# Devil's advocate: saving America from socialized medicine. **URL:** \ **Category:** Great Debates\ **Created:** [January 26, 2009, 7:39am UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032 "2009-01-26T07:39:12Z")\ **Posts on this page:** 20\ **Page:** 4
**Author:** ![clairobscur](https://avatars.discourse-cdn.com/v4/letter/c/839c29/32.png) [@clairobscur](https://boards.straightdope.com/u/clairobscur)\ **Post date:** [January 27, 2009, 4:30am UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/61 "2009-01-27T04:30:53Z")
> [@curlcoat](#): > > If you are talking about a single form for the patient, I don’t fill out forms for my visits with the insurance I have now (and haven’t for years). If you mean for the doctors and their staffs, I really have to believe that the government would generate _at least_ as much paper. Doctors fill only a single form, here, in almost all cases. I can’t see why it would have to be different in the USA. ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [January 27, 2009, 5:06am UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/62 "2009-01-27T05:06:32Z")
> [@clairobscur](#): > > Doctors fill only a single form, here, in almost all cases. I can’t see why it would have to be different in the USA. I think it would be different based on the way every other US government agency is run, as well as how private insurance runs here already. ---
**Author:** ![RickJay](https://avatars.discourse-cdn.com/v4/letter/r/bb73d2/32.png) [@RickJay](https://boards.straightdope.com/u/RickJay)\ **Post date:** [January 27, 2009, 5:09am UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/63 "2009-01-27T05:09:47Z")
> [@curlcoat](#): > > And I’m 51. I’m not sure I get your point. Yes, health care beyond the basics is expensive. Do you think it would be (and should be) less expensive if the government ran it? It’s certainly true that the Canadian system delivers far more cost efficient care. Always has, ever since it was created. Of course, every national system is different so who knows what might get set up, but it can be done. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [January 27, 2009, 5:23am UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/64 "2009-01-27T05:23:56Z")
> [@Grumman](#): > > Personally, I see a difference between forcing people to not do “bad” things, and forcing people to do “good” things. Driving recklessly and thereby risking other people’s lives is “bad” in a way that failing to subsidise people’s healthcare isn’t. Again, unless you want people to die from lack of treatment when they get sick without insurance, you and I will subsidize them anyway through higher doctor bills or taxes. If I’m going to pay for it anyway, why not do it in some sort of rational fashion, one that can help cut costs by earlier treatment and cut overhead out of the system. ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [January 27, 2009, 5:33am UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/65 "2009-01-27T05:33:03Z")
> [@foolsguinea](#): > > [COLOR=“SeaGreen”]Canadian Medicare is much more efficient than US private health care. Don’t believe me. [Read this linked article.](http://www.ourfuture.org/blog-entry/mythbusting-canadian-health-care-part-i) I’m not going to quote from it, because you should read the whole thing. There were an awful lot of things in there that don’t jive with my personal experiences in California, such as having to wait weeks to get an appt with a specialist, and a doctor having to spend 35 hours a week (!) talking to insurance companies. If nothing else, any time I’ve had an insurance company deny something, it has been my responsibility and not the doctor’s to deal with it. She also really glossed over the issue of rural Canadians living rather far from anything other than basic medical care, and the differences between the provences. Another thing that the article doesn’t address - Canada isn’t the US. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [January 27, 2009, 5:48am UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/66 "2009-01-27T05:48:18Z")
> [@curlcoat](#): > > And I’m 51. I’m not sure I get your point. Yes, health care beyond the basics is expensive. Do you think it would be (and should be) less expensive if the government ran it? Yes. It’s cheaper in other places. Now if Republicans ran it, all bets are off. Medicare is actually very efficient. > [@](#): > > 60% is only 10% over the majority, and it probably represents close to the number of people that were uninsured or were paying for private insurance prior to UHC. After the shiny newness has worn off, it will be interesting to see how many still like it. Any evidence of that? Seems more likely to me that those who are ideologically opposed to the idea are against it. As I said, it is also more expensive than originally projected, so that might have something to do with it also. > [@](#): > > As for the working poor, sorry but far far too many of them put themselves into that situation. Why is it that responsible people are required to pay for the irresponsible? What an elitist statement. So, someone working hard for 40 hours a week is avoiding a better paying job? Not everyone can be doctors or lawyers or even chefs. You clearly are a literate person who writes well. Did you choose to be that, or were you born that way and grew up that way? A lot of us got born on second base if not on third. Lets not look down our noses at those still trying to get on. > [@](#): > > Positive - medical and dental insurance is what I did before I couldn’t work any more. Interesting. Who did you talk to at the doctors’ offices then? My wife and I have both spoken directly to insurance people at the office. Not 100% do - a friend of ours opened her own dentist’s office, and I don’t think she could afford a full time insurance person. But all moderate sized practices (four doctors or more) I know of have one. [quote Do you really believe that the US government, author of the income tax rules, could possibly have something that simple? If you are talking about a single form for the patient, I don’t fill out forms for my visits with the insurance I have now (and haven’t for years). If you mean for the doctors and their staffs, I really have to believe that the government would generate _at least_ as much paper. [/quote] Haven’t you ever gotten rejected for treatment for some obscure reason? We have, and it takes forever to resolve, and even more for the poor person at the doctor’s office who knows the obscure ways of insurance companies. Sure 99% go through fine, probably electronically now, but that 1% is the killer. If different insurance companies have different rules and different coding, don’t you think that adds to complexity? > [@](#): > > Again, just calling it preventative care doesn’t tell me anything. It could be something as simple as one well visit a year all the way to paying for all of the new vacicnations they are coming out with for adults, full body scans, annual mammos, etc. > > Also, simply because an insurance company pays for something doesn’t mean they it because they think it will save them money. Insurance companies are in the business of selling policies and particularly in the case of group policies, they offer things that they find will influence people to sign up. So, you think people without insurance go for yearly checkups? Get standard tests done? Lets worry about that before we worry about expensive full body scans. Are you really having trouble seeing the logic of a $100 test now making a $50K hospital stay later unnecessary? ---
**Author:** ![foolsguinea](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foolsguinea/32/14751_2.png) [@foolsguinea](https://boards.straightdope.com/u/foolsguinea)\ **Post date:** [January 27, 2009, 6:06am UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/67 "2009-01-27T06:06:10Z")
> [@curlcoat](#): > > Another thing that the article doesn’t address - Canada isn’t the US. Does it claim that Canada is somehow the US? Does it assume it? I think not. Oh, wait, you say that Canada is unlike the US somehow. Well, that’s possibly [another thread, so I’ve started one.](http://boards.straightdope.com/sdmb/showthread.php?p=10747826#post10747826) In the Pit, so you don’t have to be polite about it. ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [January 27, 2009, 6:52am UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/68 "2009-01-27T06:52:32Z")
> [@Voyager](#): > > Yes. It’s cheaper in other places. Now if Republicans ran it, all bets are off. Medicare is actually very efficient. You want less money spent on health care? In what way do you think that Medicare is very efficient? > [@](#): > > Any evidence of that? Seems more likely to me that those who are ideologically opposed to the idea are against it. As I said, it is also more expensive than originally projected, so that might have something to do with it also. Those who are against (what do I call it now if socialized is the wrong word?) one US wide insurance plan run by the government tend to be those that have no need for it. Because they have insurance. Those who are for it tend to be those that don’t have insurance, and those who think that handing things to poor people is a good idea. > [@](#): > > What an elitist statement. So, someone working hard for 40 hours a week is avoiding a better paying job? Not everyone can be doctors or lawyers or even chefs. You clearly are a literate person who writes well. Did you choose to be that, or were you born that way and grew up that way? A lot of us got born on second base if not on third. Lets not look down our noses at those still trying to get on. I was born on third base myself, if by that you mean in poverty and then given a less than stellar education. I have worked three jobs at once, lived near the Canadian border in a house without heat and etc. I learned to be responsible for myself, I learned to delay gratification until I could actually afford it. I am not and was never a doctor, lawyer, chef or held any other job that paid extremely well and came with great benefits. And yet, even with just a high school education I have always held jobs that had group health insurance since I was 20. I am not looking down my nose on anyone that is actually trying to get on, I am looking down on those who think they “deserve” X, whether or not they can actually afford X. People who buy houses and cars they can’t really afford, who start families when they don’t have good jobs and decent health insurance, who run up big credit card bills, who have no savings and no plan should some disaster happen. I worked hard for my semi-comfortable middle class life. I am not giving it up without a fight. I don’t see why my retirement years (which have actually turned into my disability years) should be threatened because people cannot be bothered to make things like health insurance more important than an SUV, a bigger house or three children. > [@](#): > > Interesting. Who did you talk to at the doctors’ offices then? My wife and I have both spoken directly to insurance people at the office. Not 100% do - a friend of ours opened her own dentist’s office, and I don’t think she could afford a full time insurance person. But all moderate sized practices (four doctors or more) I know of have one. Then perhaps it is a regional thing. I have not talked to the office my orthopedist is in since I’ve only been there twice, but I have talked to my rheumatologist’s people, the folks in my GP’s office, the dentist’s, my allergist when I still went there. Medical insurance (group) is what I _did_, so I talked to all of them. > [@](#): > > Haven’t you ever gotten rejected for treatment for some obscure reason? I have had drugs rejected, PT rejected and non-mainstream treatment rejected. > [@](#): > > We have, and it takes forever to resolve, and even more for the poor person at the doctor’s office who knows the obscure ways of insurance companies. Sure 99% go through fine, probably electronically now, but that 1% is the killer. If different insurance companies have different rules and different coding, don’t you think that adds to complexity? I don’t know much about individual plans, so if that is what you have, this may not apply. However, thruout the years that I was involved in group insurance, particularly large groups, the plans were all essentially the same. If you were rejected for something by your insurance company, you would probably also have been rejected by all the others - they all use the same statistics. And this is another reason why I am against the government taking over - they will, I can guarantee, write a plan that will automatically pay for all well child, all maternity, all office visits for sniffles and other things that really are not going to seriously impact the health of the people. And, they will most likely limit cancer care, marginally elective surgeries such as that for sleep apnea, restrict access to tests beyond xrays and blood tests and severely cut back on drug coverage. Because this is what the lesser insurance companies do, the ones that are trying to cut costs such as the average HMO. Like Kaiser, which was and may still be a non-profit. And the punch line? We won’t have any choices unless it’s opt out. > [@](#): > > So, you think people without insurance go for yearly checkups? Get standard tests done? Lets worry about that before we worry about expensive full body scans. > > Are you really having trouble seeing the logic of a $100 test now making a $50K hospital stay later unnecessary? I think you are having trouble seeing the logic of a $100 test multiplied by a couple of hundred thousand people who have no health problems. There is no financial reason to have preventative care visits available to healthy young people, except that it sells insurance policies. Yet you want me to pay to have this available to every person in the US? ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [January 27, 2009, 6:54am UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/69 "2009-01-27T06:54:14Z")
> [@foolsguinea](#): > > Does it claim that Canada is somehow the US? Does it assume it? I think not. It makes comparisons as if the two countries are equal. They aren’t. ---
**Author:** ![gaffa](https://avatars.discourse-cdn.com/v4/letter/g/e68b1a/32.png) [@gaffa](https://boards.straightdope.com/u/gaffa)\ **Post date:** [January 27, 2009, 7:29am UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/70 "2009-01-27T07:29:45Z")
> [@curlcoat](#): > > This isn’t true - none of my doctors have a separate person in their office that just does insurance. My _dentist_ has one person in his office just to handle insurance. He’s increased the amount of Medicare work he takes because it’s easier to bill one consistent set of procedures and billing than the rat’s nest of different ones for all the various insurance companies. > [@](#): > > Plus, even if we did have a socialized plan, how would billing be different? One set of codes, one payer. Single payer. As Joe Bob Brigg’s said “I’m surprised I have to explain these things.” ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [January 27, 2009, 8:05am UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/71 "2009-01-27T08:05:02Z")
> [@gaffa](#): > > One set of codes, one payer. Single payer. As Joe Bob Brigg’s said “I’m surprised I have to explain these things.” The coding is already standardized. I fail to see how only paying the government (as well as a few remaining private insurers) is going to reduce paperwork for doctors. Have you ever experienced the amount of paperwork the government generates? ---
**Author:** ![Hilarity\_N.Suze](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/hilarity_n.suze/32/6223_2.png) [@Hilarity\_N.Suze](https://boards.straightdope.com/u/Hilarity_N.Suze)\ **Post date:** [January 27, 2009, 8:38am UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/72 "2009-01-27T08:38:19Z")
What we have in the US is a rat’s nest of third-party payors, lawyers, Medicare, Medicaid, and a whole lot of people whose salaries depend on maintaining the status quo. We have insurance companies who set aside $35,000 to defend against a claim that would cost them $17,000. We have doctors who, 25 years ago, had one person to deal with the insurance, and now they have a whole department to deal with it. I worked for lawyers who spent $6000 a year to keep up with Medicare/Medicaid legislation, in CLE and updates, so they could explain to their physician clients how not to commit Medicare fraud, and of course that cost is transmitted tenfold to the clients. Who then pass it along to their patients. The hospital I worked for had a patient who came in every three weeks for an orphan drug. The patient was on Medicaid. Medicaid reimbursed the hospital $950, the drug cost $1500. In other words, we lost around $600 every time this patient walked through the door. At the same time, Medicaid reimbursed more if a patient was diagnosed with viral pneumonia than with bacterial pneumonia (let’s say; it may have been the reverse) so no matter which kind of pneumonia the patient actually had, it was coded as the one that paid more. One way, it was enough to pay the doctor’s cost of treating the patient, the other way, it wasn’t. One of my colleagues is a former RN whose salary is around $120,000 at the insurance company she works for, plus other bennies like a fairly nice company car, and her job is, basically, to look at claims and make sure they are actually covered. You can read between the lines on this–if she doesn’t catch at least $120,000 worth of claims that can be disallowed, she will probably be out of a job next year. If she catches a lot more than $120,000, maybe she’ll get a raise. Meanwhile, a friend of mine and her husband were doing great 10 years ago. They both had good jobs, they had a couple of kids, they had two rental houses and one they lived in. Then he had a heart problem, which has resulted in a bypass, some kind of implant that has to be tested once a year, and severely cut back hours. He just can’t do what he used to do. And she had a brain tumor. They did have insurance, but nonetheless, after the heart problems and the brain tumor, they had to sell all their houses to pay the medical bills, one of them is now 100% disabled and the other 50% disabled, and they’re renting. No savings and nothing to fall back on and no vacations ever again. And not only that, but health care costs are sneaky. You can’t ask, “How much is this going to cost?” because the only people who know are the insurance companies. For instance I went in and had a physical this year, because it had been a long time, and my doctor wanted to make sure I was healthy enough to take Fosamax. (Ha; they give this to people in nursing homes, how healthy do you have to be?) I asked how much it would cost, the receptionist looked at my insurance card and said, “Oh, just the copay.” $20. Okay, fine. Weeks later I got the lab bills, which added up to almost $1000. If I had known that, I would have stayed the hell away. I know I’m healthy, and I could make that choice. (I could also afford to pay it, but that was luck.) There are people who aren’t healthy, though, and who can’t make that choice, and they get hit with the lab costs, etc., and end up getting calls from collection agencies. I think the first thing I’d do to fix healthcare would be to get rid of all insurance companies, period. Of course this would throw a lot of people out of work. A hell of a lot of people. There would be opposition, and there would be lobbying. But I think we can’t even see what’s wrong with health care until we cut through some of the weeds, and by weeds, I mean insurance companies. Why do there have to be codes? Why can’t a person be told the cost of an office visit with lab work, up front? Why do insurance companies pay more if it’s one kind of diagnosis and less if it’s another? It’s a total mess. ---
**Author:** ![brazil84](https://avatars.discourse-cdn.com/v4/letter/b/8491ac/32.png) [@brazil84](https://boards.straightdope.com/u/brazil84)\ **Post date:** [January 27, 2009, 8:49am UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/73 "2009-01-27T08:49:21Z")
> [@scifisam2009](#): > > It is all those things in the UK. Do you happen to have a cite for that? Thanks. ---
**Author:** ![Lobohan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lobohan/32/79_2.png) [@Lobohan](https://boards.straightdope.com/u/Lobohan)\ **Post date:** [January 27, 2009, 9:18am UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/74 "2009-01-27T09:18:34Z")
> [@brazil84](#): > > Do you happen to have a cite for that? Thanks. I have no idea the credibility of this site, I just found it with a 30 second google search.: [http://www.uk-insurance-index.co.uk/article-8.html](http://www.uk-insurance-index.co.uk/article-8.html) It says that a discount private insurance would be £15 and a top of the pile single person policy for a 43 year old would be £145 a month. As an aside, I’m a small business owner and my group policy is around $125 a person a month for bottom of the barrel, high deductible/copay coverage. Before I started my business I looked at single person insurance and it was three or four times what I’m paying at the group rate. [/Anecdote] ---
**Author:** ![foolsguinea](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foolsguinea/32/14751_2.png) [@foolsguinea](https://boards.straightdope.com/u/foolsguinea)\ **Post date:** [January 27, 2009, 9:27am UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/75 "2009-01-27T09:27:21Z")
Takes a bit of looking, but through previously given links: [An anecdote that demonstrates the difference in private care between the UK & USA:](http://boards.straightdope.com/sdmb/showpost.php?p=10339815&postcount=20) > [@Bam Boo Gut](#): > > I had some small red dots on my face & body - I went to a dermitologist in the states who said they were precancerous and he would laser them off for USD$100.00 each. Since I was soon going to England I waited and visited a private dermitologist there. > > She told me the name of the condition - spider something or the other and said she’d take them all off for ten quid but they didn’t need to come off. I kept them - they’ve faded. > > From the John Goodman blog: > "In Britain and Canada, it is easier to see a physician and there are more visits than in the United States. > > However, once at the doctor’s office, Americans with real problems get more services and get more attention (almost one in three spend more than 20 minutes with the physician in the United States compared with one in five in Canada and one in 20 in Britain). " > > What kind of Americans does he mean here - Americans with health insurance? As opposed to any Canadian or any Englishperson? Won’t more visits to the doctor make “real problems” less likely? On US inefficiency, from a study. This seems to go to Martin Hyde’s point that we’d screw it up somehow, but I’m not convinced that’s a good reason to do nothing. [http://content.healthaffairs.org/cgi/content/full/23/3/10](http://content.healthaffairs.org/cgi/content/full/23/3/10) : > [@Health Affairs](#): > > By international standards, the U.S. approach to financing health care is extremely complex. Research suggests that a sizable fraction of higher U.S. health spending, not explainable by higher GDP per capita, can be traced to the higher administrative overhead required by such a complex system.[sup][16](http://content.healthaffairs.org/cgi/content/full/23/3/10#R16)[/sup] To quote economist Henry Aaron on this point: “Like many other observers, I look at the U.S. health care system and see an administrative monstrosity, a truly bizarre mélange of thousands of payers with payment systems that differ for no socially beneficial reason, as well as staggeringly complex public system with mind-boggling administered prices and other rules expressing distinctions that can only be regarded as weird.”[sup][17](http://content.healthaffairs.org/cgi/content/full/23/3/10#R17)[/sup] From the other link in my OP (& since you didn’t go to the website with the nice quick abstract, I now send you straight to [the PDF](http://www.pnhp.org/publications/payingnotgetting.pdf)): > [@Steffie Woolhandler and David U. Himmelstein](#): > > ABSTRACT: The threat of steep tax hikes has torpedoed the debate over national health insurance. > Yet according to our calculations, the current tax-financed share of health spending > is far higher than most people think: 59.8 percent. This figure (which is about fifteen > percentage points higher than the official Centers for Medicare and Medicaid Services > [CMS] estimate) includes health care–related tax subsidies and public employees’ health > benefits, neither of which are classified as public expenditures in the CMS accounting > framework. U.S. tax-financed health spending is now the highest in the world. Indeed, our > tax-financed costs exceed total costs in every nation except Switzerland. But the sub rosa > character of much tax-financed health spending in the United States obscures its > regressivity. Public spending for care of the poor, elderly, and disabled is hotly debated and > intensely scrutinized. But tax subsidies that accrue mostly to the affluent and health benefits > for middle-class government workers are mostly below the radar screen. National > health insurance would require smaller tax increases than most people imagine and would > make government’s role in financing care more visible and explicit. ---
**Author:** ![foolsguinea](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foolsguinea/32/14751_2.png) [@foolsguinea](https://boards.straightdope.com/u/foolsguinea)\ **Post date:** [January 27, 2009, 9:31am UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/76 "2009-01-27T09:31:10Z")
Here, this is worth quoting: > [@Steffie Woolhandler and David U. Himmelstein](#): > > Most Americans have private health insurance. Citizens of most other wealthy > nations have national health insurance. Hence the perception that those nations’ > health care systems are public while ours is private. But these labels obscure the > predominance of private medical practice and hospitals in Canada and most European > countries and the dominance of tax-financed health care in the United > States. As shown in Exhibit 5, Americans now pay higher taxes per capita for financing > health care than do any other nation’s citizens. > The huge role of the government in financing American health care is obscured > by the fact that nearly one-third of these tax dollars meander through private insurers > on their way to the patient’s bedside. What originates as taxes paid by private > households ends up as recycled “private” spending in the CMS accounts. Insurance > firms not only siphon off overhead and profits in the process, they also > inflict huge paperwork burdens and costs on providers. We have detailed these > costs in the past. For 1999 we estimate that health administration spending was > more than $309 billion. At least half of this could have been saved through a shift > to national health insurance. Disinterested civil servants, and even skeptics, > agree that U.S. health care costs need not rise under national health insurance because > administrative savings would roughly offset the increased costs of care for > today’s uninsured and underinsured persons. > While national health insurance wouldn’t cost Americans more, it would mean > that taxes would pay a bigger share of health care costs and that private insurance > and patients would pay a smaller share. Yet government now spends far more on > health care—and national health insurance would require a smaller tax increase— > than most Americans believe. The step from our current level of tax financing— > 59.8 percent—to Canada or Australia’s 70 percent is less steep than the > CMS figures on public spending imply. About $130 billion per year—the amount > of the recent tax cuts—would get us from here to there. > > \*\* Regressivity of tax subsidies. \*\*The sub rosa character of much tax-financed > health spending in the United States veils the regressive pattern of government > funding. Highly visibleMedicaid spending benefits the poor; obscure but burgeoning > tax subsidies benefit the affluentwho are most likely to have employer-paid coverage > and whose higher marginal tax rates translate into greater tax savings. For > instance, in 1998 federal tax subsidies alone averaged $2,357 for families with incomes > above $100,000 but only $71 for families with incomes below $15,000.20 ---
**Author:** ![Ocean\_Annie](https://avatars.discourse-cdn.com/v4/letter/o/8797f3/32.png) [@Ocean\_Annie](https://boards.straightdope.com/u/Ocean_Annie)\ **Post date:** [January 27, 2009, 10:18am UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/77 "2009-01-27T10:18:06Z")
> [@curlcoat](#): > > So the only difference from what we have now is the government would be running another insurance plan? No thanks! The only people benefiting from the system we have now are lobbyists, corporate insurance, executives, drug companies, and bribed lawmakers. Patients and health care providers are the losers. It doesn’t seem rational to fund a health care system that profits people who undermine its viability. If the government nationalizes health care, it will remove profit. This will eliminate the administrative costs for screening, challenging claims and harassing providers. It also eliminates highly paid lobbyists and astronomical executive compensation. The government can negotiate drug prices –unlike Bush –and eliminate pharmaceutical advertising. It will be a much more cost effective, efficient, and moral health care system that functions as a public service. ---
**Author:** ![Martin\_Hyde](https://avatars.discourse-cdn.com/v4/letter/m/47e85d/32.png) [@Martin\_Hyde](https://boards.straightdope.com/u/Martin_Hyde)\ **Post date:** [January 27, 2009, 1:18pm UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/78 "2009-01-27T13:18:09Z")
> [@foolsguinea](#): > > Is this where it’s going to land? Opposition to socialized medicine is driven by contempt for the underclass? > > I mean, I sort of thought that it was going somewhere like that, & I think my OP reflects that. But is this really going to be our justification? Can we honestly say that it’s a basis for policy? The “underclass” is a sweeping term that holds little meaning. Generally speaking the types of people who would be prone to abusing a single payer system are the chronically homeless (who already cost us from anywhere to $20,000-$150,000 a year per transient) and the urban poor who have a high incidence of drug addiction and a general feeling of entitlement. Generally my personal opposition to socialized medicine is based on a few different concepts: 1. As I said, single payer won’t create equality of result. Some hospitals will still be better than others. Generally these hospitals will give better treatment to wealthy benefactors than they will to street people. If you try to regulate this away then private hospitals will quickly eclipse public ones in quality of care. If you try to regulate it even further then quality of care in general goes down and the wealthy will start taking “health care vacations” to other countries. Right now it isn’t unheard of for the middle class to do this to save money–the wealthy on the other hand can get the best care in the world here in the United States (although I’m sure some scattered specialist programs around the world may be best in their field.) 2. I’m not convinced that it will be cheaper. I agree we can certainly eliminate the profit margin of the insurance companies, but is that going to offset the massive increase in doctor’s visits? There are a lot of people now who don’t regularly go to a doctor for every little thing because they don’t feel like paying for it. I actually think this is a good thing, people shouldn’t go to a doctor over every little thing as a matter of national policy. Our current system gives us a pretty high life expectancy, quite high if you factor out the large numbers of urban poor who drag down the average (and who most likely will receive the _least_ benefit from single payer health care.) ---
**Author:** ![Martin\_Hyde](https://avatars.discourse-cdn.com/v4/letter/m/47e85d/32.png) [@Martin\_Hyde](https://boards.straightdope.com/u/Martin_Hyde)\ **Post date:** [January 27, 2009, 1:30pm UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/79 "2009-01-27T13:30:59Z")
> [@RickJay](#): > > It’s certainly true that the Canadian system delivers far more cost efficient care. Always has, ever since it was created. Of course, every national system is different so who knows what might get set up, but it can be done. Generally speaking, as an American, I think there are few first world governments that are less efficient than that of the United States. I honestly guess we could speculate as to why that is (maybe it’s because of our strong Federal system, maybe it’s because of our large population of extremely mixed social and cultural backgrounds, maybe it’s something to do with how the Federal government itself works–we could talk about this in a thread of its own). But given those truths someone pointing out that “ooh, ooh, look how efficient Canada’s system is compared to ours!” doesn’t really inspire much confidence. Most educated people understand a free market system will be more efficient than a socialized system. Usually the arguments for socialization ignore the matter of economic efficiency, for example if you feel that health care should be a public service and not a standard service that should be subject to the whims of a free market then you aren’t really too interested in economic efficiency in the first place. So the fact that our mixed-free market health care system (I say mixed because many of the best hospitals receive large influxes of funding from the State and Federal government every year as well as receiving hundreds of millions from private donors and such every year–this is why many major public hospitals employ people like Michelle Obama) is actually _less efficient_ than socialized systems suggests to me that a fully socialized system done in the United States would quickly establish itself as the least efficient of any such system in the world. As a conservative, I’m actually somewhat open to the suggestion that maybe health care should be a public service. So lack of efficiency wouldn’t instantly lead me to oppose a single payer health care system. But I’d honestly need more details. I think our health care system is in bad need of overhaul, if we just modify it by getting rid of the insurance companies and having the government pay all the bills I actually think our already ludicrously high national health care costs will skyrocket, because you’d be pumping more government money into a system that is already fairly chaotic. I actually think the problems with our health care system are somewhat analogous to our public educational system. Generally primary and secondary education in this country varies **widely** from school district to school district. Let’s totally discount private schools here, some of the best High Schools in the country are public schools. There is an enormous variation in the quality of education from one public school to another, even within the same school districts. The wealthier families tend to have better neighborhoods, which lead to nicer schools, and attract better teachers. Most teachers do not want to work in an urban ghetto where they have to go through metal detectors on their way to work every day and where stabbings and shootings are par for the course. We ostensibly have “single payer” primary and secondary education (State and Local governments, and to a lesser degree the Federal government) and it’s not created equality of result. ---
**Author:** ![MichaelQReilly](https://avatars.discourse-cdn.com/v4/letter/m/df705f/32.png) [@MichaelQReilly](https://boards.straightdope.com/u/MichaelQReilly)\ **Post date:** [January 27, 2009, 3:14pm UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/80 "2009-01-27T15:14:56Z")
> [@curlcoat](#): > > This isn’t true - none of my doctors have a separate person in their office that just does insurance. This is just wrong. My brother works for a company that makes practice management software for doctors and surgery centers. Its a pretty small practice if an office _only_ has one person that does billing. [Previous page](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032.md?page=3) [Next page](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032.md?page=5)