Why does the US healthcare cost twice as much but is not universal? Because it's not universal.

Source: http://interactioninstitute.org/illustrating-equality-vs-equity/

When people get annual checkups and go to the doctor themselves because they're concerned about their health, they don't get as sick as often, and avoid burdening society with the costs of being taken to the hospital when they can't take care of themselves. Denying care by default, the approach of most private health insurers to anything beyond routine visits, then burdens society with monitoring, negotiating and litigating every service as an insurance claim. Canada, the UK, and Australia spend 50-75% less on administrative costs than the US, while all have higher life expectancies. Administration costs don't make people healthier, and they are a major factor in provider burnout, especially in community mental healthcare. As a provider, it can cost me as much time as a session to generate, issue and track the documentation to get paid for the session.

When children and the poor don't have preventive health care and insurance, it doesn't change that providers still cannot ethically deny care in critical situations, so the system pays those costs regardless. Instead of a routine visit to a doctor, our system can pay 10 or 1000 times as much for a visit to the ER and related hospital stay. Instead of paying a few thousand dollars per year to everyone to have quality long-term mental health & substance use disorder care, we pay hundreds of thousands in acute care when there are accidents, attempted suicides, and overdoses. Even if a person is not insured, hospitals must then look to recoup the costs of the uninsured, and engage in across-the-board price inflation, according to this JAMA article,

by padding the bills of other patients who are insured--which in turn makes insurers deny claims rightfully.

In the US, we over-rely on prescription drugs to such a degree that pharmaceutical companies have a stranglehold on high prices. Instead of clear-headed cost comparison between behavioral interventions like psychotherapy, health coaching, and digital app-based supports, versus pharmaceutical ones, we opt for the drugs by default in many cases. Because changing behavior is seen as 'hard' by the medical profession, we ignore the dignity, empowerment, cost savings, reduced complications, and joy of behavioral interventions as a first-line intervention.

The reality of the "how will we pay for universal care" question is this: we're paying for it already, badly. Our present system is perhaps the worst possible way to organize providing care, trapping not just the poor in cycles of poverty, but our entire society.

An analogy: our present healthcare system works by denying people a glass of water— until they show up at the ER with their organs shutting down, can't even swallow for themselves, and needing intravenous rehydration. Because we have municipal water systems that have socialized the cost of drinkable water, we don't see this particular issue in most healthcare situations -- but we actually do organize care in this way with so many other preventable health conditions, whether someone is insured or not.

If we socialize the cost of always-accessible healthcare, if similar nations like Canada, Australia, and the UK are any indication, we will spend radically less on it. The U.S. Constitution's Preamble states one of its main purposes is to “promote the general welfare". The lack of universal care is the biggest detriment to the general welfare we face on a day-to-day basis. We need to commit to it from a reasonable starting point, and then keep evolving to find the most balanced, fair, and sustainable ways to organize continuing to pay for it. Of necessity, this will involve a good deal of private sector creativity alongside government programs.

We at Technotherapy Public Benefit Corp., for example, are aiming to create universal, planetary-scale behavioral health service reducing costs and increasing access to primary and specialty mental healthcare by providing it online. In the long run, those elements of the private sector interested in profiting and profiteering over the present systems' manifest dysfunction will not last. Wall Street knows this, and it explains the sharp plunge in public healthcare stocks after Senator Sanders' Nevada primary win. However, we believe organizations committed to providing quality health service to all, and responsibly socializing the wealth and well-being that universal care generates, will flourish.

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