When you explain to them that they will lose their existing insurance and be forced to take medicare then support plummets.
It's a complete mystery to me why people keep pushing medicare for all when a public option is much more popular, and this is even before the ad blitz that would happen should this ever become a serious possibility (which wont happen without a massive political realignment).
The main problem here is that the Republican establishment is led by the plutocrats (the top 0.1%) with a strong economically populist insurgency, while the Democratic establishment is led by professionals (the top 10%) with a a strong leftist insurgency.
But while you can have affordable healthcare with overpaid CEOs, you cannot have affordable healthcare with medical professionals earning the salaries they currently earn, and these groups have enormous power over the Democratic party establishment. We are now spending 19% of GDP on healthcare and that number keeps going up, meanwhile the only thing the Democrats can do is advocate for more government subsidies to allow the professional classes to keep extracting even more from working class americans. You simply can't have universal healthcare while median nurse practitioner wages are $50/hr (https://www.bls.gov/oes/current/oes291171.htm) and no one is willing to take a hammer to medical professional wages in order to make universal healthcare affordable. This is why we got Obamacare/Romneycare when the Democrats controlled all branches of government -- there was no support for anything other than more subsidies being funneled into the pockets of the health care system.
It is the exact same situation as with higher education -- completely out of control costs that are bankrupting people as we spend triple what the rest of the world spends, and what is the Democrat policy? More taxpayers subsidies are needed, because they are not going to take a hammer to the professionals working in higher education anymore than they are willing will take a hammer to the professionals working in healthcare. Both of these are key Democratic constituencies.
Really some kind of political realignment has to happen because the current economic status of this country is that we are being stripped bare by the professional classes who have failed to provide us with either affordable higher education or affordable healthcare and who can only demand more taxpayer subsidies or else they will refuse to provide these crucial services. But people are fooling themselves if they don't see the enormous wells of anger and resentment against the nations universities and hospitals. There simply isn't the support to shovel more subsidies into these groups, and it doesn't matter how you package it, whether a medicare for all program or something else. You are not going to get European style social benefits until these industries are shrunk to requiring European style spending levels. We are talking 50% cuts in total spending just to start things off and even more in higher education.
At least one political party has to be willing to both massively cut costs and provide insurance guarantees to ensure coverage. Those who ar...
The polling data I’ve seen disagrees, but of course it’s going to be up to elections and not polling.
Cost controls and increased revenue will be necessary, but neither will be excessive to accomplish the goal. I carry around Sander’s Medicare For All bill as well as the accounting breakdown when canvassing (practicing for my own federal office run), so I am familiar with the details.
Correct. The only reason a state can't execute the plan is that the bulk of the heavy lifting has to be done on the cost control side which is interstate commerce. Hell, an individual city or even neighborhood could create an insurance pool if it was affordable. Healthcare is not a financing problem or an insurance/risk pooling problem, it's almost entirely a cost control problem.
None of these things will happen until the power of the professional classes is broken. They will fight it, and you will find that you don't have the votes in congress to do any of this stuff. Seriously people are walking into an oncoming freight train thinking they will reorganize 20% of the economy through the power of sheer idealism and it would be funny if the stakes weren't real. But we will meet again in 20 years when the situation is much worse, and you will be confused as all hell why none of these plans were realized. As long as the professionals are in the drivers seat of the Democratic party, you can push the truck as hard as you want but they will steer it towards an Obamacare style solution, at which point you will say "We must push harder! It will happen!"
But it will never happen, not as long as the Neera Tandens of this world are calling the shots in the Democratic Party.
Yes, there has to be unrest. Promising all sorts of benefits isn't the battle. Those who think they can combine the exorbitant spending of a US system with the social financing of a European system are not serious players in these discussions.
Same for universities. If you want European style public financing of Universities, get ready for a system where universities accept only 1/2 of the students that American universities accept, where a degree lasts only 3 years, and where total spending per student is 50% of the US level even on a GDP basis.
This is the kind of the system that you can get the public to agree to fully fund, and it again requires massive cuts to university staffing, shutting down a lot of schools, as well as lower salaries (on average) of those who remain.
When that starts polling well together with the free tuition part, then you know you have real backing for a European style system.
I'm from Europe and I think European systems are more rational and ultimately much more humane, but they are so far different from what is happening in the U.S. that when I see the college kids argue "why can't we have what they have in Germany/France", I want to yell back "If we had a French system you would have never been accepted to University." People have no idea of whether or not these moves will be popular.
Keep in mind that when European nations adopted universal health systems, the health care sector was a small part of the economy and the nations were politically united with high levels of social trust and solidarity.
When England adopted the National Health Service act in 1946, healthcare was less than 3% of GDP (https://www.nuffieldtrust.org.uk/chart/nhs-spending-as-a-per...) and the nation had high levels of social trust especially trust in government (they just won WW2, large portions of the economy were nationalized, they were used to rationing, etc). Even then it took a big battle, with lots of organizing to get it done.
So when people say "why can't we do what the Europeans did", the Europeans never took over 20% of their economy, they took over ~3% of their economy and that grew to 10%
There is a big difference in the political battle to take 3% versus 20%. Today, in almost every city the hospital is the biggest employer. Healthcare workers are huge political players, and while they certainly favor more government spending, they do not favor more cuts. But taxpayers favor the free stuff, not the "we will tax you more" part. These are huge requirements for social trust and especially trust in government. But now, the U.S. is as divided as never before and social trust, particularly trust in government, is rapidly falling. (source: https://www.pewresearch.org/fact-tank/2019/07/22/key-finding...). The younger generation is in the curious position of demanding more free stuff while also trusting government the least of any generation.
So when all these people say "Hey, free stuff polls really well, we can do this people", I just roll my eyes. This would be 10x the achievement of what the Europeans accomplished and in a nation completely divided and growing farther apart each day.
It's not at all flippant when one side describes the benefits but not the costs. If it was marketed accurately, I wouldn't call it the free stuff platform. But then if it was marketed accurately you wouldn't have the majority of people thinking that medicare for all was really a public option proposal, or Kamala Harris throwing smoke in people's eyes by simultaneously distancing herself from medicare for all while also advocating for it. Let's be honest about the level of honesty here.
Overall I tend to agree with this. However the other half of the insane cost (19% of GDP) is the overpay on drugs.
The US has so many idiotic laws that often date back to 1900-1950 in terms of health care. During WW2 because of wage caps companies started to offer health care and that was essentially institutionalized. This is one of the single dumbest polices ever, since it means people who lose their job lose their health care. It means much less diversity in terms of the type of health care coverage that can be used. It also means that people have much less visibility into the cost of their health care, people often say median wages haven't gone up but a large part of that is because health care cost have gone up in almost equal measure.
If you systematically go threw the US health care system it is littered with anti-competitive rules that benefit particular groups on every level. I think people often make it out to be a simple US is "private" system and its bad, so if you change it to a public system its gone be good. I don't know if that is true, many of the same issues persist and somebody has to pay the money eventually. Such a system would help the people who now pay way to much now but society will pay either way and probably +20% of GDP.
At the same time the cost of most non-insurance health care and operations go down. Beauty, eyes and so on go down and down. Cash only health care is WAY cheaper. Something is seriously wrong with this system.
Agree that drug costs are also crazy. To me that is part of overall healthcare costs being too high. I used to believe that the cost of non-insurance goes down until you look at the costs of veterinary care, which has been rising even faster and which is generally cash based.
Bottom line, it's best to think of health care as a type of extraction racket. How much does it cost? Well, how much do you have? If you love your pet or your own life, you will end up paying.
There are a number of things that can be done to lower costs. Limit drug patents, force drug makers to make samples available to generics competitors, insurance adequacy laws that ban out of coverage charges, ban surprise charges, mandate a law of one price so that different patients can't get charged different prices based on whether they pay cash or insurance or what type of insurance. Mandate price transparency, mandate citing bills ahead of time rather than forcing customers to make general 'promises to pay'. There is lots of progress to be made and low hanging fruit available.
This supply side intervention is not a substitute for addressing the insurance market, which should be addressed. But the bulk of the problem is on the supply side, not the demand side, and as you drive costs down, then different types of insurance reforms become more affordable and thus more politically feasible.
But it makes you wonder why even the most strident advocates of single payer are not talking about cutting costs nearly so much as they are talking about the government paying your bill. This is just a sign that they know there is not political support to tackle the tough questions, there is only political support to advocate for benefits, which is another way of saying there is no real political support to tackle this problem. And if there is no political will to make reforms on the supply side now when individual Americans are being hit with exorbitant bills, then what will be the political will to do this when it is "government" that is on the hook for the bill?
It is a highly complex issue. School is expensive. However, I know a gastroenterologists with a starting salary of $425k in Arizona. It is insane that anyone needs to make that kind of money, straight out of school.
Medicine in US feels like a sham, people are stressed out about medical tests because of cost. A millionaire can be bankrupt by a serious illness. It is insane and I can't believe it is not a bigger issue for most Americans.
People like to talk crap about Obamacare, but Obama was the one that got rid of the policy limits. I have read stories about families loosing their insurance because their kids were sick and they went over their limit of 1 million dollars.
If you are a part of this rotten medical system and are fine with it.....i dont know how you sleep at night.
Edit: Obamacare was not a good solution but it helped some. If other countries can have lower cost, we can lower the cost of care in the US.
It's actually linear if you compare it by percentage of GDP of country. I'm not entirely sure what metric you are using but with GDP it's linear. The only problem it seem is that USA cost is much higher compare to other country.
I have incurred over a million dollars in medical bills since Sept, 24, 2018. I get a pembro drip that is 28K every three weeks. And a CT scan every few months, 45 treatments of radiation.. 10K a pop on average.
Feeding tube insertion. 40K.
They had to try a few times since my stomach rides high. They had to basically use a live "CT" scan while sending a thing down my throat to push my stomach below my ribs so they could poke a hole in my belly and insert a feeding tube. And then they used staples to hold everything in-place. My god it hurt and they have amazing drugs that make you feel so good and pass out for three hours. Then you wake up screaming frantically pushing the button for more drugs. My sister had twins vaginally.. It is a toss-up who has done more pain.
I am lucky.. I am cheap. I have no kids, and my possessions fit in the back of a 1987 Volvo wagon. I tested that when I moved after I found out about the cancer. But I have gone through all this without worrying about money, kids, or bills. I was lucky I just had enough savings I could quit everything and do my health.
But my god. If you get cancer and you have a mortgage you are fucked. It has consumed every minute of my last year. Every second you think about it growing in you.
Sorry man. US healthcare is honestly brutal. I am hoping you have insurance, which has a decent max out of pocket limit. It isn't a solution this insane problem though.
I too went into medical debt in my 20's. Now, in my 30s I deal with chronic pain but at least my credit recovered. I hope you recover from this!
I think this is incredible and everyone should seriously evaluate their commitment to both their money and time when it comes to charity work. So many people "want the government to do something", very few will get their hands dirty.
29 comments
[ 3.5 ms ] story [ 81.9 ms ] threadThe US system is expensive and increasingly cruel.
I do not expect that state of affairs to endure too much longer.
When you explain to them that they will lose their existing insurance and be forced to take medicare then support plummets.
It's a complete mystery to me why people keep pushing medicare for all when a public option is much more popular, and this is even before the ad blitz that would happen should this ever become a serious possibility (which wont happen without a massive political realignment).
The main problem here is that the Republican establishment is led by the plutocrats (the top 0.1%) with a strong economically populist insurgency, while the Democratic establishment is led by professionals (the top 10%) with a a strong leftist insurgency.
But while you can have affordable healthcare with overpaid CEOs, you cannot have affordable healthcare with medical professionals earning the salaries they currently earn, and these groups have enormous power over the Democratic party establishment. We are now spending 19% of GDP on healthcare and that number keeps going up, meanwhile the only thing the Democrats can do is advocate for more government subsidies to allow the professional classes to keep extracting even more from working class americans. You simply can't have universal healthcare while median nurse practitioner wages are $50/hr (https://www.bls.gov/oes/current/oes291171.htm) and no one is willing to take a hammer to medical professional wages in order to make universal healthcare affordable. This is why we got Obamacare/Romneycare when the Democrats controlled all branches of government -- there was no support for anything other than more subsidies being funneled into the pockets of the health care system.
It is the exact same situation as with higher education -- completely out of control costs that are bankrupting people as we spend triple what the rest of the world spends, and what is the Democrat policy? More taxpayers subsidies are needed, because they are not going to take a hammer to the professionals working in higher education anymore than they are willing will take a hammer to the professionals working in healthcare. Both of these are key Democratic constituencies.
Really some kind of political realignment has to happen because the current economic status of this country is that we are being stripped bare by the professional classes who have failed to provide us with either affordable higher education or affordable healthcare and who can only demand more taxpayer subsidies or else they will refuse to provide these crucial services. But people are fooling themselves if they don't see the enormous wells of anger and resentment against the nations universities and hospitals. There simply isn't the support to shovel more subsidies into these groups, and it doesn't matter how you package it, whether a medicare for all program or something else. You are not going to get European style social benefits until these industries are shrunk to requiring European style spending levels. We are talking 50% cuts in total spending just to start things off and even more in higher education.
At least one political party has to be willing to both massively cut costs and provide insurance guarantees to ensure coverage. Those who ar...
Cost controls and increased revenue will be necessary, but neither will be excessive to accomplish the goal. I carry around Sander’s Medicare For All bill as well as the accounting breakdown when canvassing (practicing for my own federal office run), so I am familiar with the details.
But it will never happen, not as long as the Neera Tandens of this world are calling the shots in the Democratic Party.
And the Medicare For All movement knows it.
Organizing to take seats, build something like a 10 million volunteer group, and plans for all that to be very highly active, are in the works.
The current system is completely unacceptable. As it has come into it's own now, the number of impacted Americans will grow rapidly.
I expect there will be significant unrest over this issue.
Same for universities. If you want European style public financing of Universities, get ready for a system where universities accept only 1/2 of the students that American universities accept, where a degree lasts only 3 years, and where total spending per student is 50% of the US level even on a GDP basis.
This is the kind of the system that you can get the public to agree to fully fund, and it again requires massive cuts to university staffing, shutting down a lot of schools, as well as lower salaries (on average) of those who remain.
When that starts polling well together with the free tuition part, then you know you have real backing for a European style system.
I'm from Europe and I think European systems are more rational and ultimately much more humane, but they are so far different from what is happening in the U.S. that when I see the college kids argue "why can't we have what they have in Germany/France", I want to yell back "If we had a French system you would have never been accepted to University." People have no idea of whether or not these moves will be popular.
Keep in mind that when European nations adopted universal health systems, the health care sector was a small part of the economy and the nations were politically united with high levels of social trust and solidarity.
When England adopted the National Health Service act in 1946, healthcare was less than 3% of GDP (https://www.nuffieldtrust.org.uk/chart/nhs-spending-as-a-per...) and the nation had high levels of social trust especially trust in government (they just won WW2, large portions of the economy were nationalized, they were used to rationing, etc). Even then it took a big battle, with lots of organizing to get it done.
So when people say "why can't we do what the Europeans did", the Europeans never took over 20% of their economy, they took over ~3% of their economy and that grew to 10%
There is a big difference in the political battle to take 3% versus 20%. Today, in almost every city the hospital is the biggest employer. Healthcare workers are huge political players, and while they certainly favor more government spending, they do not favor more cuts. But taxpayers favor the free stuff, not the "we will tax you more" part. These are huge requirements for social trust and especially trust in government. But now, the U.S. is as divided as never before and social trust, particularly trust in government, is rapidly falling. (source: https://www.pewresearch.org/fact-tank/2019/07/22/key-finding...). The younger generation is in the curious position of demanding more free stuff while also trusting government the least of any generation.
So when all these people say "Hey, free stuff polls really well, we can do this people", I just roll my eyes. This would be 10x the achievement of what the Europeans accomplished and in a nation completely divided and growing farther apart each day.
The US has so many idiotic laws that often date back to 1900-1950 in terms of health care. During WW2 because of wage caps companies started to offer health care and that was essentially institutionalized. This is one of the single dumbest polices ever, since it means people who lose their job lose their health care. It means much less diversity in terms of the type of health care coverage that can be used. It also means that people have much less visibility into the cost of their health care, people often say median wages haven't gone up but a large part of that is because health care cost have gone up in almost equal measure.
If you systematically go threw the US health care system it is littered with anti-competitive rules that benefit particular groups on every level. I think people often make it out to be a simple US is "private" system and its bad, so if you change it to a public system its gone be good. I don't know if that is true, many of the same issues persist and somebody has to pay the money eventually. Such a system would help the people who now pay way to much now but society will pay either way and probably +20% of GDP.
At the same time the cost of most non-insurance health care and operations go down. Beauty, eyes and so on go down and down. Cash only health care is WAY cheaper. Something is seriously wrong with this system.
Bottom line, it's best to think of health care as a type of extraction racket. How much does it cost? Well, how much do you have? If you love your pet or your own life, you will end up paying.
There are a number of things that can be done to lower costs. Limit drug patents, force drug makers to make samples available to generics competitors, insurance adequacy laws that ban out of coverage charges, ban surprise charges, mandate a law of one price so that different patients can't get charged different prices based on whether they pay cash or insurance or what type of insurance. Mandate price transparency, mandate citing bills ahead of time rather than forcing customers to make general 'promises to pay'. There is lots of progress to be made and low hanging fruit available.
This supply side intervention is not a substitute for addressing the insurance market, which should be addressed. But the bulk of the problem is on the supply side, not the demand side, and as you drive costs down, then different types of insurance reforms become more affordable and thus more politically feasible.
But it makes you wonder why even the most strident advocates of single payer are not talking about cutting costs nearly so much as they are talking about the government paying your bill. This is just a sign that they know there is not political support to tackle the tough questions, there is only political support to advocate for benefits, which is another way of saying there is no real political support to tackle this problem. And if there is no political will to make reforms on the supply side now when individual Americans are being hit with exorbitant bills, then what will be the political will to do this when it is "government" that is on the hook for the bill?
Medicine in US feels like a sham, people are stressed out about medical tests because of cost. A millionaire can be bankrupt by a serious illness. It is insane and I can't believe it is not a bigger issue for most Americans.
People like to talk crap about Obamacare, but Obama was the one that got rid of the policy limits. I have read stories about families loosing their insurance because their kids were sick and they went over their limit of 1 million dollars.
If you are a part of this rotten medical system and are fine with it.....i dont know how you sleep at night.
Edit: Obamacare was not a good solution but it helped some. If other countries can have lower cost, we can lower the cost of care in the US.
I think health care costs can easily become exponential, no matter what society you live in.
It's actually linear if you compare it by percentage of GDP of country. I'm not entirely sure what metric you are using but with GDP it's linear. The only problem it seem is that USA cost is much higher compare to other country.
Exponential would have bankrupt a country.
Yes, maybe treatment in Canada will be free, but would a million dollars (anywhere) have a chance at a complete cure?
Feeding tube insertion. 40K.
They had to try a few times since my stomach rides high. They had to basically use a live "CT" scan while sending a thing down my throat to push my stomach below my ribs so they could poke a hole in my belly and insert a feeding tube. And then they used staples to hold everything in-place. My god it hurt and they have amazing drugs that make you feel so good and pass out for three hours. Then you wake up screaming frantically pushing the button for more drugs. My sister had twins vaginally.. It is a toss-up who has done more pain.
I am lucky.. I am cheap. I have no kids, and my possessions fit in the back of a 1987 Volvo wagon. I tested that when I moved after I found out about the cancer. But I have gone through all this without worrying about money, kids, or bills. I was lucky I just had enough savings I could quit everything and do my health.
But my god. If you get cancer and you have a mortgage you are fucked. It has consumed every minute of my last year. Every second you think about it growing in you.
I wish everything goes well. You can do it.
I too went into medical debt in my 20's. Now, in my 30s I deal with chronic pain but at least my credit recovered. I hope you recover from this!