Why not free universal healthcare if

[mheslep]

I've recently learned the central limit theorem is a pretty important concept to use in insurance...

Its important to note that a large part the payments system in health care that's labeled insurance is really not. Insurance as you allude to above is the practice of covering the unexpected. The current system pays in large part for every day known expenses and is thus mislabeled.

 

[W3pcq]

Kind of a catch 22. Government health care will end up underfunded and mismanaged, private health care will end up exploiting us, jacking up prices and charging the most they possibly can without losing money. I guess that private may be better for the wealthy because they can afford outrageous prices and they want to shop around. Now i see the moral problem.

Why not have government health care to those who buy in(pay health tax), and still let the private sector offer practices as an alternative for people with extra cash? I guess if you pay your health tax, you get your meds at "canadian prices" and can still get private care whenever you want. If you don't pay health tax, you must pay for insanely high priced meds and must pay for all your health bills ie. no insurance company.

 

[AsianSensationK]

Its important to note that a large part the payments system in health care that's labeled insurance is really not. Insurance as you allude to above is the practice of covering the unexpected. The current system pays in large part for every day known expenses and is thus mislabeled.

Hmm...What are the everyday expenses you're referring too?

 

[mheslep]

Hmm...What are the everyday expenses you're referring too?

All generic medical care. Every general check up minus a $20 copay. Flu shots. Every day prescriptions minus a copay. All of these known expenses are paid for by health 'insurance'. Insurance, in the common sense, is something that protects us against the unlikely but involves large losses if they do occur as in major catastrophes. Health 'insurers' are in large part just middle men to enable use of the employer based health care tax exemption.

 

[AsianSensationK]

That's a good point.

It makes me think universal health insurance might actually do more of the stuff we expect insurance to do, and not just the middle men stuff.

 

[mheslep]

As you correctly point out, it is of the same kind as the required auto liability insurance, although it goes further. As the fee of the mandatory public health insurance is (for the same services) proportional to revenue, it is ALSO a kind of tax, in that it imposes some kind of solidarity (the rich pay a bit for the poor), while the car insurance is flat fee of course (well, not depending on your wealth, but rather on your objective risk factor).

But in both cases (actually more so for the health care) it is a relatively SMALL fee which can cover a potentially LARGE expense, and which, as your example points out, nobody can be sure not to need one day. In other words, to avoid a small expense, people who would refuse a minimum coverage do something objectively stupid. In any case, it is a small (relatively to your wealth) fee, it is not going to avoid you buy a bigger house, or go on a fancier holiday or anything, and you run a serious risk that one day, you have a SERIOUS problem. That's why it is objectively stupid: the gain you get from refusing it doesn't weight in with the potential danger you put yourself into.

As to the nanny state, I'm also against law enforcement that *obliges* you to BEHAVE in a safe way (as long as you're not increasing the risk for others of course). Nobody can determine how much pleasure you get from smoking, and whether or not you are willing to sacrifice your health for the pleasure of smoking, say. So although for most people, this is a stupid action, as you cannot quantify the "gain" (pleasure in doing so), you cannot objectively show that it is stupid.

But the insurance fee is really small, so you can quantify it. The gain isn't big, it is equal to the fee.

Some data coming in from Mass. Romney Mandatory Care.

No health insurance? Face fines
Failure to subscribe can cost residents up to $912 a year

Massachusetts has begun imposing stiff fines on residents who, for whatever reason, fail to purchase health insurance.

The program is the enforcement end of the state's universal health-insurance plan – and the fees reach up to $912 a year.

The state health-insurance initiative, signed into law by former Gov. Mitt Romney, has been compared to Democratic presidential candidate Hillary Clinton's national universal health-care plan – especially on the enforcement side.

The penalties apply to anyone deemed able to afford health insurance by the Commonwealth Health Insurance Connector Authority, the state agency that oversees the entire program.

 

[W3pcq]

The idea of having a penalty for not buying health insurance seams dangerous to me. They could raise their prices as high as they want, and if you can't pay, they take your house, take your car, bankrupt you etc. If we have a capitalist health care system then we ought to have the right to buy or not buy services. That is one of the only ways to keep prices within affordability. If they charge too much, people who can't afford it won't buy it. If people don't buy it, they lose customers. That and competition are the two factors that regulate price.

 

[vanesch]

That is why we may want to have a system where there is a specific medical tax paid yearly which goes into an exclusive medical fund.

Eh, yes of course. In fact, what happens in many European countries, is that this fund is always in the red, and must hence get extra money from the "big tax pot". In other words, the "minimum insurance" goes in the specific health care pot, but its expenses are bigger than its incomes, so it is compensated for by general tax money. That's why you usually get out on average as much as you put in (which can never work for a real private insurance!).

 

[vanesch]

Why not have government health care to those who buy in(pay health tax), and still let the private sector offer practices as an alternative for people with extra cash?

That's actually how it works with most European countries, except that they don't let you opt out from the governement system: you pay in any case your contribution. Even if you go to private practices, the public system will reimburse you what you would have paid (more or less) if you went to a public hospital (in other words, where it would have been essentially "free" or almost free). If you want to go to a more expensive private clinic, no problem, but you won't get more out of the public pot (even a bit less). However, you can (and most people do) take on top of that a private insurance which will cover (part of) these higher expenses, according to different terms depending on the insurance you took. Here you're totally free.

If you go to a doctor, there are those doctors that align themselves on publicly fixed tariffs, and there are those that set their own tariffs ; a doctor has to announce in which category he plays. Doctors are encouraged to align themselves on the public tariffs (I don't know the system exactly, but I think, with fiscal advantages etc...).
By the public insurance you will get partly refunded the fixed tariff (minus something). If you went to a more expensive doctor, then you pay the difference (even a bit more), again, unless you've taken a private insurance against it.

For instance, in France, a normal doctor's visit is publicly fixed to 21 Euros. If I go to a doctor aligned on the public tariff, I get back 20 Euros. My personal doctor is not in this system, and asks 31 Euro for a visit, and I get back 16 Euro from the public insurance (so a bit less than if I went to a doctor that was aligned). My private insurance doesn't take that into account, so I pay the 15 Euros difference.

 

[vanesch]

The idea of having a penalty for not buying health insurance seams dangerous to me. They could raise their prices as high as they want, and if you can't pay, they take your house, take your car, bankrupt you etc.

No, in Europe it is fixed by government, and proportional to your income. It is a very small fraction of your income, much less than income taxes. If you get a salary, then it is even taken from it before you get the salary, so you don't even have to do anything! You cannot get a fine for not paying it, it is taken "at the source". Your employer is responsible for this handling. If you are unemployed, with an unemployment aid, this is taken care off also. It is only when you drop out of the system (unemployed, no income) that you have a problem. Then you can only rely on public health service.
If you have your own business, well, that's different then, you have to do the paperwork yourself.

 

[mheslep]

No, in Europe it is fixed by government, and proportional to your income. It is a very small fraction of your income, much less than income taxes. If you get a salary, then it is even taken from it before you get the salary, so you don't even have to do anything! You cannot get a fine for not paying it, it is taken "at the source". Your employer is responsible for this handling. If you are unemployed, with an unemployment aid, this is taken care off also. It is only when you drop out of the system (unemployed, no income) that you have a problem. Then you can only rely on public health service.
If you have your own business, well, that's different then, you have to do the paperwork yourself.

Vanesch: Is this recent in the EU? Some time ago the EU was like Canada in the 90's in which there was the govt. run heath care system paid for largely by taxes. There was no other mandatory sign up as you were onboard just by being a citizen. So now in the EU, this mandatory sign up involves fees in addition to your taxes?

 

[Schrodinger's Dog]

The idea of having a penalty for not buying health insurance seams dangerous to me. They could raise their prices as high as they want, and if you can't pay, they take your house, take your car, bankrupt you etc. If we have a capitalist health care system then we ought to have the right to buy or not buy services. That is one of the only ways to keep prices within affordability. If they charge too much, people who can't afford it won't buy it. If people don't buy it, they lose customers. That and competition are the two factors that regulate price.

Well if you can't afford to pay because you are unemployed then you don't have to. And you never get bankrupted by national insurance, because it is a percentage of what you earn, not what you don't.

Eh, yes of course. In fact, what happens in many European countries, is that this fund is always in the red, and must hence get extra money from the "big tax pot". In other words, the "minimum insurance" goes in the specific health care pot, but its expenses are bigger than its incomes, so it is compensated for by general tax money. That's why you usually get out on average as much as you put in (which can never work for a real private insurance!).

In the UK the expense is seldom more than the recompense. It's subsidised, but the cost isn't actually that great and because the GDP outlay is low, it isn't even that significant.

Vanesch: Is this recent in the EU? Some time ago the EU was like Canada in the 90's in which there was the govt. run heath care system paid for largely by taxes. There was no other mandatory sign up as you were onboard just by being a citizen. So now in the EU, this mandatory sign up involves fees in addition to your taxes?

It does indeed, but they are not that high, and are graduated based on earnings, for example those who pay the higher tax bracket only pay a flat 1% national insurance, as the rest is covered by their taxes. So the outlay isn't actually significantly higher. Although of course it is somewhat more. That is the UK system though.

 

[W3pcq]

Well if you can't afford to pay because you are unemployed then you don't have to. And you never get bankrupted by national insurance, because it is a percentage of what you earn, not what you don't.

Actually I was talking about mandated private insurance.

 

[Schrodinger's Dog]

Actually I was talking about mandated private insurance.

Which is a stupid idea frankly. Should make it part of taxes if it's going to be mandatory, saves admin costs.

 

[mheslep]

Resurrecting this thread to collect some sources:

b) Do you have a source for this claim? Is this problem long-lasting and widespread, or only isolated to a small number of cases or specific treatment types, and for a short-period? AFAIK, in India, services in government hospitals aren't denied, and the treatment time is usually reasonable.

o UK Average wait for surgery 220 days
o 10,000 people in UK waited 15 mos for surgery. Economist magazine of London, pg 55, April 13, 02
o UK woman whose cancer surgery was postponed until it had to be canceled because it became inoperable during delays. Economist, Nov 24, 2001, pg 52.
o Supreme Court of Canada: Chaoulli v. Quebec 2005:

...The evidence in this case shows that delays in the public health care system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public health care. The evidence also demonstrates that the prohibition against private health insurance and its consequence of denying people vital health care result in physical and psychological suffering that meets a threshold test of seriousness...

 

[cristo]

Resurrecting this thread to collect some sources:
o UK Average wait for surgery 220 days
o 10,000 people in UK waited 15 mos for surgery. Economist magazine of London, pg 55, April 13, 02
o UK woman whose cancer surgery was postponed until it had to be canceled because it became inoperable during delays. Economist, Nov 24, 2001, pg 52.

1. This data is 8,7 and 6 years old, respectively. A lot has happened to the NHS in this time.
2. One case (i.e. the last one) does not prove a trend.

 

[drankin]

Average wait is 220 days for surgery is 220 days!?? That certainly wouldn't work in the US.

My father-in-law had to have a kidney removed recently due to the beginnings of cancer. He was in and out within 4 days. No cancer now. 220 days and he wouldn't be with us.

 

[mheslep]

It depends on your definition of "universal healthcare." I would define it to mean that one can obtain the same level of healthcare from the hospitals, regardless of the amount of money you have, or position in society you hold. With the NHS, for example, this is the case.

Certainly a government can attempt to force a system where there is equality of some result, healthcare denial for instance. I decline to call waiting around for surgery for six months any kind of an acceptable result for mainstream healthcare.

That there is a private healthcare for those that choose not to take up the NHS healthcare is regardless.

Not sure what you mean by 'is regardless', but that's my b), inclusion of private/market care, for people that refuse to tolerate the NHS. Health in the UK is not universally provided by the government. Nor would I completely accept that healthcare is universally available from the government in the UK, as that would mean a test at 100% of the population, and given the strains on the current system at partial use I believe NHS is incapable of supporting 100% use over time.

 

[mheslep]

1. This data is 8,7 and 6 years old, respectively. A lot has happened to the NHS in this time.

And to EU healthcare in general during the same period: its increasingly provided by private/market sources, less by the government.
http://www.reuters.com/article/latestCrisis/idUSL08617092
http://en.wikipedia.org/wiki/Health_care_reform#The_Netherlands

 

[misgfool]

I decline to call waiting around for surgery for six months any kind of an acceptable result for mainstream healthcare.

Apparently to measure performance of healthcare system you need to get statistics. We can measure performance as the queue length but I would see life expectancy, child mortality or average of sick days out of work a better indicator of a functioning healthcare system.

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

 

[mheslep]

Apparently to measure performance of healthcare system you need to get statistics. We can measure performance as the queue length but I would see life expectancy, child mortality or average of sick days out of work a better indicator of the functioning healthcare system.

I'd not be so inclined. Life expectancy, in particular, depends on many variables totally unrelated to actions of health providers. Why not go directly to health specific metrics: cancer, heart disease, etc, survival rates? That is, if I contract cancer, survival rates are the numbers I want to know and not something that is skewed by people dying in car wrecks, genetic make up, diet, or some other life style aspect of the society.

 

[cristo]

Average wait is 220 days for surgery is 220 days!?? That certainly wouldn't work in the US.

My father-in-law had to have a kidney removed recently due to the beginnings of cancer. He was in and out within 4 days. No cancer now. 220 days and he wouldn't be with us.

You can tell absolutely any story you like with statistics. Clearly, life-saving surgeries do not have waiting lists of 220 days.

Certainly a government can attempt to force a system where there is equality of some result, healthcare denial for instance. I decline to call waiting around for surgery for six months any kind of an acceptable result for mainstream healthcare.

You've failed to show me any statistics that show this in general.

Not sure what you mean by 'is regardless',

Nor do I: it doesn't make sense, I admit.

but that's my b), inclusion of private/market care, for people that refuse to tolerate the NHS. Health in the UK is not universally provided by the government. Nor would I completely accept that healthcare is universally available from the government in the UK, as that would mean a test at 100% of the population, and given the strains on the current system at partial use I believe NHS is incapable of supporting 100% use over time.

But that's just like saying "millionaires don't live in council houses, thus the council housing system is fundamentally flawed." Of course, if you have a lot of money, then you will go private. Why do you think people fly first class on planes? Because economy class won't get them to their destination?

And to EU healthcare in general during the same period: its increasingly provided by private/market sources, less by the government.
http://www.reuters.com/article/latestCrisis/idUSL08617092
http://en.wikipedia.org/wiki/Health_care_reform#The_Netherlands

I don't see what you're trying to do here. I was talking about the UK, and refuting your points. You then dig up articles from other countries, and on wikipedia to prove [sic] your point.

 

[misgfool]

I'd not be so inclined. Life expectancy, in particular, depends on many variables totally unrelated to actions of health providers. Why not go directly to health specific metrics: cancer, heart disease, etc, survival rates? That is, if I contract cancer, survival rates are the numbers I want to know and not something that is skewed by people dying in car wrecks, genetic make up, diet, or some other life style aspect of the society.

I see your point. However, if the entire nation has healthier lifestyle doesn't that mean that pre-emptive work done by public heathcare is providing very good results? This work done is much more cost-effective, which is of course what we seek the most, than treating already sick people. Surely private sector won't educate general public (not paying customers) of healthier living.

 

[mheslep]

...I don't see what you're trying to do here. I was talking about the UK, and refuting your points. You then dig up articles from other countries, and on wikipedia to prove [sic] your point.

I'm arguing my original statement: Universal government healthcare doesn't exist, anywhere.

 

[mheslep]

... Surely private sector won't educate general public (not paying customers) of healthier living.

I get stuff frequently from my provider of non-tax deductible automotive insurance on how to be a better driver, and generally (I believe) the auto insurers in part sponsor the public campaigns to improve auto safety and inform on same. And my home insurer insists on smoke detectors and fire extinguishers for a good rate.

 

[mheslep]

...You've failed to show me any statistics that show this in general...

Yes I clearly did, you criticized them for being old.

 

[mheslep]

...But that's just like saying "millionaires don't live in council houses, thus the council housing system is fundamentally flawed." Of course, if you have a lot of money, then you will go private. Why do you think people fly first class on planes? Because economy class won't get them to their destination? ...

The analogy would be that the 'council housing system is not universal'. I wasn't arguing here that NHS is fundamentally flawed*, just that it and other such systems are not what they are often claimed to be: universal.

*Though I do think it is an inefficient way to deliver health care.

 

[cristo]

The analogy would be that the 'council housing system is not universal'.

You are taking the term "universal healthcare" here to mean that everyone must use it. To use the term in that sense here is ridiculous. The fact is that everyone has the same opportunity to use the NHS. Whether they choose to or not is entirely up to them.

 

[mheslep]

You are taking the term "universal healthcare" here to mean that everyone must use it. To use the term in that sense here is ridiculous. The fact is that everyone has the same opportunity to use the NHS. Whether they choose to or not is entirely up to them.

'must' -> 'can'. And you're back to equality of some result again, in this case equality of 'NHS'. NHS does not equal health care, as 220 day waiting periods demonstrate.

 

[mheslep]

Canadian born physician David Gratzner essay on health care

http://www.city-journal.org/html/17_3_canadian_healthcare.html

...I was once a believer in socialized medicine. I don’t want to overstate my case: growing up in Canada, I didn’t spend much time contemplating the nuances of health economics. I wanted to get into medical school—my mind brimmed with statistics on MCAT scores and admissions rates, not health spending. But as a Canadian, I had soaked up three things from my environment: a love of ice hockey; an ability to convert Celsius into Fahrenheit in my head; and the belief that government-run health care was truly compassionate. What I knew about American health care was unappealing: high expenses and lots of uninsured people. When HillaryCare shook Washington, I remember thinking that the Clintonistas were right.

My health-care prejudices crumbled not in the classroom but on the way to one. On a subzero Winnipeg morning in 1997, I cut across the hospital emergency room to shave a few minutes off my frigid commute. Swinging open the door, I stepped into a nightmare: the ER overflowed with elderly people on stretchers, waiting for admission. Some, it turned out, had waited five days. The air stank with sweat and urine. Right then, I began to reconsider everything that I thought I knew about Canadian health care. I soon discovered that the problems went well beyond overcrowded ERs. Patients had to wait for practically any diagnostic test or procedure, such as the man with persistent pain from a hernia operation whom we referred to a pain clinic—with a three-year wait list; or the woman needing a sleep study to diagnose what seemed like sleep apnea, who faced a two-year delay; or the woman with breast cancer who needed to wait four months for radiation therapy, when the standard of care was four weeks.

I decided to write about what I saw. By day, I attended classes and visited patients; at night, I worked on a book. Unfortunately, statistics on Canadian health care’s weaknesses were hard to come by, and even finding people willing to criticize the system was difficult, such was the emotional support that it then enjoyed. One family friend, diagnosed with cancer, was told to wait for potentially lifesaving chemotherapy. I called to see if I could write about his plight. Worried about repercussions, he asked me to change his name. A bit later, he asked if I could change his sex in the story, and maybe his town. Finally, he asked if I could change the illness, too...

Nor were the problems I identified unique to Canada—they characterized all government-run health-care systems. Consider the recent British controversy over a cancer patient who tried to get an appointment with a specialist, only to have it canceled—48 times. More than 1 million Britons must wait for some type of care, with 200,000 in line for longer than six months. A while back, I toured a public hospital in Washington, D.C., with Tim Evans, a senior fellow at the Centre for the New Europe. The hospital was dark and dingy, but Evans observed that it was cleaner than anything in his native England.

 

[cristo]

'must' -> 'can'. And you're back to equality of some result again, in this case equality of 'NHS'. NHS does not equal health care, as 220 day waiting periods demonstrate.

Replacing words in sentences completely changes their meaning. We're just going round in circles, and you aren't making any relevant comments. Can you read what I'm saying, or are you just choosing to ignore it? Why can you not see that these two comments are different:

1. Every citizen has the opportunity to take up NHS healthcare;
1. Every citizen must take up their offer of NHS healthcare?

Furthermore, your 220 day waiting list that quote was, firstly, based on statistics which were released in 2000 and, secondly, highly misleading. What one needs to look at is waiting lists for different types of surgery, at least based on risk.

However, it's quite apparent that you do not believe in nationalised, free, healthcare, which explains why you try to present misconstrued data. I also don't wish to enter into a "my countries healthcare system is better than yours" 'discussion.' Thus, it is pointless for me to continue this discussion.

 

[Borek]

However, if the entire nation has healthier lifestyle doesn't that mean that pre-emptive work done by public heathcare is providing very good results?

Not necesarilly.

French have low level of heart diseases, which is attributed to diet and wine, it has nothing to do with healthcare - it is just a lifestyle.

Note, that even if the example I gave (about low level of heart diseases and the reason behind) is wrong, my point is still valid

 

[mheslep]

I see your point. However, if the entire nation has healthier lifestyle doesn't that mean that pre-emptive work done by public heathcare is providing very good results? This work done is much more cost-effective, which is of course what we seek the most, than treating already sick people. Surely private sector won't educate general public (not paying customers) of healthier living.

I agree with most of this, though I don't know how to correlate a healthier nation with pre-emptive care. Still it certainly makes sense that pre-emptive care probably is effective and desirable. I don't know that it has to be free at the point of access to enable it. There's an old RAND study on this around somewhere.

 

[mheslep]

...I also don't wish to enter into a "my countries healthcare system is better than yours" 'discussion.' Thus, it is pointless for me to continue this discussion.

I haven't mentioned US healthcare in this resurrected thread, not once; there's much wrong with US healthcare - medical errors, excessive cost. My statements here address the frequently floated, but unexamined, wonders of 'universal' heath care abroad.

 

[misgfool]

I get stuff frequently from my provider of non-tax deductible automotive insurance on how to be a better driver, and generally (I believe) the auto insurers in part sponsor the public campaigns to improve auto safety and inform on same. And my home insurer insists on smoke detectors and fire extinguishers for a good rate.

Yes, but you are a client for your insurance company. The company wants to collect fees from you and avoid paying in case of an accident. However a company that does not have you as a client does not care of your wellbeing.

I agree with most of this, though I don't know how to correlate a healthier nation with pre-emptive care. Still it certainly makes sense that pre-emptive care probably is effective and desirable. I don't know that it has to be free at the point of access to enable it. There's an old RAND study on this around somewhere.

I think it is in the interest of the state to have healthy, working and productive citizens. It should be free because for private sector it is more profitable to treat patients. So for it there is a conflict of interest and it is prone to select the most profitable option.