# 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:** 6
**Author:** ![Maastricht](https://avatars.discourse-cdn.com/v4/letter/m/a88e57/32.png) [@Maastricht](https://boards.straightdope.com/u/Maastricht)\ **Post date:** [January 28, 2009, 6:14am UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/101 "2009-01-28T06:14:44Z")
> [@Martin\_Hyde](#): > > I can’t speak for anyone but in America it isn’t uncommon for the poor to generally take advantage of public services. For example in many cities libraries are almost unusable because they are filled with the homeless. In many hospitals emergency rooms are constantly inundated with people trying to get some sort of drug fix by scamming the staff. It’s also not uncommon to have people use ambulances as a taxi service since they can’t refuse to come pick someone up and the poor regularly will claim they are in need of an ambulance when they actually aren’t. We don’t have that problem in the Netherlands. Mainly because we take care of our sick, homeless and addicted before things get out of hand and they become a burden to libraries and emergency care. For example, using ambulances as taxi’s isn’t done because there is good public transport and there are volunteer-run and subsidized phone-a-taxi service for the elderly who live in rural area’s. We have far fewer homeless people to begin with, and the ones we have can spend their day either in care institutions or in Salvation Army hang-outs. Junkies can get in methadone programs. All of these programs (except the phone-a bus) combine consumptive care (the “bait”) with a lot of soft or harder nudging for the client to get his act together. (the “stick and the sermon”). It works pretty well. ---
**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 28, 2009, 6:50am UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/102 "2009-01-28T06:50:35Z")
> [@Voyager](#): > > While that is true, there is evidence that the cause is not better funding. In my district there are five high schools with highly varying quality. One is one of the best in the state, and is indeed located in an area of high income. However, it gets no more money than the other schools, in fact less than the second best school, the one my kids went to, which has the advantage of being the oldest and the alma mater of the bigwigs in our town. The teachers in the best school are no better than the teachers in ours, and the facilities are actually worse. I was involved in a district wide GATE parents program, so I had a lot of contact with parents in all the schools. You are absolutely right. My response was over simplified. School funding is one of many reasons better public schools have traditionally been associated with higher income and middle class neighborhoods. Specifically, higher income earners tend to have a higher education and specific values --educational expectations, school involvement, home stability, routines, reading, etc. Fiscal policy and economic instability have exacted a social cost. The overall decline in income for most Americans has created a need for two working parents with less time for family and the PTA. If Americans want to prevent this country from looking like Russia or Mexico instead of a highly developed western democracy, it is imperative to reform health care. ---
**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 28, 2009, 7:27am UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/103 "2009-01-28T07:27:54Z")
> [@curlcoat](#): > > Again, Canada is not the US. If nothing else, they have huge areas that are only lightly populated, where a UHC type thing makes much more sense. Even in the populated areas, they don’t have the kind of masses of humanity that the US has. And they have had their UHC for, depending on when you want to count from, at least 40 years up to over 60 years, when they had an even smaller population. And they did it in pieces, not the whole nation all at once. If Massachusets works and continues to work, then maybe it can spread state by state. All at once I think is a bad idea. OK, so you would support California doing it on its own as part of a gradualist approach? Or should we wait 20 years & see if Massachusetts can hack another extra entitlement no other state has in a federation where Mass. can’t control trade between states at all? And if it’s too big a disadvantage compared to low-tax, low-service Alabama, do we say, well, then, let’s all be Alabama? An economic change like this could be done on the state level, but it’d be easier if states could control their own borders. ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [January 28, 2009, 7:35am UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/104 "2009-01-28T07:35:13Z")
> [@foolsguinea](#): > > OK, so you would support California doing it on its own as part of a gradualist approach? No, I’d much rather experiments be run using someone else’s tax money! > [@](#): > > Or should we wait 20 years & see if Massachusetts can hack another extra entitlement no other state has in a federation where Mass. can’t control trade between states at all? And if it’s too big a disadvantage compared to low-tax, low-service Alabama, do we say, well, then, let’s all be Alabama? > > An economic change like this could be done on the state level, but it’d be easier if states could control their own borders. That I don’t know anything about. Canada managed it, but then… ---
**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 28, 2009, 8:06am UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/105 "2009-01-28T08:06:03Z")
In what way is it an experiment? We could pretty much adopt plans proven to work in other countries. Oh, wait, trying to do it in one state of a federation is the risky part. Oh, well, once Mass. gets it running, you could adopt their system. If it doesn’t work in Mass., then perhaps it’s a failed experiment, & we’d just have to build a nationwide system. 😃 ---
**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 28, 2009, 8:44am UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/106 "2009-01-28T08:44:16Z")
> [@curlcoat](#): > > With UHC, the only people that you think are benefitting now that would be dropped, might be dropped, are the insurance CEOs. All the rest would still need to be involved, since the government will need people from the private sector to run the UHC, they will still need the drug companies and the companies that make medical equipment, and we will always have lobbyists and bribed lawmakers. Well, the only way it can work is to make it nonprofit which removes the perverse incentives. The government can also negotiate cost with the drug companies. > [@](#): > > Run by the _government_??? Would you be more comfortable if the insurance companies stayed as restructured nonprofits? I doubt any reform will result in a single payer system. Here are the numbers - The U.S. tax-financed health spending is the highest in the world, at 60 of total health care expenditure and 9% of GDP. This doesn’t include the direct government spending on Medicaid and veterans which hikes it up to roughly 16% of GDP. The employer provided coverage is sustained with 200 billion in tax breaks. One of the lucky beneficiary of health care subsidies --the CEO of United Health Care who earned 124.8 million in 2005. The unlucky payer who received nothing, the uninsured. > **[Are Americans Closer Than we Think to National Health Insurance?](https://www.medscape.com/viewarticle/439801)** > > According to this political scientist, we shouldn't count on a coherent national health insurance plan. [http://content.healthaffairs.org/cgi/reprint/21/4/88.pdf](http://content.healthaffairs.org/cgi/reprint/21/4/88.pdf) [http://taxvox.taxpolicycenter.org/blog/\_archives/2008/2/29/3553045.html](http://taxvox.taxpolicycenter.org/blog/_archives/2008/2/29/3553045.html) [http://healthcare-economist.com/2006/02/14/united-health-ceo-earned-1248-million-in-2005/](http://healthcare-economist.com/2006/02/14/united-health-ceo-earned-1248-million-in-2005/) ---
**Author:** ![jackdavinci](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/jackdavinci/32/3259_2.png) [@jackdavinci](https://boards.straightdope.com/u/jackdavinci)\ **Post date:** [January 28, 2009, 3:42pm UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/107 "2009-01-28T15:42:01Z")
> [@Grumman](#): > > And unlike even compulsary health insurance, a single-payer system makes no attempt to minimise the cost to other customers of providing treatment to an individual. Even if you never smoke, never drink, exercise every day, and never have so much as a cold until you die at the age of 120, you still get charged the same for a service you don’t want and never use. There’s nothing inherent in the single payer system that says that. Most single payer systems don’t account for that, but there’s no reason they couldn’t. Just give a tax break to those willing to make identifiable healthy choices. What I find annoying is that most of the so called problems with national heathcare people gripe about are de facto problems with specific countries implementations. Very few of these problems are inherent, and aren’t really problems - they are a matter of prioritizing. Such as - if we have national healthcare no one will be allowed to get specialized care. Who says? There’s nothing preventing us from allowing people to get supplemental insurance and private doctors from their own pocket. ---
**Author:** ![MichaelQReilly](https://avatars.discourse-cdn.com/v4/letter/m/df705f/32.png) [@MichaelQReilly](https://boards.straightdope.com/u/MichaelQReilly)\ **Post date:** [January 28, 2009, 7:44pm UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/108 "2009-01-28T19:44:03Z")
> [@curlcoat](#): > > Which isn’t what I said. I said that it isn’t true that _all_ doctors have one or more people on staff that only do insurance billing, for example none of my doctors do. This may be because of the four doctors I see regularly, only one is in a big practice. What I’m saying is that unless it’s truly a tiny practice you are probably wrong. If they don’t have somebody in house doing it, they are likely farming it all out to a billing company. ---
**Author:** ![RickJay](https://avatars.discourse-cdn.com/v4/letter/r/bb73d2/32.png) [@RickJay](https://boards.straightdope.com/u/RickJay)\ **Post date:** [January 28, 2009, 7:55pm UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/109 "2009-01-28T19:55:41Z")
> [@curlcoat](#): > > IAgain, Canada is not the US. If nothing else, they have huge areas that are only lightly populated, where a UHC type thing makes much more sense. How does universal health insurance make “more sense” in a lightly populated area? What possible benefit could low population density have to a single payer health insurance system? Logically, it should cost more if people are spread out. ---
**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 28, 2009, 8:08pm UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/110 "2009-01-28T20:08:15Z")
> [@gaffa](#): > > The New Yorker had an excellent article by Malcolm Gladwell in their Feburary 13, 2006 issue called “Million Dollar Murray”. Sadly, it’s not available to non-subscribers, [but here’s the abstract](http://www.newyorker.com/archive/2006/02/13/060213fa_fact). > > The gist of the article is that the homeless alcoholic of the title was capable of being a useful member of society, and was whenever a social worker was able to get him into a program. But that every one of these programs had a time limit, and as soon as he “graduated” from the program, he’d wind up back on the street. It costs _more_ to care for a homeless person on the streets than to get them a studio apartment and a full time assistant. Minor medical problems in an apartment balloon into life-threatening crises out on the streets. I get the New Yorker, and I remember that article. Excellent example of the insanity of our current system. ---
**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 28, 2009, 8:22pm UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/111 "2009-01-28T20:22:45Z")
> [@curlcoat](#): > > Again, Canada is not the US. If nothing else, they have huge areas that are only lightly populated, where a UHC type thing makes much more sense. Even in the populated areas, they don’t have the kind of masses of humanity that the US has. And they have had their UHC for, depending on when you want to count from, at least 40 years up to over 60 years, when they had an even smaller population. And they did it in pieces, not the whole nation all at once. If Massachusets works and continues to work, then maybe it can spread state by state. All at once I think is a bad idea. Try driving East, and you will see large areas in the US that are lightly populated. I don’t know if this is still an issue, but at one point there was a crisis in getting medical care to rural areas of the US. If you consider the presence of large, underpopulated areas a good justification for UHC, welcome to the club. As for bankruptcies, maybe you haven’t gone bankrupt due to medical bills, but in 2001 half the bankruptcies in the US were due to medical costs. [Cite.](http://www.consumeraffairs.com/news04/2005/bankruptcy_study.html) ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [January 28, 2009, 8:56pm UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/112 "2009-01-28T20:56:28Z")
> [@foolsguinea](#): > > In what way is it an experiment? We could pretty much adopt plans proven to work in other countries. A plan that works elsewhere will not necessarily work here, therefore it would be an experiement. > [@](#): > > Oh, wait, trying to do it in one state of a federation is the risky part. Oh, well, once Mass. gets it running, you could adopt their system. Any state interested in giving it a try could do so, yes. > [@](#): > > If it doesn’t work in Mass., then perhaps it’s a failed experiment, & we’d just have to build a nationwide system. 😃 Is it logical to do that if it failed in Mass? ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [January 28, 2009, 9:01pm UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/113 "2009-01-28T21:01:30Z")
> [@Ocean\_Annie](#): > > Well, the only way it can work is to make it nonprofit which removes the perverse incentives. It didn’t work for Kaiser - it may still not be working, I don’t know if they are still a non-profit or not as I haven’t worked for them in many years. > [@](#): > > The government can also negotiate cost with the drug companies. They already do, as do the private insurance companies. > [@](#): > > Would you be more comfortable if the insurance companies stayed as restructured nonprofits? No, I don’t think I would be comfortable with the government being involved, nor with non-profit. > [@](#): > > One of the lucky beneficiary of health care subsidies --the CEO of United Health Care who earned 124.8 million in 2005. Actually, this is one of the things I wish the government would get involved with - the buying up of smaller companies by UHC. I don’t know why this isn’t anti-trust, tho I also don’t know why what the gas companies are doing to us isn’t anti-trust either… ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [January 28, 2009, 9:04pm UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/114 "2009-01-28T21:04:23Z")
> [@jackdavinci](#): > > There’s nothing preventing us from allowing people to get supplemental insurance and private doctors from their own pocket. Oh goody. I get to pay more in taxes to subsidize insurance for the nation and pay premiums to a private company? ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [January 28, 2009, 9:09pm UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/115 "2009-01-28T21:09:24Z")
> [@MichaelQReilly](#): > > What I’m saying is that unless it’s truly a tiny practice you are probably wrong. If they don’t have somebody in house doing it, they are likely farming it all out to a billing company. Why would you be unable to believe that I have actually talked to the doctors offices that I go to about this, and that you are wrong? I worked in insurance for over 25 years, and at one time dabbled with the idea that I would start up a home business handling insurance for small doctors offices. It wasn’t needed. Where do you get the idea that doctors (or their staff) have to spend hours and hours every week on insurance claims anyway? The big companies are mostly electronic these days and the ones that aren’t usually have a PPO or HMO sort of relationship with the doctors, so they bill weekly/monthly/whatever the contract says. I just don’t get this belief that doctors and their staffs have to spend all this time on insurance issues. ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [January 28, 2009, 9:12pm UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/116 "2009-01-28T21:12:33Z")
> [@RickJay](#): > > How does universal health insurance make “more sense” in a lightly populated area? What possible benefit could low population density have to a single payer health insurance system? > > Logically, it should cost more if people are spread out. Logically, a low populated area is not going to be profitable enough to support more than one GP doctor, if that. So the only way the government can assure that people living in the NW Territories or the plains got at least basic health care would be to subsidize it. And, yes, because that would cost a lot, the next logical step is to make it nationwide to spread out the cost. ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [January 28, 2009, 9:24pm UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/117 "2009-01-28T21:24:07Z")
> [@Voyager](#): > > Try driving East, and you will see large areas in the US that are lightly populated. I don’t know if this is still an issue, but at one point there was a crisis in getting medical care to rural areas of the US. If you consider the presence of large, underpopulated areas a good justification for UHC, welcome to the club. I regularly drive all over the US east of the Rockies and have frequently gone further east than that. It is the extremely rare area that is as lightly populated as northern Canada was (and probably still is) 40 years ago. > [@](#): > > As for bankruptcies, maybe you haven’t gone bankrupt due to medical bills, but in 2001 half the bankruptcies in the US were due to medical costs. [Cite.](http://www.consumeraffairs.com/news04/2005/bankruptcy_study.html) What would make that meaningful is you could tell me if those people all went bankrupt despite having been responsible. In other words, did they all go bankrupt despite having had savings, insurance, good health practices? I didn’t click on the link because I am on dial-up and need to leave soon, but I am assuming that it is like all the others I’ve seen - so and so got cancer and the treatment has bankrupt him, but no mention of what led up to it other than “medical bills”. See, my father-in-law and mother-in-law both died of cancer, but left no bills because they were both responsible enough to have insurance and assets that covered their treatments. My grandmother died in a nursing home - again, no bills. If the guy across the street gets cancer he is going to be up shit creek because he bought more house than he can afford and they had three kids, a pool and two mid range SUVs by the time they were in their 30’s. It seems that every time I turn around, someone has some plan to help save irresponsible people from themselves, using my money. I can’t afford to subsidize these people any more! ---
**Author:** ![Strassia](https://avatars.discourse-cdn.com/v4/letter/s/e8c25b/32.png) [@Strassia](https://boards.straightdope.com/u/Strassia)\ **Post date:** [January 28, 2009, 9:52pm UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/118 "2009-01-28T21:52:49Z")
> [@curlcoat](#): > > A plan that works elsewhere will not necessarily work here, therefore it would be an experiement. > > Any state interested in giving it a try could do so, yes. > > Is it logical to do that if it failed in Mass? It depends on why it fails. For example, if it fails because a large number of people from all over the Northeast move to Mass when they lose their insurance, artificially increasing the number of non-tax payers using the system, then yes it would be logical to do it on a national scale. > [@](#): > > It seems that every time I turn around, someone has some plan to help save irresponsible people from themselves, using my money. I can’t afford to subsidize these people any more! You do realize that we are all subsidizing the medical care of CEO’s and other high earners as well as those that have no insurance right now? The only ones not on the grave train are those that make too much for assistance, but don’t get insured through an employer. That means that the current structure, regardless of its efficiency, puts pressure on potential entrepreneurs. Say my wife and I have a great idea for a new business. We have saved enough money to start the business and we ready to go, but if we both quite or jobs, our health insurance costs triple. The current setup basically uses federal money to discourage competition. Jonathan ---
**Author:** ![Foxy40](https://avatars.discourse-cdn.com/v4/letter/f/a9a28c/32.png) [@Foxy40](https://boards.straightdope.com/u/Foxy40)\ **Post date:** [January 28, 2009, 10:28pm UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/119 "2009-01-28T22:28:11Z")
> [@curlcoat](#): > > Why would you be unable to believe that I have actually talked to the doctors offices that I go to about this, and that you are wrong? I worked in insurance for over 25 years, and at one time dabbled with the idea that I would start up a home business handling insurance for small doctors offices. It wasn’t needed. > > Where do you get the idea that doctors (or their staff) have to spend hours and hours every week on insurance claims anyway? The big companies are mostly electronic these days and the ones that aren’t usually have a PPO or HMO sort of relationship with the doctors, so they bill weekly/monthly/whatever the contract says. I just don’t get this belief that doctors and their staffs have to spend all this time on insurance issues. I am sorry but I must pipe in here. As a member of the MGMA, ([http://mgma.com/](http://mgma.com/)) I can tell you that you are very wrong. Outsourced billing isn’t needed because it is less expensive to do in house. Many claims are paid electronically but it takes a staff to enter the charges, codes and follow up when they are often denied for one reason or another. In addition, depending on the state, many liability claims are not accepted electronic and must be send with the office notes. (Workers compensation, auto accidents, slip and fall). It is the very small practice indeed that can have one staff member to do this. An average orthopedic office with three clinicians requires two to three billers to make sure the claims are submitted and paid correctly. Doctors, particularly surgeons spend hours trying to get surgeries precertified. Insurance companies seem to look for any way to get out of approving and once they do, they will reject a claim for every mistakenly dotted i. So staff required is a precertification specialist, a billing code entry staff member and people to submit the claims and make sure they are paid correctly. In essence, offices, particularly specialists, utilitize enormous staff resources on insurance. ---
**Author:** ![Euphonious\_Polemic](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/euphonious_polemic/32/3002_2.png) [@Euphonious\_Polemic](https://boards.straightdope.com/u/Euphonious_Polemic)\ **Post date:** [January 28, 2009, 10:34pm UTC](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032/120 "2009-01-28T22:34:38Z")
> [@curlcoat](#): > > Logically, a low populated area is not going to be profitable enough to support more than one GP doctor, if that. So the only way the government can assure that people living in the NW Territories or the plains got at least basic health care would be to subsidize it. And, yes, because that would cost a lot, the next logical step is to make it nationwide to spread out the cost. And yet the data says that despite the areas of low population density in Canada, we spend less per capita and less per GDP than the United States does. Why is this? [Previous page](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032.md?page=5) [Next page](https://boards.straightdope.com/t/devils-advocate-saving-america-from-socialized-medicine/483032.md?page=7)