side effects of socialized health care

Great Debates
1

What would be the unintended side effects of instituting a socialed health care system in the US?

Would it become the US’s duty to attempt to keep costs low by making America healthier?

What about long-term affects? For instance, not that drug legalization is going to happen any time soon, but would it be an impossibility if we had a socialized system of health care?

What about the income levels of those of us who already have health care through work? Our taxes would rise, would our salaries?

What would happen to the medical industry? Would the doctors be paid any more or less? Would the quality of people entering med. schools increase or decrease?

I put this in great debates because I don’t think that these questions have clear-cut factual answers.

2

A lot more people would be a lot healthier and a few would be poorer. Oh, and the Libertarians would cry about being stolen from a lot.

That may just be a necessary evil.

I don’t see why not, but in any event, addicts without jobs and health insurance would finally be able to get the treatment they need.

Possibly, since your employer is no longer providing health insurance. But not by much - the more money you make, the more money you would be losing.

Doctors would probably be paid less. As for the quality, that is up in the air. One could argue that more dedicated people would be in the health care fields.

One thing that you have to remember when you’re talking about socialized health care… when you are healthy and fit, it seems like a bad idea. You lose money, of course it is bad! But then something terrible happens. You suffer a back injury. You lose your ability to work. You go on unemployment, and start leeching off the system, while you can’t afford the medical treatment you need to get better. You damn your family to poverty. This has happened to two of my uncles, and I am currently undergoing intensive medical treatment under my father’s work’s health plan - but next year, I’m not allowed to be on it anymore, and I don’t know how I will afford it then, since I can’t work.

Right now, the people who need care the most are the people who can not get it.

3

You might want to bump this Monday morning so all our British friends on the other side of the pond will see it. They might have a few pertinent points to make…

4

Pretty much by definition. :wink: Really. If you can get it, you get it, and then no longer need it!

5

IMHO it removes one of the objections against euthenasia, i.e. that it would be done for financial reasons. If it doesn’t cost the patient’s family anything to keep him/her on life support, you can be sure the decision won’t be based on money.

Personally I think that’s a desirable side effect but I’m sure not everyone feels that way.

6

AFAICR scr4 one medical organization of concerned doctors, did mention that their opposition to euthanasia is because of the current profit factor in the American medical system, AFAICR there is also a plan in Oregon that does help cover most of the health costs of the people, no wonder there was little opposition (in Oregon, not the feds) in approving the new laws on euthanasia.

IMO here are another unintended advantage of universal care:

  • (Here is a bone for conservatives to chew on :slight_smile: ) Some abusive unions will lose power, since their reason to be nowadays, is more related to their efforts to protect health care benefits for their members.

  • Today, people who start new companies are at a disadvantage, since very few capable workers risk working for a start up with very little benefits, it should be noticed that now insurance companies do give better deals to large corporations, and very little to small companies, putting startups at an economic disadvantage right out of the bat, the situation is worse for people working on their own. Universal health care does away with this unfair advantage large corporations have.

  • Globally speaking, the presence of universal health care elsewhere is also giving an incentive to corporations to leave America; I do think more jobs would remain here if we had universal health.

  • And related to that, I think more dislocation and loss of jobs will continue to occur, not having to lose health care, when one loses their jobs, will in my opinion, dispose of a lot of stress families that are down on their luck (this is devastating if family members have preexisting conditions) are seeing now.

7

Well, for one thing, we could expect more Americans to be dissatisfied with their health care, as is the case in Canada:

http://quote.bloomberg.com/apps/news?pid=10000082&sid=atxE0RACU.6o&refer=canada

From what I’ve read, waiting periods for routine procedures like pap smears are outrageously long. My middle class cousin in Toronto had to wait about three days to get an x-ray after he broke his ankle playing hockey. These are things that the poorest American can have done immediately with or without medical insurance.

When you take away the incentive the best and brightest stop performing. A skilled surgeon in Seattle can be counted on to wake up at 3 AM and bust his/her butt working all day for a solid $500,000/year. Move them to Vancouver and they start asking themselves if it’s worth it. Remove them from the supply of providers and we all lose.

8

The US already has socialised healthcare to some extent., in that “society” (ie. taxation) pays for a level of healthcare for some people who can’t afford it. The question is about universal socialised healthcare, whereby taxation pays for that healthcare for everyone.

To see the effects of universal socialised healthcare, one need merely look at pretty much every other industrialised democracy except the US.

9

Or just those with insurance lose?

10

That is from the same study!

Seeing the big picture, I notice good and bad points for both sides of this discussion, IMHO, the Blomberg piece is only showing us parts of the reports that in the end mislead many people in America. It is, in my opinion, a situation were propaganda from well to do think thanks and HMOs is obliterating serious discussion on the matter.

11

First, ‘unintended’ consequences are generally the ones that are not predictable. Like the social changes in teenage life from the rise of the automobile. So let’s talk about the conequences that are pretty predictable, have happened elsewhere, but still get neglected in discusssions of implementing socialized medicine:

[ul]
[li]Waiting Lists. This is inevitable. When you lower the cost for something, demand increases unless the demand is completely inelastic. If demand increases and supply remains the same, you have a gap. In a free market system, the gap is closed by increased prices, which lower demand and stimulate supply. In a command economy, you wind up with shortages. [/li]
If you would like the see the waiting lists currently in Alberta, you can go to this link. Bear in mind that Alberta spends more than average on health care in Canada, and wait lists are even worse in many other provinces.

For example, at the University of Alberta hospital at this moment, there are 2,785 patients on the waiting lists for an MRI scan, and the wait time is THIRTY FIVE WEEKS. Need knee replacement surgery? Expect to hobble for a while. The waiting list at the U of A is currently 61 weeks.

[li]Doctor and nurse shortages. This is unpredictable, because in other countries when they institute socialized medicine the doctors and nurses tend to flee to the U.S. If the U.S. does it, I don’t know where they’ll go. But once the government starts paying doctor salaries, there will be pressure to keep them in check. Again, if you reduce the value of something, you’ll get less of it.[/li]
[li]All kinds of distortions due to politics. Once health care enters the realm of politics, it becomes subject to political favoratism, horse trading, etc. Districts with powerful constituencies will get the newest, biggest facilities, even if they don’t need them. Poorer districts or ‘safe’ districts that politicians can ignore will get the shaft. [/li][/ul]

We’re entering new territory here, because the U.S. has been the ‘escape valve’ of other socialized medical systems. Because the rich in Canada get the same care as the poor if they stay in Canada, the very rich go to the U.S. for treatment. This offloads a substantial burden on our system. But if the U.S. socializes health care, where will your rich go? I predict the rise of ‘health care states’. You already see this in some island countries and plastic surgery or treatment that gets around drug and medical device regulation in other countries. Maybe Bermuda will start building advanced hospitals to pay for the wealthy Americans who want better treatment they can’t get at home. This will also give the best doctors a place to flee to when the U.S. government tries to control them.

It remains to be seen what will happen to medical research - much of which is undertaken because of the high profits available from catering to the wealthy. Limit what the wealthy can pay, and it might not be healthy for research.

I don’t know about ‘duty’, but if the U.S. is anything like Canada, you’ll start hearing arguments like this, “Since we taxpayers are paying for your health, we have a right to prevent you from doing X” (‘X’ being overeating, smoking, riding without a helmet, not wearing seatbelts, or anything else the nanny-statists want to stop you from doing). This is a powerful argument against socialized medicine - once the state is paying the bills, it gives the state an ‘in’ to start eroding your civil liberties.

I don’t see much of a connection here. Canada is more likely to legalize drugs than is the U.S., and we have socialized medicine. I don’t think the issues are related.

Eventually, probably. If the move to socialized medicine were revenue-neutral, it would all eventually come out in the wash. But I don’t think this is the case.

The best doctors will get paid less. The worst will get paid more. There will be less of an incentive to excel, and less of an incentive to work harder to get into the best schools so you can get the best jobs.

12

For one thing, moral hazard will increase. If your behavior has no effect on how much you pay for health care, that takes away one of the major incentives to stay healthy and avoid injury. If I have to pay the same amount in taxes to support a national healthcare system no matter what I do, I might as well not watch my cholesterol and let the government pay for my Lipitor.

13

I strongly doubt that the US will suddenly be rejected by foreign doctors because of slightly reduced salaries, or for ideological reasons. My cousin comes from a country with a higher standard of living than the US, and his wife is from one witha much lower standard of living and appaling doctors salaries - both would like to stay in the US permanently, if allowed, and not for professional reasons.

If this will happen, it’ll happen in places where costs are low, and politics are relativley stable - India, Thailand, etc. It’s just another step on the outsourcing road, and will happen with or without changes in the US healthcare system.

Here we hint at a very important issue - pharmaceuticals. Without the private sector dominating their largest market, the drugs companines will need to radically rethink their whole economic outlook. And that is extremely unpredictable. And is something that would affect the whole world.

14

But is it really an incentive? Do large numbers of Americans quit smoking to save money on their insurance? Do alcoholics quit so they’ll be acceptable to the healthcare system?

15

There are a lot more countries with national health care than Canada, you know. I’m not familiar with the specifics of the Canadian or British systems vs. the ones in France, Germany, the Netherlands, or any of the many other countries… but I do know that when people use the failings of one company like Enron to say “See? Corporations will always screw the public!”, they get reamed for it, and rightfully so.

“Start”? We already hear those very same arguments - if you’re injured or killed because you don’t wear a seat belt, then taxpayers have to pay the police to investigate and scrape you off the road, taxpayers and/or other hospital patients have to pay for your treatment at an emergency room, etc.

Those who want a nanny state will seize on any justification they can, no matter how meritless it is. We shouldn’t let them stop this country from catching up to the rest of the world in providing health care to people who can’t afford it.

16

Canada is a special case in this regard, as you well know, Sam. In almost every other ‘socialised’ nation, as long as you have paid your contribution to the universal care, you can further pay for private care in your own country, like here in the UK and in practically all of Europe.

I personally find the Canadian system absurd, although perhaps the only reason it is not ‘European’ is because it has the US on its doorstep!

17

BTW I do think the Canadian system needs reform, but once again many in the right forget this: There will be no end to private health care, many countries that have universal health care have a mix of government and private health, we are proposing only an end to the irrational health care that we have now.

18

Kind of debatable whether this will occur to a greater extent than it does already because those people who have health care also lose some or all of the cost incentive. I suppose in theory, this might occur for those who don’t currently have health care, except I don’t think there is any evidence that these people are taking very good care of themselves now…And, in fact, these people often don’t get routine preventative care and then end up in the emergency room with serious conditions, costing all of us a lot of money.

There is one thing that will undoubtably happen under a single-payer system: Some people who are making gobs of money off our current inefficient health care system and bureaucracy (e.g., the drug companies, the private insurers and their health care bureaucracy, …) won’t be able to do so anymore…or at least not to this great a degree. This fact alone pretty much explains a lot of the horror stories that Americans are fed regarding universal health care and why these don’t seem to add up when you look at such things as health care indicators (infant mortality, life expectancy, …) in various countries. Economic arguments that libertarians make when it suits their purposes (i.e., not in this case) would suggest that it would also have benefits for the economy because people would not be so tied to their jobs because of health care and would have more flexibility to change jobs or quit their job and start in business for themselves or do consulting.

To be fair though, universal health care is not a magic bullet that will solve every problem that we face. The problems of controlling health care expenses and deciding how limited resources get allocated exist in any health care system.

19

I really don’t heve the energy to get into a big debate right now, but I wanted to reply to a couple of things.

Yes, taxes will go up. On the other hand, you’ll no longer be paying your insurance premium out of a payroll deduction. Or, you would still be paying your insurance premium; but it will be in the form of a tax instead of a payment to a private company. So I don’t see where there is much of a difference.

I know you’ll disagree with me, Sam; but I think BuchCo has done a pretty good job of eroding our civil liberties already. :wink:

Riding without a helmet. Hm. That’s a tough one. I always ride with a helmet. But I don’t like being told I have to. It’s a moot point in any case, at least where I live. Helmets are required here, and they were required when I lived in California. The same goes for seat belts. “Click it, or ticket!”

As far as smoking and over-eating, I would love so see programs that help smokers and obese people get help!

Yes, we have some socialised medicine. Here’s a story. I was taking EMT training, part of which involved spending a day in an emergency room. A guy comes in with a bullet in his arm. He was sitting in his car, when someone came up and shot his cousin. The bullet went through his cousin and lodged in this man’s arm. (I don’t know what happened to the cousin.) The doctor, seeing the man was black, pulled the ER nurse aside and said, “Let’s pack him up and send him to County [USC Medical Center]”. The nurse said, “He has insurance, doctor.*” “Oh,” said the doctor, “I guess we can take care of him here.”

I found this to be appalling! Here’s a guy who’s been shot! He needs medical care. It is immoral to send him to a charity hospital, just because you suspect he doesn’t have insurance! If we had socialised medicine, this man would have been treated without question. Turning someone away because they don’t have insurance is wrong. Period.

Thankfully, I have not had to go to hospital without insurance (yet – I’m not currently insured). I have spoken to people who have, and they describe crowded conditions and sub-par care. People with legitimate need for medication are often not given the medication because the staff seem to think they are all drug abusers. Basically, “If you’re poor, then you’re an addict.” Maybe it’s different outside of L.A. and San Diego; but this is the treatment that has been described to me by people I know.

Also: If you think universal health care would have too many restrictions, you need to look at some of the HMOs people have to use if they want insurance. I was no longer covered for dental care with the dentist I had been seeing for 15 years, just because he was on that list, but not this one. (This was resolved after we got a new insurance plan; but the experience turned me off of HMOs.) With UHC, a person would be able to attend his or her regular doctor.

20

GIGObuster wrote

Speaking as someone who has started several new companies, and as someone who’s friends are pretty much all of that same breed, I can say this is nonsense. There are many advantages and many advantages to working at a startup, but I’ve never lost a potential employee (or had an employee quit) because he went somewhere where the health benefits were better.

Again, as a businessman and entrepreneur, and as a friend of similar others, I’ve never seen this. Cite?

By the way, in general, I’m just one voice, but I suspect that if you asked around, you’d find most other businessmen are like me and are completely against socialized medicine. Your whole premise that this is to our benefit is mistaken.

Johnny L.A. wrote

There’s a huge difference. One choice is managed by a private enterprise, and one by the government. Tell me you’ve never noticed the differences of efficiency between the DMV and a private enterprise. There’s a thread floating around the pit now about how inefficient a department in the city of Chicago is. It’s amusing, but rings true of pretty much everything government touches. Government has no day-to-day need to produce, and therefore it doesn’t.