Socialized Health Care in the USA

[Jester]

... and the fully functioning health care systems in pretty much every other developed country are what, flukes?

Government systems appear to work more or less fine. No system is flawless, but it certainly doesn't seem to be socialism that's wrecking health care in Canada, Britain, Sweden, or any of the dozen other countries where it's in use.

You can't just assert that the free market is good and government is bad, and wave away decades of experience to the contrary.

-Jester

[kandrathe]

You can't just assert that the free market is good and government is bad, and wave away decades of experience to the contrary.

Government is not bad. When government is limited to the purposes of preserving freedom, and removing fraud, then it is good. I would say that the free market, and government have both shown their ugly sides. I don't see that you can on the one hand believe in a model where services are offered by corporations, but then on the other hand also believe that government should take over offering a service that is also offered by private corporations. Specifically what I've heard about Britain's system is that it faces a 15 billion pound deficit, the hospitals are overcrowded, dirty and understaffed, and that people have to wait on lists for weeks or months for medical care.

I just don't believe in collectivism in any form. I disagree with the practice of casting a net of taxes across the people for the purpose to giving that wealth to others. Yes, collect taxes to pay for running the government, and defending our liberties, then let us figure out how we will organize our society. Adding to the mass of government should not be an answer to our problems, but I do believe LEADERSHIP can help lead us to discovering an answer.

This article by the The American Journal of Medicine analyzed a random national sample of 2,314 bankruptcy filers. 75% of these people had medical insurance.

Some of the significant findings were;

• The highest out-of-pocket health care costs were associated with non-stroke neurological illnesses, such as multiple sclerosis, followed by diabetes, injuries, stroke, mental illnesses and heart disease.
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• For 48% of medical debtors, hospital bills were the largest single out-of-pocket expense. Prescription drugs for 18.6%, doctors’ bills for 15.1% and insurance premiums for 4.1% of other debtors were the largest expense. Medical equipment and nursing homes where the largest expense for the remainder of medical debtors.
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• Illness-associated loss of income also contributed to financial problems related to medical bills. In 37.9% of medical debtors, the illness resulted in the patient’s family member losing or quitting a job; in 24.4% of debtors, the illness led to getting fired.
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• Unaffordable healthcare costs contributed directly to the bankruptcy of 92% of medical debtors.<>
  [st]
  So, my point in showing you this is that the US system is broken for everyone, both the insured and uninsured alike. The problem is not that the government does not offer a public option, but that the costs of getting catastrophically ill are too high for low, middle, and even upper middle income people to be able to afford.

[--Pete]

Hi,

So, my point in showing you this is that the US system is broken for everyone, both the insured and uninsured alike.

I agree completely with this statement. I also agree with your previous statement that continuing to do something that has failed repeatedly in the past is insane. Now, our health care system in this country is primarily one with the free market suppling a lot of the insurance and services, and the government more or less (mostly less) regulating it. The outcome is expensive, inefficient, probably corrupt. And your solution is more of the same?

I doubt that our government (the best government that money can buy) will really solve the problem, but they can hardly make it worse. We need change, and even a little change can, in the long run, lead to great improvements. So, I'm willing to settle for an incremental start with the hope of an eventual solution.

--Pete

[Thecla]

So, my point in showing you this is that the US system is broken for everyone, both the insured and uninsured alike. The problem is not that the government does not offer a public option, but that the costs of getting catastrophically ill are too high for low, middle, and even upper middle income people to be able to afford.

It's an interesting link.:)

But I do find that trying to understand your logic gives me a headache. The system is broken for the uninsured? Ah yes, but it's also broken for the insured (except for the wealthy). The private system of insurance that is self-paid or partly-paid through ones job is borked? Just goes to show that public health insurance wouldn't solve anything.

And the problem is that people can't afford to pay for their own health care? So the solution is

I believe we need to move towards a system where families pay out of their own pockets for either their care or their insurance

No doubt, of course, this would work just fine in a society where life is nasty, brutish and short (except, as always, for the wealthy).

[Skandranon]

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.

Really, not believing in capitalism is probably the weirdest accusation thrown yet. I come from the right wing of the Canadian political spectrum, and I'm quite happy to see medical procedures that respond to free-market pressures released to the free market. That's exactly what happens, by the way. It's that much of health care doesn't respond to free market incentives.

And you continue to make your argument that "if some illnesses are not catastrophic, they all aren't". I'm not asserting that they all are. You are asserting that they all are not, or that they make for a tiny proportion of illnesses. Neither is true.

Furthermore, read the goddamn article. Here, I'll post an excerpt.

For that matter, when you have to pay for your own health care, does your consumption really become more efficient? In the late nineteen-seventies, the rand Corporation did an extensive study on the question, randomly assigning families to health plans with co-payment levels at zero per cent, twenty-five per cent, fifty per cent, or ninety-five per cent, up to six thousand dollars. As you might expect, the more that people were asked to chip in for their health care the less care they used. The problem was that they cut back equally on both frivolous care and useful care. Poor people in the high-deductible group with hypertension, for instance, didn’t do nearly as good a job of controlling their blood pressure as those in other groups, resulting in a ten-per-cent increase in the likelihood of death. As a recent Commonwealth Fund study concluded, cost sharing is “a blunt instrument.” Of course it is: how should the average consumer be expected to know beforehand what care is frivolous and what care is useful?

People make terrible decisions when they are asked to ration their own health care. Genuine, good-faith effort to save the system money wind up costing way more in the long run. Unless you propose to educate three hundred million citizens with the rudimentary medical knowledge to figure out what care to forego, blanket covering anyone will save trillions of dollars in the long run, even if it means that some people who don't deserve it, in your worldview, get free care.

[--Pete]

Hi,

Unless you propose to educate three hundred million citizens . . .

I think you've gotten to the crux of the matter. If Jefferson had been right, then the vast majority would do what was best. Unfortunately, Hamilton had a better read on the average man.

--Pete

[kandrathe]

Really, not believing in capitalism is probably the weirdest accusation thrown yet. I come from the right wing of the Canadian political spectrum, and I'm quite happy to see medical procedures that respond to free-market pressures released to the free market. That's exactly what happens, by the way. It's that much of health care doesn't respond to free market incentives.

Which, is my approach to resolving the problem. Why is health care too expensive? Perhaps there is not enough supply. So, offer to pay for student loans for those professions in short supply if they agree to practice medicine at XYZ hospital for four years. Perhaps, due to tort, doctors order more tests than are needed. Fix tort. Maybe there are not enough hospitals per capita, or that they are being misused. So in essence, fix the things that are broken, rather than move paying for the broken system to another broken system, the US federal government. What we don't need is another huge sucking money hole in our budget.

And you continue to make your argument that "if some illnesses are not catastrophic, they all aren't".

No, I'm not making that argument. I'm asserting that health care is too expensive. They average hospital stay of 5 days, costs about $25,000. But, there are many factors, one of which is the frivolous use of health care because it is perceived to be inexpensive or free. How did the human race ever make it this far without knowing what is an emergency and what is not? I propose that yes, we educate 300 million people on the basics of first aid, and health care. In fact, lets make that a mandatory class in the 9th grade.

[kandrathe]

Just goes to show that public health insurance wouldn't solve anything.

It would move the cost into a deficit riddled federal budget, and more than likely it would accelerate the growth of the national debt.

No doubt, of course, this would work just fine in a society where life is nasty, brutish and short (except, as always, for the wealthy).

You omitted the part where I said we still need catastrophic coverage.

I think queuing up on a waiting list to get mediocre treatment in run down, dirty understaffed hospitals sounds pretty nasty, and brutish.

[kandrathe]

I doubt that our government (the best government that money can buy) will really solve the problem, but they can hardly make it worse. We need change, and even a little change can, in the long run, lead to great improvements. So, I'm willing to settle for an incremental start with the hope of an eventual solution.

I guess I just don't have any faith in them doing anything other than what they've done to Medicare and Medicaid.

I agree that radical things need to be done to change the system. Let's just try something radically American, rather than radically European.

[Thecla]

I guess I just don't have any faith in them doing anything other than what they've done to Medicare and Medicaid.

I agree that radical things need to be done to change the system. Let's just try something radically American, rather than radically European.

It seems to me the current system is already radically american (or, perhaps more accurately, USian), and it's not working. It's not containing costs, it's not providing effective health care per dollar, it's not encouraging preventive health care, it spends too much on the old at the expense of the young, it leaves many people uninsured or underinsured, etc etc -- all the things already mentioned. About the only thing more radically american one could do is to cut out medicare and medicaid altogether (and social security while one is at it).

Now I understand you're coming at this from a definite "small-government view" in which it seems like the military is about the only necessary government institution (though one might ask why that should be excepted if everything else is better off without government interferences -- after all, the US already went part way in Iraq to privatizing military functions, and the CIA considered outsourcing terrorist assasinations to Blackwater;)).

But in my view access to adequate health care is a basic thing that every member of a society should have, just as every child, however poor their family, should have the opportunity to acquire an education. And I don't see how those goals can be met without strong public and government support and a willingness on the part of people to pay for them.

[kandrathe]

It seems to me the current system is already radically American (or, perhaps more accurately, USian), and it's not working. It's not containing costs, it's not providing effective health care per dollar, it's not encouraging preventive health care, it spends too much on the old at the expense of the young, it leaves many people uninsured or underinsured, etc etc -- all the things already mentioned. About the only thing more radically American one could do is to cut out Medicare and Medicaid altogether (and social security while one is at it).

Which really speaks to the need for analyzing the problems to determine root causes, and then implementing a resolution. Destroying the health insurance industry, and rationing health care will not address the problems of supply and demand.

Now I understand you're coming at this from a definite "small-government view" in which it seems like the military is about the only necessary government institution (though one might ask why that should be excepted if everything else is better off without government interferences -- after all, the US already went part way in Iraq to privatizing military functions, and the CIA considered outsourcing terrorist assassinations to Blackwater;)).

I seem to recall that the Brits had mercenaries to kill off their revolutionary brothers. Outsourcing military functions is a pretty age old tradition. In the scheme of plan, do, study, act, many times the government should have a role in planning, and studying, but either by fiat, or tradition, or growth over time they end up implementing functions that may better be done by the private sector.

Such as, the postal service. Thank you Ben Franklin, but the USPS is lower quality, more expensive, and bankrupt. The fundamental concept that I object to is where the government, through force, takes away peoples property to then distributes it according to their redistribution rules.

But in my view access to adequate health care is a basic thing that every member of a society should have, just as every child, however poor their family, should have the opportunity to acquire an education. And I don't see how those goals can be met without strong public and government support and a willingness on the part of people to pay for them.

I understand that it is hard to let go, and allow things to flow within the private sector. It is much easier to use the power of law to force the changes you determine will help. So, there used to be this perceived problem that older people weren't getting adequate health care, so they implemented by fiat, Medicare. Same with poor people and Medicaid. These are like dams in the free flow of supply and demand, now 50% of other peoples health care costs are being shouldered by the same workers who then have to insure and provide for their own health care. As it is with SSI, now we have the baby boom where their are more people consuming the service than there are people to provide it, or pay for it. It's a monumental pyramid scheme that set to crash, and the politicians are only doing "feel good" fixes to slide by for another four years. We've been watching this bus approach for 20 years, so the fact that its here now is no surprise.

[Jester]

Let's just try something radically American, rather than radically European.

My Latin is too feeble to give that a fancy name, but I'm pretty sure the Argument from National Identity is fallacious.

-Jester

[kandrathe]

My Latin is too feeble to give that a fancy name, but I'm pretty sure the Argument from National Identity is fallacious.

I was trying to tactfully suggest that we embrace the free market rather than succumb to the socialist model.

[Jester]

I was trying to tactfully suggest that we embrace the free market rather than succumb to the socialist model.

You wanted to tactfully suggest what you've been shouting at the top of your lungs in every thread since the boards opened? By not-so-subtly implying that systems developed in America are inherently better than systems developed in Europe?

I'm not sure that really counts as "tact".

-Jester

[Swiss Mercenary]

Which, is my approach to resolving the problem. Why is health care too expensive? Perhaps there is not enough supply.

Or, in America, there is too much supply. In any free market system, hospitals have an incentive to provide it, beyond necessary levels, if they want to retain customers. Right now, as a rule, they operate at under-capacity. And the American working class, through insurance, picks up the bill for medical devices that sit there, gathering dust, specialists that spend half the day picking their nose, and beds left empty.


Not to mention that a quarter of your healthcare costs have nothing to do with care. Its goes towards paperwork, administration, and to line the pockets of insurance companies. Strangely enough, countries with socalised healthcare spend less then a third of what americans do on paperwork and overhead. It seems the free market is a monumental failure at delivering best service for lowest cost, in that respect. (And service here means insurance, not actual treatment). When I can check in to a hospital without concerns that my bills will be left unpaid because my insurer is grasping at straws, to try to deny having to pay out, or without concerns that my 60% coverage will lead me to not being able to afford treatment... I think the service government insurance provides is leaps and bounds ahead of the competition.

And don't forget - that's just the icing on the cake. You also pay more for actual treatment, because of the points I've made in the first paragraph.

[--Pete]

Hi,

My Latin is too feeble to give that a fancy name, but I'm pretty sure the Argument from National Identity is fallacious.

I believe 'prejudice' is appropriate -- from the Latin praejudicium.;)

--Pete

[--Pete]

Hi,

Or, in America, there is too much supply.

Yes and no. There is a surplus of supply of medical equipment in the larger cities. There is a shortage of doctors, especially in rural areas and in certain higher risk specialties. There is a even greater shortage of trained nurses. Many of the health care practitioners in our hospitals are foreigners who are here on a work visa.

But, ultimately, that doesn't matter. The whole 'supply and demand' concept fails when the consumer isn't buying the product in the first place. I have no hard data, but I'd guess that most of the insured are covered by a plan offered by an employer. In some cases, an employee may have a choice of plans, in most there is only one. Of the remainder, I'd guess that a large percentage are covered by Medicare or Medicaid. Again, no choice on the part of the consumer. Actual services received are determined, to a large degree, by insurance coverage. And the costs of these services are established by agreements between the insurance companies and the medical providers.

Yes, it is a mess.

--Pete

[kandrathe]

You wanted to tactfully suggest what you've been shouting at the top of your lungs in every thread since the boards opened? By not-so-subtly implying that systems developed in America are inherently better than systems developed in Europe?

I'm not sure that really counts as "tact".

I remember being somewhat complimentary of the German system. And... I'm sorry if my libertarian passion seems boorish. I really do like many parts of European culture. I'm actually most critical of the continuing socialist slide in the US government, and as for Europe, if it works for the people, and they are happy with it, then more power to them.

Really, the biggest issue I have with the US system's erosion is on the freedom of choice. The lower 50% of workers pay little or no taxes at all, but still get an equal share of all the benefits. The upper 50% of the workers are taxed at a high rate to pay for systems whether they use them or not. Yes, the worker or pensioner, who now has a significantly lower income can go send his children to a private school, or go purchase health care outside of the system. That is, if they happen to earn enough to still cover their other life costs.

Why not socialize energy usage? Why not socialize food distribution? How about shelter? If people have an inherent right for education, or health care, then they have a right to eat, to heat their home, and to have affordable housing. If the government can provide the most efficient administration of health care, then why not these other life sustaining functions?

[kandrathe]

Yes, it is a mess.

One other complicating factor is consumer choice. Say you are incapacitated and your spouse needs to make a decision on the surgery that may save your life. Would they choose a) the first timer for $30,000 cost, b) somewhat experienced for $75,000 cost, or c) the world best in the field for $300,000? What if your employer paid 60%, or 80%, or 100%? What if you never saw the costs at all?

We don't make consumer decision's this way for buying most other services.

[Jester]

Why not socialize energy usage? Why not socialize food distribution? How about shelter? If people have an inherent right for education, or health care, then they have a right to eat, to heat their home, and to have affordable housing. If the government can provide the most efficient administration of health care, then why not these other life sustaining functions?

Socialized energy production makes sense to me. (What socialized energy usage would be, I have no idea. The government turns on my toaster for me?) It's a high-volume, infrastructral product where new market entrants face almost absurdly prohibitive entry costs.

Socialized education (k-12) is already a reality in all developed countries. Do you object to that?

People already spend their bottom dollar on food, and always will. So it isn't necessary to provide it equally, so long as you provide some baseline income for the extremely poor.

Shelter is a tough question, but at the very bottom, it seems clear that at least some homeless shelters are a necessity to prevent serious social problems (streets that can't be walked at night, overcrowded prisons). Beyond that, I'm not sure socialized housing has been a huge success, but there have been cases where it's been done well enough.

The point I'd emphasize is that all markets are different. Some products lend themselves very well to being publicly provided, and some do not. Each should be judged on its own merits.

-Jester