One of the ways the left “wins” arguments is by changing the meaning of the words they use.
— Humpty Dumpty
So, what is healthcare?
Healthcare is anything that is caring for your health. That is the skills of a doctor or health professional. The medications you might take for high blood pressure or pain. It is setting a bone or removing a tumor.
Healthcare is about your mental and physical health. Everything from a band-aid to a heart transplant, and everything in between, is health care.
What is access to healthcare?
This is about your ability to get healthcare.
If you are in a vehicle accident, they pick you up, carry you to the hospital, and take care of your injuries. That is access to healthcare.
You are having trouble breathing, walk into the emergency room, they put you on a nebulizer, admit you, and take care of you until you can walk out the door. That is access to healthcare.
You cut your toenail too short, and it becomes an ingrown toenail, badly infected. You walk into the urgent care, and they take half your toenail off and write you a prescription for an anti-biotic. That is access to healthcare.
You think you have a sinus infection, you call your doctor’s office. They schedule you to see your doctor or another later that day. That is access to health care.
Your doctor thinks a skin growth might be cancerous. He refers you to the dermatologist, two weeks later, you are seen, and a biopsy is taken, tested, the results are back to you and your doctor 15 days after first being seen by your doctor.
Being able to get a doctor is part of access to healthcare. So is the ability to get medical tests done in a timely fashion.
In Montreal, CA in 2021, it took 862 days, on average, before you were assigned a family doctor.
As of 2042, on Friday, most of the hospitals emergency rooms in Montreal are over capacity. Most of the over capacity hospitals have had patients on stretchers for over 24 hours, some for over 48 hours. They don’t even bother to give wait times.
A different website gives wait times ranging from just over an hour to more than 6 hours.
The website I found with wait times for US hospitals shows about the same for Boston hospitals. But, a data point that I have is that my local hospital has a listed wait time of 2.2 hours. My personal experience at that hospital is that wait times are generally much less than that. You are normally seen by a triage nurse within a few minutes of arriving.
You can have good healthcare, good access to healthcare, or some mixture of the two.
In the United States, no person can be turned away from an ER because of their ability to pay.
Paying for Healthcare
Paying for healthcare is where things start to get very complex. When a friend came down to visit from Canada, she was horrified with how medical payments were done, here in the states. On the other hand, when she got sick, she was seen by a doctor within 15 minutes of arriving at an urgent care facility. She left with antibiotics, in hand. She had paid in full for her medical service, around $100.
She agreed that her access to healthcare, in the states, was better than it was in Canada. She felt that the quality of her healthcare was better in the states, and she was surprised at how little it cost.
The first issue with healthcare, is that you have no ability to shop for services. Until recently, with the creation of boutique medial services, you didn’t know how much accessing your doctor was going to cost.
I had a slow leak in the rim/wheel of the truck. Not an issue, every other week I gave it another shot of air.
It finally decided to become a fast leak. I called my guy, asked how much to move the current tire to a new rim. He told me. I ordered a new wheel, took it and the truck to him.
At the end of the morning, my truck had a new rim and the cost was within $5 of what he quoted me. The difference being a choice to replace the valve stem.
I came out of my doctor’s office, asked what the cost was. Paid in full. Then three weeks later, gotten a bill for more because they hadn’t coded the office visit correctly. They ate that extra after I made complaints to the administration.
If we agree I have paid, in full, then they don’t get to change the bill later.
Regardless, there is no real way to find out the prices of different procedures, ahead of time.
The next issue with healthcare costs is that the person paying for the procedures/visits is not the person who is getting the procedure. There is no reason for you to shop around when somebody else is going to pay. You will always choose the best quality you can find.
So what about payments?
You can pay at the point of service, or you can pre-pay.
“Point of service” is paying when the service is performed. If you go in to have your car serviced, you are expected to pay for that service before you leave. That is payment at the point of service.
The few times when some vendor or service person has said, “I know you, you’re good for it, come back tomorrow and pay.” has been so few and far between, it sticks in my mind.
My barber only takes cash, no cards. I didn’t know that when I sat down. It got done, found out that I didn’t have enough cash, left my lady as collateral, went and got more cash. I got my lady out of hock and called it a day.
Most healthcare is billed out after service, but is still considered payment at the point of service.
Pre-payment for medical services is when you pay something now for services you might need later.
In America, that is done with insurance. You purchase insurance to cover your healthcare costs.
Originally, health insurance was designed to cover unusual health events. You broke your leg, insurance covered it. You required your appendix removed, insurance covered it. You require a hip replacement, insurance covered it.
If you require an annual physical, insurance doesn’t cover it. Most of the maintenance costs of healthcare were paid out of pocket, not with insurance.
The government broke this model.
The benefits your employer gives you are part of your total compensation package. Only some of those benefits are taxable. One of the things that is not taxed, is your healthcare costs. Nor the amount your employer pays towards your healthcare insurance.
Consider the following, you are offered $50,000/year. You pay $13,000 in health insurance per year. That leaves $37,000. The government takes 30% of that, leaving you $25,900.
A different firm offers you $45,000 per year with matching insurance payments. This means that you will be paying $6,500 in insurance and the company will pay $6,500 for a total of $13,000. Your taxable income is $38,500. The government still takes 30%, leaving you with $26,950.
By taking a lower salary $5000 less, you get to take home just over a $1000 more. Not bad.
These tax games actually changed the face of medical insurance. For healthy, young people, this equation wasn’t as persuasive. So “insurance” started to cover healthcare maintenance. This drastically increased the cost of insurance.
Whereas, before, the insurance company could play the odds, taking money from everybody, knowing they would only have to pay a few, the new model required them to collect money and pay money for everybody.
A healthy 25-year-old didn’t cost the insurance company anything, on average. But now that maintenance is included, even the 25-year-old costs money. All of that had to be paid for.
The other place where the government interferes with insurance pricing, is in boundary limits.
There are places in this country where the side of the street you live on changes the cost of your medical insurance.
While you might think you have “Blue Cross/Blue Shield” insurance, I can promise you that you do not.
If you look at your insurance card, you will find that you have “Blue Cross/Blue Shield of STATE”. This is because medical insurance companies can only offer medical insurance in their state.
This means that there are 50 different Blue Cross/Blue shield insurance companies. Are they inter related? Yes. It is a legal fiction that keeps them separate.
In addition to the visible insurance costs, there are other hidden insurance costs. The federal government of the US takes a part of your income and uses it to fund Medicare and Medicaid.
When people talk about “free healthcare” in the UK or Canada, they are lying. There is no free healthcare in any country.
It is free at the point of service. The citizens of those countries pay for their healthcare via taxes.
The NHS of the UK spent $231.6 Billion on health services in the 2022/2023 budget year. This is out of a budget of $1,551 Billion. The NHS budget was 15% of the total budget.
This puts the price, per person, at about $3,400, or $13,600 per family of 4. Just about the same as the pre-Obamacare cost for family insurance in the United States.
The point is that healthcare in the UK is NOT free.
What they mean by “healthcare”
The left conflates healthcare with paying for healthcare. In the process, we have created a situation where healthcare costs more for most people. Access to healthcare has gone down. And the quality of healthcare seems to be slipping.
But, the left yells that more people have access to healthcare than ever before.
They didn’t really get more access, they just changed how much they pay for healthcare and who pays for healthcare.
I’m reminded of a show I watched a few years ago.
In the show, the couple set out to find out if they could live as a couple at menial labor.
He got a job, but I do not believe she did. His job did not have healthcare benefits. He was working at nearly minimum wage.
She was prone to getting UTIs. About 6 months into this experiment, she came down with what she knew was a UTI.
So they went to the ER to get treated. They ended up with a bill in the thousands.
They held this up as a reason people can’t live on such low wages.
They cheated for their story. First, she could have gotten a job. If they were as good as he said they were, they should have been able to work their way out of that starting wage/position. They didn’t.
Second, the cost of an ER visit is pretty high. The cost of an urgent care visit is much lower. My last urgent care visit included minor surgery. My total cost, before insurance, was less than $200.
The cost of diagnosing a UTI and prescribing an antibiotic is around $100. There are telehealth options available today that are even cheaper.
By making a shitty decision, they cost themselves over $1500 in medical bills, which could have been less than $125.
Conclusion
Make sure you hold them to using the right terms. Don’t let them redefine words to confuse and conflate the different issues at play.