Pretty much everything most Americans (even liberals!) thought about UHC 10 years ago was a series of damning myths. "Those countries are all on the verge of economic collapse because of UHC." "You have to pay 50% of your income to taxes to make UHC work" etc.
And how this misconception came about and why these myths were sold to people is an extremely interesting question, to which I do not entirely know the answer. However.
If we sidestep the "innate rights" argument, and agree that the right to healthcare is something which can be granted by a government to its citizens at will (and with whatever limitations it deems expedient/necessary), then things become simpler. First, we establish that it is within the capability of the society to provide for that right, if it is granted. This is self-evidently the case as regards the USA. Other similar societies manage to provide for that right at a cost of around 8% of GDP. The USA currently spends about 15% of GDP on healthcare. Therefore the wealth of the country can undoubtedly support the provision.
The only question then becomes, does the US society, as a whole, want to do this?
Let's look at the advantages.
- Every citizen has access to healthcare irrespective of wealth
- Nobody is contributing to the provision of a service they are not permitted to access
- "Freeloading" is only possible by tax evasion
- Nobody is forced to accept or remain in a job they dislike in order to secure healthcare
- Nobody who is involuntarily forced from their job will lose healthcare access
- Heathcare access cannot be arbitrarily terminated by an employer looking to save money
- Treatment provided is not restricted by insurance loss adjusters
- Choice of provider is not restricted by insurance company contracts
- Previous need for healthcare provision does not affect future entitlement
- No lifetime ceiling on entitlement to care
- The most expert consultants can have the most serious and complicated cases referred to them without losing income, even if these patients are relatively impecunious
- Entitlement to care means that anyone failed by the system (not provided with adequate care) has legal redress
- Citizens freed from a potentially intolerable burden of charity if a personal acquaintance lacks entitlement to care for a serious condition
- Paying for insurance, while remaining an option, is no longer compulsory
- Inclusion of political decision-makers within a universal system forces these people to support the system and prevents publicly-funded care becoming "second-rate"
- Elimination of stress and worry about paying for treatment
- Good value for money (8% of GDP for full coverage as opposed to 15% of GDP for incomplete coverage), partly through efficiency savings and partly through economies of scale/bulk purchasing potential
- More disposable income for everyone (and the absence of any need to lock money away in health savings accounts) stimulates the economy
There may well be more, but I'll move on for now.
Real disadvantages are few.
- System may be underfunded if politicians court popularity by cutting taxes - but in that case, nobody is any worse off than in the present US situation, as insurance may still be purchased. Also, note that point 15 above militates against that eventuality to some extent.
- Large-scale system vulnerable to self-perpetuating internal bureaucracy and large-scale bad decisions (likely to be a smaller effect than the positive effect noted at 17 above, however)
Now let's look at the advantages of the present US system.
Citizens are not compelled to pay for anyone else's healthcare - no wait, they are, in their taxes (Medicare and Medicaid) and in the overcharging inflicted on them by hospitals to cover the care they are forced to give to uninsured emergency casesCitizens are not compelled to pay for the care of the improvident or those whose health problems are the result of poor lifestyle choices - no wait, they are, see above, and also consider that many people who make unhealthy lifestyle choices are covered by insurance, which others pay into- Affluent citizens can access top-quality care immediately without waiting in line behind the hoi polloi - sure, but they can do that anywhere, nobody is stopping them from taking out insurance for enhanced service even where there is a universal system in operation
Affluent citizens who choose to rely on their own insurance cover or on self-pay are able to opt out of paying any tax to support the publicly-funded sector - no wait, they're not
Any demands to change that situation (points 1, 2 and 4) inevitably, logically and inescapably lead to the possibility, indeed likelihood, indeed
certainty, that people of limited means will die because they have no way to access the healthcare they need. You simply
cannot assert that nobody should be compelled to contribute to the cost of a service that is needed, as a matter of life and death, by someone who has no hope of being able to pay for it for themselves, without accepting that the probable consequence of this assertion is that this person will be left to die. And no fantasy of charity fairies funded by a few philanthropists willing to contribute way above their proportionate share will change that. And a move to a universal-access system will not make the compulsion element one iota worse than it is under the present system.
Now of course the citizens of the USA are entirely at liberty to reject the introduction of a universal healthcare system for whatever reason they choose. But I'm struggling for reasons here, beyond the assertion that this is communism so we can't have it (even though somehow we're prepared to put up with communism to provide everything from education to firefighting to foreign embassies to library books).
Anybody got any other perspectives on this?
Rolfe.
). I have alot more I wish to discuss, but a family issue is going to keep me away from the forums/away from internet access for a few days.