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The importance of social trust has had a major impact on my belief in the importance of government-guaranteed tax-funded universal healthcare. Before about 2015

by scythe 6y ago

The importance of social trust has had a major impact on my belief in the importance of government-guaranteed tax-funded universal healthcare. Before about 2015, I thought it was nice, but not a pressing crisis, but around then, I started to notice things like signs saying "why does my insulin cost more than methadone?" and "why is medical marijuana cheaper than my heart disease medication?". These situations might have simple economic explanations in terms of supply-side dynamics, but they are morally infuriating to the same chunk of the electorate who self-identify as conservative capitalists. Not long after, Martin Shkreli appeared. There seems to be a powerful, possibly instinctive, connection between A: being able to turn to someone for help when you're in need and B: considering that someone to be trustworthy. In 2020, we saw this writ large, when the United States became the global epicenter of conspiracy theories about SARS-CoV-2. The general population's trust in the medical system and the government is a huge unaccounted-for externality that can have serious effects on our economic and political stability. Furthermore, one of the most lamented, supposedly idiosyncratic, problems with the US medical system is the sheer amount of paperwork required to do almost anything. It seems like an excellent example of this: >We need to trust the people around us in order to live happy, productive lives. If we don’t trust them, we end up having to find costly ways to formalize our relationships. (Opponents of guaranteed universal healthcare in the United States will generally agree that we do not have a "free" market in healthcare, but it is usually harder to convince them it will never be politically possible in light of the above.)

inglor_cz 6y ago
Czech doctors tend to complain about tons of paperwork, too. We have a public healthcare system with almost universal coverage. There must be an element of "cover your ass" in there. Usually, excess of papers indicates someone's wariness of possible averse consequences down the line.
mikem170 6y ago
I agree with you on calling out the moral absurdities in our health care system, and how that is a reflection on our level of social trust. I'd like to see changes, also. Cynically I would say that politically we have optimized for profit and bureaucracy. Would I be wrong? I'd say that this is because our democracy is imperfect - money, corporations, and corruption are driving too much of our politics. It's always bothered me that so many people would presume to fix health care at the federal level. For a while Congress has been one of the least trusted institutions in the country. Why do we expect them to fix anything? The Affordable Care Act was anything but that, it did nothing to control costs or fix all the pricing transparency problems. Poor folks get a free yearly visit and screenings but have to pay a few thousand dollar deductible when they are sick (money they typically don't have) before they get any covered care, while the government subsidized insurance premiums go right past the recipients directly into the pockets of the insurance companies. I'd be more comfortable seeing something like many of the countries in Europe have, price controls on drugs and simple standards set at a national level, with implementation details, tax collection, and administrative details left to the states or provinces. The states were just starting to innovate before the ACA. Vermont tried single payer. Massachusetts had Romneycare. NY and California we making plans, etc. With the ACA the feds commandeered the whole thing, and didn't do so great a job with it. I think that the states are in a much better position to fix this, but that the insurance companies and other related incumbents would rather have this controlled from a federal level where they can most easily influence the outcome to be in their favor.

by scythe 6y ago

inglor_cz 6y ago

Czech doctors tend to complain about tons of paperwork, too. We have a public healthcare system with almost universal coverage. There must be an element of "cover your ass" in there. Usually, excess of papers indicates someone's wariness of possible averse consequences down the line.

mikem170 6y ago

I agree with you on calling out the moral absurdities in our health care system, and how that is a reflection on our level of social trust. I'd like to see changes, also. Cynically I would say that politically we have optimized for profit and bureaucracy. Would I be wrong? I'd say that this is because our democracy is imperfect - money, corporations, and corruption are driving too much of our politics. It's always bothered me that so many people would presume to fix health care at the federal level. For a while Congress has been one of the least trusted institutions in the country. Why do we expect them to fix anything? The Affordable Care Act was anything but that, it did nothing to control costs or fix all the pricing transparency problems. Poor folks get a free yearly visit and screenings but have to pay a few thousand dollar deductible when they are sick (money they typically don't have) before they get any covered care, while the government subsidized insurance premiums go right past the recipients directly into the pockets of the insurance companies. I'd be more comfortable seeing something like many of the countries in Europe have, price controls on drugs and simple standards set at a national level, with implementation details, tax collection, and administrative details left to the states or provinces. The states were just starting to innovate before the ACA. Vermont tried single payer. Massachusetts had Romneycare. NY and California we making plans, etc. With the ACA the feds commandeered the whole thing, and didn't do so great a job with it. I think that the states are in a much better position to fix this, but that the insurance companies and other related incumbents would rather have this controlled from a federal level where they can most easily influence the outcome to be in their favor.