Universal Health Coverage: some ammunition

[gcomeau]

I often see people floundering a bit when they're trying to advocate for universal health coverage, they know why it's a good thing but they aren't very good at getting the point across. So I figured I'd take a shot at putting together a few suggestions on how to convince people conditioned by decades of "socialism is for commies!!!" scare tactic politics that universal coverage is what they really, really want to happen. The best approach is not to try to overwhelm people with technical analysis, include a few facts and figures to prove you know what you're talking about but you have to get them to look at things from your viewpoint and charts and graphs and spreadsheets aren't going to cut it. Alternatively, just making "it's the right thing to do" moral appeals is not going to convince many people either.

Universal Care vs. Universal Coverage

There is a difference between "Universal Health Care" and "Universal Health Coverage." The goal of the universal coverage is of course to result in the universal provision of care, but try not to muddy the waters by confusing the two. If you talk about the government providing Universal Health Care you put images in people's heads of government nationalizing all the hospitals or something. That is a bad thing for two reasons

1. People don't like the idea.
2. They're actually right not to like it. Bad idea.

Example: Canada. They do not actually have Universal Health Care, they have universal coverage. Health Care is a private industry, the government covers the insuring. This is, IMO, the optimal use case.

The Free Market

To a lot of right-leaning opponents of universal coverage this is the major sticking point. Get them here and you'll have a good chance of winning them over. And it's not even that hard an argument to make really. Just do NOT trash the free market. It's the wrong approach tactically, and it's wrongheaded on top of it. The Free Market is great... as long as let it do what it's designed to do and don't try to make it do things it simply is not intended for. The free market is a wonderful thing. It really is. As long as it is properly regulated to control abuses it is great at driving efficiencies up, managing resource distribution, etc... when it is dealing with commodities. It is NOt true when dealing with insurance. The following is a relatively good example 9I think) to get people to understand this:

Sun Screen

Let's say I sell sun screen. The market provides all kinds of natural regulating forces to push me towards doing this effectively both for myself and for the consumers. I want a good customer base, so I don't focus my efforts in Alaska in December. I go where the need for my product exists. If I don't do that I go out of business and die off. Once I get there I want those people who need my product to buy from me and not my competitors, so I do one of two things:

1. I keep my prices low to remain competitive. In order to be able to do that and still make money I try to maximize the efficiency of my production to improve my profit margins.
2. I make my sales based on superior quality that justifies a higher selling price. I direct my attention towards improving my product.

So the market forces just naturally produce a drive to fill the need for both high quality materials and high efficiency production... and to direct those resources where they are most needed.

Insurance

I now sell insurance. When I was a sun screen salesman I wanted people who needed my product the most to be my customers, because that made me money and was good for business. Do I want people who need insurance the most to be my customers in this business? NO. I will go freaking bankrupt if all my customers actually need what I'm selling them. I don't want to sell a $10,000 insurance policy to someone then have to pay for their $100,000 neurosurgery. I want to sell a $10,000 insurance policy to the healthiest person on the planet who never has to visit the doctor or get medical treatment... who just hands me their money and expects nothing in return. When we're dealing with insurance trying to apply natural market forces to the system backfires... because people selling insurance NEVER WANT THEIR CUSTOMERS TO USE THEIR PRODUCT. It is actually worth it to them to spend money actively avoiding providing services to the people who need it the most instead of spending that money better providing for that need. Which screws the efficiency of the system all to hell too.

So what do we end up getting? Insurance companies taking as much money as they can from healthy people while providing the minimal amount of service they can manage. And sick people having to pay massive amounts of their money seperately to get treatment. It is a system designed to make health care as expensive as possible to the general population.

This is a simple case to make. You just walk people through that easy comparison and it is not that hard to make people understand why insurance is not like other businesses and why it is very poorly handled by private enterprise. Don't get all up in people's face about the "evils of capitalism" or something, you're going to run into a brick wall, and it's a stupid argument anyway. Convince them you understand the benefits of a free market economy, and then show them that insurance just happens to be an exception. Depending on private enterprise to fill a need it is unprofitable to fill is just crazy. Private insurance companies can make very good money, no doubt, but they do it by convincing Alaskans to buy sun screen in bulk... so to speak. Good for the insurance company, sucks for everyone else.

The Budget

The other major hurdle you will usually run into is people who say we can't afford universal health coverage because of the budget deficits.... high taxes... arrrgh run away!!!!

Baloney.

<//titania.sourceoecd.org/vl=2126251/cl=12/nw=1/rpsv/factbook/images/graphics/10-02-01-g1.gif>

(The forums really do not like that link for some reason, won't let me make it clickable. Just put an "Http:" in front of it and stick in your browser address bar.)

THAT is what trying to let the private sector handle health coverage has gotten the United States. It costs this country a fortune, because like we just finished explaining when we're dealing with insurance the free market naturally decreases the efficiency with which services are delivered where they are needed. Not only that, but look only at the red portion of those bars. That is the cost to the government alone, public sector expenditures. the U.S. citizens get stuck with all those huge out of pocket expenses, you think that means the government has lower costs so it's easier on the budget and we get lower taxes? Think again. Like we just finished explaining, the need of actual sick people for coverage is NOT largely met by the private sector, they spend all their time and effort avoiding doing that. So what ends up happening? The U.S. government spends just as much tax money on healthcare as Canada does, while it's citizens still fork out way more in out of pocket expenses (that blue part of the bar).

To further illustrate:

http://content.nejm.org/cgi/content/short/349/8/768

The Canadian system spends 1/6th of it's funds on program administration.
The United States? ONE THIRD of all money spent on health care in the U.S. goes to administration. Why? Because every insurance company is paying staff to do nothing but pour over claims trying to avoid paying for care. Every doctor's office has to keep track of 15 different kinds of paperwork from 15 different providers with 15 different claim systems. It's a mess. And it's completely unnecessary.

Logistics

This is the tricky part. The U.S. health care system is SO screwed up that dismantling it and replacing it with a proper, efficient, functional universal coverage system is going to be a painful process. If you try and do it overnight then what does that involve? How many private insurers lay of all their employees and what do you do about them?

What about provider costs? You can't just have providers gauging the government because they know they'll pay for everything. You need to work out a pricing agreement to restrict the maximum cost of services within an agreed, reasonable range. "Yes, you can charge $25,000 for a bypass surgery... no, you cannot charge a quarter million. Manage your costs and payrolls appropriately." That kind of thing.

The logistics of instituting such a sweeping change are the most valid roadblock that needs to be overcome to institute sweeping reform of the system. I won't pretend to know how to deal with it, it's going to be nasty. It's going to slow things down. But it is also not getting any easier the longer we put it off, and it is very necessary.

Those Pesky Anecdotal Arguments

"But my cousin's sister's aunt had to wait for weeks for an MRI in Canada! And my brother's roommates father got one in a day here!"

Yeah, so? Is anyone saying the system is prefect and without flaw? No, I don't believe we are. It is just way the hell better than what the states has now. It will still have it's problems, but they are smaller problems than we face currently. If you give everyone access to medical care is there going to be more strain on the system and probably longer wait times? Yes, obviously. If you prioritize care by urgency and necessity are people looking to have elective procedures going to be inconvenienced sometimes? Yes they are.



Anyway, hope that is of use to anyone who might be in the mood to go try to convince some people that they shouldn't live in fear of "the socialism!!!". I know many here have probably already seen figures like these many times, but it's not just about having the facts on your side. If you can't get people receptive to listening to them, and if you don't take the time to explain them in a way that makes people really properly understand them, then just being right is not doing you a whole lot of good.

[Idealism]

1. "Teh Socialism" is the next "Teh Gay"

:(

[GreenPartyVoter]

2. Except that one can choose to be socialist...

[Cleita]

3. K&R

Also, the best website to really learn this issue is The Physicians for a National Health Plan.

http://www.pnhp.org.

Anyone who spends some time there will come back armed for any argument that any health industry lobbyist or publicist might want to throw their way.

[annabanana]

5. That's the #1 site for National Healthcare. . IMHO

Medical professionals truly understand why our current system is untenable. When the American public makes common cause with the Doctors & Nurses, we have got. . . a movement.

[ayeshahaqqiqa]

4. As one of those who fills out insurance claim forms for an MD,

I can tell you that you have stated the case for Universal Coverage VERY well. I especially like the idea of a set range of prices for given services--and it should be reasonable. I still recall getting a rejection notice from an insurance company for an office visit that cost $32.00 They said that the cost was "unreasonably expensive". I'd like to know exactly how much they expect an MD to charge for an office visit of 30-45 minutes!

I work for a non-profit, and so I wonder what happens to the for-profit offices with some of this.

Give me one form to fill out, and uniform coding for that form, and I'll be very happy.

[Cleita]

7. Funny you should bring this up.

My last yearly physical, paid for by Medicare, was all of ten minutes. I work for a doctor part time who does business on a cash basis only and he gets $160 for an hour consult. So you can see how badly our medical system is broken and it's the insurers who broke it. The doctors are only covering themselves when they start refusing insurance.

[drm604]

6. K&R

This is something we need to immediately push the Obama administration on, and we need to push hard. Currently it sounds like he wants to keep private insurance involved. We need to somehow convince him otherwise.

I think that we currently have an opening that needs to be taken advantage of. Industry, in particular the auto industry, needs to be relieved of their health insurance costs. We need to get companies like GM lobbying for single payer universal coverage.

As far as logistics, we already have a government payer system in place, Medicare. We start with that, make some modifications (prescription coverage in particular) and extend it to cover everyone.

[gcomeau]

9. If we can just...

...get it through enough people's heads that Universal single payer is a SOLUTION to the budget deficit and not something that will make it worse, and that we get that AND a more effective system all in one package, that's most of the job done right there. Someone needs to convince the Obama people to mobilize that army of volunteers and organizers of his again. Only this time train them up on how to educate people on Single-Payer then let let them loose. You know a lot of them would just love doing it, they want to be involved, they want things to change. Arm them up and point them at the enemy!

If you create enough popular support for the idea the rest takes care of itself. Combine Obama's initial approval ratings with broad support for the initiative and Congress will fall in line.

[drm604]

10. I'm convinced that he intends to use that army of volunteers for this kind of thing.

He still has those email lists, and he still has all of those cell numbers for text messaging and I think that he fully intends to use them.

What we need to do is to convince him to use it for this. I've been thinking about what I want to do now that the election is over and I'm starting to think that I want to put my time into pushing for health care.

Any ideas as to what would be the best way to proceed?

[gcomeau]

11. Well...

...I just popped in to the Change.gov site and fired them a message in their "Share your Vision" page.

I appreciate that it is a difficult thing to convince a nation whose population was subjected to decades of fear tactic politics associating single-payer universal health insurance coverage with socialism (which of course is just code for the great godless Red Menace) to get behind a universal health insurance program. I also appreciate the magnitude of the logistical difficulties involved in such a sweeping overhaul of the mess of a system we currently have. But this has to happen. We need it. Desperately. PLEASE put some serious thought into mobilizing that army of volunteers and organizers that came out for you in the campaign to educate people on what Single Payer coverage would actually mean for them and for the nation. Build a base of support for it to propel it through Congress.

Don't let people pull that "we have a budget deficit so we can't do it" garbage. These figures aren't exactly a secret:

//titania.sourceoecd.org/vl=2126251/cl=12/nw=1/rpsv/factbook/images/graphics/10-02-01-g1.gif

Single payer will save us money! LOTS of money. It's part of a *solution* to the deficit. The U.S. wastes hundreds of billions a year on the ridiculous system we're using now, we pay more than EVERY other industrialized nation that uses universal coverage plans, and we don't even manage to cover everyone while we do it. It's a disgrace.

Don't let people twist it into a "you hate capitalism!" argument. The free market is a great thing, but it isn't designed to handle insurance. It just *isn't*. If I'm selling cars, or food, or sunblock, or pencils, or any other commodity I want the people who really need what I'm selling as my customers, and will compete to get them. Because that's a profitable arrangement for me. That simple fact is what underlies all the market forces that push towards more efficient production, improved product quality, the effective distribution of resources to where they are most needed.... and NONE OF THAT really applies to the insurance industry. Just make people understand that for cripes sake. People selling insurance don't want people who NEED insurance as costumers, because those people don't make them money, they cost them money. It's not a complicated thing to explain to people. Just put in the effort and do it. You don't have to come across as anti-free market, you come across as the people who understand what the free market is and is not good at.

Just please, take advantage of the momentum you have while you have it and get this done. It'll help the budget, it'll help all of us, it's an all around win for everyone except the insurance agencies. Will they take it on the chin when a national health insurance plan takes away their customer base? Yeah. Is avoiding doing that to them worth several hundred billion dollars a year in wasteful spending? Heck no.

Come on guys, make single-payer happen. Pay the price necessary to get it instituted. In the short term you'll undoubtedly take an enormous amount of flak from the right, but let people see how the system really works for a few years and they'll tell the right wing to take a walk.

If we get enough people hammering it at them they might get the point.

[drm604]

12. Excellent message!

:applause:

Let's hope that whoever is reading these passes it on.

[BrklynLiberal]

8. To the greatest page....

[LWolf]

13. HR 676.

I have no trouble talking about Universal Health CARE.

I'll continue to do so.

[gcomeau]

14. HR 676...

...is for National Health Insurance. Ie: COVERAGE. So I'm not following what your big all caps "CARE" was in reference to. Was I insufficiently clear in my explanation of terms?

[LWolf]

15. You are clear.

Since you asked, I put "CARE" in caps because that is the goal. I have "coverage." I'm told that it is good "coverage."

I, and my employer, pay quite a bit for that "coverage."

I don't access some of the CARE that I need, because I have no $$ left to spend on deductibles and copays after paying the premium for my "coverage."

I sincerely doubt if I am the only person in the nation who gets less CARE than she should, despite the "coverage."

A problem solved by HR 676.

I'm not going to play games with semantics. I'm not going to pander to the arrogant, the misinformed, or those who would ensure a large underclass while preserving their own status. I'd rather educate them, myself.