More Tim Faust, I love this guy:Quote:
Back in the 70s and 80s there was an experiment called the Rand Health Insurance Experiment. This was back in a mythical, legendary time I wasn't alive for, before we had things like copays and coinsurance and deductibles, which are what the experiment wanted to test. What happens if you make folks pay for more of their own healthcare? I don't really make Powerpoints so I’ll spare you the charts and get into the middle of it.
Turns out, people who can already afford healthcare aren't that affected by needing to pay [a little bit] to somebody to get their healthcare. That makes sense. But people who can't afford to pay these costs don't seek care. I don't mean emergency care; if you get hit by a truck or you get cancer or whatever you're still going to go to the hospital; you're still going to go to the emergency room. No, no, I mean people who can't afford to pay for healthcare who are then forced to pay for healthcare don’t get primary care. They don't get preventative care. Because we demand they bear the burden of expensive healthcare costs they turn their bodies into ticking time bombs until they have a heart attack at their jobs. Consumer-driven healthcare only benefits the people who seek to profit from our bodies.
But there’s a happy opposite, and it's real, and it's attainable. Everyone benefits when accessing care is affordable and easy. Delivering care--being a doctor, being a nurse, comforting the afflicted, diagnosing, treating--that's all complicated. Paying for healthcare; that's really simple.
A lot of this hinges on the idea of the “universal risk pool.” That sounds kind of wonky but it's pretty simple; I'll run you through it.
A risk pool is how many people pool their resources together in order to pay for the healthcare costs of other people in the pool.
Because most people are healthy, the larger the pool, the easier it is to weather the cost of someone getting very sick or needing a lot of care, right? If one person gets, you know, needs healthcare in the given course of a year, it's a lot easier to pay for it when you've got 300 million people sharing the cost than if you've got a thousand people sharing the cost.
Insurers are examples of risk pools, but they’re small and they're fragmented. One hospitalization, one really weird accident, one premature birth, can drive costs up for everybody--which is why your premiums go up 30% year over year. The largest risk pool of all is the universal risk pool — the federal single-payer.
So let’s build it. Maybe we extend federal programs that already exist. Maybe a little thing called ‘Medicare for All’.
Because once you have a universal risk pool and a federal single-payer you can use it to do a lot of pretty cool things. Let's go through those.
One, you can drive down costs. Almost all medical costs in America are set as a function of Medicare. If Medicare has a larger, healthier risk pool, its overall per-person costs go down, right? And therefore it has the leverage to compel providers to offer fair prices for care. And as a federal entity using public funds, it’s not going to siphon fifteen percent of its revenue away as profit—like a private insurer.
Two, federal single-payer lets us disentangle employment from healthcare. That's right! What kind of job you got, or who your employer is, or whether your boss is cool or if your boss sucks should not dictate whether you are eligible to receive healthcare. It cruel that the poorest among us are coerced into remaining in unsafe or unjust working environments from fear of losing healthcare; it is crueler still that the healthcare of their children is shackled to the quality of their parents’ employer. That is not the America I demand to live in.
Three, because the federal single-payer; the federal actor bears costs of providing care--paying doctors, paying nurses, home health aides, etcetera--and bears the costs of not providing care--the hellworld where everyone gets sick and dies at the same time--it can finally be a tool for realizing actual health justice. Medicare for All is the starting point. It is not the goal.
If your population is sick and they are dying because they don’t have a place to live, then housing is healthcare, and you build housing to bring healthcare costs down.
If your population is sick because they don't have access to healthy food to eat, that doesn't cost seven bucks for a carrot or whatever, then food is healthcare, and you provide them with affordable food options to bring food costs down.
This is the actual work of health justice, and this better world can be ours!
There is solidarity in the moral community of universal healthcare. It gives my life meaning to help others, and it it is my honor and privilege to assist in the care of people around me, even if it’s just through my taxes. Those who say that, "I don't know why I should pay for someone else's pregnancy" have no moral ambition and no backbone. The evolution of American private insurance is rooted in this cruel, libertarian ideology of "individual accountability," atomized personal isolation, the consumer-driven healthcare movement. It is unconscionable, it is barbaric, and it must be exorcised from our national myth.
The stuff about Medicare for all as just the first step toward "health justice" is very compelling and addresses a lot of the naysayers who think we can't have single-payer because Americans eat too much junk food (which, again, is vigorously marketed). We can have single-payer and then not have people eat so much junk food. It's an interesting thought.
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Molly Lambert wrote:
The future holds the possibility to be great or terrible, and since it has not yet occurred it remains simultaneously both.
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