Years ago my primary told me that if we eliminate all the people in health care who do not actually deliver care we could reduce costs by fifty percent.
My semi-libertarian friend talks about how the incentives are misaligned - denying care increases profits, so with a for profit insurance model, there's a strong incentive to deny care. You've said pretty much the same thing, just worded slightly differently.
I just think it's interesting that someone who thinks of himself as a libertarian, but who isn't dumb, is in favor of single payer.
Other countries do it. Corp wants us dead. Seat belts in cars is a great example of Greed. Below 55 mph, on average, you aren't injured long term, so no Insurance payout. ( Airbags now help lower numbers of those that do get hurt, long term.) Insurance Companies want you to die. No payout at all. High speeds, even with seat belts. More likely to die. No payout.
I’m 73 and have had asthma since 1980. I also have an immune deficiency that requires weekly infusions. I have EPI which is exocrine pancreatic insufficiency which means my pancreas doesn’t produce enough enzymes to properly digest my food which means without the proper medication my stomach is bloated and hurts all the time. I have other chronic illnesses but these are the most expensive. The asthma maintenance inhaler, taken twice daily is $500 a month. Another inhaler that I take daily costs $500 a month. My EPI medication costs $500 a month. I take Dupixent for asthma and eczema which is $5000 a month. The Hizentra I use for my immune deficiency is $5000 a month.
As a senior citizen on social security I make less than $26,000 a year. Obviously I don’t have the money to pay for these medications so I am on patient assistance programs. A woman who is in charge of patient assistance programs where my PCP is told me just this morning to apply for a new Medicare program where I wouldn’t have to pay for my prescriptions. There’s a catch though. If you have any money in investments, such as for long-term care, you don’t qualify. She said pharmaceutical companies are pushing this rather than giving patients free medicine. This tells me pharmaceutical companies lobbied Congress to go along with this. All three of my legislators are Republicans but I will go to their offices and discuss this with their staff.
Our legislators are not in favor of universal healthcare because of money they get from lobbying for their campaigns. So what can we as citizens do?
Excellent piece of investigative journalism Quasim. With your permission I would like to excerpt portions to include in the Letters to the Editor section of our local newspaper.
Fantastic comment, all true---and then some. Let me first point to a small demographic error (demographic history is one of my academic fields). Life tables presume that those born in year zero will experience the same life expectancy as current adults. Because of covid deaths, measured life expectancy appeared to decline---but if you have later data, it would show E0 at about 76 years, as it was before Covid.
Perhaps you should have made clear that M4A would eliminate the wretched for-profit, absurdly named Medicare Advantage.
On appointments: we have to schedule our annual physicals a year in advance as well as appointments with specialists. To get such appointments when sick is a great struggle.
But let me point out a key point you have missed. Our public health system (and by that I mean the absolutely essential state and local health systems) is premised on improving the health of individuals, certainly a good goal. But they implicitly blame individuals for not taking care of themselves. In essence, they ignore population health. Poor families, for instance, who live near a landfill or garbage dump will have poor health because they live in such an environment. Children who live in older houses or apartments that have not been renovated, eliminating the lead paint, may well get sick putting paint chips in their mouths. The worst well-known case: the Flint water crisis. Public health must go beyond M4A, essential as that is, and champion such population health. This would certainly mean cleaning up dangerous places but it would extend to enforcing universal vaccine mandates.
If Dr. Abdul el-Sayed wins in MI, he will be a strong voice for population health, for he practiced it, dramatically improving the health and hundreds of thousands of poor Detroit folk. (He also laments, repeatedly, that when he drove from his Ann Arbor home to Detroit, life expectancy declined by around seven years (I may have this a bit off).
Universal health care should also eliminate the need for lawyers to handle workers' compensation cases. I have practiced black lung benefits law, and have served as a hearing officer in Federal Employees' Compensation Act cases. The basic issue in any workers' comp case of which I am aware is some permutation of: did the injury arise out of or in the course of the employment? The only reason I can see that there's a social benefit in practicing workers' comp law is that the U.S. has a seriously fouled up medical system.
The key factor in the legalized betting system that we call insurance is N - the number of people in the pool. The larger the N, the greater the number of people”winners” - those paying in to cover the costs for the “losers” who have claims. When there are hundreds of insurance companies, each company’s N is smaller, hence, premiums are higher. Further, boosting N requires advertising, which adds a cost; for each insurer.
Imagine if N were the entire population. As noted, administrative costs would go down, advertising would no longer be necessary, and profit would no longer be part of the equation.
Universal healthcare is close to the ultimate “No duh!”.
The NHS in Britain does work very well but yes it has been deprived of funding for may years, especially when the conservatives were in power for 14 years. Now Reform, a very right wing political party, often styling itself on Trump type policies is very much banging the health insurance drum and has every intention of disbanding the NHS. Luckily, the NHS is a most beloved institution in the UK with great support. Our main problem at the moment is trying to expel Palantir from certain NHS Trusts that allowed that organization in, before our private and personal data is stolen by that hideous company. There is an active and ongoing movement to remove Palantir from any NHS sites.
Brilliant examination Qasim of the true costs of not having universal health care for all in this country. Thank you. The large health care industry providers in this country do not want to lose their stranglehold on supplying health care to those who do not have Medicare, Medicaid or Tricare. They are vampires who are pushing their profit margin to the breaking point for so many folks who no longer can afford/no longer have health care. I am presuming that they lobby our Congress heavily (and our president) to keep their businesses running despite the fact that it is not in the best interest of most Americans.
1. Healthcare is not a market good. In order to have a "market", one needs an infinite number of buyers and sellers, price transparency, and no information asymmetries. Healthcare offers none of these things, except perhaps an infinite number of buyers.
Speaking of information - unless you have medical training or otherwise have a fair amount of smarts and a *lot* of time on your hands, neither you or I have any idea whether a recommended course of treatment is:
*medically necessary
*not the standard course of treatment but supported by an educated minority of informed medical opinion
*generally safe and effective but cheaper options are available
*pure quackery
*contraindicated in your particular case
*an appropriate treatment but you can get something similar for less at the other clinic down the street
*an appropriate course of treatment but another provider can perform it better
*palliative at most
*superseded by new methods of treatment
*something else
*more than one of the above
Now, focusing on price transparency for a bit, imagine that you are lying flat on your back in the ER in Stutsman County, North Dakota. Are you going to look over a menu of treatment options and bargain and discuss qualifications with that nice Dr. Finster, washing between his toes over there? Or are you going to take your chances and hope that you don't bleed out before you can Uber it over to the next nearest ER, which is only 40 miles away?
Then throw in health insurance. That means that we are mostly spending other people's money. At the same time, medical procedures are expensive enough that for most of us, paying out of pocket is not really an option.
2. Anyone with as brains as God gave a baby rabbit can tell that the US healthcare system is utterly dysfunctional. By any objective measure, it delivers substandard outcomes and does so at exorbitant cost.
The problem is that all those inefficiencies mean profits. (Market theoreticians say that in a perfect market, everyone breaks even, which in turn demonstrates just how imperfect the US healthcare market is, but that is another matter.)
Everyone agrees that reform is needed and inefficiencies eliminated. The problem is that the there are a lot of people and institutions that profit off those inefficiencies. None of them want their slice of the pie to be touched, all of them are entrenched and all of them have their congressmen on speed dial.
To give a few examples:
*The AMA
*The trial lawyers
*The HMOs and hospitals
*The insurance companies
*The alternative medicine industry (because legit medical care is expensive)
*The pharma manufacturers (generic and name brand have somewhat different interests at stake here)
*The unions (many of which run their own health insurance plans)
Any real reform will put some of the above out of business, and will substantially limit the profits available to others.
For instance, can you imagine the howling from the AMA if reforms had the effect of reducing doctors' salaries to European levels? "How am I supposed to keep two ex-wives and a Porsche on a measly $85K a year?" For that matter, the ex-wives and the Porsche dealer won't be too happy, either.
These interests don't necessarily line up with one political party or the other, so it's not like we can just vote Team D or Team R and we got the problem licked. The people in charge of these interests have careers and vacation homes at stake, and they are going to fight against reform a lot harder than someone not invested in the status quo will fight for reform.
3. I have often heard it said that state run healthcare will kill entrepreneurship. Quite the opposite. A lot of people would love to set up on their own, but health insurance costs make it impossible. That goes double if you have a human kitten with a pre-existing condition.
EXCELLENT article! I read yesterday, I believe, that Mexico now has universal healthcare! If they can, we should be able to manage the healthcare for everyone.
Years ago my primary told me that if we eliminate all the people in health care who do not actually deliver care we could reduce costs by fifty percent.
My semi-libertarian friend talks about how the incentives are misaligned - denying care increases profits, so with a for profit insurance model, there's a strong incentive to deny care. You've said pretty much the same thing, just worded slightly differently.
I just think it's interesting that someone who thinks of himself as a libertarian, but who isn't dumb, is in favor of single payer.
Thanks Qasim. So true.
Other countries do it. Corp wants us dead. Seat belts in cars is a great example of Greed. Below 55 mph, on average, you aren't injured long term, so no Insurance payout. ( Airbags now help lower numbers of those that do get hurt, long term.) Insurance Companies want you to die. No payout at all. High speeds, even with seat belts. More likely to die. No payout.
I’m 73 and have had asthma since 1980. I also have an immune deficiency that requires weekly infusions. I have EPI which is exocrine pancreatic insufficiency which means my pancreas doesn’t produce enough enzymes to properly digest my food which means without the proper medication my stomach is bloated and hurts all the time. I have other chronic illnesses but these are the most expensive. The asthma maintenance inhaler, taken twice daily is $500 a month. Another inhaler that I take daily costs $500 a month. My EPI medication costs $500 a month. I take Dupixent for asthma and eczema which is $5000 a month. The Hizentra I use for my immune deficiency is $5000 a month.
As a senior citizen on social security I make less than $26,000 a year. Obviously I don’t have the money to pay for these medications so I am on patient assistance programs. A woman who is in charge of patient assistance programs where my PCP is told me just this morning to apply for a new Medicare program where I wouldn’t have to pay for my prescriptions. There’s a catch though. If you have any money in investments, such as for long-term care, you don’t qualify. She said pharmaceutical companies are pushing this rather than giving patients free medicine. This tells me pharmaceutical companies lobbied Congress to go along with this. All three of my legislators are Republicans but I will go to their offices and discuss this with their staff.
Our legislators are not in favor of universal healthcare because of money they get from lobbying for their campaigns. So what can we as citizens do?
I'm also in the camp of "no universal healthcare no vote"
Excellent piece of investigative journalism Quasim. With your permission I would like to excerpt portions to include in the Letters to the Editor section of our local newspaper.
Argument 3 may be overtaken by events anyway - seems like a good candidate for AI to take over all those jobs.
Fantastic comment, all true---and then some. Let me first point to a small demographic error (demographic history is one of my academic fields). Life tables presume that those born in year zero will experience the same life expectancy as current adults. Because of covid deaths, measured life expectancy appeared to decline---but if you have later data, it would show E0 at about 76 years, as it was before Covid.
Perhaps you should have made clear that M4A would eliminate the wretched for-profit, absurdly named Medicare Advantage.
On appointments: we have to schedule our annual physicals a year in advance as well as appointments with specialists. To get such appointments when sick is a great struggle.
But let me point out a key point you have missed. Our public health system (and by that I mean the absolutely essential state and local health systems) is premised on improving the health of individuals, certainly a good goal. But they implicitly blame individuals for not taking care of themselves. In essence, they ignore population health. Poor families, for instance, who live near a landfill or garbage dump will have poor health because they live in such an environment. Children who live in older houses or apartments that have not been renovated, eliminating the lead paint, may well get sick putting paint chips in their mouths. The worst well-known case: the Flint water crisis. Public health must go beyond M4A, essential as that is, and champion such population health. This would certainly mean cleaning up dangerous places but it would extend to enforcing universal vaccine mandates.
If Dr. Abdul el-Sayed wins in MI, he will be a strong voice for population health, for he practiced it, dramatically improving the health and hundreds of thousands of poor Detroit folk. (He also laments, repeatedly, that when he drove from his Ann Arbor home to Detroit, life expectancy declined by around seven years (I may have this a bit off).
Universal health care should also eliminate the need for lawyers to handle workers' compensation cases. I have practiced black lung benefits law, and have served as a hearing officer in Federal Employees' Compensation Act cases. The basic issue in any workers' comp case of which I am aware is some permutation of: did the injury arise out of or in the course of the employment? The only reason I can see that there's a social benefit in practicing workers' comp law is that the U.S. has a seriously fouled up medical system.
The key factor in the legalized betting system that we call insurance is N - the number of people in the pool. The larger the N, the greater the number of people”winners” - those paying in to cover the costs for the “losers” who have claims. When there are hundreds of insurance companies, each company’s N is smaller, hence, premiums are higher. Further, boosting N requires advertising, which adds a cost; for each insurer.
Imagine if N were the entire population. As noted, administrative costs would go down, advertising would no longer be necessary, and profit would no longer be part of the equation.
Universal healthcare is close to the ultimate “No duh!”.
The NHS in Britain does work very well but yes it has been deprived of funding for may years, especially when the conservatives were in power for 14 years. Now Reform, a very right wing political party, often styling itself on Trump type policies is very much banging the health insurance drum and has every intention of disbanding the NHS. Luckily, the NHS is a most beloved institution in the UK with great support. Our main problem at the moment is trying to expel Palantir from certain NHS Trusts that allowed that organization in, before our private and personal data is stolen by that hideous company. There is an active and ongoing movement to remove Palantir from any NHS sites.
Brilliant examination Qasim of the true costs of not having universal health care for all in this country. Thank you. The large health care industry providers in this country do not want to lose their stranglehold on supplying health care to those who do not have Medicare, Medicaid or Tricare. They are vampires who are pushing their profit margin to the breaking point for so many folks who no longer can afford/no longer have health care. I am presuming that they lobby our Congress heavily (and our president) to keep their businesses running despite the fact that it is not in the best interest of most Americans.
i am for Universal Health Care….it works well in other countries, why are we (USA) so far behind?
1. Healthcare is not a market good. In order to have a "market", one needs an infinite number of buyers and sellers, price transparency, and no information asymmetries. Healthcare offers none of these things, except perhaps an infinite number of buyers.
Speaking of information - unless you have medical training or otherwise have a fair amount of smarts and a *lot* of time on your hands, neither you or I have any idea whether a recommended course of treatment is:
*medically necessary
*not the standard course of treatment but supported by an educated minority of informed medical opinion
*generally safe and effective but cheaper options are available
*pure quackery
*contraindicated in your particular case
*an appropriate treatment but you can get something similar for less at the other clinic down the street
*an appropriate course of treatment but another provider can perform it better
*palliative at most
*superseded by new methods of treatment
*something else
*more than one of the above
Now, focusing on price transparency for a bit, imagine that you are lying flat on your back in the ER in Stutsman County, North Dakota. Are you going to look over a menu of treatment options and bargain and discuss qualifications with that nice Dr. Finster, washing between his toes over there? Or are you going to take your chances and hope that you don't bleed out before you can Uber it over to the next nearest ER, which is only 40 miles away?
Then throw in health insurance. That means that we are mostly spending other people's money. At the same time, medical procedures are expensive enough that for most of us, paying out of pocket is not really an option.
2. Anyone with as brains as God gave a baby rabbit can tell that the US healthcare system is utterly dysfunctional. By any objective measure, it delivers substandard outcomes and does so at exorbitant cost.
The problem is that all those inefficiencies mean profits. (Market theoreticians say that in a perfect market, everyone breaks even, which in turn demonstrates just how imperfect the US healthcare market is, but that is another matter.)
Everyone agrees that reform is needed and inefficiencies eliminated. The problem is that the there are a lot of people and institutions that profit off those inefficiencies. None of them want their slice of the pie to be touched, all of them are entrenched and all of them have their congressmen on speed dial.
To give a few examples:
*The AMA
*The trial lawyers
*The HMOs and hospitals
*The insurance companies
*The alternative medicine industry (because legit medical care is expensive)
*The pharma manufacturers (generic and name brand have somewhat different interests at stake here)
*The unions (many of which run their own health insurance plans)
Any real reform will put some of the above out of business, and will substantially limit the profits available to others.
For instance, can you imagine the howling from the AMA if reforms had the effect of reducing doctors' salaries to European levels? "How am I supposed to keep two ex-wives and a Porsche on a measly $85K a year?" For that matter, the ex-wives and the Porsche dealer won't be too happy, either.
These interests don't necessarily line up with one political party or the other, so it's not like we can just vote Team D or Team R and we got the problem licked. The people in charge of these interests have careers and vacation homes at stake, and they are going to fight against reform a lot harder than someone not invested in the status quo will fight for reform.
3. I have often heard it said that state run healthcare will kill entrepreneurship. Quite the opposite. A lot of people would love to set up on their own, but health insurance costs make it impossible. That goes double if you have a human kitten with a pre-existing condition.
EXCELLENT article! I read yesterday, I believe, that Mexico now has universal healthcare! If they can, we should be able to manage the healthcare for everyone.