I had an opportunity last week to talk to atheist and PoC issues commentator and activist Jamila Bey on her show The Sex, Politics, and Religion Hour on Voice of Russia Radio. We were discussing the recent Supreme Court Ruling on the Affordable Care Act, derisively nicknamed “Obamacare” by idiots.
Once again this qualifies as one of those times when I step firmly outside of the usual subject matter of this blog, but health policy is the kind of stuff that makes my socks roll up and down.
Some important things that I failed to articulate well during the interview:
- It is likely true that the richest Americans get ‘better’ care than the richest Canadian would (if ze went to a public sector hospital). I put ‘better’ in quotes because oftentimes the more expensive care is a result of additional and unnecessary testing and medical ‘extras’. There are drugs and technologies that are available to Americans who are willing/able to pay that you couldn’t get in Canada, but usually if something doesn’t get funded by Canadian Medicare, it’s because the additional benefit is not worth the additional cost (i.e., much more expensive, only marginally better health outcomes for patients).
- The Canadian health care system doesn’t handle extremely rare conditions well. If you have a disease that is expensive to treat and is not listed on the formula for funding, it can often be incredibly difficult to get the appropriate care. These circumstances obviously do not happen often, but when they do it is the cause for national consternation.
- The figure I cited of ~30-40% of American health care costs being administrative came from this study.
- Some health care in Canada is delivered on a private, for-profit basis. Doctors in Canada may choose to practice either in the private sector or in the public sector, but not both. It is usually far more simple and profitable to practice in the public sector, so private clinics are rare.
- I forgot one of my favourite talking points, which is that medical bankruptcies are very much a foreign concept to we Canadians. You can go broke if you get sick and you lose your job and you can’t afford to pay your mortgage, but you won’t go broke paying for your medical bills. Considering that somewhere in the neighbourhood of 40% of American bankruptcies are due to medical expenses, you can imagine how much more resilient and stable the Canadian economy is for this reason alone.
Jamila made it clear that I was welcome to come back on the show another time, so you may be seeing more conversations like this popping up here soon.
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Interesting!
I’ll go listen.
Either of these facts standing alone drives my good-governance urges up a wall. Both circumstances are objectively stupid, counter-productive ideas that mean a small number of people are getting huge $$ based directly on the misery and death of other people. Even more bad, they have negative consequences for everyone else. The pile of $$ going to admin could be going for useful goods and services. Everytime there is a bankruptcy, it’s not just the hospitals not getting paid; it’s the entire system including mortgages, loans, goods and services not being bought, etc.
This unfortunate product of bad policy has particular relevance when you consider the role that bankruptcy and the housing market played in the recent economic collapse. When you have one person defaulting on their mortgage, it’s shitty because it drags down your property value. When it’s 2 or 3 houses on your street, it’s a serious issue. When it’s entire neighbourhoods going down, you get a full-scale meltdown. Our economy is predicated on the idea that people stay in their homes – a fixed address is the foundation of pretty much every interaction you have with the state. When a bunch of people are forced from their homes, there is a major ‘knock-on’ effect that impacts employment, education, commerce, pretty much all of the pillars of economic stability (to say nothing of growth).
Affordable health care means housing stability, which means that even if the out-of-pocket cost were the same, the damage done by occasional need for services is hugely mitigated. That argument alone, in a sane world, would be enough to get ‘fiscal conservatives’ on board with ensuring that insurance is affordable. But of course, the conservatives currently holding power are fiscal arsons, who would rather see the whole country burn to the ground than have the government involved in service provision.
Rich people all over the world, including perhaps Canada, travel to the US for treatment of rare conditions. In Europe we sometimes see fund raising to send people over, and sometimes I believe the state has paid to do so. But in the meantime, aren’t poor Americans with rare conditions basically screwed? Here’s the article that gave me that impression. So – our state is buying medical resources that the US doesn’t offer it’s own people?
Well said.
In most cases, yeah, the poor are screwed. If you’re poor enough and lucky enough, you may be able to get treatment through Medicaid. However, for very exotic or poorly recognized conditions, it’s far less likely.
Fantastic.
I especially loved ‘you’ve stopped shitting on the kitchen floor, and have now started shitting on the bathroom floor! This is a big improvement! This is less terrible than before! But….’
😛
> derisively nicknamed “Obamacare” by idiots.
This may have been its origin, but as far as I can tell pretty much everyone is using this moniker now, at least in informal discussions.
Probably because the President tried to turn it around on them. Because, you know, Obama cares and all that.