Universal Health Coverage

[iNow]

.

 

Here's a quote from Paranoia.

 

Here's the crux: The problem with healthcare is cost. And competition has solved that problem time and time again - so many times that I hardly see the logic in ignoring its possibility. That's cold, hard pragmatism.

 

 

The data above show that the US system- based on competition and a free market- is the most expensive.

 

In this case competition has failed to solve the cost problem.

 

Since healthcare is an infinite sink (no matter what you spend people will still not be satisfied because their loved ones will still die) the question is how much healthcare can you get for a given cost and it seems that everyone in the world does better than the US on this score.

 

Quite right. The love fest for a "free market" is outdated. It does not cure all ills, and sometimes is far worse than proper planning and control.

[ParanoiA]

Oh for the love of...Thor, is it?

 

WE DO NOT HAVE A FREE MARKET HEALTHCARE SYSTEM IN THE UNITED STATES OF AMERICA.

 

We have a socialist bubble within a capitalist framework. Stop with the logical fallacies that presuppose we have a free market here, we do not.

 

Our present system is the perfect example of why non-competitive markets are hideous for efficiency. There is no check on a socialist system. There is a natural check in an actual free market, even a regulated free market. But we do not have one of those here.

 

I'll go back to where I started a year ago when this thread first started - why do we want to trade one crappy system for another one? Why trade one set of problems for a different set? Our problems here are still cost. Not insurance, like the rich fat cats on Wall Street love for you all to believe. (Hillary had them jumping in their shoes at the broadened prospect of government paid insurance).

 

Quite right. The love fest for a "free market" is outdated. It does not cure all ills, and sometimes is far worse than proper planning and control.

 

It's not outdated; it's that freedom is up for sale. Free market capitalism is the only philosophically proper compliment to individual liberty. All other forms of capital management are an investment in the polar opposite to that end. Man will never evolve to govern himself by investing in external coersion.

Edited October 13, 2008 by ParanoiA

[npts2020]

ParanoiA: Explain to me exactly how current regulations keep "free market" principles from operating in Americas health care system. It seems to me that anyone who wants to can provide health care so long as they meet the requirements for the service they are providing i.e RN's and LPN's meet training requirements, doctors have graduated from medical school and served an acceptable residency etc. BTW anarchy is the "philosophical compliment to individual liberty", is that what you are advocating or just corporate anarchy?

[Realitycheck]

I wonder how physicians in other countries justify the cost of med school with the lower salaries that they receive. Does their education cost proportionally less, as well?

 

For example, in Canada, which has a broad publicly-funded health system, the average physician earns only 42 percent of the annual salary earned by their counterparts in the United States,[citation needed] this has led to long waiting lists for care (17.8 weeks in 2006).

 

Sounds like I would want to model it on the UK system.

 

On the flip side, here is another example of paying for what does not work.

 

A study performed in the United States comparing for-profit and not-for-profit dialysis units found that the for-profit units had a mortality rate which significantly exceeded (by between 4% to 13%) that of the not-for-profit dialysis units. This is counterintuitive, given the propensity of the for-profit system to "cream-skim" and take the less ill patients. This may in fact represent an even higher absolute divide in mortality between for-profit and not-for-profit healthcare settings if patients of similar baseline illness were to be compared. The authors attribute this increased mortality to cutting back on personnel numbers and quality, as well as dialysis dose, in order to augment profit.[11]

 

Some studies have found that private for-profit hospitals are more expensive and have higher death rates than private not-for-profit hospitals. The researchers attribute these patterns to the for-profit nature of the hospitals.[7]

[ParanoiA]

ParanoiA: Explain to me exactly how current regulations keep "free market" principles from operating in Americas health care system. It seems to me that anyone who wants to can provide health care so long as they meet the requirements for the service they are providing i.e RN's and LPN's meet training requirements, doctors have graduated from medical school and served an acceptable residency etc. BTW anarchy is the "philosophical compliment to individual liberty", is that what you are advocating or just corporate anarchy?

 

 

Ok. For one, the government tax credits to business to offer health insurance but not to individuals to purchase their own (although McCain is pimping a $5,000 credit). This puts the competition in the employers field, not the individual, and incidentally quality is rarely chosen over price. Your employer doesn’t give a crap how good or bad your insurance is, they only care how cheap it is. And they make this decision for tens, or hundreds, or thousands of people that work for that company. This is the same effect of socialized medicine – your level of care decided for you, not by you. HMO's that restrict what doctors and specialists you can see. That's actually the most far reaching socialist themed enumeration and deserves far more narrative, but I'll let your senses work out how that has undermined the individual.

 

For two, we’re slaves to insurance and their presence in the market. We think we need insurance and that’s all you hear from politicians. They are absolutely loving how well the conditioning has worked. To redirect your focus from the actual problem, to a pseudo solution that gets insurance companies even more rich and powerful to continue to undermine the intentions of medical personnel. Your imperative is quality care. Your doctor’s imperative is quality care. The insurance company’s imperative is low cost, low payout, deny everything possible. They control costs and actually dictate your treatment. The insurance method is not compatible and is destined to continue working for themselves and not you. This is a disservice. And today’s politicians are advocating this idea…for you.

 

Third, the monopolized pharmaceutical market enjoyed by American drug manufacturers. Americans are restricted by law to purchase prescription drugs outside of the US. This was further facilitated by the Dorgan amendment that was defeated in 2007. The FDA is suspiciously financially supporting our pharmaceutical market in the face of much cheaper and arguably safer equivalent medications from countries like Canada. This creates the price fixed structure they are screwing us with today.

 

Is that what you meant by corporate anarchy? Looks to me like government-corporate marriage in the great healthcare sham of the US.

 

None of these examples are compatible with free market principles. They create a socialist structure out of the capitalist framework. Our healthcare is managed by an oligarchy.

 

BTW anarchy is the "philosophical compliment to individual liberty"...

 

Actually that's true, and should be the end evolutionary goal of man, in terms of ethical negotiation and cooperation between humans. Government is a present necessity, not a future investment.

[iNow]

Ok. For one, the government tax credits to business to offer health insurance but not to individuals to purchase their own (although McCain is pimping a $5,000 credit). This puts the competition in the employers field, not the individual, and incidentally quality is rarely chosen over price. Your employer doesn’t give a crap how good or bad your insurance is, they only care how cheap it is. And they make this decision for tens, or hundreds, or thousands of people that work for that company.

 

Not entirely true. They simply MUST care about the quality, since that is what the employees care about. Since health coverage is part of the offer package being decided upon by staff, highly qualified individuals will go elsewhere if the benefits are not good enough at your company.

 

I may make a lower salary where I am relative to another company, but if I get better health care, better stock options, more days off, and flex time then that all matters and impacts the decision to come work for them. If they simply offer me "Jim-Bobs Healthy for a Buck" insurance, it shows how much they value me and my contributions (or, more appropriately, how little they value me) and I'm likely not to work for them unless I have no other options.

 

The cost only approach is idealized and does not represent reality. While, of course, employers care about bottom line, sometimes non-monetary costs/benefits are a huge part of the overall equation being considered.

[ParanoiA]

Not entirely true. They simply MUST care about the quality, since that is what the employees care about. Since health coverage is part of the offer package being decided upon by staff, highly qualified individuals will go elsewhere if the benefits are not good enough at your company.

 

True enough, I'll concede that. And surely this doesn't make up for the total effective circumvention of individual shopping, which creates this socialist bubble I detest and was asked to elaborate on.

 

And since we're on the subject, isn't it arbitrary and odd that we hold employers accountable for health benefits? I mean, I suppose they started it by offering it as a benefit, but the word "benefit" has lost its meaning and is now taken for granted. Why don't we expect them to pay for lettuce or car tags?

 

I think it's high time we the people request our employers to turn our benefits into liquid, demand equal treatment from the feds and let us shop for our benefits. Imagine the competition created from a sudden pool of millions of individual shoppers as opposed to a fractional pool of business. Basically spreading the current consolidated consumer power.

[John Cuthber]

Has anyone mentioned the fact that some might think it's just plain unciviliseed to let poor people die in the street?

 

 

It's also unhygienic and dead people can't work very hard so they are a loss to the ecconomy.

[Mr Skeptic]

Second, I've heard it said - and I'm not asserting this myself but rather throwing this out there to get your take on it - that monopolies don't happen in a truly free market, that monopolies are always enabled by government interference. Obviously, this sounds suspicious, but then the monopolies that I'm aware of were enabled by regulation of some kind.

 

That's not true. There are natural monopolies. They exist when the efficiencies of scale outweigh the inefficiencies of scale, and also when there are high costs to enter the market. One example is companies providing city-wide infrastructure based products. A company providing water, electricity, gas, telephone, etc, will need to connect themselves to your house with pipes and wires. A competitor would need to essentially copy all that infrastructure to compete.

[Realitycheck]

Has anyone mentioned the fact that some might think it's just plain unciviliseed to let poor people die in the street?

 

 

It's also unhygienic and dead people can't work very hard so they are a loss to the ecconomy.

 

Yay!!!! Somebody finally hit the jackpot button! I knew that sooner or later somebody would figure out how to improve worker productivity, efficiency, and efficacy, all in one shot! John Cuthbert, you are THE MAN!

 

Better to fix it early, than wait till it takes 2 surgeries, radiation, and chemotherapy, all done completely unsystematically. Better to teach them preventative maintenance than joke around to the side, saying, "Oh look at the poor black man, if only he knew, if only he knew ..."

Edited October 15, 2008 by agentchange

[ParanoiA]

Has anyone mentioned the fact that some might think it's just plain unciviliseed to let poor people die in the street?

 

Yes, that's been mentioned for decades which is why we have a mutli-hundred billion dollar entitlement system for them and laws that require emergency rooms to admit everyone regardless of any ability to pay anything at all. And is, in fact, significantly to blame for the high cost of healthcare here since the insured are soaked for the losses. And no, no one mentions the incivility of forcing people to give a service for free.

 

That's not true. There are natural monopolies. They exist when the efficiencies of scale outweigh the inefficiencies of scale, and also when there are high costs to enter the market. One example is companies providing city-wide infrastructure based products. A company providing water, electricity, gas, telephone, etc, will need to connect themselves to your house with pipes and wires. A competitor would need to essentially copy all that infrastructure to compete.

 

I don't dispute that, it all sounds plausible to me, but is there an example of a monopoly that wasn't enabled by some kind of government regulation? I tossed this question out there because it was a bold statement made in a discerning atmosphere, and as I pondered it and I realized I really couldn't think of any monopolies that weren't empowered by some kind of legislation.

Edited October 15, 2008 by ParanoiA
multiple post merged

[Mr Skeptic]

Ok. For one, the government tax credits to business to offer health insurance but not to individuals to purchase their own (although McCain is pimping a $5,000 credit). This puts the competition in the employers field, not the individual, and incidentally quality is rarely chosen over price. Your employer doesn’t give a crap how good or bad your insurance is, they only care how cheap it is. And they make this decision for tens, or hundreds, or thousands of people that work for that company. This is the same effect of socialized medicine – your level of care decided for you, not by you. HMO's that restrict what doctors and specialists you can see. That's actually the most far reaching socialist themed enumeration and deserves far more narrative, but I'll let your senses work out how that has undermined the individual.

 

I agree, a large problem here is that the individual has little choice here, so free market principles don't apply well. However, a similar problem exists naturally with healthcare. If you are badly injured, you will be taken to a nearby hospital. You might even be unconscious and be unable to choose. You could choose ahead of time and put a note in your wallet, but if you are traveling, you'd need to choose a hospital for everywhere you go.

 

For two, we’re slaves to insurance and their presence in the market. We think we need insurance and that’s all you hear from politicians. They are absolutely loving how well the conditioning has worked. To redirect your focus from the actual problem, to a pseudo solution that gets insurance companies even more rich and powerful to continue to undermine the intentions of medical personnel. Your imperative is quality care. Your doctor’s imperative is quality care. The insurance company’s imperative is low cost, low payout, deny everything possible. They control costs and actually dictate your treatment. The insurance method is not compatible and is destined to continue working for themselves and not you. This is a disservice. And today’s politicians are advocating this idea…for you.

 

This is one of the things I least like. I don't much like the idea of insurance because it is in their interests to screw you as much as they legally can. If you got to choose your own insurance, you could at least make them be interested in their reputation too. Insurance seems like the kind of thing that could be run by the government, and that might turn out better than private insurance. Presumably, the government would have your best interests in mind, whereas private insurance would have profit as its main interest.

 

edit: I forgot to mention, the existence of insurance also changes the true cost system for healthcare. Doctors are charging people's insurance, and not the people themselves. The people have little reason to want to save their insurance company money, and the result is higher costs than there should be. And if you don't have healthcare, you will notice this a bit before you go bankrupt.

 

Here's what I'm thinking:

The government provides an insurance that pays for most of your healthcare costs, with the percentage they cover increasing as the price of care increases, in such a way that the more they have to spend the more you have to spend. The increase for you should be enough that you try to save money, but not so much as to bankrupt you. The percent of coverage could also depend on what kind of treatment you receive, eg checkups or life-threatening conditions could get more coverage, and comfort or beauty treatments would receive less or no coverage.

 

Then, you can choose pretty much whatever doctors and treatments you want.

Edited October 15, 2008 by Mr Skeptic

[Realitycheck]

Some insurance is pretty much a given if you want upper tiers of quality of care, just don't expect guarantees.

[Pangloss]

Has anyone mentioned the fact that some might think it's just plain unciviliseed to let poor people die in the street?

 

Are poor people dying in our streets?

 

John Edwards spent a great deal of time during his presidential run telling us so, but he never seemed to be able to produce any actual numbers. I wondered at the time if perhaps that might be because the numbers (because I'm sure there are some) just were not all that impressive.

[iNow]

Are poor people dying in our streets?

Yes, they are.

[Pangloss]

How many billions do we need to fix that?

 

It's not as if billions matter anymore, of course. A billion here and a billion there and pretty soon you're not even talking about real money.

[Severian]

The British National Health Service (NHS) is pretty good, despite what some people say. Whatever complaint you have, you'll get treatment. Maybe not ALL drugs/treatments are available, but the vast majority are.

 

I have lived in the UK, Germany, France and Switzerland, and I had experience of the health care in all of these countries. I can categorically say that the worst health care I had was in the UK (with Switzerland being the best).

 

It is also true though that the NHS was the cheapest, even if I would consider all my NI contributions going to the NHS (which it doesn't).

 

But irrespective of cost, I find it unacceptable that the NHS is touted as providing universal health care, while withholding drugs that would improve someone's life.

[Realitycheck]

FYI: Lots of interesting information on this website. Easily accessible comparisons of economic and demographic data for 200 countries. U.S. ranks 45th in the world for mortality rate. Did YOU know that Germany actually exports more goods than China?

 

http://www.indexmundi.com/g/r.aspx?t=0&v=30&l=en

[ecoli]

I've sort of come to the conclusion that we either need to completely free-market-ize the health care industry or completely socialize it.

 

This half way system that we have now obviously isn't working. So we either need to make the healthcare companies compete with each other (to drive down costs and increase availability) or socialize it to insure everyone gets complete coverage.

 

I think the free market solution will work better, but the current system is so unacceptable that I'd rather take the socialized version than what we have now.

[John Cuthber]

If you completely "free-marketize" it who treats the very poor? Or do you just let them die?

Having their fees paid by the government isn't a free market (as has been pointed out). Even if, for example, the church picked up the bill for the people in extreme poverty this would distort the market.

So it seems either you have an inefficient half and half compromise, people dying on the street or totally socialized healthcare.

Interesting.

[ecoli]

If you completely "free-marketize" it who treats the very poor? Or do you just let them die?

 

Competition will drive down the cost to be affordable... or are you talking about the homeless who won't even be able to afford that?

 

I don't think I have the answer to that, but here's an excellent article about health insurance, risk and how government intervention plays into the cost of insurance: http://mises.org/story/2021

[ParanoiA]

Philosophically, I actually don't have much of an issue with Healthcare being the government's jurisdiction; it wouldn't be too hard to make comparisons to police and fire control service.

 

My objections come from freedom of choice becoming freedom from choice. I could only sign on to a system that somehow preserves competition between providers, and doesn't do things like Severian brought up, like witholding medications for whatever beaurocratic reasons.

 

And what about the prescription drug racket? Any government run system is going to make these idiots richer than shit, inflating already over-inflated pricing, unless we take over that as well. Then you lose the advantage of capitalist driven research and development, talent and etc.

 

There must be a way to preserve the advantageous components of capitalism.

[Mr Skeptic]

So it seems either you have an inefficient half and half compromise, people dying on the street or totally socialized healthcare.

Interesting.

 

That is in fact the reason that I'm in favor of universal healthcare --- because we have it anyhow. The way we have it set up, some people pay for their own healthcare, and then pay for that of the people who decided they didn't need or couldn't afford healthcare.

[iNow]

If you completely "free-marketize" it who treats the very poor? Or do you just let them die?

 

Competition will drive down the cost to be affordable... or are you talking about the homeless who won't even be able to afford that?

 

I don't think I have the answer to that...

 

Socialized medicine is an answer, no? (I'm pretty sure that, yes, John was referring to people who had barely enough money for sustinence, let alone medical care).

[Realitycheck]

What about the single mother with 2 kids who actually does make $20,000 a year, barely enough to cover expenses somehow. How does she pay for insurance, deductibles, copays, etc.? She is not exactly homeless, dying in the street, but she fits into this model where she and her family somehow gets treated because she is under a certain income level or whatever.

 

The way I look at it is this. If you look at the expenditures of the budget for any year, there are a number of people who have 6.2% of taxes withheld who will not live long enough to benefit from Social Security. There are a number of people who have 1.45% of taxes withheld who will never get any benefits of Medicare or Medicaid. 11.79% of our taxes is paid out for unemployment and there are people who will hardly ever receive any benefit out of this. And the list goes on.

 

Why not even the playing field so that everyone benefits equally, at least from the perspective of healthcare?

 

http://en.wikipedia.org/wiki/Image:Fy2007spendingbycategory.png

 

How about the guy who works every single day from age 18 to 64, averaging $50,000 a year, till on his 65th birthday, when he is all set to retire, made in the shade, he keels over and croaks.

 

That's $145,700, up in smoke!

 

I guess all of these people are just SOL.

 

 

Anyway, regarding ecoli's link. This stood out to me.

 

It is increasingly rational for people to be uninsured.

 

Of course, dropping out of the insurance market is a risky thing to do, but young healthy people are almost crazy to pay the high premiums that come about from subsidizing all these unhealthy lifestyles and covering risk that they know don't apply to them.

 

The most likely scenario that led to my spinal cord cancer is that I was a victim of oxidized stress because I got back into bodybuilding when I was 35 years old. Eating right, multivitamins, whey protein, NAC and Vit. C antioxidants among others, you name it. The only plausible scenario is that I was possibly putting excess stress on my body's resources. Of course, when you get into the area of carcinogens, it opens the door to just about anything, so who really knows. It could have been caused by anything.

 

All healthcare provision will become increasingly politicized: the government will design lists of good diseases for which you do get treatment (such as AIDS, I'm sure) and bad diseases, such as those you get from smoking too much. Those with the bad diseases the government will let die.

 

This next paragraph really calls the integrity of this entire article into question.

 

To repair the healthcare system, we need to abolish the US Food and Drug Administration (FDA) and all bureaus of public health and safety, which require all pharmaceutical products to be licensed by them before they can be marketed. These institutions delay the production and delivery of drugs, raise the costs of production, and thereby cause unnecessarily high prices as well as the unnecessary death and suffering that result from the fact that effective drugs do not appear on the market until many people have died or suffered for many years.[4]

 

These next two paragraphs kind of sum up everything in a nutshell.

 

For those who believe that consumer safety would be hurt under such an open, competitive system (a free market in healthcare), let me use an analogy. Suppose you were to say, "Look, some people have crummy Chevy cars, which are less safe and less comfortable. This falls short of our goal that all consumers get only the best. Therefore we should insist that all cars live up to the standards of a BMW or a Mercedes." Would we all wind up with the comfort and safety of driving luxury cars? Of course not. Many of us would have to resort to bicycles or go on foot. If all cars had to be luxury cars, very few of us would be able to ride in any sort of car.

 

With respect to doctors, a similar situation has been put in place. We have basically outlawed all Chevy doctors who focus on the less expensive minor health problems (which is, in fact, all that most people have) and are forced instead to use Mercedes doctors who charge Mercedes prices even for ailments that can be fixed by people with significantly less training.

 

Which is not entirely accurate. Amongst all of the Mercedes doctors in training that I have seen, only one of them would give me a prescription for a steroid to help correct this problem that I had with chronic inflammation of the rotator cuff, and that was just for a few days. So what did I do? I went to an outside doctor, what could be referred to as a Chevy doctor, because he only charged $59 for a visit and most likely, provided that I had substantiation of my condition with copies of the results of an MRI, he gave me this prescription for a month of steroid use to help rehab my way out of this severely chronic condition. It's still not well, but it is at least manageable now. So there is a place for the Chevy doctor after all. Of course, if I did not take the initiative to do so much reading to enable myself, I would still be way back and headed for a casket probably.

Edited October 17, 2008 by agentchange
multiple post merged