Latest / The Health Care for All Podcast / EP2: The U.S. vs. Universal Health Care
Transcript
- Rebecca Schoon: If we were spending double what other countries do per person and we were all living. 10 years longer, then great. Maybe that's a good way to spend money. The problem is that compared to other wealthy nations, Americans on average live shorter, sicker lives. Collin Stackhouse: Welcome to the Health Care for All Podcast brought to you by Health Care for All Oregon. ⁓ Oregon is on track to be the first state to make the move to a universal healthcare system and we're really glad that you could join us for the conversation. I am Collin Stackhouse. Rebecca Schoon: and I'm Dr. Rebecca Schoon. On today's episode, we are going to talk about why is universal healthcare the solution to the many, many, many problems in our current health system. Collin Stackhouse: A lot of people are already very aware that our healthcare system is not working. It is broken. It is a headline constantly in the news. We hear personal stories everywhere, both from our friends and neighbors and also on social media, Most importantly, people are living with the problems that come from getting care in a system that's not based on ensuring care, but on, a paycheck in a CEO's pocket. People are seeing their personal paychecks drained towards healthcare costs and they're not getting the care that they need and they deserve. And people are also having good experiences, right? So they may be wondering, since it's working for them, why should we be advocating for such a monumental shift in our healthcare system? Rebecca Schoon: So what we're going to do today is take a macro view of our health system. We'll be looking at how these individual experiences really point to larger problematic patterns that we see in the health system overall. And for those of you who've had relatively good experiences with your health insurance, we're going to talk about how the system harms so many of the people around you but also how it's an enormous drain on and really waste of our country's resources. We'll be doing full episodes on a lot of these topics in the future, and we'll be posting related graphs and links to the data that we're discussing today on our website. So if you want a deeper dive, go to hcao.org. Collin Stackhouse: of this episode that I'm really excited for is what I'm calling a gripe session because everything is just so terrible with our healthcare system that we gotta let loose and I don't know, scream, freak out about it. so I want to read some synonyms for the word gripe, which is to complain, to grumble, to moan, to whine, to kvetch, to bellyache, to have some beef, to grouch, to carp, to fuss, and to squawk. And I feel like doing that daily when I think about our broken healthcare system. And to be honest, this being such a ridiculous topic to have a podcast about because this has been put to bed in so many other countries the idea of this being something that is still so up for debate feels just ludicrous. And I think that from what I can see and what I've read, I think most countries don't understand how terrible our system is, but once they get a little bit of it, they are shocked and they can't understand how we could possibly let it get this way. Rebecca Schoon: I love that you mentioned the debate for universal healthcare. One of my favorite assignments that I did in my class on universal healthcare was I asked students to go trawl the internet, find the worst they could find, find the biggest critiques, And In countries with universal healthcare, even the extreme opposition parties, most of the debate is around, let's say, coverage for immigrants But in no country is the opposition party arguing to get rid of universal healthcare. Collin Stackhouse: Right, universal healthcare is still... the baseline, it's the middle of the road, it's normal. And I think that's one of the key points that I have locked onto like a dog on a bone. And frankly, why I got started with Health Care for All Oregon is that universal health care is normal. And what we currently do in the US is so abnormal, so obviously broken, we need universal health care. Two other things that I sort of say as a mantra, because they are truths that I've found from doing. some research and just talking with experts like you, Rebecca, and other people in the field is that universal health care saves lives and universal health care saves money. And so if you are interested in improving people's lives in the United States and interested in saving some money, universal health care is something that you should be advocating for. So we're gonna go through some of the key points that Rebecca goes over in her policy class and sort of asking from a lay person's view, which is my view, asking Rebecca as an expert in this field to explain some of these key features about universal healthcare and together we're going to make the case for universal healthcare. The United States spends far more on healthcare than any other wealthy country, yet we achieve far less access and we have worse health outcomes. Rebecca, what's the deal? Rebecca Schoon: this is the thing that's the alarm bell. so currently the United States is an outlier. We are the weird, bizarre anomaly when you look at healthcare spending. it's almost 18 % of our GDP and all experts expect that to climb to over 20%. of our country's GDP in the next couple of years. So what does that mean? It means almost one out of every $5 that our country spends is directed to our health system. Now, our peer nations, other wealthy nations, they're spending about 10 to 12 % of GDP on healthcare. And with that 10 to 12%, they're covering everyone in their country. And one little note, ⁓ since we're talking about percentage of GDP, that means this difference is not just about population size. We often see that on social media, right, Collin, that people are saying, well, their spending's lower because they have fewer people. No, percentage of GDP has already taken that into account. ⁓ So we have the US spending almost twice as much per dollar of economic output while leaving millions of uninsured. Collin Stackhouse: spending the most, but we're clearly getting the best healthcare on the planet, right? So what's the problem? Rebecca Schoon: the problem is that while spending more than any other country, our health outcomes are really the worst among our peer nations. And it's that combination that's the problem. If we were spending double what other countries do per person and we were all living. 10 years longer, then great. Maybe that's a good way to spend money. The problem is that compared to other wealthy nations, Americans on average live shorter, sicker lives. So if you look at comparative data on infant mortality, maternal mortality, chronic disease rates, we rank near the worst among all other high income nations. We are not getting value for all this money that we're pouring into the system. Collin Stackhouse: Another thing that we're hearing both around the country and in Oregon is that people are going without care because they can't afford it. What's the deal? Rebecca Schoon: we have a lot of studies on this and what we see is that almost one in three Americans regularly skip recommended treatments, tests, or they don't buy their medications because of the cost. So they're delaying care because it's too expensive. What this means is that someone is suffering. They are living with symptoms and pain and negative health effects for longer than they should have to. But also, What this means is that when they do eventually get care, it's because they've been forced to because that situation has become a crisis or an emergency. this is more dangerous for people who are choosing to do this, but also it's more expensive for them individually and to our health system. It's much cheaper to treat healthcare issues earlier on. Once it's become a serious health issue, it's more expensive for the person individually, but the health system is now bearing the cost of a more expensive procedure or type of treatment. work is guided by the idea that no one should have to choose between paying for groceries and a doctor's visit. Collin Stackhouse: I worked for a while in an emergency department here in the Portland area. And there were patients that ran the gamut of the things that we're going to be talking about on this podcast. There were people who didn't have any sort of primary care available to them. And so they sort of treated the emergency room as like an urgent care or the really the only way they could see a doctor, which is way too expensive for the hospital to serve people like that. It was also full of people having real emergencies that did have to wait, depending on their triage level, which is just how emergency rooms work. at any emergency room anywhere in the world. If you're not going to die, you will get moved down the list, but if you are having a life-threatening injury, you're going to be moved up the list. There were quite a few people, like you said, who had delayed treatment for so long that they were arriving in an emergent situation that would have been totally remedied by having a functioning primary care relationship or any other way to get treatment besides the emergency room being their only option when it's kind of too late and it is actually an emergency, but it didn't need to be. Something that our members and our volunteers have talked to us about and we've experienced ourselves is that insurance companies are interfering with our doctor's recommendations. So there's somebody in the middle between what your doctor says you need and you getting the care that you need and those would be these insurance companies. Let's talk about it. Rebecca Schoon: That is so prominent in our current system that people think it's normal. People think that pre authorizations are something that just comes along with insurance. ⁓ No, that is a uniquely American invention from private insurance companies. ⁓ So pre authorizations, denying your claims, establishing narrow networks. So there's only a small group of physicians that you can choose from to go see. ⁓ These are all things that private insurance companies have created to maximize their profits. And what that means is that your insurance coverage decisions are often made by insurance staff, not by the doctors who know your case, not by the doctors whose primary concern is to get you better. In fact, we see about one in five patients have had a necessary claim denied. the interesting thing here is that there's this big fear that a lot of people have around universal health care that it means the government is going to get in between you and your doctor's decisions when in reality that fear, that nightmare scenario is currently happening. It's already happening in the form of private health insurance interference. Collin Stackhouse: I spend a lot of time on our social media channel and there's a lot of people that are defending their... private insurance and it sort of feels like witnessing somebody with Stockholm Syndrome not really understanding that their private insurance is in fact a huge factor in the problems that they're receiving. So when you mentioned that one in five patients has a necessary claim denied, I saw this other content creator is informing us that. eighty % of those appeals are approved, of indicating that the care was necessary all along, but the insurance denial was an unnecessary step to sort of prevent that treatment. Rebecca Schoon: so many people don't know that they can make the appeal. So that statistic that you just talked about is the people who have the time, the resources, the knowledge to actually lodge the appeal. the reason why private insurance does this is because they know a lot of people won't have the resources or bother. So they get to save money on that and the burden is placed on the individual through not getting the care they need. One other way that we can look for evidence is looking at Medicare. we often think of Medicare as government-run insurance to provide health insurance to people 65 and older. That is true. That's what we call traditional Medicare. But in recent decades, there's also been the rise of Medicare Advantage. ⁓ Yes, Collin Stackhouse: Eww. Rebecca Schoon: Medicare Advantage, as ⁓ you know, ⁓ is actually private insurance So that was allowed about 30 years ago, where private insurance was ⁓ given permission to start offering Medicare plans. So they have to offer the same ⁓ benefits and coverage. but One thing that's distinctive with Medicare Advantage is they use all of their normal private insurance tricks to save money. So, pre-authorizations, denials, whereas traditional Medicare, there's essentially no pre-authorizations required. Under traditional Medicare, There's a small like less than 1 % of services that require pre-authorization. But 99%, almost all Medicare Advantage plans require pre-authorization for many services. So it's not a natural normal part of insurance. It's an invention by private health insurance to delay and deny your care. Collin Stackhouse: Healthcare for All Oregon's perspective is that medical decisions should be made by doctors, not by people trying to protect a company's bottom line. Rebecca Schoon: Yes, and that's what universal healthcare systems provide. Collin Stackhouse: So that's the perspective on how insurance companies are sort of inserting themselves in between the care that you are recommended from your doctor and the care that you're actually receiving. On the floor of the hospital, in the emergency rooms, the people that are providing the care are also struggling in this system. Physicians and nurses are burning out more rapidly and in greater numbers than ever before. Rebecca Schoon: Right, so Healthcare for All Oregon was actually just part of a nationwide study we partnered with Physicians For A National Health Program on this very topic, ⁓ measuring burnout and what's called moral injury. We'll definitely talk about this more later on in another episode, but suffice to healthcare workers are under a tremendous strain trying to navigate the barriers that are systematic Oregon in particular is facing pretty big shortages of primary care providers and it's only getting worse. So studies have shown that physicians in private clinics, they're spending on average about 25 % of their time on patient care. ⁓ 50 % of their time ⁓ is having to go through all the paperwork and administration to administer that care navigate insurance disputes, file appeals to those denials. This is not why our healthcare workers went into the field, they want to provide care. They want to be there for their patients. So this is one of the major advantages of a universal healthcare system. It dramatically reduces this administrative burden, which in turn will free up physician time to provide more care and help reduce that burnout that they're experiencing. this too. Yeah. Collin Stackhouse: Right, so universal health care would lessen the administrative burden, which is good because currently one third of every dollar spent in the health care space goes to administration, billing, insurance, and not to making people healthier. Rebecca Schoon: In fact, when we talk about that data before that healthcare spending is twice the average of universal healthcare systems, The number one cause of financial waste in our system is what researchers call administrative bloat. So we all hate bureaucracy, right? I never hear people defending inefficient bureaucratic systems. Ours is the worst. So we see doctors, hospitals, clinics spending an enormous amount of time, staff hours, navigating thousands of different insurance plans, billing codes, prior authorization rules, fighting those denials. all of that overhead, is money that could be spent paying for doctors, nurses, and expanding treatment in our system. Collin Stackhouse: So every insurer has their own prices and they engage with these sort of endless price negotiations with the providers. There's billing processes, there's prior authorization rules, and there's reporting requirements. And the end result is this staggering, very obvious inefficiency where roughly one in $4 that's spent on health insurance goes to something other than the patient care, like marketing, billing, profits, or other middlemen. Rebecca Schoon: There was a study by the RAND Corporation out of UCLA that identified that that $1 you mentioned is absolute waste in our system. This administrative bloat. contributes nothing to better health care outcomes, contributes nothing to the provision and delivery of health care. It's an administrative layer that's unnecessary and universal health care gets rid of that administrative layer, saving money, allowing us to put that money towards expanding care. Collin Stackhouse: Another thing that we hear, currently your healthcare coverage is tied to your job and that can disappear overnight. One of the frustrations that I've experienced personally in this healthcare system is having... coverage tied to your job and also tied to your income level. I have been both, fortunate and unfortunate enough to qualify for Oregon's version of Medicaid. when I've been on Medicaid, I've been working very, very, very hard, but my income has stayed low enough that I still qualify for the Oregon Health Plan. ⁓ And it's this ⁓ strange cycle that a lot of friends and acquaintances in similar positions talk about where ⁓ we need to be making more income. And also it's challenging to get higher income in 2026 in America. but we're sort of grateful that at least the bare minimum of our health care is covered, even though we're financially in this, situation. so currently your health care insurance and your coverage is tied to your job. And the reality is that you can lose your job overnight. That sort of coverage and that safety net can disappear in an instant. Rebecca Schoon: millions of Americans lose their health insurance when they lose a job, change jobs, or even have to just cut back their hours to less than full time. So what we're seeing here is that people are forced to stay in jobs they would otherwise leave, In universal health care, they have eliminated this connection between employment and your health insurance. So workers have the freedom to find the jobs that are most fulfilling and allows them to contribute to their communities in the ways that they're best suited to do. Collin Stackhouse: Yet another reason why universal healthcare is part of the solution is that medical bills are the leading cause of bankruptcy in the United States. In other countries, I think there's some statistic like countries that have medical bankruptcy. Australia has a little bit, I guess. I don't quite understand how that works. And then it's the United States for the bulk of every medical bankruptcy that exists in the world. Rebecca Schoon: In fact, of all the bankruptcies that happened in the US, actually just saw data that put it at 66.5 % of them are due to medical debt. Collin Stackhouse: that's fine. It's fine. Rebecca Schoon: And that comes out to about half a million people a year. Over 500,000 Americans every year are going bankrupt due to medical debt. One serious illness or accident ends up devastating a family financially, So as you pointed out Collin, this crisis really doesn't exist in large scale in countries with universal health care. It's a rarity. Collin Stackhouse: Right, this information is easy to find, but I think people don't know where to look, and honestly, I think a lot of people just are not living and breathing this like both of us are, right? So we don't compare the United States to this global reality very often, but that's why we're here, Another factor in the incredibly high cost of care in the United States is that prescription drug prices are set by what the market will bear, not by the financial reality of the patients and not by what is fair for both the patients and the providers. Rebecca Schoon: Americans in fact pay about two to four times more for the same medications than people a lot of our other peer nations. Collin Stackhouse: When we say a peer country, we mean a country that is poorer than the United States, because we've got the most money. But all of these other countries are also wealthy and thriving, and every single one of them has a universal health care system of some kind. Rebecca Schoon: So in universal healthcare systems, prescription drug prices are much lower. in the United Kingdom, 90 % of prescription drugs are dispensed free of charge. There is no cost to your prescription drug. And of the remaining 10%, they're all set at a flat fee of just under 10 pounds. That is about $13. And I'm talking all prescription drugs. So we do talk about how facts and data sometimes can't change peoples minds. ⁓ Sometimes facts, I think, can make such a big impression helping people to understand that our system is not the way it needs to be. There are other countries that have found solutions and we can apply those here in the US as well. And so a universal system is able to negotiate drug prices on behalf of everyone. You can think of it like why you go to Costco. Why do you go to Costco, Colin? You have it! Okay. Collin Stackhouse: I've never been to Costco. So can't say. Why do people go to Costco, Rebecca? Rebecca Schoon: People go to Costco because when you buy in bulk, you save money. So if you buy 50 rolls of toilet paper at once, you're going to get a cheaper per unit price on that toilet paper. so the same mechanism happens in universal health care systems. they're able to negotiate a lower price because they're buying in bulk. If a system is buying all the heart medication for the entire population, they're able to negotiate a much lower price for that medication. So these countries are able to do that across the board for all of their prescription drugs. And even beyond that, for all the bandages, all the machinery. So it offers a huge cost savings that the United States is just leaving on the table with our fractured system. Collin Stackhouse: So the reality is we're in the system that has been designed to increase the cost for the American patient, for all of us in this health care system. And that cost is also shuffled towards businesses. So businesses are often squeezed by the rising premiums, the costs that they incur to provide the health care coverage to their employees. Rebecca Schoon: Businesses bear a huge burden in the responsibility of offering healthcare to their seen rapidly rising premiums that are eating into budgets that could otherwise go towards wages, hiring, or other kind of growth strategies. so much of staff time is dedicated to researching, negotiating with health insurance companies to get the best plan for employees. Universal healthcare would remove that from business responsibilities. It also frees up entrepreneurs to take risks, start new businesses. This has been cited as a real barrier to people who want to start a business, but they can't afford their own health insurance It frees up businesses to contribute more fully to Oregon's overall economy. Small businesses are also impacted in that if you are an employer that has fewer than 50 employees, you don't have to offer health insurance. That means you're at greater risk for turnover, good employees leaving because they have to move on to a job where they can get So there's a real business case for universal health care. Collin Stackhouse: So to wrap it all up, health inequities are built into this current system, Our American healthcare system is broken. Rebecca Schoon: This is one of the most harmful aspects of our system. see healthcare access distributed inequitably across different areas of our society. see significantly higher rates of uninsurance among Black, Latino, Native American Oregonians. we have people in rural areas who face really long distances to get care. They see provider shortages urban residents don't face. when your access to healthcare depends on your income, your employer, your zip code, it just shows the system is not working for everyone. And we have a better solution waiting in the wings. Collin Stackhouse: for listening to the very end of the episode on this case for universal healthcare. We think that it is such an obvious solution that we are 50 years behind schedule. fortunately, Oregon is in a place to be a trailblazer in this effort to bring universal health care to every resident of our state. Rebecca Schoon: See you next time.