I think this is one of the best conceived plans I have heard of. Just in the telling it is apparent that not all of the issues have been thought through. I firmly believe in universal health care and think it is by far the best way to go. I really believe that it would be not that hard to design, as some combination of employer and individual payer, with provisions for the unemployed, and indigent with both state and federal contributions. That is providing you can keep the rent seekers, and "special interest" out of the process. My biggest concern with a universal health care program is what I call the python problem. Such a program would be under intense scrutiny with constant attempts to "cost justify" and "compare" to existing programs. Under our current program there is by definition, a significant amount of unmet health care needs. During the initial phases of any new universal health care program, people who have been delaying care or been denied care will rush to obtain services. This will have two effects one will be a shortage of qualified personnel, the other will be a temporary increase in costs. With patience and planning this would eventually work its way through the system. Also since we already have unmet needs we will may need to increase both personnel and facilities, at a slightly increased cost per person, although it may be that the increased efficiency of such a system would actually bring costs down below current levels. The big trick will be to keep special interests from driving the politicians to enact special privileges to create new rents.
It's so wild how much we spend on healthcare in America. I'm hoping the natural evolution will lead to universal healthcare. One of the challenges is that there is such a large middle man (for lack of a better term) industry in healthcare. But eventually, we need to flip the switch, right? It's not like those jobs are going to disappear.
Also... this article makes me want to move to Utah (haha).
The US made me do things so piecemeal, but the nice thing is that we can see that universal healthcare works! Getting there is always the challenge..... (and yes, come to Utahpia!)
So many factors...I think any state or organization that tries to fix this will create a mess, and my hope is the mess created is a step in the right direction. It’s atrocious.
I do think a lot of dollars/legislation is needed to change our farming, endemic loneliness, quality food access, and other environmental and societal factors that all tie into the dismal state of our health. Even if we fix insurance, if we don’t support or society from a health standpoint, the need for expensive disease care will continue to spiral out of control. I work as a consultant helping companies place their insurance in place and manage their programs. The acceleration of chronic disease is adding fuel to the fire. Our society has created a place where it is extremely difficult to prevent disease. We need to invest to change that!
I very much agree. I wonder if changing the incentive would fix things in that direction though? For example, if the state was paying directly for our care, wouldn't it be in the state's interest to do things that would lower their medical cost? For example, minimize the use of cars, make it so that almost every aspect of life requires some walkability, make stairs the main features of buildings rather than elevator banks, outlaw certain foods that are known to be problematic.... That's why Amsterdam and Copenhagen were redesigned to remove cars and it's estimated they increased the life expectancy of people living in both cities by about three years!
Wow, I did not know that stat. I do think the payer definitely has ncentive to invest in structural changes. I see it with companies I work with that pay for various programs to better there employees lives. But the few that are successful are multi-multi-faceted and there is never a clear tie between one program and costs lowering. It ends up being some sort of cultural shift that seems to have a life of its own. And without a clear line between an investment and an outcome it’s hard to get c-suites to invest...
Oct 17, 2023·edited Oct 17, 2023Liked by Elle Griffin
It makes perfect sense. Which is why politicians (and their minions) will oppose it. Plus the Insurance companies, who keep politicians in their pockets, will use their political influence to keep their companies from going out of business. I truly hope it happens. It could be a tipping point for other states. Common sense needs to finally beat special interests and dogmatic politics.
This is so exciting! The proposal makes so much sense - especially eliminating private health insurance. Healthcare and profit for shareholders are antithetical. Do you know whether this addresses the trend of venture capitalists buying up health systems and gutting them? Also, the U.S. has had a viable, successful government-run health care system for decades - for military families. Proof that it works.
I am watching this with interest. The UK's NHS is one of our largest employers - our taxes go directly to state funded hospitals, but it's slowly breaking apart due to the overhang from Covid and an increasingly elderly population with patchy social care. It's not enough to have accessible healthcare, if a quarter of hospital beds are occupied with dementia patients wauting for a nursing home or you can't get a rehab appointment after a stroke. I wonder how Utah will manage this?
Hmmmmm, that's worth learning from for sure. Nursing homes are a very profitable business though, so I wonder why there aren't enough? Are they privately owned over there?
Yes, most of them are private you still find occasional local authority run homes, if you are lucky. The problem is: a) it costs a lot of money to do care well. You need people on the rota around the clock as well as people to do housekeeping, cooking, medicine etc. Which leads me to point b) how we pay for it. In the UK you get no help with social care until your savings dwindle to £23,000. A care home place costs roughly a £1,000 a week so it's possible to end up selling your house and burning through your savings to pay for care, especially with a long term condition like dementia. On top of that, local authorities do not pay the full cost for care beds of those without savings, so care homes with overcharge self-funders to stay afloat or else refuse to take any LA applicants. The net result is more elderly people in hospital who can't be discharged home (dangerous) and have no care home to go to.
Oh, and the pay & career prospects for carers is diabolical so fewer people want to do it, making care homes harder to run.
Politicians keep promising to sort it out, but it's a toxic issue.
Ahhhhh! Yeah that's tricky. I have no solution for the ideal way to care for the elderly—though I do believe we could somehow arrive at a future where people are just healthier, like in the blue zones, so that they don't need as much care in their elder years?
The fact that we are still striving to make healthcare affordable is evidence of the failure of all past attempts to accomplish that task. I've been in healthcare since the early 1980s. Our healthcare delivery system was problematic then, and it remains so now. One of the main reasons for its perpetual challenges is that we operate (no pun intended) in an ever-changing environment—things are constantly in flux. Here is a list of some, though not all, of the factors: technological advancements, government regulation, institutional expansion, public expectations, educational costs, professional compensation, insurance considerations, legal pressures... and each of these is subject to both internal and external price inflation.
Frankly, there are many plates spinning, with money flowing in multiple directions. Unfortunately, patients' needs are often touted as the rationale for change and reform, but in reality, they only receive what is left after others have extracted their profit.
I wish Utah and anyone trying to improve the situation the best of luck. One piece of advice, however, is to deprioritize those regulators, industries, and opportunists who are hindering those committed to helping others.
You're so right, and it's very tricky. No matter what country you are in, the healthcare system is an experiment and we are constantly tweaking them as we learn more. It would do us a lot of good to study what works and what doesn't and to try to learn from those other experiments. (Because ours didn't work out too well!)
Thanks for this post. We definitely need to remember the famous label of the states as "Laboratories of Democracy."
I think we should have universal healthcare. We can certainly afford it as a country and it is a huge cause and effect of inequality. I also think that in the competition for residents and businesses, a universal state plan could be a huge advantage.
In addition to looking at why Vermont did not succeed, it is also useful to look as well at what happened in Washington State in 2019 and to understand the POV of which institutions would oppose a plan.
I love states as "laboratories of democracy!" And thank you for sharing this link, no matter which state we are in, universal healthcare is an uphill battle in the United States!
From your keyboard to God's inbox
I think this is one of the best conceived plans I have heard of. Just in the telling it is apparent that not all of the issues have been thought through. I firmly believe in universal health care and think it is by far the best way to go. I really believe that it would be not that hard to design, as some combination of employer and individual payer, with provisions for the unemployed, and indigent with both state and federal contributions. That is providing you can keep the rent seekers, and "special interest" out of the process. My biggest concern with a universal health care program is what I call the python problem. Such a program would be under intense scrutiny with constant attempts to "cost justify" and "compare" to existing programs. Under our current program there is by definition, a significant amount of unmet health care needs. During the initial phases of any new universal health care program, people who have been delaying care or been denied care will rush to obtain services. This will have two effects one will be a shortage of qualified personnel, the other will be a temporary increase in costs. With patience and planning this would eventually work its way through the system. Also since we already have unmet needs we will may need to increase both personnel and facilities, at a slightly increased cost per person, although it may be that the increased efficiency of such a system would actually bring costs down below current levels. The big trick will be to keep special interests from driving the politicians to enact special privileges to create new rents.
That's a very good point... the rush to healthcare. Interestingly, this is what makes Utah an ideal starting point for universal healthcare at the state level. We have the youngest state in the US (we have a median age of 31.9 years), and thus spend the lowest amount per capita of any other state ($7,522 per person). https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet
It's so wild how much we spend on healthcare in America. I'm hoping the natural evolution will lead to universal healthcare. One of the challenges is that there is such a large middle man (for lack of a better term) industry in healthcare. But eventually, we need to flip the switch, right? It's not like those jobs are going to disappear.
Also... this article makes me want to move to Utah (haha).
The US made me do things so piecemeal, but the nice thing is that we can see that universal healthcare works! Getting there is always the challenge..... (and yes, come to Utahpia!)
So many factors...I think any state or organization that tries to fix this will create a mess, and my hope is the mess created is a step in the right direction. It’s atrocious.
I do think a lot of dollars/legislation is needed to change our farming, endemic loneliness, quality food access, and other environmental and societal factors that all tie into the dismal state of our health. Even if we fix insurance, if we don’t support or society from a health standpoint, the need for expensive disease care will continue to spiral out of control. I work as a consultant helping companies place their insurance in place and manage their programs. The acceleration of chronic disease is adding fuel to the fire. Our society has created a place where it is extremely difficult to prevent disease. We need to invest to change that!
I very much agree. I wonder if changing the incentive would fix things in that direction though? For example, if the state was paying directly for our care, wouldn't it be in the state's interest to do things that would lower their medical cost? For example, minimize the use of cars, make it so that almost every aspect of life requires some walkability, make stairs the main features of buildings rather than elevator banks, outlaw certain foods that are known to be problematic.... That's why Amsterdam and Copenhagen were redesigned to remove cars and it's estimated they increased the life expectancy of people living in both cities by about three years!
Wow, I did not know that stat. I do think the payer definitely has ncentive to invest in structural changes. I see it with companies I work with that pay for various programs to better there employees lives. But the few that are successful are multi-multi-faceted and there is never a clear tie between one program and costs lowering. It ends up being some sort of cultural shift that seems to have a life of its own. And without a clear line between an investment and an outcome it’s hard to get c-suites to invest...
It makes perfect sense. Which is why politicians (and their minions) will oppose it. Plus the Insurance companies, who keep politicians in their pockets, will use their political influence to keep their companies from going out of business. I truly hope it happens. It could be a tipping point for other states. Common sense needs to finally beat special interests and dogmatic politics.
This is so exciting! The proposal makes so much sense - especially eliminating private health insurance. Healthcare and profit for shareholders are antithetical. Do you know whether this addresses the trend of venture capitalists buying up health systems and gutting them? Also, the U.S. has had a viable, successful government-run health care system for decades - for military families. Proof that it works.
You have a good point about military families! And what trend are you referring to? Do you have a specific example of medical practices being gutted?
Gift link to the whole article. The other link is to the podcast of it. https://www.nytimes.com/2023/06/15/magazine/doctors-moral-crises.html?unlocked_article_code=R-wpn2WemTn38Pz1gKfOpLrEXqPsafrS6eNQdd7UDeMNK6UpC8dkJ27t6Z3PD-8X4QKNAIsMPXW1-lYjCDEx-HMPEZuQnBNTp6yHJ5QpGMY85OqnvuFnq62fXSsA3h4ldUCqhqR97no5-NoRpHPbL13Tdft2A7ZNAlwmGoE5iR6Q5I_GXK6Ltuf_qL-zYaqFT2j3SnbPzn9xluoYeGFEGHCgEPB4Al9y68livLysoyZNhh3tdeicVMYgOGy7wJN8c3MsMADo8oGuyZUb-qonzdk9paD9805Mwbk36KlVwjIDMYrn2ZVgPm7b_5inVRxO_61FvQKBQvGam_iUsKmP&smid=url-share
Found it! https://www.nytimes.com/2023/07/16/podcasts/the-daily/the-sunday-read-the-moral-crisis-of-americas-doctors.html
Oh thank you!!!!!!
Here’s one article. I’m thinking specifically of an episode of The Daily, NYT’s podcast. Will keep looking. https://www.nytimes.com/2023/02/05/opinion/doctors-universal-health-care.html
I am watching this with interest. The UK's NHS is one of our largest employers - our taxes go directly to state funded hospitals, but it's slowly breaking apart due to the overhang from Covid and an increasingly elderly population with patchy social care. It's not enough to have accessible healthcare, if a quarter of hospital beds are occupied with dementia patients wauting for a nursing home or you can't get a rehab appointment after a stroke. I wonder how Utah will manage this?
Hmmmmm, that's worth learning from for sure. Nursing homes are a very profitable business though, so I wonder why there aren't enough? Are they privately owned over there?
Yes, most of them are private you still find occasional local authority run homes, if you are lucky. The problem is: a) it costs a lot of money to do care well. You need people on the rota around the clock as well as people to do housekeeping, cooking, medicine etc. Which leads me to point b) how we pay for it. In the UK you get no help with social care until your savings dwindle to £23,000. A care home place costs roughly a £1,000 a week so it's possible to end up selling your house and burning through your savings to pay for care, especially with a long term condition like dementia. On top of that, local authorities do not pay the full cost for care beds of those without savings, so care homes with overcharge self-funders to stay afloat or else refuse to take any LA applicants. The net result is more elderly people in hospital who can't be discharged home (dangerous) and have no care home to go to.
Oh, and the pay & career prospects for carers is diabolical so fewer people want to do it, making care homes harder to run.
Politicians keep promising to sort it out, but it's a toxic issue.
Ahhhhh! Yeah that's tricky. I have no solution for the ideal way to care for the elderly—though I do believe we could somehow arrive at a future where people are just healthier, like in the blue zones, so that they don't need as much care in their elder years?
The fact that we are still striving to make healthcare affordable is evidence of the failure of all past attempts to accomplish that task. I've been in healthcare since the early 1980s. Our healthcare delivery system was problematic then, and it remains so now. One of the main reasons for its perpetual challenges is that we operate (no pun intended) in an ever-changing environment—things are constantly in flux. Here is a list of some, though not all, of the factors: technological advancements, government regulation, institutional expansion, public expectations, educational costs, professional compensation, insurance considerations, legal pressures... and each of these is subject to both internal and external price inflation.
Frankly, there are many plates spinning, with money flowing in multiple directions. Unfortunately, patients' needs are often touted as the rationale for change and reform, but in reality, they only receive what is left after others have extracted their profit.
I wish Utah and anyone trying to improve the situation the best of luck. One piece of advice, however, is to deprioritize those regulators, industries, and opportunists who are hindering those committed to helping others.
You're so right, and it's very tricky. No matter what country you are in, the healthcare system is an experiment and we are constantly tweaking them as we learn more. It would do us a lot of good to study what works and what doesn't and to try to learn from those other experiments. (Because ours didn't work out too well!)
Thanks for this post. We definitely need to remember the famous label of the states as "Laboratories of Democracy."
I think we should have universal healthcare. We can certainly afford it as a country and it is a huge cause and effect of inequality. I also think that in the competition for residents and businesses, a universal state plan could be a huge advantage.
In addition to looking at why Vermont did not succeed, it is also useful to look as well at what happened in Washington State in 2019 and to understand the POV of which institutions would oppose a plan.
https://www.nytimes.com/2019/06/27/upshot/washington-state-weakened-public-option-.html
I love states as "laboratories of democracy!" And thank you for sharing this link, no matter which state we are in, universal healthcare is an uphill battle in the United States!