Obviously, the shareholders think the current US system is best … people are required BY LAW to buy them a new Learjet … you have to admit, that’s a sweetheart deal.
I’ll say it again: Canada. And I’m genuinely mystified by what point you’re trying to make. If your point is that health care reform was talked about in Canada in the early part of the 20th century, so it was in the US, too, going back as far as Theorodore Roosevelt’s UHC proposals in 1912 and FDR’s actual draft legislation in 1933 as part of his Social Security legislation – and which, in an all-too-familiar move, was scuttled due to fierce opposition by the AMA. Then, around the same time that the UK created the NHS as part of postwar rebuilding, Harry Truman tried again, and was again met with fierce opposition(this 1949 letter sounds like something Obama might have written, except he gets those kinds of attacks from much more strident complete crazies, against much more modest initiatives). And then of course there are all the more recent efforts, the successful passage of Medicare against the right-wing prognostications of doom and the encroachment of communism in the USA, and more reform failures, like those of Nixon and Clinton.
If, conversely, your point is that the institutions and mindset of private insurance became well established in the US through the 20th century, first I would argue that they were much less well established when UHC initiatives failed in the earlier part of the century, as above. I would also argue that private insurance was well established in Canada, too. Real universal health care recognizable in its present form didn’t start to become established until well after the Medical Care Act of 1966, and I’m easily old enough to have had to personally deal with a system full of loopholes many many years later than that – in which for instance doctors could opt out of the system, charge whatever the hell they liked, and then the patient would get reimbursed directly, but only for only the government-set fee schedule.
That nonsense was finally prohibited by the Canada Health Act of 1984, which was basically the last important step in the realization of the present system where money is just simply never a consideration in medically necessary health care. And, as I always like to mention because it’s so delightful, in the intervening years the private health insurers packed their bags and got their sorry asses the hell out of the country, though a few remained and still try to hawk supplementary insurance, almost exclusively as employer group plans. Further refinements were made more recently still, as in the Social Union Framework Agreement of 1999.
So, no, I don’t see any really significant differences between the two countries, which for the most part are socioeconomically so similar. Canada is much more like the US than like Germany, say, which has a long tradition of social solidarity and has had a form of UHC since the time of Bismarck. UHC is, simply, both a reflection of societal values and a purely pragmatic recognition of how health care really works – that it’s not a free market enterprise, and that relegating health care to the free market yields results that are both economically disastrous and morally repugnant. The major difference is that in the US there is a growing rift between reality and the messages being promulgated by an increasingly powerful oligarchy, with AHIP and the AMA as the primary cheerleaders, but actively supported by the rest of the plutocracy because, let’s face it, their health care is just terrific. The fact is that what a great many – perhaps most – Americans believe about Canadian, British, and European health care is not just wrong, it’s flabbergasting nonsense. And that’s just the way the health insurance industry likes it. I talked about one aspect of that here.
And I’ll say it again myself…I don’t see a remote similarity between Canada in the 40’s and the US today after over 6 decades under our current system. If you can’t see the difference between the two situations then I don’t see how we could possibly close the gap nor have a meaningful discussion on this because, honestly, I don’t see any similarity. And if you do then every other example will equally look the same (hell, the UK would be exactly the same since Canada and the UK in the 40’s were much more similar, and their movement towards a UHC system at that time stemmed from similar forces at the root level).
I’m equally mystified that you can’t figure out my point, whether you agree with it or not.
But we DIDN’T go that route, nor was the public support there for such a move in the 40’s. We were in completely different places, our political system is substantially different and our public support was different. In short, we weren’t similar in any way, which is why we went the way we went as an evolutionary progression from what we had before and why Canada and the UK went the way they went. Regardless, we DID go a different way, and now we’ve had 60 years of entrenchment that can’t simply be handwaved aside or laid completely at the Republicans feet.
To de-mystify my point, it’s historical reasons why our system is so fucked up today and why it is what it is today. This seems obvious to me based on simply looking at the evolution of our current system and how it tied into the our historical view of healthcare as well as our political system and how that ties into what can and can’t be done to radically shift such a program. To put it into another context, how did it work out for GW Bush to shift the social security program? Everyone knows we need social security reform of some kind or another, yet it’s considered a third rail of US politics.
Either way, there are paths to single payer if that is what people want.
First off, make public health care options available on the state and federal exchanges. Medicare, medicaid, VA, etc. Because these programs offer lower reimbursement (and the VA negotiates for medical supplies) they will be cheaper than private insurance. During the creation of the health care law one of the reasons AHIP fought the public option was because it would cost 20-30% less than a comparable private plan. Right now about 1/3 of hte country is on a public health system, if you opened up the VA, medicare & medicaid to the public that number would easily shoot to 50%+ and higher because of the better prices. After enough people are on public health care, create one single public health system that combines the 3 programs.
Another tactic is pass single payer on the state level. Marijuana legalization used to be controversial until Colorado and Washington passed it. Now 3 years later and nobody cares as much, 4 states plus DC have it legalized and various states will have it as an issue in the 2016 election. Gay marriage used to be controversial. If a large state like CA, IL, NY or PA can pass single payer and show it works (and works better than the current system) that opens the door for other states to create a similar system. Eventually the entire nation could convert to single payer.
So there are 2 independent paths to single payer that would make single payer realistic on the national level int he US, but both paths would take 10-30 years to reach maturity.
Either way, single payer won’t solve all our problems. It won’t change the fact that we spend 2x as much as most other wealthy nations.
I totally agree, and I think that the ACA was a good first step towards that. I think it was kind of the only realistic first step towards that, to be honest, since it was, IMHO, the most that could be done in the window that was politically available.
Ok…I’ll read the link tonight. From what you posted there it DOES seem fairly similar, especially if they had that tie in place between job and insurance for a long time as we did.
I suppose if you insist on basing your views on misleading and factually incorrect beliefs then we’re just going to have to disagree on many of these points, though I certainly agree with you that the US system has become entrenched and, for all the reasons that you and I have both stated, is going to be extremely difficult to change.
But let me try one more time to set you straight on some of the misconceptions. You keep trying to assert that somehow single-payer magically arrived in Canada in the 40s and that was that. You’re incorrectly extrapolating from something you read in Wikipedia while I actually lived it, at least the latter stages of it, and let me tell you from first-hand experience that it isn’t so. That was the beginning of subsidized hospital coverage in one province, the tiniest embryonic hint of real UHC in the many decades to come. Two decades later, in 1962, things were still hotly developing and hotly disputed just in that one province alone – the year of the bitter Saskatchewan doctors’ strike – an unprecedented medical services disruption in which doctors rose up against the spectre of “socialized medicine” and “communism” and signed a pledge to close up their practices and move out of the province – while newspapers warned of the dire prospect of a socialized province without any doctors.
Sound familiar? Does that sound like national UHC was meekly adopted twenty years earlier? And your own AMA – yes, the American Medical Association – was right in the middle of the fisticuffs against “socialized medicine”, right there in Saskatchewan. Now tell me again how our two countries are so radically different, and how single-payer was so readily adopted in Canada. As I said before, almost a quarter of a century later, there were still lots of doctors in Ontario where I lived who were opting out of the newly introduced public insurance system and railing against it, and it wasn’t until after the mid-80s that true single-payer universal health care existed nationwide.
Finally, you make the statement that “we DIDN’T go that route” as if there wasn’t a hope in hell that you ever could. But it’s a FACT that FDR had universal health care legislation drafted as part of Social Security legislation. There were other opportunities before and after. FDR’s Social Security did pass, and so did Medicare in the 60s. FDR’s health care might have passed too, or Medicare might have failed – especially with Saint Ronnie’s “Coffee Cup” campaign to demonize it as a Communist plot to end all freedom in America. To a large extent these are accidents of history that could have gone either way, not the slam-dunks you make them out to be.
Definitely worth a look, but I would also point out that Switzerland has the second most expensive per-capita health care costs in the OECD, not counting the US which is entirely off the chart.
Why not? Doesn’t it depend on how it’s implemented? And it doesn’t have to be “government-run health care”. The beauty of the system in Canada and many others like it is the way it meshes universal public funding with private delivery. There’s nothing wrong with for-profit health care services – which in fact is usually the best way to deliver health care – as long as their fees conform to the negotiated fee schedule. That’s how costs are controlled, and all the while providing guaranteed coverage with no meddling in claims. The problem is not with for-profit health services, the problem is with the ridiculous and obscenely immoral idea that the free market has a role in making a business out of insuring, adjudicating and presiding over the provision of human health care and the valuation of human life. The idea that this should be legal and even acceptable business practice sinks far below the level of legalized racketeering.
We spend a little over 3 trillion a year on health care in the US, 18% of GDP.
HR676 (medicare for all) would save $572 billion in the first year. I’m assuming those are ideal scenario numbers.
So health spending would drop from 3 trillion to about 2.45, health spending would drop to 14.6% of GDP.
Single payer is much more humane and cost effective than our current system, but most OECD nations spend 8-11% of GDP on health care. The Netherlands, which a private run system like a (as far as I know) well oiled version of Obamacare only spends 8% of GDP on health care. For the US to have health care as cost effective as the Netherlands (or the UK, Japan, Israel or any other nation that only spends 8% on health) we would need to cut 1.6 trillion a year from health care.
So the fact that multi-payer systems like the ones in Israel or the Netherlands can provide humane, high quality health care to everyone for 8% of GDP shows that single payer in and of itself is not the solution. It is a massive step forward, but even if we had single payer and even if the best predictions came true (we saved $572 billion a year), we would still have the most expensive health system on earth and pay about 2x as much as a % of GDP vs places like the Netherlands.
There are lots of different systems out there. Public payer/private provider (Canada). Public payer/public provider (UK). Private payer/private provider (Netherlands). They all spend a fraction of what we do. I think the reason is that there is a very strong role for both the public and private sectors to drive up efficiency and drive down costs, something that doesn’t exist here nearly as much.
Thing is, XT, you describe the American health insurance history and declare “See? Totally different from everyone else. Prove me wrong.” But you have most certainly not proved yourself right. ( I am reminded of the “most diverse country” discussion we had a month ago or so.) Except for the poorest of people, prior to the 40s Canadian health care was paid for by private money. The desperation for doctors in rural Saskatchewan provided a kernel to grow a public system which succeeded. There was call for similar reforms in the states that failed. Your historical quotes don’t make plain why our thinking divided at that point.
No, I don’t believe you will agree to disagree, so you would be incorrect on that (after all, I’ve followed your debate in the agnostic thread so know you never give up, never surrender :p). That we DO disagree is, of course, accurate, though we agree on some things and not on others.
No, I didn’t assert that it magically arrived in Canada. I linked to the freaking wiki AND I cut and pasted relevant text as well, so I’m well aware of exactly how it happened (I also lived in Canada for several years). You can follow the exact progression in the wiki I linked to, so I didn’t really need a narrative on it. It’s unlike the progression in the US, and Canada didn’t have a system remotely like ours BEFORE they started down the single payer route in any case.
Possibly in some alternative universe using the many worlds theory you are correct. However, in THIS universe it didn’t happy. Close is meaningless since, having not happened we progressed down THIS path for the last 60+ years and, well, here we are. A place that Canada wasn’t at when they started down the path…but, glad you acknowledged that even there and even at that time in the past it was hard even for them WITHOUT OUR ENTRENCHED SYSTEM. I’m sure you don’t think this is meaningful, but I guess we’ll have to agree to disagree that you’ve just made a point on what I’ve been saying all along.
None of this means we can’t go down that path ourselves, btw. I think that the ACA was a first step down that path, and if it works out then others will follow. I don’t believe that anyone could have taken us down the path to a single payer/UHC type system in one leap, and that this is just liberal fantasy. It’s going to take small, incremental steps IHMO for us to get there, but I think that the US is going to get there eventually. All the arguments that it saves money and is better are really meaningless until we cross the point where the majority of people not only say they want it but agitate vigorously for it. It’s like same sex marriage and, perhaps, legalization of marijuana, or, recently, the seeming rapidity of warming relations with Cuba after decades of entrenched hostility…once we reach a certain public mass it’s like rolling a large rock down a hill you’ve been pushing hill seemingly forever. It’s a lot easier to push it downhill than up.
And yet, when I was shown an example from Wesley Clark I was more than willing to look at it closely and at least provisionally agree that it looks the same or similar enough to provoke thought and perhaps have me rethink some of my core assumptions. I wish some of you would at least rethink some of yours as well, as I think there are a lot of moving parts in this and it’s not the easy answer some are making it out to be. Again, if it were easy I think we’d have done it by now.
I’d say the reason we diverged (which is pure speculation on my part) has to do with how Americans in the 40s looked at government and what it should do verse how folks in the UK (and Canada) looked at it. Europeans in general have very different ideas on what government should do than Americans did and even do today, and the UK especially was very hard hit by the war, which I think had multiple impacts on the question (a lot of UK healthcare had been disrupted by the war and the people were wanting direct and tangible aid from the government…I think, again, purely speculatively, that Canadians felt similarly for similar reasons, though they hadn’t had the massive disruption of direct damage from the war).
Hey man I didn’t say you were being unreasonable.More that youre not really addressing the point. I just said laying out American health coverage history doesn’t illustrate how UHC in America was doomed. It also doesn’t address how every Western country had very different routes to UHC. The differences between Canada, Britain, Japan, Germany and France didn’t seem to stop any of us.
But it’s NOT doomed in the US. That wasn’t the question the OP was asking…s/he was asking why it’s so fucked up. I think that history does demonstrate/illustrate why the US went a different path than other Western countries, but like with the small wolf I don’t expect everyone else to see it my way.
I guess if I was going to argue your side I might say that the comradery and devastation of WWII is the only thing that pushed the U.K. away from an American system and once started became entrenched. Germany’s system is a swath of stern thoughtful compromises which people were willing to swallow in their years of reconciliation. Canada was as I said an outgrowth of isolated communities just flat out desperate for doctors.
But to argue the other side again, the fact that American health coverage grew out of factory horrors doesn’t quite give the full story why UHC was rejected in America.
Eta: I said “was” doomed. Like back when most Western nations did it.I didn’t say that you said it was currently impossible.
I don’t believe that was the reason the UK and Europe didn’t go with an American style system though (well…I did say that part of it was the sheer destruction of WWI and WWII, and I do believe it was a factor, but not with them forgoing the American path, merely with why they evolved the systems they evolved). I don’t think that an American style system was in the cards for any of those countries because I think that the political systems didn’t necessitate them and that the citizens view of the role of government is and was vastly different…and I also think that the scares of two major world wars sat more heavily on some of those nations as well.
I didn’t say this, however. I said that the US system grew out of how Americans thought about healthcare, and how we were coupling many things with ones job, as well as the American political system which is a compromise system (when it works) and American attitudes about what the government should and shouldn’t do, especially in the 40’s. There were also some anti-Red feelings and a general uneasy with socialism, as well as some reaction to some of FDR’s efforts…after all, as noted by wolfpup, FDR DID try to push though something like this, and he was one of the more successful presidents in pushing through his programs. But it didn’t work and we didn’t go that route. Contrary to what seems to be the popular belief we didn’t go full privatized either…we went with a compromise system that sort of straddles both (meaning it sucks) and has been further refined with more compromise down the road, with regulation and deregulation efforts and is generally the worst of all worlds except for one thing…for the majority of our history with healthcare it’s served the majority of our people good enough. If it costs more, well, we are a very rich nation, and it wouldn’t be the first thing we paid more for than other nations. If it didn’t cover everyone, well, we’ve attempted to patch those gaps (badly) at various times in our history, and as long as the majority were happy enough with it there just hasn’t been pressure for major change. That, itself, is changing…which is why the ACA worked despite massive push back from the then minority party.
Just wanted to make my position clear. Didn’t think you were saying the various things you think I thought you said. 
But we are talking past each other a little here. If you want to show America’s path was unique then you have to show that France, Canada and England DIDN’T have similar situations. That they DIDN’T have horrible industrial deaths that encouraged company or union based health care systems before UHC got implemented. Did the industrial and union explosion only happen in America? No? Then why was America’s version the block to UHC?
I believe his phrase was “utter horseshit”. Like private healthcare was somehow invented in the US and wasn’t the norm until around the middle of the 20th century.
The only reason I’ve been able to come up with that American business hasn’t been more strongly supportive of UHC – and being relieved of this responsibility – is that company-related health insurance has a limiting effect on worker bee mobility. But it’s really a mystery why this argument isn’t advanced more often by the nation’s employers. I know what my employer spends on health care for its work force every year and I would think they’d like to be out from under this burden.
We can do this.
Your post WAS utter horseshit for the reasons I already stated which didn’t have anything to do with the US inventing healthcare (we don’t have private healthcare btw, so, more horseshit) but instead because of your ridiculous assertion about waving flags and cigarette smoking cowboys as the rationale for what we do have.
And the healthcare system that we moved towards in the 40’s and over the intervening 60+ years was NOT the norm, anywhere else…it was pretty uniquely an American original fuckup (though I guess Sweden had something similar). What we had before that was similar to several other nations but what we ended up with wasn’t.
Right. Who asserted these characterisations?
btw, “we” when talking about countries always suggests a little too much emotional investment, and a presumption to speak of behalf of others.
That would be you.
shrug I’m an American…these things happened in American history. That makes me part of ‘we’. YMMV.