Healthcare Is A Human Right
June 15, 2018 9:50 AM   Subscribe

“Historically, European nations have more developed welfare states, stronger unions, and less inequality, all of which are the products of more potent left-wing parties and labor movements that succeeded in reforming capitalism in the post–Second World War period. But this never happened here. The United States therefore needs a healthcare system that has universalism—and equity—built into its very foundation.” Single-Payer Or Bust: By providing a single tier of coverage to all, with automatic enrollment, comprehensive benefits, and no cost-sharing, single-payer provides a distinct, egalitarian vision of universality. (Dissent)
posted by The Whelk (38 comments total) 47 users marked this as a favorite
 
Every OECD country (the 36 most developed countries) except the US has a program which claims to deliver universal healthcare, although few are pure single payer and without cost-sharing (Scotland and Wales come closest, as far as I know).

The US has the 4th largest per capita public sector spend on healthcare in the OECD, and the 3 countries with larger government spend all have higher per capita GDP. So it's probably safe to say that failing to provide universal healthcare is a false economy.

When it comes to overall spend, the US is a huge outlier.

Sorry for sharing this where it's slightly tangential to the main point (single payer is, after all, a subset of universal healthcare), but I think those numbers need to be right out on the table before going into nuances of implementation.
posted by ambrosen at 10:22 AM on June 15, 2018 [7 favorites]


It's worth approaching this from idea that it benefits me if other people are taken care of. Healthy people create interesting things, they're nicer, they take care of details, they are exciting to create/play with, they are able to take care of a thousand things that I don't want to think about, I can trust them more if they're not desperate, they're just lovely to interact with, and without that complexity what's the point in being alive?

These are vague, general statements, but if particularized, they present a powerful argument from a neglected perspective.

There may be people out there thinking that automation means there's less need to take care of others (i.e. some might imagine it means fewer healthy people would needed to keep the rest comfortable), but that's not so, and that argument should be elucidated also.

People are overwhelmingly, in numbers, good-intentioned, creative, and fun, when they have a chance. Since our more mediated experience of other people skews our perceptions strongly toward the negative, those positive tendencies need to be communicated also.
posted by amtho at 10:47 AM on June 15, 2018 [16 favorites]


People are overwhelmingly, in numbers, good-intentioned, creative, and fun, when they have a chance. [citation required]
posted by spacewrench at 11:04 AM on June 15, 2018 [1 favorite]


Yeah, but when The Economist (The Economist!) chimes in supporting universal health care, you know the wind has changed direction.
posted by homerica at 11:10 AM on June 15, 2018 [4 favorites]


Enlightened self-interest: it's more likely that I'll remain healthy if the folks around me are able to get treatment for communicable diseases. What do you think would've happened if the 2003 SARS outbreak had occurred in Buffalo instead of Toronto?
posted by Mary Ellen Carter at 11:13 AM on June 15, 2018 [9 favorites]


> It's worth approaching this from idea that it benefits me if other people are taken care of. Healthy people create interesting things, they're nicer, they take care of details, [...]

Yes, and even more directly: I have good health insurance through my employer, but that means I'm chained to my job. If I want to start my own software company, or go part-time so that I can spend more time playing with my daughter - I can't. I don't dare to, because my kids need health care, and that means I need to stay at my job.

Absolutely nothing against my job, which I love, and my employers, who are pretty great. But it sucks that I don't have the option to go out and create interesting things without risking coverage for my kids.
posted by RedOrGreen at 11:18 AM on June 15, 2018 [10 favorites]


The first time I used healthcare services here in Canada and wasn't hit up for insurance info or co-payment or anything like that, I heaved a sigh of relief I didn't think was possible. I can go to the doctor now if I need to, instead of hoping to find an employer that would subsidize health insurance or just cross my fingers when I was living in the US (which I am originally from). It's freeing but hard to shake off the old shackles of not going because my brain still thinks I have to pay.

I routinely disabuse family and friends back home in the States who say, "well, yeah, you have free healthcare." My dudes, I do not. I am happy and willing to pay higher taxes to make sure me, my neighbours, and anyone else in this damn country can go to the doctor without fear of bankruptcy, without fear of thinking that only the rich deserve healthcare. I will fight tooth and nail here in Canada to keep it. Is it perfect? God no. But at least I have it.
posted by Kitteh at 11:20 AM on June 15, 2018 [18 favorites]


Sorry, I forgot to add: I want the US to have proper healthcare coverage. I saw what serious illness could do when my stepfather got very very sick. I am seeing what it can do to my relatively healthy mother. It breaks you. Grinds you down. Makes everything fraught. Hearing your parent cry on a long distance phone call about healthcare kills you inside because you can't do anything.
posted by Kitteh at 11:27 AM on June 15, 2018 [3 favorites]


I grew up in Canada, and spent 6 years living in Germany. In my experience, the overall quality of care in Germany is better, but then you have to still navigate the healthcare system. I'm not sure I'd say its worth the (arguably) poorer quality of care, but there is something to be said for the Canadian model in that you really do feel like health care is a right, which you can take for granted, and go see a doctor whenever you want.

That being said, I've always been surpised by the extent to which many Americans are laser-focused on single payer models. This article makes the case well for the American context.
posted by Alex404 at 11:36 AM on June 15, 2018 [3 favorites]


Also, I'm not comfortable starting a business where I'd have to hire other people because the revenue model of decent pay PLUS health insurance is just too much.
posted by amtho at 11:43 AM on June 15, 2018 [1 favorite]


I know how so many Americans are quite enthralled with Obamacare and I get that's it definitely better than pre-Obamacare, but when it was introduced my sense of it was "What a load of crap!" for exactly the reasons outlined in the article. It doesn't address equity (so poor people will still get less and poorer quality care) and it doesn't address choice (people are still being told what doctors to see, what hospital to go to, having to get treatments approved, etc.). I would add to those things, that it doesn't really raise the standard of care. By that I mean "the level below which care is not permitted to fall. i.e. the standards). People who have no insurance or crappy insurance still get crappy care in the U.S. Vans and trucks providing healthcare to the homeless still exist. The standard of care in the US is "a truck from which you get healthcare."

That's not universal, folks. Get it together.

And yeah, trying to navigate US healthcare sucks. I imagine it's also a pain in other non-single-payer systems, even those that are more universal.
posted by If only I had a penguin... at 11:43 AM on June 15, 2018 [6 favorites]


I think most people understand by now that single-payer isn't the only path to universal coverage, but let's also remember that single-payer isn't the only path to single-payer. Or, riffing off of this bit from the article:
In sum, the political road to Germany and the Netherlands could prove just as steep as the one to Saskatchewan.
it seems to me that the ideal path toward Saskatchewan may involve some detours through Germany and the Netherlands. Single-payer should always be talked about as the desired end state, but we should also take every step possible toward universal coverage that reduces harm in the short term and gets people comfortable with the idea of universality paid for by taxes and subsidies, until such a time as a comprehensive refactoring of the many patchwork of single-payer, universal, and market-based systems we have operating simultaneously can be achieved.

If shouting "single payer!" from the rooftops helps create political momentum, let's do that. Let's also elect as many candidates as possible who support single-payer. But let's also acknowledge that there are practical constraints that don't just evaporate when we get 218 single payer supporters in the House and 60 in the Senate, and be honest about how we plan to deal with these constraints as we try to reach that desired end state.
posted by tonycpsu at 12:25 PM on June 15, 2018 [2 favorites]


Or, I guess to TL;DR that last comment: "Bust" is much easier to say when it's not your bank account that's getting busted because we failed to expand access to coverage that wasn't exactly what we wanted at the time.
posted by tonycpsu at 12:27 PM on June 15, 2018


Only 50 Senators are needed to destroy the filibuster for good. Doing so would make the government more responsive to citizens and thus increase faith in it overall. Why do you think McConnell has failed to do that in spite of the fact that he's willing to tear down every other norm? Because the filibuster is inherently regressive. Repealing it while in the process of passing Medicare for All would be a huge fuck you to those who want this country and its citizens to fail.
posted by bookman117 at 12:58 PM on June 15, 2018 [2 favorites]


I am happy and willing to pay higher taxes to make sure me, my neighbours, and anyone else in this damn country can go to the doctor without fear of bankruptcy, without fear of thinking that only the rich deserve healthcare.

Especially since I worked out that I pay much less in taxes than Americans pay in premiums.
posted by flabdablet at 1:05 PM on June 15, 2018 [6 favorites]


I think on the American side there is a fear of health care being rationed out and actual needs not being covered by some monolithic system. This absolutely does happen here in Canada. Fairly regularly there will be stories in the news about people seeking treatments that are available in the US or elsewhere but haven't been incorporated into the public health system here. Its a double whammy for these people because not only are the treatments not being covered here, but because these are generally newer treatments they are extremely expensive. Sometimes they are able to advocate for themselves and get the system to provide the coverage but if they aren't then they're stuck in a terrible position.

However for the majority of people and situations our health care system does a pretty good job. From my own life my wife had both of our kids delivered in the hospital - once by a doctor and once by a midwife (our choice). It cost us $15 for some optional orientation book and whatever the cost of parking was. I fell while ice skating last fall and ended up with a minor fracture on my arm. I went to the hospital and they took some x-rays and I was in and out in under 2 hours. My total cost was $20 for the sling they gave me. I went back for a couple of follow up visits which were totally free to me.

More recently my 81 year-old mother had both of her knees replaced last month. They had her in the hospital for a week and then a rehab facility for 2 weeks after that. None of that cost her anything. Now to a lot of people double knee replacement surgery for an 81 year-old probably sounds like a pretty poor allocation of health resources. My mom's sister lives in the US and had her knees replaced years ago and told my mom that she wouldn't be a good candidate for the surgery because her pain "wasn't that bad" but someone here did the math and decided that the quality of life improvement was worth the cost to the system in cases like my mom's.

When the doctors examined my mom they found significant degradation of both knees. Maybe my mom has a high pain threshold or maybe she's been living with a lot of pain for a long time. I don't know. But 5 weeks post-surgery she's at a point where on average she has the same pain now as she did before the surgery and the pain is lessening every day. I don't think she'll ever be running marathons but she's expecting to be able to go for walks again and resume her active lifestyle. Her mother lived into her 90s so my mom hopefully has a long time ahead of her to enjoy her increased mobility and decreased pain.

As a retired teacher my mom also has pretty good private supplementary health insurance. And it is likely that if a mandatory insurance regime were in place instead of single-payer she would be equally covered. For the hospital and rehab facility stays she didn't have to pay anything. Because she has the supplementary health insurance she was placed in semi-private rooms but if she didn't have any then she still wouldn't have paid anything unless she specifically requested to stay in a semi-private room (ie if you don't have insurance and don't want to pay for it but that's the only room left then lucky you, you get the room for free but might be moved to a general room as space becomes available). Now that she's back home the insurance helps a lot because it covers the cost of her prescriptions except for a $4.00 dispensing fee. As a senior she may also be covered under a public plan for drugs. I don't know which one is paying for them but between the two plans she pays next to nothing for her medicines.

It is a great thing to not have to know how your health care is being paid for just that it is being paid.
posted by any portmanteau in a storm at 1:21 PM on June 15, 2018 [6 favorites]


Especially since I worked out that I pay much less in taxes than Americans pay in premiums.

This is something that, in my experience, people who aren't from the US often have real difficulty with understanding. I've known a fair few Canadians who complain about how much more they'd make in the US, and how much less they'd pay in taxes... but they never factor in premiums, let alone deductibles, co-insurance, copays... in some cases, even allowing for higher wages, you fail to break even, and you end up with worse access to care. Or they talk about the lengthy waits for things like MRIs or specialist visits... but are shocked to hear that people in the US often wait that long, or are unable to afford to actually access care, despite faithfully paying their monthly premiums. It's genuinely difficult to get people who haven't lived in it to understand just how dreadful and expensive the US system is.
posted by halation at 2:39 PM on June 15, 2018 [9 favorites]


My sister had surgery at the beginning of the year, laparoscopic out patient, she was at the hospital around 7 hours. She sent me a snap of the bill, over €60,000 USD before the insurance adjustment. Her cost was around $5,000.

Not long after, on the other side of the Atlantic, I had a total nephrectomy of my left kidney and was in the hospital for a full week. My out of pocket costs were €45 at the pharmacy when I got home for some 1000mg paracetamol, various bandages and some feminine products post-catheter.

She pays ~ $40 a month for synthroid, I pay €2 a box.

I take my kids to the pediatrician without a care because the only cost is waiting our turn.

For profit healthcare, where the bottom line of shareholders and CEOs are most important, can go die a horrible painful death in a fire, hopefully along with the fuck-you-got-mine pigheadedness daftly propping it up.
posted by romakimmy at 2:49 PM on June 15, 2018 [9 favorites]


Canada handles (some) cancers, heart attacks, and I guess prenatal care pretty well. Anything that would require a specialist non-emergently... 👎
posted by cotton dress sock at 2:51 PM on June 15, 2018


Especially since I worked out that I pay much less in taxes than Americans pay in premiums.

I've seen some math that showed it was a wash.
posted by cotton dress sock at 2:52 PM on June 15, 2018


When my husband broke his foot during our 2012 vacation in the US and we had to go to Urgent Care, just navigating that with travel insurance was nightmarish. He couldn't believe how much they nickel and dimed you. I am like, "This is why I hardly ever went to see a doctor as an adult. I couldn't afford to."
posted by Kitteh at 2:56 PM on June 15, 2018 [1 favorite]


In the end, the real death panels were the insurance companies we had with us the whole time.
posted by stet at 4:28 PM on June 15, 2018 [16 favorites]


I think on the American side there is a fear of health care being rationed out and actual needs not being covered by some monolithic system. This absolutely does happen here in Canada. Fairly regularly there will be stories in the news about people seeking treatments that are available in the US or elsewhere but haven't been incorporated into the public health system here.

I think this happens far more often in the U.S., the only difference is that when someone in Canada is denied care it's front page news and soon their MP and the media and everyone else is on the case. When it happens in the U.S. it's not news and nobody seems to care.
posted by If only I had a penguin... at 6:22 PM on June 15, 2018 [16 favorites]


I’m having a pretty big surgery soon, and I’m just done with an earlier surgery (unrelated) by pure chance the order I did them in saved a crazy amount of money because the first surgery filled the deductible so for the second much bigger surgery its only the co-pay. I only figured this out when earlier today I got the call from the insurance guy telling me that insurance would cover it. Pure fucking luck. Whether you have to pay or not pay shouldn’t be down to fucking luck. And I’m not even that bad off considering how much better it is in CA. God Medicare for all can’t come soon enough.
posted by Homo neanderthalensis at 7:18 PM on June 15, 2018 [2 favorites]


Never forget that Nancy Pelosi and the Democrats in the House passed an ACA bill with a public option -- not total single payer but a big step in that direction. This bill then failed in the Senate even though all 59 Democrats were in favor because Joe Lieberman, an independent, flip-flopped at the last minute and refused to provide the 60th vote. So Democrats came within a single vote of providing a public option in Obamacare.

And for their efforts they got slaughtered in the next election and to this day many annoying lefties continue with the slur that they never even tried. It's hard to imagine Democratic politicians being eager to stick their necks out again for single-payer when there are those on the left still ready to stab them in the back.
posted by JackFlash at 7:44 PM on June 15, 2018 [12 favorites]


I've long been loyal to the "three-legged stool" model of Obamacare, but after years watching the policy as it weathers various attacks and (mostly minor) design failures, I've begun to wonder whether a better metaphor isn't a Tokamak. Yes, if you arrange sufficiently powerful magnets in a sufficiently clever orientation you can force your plasma together and fuse it, but the plasma of capitalism really really doesn't want to provide costly healthcare to poor folks on its own, and you have to be very clever indeed, with lots of continual adjustments and costly repairs, in order to compress that stuff into a useful shape. Much better to just abandon the market altogether and socialize medicine like god and nature intended.
posted by chortly at 7:46 PM on June 15, 2018 [2 favorites]


Every day of my life I see examples of people who thought they were paying for adequate coverage getting screwed by their insurance company. I’m constantly wondering how much worse things need to get in the U.S. before all the “horror stories” of rationed health care sound like a blessing.

I’m much more comfortable rationing health care because “this is how much money we have and here is the line you need to cross to get expensive service X” than I am with “HealthCo, Inc, needs to deliver a profit to its shareholders and so we never cover expensive service X unless Doctor Bartfast is willing to jump through all these hurdles that only HealthCo, Inc. decides are important.” Our current system employs tens of thousands of non-clinicians to ration health care on purely financial, non-clinical, considerations in the name of “not rationing” health care. I swear to you Mefites, I deal with this every single day.

And the amazing thing about this, I’ve *never* seen a physician order Expensive Sevice X to milk the system or enrich themselves. The vast majority of physicians want Expensive Service X because they truly believe it will improve or save their patient’s life. The vast majority of times Expensive Service X is ordered it’s because we think it will help our patient, not that it will enrich us. If ordering Expensive Service X is not cost effective for the system, we understand and will work around that. But if Expensive Test X is clearly the right thing to do but HealrhCo, Inc. doesn’t want to pay for it because it cuts into shareholder profits, I become all HULK SMASH! trying to get it done, and in fact many times I don’t have the fight in me to get it done.

So, if the free market doesn’t motivate decisions by health care providers and the free market doesn’t motivate the decisions made by sick people who don’t have the knowledge or ability to shop around for Expensive Service X, what we have is not the free market, but instead we have exploitation of vulnerable sick people by a system that cares more about not delivering expensive services than spending money to save lives.
posted by Slarty Bartfast at 11:06 PM on June 15, 2018 [8 favorites]


Never forget that Nancy Pelosi and the Democrats in the House passed an ACA bill with a public option -- not total single payer but a big step in that direction. This bill then failed in the Senate even though all 59 Democrats were in favor because Joe Lieberman, an independent, flip-flopped at the last minute and refused to provide the 60th vote. So Democrats came within a single vote of providing a public option in Obamacare.

How often does one party get 60 votes? The Democratic Party collectively chose preservation of the filibuster over the public option.
posted by moorooka at 11:36 PM on June 15, 2018


And for their efforts they got slaughtered in the next election and to this day many annoying lefties continue with the slur that they never even tried. It's hard to imagine Democratic politicians being eager to stick their necks out again for single-payer when there are those on the left still ready to stab them in the back.

It’s easier to imagine it if it becomes impossible for candidates to win Democratic primaries without commiting to it.
posted by moorooka at 11:45 PM on June 15, 2018


I've seen some math that showed it was a wash.

That math is wrong, because otherwise US spending on healthcare per capita would not be much more than Australia's.

US healthcare is not significantly better than Australia's, yet it costs about twice as much per citizen. The best explanation for most of the difference is that the US system is completely infested with rentiers.
posted by flabdablet at 12:47 AM on June 16, 2018 [9 favorites]


If the US healthcare system is twice as expensive as the Australian system, someone is taking a huge amount of money out of the US system, and that is exactly why it is so difficult to change in one big go. Its important to keep the eye on the ball, but its also important to understand that this will take time. Just as it did in all the countries that have universal healthcare today.
Its also more difficult today than it was post WW2, because the cost of healthcare has soared. Here, the cost of healthcare as a percentage of the whole public budget has tripled since 1950, while the budget as a whole has more than doubled. Its much easier to nationalize a small sector than a huge one.
Finally, I think the cost of education is a bigger issue than most imagine. Being a doctor is a good job most places. But here at least, doctors don’t have a huge debt to pay off, because education is free. I once heard an evil Danish doctor on the radio, who had emigrated to the US because she got five times the pay and a PA at an American hospital. Yeah, after we the Danish taxpayers paid your ten years of education, including stipends during the first five years and a living wage during your doctoral studies. Grrr.
posted by mumimor at 4:42 AM on June 16, 2018 [1 favorite]


I’m much more comfortable rationing health care because “this is how much money we have and here is the line you need to cross to get expensive service X”

Care is not rationed in Canada for this reason. In other words, this statement

"someone here did the math and decided that the quality of life improvement was worth the cost to the system in cases like my mom's."

Is not actually true. No one did the math. Knee replacements are covered. End of story. There's no case-by-case how old is this person, what else do they have, do they really use their knees that much or whatever, etc.

That means that if you see somoene in Canada whose care wasn't covered, it's not generally because it was too expensive (equally expensive treatments are covered) or because someone decided they weren't a good fit or whatever, it's because the thing not being covered is rare or new so no one has put it on the list of covered services yet. Then there's some inertia getting it on the list, sometimes, but basically it's the new/rare thing, not "you're not eligible."
posted by If only I had a penguin... at 4:54 AM on June 16, 2018 [2 favorites]


Yeah, after we the Danish taxpayers paid your ten years of education, including stipends during the first five years and a living wage during your doctoral studies. Grrr

It's not often recognized, with all the complaining from doctors about school loans, but in the U.S. Medicare taxes pay each doctor over $100,000 a year for their internship and residency. The doctor keeps about half of that and the other half goes to the teaching hospital.

I don't know any other profession that will give you $100,000 a year in taxpayer money for post-graduate work so that you can get salaries paying hundreds of thousands a year.
posted by JackFlash at 5:44 AM on June 16, 2018 [3 favorites]


I once heard an evil Danish doctor on the radio, who had emigrated to the US because she got five times the pay and a PA at an American hospital.

What you probably didn't know is that she would have had to repeat her 3 to 5 years of post-graduate residency once she reached the U.S., no matter how experienced she was, because the AMA tries to limit immigration of foreign doctors to reduce competition and keep prices high.
posted by JackFlash at 5:50 AM on June 16, 2018 [2 favorites]


I’m just not able to persuade this old ipad to copy-paste, but she will have gotten quite a bit more than that during her post-graduate work here. And of course free healthcare, very cheap childcare if she had kids, and in some, not all, areas, university housing. And she would still get a very fine pay relative to other people here after her doctoral work.
Generally I’m fine with people going abroad with their educations. But this woman was being interviewed because she advocated for the American healthcare system. Not on its merits of providing better healthcare, but because it provides better wages and working conditions for doctors.
posted by mumimor at 6:13 AM on June 16, 2018 [1 favorite]


Medicine is one of the most regulated professions. I do not think it can be easily be reduced to salary. Everyone has a stake in how doctors are trained. Due to USA hyper-individualism doctors have maintained a lot of independence. While I would loved to be in European style system with a modest salary and training payed for. Doctors also due they hyper-individualism take on a lot of risk in terms of malpractice that they don't have in Europe. Your personal assets can be target in law suits. While the idea of heroic doctors is finally dying and the understanding that systems are more important for preventing errors the legal attitudes are not there yet. I just started applying for my first post residency job and the amount of paper work I have to fill out for tort related issues is more than things about my medical training. I can got on for hours how messed up medical training is in the U.S, but I would still do it over again.
Disclosure: I am family medicine resident.
posted by roguewraith at 8:37 AM on June 16, 2018


I really don’t know enough about medicine in the US to be critical of doctors pay, it was more the attitude of the Danish doctor that enraged me.
Actually many doctors here have private practices, it’s just that they are paid by the government/taxpayers, rather than by each individual patient. My doctor has a huge, popular practice and is quite well off. But it’s true that we don’t have the level of litigation one sees in the US.
posted by mumimor at 2:40 AM on June 17, 2018


This issue of Dissent, as well as the Winter 2018 edition of Jacobin are chock full of articles on UHC.
posted by daHIFI at 9:04 AM on June 18, 2018 [1 favorite]


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