Unspeakable Realities Block Universal Health Coverage In The US

[Recursion]

https://www.forbes.com/sites/chrisladd/2017/03/13/unspeakable-realities-block-universal-health-coverage-in-the-us/#7d9bdbb9186a

I wish this weren't true, but I think it is.

When it seems like people are voting against their interests, I have probably failed to understand their interests. We cannot begin to understand Election 2016 until we acknowledge the power and reach of socialism for white people.

Americans with good jobs live in a socialist welfare state more generous, cushioned and expensive to the public than any in Europe. Like a European system, we pool our resources to share the burden of catastrophic expenses, but unlike European models, our approach doesn’t cover everyone.

...

No one stated their intention to create a social welfare program for white people, specifically white men, but they didn’t need to. By handing control to employers at a time when virtually every good paying job was reserved for white men the program silently accomplished that goal.

White socialism played a vital political role, as blue collar factory workers and executives all pooled their resources for mutual support and protection, binding them together culturally and politically. Higher income workers certainly benefited more, but almost all the benefits of this system from health care to pensions originally accrued to white families through their male breadwinners. Blue collar or white collar, their fates were largely united by their racial identity and employment status.

[bigbrother05]

1. This dovetails with the Right-to-Work movement in the South

Where the white male population quit viewing unions as their strength, RTW gained prominence as a way to avoid the equal pay/equal opportunity unionized ethos.

Unionized textile factories employed many women and minorities, that industry (and their unions) were decimated by globalization. The majority of union growth is now in the service sectors that are strongly representing women and minorities.

[lindysalsagal]

2. My take: In the 10's, 20's, 30's, blacks were invisible: Not really discounted, unseen.

I am not sure that the typical voter or even rep from those days was thinking, "Keep everything for us, and stiff the blacks." I think it's all functioning a step before that where blacks aren't even considered.

In other words, the thought, "Let's create a general welfare system for us" didn't originally have a side that included, "but not them."

There simply was no "them."

Now, over the decades, when we've managed to include minorities into our general awareness of "us" some have arrived at the conclusion that "let's exclude them."

I think it was not really intentional when it was created, but now, fRump's bigted voters are very clearly opposed to including "them" into anything tha benefits the white majority.

I think exclusions are a 21st century consideration, and, yes, are one reason why the right cannot legislate about healthcare, or immigration, or anything.

[former9thward]

3. Social welfare is not socialism.

But to the larger point. Employers were never "handed control" of the medical insurance system. Just the opposite. Medical insurance did not exist before WW II. When the war started FDR froze wages and prices. There was a labor shortage so employers began to offer benefits to attract workers. Benefits were exempt from the freeze. After the war insurance became a standard part of the compensation package.

Slowly as a way to avoid large wage increases the number of things covered by insurance went up and up. Of course this meant insurance became very costly and that is where we are at now. In my view medical insurance should be treated like any other insurance. It should not cover everything. Your car or homeowners insurance does not cover most expenses with those and that is why it is affordable to most people.

[KingCharlemagne]

6. In my view, healthcare should not be a for-profit enterprise. (All doctors

and R.N.s should be federal employees receiving a U.S. government paycheck and all in-patient facilities should be nationalized.)

The whole concept of "medical insurance" is a moral obscenity.

[AngryAmish]

17. So the cosmetic plastic surgery profession goes away?

That will never happen.

[angstlessk]

22. That's not covered by insurance, anyway...that is paid for by the patient...

so they are not dependent on insurance at all...needed plastic surgery would still be covered.

[Aristus]

23. That's the Beveridge model of national health.

The kind they use in the UK.

There are two major models of national health: the Beveridge model, in which hospitals, clinics, doctors, nurses and allied health workers are all government employees and draw government salaries. And the Bismarck model, instituted in Germany in the 19th Century. In this model, you have a mixure of public and private health services, but the national health insurance pays a citizen's medical bills, instead of a private health insurance company, or the patient paying out of pocket.

In both systems, private medical providers are allowed to practice, and charge whatever rates they wish for (usually) elective services like capped teeth, plastic surgery, etc. The patient can purchase additional insurance out of pocket for these services, or pay cash.

If we ever go to national health insurance, the US will more likely use the Bismarck model, since the Beveridge model is much closer to the "socialized medicine" so many people in this country are taught to fear.

[Wounded Bear]

25. IOW, the ACA is based on the Bismark model...

[KingCharlemagne]

29. Thanks! I learned something today. - nt

[Ligyron]

9. Too many concerns are trying to make money off of medicine in general.

I certainly don't begrudge doctors and medical personnel in general making all the money they can. The price of drugs, however, are ridiculous and the huge insurance industry itself is an unnecessary middle-man.

There's a lot of unneeded duplication in what is insured too - like having to have a separate policy for medical treatment associated with car accidents and work related injuries plus liability for medical treatment with your home insurance. They often get to collect premiums twice but make sure you can't collect duplicate benefits by law.

It's all health care and single payer, naturally, would eliminate much of this.

[subterranean]

27. For many people, health insurance doesn't cover everything.

Many insurance plans these days (mine included) have deductibles of thousands of dollars. They are really only useful when something major happens. So in that sense, health insurance in the U.S. is already a lot like car or homeowners insurance. I've never reached the deductible on my health insurance, when I've had it.

[Progressive dog]

4. That is far from true

In the US, we all get less care at higher prices. If our prices were in line with other developed countries, the US could provide universal care and save nearly half of our health spending.
BTW Chris Ladd was a Republican for thirty years before quitting over Trump just last year.

[exboyfil]

28. You are right

What the federal and state governments currently pay out alone would be nearly enough to cover everyone if spending per capita was at the same rate as most of the other OECD countries.

[malthaussen]

5. Arguably, most if not all societies are erected on the bodies of slaves.

You have helots in Sparta and the slaves in Athens and every other city-state. Rome had the slaves and a mass of plebians who lived on the public dole and slept in doorways. But she was also an empire who subsidized her citizens by plundering other countries. This continued to be the model into the Middle Ages, with a population of serfs who lived hand-to-mouth while the aristocrats squabbled among each other. As States rose, Empires grew which exploited other civilizations not lucky enough to have gunpowder and seagoing navigation. This model has persisted right to the present day, the US has always been an economic empire that exploited the raw materials of other areas (as well as those within the confines of the State), not least of which raw materials was the human resources.

Domestically, after slavery was legally abolished in the US, we continued to exploit an underclass of non-white residents to do everything from laundry and domestic service to picking the crops for scarcely enough to live on. This had resulted in a nice, cozy life for enough white citizens to stave off a revolt by the skilled laborers. Now, for whatever reasons, there is less fear of some working-class revolt, so the bones thrown to that class to muzzle it are being withdrawn, we are moving to drive out the non-whites who do our menial labor, with the apparent objective of forcing the once-middle class to do it instead.

-- Mal

[KingCharlemagne]

8. Save for a few historical aberrations like the U.S. use of chattel

slavery, the system of slavery preceded the system of feudalism which preceded the system of capitalism (where we are now). The next step in our evolution as a species is global socialism. I don't think it will happen in the few years that remain to me, but I think it will happen eventually. Trump is simply sharpening the capitalist contradictions, thereby hastening the onset of the socialist revolution.

[malthaussen]

12. Maybe, but the problem is really authoritarianism, IMO.

Both capitalism and socialism allow extremes of authoritarianism to take hold, arguably capitalism is harder for it, but we are seeing it flourish now. The annoying thing about authoritarianism is that it is not something only imposed from the top down: as the late Terry Pratchett said, humans have a design flaw, they have a tendency to bend at the knee. Rather than workers of the US casting off their chains, they have gleefully donned them. One might hope that eventually they will react against this and the proverbial pendulum will begin to swing the other way, but we must remember that their religion supports this tendency to bow to authority. This "land of the free" has a curious love of deference and subordination in constant tension with its supposed love of liberty.

-- Mal

[KingCharlemagne]

16. It's called a "Dictatorship of the Proletariat" for a reason. The question is who

shall have authority, people who work for a living or capitalist-rentier parasites.

N.B. Marx and Engels envisioned that the transition from Socialism (where some form of state authority was still required) to Communism would see a concomitant "withering away of the state."

[Sancho]

7. There's another reality of the US system - doctors and hospitals make too much....

In general, health care workers in single payer systems are paid well, but in the US they average much more. Also, our hospitals and associated industries are seriously for profit, and they make big bucks for investors. The private PAs, insurance networks, and hospital collectives are doing well and they employee some pricy people.

If there was a single-payer system/public option, hospitals would be publicly owned and health care employees would make a lot less.

Of course, you could have a parallel private system (like public schools vs private schools) for those who could afford it, and some of the health care system would cost more and earn more for those practitioners. In general though, you would have a significant shift in salaries.

[Recursion]

10. US average physician salary is $200K. OECD average is $90K

German doctors actually max out at around €90K, except for some hard-to-fill specialties.

Oddly, though, Canada has physician salaries almost as high as the US's, so it's not necessarily a deal-breaker. Particularly as Canada does not have for-profit hospitals.

[tblue37]

13. But our physicians also graduate from med school with a mountain of debt. My daughter ended up with

a quarter million in debt, which ballooned to $300,000 because of interest before she was able to start paying it down after completing her two residencies.

She will be 36 this year, but still has to work so much to make enough money to pay down her debt that she still doesn't feel able to have a kid, because she wants to be able to cut back her work hours and spend time with the child when she has one, if she ever can!

[AngryAmish]

18. It is insane that a woman smart enough to be a doctor is discouraged from having children.

This is Idiocracy come to life. Cleetus having a dozen with five mothers is not discouraged.

[tblue37]

30. She also is discouraged from doing the sort of work in underserved

communities that she always assumed she would be able to do. By the time she puts in the hours she works to pay down her debt, she has no time or energy left over.

[AngryAmish]

31. Lunacy.

[crazycatlady]

11. Maybe the cost of medical school needs to be addressed

I used to babysit for a pediatrician's children. She was well into her 40s and still paying off her student loan debt.

It is not uncommon for doctors to graduate with 300,000 in student loan debt. They need these high salaries to pay it off.

[tblue37]

14. $300,000: Right on the money--see my post above yours. nt

[eniwetok]

15. American Doctor Corps!

I'd love to see some program where we pay for a Doctor's medical training on the provision they agree to work for a much lower salary for their first 10-15 years.

But does anyone recall that back in the 90's the Clinton Admin wanted to cut down on a surplus of doctors? It made no sense from a supply and demand perspective... but it was proposed and I assume it happened.... http://www.cnn.com/HEALTH/9708/24/doctor.glut/

The idea was to save Medicare some money on training... but wouldn't fewer doctors put upward pressure on the prices they could charge?

[Sgent]

32. I don't know if they cut down on the number of slots

but the Clinton administration did cap the number of residency slots. The ACA expanded that number.

There are a number of programs that allow physicians to repay debt relatively quickly, esp. if they are a US Citizen. The best one is probably the national health service which gives them a fairly reasonable salary (O-3 + physician stipend + housing allowance), federal benefits, and retroactive GI Bill. Its only open to PCP's and Dentists however. They have to work in a medically underserved area -- usually rural.

[DinahMoeHum]

19. Chris Ladd: "A generation ago, Rick Perry was a Democrat. . .

. . .and Elizabeth Warren was a Republican. . ."

Link to tweet

Chris Ladd's new blog: Political Orphans
http://politicalorphans.com/

An interview with Jeff Pearlman, sports writer:
http://www.jeffpearlman.com/chris-ladd/

Seems like a great guy to know and have as an ally.

[Iggo]

20. Tax the rich. Feed the poor. (n/t)

[Kimchijeon]

21. That ladder-kicking mentality

"I've got mine, now fuck everyone else"

So selfish.

[KG]

24. I lulz'd

Forbes.

[Recursion]

26. Did you bother to read it? The author wants universal health care

Not sure why a description of the role of white supremacism in stimying American attempts at universal health care makes you lulz.