We’ve all seen it: You walk into a convenience store and there on the counter is the picture of a child taped to a jar. Scrawled on the picture is an appeal to leave your change to finance a bone marrow transplant or some other treatment the child’s family cannot afford. Or maybe you can help out by buying a pizza on the night that one dollar per sale goes to the medical expenses of the victim of a fire or accident. Do you feel good about being able to help, or are you outraged that these families have to beg for desperately needed assistance?

If you don’t feel guilty passing up such chances to help, perhaps it is because you realize the ultimate futility of such appeals. But if you don’t support doing something about it, you should feel guilty. These are neighbors in need. We can turn away from them now, but what happens when we need medical care we cannot afford?

Chances are, you don’t have enough insurance to keep from going bankrupt if you get an illness or injury requiring expensive treatment. Sixty percent of bankruptcies are due to medical bills, and 75 percent of those undergoing medical bankruptcy are insured. In other words, simply having insurance isn’t enough if you can’t afford to use it, or if you use it and go broke anyway. Medical bankruptcies are unheard of in other developed countries. There, risk sharing through universal health care prevents the unlucky families who most need help from having financial ruin added to their burden. Everyone contributes to the system so that none need go without care when it is needed.

Aside from the humanitarian issue of having nearly 30 million Americans uninsured, most of whom are the working poor, there are many practical advantages to universal health care. When access to care is not tied to employment, it is much easier to change jobs. People are free to work where they want instead of keeping a job with medical benefits that doesn’t otherwise fit their needs. If they want to start their own business, they don’t have to worry about losing it due to unexpected illness or injury. Businesses are more competitive with overseas competitors when they do not have to pay extortionate rates for insurance and instead have predictable costs. These costs are significantly less in countries with universal health care than they are in the American system of access through for-profit medical insurance.

The financial benefits of universal health care are well known, but since some continue to claim that we cannot afford it in the U.S., it bears repeating: Other countries provide universal, comprehensive care for as little as half the amount per person that we pay in the U.S. for care that is full of gaps even for the insured. While it’s not estimated that we will save that much under the plan recently introduced in Congress by Bernie Sanders, his proposal for an improved system of Medicare for All would provide comprehensive care to every American at less cost than the current system.

Such a system would have built-in cost controls lacking in the Affordable Care Act. Without such constraints, the system will ultimately become unsustainable due to the familiar “death spiral” of medical insurance: As costs rise, fewer can afford it, leading to premium increases to maintain profits, which leads to fewer being able to afford it, thus causing a new cycle of price increases. Ultimately, most of us will not be able to afford insurance without the subsidies offered under Obamacare. These subsidies amount to a bailout of Wall Street investors in the insurance industry for the sole purpose of maintaining their profits. They add nothing of value to the system to justify their siphoning 30 cents out of every health care dollar, when Medicare overhead is less than a tenth of that.

When you understand the economics of universal health care, it is hard to argue that we cannot afford it. The question then becomes, do we really want to pay more for less care for ourselves and our loved ones, just to deny it to those we think may not be worthy?

Rick Staggenborg is a retired psychiatrist living in Roseburg. He is the president of Health Care for All Oregon-Douglas County and a member of Physicians for a National Health Program.

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(15) comments

Mogie

I don't want to live in a socialism state where government controls the distribution of goods and services. I want a society based on a free market. Bernie Sanders floated the idea of universal healthcare. His plan would have increased taxes. It could limit who you see. What if you want to continue seeing your current doctor?
What makes you think you would have that priviledge? You think waits to see a doctor are long now once the government gets involved they will only increase. Can't think of any government program that is known for being timely and efficient. I don't want more government involvement in my life. Medicaid and Medicare are currently taxing our system. Universal healthcare would add to that bloated bill. If I get drunk and decide to drive why should the tax payer be obligated to pay my hospital bill after my car wreck?

mysteron

You don't get the idea or principal logic behind universal healthcare. Yes your taxes would likely go up, but the 25% of your currentl salary going to pay your healthcare would disappear. The savings in your healthcare premiums would far outstrip the added raise in your taxes. Everyone would be better off. I have lived in four countries with universal healthcare, and its not perfect by any means but compared to the for profit scheme that is destroying this country it is light years ahead. It's the swamp that are telling you differently. As for the 'socialism' comment, you live with socialism every day but are likely unable to see it, or willing to acknowledge it.

Mogie

Don't have a salary. Don't pay health care premiums. I want less government in my life not more. I like the notion of "if you want something work hard and pay for it". I have seen disease in my family but family handled that. Moved a sick person in and took care of them. Did that for many years. Dealt with crippling RA, epilepsy, kidney failure, drug addiction and a person with severe mental illness. Did without sometimes but paid our own way. To me "America land of the free" means to be free from government but to the socialist it seems to mean land of the freebie.

mysteron

So with no salary and no healthcare payments you must be living entirely off your savings. Lucky for those that can.

Mogie

We don't have a saving account. Live month to month. All bills are paid and no debt. You would be surprised the amount of money you can save if you really try.

Mogie

Lets say i smoke cigarettes. I get a disease from that. Seems unfair to the health minded person that someone whose own choices is the reason for their health problems gets a free medical care. In this case it would be my own choice to pick up a cigarette and start smoking. But I should expect the tax payer to pay for my stupid choice? How is that fair?

mysteron

As Mark Lenihan states, you already are, and for every example you state I could come up with a corresponding one. What about the health nut who runs 10 miles every day then has a massive heart attack at 35 and can't work another day in their life. Any healthcare system needs to provide a minimum standard of care for everyone. A for profit system will always ration care based on your ability to pay and then challenge those things you can actually pay for.

RickStaggenborgMD

You need to read more carefully. It is explained in the article that we would SAVE money with universal health care, as experience in other nations has shown.

So again, do you want to spend more to get less, just so you can deny care to those you deem "unworthy?"

Mark Lenihan

The simple fact is that every person purchasing private insurance, whether it be through work or a personal policy, is already paying for other individuals' cosmetic procedures such as nose jobs and boob jobs. The author's post, however,is not discussing these situations, as that is one of the issues that will have to be worked out. He is dealing with the fact that people are going bankrupt while dealing with life-threatening medical issues and that is the number one reason why a single-payer system is the best solution to our current "for profit" insurance system.

NJ

I've always felt if the industry of insurance is removed from health care it would make for better health care. Profit is the the insidious disease that we now all share in that it's for profit insurance carriers that control how healthy we're allowed to be. There's a national database for any individual who is provided medical care. Is the database information shared across the country? Can you leave Roseburg, travel to Ohio, get hurt and have an Ohio doctor have access to your health history? No.

While working in another state, I have been to a dentist who's taken a full set of x-rays and confirmed, yep, that tooth has got to come out, then told me I had to have it pulled by an Oral Surgeon. Once in the surgeon's office I'm told I need a full set of x-rays. Why? I just received a full set of x-rays 2 days ago. Can't you go into the database, access my file and see those x-rays? NO. Why not? That national database is only for the insurance industry's coding of keeping track of what they'll pay.

But our medical professionals now spend over half of their in-person appointment tapping on their laptops to satisfy the Insurance industry. They're no longer allowed to just be doctors, spending their time listening to their patients. They're now running patients through a mill, only a certain amount of time with any patient in order to satisfy the needs of an insurance company which has no intrinsic value to the health or care of a patient.

A Single Payer System will have wrinkles to straighten out, but will ultimately allow medical professionals to be medical professionals instead of insurance company data entry clerks. Health care can return to keeping us healthy in an across the board cost. It would cover preventative to major medical expenses. It would allow every one of us to choose the medical professionals of our choice. And Mogie, I'd even suggest that a Single Payer system while keeping us healthier would not mean keeping our cosmetic vanity healthier. A cosmetic procedure for vanity would mean the opening of a wallet to get what one would want.

Mogie

What one person could consider vanity another could consider physiological necessary. By that I mean they could use the idea that their mental health and/or self esteem depended on some sort of vanity procedure. Opening a can on worms with that idea.

RickStaggenborgMD

This isn't how mental health is covered in any system, single payer or otherwise. There are already requirements for mental health coverage even in the existing fragmented system, and it hasn't led to anything like this.

In any health care system of which I am aware, all services need to be assigned a code. This even applies to the VA, where services are not paid for on a fee-for-service basis. These codes are quite specifically defined, and specifically designed in part to avoid the type of unscrupulous billing practices you are worried about.

NJ

Not a can of worms, you make a valid point with women's health. The key words are health, vanity, and cosmetic. The example that comes to mind is if a woman's breasts are so large a medical professional knows that in 30 years the woman will have chronic pain and constant issues with their back, the seemingly cosmetic issue would need to be corrected. If her breasts are too small for her liking, but she chooses to correct to a point where they most certainly will cause her the above mentioned chronic back issues later in life, then her procedure should be questioned by her medical professional or surgeon, and where the cost would fall. Would the system then have to question whether the need for larger breasts stem from a mental (emotional) cause? The cosmetic surgeon would be prudent in assessing if her need was cosmetic desire or if she'd gain from the help of a mental health professional.

By the way, this example applies to men as well. Men also might want cosmetic correction from mastectomy scarring after breast cancer, or from the development of breast tissue as a side effect of a certain drug.

One thing for sure, it will take people like those of us discussing here, to make sure our elected officials make a single payer system non-political, not to be used as a partisan tug-of-war. We have to engage in making change be what we need and want.

Mogie

Universal health care could also mean that the tax payer is going to end up paying for Jane Doe's nose job or boob job unless the writer of the article is suggesting exemptions from UNIVERSAL health care.

clowe76

Universal health care refers to *who* is covered: Everybody In, Nobody Out. Not to what is covered.

Both of the major bills in Congress (H.R. 676 Improved and Expanded Medicare for All Act and S. 1804 Medicare for All Act) as well as the bills that have been in the Oregon legislature, in 2017 numbered S.B. 1046, the Health Care for All Oregon Act, focus on "medically necessary treatments."

In the Oregon bill, a provision discussing what the Board that determines coverage must cover and may cover says in Section 2.(4)(f) "Health care services that are cosmetic may be covered if necessary for the participant to obtain employment, to improve mental health or to function in society." This is permissive, the Board *may* cover cosmetic services for those ends. In past versions of the bill, issues such as reconstructive surgery following and accident or following a mastectomy were specifically mentioned. This time around it appears that the drafters decided that it would be impossible to list all contingencies. The overall shape of criteria for what is covered (medically necessary, evidence based, cost effective) show clearly that the the mental health aspect will need to have support as medically necessary and not just reflect patient desire.

Taxpayers and premium payers end up paying much more for deferred care due to cost, until care cannot be avoided, than for removing barriers to timely early and preventive care. Early care is both more cost efficient and health effective.

If you want to see what actually is proposed, instead of making stuff up, you can see the S.B. 1046 at https://olis.leg.state.or.us/liz/2017R1/Downloads/MeasureDocument/SB1046/Introduced . Or you can keep making stuff up, and we will understand just how serious your argument are (not very).

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