Universal Health Coverage: some ammunition [View All]

[gcomeau]

I often see people floundering a bit when they're trying to advocate for universal health coverage, they know why it's a good thing but they aren't very good at getting the point across. So I figured I'd take a shot at putting together a few suggestions on how to convince people conditioned by decades of "socialism is for commies!!!" scare tactic politics that universal coverage is what they really, really want to happen. The best approach is not to try to overwhelm people with technical analysis, include a few facts and figures to prove you know what you're talking about but you have to get them to look at things from your viewpoint and charts and graphs and spreadsheets aren't going to cut it. Alternatively, just making "it's the right thing to do" moral appeals is not going to convince many people either.

Universal Care vs. Universal Coverage

There is a difference between "Universal Health Care" and "Universal Health Coverage." The goal of the universal coverage is of course to result in the universal provision of care, but try not to muddy the waters by confusing the two. If you talk about the government providing Universal Health Care you put images in people's heads of government nationalizing all the hospitals or something. That is a bad thing for two reasons

1. People don't like the idea.
2. They're actually right not to like it. Bad idea.

Example: Canada. They do not actually have Universal Health Care, they have universal coverage. Health Care is a private industry, the government covers the insuring. This is, IMO, the optimal use case.

The Free Market

To a lot of right-leaning opponents of universal coverage this is the major sticking point. Get them here and you'll have a good chance of winning them over. And it's not even that hard an argument to make really. Just do NOT trash the free market. It's the wrong approach tactically, and it's wrongheaded on top of it. The Free Market is great... as long as let it do what it's designed to do and don't try to make it do things it simply is not intended for. The free market is a wonderful thing. It really is. As long as it is properly regulated to control abuses it is great at driving efficiencies up, managing resource distribution, etc... when it is dealing with commodities. It is NOt true when dealing with insurance. The following is a relatively good example 9I think) to get people to understand this:

Sun Screen

Let's say I sell sun screen. The market provides all kinds of natural regulating forces to push me towards doing this effectively both for myself and for the consumers. I want a good customer base, so I don't focus my efforts in Alaska in December. I go where the need for my product exists. If I don't do that I go out of business and die off. Once I get there I want those people who need my product to buy from me and not my competitors, so I do one of two things:

1. I keep my prices low to remain competitive. In order to be able to do that and still make money I try to maximize the efficiency of my production to improve my profit margins.
2. I make my sales based on superior quality that justifies a higher selling price. I direct my attention towards improving my product.

So the market forces just naturally produce a drive to fill the need for both high quality materials and high efficiency production... and to direct those resources where they are most needed.

Insurance

I now sell insurance. When I was a sun screen salesman I wanted people who needed my product the most to be my customers, because that made me money and was good for business. Do I want people who need insurance the most to be my customers in this business? NO. I will go freaking bankrupt if all my customers actually need what I'm selling them. I don't want to sell a $10,000 insurance policy to someone then have to pay for their $100,000 neurosurgery. I want to sell a $10,000 insurance policy to the healthiest person on the planet who never has to visit the doctor or get medical treatment... who just hands me their money and expects nothing in return. When we're dealing with insurance trying to apply natural market forces to the system backfires... because people selling insurance NEVER WANT THEIR CUSTOMERS TO USE THEIR PRODUCT. It is actually worth it to them to spend money actively avoiding providing services to the people who need it the most instead of spending that money better providing for that need. Which screws the efficiency of the system all to hell too.

So what do we end up getting? Insurance companies taking as much money as they can from healthy people while providing the minimal amount of service they can manage. And sick people having to pay massive amounts of their money seperately to get treatment. It is a system designed to make health care as expensive as possible to the general population.

This is a simple case to make. You just walk people through that easy comparison and it is not that hard to make people understand why insurance is not like other businesses and why it is very poorly handled by private enterprise. Don't get all up in people's face about the "evils of capitalism" or something, you're going to run into a brick wall, and it's a stupid argument anyway. Convince them you understand the benefits of a free market economy, and then show them that insurance just happens to be an exception. Depending on private enterprise to fill a need it is unprofitable to fill is just crazy. Private insurance companies can make very good money, no doubt, but they do it by convincing Alaskans to buy sun screen in bulk... so to speak. Good for the insurance company, sucks for everyone else.

The Budget

The other major hurdle you will usually run into is people who say we can't afford universal health coverage because of the budget deficits.... high taxes... arrrgh run away!!!!

Baloney.

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(The forums really do not like that link for some reason, won't let me make it clickable. Just put an "Http:" in front of it and stick in your browser address bar.)

THAT is what trying to let the private sector handle health coverage has gotten the United States. It costs this country a fortune, because like we just finished explaining when we're dealing with insurance the free market naturally decreases the efficiency with which services are delivered where they are needed. Not only that, but look only at the red portion of those bars. That is the cost to the government alone, public sector expenditures. the U.S. citizens get stuck with all those huge out of pocket expenses, you think that means the government has lower costs so it's easier on the budget and we get lower taxes? Think again. Like we just finished explaining, the need of actual sick people for coverage is NOT largely met by the private sector, they spend all their time and effort avoiding doing that. So what ends up happening? The U.S. government spends just as much tax money on healthcare as Canada does, while it's citizens still fork out way more in out of pocket expenses (that blue part of the bar).

To further illustrate:

http://content.nejm.org/cgi/content/short/349/8/768

The Canadian system spends 1/6th of it's funds on program administration.
The United States? ONE THIRD of all money spent on health care in the U.S. goes to administration. Why? Because every insurance company is paying staff to do nothing but pour over claims trying to avoid paying for care. Every doctor's office has to keep track of 15 different kinds of paperwork from 15 different providers with 15 different claim systems. It's a mess. And it's completely unnecessary.

Logistics

This is the tricky part. The U.S. health care system is SO screwed up that dismantling it and replacing it with a proper, efficient, functional universal coverage system is going to be a painful process. If you try and do it overnight then what does that involve? How many private insurers lay of all their employees and what do you do about them?

What about provider costs? You can't just have providers gauging the government because they know they'll pay for everything. You need to work out a pricing agreement to restrict the maximum cost of services within an agreed, reasonable range. "Yes, you can charge $25,000 for a bypass surgery... no, you cannot charge a quarter million. Manage your costs and payrolls appropriately." That kind of thing.

The logistics of instituting such a sweeping change are the most valid roadblock that needs to be overcome to institute sweeping reform of the system. I won't pretend to know how to deal with it, it's going to be nasty. It's going to slow things down. But it is also not getting any easier the longer we put it off, and it is very necessary.

Those Pesky Anecdotal Arguments

"But my cousin's sister's aunt had to wait for weeks for an MRI in Canada! And my brother's roommates father got one in a day here!"

Yeah, so? Is anyone saying the system is prefect and without flaw? No, I don't believe we are. It is just way the hell better than what the states has now. It will still have it's problems, but they are smaller problems than we face currently. If you give everyone access to medical care is there going to be more strain on the system and probably longer wait times? Yes, obviously. If you prioritize care by urgency and necessity are people looking to have elective procedures going to be inconvenienced sometimes? Yes they are.



Anyway, hope that is of use to anyone who might be in the mood to go try to convince some people that they shouldn't live in fear of "the socialism!!!". I know many here have probably already seen figures like these many times, but it's not just about having the facts on your side. If you can't get people receptive to listening to them, and if you don't take the time to explain them in a way that makes people really properly understand them, then just being right is not doing you a whole lot of good.