And that, right there, is the primary sticking point, ideologically and economically speaking.
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They just want to keep “their Medicare” and get all the services they “paid for”.
The tie in to climate change is that Americans have a very, very highly developed sense of what goods and services they are entitled to, and how much they should be required to pay for them. And they exercise that sense at the polls.
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This, to a couple of powers of ten.
Every day in the US there are bedridden 92 year olds who receive pacemakers, and 400 pound diabetic lifetime smokers who receive knee replacements. They (and their families) vote.
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And there are autistic people denied organ transplants because studies suggest we don’t live as long and don’t get the same quality of life…
Let’s bring it a little closer to home, rather than using the “undeserving” (?)
The US has 4.5x as many MRI machines per person as Canada.
Your child has some odd, but persistent dizziness. The American doctor thinks very little of ordering an MRI, just in case there’s something more serious. The Canadian doctor is vastly less likely to.
The MRI is unlikely to reveal anything interesting. But on rare occasion is does, and the result could save your child’s life. (These are the sorts of things that make Canada’s health outcomes a smidgen worse than American outcomes while saving a ton of money.)
Do you accept the trade-off? Especially if your household income is, say, $120K you’re not actually saving anything much on medical care - your expenditure, does, however, provide the same level of medical care as you are receiving for your fellow Americans who are not so fortunate. (The answer is “yes”, by the way :-))
The truth is that if I’m going to be at all effective at persuading those who aren’t already in my camp, I have to understand, and to some degree, empathize, with their objections. Without that ability, then I’m essentially prizing my “moral superiority” over actually having a chance to help my fellow man (through political channels, anyway).
Canadian E0 is 82.2 years. American is 79.3 years. So Canada’s health outcomes are still better than ours.
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That MRI for your child’s dizziness is every bit as available for the poor child in the USA as it is for the child of the wealthy. I work in a major urban hospital and I can tell you that’s a fact. Medicaid coverage for children is readily available with no out of pocket costs.
So it makes complete sense to me that if the rich can afford that scan, and the poor have it as a result of Medicaid, the middle class is going to balk at being told they will have to do without.
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My comparison is between those who have decent access to the Canadian health system (very high) compared to those who have decent access to the American health system (fairly high). I am pointing out that there is a minor sacrifice (really minor, the outcomes for individual diseases are surprisingly close considering the difference in expenditures) for those who currently have good access to healthcare, but they are real.
That health outcomes overall would improve with wider access is a no-brainer and is the moral justification for the exercise.
Still, before I get too full of myself, it’s incumbent on me to remember that we could almost certainly increase global health outcomes by sacrificing most of the expensive healthcare to buy better primary healthcare in much of the world, and yet I’m not rushing to have the sort of healthcare that saved my son’s life instead used to save several dozens or even hundreds elsewhere.
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Truly? I have no doubt that medical care that is directly related to the problem would be available under Medicaid. However my example (completely made up) is meant to illustrate cases where an MRI is not considered medically necessary, but would be a common “extra service” that most physicians would supply to an insured person.
I would be shocked if Medicaid would pay for unnecessary procedures (that may have some benefit, but very likely not).
After all, reduced unnecessary testing is one of the major tools in your arsenal of cost control.
In the three states where I have worked, if a physician documents that the child may have a diagnosis where an MRI would be useful in determining treatment, Medicaid will pay. End of story.
And because American physicians (rightly or wrongly) believe they may be savaged in a malpractice settlement if they fail to do everything remotely of benefit, they document the diagnosis and order the scan.
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There is a Chrome plugin called “Lazy Truth”
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