I have the impression that what they mostly hate is helping people of a different color, although that might not explain Colorado.
A huge difference is that even in the European countries that base their health care on insurance both the insurance companies and the hospitals are non-profit and required to accept all comers. When my son was born in Switzerland the total cost for 5 months of prenatal care and 7 days in the hospital was SFR 350 which in 1967 was about $80. And we didn’t even have insurance.
Colorado is 1/3 Republican, 1/3 Democrat, 1/3 Third Party or Independent. So the numbers say a lot of non-Repulicans voted against single-payer even if every Republican except me voted that way.
The analogy I was thinking of was like when my car got major hail damage. I paid $250 and $15,000 of damage was fixed. And that is not an unusual repair bill; the wife’s Tesla needed over $10,000 in repairs for some gashes on a fender and glass damage. Had it been the health insurance model my premiums would have been 4X as much, a $2000 deductible and paying 40% of the repair out of pocket.
And the reality is that while in catastrophic cases health insurance does protect the consumer (I would have been bankrupted by my daughter’s illness without it) that in most cases having insurance is worthless as a savings protector. Simply making insurance available to more people is not a solution. The insurance payment structure needs to be overhauled along with massive reductions in health care costs. A sleep study where some tech watches you sleep should not cost $12,000 … and we should not have to pay 30% of that with insurance.
I’m sorry but it’s just not a valid analogy. Your car insurance has a maximum payment of the value of the car. What is the maximum payment you are willing to accept for your life?
Health insurance costs so much more because health care costs so much more, and because we dont’ have a “total loss” mode (remember death panels?) where the insurer can just write off you you off and pay off your next of kin.
These are two different problems, with two different solutions.
Payment models are actually all over the place. I’ve high-deductible plans with a tax-preferred HSA. I’ve had relatively low-deductible plans with high co-pays. I’ve had medium-deductible plans with middle-of-the-road copayments but pretty reasonable out-of-pocket maximums. There are tons of ways to structure the insurance payments. What seems like a good payment model to you might be terrible for me.
The insurance piece is broken because the GOP gutted the mandate and neutered the exchanges, and is now trying to claw back the subsidies to the lower level that weren’t sufficient for most poorer payers. That is two of the three legs of the stool.
As far as reducing overall costs, that only happens when the payer (whether that’s the government or insurance companies) has both the ability and the incentive to force providers to charge less. The end user has no power, since there is often only a small number of providers (sometimes only one in an area) and the consumer is almost always in a situation where haggling over price is either impossible or literally detrimental to their well-being.
Those "should"s are doing a lot of work there, and actually hit at some of the fundamental problems with designing and implementing a health-care system.
How do we determine what a health-care procedure “should” cost? In most areas of life we say it should cost what the market will bear. How much would you pay for a sleep study? How much would I pay? What if I know that my insurance will cover most of the cost? Who gets to decide whether I need it or not? And when you need one are you willing to shop around based on the cost or will you choose the “best” provider regardless of the cost?
And what “should” the payment model be? Should a family earning $40k a year pay the same premiums and have the same deductible as a family earning $400k? Should I have to be employed by a large corporation to have access to lower-cost plans where the insurers have the leverage and incentive to force lower rates on providers?
These are not trivial questions, and require serious politicians to work through them and propose serious solutions.
When the Affordable Care Act was in the making (Late-2000’s - Obama), there were endless surveys gauging people’s opinions.
ALL the opinion polls about “Obamacare” skewed strongly negative. ALL the opinion polls about the actual components of the ACA skewed strongly positive.
[Worth noting that the ACA is hugely popular today.]
What does that tell us?
Right-wing propaganda is a powerful thing, and
People can’t be bothered with reading and understanding pretty simple information.
Right, Medicare is just a different risk pool (only old people) with a different funding mechanism (dedicated taxation) and different payment methods. It does have better price controls and lower overhead than private insurers, but it certainly isn’t “free” to to the consumer. It is almost certainly a better deal than someone over 65 could get outside of the system (assuming the same coverage).
There is also Medicare Advantage which is much more like what an employer-provided plan looks like. That is about the only actual policy proposal in Project 2025, for example - growing Medicare Advantage and reducing “traditional” Medicare. That almost certainly won’t bring down costs, or be good for the end consumer, but at least it’s a plan.
The VA is yet another system with an entirely different set of parameters. It’s much more like the UK’s NHS where the providers (often) actually work directly for the system rather than being third-party providers that are merely paid by the system (like Medicare).
There is no free lunch here. The money has to come from somewhere. And the decisions about who gets what care and who pays for it has to be made by someone. And any reduction in overall health care spending has to come out of somebody’s pocket (or be a reduction in services that some people are currently receiving).
Incorrect. The insurance piece is broken because of insurance greed. We pay for it and don’t get the coverage we need. Insurance can veto necessary procedures and medicine it doesn’t want to pay for. Has happened to me and many other Americans. And that is where this debate often fails. It in not about getting more people health insurance and subsidizing it as need be. The entire system is broken.
Except in many cases the consumer does not have full knowledge of the costs associated or the ability to opt out. When was the last time you got a menu at a hospital? In the sleep study case, Kaiser said, “We will not treat you unless you get the sleep study.” We had no options. We were not given a price. “The market” is where pricing is fully disclosed and the customer can say no I don’t want that. That is not health care.
And to continue the analogy, why are we against price gouging of water in a natural disaster if that’s what the market will bare? But yet we allow price gouging in the medical field.
And the result while Obamacare was in effect was simply getting people on insurance was not THE solution to health care costs. If every American resident (legal and illegal) were on health insurance and it were subsidized if you were below the poverty level, would there still be a health care cost crisis? I think so.
I think we are saying the same thing. Whenever you put the decision-making power in the hands of a for-profit business the motivating factor will be greed. That is by design. It’s the only thing corporations exist to do - maximize profits.
If you want the decisions to be made without greed as a factor you have to move the decision-making power elsewhere.
Never. But I would argue it doesn’t really matter. My wife is a provider and she has no idea what it costs to any individual patient for them to see her. It depends entirely on their insurance companies negotiated rates. And even if you were shown two different prices, almost nobody is going to chose the lower cost if there is any chance it has potential worse outcomes. People just don’t think that way when it comes to their health.
I think it’s a fundamental mistake to try to think of health care as a free market of any sort, at least with respect to patients (it could be seen as a market between providers and payers). It should be more of a public service like a utility where rates are negotiated by the government and providers compete to provide those services at a price and quality that will increase business. You could add third-party insurers in the middle like Germany and others do if you want.
Sorry for the double-post. I also think this is exactly right. Obamacare (as passed) was not fundamentally a cost-control measure. It was a universal coverage measure. It was a way to attempt to create a system where everybody could be covered without being screwed because they were too poor or worked for an employer that didn’t provide a group plan or had a pre-existing condition.
There were cost-control measures in the initial bill, but those were largely removed in an effort to get it passed. Remember the public option? That could have driven costs down by allowing competition in the insurance space. The insurance companies (and Joe Lieberman) killed it. Remember “death panels”? Requiring/encouraging providers to have end-of-life discussions with patients before heroic care is provided to terminal patients can save massive amounts of money. Obamacare initially had provisions for Medicare to negotiate drug pricing, but Pharma got that removed. It did come back in the Inflation Reduction Act but only for a small set of high-cost drugs (and some of these were removed by the Big Beautiful Bill).
Not everyone is missing it. The fact that people can’t afford healthcare is the explicit reason the Democratic party is provoking the Republicans. It’s what Democrats are campaigning on: “your healthcare costs will go up a lot”. The details about Obamacare, Medicaid, etc are minutiae given to wonky reporters that regular people simply don’t bother with.
The Republicans have already acknowledged healthcare costs are a problem. They’re still holding out against negotiating about it. But given that they’re talking about it, it won’t be long before they have to do more than just talk. More than half the Americans that will be directly affected by the healthcare cost changes live in Republican-controlled states.
Healthcare is one of the wedge issues that’s going to crack the Republican coalition.
Why should anyone “do the right thing” when the “lose their jobs in order to do the right thing” means the election of the party that will undo the right thing in the next election cycle?
As we’ve seen with the ACA vs Obama Care stupidity the problem is the electorate. And we can’t fix stupid.
You’ve made an excellent point although I would tweak that slightly:
Healthcare is one of the wedge issues that’s we fervently hope is going to crack the Republican coalition. Dems are trying but success is not guaranteed.
Car insurance is a bad analogy. There is a cap on car insurance payouts for repairs - the value of the car. There is a cap on liability payouts also. Above that the car is considered totaled and you get the value. If medical insurance were the same way, they’d declare people totaled.
Which might well have happened without Medicare.
Traditional Medicare isn’t free, but it is single payer. And very popular. So people do like single payer plans, or at least ones they are used to.
And Medicare Advantage is a ploy by the insurance companies to reverse the good parts of Medicare. It appears that refusing to pay is a big thing for Medicare Advantage plans, not to mention that there are preferred suppliers. Not a problem for my traditional with Medigap plan.
Certain things are almost impossible to get rid of. It only takes passing Universal Basic Income or Universal Medicare once and the people will get used to it and refuse to give it up. Think about the massive backlash during Trump’s first term when they were going to get rid of that “horrible Obamacare” and even the Republican base rose up against them and shot it down.
A few martyrs willing to take one for the team to get these things passed would be a cause worth running for (being a politician doesn’t need to be a lifelong job anyway). Now, ideally, the voters would keep them in office in spite of the negative campaign that would follow, but I don’t have a lot of faith in the typical voter (as you said, we can’t fix stupid).
A competitive free market finds the most efficient way to make money. We have several ways that fails in the field of healthcare.
If you have a large enough employer, they choose one or two medical insurance companies. The company is selling to the employer, not to the end user. If your employer picks the one company you cannot stand, your only option is to change jobs. That is not really a competitive market.
Whenever insurance is involved, the end user does not really care what the price is. When you wreck your car, it doesn’t really matter to you whether the body shop gets $500 or $4000. The insurance is paying it, not you. With medical care, it’s the same idea. That is not a free market.
Efficiency in the medical field is not usually a prime concern. If it does become important, it is one of those horrifying cases the call triage. If only one doctor is available for hundreds of people in agony after a plane crash, the people with the best chance of living get priority. It happens a lot in war too.
Medical care is one of those places where capitalism just doesn’t work all that well.
We let people who have very low health care needs go without paying for insurance.
Then if they get a million dollar injury (maybe a motorcycle accident in a helmet-optional state like mine), the cost of care for the freeloader is mostly bourn by Americans who are already paying for their own insurance.
Without the subsidies, even more Americans will go without AKA become freeloaders. Neither Democrats nor Republicans want to think about it that way, turning the Affordable Care Act into a left-right issue in a country where left-right issues create shutdown gridlock.
But that was around before Sibelius. I think it is due to the outragously high medical cost, but suppose we were to lower medical costs - would the greed of the insurance companies keep the high cost of the insurance itself?
Do I need to keep any answer with spitting distance of the shutdown? Because right now, I cannot think of a response, to your question, relevant to the shutdown.