work. I’m asking why some voters can’t learn from history, and why some voters seem to keep falling for the same arguments that have been proven wrong over and over again. I’m lamenting this state of affairs.
I’m also saying that you can’t formulate a policy that 100% of the voters will approve of. Any program will have supporters and detractors. Having a standard that there must be nobody with negative perceptions before moving forward means nothing will ever move forward. It’s an impossible standard. Simply noting that there are voters out there that feel this way should not be a way to end a conversation. If UH ever passes, yes there will be a subset of the population that will be unhappy, but I’m saying that’s not a reason to give up the idea. If it was, then we’d have to give up pretty much every idea.
It’s not getting too much attention, partly because it’s an important issue in itself, and partly because it intersects with so many other policies.
Immigration - Trump said he’d love to see more immigration from countries like the ones in Scandinavia rather than shithole countries. One of the things that puts people off emigrating to the US is the lack of universal healthcare. This seems to have very reputable sources: https://www.inc.com/jessica-stillman/new-survey-expats-dont-want-to-come-to-america-any.html
From there:
Accessing affordable healthcare in particular seems to have potential migrants spooked. One-in-three respondents rated the U.S. as very bad when it comes to the issue, compared to a worldwide average of seven percent for this question. Only Nigeria has a more troubled healthcare system, according to expats.
If you have a long-term condition but can still work reliably in a skillset the US wants (IOW, you’re the kind of immigrant most countries want, but you have diabetes or lost a leg in a car crash), moving to the US is going to mean you paying very large extra premiums. Or if your partner or child does. Or you just don’t want to move to a country, go through the whole citizenship process, build a life, and then see it all whipped away from you if you get cancer.
The other main factor cited there is the work-life balance. And healthcare being primary provided by employers gives employers huge amounts of power over their employees.
So there’s another one - employment.
So that’s three major issues in one: healthcare, immigration and employment. There’s probably more.
Great post. I’d add one more issue: entrepreneurship. How many would-be business founders are discouraged from striking out on their own by the doubling or tripling of their health insurance costs that would occur when they leave their corporate jobs?
It’s not like people are setting their house on fire to get the benefit of free fire fighting or getting themselves murdered to get the benefit of free police service. And I doubt anybody would try to get cancer in order to enjoy the benefit of free health care.