Taking a slightly different tack than some in the thread…
Right!
In order for Universal Health Care to be a success, we have to cut a LOT of people out of the industry.
This is also known as “improving efficiency”, something that started to happen in earnest during a little thing I like to call “The Industrial Revolution”, and created the robust world economy we enjoy today.
It is not a thing to be avoided, it is a thing to be embraced, a proposition that economically minded people should be champing at the bit to dig into. It’s a chance to take an industry that consumes 18% of our GDP and turn it into an equivalently effective industry that consumes 12% of our GDP. That’s freeing up 6% of our GDP to do something else. Something fun, something awesome. Today, that 6% goes to administering an suboptimal healthcare system, yay.
I think a lot of the resistance to universal health care is the idea that the middle class is footing the bill for that roughly 30% of the population that “don’t pull their load”, and who also are more prone to doing unhealthy stuff like smoke, be obese, drink too much, get STIs, etc…
Combine that with a lot of muddling-together of socio-economic status and race, and you get a pretty powerful us-vs-them mentality. From the standpoint of a white middle-class family, it looks like the people at the bottom end of the socioeconomic ladder will be both disproportionate consumers of universal health care, as well as not paying their proportional share. In other words, they’re going to use more and pay less versus their peers. And it doesn’t help that in a lot of cases, the people at the bottom of the socioeconomic ladder often don’t look or talk like they do either.
How do we bring the middle class around? I’d think that politicians would be good to find the cracks in the system that catch your working, middle-class white families and point out how UHC will benefit them in those cases- having their elderly retiree parents treated, for example.
The government provides the infrastructure for cars, namely the roads. And the government provides the regulatory system that ensures the food is safe.
Similarly with UHC, it doesn’t automatically mean that the government provides the entire health care system. It provides the necessary funding and organization, to ensure people can access health care.
Crosswalks? Crosswalks?! You mean like painted lines on the road? What are you, some kind of line-following commie robot?! “Beep-boop-I-am-a-slave-to-convention, beep-boop-I-only-go-where-the-collective-tells-me, beep-boop…”
Middle-class buy-in is the key to acceptance of the welfare state in western Europe. To take how that buy-in worked in my country:
The medical care that your doctor thinks that you need will be available to you and your family. The only restrictions on your doctor’s clinical judgement relate to treatments that are not safe, or not cost-effective across the whole population. So no-one is going to second-guess your doctor and present you with an unexpected bill.
Your care does not depend upon your employer’s insurance policy, and is entirely between you and your doctor. You will be covered in exactly the same way, whether or not you change jobs.
The cost to a taxpayer will probably be less than paying by private insurance premiums. Everyone will be paying according to their means, through their taxes. But what is spent on the system as a whole will be decided by your elected representatives.
(And anyone will be free to take out private insurance and/or pay for private treatment if they wish).
I think you are reading this to mean that the “true” cost of tuition is $36K, that out-of-staters pay the true cost, and that in-staters are subsidized to the tune of $25K. This is false.
The actual cost is probably closer to $14-15K per student, of which the taxpayer actually subsidizes something on the order to 20-40%. Out-of-state and especially international students are profit centers; they in effect help to subsidize the in-state students because they pay vastly higher rates.
I’m under the impression that sometime in the late 1940s-early 1950s (or even before), most western European countries went the UHC route in some way, while the US went the private health insurance route.
If that’s actually true, that’s something that might explain the seemingly outsized resistance in the US- the European countries weren’t overturning an existing system, but basically building one from scratch.
To the consumer, it’s a combination of “the devil you know” and some fairly deep skepticism of claims that a government-run program will be cheaper overall than what they currently have. The thing that seems to be forgotten is that for the vast majority of people, the vast majority of the time, the system works adequately. Adequately enough anyway, that people are hesitant to up-end the apple cart.
Where it falls down for most is one or a combination of a handful of situations- long-term job loss, particularly shitty coverage, or chronic disease. But again, most people aren’t unemployed long-term, have terrible coverage, or are chronically ill, so it seems sort of academic for a great many people. And many that are (not all) are covered by Medicare as senior citizens anyway.
So if you were to look at someone like me, but more conservative/skeptical, you’d basically have to prove the following to get this hypothetical me on board:
[ol]
[li]It will definitely cost me less to insure my family overall.[/li][li]I won’t give up any standard of care relative to the present day.[/li][li]I won’t give up any standard of convenience (time, scheduling, location) relative to the present day.[/li][li]I won’t give up my current freedom of choice in terms of providers/facilities relative to today.[/li][/ol]
Most proposals concentrate on the uninsured/under-insured angle and chronic disease angles, and don’t put much effort into proving how a regular family without any of that is going to benefit. Which is strange, because most voters fall in that category.
Precisely, in order for healthcare to cost less millions of people will either have to be put out of work or paid significantly less.
What gives you confidence that our government will be able to accomplish this?
You don’t have to be long-term unemployed, however, to have to deal with changing your doctors and your prescriptions just because you changed jobs (never mind lost a job), or because your employer decided to change who they contracted with.
The notion that you HAVE this standard of convenience and freedom of choice right now is, for the overwhelming majority of “regular familes,” an illusion. It works well enough most of the time, but most of us get our coverage through our employer (or our spouse’s or parent’s employer), and that employer and their contracting health insurance provider is free to decide to change the coverage, change the drug formulary, drop St. Somebody’s Hospital from the network, etc. You get a divorce and you might need to change coverage, in turn changing your choice of providers; Dad goes on disability and the same thing can happen.
The goal of universal health coverage isn’t (and can’t be, in a resource-constrained world) to give everybody the perfect experience; it’s to give everybody adequate coverage, so that no matter the circumstances of your life and no matter the changes in those circumstances, you’ll still have adequate access to good providers. They may not be the most convenient providers (although in a universal environment, the majority of providers are going to accept the default coverage), but you won’t have the experience of going across state lines and discovering that everything is out-of-network.
It really depends on the Republicans. If they are actively sabotaging the effort, the way they actively sabotaged the ACA, it’s very possibly going to fail.
The ACA has managed to remain operational, and provide at least some measure of health care protection and cost control for Americans, despite being an overly complex neutered version of UHC, avoiding any active price controls, bereft of any level of management from the legislature, and subject to ongoing attacks by half the government to destroy the very underpinnings of it’s structure.
If the large majority of our government works toward a successful rollout of UHC, it’ll work just fine. Many of the people being put out of work are private employees to begin with. The efficiencies can be gained in places like private hospitals, where today, 20 people can walk in with the same needs and walk out with 20 different bills, going to 20 different insurance companies, with 20 different co-pays, deductibles, and payment structures.
Perception is reality when we’re discussing people and who they may vote for based on policy positions. People think that they have this illusory choice and convenience, which means that people trying to pitch another system have to dispel the idea that they’re going to get less of each under a UHC system.
Sounds like you’re expecting to guilt people into voting for it apparently. That rarely works in actual real-world elections.
I mean, what you say is true and noble, but most people are satisfied with what they’ve currently got. So getting them to vote for something that may potentially offer less service (as they perceive it) for potentially more cost (if the increase in taxes outweighs their current premiums), and potentially less convenience is an extremely hard sell.
What I’m saying is that the politicians advocating UHC are hawking the wrong aspects of it to the public. In general, the average voter probably is most interested in how it’s going to impact his wallet, how it’s going to affect his ability to go to the doctors he wants, when he wants, and whether or not he’ll get the same level of care he currently does. Anything about un/underinsured people, under served communities, or the like is probably way outside the realm of stuff he’s going to care about, when someone says this may affect those things I mentioned above.
So the politicians need to really amp it up on the aspects that would positively affect the average American who is insured through their employer and has what they consider adequate coverage. Maybe point out the continuous aspects- no COBRA, not tied to employment. Maybe point out that drug costs would probably go down. Maybe point out that you’d have no balance billing or out-of-network woes, etc… All things that would affect that average voter, while stuff about being uninsured and having to go to the free clinic might as well be science fiction to them.
Can you name even one country that has been able to reduce its healthcare spending by 33%?
Shouldn’t be hard since rest of the modern world apparently has this ability. Maybe they just haven’t done it yet and are waiting for the right time.
It seems to me that if we wanted to reduce health care costs, we’d outlaw insurance companies completely. End of story. Cash for services. Then you eliminate a lot of horrible incentives that drive costs up for people who pay (while, admittedly, making people who don’t pay, pay).
Another example would be if something grows at a pace of 3.03% like the US healthcare per capita spending and you reduce that to the OECD average of 2.68%, then you would have a 33% difference in about 110 years. So it is possible that our grandchildren or great grand children will live to see it.
Is your goal cost-cutting, or having a healthier and more productive nation? To cut costs, stop paying for medical services. Let folks buy their own funerals. For a healthier nation:
Establish Medicare For All, with premiums paying for basic healthcare at institutionally negotiated rates.
Private insurers should sell supplemental coverage to those wanting and affording anything more.
The current USA mix of private and public coverages drives huge overhead, a big factor in high costs here. I read somewhere that Duke University hospital, with 900 beds, has 1300 clerks working on compliance with every requirement. That’s nuts. And private medical insurers still net nice profits, shoveled into pockets of shareholders and executives.
Cutting healthcare will lead to a sicker, weaker nation. Whose interests are served?