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- Location: United States
I take it from the conversation that most, if not all of you either don't work in health care or any of the related fields that provide or support health care in this country. I have worked in health care IT for 20+ years, including payer insurance so I have some experience and perspective on the subject.
Some background...we've all heard that the US has the best health care system in the world. But in reality, if you measure the US versus many first world western nations, we're not leading (and in some cases, significantly behind) in a variety of industry metrics. We do have the best trained health care workers, facilities and technology. The problem for many Americans is access, either due to economic or logistical issues. People who do not engage the health care system, especially early on will be sicker and therefore, use more expensive resources of the health care system later on.
Our health care delivery system is unique in the world for its complexity. The system is largely based on private sector insurance, which grew out of post WWII American business. Because of the piecemeal approach, it's never been able to cover the majority of the entirety of the US population. As a result, we got federal mandated health care for the poor...Medicaid. Run by the states themselves, the idea was to guarantee access to the system for the most economically disadvantaged. At the same time, Medicare for senior citizens was created. Both are mostly single payer systems (i.e., the government pays the health care providers for service rendered), but states run Medicaid while the feds run Medicare. On top of that you have the Veterans Administration system which is also single payer federally based but everyone agrees has serious problems, mainly to initial access because of red tape. Once you get access, it's supposed to be pretty good.
So in one lifespan, you could be on Medicaid at one point, payer insurance from an employer and Medicare at the end of life (or the VA system)...all with their own databases, support infrastructures, payer networks, everything. Does this sound efficient? Most of the rest of the world would say no. Virtually all other 1st world nations (and many third world ones) have single payer systems, which is just another term for government paid healthcare. There's lots of consternation in this country over the very topic, some of which has been said earlier in this thread. Yet Medicare seems to have high approval ratings for the seniors who use it, which is basically just what the rest of the world is doing, limited by age.
The politics of the issue are framed in the polarization of the political process in general. In other worlds, if your political opponent comes up with an idea, you must trash it by default, regardless of how much of it you might agree with. This has made some interesting bedfellows and protest which, if looking from the outside in, is absolutely absurdist. If you joined the rest of the world in the single payer model, you would likely do away with the entire private insurance industry, sending all of those companies nationwide out of business, or at least just end up being government contractors. If the US had done single payer early on, say after WWII, this discussion would be academic. But Truman's poll numbers were horrible and the Eisenhower and Kennedy administrations were dealing with the Cold War mostly. By the time the Johnson administration came around, private insurance health care was firmly entrenched. The best that he could do was to fill in the gaps in the system (Medicaid, Medicare). But other gaps remained (like employers that didn't offer health care or the short term unemployed) and those gaps would only grow enormously in recent years. For context, Britain's Margaret Thatcher was a huge supporter of single payer universal health care and passed legislation guaranteeing it in the UK.
The Affordable Care Act (nee Obamacare) actually grew out of ideas from the Heritage Foundation...not exactly the beacon of liberal policy making. The idea was this: "Could you use the existing private insurance market to fill in the coverage gaps and make universal health care possible?" The idea was mandating that everyone join the insurance system run by the free market, not the government (like Medicaid/Medicare). Large companies who already provided insurance for employees could still do so. But the tax structure would subsidize everyone else and there would be a sliding scale of payment depending on the person's income, employment (or lack thereof), etc. The idea was adopted and implemented by Mitt Romney in Massachusetts and was largely successful.
But when President Obama proposed doing the same thing, Republicans who spent years working or implementing the idea all of a sudden washed their hands of it, largely because of who was trying to implement it on a nationwide scale. This is curious since it would be the final stake in the heart of ever having a single payer system in the US....which conservatives usually say they want. Why abandon your own idea if your political opponent wants to do it? That used to be called in political circles, a victory. Now a victory is considered to be a total repeal of the legislation, putting us back to the old system with it's growing gaps of millions of Americans and natural inefficiencies.
By far, the mandate that everyone join the system is the most unpopular of the plan. The people of the US has a history of distrusting government mandates, regardless of how benign they might be. But from an actuarial standpoint, it only works of everyone actually participates (healthy and sick people in the same system). Sick people get the care they need, but more important long term, healthy people engage the system early and stay healthy longer. The alternative is either single payer, or what we have now where people avoid care due to the costs and only show up when they are very sick, after cheaper therapies were available earlier.
Some say that you should have a "right" not to have insurance and not to engage the system. The problem is that health care isn't something like a car. You don't want to pay mandated car insurance? Don't own a car. But everyone has to visit the doctor or a hospital sooner or later and it's best if (like a car), you go in for routine maintenance. Since the likely hood that you will engage the health care system is about 100%, platitudes on independence don't make sense here. Since the system costs money to run, we have to figure out a way to make the system work for all without bankrupting the government or families. The rest of the world figured this out decades ago and nobody complains. Here, we seem to have a perverse wish to have the right to get sick on our own without a safety net, which only drives up the cost of heath care for everyone when said person shows up in an ER (the most expensive of all care) or waits too long to solve a medical issue that could have been treated less expensively and with a better outcome years earlier.
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