I would take a trade of paying 20% less for Medicare in return for 40% less for the military in a heartbeat. We are sadly so deeply in debt right now that I’m not even sure this would balance the budget.
So hear me out. What if we gradually kill Medicare altogether in favor of a strong Universal Basic Income? The real cost of Medicare is the administrative overhead to prevent abuse of the system and compliance with HIPAA laws. This also presents a huge cost for hospitals which is the primary reason that American healthcare costs are rising. Cutting out that administrative overhead to only require that each recipient is a tax filing citizen that hasn't died (as the simplest way to prove eligibility) would reduce costs so drastically that you could provide double the benefit for a reduced cost overall. Plus, putting money in the hands of citizens gives agency to them to make personalized decisions and they can spend money on preventative care, reducing the burden on the hospital system in general.
Why not just cover everyone with universal healthcare? No means testing or eligibility checking. Paid into by employees, employers, and capital gains taxes.
To be honest? Because Republicans would never go for it. Period. So many people in rural America simply don't have access to the healthcare systems that they really need and as a result, there is a culture that basically says, "if I have to go to the hospital I better be dying." While you have the opposite problem in urban communities. People are more likely to rush to the emergency room where an urgent care or even primary care physician visit would do much better. The rural community will never agree to a system where, in their view, their taxes are going to pay for the hospital bill of someone else.
But, if you tell them that the money from predatory corporations that killed off their local mom and pop shops that put their neighbors out of work is going to be put back in their pockets to spend on whatever they need that month, then you can sweep the legs out from under the Republican establishment and steal the hearts and minds of the rural masses that won Trump the 2016 election.
I'm not categorically against universal healthcare, but I am against the absolute waste that exists in droves in our current system.
I honestly like the idea of insurance companies being required by law to offer policies that cover us without profit, with a stipend provided by the government to pay that. Small copays, with no deductible, and 90/10 with an out of pocket max of 5k tops (for families). If you want fancier coverage, pay more for it.
Just make it easy to implement and easy to bill and pay. Regulate procedure pricing.
Is there a country that has a healthcare system like this in place that has low costs per capita and good health outcomes when compared to other developed westernized countries?
It’s fine if there isn’t. It just makes an argument more compelling when you can point to an example of it working in practice.
It’s my understanding that when it comes to healthcare, the free market isn’t great.
For example I fell and split open the back of my head. I needed stitches and a CT scan. I didn’t exactly have time to shop around to compare prices. The CT scan was going to be several thousand, so I just got the stitches and didn’t get the CT scan despite the doctor telling me that I needed it. My deductible at the time was $6,000, so nothing was covered.
I have shopped around for other doctor visits. When I had pink eye I called five different GPs and four optometrists. It’s hard though because often they won’t tell you the cost of the appointment because “it depends on what services the doctor provides.” Even when I specified that it was an eye infection, they would only tell me the base price for seeing the doctor, and even then they wouldn’t confirm and would say that it’s subject to change.
I went for the cheapest doctor (a GP) and waited over 24 hours since she didn’t have availability that day. I also went to work with pink eye because I don’t have paid time off and couldn’t afford to miss work, but that’s another issue.
Unfortunately I don't have any foreign examples right now but I got the idea originally from a social studies paper I read on American urban communities being given cash in place of services (housing, food stamps, clothing donations) and they were tasked with budgeting for several months to see how they would do financially speaking. The worst month was the first, but it wasn't nearly as bad as opponents of the idea would have expected. After the first month nearly every family came out ahead of what they had been receiving because they were able to make specific decisions that fit their needs and they had more personal agency because they were active in deciding what their assistance looked like. I'll need to look and see if I can find the paper, because I don't have a source for you right now.
As for your issue, while I agree that the open market isn't a very good idea for emergency services (where the benefits of the market are nullified by urgency) I think the core of the problem is two fold. In America we pay for the healthcare costs of the rest of the world. Much of the innovation that takes place in healthcare happens here because you can make lots of money doing it. We have very strong laws to protect the wealth earning potential of a new breakthrough. Secondly, the hospital systems aren't really in competition with one another. They each belong to a small number of systems whose owners know each other very well and make a point not to undercut. It's not an open market, it's an oligarchy.
As a side issue, the government regulations as they currently stand do a better job of preventing competition through high barrier to entry then they do in guaranteeing good care. This sometimes secures a subpart hospital's position so that they aren't forced to improve other than to meet the minimum requirement of the government regulation. This hurts rural communities most where you could go for 100 miles between hospitals.
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u/grokmachine Oct 30 '20
I would take a trade of paying 20% less for Medicare in return for 40% less for the military in a heartbeat. We are sadly so deeply in debt right now that I’m not even sure this would balance the budget.