A good question would be what can be done to fix healthcare in the US?
My understanding is that most voters don't support universal healthcare. IIRC even Obamacare was labeled as controversial. Current model costs way more, the model is clearly broken, why there is no pressure to fix it?
ps. I don't want to get political or anything by mentioning Obamacare. I'm genuinely curious because the problems of the current healthcare system are very well known and discussed for at least 20 years.
I see your desire to not get political, but healthcare in the US is inherently a very political topic.
Both the democrat and republican "Media" want you to think that voters don't support universal healthcare. One would expect that from the right, but from the left? As I see, every question about healthcare reform during the democratic presidential debate had the right's frame: instead of highlighting the failures of the current system (the cost, the quality, un or underinsured people, personal tragedies due to lack of healthcare), the questions were phrased focusing on mainly the positives ("some people love their current healthcare plan").
This Fox News Voter Analysis shows a surprising number of voters support (Strongly/Somewhat favor 70%) "Changing the health care system so that any American can buy into a government-run health care plan if they want to" See: https://www.foxnews.com/elections/2020/general-results/voter...
I might be too far in my progressive YouTube bubble, but there was definitely pressure to fix it. Very recently, there was tremendous pressure on the progressive members of the Democratic Party to ask for a vote on M4All in exchange to their vote for Pelosi as speaker. You can search for #ForceTheVote on different platforms. Unfortunately, none of the progressives exercised their power, and Pelosi was confirmed.
My understanding is that most voters don't support universal healthcare.
Most Americans think it is the government's responsibility to ensure all Americans have healthcare coverage [0]. Also, it seems like you're talking about Obamacare as if it is universal healthcare. It's not.
why there is no pressure to fix it?
There is pressure. We're not even weeks removed from the "Force the Vote" campaign for Medicare for all. This is just the latest push to get something done about healthcare in the US.
Overall, this is just another way where most politicians (in this case, Republicans and moderate Democrats) are representing their lobbyists more than their constituents.
> Overall, this is just another way where most politicians (in this case, Republicans and moderate Democrats) are representing their lobbyists more than their constituents.
I would be careful with this interpretation. Universal healthcare has broad support but when phrased in the context of specifics or in the context of what has to be given up to achieve it the percentage of people supporting it declines.
Agreed. Of course, if ask Americans “wouldn’t it be nice if everybody had access to healthcare" everyone says yes. If you touch on how, who pays, or if you have to give up existing care, approval tanks
> My understanding is that most voters don't support universal healthcare.
Medicare is almost universal healthcare for the elderly and disabled. Expand that and there you go.
Obviously, expanding it to the whole country in one fell swoop would cause a lot of problems. Instead, I would drop the age requirement over many years, to give the systems time to adapt, and allow for oversight and addressing of problems. Potentially also add coverage from the bottom up. Targeting something like 1% increase in enrollment for a few years, and see if you can increase that over time to 5%.
Medicare is universal health care for hospitalization (i.e. emergencies. The second you’re not in the hospital, you’re dealing with means testing and various insurance company offerings.
I have no personal experience with the VA, but unlike Medicare which seems to be almost universally liked by seniors, I’ve heard almost nothing but complaints from military members about the VA. If I were going to attempt universal health care, seems better to start by expanding the program that has the most goodwill.
I've heard good things about VA health care, when people are able to get care. But there's a lot of waiting to get care, and sometimes a lot of fighting [1] to show eligibility in addition to all the waiting. Psychiatric care is reportedly much more problematic, as well.
I agree, it wouldn't be the one to expand, because of lack of goodwill, and lack of capacity for more patients.
[1] One of my relatives has symptoms associated with Agent Orange exposure, but had a lot of trouble getting the VA to cover it until recently, because (as I understand) his service records didn't show that he was in an area with exposure. Some recent laws passed changed the criteria that granted eligibility, and he's been happy with the care he's received since.
The law has 2 parts: the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act.
If you actually do read it, note that many of the items in the bill required rule making and have entries in the federal register with the final rules. I don't know of an index that points to all the final rules.
Obama himself has referred to it as Obamacare. It may have started as a dig at the plan by its opponents, but now most people know it as Obamacare while ACA might as well be political jargon.
A lot needs to be fixed. Most of our problems boil down to lack of competition and regulatory capture.
As a regular citizen, I would do the following.
See if your state has certificate of need laws and ask your state representatives to repeal them. If your state has these laws you are likely paying 5% more for medical services with no difference in quality of care.
Look into direct primary care clinics. Oftentimes you can get wholesale prices for labs, procedures, and imaging as a membership benefit of their practice. You can find a lot of clinics that run in the $80-100 range per month per person. (usually cheaper if you have multiple family members) You get more time with your doctor, and the incentive structures in this type of practice are much better aligned than in traditional fee for service clinics.
I would look into reforming the Hatch Waxman Act. Specifically I would require drug manufacturers to give samples of their drugs to the FDA which in turn would give them to generic drug manufacturers who want to enter the market. I would also end the (many) shenanigans that occur when drug patents expire.
Let nurses and doctors easily transfer credentials across state lines. This is often unbelievably burdensome.
Most prices aren't "real" when you get your medical bill. Most of the markups are insane and thus you can negotiate with billing offices to get a more reasonable rate. My general rule of thumb is to start at 10% of the bill and negotiate from there.
I just learned about Direct Primary Care a few weeks ago from the White Coat Investor podcast [1].
The doctor interviewed does a direct pass-through on lab expenses. MRI's get done for hundreds (not thousands or tens of thousands) of dollars, basic blood work costs single dollars (and I think one common test was under $1). It's a whole different world of medical care in which your medical insurance becomes more like every other insurance product out there - only used for significant events not the mundane day-to-day stuff.
Also, published prices in a standard format available on the web would go a long ways. Current state of system: How much does something cost? You will find out after the fact.
A good question would be what can be done to fix healthcare in the US?
I honestly think a good first step would be to break out the concept of long term medications from insurance. Payment support (or outright buying for low income folks) for medications that are needed long term would go a long way to making sure some very vulnerable parts of the population (diabetics, long-term cancer medication takers) are covered.
I don't think there is a "one big plan" solution, and carving off parts of the problem would actually be a better way to go.
US healthcare culture is very different from that of many countries with "free" universal healthcare.
In many such countries, there's no such thing as a yearly / annual checkup. People go to the doctor when they feel sick - or if they actually get checkups, it's in the light of some illness like cancer.
Usually, there's nor any "full" check, meaning that doctors will run every test known to man on you, just to be sure. Tests are done in a holistic way, as they start getting an idea of what's wrong with you.
And unless you have something really pressing, you won't get an appointment (or even treatment) STRAIGHT AWAY.
I guess my point is that a lot of Americans would probably feel that they were receiving vastly inferior treatment, but maybe they're used to getting overtreatment?
The incentives are all wrong. Tests are money spinners, so hospitals and clinics push them hard. Over-testing is usually associated with worse health outcomes. For example, nearly anyone who gets a full body scan has a few suspicious looking blobs. It's almost always nothing, but it results in unnecessary treatment or exploratory surgery while not actually saving many lives.
Voters typically like the idea of universal coverage, and strongly dislike the idea of being forced to give up their health insurance. The idea of banning private insurance is deeply underwater.
This is one reason why some advocate for a strong public option; if it’s seen as superior to the private choices it would either win out (resulting in de facto single payer), or drive down the cost of private insurance until it’s price competitive with the public option.
I can't see the US ever adopting a single payer health care system. However I do think they could adopt a health care justice system.
The US cares a lot about justice, and free markets. Some kind of well funded, and empowered FBI system for ensuring citizens get fair value for the money spent.
I’ve seen surveys reporting that over 90% of Democrats and a significant minority of Republicans want universal health care. It may be out of scope for this discussion to figure out why the priorities of voters do not translate to policy in the United States.
> My understanding is that most voters don't support universal healthcare.
They don't support the version of universal healthcare that's usually proposed, but give them a way to make their own choices to keep them out of a Charlie Gard (a.k.a. "Death Panel") situation, even if it means having to pay extra, then there would be much more support.
making cost non-negotiable would help a lot. Then the behind the scenes cat and mouse billing/reimbursement game insurance and providers play no longer exists. Providers and insurance will have to compete on price with the patient fully informed.
But whether people would support a specific plan that has a new payroll tax(and greatly reduces premiums, deductibles and copays, and still saves the government hundreds of billions each year) and all but abolishes private insurers is less certain. This is part of the reason why Biden's plan is for a new government insurance plan, not single payer or "funded" through a payroll tax. But it does include some provisions of S.1129 - Medicare for All like the start of lowering the medicare age
My understanding is that most voters don't support universal healthcare.
One part of our population does have universal health care: Native American tribes on reservations. It is perhaps the worst health care in the country, particularly if you get sick as the budget runs out ("don't get sick after June" is a documentary on the subject). If the United States is incapable of providing decent health care for a very small percentage of the population then what chance does it have for the greater population? I will believe in US universal health care when they can do it right at a small scale.
There is little political will or impetus behind properly funding programs for Native Americans, or running agencies like the Indian Health Service, because Native Americans don't have the visibility or political clout to force the American government to take them seriously, as do other groups like African Americans.
Also, some like to point at European countries (e.g. France) as proof that universal healthcare works, ignoring that a) some of those countries are very different from the US, and b) even the "successful" ones aren't proven viable for the future, i.e. rising costs.
If you want to improve things, how? The money has to come from somewhere, and so far may of the plans punish those that already have health plans. Some administration needs the balls to truly reform healthcare laws - but that's one hell of a fight, especially while concurrently fighting all the other issues/culture wars at the moment.
They've proven cheaper and more effective in other countries for decades... Healthcare costs are rising everywhere as well, it alone isn't enough to somehow wipe away the fact the US pays about double for worse care.
Decades isn't long enough. If Healthcare costs are rising everywhere, then no-one has a stable solution.
And I'm talking about universal healthcare, not American healthcare; the difference being that there are more than one factors that goes into the end-result of American healthcare, so if you start talking about universal specifically and then switch to American outcomes, you are implying the one follows from the other, and the burden is on you that that outcome is purely due to that one factor (and not, say, a culture of litigation; or cultures of corporate lobbying/corruption etc).
I'd also wonder which part of my post drew downvotes. I hope it's not that I dared suggest that Obama lied. But that was one reason it was controversial, and that future efforts at something similar are now damaged; who'd trust a similar proposition when even wunderkind Obama couldn't be straight about the deal?
My understanding is that most voters don't support universal healthcare. IIRC even Obamacare was labeled as controversial. Current model costs way more, the model is clearly broken, why there is no pressure to fix it?
ps. I don't want to get political or anything by mentioning Obamacare. I'm genuinely curious because the problems of the current healthcare system are very well known and discussed for at least 20 years.