As the title states, I’d like to have a discussion about what the actual obstacles to universal health care are, and how to address them.
How do we go from an insurance based system to UHC?
Is it mostly about the money? If so, can we get into the nuts and bolts of what that means?
Or is it really about the quality of health care?
I recently made an appointment with a dermatologist and my wait time is better than three months. This isn’t the first long wait I’ve experienced with this particular speciality, so maybe we just have a shortage of doctors in this field, but I also have had very long waits to see two different ENT doctors, so long waits don’t appear to be unique to UHC systems.
The only way to get true universal healthcare would be for the government to take over the medical industry. Every doctor, nurse, lab tech, etc. would be a government employee, every hospital, clinic, etc. would be a government facility.
And we all know what a sterling job government does at running things.
Based on the health care systems of many other countries, they do a lot better than the private sector for providing health care to their citizens.
I think the only obstacle is political, and it is inevitable – at some point in the next few decades we will have a UHC system. I think one similar to Canada is most likely.
Our system is wildly overpriced. Getting uhc would be easier if we spent 11% of gdp on healthcare. We spend 18%. Getting the spending is hard at those prices.
There are financial groups opposed to it. The ama, hospital industry, pharma, medical device industry etc would all lose money and none wants that.
There is an anti-statist mentality in the US, and you can’t have meaningful health reform without the state involved.
The US has strong racial and cultural divides. Any attempt at uhc will be presented to ‘self disciplined’ white people as a zero sum. Game. Ie, why should you as a morally superior white person pay more in taxes and get fewer services so morally inferior non-whites, poor people and people who lack your moral fiber get more services and less taxes/expenses. It works.
Even in blue states where many of these issues are easy to control they cannot stop medical spending. Blue states do not have to worry about anti statist or angry white people voting them out of office. And with one party rule the power of money is diluted heavily. But even the west coast and northeast do almost nothing to reduce medical inflation. I have no idea. What the answer is.
Oh yes, the Interstate system, NASA, winning WW II, the Hoover Dam, TVA, Social Security, Medicare… what colossal failures those all were because of the government!
Money … multiply the share price by the number of shares issued by every publically traded health service corporation, add them up … well, not exactly chump-change. It’s not like this huge amount of money spent on health care is disappearing, it goes from your pocket into someone else’s …
All this complaining about the “high cost of health care in the USA” tends to come across as sour grapes … Merek could be bought at $30 a share in Sept 2011, today it trades at almost $60 a share … double your capital in fours years … PLUS 3.06% yield … [ka’ching] … I see nothing wrong with this system.
One of my co-workers is livid that he has to pay an extra $25 for his health care now that the ACA is in place. Completely ignores the fact that millions of people now have health care who otherwise wouldn’t; all he cares about is his $25.
Here’s the thing though; you don’t know his finances. It’s all well and good to castigate him for being more concerned with that $25 (a month, I’m assuming) than for the other people, but that $25/month could mean the difference between him being able to take his kids to the movies, take his wife out for a hamburger, or pay a bill, or whatever’s important to him.
And to him, it’s likely especially onerous because it was imposed on him from without- someone basically made a value judgment in his stead and decided that $25/month *that he earned *was better spent on someone else, than on him and his.
That’s kind of the crux here; a lot (the majority?) of people have employer-based health care, pay their premiums, and have adequate health care. Any sort of universal health care plan is going to essentially have to offer them more for the same amount of money, ***OR *** offer them the same level of care for less money. with “same level of care” meaning the same amount of choice, same amount of coverage, less wait times, etc…
TL;DR: For the majority of people, the current system works, and universal health care is something that will have to be carefully sold to them as something that benefits them, rather than just appealing to their sense of charity toward people who they likely view as irresponsible, criminal, egregious moochers, or whatever.
XT has argued very persuasively in several of these health care threads that the real obstacle is the American political system. I don’t like that conclusion personally, but more and more I think he’s right.
Would a federally administered, universal health care system be constitutional? I honestly have no idea.
MIght we not see some for of UHC at the state level first, or would that be too difficult to do? Again, I honestly have no idea.
But I think the biggest obstacle, as noted above and assuming it IS constitutional, is $$$. A lot of people are making a lot of money off the current system, and they’ll be doing their best to keep it that way. As long as their is no groundswell to implement UHC, the $$$ is always going to win. Anyone wishing to implement UHC needs to get that groundswell going. Good luck.
Don’t mention how much more he pays than people in France.
The gov’t doesn’t have to take over the doctors, they would take over the insurance companies. One giant government operated insurance company paid with tax dollars instead of premiums. We already have gov’t operated insurance, it would “simply” have to be expanded to cover more people.
I agree that politics is the major stumbling block. There’s a group that feels the “free market” is more “efficient” despite the fact that huge honking amount of effort goes into managing the diversity of insurance companies, and managing the various payments into and out of those companies. It also ignores the stone cold fact that a country like Germany spends less per capita covering their entire population than the US Government already spends per capita covering a fraction of our population.
I don’t even think you have to go so far as to attribute motives to people. The current system works for the vast majority of the people. It utterly fails a minority of the people.
I wouldn’t describe that as poilitics, more like, reality. Would you be willing to give up 75% of your income for universal healthcare, all other things being equal? How about 50%? Somewhere there is a line where the majority of people will say yes, they are willing to give up that much. We are no where close.
I also think it would be persuasive if another country were to implement UHC, and have better outcomes across the board, including research and development, and innovation. No one comes close to the US in those arenas.
First, the government does a pretty good job running things that should not be for-profit enterprises, and sometimes even things that should.
Second, you don’t need to nationalize the healthcare industry to provide universal healthcare. Effectively, you only need to nationalize the health insurance industry. There’s this place where people say they do it that way. Perhaps you’ve heard of it: Canadia, I think it’s called?
I think this is an important point that is overlooked in a lot of the debate on this topic. We free-market types tend to be of the impression that we (the U.S.) are footing this bill for the world, and if we copy other countries then innovation in medicine will decline signficantly. Maybe we’re wrong, but I don’t see anyone making a good case to refute this notion. And if the answer is, “You can’t prove that you’re right,” then you’re missing the point: I’m not asking you to change anything. If you want us to support a big change in the structure of healthcare, then the burden is on you to convince us.
Remember, for those of us who are big on free markets, one of the reasons is that they “naturally” generate innovation.
One other aside: While the US system is not nearly as “social” as most other developed countries, referring to our existing system as a “free market” is a bit of an insult to free markets. When I deal with healthcare providers and insurers, I don’t feel at all like a customer with any “power”–I feel like someone dealing with a take-it-or-leave-it monopoly, much the same as when I deal with my cable company. My employer has selected the insurance provider/plan, and I can’t afford to just quit it and choose another…in a real free market, customers are much more free choose who they’re doing business with (and any time the answer is “take it or leave it”, real competition is missing from the equation).
As a libertarian, I’m not fond of big-government solutions. On the other hand, we’ve made such a hash of the provision/funding of healthcare services in this country, I find that I’m more open to alternatives. However, if you want to sell me on a UHC idea, the key is going to be convincing me that it will be a system that is at least somewhat subject to market forces, and that it will still encourage innovation (which means it will still allow innovators to get rich).
Also, critically, there needs to be some real thought about how government programs become a political football. I’m not real enthusiastic about the idea of Congress debating the relative value of medical treatments, particularly given how many of our representatives believe more in magic than in science.
If we’re throwing our money into a pool to cover scientific medicine, that’s one thing…but how long before my tax money is paying for chiropractors, acupuncturists, and holistic medicine? How long before Scientologists find a way to get their engram-clearing crap onto the list?
The current system doesn’t do much to reward useful innovation, either. Nonprofits drive most real innovation. For-profit pharmaceutical companies reap much bigger rewards by developing drugs that manage disease processes, instead of curing them. That’s why we’ve developed one new antibiotic in 30-odd years, but dozens of boner pills and anti-depressants. It’s just one more reason why healthcare should be seen as a public good.
Someone should let the Germans know that they are doing UHC all wrong. They still have all those pesky insurance companies, private hospitals and physicians associations.
ETA that this system is one of the oldest in the world. Teddy Roosevelt pushed for the U.S. to adopt that system but was shouted down by cries of “Socialism!!!”