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Universal Healthcare in the United States


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Starting off, I have to admit I am heavily biased.

My dad retired as a Senior Master Sergeant in the USAF, so growing up I always had free health care through Tricare.

And when I finished high school I also joined up. Served six years and quit as a Staff Sergeant. So for the first 25 years of my life I never once had to worry about health care expenses.

Military doctors only ordered labs and tests necessary to keep the person healthy. There was never any profit motivation. I just showed up when I was sick, they did what they could do to fix me, and then I went home. I needed my wisdom teeth removed? It was taken care of at no cost to me.

 

So what exactly is the argument against universal healthcare in the United States? (Single Payer)

That poor people don't deserve to be healthy because....... they have no money and it might make the rich have less money in their bank accounts?

 

Edited by A True Kaniggit
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48 minutes ago, A True Kaniggit said:

Starting off, I have to admit I am heavily biased.

My dad retired as a Senior Master Sergeant in the USAF, so growing up I always had free health care through Tricare.

And when I finished high school I also joined up. Served six years and quit as a Staff Sergeant. So for the first 25 years of my life I never once had to worry about health care expenses.

Military doctors only ordered labs and tests necessary to keep the person healthy. There was never any profit motivation. I just showed up when I was sick, they did what they could do to fix me, and then I went home. I needed my wisdom teeth removed? It was taken care of at no cost to me.

 

So what exactly is the argument against universal healthcare in the United States? (Single Payer)

That poor people don't deserve to be healthy because....... they have no money and it might make the rich have less money in their bank accounts?

 

Mostly that bolded part, they erroneously think it's more expensive than what we have now, they think they'd be waiting for major surgery, or they are otherwise afraid that they will lose their 'good' insurance.

 

 

 

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1 hour ago, A True Kaniggit said:

That poor people don't deserve to be healthy because....... they have no money and it might make the rich have less money in their bank accounts?

The fact is most Americans do believe healthcare is a right and the government's responsibility.  The problem, of course, is they're also worried about increased costs, taxes, and losing their own insurance.  Disapproval for Medicare-for-All skyrockets to near 60 percent if you tell respondents it would eliminate private insurance companies. 

And there's also the anti-government strain - when respondents opposed to universal coverage are asked why, the top answer is usually something like "don't want government involved," edging out other top answers such as increased costs or limiting competition. 

Finally, terminology matters.  Public option is significantly more popular than MFA, and MFA is significantly more popular than single payer. 

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31 minutes ago, DMC said:

Disapproval for Medicare-for-All skyrockets to near 60 percent if you tell respondents it would eliminate private insurance companies. 

I'm waiting for a big reportage as to what happens with this attitude w/in all those groups when the bills arrived for the the Covid hospital treatments and then therapy -- if the patient survived -- from the insurance companies.  It's been quite soon since after vaccines arrived, that the insurance companies resumed charging for Covid.

Which, of course, is another primary reason They scream, "covid doesn't exist, is a hoax, died with covid, not of covid ...."  But of course, They can't say that.

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I'll add the contrary part to the conversation. But first, will start out by saying the US system is convoluted and hugely inefficient. 

That said, for those that do have good insurance, the quality of service simply is better in the US than in a single payer system. I've lived in a number of different countries including OECD states with universal health care. 

My experience has been that universal healthcare provides adequate basic care with reasonable personal costs.  I was hospitalized at one point while under such a system and had to have minor surgery which was totally within the capability of the doctors present (whose salary was a lot lower than a US Dr).  However, everything was obviously on a cost savings scheme. I shared a recovery room with 5 other patients and the medicine carefully rationed out.   It was far from intolerable, but not exactly pleasant.  I think the final bill was around $600 USD equivalent including a few days of hospital stay.  Totally reasonable!

Fast forward to living in the US, under my Federal health insurance plan, my child was born leading to a two day stay at the hospital. We had our own personal room, the Dr. and staff were basically on call when the time came, and we had no want for service throughout the time.  We got the insurance statement in the mail a bit later which had charges in excess of $40k and our personal out of pocket cost was $10.  Ten dollars!

The USG pays for 70% of insurance premium cost for Federal employees and negotiates contracts with providers.  But that wasnt even the best deal for much of my time in the US. For several years, my spouse's health insurance, which covered the whole family, was literally free. No premiums, only $15 co-pays for any and all services, all paid by her employer.  Nowadays, I am back under my spouse's (different employers) health insurance which is a reasonable $200 a month for the whole family including dental, no minimum out of pocket, and a maximum out of pocket in the 5k range with all costs beyond that 100% covered by the insurance.

So here is the rub... I'm not some billionaire enjoying the spoils.  We are simply folks with in-demand skills that companies need (or just being a federal employee in my case) and are willing to shell out large premiums each year as part of the compensation package.  So here is the problem for getting a shift in politics to change the system. A significant percent of voters in the US are benefiting from the system that exists.  Moreover, I am willing to bet that a very large part of these folks are educated Democrats, which means the most left-ward party of our system doesn't have consensus on the issue.  At the end of the day does anything in the last few decades of voting behavior suggest that people are willing to make sacrifices in sake of the greater good? 

 

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1 hour ago, horangi said:

So here is the problem for getting a shift in politics to change the system. A significant percent of voters in the US are benefiting from the system that exists.  Moreover, I am willing to bet that a very large part of these folks are educated Democrats, which means the most left-ward party of our system doesn't have consensus on the issue.

That last part isn't true.  Whether you look here, here, or here, there is consensus among Democrats when it comes to at least the public option - and frankly Medicare for All as well unless you have a really stringent definition of consensus.

That being said, it would still take considerably larger majorities (not to mention, at the moment, a much more popular president) in both chambers for the Dems to pass even the public option.  Which is why Biden - and hell even Sanders - didn't even bother to try.

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Some thoughts off the top of my head - mostly based on my health policy experience whilst I was in the US

1. The US health system is fucked - Look, I know people make arguments that some employer based insurance works really well for some people and they would loathe to give it up - but even those people can come under significant financial strain when it comes to deductibles & cost-sharing. There are policy issues within the US health system that just do not exist outside of the country - something like Surprise Medical bills or balance billing being one of them ( Congress basically *just* enacted federal legislation regarding this after years of it being an issue) - here in the UK, I don't even have to *think* about this stuff for my patients. In addition, things like prior authorizations are even worse. If a doctor thinks you need a particular investigation or treatment, sometimes prior authorizations are needed by the insurance company  - this causes delays and can ( and has) resulted in significant harm for patients whilst also taking time away from the physician whilst they try and treat their patients.

Make no mistake, prior authorizations harm patients all the time

Quote

In a 2010 study analyzing new Medicaid prior authorization requirements for several bipolar disorder medications, for example, one-third fewer patients had started on those medications four months after the prior authorization program was implemented, a massive decrease unlikely to have been driven by prior authorization denials alone.

For every prior authorization request, a provider can lose up to an hour or more wading through an administrative quagmire. There are often labyrinthine phone trees to maneuver through, patient records to unearth, and faxes — yes, faxes — to be sent.

Even after providers do everything insurers ask, there’s no guarantee the request will be approved, and it can take days or weeks to hear back. All the while, patients hung up in the process are waiting for their medications and others are growing restless in the waiting room.

Like I said before, I've been practicing medicine for 3 years and I don't even think about this stuff with my patients - if I think a patient has some sort of cancer, even if I don't know what specific type, I can start the process of them getting their whole body scanned and that scan happening in 2 weeks or lesser. I think the only people who really understand how fucked up the system is are healthcare professionals who deal with it & patients. It's the patients I feel for more than anyone else, imagine going through the worst days in your life and then being stuck with a huge bill you need pay - Here is a twitter thread from a doctor who suffered a cardiac arrest at home and recovered and what he had to deal with

2. Universal healthcare is not equal to single payer - I think there are ways to get to universal coverage of a population without it being single payer, especially in a place like the US where the private insurers are huge & have significant lobbying power - a mix of private & public programs leading to universal coverage *can* work, but it requires heavy regulation from the government within these private spheres. Some countries do have a significant private insurer market, but it is heavily regulated and completely different from the current regulation landscape in the US. Realistically, I think that is what will need to happen where you still have the private insurers but they are regulated heavily by the federal government. You don't have to have single payer to get universal coverage for your population

3. Waiting on opinion polls etc - I think about this a lot especially when it comes to health policy. 95% of people have no idea about health, health policy or the specifics of how terrible things can be for both patients and physicians because of the significant information asymmetry that exists within medicine - I think waiting until you reach a certain amount of consensus in these polls is naive, to be fair, we've moved a long way on them in the last decade and the US system is built for incrementalism, but the harms are significant and are happening right now - I'm not saying I have a solution per se to the gridlock that is the senate and getting something significant through it will be tough with the way it is - but I think there is scope for passing something that might be perceived as unpopular, but then shifts public opinion after it is implemented.

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1 hour ago, Raja said:

but I think there is scope for passing something that might be perceived as unpopular, but then shifts public opinion after it is implemented.

Well, you could argue the ACA was exactly that.  But even that took very strong majorities and a very committed president.  As for most people having no idea about health policy, sure.  You could say this about many issues, arguably most issues.  Perhaps that's why the culture war gains so much traction here - the issues are simple enough for Americans to understand.  Abortion bad!  Guns good!  Critical race theory?  I don't understand!  Grrr!!!!

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I remember several years ago in another thread about the topic on this board that there was a poster whose main argument against universal health care in the USA was that America was a nation of hypochondriacs, and if the government paid for everyone's health care that people would be running to the doctor all the time for issues that weren't real illnesses and so health care costs would skyrocket. She seemed to have believe that Americans were way more likely to be this way than citizens of most other countries , so pointing out how it worked in other places did not change her opinion.

I do NOT agree with the above myself but will always remember that as a unique argument for the USA couldn't afford universal care. 

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37 minutes ago, Ormond said:

I remember several years ago in another thread about the topic on this board that there was a poster whose main argument against universal health care in the USA was that America was a nation of hypochondriacs, and if the government paid for everyone's health care that people would be running to the doctor all the time for issues that weren't real illnesses and so health care costs would skyrocket. She seemed to have believe that Americans were way more likely to be this way than citizens of most other countries , so pointing out how it worked in other places did not change her opinion.

I do NOT agree with the above myself but will always remember that as a unique argument for the USA couldn't afford universal care. 

People like that do exist.

I once saw a patient check into the Emergency Department 4 times in a 24 hour period.

But yeah, fairly certain the number is so low as to be negligible in the grand scheme of things. 

Edited by A True Kaniggit
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What's this, a soapbox for whinging at political idiocy in my tiny corner of the world? Don't mind me, I'll just be a moment.

My huge gripe with the health care system in Norway is that politicians are obsessed with cutting spending, when what they should be doing is increasing it. Even from a completely cold and rational financial standpoint, as I see it, your options are A) The state picking up the tab for fully curing a patient using the most cutting edge (if somewhat expensive) treatments and expertise available, which would let them rejoin the workforce, pay taxes & contribute to the economy, or B), Barely give enough treatment so that they survive (which still has costs)/drag feet until the condition worsens/lose expertise when bright minds seek more profitable work elsewhere, all of which resulting in survivors barely hanging on, in agony and despair, while subsisting on disability for the rest of their lives, which is paid for by...? You guessed it!

Exactly how does that save any fucking money?

 

So if you do go UHC, Americans, make sure you don't do it the dumb way.

Edited by lacuna
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11 hours ago, DMC said:

That last part isn't true.  Whether you look here, here, or here, there is consensus among Democrats when it comes to at least the public option - and frankly Medicare for All as well unless you have a really stringent definition of consensus.

That being said, it would still take considerably larger majorities (not to mention, at the moment, a much more popular president) in both chambers for the Dems to pass even the public option.  Which is why Biden - and hell even Sanders - didn't even bother to try.

Yep, however unless I am mistaken (which has been known to happen :D), the public option doesnt directly threaten the status quo for folks with private insurance.  Probably a better indicator would be support for a plan that removes the incentive to companies to provide health care and how it goes about doing so.  I believe Bernie's version of medicare for all would do that, but not all of the proposed plans take that action. 

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7 minutes ago, horangi said:

Yep, however unless I am mistaken (which has been known to happen :D), the public option doesnt directly threaten the status quo for folks with private insurance.  Probably a better indicator would be support for a plan that removes the incentive to companies to provide health care and how it goes about doing so.  I believe Bernie's version of medicare for all would do that, but not all of the proposed plans take that action. 

Yes, the public option retains private insurance, but MFA is just a brand name for single payer.  And like I said, even MFA virtually has consensus among Dems.

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Quote

In addition, things like prior authorizations are even worse. If a doctor thinks you need a particular investigation or treatment, sometimes prior authorizations are needed by the insurance company  - this causes delays and can ( and has) resulted in significant harm for patients whilst also taking time away from the physician whilst they try and treat their patients.

 

This just happened to me actually. My doctor's office explained that it's become a standard delay tactic of the insurance companies. Scared the hell out of me because no one warned me and I just saw on the website of the insurer that I was denied coverage for my treatments. It did delay care. My doctor was forced to go to this meeting and lay out the case why I need the treatment with an insurance company doctor. I wonder who is paying for all that mess.

 

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