For what it may be worth, I am pretty confident that quality of care would decline significantly (for people in the upper tier). I base this on the observation that America’s underclass has a tendency to cause a lot of problems with whatever institutions they come into contact with.
My opinion only.
Heh, that might work!
I think that’s a good question and I will think about it and try to come up with a good answer. I do agree that reasonably prompt service is a factor in assessing quality of care. What is reasonable depends on how serious and urgent the problem is.
Doesn’t seem to happen here.
Canada’s health care system is not fantastic, and to be honest some European countries have a lot to teach us that we seem to refuse to listen to because of a nationwide myth that our health care system is some wonderful thing without equal anywhere. The quality of care varies enormously from place to place (though I guess that’ll always be true.) However, it generally works pretty well.
My best friend lives in California; he makes a LOT of money and has what is supposedly a very good health insurance plan. Frankly, his health care sucks as compared to what I enjoy. The quality of care when he gets it is pretty good, but it’s an administrative nightmare with far, far more out-of-pocket costs. It’s anecdotal, but I’m curious as to how many Americans actually enjoy health care that’s better than the typical middle class joe in any other modern, rich nation.
He pays more tax than I do, too, Canada’s reputation to the contrary.
I suspect a lot of the difference has nothing to do with being “socialized” or not - millions and millions of Americans are on some form of government health insurance, more than Canada’s entire population - but just that there’s waste in having so many government-run systems that do the same thing.
I don’t agree with your conclusion in point 12. I also didn’t understand Yoyager’s
post - “That’s fine - but you prevent those not getting insurance at 25 from getting it at 50? If not, you are clearly allowing them to game the system.” I don’t understand how having folks at 25 not getting socialized medicine but allowing them in at 50 is gaming the system, nor how it is all that different than what we have now with Medicare. Or Medicaid for that matter.
Things suck for the poor already, but they don’t for the middle class or the rich. Why should the middle class continue to pay for their own coverage and the rich pay for theirs and the poor? It’s close to what we are doing now anyway, it just lets the middle class off the hook.
UHC?
Reading this post, it appears that the only ones that would benefit significantly from socialized medicine are the ones that are already using Medicaid or who are in the grey area between making too much for that and not making enough to afford private insurance. Everyone else will pay more for less care. How is this a good risk for everyone?
I’ll be clearer. I thought this issue was well understood, since it was one of the few real differences between Obama and Clinton during the primaries.
Young people have fewer healthcare costs than old people. If you have a risk pool including all ages, they tend to subsidize the elderly, which is fair since they will eventually get old themselves and be subsidized. Since they are doing this, it is to their advantage to remove themselves from the system, and go back in when their expected costs are greater than their payments. Obviously this will raise premiums for the elderly, especially those past their earning years and who can’t afford it. But if we are going to have affordable healthcare, then the government (you and me) winds up subsidizing it, so those who opt out when they are young get too cheap care at the taxpayer’s expense.
As for Medicare, I am paying now for that even though I am too young to get any benefits, so there is no issue. I have to pay unless I am in a non-Medicare plan. (I think forcing the Feds into Medicare is a fine idea.) Medicaid is the taxpayers as a whole subsidizing the poor, and so that isn’t really relevant.
In the New Yorker this week, their medical writer, a cardiologist in Massachusetts, said that before UHC 10% of his clients couldn’t afford care. He waived fees for them, but many could not afford tests or therapy. After UHC, no one had this problem. I’ve read that a big problem with it is that since the economy went into the dumper the money coming into the system from the employed is less than forecast, so the government has to make up more. Still, I think over 60% are happy with the program.
As for the US in general, we have a very inefficient system, with each doctor having at least one insurance person to handle billing, and a large and expensive insurance infrastructure to check billing and minimize costs to increase profit. Without this, costs should go down. Preventative care for those who don’t feel they can afford a doctor unless they absolutely need one should bring down costs also.
Hell, when I found my pulse was fluttery I felt able to go to the doctor because of my good coverage, and probably avoided an expensive heart attack with expensive hospital care at best, and an expensive funeral at worst. Not to mention the benefit to society of my illuminating posts here. 
Not debating or referencing anyone here, having only read a few posts, but just offering my perspective.
I personally have a few concerns with the models of “socialized” health care I’ve seen, including the issue of opting out (making it mandatory, both in terms of having insurance and of certain “preventative” procedures). I do not look forward to a mandatory version of the cradle to grave medical model of “health care” currently in vougue. And I want to see people able to seek “alternative” care like midwifery or naturopathic.
On the other hand, I feel strongly that health care is a basic human right. Ability to pay should never be an issue when there is a serious concern about health or an immediate need for care. Basic medical, absolutely. A need for surgery or infection meds or ER care, yes. Free to all. No question.
For the most part, my family has been healthy and taken responsibility for our health and paid out of pocket. At most, we did annual medical, dental, vision visits. We used “alternative” providers for most of our needs, including the births of our 2 children.
We never ran to the Dr for minor issues or ones we knew to be self-resolving. We ate well, exercised, did everything possible to be healthy. (good thing, given no insurance) I reckon we saved the state many thousands in unneeded care during our time as eligible for state funding. The home births, paid out of pocket, cost roughly 10 grand less than the typical hospital births the state would have gladly paid for (but hesitated to for a home birth)
But my husband had this genetic condition, with which he wasn’t diagnosed until age 30, and which didn’t leave him disabled until age 42 or so, and which didn’t kill him until 45, and which we had no health coverage to deal with regardless.
The fact that we lacked any medical coverage played a huge role in his death. He could likely have lived many years longer if he’d had insurance/coverage and been able to seek regular monitoring and treatment.
As it was, he only sought care at the end, when it was too late. (yes, I argued with him, but he was so concerned about the costs, he refused)
I feel the biggest issue wrt health care costs in this nation are 1. the unhealthy practices of our people (poor diet, lack of exercise, other lifestyle traits) and 2. the
over-reliance of the medical feild on technology and intervention and DRUGS at the expense of prevention and low-tech approaches.
And of course, the profit motive of having private insurance cover it all. DUH!
This is the real conservative opposition to universal health care, a social value system at the core of free market ideology: freedom depends on the ability to pay. However, in the halls of Congress, the real health care debate isn’t about limiting government spending. It is about who will profit from government spending.
The U.S. government already heavily subsidizes health care with tax advantages for private insurance and direct funding to care for the elderly, veterans, disabled, and destitute. Instead of using public funds to make health care an efficient public service, tax payers subsidize the profits of pharmaceutical and insurance industries.
UHC stands for Universal Health Care.
Fair enough.
It’s very different. Right now, Medicare & Medicaid are tax-funded. So a portion of income for everyone who pays taxes is allocated for those programs. But in an opt-in system with premiums, those with fewer needs (statistically a younger bunch) or with greater private wealth (to buy health care outside the insurance program) could decline to pay in until they find themselves with greater need or less wealth. From a certain individualist or Malthusian aspect, this is appealing. If you never paid, you suffer alone. But I don’t see how to stop hospitals from treating those in need anyway, for reasons of medical ethics.
Um, thanks for making this point; I explained it wrong earlier. You’re right, under the present system, everyone pays for their own care, except for wards & employees of the state (the indigent, the disabled, military personnel, civil servants), who are covered by tax dollars. (And if you’re disabled, it’s very hard to get this officially recognized & get on the rolls.)
But under a single-payer system, nobody’s paying for their own coverage, unless they want to. Everyone pays taxes, operating costs of hospitals are covered as part of the commons (much as roads are paved), & everyone gets something out. (And if you become disabled, you are already on the rolls.)
Would you say that the rich subsidize highway access for the poor? Arguably, the rich subsidize everyone, but given that the government can create money (& chooses not to), it’s truer to say that the government does it & then taxes money out of the system to keep the money supply in balance.
Because it exchanges a risky reliance on private companies for a reliance on a commons that everyone uses. This in fact goes against brazil84’s point. A program for the poor—say, Medicaid—is a poor program. But a program for everyone—such as the highway system, or the Post Office before UPS & FedEx became big—has the entire country counting on it. The sacred trust of the whole country is placed in that institution; good care is not a matter of commercial interest, but of duty.
The UAW had the best pensions & best health insurance in the country, except for that of the quite rich. Now their source is drying up, because they relied on private corporations in competition with other corporations (as well as with their own after-market) to fund their benefits. Now that well is drying up. GM will go under & fob its pensions off on the federal government, & the guaranteed auto worker health benefits are being cut to forestall that. Such security available to workers above the median income that the private sector provided is gone. Is gone already.
As for the rich, they are paying more for Medicaid, Medicare, & military/veterans care than their counterparts in Europe are for UHC, & share in none of it; they buy health insurance as well, or pay full price for services. Some of this may be due to Americans getting injured more than Europeans, since we’re the world’s policeman and all. But some is due to the inefficiency of having many private insurers with different standards & forms, & those companies trying to make a profit as well.
There are other things which happen in the United States but not in Canada. For example, our murder rate is roughly triple yours, mainly because we have a big underclass which is pretty good at causing social problems.
InterestedObserver, you would love health care in Britain. There’s a strong advocacy for alternative medicine there, as well as a total lack of charge to those who suddenly have to go to hospitals (for anything).
Which is why comparisons to the UK are perhaps more apt than comparisons to Canada. And socialized medicine does work in the UK, with* its* massive underclass of pikeys, chavs, thugs, taffies, Jordan, & other hateful leeches on the body politic. 
Not perfectly, but more efficiently than what we do here. (And the UK’s economy is if possible an even more insanely over-leveraged mess than ours.)
One of my good friends in Canada was seriously injured at work about two years ago. This injury left him with amputated fingers among other medical problems. He’s had serious chronic pain for most of his waking moments since that time. At present he needs to have a surgery to correct some nerve issues he’s having in his injured hand which his doctors believe are the reason he is suffering debilitating pain. He’s been waiting for this surgery for about four months now.
I’ve never had to have surgery of any kind, but people in my family have and of the one person whose medical details I know intimately she has never had to wait more than a week or two between the time her doctor decided she needed x procedure and the procedure being performed.
This anecdote isn’t to say your example involving your Californian friend is invalid, or that my example involving my Canadian friend is representative of medical care in Canada. It is only to say that in every system there are examples of extremely fucked up situations and simply by regurgitating anecdotes we aren’t actually exploring the real facts of the matter.
This sounds extraordinarily haughty. It conjures the image of a nobleman of old refusing to stay under the same roof as peasants.
Care to elaborate?
Generally while the concept of single-payer seems fine on paper my biggest concern would be that medical care is not standardized in the U.S. Just because the taxpayers are footing all the bills won’t magically make medical care better.
Won’t there still be hospitals that receive major donations from wealthy patrons? Won’t these hospitals be able to attract the best doctors and install the best equipment? The government footing the bill of individual patients isn’t going to create equality across the board in medical care.
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.
Or the image of a President who sends his children to a school like Sidwell Friends. Actually, the image of any educated parent who shells out the extra money so that his or her family can live in a “nice neighborhood” and his or her children can go to “good schools.”
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?
Perhaps you’d like a “separate but equal” health care system, so you would not have to catch cooties from the nasty “underclass”