Universal Healthcare would be the most useful thing that could happen to help gig workers.
Taxing everyone to hell to cover every health expense is immoral.
Universal healthcare is such a moral sham, and what we have now in the US is also pretty bad. There is a better way.
If you're trying to get enough hospitals to do this that people don't just go to a cheaper hospital, then almost all hospitals are going to have to raise their prices... and that's effectively the same as a tax. They're "robbing" every patient the same way.
The hospital can turn of course offer to foot the bill, but can do so only after you’ve exhausted other options. But none of this is forced.
1) More expensive healthcare, to cover for these cases directly in a fund or via third party insurance.
2) Healthcare scarcity.
You can't draw blood from a stone. Healthcare investors/workers at large don't get in to become a charity so your "solution" comes with explicit downsides you should mention.
No solution is perfect, but that’s a world that’s more personal for those helping and being helped. It also is more economically efficient. I’m not saying this is the only solution, but one that starts with robbing your neighbor is the moral low route and we should and can do better.
This is somewhat of a myth; at least it is nuanced. The care in the ER is to stabilize the patient, not fix them. They provide acute care only.
Even acute care can be quite limited. People are triaged based on how acute their case is. Many languish in an uncomfortable waiting room for hours till they crash or leave.
This rationing is done by limiting the beds so that the ER is almost always over capacity. This is by design. Since ER are cost centers, when a hospital asks for a building permit from the municipality, the number of emergency room beds open to the public is the primary negotiation. It's the bottleneck that limits costs.
Emergency beds equipped to handle trauma, e.g, gunshot wounds or car accidents, is even more limited. To avoid costs, many hospitals simply do not have a trauma center, unless the municipality agrees to have significant subsidy. People die in ambulances while they search for a hospital with an open trauma bed.
This is a complex and heartbreaking topic.
When you're already working the gig economy, I imagine $500 / mo is a lot more of your relative income than $100 or whatever for me.
What's the methodology for calculating the amount of people dying from "lack of health care"?
If I had to guess. I haven't looked, though, of course.
It is like employment insurance. Self employed love to opt out, but come a major economic crisis, they demand they be allowed to participate.
Many people have to choose between paying for something that primarily only matters in case of a bad event (health insurance), versus paying for things that if they don't pay for them, bad things happen with certainty, fairly quickly - loss of power, going hungry, not having gas for the car that they require because our public transit systems have been systematically disassembled (again over the last half a century), astronomical interest/late fees on loans and a credit score drop that can mean credit gets even more expensive, or is automatically revoked, or impacts one's ability to find employment in a kafka-esque hell where having too bad a credit rating means a fair number of companies won't employ you.
When Wallyworld has staff who train employees in how to file for government benefits, maybe it's time to look at corporate tax share (in the 50's it used to be about 50%, now it's a few percent) and minimum wages.
[1] https://www.cnbc.com/2018/08/28/about-half-of-californias-gi...
[2] The U.S. spent $8,233 on health per person in 2010. Norway, the Netherlands and Switzerland are the next highest spenders, but in the same year, they all spent at least $3,000 less per person. The average spending on health care among the other 33 developed OECD countries was $3,268 per person. https://www.pbs.org/newshour/health/health-costs-how-the-us-...
Governments regulate indirectly like this all the time, there's nothing "weird" about it.
The Democrats fixed that good. Will providing healthcare to everyone end racism?
If you ask a Democrat about whether they support socialized healthcare, they'll tell you that they of course support "universal access."
What is "universal healthcare" anyway? It sounds like some the kind of intensely workshopped and whiteboarded meaningless marriage between socialized healthcare and "universal access" that "Medicare for All" was designed to head off.
I think the Democrats correctly recognize that there is not a deep belief in the idea that of socialized universal healthcare in America. In the survey you quoted, I would bet that about 20-30 out of that 70% support the effects of it (i.e. universal free or cheap healthcare), but would not support a tax increase to pay for it if needed.
Regulate pharma pricing, cut the insurance companies as middlemen (they make $10's of billion in profit and their CEOs get paid millions), and make medical school affordable, even subsidize it if necessary.
All of these issues we can sit here and discuss for hours have solutions, change will only happen when we all agree that healthcare is a human right, and shouldn't be tied to a job.
"It's a matter of creating a sound plan" is not the trivial thing you make it out to be without having a broad mandate about healthcare. You sound like the typical person who has never run for political office, but somehow thinks that they would totally fix the system if they were in charge.
Governments are an efficient market of sorts. Affecting the market needs either broad changes in society's point of view, or catastrophic events. It's indicative of the magnitude of conservative thought in American society that even the worst pandemic in US history did not result in a bipartisan push towards socialized healthcare.
For what it's worth – I agree with you about healthcare being a human right, but I'm not the person you need to convince. It's the people in your nearest conservative-leaning district who tend to treat healthcare more like going to the car dealership.
Similar, if OP thinks that there is an obvious case that Americans would back a completely socialized healthcare system, they are probably wrong, and the politicians that actually spend all their time talking to people and understanding the "market" of votes are probably right. One survey quoting a number of 70% does not mean anything particularly significant.
The problem with healthcare as a market is that it isn’t. We don’t allow medical professionals to decide that you don’t deserve blood pressure medication. But we do let bean counters decide that you get to die for lack of resources.
By doing this not only have we created a moral dystopia, but we’re wasting resources that we supposedly care about.
"Democrats" were not against health care. Some dems wanted a different candidate to win, and they argued against Bernie. Some dems were against Biden and argued against him too.
Californias State Assembly has tried to get UHC, it was blocked by Newsom. If it cannot be done in California then it’s clear the Democrats aren’t going to fix it and have no political solution.
I don't have enough info to comment on your second point, but what I've heard was there were serious concerns in the bill and that's why gov. Newsom vetoed the bill.
If you haven't looked it up, why would your claim that this is an opinion be anything other than noise? Find out whether its a fact or not (if you care) and come back and tell us.
> From my OPINION there are more people covered and are benefiting from medicare and medicaid because of those improvements.
This is not a matter for opinion. It's a claim fact that you can choose to verify or not.
FWIW, I agree that the GP post you first responded to is trash.
Take a moment, breathe deeply and try to relax ;)
The Franken recount and Kennedy death meant they couldn’t negotiate further and had to pass the reconciled bill for Obamacare without a Medicare buy-in option, unless they had literally any Republican cross the aisle - which they refused to do. It’s just such ignorant bad faith to claim otherwise.
And since primary taxation happens at the Federal level, the state-options are essentially impossible without the Feds giving states that provide universal healthcare the ability to not pay Medicare/Medicaid payroll taxes — again which is impossible without Republicans support.
Here’s the latest M4A bill with dozens of D sponsors:
https://www.congress.gov/bill/117th-congress/house-bill/1976...
https://en.m.wikipedia.org/wiki/Nuclear_option
My preferred solution is to abolish the Senate.
I didn’t say “vote democratic”. I said, don’t vote conservative. Two different things.
So technically yes, I guess we can blame the Dems for not fixing healthcare in 11 days.
Note: Republicans later won that seat - https://www.cp24.com/democrats-scramble-after-republican-tak...
https://en.m.wikipedia.org/wiki/Strom_Thurmond_filibuster_of...
https://en.m.wikipedia.org/wiki/Nuclear_option
My preferred solution is to abolish the Senate.
Being extremely selfish for a moment, I can see the argument for how it got worse. For ultra-rich software engineers like us, yup, it got worse. There are basically the same number of doctors as there was before the ACA, but now more people can see them. This means you have to wait for appointments. I also think that medicine got ultra-industrialized What insurance covers and how much also decreased for us ("Cadillac tax" or something). I don't have many medical needs but I can tell you my insurance company tends to deny everything and you have to file 300 appeals if you even walk past a medical complex. It didn't used to be like that. But in the end, it doesn't really matter. You get paid a shit ton of money, sometimes you spend it on medical treatment.
So saying dems had a supermajority and they could do anything they want is wrong, just like the dems have 50 + 1 and they can do things with majority votes - no they can't.
I don't think healthcare is worse now than then. My mom was very ill when obama was president, and she couldn't get health care. She got free healthcare from the hospital. She died of cancer a few year later. Yeah, I was helping her, but she would have been better off if obama care had been available for her.
The dems cannot fix it because they don't have a sufficient number of votes in congress. Even if they got to 60 in the senate to vote over the filibuster, they'd still need a few more because of Sinema and Manchin.
The dems have a majority now, and they are going to having trouble passing a budget funding gap fix in december. Let me repeat that - they have a majority and they will struggle to avoid a govt shutdown. https://rollcall.com/2022/09/16/conservatives-ire-over-stopg...
Let
The limiting political factor is no longer the demand side of the scale—the voters and their fear of "socialism"—but rather on the supply side—the electable candidates and their unwillingness to do anything about it.
> Do you support universal healthcare?
> Do you support raising your taxes by $X per year?
> Do you support universal healthcare if it means raising your taxes by $X per year?
Which question do you think they asked?
This would be a biased question to ask, since the economic effect on a U.S. citizen couldn't be measured by the tax rate alone.
Conservatives aren't the only thing stopping universal healthcare. It's corrupt politicians in the pockets of health insurance.
Simultaneously, they need to reduce the regulatory burden on health insurance companies (but always accept pre-existing conditions). This way more health insurance startups can compete with the large legal entities that are health insurance companies.
With these two in place, no employer will ever control healthcare for employees, insurance companies will need to learn to live in thin margins and medical providers don't need to bear the administrative burden of insurance, this, reduce cost or pay more to the providers and nurses. In this way, insurance companies that cannot compete on price will fail and that is healthy capitalism.
Insurance companies exist to hedge risk - the federal government doesn't need to hedge, it can literally inflate the risk out of the market.
Pay my doctor's well, they deserve it. I don't even remember who I bought insurance from - don't care if they get paid.
To start with, they would have lower costs of executive pay than entrenched players. A startup can disrupt with operational costs.
Later they can negotiate better prices with providers, source cheaper drugs from around the world, use technology more efficiently. There is so much room to do something here, if the regulatory burden were low.
The real answer is not to acknowledge employer sponsored health insurance at all, and to treat it (tax it) just like every other form of compensation. Its current treatment is a nearly 100 year old remnant of attacks against unions. If you stop the giveaway to employers, employee-provided health insurance would evaporate, and the government would be forced to take rational action on healthcare provision and costs.
Health insurance is as much of a scam as casino gambling, and should be regulated out of existence.
Because of this, an individual buyer of health insurance is going to have a hugely variable cost of insurance, based on their risk profile. Currently, this risk is spread out by grouping employees of a company together, spreading the cost. That is why larger companies get much cheaper rates.
Health insurance risk is so varied, and so often not something the individual can control, that the only fair and efficient way to insure everyone is to create a single, large, cohort... spread the risk to every citizen via universal coverage.
That's the point. The insurance business can only exist if it can pay for healthcare of an "average pool". They cannot just go seek the healthiest people for group coverage any more. They must maintain their business and profits for the "average pool".
There are a large number of ways to provide such an insurance. They can negotiate with providers, drug distributors, invest in securities, improve productivity with technology and even cut CEO pay so that their intake of premiums <= outlay for insurance. That's it. If insurance companies can't manage costs, they will have to raise premiums. Because of 24/7 open enrollment, people will exit any insurance provider that raises premiums too much. If the insurance company can't compete, they will have to file for bankruptcy and customers can just go to another insurance provider.
The risk-based business model that exists today is predatory. It does not have to be this way. Most other countries with private insurance don't have the American predatory system either.
> In 1943 the War Labor Board, which had one year earlier introduced wage and price controls, ruled that contributions to insurance and pension funds did not count as wages. In a war economy with labor shortages, employer contributions for employee health benefits became a means of maneuvering around wage controls.
Would it be federal, or state-wide? How would it be funded? Would it be public "option", or would private pay be banned like in Canada? How would compensation rates be updated, and how often? Ask any hospital administrator what they think of Medicare/Medicaid rates, and they'll probably answer that they're set too low and that they lose money on Medicare/Medicaid patients.
The details on "universal healthcare" can range from heavily-regulated private insurance - Germany for example - to outright bans on private pay for items insured by the government (Canada). A lot of Americans seem to want some sort of federal system that provides insurance for everything, which seems like the best way to get the most expensive, least capable system imaginable. Imagine having yet another insanely expensive, totally underfunded entitlement program that politicians can continuously pad with new promises every 2-4 years when they need to get re-elected.
The Canadian experience (source: Canadian currently living in the US) is one you do not want to replicate, so be wary - Canadians have little confidence in their system at this point, even though it's quite expensive relative to European peers - and we have shockingly low numbers of imaging machines, hospital beds, urgent care clinics, etc. per capita, all well having administrative bloat that makes university administration look positively lean by comparison.
People love to fret about this politician or that politician, but the reality is that Canada got the incentives totally wrong because they sounded nice. No out-of-pocket expenses? No evil private medicine? No profit from healthcare!
As it turns out, central planning fails in healthcare just like it fails everywhere else. So "ensuring everyone has access to reasonably good healthcare" is an excellent goal, but "giving any level of government a monopoly on healthcare insurance" will be the death knell of the generally excellent healthcare Americans have access to if you have insurance.
Virtually every rich country except America manages to provide “free at point of use” healthcare because of government intervention. And of note, if you’re not happy with what the government provides in most of these countries, you can usually top up to gold-plated health care at a fraction of the cost in the US. Last I checked, the US also managed to do this just fine where it has to: the VHA spends about as much as the NHS does and also gets excellent outcomes.
Talking about “the Canadian experience” seems strange to me: don’t each of the provinces/territories do it differently? The Manitobans in my family seem very happy with the provision they get. Regardless, 75% of Canadians are “proud” of Canadian health provision[0].
Most rich countries (that aren’t America) also have essentially instant and free transfers between bank accounts … because either the government intervened or threatened to intervene.
0: https://biv.com/article/2020/08/covid-19-crisis-has-failed-e...
It's a bad system and since that article was published public sentiment has been worsening: https://nationalpost.com/news/canada/first-reading-canadian-...
Most people who have glowing things to say about it have had minimal interactions with the system. The overall data shows predictable results when government intervention completely skews market incentives: the patient experience blows, administration is bloated to hell, it lacks capacity, and it bleeds healthcare professionals across the border where pay and working conditions are generally better.
The fact that anyone defends the system as it's currently designed is honestly baffling to me. If you took another essential industry - food - and applied similar incentives (any food paid for by government can't be purchased privately, government sets the rates, etc.) most people would correctly predict it would be disastrous.
On this, I’m curious about your experiences with the US system: do you buy your own or is it provisioned via an employer? Have you mostly been financially secure while interacting with it?
-Private insurance is allowed to exist and compete with the public offering
-Everyone is entitled by law to the public health system for any kind of injury or health need.
-The hospitals used by the public health system are government-owned. They are run by government bureocrats and staffed with private employees (the doctors, nurses, janitorial staff, etc)
-The hospitals are managed by the respective jurisdictions in which they are, but they have to follow the basic model that the federal government imposes through the national health ministry.
The best hospital systems in the world, like Mayo Clinic and Cleveland Clinic, are generally non-profits operating in a mixed system where they take private insurance, out-of-pocket payments, and medicare/medicaid. They have to remain competitive otherwise they won't attract customers from out-of-state or out-of-country. If you basically force patients on the public system to only use certain government-run hospitals, you're dooming them to an inferior experience than what you could get by perhaps enhancing access to public pay for some services.
1) The incentive to innovate in the overall medical field is fulfilled by the existence of private hospitals, which according to my OC wouldn't be banned or cease to exist. They would coexist alongside the public ones.
2) Behind your statement lies the necessary asumption that the medical staff would not provide a good service to their patients because the government would pay them less than private hospitals. While it is a spectrum, most decent doctors won't treat their patients worse because they are getting paid less, something that is not the patient's fault nor responsibility.
Besides, one does not choose to get ill or suddenly feel in need of medical care.
Your use of the word "customer" to refer to a medical patient sickens me.
This is one of the top hospital systems in the world, and they serve patients from all socioeconomic backgrounds. You may want to think about what information they have that you don't when it comes to delivering world-class healthcare.
We're talking about government policy here, not leadership of private hospitals.
It's just a lazy argument to say central planning fails in healthcare, because it generally works well in other countries.
The biggest complaint I hear about the Canadian system are wait times, but those affect the expensive US system, too. My wife needed back surgery and couldn't get it scheduled until 6 months out in the US, after jumping through health insurance hoops (useless procedures to check boxes) for 6 months prior to that.
Ended up in the ER told "don't move or you might not walk again" while she had to wait 2 days, writhing in pain (but not allowed to move!) until a surgeon performed her surgery 4 months earlier than scheduled.
And we paid 10s of thousands of dollars, which took years to pay off.
Outcomes aren't uniformly better, by the way. Canada routinely ranks near the bottom of the OECD and like one notch above America, but in America you can get the best healthcare in the world (Mayo Clinic, Cleveland Clinic, etc.)
Canada has no equivalent - the small Cleveland Clinic presence in Canada hasn't bothered trying to open a hospital because it would basically be impossible, unlike in the UK where private hospitals still exist.
The healthcare professionals in Canada are very well-trained, but there are too few of them and they're smothered in useless bureaucracy.
another day on the news, someone suffered a stroke and because the ambulance didn't come on time she is partially paralyzed.
another couple had a miscarriage with the mother dying because surgical tools were not sanitized properly.
some desperate and sick of waiting travel to US or abroad (Korea, Japan).
family doctor, nurse shortage is half the problem. canadian medical school breadth of teaching is generalist and do not go deep enough.
there are now calls for privatization. i wish people would stop fetishizing canadian public health care, its better than nothing but behind the rest.
It's illegal to compete with it.
It's like saying AT&T "worked". Sure you could buy a phone service and pay $$$$ for it, but if I had a better way of running it, they would put me in jail for trying.
Plenty of counties also provide market healthcare with private insurance without the American issues, e.g. Switzerland [1]. If we want to keep a market-based model, there are reforms that point the way forward.
[1] https://en.m.wikipedia.org/wiki/Healthcare_in_Switzerland
Lots of countries in South America have a lot more problems than healthcare. Maybe consider their per capita GDP or something to offset that fact.
Even with that, Costa Ricans, Chileans, Cubans, Panamanians, Uruguayans and Colombians have longer life expectancies than the US, which manages to be 54th in the world while spending about as much tax money per capita as any other country does on healthcare.
If you can't make the VA model work in America, that's good evidence that a bigger model would suffer the same, but bigger problems.
I'll add: it feels like the veterans are begging the VA when they should have that basic human right by default.
Ah, so that's why wholesale prices are so much higher than retail. Diseconomies of scale.
And if you can't make it work in America, the country with the most screwed up and corrupt healthcare in the world[*], how could you expect to make it work anywhere?
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[*] It's a big claim, but I don't know how else you refer to a country that spends twice as much on healthcare per capita than any other country, but comes in 54th for life expectancy, while being the main cause of bankruptcies.
If you do not like this structure then you should have worked to block Obamacare from becoming law, because that was a primary objective of the legislation: to decouple health care plans from large companies and employers, and make that insurance more accessible, on the free market, to more workers than ever before.
agreed, but they won't. Most of the "gig" companies are exploitative parasites.
Did it? There was lots of talk at the time about how you get to keep your private plan. And the actual text of the ACA mandated that large employers offer health insurance, which was not the case before the ACA.
What provisions in the ACA made great efforts to decouple them? i.e., which provisions incentivized individuals to not be on employer plans, or employers not to offer them?
Editorial: This is why everyone calls it Obamacare. The Reps love the knock. The Dems are not wanting to remind anyone Affordable is in the name.
Note: I'm not knocking ACA per se. We should have health care. The issue is ACA is a fine example of: good idea, poor execution. And no one has the will to fix what is by most accounts not living up to its promise or need.
I'm not sure what you mean by "decoupled." I could buy private health insurance prior to the ACA and it was cheaper (at least for me it was). Also, I wouldn't call the marketplace "open." Right now health insurance is like the internet in that you can only purchase it from local providers and you can only realistically use it at "in network providers" without the cost becoming astronomical. The lack of competition is what is artificially keeping prices high. Case in point: my dental and vision insurance can be used in all 50 states with a huge number of providers and costs a fraction of what my health insurance costs.
Isn't that largely because dental and vision insurance has pretty limited coverage? For example if you get oral or eye cancer that would usually be covered by your health plan, not your dental or vision plan.