Where were those “Hands Off ACA” signs in December when the Democrats repealed it?
What’s that you say? You saw no breathless editorials in this paper about the Democrats repealing key provisions of the ACA? You saw no marches, heard no screeching. Besides, the Democrats LOVE the ACA and support every jot and tittle thereof; how could they have repealed it without you knowing about it?
Because they repealed the part where they actually pretended to pay for some of it. They repealed hundreds of billions in taxes; yes, believe it or not, there are taxes Democrats actually don’t like: the kind that their campaign donors have to pay.
So, typically, the Dems retained the handouts, freebies, and giveaways, but repealed the means to pay for (some) of it. "That’s not policy, it’s vandalism."
Recall, too: the ACA enacted enormous cuts to Medicare – which the Dems will fight to their last breath to save.
And it’s just dishonest to discuss life expectancy in a column about health care, without mentioning the effect of poor people murdering each other in appalling numbers.
Speaking of dishonest, another column without mentioning cost.
In short, in the finest tradition of NYT opinion writing.
2
After years of listening to Republican healthcare proposals and policies (as well as their positions on matters such as gun regulation), I am starting to believe that, for many Republicans, one's life is only of value if one is either:
A. Wealthy
B. Male
C. White
D. A fetus
E. Any combination of the above.
As a 66 year old woman, I feel uncomfortably disposable. The fact that my Social Security and Medicare have kicked in helps somewhat, but I worry about what will happen if we get another 4 years of the Trump/McConnell axis.
21
Did Trump fie all he senior executive staff of CDC so that he could outsource the billions budgeted for CDC work to his supporters and Trump Inc?
5
Look - if the South and the Bible belt really don't want health care, why force it on them? I've proposed before: when you're 18, you can get in (for free) into a sensible health care system. Call it LibCare. You can leave at any time (upon winning the lotto, say) but getting back in is a vestiture process, one that takes longer to do based on, say, age and general health. You can't just not pay anything for 30 years and suddenly get on board when you find you have a stage 3 colon cancer and will lose your house.
Think of a bloc of 1/3 of Americans bypassing insurers entirely to force hospitals to, say, charge a dime per aspirin rather than $30. "Don't want to deal with us? OK, we'll take all 100k of us elsewhere". I'm sure the fat would get cut.
And those who are terrified of not getting to see their personal physician each time? There's still the insurance system available for them. Walk away from selfish and the idiots, and when something expensive goes wrong, let them rot.
4
It's not just that "doctor's groups" are restricting the number of doctors. Many bright students do not want to take on the debt that's required to finish med school. Or if they do take on the debt they need the big bucks to be able to stay afloat. What needs to happen is increase the number of slots for more students and decrease the debt load. I am a semi retired physician who had low debt load upon graduation. I am not sure I would make the same decision now when I look at the current costs of med school.
7
Healthcare is a human right not a profit center. Democrats can push through an enhancement or expansion of Medicare taking backing back the senate and WH in 2020.
3
The hard sell by BigPharma and the WHO of the HPV vaccine in Rwanda testifies on the lack of education in Rwanda. the HPV is fraught with adverse and unnecessary side effects.
3
Yes, in principle universal medicare care is the actual goal. As is lowering the costs of healthcare. Germany has a multi-payer system in which payments and costs are very tightly regulated. Mr. Kristof's argument is: ergo we need not aim for M4A. That is a counterproductive and disingenuous argument at this moment.
The Only proposal on the table for the Universal Healthcare Mr. Kristof extols And which addresses costs is the Medicare for All single payer system. It makes sense that in a country as large and heterogeneous as the US a single payer approach Is the only one that will reduce costs by eliminating the vast administrative waste of insurers and doctors and hospitals and lawyers and patients fighting over payment and coverage. Multi-payer re-introduces both complexity and expense. (Imagine is social security were administered by the Sates for example! And obviously there is the hateful abuse of medicaid in benighted states.) Especially considering shirker states like Kentucky who both take more federal money than they give and Still work to deny healthcare to both their own citizens And the citizens of the rest of our country. National single payer gets past the nasty corruption of the Moscow Mitchs who keep the benighted states they (soon, formerly) dominate down.
Pundits need to get past their own echo-chamber and the dictates of their owners. The medicare for all plan is what people want. Medical dental vision, no out of pocket, no networks.
9
It seems to be hard-wired into the nation's psyche that one does not deserve goods/services they can't pay for. As long as we treat access to a reasonable level of health care like any other commodity, we won't solve this problem.
12
Mr. Kristof:
I was interested in your op ed in the NYTimes, February 23, 2020 discussing US health care.
I was puzzled by your statement “doctor groups limiting medical training and qualified foreign physicians to keep prices down.”
In the past I led one of the largest resident training programs in the country, and having testified before Medicare leadership in Washington and the New York State Health Department in Albany requesting more training positions.
According to the website of the National Residency Matching Program, of the thirty-two thousand plus training positions offered in the residency match of 2019, 1644 went unfilled. Two hundred and twenty-seven of these were in internal medicine and 280 were in family medicine. Less than half of those going into internal medicine and family medicine residencies were graduates of US medical schools, so the majority seem to have been foreign trainees.
Therefore it seems that if “doctors groups” are limiting training opportunities, it seems unlikely that they are doing so by limiting the traditional and approved training programs that continue to have vacancies.
I would be interested in learning more about those elements you cite and would appreciate hearing from you.
James Scheuer MD.
(Dr. Scheuer is Distinguished Professor Emeritus
The Albert Einstein College of Mediciine/Montefiore Medical Center)
6
When doctors are replaced by diagnostic software and the like so the profession goes the way of tenured professors, librarians, and press photographers we will miss them but we won't have much sympathy for them. Not after their decades of gouging and lobbying for the same.
4
As a primary care physician I have seen Congress, CMS and insurers set one medical specialty against each other in terms of payment with the wealthier specialties lobbying resulting in higher pay compared to pEdiatricians, family practitioners and General Internist’s. They destroyed primary care and any doctor patient relationships. At the same time insurers and employers have kidnapped patients trying to sell them back to physicians for care at a discounted rate in managed care settings where administrators make the medical decisions Bring in health care systems which are replacing physicians with nurse practitioners for overhead reduction purposes and pharmaceutical firms with no limits to what they can charge matched only by medical device companies doing the same. It’s a mess with elected officials the root cause of most of it.
13
The failure of the American medical system is not hard to work out. Anything that is commodified is altered. If you can pay, you get; if not, you don't get. Once you lose the health aspects of a system and reduce it all to how much it costs, more people are going to get sick and die. It's really not rocket science, it's basic economics.
How any country can take pride in groundbreaking, expensive medical procedures that save a relatively few outlier cases, compared with the vast majority who are disadvantaged before they are conceived, continues to perplex me.
18
Let's not forget lack of vision and hearing coverage in most health insurance policies, as well as lack of dental coverage.
8
I'm reminded of the big fight out here recently. Our second great state educational institution, Washington State, wanted to open a new medical school. Some parts of the powers that be fought tooth and nail to stop that from happening. Sounded like a wonderful idea to me. The arguments against were unconvincing to say the least. Our best and probably only way for our country to address health care now is via a public option. Like most Democrats I believe that everybody has a right to good and affordable health care. Sanders won't be able to get us any closer than the other Democrats who could very well accomplish more because they are so much more practical.
Brilliant insights from Kristof again. He is doing some of the best and most honest writing about our modern condition anywhere.
4
Trump doesn't care about the health care of so many Americans. Ironically, those he cares least about cheer the loudest for him at the rallies. Unless and until that changes, our system will remain one that provides world-class care for most and sub-standard care for some. How can that be viewed as patriotic?
8
The sad fact is that our heath system is run for the benefit of the providers and not the patients. Here it's profits first, care second.
9
“Prices for virtually any health care product or service in the United States tend to be at least twice as high as those for comparable products or services in other countries,” Reinhardt wrote."
Yes. The facts are in. We, US citizens, pay way more for basic services, then other countries. Yet this isnt limited to health care.Its across the board in many of what we'd now call basic services and products. Why do US consumers pay 3-5xs more on basic cell-phone plans then do Europeans, even those on the African continent? Who often get service in very remote locations. Where I/we lose service simply by walking into a big-box retailer's concrete bunker-like outlet!
I've received calls from a traveling family member in Kazakhstan...only to lose them on my end in a major urban center going under a bridge!
Why? Its actually so obvious, I'm surprised Mr. Kristoff isnt all over it. We, Americans, have given up on free-markets. What? Oh yes! We have. We're allowing for many reasons, political and social, for Monopolies and Conglomerates to smother what until recently was a decently running free-markets system.
In the early 2000's, ours was a market system aimed at getting good products, inexpensively to consumers. Since then? We've let the providers diminish, and in most cases be swallowed up by larger firms. All under the guise of "better efficiency" and in some cases the out right lies of better pricing and services. Or so they sold it to the FTC regulators. They bit. We lost.
9
You are describing the financialization of the US economy. Nothing is what it seems on the surface. It is now all about how anything and everything can be abstracted into a financial product and then sold on the casino of the Capital markets. One day, we may wake up and see the revolution of the MBAs and investment speculators for what they are doing to us. Meanwhile, we are vassals of Wilbur Ross and Steve Mnuchin who are surely contributing their valuable time to government not just for the juicy opportunities but for the promise of pardons later on.
7
Because of a pre-existing condition (allergies!) I was unable to buy health insurance in the 1990s. I paid for care out of pocket - a fortune- but eventually trouble caught up with me and because of a lack of care, I became disabled. I couldn't work. I lost everything, including my home. I came close to dying. It was like a nuclear weapon got dropped on my life. It took 20 years to try to rebuild my life to a semblance of what it had been before. Economically and medically, I will never fully recover.
What Trump is doing trying to take health care away from millions of people is despicable. If that happens, people will die. Their children will be orphans. Or people will struggle, bottom out and wind up bankrupt.
All this while Trump continually lies and claims he's making health care better - as he tries to destroy the lives of millions of people.
For anyone confused by how Bernie Sanders is racking up all those votes - this is how.
A few days ago a commenter posted here, apparently using her real name. She's a nurse at a Philadelphia hospital that primarily serves a poor community. It was a disaster when the hospital's Level 1 Trauma Center closed since it was the only one in the area that served the poor community. According to her, Bernie Sanders was the only politician who got in touch with the hospital to see what could be done.
All I can say is
Go Bernie!
14
Freedom of choice comes at a price.
1
Nick, you are right on and regrettably the pro-democracy, freedom of the press Americans, still in the majority, will lose next November. Health care will also be lost.
2
ObamaCare has cost me $25,000 a year, more than a third of my annual income, when I include copays, etcetera. The only thing covered is the 15 minute yearly physical, where my doctor tells me which specialists I should go to, that I can't afford. The $15,000 sent directly to the insurance agency is for the privilege of them not covering access to healthcare. So far, I am healthy. Insurance wouldn't cover an additional mammogram to investigate a lump, which along with my mother's breast cancer, puts me at great risk. If they wouldn't cover a mammogram for the $15,000 I pay them yearly, what else wouldn't they cover? ObamaCare was a great gift to the rigged system and is continuing to destroy the middle class. I am not poor enough, yet, to qualify for anything else, but as an ivy-league educated PhD even, I am poor enough so I have to live below the poverty level in order to make sure I have enough to give to the insurance agency, which does nothing for me... Plus they would kill me, if I did get sick. This is insanity, I have lived in Japan and France and never paid more than a few dollars for any healthcare, and I received actual healthcare.
7
@Lilly
Then vote for Medicare For All and a humane universal healthcare system, supported by most Democrats....and violently opposed by all Republicans.
20
Finally an article that also points the finger at doctor and dentist groups playing a role in exacerbating the healthcare crisis in this country. We have heard in detail through news reports about how the nexus of insurance, phama and hospital management companies has resulted in terrible inefficiencies and ballooning medical costs in America. I think doctors and medical providers should not be immune from criticism as well. Why do they get paid multiples of what a similarly qualified person is paid anywhere else in the world? It is no wonder that NHS doctors from the UK want to move here when they get a chance. The whole system is rotten to the core and it will only get worse.
7
I am a school bus driver. One of my 3rd graders got on the bus one day and said “ When I grow up I’m going to be a doctor because that’s how to make the most money”. Even the kids know.
7
There seems to be an interesting common thread in many of the states that have rejected or limited many of the solutions in the original "Obamacare" legislation. They reject the funds because it would help the less well off in their particular state. It would seem obvious they prefer to deny care to everyone rather than benefit a minority. It always mystifies me that this attitude is so prevalent and popular.
9
American was founded on - and is built on - a rich record of Cruel Calvinist Christianity, Norwichman.
Nice GOPeople.
12
Medicare covers only the pulling of a rotted tooth. If you need to preserve your teeth by preventive cleanings, repairs and fillings, that's on you. So we who have health care supplied by Medicare and the cheapest possible additional Insurance Provider's program have to let our teeth painfully rot until they can be pulled out.
One help is going to the local school of dentistry, who for my Portland location is less than half for a crown than a regular dentist and cleanings are also less. You have to pay as you go however.
To help solve my dental care, I got a very small limit credit card to use for trying to save my teeth and then when it is paid to zero, I then can get something else done.
It's sad when a bank seems more involved in whether I have healthy teeth than the system that is supposed to provide me health coverage, like my teeth aren't actually part of my body.
They could at least give us a free blender when they send out our Medicare coverage information.
5
Mr. Kristoff
Given that politicians from places like Mississippi, Kentucky and Texas have run a lot of our politics, why is it a surprise that we get MISSISSIPPI results in health care outcomes and education?
Those people simply don’t value health care and education. As individual states, they never have valued education or health care for anyone but upper class whites. The nation simply reflects those priorities.
The Electoral College, progressive dreaming and greed will relegate America to a third world like country in the next 20 to 30 years.
14
We’re already there I think.
8
Providers and insurers are guilty of racketeering in an extortion scam.
The costs of care are deliberately jacked up so high that no one dares go without insurance.
Insurers gouge consumers with the highest rates people can barely afford, and even then, the copays and deductibles can wipe out savings.
You pay $20,000 a year per family — and hope no one gets sick.
And if anyone in the family gets even a minor illness or injury, your deductibles and copays will be an additional $15,000 — and that’s if you are within network.
If you get into an accident, and the ambulance takes you to the nearest hospital — but it’s “out of network “ — you can get a surprise bill for over $100,000.
That’s why private equity is buying up medical practices and surgical centers — medicine is a racket.
77
Scam is exactly the word.
My husband and I cannot afford the $29,200/year that includes 2 $5,000 deductibles. We are self employed and therefore pariahs in the insurance world.
I recently went to an ENT at Bellevue Hospital in NYC. I was billed $1,160 plus a NYS surcharge for a total $1,272. The visit was 12 minutes long. No tests were administered, no prescriptions issued. That 12 minute rate, extended out to an hour is over $5,000 an hour.
The legally mandated posting of costs is nowhere to be found on Bellevue’s website. Letters to the hospital billing center and the NYC Commissioner of Health and Hospitals requesting an equitable bill go unanswered.
I am 15 months away from Medicare, hopefully I remain healthy and can afford the Part Whatever supplemental plan. I have no doubt that by then someone will have mucked that up as well.
25
The notion that for profit, private insurers can provide affordable, universal health care coverage is a fairy tale we´ve been telling the public for too long. All the while, we subsidize and subsidize and subsidize while premiums, copays, deductibles and general costs just keep going up and up. I´m done supporting "premium supports" in the form of my tax dollars sent to private insurers. That´s what´s going on now.
Germany didn´t have what we have -- a national, government administered health insurance provider that manages to cover most of the needs of the elderly. We can build on that, reducing costs as we incorporate the young and healthy, and vastly improving it by covering 100%, not 80%. Anyone who thinks Medicare as it exists now is perfect hasn´t had to deal with the nightmare of choosing supplements and worrying about all that fine print.
We don´t need more Rube Goldbergesque "solutions" that rely on for profit, private insurers. Simplicity, universality, expansion of what we already have in place -- compassion, love and an American can do spirit is what we need to bring to the table, so that every last person in this country can see a doctor when they need to and get the care we all need. No more fairy tales.
34
I have to agree with Nick on just about everything in this fine piece except for one point about dentistry. As a retired dentist, I know that there already are enough well trained dentists to meet the dental needs of the entire country, especially if well trained auxiliaries are utilized. Most dentists would welcome an influx of new patients. The problem is not that there is too little professional capacity; rather it is that half the country cannot afford dental care. If it were a covered expense under a comprehensive universal health care plan, we could catch small problems well before they became debilitating ( and costly). The rest of the modern world is way ahead of us in terms of prevention and early treatment of dental disease, at far less overall cost.
78
By failing to provide for dental care we also ignore the fact that poor oral hygiene impacts more than just one’s teeth. Gum disease is, to name a few issues, linked to cardiac problems, premature birth, and possibily dementia. How short-sighted.
27
Rwanda may be vaccinating girls at a higher rate than the US for cervical CA. And what is their vaccination rate for boys? You don't vaccinate girls to prevent cervical cancer--you vaccinate boys and girls. Cervical CA is a sexually transmitted disease.
2
Medicare Advantage plans for seniors are making money by not paying medical claims, doctors dropping out of plans and the inability to switch back to Original Medicare. The Trump administration is pushing the private insurance company plans, Medicare Advantage, which further tries to privatize Medicare.
Making life difficult, if not impossible, for seniors at is another example of the broken health care system in the US.
https://www.nytimes.com/2020/02/21/business/medicare-advantage-retirement.html?action=click&module=News&pgtype=Homepage
1
Today, I spoke to a young man about the fact that I am in constant pain from two teeth which need to be root canal-ed. One is cracked. The other is broken. They are this way because I cannot afford the (uncovered) $800 for the mouth guard which would protect them from the grinding which I do at night. This is caused by 1) chronic pain bc I cannot get proper pain control due to the Federal Government's hissy fit over opioids which are killing addicts NOT pain patients and 2) the fact that I am divorcing an abusive man who simply will not leave me alone and there is nothing I can do, inside or outside a courtroom to get him to stop. No one gives a Tinker's Dam what this horrible man does. Every possibly control and abuse is *just fine,* up to murder--then they will jail him.
While I was saying that I spent the last 3 weeks arguing with my insurance company to cover 50% of the $6000 in dental work which I require (I didn't mention the exact sum), I was guiltily aware that at least FOUR of his front teeth were completely rotted out of his mouth. They needed more than a root canal. They needed to be extracted, bc he was clearly uninsured. (Like mine) They probably caused him constant headaches, had been infected more than once, and were dead. The only good part about them being dead, is that they probably hurt less.
My teeth, going on their THIRD infection, may be dead as well.
2
Of course Trump wants to destroy Obamacare. First, Obama dared to make a joke about Trump, and Trump cannot bear to be laughed at. Second, Obamacare defies one of the fundamental truths of Trump's universe: The rich must live, and the poor must suffer and DIE. The rich are "winners," therefore they "deserve" all the benefits they enjoy. The poor are "losers." In Trump's eyes, they have worked hard enough, they don't hustle enough, and they don't bend the rules enough to make tons of money. Therefore, they deserve NOTHING.
I believe Trump truly ENJOYS having the power of life and death over fellow Americans. It feeds his ravening ego and helps him to justify all the awful things he's done in his life. Yet his voters (most of whom are people of modest means) love him for it, because they think he's sticking it to "those people" (Hispanics, Muslims, LGBTQ, "libtards," take your pick). Wait until he starts cutting Social Security and Medicare (after the election, of course). Maybe then Trump voters will realize how badly they've been suckered.
5
Not a chance.
1
Our vaccination rates are lower because of left-wing anti-vaxers!! Inane.
2
Pres. Trump's making Americans' healthcare worse because Republicans want him to - they have smeared government funded services as a socialist plot for so long, that they're willing to send Americans to an early grave to win their point.
Focus on Pres. Trump takes the spotlight off his party. It may seem Trump's rebranded the GOP, but he repackaged himself for sale to their extremist base. He only had to change party affiliation and play up his racist hatred of Pres. Barack Obama to close the deal.
Trashing our health care system is an extension of GOP obsession with destroying Obama's legacy and opposition to 'ObamaCare' in particular. Leader Mitch McConnell tried to prevent the ACA from seeing the light of day, packed it with 'poison pills' before passage, and now Republicans are dismantling it in the courts.
Mcconnell's blocking Obama nominees up and down the federal bench, paved the way for Trump's packing the courts with ultra conservative Federalist Society judges. The fate of the ACA is in the hands of ideologues who oppose it on principle, consequences be damned.
In 2016, Republicans, keeping their eyes on the prize, united behind Trump even if they had to hold their nose. While Democrats, taking their eyes off the ball and focussing on their divisions, sat on their hands rather than vote for Clinton. In 2020 it may play out the same - piling wreckage on wreckage.
39
Nicolas
Democrats’ internecine battle over so-called Medicare for all is largely irrelevant, because the plan won’t get through Congress.
Don't be so sure.....
You are not listening to the people vote - and the polls - and what they want - and the enthusiasm to vote for those that actually represent them.... and to throw out the bums that don't listen... Have a little faith in democracy...
I may be a cock eyed optimist - but your casual dismissal of Medicare for all is upsetting.
1
Three groups of people who need to have reality explained to them.
1. The AMA is the most successful labor union in history, but its members vote consistently with the GOP to weaken unions. But the ship is sinking and the water level is reaching them too. I see my family physicians getting sucked into the corporate practices, and becoming just employees. Their union will be sidelined too.
2. Meanwhile small business owners also consistently vote with the GOP against Medicare of All, even though it would be a boon for them. It would relieve them of the burden of finding and paying for medical costs for their workers, and give them a level playing field with the big corporations. Nope, they don’t want that.
3. Seniors already on Medicare are just being selfish. They put their grandkids at risk, without a thought.
32
Once you say that your problems are society's problems, you have given up on the American dream, the point of the Declaration of Independence and the Constitution. Forcing others to resolve your problems may seem nice, but it's the road to tyranny, to ignorant and compliant citizens who cannot think wisely or with innovation. Correct speech and behavior forced by law is rarely correct for long. Citizens need to be strong, innovative, imaginative, hard working, dedicated, and willing to take risks. We are building a nation of fragility, fear and dependency.
If Sanders ends up the nominee vs Trump we can hope for one thing that may stop his second term: a group of hidden Sanders votes among professed Trump supporters. Recall the hidden Trump voters in 2016 who screwed up the polls. Where would hidden Sanders voters come from? I would guess from financially struggling Trumpsters who finally realize that they could easily lose their health insurance under Trump, especially if the Dems lose the house along with the Senate. You can be certain that making such a case would be job#1 for a Sanders campaign and the rest of the ticket. What will a struggling Trumpster do when faced with a choice between a democratic socialist or no health insurance? Prior to 2016 election I was certain I knew the answer. Now not so much.
Nicholas -- I'm not sure why you keep beating the anti-China drum. It has all the echoes of a 1950's-era Red China scare tactic.
That said, thank you for pointing out that if a virus outbreak occurs here in the US we are woefully unprepared to deal with it. Instead we will likely have more Trump ranting and raving substituting for reasoned policy management.
Already he's ranting about the repatriation of infected Americans coming back home. What the heck is this about? Does he think that ill Americans suddenly become "men without a country" destined to travel the world on a ship of the damned?
We're a rapidly unraveling society. We've got a mad man in the White House and an opposition party undergoing self-destruct. The mad man has already begun dismantling the inadequate public health system including stripping indigent Americans of their Medicaid coverage.
Pestilence, a horseman of the apocalypse has now risen up and we're going to rely on our crippled public health system to deal with this?
Trump is so busy hating and tweeting that he has been behind the 8 ball on all of our real problems. I remember when Ebola hit. Obama and his staff took off running and didn't stop until it was safe again. Trump gets a F for his lousy job he's doing as President.
7
I wonder if any of you realize the VA is single payer healthcare? All the horror stories are a result of the govt workers realizing they get paid if they work hard or not. They soon discover they won't get fired if they choose to skate and then everyone begins to feel the frustration when it takes forever to get help when you need it. Just so you know the Canadians that can afford to escape their wonderful healthcare system come here for care. Did you know it's illegal to go outside of the govt system? Can you say forced compliance? Enjoy your misery, it will be shocking to see how poor the govt does things when you don't have anywhere else to go, lol.
1
TRump wants to take away pre-existing condition coverage
while lying about it.
DUH
2
@bill b its already happened. If you want to switch within medicare for your piece of the insurance, the companies can make you wait anywhere from 1-6 months for coverage of same. If you have scripts for that particular disease, you pay OOP.
1
"Whatever happens with the coronavirus..." Yeah right, here's what will happen. A major pandemic is going to hit the world, and it's actually not Trump's fault. It's the fault of poor hygiene and primitive eating habits in China. Fact.
Great column Mr Kristof. Truth.
Bet you Bernie isn’t giving up his private healthcare
Bernie is on the great government program that is “too good, too comprehensive, too expensive” for the rest of us peons.
Xi Jinping and Donald Trump inherited their power and privilege.
Xi is the princeling son of a Chinese Long March legend father who rose and then was purged by Mao Zedong. Before being redeemed and resurrected by Deng Xiaoping.
By eliminating democracy with Chinese characteristics aka a term- limited collective leadership model, Xi has assumed and presumed to reign and rule until his natural death grasping the Mandate of Heaven of a Chinese Emperor.
Donald Trump, Sr. was smart and wise enough to pick a New York City real estate baron daddy to inherit 295 streams of income from in order to shield him from being the worst losing businessman in America over a 10 year period.
1
Good healthcare is actually of strategic importance as well.
It took the U.K. 2 World wars and the Boer War to wake up to how relatively unhealthy their youth were compared with the youth of other countries, including Germany.
Lord Baden Powel founded the Scouting movement after noting the lack of fitness of British troops compared with the Boers. Outdoor activities, however, were still not enough without the backing of universal healcare system. Germany has had one since the 1880s and coupled with outdoor activities in organisations like the Scouts and then the Hitler Youth, made German troops physically superior to their British counterparts.
Although Australia lacked Medicare until 1973, the partial system it had until then was still superior to the total absence of universal healthcare the British laboured under. Australia (like the U.S.) also has a much healthier climate (notwithstanding the recent bushfire smoke pollution). Both U.S. and Australian troops were noticably healthier than the Brits in WW1.
If the U.S. wants a healthy fit military, get moving on a universal healthcare system.
1
Is that so, Nick?
Weren't your Democrats supposed to have "fixed" everything by now with O-Care?
@The Commoner Unfortunately there were issues after the insurance companies demanded changes. Instead of fixing, the republicans have continued to erode because they were unable to repeal. That seems to be there answer to everything that might benefit their constituents and we seem to be too stupid and end up voting against ourselves in electing these chumps.
6
The healthcare system, the education system, the social system, and much else are all a mess due to one single problem. Our experts have lumped the brain and mind as just the mind when these are two separate entities. As a result the focus is on mind education while brain education is not only neglected, the brain is miseducated.
Since the birth of civilization mind education is improving creating a better and better infrastructure, while brain education is as messed up as ever. As emotional health (EH) is a function of brain education our EH is messed up that has created this mess in education, health and society.
All this mess is a symptom of emotionally challenged brains and to solve our problems we try to deal with the symptoms instead of healing the brain illness. It is like the house is on fire and we try to manage and control the heat and the smoke. No wonder our problems are as bad as ever.
Almost 50% of Americans have to struggle paying bills. It is because we make good money with our well educated minds but we spend it with our miseducated brains.
The symptom in chief of what is wrong with America is Trump. He has a brilliant mind with an insane brain.
The panacea for all this mess is EH. Focusing on EH will fix not only our healthcare system, it will take away the education and student. unhappiness, the drug addiction, the relationship, the tiredness mess. Here is my basic hypothesis: https://youtu.be/nmzwj-W8Mww
Please write about this fundamental cause.
We need Medicare for All!!! There are 27 million people in the US who have NO health insurance. There are millions who cannot afford their deductibles and co-pays so they don't go to see doctors. The major reason for bankruptcy in the US is medical bills. Insurance companies exist to make profits. They care nothing about our health.
Stop saying this isn't going to happen. We need journalists who continue to tell the public WHY it is necessary. Fox propaganda network keeps repeating that we can't afford Medicare for All.
Nobody should have to put out a GoFundMe page in an attempt to get money for needed medical care.
If other countries can pass healthcare for ALL of their citizens, so can the US.
STOP TELLING PEOPLE THAT THIS WON'T PASS. TELL PEOPLE WHY WE MUST HAVE MEDICARE FOR ALL.
Listen to Medicare for All: Last Week Tonight with John Oliver (HBO) Feb 16, 2020
LastWeekTonight
As presidential candidates continue to discuss Medicare for All, John Oliver explores how much it might cost, what it will change, and who it will help.
https://youtu.be/7Z2XRg3dy9k
4
We all know this. You need to tell other people.
Does stating the obvious qualify as journalism?
Wow, the Donald really wanted to leave 14 Americans behind, oh yeah, bone spurs. Think how upset he will be when a tidal surge begins to swamp his Mara Lago driveway. Drain the swamp! There is a new moderate and the NYT is no longer readily relating to real liberals so not to worry new populist Republicans. Of course college should be free as high schools and libraries are free. Yep just got that giant R on my metro card so it's time to share the wealth and the Medicare but not my discount on my bus ride. Hehehe.
My family doctor in NJ is complaining that he gets too many of the sick patients in town, that his peers are more successful in avoiding them. If the financial incentives are for family doctors to avoid the sickest patients, that really is a damning commentary about our system.
If Trump beats Sanders it will be because of opposition to Medicare for All. Trump will then proceed to dismantle Obamacare, Medicaid, and Medicare.
2
To be facetious, I state that any reform of health care is too radical for the American people. We're number 1 in everything. To believe otherwise is unAmerican. Same with agreeing that global warming is a problem. To radical for the American people. Raise the minimum wage? Also too extreme. Same formula can be applied to many problems. We must maintain the status quo.
To be serious, this attitude is prevalent and maintained by the political establishment, amplified by Fox News, and fervently believed by perhaps a majority of Americans.
Would be dental therapists need to take some lessons from nurses on organizing, developing curricula for "advanced practice" and political action for both changing state licensing laws and dealing with recalcitrant (mostly aging) practitioners.
It's been a long, but steady battle in nursing. The newest step is the development and sanctioning of doctorates in nursing practice, now available in major university programs (Penn, UW, and others). An analogous degree program is already well-established in physical therapy practice as well.
1
Our healthcare costs are unsustainable
Tough time means tough choices. The answer is not Medicare for all as people want choices. Here are some tough solutions we need to consider:
1ne: Insurers should require that obese customers wear activity devices. Those who don’t exercise should pay more for health insurance if their obesity is caused by a lack of exercise and a poor diet.
2wo: All health insurance companies and PBM’s should be non-profit. It worked prior to the 80″s and it can help lower costs.
3hree: Stop unnecessary medical tests like MRIs and X-rays.
4our: Healthcare tort reform. It’s the practice of medicine.
5ive: Negioate prescription drug prices for Medicare. It has to happen and is long overdue.
6ix: Set guidelines for hospital costs. Prices can vary by thousands of dollars between hospitals.
7even: Mandate wellness exams for all patients including visits with registered dieticians.
8ight: The FDA should approve drugs based both on efficacy and other drugs on the market to eliminate “me too” drugs.
9ine: Compensation of drug company CEO’s should be limited. Capitalism is broken when people can’t afford insulin while a drug company CEO takes home over $20 million.
10en: Tax sugary drinks and foods and require new warning labels on high sugar and high-fat foods.
11leven: Stop expensive care for elderly patients. Spending hundreds of thousands of dollars on cancer treatments and surgery for someone in their late stages of life makes no sense.
8
This story is right on the mark. Our medical care system is very overpriced and it’s caused by anti competitive practices by the medical professionals and their lobbyists.
He always likes the dictators: Xi, Putin, Kim Jong Un, Duterte, etc. He sides with them because he believes that if the American people will give him a second term he can join this “ strongman club.”
That’s precisely what is at stake in November. If the American people grant him the legitimacy of a second term, we will get an American President who will act the the authoritarians he craves to emulate.
2
@JT FLORIDA
Much worse, he might declare a national emergency to postpone the election due in 2024 in order to remain indefinitely as president. This is the dilemma we are faced with thanks to those untutored supporters of Trump.
2
I have this wing nut theory that football is to blame for out-of-control administrative costs in health care. And, college tuition for that matter.
Track the rise in university football coach’s salaries and it tracks along with the increase in healthcare prices and tuition. Coincidence? The new football coach gets a raise, the president of the university medical center gets a raise, the chancellor gets a raise—you know the rest of the story.
My brother-in-law is VP of something at a large university medical center and he earns $500,000 a year. His wife earns $450,000 as general counsel. Their boss makes $1.75 million. The right’s favorite philosophy—trickledown. It’s a feel good philosophy. For some reason it stops tricking by the time it reaches the custodial staff that heroically keeps you from getting MRSA.
I know—wing nut.
2
This is one time I can’t blame Republicans. Look at where the health of this country is the poorest. Red or blue counties? Oh please. The people most affected by this horrific “healthcare” system continued to adore Trump and his lackeys at their own expense and the expense of their children. So why do anything? Meanwhile they sit glued to Fox spewing their liberal hate. What’s so liberal about quality healthcare for all.
Vote Blue or absolutely nothing will change.
7
These Trump supporters deserve it. The problem in this country is generally the poor level of education and ability to think critically. Until that happens Republicans will keep fooling these people with charlatans like trump.
2
It's hard to take Kristof seriously here about child survival rates after he just wrote a column about supposed white privilege (i.e. bootstraps) and the American Homesteading Act. He sees everything from such a politicized (data-rich and understanding-poor) viewpoint that it's hard to decipher the truth. Just the thought that American pioneers (typically immigrants... yes, white) are part of white privilege injustice is stunning! How many children are buried out among those abandoned homesteads in South Dakota, Oklahoma, etc.? Let's give Kristof an oxen-drawn wagon full of hand implements of his choice and magically transport him to 80 acres somewhere out west and give him five years to improve it. Presumably, Kristof will first need to clear the land or cut sod to build a cabin/sod house and to farm - and no one will be 'carrying his water' for him. The value of that parcel after 5 years, if he's lucky enough to be successful, is 90% value-added (sweat equity) and 10% unimproved real estate. Spread that "wealth" over, say, 128 descendants (after 7 generations, at 2 surviving offspring/generation, who maintain property values and pay taxes) and you're not looking at a whole lot of white privilege. The dismal rural statistics he points to in this article (if there are ANY significant consequences left of this "gift") would only reflect this. Maybe Kristof should spend time among the Amish (woops... too white) or the Lakota Sioux who could enlighten him about rural life.
2
So much of the cogent deeply important insights of your essay are compromised by a word salad of distracting examples. You can do better not by telling the US President to insult the President of China at this critical time but by cleaning up your thinking.
Pro-life Republicans keep killing children and adults by taking away health care, food stamps, and more. How is that pro-life?
6
Let’s face it! Our whole system - medical, political, educational, infrastructure - is broken. We live in a third world like oligarchy which takes care of the wealthy in every way but leaves the rest with plenty of calories on the cheap (hence, the obesity epidemic in the working classes) and lots of lowlife entertainment (football, basketball, Jerry Springer, Howard Stern, porn, social media, Ultimate Fighting, Trump rallies, and on and on). That’s why, in a nutshell, it never gets fixed.
2
What did you expect from the master of disaster? Trump has a plan for absolutely nothing. He didn’t have a plan to get elected and then when the gullible ‘base’ voted for him in states with low educational levels and terrible health care participation rates, matched with the outdated Electoral College; well, you can guess that you have a perfect storm of trouble for America.
Combine all that with some concerted meddling from Vladimir Putin and his army of online warriors, and you get chaos for four years in America. Trump promised to make everything right in America. He even told black voters to try him out with ‘what have you got to lose?’ Well, they have everything to lose and so do the rest of Americans.
Trump has been proven, over and over and over, to be incompetent at everything he puts his hands to. The only thing that saved him from four bankruptcies was a platoon of lawyers and other people that paid the bills for him. Trump has stiffed everyone that has done business with him. Trump is a con-artist. Film-flam Man, yet he convinced enough people to vote for his hollow nonsense. His constant lying and name-calling appeals to the juvenile part of America that eschews school, health care and sanity when it comes to guns. If that is the true America then the rest of the world mourns for you.
When you all come to your collective senses, send out word and we, the rest of planet earth, that believes in democracy, ethics and moral values, will be happy.
2
ah. if only americans had anything to learn from other countries.....
the sounds of USA USA USA are better than actually doing something about joining the 'civilized' world.
2
Where are the right to life zealots on what is happening to shorten the lives of many people?
1
It continues to be apparent, as a matter of history, Republicans believe that healthcare is a privilege, by and for the privileged only.
Many of the president's supporters believe in the premise that "if you're white, wealthy, and male like me, you deserve health care. Look at this example:
"In the United States, Donald Trump rode to victory with a call to expel “criminal aliens.” In his announcement of his run for office, he spoke of Mexican immigrants as “rapists.” Since he has taken office, he has harshly targeted immigrants in the United States; at his rally on Saturday in Harrisburg, Pa., he compared immigrants — as he did last year — to poisonous snakes, to great applause. It is worth noting that this tactic of dehumanization — referring to humans as animals — has historically been used to foment hatred and violence against chosen groups. In the lead up to the Rwandan genocide, for instance, Tutsis were regularly described as snakes." https://www.nytimes.com/2017/05/01/opinion/who-is-a-criminal.html?ref=opinion
So who is criminal, Donald J Trump.
1
Government should make 6month dental cleaning mandatory for all children. Just like immunization shots.
3
I read in The Guardian that last May Trump cut $750 million from a fund to help other countries deal with epidemic outbreaks like the Chinese coronavirus and also eliminated the office of the person in charge of handling such an outbreak within the U.S. If true, why doesn't this get reported by American news? It seems a mind-bogglingly stupid move. I also read that Obama cut $9 billion from the same fund in 2012 spread over several years. If so, he was just as stupid. Guess now we get to pay the price if this current outbreak turns out to be the deadly sort scientists have been fearing.
Such a simplistic and ignorant column. "We are bad at vaccinating" - yes we have people who refuse to be vaccinated, and it is not Trump's fault. "Trump's policies have led to loss of insurance for 400,000 children" - just a partisan lie.
1
As ultra-conservative would say: " It's the price of freedom ... and it's fake news... and the U.S.A. is the greatest IN EVERYTHING and if you don't like it, leave." Always a winning argument.
1
So here we are in the US....Land of uninsured, high deductibles and outlandish copays. Folks will get sick and not go to the hospital....Not until they are mostly dead....This has full scale disaster written all over it. This is going to spread like heated butter.
1
The Trump voter does not care that he is kicking children off their healthcare or putting them in cages. They don’t care that his budget is proposing massive cuts to Social Security and is including additional tax cuts for his Mar-a-Lago friends. They don’t care that he is burning down the Justice Department. They want a continuation of his racist policies, they want that wall built, they want him re-elected and that is all that matters. Unfortunately and tragically they may very well get their wish.
3
The mere words Trump and Pandemic in the same sentence fill me with nausea. And anticipatory Panic.
Seriously.
4
It is no surprise because everything Trump touches turns to muck. And how stupid not to realize that there were or could be infected passengers in the group of US citizens/residents from the cruise ship hit by cononavirus. Hey but let's ignore science and spread of disease. Maybe if the CDC was not so shortfunded and Trump officials were not so sure of themselves, there could have been an effective quarantine.
2
Cruelty is the meaning.
We Americans and the entire world environment will not survive another 4 years of the same policies of this administration.
We will exist yes, but many will not and many will suffer as we watch helplessly.
Please vote blue no matter who in such large numbers that dwarf the 2018 midterms.
We MUST win those four electoral college states, Michigan, Florida, Wisconsin and Pennsylvania that gave this bigot the election in 2016.
We MUST win the senate and retain the house....then impeach and remove in due course this whole administration.
2
Trump already did enormous budget cuts for Medicaid, the National Institutes of Health and the Centers for Disease Control and Prevention in his last budget and now he plans to again in the 2021 budget. He will be lucky if the Coronovirus doesn't become his Katrina.
It is deplorable for a country as rich as the United States not to guarantee health care for everyone so we have a healthy, productive work force. 1 out of 2 senior citizens can't afford their medicines, the State of Utah is saving money sending employees to Mexico and Canada on short vacations to buy cheaper medicines and paying for the trips, and 58 million American adults can't afford their drugs. We should be ashamed for the World to witness such greed.
27
Certainly our healthcare system is a mess. Certainly it could be better. One problem that I see is that extraordinary amounts of money are spent in trying to keep some very sick people alive for a few more months while others go without basic care.
I understand the dilemma here. If we have the technology to possibly save someone who wants to fight to recover, can we ethically deny them, saying "we already spent our quota on you"? I cannot imagine. Yet sometimes I think both physicians, particularly specialists, draw patients and their families into believing that they can save someone that they really cannot. I note specialists in particular because sometimes they are so trained on their own speciality that they are not looking clearly at the big picture. It is also easier to tell a family, "we can try this" than to tell them that it is time to let go.
It also doesn't help that we live in a death-denying culture. Whether it is the family or the physician, sometimes people simply do not want to accept that death is coming. It is coming for all of us and sometimes it doesn't make sense to turn our final months into the misery of constant medical procedures.
Meanwhile, the healthcare-poor (those who may have coverage but cannot afford their out-of-pocket costs) take their medication every other day or don't go to the doctor when they could readily be treated.
We need to change our system. We also need to change our values and expectations of the medical profession.
1
What if government subsidized (how TBD) travel to other countries for treatments were an option? Would that extra competition from the loss of now captive patients help reduce costs here?
Nicholas Kristof deserves credit for calling out the AMA for restricting doctors to increase their own income. But, to be ethical, we must also require full restitution to their victims.
As I wrote in a comment at the end of 2019,
"We need to distinguish legitimate doctors' pay from that due to the political power of the AMA, amounting to trillions of dollars. Justice requires that this should be returned to the consumers victimized; in addition, the medical businesses should also pay restitution to those whose health has been harmed as a result of not getting timely medical care.
"We understand the need for restitution for slavery and Jim Crow -- the same principle should be applied here."
The AMA's use of government has been policy for many decades, thus requiring full restitution for this injustice, especially for those who died or whose health suffered.
Failure on our part to do so would perpetuate injustice.
2
One of the reasons that U.S. health care is so expensive is the cost of health care labor. As economist William Baumol pointed out, health care is a sector where productivity gains are slow and thus the workforce cannot work more efficiently than in years past (think of the time and effort it takes to do a wound dressing change, it hasn't changed in the past few decades). Furthermore, the cost of education has increased, increasing the cost of health care labor as people take on six figure educational debt to enter the health care labor force. Health care is one of the few service-oriented sectors with opportunities for individuals from all social strata to improve their lot. Yet, increased spending on health care services at the expense of other social services does not seem to improve quality nor quantity of life. The private sector has no incentive to drive the needed change towards increasing resources for social services, while foundations, even those as well-funded as Gates, lack the scale to drive change. Reinhardt challenges us to come to an agreement as a nation on this question: "to what extent should we be our brothers’ and sisters’ keepers when it comes to health care?"
Trump has no plan and the Senate has no workable plan either. Meanwhile the health card executives in the insurance and pharma business continue to make record salaries. and the affordable health care program isn't affordable. It was a start, taking it into government is the way to go.
1
In many aspects this is an intentional “third world” country. It is quite obvious that it has been Republican strategy all along to further the divide, disrupt and disenfranchise. The evangelists are all in since it provides a never ending supply of desperate and deplorable souls for their flock. The destruction of civic society is a conscious choice by Republicans, Church leaders and other demagogues and they won’t ever support anything that betters life for the common woman or man. They will never be convinced and need to be defeated.
Democrats need to understand this, grow up, stand together, do the talk and the walk! Let ‘them’ try to rip and twist the facts. We can be confident to be endowed with the eternal truth of common sense which makes ‘their’ hypocrisy ever more obvious.
‘All men are created equal’, ‘Love your neighbor as yourself’. ‘The sky is blue’ and we will fight to the nail to keep it that way.
Let’s get out onto the streets with heads held high, support the good people and let’s not get too consumed in the process for the nomination. Regardless who is the winner we need to back her or him, demonstrating a healthy ability to debate different ideas even if this takes adjusting with a compromise. Then show up in numbers and give ‘them’ the boot in November. It can be that simple.
4
" .... it’s not policy but vandalism."
That is a pithy encapsulation of the entire Trump presidency so far, not just his health care bait and switch. It might be useful to provide a short recap of all of Trump's vandalism masquerading as policy to provide context for whatever detailed analysis of a particular policy failure is being offered.
4
What M. Kristof is saying has been said many times before but until we realize that the word "co-operation" is not obscene,, and that "nobody tells ME what to do" is not the only foundation of a society, we will make no progress.
2
Your excellent writing needs a better title. I suggest, "Absent Leadership, American Healthcare Worsens with Dire Consequences for American Health". Without law, order, or competition, we inherit the worst of all worlds. Sleepy independents and snoring Republicans are falsely assured that the current President is operating with unique insights and clever stealth strategy; Democrats are all but blind with rage against this one man. If we all listen more closely, we might be like Dorothy, Toto, Lion, Tin Man, and Straw Man who heard the fake Wizard say, "Pay no attention to the man behind the curtain." For all the reasons Mr. Kristof has written we need more courage, heart, and intellectual prowess to lead us forward on health care and so much more.
Trump and all down-ballot Republicans are vulnerable over the issue of healthcare. As Mr. Kristof points out, the Trump Adm. is pursuing a lawsuit to declare the entire ACA un-Constitutional.
Donald, being a savvy politician, has asked his Justice Dept. to hold off until after the election. It's the pinnacle of hypocrisy because he knows it's a loser for him.
Trump and the GOP want to M.A.G.A. by bringing back those cheap, skimpy health plans with high deductibles and low ceilings, aka. "Bankruptcy Specials" that were banned under Obamacare. That, in a nutshell, is Trumpcare.
1
Still another reason to finally kick that kook Sanders to the curb and start looking at candidates who understand the challenges and who have an actual workable plan that will get thru Congress. The debates we are having now are ridiculous and counterproductive.
Why do you think Bernie has such strong support? For every 500,000 Americans that go bankrupt because of medical debt each year or the millions that get surprise medical bills there are 4-8 direct relatives who suffer with them. Take this times 20 years of greedy 'for-profit' medicine and it becomes a tidal wave.
The amoral and immoral republican cult who cast their vote to support the 'king' in the senate have denigrated the founding fathers of our land who were bathed in the Scottish Enlightenment. Our country has become a country of lies and many citizens can see this.
Will there be enough to put a stop to the authoritarians?
1
The Evangelicals said recently Trump is profoundly immoral. When you let a billionaire in office they are already out of touch with 99 percent of the American population. The Grand old Polluters/GOP supporters must have money to and don’t need to be on Social security ,Medicare or Medicaid.By showing they have no affordable health care for all America by now the GOP just will show they won’t ever have it for us in the future. Wake up supporters you have been taken advantage of again.
Mr. Kristof touches on just a few aspects of the damage Trump has done to the nation's health. Our watchdog for everything from high tech medical devices to chicken processing plants is the FDA. Trump scaled back its activities in 2018, and they continue to plummet. See Charles Piller, Science, Jul. 2, 2019, for the details. No wonder the rest of the world is hesitant about buying our farm products! https://www.sciencemag.org/news/2019/07/exclusive-fda-enforcement-actions-plummet-under-trump
Speaking of "moral morass" & "soul", can somebody explain how people who call themselves "pro life" are not leading the charge for universal health care but are actively opposed to it?
2
DJT calla critics “wise guys” and yelled “take her out” about the Ukraine ambassador. His interest in health is as real as his orange makeup. The insurance companies will cry crocodile tears about their employees losing their jobs if they no longer can hire people to find reasons to refuse care. The fake meme about people happy with their insurance ignores the unemployed and disabled. Next time Trump has a doctors appointment maybe he can try driving a 20 year old car to a clinic in W VA, like so many in his “base.”
2
Yet we will vote for Trump again. We will get what we deserve.
Please look objectively at the health CARE situation in the United States. For just once, try to filter out the journalistic sensationalism and advocation of narrow minded agendas.
...
The actual health care in the United States is very, very good.
As we continue to add more and more and more people to Government Programs.....for some reason.....the cost of Health Care keeps rising! Am I wrong?
....
Another observation is that various Unions provide health CARE....not insurance....but actual health CARE.....locally to their membership. Likewise.....Massachusetts....(remember how we were instructed to mock RomneyCare?)....has its own successful LOCAL health care system. And again...in San Francisco.....there's locally funded Health CARE for all residents.
....
I conclude that Mr. Kristof is advocating a very wrong-headed solution.......National Health Care is an epic fail.....already proven. The Federal Programs are rampant with corruption. The cost of ObamaCare INSURANCE has broken the Treasury and created a huge burden on the National Budget.....worse.....its not working.
It seems to make far better sense to eliminate the mindless crusade towards an obsolete idea ... and instead encourage local governments to provide more services.
1
I was in Rochester, NY's ED's two times in November-before the peak of the flu season. In one I sat in a hallway for 8 hours and they performed procedures where there with no privacy and had me give urine samples in a dirty public restroom. When I was finally admitted because of a septic blood infection we walked through the main ED room. It looked like we were walking into India. Obviously sick people were crammed all over the place. Nurse's were exhausted and wait times to see doctors was long. If you think the US is ready for an epidemic you are sorely mistaken.
1
"At this festive season of the year, Mr Scrooge, ... it is more than usually desirable that we should make some slight provision for the Poor and destitute, who suffer greatly at the present time. Many thousands are in want of common necessaries; hundreds of thousands are in want of common comforts, sir."
"Are there no prisons?"
"Plenty of prisons..."
"And the Union workhouses." demanded Scrooge. "Are they still in operation?"
"Both very busy, sir..."
"Those who are badly off must go there."
"Many can't go there; and many would rather die."
"If they would rather die," said Scrooge, "they had better do it, and decrease the surplus population."
— From Stave One of "A Christmas Carol"
(Charles Dickens, 1843)
1
Our employer based healthcare system is without a doubt, ludicrous. Your health insurance should not be contingent upon your employment. Everyone should have the option to buy into Medicare. Not free Medicare, but a buy in option to compete with the big five. The CEO's of the big five make tens of millions of dollars per year while their companies deny care. The more care they can get away with denying, the more money they make. They bribe politicians to perpetuate this shameful scam.
1
This is spot on: America pays more, for less effective health care, than the rest of the world. Everybody else offers universal coverage, gets far better results, and pays less. And we have the corner on the world's medical bankruptcy.
AND YET, you slip in the Times's required slam at Medicare4All. Every other advanced nation on the planet has better cheaper care that features universal coverage, and you explain that they use different systems to get there. How is it then that you can continue this chant against M4A? Get out of the way! We can do what the rest of the world routinely does, and if we choose to go via M4All, well so be it.
Good column Mr. Kristof.
But loose the chant. We seniors are not afraid of Medicare, and it is our coverage. Don't be afraid. We'll explain how it works for us.
So, again. Get out of the way.
1
Don't forget eyeglasses. Medicare and Medicaid don't pay for eye exams or eye glasses. Do you feel safe on the roads knowing there are people who can't afford new eyeglasses driving around half blind?
I saw that in India there is a program, with the help of the US, that provides eye exams and eye glasses to people for two dollars a pair. Why can't we have affordable exams and glasses in America?
2
How much money should you have before you have a child in the USA?
How much does it cost to properly raise a child in the USA per year?
This could be very helpful to know. Maybe you could put this information in your column.
1
Thank you. Keep the light pointed at this shameful problem.
Good column. The USA is just a total sham and lie, unless and until it decides to catch up with the rest of the world. it's had decades to do so, and simply fails to function and govern itself properly. The hubris is nauseating - USA needs to get its act together or cease to exist.
1
The same thing as Making America Great Again. Vote GOP to ensure up is down and war is peace.
Medicare for all. Single payer. Universal coverage. All get labeled with some sort of 'ist' and is DOA. Maybe a name change is in order. How about a 'you'll never have to rely on a go fund me page for youer medical needs.
When you talk about the Corona virus and pandemics why do you ignore that Trump eliminated a White House level department to deal with exactly these types of problems?
1
Why has the republican party been unable to offer the fantastic healthcare plan they've claimed to have since Obamacare was born? Is it possible that they have no clue??? I'm shocked!
Of course Trump makes our health care worse. He makes everything worse. Everything. Hospitals are legalized thieves. Doctors are legalized thieves. It's money,money,not health care. Medicine,and big drug companies,more of the same,money not health. Trump's government? Incompetence and money for insiders.
1
Here's a crazy idea - take profit out of all aspects of healthcare delivery.
Nobody should be profiting on people's lives, let alone their health and well-being. If you think about it, the healthcare industry is virtually cannibalistic.
The reason American healthcare provision is so pathetic is that our elected representatives sold out Americans for gratuities - campaign donations and otherwise.
1
Mr. Kristof. Thank you.
There are lessons we can learn from this coronavirus crisis. Initially, China was trying to hide the news of the outbreak - a transparency problem. China did not want the outside world to know about the virus.
To see cuts been proposed in the budgets of Medicaid, NIH and CDC, is nothing but reckless. To do so, is to assume complacency that all is well here in our country. Can we say, an outbreak of the coronavirus magnitude cannot happen here? There are trained and skilled professionals at the NIH and CDC, providing valuable expertise and guidance to everyone. The government should be investing in research and development in health and technology. Areas that have benefited our people and country, and other countries. That has helped us to be prepared, maintain the awareness and have a better system and organization. In fact, there a few medical professionals in the WHO team helping China. When we have trained professionals, that not only benefits our country, but, around the world as well. We see the problem right now in China, that is impacting the entire world.
But Bernie Sanders and Elizabeth Warren if elected would work tirelessly for universal healthcare-just what we need and in a form that would save millions. You wring your hands over Bernie's success and front-runner status because you don't think he can win and/or that his plans would fail if he did. You want to have it all ways at once.
2
"What matters is the universal part." Yes, but not quite enough to be effective. What really matters in the end is affordability. High cost universal "coverage" won't help struggling people very much. And if by some impossible magic, in theory health care costs could be made affordable without insurance, universality would matter much less.
Insurance executives make obscene amounts of money, while many people (especially those who do not get health insurance through their employer - yes, there are many who don't) struggle mightily to pay for insurance and then get very little in return. Health insurance should not be a for-profit business.
3
There has been plenty of talk about US health care. That is one the biggest topics in the Democratic primaries. Defeatist quips about Medicare for all fall into the NYTs mantra that Sanders must be stopped by a realistic moderate Democrat. His supporters and their surging campaign beg to differ with Kristoff. The ACA was running out of steam when Obama's 2nd term was ending. Insurance companies were pulling out of the ACA insurance market. With Trump insurance companies are tending back to their impervious overly expensive ways. The US spends vastly more money on health care than any other country yet, as has been said many times, it has the worst medical outcomes. Trump has made it worse and proposes to cut funding to Medicaid and other important health care institutes and programs. Trump is about tax giveaways to his rich cronies. In his mind if health care suffers so be it.
2
Political deal making is messy, but in the case of the ACA, trying to keep the insurance and healthcare vultures happy instead of just putting everyone on Medicare, or a one payer government program was the chief failure.
Eventually a vast majority of Americans will realize that even with its faults ACA was the beginning of much needed improvement and the GOP will collapse as they did with Social Security, Medicare and other worth while programs that they fought to kill in the crib.
These will be some of the uniquely "American Freedoms" taken away by the ACA and ultimately Medicare for All:
1. The "freedom" to go bankrupt and lose one's home because of a serious illness or accident in your family.
2. The "freedom" of the insurance vultures to deny you insurance, or cancel your policy when you get sick.
3. The "freedom" for taxpayers to pay the $2000 when the uninsured go to emergency rooms instead of $100 for a doctor visit.
4. The "freedom" of the nation to spend 17% of GNP on healthcare, with poorer results than every other industrialized nation who are paying only 10%
5. The "freedom" to keep uninsured children from receiving the early care that might prevent us from having the taxpayers support them for the rest of their lives.
6. The "freedom" to keep working in the same dead end job because your very sick wife, husband or child will not be covered by a new employer's healthcare policy.
3
I would love to understand what happened to coverage for dental care since the 1980s. That sees to be the time when employers started having their employees chip in to pay for their healthcare premiums and dental care started to disappear from healthcare plans. I paid nothing towards my insurance except a $15 copay for a post and crown in 1985. Today I pay 1/2 of my premium though I work for one of the largest employers in the country and I just had to shell out $1,300 cash for a post and crown. Why aren't insurers including dental anymore? Why aren't they including eyecare anymore? Premiums keep going up and coverage keeps going down. It's time to fix the system and only the gov't can do that. Bernie all the way.
1
What's amazing about this column is that Kristof describes all of the problems with America's heath care system in the same way that Bernie Sanders describes them; yet Kristof argues that Bernie is unelectable. Makes no sense.
4
What the Obama administration ACA accomplished was to give the corporate private health insurance industry control of health care delivery in America. A template where those that have the financial means can buy into health insurance plans with the fewest restrictions and widest access to medical providers, ancillary health services and goods. It’s a system where health care is an operational marketplace with health care a product offered to consumers. Health care has become less and less about the doctor/patient partnership and more and more concentrated on what insurance coverage will allow. Bottom line, America a country where those who can afford it get the best medical care.
2
ACA has all the problems you mentioned. Yet I couldn’t get coverage because of preexisting conditions. So, that alone made it a Godsend. I would love to kick the blood sucking parasites (aka as insurance companies) out of the equation and de-corporatize healthcare. But ACA was at least a small step in the right direction, because it allowed me to get coverage. IT also helped some 40 million Americans get covered. Now its time to raise the bar.
4
Dental therapists cannot provide care "more cheaply" than dentists can. Overhead for a dental practice is no different for a dental therapist than it is for a dentist, and care is compromised because dental therapists receive at best perfunctory training with little understanding of oral medicine. Data from states such as Minnesota who have licensed dental therapists show that they are not working in underserved areas but are in cities where they must charge what dentists charge to cover overhead. A more meaningful way to address the high costs of dental care might be to address the high costs of dental education ($400,000+ per student) and employ more hygienists in public health settings to educate patients on oral hygiene and nutrition so there is less dental disease in the US.
2
Why has no one proposed that all members of Congress (plus family who benefit) who oppose universal healthcare immediately lose their government paid healthcare? Perhaps if they had to experience real life and try to buy healthcare insurance on the open market we’d see a change in their opposition.
5
Why can’t we lower the Medicare eligible age one year every 3 years and eventually all will be covered?
3
After 20 years in the US I still cannot understand why Americans hate a single payer system. I hear 1. they don't want bureaucrats to decide on health care, 2. think it's going to raise their taxes and 3. don't want to be "forced" to buy healthcare. Yet many times a year they have to call their insurers to verify that a proposed treatment or medication is covered for themselves or a loved one and failure to do so incurs important financial implications. Are the private call center underpayed employeees any better than "bureaucrats"? And if they take the cost of their expensive coverage plus it seems the endless list of extra costs I guess that is more than what would be the taxes on healthcare especially that with universal coverage the prices could go down. Finally they buy car insurance because they are mandated to do it. Is health less important than a car?
6
A letter in my local paper described an elderly American's experience in Britain when he suffered stroke symptoms then received expert care that required a three day hospital stay and was charged only $2000 dollars. (It would have been free if he were British).
This is part of what he wrote:
“There I remained for three days and two nights undergoing many tests, including an MRI. When I rang the help bell, an attendant was there within five minutes. The printouts of my tests, a dossier about one inch thick, were presented to a team of doctors headed by a world-renowned authority on strokes. The whole team came to my bedside and explained the results. It was atrial fibrillation, not a stroke. I was not discharged until I had been examined by three therapists speech, occupational and cognitive”.
As an American healthcare investor I find this incident very disturbing. To maintain the profit margins,that make me rich, my investments in hospital, insurance and drug company stocks, require that $2000 dollars cover the in hospital cost of about 4 Tylenol tablets and that the care he received, cost him or the taxpayer, about $160,000 dollars.
If America were to provide health care without obscene profit how could we pay hundred million dollar health care company CEOs salaries, and how could those health care companies and CEOs pump millions into our elections and political system?
All that expert health care at such a low cost seems to be very "un-American".
6
If you have health insurance, you can get still be denied appropriate health care by your insurer, get hit by crippling "surprise" bills, and pay a significant part of your income in premiums, co-pays, etc even if you are healthy. But even before those problems is that it can be impossible to get health insurance even if you can pay for it. My adult son is self-employed, bought health insurance through the NV health insurance exchange, paid for six months up front, and then was terminated without notice for "late" payment (not clear why payment was deemed "late.". They will not reinstate him. He cannot buy health insurance again until Nov. except for short-term insurance (very high premiums, little coverage) and even that for 6 months with no renewals. It is 8 months from now until Nov. So you have a situation of someone who wants to have insurance, can pay for it, and cannot buy it. The health insurance industry has just substituted the scam of "late payments" for the scam of "pre-existing conditions" in order to deny people health care.
11
Nicholas,
There is currently alot of money spent on US "healthcare", the problem is that this money is siphoned off by the very providers. Usually, by simple greed to place more profits in their pockets. Especially, the US Health Insurance Industry, Hospitals, Physicians, Pharmaceuticals, and Medical devices that have all learned how to play the game. Our Government Representatives are paid by Lobbyists to enrich themselves and ignore or pass needed legislation, but in doing so the American citizen suffers irreparable harm.
This brings us to an unfathomable consequence, that we spend more than any other nation with worse outcomes. The reality is that too many Americans have no access to healthcare and die much too soon. Worse is that we have all become overwhelmed and complacent.
2
After promising better and less expensive health care for all Americans, all the country actually got was John McCain’s thumb. And it’s fortunate that that thumb was there. The republicans have no health care plan beyond that identified by former congressman Alan Grayson...first, don’t get sick, and, second, if you get sick, die quickly. And as for the Trump plan? Really? The most productive action the Democratic House could take RIGHT NOW would be to take the existing ACA and, by modifying it, make it work for everybody. The drawback is, after having cleaned it up, the Democrats wouldn’t tell anybody about it...
3
Sometimes what i feel is even more basic than what I think I feel even if the words I use are identical. I saw off to the side that the administration was very confident about how to deal with the coronavirus. I literally felt terrified in seeing that. I can say that I can't imagine them doing anything competently, let alone morally. It is another thing to actually feel it at such a basic level.
3
Yes its the costs that allow the increase. $50,000 for a procedure thats $5000 in France.$6000 ER bill for a headache.etc. Drugs costing anywhere fro $40 t0 $400 dollars in same town depending on the store.
1000 lobbyists in DC working every day to assure this.
6
I am so glad that Mr. Kristof mentions the poor state of dental care in this country. So many people lack good dental care, and this is not about having a perfect smile. It’s about health issues, such as infections that can lead to heart disease, for example. There is a false separation of the dental and medical worlds in the U.S. and it’s all about turf wars and profits. I recommend highly a book about this. It’s called Teeth, The Story of Beauty, Inequality, and the Struggle for Oral Health in America, by Mary Otto. I had an uncle, long deceased now, who advocated for national dental care insurance and suffered professionally as a result. Let’s hope that someday everybody here need not suffer from intractable oral pain and embarrassment.
11
Why not drop the term 'Universal Healthcare' which the System seems to consider toxic, and call it 'Vital Defence', since Defence rings positive in most ears? If ill health is the common enemy of us all, any system to fight it, is the real Defence Establishment, not all the multifarious and ingenious instruments of War guaranteed to destroy us and our planet in a jiffy, to develop which, the human race so unthinkingly devotes such a large proportion of its wealth. If we reprioritise and clamber out of the box, much of the mindless waste/ unnecessary pain that Kristof regularly draws our attention to, could be avoided. What a vastly superior quality of life would be available to everyone everywhere. Something devoutly to be wished for ... and campaigned for.
3
Reading this essay from Kristof has a vibe of Ground Hog Day; once again we have an analysis of a problem that is born of the same old, heavy over reach of the business class against the lower classes.
Kristof opines that moderates don't need to fear Sanders because his Medicare for All has no chance of passing Congress and getting to the president's desk for a signature.
In any case, what is unnerving about Sanders is his willingness to call a spade a spade; healthcare is costly because there are too many extra, ancillary service / administrator types feasting at the same trough the patient must feed at. It is a scary prospect that if Medicare for All were to pass then there would be lay offs of an "administration class" that provides no real functional health value or service to the system.
Perhaps some of them will need to retrain as medical workers to address the greater demand for medical service since it would now be readily available to those in need.
8
Why is there not more discussion of the cost of health care and more of an effort, legislatively and otherwise, to do something about it? I suspect it is because, one, there are such large constituencies profiting from this mess (doctors, hospitals, clinics, drug manufacturers, equipment makers) and because it is considered to be one of those intractable problems that no one knows how to solve. Yet, solve it we must.
During the disastrous "debate" about Obamacare, almost no one mentioned that we, as a nation, are collectively paying for great health care right now. The question, then, is how to allocate, and reduce, that spending while getting access for 99.9% of citizens rather than just the wealthy or those who have good insurance through their employer. The opposition is centered around two factions: those who fear losing the good deal they have now and those too self centered to care about anyone but themselves and their immediate family.
Because we collectively failed to understand the roots of the controversy, we also failed to come up with a way to make a new system work for all. So, years later, we are still trying to realize that the most important improvement in American lives, as lived day to day, would be access to health care without financial destruction. Still.
7
Healthy people are more productive citizens and taxpayers. The money saved by denying Americans affordable health care is spent on disability and other programs that support those who cannot work.
2
The defensive positions of those of the ilk of Trump and Republicans lies primarily in the American hubris. We're number one. Too many Americans simply cannot understand that the US has been running on momentum for so long that it approaches a mythical condition. The US is not a democracy but an oligarchy. The US is the only country where elections are paid for and representatives owned before being elected. The absurdity of the American condition is best seen with Bloomberg. He boasts of not taking any 'big' money from anyone, of not being beholding to anyone, of dealing directly with the voters; and then there he is, buying attention by the hundreds of millions of dollars. In the more advanced and truer democracies like Great Britain, Germany, France, and Canada, most oversize contributions to political campaigns are against the law. In the US system it is all about entertainment and money. How perverse? How treasonous?
The main oligarch that is ruining the health of the average American is the health care insurance industry. Regardless of whether or not doctors get paid too much, education costs too much, hospitals market their services beyond providing them, or pharmaceutical costs are too high; the insurance or administrative part of the equation costs five to seven times as much as it does in our peer nations. There is absolutely no worthwhile aspect of private, for profit, administration. The CEOs of these companies make almost half a billion a year.
5
This from the column:
"When their teeth rot, they suffer constant excruciating, debilitating pain..."
The care of teeth is one of the great failures of health care. Rotting teeth not only cause years of pain, the bacteria grown and released into the body is believed to have enormous consequences for general health. Heart disease and cancers are linked to bacteria in ways that haven't been fully explored by science and medicine but there is little doubt that there is an important connection.
Medicare does not cover dental work. Why? Probably because the cost would be too high and the use too widespread.
I have read that 25% of citizens over 65 have no teeth. None. What happened? Diet loaded with sugars of course is one factor. Another is neglect, of teeth in earlier stages of rotting away. Preventative care can save teeth, giving the person a longer, happier life and potentially stopping diseases.
No, I am not a dentist, nor a doctor (nor do I play one on TV). I write this comment based on reading, information picked up from people I know and visits to my own dental professional.
That people lack access to care is evident in the hundreds, even thousands, who show up when "come one, come all" free clinics are offered around the country.
6
Mr. Kristof,
I listened too Tightrope and was gutted, bought the book and the pictures made me cry. The people in your book are the people I see in my practice on a daily basis.
I am a 50 year old Family Physician from Missoula, MT and new CMO of a FQHC. I took the job, in part, because I feel this is one place in our medical system I can make a local but significant impact, probably naive.
Thank you from the bottom of my heart for writing about these issues. I keep articles like this and have marked up Tightrope, hoping somewhere in this excellent reporting there has to be a solution, a simple thing I can do that will change the arc of a patients life.
Humbly,
James Quirk
PS. See you in a few weeks in Missoula.
6
Why the silence on the role of insurance companies? Insurance companies make profits by: (1) recruiting low risk customers, (2) charging the highest premiums the market will bear, (3) and when accidents happen, seeking to have someone else pay, paying as little as possible, or not paying at all. In the case of health insurance, it employs armies of people authorizing medical acts recommended by doctors (None of this in the NHS. When I lived in London, my doctor received a handsome yearly bonus when the health of the patients in his surgery improved). It also employs thousands of lawyers charged with shifting the responsibility to pay damages to others, or not pay at all.
Insurance companies contribute greatly to the yearly $10,000 per person health-care cost per person, while leaving millions without insurance at all, and more millions with inadequate insurance. Insurance, and pharmaceutical companies, and many doctors, have the power to maintain their grip extracting profits from the health industry, all of us. That is the political obstacle. Is it unmovable?
6
Let’s start with the elephant in the room. That we spend an inordinate amount of money on salaries for people who do not interact with patients. The growth of hospital administrations in these “not-for-profit” profit-driven health systems is a runaway train that local governments don’t have enough power to negotiate with. Hospitals are the largest employers in many American cities. Hospital systems have *zero* interest in controlling healthcare costs. They just want the largest piece of the pie they can negotiate. These health systems should be mandated to report what percentage of their salaries go to people who don’t take care of patients.
6
Kristof’s comments that it is imperative we gain universal coverage for medical and dental care (I completely agree), after saying that Medicare for all won’t be achievable.
I wish he would clarify what he sees as the difference between the two.
I personally believe proponents of universal coverage should “market” it as “universal coverage of ESSENTIAL medical and dental care” and display an unemployed 6 month old with pneumonia and a 4 year old with a severe toothache as (literal) poster children.
My hope is that after a “minimal” universal program is implemented, most people will say the equivalent of Carlton Heston’s notorious, “they will have to take it from my cold, dead hands”.
Stephen Rinsler, MD
(Toyota Corolla owner)
5
@Stephen Rinsler -- I've long opined -- only half in jest -- that our political leaders should be required to take for themselves, for life, the average American's benefits package.
We'd get universal health care and defined-benefit portable pensions so fast, it'd leave a sonic boom.
5
Apparently our de facto criminal health care system is not criminal enough for Trump.
He wants to eliminate the pre existing condition mandate, add more exceptions to make existing policies useless and make billionaire HMO, big pharm execs more money off the health of the average citizen.
6
What I find depressing is voters continually vote against their own interests. Most Americans are aware there is something broken about our health care system, but they don't seem to make the connection between their representatives in the House and Senate with why that is. Until voters wake up and force the issue (not just healthcare) it will remain a morass.
6
Union members who vote for Bernie must have lost their marbles. Or perhaps the unions' limp response to Medicare for all is the problem. Those of us who have paid into union based benefits for the whole of our working life suddenly have to wonder, what now? Disposing entirely with the ACA is clearly throwing out the baby with the bath water.
For goodness sake show some mettle, unions. Or you're in a death spiral.
@Marion Francoz. Your post is a neat illustration of what ails us: “I gots mine, too bad about the rest of youse.” You may want to consider that the cost of your insurance represents income that would be yours, to purchase an overpriced, unreliable product.
2
Dear Mr Kristof,
Your next “win a trip” event can take place here in the good ole USA with stops across the country to interview regular people, health care providers, industry executives, and government officials. For fun and emphasis you can also include a stop at the home of the wise oracle, Michael Moore.
2
While the Republicans controlled all of Congress, Trump literally shrugged his shoulders about their inability to pass any legislation to improve healthcare.
6
Trump is making health care worse. However, let's not put all the blame on Trump.
Republicans have campaigned on repealing the ACA. Paul Ryan has a self claimed goal of eliminating Medicaid. Several states are now in court trying to get the ACA declared unconstitutional.
Since Trump has become president, he has gotten the blame for things Republicans would be doing if Trump had never been elected. For example, the Trump Tax Cut could have been just as readily called the Bush or Rubio Tax Cut.
2
Blaming Trump for the current American Health care system is like blaming him for the sinking of the titanic. These kinds of biased opinions are only going to ensure the reelection of Trump by a land slide. Exploiting the spread of Corona virus in the far east to blame the health care system we have will only elect a socialist Democrat to be the nominee of the democratic party, only to be defeated by Trump in the general election.
Problem with our health care system is it needs fine tuning to ensure health care for all. It does not need an overhaul or repeal. Any candidate who tries to tinker with medicare for all above 65 will be defeated by a large margin. So stop the nonsense about medicare for all ages because it will only ruin the medicare for all above age 65.
2
Perhaps the most important lesson to be learned from this is that Trump is simply playing the usual game that Republicans play. Enact large tax cuts for corporations and wealthy individuals, and then, after realizing that the cuts aren't going to pay for themselves, start cutting social programs to pay for the enormous deficit created by the tax cuts.. We've seen that played out over and over again since supply-side (trickle down) economics first raised its ugly head during the Reagan years. And here we are again with Trump's proposal for drastic cuts in Medicaid, the NIH and the CDC to help pay for the deficit he created.
4
Yet more handwringing about this awful state of affairs. How can Americans be against affordable health care for all of us, many ask. How can Trump voters be against this? After all, their kids get sick too.
The answer is surprisingly easy - race. Trump voters (whose voices are the only ones that matter in Trump's America) will gladly go without affordable health care, as long as other folks, you know, brown skinned Americans, have to do without as well. Trump voters would rather see their own children die from serious illnesses than to think their brown skinned neighbor would get access to the same health care they do.
As one Trump voter complained to the Times, "He's not hurting the people he's supposed to be hurting." And understand Trump is not driving this train. It's his voters. They think that they are the only citizens "entitled" to affordable health care. The rest of us, according to their racist views, aren't "worthy" and are getting "free stuff".
And since even this far right Supreme Court would have difficulty rubber stamping a whites only health care plan, this means that all of us will suffer, indefinitely. But make no mistake, if Trump voters (and by extension, all Republicans in Congress, and of course Trump himself) could see an affordable health care plan only available to them and not to the rest of us, they would vote for it in a New York minute. And they'd drop their private insurance at warp speed - you know, the insurance they claim to love so much?
6
Each one of these editorials that I’m reading in the New York Times remind me of the parable of the blind men and the elephant: one of the men is holding the tail claiming that this is an elephant, the other one is grappling with its trunk has decided that this is the elephant. Another man is cradling its leg confident that this is the elephant. In fact they’re all the elephant! And this way everything that Donald Trump is destroying whether it’s healthcare, or national security, our rule of law, or our American way of life are ALL part of a devastating problem and national nightmare which will only be resolved when Donald Trump is finally removed from office by any legal means possible .
4
Nicholas,
The elephant in the room is liability. We doctors are subjected to unlimited liability and so there is widespread 'risk management' which inevitably trickles down to who gets what kind of care. The worst is that there is really not the doctor shortage that you imagine but a fear that every treated person is a potential threat. Keep in mind that most of us would give a day a week, at least, of free care if we were indemnified somehow against legal threats. That, of course, will not happen.
5
Vietnam Nam and now the Mideast. The difference being that JBJ had the FDR thing going minus the overt racism. No one of his stature as a legislator has been on the stage since his early exit. He was reviled for his mistake of escalation but he not only gave the country programs that benefited everyone he predicted the future: The Southern Strategy. What we need in politics today is a sausage maker. Not one in sight. Democracy is taken over by virtue signalers afraid to get their hands dirty, backed up by social justice warriors who mistake purity for politics. If Bernie is what he appears to be: a fire eating Jew from Brooklyn who’ll take no prisoners, he would win in a landslide. Unfortunately, he didn’t see his act leading to where it is now and he doesn’t have the legislative skill to accomplish much by himself. The corporate Democrats are too scared to jump in to give him a hand. They have forgotten what it means to be a Democrat. With the choice they would offer, it makes sense to disengage and wait for things to get worse, because they will. By that time, maybe a legendary figure will emerge.
2
you're absolutely right about health care professionals perpetuating the financial improprieties.. just look at physician staffing firms vehemently defending surprise ER MD bills
2
You are so right! We need to get back to talking about affordable universal care, including medication, eye and dental care. The label can be debated soon after. I thought “Obama care” was a stepping stone? If those candidates for president & congress only talk about that kind of care they are spinning their wheels and aren’t ready to support what the people of this country need. As for me, I demand it!
How hilarious to blame Republicans for ridiculous health care costs. People come from all over the world to become healthcare professionals in the USA, precisely because it's so bloated, cumbersome and massively expensive-- all of which enriches the insiders at the recieving end of all that money and red tape. Our healthcare system has every bit as much greed and cold ambition in it as Wall Street. And most of the upper middle class professionals and immigrants in American medicine are Democrats.
The article states that "Rich Americans live 20 years longer than poor Americans, and low-income American men have approximately the longevity of men living in Sudan."
The really sad commentary here is that it is the low-income, short longevity American men who are voting for a 73 year old billionaire who doesn't care if they die young.
5
Speaking of the coronavirus and what this country should learn from it:
I am in favor of a Constitutional Amendment to go into effect immediately clarifying the circumstances under which Presidents can be removed from office; making it crystal clear that the House and Senate may, by acting jointly and by simple majority vote, expel a President from office for no reason at all, without any further trial or right of appeal, acting under the well established and frequently utilized rule for achieving a happy life, “Happy and relieved is the one who rids himself of a great pox.”
1
David Cutter knows a few things about health care costs: https://www.help.senate.gov/imo/media/doc/Cutler.pdf . Without getting a handle on our administrative overheads (including time spent for compliance), we have very little chance of making a dent.
This does not mean MCR ffor All but without federal involvement we are sunk. The breakdowns in this area, according to Sutter, include: claims submission, eligibility and benefit verification, EOB forms, and claim status and payment inquiries, and more.
Yes, almost all elements of healtcare are oversold and overused in the US. They have been for a long time. Doctors and hospitals are culpable in this longstanding problem. But if we do not get a handle on the insurance overheads with reasoned federal involvement (and they have not been so good in the past), we are doomed.
2
@JSK
Sorry for misspelling Mr. Cutler's name so many times. Hope it is just carelessness and not my age.
The medical profession is, in my opinion, the biggest example of an industry where America ruthlessly protects itself from 'foreign labor' and 'globalism'. Guess what the result is? A laughably worse level of health care than we should have based on the country's wealth, at an incredible expense.
It actually makes so much of our political discourse (particularly on the right) sound like a joke.
1
I am medical drop out. After 2010 it became much harder to see the doctor even with insurance. One doctor I saw had every patient sign an agreement to pay whatever the insurance company didn't cover. That should be illegal, period.
Then, in 2013 I was downsized. I fell off my bike, cracked my helmet and was unconscious for a few seconds. I was cut up and bleeding. I didn't bother to go for medical care. I had a concussion. It took four months for the symptoms to subside. I couldn't see going to the ER or a doctor when I wasn't making any money and I couldn't know the cost in advance. So I lived through the nausea, the dizziness, the sudden loss of balance without seeing a doctor.
Now, even though I have a job and insurance I can't see picking out a primary physician, wondering how long that physician will be on the plan, going for any tests, etc. Why? Because I know that my health is not important to the insurance company. Their bottom line is far more important as is the salary they pay to their CEO. And the $6000 deductible is not a good idea but it means that I don't have to pay for the insurance.
Only in America is access to decent medical care when and where we need it a luxury.
2/22/2020 8:20pm first submit
9:25pm second submit
8
We have the government unwilling to govern for the people.
The population is indoctrinated to believe that any social service, be it health, education, public transportation, and quality childcare is the bad monster, Socialism, it will come and eat you. Capitalists are fearmongering to hold on to their wealth, and they choke on their money and still, they don't have enough.
As long as healthcare is just a big corporate for-profit industry nothing will change.
We need a government with the will to change that, only Sanders and Warren have the devotion and the will to do it.
2
You mention hpv vaccination rates in other countries...well many of our google/Facebook savy mothers are terrifed of hpv vaccination bc of false information on these media platforms. As a primary care physician, it is EXHAUSTING to argue against their fixed, false beliefs against the power and effectiveness of vaccines. In the last week two weeks, several moms have declined both meningitis and hpv vaccines for their 11 year olds despite my guidance in favor of them bc “the school doesnt require them” and “they dont know enough or havent heard about them”. Yes, you’ve never heard of meningitis bc its not in the news ladies. So americans need to take some responsibility for when these infections-like meningitis-and the resulting morbidity return.
3
Kristof and most Times Opinion columnists are apparently ignore the following recommendations that improve the health and the opportunities for success of all Americans
1. obey the law and don't get a criminal record
2. don't abuse drugs or alcohol
3. get the best education and work skills possible
4. don't have children before you can support them
5. don't consider yourself a victim since that gets you nowhere
The failure to follow these recommendations is harmful to one's health and opportunity of success in any country in the world.
2
Our “system” wants to maximize death-to get rid of the chronically poor and chronically ill, AFTER the ill have spent down their life savings,-putting it in the hands of the likes of the Sacklers. The 21st century will be known historically as the century of greed. Trump’s system is to privatize vast pieces of the economy for pennies on the dollar go the US but substantial commissions to him. His foolish followers fail to see that (1) a “smaller” federal government just means that some loyal friend or family member of Trump has taken over with no accountability and (2) he’s stripping the USA of the assets that support the full faith and credit of the dollar. Only hard assets will have value in the future and Trump loyalists will own them all. He is the much feared deep state.
3
The present US is a sham! I am a US citizen in Denmark and All my US friends and relatives are dumbstruck when I tell them how it works here and how little it costs per capita compared to their US systems. Americans have been brainwashed into believing that Medicaid for all is impossible.
The US healthcare system is overpriced and confusing. This limits the security and mobility of the US workforce. I have learned from my 40 year stay in Denmark that the freedom and security that universal healthcare (and education) give to every danish individual is cheaper for government and better for the bottom line of any country's GNP..
6
Sadly, Obamacare has not solved all these problems; some of my friends simply can't afford it, and one plan that my friend could afford has an outrageously high $6500 hospitalization deductible. For the elderly, Medicaid is almost impossible to get unless you are absolutely destitute. And if you do have a little money, you are in great danger of someone seizing guardianship of you and your estate, stealing all your possessions, kidnapping you and forcing you into a nursing home. If they don't steal everything before you get there, when you're there, they'll go after everything you have. This newspaper reported a case where nuns (yes) were trying to steal a couple's money through guardianship because they thought the husband wasn't paying enough for care for his wife.
1
Blame Trump? Let's put the blame where it really belongs. On American citizens.
3
IF THERE IS ANY PLACE WHERE TRUMP IS VULNERABLE, It's healthcare. Trump is the worst possible face of the GOPpers, throwing people in need off of health insurance, including children, as well as those unable to pay, the disabled and the chronically ill. The objection to his healthcare policies cuts across party lines as well as ethnic and religious groups. Trump's message is clear: He's given a $1 trillion dollar tax cut to the 1%, while slashing healthcare for the 99%. He's set to give another $1 trillion to the 1%, while slashing programs further for the 99%. Trump's policies will result in a sharp increase in illness and deaths among the 99%, while the 1%, who do NOT need any more money, leave alone access to healthcare, will be socking away money stolen from the 99% to increase their vast wealth. Trump is, by these policies, pushing war of Reagan against the middle class, to its ultimate goal of eliminating the majority of people in the US from a livable existence. Trump deprives We The People of our unalienable rights to Life, Liberty and the Pursuit of Happiness. A vote for Trump is a vote for the death of the middle class! What will the 99% do if they're the only ones surviving Trump's policies? There would be only 3.334 million people left. Who will provide the goods services for the 1%? They'd have to bring in foreign workers.
3
What Obamacare has proved is that the individual market has failed. About half the country is under a Government paid plan at much lower reimbursement rates shifting more costs to the private market. The court case on the individual mandate has nothing to do with the employer mandate, subsidies or the rest of the ACA
Corona virus? CDC budget? Your piece is simply a shameless plug for Medicare for all. Change the title
Cost, universality, access, no system provides all three, take a closer look at the Canadian and EU models, Americans expect medical care on demand
If you think the American system is expensive now, just wait until it’s free.
1
Trump makes everything worse, unless you have a very large portfolio and no conscience. If you have a large portfolio and conscience, and many do, you have to be deeply troubled.
1
China needs to end the cruel live animals markets where the virus was born. This affects the life of the world. The environment - the species going extinct bc of these cruel and inhumane practices. The virus is here. We can’t ignore it. We can call for a worldwide outrage against selling tiger parts, wolf pupils and the almost extinct pangolins.
These creatures make up the beauty and incredible diversity in the natural world. Elephants - here so long before us- almost gone.
This is a wordwide problem. Perhaps Karma hits us all.
1
It's kind of ironic that Trump wants to make healthcare worse when it is mostly his cult who need improved healthcare. If we actually make healthcare bad enough we may be able to rid our selves of all that dead weight.
Sympathy for the downtrodden is okay, but when they themselves cling to someone who hurts them it may be best to simply let things play out. Anyone who thinks that Trump is a good president kind of deserves him.
1
I don't have children.
I can't afford to take care of a child properly.
2
It’s called the Golden Rule. Not from the Bible, but from the GOP Rulebook. “ HE who has the Gold, makes the Rules “. And if you have no Gold, or the Cash equivalent, you have no right to Healthcare. Seek Charity help, or just Die.
Seriously.
3
Nicholas we need Medicare for All. The problem with our healthcare system is Capitalism. Predatory capitalism seeks
only profits and cares nothing about the needs of the people.
Capitalism cares nothing about the environment or Mother Earth.
Let’s face the facts.
2
The healthcare system as it stands now is collapsing under its own weight and greed. Removing the rest of the ACA will hobble healthcare further. Surprise billings are coming for you if you call or go to a hospital, see a doctor or take meds. It will get a lot worse and no one can do anything about it but TALK. All you will get is talk from any politician especially a Republican. More than likely the healthcare industry bankrolls your Republican representative.
Our economy is mostly healthcare now and it wants your money! Oligopolies (monopolies) that demand and don't bargain with a single person.
We set these giant behemoths up by allowing all the mergers. We also created the only remedy: the government as agent for the people whether being single payer or rate setting.
Our healthcare system is collapsing! Maybe the sooner the better so that people will wake up!
As for Medicare and all these new benefits, dentists, vision, etc; well they are rip off artists extraordinaire. One dentist chain said I needed 4 crowns and antibiotics that were not covered. I never got my teeth cleaned, but I did get a good sales job! The vision benefit you get companies usually give a 20% discount and wow Medicare gives a 20% discount: wow more MONEY!!!
You say that 400,000 children have lost their health insurance. We know that this administration has shut down, or limited access to safe abortions.
I keep waiting to see the consequences. I haven't seen children dying on the streets. I haven't seen mothers and dead babies on the streets from botched, back-alley abortions. Thankfully, I haven't lest you misunderstand me.
When will the cruel people in the world see the impact that their actions have caused? Maybe they won't. Maybe the emergency rooms take care of these things. I don't know.
2
As a retired prof here in cold Alberta, I pay nothing for ihealth and drug insurance except for travel abroad, private rooms here, eye glasses, and a portion of dental care. Working, I paid about $35 a month for health coverage - doctors, hospitals, and some medicines. My point is that if Canadians get more, pay less, have almost no medical bankruptcies, and live longer, what is holding Americans back? My wife had a famous cancer surgeon. Cost? 0$. I had a doctor with 6 research projects and an equal number of international gold medals examine me for pancreas possibilities several years back. Cost? 0$.
Thousands of dollars' worth of tests later for me, and for my spouse's chemo, radiation, and therapy, and we feel reborn, not dead broke or plain dead.
Why are Americans paying $2-25,000 a year plus other costs or starving in order to buy meds, get a filling, or be vaccinated against a communal epidemic? How dumb can people be to accept this con game by U.S. health providers and insurers? How contemptible can doctors, drug makers, and hospital managers be to sip brandy while kids and the poor weaken and fade? How corrupt can Senators and Representatives be to take warchest funds and fix nothing? How loathsome can a President and his Administration be to cut ACA and kill more citizens?
Wake up, "Congers". Sanders is nipping at your feet, Capitalism Lovers. Oh, that's a dog at your heels. Or is it a wolf?
4
If you were to start a brand new country from scratch, is there one single piece of the U.S. health care system that you would use?
2
The "mess" in the American health care system is a mirror image of libertarian leanings of the Republican Party. Their fundamental beliefs are in limited government where things like education, infrastructure, and healthcare should be run by industry for a profit and are NOT in any sense the responsibility of the Government. And they mean that exactly, totally!
It is each and every individual's responsibility to be born rich. Paul Ryan's plan was to create huge tax cuts and massive deficits and then fix the deficits by getting rid of healthcare, Social Security and Medicare, and replace public schools with private charter schools. Most Republican congress people believe all that and they vote that way, so they prove that they believe it. They lie about their plans to appease the masses.
Republicans love Trump because of his willingness to lie. Publicly Trump says he will create the best, cheapest healthcare in the world. What did he do? He looked the other way while Congress, but for our last great Patriot J. McCain, tried to repeal the ACA. Trump is again trumpeting his wonderful healthcare plans. while his administration is actively backing the lawsuit to make the ACA unconstitutional. No replacement is planned.
The chaos in healthcare evolved from the wave of bipartisan deregulation of the 80's that gave control to big medicine and big pharma. They will keep their power as long as Republicans are in control because they finance Congress.
5
Why wasn't dental care included with Medicare?
1
Two things....who else in the world fires people who give him news he does not want to hear?
......The Republicans have had DECADES to come up with a better health care plan... Hillary Clinton's plan was totally rejected in the 90's. Regardless of whether you agreed with that plan or not, the handwriting was on the wall. Something needed to be done. Here we are almost 30 years later and the Republicans cling to the notion 'the private sector will save the day'. Just like richer wealthier people will invest in the lower classes. And for their allegiance, the lower classes are getting a few meager percent increase in income and tens of millions kicked off health care. The message here is so clear: if you want to see the lower classes get reasonable health care, pay for it yourself. I repeat for the umpteenth time: The government is trying to limit the size of the health care pie. Everyone in that pie is trying, desperately, to keep their piece from getting smaller (and to take from the other people's pieces). Guess who is getting the short end here? Patients and front line health care workers. Surprise, surprise. Trickle down doesn't work here either.
45
@Walking Man - trump health care = Go Fund Me. If that doesn't work, JDD. Just Drop Dead.
3
I'm an ex-pat Kiwi, from a country with "socialized" medicine and universal healthcare for all. I've lived in the States for 21 years. I'm the first to admit that NO healthcare system is perfect and NZ certainly has some issues. But, none of those issues compare to the shambles of the American "healthcare" system. This country should be embarrassed, I repeat, embarrassed at the inequity, the high costs, and the low health outcomes and statistics compared to many other countries. Not to mention the insidious stress that we all live with about whether we can afford our healthcare or a health crisis. That low-income men in the USA have the same life expectancy as men living in Sudan? WOW. That is dire, pathetic, and deeply shameful.
What I don't get is that so many other countries are doing healthcare better than the USA, yet the USA is so insular, so arrogant, and so individualistic that they can't learn from other nations who have been doing healthcare better for decades.
In NZ you have access to universal healthcare and the ability to buy private health insurance if you so choose. And guess what? The cost of private insurance is lower in NZ than it is here, despite a significantly lower population.
Get a grip USA, and do better with healthcare. Because right now, the healthcare situation in this country is shameful and pathetic.
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@Lisa
A letter in my local paper described an elderly American's experience in Britain when he suffered stroke symptoms then received expert care that required a three day hospital stay and was charged only $2000 dollars. (It would have been free if he were British).
This is part of what he wrote:
“There I remained for three days and two nights undergoing many tests, including an MRI. When I rang the help bell, an attendant was there within five minutes. The printouts of my tests, a dossier about one inch thick, were presented to a team of doctors headed by a world-renowned authority on strokes. The whole team came to my bedside and explained the results. It was atrial fibrillation, not a stroke. I was not discharged until I had been examined by three therapists speech, occupational and cognitive”.
As an American healthcare investor I find this incident very disturbing. To maintain the profit margins,that make me rich, my investments in hospital, insurance and drug company stocks, require that $2000 dollars cover the in hospital cost of about 4 Tylenol tablets and that the care he received, cost him or the taxpayer, about $160,000 dollars.
If America were to provide health care without obscene profit how could we pay hundred million dollar health care company CEOs salaries, and how could those health care companies and CEOs pump millions into our elections and political system?
All that expert health care at such a low cost seems to be very "un-American".
13
@Lisa
I agree with every single word you wrote, Lisa. But unfortunately it's never seemed more unlikely that Americans will ever get their collective act together on health care.
Because #GunsGodAbortion, and FREE-DUMB!
6
Great column. Here is what I would like to see the Democratic nominee do in his/her first debate with Trump. Or even earlier. Offer to drop out and concede the election if Trump fulfills his most important campaign promise. The one that no one seems to remember: his promise to give health care to all at lower costs. They should further pledge, that should he get that done, to attend his next rally and hold up one of those "Promises Made/Promises Kept" signs. Better yet, let's have every Democrat on the next debate stage bring one of those signs, hold it up and pledge to bring it to the next Trump rally if he gets health care for all or if Mexico's check clears for the wall. Or they could each take a turn to challenge him to keep one of the many promises he lied about. Bringing down the deficit is another good one. It's time for them to stop squabbling and bring the fight to Trump.
5
@Patrick Flynn Trump promised that before, and he was lying. What makes you think he wouldn't lie again?
Loooking at life expectancy can be deceptive. America is a very diverse nation. Unfortunately there are many social pathologies (guns, drugs, single parenthood, poverty) that all have an effect on life expectancies. As many doctors have told me "seeing a doctor won't make you healthy..doing what they tell you to do probably will". Like it or not, life expectancies and infant mortality aren't generally related to access to healthcare.
2
@Bill
But that is true in any country. There are addicts, poverty and single parenthood everywhere in the world. Even if you factor all of those things in, your country still has a lower overall life expectancy than the countries that have universal health care.
The only exception is gun violence, which is a uniquely American problem created by the combined evils of the 2nd Amendment and the NRA.
4
It all comes down which group contributes the most money to the right political campaign regardless of party. I have never understood why americans dismiss the ideas and practices of other countries when the outcomes are better. Wasn't it Churchill who said "Americans always do the right thing after everything fails" (paraphrase). Well the list of 'failures' is growing longer while we americans become less open to the better ideas of others. How dare we be so arrogant at the expense of whole swaths of citizens.
5
With all the talk about protecting "job creators" and "putting money back in the pockets of consumers," I do not understand why the US does not provide universal, single-payer, not fee-for-service healthcare.
Taking healthcare costs off the backs of US businesses would immediately make those businesses more competitive on the global stage. Taking the burden of insurance costs off the backs of consumers would immediately make paychecks go farther. By not binding job options to health insurance, employees would have increased flexibility to pursue different job opportunities in response to changes in markets or personal needs or interests.
Yes, taxes would likely rise to pay for healthcare, but in any number of configurations, those rises would be far less than what consumers are stuck with now in premiums, copays, and uncovered expenses. Remember too that healthcare debt is now the number one reason for personal bankruptcies in the US.
Insurance adds a layer of unproductive profit-taking to healthcare delivery, and does nothing to make healthcare more efficient or cost-effective. Ample evidence exists showing that insurance, through obfuscation and arcane coding systems, undermines clear cost metrics and management.
Finally, economics aside, it is morally and ethically reprehensible that the wealthiest, most technologically advanced nation in the history of the world *chooses* — and it is a choice — to not provide healthcare coverage for all of its citizens.
5
We have NO universal Health Care, National Health or anything like what civilized countries have for their citizens. Medicare is NOT universal health care for those 65 and older. Here is what it is: A guaranteed stream of premiums to private, State run and Licensed Insurance Companies and Global Drug Companies.
I pay a Part B premium for Medicare medical expense partial coverages. I also pay for Prescription Drug insurance plus a life-time penalty for a 60 day lapse in the premium I paid to the Illinois Insurance company when I moved to Florida and failed to get a new local Insurance policy as required by law.
Bush JR and Republicans passed this Medicare Part D law which makes in legally mandatory for retirees to buy insurance from a local State Insurance Company. Guaranteed income to insurance companies. It also added the punishment of imposing a lifetime fine if the premium ever stopped being paid for more than 60 days. In addition to the fine, the insurance company could now charge you any premium it desired and you have to pay. Finally, the Insurance Company can make you pay twice by directly billing you while Social Security withholds the premium from you SS pension check each month but pays it in arrears.
And, thanks to ObamaCare, drug companies now charge $1,000 a month for my eye drop whereas it was free in 2016 as an employee earning 3 times my retirement income.
This is the world of Republicans and moderate Democrats.
5
First off, Dave, if you’re paying an added Part B premium, it’s because you did not sign up for Medicare during the enrollment window.
Second, you’re not required to buy Part D...though it’s silly not to. And many Medicare Advantage plans fold in prescription coverage; try an HMO.
Third, Obamacare didn’t raise your eyedrops cost, though arguably it didn’t do enough to keep them low. Blame your insurer, and blame the drug company. And blame Rick Scott, most assuredly.
1
I think at the heart of the problem is the love too many Americans have for the almighty dollar. From worshiping billionaires to the point of allowing them to run the nation (or choose who does), to placing a higher priority on big salaries than on simply doing our jobs well and helping others, we are motivated far too much by money.
But I think much of it isn't really love for money, but fear of not having enough to get by - and that comes from the inherent insecurities caused by our system.
I've been in Europe and spoken with a number of Europeans about their lives. When you don't have to worry about "lunch money" when you go to school, when you know that your college or trade school comes free, when your health care isn't some lurking monster threatening to wipe you out financially and existentially with an unexpected diagnosis, and when you don't have to worry about homelessness when your company downsizes - all these things have a huge effect on one's attitude toward money.
Most of us would, I think, be much more egalitarian and less selfish in a society like Europe's. This "rugged individualism" that the US has been promoting may have produced the most billionaires anywhere in the world, but it has turned too many of us into a bunch of money-grubbing rats, snarling at one another for our own piece of the pie.
And of course that affects our health care choices in significant ways, and prevents us from supporting M4A, since "I'm not paying for THOSE people!"
7
Many countries have a much better K-12 system of education. They have stiff entrance exams to higher education. Students who are well educated by the system in those countries and pass exams are admitted directly into a medical faculty and graduate with medical degrees. In contrast, colleges in the US for the most part must try to raise the education of college students to high school level, except perhaps at the elite schools which cost a small fortune to attend. THEN, students who make it through the filter of college spend four more years (at high cost often) to get a medical degree. In the end the doctor's career is shorter and costs more to achieve. This negative "education" aspect is not the entire cause of our high cost problem but I never see anyone pointing out this difference between the US and many other countries.
5
Americans need universal health care but also affordable health care that is not lost when one loses one's job. ACA was a big improvement - primarily because it insured irrespective of pre-existing conditions, was not tied to employment, and provided at least some insurance for catastrophic care. But ACA was and is too expensive for many, perhaps for most Americans to afford and it is of limited use in non-catastrophic care because of the high deductibles. Most of the benefits of ACA accrued to insurers, not to American families. We need to do much, not just marginally, better. Continuing to keep the issue on the front burner as Sanders and Warren do is the way forward. Depending on the outcome of this fall's congressional elections significant improvements on ACA may or may not be politically achievable. Irrespective, progress cannot be made by ignoring the single biggest, most frightening issue - a serious illness or injury - that confronts most American families.
4
Some dissembling here. The study on children Nick cites says:
"Policy interventions should focus on infants and on children ages 15–19, the two age groups with the greatest disparities, by addressing perinatal causes of death, automobile accidents, and assaults by firearm."
Our health care system is only responsible for the issue of perinatal deaths. The US rate of infant deaths is worse than Europe's, but much better than China's. In this area, if Nick bothered to deconstruct the problem, is complicated by undocumented immigrants who do not have adequate access to prenatal care, Native Americans who are not well served by IHS and African Americans who are under-served in states like Alabama and Mississippi. For all its problems California is a state we should look to for its efforts that enabled it to have the lowest infant death rate.
3
What I find particularly frustrating about Op-Ed pieces and news stories like this is the Comments section where my fellow well-meaning Democrats bemoan the heartbreaking realities of the Trump Administration. Yet here we are, apparently nominating a guaranteed-to-lose Socialist whose defeat will result in four more years of the very thing they fume about.
Go figure!
3
How did the corporate centrist fare against Trump last time around?
13
It won the popular vote by 3 million votes.
This time neither trump not Bernie will get what Hillary got.
3
@ George S., Aw, c’mon why so pessimistic? Have a little faith, and vote blue no matter who! Repeat after me!
1
mcconnell was very clear on this issue when he stated last year that Affordable health care for the middle class is socialism and republicans will not allow it.
6
Picture this scenario. An poor person who lost health insurance because of Trump’s policies catches the Coronavirus. Perhaps they got it because they are a low level employee at an airport. With no healthcare he or she will do what they always do, tough it out don’t see a doctor because it is too expensive and go to work spreading it to more people. When they finally collapse and perhaps get taken to the hospital they will likely infect more people until they are diagnosed. We will then have an outbreak in the U.S with an unknown number of victims who will continue to spread the virus. It can’t happen here you say because we will keep infected tourist out of the country. That is simply not possible, once the virus spreads to Africa it will be carried by migrants into Europe and then by travelers to the U.S. It is simply impossible to wall of a country as large as the U.S. from contagion. Alex Azar who heads HHS which includes the agencies like the CDC which would fight the disease believes his highest priority is to destroy Obamacare and push people out of Medicaid. A healthcare system headed by someone dedicated to pushing people off the insurance roles is a formula for disaster in the coming crisis.
9
Universal is a great concept. It is a worthy goal. It is something we need now. It is a must for a civilized nation.
But it must be universal in a holistic sense. It is essential that each of us do things necessary to stay well and fit. We must eat more natural whole foods; we must exercise daily and maintain healthy social relationships. Reduce stress and get a good night's sleep.
Yes, many can't do this and the reasons are legion, and almost none of them are related to health insurance.
So please, sort out that which should be covered and stop giving us all a way out by a free service with medical care and no help with all the rest.
1
I am NOT anti-science. I've been looking for the science to justify the pharmecuticals. There aren't any. I don't trust the pharmaceutical industry as far as I can throw them. They PERMEATE our medical schools and control the government through their money. They are now trying to mandate vaccines..very much untested vaccines. And we have and are being herded into a massive health crisis. We can't even sue them. The damage is so massive that it can't be overstated. There is science out there that definitely proves the danger of vaccines..look at Japan's results after almost completely eliminating their vaccine program..far healthier than us. 54% of our young people have chronic disease. Who ever is elected next, needs to investigate. The doctors have been lied to. The public has been lied to. It is a massive, massive cover up. If you have any sense at all, check it out. I didn't want to see it, it is so disturbing. But there is a huge problem and we can't talk about our health system without addressing this malevolent industry.
2
Here’s the recommended vaccination sched for Japan. It’s at least as extensive as ours.
https://www.jpeds.or.jp/uploads/files/20180801_JPS Schedule English.pdf
But yes, they don’t mandate vaccinations. That’s why they had a large measles outbreak last year. Try the bit about how measles ain’t that bad, and I’ll cite you the death rates: around 100, 000 kids died of it, last time WHO published the stats.
Not anti-science, my foot.
2
@Robert this doesn’t negate the rest of my assertions. What other outbreaks has Japan had? And do their young have chronic health issues at age 18 to the extent our American young have? And what about the huge numbers of vaccines required now? Looks like a profit machine for the pharmecuticals to me. Why would you trust an industry that has such a terrible safety record? Do you realize our Congress gets more money from the pharmecuticals than oil and the war machines combined? And that Murdoch’s media is in business because pharmecuticals do so much advertising? Look up exactly what the CDC really is.
Nice work, Nicholas but your analysis fails to identify the most fundamental flaw in the U.S. health care industry. Don't feel too badly, though - virtually all analyses from just about every corner of society is equally flawed.
Simply, HEALTH CARE AND HEALTH INSURANCE ARE NOT THE SAME THING. To succeed, any proposal to address the flaws and inequities you correctly note must start with that understanding. For-profit insurers injected themselves into our health care delivery system long, long ago and we have allowed them to take a stranglehold so comprehensive, so complete, that the terms "healthcare" and "coverage" are used interchangeably. They shouldn't be. We as a society will NEVER gain control over the distribution of heath care within our borders until we reign in the excesses of health insurers. In a perfect world, they would be taken out of the healthcare loop entirely.
Good luck with that. The insurers are embedded not only in the healthcare industry but, as you know, even more so into the pockets of Congress. They wont go down without a fight.
3
We argue against universal care, because it will result, the claim goes, in rationing medical care and long wait times, while increasing the tax burden.
Of course, we ration care already - away form those who don't have jobs that will support it - and have limitless wait times for people with no coverage.
As for the increased cost: The hidden cost of premiums, if made visible paycheck would show that 10K - 20K (or $5 - $10 per hour) of their compensation goes to healthcare.
As for the indictment of professionals keeping costs high - there is truth in it. MDs have to earn enough in their career - which often doesn't start until they are around 30 - to pay off about $300K in debt. And there are currently more students in the US than their are residencies to train them. Foreigners make the shortage worse.
Moreover, that professional has to charge enough to run an office that will include a group of people billing patients because the healthcare company does not collect copays and deductibles; and more to manage the incredibly complex and opaque insurance billing process.
The doctors, and the nurses, technicians, PAs, that work with them, are the ONLY people who add value to the whole process and provide the actual medical service. All of the rest are overhead.
We need to overhaul drug prices, overhead costs, profiteering of insurers, end of life costs, hospitalization fees and lack of transparency of cost of care. And we need to cover everyone.
2
All I can say is that I am lucky to have Medicare and a secondary insurance from my former employer. In these last three years of Trump I have had to make numerous visits to my gastroenterologist. Fortunately, I also have a low co-pay on prescription drugs and I have recovered and I am able to function without the problems. Now, if Americans will do the right thing on November 3, I will be able to stop taking the medications too.
4
The US has the best health care system in the world. Reading the New York Times, foreigners might get confused and think that we don't have enough medical facilities or that they're in poor shape. Not true. I can honestly say that we've built too many gorgeous facilities. I see spectacular clinics, with all the latest medical equipment, in every direction. No wait times, single rooms, waterfalls in the lobby. This is capitalism at work. IF you have good insurance, this is the place you want to live, above anywhere else in the world. Access and cost are a problem for a sub-section of the country, and that's why the life expectancy numbers are skewed down for those under 65. Those above 64 get to enjoy the fruits of this system until they die. They love it. Most Americans are happy with the current system. Happy with their plan and access to all these great facilities and doctors. Drastic change is not going to be supported in the voting both. Incremental change, building on Obamacare to help the underinsured, is the only thing that has a realistic chance of happening. That's what the moderate wing of the party is proposing. I fear for the down ballot losses with Bernie leading the ticket. Imagine if the R's still controlled the House. I shudder. No wonder Putin likes Bernie.
3
@Steve
"IF you have good insurance, this is the place you want to live, above anywhere else in the world."
How nice for you.
But what about the people who don't have good health insurance. How many of your fellow Americans have little or no insurance through no fault of their own? Can't get it? Can't afford it? People who work two part time job that don't provide insurance? Hard-working people who don't deserve to die because they can't afford your so-called health care system?
Don't you realize that you're just one job loss away from potentially going bankrupt if you get ill?
@LauraF Politically, improvement of the ACA is doable. Medicare for All is not.
I am a health care industry and insurance company investor, and unlike doctors and health care workers who care for people, I do not. I care for profit and the CEOs of all of the companies in which I invest, work for me the stock holder.
Our goal is to make as much money as we can off human illness and suffering, while providing service in a manner that keeps us in business and within the law as our attorneys interpret it.
Profit drives our policies and practice, not what is best for patients and the nation.
The old time highway robbers used to say "Your money or your life" and many of them were caught and hung. But isn't it great........ we can take all of your money, and sometimes even your life, and yet remain respected pillars of the community.
Our nation has socialized military, socialized police, socialized legislatures and socialized court systems, because if those institutions were turned over to capitalists it would subject America to great harm and expense perpetrated by people like me. For profit health care is no different.
It is illogical to allow profit to be part of any system we must use to avoid suffering and death, because like the Mafia, business will use the inherent leverage to extort a price most cannot afford, but all must still pay.
13
Doctors are not overpaid. They have to earn it. And they support the services of technicians, nurses and other workers based on their ability to help patients. I believe the problem is political: their is a powerful set of groups who apparently want us to suffer in any way possible. Depriving the rest of us of medical care is merely one way these sado-economics are manipulated to hurt the general population. I wonder about why a hugely wealthy individual even thinks about depriving the rest of us of basics. But they do. And of course we see religious organizations, themselves capitalist enterprises, paying lip service to the idea of helping the poor while actually strengthening those who chose to punish us for sharing their planet.
3
The basic problem is the one constantly pointed out by Sanders and Warren - big money runs the show and rigs the system.
Our corrupt Congress, both Democrat and Republican is totally dependent on big money donations to stay in office and legalized bribes (like speaking fees, book deals, cushy lobbying jobs after leaving office, etc) to live the good life. So when the big pharma and medical specialists and private hospital groups tell these men and women in Congress how to vote, they do it. They ignore their duty to promote the general welfare and instead promote the welfare of the 1% in order to help their own welfare.
So when you say that Medicare for all will never get through Congress, you are simply pointing out that the 1% owners of our government won't allow it.
4
I'm someone who's been aided by Obamacare. Without it, I wouldn't have been as healthy as I was when I aged into Medicare and Medicaid.
America was once the richest and most powerful country in the world. We aren't any longer and this is reflected in the way we treat our poorer citizens.
Former President Obama gave our country something precious. Millions of Americans were aided by Obamacare and millions of Americans thank him for what he did for us.
For the GOP to attempt to undermine and destroy this incredibly beneficial medical coverage is the height of arrogance and an example of disdain for the poor.
Without this safety net, we leave our country open to illness on a massive scale, something we can't afford and that will, ultimately, drag our country further down the slope to Third World status.
3
I spent a cloudy Saturday yesterday rewatching "The Big Short." I think the healthcare industry is approaching a crisis of the same sort in this country. We are a pandemic or toxic pollution incident away from revealing the corruption and weaknesses in healthcare delivery. The prices are spiraling beyond affordability and cannot be sustained. In the meantime the providers and vendors are making hay while the sun shines. I realize gone are the days when the local doc was sometimes paid in quilts and chickens, but also gone are the days when they were content to be comfortable but not wealthy. Same with hospitals, formerly the good sisters had the administrating duties, running everything from the laundry and kitchen to the pharmacy and the hospital foundation. I worked as a nurse in surgery and the vendors had sales reps in the OR and then had lunch catered in for the docs team. All in the hope that that new device would now be stocked in materials management and used by and billed at an outrageous cost because that particular prima dona wanted it available. Multiply that by all the surgeons on staff. The same with reps and medications. In the meantime, hospital staff were hoping that we would get a COLA that would at least cover the increased insurance premium.
1
I never hear any mention of Insurance Companies. Duplicate paperwork with information in every language in one envelope each time there is a doctor visit. There is a random person who has the ability to deny a procedure a doctor needs. Young people have no incentive to become doctors. Med school should be free with clinics run by residents who benefit so that uninsured or low income people could go instead of the ER or for profit walk in clinics. We used to pay our doctors and get reimbursements from insurance. Now because if the ridiculous insurance system offices need huge staffs. Doctors who put years and money into education are not the problem.
2
“What’s imperative is simply achieving universal medical and dental coverage, either by a single-payer system (like Britain’s) or a multipayer system (like Germany’s); both work fine. What matters is the universal part.”
I’d like to know the difference between “Medicare for all” versus “single-payer system”. I don’t think there is a difference. For some reason people fear the word Medicare. I’m on Medicare and I love it. I can go to any doctor and my expenses are minimal.
My daughter’s private health insurance through her husband’s job just changed their healthcare plan and they can now no longer use the pediatrician that they loved for their baby. When they had their baby their doctor was covered by their insurance but apparently the hospital that their doctor sent them to was not. They are now stuck with over $8000 in hospital bills. Our current system of healthcare is a complicated mess that can bankrupt you even if you have private “insurance “.
6
Republicans seem to desire the US becomes a developing country with no support of infrastructure or social services. What is wrong with these people? Vote against all GOP and Trump supporters.
11
I am a 66 y.o.retired carpenter in good health.Non smoker/drinker for over 35 years.I bike 15 mi. daily and visit the gym 3x a week.I was diagnosed with an impacted gall bladder last year.I had a laparoscopic cholecystectomy done at my local hospital.Total tab; 73K,give or take a few hundred.Did I mention it was same day surgery.As soon as you can walk you must leave.Literally about three hours after surgery.I had basic medicare at that time.My end is roughly 15% of the total cost. Bankruptcy is on my radar now.Am I an anomaly?IMHO the system is not working for the 99%The thought of another surgery is paralyzing at this time...
12
Every developed nation rations health care - most do it based on need. America does it on ability to pay. When you go to the emergency room, you are asked how would you like to pay for this - if you can't, they deny your care and send you to another hospital. In Canada, people are queued (triaged) based on need for care instead of ability to pay. And there is no bill waiting for you at the end (or surprise bill sent weeks or months afterward) causing financial ruin and bankruptcy.
Granted, the Canadian system has its flaws like all systems but it is still sound and efficient and provides care to all regardless of ability to pay. And no one ever goes bankrupt because of a medical catastrophe in the family - in Canada, that ended in the 1957 with the HIDS (Hospital Insurance and Diagnostic Services Act).
8
I think EVERYONE in the US will support Medicare for All once they stop being afraid. I have lived in many countries including 6 years in Brazil- the medical coverage is incredible. They have Health Centers ( Poste de saúde) for people with low income. You see a Doctor for free, you get glasses for free, you get vaccinations for free, the list goes on and on. Obviously you pay taxes but even if you are momentarily unemployed, there is a safety net. BERNIE.
6
Brazil doesn’t have medicare for all. Brazil has socialized medicine via local clinics, plus considerable private insurance.
A couple of points:
1. No profession in this country carries the level of personal liability that physicians have. If teachers, for instance, could be held personally liable for poor outcomes- i.e., parents could sue them if Johnny didn’t get into Harvard- and we required teachers to carry and pay for malpractice insurance out of their own pockets as a condition of licensure, then you’d have to pay teachers a ton more money to get anyone to enter the profession. That seems rather obvious.
2. As a percentage of total healthcare expenditures, provider pay is only about 10%, by independent analysis. You could cut physician incomes by half, and it wouldn’t make any measurable dent in overall healthcare costs. Inflation adjusted physician incomes have remained essentially flat, or declined over the past 30 years, while overall healthcare costs have gone up exponentially. The reason for this is the enormous amount of administrative bloat in our system, and the large number of hands in the cookie jar, so to speak, who have no role in actual patient care. You can thank the enormous amount of regulatory burden on the system for a great deal of that. Hospitals employ small armies of people in administrative roles, whose only purpose is to ensure regulatory and compliance measures are met, so that hospitals can stay accredited by the likes of JCAHO and CMS and thus continue to get paid. If you want to make healthcare cheaper, find a way to cut administrative bloat.
1
While I agree that there should be Med Mal reform, it is a misnomer to say doctors are responsible for poor outcomes, physicians are only responsible for outcomes caused by medical negligence, actually the best reform would be similar to workers comp where a threshold of poor outcomes could be established for compensation
@Eric
The administrative armies to meet regulatory compliance are small compared to the armies needed by hospitals and doctors to secure payments from the myriad of insurance companies whose main goal is to take in premiums and pay out as little as possible.
6
@JimmyP in theory what you say is true, however in practice that’s not really the case. I personally have been named in malpractice suits in which there was no negligence or deviation from the standard of care involved, however due to a bad outcome, the patient filed suit. All it takes is for the patient to find a lawyer to take the case, and anyone can file suit even if there was no negligence involved. The trial lawyers see opportunity in these cases to make an easy buck and are simply looking for a quick settlement, which they often get. There are a ton of frivolous lawsuits that bog down the tort system and add to overall healthcare costs.
1
The subject of dental care interests me greatly, as it would anyone who has suffered toothache. The affliction sounds trivial, in a way, but anyone who has had one knows it's anything but. I think folks without the most basic dental care must be eager for whatever pain remedies are available, and I wonder if this might be a big part of the opioid/addiction crisis we now have.
6
Obvious simple problems. The leading candidate cannot be shaken or distracted from a message that points out these obvious problems. The media cannot sufficiently spin or blunt this message despite the scary use of the "S" word. ... and yet, they act mystified that he is leading by huge margins. Maybe there are limits to the power of "electability" messaging in service of stealing wealth and life from the masses?
4
So glad you mentioned the appalling dental health deficiencies in the United States. That is a National disgrace. When I was in Viet Nam I noticed that basic dental care , even among refugees was better than what I saw in Appalachia. It's no secret that many wealthy Americans go to Mexico or Panama for dental work enjoying the travel, vacation and dental procedures for less than what the dental procedure alone costs back home!
5
Is Trump enabling the lack of vision of the Republican party or is the Republican party enabling the pitiful perspective of the executive branch? There is a great deal of fear and rumor mongering about "socialist" medicine. There are are drawbacks, but there are benefits, too. What surprises me is that our business, scientific and tech communities of extraordinary capability refuse to produce a serious and comprehensive plan based on a careful analysis of costs and benefits.
2
I don't think competition is the deterrent Mr. Kristof implies at the end of the article. When was the last time a new physician came to town and prices dropped? Medical school is difficult. Its graduates should not be expected to work for plumber's wages. There are other factors involved in the cost. Technology for one. The selling point of a new instrument is often the dollar amount of the procedure. And the insurance companies want prices to go up. You can't charge $1,000/month if people can finance their care for $1500 per year. Insurance companies love that financial disaster awaits those without gold plans.
2
Nick, you write, "Democrats’ internecine battle over so-called Medicare for all is largely irrelevant, because the plan won’t get through Congress." Exactly! Congress will never pass such a bill. The fact that Congress actually enters the equation at all puts a kiss of death on it.
As for dental, I gave up hope on that a long time ago.
Bernie needs to wise up. MFA is a costly pipe dream. I acknowledge the importance of health care but far more realism is required.
4
Kristof is certainly correct that our health care delivery system is an unmitigated mess and costs us individually and collectively a fortune.
What worries me about Bernie Sanders' plan is exactly what Kristof points out: it will not pass Congress.
Buttigieg has a much better approach to coverage for everyone, and it would stand a much better chance of being passed in some form.
The only way to get any kind of health care coverage improvement is if the Democrats win the majority in the Senate and keep the majority in the House.
7
Mr Kristof does not mention that the number of residency-trained physicians in the United States is controlled by the Center for Medicaid and Medicare Services, a federal government organization. Most states require at least some post-medical school training in order to apply for a medical license in that state. Thus the number of physicians is NOT controlled by doctors. When Congress votes on the CMS budget it can affect the number of training slots for physicians. With the influx of medical students from both the US and abroad it is now very competitive to land a residency slot: a student can graduate from a medical school in the US and not match into a residency slot. In order for a hospital to create a training site for residents it needs funding from CMS in order to pay for resident and faculty salaries, administration costs, insurance costs etc. Thus it is the federal government that controls the number of physicians in the US.
3
what is position of AMA in regard to slots. do they and other medical associations lobby for more funding and slots?
1
Do you have a source for this claim That the federal government controls the number of resident physicians. Thanks
In the early 80's in Chapel Hill, NC, I had an excellent pastor who preached a sermon on Christ and healing and wove into the sermon a line about meeting the healthcare needs of all. Immediately thereafter a professor in the School of Pharmacy who was a member of the congregation planted himself in the pastor's office morning after morning after morning to attack him for expressing a view like Mr. Kristof's. Some Americans are still waging now the same war on necessary change in this country.
We need more family care doctors in this country and the funds to educate them without the punishing high debt they must incur to become physicians. Our national values are skewed, and it's time for repentance and reform.
Along with the healthcare crisis is the nutrition crisis. The usually ignored hunger statistics in this country are frequently the cause of poor health and poor treatment outcomes. We need to offer home economics in every high school again, and preach nutrition and somehow get the population to garden again where possible and to exercise more appropriately, but that requires properly fitting shoes...
All of these issues are addressed in Arthur Simon of Bread for the World's excellent book SILENCE CAN KILL.
7
oh my gosh. it sounds like you and your pastor are advocating values that run counter to the views of the Christians who are rabid Trump supporters.
Many Americans struggle mightily to pay for their substandard treatments, and they delay critically needed care due to the lack of cash demanded by medical providers upfront for MRIs and CT scans or a specialist's consult. Some in car wrecks will even deny the service of an ambulance due to fear of a bill that can run to thousands of dollars, and instead call a friend to pick them up instead. In regard to health care, we have become a second or third-world nation. Heaven help us when the coronavirus reaches us.
13
Whoever runs against Trump this Fall should hammer away at the message that Trump's Justice Department is actively pursuing using the courts to end the ACA, which would cause millions of Americans to lose access to health insurance, including all who have "pre-existing conditions".
The Democrat might also let people know that they would not put children in cages.
11
There is also the powerful incentive to deny healthcare. We pay a fortune for “ insurance” that has as a primary function denying healthcare. The last thing our system is designed for is delivering medical solutions.
19
The answer here is so ridiculously easy I want to scream and cry.
Eliminate for profit health systems/insurance ASAP.
Allow only nonprofits to be in the business.
We have robust companies in place that provide excellent health care with good value because they are focussed on patient care not CEO salaries.
Take a look at Geisinger, Gundersen, or InterMountain Health.
The answer is here now.
The future is here now.
12
Despite spending about $11K per person in the US, about 25% of the population has no access to healthcare (30M no insurance, 55+M can't afford to use what they have). We have medical bankruptcies that no other country has. People have to decide whether to eat or ration their meds. Insurers add about 30% overhead to medical costs. Medical executives take home outrageous compensation. Our system is immoral, ineffective and an anchor on productivity. It is time for (Improved) Medicare for All. Check out the bills in the Senate and House.
15
Not mentioned regarding access to care are the campaigns in states across the US to limit what nurse practitioners can do. Nurse practitioners are RNs who receive graduate education in diagnosis and treatment, and are trained to manage most common and chronic conditions, as well as when to refer to a physician. They are reimbursed at a lower rate than physicians for the same tasks, and in health care organizations they generally earn less than half what the physicians earn. Allowing nurse practitioners to practice to the full extent of their training would expand access to care for many and improve affordability.
11
One area that was overlooked is the number of preventable medical errors that take place in this country. According to John Hopkins and other researchers, medical errors are the third leading cause of death. Many of these errors are due to poor systems, untrained staff, and errors in judgment. While some health care systems, and hospitals have made safety improvement, many others haven't. Why is that? Would we tolerate such lethal statistics if it involved our airlines?
Having worked in health care risk management, I still see the same medical errors being repeated that I lectured about thirty years ago. For such a rich country as ours, it suggests that our entire health care system is fragmented and broken. Universal health care may be the much needed catalyst to create a more cohesive health care system that provides the same quality and safety standards for all.
10
Statistics comparing America with other countries can be both illuminating and also misleading. Ours is a more heterogeneous country than many others and we are saddled with a system designed to support white privilege since the first slave ships arrived on our shores in 1619.
In addition to the iron rice bowls of the insurance companies and provider groups, racism drives down our national averages. I can remember a home visit I made as a medical student to a New York tenement where the family was clustered around a smouldering lead battery as their only source of heat.
Hospitals delude themselves they provide good care because they provide it to all who can get there while many on the "other side of the tracks" are economically unable to reach them.
I fear many dislike the idea of universal coverage because universal means inclusion of Those People.
It's important to collect comparative data but it's just as important to look beneath the stats to turn data into information.
10
The U.S. capitalist economy is based on "monetizing" the needs of our citizens to generate corporate profits. This has been the financial priority of the U.S. since 1980 when Reagan was elected. This is the GOP philosophy: that corporate profits benefit all citizens through "supply-side, trickle-down" effects.
The adverse results are evident throughout every sector of the U.S. economy and yet citizens keep voting for this very same philosophy.
14
As a country becomes wealthier, the share of spending on healthcare rises. Based on that correlation, the US is not out of line. Moreover, almost all of our failure as a country in terms of life expectancy can be attributed to obesity rates and "deaths of despair."
The solution, however, is not to interfere with the wonderful medical care enjoyed by the fortunate, but to spend more money to provide better care and prevention to the less fortunate.
2
@David R
"As a country becomes wealthier, the share of spending on healthcare rises. Based on that correlation, the US is not out of line."
US healthcare costs $10,224 per head per year. The average for western Europe, where several countries are richer per capita than the US, is $5,100 -- yet Europe gets better outcomes and covers everyone.
Somehow, though, your advice is "to spend more money". How about reining in the current rip-off?
16
The refusal the people controlling American healthcare to deliver basic life-saving and human kindness to the our vulnerable citizens – especially our children – is sheer barbarity.
It is seen in some selfish physicians and dentists who protect their turf and their bank accounts to deny basic, affordable care.
It is seen in so-called “private non-profit” hospital systems which gobble up competitors to create monopolies. Building shiny palaces, they pay executives seven-figure benefits which have doubled in recent years. Low-income people are charged the full price, and the difference between that and the lower price paid by insurers is used to justify the non-profit's exemption from paying taxes.
We could restore the safety net of the Affordable Care Act with a little tinkering. Instead, President Trump relishes taking medical care from those who most need it. and too many Republicans are happy with that.
Democratic presidential-wannabes like Bernie Sanders and Elizabeth Warren demand budget-busting socialized medicine instead of incremental changes which would bring quick relief and universal coverage.
Joe Biden has a reasonable approach. As much as the current mood is to attack Michael Bloomberg, he has a record of helping needy families of all races receive care, and he now agrees that the ACA is important.
As Nicholas Kristof points out, America should be ashamed of its healthcare outcomes – notably because there is no excuse for the miserable third-world numbers.
5
@sdw,
It’s oxymoronic to claim “quick relief” via “incremental changes.”
It would be slow relief at best, and no relief at all for those who die while awaiting those changes.
How many people are you willing to leave out of access to decent healthcare? Currently, it’s around thirty million.
Our healthcare payment system is a mess. Our healthcare itself remains the best on earth. The payment system is a mess because government is involved. We will be paying for the foolishness of Medicare & Medicaid for generations to come.
1
@Keith Colonna
"Our healthcare itself remains the best on earth"
So you didn't read the (excellent) article?
"The payment system is a mess because government is involved"
The US has less gvt involvement in its healthcare than any other developed country on earth. This means that the citizen is helpless in the face of an industry that can literally say "Your money or your life."
9
Government controls half our healthcare now. But no thanks on total control. I know of too many first-hand stories of people allegedly getting ‘good quality free healthcare’ in Canada and the UK. That phrase is an oxymoron. Increasing government control is a recipe to make things here worse, not better.
What about the stories of “quality medical care” here in the US? We can trade anecdotes all day long, but the aggregate is what tells the real story. I’ve lived in 7 countries, including the uk and Germany, but also South Africa and Mexico - the medical experience in the US is firmly at the bottom.
9
One thing that muddies the waters is the perceived cost of insurance. Generally speaking no two plans are alike. Insurance companies make up plans to suit the needs of the employer in terms of what combination of network, coverage and deductibles gets the employer to a palatable price to them and their employees. Some companies offer plans with no premiums and low or no deductibles. For the rest it is a mix. Push one cost up to bring another down.
To people working at a company that offers zero to low cost insurance with a good network of providers, any cost (eg payroll tax, which is how Bernie wants to pay) that reduces pay will be nonstarter. Unions and those witj high paying professions will be the first to object.
1
No one alone can solve our present health care costs issues. We are far too unhealthy a nation to simply offer up universal care for all and expect there to be enough resources available for everyone to get the same care they receive now.
1. We need a fully integrated system in our schools and communities to improve healthy eating and exercise.
2. Our farming subsidies must shift from soy corn etc to superfood veggies.
3. We need taxes on guns and cigarettes, refined sugars, non nutritive foods and alcohol to offset their health care costs.
4. Medicine is gilded by doctors who are incented financially to order tests and more meds. Physicians are trained (mandatory training) to learn how to bill more by adding components to the physical exam and history that are not critical for a specific case but bill more. Doctors get paid more for procedures (more expense) than discussing a healthy diet or stresses. Doctors must become incented to improve patient outcomes.
5. A great deal of medicine is performed by overly trained (expensive) physicians. Nurses, nurse practitioners and physician assistants should play far far larger roles in care.
6.The economy of every state and and the territory of almost every Representative relies on either local hospital economies, insurance economies or both. So any changes in health care must realistically include these considerations.
Let’s find someone to lead this who can get all of the stakeholders to the table. It can be done.
8
We need a free market system in healthcare. We need more medical/healthcare insurance companies, not less. We need portability. We need more health savings accounts. We need more clinics, for minor medical and dental procedures.
We need the federal government out of healthcare. If government-centered healthcare worked, the VA would be a model. It’s not.
1
@Cjmesq0: From an article in Forbes, the standard bearer of the free market system: “First, lost in the current rancor about the VA is the recognition that the VA healthcare system has consistently out-performed the non-VA/private sector in quality of care and patient safety.”
4
The VA and Medicare are both run more efficiently and cheaply than private insurance, with results that equal or exceed the latter, both for the physical health and financial health of their patients.
You’re badly misinformed.
3
@Cjmesq0
“VA health care is as good or in some cases better than that offered by the private sector on key measures including wait times, according to a study commissioned by the American Legion.”
http://www.military.com/daily-news/2017/09/20/va-wait-times-good-better-private-sector-report.html
“The Veterans Affairs health care system generally performs better than or similar to other health care systems on providing safe and effective care to patients, according to a new RAND Corporation study.”
https://www.rand.org/news/press/2016/07/18.html
Restraint of trade makes health care much more expensive, since it reduces the supply of caregivers. A panel of one of them, doctors, determine Medicare reimbursements, so Medicare for all will be only a partial solution to high healthcare costs.
Medicare’s overhead is three percent.
The ACA allows private insurers fifteen to twenty percent.
The math speaks for itself.
2
I note that you mention the casualties of the lack of health insurance first and then the cost of care. I understand that the casualties are a worse calamity, but should we consider addressing the costs first? Doing so would mean that whatever means we subsequently choose to tackle uninsurance and underinsurance, it would cost less to do so.
It's not so much vandalism but a policy of ripoff by the 'job creators' through the Republican Party. It's all about creating a maximally extractive economy and passing the burden of government onto the common people. Health care is but one front in an overall war to dismantle government except for law enforcement, military, and subsidies to corporations and preferred classes.
5
We now spend $10,000 x 300,000,000 = 3 trillion /yr on health care in the USA. Medicare for All, which most physicians prefer as the single payer system, would cost about the same or less. What is needed is federal regulation and oversight over the entire system. Pharma costs, hospital costs, and physician costs would be under some regulation like in other developed countries.
As a physician, the lack of insurance coverage is immoral. MD's see the result of this daily --- ie. the child with fever brought in too late, the breast lump that was too expensive, the insulin that was shared and under dosed due to cost.
12
Please don’t assume that all healthcare providers are part of the problem. I am a physician, and I would not join or support the AMA. I practice in a primary care specialty, and we are relying more and more on nurse practitioners and physicians assistants to provide care. The reason is because medical school graduates are graduating with either a huge amount of debt (often the cost of a home) or a huge desire to make much more money than a primary care provider makes, and choosing to train in lucrative specialties. Apparently the idealism of the 60’s is no more. The reimbursement is high for performing procedures, and not for counseling about obesity, addressing mental health issues, or a person’s general well being.
And, once a person graduates they often want to live in an area with a sophisticated medical complex and access to quality education. The density of physicians in different parts of the country reflect that.
I support universal healthcare and similar programs to improve the US healthcare system. All it may take is for the people whose lives are affected negatively by the current system to go to the polls and vote. And not just in NY and California, but in Ohio, Pa, Wisconsin, Texas, etc. As long as people either don’t vote or vote blindly against their own interests nothing will change.
31
Medicare for all, although unobtainable in Congress, is theoretically a positive option for dealing with the huge gaps in coverage and economic hardship currently afflicting Americans who are ill but have no or inadequate health coverage. Until you think about what Republicans did to Obamacare. Essentially hollowing it out with law suits, cutting out parts of the program, underfunding it. etc. so that currently it's only a shell of what it was initially. What do you think Republicans would do to Medicare for All? Look at Trump's budget for a preview.
3
We do not have a "health care system". Stop using this term. What we have is a Health Insurance System. Start calling it that. We don't talk about the auto care industry. We don't talk about the home care industry. We talk about the auto insurance industry and the home insurance industry. We certainly don't imply in our discourse that these industries care about us (although their advertising does). The health insurance industry is a gambling operation, and as such it is structured so that the House always wins.
30
Mr Kristoff, really enjoy your columns. I’m a lifelong medical educator and prof of psychiatry at northwestern, and very concerned about shortage of mental health care in the US. We have many more medical schools now, but CMS. Stipends for residency training have been capped since 1997. We had 800 American med school grad applicants for our 8 residency spots this year. - and 100s of IMG applicants. Most would make great docs- but we can’t increase the size of our residency program without more funding. Residency has become the rate limiting step. APNs snd PAs are wonderful and can do a lot - but in my experience their skills and knowledge are at the level of a good second year medicine resident. We still need many more physicians - and frankly, most of my grads make about as much as a successful plumber w his own small company. But they have $200k in loans yo pay back staring at age 30.
Physicians are also leaving medicine because it his increasingly run by corporate types who don’t share our values - docs can’t practice according to their values.
Worrisome.
Josn Anzia, MD
16
A possible path for flipping red states would be to emphasize a rebuild and restructure of rural heath care which is collapsing under a profit-driven model. There is no plan at all from the Republicans, but the need is obvious.
15
The collapse accelerated under Obamacare as did the pool of insurance companies over coverage in the individual market. BTW i am in what I call an alternate single payer market...there is only one company who offers insurance at insanely high rates. As a bonus none of doctors I see participate in the plan so I pay out of pocket to see them.
3
That is my situation, too. Anyone who says they love their health insurance probably has not actually had to use it. Planning to carve out hours on the phone tomorrow trying to negotiate 3 bills. So much for being a productive employee. Imagine if surprise medical bills were not a thing?
10
@michel ridgeway
Obamacare was a Republican plan, similar to the plans of Nixon and Romney. Republican legislators just didn’t vote for it.
Two conclusions:
1. Democrats shouldn’t compromise with Republicans — who will cut off their noses to spite their faces before agreeing to any social “welfare” policies that might make Democrats look good.
2. Democrats shouldn’t pass Republican-style legislation because it’s bound to either fall far short of its stated goals or completely fail.
Unfortunately there are not many mirrors in Rubeville. And there are definitely not any to be found in halls of Congress, especially in the GOP offices. I have pretty good health care. However, we have to start checking all the ala carte items added when ever something goes wrong with the body. I just wonder how people with little resources and no insurance survive. The one thing I don't wonder about. The medical profession is a racket resigned to keep prices high and competition out. If the medical profession were steel, autos or soy beans they would be up before the WTO.
2
What saddens me most is that there are thousands of highly skilled nurse practitioners in North America who cannot work to our full scope of practice because physicians are scared we will replace them. Yet so many people are without health care. Fix this.
8
With a high deductible plan (~20k, covering in-network care) and a family member who has a chronic illness, I spend a lot of time thinking about what we personally could have done with the money we're spending on health insurance (a hefty monthly fee) and then meeting the deductible through the calendar year. Maybe we'd have bought a used car, perhaps taken a vacation.
Professionally, as I work in municipal government, the time I spend discussing health care with employees (determining qualifying event or not, negotiating health insurance premium share with unions, processing changes, etc) is like the high 'attention' deductible for my job - maybe we'd have been able to have better OSHA training, a better procurement spec for our last fire truck, closer oversight on a major capital project.
*These* costs (the substitution of CVS pharmacy instead of durable goods in my personal life, the substitution of endless hours of negotiations regarding premium share vs employee training and major capital oversight on my professional life) are rarely broached in articles.
19
How about Medicare running out of money in just 6 years? No one is even talking about it. Medicare-for-no-one doesn't seem like a good plan at all.
Kristof wants it both ways... It's Medicare For All or the same maze of waste & nothing we have now. There is no middle ground. Kristof says it won't get through Congress, but never answers what will? . I really believe we can get it down to 55 in the next few years. Vote for Sanders ( or Warren ) and stop tearing him down. There are some truly important issues right now, the environment, the defense budget & war machine. But Health Care is the issue of our time.
8
Costs can be reined in and universal non-exploitative care is possible:
1) Transparent, universal, cost-effective, risk adjusted (John Wasson's HYH - How's Your Health) Direct Primary Care with no middlemen between the primary care doctor and patient + catastrophic "wrap around" health insurance via a MUTUAL insurance company + progressively subsidized Health Savings Accounts (HSA's) that begin on conception, are tax free in and tax free out + incentives for fitness & wellness + HSA Bank that supports safe investments.
2) Continuity of Care from conception to signing of death certificate. TEAM support of the Biopsychosocial model of interaction, intervention and outcome improvement over time with the TEAM derived from the counties of care e.g.: Psychiatric Social Workers, Midwives, Physical & Occupational Therapists, Community Pharmacists, Tele-Self-Care Nurses, Comparative Effectiveness Study & Continuity of Care Facilitators, Mesh-networking & AI-programming Specialists, PCPs, CMA's, Community Health Workers, Caregivers, Nutritionists...
3) Integration of Healthcare with Energy Production & Distribution, Agriculture, Climate Stress Control, Transportation, Manufacturing, Housing, Education, Infrastructure, R&D, Innovation....
4) Community-centered Entrepreneurship with purposeful targeting such as the continuous improvement of pregnancy outcomes defined by miscarriage, premature birth, infant mortality, maternal morbidity / mortality, ASD births, outcome disparities.
3
We are also the only country in the world that permits direct-to-consumer medical advertising—of what are necessarily the most expensive products.
And also the only one with a tort system for malpractice—resulting in rafts of unnecessary tests and time lost to excessive “documentation. “
Would Bernie’s plan change any of that?
13
For all its shortcomings I consider myself blessed I was born in the NHS state. I, my children, and grandchildren were born in NHS hospitals and my grandparents and parents died in NHS hospitals. We all have had exemplary care. Free at the point of delivery and paid for out of taxes, with heavily subsidised prescriptions (approx $10) for those in work up to the age of 60, otherwise gratis, the reason the NHS is the UK's holy cow is not only related to health care but because we are not beholden to any employer for insurance payments. If we don't like our jobs we can move knowing our health care will not be compromised. That is real freedom.
71
To Helen: yes, we should never take the NHS for granted.
I cannot begin to imagine what it must be like to not only suffer a life-threatening illness, but on top of that have to worry whether my medical insurance covered all my bills. To get sick, and not to be able to afford to get treatment. To have the threat of bankruptcy hanging over me and my family’s heads because someone has a serious illness or injury which requires long-term care.
I may very well find out if Boris Johnson and the Tory Party have their way ...
18
@Helen, I couldn’t agree more with you. Having experienced the best that both the NHS and the Australian Medicare system have to offer, I fail to comprehend why medical services in the US should have become so politicised, let alone the bandying about of denunciations of “socialism” and “liberalism” as things to be feared. OK, so in Oz we wrinklier don’t get free prescriptions, but AUD5-6 is hardly arduous, and my wife and I haven’t had to pay for a consultation with a more than competent GP of our choice in years. As for US$20,000 annually for health insurance, as posited in that article, that is simply obscene. Sure, I could take out private health insurance here in Australia, at less than a quarter of that amount, but apart from a few privileges such as private hospital accommodation, and perhaps not having to wait a bit longer for specialist services, in an emergency it makes no difference at all, and quite frankly isn’t worth it. And Medicare in Oz is funded by the individual by way of a 2% levy on taxable income above say AUD20,000 a year, so something we haven’t had to worry about for ages. Nor did the sky fall in when Medicare was introduced 30-odd years ago, as predicted by the medical profession at the time. The land of the free and the home of the brave could do with a dose of common sense and compassion too in that regard.
18
Same old same old. The people suffer, well not the rich ones, and the medical industry gets richer and buys politicians to maintain the status quo. Trickle up economy. Do the Republicans care? No. Do corporate Democrats care? No. Does our conman president care. No. The wrong people for the people are in power. Get it?
20
I can’t figure out why more people aren’t worried about all the food industry workers, from field and slaughterhouse to restaurants and grocery stores, who can’t afford decent health care. That, plus the fact that most or all of those workers also don’t have paid sick leave, means that they are likely to work while sick, which endangers all of us. Now that I think about it, I wonder if that is behind the recent problems with romaine lettuce.
26
Bingo!
Finally, a key word appears in a column on American public health: UNIVERSAL
Sweden provides UNIVERSAL health care. Average life expectancy for women - 84 y, for men - 81. Sweden sees each of us in terms of SES variables, not as in America in terms of fictional "race"
All (99%) pregnant women enter a pre, peri, and post natal maternal care system at gestational week 12 +/- with the result that Sweden has one of the best infant/maternal mortality and health records in the world.
SES matters: The higher the education and economic level of women, the longer the life - lower 81, higher 86. The data are there, available to all the medical researchers for whom I work, complete data on our individual medical histories. I can access mine in a minute, see variation in blood values, medication, diagnoses made, recommendations made. Country of birth, yes "race" no.
Take a look at the amazing (116 picks at 01:19 AM) Socrates' list of % of GDP spent on care. The 10 most advanced nations, 10%+/-, less advanced USA 17.2%.
Universal is the only solution.
Only-NeverInSweden.blogspot.com
Citizen US SE
34
@Larry Lundgren - A few might be interested in this news flash from Tanzania. A Swedish medical researcher for whom I am manuscript reviewer reports that "hen" (Swedish for he/she) will be sending a manuscript tomorrow about research on applyinig the Swedish model of maternal care to locations in African countries, research supported for the Gates Foundation.
Since I know all too well the infant and maternal mortality/health outcomes for American sub-populations seen as black, perhaps the Gates Foundation should support a Swedish research team to come to, for example, Minnesota to study applying the Swedish model there. I wish Ilhan Omar could consider learning about this American problem.
10:39 CET 2/23
10
@Larry Lundgren - One more item suggesting the importance of UHC-from Our Twisted DNA by Tim Flannery (review of Carl Zimmer book)
"Studies show that although living in poverty does not reduce the heritability of intelligence in Europe, In the USA it does. Could it be that the existence in Europe of UNIVERSAL HEALTH CARE and more generous social programs in protecting the intelligence of its most vulnerable citizens?"
UHC is a must, whatever the truth of that little story. I realize that our President places no value on intelligence, so if he gets 4 more promoting intelligence will be a lost art.
Just me
11:18 CET 2/23
8
@Larry Lundgren : USA also needs to figure out the teeth, eyes, and brain are also part of the body and belong 100% in "healthcare coverage". Is it only in the USA that teeth, eyes, and brain are for some reason detached from the human body? Weird country USA.
1
Back in 1986 my first Letter to the Editor was published in the L.A. Times. As a health professional working in a hospital setting it was hard to see the financial pain the uninsured had to endure; bankruptcies, loss of homes, etc.
Since the Western Industrialized nations had some form of universal health coverage for their people in place for decades why the U.S. could not glean the best from all these models and come up with a plan.
Isn't it about time we joined the rest of the civilized world and put in place a universal single payer plan? The problem is everyone must get in the pool for it to work properly. There are those who can't seem to see the problem of millions of Americans struggling to live either without coverage or with junk policies. And, there are those who are selfish and don't want to pay higher taxes to cover others. The reality is we are doing so every day when we pay a premium for our car or home insurance. This premium is going to pay for someone collectively whose house burnt down, or car got totaled. That is the way insurance works. And, some day others may be paying for your misfortune.
32
I grew up in a career military family in the day when all medical and dental services were handled by military doctors and dentists in military hospitals and clinics. It was genuine social medicine and my experience and that of my entire family was excellent.
I was born in an American Army hospital overseas and my brothers were all born in Army hospitals. I was diagnosed with TB in 7th grade when they tested and innoculated my entire Army school. The disease was caught very early on and I was cured by Army docs.
When I joined the Air Force, again I had military medical and dental care. I broke a tooth in Basic Training, went the next day to an Air Force dentist and he told me he was doing a temporary fix until I was stationed at a permanent base. That temporary work lasted 30 years.
The best private American healthcare I have had has been Kaiser Permanente, which was developed from a socialized medicine model. It is the highest rated healthcare on the west coast and my experience was superb.
All other healthcare I have utilized in this country has been pretty atrocious. Doctors seem not to care, long wait times for appointments and lots of unnecessary drugs prescribed and tests ordered. There is no compassion in healthcare any longer in this country. We are units to be processed and exploited for money. I try not to participate in the medical industrial complex in this country - their mistakes are the third leading cause of death after heart disease and cancer!
40
Think national healthcare is bad, that you won't save money? My brother married the love of his life, who happened to be a Brit, and moved to England. He has free medical which includes dental care. The crown he needed for this tooth cost a whopping 80 pounds, about $100. My crown I just needed? $1500. 15xs as much. I had to borrow the money for it and now have the added stress of more debt. Universal healthcare now.
75
Thank you Nicholas for continuing to focus on issues of healthcare, and America’s need for changes.
The solutions are within our grasp, but getting there has proven to be difficult. We may be at a tipping point as Sanders appears to be heading towards the nomination. Universal healthcare being his signature issue, and Trump having less than nothing to offer.
Many worry about losing their private insurance, as if their Doctor is part of that package. The doctors will still be there, just freed up from having to interface with and comply with the insurance companies. Generally speaking, doctors want to provide healthcare. Insurance companies want to make money. They ought be separated.
24
Mr. Kristof oversimplifies the issue of foreign physicians. If it weren't for foreign physicians, we would have an even worse shortage of primary care physicians and psychiatrists as they are the lowest paying specialties and therefore many American grads refuse to enter them. Who wants to waste a medical school education making $200,00 per year when you can enter a surgical specialty and making $500,000 and in many cases a million or more. (And don't say this is due to medical school debt as studies have shown there is no correlation between extent of debt and choice of specialty).
So we've ended up an overabundance of surgeons doing unnecessary and expensive surgeries (the estimate is that at least 85% of back surgeries for pain are unnecessary) but ignore making sure that people are up to date on vaccines and that mental health issues are properly addressed.
And let us not forget that many of those of foreign physicians come from countries where there are already major shortage of physicians.
The idea that if we just add a public option to the ACA everything will be fine is ludicrous.
7
Why does anyone (including surgeons) need to make $500K/year. Isn’t $ 200K/year enough (which easily is in the top 20th percentile in the US) for most municipalities, including San Francisco. One keeps hearing the argument that if there is not enough money to be made, no one will go into medicine. Is that what we want, medical professionals who are in it mainly for the money? I submit that a large part of the US’ woes with health insurance has to do with its for-profit nature. Insurance rates go up, so do the number of millions the executives get awarded yearly. Insurance companies have a long history of not wanting to pay out claims where avoidable. An employer, required by law, has no skin (from a pure capitalistic point of view) in the game. Whatever meets the minimum requirement. Too bad if it means employees have insufficient or inadequate coverage. Leading cause of personal bankruptcy in the US is from medical expenses. Every ER in the country runs at a loss because they are obligated to treat anyone who walks in as a result of very high operating costs (malpractice insurance, operational costs etc). At the end of the day, in the extreme capitalist society of today, health insurance just gets in the way of profits. Perhaps what should be repealed are all forms of health insurance the Federal government provides to its senators and representative. Maybe after a few go bankrupt will things change. Too much money to be made in this alas. Sickening in itself.
4
$500K per year is not much for what a surgeon does. I’d rather not have a penny pincher operating on me. I have seen mentioned in this paper a transit worker making over $250K with overtime. Many firemen and policemen approach $200K using a warped overtime system where overtime is built in and planned for. And it’s not just the big cities. My small towns paid fir staff have said they cannot survive without overtime though they make well above the average income and who have more days off, which some would equate to a part-time job. I know they are there 24 hours but the work does not entail even remotely that many hours.
3
@JimH
But it's okay to pay a primary care doc who you hope to help keep you health or a psychiatrist who might help prevent you from committing suicide far less.
Are the lives they save any less valuable then the lives surgeons save?
Couldn't someone In the Library of Congress do a quick summary comparison of the costs, funding mechanisms, administrative procedures, and organisations of the health systems in other Western countries, and give it to every member of Congress?
We have a great system in Australia. Public and private. But most people love our public system, so our private insurers are in difficulties.
5
Canada is nowhere as rich as the US and Canada has decent health care for everyone. You never see a bill. You have no idea what anything costs.You show up and get taken care of. Period. If Canada can do it so can the US, but Canada has been refining health care for decades and the US will not achieve this overnight because many things have to change, drug costs, the propensity to sue for everything. Insurance companies, and all the surrounding money makers have to adjust. It will take time to undo decades of high profits around health care in the States. It can be done a bit at a time.
19
ObamaCare defunded SCHIP, despite the fact that many of the children did not get coverage under Obamacare. He needed the funds to cover 10 million healthy, able bodied, childless adults. He defunded Medicare to the tune of $0.8 trillion and pretended there would be a voluntary long term care insurance program that would save Medicaid $0.5 trillion in nursing home care. So why is it that rather than Obamacare not adding a single thin dime to the national debt it has added $1.5 trillion in deficit spending? And that $2500 the typical family was going to save on annual healthcare cost instead added at least $2500 per year in additional premiums or co-pays and deductibles?
Big medicine added at least $2 trillion in profits. The salaries of the heads of non profits DOUBLED to average $3 million. $1.5 million wasn't enough for the heads of charities. [And the rest of charity hospital executive salaries experienced similar increases. Doctors and nurses didn't get big compensation increases, only the ruling elite.]
Many rural hospitals and urban clinics that served a high proportion of Medicaid patients closed. The problem was worse in states that expanded Medicaid than in states that did not expand Medicaid, so it wasn't the evil Republican's who created the problem by not accepting the federal largesse of free birth control pills.
Drug prices, 70% of which are generics, increased at 2.4 times the rate of inflation and hospital charges increased at 3.3 times.
3
@ebmem Would you site your source for the claim that the situation is worse for the states that expanded Medicaid than it is for those that did not? According to the January 2018 edition of Health Affairs, “ Hospitals in states that expanded Medicaid were about 6 times less likely to close than hospitals in non-expansion states, according to a study by researchers at the University of Colorado Anschutz Medical Campus.”
16
If this corona virus comes to our shores and becomes the pandemic of our worst nightmares it will not care whether or not a victim has health insurance or not. It will be the great equalizer.
4
And every time a single payer system that could contain costs is proposed, a politician in the thrall of the health insurance industry, like a Joe Biden, stands up and gives a speech and says we can't afford it because it would cost a quadrillion dollars over forty years, and it would raise your taxes, and it would somehow actually be taking your insurance away in disguise. Or, like Hillary during the 2016 debates, that it's better to live in a country where you can start a business and become a billionaire, which of course you could never do if you didn't lose your health insurance if you quit your job. And communism.
8
Imagine if we ran fire services like we ran healthcare. Many millions unable to access or afford firefighters, many thousands bankrupted by fires, access to fire fighting only through employers: lose your job, lose your access, saturation advertising on TV about fire services, layers of fire department management making ridiculous salaries, complex billing for firefighting, huge administrative overheads, people who thought they were covered getting huge bills because out-of-network fire departments dispatched to fires, huge and escalating costs for fire fighting equipment because manufacturers bought up by hedge funds ....
... what nation would tolerate this chicanery? Yet our healthcare system persists.
61
@Xoxarle
I lived in rural Arkansas and we had a volunteer fire department. If you were unable to afford the yearly dues, they would watch your house burn down and charge you a fee for showing up to the fire.
Kinda like health care down there. Hospitals an hour or more away, ambulance fees $1500. or more, and doctor offices in town were closed at 5 PM.
Look. When I worked as an RN Case Manager for healthcare insurance we needed to discriminate and prove strict criteria in order to get insurance approvals. As an RN Case Manager we needed to come up with strict criteria to get approvals for our patients to get even their short stays approved.
But then comes along Melania Trump who went to Walter Reed for an outpatient procedure and ended up staying inpatient for a week! At whose expense?
Donald Trump hasn’t a care in the world about who’s paying for the average Joe’s healthcare. And he never will. But he sure is willing to decimate anything possible for the every day guy’s chance at living a better life - with healthcare insurance.
26
A powerful article but one major flaw: quality health care is relatively minor determinant of life expectancy and health. A wealth of epidemiological data demonstrates that poor food quality, a sedentary lifestyle, obesity, drug addiction, suicide and murder, depression, financial stress, and social isolation are major causes of premature death in our country. Want Americans to live longer? Ask why we live such unhealthy lives.
4
@Dr B If an individual is unable to afford healthcare how are they to receive mental health treatment for their obesity, drug addiction, their depression, or their social isolation? If they cannot afford healthcare when will they see a physician who can encourage them to engage in healthy lifestyles, who can monitor their weight and refer them to a dietitian who can help them understand how to fix healthy meals and provide guidance for healthy weight loss?
13
You nailed the reality that most will not accept.
health care without worry is a great help to the whole society.
1
When people ask how do you pay for 'Medicare for all' the simple answer is, we already are paying for it, we just are not getting it. Getting to the solution is not easy but the money is there we just need to be smarter about how we use it.
49
I have great healthcare and will not give it up to fund Medicare for all.
@Nycdweller
But what if your health CARE were the same (or better), and you didn't have to pay an insurance company for it... AND the new amount of taxes was LESS than your premium is now?
this is what we're talking about.
18
You and others continue to perpetuate the lie that it is going to be free which it will not. The money had to come from somewhere and it is most likely going to be via a payroll tax. You may not have pay a premium directly and it a reality distortion field you might think it costs nothing m, but it definitely will. If employers have shoulder the entire cost then you will be paid less as benefits cost money, which means less money for your salary. When any business cost, including taxes, companies raise prices as no one who is in business will continue to eat price increases. My company continually increases prices just to stay even. We do not want to, but we also do not have buckets of money laying around to cover annual increases in compliance, energy, healthcare, taxes (federal, local and state), insurance, rent, etc. The only expense we have been able to minimize is Unemployment Insurance because we have never had a claim filed against us.
Why not be up front about and tell people it will cost them but it will hopefully be less than they are paying now. We’ve already gone through the “if you like your doctor you can keep your doctor”. That alone turns a lot of people off to UHC because they were rooked once and it hurt. Please tell to me how paying higher premiums and deductible for less choice (doctors and insurance companies) is better.
At NYC city dweller....fantastic news and good for you. You don’t say what is so great about it: Your premium? Your coverage? Where can others get the same? Or, are you just saying, just like the elected senators and representatives, I’m OK, thank you very much, so this is not an issue of importance to me, so too bad for the rest of you, but I’m not interested in any change that could benefi the communiuty within which you live?
1
Great piece. Recently my 30 year old son asked me if health care in the US was this dysfunctional and predatory (also characteristics of the current main stream brand of American health care) twenty years ago. My answer was unequivocally,“No.” It has steadily deteriorated since then into an unaffordable, competitive, deceitful, and practically unnegotiable morass of fees, surprise charges, and bureaucratic hoops and dead ends with most patients being ushered through their care as if on a conveyor belt. I frankly don’t see how any elderly or otherwise vulnerable person can even attempt to survive serious medical care without the assistance (and persistent vigilance) of an advocate. I guess that may be a contributing factor to the declining longevity statistics you cite. Thanks for the good article.
15
Anyone who’s had to actually use medical care knows the problem isn’t access, but affordability. You’ve basically made the case in your article for Medicare for All.
14
How are the elite that are in power going to control how artificial intelligence will make diagnostics much more accurate then a doctor who has an MD, Phd. ? This is the only industry I think will benefit from artificial intelligence. With quantum computing, they will be able to do so much more then a doctor's visit that is 15 minutes, and a prescription. Artificial Intelligence will be able to analyze data and predict disease in which an MD will miss everyday and twice on Sundays. It makes sense that this will drive down the costs of healthcare if the powers that be don't get their greedy little hands on this innovation. This is what they call socialism - when human life and quality of life isn't limited to the rich, it is ethically and morally the right thing to do. Hopefully, computers will be a savior for this travesty of a healthcare industry based on curriculum that has been funded by the pharmaceutical industry. Something has to change, many are suffering in this country that aren't covered by your local news or internet sites.
2
In a system which includes so many people and so much money, the only way change will occur is through political action. The Republican Party will never take any action since their donors are the ones making lots of money from sick Americans. Any hope for substantial change will come only if the Democrats take full control of the federal government one day. (Just one more reason to vote straight Democratic this November 3rd). Let's just hope that if (when?) that happens, the Democrats have enough sense to ensure that any changes they make are permanent (maybe through a Constitutional amendment?). Otherwise the Republicans will just try to turn back the clock if (God forbid) they are in control some day.
12
People who heard Uwe Reinhardt, referenced here, discuss health policy tended to find him unforgettable.
Sounding like a cross between Henry Kissinger and Sgt. Schultz, Prof. Reinhard was both brilliant and funny. His life work was trying to understand all factors causing U.S, resistance to implementing a national health care/coverage scheme.
Fear of complexity has not been one of them, he said in the runup to the 1990s iteration of the debate: "America is bureacracy mad! If we had a national plan that required us to measure our height by being dunked in a barrel to determine specific gravity, we would love it!!"
Mr. Kristof should have clarified that while Canada is a single-payer coverage system, the UK's National Health Service is a government run care system. The former reimburses providers, the latter is a direct provider (sort of like a national HMO).
7
In spite of what some people individually believe as obvious truth, Americans are divided evenly as to healthcare being a basic human right. This is probably reflective of our foundational culture of individualism, but it makes no difference of the origins of this difference in core belief. It would seem unlikely with this fundamental difference in opinion that massive changes in economics and societal expectations are likely. It will take skilled leadership skill to even implement incremental change to improve healthcare for those underserved populations. Asserting that the majority of Americans believe healthcare is a right and those that don’t are mistaken or morally deficient will not be productive. One of the cardinal rules for attempting big changes is to be completely honest with yourself as to current reality. We don’t have cultural, moral or ethical consensus on this issue unlike other countries like England who celebrated the NHS at the opening ceremony of the Olympics. The skill will be in building a consensus as to why improving healthcare is a benefit to all. The details of policy and economics are interesting, but not germane or convincing, until there is that consensus.
6
@Maui Doc I am not sure how we ever get that consensus. I read a number of conservative sites. I have noticed a strong correlation between people who claim to believe in 'right to life' but don't believe that a life is entitled to healthcare after it is born.
I wasn't sure I was understanding that attitude. It seemed contradictory. So i started commenting on those sites; on that issue. The responses I got back (if any) tended to be along the lines of "Yes, I believe that abortion is murder, but that doesn't mean I have any responsibility for the baby". I guess the sins of the parents do fall on the child. even in the 21st Century.
I also have a friend who lives in a very conservative area. He has a neighbor with serious heart problems.
This neighbor's life has been saved by intensive care that is paid for by ACA insurance; but he calls it 'ObummerCare'. He wouldn't vote for a Democrat even though his life depends upon it.
May god have mercy on our souls.
1
@Harvey Bernstein
Most of China's citizens (95%) have at least basic health coverage.
Perhaps, if Covid-19 becomes widespread here, more citizens will see the value of universal coverage/care. Imagine, worrying about whether or not the person walking, sitting, riding next to you or your child at school, has access to health care and so won't feel compelled to "tough it out" if they feel "something" coming on. Or, the person that worked in the plant preparing pre-packaged salad mix or hamburger, or the person that last touched the door handle, paperwork you need to fill out etc.
@Nancy So we are reduced to hoping Covid-19 becomes endemic or pandemic. I don't think it would help.
Do you remember that Trump was one of the big mouths complaining that volunteer healthcare workers who went to Africa to fight EBOLA were being allowed to come home. BTW, they had tested negative and were going to be quarantined.
These people were braver and more compassionate than I ever will be. You are welcome to your own judgement on our fearless leader. But I do know that he is currently trying to void the ACA and that he gets rabid (pun intended) cheers at his rallies for doing that.
Where is the common ground?
The U.S. is not prepared for the coronavirus threat primarily because we do not have universal access to healthcare.
Without a comprehensive system for testing and delivering care, we have no effective response to a serious pandemic. Our rudimentary and underfunded public health infrastructure is simply not up to the task. And depending on a disconnected hodgepodge of nonprofit and for profit care delivery providers leaves too many holes to slow or stop the spread of a highly contagious virus.
So here we are, in the wealthiest country in the world, pretty much left just hoping the coronavirus evolves into something less dangerous as soon as possible.
16
I agree that Medicare for all would not get through Congress however there are 2 changes that would help tremendously and could get through a Democratic Congress and President
1. Federal takeover of Medicaid. This would stop the red states from continuously hacking away at it to throw people off. It would also take the costs off the states books
2. Put everyone who is on Social Security on Medicare. Half the people on social security go on before age 65. This would remove them from private insurance risk pool. If they are uninsured and get treated their costs have to be born for the rest of us
The cost for these can be covered by a package of additional taxes. Whatever isn’t covered we can just borrow. No one cared when Trump blew up the deficit
3
Generally, this column is absolutely true, but I am not certain that there is a cabal against foreign doctors who want to become licensed and practice in the US. The problem is that the medical skills and experiences needed to practice here are not the same as in other countries. The admission of international medical graduates into training programs is a very complex subject, with funding issues, language issues and visa issues. In addition, many countries have seen enough of a "brain drain" of physicians who prefer to practice in the US, such that they have decried pathways that might lead to more of their citizen physicians coming here.
What Mr. Kristof does not mention is the fact that we train the wrong physicians. Our residency and fellowship systems are not aligned with the needs of the country -- too many subspecialists, not enough primary care physicians in the pipeline. Why this is so is a complex issue, but the government, through its charter to fund residency training, could fix this quickly. On the other hand, there would be huge pushback from department and divisional specialty training leaders and from the ACGME, the overall credentialing organization. In addition, if you want to improve access to care, you create incentives for physicians to work longer in their careers. It may be wise for a surgeon to leave the OR at a certain age, but that same doctor could morph her career into beneficial work, even primary care with some extra training.
5
ANOTHER MODEST PROPOSAL
Look, if you kill off the old and some of poor, that takes care of that social bill. You need the poor to exploit and use for gun fodder until the Autonomous Weapon Systems (AWS) are developed and operational. (On that see climate change and in ability to conduct war with humans). And, add to that when all or most repeatable production is automated there will be no need.
Then you have a country (not nation) with wealthy people who own the worldwide means of production and control everything and everybody through interlinking BOD and or treaties.
When considering the cost associated with maintaining the current social contract, and the lack of reinvestment in the people here, there is no other way, just eliminate those who cannot sustain themselves, quickly or slowly. make being poor and homeless a federal crime. Then, use the arrestees as slave labor as has been done for centuries. Only now it's covered by the veneer of LAW. It's being done in many for hire prison systems. It simply needs to be expanded. With that in mind maybe we do need to keep some of the poor. I would guess the details will be worked out.
Once all that's taken into consideration, the borders anywhere can be defended by the AWS against the tide of refugees from countries that will be suffering form climate alteration. machines have no feelings (unless there is a Technological Singularity). So the command and programming to eliminate dangerous elements will be a cakewalk.
4
Your invitation for reflection on our faulty, and expensive, medical care, is an urgency. We all want, and deserve, quality affordable care. On that, we have failed miserably thus far, and with the republican (and Trump's) cruel gall to deny health insurance to the poor, that they take for granted for themselves. There is also a lack of justice in a system more geared to make sure their billing is up to date that physician's (and nurses) oath, to do always what's in patient's best interest. That Big Pharma tends to gauge us in prohibitive prices is shameful; that some hospitals (even the non-profits) and insurance companies take an inordinate cut in the financial proceeds, also true...and in need of change. Although these United States is superb in complicated procedures, it fails in the common one's, far too expensive in comparison with the service and/or goods offered. Furthermore, the current medical care is not safe enough, as transparency is clouded and revealing an unenviable rate of complications and early deaths from medical errors (many, preventable). And, of course, having a public option, would keep us more honest. Last though not least, we are way behind other developed nations in offering preventive care (diet, exercise, dental and mental checks), so much cheaper that having to treat a disease (call it obesity, leading to diabetes and hypertension and cardiopulmonary problems, cancer, even Alzheimer's; unrelieved chronic stress leading to drug abuse, etc).
5
Trump fears the coronavirus outbreak but as usual, his solution is to build a wall-i.e. forbid any American with the virus to be returned to the United States.He, obviously, has no comprehension of how pandemics spread.He is putting the country at risk if he continues to support a reduction in spending for public health by underfunding the National Institutes of Health and the Centers for Disease Control and Prevention.In an interconnected world there will be more outbreaks of dangerous disease and our best defense is the expertise of NIH and the CDC-they need to be funded to the maximum-now is the time to let your Congress person know so Trump doesn’t slip through another budget that does favors only for his wealthy friends.
11
I wish Mr. Kristof, who I believe has a sincere and good intent in everything he does, (and therefore I trust him to try to tell the truth) would get his mind around this one and then endorse Sanders, the only one who will inspire the nation to beat Trump. Maybe he hasn’t had the experience of friends overseas looking in horror and disbelief at the unconscionably brutal system we have here. Healthcare is very different from health insurance, which extracts 100 billion from the healthcare that Americans could be receiving, if that managerial layer were not intruding between the doctor and patient.
13
Perhaps there was not enough room in this column to mention the millions of bankruptcies every year caused by medical expenses or the long, long lines that form when traveling free clinics are set up - as if we were some poor third world country - or the people setting up gofundme pages to pay for a child’s surgery.
Sure Medicare for all would cost a lot - but a lot less than the scare mongers say - but it would be worth it.
31
@Mark Marks yes, but do you really think it will go through congress? Remember Obama had to drop the public option and both houses were Democratic.
3
Suggestion: Read the book "The Price We Pay by Marly McKary,MD. It is clear we are spending too much money and there are a lot of opportunities to reduce the spending and at the same time improve care and provide care for all. Health care is a human right and we should make that right available to all with no exceptions.
3
A few years ago, I took my kids into the local county health department for vaccines and some routine care. It costs a little bit of money, but at least it is available if your kids need some routine help. This is not a panacea for the healthcare problems in our country; just a reminder for people who are desperate with nowhere else to turn. My father was a heart surgeon, and my husband and I are both college educated people who have struggled to make ends meet. Just saying....the economy isn't working for many of us, and we often don't have access to affordable good-quality healthcare.
17
“Prices for virtually any health care product or service in the United States tend to be at least twice as high as those for comparable products or services in other countries,” Reinhardt wrote. Just twice? A lumbar injection my wife received last summer to relieve lower back pain, in Chicago, cost $7500 (of which we paid, after insurance, 10%), while a similar shot she later received that summer in Moscow, after the first shot didn't take, cost us just $100, without insurance. That's 75 times more in the U.S., for a procedure that didn't even work. This is just wrong.
9
Cost can be twice, but they are often ten, fifty or even a hundred times greater. Especially for drugs.
It’s actually cheaper to fly to Europe or the Far East, have your procedure and then convalesce at a luxury hotel than it is to have the procedure done here.
12
The author contradicts himself on several points. The United States nay have less children vaccinated, but this can be attributed to the now debunked theory, spread by liberals, that immunizations cause Autism. Could it be the reason poor citizens receive lower quality health care is because of poor services from existing government health care programs. In California, we have Medi Cal, known for its bad service and disfunction. Many local doctors will not see Medi Cal patients, forcing them to travel long distances to find a doctor who will see them. If we have to travel 30 miles or more to see physician, why bother. This speaks to the efficiency of government options. Finally poor communities tend to have less healthy diets. Is Trump responsible for this as well? Healthy food is not expensive, but it is easier to pick up fast food or even something pre-made. In spite of all the information we get regularly on healthy eating, people still opt for the unhealthy choices. Why is it that counties like France have better health rates than we do? The French diet, rich with butter and sauces, is healthier than the choices made by many United States citizens. Can Trump be blamed for this as well? At some point we just have to accept that people will continue to make bad choices? Finally, I have two children, both with additional medical needs and they are on my policy without interruption. Can you clarify your sources as to why children are losing coverage?
1
One of this commenter’s responses was striking to me: the one about poor choices individuals make.
Does the commenter really believe that Americans, in contrast to citizens of other nations, make an unusually increased number of poor choices ?
Why would this be?
How could this be?
7
@David Berman MD The election of Donald Trump was a poor choice. Nutritional dysfunction in the marketplace of ideas, one might say.
3
@David Berman MD
You can trying try to spin the issue any way you choose, however you cannot deny the facts. The U.S. is a leader is childhood obesity and diabetes. Why you ask? Poor choices? Lack of information? Ignorance? How could this be is rather naive. Why do people open fire in schools? There may be several reasons, however we cannot blame their actions on Trump or any one cause.
Why do you think Sanders is winning? We need universal access to healthcare. No other candidate is trustworthy in even this issue. No other candidate is running on the American people who are giving up eating lunch to pay for his campaign to win, so we can live in a civilized country. I have had personal experience with free national healthcare in France, and Japan, among other places. I have family friends who moved to South Korea and Australia even, so they could send their kids to college for free and get healthcare. We need Sanders. If you don’t understand this, please don’t try to sabotage his candidacy yet again. We are literally dying for the freedom of healthcare.
13
Only 3 states have voted. How about waiting to see what the other 47 have to say?
The reason Americans have shorter life expectancy than citizens of many other countries, some much less well off than us, is that we have large underclasses of dopers, drunks, the promiscuous, parents who abandon their families, people who play with guns, criminals of various sorts, those who live on junk food, etc. Other countries don't have them, or many fewer in proportion.
It's not because of our health care system.
4
Tens of thousands of Americans die each year PRIMARILY from lack of access to preventative care. That’s a fact.
What is going to help you survive cancer better? The freedom to see a doctor when you have an issue that gets diagnosed as stage 1, or having to wait by necessity and go to the ER when you have a crisis that gets diagnosed as stage 4?
16
BTW, Other countries have crime, the poor, drug addicts, the overweight, etc.
Funny thing about drug addiction. If you decriminalize it, and give addicts access to counseling an support, rates of addiction go DOWN. See Portugal.
8
In America access to health care has become a luxury item much like Mercedes Benzes, Audis, or decent housing. America is not a country where being middle or working class or poor is a good idea. Since the 1980s very little has been done to ensure that working Americans, (by that I mean most of us) have access to medical care when and where we need it without the worry of going bankrupt, can have decent housing without spending over half of what we net, or that our infrastructure and public spaces are up to date. Our elected officials do not serve us. They serve their richest donors.
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@hen3ry
For as long as inequality is allowed to remain in the healthcare system, some people will have full coverage, many will have insufficient coverage, and many will die needlessly.
3
The greatest inequity in our health care system is that 27.9 million Americans are uninsured. And that was contemplated from the start. Obamacare included a coverage gap from day one because it was too expensive to insure everybody. And Democrats had to choose who would not be covered -- the poor or the working class.
In the end, the working class, mostly Republicans, were the ones who were not insured while the poor, mostly Democrats, were covered. Coincidence? I don't think so.
Obamacare benefited poor Democrats at the expense of working class Republicans, and while Democrats have never acknowledged this fact, it is a major reason why the working class resents the poor and vote Republican.
1
My ObamaCare costs me $15,000 a year and zero is covered. I pay online third of my $60,000 yearly income total for out of pocket expenses, copays and every other excuse to take everything I have. Please don’t take away this chance for us to actually live like my friends in every other developed country. I’m begging you to help us elect the only candidate who will beat Trump and change our future to one of hope. Sanders
16
@Lilly Democrats change the subject rather than admit their partisan approach to health care. Bernie Sanders is a convenient diversion from the truth. Why not talk about Roger Stone? He's equally relevant.
I respect your opinion and support your interest in integrity in governance and the separation of powers, Checks and Balances and our Constitution. Why am I mentioning my thoughts regarding healthcare? Because we Americans are literally dying for lack of access to healthcare from a managerial layer that has been allowed to insert itself between doctor and patient and I and my family who loves me had to face the fact that I had a cancer scare recently and we realized, because my insurance refused to even cover a diagnostic extra mammogram to investigate a lump, together with my mother’s history of breast cancer, I realized I could die from living in this country. That’s why I am giving Sanders my lunch money. One reason anyway. And there are millions of Americans in this very moment in similar circumstances. My European friends are aghast and in disbelief at the actual abuse and unconscionable stress we live with here. A friend just had both elderly parents in the hospital for two months straight, now have home care included and it cost them almost nothing at all. A few hundred dollars. Because their country values their quality of life. That’s what governments are for. Here, government serves billionaires. It’s barbaric. It’s time for our FDR Democrat. Sanders.
15
Mr. Trump is already bungling the corona virus probable outbreak in the US.
From Science Mag. Feb. 14 2020 there is simply inadequate testing capability or sensitivity to detect early cases. A few cases have and will continue to occur in the US that are not caught by quarantine of China travelers. Those cases won't be caught, until the disease has become contagious and already has infected others. Unless those cells of contagion are caught early, the disease will grow rapidly.
Since there is no cure and won't be a vaccine for many months there should be a plan for handling potentially tens of thousands of cases. Very clearly there is no national plan nor financial resources for that.
Local medical authorities are mounting expensive monitoring programs for identified travelers. There is no FEMA funding to help them until the outbreak becomes dangerous.
Trump's thoughts on the matter is that Xi is doing a marvelous job. Success is 70,000 cases of people who are demonstrably sick? The quality of Xi's work can be assessed in a year, but not now.
Meanwhile, now is the time make sure that the US doesn't have 70,000 more cases. Early treatment, hospitalization and quarantine are needed to catch all likely cases that can spread the disease.
Trump should be reassuring the American people that all necessary steps are taken and emergency funding provided to support it.
But instead Trump is busy hiding Russian support for his campaign and bragging about his wall.
7
Another feature of our healthcare system that drives up costs are certificates of need which are basically monopolies given by states to certain healthcare providers. In this state, once a provider has a CON in an area for a particular service, its virtually impossible for a competitor to come in unless they are connected to the three person unelected Healthcare Authority board.
2
I think that Americans have to realize that the US is not a "civilized country" so long as it continues with its present approach to the health of its citizens (I include in this assessment of the lack of care for citizens' lives the horrific inability and unwillingness to control guns). The sad reality that much of this lack of care is explicitly due to the radical ideology of the American right - an ideology that is deeply embedded in many parts of the country - only adds to the horror.
29
Yet the right will continue to vote as they do.
2
@Fed up : That would not be a problem if the rational patriotic rest of us were united and outvoted them in every election with a huge margin. Regretfully we are divided while they are united.
2
Thank you for speaking up. Americans are getting harder for the dark money (Jane Mayer) to brainwash when more and more of us have or know Americans who are literally dying because we are living in the Koch brothers’ and otter billionaires’ America. Shout out also to Anand Giriharadas for knowing that the country that destroyed the Nazis can certainly exert the public will to enact universal healthcare.
1
I agree with most of what Mr. Kristof has written, our health care system, in general, is shameful. We can blame our so called representatives in Washington (owned by the heath "care" lobby) for it, together with the limitless and unchecked greed of doctors, hospital operators and insurance companies. However, he is wrong on his example of HPV vaccination rate. He should do some research (for example looking at what is happening in Great Britain where the HPV vaccination rate of young women is very high) and if he did he would have found out that the HPV vaccine is extremely ineffective with a large number of dangerous side effects. It is a for profit sham, nothing more. See e.g.: https://vaxinsider.com/the-great-hpv-lie/. Vaccination has done a lot of good for human society, eliminating some very dangerous deadly diseases, but what he have today in our country is dangerous over-vaccination, serving no positive societal purpose just the insatiable profit interest of the vaccine manufacturers and their supporters. There is no other developed nation mandating 40+ invitations for ever child, starting on day one of their lives. Yet, our children and our population are not healthier than those of other developed nations, to the contrary. Our representatives should look at data from all around the world instead of listening to lobbyists.
Isn't the problem really one of cost, rather than insurance or universal coverage? As long as costs remain absurdly high, it is very hard to see how any redistribution system can work in practice.
Both are issues. It’s outrageous that Americans either lack access to preventative care, or self deny due to costs, as millions do. It’s costs lives, thousands of lives lost each year. Unnecessarily. Because insurance profits rate higher than lives.
5
Nicholas I read your newsletter earlier today on my phone and emailed back, but will put my comments here: I am a Speech Language Pathologist living in Los Angeles. Just a small, but important fact/correction: in California, at least (I am not sure of the procedures and costs, if any, in other states), parents who have children who are delayed in talking or whom they suspect have other developmental delays, can take them to their local Regional Center for an evaluation and treatment, if they are younger than 3. If they have no insurance, the service is free to them. After age 3, the local school district has the responsibility to provide service, if the child qualifies, again at no cost to the parent. Many parents and doctors seem to be unaware of this, and if your column reaches some of them, you will have done your mitzvah for the day.
Sent from my mobile phone
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@Lianne : This is great and good to know. But keep in mind that CA is one of the most, if not the most progressive state of our union. The rest of the states are far behind.
2
@Eva I think that the laws that drive Regional Center are Fed based. I know for sure that the laws that drive the services in school districts are Fed based. That is not to say that other states have the same, lesser, or more intense services. That being said, I am grateful I live in a progressive state where services are available.
I am a Speech-Language Pathologist in Florida. Early intervention has been eviscerated in this state.
We lack enough physicians and attorneys in the US. You will scoff if you live in an affluent or urban area. However, there are not enough practitioners in rural areas, especially the poorest ones. And that is partly due to the high levels of debt most medical and law students must take on for their educations. So it’s not just a healthcare issue, it’s also an education and debt problem.
If nothing else, the various healthcare plans that the federal government makes available to federal employees should be available to everyone else.
1
It’s also because the AMA controls the supply of doctors, keeping it artificially low to boost demand and salaries. We need more medical schools and more medical students, but that would mean fighting the doctor lobby.
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@Lawyermom
The biggest problem I have with your theses is that the very underserved rural areas you speak of are the most ardent supporters of Trump and the Republicans, generally. These are the people who sport MAGA hats and cheer as Trump excoriates liberals, blacks, Hispanics, Korean film makers and -- well you know....
I've spent years living part-time in rural upstate New York and have never quite fathomed why these people consistently, year after year, election after election, vote against their own interests.
For generations now these people have been willfully exploited. They consistently vote into power politicians who then actively work against them.
I used to care; I no longer do.
1
The failure to make dental care an integral part of health insurance coverage, including Medicare and Medicaid, has always struck me as gross stupidity. It’s not just a matter of how much an abscessed tooth or untreated cavity hurts. It’s a matter of how essential oral health is to overall health. I’m not a dentist, married to a dentist, or related to a dentist; moreover, I dread going to the dentist as much as anyone, even for routine cleanings. But I know that I am better off physically because I regularly see a dentist. Who can possibly be healthy with bacteria from an abscess circulating through their system? And because pain stresses the body, who can be healthy, productive, or happy if oral pain is a constant in their life?
9
I have to wonder if the US is not on a course which will lead us to Medicare for All in 4-8 years.
Scenario: Bernie Sanders runs for President, loses to Donald Trump. Obamacare repealed or declared unconstitutional during President Trump’s second term. It is not replaced and 25 million Americans lose health care insurance. Democratic sweep in four years. Congress still cannot agree on plan to restore lost coverage other than Medicare for all.
Solution: Under Democrats it is past.
@William Ball not necessarily, remember the public option that Obama had to drop and he had both houses at the time.
Thankfully, with Senator Sanders crushing it in Nevada, we'll in short order be joining the rest of the ENTIRE developed nations in the world with universal health care.
People have been conned by the "American Dream" for far too long.
After all, it says it right there. It's called the "American Dream" because you have to be asleep to believe it.
8
@Raven : Sanders means well but he has no sense of reality. Mr. Kristof is right, congress (even with Democratic majorities in both houses) will never pass medicare for all because of the way our elections are financed. The most important thing for Democrats, after defeating Trump, should be to reform our election system and eliminate the role private and corporate money play in it. This will require a law that repeals the infamous and insane Scalia driven SCOTUS decision ruling that money equals free speech.
3
Crushing it in Nevada...there are 47 more states that haven’t voted.
Medicare for all. Bernie Sanders for President.
He is winning big time. Time to change your tune my friend. It ain’t funny anymore.
9
@Blunt get real, for it to become law it has to pass both houses. Unless Bernie would become king he can't make it happen
He won’t win
Can we please drop this nonsense about U.S. health care being higher cost.
It’s more expensive in dollar terms, but salaries in the U.S. are far higher than they are in Canada and the U.K. The quality of care in the U.S. is higher, and the range of available treatments is wider.
Everyone understands that the U.S. system is inequitable and fragmentary. It contains many inefficiencies, and opaque pricing that masks innumerable kickbacks and rake-offs. However, an honest analysis of its cost has to be based on the service it delivers and ability of its users to pay for it: hours worked per gall bladder extracted, or something like that. It also has to reflect the fact that doctors, nurses, pharma workers and other specialists don’t work for nothing. A house in a suburb of New York or San Francisco costs a lot more than a house in flyover country. So does the food, the car insurance and everything else - none of which can be changed by Medicare for All or the expansion of the Affordable Care Act.
Trump is a disaster. We know that. However, he achieves his success by painting a false picture of the situation he’s pretending to deal with. Is it too much to ask that people who write in opposition make an effort to present a true one?
4
It’s not nonsense, the USA for-profit system is twice as expensive as other first world countries, which have better outcomes, nobody bankrupted, and are fully inclusive.
I’ve experienced both systems for decades, and care is broadly comparable, but costs and billing are a nightmare here, even for those with good insurance. Foreign systems are not run primarily for greed and profit, and don’t seek to ambush you by stealth. The US system is basically inhumane, it is viewed with horror by those who live abroad and cannot fathom exploiting people in desperate need the way insurers, hospitals and pharmaceuticals do here.
12
In the U.S. we believe that great healthcare equals great health.
But, what if that belief is wrong?
And, so, we have built the most technologically advanced healthcare with the finest doctors, specialists, hospitals and pharmacueticals on Earth to focus on treating care of really sick people, not on keeping healthy people - healthy. We have spared no expense. And, yet, Western and Northern Europeans have 50% the rate of: type 2 diabetes, heart disease, cardiovascular disease, stroke, heart attack, etc., then we do here in the U.S.
Could it possibly be that the reason why people live longer with less disability in say, Scandinavia, is that their people and their societies focus on lifelong health and lifestyle to prevent the need for so much healthcare, and not so much spending on healthcare? I lived in rural Northern Germany for five years and the people there do not use healthcare nearly as much as we do in the U.S. In fact most senior citizens there do not take ANY prescription drugs...no need to, they're healthy.
A major reason why healthcare is cheaper in countries where people live longer than in the U.S. is that those people take much better care of their own health outside of their healthcare systems.
They focus on health not healthcare to keep themselves healthy and living longer, less disabled lives.
2
No, it’s cheaper because costs are regulated, and it’s not run for profit.
12
@SparkyTheWonderPup perhaps it's because they have access to medical care when and where they need it. That alone can make a huge difference.
9
Sparky is so right. Health care is a minor determinant of health. Yes cut costs and cover all, but to really improve life expectancy, address America's epidemic of obesity, despair, opioid use, inactivity, social isolation and other self destructive habits. We could begin by confronting poverty and income inequality.
“The industry that is supposed to improve our health is undermining it.”
With the profiteering providers, insurers and big Pharma on the one hand and Trump with a complicit Republican dominated Senate doing all he can to ruin the limited progress we gained and were building on with the ACA, we have so much to be angry about. The needless suffering is inexcusable. I shudder at the thought of an outbreak of Coronavirus here. Trump is praising the Chinese president for his handling of this crisis, but reporting indicates he was AWOL at the start and the deaths continue to mount.
Why did this administration think cutting the budgets of NIH and the CDC a good idea?
Our healthcare system should be front and center when we go to the polls. We need to choose leaders who want to fix it. Frankly, I’m not in any mood to hear about what we can’t have in this country because some privileged politician wants to stay in a cushy post in Washington, funded by the people represented in the above quote.
9
Let us not overlook the advantages for businesses and their employees. For the last twenty years, I, as a small business owner, have made decisions about providing health insurance for my employees. It is ridiculously expensive and the coverage has such high deductibles that many employees can’t afford to use it (although the Obamacare reforms at least added free health prevention services.) I should not have to be a health care administrator. A Medicare for All system would allow me to focus on my business, provide better coverage to keep my employees healthier, and the savings to me and my employees would more than cover the necessary taxes we would need to pay to make the system work. I lived in Europe for a couple of years. People love their health coverage and cannot even fathom that we don’t provide universal health care.
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@Steve: You raise an important point that is often overlooked in discussions about healthcare in the US. It makes no sense at all to saddle US employers with the burden of providing and managing health insurance plans for their employees.
The burden of providing health insurance forces employers to devote significant financial and personnel resources to complex tasks that having nothing to do with the core missions and competencies of their businesses.
This burden also ties employees to their employers in ways that reduce job flexibility and the ability to negotiate wages and other benefits.
Finally, this health insurance burden makes US companies less competitive on the world stage, where they must compete with companies that are not saddled with with the same burden. And I’m not just talking about insurance costs, per se; the US insurance model is geared towards catastrophic coverage rather than preventative care. Comprehensive preventative care makes for happier, healthier people (employees), and costs less than catastrophic care in the long run.
You want to talk about jobs? Then help our businesses be more competitive and our people happier and healthier.
5
Nicholas Kristoff is right on all counts. But I believe “Medicare for All” to be an unproductive, negative trope that distracts all Democrat candidates, leads to (often rancorous) unproductive anger & animosity, is a waste of time that leads the discussants away from the overriding, legitimate issue which is Healthcare for All: Effective, truly accessible Healthcare that results in enhanced quality of life and family stability. In focusing on Medicare for All (MFA) we confuse means with ends (solutions. Healthcare for All is not confusing, is understood by everyone and renders MFA irrelevant.
6
It is not only European countries with much more cost effective health outcomes. The US spends about four times more per capita on healthcare than Panamá does. What does it buy? A rapidly diminishing advantage in life expectancy over Panamá. The difference is now 0.2 years in life expectancy for 4 times as much money spent.
10
Why can’t the Federal government fund the expansion of medical schools in this country and provide scholarships on a competitive basis. Then require each newly minted medical professionals to work in underserved communities for ten or so years in exchange for their free education?
6
@John Casana
I am all for increasing the supply of doctors. However, everyone should realize that increasing the number of students in med schools means more doctors must be teaching them. Initially, that means FEWER doctors are left to treat patients.
1
@John
Our K-12 schools are too underfunded because America has this stupid idea to fund them by local property taxes. The parenting, teaching and administrating is also not good enough. Furthermore, several states and regions don’t even value education.
I sincerely doubt our education system could provide enough qualified candidates. When there is a shortage, the employee calls the shots.
1
Kristof wrote:
"Trump’s policies have led to the loss of health insurance for 400,000 children. Imagine that your child is crying from an ear infection or a toothache and you have no doctor to go to."
Those are great words if your purpose is purely to gain political power by manipulating the emotions of the public. But if you truly care about people getting good healthcare, then those words are a deception.
Having health insurance is very important. Wide disagreement exists about the best way to have it provided. I won't argue for any of them here now. The point that should be made, indeed shouted so everyone really hears, and that everyone needs to understand is this: There is a big difference between having health insurance and actually getting health care.
You can design whatever scheme you wish to provide health insurance to every single person. But health insurance does not deliver any health care. Only actual care providers and care facilities deliver any health care.
Do you think we have many unemployed doctors or many doctors who have many hours every day where they have no patients to care for? Do you think our hospitals and clinics are operating at substantial under-capacity. If you believe any of those fantasies, then providing more people with health insurance will enable them to get more health care. But if you realize that such under-utilization does not exist, then you see the deception that politicians are now putting over on us.
6
I wish Mr. Kristof, who I believe has a sincere and good intent in everything he does, would get his mind around this one and then endorse Bernie. Maybe he hasn’t had the experience of friends overseas looking in horror and disbelief at the unconscionably brutal system we have here. Healthcare is very different from health insurance, which extracts 100 billion from the healthcare that Americans could be receiving, if that managerial layer were not intruding between the doctor and patient.
5
"“The industry that is supposed to improve our health is undermining it.”"
That "industry" includes hospitals, doctors, drug and device manufacturers, dentists, and even insurance companies who, as middlemen, exact their pound of flesh.
Greed abounds in many industries, but that governs healthcare delivery is particularly pernicious in light of the Hippocratic Oath and the expectation that the ancnillary medical professionals who care for you are actually going to do just that.
Nicholas I agree with everything you write on healthcare, but one thing: in this piece, you use the wrong word to describe the impact of repealing the ACA without replacing it on the lives of Americans.
You say such a move would'nt be policy but "vandalism". I'd say, it would be more like murder.
15
@ChristineMcM Kristof is wrong about doctors. He cites Uwe Reinhardt, but he obvious didnt read Uwe's book. Uwe's analysis shows that more doctors = more spending = higher costs.
Ask yourself this question -- why are dermatology costs sky high in Manhattan when in fact Manhattan has more dermatologists per capita than any other region in the world?
If more doctors = higher competition = lower costs, then Manhattan should have the lowest dermatology prices, not the highest.
@Diana: I used to write about our healthcare system and you're right, provider costs aren't determined by supply and demand per basic economic, but by regional rates. From what I've seen over the years, many providers charge what they can, unless they're serving a population covered by a regulated system like Medicare. Even Medicare, however, uses regional rating--eg, physicians in Boston are usually compensated more because of the number of teaching hospitals. Medicare, Medicaid, the VA, and state health systems such as prisons and community clinics are the few payers system) with the power to set pricing.
Two thoughts...
People against single payer fall into two categories: 1. People who haven’t had a catastrophic medical event and are running on borrowed time or 2. xenophobes who don’t want to pay for “freeloaders.”
Having been on Medicare, I can tell you it is not a panacea. You need to contract separately for dental, vision, drugs, etc. Changing coverage area is a nightmare. I could easily go on and on.
American healthcare needs to be redesigned from the ground up, especially with respect to billing and paying. Let’s go beyond “Medicare for all.”
18
@PJD Third category: public employees,including unionized employees and elected officials. They are well insured, at our expense, and have no interest in changing the status quo.
3
Not Medicare for all, Healthcare for all.
What do these so-called journalists don’t understand, healthcare for all available is available in Europe , Canada and many other countries in the world even in China.
What are (uninformed) people complaining about, waiting times?
There are waiting times right now and you are paying for waiting.
All my family members live in countries that have Universal healthcare, many of them are elderly, and they all have healthcare available to them when they need it, never depending on how much it will costs or if they can afford it.
How can this even be worth a discussion after hearing non stop about bankruptcy because of pure greed by insurance companies, For profit hospitals, for extreme greed by pharmaceuticals.
Wake up America and stop feeding our country with horrific obesity causing foods.
2
Your comparisons to various African countries are particularly apt. Who's the s___hole country now?
But our wealthy citizens are doing just fine. So I guess we're great after all.
10
"The average cost of a family health insurance policy is $20,000, which is a reason for a company not to hire a junior employee and assume insurance costs."
No kidding! It's a sign how superficial our health-care debate has been that the chilling effect of our dysfunctional health-insurance system on jobs so rarely comes up.
If we had a truly pro-worker agenda in America, we would set a graceful path to wean ourselves off employer-provided health insurance. It is an albatross that for decades has discouraged hiring American workers and enabled offshoring. It is the main reason consulting firms like Mayor Pete's old employer McKinsey have advised corporations to convert their workforces from staff to contractors. It appears to be one factor in age discrimination. It's one reason we are being sold the bill of goods that the gig economy is some great labor innovation.
Looking at the results of today's Nevada caucus, I give credit to the rank-and-file members of the Culinary Workers Union in Nevada for breaking with their leadership on Bernie Sanders and Medicare for All and realizing that their sweet union-negotiated health benefits aren't all that.
Any public option that doesn't take on the medical-industrial complex and put us on a path toward decoupling employment from health insurance just isn't gonna cut it. It's why, even though I favor the public option over Medicare for All, I trust Bernie on health care over Mayor Pete and his "Medicare for All Who Want It."
22
Thanks for this, Nicholas. We need to realize that our health care system is woefully inadequate for many Americans. I’m soon to be on Medicare, after having reasonable coverage (although not great) through my state health care plan while working and now in retirement.
We need to do better in the U.S.
5
This column contains a litany of well-known critiques of the American health care system, but I'm at a loss as to what point Kristof is trying to make when he refers to what it is that we need. I can't reconcile "Democrats’ internecine battle over so-called Medicare for all is largely irrelevant, because the plan won’t get through Congress" with "What’s imperative is simply achieving universal medical and dental coverage, either by a single-payer system (like Britain’s) or a multipayer system (like Germany’s); both work fine." What IS it that he thinks Congress would pass that would result in universal coverage?
6
The thorny issue which is stymieing progress at addressing the high cost of health insurance as well as the predatory nature of insurance companies are the health care lobbyists. The facts are clear, both Harvard and Yale have recently published studies proving that Medicare for All would be cheaper than the public/private option being pushed by moderates Pete Buttigieg, Joe Biden and Bloomberg. The Yale study states that Medicare for All would save over $450 million per year and save over 68,000 preventable deaths.
The lobbyists as well as presidential candidates who accept PAC money from the health insurance industry distort the facts and threaten that Medicare for All would blow up the federal budget. They don't mention that the huge power of M4A would allow the federal government to negotiate pricing as well as efficiently root out fraud in insurance reimbursements. Lobbyists purposely focus on scare tactics like claiming that M4A would raise taxes, abruptly end private employer insurance & exaggerate that the government would have too much control over people's private health information ignoring recent studies as well as distorting the fact that there are already HIPPA laws in place to protect information.
70% of the electorate support the idea of M4A,according to the Kaiser Health Tracking Poll including Republicans. Those politicians who rely on insurance money to fuel their campaigns will do everything in their power to misrepresent the facts. The system is broken.
8
It is atrocious that we don't allow more foreign doctors, particularly primary care doctors. I currently live in China (Kristoff is wrong about the Chinese response to the Covid-19, it is far more complicated and localized - but that is another, long topic) and have lived in Korea; the price to see a doctor in either countries is about ten bucks. That's right: you sprain your wrist, you have a minor ailment, ten bucks gets you in the door,
These doctors are every bit as well educated - probably more so, given how competitive the education systems are in Korea and China - and would be happy to make half of what American doctors make. They would come in droves, but they're kept out.
5
I have been a nurse for over 40 years, married to a primary care doc, numerous docs in the family. We don’t need foreign doctors fromChina, who can have significant cultural shortcomings among Americans they are treating. We have plenty of smart, qualified US students who would become excellent doctors if we subsidized their education so they wouldn’t be so deeply in debt.
@Margaret Layman
My sister is a doctor and my brother in law is pediatric surgeon at Scripps in La Jolla. They live in a big house in La Jolla. God bless em, they make a ton of money, and they love and care for their patients. But I know doctors around the world make far less than they do, and do just as good of a job.
Listen: our factory workers compete with Chinese factory workers. Our call center workers compete with workers in India. Why on earth should our doctors get such a free pass?
2
@David USA takes in more foreign doctors than all other nations on earth, combined.
Most of these imported doctors come from impoverished countries with sky high mortality rates, their healthcare systems are far worse than the USA.
Yes the USA poaches these doctors and guarantees that the home country's health system will be in shambles.
Consider this -- there are more Nigerian surgeons living in Miami than the ENTIRE COUNTRY of Nigeria.
1
"Democrats’ internecine battle over so-called Medicare for all is largely irrelevant, because the plan won’t get through Congress. What’s imperative is simply achieving universal medical and dental coverage, either by a single-payer system (like Britain’s) or a multipayer system (like Germany’s); both work fine. What matters is the universal part."
I'm confused by this. Medicare for All is a single-payer system—and it's the only plan proposed that would achieve universal medical and (at least in Warren's version) dental coverage. Your first sentence seems at odds with what follows.
6
There is no US Healthcare 'System;' just a 'situation.' The root problem, preventing us from getting to universal and uniform coverage, is employment-based medical insurance. During WW2, businesses had difficulty competing for employees because of wage controls. In 1943 the IRS granted businesses permission to provide medical insurance as a pre-tax perk to attract employees. To this day, the government subsidizes employment-based medical insurance; paradoxically the higher the employee's tax bracket, the higher the subsidy, i.e., more for those with million dollar salaries than those at the low end. This has spawned a 'non-system' of commercial insurance, permitted by law to take 20% of premium dollars for administration and profit. They provide a panoply of confusing and incomprehensible plans that an average college graduate cannot understand. How many NYT readers can exactly define the terms 'co-insurance, deductible, co-payment, maximum out of pocket?' That different plans, by offering more incomparable choices, permit the individuals to buy what they need, is a flawed notion. Those choices require complex/sophisticated 'risk management' expertise, pitting the individual against the elite of risk managers - insurance companies. We need a universal system that provides a uniformly high level of care. Like Medicare, the cost should be adjusted, based on income. It makes sense to most subsidize those on the lowest socioeconomic ladder rungs, not those on top.
19
One component of the problem of health care costs that I never see mentioned: the cost of a medical education in the US. In many European countries, Belgium included, higher education is ‘free’ (for all intents and purposes).
Which brings me to the next point: Belgian health care is state-of-the-art and extremely affordable, including all preventative care as well as dental. It is a model that should be studied.
14
@Eurorohn : Agreed, we should study all other health care systems that are cheaper and provide better outcomes than the unsustainable system that we have (that equals just about all systems in al developed nations). The problem is that way too many people, including most in congress, believe in the myth of the US being "exceptional", which they translate into "we have nothing to learn from no one".
2
Excellent!
From LANCET this month:
Improving the prognosis of health care in the USA
Lead author Prof Alison P Galvani , Center for Infectious Disease Modeling and Analysis, Yale School of Public Health
According to this study published in the current issue of The Lancet introducing a universal, single-payer health care system in our country would save >68,000 lives and more than $450 billion annually.
Excerpts:
"If the Affordable Care Act were to be repealed, we would expect an additional annual loss of more than 38 500 lives. Compared with health-care access before the Affordable Care Act, the legislation proposed by Senator Sanders, would save 107 000 lives annually. To inform policy makers' ongoing deliberations, we also introduce an interactive online tool through which users can explore how input assumptions influence spending projections and tailor a plan to finance the predicted expenditure."
8
Other countries with universal healthcare coverage don’t have people weighing 400 pounds. They don’t have small towns where opioids are as common as morning coffee. They don’t have women having six kids by six fathers by the time they are 25. I am in favor of universal coverage (though NOT Bernie’s M4A). But if we are importing the Swiss or Norwegian healthcare, let’s also import the European lifestyle. Let’s put social and economic pressure on people to lose weight, to exorcise, to vaccinate their kids and to have an abortion in case of an unwanted or abnormal pregnancy. If my taxes are paying for your healthcare, I should have a say in your health.
9
@Mor All stick and no carrot? I know I'm not alone in finding it very difficult to exercise outside of a too-pricey gym; and I'm not the only one who's dismayed by how expensive good, nutritious food is compared to junk food on a calorie-by-calorie basis. Not to mention, junk food is everywhere; nutritious food not so much.
6
@dtm I know I am not alone in exercising every day by walking, running and doing simple weight-lifting in the privacy of home. I am not alone in spending money on fresh fruits and vegetables and cooking delicious food in my own kitchen, while consuming half of the calories of the average American. I am not alone in maintaining my high-school weight 25 years and two kids later. Not to mention the fact that I’d rather starve than eat the food-like substances sold in MacDonalds. So perhaps you should take a look in the mirror before demanding that society pays for your self-indulgence.
2
@mor
You forgot to mention the alcoholics, gun violence and pollution.
Worst yet, Americans are capable of adopting a more health outlook. Our government gleefully rolled back school lunch standards to include more fatty junk foods.
Health care in this country will always be difficult with our lack of qualified doctors in places of need, a raggedy education system that excels at producing poor people and an indifferent upper class.
Early childhood education is not just about when the child enters the classroom. It starts much before pregnancy. Both the mother and the father have to be healthy and smoke and drug free. During pregnancy the mother has to eat healthy and be careful and avoid any physical and emotional pain to the fetus.
Real education starts with how the child is brought up. We embed the belief of each one being the best. It creates a trophy self-image that for all it's life demands a trophy life. It leads to these social ills of unhappiness, frustration with our successes, drug addictions, suicide, divorce, crime & other ills off society.
The trick is to postpone self-identity for as long as possible. Let the self-image develop through hugs & kisses.
We need to create a whole new profession of Wise Parenting coaches & inspectors. We also need to create teachers who can detect which student needs emotional health healing. The student stays in school for mostly over a decade. There is enough time to heal the emotional health of the emotionally challenged.
As emotional health is the foundation of education, society, relationships, financial stability, happiness, and health etc. just look at all the problems of social ills due to not having testing and manual for emotional health.
Wisdom is above all love and just as love is an emotion so is wisdom. Wisdom is an emotion that springs from emotional health. So emotional health is wisdom. Thus making society emotionally healthy is priceless.
1
It's a shame that the most affluent country doesn't have an universal healthcare.
I understand your urge to get one and even demanding dental care.
These are the countries which provide Medicare with dental care and their income tax rates followed by sales tax rates.
Source : Wikipedia
Austria 55% 20%
Denmark 56% 25
Finland 54% 24
Germany 47% 19
Greece 45% 24
Italy 47% 22
Mexico 35% 16
Poland 32% 23
Spain 45% 21
Sweden 57% 25
Turkey 35% 18
United Kingdom (UK) 47% 20
and
USA 37% 11.75
everything comes with price tag.
Are Americans who believe in a small government and dislike socialism ready for this?
4
@uji10jo The better comparison would show a combined percentage for taxes and health care. The high tax rates in some or all of those other countries include most, if not all, of the cost of health care.
2
@dtm True. The amount and what to be covered are different by the country.
Yet, doesn't Sanders' Medicare for all give an impression that by charging wealthiest extra tax, everything is covered including dental and prescription drugs.? (Plus college tuition and student debt?)
In Canada, prescription is partially covered and dental is not covered yet.
I understand why Obamacare took so long to come up with a plan, finance and actual application of the plan, though it's not a perfect plan. Trump boasted he cancelled Obamacare because he had better plan. Who would believe it?
Screaming "Medicare for all" is catchy but
is it really that easy?
I say don't over-promise and give people false promises, Mr. Sanders.
@uji10jo : Obamacare is better than what we had before but it is fundamentally and fatally flawed because it includes no cost control. Hence, insurance companies could and did raise rates at a disgustingly predatory unjustifiable 20%+ every year, way way above inflation, ever since. Congress should make this kind of behavior criminal.
14
You know what, when will the DOCTORS stand up for US the patients? This is part of the problem They milk the medical billing industry to the point of delirium. They have a lot of fault in this heinous system as well as the insurance CEO's .
15
@Travis ` Which is why we need less doctors, not more.
I refer you to the Eastman Institute for Oral Health; Eastman Dental Center, formerly known as the Eastman Dental Dispensary; & a few other earlier names.
Originally founded by Henry Lomb of Bausch & Lomb fame & continued to be funded by George Eastman of Kodak fame.
Yes, the ultimate object might have been to have a supply of healthy workers but the children of those workers did benefit from having their dental needs assessed and improved.
I don't agree with the paternalism of corporations but sometimes their policies benefit society.
2
"We spend an average of more than $10,000 per person on health care each year..."
This is why the oft-repeated charge against MFA that it's too expensive and unaffordable is dishonest. Estimates for 10 year outlays for the current system are $35 billion, for MFA $25 billion - that's a billion a year savings for MFA. And yet the MSM and others who challenge Sanders don't mention this.
And speaking of honesty, everyone presents Sanders' plan as something he's going to implement Day 1, with no time to allow for a transition. Even if he wanted to do that, it would be impossible. The very nature of a change this big demands that it take some time. Implementing the ACA did, and so will this. It''s just fear-mongering.
What is yet to be explained by Sanders is how he plans to deal with the workers from the private sector who will lose their jobs. There are ways to handle this, like guaranteeing those who want to continue in the field be given jobs in the Medicare/Medicaid departments, or free tuition and enhanced unemployment checks to cover those who want to get retrained into a new career, etc. But whatever the plan is, it needs to be concrete and assured, not made up of vague promises like were given with NAFTA ("Yes, we'll lose jobs, but they'll be replaced with better ones").
And I'm curious Nicholas why you say MFA can never get through Congress? They said that about the ACA too. And if not MFA, what would a single payer plan look like? How is that different than MFA?
6
The American Healthcare system is a cautionary tale of unfettered capitalism. Not everything should be for profit; bureaucrats stand in the way of patients and quality care. It's paradoxical that we can have among the best quality of care--but possibly the worst access to that care.
15
I wish someone would do a survey of hospitals and organized medical groups to ascertain how much of an administrative burden is posed by the current Medicare system of billing, that requires assignment of complex ICD10 codes, based on complex documentation rules and a DRG payment system that has multiple levels of payment based on DRG, DRG with CC (complication) or DRG with MCC (major complication). While some private insurances have adopted these categories, let us not forget that they were developed by and are required by Medicare for payment. So hospitals are not going to eliminate their "armies" of administrative billing staff unless Medicare moves to a different system of payment for care - ie: give each hospital a fixed amount of $$s based on population and let them use it any way they want. I believe Canada does something like this? What happens if the hospital runs out of money because they give "too much care" to "too many really sick people?" And who decides whether your 90 year old cripped grandmother should get that $10,000 pacemaker implant if money is running short? (The fact that the pacemaker is so expensive is another story that needs to be dealt with - but not necessarily by Medicare for All.
1
@MB California : As far as I am aware of Medicare billing practices are not any more burdensome on doctors than billing practices of private insurance companies. Both require a LOT of administration and knowledge, which could easily eliminated by a nation-wide universal health care system, like in Britain, France, etc.
1
Universities routinely issue breathless press releases about some revolutionary medical procedure or diagnostic tool developed under their auspices, most of which will never see the light of day, except perhaps for the extremely wealthy. Pharmaceutical companies concentrate on drugs which manage symptoms, in perpetuity, because actual cures are unprofitable. The amount of money they spend on marketing, for obscenely priced products of negligible value is unequaled by anyone except perhaps the cosmetics industry. Along with Medicare for All, we need a government run conduit not just for medical research but for the actual manufacture of drugs and devices. Some will complain that is "choosing winners", but so far all we've been doing is choosing losers. Our medical philosophy is embodied in a Monty Python sketch where a doctor assures a patient "Mr. Notlob, there's nothing wrong with you that an expensive operation can't prolong."
12
@ Ed conner: healthcare is not a entitlement and it will not cost 30 billion. Other countries spend a fraction of what we pay and provide universal coverage. It’s called depriving the healthcare industry of excessive profits. These are the forces that will fight tooth and nail to keep things as they are. They don’t want to give up their billion dollar stock buybacks or huge dividends. A recent article in the Times was about a family with good insurance that was presented with a 140,000 medical bill. Unheard of in other countries and should not happen here.
27
I don't understand why a discussion of the problems of health care has to drag China into the conversations. America's problems are independent of what's happening in China right now. The coronavirus anxiety should not be the occasion that reminds you of the dysfunction of your health care system.
7
The costs to most American of exorbitant and mostly uncovered dental care is thankfully mention in this American Healthcare Opinion by Nicholas. It is unfortunate that a man who cares as much as he does about the health of the people also cannot help waving red flags against Bernie Sanders. I'm not a fan of Bernie's or a supporter at this point, but my respect for him is high. His passion about the welfare of regular folks is justifiably contagious. It wrong to assume that Medicare for All would bankrupt the country or to believe that it cannot take place over the next 10 years. Bernie and Elizabeth are giving it a voice, and it's about time. Bernie is not a con. He may be unrealistic and idealistic and his dreams are big. Bernie is driving the electorate in a good and necessary direction, Hallelujah!
27
67 million Americans have either no healthcare or poor-quality high-deductible health care. That means they are discouraged from going to a doctor unless they're seriously ill. And that means that in the event of an epidemic they're much more likely to tough it out and go to work or school until their symptoms can no longer be ignored or minimized.
If my neighbor becomes ill and can't see a doctor under these conditions, my life or health is threatened even though I have excellent health insurance. Universal healthcare safeguards everyone's health, including that of people who already have health insurance.
55
I had been wondering of late. One: what would happen to all of the employed people in the health insurance industry and what would happen to them. I believe the number is half of one million people. I think Bernies solution is similar to what the country tried when NAFTA was implemented and since there is so much anger in the land, it doesn't seem that that was particularly successful and therefore maybe should not be considered.
Secondly, How many problems in our country might be solved if we only implemented an increase to the minimum wage of $15 throughout the country.
Thirdly. If we implemented and enforced e-varify thoughout the country instead of rounding up hard working people and scaring the most vulnerable among them but arrested the company management for hiring them in the first place. I agree the Trump organization would be hollowed out and the family all in jail except the golden haired one, but. We might return to that vision of our country that we really could live with and when we see ourselves in the mirror we would respect ourselves once again.
1
@JBG3
The economy changing happens all the time whether we like it or not. People lose jobs in manufacturing. The percent of people in farming is minuscule compared to 70 years ago.
But I don't underestimate the pain for those employees in that transition.
I work in high-tech and we are constantly having to learn as technology changes.
I believe Bernie's plan does include job re-training.
There is a shortage of people in many areas, construction, accounting, software developers.
My hope is that we would invest more in education and at least some of them would become teachers.
And maybe somehow more healthcare in rural areas.
5
@JBG3 - Already robots or "chatbots" are being utilized by patients for healthcare advice. Many AI professionals predicts that robots will eventually replace much of the routine administrative work that health care insurers, insurance adjusters and underwriters as well as claims representatives currently hold. Just like the autonomous trucks in the future, formerly well paid truck drivers will soon be seeking retraining or face a bleak prospect of minimum wage type work. Welcome to the 21st century where capitalism favors the rugged individualist instead of scary "socialism" or worse "communism" as envisioned by Bloomberg. What could be more terrifying a Socialist president or a Trump presidency where individuals are expected to pull themselves up by their bootstraps and quit being snowflakes. Strange how this sentiment quickly changes when one's comfortable insurance job is at risk.
2
@JBG3 Loss of jobs in health insurance sector and lobbying by insurance cos is exactly why single payer will never happen.
The insurance industry will spend every penny of its 100 billion dollar warchest to bribe Congress into blocking any kind of health system that doesn't include them in it.
2
Nicholas makes some good points, like increasing immunization, evidenced based healthcare to better outcomes and keeping Obamacare. But a problem with dental therapists proposals is their scope of practice is too broad and includes surgical procedures, which have shown to be counterproductive. Yes to preventative dental service expansion, and private dental insurance but not to a government plan like the UK. Those who use the UK's dental care plan have some of the poorest oral health in Europe. If government is to be involved in oral health care it should begin with children, especially preventive services and reevaluated to gauge the outcomes before attempting a comprehensive program for adults. This has shown to be successful at the county, and state level.
2
Nick, I agree with you but I am confused by your preference for a universal healthcare from a single payer or multiple payers as in some European countries vs. your assertion that Medicare for All will never be enacted here?
I thought M4A is a universal healthcare system based on a single payer solution, no? whether its the government paying for healthcare based on taxes or a quasi government agency paying for it.
Its time for you to expand on your idea of a universal healthcare solution vs M4A. If your idea is based on expanding the privately provided mess as we have now it would be a nonstarter. There is no financial incentive for private providers to offer universal care for all people without the convoluted system of denials, huge out of pocket payments, caps and surprise billings.
2
Right, access along with ability to pay/cost are the urgent issues. With the former, there is a unique problem in rural areas where hospitals are closing sot that even those who could pay have to travel much too far for needed, even emergency care.
I agree that "Medicare for All" will not fly. The ACA, which left private insurance in place, barely made it through Congress. With millions of folks unhappy about the idea of losing their current private insurance, throwing the entire system up for grabs will not work. In addition, the nation is exhausted from the chaos and upheaval of the Trump years. The last thing that is going to appeal to most voters is a call to up end everything. Many of us crave some stability and sanity, not a new revolution - change, absolutely, but doable improvements which move us toward the important goals of getting everyone adequately covered.
1
Some of the other first world industrial countries get universal healthcare with non-profit insurance companies.
I understand why Sanders is for Medicare for All. American insurance companies have already proved they cannot be trusted.
And a Yale report says Medicare for all will save $450 Billion a year - a year - which is 13%. And also 68,000 lives.
People say how are we going to pay for Medicare for All.
We spent $3.5 Trillion on healthcare last year.
$11,000 per person and 18% of GDP, twice as much as the other first world industrial countries.
Where did that money come from?
We already are paying for Medicare for All. We just aren't getting it.
Those countries get some form of universal healthcare. We have parts of the US with infant mortality rates of a third world country. We have to fight with our insurance companies to pay claims. We get surprise medical bills of tens of thousands of dollars. We have medical bankruptcies.
Take all that money we are paying insurance companies and redirect it to Medicare for All.
A family of 4 paying $24,000 for health insurance will instead pay $20,000 in taxes and save money.
For people who get their insurance through their employers, the employer will pay the tax instead of paying an insurance premium.
And those employers will save money. They could even pass some of that savings on to the employee but I'm not holding my breath.
57
@Independent : In addition, the U.S. has spent literal trillions on "defense" in this century, only most of it is not actual defense but cynical wars of choice, fantasy weapons to replace those that are still serviceable, and covert actions designed to make the world safe for corporate America.
Cut back the military to actual defensive needs, and there are huge savings right there.
2
Nicholas certainly has trenchantly accurate points to make about why health care in the United States is such a mess, and is certainly accurate that insurance companies, Big Pharma, and the medical professionals and their organizations all have some part in it.
But bottom-lining it , the fundamental cause of all this is that given our Calvinist, Social Darwinist founding heritage, far too many people in this nation--especially the libertarian oligarchs who control our political systems--believe health care is a privilege, not a right, and not for all the people, because, in their viewpoint, if you're not well-off the reason for that is located entirely within you, some flaw or fault of personality or character, and you therefore don't deserve it.
Though many have forgotten the original religious underpinnings of this viewpoint, we still think that those who have done well show their worthiness for health care and a lot of other privileges by having the money to pay for it (though it's often amazing how many of the "privileged" rig the game enough to get away with not paying full price, or sometimes much of a price at all). That "if you're so smart, why aren't you rich" ethos pervades our social and political systems, and very little will change as long as it does.
24
Trump and his Republicans have to pay for their tax cuts. So they want to slash Social Security, Medicare and Medicaid and do away with Obamacare. That is where the money will come from -- that's been their plan all along, or at least ever since Reagan. They are taking whatever they can for themselves, while they can. They are concerned about their own self-interests, not the best interests of our country. The medical and dental professions have also been a problem for decades. So it looks like there's plenty of greed to go around. It's also true that China should have been more forthcoming about coronavirus at the outset. But what awaits us now that infections are skyrocketing in countries that exert far less control over their people? Let's hope we can work together globally to control this outbreak, although our lack of effective action against climate change is not making us look too good on the worldwide cooperation front right now.
18
If I may refer to your newsletter, Mr. Kristof. You wrote that "Bernie Sanders struck [you] in the debate as disconcertingly angry. I agree. The near-purple color of his face and vehemence of expression conveyed a deep, visceral, personal hatred for Michael Bloomberg for no other apparent reason than his wealth.
Mike Bloomberg is fair game for opponent criticism, just as HIS opponents are, but he has done some extraordinary things for the public good. Sure, he can afford to, but he has chosen to use part of his wealth in this way.
Since early 2017 we have had more than enough right-wing bile emanating from the White House in the persona of Donald Trump. We hardly need more hatred going forward from the Left with Bernie and his Bros as avatars.
Probably nobody needs to worry about left-wing presidential hatred. In a general election, it would be crushed like an empty Pepsi can under a grand piano, no offense to pianos anywhere.
The nation is making some sensible progress on gun safety in America. Thank you Mike Bloomberg.
@John lebaron
In a democracy, we shouldn't have to depend on the noblesse oblige of people like Bloomberg. If we had a just system of taxation, there would not be so much disposable income at the top to finance their vanity projects. For every Bloomberg, there's a dozen Koch's spending their millions in their own perverted fashion. Jeff Bezos, the world's richest man is also the world's biggest tightwad, giving almost nothing to charity. With the threat of higher taxes looming, he suddenly decides to donate $10 billion to combat global warming. Quite admirable, but he is using the Mark Zuckerberg argument that the enlightened wealthy know best how to spend their money, so government should leave them be.
6
@stan continople. I don't disagree with your point, Stan. Continople (har!) My point was quite different.
With all due respect always to you
Medicine makes many very wealthy whether Medicare Advantage in particular or Fee for Services. There should be some system not free but reliable. One has a different value if one had great options employed non union and if Medicare only In old age. Nothing free completely works but Obama Care was good for some but not all. The cost of drugs is a racket.
America is great but not known for equitable medical services any where as Germany and other countries. Including other systems. Yes everyone needs healthcare and we all should pay into a system that basically protects us children also healthy adults as majority and if one health declines in old age.
This should provide a measure of funds for the unfortunate ones visited with illnesses difficult to cure or major suffering.
Why some insurances would not cover eyes or dental both ourageously expensive. we are born and eventually we die. Why will every citizen not have care at each stage of this journey
Bloomberg Magazine months ago had an article on wealth of doctors.as a career. Gone are your General Practitioner who really cared 4 you and knew your Specialists. Now that is gone and hospitals have monopolies and yes technology is great but true care and recovery a fad. Doctors you never seen operate at high fees and then farm those on Medicare to often bad
recovery centers.
2
China provides universal health coverage, with workers contributing to reasonably priced premiums. If China can do this, I see no reason why this can't be done in the US.
I'm a senior on Medicare... and medicare is great! Most seniors will tell you that. A (gradual) expansion of Medicare to all Americans would be an ideal system. As Bernie suggests, this will lead to the lowest overall healthcare costs.
I see no reason why people shouldn't be allowed to purchase private insurance if they want it... but they would still pay taxes to support Medicare. You can send your kids to private school, but you still must pay taxes for public education.
17
''...battle over so-called Medicare for all is largely irrelevant, because the plan won’t get through Congress. '' - Sorry Sir, but you lost me right there with such a defeatist mentality.
I would submit that is why we are where we are (especially since the 2016 election) and why the press and pundit alike are dampening any expectations of what could be achieved.
I will give you a simple scenario. The house stays in Democrat control (actually increases) and Democrats take back a few Senate seats, leaving them with a majority. They enact the ''nuclear option'' (not having to have 60 votes for cloture but just 50+1) and voila. President Sanders signs into law Medicare for all.
What if Democrats do make up 60 votes in the Senate? Then the possibilities are endless. The backlash and pendulum swinging back from these 3-4 years of radical and lawless republican control will be savage. Mark me words.
Time to join the rest of the industrialized nations that put their citizens first, and not just profit.
110
@FunkyIrishman : What you conveniently forget is that a large number of centrist Democrats also oppose medicare for all. Many trade unions who fought hard and won gold plated heath care plans for their members (in lieu of lower salaries) oppose it. Also, the nuclear option, eliminating the filibuster, is a very two edged sword as Harry Reed and the senate Democrats have learned. Once eliminated it does not come back, and the senate majority tends to change every couple of years.
1
@Eva "gold plated heath care plans" are a myth.
They "gilded" at best in the worst sense of the word.
@FunkyIrishman
Nothing radical is needed to pass significant legislation. Just a simple majority and use reconciliation. The Republicans used this process to pass the 2017 tax cuts.
Finally...Nicholas is pulling us back to where we need be. It is not that I am calloused toward the Chinese who have been so negligently victimized by the coronavirus epidemic. I am not so heartless; rather I am saddened and sympathetic. But the state of our health care system here is unconscionable considering the U.S. is the wealthiest and (once) most democratic of all societies. I trained as an RN a number of years ago. I witnessed up-close and personally early deaths and preventable diseases because of a lack of unaffordable and/or inaccessible health insurance. Then came the ACA, not perfect, but a tangible beginning to universal health care reform. Donald Trump is an unstable and I believe mentally unwell man. At every turn, he is putting our health and welfare at risk. Under his "rule" and abetted by an unethical Cabinet and Republican Senate, not only us but also our children and grandchildren are vulnerable to having our lives cut short by diseases which are treatable if not totally curable. Please let us not split hairs over the differences in our candidates health care policies. The big picture is that everyone of them are going to help us on Day One. They will take care of us; Trump never will.
72
"In my reporting, I’ve been struck by how much more widespread dental pain is in America than in other countries"
I am glad that you brought universal dental coverage into your discussion.
Older adults are less likely to visit the dentist according to new research. And that trend that could have far-reaching health and economic consequences. Research shows associations between poor oral health and stroke and cardiovascular disease risk.
The study, published in the journal Research on Aging analyzed the use of dental services among adults aged 50 and older using five waves of the University of Michigan’s Health and Retirement Study. It found, in part, that “as people became older, the use of dental services declined.
Fewer older people have dental coverage. Around two in three Medicare beneficiaries in the US equivalent to 37 million people have no dental coverage according to a Kaiser Family Foundation analysis
For older adults on a fixed income, oral health may compete for priority alongside chronic health conditions or illnesses.
7
"Medicare for All" seems a red herring while improving and implementing the ACA seems the most likely. I can be very disgusted with candidates who are will to possibly torpedo the whole election over a non-starter as indicated by many polls.
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There is another aspect to poor dental care--chronic gingivitis and its correlation to cardiovascular disease. To say there are people with CVD and no gingivitis or people with gingivitis with no CVD is meaningless. This isn't a 1:1 causal relationship, but there is certainly a correlation that may well be causal. It's not just tooth pain, bad as it is, it is likely shortening life expectancy.
Dental disease itself and poor teeth are--like it or not--ways people are subtlety discriminated against. A smile that shows several missing teeth isn't going to be seen in a board room. Next time you see someone with bad teeth, ask yourself honestly how you feel about them.
The Democrats would do well to run on improving health care and quit trying to make perfect the enemy of the good. That is the single most important thing they've got on the Republicans, and they should take that to the red countryside. Period. End.
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I agree we need more “extenders” in medicine and dental care to provide routine preventive services. But there is a fundamental issue regarding doctors and training. A foreign medical graduate usually did not have to pay for medical school whereas many US medical students graduate with six figure debt. Then in residency and fellowship are paid relatively low salaries. Lowering physician salaries will risk lowering the ability of graduates to pay back loans. Free medical school with obligatory service in underserved areas is one possibility.
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I believe that there are several democratic candidates who would like to address the problems with healthcare in this country. Yet how many N.Y. Times columnist have written extensively on how these candidates are unelectable because of their “radical ideas” on trying to fix the problem.? Radical changes are needed and many are afraid of a new system. Republicans will add fuel to the fire and cal it socialism. Many Americans are happy with their “private plans “ and fear changes but as costs increase and companies cut back on these plans and turn them into catastrophic only plans their complacency will change. It would seem that our healthcare system will have to get worse before many are convinced that Warren and Sanders were right after all.
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@Vincent :
Republicans don't need to "call it socialism."
Bernie does that on his own.
I'm guessing a $30 trillion new entitlement won't get him 270 electoral votes.
1
is it any wonder that more and more people don't think capitalism or democracy are particularly good ideas. For each person, who loses or never has received the rudimentary health care they need, democracy has failed. For anyone with a medical bill that demolishes their future, capitalism seems a dismal way to do our economic system to say nothing of healthcare system out of control.
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America wins the gold for the Greatest Healthcare Rip-Off in the world, where $1 trillion in excess costs are charged each and every year to Americans in the form of useless middlemen insurance companies (and their CEOs and stockholder dividends from people getting sick and dying), hospital corporations (and their CEOs and stockholder dividends), and PhRMA corporations (and their CEOs and stockholder dividends) and other unregulated medical extortion that is as American as apple pie.
Country and Healthcare as a % of GDP
United States 17.2%
Switzerland 12.4%
Germany 11.3
Sweden 11.0
France 11.0
Japan 10.9
Netherlands 10.5
Norway 10.5
Belgium 10.4
Austria 10.4
Denmark 10.4
Canada 10.3
UK 9.7
Australia 9.6
Finland 9.4
New Zealand 9.2
Spain 9.0
Portugal 8.9
Italy 8.9
Iceland 8.6%
For anyone who pretends that Medicare For All - or other serious proposals for true universal healthcare coverage - would be unaffordable or cost trillions more than our current system, that is simply untrue.
The rest of the rich world has already proven that better, cheaper, more efficient healthcare is available.
It's simply a matter of sensible regulation and converting from America's ludicrous premium-copay-deductible Rube Goldberg healthcare extortion model into one of the much better systems up and running abroad.
And the Republican Party - and the Greed Over People for which they blindly stand - will do will surely do nothing for healthcare except raise its deadly price.
November 3 2020
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@Socrates They used to call Britain a nation of shopkeepers. We’re a nation of useless middlemen running a variety of protection rackets. (The prototype is in the “oldest profession”: the procurer.)
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@Socrates All sadly true. But to achieve universal care in our country, you need a viable road map to get there, not the Sanders’ approach which promises far more generous benefits than any other country listed, unquantifiable costs and no defined way to pay for it. Bernie admits it’s impossible to know how much his “plan” will cost, and he offers only a grab bag of potential tax solutions. That might be enough to attract votes at the ballot box, but never enough to attract 60 votes in the Senate to actually become law. From a social justice standpoint I agree with Bernie 100%, but politically it is a nonstarter.
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@Socrates
Another huge factor to why healthcare devours so much of our GDP in comparison to the countries you listed is that we use more healthcare in U.S. We are much less healthy and take much poorer care of ourselves generally. For example, obesity rates are far lower in the countries you listed compared to here in the U.S.
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... and don’t forget that mortality rates have been climbing disproportionately in the 25-64 year-old age group since Trump began his term in office, with more deaths by suicide, gun violence, and opioid overdoses. Expect this awful trend to continue if Trump gets re-elected...
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Kristof's comments were right on before China bungled the coronavirus outbreak, and will be right on after.
This is why we need a Democrat in the White House, to make health care coverage universal, and to extend it to include mental and dental, the first often ignored, and second segregated in a separate system.
Anyone who has dealt with a serious illness has experienced receiving a multitude of "this is not a bill" letters with a confusing set of numbers deriving ridiculous charges for procedures whose names would be incomprehensible even if they weren't abbreviated, which they are. The bills then come from multiple sources at different times, many of them "surprise" bills for services that careful customers verified were covered, only to find that they're not, because someone out-of-network worked at the in-network facility they went to.
The cost of all this monitoring and billing, by separate insurers, dealing with customers in thousands of different plans with different rates, is absurd. Nor do care providers like having to spend hours on the phone with insurers, begging for approval.
And for all that cost, not everyone is covered, coverage is often inadequate, and we don't live as long.
I'm waiting for an expose saying that Vladimir Putin and Russia designed American health care to sabotage the American economy. Won't happen; tweeting is cheaper.
We don't need no stinkin' coronavirus; we have doctors who prescribed opoiods!
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This is a good essay by Kristof.
I disagree with him on a few points (but of course I could also be wrong on some issues).
One of the great things about the Bernie Sanders program is the focus it brings to health care.
I agree with Sanders that we need to move toward a single-payer system. But extending health care to the uninsured requires the training of more doctors. There are about a million physicians in the US. My guess is that we would need to increase that number by 300,000 to 400,000.
Why not a government-funded fellowship program that takes top students from high school and gives them funding for four-years of university education, four years of medical school, and a residency. In return, the recipients would agree to serve for say ten years in the communities they grew up in. This would be directed at ensuring that all communities have physicians, including those in flyover country.
Of course, it would take time to train such doctors. The fact that it might take time is not mentioned in the Sanders presentations.
I also don't like the wealth tax that Sanders proposes. Yes the wealthy should pay more. But why not raise income tax rates on the very top earners?
Just like the alchemists were wrong when they dreamed of turning base metals into gold, I worry that economists might be wrong in assuming that the stock certificates of billionaires can be transformed into medical care for the poor.
So in my view the Sanders plan has some flaws.
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When I was a county social worker in SC in the 1970s and 1980s, a family of four on welfare got $104 a month (for rent, utilities, clothing, school costs, transportation, etc.), food stamps and Medicaid. I don't know the current rate, but I'd bet it's not kept up with inflation.
Yet the way to stop the cycle of poverty is to make sure children have all they need to grow up healthy and well-educated so that they can get and hold decent jobs. That can't happen when they don't have any way to get healthcare. It's especially difficult for people who live in rural areas without any doctors or transportation.
Trump may claim to care about the "little guy" but he doesn't. He must be replaced.
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Counterwill has been studied in children. It is not confined to them; it is there whenever a person is told what to do by someone more powerful than they.
That would put Medicare for all at risk as well as our current adverse relationship with third party payers. In a regulated environment such as ours counterwill results in 'gaming the system'–an endless spiral of actions and reactions trying to control gaming behaviors.
The way to control counterwill is to have the brake come from the customer–'who is always right.' That means the single party payer needs to be the empowered patient. Empowered with an well funded HSA–even one guaranteed by a grant from Medicaid if needed.
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@America's Favorite Country Doctor : Nonsense. A patient has no ability to negotiate service prices with his/her doctor, not to mention with a hospital. This is typical Republican canard.
1
I have only to look at the parking lot at our local hospitals or the addresses of our physicians and dentists to realize how much money they make at the expense of their clients. Benz's and Beemers, homes at a local gated community or other exclusive enclave, and other nauseating excesses tell me that none of them are going to be happy with having their incomes restricted or limited to help millions of Americans with their health care. Thirty years ago I worked for a national company that gave me health insurance for about $35.00 a month. When I left their employ in 2000 I was offered Cobra at about $1000/month. All I can say is one of the few benefits of being 65 is Medicare and Social Security. Our system is obscene.
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@Beth kinstler I am not a health professional, but I personally think that doctors and surgeons SHOULD be rich. They do incredible and often stressful work! It's the insurance companies that provide no purpose and should be done away with. That's where we will save money. Actually, with the proposed NY Health plan, which is like Medicare for All, it's the intention that doctors will get paid MORE than the Medicare rates. Some doctors that are notoriously underpaid (family practice physicians) will get paid more as well. www.nyhcampaign.org
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Yes the dentists doctors and lawyers - and who is educated in those professions? The wealthy kids.
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@Julia I do not minimize the dedication and skill of health professionals who "do incredible and often stressful work." But I could tell endless stories about the accompanying entitlement attitudes.
By contrast, I would like to maximize the incredible and often stressful work done by school-teachers on all levels. I taught 1st grade and Kindergarten for 20 years and was continuously and simultaneously a teacher, mom, counselor, nurse, social worker, advocate, for those little kids. This was mostly because our cultural and educational priorities insist that we focus adolescents and teens, "who have REAL problems," (as I was told over and over by guidance counselors and administrators.)
Those same priorities place the salary levels of every level of educators way, WAY down on the scale.
I don't know a teacher who can support a family on that one paycheck; supplemental sources of income have become a necessity.
No, you won't find Benzes and BMWs is teachers' parking lots (if there even is a parking lot.)
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I am hoping that the proposed budget cuts for NIH and CDC are coming into very sharp focus just about now. Also, some things that are obvious to all in hindsight, might be known a little bit ahead of time by workers in the relevant field?
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Nicholas, you have a big heart! However, you are ill informed about health care financing. Just last week, The Lancet published a well researched article from Yale on the 450 billion dollar savings that would ensue with simplifying our bureaucracy by eliminating private insurance. Many other sound studies have found similar or higher savings with a single-payer system. By the way, Medicare for All and the British systems are both single -payer systems. we will never get universal care without a single-payer system. Germany is a very highly regulated system and in essence operates as a single-payer system. it would be easier and more efficient to establish a single payer system than pass such stiff regulations with our powerful private insurance industry.
The quality of care would go up immesurably with a single payer system. Everyone would have access to comprehensive care. We could put more money into prevention and fund long term care in the elderly (currently a disaster). There would be the ability to establish national priorities, such as establishing more treatment centers for opioid addiction or reducing racial disparities in health care.
So Nicholas, it is well worth it to fight for a Medicare for All.
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@james binder, MD
It's nice to hear a comment from someone who actually understands what he is talking about! Thank you!
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@james binder, MD In Europe only Spain and the U.K. have single payer systems.
@james binder, MD - A single payer system? No. It's dictatorship! Like China's One-Party rule. A single payer system must be abhorrent to Nicholas Kristof, who has written "scathing columns about Xi...", his public enemy number one, the great dictator who supposedly is much admired by Trump.
The real tragedy of American healthcare is how most Americans are brainwashed by its individualism and personal freedom ideology that enabled exploitation by the super rich. No matter how facts and evidence tell the opposite, a single payer system will be rejected.
2
China has not failed to have a socialist health care system. It has only recently failed to act fast in dealing with the Corona (Cor) virus. It did effectively eliminate the threat of SARS Cor virus earlier in this century and I think after building new hospital and quarantine facilities at one per every 10 days rate will sooner or later say good bye to COVID-19, the most recent Cor virus. China's appetite for consuming wild animals such as civet cats, bats and back yard poultry is the primary reason for the new emerging viruses at regular intervals.
The US health system has long been somewhat of a mess for some millions who cannot afford health insurance well before DJT took office. On top of that there is no government managed health insurance for those who do not have private insurance, medicare for all ages above 65, VA insurance, insurance for defense or government personnel . Those who have health insurance for these groups it is the best in the world.
What is making it worse for the remainder of the uninsured and uncared for people is partly self inflicted harm
What has made it worse for some who have no health insurance is those causing self inflicted harm. Due to excessive smoking, alcohol consumption, illicit drug abuse, not taking age appropriate viral infection, rash driving crashes, neglect to take immunization, lack of a balanced diet and a lifestyle that contributes to type II diabetes, obesity and metabolic syndromes. Stressful lifestyle can be harmful too.
3
In the above post in the last pragraph 3rd line "not taking age appropriate viral infection" should read not taking age appropriate vaccines.
1
Thank you for raising the important issue of dental insurance. I have never understood why dental care is not insured in the same way as medical care, especially when poor dental health leads to systemic medical issues that could be prevented if good dental care eliminated the risk in the first place.
I believe dental care should be covered under every medical policy; it's unfortunate that it wasn't added to the list of minimum coverage that the Affordable Care Act required, although the political obstacles surrounding the Act's passage and implementation certainly explain why its proponents didn't choose that particular battle. Often, dentists are the first line of defense against certain deadly cancers, yet lack of insurance coverage discourages patients from seeking care that could result in early diagnosis. At the very least, a dentist could be covered as a "specialist" in much the same way a dermatologist is - with a higher co-pay, perhaps, but at least there's coverage.
As a retiree who is too old (apparently) to be considered for another job, I am fortunate to be eligible for retiree health insurance through a prior employer. But my retiree benefits don't include dental insurance. Apparently, someone decided that we old people don't really need teeth.
87
@QSAT I have dental insurance through my wife's retirement but it is a joke. Never pays more than 50% of charges. My less-than-ideal solution is not an option for many, depending on geographical location, but the Mexican dentists in border towns do excellent work (best to go to those recommended by friends). I have friends who have had extensive dental work done in Mexico and the savings paid for the dental work and airfare & lodging.
11
@Warren totally agree. We dropped dental insurance because it basically paid for checkups and that's about it. Need a crown or other complex work? forget it.
5
@QSAT I have dental insurance and have just dropped $1,000 on a bad periodontist and a good regular dentist who gave me a crown.
Let's not forget vision either. Since when are our teeth and eyes not part of our bodies?
3
I fear that the American response to an epidemic of the new corona virus, assuming China’s level of identified patients, would be vastly more chaotic than China’s. A homogeneous population, plus an authoritarian government can have an edge in this type of crisis. They built a hospital in under 20 days. Probably a lot of safety measures were ignored, but they got it done. Their streets were empty, in huge cities. I don’t see that happening anywhere in America, except possibly on a large military base. Nah.
12
Mr Kristof
Kicking kids off insurance is an easy way to get what he wants. Kids cannot complain.
To another one of your points, one of the biggest cost issues in healthcare is the imbalance between specialists and primary care physicians. If there was a reversal of the ratio of 2/3 specialists 1/3 primary care physicians there would be significant savings and improved outcomes with fewer procedures.
7
Physicians have many times in the past century run interference against the expanding scopes of many health professionals(midwives, audiologists, optometrists, NPs, etc). But you repeat a common trope, one that is frequently also heard up here in Canada, that physicians control the number of seats in medical school and the number of residency slots. Not so, either in the USA or Canada
12
@David Mathies Ironically enough, the states where NPs have independence from doctors causes costs to go UP, not down.
More healthcare providers, wjhether they are nurses or physicians, only increases costs.
Research how the Swiss and Germans CONTROL their healthcare costs by forcing insurance companies to open their books and by "limiting" their overall profits. The result? Realistic medical costs.
We could do that in a heartbeat. But with all the money involved it's highly doubtful it'll ever happen in this "capitalistic" focused system.
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So many articles like this have been written over the years, but so little changes. Why?
It's an easy answer. The failures of American medicine are not complex. They are due to systematic and immoral financial predation at every level, mostly by corporate entities, combined with strategic regulatory inoculation against free-market forces that could theoretically drive costs down.
Problems like this require political solutions.
526
Free market forces are a majority of the problem - many groups have found ways to obtain whatever the market will bear - keep on pushing and pushing - until the people stand united and put a stop to it - why should we pay twice as much as all the other Industrialized developed countries in the world for results no better or maybe worse than a number of other countries - we are 32nd in maternal mortality - down the list in longevity - many people go bankrupt each year due to medical expenses - lots of people cry about copays - deductibles - surprise billing - in network hospital out of network E.R. Drs. Pathologist Labs - Dream it up - it’s happening - STAND UP - DO SOMETHING ABOUT IT. The other countries have it - apparently it’s not too expensive - Bernie Sanders and Elizabeth Warren are both options - it would roll out slowly I believe - drop down from 65 to 55, then again, and again until all are covered.
28
@Frank Yes, the basic problem is that too many people are making money from the existing dysfunctional health care system.
It's the same reason we have a far worse opioid epidemic in the US than any faced by European countries: Pharma companies made money getting people hooked on painkillers in the U.S., and that business model didn't work in Europe.
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@Nicholas Kristof
all true, unfortunately.
In terms of opioids, I hope you do a story on Mundipharma and its plans for the developing world
5
"And doctor groups limit medical training and qualified foreign physicians to keep prices high; that’s why there are fewer doctors per capita in the United States than in peer countries."
Nicholas, you are right about the U.S. having too few doctors. You are wrong about the cause of this. I'm a family medicine physician who works as the chief medical officer for the clinic system supporting a family medicine residency. We would desperately like to increase our number of training slots for family physicians, and do so when we can. The money is just not there for this in any great amount. To get by we use a combination of federal money, pharmacy revenues, and money from patient visits. We scrape by every year. We are not being limited by a "doctor's group." Financing the training of new primary care doctors is just not a priority of the US federal government or private health care systems.
172
@APB The A.M.A. has lobbied against expansion of medical training slots to meet need, and also against making it easier to bring qualified foreign physicians into the U.S. to practice.
180
@APB : Mt Kristof is right and you are wrong. The AMA has worked hard on both limiting the number of available slots in medical schools and on making the examination that immigrant highly qualified doctors have to pass ever more difficult, to the degree that most US trained practicing doctors would never be able to pass the examination. These are shameful facts.
23
@Nicholas Kristof That's incorrect. Over the last 20 years residency slots and medical school slots have increased by 40%.
The LCME, not the AMA, controls accreditation of med schools and since 1970, only 3 new schools have been blocked from accreditation, meaning 95% of the applications were approved.
There have been 60 new medical schools (MD and DO programs) created since 2000.
USA already take in more foreign docs than all other nations on earth, combined. Almost 1/3 of residency training slots go to FMGs, again by far a higher percentage than every other nation on Earth.
USA should not be poaching foreign docs. If you've read all of Uwe REinhardt's work, you would know the following facts:
1. Doctor income accounts for only 10% of total heatlhcare costs. Slashing doctor income by 50% would only decrease costs by 5%
2. USA poaches foreign docs from impoverished nations who need those docs far more than we do. Example -- there are more Nigerian surgeons in Miami than surgeons in the entire country of Nigeria.
21
Whether you are rich or poor a deadly virus does not discriminate against who it preys on. The more people are infected who do not have the benefit of health care in any country the greater the spread of the epidemic.
This is why it is so critical to provide tax payer funded healthcare. It is not socialist, it is just plain common sense.
I fail to understand why health care for all is so controversial in the US. The rich can still utilise their own private hospitals whilst the mass of the population benefit.
I also fail to understand how ordinary people are drawn to Trump when his health care policies, will lead to millions of American's not having any form of health care.
I do hope there is a change in all this in 2020.
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@Koret You are absolutely right and I totally agree with you. I came from an Asian country where everyone has some kind of health care coverage under the national health care system. So, I fail to understand why there are people who oppose to "health care for all."
Actually, to be honest, I do not like "Medicare for all" because Medicare is too complicated and not enough. Medicare itself needs to be improved, too.
16
@Koret The problem is that “Let Us Prey” is more accurate than “In God We Trust”.
2
Thank you for this reminder to look at our own shortcomings before we think we’re superior to the next nation. Our own house is far from in order, and there’s plenty of fault to be found right here.
Thinking of how Trump and other Republicans have longed to repeal the ACA and cut Medicaid benefits - hitting citizens in such a vulnerable place is, evidently, a pretty small price to the GOP for the glory of hitting President Obama’s legacy and diminishing the power of social safety nets - makes it that much more frustrating to see the Democratic candidates go after one another on the topic of healthcare.
Whatever approach one takes, be it a sweeping change or strengthening the existing legislation, the fact remains that Democrats are all, ultimately, working to have everyone protected by affordable and comprehensive access to medical care. We are all on the same team here; and just look what the other side has been scheming to take away.
34
@NM Nicely said, NM. Here's hoping...
4
"Democrats’ internecine battle over so-called Medicare for all is largely irrelevant, because the plan won’t get through Congress."
"No, we can't" helped Hillary lose to Trump.
Also nice of Kristof to notice problems with the US medical care system that have been obvious to many, who pay attention, for decades. /s
10
“Democrats’ internecine battle over so-called Medicare for all is largely irrelevant, because the plan won’t get through Congress.”
This is a defeatist attitude that it will not get through Congress. Republicans have health care issues just like Democrats. Talk to many Republicans and they like the idea of Medicare for All. There were 530,000 bankruptcies in 2019 from healthcare debt and these were not only Democrats. A new Yale Study shows Medicare for All will prevent 68,000 unnecessary deaths and will save $450 billion - each and every year. Please join Bernies movement that will get him the votes. There was a time when Democrats thought big - like JFK’s putting a man on the moon.
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@steve Thanks for commenting, but you misstate the Yale study. It suggests that lack of insurance causes 68,000 deaths, but it doesn't matter whether one fixes the lack of insurance with a single-payer system or a multi-payer system. Germany's multi-payer universal system is one of the best in the world. No need to get into a intra-Democratic battle over single- vs. multi-payer system; what's important is to fight for universal coverage (dental as well as medical) and note the difference with the GOP.
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@Nicholas Kristof
Via Yales TheLancet publication they are referring to Medicare For All
“Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US$450 billion annually (based on the value of the US$ in 2017). The entire system could be funded with less financial outlay than is incurred by employers and households paying for health-care premiums combined with existing government allocations. This shift to single-payer health care would provide the greatest relief to lower-income households. Furthermore, we estimate that ensuring health-care access for all Americans would save more than 68 000 lives and 1·73 million life-years every year compared with the status quo.”
16
@Nicholas Kristof
Germany's highly regulated multi-payer system would be harder to implement in the US than single-payer (don't forget the multi-payers are privately managed not-for-profit funds, not for-profit insurance companies like we have in the US.) M4A (at least as proposed by Warren and I believe as proposed by Sanders) is a single-payer system. The various public options are not single-payer and are nothing at all like the German system. None of these public options would achieve universal coverage.
7