MEDICAL CARE SHOULD BE FREE
Access to good quality, compassionate medical care is a basic need, and a right (for all beings as far as I am concerned). And yet, medical care costs money. A lot of money. It is expensive!
Why do we have governments? To take care of the best interests of all the people and the ecosystems upon which we live. Education and medical care are two of the most important pillars of society directly impacting the ability of people to thrive. We all pay taxes (well, most of us) which are meant to be used by our governments to help care for us. The federal income tax rates in the US are 10-35% depending on the income. State income taxes are variable, 0-13.3%. About half of the federal budget (spending money) comes from taxes. In the federal budget, approximately one quarter goes to healthcare between Medicare (subsidises healthcare for 65+ year olds) and Medicaid (healthcare for low income folks).
Federal spending
Mandatory spending includes a variety of programs and subsidies including for housing, food stamps, unemployment benefits, and a variety of other important categories including the Affordable Care Act (makes health insurance more affordable, expands Medicaid).
Department spending includes Department of Health and Human Services, the Department of Education, the Department of Transportation, and the Department of Housing and Urban Development
The US already spends a lot of money on health care, both total and per capita. In fact, per capita spending is higher than any other “wealthy” country. And, approximately 9% of the US population is not even covered by any type of health care. More here. And yet the US medical system does not have the best outcomes and care, overall. The US has lower life expectancy and higher infant mortality rates.
So why do we in the US pay more, have so many people not covered, and have worse health overall? To answer that, let’s dive into the US healthcare system, the costs of medical care, and the politics (yes, I am going there).
HEALTHCARE SYSTEMS
It is in the peoples’ best interest to have medical care paid for using their taxes, so that all people are covered, irrespective of their income or employment status. There are five different models for healthcare systems in different countries:
Single-payer (paid for by one public body; universal healthcare)- 32 countries including Australia, UK
Universal public insurance (paid for by employer or for the registered unemployed)- 29 countries including Singapore, Japan
Universal public-private insurance (the government covers those who are ineligible for private)- 8 countries including Austria, Mexico
Universal private health insurance- 5 countries including Germany, Switzerland
Non-universal insurance- 16 countries including US, Yemen
The US is the only so-called developed country to have non-universal insurance. Despite being the richest country in the world, in order to be guaranteed care if you become ill, you must have health insurance. If you are lucky to have a job, and lucky/privileged enough that your employer pays towards your health insurance, you may only need to pay a small amount each month e.g., $60 a month. But if not, you may need to be paying much more: potentially thousands of dollars per month. And most health insurance will only partially cover costs (insert “co-pay”, “deductibles”). There are MANY competing health insurance companies (about 6000 of them!!!). Insurance companies exist to make money. They have no care for the welfare of the folks they insure, and in fact the more people see a doctor, the more money they make. That sounds like a great system to me -_-
The Health Insurance Industrial Complex is a behemoth, and it is purposefully difficult to navigate through all the different terms, costs, and reams of paperwork. Medical costs are higher in the US than in other countries. There are a few reasons for this, including the higher cost of drugs, US doctors run more tests, there are more sophisticated and expensive tests available, and there are overall higher wages for medical staff. Administrative costs and various other charges inflate medical bills, by 3 to 25%. Did you know that you can negotiate your medical bills, like buying a used car? And you can pay less if you pay cash?
Medical bankruptcy happens in the US, and is the main cause of bankruptcy (~66% of bankrupt folks): around 530,000 people a year. For those not in the US, medical bankruptcy can occur if you have an accident or become ill and your medical costs are so much that you cannot pay those bills, and you must declare bankruptcy and literally lose everything. This system is the reason many people avoid or do not go to the doctor unless they absolutely have to. Especially for undocumented folks, or folks of colour, the Medical Industrial Complex is a dangerous place. And here I want to mention another extremely important fact: medical racism is very real, and extremely dangerous. Fore example, maternal mortality rates are 3-4 times higher in black women than white women.
The system is very broken.
WHY DOES MEDICAL CARE COST SO MUCH
Medical care costs money. When I was a general practice veterinarian, I could buy medical items at cost-price from the supplier. Yes, that was a cheaper way to buy for sure, but I also got to see the actual price of things. Drugs are highly variable in price. Enfolded into the cost of a drug comes the whole drug development process which is lengthy (about 10 years to develop a new drug currently) and costly (millions of dollars). A drug’s cost will depend on the type of drug, whether or not it is on patent or the company has a monopoly, and of course the desired profit margin. Don’t forget that pharmaceutical companies are allowed to advertise drugs in the US just like the latest cereal or cleaning product. In the US, there is no government regulation on medicine costs, so pharmaceutical companies can charge whatever they want. And there’s no government subsidising of prices- they rely on your insurance to cover it (if you have it!). So this is all why an Albuterol asthma inhaler costs $65 in the US and $7 in Australia (this I know).
It’s not only drugs that are expensive, but equipment is too. Especially sophisticated equipment like MRIs and blood analysers are tens of thousands to hundreds of thousands of dollars. They may be bought outright or leased. And all these development and distribution companies want to make a profit, and often a hefty one.
Medical expertise is also expensive. A GP doctor takes around 10 years to complete their tertiary education and training, and the cost of that training in the US is around $200,000. Not only is that a lot of money to be paid in loans or otherwise (and loans accrue interest!), but there is also the opportunity cost of not earning money during that time, and also not investing or saving for retirement. So your GP doctor who earns $150,000+ a year makes a good amount of money, but there’s also those factors to consider. On the other side, nurse training takes ~4 years and costs around $40,000, with also the same opportunity costs. And they only earn around $65,000. Nurses are grossly underpaid for the work they do.
So drugs are expensive, equipment is expensive, expertise is expensive. The medical system in the US also runs a lot more tests than anywhere else. Why is that? Some of that is the training they receive that teaches them to try not to miss anything, so a comprehensive panel of various testing is more likely to find things. But also they run all these tests to cover themselves because of the fear of malpractice lawsuits. This is another factor that differs in the US from other countries. Around 17,000 malpractice cases are filed in the US each year. 75-100% of doctors will have a malpractice claim filed against them in their careers- yes, it’s virtually inevitable. Doctors are humans too, and this takes immense emotional, and potentially professional and financial toll.
WHY IS MEDICAL CARE FOR ALL NOT FREE IN THE US
This is the trillion-dollar (literally) question. I wanted to trace back the history.
The colonisation of the US by Britain started in 1620 with the Puritans (strict Protestants who left Britain because they wanted greater religious rigor and ability to make their own decisions). At that time medical practice in Britain was shifting to a more scientific way rather than based on superstition: the Scientific Revolution was afoot. Before the invasion by the British, the original peoples of so-called America had their health care based on their medicine systems and many generations of oral wisdom. This knowledge was greatly suppressed or obliterated through colonisation, wars (mass murder/genocide), and the Church Industrial Complex including through coercion into missions including here in what is now called California.
The origins of the Western medical system in America started with the founding of the first medical society in 1735, and the first medical school at the College of Philadelphia in 1765. There began a shift to a more sophisticated medical practice, more prestige, and higher medical prices in 1920s. The first inklings of health insurance started in the US in 1929. The reason this model was established was to give hospitals a steady income stream when revenues were decreasing through the Depression. Yep, it was about making money (and, you need to be able to keep the lights on). And it just snowballed from there to its current bloated state. Read more on history here.
SO WHY IS HEALTHCARE FOR ALL A POLITICALLY-POLARISED ISSUE
Everyone is likely to need some kind of medical care at some point in their lives, no matter their political beliefs. Healthcare for all (often thought of as “Medicare-for-all”) is currently seen as a progressive Democrat policy in the US. Some of this polarisation is likely a result of the influence of powerful lobby groups from pharma and insurance companies. These lobbyists have spent the most money out of all the lobbyist groups in the last 20+ years. They have spent BILLIONS of dollars to influence government to make decisions in their favour, in favour of greater profits.
A poll in April 2020 found that 69% of voters supported Medicare for All, and only 18% were in opposition. That’s folks with both left and right politics. That poll was during the early days of the pandemic, and the pandemic has really helped people see how important healthcare (disease care) really is. The time is ripe for change.
What is the opposition to health care access for all people? Some of it could be in the current name re: Senator Bernie Sanders as Medicare for All. The current Medicare system as it stands has problems (like anything really), so it would need to be clear what a new Healthcare system actually looked like- probably not literally just expanding the current Medicare system. A classical single-payer system may not actually be appropriate for the US: a hybrid system could be better. And of course, any new system would mean a significant overhaul of the current system, which takes a lot of time and of course money. With the presidential term of 4 years, it might not even get implemented before a change of government could trash it, especially if the US flip-flops between Democrat and Republican administrations.
The little meme that could. Photo credit: AA
There is a concern that with healthcare for all, the quality of care would decrease, and wait times increase. Certainly wait times could be longer, as is the case in Canada, UK, Australia. I am not sure about the quality of care though. Perhaps some of the doctors and specialist centres accustomed to being paid extremely well by insurance companies may be attracted elsewhere in the world? I doubt it, honestly, and couldn’t find more to support those arguments. Please comment below if you know more. I did read that some conservative folks were concerned it wasn’t fair if everyone had the same access to healthcare. This speaks to elitism and privilege.
There was also concern raised that a healthcare for all system could take decisions out of doctors’ hands into the hands of the folks running the system. I think there could be some truth in this- there could be guidelines for care within more modest means than currently practiced e.g., maybe there is a framework preventing a huge battery of tests to be run for a standard broken arm. This way of practice is at odds with the current way of doing things in many practices in the US. Especially during the transition time, there would need to be an oversight group of doctors ensuring that there is no red tape preventing doctors from making robust, fair, necessary medical decisions based on their expertise. That’s absolutely critical. And also to make sure that this new system would not increase malpractice claims. Lots of work to do.
There is also the concern that healthcare for all will increase government spending and debt, which of course it would do unless government spending was also massively overhauled in other areas. Yes, absolutely, taxes would also need to be raised (likely another reason for Republican opposition). In Sweden, the top personal income tax rate is 57%, but most Swedish people understand that their taxes go to the betterment of their country, including their single-payer healthcare system (healthcare for all). It’s a completely different perspective.
And of course, the last point of why there is opposition to a healthcare system for all, is that likely the 6000+ private health insurance companies in the US would fold. And the lobbyists might have less to do (but I am sure they will pivot). What is the government for again?
CONCLUSION
Our taxes should pay for education and medical care for all people in the so-called United States of America. Your income, employment status, or visa status, should not dictate whether or not you have access to this basic human right. A person living in the US should not have to cross the border to Canada or Mexico to buy their medicine. No person should ever lose everything they own to pay for medical bills. It is time for Healthcare for all (but not necessarily “Medicare for all”): change my mind.