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I don't know enough about how the health care industry works in the USA, and I wouldn't be so presumptuous as to tell Americans what they should do; but here are some matters to consider relevant to how UHC operates in most other developed nations.
Fees charged by doctors, hospitals, and the cost of pharmaceuticals are negotiated by the departments of health, and the buying power of a single provider works to reduce ridiculous profit taking. The cost of pharmaceuticals to the consumer is further reduced by government subsidies, or in some cases completely eliminated thereby. The agreed fees by doctors and hospitals are paid by the UHC system, which is financed by means of general taxation, assisted in some countries by a modest levy (in Australia - for example - an amount of 2% of assessable income - or roughly $1,200 a year for the average wage earner on $60,000 p.a.). Private health insurance is available in Australia, and in the UK, but is not necessary in either place.
One of the factors seemingly ignored in the discussions devolving about the cost of UHC is the elimination of the necessity for private health insurance.
According to Forbes, the average cost of health insurance (which includes employer and individual contributions,) for a family of four stands at $25,826 in the USA - and this does not include the co-pays, nor take into account the lifetime limitations and exemptions imposed by many policies. It would take a very large tax hike to eliminate that saving to both the individual and the employer.
The other factor being medical services can remain provided by private practitioners (as it is in most UHC systems,) and the coverage can be of a universal standard - the rich will not receive superior health care to the poor. That may not suit everyone dedicated to the capitalist ideology, but it would certainly improve the health level of society in general (you will be less likely to contract a communicable disease from someone sitting next to you in the train or the cinema).
Contrary to many claims, none of the countries practicing UHC have gone broke, and the standard of health care available in most is (according to the WHO) superior to that under the private system extant in the USA. This is not an indictment of the expertise of the American medical profession - the poor rating simply reflects the fact that this expertise is not available to all Americans. Getting the health care you can afford may appeal to the 'haves', but is less than ideal for the 'have nots', which often comprise a significant proportion of the population.
But making continuing education free would. College is free in China and India. I would hope we could be as good as that.It would act similarly to what the taxpayer backed student loan system is doing to the price of a university education.
What needs to be done, which is also part of every successful single payer system is to have cost controls. As much as possible, take the profit motive out. Of course companies that make drugs, medical equipment etc etc are entitled to make a profit. But, there would need to be a ceiling on the cost a co. can charge for every item related directly to health care and that includes services too. There has to be reason in what we pay for those goods and services. Aspirin should never cost $20 a pill. I'm not talking about a ceiling on things that the doctor needs to get you healthy and keep you that way. Under the current AHCA and ACA HMO's can and do limit services to control cost to their shareholders. THAT'S the biggest problem with making it work. THe paying entity should never be the one in charge of what doctors deem necessary to treat people. There should NEVER be a stockholder's meeting to put pressure on the administers of that healthcare to maximize profit by limiting services or the tools necessary to allow doctors to do great work. Single payer alone won't get there but it's still better than free markets in this case. That's been proven many times before. If everyone understands that you cannot make more money by cheating the patient out of first rate care or hit the patient with outrageous bills that are not itemized and explained before procedures whenever possible, then there are controls on what the final tally will be. The way it works now is that doctors and hospitals never have to face the consumer to explain how they came to their final figure. We are just supposed to accept any fucking thing and then try to find a way to pay it, even if it means selling your house. Good health should never be measured by ability to pay. The elite have enough advantages without having an edge on living healthy lives. Docs in Canada are content to make 150 to 200 grand a year. But under the free market system, income is only limited by how many ops or how much that doc can negotiate for him/her self from the hospital or HMO. Of course every cent is picked up by the patient in one form or another.
Health care, by its very title should be a "care" market and because it is not a market that can possibly, fairly and justly, operate as other markets do (because it involves unconscious people and pain and suffering and those who will take unfair advantage of the pain, suffering and lack of consciousness of others), it needs to flip to the advantage of the patient at least as much or more than the provider. If not single payer, it should ideally, at the very least, be, a not-for-profit sector. Not for profit does not mean no one makes any money or gets any raises, it means expenses are paid. Those expenses could include a measure of spending for increased care and efficiency. It is odd (or perhaps not) that many discussions of health care leave out of the "affordability" debate, whether America can afford such high priced CEO's and instead of figuring out where the money is going to come from to pay them obscene pay, perhaps figure out, as some CEO's and BoD's do, how to get the same job done, for a lot less. If low wage labor jobs can be gotten rid of and given to foreigners that do the same job for less, then so can high paid salaried, profit sharing, stock compensation, jobs.
If anyone suggests getting picky about who gets covered, who does not, then NO pool based coverage will work, without being very expensive, because the pools become too small.
A big rock thrown in a small plastic child's pool has a much bigger impact than a big rock thrown in an ocean. The idea is to make the pool large and massive enough, that impacts to it are small ripples, instead of tsunamis, in a relative sense. In addition, making payment to and payment from, easy, eliminates a huge cost in massive multiple payers, both to, and from the layers of profit added, to do so.
Last edited by KnotaFrayed; 18th March 2017 at 09:33 AM.