If the U.S. government decided to go into the healthcare business and set up their own hospitals clinics etc, employe their own staff from top to bottom could they give us adequate healthcare at a more affordable price. I would think Kaiser might be a fair model for comparison.
Probably; as I recall one of the arguments against doing so during the health care debate was that private industry couldn’t compete, which would be just terrible. Capitalism worship > affordable health care.
That is exactly what happened. A public option tied to medicare would have rates 20-30% cheaper than private insurance due to lower overhead and lower reimbursement rates to medical providers. So the insurance industry had it killed.
To the OP: you are describing the VA. That is a socialized system where both payer and provider are public entities (as opposed to programs like medicare or medicaid where the payer is a public entity but the providers are private).
From what I know, due to recent reforms the VA’s quality has gone up while prices are either declining or not growing as fast. A VA buy in would be nice. Probably not politically feasible anytime soon.
I would think that because lives are at stake we have a virtual hostage situation dictating prices. This gives the provider an unfair advantage in my eyes. Is there a huge medical lobby at work in Washington? In Los Angeles we have county hospitals which do struggle and don’t provide the best service but it is far better than nothing. I have Kaiser insurance and everytime I go for a visit I find myself impressed with every aspect of the service.
Do they get to use any tax revenue to fund it?
What else are they supposed to use?
Fees. If they get to use tax revenue, then they’re not “competing” in any meaningful sense of the word.
I would LOVE to compete against my competition when I’m the only one who can draw on tax revenue. Woo-hoo, I’m competin’ like a Mo Fo over here!!
I don’t know that creating a system from scratch like that would be useful for many years. Better alternatives are already here that can utilize the existing infrastructure, such as Medicare for all. Of course, this type of program was strongly opposed by the usual industry suspects, and elements of it were stripped from the ACA, as Der and Wes have stated.
Kaiser is a good model since they have everything under one roof - it is a microcosm of UHC - everything is taken care of in one place - it is efficient, and people like it. The problem is they are geographically limited. They could not build enough Kaiser facilities to handle the entire country. Meanwhile, state-run programs are already set up and running in every corner of the US, it’s just a matter of expanding access to them.
Well, I should think that if it’s cheaper, more affordable etc then they would use fees and profits to fund it…no? What does Kaiser use to fund it’s operations?
Tell it to the USPS, Mace. Sure, they get some advantages, but they also get an outside body that sets their prices and places requirements on the services they provide…including fiercely unprofitable ones and ones that exceed all sense (like funding retirement plans for 75 years).
Yes they are in the ways that matters most for health care: cost to society, and quality of care.
Lots of socially useful things don’t work well on a fee for service basis.
No, because of economy of scale, because the vast majority of people aren’t medically expert enough to rationally “shop” for care, and because the necessity/urgency of health care lends itself too much to what amounts to blackmail. You can’t just walk away and look for a better deal when you are in agony or dying.
Yes, indeed you are, if you providing an equal or better service and the amount of tax revenue that you are consuming (per consumer of your services) is less than what your competitor is taking in in fees. Tax revenues are not unlimited free money, any more than any other sorts of revenues are.
Why does it have to be fees? What is the meaningful difference between taxes and insurance premiums in this case, except that the price of the insurance is effectively on a sliding scale according to ability to pay?
Yes, the USPS is in the difficult position of providing universal service. So UPS and FedEx can skim off the most profitable urban deliveries, and then pay the USPS to make their inefficient rural deliveries.
Economic theory and all real-world observation indicates that they would be far more efficient.
Healthcare is not a commodity well-suited to market provision, and it is a particularily bad fit for insurance. There are fairly well-known economic mechanisms behind the fact that government-run UHCs tend to be the most cost-effective way of delivereing national health care.
Capitalism worship; it’s more important that it be run on a fee basis that it is for it to actually work well.
I think you hit the nail on the head here. My vote would be no fees. For those who chose to have private insurance either allow tax credits or deductions but everyone should pay in as a tax. Do away with medicare all together.
This is the thesis of Best Care Anywhere: Why VA Healthcare is Better Than Yours
Veterans organizations are against letting civilians into their system, so author Phillip Longman advocated having the government take over failing hospitals to create a parallel civilian system using the exact same concepts, policies, and software used by VA.
Longman, a political moderate, does not argue that government-run healthcare is inherently better. He says that the VA used to be mediocre, but in recent decades decisions were made that resulted in the current superiority.
Could a government run health-care system compete on both price and quality, simultaneously? Certainly. Of course, some government-run hospitals are better than others, just as with non-profits. I suppose there are even good for-profit hospitals, although they rarely are mentioned in lists ranking the best.
How big is the lobby in Washington resisting goverment owned healthcare?
This is the model in Australia, everyone who earns a certain amount pays a levy (tax) and if you want private care on top of that you can get rebates on the premiums if you earn under a certain amount.