For the Health (Care) of America

Some of the current political climate in America, and, to be honest, Britain, has involved healthcare. In the US there has been a lot of railing against ‘Obamacare’ because it costs too much; while in the UK a lot of the Brexit talk focused on money spent (or not spent) on the NHS.

I’m of the opinion that the ‘life, liberty, and pursuit of happiness’ line spoken about in the Declaration of Independence includes, you know, actually living. That includes not living in fear of going bankrupt because of sickness or some accident. Thus I believe government-provided healthcare, like the kind provided by the NHS and which has an equivalent in almost all Western countries except the US, is necessary for the pursuit of happiness. And, you know, that whole ‘life’ bit, too.

The Case for Insurance

Both the US and UK (and many other places) use private insurance companies to provide and/or supplement healthcare. This is not necessarily a bad thing in and of itself. Insurance companies employ thousands, if not hundreds of thousands, of people. They, in turn, contribute to the economy and help keep others employed. Without their jobs they would either be unemployed and potentially living off benefits or working elsewhere that doesn’t necessarily pay as much. Thus insurance companies play a vital role in keeping the whole system afloat.

In the UK insurance is used either to supplement the NHS or for some people bypass it completely. I posted a link to an article before about how great the NHS can seem for outside observers, which for the most part I agree with. But it is also exceedingly slow for anything that’s not an immediate emergency.  I found getting an initial appointment quite easy and simple — usually I could schedule for the next day or within the week. When I needed a referral, however, I could wait for a long time. Then wait. And wait some more. Often it takes months once the referral is made to see the specialist. For those who have private insurance, however, the wait time is much quicker and can, sometimes, remove the need for a referral in the first place. If you need to see a neurologist you can schedule an appointment with a neurologist directly instead of seeing your GP and getting referred to a neurologist, for example.

It’s stressful, tiring and annoying having to wait and not knowing what’s going on. Private insurance can help ease that time, though obviously can’t eliminate it completely. Modern medicine just doesn’t have the ability to instantaneously give diagnoses. Even in the best sci-fi shows they haven’t cured every disease or ailment in the known universe. So insurance does have some benefits, potentially.

The Case Against Insurance and for Universal Health Care

The number one cause for bankruptcy in the US is medical expenses. As the Huffington Post pointed out about a recent Harvard Study, medical bills cause 62 percent of American bankruptcies, equalling about 2 million people a year. Of those people, nearly three-quarters of them (72 percent, or 78, depending on the article you read) actually had insurance. What’s the point of paying hundreds or thousands of dollars every year if it’s not going to be worthwhile? If you spent $5000 on car repairs only to have it break down as soon as you left the mechanic wouldn’t you demand your money back? If having health insurance doesn’t actually pay for health care, what’s the point?

In addition, health insurance plans are confusing. The general basics aren’t mind-boggling, necessarily, but knowing all the intricacies of what treatments are covered, which ones aren’t covered, if you’re ‘in network’ or ‘out of network’ and all sorts of specialised details makes the whole situation mystifying. Even the HealthCare.gov (aka ‘Obamacare’) official website has a whole glossary of terms to help people understand what it is they’re buying and receiving. It may not be like getting a PhD in rocket science but it sure isn’t basic arithmetic, either. Wouldn’t it be much easier if you went to the doctor and said, ‘I’m sick’, and that’s all you had to worry about in your health care decision?

There are a lot of critics and criticism against single-payer, ranging from doctors not having choices, the cost would be too high to long wait times (okay, that’s valid, as I pointed out). Some people don’t like the idea of ‘socialism’ or government-mandated anything, or more money for taxes. Those criticisms are mostly rubbish. The next part will be technical and include a lot of math and statistics, so be warned now.

healthcare

According to a 2015 Time article, on average Americans spend $89 a month on health insurance, or $1318 a year (although one post had that as high as $386 a month for single coverage, or $4632 a year, and even higher with plans that covered families). That’s before any deductibles, co-pays or other out-of-pocket expenses. Assuming, for the sake of argument, that a little less than half the of the American population (say roughly 150 million) pays for healthcare, that’s almost $200 billion a year, or $700 billion if using the higher number. Either way, that’s a ton of money spent on health insurance for private companies each year. Imagine if that went to the government instead.

The US spends the most per capita on healthcare of any country in the world. According to the World Bank, the US spends more than 17% of its GDP on health costs. The next closest Western country is Sweden, at nearly 12% of GDP. Most of the countries that have national health systems, including Canada, Australia, France and the rest of Western Europe spend anywhere between 9-11.5%, often hovering about 10%. The UK only spends 9% of its GDP on healthcare. Obviously, somewhere along the way, America got a little out of hand. Having a national health system will lower those costs.

According to the US Census bureau, the median income in the US is $55,775, and the average tax rate (federal, state, Social Security, etc.) is roughly 15% at that income. The Tax Policy Center has the effective tax rate (as a measure of percentage of GDP) at 24%, which is well-below the world average. Raising the average tax rate from 15% to 17% is, lo and behold, about the same amount the average person pays in health care costs already. So, effectively people can pay the exact same amount of money as they already are, have complete coverage from childhood til death and not have to worry about going bankrupt. Why is that a bad thing?

Why Nationalised Healthcare Is A Good Idea

Aside from not going bankrupt, there are plenty of other reasons to have nationalised healthcare. The Physicians for A National Health Program (PNHP) have created a chart highlighting some of the benefits of such a thing, including lifetime coverage, lowered administrative costs and plenty of patient choice (everything is ‘in network’, so patients can choose to go wherever they’d like). Other sites offer different viewpoints about the pros and cons, though the ‘cons’, I find, tend to be rather flimsy.

Even some typically right-leaning groups and publications have argued in favour of universal health care. The Economist, for example, wrote in a 2009 article that it’s a ‘common good’. It points out that Americans already also consider it a form of ‘common good’, since the US does already provide healthcare for the poorest group of people through Medicare and for veterans through the VA. So the US already has government-run systems. Why not expand upon those to include everyone? In the immortal words of Bon Jovi, ‘we’re halfway there’… And, in Star Trek it seemed like every species had free, universal health care. You never heard them complain about the lack of competition or some other illogical, murky statement. They just enjoyed getting healed.

One of the arguments against single-payer is that because there is competition amongst providers costs remain low. But because there are actually so many different companies and no coherent plan amongst them — and so many different places where they ‘compete’ — the reality is that there is no real competition. It’s like saying that because three pizza chains in California compete for customers then people who want to eat pizza in Michigan get lower prices. It’s false equivalency, the competition argument.

Though there are plenty of other arguments, I’ll leave off with this. Would you rather have your health choices in the hands of a private company concerned with making profits above all else, or a government charged with taking care of its citizens?

Heath insurance providers are businesses. Like all businesses their main goal is to make a profit. You are a consumer of a product for them and though it may seem like you have other choices in getting providers in reality your options are fairly limited. Especially if your workplace is providing health insurance (how many companies, plans or options do they offer you as an employee? I would think not many). So, since the providers have basically a monopoly over you they can charge whatever they want to make more money for themselves. There is no reason for them to actually provide services if it means losing money and profit. That’s why there have been so many insurance claims denied for things like ‘pre-existing conditions’ (which is an oxymoron since something either exists or it doesn’t; there’s no such thing as ‘pre-existing’. But that’s a philosophical and semantic argument). There’s a reason there’s have been findings that business behave like sociopaths. It’s because businesses basically are sociopaths.

Governments, on the other hand, have social contracts with their citizens. A healthy, productive, engaged populace is good for the government. If the citizen workforce is sick and not working, therefore not making money, the government gains no taxes because there’s no income. It’s in the government’s interest to make sure its citizens can work.

I for one trust the government more than a private corporation. Besides, I have other things I would rather (or need) so spend money on, like school loans. But that’s a post for another day.

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