What have I got from that?
First, the problems with the US insurance system seem systemic, and serious. The fact that for most people their healthcare is tied to their job is a major drawback. It potentially ties people to the job they have, rather than setting them free to pursue more attractive possibilities, especially possibilities such as becoming self-employed, when that would result in loss of health coverage. It also appears to be a significant cost for employers. It also means that in practice most people don't get to shop around and choose their own insurance cover - they're stuck with what their job provides.
There is also a serious problem with people falling through the net, like the woman who got breast cancer at the wrong time, and became uninsurable. To that we could add the woman (from a report linked from another thread) who was on maternity leave and about to give birth when her company went bust and she suddenly had no health insurance. Or the family referred to by another poster who made a bad choice of insurance policy and found themselves without cover and owing many thousands of dollars.
Not to mention (because the programme didn't) the people who simply can't afford any insurance premium because they don't earn enough, and at the same time don't qualify for Medicaid.
These last problems are problems with entitlement. The woman with breast cancer simply was not entitled to any healthcare funding. The pregnant mother wasn't entitled to any cover for the delivery, and ended up owing about $17,000 as I recall. Which was going to bankrupt her. The family with the poor insurance policy wasn't entitled to any help either. It is quite possible in the USA to find yourself with no entitlement to healthcare funding, either through bad luck or a bad choice. And if you're in that position, tough.
Now if we skip over the false analogies, the next relevant section was really a trawl through universal healthcare systems to find something to frighten the viewers with. And the one section from my own country, I know was grossly misrepresented. The rest of it, well, it's hard to say. It seemed the presenter was cherrypicking the worst aspects he could find. But you know what? I didn't see anyone in that segment in real distress. Nothing to compare to the breast cancer story. A few people who had chosen to access the US healthcare system, and were fine. We don't know if their imaginings about what might have happened if they'd waited in Canada were justified or not. The one Canadian patient we did see was receiving care and treatment, and was merely waiting (quite comfortably) for a bed on a proper ward after an emergency admission.
The difference that was completely fudged was ENTITLEMENT. The Canadian patients, and the English people trying to register for NHS dentistry, and any of the British patients he might have identified who have been in the news because something went wrong and they were badly served, are ENTITLED to health care. And that is immensely empowering. People who have fallen through a crack in an insurance based system are powerless. People who have been let down by a universal system are empowered, because they have not been given something which they should have been given.
They can then complain. Loudly. They can lobby politicians, and vote for the ones who promise the right things, and stage protests at the Houses of Parliament, and whip up hard-hitting press campaigns. And the politicians can't shuffle off responsibility to the free market. It's their responsibility, and they better pony up or pay the price at the next election. Never underestimate the power of the votes of the people who want to see their healthcare improved.
That's how the NHS has improved the waiting times massively. That's how we have guaranteed access to a same-day appointment with our family doctor. Because the people let the politicians know what they wanted, and the politicians negotiated with the doctors to provide these things.
A fascinating programme could have been made, contrasting the freedom people have under universal healthcare systems - freedom to change jobs, to drop out of work (and back into education, or a caring role, or even just take a sabbatical), to become self-employed - all with no effect on their healthcare entitlement - with the restrictions placed on employees where healthcare comes with the job. And contrasting the powerlessness of those in an insurance-based system who fall through the cracks in the system, with the empowerment of people who have healthcare as an entitlement by virtue of their citizenship, and who can (and do) then cause an almighty row if the system doesn't deliver what they're entitled to.
But that woudn't have suited the agenda.
So the presenter didn't want to go the universal healthcare route. We got that. What were his suggestions, then?
Two modest ones. First, that a particular type of high-excess insurance policy was advantageous. Indeed, it did sound as if it had merit. The employer provided the policy, and also provided the amount of the excess, once per year, into a dedicated account that the employee could administer. But how does that even begin to address the problems identified at the beginning? It doesn't. Not even slightly.
Second, that basic primary healthcare practices could be very cost-effective if they didn't waste money and time dealing with insurance companies. If you happen to be someone whose healthcare needs don't cost more than a couple of hundred dollars, and you have a couple of hundred dollars, then they're a good idea. (I'm not quite sure what I think of this great innovative idea that's essentially taking primary human healthcare to where primary veterinary healthcare was in the 1970s, but it's OK as far as it goes.)
But if you're not in that category? You've not just got a minor ear infection, or a cut above your eye from playing football. You've got breast cancer. Like the woman crying her eyes out in the first segment. What good is such a clinic to you? None at all.
The apparent success of the insurance model presented, and the basic primary care clinics, was used to make some larger point about how competition brings down price. Even there, it wasn't really justified. The price came down for the high-excess insured people because the system introduced an element of responsibility. A very similar element of responsibility can be seen in universal systems, where people know that they are accessing a common good fund, and are motivated not to abuse it. And the price came down for the primary clinics because they cut out the insurance company's slice of the action. And there was no attempt at all to widen the analogy and explore how competition might be introduced for things like quadruple bypasses, and just how far that might bring down prices.
The insurance companies, who were criticised initially, were completely let off the hook. The apologia from the insurance representative was accepted uncritically, even though she was saying that one in 33 claims isn't honoured, and that the woman with breast cancer was on her own because she was too expensive. The example of the great reduction in the cost of basic primary healthcare if the insurers are cut out of the loop simply wasn't explored as it might affect other areas of healthcare. (Because, how can you possibly cut insurers out of the loop for the big-ticket items? Oh wait....)
The programme was a mish-mash, it was dishonest in several respects, and it failed to follow through on its own points. What it didn't even attempt to do was to claim that it had the solution to the "healthcare crisis". Because it didn't. I can't even begin to understand how Dan got the impression that it did.
Rolfe.
) Sounds like a system that has advantages - if you have to have insurance at all, that is. So?
