This may be true, but since the US Federal Government taxes income rather than wealth, I’m not sure how it is relevant.
No, I never said that. I conceded that most countries have more efficient health care systems. I conceded that most countries have more socialized health care systems than the United States. I then argued that it’s generally understood that a free market is more efficient than a completely socialized system.
The next step of my argument is this: If our relatively free system is less efficient than your relatively socialized system (obviously there’s a sliding scale between completely government ran and financed health care covering all aspects of medical practice and a more or less purely capitalist and privately ran system, the U.S. is farther towards the capitalist model than Canada but still has many socialist aspects even today) then I can only imagine moving to a more socialist system would increase the inefficiency.
Basically I simply don’t believe the differences in efficiency between the Canadian and the Americans systems is explained because of the socialist aspects of the Canadian system lacking in the American system. I think it is because of systemic differences in both countries health care systems.
I agree we pay more than you do, I disagree as to the reasons.
With all due respect Canada is about equivalent in size and GDP to California, the U.S. has fifty different sovereign governments, most of which divide up health care responsibilities to counties and municipalities.
Australia barely has more people in it that Michigan. It’s worth noting that the United States does have single-payer health care–Medicare, and there are more Americans covered by Medicare at present than there are people in Canada.
Generally speaking most Americans don’t rate Medicare too highly and essentially expanding the program to cover everyone below age 65 doesn’t resonate too well.
Well, my understanding was that a big thrust of support for “universal health care” is so that everyone can get all the medical care you need. If that isn’t the case then it is a bit of a different animal.
I probably wouldn’t have a problem with some sort of publicly funded program that subsidized regular doctor’s visits (within reason.)
Well, I think we do give people a pretty good base line. Our life expectancy is pretty good; where I think most people have trouble is when we start talking about chronic and extremely expensive-to-treat conditions like cancer and various other ailments that people ostensibly are going bankrupt in droves over. Giving people treatment for cancer isn’t what I would qualify as “basic medical care.” It also isn’t preventive or emergency medicine. It’s highly involved stuff that involves lots of expensive medications, treatments, and the time of expensive specialists.
Health care is a service, not a commodity, prescription medications are more akin to a commodity.
Like any service, there are certain prices people are willing to pay for it. Some people are willing to pay more, some are only willing to pay less. Some aren’t even interested in the service.
I’ve known many a person who ignores medical issues simply because they don’t like going to a doctor. I’ve had elderly people in my family who never went to a doctor to deal with profound hearing loss because they just regarded that as part of getting old and were too proud to get in and get a hearing aid.
I’ve even known people with terminal illnesses who after a diagnosis more or less refused any more medical treatment.
It’s just like any other service–take legal services for example. Say a neighbor wrongs me. Some people will want to sue, some won’t want to sue. It depends on the nature of the wrong and the individual, some people will sue over anything and some won’t sue over anything. Different lawyers charge different rates, people shop around for the service.
Now, primary education is an example of a service that isn’t really at all a free market. You can choose to pay more but you have to pay for some of it. Whether you have children or not, you have to pay taxes. And whether you want your children to go to school or not, the state mandates it until a certain age. You also have the option of paying a premium for private schooling, but you don’t have the option of opting your children out of any education at all or of opting out of paying property taxes to fund local school districts.
The military is another example of a service that is completely socialized. You have no choice as to whether or not you’re going to pay for its upkeep, and whether you want military protection or not, you get it while living within the confines of the United States whether you want it or not.
At present I think health care has a lot more in common with a standard service that is influenced by a somewhat free market than it does with truly socialized services like military (or police) protection, and primary education.
Public schools are funded by a variety of sources, not exclusively property taxes. Universities are outside the scope of my original point, which only spoke of primary and secondary education (aka K-12), post-secondary is a totally different system.
However your point about universities is worth noting because many of the best hospitals are associated with universities and they get millions upon millions of dollars every year from wealthy alumni. That creates an imbalance between a hospital like that which has a huge amount of funding, and attracts the best doctors, then a hospital which doesn’t. The only way those imbalances could be evened out is if you disallowed private donations to these sort of hospitals and/or forced those donations to be put into a general fund distributed equally to all hospitals.
I don’t have any disdain for the homeless or the working poor.
I do have to wonder why someone would “lose everything” if someone got sick in their family. I’m not entirely convinced that we should react to any death due to illness or disease as the end of the world. Death is part of the human existence and sometimes it’s questionable how much money we spend to try and stave it off, especially when it is other people’s money that we’re spending.
Obviously I think we should try to extend healthy life as long as possible, but I question the hundreds of thousands spent on people with cancer that on fair assessment they most likely won’t beat. Especially when the person has already lived a long and productive life.
I don’t buy into this “Cult of Life at Any Cost” thinking. Death is an important, essential, and inevitable thing and it’s questionable how much we should burden then living with trying to prevent it.
Looking at this article there was an estimate of ~750,000 homeless in the United States in 2005. That’s around .25% of our population (just using ballpark figures of 750k and 300m as total U.S. population.)
Looking at this there is an estimated 50,000 homeless people in the Netherlands. That’s around .3% of your population presuming a population number of 16.4m. Obviously these are “napkin calculations” but unless either numbers are extremely far off then I do not think there is a dramatic difference in the portions of our respective countries populations that are homeless.
As someone who has had many dealings with the homeless I’ll say this: The people who are trying to get their lives back in order usually do so. There are so many services for them that it’s quite possible. Unfortunately I’m sure some of them just fail to get reemployed and reintegrated in society and possibly become permanently homeless. Those are the real tragedies. The other portion of the homeless are the chronically homeless who will never be reintegrated into society because they are mentally ill. They believe doctors implant tracking devices under their skin. They don’t want nor could they hold down a job, many of them would even eschew a residency because it would facilitate the government tracking them down. These are very sick people that are definitely in need of medical care–it’s unfortunate we moved to “community” treatment for mental illness during the 1980s. Before that there was a greater focus on housing these people in mental hospitals long term.
While this is an interesting thread, I don’t actually think you know what it means to play devil’s advocate. As a devil’s advocate you’re supposed to embrace the arguments of the side you disagree with, make it your own and argue that side as a logic exercise to fully understand that side’s argument (and to better be able to rebut it with your true feelings on the matter.) What you’ve actually rather done is just state arguments you disagree with and then explain why, that’s not really playing devil’s advocate (which is of course fine, although it makes your first post seem somewhat out of sync with the thread itself.)
Then why do so many people have to continually see a large portion of their pay check taken by FICA and Federal Income Tax Withholding? If we don’t need that money, we should simply declare the bottom 50% of earners tax exempt.
As a business owner and someone who isn’t in the bottom 50% of earners, I’ve long never understood why liberals are usually the ones most apt to ask for increased payroll taxes. They reduce the take home pay of my employees and makes it harder for me to employ more people (as I have to match their payroll taxes), it’s lose-lose for the lower class.
Sure, they get a lot of their Federal Income tax with holding back and can take an earned income credit and et cetera. But in my experience with low wage earners they need cash now not come tax time.
But the single most significant systemic difference is that one has a federally mandated universal health insurance system and the other doesn’t. What other “systemic differences” do you think account for the cost difference?
I’m not saying there might not be other good reasons, but can you name some of them?
In terms of how it works, that’s the way Canada works; the provinces, not the federal government, actually do the administration of the health insurance system, and much of the local work is tasked out to municipalities, plus they’re dealing with doctors, clinics, and hospitals as individual actors, since they’re mostly in business for themselves. The feds throw in money based on a set of extremely basic requirements laid out in the Canada Health Act (e.g. you can’t deny care to Canadians from other provinces, you can’t exclude anyone from coverage, stuff like that) but the truth is that, in actual fact, Canada does NOT have one universal health insurance system, it has 13. (Three territories, too.) The ten provinces are essentially as individually powerful as states. Theoretically, any of them could drop out of the Canada Health Act and stop offering universal health coverage, though none would actually want to get off the gravy train.
The only real material difference is population - but, why does that matter? The USA has about nine times as many people, but presumably has nine times the tax base, nine times the available labour pool, and so on. Given that the Canadian system is provincially run, and the Province of Ontario - with a population that would rank it among the biggest U.S. states, comparable to Illinois or Pennsylvania - seems able to administer health insurance, why could you not have a system that does that 50 times over, as opposed to 13 times over? Why can 13 jurisdictions run something like this reasonably effectively, but not 50?
Again - I’m not saying this might not be true. But you’ve provided no reasons why it would be true.
Of course, one would expect that some jurisdictions will run the insurance system better than others. But, hell, that happens here. It’s up to the voters to punish the provincial politicians for that.
Everyone does get the care they need, at least within the bounds of the purpose of the system - again, it doesn’t apply to drugs or (inexplicably, to me) your teeth.
However, they do not get all the care they WANT. If you want a nose job, bring your MasterCard. With a few outliers, the division of what you pay for directly and what you don’t is generally pretty reasonable.
I guess we’ll have to disagree on this. To me, treating someone for a disease that is killing them is pretty fundamental medical treatment. It may be expensive, but you can’t really say you’re providing someone with necessary care if you don’t treat fatal diseases.
Screw that. You can have my immortality when you pry my cold, dead hands off of it.
I’d prefer that my death be my own choice, rather than as a way to increase some insurance company stockholder’s dividend.
There is a big difference between not needing my money and being able to get money from the rich. Historically, whenever a new government spending project starts up, they go straight for the middle class. How do you think we ended up paying almost 30% in payroll taxes already?
It doesn’t guarantee payment if the insured is no longer covered or if the surgery is anything other than what is on the document. I’m sorry, but I just don’t believe this, unless you are talking about something other than group medical insurance, which is the subject at hand.
Uh, no. Unless things changed drastically in the last few years since Medicare started to go privatized, it is generally harder to get Medicare to pay anything.
None of this jives with the last 25 years of my working life, so I can only assume that you are not talking about group medical insurance.
You can’t opt out of the school system if you have kids? What about all those people homeschooling?
(Primary and secondary education is funded by the state from your tax dollars, btw. Universities are tertiary education).
I assume they’re not talking about the medical blls run up while making reasonable attempts to save that person’s life. Not everyone with, say, cancer, is a no-hoper who’s going to die soon anyway, so it’s worthwhile trying to save them even on economic grounds. Yes, sometimes death is inevitable, but that doesn’t mean we should just give up on treating all serious illnesses. Then, if one parent in a family dies and the kids are still dependant on their parents, that’s a lot of income gone.
Pretty easy to ‘lose everything’ if (for example) you’re a two-parent two-kid family whose entire savings go on healthcare for the ill parent, then some more on a loan tied to the home because that’s the only way you can pay for his/her treatment, and then the main breadwinner dies (or the parent who isn’t the main breadwinner dies, and the other parent suddenly has huge childcare costs). All at a time when the bereaved are even less likely to be able to cope emotionally with such financial upheaval than they would have otherwise.
So the government just decides that all businesses will give everyone a raise?
Medicaid (and MediCal) does far more than provide emergency care.
I guess I’m glad I don’t live in Mass I guess then. OTOH, I do live in a state where thousands come who don’t pay taxes and who need quite a bit of health care, and it bankrupts us. Not sure why extending that over an even larger area is such a good idea.
What tax break?
Or, you could quit expecting the responsible people to pay for the irresponsible. Novel concept, I know.
Here is an excellent source of information on coverage for employed people.
Are all that 38% of workers without insurance slackers? I suspect lots of them have high school diplomas. Not everyone can be rocket scientists like you and me - don’t you think people living up to their capabilities deserve to be able to have their families treated?
Sure. We have a cafeteria benefits system, so I get a certain amount of funny money every year, and can add benefits with real money beyond that. Basic medical coverage is required. I think you may be able to get out of it if you can prove you are covered by someone else, but am not sure. If you don’t spend all your funny money, you don’t get it in cash
We can trade anecdotes until the cows come home about irresponsible people at all income levels. I know doctors living in La Jolla without any savings. But facts are facts. A lot of people are living on the edge, in no small part due to the lack of income growth of the bottom 90% in the past 8 years. For those 1/3 of workers without insurance, a big bill can easily eat up whatever savings they have and throw them over the edge even if they have been responsible. I don’t know about down there, but up here at least 80% of foreclosures reported in the paper have been for houses in the 900 - 1500 sq ft. range, with prices usually less than $300K - a pittance for the Bay Area. These are people trying to get ahead by buying the cheapest house they could and at least getting into the game. I’d suspect that a lot of these people (and I have anecdotal evidence from the Times which doesn’t count either) have been working hard, trying to make ends meet, and then getting zapped by illness, and, even worse, inability to work.
Fine. We’re talking medical coverage. In this case people get bankrupted by disaster by definition. Do you think that everyone of that 38% of uninsured workers can get a better job with insurance at will. (Remember our CA unemployment rate is now > 9%.) We’re not talking about people who don’t want to work - they’re on Medicaid anyway (and I think there are fewer of them than you think) I’m talking about working people who are getting screwed.
Neither do Americans. Germans are plenty responsible, and they manage to keep that way despite having UHC. I think Canadians are fairly responsible also. Ditto the British. However did they manage it with socialized medicine?
You don’t believe that group medical insurance doesn’t pay if they can get away with it? Really? You can’t be serious. Assume I couldn’t spend ten seconds on google and find you 50,000 anecdotes. They are a for profit business. Every dollar spent on care is a dollar they lose in profit. Of course they minimize payments. Don’t you understand how the free market works?
If you’ve been working for 25 years, you’re probably in your mid 40s. In all that time you’ve never learned that the word is jibe. Isn’t it possible that you also might have missed a lot when it comes to understanding how health care insurance works?
I actually agree with you about life at any cost. I doubt that anyone is going to bring it up, but one way a UHC system could save money is supporting the terminally ill dying at home. In our system today those of us with good insurance can prolong things. Doctors are not going to go against the wishes of a patient the hospital makes money, and the insurance company might have approved the stay before the patient became terminal. Whatever system we have is going to include rationing - this is a splendid place to do some.
But I was thinking of less dire situations. My wife’s retinal surgeries cost about $50K all told. They eventually worked, and it was certainly not a life or death situation. My mother in law fell and got a hip and shoulder replacement. That worked also. There are lots of treatments like that which improve quality of life, or maybe even save a life, which cost a lot of money and which could easily bankrupt a family without insurance.
If you want an example of irrational insurance company behavior, try this. When we switched from United to Blue Cross I started getting claims rejected asking for certification that no one else had coverage. One I can understand, but we got a half dozen of these before I finally called the insurance company (twice) and told them to quit it. I did send back the forms. In each case they held up payment. So, my doctors got screwed, the insurance company spent money on extra paperwork, and I wasted my time getting this settled.
And did I mention that my company is self-insured, so this was probably a reflex action by Blue Cross, one that might not even improve their profit? (I have no idea of the terms of the contract.)
Such is our highly efficient private system. :rolleyes:
It did. I am not trying to argue for this or anything, I was just telling you what they did in France. The company I worked for at the time has a French service office, so I heard about it.
And neither covers everyone. My wife works in a hospital in the SF Bay Area. She regularly sees patients come in without any form of insurance and no ability to pay. The hospital takes a loss on those patients that has to be made up in the fees that are charged to everyone else.
There is also the fact that you don’t qualify for these things if you have any assets. So what could be a temporary setback with proper insurance lives you homeless and broke before you can get any assistance.
If it was extended over a larger area, why would they come here instead of staying where they are? If every state had UHC, there would be no point in moving to try and get better coverage.
Employer supplied insurance is paid for pretax. Individual insurance is paid post tax. That means a self employed person needs to earn enough money to pay for insurance plus the tax on the money earned to pay for insurance. That is why highly competitive jobs offer such great medical benefits. For every dollar they spend on medical insurance, you would have to pay about 1.3 out of pocket if they just gave you more cash and told you to buy your own. That puts the self employed at competitive disadvantage.
You throw the word responsible around as if people should know better than to get sick when they can’t afford it. I have good coverage and decent nest egg for my age and income. My wife and I both have good jobs. But if my son developed leukemia right before my wife came down with Lupus, I would probably loose my home, and all my savings even with insurance. And I would not be eligible for Medicare or Medical assistance because I have job and private insurance. I will just be in debt for the rest of my life. And all because I wasn’t responsible enough.
Jonathan
Yeah, its pretty apparent from her(?) posts that she has little idea of the realities of medical billing and what not, despite whatever job in the insurance industry she had.