actually, the supreme court has ruled there is no “right” to education
I thought the best method for that should have been that the penalty for not joining was that you were automatically enrolled, and the premiums come out of your taxes. The penalty for not being able to afford the premiums really just annoyed people.
You can call it what you like but it doesn’t make it so.
I can call the police force a “commodity” or the armed forces, or the roads, education or the fire services. It doesn’t mean that they actually are a commodity or can realistically be treated like one for all the reasons I stated in my original post.
really…do you have a cite for that?
The issue is not whether or not you call medical care a commodity or something else, it’s what is the most efficient and effective way of making it available to as wide a number of people as possible, as conveniently as possible, at the point they need it.
Pooling resources, whether through insurance or taxes, is the route most societies have gone down: but the question is whether you get the best results from treating that pooling through insurance as an open-market commodity, with the end user free (which for many would actually mean “compelled by circumstances”) to decide what sort of pool to buy into or whether to buy at all - bearing in mind the imbalance of information between purchaser and provider, and the imponderables necessarily involved.
If I’m buying food or a car then I’m buying a commodity and treating those items as a commodity works perfectly well.
The same cannot be said for healthcare. The number of people who *need *a Ferrari are far outnumbered by those who merely *want *one. This situation is reversed when considering a kidney and in only one of these scenarios is a person’s life in danger through not getting what they want or need.
And anyway, there is no such thing as not allowing people to buy-in at all, not unless you are prepared to leave car-crash victims dying in their wrecks because they have foregone health insurance. Ultimately everyone will need medical attention whether they’ve paid for it or not.
(Unfortunately, even as write this I get the feeling that an uncomfortably large, vocal minority would be happy to deny *any *sort of treatment for the uninsured)
Well, in Spain we do have medical-services-related fraud, but it’s mainly in the form of “private insurers using the public system and trying to bill as if they’d provided the services themselves”.
Other issues linked to whether certain uses of the system are kosher or not include:
1.- people living abroad (i.e., not contributing into the system) using our services.
1a.- people living in other countries which are part of European Social Security. BEEP, error, these people are contributing to the system! Not directly, but through the exchange set up between all contributing countries, so while one may complain about details of access, these people are contributing.
1b.- people who come to visit their immigrant relative, and who go to the doctor under their immigrant relative’s access. How is this different from my maternal grandmother never paying a penny into the system and getting full access? Oh, for her it’s ok because she had a local accent? Fuck that.
1c.- healthcare level differentials. That happens internally as well, the solution goes through a better use of the exchange and a better harmonization of services.
1d.- fucking stupid tourists doing fucking stupid things and breaking their fucking stupid skulls, but sadly not so much we’re not required to heal them. The Brits are already telling their own people “dammit guys stop making the whole country look bad”, but they’re not the only ones sending that kind of people, just the ones with the reputation.
2.- companies paying less into SS than they should. This is part of general tax-evasion issues and handled by the same people. Whether they’re called IRS, Treasury or Hacienda, pissing off the taxman is never a good idea. Ask Al Capone if you don’t believe me.
Totally missing the point again, I see. The primary health care debate isn’t about the medical services side of it, it’s the question of accessibility and therefore a question of how it’s funded. Police officers, firemen, and public school teachers don’t work for free, either, but we’re not called upon to pay out of pocket or via private insurance whenever we need their services. Doctors need not be public employees as in those examples, although some countries have chosen to do that; others simply pay their fees as private practitioners out of public funds.
Thousands of Americans die every year from lack of health care because they can’t afford the health care they need and so they don’t have access to it. It’s not because doctors and hospitals are failing them, but because their government is failing them, and specifically, they are victims of a right-wing ideology that objects on principle to public services, and treats health care as if it were a discretionary commodity. Yet because everyone needs health care, the logical, efficient, and humane way to pay for it is to treat health care coverage for medically necessary services as a public service available to everyone, like police and fire services and public education.
No, the people who were arguing about whether or not it’s a commodity are the ones missing the point. Having that argument at all allows the hard-right to continue opposing anything and everything that’s been done to make healthcare more accessible in the US. You can call it a right or a commodity or even call it “James”. It doesn’t matter. The fact is that the US has 9% who are uninsured, who could get insurance if we did a few technically easy things with the ACA. We wouldn’t have to monkey with the insurance for others that already have it, and we wouldn’t destroy our budget.
I’m not arguing about whether it is a commodity, I’m telling you that it isn’t. If you treat it as if it is you’ll end up creating a bad system because healthcare just doesn’t work in the way that true commodities do. Now if you just label it as a commodity and treat it like it isn’t then fine, go ahead but I’m afraid I’ve lost the relevance of what you are saying.
Also, you seem to be labouring under the misapprehension that being able to tick the box “insured” is a worthy end goal in and of itself.
That’s a classic case of the of the metric driving the solution. I can create an insurance policy so cheap and useless that you’ll be able to tick that box for everyone and yet still not have moved the quality of healthcare for the poor not one jot.
nd I’m telling you that whether it’s a commodity or not is a distraction from the real issue of getting people insured, and making sure that there’s healthcare service providers getting paid.
Being insured is necessary without being sufficient, and it is a worthy goal to have everyone insured through either private or public means. The ACA put regulations in place so that insurance could be obtained with specific sets of benefits that are required to be covered, removal of lifetime caps, removal of pre-ex exclusions, community rating, closing of the medicare drug donut hole, etc. We need to get people insured. And the ACA closed up a lot of the loopholes that insurers used in the past. I don’t say that getting people insured is the end-all, be-all. But it’s the first order of business, because having insurance is better than not having insurance (either private or public). Surely, you don’t disagree with that, right? We can get to UHC without single-payer. Other countries have done it, and so can we.
I don’t think you’re reading what I’m saying all that closely.
My original rebuke regarding “commodities” was not in response to anything you wrote. Feel free to ignore it but my point stands anyway. You are free to consider it a distraction if you like.
No I don’t disagree. Within the framework of your current insurance system what you suggest is making the best of a bad job and is probably the best you can hope for.
Sure a classic “single payer” is not the only way of doing it but I think your proposed direction of travel on this, though well-intended, gets you not far enough, not quickly enough, still entails massive political battles every step of the way and sacrifices a greater vision for the short-term tweaks.
I don’t think so, I’m clear on what you are suggesting and why. I just don’t agree.
Of course there is. But the system you have made, has a very large number of independent entities most with their own procedures and systems. Through those various setups move an immense amount of money each year. More than five times your military budget. There is no price transparency or set prices, charges tend to be negotiable, and there is a large asymmetry of information. It is not at all transparent.
This system is simply a far, far richer ecosystem for fraud than the more clear-cut and transparent setups out there. The issue exists in most setups, but is a far smaller problem in most western nations.
I am sure there is some fraud in the US High School system too, but how does the amount of dollars compare to the fraud in US healthcare?
There’s about 29 million uninsured in the US. Getting those people enrolled in something is a big step in the right direction, and would improve a lot of lives.
The massive political battles to get single-payer wouldn’t be worth the hassle. I don’t think we’d ever get it (aside from the fact that I don’t want it myself). And if we did, the sabotage from Republicans would be on a grander scale than it is in the current patchwork system.
So, I opt to keep what we have, and make my tweaks. But they’re not short-term tweaks. They’re for the long-term good, IMO.
People are self-centered: what’s in it for me? If you have good health insurance from your job why care about those people who don’t? Thus Republican support to get rid of Obamacare but no plan to get rid of Medicare (because everyone will get Medicare eventually). On the other hand Medicare for All offers something for everyone–for example universal provider coverage. So you are traveling and get in a car accident–and then get a $10,000 copay because the hospital is out of network.
But Medicare for all offers a lot more than universal coverage–it offers cost controls so health care doesn’t bankrupt the country.
Did you read the latest news today?
From here:
The ACA requires coverage for care you receive in an emergency room if it’s really an emergency. I suspect your car accident with the supposed $10,000 copay will likely be either a real emergency or an incredible lack of judgement on your part.
You are driving through on a green when a drunk flies in and t-bones you hard. Your leg is shattered, requiring traction and pins. Emergency care means stabilizing you, but the surgery on your leg would fall outside the bounds of emergency care because it is not immediately life threatening. You cannot realistically be transported 650 miles to your nearest in-network hospital.
This sort of thing could happen and probably does.
Bit of a whoosh, I think. There is no cost difference for emergency care (see here). So the $10,000 copay from the car accident was surely a result of you deciding to take care of a few other things when you conveniently found yourself at a hospital. (Of course, this is also unlikely as you probably exceeded your out-of-pocket max and the insurance company will pick it all up).
As an Australian I find this unthinkable.
This article is an argument for single payer but since this seems to be the active Healthcare thread, I will post it here.