Questions About Universal Healthcare

by Dave Schuler on December 8, 2013

When I read this remark by Colin Powell, to the effect that the United States should adopt some soft of universal healthcare as is present in every other developed country:

Former Secretary of State Colin Powell said universal health care should be available to all Americans. He was speaking at a charity event for prostate cancer survivors in Seattle.

Powell told the audience that countries in Europe, Canada and South Korea offer universal, single-payer health care and said he often asks why the United States has not implemented the same system.

“Whether it’s Obamacare, or son of Obamacare, I don’t care,” Powell said. “As long as we get it done.”

it brought some questions to mind. Is universal healthcare primarily a cause or an effect? Why doesn’t the United States have a system of universal healthcare? It is politically easier to adopt such a system in countries with higher social cohesion?

I’ve favored some sort of universal healthcare in the United States for decades and have wracked my brain to understand why we don’t have one. My tentative conclusion is that universal healthcare is not primarily a cause of lower healthcare costs but that universal healthcare and lower costs share a common cause. The Scandinavian countries, famous for their cradle-to-grave welfare states, have scaled them back as they have become less socially cohesive as has France. To a certain extent the same is the case in the United Kingdom.

Since the United States is the least socially cohesive major economy, it makes a certain amount of sense that social programs would be more difficult for us to adopt.

The PPACA does not effect a system of universal care. It doesn’t even effect a system of universal insurance. Its advocates hope that, buoyed by the PPACA’s successes, we will be moved to expand on it and implement a system of universal care.

At this moment it appears that, if anything, the effect of the PPACA will be to put an official imprimatur on a tiered system of care with a lower level of care being available to people on Medicaid and those covered under the individual insurance market and a higher level of care available to those insured by Medicare or large group plans.

{ 11 comments… read them below or add one }

Jimbino December 8, 2013 at 1:55 pm

Health care is not healthcare insurance.

Obamacare is universal healthcare insurance, except that smart folks like the Amish, the Mennonites and I do not participate in it. Neither do the lucky illegal aliens or Medicare and VA recipients.

Furthermore, pregnancy is no more a healthcare issue than is a haircut or a waxing, unless something goes wrong. Why then does Obamacare tax young childfree men to support pregnancy, but not waxing or dental work?

Good health care has nothing to do with insurance. Amerikans can get good health care now, just like they can get good food, good travel, good wine and good sex.

Woe is the day that we see Obamafood, Obamawine or Obamasex!

PD Shaw December 8, 2013 at 3:54 pm

Some thoughts:

1. Employer-sponsorship. I don’t think any other OECD countries latched on to employer sponsorship like the U.S., and the timing of its rise during the post-war boom made it very successful and ensured that healthcare was fragmentary and difficult to nationalize.

2. Religious institutions have remained more significant players than in other OECD countries, sanding off some of the rough edges of the healthcare system, and again making it difficult to nationalize without a national religion.

3. Lack of communist threat. How many Western European countries latched onto universal healthcare insurance to keep the middle class from supporting Marxists?

steve December 8, 2013 at 4:11 pm

Universal health care makes it easier to address costs. Everyone is affected, so you dont have the same interest group problems we have.

I have always assumed we dont have universal health care because of our lack of trust in government.I also think PD is correct to name religion as our predominant faith (Protestant) closely ties rewards to works, especially with the prosperity gospel.

Steve

Dave Schuler December 8, 2013 at 4:59 pm

Universal health care makes it easier to address costs.

Are you sure that you don’t have reverse causality? That is, that being able to address costs makes it easier to have universal healthcare? Or that universal healthcare and the ability to address costs have a common cause?

Andy December 8, 2013 at 5:01 pm

Universal health care makes it easier to address costs. Everyone is affected, so you dont have the same interest group problems we have.

In theory, I agree with your first sentence. In reality I think our political system and Dave’s point about social cohesion come into play. The Doc Fix is the most obvious example.

steve December 8, 2013 at 5:59 pm

When they increase taxes to pay for health care in France, or they cut something, sometimes they get riots. Partly that may be because the French like to riot, but it is also because everyone is affected. In the US, you can selectively increase spending in one area of health care, say Medicare, to help one interest group, without as much effect you would get from increasing spending on everyone’s care. If premiums go up in California for private insurance, no one in Illinois cares. (To clarify, I am assuming universal health care where everyone is int he same system, which is what everyone else has IIRC.)

Steve

PD Shaw December 8, 2013 at 6:23 pm

My comment about religion was about religious healthcare providers — they account for about 1/5th in the U.S., mostly Catholic. Eight of the twenty-five largest healthcare systems are religiously affiliated.

I’m not suggesting that other countries do not have religiously affiliated, that certainly must have been the norm at one time. Its just persisted longer as stewardship independent from the state, benefiting from private philanthropy. As a result, the state finds it difficult to preempt the field.

PD Shaw December 8, 2013 at 6:25 pm

steve, I don’t know why you assume the U.S. government would be better at taming costs. Mickey Kaus supports a single-payer system partly for that reason. The government cannot reduce costs without public backlash. So we borrow.

PD Shaw December 8, 2013 at 6:26 pm

Should read: “Mickey Kaus supports a single-payer system partly for the reason that the U.S. government could not.”

Dave Schuler December 8, 2013 at 6:39 pm

I don’t know why you assume the U.S. government would be better at taming costs.

That suggests the position that I’ve been approaching after years of believing what I presume Steve does. I thought we might be able to control costs by going to a single payer system. Now I’m beginning to believe that the problem is that we’re just not willing to control costs and single payer would no more control costs than our present system.

Dave Schuler December 8, 2013 at 6:46 pm

My comment about religion was about religious healthcare providers — they account for about 1/5th in the U.S., mostly Catholic.

That returns to a point I made in an earlier post. There are differences in healthcare provision strategies among different religious groups, particularly as it pertains to end-of-life care.

Blacks, who are overwhelmingly Baptist, AME, or other evangelical, tend to seek heroic measures. It’s been claimed that’s because they don’t trust the medical establishment to give them a fair shake.

Jews, too, tend to seek heroic measures. The claim that’s generally made about this is that it’s due to the Jewish emphasis on a reverence for life but a somewhat less benign explanation is that Jews tend not to believe in an afterlife and when this is all there is clinging to it is not that surprising.

The greatest proponents of palliative care tend to be Catholics. The proportion of Catholic hospitals that have palliative care centers far exceeds that of non-Catholic hospitals that do.

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