Healthcare Is A Human Right
January 26, 2018 10:52 AM   Subscribe

 
This year I'm going to pay about $6000 for a crappy high-deductible medical plan and accompanying HSA. I'm also going to pay close to another $1000 in medicare taxes. I would gladly pay double that if it meant I and everyone else in this country had access to health care, not least of which because it would undoubtedly be better than my extremely disappointing coverage.
posted by Mr.Encyclopedia at 11:28 AM on January 26, 2018 [24 favorites]


I think the audience numbers are significant. This is a one-time event created and promoted by third-tier news sources not on TV, and it got 1.1 million viewers. For comparison, in July of last year, Fox News was getting 2.1 million viewers in prime time and 1.3 million viewers during the day. Given that Fox has a twenty year head start, an enormous pool of capital resources, and an active marketing operation, I think Bernie's numbers are pretty darn good. Plus, if Fox News can have an outsized influence on the politics of this country with a core audience that size, then the left can do it, too.
posted by vibrotronica at 11:30 AM on January 26, 2018 [8 favorites]


Not to rain on anyone's parade, but while healthcare may well be a human right, it isn't a constitutional right. We are a nation of laws and that means winding your way through the legal and legislative process. Single payer may very well be the best pragmatic solution, but given our governance with its political, legislative and regulatory capture, it is not a practical or perhaps even possible solution. You cannot reasonably expect an assembly of idiots to produce Elizabethan sonnets...
posted by jim in austin at 11:30 AM on January 26, 2018 [2 favorites]


Not to rain on anyone's parade, but while healthcare may well be a human right, it isn't a constitutional right. We are a nation of laws and that means winding your way through the legal and legislative process. Single payer may very well be the best pragmatic solution, but given our governance with its political, legislative and regulatory capture, it is not a practical or perhaps even possible solution. You cannot reasonably expect an assembly of idiots to produce Elizabethan sonnets...

Sort of, but also #MedicareForAll. There was at one point a perfectly good plan to get national healthcare here, courtesy of ambiguous figure Lyndon Johnson - start by expanding coverage so that children are covered longer and older people are covered sooner, and work toward the middle until everyone is covered. We are a nation of laws-that-run-Medicare, and, as much as Paul Ryan would like to destroy it because his soul belongs to Satan, we are capable of running a nationally administered medical program.
posted by Frowner at 11:36 AM on January 26, 2018 [50 favorites]


Sort of, but also #MedicareForAll.

Medicare will be doing well to keep its head above the water without taking on the burden of battling 1/6th of the GDP in the healthcare sector...
posted by jim in austin at 11:42 AM on January 26, 2018


Not to rain on anyone's parade, but while healthcare may well be a human right, it isn't a constitutional right. We are a nation of laws and that means winding your way through the legal and legislative process. Single payer may very well be the best pragmatic solution, but given our governance with its political, legislative and regulatory capture, it is not a practical or perhaps even possible solution. You cannot reasonably expect an assembly of idiots to produce Elizabethan sonnets...

Oh, it's possible. Dems get majority in House and 60 in Senate, plus Dem president. They ram through Medicare for All the same way the Republicans ram their trash through. Done and dusted.

Plus: "we are a nation of laws"? lol. We are a nation ruled by political consensus found through white supremacy.
posted by Automocar at 11:43 AM on January 26, 2018 [57 favorites]


Not to rain on anyone's parade, but while healthcare may well be a human right, it isn't a constitutional right. We are a nation of laws and that means winding your way through the legal and legislative process.

Well, the nifty thing about Medicare for All is there's no legal process required. Medicare is well established, it's imminently constitutional and completely above reproach legally. There is nothing about changing the minimum age requirement from 65 to 0 that changes any of that. It's on firmer ground than any other possible universal coverage plan. All you have to do is get the votes for it--and I think the Dems are increasingly willing to do it. They were content to go the moderate route with free market incentives and regulations (the Affordable Care Act), but if the GOP is going to fight it every step of the way and call it socialism, there's no point in not just implementing the easier, simpler, less assailable socialist alternative. There's no rhetoric the Republicans can deploy against it that they haven't already used for Obamacare.
posted by Pater Aletheias at 11:54 AM on January 26, 2018 [36 favorites]


Oh, it's possible. Dems get majority in House and 60 in Senate, plus Dem president. They ram through Medicare for All the same way the Republicans ram their trash through. Done and dusted.

Probably not since nearly as many Dems are on the take from the healthcare sector as the GOP. That should be evident from the ACA dog's breakfast...

Plus: "we are a nation of laws"? lol. We are a nation ruled by political consensus found through white supremacy.

No, The Supremes always get to sing the last note...
posted by jim in austin at 11:57 AM on January 26, 2018 [2 favorites]


Probably not since nearly as many Dems are on the take from the healthcare sector as the GOP. That should be evident from the ACA dog's breakfast...

It was Joe Lieberman who vetoed any possible single-payer and Joe Lieberman was an independent, not a Democrat.
posted by JackFlash at 12:02 PM on January 26, 2018 [7 favorites]


Not to rain on anyone's parade

*proceeds to rain on parade for, like, a while*
posted by curious nu at 12:02 PM on January 26, 2018 [55 favorites]


If you think most Supreme Court decisions are based on the law I have a bridge to sell you.
posted by Automocar at 12:02 PM on January 26, 2018 [18 favorites]


The great thing about the U.S. Constitution is that it can be amended when it's deemed necessary.
posted by The Underpants Monster at 12:03 PM on January 26, 2018 [15 favorites]


Start with Medicare for All. When there's pushback, allow people to buy in to Medicare instead as a compromise. Public option with moving mandatory Medicare to 50. Within 10 years it will be from infancy to death.

The public is becoming more and more comfortable not only with universal health care but with single payer, and the US has a single payer system, just one that only covers 65 and up.

As for political will, the Dems are already realizing which way the winds are shifting and the Republicans have now been shown to have no idea how to plan any healthcare system.

The next four years. That's all it will take.
posted by Lord Chancellor at 12:05 PM on January 26, 2018 [9 favorites]


Probably not since nearly as many Dems are on the take from the healthcare sector as the GOP. That should be evident from the ACA dog's breakfast...

It was Joe Lieberman who vetoed any possible single-payer and Joe Lieberman was an independent, not a Democrat.


Also, the political calculus has shifted drastically over the last 10 years. Single payer is becoming the standard for almost all Dems.
posted by Lord Chancellor at 12:06 PM on January 26, 2018 [3 favorites]


Does the US spend less on social programs (not including healthcare) than Canada and Norway do? Because if the study I posted the other day is correct, low spending on social programs might be the biggest source of poor health outcomes in the US. It might have little to do with how much you do or don't spend directly on healthcare. A change to single-payer might do little for you (other than lower your tax and insurance bills) if you don't also start spending more on programs for poor people.
posted by clawsoon at 12:12 PM on January 26, 2018 [8 favorites]


I like how the objections to universal healthcare are that it is not practically possible while ignoring the fact that an enormous chunk of the world has made it work. The US is supposedly a great and powerful country but no, it can't possibly care for its citizens.

In 1998, I was in San Francisco working to try and start a company. I did not have healthcare when I fell of a chair and fractured my ankle. So I made do because I couldn't afford to see a doctor and limped on one foot hoping it would heal itself. The experience was degrading. My foot did slowly heal itself over a month or so and I started walking again. So I was lucky I suppose.

I wanted to leave the US in 2008 partly for that. Because I didn't want to live in a country, or contribute my taxes, where only the wealthy were guaranteed to be taken care of. I moved to the UK and more recently to the Netherlands. (yes, partly because I see the UK govt now leaning towards the same meanness of spirit)

By the way, if it is cold out and I happen to be wearing stiff boots, I get a pain in my left ankle that makes it difficult to walk. This can last for days. I take it as my regular reminder, should I think of going back.
posted by vacapinta at 12:14 PM on January 26, 2018 [41 favorites]


We are a nation of laws

A year into the Trump administration, it's not clear to me how anyone could say that with a straight face or any kind of intellectual honesty.
posted by Naberius at 12:15 PM on January 26, 2018 [58 favorites]


Does the US spend less on social programs (not including healthcare) than Canada and Norway do? Because if the study I posted the other day is correct, low spending on social programs might be the biggest source of poor health outcomes in the US. It might have little to do with how much you do or don't spend directly on healthcare. A change to single-payer might do little for you (other than lower your tax and insurance bills) if you don't also start spending more on programs for poor people.

This seems like an intuitive statement, but I believe you are wrong, because the study you posted is coming from a Canadian perspective, where a certain baseline of access to healthcare for all citizens is already built in. I can totally buy that at a certain point, you need to increase spending on other social services to get better health outcomes.

However, since in the United States healthcare access is rationed by money, you do not have a comparable pool to judge this by. That is to say: if you receive higher social services but still can't go to see a doctor because you can't afford it, I don't think higher social services spending will make you healthier. Everyone needs equal access to healthcare before you can make that argument.
posted by Automocar at 12:21 PM on January 26, 2018 [1 favorite]


Discussion on this topic might benefit from an awareness of the difference between negative and positive rights. The rights we have today are mostly negative rights -- the right to be free from various sorts of interference. A positive right says that people have the right to receive some kind of service or benefit. Such a right contains an implicit assumption that someone somewhere is willing to provide that service or benefit. But since this isn't always the case, positive rights require the use of aggression or coercion, since someone must provide the benefit or service.

Whatever you think about various asserted positive rights (universal healthcare, the right to internet access, anti-discrimination laws, living-wage laws), this distinction between positive and negative rights is the underlying difference that makes discussion of those topics so much more contentious.
posted by closetphilosopher at 12:23 PM on January 26, 2018 [11 favorites]


But since this isn't always the case, positive rights require the use of aggression or coercion, since someone must provide the benefit or service.

This is only true if you view taxation as aggression or coercion, as opposed to table stakes for being part of a civilized society. If that's the case, please go live in the wilderness with all the other freedom loving libertarian ubermensch and don't come crying to the rest of us when your gulch floods and there's no social safety net to help you back on your feet again.
posted by tocts at 12:36 PM on January 26, 2018 [14 favorites]


The Democrats were perfectly positioned to ram home single-payer under Obama, and they completely blew it. Then a bunch of them thought it was a good idea to distance themselves from the ACA during congressional elections, and they have yet to win back the majority. Chickenshits.
posted by Brocktoon at 12:41 PM on January 26, 2018 [20 favorites]


The great thing about the U.S. Constitution is that it can be amended when it's deemed necessary.

Successful constitutional amendments are rarer than hens teeth. The rule of thumb is, if a politician tells you the solution to your problem is a constitutional amendment, then they have no solution...
posted by jim in austin at 12:42 PM on January 26, 2018 [4 favorites]


The Dems were short one vote (Lieberman) from adding a Medicare buy-in to the ACA with a more conservative caucus in 2009, and that was when they had to meet the 60 vote threshold. Since then, the GOP made 50 votes the threshold for ACA repeal and tax "reform", and the insurance industry's wishes were totally ignored during ACA repeal. So there are no excuses for not getting this done.
posted by chimpsonfilm at 12:44 PM on January 26, 2018 [5 favorites]


Maybe it's okay to discuss and even attempt things that would upset our overlords.
posted by The Gaffer at 12:45 PM on January 26, 2018 [40 favorites]


I like how the objections to universal healthcare are that it is not practically possible while ignoring the fact that an enormous chunk of the world has made it work.

An enormous chunk of the world is not the US. Sort of the downside of exceptionalism...
posted by jim in austin at 12:46 PM on January 26, 2018


So there are no excuses for not getting this done.

Other than a 60-vote Democratic majority in the senate.
posted by JackFlash at 12:49 PM on January 26, 2018


Medicare For All, or something very much like it, is going to be the only way I will be able to retire ever.

Also I want to watch Anthem burn and dance on its grave.
posted by Foosnark at 12:54 PM on January 26, 2018 [6 favorites]


I, for one, am exceedingly tired of being told that there's no point in even trying to make this country a better place to live in. "Oh, but the Republicans." I mean, apparently the Republicans don't even need to do anything at all, if their very existence prevents us from ever trying.
posted by shapes that haunt the dusk at 1:08 PM on January 26, 2018 [54 favorites]


I, for one, am exceedingly tired of being told that there's no point in even trying to make this country a better place to live in.

No,no. By all means strive. It is the Good Fight. Just don't get your hopes up...
posted by jim in austin at 1:26 PM on January 26, 2018


This year I'm going to pay about $6000 for a crappy high-deductible medical plan and accompanying HSA. I'm also going to pay close to another $1000 in medicare taxes. I would gladly pay double that if it meant I and everyone else in this country had access to health care, not least of which because it would undoubtedly be better than my extremely disappointing coverage.

Good news- you don't need to pay double that! "Even public spending on health care, on a per capita basis, is higher in the U.S. than in most other countries with universal public coverage." In other words, we could spend less than we are currently spending on public, non-universal programs and have proper universal coverage. No need for a tax increase, no need to pay for your private coverage.
posted by cushie at 1:31 PM on January 26, 2018 [6 favorites]


Um, we would need a tax increase. A lot of current healthcare spending is non-governmental. Even assuming strict cost controls I've seen estimates as high as $1.8 trillion in additional taxes, because the government is going to have to pay for some percentage of the current total private spending on healthcare.
posted by Automocar at 1:37 PM on January 26, 2018


I like how the objections to universal healthcare are that it is not practically possible while ignoring the fact that an enormous chunk of the world has made it work. The US is supposedly a great and powerful country but no, it can't possibly care for its citizens.

I don't believe anyone is saying it couldn't work. They're pointing out the difficulties.

I am extremely in favor of Medicare for All. Holy God, please. The Medicare expansion is the reason a friend of mine is able to get treatment for her Stage III breast cancer--or at least qualify immediately without going through the protracted hell that's applying for disability while the cancer grows (at least I think some cancer patients qualify for disability). It is literally the only reason.

But that said--there are massive differences between the USA and other countries. The primary one is that the majority of those countries started with a public option/publicly-funded healthcare from the outset, and those that didn't, well, they also didn't have the biggest private healthcare economy in the world. We're talking crashing a multi-billion dollar industry. I won't weep for the execs or their shareholders, but that's a lot of jobs to lose. If the Dems ram through anything, I hope it's a long-term plan, akin to what was offered by Clinton.

Like, over 10 years:
  • Phase in eligibility for automatic, free insurance, with minimum requirements decreasing every year until everyone, no matter how rich you are, has Medicare by the end of the decade.
  • From the outset, allow everyone to purchase Medicare, with subsidies inversely proportional to income that also increase for everyone over the years.
  • Continue to allow the private insurance market to exist. Run it like you see in countries like Germany: eventually everyone has access to government-provided healthcare, but they're allowed to purchase additional private insurance on top of that. Example: people who want the extra perks or offered by employers to sweeten their job offers.
If we wake up tomorrow and declare Medicare for everyone, period, you will see the crash of the healthcare marketplace. Private insurance companies don't just employ their own people, their existence requires the employment of a veritable army of administrative staff by healthcare providers to handle the byzantine web of insurance claims. This system is fucked up and bloated and should not exist anywhere near the level of it does--but it doesn't change the fact that there are millions of low-to-middle-income people whose jobs depend on this system. If you install free healthcare for all immediately you fuck all these people over. They are going to need to find new jobs and very likely will require retraining for whatever they do next. Presumably most people here support MFA partly due to holding compassionate attitudes towards the welfare of the general population. So as odious as the execs are, let's remember that the vast majority of these employees are not execs, they're not shareholders, they're people like you and me who will be terrified about losing their source of income and utterly screwed if they're left twisting in the wind.
posted by schroedinger at 1:39 PM on January 26, 2018 [11 favorites]


Compounding the problem of all the now-unemployed health insurance workers is that the government will immediately have to hire an army of health insurance workers to administer the now-larger Medicare.
posted by The Gaffer at 1:42 PM on January 26, 2018 [9 favorites]


Um, we would need a tax increase.

I'm single, no dependents, non-smoker. My health insurance is about $1800/year for a high deductible plan. I'd happily accept a $2000 tax increase if it meant being covered by Medicare instead of my current insurance carrier.
posted by nathan_teske at 1:44 PM on January 26, 2018 [17 favorites]


Because if the study I posted the other day is correct, low spending on social programs might be the biggest source of poor health outcomes in the US. It might have little to do with how much you do or don't spend directly on healthcare.

Single payer incentives the government to provide cheaper alternatives to health care, things like preventative measures, food laws and social programs, as they are cheaper then waiting to the person ends up seeing a doctor. One of the big flaws in the US is that there is limited amount of financial incentive for the government to improve the health of its citizens.
posted by Bovine Love at 1:45 PM on January 26, 2018 [10 favorites]


If the Dems ram through anything, I hope it's a long-term plan, akin to what was offered by Clinton.

It can't be. I mean, I hear what you're saying and agree that a phase-in would be smarter. But just as a practical political matter it needs to be fully in effect, so that hundreds of millions of people will be receiving the benefits of it, before the next House election. Or else people will get scared and stupid again and put the Republicans in charge who will just ruin it all over again.
posted by GCU Sweet and Full of Grace at 1:57 PM on January 26, 2018 [6 favorites]


And a couple more points to consider:
  1. Another unpopular point: the switch to government healthcare will necessitate the contraction of healthcare access. I don't mean "everyone gets shit healthcare now", I mean "everyone gets the healthcare they need instead of all the extra stuff they want". Americans are notorious for consuming extra healthcare whenever they can; think superfluous tests and access to higher-cost medications, whose use is facilitated by a fee-for-service payment system for physicians who write scripts for these tests and give clearances to insurance companies. This is obviously a worthwhile trade-off and the reason I call those things superfluous is because they aren't needed. But tell that to the person who read online that they must get this extra blood test or whatnot who is told they're not eligible to do so.
  2. Right now the vast majority of physicians are paid via fee-for-service. This drives up both costs and consumption. When the government increases its dominance of the healthcare market even further fees will continue to drop, and my guess is we're going to see physician payment move to straight salaried.
  3. Ultimately this is good, because fee-for-service facilitates bloating in healthcare consumption. But the side effect will be a contraction in healthcare provider salaries, which means less money to pay off massive student loans. And if you think that won't affect the number of medical students, well, read about the shortage of PCPs/family doctors--particularly in rural areas--because those positions pay less. So any MFA plan will need to include provisions to bring down costs of getting a medical educations to individual students.
  4. Speaking of extra provisions--the contraction of the private market will mean already underserved areas, like impoverished and rural communities, will see the few providers they have start to pull out in favor of centralizing their offerings in richer areas. So an MFA bill will also need to include provisions to build hospitals and clinics and PCP offices to enable these people to access the healthcare they need.
I am sure there are more. I think all of the above is a good thing in the long run. We don't need that extra healthcare, we do need to get rid of fee-for-service, we should have lower med school tuition. Ideally medical education should be wholly funded by the government, or at least heavily subsidized. It would also ensure we aren't getting shortages in lower-paid areas--shortages like the ones we already have. And God knows we'd benefit from healthcare systems that establish offices based on need rather than profit. But I bring up the above because they are further complications--and undoubtedly there are even more--that increase the cost of such a bill and will therefore have to be accounted for both financially and in talking points to ensure those enjoying their new insurance are actually able to use it.
posted by schroedinger at 1:59 PM on January 26, 2018 [7 favorites]


Compounding the problem of all the now-unemployed health insurance workers is that the government will immediately have to hire an army of health insurance workers to administer the now-larger Medicare.

If you think that a single major insurance provider will require the same investment in administrators as the current byzantine system does, well, I suggest you look at the massive increases in administrative investment in current healthcare systems and ask literally any provider who has to deal with multiple insurance companies. Increased efficiency means providing the same amount of healthcare will require fewer workers. It's just math, dude.
posted by schroedinger at 2:02 PM on January 26, 2018 [3 favorites]


"Um, we would need a tax increase. A lot of current healthcare spending is non-governmental. Even assuming strict cost controls I've seen estimates as high as $1.8 trillion in additional taxes, because the government is going to have to pay for some percentage of the current total private spending on healthcare."

With respect, perhaps your basic point is that US healthcare is insanely expensive compared to every other country. And you're right -- due to the inefficiencies of all those people pushing paper around, and the claims and counter claims, and the skimming of profit by all the middle-persons.

So the government has to intervene in this marketplace, just as it has been doing for the past 100 years and more -- going back to the trustbusters, US Steel, Standard Oil, Teddy Roosevelt, etc. And the US gvt is still intervening to protect the citizen against "natural monopolies", as with the price regulation of electricity supply.

Healthcare is a disaster as a marketplace, with elements of the "natural monopoly", but compounded by the disproportionate power of the supplier (the doc) over the consumer (the patient) -- who is hurried, worried and uniformed.

This failure of the marketplace is why every other developed country has gvt oversight, and the US will have to do likewise.
posted by Drogue at 2:07 PM on January 26, 2018 [6 favorites]


I'm going to leave this and then stop my little screed:

As someone who desperately wants MFA, whose friends lives depend on it and whose own life has depended on access to publicly-funded healthcare, I strongly resent these pithy dismissals of actual issues substantiated by the actual math used by the real world. Shitty policy either doesn't get passed or if it does it crashes and burns upon implementation and carries massive ripples of negative side effects in its wake. We don't need to look any farther than the administration of the narcissistic clown who passes for a POTUS.

These actual, real, math-based issues need to be confronted seriously if we want this to succeed. Your rhetoric is empty if you can't account for the inevitable side-effects for the plan and you're basically saying "I would rather this plan either never pass or not succeed as long as it means I get to keep touting my slogans and replying to extensive policy questions with one-off snarky bullshit."
posted by schroedinger at 2:07 PM on January 26, 2018 [11 favorites]


but it doesn't change the fact that there are millions of low-to-middle-income people whose jobs depend on this system.

That is not a valid justification for the deaths of so many people who can't afford medical care or medicines.

Industries change. Automation and overseas imports have already shifted the job market significantly and no one is seriously trying to bring back old-school coal mining or employing massive amounts of factory workers instead of robots. Yes, those changes were driven largely by corporate profit margins, but maybe just this once we can put the well-being of our citizens above investors' interests.
posted by ananci at 2:10 PM on January 26, 2018 [11 favorites]


What is the biggest pushback against moving from a for-profit private health insurance industry to a government run single payer plan? Is it the dirty word "socialism" that strikes fear into the hearts of the uninformed? Is it the lobbies? Maybe lobby reform would also need to happen?
posted by Hazelsmrf at 2:15 PM on January 26, 2018 [2 favorites]


President Bernie Sanders... Does that sound outlandish to anyone? Does it?
posted by Laotic at 2:22 PM on January 26, 2018 [2 favorites]


President Bernie Sanders... Does that sound outlandish to anyone? Does it?

I am a huge fan of Bernie, but he's 76, would that even be realistic?
posted by Hazelsmrf at 2:25 PM on January 26, 2018 [2 favorites]


Also, the government pays out the ass right now for emergency care, whereas preventative care (only available to those with insurance) is significantly cheaper (probably mentioned already).
posted by Brocktoon at 2:31 PM on January 26, 2018 [1 favorite]


I find it kinda hilarious that the "We can't blow up 1/6th of the economy!" talking point gets morphed into "we need to blow up 1/6th of the economy!", depending on whether the political party making the hypothetical changes leans right or leans left.

Millions of voters put food on the table via the US health care industry. Whether or not those people would be better off with Single Payer and different career, it's ridiculous to think that asking all those people to get a different job will be smooth sailing, politically.
posted by sideshow at 2:34 PM on January 26, 2018 [3 favorites]


President Bernie Sanders... Does that sound outlandish to anyone? Does it?

Given that he hasn't changed his opinion on indemnifing the gun industry, yeah.

That is not a valid justification for the deaths of so many people who can't afford medical care or medicines.

Industries change. Automation and overseas imports have already shifted the job market significantly and no one is seriously trying to bring back old-school coal mining or employing massive amounts of factory workers instead of robots. Yes, those changes were driven largely by corporate profit margins, but maybe just this once we can put the well-being of our citizens above investors' interests.


Congratulations, you just crashed the economy because you shrank it by a good 10% without anything to stabilize it. People aren't talking about investors - they're talking about the fact that the US healthcare industry employs a lot of people, and the plans some of you are suggesting would shrink that workforce significantly in a short period of time, with no plans for it.

You may not believe in macroeconomics, but rest assured that macroeconomics believes in you.
posted by NoxAeternum at 2:34 PM on January 26, 2018 [6 favorites]


I agree with everyone here who is saying that Medicare for All will be a huge disruptor.

Do they agree that Medicare for All is nevertheless, at some future point yet to be determined, highly desirable?
posted by Drogue at 2:38 PM on January 26, 2018


Assuming we can achieve the same kind of results the rest of the civilized world has already achieved, we'll be injecting 6-8% of the GDP back into the economy instead of sinking it into the health care morass. And this won't be money that goes into rich people's pockets, it will go to the working class. A huge burden will be lifted. People will have more money, and feel more secure. Businesses will save billions of dollars a year. With the indenturing effects of health insurance taken off the table, employees will feel freer to quit their jobs if conditions get too bad, and will be able to start new businesses and pursue their dreams. There will be a lot of new job opportunities for those currently employed by the health insurance companies and medical billing departments. And I guarantee you that all of those jobs will be much more productive than what those people are doing now. And if those people, who have all had a hand in denying health care for millions of Americans, can't find new jobs immediately, well, at least they can get unemployment benefits and Medicare.
posted by vibrotronica at 2:51 PM on January 26, 2018 [13 favorites]


"Assuming we can achieve the same kind of results the rest of the civilized world has already achieved, we'll be injecting 6-8% of the GDP back into the economy"

Yup. The US spends 17.1 per cent of its GDP on healthcare. The European average is 10.1 per cent. In cash terms, US healthcare costs $9,892 per head per year. Switzerland is a distant second with $7,919. The UK spends $4,192, Canada $4,753, France $4,600, Germany $5,551, etc, etc.
https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita

Yet every developed country has outcomes equivalent to America’s *and* covers every single citizen from cradle to grave, no questions asked.

What's not to like?
posted by Drogue at 2:55 PM on January 26, 2018 [5 favorites]


If we wake up tomorrow and declare Medicare for everyone, period, you will see the crash of the healthcare marketplace. Private insurance companies don't just employ their own people, their existence requires the employment of a veritable army of administrative staff by healthcare providers to handle the byzantine web of insurance claims. This system is fucked up and bloated and should not exist anywhere near the level of it does--but it doesn't change the fact that there are millions of low-to-middle-income people whose jobs depend on this system. If you install free healthcare for all immediately you fuck all these people over.

The political and economic scenario in which Medicare-for-All is implemented would, in all likelihood, mean that transfer is largely just from the private sector to the public. CMS, or whatever the hypothetical American NHS that would be created, could definitely handle (and compared to their current leadership, would welcome) a large influx of workers at both the federal and state levels, with the bonus that their jobs would be far more secure and the job protections would be far wider.
posted by zombieflanders at 2:59 PM on January 26, 2018 [2 favorites]


So, jobs will magically appear because reasons, and even if they don't, well those people were doing evil, so fuck them.

Do you not see why that sort of argument might not be taken seriously? Even if (yes, if) UHC somehow spurred a boom in economic growth the likes of which has not been seen in decades, there would be a significant amount of lag in those jobs coming online. Meanwhile, you've just put a significant amount of people out of work. Economies don't handle shocks like that well.

People aren't saying "don't do it", they're saying "do it smart, and rhetoric doesn't make macroeconomics go away."
posted by NoxAeternum at 3:00 PM on January 26, 2018 [5 favorites]


I mean, correct me if I'm wrong, but when other nations with single-payer health care implemented it they didn't all of the sudden send all the workers from the health care industry into poverty.
posted by zombieflanders at 3:02 PM on January 26, 2018 [7 favorites]


That's because many of the nations that have implemented UHC did so in the wake of destructive conflict that had left much of their society in rubble.
posted by NoxAeternum at 3:05 PM on January 26, 2018 [4 favorites]


Millions of voters put food on the table via the US health care industry

To me this sounds like the argument that we have to keep mining coal in order to support the coal miners.
posted by Foosnark at 3:07 PM on January 26, 2018 [17 favorites]


if (yes, if) UHC somehow spurred a boom in economic growth the likes of which has not been seen in decades, there would be a significant amount of lag in those jobs coming online. Meanwhile, you've just put a significant amount of people out of work.

So they... go on welfare, which costs the nation less than it's currently paying for inefficient health care? And within a few years, we've stabilized our new system enough that most of them have found jobs in the national health care system, and some have moved on to other careers?

It sure looks like we'd have at least a 5% GDP buffer to work with, to get past the initial rough spots.
posted by ErisLordFreedom at 3:10 PM on January 26, 2018 [8 favorites]


With respect, perhaps your basic point is that US healthcare is insanely expensive compared to every other country. And you're right -- due to the inefficiencies of all those people pushing paper around, and the claims and counter claims, and the skimming of profit by all the middle-persons.

No, my point was that those of us (including me! very very very much including me!) who favor single-payer healthcare need to be clear-eyed about the fight ahead, because there is going to be a hard fight ahead, and saying things like "there won't be a tax increase because we'll save so much money through cost controls!" is... not correct.

For example, let's compare total healthcare spending as a percentage of GDP to a system favored by many single-payer advocates (2014 figures): United States, 17.1%. United Kingdom... 9.1%

So let's say that the United States gets total healthcare spending as a percentage of GDP down to 9%. That would be 1.6 trillion dollars, give or take. The federal government spent about a trillion dollars on healthcare in 2014. So we'd need to find 600 billion extra dollars every year, minimum.

Most projections I've seen are based on a variety of assumptions, the two biggest ones being a gradual rollout of Medicare over a period of years combined with increasing cost efficiencies (so hopefully you're balancing out the increased costs with decreased costs due to cost controls.) But you still need to find a lot more money via taxes to pay for this.
posted by Automocar at 3:10 PM on January 26, 2018 [1 favorite]


Where are the doctors who are going to care for all these people magically going to come from? What's Sanders's plan for overcoming the fluid bag shortage? What about the new drug shortages happening daily?

Cute speech from a guy who has no idea how health care actually works.
posted by themanwho at 3:14 PM on January 26, 2018 [2 favorites]


That's because many of the nations that have implemented UHC did so in the wake of destructive conflict that had left much of their society in rubble.

The only major economic powers I can think of that come close to that definition is France and maaaybe the UK immediately post-WW2. Every other country that has it was done well before or after such conflicts.
posted by zombieflanders at 3:14 PM on January 26, 2018 [2 favorites]


I am a huge fan of Bernie, but he's 76, would that even be realistic?

He's considering it. And another run is what I immediately thought of when I saw this posting. And he's only five years older than our current president.

And speaking of which, there's a lot of Americans that have waited a long time to see him square off with Donald Trump.
posted by FJT at 3:15 PM on January 26, 2018 [1 favorite]


There is being realistic, and there is self-sabotage. Bringing out a laundry list of special pleading against a system which demonstrably works in a wide variety of countries, many of them significantly poorer than the United States, veers more towards the latter. Are there difficult policy questions and tricky details that will need to be filled in? Yes, of course there are, but this metafilter thread does not need to address every conceivable objection before we even ask our representatives, the nominal policy experts, to seriously consider universal health care.
posted by Pyry at 3:18 PM on January 26, 2018 [19 favorites]


More tax money might be needed - or regulations that look into reasonable costs for health care services, and enforce those costs. Possibly regulations are needed to state that health care cannot be a for-profit business at all, that it's illegal to set up extortion as a business plan, and "pay me what I want or die" is the very foundation of extortion.

I get that an overnight fix would indeed be utter chaos, and not the best method. (I still think it'd be better than continuing what we have now with vague thoughts of "maybe someone will come up with something in the future.")

But it'd be much less traumatic to have medicare automatically cover, f'rex, pregnant women's prenatal care, and children up to the age of 5 - hey look, all that preschool vaccination stuff is covered - and lower the higher end age to 60 or even 55, and every 5 years, add 5 years of coverage to both ends of that until it meets in the middle.

What we're fighting right now is the Republican claim that some people just don't deserve to be healthy, and we need to absolutely reject that. We can discuss "what can we afford" and "how would we provide coverage and care," but that's not what's currently being argued.
posted by ErisLordFreedom at 3:21 PM on January 26, 2018 [8 favorites]


To me this sounds like the argument that we have to keep mining coal in order to support the coal miners.

Except there are not enough miners to fill a major collegiate football stadium compared to the +2.5 million in the health insurance industry...
posted by jim in austin at 3:28 PM on January 26, 2018


"So let's say that the United States gets total healthcare spending as a percentage of GDP down to 9%. That would be 1.6 trillion dollars, give or take. The federal government spent about a trillion dollars on healthcare in 2014. So we'd need to find 600 billion extra dollars every year, minimum."

Please cite your sources. The OECD has gvt versus private healthcare spends in the US at nearer 50/50.
https://data.oecd.org/healthres/health-spending.htm
posted by Drogue at 3:30 PM on January 26, 2018 [1 favorite]


To me this sounds like the argument that we have to keep mining coal in order to support the coal miners

No, it's the argument that asking coal miners to vote to outlaw coal mining is not a good way to get coal miners to vote for your agenda. Also, there are 300x more people employed in US health care than coal mining, so even with your original argument the politically smart thing to do would be in fact to "keep mining more coal".
posted by sideshow at 3:32 PM on January 26, 2018 [1 favorite]


there are 300x more people employed in US health care than coal mining,

How many of them have good health care coverage, vs how many are contractors whose jobs offer them health insurance that costs as much as their rent? Because those are not votes guaranteed to keep the system as it is.

For a lot of people, "omg I might lose my job" is not as big a threat as "omg I might lose my health insurance." Take away that fear, and they'd be free to seek out a job that better fits their skills, and where they could argue for a living wage.
posted by ErisLordFreedom at 3:36 PM on January 26, 2018 [6 favorites]


Well, I'm also positive that the health insurance industry is trying as hard as it possibly can to automate away 2.49 million or so of those 2.5 million jobs, so the concerns might be moot by the time any proposal that might eliminate those jobs comes to a vote.
posted by Copronymus at 3:38 PM on January 26, 2018 [3 favorites]


Please cite your sources. The OECD has gvt versus private healthcare spends in the US at nearer 50/50.

That trillion dollars is just what the government currently spends on healthcare. That’s not a total expenditure.
posted by Automocar at 3:38 PM on January 26, 2018


This seems like an intuitive statement, but I believe you are wrong, because the study you posted is coming from a Canadian perspective

The study did say that it confirmed results which have been found in similar American studies, so there's that.
posted by clawsoon at 3:39 PM on January 26, 2018


I agree with Pyry. At some point it just gets tedious to fight all these negative waves.

Yes it'll be tough to implement such a major change. But the alternative is to continue with a system that's so ruinously overpriced that tens of millions have no coverage except the ER, and all the rest are paying twice as much as they should.
posted by Drogue at 3:41 PM on January 26, 2018 [5 favorites]


Another unpopular point: the switch to government healthcare will necessitate the contraction of healthcare access. I don't mean "everyone gets shit healthcare now", I mean "everyone gets the healthcare they need instead of all the extra stuff they want".

This is one of those Republican talking points that has been proven false by study after study. It is the motivation for all of the Republican "skin in the game" high deductible gambits they try to foist on the public which is really just cover for employer benefit cuts.

People in the U.S. do not consume significantly more healthcare than people in other developed countries. They simply pay much higher prices -- twice as much -- for every pill they take, every doctor they visit, every medical device, every hospital procedure. Excessive prices are why U.S. healthcare is so costly.
posted by JackFlash at 3:44 PM on January 26, 2018 [26 favorites]


"People in the U.S. do not consume significantly more healthcare than people in other developed countries. They simply pay much higher prices "

Correct. The US has fewer physicians per person than the average for OECD countries, fewer appointments and fewer acute beds. In 2010, for instance, the U.S. had 2.4 practicing physicians per 1,000 people — well below below the OECD average of 3.1. In 2009, there were 2.6 hospital beds per 1,000 population, way lower than the OECD average of 3.4 beds.
http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective

I'd also love to hear how there'd be less "access" with UHC. There is no other developed country on the planet where tens of millions of citizens have no access to healthcare except the ER.
posted by Drogue at 3:54 PM on January 26, 2018 [10 favorites]


What's Sanders's plan for overcoming the fluid bag shortage? What about the new drug shortages happening daily? Cute speech from a guy who has no idea how health care actually works.

Turn on the electricity and water in Puerto Rico?

The fluid bag shortage is because most of them are made in Puerto Rico. And 80 pharmaceutical companies are located in Puerto Rico accounting for 10% of all the drugs consumed in the U.S.
posted by JackFlash at 3:57 PM on January 26, 2018 [33 favorites]


"Where are the doctors who are going to care for all these people magically going to come from?"

Sure. It'd be much less trouble if tens of millions of Americans just couldn't see a doctor at all.
posted by Drogue at 4:04 PM on January 26, 2018 [3 favorites]


Wait guys, I am getting a brain wave.

Problem 1) Hundreds of thousands of paper pushers will be thrown out of work.
Problem 2) There won't be enough doctors and nurses to handle the increased healthcare demand.

Maybe we can solve one problem with another?
posted by Balna Watya at 4:07 PM on January 26, 2018 [7 favorites]


In one of my classes the other day, we the professor was talking about retrospective opinions on the morality of the Founders with regards to the Constitution. There was the glowing, revisionist view that portrayed the Founders as the true Greatest Generation, flawless and brilliant for having crafted the perfect document. On the opposite end of that was a quote from the abolitionist William Lloyd Garrison calling the constitution an "agreement with hell." Then there was the middle path, the professor's view, that the Framers were imperfect politicians trying to create a document that everyone would agree on, because even an imperfect document was better than seeing the new country fall apart.

I was a little frustrated that William Lloyd Garrison was sort of skipped over. Garrison was, obviously, talking about slavery. Preserving slavery may have been a way to bring everyone on board with the Constitution, but it still preserved what was arguably the most brutal engine of human suffering in history. It was, in Garrison's words, a "covenant with death." For the millions of people whose lives were brutalized under slavery, it doesn't matter if the institution was preserved for, like, a really good reason, because the fact remained that their lives were brutalized regardless of the justification for it. And so slavery remained for another 87 years, until we fought a war over it.

In America today, we are seeing declining life expectancy, even as healthcare costs continue to rise. Quality of life is declining, and we stand alone among industrialized nations in being a place where a medical problem can completely derail your entire life, shunting you into poverty. It's not the brutal system that slavery was, but it's not an abstract problem, either. People are dying because of our healthcare system, and they will continue to die because of it. It disproportionately affects low-income people and people of color (many of whom are the descendants of slaves). The opioid crisis is driven in large part by a healthcare system that incentivizes profit, seeing drugs as a cheaper solution that sustainable solutions like physical therapy. There's a million examples of stuff like this.

What we have now is a healthcare system that causes extraordinary suffering. It's like the arguments about holding the wolf by its ears; we know the right thing to do, but we've got to be pragmatic, don't we? But it's one thing to be forced to make compromises. It's another to negotiate with ourselves and say "oh, they'll never go for it." I'd rather be forceful on this and fail than be weak and allow things to stay the same (which has happened in recent memory). Enough talk about what's realistic. Any compromise on this is a covenant with death. The people who are continuing to die under this healthcare system are just as dead as they would be if no one cared at all.
posted by shapes that haunt the dusk at 4:12 PM on January 26, 2018 [26 favorites]


One aspect not mentioned often is that more accessible health care reduces the amount of emergency and complex-condition health care that's needed.

If everyone gets a thorough annual exam that catches early symptoms, there's a lot less "emergency surgery for dying organ that's been having problems for three years." Early cancer detection means treatment with minor surgery and pills, not a six-month course of radiation and chemo treatments and a three-year recovery plan. Early liver problem detection means "take these pills; change this part of your diet" instead of "sign up for a transplant."

More comprehensive coverage means fewer doctors needed and fewer health care costs across the nation.

(And wow, that's before we get into the cost of contraceptives vs abortions vs cost of birth + child care.)
posted by ErisLordFreedom at 4:14 PM on January 26, 2018 [10 favorites]


He's considering it. And another run is what I immediately thought of when I saw this posting. And he's only five years older than our current president.

If you're trying to sell me on septuagenarians as president our current one isn't exactly a great poster boy for the idea. Plus Sanders would be 80 the year he'd be inaugurated and pushing 90 after eight years. I admire a lot of what he's said over the years but it's time for him to pass the torch.
posted by octothorpe at 4:46 PM on January 26, 2018 [10 favorites]


Bernie should find a nice candidate to back and pitch himself for head of HHS.
posted by ErisLordFreedom at 4:49 PM on January 26, 2018 [11 favorites]


The people who are prosperous enough in the current system to get "extra" medical services by dint of having really, really good insurance would be prosperous enough to pay for private services over and above what a single-payer system would cover. They do it all the time in the UK.
posted by The Underpants Monster at 4:55 PM on January 26, 2018 [10 favorites]


The people who are prosperous enough in the current system to get "extra" medical services by dint of having really, really good insurance would be prosperous enough to pay for private services over and above what a single-payer system would cover. They do it all the time in the UK.
And there would presumably still be a market for providing health insurance to people who want things not provided by the single-payer system, like not-strictly-necessary tests/procedures and better accommodation in hospital. This is roughly how it works here in Australia (our mixed public/private system isn't perfect, but it could get a lot worse while still being vastly better than the US system). The private insurance industry would certainly shrink, but it wouldn't need to "collapse" if the transition was handled sensibly.
posted by A Thousand Baited Hooks at 5:46 PM on January 26, 2018 [9 favorites]


What is this "extra medical stuff" that you're getting now in your current for-profit industry that you feel you wouldn't get under a single payer? Here's a HUGE advantage that single payer has over the for-profit industry. There's nobody denying claims because something is too expensive or they don't deem it necessary. If your doctor says you need X treatment, then X treatment is covered. That's it. There should be nobody else making decisions based on how profitable or not profitable this or that procedure is.

And I've honestly never felt that I was only getting the bare minimum. If I have a good reason to request so and so test, chances are my doctor will order it. If she thinks that there's really no reason to do that test, then she won't. I am free to go see a different doctor if I don't agree.

And don't discount the value of preventative care. How many people who are underinsured or not insured go get regular check ups? Or stay home until it's pretty obvious their arm is about to fall off? It's a lot more expensive to treat these things after they've been getting worse over the months, catching it early is key to keeping the costs down.
posted by Hazelsmrf at 5:58 PM on January 26, 2018 [1 favorite]


The private insurance industry would certainly shrink, but it wouldn't need to "collapse" if the transition was handled sensibly.

Yes exactly, in Canada we still have private health plans through our employers. These plans cover gaps that aren't covered by our provincial insurance. Things like dental, medications, private rooms for hospital stays, yearly eye exams, glasses/contact lenses, orthodontics, and a limited coverage for things like psychologists, chiropractors, physiotherapy, social workers etc. And there are good plans that cover everything, and there are crappy plans that cover almost nothing. Some employers cover all the fees, some employers only cover some of it.

Going to a single payer will shake things up a lot, but there will still be a need for private insurance companies, there will still be jobs there.
posted by Hazelsmrf at 6:07 PM on January 26, 2018 [2 favorites]


There are a lot of expenses of our private insurance system that are not obvious or visible to the public.

I work for a "safety net" hospital: we're the hospital for people on Medicaid and the uninsured. A huge expense for my hospital is that poor people come to the hospital, but when they're well, there is nowhere for them to go that is safe. We can't discharge patients back to the street if they're homeless for example. If they have substance use disorders, there are literally no inpatient programs we can discharge straight to in our community. Nursing homes have the right to say no to any patient, and they don't want complicated, poor, addicted or homeless patients, and definitely never take uninsured patients. So patients just sit in the hospital costing $2-3000 a day.

Single Payer is not the only solution we need for this: we need a massively more robust social safety net so people have homes and income etc. But it is absolutely one part of the solution. When we get Single Payer, we will be able to exert much more influence on nursing homes. I can't see how they will be able to refuse patients anymore because their income will come solely from the one, Single Payer, the state. It really increases the state's ability to regulate the industry. Along with other legeslation that some states (California) were already moving toward under Obamacare, more state healthcare funds can be channeled into evidence-based substance treatment programs, adult outpatient programs, etc, to provide outside of hospital resources. And if there is one, Single Payer, there is much more motivation to reduce costs by spending on the cheap interventions (primary care) to avoid spending on the hospital side.

Another idiotic part of our current system is the number of people employed in hospitals dealing with the fickle requirements of dozens of different payers. One payer, one system, way less staff needed. I just started a new job doing Nurse Care Management which is about half this kind of stupid crap: faxing packets of information to different companies who all accept different insurance and require different paperwork. It's utterly moronic. Again, Single Payer is not the only intervention needed: A single Electronic Health Record (or compatible systems that can mutually communicate) would save millions of dollars and would also save lives! Single Payer would make this kind of shared EHR much more possible and plausible, as this could simply be a requirement of any EHR company that wishes to do business with the Single Payer in question - the state.

Yes, job losses to Single Payer are a very real thing. I can't wait to get fired. I would much rather as a nurse I spend my time in the patient's room, making sure they have the home medical equipment they need when they discharge, or have referrals to services they need, than sitting on the phone with an insurance rep. I don't trivialize it but the health insurance industry is just an absurd make-work project whose main purpose is to syphon money to insurance CEOs.

There is a lot of work to do out here: building housing, repairing infrastructure, education, social services, rebuilding the energy grid to a sustainable one. There is work to do and we should grow those industries and let this failed industry die.
posted by latkes at 6:15 PM on January 26, 2018 [25 favorites]


this metafilter thread does not need to address every conceivable objection before we even ask our representatives, the nominal policy experts, to seriously consider universal health care.

OK but did you just argue that we shouldn't discuss policy in this thread because it makes people feel bad, because seriously, this is a website for discussion.

Also let's revisit this:

No, my point was that those of us (including me! very very very much including me!) who favor single-payer healthcare need to be clear-eyed about the fight ahead, because there is going to be a hard fight ahead, and saying things like "there won't be a tax increase because we'll save so much money through cost controls!" is... not correct.

------

Like, what will convince you people that we're on your side? That we also want MFA? What can we say to point out that everything we've talked about is in the name of getting it implemented? Did you not see the little pie-in-the-sky implementation plan I laid out above? Did you not read Clinton's actual plan (hypothetical--I know the answer to that one)? Why is it that as soon as someone on your side raises a question you jump down their throats like they're the goddamn enemy when they have the same fucking goals as you?
posted by schroedinger at 6:52 PM on January 26, 2018 [2 favorites]


No, my point was that those of us (including me! very very very much including me!) who favor single-payer healthcare need to be clear-eyed about the fight ahead, because there is going to be a hard fight ahead, and saying things like "there won't be a tax increase because we'll save so much money through cost controls!" is... not correct.

Well, you need to be clear about exactly what that means. The U.S. already spends twice as much per capita for healthcare as every other developed country in the world. So there is obviously plenty of money available to provide top notch healthcare for every citizen of the U.S. It doesn't require any more financial sacrifice by citizens to get a better single payer system. It's just a matter of using the money already spent in a more efficient and equitable manner.

Here (3-page PDF) is a good breakdown of healthcare spending and funding sources in the U.S.

Government -- federal and state -- already provide 45% of all healthcare in the U.S. So we are already a long way to government healthcare.

Households provide out of pocket 28%. This is for a combination of premium sharing for employer insurance, premiums for individual/non-employer insurance and out of pocket deductibles and co-pays. So this money could be reallocated by taxes and/or government premiums. In exchange, households would no longer have out of pocket spending for premiums, deductibles or co-pays.

And then private businesses provide 20% of healthcare spending through employer insurance. This 20% could be reallocated by an employer tax that would relieve businesses from dealing with health insurance. Businesses should welcome this relief from a hassle that has nothing to do with running a business.

So when you saying there must be tax increases, it is a little misleading. It is really only a reallocation of money the U.S. citizens are already spending. With increased efficiency and better price controls, the net effect would be a cost reduction to every U.S. citizen. It does not require more spending than currently.
posted by JackFlash at 8:09 PM on January 26, 2018 [9 favorites]


This year I'm going to pay about $6000 for a crappy high-deductible medical plan and accompanying HSA. I'm also going to pay close to another $1000 in medicare taxes. I would gladly pay double that if it meant I and everyone else in this country had access to health care, not least of which because it would undoubtedly be better than my extremely disappointing coverage.

I just did my taxes. Last year my employer paid $21K and I paid $2K in premiums and I also paid an additional $5K in deductible expenses. For which I got fuck all really. Most doctors in the US only seem to be interested in "treating" you insofar as it makes them money and not at all interested in medicine. I have been suffering from an undiagnosed ailment and have found any number of doctors willing to treat it but none willing to spend some time figuring out what it is first. Just recently I had a surgeon fight me tooth and nail on moving a diagnostic surgery to a hospital setting despite my blood pressure regularly and inexplicably spiking up to 200/150. They wanted to do it in the surgical center their practice part owns, imagine that. My GP was like Fuck no- if you have surgery it better be no more than one floor from a crashcart and a code team. She wrote a note that was not appreciated and I had to cancel the surgery so I'm STILL diagnosed. Fuck. This. Shit.

I think I will take my $5K expected medical expenses this year and pay for a month of leave and a trip to Germany or Portugal to actually get diagnosed. By a real doctor, not a used car salesman.
posted by fshgrl at 8:58 PM on January 26, 2018 [8 favorites]


Like, what will convince you people that we're on your side? That we also want MFA? What can we say to point out that everything we've talked about is in the name of getting it implemented? Did you not see the little pie-in-the-sky implementation plan I laid out above? Did you not read Clinton's actual plan (hypothetical--I know the answer to that one)? Why is it that as soon as someone on your side raises a question you jump down their throats like they're the goddamn enemy when they have the same fucking goals as you?

I think it may be because we don't have the same goals. You do realize that, to someone who wants UHC -- now, full stop -- you come off a lot like the white moderate from Letter from a Birmingham jail?

"...the white moderate, who is more devoted to "order" than to justice; who prefers a negative peace which is the absence of tension to a positive peace which is the presence of justice; who constantly says: "I agree with you in the goal you seek, but I cannot agree with your methods of direct action"; who paternalistically believes he can set the timetable for another man's freedom; who lives by a mythical concept of time and who constantly advises the Negro to wait for a "more convenient season." Shallow understanding from people of good will is more frustrating than absolute misunderstanding from people of ill will. Lukewarm acceptance is much more bewildering than outright rejection."
posted by durandal at 9:07 PM on January 26, 2018 [3 favorites]


I don't think its the patients, I think it's the doctors. They own the testing facilities now for the most part so they will order test and not even look at the results if my experience is anything to go by.
posted by fshgrl at 10:51 PM on January 26, 2018 [2 favorites]


I am talking about the Americans who do have access to healthcare. This is not a new concept. Like I said in the comment: think superfluous tests and treatments. Please read here (also provides a broader discussion of the subject), or if you prefer a less wonky (and more recent) take look here. It does not take a lot of digging into healthcare policy to pull this fact up.
posted by schroedinger at 6:30 AM on January 27, 2018 [1 favorite]


I mean "everyone gets the healthcare they need instead of all the extra stuff they want". Americans are notorious for consuming extra healthcare whenever they can; think superfluous tests and access to higher-cost medications, whose use is facilitated by a fee-for-service payment system for physicians who write scripts for these tests and give clearances to insurance companies. This is obviously a worthwhile trade-off and the reason I call those things superfluous is because they aren't needed.

These things are not driven by the public consumers of health care, they are all symptoms of the current screwy system. Who wants more health care? People just want to be not sick. The demand for expensive new drugs is driven by massive marketing campaigns. Extra tests are providers padding bills and covering their asses legally.

Nobody who is sick thinks "hey, I want more treatment, more tests, more drugs," unless they have some psychological issue. People want to get well with as little time and fuss as possible.
posted by Meatbomb at 6:38 AM on January 27, 2018 [7 favorites]


Actually, the case of Charlie Gard is a great example of this. There was no way for that kid would ever have a life outside the ICU. There was no way he was ever going to become conscious again. The NIH wanted to take him off life support because, well, it was unnecessary medical treatment. It was a lot of money being spent on a lost cause--sort of like people whose parents never put in a DNR order and now they keep resuscitating mom or dad past the point of sanity or compassion. But his parents didn't want life support withdrawn. In the US, should Gard's parents have had insurance it is quite likely he'd be on life support to this day. Like I said: extra medicine.

(also: the NIH was right, and I think Gard's removal was best for everyone--but the US's reaction to it says everything about the adjustment that will need to be made about how much medicine is expended on different cases)
posted by schroedinger at 6:40 AM on January 27, 2018 [2 favorites]


Would Medicare for All also include comprehensive dental and vision coverage? I have decent insurance as a federal employee, but my dental coverage is garbage, and the supplemental plans are a waste of money. I just spent $2,800 having a broken tooth repaired (root canal + crown). I’m not arguing that I shouldn’t have to pay for services, but that’s an astonishing amount of money to spend in two days. We can, and should, do better as a nation.
posted by wintermind at 7:48 AM on January 27, 2018


"In the US, should Gard's parents have had insurance it is quite likely he'd be on life support to this day."

Really?

“Steffen Rivenburg Jr. was removed from life support Thursday afternoon. The child’s biological parents filed court orders to keep their son on life support, but a Montgomery County judge denied appeals, deciding the doctors know what’s best.”
http://myfox8.com/2017/06/09/baby-dies-after-judge-denies-appeal-to-keep-him-on-life-support/

“Two weeks ago, the final chapter in Israel Stinson’s young life was closed when a Los Angeles Superior Court judge ruled that the child was brain-dead and could be permanently removed from a ventilator.”
http://www.miamiherald.com/news/nation-world/national/article101240392.html

“In just the last 18 months, Boston Children’s Hospital has been involved in at least five cases where a disputed medical diagnosis led to parents either losing custody or being threatened with that extreme measure. Similar custody fights have occurred on occasion at other pediatric hospitals around the country.”
https://www.bostonglobe.com/metro/2013/12/15/justina/vnwzbbNdiodSD7WDTh6xZI/story.html
posted by Drogue at 7:48 AM on January 27, 2018 [3 favorites]


there's a pretty toxic mix of issues around over treatment, and significant amounts of money are burned, e.g. 4 billion in breast cancer alone.

There's a lot of healthcare consumed by the 'worried well' and a lot of Big Pharma advertising bucks go into creating many of these worried well and encouraging them to contact their primary care physicians for X or Y. That then starts a ball rolling of ever increasing tests and sometime treatment for false positives as in the breast Ca example above.

This Vox article puts the estimated costs in the 100-200+ billion range. One study suggested a Trillion dollars.

It's getting some attention no0w and we are seeing some great data generated like this " interpolated median response for the percentage of care delivered that is unnecessary was 20.6% for overall medical care, 22.0% for prescription medications, 24.9% for tests, and 11.1% for procedures (Fig 1A and 1B).

an increase in CT scanning for example leads to more 'incidentalomas' which unfortunately lead to an increase in nephrectomies that may be completely benign masses.

I vaguely recall a social media campaign against this on Twitter a few years back but can't for the life of me find it now..... (on edit I found it! The Choosing Wisely Campaign)
posted by Wilder at 7:59 AM on January 27, 2018 [1 favorite]


"everyone gets the healthcare they need instead of all the extra stuff they want".

I know people who believe that eyeglasses aren't needed or you should just pay for all it it yourself and that vision insurance is ridiculous.

I lost a fight with my insurance company who declared the surgery for my eye condition - strabismus so bad I don't have any distance judgement, cannot legally drive and have random people ask me what's wrong with my eye, and had to pay $500 more for my glasses than my wife last time we got glasses due to the way the prescriptions are different - was purely cosmetic and not covered.

So then we get to argue over what's needed. Which could be really irritating.
posted by mephron at 12:45 PM on January 27, 2018 [6 favorites]


Americans don’t consume more health care than the Germans or the Japanese. We actually go to the doctor less often. The real reason American health care is so expensive compared to other countries is that the prices are higher. We pay more for everything from angioplasties to C-sections, from hip replacements to opioids. That’s because the private insurance companies that pay for most of these doctor visits, prescriptions, and procedures don’t have enough negotiating power. (Vox video)
posted by en forme de poire at 1:04 PM on January 27, 2018 [8 favorites]


Would Medicare for All also include comprehensive dental and vision coverage?

Currently, Medicare does not cover either, so, unless they are added, I doubt M4A would. Currently, if you are on Medicare, you must purchase additional coverage which may, or may not, add dental and vision.
posted by Thorzdad at 1:08 PM on January 27, 2018


Also, from the article schroedinger cited above:
What may seem surprising from our cross-country comparisons is that the United States is not always an outlier with respect to conventional measures of healthcare utilization. In part, this is explained by the lack of consistent measures across countries—a hospital day in the United States is far more resource-intensive than in France, and the extensive substitution of outpatient surgical care for inpatient surgery in the United States is not reflected in most comparative data (Angrisano, Farrell, Kocher, Laboissiere, and Parker, 2007).

...

The policies of both private and public insurers have traditionally offered a more welcoming and cost-unconscious approach to the provision of new healthcare technologies in the United States. Health insurance coverage is often extended to technologies with the potential to provide benefits, even if those benefits ultimately prove to be elusive, and without regard to their cost. Almost uniquely among wealthy nations, the United States typically does not consider effectiveness relative to its costs or to the costs of alternative treatments (Garber, 2004).
"Consuming more health-care" is sort of a weird phrase because it seems like it's focusing on or blaming the patient for being a neurotic hypochondriac or something. But arguably it's not even really about the patient's behavior as much as it is about how exactly insurance providers are able to bargain with doctors and how they decide what they will and won't cover.
posted by en forme de poire at 1:22 PM on January 27, 2018


Also, just to clear one thing up, the Sanders bill does have a phase-in period over 4 years where the eligibility age for Medicare would be progressively dropped.

> > this metafilter thread does not need to address every conceivable objection before we even ask our representatives, the nominal policy experts, to seriously consider universal health care.

> OK but did you just argue that we shouldn't discuss policy in this thread because it makes people feel bad, because seriously, this is a website for discussion.


I think that's a super disingenuous reading of that comment and I suspect it wasn't even written about your contributions to the thread. What I read Pyry as saying is that we, as people who do not get paid to craft health care policy, are not required to do all of our representatives' work for them before we can advocate that they pursue a particular direction. There's a difference between saying that there are open questions that need to be answered before single-payer is implemented, vs. claiming that single-payer is infeasible/unrealistic/otherwise-not-worth-advocating-for just because these questions need to be addressed. I realize that this second position is not yours, but other people in this thread have come much closer to expressing it.
posted by en forme de poire at 1:47 PM on January 27, 2018 [8 favorites]


Would Medicare for All also include comprehensive dental and vision coverage?
Currently, Medicare does not cover either, so, unless they are added, I doubt M4A would.


both the Sanders bill in the Senate and the Conyers bill in the House (or whoever took it over after he resigned) include coverage for dental. not sure on vision, it's been a while since I read about it.
posted by indubitable at 5:45 PM on January 27, 2018 [3 favorites]


The primary one is that the majority of those countries started with a public option/publicly-funded healthcare from the outset

Really? Please name those countries that started with a public system.
posted by HiroProtagonist at 5:37 PM on January 28, 2018 [1 favorite]


Another unpopular point: the switch to government healthcare will necessitate the contraction of healthcare access. I don't mean "everyone gets shit healthcare now", I mean "everyone gets the healthcare they need instead of all the extra stuff they want". Americans are notorious for consuming extra healthcare whenever they can; think superfluous tests and access to higher-cost medications, whose use is facilitated by a fee-for-service payment system for physicians who write scripts for these tests and give clearances to insurance companies. This is obviously a worthwhile trade-off and the reason I call those things superfluous is because they aren't needed. But tell that to the person who read online that they must get this extra blood test or whatnot who is told they're not eligible to do so.

So people who think they deserve those 'extras' are free to pay for health insurance that gives them that.
posted by HiroProtagonist at 5:40 PM on January 28, 2018


The most underrated argument for single-payer health care - "If you need some medical procedure, you are virtually guaranteed several hours of tedious form-filling, made much worse by the knowledge that if you mess up, your insurance might not cover it, and the provider will take you for all you've got. Eradicating this needless anxiety is perhaps the most underrated argument for Medicare for all. Universal health care would make living in American society tremendously simpler and less stressful."
posted by kliuless at 9:26 PM on February 15, 2018 [3 favorites]


« Older snarking in the face of oppression   |   Disaster Tourism - an exploration of "dark travel" Newer »


This thread has been archived and is closed to new comments