Skip to content

Why Can't America Have a Grown-Up Healthcare Conversation?

2017-03-28 · explainer · John · 7:05 · watch on YouTube

Topic: US politics & society · mode: News analysis · tags: timely hook

John argues that America cannot have a grown-up health care conversation: the system is expensive and underperforming, but because about 70% of Americans like their own care, every reform (the ACA, the Republican bill, Medicare for All, deregulation) involves trade-offs, and leaders pander unless voters accept them.

What is said

The parts of the video and what is said in each (★ — how much it matters to the video).

00:00:00 — The ACA exchanges cover only 6% of Americans; the focus on them shows an inability to have a grown-up health care conversation

  • ★★ John says only about 6% of Americans get their insurance through the Obamacare exchanges, by far the smallest slice of the US health insurance pie. — 00:00:09 · United States
  • ★★★ John thinks the relentless political focus on the exchanges reflects a larger inability to have a grown-up conversation about health care. (hedged) — 00:00:20

00:00:29 — How US health insurance works: private and public pools, employer coverage, the uninsured

  • ★ John points viewers who want far more information about health and health care to Healthcare Triage. — 00:00:33
  • ★★ John explains that health insurance takes money from healthy people to buy care for sick people, through private premiums or public taxes; the US has both. — 00:00:38 · United States
  • ★★ John says almost everyone over 65 is in Medicare, many veterans in a similar Veterans Administration pool, and many low-income and disabled Americans in Medicaid. — 00:00:55
  • ★★ John says just over half of Americans are privately insured, mostly through employers, because large companies must offer health plans. — 00:01:08
  • ★★ John says 9% of Americans have no health insurance; the figure has dropped a lot in five years but is still higher than in any other wealthy nation. — 00:01:22 · United States

00:01:30 — US costs and outcomes, and why health care is a weird market (inelastic demand, illusory competition, confusing plans, job lock)

  • ★★★ John says the US spends about 18% of its economic output on health care, against an average closer to 12% among other wealthy nations, a system he calls 'bananas'. — 00:01:34 · United States
  • ★★ John says US health outcomes are poor: it trails Chile and Slovenia in life expectancy, though both spend under 10% of GDP on health care and have higher tobacco use. — 00:01:44
  • ★★ John says private participation does not drive health costs down because health care is a weird market, first because of inelastic demand: you pay whatever a life-saving medicine costs. — 00:01:59
  • ★★ John says competition is something of an illusion: during a heart attack you cannot shop around hospitals for the best deal. — 00:02:21
  • ★★ John says insurers should compete, but plans are so confusing, covering thousands of procedures, that people cannot compare them and find later their needs aren't covered. — 00:02:33
  • ★★ John says tying insurance to working for a big company is a huge disincentive to innovation and entrepreneurship. — 00:02:51
  • ★★ John says the US spends more tax dollars per person on publicly funded health care than most countries, yet most people lack publicly funded care. — 00:03:03 · United States

00:03:14 — 70% like their own care, so reform is hard: quality, cost and access; the ACA and the GOP bill as trade-offs; collar aside

  • ★★★ John says only about 32% of Americans rate the health care system good or excellent, but around 70% rate their personal health care that way. — 00:03:14 · United States
  • ★★★ John says therein lies the problem: serious reform means big changes for many of that 70%, as Republicans learned when abstract reform talk met pen and paper. — 00:03:25 · Republican Party
  • ★★ John says all health care reform boils down to three factors: quality, cost and access. — 00:03:40
  • ★★★ John says Obamacare improved access but not quality or cost, spending about a trillion dollars in its first decade, offset by taxes and cuts to be deficit-neutral; fewer are uninsured at high cost. — 00:03:44
  • ★★ John says the Republican bill would have cut government health spending but cost millions their insurance (a hard sell to moderates), while its tax credits meant more spending (a hard sell to conservatives). — 00:04:04 · Republican Party

  • ★★★ John says neither the ACA nor the GOP bill addresses overall cost or quality; to discuss those we must accept, as Healthcare Triage always says, that trade-offs are inevitable. — 00:04:20 · Republican Party

    “Tradeoffs are inevitable.”

00:04:40 — Trade-offs of Medicare for All, Medicare as an expensive single payer, and right-wing proposals to cut funding and regulation

  • ★★★ John says the most cited fix is single payer, Bernie Sanders's Medicare for All; studies show it would lower overall costs, probably not to European levels, through less administration, advertising and stronger price negotiation. (hedged) — 00:04:40
  • ★★★ John says Medicare for All would also cost hundreds of thousands of jobs, many good-paying, and lower the incomes of many others, including doctors and nurses. — 00:05:09
  • ★★ John says spending 12% of GDP on health instead of 18% would be good with similar outcomes, but 6% of the economy vanishing overnight is a recession; recovery would be fairly quick but not painless. — 00:05:29
  • ★★ John says the US already has a single-payer system in Medicare and it is very expensive by world standards, because Americans resist the regulations and price controls needed to rein in spending. — 00:05:46 · United States
  • ★★ John concludes that a single-payer system on its own would not solve all US problems and would bring trade-offs. — 00:06:02
  • ★★ John says some on the right want to scale back or eliminate government health funding to let markets work; that might lower prices, but many millions would lose insurance. (hedged) — 00:06:07
  • ★★ John says decreasing regulation might lower prices but raises the risk of inadequately trained professionals and unsafe medications. (hedged) — 00:06:20

00:06:30 — No magic bullet: talk openly about trade-offs or be pandered to; sign-off

  • ★★★ John says over-regulation, tort reform, marketplaces or competition are no magic bullet: there is no solution where everyone wins and no one loses. — 00:06:30
  • ★★ Aaron Carroll (quoted): Dr. Carroll, quoted by John from Twitter: however you reform health care there will be trade-offs, and those who promise you everything are lying. — 00:06:45 · Twitter
  • ★★★ John says a better US health care system requires talking openly about trade-offs, because when we let ourselves be pandered to, elected leaders gladly oblige. — 00:06:52 · United States

In the description and comments

  • ★ John points readers to The Incidental Economist, where Aaron Carroll and Austin Frakt have written a lot about how US health care outcomes compare with other countries. — video description
  • ★★ Citing the Kaiser Foundation, John breaks down where Americans get health insurance: about 6% through the ACA exchanges, 49% through employers, 20% Medicaid, 14% Medicare, and 9% uninsured. — video description
  • ★★ John notes Medicare for All would lower overall US health care costs but cause a lot of job loss, possibly as many as two million jobs. (hedged) — video description
  • ★★ Citing the Congressional Budget Office, John says even modest cuts to insurance subsidies, like those in the GOP repeal and replace of the ACA, would leave tens of millions without coverage. — video description · Republican Party

Threads in this video

Mentioned

Central: Affordable Care Act · health care prices in the United States · health insurance · opportunity cost · United States · universal health care

Also: People: Aaron Carroll · Bernie Sanders

Projects: Healthcare Triage

Organizations: Republican Party · Twitter · United States Department of Veterans Affairs

Concepts: competition (economics) · employer-sponsored health insurance · entrepreneurship · Government spending · life expectancy · myocardial infarction · price controls · price elasticity of demand · recession · regulation · tax credit · tobacco smoking · tort reform

Places: Chile · Slovenia

Policies: American Health Care Act · Health insurance marketplace · Medicaid · Medicare · Medicare for All

Only in the description or credits: Austin Frakt · Congressional Budget Office · Kaiser Family Foundation · The Incidental Economist

Also centred on Affordable Care Act: Adorable Puppy Explains Health Care Bill · Bigger Pizzas: A Capitalist Case for Health Care Reform · The Lowdown on the Shutdown · Applying for Health Insurance: Then and Now · Is Obamacare Working? The Affordable Care Act Five Years Later · Understanding Donald Trump and Hillary Clinton's Health Care Reform Proposals

Also centred on health care prices in the United States: The Political Situation at the County Fair · Health Care Reform Thought Bubble · The 1200% Increase in my Prescription Drug Costs · Question Tuesday! Paula Deen Riding Me (and critical reading) · Why Are American Health Care Costs So High? · Is Obamacare Working? The Affordable Care Act Five Years Later

Also centred on opportunity cost: A Video about Videos · How to Make Goals, Not Resolutions · This Video Is Actually Three Videos · Let's Try Radiation Therapy!

Also centred on universal health care: Ranting and Giving Stuff Away · Health Care Overhaul Summarized Via MASSIVE PIG · Health Care Reform Thought Bubble · Health Care Reform: The Hank Factor · Adorable Puppy Explains Health Care Bill · I OWN WARNER CHILCOTT!

← Previous: I Disagree with Me (Thoughts from Lake Powell) · Next → No Cut Confessional: Priorities