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Healthcare! A much needed reform in the US.

For discussion and debate about anything. (Not a roleplay related forum; out-of-character commentary only.)

Which form of Healthcare should the US have?

General Taxation (to the Federal, State, County or Municipality level)
41
26%
National Health Insurance
80
51%
Voluntary or Private Health Insurance
29
18%
Out-of-pocket Payments
6
4%
Donations to charities
2
1%
 
Total votes : 158

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Celritannia
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Healthcare! A much needed reform in the US.

Postby Celritannia » Sun Sep 13, 2020 8:53 am

Universal Healthcare, the mere sound of it has some American immediately link it to Communism or Socialism, yet it is something that the US is in dire need of.

Firstly, what is Universal Healthcare?
Well, it is a system of healthcare where medical coverage is accessible to all members of a country or region.
Perhaps your immediate thoughts turn to government control or interference, but this is not true.
There are different systems in which Universal Healthcare can be applied.
Here are a few examples:

National Health Insurance
Sometimes known as Social Health Insurance or the Bismarck Model, it is system where all individuals of a nation are required, by law, to have Health Insurance. This can be provided by Public Institutions, Private Companies, or a combination of both.
Most of the time, national governments regulate how much a Private Insurance Company can charge, ensuring no one is left without insurance, and those who are unable to pay for certain reasons or exceptions, are subsidised by the National or Regional/Local Government.

Users:
Germany
Japan
Netherlands
South Korea
Switzerland


A system which there is a single public system that provides healthcare, this can be broken into two categories: Single-Payer/Social Health Insurance or a Tax Based System. Both systems can also be employed at the same time.

Users:
Canada
Medicare Canada
Australia
The Nordic Countries.
New Zealand
United Kingdom
NHS England
NHS Scotland
NHS Wales
Health and Social Care Northern Ireland

In general, here is a full list of Universal Health Care uses with a detailed map.



Where Private Health Insurance is concerned, it is a system where there is limited government or social funding, with some exceptions to the poorest of society, which is exactly what the United States uses (the only western country to do so, and one of very few in the world not to have Universal Healthcare).

However, countries where single payer systems (especially tax-based ones) also have Private Health Companies still operating withing the country, such as BUPA in the UK.

Why is all this information necessary? It’s simple. The system that the United States uses is generally damaging to the majority of people. A Universal Healthcare System is required to help the people of the US to improve as a country.
No matter if you are Left Wing, a Liberal or Right wing, Universal Healthcare can benefit everyone.

Now, you might be thinking “But Celrit, I don’t want the government being involved with my healthcare,” and I can say, I understand. But a Universal Healthcare system is not meant to be government controlled.
In the UK, while the NHS may be owned by the Government, but it is medical professionals and managers who understand the system that run it, not run by the government.
I dislike the conservative government, but that does not mean I dislike the NHS system. It’s one thing a great majority of people in the devolved countries support.

But there are far more pressing concerns for the US, one of them is how much insurance companies charge, or even refuse to cover certain individuals because they have too many medical concerns. How is this fair? Why should people who deal with finance determine if you are able to be covered for a medical procedure?
Or, how can Insurance companies get away charging you an extortionate amount of money from your pay check?
The beauty of a Universal Healthcare system, regardless of the type, means the payments are regulated by the government to ensure you are not out-of-pocket. You keep more of your money than paying so much into health insurance.

Perhaps you will point out that your health insurance premiums were increased because of Obamacare, but did the Affordable Care Act actual state these insurance companies had to increase their prices? No. The Insurance Companies raised their premiums themselves, because they did not like the concept of ensuring more people had access to healthcare.
How can we allow a system which healthcare is allowed to be afforded by those who are rich? Millions of families, even with the ACA, are still unable to get insurance, or medical care is still too expansive for their wages. I mean, $4,000 for an ambulance journey? How is this even considered acceptable?
Not only this, but the US spends more on healthcare than any other country in the world, not because of medical procedure or doctors, but because of administration, legal fees, and insurance companies. A universal Healthcare system will decrease the amount not only you will pay as a whole, but how much the Federal Government will spend on healthcare.

Maybe you think that health insurance is something like housing or car insurance, but is that a fair comparison? A car is something you purchase; a house is something you purchase.
But your health? Your health is something you are born with. Your health is not a luxury item or piece of technology, it is what you need to survive. How can health insurance companies charge you for something you did not select yourself? You are born with your health and it should not be a commodity to be priced.

Perhaps you think that the insurance system is fine. But can the same be said by a server at your favourite restaurant, fast food place, or another service you like to use?
You may not think you need a Universal Healthcare system, but any service you require or partake in, those workers will require health coverage just as much as you do. If they have good health provided by Universal Healthcare, this means you will be able to continue enjoying the service you use.
After all, one of the major benefits of a Universal Healthcare service is providing a healthy work force for the economy.

Let’s also not forget though, in the US, people who do not have much money have to sacrifice food for medicine, or vice-versa. In the richest country in the world, is it right to see people starving themselves in order to get much needed medicine, or forgoing life-saving procedure just so they can eat?
In many of the northern states of America, people cross the boarder just so they can purchase the same drug in Canada at a much cheaper price.

Which leads onto one of the major problems of US healthcare, the drug companies and lobbyists in congress. After Health Insurance companies, these are the worst people in US healthcare, charging hundreds or thousands of dollars for your drugs, despite being cheap to make. With a universal Healthcare system, drug prices are regulated to ensure those that need them are able to afford them.

Overall, the US healthcare system is damaging to everyone, no matter if you can afford it or not.
You pay more than you should, others cannot afford it, and your insurance companies see your health as profit.

Now, will Universal Healthcare work in the US? Of course, but this depends on the system.
Personally, I do not think a single-payer system will work, especially a tax based one. It would be more logical to employ a National Insurance System at a federal level, and allow each state to decide if it wishes to be single-payer of tax based. The Federal Government’s responsibility in health care should be merely an oversight, to ensure all citizens have insurance, regulate how much insurance companies should charge, and subsidise those that cannot.

But what do you think NSG? Does the US seriously need to rethink Healthcare? Should the US move towards a Universal Healthcare, and if so, which version should they employ?
Last edited by Celritannia on Wed Sep 16, 2020 1:31 pm, edited 10 times in total.

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Major-Tom
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Postby Major-Tom » Sun Sep 13, 2020 8:57 am

I'm not particularly rigid on the type of universal healthcare we ought to move towards. We can think back to 2010, for instance, when the Dems were one vote shy of adding a public option to the ACA that would've covered millions and millions of Americans from all walks of life. But, Joe Fucking Lieberman shot it down, and thus we ended up with the most watered down version of the bill possible, and the result of that has been awful.

Personally, I'm fine with full on single-payer, but I think in order to transition to that point, we'll have to take some baby steps along the way. It's not something that can be legislated and implemented overnight, and a solid option for both fiscal responsibility and dependable healthcare coverage would be to bring back a universal, free at the point of payment, public option as a start for people regardless of age or income, before exploring our next options (IE would we want to keep private insurers around, etc etc).
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Postby Sundiata » Sun Sep 13, 2020 8:57 am

I'm in favor of amending the affordable care act and adding a public option, this way people who need healthcare get healthcare and Americans get to retain their freedom of choice via different private options for insurance.
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Postby Major-Tom » Sun Sep 13, 2020 8:59 am

Sundiata wrote:I'm in favor of amending the affordable care act and adding a public option, this way people who need healthcare get healthcare and Americans get to retain their freedom of choice via different private options for insurance.


That was my thought exactly, it also helps drive down initial costs. It's still ambitious, though, we'd need a pretty bulletproof Dem Senate Majority to pass it, not just a Democratic President. I'm skeptical that we'll even see a public option until the end of the decade.
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Postby Sundiata » Sun Sep 13, 2020 9:01 am

Major-Tom wrote:
Sundiata wrote:I'm in favor of amending the affordable care act and adding a public option, this way people who need healthcare get healthcare and Americans get to retain their freedom of choice via different private options for insurance.


That was my thought exactly, it also helps drive down initial costs. It's still ambitious, though, we'd need a pretty bulletproof Dem Senate Majority to pass it, not just a Democratic President. I'm skeptical that we'll even see a public option until the end of the decade.

Yeah, but it's possible. Nancy Pelsoi wants it too.
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Postby Ifreann » Sun Sep 13, 2020 9:02 am

Sundiata wrote:I'm in favor of amending the affordable care act and adding a public option, this way people who need healthcare get healthcare and Americans get to retain their freedom of choice via different private options for insurance.

Freedom is when there is one doctor you can afford to see and dozens of doctors that you can't.
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Postby Sundiata » Sun Sep 13, 2020 9:06 am

Ifreann wrote:
Sundiata wrote:I'm in favor of amending the affordable care act and adding a public option, this way people who need healthcare get healthcare and Americans get to retain their freedom of choice via different private options for insurance.

Freedom is when there is one doctor you can afford to see and dozens of doctors that you can't.
That's untrue with a well-funded public option for all. You'd have variety but if you like your doctor you can keep your doctor.
Last edited by Sundiata on Sun Sep 13, 2020 9:06 am, edited 1 time in total.
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Postby Ifreann » Sun Sep 13, 2020 9:12 am

Sundiata wrote:
Ifreann wrote:Freedom is when there is one doctor you can afford to see and dozens of doctors that you can't.
That's untrue with a well-funded public option for all.

If buying private insurance doesn't provide some kind of benefit, some doctors who cannot be seen otherwise, some hospital facilities that would otherwise not be available, something, then it's a scam and people are being tricked into paying for nothing and clearly the whole thing should be shut down. If it does provide some kind of benefit then it will always be true that some people will be denied that benefit because they cannot afford private insurance. The specifics might vary, but it will always be the case that the freedom you are talking about will have a price tag, and thus some people will always be denied that freedom.
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Postby Sundiata » Sun Sep 13, 2020 9:18 am

Ifreann wrote:
Sundiata wrote: That's untrue with a well-funded public option for all.

If buying private insurance doesn't provide some kind of benefit, some doctors who cannot be seen otherwise, some hospital facilities that would otherwise not be available, something, then it's a scam and people are being tricked into paying for nothing and clearly the whole thing should be shut down. If it does provide some kind of benefit then it will always be true that some people will be denied that benefit because they cannot afford private insurance. The specifics might vary, but it will always be the case that the freedom you are talking about will have a price tag, and thus some people will always be denied that freedom.

The public option will be free at the point of service and inexpensive. If you can't afford the public option, costs will be subsidized down or waivered. This is how we accomplish universal healthcare coverage for all people while also maintaining economic freedom in the United States.
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Postby Celritannia » Sun Sep 13, 2020 9:19 am

Sundiata wrote:
Ifreann wrote:If buying private insurance doesn't provide some kind of benefit, some doctors who cannot be seen otherwise, some hospital facilities that would otherwise not be available, something, then it's a scam and people are being tricked into paying for nothing and clearly the whole thing should be shut down. If it does provide some kind of benefit then it will always be true that some people will be denied that benefit because they cannot afford private insurance. The specifics might vary, but it will always be the case that the freedom you are talking about will have a price tag, and thus some people will always be denied that freedom.

The public option will be free at the point of service and inexpensive. If you can't afford the public option, costs will be subsidized down or waivered. This is how we accomplish universal healthcare coverage for all people while also maintaining economic freedom in the United States.


Which is what Canada does.

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Postby Sundiata » Sun Sep 13, 2020 9:20 am

Celritannia wrote:
Sundiata wrote:The public option will be free at the point of service and inexpensive. If you can't afford the public option, costs will be subsidized down or waivered. This is how we accomplish universal healthcare coverage for all people while also maintaining economic freedom in the United States.


Which is what Canada does.
America can do it better.
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Postby Celritannia » Sun Sep 13, 2020 9:23 am

Sundiata wrote:
Celritannia wrote:
Which is what Canada does.
America can do it better.


Does that matter? What matters is people have access to healthcare, and insurance companies are regulated in order not to charge so much.

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Postby Nobel Hobos 2 » Sun Sep 13, 2020 9:23 am

Celritannia wrote:Well, it is a system of healthcare where medical coverage is accessible to all members of a country or region.


To me, "health care" means treatment by doctors.

In the US, the term seems to have been co-opted by private insurers to make their role seem indispensable: "healthcare" means care covered by insurance or by government, or even just the insurance aspect of it (ie the payments not the actual care).
No healthcare? You'll have to pay to see a doctor.
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Postby Ifreann » Sun Sep 13, 2020 9:24 am

Sundiata wrote:
Ifreann wrote:If buying private insurance doesn't provide some kind of benefit, some doctors who cannot be seen otherwise, some hospital facilities that would otherwise not be available, something, then it's a scam and people are being tricked into paying for nothing and clearly the whole thing should be shut down. If it does provide some kind of benefit then it will always be true that some people will be denied that benefit because they cannot afford private insurance. The specifics might vary, but it will always be the case that the freedom you are talking about will have a price tag, and thus some people will always be denied that freedom.

The public option will be free at the point of service and inexpensive. If you can't afford the public option, costs will be subsidized down or waivered.

I'm not saying there shouldn't be a public option. I'm saying there shouldn't be a private option. Private, for-profit healthcare should not exist.
This is how we accomplish universal healthcare coverage for all people while also maintaining economic freedom in the United States.

Economic freedom, the freedom for the rich to do as they will and the poor to do as they are told.
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Postby Sundiata » Sun Sep 13, 2020 9:33 am

Ifreann wrote:
Sundiata wrote:The public option will be free at the point of service and inexpensive. If you can't afford the public option, costs will be subsidized down or waivered.

I'm not saying there shouldn't be a public option. I'm saying there shouldn't be a private option. Private, for-profit healthcare should not exist.
This is how we accomplish universal healthcare coverage for all people while also maintaining economic freedom in the United States.

Economic freedom, the freedom for the rich to do as they will and the poor to do as they are told.

I fundamentally disagree with that premise. If the public sector does something let the private sector compete. The public and private sector exist to hold the other accountable. Everyone has the right to go into business for themselves and this includes the business of health insurance. Economic freedom improves the general welfare, including the lives and livelihood of the poor.

Socialism is not the way forward, economic freedom is.
Last edited by Sundiata on Sun Sep 13, 2020 9:37 am, edited 2 times in total.
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Postby Celritannia » Sun Sep 13, 2020 9:37 am

Sundiata wrote:
Ifreann wrote:I'm not saying there shouldn't be a public option. I'm saying there shouldn't be a private option. Private, for-profit healthcare should not exist.

Economic freedom, the freedom for the rich to do as they will and the poor to do as they are told.

I fundamentally disagree with that premise. If the public sector does something let the private sector compete. The public and private sector exist to hold the other accountable. Everyone has the right to go into business for himself and this includes the business of health insurance. Economic freedom improves the general welfare, including the lives and livelihood of the poor.

Socialism is not the way forward.


The private sector does not exit to hold the public sector to account, that's a ludicrous statement.

And single-payer healthcare is not socialism.

As I have also pointed out, private healthcare still exists in the UK, alongside the taxed-payed system.
Last edited by Celritannia on Sun Sep 13, 2020 9:39 am, edited 1 time in total.

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Postby Page » Sun Sep 13, 2020 9:37 am

The very concept of health insurance is repugnant. Single-payer public insurance is the least awful form of it, but we should aspire to a world where health care is utterly divorced from capitalism. People should pay what they can relative to their ability and get whatever they need.

I see single-payer as a centrist compromise position that can serve as a stepping stone to nationalization.
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Postby Atheris » Sun Sep 13, 2020 9:40 am

Universal healthcare is too much. I'm fine with Medicare for All, with private healthcare serving in a system where taxed-payed exists alongside it.
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Postby Nobel Hobos 2 » Sun Sep 13, 2020 9:40 am

Celritannia wrote:
Sundiata wrote:America can do it better.


Does that matter? What matters is people have access to healthcare, and insurance companies are regulated in order not to charge so much.


Cheaper than currently perhaps. I think if the US set about trying to provide health services to everyone for the same or less per person as Canada, the result would be significantly worse than Canada has.

It's like "defund the police", taken literally. Expecting to get better service by paying less money defies all market logic.

A limit on how much cheaper the US system could be, is that so much of the infrastructure is privately owned. Just nationalizing it would be one approach, I guess, but the nearest to that which would be politically possible would be buying them out. Terribly expensive. And the supposed virtue of free enterprise systems -- competition between providers of similar services -- does not work so well when the buyer is government. To be the Single Payer does have advantages in some things (eg pharmaceuticals) where govt can just set the price ... but that's because those things can be sourced from outside the US (I know, there's a law, repeal it) which breaks attempts at supplier collusion. That doesn't work so well for big assets like hospitals which take years to replace, nor for highly skilled labor like doctors and specialists ... which take even longer. Going out of business is not an option for government, they can't plausibly threaten the market with it ... therefore they're always at a disadvantage getting involved in a major industry.

Well the bottom line is that expanding Medicare to everyone who wants it (including putting it as an option on health exchanges) would increase the public share of spending and make it more like a Single Payer. Any downward pressure that might put on overall health spending would be gradual and might not even happen. Government cannot guarantee a smaller health sector: it shouldn't be a promise or even a priority.
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Postby Ifreann » Sun Sep 13, 2020 9:40 am

Sundiata wrote:
Ifreann wrote:I'm not saying there shouldn't be a public option. I'm saying there shouldn't be a private option. Private, for-profit healthcare should not exist.

Economic freedom, the freedom for the rich to do as they will and the poor to do as they are told.

I fundamentally disagree with that premise. If the public sector does something let the private sector compete. The public and private sector exist to hold the other accountable.

Publicly funded healthcare is not held accountable by for-profit healthcare. That doesn't make any sense at all.
Everyone has the right to go into business for himself and this includes the business of health insurance.

Everyone has the right to go into business in the same way that everyone has the right to have an island build for themselves off the coast of Dubai.
Economic freedom improves the general welfare, including the lives and livelihood of the poor.

It does not improve the life of a poor person for there to be a doctor somewhere who won't see them, a hospital somewhere that will not admit them except in an emergency.
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Civil Rights Lovefest

Postby Celritannia » Sun Sep 13, 2020 9:41 am

Atheris wrote:Universal healthcare is too much. I'm fine with Medicare for All, with private healthcare serving in a system where taxed-payed exists alongside it.


What you described is a form of Universal Healthcare.

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Civil Rights Lovefest

Postby Page » Sun Sep 13, 2020 9:42 am

Atheris wrote:Universal healthcare is too much.


Too much what?
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Postby Freiheit Reich » Sun Sep 13, 2020 9:43 am

Should be universal and paid with a percent of income taxes and small deductibles (to discourage unnecessary visits) similar to Taiwan's system. I tend to support a small government but basic healthcare should be a right. If the USA can fund expensive foreign invasions in the Middle East, it can provide basic healthcare to its citizens.

One way to cut down costs would be to outsource major procedures to cheaper countries like India, Thailand, etc... Patients would be required to go to cheaper countries for complex surgeries or pay a higher portion of the costs if they choose to do it in the USA.
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Sundiata
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Postby Sundiata » Sun Sep 13, 2020 9:44 am

Celritannia wrote:
Sundiata wrote:I fundamentally disagree with that premise. If the public sector does something let the private sector compete. The public and private sector exist to hold the other accountable. Everyone has the right to go into business for himself and this includes the business of health insurance. Economic freedom improves the general welfare, including the lives and livelihood of the poor.

Socialism is not the way forward.


the private secotr does not exit to hold the public sector to account, that's a ludicrous statement.

And single-payer healthcare is not socialism.

Multi-payer healthcare is the best system, there should be as many programs for healthcare as there are brands of cereal, including a robust public option that ensures low costs for all. Rather than looking to Canada for inspiration on healthcare, we should be looking to our friends in Singapore: which is currently the most economically free country in the world.

I want universal healthcare just as much as you do; I do not want socialism.
Last edited by Sundiata on Sun Sep 13, 2020 9:45 am, edited 1 time in total.
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Postby Nobel Hobos 2 » Sun Sep 13, 2020 9:44 am

Atheris wrote:Universal healthcare is too much. I'm fine with Medicare for All, with private healthcare serving in a system where taxed-payed exists alongside it.


Bernie's Medicare for All would apply to everyone even those currently holding private insurance. It's universal healthcare.

Maybe you mean Elizabeth Warren's version ?
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