Indeed. Before Medicare, those people just fucking died.
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Yeah, but at least we didn’t have to pay for a bunch of moochers… /s
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You are correct! I definitely made that mistake. I got it flipped around. It’s a proportional tax, and thus regressive to some extent. Making it a progressive tax is what would generate more revenue. However, I’m skeptical that would really be needed.
Yes, that was part of what I was saying; that the ACA greatly reduced the number of uninsured. If I recall correctly the current rate of health insurance was in the 85-86% range. Given the individual mandate part of the ACA (at least, until recently), I assume that number is pretty close to maximum load. If people don’t have insurance through the ACA, why would we expect them to have insurance through a single-payer system? It might tick up a bit, but I assume a lot of that is because people are homeless/transient, expats or incarcerated.
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Case in point: insulin, a drug that has not changed substantially in almost a century, now costs so much that Eli Lilly is getting press for producing a generic that “only” costs $137 per vial, which is half of the name-brand price ($275). In 1996, insulin cost $21 per vial. Inflation isn’t that ridiculous, and according to CNN the cost for manufacturing insulin for a person for an entire year is about what it costs to buy one of these new generic vials.
https://www.cnn.com/2019/03/04/health/insulin-price-humalog-generic-eli-lilly-bn/index.html
Prices are going up simply because they can. There is no market force demanding that insulin cost over 13 times what it did less than 25 years ago besides corporate greed. After all, what are people going to do, not take their insulin?
Oh, wait.
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I am betting that only one of the two of of us trains public health professionals and researches population health…
You seem to have difficulty with reading comprehension since I have explicitly written several times in this thread that (a) I support single payer and even nationalized health care in this country, and (b) that universal high quality coverage is an important determinant of health.
That is a separate claim from what is needed to get the US’s population health measures (life expectancy, infant mortality, etc.) from just below Cuba’s to up near Finland’s or Japan’s (i…e addressing the major determinants of illness and health).
I don’t agree that it is separate. We could make a great deal of progress against inequality, racism, and mass incarceration and still have terrible health outcomes due to inadequate coverage and a large number of people who can’t afford care. The good thing: it’s not either-or. We can do both.
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Of course it is not either or! I never argued it was. I am simply saying that the population health consequences of WIC, clean water, lead in buildings, racial profiling by police, incarceration for marijuana posession, racist and homophobic and transphobic limitation on economic opportunity, xenophobic violence, etc. ad literally nauseaum are not prevented by health care.
Given that I’m the 4th or 5th person to respond to you in this thread, I would humbly submit that you are not making yourself clear. Getting frustrated with us that we are not understanding you is not productive.
I’m still hung up with your initial statement;
In which you dismiss, or state as negligible, the effect of lack of insurance or underinsurance as a factor in health outcomes and mortality. I respect your expertise in the subject of public health, but at the same time, think that what you seem to be saying in that initial post is overstated to the point of being misleading.
Evidence: people die due to lack of insurance, inability to pay for treatment, or lack of coverage for their particular illness every day in the US. If I need to track down the citations, I will. But I think you know this already.
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‘Approximately two years after the lottery, researchers found that Medicaid had no statistically significant impact on physical health measures, but “it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.”’
Those are outcomes it wasn’t powered to find. 2 years is an extremely short amount of time to get statistically significant health outcome data out of a large population study.
From the article you cited:
The researchers looked at mortality rates, but they could not reach any conclusions because of the extremely low death rate of the general population of able-bodied Oregon adults aged 19 to 64.[5]
The Framingham Study took 12-25 years to tease out statistically significant outcomes differences from risk factors that we know cause increased mortality.
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Yeah, not seeing statistically significant changes in health is kind of meaningless.
The study did find it increased diabetes detection and management. Are we supposed to think that would not have a positive effect on physical health?
What about lower rates of depression? Is that not going to result in positive health outcomes? Isn’t that already a positive health outcome?
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According to an online inflation calculator, the inflation since 1996 has been 60%, so that $21 vial of insulin would cost $33.69 in 2019 dollars.
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It’s better than nicotine: get everyone fat (appropriately Phillip Morris’ new job), then everyone has to buy your insulin to live! Now there’s a business plan.
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