why should us change to UHc?

[teflep]

This is one area my cold conservative heart could shift, but I have many questions/concerns. So, lay it on me....why should we? How funded? What happens to the insurance jobs? NPR was discussing this on my way in this morning so it has resurfaced for me. I have concerns about access, especially for non-emergency procedures, but maybe there is a country that has addressed this?

[Deleted]

I don't know how it would be funded or administered. I'd leave that to those with expertise in the area.

But ultimately, I support UHC because, as I've explained before, healthcare is too different from other needs to left to the market.

Willie Poorboy and Richie Rich both need a place to live. Willie can share a studio apartment with his brother. Richie can buy a mansion. At the end of the day, they both have a place to sleep. Willie can eat canned tuna while Riche eats fresh lobster. Willie can ride his bike or take the bus to work while Richie can have his driver take him to his financial planner's office.

But when Willie gets sick, he needs the same care as Richie. Willie can't just get weaker chemo treatments or less of his appendix taken out. They need the same treatment. Insurance doesn't really solve the problem, IMO, because Willie can't afford to pay for the same insurance coverage as Richie. But again, when he needs medical care, he still needs the same medical care.

[Deleted]

Also, I will add that healthcare is different from the other needs that I mentioned because of the level of professionalism needed to administer it.

Now, I know that there are problems with inexperienced people operating charities, but at the end of the day, it is much easier to open a meal program or a homeless shelter than a free clinic. I mean, it might not be the best use of resources or most effective program, but still, without any specialized skill, I could open up a meal program for the hungry. I am capable of renting a space, buying plates and utensils, buying or soliciting donations for food, and hiring or finding volunteers to serve the food. Or I could pack a cart full of food and go hand it out to every homeless person I see. But I cannot start providing medical care to those who can't afford it, no matter how much I might care about them.

[lys]

Not a fan of UHC.
We have a free clinic in our community for those who fall between the cracks and cannot afford medical costs. Physicians, PAs, nurses and other clinic staff are volunteering their time (rotating basis).

You need to meet heath department standards in order to feed people -- and that can be a bigger hasstle

[Deleted]

Sept 10, 2012 11:59:00 GMT -5 lys said:

You need to meet heath department standards in order to feed people -- and that can be a bigger hasstle

Wait wait wait, are you implying that meeting health department standards is a bigger hassle than providing MEDICAL care? LOL. I've worked in restaurants. I'm pretty sure I could figure it out. Yes, meeting health department standards can be a pain, but I'm pretty sure getting a medical degree is slightly larger hassle.

And I'm pretty sure I don't have to meet health department standards to just start handing out granola bars to homeless people.

[Deleted]

i get the sense that in countries like England that have UHC the quality and availability of care is dependent on your zip code the same way the quality of schools in the US is based on zip code and relevant affluence.

My ILs have received wonderful care through the NHS including a liver transplant a few years ago, but I think their NHS council is a fairly affluent whereas I read about shortages and backlogs in poorer parts of the UK like the north.

[teflep]

I get the human aspect of all should have access but where are all our UHc supporters? Dangit, does my heart remain cold now?

[ladybrettashley]

UHC does not have to mean a dramatic change to Canadian-style single payor (although that's what I would prefer).

The Swiss model is probably the most similar to what we could achieve in the U.S., but since it still relies on private insurers, it is one of the most expensive of all the UHC models (still much better than the U.S.).

I think both liberals and conservatives are in favor of disentangling health insurance from employers, conservatives for the competitive and entrepreneur aspects, liberals for the equality issues, but I think that would be the biggest stumbling block to having a true UHC 'system.'

No matter which type of UHC system you choose, it has to rely on either the government (socialism!) or mandates (loss of freedom!), or it won't truly be Universal.

[MrsAxilla]

Sept 10, 2012 12:22:12 GMT -5 teflep said:

I get the human aspect of all should have access but where are all our UHc supporters? Dangit, does my heart remain cold now?

You know, I've been sitting on my ass for almost a year, and you ask this question during one of the busiest weeks I've had. Also, I've been trying really hard to come up with a succinct, well-reasoned argument complete with citations, but I've been busy and I'm out of practice.

I suppose for me it comes down to this:
1) the purpose of our government, as a constitutional construct and (in theory) a nonpartisan entity, is for the "general welfare" of it's citizens.
2) the purpose of corporations and businesses is to make money via the free market.
3) corporations and businesses are by definition non-altruistic. If they were altruistic, they would organize as non-profits.
4) our health is too precious and too unpredictable to be a commodity on the free market and subject to the most profitable course of action.

By way of background, I lobbied on behalf of hospitals, healthcare facilities and providers to the legislature, on matters related to insurance specifically. I worked for a medical school, and lobbied on behalf of them, as well. I have lots of anecdotes and first-hand accounts of how the healthcare system actually works (and a bunch research buried in my basement).

In the end, it comes down to this: we all have to pay our student loans, feed our families, and make ends meet. Some of us would also like yachts and vacation homes and other trappings of wealth. The current system - which relies on the free market and is motivated by profit - encourages fraud, abuse, neglect, and poor quality of healthcare - all in the pursuit of profits. The current system allows corporations to gamble with our precious and irreplaceable health in order to make more money.

The government, on the other hand, is motivated to provide for our general welfare. (This is where we get sidetracked by an argument about the corruption and greed of the individuals who make up 'the government'. But let's leave that aside for now).

If you look at the government run healthcare programs (Tricare, Medicare, Medicaid, and the VA), you'll find that they are efficient, have good outcomes, and their patients and healthcare providers are generally satisfied. (This is where we get sidetracked by an argument that Medicare is going bankrupt and is completely unsustainable, and that lots of providers won't take Medicare. True - EXCEPT THAT this is purposeful. It is set up to fail financially, no matter how well it performs. If you want cites for that, you'll have to wait until my temp job is over. Regardless, if America is truly awesome, we could address those problems).

I believe that the success of the gov't run programs is because they are meant to provide for the general welfare (inherently altruistic); not to make profits. Profit-driven systems work best with stable, fungible goods - not precious, unpredictable, irreplaceable things like our health. Ergo, in the end, I'd rather my health be at the hands of an inherently altruistic entity that I have a semblance of control over (via my vote) then a profit-driven system who is by definition not altruistic and I have no power to control.

Virtually every westernized country has UHC - to varying degrees of cost and success. Surely, if America is so exceptional, we can take the best from the examples we have, work to avoid the pitfalls that other countries have faced, and create a system that takes care of its citizens, while providing jobs and security for all of us.

But I'm a flaming hippy commie pinko, so there's that.

[Deleted]

Sept 10, 2012 12:08:14 GMT -5 @septimus said:

i get the sense that in countries like England that have UHC the quality and availability of care is dependent on your zip code the same way the quality of schools in the US is based on zip code and relevant affluence.

My ILs have received wonderful care through the NHS including a liver transplant a few years ago, but I think their NHS council is a fairly affluent whereas I read about shortages and backlogs in poorer parts of the UK like the north.

To an extent that would be true in Oz as well, but no one will ever deny payment for any of my pre-exisiting conditions, it doesn't even get brought up (although there are a few instances it might if your new to the private system for example). For me I don't know if you can "fix" what's wrong with the US system, cost of education and other factors play into it as well. I can't see myself ever living in the US again due to my health and the fact that I would have trouble with insurance (I have had collegues with no health issues move and have issues). For me that's just sad.

[Deleted]

I don't have time to write much now, but I wanted o say that UHC doesn't have to be more expensive. Canada spends less than the US (per capita) to treat more. The biggest reason, iirc, is becase of the admin costs in the US related to the clusterfuck that is the insurance companies, billing, etc.

I don't think you should ever trust a private corporation, whose goal is to PROFIT, not save a life, with your medical needs. It is thir job to deny coverage. The govt won't do that (although I do find in the US people have such distrust of the govt).

Our system isn't perfect, but it's cheaper overall, and more people are covered. I think (hope?) the US could take the best features of a number of systems (swiss, Germany, england, oz) to make a truly workd-class system.

[basilosaurus]

As a quick answer, if I think about insurance companies and their profits, that's all being taken away from healthcare. Add in the costs on both sides of dealing with insurance claims/denials just from the staff side, and you have even more money taken away from direct care.

So, from a standpoint of controlling costs, it seems, to me, fairly obvious that having a profit making middle man is a major problem.

[SusanBAnthony]

Anecdotes! I used to oppose UHC. I had always had great insurance (my dad worked for universities and my mom for hospitals) and my first job out of college was for a huge company that offered great insurance. Plus, in MN insurance companies are required to be non-profits. I just thought everyone with a job had that.

Then I quit to stay at home. DH worked for a small company with bad insurance, but whatever, we could afford it (barely- and we are probably upper middle class). Then he got laid off. He immeadiately got a new job (never miss a paycheck, woot!) as a consultant. Our COBRA was 1500$ a month. It was going to run out soon, and we started looking into independant insurance. We couldn't even get through the applications! They wanted every.single.visit that each of us had had for the last five years. And I knew, from conversations on here, that if we missed a single thing, they could yank our insurance at any point.

We moved xcountry to a new job in a new state, and 95% of the reason is so that we could get insurance. That is just crazy. That is not acceptable.

If insurance is this difficult for someone with a household income like ours, how in the world can someone with an income of 30k possibly hope to get medical care? Everyone is all free clinics!!!! Eleventy!!!!! I don't know what magical city has magical free clinics that people can effectively use, but the one experience I have is when DH was a grad student with no dental insurance, making maybe 20k a year, which was low enough he could qualify for food stamps, fwiw. He paid OOP for cleanings but couldn't afford to get cavities filled. He went to the free clinic and it was open for a few hours once a month. They triaged, and only ever got to people who were in extreme pain- they were never going to get to him until he his tooth was rotting out of his mouth. He put it on a credit card on the expectation of future income, but most people don't have choice (or they do it anyway and file bankruptcy due to medical bills).

[aurora]

Some of the other posters have covered a lot of it, but I'd like to add that a universal system that covers a person from birth to death has a lot more incentive to cover preventive care well (since presumably it would lead to fewer large bills down the line). In the current US system, many people switch jobs every 5-7 years, and many companies switch health insurers even more frequently (esp. for mid-size companies with big bills but less bargaining power this is one of the easiest ways to keep costs from rising astronomically). If an insurer knows they'll only be covering a person for an average of 3-4 years, there is absolutely no incentive to do anything except deny and push the costs on to the next insurer.

I know lys won't come back to play, but I am laughing that she thinks it is just poor people who fall through the cracks and that having an urgent care clinic available to them is somehow comparable to having a regular PCP and comprehensive, ongoing care.

[shouldbworkin]

My sister lived overseas for 5 years and had UHC. They still had insurance companies. there was basic care and then you could add on extra insurance. So, I don't worry too much about the insurance industry.

[ringstrue]

I am for it. I am not for one specific model.

Financially, it is apparently cheaper than what we are doing now when you factor in how states end up paying the hospital bills. Ofcourse, if we ever raised taxes, or just stopped giving tax breaks to certain groups who wouldn't be teetering on the poverty line without them, the finances would be even more available. Zoe could speak on this way better than I. Where is ZOE!?!??!?

The poor would be WAY better off with it - to the point where, imo, there wouldn't be such a push to raise the minimum wage all the dang time, and where they now had more funds available to them to take care of themselves and their kids, pay for daycare, etc.

To be freakanomics-ish for a second, one of the poor's biggest financial issues is trying to raise kids they often did not plan for. I just wonder, if you handed out IUDs virtually free of change - or some other form they don't have to think about every day - What would happen after say, 30 years? Would it be like that scenario where crime drops for seemingly no reason? What would they other benefits be to society??

As for jobs, the way I understand it, you are taking about the same roles under private ins. companies now being needed as govt. jobs. Ofcourse they may become only contract jobs, but with UHC that's hardly the same concern it is now. The only difference may be less salesmen jobs, which sucks. My comfort in that is that most salesmen do not sell the same thing their entire careers and many are used to diversifying what they sell.

Small businesses and sole proprietorship's would/could soar in this scenario. To get on my soapbox for a second: right now, we are in this situation in America where it's easiest to "sell out." It should naturally be easiest to do things the simplest way. The simplest way to get food is to grow it. The simplest way to get something is to make it. The simplest way to work is to be a contractor or sole proprietor. But right now, those are the HARDEST ways to go about getting food, getting what you need, and having a good job with healthcare, retirement, ability to take time off, etc. They are the most expensive, most time consuming, and require the biggest learning curve. Its tons easier to become an employee and just get all those things in a nice little package.

UHC, the way I understand it, gives people more ability to weigh the to pros and cons of going on your own or being part of a company. Company perks are about company cars, parties, stock options, bonuses, etc. They should NOT be about whether you can retire or not. They should NOT be about whether you have healthcare or not.

[ringstrue]

I also just don't think "insurance" as a concept can apply well to "health care". It works for cars, because one day you can decided its not worth it and get rid of your car. It works in scenarios where the consumer has the ability to do without. But the consumer is always at an inherent disadvantage with their own health when you are taking about their entire life.

[ringstrue]

Oh yes! Relocation is a huge deal. Not just for families with their jobs, but also the doctors offices themselves. Who wants their practice in a part of town where no one pays on time or simply can't pay? I mean they may have the biggest heart in the world but they have their own bills to pay too. You could see our inner cities improve dramatically in just a few years with UHC implemented.

[mominatrix]

Can I just ditto Axila... because she hit the nail on the head.

Andplusalso - our outcomes aren't better than other countries and are, in fact, coming up to be worse. The latest, a study out of The Commonwealth Fund that Americans are far MORE likely than people in the UK, Germany or France to die of PREVENTABLE conditions. This, despite paying twice what the residents of those countries pay (per capita) for health care.


Here's a news story about the study:

August 29, 2012 | 4:00 PM | By Rachel Zimmerman

Report: U.S. Lags When It Comes To Preventable Deaths
FILED UNDER: Insurance, Medicine/Science, Money, insurance, preventable death
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(Health Affairs)

More bad news for the U.S. health care system. According to a new report by the Commonwealth Fund, America is worst among three other industrialized nations when it comes to preventing avoidable deaths through timely, effective medical care. The problem, once again, is the lack of health insurance, the report suggests. (Things were worse for folks under 65; presumably those over that age qualify for Medicare.)

Commonwealth Fund President Karen Davis is quoted in the news release saying: “Despite spending about twice as much per person each year on health care as France, Germany or the U.K.— $8,400 in 2010—the U.S. is increasingly falling behind these countries in terms of progress in lowering the potentially preventable death rate. The good news is that the Affordable Care Act is already beginning to close the gaps in access to care. When fully implemented, it will cover nearly all Americans, with the potential to put our country on track to improve to levels seen in the best-performing countries.”

From the Commonwealth Fund news release:

The United States lags three other industrialized nations — France, Germany, and the United Kingdom — in its potentially preventable death rate, and in the pace of improvement in preventing deaths that could have been avoided with timely and effective health care, according to a Commonwealth Fund–supported study published as a web first online today in Health Affairs. Between 1999 and 2006/2007, the overall potentially preventable death rate among men ages 0 to 74 dropped by only 18.5 percent in the United States, while the rate declined by nearly 37 percent in the U.K. For women, the rate fell by 17.5 percent in the U.S. but by nearly 32 percent in the U.K.

Compared with people enrolled in individual market plans, a majority of those enrolled in employer group plans have far more comprehensive coverage with less cost-sharing. Most group plans had an actuarial value of 80 percent to 89 percent, qualifying them as “gold” plans to be sold in the exchanges, compared with an actuarial value of below 60 percent for the “tin” plans, according to the study. Actuarial value is the proportion of the medical bill that the insurer pays, compared with what the insured person pays out of pocket in deductibles, co-payments, and other cost-sharing.

In “In Amenable Mortality—Deaths Avoidable Through Health Care—Progress In the U.S. Lags That of Three European Countries,” Ellen Nolte, Director of Health and Healthcare at RAND Europe and Martin McKee, Professor of European Public Health at the London School of Hygiene & Tropical Medicine analyzed amenable mortality trends. Amenable mortality is a measure of deaths before age 75 that could potentially have been prevented by timely access to appropriate health care. The research also looked at death rates for those under 65, as well as deaths between ages 65 and 74 from conditions like treatable cancer, diabetes, infections, and heart disease.

While the pace of improvement was slower in the U.S. for both age groups, the lag was most pronounced among American men and women under age 65, who are more likely to be uninsured and have problems with access to care than those 65 and older, who are eligible for Medicare. By comparison, France, Germany, and the U.K. all provide affordable, universal coverage to their populations regardless of age. “These findings strengthen the case for reforms that will enable all Americans to receive timely and effective health care” said Nolte, lead author of the study.

commonhealth.wbur.org/2012/08/report-u-s-lags-when-it-comes-to-preventable-deaths


When we see profits being skimmed off the top, health insurance CEO's making literally $100M/yr+, and businesses that are in business to deny coverage, how can we possibly think that this is the best system for our physical health??? It may be the best system for the economic health of some, and IMHO, that's the only reason it continues to exist.

[mominatrix]

Sept 12, 2012 8:39:45 GMT -5 ringstrue said:

I also just don't think "insurance" as a concept can apply well to "health care". It works for cars, because one day you can decided its not worth it and get rid of your car. It works in scenarios where the consumer has the ability to do without. But the consumer is always at an inherent disadvantage with their own health when you are taking about their entire life.

The for-profit health insurance company model is frightening, which is why it's illegal in so many countries.


When I'm queen of the world, if I can't force single payer, I'll require all health insurance companies to be Mutuals.

[earlgreyhot]

Thank you Axila. I agree 100%, though I don't have the credentials you do. I'm also pretty pink about these things and don't inherently mistrust the government. I choose to believe that it is setup as a force for good, even if there are many real and valid problems with it.

And SusanBAnthony has me twitching. My husband is thinking of starting his own company and the thought of having to get insurance on our own makes me want to go find a corner and suck my thumb. Five years of office visits?!?!? UGH UGH UGH. We've been pretty proactive about our health, which means they would find all kinds of possible preexisting conditions. Beginning with DH's blood pressure. We've been really, really lucky so far with large group plans that cover everything with no issue.

[MixedBerryJam]

Sept 10, 2012 11:59:00 GMT -5 lys said:

Not a fan of UHC.
We have a free clinic in our community for those who fall between the cracks and cannot afford medical costs. Physicians, PAs, nurses and other clinic staff are volunteering their time (rotating basis).

You need to meet heath department standards in order to feed people -- and that can be a bigger hasstle

What you're saying is that the poorest of the poor are entitled to receive charity. With UHC everyone will be entitled to receive health care. The difference is not just semantic.

[ttt]

And here's a pro-business argument for it: it will allow the US to compete more effectively with other countries. Just look at the auto industry- health insurance/benefits are a huge burden that auto makers in Asia and Europe don't have.

Also, it encourages entrepreneurship. I know several people - in fact, I think mx is one of them - who would love to start their own businesses but can't because they can't afford (or can't even get) health insurance on an individual basis.

The real question is, why NOT go to a universal system? Every other developed nation on Earth has done it. I'm not aware of any of them who are saying "gosh I wish our system could be just like the American system." Most people look at our system in horror, that we live in the richest nation on the planet and have millions of people who can't get basic healthcare or who worry that they can't go to the doctor because they might end up losing their home.