On 29 January 2019 we saw the first CNN Town Hall for a candidate for the 2020 US presidential election. Kamala Harris, a Democratic senator from California, is one of the more impressive members of what promises to be a huge field.
CNN is reporting the Town Hall had the highest ever viewership for a Town Hall in the 25-54 category.
On 18 February another of the better candidates, Senator Amy Klobuchar (D) from Minnesota, had her first CNN Town Hall.
Yesterday, it was the turn of Bernie Sanders (I-Vermont). It’s thanks to Bernie’s 2016 campaign that universal healthcare is finally under serious consideration in the US. He has advocated for this his whole career, and when the US finally takes it up, he will deserve much of the credit.
There’s clearly already a lot of interest despite the election being almost two years away.
The 2020 Election
One of the main reasons for this interest is the state of the Democratic Party itself. The Overton Window is shifting so that policies that would once never be under consideration are now considered more mainstream.
In my opinion, the most important of these is the question of universal, single-payer healthcare. Universal healthcare is not a radical idea. Every other industrialized nation (and more besides) has universal healthcare. There’s a good reason for that – it makes sense.
So far, Democratic candidates are focusing on the fact that access to healthcare should be a basic human right. They also frequently note that every other OECD nation else has universal healthcare.
These points are true of course, but I’m not sure they’re arguments that will attract the independent and centre right voters the Democratic Party needs to win the presidency.
Universal healthcare is good for the economy. It will save a country the size of the US trillions, and there are plenty of places that money could do a lot of good. I think they need to talk more about that to attract those independent and centre-right voters.
The 2020 Election and the GOP
The GOP has made the announcement that Donald Trump is such a great president they will not have a primary. The level of delusion in that statement alone shows just how out of touch they are. Trump won because he was able to reach out to many who felt that politicians didn’t care about them. Now that he’s president, his actions are showing he doesn’t care about them either. In fact, he cares even less than the traditional politician.
Whether Trump will win another term is (unbelievably) up in the air at the moment. However, the Republicans are losing the healthcare argument. The Democratic candidate who can come up with the policy proposal that appeals most to voters on universal healthcare is likely to have a strong chance of not only becoming the party’s nominee, but becoming president.
The GOP, Donald Trump, and Healthcare
Donald Trump is a bad messenger for his party on healthcare. In the past he’s given praise to the healthcare systems in both Canada and Scotland. He’s also said he doesn’t want anyone to be without healthcare by using those countries as examples. However, the GOP has done their best to take away healthcare from those who finally got it because of Obamacare.
Trump went out of his way to insult the late Senator John McCain (R-Arizona), whose vote against his own party means Obamacare still exists in the US despite the best efforts of the Republicans. However, they have significantly weakened it.
Also during the 2016 campaign, an announcement that Obamacare premiums would rise saw a slew of footage of Trump lying about the issue. He was immediately out on the campaign trail bemoaning how his own employees were having a “terrible” time “because of Obamacare.” In reality, his employees were not having a “terrible time” at all. He provides the insurance for at least 90% of his employees so the increases had no effect on them.
Trump’s Base
Trump’s base is made up largely of those who are older and less educated than average. Those are the very people who are also, on average, likely to be in poorer health and less likely to be able to afford insurance. As a result, healthcare is a very important issue for them. They are part of the demographic that says in surveys they want universal healthcare.
Trump is proving that he doesn’t care about his base in the way they thought he would when he got their vote. A majority still worship him in a cult-like way, but more and more are starting to see reality. When it comes to voting for Trump or universal healthcare, they may just vote in their best interest.
USians Want Universal Healthcare
I wrote about the healthcare issue shortly before the 2016 election (‘America’s Healthcare Problem‘) and again a few months later (‘Americans Want Universal Healthcare‘).
One of the most important statistics from the second article was one from Quinnipiac University. This is what I wrote:
Since Trump’s election, Quinnipiac University has been asking this question in their regular surveys:
How important is it to you that health insurance be affordable for all Americans: very important, somewhat important, not so important, or not important at all?
The results have been consistent – USians, virtually universally, want EVERYONE to be able to have affordable health insurance:
More recently, a survey in June/July 2018 by Reuters shows 70% of USians support Medicare for all. Within that, 52% of Republicans want Medicare for all.
Cross-hatched lines indicate margin of error. Data are polling of American adults in June and July 2018. Respondents: Medicare for all = 2,989. (Click graphic to go to source.)
Democratic Policy Proposals
Senators Kamala Harris (left) and Amy Klobuchar
Senators Kamala Harris and Amy Klobuchar are at opposite ends of the spectrum within the Democratic party when it comes to healthcare. Harris’s policy proposal is Medicare for all and doing away with private insurance altogether. Klobuchar is to extend the current Medicaid system to more people but otherwise retain the status quo.
I found both Senator Harris and Senator Klobuchar very impressive in their respective CNN Town Halls. I agree with most of their policy positions but I consider both are wrong regarding their proposals for healthcare. In my opinion though, Harris goes too far and Klobuchar doesn’t go far enough.
I agree with Harris on the introduction of Medicare for all in the US (see why below). However, I think abolishing private health insurance altogether is a step too far. That is not actually what most countries with single-payer healthcare do, despite what many on the right in the US assume.
I delayed posting this by a day so I could watch the Bernie Sanders CNN Town Hall in case there was anything new there. As he always has, Sanders proposes Medicare for all. I’m not a fan of The Bern, but I admit he’s much better at explaining the benefits of a universal, single-payer healthcare system. For example, he pointed out that as all doctors are part of the same system, people will, indeed, be able to keep their doctor.
Other candidates will have different proposals. I hope one comes up with one that can appeal to a majority of USians as I think this is the issue this election will be fought on.
Capitalism versus Socialism
Doing away with private insurance altogether is a pure socialist model. I do not consider socialism a valid economic system. It simply doesn’t work because it’s simply not a natural way for humans to live. In those cases where a society has tried to enforce it (communism) it’s been a disaster.
A capitalist system with elements of socialism is the best way to go in my opinion. For example, most of us consider things like a progressive tax system where the wealthy pay a bigger proportion of their income than the poor to be fairer. Again, despite what the GOP thinks, it’s better economically too. Some redistribution of wealth also makes a society healthier in general, and I don’t just mean physically healthier. That makes a society a safer and more pleasant place to be a part of.
It is also better for society as a whole for some things to be under central control for efficiency and cost reasons. Infrastructure, education, law enforcement, courts, and the military are some examples. Most democracies have come to the realization that a single-payer healthcare system is one of the things that works better if it’s managed centrally.
Note that although the US has a socialist system for infrastructure, education, law enforcement etc., that hasn’t meant there are no non-government options. There are still private schools, private security, and privately owned elements of infrastructure, including roads. The same can also be the case with single-payer healthcare, and indeed unless they’re communist, all countries with single-payer healthcare systems also have private healthcare options.
Why Buy Private Health Insurance in a Country with Universal Healthcare?
In a country with universal healthcare, private insurance is significantly cheaper than it is in the US. In New Zealand, those who purchase it do so for four main reasons:
1. They can choose the timing of elective surgery.
2. There are packages that cover items that aren’t covered by the public system e.g. in New Zealand prescription glasses and dental care for adults aren’t part of the public system.
3. They can have their elective surgery in more luxurious surroundings.
4. They can choose which specialist performs their surgery.
The Market Doesn’t Work for Healthcare
The main reason proponents of a capitalist system for healthcare give for supporting it is the cost. They say it’s cheaper and more efficient for the market to handle everything. I agree with the market forces model for many things, but there are multiple reasons why it shouldn’t be applied to healthcare.
There is one main one that trumps all the others. The basic fact it that in reality, people have little or no choice when it comes to health provision. They just do what the medical professionals tell them and pay the bill. Oftentimes, they’re in no condition to make a choice anyway. Even if they’re completely lucid, they’re frequently still vulnerable in some way. Fear and lack of knowledge and just two major factors that are at play in almost all cases.
There are many ways a universal healthcare policy can work. All the single-payer systems around the world are different and none is perfect. This gives the US a huge advantage. They have evidence from multiple systems and can make an informed choice about which elements to implement and how, to best effect.
The Cost of US Healthcare
Given the extra attention healthcare is getting in the US media these days, USians are beginning to become aware that, despite what they’ve been told, their healthcare system is neither the cheapest nor the best.
The only system with a comparable cost to the US is Norway, and they provide benefits I can’t imagine the US even considering. The average expenditure of comparable countries shows health costs in the US are way out of kilter with the rest of the OECD. That’s why I said above the US could save trillions on healthcare. And that’s despite covering tens of millions more people.
For their current high expenditure, you’d expect that the health of USians would be better than that of everyone else. But it’s not. Life expectancy in New Zealand, Australia, Canada, Japan, South Korea, France, Germany, the United Kingdom, Sweden, Norway, and elsewhere is significantly higher (at least a year) than in the US.
One of the more shocking statistics is the infant mortality rate in the US. Largely because so many poor people don’t have adequate healthcare, the US has the highest infant mortality rate in the OECD.
(New Zealand’s infant mortality rate in 2016 was 3.58 per 1,000 live births.)
Why a Single-Payer System is Better
There are multiple rationales why a universal system is better. They fall into three main categories.
1. It Benefits the Entire Economy
Firstly, universal coverage is better for the whole economy.
Long-Term Government Strategies
(a) A government can focus on long-term prevention strategies. Policy makers can focus on prevention issues which have long-term benefits for the country. One of the things the New Zealand government (whichever party is currently leading it) has been working on for many years is smoking prevention. Long-term, this both improves the health of all and reduces healthcare costs. It’s the sort of thing that can be done when there is a long-term strategy in place. The private sector has no incentive to improve the overall health of the population.
(b) Population education. Some of those that the NZ government has done or is doing include: smoking cessation, mental health illness awareness, family violence reduction, and healthy eating.
Other Advantages
(c) Society as a whole is healthier, which improves the output of the economy, reduces crime*, and increases overall well-being. *E.g. a study showed that 80% of prisoners had literacy difficulties because of childhood hearing issues. This, of course, had an impact on employment. If they had had the very inexpensive intervention of grommets put in as children, they might not have had to turn to crime to survive. That in turn saves all the police, justice, social support costs and more. Instead the person is a healthy, productive, member of society.
(d) As everyone has access to primary healthcare, people do not wait until they are so sick they need to attend the Emergency Room at the hospital. Taking care of problems at an early stage is much cheaper for everyone, and also means people spend more time in work or education.
(e) Employers have access to a healthier pool of workers that they can rely on to stay healthy for longer.
(f) People are less stressed because they don’t have to worry about what will happen to them if something goes wrong. They know quality healthcare is available to them.
(g) A population that is better looked after when it is younger will be healthier when it is older, thereby reducing the inevitable cost of looking after the elderly. This is particularly true because those who can’t afford health insurance are those that are more likely to be less healthy and therefore cost more as they age.
(h) Because they don’t have to worry about affording healthcare, people are more likely to take the risk of starting a new business. Small businesses are the lifeblood of any economy, and making it easier to start a business is a boon to any economy.
2. Separating Healthcare from Employment
Secondly, there’s the issue of separating healthcare provision from employment. This, on it’s own, is one of the major economic benefits of a single-payer system.
(a) An employer is more likely to take on a new employee if they don’t have to worry about the hassle of arranging health insurance and the additional cost of providing that insurance.
(b) The work force as a whole is more dynamic if a person’s healthcare remains consistent whatever their employment status. For example, people are more likely to be in a role that suits them and their talents best rather than one where they can get health insurance.
(c) Smaller and more rural states have a better chance of retaining their people and attracting new ones because healthcare becomes more evenly available. Thus the divide between rural and urban states will reduce.
(d) There is no barrier to increasing an employee’s hours or changing their status to make their employment more secure, thus benefiting both the employer and employee. (In the US these things can make providing health insurance mandatory.)
(e) The cost of health insurance is not a barrier to a business increasing in size, making expansion more likely. (Going over 50 FTEs currently means a requirement to provide health insurance to staff in the US.)
(f) The provision of health insurance doesn’t give large companies an advantage in hiring employees, so smaller employers are on a more equal footing when it comes to attracting the best. Therefore, smaller businesses have a better chance both of growth and success.
Wages Should Rise
(g) It takes a certain amount of power away from employers in employment contract negotiations and they are therefore more fair and balanced.
(h) With health insurance as part of an employment package and insurance costs constantly increasing, wages don’t increase because the cost of providing insurance increases instead. Further, as insurance costs are tax deductible, the employer has an incentive to prefer them over wage increases.
Note that in a universal system, some employers still provide private insurance for their employees. The reasons a person might still have private insurance noted above can also benefit an employer.
3. Increased Efficiency
(a) The cost of healthcare will reduce for all because of the involvement in the whole population in paying for it via their taxes.
(b) At the moment there is little or no incentive for healthcare providers to look at cutting costs or increasing efficiency. (Having said that, there are some who are doing good work in this ares.) Hospitals and other health providers put their costs up, insurance companies pay the extra, and those costs are passed on in the form of increased insurance costs. The cost of healthcare has been consistently and significantly ahead of inflation for decades. Some of this is due to things like technological advances and the availability of new treatments, but much of it is not.
4. Drug Costs
Drug costs are also a major issue in the United States. California tried to do something about that at the last election, but unfortunately they weren’t successful. From Wikipedia:
Proposition 61 was a California ballot proposition that appeared on the November 8, 2016 ballot. It would have prohibited the state of California from buying any prescription drug from a drug manufacturer at price over the lowest price paid for the drug by the United States Department of Veterans Affairs. It would have exempted managed care programs funded through Medi-Cal.[2] According to the fiscal impact statement issued by California Legislative Analyst’s Office, “potential for state savings of an unknown amount depending on (1) how the measure’s implementation challenges are addressed and (2) the responses of drug manufacturers regarding the provision and pricing of their drugs.” [3]
Proposition 61 was rejected by a vote of 47 to 53 percent.[4]
The Department of Veterans’ Affairs (VA) negotiates its drug costs in the same way that Pharmac does in New Zealand. This means that the VA pays by far the lowest cost for drugs in the US. However, drug companies donated over US$100 million (Bernie Sanders says US$131 million) to campaigns in California that oppose Proposition 61. There was also a lot of what looked to me like misinformation to me in relation to this issue. As a result, groups like Veterans of Foreign Wars have come out in strong opposition to the Proposition because they have been convinced that it will increase drug costs for veterans. This is just one example of how those with a stake in maintaining their profits muddy the information water.
Consequences of High Drug Costs
Real people are suffering and dying every day in the United States because of the failure of politicians to address this issue. It’s not going away, and it’s not going to get any easier. Policy makers have the advantage of being able to look at several models around the world and choosing the best bits from each to design an exceptional American system. For the sake of her population, let’s hope they find the courage.
This story from CBS is about a young man (26) who died because he couldn’t afford his insulin. The cost was US$1,300 per month.
Universal Coverage Around the World
Insulin is one of the multiple drugs I take and one of the companies in this story makes the insulin I use. Because of the NZ health system, I pay NZ$20 per year for insulin. The most any family pays for drugs is NZ$100 per year. Once they reach that limit, prescription drugs are free for the rest of the year. Those with the lowest income levels, including all children, pay nothing.
Even with the low price of drugs in New Zealand, there are still people who can’t afford their medication. Sometimes it’s simply because they can’t get to the pharmacy to collect it. I imagine the problem of people not getting the medication they need must be huge in the US considering that even with our system there are still people that have issues.
Our system isn’t perfect, and most people in a country with universal healthcare still have complaints. Our governments constantly work to improve things, and in NZ at least, political parties have lost elections because of the way they manage the health system. However, most people generally accept that healthcare is something that a government should provide with our taxes.
As can be seen by the graphic below though, whatever our complaints, those of us with universal healthcare systems prefer them to what the US has.
The Future for the USA
I think there is no doubt that the US will get universal healthcare. It’s only a matter of time. Despite all those who lobby against it, public opinion is now such that the politicians can’t ignore the issue. The people want universal healthcare.
Politicians used to get away with saying it’s too expensive. They’d quote the amount taxes would need to increase without noting that no one would have to pay for private insurance anymore. Also, judging by costs in other countries, the cost is likely to be less than what the US currently pays per capita. Therefore, as well as not paying private insurance, the increase in taxes for most will be less than what they paid for insurance.
The poor shouldn’t have to pay higher taxes either. Increases in the top marginal rates, with the biggest increases on the top five percent, would cover the cost without the poor having to pay any extra. The statistic that the three wealthiest people in the US are worth more than the poorest 50% of the population makes it clear who can and can’t afford higher taxes.
And, despite what many Republicans will say, an increase in taxes for the wealthy will NOT slow economic growth. The opposite, however, would be true if the tax rate of the poor and lower middle class was increased.
Universal healthcare is an investment in the people that will pay the country back in multiple ways. The US can’t afford not to get universal healthcare.
Reference (and highly recommended)
Leonhardt, David. Here’s the Deal (Kindle Single). Byliner Inc.. Kindle Edition.
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I strongly reject government-run healthcare and all the Democratic candidates. What a disaster they are!
If healthcare is a “right”, as they love to keep repeating, why don’t babies who survive a botched abortion get it?
I value freedom. If the government decides if and when I get healthcare, I have given away my freedom.
I also don’t want doctors to be servants of the government, who get their pay dictated by the government.
Yeah, single-payer healthcare and the Green New Deal–sure, we can pay for all this!! What a great investment, as Kamala Harris likes to say!
No, how about we stick with a free-market model and limit government?
Now we don’t have to pay a penalty if we don’t get health insurance that is horrible anyway!
Whether or not you get healthcare is decided much more in a private system than a public one. In a public one there are no lifetime limits, no limits to the cost of your treatment. Doctors are not “servants of the government”. Doctors make their decisions based on clinical need. In a private system it’s money that counts and people are far more open to corrupt decisions, such as prescribing certain drugs because of the benefits they will get. That doesn’t happen in a public system.
Botched abortions tend to be performed by back street providers in countries that fail to provide safe abortion facilities. I’m not sure what their relevance to this post it. However, babies who survive a botched abortion do get free healthcare in a public system just like everyone else.
I’ve made no mention of the green new deal, and again, what relevance does that have to this post? Personally, I think the Green New Deal is a pipe dream. It has no chance of getting through government. I prefer Nancy Pelosi’s approach. I do decry the global warming denialism of the GOP. They are the only major political party in the world that denies climate change. Further, your president’s remarks on the subject are particularly stupid. His understanding of the science is clearly nil.
I’m not sure you have even read my post as you seem not to have understood much of it.
Thank you, Heather, for using the term “USians”.
I first heard of “USAnians” some eleven years ago, and I liked it. But when I myself used the term I got the virtual cr*p beat out of me on the Internet! Red White and Blue AMERICANS were outraged! How dare I???
I lamely made the point that America is everything from Alaska to Tierra del Fuego, and it seemed to me to be pretty arrogant to apply the name “America” only to the US and to forget all the other countries on this continent.
I got flamed for that. Got a virtual whipping. I sure got hauled out behind the electronic woodshed.
So I’m happy to see “USian” here. And I still like “USAnian”. I’d prefer to live in a northern part of the Continent of America, in the Pennsylvania part of the US (and the central part of that), than to see myself as identified with the entire continent in a way that kind of erases everyone else.
So I’m a USian or a USAnian. And I’m still part of America, along with Spanish and Portuguese-speaking people as well as French Canadians – and don’t forget the Native Indian People and First Nations People and their languages that are in danger of being lost.
Thanks, Heather, Friend of Jerry…
Thanks Laurance. That’s exactly the reason I use the term. As you say, American in everyone from the north pole to Tierra del Fuego over two continents. North American includes Canadians. I don’t think anyone has ever given me much of a hard time over it, though a couple of people have questioned it. I just explain it. I suppose a lot of people think I’m being pedantic, but I don’t care.
I settled on USians because I was thinking of how I would pronounce it if I has to say it out loud, and that seemed to flow the easiest – you-ess-e-an.
Thanks, Heather…I feel encouraged to start using the term again. And thanks for the pronunciation. I was thinking yoose-i-an, but I like you-ess-e-an better. As for USAnians, I was thinking you-san-ians. I’ll stick with your term and pronunciation!
And as for languages I forgot Pannsilfaani Daitsch, which can still be heard in places hereabouts.
Yeah…some people don’t realize that Canadians are Americans, too. As for Mexicans, well, we do have the term “Latin Americans”. They’re Americans. And the South Americans are Americans. As for Canadians, well, they’re North Americans as we are, but I think some people just aren’t thinking about it.
There’s Central American too, though I’ve never been clear whether that includes Mexico or not. I thought it did, but NAFTA says different and it’s far more likely to be right than me.
Dan – Your vaunted “freedom” is an illusion.
OK, you don’t want the government making healthcare decisions for you. Fair enough. But SOMEONE is making healthcare decisions for you NOW. You don’t have any freedom. The person making your healthcare decisions in the current system is an insurance adjuster with no medical background and a profit motive.
So, make your argument on the basis of fact, not on some fantasy of your “freedom”.
Also, I notice your snark about botched abortions. At the moment, the US has the highest rate of maternal mortality in the developed world, and it is rising. What that usually means is that if the mother dies, the fetus dies, too. The insurance industry is not interested in solving this. If you’re so concerned about the fetus, why are you and yours not addressing this?
We also have a life-expectancy rate that is going DOWN. The insurance industry shows no signs of addressing this, either.
We have the highest rate of expenditure for health care per capita, and the worst outcomes, which means that we’re not getting any bang for the buck.
Freedom?
Right.
L
Heather – This is an excellent, complete post. Kudos to you!
We spent many years writing software for the healthcare industry, and one of my former business partners continues to do consulting for home care.
The for-profit sector of healthcare is making record profits. They are already moving to protect themselves as public opinion goes against them. I agree with you completely that some kind of public-private system is the best option, so I would not call it “single payer”. I like the Swiss system quite a lot.
They money that we spend on “healthcare” is not going to healthcare. It is going into the pockets of investors. This is why our outcomes are so bad and our costs are so high. It is also why some kind of public option would actually be cheaper than what we have now. If you limit the profits, that money can go toward actual health services.
But, getting there is going to be a battle. The investor class is not going to share their record profits without a fight. Be prepared for a lot of “socialism” nonsense, shrieked at the highest decibels.
L
Thanks Linda.
Your point about the industry already protecting itself is well made. The example of the drug industry spending over US$100 million is just one state to stop a fairer system shows how big the push back is going to be from those who are making money now. I vaguely remember an old Michael Moore documentary (similar to his gun one ‘Fahrenheit 911’) showing just how much government representatives are getting from health industry sources. It was huge, and not limited to one side of the aisle. Another reason money needs to be got out of politics!
One of the biggest costs in US health is just the cost of administering the insurance claims, most of which would go away under a public system. As you say, that money could be spent in the actual hospitals.
Another problem is unnecessary tests. A doctor orders a whole slew of blood etc. tests on a patient in hospital that they know they don’t need, but for every extra test there’s a bigger bill to the insurance company and a bigger profit for the hospital. In a public system hospitals have budgets, but they aren’t required to make a profit. So, there’s an incentive for greater efficiency and productivity as they compete in national league tables for things like how soon emergency room patients are seen from the time they arrive at hospital.
Yes, investors, in our US system, are the beneficiaries. The idea that healthcare should be conducted for private profit is absurd.
After reading that first comment you got on this subject, it should be easy to see why the U.S. is where it is. It is embarrassing and totally wrong. I hope the U.S. can wake up from this ignorance and do something but I do not plan on it.
Your article is a very good one and also asks the most important question. Why can’t the U.S. look at the rest of the world at real results and then pick what they need? The ignorance here is overwhelming. I believe most of the candidates are doing a very poor job and have not really given this much thought. To just say give everyone Medicare tells me they don’t even know what medicare is. Hell, I am on Medicare and there is much I don’t know, but what I do know is, medicare does not start until you are 65. At 65 it is mandatory but I’m not sure how that works for some. You pay into medicare all of your working life through payroll deduction, just as you do with social security. Then when you turn 65 medicare kicks in and you then continue to pay a monthly fee of around $125 per month. They will automatically deduct that fee from your social security. If you do not get social security then you must pay the monthly in another way. If you cannot pay, far as I know you don’t get it. It is not free.
Also, medicare does not cover everything. Hospital is part A and Medical is part B. The coverage is approximately 80%. So, how do you pay the rest. Most of us get additional coverage with private health insurance called supplemental. Also, your supplemental needs to cover your drugs because Medicare does not cover most of that. All of this information should tell anyone that just saying Medicare for all does not get it. Not even close. If we want to get to single payer you must change medicare so that it actually does that or find something else.
I would also just say this. Millions of Americans have no insurance even with Obama Care or whatever you want to call it. This is due to the fact that it is no longer mandatory.
Anyway, what we need is to get Heather to come over here and educate the politicians so they can speak with some knowledge on this matter.
Hi Randall – I just found this in the spam folder. I’ve got no idea how it ended up there as I can’t see anything that’s a problem, but then I don’t really understand how it works.
Well done Heather. I think your analysis should encourage naysayers to change their minds.
Cheers Rick. Whenever I watch US TV on this issue, I worry about the amount of disinformation given out by those who want to protect the current regime. It means a lot of people don’t really know what they’re arguing against when they argue for retaining the current US system.
I think a lot of it is fear of the unknown too, especially with an issue as important to everyone’s life as healthcare. There was huge opposition to Obamacare, which wasn’t even that big a change, but now most people don’t want it repealed, just fixed. As you know, a lot of older Republicans breathed a huge sigh of relief when John McCain did his thumbs down vote on Obamacare.
Sadly, I wrote a reply earlier but it did not make it. Oh well, will try again.
I think the best idea would be to have Heather come to the U.S. and educate the politicians on this so they will have some idea what they are talking about. For most of what I have heard from them is that they currently do not know what they want or are talking about.
As Heather makes clear in her posting, the easy and best way to do this is simply look at the examples from around the world and come up with a plan. What is so difficult about that? Everything we know about our own system is bad. The cost and the quality of care should tell us this. What we have is good health care for the rich and powerful. And since the people who control what and how we are to be covered for health care are in congress, we continue to get very little. Those in control have no incentive and in fact do much better by refusing to do better. The big time insurance companies carry lots of weight and are one of the biggest lobby organization in Washington.
I am old enough to be on Medicare so I know a little something about it. In it’s present form it cannot cover everyone so if a politician says – just give everyone medicare, that does not get the job done and it shows they do not know what they are talking about if they think that will do it.
Thanks for the vote of confidence Randall.
I worked in hospital administration, both public and private, for about half my career. So, I can tell you there’s already an international network that the US could plug into of administrators that visit hospitals around the world that are doing particularly well in a certain area so they can take those ideas back to their own hospitals. US doctors and other health professionals are, of course, already part of such networks, but they exist for the various areas of hospital management too.
Thank you for a very interesting and informative article. Change will come to the US healthcare system system since more and more voters wish it to change. It took years to get Medicare and Medicaid but people see those programs work. Healthcare as a right will come.
A majority called Medicare and Medicaid socialism when they were introduced too. Now it’s only the Paul Ryans of the world that want to get rid of them. When the NHS was introduced into Britain just after WWII, there were a lot of skeptics too. Now, there’s almost no one who would be without it there and healthcare is viewed as a right virtually universally.
Thanks for the excellent post. I have been convinced of universal healthcare in the US for a very long time. While I think your arguments here are the right ones for people who follow politics and policy, the Dems need messages to regular folk that focus on real benefits and fears. Here’s my off-the-cuff list:
1) Americans don’t seem to measure themselves or their country relative to other countries. Most of them seem to assume the US is either the best or, if it isn’t, it is something that doesn’t matter. Anyone who tries to convince them otherwise risks being seen as delivering an anti-American message. It’s a good argument for those of us who see ourselves more as citizens of the world but, in general, we are already sold on universal healthcare.
2) Lower prices always makes a compelling message. The risk in promising lower prices is that we’ve all heard that one before. What is needed here are quick, short explanations of how universal healthcare will lower prices. This is one place where bringing in other countries may work. For example, an explanation of why drug prices are cheaper in Canada would help immensely. Speaking of Canada, we should lean heavily on their example, not because their plan is the best but because Americans think of Canada as being a lot like the US. It is much less foreign to them. Adopting something from Canada will be seen as similar to one state adopting from another.
3) Convenience and lack of worry are hot points. I don’t think regular folk have any idea how much easier universal healthcare will make their lives. Dealing with insurance companies is painful and expensive. Even though universal healthcare won’t eliminate all of these things, any help will be totally motivating. Perhaps Medicare and vets experiences can be used to advantage here. They should make some good videos depicting how easy things might be under universal healthcare.
4) I would like to see Dems come up with a quick answer or two to the “socialism” charge. Currently, their responses seem mostly to be a version of “Guilty as charged. So what? That’s a good thing!” True enough but not very convincing to those who have grown up with it drummed into their heads that it is to be avoided, like Communism. Obviously, we already have government systems that work. It is important to deflate socialism from junior communism to simply one way our system uses to manage certain things.
5) “Will I be able to keep my current doctor?” This is clearly going to be something opponents will use against any change to the US healthcare system. The fact that Obama got it wrong initially, and later in response to opposition, makes it even more important to have a good answer. The GOP managed to weaponize this and the Dems need to respond. First, any change to our current system will cause changes to doctors, who they are affiliated with, and how they do business. This will result in some people having to switch doctors. Second, most people have had to switch doctors at some point (need to check if this is true) when, for example, their employer switched insurers or plans under the same insurer. This did happen to me. Perhaps the best argument is the fact that virtually all doctors will be able to accept patients under a system in which everyone is enrolled. It should be far easier to see any doctor you want in a system where fewer organizations sit between you and the doctor.
I’m sure there are other arguments that need to be made but that’s more than enough for now.
Thanks Paul.
Those are all excellent points that I agree with completely. There needs to be a proper discussion about how to present this issue to the electorate and those are all things that need talking about.
My guess is, single payer would be the best system and single would mean the government. Private insurance companies to cover health care would go away. That does not mean people do not pay, they just pay the government. The single payer would have the power to negotiate cost. Currently, I believe our insurance company system costs us around 30%. That would go away under single payer and save tons of money. Also, insurance companies have no incentive to reduce cost because they just raise rates and drive on.
This system also allows everyone to stay insured while changing jobs, getting fired and so on. Right now we are screwed. I suspect how much you pay should be based on income and other things like single/family. Everyone should be in from age 21 or whatever looks right.
That’s the way some countries do it, but not NZ. We choose our GP, though if a GP is popular s/he may not be taking new patients because they can’t handle any more. All GPs are paid on a per visit basis directly by the government. These days, especially in the bigger cities where premises etc are more expensive, most also charge a fee on top of the government subsidy. However, all children (14 and under) are fully funded, including for out of hours visits i.e. there are no extra charges. People on low incomes or most social security benefits also receive a higher subsidy and for many that also means their visits are free. Maternity care is all free, as are some conditions that require a lot of doctor visits.
We’re referred to specialists or for x-rays/scans/tests by our GPs. We can go public or private. If we go public, there are no more costs for surgery, tests, or anything else. Hospitals are fully funded by the government. We don’t even have to think about money. The biggest complaint is that some have parking that you have to pay for, and people don’t think they should have to pay for parking at a public hospital. People who go to hospital a lot like dialysis patients get free parking.
Laboratory tests are all free whether we go public or private.
Palliative care is free.
Drugs cost $5 per prescription up to a maximum of $100 per family per year. We pay the pharmacy. Then they’re free. However, they’re free for all children under 14 and those on low incomes and most social security benefits. The government negotiates with the drug companies on behalf of the entire population and is therefore able to get very good prices and it subsidizes any costs over what we pay directly to the drug company.
If we see a private specialist we have to pay them directly and those with private health insurance can claim that cost back of course. The doctors are the same though because most specialists have private practices as well as work in a hospital. People choose private because if you go public and your problem isn’t a major one you may get seen by a registrar rather than the specialist and you may also may have to wait to see a hospital specialist for up to three months.
We also have emergency departments at hospitals of course. They are free of charge. I’m in a small town and if I had a major emergency I’d be taken to my local small hospital then taken as appropriate by helicopter or ambulance (2 hours) to the nearest level one hospital. There’d be no charge for that either though I would receive a bill. That’s because all ambulances and emergency helicopters in NZ are run by charitable trusts and rely on a combination of donations and some government funding. Also, many of the paramedics/pilots etc are volunteers. The government funding doesn’t cover everything, which is a bone of contention with many of us.
As I said in the post, our system isn’t perfect by any means, but I think it’s at least better than what’s in the US, especially for children, older people, those with ongoing issues, and those on low incomes.
If there’s something I’ve forgotten and you want to know, obviously feel free to ask.
I find that modern democracies are confused as to the proper role of government with respect to capitalism. I think the experts understand but not most of the general public. We all enjoy the fruits of competition but most don’t respect government’s role in creating and management of the playing field. Government must allow the competition to occur only in those areas where it benefits the country and its people. In short, it must allow only good competition and rein in the bad.
Of course, good vs bad competition is a hugely complex subject but some of it is pretty easy. For example, insurance companies can’t be allowed to compete on which avoids payout the best by obfuscating insurance policy language and fooling the customer. Electric supply companies must not compete such that they undermine safety or reliability. These things do get argued in the halls of government but both sides seem to regard it as something government shouldn’t be doing rather than one of the most important tasks in a modern economy.
Quite honestly, I find that’s only a problem in the US. Most modern democracies didn’t have the level of fear of socialism/liberalism that the US does. Most of us don’t like communism, but we don’t see any problem with elements of socialism in our society. In fact, we see it as a good thing. The argument is how, where, and how much to do it, but not the fact that it’s necessary in multiple ways.
I see the US as fearing government from the founding of the the republic, then it being force-fed into the US psyche in the Cold War era. (I don’t know if I’m right – that’s just how it looks to me.) We just don’t have that fear. For example, we would rather trust the government with our info than a private institution because our experience is that it’s safer there than with someone who has a profit motive. We always find it surprising that the opposite is true in the US.
Another important role for government is to improve transparency in the marketplace. If the market is driven by supply and demand; if the idea “buyer beware” makes sense, the economy should take place where consumers can shop and compare. Thus, enforcing truth in advertising, forcing producers to label products reasonably and forcing companies to honor guarantees, etc. is something that allows the market to operate properly.
I agree but a lot can be hidden even with transparency. Insurance companies can claim that their policies are transparent with respect to what they’ll pay out on. Unfortunately, most people don’t know all the risks that they need covered or the relevant statistics that would tell them what covering each risk should cost. Of course, government could educate consumers but the subject is just too complicated. Most people just cross their fingers behind their backs and sign.
It could be argued that even if a consumer could analyze all the risks and insurance plans, they are making decisions that they would rather not be making individually anyway. The government should establish a standard plan (or two or three) that covered all risks fairly, give them simple names, and require that insurance companies provide them properly labeled. I would be happy with that. I have no problem with insurance providers offering alternative or supplemental plans but they should offer basic plans that serve the population well and prevent them each from having to become actuaries. Insurance companies should compete on other aspects of their business.
You have done a wonderful job of laying out the issues. I live in the US, and I briefly worked for one of the major US healthcare insurance companies. I think we USians deserve SO much better than we’re getting now. I agree that it would be impossible to get rid of the private insurers, nor should we. However, if Medicare were more broadly available, I’m sure many people would jump at the chance to sign up.
Your arguments reminded me of ones I saw in a book I’ve been reading: The Nordic Theory of Everything by Anu Partanen. The author made some of the same points as you did, and did so in a compassionate, non-condescending way. She had lived in both the US and Finland, and she learned firsthand how much stress the US system causes to those who have to navigate it.
Thank you!
Thanks Andrea.
Heather, I am sure you are right about the fear of socialism here in the US. However, from what I know of Europe, they don’t have a much more sophisticated view of how governments need to manage markets either. They have just as many citizens who view globalization as some sort of villain rather than being the source of much of their current prosperity. There are certainly legitimate complaints but I think they should be directed at government’s management of capitalism’s playing field, not the players who are simply following the rules they set down. (Those actually breaking the rules should be prosecuted.)
I guess it depends who you know. I can’t claim to be any sort of expert on what Europeans think, and the ones I know are those who are like-minded so my view is probably skewed. There’s certainly a dangerous move to the far right in a lot of countries in Europe which is really scary.
I’ve always thought it was a bit weird putting a political party in charge of government that thought government was a bad thing and wanted to get rid of it. Those same parties are pretty good at interfering at a pretty personal level when it comes to stuff they don’t like, such as what consenting adults do in the privacy of their bedrooms.
Yes, I agree. It seems crazy for a politician to claim government is bad. In the US it seems to have started with Ronald Reagan who famously said “The most terrifying words in the English language are: I’m from the government and I’m here to help.” There are many on both sides that seem to have completely lost the idea that the government should provide services and work properly.
Randall, you make good points about Medicare-for-all. (I too am on Medicare.) However, I see several positives about going that route. First, Medicare represents a government program that works, though it has limitations like those you point out. Second, it is an infrastructure that already exists. It is much easier to scale up an existing infrastructure than to create a brand new one. Whatever happens with US healthcare, some sort of gradual transition will help avoid complete disruption of the existing healthcare industry. By increasing Medicare coverage gradually, industries that will inevitably scale down will do so gradually. This will give the needed time for those working in the industry to switch to working for Medicare infrastructure or moving out of healthcare altogether. Same for investors in our existing infrastructure.
Thank you Heather, for an excellent post.
Many OECD countries have ‘mixed’ systems, so not ‘only’ single payer system (as indeed you point out). But in all OECD countries the ‘single payer’ is the backbone.
One point in favour of Universal Health Care you did not mention is the spread of contagious diseases like eg. TB. It does not matter how good your private insurance is, the people you encounter may have TB, your greatest insurance will not protect you from contracting it. Universal Health Care is the best way to suppress such diseases. It reduces everybody’s risk.
Excellent point re contagious diseases that I should have written about. TB is one that has to be targeted here too because of people coming in from countries where it’s common. Also, one of my #1 hates is anti-vaxxers and a centralized system combined with education also helps with making sure everyone is vaccinated, which is naturally free. (We’re still a free country of course, so vaccination isn’t mandatory.) A centralized system allows the government to identify communities that aren’t vaccinating and find ways to get into those communities e.g. by using doctors/nurses that speak the language and vaccinating in locations a particular group might congregate as a community rather than in doctor’s premises (which can be scary or just difficult to get to).
Flu vaccines are free to a lot of people too, including everyone 65 and older, those with conditions that may make recovery more difficult (e.g. diabetes), those who are immuno-compromised etc. Another of my pet hates is people who can get free flu vaccinations and don’t. They clog up the hospitals in the winter time, and that sometimes means things like elective surgery for others having to be postponed. They cost millions that we wouldn’t have to spend if they just got vaccinated, including by weakening themselves long-term and thus requiring more interventions in future.
More and more employers are offering free flu vaccinations as well because of the benefits. It’s one of the best fence-at-the-top-of-the-cliff moves they can made re health.
@Dan (for some reason the reply button doesn’t work)
What the f… is a “survivor of a botched abortion”? A woman surviving a ‘private’ back street alley abortion? Or what? And how would Universal Healthcare not prevent, or tend to prevent, that?
If you think that a Health Insurance company has more interest in your health than the State, I have a nice, shining bridge to sell you. Your ‘freedom’ is to choose between them. Freedom schmeedom.
I think your post is mildly unhinged.
In many places kids can’t attend school if they are not immunized. It seems to me this is a very fair and proper policy.
I think some places have that rule here too, but it’s up to the individual kindergartens/schools.
Heather, for some reason my replies do not appear under the comment I’m replying to. Any idea why?
Also, my id and email do not auto-fill.
WordPress has just had a major upgrade, and this is one of several problems. It won’t display png files in posts either – I had to re-save my png files as jpegs to get them to display. The guy who looks after my site is reports this stuff to WordPress, and hopefully they’re working on it. In the meantime, all I can do is apologize. Sorry.
Gotcha. Hmmm… now the reply button caused “comment” to appear in the entry window. A red boarder comes next. Now lets see what happens when I hit enter. 😎
Nothing changed. I hope they fix it.
There is nothing wrong with a hybrid system that still allows room for private insurance participation but if the single payer system can cover the program without private insurance that would still be best. The reason we ended up with this hybrid system here, referred to as Obama care was mainly political. Big insurance lobby had to power and influence to do it and Obama caved in. However, to keep everyone in and everyone happy we end up with a more complicated system and it still works for some but not all. It is kind of like changing your money system, such as what happened in England around 1970. It was a huge problem with lots of yelling and screaming but in the end, they got a new system. Everyone survived and moved on.
People can justify having a hybrid, I just say it does not have to be that way. Some of the comments here say things like – polling shows people want Medicare. Find, but do they even know what Medicare is. I don’t think so. Medicare by itself does not get it done unless we make some changes. If anyone tells you it does, they are wrong. Certainly it could be enhanced so it could cover all but that will cost more. Others are suggesting Medicare for 50 years of age and older. Okay, but what about everyone under 50?
When they first started Social Security it only covered a certain part of the population. Now it covers more but still, not all. Hell, if your career is in congress you don’t pay anything into Social Security. I can remember when they added lots of self employed people. It was a slow gradual thing. Maybe anything like health care for all here will be the same, very slow over a long period of time.
Reminds me of when Sweden switched from driving on the right to driving on the left. At midnight they removed the bags over one set of signs and put them on the other. The transition was relatively painless.
As far as healthcare goes, I think a little disruption is ok. We should work to minimize it but not at the expense of doing something dramatically good for the country.
Fixing problems always involves change. Fixing a big problem means big changes. It always irritated me that Obama got so beat up when he claimed that people will be able to keep their doctor under Obamacare. First, that was mostly true. Second, anyone that thought about it for a second knew it wasn’t true for absolutely everyone. An intelligent person, hearing Obama’s statement, never interpreted it to mean absolutely everyone. New rules would obviously disqualify some insurance plans, causing some people to change plans, sometimes forcing a doctor change. Pretending that no one will be hurt by a change is dead on arrival. Politicians shouldn’t even go there in the first place, IMHO.
I wish I could say something substantive, but everyone above cleared the way. It’s about ethics, clear and clean. Why religion obfuscates that endeavor, well, we know. Power hungry people are a difficult lot. Esp. when they sit on billion$.
It is a hard pill to swallow for many in the U.S. this idea of socialism. However, swallow it they must if we are ever going to have a better health care system. This false idea that government is always the wrong answer is built in and wrong. We rely on government for lots of things and apparently don’t even know it. It is so bad you hear some old people say – Government better keep their hands off my Medicare. I wonder how deep this stupid really is? How do they think we got the interstate highway system. How did we get to the moon, Federal Express? Where do they think the weather forecast comes from? And speaking of health care, where do you think every person in the military and their families get health care? I am not talking about the VA because that is slightly different, I mean active duty. And it is all free.
The old saying is – You never miss what you don’t have. For us that would be good health care.
Yes, the disconnect between government and voters is sad. It is a disease that afflicts both rich and middle-class. I have a friend that says he always votes Republican because they’re the only ones he believes will lower his taxes. That is really his only concern. He doesn’t follow politics and current events at all. He lives in a rich area on a hillside surrounded by rich white people like him. The fact that his whole situation would evaporate if the government went away just doesn’t matter to him.
I have a friend exactly like that. Thinks the government is stealing his money; just wants lower taxes. He doesn’t vote, so I guess his naivete doesn’t matter, but he doesn’t vote because of his naivete. There is no way to talk politics with him because he is so far out of the loop, “it’s all Greek to him”. And his suspicion supersedes rational conversation. He’s a smart guy; he’s a mechanical engineer in fact- go figure. Why are so many Americans like this? Does America need to have another Great Depression to wake people up? It’s sad to think that’s what it might take.
I think another one of the reasons (probably not the most important one, but still a heavy contributor) is the ridiculously high indemnities awarded in case of litigation in the US. It not only forces doctor’s insurance premiums up, but forces them to cover their butts by requesting lots of unnecessary, expensive tests and imaging, that would normally and reasonably not be indicated (at least not in first instance).
I found the case of the young man dying because he could not afford his insulin breathtakingly horrible. Worthy of the most sordid and desperate of ‘shithole’ countries, and even then.
The cost of producing human insulin for one patient is in the order of 50 US$ a year, and analog insulins about double that.
(those 1300 US$ he had to pay was surely per year, not per month, was it?) even per year it is more than an order of magnitude too much.
I know, production is not all that costs, but it still is totally unconscionable, a quasi-criminal racket.
I looked up on Hubert Humphrey, what an incredibly better president he would have been than Mr Nixon! My late mother sometimes mentioned him, always in a positive light, she thought he was a gentleman (something she was very serious about), contrary to Mr Nixon. [She lived to see Mr Obama, although she already was mildly demented by then, she still thought that it was great that a ‘coloured’ man was the US president -and a gentleman, of course-, but I’m grateful she was spared Mr Trump].
I think that someone reasonable, like Mr Inslee would be a good proxy for Mr Humphrey.
If Mr Humphrey were still alive, and if I’d be eligible to vote in US elections (I’m not) I’d vote for Mr Humphrey.
I hope for an Inslee-Harris or Inslee-Klobuchar ticket (or a Harris-Inslee or Klobuchar-Inslee one). They are, I reckon, the best option to beat Mr Trump next year. I’m less sure about Mr Beto, maybe he would, but could he?
I see where David Brooks, opinion writer for the NYTs wrote a piece on health care and the Medicare for all idea. Brooks is a lost old fashion republican and I say lost in that he hates Trump and wonders what happened to his party. Whatever he has lost he still sounds like a guy who is very conservative and really seems to not know enough about the subject he writes about.
His primary argument with Medicare for all is that it will be nearly impossible to do and cost huge amounts of money. But I find his article mostly shows he really does not know much about Medicare and is taking his shots from old republican points. He states that Medicare for all will do away with private health insurance. That simply is not true. He also says Medicare pays far less to hospitals than private health insurance? Maybe 40% less. Therefore lots of hospitals will go out of business and how will doctors make a living. I am not sure where he gets this stuff but it just makes no sense.
Maybe if Brooks were older and actually was on Medicare as he will be when he turns 65, he will learn more about it. Medicare is essentially mandatory for everyone upon reaching 65 years old. This much I know because I am on it. You can elect not to carry any (supplemental private health insurance) if you want but it is not a good idea. Medicare does not pay 100% of your hospital costs. It is closer to about 80%. It does not pay for most of your prescriptions. So unless you are poor or something, most people pick up a supplemental coverage with private insurance. I certainly did and most people do this. So how does he get this idea that all private health insurance goes away? He is wrong on so much of what he is trying to say that his article is really worthless.
Maybe when old republicans loose their way this is what happens to them.
I think they feel the need to stick to the party line that Medicare for all is socialism and the government interfering etc.
As I pointed out in the post (though not in great detail) a universal system would actually be both cheaper and better than what the US has now. The US pays a fortune for health. a lot of which is completely unnecessary. Taxes would rise on those on upper incomes. (Hopefully they wouldn’t be stupid enough to raise them on the poor.) However, that would more than be compensated for by the reduction in health insurance costs. There would be genuine competition between companies too, and they would have to be more open about what they cover because of the government paying the majority.
Universal healthcare that’s mostly single payer is a no-brainer economically, and that’s supposed to be what the Republicans are all about. Done properly, it would provide a boost to the economy and it would continue to increase helping the economy long-term because of the improvement in population health overall.
I didn’t read the article but, as you describe it, it sounds like the usual grab bag assortment of complaints. The fact that other countries make universal health care work makes how we get there the only real issue. Now that voters, via Obamacare, have gotten a hint as to what proper health care might be like, are never going back. We will have some kind of new health care system as soon as Dems have power again. Republicans and their insurance company buddies better get wise to that fact. They can either be part of the solution or part of the problem. It is going to be disruptive but that alone is not a reason not to do it.
Those last three sentences bear constant repeating! The first two of them should be part of a stock speech.
Change is scary, though many won’t admit that’s the reason they don’t want to change. Those that don’t want to change because they are benefiting from the current system like drug companies use that fear.
One thing that might be interesting for the rest of the world to know, rich folks in the U.S. do not pay much for anything. Whether you are talking about income taxes, medicare, social security and the rest, they just don’t pay. The cap on income paying into social security is roughly $125,000. Above that you pay nothing. It is similar for medicare. And guess what – members of congress do not even participate in any of this. So when you hear the poor republicans crying about how broke our welfare system is, it is all bull. The only problem is people are not paying. And by the way, to call social security or medicare socialism is also wrong. The people who get it are paying for it. It comes out of your pay every payday in the form of payroll deductions, just like taxes. And, even after you go on medicare, you continue to pay monthly, about $125 a month. So don’t believe all the crap you here. Medicare as it is today in America is not free by any standard.
I’m shocked that there is an income cap on Medicare, but as it’s a separate insurance system rather than funded by general taxes I can understand why. I think that a Medicare for all system either needs to have no income cap so the wealthier are helping to fund poorer people, or it becomes part of general taxation as it is here.
We do have a separate compulsory insurance scheme for accidents. It covers sporting injuries, work accidents, MVAs, and medical misadventure. Part of our vehicle registration goes to the scheme for the MVA part and depends on the type of vehicle due to some having more accidents than others. However, car owners do subsidize motorcycles to a certain extent. Most of the rest is taken from your income by your employer (or from your social security or other benefit) and sent to ACC on your behalf. There are different rates depending on what you do. Employers have to pay according to no. of employees and the type of industry too. So sugar manufacturing is 0.80 per $100 paid, while some forestry jobs are $4 or more per $100. It’s based on actual data and changes so an industry has an incentive to clean itself up, and really big employers (those with enough that their data is statistically significant) can get an individual rate. For example even though coal mining is a very dangerous job, it’s rate is less than $2/$100 because they have such good safety programmes and therefore low accident rates. ACC works more like Medicare, in that you get seen immediately and go to a private hospital for your surgery. It also provides a much higher income replacement than ordinary Social Security (80% of pre-injury earnings until you’re recovered or 65 yo), It used to only pay 80% of health costs, but too many poor people were getting stuck with health bills they couldn’t pay so for about 30 years now it’s paid 100%.
It covers medical accidents too. We can’t sue except in exceptional circumstances, but all our medical expenses, rehabilitation expenses, any changes needed to houses, vehicles etc. plus 80% of pre-injury income are paid. Doctors are still judged by the medical council and can have their licence revoked, but in general they’re more open about talking about accidents with their peers and what to do to make sure they don’t happen again because they won’t get sued.
Also, it means that a case that might not succeed in court you still get all you medical etc costs paid, there are no legal costs, the courts are less clogged, and society is less litigious.
Heather, this sounds way too rational. Of course the reason the US has difficulty implementing rational schemes for healthcare is the history of the current system. The fact that the whole thing was dominated by an insurance industry bent on profit. So, the USians are stuck with a legacy that is complex and works not for the advantage of average people. It is so embedded that I would have to guess it will take another 50 years to finally reach a simplified, rational, approach.
And all that detail about NZ’s system and others is right there for the Americans to learn from and pick out all the things they need to have a good system. And yet, here we are.
And not just NZ of course. As I said in the post, the US has the chance to build a system the rest of the world will envy by studying what works and what doesn’t everywhere else.
Just to indicate how little thought and real study goes into this important subject in the U.S., take a look at the current democratic bill on Medicare for all currently proposed and signed on to by over 100 democrats in congress. It is stupidity times 10. This simple idea or plan will totally take over as the health system and remove all outside insurance. If allowed to go as it is, would likely bankrupt the country in no time. It absolutely covers everything, including dental and every other health concern. It would instantly replace everything in existence. As I explained briefly in early comments, medicare currently is nothing like this. And in it’s current form and amounts paid for by participates, it will go broke in a few years if pay in is not increased a great deal. Anyway, this is the current mentality we have, from total coverage to nothing at all.
Randall, this sounds like a big fat pile of FUD. Of course pay-in will have to increase. Insurance companies may pay a lesser role going forward but as long as there are still people who want more insurance, I am sure they’ll be with us. No one is going to outlaw private insurance. Claims that this will bankrupt the country are just scare tactics. Other rich countries have figured this out. I see no reason why the US can’t do so.
There are some candidates for the Dem nomination who want to outlaw private insurance. Imo, it shows they don’t understand the issue and are just parroting what others have said. Of course, outlawing private insurance will never pass but just calling for it is a problem because of the opportunities it gives the GOP to criticize. Candidates need to come up with proper proposals that the party can coalesce around or they will fail.
I should have made reference to the article on line but this Medicare for all 2019 act is real. Unlikely for sure but it is an actual bill in the house. As described it would cover everyone and totally overhaul and eliminate all private health insurance. One of the problems with many of these new Social democrats as they are called now, is they are campaigning for the moon. Complete health care for all, free college, guaranteed job and wages. I don’t know, maybe we all get a free car as well.
We used to have an employment scheme in NZ back in the 1970s and early 80s that was basically guaranteed work for all. The jobs were only for six months at a time and you had to work for some kind of charity, government dept, school, or non-profit org. I worked as an administrator of the programme for the Department of Labour back in my early 20s.
A lot of the jobs were clerical-type work, and they were great for on-the-job training. Most of them were manual labour such as developing walking tracks etc in the national parks. In the part of the country I lived, many of the jobs were working for local iwi (tribes), maintaining and developing their marae (communal meeting place of an iwi that incorporates a meeting hall, kitchens and dining hall, etc.). It did work well.
People developed skills they could take into the private workforce, they got into or kept the habit of working. For some it was a good way to keep them off the streets and took away the time of need to commit crimes like petty theft too. Many people felt useful for the first time in their life e.g. working on their own marae was a great source of pride.
It was a very popular scheme. The upfront cost was expensive of course. I don’t know if there was research into the long-term benefits, but it probably didn’t run for long enough to show whether the cost was worth any long-term benefit.
I don’t know the details of what’s being proposed but surely making private health insurance illegal is not part of it, right? On the other hand, drastically reducing the size of the health insurance industry should virtually be an up-front goal. After all, if we are paying too much for health care, isn’t the health insurance industry where much of the money ends up? Let’s put it another way. If a new health care system does not reduce the insurance industry, then it is unlikely to reduce costs. This is true independent of whether we pay via our employers, directly, via taxes or whatever.
Lets just go back and look at the facts of what they were attempting to do at the beginning of the Obama presidency. Healthcare was the item and single payer was the game. Single payer meant (the government). If it was to mean anything else, let me know. So this system certainly eliminates private insurance. So what happened. The health insurance industry along with the republicans all went nuts and Obama caved in to what they ended up with — Obama care. It was a half baked compromise that allowed the private insurance business to remain and it is now a mess. This is where we have been for the past 10 years or so.
Why do you keep saying “eliminates private insurance”? It doesn’t make it illegal right? If we had universal care, surely private insurers would offer plans to fill in gaps and offer better services to those that can and choose to afford them. To keep saying “eliminates private insurance” makes you sound like a health insurance industry shill.
I do not want to hog space on Heather’s site but will comment one more time. I know PCC does not like people to dominate on his place and I do not blame him.
Please go back and notice Heather’s piece on this subject. Notice the reference to single payer? It is not a matter of legal or illegal, it is simply a reality of government run health care. Check with any health insurance experts you like concerning the possibility of competition between the government and private health insurance for business. I am sure you have experienced a fair verses unfair fight. Competing with the government is not a fair fight. Private insurance must make a profit, pay taxes, and all the things that go on with fair competition. The government does none of those things so it is not possible for a private firm to compete with the government. Pure size alone eliminates competition. Does mom and pop compete with Walmart? No.
I don’t mind an ongoing discussion as long as it’s substantial, which this one is.
I hadn’t heard that. I’ve watched quite a few of the town halls with the Dem candidates but not all. Do you recall which candidates actually want to outlaw private health insurance? I suspect it might not even be constitutional.
Kamala Harris. It was the one thing about her Town Hall where I disagreed with her. It was the big news from her TH at the time which was a shame, because she was REALLY impressive otherwise, and it seemed to me that healthcare was an area she had a bit to learn.
When I saw/heard the coverage from the right after her TH, I got the impression they were zeroing in on that because she was so impressive and they were looking at a way to discredit her. I doubt she’ll stick with that position. I felt like she didn’t actually know the answer re private health insurance and just assumed that was the case in a universal/single-payer system. However, it’s early days yet and there’s plenty of time for her to refine her policies.
So far, she’s the candidate I like best, so I hope she does anyway.
I’ve heard what she said in the town hall and it really doesn’t sound like she’s talking about outlawing private insurance:
https://www.realclearpolitics.com/video/2019/01/29/kamala_harris_on_private_health_insurance_market_eliminate_all_of_that_lets_move_on.html
The question involved whether someone should be able to keep their private insurance. That’s really a different question. If we make any big changes to our health care system at the level of single-payer or Medicare-for-all, many will not be able to keep their current plan. We can’t fix the problem without changing anything.
The internet is full of people trying to turn her position into scary stuff. This is where “outlaw private insurance” comes from.
I listened very carefully to her answer, and although she certainly didn’t use the word “outlaw” she was clear that she thought no one would need health insurance anymore and that there would be no more private health insurance. However, as I said above, this is because at this stage she’s on the single-payer band wagon without a full understanding of what it would mean.
As Randall has mentioned, many people don’t really understand how Medicare works, and even fewer understand how things work in other countries. e.g. I’ve heard journalists and political commentators complaining about one part of the British system and saying because of that the whole system is a disaster and the US should steer clear. We all know that logic doesn’t work, but most people aren’t in a position to argue the case because they haven’t lived with the system in a meaningful way in another country.
Imo you’re correct that the outlawing won’t happen. It wouldn’t work unless the US turned into communist Russia or something, which some of the far left Dems may fantasize about, but we all know they wouldn’t really like it in reality and it’s not going to happen despite what the GOP fear-machine claims.
I haven’t made a study of what the various Dems are actually proposing but I’ve been assuming (a) plans are in flux as we’re not at the point where there’s actual legislation on the table, (b) when people say “medicare for all”, they are really only talking about the government administering it rather than employers. They are not talking about details of funding. I’m sure that’s partly to avoid an issue they would rather not talk about, but it is also something that is best hammered out when Dems have actual power again and negotiation of real legislation can occur. It seems both sides are playing a game where they pretend that “Medicare for all” represents specific legislation with details that best support their political needs. Dems want to pretend it is all roses and kittens and the GOP wants to pretend that it will destroy the country economically. As usual, neither is reality but we’re not at the point where it matters. The main thing is to get health care system out of the hands of employers and make it a benefit guaranteed to every citizen and get it out from under the insurance industry’s gouging and obfuscation.
That’s why I said earlier (not that I expect you to remember everything I write!!!) that the Dems need to coalesce around a proper policy proposal. There is a problem that there is legislation in the house that proposes Medicare for all already. It won’t get through the Senate even if it makes it through the House, but to me it’s another one of those waste of time votes like the dozens to get rid of Obamacare when there was no chance of it happening.
Imo they should use proper order. Develop a proper proposal after research, then go through a proper debate process to refine the policy and get support from across the aisle. Healthcare is too important to be done any other way. I suspect the extreme partisanship may be a problem on a high profile item like healthcare, but the majority of people would like cooperation, and the majority want universal healthcare despite the GOP scare tactics.
Your last sentence is really important imo. I’m not a fan of Bernie, but back in 2016 I said he deserved the credit for getting the US talking about this issue and when you guys finally get universal healthcare, it will be down to him. Because of all the talk, more and more are understanding that the scare tactics of the GOP around “socialist medicine” is just BS.
Yes, I agree.
I was expecting a post about the horrific shootings in these Christchurch mosques. I note the oxymoronic character of a ‘Christchurch mosque’, but I guess that it is not the right place and time now. . Even NZ is not spared, it seems.
These shootings are heinous, Ms Adern got it just right. Horrifying, unconscionable, heartbreaking, undefensible.
In NZ of all places….
It’s a bit close at the moment Nicky. My brother lives in one of the streets bordering Hagley Park and his three young kids were in lock-down in schools close by. Also, two of his staff were in the mosque at the time. Both were thankfully uninjured but obviously saw some pretty traumatic stuff. And I saw a very close friend’s eldest son, a police officer, in the thick of it.
Our last mass shooting was in 1990, and that was by a severely mentally ill man suffering from delusions. The only terrorist incident here ever was when the French blew up the Greenpeace ship Rainbow Warrior in 1985.
This sort of stuff doesn’t happen in NZ and the whole country is in a state of shock. The murderer said he deliberately chose ChCh, NZ, to prove that this can happen in a peaceful place too. I don’t get the logic of that, but then I’ve never understood why someone would be a white supremacist either. To me it’s a completely bizarre and illogical way of thinking.
I may be able to write something in a few days, but I don’t feel able to now. Sorry.
No,Heather, I am sorry for expecting a quick reaction from you. It is so incredible, in NZ, about the last place where we would expect it.
But the trolls are already in full blast mode: “You see gun laws don’t help?” “If there had been a good guy with a gun the shooter would have been stopped quicker” etc. etc.,you know the chorus.
What I find difficult to grasp is that there is no central register of gun ownership in the US (or elsewhere). With modern technology that should not be very difficult or expensive. Name and number of the owner, serial no, profile of the bullet and cartridge, quite simple. And it does in no way infringe on the 2nd amendment.
We used to have one in NZ, but then we changed to just licencing gun owners. I was only a kid (c. 7-9), but I remember it and thinking it was a bad move. (My father was a hunter so I was aware of guns.) This guy got a licence despite our strict gun laws, and the PM has already promised a change. I hope that will result in licencing guns as well as their owners, but it’s too soon to know of course.
I don’t want to say anything about the shooting either. Heather will tell us when she wants. I did want to pass on some better news I heard last night regarding the gun mess here. Many may not know but one of the primary items that lets our gun industry get by with murder is the additional laws of immunity. Many may not know this, I didn’t but back in republican Bush days, they past a law saying you cannot sue gun manufacturers. I guess they were worried about that so a little legislation took care of it. Imagine if you did this for other manufacturers, such as builders of cars. If the car Ford made was real good at running over people and killing them, you would just say, too bad, can’t sue them. But nobody gets a law like this except the gun makers. But just now, after fighting hard in Conn. where Sandy Hook took place back in 2012, they got this law changed. So now they can go forward with legal actions and sue Remington, the maker of the assault rifle that killed all those kids. Just maybe they will be able to put some of these guys out of business.
Unfortunately, I doubt it will make a difference. I just can’t see a manufacturer being found guilty. I’d like to see those who sell guns targeted better. If a seller has a good reason to know that a gun will be used in a criminal way, or doesn’t do proper background checks, they should be held liable imo. And the gun show loophole should be closed.
I think all guns should have to be sold via a licensed dealer. Even if the sale is between friends or family, a third party should be involved and the proper checks done. I assume straw purchases are already illegal, but they don’t appear to be prosecuted. That’s how all the guns get into the hands of criminals in places like Chicago.
And afaik, California is the only state that makes a point (with a special task force) of confiscating the guns of those who get a criminal conviction.
The UK is having a major problem with knife attacks because people can’t get guns. Although that’s pretty awful, an attacker can do less damage to less people with a knife than a gun. I bet some in the US wish they had the same problem as the UK.
I believe the effect, now that the law has been changed to allow people to go forward, will be to put the manufacturers out of business (bankrupt). This will be civil lawsuits not criminal. Let the money do the talking just like they do.
They will show in court that these manufacturers are advertising weapons of murder. Just the thing you need to be a step ahead of the police or anyone else. Eventually, with some good proper cases, the gun manufacturers will be almost prevented from their advertising. Think of the cigarette business and what happened to them.
The difference is there are valid uses for firearms. There are none for cigarettes.
I don’t think we need to get rid of guns altogether, but the US needs proper laws that are enforced, and a major attitude change. The NRA has a lot to answer for, especially the SCOTUS decision of 2006.
I think gun manufacturers should be doing research to make their guns safer. For example, with triggers that recognize the fingerprint of the owner and more complex safety catches. I read somewhere that a gun seller that committed to selling such guns was forced into bankruptcy by NRA shills – it seems the NRA are actively opposed to making guns harder to fire!
The NRA has also got laws passed that means research effectively can’t be done by the CDC and others. That is a national disgrace.
(I know you already know a lot of this, but there may be people reading it who don’t.)
We still need weapons for the security reasons too. Police and the military in particular, though we need to find a way to keep them out of the hands of the bad guys. In NZ the police still don’t carry guns in their person most of the time, though in recent years it’s become standard practice for all officers to have access to a rifle that’s kept in a locked cabinet in the boot (trunk) of their car. We have separate Armed Offenders Squads (AOS) within each jurisdiction that’s called out when a criminal is armed.
There’s also hunting. There are probably more NZers who are gun owners than USians, and I believe Canada has a very high rate too. The difference is around attitudes and the types of guns that are available. And the hunting is largely farmers going after pests like rabbits and opossums. There’s duck-shooting in season, and sometimes deer and wild pigs. We don’t have any other feral ungulates (except a few horses in a very small area) or things like bears or large cats etc.
The only people who have hand guns, for example, are the Diplomatic Protection Squad (who provide security for the PM and others who may need it). Others can only get hand guns in exceptional circumstances. There’s quite a rigmarole for ordinary citizens to get a gun licence just for a rifle for hunting. It’s even harder for other types of guns, and it’s very rare that it happens. The police are in charge of the licencing process, which includes interviews of multiple people including partners and previous partners to ensure the licencee isn’t like to attack their partner or has anger issues. Guns and ammunition are also difficult to buy.
And having said all that, it’s been revealed that the Mosque murderer had a valid gun licence. The PM has committed to change our gun laws as a result to make one even harder to get. The president of our equivalent of the NRA, which in recent years has been getting support from the US NRA, has already spoken out against that. From looking at the gun the killer used she says it looks like he’s made illegal changes to it that mean he should have had a special licence that he didn’t have. However, there’s still the question of where he got the parts, because they’re virtually impossible to come by here. He may have made the parts himself, or had someone make them for him. In that case, the person who made the parts will be criminally charged too as it’s illegal.
I certainly agree with much you say on the gun issue but would say the only valid reason for guns is for the police and other agencies who protect us. Valid for hunting is conditional on the hobby of hunting and is very widely only covering certain weapons like shotguns and some rifles. Many of the most popular guns sold today and making the gun makers rich are not hunting guns and are more evil than cigs. Cigs cannot shoot and kill other people like guns.
Hand guns are worst of all and have no justification in the civilian world. Now if people want to keep them at a shooting facility for some kinds of target practice, that is about as far as I would go. Hand guns kill the majority of people in this country and are essentially useless for hunting. They are also nearly useless for the average person who thinks they need one for protection. Nearly always you cannot hit anything with it. They go off by accident all the time because most people want semi-automatic hand guns and they are the most dangerous.
Most people will try to make a case for these assault weapons such as that thing this murder used in NZ but that is simply lies. There is no reason for those weapons. They are for killing people. Lots of people and very quickly.
Other people try to make a case or reason to have a gun yet they live in a city or town. I know of no town or city in America that use to allow people to carry loaded guns in the city limits. Now this seems to be going away. It is total ignorance. Why would you allow someone to carry a loaded weapon in the city limits when it is illegal to shoot that weapon? It is illegal the shoot a gun from an auto. It is illegal to shoot a gun from a public road or across a public road. Anyone who ever hunted knows these rules and laws but it seem most people do not.
I agree with all that, although I would argue that smokers can kill others with their second-hand smoke.
I’ve heard a US farmer say he needs a semi because of the wild pigs that invade his farm! He reckons that’s the only weapon that can get them! They’ll come up with any reason if they’re desperate enough, but the real reason is that they want the guns themselves for their private (right-wing) militias and because of their survivalist mentality.
Though there are gun nuts that are survivalists and such, I think a lot of Americans want a gun only because they can. They’ve seen many movies and tv shows in which good guys defend themselves and their families and that trumps any logic they are able to bring to it. There’s also the bias that tells them that they will handle their guns safely as only other, stupid people that accidentally shoot their kids, neighbors, own foot, etc. It’s the same bias that tells them they are smarter than everyone else, though statistics and common sense suggest otherwise.
Yeah. Everyone thinks they’re a better driver than average too.
Quite honestly, I think a lot of men have a fantasy where they end up a hero after shooting the bad guy. The reality is, as my last post on guns pointed out, that even the best trained cops usually shoot (and often kill) a whole lit of innocent victims in such scenarios. An amateur is more likely to shoot himself in the foot, be shot himself, or get home to discover one of his kids dead after they find the gun.
P.S. I’ll be offline now for a couple of days.
Lets just forget the cigarette/gun comparison. I have to say the gun people are far more damaging to our society than smoking. When you see the guy with a cig standing out in the weather to have his smoke you can go out there and tell him what he is doing is bad. But the guy with a gun gets to bring it into the place of business in many places – I even saw a guy carrying a gun in the grocery store. So this is where we are in America – the guy with a cig has to go outside and smoke but the guy with the semi auto hand gun gets to walk around in your store. Something is upside down and somebody is sick.
That farmer who said something about the pigs is the stupid one. Just because the pigs are smarter than he is, needs an assault weapon to go after them. Give one to the pig and that’s the end of the farmer. I have known a lot of hunters and I never knew one who wanted an assault rifle or was stupid enough to waste money on such a thing. Most hunting is done with shotguns because they are the best for most hunting and they are much safer. Anyone who has to ask, why are shotguns so much safer is just telling you how stupid he is and he knows nothing about hunting or guns.
Just be sure you know – this sick individual who killed all those people in NZ, did so because of the gun he had. When you are hit with high velocity bullets from these weapons they do great damage. That is why the only place they were made for was war, for the military. Shooting people is what they do in the military. Putting these things in the hands of civilians is just pure ignorance and any country that allows it is loaded with ignorant people.
I agree. I expect that one of the changes to NZ law will be that semis will either no longer be available, or only available in exceptional circumstances. There was a member of Federated Farmers (the farmers’ union) that said some South Island inland high country farmers use semis for rabbits. I actually accept they need them because those guys are sometimes killing 50,000 (no, not a typo, fifty thousand) rabbits off their properties each year and they only way to get them is with a semi. They eat huge amounts of grass and it would destroy them economically if they couldn’t use a semi. Apart from that, I see no reason for anyone to have one, I think they should otherwise be banned.
There are also loopholes in the law around ammunition and magazines that the murderer took advantage of, and I expect those loopholes will be closed.
Parliament has tried to fix the laws in 2002, 2007, and 2012, but there were never enough votes. I expect there will be this time. 1. The party of the deputy PM is basically being forced to vote for the changes via the coalition agreement with the PM’s Labour Party. He’s clearly not happy about it. The National Party are doing their best to cooperate and are meeting with the government regularly over the changes. They are the biggest party in parliament and represent most farmers and are the main opposition. I expect that they will vote for the changes because of majority public opinion. There will be some stuff they’re not happy with and it’s hard to know whether they will vote against those things or not. I expect the changes will go through whether or not they vote for them though.
I feel that farmers or hunters in the U.S. and NZ are blowing a lot of smoke at you attempting to make excuses for the guns they want. If NZ truly has rabbits eating all their grass and semi automatic rifles are the only thing that will save them, I have a bridge to sell to them as well. There would have to be a huge imbalance of rabbit to predator species and if so, they need more help than guns. This looks more like a science project. There are many predators here that wipe out the rabbit populations and over supply is hardly a problem.
They make lots of semi automatic shotguns that would do a far better job if killing rabbits if this is their goal. As I said before, there is no reasonable reason why hunting would require or need any semi automatic rifle. If the person is such a poor shot then I would suggest practice or find something else to do.
When it comes to the rabbits they have a case. There is a huge predator/prey imbalance. They are an introduced species and they have no predators here except for the odd feral cat. There was a virus that was to be introduced to wipe them out, but someone brought it into the country illegally and it wasn’t put into the rabbit population properly and so wasn’t as effective as it would have been if they’d waited for the scientists to do it. Now, partly because of the way it was introduced, the rabbits have developed an immunity. They’re looking for another virus, but have not yet been successful. It’s only a small number of farmers with this excuse, but most of those using it are using it genuinely. Most farmers can and do use a rifle for pest control. They use professional rabbit hunters on these rabbit-riddled properties, and the hunters mostly use rifles except for these particular properties.
Sorry to hear about that problem. One that is unique to the Island situation I’m sure, similar to the snake problem on Guam. When we look at the potential predators for rabbits it is almost endless. Anyway, glad to see NZ is making fast progress on the gun issue compared to this country where the problem is entirely human.
You’ve probably seen by now that all semis, amongst other types are to be banned from sale here. However, the low-calibre ones that are used on rabbits will still be allowed. They didn’t use the sort of high-calibre guns and ammunition that was used in the mosque shooting; the hunters need to be able to pick up the rabbit carcasses and take them away.
Yes, far beyond anything we could ever hope for in this country. I suspect our only improvement here will be when they are able to sue these big manufactures into the grave. I hope they can do this before we are all in one ahead of them.