Well, yes. ERs have long waits because the people who go to them generally have reason to wait; the reason the waits aren’t even longer, though, is that the trouble of going imposes a price on an ER visit. There’s an upper limit to how long people will wait with a minor problem.
It’s pretty routine in Canada to have two people debate whether or not Person A should go to the ER, with Person B saying “you should have that looked at in the ER” and Person B saying"nah, too much trouble."
Slightly relevant quote from a non-US conservative:
David Cameron, Prime Minister’s Questions re. NHS reform, 8th February, 2012.
One answer (assuming that we’re comparing UHC to private health insurance) is that there are a number of reasons why private health insurance, as a concept, is fundamentally broken.
Here are two of them:
(1) For most businesses, one of the things the “invisible hand” of the free market does is give businesses an incentive to treat customers well. If you go to burger king and order a burger and get a rotten burger full of maggots, or something, the negative publicity burger king will get, the loss of repeat business from you and everyone else who sees the maggots, etc., will FAR outweight the savings that burger king might gain by relaxing their quality standards enough to let maggoty burgers slip through. That’s because every transaction burger king ever has with a customer is for a fairly small amount of money, so they would lose far more by generating customer badwill than they would by making a really cheap and terrible product (well, more than it’s already arguably cheap and terrible).
Health insurance is different, however. There are some number of individual customers who are going to develop diseases and conditions that require millions, if not tens of millions, of dollars to treat. So poor Joe comes in to the insurance company and says “whoops, I have developed a nasty condition that requires $100,000 of treatment every month for the rest of my life”. At this point the insurance company can try to find some means, legal or illegal, to avoid having to pay out. And if they do, they’ll presumably suffer some negatives of badwill and loss of patronage and negative publicity and stuff. But unlike in the burger king case, where they’re weighing negative publicity vs a $3 lunch transaction, here they’re weighing negative publicity vs a really huge amount of money. So the “invisible hand of the market” actually gives insurance companies a strong incentive to be ruthless and evil. (You might ask why this doesn’t apply to other forms of insurance, and to a certain extent it does, but the big answer is that health insurance has SUCH a hugely varying range of money that different sick people are going to need. With house or car insurance, there’s generally a fairly easily calculatable worst case (the house is entirely destroyed), so there aren’t these freak outlying cases which suddenly cost huge amounts.)
(2) There’s the serious problem of preexisting conditions. Healthcare insurance companies want to make money. Therefore they want to insure people who are a good bet. So suppose you have one of these conditions which means that you are guaranteed to need thousands of dollars of treatment per month on an ongoing basis. No insurance company will, if it’s purely up to them, sell you insurance. At least, not insurance that will cost less than what you’re guaranteed to be paying in the first place. Why would they? Which means that if all insurance comes from private companies, someone who is unlucky enough to develop an expensive ongoing condition will never be able to purchase insurance at all. So either they’re totally screwed because they can’t get insurance, or they have to have been lucky/smart/careful enough to have already purchased insurance back when they were healthy… but at this point they’re totally locked into this one insurance provider, and if they lose their job, or get poor for a while and miss a payment, or fail to dot an i or cross a t on some piece of paperwork which gives the insurance company an excuse to drop them (which of course it has an incentive to do), they’re SOL.
Again, you might ask why this is different from any other type of insurance? Because if someone is such a terrible driver that they can’t get auto insurance, well, they can survive without a car.
This. Glad you’re in WA, we are decent folk up here. 
At what point do we, who are paying for all this, get to tell poor, pitiful Joe that he’s well and truly fucked? Obviously not $100K per month for life, you’ll apparently allow that. What about $500K a day for life? One million dollars an hour for life?
Why would taxpayers and the legislators they elect be any less venal than private insurers? After all, money not spent on Joe’s care can go to parks or highways or schools, all of which more directly benefit them than the warm fuzzies associated with heroically expensive expenditures involved with Joe’s care.
More to the point, why should the taxpayers and legislators be any less venal? Surely it’s not an offense to human dignity to say: Syndrome X is terrible, but $10 million dollars in treatment for a single person is more than a bit excessive. Everybody’s gotta go at some point.
You know I disagree with you pretty much every time you post, but this was excellent.
So here’s my $64,000 question: why doesn’t the free market encourage US health insurers to compete on price? An insurer that cut its premium prices in half would surely have customers flocking to them, thus creating a critical mass of customers that allows significant economies of scale, which in turn allow them to be less exclusionary and litigious, bolstering their reputation and allowing them to dominate the market and become profitable and further lowering premiums.
(If there’s any doubt that the above model could work with enough people, simply look to a UHC country.)
It would of course require a huge seed capital, but it’s something I could see Warren Buffet or the Bill & Linda Gates foundation kicking off.
Bonus Q: what do they compete on?
Those are excellent questions, and I’m honestly curious to know how countries with UHC deal with them.
But the basic difference is twofold:
(1) While it’s certainly important for a country’s UHC program to not hemorrhaging money, the program itself, as a whole, is not something that is trying to make a profit. There are lots of individual people in a private insurance company who have a strong financial incentive to screw Joe in that case. In a UHC system, not so much.
(2) If you view UHC as nationwide insurance, you at least get the benefit of having as large a pool of healthy people as possible balancing out the sick people. So the cost to the program as a whole of any single super-high-cost individual is lower than for any single private insurance company.
I have no idea where you’re coming from on this but, racial shit aside, I can’t even work out your definition of ‘universal’.
More broadly, the one thing I can never, ever understand about this debate in the US is how it’s kept so parochial - like the 20-30 other leading democracies that all have varitaions on UHC, and political party’s of hugely diverse beliefs, each make it work for them.
If there’s a problem you as an American don’t understand, go and look at how other socities solved it. People in those 20-30 countires keep NOT voting for change in their UHC for a very good reason.
You don’t. It’s a medical decision based on purely medical grounds. You do at least grasp that costing is a totally different concept in the USA as compared with everywhere else?
You have a healthcare budget like you have a schools budget. The democratic mechanism is the same.
The modern Republican party is based on a set of shared delusions. One of them is that America is by definition the best at everything. Best hospitals, best schools, best food, best *.
Modern Republicans will refuse to believe that other countries can do things better than we do.
There is also the shared delusion that private is always superior to public. Even roads. And the shared delusion of the Liberal Power Grab™ is out to make people weak, so they can be dependent on Liberals forever and then… something… concentration camps, maybe?
I tried to explain this in my first post, but I guess I failed. The American system is so expensive because:
Insurance companies are unnecessary in the health industry, and making a profit. If they collect 500 dollars to provide 250 dollars of health care, the effective price of health care just doubled. They have to make a profit, right? Only way they can do that is by collecting more money than they pay out.
Lots of Americans can’t afford care for minor medical issues. Because they don’t fix these issues, they become emergency issues, which they also can’t pay for but end up costing society a lot more than just paying for the non-emergency treatment would have. The hospital has to make up the cost of these expensive procedures (that aren’t being paid for) somehow, right? So the cost to people who CAN pay goes up.
In addition, a thousand different insurance companies with a thousand different rules for payment, coverage and networks, means medical billing is a huge cost because each patient has a completely different set of forms and rules.
Clearly there must be limits; a system that paid out for any claim no matter how extraordinary would bankrupt itself. But the purpose of insurance per se is not to pay for health care but to mitigate risk. With a sufficiently low probability of requiring $10M in care (however low that may be), it could be utility-increasing overall for the health plan to cover it.
But I’m not sure that’s the point. I suppose an argument would be that, given the agreement to provide some such expensive treatment, a non-profit entity would be less likely to shirk. (Another might be that a plan with a giant risk pool could provide a higher level of benefits, and could be more forgiving of known health conditions.)
This, from up thread, seemed to make some good points on the narrow issue of Admin costs:
I have to say that a country like the USA that will soon be paying 20% of GDP on health - max UHC budget 12% of GDP - really doesn’t have to worry about the the level of a national UHC budget.
If the US went UHC in any kind of comparable way, you could treat everyone in lower orbit and give them a really scenic view for 20%.
Really, budget is the least of the issue.
Do tell your chain of reasoning in which the premise white people would be for UHC if non-white people were excluded (an incorrect one, but no matter here) implies that all non-white people would then be for UHC. Or against it. Or anything.
That wasn’t the premise.
Because it costs less to the country overall, because it helps equality (helps, not guarantees) and because… well, actually, those two points are enough for me.
The amusingly-named NICE in the UK decides which drugs and treatments to license, in part based on their cost vs. their effectiveness. Private insurance firms do the same; just because you have private insurance doesn’t mean you can get ANY medication. They both operate within a budget.
This effectively means that there is a limit on how much is spent on individuals - at least in the long-term. No medication that costs $500k a day long-term (or even $50k) is going to be licensed for use in the NHS.
NICE was brought up as an example of ‘death panels’ by people who apparently thought private healthcare companies have unlimited budgets.
Health insurers are relatively low margin operations (not counting overhead) so they can’t cut their premiums in half. Unless of course they tried to force doctors to take half, which is going to ensure that the doctors would not accept their policies. They’d wind up directing their customers to drunks and faith healers.
What do they compete in? For the general public price to some extent, but also service. (At least the ads running now are around this.) And a lot on whether your doctor takes their coverage. I’ve looked at some pricing plans, and they are so complicated that it really takes sophisticated mathematical skills to figure out which are best, and even then the answer depends strongly on how sick you expect to be next year. If you are healthy a lower cost high deductible plan works - if you are sick you’ll get screwed.
But they really compete on selling their plans to HR people in companies and for large companies that is more equal. When my large company got swallowed up by a still larger company, my health benefits improved tremendously, and not out of altruism of our CEO.
The only one who can get away with cutting payments to doctors is Medicare. And they can do it because they’ve got a near monopoly on the biggest set of healthcare consumers. And I think the motivation is not what is reasonable for all parties but purely political.