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Universal Health Care is the Only Right Action

There are many reasons why adopting universal health care in the United States is the right thing to do. First, it would save money. Yes, you read that right – SAVE money. At first glance it would appear that providing better health care to more citizens would add substantial cost. There are more than 40 million Americans without health insurance. If no other changes were made in our health care system, providing basic health care to those 40 million Americans would increase the $1.9 trillion per year cost of the American health care system by an estimated $77 billion — about a 4% increase. But that 4% increase would only be present if we added yet another level of complexity to our bloated private payer system, and that would be foolish.

How can providing health care for the 16% of Americans who don't have insurance add only 4% to our nation's health care bill? The only health care now available to those without insurance is emergency rooms — the most expensive and least efficient mechanism for handling medical care. Routine care, preventative treatment and medication are far lower cost as well as being more humane than waiting until crisis drives sick people to the emergency room. In addition, today, many people enter our medicare system at 65 with conditions that could and should have been addressed years earlier under a more reasonable system. It costs our nation fully as much to perform a hip transplant at age 65 as it would have cost to save the individual years of suffering by performing the procedure earlier.

The statistics, but not the conclusion, that I present here are based on the 94 page document Accounting for the cost of health care in the United States by the prestigious McKinsey Global Institute. It's available free, and if you have the time, I highly recommend reading the whole report. It's packed with facts, and stops short of making recommendations.

Around the world, the per capita cost of health care is generally proportional to national income levels. The United States is the only developed country whose health care costs are dramatically higher than would be expected from our income levels. Our costs are $480 billion per year (33%) higher than would be expected from our income levels. Do we receive better health care for those dollars? Objectively, no. $480 billion is a huge amount of money. It's $1600 per year for every man, woman, and child. It's more than six times the additional cost of providing ongoing health care to those now without medical insurance. So where does that $480 billion go?

Are Americans sicker than others? The bottom line is, no. We get a few conditions more often, many others less often, and we are on average younger than the citizens of other highly developed countries, which would be expected to lower our health care cost substantially. How about the costs of medical malpractice insurance and litigation? Our country's excess in damage awards costs us $20 billion per year. While this is certainly an area for correction, it only represents 4% of the overspending.

$66 billion of the overage is due to the cost of drugs, even though we use 20% less prescription drugs than other developed nations. Our cost for a prescription is 70% higher than the same drug in other countries. Another $18 billion of overage is attributable to non-drug supplies. Devices such as pacemakers and knee implants are over 50% more expensive than the same devices sold in other countries. There is a remarkable correlation between the highest profit procedures and those which are performed much more frequently in the United States than in other countries. Unnecessary testing, in part driven by fear of malpractice lawsuits, adds billions more to our costs. Inefficient administration, such as assigning menial tasks to skilled nurses, adds additional billions.

About Jonathan Lockwood Huie

  • Clavos

    You offer, as one of the reasons for adopting universal health care, “…improving the nation’s productivity because we’ll be healthier.”

    UHC will not guarantee that we, as a nation will be healthier; people will still overeat, smoke, drink alcohol, have unprotected sex, ride motorcycles helmetless and ingest recreational drugs.

    Poorly educated underclass women will still not be sophisticated enough to seek medical advice during pregnancy, and even if they do will likely not follow it.

    Many will continue to not get regular checkups, take their meds as directed, h and/or will engage in other detrimental, unhealthy behaviors.

    And some patients will be denied treatment (a phenomenon common to all UHC schemes — which are cost-centered), such as happened recently in the UK, where a decision was made to no longer treat women with terminal breast cancer.

    UHC will however, further increase the government’s power over its citizens — in anticipation of UHC, the gummint is already advising physicians (I have one in my family) that if they don’t keep digital records, they will be paid less for their services to patients by Medicare and Medicaid than those who do keep such records. And, of course, how can we ignore the push on in Washington to centralize all such digital medical records?

  • http://www.dreamthisday.com Jonathan Lockwood Huie

    Clavos: You are right – universal health care isn’t perfect in other countries, and it wouldn’t be perfect here. It’s just a LOT better than what we have now. Public education is also far from perfect, but would you choose not to have it?

  • Clavos

    universal health care isn’t perfect in other countries, and it wouldn’t be perfect here. It’s just a LOT better than what we have now.

    I’m a long way from convinced of that — in fairness, not just by your article; nothing I’ve read about UHC convinces me that we’ll be substantially better off with it, and in fact my nearly four years direct experience managing my sick wife’s multiple illnesses under the auspices of Medicare serves to convince me that there’s every reason to believe we’ll be a lot worse off under UHC — unless the government doesn’t administer it.

    Public education is also far from perfect, but would you choose not to have it? I’m in favor of vouchers — I believe that no parents should have to send their children to government schools if they don’t want to.

  • http://www.republicofdave.com Dave Nalle

    To quote a sign at a recent Tea Party:

    “If we get socialized medicine, where will Canadians go if they need health care.”

    Dave

  • Jordan Richardson

    I dunno, eh? We’ll probably just all up and die, eh? Gosh, where would we EVER be without the U.S.A. anyway, eh?

    Sorry, I have to go. There’s a late night hockey game and I need to stop by Tim Horton’s first because I hear Celine Dion’s going to be there signing autographs in maple syrup.

  • STM

    Dave: “If we get socialized medicine, where will Canadians go if they need health care.”

    Since most of ‘em who go to US hospitals are living in conurbations that just happen to have a national border running through the middle, as we’ve discussed before Dave, they’ll probably still go to the same hospitals.

    The real issue isn’t Canadians, who seem reasonably happy with their healthcare system, but Americans.

    The question at the Tea Party should have been: “Won’t it be great that Americans without health insurance will now be able to get the same quality healthcare enjoyed by the rest of their countrymen?”

    What I find bizarre is that Americxans think spending billions on outdated air and naval fleets and military thinking that belongs in the cold war is a legit use of their taxes, but health care that keeps the whole nation happy and healthy isn’t.

  • STM

    And I can tell you that living in a country that has universal health care takes a load off the mind – especially in these uncertain times.

    My wife is a supporter … she works in one of the world’s top, pioneering heart/lung transplant units, and none of the people she looks after ever have to pay a cent.

    Nor should they. That’s what they pay their taxes for.

  • Jordan Richardson

    I have a chronic medical condition that makes visits to hospitals, specialists, and doctors very much a part of my life. I have NEVER had a problem seeing any specialist I’ve wanted, getting medication I’ve wanted, and getting procedures I’ve wanted.

    Nobody asks me what insurance I have or sends me away because I’ve got Blue Cross and I needed something else. This notion that the universal health care the majority of the developed world enjoys is somehow the doorway to socialism or a bad thing or whatever the hell is just laughable, as is the propaganda people have to come up with in order to shove it down.

    And the really sad thing is that the people who really could use universal health care won’t get a chance to because the fat cats, the ones who can afford the coverage, will ensure that their voices are never heard.

    It’s pretty much an accepted fact around the world that universal health care, while hardly flawless, is a preferable system to the one that exists in the United States. Nobody listens to the ridiculous notion of people with UHC lacking choice and being forced to go to certain doctors because it’s not true. As for the idea of line-ups, it happens but cases are treated on a priority basis. My wife works in the medical field, like her mother before her, and has seen both systems from the inside. Guess which one she prefers, both as a worker and a patient?

    The biggest problem citizens of the United States have is that you can’t get as rich off of people’s illnesses under universal health care. Drug companies can’t turn in billions of dollars in profit because people need medication to live. How sad.

    Honestly, if you guys decide on not wanting universal health care for whatever reason, that’s great. But don’t start lobbing stones at the rest of the world because we happen to enjoy it and find that it enriches our lives. No wonder people associate the idea of arrogance with Americans.

  • STM

    I think they fear what they don’t know and understand. Simple as that.

    It never cost any jobs here because the health insurance companies came up with more products that could be covered, and great, attractive and competitive premiums.

    I’d say under Medicare in Australia, the industry has grown.

    I have a combination of both. I pay over the odds for Medicare because of my taxable wage, but then get a tax break on family private insurance.

    However, the beauty is in such situations as the other day when my daughter, who is epileptic, was rushed to a clean, modern and well-equipped, well staffed paediatric emergency ward of a public hospital after suffering a fit. She was attended to immediately, and no one asks us whether we’ve got private cover or not.

    Her own doctor has rooms at that hospital, so she comes down for a look – and it doesn’t cost.

    It just happens, and there’s no irksome paperwork to fill out.

    I go to a doctor, a GP, who bulk-bills the government. All I do is hand over my Medicare card, the receptionist swipes it, I sign it and voila. Any upfront costs elsewhere can be refunded in cash at the local Medicare office, or sent by cheque, and the difference – the gap – is often picked up by my insurer.

    I’m sure that what Americans suffer from in regard to this is fear, Jordan, and that’s it.

    They are way behind the times on this one.

    They’ve never had UHC, so they don’t know good it is.

    It’s become the third rail of politics in Australia. Any government doing away with it would be punted from office in a flash, and yet like the US, there was much wailing and gnashing of teeth when it was introduced here in the early 1970s.

    It’s had some reincarnations since, but remains as a fantastic thing that our governments do for us. It’s not perfect, but it’s pretty damn good.

    Or that we do for ourselves, really, because it’s funded in part by our tax dollars.

  • Jordan Richardson

    Yep, sounds like we have the same system here in Canada. My experience is virtually the same, with something called a Care Card that they just put through.

    Nobody on any serious level in Canada talks about taking away our health care system. Hell, we voted Tommy Douglas, who introduced universal health care to Canada in the 60s, ahead of Wayne Fucking Gretzky to be our Favourite Canadian.

    Now that’s something!

  • STM

    Mate, what’s Tim Horton’s??? A Canadian institution, obviously.

    I guess I can look it up on the net.

  • Jordan Richardson

    Yes sir, a Canadian institution. Best donuts and coffee anywhere ever!

  • STM

    OK, I just looked it up. Coffee and doughnuts (please note correct spelling).

    We do have a couple of home-grown chains that have been exported overseas – Gloria Jeans, which I’ve also seen in The Philippines – but because of the huge number of migrants from southern Europe, Italy especially, and the warm climate here there are coffee bars, mostly al fresco, serving espresso-style Italian coffee on every second corner.

    I was in Portugal at the end of 2007, and felt very much at home wandering down to the cafe for a couple of coffees in the morning.

    It way outstrips tea as the hot beverage of choice here now.

  • STM

    Can’t imagine you’d be too keen sitting outside on a cold winter’s day in Vancouver, though :)

  • STM

    Good to see Her Maj is still on the front of the Canadian coins :)

    She’s fallen off all our notes now, except the $5.

  • Jordan Richardson

    Oh ya, Queen’s still on the money.

    I’ll have to look for Gloria Jeans if I ever make my way to the Philippines with the wifey. We’ve got the coffee bar thing going on here, which is pretty cool as an alternative for the equally omnipresent Starbucks chains.

  • Clavos

    OK, so all the rest of the Anglosphere has great UHC, but, you don’t have the fuckup government we have.

    Believe me, Medicare in this country sucks big time, and it’s breaking the bank (it’s THE most expensive entitlement program in the country), yet it only serves crips and old farts.

    I’m in favor of UHC as long as the government’s only role in it is as payer of the bills, with no control of it. Fat chance of that ever happening.

  • STM

    Clav: “but, you don’t have the fuckup government we have”.

    Geez, I dunno Clav. That might be stretching it a bit … they’re all much of a muchness in my experience.

    Personally, I think it’d be a bit different in the US if it was for everyone. That way the bureaucracy HAS to focus on the job at hand. There’s no getting around it, it’s in everyone’s face, and it has to be set up to deal with what it has to do from the outset.

    That’s my guess, but then I’ve been wrong in the past …

  • http://ruvysroost.blogspot.com Ruvy

    Jonathan, for once you make sense, and you didn’t pucker up to the derriere of the “Blessed of Hussein”. Congratulations on both counts!

    Israel, like Australia, has universal health care. Frankly, it is an enormous blessing to this not so healthy Jew.

    Clavos raises points that are legitimate – but the problems he cites arise from America’s “I gotta have it right now” culture and the advertising that goes along with it. In other words, the changes would have to take place in America;s culture to be alleviated.

    Cultural change is the most difficult to manage of all forms of change. And part of the resistance to universal health care arises in the culture. The first plan for universal health care was submitted to congress by Meyer London (Soc. NY) in 1904!

  • http://blogcritics.org/writer/dan_miller Dan(Miller)

    The article includes this statement:I would vote to provide medical care to all our citizens, regardless of the cost. (Emphasis added) In 2004, it was found that

    The vast majority (79%) of the uninsured are citizens. However, a disproportionate percentage of the uninsured are non-citizens. While non-citizens are 7% of the population, they are 21% of the uninsured. Non-citizens are a disproportionate percentage of the uninsured because they are more likely to have characteristics associated with higher uninsured rates. Non-citizens are more likely than citizens to:

    * be Hispanic (59% vs. 12%),
    * have incomes below 200% FPL (51% vs. 30%),
    * be young adults age 18 to 34 (42% vs. 22%), and
    * work for small firms with fewer than 100 employees (34% vs. 22%).

    It seems highly unlikely that “universal health care,” if enacted, would exclude non-citizens.

    Dan(Miller)

  • Bliffle

    Clavos is guessing:

    “Believe me, Medicare in this country sucks big time, and it’s breaking the bank (it’s THE most expensive entitlement program in the country), yet it only serves crips and old farts.”

    I suspect that Clavos is speaking from his protected refuge in the Military medical system, which he seems to be mining successfully.

    Medicare is very good, and not very costly. Any shortcomes can be accomodated easily by minor adjustments in the withholding rates.

    the most expensive entitlement program in the USA is the one that bails out failed banks and businesses.

  • Clavos

    I suspect that Clavos is speaking from his protected refuge in the Military medical system, which he seems to be mining successfully.

    Medicare is very good, and not very costly. Any shortcomes can be accomodated easily by minor adjustments in the withholding rates.

    Wrong, wrong, wrong, bliffle!!

    Clavos is speaking from four years’ direct experience spending more than $400K of Medicare’s money taking care of his very ill wife.

    Medicare is NOT good; their error rate in billing is frightening — if my wife had not spent 30 years as a senior executive in the insurance industry, giving her far more expertise than even the managers at Medicare’s billing division, CMS, we would have been ripped off by Medicare (because of errors, not maliciously) for more than $75K from our pockets during those four years.

    As it is, the taxpayers have been ripped off royally by Medicare’s penchant for paying too much, particularly for durable medical equipment — I’ve told the story on these threads before of my wife’s $2500 wheelchair, for which Medicare paid $5000.

    And I am not a patient in the “military medical system,” the Department of Veterans Affairs is a Cabinet-level civilian agency with no connection whatever to the military. It is significantly better run (though with a far more authoritarian structure) than Medicare.

  • http://www.dreamthisday.com Jonathan Lockwood Huie

    Dan – re #20

    I didn’t mean to be exclusionary. For “citizens” please read “legal residents” – in contrast to “illegal aliens.”

  • http://awakephilosopher.blogspot.com Kaelieh

    This whole notion of UHC, isn’t even about getting healthcare. It’s about universal coverage. Coverage doesn’t gurantee access to healthcare and not having coverage doesn’t mean you don’t still get healthcare.

    As long as there is a middle man, insurance companies and even single payer (since it takes money from individuals, the taxpayer, pools the funds together and then pays it out to doctors), we are always going to have high costs.

    If you have patients paying directly to the doctors for services prices would come down the highest possible amount, because you’re taking funds from only the people using the services instead of being able to get funds from both parties of individuals (those who seek services and those who don’t) for providing the same amount of care.

    When the medical field is restrained by the patient’s individual ability to pay, they have to bring down prices to an affordable level or go out of business.

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    “As long as there is a middle man, insurance companies and even single payer (since it takes money from individuals, the taxpayer, pools the funds together and then pays it out to doctors), we are always going to have high costs.”

    Good point. Naomi Klein, I believe, and others are of the same mind. It’s the first thing to get rid of.

  • http://www.dreamthisday.com Jonathan Lockwood Huie

    Kaelieh, Are you seriously proposing to abolish health insurance altogether?

    The point of insurance is to pool the risk of catastrophic events. Catastrophic illnesses require hundreds of thousands of dollars of treatment. In the absence of insurance (or a public program) a catastrophic illness would be a death sentence for anyone beyond perhaps the top 2% on Americans. Actually, it would soon become a death sentence for any American as the skill base for handling those kinds of conditions would evaporate. Is that really what you are proposing?

  • Glenn Cessor

    Clavos -

    Why does Medicare spend too much? Maybe it’s because the Bush administration took away its ability to NEGOTIATE PRICES with Big Pharma and medical suppliers!

    Does Medicare screw up sometimes? Sure! Show me a human institution who doesn’t! BUT their overhead is FAR less than that of ANY HMO, and – unlike yours – my family’s experience with Medicare is GOOD!

    And what happens when we trust our healthcare to the private sector? “We don’t cover that surgery!” or “That’s a pre-existing condition and we won’t pay!” Does THAT kind of response belong in the world’s greatest nation? Ask Obama about the battles his mother was fighting with the insurance companies while she was dying of cancer!

    And – as I’ve pointed out SEVERAL times – the final proof lay in the FACT that the list of countries ordered by life expectancy, the TOP TWENTY-SEVEN all have some form of UHC (we’re #30, just behind Jordan and Bosnia), and while – as Dave pointed out – according to the OECD our government presently pays about as much per capita as the other countries do, when the PRIVATE cost is added in, we pay nearly twice as much as ANY of the top twenty-seven countries!

    Clavos, this is a fight you cannot win. ALL of the facts, ALL of the statistics show that UHC is better for the population AND better for the economy. All the conservatives have is rhetoric…and the funding of Big Pharma.

  • Clavos

    Why does Medicare spend too much?

    Because it’s run by government employees without accountability, who are nearly impossible to fire, and widely subject to corruption.

    And that’s just for starters.

    BUT their overhead is FAR less than that of ANY HMO…

    This is a favorite strawman of apologists for UHC, but it’s irrelevant, because Medicare doesn’t include, among other things, the $7 million it pays out daily in fraud in it’s “overhead” calculations.

    And what happens when we trust our healthcare to the private sector? “We don’t cover that surgery!” or “That’s a pre-existing condition and we won’t pay!” Does THAT kind of response belong in the world’s greatest nation?

    No, it doesn’t. However, that kind of response is frequently given to patients in virtually every country with UHC; most recently in the UK where women with advanced breast cancer were informed they will no longer receive treatment because it’s too expensive. You can rest assured there will inevitably be rationing here, as well.

    Medicare already rations; my wife has been refused payment by Medicare for treatment plans recommended by her doctors. Fortunately, I’m able to pay for a top drawer private insurance plan, which, while very expensive, is not an HMO, but a PPO, and refuses nothing, to take up the shortfalls Medicare refuses.

    If the government is allowed to take over the health care industry, such plans will disappear (because of competition from “free” government plans), and people will be forced to accept the dictates of the government regarding their health care.

    Medicare is already the largest entitlement program in the US. When UHC is extended to the degree being proposed, there will not be sufficient funding without an enormous increase in taxes, which will come on top of the enormous tax increases necessary to pay for Obama’s blatant remaking of our society into the quintessential Nanny state.

    Fortunately, for me, I have citizenship in another (much cheaper) country to which to retreat; much as you plan to do, Glenn.

    As to my “winning” this fight: another irrelevancy; I don’t choose my fights by their winnability. But in any case, when the American people (unlike the European sheeple) finally understand what they’re getting into, there will be millions standing with me on this issue.

    In the meantime, I’ll keep sounding the alarm.

  • http://drdreadful.blogspot.com Dr Dreadful

    most recently in the UK where women with advanced breast cancer were informed they will no longer receive treatment because it’s too expensive.

    Where did you read that, Clav? And how recent was it? I did find one instance in 2005 where a local NHS trust refused to prescribe a patient Herceptin because it didn’t like the risk/cost ratio, but the trust in that case was going against accepted policy.

    The most recent development seems to have been a new set of guidelines from the National Institute For Health and Clinical Excellence (NICE*) with regard to treatment options for women with advanced breast cancer, which includes discontinuing the use of the drug trastuzumab in end-stage patients – but that’s because the drug no longer does any good at that point.

    There’s no talk of refusing treatment altogether from what I can see.

    * No, really.

  • Glenn Contrarian

    Clavos -

    No offense, guy, but I see a LOT of disinformation in your reply – Doc was kind enough to point out some of it. I don’t have the time to point out all of it right now, but I will when I can.

  • Clavos

    Glenn,

    No offense taken, guy.

    By way of pre-emption, I will concede to Doc that perhaps I was somewhat hasty in relying on a tidbit gleaned from the MSM regarding the denial of treatment in the UK. I can no longer even find the tidbit, so Doc, I retract, for the time being, the allegation.

    However, pretty much the rest of my comment (#28) is a product of my direct, personal experience with Medicare, and I stand by all of it.

    Steve Forbes has written a very cogent and hard-hitting opinion piece on the issue of UHC. Here are a couple of quotes from his article:Let’s clear up some of the myths. Both Medicare and Medi-caid are heavily subsidized by privately insured patients, to the tune of $90 billion a year. Federal reimbursement in these two programs is far below cost, which is why an increasing number of doctors are refusing to treat or are substantially cutting back on the number of Medicare and Medicaid patients they see.

    Medicare and Medicaid are rife with fraud. Unlike private insurers, the government refuses to spend real resources on routing out the wrongdoing: overbilling, overtesting and charging for visits not made or tests not given. The quality of care will decline. Health care “outcomes” for Medicaid patients are substantially below those of similar private-insurance patients. Fees are so low that patients are often treated more like ill, undesirable cattle. (Emphasis added)And:Socialized systems are anathema to innovation. Breakthroughs in medications, diagnostic tools and medical devices require substantial capital investment and entail high risk. In the pharmaceutical industry, barely one in 250 promising compounds ever makes it to the marketplace. In the 1960s western Europe was a font of new medicines. But nationalized medicine put a stop to that. Today most of the breakthroughs come from the U.S. Even when another country invents something, it is in the U.S. that the product is fully developed. For example, the MRI breakthrough was achieved by a Brit, but MRIs are much more widely used in the U.S.

    Medicare is no exception to this anti-innovation bias.Forbes offers some alternative ideas, as well:There are many positive, nongovernment things that could instead be done.

    –Allow mandate-free insurance policies. True catastrophic health insurance–not the current dollar-for-dollar coverage–is very affordable.

    –Permit people to buy health insurance across state lines. Removing such barriers would sharply increase competition.

    –Make it easier for small businesses to buy insurance in a pool, whether through trade associations or other kinds of affiliations.

    –Equalize the tax treatment of premiums. Companies get a tax deduction for health insurance premiums, as do the self-employed. Why not give that break to employees who choose to buy their own individual policies? They would get a deduction or a refundable tax credit (meaning if they don’t have a tax liability they’d get an actual check from Uncle Sam). Many small businesses offer no insurance, or those that do may offer policies some workers find unsatisfactory. These folks should have the ability to easily get their own alternatives.

    –Raise limits on contributions to HSAs and on permissible deductibles.

    All of these ideas would substantially cut the number of un-insured. For those truly uninsurable, why not give them the medical equivalent of food stamps and subsidize their catastrophic health insurance premiums through private companies?Medical care comprises 17% of our economy. That’s too much to much to be allowed to fall under the control of an inept, power-hungry bureaucracy.

    Reform is needed. But, giving the feds control of the medical industry will not only bankrupt the nation, it will result in a decidedly inferior system, not an improved one.

  • Clavos

    Dang.

    There were blockquotes in that comment. I apologize for any confusion their absence may cause.

    We really need a preview function for comments!

  • Ed Watson

    The best reason for dumping socialized healthcare is Obama himself: The Obamacare will bring “greater inefficiencies” to our country’s health care system.

    “The reforms we seek would bring greater competition, choice, savings and inefficiencies to our health care system,” Obama said in remarks after a health care roundtable with physicians, nurses and health care providers. “And greater stability and security to America’s families and businesses.” Read more.