I have stated repeatedly that I think the fight over some form of nationalized health care is over, and that we will one day have a European-style system in place. The only question is when big business will successfully pressure the government to take over and how much of their current health care funding responsibilities they can manage to lay at the feet of government.
Yesterday, the NY Times has a piece stating that some of the real firm opposition to nationalized health care comes from, of all places, unions:
Most advocates of universal health care focus on the opposition of Republicans and insurance companies. But perhaps the most important factor keeping an overhaul off the national agenda is one that few Democrats acknowledge: most of Mr. Gettelfinger’s fellow labor leaders don’t support a single-payer system either.
The reason comes down to simple self-interest. The United Auto Workers is one of the few private-sector unions that doesn’t run its own health plan. Rather, most have created huge companies to administer their workers’ plans, giving them a large and often corrupt stake in the current system.
Opposition to a national health care plan is as much a part of the American trade union tradition as the picket line. It goes back to Samuel Gompers, the founder of the American Federation of Labor, who railed at early Congressional efforts to pass a law mandating employer coverage as Britain had done, which he said had “taken much of the virility out of the British unions.”
This line of thinking led to the notorious decision in 1991 by the A.F.L.-C.I.O.’s health care committee to reject a proposal that the federation support a single-payer plan. The majority said a national system simply had no chance in Congress, but others saw a conflict of interest: government-supplied health care would put union-run plans out of business.
Which, of course, would mean that opposition to nationalized health care would create some strange bedfellows. Anyone have more on this?
*** Update ***
More here from Ezra Klein.
Doug
Thanks for pointing that out. I was utterly unaware of the union-opposition angle to this issue.
Steve
On a separate level, health care is often the #1 issue of contention in collective bargaining negotiations. Thus, the employer-run health care system gives unions a major reason to exist in the first place.
Assume, for the sake of argument, that the government was to enact a program where every worker makes at least $50/hour, gets free health care, has a guaranteed pension, etc, all courtesy of Uncle Sam. Why would any worker want to join a union at that point, when they already get everything they could dream of from the government? Thus, paradoxically, unions would have an incentive to oppose such a worker-friendly program out of pure self-interest.
Of course, the union bosses would be lynched by the rank-and-file if they ever publicly came out against such a program. The same thing may happen with health care. In the 1990s, when many Americans had doubts about whether it made sense to have a national health care system, the unions could get away with opposing it. But these days, when there seems to be a growing consensus that some type of national solution is required, it’s going to be tougher and tougher for unions to take an anti-worker position.
silky
Keep in mind that this isn’t true of all unions. The SEIU, which I believe is currently the largest union in the country and certainly the fastest growing, very much supports government-run healthcare and lobbies relentlessly on its behalf.
Steve S
The Unions problem is that they are no longer relevant. When they were fighting for the 40 hour work week, 8 hour work day, etc. they involved everybody.
But now… What’s the point?
greg
The other problem,as I see it, is that a national health care scheme might result in lesser benefits than they have now.
ppGaz
Interesting story. I’d like to know which sources of well funded opposition to single-payer is NOT totally self-serving and based on allegiance to its own money and power.
I don’t think there is any well organized opposition that can claim to be objective and have only the best interests of citizens at heart. If such opposition is out there, and being effective and assiduous in its opposition, I’d like to hear about it.
Jack Roy
One note: National health care might be contrary to the interests of union elites (if one accepts Fitch’s description of the unions, which I don’t), but it would be highly desired by the unions’ constituencies. Analogously, term limits are very bad things for every current incumbent, but it doesn’t mean a popular movement doesn’t swell up every so often and force incumbents to swallow them.
The one effect I can see of having elites opposed to national health care would be that unions would be unlikely to provide political leadership on the issue, and in the absence of other corners pushing for national health care the tepid support of unions could mean that it just didn’t become a live issue. But if, say, a Democratic politician provides the leadership instead, that becomes rather secondary; once the issue gets on the agenda, publicly opposing it would be pretty risky for any official that has to be elected by union members.
Bottom line: Union leaders that want national health care can push for national health care, make it an issue, and work for its passage. Leaders that don’t want it can avoid making it an issue, but don’t have a real ability to oppose its passage.
(Again, this is all applicable only if you accept Fitch’s descriptions, and it sounds fishy to me.)
Detlef
I´m puzzled by that NYT piece. Of course I´m not an American so maybe I´m overlooking something.
But perhaps the most important factor keeping an overhaul off the national agenda is one that few Democrats acknowledge: most of Mr. Gettelfinger’s fellow labor leaders don’t support a single-payer system either.
I thought that unions in the USA – except maybe those for state employees – were pretty weak today? At least that´s what I´ve been reading in American media for years. But this author states that unions are “perhaps the most important factor”?
Does he really think that the USA would have gotten a national health care system in the 1990s if the unions would have supported it? Despite all the other opposition from “Republicans and insurance companies”?
Is that for real? Or just an attempt to somehow and preemptively shift blame?
Mind you, I´m not excusing the unions described in this op-ed. I´m just puzzled by the statement above.
demimondian
Another note: there are a number of smaller unions that do support single payer: like the SEIU and the NAFSCME — you know, the unions which are growing fastest? (And then there’s the UAW.) One could argue that the article says is “The Teamsters, almost certainly the most corrupt union in America, are corrupt.” Sounds like the RWNM to me. (Hey, OCSteve: when do I start getting my VRWC talking points? All I’ve got are the ones I wrote myself, and although I think they’re better than Karl’s, I’m not sure he’d agree.)
The “traditional” craft unions sren’t doing very well any more, largely because they’ve gotten what their members needed, and now exist in relative stasis. They’re also the ones that the press thinks of as “the union movement”, which leads to the conclusion the the union movement is moribund. In fact, the union movement is growing, but in places where there’s a need for better worker pay and benefits: among municipal workers, among teachers, among nurses and other “second class” health care personnel, and among service workers.
Gosh — people acting as rational actors. Fascinating.
Sojourner
Jobs moving to other countries.
Declining wages as corporations rake in big profits.
Corporations that raid their workers’ pensions.
Republican judges like Janice Rogers Brown who don’t believe in labor laws.
I’d say there’s still quite a lot that needs to be done.
demimondian
Tell that to the janitor in your building, or to the nurse next to your hospital bed — or the school teacher who works with your kids.
The manufacturing craft unions have a hard time being effective in an economy in which manufacturing is not growing. As evidence, I point out that service unions are growing very fast — which is unsurprising, since the demand for service workers is outstripping supply.
(Aside: manufacturing craft and industry unions are not as irrelevant as the libertarians would like you to believe, even there. It’s pretty clear that the lack of unions didn’t pretect tectile jobs in the South, for instance. Manufacturing has become fungible, which makes national unionization irrelevant. That leads me to predict the rise of a trans-national union movement in the next decade or so, which will attempt to establish baseline pay and benefits across crafts and industries in many nations simultaneously. Expect a rise in red-baiting when that happens, too.)
rachel
Unions in bed with big pharma? On this issue, you bet it could happen.
nyrev
Considering how much of big pharma is saying, “Screw it, we’re moving production to India/Ireland/Latin America”, I’d say the unions have other problems.
Sojourner
Not just the unions. Unemployed Americans is a problem for everyone. Too bad the Repubs haven’t figured that out.
rilkefan
Amusingly, there’s evidence that unions are good for companies – the organized framework for bargaining and dealing with grievances makes for better relations between workers and management.
Also note that even the leftiest of my lefty friends is extremely aware of problems in unions, some of them stemming from deliberate manipulation by those wishing to minimize workers’ rights.
Oh,Boy.Stupidity!
Oh, this is classic. You lame-os go on and on about how “the Gubmint is spying on me” (which it’s not by the way), but then you nitwits are first in line for socialized health care. The govt. won’t have to spy on you at that point. It’ll own you.
Sojourner
Huh? Your name really says it all, doesn’t it.
LOL.
Perry Como
Exactly. Freakin’ liberals expect the government to provide things like health care and retirement benefits, but can’t trust the government to monitor their phone calls. Trust the government, it’s here to help you.
Don
Personally I’d like to see a hybrid system of some sort; a mandating and providing of base-level care and immunizations for all, even if it’s done primarily by nurse-practitioners and the like. So much medicine is simpler than car mechanics but doesn’t get done, resulting in larger costs down the road for all of us. Does the money we save keeping everything 100% private offset what a TB outbreak costs us? Lost productivity from flu epidemics?
You want coverage for a new kidney or heart, you buy your own care – I’ve no problem with that. I’d just like to see us apply the same sense to health we do to, say, homes. You have to buy fire insurance for your home in case it burns down, but we’re going to require that your electrical be up to a certain code and make sure there’s a fire department nearby to keep the blaze from spreading to your neighbors.
ppGaz
Your homeowner’s insurance costs a small fraction of what it would cost you to provide good medical coverage for the family that lives in the house.
Your comparison is inapt. Very few Americans can afford serious health care. Few would be able to afford, on their own, full insurance coverage. Most Americans have coverage, and access to care, only if their jobs provide it. Now the situation has worsened to the point where corporations are being hurt by the costs and the imbalances.
The present situation is not acceptable and not sustainable. Ergo, this thread. In particular, the first sentence of the thread. It’s not longer a question of whether, it’s a question of how far into the abyss we’re willing to go before doing the sensible thing and moving toward a single-payer solution.
People who think medicine is cheap and simple just don’t know what they are talking about. The cheap and simple parts aren’t the problem. The problem is that you can’t have any of the thousands of serious medical problems that might affect you, if you are mainstream middle class, without having your wallet take a hit in the six figure range, and up. How many people do you know who can write a check and pay a $150k invoice? That’s what three days in the hospital can cost you in the blink of an eye today in this country.
If you don’t believe me, I have the bills right here, dated August of this year. And the $150k is not the whole cost. There’s another $25k in incidentals over there in the other drawer.
scs
I think a better solution to national healthcare would be to expand the state healthcare systems that already exists. For instance, as a self-employed person now, I buy into my state’s Blue Cross system, which hasn’t been too bad. Actually when I worked for some very small companies before, they made me pay practically most of my healthcare premiums anyway, so the prices are not that different from my “workplace coverage”, and I control it myself.
The problem with self-pay insurance is that if you miss or are late on a payment, you are dropped. Once you are dropped, you have to enroll again. When you re-enroll, you no longer are covered for anything even remotely related to any condition you ever had in your life before that for the first year or two of coverage. If you ever had the flu before, you will not be covered for a flu or anything related to lung infections, for the first (I believe) 2 years. I heard a story of someone who broke his ankle years before health insurance and that was used as a reason to deny him treatment for arthritus because that his broken ankle might have somehow contributed to his arthritus. The insurance companies can basically stretch this pre-existing condtion to exclude almost anything they want. This should be adjusted somehow. Probably this will have to be done through government legislation because the insurance companies will not want to voluntarily give in on costs.
I think it’s better to keep it on the state level because it will keep the bureaucracy smaller. Different states insurances can compete against each other over benefits and costs and the efficiency of the states insurance will be used to promote the value of a state’s living conditions to attract residents. I’ve heard state budgets were more in the black than the government’s deficits so they are better financially prepared for it. Perhaps the Fed governments can help redirect some funds to states for this, but over all, I say keep it in the states as a voluntary program competing against existing workplace insurance.
ppGaz
Jesus, now we are going to have the high schoolers debating health insurance?
In order for any large system to work, you have to have the largest possible base of insureds in order to spread the risk. Do you even know what actuarial tables are? Do you know why group insurance can abate the preexisting condition restrictions while individual insurance can’t?
Your foolish proposal would simply bankrupt those states foolish enough to try to do such a thing on their own. Which is why you don’t see states lining up NOW to do it.
Good God, is there an educated voter somewhere in this country?
scs
They already ARE doing it. The state Blue Cross system has been around for a long time, and apparently doing well. I just say – expand it.
ppGaz
But your own example demonstrates that Blue Cross is not the answer. They abate risk by excluding it. Real coverage can’t do that. That’s the whole concept behind GROUP insurance. The group is the safety net … the acturial probability that enough people will not be sick at any given time and will be paying into the system to fund the care for those who are sick.
Fuck me. I can’t believe that in this day and age, people don’t know how this stuff works. Without an aggressive national plan, and generally available care, this country is going to be ruined by the costs of healthcare. Forget Social Security, it’s medical care that is going to break the country.
If there were easy and workable alternatives to some form of national single-payer system, we’d have seen them already.
scs
Here’ some info I just found in Wilkipedia on the Blue Cross for an fyi. I never really understood exactly how it was structured. Apparently each state can be different.
demimondian
And if you don’t want to believe ppG, someday, let me tell you the story of what having a baby do time in NICU can do to a young family struggling to make it in academia.
It isn’t pretty to look at many tens of thousands of dollars of bills, knowing that the parents of the kid in the isolation room across the way are going to get ten times the bills — and that their kid will never go home with them. At least the second demi-kid came home healthy.
scs
I get that about group probability. But, you have a limit on how many people you need to form this group. For instance, when they take a political poll, they usually take a sample of about 1000 people, which pollsters have determined is enough people to get a representative sample of the public.
I’m not sure how many people you would need in a health plan to get statistical maximum efficiency, but I’m sure the population of most states is enough to achieve this group advantage. Any more than that is just more of the same.
The problem is, like you brought up, is how to improve this system’s coverage without bankrupting it. I think if we add some Federal and state funding to Blue Cross sytems and then in return, the states ask for accountablity to provide better benefits and access, we might achieve some improvements.
ppGaz
Holy shit. This enormous crisis facing the country, and here scs had the answer the whole time:
Everybody just buy Blue Cross insurance.
See, simple! Nothing to it!
Good lord. That’s it for me today, if blogging has descended to this. I need a day off.
Next from scs: Water from wine tips, and what shoes to wear while walking on water.
scs
Hey it worked for me.
scs
Sandals. Your feet dry out faster.
DecidedFenceSitter
Question SCS, how does someone pay BCBS on 6.25 an hour?
The Other Steve
So then why aren’t they doing something about that?
But that’s not what you hear about when they talk Unions. Instead it’s complaining that their co-pay is going from $5 a visit to $10, when the average American is paying $20.
The point of what I said was obviously lost on you.
scs
The rate structure depends on your age and your deductible. In my state you can get coverage starting for I think less than $100 a month at the highest deductible if you are a young person. Guys are lucky and get to pay about $50 less than girls because they don’t go to OBGYNs. Most cable bills are about $50, gas bill over $200 in winter, so not that much more than other expenses. BCBS, however, is not too handy when you get into your 50’s, say, cause I think it goes up to about $350 per month, but by 65 you can get Medicaid.
I think Medicare (or Medicaid? get them confused) is available to the working poor, so it someone is making $6.25 an hour and has a family, they might be eligible for that. Some jobs offer subsidized health insurance for part time workers for a monthly fee. I’m talking about the middle class that is getting squeezed. Now BCBS is not ideal of course, but at least you control it yourself and don’t have to worry about losing your coverage everytime you switch jobs. I’d be interested to see how much better we can make it if we put in more funding from the states.
The Other Steve
Honestly, I’m for scs’s suggestion, to a degree.
But ppGaz is also right. For insurance to work you have to have a large population of people who don’t need it. Thus for health insurance, you need a lot of healthy people in the system. That’s the main problem with the voluntary buy-in system. The only people who buy in are those who know they’ll need it. But if you can get everybody in the State to “buy” in, then you’ve got reduced cost per person.
Even so, there are substantial problems with the current insurance system. I would think that I as the recipient of the healthcare would be considered the customer, but I am not. It is more often the insurer or the employer. That’s a problem.
Fundamentally, however, I think the main problem with the system is that both hospitals and insurance are stock market ventures. To please the stock holders you have to increase revenues. Well how do you do that with healthcare?
you gotta make sure people keep coming back for more, but that’s contrary to the premise of why I as a sick person go to seek care.
I add to this the note about the poor doctor in Australia who discovered that “ulcers” could be cured with antibiotic, and did not in fact need billions of dollars of anti-acid medications.
I take allergy medication, at about $100/month. What if instead of daily maintenance, there was a way to actually cure my condition? Would that not be preferable? It certainly would be for me. You’d think it would be for the insurance companies as well.
But the insurance companies have to keep increasing revenues, which means increasing their costs… so it wouldn’t be worthwhile to them to decrease costs.
So nobody cares to sponsor studies which find a cure for allergies. It’s better for everybody involved(other than the patient) to develop drugs that maintain the condition.
scs
As we see from the Wilkipedia info, BCBS is semi-private, and apparently making good revenue. Medicaid (for low income people) is struggling. I say, have the states do a large stock buy out of BCBS, so that they will have a strong controlling interest. Or also, they could negotiate some deals where they provide funding for more control. BCBS might agree to the control if they can count on a steady revenue stream. Start requiring state college students through the colleges and tuition and part-time workers through ther jobs ( money taken out of their paychecks) to contribute some to BCBS to get some minimal coverage. As part-time workers and college students tend to be younger, and so healthier, you should make more money off of them than you pay out. Use this extra revenue to limit the time for pre-existing condition coverage from 2 years to, say, 6 months, and to lower the deductibles for older people. Anyway, those are just some ideas. There are many ways to approach this. A little creative thinking should go a long way.
ppGaz
Uh, that’s not what the question was. Not even in the ballpark.
Good lord, shut this thread down. If it gets any stupider in here, the thread will actually become a black hole into which information will be drained, and disappear forever. Eventually, all the information in the world will be pulled into this thread and be gone.
capelza
Not to sound all moonbatty, but I do have a deep moral issue with stockholders making money climbing up the backs of people in need of urgent life saving or long term healthcare. A potentially life or death issue boiled down to the quarterly report.
Sojourner
What you said was that you didn’t see the need for unions anymore. I pointed out some uses for them.
Krista
An extra $100 a month for healthcare? Do you have any idea how many people can’t afford that? I wouldn’t be able to afford that right now.
There has got to be a happy medium between your system, which bankrupts people, and ours, which pays for ridiculous stuff. I think it’s obscene that there are people in the U.S. right now that have no chance of overcoming cancer, because they can no longer afford treatment. There are people in your country right now, who are suffering and dying, for no other reason than that they cannot afford treatment. All men are created equal? My ass, they are.
Now, our system needs work, too. We do get subsidized prescriptions, but there are still many people who lose their life savings because certain drugs are just way too bloody expensive. And there are abuses — we have a shortage of doctors here, because they all want to go down to the U.S., where the big bucks are. So, a lot of people have no family physician, and wind up going to the ER as their primary care if they need a prescription or something. That drives up costs considerably. Like any system, there are always going to be abuses. But at least I know that if I ever have a baby who needs to spend time in the NICU, I won’t have tens of thousans of dollars worth of bills to add on to the (considerable) stress.
There’s got to be some sort of happy medium, right?
prufrock
I’m in favor of a single-payer system, but I don’t know if it is immediately inevitable. I used to think it was until I read this article by Malcolm Gladwell on the state of health insurance in this country. It is entirely possible that this country will initially be sold on the idea of health insurance that is actuarial, instead of social in nature (Dubya’s already tried it with the Health Savings Accounts).
Do we really need to go down the road where seventy year olds die because they can’t afford the premiums before we realize that actuarial health insurance is a bad idea?
CaseyL
To be fair, or at least bring some historical perspective, it is true that “healthcare” is much different than it was in the days when insurance was either inexpensive or not needed (i.e., when people simply paid out of pocket for healthcare).
Chiefly, the options we have now simply didn’t exist.
People live longer – often with chronic illnesses requiring high-cost diagnostic drugs and techniques, and maintenance drugs, all of which simply didn’t exist 20, 30 years ago. People live longer – and need acute system repair and replacement (organ transplants, cardiac surgery, brain surgery). People with congenital diseases that used to kill them before adolescence now live normal lifespans – often requiring very expensive treatment throughout those lifespans.
We’ve never had any sane national discussion about the impact of medical advances on the costs of healthcare. The few times the issue’s even been broached, it quickly devolves into simplistic polarization. I understand and sympathize with the idea that the richest nation on earth should damned well be able to afford to subsidize the very finest healthcare for every single one of its citizens.
But I also can understand how that might be economically devastating, when we have an increasing number of high-maintenance individuals living longer – and, above all, a medical research model that seems unable to come up with actual cures for most chronic conditions, settling instead for palliatives.
It’s the research model that, I think, needs to be addressed. The really expensive chronic conditions driving high medical costs are genetic, immunological, and molecular. I don’t know how much the treat-instead-of-cure model is driven by Big Pharma profiteering, how much of it is due to the limitations of molecular medicine (still a rather new discipline), how much actual good ‘miracle therapies’ like cloning and DNA-based treatments can do.
Until we can have some kind of well-informed, honest discussion about what’s actually driving the costs, we’re never going to grapple with the real issues.
MC
One problem with health insurance is that it isn’t really “insurance”. True insurance is purely risk-shifting and in the case of catastrophic medical, the large pool is a solution to costs. Not everyone is going to get into a car accident, need NICU care for their kids, or need an organ transplant.
The other part of insurance is more like a buying club. Everyone needs to go to the doctor’s office from time to time. Everyone gets infections, needs vaccinated, needs prescription meds from time-to-time. How do you effectively price these services? A true market would seem to be the best way, but without the purchase of these basic services, things turn into the catastrophic category.
We need to somehow separate the “buying club” component of health insurance from the “insurance” part of health insurance. Traditional models of insurance would probably serve the catastrophic part well, we could probably even let the government run that, but how do we address the buyer’s club component in a way that allows access for everyone and overcomes a potential market failure where people forgo medical care until the insurance kicks in?
The Other Steve
scs writes:
Uhh. I have BCBS insurance, and my costs have been going up 20% annually for the past 5 years or so. If they are profitable compared to Medicaid it is not because they are more intelligent or more efficient. It’s because they’ve been passing the fucking costs on to me.
The entire system as it currently stands is fundamentally broken. As I’ve noted, it’s largely because it does not operate as a free market economic system.
The Other Steve
What galls me is when I got the bill for my gall bladder surgery last year.
Total was something like $11,000… But BCBS negotiated it down to $4500 and that’s what they paid.
I’m like WTF!? Why doesn’t the stupid hospital just charge $4500 to begin with, if that’s all they are going to ever get? What if I had no insurance? I’d be stuck with the $11k bill, which would really really suck.
I gotta hand it to our Attorney General here in Minnesota. Mike Hatch. After receiving numerous consumer complaints about debt collection, he negotiated an agreement,with several large Minnesota Hospitals that they give the same pricing to those without insurance that they do to those with. The first sane thing I’ve seen happen in healthcare in a long time. And the Hospitals realized it was in their best interest because while someone might pay a $4500 bill, they were going to default on $11k.
http://news.minnesota.publicradio.org/features/2005/05/05_bensonl_hospitalcharges/
rachel
I’ve lived in two countries with government-enforced pricing for healthcare, and universal, tax-funded insurance plans: Japan and now South Korea.
1) I can afford to pay my insurance costs every month, and I can go to just about any doctor or hospital I want to. No arguments, no waiting, and hospitals and clinics are everywhere. Medical care here is good, affordable, quick and reliable.
2) My husband, for reasons that are too complicated to go into here, can’t buy into the national insurance scheme. He has a chronic condition that would kill him eventually if he weren’t treated for it. Even without the insurance, we can still afford his hospital visits, treatment and medicine because the government controlls all medical prices, costs and fees. We’ve compared pricing to what similar care w/o insurance would cost us in the States, and in short, if we had been living in the States and dealing with this situation, we would have been *beggared* by now. No lie. As it is, we still have a comfortable life. Just not as much spending money as we would if he were able to get the local insurance like I am.
3) If we were to go back to the States and try to get insurance to pay for his treatment, we would not be able to because he has a ‘pre-existing condition.’ See the what I said about being beggared above.
4) Healthcare for middle-class and poor citizens in the US is a shame and a scandal. There is not a single Japanese, Korean, Canadian or British friend of mine who is familiar with US healthcare that thinks it is even remotely a good good system. And they certainly don’t want it for themselves.
The free market works great when you are chosing a carpet for your living room; it’s not so great when the company that holds the patent on the medicine you must take to live can (and does) charge whatever they damned well want for it.
scs
The trick is we have to get young healthy people who choose to go without health insurance to start paying into the system right now as that will drive down the costs for the older people. I still think my idea to require businesses in a state who employ part-time workers and who don’t provide health insurance to pay a small amount into a state system for each uninsured worker and to require all colleges and technical schools in a state to also pay a little to the state for each student they enroll is a good idea and should catch the majority of the young adult uninsured. The institutions in turn will probably get the money back from their employee’s paycheck or raise tuition, but I think it’s a fair exchange to get some catastrophe insurance for young people. That will be a good way to get the people who have the highest rates of not being insured into the system. Of course, this is just based on my guesses. I’d love to see a study of costs vs. benefits for my idea to see if it’s practical.
scs
Well I think there are a couple reasons for that. First of all I know the GNP per person in South Korea is a lot less than the US. I don’t know if you’re working for an American affiliated company over there, but if you are, you probably get better paid there than the average person there. Second of all, the US system is going to be more expensive because a lot more research is done here. Doctors are paid a lot more money here because in part they come out of medical school with more loans to pay off. Medical schools are more expensive here because among other reasons universities are involved in and pay for more research that the whole world benefits from. Same with the pharmaceutical companies. So the rest of the world is piggy-backing off our facilities.
That’s my impression anyway. Feel free to correct me with different info if you have more specific info on this.
scs
That may be true, but I think what many people don’t talk about is we already have an underground health insurence system here. And that is- don’t pay. For instance, I know a guy without health insurance in his thirties who suddenly had a small stroke. His bill for the tests and some ongoing treatment was I think over $10,000 dollars. He arranged some payment plan with the hospital, got some aid, and only has to pay a very small amount every month to the hospital, I think like $50 a month, to get continuing treatment. As long as he pays this amount faithfully, they will not start any debt collection procedures. Of course that all depends on luck as to which hospital you live near, but I’m sure arrangements like this happen all over the country. So in the end, a lot of people work it out here even without health insurance.
scs
Sorry to post again, but just read John’s update. Apparently, the statewide push for healthcare is already gaining momentum.
RonB
Just in case anyone isn’t aware of the theoretical models for universal health care, here’s a pretty good list of pros and cons of the various plans.
rachel
That’s pretty much what the system here *is*–it’s basically similar to what you’re suggesting. (You’re on the right track with that, IMO). Workers pay part of the insurance owing (based on their salaries), and their employers pay the other part. And everybody in the workforce is required by the government to participate. Oh, I suppose an employee could say, “I don’t want to pay,” but then his employer can also say, “then I don’t have to pay either, and if you get hit by a truck tomorrow, you’re on your own.” I don’t think this happens much though. My own monthly insurance payment is so small an amount that I usually can’t be bothered to remember what it is. It might happen to people who make very little money, but even without insurance they’re still better off here.
I’m not and I never have been. I’ve alway’s worked on the local economy and I’ve always earned about what the average Japanese or Korean of my age and education level makes–perhaps a bit less now because I lose seniority every time I change jobs.
Oh, and poor citizen’s health insurance is fully funded by the government in Korea–and in Japan too, I think, but it never came up as a topic of conversation over there.
(shrugs) Medical research is being done all over the industrialized world. Dolly the sheep was cloned in the UK, SNUppy in Korea, there’s SARS research in Canada, influenza research in China, Singapore in Taiwan… Why are US citizens the only ones paying through the nose for it? What good does it do you personally to have all this great research going on in your country if you can’t afford medical care when you need it?
And why are they willing to go so deeply into debt? Because they can charge whatever they can get away with once they start practicing–and everybody knows it. One of the biggest complaints I’ve heard Japanese and Korean doctors make is that they are not allowed to charge what doctors in the US are. It’s not that they aren’t wealthy already; they have big, expensive cars, big expensive homes, and their pick of the single girls to marry (no small consideration when men outnumber women in both countries). Make no mistake, doctors in these countries do very well for themselves. They just want… more. Oh, and medical schools are not cheap here either; only the wealthy families can afford to send their kids to them.
I’m not crying for them. There are plenty of doctors, and they do just fine on the ‘mere pittances’ they’re allowed to charge.
Hey, the same set-ups exist in other countries, including the one I’m living in right now, it’s just that big pharma and medical associations haven’t brainwashed the public outside the US into being bad shoppers.
And about the un-insured guy who was able to wangle a good deal for his healthcare after his stroke? He’s going to be paying $50 a month for the rest of his life (or until they have to re-negociate the fee because of inflation), and he’s still not covered for anything else that may happen to him or his family–and you think he’s lucky. It shouldn’t be like that.
scs
Well Rachel, you made some good points. I don’t know what the solution is here though because to do what other countries do, we’ll have to change so much about out system. Colleges and medical schools are not supported as much by the government here, so they will be more expensive, our income distribution is not as flat here, so doctors probably won’t accept being in the middle of the scale. As for the guy with the stroke, he was fairly lucky to get that deal, compared to what it could have been, because otherwise the hospital could have started taking away any assets he had, and garnishing his wages. But I agree, not ideal for him. Hopefully someone will come up with something soon.
ppGaz
They have. It’s called National Single Payer, similar to what other countries have been doing successfully for years. It’s neither new, nor rocket science. It’s just been made politically incorrect here by powerful moneyed interests who don’t want to see their gravy train derailed. Your government is in the pocket of those interests, and it would behoove you to know about it.
scs
Off of the list linked to by RonB above, I’ll going to vote for the multiple payer system. I think that has the highest likelyhood of being politically palatable and so the highest chance of getting established.
Sojourner
It’s mainly a question of how long it takes for people to figure out that the US no longer has the best health care system. They do, however, have the most expensive.
Of course about 1/3 of the country still believes that Saddam was involved in 9/11 so I’m not optimistic that they’re going to figure this out in the near future.
ppGaz
Considering what does done to them this year, in the guise of “reform” to banking laws and “prescription coverage” in Medicare …. I’m afeared you might be right. The middle class has been fucked royally by this rotten government. The damage caused by these assholes will take a long to time to repair. Bad government has a price, and we’ll be paying the bills for these turds … well, my granddaughter Maci will be paying for it when she’s my age.
Sojourner
Hopefully, her generation won’t be as gullible and fearful as our generation. Hopefully, her generation will fight to preserve the rights our forefathers gave their lives for, instead of giving them up for phony promises of safety.
ppGaz
Well, she’s off to a good start. She is a relentless ball of energy, unstoppable in her quest to get to her target, which might be a cat’s tail or a pair of glasses or a Playskool something or other …. At the age of 4 months (September) we declared her a menace to anything that got in her way. None of us has seen anything quite like her.
Look out world!!
Sojourner
You go, girlfriend!!!
Krista
ppGaz – you’re having a blast, aren’t you? Good stuff. Enjoy! If she turns out to have anywhere near as much passion and energy as her grandfather, she’ll be unstoppable, indeed.
Krista
ppGaz – you’re having a blast, aren’t you? Good stuff. Enjoy! If she turns out to have anywhere near as much passion and energy as her grandfather, she’ll be unstoppable, indeed.
Hopefully she won’t cuss as much, though. :)
ppGaz
Yes, Maci is definitely a force in the universe. We are all in awe over here.
As for cussing, I don’t do it much in “real life.” And then it’s mostly at inanimate objects like computers.
But online, everything is theatrical. If you don’t believe me, ask a certain DougJ ;-) Cussing is just a theatrical device when I do it. Unless it’s Darrell, and then I mean it.