The "truth" about universal health care

[AuntiePinko]

Dear Auntie Pinko,

I know the state of our health care here in America is a mess. We have 40 million people uninsured—more or less. The cost of health care is skyrocketing. I have read heartbreaking stories of people going bankrupt trying to pay enormous medical bills. I keep saying that there must be a better way.

To me universal health care is the answer but conservatives always scream that universal health care is "socialism" and that socialized medicine never works. I have heard right-wing talk show hosts denounce universal health care as a recipe for disaster and they always have someone call in who states that they once lived in Britain/Norway/Canada— (take your pick)—and that the socialized health care there is "horrible". They talk about how it takes "years" to have surgery done and that the people in those countries "hate" their health care system and come to America to get treatment.

So what is the real story? Are the people the people in places like Britain miserable because they can't get the surgery they need due to the long waits or is it all BS? I'd really like to know what the truth is.

Thanks

Rick
Middletown Pa


Dear Rick

I am pretty sure that if talk radio hosts in a country that has “socialized medicine” were to discuss on the air the advantages of changing to a private-sector market-based health-care system, there would be plenty of people available to phone in and talk about having lived in America and how the health care here is “horrible.” And the horror stories they could tell would be as bad or worse than whatever you hear on American talk radio about “socialized medicine” countries. Truth, in a debate like this, depends on your perspective.

Auntie Pinko firmly supports a single-payer health care system regulated by government oversight, and universally available to everyone.

That said, it is a fact that such systems are neither as flexible, nor as responsive, nor even as successful, as the very highest level of America’s market-based private sector health care system. People do have to wait for some types of care that are instantly available here in America—if you can pay for them, or work the system to get them without the money up front and then go into bankruptcy or spend years in debt paying for them.

But irksome as those waiting lists may be, in “socialized medicine” countries, there are no waiting lists for emergency care your child needs when she experiences a painful, life-threatening asthma attack. And your mother need never choose between paying the heat bill and buying her life-sustaining medications. You may have to wait months, maybe even years, for that knee-joint replacement surgery, but if you fall down the stairs and break your leg, there will be no waiting to get the bone set, a cast applied, and pain medication dispensed—and no bill, either.

Those who worry about the implications of single-payer health care plans do have some valid points to make, and we should not dismiss them out of hand. There is less incentive for some kinds of medical research and development, and sometimes even a cost-based dis-incentive for the kinds of experimental processes and pilot studies that pioneer new treatments—sometimes life-saving ones. The systems are always costly, and they are often maddeningly bureaucratic and sometimes dangerously inefficient.

And there’s no other way to put it—they prioritize some types of care over others. The trade-offs can be agonizing for individuals, and their families who are denied some kinds of care—such as extreme life-extending and palliative care for increasingly fragile elderly parents and grandparents. A health care system funded by the public purse may have to make ugly choices about one more round of incredibly expensive cardiac repair for 75-year-old Grandpa, as opposed to an incredibly expensive corrective surgery for 2-year-old Baby, born with congenital bone abnormalities.

It’s much easier for us to leave that decision to a “market” that decides based on their ability to pay: If both are from wealthy households, both might get what they need. But if both are from poor households, neither is likely to get what they need. No one likes the thought of trusting the government to make such decisions.

But here’s the thing: We are the government, we control the government. If we want Grandpa and everyone like him to have free access to that life-extending expensive care, we can make that choice and raise our taxes to pay for it. At some point, we will have to have the wrenchingly painful public discussion of priorities and what we all, collectively, want to pay for—both for ourselves and our neighbors, since we are all in the same boat.

And that is why so many people don’t want to have the discussion. Those who benefit from a system where you can get anything you can pay for or go into bankruptcy or debt for, don’t like the idea of sharing a same system with those of us who cannot access such a system because we have neither the cash nor the credit required. Because the same limits, the same priorities, would apply to everyone.

Oh, the very wealthy would certainly be able to go somewhere and get whatever they wanted—money will still buy anything in this sad world. But the large number of people who imagine that, if they were really in a tight spot, they could make the system work for them somehow, are wary about accepting those limitations.

And we should be honest about how huge a sector of our economy is supported by people who are willing to pay for care that they don’t really need: Plastic surgery. Weight loss. Erectile dysfunction. Escaping the natural consequences of aging and unhealthy lifestyles. If a single-payer system were to prioritize those things very low, and have long waiting lists, no public subsidies for the technical specialists to train themselves, no public money poured into pharmaceutical research, there would be a major, if temporary, economic dislocation.

I like to think that in the long run, that economic dislocation would be alleviated by public investments in researching better preventive care, finding alternative therapies for chronic conditions that require costly extreme interventions, and the overall effects of having better health care easily accessible for everyone. But it would be a rough ride.

And that’s the truth. Thanks for asking Auntie Pinko, Rick!

[Katherine Brengle]

1. I think this is the best piece on universal healthcare I've seen yet.

Kudos, saving this to pass around in the morning.

[Pharaoh]

2. Thanks Auntie Pinko!

:toast:

[Viva_La_Revolution]

3. you nailed it...

the pro's and con's. Thanks!

[muriel_volestrangler]

4. Seems a good summary

I live in the UK, and there are decisions about funding priorities which always go against someone. There can be bad bureaucratic decisions made (eg an inappropriate target is set, which diverts work away from an area it would be more useful), but basic treatment is there for everyone.

[TygrBright]

5. It's not *government* bureaucracy I worry about...

>>The systems are always costly, and they are often maddeningly bureaucratic and sometimes dangerously inefficient.<<

Is it even possible for ANY government bureaucracy, however tortuous, illogical, and inefficient, to be worse than the outright malicious and intentionally ineffective bureaucracy of private-sector "managed" care?

pithily,
Bright

[starroute]

6. The one aspect that isn't being discussed here is risk

Universal health care functions as a kind of insurance. It spreads the risk around. It removes the possibility of falling out the bottom entirely -- say by dying or going bankrupt -- at the cost of removing certain top-end advantages. That trade-off can be examined rationally, as Auntie Pinko has done so eloquently. But there's another, more philosophical aspect underlying the debates about health care -- and that is the role of risk itself in human life.

The conventional free market types tend to see risk as a good thing -- an incentive for people to keep on their toes and strive to get ahead. That's partly because they're working off a social Darwinist model of society -- survival of the fittest and the unfit fall by the wayside -- which is why they also tend to be against social security, welfare, and anything else which reduces that incentive. But I think another factor is that those people are generally high achievers themselves, who thrive on risk and challenge and don't understand why everybody can't be like them.

The anti-risk position has generally been expressed from a hippie-ish point of view -- that risk creates anxiety, leads to misplaced priorities, and keeps people from fully engaging with life. But that position has always had a certain amount of wistful thinking behind it -- as well as being vulnerable to the claim that the European nations have been stagnant and decadent since World War II because of their social welfare systems. (A claim that isn't necessarily true but has seemed plausible enough to have traction, especially in the US.)

Lately, however, I've seen signs of an interesting third position developing in the form of the argument that our present health care system (combined with our onerous bankruptcy laws) discourages innovation and entrepreneurship because it causes people to stay with safe jobs instead of setting out on their own to patent that great idea and start manufacturing widgets in their garage. And that since economies grow at the edges, this high a level of risk is in itself a recipe for stagnation.

This argument is significant, in part, because it is aimed directly at the free enterprise types, while incorporating aspects of the hippie-creativity take on things. But it also opens the way to a more general discussion of the role of risk in human life (and evolution.) When does risk encourage innovation and achievement? When does it work against it? How much risk is too much, how much is too little, and how much is just right?

Human beings are constantly making these kinds of calculations. They are so central to the way we approach things that they are built into most of our games. And any social or economic system that works along with them is going to get a lot further than one that tries to ignore or frustrate them.

Risk management is essential to modern capitalism. The corporation was invented on the basis of limited liability -- the concept that you could invest in an enterprise and risk only the amount of that investment, so that even if the corporation went belly-up, you wouldn't lose your shirt. Insurance is another way of spreading risk around so that no one loses more than they can afford.

The tools for keeping risk at manageable levels are already there in the structure of free enterprise -- but somehow ordinary citizens are not seen as being entitled to the same degree of control over their own lives as businessmen and investors. Instead, they're treated by the system as raw materials to be exploited in whatever way will maximize profits.

If the conservatives are serious about this being an "ownership" society, they will have to acknowledge that for most people, "ownership" means not the house they might buy some day or the retirement fund to which they entrust their savings, but ownership over the assets that are most crucial to them -- their own health, their own lives, and their own futures.

One of the greatest flaws in private health insurance is that you don't "own" anything. You can pay thousands ever year for decades, but the moment you lose that insurance, it's all gone. You never actually owned it -- you were only renting. With universal health care, on the other hand, you as a citizen have a permanent stake, and no one can take that away from you.

The key here is the phrase "as a citizen." Private ownership may be fine for the rich -- but for those of us who are less than wealthy, it isn't sufficient. For the poor, it isn't even adequate to handle day-to-day necessities. For the middle class, it isn't sufficient to overcome crises. Some sort of collective ownership is essential -- but the real question is what form that is to take and how to make it work.

[bvar22]

7. How many Democrats support "Single Payer Universal HealthCare"?

AFAIK, Among those running for President 2008, ONLY Dennis Kucinich supports Medicare for ALL!

Beware of Democratic Contenders selling a package of HMO and Insurance Company subsidies copuled with MANDATORY Health Insurance and calling this obscenity "Universal HealthCare".

The Democratic Party is a BIG TENT, but there is NO ROOM for those
who advance the agenda of THE RICH (Corporate Owners) at the EXPENSE of LABOR and the POOR.

[eridani]

8. On the subject of innovation--

--may I point out that for the three most important and useful medical innovations of the 20th century--insulin, penicillin, and the polio vaccine--earned NOT A SINGLE DIME for their inventors/discoverers? So much for the notion of profits being essential to innovation. Real producers are far more interested in invention than in the process of blocking access to their inventions without hefty tolls. They'd much rather be able to write their own funding tickets for their next project.

[Vidar]

9. Couldn't agree more, AuntiePinko.

[Swagman]

10. we have universal health care in Australia and everyone loves it

..any politician who has tried to close it down has been kicked out of office...even the odious John Howard (Barak Obama basher) who hates socialised medecine doesn't dare touch it. Once it's in--it's in forever..which is why the big drug companies and private health care fight tooth and nail to keep it out.

For all it's problems..it's the very best thing to have.

[uberllama42]

11. Actually, I've heard that the Netherlands is switching back to private health care

No one has been able to tell me why the could possibly want profit-driven medicine back. For a while I thought that their economy must be far less corporate-driven than ours in America, but then I read that they are now a tax shelter as well. Seems to me like they're trying to set up a corporate capitalist dystopia. I don't want to judge hastily, because I haven't read that much about it, but my imporession is that that's where they're headed.

[Bob_in_VA]

12. Socialized medicine

If I understand this, "socialized medicine" refers to a system where everyone's tax dollars are used to pay for universal medical care. This is supposed to be bad... yet we do this routinely in the areas of police and fire protection. Has anyone heard complaints from the right wing about "socialized law enforcement"? Me neither.

[ninkasi]

13. Good point...

Welcome to DU.:hi: :hi: We also use tax dollars to subsidize profitable corporations, and get no benefit from that. Our current system is one that is generous to the wealthy, and cruel to the poor and ever shrinking middle class.

[Karenina]

14. A system where 12-year-olds DIE

for the lack of dental care...

[nxylas]

15. I used to live in Britain

I'll tell you now that the only Britons who would give up their National Health Service for an American-style private system are Thatcherite relics who care more about ideological purity than whether the system actually works. Even Thatcher herself knew that to privatize the NHS would be electoral suicide, much as she would have loved to.

[TrogL]

16. I live in Canada - emergency! a friend had his appendix removed

I'm paying the bills.

The cost so far (in loonies)

Health care insurance premium - $88.00 (family rate) (http://www.health.gov.ab.ca/resources/resources_statsfacts.html)

$5.00 - gas to drive various relatives to hospital
$6.00 - pop from vending machine to keep kids entertained
$4.50 - candy (see above)
$5.95 - magazine to keep patient entertained

He'll probably be in about a week, maybe less, so I'm putting the total cost (not including premium) at about $55.00.

What would be the equivalent in the states for the typical guy (ie. no health insurance)?

(on edit)

Oh yeah, waiting time? He was holding things up because he wanted a priest's blessing before he went in for surgery.

[reprobate]

17. There's another possibility. A combined system.

A Universal Single Payer system for the large number of illnesses and surgeries that most people need. The emergency procedures that life and health depend on. Also the normal well patient care that keeps us healthy.

Then combine that with the insurance carriers to write those policies that will cover those things that we as a society will not agree to finance. Things like cosmetic surgery for purely egocentric reasons, and weight loss surgery.

These policies could be inexpensive because they would be underwritten like the current individual policy today. Underwriting would base the premium on individual factors.

[thinkbridge]

18. status quo is worst case scenario

Whatever the downside of government-aided medical care may be - and I believe "socialized medicine" can be a misleading term - people in countries that have it are generally, overall, healthier than people here. Besides, those who can afford it will always get better health care anyway. But government-aided systems create a "zone" where the poor or lower-income working people - some of whom work VERY hard and deserve a break - can get SOME kind of health care.

As it stands, I know lots of people who can't get anywhere near normal health care, and are going through life with such things as bad teeth, no checkups except for pregnancy, and over-the-counter generic meds - until some crisis brings them to the brink of death. In these cases, ANY even bureaucratically mismanaged health care (and that's just theoretically) willl work out better than waiting for some "point of light" to magically appear and save the day.. It's like investing in the lottery for your retirement.