January 19, 2018

Nuancing universal health care, #Medicare4All and copays

This is taken from an update about my Robert "Beto" O'Rourke visit to Northeast Texas two weeks ago, with a paragraph that was originally in the middle of this update pushed to the top.

If you're citing "Medicare for all" as your national health insurance model, you need to note that the actual Medicare program requires you to have your wallet open if you're middle class. Bernie Sanders got backfire in 2016 for wanting to present a "Medicare for all" that was really something more like workman's compensation.

And, I think this is the problem. A lot of Americans are flinging around the phrase "Medicare for All" without asking what the actual Medicare program is. And, if that's what O'Rourke means by saying we can do better than it — if he's referring to what level of coverage Medicare actually has, well, he's right.

A recent Tweet led me to one other update that needs to be italicized.

If you're citing "Medicare for all" as your national health insurance model, you need to note that MediCAID covers many things Medicare does not. But, from Bernie Sanders on down, classism in the US means that we can't talk about "Medicaid for all" because that would invoke poor people.

Back to the heart of things. In my original post about Beto's visit to Northeast Texas, I noted that he was some degree of squish on single-payer national health care, but less than Wendy Davis in her gov run four years ago on other issues.

As for him being a squish of some sort on single-payer? Well, if it is truly universal, in that everybody in the country, no ifs, ands or buts, has coverage, that's the rock-bottom starting point. A lot of the other developed counties that have national health care have co-pays, after all, and some people bashing Beto-Bob on this may not be aware of that. No, it's not ideal, and it's not close to gov candidate Tom Wakely's idea of a Texas NHS. But, if it is universal coverage, that's the baseline.

Per Wiki, many of those other countries have what is called two-tier care. Part of that second tier, with Denmark France and Germany countries mentioned by name, is for private insurance to cover the cost of copays. And, yes, that's deliberately boldfaced. Many countries with national health care use a two-tier system like that. Government insurance covers all basic medical and surgical needs. You buy private care for elective and experimental surgery and other things.

People need to look at the details of how universal health care works in these other developed countries, and is funded, in general. If you're poor, copays, etc., are usually paid by the government, kind of like Medicaid. But, if you're middle-class, in most the developed world? No, you need to have your own wallet open. Not a lot, maybe. But you need to have your own wallet open.

As for the amount of copays? Brains says Norway's is just $219 per person. That said, Norway has the highest overall cost of health care per person outside the US, and that's with a sovereign wealth fund and oil money.

Germany has an insurer-based universal health care system. Payment for the insurance works similar to here. It has much smaller copays than here, but it does have some. More details here. And, the German system isn't perfect; read here.

In countries like it and Switzerland, then, you're paying part of your health care premiums directly, rather than through a tax-based system. If you're in a low-income job, let alone unemployed, the government helps with this. But, if you're middle class? You're paying.

I went into this in some detail when I called out the groupies of Actual Flatticus and his toady, ShirtLost DumbShit Zack Haller, for being sketch on the details themselves.

As for people bashing Beto-Bob for wanting national health care to be useable at for-profit hospitals? You folks are either ignorant or willfully obtuse if you think nonprofit hospitals are significantly different from for-profits, because they ain't.

Thirty seconds of Googling found me not one but two Pro Publica pieces with in-depth coverage of major ethical wrongs of nonprofit hospitals. And I can certainly find more. And, it looks like I may feel the need to do that, and do a separate piece.

If you want a true British NHS, as I do, fine. But stop falsely claiming that, within the current hospital system, nonprofits hospitals are somehow enlightened versus for-profit ones. For that matter, per Wiki, a few extra quid and bob will get you extra service even in an NHS hospital.

The NFL of concussion likes and Kaepernick hating is a nonprofit, for doorknob's sake.

Besides that, you know who else runs nonprofit hospitals? The no-abortion, no birth control Catholic Church.

Another issue is that "no copays" people may not be talking about cost controls. I sure don't want a no-copays national health care that still costs more than twice as much to treat a person as other developed nations. I have said that MANY times.

I think, other than reimportation of meds from Canada, few Dems and not that many Greens have tackled this issue. I've said I want at least a partial National Health Service, similar to Britain's, as part of the cost control side.

No, Beto-Bob hasn't mentioned that. But, as far as I know, neither has Sema Hernandez. Tom Wakely, for governor, has, in spades.

So, is Sema Hernandez' stance overall better than Beto-Bob's? Yes. Is it perfect? No. (And, I'll fess up that not being from Houston, I've not met her.)

And, if Brains is going to throw skepticism elbows at me? I've already commented to you 12 months or so ago on a bunch of stuff related to Jill Stein's recount. And, if you're going to go by his actual first name, you can call him Robert? Or "Robert Francis," per earlier cracking wise by me that he's a "Kennedy brother by an El Paso father."

And, I'll later tackle the issue of possibly undervoting this race in the general election.


Oh, while I'm here — Beto adopted, or was given, the nickname pre-adulthood. And, I'm sure he's not the only Anglo named Robert in a Hispanic-heavy area to take, or be given, the nickname.

So, "some people" who want to play with this? Just as on the for-profit vs nonprofit hospitals, and on the universal service? I think we're in "gotcha" territory.

Also, Brains knows what I put in italics, specifically because he sold Medicare supplement insurance. If Medicare copays weren't that high, he wouldn't have been selling such things.


PDiddie said...

You got too many fucking strawmen in this post for me to bother with. What I think -- and what you think, or have Googled up -- isn't what Bob thinks. Nobody knows what Bob thinks yet.

Non-profit hospitals are about 60% of the nation's total. They are more popular in urban areas where more people have insurance. The quality of care is about the same at both (industry studies), but for-profits tend to make more money. (See if you can Google up how this happens.) The only downside IMO is that for-profits pay about $12 billion in income and property taxes annually.

I've been a healthcare insurance professional since 2002. I believe my base of knowledge exceeds yours in this area.

Again, you're not entirely wrong about everything. But you appear to know only that which you can Google. And that ain't enough.

But you should stop focusing on me and start focusing on O'Rourke. See if you can get a straight answer out of him on what HE thinks. My guess is you're capable of coming to the same conclusion I did: that he's a fraud.

Gadfly said...

I don't claim to know everything, or close to it, about U.S. health care coverage, or abroad.

I do know that a lot of Americans think that "national health care" in other developed countries, on both payment and coverage, is the same from country to country. And it's not.

I do know that "some people" are demonizing O'Rourke for wanting whatever version of universal health care we get to pay out to for-profit as well as nonprofit hospitals. And you've retweeted that. Yes, RTs don't necessarily indicate agreements, but I took the particular RT as indicating you did.

If you want to expressly disavow demonizing O'Rourke over that issue, that's fine. The comment box is still here.

And, yes, I've said I want government-owned NHS type system, at least in part. But, that's different from privately owned for-profit OR nonprofit hospitals, so, that's not a "gotcha" against me.


And, as far as the undervote issue in the general? If I read correctly, I think DBC also tilts more my way than yours.

Gadfly said...

Well, to be precise, right now, David leans more my way than yours on undervoting, though he says it's still possible you could talk him out of it.