When I took a health care economics course back in the 1980s, "insurance" was taught as a gambling decision--how much risk are you willing to take. But universal coverage removes that risk. So why is it still called insurance? My preference is that we declare health care as a human right, drop the label of insurance, and figure out how everyone in this country receives the care they need (vs. want) on a sliding scale of income/resources. Anything else is simply cruel IMHO.
"Seen from a Country that does health care better” - Basically all of them? Name a country that spends more and gets less value for its money. "We’re Number 1! We’re number 1! ‘Mericka, F**k Yeah!” (In your best JVL Cletus voice)
We’re a nation in which the majority of us are willfully ignorant, xenophobic yokels.
Will also add that whoever lobbies for the insurance industry should win a lobbyist memorial or at least a statue on K Street of like an uneeded prior authorization.
The debate is literally how to keep subsidizing for profit corporations to provide their product not how to cap their profits or simply let the Medicare for all be an option - it’s literally pay $15000/yr to cover yourself as a healthy 28yo making 120k/yr OR subsidize that rate - no in-between.
I volunteer in the SHIP program to help benes with Medicare. Thus far it is still funded by HHS. Many people think Medicare is universal care and are so surprised when they reach 65 that there are premiums ,decuctibles and copays and if they do not sign up at the right time penalties. Since 1965, Congress has meddled with it with a lot of pressure from private insurance. Thus it was decided to add medication with private insurance ,Part D. These plans change yearly and your drug may disappear from the formulary. Then we added Medicare Advantage plans where private insurance takes over your care for big bucks. Lots of abuse and possibly fraud in this system. And what do benes do when something is denied? Not easy to appeal. Without help, many end up calling the ship program when they are at the third level of appeal before a judge. I could go on about how Medicaid works with Medicare if the bene has a very low income but how difficult to qualify for the low income help. So frustrating! Thanks for your wonderful work. I would love it if you did a deep dive into Medicare. Senator Scott has quite a history with Medicare.
An issue proponents of universal health care rarely address is how do we get there from here.
Obamacare remains the best program we have to bring health care to everyone without breaking the system or running contrary to American cultural preferences.
It remains surprising that Republicans have not adopted Obamacare as their own - a program that leaves intact the current insurer-hospital model that most Americans under 65 already use.
I have never EVER met a Republican in France (and there are lots of Republicans/American conservatives in France) who didn't like the French healthcare system. :-)
I believe in my heart the Universal Healthcare is the only logical answer to this dilemma. Too much money in politics will not allow this to happen. Too many ins and and outs of the for profit insurance companies make accessing so difficult even for those that have coverage. It's designed that way on purpose.
Add in the people that can fortunately pay for their gold plan - why should the poors get a handout? I pay for mine, they should pay too! We have always been somewhat this way but we're now a more I got mine so f you kind of country.
I told my husband if some devastating illness happens to me, just let me go if there's no real hope, just a dragging out of the inevitable end. No point in 2 people going down, albeit in different ways.
I have lived in Australia and family members have lived in Germany. Both have heavily regulated multi-payer systems that cover everyone for far less than the US and outperformed single payer in UK during the initial COVID waves. Single payer means single government boss, RFK in our case, and there as here, conservatives preferred tax cuts and inflationary, labor force restricting Brexit to funding enough capacity and recruiting enough brown skinned immigrant docs to handle an aging population.
The Commonwealth Fund has published some great info on international systems:
Dems, or Bulwark, just need to get a group of Obama-Trump voters who run small businesses or use ACA exchanges, have a family member with diabetes or other regular prescription bills and go to Australia and Germany. Meet with similar businesses and patients there and see what their costs, wait times and care quality are like. Stream it. Televise it.
A more significant contrast is healthcare in Thailand. One of the poorest countries in the world has universal healthcare. Shame on you US. And they make it work by cutting out the middlemen—no 100 buck bandages, and capping doctors' wages to a reasonable amount. Their beloved King made this so.
I recently used the emergency room at my only local hospital for a health problem that was not life threatening but could have been, and needed to be seen that day. That 3 hour visit, which included a CT scan, was billed to Medicare for $19,561 dollars. I don’t know how much would be billed to an individual without insurance. I do know, however, that if I could see a medical doctor, same day (what doctor sees anyone same day in their office anymore), the cost of the office visit, IV, labs, and CT (in a non-hospital setting) would likely be less than $2,000.
How do earnings for medical professionals differ between the U.S. and Japan? My gut tells me Americans are paid more highly than Japanese. What are the facts?
I don't know the answer about Japan but the two doctors in my French family here say that American doctors are paid MUCH more than French ones. However......
The French doctors didn't have to pay for medical school. They have no debt. Also their insurance costs are much less.
Politicians seem to see this as a political problem.
It's not.
With most Americans. it's a heart breaker - and in some cases, a life breaker. It shouldn't be in the same class as whether we give more to the military, or even should we spend more on education.
Health, food and shelter are the three basics of life.
All wealthy democracies save one have reached a consensus that health care is a right. Until the United States achieves such a consensus, we will have fragmented, expensive health care that works just well enough to reach just enough of the people just enough of the time so as to make meaningful reform a once-in-a-generation possibility.
We returned from a decade living in Europe (medical care in 3 countries) when the Affordable Care Act was working its way thru Congress. The degree to which so many people were unwilling to believe how much cheaper and convenient care was in other countries was mind boggling. Since then, the willfully stubborn ignorance has become even worse.
It’s impossible to solve a problem when half the population has been convinced that the problem doesn’t exist. It’s impossible to make substantive changes to a highly-complex and deeply-entrenched system when half the people it would serve believe that stories such as this essay about Japan’s system are lies.
Healthcare is accepted as a public good in Japan. As a much more homogeneous society than the US, expect the Japanese lack the xenophobic fear/distrust seen here (i.e. all these people who look different than me must be free loaders).
In the US healthcare is mostly a private good. While for profit healthcare has the potential to deliver efficient low cost care, in practice it's very different. Front line health care providers have become factory staff working for wealthy profit driven owners / executives / shareholders. As bad as the HMO/Insurance company model has worked, the current Private Equity/hedge fund model for sucking profits out of and bankrupting hospitals is much worse.
In the short run, see a difficult path to developing quality cost effective healthcare for the poor and the middle class in this country. Too much money to be made by investors, who in turn have excessive lobbying influence.
Believe the best option in the short term is the public utility model. Profit margins are capped and a public state level board approve rate increase and monitor system service delivery. Doctors, nurses and other frontline health care workers are decently compensated. Facilities are decently maintained where needed. Will require tremendous political will to even go to this model. And a lot of us may have to accept lower returns from our IRAs.
[The business school professor who taught my class about public and private goods is none other than Peter Navarro. While he had quite the ego and manic confidence in 1995, he was a fully committed populist fearful the middle class was being destroyed by globalism. Don't recognize the person who now works for Trump.]
When I took a health care economics course back in the 1980s, "insurance" was taught as a gambling decision--how much risk are you willing to take. But universal coverage removes that risk. So why is it still called insurance? My preference is that we declare health care as a human right, drop the label of insurance, and figure out how everyone in this country receives the care they need (vs. want) on a sliding scale of income/resources. Anything else is simply cruel IMHO.
I highly recommend the article about obesity in Japan.
"Seen from a Country that does health care better” - Basically all of them? Name a country that spends more and gets less value for its money. "We’re Number 1! We’re number 1! ‘Mericka, F**k Yeah!” (In your best JVL Cletus voice)
We’re a nation in which the majority of us are willfully ignorant, xenophobic yokels.
Will also add that whoever lobbies for the insurance industry should win a lobbyist memorial or at least a statue on K Street of like an uneeded prior authorization.
The debate is literally how to keep subsidizing for profit corporations to provide their product not how to cap their profits or simply let the Medicare for all be an option - it’s literally pay $15000/yr to cover yourself as a healthy 28yo making 120k/yr OR subsidize that rate - no in-between.
I volunteer in the SHIP program to help benes with Medicare. Thus far it is still funded by HHS. Many people think Medicare is universal care and are so surprised when they reach 65 that there are premiums ,decuctibles and copays and if they do not sign up at the right time penalties. Since 1965, Congress has meddled with it with a lot of pressure from private insurance. Thus it was decided to add medication with private insurance ,Part D. These plans change yearly and your drug may disappear from the formulary. Then we added Medicare Advantage plans where private insurance takes over your care for big bucks. Lots of abuse and possibly fraud in this system. And what do benes do when something is denied? Not easy to appeal. Without help, many end up calling the ship program when they are at the third level of appeal before a judge. I could go on about how Medicaid works with Medicare if the bene has a very low income but how difficult to qualify for the low income help. So frustrating! Thanks for your wonderful work. I would love it if you did a deep dive into Medicare. Senator Scott has quite a history with Medicare.
An issue proponents of universal health care rarely address is how do we get there from here.
Obamacare remains the best program we have to bring health care to everyone without breaking the system or running contrary to American cultural preferences.
It remains surprising that Republicans have not adopted Obamacare as their own - a program that leaves intact the current insurer-hospital model that most Americans under 65 already use.
I have never EVER met a Republican in France (and there are lots of Republicans/American conservatives in France) who didn't like the French healthcare system. :-)
You went all the way to France and you still can’t avoid Republicans? My hopes for a life without them are dashed.
I believe in my heart the Universal Healthcare is the only logical answer to this dilemma. Too much money in politics will not allow this to happen. Too many ins and and outs of the for profit insurance companies make accessing so difficult even for those that have coverage. It's designed that way on purpose.
Add in the people that can fortunately pay for their gold plan - why should the poors get a handout? I pay for mine, they should pay too! We have always been somewhat this way but we're now a more I got mine so f you kind of country.
I told my husband if some devastating illness happens to me, just let me go if there's no real hope, just a dragging out of the inevitable end. No point in 2 people going down, albeit in different ways.
Thank you Jonathan for your excellent writing.
I have lived in Australia and family members have lived in Germany. Both have heavily regulated multi-payer systems that cover everyone for far less than the US and outperformed single payer in UK during the initial COVID waves. Single payer means single government boss, RFK in our case, and there as here, conservatives preferred tax cuts and inflationary, labor force restricting Brexit to funding enough capacity and recruiting enough brown skinned immigrant docs to handle an aging population.
The Commonwealth Fund has published some great info on international systems:
https://www.commonwealthfund.org/publications/fund-reports/2024/sep/mirror-mirror-2024
https://www.commonwealthfund.org/international-health-policy-center/countries/australia
https://www.commonwealthfund.org/publications/fund-reports/2015/jan/international-profiles-health-care-systems-2014-australia-canada
https://www.commonwealthfund.org/publications/issue-briefs/2024/dec/health-care-affordability-older-adults-how-us-compares-other-countries
https://www.commonwealthfund.org/publications/other-publication/2012/jun/using-insurance-exchanges-govern-health-insurance-markets
Dems, or Bulwark, just need to get a group of Obama-Trump voters who run small businesses or use ACA exchanges, have a family member with diabetes or other regular prescription bills and go to Australia and Germany. Meet with similar businesses and patients there and see what their costs, wait times and care quality are like. Stream it. Televise it.
A more significant contrast is healthcare in Thailand. One of the poorest countries in the world has universal healthcare. Shame on you US. And they make it work by cutting out the middlemen—no 100 buck bandages, and capping doctors' wages to a reasonable amount. Their beloved King made this so.
I recently used the emergency room at my only local hospital for a health problem that was not life threatening but could have been, and needed to be seen that day. That 3 hour visit, which included a CT scan, was billed to Medicare for $19,561 dollars. I don’t know how much would be billed to an individual without insurance. I do know, however, that if I could see a medical doctor, same day (what doctor sees anyone same day in their office anymore), the cost of the office visit, IV, labs, and CT (in a non-hospital setting) would likely be less than $2,000.
How do earnings for medical professionals differ between the U.S. and Japan? My gut tells me Americans are paid more highly than Japanese. What are the facts?
I don't know the answer about Japan but the two doctors in my French family here say that American doctors are paid MUCH more than French ones. However......
The French doctors didn't have to pay for medical school. They have no debt. Also their insurance costs are much less.
Politicians seem to see this as a political problem.
It's not.
With most Americans. it's a heart breaker - and in some cases, a life breaker. It shouldn't be in the same class as whether we give more to the military, or even should we spend more on education.
Health, food and shelter are the three basics of life.
All wealthy democracies save one have reached a consensus that health care is a right. Until the United States achieves such a consensus, we will have fragmented, expensive health care that works just well enough to reach just enough of the people just enough of the time so as to make meaningful reform a once-in-a-generation possibility.
We returned from a decade living in Europe (medical care in 3 countries) when the Affordable Care Act was working its way thru Congress. The degree to which so many people were unwilling to believe how much cheaper and convenient care was in other countries was mind boggling. Since then, the willfully stubborn ignorance has become even worse.
It’s impossible to solve a problem when half the population has been convinced that the problem doesn’t exist. It’s impossible to make substantive changes to a highly-complex and deeply-entrenched system when half the people it would serve believe that stories such as this essay about Japan’s system are lies.
America truly is exceptional.
"The degree to which so many people were unwilling to believe how much cheaper and convenient care was in other countries was mind boggling."
Yes, I have thrown myself against THAT brick wall time and time again. They just refuse to believe me.
Healthcare is accepted as a public good in Japan. As a much more homogeneous society than the US, expect the Japanese lack the xenophobic fear/distrust seen here (i.e. all these people who look different than me must be free loaders).
In the US healthcare is mostly a private good. While for profit healthcare has the potential to deliver efficient low cost care, in practice it's very different. Front line health care providers have become factory staff working for wealthy profit driven owners / executives / shareholders. As bad as the HMO/Insurance company model has worked, the current Private Equity/hedge fund model for sucking profits out of and bankrupting hospitals is much worse.
In the short run, see a difficult path to developing quality cost effective healthcare for the poor and the middle class in this country. Too much money to be made by investors, who in turn have excessive lobbying influence.
Believe the best option in the short term is the public utility model. Profit margins are capped and a public state level board approve rate increase and monitor system service delivery. Doctors, nurses and other frontline health care workers are decently compensated. Facilities are decently maintained where needed. Will require tremendous political will to even go to this model. And a lot of us may have to accept lower returns from our IRAs.
[The business school professor who taught my class about public and private goods is none other than Peter Navarro. While he had quite the ego and manic confidence in 1995, he was a fully committed populist fearful the middle class was being destroyed by globalism. Don't recognize the person who now works for Trump.]