I feel bad that I usually mention Kevin Drum only when I’m quarreling with him for supporting Amy Sullivan’s scolding of the meanie “secularists”. So credit here for this quote that Ezra snagged. (The entire post is good, too.)
As progressives, our goal shouldn’t be to provide gold-plated care to every person in the country, nor should it be to restrict the ability of the rich to get better service if they want to pay for it. Our goal should be to provide decent care to everyone, with the market free to operate on top of that.
It’s a useful insight into some of the resistance to universal health care. I’m continually amazed at how much politics is driven by the notion that a lot of rich and powerful people seem to have that wealth is kind of pointless unless you can lord it over everyone else. And how middle class people slavishly follow that line of thinking. That your foie gras somehow tastes less exquisite if the family down the hill has enough sandwiches for everyone. Wealth is all relative, and if gaping inequalities are moderated, apparently it stings the hides of many a Republican voter, even if they actually are as comfortable and secure as ever before.
From that viewpoint, some of the more insane deregulation schemes and crazy economic maneuvers that have led us into the economic situation we’re in now make a lot more sense. Yes, economic collapse means the direct loss of a lot of money for a lot of rich people, so in that sense, this free market ideology makes no sense at all. But the chaos can be used, in theory at least, to really lay waste to the American middle class, open up gaping inequalities in wealth, and make the rich seem even richer even if they end up with the same or even a little less absolute cash in their pockets. (Though of course, the second part is to ram through economic “reforms” that funnel more wealth up the chain.) So there’s that thought. It at least explains the fondness for the “but the poor have old, crappy TVs, so they’re not poor!” argument. There’s a subtext there of begrudging people even their small, modest pleasures. If we can all watch the same TV shows—or get vaccinated—that makes those $10,000 TV just a little less hi-def and shiny, I suppose.
This sort of begrudging attitude works all the way down the chain. We all get to feel a little richer when the person down the chain from us is living in squalor. Opponents of universal health care have been able to work this base human instinct, believe you and me. Whenever I argue with someone who’s terrified of “socialized medicine”, I usually find three objections:
- It’ll cost more.
- I won’t be able to see my chosen doctor.
- The bureaucracy!
These are three objections that are easy enough to knock down. You just point out that the insurance companies already do this, and because they are constantly swapping customers, they have no incentive to cut costs with prevention, or to work with doctors so that you can see a doctor. Under universal health care, they’ll have incentives. And bureaucracy from insurance comes from the fact that they’re always trying to weasel out of paying what they owe you, but under universal health care, that’ll be banned (in theory), eliminating entire paperwork-generating departments. Under single payer, all these problems would be cut in half again.
Once you conquer the official objections, I find, the truth then usually comes out. They don’t want to share. It’s expressed in various ways, but the main one is this haunting fear of having to wait in line because all the poor people will just be getting health care like they’re entitled, which of course, they are.
My takeaway is this: At the heart of the debate is the notion that getting regular health care, especially preventative care, is a marker of middle class status, like owning a home or having a wife who doesn’t work. By expanding the right to have a regular doctor who sees you on a regular basis to the poor, you are taking from a lot of middle class people of a status item, and they feel the pinch of that. It’s like as if the poor all got to have new cars, mortgages, or Dillards’ credit cards.
In order for progressives to get around this issue, we need to find rhetorical strategies that quiet these unavoidable assholey begrudging attitudes, while appealing to people’s rational concerns for their own pocketbooks and to the better sides of them. Kevin’s idea—highlighting that you can pay for “better” (more elite) care out of pocket if you wish, and no one will stop you, is one strategy. Another that occurs to me while I’m writing this is highlighting the geographic nature of doctors’ patient list. Point out that universal health care is more going to focus on getting more doctors into lower income neighborhoods than forcing their doctor to double his patient list, even though he doesn’t have time in the day to see all those people.
As an added bonus, you can always point out that universal health care schemes to get doctors into lower income neighborhoods will also be focused on getting more doctors out to rural areas. The begrudging middle class white person might not be willing to hear about helping out communities that are primarily people of color, but they’re probably a bit more open to hearing about how red-blooded, pick-up truck-driving, Republican-voting white people like themselves but in more rural areas are also feeling the pinch because doctors don’t find in financially feasible to work in rural areas when so many Americans don’t have health insurance.
105 Responses to “Talking to begrudging middle class types about health care”
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Access to healthcare has been so critical to me and my family that virtually no major economic decision we’ve made - since getting married, especially since the birth of our daughter, and REALLY especially since my first cancer diagnosis in 2000 - without taking into account the impact it might have on our ability to continue to obtain healthcare.
Sometimes I feel imprisoned, held hostage by something which should be relatively minor and automatic in the grand scheme of things. But such is life in America, home of The Best Damn Medical System In The World!…
It IS the best medical system—if you can afford it! Therein lies the problem.
Hey, Mike Ess, welcome to the boat! We’ve been cruising here since 1994, when my husband had heart surgery to repair a congenital defect. When I became a full-time graduate student, we decided that it would be best for me to be a poorly-paid “research associate” who was taking classes rather than a student because … you guessed it … HEALTH CARE!
I don’t quite understand the “zero sum game” thinking, but I don’t get into status games with my neighbors, either. It isn’t about having enough, it isn’t about having more than enough or even alot, it is about having more than other people!
How juvenile can you get?
My husband is starting to get worried that his higher-ups are going to force him to fire one of his employees. She’s a good employee, but she’s had a sinus infection for months and can’t afford to see a doctor to get it cleared up. She’s the sole support of her family right now (on $15 an hour in Los Angeles) because her husband injured his back and can’t work, and they have three kids at home, so she can’t afford to lose a single dollar from her paycheck, even for healthcare for herself.
He’s going to fight for her but, still, she may end up getting fired for not having health insurance. That’s pretty fucked-up.
Well, I think there is a deeper underlying issue here which is that americans of all classes partake in the same cultural notions–that there’s no “free lunch” and that univesal health care wouldl expand the pot of needy people (to include everyone) without expanding the pot of money to care for their needs. We actually need to present people with a ballpark notion of how much they aer spending already vs. how much they would be spending under a new system. The right has gamed this finely, comparing systems that are universal but underfunded to systems that are not universal and occasionally not underfunded. Its true that health care for all britons is not funded at the same level that a fully insured and very lucky upper class person with a great job and benefits gets. On the other hand for quite a bit less money than that person spends a year on their coverage or on cobra when they lose a job we could all pay into a general system and all get great insurance.
The right has played on fears of a huge mass of uninsured poor people whose needs will drain a public system. In a funny way every time we say “but 47 million are uninsured” that plays into their hands because deep down every american thinks its a zero sum game. Obviously if you take the X billion dollars that we are currently paying for a bad system in which even middle class people feel underinsured and try to include 47 million more you are going to make things worse for the underinsured while making things better for the previously uninsured.
We need to attack this zero sum game theory at its base and talk about transferring money from places that don’t need it–the war–to places that do–real insurance for everyone. We need to shift our emphasis in arguing from browbeating insured people about how selfish they are to explaining to them how *unsafe* they are under the current system while assuaging their fears that they will give up some things they (think) they value for something no american really values–the public good.
aimai
Hmph. Having lived under Socialized (Aieeee)
Medicine most of my life utnil I moved to the U.S., I am constantly shocked by how often bureaucrats here tell me what medicines my doctor can prescribe, and what tests can be ordered. Hell, every time my employer decides to save money by switching plans (four times in five years, so far) there’s a chance my regular doctor won’t be covered at all. The health care financial statements my family gets are completely unreadable, and the last time I had a major claim it took me 10 months of dealing with bureaucrats to sort it out.
I find it funny everyone freaks out over “socialized” medicine, but everyone just loooooves “socialized” retirement (i.e., Social Security) so much so that not even the shrillest of Republican campaigns have been able to dismantle it.
Yes! This really resonates as true based on the conversations I’ve had with people against universal health care. I’ve gotten the same impression about people who are against unions and blue collar laborers who make good money. It’s totally a status and class thing. I have a coworker (paralegal) who just has the same resentment about union workers who aren’t college educated who make quite a bit more or the same as we do, because they just don’t deserve it. As if they don’t deserve to make a comfortable living because they didn’t go to college.
The one that really irks me is “They won’t let me see the doctor I want!!” Ignoring the, erm, inaccuracies of that statement, isn’t that what insurance companies do?
Just sayin’, my psychiatry appointments would be much more affordable if he was on my plan [he’s the best in my area and he’s really helpful, which is why I grit my teeth and pay the extra cash].
Well… The truth of the matter is that healthcare services and infrastructure are limited in scope in this country. So the reality is that if a lot of new “customers” (ie the poor) suddenly flood the system, you really won’t be able to see a doctor when you need one. This would hopefully work itself out, but it would be an expensive and lengthy proposition.
While I favor a single payer system, I never hear anyone address this problem. Thoughts, ‘goners?
I disagree with this completely.
We have the sort of system Drum suggests in our ‘justice’ system, for example. Due process of law is a right. But the wealthy and powerful get the best representation money can buy, and the poor… don’t. Do we want to provide the medical equivalent of public defenders - understaffed, underpaid, overworked, and because of those three factors inferior (despite their best intentions)? I don’t want a ‘universal health care’ system where the poor routinely have a (much) higher chance of dying in it than the rich, as they have a (much) higher chance of being wrongfully imprisoned today. We can do better than that.
Moreover, there really is a finite amount of health care - in terms of doctors, facilities, and so on - and that amount is only going to shrink (with universal health care) as the people now deprived of health care assert their rights and the doctors who really are ‘in it for the money’ transfer to fields and practices in the private sector where they can charge as much as they want. If the wealthy are allowed to suck up more than their fair share of health care resources, the poor will end up with less - and money doesn’t make a person more or less worthy of life.
Canada has restrictions on private funding of health care services. I’m inclined to think such restrictions are not just a good idea; if we want health care to be a *right*, and not a privilege - rights are not things money can buy! - such restrictions are vital to build a truly egalitarian society. Access to health care means access to life itself. As it stands, if people can use their wealth to buy better health care than those without wealth receive, then we have a society where your wealth determines how worthy of life you are. And that should be anathema to any progressive.
Ah, no it’s not. Seriously, it’s not. It’s on par with other western countries pretty much. Truly. And then when you add in the problems with access, it’s no wonder the mean health levels in the US are so much lower.
I’ve grown up under two ’socialised’ medical systems in two different countries, and I’ve never had the fear, constraints and expenses that I’ve had about health-care that I’ve had since I arrived in the US.
I mean, travelling across to the other side of the city to get to approved hospital, while bleeding, just still is completely fucked-up in my mind. I can’t believe I had to do that, on public transport no less.
ithaqua-
Aren’t housing and food necessities too? But that doesn’t mean you shouldn’t be able to buy a bigger house or more expensive food if you want it.
Or, the above mentioned Social Security. You can have a big retirement plan if you want it, but EVERYONE gets a basic package with Social Security.
OT, but someone should explain this to Mary Cheney, what with her store-bought “marriage rights” and all…
Right fucking on, Amanda.
This is EXACTLY what I realized about my in-laws last year when the healthcare debate came up. You could see their veins pop out of their necks at the idea that poor black women who had unprotected sex at one point in their lives would have access to the same care that they do. In their brains, people are poor because they’ve chosen to not work hard or be smart, so they DESERVE to be PUNISHED with bad health care. Nevermind that these same in-laws are squarely middle class and that they would pay less for health care under a universal plan; they have a big hard-on for rich people, as if rich people became so by working harder and being more clever than poor people, so they try very desperately to distance themselves from blacks and “hillbillies,” as they call them.
This is such and important post. Awesome.
I’ve thought for a long time that if we were going to see substantive changes in the system, whether we’re talking about health care or some other social system, the middle class will have to be almost completely gone. Until the middle class gets kicked in the teeth a few dozen times by the wealthy, until we have a system of landowners and peons, we’re not going to have any sort of social revolution. That’s why I liked Edwards so much–he was the candidate who’s come the closest in recent years to declaring a full-on retaliation on the wealthy in the ongoing class war.
“Hey, Mike Ess, welcome to the boat!”
Cool, ain’t it?
Nothing quite like being held prisoner to your need for healthcare…
But at least all Americans can rest easy knowing that we spent our money to kill people in the desert instead of helping Americans stay alive and healthy at home…
If you look at health care as a “good” (like socks or groceries or keyboards), it’s treated as a luxury good rather than a staple. Since health care is treated as an economic luxury, it’s little wonder that it’s a marker of middle class status and people want to protect it.
@vitaminC:
Might be better to say “when you want” than “when you need“. If people who need to see a doctor can’t, that’s a problem. If people who want to see a specific doctor at a specific time can’t, but they do have alternatives that meet their primary needs, that may still be a problem, but one a lot of people would be happy to have by comparison.
but that would assume that Republicans have any empathy with anyone at all, something not in evidence, I submit.There’s a reason the saying goes “all boats rise with tide”, and not “all tides rise with the biggest boats”.
Why this is so hard for people to get, or why people continue to act against their own economic best interests for fear of losing some symbol of eitther their social status or some other heavily-invested-in-facet-of-their-identity, is a little beyond me.
True, but it’s not always so easy to make that distinction. What are “primary needs”, for example? Does preventative medicine come under this category? If so, the system will be overwhelmed by a sudden influx of people. My point was more geared toward healthcare shortages in this country (hospital closings, nursing/doctor shortages, etc).
@vitaminC:
Triage, I suppose. Prevention is, generally speaking, cheaper than catastrophic failure, so I can only hope it would be made a priority. But you wouldn’t shut the door in the face of someone who was bleeding do death because 10 other people needed routine physicals - you reschedule, or something, you know?
Assuming there’s the capacity or resources to reschedule, yes. My point is that this will become less likely, in the short term, if the number of patients increases dramatically but the infrastructure doesn’t.
Ferret, have you ever had to get the doctor to see you in the waning hours of a Friday when you are slated to travel overseas the following Sunday because of your work?
More pressing, many people don’t have much play in their schedules - they get FIRED if they can’t be at work at certain times. That leaves them little room to just take whatever appointment their doc gives them. We were constantly fighting with the services my husband was referred to to STOP “just sending him a time to show up” and to start working to pick times when he could make an appointment because he wasn’t teaching!
Hardly a “want”.
Aren’t housing and food necessities too? But that doesn’t mean you shouldn’t be able to buy a bigger house or more expensive food if you want it.
Well, that’s kind of where the analogy breaks down. In a two-tier system (what we’re busily fighting against here in Soviet Canuckistan, and losing, thanks to right-wing pols who get all their ideological guidance from you folks), having the “right” to buy the healthcare equivalent of a bigger house means automatically that someone winds up with a smaller house than they should rightfully have. To continue the metaphor, if there were a way to guarantee that providing bigger houses to people who could afford it didn’t mean the rest of us wind up living in cockroach-infested slums because there’s only so many resources to go around, I’d be more in favour of it than I already am, but there really isn’t any way to do it fairly, so I’m utterly opposed.
I mean, jesus, are you people so in love with the idea of dollar democracy that it trumps basic notions like “sharing”?!
Interrobang-
When Social Security was created, did we have to outlaw private retirement plans?
Do we outlaw private schools because we have public schools?
The problem is that there aren’t enough doctors, nurses, or facilities to go around. Unfortunately, shifting availability in healthcare, unlike education, has the unfortunate consequence of death for some people
That could be solved by a massive government investment to get the system up to snuff.
To dig a little deeper, you have to look at the fear at the root of this. A whole lot of people who think of themselves as “middle class” are not actually middle class. They’re working poor. But for a whole lot of reasons, they want to cling to the illusion that they’re middle class.
The myth remains that America is the land of the great middle class, when in fact, if the middle class is an endangered species, and our current income gaps are some of the highest in our history.
But maintaining the myth is good for the people who are actually benefiting from this economy, and the working class buys into idea. The idea of healthcare being a middle class privilege is one of the few things they have that allows them to maintain the illusion (because their wages are stagnant, and their debt is high, and the value of their house has dropped, and they know they’re one job loss away from bankruptcy).
So, while these attitudes are real, I don’t think they’re based in malice, but in fear. To solve the problems, we have to help alleviate fear, to help people move beyond the us vs them thinking, help people see how everyone benefits when we do things to help the most economically vulnerable.
True, and we all know how quickly things like that get accomplished.
My fear is that conservatives, in their quest to “prove” that government can’t accomplish anything, will mandate universal healthcare without mandating a budget for it–thereby sabotaging the effort by ostensibly giving the people what they want.
“Aren’t housing and food necessities too? But that doesn’t mean you shouldn’t be able to buy a bigger house or more expensive food if you want it.”
Besides what Interrobang said (though I would quibble: all resources are scarce - how many slum-dwellers could be housed in decent apartments for the price of one of those giant sprawling suburban mansions?), the size of your house doesn’t directly impact your life expectancy, whereas the quality of your health care does.
“You could see their veins pop out of their necks at the idea that poor black women who had unprotected sex at one point in their lives would have access to the same care that they do. In their brains, people are poor because they’ve chosen to not work hard or be smart, so they DESERVE to be PUNISHED with bad health care.”
This is absolutely the problem progressives face, and the problem Drum’s idea makes worse: the idea, held by so many Americans, that wealth determines not only your moral status but even your very right to live. (Heh, yeah, why not frame universal health care as the ‘right to life’? Take back the term, progressives!) The amount of resources that you ‘deserve’ to spend on your own life, they think, is determined by how valuable you are to society, as defined by how much money society provided you with. Dividing health care into ‘welfare-care’ for the poor and ‘wealth-care’ for the rich just plays into the idea that the poor get the inferior care they deserve and makes it easier for the monied interests to oppose it.
We need to push, and push hard, the idea that everyone, male and female, black and white, Teh Sex or no Teh Sex, is equal and has an equal right to life. And as long as wealth provides the wealthy with better health care and thus a greater right to life, the structure of American society itself will oppose genuine equality.
f-ing brilliant.
I mean, jesus, are you people so in love with the idea of dollar democracy that it trumps basic notions like “sharing”?!
Even “sharing” doesn’t quite describe it here, since the middle class pays most of the bills.
I think what we are discussing is the difference between a system based on “healthcare as a privilege” and one where “healthcare is an entitlement”.
The experience with attempts to remove social security payouts from the wealthy speaks to the unwillingness of people who don’t need that check to give up an entitlement. What they fear is giving up their privilege.
Its also worth pointing out Medicade and S-CHIP work very well for those who qualify and are hardly “welfare-care” or “cock roach infested slums”. They’re more like small 3-bedroom ranch homes.
Excellent post. I work with a lot of people in the “but socialized medicine is bad, look at Canada!” camp. I don’t usually argue the point much because I can’t think of what I can say that would make change their mind. If they don’t already see the importance of caring for fellow citizens I’m at a loss. Oh, and of course they are all good church-going christians.
A lot of those problems, though, are due to poor allocation of the resources that we already have. County hospitals are shutting down because their emergency rooms are overwhelmed by uninsured patients who can’t pay. There’s a nursing shortage because hospitals needed to cut costs and couldn’t get the insurance companies to cough up their reimbursements on time, so they fired a bunch of nurses and discovered too late that nurses are actually vital to patient care. Etc.
We will need to do some major restructuring, including subsidizing the educations of people who choose to become doctors, nurses and/or physician’s assistants. It would be insane for us to declare that someone who wants to go to medical school has to incur $300,000 in debt to get a $100,000 a year job in a single-payer system.
Every new venture has start-up costs. It’s part of having a capitalist system. What are you, a communist for thinking that it’s bad to have start-up costs?
“When Social Security was created, did we have to outlaw private retirement plans?
Do we outlaw private schools because we have public schools? ”
Well, I’m not Interrobang, but perhaps we should. Actually, the public school/private school distinction is a good example; the wealthy get to ‘opt out’ of public schools, their children have access to educational resources that public schools can’t afford, and the advantage provided them by inherited wealth is compounded. And then their kids grow up to be conservatives who imagine they pulled themselves up by their bootstraps (and that the public school dropouts working minimum wage are there because they’re lazy and stupid), and the gap between rich and poor perpetuates itself. ‘Elite’ private schools are as anathema to a genuinely egalitarian society as a two-tiered health care system is.
As for Social Security: I don’t see how we could ban private retirement accounts without banning savings, that is, eliminating money entirely. Which, in the end, is the only ethical course if we really want a society where all people are created equal; but American society isn’t anywhere near ready for that step yet.
re: the boat….
This reminds me of the opening of David Rakoff’s book (paraphrasing):
“Ah, the Reagan years. A rising tide lifts all boats. Except that some people had been given stones instead of boats and no one told them. Oh well, tra la.”
True, and this is really the heart of the matter. As I stated above, getting people to understand the tangible benefits they will reap from re-tooling the system is going to be a long, arduous, uphill battle. Not to mention the conservative shell game I could see happening with the actual nuts and bolts funding…
Well, gee, I’m not seeking to abolish private property so I think we’re on different wavelengths here. I just want a strong social safety net that no one can fall through.
It doesn’t really bother me if someone owns a Mercedes as long as everyone has basic food, housing, health care, and education.
– are you people so in love with the idea of dollar democracy that it trumps basic notions like “sharing”?!
Yes. The mantra for way too many Americans is “I’ve got mine, fuck the rest of you.”
Fun fact: “Pursuit of happiness” in the DofI originally read “property”. This clearly means that the original intent of the founders was Communism.
Yes thats the 18th Century meaning of the word. But notice it says “pursuit” not “guarantee”.
I think we’re getting into a discussion about equality of opportunity vs. equality of results now.
I’ be perfectly happy to let the rich pay for stupid health care. If they want antibiotics to treat their viruses and full genetic screenings so that their add-on health plans will refuse to cover them, that’s fine with me.
The whole question of what constitutes gold-plated care is divisive but not entirely stupid. Just read about some of the things that hospitals in competitive areas do (decorated rooms, gourmet dietitians, concierge service) to attract the “right kind” of patients. Every time I see a TV commercial urging me to get my care at one hospital instead of another, it creeps me out to think of the money that’s not being spent on actual patient care.
Improvement of reimbursement for primary care and reduction of specialist reimbursement would help readjust the doctor mix of the country. I don’t see that there is a serious problem with system capacity for outpatient medical care, that couldn’t be readily overcome with single-payer and some minor tweaking of the doctor production system.
The current status items in health care are plastic surgery and concierge practices.
Should we chuck the public-defender system and let poor people do without lawyers, since PDs are understaffed and overworked?
vitaminC, a good marketeer would say that increased demand for medical service would mean more supply. Jobs for doctors means more people will become doctors to go after that available demand.
I’ve seen many liberal arguments in favor of universal health care that posits that everyone will get Cadillac care. Or at least I’ve seen liberals bemoan the poor’s lack of access to extremely expensive, new fangled procedures, which will in no way be covered under a universal plan.
Under universal health care, all women will be able to get mammograms and standard pap smears. They will not be able to get breast MRIs (much more effective at detecting breast cancer, but run at $15k a pop) or the new, better pap smears (which currently cost three times as much as the standard).
As long as we’re discussing this, I’d like to disabuse everyone of the notion that: 1. Universal health care is free. 2. Everyone will have access to the best of the best.
I’ve told this story before, but in the context of “how to teach the middle class that we all need to be insured”, I think it works great.
I was insured. In fact I worked for an insurance company. So my benefits were KICK-ASS. And I was pregnant, and working. And one day my face and arm went numb on a conference call at work. So I called my doctor and she said yes, pregnant women are at higher risk for stroke, better get to an ER.
So I went to the ER. Now I live in a big city, not a suburb, but at the time I was on the edge of that city and our hospital was part of a hospital group that is considered among the best in the country. This wasn’t an inner city hospital full of poor black kids who shot each other; the ER was mostly full of the elderly and middle-aged.
Fun fact: there are clot-busting drugs that can minimize the damage done by a stroke to almost nothing if given in 3 hours. If given after 12 hours stroke treatment does nothing; at that point the damge is permanent and the only “treatment” is rehab.
I was triaged as “Urgent” — which is correct; not dying, but a pregnant woman who might be having a stroke is a matter of serious concern.
And I was not seen by a doctor for ten hours, who then said that they couldn’t do a CAT or MRI scan to see if I was actually having a stroke until morning, which would have been another five hours away. So I checked myself out of the ER on the grounds that if I had had a stroke, it was apparent they were going to do nothing about it on a timely basis, and I might as well go to my regular doctor.
My insurance benefits meant nothing. I couldn’t be *seen* in the ER, a pregnant woman maybe having a stroke, until it was far too late for any treatment to help, because the ER is understaffed and underfunded because it is the first line of care for the uninsured and the uninsured then can’t pay the bills. And this can happen to you too, Suburban Voter with Good Insurance. Just think about shopping in the city and having a stroke. They won’t airlift you back to your gated suburb; you will go to the closest ER, and it will have the same problems my ER did. Your stroke will not wait until you’re home in your safe middle-class-only enclave (and even if it did, your hospital’s ER might serve a surprising number of uninsured people. My husband has been known to make $100,000K a year and be uninsured because he is an IT consultant and usually gets jobs without benefits. Good health insurnce costs $900/month for a family. Even with $100,000K a year to play with, that’s an ouchie.)
I work with a lot of people in the “but socialized medicine is bad, look at Canada!” camp. I
What? Canada’s health care system is great. If you lose your job, you still have health care. If you move to another province, you still have health care. And it is good care, and it is provided with dignity and concern, and the only time I’ve known people to be on waiting lists was when they had to travel. This is a problem for people in isolated or rural parts of Canada - which covers a lot of ground, so to speak. If you live in, say Norman Wells, N.W.T., you’re going to have to do some planning to see a specialist.
Ok, so maybe I’m way off base here, but I have a feeling that the reason the begrudging middle class thinks that the poor (working or otherwise) and uninsured get what they “deserve” is due to a need to convince themselves that they have a shot.
A lot of these folks are lower middle class, and they want to move up the ladder (even if someone took all the rungs away) and someday be a member of the Rich folk. So long as they believe that the poor people are where they are because they aren’t working hard enough they can continue to believe that if they work just a little bit harder someday they’ll have the fancy cars and the bigger house and all that.
The minute they accept that the system that we have in place now is the reason that the uninsured and poor can’t get the basic necessities they have a right to as human beings, they have to accept that the system is also keeping them where they are, and that they’ll never be as rich as they want.
It’s going to be a depressing realization for them, but it’s necessary, so that we can all move forward.
The Republicans have strung along their middle and lower middle class supporters with promises of “If you work hard, someday you’ll be just as wealthy as me”, if those supporters finally realize that those same people were making sure that brass ring was just out of reach…Well it would be an interesting day.
Well, thanks for reporting those strawmen, Erika.
As long as we’re discussing this, I’d like to disabuse everyone of the notion that: 1. Universal health care is free.
Gosh, roads aren’t free either, but we still like having them. We think of roadways as a right, like voting, or gun ownership, or education. Why shouldn’t health care be a right? As for the best of the best… so what? Society will be better off if everyone has a place in the health care system. Right now we have people divorcing, losing their homes, dying because they don’t have health insurance. Emergency rooms are inappropriately burdened with the uninsured. I see children every day with hearing and vision problems that could have been prevented if they’d had access to doctors when they were young. Screw Cadillac care - we need more bikes.
“…. people are poor because they’ve chosen to not work hard or be smart, so they DESERVE to be PUNISHED with bad health care.”
and
“The right has played on fears of a huge mass of uninsured poor people whose needs will drain a public system.”
IMHO, the root cause of this nastiness is a deep (and generalized) fear that “there is not enough to go around.” And applies to absolutely everything, from food/water and shelter, to healthcare, to money, etc, etc. If everyone would just realize that there is enough to go around, that if people weren’t so greedy and scared that they horded resources, denying from others without the basic necessities of life … there would be enough — of everything — to go around!
“If everyone would just realize that there is enough to go around, that if people weren’t so greedy and scared that they horded resources, denying from others without the basic necessities of life … there would be enough — of everything — to go around!”
Dirty Communist!…
:)
“… getting people to understand the tangible benefits they will reap from re-tooling the system is going to be a long, arduous, uphill battle. Not to mention the conservative shell game I could see happening with the actual nuts and bolts funding…”
Well gee, if it’s going to be so hard, why bother? I mean, it’s not like the effort would be worth it or anything …
Or, if they would realize that wealth itself is not a zero-sum game. New wealth is created all the time. The problem isn’t the creation of this wealth, its the fact that its not always distributed very well. Hence, the need for the welfare state.
Ok, so maybe I’m way off base here, but I have a feeling that the reason the begrudging middle class thinks that the poor (working or otherwise) and uninsured get what they “deserve” is due to a need to convince themselves that they have a shot.
A lot of these folks are lower middle class, and they want to move up the ladder (even if someone took all the rungs away) and someday be a member of the Rich folk. So long as they believe that the poor people are where they are because they aren’t working hard enough they can continue to believe that if they work just a little bit harder someday they’ll have the fancy cars and the bigger house and all that.
The minute they accept that the system that we have in place now is the reason that the uninsured and poor can’t get the basic necessities they have a right to as human beings, they have to accept that the system is also keeping them where they are, and that they’ll never be as rich as they want.
It’s going to be a depressing realization for them, but it’s necessary, so that we can all move forward.
The Republicans have strung along their middle and lower middle class supporters with promises of “If you work hard, someday you’ll be just as wealthy as me”, if those supporters finally realize that those same people were making sure that brass ring was just out of reach…Well it would be an interesting day.
You have it exactly right. It’s relative deprivation theory, as described by Ted Gurr in “Why Men Rebel”, just kind of in reverse. http://en.wikipedia.org/wiki/Relative_deprivation
The middle class don’t feel deprived when they see people with more than them, the feel deprived when the gap between themselves and those less than them is narrowed.
There’s also a money-where-your-mouth-is factor for the so-called pro-life crowd:
Why does America have the worst infant mortality rate in the developed world?
‘Cuz we’re the only country in the developed world without universal health care, including prenatal.
These people claim to care about the unborn, right?
‘Begruding’ is putting it too mildly.
If I were an alien biologist able to look at the human race with an impartial eye, I really think I would conclude that we were a warring parasitical species that was teetering on the edge of massive population crash based almost entirely on our ‘begruding’ behavior. The learned inability to share or conserve resources (including basic healthcare) and “give back”–either to each other, or to the very ecosystems that we depend on for survival is a poor long-term survival strategy that only “works” up until it is a colossal, tragic failure (as we’ve seen time and time again throughout history.)
You’d think we’d try something else sometime, wouldn’t you?
There’s two issues here in Canada when dealing with “2-tier” health insurance.
One of those problems is the draining of resources from the overall whole. If people can choose between a private plan or the public system, and can afford the more expensive (and therefore more convenient, more comfortable, etc) health care plan, the profit motive means doctors may move to the private care system for the promise of bigger paychecks, leaving the public system underpowered, and increasing the motivation to move to the Private system. I understand this sort of system happened with parts of the Australian system.
The other issue is what sort of additional health benefits we might see above and beyond the traditional service. For instance, how much is a person willing to spend on eyeglass frames for fashion purposes, or whether they want fancier “invisible” braces or retainers as opposed to the more traditional models, or private hospital rooms. These sort of convenience services might be better suited by a sliding scale of services that the market provides, and might be worked into a basic universal system to provide a more robust service that scales with wealth without having to sacrifice basic universal care.
There is not a doctor shortage. The real problem is the focus on other-than-primary care in the system. The US has plenty of doctors, but far too many have entered specialty care because of the pay and prestige.
It does not help this situation when the admissions systems for medical schools are thoroughly geared toward selecting for and producing specialists rather than generalists.
What is needed is incentives to go into front-line care and a good shakeup of the admissions systems and financing for medical schools.
Anyone remember Northern Exposure?
#2
Actually I seriously doubt that it is “the best,” even for people with unlimited disposable resources to spend.
Around the time I was born, say the mid-1960s, I suppose that for a person with huge wealth compared to a reasonable ballpark estimate of what the very best help medical science had to offer would cost, the USA was the place to shop for cutting-edge care, because of our general lead in science and technology and because we were the global HQ of wealth, and (sort of) hence wealthy people. (Who tend to be rather older on the average than the general population, though also better cared for in their younger lives, seeing as the percentage of rags-to-riches cases in the wealthy elites is much lower than popular myth supposes–so anyway, they probably form a very reliable market for medical services, having both more cash to supply and more illness driving demand.)
But that was 40 years ago. Since then, we have lost our overall lead in average standard of living, to Europe for sure, and perhaps, despite certain tremendous liabilities in the quality of life department (such as overcrowding, pollution, and high cost of living) even to Japan. And while a specialized tier of service for people who can pay any price is probably sufficient to generate a market of sophisticated service for those people, I suggest that the base of physicians and other practitioners to draw the elite doctors etc from is a function of the level of medical standards offered the general population, since most doctors would get most of their experience from serving this larger group, unless the polarization of rich and poor is so tremendous the poor have literally nothing to pay and get nothing at all.
The point is, if I had tens of millions of dollars to pay for the best medical services, and since the price of a plane ticket and expensive hotel accomodations is trivial compared to a medical bill, I would think that, after soberly considering my options, I’d find the best high-end medical care not in the USA, but in Europe–if not in countries like Britain or France or Germany, then in Switzerland. Or perhaps even in Sweden, if my reasoning is correct.
Anyway it is rather silly to brag about the alleged high quality of medicine shopped for by the rich and powerful of the world, since the global ruling class is very mobile and can afford to hire people to do some serious global comparison shopping for them. Perhaps one would not want to go to India for some very advanced and risky, cutting-edge procedure–but for something routine, surely the overall costs can be greatly reduced, even after paying for transport and lodging and bribes for being foreign and lavishing extra funds to see to it that quality of service is up to European (or even mere American) standards in every respect. And for cutting edge stuff, rich people from anywhere can go anywhere this or that service is offered. There is no need to reside in the USA, or Sweden for that matter, to take advantage of US or Swedish clinics if one is paying cash regardless. Vice versa, the only reason that a particular clinic offering some very advanced services should not locate in some cheap Third World nation (where a lot of their customers, after all, reside, as expatriates or as local elites) would be insofar as a highly developed infrastructure of services and a highly developed and vibrant local medical culture enhance the value of such facilities and practitioners.
Which, as I argued above, would be most likely and effectively provided by raising the general standard of medical care for the average person.
Once upon a time, despite the iniquities and inefficiencies of our patchworlk medical financing system, the average US income was so high, and the competing standards of living of even the most advanced rival nations overseas so relatively low, that we provided that best average standard in medicine. But those days are long gone.
We are bragging on past glories, and on competition to service the rich folks of the world. (Dinesh D’Souza to the contrary, Jimmy Carter never did turn against the Shah of Iran, and the breaking point with the Iranian radicals came when he ensured the refugee Shah’s right to enter the USA–for medical treatment.) And I doubt we can even retain our competitiveness for the latter, unless perhaps we go beyond merely avoiding the “burden” of socilizing medicine for everyone and actually subsidize private care for the rich at the expense of everyone else.
Indeed I suspect we have been doing this all along; certainly much of the advance of US “private” medicine has come from taxpayer-funded research, ostensibly for the benefit of all of us, but always and increasingly channeled via privatization to the already rich.
It was Michael Harrington who said we have “socialism for the rich and free enterprise for the poor.”
At this date I suspect our rich are leaching off not just our poor anemic corpses but sipping from the European taxpayer as well.
Why does America have the worst infant mortality rate in the developed world?
Because we emphasize a Culture of Life that treasures the Unborn Citizen!
“Nothing is too good for the working class.”
- Anarchosyndicalist Rudolph Rucker
But I guess that makes me a far left extremist.
By expanding the right to have a regular doctor who sees you on a regular basis to the poor, you are taking from a lot of middle class people of a status item, and they feel the pinch of that.
Thorstein Veblen described this phenomenon in great detail a hundred years ago; goods whose market value depends on their inaccessibility to those lower on the social status ladder are called “Veblen Goods” for this reason.
What he had to say about this phenomenon was so obviously true that nobody really bothered to try to refute his theories. Instead, mainstream (i.e. right-wing) economists simply ignored those factors altogether when building their models about how free markets function.
Growing up in the States, I spent a lot of time grappling with American status anxiety and the horrific oppression and exploitation it has given rise to in the last 300 years. I tried to figure out a way that we could overcome this stupid sense that other people have to be made to suffer if we are to feel good about ourselves.
Eventually, I gave up and moved to Canada. It’s awesome.
A terrific two-part series debunking Canadian health care myths, by Sara Robinson, is up here and here.
About the objections:
Actually the US is the country that spends more dollars per capita in health care. And the quality is worse too, so go figure.
In most countries with socialized healthcare, you can swap doctors whenever you want -provided the one you want is available in your zone- and you’re also entitled to a second opinion if you ask for it.
The only thing I had to do to grant my access to the public healthcare system was to call a number and tell them where they should send my identification card. And in the case I have to be transferred to a private provider -like it usually happens when you’re appointed for an ultrasound, for instance- I won’t have to worry about bureaucracy at all, it’s all done by the public system.
Hoping my previous comment comes out of moderation, I think I can bottom line it thus:
Actually medicine isn’t a commodity like shampoo or rope or razor blades. It’s a service, and the quality of medical care, overall, is a very subjective thing to judge. But it is a cooperative human endevour, and so I would expect that the rich of the world nowadays are voting with their first-class frequent flyer miles to check into clinics and hospitals in Western Europe.
Because the quality of medical care offered people willing and able to pay unlimited amounts out of pocket has to have some bearing on the quality of the local pool of medical talent, and that, I would expect, would only be enhanced by raising the standards of care offered the average person. The higher the base is set, the more experience practitioners will have with more numerous patients cared for more intensively and tracked more consistently. An MD, even a “specialist in diseases of the rich” as Tom Lehrer put it, from France or Sweden is going to be a better doctor than one from the USA, by virtue of the higher standard they are expected to hold to for the least favored patient, which also means more people per capita are patients at any given time. Setting a fairly high standard of care for even the least well off patients also means enhancing the market for general and specialized infrastructure for medicine, which would be an asset for even the most expensive private practice.
We should level the field, even if it imposes extra costs on the rich who are willing to pay out of pocket, because many of those costs will be offset by benefits.
Another thing I think we should notice–we have in fact been publicly subsidizing medicine, in the form of publicly funded basic medical research, for several generations now. But since we privatize actual delivery of care–even to the point of relinquishing patents for medicines, devices, and techniques developed on the public dime to private corporations–we actually have the reverse–the general public, via taxes, enhances the quality of medical care available to the rich minority, and many of us get nothing in return, since these publicly funded advances are not available to us, though we pay a share for them anyway.
Insofar as the rich patients of the world continue to patronize US rather than European establishments and practitioners, I suspect it is because of this subsidy counteracting the otherwise low standards of infrastructure and medical community our society would support on a purely market base.
Because I suspect using a certain word put my previous post into mod, let me paraphrase rather than quote Michael Harrington:
We have [S-word] for the rich and free enterprise for the poor.
Hear, hear, BlackBloc
Universal health care should be - indeed, must be, if it’s to be truly universal - the same quality for every person, rich or poor, capitalist or labor; that same quality should be as high as our resources allow, which means ‘gold-plated’ if we can gold-plate it for everyone, a decently basic level if that’s all we can manage.
“Should we chuck the public-defender system and let poor people do without lawyers, since PDs are understaffed and overworked?”
I think you’re missing my point. What I suggest, analogously, is chucking the private legal system, shifting the monies from there to the public sector, and assigning every defendant (no matter how rich) a public defender. Only with health care.
Of course they do. They just don’t give a shit about them once they’re born, unless it’s one of their own (and sometimes not even then).
The reason all the middle-class and lower conservatives and moderates *I* know personally are afraid of it, is that they’ve had drilled into them by Hegemony propagandists for the past twenty-odd years that health care in other countries with “socialized medicine” absolutely sucks, and that they or their kids or their friends will DIE of simply treatable diseases, that no matter how bad it is here and now, it will get WORSE with national health care, and this is because they don’t get any corrective information, all they get are the horror stories - they don’t know any better and (being good little authoritarians like most Americans) they never think to go out and fact-check by talking to a wide range of foreigners - they just take the horror stories of how bad “socilaized medicine” is abroad (some few of which ARE true, of course) as gospel and so they daren’t allow a change to the system we have now.
I’ve never run across anyone IRL who doesn’t want to share, who would rather suffer dog-in-manger-like than allow the “unworthy” access, not even in all my years as a theocon.
“…is that they’ve had drilled into them by Hegemony propagandists for the past twenty-odd years that health care in other countries with “socialized medicine” absolutely sucks, and that they or their kids or their friends will DIE of simply treatable diseases…”
The first implementation question is:
Will George Bush, Dick Cheney, or anybody they know, anybody they like, anybody who has worked for them or their families in the past be involved?
If so, we can kiss it all off because people WILL “DIE of simply treatable diseases”, etc.
For examples, see “Katrina, Hurricane”, “FDA”, “DHS”, and any other government department or agency currently operated by the Bushites and/or their evil minions…
It was Michael Harrington who said we have “socialism for the rich and free enterprise for the poor.”
I’ve been trying to track down this citation. The attributions on the Internet all over the place, as is so often the case: Harrington, MLK, and Milton Friedman have all used it in books and speeches, and Friedman apparently made claims to it being his coinage. But the most convincing attribution I could find was to Gore Vidal. Christopher Hitchens credits him with coining the phrase when he was campaigning in 1960. (See Hitchens’ book “Unacknowledged Legislation”, which is searchable online.)
I’ve never understood the worry surrounding “I won’t be able to see my chosen doctor.” There’s something I’m missing, I think, maybe because I care mostly about who happens to be relatively close by if I have some kind of emergency befall me. I’ll gladly give up excellence, even if I knew who had it, in favor of baseline competence.
Are people in general really so loyal to their doctors that it’d be a deal-breaker to have to pick another one from a list? Is this something that kicks in when a doctor becomes a permanent fixture in your life?
Here’s a question for those of you who have health insurance in the US: Is it good anywhere in the country, or only in the city or metro area in which you live?
Every health insurance policy I’ve been covered under, at least in my adult years, has been limited to doctors where I live. So, let’s say I travel to another city and get sick. Sick enough that I need to see a doctor so that the illness doesn’t progress to the stage where I might wind up in the emergency room. (This isn’t hypothetical, it’s actually happened.)
In a sane system, there should be no problem, right? However, here in the home of The Best Damn Medical System In The World!, the insurance companies I’ve had to deal with for the past (mumble, mumble) years have included restrictions in their policies that deny coverage if I seek medical care from someone outside the area where I live. I’m not talking about seeking care from a doctor that’s not in their network, I’m talking about seeking care from a doctor who is in their network, but just happens to be in a city that is not my own. I mean, it wasn’t as if I couldn’t have hopped on the next airplane home to visit my regular doctor.
Mnemosyne, your husband’s supervisee might be protected by the Family and Medical Leave Act. The company would need to have at least 50 employees, and she’d need to have worked there for at least a year. If that’s the case, then she’d be on pretty solid ground with a sinus infection. What she’d have to do is inform her supervisor that she’s got an FMLA-covered condition, and she’d possibly have to fill out some paperwork to that effect. If she has the seniority and the company is big enough, it would be worth looking into.
“It’s a useful insight into some of the resistance to universal health care.”
Amanda, in some other posts on Pandagon and MouseWords you’ve described yourself as a socialist, yet you see no problem with Kevin Drum’s assertion that it is okay to have the market operate on top of a social insurance scheme. Kevin is saying it’s okay for the rich to buy a better level of service than what the government might provide for the poor. Should I assume that when you call yourself a socialist, you thinking of the Overton Window? That is, you’re trying to steal the word “socialist” back from types like Rush Limbaugh, who try to use the word as an insult? I’ve been reading you for 5 years now and I can’t think of a single time you’ve ever suggested a social reform that couldn’t be harmonized with Jeremy Bentham’s work on social utility back in 1776. I don’ t recall you ever suggesting the radical restructuring of the economic relations of society.
Mnemosyne, your husband’s supervisee might be protected by the Family and Medical Leave Act. The company would need to have at least 50 employees, and she’d need to have worked there for at least a year.
Unfortunately, she’s pretty new — the other part of the problem is that her sick time hasn’t kicked in yet (in California your employer can take 6 months to give it to you) so she’s missing out on pay every time she misses work. She was a former employee who was laid off and re-hired a couple of years later, so he knows her well and is really afraid he’s going to lose her just as he’s got her trained.
Stupid sucky “health care” system. And the saddest part of all: he works for a health care provider (home health services). Of all people, you’d think they’d be understanding and provide good health care to their employees, but I have far better health care working as a secretary at an entertainment company. He has a $1,000 deductible per year that has to be paid before the insurance kicks in.
“Point out that universal health care is more going to focus on getting more doctors into lower income neighborhoods than forcing their doctor to double his patient list, even though he doesn’t have time in the day to see all those people.”
Are all doctors male? If “he” is better than “they” when referring to a person of unknown gender, even on Pandagon, then I imagine our society is still very far from taking the gender inequality out of the language. Every language embeds a worldview, and a long history of misogyny ends up reflected in that language too.
ithaqua: you’re a tool. Way to torpedo the whole concept. Good job!
universal health care is more going to focus on getting more doctors into lower income neighborhoods
And where, precisely, are these “more doctors” going to come from.
And where, precisely, are these “more doctors” going to come from.
Uh, medical school? As I said above, we’ll have to have publicly-financed medical education since the average debt of medical school graduates is almost $200,000. (For comparison, the average law student graduates with $80,000 in debt.) The AMA is very concerned about the debt that medical students are forced to carry because it’s distorting the marketplace — people who might have chosen primary care fields feel they have to choose high-paying specialties so they can pay off their debt.
I think you underestimate the idea of pride that is involved here. When I supported universal health care, I got the following responses from my conservative friends:
“Don’t you want you children to have something and not have to depend on the Government?”
“I provide for my family. If they don’t do that for theirs, that’s their problem, not mine”
Universal health care would be a good deal for both of these people. The taxes they would pay for a Cadillac health care system is less than what they are paying for health care now.
Yet they’ve bought into the right wing myth that they MUST pull themselves up by their bootstraps to make anything of themselves. The truth is that no one does it on their own. Case in point: None of us paid for our own K-12 education. Either the taxpayers or our parents paid the bills. Furthermore, the biggest welfare queens are not poor black women, but large corporations. The wealthy take a large amount of government welfare, they just call it a different name.
When people say that there are huge wait times, I say, “It’s just like here…depends where you go and what you do.” I can get in within one to two days with my primary care doctor, and I wait perhaps ten minutes to be seen. I don’t expect that when I go to the urgent care clinic or the ER (unless someone is dying), because I know that the wait is correspondingly longer. I already deal with long wait times to get in to a specialist, and whenever I’ve had surgery that too has had a fairly long lead time. I don’t see where that’s going to change if we get national healthcare.
We just won’t be being sued and garnished for the hospital bill we can’t pay because we were being garnished for the previous one….
Healthcare is so expensive because we refuse to take responsibility for it as a society. The following public investments in health care will go a long way toward reducing health care costs.
1. Invest in the medical profession. This means subsidizing the hell out of medical schools and nursing schools. This also means student loan forgiveness for doctors who work in needed areas.
2. Invest in medical research. Medical research is almost entirely profit driven. But what is best for the marketplace isn’t always best for medicine.
3. Invest in basic care for everyone. This keeps people from getting sicker and keeps the Emergency rooms open for Emergencies.
I am a capitalist. I believe in the free market. But there are limitations to what the market can and should do. The free market is not a religion, nor is it a substitute for civic responsibility. Public health is not something that fits the free market model well.
A male with anal warts, a female whose child’s DNA does NOT match her husbands’. You think these folk want one of the Conscience Christians doing health care? The CC won’t give meds or do procedures because it interferes with their right to be sanctimonious.
Many people spend years telling the professional all these health related secrets. Maybe they don’t want to start over. It’s about trust and the surety that your care is paramount.
“the notion that getting regular health care, especially preventative care, is a marker of middle class status”
Wow. You absolutely nailed it. Kudos.
I don’t see a problem with it being considered a right. I do see a problem with considering it as being “free.” People are very aware that roads aren’t free, that’s why they’ll often vote down road building programs when they reach the ballot. They certainly did it in my neck of the woods.
Part of the health care discussion needs to be: how much can we afford, how can we provide it, and how much are we willing to spend on it. Maybe with sensible, reasoned arguments, we can convince everyone that it’s worth it. Saying that it’s free and implying that the transition will be easy reeks of bullshit.
IMO it is only a matter of time (2 to 6 years) before some significant rework of the current healthcare system is implemented. The current cost increases borne by the people are unsustainable. So the question is not if, but what will we get?
Some would welcome a system where private fee-for-service is abolished (even punished as under the original Clinton plan). Some would welcome a system where medical school students are told what their speciality will be, where they will practice, and what they will earn. Some would welcome a system where all Pharmaceutical research is dictated by a central committee based upon some criteria. Basically, some would welcome a system that is free from the pressures of profit and loss. That may be the right answer. It may not.
But for better or worse, the structure of the system we are going to get is being crafted by whom? Is it Senator Obama, Senator Clinton, Senator McCain?
Does Harold Ickes get his fingers in it again?
I would like to see a new, fair system. One that would serve all the people. But I just can’t see who is going to give us this new system.
For all the people concerned about “keeping my same doctor!!!!!” maybe we could write in a little note that says if you’ve already got a doc, you can keep going to the same doc. I don’t have a “preferred” doctor because I just very recently got insurance (and it’s hurting me financially but at least I’m just paying for healthy me and not an entire family). But I can understand why some people may want to stick with the same people. I have to find a gynecologist (!!!) my very first one (!!!!!!!) and it’s very hard. I don’t want just anyone examining my lady business so I’m sure once I find one I’m okay with, I’ll probably want to stick with that one.
But most people — lower-income, uninsured people — DON’T have a preferred doctor. They have no doctor, except for the occasional ER visit where they will likely be checked by an intern or someone else low on the totem pole. And I have to say, if I find a gynecologist that I’m comfortable enough with (which isn’t easy for me), I can’t say I’d be all gungho at first about dropping that doctor just so some other person I don’t know could get basic health care. I know I’d put my money where my mouth is and get over it but I’m pretty sure there’d be some initial complaining in the beginning.
The problem is that some people (the ‘I paid for mine so you can pay for yours’ group) won’t be able to get over that or even imagine for ten seconds that they could get over that. Or, for that matter, even consider that this big huge worry they have may not even be an issue, that they may get to stick with the doc they’ve got.
Some would welcome a system where medical school students are told what their speciality will be, where they will practice, and what they will earn.
Huh? Even the National Health Service in England doesn’t tell medical students what they have to specialize in. Where did you pull that strawman from?
Some would welcome a system where all Pharmaceutical research is dictated by a central committee based upon some criteria.
Again — huh? Europe has some of the most advanced pharmaceutical research in the world. You may have heard of tiny companies like GlaxoSmithKline (British), Novartis (Swiss), Aventis (France), Bayer (Germany) ….
And yet they’ve managed to have universal healthcare systems. So you can stop beating that strawman, too.
OK! I’ll stop beating Hillary’s strawperson, since these items came straighr out of her original hea;th care plan. I guess I can trust her and her team to rework these so there not so obvious this time.
OK! I’ll stop beating Hillary’s strawperson, since these items came straighr out of her original hea;th care plan.
Her actual 1993 plan or the one that was reported by Elizabeth McCaughey that was pretty much made up out of whole cloth but Andrew Sullivan published anyway?
I’ve never understood the worry surrounding “I won’t be able to see my chosen doctor.”
You’ve never had a doctor who point-blank ignored what you were telling them, or insulted you, or left you in tears, or didn’t believe you were in pain so wouldn’t prescribe you the drugs you need, or didn’t believe you’d understand what your problem was so wouldn’t explain it to you, or–? I’ll stop, but I could go on.
No, people aren’t fanatically loyal to good doctors. They’re scared sick of getting stuck with bad ones and not being able to shop around for a better one. They’re not crazy to be scared. There’s nothing that’ll make you feel as demoralized or as absolutely helpless and powerless as a bad doctor. Better than no doctor, you might say. Well, yeah. Sometimes.
Hear, hear, BlackBloc
Universal health care should be - indeed, must be, if it’s to be truly universal - the same quality for every person, rich or poor, capitalist or labor; that same quality should be as high as our resources allow, which means ‘gold-plated’ if we can gold-plate it for everyone, a decently basic level if that’s all we can manage.
Mmm - at some stage in a socialised system, you have to start evaluating people and proposed spending based on cold hard criteria such as years of good health restored. This can and does lead to real controversy and heartbreak - how do you weigh timely eye operations versus clearing heart operation waiting lists, to use one NZ example?
I’m too tired to really go over this territory again but quickly…
The earlier commentators are right. While we will save huge money when it’s all said and done, we will almost certainly have huge huge upfront costs and a changover period. Beyond the usual costs of changeovers in something as intricate as a country’s heath care system, is that in the US, the issue is that health care is over rationed, and some of this isn’t just because of evil profiteers, tho’ they are a prominent issue, if not *the* prominent issue, but because the overall health infrastructure has deteriorated, and the same hugeass repair bills exist for the health care infrastructure (new hospitals, rural clinics, doctor training, etc, etc) that also exists for roads, rails, and power infrastructure. I am convinced, as I told the Agonist guys a year or so ago, that a significant barrier to initiation of a national health care system even though many actors desire it is that TPTB is trying to focus the public’s attention on health insurance, and not the declining availability of *health care*. A new national heath care initiative would reveal holes as soon as a rush of people who urgently needed care but couldn’t get it arrive to recieve it then.
I am all for national heath care. However, I want *health care* and not health insurance. We should have our eyes open as to the larger costs and struggles, so we can force this thing through despite initial dissappointment and prevent bad compromises.
As a last note, think about this…A national health care system depends on cheap doctors, who are paid distinctly middleclass wages. It’s one of the bases for why doctors resist a full-fledged attact on insurance companies–as indicated by that excellent little pair of links provided by Matt at comment 67
Actually, I haven’t, but that’s probably because I’ve been to the doctor fewer than 10 times since adulthood. I’m persuaded by the idea that “allowing you to keep your doctor” strikes a chord with people because of worry about getting stuck with a bad one like those you’ve had before. I will count myself even more fortunate in that after hearing about your frustrations. Thanks…
BTW, have I ever mentioned how much I love that you call yourself “sophonisba”?
That’s definitely a point that needs to be raised and discussed, though we shouldn’t let it be a barrier to getting changes in the system. When we have frickin’ bridges falling into the Mississippi because people are so crazy for tax cuts that they don’t realize (or don’t care) that people will literally die if we cut back too far, it’s going to be a hard sell to point out that we need start-up funds to get our health care system up to snuff.
Obviously, I think it’s worth the cost, but there are people out there who whine that they have to pay taxes for useless things like fire departments and libraries, so convincing them to spend money on things that might be controversial like health care is going to be a long slog.
What? Canada’s health care system is great. If you lose your job, you still have health care. If you move to another province, you still have health care. And it is good care, and it is provided with dignity and concern, and the only time I’ve known people to be on waiting lists was when they had to travel.
I’m from the part of the country with some of the longest waiting lists in Canada, and not the rural part. I’m from the largest city in the province. I had to wait 18 months for jaw surgery. My uncle waited six months to see a specialist about the slipped discs in his back. My teacher waited 3 years for an elective knee replacement. It took months to get in to see any specialist, and it wasn’t uncommon for there to be less than five specialists in some fields… in the whole province.
I didn’t pay a dime for my jaw surgery, and it turned out great. My oral surgeon has a great reputation across the country, and I haven’t been to a dentist that hasn’t commented on what a fantastic job my orthodontist did. My psychiatrist was really understanding, and my family doctor was always helpful and never judgmental. It never even occurred to me that a doctor could refuse to prescribe birth control and make me feel like a slut for asking.
But let’s not pretend that there are no waiting lists. The people of provinces like Saskatchewan will laugh in your face.
Can I just set something straight? There’s no reason you can’t have a universal health care system where you get to pick your own doctor. I live in Canada, and we get to pick our doctors here. I can see any doctor in the province, if I want (and if they have room for me). When our family doctor moved, I looked up a new one, met with her, and decided I wanted her to be my doctor. My mom met with a doctor, decided she didn’t like him, and chose to see mine instead. There’s no reason the US couldn’t adopt the same system.
@lawrence krubner, welcome to the XXIst century, where socialism no longer means communism.
VitaminC: The problem is that there aren’t enough doctors, nurses, or facilities to go around
According to http://www.lexas.net/laenderdaten/bevoelkerung/aerztedichte-ranking.asp, the US has more doctors per inhabitant than Sweden or Switzerland, if less than Denmark or France. Of course, they might all be in R&D, or busy filling out forms…
Major problem with “Two-tiered” is averse selection. If you are young and healty, you shove your health insurance contributions into the pockets of some for-profit company that will gladly take you on. When you become sick, or old, or short on money, you fall back on the public services, that you chose not to pay forward and cannot pay now. And through the eyes of an economist, that shows that for-profit insurance is good, because it makes money and its customers are healthy, and public health care is bad because it causes diabetis, cancer and old age.
Germany has a two-tiered system: If you are wealthy enough, you can go for private health insurance, and even if not you can gamble with one of the hundreds of insurance companies at the table. It also has a metric shitload of laws and regulations to keep the market forces that work on such a system like gravity on buttered toast from ripping the whole thing apart. The bureaucracy necessary to keep the regulations a) enforced and b) halfway watertight creates another drag at the system, which might be the second least effective in the world.
I don’t quite get what the “keeping/chosing my doctor” worry is about. Is that actually a problem in Canada or France or the U.K.?