Wednesday, October 22, 2008

UHC, Medicare For All, and some other definitions


In response to caseyOR’s question, what is UHC? I thought I’d try to answer without getting too geeky or wonky.



This abbreviation is variously used for both Universal Health Care and Universal Health Coverage.

The word coverage is used in this context to mean health insurance coverage.

Insurance is basically a useful way to pay for catastrophic things that happen to us — whether the house gets blown away by a hurricane, or someone in the family gets cancer, or some idiot T-bones the car when they run the red light. At its most basic, insurance is when a group of people all agree to put a little bit of their money ahead of time [insurance premiums] into one pool, and as people who belong to that group get hit by something huge that they couldn’t afford to pay for on their own, they can draw out what they need from that pool.

Universal health coverage just means that every single member of a population has health insurance.

Health care, on the other hand, is the sum of all the actual services you get from doctors, hospitals, clinics, laboratories, dentists, psychologists, etc. You can pay for these services with insurance, or with your own money, or with your taxes, or with some mixture of insurance, taxes, and cash.

Universal health care means that every single member of a population can get these services, no matter what their circumstances [employed, unemployed, rich, poor, healthy, sick, old, young, etc].


Single-Payer and Multi-Payer

Single-payer just means that only one entity — be it a government or a private insurance company — takes in all the insurance premiums [or taxes] and pays all the doctor bills [and hospital, and dentist, etc].

Canada’s Medicare, our Medicare, and Australia’s Medicare are all single-payer insurance systems that are run by the respective national governments. The difference between us and them is that their Medicare systems are universal — covering every single person living in their countries — while our Medicare system only covers old people.

Multi-payer means that several entities — usually lots of different private insurance companies — take in insurance premiums and pay the bills. Our current health insurance system is a multi-payer system. Most people who have health insurance get it as a benefit provided by their employer [or their spouse’s employer, or their parent’s employer, etc] but some of us have to buy our own health insurance, usually because we’re self-employed or we work for a company that’s either too poor or too cheap to provide it as a benefit.

Our multi-payer private health insurance system here in the U.S. does NOT provide universal coverage, simply because not everyone can afford it. This is basically because our insurance companies are blood-sucking leeches.

Lots of countries have multi-payer private health insurance systems — France, Germany, Switzerland are some examples. These countries all have universal coverage because their governments basically force the private insurance companies to make their insurance plans both affordable and open to anyone who wants to join. And the companies may be private, but they’re non-profit [we used to have a lot of these here in the U.S. but now we have very few]. Additionally, these countries all provide generous help to poor people who otherwise couldn’t afford the insurance premiums.

The difference between our country and all the other multi-payer countries is that their private insurance companies are all so heavily regulated by their respective governments that to us they LOOK like they’re government-run. Don’t let the U.S. insurance industry scam you — they whine loud and long about the onerous burden of regulations here, but even though we have lots and lots and lots of regulations, those rules are all tilted to favor the insurance companies, not us real people.


Medicare and Medicare For All in the U.S.

Medicare is our government-run, single-payer insurance system to pay for health care for old folks. Medicare-For-All is the short name of the National Health Insurance bill introduced by John Conyers — HR 676 — that would expand our current Medicare system to cover all of us. PNHP [Physicians for a National Health Program] has an excellent FAQ on single-payer and HR 676.

Paying for it — can we afford to do this? Short answer — Yes.

Right now, if you’re employed [let’s forget about the self-employed and the few who make very humongous salaries for the moment — they’re special cases] you and your employer together pay 15.3% of your gross salary/wages to Social Security and Medicare. You pay 1.45% to Medicare and 6.2% to Social Security [this deduction usually shows up on your pay stub labeled as FICA taxes, but people also call it ’payroll taxes’]. Your employer pays an additional amount equal to 1.45% of your gross salary/wages to Medicare and an amount equal to 6.2% of your wages/salary to Social Security.

Under HR 676 — Medicare For All — your FICA taxes would go up. The amount going to Social Security would still be 6.2% of your gross wages, but the total amount going to Medicare would be 4.75% instead of the present 1.45%. Likewise, your employer would still pay 6.2% to Social Security, and would also pay 4.75% to Medicare.

This sounds like a huge increase in taxes, but overall, most people — both employees and employers — would end up paying much less than they are now. Under HR 676 you don’t have to worry about insurance premiums, co-pays, deductibles, or other out-of-pocket expenses — it’s all been paid for ahead of time in your taxes. You just walk into any doctor’s office, any clinic, any hospital, any lab, any dentist, any optometrist, any pharmacist, any health care provider, get what you need, and walk out [we hope]. The provider then bills Medicare for the services, or medicines, or medical equipment they gave you.

No worries about losing your insurance because you change jobs, or want to work for yourself, or worse yet, lose your job. No worries about being able to afford an expensive illness, like cancer, or a heart attack. You might still have to worry about buying food for the kids and heating the house at the same time, but you’ll always, always be able to take them to the doctor if they get sick.


Socialized Medicine

Almost forgot this one. You hear the right-wingers scream socialized medicine !!! socialized medicine !!! socialized medicine !!! whenever the topic of UHC comes up. True, the Soviet union had ’socialized medicine’ and made a real mess of it, but that wasn’t the fault of socialized medicine, that was the fault of brutal and greedy tyrants who hijacked everything about their governments.

Socialized medicine actually works, and works well. It’s a basically a special kind of singe-payer — the government [the taxpayers!] owns all the hospitals and and clinics and labs and so forth, and employs all the doctors and nurses and dentists and ambulance drivers, etc. It’s probably the most cost-effective way to deliver quality medical care. The U.K. has this system. We do too, except that it’s only for veterans.

Two things to keep in mind about the VA — [1] Walter Reed is an Army hospital, not a VA hospital, and [2] yes, the Republicans, with their wars + their cuts in funding for the troops and veterans, are damaging what was once a very fine health care system — just one more reason to throw them all out of office.

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