Some people call it a hand-out, others call it a human right. But when it comes down to it, what does it really mean for you?
Single-payer, Public Option, Obamacare, etc.
The democrats on the debate stage spend a great deal of time arguing over the differences between types of socialized healthcare (or universal healthcare). For the purpose of simplifying this discussion, I will not describe the nuances between the different types of universal healthcare. I will refer to them as a whole and assume that the new system of healthcare means more people (ideally, everyone) are covered.
More coverage = lower cost
The debate always seems to come down to “what will this cost me?”, candidates say their plan will be cheaper for everyone. But if these plans cover people who can’t afford to pay for anything, how could this possibly be true?
There are lots of reasons why this can be true, I am going to focus on one.
Emergency Rooms Become Primary Care
Under the current system of healthcare, hospitals do not turn away patients. As of 2019, there were 28.5 million uninsured Americans.1
When people are uninsured they still need healthcare at some point. This can be because of an accident or a chronic health condition. What happens is that these uninsured people rely on emergency room visits to get their healthcare.
There are a few problems with this. Emergency rooms are more expensive than primary care, they become crowded with patients, and without primary care, preventable diseases can develop into chronic conditions. Chronic conditions are more expensive than the preventative care that would be used to halt or slow their progression.
A typical experience goes something like this: John is uninsured, he steadily gains weight through his 20’s. He maintains two jobs, working over 50 hours a week, still unable to make ends meet. Neither of his jobs offers him health benefits. His health deteriorates. He develops prediabetes but is undiagnosed since he cannot afford to see a primary care doctor. Eventually, his prediabetes develops into full-blown diabetes. One day John goes into a diabetic coma, a complication of his diabetes, caused by dangerously high blood sugar. John goes to the emergency room. After treatment, he is unable to pay the bills he receives from the hospital, putting him further in debt. If John is lucky either he is close to turning 65 and will be able to qualify for medicare or he will become disabled as a complication of his diabetes and qualify for medicare that way.
This series of events is all too common. The result of it is that the hospital goes unpaid. In order to cover unpaid bills, the hospital has no choice but to raise prices.
In addition to the uninsured, as of 2018, there were 44 million underinsured people.2 Underinsured is defined as someone who pays 5-10% of their income in out of pocket costs in addition to paying for health insurance. More simply put, underinsured means their insurance won’t pay for much. People in these circumstances will also receive expensive medical bills for an emergency room visit. They also have high copays and high drug prices. Being underinsured has eerily similar consequences to not being insured at all.
Much like the uninsured, the underinsured may not seek treatment due to out of pocket costs. When forced to do so they are unable to pay high hospital bills. Again, the hospital goes unpaid.
What does this mean for you?
Here is why this all matters: as hospitals go unpaid they must charge paying patients more to cover their costs (not fair, I know), since paying patients have insurance it means insurance companies are charged more. As insurance companies are charged more they must raise their prices as well. This means more people are priced out of insurance and fewer people pay hospitals, the cycle continues.
This cycle would stop if everyone were insured.
Another positive is that everyone would be able to receive primary care. This would prevent abuse of the emergency room, making it less expensive (and less busy) for actual emergencies. It would also help to prevent some diseases from becoming chronic.
Primary care exists to make sure people are doing well and to guide them to the care they need. Without primary care, diseases worsen and care becomes more expensive. For the uninsured, this just adds to the cycle of increased cost.
The Number of Uninsured Keeps Rising
This is evidence of the cycle I explained above. In 2017 there were 25.6 million people uninsured, this increased to 27.5 million in 2018 and 28.5 million in 2019.
This rise in uninsured is happening despite the baby boomer population aging into medicare.
Halting this process halts the price increases and the increase in chronic diseases, it makes the system more efficient and better for everyone, and it creates a healthier population of Americans. Healthier Americans lead to a better economy.