Martin Hyde, do you dispute that monopolies have efficiencies of distribution?
Do you dispute that we have legal restrictions on the supply side of medicine that prevent truly open free market competition?
We restrict the supply of doctors with burdensome prerequisites for licensing & an effective cap on new med students, then leave most of the demand side unregulated. In such an environment, supply cannot catch demand unless prices rise to dampen demand. So prices naturally go up. And yet medical care is not always taken freely & willingly. Persons find themselves having to purchase care in a price-inflated environment.
We have heavy legal restrictions on supply, which is state interference.
We can make health care more affordable mainly by increasing supply.
The free market, bizarrely, has instead created a whole extra layer (& profit center) of health insurance companies, which actually make health care more expensive–& are thus counter-productive.
In past generations, non-socialized medicine worked well in this country, If we eased medical doctor licensing, the free market might work again.
Short of national insurance, simply spending government funds to build a dozen new medical schools could help. Even with national insurance, we will still need more doctors. This is the necessary thing either way, & perhaps arguing for national insurance is a distraction from it.
But beyond increasing supply, using the state to manage price & distribution might at least give some relief in what is otherwise a medical care seller’s market.
I do know what it means, I just lack discipline. And I really wanted someone to point out any straw men in my argument & give a stronger argument against UHC. I kept the “Devil’s Advocate” name even though I knew I was going to do it wrong, to give the thread a distinctive name.
I thought I’d figured out how to switch, from a devil’s advocate stance to statement of the problems I have with it, throughout the thread–with the two colors–but then I just gave up. It’s easier to argue for what I really think than to argue for a system that seems deeply broken. I could argue for a free market system with an open supply side, but the present situation is disgusting to me.
Anyway, this thread has so far covered arguments *for *the present system. I think I’m going to start new threads advocating for particular possible innovations, unless someone else wants to do it:
A national health service on the UK model.
Opening more medical & nursing schools.
“Medicare for All.”
Abolition of medical licensing. (the libertarian approach)
I don’t think we need to, fiscally; I think it’s considered socially desirable to make all workers pay at least some tax.
I agree. This issue kept me out of the Democratic Party & on the GOP/libertarian side for a long time. I have come to think Social Security should be funded by income taxes corporate & private, not by wage taxes.
I think the present FICA structure allows Congress to keep taxes low on those who can afford to pay more by increasing taxes on wages. Once FICA - Social Security becomes a net loss to the federal government, I fear Social Security will be abolished & Congress will renege on the money owed the fund.
It’s an interesting argument, & needs its own thread.
We social democrats & industrial unionists have an interesting interpretation of implementation of this concept. It involves a massive overhaul of the wage system, & a great contraction the amount of bond & stock speculation legally allowed.
Paying more is not “taking care of the rest of the world”
They are only able to get rich because of everyone else and the government supporting a specific system that allows it
They are only able to keep their money because everyone else and the government protects it for them
A good portion of the ridiculously wealthy have not earned it by making positive contributions to our society, they have either inherited it, or taken advantage of barely legal or legal but hardly moral loopholes in the law or parasitic tactics or nebulous financial juggling
That’s what you find scary? That sounds normal to me.
Have you been watching the news? Anytime in the last two years?
Fwiw, I agree, there have been some enormously ill-advised home purchases in the middle class over the last ten years. I consider it a two-way swindle on the part of banks who didn’t hold the mortgage thy sold.
At inflated prices. This is why on the right some want to tax employer-provided health benefits to level the playing field (which I think is the least we should do) & on the left we have calls for a national insurance monopoly that can cut costs through public policy.
I’m actually worried about adults who get stuck with inflated prices in a half-regulated system. Medicaid & S-CHIP already cover children.
On reflection, I do believe there is a more free-market solution that is more relevant to the real problem of low supply; all those people who use chiropractors as primary care physicians are trying to find one. Increasing the number of medical schools would help more. But I still think employer-provided private health insurance is hard to hold to account, & ends up more expensive socially than either a system with no insurance or a public insurance system.
No, wait, this is the most wallbanging:
Your lack of awareness of progressivity in the tax code is flabbergasting.
:rolleyes: Being rich means you can pay the rest of the world, “the little people,” to take care of you. Owning stock or bonds means you have already cut a deal wherein other people’s work takes care of you. Being rich means more opportunity to buy stocks & bonds. Where do you get the idea that the rich are taking care of anyone?
The point is, the government has the responsibility to take care of its country.
That can mean keeping the business playing field more even, whether by taxing the the wealthiest & highest earning, or by reducing entry costs for entrepeneurs. A UHC plan might accomplish both of those aspects; it might not. Depends on how it’s written.
The government’s responsibility to protect the commons can also spur it to engage in protection of the poor to reduce the temptation to destructive behavior. Living wage laws are one attempt; socialized medicine another.
Perhaps not unless we try. Next time you want a tax cut, remember it can’t be proven you’ll have more purchasing power after.
Not unless forced to or in response to economic forces.
As for people who have too many kids, I hope for socialized medicine too include family planning funds. As a native of the Bible Belt, I’m not confident it will, but I will advocate for that.
Labor - Physicians make more in the United States than they do in Canada. In 1996 (more than 12 years ago, unfortunately) the OECD reported the average annual compensation of a physician in the United States was $199,000, in Canada it was $100,000 (USD.) So American physicians are paid almost 2x as much as their Canadian counterparts–that money has to come from somewhere.
Administrative Costs - Also according to the OECD, the United States has higher administrative costs (hospital administrators make more in the United States than in Canada.)
Malpractice Insurance - Again, this is more expensive in the United States than it is in Canada.
Unfortunately the most recent comparative data I’ve found is y. 2000 data from the OECD, which is using 1996 numbers. I’ll browse the web later for more updated figures but I would be surprised if the average compensation of doctors in Canada has doubled in relation to the compensation in America in twelve years.
Furthermore, the structure of Canadian health care is not dissimilar from our Medicare system. The government foots the bill for a lot of stuff, with some things requiring private payment.
Looking at Medicare and Medicaid, the U.S. government spends about $2,724 per individual covered (in 2004.) In the same year the Canadian government spent around $2,120 per person covered (in Canada that’s essentially the entire population, in the United States the government covers around 40% of the population.)
This is not “total amount spent per person per country” this is just a comparison of how much the U.S. government spends on people who are eligible for its health care coverage versus Canada’s. The total cost per person is much higher in the United States because the above numbers do not factor in non-government spending (which is a substantial portion in the United States and a much smaller portion in Canada.)
In 2006 Canada’s government covered about 70% of the country’s health care expenditures versus 46% here in the United States. But looking at the actual public programs in each country, our government ran program spends more per person than your government ran program. This suggests to me if we simply extended the single payer system of Medicare across the entire population that disparity would still be there. Why does our government’s single payer system pay more per person than your government’s system? I imagine it’s related to the three things I mentioned above (higher labor, administrative, and malpractice insurance costs.)
Some of it is also equipment costs. In the United States we have 33.9 CT scanners per 1,000,000 people, versus 12.0 in Canada. We have 26.5 MRI machines per 1,000,000 people versus 6.2 in Canada. MRI and CT machines regularly cost more than $1m a pop for the machines and scans on these are generally billed out at several thousand dollars. If the U.S. is buying more of these machines per capita then it suggests we’re going to have to be spending more per capita on health care.
If we went to a comprehensive single payer system I could see some administrative costs going down (these are about $1,059/capita in the U.S. and $304/capita in Canada) somewhat. Right now I’m sure some portion of the administrative costs are because every patient who comes in can have a different insurance provider, administrative staff have to get approval from these insurance providers to perform various procedures. Different providers cover different procedures in varying amounts. Ostensibly with a single payer (the government) there would be a standardized system in place as to what is covered and what isn’t covered, what co-pays if any and et cetera.
I guess we will have to disagree with this. I do wonder “how far” our responsibility to treat someone goes. If the doctor’s say someone has less than a 5% chance of surviving a cancer and it’ll cost $200,000 or more in treatment that most likely will fail; I have a hard time as seeing that a justified expense.
No. I will say that the United States government already has a monopoly in several areas and generally speaking if a private entity operated in a similar manner it would quickly go bankrupt and collapse. (Look at the enormous amount of waste the Department of Defense has; it’s nothing for the DoD to spend $12bn on development of a weapon system that never gets rolled out or put into use.) Obviously a single payer health care system is fundamentally different from the DoD, but I think it’s worth noticing how inefficient government monopolies often are in practice–yes a monopoly will theoretically operate more efficiently.
I’ve never referred to our current system of health care as a true “free market” system. It’s a mixed approach. It’s worth noting Canada’s is also a mixed approach as well, they just extend coverage to the whole population but don’t cover everything.
There’s also an excellent chance that there is a hard cap on the number of persons suitable for medical training per capita.
Short term capital gains are taxed as ordinary income. Long term capital gains are taxed less for a good reason - not all the gain is real due to inflation. I agree that the system in place is clumsy.
The problem with this is what it does to small and medium size businesses. With many of these businesses it’s critical to fold all income back into the business for growth, or even just maintenance. A wealth tax would too often require selling the business or a significant reduction in capital available to run or grow it. This is extremely inefficient and reduces economic activity and employment for the nation.
Just because you feel that additional tax money wouldn’t be levied to pay for a UHC doesn’t mean it is a fact. Especially since it’s not like suddenly, overnight, all of the people working for private insurance companies and all of their software, paperwork, contracts, etc would now be working for the federal government. That money would have to come from somewhere.
That people are being forced to participate in group insurance at work?
OK, so on one hand you disagree with me that people were stupid to buy house they couldn’t afford, and then you do?
So to make it all better for poor people you want me to either pay more for my employer provided plan, or pay to watch the government mismanage yet another health plan?
OK, then, you explain to me the tax code and how someone like Bill Gates, or heck even a regular millionaire, pays the same percentage of tax that I do. Explain it to the others in this thread that are also aware that the rich don’t pay as much as the middle class does in terms of percentage of their incomes and what write offs they have. Go ahead and tell me that the rich are paying out 30% of their monthly income and the only thing they can write off is the interest on their mortgage. Shoot, it says right there in the book from the IRS to do our taxes out of that the percentage only goes up the 35%, and we are already at almost 30% and faaaarrrrrr from rich.
What I asked is why is it that the rich folks are expected to work to get rich and then turn around and give that money to poor people. And just because those people are poor, not because they have done anything to deserve it or fallen on hard times thru no fault of their own. There is this growing belief that anyone with any money must give it to “the poor”, and if they won’t do it willingly, then we’ll just create new programs to tax it out of them.
Based on what the people of that country want.
Well, gee, that makes me want to support the idea… :rolleyes:
Oh, yeah, that’s worked really well in the past. Those folks that get free or cut rate housing take such good care of their homes. And the ones that get free food thru the food stamp program, and more money/food for each kid they have - heck, they never riot, loot or do drugs do they?
I doubt there will ever be an economic forces that would result in significant drop in prices at hospitals, so that leaves forced. You are comfortable with the idea of the federal government telling your hospital how much they are allowed to spend for your care?
The availability of “family planning” does not in any way stop people who want kids from having more than they can afford. We already have free or really cheap birth control available thru Planned Parenthood, yet 14 year olds still pop out babies.
It is if you think with your brain and not your emotions. Essentially everything you do is by choice, and if your choice is to spend your money on three kids, a car and a McMansion and not decent health insurance simply because your employer doesn’t provide it, tough noogies. If you are dirt poor and still decide to have kids, do drugs, drop out of school so that you cannot get a decent job and/or afford insurance, tough noogies. Too many people expect somebody else to take care of them as it is (see the thread on the guy trying to get more money out of US Air). Where is the incentive to make anything of yourself if the government is just going to come in and hand what you have made to someone who has done essentially nothing? When did this country turn into one big commune where we are all supposed to share everything with everyone?
Since I got behind, I’ll respond here. Yes, society should keep people from starving. It shouldn’t, and doesn’t, give middle class lives to the poor. As for UHC, that Obama and the Dems won so handily implies to me that the country does want it. I believe I’ve seen polls showing very great dissatisfaction with the current system, and for good reason.
Riots, while unfortunate, get set off by specific events. The crime rate fell with the prosperity of the '90s and the higher employment rates, It is rising as everyone but the rich got screwed in the last 8 years. It seems that a lot of these horrid poor people would much rather work than collect welfare if jobs are available to them.
Hospitals are trying to cut expenses as much as possible. Even between our first and second child there was a push to get my wife home earlier. More and more stuff is done out-patient. Better technology helps. Almost 50 years ago, when my father was in his mid-40s, he had a blood clot and was in the hospital for 6 weeks. 3 years ago, when he was almost 90, he had a heart attack, had two stents put in, and was out of there in two days.
You realize that down there the schools aren’t allowed to teach about birth control, only abstinence? The kids may not know what is available from those anti-God pro-abortion Planned Parenthood people. In any case, do you want to handle this problem like the Chinese? Certain religious groups are all for big families. Some even support them, but some don’t. I’m all for small families myself, but how do you propose to limit them constitutionally? Maybe you’d let the babies starve or something, but the babies aren’t responsible for being born.
So, a poor and uneducated person gets called by a mortgage broker and told that he can afford a house, because housing prices are always going to rise and its the only way to own something of his own. He goes to a fancy office, gets a nice sales talk,. and gets handed a complex document to sign. Maybe our friend is a legal immigrant who doesn’t read English very well, but is given an English, not Spanish document, in violation of California law. And you’re blaming him?
Whenever you do anything, you are taking a risk - buying a home, having a kid, even getting married. Some people are stupid (you know the percent of the country who are creationists) and regulations are to protect them from predatory sellers. But even smart people can get into trouble. That you (and I) have enough saved for a disaster doesn’t mean that this is a feasible avenue for everyone. In any case, it is a perfectly reasonable strategy to buy a house that stretches your budget, since people make more, if only through inflation, and a fixed rate mortgage does not go up.
You appear to be against anyone taking risks. With that attitude we’d have no explorers, not startups, and no immigrants - even 120 years ago when my ancestors came. A safety net makes it easier for people to take risks, and that is good for our economy.
Yet, according to other posters, the middle class’s income has flattened out, and I know that our taxes keep going up. Where is the middle class going then if not into taxes?
Huh, and here I thought Obama won because noone liked the idea of “President Palin”…
Eh, yes and no. Riots may get set off by specific events, but they tend to get fueled by those that see this as an opportunity to loot and just generally create mayhem.
That would depend on whether or not it is actually true that people quit committing crimes just because they got themselves a job. Also “the crime rate” encompasses a lot - do the poor tend to commit all crimes?
Expenses and prices are two completely separate things.
I don’t have any idea if any schools teach about birth control - when I went to school in the Pacific NW they didn’t teach it and I managed to find Planned Parenthood all by myself. Now, it may be that the deep south doesn’t have PP either?
Yup. I don’t see any reason why anyone has the right to continue to overpopulate the place and have more than one kid (or any kids for that matter) just because they want them. Particularly when they can’t afford said kids. There are all sorts of things in this world that I want and can’t have because I can’t afford them.
Oh piffle - don’t have them in the first place!
There is a difference between blaming him and being expected to bail him out. Some guy goes down and blows his life savings on Lotto tickets at a time when the pot is really high, and of course he doesn’t win. Do we bail him out too?
But, if I understand it correctly the mortgages that all these people got into trouble with were not fixed rate. They put down nothing or very little and gambled that the value would go up and they would be able to refinance. In California you generally can make the assumption that your house will appreciate fairly quickly, but it seems these folks added mortgage payments they could barely afford and not having a whole lot of savings into the gamble. There are risks and then there are stupidities.
Why isn’t saving feasible for everyone? I don’t mean why doesn’t everyone have enough to live on for several months, I mean why is it that having a savings account no longer seems common any more?
It isn’t good for the economy if the safety net allows a lot of people to take a lot of stupid risks. Like buying a house you can’t really afford…
You do understand that babies don’t have themselves right? You may want to punish the parents for being irresponsible, but making the baby suffer is not any kind of justice.
