The above is, indeed, one of many, many illustrations of the simple fact that the objectives and incentives of private enterprise are completely at odds with the needs of human health care, and the nexus of this problem centers around the method of health care funding. Offering such funding through the market-based drivers of private business is the classic square peg in a round hole. It just doesn’t work, and it explains why US health care is so incredibly overpriced and intractably complicated. The question of how to manage health insurers so that Americans get decent health care at reasonable prices is to tell them, by force of law, to go away and find an honest line of business. This is pretty much what happend when single-payer UHC was rolled out in Canada. With the exception of a few that still offer supplementary insurance, the health insurers got the hell out when they found that the gravy train was over and no one wanted or needed them.
Let me repeat here a point I made in a previous post, because I think it’s very important: in other first-world countries, access to health care is patient-centric, governed and prioritized by the medical profession for the benefit of the patient. It’s crucially central to this model that the insurer strictly stays out of clinical decision-making. In the US the model is insurance-centric and essentially mercenary, governed and prioritized by the insurance industry for their financial benefit, even if it’s to the detriment of the patient.
My daughter lived in Germany for several years, and she found their system inexpensive (compared to the US) and very effective. Just anecdotal, but her husband is German and while he complains about some things, never that.
Others have already responded to these two deeply flawed posts, but just to add a couple of points that perhaps were not made crystal clear.
This is only true if you exclude our current employer-paid private health insurance premiums (or self-paid private premiums) from the definition of “tax”. But of course they are making our paychecks considerably smaller, just like a tax. There’s considerable debate about the best way to implement funding for UHC, but one way would be for corporations to stop paying for private health insurance for their employees and instead pay that money in higher corporate taxes to the government to fund UHC. The effect for corporations would be neutral, and there would be no increase to personal taxation, net paychecks would remain the same.
In any event, given that healthcare in other nations costs half of what it does in the US, all the evidence is that implementing UHC funded through some form of general taxation, and not having to pay private insurance premiums, would make everyone net better off, with the possible exception of the very rich who already pay more (and should pay more) in a progressive income tax regime.
This is a misapplication of the principle. It is certainly possible to provide healthcare that is faster, better and cheaper when your point of comparison is the US. The evidence is that literally every other single developed nation does so, with some form of UHC funded through general taxation.
The ultimate way to answer what you’re trying to dig down to is: what is total healthcare expenditure? And we know the answer to that. In the U.S., it’s a least double what it is in any other developed nation.
The private insurance model does not work for healthcare, and this has nothing to do with the irrelevant minor details that you’re obsessing over.
Commercial insurance works by assessing specific individual risk and charging accordingly; and by updating that risk assessment periodically - typically annually. We accept that it’s fair to (say) charge some car drivers higher premiums than others, because your safe driving record is largely something you can control, and the financial implications of high car insurance premiums are not debilitating. Even if you can’t afford to drive a car at all you’re not dead.
But this approach doesn’t work with healthcare. Some people just require more healthcare than others. If someone gets a chronic condition, or has one from birth, the usual commercial insurance model would allow the insurance company to assess them as a bad risk - to refuse to continue their insurance past the end of the year, or to increase their premiums tenfold. Of course, we have laws to try to stop insurance companies doing this, because we acknowledge that we shouldn’t discard sick people if they don’t get healthy by December each year, a civilized society don’t just leave people to die even if their illness is a result of their own poor health choices (and usually it isn’t).
But if we’re passing laws that prevent insurance companies from operating under normal commercial principles, that indicates that the private insurance model is fundamentally inappropriate for healthcare.
Insurance for healthcare works only under a Rawlsian veil of ignorance. Suppose that before we are born, without knowing what person we will be born as, we could design a healthcare system. We might be born as a spry, healthy rich person; we might be born poor with a chronic health condition. What kind of system would we choose? The answer most people would give is that we should all contribute to the healthcare insurance pool, perhaps less if we’re poor and more if we’re wealthy. Healthcare is a basic human right, so the contribution should not be based on highly variable and uncertain individual healthcare needs, the cost should be shared among everyone. And the commitment to contribute to the pool should not be something we revise yearly, it should a fundamental part of the social contract.
In practice, such an insurance system is realized in a Universal Healthcare System where a single insurance pool is funded through general taxation.
And all this is so obvious to everyone in every single developed nation outside the U.S. that they would honestly be puzzled why someone would need to spell it out. Whereas in the U.S., such a system is often bizarrely denigrated as “socialist”, even though it’s exactly the way we fund defense spending.
I have linked in other threads to some surveys on US people’s satisfaction with their healthcare (which is intrinsically linked to the insurance side of it, as everyone knows). I think overall US satisfaction with their own healthcare is around 75 to 80%. Gallup polls have shown this recently. This includes people who are on public and private plans, and I think the %'s of satisfaction are in the same ballpark for both sides. I am one of the 75-80%, and I have private health insurance. I work for a company that self-insures its employees, and we have a Blue Cross plan that acts as a TPA.
Now, people in the US complain about the overall system. But they like their own deal, and mostly want to keep what they have.
In any other topic you name, if you get 75 to 80% saying the same thing, you call that a strong “consensus”. But in healthcare, the people who scream and yell about the need for single-payer, and who label private health insurance as evil, won’t accept that. They just can’t accept that people like what they have and don’t need to be “saved” from it.
And one of the issues we’re having in the Spanish system: medical insurance being sold which for most patients doesn’t even give access to more doctors or hospitals than the public system and which is sold on false premises: “no waiting times!!!”
First of all, in most of the country if you call your local ambulatorio for an appointment with one of the no-referral-needed specialties you’ll be seen the next weekday at the latest. Second, well, no waiting times unless the doctor is booked or only works Thursdays, two things which are much more likely in a private practice than in any center part of or affiliated with the public system. Those same private practices won’t have two doctors of the same type; in the public and semipublic places, if Doctor XYZ has the flu his patients will be treated by his short-term replacement; if he is currently undergoing emergency surgery for acute peritonitis and there hasn’t been time to get a replacement, the patients will be shuffled around to the other doctors covering his same specialty.
Honest question: have you seen a poll that breaks down opinion dividing out people who have and haven’t used their insurance for things beyond ordinary checkups and such? It seems to me, many people go through much of their life without having to test how awesome their health coverage is.
I posted this in another thread on the subject of health care. It seems to be relevant to the discussion here:
*My very local paper ran a human interest story this weekend. It was about a local family whose daughter, at the age of 13 was diagnosed with something like a weak blood vessel in the brain. (Unclippable uncoilable MCA) In a very difficult location. She was put on a “watchful waiting” program. About 2 years ago, when she was 17, there were signs that it was weakening further and might rupture soon. It seems to be a very rare thing, and required specialization was not available locally. The family went to the USA, to a New York based Dr. Amir Dehdashti.
Among the things that were explained to them at the hospital was that a down-payment of 35 000 $ was expected before they even got to see the doctor. That led to some nervous laughter.
The operation was successful, otherwise I guess it wouldn’t have made a good human interest story. During the days in New York the family mentions passing an ambulance trying to tend to someone who’d been involved in an accident. The bleeding man did not want to go in the ambulance because he could not afford it. It did make them reflect on how they’d gotten shipped across the world to best specialists, all covered by the Norwegian health care system, while the Americans in the same city could not afford an ambulance.
Which makes me think: If you really need it, the odds of seeing the best specialists in the US are probably better for the average Norwegian than for Joe Average American. Maybe way better. So the current US system is working quite well for us. Not so much for the nation whose people may have to refuse ambulances when injured, because they can’t afford them. And count themselves luck they were not unconscious and unable to refuse the ambulance.*
I’ve never seen that type of polling. I know that my own family are heavy users, and my insurance pays without hassle (so far). I have a close family member with Diabetes, and another with some other complications. I realize that my own situation is not dispositive of the issue, though.
BTW, looking at the latest Gallup Polls, about 80% like their own healthcare and about 70% like their own health coverage. Need to get that 70% higher. But those numbers aren’t bad. If we replace everything with “Medicare for All”, there is very likely to be some anger in the population as their own situation is disrupted.
The satisfaction for the overall national situation is much lower. But most people like their own situation, which I put more weight on. A lot of people will curse about a topic in abstract, but then talk about how their own situation is OK, whether it’s healthcare, congress, jobs, economy, etc.
Yeah, I’m guessing that given the options of whether they’d rather:
A) have a system where there’s pretty much no paperwork, full coverage of GP visits and all medically-necessary treatments, capped prescription prices (and free prescriptions for children, seniors, and pregnant women), at a cost of half of what they pay for their current insurance coverage (including employer contributions), with better overall outcomes; or
I wonder why you would guess that. I have the usual “good” health insurance through my employer but given the way you wrote those options, A is better than what I currently have.
Granted, my issue with the system (as per the “like what they currently have” idea) is that my insurance is very good except when I change jobs or when my employer changes the plans. That’s my biggest beef about it - the beaurocratic delays in switching over from one plan to the next. I’ve encountered it several times in the last decade. A person’s treatment plan should **never **be paused or change just because the insurance changed.
That might be true in some cases. But it’s a paternalistic talking point, and I doubt it would be persuasive as a political argument.
I think a better approach is to work to get the rest of America coverage, i.e. the uninsured, without telling people who already have it that they don’t know how much better Country X has it…
The point was that most Americans who say they are happy with their healthcare don’t realize how awful it really is, because (a) most people have never needed to use it in one of the situations where it seriously screws you; and (b) they simply have no knowledge of the patient experience (or much lower cost) in a good system.
I’m going to backtrack and take issue with this. The quality has to be ‘good enough’. Just because something isn’t perfect doesn’t mean it isn’t good enough.
Ah, gotcha. I’m in agreement with you, then. I’ve never encountered better health care either, but I’m so crotchety these days that even my one beef makes me want to change our system.
What you “like” is always relative to the alternatives, and also highly affected by personal experience that may not be representative of the whole. I suspect you’d get quite a different answer about how terrifically health-insurance-as-a-business works for them if you asked the millions of people who have had major claims denials, or worse, those who have been bankrupted and reduced to destitution by medical bills. Even with the ACA, medical bills remain the leading cause of bankruptcies, and most of the people affected thought they were protected by insurance, but were hit either by major claims denials or major out-of-pocket expenses.
And that doesn’t even touch on issues of cost, or the essential clinical autonomy of doctors and patients which is totally devastated by the private insurance model. The people you really need to ask are not those who have no experience with any other system – or perhaps lack even a basic understanding of other systems – but those who know other systems well.
Like my brother, for instance. You could ask him. He moved to the US from Canada a couple of decades ago and is now a US citizen. He moved to take a high-level job in the US that naturally offered first-class health coverage, so I asked him recently – having now had extensive exposure to both health care systems – how he felt about his overall experiences and how he thinks it compares to his experiences in Canada. Having heard his answer I would give you this caution: go ahead and ask him, but do not ask him when there are small children around, because he is unable to properly elucidate the full breadth of his feelings without picturesque language that is unsuitable for young or sensitive ears.
I don’t think it’s “paternalistic” to point people to real-world facts about critical issues that affect their lives.
You don’t seem to have read far enough in your cite.
Just a bit down we get
So the way to get that 70% higher is Medicare for All. And this means that satisfaction with traditional insurance is a bit lower than 69%.
Satisfaction with medical care doesn’t have a lot to do with satisfaction with coverage. You can still love your doctor even if your insurance company makes your life hell. And most people get to choose their doctors but not their insurance, which will lead them to rate their medical care higher.
