Universal health care in the US and elsewhere

In My Humble Opinion
21

Most UHC systems are fairly recent, a lot were created in the 70s and 80s.

A big reason the US can’t get one now is our health care is 18% of the economy. Back in 1980 it was only 9%, around 1965 (when medicare and medicaid were created) it was around 6%. It is easier to totally revamp something that is 6% of the economy vs something that is 18%. Also back then business interests weren’t nearly as powerful.

A big reason the US doesn’t have one is the US has very anti-statist attitudes due to our anti-communist history. Plus the US is heavily divided by race and class, any attempt at UHC is presented to whites as ‘you have to pay so nonwhites can see a doctor’ and presented to the working class and middle class as ‘you have to pay so poor people can see a doctor’. These divisions of white vs non-white and middle class/working class vs poor help stop any health reform.

22

I would quibble a little with that description. Relative to human history, that’s “fairly recent” but in the context of modern medicine much less so. Washing your hands before wound treatment and childbirth wasn’t general practice before the 1880s for Pete’s sake.

23

The problem with that is that the states won’t be able to pull it off. Let’s say California passes Universal Health Care and Missouri doesn’t. My seven year old gets leukemia, and treatment will run $1M. I pack up and move to California. Non-residents moving in will bankrupt the systems. You could put in a residency requirement, but even that is going to be problematic, since chronic medical conditions require YEARS of treatment.

24

Why hasn’t it bankrupted Canada?

Because residency requirements are actually very effective. Few will wait a year or more for treatment.

The real issue is that states can’t hide costs as effectively as the feds. Single payer can’t work if people know the cost.

25

I think another factor that isn’t talked about much is the speed of health care innovation. Back in the 60s and 70s isn’t wasn’t clear to most people that there would be brand new innovations that governments could not afford. Few people are scared about breaking a leg or even getting chemo. It’s being told there’s a $100,000 treatment that can save them and they won’t be able to afford it. Then national health care comes around and… they still can’t get it because the government can’t afford it.

This problem will really come into focus when anti-aging drugs come out. Rich people will be young forever and the rest of us will age and die, because there is simply no way to give all 300 million Americans something so cutting edge. Maybe 50 years after the technology first surfaces it will be cheap enough, but in the first few decades every single non-violent death will be preventable and we won’t prevent it due to cost.

26

As opposed to being self-reliant and looking though the couch cushions for that pesky $100,000 ?

27

Shortly after my sister in law’s father was diagnosed with ASL, SiL’s parents moved into her house. A pretty logical move when your daughter happens to be a doctor. As our region’s social services for families of long-term patients were much better than those of their region, and as SiL-Dad was an asshole, he enjoyed gloating about getting such better services.

Until he found out about residency requirements. Oops and excuse me while I laugh discreetely. He did get those better services, eventually - but it was eventually.

28

That’s not the choice though. The choices are between being in the same pool with everyone else, or having a job that actually does put you in a privileged position vis a vis health care, which many good union jobs do.

29

Because all providences in Canada have a minimum level of health care that reduces the need to move to get any at all.

30

Providences?

Health care in Canada is a Federal system, but administered provincially. I don’t believe there are any considerable differences between coverage in Newfoundland and British Columbia.

Sent from my XT1635-02 using Tapatalk

31

This being IMHO, I can give my opinion that the main reason there was and is so much resistance to social welfare of all kinds is the widespread belief that the main beneficiaries will be them. Blacks, Hispanics, whatever group you think is milking the system. And health care is one of the main ones. When Canada introduced its medicare (each province has its own although the federal government enforces minimum standards) medical care was much cheaper. And much less effective. All this life-saving technology doesn’t come cheap. The costs grew here too, but not nearly as fast as in the US. There are several reasons for that.

Most important, there are no profit-taking organizations. Hospitals in the US used to be mostly municipal, religious (I and my sibs were all born in Presbyterian hospital in Philadelphia), or attached to a medical school. There were for-profit hospitals, but in Philly, at least, they were a small part of the mix. Insurance companies collect a lot of that 18%. Doctors and insurance employ a huge army of leeches called coders that mostly are engaged in combat against each other and we all pay their cost. Nothing like that exists in Canada.

Malpractice. Not only do doctors have to pay a lot for their insurance, but they practice defensive medicine at great cost and some harm to their patient. They get can sued nonetheless any time the outcome is bad even though they can prove they followed the best practice.

The cost of a medical education. I believe that a year of med school at McGill is the same as the cost of any other program, maybe $3000 for a resident of Quebec, somewhat more for an out-of-province Canadian and something like $12,000 for a foreigner. My DIL, after borrowing money for her first two years of med school in the US and getting a public health scholarship (taxed in full!) for her last two years, ended up with a debt of $150,000. She went into family medicine anyway and is still paying down her debt 18 years later. Imagine if she had a debt of $300,000. She would have had to go into some high-priced specialty.

32

I never thought of it in precisely that metaphor, and now I can’t stop chuckling at the images it conjures up!

:smiley:

33

No, that’s not the reason. There are residency requirements, but the coverage is portable and universal between provinces.

If I pull up stakes and move from Saskatchewan to Alberta, yes, there’s a three month residency requirement before I get an Alberta health card.

But that doesn’t mean I pay for health care myself. During that three month period, my Saskatchewan health card covers me for medical care in Alberta.

Alberta then bills Saskatchewan for my medical care during the transition period.

So no, the waiting period doesn’t deter people from moving to another province.

The real reason that portability doesn’t bankrupt our Medicare system is pointed out by Dangerosa and Leaffan: there isn’t a great deal of difference between the providences … er, provinces, in the medical coverage. They’re all subject to the Canada Health Act rules, and generally provide the same level of service.

If a treatment is available in Province A that is not available in Province B, and a resident of Province B needs that treatment, the Medicare system in Province B generally pays for that person to get that treatment in Province A.

This issue normally comes up with the smaller provinces/territories, like Prince Edward Island and Nunavut. Given their population, they just can’t cover the full range of medical services that larger provinces can cover. So the medicare systems in the smaller provinces and territories will pay for their residents to get that health care.

For example, it came out in the trial of Senator Mike Duffy that he was concerned that if he kept his PEI residence, as required by the Constitution to be a Senator, that PEI hospitals couldn’t treat his particular heart condition. But the PEI Medicare system made an arrangement for him to get the treatment he needed in Toronto, paid for by PEI.

Another PEI example is that there are no doctors in PEI who perform abortions. But abortion is a medical service and therefore covered by Medicare. The PEI medicare system therefore pays PEI residents who want an abortion to have it done in the neighbouring province of New Brunswick.