John Stockman’s Medical Bills Topped $1M – What Happened?

The government is on the hook for the old population and the poor population: the 2 most expensive subsets. Yet private insurance still isn't affordable despite only having to cover the lower-risk chunk of the pop. It's insane.

First, US insurance companies are often pseudo non-profits, with profit caps. [1]

Second, another model is Medicare Advantage where beneficiaries can choose a private entity to administer their Medicare plan.

Third, most commercial insurance in the US is not actually underwritten by insurance co's, but by "self-funded" employers. In this case, the insurance company is merely a third-party administrator (TPA) for the employee plans, using XYZ's bank account (and trying to save them money, offer health incentive programs, etc., to secure repeat business). Most companies with more than, say, 500 employees operate this way, though usually you won't even know this is the case.

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Finally, if by

> do we want to provide universal access to healthcare?

you mean "do we want everyone to have healthcare?", the answer is an easy "yes". We want universal access to housing, healthcare, employment, etc.

But if the question is "do we want the government to use taxes to ensure that everyone has healthcare?", the answer is far more divided. There's a lot of interesting examples elsewhere. But as you've mentioned, the US government has already dipped its toe into those waters with the VA, and I don't think it's been perceived as a success.

[1] http://thehealthcareblog.com/blog/2012/02/04/does-obamacare-...

People are frankly -- and justifiably -- scared of going to the emergency room. To the point of declining transport from the scene of an accident or other medical event, etc.

They actively ask people not to call an ambulance.

It's not necessarily that they fear the doctor or the treatment. They fear the bill.

And yes, often enough these are people with insurance.

A couple of years ago, I faced bills north of three grand, because someone called the paramedics when I didn't need them. I'd purchased the best insurance plan available to me, that year, and I was told at the time that service should be covered. Nope: Insurance failed to pick up the majority of it.

Fortunately, I could afford to cover the expense. And the paramedics -- part of the local fire department rather than privately owned -- forgave the balance of their charges when they learned that insurance had crapped out on all but a couple of hundred. (It cost, at that time, about a grand just to "roll the bus", with surcharges added to that for actual service and transport.)

That last was another reminder that public, non-profit safety can be a lot kinder than private, for-profit.

The southern democrats were successful in the 1930s and 1940s in blocking any measure that might put a crack in the armor of segregation.

Wartime price controls handed unions the ability to negotiate primo health benefits as well. So at the end of the day, nobody really cared enough during the time that the federal government could get stuff done.

It goes into comparing health systems around the world and understanding the history of why they went into effect.

There is a cheeky answer to your question: we have _all_ the main systems that are used in Europe and other places in the world.

There are 4 main systems 1. Beveridge (public health care providers and insurance rolled into one, like the NHS in UK): The VA and healthcare systems used for native americans use this system

2. National health insurance (private healthcare providers and public insurance funded by the government, like Canada's system): Medicare was copied from the Canadian system (even the name!).

3. Bismarck Model: (private healthcare providers and mostly private insurance, along with an individual mandate and heavy regulation of insurance companies: this is used in Germany and Japan). Obamacare was an incomplete attempt to move more towards this model.

4 Out of pocket model: (fully private: a non-system used by most poor countries in the world). This is what the uninsured fall back on.

A less cheeky answer involves looking at the common factor in the rise of systems 1, 2 and 3 in countries around the world. The fundamental political driving force behind this was a moral and ethical decision that healthcare is a human right that the government should provide. When Clinton attempted healthcare reform in 1994 he couched the politics of it in economic terms saying that we need to reduce costs, and it failed. Obamacare only began to make some headway once the politics and debate around it started focusing more on the basic moral and ethical question of whether our society should provide universal access to healthcare.

So it's this weird situation where maybe some people want it for economic reasons (our system is by far the worst in terms of costs per outcome), but politically the best thing is to make this a fundamental moral question of healthcare as a human right. Most constitutions written in the second half of the century include some kind of reference to healthcare as a human right.