What Happened to Universal Health Care?
Surveys show that two out of three Americans support universal health care, so why don’t we have it? Maybe we should look at the German and Israeli models.
Yes, most Americans do like the idea of universal and guaranteed health care (see poll results here) but a great many don’t trust the government to run it. This, more than anything else, may explain why we don’t have what other advanced Western economies already have, or mostly have.
Republicans claim that any universal health care plan, such as Medicare for All, would be the largest government takeover of the economy in history. I don’t want to address ideological or partisan political claims, though. It will get me nowhere. But one hidden assumption underlying Republican objections is the belief that all those projected new government employees will be unionized. That belief is almost certainly correct. Union growth in private industry today is moribund; almost all the growth is in the public sector, and a nationally run health care program would hardly be an exception.
Why the contempt for unions, though? I’m a former union president (The Indianapolis Star, TNG-CWA 34070). New employees did not have to join, but more than half did, which was the critical mass. Yet I’d meet resistance from some new employees, the most challenging objection being that unions “protect bad workers.” I’d argue that we protected due process in cases of employee discipline and dismissals, but I knew they had a point. They clearly were thinking of teacher unions and other public employee unions. In the case of the former, I knew from my past reporting that it is next to impossible to fire a unionized school teacher in this country for poor performance.
Nonetheless, support for unions overall remains fairly high overall in America, even if most people don’t belong to unions. So, while hostility to unions is a factor in opposing universal health care, in cannot be the only one. (See a Gallup poll here for attitudes toward unions.)
Poor lifestyle choices
Some people just don’t want to pay for other people’s poor lifestyle choices. This is most evident from the broad support for anti-smoking campaigns. We know cigarette smoke contains carcinogens and we tax cigarettes heavily to discourage people from taking up or continuing the habit, but also to raise revenue. Lung disease, whether cancer or COPD, and other smoking-related diseases are very expensive to treat. Quitting smoking and leading a healthy lifestyle won’t cure death itself, of course, but as a gerontologist told me while doing a story on living longer, the goal is to get people to age 85 or so without suffering serious illness as 85 years is traditionally considered our natural life span (as opposed to life expectancy).
Obesity is arguably a bigger problem than smoking ever was. In some communities well over half the population is overweight or obese. Anti-fat shaming and size acceptance might be politically correct these days, but obese people will suffer more infirmities and disease, on average, than other Americans. And, we’ll all have to pay for that.
Paying the piper
There’s another likely reason we don’t have universal health care, this time influencing the health care providers as opposed to consumers. It’s the expected loss of income by those who profit from current high prices. Progressives like to pick on insurance companies, “Big Pharma,” and for-profit hospitals but that may be because they really don’t like Capitalism. I’m not against free markets, but one way or another I think we do need universal health care, and the case against our current health care system is hardly fatuous. Right now, it seems that all hospitals, including non-profits, compete with each other for customers much as auto dealers and hoteliers do – lavish entries, modern suites and amenities, and heavy, heavy advertising campaigns. They’re raking in the big bucks, though their expenses clearly are high. Lots of doctors and surgeons, too, are doing very, very well. Yet any universal health care plan is sure to involve price controls and/or will resort to abandoning fee-for-service, perhaps in favor of fixed payment on a per patient basis. While hospitals and other health care providers would rather see an insured person come through the doors than an uninsured person, it’s clear that if all rates are to be set by the government cash flow will be reduced. (In fairness, I must note that many health care professionals support universal health care even if it might cost them some income; the only question then would be how to pay for this.)
Role models?
Probably the best way to find a universal plan that might work for us is to look more closely at countries that have good ones. I’ll limit myself to Germany and Israel, but add the highly touted British system to show that, while it has many positives, it is not quite what it’s held out to be, either.
In Germany, employers and their employees pay for most of the health care system through premiums. All workers contribute about 7.5 percent of their salary into a public health insurance pool. Employers match that 7.5 percent contribution. Well-to-do people can opt out of the system, but then there are great hurdles to opting back in (this presumably is done to avoid people cheating the system by refusing to pay into it but vying for assistance if and when seriously ill). Additionally, out-of-pocket expenses are capped at around 2 percent of income. For an introduction to the German system see an NBC News article here.
Israel is another country with near-universal and mandatory health insurance, but let me make two things clear at the start: All Israeli citizens, including Palestinian Arabs who are citizens of the State of Israel, qualify for this plan. Whether clinics in smaller Arab villages are as good as those in Jewish communities is something I cannot answer, and Palestinians in the West Bank and Gaza are not part of this program.
A brief summary of the Israeli program, from a readable and accessible policy institute study: “Israel provides universal coverage to citizens and permanent residents as part of its national health insurance law. Residents choose from four competing nonprofit health plans that provide a mandated benefit package, including hospital, primary, specialty, mental health, and maternity care, as well as prescription drugs and other services. There are no deductibles, but some cost-sharing is required for specialist visits and prescription drugs. The compulsory insurance system is funded primarily through a national income tax and an income-related health tax.” See full study here.
As in the German plan (and like Social Security and Medicare in the US), Israelis pay a fixed percentage of their income toward their insurance, i.e., a flat rate tax. I emphasize this because a flat rate income tax is seen as some kind of diabolical Republican scheme to further screw poor people yet, somehow, it’s perfectly fine in these contexts.
The universal health care system best known to most Americans likely is the United Kingdom’s National Health Service. It really is “socialized medicine” and most of its funding comes from general tax revenues (not a flat rate tax), and only a small portion comes from individual National Insurance premiums. Point-of-service typically is free to the patient. Most doctors and surgeons also are employees of the government for at least part of their careers, if not all. Nonetheless, the UK really has a two-tier system as many well-to-do people carry private insurance in addition to National Insurance in order to bypass the government plan, or they simply pay the full cost out of pocket. Remarkably, they may end up seeing the same doctors or surgeons as inside the NHS, but they almost always will get their treatment faster, i.e., they move to the head of the line based on their ability to buy this extra insurance. It’s really quite antithetical to the initial idea of the “socialized” medicine there.
So, which is best?
I cannot claim that any of the models addressed above are perfect, and they’re certainly not “free.” I just think it’s shocking that some people in this country may fail to get the treatment they need because of an inability to pay or because they have inadequate insurance. I also know that medical debt for all Americans stands at over $140 billion (see report here.) But we can learn a lot from international examples, and I say that the German and Israeli models in particular are better than what we have now.
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