Universal Health Coverage

[Pangloss]

just chiming in on the budget deficit issue, currently the government deficit is running at about 40-50% of the gdp (about 8-9 trillion dollars) and climing fast, by no means an unprecedented level, but still not very good.

 

its interesting to see how the debt breaks down, once you add in things like social debt (social security etc.) the debt jumps to about 58 trillion dollars.

 

also of the 8 trillion dollars the government owes directly china owns 1.5 trillion. hence why we never reevaluate our exchange rate with them.

 

I think you meant the debt in the first paragraph, rather than the deficit.

[Realitycheck]

Alright, here is some more simple math.

 

Total personal medical costs for the calendar year 2000

(National Health Statistics Group)

 

$1.1 trillion dollars

 

 

Total People actively in the Workforce for the year 2000 (Total Population 281 million)

(U.S. Census)

 

129.7 million

 

 

Now if we divide the dollars needed to make it work by the people working, we get $8,481, or $706 a month. So much for that plan. If we somehow were able to cut the total price in half in the process and effectively have an additional 50 million people contribute by paying for it out of their pocket or any other means, then it would still come out to $3,060 a year, or $255 a month.

[JohnB]

Quick question. Why is your private insurance so expensive? A combined premium for both my wife and I is only around A$160 per month.

I want an example of efficiency and good quality care. Not just one. Not just the other. Both. Waiting lists are not an example of good care - that's rotten care.

Well, I thought that at around 3% admin costs ours was pretty efficient. As for good care, I'd like to see some sort of objective proof that hospital care in the US is superior to that in Australia. Personally I'd put our hospitals, Doctors and Nurses as equal to the best in the world.

The government cherry picking for me what procedures are important and what are not is not an example of good care - that's totalitarian care.

In our system the government does not decide these things, the Doctors do. The Doctors decide (in consultation with the patient) which procedures would be best and surgery is allocated on the basis of need.

 

Regardless of the system used if there are 1,000 ORs and 1,500 people needing surgery you put the acute cases first. Otherwise you get a heart patient dying while a politicians mistress uses the OR to get a boob job. That may be acceptable in a true free market system but is an anathema to the Australian psyche.

 

One thing that hasn't been mentioned is geography. A system that works for Australia (7.6 million square klms; 20 million people) will probably not work for the US (9.8 million square klms; 301 million people) or the UK (245,000 square klms; 60.7 million people). In the UK you could put a hospital just about anywhere and be within 60 miles of a fair sized city but there is a fair bit of Oz where you could stick a hospital and not have a house for 150 miles.

 

It may be that for a given nation the answer of private/public/mixed is more a function of population number and distribution than ideology.

[Sisyphus]

I want an example of efficiency and good quality care. Not just one. Not just the other. Both. Waiting lists are not an example of good care - that's rotten care. The government cherry picking for me what procedures are important and what are not is not an example of good care - that's totalitarian care. I can give the semblance of efficiency by hiring one doctor and one nurse in one room to service the whole damn country - I'll only spend a couple hundred thousand dollars a year in salaries' date=' but the line would stretch from New York to California and be littered with dead bodies - that's horrible care.

 

I want an example of a socialist healthcare system that provides quality - choice, talent and etc - and is efficient. I don't believe it exists. I believe it will exist in a truly free market healthcare system.[/quote']

 

I don't understand what you want to hear. We agree they spend a lot less money. Good. We agree that far more of the money spent actually goes to healthcare, instead of administration. Good. You seem to believe, however, that countries with socialized medicine have inferior care. I don't understand why you think that. I mean, they're healthier, right? So perhaps their lifestyles are healthier, but still, it can't be horrible, can it? Aside from that, all I have is anecdotal stuff. You may not have met anyone who complains about it, but every foreigner I've talked to about it has. I have a friend who moved away from a great job and all her friends back to Poland, which she hadn't lived in in six years, to have a baby, just because the healthcare there is better and cheaper. Better and cheaper. Poland. What would convince you?

[PhDP]

Where do you get faith? Economic fairy tales? Capitalism is proven to work - there's no faith needed.

 

That...

 

My contention is that things the government doesn't bother itself with stays reasonable. If the government started manufacturing chocolate bars, they would be 10 bucks a piece and would be dry and flaky.

 

...needs a lot of faith. It's not factual, state-controlled monopolies are often very efficient, sometime they are not as good as the private sector, sometime they are better, but the government can be reasonable. Although chocolate bars are doing very fine in the hands of the private sector.

[ParanoiA]

That...

 

My contention is that things the government doesn't bother itself with stays reasonable. If the government started manufacturing chocolate bars, they would be 10 bucks a piece and would be dry and flaky.

 

...needs a lot of faith. It's not factual, state-controlled monopolies are often very efficient, sometime they are not as good as the private sector, sometime they are better, but the government can be reasonable. Although chocolate bars are doing very fine in the hands of the private sector.

 

I wonder if we could compare a state-controlled/owned chocolate bar to an american one, compare prices and quality. An international politically ideological chocolate test...

[Realitycheck]

Realistically, when you talk about abolishing 2/3 of the health insurance industry, 2/3 of the marketing sector for healthcare, and the list really goes on and on, things really start getting painful for the nation as a whole. Healthcare is big business. Bill Clinton probably has something mapped up in his closet that is workable, but it is surely so drastic in its effect on the economy that it would lead to a witchhunt over a private little fling.

[Pangloss]

I wondered about that the other day myself, agentchange -- what would happen if Bill Clinton got into another affair, now that his wife is running for president. I've no idea, but it could certainly make fertile fodder for her opposition. At the very least she'd have to deal with press speculation about divorce, and endless questions on the subject.

[Realitycheck]

I think she gets sympathy because of that.

[ParanoiA]

I don't understand what you want to hear. We agree they spend a lot less money. Good. We agree that far more of the money spent actually goes to healthcare, instead of administration. Good. You seem to believe, however, that countries with socialized medicine have inferior care. I don't understand why you think that.

 

We don't agree on any such thing. I only said that in a socialized system you might get one or the other, but not both. There's no internal push to achieve anything beyond a bare minimum really.

 

Moreso, my contention is that a free market will work much better than a controlled one - and right now we have a controlled market that you want to compare to a socialized market. I have no interest in defending the current market as it's not what I'm contending.

 

Just last night, my son had to go to the ER after an altercation with a razor blade and a teddy bear - it's a story in and of itself. Later in the evening my wife told me they had a sign posted in the waiting room, which is a recent development, that stated a gaurantee to see a doctor within 30 minutes, no matter the condition - or you get free movie tickets.

 

Now obviously, this isn't all that meaningful, they can just have you wait back in the ER rather than the waiting room - get a doctor to poke his head in and say hi - and viola! - no movie tickets. But apparently they're feeling pressure to address the wait time and they're trying to do something about it - appeasing the public, the consumer. A taste of benefit from competition. I don't believe I would see this in socialized medicine.

[Pangloss]

Is your son ok?

 

You should be more careful about taking stray teddy bears in off the street!

[ParanoiA]

Is your son ok?

 

You should be more careful about taking stray teddy bears in off the street!

 

Yeah, he's fine and now he thinks his stitches are cool.

 

Despite my previous instruction on proper cutting technique, he did not pay attention to his other hand being in the cut path, so when he tried to cut some internal wires out of the poor thing he cut two of his fingers from the follow through. One was cut quite deep and freaked him out a bit.

 

The funny part (in hind sight) was him running to me with his hand all bloody looking for a band-aid. He knew he was doing something wrong because all he told me is that he was playing with this teddy bear and it cut him. I knew he was full of it, but you should have seen me examining this teddy bear trying to figure out how on earth it could cut. I thought we might have another recall on China made toys again!

[Pangloss]

I knew he was full of it, but you should have seen me examining this teddy bear trying to figure out how on earth it could cut. I thought we might have another recall on China made toys again!

 

ROFL!

[Sisyphus]

We don't agree on any such thing. I only said that in a socialized system you might get one or the other, but not both. There's no internal push to achieve anything beyond a bare minimum really.

 

We don't? Surely those things are an objective reality, no?

 

Moreso, my contention is that a free market will work much better than a controlled one - and right now we have a controlled market that you want to compare to a socialized market. I have no interest in defending the current market as it's not what I'm contending.

 

Aha! Now that's a more reasonable assertion, but not quite what you were saying earlier, I don't think. You said it wouldn't be an improvement over our current system.

 

Just last night, my son had to go to the ER after an altercation with a razor blade and a teddy bear - it's a story in and of itself. Later in the evening my wife told me they had a sign posted in the waiting room, which is a recent development, that stated a gaurantee to see a doctor within 30 minutes, no matter the condition - or you get free movie tickets.

 

Now obviously, this isn't all that meaningful, they can just have you wait back in the ER rather than the waiting room - get a doctor to poke his head in and say hi - and viola! - no movie tickets. But apparently they're feeling pressure to address the wait time and they're trying to do something about it - appeasing the public, the consumer. A taste of benefit from competition. I don't believe I would see this in socialized medicine.

 

But that's just it. You're not going to have competition there, no matter what. If you have an emergency medical situation, you're not going to shop around, you're going to the nearest emergency room. Essentially, every hospital has its own monopoly, which is why I don't think a freer market (whatever that would entail) is a good idea. Because whatever bad you have to say about a government monopoly (which is, after all, accountable to the people), a private monopoly is so much worse. Especially a safe monopoly for a necessary service.

 

BTW, I'll take your 30 minute razor teddy wait anecdote and counter it with what happened to my father 3 months ago: severe hand injury from a table saw, followed by a 4 hour wait in the emergency room applying pressure with a blood-soaked towel, followed by a $12000 bill in the mail, followed by a lengthy legal dispute with the health insurance company, followed by a check from said company for $8000.

[iNow]

But that's just it. You're not going to have competition there, no matter what. If you have an emergency medical situation, you're not going to shop around, you're going to the nearest emergency room. Essentially, every hospital has its own monopoly, which is why I don't think a freer market (whatever that would entail) is a good idea.

My own city may be the exception rather than the rule, but we have about 7to 10 hospitals within a 30 mile radius. I think you'd be hard pressed to call any of them a monopoly since there are so many (although, one IS a Level 2 trauma facilitiy complete with Starflight Medivac, and I'd totally choose to go there if I were really in need of some major help)... but, notice I used the word "choose."

[Sisyphus]

Yes, you can choose in a lot of circumstances, and a lot you can't, like most emergency situations. Of course, I don't think there are any countries with socialized medicine where you have to go to a particular hospital, doctor, etc. So in that sense, you actually have just as much competition in those countries, just based purely on quality of care and not cost.

[iNow]

I don't think there are any countries with socialized medicine where you have to go to a particular hospital, doctor, etc. So in that sense, you actually have just as much competition in those countries, just based purely on quality of care and not cost.

If medicine is socialized, would there be any significant difference between those hospitals?

 

Additionally, I'd suggest we first discover how many hospitals per capita there are in in these countries with socialized medicine, and how spread out they are, before we make ANY conclusions about the citizenships choice of where to go for treatment. To be perfectly frank, I find your suggestion that a socialized system has "just as much competition" as private market hospitals... uhmmm... not possibly correct, but I'm trying to remain open minded and see the other side of the discussion.

[Sisyphus]

Why do you find it not possibly correct? (If you can say why non-tautologically, I'll give you a cookie.)

[ParanoiA]

Aha! Now that's a more reasonable assertion, but not quite what you were saying earlier, I don't think. You said it wouldn't be an improvement over our current system.

 

It wouldn't, but I have no way to prove that assertion any more than you can prove it not true. The point is, how is it really better? So you want to spend who knows how many billions of dollars and bullshit to switch over to a system that may or may not be marginally better or worse. What's the point? Why are we setting the bar so low?

 

We're americans. What happened to our pioneering spirit? Why do you want to look like everybody else? Socialized medicine has as many disadvantages as our current system does so why do we want to switch problems? Blow a bunch of cash and manpower just to have a different set of problems. Wow...what kind of cold, hard pragmatism is that?

 

Come on, we can do better than that. I say give the free market an actual shot. Review the regulations and quit cowtowing special interests and trying to control everything and everyone. Drop the tax incentives or punishments - well the whole tax code really - and level the field.

 

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.

[Sisyphus]

My assertion is that it would be a lot more than marginally better than our current system, as based on comparisons with existing systems in certain other countries. The quality of care is, I believe, better - perhaps only marginally, perhaps not - but the level of efficiency is far better. Additionally, I see the many fears expressed about socializing medicine (that doctors become lazy from lack of competition, that there is no progress, that people overly take advantage of it to the detriment of everyone else, that the bureaucracy grows and dwarfs the actual healthcare, that individuals have no real options about their own treatment, etc.) really not coming to pass. Frankly, I wouldn't have believed it unless I'd seen it myself, but I have seen it myself, so there you have it.

 

As for how either would compare with a completely unregulated system, I have no analogous basis for comparison (the only countries without regulated healthcare don't have healthcare, period), only speculation. But I have stated my reasons for believing that healthcare would be especially susceptible to the many negative aspects of laissez-faire capitalism, and not particularly well-suited to reap its many benefits. Specifically, I see a tendency towards monopolism of a necessary service ("highway robbery"), which would be the worst possible scenario.

[ParanoiA]

Specifically, I see a tendency towards monopolism of a necessary service ("highway robbery"), which would be the worst possible scenario.

 

First, this is why I didn't say remove all regulations, I said review the regulations - which I'm assuming would cover this sort of thing.

 

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.

 

As capitalist as I proudly am, I'm not sure I'd be comfortable testing that theory out though....

[Realitycheck]

Well, I spent a little while compiling data onto a spreadsheet to compare countries and so forth. Then I found this wiki which pretty much summarizes everything fairly well, ie. cost/benefit/efficiency vs. free market competition. Canada and UK have some good things going on. Canada has essentially no national debt and UK has very good quality healthcare and the differences in quality are not that drastic. The major differences lie in things like wait times and, of course, a big pay cut for healthcare professionals.

 

http://en.wikipedia.org/wiki/Publicly-funded_medicine

eco comparison.pdf

Edited October 12, 2008 by agentchange

[bombus]

Perhaps those supporting state run healthcare would care to point out any instance of state run healthcare which has actually provided a decent healthcare service?

 

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. Also Cuba, despite its miserable GDP has a very good health service. (Oops, mentioned Cuba - I must be an extremist commie:-))

 

see here:

 

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

 

Anyway, I thoroughly recommend a nationalised health system run not-for-profit and funded by general taxation. Works out as much better value. However, the UK Government are trying to privatise it bit by bit because they're scared of increasing taxes to pay for it, as few voters would get the message that the increase in taxation would be cheaper than medical insurance...

Edited October 12, 2008 by bombus

[Realitycheck]

Some excerpts:

 

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] The quality of health maintenance organizations and managed care has also been criticized by proponents of publicly funded health care.[8] (kind of hard to believe)

 

According to a 2000 study of the World Health Organization, publicly funded systems of industrial nations spend less on health care, both as a percentage of their GDP and per capita, and enjoy superior population-based health care outcomes.[9]

 

Proponents of publicly funded health care point out that the United States, which has a partly free market health care system, spends a higher proportion of its GDP on health care (15%) than most other countries.[11] They have claimed that the need to provide profits to investors in a predominantly free market health system, and the additional administrative spending, tends to drive up costs, leading to more expensive health care provision. 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 have attributed this to the for-profit nature of these hospitals.[7]

 

International comparisons of health care quality are difficult and have yielded mixed results. For example, an international comparison of health systems in six countries by the Commonwealth Fund ranked the UK's publicly funded system first overall and first in quality of care. Systems in the United States and Canada tied for the lowest overall ranking and toward the bottom for quality of care.[19]

 

Overall, Canadians are quite satisfied with the quality of health care they receive. In a regularly conducted opinion poll, 70% of Canadians reported that they were either very satisfied or somewhat satisfied with the quality of care they receive compared to 30% being somewhat dissatisfied or very dissatisfied. The main factor of dissatisfaction is waiting times.[20]

 

It has also been noted that the largely free market system of health care in the United States has led to the faster development of more advanced medical treatment and new drugs, and that cancer patients in the United States for many forms of cancer, including those of the breast, thyroid and lung, have higher survival rates than their counterparts in publicly-funded health systems in Europe.[18] Some analysts have pointed out the difficulty of comparing international health statistics. In particular, the mortality rates for cancer in the United States is at about the same level as many other countries, suggesting that the higher survival rates are a function of the way cancer is diagnosed.[24]

 

The United States does spend more on health care, as an absolute dollar amount and per capita, than any other nation. It also spends a greater fraction of its national budget on health care than Canada, Germany, France, or Japan. In 2004 the United States spent $6,102USD per person on health care, 92.7% more than any other G7 country, and 19.9% more than Luxembourg, which, after the US, had the highest spending in the OECD.[33]

[John Cuthber]

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 systme- 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.