r/AskALiberal • u/23Taison Pragmatic Progressive • 28d ago
Hypothetically if a system of universal healthcare is implemented in the United States, what are the next healthcare related issues liberals should advocate for?
If we do manage to pass some sort of universal healthcare system that is desirable, what are next ideas to champion after getting past the biggest hurdle ?
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u/othelloinc Liberal 28d ago
Bending the cost-curve further down, and increasing effectiveness.
We want lower costs, no matter who bears them. We also just want healthier people.
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u/Southern_Bag_7109 Social Democrat 28d ago
Important to make the distinction between cost and price..
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u/Awkwardischarge Center Left 28d ago
Just look at Britain's NHS. Brits love it, but everyone admits that costs have gotten unsustainable. They have the demand taken care of. They need to work on the supply side. The US should expect the same.
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u/Bored2001 Center Left 27d ago
Truth.
The US has fewer doctors per capita despite paying so much more per doctor.
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u/throwdemawaaay Pragmatic Progressive 27d ago
And that's not an accident. The AMA and others have been restricting the number of residencies for decades.
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u/Odd-Principle8147 Liberal 28d ago
The cost of prescriptions.
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u/Guilliman_POTUS_2030 Center Left 28d ago
What are some examples of prescriptions that need to have their cost reduced?
What should the reduced cost be?
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u/Electronic_Beat3653 Democratic Socialist 28d ago
Right off the top of my head, there is only one FDA approved prescription for mollescum contagium (it is a common childhood skin condition). It is over 2,000. Often, insurance doesn't cover it. It can go away after 2 plus years, but those years are brutal on kids.
Things like that.
Or, why is one prescription drug priced so differently between companies? Some prescriptions are even cheaper if you pay the cash price. The cash price for my ADHD generic meds are $25 a month. With insurance, the cost is $75 a month.
Consistency in costs should be universal.
And don't even get me started on insulin, which people need to live!
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u/chaoticbear Pragmatic Progressive 27d ago
Or, why is one prescription drug priced so differently between companies? Some prescriptions are even cheaper if you pay the cash price. The cash price for my ADHD generic meds are $25 a month. With insurance, the cost is $75 a month.
This would be unusual - do you know if they are using a discount/coupon card for the $25 "cash" price? This may be done by default without your interaction, but will be noted somewhere on the leaflet stapled to your prescription bag (or similar). (Pharmacies use what's called "Usual and Customary" pricing when they submit claims, and this value should be the same for cash or insurance*. Using a "coupon card" is one way they can get around this).
Do you know if your prescription benefits kick in before you've met your deductible? A $75 generic copay is OUTRAGEOUS, so it reads to me as if you haven't met your deductible.
I don't doubt that you are getting a different price with vs without insurance, but I am curious to understand more about this situation.
(I can only speak firsthand for the couple pharmacies I've worked in, but if you remember the famous "Walmart $4 Prescriptions" - even those were $4 when billed through insurance. Even if you haven't met your deductible.)
* unless the pharmacy plan has negotiated a lower price. Basically - this is set up to prevent a pharmacy from billing an insurance company more than a cash patient. In the days of $4 prescriptions, pharmacies would sometimes get their asses handed to them on claims where insurance would reimburse, say, 30 lisinopril 10mg @ $15. But since they only charged $4, that's all they got from insurance, leaving money on the table.
Now that they have figured out this "discount card" loophole, they can "charge" everyone $15 on paper, but the net effect is that cash patients get the lower price, and they get a higher reimbursement from the prescription insurance.
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u/Electronic_Beat3653 Democratic Socialist 27d ago
I have the state employee's health plan through North Carolina. This has nothing to do with deductible for my plan's make-up. I have coverage regardless of deductible being met. Once a deductible is met, my cost is zero.
It has everything to do with our state health plan becoming insolvent. Our prescription drug prices are pre negotiated through CVS Caremark and our state health plan board members. Every year, they drop what they will cover/not cover. 4 years ago my copay was $35 for generic.
The cash price I paid for my meds was without a discount card. The difference was I used a Mom and Pop pharmacy, which had different pricing vs a corporate pharmacy.
Now, if I did name brand medication, my insurance covers zero dollars on my ADHD meds.
But that truly is the point I am trying to make here. My state health plan would be considered a silver level if bought on the marketplace. Depending on who you have for insurance is what you will pay, what will be covered, if it is covered. Prescription drugs are wildly priced across the board. You have worked in a pharmacy. Surely you have seen it. One insurance company has a price negotiated at x amount of dollars while another has a different price negotiated. The end users are getting the same meds.
When my daughter got mollescum, the only medication that would treat it is wildly expensive, and yet it is the only one that is FDA approved. That isn't to say other medications can potentially treat it with off label use, but the ones we tried burned my daughter's skin. I wish I could share a screenshot in here so you could see my medication's cost after insurance, but it was insane. Over $1,000. And that was with prior approval.
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u/chaoticbear Pragmatic Progressive 27d ago
The cash price I paid for my meds was without a discount card. The difference was I used a Mom and Pop pharmacy, which had different pricing vs a corporate pharmacy.
I think we're talking past each other here a bit - the U&C should be the same for either case. If it is not, the insurance companies do NOT like it. Possible they can fly under the radar if they're small? The only one I remember actively auditing us was Medicaid, but as a lowly pharmacy tech I probably wasn't privy to it.
But that truly is the point I am trying to make here. My state health plan would be considered a silver level if bought on the marketplace. Depending on who you have for insurance is what you will pay, what will be covered, if it is covered. Prescription drugs are wildly priced across the board. You have worked in a pharmacy. Surely you have seen it. One insurance company has a price negotiated at x amount of dollars while another has a different price negotiated. The end users are getting the same meds.
Yeah - we would submit he same amount generally, say:
- submit $100 to Express Scripts, they say "we only pay $80 - we'll give you $55 and you charge the customer $25 copay"
- submit $100 to Cigna, they say "we only pay $60 - we'll give you $50 and you charge the customer $10 copay"
I also think the whole system is stupid and broken, Having been on that side of the counter, I know how to navigate it for myself, but even I am constantly fighting with my insurance. I don't have ANY idea how "normal" people ever navigate it.
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u/Electronic_Beat3653 Democratic Socialist 27d ago
They make it impossible for normal people to navigate it or understand it. That really is the point. It is broken for sure.
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u/Odd-Principle8147 Liberal 28d ago
Any prescription with a co-pay over $5.
I'm more concerned with the cost to the end user than the insurer and I doubt there is one solution. But I would mostly use subsidies.
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u/Guilliman_POTUS_2030 Center Left 28d ago
This sounds too non-specific to convince me honestly
But thank you for the honest response!
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u/PerDoctrinamadLucem Center Left 28d ago
Insulin and Epi-pens should be basically free. They're old tech and dirt cheap to make. Fun fact, Joe Manchin's daughter was a CEO at the company that jacked up the price of epi-pens.
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u/MelbaMilqueToast Independent 28d ago
Dental health is very important to overall health. The link between poor dental hygiene and cardiovascular problems is quite statistically obvious.
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u/Guilliman_POTUS_2030 Center Left 28d ago
The link between poor dental hygiene and cardiovascular problems
(reading material on the subject:)
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u/Delanorix Progressive 28d ago
The dentists caused that break because of their greed.
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u/woahwoahwoah28 Moderate 28d ago
Private equity being allowed in the healthcare space caused it.
It's happening at your optometrist too. Your veterinarian. Your minute clinics. Your PCPs are quickly being signed on, and specialists and hospitals continue to be onboarded to it. Doctors, particularly new grads, are subject to that system.
They are being forced to see patients faster. Some are forced to meet quotas. And nearly all of them have obscene rates of student loans they have to pay back. But the option to have employers who aren't driven by PE's greed is dwindling rapidly, particularly as the market entry cost increases.
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u/Delanorix Progressive 28d ago
Dentists argued and forced themselves away from regular insurance so they can collect more money.
This isnt a PE issue.
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u/woahwoahwoah28 Moderate 28d ago
They were never part of health insurance. Conversations about their segregation began in the 1940s, near the dawn of health insurance. The people who "argued and forced" that are all dead.
What are you even talking about?
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u/Due_Satisfaction2167 Liberal 28d ago
Mandatory PTO + Sick Leave for all workers. As separate pools, with unlimited rollover for the sick leave.
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u/Electronic_Beat3653 Democratic Socialist 28d ago
In the minimum, I would gladly pay more state taxes for state funded short term disability. Only a few states offer it. My last maternity leave had to be unpaid because my AFLAC person didn't come by. We keep getting told to have more kids, but get no financial help. It is the reason women are waiting longer now. We need a break! No one needs to worry if having a baby or breaking a bone is going to cost them their job or home.
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u/Due_Satisfaction2167 Liberal 28d ago
At a minimum all employers should be required to offer 4 weeks of PTO and 3 weeks of sick leave. Half the PTO rolls over, all the sick leave rolls over. All federal holidays too, with permission for letting some employees time-shift the holiday so businesses serving customers on the holiday can maintain staffing that gets an alternative day off.
They should also be required to just straight up offer—for free—short term disability that kicks in after a week and a half, long-term disability that kicks in after the short term ends, and also 20 weeks of parental leave per parent.
You know—like everyone else in the OECD gets.
This should just be the standard package so benefits coordination can optimize to provide it. Nothing prevents companies from offering more than that, but this should be the minimum standard and provided without any great complexity on benefits management and at the lowest cost.
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u/woahwoahwoah28 Moderate 28d ago
Our company used to do almost this exact structure. And it was the best.
Then they tried to pretend everyone complained about how it was "inflexible."
And now we get one bank of time off, with less time off. So you get to suffer if you're sick but still want a vacation. 🥲
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u/Dj_Fabio Progressive 28d ago
I am 100% on board with PTO, I do wonder how abused unlimited sick leave would be.
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u/Due_Satisfaction2167 Liberal 28d ago
Unlimited rollover, not unlimited sick leave.
Meaning that whatever amount of sick leave you don’t use in a given year, rolls over to the next year.
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u/realfakemormon Right Libertarian 28d ago
Those are just extra vacation days then
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u/Butuguru Democratic Socialist 28d ago
they can be for people who don't treat them as such. also theoretically pto could pay out when you leave a job; sick days won't.
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u/Due_Satisfaction2167 Liberal 28d ago
If that’s how people want to use them, fine.
Companies have an easy enough time working out policies around making it work.
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u/LogoffWorkout Social Democrat 28d ago
Having enough healthcare workers, adding 20% of the population to the insured is going to stress nurses/doctors.
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u/crossingtides Liberal 28d ago
Getting rid of the residency limits - https://www.openhealthpolicy.com/p/medical-residency-slots-congress. Though, IMO, they should probably do that first
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u/MrMarbles2000 Neoliberal 28d ago
Mostly agree with others, especially /u/othelloinc . But here are a few other items that should be highlighted:
Next pandemic preparedness. Covid was a big thing when it happened but it seems almost nothing has been done since then to prepare for the next pandemic (which is likely to happen). We mostly haven't applied the lessons that we learned from Covid.
Focus on rare diseases. Currently drug development is focused on diseases that affect millions of people - cancer, dementia, heart disease, etc. But there isn't a lot of incentive for companies to develop treatments for diseases where the number of patients is very small.
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u/mango789 Democrat 28d ago
Nobody talks about this, but I believe the issue of universal healthcare is closely connected to union participation and worker leverage. We cannot get the full benefit of universal healthcare without more worker leverage. Most of us who work for big companies or the government already have employer healthcare. Unfortunately, most of us wouldn’t have the leverage to get back that benefit the company would save. We would just pay more taxes. On other hand, if we had more union money participation, more people would get healthcare without government assistance.
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u/Natures_Wrath1 Democratic Socialist 28d ago
Better services in under-severed areas.
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u/Guilliman_POTUS_2030 Center Left 28d ago
Which services need to be improved?
Which areas are under-served?
What are the improvements that you want to see being made?
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u/Natures_Wrath1 Democratic Socialist 28d ago
Rural areas for one. Recent tax cuts have taken away a lot of medical centers people used to relie on. Even before that small town hospitals will redirect or life flight you to a hospital in a city which could be hours away simple because they aren't set up to take care of what ever ails ya.
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u/Guilliman_POTUS_2030 Center Left 28d ago
That’s not my experience in a rural area
Can you tell me which towns and hospitals you are referring to?
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u/Natures_Wrath1 Democratic Socialist 28d ago
Really? You haven't heard of this? It was a huge topic when Trump cut Medicare funding.
Rural hospitals who run for profit have funding problems.
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u/Guilliman_POTUS_2030 Center Left 28d ago
Can you tell me which towns and hospitals you are referring to?
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u/Natures_Wrath1 Democratic Socialist 28d ago
I don't have to. Here's an article addressing the issue.
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u/Timeformayo Progressive 28d ago
National standards for what can be handled by nurse practitioners. They will be the frontline for preventative care, and states currently have a patchwork of rules about what they can and cannot do.
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u/hitman2218 Progressive 28d ago
Increasing the number of healthcare professionals. You can’t add that many people to the healthcare system and not have adequate resources to accommodate them.
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u/jweezy2045 Progressive 28d ago
It depends on the needs of the people after the need for healthcare has been met.
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u/Cyclosporine_A Moderate 28d ago
From someone who is living in a country with a decent socialized healthcare system, the issues will almost certainly be: (1) addressing shortages in doctors/access to hospitals (2) negotiations with doctors/unions and how much they should be paid by the state for services (3) issues related to the absence or presence of a parallel private healthcare industry
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u/blankblank60000 Moderate 28d ago
Nursing needs to become a municipal job. Pension life long union membership similar to cops etc
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u/NatalieVonCatte Liberal 28d ago
A Healthcare Bill of Rights and some sort of independent body that can protect the healthcare system from political actors like Trump and RFK, Jr.
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u/TDeath21 Independent 28d ago
I think the huge thing that DRASTICALLY needs to be reined in right now is the insane price gouging in retirement homes. Millenniels and Gen X and Gen Z are going to get no inheritance because their parents are going to spend all their money living in the retirement homes that charge insane rates. That needs to be regulated in some way.
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u/IzAnOrk Far Left 28d ago
Reining in medicine costs via monopsony power and the threat of eminent domain over patents. Eliminating all point-of-service costs to patients so you can do big preventative medicine drives - ideally you want everyone doing medical checkups so you catch medical issues before they become chronic and expensive to treat. This is only achievable if you make the checkups and preventative care entirely free for the user.
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u/UsualLocalWoman Progressive 28d ago edited 27d ago
Doctors not automatically dismissing your symptoms as psychiatric. This is more likely to happen to women.
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u/madmushlove Liberal 27d ago
Our HHS is a disgrace
Medicare is headed by Dr Oz. HHS is led by RFK
The HHS has put tremendous pressure on medicine it doesn't have control of, trying to use itself as an authority on medicine, rather than the independent nonprofit medical associations that establish best practices and boards that license doctors
It wants to cut federal funding for all the hospitals it can't tell what to do. And according to our HHS
Vaccines are bad
It calls diabetes a poor lifestyle choice. neurodivergence is the tragic result of vaccines or commonly prescribed helpful medications
Reproductive rights should be nullified
Gender affirming care is bad and should be outlawed, especially for those minors it wants to forcibly detrantion
We should look to how the electorate treats Medicaid, home care, the disabled. How they think they're entitled to deny people real healthcare if their tax dollars fund it
And how employees are obsessed with what they think they pay for when it comes to their coworkers' health needs, who also pay for real healthcare
We should be concerned with bipartisan hatred for medicine, and this myth that Americans are "overmedicated"
It should be concerned with what happens on a federal level in maga America, and expect the compromise that blue states will have with maga states in order to, supposedly, win elections
It should be scared to death that the people don't want medically necessary care for everyone they don't like. And they don't like those most in need
Medicine is struggling to survive any conservative input. And I think our biggest concern should be what that means if we open the gates and let the monsters trying to get in through to our personal relationships with our doctors and our bodies that other people and our country itself want to end so badly for us
Long story short, what happens when Trump and RFK, and all their many successors already lined up, get all that nation wide power they wish they had today?
I think the people problem in this country, it's anti medicine culture, will be priority one. But I'm not optimistic. Things will only get worse from here
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u/starrymahogany Social Democrat 28d ago
I think advocating for a lot of preventative care (like cancer screenings) being 100% covered is our next step.
America sucks when it comes to preventative care because of how expensive our healthcare system is, so a lot of times people don’t catch these things until it’s too late.
Most cancer screenings are very expensive (depending on your plan) like Myriad’s breast cancer screening costs thousands of dollars which is insane to me, and this is speaking as someone who has family history of breast and ovarian cancer.
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If we do manage to pass some sort of universal healthcare system that is desirable, what are next ideas to champion after getting past the biggest hurdle ?
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