7 ms·

The fact that the provided charts have no comparison to existing universal coverage systems (e.g. Canada, Europe) is frustrating. American news organizations tr

The fact that the provided charts have no comparison to existing universal coverage systems (e.g. Canada, Europe) is frustrating. American news organizations treat the topic as if it were new and as if the care of American bodies is radically different from the care of the hundreds of millions of human bodies already being looked after by existing social welfare plans.

citilife 8y ago
You really really don't want to compare with the rest of the worlds universal coverage systems to the U.S.. Many places have way more significant wait times for treatment... Canada: https://torontosun.com/2017/02/16/canada-has-worst-erreferral-wait-times-in-11-developed-countries-report/wcm/2f7966f0-0daa-4589-aba7-68e54e0a056e https://torontosun.com/2017/02/16/canada-has-worst-erreferra... Ireland: https://www.irishtimes.com/news/health/new-record-of-more-than-718-000-patients-on-waiting-lists-1.3628584 https://www.irishtimes.com/news/health/new-record-of-more-th... There's more, but lets get real. The U.S. system has it's problems, but at least I can get treatment. That's why it's a difficult subject and why we should be cautious on how to proceed. Perhaps run trials per state or something as well.
- bertil 8y ago
  > at least I can get treatment I’m assuming that you realise the singular first person in that statement is very much that: singular. > Let’s get real The New York Times sees “real” as under a Rawlsian veil: they imagine being any citizen. You seemingly disagree with that approach.
- patmcc 8y ago
  >>Many places have way more significant wait times for treatment... Canadian here - yep, there are sometimes wait times, especially for specialists, especially if it's something that is unpleasant but not urgently life threatening. That sucks. I'd still take that over some percentage of the population just not having access to care, or having a huge number of medical bankruptcies. As for the ER - it even says in the article you link, that's largely people who could have gone to their primary care physician. Those are the people waiting. If you go in with a stroke, you're not waiting. I've (luckily) never been to the ER for a life-threatening situation, but I have for injuries where I needed urgent care, and got excellent treatment - and yes, once I had to wait for the guy ahead of me who had a stroke. I'm ok with that.
  - AlexandrB 8y ago
    > That sucks. I'd still take that over some percentage of the population just not having access to care, or having a huge number of medical bankruptcies. Yup. I'd rather wait 10 hours in ER for something non-life-threatening than get immediate care and spend the next 10 weeks fighting with insurance companies or filing for bankruptcy.
- asnrk 8y ago
  Since most of the other OECD states are representative democracies of one sort or another, and since pretty much all of them have some form of universal health coverage, if the US system's an improvement over any of those in other OECD states, I expect there are strong, popular reform movements in at least some of them looking to move their system closer to that of the US. Right? Not to improve their systems in other ways, but specifically to move closer to that of the US. Since that'd be a clear improvement if they just "get real".
  - moorhosj 8y ago
    I’ve raised this exact question and never seen an honest response. Why aren’t politicians in other OECD countries trying to make their system more like ours? Why aren’t their citizens demanding it?
- taoistextremist 8y ago
  So, according to your article, 29% of Canadians had to wait 4 or more hours, whereas 24% of Americans did, so I'm not seeing much comparative improvements and I'd hypothesize that long ER wait times are not to do with which healthcare model you have, it has to do with misuse of ER. Meanwhile, France, Germany and the Netherlands all had outstanding numbers, and as far as I know they all have universal coverage.
  - cbhl 8y ago
    Having used the ER twice in fifth grade in Canada, it seemed fine? Like, yes, sure you have to wait 12 hours to see a doctor if you're not bleeding out the chest. But also, I didn't have to face the prospect of paying $300 for a 15 minute consult, or going to jail to receive treatment. If you have a cold, you find a PCP or a "health clinic" and make an appointment for same-day or later-that-week. And sure it's hard to find that PCP, but with my PCP in the US I have to book appointments three weeks in advance! I'd argue "75%ile time waiting in the ER" is not a great metric. That neither tells you how easy it is you are to get preventative or routine treatment, nor how well your ER is able to handle a mass-shooting type catastrophe.
    - citilife 8y ago
      _Without insurance_ you can see a doctor in the U.S. for relatively cheap. I'm talking, $100 for a clinic visit. I've done it plenty of times for less. The healthcare in the U.S. seems nuts because you are _billed_ for hundreds of dollars, but that's because they have to subsidize medicare patients AND insurance companies have negotiated rates based on percentages. So, they may only pay 40% of what is billed, but you are shown much more. It's a scam everyone is involved in, which is why we need open pricing and open "how much insurance actually paid".
      - cbhl 8y ago
        Without insurance, a 15-minute consult in Canada is, like, $40 CAD. That's like $20 USD. Factor of 5x or 10x savings.
  - 8y ago
- Brakenshire 8y ago
  You can always buy private medical insurance to give you fast access to specialists for non-urgent care, or it can be provided through your work, in exactly the same way as the American system. The difference between America and somewhere like the UK is that in the UK expensive private medical insurance is optional, and there is a baseline of decent medical care available to everyone. And that baseline universal care is provided for the same amount of taxpayer spending (as a percentage of GDP) as the US spends on providing Medicare, Medicaid, and those partial programmes. The US spends about 8% of GDP on private medical care, and another 8% on public care. Universal healthcare is about making the public, taxpayer-funded part of that expenditure more efficient, not about abolishing the private part of it.
- jellicle 8y ago
  US stats don't include the 25%+, more like 50% really, of the population who are financially excluded from medical care (even though some are "insured"). Anybody who does this: "I have a medical issue but I'm not going to seek treatment for it because I'll get a bill for $10K" should be viewed as having infinite wait times, and counted in the stats thusly. But they aren't. "Oh, I've got this giant infected cut on my hand and I'm not going to go to the doctor because I'll end up broke" simply doesn't exist in Canada or Ireland, or any other first-world nation. And hey poster, I guess you didn't get to the bottom of your linked article: "Almost three-quarters of Canadians rated their quality of care as very good or excellent, well above the international average of 65%, she said."
- erentz 8y ago
  This comparison is flawed if it excludes those who have to wait indefinitely due to not having sufficient coverage. Put those in and wait times wouldn’t look so great in the US anymore.
- Amygaz 8y ago
  You're cherry picking, and the US is getting worse every year in that metric, while other countries have started tackling that. But the main thing is this has nothing to do with the universality of healthcare, more about how it has been implemented in those two countries. Go look at the UK, France, Germany, Australia.
nugget 8y ago
One difference I’ve noted between Americans and Europeans (especially the British) is the attitude towards quality of care. Many more Americans expect the “best” care; it’s almost encoded in DNA, like a byproduct of their fiercely independent historical nature. By contrast, the British are more communal and expect the same care that the vast majority of their fellow citizens receive. It doesn’t seem to bother the British that a small % of wealthy people can purchase better care in a mirrored private insurance system. If the American health care system is restructured and the result is 70% universal medicare and 30% supplemental private insurance or fee for service (with better quality providers, expanded diagnostic services, and shorter wait times), is that a real leap forward or will there simply be a different set of political problems created?
- deogeo 8y ago
  > is that a real leap forward or will there simply be a different set of political problems created? The question you should be asking is, will fewer people die of preventable medical causes.
  - nugget 8y ago
    That’s a very commendable metric to use but there’s very little political support for it. If Medicare banned hip replacements for anyone older than 75 and reallocated those resources to preventative care, many more “years” of life would likely be saved. (Not to mention heroic end of life care in hospital ICUs which Americans seem to culturally celebrate.) But you would start to see backlash from families affected. My point is simply that you couldn’t import the NHS to America and expect it to function well; there are unique social, cultural, and political considerations that have to be factored into a reform of the system.
    - akiselev 8y ago
      How'd you go from "will fewer people die of preventable medical causes" to "[i]f Medicare banned hip replacements for anyone older than 75"? To your specific example, immobility is a significant contributing factor for most age related conditions and a hip replacement is an expensive but efficient preventative treatment in old age, especially when it enables the patient to return to regular exercise. Hip replacements aren't like organ transplants where there are a limited number to go around that present an unavoidable moral dilemma. Such a ban would be political suicide for anyone who even proposes it since seniors vote much more reliably so I don't think anyone expects to ship the NHS bureaucracy here wholesale.
AndrewKemendo 8y ago
It's because there is no direct comparison. No country on earth with single payer or other universal coverage has anywhere near the number of citizens nor geographic or social diversity as the US. Now, that doesn't mean we can't learn from those countries, but our own smaller scale federal health care systems (medicare, VA, tricare) are already large enough to compare with and done so. It's quite unfortunate, but the entire federal system has to change in order to lay the groundwork for a single payer system.
- objektif 8y ago
  I think this diversity can be benefitial for insurance right? Isnt that the whole idea behind the idea of diversification?
- deleted 8y ago
  [deleted]
- dragonwriter 8y ago
  > No country on earth with single payer or other universal coverage has anywhere near the number of citizens nor geographic or social diversity as the US. That's both not true (the PRC exists, and alone is sufficient to disprove that no country with universal coverage exceeds the US on any of the measures you listed) and not relevant, as none of those are significant per-capita or per-GDP healthcare cost drivers.
  - AndrewKemendo 8y ago
    I'm sorry, just to be clear, you're making a serious contention that the PRC 1. Has universal healthcare (false) and 2. that it's something that is to be imitated?
    - dragonwriter 8y ago
      > you're making a serious contention that the PRC 1. Has universal healthcare (false) The PRC has universal healthcare coverage entitlement by national policy, financed and administered largely by local governments under national standards (with central subsidies to poorer regions), and has over 95% of the population covered through public-funded programs. [0] > 2. that it's something that is to be imitated? The claim was no country with certain features exists; being worthy of imitation was not one of the features. I never advocated emulating the PRC either in general or in the specifics of their mechanism of addressing universal healthcare access; in fact, I specifically pointed out that, as well.as being false, the claim about countries sharing those features was irrelevant to the healthcare discussion (which implies that a country meeting the supposedly unmet description has no particular reason to have special status as a model for the US.) [0] https://international.commonwealthfund.org/countries/china/ https://international.commonwealthfund.org/countries/china/
int_19h 8y ago
The ignorance about how other countries do it extends to proponents of various public healthcare plans, as well. For example, I was surprised to find out that a lot of people have recently become convinced that "Medicare for All" (i.e. single payer) is how things are done in all developed countries other than US, and that public option is some kind of conspiracy to cheat them of having the same.
erentz 8y ago
They’re also stupid because they perpetuate this meaningless idea that things can’t be done because of “politics”. Quote: “But most also said plans that eliminate it now are politically infeasible.” Three years ago Medicare for All was “politically infeasible”. Then it turned out when you presented a direct, clear policy that improved people’s lives and was clearly untainted by special interests, people started to sign up. And suddenly every democrat candidate who hopes to have a shot at least has to pretend to offer Medicare for All. (Pretend because obviously some are for “realistic” “politically feasible” plans that mostly maintain the status quo and keep lobbyists and the insurance industry happy.)
- comex 8y ago
  The article mentions that the idea of “Medicare for All” is currently popular in part because it’s not clear: > But when people hear arguments against it, their support plummets. It turns out that most people don’t really know what Medicare for all means. Even asking three policy experts might yield three different answers.
  - erentz 8y ago
    There’s a bunch of conjecture there, it doesn’t say what these arguments against it are. It doesn’t allow someone to argue for it and test to see if they remain persuaded when the idea is also defended. And in saying “most people don’t know what Medicare for All means” I don’t see anything testing that by asking what people think it means. I suspect most people think “medicare for all” means exactly what it says. Everyone gets Medicare, that thing that you currently only get when you’re over 65.
    - comex 8y ago
      Do they? According to a poll from last month, 55% of Americans thought that if "Medicare-for-all" was put into place, they'd be able to keep their current health insurance (35% thought they would not, 10% didn't know). [1] ...That's despite the fact that earlier in the same poll, according to the methodology document, the questioner had asked their opinion about "having a national health plan, sometimes called Medicare-for-all, in which all Americans would get their insurance from a single government plan" and, separately, "creating a national government administered health plan similar to Medicare that would be open to anyone, but would allow people to keep the coverage they have if they prefer". Take from that what you will. After noticing that weirdness, I looked for polls from other pollsters on the same subject. In an online poll from last October [3], when asked "When you hear candidates talking about 'Medicare for All', what do you think they are proposing?", 52% picked "A single, government-run health insurance program to cover all Americans", 21% picked "An optional government-run program that would compete with private insurance"... and 24% picked "Neither of these". That's roughly consistent with the other poll if you group "optional" and "neither" together, but I have no idea what people who picked "neither" think Medicare-for-all actually is. Another relevant question is how many people support single payer or a public option when the choices are explained more clearly. Going back to the first poll, in the earlier question I mentioned before, 56% supported single payer, while 74% supported a public option. However, a later question asked "Would you favor or oppose a national Medicare-for-all plan if you heard that it would..." with a series of hypotheticals. One of those, "Guarantee health insurance as a right for all Americans", had 71% in favor; but "Require most Americans to pay more in taxes" and "Eliminate private health insurance companies" each had 37% in favor. (I suspect the authors of the NYTimes article had this poll in mind when they wrote "when people hear arguments against it, their support plummets".) Once again, the methodology is confusing: the question literally asks if the respondent would support (or oppose) Medicare-for-all as a whole if the hypothetical were true, but some probably responded based on whether they liked the hypothetical itself. That might help explain how "Eliminate private health insurance companies" polled worse than "having a national health plan [..] in which all Americans would get their insurance from a single government plan" from earlier. Another part of the explanation is probably just ignorance and people not thinking about the issue very hard. From the second poll, when asked which option they would favor most, single payer, public option, and "neither" were all roughly tied, at 34%, 33%, and 30% respectively. The first two add up to 67% preferring either single payer or a public option. This is close to the 74% who supported a public option in the other poll, which makes the results roughly consistent, assuming that respondents to this poll who preferred single payer would still prefer a public option to nothing. Anyway... it's certainly true that single payer has substantial support, and that it seems a lot more politically feasible today than it did in 2016, in large part due to the efforts of Bernie Sanders and others. But it's likely all downhill from here. Medicare-for-all has become such a popular rallying cry on the left that it doesn't have much room to grow. And for any variant of Medicare-for-all (like anything else), once a concrete policy is on the table and its costs and downsides are available to criticize, support will fall; and once conservative figures leap on the opportunity to rally the base with that criticism, what bipartisan support currently exists will evaporate. That doesn't mean it can't maintain enough momentum to become a reality: it could. But it will help to have a higher starting point of popularity, and so evaluations of "political feasibility" do matter. [1] https://www.kff.org/slideshow/public-opinion-on-single-payer-national-health-plans-and-expanding-access-to-medicare-coverage/ https://www.kff.org/slideshow/public-opinion-on-single-payer... [2] http://files.kff.org/attachment/Topline-KFF-Health-Tracking-Poll-January-2019 http://files.kff.org/attachment/Topline-KFF-Health-Tracking-... [3] https://www.axios.com/medicare-for-all-poll-midterm-elections-e7b93daf-b261-42f7-85ca-8d1bcb2eb1f0.html https://www.axios.com/medicare-for-all-poll-midterm-election...
Amygaz 8y ago
I just want to point out that different countries in Europe have different implementation of universal health care system. UK != France != Swiss != Germany ~= Netherlands... The German system, which is also the oldest universal healthcare system, would be the best/easiest fit to transition the USA towards that.

citilife 8y ago

You really really don't want to compare with the rest of the worlds universal coverage systems to the U.S.. Many places have way more significant wait times for treatment... Canada: https://torontosun.com/2017/02/16/canada-has-worst-erreferral-wait-times-in-11-developed-countries-report/wcm/2f7966f0-0daa-4589-aba7-68e54e0a056e https://torontosun.com/2017/02/16/canada-has-worst-erreferra... Ireland: https://www.irishtimes.com/news/health/new-record-of-more-than-718-000-patients-on-waiting-lists-1.3628584 https://www.irishtimes.com/news/health/new-record-of-more-th... There's more, but lets get real. The U.S. system has it's problems, but at least I can get treatment. That's why it's a difficult subject and why we should be cautious on how to proceed. Perhaps run trials per state or something as well.

bertil 8y ago
> at least I can get treatment I’m assuming that you realise the singular first person in that statement is very much that: singular. > Let’s get real The New York Times sees “real” as under a Rawlsian veil: they imagine being any citizen. You seemingly disagree with that approach.
patmcc 8y ago
>>Many places have way more significant wait times for treatment... Canadian here - yep, there are sometimes wait times, especially for specialists, especially if it's something that is unpleasant but not urgently life threatening. That sucks. I'd still take that over some percentage of the population just not having access to care, or having a huge number of medical bankruptcies. As for the ER - it even says in the article you link, that's largely people who could have gone to their primary care physician. Those are the people waiting. If you go in with a stroke, you're not waiting. I've (luckily) never been to the ER for a life-threatening situation, but I have for injuries where I needed urgent care, and got excellent treatment - and yes, once I had to wait for the guy ahead of me who had a stroke. I'm ok with that.
- AlexandrB 8y ago
  > That sucks. I'd still take that over some percentage of the population just not having access to care, or having a huge number of medical bankruptcies. Yup. I'd rather wait 10 hours in ER for something non-life-threatening than get immediate care and spend the next 10 weeks fighting with insurance companies or filing for bankruptcy.
asnrk 8y ago
Since most of the other OECD states are representative democracies of one sort or another, and since pretty much all of them have some form of universal health coverage, if the US system's an improvement over any of those in other OECD states, I expect there are strong, popular reform movements in at least some of them looking to move their system closer to that of the US. Right? Not to improve their systems in other ways, but specifically to move closer to that of the US. Since that'd be a clear improvement if they just "get real".
- moorhosj 8y ago
  I’ve raised this exact question and never seen an honest response. Why aren’t politicians in other OECD countries trying to make their system more like ours? Why aren’t their citizens demanding it?
taoistextremist 8y ago
So, according to your article, 29% of Canadians had to wait 4 or more hours, whereas 24% of Americans did, so I'm not seeing much comparative improvements and I'd hypothesize that long ER wait times are not to do with which healthcare model you have, it has to do with misuse of ER. Meanwhile, France, Germany and the Netherlands all had outstanding numbers, and as far as I know they all have universal coverage.
- cbhl 8y ago
  Having used the ER twice in fifth grade in Canada, it seemed fine? Like, yes, sure you have to wait 12 hours to see a doctor if you're not bleeding out the chest. But also, I didn't have to face the prospect of paying $300 for a 15 minute consult, or going to jail to receive treatment. If you have a cold, you find a PCP or a "health clinic" and make an appointment for same-day or later-that-week. And sure it's hard to find that PCP, but with my PCP in the US I have to book appointments three weeks in advance! I'd argue "75%ile time waiting in the ER" is not a great metric. That neither tells you how easy it is you are to get preventative or routine treatment, nor how well your ER is able to handle a mass-shooting type catastrophe.
  - citilife 8y ago
    _Without insurance_ you can see a doctor in the U.S. for relatively cheap. I'm talking, $100 for a clinic visit. I've done it plenty of times for less. The healthcare in the U.S. seems nuts because you are _billed_ for hundreds of dollars, but that's because they have to subsidize medicare patients AND insurance companies have negotiated rates based on percentages. So, they may only pay 40% of what is billed, but you are shown much more. It's a scam everyone is involved in, which is why we need open pricing and open "how much insurance actually paid".
    - cbhl 8y ago
      Without insurance, a 15-minute consult in Canada is, like, $40 CAD. That's like $20 USD. Factor of 5x or 10x savings.
- 8y ago
Brakenshire 8y ago
You can always buy private medical insurance to give you fast access to specialists for non-urgent care, or it can be provided through your work, in exactly the same way as the American system. The difference between America and somewhere like the UK is that in the UK expensive private medical insurance is optional, and there is a baseline of decent medical care available to everyone. And that baseline universal care is provided for the same amount of taxpayer spending (as a percentage of GDP) as the US spends on providing Medicare, Medicaid, and those partial programmes. The US spends about 8% of GDP on private medical care, and another 8% on public care. Universal healthcare is about making the public, taxpayer-funded part of that expenditure more efficient, not about abolishing the private part of it.
jellicle 8y ago
US stats don't include the 25%+, more like 50% really, of the population who are financially excluded from medical care (even though some are "insured"). Anybody who does this: "I have a medical issue but I'm not going to seek treatment for it because I'll get a bill for $10K" should be viewed as having infinite wait times, and counted in the stats thusly. But they aren't. "Oh, I've got this giant infected cut on my hand and I'm not going to go to the doctor because I'll end up broke" simply doesn't exist in Canada or Ireland, or any other first-world nation. And hey poster, I guess you didn't get to the bottom of your linked article: "Almost three-quarters of Canadians rated their quality of care as very good or excellent, well above the international average of 65%, she said."
erentz 8y ago
This comparison is flawed if it excludes those who have to wait indefinitely due to not having sufficient coverage. Put those in and wait times wouldn’t look so great in the US anymore.
Amygaz 8y ago
You're cherry picking, and the US is getting worse every year in that metric, while other countries have started tackling that. But the main thing is this has nothing to do with the universality of healthcare, more about how it has been implemented in those two countries. Go look at the UK, France, Germany, Australia.

nugget 8y ago

One difference I’ve noted between Americans and Europeans (especially the British) is the attitude towards quality of care. Many more Americans expect the “best” care; it’s almost encoded in DNA, like a byproduct of their fiercely independent historical nature. By contrast, the British are more communal and expect the same care that the vast majority of their fellow citizens receive. It doesn’t seem to bother the British that a small % of wealthy people can purchase better care in a mirrored private insurance system. If the American health care system is restructured and the result is 70% universal medicare and 30% supplemental private insurance or fee for service (with better quality providers, expanded diagnostic services, and shorter wait times), is that a real leap forward or will there simply be a different set of political problems created?

deogeo 8y ago
> is that a real leap forward or will there simply be a different set of political problems created? The question you should be asking is, will fewer people die of preventable medical causes.
- nugget 8y ago
  That’s a very commendable metric to use but there’s very little political support for it. If Medicare banned hip replacements for anyone older than 75 and reallocated those resources to preventative care, many more “years” of life would likely be saved. (Not to mention heroic end of life care in hospital ICUs which Americans seem to culturally celebrate.) But you would start to see backlash from families affected. My point is simply that you couldn’t import the NHS to America and expect it to function well; there are unique social, cultural, and political considerations that have to be factored into a reform of the system.
  - akiselev 8y ago
    How'd you go from "will fewer people die of preventable medical causes" to "[i]f Medicare banned hip replacements for anyone older than 75"? To your specific example, immobility is a significant contributing factor for most age related conditions and a hip replacement is an expensive but efficient preventative treatment in old age, especially when it enables the patient to return to regular exercise. Hip replacements aren't like organ transplants where there are a limited number to go around that present an unavoidable moral dilemma. Such a ban would be political suicide for anyone who even proposes it since seniors vote much more reliably so I don't think anyone expects to ship the NHS bureaucracy here wholesale.

AndrewKemendo 8y ago

It's because there is no direct comparison. No country on earth with single payer or other universal coverage has anywhere near the number of citizens nor geographic or social diversity as the US. Now, that doesn't mean we can't learn from those countries, but our own smaller scale federal health care systems (medicare, VA, tricare) are already large enough to compare with and done so. It's quite unfortunate, but the entire federal system has to change in order to lay the groundwork for a single payer system.

objektif 8y ago
I think this diversity can be benefitial for insurance right? Isnt that the whole idea behind the idea of diversification?
deleted 8y ago
[deleted]
dragonwriter 8y ago
> No country on earth with single payer or other universal coverage has anywhere near the number of citizens nor geographic or social diversity as the US. That's both not true (the PRC exists, and alone is sufficient to disprove that no country with universal coverage exceeds the US on any of the measures you listed) and not relevant, as none of those are significant per-capita or per-GDP healthcare cost drivers.
- AndrewKemendo 8y ago
  I'm sorry, just to be clear, you're making a serious contention that the PRC 1. Has universal healthcare (false) and 2. that it's something that is to be imitated?
  - dragonwriter 8y ago
    > you're making a serious contention that the PRC 1. Has universal healthcare (false) The PRC has universal healthcare coverage entitlement by national policy, financed and administered largely by local governments under national standards (with central subsidies to poorer regions), and has over 95% of the population covered through public-funded programs. [0] > 2. that it's something that is to be imitated? The claim was no country with certain features exists; being worthy of imitation was not one of the features. I never advocated emulating the PRC either in general or in the specifics of their mechanism of addressing universal healthcare access; in fact, I specifically pointed out that, as well.as being false, the claim about countries sharing those features was irrelevant to the healthcare discussion (which implies that a country meeting the supposedly unmet description has no particular reason to have special status as a model for the US.) [0] https://international.commonwealthfund.org/countries/china/ https://international.commonwealthfund.org/countries/china/

int_19h 8y ago

The ignorance about how other countries do it extends to proponents of various public healthcare plans, as well. For example, I was surprised to find out that a lot of people have recently become convinced that "Medicare for All" (i.e. single payer) is how things are done in all developed countries other than US, and that public option is some kind of conspiracy to cheat them of having the same.

erentz 8y ago

They’re also stupid because they perpetuate this meaningless idea that things can’t be done because of “politics”. Quote: “But most also said plans that eliminate it now are politically infeasible.” Three years ago Medicare for All was “politically infeasible”. Then it turned out when you presented a direct, clear policy that improved people’s lives and was clearly untainted by special interests, people started to sign up. And suddenly every democrat candidate who hopes to have a shot at least has to pretend to offer Medicare for All. (Pretend because obviously some are for “realistic” “politically feasible” plans that mostly maintain the status quo and keep lobbyists and the insurance industry happy.)

comex 8y ago
The article mentions that the idea of “Medicare for All” is currently popular in part because it’s not clear: > But when people hear arguments against it, their support plummets. It turns out that most people don’t really know what Medicare for all means. Even asking three policy experts might yield three different answers.
- erentz 8y ago
  There’s a bunch of conjecture there, it doesn’t say what these arguments against it are. It doesn’t allow someone to argue for it and test to see if they remain persuaded when the idea is also defended. And in saying “most people don’t know what Medicare for All means” I don’t see anything testing that by asking what people think it means. I suspect most people think “medicare for all” means exactly what it says. Everyone gets Medicare, that thing that you currently only get when you’re over 65.
  - comex 8y ago
    Do they? According to a poll from last month, 55% of Americans thought that if "Medicare-for-all" was put into place, they'd be able to keep their current health insurance (35% thought they would not, 10% didn't know). [1] ...That's despite the fact that earlier in the same poll, according to the methodology document, the questioner had asked their opinion about "having a national health plan, sometimes called Medicare-for-all, in which all Americans would get their insurance from a single government plan" and, separately, "creating a national government administered health plan similar to Medicare that would be open to anyone, but would allow people to keep the coverage they have if they prefer". Take from that what you will. After noticing that weirdness, I looked for polls from other pollsters on the same subject. In an online poll from last October [3], when asked "When you hear candidates talking about 'Medicare for All', what do you think they are proposing?", 52% picked "A single, government-run health insurance program to cover all Americans", 21% picked "An optional government-run program that would compete with private insurance"... and 24% picked "Neither of these". That's roughly consistent with the other poll if you group "optional" and "neither" together, but I have no idea what people who picked "neither" think Medicare-for-all actually is. Another relevant question is how many people support single payer or a public option when the choices are explained more clearly. Going back to the first poll, in the earlier question I mentioned before, 56% supported single payer, while 74% supported a public option. However, a later question asked "Would you favor or oppose a national Medicare-for-all plan if you heard that it would..." with a series of hypotheticals. One of those, "Guarantee health insurance as a right for all Americans", had 71% in favor; but "Require most Americans to pay more in taxes" and "Eliminate private health insurance companies" each had 37% in favor. (I suspect the authors of the NYTimes article had this poll in mind when they wrote "when people hear arguments against it, their support plummets".) Once again, the methodology is confusing: the question literally asks if the respondent would support (or oppose) Medicare-for-all as a whole if the hypothetical were true, but some probably responded based on whether they liked the hypothetical itself. That might help explain how "Eliminate private health insurance companies" polled worse than "having a national health plan [..] in which all Americans would get their insurance from a single government plan" from earlier. Another part of the explanation is probably just ignorance and people not thinking about the issue very hard. From the second poll, when asked which option they would favor most, single payer, public option, and "neither" were all roughly tied, at 34%, 33%, and 30% respectively. The first two add up to 67% preferring either single payer or a public option. This is close to the 74% who supported a public option in the other poll, which makes the results roughly consistent, assuming that respondents to this poll who preferred single payer would still prefer a public option to nothing. Anyway... it's certainly true that single payer has substantial support, and that it seems a lot more politically feasible today than it did in 2016, in large part due to the efforts of Bernie Sanders and others. But it's likely all downhill from here. Medicare-for-all has become such a popular rallying cry on the left that it doesn't have much room to grow. And for any variant of Medicare-for-all (like anything else), once a concrete policy is on the table and its costs and downsides are available to criticize, support will fall; and once conservative figures leap on the opportunity to rally the base with that criticism, what bipartisan support currently exists will evaporate. That doesn't mean it can't maintain enough momentum to become a reality: it could. But it will help to have a higher starting point of popularity, and so evaluations of "political feasibility" do matter. [1] https://www.kff.org/slideshow/public-opinion-on-single-payer-national-health-plans-and-expanding-access-to-medicare-coverage/ https://www.kff.org/slideshow/public-opinion-on-single-payer... [2] http://files.kff.org/attachment/Topline-KFF-Health-Tracking-Poll-January-2019 http://files.kff.org/attachment/Topline-KFF-Health-Tracking-... [3] https://www.axios.com/medicare-for-all-poll-midterm-elections-e7b93daf-b261-42f7-85ca-8d1bcb2eb1f0.html https://www.axios.com/medicare-for-all-poll-midterm-election...

Amygaz 8y ago

I just want to point out that different countries in Europe have different implementation of universal health care system. UK != France != Swiss != Germany ~= Netherlands... The German system, which is also the oldest universal healthcare system, would be the best/easiest fit to transition the USA towards that.