I was wrong.
I think Senator Cruz is wrong.
I feel ashamed that it took me so long to figure it out. And I hope for all of our sakes, Cruz and co. figure it out before he embarrasses himself and his country any more. Reading green eggs and ham to no one over a microphone just shows me that he's so blind, that he'll never see the solution when it does present itself. He might as well have plugged his ears, covered his eyes and sung at the top of his lungs. I was ashamed of him.
I don't claim to have any real answers, but I used to. I used to look at universal healthcare as the ultimate terrible idea. In fact, mk and I raised voices over thai food about the subject. I was yelling about things like smokers elevating the cost of healthcare. I was yelling about obese people and dumb people and every other group I could think of to blame. I was yelling. I was frustrated.
And I was wrong.
That discussion happened about 4 years ago. A lot has changed for me. I now regularly deal with a lot of poor people. I watch them make tragically poor choices again and again that end up costing the taxpayers a lot of money. I watch food stamp abuse. I see housing subsidies abused. I see emergency room visits for addicts who need a fix of something to keep the withdrawals at bay.
Meanwhile, I work a 9-5 job and make a good living - not enough to have new cars and the latest iPad, but it's enough to live in relative safety and security. Knowing that I work so hard and pay for others' poor choices is a really hard pill to swallow. The old me used to think "I work hard and they don't, so I deserve something for all of my work". The new me realizes there's a lot more nuance to the story. There's a lot more to people's stories. There's a lot more room for compassion and understanding.
This morning on NPR I listened to sound bytes of Presidents Obama and Clinton discussing the healthcare exchanges and how little they will cost for many Americans. I heard things like "less than your cell phone bill" for a woman in her late 20's. I heard about families in Texas earning less than 50k would be eligible for decent coverage (silver level) for about $100.
I've thought of my conversation with mk a lot over the last several years and regretted it. I've known I was wrong at some level, but hearing the new this morning cemented in my mind that I was really, really, wrong.
Together, my employer and I pay $1478 per month for my healthcare coverage. Yah. That's group medical. That's $17,736 per year. And I still get to pay for copays and deductibles, etc. And here's the sad part: I have it good. So many people have no coverage or far worse coverage. Some of you reading this might want to punch me in the throat for complaining.
Our healthcare system is so far broken - who was I to claim this kind of universal healthcare wouldn't work? The time for using political tricks, time wasters, and cheap shots is over. The current system is so far past rescue - it's time for a fresh start. It's time to build a sensible system from the ground up. It's time for a reboot.
I don't understand all of the details of it, but let's give the Affordable Care Act a chance. I doubt anyone knows exactly how the law will play out, but at this point it's worth a shot. All of this partisan nonsense makes me wish the the law went further. It makes me wish we all had the same opportunity. Let's learn some lessons from some of our neighbors (Canada, UK, Norway, etc.) and make an even better system.
I was wrong. Let's start making it right.
Damn, this was nice to read. It takes fucking courage to admit when you're wrong about something. And you explained your thought processes quite well too. At the end of the day it's about caring for the system and making sure everyone in the system has comfort, security, health, and their basic needs met. If you argue anecdotally from an individualistic perspective you are bound to put one imagined groups interests (i..e, your own) over everyone else's.
I don't want to dive into politics, but it's worth keeping in mind that politicians are not incarnations of public interest. They are human beings with their own interests-- namely, persuading people to vote for them in the interest of keeping their jobs. This means that they will say, endorse and do things that might be good for them on a political timescale, but not necessarily good for the public, especially since changes in society and economic systems take a longer time to manifest. Basically, a healthier nation means a nation more able to work, which means more goods and services, which means greater wealth creation and therefore a higher standard of living. This shit is complicated, which is why we elect people to make decisions on things we are not experts in. Unfortunately, politicians are often not experts in all the things they have to make decisions on either and we can't reasonably expect them to be as expertise takes a long time to develop. Hopefully, we will be able to someday create a system that allows the public and economic interests to be served over the interests of individuals while maintaining our economic strength.
Hang on though, it's not as if there aren't problems with state provided health care in other countries (I know that's not what you were saying, but I think it's important to make this distinction). One advantage the U.S. has is that people can go to any doctor that they want to, provided that they have the money. Another advantage is that people think about whether or not they really need to go to the doctor and so doctors and hospitals are not inundated with people who are there for minor reasons that may or may likely clear up on their own. All I'm saying is that one is not necessarily better than the other, simply by virtue of one being what the other is not. Ideally, healthcare should allow people who need to see a doctor to go to one, while still providing doctors with the incentives to give quality care and without clogging up the system because healthcare is suddenly "free". The American system might work or at least work a lot better if costs weren't so insanely and artificially high. That's more of an issue with approved medical suppliers and drug companies, as I understand it. Drug companies need incentives to research a develop new drugs, so that's definitely a part of the problem that wouldn't be solved by free healthcare.
For state-covered, non-life-threatening treatments we can go to any doctor we want, but we might have to wait some time for the specialist we want. If you need urgent care in emergency at a hospital you get the best, for free, immediately, at least in Toronto. You do not get billed. Even brain surgery. Best care, several opinions, no bill. Are there problems? of course. Can we continue with an ageing population? Who knows. Maybe theadvancedapes or sounds_sound can chime in about his experience in Canada - although he's a healthy guy (or so it seems).One advantage the U.S. has is that people can go to any doctor that they want to, provided that they have the money.
There's a lot of misinformation being spread about the Canadian health care system. Canadians can go to any doctor they want. If they have money, they can join a for-profit Cleveland Clinic or one of their competitors.
The more I read your posts the more I agree with you about everything fellow Canadian. I absolutely hate it about how Canada is always brought up as an example about how bad a healthcare system can be. They say people are dying waiting in line for healthcare left right and center. There was a guy who died after a long wait in the emergency room like 6 years and people are still freaking out about it here in Winnipeg. And his was more caused by discrimination against him being homeless and native. Yeah we complain about certain parts in our politics, but we are just trying to make it even better. But our healthcare is streets ahead of the american system even with Obamacare.
Sure, but there are countries where this isn't the case. At the moment, in the U.S., part of the problem is that emergency rooms have to administer urgent care, whether or not someone can pay for it. This is why there are so many homeless admitted as John/Jane Doe. This is of course a problem for hospitals, but it's terrible for people being admitted as J. Doe because of course, the hospitals will not have access to their medical records. It must be harrowing enough to try to save someone's life, but to do so without even the possibility of access to a medical history must be much worse for the doctors. Anyway, the U.S. attracts high quality doctors and nurses of all kinds from all over the world in part because of the pay incentives. However the new system emerges, I hope that the quality of the medical professionals will stay the same or increase but for that to happen, there needs to be good incentives in place to attract them to the States to practice medicine. The issue of the age bubble needs to be taken into serious consideration and I hope that segment of the population will be well served by Obamacare without causing any other segment of the population to lack for anything.There's a lot of misinformation being spread about the Canadian health care system. Canadians can go to any doctor they want. If they have money, they can join a for-profit Cleveland Clinic or one of their competitors.
The US absolutely needs a state-run alternative to healthcare. The costs are a huge part of what's wrong in the US, and layers of administration and insurance companies contribute to that greatly. But it's not even the cost which is most horrific. Healthcare has become capitalism run amok in the US. Insurance companies, (thankfully not after 2014) could deny coverage to anyone based on pre-existing conditions, which estimates say could be from 20-50% of adults. So 20-50% of adults aren't even eligible for US healthcare or have to jump through hoops and hope for the best to get it. Pretty much the only option is to be on a grandfathered plan. That's absolutely ludicrous. It's one of the most ludicrous things that we as a society accept. The idea that US healthcare is not-so-bad relies on an idealistic view of the US system, i.e. where everyone actually has it and can afford it. But still ~15% of Americans go without it, with the brunt of them being the poor. It creates problems where hospitals will try to turn down patients without healthcare because the costs without it are insurmountable. It's absolutely not acceptable in a developed society. All the advantages of US healthcare would be well worth trading-in completely to fix its flaws. Let those things be luxuries if they have to be.
I'm not saying that "US healthcare is not-so-bad." Clearly the policies in place have allowed businesses to take advantage of the system much to the detriment of the citizens, believe me, I know first hand and at the moment I am definitely at the lowest end of income spectrum and I don't have healthcare. "Trading-in completely" without figuring out how that system will operate and what the possible repercussions would be in a variety of scenarios could result in a system that fails just as utterly as the one we have now. I have the luxury of being relatively young and healthy, so from where I sit, I would rather a well-thought out and conceived state-run healthcare be put into place in a manner that will ensure its success, even if it isn't put into place overnight. The transition period will likely be messy and leave a lot of people with a sour taste in their mouth, but hopefully if the new system is well-crafted, those kinks will be able to be resolved quickly.
|One advantage the U.S. has is that people can go to any doctor that they want to, provided that they have the money In the UK we currently have a mix and match system of medical care. You can use the NHS for anything you want to and supplement it with Private medical care to get what you want and then jump back to NHS lines. So whilst I agree that this is an advantage, you can get both benefits and neither issue that way. I think a mix of Private-Public healthcare is the best approach to any system; it allows freedom from being locked into certain medical treatments and it doesn't bankrupt you from medical bills. You're bang on about people going to the doctor about nothing though, I spent a day with a Nurse in a local surgery for experience and quite a few of the cases were people complaining about nothing at all. Lot of genuine cases too though, I'd rather that risk than someone losing out on healthcare. When I was in the US with my family we saw a minor accident and my Dad immediately went to call 911 to get an ambulance and was urged not to by everyone involved. It was so surreal from our culture that someone had a broken arm and went "I'll sort it out at home" rather than go into hospital for it. It's been weird growing up and having to decide "Is this worth an ambulance" but it'd be so much worse if I had to think "Can I afford an ambulance" on top of that.
Yeah, definitely. Where I live now, it's about $1400 for an ambulance, but in some states/cities, it's much higher. I think a mix is the right way to go too, but somehow I don't think finding the right mix for the U.S. will be so easily accomplished. It's tempting to want to change everything, but the reality is that when even one thing changes, there are a lot of things that have to adjust. I'm glad that it's an issue that the public is concerned enough about that political action is being taken, but of course this means a whole lot of talking before anything is done. In the meantime, I guess those of us within the States just have to do what we can to stay as healthy as possible until whatever the new reality will be emerges.
Really? Let me share this story... A couple weeks ago, my mom fell ill. She thought it was a bad case of food poisoning and it would pass. For 12 hours, she was bleeding from an area, well, you should not bleed from. She called her gastroenterologist; he was on vacation. She asked to see his partner or the physicians assistant. The office said no, she could only see her physician. She called her primary care doctor. He told her to go to the ER and referred her to another specialist. She went to the ER. They took excellent care of her. She was supposed to make an appointment with the specialist in 2-3 days to go over test results. When she called to make the appointment, the doctor refused to take new patients. Meanwhile, Mom's antibiotic is running out. Because the specialist would not see her, they would not refill her medication. She had to call the ER to get a refill. After, again, fighting with the new specialist to make an appointment, she ended up with one -- a month after the initial incident. Ultimately, three weeks after going to the ER, she had to wrangle with the hospital to get her test results -- negative for infection -- sent to her primary care doctor and her own gastroenterologist. Oh, did I mention my mom has insurance? And that she pays a premium of over $600 a month? Even with money and insurance, when she really needed care without worry, she got the runaround. For all the people who say the system in Canada or the United Kingdom is a mess, guess what? There are problems here, too.One advantage the U.S. has is that people can go to any doctor that they want to, provided that they have the money.
Sorry to hear about your mother, but you're taking one line of what I wrote out of context and not really addressing the meaning of that line. Having insurance is not the same as having enough money to see any doctor available. You can bet that very wealthy people have better access to doctors and medications, not to mention priority because of their wealth. I am not saying that the U.S. system is good or that it works or that it's not that bad, I'm simply saying that the system on its own is not the entirety of the problem. Systems have advantages and disadvantages and simply switching to another one will not solve all the problems. Also, I never mentioned Canada. Not once. And yet, several replies treat my comment as if I had. I don't understand. There are more countries in the world than the U.S., the U.K. and Canada.
I don't know if Obamacare is right, but I do know that the healthcare system in this country is dead wrong. It's not just the lack of insurance but the extreme prices that the medical universe charges because of the broken insurance situation. I'm optimistically but hesitantly hoping this is a step in the right direction.
I remember the conversation, but not the raised voices. I think this conversation was before passage of the ACA. My feelings regarding healthcare haven't much changed, and I think have been strongly influenced by a father than needed a lot of it, and working in the research side of the system. I'm not sure how successful the ACA will be from the outset, but I am at least optimistic that change has come to the system. It is so very broken, and so many people have suffered needlessly. IMO there is plenty of room for the feelings behind your previous stance. Humans abuse systems, public and private. It's what they do. The good thing is that some systems are less prone to abuse by design. However, to get there, we need everyone working towards the goal of building the best system we can. It's a sad state of affairs that US politics are so divided, that both sides fight over ideological grounds rather than crafting systems influenced by them. I've made a similar journey from other places to this one, probably since we've had that conversation. I strongly believe that there is truth here. We need to communicate with each other. Ideals feel great when they are affirmed, but living like that is nonsense. The world we want is not the world that is, or the world that will be. But, if we listen to one another, we will understand why that is ok, and most importantly, we will be able to change the world into one that neither of us chose, but both of us can see as an improvement. I wouldn't say that you were wrong. I would say that you aren't worried about being right. Neither of us was right. But, the more we talk about this, the better we both can understand what is, and the more likely what will be will be an improvement. I hope this is a lesson that US politics is teaching the upcoming generation. Thanks for writing this, Steve.The old me used to think "I work hard and they don't, so I deserve something for all of my work". The new me realizes there's a lot more nuance to the story. There's a lot more to people's stories.
Great, great post. Two things -- a. Obamacare certainly has issues, but any change is for the better. Various parties have been trying to reform health care in this country for like 50 years, and I for one am just glad someone finally succeeded in making any change. b. That's such a natural thing to think; I catch myself thinking it sometimes, on bad days. It just sucks that things have to be this way, but breaking free of that way of thinking is huge. Great post.The old me used to think "I work hard and they don't, so I deserve something for all of my work".
I'm actually moving to Canada this February. I'll let you know how it is! Well. I mean, hopefully I won't have to use it. I'll also know a lot more Canadians and their actual experience with single payer (I know a lot of their politics happens over its imperfections.) But yeah, I wish obamacare went farther. I hope America learns something from the grueling process. I hope it's worth it. I hope technology can push costs down instead of up one day soon. I hope I'll be able to live forever.
Don't feel bad about not understanding all of the details. Not even top hospital execs understand the details, because many of them haven't been decided upon. It's a Rube-Goldberg machine instead of a simple pulley and lever, because that was the only way they could satisfy all of the various, competing constituencies. I agree that the system is broken, and that it needs some fixing. We shall see if this law represents a reasonable solution.
Now that you're on the other side of the fence, you can have all of the fun of debating the shortcomings of the ACA and how, within the context of government-controlled healthcare, things can be improved. It's certainly not perfect, and while the ACA does a lot to address who pays how much, it doesn't do nearly as much to directly control health care costs.
I don't live in the USA any more, so I don't follow the details of the ACA. However, it seems to be a small step in the right direction. To avoid being bogged down in details, it helps sometimes to think about what an ideal health care system would look like (ignoring costs for the moment). What I'd like is a system where any citizen can go to any health care facility and get the best care possible, at no cost to them. Now think about what's the best way to make that happen - or get as close to it as you can afford. I don't have answers but I know what I'd like to see - a society where good healthcare is one of the benefits of citizenship.
Shared experiences in the same IRL locations and time and space really, really help with empathy across socioeconomic boundaries. They are scary boundaries to traverse. Exposing privilege to oneself is painful, but as Steve is telling us ... it can be a growth experience. high fives this whole threadI now regularly deal with a lot of poor people.
It will play out by employers dropping all healthcare coverage due to skyrocketed costs and individuals having to buy from the government exchanges or face fines or prison. This was the Obama long game, they want a single payer system where the government controls everything and healthcare is no different than how they operate in Cuba. Hope and change baby!