Back in 2019 when universal healthcare was being discussed during the Democratic primary, the Pod Save America guys addressed the question of “Who will pay for it??!” with…

America only ever has one total medical bill, for all the medical expenses and associated costs that we all use, every year. And even if someone doesn’t go to the doctor, then that still eventually adds up to a cost that we all pay, because someday they’ll miss work, or die, or they’ll get really sick and wind up having to declare bankruptcy, and that’s a cost that affects us all, too. There’s no way to subtract from that total cost; either people get the treatment that they need, or the cost gets distributed around anyway, sooner or later. So really, the only variable over which we have meaningful control is how much inefficiency is built into that system, and private insurance is an absolutely massive source of inefficiency.

Also, I can’t fucking believe that we haven’t had a major campaign on the premise of “Never have to think about your insurance EVER AGAIN!” because every goddamn time I have to think about my insurance, whether I’ve got it, whether it covers what I’m thinking of, whether I’m at the right doctor or not, I feel bile rising in the back of my throat. Having to think about insurance should probably poll at around the same level of rectal polyps, and yet we all have to think about it at some point or other, and it’s fucking bullshit.

We as Citizens need to start acting like this is our damn country, and we deserve to have a minimum quality of life that isn’t garbage, just for being citizens, not even for working 40hrs a week at slave wages while billionaires make themselves incrementally into trillionaires. We deserve healthcare we can afford, we deserve housing we can afford, we deserve vehicles we can afford and don’t break down with planned obsolescence constantly. The rich deserve equal return on their investment to the effort they put into it. I don’t know exactly how that looks because I want retirement funds, and investments for the average person to actually pay, while the investments for the rich pay them enough to barely keep their quality of life. Probably caps on annual returns would do it, if the rich suddenly CAN’T take more from the stock market, then it goes to the poor’s cuz it has to go someplace. Is what I’m saying anti capitalism? No more than bailouts for failed businesses that cause recessions and giving their executives golden parachute leave packages, so anyone against it but for bailouts, isn’t a capitalist either. Giving capital to failed businesses is the antithesis of capitalism.

You’re also paying for the care of the homeless, disabled, mentally ill, and otherwise impoverished in the least efficient way possible.

EMTALA and other regulations mean they’re not able to be turned away from an emergency room without at least an evaluation, and they’re not able to be refused care for an immediately life threatening condition. There’s even regulations at the federal and state levels that determine whether or not they have to be admitted or transferred to higher levels of care or better equipped hospitals. And there’s similar stuff that applies to first responders. So you’re not gonna ask someone about their insurance or go through their pockets for a card before initiating treatment. Most people would agree with this because at even the most basic level they understand that you can’t wait for that to start something like CPR, even if they don’t have enough empathy to think about how fucked up it would be in general to negotiate financial matters when a person is actively dying or to just discontinue CPR when you find out they don’t have insurance. Also what if you make a billing mistake and abort lifesaving care you weren’t supposed to? You can’t bring them back to life. We’d have to degenerate to some pretty deep lows of empathy to start tolerating that kind of thing although I suppose we’re already at levels of degeneracy that shock me.

But this also means that someone with diabetes or heart disease who can’t afford regular outpatient doctor’s visits is at best utilizing an expensive ER for primary care. At the worst they’re using the ER for repeated expensive emergency treatments when regular outpatient primary care would be much cheaper and more efficient. So instead of getting insulin or antidiabetics like metformin (which are both old as shit and cheap to produce by now) they’re getting IV fluids and medications and intensive monitoring of those therapies. This is also clogging up the ERs so they don’t have the resources to handle genuinely unexpected accidents and other sudden illnesses.

If they can’t afford a regular doctor, how do people think they’re paying that ER bill? Many hospitals offer financial aid, but where’s that money coming from? And when they just don’t pay at all, who’s paying for those supplies and wages? They can’t get repo’ed so the bill just goes to collections where it also never gets paid. It might get bought at a lower rate by a debt collection company but ultimately the hospital is just eating at least part of the cost and and compensating by charging the people who can pay more.

So we could be paying for people’s daily oral medications and other treatments that are relatively speaking cheap, but on top of that, these repeated crises are also making these people even less able to afford their care over time. When you chop off a minimum wage workers legs from diabetes related gangrene, they’re not going to go back to a physically intensive job. They might be able to do a call center job but they’re probably also collecting trauma and other mental illnesses too. They’re lucky if their trauma and the constant mental and physical demands of a low wage job haven’t resulted in some kind of substance abuse. They might also be tearing apart their muscles joints and ligaments with repetitive stress injuries that eventually build up to untreatable levels.

So yeah, you’re already paying for other people’s care, you’re just doing it in the most expensive way possible. And that argument is also assuming you’re a sociopath who doesn’t already care that it’s horribly inhumane.

A system run by the government where we all contribute? Sounds like COMMUNISM! No thanks, I’d rather pay my $8,000/mo insurance bill like a REAL MAN. Suffering builds character.