So...the healthcare CEO shooter was caught. I won't post it here but he had a manifesto about the healthcare industry being screwed up, and he basically admitted he wasn't an expert on the matter, although he clearly understood that there was a problem.
Again, I don't condone what the guy did. I believe that he should be held accountable for his crimes. But....he's right that healthcare is screwed up, so I figured I would try to flesh out what's so screwed up with the healthcare system.
It really is the profit motive
Okay, so, here's the reality of things. And this is an argument I noticed with the jobs thing too, which is why I'm so anti work, but here's the reality of capitalism in this country. A company's first priority is to maximize shareholder value. It's not to "create jobs", it's not to provide a service. It's to maximize their own value. Period. End of story. Any and all good things that come from capitalism come by coincidence from this system. And heck, that's why we tend to justify this system as the system. The theory is that by encouraging people to act in their self interest, they will act in the public interest too. And in some ways, sometimes public interest aligns with private interest, and sometimes it doesn't.
When it does, that's good. That's capitalism at work, and everything good that comes out of this system deserves credit. But we need to throw away this childish idea that private interest and public interest always align. They don't. On the worker side of thing, businesses will try to extract as much value from workers, while paying them as little money as possible. And this is why the job system ultimately doesn't work well, and that's why I have the ideology I do. We like to act like businesses are "job creators" and the wealth will trickle down, and it never ever does. In reality workers are slaves under capitalism. We just use language and philosophy to try to circumvent this fact and we end up with this hot mess of "the system is voluntary but also kind of not."
The same is true with healthcare. As a matter of fact, I will argue that our healthcare system is so grotesquely broken that no amount of trying to clean it up with tweaks around the edges will ever work. Multiple for profit industries, from the doctors and the hospitals, to the insurance industry all have their hands in the pie, leading to circumstances where the cost of care is absurd, but because the care is necessary, because consumers dont realistically have options, and because people can't realistically say no, well, these companies can charge as much as they want. Which is how we get to the point that hospitals charge like $100 for aspirin, with everything being scaled up from there accordingly well into the tens and hundreds of thousands of dollars. What are you gonna do? Say no? Go to another hospital? It's nonsense. And insurance companies. Again, trying to maximize shareholder value. What does that look like? Well, it means charging you as much as possible, which they do. Your average person spends $8951 for health coverage a year, which comes out to around $746 a month, and for a family, $25,572, or $2131 a month. Now, Im not sure people individually pay all that, employers probably pick up some of the tab, but still, that's ridiculous. Another source has it at $477 a month, which sounds more about right to me. $746 sounds crazy even for me. It's crazy regardless. And I've experienced these kinds of issues before. I remember when my dad got a new job during the recession after his last one laid him off to keep their precious "record profits", we went without insurance for a while because it cost like $1200 a month, and amounted to about 40% of our income at the time. It was insane. Eventually another company came in and we got better coverage, at least until i turned 26, but still. That's the reality of healthcare in this country.
And then these guys will turn around and deny as many claims as possible and try to limit how much they pay out. So not only does the profit motive incentivize overcharging, but it also incentivizes underdelivering. It's simple. If the goal of an insurance company is to make as much money as possible, not only will they charge as much as possible, but pay out as little as possible. And what are you gonna do, say no? You need that life saving care. So they got you by the balls.
By the way, that's why people often DO deny themselves care. They don't go to the hospital when they need to. They dont get the care they need to. And tens of thousands of people die a year because of this. Many of us dont even have insurance because with the above rates, how the everloving fudge can we afford it? And even if we do, we're often afraid to use it because these guys WILL still leave us stuck with a massive bill we can't afford. So many of us prefer not to get care, even when we clearly have something wrong with us.
Why the ACA was a watered down compromise that didn't fix the problem
This brings us to ACA, or Obamacare as some call it. The ACA was intended to be the healthcare fix that would solve the problems. But, for those of us who remember the fight at the time, it was a mess. It was this 1k page bill, no one actually read the thing. No one knew what it actually did, and it was just a hot mess we passed through because it was all we could.
The point of the ACA was primarily to have an insurance mandate system. Basically, the way to reduce costs was to have everyone covered, the way to have everyone covered was to mandate they have insurance. So the big thing was that it mandated everyone get insurance or they pay a fine, or basically an additional tax, of like $650 on their paychecks. Okay....so....it costs $450-750ish on average for insurance accoreding to the above A MONTH, so....youre saying we either gotta pay around $5000-9000 a year for insurance that screws us...or pay $650 for a fine? Most people would pay a fine. Because they can't afford this crap.
And don't get me wrong, Obamacare did some good things. it got rid of the discrimination for preexisting conditions where insurance companies were charging even more, or refusing to cover people with medical conditions that were pre existing that would cost them money. But at the same time, this also was compensated for by these companies charging more for everyone else, making their healthcare less affordable. Young healthy people could get insurance more cheaply,. and then they couldnt. But at the same time it helped the people who actually...needed...the care. Still, I'm trying to report on it fairly as I see it, and insurance companies bypassed the regulation and just charged more for everyone else.
It mandated all full time employees get health insurance. But because of the gargantuan costs mentioned above, many employers were like screw this I aint paying this crap, and they knocked their employees down to part time.This is why most minimum wage type service jobs refuse to hire people over 25 hours and will FIRE you if you clock in even 1 minute too much. because theyre legally required to pay for healthcare, and they dont wanna do that. So have fun juggling multiple jobs just to survive. It's almost like employers dont wanna pay people money...
It did stuff like, try to pay states to provide a medicaid expansion so poor people could get free care. But...it went state by state. Some states refused to implement it at all. Others implemented it in passive aggressive ways, trying to push work requirements, wellness programs, and complicated sign up procedures that disincentivized people from applying. And it had a strict cut off. Like 138% of the poverty line. If you were at 137% of the poverty line, you had free healthcare. If you had 139% of it, tough luck, you're on your own. And this is a poverty trap that keeps people in poverty. It also increases resentment among the lower middle class as people at say, 200% of the poverty line were like I WORK SO HARD FOR EVERYTHING WHY DO THEY GET CRAP FOR FREE AND I DON'T?! And they kind of have a point. I mean, lower middle class guys have it hard sometimes. because they're just rich enough to not get the help the truly poor and destitute get, but they're still obviously struggling. Given the poverty line is $16k a year or so, 138% of that is $22k, and your average individual yearly insurance premiums are, as I already established, $5-9k. For a family of 4, poverty line is say $31k a year give or take. And then the insurance coverage costs...$21k. Like wtf is this?! How is this even remotely affordable?!
And this isn't even getting to these companies denying claims. Kyle Kulinski did a video today explaining what things cost to people who live in other countries and were like "wtf if you're poor i guess youre not allowed to be alive?" basically. Or you're in debt, or lucky enough to be covered by medicaid.
It's a mess. And this is why, despite the ACA being a relatively decent step forward and better than what existed before (which was even more laissez faire and predatory), people are still angry and were calling for more dramatic solutions like medicare for all.
And this is why I despised Biden for trying to preserve the ACA against people who want to expand it further, because he cares more about his former boss and good buddy Barack Obama's legacy than about doing the right thing for the American people.
You know, I keep saying it. The democrats losing the 2024 election and people cheering on the CEO killer aren't unrelated to me. I mean, it seems very clear to me that people are in a populist "eat the rich" mood right now, and it's not really so much that democrats lost for being too far left (although maybe they were at times on culture issues), it has more to do with the fact that democrats were clearly ignoring peoples' material needs. Kamala Harris wouldn't even run on a fricking public option, because it was too far left, and she was too busy clinking champagne glasses with the cheneys and their supporters than doing what's right by the american people. People are ANGRY, they're LIVID. And they WANT CHANGE! And democrats are just like "well tough crap, we live in a right wing country, vote for us or else" and they wonder why they keep losing elections. It was true in 2016, it's true in 2024.
Again, I don't condone the killer. But can we at least understand just how pissed off your average American is at a broken system right now? We've been advocating for changing things through proper channels for years. And the people in power just wont listen or respond to our concerns. We get the democrats who won't do F all for us, and the republicans who will make it even worse. And sometimes, people punish the democrats by electing the republican for some reason. Because they think that for some reason trump will make their lives better. He won't, but that's another discussion for another day.
Why public healthcare is the solution
So...people wonder, okay, well, how do we fix this? And the proper answer IS basically, medicare for all. If everyone was covered, everyone would go to the doctor when they needed it, the care would be covered, and everyone would get the care we needed without being forced to be in medical debt.
The federal government, acting as a monopsony, think, the single buyer, instead of a monopoly, which is a single seller, (hence, "single payer) would be able to negotiate directly with the companies, and get the prices down. Because what are the companies gonna do, say no? This would save hundreds of billions of dollars a year. Not having a complex medical billing industry would save even more money. All in all, we could be saving upwards of $450 billion.
So, everyone would get the care they need, it would cost less. And even more importantly, costs would scale with your income. People who are poor would get free care. Those who can afford to pay would pay more in taxes. As we know from the Sanders and Warren 2020 plans, a lot of these costs would come from just taking all that money employers pay on insurance, and rolling it over into a payroll tax. And households would be responsible for some taxation too. Bernie, for example, had a 4% tax on take home income over $29000 a year. This is nothing compared to what people pay for with insurance.
So...yeah. That's the solution. That's the ideal solution. And even I have considered my own plan for this before. I'm not sure I'd go for it because I also support a $4 trillion UBI, and I support that too, but I believe at least we need a public option.
The public option tradeoffs
So a public option would be a lot cheaper. By my latest estimate, funding single payer would cost $2.4 trillion a year, although I may have overshot it given how we could save $450 billion a year, so maybe $2 trillion was more in line with what it would actually cost. Still...that's a lot, especially on top of UBI.
So let's discuss a public option like the medicare for america act of 2019 or medicare extra for all. So, instead of costing around $2 trillion, these programs cost more like $250-500 billion.
They do shift some costs to consumers. Poor people would get free care, but people above say, 100-200% of the poverty line would pay a small portion of their income, say 2-8%, toward premiums. 2% at the bottom end, say, 150% of the poverty line give or take, while those making more than 4-6x the poverty line would pay around 8%. So say 150% for a family of four. Poverty line is around $31k, so 46k for that amount. 2% of income would be like, $920 a year. Or...$77 a month. That's A LOT better. Or say you make 6x and pay 8%, that's $180k a year give or take, that's $14400 a year or $1200 a month. Which, with that income, isn't the end of the world.
You'd still get stuck with bills, and deductibles, but the public option, if robust, would at least force the private industry to at least meet the public option's standard. Which would force it to offer better care than the public option to stay in business. And the deductibles would be much lower than now, and likely align with income.
It would be better. I admit, compared to single payer, a public option is a half measure. but this IS the compromise. Anything less than this is garbage, this is the bare minimum we should accept.
Biden ran on a public option in 2020 that I presume would operate somewhat like this, but Harris declined to in 2024. No wonder she lost. People want their healthcare costs fixed and her plan was to tinker around the edges, despite running on exactly this kind of plan in 2020.
Addressing common criticisms to public healthcare
The big argument, other than cost, comes down to the idea that we will have to ration care and how those systems have long wait times. We already ration care. We just do it via the market, where poor people dont get care and wealthy people do. In capitalism, you are basically paying to be alive and if you cant afford it, well, sucks to be you. There's a reason why poor people live a full decade less than rich people. Sure, you might have to wait for non essential surgeries, but public healthcare systems operate on a triage basis where those who need care most get it, and those who can wait wait. Seems fairer than "well if you're poor go ahead and die."
Second, people fear the government will implement death panels. But, and this is what that shooting was in part about, we already have death panels. They're called insurance companies.They deny and delay care, and people gotta suffer because of it. This dystopian fear people have about public healthcare killing people, which, I admit, isnt even fully unfounded (see canada not long ago), is already happening here in America. We just have this double standard that when the state kills someone it's evil but when capitalism does it, oh well, just sweep it under the rug.
Third, people say we will lack the innovation we currently have, and how profits fund advancements in medicine. After watching the federal government pump tons of money into funding a vaccine for covid, and then watching the government then let the pharmaceutical companies start charging for it, I'm just gonna say shut the heck up on this one. Our tax dollars fund tons of medical research, and most profit goes to make rich people richer, not fund cures for stuff.
Fourth, people claim that not having payments attached to healthcare cause a "moral hazard" that incentivizes people to seek out care. And that we need payments associated with care to keep the number of people seeking it down. But outside of a handful of hypochondriacs, most people seek care because SOMETHING IS WRONG WITH THEM, and punishing people financially is how we get this mess where people delay care they need, suffer in silence, and we ultimately lose tens of thousands of people a year.
Also, this seems to be one of those weird abstract "capitalism gud" arguments. Again. Capitalism is good in most industries to some degree. But healthcare is a massive market failure, and I believe that a medicare for all system would fix things.
Conclusion
So, this is a long article from me, but this is basically explaining the actual core issues with healthcare and how to fix them. This is why I believe what I've believed, this is why I've spent much of the past decade advocating for either a single payer or a public option system. While the profit motive is an important motivator in capitalism to make it work, sometimes it doesnt lead to good outcomes. And sometimes the outcomes are so bad that we should reconsider "literal socialism" to fix it. healthcare is one of those industries. No amount of band aid fixes is ever gonna fix this crap, the ACA just tinkers around the edges, we need a full system wide fix.
Ideally, single payer would get the best outcome. it would be extremely expensive for the government, probably in the ballpark of $2 trillion in additional healthcare spending, but it would ensure everyone is covered and gets the care that they need. It would, in some ways, be cheaper for most people. Honestly? The wealthy would pay the most under such a system as they could best afford it. Everyone else would get cheaper or free healthcare.
A public option is kind of a half measure. I only support shifting to that because I also wanna fund a $4 trillion UBI on top of healthcare and I'm not sure we can afford both. But even that would probably reduce the problem, bringing premiums down to reasonable amounts and obviously capping deductibles and out of pocket costs at something americans can actually afford. It lacks the elegance of single payer as a solution, but it would probably improve things greatly, and should be the bare minimum that we accept.
Honestly, it's baffling to me. This is a no brainer. But washington doesnt want change, because washington is corrupt. They fought bernie on it. Biden promised a public option, never delivered it. Harris ran on one in 2020, dropped it in 2024, and yeah, she lost the election. Im not saying this is the sole issue why, but i honestly believe it's part of it. Democrats have a problem because they're too captured by corporate interests, too obsessed with running to the center, and won't do F all to fix problems. And sadly, people somehow thought trump was better as a result of that.
Make no difference, he's not. He wants to repeal the ACA. He has no healthcare solution. But voters, despite their pain being real, are kind of ignorant and uneducated and make bad decisions sometimes, and they chose Trump.
I guess, when the choice is between the lying con man and the other person who won't do F all for you, people stop caring, and that's probably why no one showed up at the polls to vote for Harris.
*sigh*
But that's why the democrats lost IMO. And that's also why most of them are cheering for this killer instead of condemning vigilante violence. Again, I don't support the killer. I wanna make that clear. Vigilante violence is wrong. But holy crap, I'd be lying if I said that this didn't happen because people in power have been ignoring the problem for years and stopping change through more legitimate mechanisms. The system has to work for the people, or eventually the people are going to get angry and revolt. Again, I don't support violent vigilantism or revolution, I'm more condemning the powers that be for being so fricking inflexible on the matter and refusing to implement change. Wasn't it JFK who said those who make peaceful change impossible make violent revolution inevitable?
Between electing trump and this more recent tragedy, I kinda feel like I'm living in france in the 1780s. And that's not really a good place to be. We need change, legitimate change, through legitimate avenues. We need healthcare reform. I outlined the problems. I outlined the solutions. This is common sense, honestly. The only problem is the wealthy keep pushing a crappy status quo that no one wants on us, and people are getting increasingly angry.
Once again, I call on the democrats to actually advocate for actual healthcare reform. Show that political courage. Buck the political establishment. Push for change, real change, that improves peoples' lives. Stop being cowards and show some backbone for once in your pathetic lives.
And yeah, that's my stance on this.
