Universal Medical Insurance

[Bronzeage]

For all the hand wringing about universal healthcare and laments of "who will pay for it," the simple fact is, we have universal healthcare right now.

If a person in the United States collapses in the street and is taken to a hospital, it doesn't matter who they, citizen or immigrant, undocumented, uninsured, on and on, they will be treated.

They will be treated with the most expensive healthcare on this planet. It maybe too late to be of any real help, but it costs the same, without regard to the outcome of the treatment. The best part of this farce is that we all pay for it. In the tradition of the "there's no such thing as a free lunch" school of economics, the cost of healthcare to those who can't pay for it is squeezed out of the economy, one way or another.

This leaves the question, 'If we're already paying for bad and expensive healthcare, what are people bitching about?,

The answer is obvious. The objection is not to paying for healthcare, the objection is to good healthcare at reasonable costs. Since the greatest amount of this expensive and inadequate treatment is absorbed by the poor, the logical extension is, the real problem is supplying quality healthcare to poor people. It gets murky at this point, because it's difficult to understand the motives. Perhaps there is a belief that healthy poor people will simple result in poor people living longer and thus consume more wealth which rightfully belongs to rich people.

Personally, I think it's just a general dislike of poor people.

It's just unrestrained free-market greed. I don't want to be bothered by a rule change affecting my business and have to provide additional service or product when I can presently maximize my profit, so leave me alone.

But you bring up a good point, namely that there is a difference between having an accident or getting sick, and actual healthcare. Ideally, healthcare is something we do to ourselves and we only have an insurance policy because we know shit happens despite our best efforts. It should operate precisely like owning a home or an auto and having an insurance policy, but it doesn't.

With healthcare there is no obligation on the part of the insured to do anything to maintain the working condition of their asset, namely, their health. Therefore there is no way to control costs. Poor people are the least likely to be healthy long term. And as you say, if they have an accident or an illness they will get care, but it is a scary, bottomless pit to "insure" any asset unconditionally. Hence the reluctance to go full monty.

Is this one of those posts where you are trying to speak ironically, as if you are greedy free market capitalist?

 

[T.G.G. Moogly]

For all the hand wringing about universal healthcare and laments of "who will pay for it," the simple fact is, we have universal healthcare right now.

If a person in the United States collapses in the street and is taken to a hospital, it doesn't matter who they, citizen or immigrant, undocumented, uninsured, on and on, they will be treated.

They will be treated with the most expensive healthcare on this planet. It maybe too late to be of any real help, but it costs the same, without regard to the outcome of the treatment. The best part of this farce is that we all pay for it. In the tradition of the "there's no such thing as a free lunch" school of economics, the cost of healthcare to those who can't pay for it is squeezed out of the economy, one way or another.

This leaves the question, 'If we're already paying for bad and expensive healthcare, what are people bitching about?,

The answer is obvious. The objection is not to paying for healthcare, the objection is to good healthcare at reasonable costs. Since the greatest amount of this expensive and inadequate treatment is absorbed by the poor, the logical extension is, the real problem is supplying quality healthcare to poor people. It gets murky at this point, because it's difficult to understand the motives. Perhaps there is a belief that healthy poor people will simple result in poor people living longer and thus consume more wealth which rightfully belongs to rich people.

Personally, I think it's just a general dislike of poor people.

It's just unrestrained free-market greed. I don't want to be bothered by a rule change affecting my business and have to provide additional service or product when I can presently maximize my profit, so leave me alone.

But you bring up a good point, namely that there is a difference between having an accident or getting sick, and actual healthcare. Ideally, healthcare is something we do to ourselves and we only have an insurance policy because we know shit happens despite our best efforts. It should operate precisely like owning a home or an auto and having an insurance policy, but it doesn't.

With healthcare there is no obligation on the part of the insured to do anything to maintain the working condition of their asset, namely, their health. Therefore there is no way to control costs. Poor people are the least likely to be healthy long term. And as you say, if they have an accident or an illness they will get care, but it is a scary, bottomless pit to "insure" any asset unconditionally. Hence the reluctance to go full monty.

Is this one of those posts where you are trying to speak ironically, as if you are greedy free market capitalist?

No. I want UHC. I'm just being honest.

 

[Bronzeage]

Is this one of those posts where you are trying to speak ironically, as if you are greedy free market capitalist?

No. I want UHC. I'm just being honest.

In the past I have modestly proposed that providing healthcare for poor people would make them healthier and remove their incentive to stop being poor, which is counter to your supposition that healthcare would give them an incentive to stop being healthy.

 

[Toni]

Is this one of those posts where you are trying to speak ironically, as if you are greedy free market capitalist?

No. I want UHC. I'm just being honest.

In the past I have modestly proposed that providing healthcare for poor people would make them healthier and remove their incentive to stop being poor, which is counter to your supposition that healthcare would give them an incentive to stop being healthy.

Yeah, it's an enormous struggle to be poor and to get health care that isn't emergency room care that would be better provided in an actual clinic where you are an established patient. Lots of people fall through cracks:


https://apnews.com/865c6779fa90457b...or,-left-out-of-health-debate,-seek-free-care

People in central Appalachia are 41 percent more likely to get diabetes and 42 percent more likely to die of heart disease than the rest of the nation, according to a study released in August by the Appalachian Regional Commission and other groups. The study also found that the region’s supply of specialty doctors per 100,000 people is 65 percent lower than in the rest of the nation.

And people from southwestern Virginia die on average 10 years sooner than those from wealthier counties close to Washington, said August Wallmeyer, an author who lobbies the Virginia legislature on health issues.

https://www.vice.com/en_us/article/...-at-a-remote-medical-clinic-in-appalachia-ang

The Remote Area Medical Clinic is a vast open-air mash unit staffed by 1,200 volunteers from all over the country that appears in Wise, Virginia, every summer. In 2015, when I was there, they performed 7,035 dental procedures and gave away 840 pairs of glasses to 2,172 people who couldn't otherwise afford them. Dozens of other medical services were on offer: EKGs, ultrasounds, endocrinology, orthotics—all of it free. In a region where specialists are rare, demand is incredibly high. Would-be patients camp out for multiple nights to stake their spots in line, endure intense heat on top of their pain, and sometimes wait all day for treatment.

https://www.nytimes.com/2017/07/23/...ral-poor-affordable-care-act-republicans.html

Ms. Neal had driven six hours from Hickory, N.C., with her wife, Angel Neal, 35. Both women have chronic conditions and struggle in low-paying jobs without health coverage to afford medicines.

Robin Neal has fought Type 1 diabetes since age 10, she said. Angel Neal, who drives a forklift, has pancreatitis. Her medication costs $500 for 70 pills, she said, beyond her means. She had gone two years without the drugs.

Dr. Joseph A. Aloi, an endocrinologist from Wake Forest School of Medicine, examined both women. Standing outside the tent later, he said: “Insulin is coming up on its 100-year anniversary. People know how to take care of their diabetes. They can’t afford the insulin. They run out, they spiral out of control and end up in the hospital.”

After an hour in the tent hooked up to intravenous drips, the women were discharged. They walked the central artery of the fairground, passing medical personnel inviting them to presentations about breast cancer and opioid abuse. The Neals skipped these come-ons. They headed to a big, crowded pavilion offering eye tests. Robin Neal, whose vision was tested at 20/100, desperately needed a pair of the free eyeglasses RAM offered. She joined another long line on the sweltering day.

These articles (and there are many more on the net) focus on Appalacia. I'm more familiar with the economics and health situation there than other areas which is why I posted.

One thing I would like to point out: A LOT of these people have serious dental problems, which in and of themselves are bad enough. But the reality is that serious dental problems lead to other serious health problems, including heart problems. Dental care is not optional care.

 

[T.G.G. Moogly]

Is this one of those posts where you are trying to speak ironically, as if you are greedy free market capitalist?

No. I want UHC. I'm just being honest.

In the past I have modestly proposed that providing healthcare for poor people would make them healthier and remove their incentive to stop being poor, which is counter to your supposition that healthcare would give them an incentive to stop being healthy.

I don't know if that is true or not. I certainly hope it would be, but is it born out in any studies? Are people from nations with UHC healthier than here in the U.S.? I don't know.

In truth that's not really an important question anyway because it's really the old decision between guns and butter. In the U.S. we'd rather nave fleets of aircraft carriers than UHC. The money is there, it's just a matter of how we're going to spend it.

 

[lpetrich]

In NHS, UK’s health care system, rationing isn’t a dirty word - Vox noting 2016 International Survey of Primary Care Consumers : International Health Care System Profiles

The 2016 Commonwealth Fund International Survey of 11 nations finds that adults in the United States are far more likely than those in other countries to go without needed care because of costs and to struggle to afford basic necessities such as housing and healthy food. U.S. adults are also more likely to report having poor health and emotional distress.

Back to Vox

In 2016, the Commonwealth Fund, our partners on this project, surveyed 11 high-income countries about cost-related barriers to care. Americans were the most likely to skip needed care because of costs, with 33 percent having done so over the past year. Residents of the United Kingdom were among the least likely, with only 7 percent saying the same. The same was true, notably, of dental care; 32 percent of Americans said they skipped needed dental services due to cost, while only 11 percent of Britons did the same.

Yet in 2016, health care spending in the US equaled more than 17 percent of the country’s GDP, while the share of health spending in Britain was only 9.7 percent. Nor do health outcomes seem to be suffering. Life expectancy in Britain is higher than in the US, and on measures of “mortality amenable to health care” — which specifically track deaths that could have been prevented by medical intervention — the US performs worse than the UK.

So here, then, is the comparison: The UK spends barely half what we do, covers everyone, rarely lets cost prove a barrier for people seeking care, and boasts health outcomes better than ours.

But how does the UK do it? A key is in rationing.

No system can say yes to every desired treatment, in every context, at any price. All systems have to tell somebody no: Either providers cannot charge what they want, or patients cannot have what they want, or taxes are going to be much higher than anyone wants.

However, what's in the US is rationing by cost, and it is something that given a lot of money to those who benefit from it. So when anyone proposed reforms, they make a big issue out of government rationing.

In a Congressional hearing, AOC expressed it as self-imposed rationing, rationing that she had imposed on herself during her waitress/bartender career.

“The US health care system has been designed as if, with enormous intelligence and intent, it was to be as resistant to cost control as possible,” Aaron says.

It doesn't have to be some central planner designing it. The participants in the system each resisting cost control can easily have done it in a much more

The UK is the opposite of the US in how it says no. It has embraced the idea we fear most: rationing. There is, in the UK, a government agency that decides which treatments are worth covering, and for whom. It is an agency that has even decided, from the government’s perspective, how much a life is worth in hard currency. It has made the UK system uniquely centralized, transparent, and equitable. But it is built on a faith in government, and a political and social solidarity, that is hard to imagine in the US.

 

[lpetrich]

At the center of the UK system sits the National Health Service. Founded in 1948, the NHS goes beyond single-payer health care into truly socialized medicine: The government doesn’t just pay for services, it also runs hospitals and employs doctors. The system is financed through taxes, everyone is covered, and supplemental private insurance is rare; unlike in, say, France, where most residents have supplemental insurance, only one in 10 Britons go outside the NHS system for private coverage.

In effect, much like the US Veterans Administration but on a national scale.

How it makes decisions:

In 1999, the British government set up the National Institute for Care Excellence, or NICE, to assess the cost-effectiveness of medications, procedures, and other treatments, and make recommendations to the National Health Service about what to cover and how. NICE has forced the NHS to become the anti-US: Rather than obscuring its judgments and saying no through countless individual acts of price discrimination, NICE makes the system’s values visible, and it says no, or yes, all at once, in full view of the public.

It does so with the help of what it calls Quality-Adjusted Life Years. A year of very healthy life is 1 QALY, while being dead is 0 QALY's.

With some exceptions, the organization values one QALY at between 20,000 and 30,000 pounds, roughly $26,000 to $40,000. If a treatment will give someone another year of life in good health and it costs less than 20,000 pounds, it clears NICE’s bar. Between 20,000 and 30,000 pounds, it’s a closer call. Above 30,000 pounds, treatments are often rejected — though there are exceptions, as in some end-of-life care and, more recently, some pricey cancer drugs.

QALY's can be controversial -- what level of sickness is what fraction of 1, and people with disabilities can lead worthwhile lives.

Then a problem with the US.

The late Uwe Reinhardt, the famed health economist who helped set up Taiwan’s single-payer system (read my colleague Dylan Scott for more on that), once told me that he feared American politics was too captured to properly construct a single-payer system.

“I have not advocated the single-payer model here,” he said, “because our government is too corrupt. Medicare is a large insurance company whose board of directors — Ways and Means and Senate Finance — accept payments from vendors to the company. In the private market, that would get you into trouble.

“When you go to Taiwan or Canada,” he continued, “the kind of lobbying we have [in America] is illegal there. You can’t pay money to influence the party the same way. Therefore, the bureaucrats who run these systems are pretty much insulated from these pressures.”

That is why it is encouraging that some US politicians are accepting mostly small donations and avoiding schmoozing big donors in places like wine caves. AOC is only the most prominent of such politicians.

 

[T.G.G. Moogly]

The UK is the opposite of the US in how it says no. It has embraced the idea we fear most: rationing. There is, in the UK, a government agency that decides which treatments are worth covering, and for whom. It is an agency that has even decided, from the government’s perspective, how much a life is worth in hard currency. It has made the UK system uniquely centralized, transparent, and equitable. But it is built on a faith in government, and a political and social solidarity, that is hard to imagine in the US.

Can it ever be any other way?