Thursday, March 9, 2017

The Case For National Health

The Affordable Care Act was a good idea terribly executed.  It was only affordable if you were dirt poor.  It will be repealed.  Most likely the ACA will be replaced by what we had before, which was nothing except a platform of insurance plans.  Oh, sure, there will be talk of savings accounts that are tax free but that won't help the folks who don't have enough money left over at the end of a month to make deposits in those accounts.   The Republican party is for small government and big defense spending.  That usually means you are on your own and thanks for your tax money to buy a new fighter jet to add to our arsenal.  That is all well and good.  But we are at a crossroads.  While every other western industrialized nation in the world has a national health system of some sort, the US is still working with a healthcare model of a hundred years ago:  those with money get well and live, the poor get sick and die.  



The green areas represent those nations who have some kind of cradle-to-grave health network.  Most everyone except the poorest or most corrupt nations.

After the Depression the Congress recognized that taking care of the elderly poor was more expensive than creating a system whereby they would pay into a fund and get subsidized after retirement.  Social Security was born.  Likewise Medicare in the 60's.  Both parties came together to provide a safety net for the elderly in America.  Yeah, taxes from your paycheck were taken out with the promise you'd get it back when you retired, reached a certain age or needed it.  

I am making a case for National Health.  It will, of course, never happen, and unfortunately it will keep us a poorer and sicker country.  When I was at the Mary Davis Home we often took trips to other state detention centers in a quest to learn from the; taking what worked elsewhere and then taking it home to try.  Learning from others makes one smarter, right?  Well, just mention National Healthcare and you'll get all kinds of bat-shit crazy moronic relies:  "it's Commie socialism",  "we are American, we don't need anyone else's ideas", "I already pay too much in taxes", and so on. 




The present American healthcare system, before and after Obamacare, is the most expensive in the world.  And yet in 2013 a study examining 11 industrialized nations showed the US had the 5th in quality and last in infant mortality. We also did the worst job in preventing treatable diseases like stroke, diabetes, high blood pressure and some treatable cancers. (1)  The expense is because different hospitals charge different prices, and some states are more expensive than others, all the time big pharma can charge whatever they want for their products.  Just look at the $1000 hepatitis pill or the recent Epipen pricing where a single dose went from $75 to $600.  In addition different insurance customer pools will determine higher or lower costs. 

There is no doubt that Obamacare was lacking in price constraints in both premiums and deductibles.  The fact that they had a tough time signing up younger insurers did them in, too.  The Republicans are right in that the ACA was imperfect.  And now the new Administration and Congress put out their new proposal a couple days ago.  Many have referred to it as Obamacare 2.0 or Lite.  Their plan relies on Health Savings Accounts but many can't afford them.  The new plan is tougher on those advancing in age tiers.  Those 40, 50, or 60 are going to get slammed financially.  Once again, an imperfect healthcare system.  


Let's talk a bit about these usual deterrents to national health.  


1.  Many point to Britain's system that is running out of money.  That wouldn't affect an American system because the money we throw at health care is 5 times what they pay.  

2.  Some point to Canada's healthcare system that pays too little to their doctors.  Well, that seems like an easy fix doesn't it?  

3.  It is socialist communism.  Well, so is Social Security, Medicare, Medicaid and most of he federal government.  Social Security and Medicare seem to be working just fine, at least when it's coffers are being robbed by the politicians.  

If America had a Single-payer system:

1.  Instead of forking over anywhere between $400 to $1500 per month for insurance, your cost will be determined by your ability to pay.  The average worker making $45,000 a month will pay from $230 - $250 per month.  

2.  In a National Health system it will be cradle-to-grave with a small copay for doctor visits.  Hospitals stays would be paid by the pool that includes all Americans.  If you work, you pay in just like Social Security.  

3.  All areas of medical need would be covered: dental, vision, reproductive services, child birth and end-of-life hospital stays.  

4.  Doctors would be paid fee-for-service, from the hospital, or from the HMO.  They would be paid similarly to what they make now.  By eliminating private insurers 400 billion would be saved annually by pre-negotiated fees.  This can then be floated back into the system.  

5.  There is a myth that in a governmental universal healthcare system that those entities would dictate medical treatment, much like insurance companies do now.  That is no the case in universal health:  all medical determination would be made by the doctor and patient and patient family.  The government is a holder of fees only. (2) 

Having said all that, America will buck the trend of the rest of the world and retain its impossibly expensive system leaving many millions without insurance.  Many families will go bankrupt when hospital costs skyrocket even more than they have.  We are too wed to political party, too wed to big medical and big pharma.  The lobbyists pay a great deal to political campaigns to insure that our Congress will keep the status quo.  Of course lets not forget that our politicians have their own very lucrative and inexpensive healthcare system.  

Perhaps in a hundred years after many reforms we may do what every civilized country in the world is doing, and it is a shame that America no longer has the integrity, balls or motivation to do what past Congress' have done with programs like Social Security and program passed during the era of the Great Society.  I hate to tell you flag wavers but the American Way is not always the Best Way. 

1.  Consumer Reports
2.  Physicians for National Health (PNHP.org)

1 comment:

  1. Well done Mike. The changes proposed and likely to be approved by Congress are a huge step backward. Seems to be the direction many want to go on a variety of issues.

    ReplyDelete