I’m no expert on healthcare, and due to being somewhat healthy its policy has never been a very interesting subject to me. However, there are some things that don’t seem to compute in my little brain. I may very well have gotten one or more of these things wrong:
Americans in general are very sceptical to, if not downright hostile towards the idea of socialised healthcare. Because it is supposedly expensive and ineffective.
Americans pay more for healthcare per capita than any other country in the world.
America scores very low in international comparisons of the quality of their healthcare, preventable deaths and general health. It also has the highest infant mortality rate.
The countries that score highest, such as France, Spain and Japan all have socialised healthcare and/or universal health insurance.
So unless you’re a major stockholder of medical insurance companies, what’s your beef with socialised healthcare? And what’s so great about the current system if it costs twice as much and performs much worse than all the comparable ones?
First of all, let me say that I believe that almost all of the available data on health care which has been so far injected into the debate on UHC can and has been skewed to reflect whatever point you (the generic you) is trying to make, from both sides. I cannot find something comprehensive that isn’t shaded in some way. It’s driving me crazy.
To address your OP, I am approaching UHC from the viewpoint of my own life and future plans.
I recognize that there are too many people who can’t afford the healthcare they want. I understand that we need to do something as a society to fix it, but I also understand that society as a whole isn’t necessarily the smartest group of people as a whole. This make me wary of just covering everybody, since I don’t trust everybody to make good decisions about their health.
I have been very proactive regarding my healthcare - HSA, healthy eating, etc. I budget medical expenses closely. But, not too many people do that, and quite honestly, I don’t really have any extra money to spread around. We are solidly middle class, in a cheap area of the country, and there is no extra money for your health care. Sorry.
I have a one-woman business I’m working on out of home. It’s a nice niche kind of thing, and I am working hard to turn it into something good and profitable. But, now the idea that I have to project insurance costs into my employment budget (when I go above that $250K mark) makes me take pause, and may quash my ability to get any bigger. I would never be a bad employer - I am planning on hiring SAHMs who have kids are in school, with flexible work hours, and had considered offering a monthly deposit into an HSA in lieu of insurance. That seems like a good employment deal to me, when I was a broke SAHM. Now, not so much. There go those jobs.
On a philosophical level, I don’t see where it says that the government is responsible for any of that. I also think that constant entitlements eat away at the concept of charity, which is a super way to make sure that your money is being spent how you want it to be spent. I have a serious problem with the government swooping down and taking my money and pissing it away on anything it wants - it seems like borderline theft to me.
My perspectives on Health Care come from the following:
Personal Health Care Experience:
I have received medical care in the following situations:
Private care in the US with a catastrophic policy only. Paid for all care with cash, only had a policy in case of hospitalization. Had a private doctor who was thrilled to be paid immediately for services rendered.
Socialized care in the UK. I was an expat who paid into the UK system. 1 interaction with the system due to an injury did not impress me, but I also understand that I only had the single interaction.
Government care in the military. This was typically routine stuff (innoculations, physicals, etc.). VERY dependent on Corpsmen and DOs, few Docs.
Current employer provided plan (PPO/HMO combo with out of network reimbursements once deductible is met).
One-Off/Anecdotal Experience:
Wife worked in the VA system. Physician friends who work for Kaiser, State of CA, State of NV, and others.
Education and Work:
Consultant to physician offices in Southern California (finanial, business growth, etc.). Attended Health Care business and policy forums in Southern California for several years (http://www.merage.uci.edu/EventSites/HealthConf/2009Video/index.asp).
My proposal:
Combine Medicare, Tricare and the Federal Employee healthcare plan (including Congress) into one package. Determine an annual cost of delivery, and offer it to anyone who wishes to buy in. Have a sliding scale of price based on income (full price if you are rich, dropping down to nothing for the poor).
HOWEVER
Be prepared for rationing (either of time or type of services). Remember the Oregon plan? That was an example of how you deliver HC when resources are limited. You don’t do hip replacements for 85 year olds. You don’t do breast jobs for cancer patients (implants to replace breasts lost to mastectomy). You will also have to deal with a limited number of physicians willing to take these types of patients, and those that do will probably have to depend more on nurse practioners and less on Physicians.
In the long run, if you want to socialize medicine, you will have to come to terms with the cost of medical school. You can not have a doctor graduate with $200k in loans if you are going to pay him like an average government worker.
Nice, well thought out post. I too have had a small business and worried about providing health care for my employees.
The things that influence me are:
The problem when you switch insurance companies. If you get laid off and consult/start a small business you may be unable to find an insurer due to “pre-existing conditions”, or the cost may be very high.
There is a disturbing pattern of insurance companies accepting payments for years, and then when big claims arise go back and try and find any small problem you did not disclose when applying and canceling your insurance.
Doctor’s pay an enormous amount of money to deal with all the different insurance companies. When I was treated in France I went to see a doctor who had no staff other than himself in the office. Almost inconceivable here.
Small businesses and individuals pay higher rates than large corporations.
Unlike other countries, the US does not negotiate with drug companies to get better prices. This means the US is subsidising the rest of the world’s costs.
Not even if you end up saving money on your own, personal healthcare?
It’s my understanding that the $250k mark is profit, not the entire worth of the company. If you start making $250k profit, will providing healthcare for you employees really be that big a deal?
Do you feel the same way about the highway system, or law enforcement, or education, or the fire department? Or should those be handled by relying on the (uncoerced) charities of others?
My point of view- I’ve worked my way up from below the poverty line to being up near the top 5% or so. When I was a young adult, I had to endure at least a month or so of bronchitis every year because I had no insurance at all. I’m glad I never broke a bone, or contracted anything really serious. I don’t want anyone else to go through that, if I can help it.
I can’t really discuss my true views on health care in wonky political circles because they wouldn’t go over very well. For those situations I adapt and just regurgitate some safe democratic talking points, maybe cite some numbers that I only kind of understand. I really don’t comprehend many of the complexities of our crazy system and how it all affects our economic situation, yet my personal position couldn’t be clearer.
I don’t really care how much universal health care costs or what the downsides are. I do want to take care to accomplish it as effectively and productively as possible, but no stats could convince me that universal health care in of itself is a bad idea. For all I know the republicans are right and we can’t really afford it, nobody ACTUALLY knows. I just feel like if there is one thing that should not be a commodity subject to the whims of the free market, it’s our health. Ideally nobody should have to worry about dying because they can’t pay the bills, and in our rich and prosperous country there’s just no moral justification for it. The government should offer health care because they will not be driven by profits and everybody gets the health care that I view as a human right. It will be very far from perfect, but it will always be better than the alternative from a moral perspective.
That is a very simple and entirely emotional viewpoint, but i suspect that a lot of democrats (and republicans) feel exactly the same way, the rest is just a matter of how to dress up our rhetoric to make it seem like we are coming at it from a highly practical perspective. The opponents of public health care do have a lot of compelling arguments from the financial perspective (maybe it will hurt the deficit big time, maybe private companies really won’t be able to compete with the government plan and we march one step closer to socialism) as do the proponents (maybe the insurance bureaucracy is so inefficient that we are getting a really terrible value for our money that costs more than the public plan would), but the truth as I see it is that nobody really knows how well it will work until it happens.
What I do really object to are the few bits of rhetoric that are completely out of place in this discussion. That somehow the government will “come between” you and your doctor any more than the insurance companies already do. And the granddaddy of them all, the “but the liiiines” argument. First of all, in all likelihood we will not have the long lines from hell that opponents fear so much. Even if for some crazy reason we did, those who have money could afford the service they are accustomed to without waiting in the emergency room with the plebeians. Those who would not have insurance otherwise would most likely opt for a wait before health care to…you know…no health care. It’s not like the uninsured millions are going to all of a sudden say “Well I thought I wanted health care, but if I’d had known I would have to wait in a line…”.
There will be lines - since there are already lines. The question is how much of a line (or same day wait) is the American public willing to tolerate. When the retired have lines, it does not impact their paycheck. When people on welfare have lines (Medicaid), it does not impact their paycheck. If I have to take an entire day of work because of overloaded physicians offices - I have an issue and want to be able to take out my wallet.
When I developed a cyst that had some of the markings of skin cancer, I did not want to wait for a specialist appointment - and I did not thanks to my HC policy that my employer provides. If I had to wait months for the same appointment, I would not be happy.
That is a key issue, however. Some of the proponents of Government HC want there to only be ONE system. The UK has been allowing private care in addition to public care, and that is a model we would need to try to copy.
Would you be willing to buy into the Medicare system?
I approach it from the point of desperation: We cant keep having the kind of crappy service we have and still leave tens of millions out in the cold.
I am not afraid of “socialization”. I consider myself beyond the fear mongering tools that stem from the Cold War. I am also not afraid of “big government” because government can do some things well. Being a government employee myself, I know where the stereotype comes from but I also see contradictions to that epitaph everyday among my fellow hard-working co-workers
Things have to change, and I’d rather have change that’s not the best it can be than no change at all
Regardless of whether I can inflate the overall lifespan, etc. that doesn’t necessarily mean I should. I mean, if you really want the maximum -average- lifespan for the whole populace, your best way to achieve that is on a need-based prioritizing system.
Well in a need-based system, generally it’s going to be the people living stupid, unhealthy lives that are going to be in there. The person who lived smart, took care of himself, worked hard, and planned ahead ends up getting screwed. But, of course it’s very unlikely that we would ever go to a purely need-based system.
The reason we don’t go to a need-based system, is because it’s not fair to the people who did good things for society, who enable society to continue. But so that means that already, we and everybody else including all of Europe is saying, “Yeah you’re more needy, but screw you, work harder and live healthier.” So it’s not like they’re -actually- covering everyone and everything is ladeeda and as good as it can get from a purely statistical standpoint.
Sure we cover less than they do, but we’re all in the gradients of gray.
Personally, the only reason I see to cover the currently uncovered people is so that they’re not swamping the ER. Otherwise, I’d say that we’re doing as we should. To whit, there’s something there in an emergency. Yes, it sucks, but it’s -supposed- to suck. Otherwise what’s the point of advancing beyond poverty?
The performance is, probably, not all that linked to the cost. The US has some particular items which inflate the amount we pay like higher medical malpractice insurance due to the litigious nature of Americans, the higher cost of medical education, that we end up paying for most of the R&D costs of most of the world’s pharmaceuticals (which is admittedly somewhat related to universal healthcare, since a national health care can haggle the price down and thus not take on the cost), etc.
A lot of these can just as easily be fixed through alternate legislation like government aid in medical education costs, lower caps on malpractice payouts and/or stricter regulations on when and who you can actually sue, and tariffs on other governments for medical supplies from the US.
Yes we are talking about a public option since that is what is on the table. Once again I do understand that a long line is annoying at best or dangerous at worst, but either you can afford health care or you can’t. If you can pay then you can get the cyst looked at with the ease you expect, this is one of the benefits of having money . If you cannot pay and you have to wait for care, it’s not like you’re any worse off than you would have been if you didn’t even have the ability to wait in line for it. And yes people will lose wages and all that, once again that’s a necessary evil that most people would gladly accept over simply not having any health care. I just think all that long line stuff entirely misses the point, its always diversionary and sometimes alarmist.
And yes I would buy into any government help I was eligible for when it comes to my health. Fortunately I’m relatively healthy by all indications and hopefully will be until either I can afford HC or it is given to me. Not everyone is so lucky though.
The somewhat unusual points that I bring to the debate are:
Cross-country comparisons are fatally flawed by not taking into account different populations. Comparing homogeneous Sweden and the diverse US is apples and oranges; a better measure would be Sweden and the heavily Scandinavian Upper Midwest.
What medicine needs is a market, and the US does not have a market. The incentive systems are all screwed up. Patients have to go with the insurer that their employer mandates, regardless of how they are treated. Insurers try their best to avoid paying for medical procedures, but it’s doctors who are harmed by this, not the patient. Doctors try to do as many procedures as possible, but it’s the patient, not the insurer, that takes the fall.
Basically, you have the patient, the insurer, and the doctor. In every combination, A gets to decide how much B screws over C, rather than having his actions feed back on himself. No wonder healthcare costs are screwed up.
Restricting doctors’ pay, whether through cutting back on reimbursement or making them salaries of a government with all the bargaining power, is not the answer. Physicians’ salaries make up about 10% of all healthcare expenditures, and medicine is already lower-paying than other professions that high-skilled med students could go into.
The US pays more, partly, because it’s subsidizing medical R&D for the rest of the world. Many other countries have monopsonies on healthcare (monopsony = one buyer, monopoly = one seller). If the US moves to a centralized model, either their costs will increase or medical progress will slow.
And before you rejoice at the chance of making those stinkin’ Euro-freeloaders pay their share, remember that a monopsonistic government will bargain down prices - and healthcare providers will lower the amount of healthcare producedin response.
I’m no expert on healthcare, and due to being somewhat healthy its policy has never been a very interesting subject to me. However, there are some things that don’t seem to compute in my little brain. I may very well have gotten one or more of these things wrong:
It’s not supposedly expensive, it is expensive. Americans don’t want another trillion dollar program spent in haste so they can have another socialist rationing program.
Americans get more (faster) care than any other country in the world.
Try and get a hip replaced in Canada or the UK versus someone insured in the US.
Countries like Japan have a higher personal savings rate than the United States so there is probably a greater degree of financial responsibility. We have an aging population in the US that is about to retire and if no other changes are made, payroll taxes are going to go up to cover not only regular retirement benefits, but any gap in social services due to a low personal savings rate.
Nothing is so great. This is strawman post because it suggests that the options are either socialism or the current status quo. That is a poor approach to any problem.
There are millions of people who would rather have cell phones, 52" TV’s, cable, and smoke 2 packs a day than buy insurance. When you weed out these people you’re left with a much smaller gap between the people on Medicaid and those who are not. That is the real gap of uninsured. In addition, some of the people in this gap are not insured because of pre-existing conditions. All of that can be addressed without a massive government program.
This would be better dealt with through tax deductions for higher premiums, better regulated cross insurance for the industry, government sponsorship of leading edge drugs, longer drug patent life in exchange for lower prices, responsible medical lawsuits, and a host of other innovative methods of lowering or covering costs.
What will likely happen if the current proposal is voted in will be mandatory insurance. Some of the people in the gap will be forced to buy what the government is selling. That’s fine if it doesn’t affect current insurance options or drive jobs overseas. Since it’s being rushed through Congress it’s rightfully being viewed with extreme skepticism by those who watched the last stimulus package fly through Congress without a chance to scrutinize it. Trillion dollar programs should first be financially viable, secondly they should be financially viable, and finally they should be financially viable.
The law of unintended consequences will mean that government mandates on insurance companies may drive people to government programs due to higher prices. Ultimately those people will be stuck with socialized rationing of the monies available.
Yes, this is true. Unfortunately, that’s how it is sometimes. It sucks that health conditions take this kind of toll, but medical care is a service. I have several examples in my own family (diabetes, brain damage, cancers). Big time chronic medical problems cost big time money, and can keep people poor. That’s the reality, and I don’t think that a sweeping, crazy expensive entitlement program is the way to help with this.
I don’t have a problem with an overhaul of the insurance business. I believe in free markets, so these types of policies should be allowed to exist. But, we should also remove the roadblocks and create incentives for the development of competing policies/systems. In addition, it would be easy to penalize this type of unfair behavior on the part of the insurance company through legislation.
I’m assuming you mean Federal tax rates - did you mean insurance rates?
It also means that those same drug companies have the cash to develop other life-saving drugs. Like it or not, the profit motive rules, and if we start monkeying around with drug prices, we will cost lives, because the next drug for hypertension or diabetes or cancer will never be developed. The FDA gets a huge share of the blame on this one, since a huge part of the costs come from the mandated testing the companies have to go through. IMO, these trials go on far too long and are far too costly.
I don’t think it has so much to do with the expense or how effective or ineffective it is. It’s the system we have always known, and we are comfortable with it. Better the devil you know than the one you don’t. Also, Americans (painting with the same broad brush you are using) are kind of skeptical of big government, and supposed government efficiency. We’ve seen how THAT can work out. Our system is subtly different than that in Canada and perhaps Europe, and I think that many Americans feel it’s more susceptible to pork and abuse. Also, while Americans are willing to pay for healthcare via the current backdoor system I don’t think a lot of them would like to pay more in taxes…it’s another one of those quirks that makes us subtly different than a lot of other countries.
So what? We pay more per capita for a LOT of things than every other country on earth. Food for one thing. Drugs too. Porn most likely. Housing. Entertainment. And though we spend more we probably don’t get better porn, housing, food or drugs. Such is life.
One can make the figures dance and sing. I don’t believe that this bullet point has been proven. However, for the sake of the discussion let’s assume you are correct and we rank low on these things. One would expect that, given this as being fact, that Americans would be crying out for better, cheaper and more comprehensive health care. However, this hasn’t been the case. Basically, I don’t think that for the general population this is a high priority. If we wanted health then large numbers of us wouldn’t be so fat, out of shape and unhealthy.
True enough, though again one can skew the numbers in several ways to show whatever you are trying to show. But again, for the sake of argument, let’s say this is fact. Basically it’s a matter of priorities. Those countries have different priorities than the US does, and their citizens have different expectations and different perceptions of what is or isn’t important to them, as a whole.
Also, I think a lot of people question how sustainable some of these countries programs are…and, I think a lot of Americans feel that, to a certain extent, the US subsidizes these other countries health care through a variety of things (such as defense and even our own health care system and R&D).
I’m skeptical it would work in the US…and I’m skeptical that it works as great in other countries as some claim. I’m skeptical that it’s sustainable, especially here in the US. I don’t want my taxes to go sky high.
Nothing is so great about our current system. All health care systems are based on different goals and priorities of a given population, and based on some method of rationing health care. After all, health care isn’t an infinite resource…in the end SOME method has to be used to ration this limited resource. While I think our own current system is less than optimal, I am unconvinced that a UHC system in the US would be better, or less expensive, or more efficient. In fact, I’m pretty sure that it would be none of those things, and in the end, from my own perspective, I believe that it would cost more and give me, personally, less.
Of course, this could simply be a case of better the devil I know than the one with so many unknowns in it…
No, I mean insurance rates. The larger and more diverse the collections of employees you have the lower the risk for the insurance company and the lower the rates the company pays. The extreme example is individual health insurance which is absurdly expensive. At my age, that is by far my largest single monthly expense.
They’re already making those bad decisions - drunk driving, bar fights, gang shootings, mommys who won’t vaccinate, the hypochondriacs who go to the doctor for every hangnail and runny nose, people who treat themselves with snake oil and rosehips, etc., etc. I have no desire to subsidize those idiots.
Please tell me where I’m saving money here. I have yet to see it demonstrated that I will save money - I only see where it will cost me money, either through taxes, lost productivity or lost economic opportunity.
I have always read that it will apply to business with total payrolls of $250,000, which is easy to reach with just a handful of employees, especially in high income markets. I could see that threshold being reached with only 3-4 employees in some of the bigger cities.
Either way, according to the National Institute of Health…“The annual premium for an employer health plan covering a family of four averaged nearly $12,700.” So, if I have ten employees, then I’m spending over half of that $250K on employee insurance, for employees that may be going home and eating junk and staring at the TV while their arteries harden, or maybe heading to the nearest bar and driving home loaded. Why the hell would I hire anyone else?
Immaterial - we’re discussing UHC. If you’d like to PM me, I’ll be happy to share my feelings on those things.
That’s great, honestly, and we need more people like you. But, your freedom with everyone else’s money impacts those of us who haven’t yet had the opportunity to make it into that 5%. If you remember, even the smallest of changes in the household budget has a huge impact on those of us who are still hovering in the middle. You may be able to prevent someone from coughing through another bout of bronchitis, but you’re also stopping others from being able to move upward and provide a better life overall for their family.
I think it’s absurd that insurance is tied to employment. I would do away with the tax deductions for businesses and turn the insurance business over to individuals again. The changes in the health insurance market would be dramatic, and people would be forced to pay attention to their health again. You could buy into a small pool with less risk, a large pool with a lower payment, a medium pool with only redheads, etc., etc. I am being silly, but I think one of the biggest problems is the stagnation of the insurance system.
Good idea. Problem is, the unions, which have extracted generous healthcare benefits from their employers, hate the idea. Since unions are a Democratic mainstay, the administration will not touch that third rail.
Actually, I think the point of the debate is that it HAS been the case, that the majority of Americans are “crying out” for better and cheaper health care. Why do you think this is even a debate at all? A very vocal minority that feels like pushing the issue? This poll shows that number to be 82%. So 82% of Americans in that poll think the healthcare system in this country should be changed in a way to improve quality and affordability.
I think it’s a little flippant to draw the conclusion that because Americans are on average obese, this is an obvious indicator that they somehow don’t value healthcare.