Why can’t America have a grown-up healthcare conversation?

Here’s another John Green vlog post I like, one March 28 but still very timely, on the subject of health insurance in the U.S. and the dismal level of conversation about it.

Link: https://youtu.be/09RvU9_m30Q

Passion tends to far exceed information or common sense on this subject. As I’ve mentioned before, I still hear people on the left say that we need single payer because that’s what all other developed countries have, when in fact not all do. Britain, Australia, Italy, Canada, and Taiwan all have some form of single-payer, for example, but the Netherlands, Germany, Japan, Switzerland, and Israel do not.

What other countries do tend to have is universal or near-universal coverage and lower costs, achieved partly through smarter regulation and partly through the fact that they don’t have the horrendously complicated and inefficient Rube Goldberg system we have with so many different systems in one country. U.S. Medicare, for example, is a complex mix of insurance systems with public and private components. There’s basis Medicare Part A that provides coverage for hospital bills, optional Part B that covers doctor bills and the like, Part D that’s subsidized drug coverage through multiple private insurance companies, Part C (Medicare Advantage) that’s subsidized private insurance as an alternative to Part A and B and often also Part D, and there’s private Medigap insurance, heavily regulated but not subsidized, for paying some of all of what the government part of Medicare doesn’t pay, and can’t be used with Medicare Part C.

Meanwhile, the main thing people on the right seem to know about the Affordable Care Act (Obamacare) is that it’s bad and awful because it has something to do with the government. The number of misconceptions about it is amazing. I just had a discussion with an intelligent person who nonetheless mistakenly thought the out-of-pocket spending limit found on Obamacare policies was a spending limit on what insurance companies paid. In fact it’s a limit on what their customers pay. Obamacare certainly has its flaws (see this earlier post for one doctor’s ideas on how to improve it), but it’s amazing how much worse the Republican alternative passed by the House of Representatives is. Trump had promised insurance with lower premiums and deductibles and better coverage, and he ended up endorsing a House bill that’s would be close to the opposite of that for most people.

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