-Every other developed country besides the United States has affordable universal healthcare in some fashion. They have differing degrees of government involvement in the process along with private insurance to various degrees in some countries. -we spend 18 percent of our GDP on healthcare. every other developed country spends not much more than ten percent. if we ran healthcare like any of them, the difference amounts to over a trillion dollars a year. that's the equivalent of cutting people's income taxes in half. you can also look at the break down per capita and come to the same conclusions as bernie always does. -Highlighting the need for reform: medicare and other government healthcare in the United States are running out of money, despite the common thinking that our payroll and other income taxes will pay for it all. The problem is so big, that healthcare is the only thing that could potentially bankrupt the country. The debt clock shows that our current GDP and debt is around 20 trillion, but future unfunded liability from healthcare is around 120 trillion. http://www.usadebtclock.com/ http://www.politifact.com/truth-o-meter/statements/2009/jun/25/barack-obama/obama-says-medicare-and-medicaid-are-largest-defic/ http://memepoliceman.com/social-security-medicare/ -There is speculation on what will happen when Medicare runs out of sufficient money to pay its bills. We might reform the system, put it on our debt, or print money to pay for it. -before obamacare, a commonly cited statistic was that over forty five thousand people died a year without healthcare. after obamacare, that number fell. the exact number is disputed by some, but the consensus is that the number is tens of thousands. for instance, there is no shortage of stories of insurance companies that deny or battle coverage while someone is dying of cancer. http://www.pnhp.org/mortality -Despite paying more than other countries, we have significantly worse health outcomes compared to them, even beyond high death rates. Fact One: The United States ranks 23rd in infant mortality, down from 12th in 1960 and 21st in 1990 Fact Two: The United States ranks 20th in life expectancy for women down from 1st in 1945 and 13th in 1960 Fact Three: The United States ranks 21st in life expectancy for men down from 1st in 1945 and 17th in 1960. Fact Four: The United States ranks between 50th and 100th in immunizations depending on the immunization. Overall US is 67th, right behind Botswana Fact Five: Outcome studies on a variety of diseases, such as coronary artery disease, and renal failure show the United States to rank below Canada and a wide variety of industrialized nations. Conclusion: The United States ranks poorly relative to other industrialized nations in health care despite having the best trained health care providers and the best medical infrastructure of any industrialized nation -The current healthcare industry causes people to go bankrupt. One in four of your grandparents will go bankrupt trying to pay for healthcare in this country. Before Obamacare, half of bankruptcies were healthcare related. If an insurance company fights to pay for your cancer care, for instance, you will face not just the prospects of death, but won't receive any government assistance until you're lifetime saving from hard work, become depleted. -The primary way these countries save money is by negotiating and regulating costs (such as drug costs) but some also take out the insurance middleman to reduce administrative costs. https://www.pbs.org/newshour/health/health-costs-how-the-us-compares-with-other-countries https://www.youtube.com/watch?v=qSjGouBmo0M -This article does a great job breaking down costs that need addressed in a universal plan. https://www.theweek.com/articles/792893/how-pay-medicareforall?fbclid=IwAR1Rds6oKvUJHSo64ApfRcf1Wq5UqKZTp6Nw6QJYwI9RD_mDOhOvQumiQ-s -Medicare spends twenty percent less than insurance for any given procedure, and Medicaid reimburses a third less than Medicare. (consider the bigger picture. if we spent a third less than we do now overall, we would be much closer to other countries spending rates) -the non-partisan committee for a responsible federal budget gives some examples of reforming Medicare, without cutting benefits, where major savings could be established and medicare become sustainable http://www.crfb.org/blogs/how-reduce-medicare-spending-without-cutting-benefits -Insurance companies spend thirty percent on the dollar on profit and administrative costs, while Medicare spends only three percent on administration. For every doctor, it is not uncommon to see two staff people just to take care of billing. There is also the marketing and legal departments, other issues that are redundant among insurance companies that run up administrative costs. "We have 900 billing clerks at Duke (medical system, 900 bed hospital). I'm not sure we have a nurse per bed, but we have a billing clerk per bed... it's obscene." Reinhardt, Congressional Hearing on Healthcare Reform. -The main reason we spend so much is because the healthcare industry charges so much for any given procedure. The last link lists some things that are not the main problem that are commonly cited, as is also listed later on this page. https://www.vox.com/policy-and-politics/2017/10/16/16357790/health-care-prices-problem https://www.nytimes.com/2018/03/13/upshot/united-states-health-care-resembles-rest-of-world.html https://www.modernhealthcare.com/article/20180407/NEWS/180409939 -Hospitals are a bigger bad actor than insurance companies because they are prone to excessively charging simply because they can. -Doctors and other healthcare professionals salaries are included to some extent in the excess. There is an artificial restriction on the supply of doctors and they earn significantly more than their counterparts in other countries. There are fewer physicians per person than in most other OECD countries. In 2010, for instance, the U.S. had 2.4 practicing physicians per 1,000 people — well below below the OECD average of 3.1. https://www.politico.com/agenda/story/2017/10/25/doctors-salaries-pay-disparities-000557 -A, or 'the', major problem we have five percent of patients that cause half our healthcare expenses. this could potentially be regulated by creating a "high risk" category in the industry, where reimbursement is lower. If we reduced that category of expense by half, we should reduce the overall cost of healthcare by a quarter. (think of the GDP numbers, instead of 18 percent, we'd be closer to other countries) Think of the bigger picture- the average that is spent on each of those patients is $40,000 per year. You could hire a doctor to take car of just five of them and his salary would be paid for. Trying to manage care like that is easier said than done though. So what happens is we end up having the healthcare industry milk each procedure and charge too much overall. http://www.pnhp.org/news/2014/september/8-facts-that-explain-what%E2%80%99s-wrong-with-american-health-care -half of people get their insurance through their jobs. a lot of people are satisfied, but not all of them. and there is a general awareness of the waste involved. -here is a public option plan that could cover anyone wanting to join and includes allowing employers to join. this plan, Americare, achieves savings through all the means mentioned above and makes healthcare universal and affordable. https://www.msn.com/en-us/money/personalfinance/this-old-bill-could-be-the-secret-to-affordable-universal-health-care/ar-BBDmswj?li=BBnbfcN&srcref=rss -here is a dude proposing public options through expanding medicaid and medicare. this sort of pragmatism hasn't been in the media a lot in recent years, but it's slowly becoming more mainstream. the second link illustrates some of the politically infeasible aspects of trying to get to single payer. the last link argues for a medicaid public option. https://washingtonmonthly.com/2017/04/27/the-case-against-single-payer/ https://www.theguardian.com/commentisfree/2016/feb/05/bernie-sanders-single-payer-universal-coverage -https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2018/08/02/the-health-202-medicare-for-all-is-the-dream-medicaid-for-more-could-be-the-reality/5b61d4ed1b326b0207955ea2/?noredirect=on&utm_term=.d9412cfb413d https://prospect.org/article/buying-medicaid-viable-path-universal-coverage -the above link shows a slight majority of americans support universal care. there is an even higher support when you raise the proposition that it can be cheaper that way too. -universal care doesn't have to be single payer or some form of a public option. switzerland does it like obamacare, yet it's affordable. the main way, as has been discussed, is because of regulating and negotiating with the health industry on costs. https://www.forbes.com/sites/theapothecary/2011/04/29/why-switzerland-has-the-worlds-best-health-care-system/#64f2ee5a7d74 -would universal care starve research and development, innovation? this article says not, and it says that we spend around a hundred bilion per year on reseach and development. you can see it's just a fraction of what we spend on our trillions in healthcare. we could double our R and D spending and still cover everyone. http://www.pnhp.org/news/2007/november/does_universal_healt.php -is the problem malpractice costs? if you count premiums and the amount paid by insurance malpractice companies, and the cost of defensive medicine where doctors use procedures they otherwise wouldn't to avoid lawsuits, the amount comes out to less than fifty billion dollars. again, this is a small fraction of the trillions we spend in healthcare. https://www.forbes.com/sites/rickungar/2010/09/07/the-true-cost-of-medical-malpractice-it-may-surprise-you/#12feaa622ff5 -If we keep health insurance to any extent, we need to make them non-profit organizations. Because health insurance in this country is for profit, they are going to do everything in their power to avoid paying your healthcare. Their main motivation is higher profits, not your well-being. Denying claims is just one clumsy way of saving money though; the main way is by avoiding unhealthy people altogether. In other countries, any surplus funds are directed towards lowering premiums. Some of the countries have a health system like our current Medicare, where basic dental and eye health along with some luxurious arraignments are only covered through supplemental insurance beyond the government basic coverage. -none of the existing proposals are the only methods. some free market types have posited that we could have universal catastrophic care (covering care above a certainly yearly deductible), and something for the poor. the free market would drive down costs for everyone else on non-catastrophic issues that arise. A variation on this theme is they could outlaw non-catastrophic insurance and promote health savings accounts that already exist. Another variation, if lawmakers wanted to play twisted with poor tax payers, they could give them subsidies before their catastrophic coverage kicks in that they can pocket if they don't use to discourage overuse. (this wouldn't be politically popular and has questionable ethics, too) http://thefederalist.com/2017/03/31/whats-better-medicare-free-market-health-care-system/ -France is rated number one by the world health organization and has an esteemed tort reformed system. (not that this is the major driver of costs) -a universal system probably wouldn't be like the VA, especially in the USA. most countries aren't either. that is where the government is employer of healthcare workers. most universal care proposals only rely on the government at most as an insurer, not as taking over everything. government as employer like the VA is only the case in the UK, but they don't have significant problems there anyway. the VA isn't as bad as it used to be either as most veterans are happy with their care.
Would the USA suffer in the time we wait to see a Doctor?: -the idea that we have to wait longer in a single payer system is mostly a myth. according to the Commowealth for most procedures the usa is well below average in wait times. for some specialized care, the usa is towards the top, but still not best. https://www.theatlantic.com/health/archive/2013/11/universal-healthcare-doesnt-mean-waiting-longer-to-see-a-doctor/281614/ -a libertarian who supports french healthcare: "For a dozen years now I’ve led a dual life, spending more than 90 percent of my time and money in the U.S. while receiving 90 percent of my health care in my wife’s native France. On a personal level the comparison is no contest: I’ll take the French experience any day. ObamaCare opponents often warn that a new system will lead to long waiting times, mountains of paperwork, and less choice among doctors. Yet on all three of those counts the French system is significantly better, not worse, than what the U.S. has now." http://reason.com/archives/2009/12/07/why-prefer-french-health-care http://www.pnhp.org/news/2009/december/reasons-matt-welch-on-french-health-care -the idea that canadians come here because of wait times is mostly a myth. only 20 for every 18,000 canadians come here on purpose for healthcare. it's not clear why they choose to do so (maybe there's a wait issue, maybe they respect the USA more given its reputation for quality in some areas of healthcare), but it's clear the numbers are miniscule. the atlantic article above does say canada is the only country worse in wait times, so there could be that, so a slight extent. the only reason canadians are worse, though, is because they choose to not fund healthcare as much as other countries or the usa does- a political decision that can be remedied here, and isn't a problem any where else. https://www.vox.com/2016/10/9/13222798/canadians-seeking-medical-care-us-trump-debate https://www.aarp.org/politics-society/government-elections/info-03-2012/myths-canada-health-care.html
What can we conclude on wait times?: -wait times is mostly a red herring- if we want decent access to doctors we shouldn't limit the supply of doctors like we have in the usa. let the free market work more in this regard. -every other developed country is either single payer or has some sort of government involvement majorly. and they all are almost half as costly. most countries to save money by regulating costs. this is probably why specialized care wait times has been hurt some in other countries. but the fact that the usa is not the best in that regards, shows that it can be done better than here and with government involvement that covers everyone. and, all it means is we shouldn't be too gung ho on over regulating specialized care. -other countries are like us. to the extent that there are wait times, it's mostly for people who dont need urgent care. the more urgent your situation, the faster you get seen. that's how it's done here too. any delay to the less urgent isn't significant enough to justify all the good points of single payer or a government involved method. -there might be some limitation to access if we open up access to doctors to the remaining ten percent of uninsured just by demand going up some, but ten percent more people would not cause a significant shift in outcomes, and most states have less than that uninsured. There would be no lines under a universal health care system in the United States because we have about a 30% oversupply of medical equipment and surgeons, whereas demand would increase less than 10%. and, is it all that moral to make your own care better by denying it to someone else? especially when you can just find a way to take care of them that doesn't really affect you, but you simply choose not to?
thought experiment on the affordability of universal care: here are some interesting facts that can help someone do thought experiments: *healthcare costs three and a half trillion in the usa. *employers cover half the costs currently *state governments spend 600 billion currently on healthcare and the federal government spent 1.1 trillion, and depending on how the system is designed, this money would be available one way or another *the average income in the usa is around forty or fifty thousand for a person *the top ten percent of tax payers pay half the income taxes and of course the rest of people pay the rest *the richest people pay a trillion in taxes and the rest pay another trillion *almost every other developed country pays half as much as the usa does on healthcare *healthcare costs ten k in the usa per captia and half that elsewhere *someone making average income pays about six grand in taxes using thought experiments, we could assume employers would cover half the costs of healthcare in a universal system, or 1.8 trillion. federal and state government spend about 1.7 trillion. both of these equal 2.5 trillion, and that leaves a trillion in additional revenue that needs to be made up. All we would need to do is increase taxes on that current two trillion in revenue at fifty percent more, producing a trillion in additional revenue. Someone who pays 6k in taxes will now pay 9k, only three thousand more. If we got overall spending down to the level of the rest of the world at half the cost, current revenue by governments and businesses would be sufficient and no increase would be needed. If we cut overall spending by a quarter, taxes would increase a small amount. 3.5 trillion * .25 = 2.7 trillion. or in other words taxes would only go up ten percent for people, or 600 dollars for an average income person. If we kept them paying obamacare premium numbers, their cost would be 450 per month, which is not that unreasonable for healthcare. A political point would be that increasing taxes might not sit right politically with people, but paying a premium if healthcare is done that way, is not that far fetched.