So brilliant to see discussions like this finally happening.
Never mind all those contributions to their library or whatever, you got to hold the politicians to account. You’re getting a lousy deal for your bucks, folks.
That’s not true. There’s no reason doctors, labs, et alia couldn’t set up shop on their own. Don’t want to wait behind all of those critically ill or injured patients so you can have your elective surgery? Use your private insurance and go to one of them.
Actually, the government runs most things quite well. Maybe you think the VA and Midicare should be abolished and veterans and retirees should have to buy their own insurance? Get rid of Social Security and trust that people will save for the future? Turn over the national highway system to private contractors so that you only pay whatever the private owners want you to pay when you drive on their roads? Get rid of the FAA? I mean, who cares if there are rules prohibiting Free Americans from piloting an aircraft just because they have epilepsy?
Presuming you are right, the “non UHC” argument is that since Americans are currently paying for the research that allows other countries to free ride on our investment, we should continue paying twice what they pay to ensure the research continues.
Given how incredibly angry Republicans get when poor American Citizens get some free food, I find it amazing that they actively defend a system that gives Socialists across the world cheap access to health technology WE paid to invent.
Specifically, one side of the political spectrum
I think this is true to some degree, as it is also true to some degree that Socialists across the globe rely on US manufacturing as well. It’s nice that Belgium can negotiate a cheaper per unit cost for replacement hips from US makers, but how does Belgium get any replacement hips if no one in the US is making them. If it was cheaper to make them in Belgium, they would.
However, if Belgium couldn’t get any replacement hips from the USA, then they would start making them themselves (and sell them to the English for a BIG profit). Same with technology, if it wasn’t developed in the USA, then it would be developed elsewhere.
Yep, I can’t tell you how many times I regret Alexander Fleming discovered penicillin in a London hospital.
Or that DNA shit at Cambridge. I mean, really - we paid for THAT!!?
Another advantage of the USA system is that it’s far easier to raise capital, say to build the manufacturing plant for the Cure for Cancer. How long would it take to get the English government to appropriate a half billions dollars for such? How long does it take to print up 5,000,000 share certificates and hawk them for $100 each, and set the selling price to guaranty $10 annual dividend payment?
People will pay anything to save their lives …
Well, there’s the answer to the OP about one big reason UHC won’t happen in the US: this kind of appalling ignorance about how health care actually works in other countries.
It doesn’t work for anyone who’s grossly overpaying compared to anyone else in the civilized world, which is just about everyone. The fact that you’re used to being gouged doesn’t make it any more affordable, nor are the continuing cost increases sustainable. It doesn’t work for anyone who’s ever had a claim denied or treatment downgraded due to costs. It doesn’t work for those driven into bankruptcy from health care costs, the leading cause of personal bankruptcies. It doesn’t work for the uninsured, or for anyone affected by abuse/overuse of ER facilities. Put it all together and it pretty much doesn’t for anyone except the 1%.
Why don’t you ask whether someone might be willing to pay half as much for better outcomes? That’s the reality. The reality is also that costs are increasing so fast and so far out of whack with the rest of the world that the whole system is heading for a complete collapse of affordability.
Are you seriously suggesting that research and development and innovation in health care comes from insurance companies?
Actually a great deal of it comes from that allegedly incompetent government the other poster was referring to. Insurance companies contribute about as much to medical research as they do to health care itself: zero. The total measure of their value to society. Actually, their value is negative. If the government collected community-rated income-indexed premiums from everyone and just simply paid all medical bills – the classic single-payer model – costs would be cut in half, everyone would be unconditionally covered, and the insurance industry would cease to exist. That’s how awesomely useful this industry is.
My answer to the OP is the same one I already gave in another thread on this subject. When has any major health care reform ever occurred that didn’t have the support of the health insurance industry and that didn’t ultimately benefit them? The US will have universal health care when health care legislation is no longer dictated by the health insurance lobby, and not one moment sooner.
Right, like that piece of shit NASA moon landing thing.
Government can be effective, if it throws enough resources at a problem.
It is almost never efficient. Lots of different reasons for this.
Even if that’s true (and I don’t think it is, not entirely), so what? That’s how our system actually works, structurally. When you are the god king of the US and can rule by fiat then you can simply wave your magic fiat wand and impose whatever system you like. Working within OUR system, however, means working within the actual, real world gritty and dirty system of compromise that we have. The fact that the Republican party is against UHC by and large means that you need to work out a compromise with them (and their voter base)…either that or have such a crushing and overwhelming majority opinion that you can go against or around them without worrying about either what they think or the pendulum swinging back at some point and them undoing what you’ve done (or, more likely, watering it down to make an even more confusing mess than we already have).
Sorry, folks, but that’s the real world we live in and the real system we have.
[QUOTE=Lightnin’]
UHC can work anywhere else, Except America. Because reasons.
[/QUOTE]
Yeah, that reality stuff…such a bitch. 
As to the OP:
I think most of them are structural. The system we currently have has evolved over decades and become ingrained and entrenched. For most of that time it’s worked good enough for most people so there hasn’t been, until fairly recently, and big push to change (by which I mean something on most peoples radar to change it…of course there have been groups that have wanted either structural changes or systemic changes across the board for a long time).
I think to address them you have to first make people aware of both the flaws of our current system (which are myriad) as well as lay out a proposal that gets us from where we are to where we want to go, what it’s going to cost (realistically) and the roadmap on how we do it. You need to get enough people behind you and get people on both sides of the political isle (i.e. in both of the major parties plus independents and unaligned) to be discussing it and to want a change. Either that, or do what Obama et al are actually doing…make small but hopefully meaningful structural changes that put us on an eventual path to a systemic new system down the road. This way will be a lot slower but it will acclimate people to the new system (which, eventually, will simply be the system that they know and are comfortable with, as they are with the current system) where you can, again hopefully, make more small but key changes from there until eventually we have migrated to the new system without anyone really being aware of all the messy details. It will also spread out the pain.
Unless one of the parties gets such an overwhelming majority that they can essentially do whatever they want however they want to do it and are comfortable enough in their majority that they know that years down the road they won’t lose that majority and have everything they have done reversed or watered down it’s the only way that works in the real world with our real political system. I think we are already on the path, and like gay marriage and marijuana legalization I think that the attitudes of the voters has shifted and continues to shift that it’s inevitable we will go that route. But it’s not going to be instant or even something that will happen suddenly across the board…it will be a gradual progression that, once a certain point is reached will pick up speed and become a major shift to the new system or new attitude.
I think those are the talking points that the various political sides use, but I don’t think they are the main issues. In the end, and IMHO it’s about the attitudes of the voters (and how those voters are distributed in the various districts, cities, towns and states) and how willing those voters are to vote on this issue not just on one side of the political fence but on both sides, because to REALLY do this you have to have buy in from both parties. It has to be something that is so ubiquitous in the public’s narrative that it’s a no brainer…of COURSE we need this and both sides are basically fighting to ensure that they are the party that brings it to the public or supports it, and taking an opposing position is seen as being fringe. On UHC that hasn’t happened in the US…yet. But that’s what it’s going to take if you wanted to do it quickly. Or, like I said, you do it the way Obama has mapped it out. Slow and, hopefully steady, without a lot of backsliding or watering down. That’s my own main fear is that even the small changes he made will be watered down and changed so that what we get is a further mess. It’s one of the major problems with a compromise system such as ours when the parties are in direct and heated opposition.
When it comes to healthcare, it is almost impossible to be less efficient than our present system. The US spends more on healthcare administration alone than the entire UK healthcare budget, including private supplemental health insurance providers.
Blue states can implement health reform. Making it so insurance companies cannot weasel out of paying their bills, making prices transparent, creating a public option, etc. And they generally choose not to.
Yes there are definitely areas for possible efficiencies, but to say that a private system must definitely be less efficient than a government one, without any hard data, is tough to swallow.
As an exec with a Federal contractor, I see the Feds in action all the time, across many different agencies. Although they are getting better at innovation, usually via IT (check out the VA here http://fcw.com/articles/2015/06/12/va-health-record-system.aspx?s=fcwdaily_150615 )
there are systemic blocks as well, just like the private sector. Without a profit motive, Feds are usually incentivized to reduce risk and/or keep their butt safe, as opposed to innovate. Also, the FAR forces a very inefficient process for acquisition, which is the main thing that govies do. There’s a good reason for this (not allowing some bureaucrat to buy stuff from his brother-in-law at inflated prices, for example).
Except that our present system is less efficient than Medicare. (Sources linked on page.)
[quote]
Medicare Has Controlled Costs Better Than Private Insurance.
[ul][li]According to CMS, for common benefits, Medicare spending rose by an average of 4.3 percent each year between 1997 and 2009, while private insurance premiums grew at a rate of 6.5 percent per year. (See Table 13)[/ul][/li]
<snip>
Medicare Has Lower Administrative Costs Than Private Plans.
[ul][li]According to the Kaiser Family Foundation, administrative costs in Medicare are only about 2 percent of operating expenditures. Defenders of the insurance industry estimate administrative costs as 17 percent of revenue.[/li][li]Insurance industry-funded studies exclude private plans’ marketing costs and profits from their calculation of administrative costs. Even so, Medicare’s overhead is dramatically lower.[/ul][/li][/quote]
Maybe I’m not very good at math, but in my mind 2% overhead is better than 17%, and a 4.3% cost increase is better than a 6.5% one.
Good point, and something I hadn’t even thought of. If the most liberal states in the country haven’t set up their own UHC system, why would anyone think the country would do it first? Seems to me we’d see it set up in MA, NY, maybe CA long before it was instituted by the federal government.
No?
For those who think that private insurance, and the health industry writ large, is making a killing, you might find this piece interesting
Anytime you see “Contributor” on Forbes, make sure you mentally add “without fact-checkers and editorial oversight”.
Perhaps this article is better but I would be surprised.
The numbers are from NBER. Surely you’re not suggesting that they were cooked. (and no, I’m not calling you Shirley)
Anyway, read the piece.
If the private insurance and for-profit health industries are making mediocre profits, can this not be attributed to their inefficient business practices vs. single-payer as cited above? And if they are incapable of being profitable, do they not, under the Holy Free Market, deserve to fail?