What do people actually want from healthcare?

Going through some backlogs of Left, Right, and Center podcasts, someone made a claim that what people in general want from healthcare is mathematically impossible. Couldn’t find a transcript but she basically claimed that people in general want a plan that costs about as much as their cellphone bill, covers all the tests and catostrophic care they want, and have their care take place in idyllic American hospitals and not dingy wards like what’s in the UK under their NHS. She then went on to explain that politicians will promise this impossible ideal to get elected, push something that is not that ideal, then try to blame it on someone else that they couldn’t push through their ideal.

Do you all agree that this is what people in general want from healthcare? If not, what do you think people are looking for in health care? What are you looking for from health care?

I’d like to get a free MRI scan whenever I have a slight headache, but that’s just me.

I can’t speak for “all people” any more than the “someone” you are referring to can. But I think at a minimum, you should be able to see a doctor for most routine sicknesses or injuries without it being prohibitively expensive for anyone who doesn’t make six figures.

One of the big problems with our health care system is how treatments are billed. For all intents and purposes, the cost is “random”, based on how much the doctor or hospital thinks that can recover from the insurance company.

It’s also disingenuous to say we “can’t afford it” when conservatives want to build a trillion dollar wall or spend billions making stealth fighters to presumably use against either our largest trading partner or for blowing up Toyota trucks in the desert.

I’m not American but the easiest answer is that you can point at any number of UHC systems across the world and say

“That one!”

And I guarantee that it will offer better coverage at a lower cost with better outcomes for more people. Many even allow you supplement the standard free coverage with private cover as well and even that in total will come to less then the USA pays now.

People may say they value hospital aesthetics but I don’t think it would be a big factor in reality. The mathematical impossibility for me comes from the current number of trained health care workers versus the quantity of healthcare people say they want. There aren’t enough people to provide it and there isn’t the training pipeline to provide the extra demand were UHC to become a reality. We’d save lots money on administrative costs but the insurance admins aren’t fungible with doctors and nurses and techs, although certainly some of them would find jobs with the UHC administration.

Oh the blasted hellscape of the NHS. http://ca.archello.com/en/project/queen-elizabeth-university-hospital-glasgow

Americans are just weird.


American health care: “I’m all right Jack, keep your hands off my stack.”

If it’s so mathematically impossible, then why does every first world democracy have single-payer healthcare plans?

They want
[ol][li]The best health care in the world[/li][li]Available to everyone, and[/li][li]At a reasonable price.[/ol]They can have, at most, any two of these.[/li]
Health care costs are increasing in Europe as well as the US, and for the same reasons. European health care systems are going up from a lower baseline, mostly due to different demographics, expectations, and because the US spends more money on marginal cases and new pharmaceuticals.

We are going to have to ration care, either de jure or (more probably) de facto. Or continue to listen to politicians who say that our premiums will go down by $2500 a year if we increase demand and mandate coverage, or if we subsidize costs, or if we…

It’s too bad, but we will need to say “No”. We won’t, or at least we won’t vote for anyone who says we need to, but we still need to.


Depends on how you define “price”.

We seem to manage to have highways that are [ol]
[li]Mostly level and straight and kept well-paved, with clear signs, lane markers, and emergency services on patrol[/li][li]Available to everyone and[/li][li]Completely free *[/ol][/li]
But “free” really means “paid for via taxes”.

What I think you cannot have is

[li]The best health care in the world[/li][li]Available to everyone[/li][li]At a reasonable price to the individual[/li][li]With no new taxes to pay for the above[/li][/ol]

Political priorities.

I do think that to some extent the service-marketing modality of American health care could be constrained or eliminated, and that doing so would reduce waste and hence reduce the necessary price/tax.

  • May not apply to the state of New Jersey

I don’t think anyone expects that out of a UHC system (as opposed to a crazy-expensive private hospital), but they do expect that if there is a common, well-known, proven treatment for a common, well-known disease, they will have it.

Other countries with UHC do not have these “ZOMG we can’t afford a private hospital bed and Mayo clinic surgeon for every patient in the country, therefore we can’t afford to provide insulin to diabetics at reasonable cost” problems.

Somehow only providing care to those who can afford it doesn’t count as “rationing”. The theoretical dystopian hellscape where there is “de facto rationing” is the present day United States.

UHC systems do make choices about care (although not nearly as much as you think), but even if no one is individually making a choice, a choice is nevertheless being made.

Here’s what I want in terms of healthcare.

I want assurance that if I get seriously ill or injured that I won’t be financially destroyed. I want access to healthcare for ordinary illness or injury at a reasonable cost. I’m not even looking for free but a doctors visit and a weeks worth of pills for a sinus infection shouldn’t set me back $500.

When I was young and uninsured back in the 1980s here’s what happened when I got sick. I looked in the phone book and found a conveniently located doctor and made an appointment. The appointment would cost about $40 and I would get a prescription that would cost $5-10. Granted, these are 1980 prices but the idea of full self-pay at a reasonable cost would work for me but it’s impossible under the current paradigm- self-pay patients are steeply overcharged because insurers demand steep discounts of “retail” prices so the retail prices end up inflated, also the self-pay patients than can actually pay subsidize the ones that can’t.

I’m not looking for a free ride and even though I have insurance I maintain an awareness of the actual cost of medications and treatments ( not just what I pay ) and if I think something is outrageously priced I’ll find another option. This drives my doctors and pharmacists crazy although they admire it in principle. There was a time when I had a lot of itching in my ears that was not the result of any infection. My doctor prescribed an ear drop that consisted of hydrocortisone and acetic acid ( white vinegar ). And I would have paid a $20 copay for an ounce of this and my insurer would’ve paid $200. And I said no. And I went to CVS, picked up 6 bucks worth of supplies and mixed up an equivalent.

But most people don’t feel the way I do.

Yeah, it’s really bad here, surly staff, grey institutional walls and only groats for meals.
The worst is when a team of death panel official patrol the wards, patients shrinking under the covers when they glimpse their plague-doctor goose-beak masks ( to prevent identification ) and ground-length leather coats — and heaving a temporary sigh of relief to see them pass along to less fortunate folk, and pass along the beds occasionally tapping the metal bed board with a white ash wand to indicate they are to cease treatment and be taken around the back. The hospital porters waiting with lethal drugs and clubs.
Such, such are the horrors of socialism.

Holy fuck that made me laugh. :smiley:

Here in the UK (and no doubt in most other countries with UHC) you prepay through taxes and get such treatment for free.

Towards the end of their lives my parents had several serious illnesses (from Parkinson’s Disease through Macular Degeneration to Bowel Cancer.)
Their treatment cost nothing (prepaid through taxes.)

I’ve recently had a lengthy series of hospital tests for Bowel Cancer (thankfully all clear) and that didn’t cost me anything either.

That’s here in the UK under under the National Health Service.

Whenever I visit the USA, I take out $1,000,000 worth of health insurance (this is a UK Government recommendation.)
The last time I was there I injured my toe slightly.
Having a doctor clean the wound, apply disinfectant and bandage (taking 5 minutes) cost $450.

America is a great country in many ways, but really needs a decent health system.

Healthcare. That’s what people want. Not insurance, subsidies, health savings accounts, HMOs, FSAs, PPOs, high deductibles, low deductibles, catastrophic coverage, employer mandates, individual mandates, etc. They just want to see a doctor when they’re sick, and to receive the treatment they need to get better, or to avoid getting worse. And they’d also like to see their families, friends and coworkers get the same.

Maybe not coworkers.

I’ve been living in the US for 40 years and I still miss what I had when I lived in Canada for just 5 years: Go to any doctor, show them your provincial Medicare card, and poof! It’s all taken care of. Yes, of course I know taxes pay for it, but out of sight, out of mind.

True. I don’t think the distinction between “a reasonable price to the individual” and “increased taxes on someone” is maintainable. Taxpayer-funded healthcare is no different than insurance - on average, those who are covered have to pay for more than they consume. Otherwise there is no way to pay for those who consume more than they pay.

I think Americans would expect to get the same level of health care that they do under their present insurance, from any new system of health care. That’s how Obamacare was sold - we were going to cover lots more people, if you like your plan you can keep it, and your premiums would go down by $2500 a year.

To be clear, Trumpcare is not going to do any better.

I would say it does - just not very efficiently.

But if we were serious, or if the public were ready to accept serious discussion on health care, we would need to ration care as much, or more, as we do now for those who use Medicaid or charity care.

Everybody involved in the healthcare debate in the US is selling something.

Even me.


I’m serious about discussing health care. So what would this look like, under ShodanCare?

This, exactly.

There are a lot of problems which, genuinely, are difficult problems in that no society has really found the solution yet. “How do we solve climate change” is one. “How do you combine technological progress, economic growth and full employment” is another. I’m pretty certain that the solution to the last problem isn’t going to happen under capitalism but I don’t know what the solution will look like, exactly, because no society has solved the problem. Health care isn’t in that boat- there are plenty of countries with universal health care today, and they generally spend less on health care with better outcomes than we do.