I'd like to talk about healthcare. That's sort of like pregnancy, right? And by the way, obligatory disclaimer: I am not pregnant. I just refuse to relinquish my URL.
As an American who has lived abroad for almost 7 years now, I've been basking in some awesome socialised healthcare for awhile now. I am for it. I think it works, and I think it works really well. I think horror stories about waiting are anecdotal and isolated (I actually waited longer to see a doctor in the US, and I was well insured), and socialised healthcare is just something a civilised society should have. Moreover, if you're really so worried about waiting, there are parallel private systems in most countries with socialised healthcare, which are very affordable compared to American healthcare. Many of my European/from-anywhere-else-in-the-world friends don't get it - they don't understand how the US healthcare system works, why it's not more like healthcare in most of the rest of the first world, and what's so horrible about it. The why I don't so much understand, but the how and the horrible...Let me splain.
First, the US is not going to have a socialised system, well, maybe ever. For some reason I don't understand (probably because I'm a liberal and I haven't actually lived there for 7 years), people are terrified of socialised healthcare in the US. One lawmaker recently called even our measly reforms inching towards a more socialist style system "the worst thing to happen in American history," - not oh, slavery? Japanese Internment? I think even the cancellation of Arrested Development has a leg up here.
The way it works in the US is that healthcare costs are usually covered by insurance companies. You pay them, usually monthly, and then when you get sick, they pay for your care (ideally). You can purchase insurance on your own, but this is relatively rare and really expensive - usually it comes with your job. This is why a lot of Americans are insured and have access to great healthcare. If you have a very low income, are elderly, or are part of a certain group (like a child), you may be eligible for the closest thing we have to socialised care: Medicare or Medicaid. But, if you're suddenly unemployed or don't have a full-time gig which provides insurance, you're out of luck. Not much has changed with the new reforms, but they should make purchasing insurance on your own more affordable, and get rid of some of the more nefarious aspects of the system. I'll just detail what's so atrociously horrible about the way the US did it until very recently, and what's still very problematic even with the recent reform of US healthcare, known as the Affordable Care Act (ACA).
People are pissed about the ACA, important people like Suzanne Somers. She thinks it's socialised medicine, because she literally has no idea what that actually is. There are oh so many problems with the whole concept of this op-ed's existence, not to mention the op-ed itself, but her point is that she's pissed because it's socialised and LENIN! Churchill!(??)!!! I wish, but it's not. The US system is something else entirely.
Take someone who has a more specific reason to be pissed about the ACA, beyond just being a bloviating retired actress. This woman is upset because her premiums are getting a lot higher as a result of the ACA. Premiums are the price you pay per month to an insurance company for them to pay your hospital or doctor's bills in the event that you get sick. These premiums are often paid by your employer, but if you pay them outright, they are hundreds of dollars per month. She likes her insurance plan now, wants to keep it, and doesn't understand why she has to get a new, more expensive plan. The reason is because her current plan doesn't conform the standards in the ACA, likely the standards that prevent them from refusing treatment for things like pre-existing conditions. I'm going to guess she wouldn't be such a staunch defender of this plan if she got seriously sick and they refused to pay for her care because they found out she didn't disclose a yeast infection from her carefree youth.
This would have been not only perfectly legal before the ACA, but common practice. It happened frequently because this was a great way for insurance companies to save, and therefore make, money: collect premiums like clockwork, and then when an expensive set of procedures comes along do your best to dig up a reason to not pay out. Oh, and don't even bother insuring people who may be sick to begin with. So, the rise in the cost of the plan is because the insurance company now knows they don't have this great money saving option. They are now anticipating costs they could realistically sidestep before, but they still have profit margins to protect. This is also why insurance companies were not so interested in the reform in the first place.
And let's really look at this for a second: what was happening in the "pre-existing condition" situation (that the ACA has thankfully addressed)? The healthcare system was gambling on people's wellbeing - and still does, to a certain extent. Before the pre-existing condition reforms of the ACA, they would lose such a bet, and often try to wriggle out of it anyway. Someone who had been sick before was more likely to get sick again, and therefore was just a bad bet to even make. Hopefully, this will no longer be as much of a problem. But the basics of how the system works remain, and in my opinion, are just plain awful.
The core of the problem is a mismatched set of motives between a sick person, and the profit motives of private hospitals or healthcare providers and insurance companies. In the US, when you are sick or injured, you go to your doctor or a hospital. Your immediate concern is, e.g., no longer vomitting, no longer bleeding, maybe something as simple as no longer feeling tired. Toward this goal, you do what your doctor tells you.
The problem is, in the US system, you and your direct healthcare provider may only have overlapping goals to a certain extent. Your single overarching goal is to get better. It's possible, if you're dealing with a particularly good doctor or nurse, that this is also their only goal. However, it's likely that they have a parallel goal of making as much money as is realistically possible, which involves charging you for as many procedures or goods as is possible. And you're going to be a great customer, because your health is on the line, and what do you know? You're not a doctor. But in the US system, this is not just a doctor's visit about someone who is sick, it's a transaction.
As an anecdote, a bad stomach bug my husband had was met in the US with about an hour long ER wait, blood tests, a stool sample test, consultations with tons of different staff members (who often had to be reminded of the problem) and a private room with a flat screen TV for a few hours while they ran the tests. In the UK, this would be a wait in the A&E (ER) of maybe an hour (though we never waited that long), followed by a 10-15 minute discussion with a single doctor about your symptoms, after which they would prescribe the same medicine that took a private room and a few hundred dollars worth of tests in the US.
I want to be clear that I don't mean to demean individual healthcare workers in the US; they are not cynical money-grubbing assholes. They are individuals who's livelihood should depend only on them performing well in the task of making people better - but actually, it also depends, sometimes crucially, on also bringing as much money into a hospital as possible. In an excellent story out in Time earlier this year, Steven Brill goes into this in detail for a particular hospital, exposing pressure from a corporate board for doctors to encourage certain types of procedures regardless of the medical need of patients. And doctors and nurses who outright refused in this case, were fired. It's not a stretch to assume that those who complied with gusto were rewarded, or at the very least got to keep their jobs. These are not bad people - but the system they're operating in often continually, and not always subtly, reminds them of the profit motive driving it.
So we have mismatch between goals of a patient and a healthcare provider, which is not ideal. This may not be the worst part of the problem; it's a mismatch that can have parallels in socialised systems, where providers are not only concerned with treating patients, but sometimes too concerned with keeping costs down (however, outcomes in such systems would indicate this is not actually a problem). Where the most problematic mismatch comes, I think, is between the profit motives of healthcare providers and insurance companies. Healthcare providers want to make as much money as possible off of an individual patient - but insurers want to pay out as little money as possible for each patient. Because insurers have thousands if not millions of patients, they can bargain with hospitals. They can negotiate the price of a particular "health product" because a hospital would rather receive at least some payment from the insurer for thousands of patients than risk losing the business of the insurer (and their thousands of patients) entirely.
However, an individual, walking into a hospital uninsured, receives the same treatment, but when it comes to billing, has absolutely no leverage. Brill's piece focuses on hospital "charge masters" - essentially their price list. His major point is that this list is completely disconnected from reality - meaning that our "market driven" healthcare is not even a real market. They have aspirin that's something like $2.50 per pill (take two! That'll be $5) - keeping in mind you can buy hundreds of pills of aspirin online or even at a pharmacy for less. You an imagine how this scales up for procedures like surgeries or scans. For the insurance companies, this price "wish list" is meaningless - they just shoot back with a lower price they're willing to pay. But for an uninsured individual? I hope that was the best aspirin you've ever had. Such a charge master model can actually keep costs down - if it's regulated. In Japan, for example, healthcare is not quite socialised (people are insured by companies like in the US), but the government fixes the rate of procedures to avoid this sort of problem.
The only way to avoid this within the system, as an uninsured or underinsured individual who might actually have to see/pay the bill direct from the charge master, would be to try and figure out when you can safely refuse treatment from your doctor. This conflicts directly with a patient's single overarching goal to no longer be sick, and to do so as soon as possible. Now patients have to simultaneously deal with the notion and anxiety of the cost of being better. Do I need this aspirin immediately (heart attack!) or can I wait until I can get home or run to a pharmacy later?
This may seem trivial for an aspirin, but is actually more important for something like a scan. A $2.50 aspirin may be annoying, but you can probably shell out for it if necessary. But a $5000 scan? How do you figure out if that is strictly necessary or if it's possible for them to effectively treat you without it? Is being $5000 in debt better or worse than knowing for sure you have a kidney stone? As an individual prior to actually being billed, the fact is you may even have a difficult job getting your doctor to tell you how much e.g., a scan, would cost. While you're supposed to be the valued "customer", this is often information that isn't even readily available. The notion of this is ridiculous - you are not a doctor, and shouldn't have to speculate about what procedures you really "want", because this is not a "marketplace" driven by the sort of consumer desire at work in the toy aisle at WalMart. Someone might be in pain, or dying.
The response to this from people who don't like the ACA is usually something along the lines of "Well, why do I have to subsidise someone else who's sick and can't afford their own care or insurance?" The first answer to this is that because if we don't take care of the sick who can't take care of themselves, they die. So that's the alternative, and we don't really approve of letting someone die of e.g., a treatable cancer, because they only make $30k a year working two part-time jobs. This often falls on deaf ears.
The second answer, and more pertinent one, is that we already do subsidise the sick who can't afford care, we're just doing it in an amazingly roundabout, super expensive way through ERs and hospitals rather than preventative care. People who have a nasty stomach bug in the ER still get treated, they just can't pay for it - but in the end, someone does (my husband had travel insurance, by the way). The prices of other "customers" rise. We spend almost 15% of our GDP on healthcare in the US. Countries like the UK where everyone is covered spend something like 8%. The ACA will hopefully bring our % of GDP expenditures down in the long run, but if they were really interested in keeping monthly costs down, the way to do this is a single payer system, i.e., Dr. Lenin and Friends Socialised Healthcare Funhouse (sign me up, by the way!). Opponents of the ACA usually think socialist healthcare is some sort of hellscape because of one story they read - but for every horror story of "I had to wait!" from a a socialist system, there were hundreds of thousands of Americans who before ACA had no realistic access to any healthcare at all. In other words, they could just go ahead and wait until they died.
So does it mean more money out of pocket in the immediate future for some people? Yeah, it does - but they also have the option of paying a tax instead of insuring themselves. Because the other way is not only financially unsustainable, but resulted in actual physical harm to those who couldn't get covered. Everyone who hates the ACA so much has yet to present any sort of viable alternative - unless they're dirty liberals like myself suggesting a single payer, socialist system - but by and large, it's a safe assumption that anyone who doesn't like ACA probably won't like an actual socialist system.
So that's how it is. Now go kiss your local socialist healthcare provider.
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