Should the US Start with the Premise that it WILL Provide Universal Healthcare?

[Saryctos]

Are you thinking that we should take insurance out of the equation completely and let the government provide all coverage, or are you thinking that we should take insurance out of the equation completely and let the people find ways to pay for their own healthcare?

 

I believe that the current health insurance structure is one of the greatest contributors to both the cost, and displeasure within our system. I do think that people should just pay for their medical costs without the insurance system. Everything out of pocket, as though it were any other expense. However, this cannot change overnight as it would cause all sorts of troubles. But I think that a system based on paying for what you need instead of everyone paying, and only a few needing is the best option in the long run.

It's important to note that businesses that do pay for healthcare could instead be paying this as extra income, except that there are tax benefits for paying healthcare. Why not sidestep this and allow these tax breaks, and pre-tax incentives to be passed directly to the employee? This way, if you're healthy and don't have medical bills, you have extra income(as you aren't spending anything). But if you do have medical bills you can claim these costs at the reduced tax rate and/or pre-tax to some degree.

I think the problem is that the insurance scam has been running for so long that there's so many gov't based incentives to keep things the way they are. We prop up a bad system with good incentives so if you wanted to change to a better system we're going to have to find a way to artificially increase it's appeal just as we have with the current structure.

[ecoli]

The free market will cause insurers to only cover healthy people since unhealthy people cause them to have higher costs. It's a failed approach, regardless of how free or unfree you describe it as.

No, their premiums will just be higher. Do autoinsurance companies not cover accident prone?

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Frankly, I find your analogy failing, and were it not for the seriousness of the health care issue it would also be quite laughable.

 

Careful with the ad homs, iNow.

 

It's easy to point and see how a universal care system would be better than what we currently have. But don't make the mistake of thinking that these arguments are also applicable to a free market system because, well, we don't really have one.

[CharonY]

Just? First, many insurers won't take you in. I have seen that. The same goes for auto insurance, btw. Second, the increase is not negligible. In case of suspicion of cancer it boiled down to around 1k per month. Had it been diagnosed it may have been more. Also one has a waiting time before

In a truly free market however, the high risk pool will not be taken in at all as even with such an increase in premiums it will not cover the cost of the insurer.

 

 

I do think that people should just pay for their medical costs without the insurance system. Everything out of pocket, as though it were any other expense.

Generally health care is too expensive to be ever be affordable out-of-pocket if you fall seriously ill. Even if we cut down the money the MDs get as well as on prescription, the price simply cannot go down to the level of, say, car repair.

[Saryctos]

Generally health care is too expensive to be ever be affordable out-of-pocket if you fall seriously ill. Even if we cut down the money the MDs get as well as on prescription, the price simply cannot go down to the level of, say, car repair.

 

What prevents the cost from going so low? What are you physically paying for with medical care?

[Mr Skeptic]

I believe that the current health insurance structure is one of the greatest contributors to both the cost, and displeasure within our system.

 

I whole-heartedly agree. Insurance has two problems, first that they are hostile to expensive people (think in the hundreds of thousands worth of treatment), and secondly that the person getting treatment doesn't pay for much of it, so that treatment costs can be raised and the insurance has to pay for it. Then everyone's premiums are raised to pay for the more expensive treatment costs.

 

I do think that people should just pay for their medical costs without the insurance system. Everything out of pocket, as though it were any other expense. However, this cannot change overnight as it would cause all sorts of troubles. But I think that a system based on paying for what you need instead of everyone paying, and only a few needing is the best option in the long run.

 

The problem with that is that this only works when everyone can afford their treatment. The whole point of insurance is to spread the risk, both across time and across the population. You pay what your medical costs on average are estimated to cost, and the insurance company ensures that if something expensive happens to you, that you can afford it. If you get cancer or a heart attack, odds are you wouldn't be able to pay for treatment out of pocket.

[CharonY]

About everything. Trained personnel, equipment, medication, etc. They all have to be of a certain standard and that does not come cheap. Let us make a simple calculation. According to publications mean monthly health care cost range from 2187 to 7616 USD, depending on the type of cancer. This does not take indirect cost (as lost work time) into account. Now by how much do you think this has to be slashed to make it payable (considering that the treatments generally take longer than a few months) and do you think that even with reduced overhead this can be achieved?

The reason why insurances exist in the first place is that the cost cannot be easily shouldered by individuals. In an insurance system those that in this case stay healthy essentially pay for those that get ill. It is essentially a bet. Only that in case of health it is one with a big risk of losing (and hence the cost).

 

Edit: cross posted with Sceptic.

 

Another thought: Germany has a mixed system with both several public insurers as well as a number of private ones. It is mandatory to have insurance and while the private ones have better options (but are generally not more expensive) they are selective. The public ones have to take everyone in. While the system is in my experience better and cheaper than the US system, it is still a bit more expensive that the UK one, for instance. I heard of longer waiting time (except for emergencies), in the UK, though. On the other hand this does also apply to the US. Primary care waiting time for first time patients are apparently around 1-2 weeks and for specialists 2 weeks and up.

Edited April 7, 2009 by CharonY

[Saryctos]

About everything. Trained personnel, equipment, medication, etc. They all have to be of a certain standard and that does not come cheap. Let us make a simple calculation.

Most of what makes these items expensive is information, and liscensing(the 2nd biggest problem with the current healthcare system), the production costs are negligible. With further use of new Information Technology you can bring down one side of the cost over time. However, with the insurance structure firmly in place, where is the intensive to reduce cost?

 

According to publications mean monthly health care cost range from 2187 to 7616 USD, depending on the type of cancer. This does not take indirect cost (as lost work time) into account. Now by how much do you think this has to be slashed to make it payable (considering that the treatments generally take longer than a few months) and do you think that even with reduced overhead this can be achieved?

I do think that these costs can be greatly reduced with a reworking of the healthcare system, although not eliminated. I also would like to say that I do understand that even with perfect health, strange chronic debilitating conditions can show up form no fault of the patient. I do think that the gov't does have some responsibility to help ease the cost on those who do get surprised by these diseases. Just like FEMA would help anyone who's home was damaged by a large natural disaster we should consider these illnesses like a catastrophe that strikes many people spread out over the whole country.

 

The reason why insurances exist in the first place is that the cost cannot be easily shouldered by individuals. In an insurance system those that in this case stay healthy essentially pay for those that get ill. It is essentially a bet. Only that in case of health it is one with a big risk of losing (and hence the cost).

 

Edit: cross posted with Sceptic.

Well, it's not really a bet. You will get sick at some point before you die from illness/old age otherwise you'd be dealing with life-insurance instead (I don't suppose your health insurance matters if you die from something other than illness, so I'll just leave it out). Anyone who stops paying insurance without receiving the benefits are really the only 'losers' in this equation.(dying abruptly, dropping coverage, leaving the country, etc...) Everyone else will eventually win out (in terms of payment vs. benefit) if they live to recoup costs that the new generation of youngsters are forking out. It's exactly the same setup as Social Security just with different payment methods and motivations.

[The Bear's Key]

Just quickly.

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The biggest point I've been trying to make is this. It appears that many Americans think along the lines of "Yes, our system is a mess, but we do get world class treatment". I've been trying to show that your system is providing "World Class" results only if compared to the "Second World".

 

Why don't you admit the fact that compared to the rest of the developed world, your system sucks. Not only by cost, which is exhorbitant, but in outcomes, which are inferior. What I see are people devoting themselves to preventing comparison. The Catch 22 of that is that if you don't compare your outcomes with other nations, then you cannot claim your outcomes and services are "World Class".

Just quickly??

 

Awesome points there.

 

No, their premiums will just be higher. Do autoinsurance companies not cover accident prone?

Only by law. That's why a "free" market sucks at certain things like making sure everyone has insurance for vehicle accidents or treating illness/injury.

 

It's easy to point and see how a universal care system would be better than what we currently have. But don't make the mistake of thinking that these arguments are also applicable to a free market system because, well, we don't really have one.

No one in the world does, a truly free market system exists nowhere. Except perhaps in the poorest and most rogue of nations.

 

(And that seems to be the result)

[padren]

No, their premiums will just be higher. Do autoinsurance companies not cover accident prone?

The problem is we already see in the medical insurance industry where people loose their coverage retroactively once they need it.

 

We already have people who are as close to surfs as one can get because they need the employer's insurance to be guaranteed coverage.

 

As a free market advocate, how can you look at the buyer/seller in any medical transaction and not see it as a negotiation under extreme duress? The only thing that separates it from a coercive negotiation is that the insurance company isn't saying "I'll kill you if you don't get this" they are saying "You will simply die if you don't get this" and even though they aren't the cause, there is just as much duress as if they were.

 

Technically the uninsured person can shop around, but no insurance company to date apparently as decided to capitalize on all the dissatisfaction towards the status quo - why is that?

 

The answer honestly: The consumer has to buy somewhere, and they do not have the traditional marketplace "buyer's power" to simply walk away.

 

Due to that inequity relative to traditional free market transaction we have an insurance industry that fails to exploit the profits from improving their service in this regard - there is more profit to be made by not because it's such an inelastic expense for the buyer.

 

 

 

It's easy to point and see how a universal care system would be better than what we currently have. But don't make the mistake of thinking that these arguments are also applicable to a free market system because, well, we don't really have one.

 

A fundamental aspect of any free market solution involves some pretty intrinsic facets:

 

1) A person can choose to get health care, or not.

 

If healthy people try to gamble on saving money by not getting insurance when they are healthy, you'll have a pool bias as a result - more sick people will sign up and skew the numbers towards the amount a person would pay out of pocket for their own health care when sick.

That will cause more healthy people to drop out, as the expense gets higher, leading to even higher costs for those remaining.

 

Is that a solvable problem, or an inherent flaw with free market solutions?

 

2) Policies outgrow their definitions:

Children grow up and are no longer covered by family plans, marriages break up, companies go bankrupt and lay off all their employees. If you become "uninsureable" prior to one of those vulnerable transition dates, who in the free market is going to cover you?? If no one can make any money off insuring you because you've acquired a long-term illness - who's going to cover you? The balance sheet cannot be made positive there.

 

Is that a solvable problem, or an inherent flaw with free market solutions?

 

More importantly, every year we talk around this issue, people suffer and even die from the current model. Another year, means more suffering, more bankruptcies, more surfs, and more deaths.

The main problem I have with the "free market" solution is it largely boils down to pulling off all the leashes and having faith that it will find a solution - which is pretty risky when you consider the stakes.

 

If good, logical arguments can be made as to how the above problems can be solved within a free market solution - I'll be open to considering the various facets of that solution. The problem though, is in lieu of that all the while we hesitate - whether due to our disdain for social or market based solutions - we loose people.

 

But, in the interest of being open to all possible solutions, if you have any idea how the free market can solve the above issues (there are many more, but those seem the most "intrinsic" to me) please feel free to offer them and I'll consider them quite honestly. What I dislike is hearing "free market" used as a solution when the very glaring caveats are not resolved.

[ecoli]

The problem is we already see in the medical insurance industry where people loose their coverage retroactively once they need it.

well, yeah. people can't choose to go to a company that promises not to do this. As I keep saying, health insurance is not a competitive market.

 

 

Technically the uninsured person can shop around, but no insurance company to date apparently as decided to capitalize on all the dissatisfaction towards the status quo - why is that?

Becuase they benefit much more from having mini-monopolies. It's much more profitable than having to compete for business.

 

The answer honestly: The consumer has to buy somewhere, and they do not have the traditional marketplace "buyer's power" to simply walk away.

Assuming that people don't choose to have no health coverage, in a competitive system you still have to attract consumers.

 

Sick in America

aEXFUbSbg1I

 

edit: not sure if the video is working, so here's the URL. http://www.youtube.com/watch?v=aEXFUbSbg1I

it's a little dated, but quite accurate.

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The last two sections are the most relevant, actually:

 

http://www.youtube.com/watch?v=Xsp_Jh5EIT0&feature=related

http://www.youtube.com/watch?v=E_KCLm9cekU&feature=related

Edited April 8, 2009 by Pangloss
fixed video

[CharonY]

well, yeah. people can't choose to go to a company that promises not to do this. As I keep saying, health insurance is not a competitive market.

 

But in a free market system, which company would willingly insure high-risk people? They effectively cost the insurer money. Where is the incentive to take them in (without government interference that is)?

[padren]

well, yeah. people can't choose to go to a company that promises not to do this. As I keep saying, health insurance is not a competitive market.

 

Becuase they benefit much more from having mini-monopolies. It's much more profitable than having to compete for business.

 

What changes would solve this in your mind? I have a hard time trusting the free market to solve this specific issue - I am not sure there is enough incentive even if there was less regulation.

Assuming that people don't choose to have no health coverage, in a competitive system you still have to attract consumers.

 

Sick in America

 

edit: not sure if the video is working, so here's the URL. http://www.youtube.com/watch?v=aEXFUbSbg1I

I watched the full show to get the full perspective, which was interesting. On the commentary about Canada, it's worth noting that their procedural costs are lower, so the long waits seem more to do with how much they are willing to pay in total - they could pay more, which means more people will be paid needlessly during downtime, but increase the response time considerably.

 

When comparing models it's worth noting that when either system is under stress, quality will be reduced if funds aren't raised. In a free market solution, these funds occur at "time of purchase" as it's demand driven, which creates more incentive for more sellers to enter the market. This puts minimal stress on the wealthy, and much more stress on the poor.

Overall, this does seem to be questionable ethically when it comes to something as vital as health care.

When a national system such as the Canadian one experiences stress, it effects everyone, and then either everyone can bite the bullet and pay more taxes, or apply pressure to reduce waste. When a reporter runs a story on gross cost waste in Canadian hospitals it has an impact on voters, and politicians can capitalize on that - if they are smart they can push solutions that increase efficiency, lower costs by taking on "preventative care" initiatives, or what have you.

Not saying by any margin that the national system is ideal, but they are getting what they are willing to pay for just like everyone else.

 

One thing I did find interesting was the low cost non-insurance clinics - that would be very appealing to me as I don't have insurance*, and I think there's a chance I could float a solution that combined that with something similar to aflac's "accident/catastrophic illness" type plan.

 

As for how individual plans work - I think there is a lot of room for the free market to have a lot of say. If I could get a "20% flex rate" that took my "driving record" into account in terms of how smart I manage my health costs (not in avoiding going to a doctor, but keeping costs down by actually shopping around and asking smart questions... ie, cost per use instead of not using) I'd definitely have an incentive to shop around. I am sure that would be hell to administrate though....

 

I do find his analogy to "grocery insurance" to be quite over the top - and I don't think people have any interest in stacking up unnecessary surgeries, medicines and procedures just because they are "free" - doctor visits suck. A free stick in your rear is still a stick in your rear.

 

 

The question is though: how do we cover everyone? How do we ensure that people with insurance are properly covered and won't have their coverage yanked when they need it?

 

I can't for the life of me think of a good free market solution to that problem. All the other problems with government intervention can't make that issue go away for me. If that can be solved - I'm very much open to the possibilities.

 

 

* I've been rather royally burned by insurance in the past and I have zero confidence that any costs I ever incur will ever be paid by any insurance company. The whole point of insurance is the peace of mind, and I can't bring myself to pay out large premiums for the "lucky lotto" shot at hopefully squeaking though the gauntlet and being covered.

 

 

Edit:

Regarding some of the medical bankruptcy statistics, this is the best link I could find evaluating the various claims:

http://www.factcheck.org/askfactcheck/what_is_the_percentage_of_total_personal.html

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Trying to not spend all my time on this, but I found an interesting article on comparative health care costs:

 

http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2007/May/Mirror--Mirror-on-the-Wall--An-International-Update-on-the-Comparative-Performance-of-American-Healt.aspx

 

This graph especially so:

Based on those costs and the performance levels, even with the failings of say Canada, they could double their spending and still cost less per capita than Americans - I would like to think that all of John Stossel's complains could be largely remedied by doubling the amount paid in.

 

So: If we are the closest to a free market solution, why does it appear we are the furthest from high quality care? All these nations with no competition, no market drives, etc etc, are all pantsing us right now. If key regulations are causing the free market to worsen our abilities to the point of being worse than socialized solutions, what guarantees do we have we'll lift the right ones, and not just make it worse? There has to be some regulation - so it'll always be there - but what kind of rocket science is it going to take to be sure we "free" the right parts of the "free market" to make things better and not worse?

Edited April 8, 2009 by padren

[The Bear's Key]

Sick in America

 

edit: not sure if the video is working, so here's the URL. http://www.youtube.com/watch?v=aEXFUbSbg1I

 

 

The YouTube vid didn't show much that we haven't already discussed here, but the stat about 4 healthcare lobbyists for every member of Congress got my attention -- that's one main problem we need to really focus on. It's a bit sick (pun?). The other thing caught my eye was $300 for "that little pill". Unbelievable. It's insane to think of a normal-wage person (on cancer meds) having to shell out $300 for each pill.

 

The other vids? John Stossel is a weasel (more on that below). It's funny in one vid he says people leave the U.S to get healthcare, while in another vid he says people come to the U.S. to get healthcare.

 

iNow presented a vid that's not speculation or ideology arguments, but nations with real, verifiable systems, factual info -- actual models in existence of universal health working alongside private industry.

 

All John Stossel gives us is back-and-forth arguments of market/government ideology with no real substance. And lots of clips to reveal the market's "superiority" in contrast to government.

 

Besides just making arguments, he's stating the obvious (broken healthcare) and promoting his "free" market views as solutions. It's like they can't win by denying the problem, so they just admit there's a problem but offer to fix it with the same "market is best" approach.

 

Not surprising for John Stossel, the guy who...

 

• said AIDS research gets too much funding.
  
• likes for classrooms to teach propaganda material he donates.
  
• thinks global warming shall not have negative effects.
  
• claimed alleged tests showed both organic and treated veggies have no pesticide residues -- yet no tests (whatsoever) had even been done.
  
• is underhandedly biased towards "free" markets.
  

 

P.S. Have you even watched #2 and/or #4 in the OP vids?

 

(reminder: Japan, Taiwan)

[john5746]

The other vids? John Stossel is a weasel (more on that below). It's funny in one vid he says people leave the U.S to get healthcare, while in another vid he says people come to the U.S. to get healthcare.

 

I think both statements are true.

[ecoli]

I think both statements are true.

Of course... people who can afford to get quality treatment come here. Those who can't afford it go elsewhere.

 

The way our markets work is it keep quality and costs high. There's no reason to believe that it has to work this way (no other competitive market does).

 

You'll notice that one of Stossel's points was that areas that healthcare doesn't cover in the US (laser eye surgery, cosmetic surgery) costs are always getting reduced and in areas that universal health care doesn't cover (vet med) there are no waiting times.

[The Bear's Key]

The other vids? John Stossel is a weasel (more on that below). It's funny in one vid he says people leave the U.S to get healthcare, while in another vid he says people come to the U.S. to get healthcare.

I think both statements are true.

As do I But notice how I'm saying it's funny he avoided doing so within the same type of discussion or even near the same time frame.

 

At the beginning, he presented the system as broken, with people going elsewhere for treatment. But when it came to his promotion of market greatness, he presented the system as best, with *important* people coming from elsewhere to seek our healthcare. Presenting those next to each other would've diluted his second point.

 

The guy has done enough biased/underhanded reporting that it leads me to question if the people who came here did so because a rare specialist was necessary, and not because they distrusted medical care nearer to home.

 

For example, Siamese twins joined at the head went to Singapore in 2001 to be separated.

 

And they lived.

The operation was the fifth and most complicated of its type, of which only one has succeeded.

Before the operation...

 

....surgeons will have to determine which part of the brain belongs to which girl to ensure they get the correct speech and logic centres.

 

 

Not long after the success of that procedure, a set of older Siamese twins wanted it done. If you see below, 28 specialists from all over came to help -- meaning: not just from the U.S. (the girls' age seemed to make it a lot deadlier)

http://www.voanews.com/english/archive/2003-07/a-2003-07-07-54-Iranian.cfm

 

28 specialists, including experts from Singapore, the United States, France, Japan, Switzerland and Nepal....

 

 

The girls had died unfortunately. But the technology is pretty advanced as you can see below.

http://www.wired.com/wired/archive/11.10/twins_pr.html

 

...planned this operation using a new generation of virtual reality anatomical models. Rather than depending solely on transparencies, they fed CT scans, MRIs, and angiograms into a software package released by Stanford's Image Guidance Laboratories in 2002. The software synthesizes hundreds of 2-D "slices" and renders them into a 3-D model that can be viewed on a PC screen.

 

 

The public hospital was successful (and the private one wasn't, ironically), but that was largely due to the age difference between the procedures. Thus it really shows us: either hospital is as good as the other.

 

Below's some info on what to expect from Singapore medical quality/treatment.

 

 

International Patient Service Centres

<*

link

*>

 

Many healthcare providers in Singapore provide one-stop International Patient Service Centres to attend to the needs of international patients. To provide patients and their family members a hassle-free and pleasant stay in Singapore, the centres' experienced personnel offer assistance with a wide spectrum of services.

....

Healthcare providers with International Patient Service Centres are listed below.

 

Alexandra Hospital

East Shore Hospital

.... ....

.... ....

.... ....

.... ....

 

Over half the names they list are public facilities (with the rest obviously private). That lends credibility to public health, considering Singapore's ranking in the world. If anyone's curious as to which names are private/public, you can view the Wikipedia list of Singapore public and private hospitals.

 

 

 

More tourist info...

http://www.singaporemedicine.com

 

Singapore is a leading destination, not only for business and leisure, but also for world-class, affordable and safe healthcare.

 

With well-respected doctors trained in the best centres around the world, internationally-accredited hospitals and speciality centres, a global reputation as a medical convention and training centre, a fast-growing basic and clinical research hub

 

Singapore is just one of the many nations with quality healthcare that's mixed largely with public health. And it wasn't even part of the 5 nations on iNow's link.

 

John Stossel is either ignorant, dishonest, or both, as the way he plays it: those examples of nations with quality health in a mixed system just don't exist.

 

 

http://www.singaporemedicine.com

/healthcaredest/sg.asp

 

with internationally-accredited facilities and renowned physicians trained in the best centres in the world. Singapore's healthcare system was ranked as the sixth best in the world

 

The argument by "free" market politicians and reporters? It's seems to be a tactic of playing dumb, to get a compromise that ends up nearer to what they'd like.

[ecoli]

At the beginning, he presented the system as broken, with people going elsewhere for treatment. But when it came to his promotion of market greatness, he presented the system as best, with *important* people coming from elsewhere to seek our healthcare. Presenting those next to each other would've diluted his second point.

 

His point is that some aspects about it are good, others are bad. The same can be said about any system... ESPECIALLY universal care.

 

The argument by "free" market politicians and reporters? It's seems to be a tactic of playing dumb, to get a compromise that ends up nearer to what they'd like.

It's funny that you bring up Singapore then, which is a mixed system. Also the government is an effective dictatorship, and its small enough and strong enough to put price controls on health care.

 

Singapore's a pretty bad example if you're trying to copy-cat a system to implement in the US.

 

Not to mention, the profit-motivated innovation system is still very important in health care treatment. History has shown us time and time again that competitive markets keep down costs, while price controls lead to shortages.

 

Anyway, it seems silly to keep speculating when there is plenty of quality research. This paper is particularly good:

http://an5qy7ag4q.scholar.serialssolutions.com/?sid=google&auinit=S&aulast=Glied&atitle=Health+care+costs:+on+the+rise+again&id=doi:10.1257/089533003765888476

 

"The primary reason for the increase in the health sector's share of GDP over the past 30 years is technological change in medicine." This thesis is well supported by aggregate comparisons over time....

U.S. health expenditures per capita are much higher than those in other developed countries--over 40 percent higher than those in Switzerland, the second most costly country. Yet rates of growth in expenditures have been quite similar across the widely divergent health care systems of other developed countries....

This increase in expenditures is due to an expansion in demand that may occur for two related reasons. First, improvements in the health outcomes produced by a medical service mean that more patients can expect to obtain health benefits from the technology....

Second, innovations in medical care, especially cost-reducing innovations, often reduce the invasiveness and intensity of the treatment itself and thus reduce the pain, discomfort or time associated with treating a particular condition, even when outcomes do not improve. This reduction in the often substantial nonmonetary costs of treatment also expands the size of the market....

These technological developments in health care appear similar to those in other sectors in the sense that, without accounting for concurrent quality improvements, some of the new technologies cost more per unit than the technologies they replace (such as bypass surgery compared to medical management of high blood pressure), while many other treatments cost the same or less (such as angioplasty compared to bypass surgery; the new antidepressant drugs compared to psychotherapy; or outpatient cataract surgery compared to inpatient surgery).

 

conclusion:

Expenditure-increasing technological improvement is likely to continue into the future and does not appear highly responsive to policy changes. Incorporating these valuations into policy decisions implies sustaining a substantial, and ever-increasing, amount of redistribution (Glied, 1998; Cutler, 2002). As the costs of private coverage rise to incorporate new health care technologies, the numbers of people who lack private coverage will also increase. Higher costs may also encourage fragmentation of the market, leading healthier people to select health plans that exclude sicker people and leaving those with serious health problems to bear a greater share of their own costs. As the costs of public coverage rise, so will the amounts of revenue needed to cover existing beneficiaries. Increases in public costs will also limit the ability of the public system to extend coverage to those uninsured. The unique public policy challenge of health care is the problem of maintaining some degree of equity in the face of technological change that persistently increases the cost of meeting that goal.

 

Here is an economics paper about demand for private health care in the UK:

http://an5qy7ag4q.scholar.serialssolutions.com/?sid=google&auinit=C&aulast=Propper&atitle=The+demand+for+private+health+care+in+the+UK&title=Journal+of+health+economics&volume=19&issue=6&date=2000&spage=855&issn=0167-6296

[Pangloss]

I think someone mentioned Berkshire-Hathaway's AAA rating earlier in this thread. I happened to catch a news bit a few minutes ago that they lost that rating today.

 

http://www.reuters.com/article/marketsNews/idUSN0863300420090409

[The Bear's Key]

The same can be said about any system...

Correct.

 

ESPECIALLY universal care.

Wrong.

 

It's funny that you bring up Singapore then, which is a mixed system.

Didn't I already mention that?

 

v v v v v v v v v v v v v v v

Singapore is just one of the many nations with quality healthcare that's mixed largely with public health. And it wasn't even part of the 5 nations on iNow's link.

 

 

And in a less direct manner, again...

Over half the names they list are public facilities (with the rest obviously private). That lends credibility to public health, considering Singapore's ranking in the world.

 

My point is that Singapore gets top-notch healthcare with a mixed system of public/private.

 

 

By the way, doesn't Singapore look fairly capitalist (the night pic) just by viewing its infrastructure?

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Can't hide from the real world forever, no matter what John Stossel tries to distract, especially with the internet still growing leaps and bounds.

[padren]

You'll notice that one of Stossel's points was that areas that healthcare doesn't cover in the US (laser eye surgery, cosmetic surgery) costs are always getting reduced and in areas that universal health care doesn't cover (vet med) there are no waiting times.

 

I don't think anyone is arguing that non-catastrophic out-of-pocket care does anything but excel in the free market. The market advantages are pretty obvious to me. I honestly agree with you about all of that - free market does a lot better there.

 

But that's all beside the point at the end of the day: How do we cover everyone, how do we deal with catastrophic illness? For all the good the free market does (and it does do a lot of good) it fails to address these critical issues, without which it's benefits are largely moot when considering it as a singular solution.

[ecoli]

Wrong.

I'm wrong that universal health care has particularly special flaws? Maybe you should read that paper again. Things that make private health care expensive are the SAME THINGS that make universal care expensive. Except, with socialized care, you don't have the extra benfit of cost cutting competition. This is standard economic theory.

 

 

By the way, doesn't Singapore look fairly capitalist (the night pic) just by viewing its infrastructure?

 

I never said singapore doesn't have captilist- type economy, I said the government was effectively a dictatorship, with much more power and control over the economy than what would be possible here (for better or worse).

 

Can't hide from the real world forever, no matter what John Stossel tries to distract, especially with the internet still growing leaps and bounds.

I have no idea what point you're trying to make with this statement.

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For all the good the free market does (and it does do a lot of good) it fails to address these critical issues, without which it's benefits are largely moot when considering it as a singular solution.

We have a mixed system, and everybody claims to be unhappy. I have not yet heard a convincing argument that a [true] free market system couldn't provide much better care and coverage than socialized system.

 

Considering new ideas such as health savings account, where small things are paid out of pocket, and the private insurance covers the rest.

[iNow]

I have no idea what point you're trying to make with this statement.

My interpretation of his point is that the free market alone must be coupled with other approaches to EVER have a chance at working to adequately care for those in poverty or with chronic issues, and that your single-minded approach and assertions that the free market alone it is a panacea has been proven wrong time and again, especially in the context of healthcare.

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We have a mixed system, and everybody claims to be unhappy. I have not yet heard a convincing argument that a [true] free market system couldn't provide much better care and coverage than socialized system.

Here's the part of the argument you're missing or ignoring. Who are the beneficiaries of that care, and who gets left out with your free market system? What about them?

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[Pangloss]

My interpretation of his point is that the free market alone must be coupled with other approaches to EVER have a chance at working to adequately care for those in poverty or with chronic issues, and that your single-minded approach and assertions that the free market alone it is a panacea has been proven wrong time and again, especially in the context of healthcare.

 

One could say the same thing about a socialistic approach.

[ecoli]

My interpretation of his point is that the free market alone must be coupled with other approaches to EVER have a chance at working to adequately care for those in poverty or with chronic issues, and that your single-minded approach and assertions that the free market alone it is a panacea has been proven wrong time and again, especially in the context of healthcare.

An odd thing to say, considering a free market system hasn't been tried in recent history, and that nobody is happy with our mixed system.

 

I've even said I prefer a universal system to one in which the private corporations a pulling the strings behind the scenes (and screwing everyone over). There's no evidence that this would happen in a reasonable free market system... yet everyone manages to blame the bad parts of our system on the free market and the good parts of the socialism-like parts. I think this is a naive view.

 

We know that, in our system, technology innovations drives costs up - and so reduces coverage - but please explain how costs would be kept low in a universal system? We're all paying more - which the taxpayers won't like - and so people will still be denied coverage to maintain costs.

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Here's the part of the argument you're missing or ignoring. Who are the beneficiaries of that care, and who gets left out with your free market system? What about them?

Well there are always going to be people who are too poor to get care, but I'm sure this can be covered by charities or welfare (if absolutely necessary).

 

What I'm advocating is making health care a more competitve system. The universal insurance game doesn't do that. I know that Stossel video got criticism, but the fact of the matter is, doctors/hospitals don't run their practices like a business. They don't even know how much their procedures cost.

 

How can costs be lowered if people never shop around (there's no incentive to do so when everything is covered). The only way governments can keep down prices is through price controls. And that just leads to shortages. We're back to square 1.

[iNow]

please explain how costs would be kept low in a universal system?

No, because apparently you're too damn lazy to watch the link in the OP which has begun this entire conversation. Your question is explicitly answered there, and additionally has been answered by numerous posters to this thread.

 

In case you missed it, the simple answer is centralized cost controls. You keep repeating arguments that have already been debunked, and your free market mantra is ... how'd you say it?... the next time you say it I'm going to punch you in the face. Those were your words earlier in the thread, right?

 

 

 

What I'm advocating is making health care a more competitve system. The universal insurance game doesn't do that. I know that Stossel video got criticism, but the fact of the matter is, doctors/hospitals don't run their practices like a business. They don't even know how much their procedures cost.

You're AGAIN wrong, and the evidence lies in... yep... you guessed it... those darned little videos which inspired the thread.

 

If you don't even have the integrity to get yourself on to the same baseline as the rest of us, and put forward the effort to review the foundational evidence underlying this entire conversation, then I'm not willing to waste my time rebutting positions which are completely counter to the evidence already shared.

 

 

How can costs be lowered if people never shop around (there's no incentive to do so when everything is covered). The only way governments can keep down prices is through price controls. And that just leads to shortages.

Strange how it's working elsewhere. Controls don't lead to shortages, and when they do, it's because they were set too low. Funny thing about controls is, you can adjust them when needed. Is reality not something we consider when we're arguing for free markets? I must have missed that maxim in Jon Stossels video.