Socialized Health Care in the USA

[Chesspiece_face]

Do you know who said that? Which publication. I'm not doubting it at all, I just want some extra ammo for some of my co-workers when this topic comes up again. :)

That is priceless. :)

Link

Beat'd

[kandrathe]

And you only 'hear' of people leaving Canada to get care in the US.

I don't actually hear of many people going either direction. But, if Canada was great, and the US was overpriced and poor quality then you would think that people would opt for the cheaper better option.

Do you want to go to the doctor, when you don't need to? Do you want to get operated on? I sure don't. I'd rather avoid it, when not necessary.

No, I'm sure some people would find it nice to talk to a shrink once a week, and there are these pills that remove pain, uplift mood, and curb your appetite at the same time. While we are at it, why don't we pay for your birth control, and erectile dysfunction. Personally, I suffer from male pattern baldness, so perhaps the government should do something about that as well.

Again, dealing with random accidents and illness is the part of insurance that works. It happens seldom enough that the group pool of insurance money can afford the occasional million dollar operation.

The part that doesn't work is care taking of someone's daily insulin treatments and monthly doctor visits due to adult onset type II diabetes derived from over consumption. Especially since lack of exercise, and an over abundance of cheap sugar enriched fatty foods permeates our diets.

Now, I'm not saying we should encourage people to die. Just that our society cannot afford to ignore health, and expect to get free health care. Our government is going broke with Medicare, and Medicaid, and Social Security, so why do we think that Medicare for everyone is going to be different? It sounds like that definition of insanity, where you do the same thing over and over expecting a different result. Or, perhaps we just don't care if we dump another $200K per capita burden on our children and grandchildren to deal with. We made sure that we were taken care of, but who cares about the future.

[kandrathe]

How much has the cost of insurance really gone up in terms of constant dollars?

As measured as a percentage of GDP it has gone up, but also with the increase of aging baby boomers it makes sense that they would spend their acquired wealth on health care as one of their major expenses. Also, no one is really looking at other commodities to compare how peoples awareness or tastes have changed over time either. People may be devoting more money to health care because they value it more these days.

How much of what is paid to the medical profession goes to support a broken tort system? How much of the medical expenses incurred by individuals are caused by unnecessary tests ordered so that doctors can cover themselves from liability?

Two good related questions. From what I've read if you equalized the US to Great Britain or Canada, the US spends significantly more because of tort. Although, I've also read that another issue with testing is that the physician who orders a test might also have a financial interest in the profitability of the testing laboratory. So, more tests means more profits for the physician who ordered the tests.

How much does the competition to have all the cutting edge technology at *every* facility add to medical costs? And how many tests using this technology are ordered to cover the cost of buying and running these machines?

Capital improvements usually are not that big a factor in operational costs. Accelerated depreciation would ameliorate the burden in a for profit organization, but the non-profit hospitals may have a harder time defraying the costs.

What I do know is simpler -- the USA has an expensive and inefficient medical system. Our infant mortality rate is terrible, our life expectancy is poor. If we didn't spend more than anyone else on medical care, that might be understandable -- but we don't.

Here is an interesting view on infant mortality vs GDP over time.

The free market had its chance, and it failed. Instead of supplying coverage for all, it focused on profits for a few. Letting people 'take care of their own' is great in principle, but it fails in practice as more and more people lack 'their own' to care for them.

I don't think the free market is getting a fair shake. The nature of health insurance and the number of people seeking health insurance has changed significantly from 1950 to today. Way back then, you'd pay your doctor bill yourself. Stringent regulations have limited the ability of different types of products to compete fairly in the market.

I was thinking about this analogy on my drive home today. Say that instead of health care, the government decided to give everyone a pollution free automobile. And, they put in a bunch of regulations requiring this automobile have all kinds of options that you may or may not use, but since we can't discriminate, every vehicle must have them all. Now, you don't have to pay a dime for this vehicle, and it doesn't matter if you drive it roughly or gently, or crash it into a wall. The government will take care of repairing it or replacing it if you total it. Do you think this would encourage conservation of the resource or rampant abuse of the resource? I just have to believe that if it is your cost to repair it, then you'd take better care of it.

So, the real question is: does a compassionate society take care of its members, or does it let them suffer for some idealized concept of 'rugged independence'?

Yes, of course we should care about each other, but the question I'm asking is should the government force "the workers", (or perhaps it would be more accurate to describe tax payers as "the productive class") to pay for everyones whim of health care, whether that be birth control pills, exercise programs for the obese, or detox programs for the inebriated.

Perhaps, more fundamental still: are we a compassionate society?

Just as we've talked about trying to bring about democracy by fiat in Iraq, why do we think we can legislate compassion with the force of law? Yes, we love our neighbors. We pay our taxes, or go to jail.

[kandrathe]

I thought you were too smart to fall for this kind of propaganda, kandrathe. I'm disappointed.

I'm caught. :) I was exaggerating. I know you really just set your old people adrift on ice flows, or let the polar bears or wolves eat them.

[Swiss Mercenary]

I don't actually hear of many people going either direction. But, if Canada was great, and the US was overpriced and poor quality then you would think that people would opt for the cheaper better option.

Second-hand, anecdotal evidence indicates to me that it does happen, more for say, laser eye surgery, or dentistry then other kinds of medicine, practiced at small clinics.

Otherwise, the savings comes from removing the overhead of private insurance, and from not providing excess capacity, which is the inevitable result of putting hospitals in competition with eachother. Tragedy of the commons, and all, but not something you can take advantage of if you're an insured American.

The problem with your automobile comparison, is that your automobile will also randomly total itself for no fault of your own, unless you purchase maintenance. And once it's totaled, nothing can fix it. You can't buy a new one. Sometimes, it will give tell-tale warning signs, but it costs you money to follow up on them... Money that you may not always have.

People don't need always need medical treatment because they are fat and lazy. And, as for male pattern baldness, I don't believe any socialised medical system covers that.

[kandrathe]

People don't need always need medical treatment because they are fat and lazy. And, as for male pattern baldness, I don't believe any socialised medical system covers that.

I agree. My point is that there is a significant amount of "health care" that is really personal preference rather than dealing with catastrophic illness or disease. And, for some, disease is self inflicted, so what about personal responsibility?

For example, a friend of a friend, was a union bus driver, but became permanently disabled due to his alcoholism. He pulled a full pension, and benefits until he died of the complications of his excessive alcohol consumption. Should addiction be treated the same as other chronic diseases like diabetes? If it is, then it has a ton of other social cost ramifications. I mean, the alternative is not to have him die in a gutter somewhere, only that negative consequences for poor choices are a fact of life. 20% of Americans drink more than 5 a day (and in the financial mess we are in I expect that is rising), and about 35,000 deaths per year are related to alcohol (accidents + disease).

If you make poor choices about your health, shouldn't you expect to suffer the consequences?

I think the national health care debate we SHOULD be having is related to healthy eating and exercise.

[Jester]

And, for some, disease is self inflicted, so what about personal responsibility?

Is that it? As soon as some disease has a personal responsibility issue, that invalidates the public option? What about the opposite argument, which strikes me as much stronger: most disease is *not* self-inflicted, and yet people suffer from it anyway. Often, they're even inflicted by other people. For instance, the anti-vax crowd is slowly wearing away at herd immunity. If child A catches a crippling disease because child B's parents refused to vaccinate, who pays for that, how much, and why?

Cover everyone equally, and you gain fairness and simplicity. Whatever the illness, whatever your situation, you have access to quality medical care without negotiation or worry. In pretty much all countries that have such systems they are very popular, which is certainly more than can be said about the current US system. They also cost a whole lot less.

If we leave it to the insurance company actuaries, it'll all just be down to statistics: if you belong to a high-risk group, for whatever reason, you're going to pay out the nose, whether it's totally your fault, partially your fault, or not your fault at all.

As for healthy eating and exercise, surely the government has no business whatsoever telling me what I can eat and how I spend my leisure time?

-Jester

[Delc]

No, I'm sure some people would find it nice to talk to a shrink once a week, and there are these pills that remove pain, uplift mood, and curb your appetite at the same time. While we are at it, why don't we pay for your birth control, and erectile dysfunction. Personally, I suffer from male pattern baldness, so perhaps the government should do something about that as well.

Does any insurance plan anywhere in the world cover baldness, ed, or weekly shrink visits? Why would you expect a new government plan to do so?

[--Pete]

Hi,

As for healthy eating and exercise, surely the government has no business whatsoever telling me what I can eat and how I spend my leisure time?

Whether or not the government has any business telling you how to behave is besides the point. Consider the use of motorcycle helmets or seat belts. At most, their use should be regulated by insurance companies (i.e., failure to use the safety device invalidates your claim, or they could charge a 'risk' premium). The government is in no way directly effected by your choice, yet in many areas it mandates the use of these devices 'for the common good'. Now consider the situation if the government payed for your health care. Your choices would have a (probably trivial) financial impact on the government. Do you really think that the same type of people that gave us Prohibition would really restrain themselves from legislating their life style prejudices in the name of fiscal responsibility?

Of course, that is a separate (but related) issue from health care reform. The one can lead to the other, but that is the responsibility of the concerned and informed citizen -- to establish the good and block the bad. Unfortunately, the other 99% of the population also gets a vote.;)

--Pete

[--Pete]

Hi,

Does any insurance plan anywhere in the world cover baldness, ed, or weekly shrink visits?

Don't know about the baldness and ed, but for a long time quite a few did cover a shrink. That may have changed.

--Pete

[Kevin]

Hi,
Don't know about the baldness and ed, but for a long time quite a few did cover a shrink. That may have changed.

--Pete

A certain number of visits to a shrink are covered by most plans that I've seen but not unlimited. ED is covered if there is a physical reason for it by most plans. ED prescription medicines are often covered at the higher pay level of the patient if it isn't for a physical reason (though not all plans have multiple pay levels for perscriptions).

[Jester]

Consider the use of motorcycle helmets or seat belts. At most, their use should be regulated by insurance companies (i.e., failure to use the safety device invalidates your claim, or they could charge a 'risk' premium). The government is in no way directly effected by your choice, yet in many areas it mandates the use of these devices 'for the common good'. Now consider the situation if the government payed for your health care. Your choices would have a (probably trivial) financial impact on the government.

There is a fine line between legitimate safety regulations and simple meddling. In the case of seatbelts, unrestrained passengers (especially in the front seat) can become projectiles and a danger to others, so there seems to be a case there. It's probably unnecessary to legislate (as opposed to educate) about motorcycle helmets, so long as children aren't involved.

I'm much more concerned about manufacturer safety (your car must be at least X safe, used correctly) than I am about regulating peoples' personal behaviour, which is a tricky business that treads very close to individual rights. The case could be made that the roads are in some sense public places where the government should have at least minor powers to regulate overall safety. I wouldn't push that argument too far, but it at least makes a little sense. What I eat, and what I do with my leisure time, are private decisions, and unless I choose to jog in the middle of the road, or eat durian on the bus, I don't see how such regulation could be consistent with even a modicum of personal liberty. By similar logic, if a shrink costs money, the government would have a similar incentive to outlaw depressing thoughts. And now we're in Orwell territory.

To me, it's better to just bite the bullet, pay most of the extra costs of saving people from their own stupidity, and leave it at that. (There are exceptions for triage. Alcoholics should not receive scarce liver transplants, etc...) Once you start descending into the morass of medical moral hazard, you wreck a lot of lives, disturb a lot of excrement, and I'm not convinced it even saves you a single nickel, as a society if not as a government.

Do you really think that the same type of people that gave us Prohibition would really restrain themselves from legislating their life style prejudices in the name of fiscal responsibility?

No, I really don't. But I did say they have "no business whatsoever," which doesn't preclude people meddling where they have no business. It just means I think they aren't justified in doing so. There's a long history of such pointless interference, and I had presumed (hoped?) opposition to it would be one of the rare points of agreement between Kandrathe and I.

-Jester

[SwissMercenary]

Before we get on the shrink-visits-are-fluff bandwagon, what about in the case of, say, diagnosing clinical depression? Believe it or not, but no amount of positive thinking will help you out of it - and left untreated, depression is a great way to cripple yourself - and be miserable-to-suicidal while you're at it.

While every other kid being diagnosed with ADHD may be bogus, mental illness is a very serious concern in adults. In the two years that I've known my girlfriend, she's been slowly recovering from depression, and it would break my heart to see her when she was out of pills, or missed taking one, or would, for no reason, have a relapse. And she was not as badly off as some other people.

[--Pete]

Hi,

Before we get on the shrink-visits-are-fluff bandwagon, . . .

While there is a need for mental care, shrink-visits (by many names) are one of the most abused medical benefits. Over the years, I've seen that benefit reduced and finally dropped from company provided health insurance. We've all got problems, and most of us feel better by venting them. The line between normal frustration, irritation, and anger and a 'true' mental condition is fuzzy -- and it is to the advantage of the mental health providers to move that line as close to 'normal' as possible.

. . . what about in the case of, say, diagnosing clinical depression? Believe it or not, but no amount of positive thinking will help you out of it - and left untreated, depression is a great way to cripple yourself - and be miserable-to-suicidal while you're at it.

Yes, all that is very true. There are objective symptoms of depression, such as fatigue, excessive sleeping, short temper, and others. However, it takes a trained and impartial practitioner to distinguish between true depression and a general dissatisfaction with life. Much like the case with antibiotics, which were (and, AFAIK, still are) prescribed for colds and other viral conditions at the requests of patients, anti-depressants are all too often prescribed as 'happy pills'.

While every other kid being diagnosed with ADHD may be bogus, mental illness is a very serious concern in adults. In the two years that I've known my girlfriend, she's been slowly recovering from depression, and it would break my heart to see her when she was out of pills, or missed taking one, or would, for no reason, have a relapse. And she was not as badly off as some other people.

Yes. And in some cases, depression can be a side effect of other drugs or combination of drugs. Believe me, I know.

--Pete

[kandrathe]

Is that it? As soon as some disease has a personal responsibility issue, that invalidates the public option? What about the opposite argument, which strikes me as much stronger: most disease is *not* self-inflicted, and yet people suffer from it anyway. Often, they're even inflicted by other people. For instance, the anti-vax crowd is slowly wearing away at herd immunity. If child A catches a crippling disease because child B's parents refused to vaccinate, who pays for that, how much, and why?

Ultimately, all illness is personal. You find that X happened and now you face seeking and getting medical treatment to improve your quality of life. So, not to be cruel about it, but if my neighbor decides to sleep around and ends up with HIV, should it be me that pays for his treatment? Ok, so if it wouldn't be fair for me personally to get the bill, then why is it fair for us collectively to get the bill? So yes, the opposite. Someone has H1N1 virus and decides to travel on the airplane anyway, or some new immigrants bring tuberculosis back into the US. How is this any different that living in society from the beginning of time? People are constantly infecting other people with communicable diseases. Which is why public health officials have the power to quarantine people and places.

If we leave it to the insurance company actuaries, it'll all just be down to statistics: if you belong to a high-risk group, for whatever reason, you're going to pay out the nose, whether it's totally your fault, partially your fault, or not your fault at all.

Right, but this is why for health insurance we don't treat it like automobile insurance. Insurer's aggregate the risk across a the domain of policy holders, so that if everybody pays an averaged rate which from the insurance company point of view should cover health care outlays, administrative overhead and profits. Competition will assure us that companies provide quality service, efficient administration, and the minimum acceptable profit.

Cover everyone equally, and you gain fairness and simplicity. Whatever the illness, whatever your situation, you have access to quality medical care without negotiation or worry. In pretty much all countries that have such systems they are very popular, which is certainly more than can be said about the current US system. They also cost a whole lot less.

Right, but you do this with reducing choices and by imposing a system of rationing care. Also, I might be wrong, but aren't all these nationalized health care systems bankrupting your nations budgets? Are any of them not in red ink? In the US, Medicare and Medicaid (the already nationalized health care plans) account for 50% of all health care spending and are already bankrupt.

As for healthy eating and exercise, surely the government has no business whatsoever telling me what I can eat and how I spend my leisure time?

I agree, but, rather than drive the bus of "health insurance reform", how about we figure out why the demand for health care exceeds capacity driving up the costs.

So to summarize what I think the government should do;

1) Advocate wellness, just like JFK did - less demand for health care will lower costs
2) Remove laws that limit competition, and add oversight to prevent conflicts of interest.
3) Allow people to insure themselves for basic wellness with tax free health care savings accounts
4) Remove incentives for employers being the provider of health care plans -- add incentives for employers contributing to the employees HCSA (like they do with 401K).
5) Move to a model of focus on catastrophic health insurance. All the other comprehensive things can be add ons.

[Skandranon]

Yes, of course we should care about each other, but the question I'm asking is should the government force "the workers", (or perhaps it would be more accurate to describe tax payers as "the productive class") to pay for everyones whim of health care, whether that be birth control pills, exercise programs for the obese, or detox programs for the inebriated.

Firstly, I'm not sure of the logical soundness of "some people can be ill due to their own actions, therefore we must treat everyone as if they grow ill due to their own actions". There are illnesses you can aggravate or produce favourable preconditions for, but those same illnesses can easily crop up in people who have never done a thing to make it worse. Once again, if you didn't notice the link in my earlier post, please read it.

Secondly, I feel it's kind of straw-mannish to jump on the most extreme examples of what health care could provide and use it as a reason to dismiss the entire idea. Even "universal" health care systems don't cover everything. There are a number of procedures not covered in Canada for the very reason that they behave more like traditional goods and services.

Put another way, it's not a battle of the extremes here, "cover-everything" vs. "cover nothing". There are a lot of reasons for a public plan not to cover something. You, however, are in fact arguing the cover-nothing extreme, so for logical reasons it's incumbent on you to take the example most favourable to public health care and explain why it shouldn't be public.

[kandrathe]

Before we get on the shrink-visits-are-fluff bandwagon, what about in the case of, say, diagnosing clinical depression? Believe it or not, but no amount of positive thinking will help you out of it - and left untreated, depression is a great way to cripple yourself - and be miserable-to-suicidal while you're at it.

While every other kid being diagnosed with ADHD may be bogus, mental illness is a very serious concern in adults. In the two years that I've known my girlfriend, she's been slowly recovering from depression, and it would break my heart to see her when she was out of pills, or missed taking one, or would, for no reason, have a relapse. And she was not as badly off as some other people.

I too know people who suffer from clinical depression. It's not fluff, but it is often a chronic problem that needs years of attention to correct, and perhaps after that life long maintenance. According to the CDC, about 5% of all prescriptions written in the US are for SSRI's. It is estimated that 1 in 5 men, and 1 in 3 women will suffer at least one extended bout of depression in their lives. At any given time, about 5% of the US population is suffering from depression. I don't look at it any different than I would diabetes, which affects about 10% of the US population. If you have diabetes who should pay for your medicine and care? You or someone else?

[--Pete]

Hi,

3) Allow people to insure themselves for basic wellness with tax free health care savings accounts
4) Remove incentives for employers being the provider of health care plans -- add incentives for employers contributing to the employees HCSA (like they do with 401K).

You are assuming, wrongly I think, that the people who do not have health insurance don't have it by choice. It's rather difficult for someone with a minimum wage job (say $600 a month after deductions) to afford $600 to $1500 a month premiums. Your proposals seem intent on fixing the problems with those already insured -- they do nothing for those without insurance.

Also, HCSA may be a good idea for routine medical needs (I don't think so, but for the sake of discussion . . .) but how would you address major medical expenses? Is it reasonable to expect someone to have between one and two *million* in a HCSA to cover the overall costs of leukemia? Especially if that person is a twenty something year old medical student who has never really had a job and (most likely) is already deeply in debt to finance his education.

--Pete

[kandrathe]

Put another way, it's not a battle of the extremes here, "cover-everything" vs. "cover nothing". There are a lot of reasons for a public plan not to cover something. You, however, are in fact arguing the cover-nothing extreme, so for logical reasons it's incumbent on you to take the example most favourable to public health care and explain why it shouldn't be public.

Yes, I thought it was a straw man (and a plea to compassion) to assume that all illnesses were catastrophic. Yes, catastrophic illnesses are each expensive, but a million unnecessary trips to the emergency room for basic first aid are also expensive. I'm actually advocating for "something", but that the "something" be driven by the free market. It is the free market, when the government is doing its proper job (preserve liberty and remove fraud), that will create the most efficient service for health insurance. The government has no incentive to be efficient, and all the power to be abusive.

If you don't believe at all in capitalism, then I can understand why you'd advocate a state run system.

My question is really who should be responsible for your health? Not only in maintaining it, but also in paying for the costs of fixing you when you are broken. It sounds nice to think that the publics health should be maintained by "the public", but that is really just another form of collectivism. People also need food, so the same argument for health care might be used to ration and distribute food. Or, housing. Or, transportation.

[kandrathe]

You are assuming, wrongly I think, that the people who do not have health insurance don't have it by choice. It's rather difficult for someone with a minimum wage job (say $600 a month after deductions) to afford $600 to $1500 a month premiums. Your proposals seem intent on fixing the problems with those already insured -- they do nothing for those without insurance.

Actually, I don't have health insurance at the moment. I want it, but I'm choosing to make my house payments. I know what you are saying. The price of insurance needs to come down, and that will only happen when I can get a plan that is trimmed to cover only those things (like an accident or cancer, or something huge that I cannot afford to pay for) I need. We don't drink, we don't go to a shrink, we don't sleep around, and we won't get pregnant, and etc. If I needed to spend a couple hundred a month on some treatment, then I could afford to pay that out of my pocket, rather than make a claim on insurance.

Also, HCSA may be a good idea for routine medical needs (I don't think so, but for the sake of discussion . . .) but how would you address major medical expenses? Is it reasonable to expect someone to have between one and two *million* in a HCSA to cover the overall costs of leukemia? Especially if that person is a twenty something year old medical student who has never really had a job and (most likely) is already deeply in debt to finance his education.

Yes, you are right. HCSA wouldn't replace the need for some insurance that covered the more rare and expensive stuff. But, if you wanted to use your HCSA for pills, or shrinks, or health club membership, or birth control, then I don't have an issue with that either. It's your money, so people should be more free in using it on general health and wellness.