the impact of universal health care

A few people, after reading the few posts I wrote on health care, came to the conclusion that I am against universal health care. Some even expressing hostility towards me for living in Italy, *enjoying the luxury of universal health care*. I was even called a shill for the insurance companies. HAHA

The funny thing is, I actually like the universal health care system here in Italy. Having lived with the current American system, and the socialized system in Italy, I really don't have any personal complaints with either system. I see the good and bad with both.

In the US you pay your monthly insurance payments, which are subsidized by your employer, and hope you never get seriously sick, or injured. You also have, through your insurance coverage, the ability to go to the doctor when you have aches, pains, and colds. You can get checkups and yearly examines. If you do get a catastrophic illness or injury that is not covered in your plan, or if your insurance company denies your claim, or drops you, you can go in debt trying to cover those bills. That is, if you are lucky enough to have a job that covers the major part of your insurance, or you can afford it on your own. Only those who have private insurance, or who qualify for Medicare, Medicaid, and SCHIP are covered. This leaves people out.

In socialized medicine you pay monthly taxes which contribute to the universal health care program, and hope you never get seriously sick or injured. You have free access to the hospitals. If you get a chronic or catastrophic injury or illness, you are covered, in most all cases. (We do hear the stories of people denied care). If you need to go to the doctor for a cold or allergies, or something minor, you pay for the doctors visit. Annual examines tend to not be as frequent and you pay a fee for them (in the states the say you should have mammograms, colonoscopies, etc. every year. In Italy they don't push those tests as much.) Not all people pay, only those who earn salaries, and everyone is covered. No one is left out.

In the US I think there is actually more preventative care, for those who have insurance. In a universal care program there is better coverage for catastrophic and chronic illnesses. (That is from my personal observations.) I don’t think people utilize the system as much here, for preventative care, regular check ups, etc.

Many people have expressed a strong desire to implement an universal single payer health care system in America. I decided to make a (rather random) list all of the situations I could think of that directly affect, or are affected by, a change to the health care system. What would it take to get there, and what would be the impact on the tax payer, the economy and private industry?

Where to start? How to pay for it! To implement universal health care all wage earners must pay taxes to fund the universal HC system. Taxes will go up but how much? (I do not believe for one second that a program of this nature, covering 300+ M people could or should be funded by 1% of the population.)



Let’s say you make $50,000/year (median average household income). Under the current US tax system, you pay (rounded up) 30% in taxes. That is $15,000 out of pocket, annually for taxes. If we implement universal health care, and pay (a guestimate of) 45% in taxes, that is $22,500 ($1857/month) out of pocket for taxes. (That is an additional 15% in taxes to pay for universal health care. Is that enough?) This is an increase in taxes of $7500 annually for a person making $50,000 a year, an additional $625 a month. (Yipes, that's a lot. Can anyone offer any expertise/info in this area? How does that compare to what you pay for insurance annually?)

Now, take the figure $7500 (the additional 15% in taxes to cover health care) x the number of tax returns filed (in 2004) 131,113,969 = $983,354,767,500 /annual taxes generated for health care.

Take $983,354,767,500 divided by the number of Americans 303,824,640 = $3236 per person annually for health care + all costs for doctors, drugs, equipment, administration fees, etc. After all administration costs, doctors salaries, overhead, medical equipment upgrades, medications, etc. how much is left for actual care?

I wanted to find out how much England spent per person for their health care, and surprisingly, the numbers are very similar to mine. They spent £91.7 Billion on health care for 50M people. That is ~$3000 per person.

If I take those who filed tax returns subtracted from the entire population, there are still 172,710,671 people not paying into the system. Minors, unemployed, and elderly. Wow, no wonder Obama wanted to *off granny*. haha

Government would then disburse those funds to doctor and hospitals. The doctors/hospitals bill the government for everything - tests performed, hiring staff, purchasing new equipment, surgeries performed, upkeep on buildings, etc. They also have to subsidize medications, and equipment for disabled individuals. They pay all salaries. (Public employees, not the private)

The government has the pot of money ($983,354,767,500 in taxes) in which to pay all of these services. What will the Government budgets be, and how will they control and monitor costs? What happens if they can't afford the system - raise taxes? Limit care? Eliminate types of treatment? Deny requests for updated medical equipment? We hear horror stories of private insurance companies denying care, but it happens in socialized medicine as well. People have been denied surgeries or drugs because they are too expensive. There can be long waits for non-emergency care. From what I have seen in Italy the buildings suffer - chipped paint, run down structures, no private rooms, no frills. (I wrote about this before.) These are scare tactics, they are realities, as I see them here.

My husband said in Italy doctors like to use their equipment because when they perform tests they in turn can bill the government for the tests. This brings more money into their hospitals. Could this lead to fraud, or excessive tests, costing the system too much money?

If a universal health care system is instituted, is it likely people would enter the system for preventative care, and for minor illnesses that they might otherwise have ignored or skipped? Will this strain the current system? Would the system need to higher more doctors, build more hospitals or clinics?

To convert to a single payer universal health care program you need:

- drug companies to lower costs or have the government subsidize the costs
- get eliminate private insurance
- (most likely) pay doctors less money

But with so many in Washington in the pockets of pharmaceutical companies, insurance and medical industries...is this even possible? Democrats have claimed universal health care as the holy grail of reform but many are concerned with reelection and the donations they get from these industries. I asked this before, and I'll ask again, shouldn't this issue be bigger than reelection or big dollar donations? Obama is taking a hit from his far left supporters for his secret pharmaceutical deal.



It's hard to trust people who are in the pocket of certain health care industries when they say they are acting in our best interests. And also profiting. Not to mention being sold by a media who is dishonest.

Under universal health care, I assume they would get rid of Medicare, Medicaid and SCHIP. They would no longer be necessary. Or COBRA.

In Europe some people abuse the health care system using the emergency room instead of private doctors for minor illnesses. In Italy, doctors visits are not free. You pay about 150 euro for an appointment. You are sent to the hospital for tests, usually for a small fee. But to bypass the doctors fee, many will just go to the emergency room, which causes a backlog of patients, and long waits, and an extra burden on the system. If we still have people who can't afford doctors visits, is it likely they will use the emergency rooms as their primary care? Could we have lower cost clinics set up to help?

Chronic illnesses, obesity, cancer, smokers, diabetes, AIDS, etc. can all be drains on universal health care systems. For health care reform, do we also need lifestyle reform? HCR is only one solution to help with chronic conditions, but it doesn't address the larger problem. We need to stop some of these illnesses before they start.

Obesity - Do we need even more programs, starting in the schools, promoting healthier foods? More funds for physical activities in schools. More regulation on fast/junk food? Programs at large corporations like gym memberships, gyms on site, incentives for people to ride/walk to work. Other?

Diabetes - Type Two goes in hand with obesity. Type One needs more research to find a cure.

Cancer - Do we need more study into why we get certain cancers? Pollution, microwaves, food additives? Should we outlaw smoking? Need even more research to find cures for cancer?

AIDS - more education on how to prevent AIDS. Target high risk groups.

ADHD and Autism - Why are they on the rise? What causes them?

All of these things (and what else??) require money. Where would that come from?

What happens to these industries if the US does set up a single payer health care system?

Insurance -

How many people are employed by insurance companies? How much money is generated in the economy because of insurance companies, stocks, etc.? What will happen if we do away with private insurance companies and all the employees? Doctors still need malpractice insurance. Will it still be super expensive? Will the government subsidize the payments? Can clinics operate if they are forced to carry expensive malpractice insurance?

Attorneys -

Should there be tort reform with an universal health care system? Doctors will still be required to carry malpractice insurance (they do in Italy). Does the government pay for that insurance, subsidize the insurance, or not require public doctors to carry it at all? What will the outcome be to the legal industry if there is tort reform, and stricter guidelines for who can sue? Without malpractice insurance wouldn't the government be the target of lawsuits?

Pharmaceuticals-

Under universal health care you can't expect people to shell out $500 a month in drugs, etc. So, the government also has to have a deal with the drug companies for lower drug prices, or they need to subsidize costs. What will that do to the drug companies wrt innovation, research, jobs, etc?

Medical Equipment -

Under a universal health care system, when hospitals and doctors put in requests for new medical equipment, will the government approve the requests? Will equipment become outdated? What would the policy be for updating new equipment? (I wrote in my other post that many hospitals do not have all of the tools available, like MRI or CAT scan machines. Some hospitals are not equipped to offer epidurals to women having babies. My SIL had to go to a different hospital to give birth because the hospital near her house was not equipped to administer an epidural.)

What would a possible reduction in new equipment purchases do to the industry, and would it affect innovation? Do we need reform for cheaper machines and equipment?

Universities -

Currently doctors pay a lot of money to attend the best medical schools, graduating with huge student loans. Will government paid salaries pay off the student loans? Do we need to fix the cost of college admissions to medical school? Will admission costs drop anyway, because med students will opt for cheaper schools? What would that do to the universities, and quality of doctors, anything?

Other possible issues:

Strain on other government services -

Is it a possibility/concern that some people, under an universal health care system, might quit their jobs, which they had to receive health insurance, preferring instead to benefit from free health care (no job - no taxes) and receive welfare? Would this even happen?

Medical records -

Records would need to be entered into an overall government run system. Is that a concern? Privacy concerns? Government gettin' up in your business?

Current state of economy, our national debt -

Should this matter? Is this the wrong time? Does it matter, if we are paying with taxes to implement this program in this economy?

The Poor -

Again, the need for HCR is part of a much larger problem, isn't it? The large number of poor in the *richest country in the world*. While not every unemployed or poor person can become employed or no longer poor, I do think there are things that can be fixed.

Disabilities
There are those who can't work because of disabilities - mental, physical. - need more programs for creating jobs for people with certain disabilities? For example voice activated software for blind people, etc. However, some people are unable to work and will be on permanent disability.

Education
A lack of education - Schools lack funding, not enough resources to provide quality educations in poorer areas? Also, when there are school funding cuts teachers lose jobs, programs are cut. We need to put more money into the schools.... how?

Skills
Those who lack skills - Institute programs where people go to college (teachers, nurses, doctors, etc.) and tech schools and then work for the government/community for a few years?

Depressed regions
For those people living in depressed areas, places where unemployment is very high - do we need more relocation programs? Programs/new legislation/tax laws to bring industries back to those communities?

Jobs lost overseas
We have lost a lot of jobs overseas - China, India, Mexico....We need to fix tax and pollution policies to bring those companies back?

Illegal immigrants
Undocumented workers - 12 Million undocumented workers *doing the jobs that no one else wants to do*. We supposedly have lost 12 M jobs to illegal workers but they are jobs no one wants anyway? Low paying jobs? Do we need to either make illegals legal tax paying citizens, or return those jobs to the unemployed. (I don't accept the idea that these jobs are *beneath* anyone. Construction, restaurant, hotel, and farm labor are all decent industries and honest work.)

Many immigrants are living and working, and have kids attending schools, but live below the poverty line. Solutions?

Welfare recipients
Chronic unemployed/welfare recipients - Not all welfare recipients are generational poor who just "live off the government", but it does happen. Women with kids. Do we need welfare reform? Government run day cares so women can leave kids and get jobs? Work for welfare programs? (Doesn't Canada require welfare recipients to work for their checks?)

Divorce
Divorced parents, mostly women who were stay at home moms, have kids but no work experience, or money for day care?

Addicts
Some of the homeless and poor are people who have addictions. Do we legalize drugs, and tax them? Need more programs to get people clean and off the streets? Tighter border controls? The war on drugs isn't really working is it?

What else am I missing?

If you are for or against universal health care please explain why. If you have money, you have access to private care. Is it taxes, no faith in the government, just this administration, worried about the horror stories we hear, what else? I just found this article: An American Universal Health Care System

I believe a public option insurance plan would eventually lead to universal health care, so even though a public option is currently (possibly) on the table, not universal health care, I think this discussion is relevant.

What did I leave out? What else would be impacted?

I read on HotAir: "Weiner wants to destroy the private sector insurance market, which accounts for 15% of the American economy, in order to have government control health-care decisions." Insurance makes up 15% of the economy? That is pretty significant. Getting rid of the private insurance will leave a lot of people unemployed, and destroy?? 15% of the economy?

Someone else on NoQuarter asked: "That’s something I haven’t heard addressed in comparisons to UHC countries - do their presidents/prime ministers and other representatives have to use the UHC system?"

To which I replied:

Berlusconi went to the US for surgery.

Berlusconi, whom the AP calls “a media mogul and one of Italy’s richest men,” came to the United States in 2006 for surgery to correct an irregular heart beat with a pacemaker, a problem he likely discovered after his collapse at a political rally, though he maintained that fatique was the source of his fall. The operation took place at Cleveland Heart Center in Ohio. “Everything went according to expectations and without any particular problem,” Dr. Andrea Natale told the Italian news at the time.