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.
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.
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.
No, I’d much rather experiments be run using someone else’s tax money!
That I don’t know anything about. Canada managed it, but then…
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. 
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.
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.
http://content.healthaffairs.org/cgi/reprint/21/4/88.pdf
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/
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.
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.
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.
I get the New Yorker, and I remember that article. Excellent example of the insanity of our current system.
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.
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 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.
They already do, as do the private insurance companies.
No, I don’t think I would be comfortable with the government being involved, nor with non-profit.
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…
Oh goody. I get to pay more in taxes to subsidize insurance for the nation and pay premiums to a private 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.
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.
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.
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!
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.
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
I am sorry but I must pipe in here. As a member of the MGMA, (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.
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?