A question would be: what does a roadmap to universal health care, a "Medicare for all." look like? And the follow-up question would be, does the existing Medicare programme provide the appropriate model for a universal health programme? (To the latter my answer is no: leaving an individual with responsibility for 20 percent of a $150K m…
A question would be: what does a roadmap to universal health care, a "Medicare for all." look like? And the follow-up question would be, does the existing Medicare programme provide the appropriate model for a universal health programme? (To the latter my answer is no: leaving an individual with responsibility for 20 percent of a $150K medical bill still spells disaster for far too many.)
The focus on health insurance, its costs and the way companies proscribe care and treatment, is obvious and vital, but it is only one part of a much larger problem where medical (including pharmaceutical) costs are concerned. For example, I have yet to read a commentary in an American medium that speaks about the exclusivity and costs of medical education in the United States, or the culture that some medical schools cultivate that reinforces over-medication and insufficient direct personal care.
I worked at a major US medical school that accepted a small and privileged group of ca. 150 medical students annually. The first week of attendance provided orientation, including a fair of medical service providers and drug companies that dispensed luxurious gifts, such as branded leather portfolios and expensive branded pens. The medical campus included laboratories named for the company that had donated to support its services, and a major building was named for the pharmaceutical companies that sponsored its construction.
While many medical students benefit from some form of financial aid, the costs of medical education in the US makes becoming a doctor in itself an act of privilege. Average non-resident costs at a private medical school in 2023 were USD 66,176, exclusive of other academic and living expenses. Doctors may graduate with significant debt, interning in hospital where they serve double shifts, and ultimately practicing with another insurance burden--malpractice insurance.
The list goes on, and the common element is the financial bottom line. It is the pervasiveness of the capitalistic ethos of greed and profit-making that comprises the "system," not the fragmented and dysfunctional care-delivery services landscape. That is why a "Medicare for all" insurance programme is insufficient. Any roadmap toward a better, more humane healthcare framework needs to address the entire landscape that contributes to the current situation--from the training of medical personnel to care delivery, management of drug costs, and equitable assurance that medical costs never lead to death and bankruptcy.
Can you conceive of such a roadmap? Or is the culture of greed so overwhelming that it is only something one can talk about?
The roadmap is actually simpler than most realize. Look, we already have 151 million Americans on Medicaid, Medicare, or Tricare. That's more people on a government administered healthcare system than any other European nation that has guaranteed healthcare. We already have the infrastructure. This is a matter of expanding that infrastructure to ensure we accommodate all people in this country, and that is done by using the savings to transition private insurance workers, giving severance to those who cannot or do not want to shift over, and investing in four year free public college to retrain those who want a new career. The path is there, we need the political willpower to make it happen.
I appreciate your optimism. It’s been 15 years since leaving the US due to the way healthcare is managed in the US and the trajectory has been to move ever more in the direction of privatisation and profiteering. That’s a lot of inertia. That’s a deeply capitalistic culture that will likely be ever more heartless in the next four years. It’s not the procedural and technical sources of healthcare administration that pose the biggest challenge. It’s the culture that fosters what now exists. The roadmap has to account for how the culture, so deeply embedded financially, can be shifted.
I don’t expect to live to see the change that’s needed, but I’m glad for people like you willing to fight for it.
A question would be: what does a roadmap to universal health care, a "Medicare for all." look like? And the follow-up question would be, does the existing Medicare programme provide the appropriate model for a universal health programme? (To the latter my answer is no: leaving an individual with responsibility for 20 percent of a $150K medical bill still spells disaster for far too many.)
The focus on health insurance, its costs and the way companies proscribe care and treatment, is obvious and vital, but it is only one part of a much larger problem where medical (including pharmaceutical) costs are concerned. For example, I have yet to read a commentary in an American medium that speaks about the exclusivity and costs of medical education in the United States, or the culture that some medical schools cultivate that reinforces over-medication and insufficient direct personal care.
I worked at a major US medical school that accepted a small and privileged group of ca. 150 medical students annually. The first week of attendance provided orientation, including a fair of medical service providers and drug companies that dispensed luxurious gifts, such as branded leather portfolios and expensive branded pens. The medical campus included laboratories named for the company that had donated to support its services, and a major building was named for the pharmaceutical companies that sponsored its construction.
While many medical students benefit from some form of financial aid, the costs of medical education in the US makes becoming a doctor in itself an act of privilege. Average non-resident costs at a private medical school in 2023 were USD 66,176, exclusive of other academic and living expenses. Doctors may graduate with significant debt, interning in hospital where they serve double shifts, and ultimately practicing with another insurance burden--malpractice insurance.
The list goes on, and the common element is the financial bottom line. It is the pervasiveness of the capitalistic ethos of greed and profit-making that comprises the "system," not the fragmented and dysfunctional care-delivery services landscape. That is why a "Medicare for all" insurance programme is insufficient. Any roadmap toward a better, more humane healthcare framework needs to address the entire landscape that contributes to the current situation--from the training of medical personnel to care delivery, management of drug costs, and equitable assurance that medical costs never lead to death and bankruptcy.
Can you conceive of such a roadmap? Or is the culture of greed so overwhelming that it is only something one can talk about?
The roadmap is actually simpler than most realize. Look, we already have 151 million Americans on Medicaid, Medicare, or Tricare. That's more people on a government administered healthcare system than any other European nation that has guaranteed healthcare. We already have the infrastructure. This is a matter of expanding that infrastructure to ensure we accommodate all people in this country, and that is done by using the savings to transition private insurance workers, giving severance to those who cannot or do not want to shift over, and investing in four year free public college to retrain those who want a new career. The path is there, we need the political willpower to make it happen.
I appreciate your optimism. It’s been 15 years since leaving the US due to the way healthcare is managed in the US and the trajectory has been to move ever more in the direction of privatisation and profiteering. That’s a lot of inertia. That’s a deeply capitalistic culture that will likely be ever more heartless in the next four years. It’s not the procedural and technical sources of healthcare administration that pose the biggest challenge. It’s the culture that fosters what now exists. The roadmap has to account for how the culture, so deeply embedded financially, can be shifted.
I don’t expect to live to see the change that’s needed, but I’m glad for people like you willing to fight for it.