Fair enough - lalenin quotes a snip from the article I linked which also says:
"Cuban doctors abroad receive much better pay than in Cuba, along with other benefits from the state, like the right to buy a car and get a relatively luxurious house when they return. As a result, many of the finest physicians have taken posts abroad.
The doctors and nurses left in Cuba are stretched thin and overworked, resulting in a decline in the quality of care for Cubans, some doctors and patients said. The Cuban authorities say they have also treated more than 750,000 people for eye conditions like cataracts and glaucoma since the program started"
From Wiki - Healthcare in Cuba - Wikipedia
[edit] Praise for the Cuban Healthcare System
In 2006, BBC flagship news programme Newsnight featured Cuba’s Healthcare system as part of a series identifying “the world’s best public services”. The report noted that “Thanks chiefly to the American economic blockade, but partly also to the web of strange rules and regulations that constrict Cuban life, the economy is in a terrible mess: national income per head is minuscule, and resources are amazingly tight. Healthcare, however, is a top national priority” The report stated that life expectancy and infant mortality rates are pretty much the same as the USA’s. Its doctor-to-patient ratios stand comparison to any country in Western Europe. Its annual total health spend per head, however, comes in at $251; just over a tenth of the UK’s. The report concluded that the population’s admirable health is one of the key reasons why Castro is still in power.[57]
The two choices you presented as if they were the only possibilities were “rich” and “think that something will not happen to you”. There is a wide range of other options you are not acknowledging, including “refuses to personalize a national fiscal issue, because it’s manipulative and unhelpful”.
So I suppose it’s not technically an Excluded Middle fallacy, but really a Binary fallacy. But whatever.
That’s great, but I would not hold Cuba out as a shining example of where the USA should be going in terms of Universal Health Care. It’s a bit of a straw man example. There are many other good systems that the US may wish to emulate.
Given how vastly at odds the aims of the provider are with that of subscriber in this instance, I’m still having a hard time figuring out why anyone would defend the current system. The subscriber wants insurance so that someone else will pay if s/he gets sick. The insurer doesn’t want to pay for that care, they just want to collect premiums. Private insurance companies don’t want to pay for medical care, because it eats into their profits. They don’t want to cover pre-existing conditions, because they know they’ll lose money on the deal. They want to avoid paying out whenever possible.
With things like car and house insurance, it’s to cover the ‘what if’. What if my house burns down? The odds of that are unlikely, but its worth covering against just in case. But for many people, health insurance isn’t for the ‘what if’. It’s for the known, to keep their health from getting worse. These people aren’t well served by a private system that doesn’t want anything to do with them. For those of us that consider basic health care to be a human right, the private system has shown itself to work at odds to that goal, and so we feel that it needs to be scrapped.
Ogre, do you disagree that everyone should have access to at least a base level of medical care? Because if not, then that money has to come from somewhere, and if not from the patient, then it’ll come from everyone else in one form or another. UHC just means its paid upfront, and it’ll prevent people from going bankrupt trying to pay for massive medical bills. I can’t see that as anything other than a win for everyone.
I would guess it’s a matter of incentive. Insurance companies, like banks, operate on the model of “speed up the cash coming in, slow down the cash going out”. They have a natural incentive to make settling claims as slow and as complicated as possible, with the additional benefit of making the process sufficiently complicated that loopholes can be found to deny claims outright. It’s not an inherently malicious thought-process, it’s just good business.
Compare to a bureaucrat with a rubber stamp. He has effectively unlimited funding behind him. He will not be fired for not rejecting enough claims. He will not receive a bonus for finding ways to reject claims. It’s in his interest to get the claims through as efficiently as possible while keeping an eye out for fraud, not ways to save a buck. He is beholden to other bureaucrats, all the way up to an elected official - the Minister of Health, not to stockholders or boards of directors. There is no natural incentive to make the process more complicated than it already is.
I know there’s a meme that government bureaucracies multiply without limit, but it turns out the private sector can do that job just as well.
What percentage of income goes in taxes to support the socialized medical systems in different countries? I’m curious to get an idea what a baseline cost would be for me. (anything will be more than I pay now, since not counting medicare taxes that number is zero.) I apologize if someone already answered this and I missed it.
Yep. And in my experience that’s exactly what insurance companies do while Medicare pays without first denying the claim two or three times or saying that they never received the claim, etc. From the consumer side, Medicare has been a lot easier to work with than insurance.
Here’s a good spot to get started, Frontline did a story on how five different UHC programs are administered in five different countries. It compares and contrasts several different UHC models–many Americans aren’t even aware of the range of possible methods to achieve UHC that have already been tried.
Here’sa rather badly laid out comparison of health care costs around the world expressed as percentage of GDP, etc. Might want to put on sunglasses before clicking, but there’s a lot of good info in there.
If I’m reading that right, it appears that the UK is the only one where the coverage is paid for through taxes. The rest seem to just require that everyone be covered.
You’re right about that second one, it’s a pain to read.
Earlier I posted some information on two big hospital chains, showing that they burn about 35-41% of revenue on administrative overhead (AR, IT, back office). I contend that this is due primarily to having to deal with the complexities and inefficiencies of the US insurance system.
So, what about an example on the other side? A hospital system which does not have to deal with that system? In the US, I can think of one: Shriner’s. They treat very, very sick children at 22 hospitals across the US and never charge. We’re talking kids with serious burns, congenital abnormalities, and so on – lots of expensive treatment, all 100% free to the families. Shriner’s pays for it entirely through voluntary public donations. They have a reputation for providing excellent care.
Non-profits file Form 990 with the IRS. This is similar to the financial documents that publicly-traded companies have to file. The most recent 990 for Shriners I can find is from 2006 (PDF - the first page is the key part).
In 2006, the Shriner’s system collected revenues (mostly donations and growth of endowments) totalling about $736 million. Their administrative overhead for the year totalled about $47 million. So, admin overhead as a percent of revenue: about 6.4%. Compare that to the 35-41% for the most successful for-profit hospitals.
So, why can Shriner’s keep their overheard so much lower than those other places? Sure, their administrative salaries are lower. Maybe they get a break on an office supply here and there. But, really, what’s the big thing missing from the Shriner’s equation? Anyone? Anyone? They don’t have to deal with the damned insurance companies.
I want to see if I did this right. I did a currency conversion based on a $50,000 US income which came out to just about 31,000 pounds. Using the site listentotaxman.com I plugged the numbers into their tax calculator and it said the tax for national insurance was 9% or 2838.00 pounds which equates to $4579 US. (I used the 07 tax year) This was for a single person under age 65 with no other deductions beyond the tax-free allowance.
Administration costs are a killer–I had a hunch that Kaiser Permanente might have lower admin costs than average since they don’t do any outside insurance billing, and it looks like my hunch is right–from here:
How can it be right or sensible that we’re paying insurance companies billions of dollars for them to resist paying claims or denying benefits outright? Using insurance as a model for health care is flawed from the outset, because EVERYBODY needs it at some time or another. I’ve been paying car insurance for over thirty years but I’ve only made two claims during that time, totalling less than $5000. I’ve paid for homeowner’s insurace for a total of about fifteen years, and have never made a claim at all–and that’s pretty normal. NOBODY goes their entire lives without needing to see a doctor, that’s just not possible–so using the insurance model means there are no instances of people who make zero claims against benefits to offset those who do. It’s a doomed system, which was set up under flawed premises that have been getting more so as time goes on.
BTW, I find it interesting that Kaiser is extremely proactive about preventative medicine–it’s one of the ways they keep their costs down. They’d rather spend a little bit of money up front to prevent a much higher cost down the road–why doesn’t the government study their model for a template to base single payer on?
Apologies, - of course lalenin did not explicitly tout Cuba’s UHC. lalenin did contribute
I’m just saying that in a discussion about Universal Health Care in different countries, bringing up the flaws in Cuba’s medical system is probably not the best example of flaws in UHC in general.
Sounds about right. I make roughly £10k less and pay about £2000/y NI, which is around 8%.
The NI contribution isn’t just for healthcare though, it covers unemployment insurance, national pension and disability benefits (and probably some other things I’m forgetting). It’s essentially the primary source from which the welfare state is funded (other tax revenues go into the funding it to, but this is most direct one).
Okay, well educate me on the other options. I’m not an American and I don’t know the system, so come on, fight my ignorance. From everything everyone else has said I assume that the average American can either afford insurance (or to pay out of pocket), or they just hope like hell they never get sick. Is there some middle ground I’m unaware of? BTW, “refuses to personalize a national fiscal issue, because it’s manipulative and unhelpful” is not an answer to “what happens if you get sick?”
Incidentally, I never, ever said you were rich - just that if you could afford health insurance you were not truly poor. Surely someone who bandies about terms like ‘excluded middle fallacy’ knows that there is a difference between ‘rich’ and simply ‘not poor’, so don’t put words in my mouth please.
As for personalizing the issue, of course people personalize it. The government exists to serve the people, it does not exist to serve itself. When you are talking about peoples health it is personal, and I’m not sure how it could be otherwise.
Most health insurance in the US is provided by the employers, not the individuals. So if you lose your job, you lose your health insurance, and so does your family. If you work part time you probably aren’t offered health insurance at all (UPS and Starbuck’s are the only two exceptions I’m aware of). It is entirely legal for an employer to cover just the employee, leaving a spouse and children entirely uncovered.
Some days I think our health care system was set up by Ferengi.