Universal Single-Payer Healthcare

[Pangloss]

I think your concerns are valid, ParanoiA, but they're outweighed by the advantages of making this change. You're right that most people would misunderstand the reasons for it. But they don't understand the current system either, and it's unlikely that we'll ever get most people to understand most of what happens in government. As with most things in a democracy, whether or not it's successful will depend on who runs it, who monitors it, and what rules guide it.

 

Just my two bits, of course.

[bascule]

How about incentive to live healthy? Would universal healthcare bring more or less incentive to live a more healthy lifestyle?

 

In systems with universal healthcare there's an added incentive for the healthcare system to bring costs down by promoting healthier lifestyles.

[iNow]

I think your concerns are valid, ParanoiA, but they're outweighed by the advantages of making this change. You're right that most people would misunderstand the reasons for it. But they don't understand the current system either, and it's unlikely that we'll ever get most people to understand most of what happens in government. As with most things in a democracy, whether or not it's successful will depend on who runs it, who monitors it, and what rules guide it.

I would greatly like to see this implemented. There are way too many things being run incorrectly right now, and I just can't see how you can reasonably defend the existing US healthcare system (that is rhetorical, please don't slam me with a bunch of "what about this" and "what about that" comments).

 

We'd actually be healthier in the long run, as more people would seek help early before problems progressed. I'd be able to spend my presription money on better food.

 

 

I say it's time for a revolt like in France or Britain, but then again, maybe I just need a nice vino and a smoke.

 

 

 

 

 

Btw ParanoiA, I believe you were referring to WIC above, but even that is still a "jump through this hoop" and "sign over your first born" method of assistance. Few qualify.

http://en.wikipedia.org/wiki/Special_Supplemental_Nutrition_Program_for_Women%2C_Infants_and_Children

[bascule]

No, instead the health costs will be determined by an entity who has NO incentive to control any costs...in fact, has incentive NOT to control costs at all.

 

The only cost control in the present system is denying care, especially particularly expensive care like organ transplants or other life saving surgeries.

 

The US has the costliest healthcare system in the world as a percentage of GDP. Americans spend a greater percentage of their money than any other country on earth, yet for some reason report nowhere near the highest satisfaction levels.

 

How can you possibly argue that a private system keeps costs lower when that's the exact opposite the present situation? The costliest healthcare system in the world is also one of the most privatized.

[Severian]

The costliest healthcare system in the world is also one of the most privatized.

 

At least it is not completely shit like the UK one.

[ParanoiA]

How can you possibly argue that a private system keeps costs lower when that's the exact opposite the present situation? The costliest healthcare system in the world is also one of the most privatized.

 

Because as I've stated over and over again in this thread, we do not enjoy a free market solution today. It's a socialist bubble within a regulated market. I don't have any more choice today than I would if we switched to socialized medicine. Government enabled monopolies and systems are not free markets.

[ecoli]

Because as I've stated over and over again in this thread, we do not enjoy a free market solution today. It's a socialist bubble within a regulated market. I don't have any more choice today than I would if we switched to socialized medicine. Government enabled monopolies and systems are not free markets.

 

This is absolutely true... The government often says "free" when they really mean "managed."

[Saryctos]

The health insurance system is really what's broken.

[bombus]

What is the advantage to the system without regard to economics?

 

Why do the best doctors flee from countries with universal healthcare?

 

They don't

 

At least it is not completely shit like the UK one.

 

The UK one is NOT completely shit at all. For most people it's far better than you'd get in the US. It's just that the US has better services if you can afford to pay for them. If you have no insurance in the US, and get shot, they'll send you home the same day after patching you up a bit. That wouldn't happen in the UK. They'd keep you in until you're fit to go home, and you wouldn't be charged a penny.

 

Cuba has one of the best health services in the world by the way.

 

The point is, in a privatized system someone is always making a profit on top of the actual cost.

 

In a not-for-profit system services can be offered cheaper (coz you get everything at cost price) so you can do more with the same money.

 

That's the bottom line really.

[bascule]

Because as I've stated over and over again in this thread, we do not enjoy a free market solution today. It's a socialist bubble within a regulated market.

 

If you're talking about the Republicans prescription drug bill I mostly agree, however...

 

How is it a socialist bubble when corporations are the ones making money hand over foot?

 

At least it is not completely shit like the UK one.

 

Ever had to drive 120 miles round trip to see an in-network specialist? With a $100 copay, of course...

[iNow]

Ever had to drive 120 miles round trip to see an in-network specialist? With a $100 copay, of course...

 

And after paying for the gas and the copay, you find out that what the specialist wants/suggests isn't covered by your plan anyway.

 

I don't see how any reasonable person can defend the existing system without severely limiting bigger picture considerations.

[john5746]

Cuba has one of the best health services in the world by the way.

 

The point is, in a privatized system someone is always making a profit on top of the actual cost.

 

In a not-for-profit system services can be offered cheaper (coz you get everything at cost price) so you can do more with the same money.

 

That's the bottom line really.

 

Nope, competition drives costs down, that has been proven over and over again. But, in the chase for profits, lower margin services might be sacrificed for higher margin services. Instead of making parts for you tape recorder, they make cd players. Instead of offering cheap x-rays for patients, they go for the MRI. Instead of fixing cleft pallets, they provide boob jobs.

[iNow]

Nope, competition drives costs down, that has been proven over and over again. But, in the chase for profits, lower margin services might be sacrificed for higher margin services. Instead of making parts for you tape recorder, they make cd players. Instead of offering cheap x-rays for patients, they go for the MRI. Instead of fixing cleft pallets, they provide boob jobs.

 

Your point applies in an abstract sense, but I don't think it fits healthcare. If competition driving down costs applied, we'd go to the doctor with the best prices/least errors, or to the pharmacist with the best prescription and medication costs. Walgreens would have weekly ads for Prozac and Viagra, and CVS would have television commercials about how they have the lowest cost Ambien and Zoloft.

 

With healthcare in the US, a comment regarding competition is not valid since it's a regulated market (described earlier in the thread as government enabled monopolies). The result of this regulation is that insurance companies themselves are the only ones driving down costs (not doctors, not pharmaceutical companies, not pharmacies, not hospitals... just the insurance companies), and some of the main ways they do drive down their costs is to deny coverage to people with existing conditions, refusing payment on needed procedures, and loopholing patients to such an extent that it is a struggle just to manage illness and act preventatively to avoid it altogether.

[ecoli]

Your point applies in an abstract sense, but I don't think it fits healthcare.

Not our current system...

In reality, the fact that we need insurance to pay for small doctor visits and relatviely inexpensive procedures is a bit dumb. We should only have health insurance for expensive procedures.

 

That way, if your just getting a flu shot or visiting for a check up, you can shop around for the cheapest prices, and you don't have to just go where the insurance company tells you.

[Mr Skeptic]

Not our current system...

In reality, the fact that we need insurance to pay for small doctor visits and relatviely inexpensive procedures is a bit dumb. We should only have health insurance for expensive procedures.

 

A bit dumb, but the insurance company would rather give you the money to have a doctor visit than potentially let a condition worsen to the point that it will be very expensive to treat. That is as it should be.

 

The other aspect is that people feel as if they are getting something out of their insurance that way, and will be happier sheeple.

[iNow]

A bit dumb, but the insurance company would rather give you the money to have a doctor visit than potentially let a condition worsen to the point that it will be very expensive to treat. That is as it should be.

I'm pretty sure this is not how it is though. For example, can you show me any insurance company that pays for nicotine replacement therapy to help people quit smoking? I can, at least, show you a huge number that do not.

 

Logically, I completely agree with you that this is the smart approach. Give little bits of money early to prevent conditions from getting worse. This saves money in the long run as those conditions are handled when it's still relatively cheap to do so (as opposed to, say, doing nothing and having the patient need dialysis or transplant, or any other major medical procedure that could have been prevented with earlier care).

 

Unfortunately, that's just not how it works. Actuarial tables and insurance provider profits explain why.

[Severian]

The UK one is NOT completely shit at all.

 

Have you had experience of our healthcare systems. I have lived in the UK, Germany, France and Switzerland and been in hospitals (and at many doctors) in each (a little brain problem). Compared to the other three the UK's NHS is a pile of steaming doggy poo.

 

In fact, this was so severe that in returning to the UK I took out private health insurance for my entire family so we wouldn't have to rely on the NHS. It is so shit that I don't want it even when it is free!

[iNow]

Have you had experience of our healthcare systems. I have lived in the UK, Germany, France and Switzerland and been in hospitals (and at many doctors) in each (a little brain problem). Compared to the other three the UK's NHS is a pile of steaming doggy poo.

I think the question at hand is how the UK system compares to the US system. Perhaps the UK system truly is not so bad in relative terms. While Germany, France, and Switzerland may be EVEN better, the UK system is still likely better than the US system

[Saryctos]

So, healthcare in the UK is free? None of it gets paid for by your taxes?

[ParanoiA]

A bit dumb, but the insurance company would rather give you the money to have a doctor visit than potentially let a condition worsen to the point that it will be very expensive to treat. That is as it should be.

 

Then why doesn't my auto insurance company pay for my safety inspections? Health insurance is the only insurance I know of that pays for every single little bit of service. Do you not see the paradigm there? The mere thought of shopping for a flu shot, or paying cash for a doctor visit just too freaky?

[ecoli]

Then why doesn't my auto insurance company pay for my safety inspections? Health insurance is the only insurance I know of that pays for every single little bit of service. Do you not see the paradigm there? The mere thought of shopping for a flu shot, or paying cash for a doctor visit just too freaky?

 

I like the analogy to car insurance. Would you pay 50 bucks for an oil change you could get for 20? The medical insurance companies prevent competition from keeping costs down.

 

A bit dumb, but the insurance company would rather give you the money to have a doctor visit than potentially let a condition worsen to the point that it will be very expensive to treat. That is as it should be.

 

It could be dumb, but that's not how the health insurance care works. Preventative care would be cheaper than more expensive care later on, but using loopholes to deny coverage is cheaper still.

 

If we had a free market system, companies that abuse the system would quickly go out of business. In our current system, they are the richest ones.

 

There's no incentive for insurance companies to cover preventative care... so why not just rid of the insurance so people have the means to with it out of pocket?

[CharonY]

Recently I was forced to look into the US health system a bit. I get a premium fee for working at the university as such I only have to pay 50$ if I used an exclusive provider network or 150$ if I want to be able to make choices outside this network.

I wonder how expensive health insurance for the average worker is, though.

 

In Germany everyone is required to get an insurance. If you are an employee with a monthly income lower than 3.937,50 € you are automatically with one of the public health insurer, if it is equal or higher you may elect to join a private one. The lesser is more expensive but gives more benefits. Up until now I was in the public system and paid roughly the amount of what I'd pay for a PPO-choice. I do have to add that in Germany some of the stories from the UK (waiting for 3 weeks before one gets an appointment) is unheard of. From what I heard the standard quality and speed with which you get your treatments in Germany is comparable with the USA, though you are treated preferentially if you are privately insured (in Germany).

 

So basing on this it appears that (with the premiums) the US system is cheaper if I only use physician within the network. How well that works out depends of course how large the network is. Other than that there are additional costs:

 

Physician visits: 10$ per visit, 20$ for specialists in the USA; 20€ per 3 months (regardless how many and which physician/specialists you visit) in Germany.

So if you have to often consult specialists in Germany you are better off.

It is even worse if you have to consult an out of network specialist. Here you have to meed 300$ deductibles and pay 30% of all costs on your own. In Germany it doesn't cost extra if you are referred to another specialist.

 

Preventive care: 10$ (or 30% out of network) in the US; free in Germany

 

These are some points that I'd have to pay out of my pocket and can be easily quantified and does not tell what actually is covered. However it appears that the German insurers appear to cover a bit more. For instance they also pay for treatment of mental illnesses and dental work, whereas in the USA you need yet another insurance.

[iNow]

Nice post CharonY. One thing I notice you didn't include are prescriptions, which many of us require to stay alive, so I'll try to supplement from my own experience below.

 

I went through a period where I was out of work for 6 months, but being a diabetic had to keep continous insurance coverage (if I let the coverage lapse, I might not get picked back up later when I applied to get new coverage since it's a pre-existing condition... I've been declined multiple times earlier in life and learned to NEVER let it lapse).

 

So, I had no income coming in, was paying $170 per month for the coverage itself (since I was not working, there was no company to match my contributions). Since I had one of the cheapest possible insurance carriers (the only one I could afford), the most difficult part was that they had a maximum monthly prescription benefit of $35. That means that each month the only amount they covered for prescriptions was $35. No more. After $35, the rest came out of my pocket.

 

Being diabetic, I go through a lot of insulin and blood glucose testing strips. The testing strips were not covered, and only the first $35 dollars of my insulin was covered. So, in addition to the $170 monthly premium to ensure my coverage did not lapse, I was paying $400 a month to stay alive and buy insulin and test strips.

 

I completely avoided going to the doctor at all because I couldn't afford the $30 co-pay and have enough money to buy food and pay my bills. It was incredibly difficult, and so frustrating. I was paying money I didn't have to maintain coverage which didn't work.

 

Now, working again with a great position, I have a tremendously better provider/plan, but I'm still paying $90/month for the coverage itself and about $180 in prescriptions and doctor visits (I have to see a specialist for my diabetes and other specialists to check my vision and nerves).

 

With my personal situation, I cannot see how coverage provided free (with the exception of the taxes paid in up front) could ever even come close to being a bad thing. This is money that I could be saving, or using to improve my house, or taking care of family members, or education, or whatever...

 

And I'm one of the lucky ones. It has to be horrid for those who have no coverage at all. Getting sick from improper diabetes care is really dangerous and gross. From blindness to gangreen to nerve damage and kidney failure... Even my out of work experience above where I could barely feed myself is better than people with no coverage have it.

 

This is just one anecdotal example, but I'm extremely confident it would not be difficult to find others with similar or worse conditions in the US.

[ecoli]

@ iNow - your situation shows that the current system of health care needs to be revamped...

 

But, I'm saying socializing it would still be more expensive than a free market, if you give the insurance companies less control.

 

In your situation, insurance only provided you with a safety net in case something worse happened, and it prevented you from shopping around for the cheapest doctors and the cheapest meds you could find. When the insurance companies control the price of doctors and meds, there's no competition and no price check by consumers.

 

Socializing medicine doesn't keep prices in check either, it just defers the cost of payment to a large group of people. While that may be a more effective method of treatment, it still winds up costing more for everyone.

[iNow]

True. Maybe we could use funds currently being wasted in Iraq. What do we spend on that? Currently, $720 million per day. Just a thought, eh. I don't disagree with your comments, but just wanted to put it in perspective and show that the money is there, but being used in ways that don't directly benefit our own people.