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from the But-I-*like*-getting-50-different-invoices-for-one-hospital-stay dept.
There is an instinct among political pundits to confuse caution for practicality — an assumption that those who advocate for incremental change are being reasonable, while those pushing for bold reforms aren’t. This is seen most starkly in the debate around health care reform, despite the fact that the “practical” pushers of limited reform fail to address the real problems in our health care system.
We all recognize that the status quo isn’t working. We spend more per person than any other country on health care, but we aren’t getting any bang for our buck. We have lower life expectancy, higher infant mortality rates and more preventable deaths, and too many personal bankruptcies are due at least in part to medical bills.
[...]Time to get real. As an economist who has spent decades studying our health care system, I can tell you that Medicare for All advocates are the only ones who are being reasonable, because theirs is the only plan that will control health care costs while finally achieving universal coverage.
The problem with incremental plans, whether they are public options, buy-ins to Medicare or Medicaid, or pumping more money into subsidies in the Affordable Care Act's individual marketplace, is that they preserve the private health insurance system weighing down our health care. [...]they are leaving the main reason for our system’s dysfunction in place: the multipayer, for-profit financing model.
Commercial insurance companies are nothing more than middle men. They add no value to our system, but they do drive up costs with their bloated claims departments, marketing and advertising budgets and executive salaries. We pay for all of these things before a single dollar is spent on the delivery of care.
They also create extra costs for providers who need large administrative staffs to deal with billing systems, accounting for as much as $100,000 per physician.
Any plans short of Medicare for All leaves these costs in place. In other words, they leave hundreds of billions of dollars a year in savings on the table.
[...]Gerald Friedman, a health care and labor economist, is an economics professor at University of Massachusetts Amherst and the director of The Hopbrook Institute.
[Related]:
Democrats' promise of Medicare for All is remarkably misguided and unrealistic
Trump wants to drop a neutron bomb on Obamacare. Over to you, 2020 voters.
Take it from me, tweaks won't fix health care. Dems should focus on Medicare for All.
(Score: 5, Insightful) by ledow on Tuesday April 09 2019, @02:43PM
I'm going to assume you're in the US.
The problem you have is the target audience. Put aside prejudices, potential abuse of the systems, outright fraud, etc. - that can all be countered by implementing proper controls. Why anyone would want a national system without proper controls, I can't fathom.
However:
You want some people - those *most genuinely unable to work* - to pay more. Maybe even people who were *never* able to work, to pay from the day they were born.
That's like charging the stupid more for their education. It sounds really great in theory, but just results in a massive polarisation of service - the stupid get poorer and therefore (because they can't afford to pay for education) stupider. The rich get richer and smarter because they can get even more education for even less proportion of their income.
You have a choice in both systems - polarisation (make the sick sicker, the poor poorer, the stupid stupider) or levelling (make the sick healthier, the poor less poor, the stupid less stupid).
Everything else you mention is an implementation detail. Sure, you have to assume that the implementation will be abused... that's an *entirely* different problem, no different to how every government contract for IT costs 10 times what is actually deployed to make it work. But putting such blanket "costs" aside, you have to decide what kind of system you want.
And I guarantee you that if you're healthy, you won't want to pay for healthcare. If you're rich, you won't want to have to support the poor. But the exception is: If you're intelligent, you should recognise that you have to support the stupid.
It's a humanitarian issue. It's an idealism issue. It's a prejudice issue (the same way that every policy gets lumps into a small set of boxes - "socialist" or whatever. It's just creating obstacles to play on people's prejudices and equate a national healthcare system with a dictatorial "communist" regime, in essence).
I honestly query the thought process of a human so selfish that they say "Well, I'm healthy, I don't see why I should pay a penny for this kid that was born with a debilitating condition through no fault of their own, they should pay for themselves!". We're not asking you to take them into your homes, wipe their backside, and pay all your pay packet to them. We're asking *everyone* to pay a blanket cost, which covers all instances, including the most extreme, and which you yourself would be eligible to benefit from in their circumstances.
If you won't implement healthcare because "it might be abused at some point", you're literally never going to do it.
If you won't implement healthcare because "I don't need it", you're selfish, verging on the inhumane.
If you won't implement healthcare because "it'll get taken over by the management costs that everything suffers", then implement controls. On everything.
You can badmouth the NHS all you like too... dictated by faceless bureaucrats or not, I have *never* had to worry what happens to me/my family if we're injured. I've never had to consider whether I can afford to be off work sick. I've never had to consider not getting treated because I just don't have the cover. I've never had to consider that I will die before I get treated. I can walk into a hospital, display my condition, and be put into a queue proportionate to my condition's urgency. Sure, it might be a month before I get my hip operation, but if I *want to* I can pay to have it done now. But I don't have to. If I don't have a penny to my name, a single asset, or any credit whatsoever... I still get the operation before it gets too serious.
There is no "rationing", there are controls. Spending billions on a cancer drug that only ten people can benefit from is stupid. There is a cost to human life and that's far beyond sensible. Especially when those billions means everyone else gets their operations a month early, or we improve outcomes for hundreds or thousands of people by even a few percent.
You have to consider - even in the most heartless outlook - the people you're saving are taxpayers. While they aren't able to work, while they are dying early, while their productivity suffers because they can't afford to go to the doctor's... they are costing you money. The longer you can get them to live, the more tax in the long-run. The more they can support their families, the less families end up on social benefits. The healthier they stay, the more productivity and years of useful work they can do. The easier their lives, the more they will make and spend.
At the moment, the US spend around 6 percent of all their household's expenditures on healthcare insurance. That's a 6% "tax", over and above stated taxes, emergency care, etc. on your health and well-being, going to private industry, which has reasons to be as profit-making as it can. We pay less than half of what the US does, taxation-wise, on healthcare and still fund the NHS. For half the price, we get a service that treats everyone.
So, by scrapping health insurance, removing the profit-portion of it entirely, you could spend MORE THAN TWICE what we do on some national health service without affecting a single household that's already paying healthcare (pretty much all of them).
There are many things in which you don't want to just be throwing money at the problem and having blanket coverage. Healthcare isn't one of them. Education is another one, very similar. Both allow "private" care to be greater for those willing to pay, while providing a basic coverage to those who cannot even afford a penny. Sure, I wouldn't want to be paying a tax that, say, supported people driving gas-guzzling cars, or similar. But education and healthcare - you spend money there to ensure you spend much less in the future.
You're "mini-medicare for all" is an NHS, and with the costs you currently pour into basic healthcare, it could be better than your current top-of-the-line healthcare. You just need to vote for it. Those billionaires who want to pay a quack to give them a pill shouldn't even figure in your plans. You have to think of the guy who broke his legs working overtime trying to earn an extra wage to pay for his kid after his wife died... You can't just keep screwing him over in perpetuity and then looking down on him because he couldn't afford insurance, when you're already paying something that would cover everyone in the country to the standards of the NHS, twice over.