7 ms·

It doesn't matter how often I come across it or from which direction: I'm just flabbergasted that the USA doesn't have universal health care.

pragmatic 16y ago
I think it's been an issue, but not that big of an issue (in voter's minds) until recently. Many of the voting blocks are already covered. Low income people have medicaid, seniors have medicare. Many people working a full time job have employer sponsored health plans. Health insurance costs are rising. It's harder to find a cheap plan. Pre-existing conditions really screw you as far as decent coverage. I'm not sure what the answer is at this point. The US is almost broke, we might not have a choice. http://esr.ibiblio.org/?p=3035 http://esr.ibiblio.org/?p=3035
- aaronblohowiak 16y ago
  Military spending.
- jbooth 16y ago
  Yeah, and it's brilliant, because the gov't is on the hook for poor people and old people, aka unprofitable insurance subjects, while the private industry scoops up profits on the rest. And before some conservative comes in telling me that insurance profits aren't that high as a % of revenue, % profits on a pass-thru payment system are not the same thing as % profits on actually building something. I saw a statistic (can't place it now and don't feel like googling, so grain of salt) that we actually have comparable government spending per capita on healthcare to some western european countries, and that's just for medicare/medicaid, without even covering everyone. No generic drugs + byzantine public/private payment systems + highest-risk populations = lots of money.
  - yummyfajitas 16y ago
    % profits on a pass-thru payment system are not the same thing as % profits on actually building something. Could you explain this claim?
    - jbooth 16y ago
      In one sentence, IMO of course, passing something through should be much cheaper than actually building something or adding value unless you're bilking people. In another sentence, insurance companies don't administer care, they just move money around. Compare to the overhead as a % of revenue for the social security administration, for example. They're a simpler passthru so it's not a completely fair comparison but insurance is closer to SS than it is to manufacturing.
      - barry-cotter 16y ago
        passing something through should be much cheaper than actually building something or adding value unless you're bilking people. The amount someone gets paid for doing something depends on how much value they capture, not how much they add. In most cases where all parties contract freely, you can't capture more than you add, but anyway _Value added and paid are often wildly out of whack_ "Bilked" is a moral judgement. If you're saying you think insurance is unjustly fair then since that's a fact about you not about insurance, sure it can be true. But it's like "profiteering", a moral/political statement, with no economic content.
        jbooth 16y ago
        Adam Smith would differ with you, in the ideal case. Value capture and rent seeking aren't how capitalism are supposed to work. Heck, if that was the best capitalism could do, I'd be inclined to try communism.
reader5000 16y ago
Basic racial politics. Welfare queens and all that jazz.
rdtsc 16y ago
Agreed. Even the ex-"Evil Empire" managed to provide decent basic health care for its citizens. Yeah, they couldn't graft a human ear onto a mouse (http://en.wikipedia.org/wiki/Vacanti_mouse http://en.wikipedia.org/wiki/Vacanti_mouse), but at least when I broke my arm or busted my teeth on a bike they never asked my mom how she is going to pay for it, or some insurance company did have to decide to only replace 2 out of 4 of my teeth, because the other 2 would be considered "cosmetic surgergy" or "experimental procedure".
rick888 16y ago
I'm flabbergasted that Europeans won't admit that it's a failing system. Both France and Sweden need to scale back their systems because it's just not efficient or cost effective. I know it's just anecdotal evidence, but everyone I know from Canada that has had to get any major surgery has come over to the US. The reason? the waiting list is too long (in the years). Most universal health care advocates will deny this, but I just can't ignore it when I've seen it happen so many times. I would rather have a system with no insurance companies that we paid for ourselves. This way, Doctors would be forced to charge affordable rates.
- galactus 16y ago
  > Both France and Sweden need to scale back their systems > because it's just not efficient or cost effective. What? Both countries have amazingly cost effective health care systems!
  - m_myers 16y ago
    And now that both sides have made mutually contradictory and equally unsupported statements, I believe the first round is a draw. Galactus will have the honors in the second round. Proceed, gentlemen.
    - arethuza 16y ago
      It's fairly easy to find supporting information for the galactus view e.g.: http://ucatlas.ucsc.edu/spend.php http://ucatlas.ucsc.edu/spend.php
      - jbooth 16y ago
        And frankly, it should be common knowledge that western europe has better/equivalent outcomes at less than half of our cost (very round figures to sidestep the nitpicking), meaning, at minimum, they're getting at least twice the value per cost that we are, and that's rounding every number in the direction that's unfavorable to europe. I could argue that let's just copy the system within europe that works best and we can go for 3x. Unfortunately, doing things that have been empirically borne out to work doesn't seem to be on the agenda these days.
mtviewdave 16y ago
I'm curious: you are aware that a universal health care law passed in the U.S. last year, right? Its goal was to make this statement no longer true in the U.S.: >If you have the wrong medical profile, you could be simply uninsurable. That’s how a free market works. by January 1, 2014. Given that health insurance systems similar to the one the Affordable Care Act sets up do provide universal insurance in other countries, it seems that the ACA has a good chance of doing what it's promised to (though I'm sure it will require tweaks and adjustments in the years to come). But regardless, a conversation about health care in the U.S. that doesn't even mention the ACA seems to be rather pointless.
spenrose 16y ago
The reason is race: http://www.kff.org/healthreform/upload/7871.pdf http://www.kff.org/healthreform/upload/7871.pdf and many others. Search for "Truman health care reform". As in many other democracies, America's right wing party is a coalition of the military, established business, the religiously observant, and what you might call resentful rural folks (who unlike the other factions exist in enough numbers to make an electoral difference). But uniquely among rich democracies, apartheid is a living memory here and still a core political differentiator. That means that anytime established business opposing something, they can get traction by implying that it's a plot to help "them". Those who mocked the grandfather who demanded that his Congressman "keep your government hands off my Medicare" for ignorance miss the point. He meant "keep Obama's black hands off my Medicare."

pragmatic 16y ago

I think it's been an issue, but not that big of an issue (in voter's minds) until recently. Many of the voting blocks are already covered. Low income people have medicaid, seniors have medicare. Many people working a full time job have employer sponsored health plans. Health insurance costs are rising. It's harder to find a cheap plan. Pre-existing conditions really screw you as far as decent coverage. I'm not sure what the answer is at this point. The US is almost broke, we might not have a choice. http://esr.ibiblio.org/?p=3035 http://esr.ibiblio.org/?p=3035

aaronblohowiak 16y ago
Military spending.
jbooth 16y ago
Yeah, and it's brilliant, because the gov't is on the hook for poor people and old people, aka unprofitable insurance subjects, while the private industry scoops up profits on the rest. And before some conservative comes in telling me that insurance profits aren't that high as a % of revenue, % profits on a pass-thru payment system are not the same thing as % profits on actually building something. I saw a statistic (can't place it now and don't feel like googling, so grain of salt) that we actually have comparable government spending per capita on healthcare to some western european countries, and that's just for medicare/medicaid, without even covering everyone. No generic drugs + byzantine public/private payment systems + highest-risk populations = lots of money.
- yummyfajitas 16y ago
  % profits on a pass-thru payment system are not the same thing as % profits on actually building something. Could you explain this claim?
  - jbooth 16y ago
    In one sentence, IMO of course, passing something through should be much cheaper than actually building something or adding value unless you're bilking people. In another sentence, insurance companies don't administer care, they just move money around. Compare to the overhead as a % of revenue for the social security administration, for example. They're a simpler passthru so it's not a completely fair comparison but insurance is closer to SS than it is to manufacturing.
    - barry-cotter 16y ago
      passing something through should be much cheaper than actually building something or adding value unless you're bilking people. The amount someone gets paid for doing something depends on how much value they capture, not how much they add. In most cases where all parties contract freely, you can't capture more than you add, but anyway _Value added and paid are often wildly out of whack_ "Bilked" is a moral judgement. If you're saying you think insurance is unjustly fair then since that's a fact about you not about insurance, sure it can be true. But it's like "profiteering", a moral/political statement, with no economic content.
      - jbooth 16y ago
        Adam Smith would differ with you, in the ideal case. Value capture and rent seeking aren't how capitalism are supposed to work. Heck, if that was the best capitalism could do, I'd be inclined to try communism.

reader5000 16y ago

Basic racial politics. Welfare queens and all that jazz.

rdtsc 16y ago

Agreed. Even the ex-"Evil Empire" managed to provide decent basic health care for its citizens. Yeah, they couldn't graft a human ear onto a mouse (http://en.wikipedia.org/wiki/Vacanti_mouse http://en.wikipedia.org/wiki/Vacanti_mouse), but at least when I broke my arm or busted my teeth on a bike they never asked my mom how she is going to pay for it, or some insurance company did have to decide to only replace 2 out of 4 of my teeth, because the other 2 would be considered "cosmetic surgergy" or "experimental procedure".

rick888 16y ago

I'm flabbergasted that Europeans won't admit that it's a failing system. Both France and Sweden need to scale back their systems because it's just not efficient or cost effective. I know it's just anecdotal evidence, but everyone I know from Canada that has had to get any major surgery has come over to the US. The reason? the waiting list is too long (in the years). Most universal health care advocates will deny this, but I just can't ignore it when I've seen it happen so many times. I would rather have a system with no insurance companies that we paid for ourselves. This way, Doctors would be forced to charge affordable rates.

galactus 16y ago
> Both France and Sweden need to scale back their systems > because it's just not efficient or cost effective. What? Both countries have amazingly cost effective health care systems!
- m_myers 16y ago
  And now that both sides have made mutually contradictory and equally unsupported statements, I believe the first round is a draw. Galactus will have the honors in the second round. Proceed, gentlemen.
  - arethuza 16y ago
    It's fairly easy to find supporting information for the galactus view e.g.: http://ucatlas.ucsc.edu/spend.php http://ucatlas.ucsc.edu/spend.php
    - jbooth 16y ago
      And frankly, it should be common knowledge that western europe has better/equivalent outcomes at less than half of our cost (very round figures to sidestep the nitpicking), meaning, at minimum, they're getting at least twice the value per cost that we are, and that's rounding every number in the direction that's unfavorable to europe. I could argue that let's just copy the system within europe that works best and we can go for 3x. Unfortunately, doing things that have been empirically borne out to work doesn't seem to be on the agenda these days.

mtviewdave 16y ago

I'm curious: you are aware that a universal health care law passed in the U.S. last year, right? Its goal was to make this statement no longer true in the U.S.: >If you have the wrong medical profile, you could be simply uninsurable. That’s how a free market works. by January 1, 2014. Given that health insurance systems similar to the one the Affordable Care Act sets up do provide universal insurance in other countries, it seems that the ACA has a good chance of doing what it's promised to (though I'm sure it will require tweaks and adjustments in the years to come). But regardless, a conversation about health care in the U.S. that doesn't even mention the ACA seems to be rather pointless.

spenrose 16y ago

The reason is race: http://www.kff.org/healthreform/upload/7871.pdf http://www.kff.org/healthreform/upload/7871.pdf and many others. Search for "Truman health care reform". As in many other democracies, America's right wing party is a coalition of the military, established business, the religiously observant, and what you might call resentful rural folks (who unlike the other factions exist in enough numbers to make an electoral difference). But uniquely among rich democracies, apartheid is a living memory here and still a core political differentiator. That means that anytime established business opposing something, they can get traction by implying that it's a plot to help "them". Those who mocked the grandfather who demanded that his Congressman "keep your government hands off my Medicare" for ignorance miss the point. He meant "keep Obama's black hands off my Medicare."