Doesn’t matter to people like my parents, who have already made up their mind. Dingy hospital in Europe? UHC is to blame, obviously. Dingy hospital in the US? Just an exceptional case, and only poor people go to that hospital anyway.
This is true. Three years ago I had back surgery in what is often considered one of the foremost inpatient facilities in the northeast, if not in the country or the world. My room was dingy as all hell, not a bit of decor on the walls.
The country could do a lot worse than following the Massachusetts model - a generous Medicaid program used by 20% of the population - and other options under “Romneycare.” It costs a lot, but I think it’s worth it. Can you think of any other budget item that is more worth it?
They want free healthcare and then to scream at Uncle Sam when they see their taxes went up 20% to pay for it.
One thing they sure as fuck don’t want is Medicare-For-All, which is what single-payer without significant tax increases would look like.
One thing people really want is to know how much something will actually cost before any procedures or treatments are done. That is the way every other business and public service works but not healthcare. Not even the doctor or front office staff can tell you before you agree to it and it can be wildly different for different patients that get the same treatment or procedure. It could be $3 or $3000 but you won’t know until after you get your bill months later.
God forbid you say you want to pay on the spot (everywhere else loves that). Not doctor’s offices and hospitals. If you try that devious little stunt, you will usually get charged the exorbitant and fictitious “rack rates” that only exist so that they can always claim that insurance companies and, especially Medicare, are getting a “deal” (the latter is required by law).
I know it is complicated but, then again, so is Amazon and they, among many others, figured how how to price insanely complicated systems a long time ago. Some people claim that the U.S. medical system is a free market failure. It isn’t because it doesn’t work as a free market at all. It is constrained and artificially manipulated from all sides. If you let doctors and patients pick what treatments are the most cost effective and let doctors and hospitals compete for patients, you would get a very different result at least for non-emergencies.
Good examples are doctors that specialize in things like elective practice surgery and LASIK eye surgery. Patients generally pay for that themselves. They know how to give reasonable estimates, take personal payments and they compete among similar providers based on the cost and quality of their work. There is little reason that routine care and most surgeries couldn’t work in a similar way.
Breast augmentation and Lasik surgery each cost about $4000 on average. Good luck getting out of an emergency room with even a simple broken arm for a total cost less than that let alone something that requires actual surgery even though putting a cast on an arm is a relatively old and simple procedure.
Lots of good responses. I love hearing everyone’s opinions. While single payer is almost assuredly the way to go, us Americans tend to have a bad habit of obsessing over market based solutions.
With that in mind, i wonder what people think about the Singapore model. Not as am alternative to UHC, but as a model that could appeal to many’s desire for a market-based solution.
You claimed the costs were increasing more slowly, which isn’t true.
I also addressed the others - the US spends more because of different demographics, different expectations, we spend more on marginal cases, excessive torts, etc. Simply transplanting single-payer into the US is not going to cut costs down to European levels - unless we ration care.
Obama tried that already - we did something like the Germans do, and it was going to cover everybody and reduce - not hold steady, not slow the rate of growth - reduce the average cost of health care by $2500 per family per year, and no one was going to have to change plans. It didn’t happen.
Nor will anything else. Or rather, we could cut costs if we cut costs, as in not spend so much - reduce the payments to doctors so they accept fewer patients, reduce the range of drugs that can be prescribed, let Grandma die because she has pneumonia and she’s 80 already. If we do that, we could implement single payer and save money. If we don’t do that, implementing single payer is not going to cut costs, and since health care costs are rising in Europe for the same reasons they are rising in the US, we will simply be overspending with a system different from what we have today.
It’s like the deficit - we can’t balance the budget unless we cut spending on things that people want the government not to cut spending on.
Regards,
Shodan
Something that’s been forgotten in all the hubbub, is that Health Care as a political challenge, is actually a sort-of accident.
The original concern, was for the bigger picture of the dramatic change from the seeming wealth of the late 1950’s and early 1960’s, to the frantic “stagflation” of the 1970’s, that subsided into the extended long decline of the American middle class into peasant status of today.
The original PROBLEM, was that the “solution” presented by the controlling Republicans, to the problems of the 60’s and 70’s, was to drive American wages down, to make American businesses more competitive internationally.
That naturally meant that the cost of living had to FALL significantly, and the single largest cost (housing) was verboten to address, because the bulk of the upper crust were making their biggest money from real estate related investments. At the same time, most American businesses were cutting costs by reducing paid benefits for workers, especially including health insurance.
Together, that translated that the SECOND largest and growing cost of living for most Americans, was health care. Politicians are willing to fight about that, hence the very long battle over whether or not to follow the path of the Europeans and others, and turn health care into a citizen/state funded service, or do something else.
All of THAT, is the only reason why this thread’s title question is being asked at all.
The reason I’m pointing all that out, is that most of the modern debate over health care, including in this thread, has been deflected by way of political gaming, until no one is looking directly at the real problems anymore. Republicans and Democrats are fighting over the SCRAPS AND EDGE DETAILS of a health care “system” which shouldn’t even exist, because it was never designed to deal with health at all.
What is being debated isn’t designed to get us healthy or keep us healthy. It has been designed entirely to set up a political football game, that all the players have now forgotten actually IS a game.
What should healthcare address?
EVERYTHING!!!
That people are sorting through and scrabbling over the limited list that the politicians have presented to us, is insane and pitiful.No; there are two, completely opposite, cases.
In Europe, the dingy hospitals are proof of Marxism’s flaws; you can expect that the doctors are also dingy, and operate with rusty scalpels. OTOH, the luxurious hospitals in Europe demonstrate bureaucrats suckling at the taxpayer’s teat, misspending their limited funds so that, again, the doctors have to operate with rusty scalpels.
In America, the dingy hospitals demonstrate the ineffable wisdom of the free market. Funds are not diverted for useless luxuries, so millions of dollars are saved to pay for salaries of essential professionals like accountants, insurance adjusters, and drug-promotion junket organizers. The luxurious hospitals, OTOH, are a tribute to the wealth generated by capitalism — the same wealth that lets every patient have an MRI or CAT scan available on a moment’s notice, or get brand-new patented pharmaceuticals ten times as expensive (and therefore ten times as wonderful) as the drugs used by Europe’s doctors and death panels.
Post-modern American thinking is easy once you get the hang of it.
What I want from a healthcare system:
Universal coverage: one system for everyone paid for with strongly progressive income tax, uncapped
Reasonable cost sharing, eliminated for low-income people
Splitting out social services spending into appropriate safety nets rather than having it bundled into the health system
Increasing said social safety net spending
Increased access to HCBS
Increased access to end of life counseling
Increased pay, training, and career ladder for home health aides
Investment in clinician training
Extension of CMMI payment reform models
Pharmaceutical negotiation
Increased federal spending on pharma research
Complete integration of mental health and oral health care into medical care
Extending push for rebalancing of institutional care
Enhanced care coordination
Reduced burden shifting onto patients and caregivers
Caregiver tax credits for lost employment time
Investment in PACE
That’s my starting point.
Kinda suitable the last president was not to be, as is traditional, a lawyer or a general, but a real estate tycoon…
Talk to the Kochs’ hand.
You addressed nothing. What “different demographics”? Do you mean this sort of thing, or can you actually cite something meaningful? Because UHC seems to work everywhere else in many varied demographics.
What do you mean by “different expectations”? People in the above-mentioned first-world countries have plain and simple expectations: when they get sick, they get treated, fully and completely with the best available skills and technology. No human being should ever expect less. Many Americans have to accept far less, simply for lack of money. It’s American expectations that need to change.
“Excessive torts”? That’s a classic right-wing bogeyman. Malpractice suites are an absurdity and a nuisance in the litigation-infested USA, but defensive medicine amounts to no more than 2.4% of health care costs.
And, once again, the German system is nothing even remotely like the US system. The German system is based on a sense of social solidarity in which 100% of the population is covered, and everyone not explicitly opting out – about 90% of the population – is covered by a common statutory universal health care system that is one of the oldest in the world. The Republican philosophy of health care spends most of its time worrying about the potential horror of “undeserving” people getting “free” health care while shoveling billions to totally useless health insurance companies for doing absolutely nothing except driving up costs.
Indeed. Though as I said in my post on this issue, the US folds social service money that we absolutely refuse to pay as social service money into health care. So our health care costs are inflated and our welfare costs deflated relative to most/all countries with UHC. This makes our numbers look worse and theirs better for the health care portion.
So part of any correction in our health care system has to be that we start pulling those social service funds back out of health care, where they are incredibly ill-spent, and start just adequately and appropriately funding social service.
TLDR: Part of our excessive health care cost is our refusal to pay appropriate welfare costs.
You will never reach a reasonable, realistic discussion on the issue if you repeat blatantly idiotic and dishonest things like this.
It was meant to express, perhaps hyperbolically, the biased view of some that there is this stark contrast between great American hospitals and rathole NHS wards. I was relating that expression by another from a radio program. I apologize if that was not clear.
It’s also worth repeating that the NHS is the furthest away from the USA of all the 20-30 first world models, so it’s necessarily the ‘go to’ choice for those seeking a dishonest contrast.
I think you said this very succinctly. I also completely agree with jsgoddess’s list as a great starting point.
I am one who currently profits from the existing system, but as I have noted elsewhere on this board, I’d happily forfeit my work to see a UHC system in place for the benefit of everyone.
[ul]
[li]As an individual, I’d like to not have to worry every time I saw a doctor that I was creating a new “preexisting condition” for health insurance companies to point to as a basis to exclude me from coverage should they ever regain the ability to do that. This had become such a concern pre-Obamacare that I told my doc I would not answer questions about any potential health concerns I had until I knew whether Obamacare would pass. This put us both in the awkward, Alice-in-Wonderland position of a doctor who was unable to provide honest treatment to a patient, and a patient who was afraid to share her true medical concerns with the doctor she was seeing. Does it get any creepier than that?[/li]
[li]For that matter, I’d like to see health insurance companies eliminated completely from having anything to do with basic healthcare coverage. They could still maintain a market to sell policies for above-and-beyond care, but not be part of the basic coverage system.[/li]
[li]I’d like to see profit and administrative costs eliminated from basic healthcare coverage. That alone would save an enormous amount currently spent on American healthcare.[/li]
[li]I’d like to not worry that I could lose everything I’ve worked for over a lifetime because of one significant health episode.[/li][/ul]
If Hillary had become President, her goal was to implement the gradual migration from Obamacare to UHC through expanding Medicare for those 50 and older as a public option. You can see where this would eventually go by gradually lowering the access age. By forcing health insurance companies to actually compete, they would have to become reasonable in their profit expectations or drop out of the market completely. Obama laid the groundwork, but the follow-through was for Hillary to do. And she would have.
As for “dingy wards,” I offer this illuminating article on the French system of healthcare, also frequently demonized as “evil socialism.” This story really stuck with me when I read it a few years ago.
That’s also true of Spain, France, Switzerland, the UK… now, because of the way the news work most people are likely to hear only of the ground-breaking stuff done in their own country or in the US and that means that if you’re in the US you only hear about one country. There is a third variant: news of “our researcher Joanne Fromaroundhere working in another country”, which in many countries leads almost inevitably to the usual lines about brain drain. Somehow I have problems picturing one of the American doctors that come to Spain to train being talked about in US news as a case of “brain drain”; I may be doing US news services a disfavor but I suspect it would be presented more as a case of “good thing our guy was there to save the day”.
This is another reason the ACA (and the ACHA) are and were flawed. You shouldn’t go after insurance companies whose job it is to defray high costs, you should go after the high costs in the first place.
Trying to get everyone insured is like saying, “Groceries cost the average family $300 per week. How can we get everyone couponed so they can get coupons to lower their cost to $150 a week?” You should instead be going after the high grocery prices so that even the non-couponed can get cheap groceries.