Much may depend upon how one parses the term “comfortable.” It could mean “accepting with enough equanimity that one can sleep well at night.” With this construction, your staunch liberal friend could agree with the bare-bones statement, yet disagree with how high the specific level of people suffering should be.
Let us take Banquet Bear’s anecdote for a moment, and with his indulgence, presume that his weight, and its attendant health challenges, is the result of poor choices he has made. Those health challenges, the need to put himself in the care of a cardiologist, and the need to employ a CPAP device, arguably fall into the category of suffering for his poor choices.
If libertarianism (which some libertarians have described to me in terms that seem calculated to lead one to view it as fundamentally benign) demands that the level of suffering that LIFE ITSELF exacts as the toll for poor choices is insuffficient, and must be supplemented by society in the form of economic punishment, then libertarianism begins to seem less benign, and flirts with “monstrous.”
Can you state what you think the outcome would be that you don’t like? Is it different from the outcome of other countries that have UHC type health care?
Because they can concentrate on the easier sort of medicine, and know that they need the state system to pick up the pieces if they happen to come across additional complications or anything more serious. The costs of setting up a parallel private system covering the complete range would be beyond the ability of the potential market to bear., unless the state system were to be wholly dismantled. You’ve only to see the fuss every time there’s some local re-organisation of services as between different hospitals and community services to guess how that would fly.
On the other hand, successive UK governments have been bringing in various forms of sub-contracting to private suppliers, and private finance deals for investment in new facilities, which have provided some rich opportunities for the private sector - but there is always plenty of concern about the extent to which this might lead to more wholesale privatisation through the backdoor.
Yes. I don’t think the US will be on a trajectory to doom anytime soon. Boom and bust years, sure, but I have no doubt the US will continue as a going concern for quite some time.
By which “they” means the private practices, in case anybody wasn’t clear. My own experience going to a big chain of private dentists in Spain was exactly what PatrickLondon describes: they were sending me to get tests done in public hospitals, paid with public money, as soon as they were beyond X-Rays; they were also demanding tests when both public-system dentists and small-office private dentists did not.
In our case, dentistry is a specialty which has always had specialists outside the system, as many of the things dentists do are considered “elective for cosmetic reasons” and therefore not covered by the public system. The big firms offer more and fancier-sounding procedures than the small docs, but they don’t have any better services and, unlike the public hospitals, they don’t share information or patients from center to center even within the same group (moving and trying to go to the same chain? They treat you as a new patient again. You’re traveling and have an emergency? “Oh, you’re not a patient in this clinic”).
on what is in many ways a gigantic subsidy for the health care, pharma, and insurance industries isn’t a sustainable strategy, especially when that piece of the pie is likely to grow in the future.
Maybe so. There certainly are lots of similarities. However your quote omits the mention of the fundamental pillars of the CHA, one of which is “comprehensiveness”, meaning that provinces are required to provide coverage of all available procedures that could reasonably be judged medically necessary – they can’t just arbitrarily omit those they don’t feel like covering, unless they’re really minor or unimportant.
The other difference is that single-payer, in compliance with the CHA, has no deductibles and no co-pays, whereas Medicare seems loaded with them and they are sometimes exorbitant. Plus there seem to be arbitrary exceptions and limitations imposed as cost-saving measures, .e.g.-
Talk to your doctor or other health care provider about why you need certain services or supplies, and ask if Medicare will cover them. If you need something that’s usually covered and your provider thinks that Medicare won’t cover it in your situation, you’ll have to read and sign a notice saying that you may have to pay for the item, service, or supply.
After you pay a deductible each benefit period, Original Medicare will cover you in full for days 1 to 60 that you are in a hospital. For days 61-90, you pay a daily coinsurance. Medicare pays for up to 60 additional hospital days in your lifetime with a high daily coinsurance, after you have used up your 90 days of hospital coverage in a benefit period.
After you use up your 60 lifetime reserve days, Medicare will no longer pay for any coverage until you start a new benefit period.
A close relative, who is now retired down there and covered by Medicare, tells me that despite Medicare he’s paying the astronomical sum of $1200 a month to continue his previous level of health care coverage post-retirement! That sounds to me like, far from ironclad coverage of everything medically necessary, Medicare has some pretty huge coverage gaps!
First of all we (all first-world nations) do provide food and shelter for those in need, either in the form of social assistance or some other means of payment, homeless shelters, subsidized housing, etc. Looking at it this way seems to expose the absence of UHC as a rather glaring illogical exception to how we deal with the necessities of life for the disadvantaged.
Secondly, the claim that the US is “doing quite well” is only true when looked at from a sufficiently high level that all you see is national economic performance and the ugly details are hidden – where you do NOT see (a) millions of cases of preventable individual hardship, sickness, and even death, and (b) the economic drag of the most expensive and inefficient health care system in the world, including the health care cost concerns of much of the middle class and the cost to employers. And this is not even getting into the question of its long-term sustainability, nor the moral dimensions of the problem.
Some specific data points that seem to contradict the idea that everything is ticking alone just wonderfully:
12.4% of American adults between 18 and 65 don’t have health insurance (28.2 million people under age 65).
An estimated 45,000 Americans die every year from lack of health care.
Health care costs significantly more per capita – and in specific cases many multiple times more – than in any other country in the world.
The US government already spends as much or more per capita on health care than other countries that have universal coverage, yet employers and individuals are still heavily burdened with excessive costs of private insurance.
Medical costs are the #1 cause of personal bankruptcies in the US, and many of those people had insurance.
There are vast gaps between those poor enough to qualify for Medicaid and those able to afford insurance, leaving millions uninsured and having to rely on grossly inefficient, costly and inadequate ER services via EMTALA – and these underserved patients who get only superficial treatment are then hounded for payment, leading to horror stories like these:
… A recent article in the New York Times detailed how Accretive Health, a medical debt collector, is using aggressive tactics such as confronting patients in their hospital beds to collect the money owed for even emergent care. The article also describes how collection agencies have long been used to go after patients after they’ve left the treatment facility. In some cases, patients were even confronted and stalled by debt collectors as they entered the emergency department on some later occasion so that the company could collect on old bills before more care was offered.
An even more recent story covered by Kaiser Health News and NPR reported on a family of four sued by its local nonprofit hospital. The family earned about $25,000 a year – below the poverty line – but the parents did not qualify for Medicaid in Ohio. It seems that the hospital had sued almost 1,600 people for unpaid medical bills from 2009 to 2011. Further, the piece reported, “[w]hile Ohio has a law that prevents foreclosures based on medical debt alone, it is legal for hospitals to garnish patient wages, attach bank accounts and get a lien on any future earnings, including from the sale of a house.”
It might even be worse in North Carolina, where a group of nonprofit hospitals sued 40,000 patients from 2005 to 2010 …
I’m looking at primarily the US. First because the thread is about Republicans (in the US), and second, because I’m much less familiar with how other countries function in this area. I think that how other countries operate in this space could be informative though. Even in the US, we do provide food, shelter, etc. for those in need. But those things are not available universally - there are still hungry and homeless. We do already provide health care/insurance to those in need through Medicaid. But even then there are gaps where people do not qualify, or even then the coverage may not be enough. My point was that if the idea that medical insurance/care was such a necessity it should be provided, there are more acute necessities that we do not provide. As we do provide some food and some housing, we also provide some health care/insurance. But still, there are those that would be hungry, and homeless, and there would be those with less than adequate health care.
Yes there are instances of lots and lots of people suffering. In spite of that, the US overall is still doing quite well. The point is that what the US is doing is working well for most of the people so I don’t think it can be said that such a change is a requirement to achieve a society that properly functions or thrives. Those two things are already happening, generally. I don’t think the current system works for everyone, and I acknowledge that lots of people get screwed through no fault of their own.
To slightly modify an old saw, ‘If a man has one foot in the icebox and one foot in the oven, overall he is doing quite well!’
I submit that for the overwhelming majority of Americans today, we are not doing quite well. Yes, compared to people in Somalia we are much better off. But we are far, far short of our own potential. Too many of us are struggling to position ourselves to avoid bankruptcy caused by any random medical emergency, whether due to “bad choices” or just being unlucky. And in the meantime we are paying ridiculous premiums, avoiding changing employers or opening businesses, and generally living with heightened anxiety and insecurity. There are plenty of things in the world that are truly beyond our control about which to be anxious. But health care, as demonstrated by so many other places, need not be one of them.
I’ll let him explain whatever he might have meant, but to me the comment is ridiculous and exactly backwards. Conservatism is a perfectly rational and pragmatic ideology, contemporary Republicanism is not – Republican ranks are currently infested with an undercurrent of racism and xenophobia that is a large part of the opposition to meaningful health care reform: what if those dark-skinned types that make up such a large proportion of the American underclass were to get health care for free? The idea is intolerable to them! :rolleyes: And the ACA as currently implemented was imposed by a dark-skinned Kenyan Muslim, so get rid of that, too! We have no idea why, just get rid of it. (I love this Andy Borowitz piece in the New Yorker: Trump supporters furious that they still have health care :D)
Here’s the thing about conservatives. There are strong and even dominant conservative factions in the countries and relevant jurisdictions in the industrialized world that have all adopted UHC without exception. In Canada, the province of Ontario went full single-payer in 1969, during the 26th year of an uninterrupted 42-year reign of a seemingly unstoppable Conservative Party. Opposition to UHC has nothing to do with conservatism, it has to do with various forms of misconceptions, bigotry, ignorance, and all the other things that characterize the antics of many current Republicans – the things that got the Orange Peril elected president of the United States.
The POTUS doesn’t really reflect the Republican Party, though; it seems that the party people who eventually accepted him only accepted him because, well, sometimes the wrong people win primaries. His win is much more a populist win than a Republican Party win. I think the core Party would love nothing more than to disassociate themselves with Trump, but politically can’t do it.
While I utterly disagree with the principles underlying conservatism in the US, there are principles underlying it. And a federally-run health insurance program runs counter to them (for many/most conservatives).
Republicanism, on the other hand, is just a political party. It is whatever Republicans want it to be. They can be the pro-UHC party tomorrow if they want.
While there’s some truth to that, I would point to the general rightward lurching and growing bigotry and irrationality and anti-science ravings among many Republicans in recent decades – McConnell’s statement that his #1 political objective was to make Obama a “one-term president”; the absence of bipartisan cooperation for the general good and relentless opposition to everything Obama proposed just because he proposed it; the concerted effort to repeal Obamacare even though they had literally nothing to offer to replace it and such a reckless action would deprive millions of their health insurance – yet the recklessness was supported by a majority of Republicans and championed by McConnell, and failed only because of Democrats and a minority of Republican defectors. I would argue that Trumpists are not a crazy anomaly within the Republican party, they’re just a more extreme version of the same crazy.
I disagree. Google “the conservative case for universal health care” and you’ll find lots of conservative pro-UHC arguments. That conservatism generally embraces free markets and private ownership doesn’t change the fact that the economics of health care (not how health care services are delivered, but the underlying market economics) don’t fit that model, never have and never will, and brighter conservatives understand that. It’s entirely plausible that intelligent conservatives would be concerned about profligate spending on health care unprecedented anywhere else in the industrialized world, and the drag that has on employers and the economy and on individual health security and the overall health of the nation. Liberals may be inclined to support UHC for reasons of social egalitarianism, but conservatives can support it for pragmatic economic and business reasons. Which is why all other advanced countries have UHC, even those with conservative traditions and strong conservative political factions.
