This Is Why We Can’t Have Nice Health Care

This Is Why We Can’t Have Nice Health Care

Alexis ChapmanWednesday,6 January 2016

We’ve had a form of universal health care in this country since 1986. That isn’t a typo, that was the year that the Emergency Medical Treatment and Active Labor Act was passed. It mandated that people have access to emergency services even if they can’t pay for them. From 1986 until the implementation of the Affordable Care Act (ACA) we had a system where some people had insurance through their jobs or Medicare or Medicaid and got health care ranging from bad to great, and other people had no insurance and mostly got health care only in case of emergency, which is terrible. It was universal health care but not universal health coverage.

To put it another way, prior to the ACA what we had was universal health care done in the unhealthiest, most inefficient way possible, and it was generally bad for everybody. Only going to the hospital when you’re having an emergency is not healthy, and having huge medical debt that you may never be able to pay off can be financially ruinous, so this system was especially crappy for the uninsured. Providing expensive emergency services for people who may never be able to pay for it is not exactly a sustainable business plan, so this system was also not great for hospitals and health care providers.

For the insured and the companies they work for, health care was (and is) still really expensive. Employer-sponsored coverage also discouraged companies from hiring employees who would need to be insured, and having almost no other way to get insurance discouraged employees from changing jobs, being self employed, or becoming entrepreneurs. Those who qualified for Medicaid could have lost their benefits if they had moved states or earned too much money, which wasn’t exactly an incentive for economic advancement. So I guess if you had Medicare this system may have been acceptable, and if you were an insurance company it was probably pretty sweet, but for the rest of us it kind of sucked.

When the Affordable Care Act was passed, the idea was that everyone had to get insurance. That’s an okay idea and it would have fixed the issue of people being uninsured. But even if the rollout hadn’t been such a fiasco, the ACA leaves us with two big problems from the old system. First of all, hospitals and health care providers in the U.S. still pay way more than they should for medical supplies and equipment, which is just one of the reasons that health care here is so outrageously expensive. And second, employers are still involved in the health care system.

One of the main benefits of the single payer health care systems that a lot of European countries have is that when there is one payer for health care, there is also only one buyer of health care supplies. In England, when hospitals need ultrasound machines, or prosthetic joints, or bandages, the government sets the prices and the quality specifications. In the U.S., the companies that sell ultrasound machines, prosthetic joints, and bandages set the prices, and if one hospital can’t afford them, then they just sell to some other hospital that can. Companies that manufacture medical equipment are obviously going to set the prices as high as they can, so in the U.S. we end up paying more, often a lot more for the exact same things, than people in Europe. As I mentioned previously, this isn’t the only reason health care costs are so much higher here, but it’s a pretty significant factor, and it’s something we’re going to have to fix if we want health care that’s actually affordable.

The other issue that we’re still grappling with here is that for a lot of Americans, their insurance is through their employer. While it was nice that in the past at least some people had access to decent insurance, at this point the whole employer-sponsored insurance system just seems weird and illogical and annoying. My employer doesn’t buy my groceries or pick out my phone provider, so why are they all up in my health care? It’s a drain on companies’ resources to have to spend time and money dealing with insurance plans and it’s a hassle for employees to have to switch insurance companies if they happen to switch jobs. But maybe the biggest current drawback of employer-sponsored health care is what happens when your employer has religious beliefs that mean they don’t want you to get certain health care at all.

The upcoming Supreme Court case Zubik v. Burwell — the latest challenge to the ACA — is a consolidation of seven different cases in which employers are arguing that it violates their religious freedom to pay for insurance for their employees if that insurance covers contraceptives. This issue was supposedly dealt with by the Contraceptive Mandate, but now Zubik et al. are saying the mandate itself actually violates their religious freedom. This issue could have been sorted out by explaining to employers that they don’t pay for insurance, they compensate people by providing insurance, and just like an employer can’t tell an employee what to do with other forms of compensation like wages or vacation days, they can’t control what they do with their insurance. That distinction has a logical appeal to me, but it’s apparently not acceptable to anyone who has already suspended logic so much that they think it’s immoral for a person to prevent an unwanted pregnancy. So the Supreme Court is going to hear the case, and even if the ACA comes out of this latest battle unscathed, it could still be under threat if a Republican wins the presidency.

I hope that Zubik et al. lose this case, and I hope none of the current Republican candidates become president, but I also hope that the ACA in it’s current form doesn’t endure for much longer. We are one of the last developed countries to implement universal health coverage. That’s really embarrassing but it’s also an opportunity to learn from all the mistakes and successes of other countries that have done this before. The single payer system isn’t perfect, but it has advantages, as do more functional insurance mandates like they have in Germany, or two tier systems like they have in Australia. I think it’s possible for the U.S. to get past the problems of the current system and create health care coverage that is actually universal and actually affordable and actually healthy. But in order to do that we’re going to need our politicians to stop trying to sabotage each other by throwing our health care under the bus; it’s stupid and also I don’t think my insurance covers metaphorical bus accidents.

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