Universal Healthcare in the United States

[A True Kaniggit]

Yeah our current system seems to be fucked up for two major reasons. 

1) The goal of the healthcare facilities is to make a profit. So it is in their interest to order more tests (even if they are not necessary for the health of the patient) to get money out of the insurance companies.

2) The goal of the insurance companies is to make a profit by not paying out claims. They collect the premiums, and then try to keep money using every excuse possible to not help the customers paying said premiums  

While the whole time patients are being gouged 3 separate ways. 1) They are paying premiums just to have insurance. 2) They have to make copayments for the actual doctor visits. 3) They then have to pay out of pocket for things their insurance company refuses to cover.

What a messed up system. 

[Pebble thats Stubby]

What happens in the US if while you are in the middle of treatment your insurance company went bust?  Do you now get the bill?

[Mlle. Zabzie]

4 minutes ago, Chataya de Fleury said:

That doesn’t happen. 

Basically, most companies are self insured and then they buy stop loss and reinsurance. The “insurance company” is there as a third party administrator (TPA) to basically have negotiated discounts and pay the claims on behalf of the company.

Even if there is true insurance and not a company self insurance with the insurance company as TPA, there is stop loss and reinsurance.

Stop loss is basically an insurance policy for the insurers or employers that says “if your claims exceed $x on this individual then we will pay” and they cover the pool of employees. Typically, only a very few employees are that expensive.

Exactly this.  Chataya and I come out different doors on what should happen from a policy perspective, but I know we both agree that it is very important to understand that “health insurance” is, for most people, really a misnomer.  That is, insurance is classically for “risk” - health care in the modern era is a certainty, not a risk.  (This is also true for things like the ACA - which has a slightly more insurance flavor but really gets people access to the TPA bulk pricing etc. for routine matters).  I think that the current system is completely convoluted and effed up.   For most people with employer provided plans, your best bet is to get the highest deductible, lowest premium option and couple that with a Health Savings Account in an amount that covers your deductible.  You want to pay the very lowest amount you can if you think that you will really be using the product to access bulk bought routine care.  You usually get a couple of “well visits” (that your premium funds, functionally), and pay any sick visits with pre tax dollars out of pocket.  There is a way to convert your unused HSA dollars into the equivalent of a 401K (basically and investment account that grows without tax to use on healthcare when you are old).  Most people do not do this because how the pieces fit together is utterly opaque and makes absolutely zero sense (similarly things like needing referrals, doctor networks, etc. - just nonsense).  Most people also still get so-so care (unless they are basically paying out of pocket).  I am under no illusions about this country.  I don’t think we ever end up with single provider, and frankly at best we will have a hybrid single payer.  UK-like model like the closest model that would have political legs in my lifetime.  But what we have now is bad for sure.

[Raja]

On 1/16/2022 at 6:42 PM, DMC said:

Well, you could argue the ACA was exactly that.  But even that took very strong majorities and a very committed president. 

Yeah, the ACA was what I had in mind when I wrote that last bit, but I'm sure we can find more examples if we look. I agree with you that people don't know details of a lot of things, and that's one of the reasons why I'm a little iffy about using opinion polls to back legislation. Like for the No surprises Act, were were out here polling to see what everyone thought before we decided that it's a ludicrous practice that affects patients and started coming up with legislation? I feel like plenty of legislation gets passed without it being subject to this whole nothing of 'well, it does not have more than 50% approval so we shouldn't do it' - this isn't directed at you per se, just the tenor of the conversations in the various politics threads.

Of course, something like this would afffect a lot of people and we're a democracy and healthcare is a big issue with voters, so I understand the reflex of turning to polling.

On 1/16/2022 at 10:22 PM, Martell Spy said:

 

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.

 

I'm sorry, this sucks

[DMC]

19 minutes ago, Raja said:

Of course, something like this would afffect a lot of people and we're a democracy and healthcare is a big issue with voters, so I understand the reflex of turning to polling.

Right, when we're talking about something as major/fundamental as shifting to single payer, turning to polling is going to be necessary simply due to the fact elected officials responsible for instituting such a change are going to rely on opinion polls.

You're certainly right that non-major/controversial legislation can be passed wherein legislators aren't all that concerned about polling.  (Not to mention certain non-major improvements can be made unilaterally/without legislation.)  Hell, look at the reconciliation bill.  There were significant healthcare provisions in it and I wager the vast majority couldn't even identify what those provisions were.  And, certainly, nobody cared about polling on the healthcare provisions specifically - plus they're the one policy area of the bill I'm most confident Manchin would actually back.

Anyway, the main reason I focused on polling is because in the OP ATK asked why Americans didn't back universal healthcare, so turning to polling seems like the intuitive thing to do to discuss that question.

[Kalbear]

@horangiis right - a big problem is that people feel (often erroneously) that their insurance would be reduced and their personal experience would suck more if the government took over.

This is largely factually untrue and is mostly a product of lobbying and FUD, but it has also been effective. 

My view is that something like the Swiss model or something like Singapore's model would be the best overall adaptation - where there is routine free Healthcare for all, everyone pays for health insurance for scarier things, and there is an ability for people to get private, better insurance in addition to basic. But the power of money in the US to make policy as it is makes it unlikely short of actual disasters to change one goddamn thing federally.

Next best step would be states, but due to some tax issues that becomes less likely too.

[Raja]

19 hours ago, DMC said:

Anyway, the main reason I focused on polling is because in the OP ATK asked why Americans didn't back universal healthcare, so turning to polling seems like the intuitive thing to do to discuss that question.

Yeah, my point on polling etc was more general as opposed to specifically focusing on the discussion in the thread. I'd be curious to read up on what the context/ public opinion was on passing other major health reforms that we've had over the last 20-30 years.

Re: the Singapore health system - I lived there for 10 years so I do have a bit of experience with the system. I think there are elements of it that work well, but implmenting that in the US would be very challenging ( to be fair, as would most other systems we have brought up here) as the health system in Singapore basically has even more government oversight & control than some of the other options currently on the table. Medisave forces you to put 6-7% of your pay into a health savings account, but that account can be used for pre-approved drugs & cost effective drugs. The government in Singapore exercises a huge amount of control all across the health system ( And this is true of Singapore in general, where the government has an absurd amount of control over everything), which is something you don't see in other single payer countries.