this post was submitted on 02 Mar 2025
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Context: If you want to give people choice and power in healthcare, you need to decentralize it, not centralize it. Because greedy people like centralization since it gives them money and power.
Kind of a shit take that supports the concentration of power and capital.
Universal Healthcare is gained when a population as a whole demands that the wealth of others be distributed in a way that benefits the whole instead of the few.
Decentralizing it, without a central authority, means wealth is not distributed and countless are left to suffer. In fact, how is that any different from the way things are right now?
Before the greedy consolidated healthcare into mega-organizations and privatized hospitals, most hospitals were run by charities, religious organizations, and local governments (usually counties). People paid cash for routine healthcare, which kept prices low, and had major medical insurance for major expenses. People had control over their healthcare.
The system was not perfect, but it was a lot better than what we have today. And we can do a lot of things to make such a system better, such as requiring hospitals to provide indigent care to those who cannot afford to pay (i.e. free or reduced cost healthcare) in exchange for not paying taxes. If they chose not to provide indigent care, then they are taxed, and that tax money is used to fund government-run hospitals and clinics.
You don't have to centralize healthcare to provide universal healthcare. There are a number of ways to do it.
Well let me know when you accomplish that. Technically, there is absolutely nothing stopping you from doing it right now.
Yes, we already have that in many major counties in Texas, and it seems to be working very well. We provide universal healthcare, unlike the rest of the country, and yet taxes are still low, and people have a choice of providers.
I would still make some recommendations that would make it better. Now we just need to refine and duplicate the model nationwide.
Texas does not have universal healthcare. It does however have the second highest maternal mortality rate in the developed world. Not just the US.
I never said Texas has universal health care. I said that certain counties in the state have universal health care.
That's still incorrect. UHC isn't just subsidized, it's free at point of sale. There are no counties in the US that offer this. There are no organizations in the US that offer this.
With Harris Health, if you qualify for free healthcare, you get a "gold card" that gives you free healthcare. You have to qualify based on your household income and household size. Others are provided services based on a sliding scale based on their income.
And there is no such thing is free healthcare. You either pay for it in advance via taxes or insurance premiums, or you pay at the time of service. It is not free, and will never be free.
Systems can be made to be more efficient and more affordable, but they will never be free since it takes resources and labor to run a healthcare system.
...no shit, I specifically said free at point of sale to not confuse you and trigger this skippable npc dialogue.
What you described is Medicaid. Something that is available everywhere in the US, and is not in anyway related to UHC.
Free at point of sale is just that. All developed countries have this, many developing countries have it.
You get treatment. At some point your id is found or you give them it. You walk out and never worry about payment.
Just like you don't pay to drive on roads in a civilized society, or pay to use a library, or pay for a child's education.
Yes, it's funded by taxes, but you don't pay, since that would be inefficient and too expensive.
UHC is more efficient because it is centralized and equal. You don't have to waste trillions on figuring out how much someone makes or if they're a gold member of this or that company. You don't need an army of useless admins making up a billion billing codes so some company can try their hardest not to pay what they've been paid to pay.
It is just: you pay taxes. If you need it you get healthcare. You don't ever "qualify," there are no means tests, there is no different treatment based on how well off you are, you just get healthcare.
We see how that works. Governments take 40% or more of your income, or insurance companies have outrageous rates. And then the bureaucrats keep part of your money for themselves, and then tell you whether you get healthcare or not by restricting use to the money you paid them. Why should I pay for government administrators to have huge salaries just to manage the money I gave them?
I would rather pay for a doctor's visit out of pocket with cash, and earn interest or invest the money that would otherwise go towards taxes or insurance fees in my own health savings account.
Most people can afford routine healthcare costs. It is the major medical that is the problem. For that, you need something like insurance, either run by the government, a cooperative, or a private company. You also pay people enough where they can put money away into a health saving account and retirement account. So wages would need to rise for that. And you need a safety net for people who cannot afford insurance, funded by taxpayers and charities. You don't have to centralize things to do any of that.
Routine healthcare should never be free, except for those in poverty. It just leads to inflation and rationing of routine healthcare.
25 years ago, health care used to be more affordable. That was before the insurance companies paid for everything, and before hospitals were privatized and consolidated. Doctors could not charge a lot because people paid cash, and people would choose doctors with affordable rates. But now with copays, people think that the doctor costs $30. So the doctors charge hundreds of dollars to the insurance companies, knowing that if the patients paid cash themselves, they would refuse to pay such high charges. These higher fees just get passed back to the patient in the form of higher insurance premiums. So insurance is inflationary. The cost of healthcare is pushed up.
Government insurance tries to handle this by putting caps on what providers can charge, but you still have the problem of rationing of healthcare based on available funds, and it also gives bureaucrats control over your healthcare. It has all of the same problems as private health insurance, except it is run by the government. And if it is centralized, you can't go anywhere else for a second opinion. If they say no, you are screwed. So that is not ideal either.
If you abolish all private healthcare, then you only have government clinics, and the problem with that is that they can deny you care if they don't like you (a political dissident) or if they don't have the budget to pay for everyone's care.
Instead of any of those, you need some kind of system that is not inflationary, is affordable, and that gives people choices in their care. If one provider says no, they can go to another. The current system is really bad, but most of the alternatives that people suggest are just as bad or worse. If you want a better system, it must include patient choice.
I take that back. There is on form of free healthcare for the patient, and that is provided by charities and religious organizations who accept donations. Then, and only then, does the patient not pay. Because if it is run by the government, the patient pays direct or indirect taxes to pay for the healthcare.
I tried searching it and couldn't find a single thing except for some articles talking about 1332 waivers from the Affordable Care Act, which is very much centralized.
Yes, unfortunately it does not get a lot of publicity. Most people outside of Texas don't even know something like this exists.
Here is the one for Harris County, Texas. #^https://www.harrishealth.org/about-us/harris-health
Other major counties in Texas have this as well.
They're funded by Federal, State, and Local government as well as philanthropic donations.
So basically a centralized healthcare solution which turns away more poor or uninsured than they help. A commendable service, but not even close to the effectiveness and mercy of universal healthcare.
As I said, the system is not perfect and it needs to be improved. And it is better than Canada telling people to choose euthanasia because the government doesn't want to pay for their care, or when the UK denied care to a little girl, and then refused to let her leave the country to get healthcare elsewhere. They don't provide universal healthcare either, despite their claims.
It's centralized government operated healthcare, you're just advocating for more centralized healthcare.
How? I never said we abolish hospitals run by charities or religious organizations. You can have a government-run healthcare system run alongside charities and religious organizations. I don't think hospitals should be for profit, though. But the government does not have to be your only choice.
One thing I don't understand is why some people are against charity and religious organizations running hospitals next to government-run hospitals. One is funded by donations, and the other is funded by taxes. If we wind up with universal care using multiple providers, what is the problem? The end goal is that people get the care they need, and they are more likely to get that when there is more than one gatekeeper.
The United States is huge. You could fit all of Europe inside the U.S. Yet they don't have ONE Europe-wide healthcare system. Each country has their own. At the very least, each state should have its own health care system, although a local network would be better. And we should not abolish charity and religious organizations from running hospitals. They should be part of the health care ecosystem as well. That way people have a choice in care since there are multiple providers.
Of course, this just highlights the problem with centralized care. If local universal care run by the government turns away people because it is underfunded, what do you think a nationwide government run healthcare system will do when it is underfunded? The same thing! They will deny care just like the insurance companies do. And you won't have any choice in the matter since they are the only provider and/or they control the money spent on your healthcare.