Sure. That’s cool that you had a good experience with your HDHP/HSA plan. What I’m advocating would be simply for the government to pay the premiums for such a plan, as well as contributing some amount (maybe matching?) to the HSA.
Here’s a plan similar to what I’ve been proposing, from Ed Dolan, who is definitely more credentialed than the undergraduate economics major referenced upthread (Dolan has a Ph.D. in economics from Yale University). He calls it UCC, for Universal Catastrophic Coverage:
I would also jack up taxes on the rich, but not on the middle class.
Most people don’t realize how awful the U.S. health system is because they have no experience of a better system, of UHC that’s free at the point of service. When I first came to the U.S. (as a young adult, having grown up in the U.K.), I did not know what any of these things mean:
pre-existing condition
deductible (as applied to healthcare)
co-pay
co-insurance
That’s not because we have different words for these things in the U.K., like cookie vs biscuit. It’s because the concepts don’t exist.
I think very few people in the U.S. can imagine a healthcare system where you need healthcare, and the first thing you think about is not anxiety over money. Under the U.S. system, physical illness is immediately exacerbated by mental anguish: am I covered, how much is this going to cost me, what kind of limitations will my insurance company impose? It’s quite reasonable to speculate that a major contributor to the worse outcomes shown in the statistics above may be the level of stress involved in obtaining reasonable healthcare in the U.S., even when you have good insurance.
And most people in the U.S. don’t focus on the huge cost of their healthcare because they never see the money in the top line of their paycheck. It disappears, paid out directly by their employer before it hits their paycheck. But it’s still a very real and very large tax tax burden that is coming out of their paycheck, just as surely as if it were income tax.
Anyone who thinks they are getting good healthcare for their money in the U.S. healthcare system is great is simply objectively wrong. Look at the statistics above. And a major element not reflected in those statistics is the drag on the economy and the constraint on personal life choices when health insurance is provided through the employer - for some people, it’s a major constraint on what jobs they can consider, and may rule out self-employment or entrepreneurial ventures.
If U.S. public opinion is that “we have great healthcare, we like it”, then U.S. public opinion is wrong. Those statistics don’t lie. It just underlines how much work we have to do to overturn decades of propaganda by vested interests, to educate the U.S. public about how awful the system is here, and about how their government is failing them.
You will never convince me that signing up for Canada’s system and its extreme wait times would be a benefit to my family, personally, given that her teachers union has negotiated an excellent pan as part of their contract with the school system. It would of course be a net, utilitarian benefit to society overall, but that is not how I live my life and not how most people do.
I had the opposite experience - I moved from the States to Australia, where UHC is called Medicare. I’ll call it Medicare AU to avoid confusion. I moved when I was in my late 30s. Medicare AU covers medical care, but not dental or optical. I imagine certain cosmetic and similar procedures are not covered, but I’ve never looked it up, and I don’t have the cultural osmosis to know offhand.
You just cannot imagine how much easier everything is. A few weeks ago, I noticed a feeling of a not-quite empty bladder when urinating, like maybe some sort of blockage. I’ve reached that age where the prostate may be a problem, so I made an appointment with my doctor (whom I’d picked), and got in when it was convenient for me, a few days later. We talked for a bit, and he prescribed some antibiotics ‘just in case’ and an ultrasound at the local hospital.
The appointment cost me nothing. The pills cost me nothing. The ultrasound cost me nothing. All I needed to do was take the doctor’s order, schedule the ultrasound, and turn up.
What does Medicare AU cost me?
Well, let’s see. My income tax is slightly higher than it would be in the States. I’ve worked it out. 10.6% higher. But income tax is the only tax I have*, and no other fees. I’m not paying SS or Medicare tax on top of that. I’m not paying copays or deductibles. I’m not having insurance payments taken out of my paycheck, and I’m not paying any private insurance premiums. All in all, I’m paying less, for health care that is at least as good in theory, and much better in practice. I don’t have to triage myself, wondering if I can afford the deductible.
I know I’m covered. And that’s a load off my mind.
Anyone who says the US system is better is either uneducated, or profiting off the current system and/or indifferent to the problems that system causes the nation as a whole.
*Well, there’s GST - sales tax - of 10% nationwide. Even that’s easier than the mishmash of sales taxes in the States. The price on the shelf is what you pay, no calculations necessary to find the final cost.
Well, bully for you. Anecdotes are evidence, right? You’d better hope she never wants to take a different job, or start her own business or retire early to write a novel. And you’d better hope she never divorces you. Personally, I would not want the quality of my healthcare to be contingent on my partner always remaining in a particular job.
Ultimately, this is what it always comes down to when you dig down through the deflecting bullshit with the likes of you and Shodan - you are denying the statistics and the evidence.
You deny the statistics that show that U.S. healthcare is objectively dramatically worse than all other developed countries, costing twice as much for worse outcomes.
You claim that it’s impossible to implement effective UHC funded out of general taxation, a model that for very obvious reasons is vastly superior the U.S. private insurance model, even when presented with the evidence that almost every other country in the world has done so.
Here’s a simplified tax calculator for Australia, if you want to do your own comparison.
Couple notes:
*Remember to convert to and from AUD - as of 31 December 2018, the rate was 1 AUD = .7058 USD per the Reserve Bank of Aus
*Australia doesn’t have filing statuses - it’s all individual.
I suspect, if you account for insurance premiums you’re paying or having deducted from your pay, many of you would come out better in Australia, or not very much worse off, in exchange for a much simpler system that is not tied to your employment.
According to health care statistics in the report I linked earlier, 33% of Americans who sought medical care experienced an access barrier because of cost. That is, 33% of Americans with a medical problem “did not fill/skipped prescription, did not visit doctor with medical problem, and/or did not get recommended care.”
So, many Americans are facing a wait time of “forever”, which may be slightly longer than the wait time they’ll face in Canada.
There’s the straw man again—certainly as regards my own views (I can’t speak for Shodan).
—I do not dispute that the U.S. healthcare system overall is worse than that of other developed countries in most ways. OVERALL. What I dispute is that middle class people who have jobs that provide good healthcare plans would be better off under a Canadian-style system, including its extreme wait times.
—I don’t say “it’s impossible to implement effective UHC funded out of general taxation”. I have in fact specifically advocated for a form of UHC (UCC) that would in fact be funded out of general taxation, although I would for political reasons want to confine it to taxation on the rich.
—Furthermore, if the political hurdles could be overcome, and there were not a revolt that scuttled the whole program, I don’t dispute that it would be possible economically to implement a single payer plan that would cover much more than I’m advocating. You could put every American on Medicaid, as long as you had the funding in place.
What I do dispute is that we would be able to do so while cutting costs. We would have to levy significantly higher taxes than other countries, because our health system is much more expensive than those other countries. Establishing a single payer would provide streamlining efficiencies on the bureaucratic side, but Obamacare already limits how much of health insurance premiums can be spent on overhead.
Even if single payer reduced that further, and I expect it would, it wouldn’t get the costs anywhere near as low as what those other countries pay. The only way to do that would be to pay doctors, hospitals, etc. much less, to clamp down on the number of tests and procedures performed, etc. And to do that suddenly would wreck the health system and wreck the U.S. economy.
To look at all these other countries and say “but they did it!” is simply throwing an ignorant tantrum. It’s like you live on a plot of land where your neighbors all planted hardwood trees 50-100 years ago, and now they are making handsome profits from the harvested lumber. You want those same kinds of profits, so you jump up and down and insist “they did it, so we can do it too!” When people tell you that if you wanted hardwood in 2018, you should have planted the trees in the mid-twentieth century, you just won’t listen.
Again, from a utilitarian perspective it would be better for the 67% to deal with longer wait times for treatment so the 33% can shorten theirs from “forever”. But in a democracy, 67% is still quite a bit larger than 33%, not to mention that voter turnout is much higher among that 67%, multiplying their electoral advantage even further. (I’d be shocked if the 33% made up more than 20% of the electorate.)
…I said “it’s impossible to implement effective UHC funded out of general taxation”? Oh wait, no: that’s what you claimed I said, but what you quoted didn’t say that at all—only that if we do so, it’s not going to involve spending less in total than we do now.
Ok, then I apologize for the lack of precision in spelling out your idiocy. Let me try to do better:
Almost every other developed country in the world in the world has implemented some form of UHC funded out of general taxation; with healthcare costs 50% lower than the U.S. and better outcomes.
Yet you claim that it’s impossible for the U.S. to implement a similar system with any cost saving.
It’s not idiocy, but yes: you have mostly stopped strawmanning me for the nonce—except that you go too far with that word “any”, and especially in italicizing it. I did say that we could get some marginal savings from less bureaucracy and a streamlined administration. But the cost of the healthcare itself is not going to go down any time soon, not unless we want to massively disrupt it and the economy at the same time, and not in a good way.
I have great insurance too, I don’t think I’ve paid more than a couple hundred in total out of pocket costs for any type of medical expenses over the past 3 years, that’s including an emergency room visit followed up by in-patient surgery, and an expensive endoscopy. I recognize that I am incredibly fortunate that I’m so well covered by my company, but I understand that in other countries I wouldn’t be incredibly fortunate, because that’s what everyone gets. Well, they get the coverage, they don’t get the dozens of bills to sort through and dispute because I should get the in-network rate instead of the out-of-network rate for that doctor I don’t even remember seeing, or the “holy crap that test was 3x what I thought it was going to be and I just blew out most of my HSA on it!” They just get the coverage.
I’m reminded of the ads for St. Jude’s Children’s Hospital, a charitable hospital where they offer free care to children with cancer. One of the parents says “I cried when I learned I woudn’t have to pay”. And I always follow up to myself “just like every single parent in France”. American parents are weeping at their good fortune to get this amazing opportunity for care, that is only available to the few people who St. Judes can care for every year, and the 500 million Europeans who get it by paying half what we pay for health care.
You’re assuming that all the 67% were happy with the way things worked out, which is clearly wrong. And that the 67% don’t care at all about the 33%, which is also clearly wrong.
Exactly right. Those who would have us believe that an HSA-based plan will solve many of these problems seem to forget that it’s the individual’s money that’s primarily funding the HSA. It’s money, that instead of paying insurance premiums, is now in a savings account that can only be used for medical-related expenses, some of which might have been paid by a lower-deductible plan.
My company throws a LOT of money into my HSA, enough that it basically fully funds the in-network deductible, so my true out of pocket costs are very low. I can only get into real trouble if I go out of network, where a separate deductible applies.
They are exceptionally generous with these benefits, and I still don’t feel that it’s better overall than UHC would be. Not the least of which is the fact that it’s twice as expensive for my company to offer than UHC is in other countries.