Explaining away US healthcare as an artifact of WWII by claiming European countries turned to nation health schemes because of economic ruins ignores one very important counterpoint: Canadian healthcare.
Canada had no wartime ruin, and indeed, excelled after the war by advances in industrialization from the demands of WWII-- much like the US. Actually, Canada got it's universal healthcare because of the efforts of Tommy Douglas and the CCF in Saskatchewan and an entire history of social democracy in Canada that's worth studying. Sufficient to say, I think the author needs to look deeper into the social fabric of American life to see the barriers to socialized healthcare.
Honest question. Did Canada have the same situation with a mandated pay-raise freeze and the end-run around that by companies in the form of company provided, tax-free, health care benefits? It seems, according to the article, that this is the base situation that entrenched company paid health plans in the first place and prevented Truman from getting traction with a national health plan.
Like I mentioned, Canada implemented many of the same wartime rations on goods and controls on wages-- with the distinction that Canada was under wartime restrictions for twice as long as the US. All said, over 10% of the population served in the military with very little conscription due to internal conflicts with French-Canadians. The pressure to keep wages was certainly there, although I can't find resources on if and how companies sweetened the deal for employees with other benefits.
Before the war, many provinces had attempted to pass healthcare legislation but were halted by financial limitations or from opposition from doctors. Shortly after the war Saskatchewan managed to pass legislation to subsidize doctor visits by entrenching a common practice for communities to pool resources to attract doctors to service rural and remote parts of the province. Perhaps this is the distinction: local and provincial governments across the country were involved right from the beginning in providing healthcare. Canada's relatively homogenous citizenry may have also helped: most Anglophone Canadians saw themselves as a body of British subjects and this likely helped themselves band together to provide a common good.
I suspect that segregation in many places in the US acted to form healthcare in a less communal nature around private businesses where discrimination was easy to enforce.
This article describes how employer-sponsored healthcare started, but it avoids the reasons why it continued. And the reason Truman didn't get support for his universal healthcare plan was the "S" word: "socialism".
From http://www.pbs.org/newshour/updates/november-19-1945-harry-t... (first link I found, it's documented numerous places):
"Almost as soon as the reinvigorated bill was announced, the once-powerful American Medical Association (AMA) capitalized on the nation’s paranoia over the threat of Communism and, despite Truman’s assertions to the contrary, attacked the bill as “socialized medicine."
Never mind that Mussolini's brand of socialism might be just a tad different than the kind that gives you socialized medicine, but one need merely utter the word to get those knees a-jerkin'.
"socialism" may have been the instrument, but why did the AMA use it to scare people out of supporting Truman's plan? Because they felt the plan encroached on their power. That's why the AMA advocated for expanded private insurance---as a bulwark against government takeover of medical care. So it may be that the "P" word is more important: "protectionism".
You've posted quite a few generic-ideological-battle-style comments to HN. Those are off-topic here. Would you please read the site rules and follow them when commenting?
Has there ever been an effort to ban employer sponsored health care? I bet it would be a much bigger issue for people if they were paying for it personally rather than having their employer shell out.
It's still a huge issue, given that even if you have insurance, out of pocket costs can reach 12k per family before it kicks in to 100%. Healthcare is about to be 1/5 of the U.S. economy (compared to ~10-12% elsewhere)
For me, that was the most egregious part of Adorable Care Act: I have to tie medical insurance to my employer.
And there was a failed effort to repeal the ACA.
It drives me crazy. I can choose auto insurance, life insurance, home insurance, disability insurance all independently from other decisions, but health is this special category that is legally linked to my employer.
TIL: "Christian Scientist" does not refer to someone who is both a Christian and a scientist. It's some quacky, new religious movement, anti-science cult.
[Edit] Corrected "new age" to "new religious movement".
New age has a fairly clear meaning, Christian Science doesn't match up with it in a couple of ways. It began in the late 1800s and is firmly rooted in Christianity.
New Age is a later 20th century thing that is not strongly tied to any historical religion.
Obamacare went in the other direction, penalizing employers for not providing insurance (and for providing insurance that doesn't meet certain standards).
Some of the Republican proposals this year had provisions for matching the employer tax break on health insurance, but none of them got rid of it (a less drastic step than banning employer provided insurance would be to only give individuals tax deductions for insurance).
> Has there ever been an effort to ban employer sponsored health care?
Yes, there is, but from the other direction from the one you are interested in (universal single-payer).
There's also been efforts to eliminate tax and other incentives and mandates that make employer-sponsored care common, which is probably closer to what you are looking for, though the people backing that would generally be ideologically opposed to prohibiting employer-sponsored health care.
> I bet it would be a much bigger issue for people
The reason health care is a major political issue across the spectrum is that it's costs are already a giant issue for most people. There's disagreement on what to do about it, not on whether it's a big issue that people feel significant impact from. Your solving a non-problem by looking for ways to make it a big issue.
I don't think there's been a serious effort yet. I seem to recall proposals floating around in the past 6 months, though. One thing I remember is making employer healthcare be taxable income.
This is primarily a problem for people who are older but not yet eligible for Medicare (government health care that becomes available at age 65). Basically, don't lose your job between age 50 and 65, unless you have literally hundreds of thousands of dollars saved just to pay for huge individual market insurance premiums.
It's far more than that. Because health care costs are artificially jacked up (so that insurance can "negotiate" them down), anyone without health insurance can be screwed, even if you aren't "poor". So - anyone that doesn't have employer-provided health care and isn't eligible for Medicare/Medicaid.
Examples: I once tried to buy some nasonex (or equivalent) without my insurance info. $180. When I didn't pay and returned with my insurance info, it dropped to $5ish. My wife gets bi-weekly injections that stops her psioratic arthritis (which she's had since her teens) from crippling her. With insurance, $50/month. Without....we were quoted in the thousands, each month.
It is very, _very_ easy for me to see situations where you need health care to be able to work, and you need work to afford health care.
And this does impact employer lock-in. Every time I switch jobs (and to a lesser but still notable degree, when my company switches insurers), we have to do a new dance of:
* getting registered for insurance. Most places backdate your insurance to date of hire, but if you want to actually get the benefits immediately, it usually takes weeks to get your info from your employer to the insurance company and then they "process" it. (I have been told by one company that it takes them 1 business day to know they GOT a fax from my company, and another 2 business days to "process" it.) From experience I can say that if you make yourself enough of a problem you can drop this down to 5-10 days, but it takes a lot of work and that's still a ridiculously long time.
* Did I mention that it's quite common to have a by-mail pharmacy? That's a separate company from your insurance, so step 1 has to repeat for the new company (that process is usually faster, but it's still easy to lose another day to it). Oh, is your drug expensive and/or restricted? That might be handled by a specialist pharmacy, which is a 3rd company. (that last is not a guarantee - I've seen it in about 50% of my insurance
* Once you have the insurance info, now you need to get the doctor to send in the prescription. For basic drugs that's simple and automated, but for expensive and/or restricted drugs, that's more hoop jumping. Have you tried to get a hold of the average american doctor's office? My experience is you call, get transferred to a nurse's voice mail. Leave a message, and in 8-24 hours they will call you back. Re-explain whatever you said in the voice mail, and they say that will need the doctor's okay. Enter a second 8-24 hour wait. Now the doctor's office will send the prescription to whatever pharmacy you need...who will reject the request because they need justification (Silly me, I thought the prescription WAS the justification). Now the doctor needs to call the insurance company directly. Which is, you might guess, usually harder that getting them to send in the prescription in the first place. (we've had wonderful doctors for this and terrible doctors for this...and in my opinion the terrible doctors are only terrible on a relative scale - I hate the hoop jumping and I'm not doing it for multiple patients)
And all of this presumes the drug ( or non-pharmaceutical care) is covered in the first place. Every time I consider switching jobs, I have to find out if they will cover my wife's treatments. (Figuring out if something specific is covered is non-trivial and I have a degree of mistrust about the results).
I'm fortunate enough to have a good wage and many job prospects. I can easily imagine someone in less beneficial circumstances getting locked into a job by the above.
But you are already paying for the lifestyle decisions of others, just in separate pools. The very definition of insurance states that you collectively pay for everyone in the same group.
As I understand it, healthcare in the US isn't voluntary, thanks to the ACA, where the onus is on citizens to have a third-party product covering them at all times. If you choose not to, but could afford it, you are fined for not doing so.
Socialized medicine just amalgamates the disjoint pools of policy holders, and allows the state to manage aspects of care (i.e. avoid the hyper-inflated per-person costs in the US).
I really don't understand your argument, you are never paying for solely your own healthcare in the US system, unless you forego cover completely and accept fines from the govt for doing so.
> Someone always has to pay, and socialized healthcare just means that your neighbor has to pay for your poor lifestyle decisions.
The existing US system has the taxpayer paying as much as a share of GDP, and more per capita, than many developed countries that have fully socialized systems. It also has more than that in private costs, on top.
Why frame the issue in this way, except to make yourself feel better about being complicit in denying your fellow citizens access to basic healthcare?
The alternative explanation is that you genuinely believe all issues requiring healthcare are the result of "poor lifestyle decisions", which is plainly ludicrous.
I think you should give some serious consideration as to why your brain forces you to frame the problem in this way. I suspect it's because at some level you do feel morally culpable for whether your neighbor lives or dies, but that inevitably leads to a position where some social programs are morally just, and a belief in orthodox anti-statism is more important to you.
The only way to square that circle is to frame all healthcare issues as "poor lifestyle decisions" and social programs as "like slavery". Much easier to feel better about a child dying because they can't get access to basic healthcare if you can just hand-wave it away as "poor lifestyle decisions."
Your attitude is sickening to me. Why not just go full-on black hat and say "fuck the sick" instead of pretending all healthcare is due to "poor lifestyle decisions"? At least that would be intellectually honest, and no less evil.
A huge fraction of health care expenses is due to lifestyle choices. Most diabetes (diet and obesity), most cancer (smoking), many knee/hip replacements (obesity), most hypertension (diet, obesity, sedentary lifestyle), not to mention alcoholism and drug addicition which at least starts with lifestyle choices.
People make the best choices they can with the information available to them.
Malcolm Gladwell recently had a podcast about how McDonalds ruined their French fries when they got bullied into changing their fryer oil from stable saturated fats to unstable polyunsaturated oil: http://revisionisthistory.com/episodes/19-mcdonalds-broke-my...
I don't think The American Heart Association's propaganda campaign against stable cooking fats helps individuals make good choices for themselves.
Where do people like you come from? Do you really not know anyone who has a congenital illness or who got a cancer diagnosis out of the blue? Do you not know anyone who, due to unpredictable circumstances out of their control, was out of work for an extended period and could not afford health insurance?
More fundamentally, why does it matter whose fault it is? This is 2017 and the US is an extremely prosperous nation. Everyone should have access to health care without being financially ruined, regardless of their "lifestyle choices."
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[ 3.1 ms ] story [ 32.9 ms ] threadCanada had no wartime ruin, and indeed, excelled after the war by advances in industrialization from the demands of WWII-- much like the US. Actually, Canada got it's universal healthcare because of the efforts of Tommy Douglas and the CCF in Saskatchewan and an entire history of social democracy in Canada that's worth studying. Sufficient to say, I think the author needs to look deeper into the social fabric of American life to see the barriers to socialized healthcare.
Before the war, many provinces had attempted to pass healthcare legislation but were halted by financial limitations or from opposition from doctors. Shortly after the war Saskatchewan managed to pass legislation to subsidize doctor visits by entrenching a common practice for communities to pool resources to attract doctors to service rural and remote parts of the province. Perhaps this is the distinction: local and provincial governments across the country were involved right from the beginning in providing healthcare. Canada's relatively homogenous citizenry may have also helped: most Anglophone Canadians saw themselves as a body of British subjects and this likely helped themselves band together to provide a common good.
I suspect that segregation in many places in the US acted to form healthcare in a less communal nature around private businesses where discrimination was easy to enforce.
From http://www.pbs.org/newshour/updates/november-19-1945-harry-t... (first link I found, it's documented numerous places): "Almost as soon as the reinvigorated bill was announced, the once-powerful American Medical Association (AMA) capitalized on the nation’s paranoia over the threat of Communism and, despite Truman’s assertions to the contrary, attacked the bill as “socialized medicine."
Never mind that Mussolini's brand of socialism might be just a tad different than the kind that gives you socialized medicine, but one need merely utter the word to get those knees a-jerkin'.
See http://www.econtalk.org/archives/2017/06/christy_ford_ch.htm...
https://news.ycombinator.com/newsguidelines.html
And there was a failed effort to repeal the ACA.
It drives me crazy. I can choose auto insurance, life insurance, home insurance, disability insurance all independently from other decisions, but health is this special category that is legally linked to my employer.
It's just that it wouldn't make sense to do that at an additional cost of thousands of dollars.
You could decline the benefits if you really wanted (e.g. if you were Christian Scientist), but you lose thousands of dollars of your compensation.
The ideal would be for your employer to deliver the same value in the form of salary, and then you have the choice free and clear.
[Edit] Corrected "new age" to "new religious movement".
New Age is a later 20th century thing that is not strongly tied to any historical religion.
1870s
> anti-science
Though popular medicine was only a little sciency when they were founded.
> quacky
They use to have lots of celebrity adherents: Joan Crawford, Mickey Rooney, George Hamilton. Kind of like Scientology nowadays.
Some of the Republican proposals this year had provisions for matching the employer tax break on health insurance, but none of them got rid of it (a less drastic step than banning employer provided insurance would be to only give individuals tax deductions for insurance).
Yes, there is, but from the other direction from the one you are interested in (universal single-payer).
There's also been efforts to eliminate tax and other incentives and mandates that make employer-sponsored care common, which is probably closer to what you are looking for, though the people backing that would generally be ideologically opposed to prohibiting employer-sponsored health care.
> I bet it would be a much bigger issue for people
The reason health care is a major political issue across the spectrum is that it's costs are already a giant issue for most people. There's disagreement on what to do about it, not on whether it's a big issue that people feel significant impact from. Your solving a non-problem by looking for ways to make it a big issue.
I mean, if you get old and/or sick you are stuck with your employer. How crazy is this?
Examples: I once tried to buy some nasonex (or equivalent) without my insurance info. $180. When I didn't pay and returned with my insurance info, it dropped to $5ish. My wife gets bi-weekly injections that stops her psioratic arthritis (which she's had since her teens) from crippling her. With insurance, $50/month. Without....we were quoted in the thousands, each month.
It is very, _very_ easy for me to see situations where you need health care to be able to work, and you need work to afford health care.
And this does impact employer lock-in. Every time I switch jobs (and to a lesser but still notable degree, when my company switches insurers), we have to do a new dance of:
* getting registered for insurance. Most places backdate your insurance to date of hire, but if you want to actually get the benefits immediately, it usually takes weeks to get your info from your employer to the insurance company and then they "process" it. (I have been told by one company that it takes them 1 business day to know they GOT a fax from my company, and another 2 business days to "process" it.) From experience I can say that if you make yourself enough of a problem you can drop this down to 5-10 days, but it takes a lot of work and that's still a ridiculously long time.
* Did I mention that it's quite common to have a by-mail pharmacy? That's a separate company from your insurance, so step 1 has to repeat for the new company (that process is usually faster, but it's still easy to lose another day to it). Oh, is your drug expensive and/or restricted? That might be handled by a specialist pharmacy, which is a 3rd company. (that last is not a guarantee - I've seen it in about 50% of my insurance
* Once you have the insurance info, now you need to get the doctor to send in the prescription. For basic drugs that's simple and automated, but for expensive and/or restricted drugs, that's more hoop jumping. Have you tried to get a hold of the average american doctor's office? My experience is you call, get transferred to a nurse's voice mail. Leave a message, and in 8-24 hours they will call you back. Re-explain whatever you said in the voice mail, and they say that will need the doctor's okay. Enter a second 8-24 hour wait. Now the doctor's office will send the prescription to whatever pharmacy you need...who will reject the request because they need justification (Silly me, I thought the prescription WAS the justification). Now the doctor needs to call the insurance company directly. Which is, you might guess, usually harder that getting them to send in the prescription in the first place. (we've had wonderful doctors for this and terrible doctors for this...and in my opinion the terrible doctors are only terrible on a relative scale - I hate the hoop jumping and I'm not doing it for multiple patients)
And all of this presumes the drug ( or non-pharmaceutical care) is covered in the first place. Every time I consider switching jobs, I have to find out if they will cover my wife's treatments. (Figuring out if something specific is covered is non-trivial and I have a degree of mistrust about the results).
I'm fortunate enough to have a good wage and many job prospects. I can easily imagine someone in less beneficial circumstances getting locked into a job by the above.
Someone always has to pay, and socialized healthcare just means that your neighbor has to pay for your poor lifestyle decisions.
Employer 'provided' healthcare is a voluntary, demand-driven benefit.
To re-purpose an earlier comment - socialism "sounds like slavery".
As I understand it, healthcare in the US isn't voluntary, thanks to the ACA, where the onus is on citizens to have a third-party product covering them at all times. If you choose not to, but could afford it, you are fined for not doing so.
Socialized medicine just amalgamates the disjoint pools of policy holders, and allows the state to manage aspects of care (i.e. avoid the hyper-inflated per-person costs in the US).
I really don't understand your argument, you are never paying for solely your own healthcare in the US system, unless you forego cover completely and accept fines from the govt for doing so.
The existing US system has the taxpayer paying as much as a share of GDP, and more per capita, than many developed countries that have fully socialized systems. It also has more than that in private costs, on top.
Why frame the issue in this way, except to make yourself feel better about being complicit in denying your fellow citizens access to basic healthcare?
The alternative explanation is that you genuinely believe all issues requiring healthcare are the result of "poor lifestyle decisions", which is plainly ludicrous.
I think you should give some serious consideration as to why your brain forces you to frame the problem in this way. I suspect it's because at some level you do feel morally culpable for whether your neighbor lives or dies, but that inevitably leads to a position where some social programs are morally just, and a belief in orthodox anti-statism is more important to you.
The only way to square that circle is to frame all healthcare issues as "poor lifestyle decisions" and social programs as "like slavery". Much easier to feel better about a child dying because they can't get access to basic healthcare if you can just hand-wave it away as "poor lifestyle decisions."
Your attitude is sickening to me. Why not just go full-on black hat and say "fuck the sick" instead of pretending all healthcare is due to "poor lifestyle decisions"? At least that would be intellectually honest, and no less evil.
Malcolm Gladwell recently had a podcast about how McDonalds ruined their French fries when they got bullied into changing their fryer oil from stable saturated fats to unstable polyunsaturated oil: http://revisionisthistory.com/episodes/19-mcdonalds-broke-my...
I don't think The American Heart Association's propaganda campaign against stable cooking fats helps individuals make good choices for themselves.
Alcohol and drug addictions usually start with physical and/or mental anguish, not 'lifestyle choices'. I wrote about this recently: https://news.ycombinator.com/item?id=15024780
More fundamentally, why does it matter whose fault it is? This is 2017 and the US is an extremely prosperous nation. Everyone should have access to health care without being financially ruined, regardless of their "lifestyle choices."
http://www.huffingtonpost.com/entry/i-dont-know-how-to-expla...
I wish NYT does a piece on origins of minimum wage. Minimum wage was brought int to make sure black people dont find employment.