November 17, 2017

#SinglePayer, #Medicare4All, #NHS, and #ActualFlatticus

Flatty’s in the hashtag, especially for Twitterers, because as long as curator Twitter accounts don’t want to let him sleep, I won’t either.

At issue, per the other three hashtags, is something where he’s technically right on one part, technically wronger on another part, and straining at gnats all the way through — with the gnat-straining causing problems itself.

Technically right? Single-payer and Medicare for All are two different things. I’ll explain in a minute.

Technically wronger? A National Health System is not at all the same as single payer. I know the difference. And he should. That’s because I’ve blogged about wanting an NHS as part of whatever we get beyond Obamacare, and he saw it. And I’ll explain that in a minute too.

Technically, a “single-payer” system is one in which one entity pays EVERYTHING. As Medicare has deductibles, a Medicare for All bill like HR 676 is not single-payer.

But it IS still “national health care” in that it offers national or “universal” coverage, which Obamacare does not.

All other advanced democracies, like the major countries of old Europe, plus Japan, South Korea and Taiwan in Asia, and Australia and New Zealand down under, offer some version of national health care. Brazil is moving there, though I’m not sure that it’s fully there yet.

A few other countries out there do as well, but that’s enough for illustration.

In some cases, the government is the insurer. In other cases, like with Obamacare, but with universal coverage, private insurers are. In some cases, like Germany, it’s a mixed system.

In all cases, though, coverage is universal. All citizens — and in many cases, all residents, not just all citizens — are covered. Deductibles vary from country to country, but are usually fairly low. And, of course, no country has health system costs per person of much more than 50 percent of the US.

So, that’s where Flatty strained at gnats. Period. End of story. Whether it was simply to be technically correct, or another case where our champion academic debater, and whatever drove him on, semi-compelled him to "have to" win, I don't know.

Flatty and Shirtless Pundit Zach Haller strained at gnats together here. Countries with national health insurance, as in universal coverage, but still having co-pays, include France and Germany, per Wiki. Many countries with national health care use a two-tier system like that. Government insurance covers all basic medical and surgical needs. You buy private care for elective and experimental surgery and other things.

Medicare for all IS universal. And, for Americans worried that our hypercapitalist insurance system, unlike private insurers in Japan and Switzerland, would charge too much on such coverage, it’s also government-payer.

There’s nothing wrong with this.

And, contra Obamacare, since this would be a change in kind, not just degree, on insurance coverage, here, the good would not be the enemy of the better. Not at all.

So, Flatty’s straining at gnats won him cheap debate points.

BUT, it obfuscated the real issue, and made it look like Bernie, Nurses United and others were a bunch of grafters and grifters.

Fuck you and the pipe you smoked in on, Smithee.

Besides, you were wrong about the NHS. At least in the Tweet I saw.

The NHS, or National Health System, is government-OWNED health care services. That’s the actual name of Britain’s socialist medical care system, and NHS is usually used as shorthand for anything else.

My turn to be correct and strain not at gnats but at reality.

In Britain, the NHS is single-payer in that there’s no deductibles. No co-pays. Period.

However, a “generic” NHS elsewhere does not have to be single-payer.

The VA system here in the US, as well as the Indian Health Service, are both NHS systems. In both cases, the government owns the hospitals and clinics and the government employs the doctors, nurses and other staff.

Yes, we have quasi-socialist medicine in the US, and veterans are the primary beneficiaries. And, the VA, for its problems, is light years ahead of the IHS, with Indians getting screwed again.

But, both the VA and the IHS don’t cover every penny of everything medical. And, the VA, at least, has income eligibility limits for at least some services.

Other notes? Besides myths of long wait times, national health care systems elsewhere in the developed world can decide not to cover certain procedures or certain medications. National health care does not mean free Laetrile.

Anyway, the bottom line issue is that straining at gnats to win debating points can undercut real progress.

I've covered some of this ground before in my piece on getting a partial NHS here in America. A few thoughts from there.

A basic version would put a government medical clinic in every county in the United States. It would also let national standards trump state ones on what medical professionals could treat what; ie, a lot of it could be done by physician's assistants and nurse practitioners.

We could then combine that with some version of national health insurance. But, having national CARE for basic and preventative services would immediately start the ball rolling on de-capitalizing our current system.

And, THAT is how you do things bottom up. People get used to the government taking care of their kids' vaccines, their own routine physicals and other preventative care, and basic medicine, and they get OK with it. States realize that non-MDs are doing this just fine and accept because they have no other choice.

And thus, per a Vox piece, throwing aside the code phrase of "Medicare for all," I would be OK with a single-payer system with copays and deductibles IF we got the free clinics along with it. Beating for-profit medicine over the head will help make things less expensive than Vox frets.

1 comment:

paintedjaguar said...

I'm tired of letting the somewhat better be the enemy of the good.