Let’s see if we can have a rational conversation about U.S. health care.
What do you think are the advantages of U.S. universal health care? What are the disadvantages?
My Opinion
I have a hard time seeing how universal health care (UHC) will reduce costs. Electronic records might, but that is distinct from UHC. When more people are covered, demand will increase. And if pre-existing restrictions are forbidden, cost to insurance companies increase, which increases the premium.
In other words, I don’t see UHC as reducing the cost — though I’d be pleasantly surprised if it did. Just doesn’t seem like an economical reality. This seems to me the biggest disadvantage.
If costs are capped through government mandate, then quality will go down. See rent control for examples on why that’s so. TINSTAAFL — there is no such thing as a free lunch. Something always has to give. It will also reduce incentive for drug companies to spend the necessary money to create new drugs if they can’t make a profit. Right now the US leads in creating life-saving drugs because of the economical incentives. If those incentives go away, then that will very likely go away.
My preferred solution is a health savings account system with high deductible major medical coverage (~$5k/yr), supplemented with reformed Medicare & Medicaid programs for those who cannot afford HSAs. This gives incentives for people to only go to the doctor when necessary (though preventative visits are free), thus keeping demand down and controlling costs. People can keep the money and roll the extra into an IRA if they do not spend it — which is better than always going to a premium.
But I’m a libertarian, so I tend to side with things that make people responsible, instead of massive government programs.
On the other hand, I’m willing to give the currently proposed method of UHC a chance. I’m not an expert in economics, and I’m probably misunderstanding many things. I know our politicians are trying to do what is in the best interest of Americans (or at least I hope so!), and maybe extending the coverage pool and encouraging preventive medicine will balance the health care budget.
But I doubt it. It’s going to cost us one way or another. The question is, is that cost worth making sure every American has health care insurance?
What do you think?
I think that everyone deserves equal access to health care, and that it’s a right, not a privilege.
Why should someone with, for example, asthma pay more for their cover?
Coincidentally, costs in the UK decrease because of bulk purchasing and negotiation power; the drug companies still make a profit.
There’s a distinction to be made between a right and an entitlement. A person in the US has freedom of speech and press, but that does not mean that they are entitled to be provided means by which to execute said speech/press (a computer, a megaphone, a printing press). In the US (at least in theory) you have the right to bear arms, but that doesn’t mean you are entitled to be provided a gun.
To argue that people have equal right to health care, this is pretty uncontroversial. Arguing that people are *entitled* to health care is an entirely different debate with different contours and precepts.
Then by your logic, insurance companies and HMOs should be imprisoned for breaching citizens’ rights to healthcare. I agree.
Not really, no. That does not follow from what I said.
Fair enough – I’m quite drunk :-)
Ha!
I love the Brits. :)
Yes, we are awesome. Can’t be helped. Natural selection made us immune to pink-gin in the days of Empire, and now we all love to spend out Saturdays getting righteously pissed. What I love is that I’m so good at it that I can still type after two bottles of chardonay :D
*out, not “out”.
Note for non-Brits: This is what’s called IRONIC.
OUR! FFS!
That’ll teach you for drinking this early in the evening!
Pffff! It’s 19:01 by my system clock. That’s Tipsy O’Clock.
Anyway, I have a good excuse: I have a fresh piercing, plus I stretched one up to 4mm today. Hence pain. Hence alcohol.
Well I’m already on my seventh Guinness so I suppose I shouldn’t criticise!
There is also a distinction to be made between a right that is desirable and a right that is essential to function. You have the right to bear arms in the United States but not the immediate need to do so, which means the government does not have to provide you with a gun. They do, however, have to provide you with protection, which is why there are armies and police forces, because people have an immediate need for security from foreign enemies and criminals. Should we have insurance to protect people from being burgled or shot at, so people who can’t afford to pay for it should just be left to be robbed or killed? Should the fire brigade work on an insurance model, only putting out fires when they are in buildings owned by people who are up to date on their insurance and have no previous wiring conditions? Should people who cannot afford insurance or who were unfortunate enough to have a pre-existing medical condition be allowed to die? You can argue that they should pull themselves up by their bootstraps all you like, but it’s hard to do that when you’re dying.
You have the right to bear arms in the United States but not the immediate need to do so, which means the government does not have to provide you with a gun. They do, however, have to provide you with protection, which is why there are armies and police forces, because people have an immediate need for security from foreign enemies and criminals.
Before there were professional constabularies, the government did not hand out guns; in the general case, it also does not follow that a government suddenly becomes responsible for fulfilling the enabling resources to exercise a right simply because its need increases.
The actual history of the formation of law enforcement as a distinct duty from citizenry (in the US) is fascinating, and has very little to do with protecting people from harm (and in fact, even today police officers are not legally required to risk harm in order to help anyone). Armies (on the scale of the US’s) exist not to protect the US, but rather to project power and pursue putative national interests.
Should the fire brigade work on an insurance model, only putting out fires when they are in buildings owned by people who are up to date on their insurance and have no previous wiring conditions?
The fire system used to work in exactly this way. The reason it doesn’t anymore (especially in densely-packed cities) is that people quickly realized the massive negative externality inherent in letting your indigent next-door neighbor’s house burning down: yours is likely next. A case can effectively be made that health care also has externalities which encourage a similar treatment. However, the two models do not exactly map.
Should people who cannot afford insurance or who were unfortunate enough to have a pre-existing medical condition be allowed to die? You can argue that they should pull themselves up by their bootstraps all you like, but it’s hard to do that when you’re dying.
No, and I would never argue that.
I’ll have more to say later, because I think this will be a place that allows rational conversation.
But this comment stuck out to me: Obama has proposed that <5% of the population would be covered by the 'public option' (whatever that turns out to be exactly). Unless there's something I'm missing completely (which is very possible), I'm not sure how the 'public option' constitutes a "massive government program."
Again, I could be unaware of something here; I've done my best to be educated about this, but it's a tough topic to tackle comprehensively.
That we allow for profit “insurance” is absurd. Literally bizaare. Here’s the deal:
It’s your premium money: Would you rather spend 20-40 cents on the dollar to pay someone to write a check to your provider — or 3-4 cents?
The best deal would be a sort of Medicare Part “E” (for everyone). It fixes Medicare’s risk pool problem (old and sick, ergo expensive) and could save trillions. As Obama has tried to point out, fixing health care is fixing “the economy stupid!”.
That you’re “libertarian” shouldn’t mean that you abandon common sense for some Randian individualist utopia. Imagine the freedom to create and take risks that could result if people didn’t have to worry about keeping a crappy job for the health care for them and their families.
Also of note from the standpoint of this blog, Daniel: there’s a huge overlap of the crazies wacked off about “Obamacare” and the Xtrian Right — just in case it hadn’t occurred to you.
Yeah Zotz, I had noticed – and why is that? Surely a programme designed to enable everyone access to healthcare should appeal to Christians. Maybe Christian Right is oxymoronic…
It is interesting to be in the UK and watch the hysteria around this issue. There are lots of problems with the NHS – too much bureaucracy vs. front-line staff, long waits for non-essential ops, postcode lotteries etc, but overall I think I’d rather have it than any other system I’ve met so far, and the US has the chance to avoid the mistakes we’ve made in putting the package together. At the top end, the US has the best healthcare in the world, at the bottom end it’s a disgrace to a civilised nation. The rich will always have access to the best healthcare, but should the poor have none at all?
You would think…
But it’s pretty clear who actually lives and promotes the “unto the least of these” admonition that Jeebus himself said is the basis of Xtrianity. And it ain’t the religious right.
In the end it boils dow to rationality: facts and evidence all say we can’t continue as we are, though we’ll never have the NHS as rational as that is. We’re not going to get Medicare Part E as I described above either.
We have too many Americans who have abandoned rationality and worship the “freemarket” religion against all evidence and despite the soreness of their own sphincters from being screwed repeatedly by essentially unregulated capitalism. And for some, the sub-sect of libertarianism is as irrational an economic religion as there exists. Exhibit A: In additon to being an economic crackpot, Ron Paul is a right wing Xtrian.
the sub-sect of libertarianism is as irrational an economic religion as there exists.
If only that were an accurate description, you’d have a point.
Exhibit A: In addition to being an economic crackpot, Ron Paul is a right wing Xtrian.
Who routinely passed up fees and treated indigent patients for free. When picking your ad homs, it helps to target people who actually make your point rather than undercut it.
I note that you didn’t actually refute my assertion re libertarianism. Most of the libertarians I know and have read are just as fevered and ill-informed as any fundamentalist cracker. Lots are both (fevered and ill-informed as well as fundamentalist crackers). In fact, libertarian crackers are the typical teebagger railing about socialist/marxist/fascist/nazi Obamacare, except for the long time corporate shills like Dick Armey who astroturfed the poor ignorant slobs. Oooooh! Teabaggers! Dick Armey! (get it?)
Secondly, your account of RPs “generosity” is also a typical dodge. I don’t dispute that Dr. Paul is probably a nice guy. Access to our health care system shouldn’t be based on whether some individual doctor is feeling “generous”.
It’s an assertion that is impossible to refute, because it has no content. “Libertarianism is an economic religion” is so far off the mark that there is nowhere to start. In fact, the notion of talking about Libertarianism as though it is economically monolithic is a non-starter.
Secondly, your account of RPs “generosity” is also a typical dodge.
It wasn’t a dodge. It was to refute the main contention on this thread that people who don’t like UHC are out to kill poor people. Your “exhibit A” is ten kinds of non sequitor, since Ron Paul’s economic beliefs (right or wrong) have nothing to do with his religion. Ron Paul himself is problematic to classify as a Libertarian (especially his immigration positions, as well as arguably his position on abortion).
Access to our health care system shouldn’t be based on whether some individual doctor is feeling “generous”.
I agree. Then again, so would most libertarians. The straw man you have built is easy to beat upon, but in the end all that comes out is straw.
Libertarians seem to always get ruffled when someone shakes their comfy little ideological cocoon or calls out the crackpot that is their (current living) guru.
I note (once again) that your reply doesn’t amount to much more than some frantic gesticulation.
ROFL. “comfy little ideological cocoon”…”their guru”…
————
I’m curious to know how you would define “libertarian”.
I tried to reply but evidently I’ve tripped the moderation filter. No expletives so I am at a loss as to why. Daniel, please advise.
did you use the word Socializm (mispelling intentional), someone had the problem with that earlier and on the forum it was figured out that the word contains the name of a certain ED medication, so was setting off spam alarms.
did you say sociali$m? it seems to block that…
Yes, it blocks that because the word contains “cialis”
I’ll remember that for future reference; but wow (LOL), any other peculiarities of the filter you’d like to share?
The only one I know of off the top of my head.
The fact remains that people are dying because of lack of healthcare (some of these WITH jobs AND insurance!) Many people are going bankrupt because of healthcare costs (again, WITH insurance). We can’t deny that these things are costing all of us.
No new idea (bill) is going to be perfect from the starting gate, but we have to start somewhere. The way things are and the fact that the US is ranked 37th among other nations in healthcare clearly indicates the way things are are not good.
I agree, people have the right to live and its time to at least try and provide SOME form of health care program for the masses. We’ll worry about the specifics later, because right now the #1 cause of bankruptcy in America is hospital bills.
A bad solution that melts down would be worse than no solution, as it may kill enthusiasm for further reform.
Some notions:
1. Rescission has got to go. It is an abusive practice that has no place in good faith insurance regimes.
2. Disentangling insurance from employment should be a priority, as it damages both the insurance market and the job market in the long run by reducing insurance competition and trapping people in jobs they might otherwise leave
3. Lower licensing restrictions for routine medical care, involving nurse practitioners into the market as direct providers to counteract the price effects of the comparative rarity of doctors
4. Slap sense into the FDA regarding criteria for making medication OTC instead of prescription-only (as getting a prescription costs money above & beyond the higher cost premium of the medication being prescription in the first place)
5. Global catastrophic insurance is an idea I’ve seen that makes sense, protecting people from going bankrupt from their medical bills while targeting the conditions that drive prices of regular coverage up and removing them from the market.
6. A real “Public option”: a government funded non-profit option which does not engage in discrimination on preexisting conditions. The issue here, the critical point, is in order to function to lower cost this entity *cannot* be allowed to run in the negative. It needs to operate like a private non-profit, much like insurance companies in Minnesota run today.
7. Graduated-cost clinics (i.e. fees depend on personal income) have been an effective innovation in my home state, and are a model that could be used nationally.
if my memory serves me, i believe one of our ‘non-profits’ took in around $6 billion in the last fiscal year. seems pretty profitable to me.
Um, if the volume of medical care provided was close to $6 billion, it would in fact not be profitable at all.
i’m sorry i didn’t make it clear, that was $6 billion above costs, again, if memory serves me because i can’t remember the name of the company. so it was basically profit.
i still think they’re better than for-profit companies because i’m sure they will use the money for good purpose. i just wanted to point out that even ‘non-profit’ doesn’t always equal no profit.
“1. Rescission has got to go. It is an abusive practice that has no place in good faith insurance regimes.”
Not entirely sure what you mean here. I assume you are talking about contract recission, but i just don’t think that has a huge impact in the industry. Getting a court to rescind a policy is pretty difficult and usually requires proving something like fraud in the inducement.
“2. Disentangling insurance from employment should be a priority, as it damages both the insurance market and the job market in the long run by reducing insurance competition and trapping people in jobs they might otherwise leave”
I like the idea of disengaging health insurance from employment except that it is likely to greatly increase the cost of health insurance for many. Costs are kept down by pooling through employers. Plus it does nothing to correct the problem of those who can’t afford private insurance rates.
“3. Lower licensing restrictions for routine medical care, involving nurse practitioners into the market as direct providers to counteract the price effects of the comparative rarity of doctors”
Good idea. Is also going to require tort reform.
“4. Slap sense into the FDA regarding criteria for making medication OTC instead of prescription-only (as getting a prescription costs money above & beyond the higher cost premium of the medication being prescription in the first place)”
Not sure how this helps people who can’t see a doc because they can’t afford it and don’t have insurance. Are they suppose to guess at which OTC medicine cures leukimia?
“5. Global catastrophic insurance is an idea I’ve seen that makes sense, protecting people from going bankrupt from their medical bills while targeting the conditions that drive prices of regular coverage up and removing them from the market.”
I’m unfamiliar. If this is private insurance I’m skeptical though in that cost is going to be a problem for insureds.
“6. A real “Public option”: a government funded non-profit option which does not engage in discrimination on preexisting conditions. The issue here, the critical point, is in order to function to lower cost this entity *cannot* be allowed to run in the negative. It needs to operate like a private non-profit, much like insurance companies in Minnesota run today.”
I wholeheartedly support this idea.
“7. Graduated-cost clinics (i.e. fees depend on personal income) have been an effective innovation in my home state, and are a model that could be used nationally.”
Not a bad idea, but only needed if people are paying for healthcare on their own and not covered by insurance of one form or another. Also unlikely to work unless you force docs to participate given their desire to maximize profits.
About 25% of people who become a net cost to their health insurer have their insurance rescinded for some minor error in their paperwork. Rather than being difficult and requiring a court order, it’s common practice.
“About 25% of people who become a net cost to their health insurer have their insurance rescinded for some minor error in their paperwork. Rather than being difficult and requiring a court order, it’s common practice.”
Source please.
If your health insurance is unilaterally rescinded by your insurer over a minor error in your paper work, your health insurer has likely committed bad faith. (An independent tort) They can certainly send you a letter and tell you they won’t pay, but then you get to sue them, retain coverage and get damages including punitives.
The insurer can say anything they want. Even take actions based on their position. That doesn’t mean they are right or have taken a legally defensible position.
Now if the “minor” error is something like failing to disclose you have cancer – then the insurer probably wins – but that’s not really all that minor is it?
Strangely enough, poor people don’t have the resources necessary to hire a lawyer to sue for a tort. And that’s not even mentioning if their coverage contract kicks disputed claims into “third-party” binding arbitration.
Poor people are represented in tort cases all the time without putting a dime on the table up front – or at all unless they win.
It’s called contingency fee representation.
Also – arbitration is not bad for the insured. It is effectively a trial before an arbitrator rather than a judge and jury. It very often gets a good result much faster than jury trial.
Yes, they exist. Now let’s talk about lawyers who might actually have a chance (quality and resources necessary to) beating an insurance company. How much do they bill out per hour?
Third-party arbitration, especially those guaranteed by contract, tend to be pretty bad for the appealing claimant.
“Yes, they exist. Now let’s talk about lawyers who might actually have a chance (quality and resources necessary to) beating an insurance company. How much do they bill out per hour?”
Are you seriously arguing that contingency fee lawyers lack the resources and talent to beat insurance company lawyers? That’s just wrong.
There are many many many very talented trial lawyers who do nothing but contingency fee work on behalf of plaintiffs. They beat the snot out of insurance companies all the time. I mean to tune of billions of dollars per year. In fact, plaintiff side work against insurance companies is some of the most profitable in the country, which draws some very talented lawyers to it.
Yeah there are bad lawyers out there, but whether they charge by the hour or based on contingency has no bearing on the quality of their work.
The fact that arbitration awards tend to be less than jury awards doesn’t make them bad.
The fact that arbitration awards tend to be less than jury awards doesn’t make them bad.
I agree. But then again, the article I linked to was primarily not about that.
re:contingency-fee based lawyers
If you’re in the industry, I’ll yield to your expertise on this one.
“I agree. But then again, the article I linked to was primarily not about that.”
Ummm – yes it was. All of the criticisms leveled in that article have little meaning to the insured except in that it may lower awards. In fact it includes a chart comparing jury and arbitration awards in med mal cases.
Um, no it wasn’t. In fact, besides the difference between arbitration award and jury awards, the article also mentions:
1. Higher use costs
2. Arbitrator bias
3. No access to a discovery process
In specific applicability to the insurance context, the article notes:
“The case of Southern United Fire Insurance Company v. Pierce, 775 So.2d 194 (Ala. 2000) demonstrates how an insurance company may draft an arbitration clause to insulate itself from damages for bad faith refusals to pay claims. The clause they used required panels of three arbitrators, tripling the fees that the consumer must pay to have his case heard. The clause also prohibited the arbitrators from allowing discovery of “evidence relating in any way to a transaction other than the [consumer s] specific transaction.” This restriction makes it impossible to prove that the company engaged in a pattern of improper denials of claims, a crucial element of establishing a case for bad faith activity.
“1. Higher use costs
2. Arbitrator bias
3. No access to a discovery process”
None of which matters to the plaintiff except in that it can cause lower awards (or in the case of higher fees eats in to the award.)
Come on – you really don’t see this?
I’m not saying it’s a perfect system. All I’m saying is that binding arbitration has it’s advantages as well. Also – guess what, you can negoatiate the arbitration clause out of your contract at the outset.
Well, the higher use costs may discourage the would-be plaintiff from ever filing a claim, reducing their reward to zero.
Also – guess what, you can negoatiate the arbitration clause out of your contract at the outset.
That is certainly a comfort to lawyers out there, not so much to people (with no legal or negotiating experience) who are buying insurance.
“Well, the higher use costs may discourage the would-be plaintiff from ever filing a claim, reducing their reward to zero.”
I understand your point here, but in the vast majority of cases that’s not how it works. The lawf irm representing the plaintiff fronts the costs.
“That is certainly a comfort to lawyers out there, not so much to people (with no legal or negotiating experience) who are buying insurance”
I get this – and it’s a good point.
The biggest issue I see is the shortage of doctors, which contributes to higher prices. If we instituted government-paid, universal health care, tens of thousands of people would still die due to lack of care every year. They’d just be on a waiting list when they died. We need to address the shortage of medical workers before any other change will have much impact.
Your shortage of doctors will end when you start training them for free, or at least having the government lend them the money at base-rate interest to train.
It’s hardly free in the UK either … have you seen how much they are charging for Doctor’s exams at the moment. Then there’s the courses you really need to do if you want to pass. Yes it may not be at the type of levels in the US but it’s certainly not free.
Er…. Yes it is! Well, to all intents and purposes. Your education gets paid for, and you get a bursary for a chunk of your education. You get loaned enough to cover the rest. Then you walk into a £120,000 per-year job.
in what world is a loan free? i have loans, and they are definitely not free.
don’t know which health trust you work for but my better half’s bursary doesn’t even begin to cover the costs of education and there is no mention of loans — 120,000 grand a year, yes some doctors do get paid that but we’re talking about consultant not all doctors. I’m not saying that doctor’s are badly paid but if it was that easy we would all do it wouldn’t we?
The GP contract STARTS at £140,000 per year – that’s entry level.
Where on earth do you get those figures from … are you saying that a medical graduate starts on £140,000 a year? Oh and I know a couple of GPs and they certainly don’t earn that sort of dosh. Not badly paid but £140,000 a year, no.
“I know our politicians are trying to do what is in the best interest of Americans”
Now *that’s* funny!
Maybe I should change “I know” to “I hope”… :)
Nah. Just change “Americans” to “the insurance companies”.
“Imagine the freedom to create and take risks that could result if people didn’t have to worry about keeping a crappy job for the health care for them and their families.”
This is exactly right.
I sold off my shares in a company I helped start and moved to another state so that my wife could pursue her dream and become an architect. While she is able to get health insurance through the university, I can’t afford to pay for a house, car, full time university student in an expensive program, health insurance for her, and health insurance for myself. Something had to go. So I don’t have health insurance.
My options are to go tell my wife to forget her dreams, to go massively into debt for her education forcing her to spend the rest of her life paying it off, or to forgo healthcare for myself and just hope nothing bad happens during the six or so years of her education.
This is what freedom from healthcare restrictions means. It means I could do what I’m doing now, and not be taking the huge risks that a 40 year old man with no health insurance is taking. And this risk is a huge net win for the country. In four years or so, a brilliant woman will be entering the workforce with a first class education and the drive to use it. She’ll be paying taxes into the system, and helping make the world a better place through her work (she’s specializing in sustainable design).
Or, I could have kept my job out of fear of losing my insurance, my wife could have ditched her dreams, and we could all be working for the insurance companies by proxy.
Cutting the ties between employment and health insurance is one of the best things we can do for both the workers and the employers.
As I’ve mentioned before, I am a student nurse and I work placements in National Health Service (NHS) hospitals. I think, therefore, that I can offer a pretty qualified opinion on this issue.
Firstly, I would like to say that I think you’re aproaching this from the wrong angle. Universal healthcare is not about reducing costs, it’s about social equality. That said, there are many, many flaws in the NHS, and I will try to address them now as I point out why it’s still something that Britain needs to be incredibly proud of.
The cost to the US economy of citizens on welfare and out of work (i.e. NOT paying taxes and NOT consuming goods at the rate an employed person does) could be HUGELY reduced with universal healthcare, but it’s a long-term commitment. As with the NHS, treatment for chronic conditions associated with ageing, such as arthritis, senility, heart disease, stroke, etc. must be available to those who need it in order to prevent human suffering, however in isolation treatment entirely misses the point.
The focus of the NHS has shifted. It’s now not about treatment, it’s about prevention. I myself am an excellent example; I am overweight – in fact, I’m technically obese. The NHS provides me with weight-loss medication that costs £120 (about $200) per month at no cost to me. Why? Well, I’ve lost 2 stones in the last three months – and if the NHS can help me to lose weight and keep it off, then £120 per month for, say, ten months, is going to be paid back ten-fold by my improved health enabling me to continue contributing to the UK economy and by my risk of obesity associated illness (such as heart disease) being greatly reduced.
Similarly, the NHS paid for nicotine patches to help me quit smoking three years ago. The payback: Less risk of cancer, more likelihood that I will live out a healthy, productive TAX-PAYING life.
But let’s have a look at treatment for a moment. Right now, I’m on a surgical ward. One of my patients has been in for an open surgical dislocation and relocation of the hip. He needed it because he fell from his bike. He’s 17 years old. Now, answer me this: Would it be better for society if he lived in the US and went on to welfare for his entire life because he wouldn’t be able to work due to his inability to walk or handle the pain when he moved? Or is it better to spend maybe £100,000 (about $160,000) to fix him up and get him into shape to work and live a decent life?
I have another patient of 19 who’s just had a surgical fussion of her L4/5 vertebrae, which were damaged when she was beaten up outside of a pub. In America, a so-called “Christian” nation, she would have been doomed to spend the rest of her (significantly shorter) life in agonising pain. In the UK, we’ve fixed her up and she’ll soon be on her way. Could the child of working-class parents in the US afford life-changing spinal surgery? I doubt it.
All of this is not to say that the NHS cannot improve. We badly need to stop doing elective surgeries such as rhinoplasty and breast-reduction except in cases of genuine health risk or deformity. Those are the procedures which are bankrupting us.
The bottom line for me as a nurse, though, is very simple: I could never refuse to care for or treat a person in need, no matter who they are. Anybody who could is not a nurse. To me they’re probably not even a human being if they could have so little compassion.
No kidding.
No one wants to come out and say it, but the whole debate really does boil down to one issue: Do you believe that your fellow Americans should be allowed to die because they are poor?
And the whole, “ERs can’t refuse service based on non-payment” argument the talking heads like to trot out is a complete non-starter. Most people don’t die of car accidents or gunshot wounds. They die of slowly progressing diseases that are more easily treatable in the early stages. Things like congestive heart disease or diabetes. The exact things that people without health insurance don’t know they have until they are being rushed to the hospital because they are dying of it.
How much cheaper is it to get someone into the doctor early, to discuss diet and cholesterol medications, than it is to do a fiveway bypass at taxpayer expense? Or, do we just let them die? Because if it’s about money, that’s really the cheapest option.
Private hospitals rarely have ERs. Mostly they’re the province of charity hospitals and state-owned facilities. Want to know what a private hospital in the UK does when a patient has a heart attack? They call an ambulance and ship them the the nearest NHS Accident and Emergency Department in record time. It’s a similar story in the US. Private hospitals are DESPERATE to avoid liability for somebody dying on their premises.
Most hospitals in the US get some amount of federal or state funding, and are therefor required to maintain an ER facility.
But I bet the private facilites ship people off to state facilities ASAP!
How much cheaper is it to get someone into the doctor early, to discuss diet and cholesterol medications, than it is to do a fiveway bypass at taxpayer expense?
Considering that humans generally are very, very bad about risk/reward calculations over the long term, this is actually an argument for not changing things. If everyone has comprehensive health coverage, making the marginal cost of listening to your doctor and taking statins and not eating bacon equal to eating bacon for twenty-five years and then having a bypass, there will be insufficient pressure on people to actually alter their behavior.
Especially because bacon tastes good.
Look, there are some really depraved people (who tend, for who knows why to gravitate towards the GOP) who do in fact think that poor people dying is not a big deal. But that is *not* by any stretch the only thing in play, or even the core, pragmatic issue complicating the actual achievement of universal medical care in the US.
I dunno, it’s a pretty big part of it as far as I can see – Reichpublitards couldn’t give a rat’s arse about anybody outside of their own demographic!
“Considering that humans generally are very, very bad about risk/reward calculations over the long term, this is actually an argument for not changing things. If everyone has comprehensive health coverage, making the marginal cost of listening to your doctor and taking statins and not eating bacon equal to eating bacon for twenty-five years and then having a bypass, there will be insufficient pressure on people to actually alter their behavior.”
I’m not advocating forcing them to change their diet. But we’ve at least made them aware of the situation and given them the option to fix it. Some percentage of people (and probably higher than you think) will make the choices that are good for their health. That number will only go up the more accessible we make health education and early health care.
If people insist on making the wrong choice, then they will have died because of their choices, not because of their inability to pay.
“But that is *not* by any stretch the only thing in play, or even the core, pragmatic issue complicating the actual achievement of universal medical care in the US.”
I disagree. The rest of it is hand-waving and smoke screens for this core issue.
Are you telling me there are some people out there who are actually unaware that bacon is bad for you?
I disagree. The rest of it is hand-waving and smoke screens for this core issue.
Well, then I don’t know what to tell you. Ascribing to your opponents such motives may make you feel morally superior, but it is almost never accurate.
Read Sundog’s post below. And again, give me one good argument that isn’t about cost.
“Are you telling me there are some people out there who are actually unaware that bacon is bad for you?”
I’m telling you that there are a LOT of people who eat bacon who’ve never sat in a doctors office and had the doctor say, “You cholesterol is too high, you are working your way toward congestive heart failure, and if you don’t take this medication and change your diet, you will die.”
“Bacon is bad for you” is distant and ephemeral, “You personally will die if you eat bacon” is immediate.
“You personally will die two-and-a-half decades from now if you eat bacon, maybe” is about as ephemeral and certainly as distant as “bacon is bad for you”.
It’s not about knowledge it’s about your locus of control. An awful lot of people think that “whatever will be, will be”. I hear a lot of people talk about how “My granny lived to 95 eating lard sandwiches for tea and smoking blacktop rolled in cigarette papers 100 times a day”. The thing is, it does happen occasionaly, and everybody knows somebody who it applies to – and everybody uses it as their favourite excuse to externalise their locus of control.
And is a complete strawman.
No doctor can tell that plaque buildup is leading to congestive heartfailure two and a half decades out.
That conversation doesn’t happen until their is visible plaque in the chest x-rays, and too high cholesterol in the blood tests. At which point it is years away, not decades. And, also, is a conversation that only happens if you have access to regular preventative care and checkups.
“Are you telling me there are some people out there who are actually unaware that bacon is bad for you?”
yes, yes there are. my mom works for an insurance company, she calls people to help them with their preventable health problems, like obesity. i’m amazed at how many of these people are genuinely unaware that eating deep fried foods every day is not healthy.
not that she told me about that because that would be a breach of confidentiality and nobody would ever do that.
Let me ask this:
Can you give me one good argument against UHC that isn’t about the cost?
“The NHS provides me with weight-loss medication that costs £120 (about $200) per month at no cost to me.”
“…, the NHS paid for nicotine patches to help me quit smoking three years ago..”
I can see the headlines the the Daily Mail now!
Ah, the Daily Mail. A newspaper founded by Oswald Mosely (who also founded the British Union of Fascists), and whose first ever headline was “Hoorah for the Brownshirts!” (the Brownshirts were what the Nazi party was known as before they took power).
To go back to your original post. I didn’t think the NHS spent that much on “cosmetic” surgery as this was only performed for mental reasons.
You’d be shocked. People have learned that they can go to their doctor and say “My ears stick out” It makes me teh sewi-side-all!”, at which point they get referred for surgery. It’s bullshit and needs to be fixed.
But how do you fix it? Any system is open to abuse so they only way to completely stop that abuse is by not proving the system in the first place. My better half is a doctor so I’ve ended up speaking to quite a few other doctors over a few drinks and I remember one of them launching into what was almost a rant about how she had signed off sick a number of members of the same extended family with back problems all of which basically trotted out the same set of ‘symptoms’. Is it worse that this happens or is it worse that people who really are ill, but with conditions that are self reported, go without care/benefits?
Can someone please spell out in spades why they think people have a *right* to health care? Lots of people say they believe this, but I have heard no sound philosophical reasoning behind it. Just curious to see if someone here can provide it.
For me it’s about a moral choice. It’s the choice between society doing its best to prevent citizens from dying in pain or generally suffering needlessly, versus making profit from people in pain. It’s a no-brainer to me.
We hold these Truths to be self-evident, that all Men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.
OK, hypothetical question:
A low earning young man lives in the richest country in the world. He develops cancer. He can’t afford to pay for his treatment and he can’t get insurance because it’s a pre-existing medical condition. Should his government:
a) do something?
b) do nothing?
The government should do nothing. He is an unlucky loser who doesn’t deserve to be carried by everyone else. It’s his own fault he’s sick and poor and why should everyone else have to pay for that piece of crap to get medical care?
Sure, in the end he’ll wind up in the emergency room and it’ll cost us all ten times as much to deal with the system’s failure to prevent or treat his illness when it was cheaper and more manageable, but that’s not the point. I want to keep my money for me, and I want a free market, where the rich people can keep making a vast majority of the money by bilking the middle class and denying poor people any access to the american dream. I mean, it’s so stupid to want everyone to have a chance at living a healthy life with as little suffering as possible. America is about greed and selfishness. Screw community and other people. Let them suffer.
Isn’t the religious right lovely??? They are so christ-like.
Universal health care reduces costs, because people can get preventative treatment, which is cheap, rather than waiting until they need to go to the ER, which is very expensive.
The US government spends $4,000 per person on health care, topped by an average of $2,000 of private spending, and 15 million people still don’t get access to non-emergency care. The UK, by comparison, spends $3,000 per person, with negligible private spending, and that is sufficient to make health care of the same standard universally available. Of course, Britain uses a single payer model which is far more efficient (and therefore “communist”) than anything that an American politician would dare propose.
I would much MUCH rather pay an extra 3000 a year in taxes and get UHC for everyone, than pay twice that much to an insurance company that will drop me the second I get cancer.
Dingdingdingding! Want to annoy a capitalist? Read Adam Smith’s “The Wealth of Nations”, the book which invented capitalism, and note that he spelled out very clearly that some things should never be run for profit – such as education and healthcare. Tell a capitalist that, though, and see how far it gets you.
It is fun to razz someone who doesn’t know the intellectual history of their own belief system. On the other hand, Adam Smith turned out to be wrong about quite a lot; being the founder of a science or discipline does not make one the font of wisdom for all time. Usually, actually, it tends to mean quite the reverse (since if the discipline is fruitful, we move from a condition of relative ignorance in the founder’s time, to a condition of being relatively more knowledgeable.)
I have to say that I do NOT accept Health Care as any sort of right; no matter what system is in place, it is a privilege that must be paid for. Currently, in the US, the system is that if you personally can’t pay for it, you don’t get it. And one thing to understand is that this system, though harsh and seemingly unfeeling, has actually served the United States as a whole rather well, playing an effective part of the overall economy and serving the populace in it’s prescribed purpose effectively, if anything but perfectly.
IF we want to change it, and it seems that a fairly large proportion of the population does, we have to accept that what has been a net economic gain will now almost certainly become a net economic loss. I have to question whether this is an appropriate time to introduce such a loss, given the economic drain of a serious recession and two wars.
Even if it is, I cannot think that any simple system will do the job. Nor do I think the US should look too hopefully outside it’s own borders; systems designed for 20 or 80 or 150 million people could far too easily be swamped by 350 million. Nor should we seek an all-encompassing panacea – if the Histories of the NHS in Britain, Single-Payer systems in Canada and Medicare system in Australia teach us anything, it is that the problem will get worse, not better, while the new system works out all the bugs involved.
Finally, the system will not work without public support. Unless some form of accommodation can be found with opponents of the system, the chances are good that the new system will collapse – leaving the US with no health care system at all, even a flawed one.
“….one thing to understand is that this system, though harsh and seemingly unfeeling, has actually served the United States as a whole rather well, playing an effective part of the overall economy and serving the populace in it’s prescribed purpose effectively…”
Can you qualify and quantify that, please?
The majority of the populace has had some form of health care, and the insurance system has made and distributed money, as any for-profit organisation/s should, in this case often by quite large amounts.
“The majority of the populace has had some form of health care, and the insurance system has made and distributed money”
I’d think the bold bits are open to debate.
Not really. If the majority of the population didn’t have at least minimum health care, we wouldn’t enjoy the quite healthy and functional working populace we have. And for the Insurance companies to do their jobs, they have no choice but to distribute the majority of the money they take in, just like any other service industry. The truth is that most of the Insurance Companies are ethical, and do their jobs well – but like all industries the few bad apples receive all the publicity.
Which is not, mind you, an argument in favour of Insurance-based Health Care, only a point that they are not the monsters sometimes portrayed.
You live in a country with 30 million unemployed people, a fair chunk of whom are out of work due to illness and/or disability. I’d call that an issue!
Actually, to be fair, I don’t live in the US, though much of my family does.
And having traveled in Africa and SE Asia, I’d call that sort of percentage chump change.
Uhu – but pretty hefty compared to, say, France.
True. Which is why I am not opposed to reform. I merely want to be CERTAIN, before hand, where the money’s coming from and that we’ll end up with something better than what we’ve currently got.
Life is risk, there are no certainties.
Look, before you leap.
LOL, Yah lets compare America to 3rd world countries, that makes lots of sense.
“And having traveled in Africa and SE Asia, I’d call that sort of percentage chump change.”
But it serves when contradicting the concept that our current system does not function effectively. If it did not, we WOULD have a third world health system, when in fact our system is actually reasonably effective and robust.
I may be misremembering, but I had thought ours was actually rated at the bottom of first world countries.
I don’t have the statistics to hand, but there is a BIG gap between even the worst Western state and the third world.
@Ty
For quality of care per-buck you may be right …
These are the facts:
We are last among industrialized nations in terms of many health outcomes.
We do excel in cancer treatments and technology (if you have the money).
We spend twice as much per person as the next highest spending country (Canada) IN THE WORLD.
Our current health care system is only as “robust” as an individual is able to pay for care and will be soon out of reach for most Americans if we do not change.
The “best” private insurance company has 20% overhead. Denying care is rewarded as a “Profit Center”. CEOs average 22 million per year. United Health’s CEO “earned” 750 million over 5 years. FOR WRITING CHECKS! What a racket, Huh? Not that bad? These people are parasites: they literally suck the blood of the American people and add no value.
At least Sundog has the balls to admit that the issue is about money. If you can’t pay, you don’t get health care.
While I find that perspective borders on the edge of sociopathic, I at least admire it for it’s clarity. Sundog is pretending it’s about something else.
Sorry, Sundog ISN’T pretending it’s about something else.
Look, it is about cost, one way or another, and it has nothing to do with “sociopathy” or whatever other colorful descriptions people come up with for the people pointing out the unfortunate but unavoidable truth that health care does not grow on trees or fall from the sky like rain. Diagnostic machines must be built and serviced, doctors must be paid, hospitals built, and medications developed and manufactured.
I pointed out seven ways above that the US could start providing greater coverage without, y’know, bankrupting the nation. Nobody has yet responded to any of the ideas I outlined. The idea that a person who is concerned about cost “must want poor people to die” is psychologically self-serving, but irresponsible. It is a real concern that needs to be addressed by any serious reform effort.
I agreed with one of your points, which was that we need to separate health care from employment. So, ‘nobody’ is incorrect.
And the whole ‘bankrupting the nation’ thing is a complete strawman as well. We are the wealthiest nation on earth. I can name a dozen far less wealthy nations that are providing UHC to their citizens all without bankruptcy.
The issue is NOT bankrupting the nation. The issue is, “I don’t want to pay any more in taxes.”
And while some people will place their own bottom line above the healthcare of the nation, I consider that a position that requires compartmentalizing away the fact that people will die because of it.
Look, I hold some positions that flatly place certain things I value over a potential other person’s life. If you break into my house and threaten my wife’s safety, I will blow you right out of your shoes with a shotgun if I get a chance to do it. But I am willing to admit that I value my wife’s safety, and heck, the general right of property owner to the sanctuary of his home, over the life of a person who threatens either of them.
But I admit I am making the choice. I’m not hiding it away as some other issue. My problem with the people who want to say, “It’s complicated” is that I think they’re clinging to that complexity out of a need not to just admit, “I value my tax dollars over the healthcare of poor people I’ve never met.”
I have a response to you Nope that is being help up by moderation. Not sure why.
I bet you mentioned the s0ciali-sm word!
Probably because it’s some kind of moderation-tripping socialism… ;)
Except the part where I freely admit I would blow someone back to god for breaking into my house. That’s pretty far from tree hugging liberal socialist.
Ah, the correct use of “it’s” … maybe American English isn’t so bad!
I live under the poverty line, so it is extremely unlikely that my taxes (such as they are) would change either way. So it is clearly not what is motivating me.
Look, the rhetoric that the US is the “wealthiest nation on Earth” is nearly meaningless in this discussion. What matters is not total wealth, but the difference between wealth and expenses. Inflation is not an infinite money machine, and “a trillion dollars here or there” has real economic effects, and when they are expenditures that are not offset, none of those effects are pleasant.
If I had latitude to unilaterally change the nation’s priorities, I would gut the military to a shell of its former self and give everyone gold-plated medical care, a personal laptop computer, and a fluffy teddybear. BUT. THAT. WILL. NEVER. HAPPEN. The difficulty is finding a way to pay for universal health care in the current political context.
It would involve a tax increase, as I’ve already noted.
The issue is not whether we can pay for it or not. The issue is whether we will agree to pay for it or not. Which is why I keep saying that the only issue is whether your money is more important to you than the health of a poor person you don’t know. And that is, once again, the ONLY issue.
All of the arguments against government plans mention “how will we pay for it?” And what that really means is, “how will we pay for it without me having to?”
When I say “How will we pay for it?” I mean exactly that. If I were lucky enough to be wealthy, I would have no problem paying more (let me tell you some time about my views of progressive taxation…and get good and drunk first so you don’t get bored). My problem is with the notion that we should do something first and then figure out how to pay for it later, as if that is a trifling detail.
Leaving work now…will continue in about an hour. :)
If you’re leaving work at 11pm on a Saturday, then your life sucks enough without us adding more taxes to it. You get a pass.
LOL. Just got home. I have another shift tomorrow at 8 am. :)
I dunno, I find discussing politics and religion to be relaxing. But that might be because I am weird.
You’re weird, but that’s the least reason for it.
“Look, it is about cost, one way or another, and it has nothing to do with “sociopathy” or whatever other colorful descriptions people come up with for the people pointing out the unfortunate but unavoidable truth that health care does not grow on trees or fall from the sky like rain.”
Look – nobody is debating that healthcare for all comes at a cost. We have to pay for it. That’s true. Not even the most strident socialist (which pretty much describes me), would disagree. The disagreement is over whether it’s worth it.
On that point you have to admit a certain “sociopathy” (ok perhaps a bit strong but I assume you get my point) in that many people are willing to say it’s not worth it because the impacted people are poor. In this country we have a long history of regarding the poor as deserving of their lot in life, lazy etc… (In my opinion, there is a sub-theme running through this in that so many of America’s poor have brown skin, but I will leave that for another day.)
We as a country make decisions all the time in which we say “money is no object.” Millitary spending is a great example. I don’t understand why we can’t take that same approach with what may be the most important decision we as a nation face – the health of our fellow citizens.
“I pointed out seven ways above that the US could start providing greater coverage without, y’know, bankrupting the nation. Nobody has yet responded to any of the ideas I outlined.”
I responded above. I like some of your ideas a lot.
Ironically, one of your ideas is a “real public option.” I’m failing to see how that differs from universal care. It will effectively eliminate private health insurance over time, in that a public option will eliminate profit motive, lower costs and still provide the same level of care. Once people see that socialized medicine is the same as for profit medicine they will flock to it.
I agree with your notion that we should not run these programs at a deficit, but I say that about government in general. That translates in to higher taxes though – which I’m fine with – but as we all know is the “third rail” of American politics.
On that point you have to admit a certain “sociopathy” (ok perhaps a bit strong but I assume you get my point) in that many people are willing to say it’s not worth it because the impacted people are poor. In this country we have a long history of regarding the poor as deserving of their lot in life, lazy etc… (In my opinion, there is a sub-theme running through this in that so many of America’s poor have brown skin, but I will leave that for another day.)
I’ll give you that some definite sociopathy and racism motivates some (i.e. a substantial minority) of the opponents of UHC; I think though that too often this is overblown to mean “all opponents are racist sociopaths”.
Ironically, one of your ideas is a “real public option.” I’m failing to see how that differs from universal care. It will effectively eliminate private health insurance over time, in that a public option will eliminate profit motive, lower costs and still provide the same level of care. Once people see that socialized medicine is the same as for profit medicine they will flock to it.
Well, it could go that way, or it could lead to a market equilibrium similar to USPS/FedEx/UPS. Either way is fine with me.
I agree with your notion that we should not run these programs at a deficit, but I say that about government in general. That translates in to higher taxes though – which I’m fine with – but as we all know is the “third rail” of American politics.
I am really glad to hear this (and just because it is impossible to decipher sarcasm over teh Internetz during earnest discussions, let me be clear this is NOT sarcastic). It is hard to discuss problems of cost with folks who think the government can simply print its way out of problems.
“I am really glad to hear this (and just because it is impossible to decipher sarcasm over teh Internetz during earnest discussions, let me be clear this is NOT sarcastic). It is hard to discuss problems of cost with folks who think the government can simply print its way out of problems”
And to be clear I’m dead serious about this. I believe strongly in government’s ability to improve the lives of citizens throughs social programs. I also believe strongly it should have to be economically responsible in doing so. Both US parties have failed miserably on the later point.
Agreed.
I’m using the word sociopathic very purposely. You have to see the people affected as not real people for most of these arguments against UHC to work.
I admit that my stance on self defense requires a degree of depersonalization of my opponent. They are not a human with a mother and friends and goals in life. They are “The guy who broke into my house and so needs to be blown the hell away.”
The people who don’t get healthcare because of our financial concerns about it aren’t real people. They are faceless group. They are not Lisa, mother of three who works at Burger King, doesn’t know about proper nutrition, and will come down with debilitating diabetes because she can’t afford the simple doctor’s visit and blood test that would have caught her blood sugar dysfunction early enough to stop the progress of the disease.
And that is a depersonalizing of the people we are affecting with our decisions. And that is sociopathic.
Am I wrong?
Gah, not purposely, purposefully. sheesh.
Sociopathy generally involves the *incapacity* to think of other humans as people (usually because the sociopath is incapable of feeling empathy), not the deliberate choice to abstract away that personhood for some other end. That has a different name.
Evil.
Now you and I disagree fundamentally, I think, on whether that’s actually what’s going on, here. I think it is reasonable to point out that if you don’t know how to pay for something, and plunge into a multi-trillion dollar program full speed ahead, it probably will have *massive* unintended consequences (wrecking an economy would indirectly kill many more people than incomplete health coverage currently does). I think it behooves a civilization to think carefully before underwriting massive changes to its infrastructure and habits.
I acknowledge that the status quo is fairly intolerable. I just recently had a health scare with Lyme Disease, and I am uninsured, and I nearly went undiagnosed because I held off care longer than was wise (due to not having any money). Many people are in a far worse situation than I am. But, much harm has been done historically by people trying to fix the problem in front of their face and managing with their solution to create ten more in its place, and that is reason to pause and consider.
@wintermute — based on your interpretation of the Constitution, wouldn’t we need taxpayer funded programs for Universal Liberty and Universal Happiness?
The freedom not to die in pain is a pretty important liberty, I’d have thought.
We do have a taxpayer-funded universal liberty program. It’s called “the police”.
*applauds”
Amazing how social institutions like the police and fire service get glossed-over by Reichpublitards.
i don’t think comparing our enemies to Nazi’s is going to get us anywhere.
*scratches head*
Republicans… Fascist retards… No, I don’t think I’m making that comparison. I think that the GOP did that all by themselves when Carribou Barbie was nominated for the VP spot.
The police do not guarantee that you exercise your liberty. They guarantee (somewhat) that others do not infringe on it.
Life Liberty and the Pursuit of Happiness are not rights set forth in the US Constitution, they are part of the text of the Declaration of Independence. While an important historical document, the Declaration does not confer rights on US citizens.
Legal rights are conferred on US citizens through the Constitution. Particularly through the Bill of Rights. The Constitution does not on its face confer a right to healthcare. Nor has any Court interpretted language in the constitution to confer such a right.
I support universal single payer government run health insurance, but there is no federal legal right to it. (As far as I know there isn’t a single state that has conferred such a right either, but I could be wrong on that.) You could perhaps say there is a moral obligation to provide health insurance, but it is not a “right.”
But “…form(ing) a more perfect union…” and “…promot(ing) the general welfare…” are in the constitution. They’re upfront in the preamble and therefore apply throughout.
Also note these words are in the context of and follow the DOI.
That we have not (yet) chosen to specifically point out that access to health care to support “life” was one of the fears of founders when the Bill of Rights was added, i.e., that a right is not specifically stated does not mean it does not exist (so many negatives!).
That’s not how the preamble works. Please point me to a case in which a Federal Court has held that the preamble to the Constitution confers a right on US Citizens. (Hell I’d take a State Court ruling if you could find one.)
“Also note these words are in the context of and follow the DOI.”
I don’t know what this means? The preamble to the consitution is also is in the “context of” and “follows” the Magna Carta, that doesn’t mean that the Magna Carta confers rights on Americans though.
“That we have not (yet) chosen to specifically point out that access to health care to support “life” was one of the fears of founders when the Bill of Rights was added, i.e., that a right is not specifically stated does not mean it does not exist..”
On what basis would such a right exist if not enumerated in the document that confers rights on citizens?
The Constitution provides a mechanism for amendment. If healthcare is to rise to the level of a right, that mechanism needs to be used. Either that or someone needs to convince a Federal Court that existing language confers such a right, which is very unlikely.
“On what basis would such a right exist if not enumerated in the document that confers rights on citizens? ”
Might I point out the tenth amendment?
Text of the 10th Amendment
“The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.”
Apparently you are trying to make some kind of federalism argument, but I’m missing it. Are you implying that there aere states who have raised healthcare to the level of a right? There are none that I know of, but as I indicated above I could be wrong about that.
Even if that were the case, I fail to see that addresses the question of a national “right” to healthcare which is what was being argued over above.
OOPS! Sorry, I meant the NInth.
Text of the 9th
“The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people”
Ok – interesting argument – I assume you are arguing that healthcare is among the unenumerated rights contemplated in the 9th Amendment but retained by the people. In order for this argument to work, you would have to convince a Court, which is not unprecedented. The 9th Amendment played a role in the finding of a constitutional right to privacy. (I think it was in Griswold v. Conn. It was not the sole basis of the ruling though.)
A 9th Amendment based argument has been used in other contexts though, and has failed. I believe people have argued a 9th Amendment right to posess drugs and avoid the draft, both of which were shot down.
In short, this is a novel argument but not one that is likely to win the day. Particularly with the current make up of the Supremes.
Actually, I suspect you are correct. But it is an interesting viewpoint to consider.
Never quote law at a lawyer. It’s like giving boxing tips to Mike Tyson. It will only end in sorrow.
“But it is an interesting viewpoint to consider.”
It is really interesting. Might even be fun to argue. I just wouldn’t bet the house on winning it.
Generally the courts have taken the view that the Ninth protects, if anything, only negative rights (such as the right against invasion of privacy). You would never be able to sustain a positive right to something (to health care, for example) using the ninth, under current jurisprudence.
And for good reason. Positive rights (if such thing even exist) are the purview of the legislature, whose job it also is to figure out how to pay for its providence.
My point re context is that there are many assumed conventions and history that couldn’t possibly be written down in any one document. As you stated, the magna carta and English common law are examples of legal structure not expressly included in the constitution but that form the context in which the constitution is implemented. Hence, I posited that the DOI is part of the context.
Context is nice, but it’s not where American “rights” come from. That’s all I’m saying.Tthe discussion was about healthcare as a right – and there is no support for that idea in our federal law.
Again, I support universal health insurance. I think it’s a good idea. I think we should do it. I think we should feel morally obligated to do it. I feel morally obligated to do it.
But as things stand right now we don’t have a “right” to it.
@windermute — correction, I meant the Declaration of Independence
The other obvious point is that having a healthy population is good for everyone, and should therefore be paid for by everyone.
If your next-door neighbour has tuberculosis, that is a direct risk to you that is worth paying to avoid. If the guy making your morning bagel has a persistent cough, but can’t afford to see a doctor about it or take time off work, don’t you think it’s in your benefit to see that he gets treated?
Apparently not. You’ve made no effort to inform yourself about even the most rudimentary facts. You open with a statement appalling in its ignorance of both health care and general economics:
In general economic terms, economy of scale generally reduces cost. Just providing the same level of care to more people will reduce the per-person costs. Additionally, people not receiving care are not consuming care.
Secondly, if you had sought out even minimal information about the state of health-care economics presently implemented in the United States, you would have discovered that a substantial amount of cost goes into “underwriting”, i.e. determining who gets what care. If everyone automatically gets health care, this cost simply disappears.
Given that you’re starting out woefully ignorant and stupid, it’s a waste of time to proceed further.
‘Tis indeed true: Sometimes an atheist is someone with only one fewer stupid idea than a theist.
How does charging in like a complete ass-hat educate anyone, or foster rational debate?
I disagree with Daniel on this topic, and even so I will tell you you’re a dick. Go away and let the grownups talk.
ROFLMAO! I went for the subtle way of saying the same thing :-D
I really don’t see the need to get personally insulting on this point. UF is known for mature debate, and ad-hominem attacks like that are out of place.
In general economic terms, economy of scale generally reduces cost. Just providing the same level of care to more people will reduce the per-person costs. Additionally, people not receiving care are not consuming care.
Magically? This is a hell of an assumption, and one unlikely to actually be true in this case since costs are dependent in part on available suppliers (a number which would remain essentially static). When consumption demand goes up and supply remains constant, price usually does something other than what you’re describing. Economy of scale reduces cost only when supply can be scaled to match demand. In all other cases, costs go up.
Secondly, if you had sought out even minimal information about the state of health-care economics presently implemented in the United States, you would have discovered that a substantial amount of cost goes into “underwriting”, i.e. determining who gets what care. If everyone automatically gets health care, this cost simply disappears.
Actually, the cost wouldn’t disappear, it would be replaced by a different cost. Namely, the cost that was previously being minimized by reducing the aggregate demand relative to supply would suddenly appear. Welcome to unintended consequences the hard way. Insurance companies may have adopted evil policies, but they adopted them for a reason. Not understanding that is a great way to fool yourself into thinking that underwriting costs were for the lulz and would magically disappear under a UHS.
I guess you missed that whole “rational” conversation point.
The thing of it is that the founders never thought the government granted rights. The “bill of rights” is really a bill of prohibitions against government. It does not guarantee anyone the right to life, liberty, or happiness, it merely guarantees that the government will not actively usurp these rights. It is restrictive, not permissive. UHC presupposes the opposite.
Additionally, people not receiving care are not paying for care.
Wha…?
I’m not entirely sure what you mean by that. In a universal system the cost is spread across the entire taxpayer base, so we all pay, whether we’re receiving care or not. Currently, every time an uninsured person waits until they’re very ill to visit an emergency room (and can’t pay), the hospital writes it off (usually a MUCH larger sum than any preventive care would have incurred) and Uncle Sam foots the bill. Guess who’s funding Uncle Sam’s bankroll?
it only costs so much because we waited so long to do something. so clearly the solution is to wait another 50 years before we decide on something because it will be cheaper then. right?
or at least most of us won’t be around to pay for it since we died an early death due to poor healthcare.
i don’t pay much attention to politics for fear of a killing rage taking over, but i did hear something interesting a few weeks back, my Senators didn’t want to sign a bill in the Senate because it would screw MN over for not sucking at providing care to it’s citizens. i don’t know what the specifics were, but i found it interesting.
Additionally, we know empirically that most countries with universal health care have a lower per-person cost for care with equal or superior metrics of health.
God save us from you Libertarian fucktards, as stupid, deluded, willfully ignorant and dogmatic as any theist.
None of the other countries have anything like our population, either. Government systems do not gain by economies of scale; rather, as greater levels of bureaucracy are needed for oversight, costs become greater.
Really? Do you really believe that?
By that logic, the armed forces would be cheaper if we broke it up into small groups. Let each state national guard unit negotiate the prices for its Abrams tanks and Apache helicopters.
America spends 50% of the world’s defense budget. And has 5% of the world’s population. Address that issue.
This isn’t about how much we spend on tanks and helicopters and personnel. I’m questioning the logic that it would somehow be cheaper if it was broken up into small chunks rather than one large group.
That’s purchasing, not systemry. Purchasing in bulk is always a good idea, whoever is doing it. Bureaucratic systems, on the other hand, become more convoluted, less responsive and more expensive the larger the system and the larger the area of responsibility.
So the military would run better if they purchased as a group, but split the armed forces up into small independent groups?
A nation’s military is almost by definition a monopsony. As such, it is a poor metaphor for pretty much any other sort of economy.
Ok, then what current federal system would cost less if split into smaller groups?
I just used the military because it was the first one I thought of.
The military is an unusual circumstance, largely designed and determined by factors that have no economic or political point.
Consider, instead, the corporate model and the bureaucratic model. Corporations do, in fact, regularly split themselves in to small, near-autonomous sub-divisions. An area manager must answer to the board for his actions, but is free to take those actions largely as he sees fit.
In a bureaucracy, all actions are subject to review and possible reversal by higher levels. In a good bureaucracy, this happens rarely, but remains a possibility.
Where adding an employee (as opposed to filling a vacancy) in the corporate model is simply a matter of another workspace, in the bureaucratic system it also means ensuring appropriate supervision and chain of control.
To put it more simply, bureaucracies tend to require far more “middle management”.
Thus, the larger the area of responsibility, the larger, proportionally the bureaucracy needed to run it. In many cases, YES, splitting a bureaucracy into multiple, independent groups DOES reduce overburden and waste – provided you aren’t ACTUALLY making an even larger bureaucracy by having to create a bureaucratic system to control all the small ones!
This is true regardless of whether a private business or a public trust is handling the system. Larger scales generally require more overhead.
But, do they require overhead disproportionate to their scale of service? That’s my question.
That depends on the bureaucracy, to a certain extent. But it certainly can.
This is not represented by a comparison of Medicare and private insurance, wherein Medicare has administrative costs around 3.5% and the private insurance companies charge an average of 30%.
Pardon if I have this wrong, but the US Medicare covers only a small proportion of the population, yes? This would therefore require only a relatively small bureaucracy, compared to one needed for the entire population.
Each insurance company only covers a small portion of the population as well.
There you touch on the countervailling point – bureaucracies have no profit motive. So a small bureaucracy can out compete a small company.
It’s at the other end of the scale things become dicey.
Are you claiming that the increase in the number of beneficiaries would cause the admin costs to rise from 3.5% to 30%?
I would say that increasing the number of beneficiaries to the entire population could, quite easily, cause administration costs to rise to well above 30%, dependent upon a wide number of factors, including system design, degree of micromanagement, and state and federal government interference, and many others. To put exact numbers on things would be premature.
@Sundog
“To put exact numbers on things would be premature.”
“I would say that increasing the number of beneficiaries to the entire population could, quite easily, cause administration costs to rise to well above 30%, …”
Ah?
I was stating a possibility. How likely that possibility is depends upon factors none of us can predict or calculate. But I would stand by that possibility.
So presumably you would stand by the possibilty that admin costs go to 90% or even down to 1%, after all as you state “none of us can predict or calculate the odds” all though you seem to be doing your best.
I would say that the 90% range is highly unlikely, barring a sudden and unforeseen epidemic of graft and corruption, but vaguely possible. No, I would not accept 1% – no bureaucracy is that efficient, even the smallest.
I’m not trying to pull numbers out of my ass here. Large bureaucracies DO produce large administration costs, both absolutely and as percentages of their operational budgets, and things in or above the 30% range are something I’d expect from such a large bureaucracy. But the number of factors that go into determining the precise amount of admin costs is very large. If handled exceptionally well, it may well be significantly less than 30%. If handled badly, it could be much higher. Without information that simply is not available, I could not make that call.
@Sundog
“I’m not trying to pull numbers out of my ass here.”
“… and things in or above the 30% range are something I’d expect from such a large bureaucracy.”
So I presume you have some facts for this the otherwise you do seem to be pulling numbers out of your arse.
” Without information that simply is not available, I could not make that call.”
… so why do you insist on doing it then?
I have explained. If you are unable or unwilling to understand, I cannot help you do so.
I think we understand that you are talking out of your ass and refuse to admit it.
@Aor
I don’t mind if someone thinks that it will be more expensive but randomly pulling figures out of the air while at the same time saying that it’s not possible to pull figures out of the air seems a strange strategy.
Ho hum …
@Sundog
I understand fully, you’re pulling figures out of your arse unless you have some facts to back it up.
Aor, Jabster, at least get your criticisms right. Go back and read this thread. I didn’t come up with any figures.
@Sundog
“… could, quite easily, cause administration costs to rise to well above 30%, …”
“I didn’t come up with any figures.”
No course you didn’t, well except the figures you did come up with … the criticism that you are pulling figures out of you arse is well founded unless of course you have some facts to back them up, oh you don’t do you?
I repeat, I didn’t come up with any figures. The 30% figure was brought up by Lowrack, and repeated by you. Also, partially quoting a statement, out of context and inaccurately, is dishonest.
I see no purpose to continuing this discussion, as you are simply repeating a lie. Good Day.
“… could, quite easily, cause administration costs to rise to well above 30%, …”
I’d be interested in what you meant by this statement then? Let’s be honest here, someone pointed out large difference between admin costs and as this wasn’t what you wanted to hear so you decided to claim something for which you had no evidence at all. If you don’t like the idea of universal government funded health care then just say so but don’t just make “facts” up as it’s likely that someone will ask you to justify your statements.
Oh I agree that when you’re just going to pull figures out of you arse, then claim you aren’t and then follow with you can’t put figures on it but do anyway, there is very little point in carrying on the discussion.
It has nothing to do with whether it is a government system or not. In economies where the supply of a good is elastic, economies of scale drive down prices. (Ty’s example of the tank is actually a good one to demonstrate this in action). In economies where the supply of goods is inelastic, economies of scale drive up prices. Medical care actually has a bit of both. Pharmaceuticals, for example, have a relatively elastic supply (companies can make more of whatever drug with little trouble) and so negotiating for a better price by pooling demand is effective at driving prices down. On the other hand, doctors are a relatively inelastic supply (we can’t make more doctors on demand),and so economies of scale for services requiring doctoral attention are not likely to respond positively.
No, we can’t make more doctors on an assembly line. But as someone pointed out, we can encourage the production of new doctors with policy.
Also, we can direct much of the low level care to non-doctor health care professionals. I can see a nurse practitioner for my strep throat and get penicillin without any doctor intervention. I can do my preventative care without seeing a doctor. And nurse practitioners and other non-doctor health care providers can be put out into the work force much faster and much less expensively than new doctors.
We can also reform our tort system in a way that it eliminates costs and encourages broader participation by all medical professionals.
I think part of the problem with this debate is that people talk past each other on what “cost” means. The overall cost of healthcare may go up if universal heath insurance is implemented. After all millions of currently uninsured people will suddenly be insured, and that insurance will have to be paid for.
That being said – based on he models we have seen from other countries – it is likely that the per person cost will go down. In part because of the elimination of profit motive. In part because of the forced decreased costs/pricing. In part because of elimination of things like insurance underwriting.
Both can be true. I think the anti-universal health insurance crowd focuses on the total number, while the pro crowd focuses on the per insured number.
To me this argument is a non-starter either way. Cost should not matter in this debate. Profit/loss should not be a factor in deciding whether all of our citizens have access to healthcare. I’m offended that we have allowed that to become the central issue in this debate.
Thanks for agreeing with me.
I often do
(Even on the apparent deliciousness of mormons.)
“Cost should not matter in this debate.”
Costs will always matter so the question is are US taxpayers prepared to pay for universal health care even if it means that either costs go up or the quality of some people’s health care goes down?
“Profit/loss should not be a factor in deciding whether all of our citizens have access to healthcare. I’m offended that we have allowed that to become the central issue in this debate.”
I agree with you on this, Bill. However, given the way our politics has been subverted by Reaganism and trickle down, cost has become a required element of any policy discussion. Inconveniently for the ideologues of the right, the facts in terms of cost are with change and not the status quo.
“…cost has become a required element of any policy discussion.”
I disagree with this. Our federal government makes policy decisions without seriously considering cost all the time. In the last 10 years we have started (and now affirmatively continued) two foreign wars without seriously evaluating cost.
Cost seems to only be an issue when we are talking about social programs that could improve the lives of the lower economic sphere. I mentioned this below in a comment that for some reason is stuck in moderation – but I think its rooted in a historical disadain for the poor as deserving what they get and being lazy. I also think race plays a factor in that a disporportionate amount of our poor are minorities.
Hasn’t Medicare been providing quality care for decades with less bureaucracy and at a fraction of the administrative cost that private insurance companies charge? Our current system sucks because it’s a for-profit industry that makes its money by denying sick people coverage and denying claims of paying customers. If you think that sounds good, I suspect you suffer from an acute case of retrocranial impaction. Putting the health of citizens in the hands of a profit based industry is galactically stupid. It has failed miserably [except if screwing their customers and denying the sickest americans coverage counts as success (which it does, if you're the insurance company)] and it will continue to fail at everything except making insurance executives filthy rich at the expense of our collective suffering.
The fact that many people actually get medical care through their insurance provider is a necessary evil that the insurance companies are working diligently to profit from at every opportunity. Making americans healthy is not the objective. Making money is (they take about 30% of your premiums right off the top. Medicare takes 3.5% for doing the same thing), and I’d prefer to be healed by people who don’t have as their primary objective the purging of my bank account.
I lived in Germany for seven years. My brother still lives there and my step-mother is from England. They have criticisms of their health care systems, but overall they are very happy with the care they receive and they don’t have to worry about going bankrupt to get well if they’re sick. With the exception of the plan U.S. government employees are on, they think our current system is a joke. I agree.
I lost a little bit of respect for you, Daniel, when I read you were a libertarian. It is a specious but ultimately vacuous philosophy.
As another poster has said, in the end the choice comes down to whether American citizens think poverty is a forfeit for good health. The American health insurance industry, far from being the free-market panacea some deluded libertarians claim it to be, is rather a bulging, corrupt, money-grabbing sore.
It should be a matter of shame for all Americans that nearly 50 million of their fellow citizens are not insured for healthcare. Forty percent of all personal bankruptcies in the US are due to medical costs for people who are insured!
And yet American receive terrible value for money (2.3 times the OECD average per-capita expenditure on heathcare), but the statistics (in terms of life expectancy, infant mortality, cancer survival rates, number of physicians and nurses, access to MRI and CT machines, etc.) put America way down the list of developed countries. Any alternative is bound to be cheaper and more efficient. It can’t really get any worse.
Anyway, that’s my tuppen’orth, from across the pond.
Indeed. The fact that we spend so much on health care, and wind up with health care that isn’t even anywhere near the best in the world, is pretty sad.
One of my close friends pays 1,600 dollars a month for health care because she has Crone’s disease. Her deductible is somewhere around 10,000 dollars. The only reason she pays this outrageous amount each month is because if she doesn’t, and she at some point requires colon surgery for the condition, it would utterly bankrupt her.
She’s paying almost 20,000 a year, and getting nothing for it other than the hope that she won’t go bankrupt at some future point if she needs surgery.
That’s our wonderful insurance system.
I am just stunned that more people aren’t enraged by our current system. I just have to wonder how much shit americans will eat before they’ve had enough. Are we truly so totally engrossed in our pathetic entertainment culture and so accustomed to being subjected to the greed of corporations that we can’t even muster the motivation to stand up against blatantly obvious injustice? Is greed really an untouchable virtue? Mooo…
In my admittedly entirely anecdotal experience, the two groups who are least likely to be enraged are people who receive comprehensive coverage through their employment, or people who are very young.
The current system didn’t enrage me until I was both 40, and no longer had the desire to work at a large corporation just ‘for the benefits’.
I’m in my late thirties and also resent having to base my job choice on health benefits. Maybe we’re just enraged because we’re old farts now. Is this how crotchety feels?
Whereas I gained more respect for Daniel when I learned he was a libertarian, so hopefully it all evens out.
If it ‘evened out’ there would be a viable libertarian party in this country. It ain’t even close to even. :)
I’m not a card-carrying libertarian. I just tend to sympathize with many points of libertarianism, especially when it comes to legalization of “consensual crimes”. I like a free market as far as possible, which doesn’t mean it’s entirely free. I define myself as a libertarian loosely — I don’t consider myself part of a party.
I think it’s a rational position, but I know people disagree. And I’m happy to listen and consider their viewpoints. I think it’s a shame, though, if you lost some respect for me just because I have a different perspective than you.
Also I don’t know what the point is of communicating something like that…?
Thanks for clearing that up, Daniel.
I think people are really missing the point, arguing over government vs. private insurance when talking about reducing costs. You can have a poorly managed bureaucracy with private or public healthcare. I think the big things that differentiate the U.S. from the rest of the world are:
- Americans are obsessed with prolonging life as much as possible, regardless of cost and mental state of the patient. About 25% of an average American’s medical costs over their whole lifetime are in their last year of life. Not saying that we should give up on people when they first start showing bad symptoms, but it’s ridiculous to spend hundreds of thousands of dollars to help someone with terminal cancer survive another two weeks.
- Too much litigation. There’s a strong culture of “Blame whoever was closest” whenever there’s any kind of medication error. Baby was born with a birth defect? Sue the obstetrician. A chemo medication was compounded incorrectly? Throw the pharmacist in jail.
There are lots of bad results of this. Malpractice insurance is more expensive than it should be, which gets passed onto the total cost of health care. Doctors order more tests and procedures than they would otherwise, because if there’s that 0.01% chance of something getting missed, they’re now liable if something does. When mistakes are made, good luck getting people to report them promptly if they’re going to lose their job over it anyway.
Institute for Safe Medication Practices has done studies showing that punitive measures do nothing to reduce the medication error rate, but we’ve still got it built into our laws that when something bad happens, someone needs to be punished.
- America has tons of regulation. The Joint Commission (the body that sets guidelines for how hospitals should operate) piles on more and more requirements for how nurses and doctors and pharmacists need to do their jobs. The level of documentation required for nurses is probably 20 times more than it was a couple of decades ago, and they just keep piling it on. I write electronic medical record software, and when we demo the software overseas, the people we show the software to are baffled at why the software can capture so much extraneous (from their point of view) documentation.
People don’t realize how much a drain it is on the whole system. Nurses are each taking care of fewer patients than they used to, and you’d think that would improve patient care, but they have less time to spend on patient care than ever, because it’s all offset by paperwork.
I think these three things are the main contributing factors to why American health care costs so much more than anywhere else in the world. Universal health care might shift some of those costs around so that fewer people notice them, but we’ll still be paying for the same inefficiencies as we are now.
One thing I meant to mention: the one thing that electronic medical records can really help with for reducing costs is aggregating huge amounts of data and determining what the best preventive practices are. The technology is still a bit too young to see widespread benefits, but check out what Kaiser Permanente has done with heart disease prevention.
“We’ve reduced death from heart disease so significantly that it is no longer the leading cause of death among our 3 million members. In fact, death from heart disease is 30% lower in our NCAL Kaiser Permanente population than in the non-KPNC population in California.”
Hopefully this will become the norm across the country for all sorts of diseases as more data is available for statistical analysis.
And yet, countries with universal health care average 2-4 more years of life than America, because you don’t have the Uninsured Poor bringing the average down.
“And yet, countries with universal health care average 2-4 more years of life than America, because you don’t have the Uninsured Poor bringing the average down.”
Got a citation for the 2nd half of that sentence? There could be all sorts of other reasons America has lower life expectancy – violent crime, unhealthy immigrant population, different methods from other countries of counting child mortality (though I’ve read that this has been standardized in the last few years). Worse health care is just one possible reason for this.
Admittedly, I have not read all the comments so far posted; I may repeat previously stated points.
This is my response to Daniel. I have an economics background, so most of my points will come from that vantage point.
1. Why universal?
Disease has negative externalities. That is, when a person is sick, it is not only harmful to them, it is harmful to society. When a person is not at work, they are not producing goods or services to the economy. If a person goes to work sick, they are less productive. Moreover, they put everyone that interacts with them at risk of becoming sick and causing a cascade of lost work through the economy. The exposure to this risk also causes overconsumption of perceived preventives, such as orange juice and vitamin supplements, because if a person is able, they will likely continue to interact with society, rather than quarantine themselves. Therefore, if we seek to maximize productivity and output, we should incentivize self-quarantine and quick recovery for sick individuals. Because it is not always in the interest or abilities of an employer to provide its workers with medical care, nor are all people employed (children, seniors, transitionally and seasonally unemployed), a body that can make transactions with everyone in a population should ensure the provision of health care.
2. Why is Universal Health Care cheaper?
UHC is cheaper for two reasons: lower transaction costs and the spreading of risks.
A transaction cost is the cost of an exchange, for example the monetary and temporal costs of Wal-mart negotiating a contract with Sony for TV shipments or the time you lose waiting to pay your restaurant bill. Cutting these costs saves both parties money. By having to make fewer transactions (everyone pays gov, gov pays doctors, as opposed to a multitude of insurance companies with different payment policies paying doctors at different times and with varying degrees of certainty of payment), the system loses less to transaction costs. Think of it as cutting out the middleman.
Health care is risky. A person could get sick at almost anytime and payment would be due at or around the time of service to restore that person’s health. However, two people are not likely to be sick at the same time. Now consider the following:
Assume a world without any insurance or public healthcare providers. Adam decides to begin saving money in case he becomes sick. After one month, he becomes sick and the cost of recovery exceeded the amount of savings, causing him to liquidate assets and take out loans. However, if Adam and Betty, both equally likely to get sick and earning the same wages, decide to share and contribute to a savings account equally, twice the money is available to pay for health care costs that may arise than in situation where Adam was the sole contributor.
Now, extrapolate that pool of 2 to a pool of 330 million. Though each person has the same risk of getting sick, there is more money to be used to pay for those who are sick. Because the sample size is so large, a reasonable estimate can be made as to how much money will need to be available at a given time. The rest of the money can be used to put in long-term investments so that the saved money can be put to even better use. In short, as the pool of contributors increases, the risk of payout (paying for health care) stays the same, but the risk of insufficient funds decreases.
Even though people have different risks of disease, with such a large sample size, these risks can be determined with a great deal of certainty. The size of the pool makes the uncertainty of the risks less of a problem.
Would UHC be cheaper? YES
* Medicare costs 2 – 4 (where’s the cents key?!?) to write a check. Insurance $.30.
* Regular provider costs $40 an office visit. ER costs $100+.
And these are only two small examples of cost differences. As T.R.Reed (Reid?) says in his new book, our malpractice costs are so high because injured parties have to recover a lifetime of medical costs. Because Europe has UHC, malpractice there involves tiny dollar amounts by comparison – in Japan a small hospital pays $400 a year. He didn’t mention average court awards, so I can’t compare our $$$millions to anyone else’s ??thousands. There’s some overhead they could take off patient fees.
As a society, we generally agree we shouldn’t let sick people die on the street if, say, their appendix bursts, and they have no money for an operation. But this does NOT mean that we agree, or we should, mandate that everyone has the same health care.
Personally, I don’t want to be bankrupted by a cureable, catastrophic illness, so I desire that type of coverage. On the other hand, if due to advanced age or type of illness, there’s little chance of my recovery to a reasonably free and active life, I’d choose to die sooner rather than later. This saves society the expense of trying to prolong my life under any circumstances for a few extra months (and in fact, a large portion of our health care bills does go to such care).
I ought to have the choice to purchase, at a low cost, this type of “Try to keep me alive — but don’t try TOO hard” insurance.
Say there’s someone else, who wants heroic measures to make every possible effort to extend his life as long as possible. Perhaps he has good reason to do so; maybe he has small children who are emotionally dependent on him (which I don’t). Such a person should be able to purchase “Keep me alive as long as you can, whatever it takes” insurance. But it should cost more.
The problem arises because of the misconception that there’s such a thing as “best health care,” and everyone should have it. In fact, what’s “best” is often a subjective matter for each person to decide. This type of misconception is a common root of religious conflicts, as well as Lefty-vs-Libertarian political conflict.
It’s similar to the education debate. If you mistakenly think that there’s such a thing as “best” education, then you’d tend to support government efforts to provide this education through a public system that everyone is forced to support. If you think of “best education” as being different depending on the individual and his/her particular life condition and situation, then you’d support a maximum of freedom and choice for parents to choose schooling options.
Finally: the root and fundamental right we have is to be left alone, as long as we’re not harming others. Health care often involves someone else going through extreme effort to gain skills as a doctor or nurse etc, and then using those skills to help me. I’d like to see these health care providers have enough incentives to do so… but I have neither the moral authority nor desire to force anyone to treat me. So I feel it muddies the waters to talk of health care as a right, as it’s not at all similar to our right to be left alone to pursue happiness according to our individual understandings of it.
Well, those were certainly “random” thoughts…
And you’re willing to pay the extra costs associated with tracking everyone’s choices and payments individually? What if your “don’t try too hard” option worked out more expensive than just putting everyone on the same plan, but let you make a living will?
> And you’re willing to pay the extra costs associated with tracking everyone’s
> choices and payments individually?
If you have a goal for how a group (say, our country) should function, the most efficient way to achieve it is almost always to have a central authority make decisions and force them on everyone. That’s why the use of force is so popular; it’s a marvelously effective way to get exactly what you want, quickly.
For example, imagine that the federal government mandated one and only one meal that all restaurants must serve, at one set price. Imagine all the extra costs that would save. The waiters wouldn’t have to track everyone’s choices, because everyone would be eating the same thing. They wouldn’t have the inefficiency of writing down and adding up your bill, since everyone would pay the same.
In this case, yes, I’m happy that I pay the extra costs associated with eating what I want, rather than being forced to eat a more efficient meal mandated by the authorities.
Freedom and choice will always have inefficiences vs systems imposed by force. The trade-off may or may not be worth it. I’d say that our default position should be to allow maximum individual choice… and we should require powerful arguments before substituting force.
The mere fact that individual choice is inefficient from the standpoint of certain goals we might have for the group… is not sufficient in itself as a reason to take away these choices.
Right, but the point is that under both systems, you’d have the same set of choices about what care you receive. But in one case, there’s a whole layer of bureaucracy set up to track what type of care people think they’ll want in the future, and ensuring that everyone pays according to that care, and ensuring that they don’t receive more care than they pay for. In the other, everyone pays a flat rate, and you just tell your doctor what level of care you want.
A better analogy would be a restaurant that has a flat price for anything on their menu, be it a burger or fillet mignon. If that flat price is less than you’d pay for your meal of choice at another restaurant, what freedom do you gain by not eating there?
Just one thing: Fire Departments.
Er. What about them?
When it comes to having your house on fire, we have an extremely strong consensus. For just about everyone, when their house is on fire, they want people to come with hoses etc and put it out.
This makes fire control such an excellent candidate for centralized control. Everyone who lives in a certain area is forced to pay towards the maintenance of a fire department, and then everyone gets the unambiguous benefit of being able to call on it when needed.
The difference with health care is that individuals have many different preferences… more surgery/medication vs less, etc etc. We agree that the job of a fire department is to spray water on the fire till it goes out… but we’ve got many different ideas about the proper role of our health care provider/system. So the virtues of a centrally-mandated system in the case of health care is far more ambiguous than in the case of fire departments.
The case for universal fire coverage is based less on consensus regarding whether a fire should be put out, and more on enlightened self-interest. People, being aware of the tendency for fires to spread from their point of origin to surrounding areas, are more apt to agree to universal fire coverage and accept community cost for the shared risk; depending on individuals to insure themselves against conflagration provides insufficient protection to external actors.
Right. If there were serious health issues that could be transmitted from person to person, as fires move from house to house, there would be far more consensus on universal health care.
Fortunately, we live in a world without infectious diseases, and no-one’s ill health ever affects anyone else.
Of course, the metaphor breaks down fast when you realize that most highly infectious diseases are infectious before they are symptomatic (influenza, colds, most STDs).
And, even if it were an apt metaphor, the average danger posed by one untreated person for the vast majority of ailments is on a different order of magnitude than the threat posed by the next house over being on fire. The only ones that come close are smallpox (which was eradicated), some of the nasty hemorrhagic viruses (which have no treatment and for whom there are already quarantine procedures in place), and MRSA/VRSA (which are usually *caused* by seeking treatment and ending up in a hospital).
So it’s “some random infections person you’ll probably never meet” versus “the house next door is on fire”? Doesn’t sound like you’re trying to stack the deck at all. I mean, it’s not like one house somewhere in town catching fire is likely to have a negative effect on you personally, is it?
And it’s not about one untreated person, but about large numbers of untreated people. There are pockets where anti-vaxxers have driven vaccination rates down to 60%-70%. These pockets are now hotbeds of measles epidemics because herd immunity has broken down. Hundreds of people have died of measles, even though a couple of decades ago, it was considered all but eradicated.
Yes, infections are spread before people know they’re carriers, but I don’t understand why that would be a reason to avoid treating or containing those infections. The scope of an infection can certainly be reduced by having preventative measures in place, and available to the most susceptible (who, by an amazing coincidence, also happen to be the poorest) people.
I mean, it’s not like one house somewhere in town catching fire is likely to have a negative effect on you personally, is it?
Do you know the history of large city conflagrations?
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Anti-vaccination nutjobs have nothing to do with the universal healthcare discussion. Their actions do put others at risk, and you’ll get no argument from me; but seeing as how vaccinations are already provided by the state, I’m not seeing the salient point.
The scope of an infection can certainly be reduced by having preventative measures in place, and available to the most susceptible (who, by an amazing coincidence, also happen to be the poorest) people.
I agree. I was simply pointing out that the metaphor was inapt. The spread of disease is unlike in many relevant ways the spread of a fire.
You’re right that universal healthcare won’t necessarily bring down costs; but that doesn’t mean it cannot have any other desirable effects.
The reason healthcare costs are out of sight in the US is not because coverage is not universal, it’s because medicine is already partly socialized (i.e. in the form of Medicare and Medicaid) but underfunded (in many places, Medicare and Medicaid reimburse doctors and hospitals mere pennies on the dollar). This means that providers … especially hospitals … are largely required to take care of people for whom they get very little repayment through these programs. When providers take losses on these patients, they pass those losses on to paying patients. For a long time this meant insured patients, but over the last 20 years insurance companies, especially using HMO plans, have negotiated out this “premium.” (And really, who can blame them?) That leaves the out-of-pocket payers to pick up the tab.
To give you an idea of how little Medicare pays for things, a doctor’s office visit that ranges from $60 to $100 or even more (depending on where you live), gets only about $8 from Medicare. Medicaid is even worse … in some states that visit is reimbursed only c. $2-3. The money to make up for this has to come from somewhere, and it’s coming in the form of spiraling cost increases.
We wouldn’t be where we are, if Medicare and Medicaid offered reasonable reimbursements, so that all of this cost-passing never took place. The problem is that if they were to pay appropriately, taxes would skyrocket in order to fund it. For decades the government has been promising to people what it no longer can afford, and the cost of healthcare has been spiraling out of control because of it.
The only politically-practical solution (because the federal government cannot afford to pay even as much as $50 for that office visit) is essentially to expand the Medicare and Medicaid type of coverage to everyone. This eliminates the cost-passing, because there are no longer any out-of-pocket payers to compensate for the losses on Medicare and Medicaid patients. The result of this, though, is that ultimately, premium payments and the government will end up paying for everything, and that’s going to be a lot of money. The kind of money that could bankrupt the country.
But leaving things as they are is really no better. Spiraling costs will bankrupt the country eventually … it will just take a little longer without universal healthcare.
Really, what should have happened was that reimbursement rates for Medicare and Medicaid should never have been ratcheted down, beginning in the 70s, again in the mid 80s, and again in the late 90s. We may well have gone past “the point of no return.” But too many politicians wanted desperately to “balance the federal budget” and so did all the states (for whom Medicaid is a vast expense). They did this artificially … simply by refusing to pay doctors and hospitals what they’d earned.
We no longer can go back to where we were, without jettisoning Medicare and Medicaid and starting over from scratch. Good luck getting that to happen, though.
In the meantime we have politicians and special-interest groups raging at each other, people arming themselves and screaming at people at town halls, and otherwise carrying on like small children. Unfortunately, doing nothing is not a solution, nor are any of the plans currently under discussion going to be a solution. As it turns out, I don’t even think a real “solution” is even desired in Washington. What is desired, is a massive distraction from the political maneuverings and shortsighted policies that created this situation in the first place.
Wow, Daniel. I just took a look back at posts for a while — lots of folks wanted to weigh in on Health Care relative to other posts.
One observation I take pleasure in noting about the community: It seems that almost all of us “godless” types (including the libertardutopians* ;-) are considerably more compassionate toward our fellow men and women than what I typically read from folks who profess to be Xtrians.
*libertardutopian is said with some affection having been one myself. Age and experience has taught me not to be too swayed by allegorical novels — whether they be economic, political, or religious. Facts, evidence and most importantly, common sense, matter in the end. Ideology, not so much
Agreed. We just came down in different places for now — and BTW I hadn’t read Heinlein until after I already considered myself a libertarian. Maybe I’ll change, or maybe you will. Who knows? I hold these beliefs fairly loosely, though I am passionately for freedom for anyone to believe or do whatever they want, as long as it doesn’t hurt others or their property (and that’s really all I mean by libertarianism). I also believe in a gov to rule in the areas where complete freedom doesn’t work.
Now I am worried…;-) Heinlein was kind of a fascist / militarist / statist guy (though I loved his novels too). I was more referrring to Ayn Rand (Atlas, Fountain.. etc.) and various religious tomes.
Ah. Haven’t read any of that.
Heard of John Galt? Galt was a Rand protagonist. There is recent reference to “Going Galt” from the right wing which basically means the “smart” driven people who create and make things disconnect from society and let the namby-pamby sociali$ts and rabble have their way.
Heinlein was kind of a fascist / militarist / statist guy
Wot?! I’ll give you militarist in a pinch if you only ever have read Starship Troopers, and that was a response to a particular real world political context. Fascist? LOL Statist? Read The Moon is a Harsh Mistress…or Friday…or really, anything else by him.
——
Ayn Rand, OTOH, was a nutter.
No, definitely not a statist, but a no-government free-market nutter of some flavour. The Cat Who Walks Through Walls, for example, has a long section set on the Moon, during which the author’s Mary Sue points out, with unutterable smugness, that poor people just don’t deserve to breathe. There is a halfwit character whose only purpose is to say that this policy is barbaric and to get logically slapped down for it, but Heinlein seems to have had so little confidence in his argument that he had it happen off-stage.
Of course, this is the same book in which he laments that family discipline would be so much better if only fathers were allowed to rape their pre-teenage daughters, so I’m half-convinced that he went insane while writing it.
On the other hand, Stranger in a Strange Land is still one of my favourite books ever.
I grok that.
I must have missed that part. Where is it again?
“Of course, this is the same book in which he laments that family discipline would be so much better if only fathers were allowed to rape their pre-teenage daughters,”
I can’t find my copy right now (my library’s a mess, and it’s been a long time since I even looked for TCWWTW), but if I find it, I’ll give you a page reference.
I’m a rabid Heinlein fan, and I always see his positions on guns, girls, etc, as the voices of his amazing imagination. Anyone can interpolate practically anything about him from his fiction and non-fiction writings. My grade ten science teacher told me “Oh, he’s a raving homosexual.” Even before “Time Enough For Love” came out.
As to health care, I’d rather not discuss it. The Canadian single-payer system saved my life and I’ll stay loyal to it to the death, which will likely be later and somewhat more comfortable than it might be under a private regime.
The right-wingers have one thing right, though: The 45+ million Americans who don’t have coverage indeed DON’T want health care insurance.
What they want is health care.
Zotz:
> It seems that almost all of us “godless” types (including the libertardutopians* ;-) are
> considerably more compassionate toward our fellow men and women than what I
> typically read from folks who profess to be Xtrians.
I’d use the word “tolerant” rather than “compassionate.” I have a strong commitment to not harming anyone unless they attack me first. I’m 100% live and let live. That’s “tolerance,” but not necessarily “compassion,” as I’m often more apt to leave people alone to deal with their own situation, rather than to try to actively help them too much.
I’d agree that the godless do tend to be more tolerant. The cause-effect may be… in our time/place, most people who are atheists are independent thinkers; they have to be to go against the theist tide of our culture. People who don’t conform, who think independently, appreciate the value of not being forced to go along with the crowd (hence, libertarianism). Add in a little Golden Rule, and this appreciation becomes tolerance.
We shouldn’t ignore, though, the inconvenient truth that charitable giving corrolates very strongly with religious identification/affiliation. If you want to guess how much someone gives in charity, the most helpful clue is whether they’re a member of a religious group. (Charity is also well-corrolated with political conservatism… but that might just be a by-product of the connection between conservatism and religious affiliation.)
After Katrina, the Mormons did amazing work in helping displaced families. In Hassidic communties, anyone who is old, sick, or down on their luck… are always taken care of by others in the group, if they’re unable to help themselves. Mormons and Hassids may believe in profoundly absurd religious dogmas… but it’s a simple fact that they donate far more in charity vs your average atheist.
I don’t think talking about “bringing down costs” in broad terms (like most of the discussion on here) is going to accomplish a whole lot. I have a feeling most of the extraneous costs come from bits and pieces of bad policy here and there that people don’t know about.
For example:
Just recently, Medicare added a new requirement for getting drug reimbursement. Now, to get reimbursed, the exact NDC (national drug code – the barcode on the back of packs of medicine) must be submitted on the reimbursement form. Seems like a good idea. If you want to get money for a drug, you have to identify specifically what you gave, right?
The problem is that no hospital currently runs its inventory system to allow this. Hospitals will order batches of a drug from whoever they can get it cheapest from and add it to the supply. Since different brands of the same generically equivalent drug have different NDCs, you could have a few different brands of acetaminophen stocked together, and up until the Medicare requirement recently, no one cared if you used one of the NDCs to be representative of everything in stock.
So now everyone is scrambling to figure out how to comply with the Medicare requirement. Make nurses write down the NDC manually? You’d need to get the NDC on the unit dose label from Pharmacy, which means that both the nurse and pharmacy are now required to manually transcribe an 11-digit number. Not a viable option. The only thing I’ve ever heard of as a reasonable possibility is to barcode scan drugs before they’re administered (a good idea anyway from a safety perspective), but putting in a system like that is prohibitively expensive for most medium- and smaller-sized hospitals – plus, good luck extracting the scanned barcode to get put on the reimbursement form automatically. My guess is that most computer systems aren’t so well integrated.
My point is that this is just one out of thousands of regulations and requirements that don’t accomplish a whole lot, and it is imposing real costs. Getting health care costs down is going to involve the unglamorous job of chipping away at junk like this piece by piece. Like I wrote earlier above, an inefficient system is going to be expensive regardless of who’s running it.
Also, in case it’s not clear, I’m not talking at all about the morality of providing universal health care – just about whether it’ll save money or not. If you consider it a moral imperative, then the money is secondary.
My overall reaction to this thread has been that there are a lot of people out telling themselves that health care will automatically get cheaper when it’s universal, because they are already biased towards the morality of universal health care. I don’t see a lot of people saying, “Yeah, it could be a lot more expensive, but that’s the price of having a just society.”
Reminds me a few years ago of one of the arguments in favor of raising cigarette taxes. “Fewer people will smoke and that will save society medical expenses!” Except that it turned out to actually cost more money, because of the extra social security payouts resulting from people living longer. At which point you realize “we probably shouldn’t have been trying to justify this based on money in the first place.” Universal health care seems similar to me – if your opinion would be the same regardless of the money, just be honest about that and leave money out of the discussion.
WELL , LET’S SEE..EVERYTHING THE GOV TOUCHES SPIRALS INTO DEBT.To much bUREAUCRACY, usless committies,delays…
example…..MEDICARE on pace for bankruptcy next year. If all the taxpayers pay into a system for SOME of the population,and it fails,logic says if all taxpayers pay into system with all population getting covered, it will fail big time…factor in fraud,abuse,you know typical government bull shit then you have a catastrophe
simply lets insurance companies compete nation wide,get ride of illegals, and tort reform…………see simple!
Wow, that was kind of stunning in it’s epic levels of incompetence.
Good job, Chris!
Impressive. Personally I’m always amused by people harping on government for “.To much bUREAUCRACY, usless committies,delays…”, and then trying to say corporations are the solution. Have they ever worked for one, or more to the point, ever tried to get anything out of one?
Obviously the solution is for individual people to do it instead of groups of individuals.
Kings! That’s what we need. ;)
I will make every attempt to assassinate the person who claims to be my king.
Nothing gets my dander up like unilateral declarations of supreme executive authority.
Good man.
“I will make every attempt to assassinate the person who claims to be my king.”
Really — you couldn’t move to the UK could you?
Elemenope wrote…
> I’m always amused by people harping on government [...] and then trying
> to say corporations are the solution.
Corporations don’t control legions of men with guns to force their will on the masses. Not once has WalMart or Apple threated to send armed employees after me to force me to buy their products. I’ve worked and applied for work at many corporations. Not once have they ever threatened me with harm if I decide to decline their job offers.
But this is common practice for the government. You follow their rules, or else your possessions and even freedom can be forcibly taken away.
Violence and force are sometimes necessary. We surely need police to use force against murderers and thieves. But force shouldn’t be the preferred method, it should be a last resort when other alternatives are clearly disastrous. We should therefore begin with a preference for the voluntary methods used by corporations, and move towards the forceful methods of government only when the need has been clearly demonstrated.
Of course, the standard Weberian definition of state makes this true by axiom. But I was merely addressing the point that bureaucracy, mismanagement, and divided responsibility have a major presence in all large-scale human organization. Sure, the state is different from private corporate entities in several salient ways, just not this one.
Actually, corporations do have legions of armed men. They’re called the “US military” and the “military industrial complex” although they’ve recently given up any pretense (in last administration) and just hire thugs like CACI and Blackwater.
Google Smedley Butler and “War is a Racket”. I have a recent military background (at the flag level) and It’s gotten much, much worse since General Butler and Ike called them out..
And you obviously didn’t pay attention in history class: Google Pinkerton and Haymarket.
Gen. Smedley Butler was AWESOME, personified.
Zotz…
> Google Pinkerton and Haymarket.
Nonsense. One can make a distinction between baseball, where fights can sometimes break out on the field… and boxing, where the very nature of the sport is fighting.
Likewise, we shouldn’t blur the distinction between (1) individuals and corporations, which may sometimes use their limited power in violent ways… and (2) government, which by it’s very nature and definition, uses its massive power to execute centrally-made decisions using force and threats of force.
Wow… You’re pretty much oblivious, aren’t you?
Corporations and government were pretty much the same thing until about January 2009. We had what approached a classic fascist state — “…the merger of state and corporate power.” They left a huge financial mess and killed a lot of Americans and others. Our great grandchildren will be dealing with the impacts.
So, along with most of the reality based community, I’m rooting that the full force of government is brought to bear on the perpetrators.
I suppose we can make room in a FEMA camp for you.
We had what approached a classic fascist state — “…the merger of state and corporate power.”
Mr. Resnick made too little of the cooperation between state and business, but you are certainly making too much of it. The corporate state is one of *eight* classical markers for fascism, and no, we were nowhere close to being a fascist state under Bush the Lesser.
The interpenetration of business interests with government will be a fact of life so long as rent-seeking is possible, and any government that has sufficient power makes rent-seeking behavior possible. The traditional Libertarian solution is to make the state weak enough so the government does not have the power to grant privilege to business, but it is a “solution” rife with problems. The Federalist approach (subsidiarity of power) and divided government approach have both also failed at sequestering business interests away from policy-making. What would you suggest we do?
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BTW, the “reality-based community” is ideologically bigger than the one in your head.
thank you Chris, for making me feel like a genius.
Ah, the perfect place for this.
I notice nobody has mentioned this before, but currently the US, and ONLY the US is footing the bill for pretty much ALL drug and medical innovation, because of the price caps around the world. That is horribly unfair. It’s not fair that other first world countries, who have the money, just refuse to help us pay for innovation. If we try reigning in costs, other countries would step up to the plate and innovation will continue at the same pace, but the costs will be spread among all the first world countries which benefit.
Anyway, I do think that’s where a lot of our 50% more costs than any other first world country come from– they’re getting a free ride, and they really SHOULDN’T be.
We also should start talking about this on a national level and diplomatically as well.
I don’t know if it’s 50% but it’s a huge deal. HR 3200 and the HELP bill fix Medicare Part D (negotiating prices) but O et al have apparently (according to Tauzin the PhRma guy) made a deal to leave as is with an 80 billion or so committment to cut prices. I think the potential is about 4 times that over 10 years if the provisions stand. It remains to be seen what will end up on O’s desk to sign.
well, offhand remembering, we spend something like 16% of GDP on health care, next highest first world country spends 11%, and others less than that. They use all our innovations though.
Here is an interesting take on that issue.
Some other things:
The vast majority of the drug innovation is publically funded, which makes the drug company gouging even more evil.
Then there’s the minor manipulation of drug content to extend patents for an effectively identical drug.
Did you know? A drug approval by FDA is based on whether there is “some” measurable benefit for “some” people over a placebo.
It’s definitely a racket and needs to fixed.
Zotz wrote…
> A drug approval by FDA is based on whether there is “some” measurable benefit
> for “some” people over a placebo.
> It’s definitely a racket and needs to fixed.
Isn’t this the entirely correct way for the FDA to function?
If approval by the FDA meant that people were forced to take a drug, then indeed the bar for such approval should be set much much higher. But in fact, FDA approval merely means that we’ll have the option of taking the drug, we won’t be prevented from doing so. Since the approval is providing increased choice, not forcing anything on anyone, the bar ought to be set much lower.
Say that a particular drug offers a possible benefit to 5% of the people who try it. To take the drug means that I’d be risking the expense, effort, and side-effects of the drug, in return for a mere 1-in-20 chance that it’d help me. How do analyze this gamble, how to I assess this risk? The assessment ought to be made by the person most directly affected. That’s 10,000 times better than the choice being made for everyone by the FDA.
No. it isn’t. Changing FDA to focus on efficacy instead of pretty much taking the drug companies at their word is. If you think most people are going to do the kind of research you impy, well, that’s a fantasy, IMO.
And if you think you have an “option” I’d say people’s thinking is influenced by the constant drug ads (which should be banned IMO). Busy doctors get hounded by patients who see the ads So even if there is a better, cheaper (maybe even a natural, non-patentable) alternative, I’d submit that doctors often succumb to the pressure, wasting resources and potentially effectiveness.
Then there is the massive lobbying of doctors by salesmen. It’s a real problem.
I’d say people’s thinking is influenced by the constant drug ads (which should be banned IMO).
Not for nothing, but as a chronic moderate asthma sufferer who doesn’t often go to the doctor (due to no insurance and being poor), I would have never known about the next-generation asthma control medications if it weren’t for the ads.
Zotz…
> If you think most people are going to do the kind of research you impy,
> well, that’s a fantasy, IMO.
I support giving people maximum freedom to make their own significant life choices. You’re suggesting here that most people, when e.g. deciding whether to take a drug, won’t make intelligent choices. Not necessarily true, as people are especially motivated when dealing with their own health. But even if what you say is true, it’s irrelevent. The fact that some/many people won’t use their freedom in the way we consider most intelligent… is insufficient reason to deny them that freedom.
> And if you think you have an “option” I’d say people’s thinking is influenced
> by the constant drug ads
Rhetorical question: are you speaking from experience, saying that you have no option re what drugs you take, since your thinking is controled by the ads you see? Or is it that having the options is OK for you, but that the intellectually-inferior masses can’t handle them?
Anyway, you didn’t say that drug ads control people, but rather that they influence people. The fact that people are merely influenced by ads and many many other things… is a weak argument for denying them the freedom to make the final choice for themselves.
I don’t buy the fact that Pfizer spending billions on Viagra and then Glaxo responding by doing the same on Cialis is actually benefiting mankind very much. Benefits man, not mankind. Indeed, if pharma companies had to demonstrate actual benefits rather than just safety to gain funding this may actually be a spur to innovation.
Also (perhaps) the most famous medical finding of recent years was that stomach ulcers are caused by bacteria and have nothing to do with stress. This was done by Aussies working in the state medical/university complex Down Under.
Hughes – If you needed Viagra and it helped you enjoy life then you may thank Pfizer for spending billions developing it. Using your approach Viagra would never have been developed. Currently a fortune is being spent to cure balding. It will not help mankind – but it will certainly help the quality of life of the men who start losing their hair. Even more is being spent on preventing obesity – that will not help mankind either but help quality of life. I know tons of extremely rich people that would give up their entire fortunes to be skinny again.
Reminds me of the argument – why do we spend billions on football? If you start going down that slope then the sentiment – why do we bother spending money on watching Shakespeare is not far down the road.
If someone can not afford the deductible for tests to confirm if a lump is something serious, they might (and probably would I imagine) forego seeing a doctor. Then, just as our current system works, their chances of catching the illness early would have been compromised by the rules you propose would make them “accountable”.
A friend of mine shares your views and thinks if care is free people will flood doctors with requests. I differ from that opinion in that I do not believe anyone wants to go to the doctor. I surely do not, and if someone has a disorder where they can not help but go how will forcing financial distress upon them help? They will keep going regardless of how much the bill is and go into debt.
I’d also ask that you consider that maybe the long lines and wait times is an indication of the poor health of our citizens. In which case, wouldn’t we want them to get care?
You want to make people accountable and avoid wasting tax dollars? How about some perspective. I think instead of trivializing health care we should instead discuss shrinking the insanely wasteful defense budget we have and pull out of the pointless wars we have started. I believe we would then find more than enough money to cover health care for the entire US population.
A friend of mine shares your views and thinks if care is free people will flood doctors with requests. I differ from that opinion in that I do not believe anyone wants to go to the doctor. I surely do not, and if someone has a disorder where they can not help but go how will forcing financial distress upon them help?
It is almost certain that behaviors would change; this occurs any time the marginal cost of a behavior changes. It probably wouldn’t be a dramatic as some think, because as you say, there is a base disincentive to visit the doctor (i.e. it is a generally unpleasant experience), but it certainly would be noticeable.
I agree with you that it is better, on balance, for a person to go to the doctor and not have to, than not go to the doctor and have to. Not by much (since the resource at issue is finite, and consumption by false positive can crowd out the resource for people who truly need it), but there it is nonetheless. And adding a financial burden atop a medical one certainly doesn’t make the medical issue any better, whatever its macro effects.
I need to introduce you to my grandmother, who goes to various doctors multiple times a week and is covered completely by medicare. :)
I have (relatively) great insurance being a retired Navy Nuc. I avoid going to the doctor in any case. They always tell me crap I don’t want to hear (LOL). Often older folks do doctors for the company, to have someone pay attention, sharing maladies with the “girls”, etc. So Daniel, I suspect that you may need to visit your grandma more often…;-).
The recent Newsweek cover story (titled something like “The Case for Killing Grandma”)…
noted that it’s common for elderly people to visit their doctors for the sake of caring human contact, over and above visits necessary for treating any particular health problem. Newsweek suggests that a more efficient health-care system would include more non-MD providers, and direct people to these non-MDs when they’re seeking human connection and psychological comfort re their state of health. This would free the MDs to concentrate more on the specifically medical issues.
Reason: My BS detector usually activates at screen names that profess reasonableness since most aren’t. You are.
We all pay into a publicly provided education system b/c somewhere in our past it was decided that an educated population was good for the nation. Why should this ideal not apply to health care?
As for the cost of national health care, here is what Bill Clinton had to say on the subject on The Daily Show:
“We spend 50% more than any other country [on health care] yet we are the only wealthy country that doesn’t insure everybody and we don’t have better health outcomes than most upper income countries[...] We are already spending 16% of our income on health care. No one else is spending more than 10.5%, and that’s Canada. That’s 8 or 9 hundred billion dollars that we are spending that we wouldn’t be spending if we had any other country’s system, and yet we don’t get better health outcomes for it and we don’t cover everyone.”
Funny vid on America’s ranking as No. 37 in the world for health care (Paul Hipp):
http://www.youtube.com/watch?v=yVgOl3cETb4
Historically, we all pay into a public education system because factories needed workers who could read basic English, do arithmetic, and follow orders. A general social desire had little to do with it. These days, I suppose, those original motivations have been mingled with the more lofty ones you listed, but the history of the thing indicates that such systems are rarely built because of a social consensus.
And to distinguish education from health care as a practical matter, public educational resources are generally consumed only for a finite period per person. The same is not true regarding health care.
Carol Hitchcock….
> We all pay into a publicly provided education system b/c somewhere in our past
> it was decided that an educated population was good for the nation. Why should
> this ideal not apply to health care?
Somewhere in our past a decision was made… and now your suggesting that that’s a rational argument for what we do now? It may be easy to blindly follow decisions made in the past, to go along with how things have been done for many years in the past. Doing so frees one from the trouble of questioning and analyzing whether the past decision was correct, or whether it was right for past times but not for future times.
The fact that going along with past decisions is easy… doesn’t make it the correct or intelligent strategy for making decisions in the present.
Stuart Resnick…
Your colossal misinterpretation of my post has left me utterly nonplussed.
Serisously, dude – chill.
Awhile back I went to a doctor with chest pains thinking I was having a heart attack (age 29). It was nothing. He did an ekg, handed me two aspirins and sent me on my way. I think he actually laughed at me. All this cost the system somewhere on the order of $500. This is my idea:
Every doctor should be given 100 “get out of jail free” cards per year. This card entitles him to check a box and null out the visit, his time spent (if he thought it trivial, which it was), and all related labor costs (not drug or equipment costs). A ton of visits are like this – just scared people – the doctor comes in, reassures them, life goes on. Call them reassurance cards. When the card is used the whole visit appears like it didn’t happen. It nulls it out of the whole system.
Here’s the kicker -
1. The doctor is not required to use these. BUT:
2. If a patient believes a card should have been used but wasn’t – a body of peers can look at the case and if it meets the requirements for the reassurance card can either assign the doctor’s card to free the patient from the debt. or sanction the doctor with a warning. Too many warnings and the doctor can face further penalties.
3. If the doctor legitimately uses up all of his/her cards in the years timespan (easily done – probably in a month) then they will be granted a cash award for $20,000 and the following year the cards they get will drop by 10.
There will be incentive to use up the cards and get back to making more money, for the greedy doctors. Honest doctors can request more cards when they run out.
Overall throughout the system – billions would be saved in not having to process claims, not having to send bills or late notices, late fees, collection agencies, not having to perform required paperwork etc. This would allow the system to get rid of all the garbage – and that’s what this visit was – garbage.
It’s such a long thread, I’m not sure this point has been made.
I’m an Aussie living in the US. If I ever lose my health insurance, I just have to drag my sick self onto a Qantas 747 and arrange for the ambulance to meet me at Sydney Airport. I therefore don’t worry about losing my insurance.
Americans do though. A lot!. How much is this worth, one wonders? Never having to worry about losing health insurance ever again? I would suspect a lot.
The tying of health to employment also imposes a big cost on the US economy. Labour mobility is reduced and companies are saddled with high costs without really caring a jot about the benefits.
I think that if you ever get appendicitis, a 12-hour flight before treatment is going to be the last thing you want. Something chronic like cancer, you’ve got a fair point, but acute, immediately life-threatening conditions you still need local coverage.
As a Canadian, I find it outrageous and barbaric that one of the wealthiest countries in the world (or at least, it used to be!) cannot “afford” basic health care for its citizens. In my view, the money that is wasted through corporate tax shelters and needless wars is criminal. Spending a fraction of this amount to ensure that all citizens have health care is an INVESTMENT
Sorry, I accidentally submitted before I was finished! :)
As I was saying, it’s an investment and a basic human right. I believe in a single-payer system – the government. Here in Canada, the system is definitely not perfect, but the idea of not going to the doctor because you don’t have the money (or the co-pay amount if you are insured) is unthinkable. You go to the doctor when you are sick and need help. This means that people do not wait until it is too late to see the doctor (until they have the money to go). Health care for Canadians, and I would dare say ANY country with a universal system, is one of the most precious things we have. We spend less on health care than the US, and yet we are all covered. Here, it is not a business, it is a government requirement. Once health care becomes profit-motivated, all ethics fly out the window in the pursuit of the almight buck. It’s just human nature.
I realize I came on a bit strong here, but I feel incredibly strongly about this! Hope no americans took offense!
I can only tell you that most European’s look in disbelieve that people are so against health care with the most stupid and moronic arguments first. Most people here actually believe that it is a set up, some practical joke by CNN since people can’t be that stupid to be against it!
Also about those so called death panels, look even if you have a global health care, private additional health care options still exists! Nothing prevents you to pay for an additional insurance that covers all other situations that the global health care does not provide. I have an additional one that covers all hospital costs that are not paid by the global insurance in my country. What is all this fuzz about?
I know – we look at it that way too. It’s like someone standing up and passionately trying to convince someone to beat them up. And then calling them nazis when they don’t. We’re talking tears, the whole meal deal. “Please – hurt me, destroy me!!!! You MUST!!! I SIMPLY CANNOT be a healthy, happy individual – that would be SOCIALIST!!!!!! What has happened to this country??? Oh, if we could only have the good ol’ days when them coloreds were in the back of the bus and women knew their place….”
This is what it looks like to outsiders when those redneck morons attend what americans call “town halls”. Truly a joke. And a terrible embarrassment to intelligent Americans like those on these posts. But take heart Americans. At least you have one of the best leaders in the free world.
This is such a non-debate that it’s actually pretty ridiculous. Look at every nation in western Europe that has universal health care. In every single one of these countries the health care cost per capita is lower, life expectancy is higher, and quality of care is on a par with what the US can offer. So why are we even debating this issue?
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Spam.
Indeed.