Universal health care in the US and elsewhere

[Machine_Elf]

Trying to come up with a health care system in the US that takes care of the health of everyone without costing an arm and a leg has been difficult. Many people are resistant to government meddling in what they see as a free-market business enterprise, while others insist that government intervention is needed in order to address what they see as a market failure that leaves many people without access to life-saving/extending treatments.

I assume every country had a time in its history before which the government was not involved in the health care business, but some countries have made the transition to some form of universal healthcare. How is it that these countries were able to make the leap, and the US has not? Will we here in the US ever get there, or are business interests just too powerful here?

[Evan_Drake]

Doctors went crazy — the non-socialist already ones, which was most — at the birth of the NHS in 1948.

Aneurin Bevan, the Minister of Health who masterminded the creation simply said: “I stuffed their mouths with gold.”

[up_the_junction]

@Machine_Elf

are business interests just too powerful here?

well yeah, they have been for 50 years. It’s not really ‘interests’ it’s rank bribery of Congress combined with corporate media propaganda. Text book stuff that had the population totally conned.

I still maintain the slow realise came when the Internet opened up the USA people to outside influences. There must have been huge debates on here, for example, back to the Millennium - first off people defending the system against socialised medicine and then slowing realising the con … how about those impassioned Town Hall meetings around Obamacare. So many wrapped in the flag and going against the interest of themselves and loved ones.

Obama and the internet did it once. It’ll be like a wave, making progress, falling back. In the end, the people will prevail.

[Really_Not_All_That_Bright]

@Machine_Elf

I assume every country had a time in its history before which the government was not involved in the health care business, but some countries have made the transition to some form of universal healthcare. How is it that these countries were able to make the leap, and the US has not? Will we here in the US ever get there, or are business interests just too powerful here?

Speaking of the UK specifically, after WWII there was a very strong national sense that We Should Take Care of People. There were thousands if not millions of injured soldiers returning, widows and orphans left to fend for themselves, and so forth. The economy was also mostly wrecked, with massive foreign debt and basically everything having been turned over to war production or blown up.

Among the ruling classes there was probably a bit of fear that the masses might rise up a la Germany or Russia, too.

In any event, there was remarkably broad agreement that Britain needed a stronger welfare state and medical care for all, hence the democratic socialist model that characterized British economic planning from 1950 to 1973 or so. It’s called the post-war consensus.

[XT]

How is it that these countries were able to make the leap, and the US has not?

How about a brief history of healthcare in the US?

The History of Healthcare: From the Late 1800’s to Now
The Late 1800’s

The earliest formalized records in America’s history of healthcare are dated toward the end of the 19th century. The industrial revolution brought steel mill jobs to many U.S. cities, but the dangerous nature of the work led to more and more workplace injuries.

As these manufacturing jobs became increasingly prevalent, their unions grew stronger. In order to shield their union members from catastrophic financial losses due to injury or illness, they began to offer various forms of sickness protections. At the time, there was very little organized structure and most decisions were made on a trial and error basis.

The 1900’s

With the turn of the century came a push for organized medicine, led in part by the American Medical Association (AMA), which was growing stronger and gained 62,000 physicians during the coming decade. But because the working class wasn’t supportive of the idea of compulsory healthcare, the U.S. didn’t see the kind of groundswell that leading European nations would see soon after.

The 26th President of the United States, Theodore Roosevelt (1901-1909), believed health insurance was important because “no country could be strong whose people were sick and poor.” Even so, he didn’t lead the charge for stronger healthcare in America. Most of the initiative in the early 1900’s was led by organizations outside the government.

The 1910’s

One of the organizations heavily involved with advancing healthcare was the American Association of Labor Legislation (AALL), who drafted legislation targeting the working class and low-income citizens (including children). Under the proposed bill, qualified recipients would see sick pay, maternity benefits, and a death benefit of $50.00 to cover funeral expenses. The cost of these benefits would be split between states, employers, and employees.

The AMA initially supported the bill, but some medical societies expressed objections, citing concerns over how doctors would be compensated. The fierce opposition caused the AMA to back down and ultimately pull support for the AALL bill. Not to mention the fact that union leaders feared compulsory health insurance would weaken them, as a portion of their power came from being able to negotiate insurance benefits for union members.

As one might expect, the private insurance industry also opposed the AALL Bill because they feared it would undermine their business. If Americans received compulsory insurance through the government, they might not see the need to purchase additional insurance policies privately (especially life insurance), which could put them out of business — or at the very least, cut into their profits. In the end, the AALL bill couldn’t garner enough support to move forward and global events turned American attention toward the war effort.

The 1920’s

Post World War I, the cost of healthcare became a more pressing matter as hospitals and physicians began to charge more than the average citizen could afford. Seeing that this was becoming an issue, a group of teachers created a program through Baylor University Hospital where they would agree to pre-pay for future medical services (up to 21 days in advance). The resulting organization was not-for-profit and only covered hospital services. It was essentially the precursor to Blue Cross.

The 1930’s

When the Great Depression hit in the 30’s, healthcare started to become a more heated debate. One might believe such conditions would create the perfect climate for compulsory, universal healthcare, but in reality, it did not. Rather, unemployment and “old age” benefits took precedence.

While “The Blues” (Blue Cross and Blue Shield) began to expand across the country, the 32nd President of the United States, Franklin Delano Roosevelt (1933-1945), knew healthcare would grow to be a substantial problem, so he got to work on a health insurance bill that included the “old age” benefits so desperately needed at the time.

However, the AMA once again fiercely opposed any plan for a national health system, causing FDR to drop the health insurance portion of the bill. The resulting Social Security Act of 1935 created a system of “old-age” benefits and allowed states to create provisions for people who were either unemployed or disabled (or both).

This is where it gets more interesting and kind of answers your question:

The 1940’sA photo of the FDR Memorial in Washington D.C. FDR played an important role in the history of healthcare in America.

As the U.S. entered World War II after the attack on Pearl Harbor, attention fell from the health insurance debate. Essentially all government focus was placed on the war effort, including the Stabilization Act of 1942, which was written to fight inflation by limiting wage increases.

Since U.S. businesses were prohibited from offering higher salaries, they began looking for other ways to recruit new employees as well as incentivizing existing ones to stay. Their solution was the foundation of employer-sponsored health insurance as we know it today. Employees enjoyed this benefit, as they didn’t have to pay taxes on their new form of compensation and they were able to secure healthcare for themselves and their families. After the war ended, this practice continued to spread as veterans returned home and began looking for work.

While this was an improvement for many, it left out vulnerable groups of people: retirees, those who are unemployed, those unable to work due to a disability, and those who had an employer that did not offer health insurance. In an effort to not alienate at-risk citizens, some government officials felt it was important to keep pushing for a national healthcare system.

The Wagner-Murray-Dingell Bill was introduced in 1943, proposing universal health care funded through a payroll tax. If the history of healthcare thus far could be a lesson for anyone, the bill was faced with intense opposition and eventually drowned in committee.

When FDR died in 1945, Harry Truman (1945-1953) became the 33rd President of the United States. He took over FDR’s old national health insurance platform from the mid-30’s, but with some key changes. Truman’s plan included all Americans, rather than only working class and poor citizens who had a hard time affording care — and it was met with mixed reactions in Congress.
…
Even after Truman was re-elected in 1948, his health insurance plan died as public support dropped off and the Korean War began. Those who could afford it began purchasing health insurance plans privately and labor unions used employer-sponsored benefits as a bargaining chip during negotiations.

The 1950’s

As the government became primarily concerned with the Korean War, the national health insurance debate was tabled, once again. While the country tried to recover from its third war in 40 years, medicine was moving forward. It could be argued that the effects of Penicillin in the 40’s opened people’s eyes to the benefits of medical advancements and discoveries.

In 1952, Jonas Salk’s team at the University of Pittsburgh created an effective Polio vaccine, which was tested nationwide two years later and was approved in 1955. During this same time frame, the first organ transplant was performed when Dr. Joseph Murray and Dr. David Hume took a kidney from one man and successfully placed it in his twin brother.

Of course, with such leaps in medical advancement, came additional cost — a story from the history of healthcare that is still repeated today. During this decade, the price of hospital care doubled, again pointing to America’s desperate need for affordable healthcare. But in the meantime, not much changed in the health insurance landscape.

The 1960’s

By the 1960, the government started tracking National Health Expenditures (NHE) and calculated them as a percentage of Gross Domestic Product (GDP). At the start of the decade, NHE accounted for 5 percent of GDP.

When John F. Kennedy (1961-1963) was sworn in as the 35th President of the United States, he wasted no time at all on a healthcare plan for senior citizens. Seeing that NHE would continue to increase and knowing that retirees would be most affected, he urged Americans to get involved in the legislative process and pushed Congress to pass his bill. But in the end, it failed miserably against harsh AMA opposition and again — fear of socialized medicine.

After Kennedy was assassinated on November 22, 1963, Vice President Lyndon B. Johnson (1963-1969) took over as the 36th President of the United States. He picked up where Kennedy left off with a senior citizen’s health plan. He proposed an extension and expansion of the Social Security Act of 1935, as well as the Hill-Burton Program (which gave government grants to medical facilities in need of modernization, in exchange for providing a “reasonable” amount of medical services to those who could not pay).

Johnson’s plan focused solely on making sure senior and disabled citizens were still able to access affordable healthcare, both through physicians and hospitals. Though Congress made hundreds of amendments to the original bill, it did not face nearly the opposition that preceding legislation had — one could speculate as to the reason for its easier path to success, but it would be impossible to pinpoint with certainty.

It passed the House and Senate with generous margins and went to the President’s desk. Johnson signed the Social Security Act of 1965 on July 30 of that year, with President Harry Truman sitting at the table with him. This bill laid the groundwork for what we now know as Medicare and Medicaid

The 1970’sA photo of the White House in Washington D.C., where many Presidents have mulled over the implications of healthcare reform throughout history.

By 1970, NHE accounted for 6.9 percent of GDP, due in part to “unexpectedly high” Medicare expenses. Because the U.S. had not formalized a health insurance system (it was still just people who could afford it buying insurance), they didn’t really have any idea how much it would cost to provide healthcare for an entire group of people — especially an older group who is more likely to have health problems. Nevertheless, this was quite a leap in a ten year time span, but it wouldn’t be the last time we’d see such jumps. This decade would mark another push for national health insurance — this time from unexpected places.

Richard Nixon (1969-1974) was elected the 37th President of the United States in 1968. As a teen, he watched two brothers die and saw his family struggle through the 1920’s to care for them. To earn extra money for the household, he worked as a janitor. When it came time to apply for colleges, he had to turn Harvard down because his scholarship didn’t include room and board.

Entering the White House as a Republican, many were surprised when he proposed new legislature that strayed from party lines in the healthcare debate. With Medicare still fresh in everyone’s minds, it wasn’t a stretch to believe additional healthcare reform would come hot on its heels, so members of Congress were already working on a plan.

In 1971, Senator Edward (Ted) Kennedy proposed a single-payer plan (a modern version of a universal, or compulsory system) that would be funded through taxes. Nixon didn’t want the government reaching so far into Americans’ lives, so he proposed his own plan, which required employers to offer health insurance to employees and even provided subsidies to those who had trouble affording the cost.

Nixon believed that basing a health insurance system in the open marketplace was the best way to strengthen the existing makeshift system of private insurers. In theory, this would have allowed the majority of Americans to have some form of health insurance. People of working age (and their immediate families) would have insurance through their employers and then they’d be on Medicare when they retired. Lawmakers believed the bill satisfied the AMA because doctors’ fees and decisions would not be influenced by the government.

Kennedy and Nixon ended up working together on a plan, but in the end, Kennedy buckled under pressure from unions and he walked away from the deal — a decision he later said was “one of the biggest mistakes of his life.” Shortly after negotiations broke down, Watergate hit and all the support Nixon’s healthcare plan had garnered completely disappeared. The bill did not survive his resignation and his successor, Gerald Ford (1974-1977) distanced himself from the scandal.

The 1980’s

By 1980, NHE accounted for 8.9 percent of GDP, an even larger leap than the decade prior. Under the Reagan Administration (1981-1989), regulations loosened across the board and privatization of healthcare became increasingly common.

In 1986, Reagan signed the Consolidated Omnibus Budget Reconciliation Act (COBRA), which allowed former employees to continue to be enrolled in their previous employer’s group health plan — as long as they agreed to pay the full premium (employer portion plus employee contribution). This provided health insurance access to the recently unemployed who might have otherwise had difficulty purchasing private insurance (due to a pre-existing condition, for example).

The 1990’s

By 1990, NHE accounted for 12.1 percent of GDP — the largest increase thus far in the history of healthcare. Like others before him, the 42nd President of the United States, Bill Clinton (1993-2001), saw that this rapid increase in healthcare expenses would be damaging to the average American and attempted to take action.

Shortly after being sworn in, Clinton proposed the Health Security Act of 1993. It proposed many similar ideas to FDR and Nixon’s plans — a mix of universal coverage while respecting the private insurance system that had formed on its own in the absence of legislation. Individuals could purchase insurance through “state-based cooperatives,” companies could not deny anyone based on a pre-existing condition, and employers would be required to offer health insurance to full-time employees.

Multiple issues stood in the way of the Clinton plan, including foreign affairs, the complexity of the bill, an increasing national deficit, and opposition from big business. After a period of debate toward the end of 1993, Congress left for winter recess with no conclusions or decisions, leading to the bill’s quiet death.

In 1996, Clinton signed the Health Insurance Portability and Accountability Act (HIPAA), which established privacy standards for individuals. It also guaranteed that a person’s medical records would be available upon their request and placed restrictions on how pre-existing conditions were treated in group health plans.

The final healthcare contribution from the Clinton Administration was part of the Balanced Budget Act of 1997. It was called the Children’s Health Insurance Program (CHIP) and it expanded Medicaid assistance to “uninsured children up to age 19 in families with incomes too high to qualify them for Medicaid.” CHIP is run by each individual State and is still in use today.

The 2000’s

By the year 2000, NHE accounted for 13.3 percent of GDP — just a 1.2 percent increase over the past decade. When George W. Bush (2001-2009) was elected the 43rd President of the United States, he wanted to update Medicare to include prescription drug coverage. This idea eventually turned into the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (sometimes called Medicare Part D). Enrollment was (and still is) voluntary, although millions of Americans use the program.

The history of healthcare slowed down at that point, as the national healthcare debate was tabled while the U.S. focused on the increased threat of terrorism and the second Iraq War. It wasn’t until election campaign mumblings began in 2006 and 2007 that insurance worked its way back into the national discussion.

When Barack Obama (2009-2017) was elected the 44th President of the United States in 2008, he wasted no time getting to work on health care reform. He worked closely with Senator Ted Kennedy to create a new healthcare law that mirrored the one Kennedy and Nixon worked on in the 70’s.

Like Nixon’s bill, it mandated that applicable large employers provide health insurance, in addition to requiring that all Americans carry health insurance, even if their employer did not offer it. The bill would establish an open Marketplace, on which insurance companies could not deny coverage based on pre-existing conditions. American citizens earning less than 400 percent of the poverty level would qualify for subsidies to help cover the cost. It wasn’t universal or single-payer coverage, but instead used the existing private insurance industry model to extend coverage to millions of Americans. The bill circulated the House and the Senate for months, going through multiple revisions, but ultimately, passed and moved to the President’s desk.

2010 to NowA photo of the Washington Monument in Washington D.C. at dusk.

While the country focused on the second Iraq War, the cost of healthcare took another leap. By 2010, NHE accounted for 17.4 percent of GDP. This period of time would bring a new, but divisive chapter in the history of healthcare in America.

On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (PPACA), commonly called the Affordable Care Act (ACA) into law. Because the law was complex and the first of its kind, the government issued a multi-year rollout of its provisions. In theory, this should have helped ease insurance companies (and individuals) through the transition, but in practice, things weren’t so smooth. The first open enrollment season for the Marketplace started in October 2013 and it was rocky, to say the least.

Anyway, that was a huge wall of text I’m sure. Bottom line…it’s more complicated than ‘corporations are evil’ and ‘Republicans hate healthcare and think it’s all socialist’. We’ve had healthcare for a long, long time, it’s been tweaked as times changed, the public has grown used to it the way it is and are on the fence about large systemic change, and it’s worked just well enough for just enough people that it hasn’t become an overriding priority for most working class Americans to get riled enough about it to push for change. A lot of countries that did adopt more progressive systems did so for other, internal reasons…and had political systems that were very different than ours and allowed them to push through stuff you couldn’t really do here, especially in the past.

[HoneyBadgerDC]

Our healthcare system reached a crisis stage a long time ago. because companies supplied healthcare to their workers and Medicare supplied healthcare to seniors and those on disability nobody really cared enough to do anything about it. The big companies are no longer willing to keep paying and Medicare is running out of money. I am a conservative but see no other options besides socialized medicine. The incentive to run the bill up has to disappear.

[elbows]

I think the universal element is the key, and that it’s about culture not politics.

Countries that held out for single payer did so because their cultures valued inclusiveness much higher. There are always political divisions with any broad widesweeping policy, in any country. Financial concerns, and capitalism issues to be addressed. But if culturally all sides value inclusivity and insist upon it then you get a system that reflects that.

[Machine_Elf]

@XT

How about a brief history of healthcare in the US?
Anyway, that was a huge wall of text I’m sure.

It was, but it was a very interesting/informative wall of text; thanks for building it.

[JackieLikesVariety]

the way forward is state by state - like Canada and it’s provinces. it will work in California and eventually it will work everywhere.

hopefully before I get a lot older.

[CarnalK]

@JackieLikesVariety

the way forward is state by state - like Canada and it’s provinces. it will work in California and eventually it will work everywhere.

hopefully before I get a lot older.

UHC in Canada required significant federal backing despite some success with more limited systems in a couple of provinces.

[Really_Not_All_That_Bright]

@JackieLikesVariety

the way forward is state by state - like Canada and it’s provinces. it will work in California and eventually it will work everywhere.

hopefully before I get a lot older.

A state-by-state system will simply incentivize those with high healthcare requirements to move to states with generous benefits.

[elbows]

Or demand change in their own states.

[CarnalK]

@Really_Not_All_That_Bright

A state-by-state system will simply incentivize those with high healthcare requirements to move to states with generous benefits.

Incentives don’t mean it will happen to a degree worth abandoning the project. Governments often try purposely to set up incentives without intended behaviour changes happening. No reason to assume an unintended incentive will prove disastrous.

[up_the_junction]

@elbows

Countries that held out for single payer did so because their cultures valued inclusiveness much higher…

‘countries’ don’t hold out. Political parties make an offer to the people at election time - this is how we propose to spend the taxation. Example: 1945 UK election Winston Churchill didn’t offer UHC and he lost in a landslide.

Most countries both main parties offered variations on the theme. The USA is so rigged none did.

[PatrickLondon]

@up_the_junction

‘countries’ don’t hold out. Political parties make an offer to the people at election time - this is how we propose to spend the taxation. Example: 1945 UK election Winston Churchill didn’t offer UHC and he lost in a landslide

All parties were committed to some sort of national health service along with implementation of the rest of the Beveridge Report, though none gave, by today’s standards, any clear details as to exactly how they would do it. His wartime coalition had done some preliminary planning work, but hadn’t got very far (it was one of his supporters that first suggested that all GPs should be salaried employees of local government, which went down like the proverbial, whereas Labour settled in the end for their being independent contractors).

His party lost the 1945 election because they were identified with the general social and economic conditions of the 1930s and were thought mostly out of touch with the widespread desire for radical change; and he personally made it worse by opening the campaign with a claim that Labour’s plans (his wartime coalition colleagues, note) meant the introduction of some sort of Gestapo.

http://www.politicsresources.net/area/uk/man/con45.htm
http://www.politicsresources.net/area/uk/man/lab45.htm

[race_to_the_bottom]

The US spends 17-18% of GDP on health care. The system is a nightmare with thousands of insurance company bureaucracies to deal with, outrageous prescription drug prices, all kinds of co-pays and deductibles, insecurity, hassles, tens of millions without insurance, medical-related personal bankruptcies, and an enormous burden on individuals and employers to keep up with the ever increasing costs and hassles in dealing with the system.

Meanwhile, other countries spend about 10% of GDP and have universal health care akin to the Medicare for All single payer system proposed for the US. This seems to me to be one of the biggest no-brainers of all time. Yet, it gets nowhere. You would think that EVERYONE except insurance companies, pharmaceutical companies, and the health care “industry” in general would be on board and there would be a irresistible tidal wave of support. Apparently not. How come?

[jasg]

@race_to_the_bottom

Yet, it gets nowhere. You would think that EVERYONE except insurance companies, pharmaceutical companies, and the health care “industry” in general would be on board and there would be a irresistible tidal wave of support. Apparently not. How come?

Those you mention have better lobbyists and propagandists.

[Evan_Drake]

And because ordinary Americans are persuaded it is a far better position to be bankrupt and dying, keeping a noble independence, than to submit to the evil tyranny of the State.

DEATH PANELS !!!***

[up_the_junction]

The great irony is the USA is the only first world society in which life expectancy is declining - so you don’t even need death panels, just residency.

[gaffa]

@race_to_the_bottom

The US spends 17-18% of GDP on health care. The system is a nightmare with thousands of insurance company bureaucracies to deal with, outrageous prescription drug prices, all kinds of co-pays and deductibles, insecurity, hassles, tens of millions without insurance, medical-related personal bankruptcies, and an enormous burden on individuals and employers to keep up with the ever increasing costs and hassles in dealing with the system.

Meanwhile, other countries spend about 10% of GDP and have universal health care akin to the Medicare for All single payer system proposed for the US. This seems to me to be one of the biggest no-brainers of all time. Yet, it gets nowhere. You would think that EVERYONE except insurance companies, pharmaceutical companies, and the health care “industry” in general would be on board and there would be a irresistible tidal wave of support. Apparently not. How come?

A friend of mine is a dentist. He had an office staff of four people just to deal with insurance billing. He decided to concentrate on on Medicare/Medicaid. Now he has one billing person since they only have to deal with a single form and coding, and say what you will about the government, they pay their bills. Also, since he’s apparently the only dentist in his state who accepts Medicare patients, he has more work that he can handle. Also, the work is a whole lot more rewarding - relieving pain, improving quality of life and even making people employable. And, since his office costs are so much lower, he’s making more money.

The general public aren’t the only ones who have been sold a bill of goods and have been convinced to vote against their own self-interest.