Who should pay the healthcare costs of the uninsured?

[mheslep]

That is a very optimistic worst case. Worst case is decades of ever decreasing and ever more expensive health care before the government and the governed finally admit that universal health care was a dreadful experiment.

But, uh, that's what's going on right now.

No, only half right. D H said under socialist health care costs would increase and service would decrease.. Yes the current US costs are increasing so that affordability is down, but overall service is not by any means decreasing (as the evidence overwhelmingly says it does under socialized health care, or anything else). US doctors have MRI machines popping up like the Star Trek tribbles episode.

...You're saying that the most pessimistic outcome you can think of is that we screw it up worse than everyone else in the world has and end up with the same state of affairs we have now. Which, as mheslep has pointed out, the Dutch have demonstrated is a problem it's straightforward to get out of.

California alone has 36millon people, the Netherlands has only 16m. Also the Netherlands, compared to the US, is monolithic in terms of ethnicity, race, and background. In '06 France was almost burned to the ground by indignant and entitled young people who for years enjoyed jobs from which they could not be fired for almost any reason. The new labor bill stopped that, gasp, and http://en.wikipedia.org/wiki/2006_labour_protests_in_France#March_28" in the streets.

I think the inflexibility the “Socialized medicine??11 The sky would fall‼‼” scare tactic leads to is more of a problem than any particular practical issue in any health care solution.

Given the evidence I say its not the detractors of socialized medicine that are naive, but instead the 'why not try it' proponents. There have been numerous severe problems mentioned throughout this thread. I am unclear on exactly which system you proposed the US copy, but you do say its not the Dutch (failure fallback) so I assume you mean the socialized state care ala UK's NHS. This thread has grown large so I'll recap some of the issues. The main economic problem w/ socialized anything:

The real cost of producing any handout will always increase rapidly as the demand increases without check. It matters not who the 3rd party payer may be. If the 3rd party (insurer/government) stops paying the increase, the supplier will inevitably start limiting the quality of the service or good.

Examples:
http://www.fraserinstitute.org/commerce.web/newsrelease.aspx?nID=4967"
http://www.oecd.org/dataoecd/5/27/26781192.pdf" , pg 3.
https://www.physicsforums.com/showpost.php?p=1609935&postcount=57"

My Italian fiance's father was diagnosed with lung cancer. Socialized medicine. They diagnosed him from a single x-ray and scheduled him for chemotherapy. Ooops, x-rays can't determine the difference between the two types of lung cancer and he was given the wrong treatment. He was almost killed because he was also given a near lethal dose of chemo by mistake. When I urged my fiance to raise a rucus, his father was put on a 6 month waiting list to get an MRI, which was at the other end of the country.

http://healthcare-economist.com/2007/09/07/wsj-on-the-dutch-health-care-system/"

In most national social health insurance programs, individuals do not know the value of health care they receive

Pic of France '06: Why not try it?
http://en.wikipedia.org/wiki/Image:Frenchriot-18-mar-06.jpg

 

[gravenewworld]

There's a misinterpretation appearing over and over in this thread: that big business, by nature of being private, is necessarily the equivalent of free market enterprise. It is not. Especially when business and government get too close, its highly unlikely that free markets win the day.

Name me ONE big free market. Just ONE, that has absolutely 0 government influence. Hint: they only exist in some utopia on paper.IN a 100% free market health care system an insurance company would have every right to deny someone health coverage if they were too much of a liability to their profits.Here is a free market for you:

http://economics.about.com/library/graphics/demand1.bmp
So tell me in this 100% free market, what do all the people who lie on the demand curve below equilibrium levels do? Also one of the assumptions of a free market is that firms that supply goods can enter and exit freely from the market. This would never happen in the real world for something like health insurance. Firms can't enter at will due to huge start up costs.

The free market is overrated.

 

[TVP45]

The reason you can't afford the help is largely because there is little in the way of a free market. BTW, I don't know of any free market health expert that proposes there should not be a safety net to catch the hard cases - like asthma.


Thats a gross inequity IMO, no one should be forced to pay those taxes. Especially at the public university level, the better off are supported by the poorer.


Yes you did. You might say that the cost was far out proportion to the benefit, or that special interests ripped off the system while delivering it, but you did directly benefit.


Thank you for your service.

Thanks for the thoughtful reply. I was not in any sense complaining, especially since I am currently smart enough to handle this. My point was I do feel an obligation to my fellow citizens - after all, we were all sojourners in a strange land once - and I willingly pay (and don't ever cheat) on taxes as the dues I owe a civilized society. I may vote against them at times but I pay them.

But, lots of people are not smart (or lucky) enough and so we see, as in the housing foreclosures where disgruntled homeowners simply trash their foreclosed houses, that the social contract does have to be taken into consideration. A night in a big city ER quickly convinces one that there is a hell of a lot of very expensive care given to relatively minor illnesses; if we turn that off for lack of funding, where do those folks go? How long will they tolerate it?

 

[fourier jr]

Americans should only pay for the roads that they use. Why not? But then they'd have to keep people who didn't pay for those roads off them, and to do that they should hire Blackwater or some other army. & if someone comes along with a bigger/better army the people who own the road should get nuclear weapons, but who would want to live in a society like that?

 

[CaptainQuasar]

mheslep quoted:

The real cost of producing any handout will always increase rapidly as the demand increases without check. It matters not who the 3rd party payer may be. If the 3rd party (insurer/government) stops paying the increase, the supplier will inevitably start limiting the quality of the service or good.

And how exactly does this not apply to a non-socialized system? That quote mentions insurers right there. Any “free market” system that actually adequately insures everyone would face the same problem that is described above. If theoretically people knowing the costs of medical procedures would fix that… then, drum roll please… we build a socialized system that tells people what the care costs! We don't need to try to build the first broadly successful free market system in the history of human kind just to try to get people informed of and responding to costs.

If what you wrote above really the summation of all of the arguments and evidence people have been able to assemble in the course of this 150-post thread, that's pretty underwhelming, and I'm glad I didn't go through and read it all. (Thank you for the summation, by the way.) It actually surprises me that you put that together and spoke as if it was daunting or something.

All you've got is some inconvenient waiting periods - which I can't imagine result in unusually high fatalities or complications, because if there were numbers like that around you'd be quoting those instead - an anecdote that except for the MRI thing could easily have happened in the U.S., and something about people not knowing the costs of their care? That's the justification you would use to claim that entertaining a publicly-funded health care system is naïveté?

And you prop that stuff up next to a picture you got off of Wikipedia of a burning car that was taken during labor / unemployment riots in the banlieues? You're pretty much making my point for me that opposition to socialized medicine is carried out via scare tactics.

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[mheslep]

Related to TVP45's comment ...I'm genuinely curious to hear what answer you have found to this in studying free-market health systems.

And the question is - in a real free market system, wouldn't it be the case that not only people like TVP45 with asthma or other costly pre-existing conditions, [...] would basically be the hot potato amongst whatever companies are footing the bill? (Something like health insurance companies, I would assume.) The most certain way to ensure commercial success, for the companies that actually do the paying for health care services, is always going to be to make sure that individuals do not transit into the category of costs-more-than-they-pay (hopefully via encouraging preventive care, but the incentive will be there to not pay for expensive, needed, procedures) and that existing costs-more-than-they-pay individuals are moved off of their rolls.

That's true in any kind of insurance and it's one of the main reasons why the insurance industry is so heavily regulated in general. And even if we were to come up with something that's different from insurance, the situation above is going to have to be the dominant factor in the risk management scenarios of whatever class of company ends up paying for the actual care.

I would think that must be a pretty large category of people. Isn't the “correct” operation of the market, as it were, going to be to minimize the resources routed to that class of people, as if they're business units that are non-essential cost centers - business units that cost more than the revenue they generate? Won't you need government intervention for that entire class of people? And if you need government involvement for such a large number of people, how free-market can any practical system ever get?

Excellent question. For focus, let's just discuss the chronically ill here. Since insurance (in the traditional, economic sense) is bought to cover the unexpected i.e. bike wreck, get cancer, then yes agreed it doesn't make sense to insure conditions stemming from chronic conditions, which by their nature are always there. So here is a case that warrants a government subsidy - part of the safety net. I don't favor insurance regulation and mandates, that just drives up the cost. The idea (published) I favor is still market related. Offer the insurance market a government subsidy to cover the chronic conditions. Works like this: Federal govt sets up a pool of money to subsidize chronic illness. Our proud Vet TVP45 or a diabetic goes out into the market place to buy health insurance. Say the usual non-chronic healthy (otherwise same conditions) pays $Xk/yr. Fed steps in, "insurance company, you can dip into this pool of $ if you cover TVP45 for conditions related to his asthma. We'll pay you $3X on top of TVP's $Xk/yr". (Maybe TVP can improve the guess - I don't know what the multiplier is of asthmatic costs vs the general population.)

Now let's scope this problem in finer detail to answer the size question. The chronically ill include many conditions like AIDs, but Asthmatics and diabetics dwarf everything else by number: Asthmatics 25 million, diabetics 15m, say 40 million chronically ill. Recall though that this chronic care subsidy is just to cover problems related to the chronic problem, like blindness from diabetes, this is not blanket coverage like medicare. If TVP45 breaks his neck bungie jumping the tax payer is off the hook, the regular insurer pays the tab. Chronic care subsidy would then be ~40m x 3Xk/yr. Thats $120B if X=1, still a fraction of the $2 trillion in health care spending. Obviously keeping the general insurance cost X low is an issue, but that's for another post.

There's a similar precedent for this kind of thing in auto insurance (at least in my state) where those that have a couple too many speeding tickets to get regular coverage are put into a state backed special insurance category, otherwise the auto insurers would never pick you up. Everybody's happy.

 

[mheslep]

mheslep quoted:

And how exactly does this not apply to a non-socialized system? That quote mentions insurers right there. Any “free market” system that actually adequately insures everyone would face the same problem that is described above.

In the context of the original post insurers means employee based insurance w/ associated tax exemption. There's very little free market about it that, as the users don't have much choice of insurance, the insurance is highly regulated, and the user's rarely see a doctor bill.

If theoretically people knowing the costs of medical procedures would fix that… then, drum roll please… we build a socialized system that tells people what the care costs!

Knowing would only help marginally. You have to know and pay to get the free market effect of "searching for the highest possible value at the lowest possible cost." What do I care about costs if the government pays, even if they can tell me the cost. It is free to me at the point of service, and just as the quote says I am going to try and get as much of it as possible until I'm checked, driving the cost through the roof until the govt. imposes rationing.

All you've got is some inconvenient waiting periods - which I can't imagine result in unusually high fatalities or complications, because if there were numbers like that around you'd be quoting those instead - an anecdote that except for the MRI thing could easily have happened in the U.S.

Come on, clik through and read the thing. Yes of course mistakes happen in the US its a big problem. Thats not main point. Its clear in this case that the father w/ cancer was either going risk death from the MRI wait, or go to another country for help.

And you prop that stuff up next to a picture you got off of Wikipedia of a burning car that was taken during labor / unemployment riots in the banlieues? You're pretty much making my point for me that opposition to socialized medicine is carried out via scare tactics.

Please stay on point. I am clearly not speaking there about implementing state care, I'm speaking to the suggestion that it could be just done away with when there's no example in modern history of doing away with any thing that cost $2 trillion. Your point was principally 'lets try socializing this massive economic sector, if it doesn't work we can just drop it as others have'. The French labor law was example of exactly that, the elimination of a very large universally government provided system for which millions had come to believe was their unassailable right. The riot posts were completely justified. (Not saying were French )

 

[mheslep]

Name me ONE big free market. Just ONE, that has absolutely 0 government influence.

Hint: they only exist in some utopia on paper.

Semiconductors. $216B. 5 orders of magnitude improvement in 30 yrs. Also entire 1st 140 years of US economic history government was involved in only 10% of the economy.

 

[CaptainQuasar]

mheslep - thank you for some cogent analysis of my hot potato question above. I do think that market-based mechanisms like what you describe ought to be part of any solution public or private. And it's good to know that even when you're proposing 100% free market there's still that level of government involvement to protect the disadvantaged players to some degree.

In response to your other post, there are lots of points to it which I'll respond to below. But my overall assessment is that this is an underwhelming set of questionable assertions to base calling naïve the people who disagree with you, especially next to your Chicken Little “The sky will fall!” story and picture of a burning car. If this really is the sum of it, as far as I see there's no reason whatsoever not to go forward with a national health plan immediately.

And another thing - I know it wasn't you who referred to any socialized medicine plan as an “experiment”, when it's what we've got most of the evidence and data about as opposed to no real systemic data at all on the theoretical fix-everything free-market solution, but doing so is absurd and pejorative and another example of how the campaign against socialized medicine can more easily be identified by common tactics rather than reasoning.

In the context of the original post insurers means employee based insurance w/ associated tax exemption. There's very little free market about it that, as the users don't have much choice of insurance, the insurance is highly regulated, and the user's rarely see a doctor bill.

I understand that. I just don't think that there's any magic way a free market system would be better able to deal with the problem without ending up denying a pretty substantial number of legitimate claims, and hence requiring government intervention on a large scale and possibly ending up back in a situation similar to what we've got now, so I don't regard a free market solution as an automatic fix to that.

Something we definitely don't want is one of the anecdotes portrayed in Sicko, where a guy cut off two of his fingers and had to choose between them, choosing the least expensive one to reattach and losing the other.

If they successfully incentivize doctors and other health care workers to increase quality in these national health systems there are equivalent ways to incentivize the patients of the healthcare system to pursue lower costs. Think of airline frequent flyer miles; that isn't a market (or if it is, it's one that could be easily implemented within a socialized medicine system), but although it isn't a market the airlines and their partners are able to get people to jump through all sorts of hoops in pursuit of frequent flier miles. I would say that programs like this would probably actually work better within a socialized medicine system rather than trying to achieve that sort of result across a patchwork of different companies.

Knowing would only help marginally. You have to know and pay to get the free market effect of "searching for the highest possible value at the lowest possible cost." What do I care about costs if the government pays, even if they can tell me the cost. It is free to me at the point of service, and just as the quote says I am going to try and get as much of it as possible until I'm checked, driving the cost through the roof until the govt. imposes rationing.

I'm skeptical that this really is an automatic outcome of every sort of care provided under an nationalizes system is drastic shortages in every category. If that really was the case I think there would be quite a lot more data to support is. I'm also skeptical that in the current system the same sort of thing isn't happening. For example, in some years past I worked as a nurse's aide and I know there was a tremendous shortage of nurse's aides and nurses that I'm pretty sure is still going on today. And of course we may lack some data on our current system because people don't even try to get procedures or services their health insurer has denied or which they otherwise can't afford.

Yes, some people behave this way in response to something that they think is all-you-can-eat, but it's pretty easily dealt with. Just think of it: commercial companies offer free deals all the time and they're somehow able to control these sorts of people.

I think the kind of incentive program I talked about before should be integral to any solution public or private and be used to encourage preventive care and other things. At some point we really need to have a nationally standardized health records system and it would be trivial to build up the infrastructure for an incentive program along with it.

Come on, clik through and read the thing. Yes of course mistakes happen in the US its a big problem. Thats not main point. Its clear in this case that the father w/ cancer was either going risk death from the MRI wait, or go to another country for help.

I clicked through and read all of them including the PDF. These just aren't any sort of justification to call the people who disagree with you naïve.

Please stay on point. I am clearly not speaking there about implementing state care, I'm speaking to the suggestion that it could be just done away with when there's no example in modern history of doing away with any thing that cost $2 trillion.

Sure there are. Every large military force ever raised in the last century amounted to that in today's dollars and gave suckling teats for all sorts of defense industry companies and jobs for millions of people, and there weren't riots when we went back down to normal levels and the contractors got cut off and the soldiers and other workers lost their jobs.

Why aren't we going to have people rioting and burning cars when we transition from our current system to your free market system if it's so inevitable with any large change? Why won't the insurers who specialize in group policies go nuts and we'll find ourselves with insurance salesmen smashing our car windows and turning them over and setting them on fire? Oh, let me guess, because there's going to be a place for them in your new system. Obviously any other transition would be handled the same way.

I've got to say, it's pretty darn arrogant for you to make a the-sky-will-fall-but-just-in-the-case-of-socialized-medicine claim, upload a photograph from a riot of all things, and then say I'm going off topic to point out that this is a completely slimy scare tactic.

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[CaptainQuasar]

Semiconductors. $216B. 5 orders of magnitude improvement in 30 yrs.

How long was it, again, before you could buy a PC-compatible processor from anyone other than Intel? (and IBM, while the reciprocal licensing deal lasted.) And surely you're familiar with the concept of companies intentionally making things obsolescent? Or making proprietary components and systems that interoperate only with each other and not with those of their competitors? Much of the progress that has been made in standardization has been the result of the efforts of a few very large and powerful consumers (like the U.S. government!) - a complete contradiction of the perfect free market scenario. The success of the semiconductor industry is by no means attributable strictly market dynamics, much less market dynamics of a perfect market.

I think that example would have some relevance if health care was also something that you had to throw away every year and buy a new one. But it isn't.

Also entire 1st 140 years of US economic history government was involved in only 10% of the economy.

Robber barons of steel, oil, coal, and railroads establishing monopolies and occasionally becoming so wealthy that the federal government had to borrow money from them (J.P. Morgan), major exploitation in the manner in which land and mineral rights were purchased from Native Americans (specifically the occasions when it was purchased, of course, there were many instances when it was not), a different currency in each state, industrial indenture of workers and child labor, http://en.wikipedia.org/wiki/The_Jungle" type stuff with sausage and hot dogs manufactured with sawdust as an additive… not a really great example of a free market itself, nor a positive depiction of the effects of laissez faire.

 

[gravenewworld]

Semiconductors. $216B. 5 orders of magnitude improvement in 30 yrs.

Oh so the same market that the US government regulates so that advanced semi conductor technology is not allowed to be sold to China under the Wassenaar Arrangement?


Once again, not an entirely free market.

Also entire 1st 140 years of US economic history government was involved in only 10% of the economy

LIke the Captain pointed out, the same 140 years of economic history in which vital consumer services like oil, communication, and transportation were DOMINATED by huge conglomerates like Standard Oil, AT&T, and railroad monopolies?



Once again, the free market is overrated.

 

[baywax]

Think about it TVP45. Let's say someone you supported going to public university is the person that invents how to cure and prevent asthma. And the invention ends up costing $12.99 at Walgreens. That's worth a few years of taxes, eh?

And how about the community you're living in. Do you want to live in a community where most people are not educated? You don't want the majority of people to have no clue as to what asthma is. You might have to rely on one or two of those people in the community to be sophisticated enough take care of you if you're caught off guard.

My taxes keep people in school, working on the roads, blowing dead satellites out of orbit and saving blue babies and comforting the elders. My taxes make my community somewhere I like to live because its a place where people take care of each other (and ultimately themselves). That's directly benefiting my life and there are fewer people running around burning down my embassy etc... because of it.

 

[TVP45]

Think about it TVP45. Let's say someone you supported going to public university is the person that invents how to cure and prevent asthma. And the invention ends up costing $12.99 at Walgreens. That's worth a few years of taxes, eh?

And how about the community you're living in. Do you want to live in a community where most people are not educated? You don't want the majority of people to have no clue as to what asthma is. You might have to rely on one or two of those people in the community to be sophisticated enough take care of you if you're caught off guard.

My taxes keep people in school, working on the roads, blowing dead satellites out of orbit and saving blue babies and comforting the elders. My taxes make my community somewhere I like to live because its a place where people take care of each other (and ultimately themselves). That's directly benefiting my life and there are fewer people running around burning down my embassy etc... because of it.

That was my point about the social contract. Civilization comes with a price. I am willing to pay my share.

 

[baywax]

That was my point about the social contract. Civilization comes with a price. I am willing to pay my share.

Sorry, I missed your point! Its a huge responsibility that boils down a few hundred dollars off a cheque. Not too mention the responsibility of solving our own health issues without burdening the system. Its all a good idea but it also gets pretty abused.

 

[mheslep]

...If they successfully incentivize doctors and other health care workers to increase quality in these national health systems there are equivalent ways to incentivize the patients of the healthcare system to pursue lower costs...

I've lost you here, sorry its a long discussion and I've been away. How exactly are doctors to be incentivized to increase quality? Are you referring to some specific national system in existence? For that matter, are you suggesting in general a country that should be closed copied as a model for the US?

 

[CaptainQuasar]

I've lost you here, sorry its a long discussion and I've been away. How exactly are doctors to be incentivized to increase quality? Are you referring to some specific national system in existence? For that matter, are you suggesting in general a country that should be closed copied as a model for the US?

In Sicko it claimed that in the U.K. there are a specific set of metrics which doctors are evaluated for: how many patients of hers stopped smoking, how many patients had a so-and-so percentage reduction in cholesterol levels, etc., for which they earn a yearly bonus. I've heard that certain HMOs in the U.S. do similar things, though I'm not sure how the bonus or incentive or whatever would work since the doctors are not employees of the HMOs.

I'm not suggesting that any country should be closely copied. Incentivizing performance is a straightforward concept that isn't limited to healthcare. I think it's more important to vigorously and consistently implement a plan to incentivize the performance of health care professionals than it is to incentivize reduction of costs.

I also mentioned that we should incentivize citizens to improve and maintain their own health. I proposed that perhaps a program like this could be based on the frequent flyer miles programs airlines use, which have obviously been affordable and effective for them in incentivizing all sorts of different behaviors in their customers.

⚛​

 

[mheslep]

I'm not suggesting that any country should be closely copied...

I don't understand. I didn't mean exactly duplicated. Given the above posts in favor of national health care, surely you could likewise point to one or more examples elsewhere and defend it as worth of, what, emulating? Seems to me that otherwise we spend a lot of time discussing something that's purely conceptual and as such will be amorphous and impossible to evaluate.

 

[CaptainQuasar]

I don't understand. I didn't mean exactly duplicated. Given the above posts in favor of national health care, surely you could likewise point to one or more examples elsewhere and defend it as worth of, what, emulating? Seems to me that otherwise we spend a lot of time discussing something that's purely conceptual and as such will be amorphous and impossible to evaluate.

What - the way you're offering up an example of a pure free market healthcare system for me to critique? Like you're not relying on something purely conceptual that's amorphous and impossible to evaluate! Half of your responses have been “That totally doesn't count, the U.S. system isn't really a free market!”

The fact that there have been widespread, citeable and referenceable successes across many countries with socialized medicine is half the argument in favor of it.

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[mheslep]

The fact that there have been widespread, citeable and referenceable successes across many countries with socialized medicine is half the argument in favor of it.

Then it should be easy. Name one or two such.

 

[CaptainQuasar]

Then it should be easy. Name one or two such.

Don't be silly. That's what this entire thread is about. Don't you try to prove I can't argue a certain way (i.e. without claiming that a specific country should be the model) and I won't do the same to you.

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[baywax]

Then it should be easy. Name one or two such.

For starters, let's get the list of countries with a national health care program:

Afghanistan*, Argentina, Austria, Australia, Belgium, Brazil, Canada, Chile, China, Cuba, Costa Rica, Cyprus, Denmark, Finland, France, Germany, Greece, Iraq*, Iceland, Ireland, Israel, Italy, Japan, Luxembourg, the Netherlands, New Zealand, Oman, Portugal, Russia, Saudi Arabia, Spain, Sweden, South Korea, Sri Lanka, Ukraine and the United Kingdom
*Universal health coverage provided by United States war funding

http://www.gadling.com/2007/07/05/what-countries-have-universal-health-care/

Note that in order for the United States to supply universal medical coverage to you, you have to have been under attack by them or occupied by them.

Keep in mind: this is a simple list of countries that have some sort of publicly sponsored health care system. For instance, Sri Lanka may be far from having a true, working universal health care system like France, but prescription drugs are provided by a government-owned drug manufacturer. This qualifies as "some sort of publicly sponsored, universal health care system."

{same source}

Here's one of the "most successful models of universal health care" according to some folks.

Singapore has a highly privatized universal health care system with an emphasis on individual fiscal responsibility. Overall spending on health care amounts to only 3% of annual GDP. Of that, 66% comes from private sources.[7] Singapore currently has the lowest infant mortality rate in the world (equaled only by Iceland) and among the highest life expectancies from birth, according to the World Health Organization.[46] Singapore has "one of the most successful healthcare systems in the world, in terms of both efficiency in financing and the results achieved in community health outcomes," according to an analysis by global consulting firm Watson Wyatt.[47] Singapore's system uses a combination of compulsory savings from payroll deductions (funded by both employers and workers) a nationalized catastrophic health insurance plan, and government subsidies, as well as "actively regulating the supply and prices of healthcare services in the country" to keep costs in check; the specific features have been described as potentially a "very difficult system to replicate in many other countries." Many Singaporeans also have supplemental private health insurance (often provided by employers) for services not covered by the national programs.[47]

http://en.wikipedia.org/wiki/Universal_health_care

Actually, that whole page has great info on each country with the system.

 

[mheslep]

Thanks for posting your find.

For starters, let's get the list of countries with a national health care program:

http://www.gadling.com/2007/07/05/what-countries-have-universal-health-care/

Keep in mind: this is a simple list of countries that have some sort of publicly sponsored health care system. For instance, Sri Lanka may be far from having a true, working universal health care system like France, but prescription drugs are provided by a government-owned drug manufacturer. This qualifies as "some sort of publicly sponsored, universal health care system."

Then by this definition the US also has a 'national' heath program, not like France, but in the form of the multi hundred billion dollar medicaid and medicare programs.

 

[baywax]

Thanks for posting your find.

Then by this definition the US also has a 'national' heath program, not like France, but in the form of the multi hundred billion dollar medicaid and medicare programs.

Yes, I've always seen it as such. But what else is happening is the de-regulation of hospitals, clinics and individual doctor's offices. De-regulation means less stringent guidelines and less (he's going to say it again) congruency. If we could count on medical associations to act on behalf of the patient rather than the shareholder then there wouldn't be as many patients going "Enron" on us.

 

[mheslep]

Here's one of the "most successful models of universal health care" according to some folks.

Ok on to Singapore. I am a little wary of comparing the US to Singapore, as its population https://www.cia.gov/library/publications/the-world-factbook/geos/sn.html#People" is more comparable to Los Angeles than the entire US, but if there are good ideas to be found why not.
Here's Wiki's direct source for Singapore, thehttp://www.watsonwyatt.com/europe/pubs/healthcare/render2.asp?ID=13850"

Impressive stats there, only 3% of GDP total health spending and they get high life expectancy and high infant survival.

So how does Singapore achieve such impressive results?

The key to Singapore’s efficient health care system is the emphasis on the individual to assume responsibility towards their own health and, importantly, their own health expenditure. The result is a system that is predominantly funded by private rather than public expenditure.

Then I see they cover more people w/ private means than does the US (table 2). Seems very similar to the Netherlands.

The public system has some interesting parallels to the US:

Eldershield

The Government has also recently introduced Eldershield, an extension to the ‘3M’ system. Eldershield is a private insurance scheme designed to help fund future medical expenses incurred in the event of severe disability, particularly at advanced ages.

= Medicare?

Medifund
Medifund is an endowment fund set up by the Singapore Government to assist those in financial hardship in funding their medical needs.

=Medicaid?

Wish there were more details on how exactly the govt. care executes the universal coverage.

 

[gravenewworld]

Interesting story on 60 minutes tonight on how the US is basically reduced to using a 3rd world program for health care.

http://www.cbsnews.com/stories/2008/02/28/60minutes/main3889496.shtml

ne of the decisive issues in the presidential campaign is likely to be health insurance. Texas and Ohio vote on Tuesday, and those states alone have nearly seven million uninsured residents; nationwide, 47 million have no health insurance. But that's just the start: millions more are underinsured, unable to pay their deductibles or get access to dental care.

Recently, 60 Minutes heard about an American relief organization that airdrops doctors and medicine into the jungles of the Amazon. It's called Remote Area Medical, or "RAM" for short.

As correspondent Scott Pelley reports, Remote Area Medical sets up emergency clinics where the needs are greatest. But these days, that's not the Amazon. This charity founded to help people who can't reach medical care finds itself throwing America a lifeline.

Isaacs saw Marty Tankersley, the man Pelley had met in the parking lot who'd driven 200 miles. It turned out Tankersley had two heart attacks and heart surgery a few years back, but almost no follow up since.

The Tankersleys live in Dalton, Ga., and fall into the underinsured category. Marty's a truck driver and has major medical insurance through his employer. But the deductible is $500, really unaffordable. And the dental insurance costs too much.

So how can a program like this treat 17,000 people on only $250,000? That's what happens when doctors don't have to deal with all the HMO/insurance/etc. BS that is driving up the cost of health care.


America has great health care! ..........if you can afford it.

 

[D H]

So how can a program like this treat 17,000 people on only $250,000? That's what happens when doctors don't have to deal with all the HMO/insurance/etc. BS that is driving up the cost of health care.

I call BS.

Think about this for a second. Physicist salaries are paid over six figures, on average, according to https://www.physicsforums.com/showthread.php?p=1632227#post1632227". Medical doctors are paid even more. $250,000 would barely pay the yearly salary for two general practitioners in the US. Two general practitioners cannot provide adequate health care for 17,000 people. Even if they could, there would be no money left over for specialists, facilities, medicine, nurses, labs, equipment, and the list goes on.

So, "how can a program like this treat 17,000 people on only $250,000?" Simple. With donated time, donated equipment, donated laboratories, donated staff. Lack of liability and lack of red tape are secondary compared to all these real costs (paid for by people in the advanced world). It's a sham to compare these costs to the costs of medical care in the US. Its fallacious to blame the cost differential on HMO/insurance/etc. Finally, its completely ludicrous to think that a government-run system would bring health care costs down to $14.70 per person per year.

 

[gravenewworld]

I call BS.

Think about this for a second. Physicist salaries are paid over six figures, on average, according to https://www.physicsforums.com/showthread.php?p=1632227#post1632227". Medical doctors are paid even more. $250,000 would barely pay the yearly salary for two general practitioners in the US. Two general practitioners cannot provide adequate health care for 17,000 people. Even if they could, there would be no money left over for specialists, facilities, medicine, nurses, labs, equipment, and the list goes on.

So, "how can a program like this treat 17,000 people on only $250,000?" Simple. With donated time, donated equipment, donated laboratories, donated staff. Lack of liability and lack of red tape are secondary compared to all these real costs (paid for by people in the advanced world). It's a sham to compare these costs to the costs of medical care in the US. Its fallacious to blame the cost differential on HMO/insurance/etc. Finally, its completely ludicrous to think that a government-run system would bring health care costs down to $14.70 per person per year.

http://content.nejm.org/cgi/content/abstract/349/8/768

Results In 1999, health administration costs totaled at least $294.3 billion in the United States, or $1,059 per capita, as compared with $307 per capita in Canada. After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada.

Liability costs?

http://www.cbo.gov/ftpdoc.cfm?index=4968

Evidence from the states indicates that premiums for malpractice insurance are lower when tort liability is restricted than they would be otherwise. But even large savings in premiums can have only a small direct impact on health care spending--private or governmental--because malpractice costs account for less than 2 percent of that spending.(3) Advocates or opponents cite other possible effects of limiting tort liability, such as reducing the extent to which physicians practice "defensive medicine" by conducting excessive procedures; preventing widespread problems of access to health care; or conversely, increasing medical injuries. However, evidence for those other effects is weak or inconclusive.

What is ridiculous is the amount of waste that goes to paying for the overhead to deal with private insurance companies.


What is ridiculous is the fact that the US has to resort to 3rd world programs to treat its citizens, EVEN CITIZENS THAT ALREADY HAVE SO CALLED HEALTH INSURANCE.

 

[wildman]

The problem in the US is that we spend WAY too much money for WAY too little health care. The US spends more per capita than Canada for Government care, never mind private insurance, and Canada gets Universal coverage for its money. Either we should be spending less or we should be getting more, but to spend more and get less? Someone must be skimming a lot of money here...

 

[Schrodinger's Dog]

I did a thread on this ages ago, but the usual vision that national healthcare is socialism/communism prevailed. It's kind of bizzarre because all in all as a US citizen you pay 14%GDP, UK 7%GDP. And in fact will probably pay way more in insurance, taxes to cover it in your life, and yet In 2000 the US was ranked in 38th place 20 places below the UK, based on a wide range of factors, not least of which was infant mortality, lack of coverage for 1/6th of the population, and a lower mortality than most countries in Europe including the UK. Cut in that 50% of the costs are in insurance and legal claims, and you quickly get the idea, that what they don't want is having to pay less for something better for everyone. Slightly and mildly insane if you ask me, but that's socialism for you, it is and always will be evil to provide universal health care. Amen. Not only that but I've lost count of the number of times I've been speaking to an American on line and they've said, I would get it checked out but I can't afford it? Strangely nonsensical system if you ask me. What's even more embarrassing is that Cuba's healthcare system is only one place below the US's according to the figures in 2000 from the WHO.

http://www.photius.com/rankings/who_world_health_ranks.html

Overall Level of Health: A good health system, above all, contributes to good health. To assess overall population health and thus to judge how well the objective of good health is being achieved, WHO has chosen to use the measure of disability- adjusted life expectancy (DALE). This has the advantage of being directly comparable to life expectancy and is readily compared across populations. The report provides estimates for all countries of disability- adjusted life expectancy. DALE is estimated to equal or exceed 70 years in 24 countries, and 60 years in over half the Member States of WHO. At the other extreme are 32 countries where disability- adjusted life expectancy is estimated to be less than 40 years. Many of these are countries characterised by major epidemics of HIV/AIDS, among other causes.

Distribution of Health in the Populations: It is not sufficient to protect or improve the average health of the population, if - at the same time - inequality worsens or remains high because the gain accrues disproportionately to those already enjoying better health. The health system also has the responsibility to try to reduce inequalities by prioritizing actions to improve the health of the worse-off, wherever these inequalities are caused by conditions amenable to intervention. The objective of good health is really twofold: the best attainable average level – goodness – and the smallest feasible differences among individuals and groups – fairness. A gain in either one of these, with no change in the other, constitutes an improvement.

Responsiveness: Responsiveness includes two major components. These are (a) respect for persons (including dignity, confidentiality and autonomy of individuals and families to decide about their own health); and (b) client orientation (including prompt attention, access to social support networks during care, quality of basic amenities and choice of provider).

Distribution of Financing: There are good and bad ways to raise the resources for a health system, but they are more or less good primarily as they affect how fairly the financial burden is shared. Fair financing, as the name suggests, is only concerned with distribution. It is not related to the total resource bill, nor to how the funds are used. The objectives of the health system do not include any particular level of total spending, either absolutely or relative to income. This is because, at all levels of spending there are other possible uses for the resources devoted to health. The level of funding to allocate to the health system is a social choice – with no correct answer. Nonetheless, the report suggests that countries spending less than around 60 dollars per person per year on health find that their populations are unable to access health services from an adequately performing health system.

In order to reflect these attributes, health systems have to carry out certain functions. They build human resources through investment and training, they deliver services, they finance all these activities. They act as the overall stewards of the resources and powers entrusted to them. In focusing on these few universal functions of health systems, the report provides evidence to assist policy-makers as they make choices to improve health system performance.

The World Health Report 2000 (1) consists of a message from the WHO’s Director-General, an overview, six chapters and statistical annexes. The chapter headings are "Why do health systems matter?", "How well do health systems perform?", Health services: well chosen, well organized?", "What resources are needed?", "Who pays for health systems?", and "How is the public interest protected?"

 

[CaptainQuasar]

I did a thread on this ages ago, but the usual vision that national healthcare is socialism/communism prevailed.

Socialism yes, but not communism in general (though point taken on Cuba). After the end of the Soviet Union many aspects of Western medicine became all the rage in Russia. They were like - wow, anesthetics with dentistry? Brilliant! (Just kidding... they understood anesthetics, of course, but there were shortages of almost every sort of medical supply under the Soviet system.)

⚛​

 

[Schrodinger's Dog]

Actually it's neither really it's a basic societal need, in spite of my tongue in cheek observation of how the US feels about socialism; Hitler had some of the finest medical care in the world. Nationalised health care isn't socialism, it's common sense, it might look like it would be more expensive but it isn't. For a start people are less likely to sue the government, particularly when they realize that the money is coming out of their taxes, so less frivolous law suits and wastes of time. No insurance costs to handle yourself, all that is handled by government, and thus it is centralised and cheaper, you might pay a little more tax, but of course when your saving from GDP, that may well not be the case. And that's a massive amount of paperwork and bureaucracy gone for a start.

Healthcare providers do not run like ordinary businesses, because if they screw up people die, so people who work their tend to be a lot more job focused and a lot more careful, people are less likely to go off sick, more likely to work over time and more committed and less likely to leave that career choice. There really is no reason why you can't have both nationalised and private healthcare running at the same time for those that can afford it. And France is number one with a GDP of 9%. That's 5% less cost and the finest medical care in the world. That's kinda sad really.

 

[baywax]

Healthcare providers do not run like ordinary businesses, because if they screw up people die, so people who work their tend to be a lot more job focused

We could say the same thing about about a brake shop or aircraft engineers or anyone with peoples lives in their hands. The difference in health care is that the practitioners are handling people, not brakes or "O" rings. They have the people right there to talk to, deal with and get to know.

and a lot more careful, people are less likely to go off sick, more likely to work over time and more committed and less likely to leave that career choice. There really is no reason why you can't have both nationalised and private healthcare running at the same time for those that can afford it. And France is number one with a GDP of 9%. That's 5% less cost and the finest medical care in the world. That's kinda sad really.

Yes it is. There's more UK citizens retiring in France because of this. It may be that with a bit more consistency between each nation's health care systems, there will be less migration and less of a burden on those countries with a good system. Also, we see more and more doctors and nurses heading south for the higher pay offered by privatized health care. If we can somehow equalize our systems we wouldn't have the shortages of family physicians we have today. There are people who have gone without a family doctor for 3 years of being on a waiting list. Its not the norm but its a reality for them.

 

[mheslep]

Nationalised health care isn't socialism, it's common sense,

If that's not socialism then what is socialism?

it might look like it would be more expensive but it isn't.

That presumes you are paying for the same thing. Given the UK rationing - wait times, etc, do you believe it is the same thing?

 

[gravenewworld]

If that's not socialism then what is socialism?

Social security checks, medicare, and medicaid.

That presumes you are paying for the same thing. Given the UK rationing - wait times, etc, do you believe it is the same thing?

How could they be the same thing? Millions in the US don't even get to go to the doctor at all because they have 0 insurance or are underinsured.

 

[turbo]

As I have pointed out before, much of the cost of medical care in the US comes from the very convoluted coding requirements of the insurance companies and their incentives to deny payment over and over again. The longer they can deny payment, the more money they make on their investments. If we went to a single-payer system, the coding requirements for health-care providers would be cogent and unified, and a MAJOR expense of health-care providers would be alleviated. First, they wouldn't need to hire as many coding specialists, and secondly, they wouldn't have to face week after week of delay in payment by the insurance companies (who will eventually pay for treatment, but delay in order to maximize their profits). My cousin is a coding specialist for a pediatric ophthalmologist and all three of us used to work for a very large ophthalmic practice (I was the network administrator) and I can attest to the fact that medical practices are under great pressure from banks to get the age of their receivables reduced so that the practices can borrow against future payments. They are also driven to over-staffing in their coding people so that claims submitted to the insurance companies have a higher chance of being paid the first time out.

Insurance companies make money by denying/delaying payments on claims. This forces medical practices (who need to buy expensive equipment, supplies, insurances, etc) to borrow money to maintain their cash flow, and they have to pay interest on that. They also have to pay staffers to meet convoluted insurance company rules on referrals, second opinions, etc, or they won't get paid. The health insurance industry is the biggest drag on the US health care system, and they need to get written out of the system. We are paying far to much for far too little.