Overall, no. But I also agree with bldysabba that the Affordable Care Act is no model for the world. I’m for the Act, but I don’t think it addresses legitimate concerns with US health care being the world’s most expensive and without outcomes to match.
For an area where India does have health care lessons others nations might partially emulate, click on:
Personally, I do not want to spend large portions of my supposed golden years getting expensive medical tests for small risks, ordered by physicians practicing defensive medicine. And I do not think you need to pay cardiothoracic surgeons as much as the President of the United States to get good results. But I do not think the Affordable Care Act affects this much one way or the other.
It isn’t. One of the recent scandals was that young doctors couldn’t find berths to finish their training, because the universities had churned out too many. Most of our immigrant medics seem to be Polish, drawn in by the fact that the NHS pays more than they can get in their own country and is banned by law from discriminating against other EU nationals, like Poles.
And France, which spends more the Britain but much less than the USA, has twice as many doctors per capita as the US.
American taxes already pay for healthcare. The USA pays more per capita in taxes for healthcare than the UK, it just doesn’t get the same service. So more government involvement could result in less tax moneys being spent on healthcare.
Our present insurance system has far too many incentives built into it for unneccessary testing, such as MRI’s which are coomonly reffered to as ATM machines. Unneccessary and expensive consultations from specialists who are just going through the motions to add to a hospital bill. Unneccessary admittance to hospitals. Fraudulent billing and use of the system by both patients and dr’s alike. I bet our overall healthcare costs could be cut in half with no loss of of service, probably more than half. Most voters don’t care because the insurance picks up the tab and the employer pays the insurance. All the incentives involved are wrong and do nothing but drive costs up.
If we did this, we’d have a public health disaster. It is just naive to think that people are going to pay for shortfalls for other people’s care - especially for people unrelated to them. So we either let them die or subsidize their care through higher costs for others, which is what happens in the US today.
You say you understand insurance, but you saying that savings accounts are the answer makes me doubt this. What of people whose bills are going to be higher than they can conceivably save? What of those who start saving and then have an expensive illness. Many of the health related bankruptcies in the US affect uninsured people who get hit with big bills and an ailment that keeps them from working, which prevents them from catching up.
It is true that many of us will eventually have expensive illnesses (but hardly all) but that usually happens after 65 where the US has a single payer system. So this is irrelevant for the current debate.
I’m not sure what you mean by advanced healthcare, but the working poor in the US can hardly afford normal healthcare, let alone advanced. Sorry, I don’t buy that the punishment for well to do person A’s cheapness is that poor person B dies. But you have captured the argument of the right in America quite well.
Hell yes. But he wants to go in the other direction.
We have an engineering group in India, and people from Silicon Valley who have returned there take an immense pay cut - but are I think better off in general. Still, even the cheaper rates are clearly not cheap enough for the poor. I am not saying that they should adopt a Western model, since this might be impossible, only that the outcomes don’t seem something to emulate.
But that’s just the thing. If people don’t care enough about other people to make up the shortfall in their medical care voluntarily, and you force them to do it, without any externalities involved, not only are you in the wrong morally (which is a subjective position, I grant), you will end up distorting the system and making everyone suffer.
In my opinion, this is what the insurance system you currently have has already done. After all, isn’t it true that everybody uses insurance to pay for most medical expenses? That distorts the market. Does any other insurance system work like that? People don’t use insurance to pay for all car repairs, or for all new car purchases. The majority of those payments are still made by people out of their own pocket. Because the expenditure is not socialised, people who are in the best position to weigh the cost benefit analysis make the decisions. I.e the people who are going to get the benefit bear the cost.
I know health seems different (and in some senses, particularly information asymmetry, it is, and that is a valid area for regulation and government involvement) but in other senses, it is not. A persons life and health, when they do not impinge on the health of society at large (contagious disease for instance, does) is a private good. They and their family are best situated to decide what costs should be Borne. If they are unable to, it is, sadly, a private loss. It is not a public health disaster. The black death was a public health disaster. And to control events like that, tax most definitely is valid. To pay for tertiary healthcare for everybody who cannot afford it, no it is not.
There’s no such a thing as a person’s life and health who doesn’t impinge on society at large: a person’s illness affects their job (paid or not, when Grandma takes care of the kids and she gets sick, the kids need another caretaker), the stress affects their relatives own performance and health, etc.
Even the death of someone who lives on the street and has nobody who cares for them or they take care of impinges upon others. Someone has to move the corpse.
No man is an island,
Entire of itself,
Every man is a piece of the continent,
A part of the main.
If a clod be washed away by the sea,
Europe is the less.
As well as if a promontory were.
As well as if a manor of thy friend’s
Or of thine own were:
Any man’s death diminishes me,
Because I am involved in mankind,
And therefore never send to know for whom the bell tolls;
It tolls for thee.
– John Donne
I think that sums up the morality issue. As far as a social issue, individual health is a public good. We do not euthanise people who are poor. If a person is unable to afford to care for himself, there are programmes that are there to help. (Not enough, IMO.) Thus a ‘private loss’ does impinge on society, and the costs are borne in the most inefficient manner by everyone else. If a preventable or curable illness makes a person unable to work, they are no longer supporting society through their contributions. If someone’s medical expenses force them into bankruptcy and they lose their home, the foreclosed property reduces the value of surrounding properties, and so on.
This argument doesn’t make sense. If efficiency was truly about “spending one’s own money” the most successfull businesses would be those that spend the less hence deliver the less. And certainly, since, as previously noted, businesses are there to make a profit, not to be efficient, this is exactly what a business would try to do : have you pay as much as possible and deliver as little as possible. For instance, in the case of healthcare, hand you an aspirin when you get cancer and bill you $ 1 million for it.
What (generally) prevents this from happening and makes a capitalism system efficient is competition and elasticity. If the furniture company sells a crappy sofa for a very high price, you’ll either not buy any furniture, or buy it from a competitor or buy chairs instead. But there are plenty of domains where this can’t work. For instance, you briefly mentioned roads. Private roads are a stupid idea because for competition to exist, you’d need, say, 5 companies building 5 different roads from New York to Washington. This would be obviously absurdely wasteful.
Healthcare has similar issues. If you get cancer, you don’t have the option to decline to buy the product (except by dying, of course), nor can you switch to an alternative product (being treated for aneurism instead) and your choice of health provider is generally severely limited (there typically won’t be many hospitals in your area equiped and staffed to treat your cancer).
As a result, you’re a captive customer, in a monopolistic or oligopolistic market with zero demand elasticity. Which is definitely not conductive to efficiency. But might be conductive to sell you an aspirin for 1 million, per above, which will be very “efficient” from the point of view of how the provider manage his own money, which you rightfully argue he will, but probably not what you mean by “efficient” when discussing healthcare.
Healthcare, as previously noted, isn’t a market well suited for the private sector. And it shows. The American healthcare system is famously by far the most costly in the developed world with outcomes less than stellar (as mesured by life expectancy, infant mortality, etc…also as previously noted). Similarly, the overhead of health assurance companies (not even mentioning their profit) or the administrative costs of health care providers (for instance to deal with dozens of different companies using hundreds of different payment schemes) are equally famously ludicrously high by comparison with developed countries with an UHC or similar system.
To maintain your “private sector is always more efficient” stance in the case of health care, you need to blind to both theory and real world measured outcomes.
I’m not sure I entirely understand how this applies to my argument.
Families and those who care for a person’s well-being are, almost by definition, those who benefit from their well-being. They are not society at large. They most decidedly ought to step up and foot said person’s medical bill. You still shouldn’t be able to force them to do it.
I’ve been through lots of John Donne many years ago. He’s useful if you’re looking for a particularly clever conceit or some particularly bitter misogyny. I don’t consider him the sort of authority that would quiet a debate on taxation. Here’s the thing - if you were using the above lines to convince me that donating to a fund to help people pay their healthcare costs is a good idea, I would totally buy it. I don’t think helping my fellow man is a bad thing. I believe strongly that community and society are important and they need to pull together to achieve great things.
I also believe that taxation is the wrong way to try and go about pulling society together on issues that should not be solved with tax money. There are certain issues we face that are good to solve with taxation. Those issues where the benefits or the harm cannot be stopped from spreading out amongst society at large. Take basic science research, or air pollution, or vaccination. Or clearing away garbage, or cleaning the streets. If 50% of us got together and contributed towards these things, we could not stop the other 50% from free-riding on our efforts. So we tax for these things. Tertiary healthcare is not one of those things.
No we do not, and should not euthanise anybody who does not want to be(and even then probably only with safeguards). The programmes that are there to help, if through taxation, should not be. If through charity, then the private loss is still a private loss. The private here simply extends to those people who care enough to try and help, may their tribe increase. Voluntarily.
As to your point about sick people’s contribution to society, first of all, if they were to be cured, I don’t think too many people contribute to society for free. They get paid. So, still private benefit, private cost. Also, warning, cold economic calculus coming up - In a system where healthcare cost what it was worth - If a sick person’s contribution to society were enough to justify the amount spent on their health, they would already be able to finance their healthcare. This may not be true in the USA today, mind, I’m not saying your system doesn’t need fixing. I’m just saying tax money ought not to be spent on tertiary healthcare.
As for the foreclosure thing - why don’t you just prevent any home from going into foreclosure then? Let anybody who can’t afford a home buy and keep one? You already tried that, and it gave you a massive housing bubble. See, I’m sure those arguments were noble too. Let’s help everybody buy a home, with tax money. Throw in a little avarice on part of mortgage lenders and bankers, everything goes boom. The avarice doesn’t get caught because the downside was socialised. Taxpayers are there to pick up the slack, who cares?
Housing is a private good. It was a bad idea to use tax money to fund it, even though intentions were good. Tertiary healthcare is a private good. It is a bad idea to use tax money to fund it, even though your intentions are good. Once again, don’t get me wrong. I think it’s a great thing that you want to fix the problem that some people can’t afford healthcare. I think the solution of using tax money will lead to greater problems.
This is a substantive post. You’re most decidedly correct that there are significant problems with a healthcare market. The ones that you point out though, are not the ones I would have highlighted. Hospitals are not natural monopolies in the sense that roads and railways are, for instance. For me, information asymmetry is a big one, limited time to make decisions is another. None are unsolvable IMO, at least not to the extent that it’s better to say just junk it all and switch to government provision. Government should play a role through sensible regulation that allows healthcare markets to work. There are also market solutions that can pop up - portals that review and compare doctors/hospitals for instance. (I’m not claiming that these have solved the problems they set out to address, just that innovations can arise to reduce the issues that exist).
Nor do I think it is fair to paint the US system as one where costs are higher because it is privately run. I think high costs in the US system are very much driven by medical insurance for all medical expenditures, which is in turn driven by the tax breaks given by the government. As an example that this can happen - India used to have very cheap rates in very good hospitals until medical insurance started becoming popular(tax breaksa again). Prices in the last decade have been skyrocketing. In quite a few private practices now(or till a few years back at least), you could still get two rates - if you’re covered by insurance, doctors will write out a receipt for a high amount because insurance payout is higher, and if you’re not, will charge you a much smaller personal rate. I expect as insurance becomes more ubiquitous, the cheaper option will start disappearing.
I believe the way the legal system is set up to deal with medical issues also has a lot to do with high costs in the US.
Then you’re not reading any of my posts. I have at no point stated that you have the right to keep everything you earn. Taxation is most decidedly valid for some things. And I don’t think Socialism means what you think it means
As shown on page 14, perhaps 80 percent of graduates of top medical schools in Ghana – one of the best governed nations in the region – also leave, mostly for Europe, after having being educated at great expense. No kind of health system can compete without doctors and nurses.
One good response to this has been for Western medical schools to establish relationships with top schools and hospitals in developing countries, with some physicians practicing part of the year in different continents. But this isn’t enough when most of your staff disappears within a few years of training. I don’t know what the solution is, but the physician, and nurse, shortage caused by the brain drain is severe.
Yep, and I’m a bit bitter that people tout their government run systems with such smug superiority. Run them by paying the costs for the distortions they introduce. Then crow about them.
The USA allows another distortion to exist - it’s the cash cow for new drug development. Most drug companies(including European ones) take 50% or more of their revenue from the US. 50% from a single country, and 50% from the rest of the world. While this is no consolation to Americans of course, it should give pause to those who claim so proudly that their government run systems are cheaper. You’re being subsidised by drug spending in the US and medical training in developing countries. And if I’m right about the demographics, by your own next generations too.
Enough private losses represent a public health disaster by definition.
People can shop for new cars - and it often takes a while. It’s a bit harder to shop for a cardiac surgeon after a heart attack. You can choose a luxury car or a cheap car or a used car, and get basic functionality with all. You can’t buy a used heart transplant.
If insurance distorts the market, it does so by giving individuals greater bargaining power against health care providers. A single person has no bargaining power with a hospital, especially if in an emergency room. An insurance company does. If this distorts the market, then so does the purchasing policies of large chain stores. It is an odd definition of distort.
Is healthcare almost fully paid for by taxes (as in England and Canada) immoral also? In the US we have food stamps, begun when we woke up to the fact that people were going hungry. Is this immoral?
BTW car repairs needed because of an accident are paid for by insurance. Not repairs caused by natural aging of the car. But cars lose value over time, so the time arrives when it does not pay to repair a car (even if it would cost only a few hundred dollars.) Do you think this is the policy we should pursue for the elderly?
In fact during the changes to Medicare the Republicans forbade the Medicare system from negotiating for lower drug prices. Those who live near the border with Canada know they can get drugs cheaper there.
But the reason that people tout their government run systems is that they give better results for less money than our mostly free enterprise system. (And insurance is not against free enterprise.)
Yep, people do go to areas of greater opportunity, and not just doctors. There are plenty of IIT grads working around me.