Universal Health Care Coverage
We know the following things about the health care system in the U.S.:
1) There are 30,000,000+ people without coverage.
2) Those without coverage pay too much.
3) Because private insurers make their profits by covering healthy people and denying care to those who need it, health care is an excellent example of a good that a market cannot provide efficiently or effecitvely.
4) People without health coverage do not get important preventive care, leading to more serious and expensive health problems.
5) People with health coverage get overtreated because much of the payout from insurers is based on how many services/tests/procedures the doctor or hospital performs.
We also know that in civilized countries, there are national universal coverage systems. If you think about the fact that today, someone could get fired or laid off, lose their health coverage, get hit by a car and end up owing thousands of dollars, or that someone could suffer a heart attack or stroke from hypertension that went undetected because that person did not have access to regular primary care, you realize that the situation is not only outrageous but literally deadly. When you look at the fact that dozens of other countries have fairer health care systems that cost less while providing better outcomes, then things start to look ridiculous.
Some wingos think that national health care systems are some sort of fascism, or something, but you probably know that old quote about capitalism giving the rich and poor alike the right to sleep under the bridge at night. Personally I don't think of "dying from a preventable condition" as a "freedom." I think of it as a cruelty. And everyone knows someone whose cousin's best friend's mom was in Canada and had to wait 39 weeks to get their inflamed appendix removed, or whatever. The fact is, the system in the United States does not do a good job of controlling wait times. But more importantly, all (that's all) health care systems allocate care. The question is, do we want to allocate care based on wealth and employment status, or do we want to allocate it based on need?
But really, I think it's important for liberals/progressives/leftists to discuss health care systems in a productive way. People who like being sick or dead more than they like efficient, fair, high quality health care cannot be part of such a discussion. At some point we need to realize that we will have to move forward without 20% or so of the people in the country. Opposition to universal coverage is like climate change denial or neo-Hooverite "cut spending during a recession" talk; it's ignorant, it's often mean-spirited, and it's largely irrelevant to solving problems. Conservatives can believe what they want. When we fix the health care system without them, they'll benefit like everyone else.
One problem with our discussion of health care is that people seem over-focused on single-payer systems. There's an article in the latest Harper's magazine that refers to all universal coverage systems as "single-payer." This is just incorrect -- there are as many universal health care system types as there are countries with universal health care systems. Hybrid systems are common. The Canadian system is different from the English system, which is different from the French or the Swedish system.
As a socialist, I lean toward actual national systems like Great Britain has. In such a system, the doctors actually work for the government. Canada has a successful single-payer system, as you know, which is basically like our system except that there is one major insurer, which is the government, and it covers everybody. France and Germany have a "social insurance" model, with hundreds of insurers run by employers and the government. This sounds like it could never work but apparently it does. Actually I should just link to this much better explanation from PNHP:
Health Care Systems - Four Basic Models
Anyway, I am posting this as a discussion starter, or a polemic, or both, or whatever. The important question at this point is not, "Should we have a national universal coverage system?" The important questions are "What will our national universal coverage system look like?" and "When the hell can we get it???"
1) There are 30,000,000+ people without coverage.
2) Those without coverage pay too much.
3) Because private insurers make their profits by covering healthy people and denying care to those who need it, health care is an excellent example of a good that a market cannot provide efficiently or effecitvely.
4) People without health coverage do not get important preventive care, leading to more serious and expensive health problems.
5) People with health coverage get overtreated because much of the payout from insurers is based on how many services/tests/procedures the doctor or hospital performs.
We also know that in civilized countries, there are national universal coverage systems. If you think about the fact that today, someone could get fired or laid off, lose their health coverage, get hit by a car and end up owing thousands of dollars, or that someone could suffer a heart attack or stroke from hypertension that went undetected because that person did not have access to regular primary care, you realize that the situation is not only outrageous but literally deadly. When you look at the fact that dozens of other countries have fairer health care systems that cost less while providing better outcomes, then things start to look ridiculous.
Some wingos think that national health care systems are some sort of fascism, or something, but you probably know that old quote about capitalism giving the rich and poor alike the right to sleep under the bridge at night. Personally I don't think of "dying from a preventable condition" as a "freedom." I think of it as a cruelty. And everyone knows someone whose cousin's best friend's mom was in Canada and had to wait 39 weeks to get their inflamed appendix removed, or whatever. The fact is, the system in the United States does not do a good job of controlling wait times. But more importantly, all (that's all) health care systems allocate care. The question is, do we want to allocate care based on wealth and employment status, or do we want to allocate it based on need?
But really, I think it's important for liberals/progressives/leftists to discuss health care systems in a productive way. People who like being sick or dead more than they like efficient, fair, high quality health care cannot be part of such a discussion. At some point we need to realize that we will have to move forward without 20% or so of the people in the country. Opposition to universal coverage is like climate change denial or neo-Hooverite "cut spending during a recession" talk; it's ignorant, it's often mean-spirited, and it's largely irrelevant to solving problems. Conservatives can believe what they want. When we fix the health care system without them, they'll benefit like everyone else.
One problem with our discussion of health care is that people seem over-focused on single-payer systems. There's an article in the latest Harper's magazine that refers to all universal coverage systems as "single-payer." This is just incorrect -- there are as many universal health care system types as there are countries with universal health care systems. Hybrid systems are common. The Canadian system is different from the English system, which is different from the French or the Swedish system.
As a socialist, I lean toward actual national systems like Great Britain has. In such a system, the doctors actually work for the government. Canada has a successful single-payer system, as you know, which is basically like our system except that there is one major insurer, which is the government, and it covers everybody. France and Germany have a "social insurance" model, with hundreds of insurers run by employers and the government. This sounds like it could never work but apparently it does. Actually I should just link to this much better explanation from PNHP:
Health Care Systems - Four Basic Models
Anyway, I am posting this as a discussion starter, or a polemic, or both, or whatever. The important question at this point is not, "Should we have a national universal coverage system?" The important questions are "What will our national universal coverage system look like?" and "When the hell can we get it???"
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Why do you think there is too much focus on single-payer? It is the only way to make health-care dollars go to health care. As long as the profit motive is a part of the system, money goes to advertising, bureaucratic crap, and profit. How is that a good thing?
January 27, 2009 11:09 PM | Reply | Permalink
Single-payer is just one kind of universal, non-profit coverage. It may or may not be the best solution for the United States. Oddly, I heard Ezekiel Emanuel, Rahm's brother, talking about this on NPR recently. Ezekiel is a leading bioethicist and an expert on health care policy. I didn't get to hear the whole talk, but he said that the problem with single-payer is that it uses the same delivery system as a privatized system, and therefore doesn't control costs adequately. I think this is the speech I heard:
http://www.youtube.com/watch?v=xxyRS4IL0nI
January 28, 2009 8:17 AM | Reply | Permalink
#2. Even those "with coverage" pay too much. I have a catastrophic policy. And until the first $5000 kicks is, I have pay the full price for everything. So the "partially insured are also getting ripped off twice!
January 27, 2009 11:11 PM | Reply | Permalink
And what do you pay annually for premiums BEFORE they start paying after that $5000. A question: Is that "deductible" a 12-month thing, or a calendar thing? In other words, if your health care costs started in September and you paid your $5000 by December 1st, would your insurance kick in and pay until the next September, or would your 'deductible clock' start all over again in January? Do you see what I am asking?
It sounds like you have a health savings account. I almost developed an ulcer just because of mine.
I think you have underestimated the number of times the partially insured are getting ripped off! It is logaryithmic!
January 27, 2009 11:23 PM | Reply | Permalink
Yes, the important question is what type of system, but we can't have that conversation because the 20% we will never convince are mostly very wealthy and powerful people for whom the current system is just fine and quite often quite profitable or them. They pull the strings of the mationettes we elect to Congress and to the Presidency. It is and was no mistake that the big insurance companies contributed heavily to Obama even before he got the nomination and thus it comes as no surprise that all the discussion of his health care package indicate it's just going to be one big subsidy program for the benefit of the insurance companies. Yes, more people will be covered but it won't be universal by any means and will only perpetuate the rotten profit motivated insurance company system we now have.
I think the system we need is some form of medicate for all with the option of buying additional insurance if you want extras the basic plan doesn't provide. I'm not talking about any essential health care services or treatments as extras but additional coverage as people in Spain who want it have or in other nations that have socialized health care (as in all our main allies in europe and asia including Canada). The idea that this one special interest (insurance companies) could impede the establishment of a national health service is sickening, but that's the primary obstacle.
Without a leader willing to defy the insurance industry's money, we really have no hope. I don't thik Obama sees himself as the man who will tell the insurance companies "no".
January 28, 2009 2:15 AM | Reply | Permalink
Thanks for posting this, Skyolt.
I have been working on a lecture for lay persons and medical professionals as well trying to explain this in a straightforward manner. I've posted the narrative on my TPM Blog:
http://tpmcafe.talkingpointsmemo.com/talk/blogs/cmhmd/2009/01/chocolate-vanilla-and-the-rock.php
I am an intensive care physician and it is clear to me that even those who think they are engaged in informed debate on healthcare reform are really woefully uninformed.
Please go over and check out my summary. There are Powerpoint slides to accompany it, but I haven't yet figured out how to post them. If anyone would like them, I can email them.
I also have a Single Payer Blog at http://cmhmd.blogspot.com
Also, I note that PNHP did what I did, stole shamelessly from T R Reid and the terrific Frontline documentary "Sick Around the World,"
Cheers,
January 28, 2009 11:34 AM | Reply | Permalink
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January 31, 2009 12:03 AM | Reply | Permalink