Tag Archives: universal health care

why the U.S. can’t have nice things, like health insurance

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According to this article in Vox, The United Nations has a goal of achieving universal health coverage in all countries by 2030. I doubt they were really thinking of the United States when they came up with that, but here we are.

I tend to blame the the situation on lobbying by the insurance industry, because they see public health insurance as an existential threat, and in this country of legalized corruption, big business gets to write our laws in its favor. I knew the American Medical Association, the special interest lobby for doctors, played a role, but I didn’t realize it was as soaked in disinformation and propaganda as this article makes it sound.

The AMA-WB campaign had two key components. First, they used mass advertising to associate NHI with socialism, while the private (or voluntary) insurance option was described as the “American Way”. These advertising efforts of the AMA were complemented by tie-in advertising from other industries fearing a return to war-time price controls. In addition, the strategy called on AMA doctors to discuss private health insurance with their patients and to distribute pamphlets echoing the individualistic advertising message (see Figure 1). Through local and state medical organizations, physicians looking to defray medical costs had organised their own insurance product, which came to be known as Blue Shield, and they were eager for enrolees. All told, approximately $250 million (in current terms) was spent to sway voters, an unprecedented amount for the time. Doctors were also instructed to use their prestige to urge local civic organisations to pass resolutions against national health insurance.

https://cepr.org/voxeu/columns/why-us-doesnt-have-national-health-insurance-political-role-ama

“WB” is a public relations, aka propaganda firm.

I still like to think that individually, most doctors chose the field because they care about human beings. But somehow, as an organized group, they can add up to something evil. And before I cast the first stone, yes I am also thinking about my own profession of engineering (what could be more wholesome than public infrastructure and public health – yes, water treatment probably saves more lives than all the world’s medicine, but that’s a digression) and our unholy alliance with the highway/auto/sprawl industry.

This article also takes aim at unions. By its telling, they wanted to saddle the private sector with the cost of the health care system so they had something to negotiate on behalf of their members (and therefore get people to want to be members). This is also twisted and evil.

What puzzles me a bit is that if big business is really so powerful, why don’t they want to be freed from the burden of providing health insurance? It would seem only to benefit a fairly narrow slice of the finance industry. But it appears that this slice, along with the organized lobbies of doctors and unions, has been powerful enough to keep the American public from having a real health care system for over half a century now.

Is the UK’s NHS collapsing?

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Here in the USA, we hear talk of imperial collapse. In the UK, everyone pretty much agrees that the empire collapsed 70 years ago, and yet the nation/republic seems to march on. They seem to be in a foul mood though. Consider this blog post, “(Why) The Death of the NHS Is a Parable of Civilizational Collapse“:

You can’t get a doctor’s appointment, unless you’re really lucky, or incredibly persistent — you’ll get an automatic message telling you no appointments are available. Ambulance? Good luck with that — they can take hours to arrive, if at all. Think about that, though, in larger terms. What does it mean to…be this painfully, jaw-droppingly, infuriatingly stupid? To give up an NHS? 90% of humanity, maybe more, would kill to enjoy such a thing. The Roman and the Gaul and the ancient Egyptian could scarcely have dreamt of such a, to them, miraculous institution. But Brits…LOL. What the…

Umair Haque, Eudaimonia and Co

So that’s a blogger’s opinion. Let’s look at two British papers, the Independent and the Guardian.

Dr Phil Banfield, chairman of council at the British Medical Association, described the “frighteningly common” situation where dying patients are forced to sleep in a corridor or on a chair while “hospitals (are) failing and falling apart and ambulances (are) stacked outside emergency departments”.

Independent

Okay, so it sounds like a series of political administrations has been underfunding it, and outcomes are not living up to the high standards and expectations of the past. But the article goes on to say they have a plan to fix it.

The NHS has lost its prestigious ranking as the best health system in a study of 11 rich countries by an influential US thinktank. The UK has fallen from first to fourth in the Commonwealth Fund’s latest analysis of the performance of the healthcare systems in the nations it studied. Norway, the Netherlands and Australia now provide better care than the UK, it found. The findings are a blow to the NHS, which had been the top-rated system in the thinktank’s two previous reports in 2017 and 2014. The US had by far the worst-rated system, despite spending the most on care.

Guardian

So it’s still in the middle of the pack of the most functional modern countries, but slipping. If your benchmark is the laughably cost-ineffective and inequitable U.S. system, it is still pretty good.

If the UK can’t do it, should the U.S. even consider the model? We do have the Veterans Administration which gets pretty high marks, and we have a system for active duty military, I guess, although I don’t know much about that. (It would be interesting for someone to compare just the VA to other countries’ systems if nobody has done that. Somebody probably has.) And then we have Medicare, which is a massive direct subsidy to the private health care system (which does nothing but complain about it), which gets reasonable marks, and Medicaid, which is a massive indirect subsidy that gets terrible marks. Still, the U.S. government does better when it is just handing out money than when it is trying to build enduring public institutions. My proposal would be to scale up Medicare to everyone (but we voted against the politician who would really have fought for this). The government could also just create a standardized medical records and billing system and force private industry to use it, or just force everyone to use whatever is used for Medicare. This would take a lot of inefficiency out of the system and maybe reduce the bureaucratic overhead of the private system down closer to the public system (yes, I meant what I said there!) while keeping whatever benefits we think the profit motive provides (those ambulances sure do arrive fast in the U.S.!), and eliminating the insane inequities in the system. This would also get preventive medicine, addiction and mental health treatment out to the people who really sorely need it, which might go a long way toward improving our intolerable drug overdoses, suicide, and even violence problems. So it would really be a win-win for almost everyone EXCEPT the finance industry, which of course owns our corrupt politicians and makes sure we can’t have nice things.

the stats on war and peace

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I seem to be on a peace rant this morning.

In the U.S. we have half a million people unhoused and at risk of freezing to death this winter. We have 1 in 5 children growing up impoverished and hungry, and the federal government tells us there is no money for universal health care, student loan forgiveness, or to house and feed the people. Yet, at $858 billion for 2023, the military budget is at it highest point ever, and ominously increasing every year.

Popular Resistance.org

That $858 billion sounds low to me. That is probably the Pentagon’s budget for the year. Don’t forget the weapons programs under the Department of Energy, the CIA and the rest of the “intelligence community” spread across various agencies, the Department of Homeland Security, and elements within the FBI and other agencies involved in national security. Then there’s the Veterans Administration, which pretty much everyone supports but is a legacy of many decades of past military spending. Active and retired military personnel do in fact have universal health care, and there is a slight irony there. No, we should not take it away from them, we should extend it to everyone else.

Universal health care would have saved lives in the pandemic

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This article in PNAS estimates that a universal health care system in the United States could have prevented 212,000 deaths in 2020 alone. That is a big fraction of the total Covid deaths that year – I don’t have the number at my fingertips but total deaths over the whole pandemic (and caused by the pandemic) recently passed one million. I assume this does not count all the deaths from other causes that a health care system could have prevented. This sounds like a pro-life policy to me!

the U.S. health care system is not just below average, it is the worst

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This is getting tiresome. Do we need any more evidence that the U.S. has slipped below average and is now bringing up the rear in many categories among developed countries? This is the 2021 Mirror, Mirror report from The Commonwealth Fund, a non-profit generally considered to be competent and non-partisan.

The U.S. ranks last out of the 11 countries included. But the ranking understates the case, because the other countries are somewhat clustered in terms of cost and outcomes, and then the U.S. is a point far away from the cloud with much higher cost and much worse outcomes. It’s not an Anglo-American failure, because the UK, Australia, and New Zealand all do well. Canada is ranked second worst, but again it is on the lower right edge of the cloud and the U.S. is way out on its own.

I do think they picked a group of very high performing countries here. There have to be other developed countries, particularly in Asia, that could have been included. But somehow, I doubt including Japan, Taiwan, etc. would make the U.S. look any better.

I wonder though what would happen if they tried to compare just the over-65 U.S. population served by Medicare to the over-65 population in the other countries. If Medicare does much better than the U.S. health care “system” (i.e., cluster-you-know-what) as a whole, it would be an even stronger argument for Medicare for All. Should the U.S. maybe try to establish a health care system before the next pandemic arrives?