Thursday 6 July 2017

Universal healthcare

Imagine a place where healthcare isn't for everone. A place where 30 million people would have to pay $1000 for a root canal (I've had a few of those, I think it's fairly common). Where a simple visit to a doctor costs $160. Where medical bills are the biggest cause of US bankrupcies. A place where another 20 million will soon face those prices. Where the first thing you ask about a new job is "Does it include healthcare insurance?" And if you buy insurance, it costs you $8000 per year for a family plan, and then if you make any claims, you get to pay part of the cost of treatment.

Poor people simply cannot afford healthcare; that's why they are uninsured, and that's why they cannot visit a doctor or dentist. The choice is stark; put up with the appalling pain of a bad tooth because if you pay to have it fixed, you don't eat this week. And that tooth won't get better without treatment; you'll face the same choice next week.

Now wake up from that nightmare. The NHS offers us universal healthcare, and where you do have to pay for part of the treatment, the payment is small; a prescription costs you £8.60, even if the medicine costs thousands. Root canal costs £53.90.

So which unfortunate country am I describing above? The USA, of course.

First, let's look at the quality of healthcare in developed countries, and I'm going to use three measures; child mortality, maternal mortality and life expectancy. Look here:

Child mortality in the USA is twice that of other developed countries, despite spending 30% more per capita on healthcare. Maternal mortality is the worst. And life expectancy is the lowest.

The USA has the most expensive, and at the same time the worst healthcare of any developed country.

How come?

Maybe they're doing something wrong. The most obvious candidate, is that they dn't have a universal healthcare system.

With a universal healthcare system, free at point of use, people don't think carefully before seeing their doctor. So a minor health problem is diagnosed and treated before it can become major, and there are plenty of conditions that, if left untreated until they become acute, are very difficult and expensive to treat. Or are fatal.

Another benefit is that it's a single payer system, what we economists call a monopsony. You know how in a monopoly, where there's one seller and many buyers, the single seller can force up prices, because the buyers have nowhere else to go? Well, in a monopsony, the single buyer can force down prices because the sellers have nowhere else to go. That's why medicine prices are so much lower in the UK than in the USA. In the UK, the NHS can say "Drop your prices, or no-one in the UK will buy". In the USA, the drug companies can raise their prices as much as they like, the buyers have no union.

And, of coure, the insurance companies are not non-profits. They take a good slice of the healthcare cost.

The USA has, by objective measure, the worst healthcare system in the developed world, and the most expensive. It could have the best, at a cost that's 2/3 of what it#s currently costing.

The USA is full of great doctors, great dentists and great hospitals. And the prevailing religion is Christian, with a philosophy of "Help the poor, heal the sick". So what's gone wrong?

When I've suggested a universal healthcare system to some Americans, they respond with "But that's socialism. Why should I pay for someone else's healthcare?"

And here's my answer to those Americans. First on the "socialism" bit. You have a fire service, a police service, a public education system and a military, and all of those are paid for by government. You don't say "Let's privatise the police". You already have many services paid for out of taxation, and the Republic hasn't fallen. I'm suggesting one more.

And why should you pay for someone else's healthcare? Because it's the right thing to do. Look, I'm an atheist, and you're probably (if you're American) a Christian.  How come an atheist has to tell a Christian that the rich should help the poor, and heal the sick?
Matthew 10:8 "Heal the sick, cleanse the lepers, raise the dead, cast out devils: freely ye have received, freely give."

OK, maybe raising the dead isn't going to happen, but we can, often, heal the sick. 

You live in a democracy, you can make this happen if you want to. You could have the best healthcase system in the world, instead of the worst, and it would cost less than you're currently paying.


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