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And those people can’t understand that they are paying more in premiums than the additional taxes that a single payer system would require, and getting less care.
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Who are the “progressives” saying that? The response I’ve seen is “Make the system more efficient”, which can be done by introducing single-payer.
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“Cutting costs” is not in any way inconsistent with “we need to increase spending.” Also, I don’t see people saying we should “cut costs” on health care. Nice strawman though. What people are pointing out is that our system does not deliver higher value for higher money – so it’s clearly an inefficient system.
Also, it is a total myth that US education performance is “significantly worse performance than the rest of the developed world.” Numerous tests and studies show we are about average, which is what you would expect statistically since we have a larger and more diverse population than most of the “developed” nations. E.g:
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At least half the countries included are among the “less developed” - Chile? I’d like to see these figures graphed against A) # of McDonalds B) # of fried chicken outlets C) # of ‘fast food’ joints in general D) # of sugary soda pops sold per capita.
I’d also like to see how they determined death ages. Do they include infant mortality? Or do the figures reflect only deaths of people who reach adulthood first? There are plenty of places like Honduras where people can live very long and remain robust well into their old age, but that’s because the infant and child mortality rates are so high that the people who have any kind of genetic weakness or lack of disease resistance die very early.
The cost savings are due to a combination of factors. Preventative care contributes some benefits – it’s not just screenings but regular doctor visits that educate the patient, risk assessment (genetic, lifestyle, psychological, etc.) and attendant early-intervention targetting, and co-ordinated care and treatment programmes. A single-payer universal system has a strong economic incentive to monitor the health of citizens and make improvements (because it has a duty to the public and not corporate shareholders to stay solvent), and has the clout to make those things happen (because of standards).
Another factor of a civilised healthcare infrastructure is a public health system that isn’t always looking over its shoulder and hedging its words lest it offend tobacco, booze and junk food corporations. These countries also tend to make medical education more affordable, so that physicians and other medical professionals can focus on their calling rather than on paying off crushing bank debt. The approach to substance abuse and addiction is also radically different elsewhere (although I suspect Americans would tend toward the current brutal Filipino delta rather than the humane European one). Nation- or state-wide billing standards and purchasing economies of scale are other big cost savers that cut down on administrative fees and price gouging.
As with addressing climate change, getting single-payer universal in place requires a significant majority of the American public to prioritise general human well-being over the shareholder value of corporate “persons.” While ACA is step in the right direction it still favours the latter over the former.
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A good list. I would just add that single payer also saves costs by not throwing money into insurance company marketing, administration, and profits and by saving money on provider administrative costs. Also, in addition to making medical education more affordable, in many other countries doctors are paid less than in the US and it is seen more as a public interest profession rather than a way to become rich.
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It’s sad that the ACA was damaged by Congress to the point where it doesn’t do its job very well. But its authors made it very clear that it was written to be an open-ended law, not a final solution by any means; it’s meant to be a step towards the universal health care law that Obama and Clinton always favored.
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and trimming administrative costs. Up here, probably the fastest rising category of costs in health and education is exactly that, and that is normally associated with the rise of private interests in the system (e.g., the capture of rehabilitative systems by OSOT in Ontario; the universities’ increasing need for private donations, and the effects that has on administration; and so forth).
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As noted in the post (see the footnote), life expectancy is measured from birth and includes infant mortality. The US has very high infant mortality comparatively. Worse than Bosnia, same as Malaysia, way worse than EU countries. But your’e right - we are better than Haiti in that respect. http://data.worldbank.org/indicator/SP.DYN.IMRT.IN?year_high_desc=false
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This. They don’t just hand out organs on a first-come first-serve basis.
But also, the varieties of the human experience don’t allow us to effeciently or meaningfully assign blame for people’s health conditions. That’s not just beeding heart thinking, the reality is that as time wears on, your body is failing. It’s in a constant state of decay and atrophy and it gets to hard correct certain problems as time wears on. I have bad knee from a game of tackle football when I was a teenager that never healed properly.
It makes it hard for me to run, and high impact exercise isn’t sustainable the more you weigh. Which leads to putting on more weight, which further compromises exercise options. Overall, I can make an effort and do pretty well. Cycling helps. But other people don’t have the same set of opportunities or problems. Your decent-paying job might require you to sit all day. Or you might live in a rural area where the roads aren’t bikable, but your healthcare shouldn’t be conditional on whether Louie tried to pile drive your legs into the ground while you dove for a touchdown.
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That’s a small price for sticking it to the freeloaders.
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Agreed. Obama placed some backdoors in ACA to a single-payer universal system for a successor who has the political will and walk through them. Really, why shouldn’t all Americans have access to the same kind of health insurance benefits that Congresspeople or members of the military have? If Medicare scales so well to our aging citizenry, why can’t that be extended (with appropriate adjustments) to the rest of the citizenry? These are the kind of questions any Democratic successor to Obama should be asking and finding a way to answer.
Despite her strong push toward the system during her husband’s Presidency, I’m not convinced that Clinton still has that will. She’s been a part of the neoliberal consensus for at least a decade and she’s deeply indebted to major investors in America’s for-profit medical industrial complex. I’m willing to give her a chance to do the right thing during her first term.
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We’ve known the sad truth of this for some time, stop rubbing it in.
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Quite honestly, it’ll depend entirely on Congress. Obama was pretty frank about the fact that he scaled the ACA back to get something passed by a hostile Congress, even if it was a half-baked law with backdoors, because it did accomplish quite a lot. If voters support a Democratic downticket then I think Hillary may at least patch some holes, but like you I doubt she’ll go through with a single-payer system unless Elizabeth Warren pushes hard.
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Well, if nothing else, it shows that without lowering costs or refusing any service currently provided we could spend a lot more money on the bottom 95% without dramatically increasing overall healthcare spending. This would increase the per-capita amount a little, but would probably push our longevity figures up to be more competitive. So at least we would be getting more for our money.
There are also several options to cut the cost of care without reducing the quantity or quality of care, such as a single payer healthcare system. It isn’t clear to me how much can be cut here, but it is not zero. Probably not the 40% cuts we would need to be on par with the most expensive European countries, but it would be a start.
We can also focus on things other than health care. Poverty, and especially childhood poverty are problems in the US in a way that most other developed (and even many developing) can’t even imagine. This for sure contributes to lower life expectancy, and also reduces efficiency of healthcare spending. This also is a major problem for education, and improved education improves health outcomes as well.
Finally, it has been shown that encouraging people to talk with their family about end-of-life care, counselling, and more access to palliative care (aka death panels) can reduce end-of-life care costs, while improving quality, and all without denying anyone care that they want.
But ultimately I think it is a mistake to look at that graph and say “we need to get healthcare spending down”. Sure, that would be nice, but we should be focusing on ways to spend money better – to increase longevity and quality of life. I don’t mind spending the most in the world on healthcare as long as we also have the best healthcare. Paying more for less is what sucks.
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Could you imagine if a drug company came out with a new medication that reduced cancer occurrence by 40% and cancer deaths by 50%?
How about a medical device company introducing a pacemaker that reduced cardiac death by 65%
Unfortunately, those results have only been achieved with healthy diet and exercise. There’s not much money to be made on THAT!
I appreciate your point that the US healthcare system spends too much money extending the life of patients with very low quality-of-life. But there is also the problem that, culturally, Americans (on average) would rather take a pill or get surgery than make long-term, behavioral and lifestyle changes.
This deserves to be highlighted. While I wouldn’t define palliative care as “death panels,” in the U.S. we still have (mostly religious-driven) taboos about discussing and addressing end-of-life decisions. Not only does this lead to higher costs due to people being kept alive who would rather be dead, but more importantly it exacts a terrible toll on the quality of life of patients and their families and friends. If your comment inspires just one person to have that discussion with an elderly parent or to draft an advance healthcare directive, you’ve done a lot with it.
In a better country, the most ruthless and heartless citizen’s response to the graph would be “why aren’t Americans getting more value for our money?” But we don’t live in that better country. We live in a country where at least half of the electorate knows the cost of everything but the value of nothing, where they think money should determine what basic human rights one gets, where they talk a lot about money but have trouble grasping the details of efficient application of those funds, and where they’re so focused on denying benefits to the “undeserving” that they often end up denying them to themselves, too.
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Speaking as a Marketplace user, it’s very clear that the insurance companies are gaming the system so that it doesn’t really provide the comprehensive coverage it was set up for.
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http://www.counterpunch.org/2007/01/26/paying-for-health-care-and-not-getting-it/
Old article but first I remember on the topic
