Health-Care Reform Discussion Question

Does the fact that the United States does not now have a system of universal health care, despite more than a half-century of strenous legislative efforts by the Democratic Party, imply that a U.S. system of universal health care would produce results significantly different than that of countries that have had such a system for decades?

Pithier: If the U.S. suddenly got the Canadian-style system that majorities of Americans have traditionally resisted, would Americans start acting like Canadians?

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22 thoughts on “Health-Care Reform Discussion Question

  1. This ignores the institutional differences between the US and other countries–I don't for a minute think that it's only public opinion that's stopped the US from having universal health care. There's a little obstacle called the Senate.

  2. It seems likely to me that having a government like Canada is in fact causally related to acting like Canadians. If Truman had enacted a Canadian-style system in the 40s, don't you think that the hypothetical Americans of the 21st century who had had a Canadian-style healthcare system for 40 years would be more like Canadians than Americans are today?So if the U.S. suddenly got a Canadian style system now, they might not “suddenly” start acting like Canadians. But it seems at least plausible that in the long term they might.

  3. I think a bigger reason is that many non-union workers, around 90% of the population, know that a government-funded health care plan is going to be a net loss for us.If non-union workers, covered under employer-provided health care plans, were looking at future wage increases due to reduced healthcare costs, or self-coverage under a public plan, then more people would be receptive to the government takeover (not me, but I digress). We will not receive these wage increases, however, and any savings seen by employers will be pocketed, as they should be. Worse yet, if the employer tax credit goes away, companies may see increased costs in healthcare plans and business taxes, which will be pushed down to the employees in some form.Additionally, not only will non-union wages not be impacted by a transition to a public plan, but after tax income will be reduced – either now or in the future – from the inevitable tax increases that must be implemented to pay for the program.The Democratic response to this is that healthcare reform is, of course, a net gain for us all, union or non-union, because we will see reduced healthcare expenses in the form of cheaper premiums, lower co-pays, etc…however this only affects those who utilize (consume) healthcare resources most; i.e. the very same people who are causing the rising costs.To answer your question: no, Americans will not start acting like Canadians. Which is why we should be very wary of this plan.

  4. The private sector and competitive market forces, not the federal government, are the best means to meeting our country's rapidly expanding health care needs. I've been looking for a way to take action and contact our legislators and sign petitions and found some good policy the U.S. Chamber of Commerce backs (here). I don't have a lot of money or time, but I figure this will help other people do good.

  5. Matt C – you're somewhat right if you're talking about Obamacare. Totally wrong though if you're talking about single-payer. Single-payer actually would be a net gain for us all. Employer's will likely pocket the gains from no longer having to subsidize employee care, which will be offset by some taxes, but having guaranteed healthcare will give employees drastically more bargaining power in the workplace and one would expect to see wages increase across the board, union or no.Janet – I realize that Raymond Shaw is the kindest, bravest, warmest, most wonderful human being you've ever known in your life, but c'mon.

  6. Well single-payer is not on the table, as WIll has dutifully noted, so my point still stands.However, I disagree about a government-provided single payer health care program giving employees more bargaining power. Does Social Security give us more bargaining power with employers vis-a-vis retirement or disability benefits? Not really, and if Social Security was taken away tomorrow we would all have more money in our hands to save and invest – which is real bargaining power. I would like to believe that there is meaningful reform legislation that could be passed, helping to reduce the waste and overconsumption in our healthcare system, that would be a net positive for most workers, particularly in the form of wage increases. When I read that the current plan for reform and coverage of ~90% of the 40+ million uninsured is going to cost $1.8 trillion…I want to puke.

  7. I don't think your Social Security analogy is apt. There's a huge difference between bargaining for something that will be happening on a distant time-horizon and something happening at the moment. If you knew you could quit your job, threaten to quit, or go on strike and that your family would still be alright if they got sick, it would radically change your relationship with your employer. The risk of standing up for yourself would be lower, so it's likely you'd do it more. If people don't have to work with the Sword of Damocles hanging over their heads, they're likely to behave differently.Additionally, if you knew that some unforseen illness wasn't going to bankrupt you, it would also change your relationship with your employer. (most personal bankruptcies are due to healthcare costs)If you know you're getting Social Security in x years it doesn't substantially change the risks to you (for or against) if you push management for more wages or benefits. Its not a bargaining chip because its not within a certain time frame. If you went to the mat because you had Social Security, you'd lose because you'd have to manage in the intervening time between now and when you start collecting SS.Removing catastrophic risk for some players in a workplace environment would substantially alter the bargaining positions and outcomes for all players. In this case, favorably for workers. . Which is precisely why it's “off the table”.

  8. Subsidizing employee care represents a gain to the employers who do it. If it weren't, they wouldn't do it.

  9. Most personal bankruptcies are due to divorce or job loss, not healthcare. If you're referring to Elizabeth Warren's recent report on the issue, her statistics are wildly off for two main reasons.1. She had a response rate of 900 bankruptcies on 2600 attempts. This is very low, and on an issue as touchy as failures of personal finance, self-selection is a huge problem. People who can blame a disease are probably much more comfortable talking about it than people who spent themselves into a hole of their own accord.2. She counted any bankruptcy with healthcare debt as a “healthcare related bankruptcy” regardless of how large that debt was. $700 in unpaid checkups for the kids on your credit card when you file? Healthcare related bankruptcy.Of course healthcare costs do push a good number of people into bankruptcy, but divorce and job loss are, and have been for quite some time, the main culprits. Splitting incomes and adding new households does terrible things to finances.

  10. As I understand it, the US employer-based insurance scheme actually came about more or less by accident. Faced with fixed wages and a shortage of labor, firms began to compete for workers by offering health insurance. There wasn't the same need for nationalized health in the US that you saw in Europe immediately post WWII. It represented an entrepreneurial response to a problem. And all was well (rimshot!) for many decades. Which has led to our current, rather anomalous situation. All other first world countries provide some system of nationalized medicine. Some have more (Great Britain, Canada) some less (Australia, Japan) and some even less (Taiwan). My guess is that the structure of a nation's health care reflects it's (changing) character. And it's a chicken-and-egg question to ask whether the Canadian national character preceded or was molded by it's health care.

  11. If you knew you could quit your job, threaten to quit, or go on strike and that your family would still be alright if they got sick, it would radically change your relationship with your employerThis is a hollow argument for supporting a government-run healthcare program. We don't want it to model unemployment insurance, which has been shown to actually increase unemployment. The last thing we need is another incentive for people not to work.The point I made still stands – the administration and legislators are attempting to sell this plan as beneficial to the average worker. Additionally, if you are someone who does not consume a lot of healthcare resources you can expect the costs to exceed the benefits of reform legislation with a public plan.

  12. @huadpe – fair enough. perhaps my data is wrong on the rank. nevertheless, the central point still stands. The potential for catastrophic risk changes the bargaining relationship substantially.@matt – I'm not saying that's why, or at least the main or only reason why, we should have single-payer, I'm saying that would be a strong benefit for working people and would substantially change the culture (which was Will's original query). Again, the unemployment analogy, even if it were accurate, is inapt. You can't eat healthcare or pay rent with it.An administration and legislators will always attempt to sell whatever they're selling as beneficial to the average worker even when it isn't, which is most cases. Their plan sucks, but that doesn't mean that there isn't a good plan.What we've got is this terrible middling-plan which doesn't solve the problem and has enough “government interference” and enough “free-market solutions” in it to keep people arguing on either side of this fake dichotomy about the reform's efficacy long after its passed and fails to solve the problem. So its basically a great recipe for more of the same with the appearance of change. Kicking the real problem down the road to the next bought off pol.Your cost/benefit argument isn't very good either. You may be someone who does not consume a lot of healthcare resources and is thus not proportionally benefiting, until you get cancer. Not to mention all the other harder to quantify, but still quite real benefits you get when other people around you are healthy. It's not just a consumer good, but a form of insurance as well. A form that would be much cheaper for all involved than what we've got or what we're likely to get.

  13. Josh,What about COBRA coverage then? I know that if dismissed, I can get my coverage at cost through COBRA for a period while I look for a new job. Yes, I have to pay for it, but the risk of being unable to afford basic necessities (see: food, housing) is already there when chancing my job. Losing a long-held job is a catastrophic risk to take for many people, with or without the healthcare component.

  14. True, and that's a good point. But if you had a gig where you could save enough for COBRA in case of unemployment, AND a health safety net, you'd definitely be ready to push back because you'd be able to use your COBRA money for housing or food.As it is, you'd likely have to choose between keeping up your COBRA payments or eating. (I don't know many working folks that could save enough for all three, or even two, and still maintain a modicum of a “normal” life. It would require a level of frugality bordering on the eccentric.) Likely you'd choose eating, lose your insurance, and be in a poor bargaining position when facing a new potential employer, ready to take whatever terms were offered.But yes, food and housing, the other two necessities, are important and should be considered a right as well. Any decent society wouldn't force people to trade their life energy to others in exchange for basic necessities which are plentiful. And this idea, currently marginal in the US but considered common sense elsewhere, would become more prevalent in a society with socialized medicine. So yes, we'd probably start thinking and thus acting more like Canadians.

  15. Your cost/benefit argument isn't very good either. You may be someone who does not consume a lot of healthcare resources and is thus not proportionally benefiting, until you get cancerI would venture to guess that there would be overwhelming political support for government subsidization of catastrophic medical illness insurance for private insurers, the likes of which my future cancer would fall into. But what we are discussing here is a system to provide everyone with funds so they can use as many healthcare resources as they wish, sick or not. The fact that you cannot see this is why you don't understand cost-benefit. I would only need to point you to the incredible damage Type II diabetes – a high-cost, primarily self-inflicted disease – is doing to Medicare to prove my point. Unemployment is a perfectly good example to support my case, because it is another similar system that people inevitably abuse to the detriment of the macroeconomy. Unemployment insurance actually incentivises people to remain unemployed, rather then bridging the gap between employment. Healthcare in general suffers from overconsumption, and we are on the verge of fattening the pig.As to the point about how you can't eat or pay the rent with healthcare coverage – see my orginal point. In the eyes of US employers, healthcare is another form of compensation, just like my salary, which buys me beer and Subway. And my point still stands – the marginal benefits we may see in reduced healthcare costs will not exceed the future tax increases, nor will we see any wage growth form reduced employer-funded healthcare costs. If am wrong about that last point – and employers suddenly start giving everyone raises…well, then I'll be wrong.

  16. You may see it as a negative, but you have conceded the point — universal health care would decrease built-in incentive to work, thus forcing employers to compete on price for people's time.

  17. This means health of common people is being ignored. This has direct effect on the country's economy.

  18. Why not regulate the cost? Force medical provders to charge everyone at cost plus 10%. Run healthcare like a utility. Then you would not necessarily need expensive insurance coverage.

  19. It seems like we could be waiting on a deadline that keeps getting postponed when it comes to health reform. I think that the only thing Americans can do to be prepared for this long wait is to research their health insurance options, and pick something that is tailored to them. It is crucial during this hard economic time to provide stability for our families, and not spend unnecessary funds on health insurance policies that don't fit our best interests. Websites like http://www.enetinsurance.com are the solution to easy research on health insurance options. eNetInsurance is a free health insurance agency providing medical quote comparison and affordable health insurance plans for individual, families, small business groups and senior citizens from the nations top carriers. Find a health insurance policy that fits you and your family without hassle.

  20. It seems like we could be waiting on a deadline that keeps getting postponed when it comes to health reform. I think that the only thing Americans can do to be prepared for this long wait is to research their health insurance options, and pick something that is tailored to them. It is crucial during this hard economic time to provide stability for our families, and not spend unnecessary funds on health insurance policies that don't fit our best interests. Websites like http://www.enetinsurance.com are the solution to easy research on health insurance options. eNetInsurance is a free health insurance agency providing medical quote comparison and affordable health insurance plans for individual, families, small business groups and senior citizens from the nations top carriers. Find a health insurance policy that fits you and your family without hassle.

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