# Healthcare vs Other Necessities **URL:** \ **Category:** In My Humble Opinion\ **Created:** [July 7, 2017, 3:13am UTC](https://boards.straightdope.com/t/healthcare-vs-other-necessities/790667 "2017-07-07T03:13:05Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![John\_Mace](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/john_mace/32/185_2.png) [@John\_Mace](https://boards.straightdope.com/u/John_Mace)\ **Post date:** [July 7, 2017, 2:36pm UTC](https://boards.straightdope.com/t/healthcare-vs-other-necessities/790667/21 "2017-07-07T14:36:47Z")
> [@Lightray](#): > > We _do_ provide free healthcare: go to an emergency room with a serious condition and they will treat you regardless of whether you will pay them. If someone _can’t_ pay, all of the rest of us get to foot the bill. That is how it works _now_. The OP asks why the federal government should provide this. That’s not the way it works now. ---
**Author:** ![Dewey\_Finn](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dewey_finn/32/4222_2.png) [@Dewey\_Finn](https://boards.straightdope.com/u/Dewey_Finn)\ **Post date:** [July 7, 2017, 2:41pm UTC](https://boards.straightdope.com/t/healthcare-vs-other-necessities/790667/22 "2017-07-07T14:41:59Z")
From the [website](https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/) for the CMMS, “In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of ability to pay. Section 1867 of the Social Security Act imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC), including active labor, regardless of an individual’s ability to pay. **Hospitals are then required to provide stabilizing treatment for patients with EMCs.** If a hospital is unable to stabilize a patient within its capability, or if the patient requests, an appropriate transfer should be implemented.” In other words, if you show up at a hospital that participates in Medicare (which is the majority of them), they have to at least provide enough treatment to “stabilize” you, whether or not you can pay. Admittedly, the federal government isn’t paying for this care. Instead, the cost is shifted to those who have insurance and can pay for their care. So the country as a whole is paying for expensive ED care for people who could be more cheaply treated otherwise. ---
**Author:** ![Lightray](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lightray/32/391_2.png) [@Lightray](https://boards.straightdope.com/u/Lightray)\ **Post date:** [July 7, 2017, 2:43pm UTC](https://boards.straightdope.com/t/healthcare-vs-other-necessities/790667/23 "2017-07-07T14:43:16Z")
> [@John\_Mace](#): > > The OP asks why the federal government should provide this. That’s not the way it works now. I someone receives emergency treatment at a hospital and cannot pay, who do you think pays for that treatment? ---
**Author:** ![rbroome](https://avatars.discourse-cdn.com/v4/letter/r/838e76/32.png) [@rbroome](https://boards.straightdope.com/u/rbroome)\ **Post date:** [July 7, 2017, 2:46pm UTC](https://boards.straightdope.com/t/healthcare-vs-other-necessities/790667/24 "2017-07-07T14:46:32Z")
The reason why healthcare should be provided by the Government is that the potential cost of healthcare, either as an out of pocket expense or as insurance, is significantly higher than most people can afford. Most people can afford food, and it is a predictable expense, for example. ---
**Author:** ![John\_Mace](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/john_mace/32/185_2.png) [@John\_Mace](https://boards.straightdope.com/u/John_Mace)\ **Post date:** [July 7, 2017, 3:00pm UTC](https://boards.straightdope.com/t/healthcare-vs-other-necessities/790667/25 "2017-07-07T15:00:09Z")
> [@Lightray](#): > > I someone receives emergency treatment at a hospital and cannot pay, who do you think pays for that treatment? Not the federal government, which is what the OP is asking about. And since insurance premiums are set by state, I wouldn’t necessarily even assume that people in CA are paying for sick people in emergency rooms in NY. Besides, the OP is asking about the feds providing it for everyone, not some subset of the country. Again, that’s not the way it is now. Yes, the federal government does pay for healthcare for some people. Even “a lot” of people (medicare and other programs). So what? ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [July 7, 2017, 3:08pm UTC](https://boards.straightdope.com/t/healthcare-vs-other-necessities/790667/26 "2017-07-07T15:08:01Z")
> [@Lightray](#): > > I someone receives emergency treatment at a hospital and cannot pay, who do you think pays for that treatment? No one does - that’s why hospitals so often have financial difficulties. They have to write off that treatment as bad debt. Oh, and they also increase prices on other services to help close the gap, meaning everyone who can pay does in fact pay more. And they can solicit donations - which, again, means individuals pay more although in that case the paying is voluntary. ---
**Author:** ![D\_Anconia](https://avatars.discourse-cdn.com/v4/letter/d/67e7ee/32.png) [@D\_Anconia](https://boards.straightdope.com/u/D_Anconia)\ **Post date:** [July 7, 2017, 3:08pm UTC](https://boards.straightdope.com/t/healthcare-vs-other-necessities/790667/27 "2017-07-07T15:08:34Z")
> [@engineer\_comp\_geek](#): > > UHC would force everyone to pay, and it would come out of taxes so ideally it would just be just another number taken out of your check and it wouldn’t affect your take-home pay. I don’t understand what you are saying. How can something be taken out of your check, but NOT affect your take-home pay? 😕 ---
**Author:** ![rbroome](https://avatars.discourse-cdn.com/v4/letter/r/838e76/32.png) [@rbroome](https://boards.straightdope.com/u/rbroome)\ **Post date:** [July 7, 2017, 3:10pm UTC](https://boards.straightdope.com/t/healthcare-vs-other-necessities/790667/28 "2017-07-07T15:10:44Z")
> [@Lightray](#): > > I someone receives emergency treatment at a hospital and cannot pay, who do you think pays for that treatment? One thing is sure, the federal government does not pay. Lets be clear, when a person comes into an emergency room and does not pay the bill, the bill is not sent to the federal government. There is no mechanism in place for that to happen. That isn’t to say the hospital doesn’t get federal money, they certainly do. But it isn’t tied directly to the cost of any single visit to the emergency room. Who does pay? The other users of the hospital. At my suburban middle class community run hospital they are relatively open about their costs and payments. Simply put, this is how their payments break out: charity care (about 4% of all their direct costs) - % of costs paid: 0. Medicaid (about 15% of their direct costs) - % of costs paid: 38. Medicare\* (about 20% of their direct costs) - % of costs paid: 87. Private insurance (about 60% of their direct costs) - % of costs paid: 134. The full cost of running a hospital are covered by a variety of incomes, fee for service payments are only one income stream. \*as I remember the briefing, and I could be wrong about this, this is the Part A payments. Medicare patients typically incur other costs that are in the “Private insurance” row. I guess this means they consider Medicare Advantage plans to be private insurance, but I am not sure. It was a couple of lawyers making the presentation and they weren’t able fully explain all the slides. ---
**Author:** ![Dewey\_Finn](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dewey_finn/32/4222_2.png) [@Dewey\_Finn](https://boards.straightdope.com/u/Dewey_Finn)\ **Post date:** [July 7, 2017, 3:14pm UTC](https://boards.straightdope.com/t/healthcare-vs-other-necessities/790667/29 "2017-07-07T15:14:25Z")
> [@John\_Mace](#): > > Not the federal government, which is what the OP is asking about. And since insurance premiums are set by state, I wouldn’t necessarily even assume that people in CA are paying for sick people in emergency rooms in NY. > > Besides, the OP is asking about the feds providing it for everyone, not some subset of the country. Again, that’s not the way it is now. > > Yes, the federal government does pay for healthcare for some people. Even “a lot” of people (medicare and other programs). So what? I think that’s an unnecessary nitpick. Given that the OP has not yet returned, I think it’s reasonable to assume the question is whether the people of the United States should pay for healthcare for all. ---
**Author:** ![running\_coach](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/running_coach/32/15836_2.png) [@running\_coach](https://boards.straightdope.com/u/running_coach)\ **Post date:** [July 7, 2017, 3:21pm UTC](https://boards.straightdope.com/t/healthcare-vs-other-necessities/790667/30 "2017-07-07T15:21:08Z")
> [@D\_Anconia](#): > > I don’t understand what you are saying. How can something be taken out of your check, but NOT affect your take-home pay? 😕 It would take the place of the Medicare tax. And any insurance premium you’re currently paying. ---
**Author:** ![D\_Anconia](https://avatars.discourse-cdn.com/v4/letter/d/67e7ee/32.png) [@D\_Anconia](https://boards.straightdope.com/u/D_Anconia)\ **Post date:** [July 7, 2017, 3:29pm UTC](https://boards.straightdope.com/t/healthcare-vs-other-necessities/790667/31 "2017-07-07T15:29:49Z")
> [@running\_coach](#): > > It would take the place of the Medicare tax. > And any insurance premium you’re currently paying. Ok, but insurance premiums taken out of your check vary by plan and from company to company. A set UHC tax could very well change your take-home pay. ---
**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\ **Post date:** [July 7, 2017, 3:56pm UTC](https://boards.straightdope.com/t/healthcare-vs-other-necessities/790667/32 "2017-07-07T15:56:59Z")
> [@elbows](#): > > Now imagine that police and fire/ambulance services were also ‘for profit’. What would that look like? 911 is gonna wanna see your receipt before they send out that fire engine, and the police are gonna require a $50 pay in advance fee before sending a car. THAT would be monsterous by any interpretation. > > But that IS what’s monsterous about for profit medicine. No one chooses sickness or injury, just as they don’t choose for their house to catch fire. It’s not for-profit, but in some places , there is no government-funded fire department. There are volunteer departments that are funded by subscriptions. And when they let a house burn down because the owner has not chosen to subscribe, the department is vilified. Americans as a group have a bit of a split personality- people want to be able to choose whether or not to buy insurance , but when that healthy 25 year old who chose not to buy insurance falls while repairing the roof to his house they also mostly don’t want the hospital to refuse to treat him. There’s a disconnect there that I don’t quite understand where people should be able to make the choice, but should be protected from the consequences of that choice. ---
**Author:** ![John\_Mace](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/john_mace/32/185_2.png) [@John\_Mace](https://boards.straightdope.com/u/John_Mace)\ **Post date:** [July 7, 2017, 3:59pm UTC](https://boards.straightdope.com/t/healthcare-vs-other-necessities/790667/33 "2017-07-07T15:59:21Z")
> [@Dewey\_Finn](#): > > I think that’s an unnecessary nitpick. Given that the OP has not yet returned, I think it’s reasonable to assume the question is whether the people of the United States should pay for healthcare for all. The federal government does not pay for people to go to the emergency room when they can’t afford it and don’t have insurance or medicare/medicaid. If you think it’s a nitpick to point that that is factually incorrect, then you are welcome to that opinion. Since that was put forth as an argument in favor of federally funded UHC, it seems reasonable to point out that it’s fallacious. Also, whether or not the feds are chartered by the constitution to take on UHC, as opposed to the states doing so, can hardly be called an “unnecessary nitpick”. But you know, we’ve had this exact debate a bazillion times on this MB, so I’m not seeing much value it rehashing it one more time. Feel free to have the last word. ---
**Author:** ![Dinsdale](https://avatars.discourse-cdn.com/v4/letter/d/97f17d/32.png) [@Dinsdale](https://boards.straightdope.com/u/Dinsdale)\ **Post date:** [July 7, 2017, 4:04pm UTC](https://boards.straightdope.com/t/healthcare-vs-other-necessities/790667/34 "2017-07-07T16:04:11Z")
As others have suggested, most people believe that a developed society ought to provide SOME level of services to its populace. Few people disagree as to - say police protection, clean water, and sewers. More and more might disagree when it comes to fire protection, education, ensuring healthy foods/drugs, but IMO most support SOME services in those areas. Most western democracies provide some access to the courts. I believe that ensuring SOME level of health care is also a legitimate and desired function of a government, especially in a wealthy developed country which presumes itself to reflect some democratic principles. How such care is funded, and the type/level of care that is included, are certainly areas in which intelligent, well-meaning folk can disagree. The other day this analogy came to me - I haven’t rigorously thought on it, tell me whether it holds to any degree. I think folk universally agree that everyone is entitled to some level of police protection under the laws. If you are wealthy enough, you can afford private security in addition - such as a gated community, or even a personal bodyguard. Sticking in the legal arena, everyone charged with a serious crime is entitled to some representation. But if you have the bucks to afford private counsel, good for you. I think of health care similarly. EVERYONE should get some basic level of health care. Say prenatal services. Insulin/medicine for objectively diagnosed and treatable conditions such as hypertension/diabetes. ER visits for emergencies. Many of these services can be well defended purely on economic basis - it is cheaper to provide insulin to a diabetic, than to deal with the subsequent effects. Better to have healthy pregnancies, than substance exposed, premature, undernourished births. But, if you are simply unfortunate enough to be born to poor, ignorant parents, and also unfortunate enough to have some rare disease, you might not get an organ transplant. Also, if you don’t make an effort WRT smoking, alcohol and drugs, exercise, well, I could imagine providing access to dietary/exercise/addiction services before you get any costly medical services. Poor, uneducated folk will die younger than wealthier folk. ---
**Author:** ![Lemur866](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lemur866/32/434_2.png) [@Lemur866](https://boards.straightdope.com/u/Lemur866)\ **Post date:** [July 7, 2017, 4:34pm UTC](https://boards.straightdope.com/t/healthcare-vs-other-necessities/790667/35 "2017-07-07T16:34:19Z")
There’s a point that can be made that universal coverage should only cover “unexpected” treatments. Since everybody should get a checkup every other year, that’s a foreseeable expense and shouldn’t be covered under an “insurance” model. So just like with property insurance you are covered if a tree crashes into your house, but they don’t pay for you to have housekeepers come twice a month to vacuum and scrub the toilets. However, this ignores a couple things. One is public health. We aren’t in some hermetically sealed bubble. We’re affected by the health of the people around us. The best way to protect yourself against cholera is to protect everyone against cholera. And if an HIV infection is one of those previously mentioned “unexpected” problems that should be covered by our catastrophic insurance protection because it isn’t routine, we all have an interest in preventing HIV infections. Then comes the fact that “go to the doctor for a routine physical every other year so he can tell you to eat less and exercise more” is not actually a very expensive service. The real cost of health care is the expensive treatments for cancer and chronic conditions, not healthy people having routine physicals. So the savings from excluding your routine stuff from your “insurance” is actually very low. And this is why almost all employment based insurance doesn’t bother to exclude this stuff. They will pay for your routine checkup even though it’s not a classic insurance function, because it’s very cheap relative to all the other costs they’re paying, and preventative medicine can prevent or ameliorate more expensive problems down the road. Should this all then be the responsibility of the Federal Government? Not necessarily, but if it’s not, the Feds still would have to mandate that everyone is covered somehow. You could have every state provide insurance services, but there would have to be mandated levels of coverage, mandates that if someone from Alabama is visiting Disneyland and gets sick they can still see a doctor and not be turned away because they’re not a citizen of California. Sure there’s the advantage of the “laboratory of democracy” and states could try different systems and we could all see which ones turn out the best. But we’ve already got such a laboratory in the dozens of other first world countries that have universal coverage systems of various sorts that work better or worse, and we could observe their outcomes and decide what would work best for us. We’ve already decided that we don’t toss sick people out of their hospital beds into the gutter just because they can’t pay. Those people get care, and then we try to figure out how to pay for it after the fact somehow. But this is a highly inefficient, unfair, confusing, and costly system. Wouldn’t it make more sense to have an efficient, fair, simple, and cheaper method of not dumping sick people into the gutter? ---
**Author:** ![Smeghead](https://avatars.discourse-cdn.com/v4/letter/s/f1d935/32.png) [@Smeghead](https://boards.straightdope.com/u/Smeghead)\ **Post date:** [July 7, 2017, 8:28pm UTC](https://boards.straightdope.com/t/healthcare-vs-other-necessities/790667/36 "2017-07-07T20:28:08Z")
Health care costs can vary widely from person to person, often with absolutely no reason other than pure dumb bad luck. If I want better food or better housing, I can work more or work harder or sacrifice something to make it happen. If I want better health, I can’t do anything to make that happen. We’re born into an uneven playing field when it comes to health\*. It seems fair to spread that burden out among the wider population. \*Yes, yes, diet and exercise and all that. I’m not talking about that. I’m talking about the child who gets leukemia or the person with a genetic defect that leaves her dependent on expensive medication for life; that sort of thing. ---
**Author:** ![TimeWinder](https://avatars.discourse-cdn.com/v4/letter/t/bcef8e/32.png) [@TimeWinder](https://boards.straightdope.com/u/TimeWinder)\ **Post date:** [July 7, 2017, 8:42pm UTC](https://boards.straightdope.com/t/healthcare-vs-other-necessities/790667/37 "2017-07-07T20:42:29Z")
> [@ishamael69](#): > > Proponents of UHC: Why is free / cheap healthcare regarded as something that the federal government should provide for everyone, as opposed to free food, free clothing, free water, or free housing? As others have said, we probably should (and often do) provide those other services to at least a “minimum survival” level. But the real answer is, of course, that the costs for those other things can be predictably managed and accounted for in a rational budget, by an individual of even below average means. Very few individuals in the US can budget for health care costs that can quickly spiral into the tens of thousands of dollars and up. Luckily, most of us won’t need it most of the time, which means that this is an excellent case for cost spreading across a population, and as with other sorts of universal needs like infrastructure and public safety, the government is (contrary to the alternative-facts crowd) far more efficient and cost effective at this than private industry, because there’s no need for every step of the bureaucracy to make a huge profit. ---
**Author:** ![steatopygia](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/steatopygia/32/3132_2.png) [@steatopygia](https://boards.straightdope.com/u/steatopygia)\ **Post date:** [July 7, 2017, 9:56pm UTC](https://boards.straightdope.com/t/healthcare-vs-other-necessities/790667/38 "2017-07-07T21:56:18Z")
> [@John\_Mace](#): > > Not the federal government, which is what the OP is asking about. And since insurance premiums are set by state, I wouldn’t necessarily even assume that people in CA are paying for sick people in emergency rooms in NY. > > Besides, the OP is asking about the feds providing it for everyone, not some subset of the country. Again, that’s not the way it is now. > > Yes, the federal government does pay for healthcare for some people. Even “a lot” of people (medicare and other programs). So what? I’ll give you a so what. For the one hundredth and first time. The US government is already paying for a substantial amount of the healthcare in the country. 34% get some form of Medicare/caid. So you would think the US government would pay approximately 34% of the per capita cost of a country with UHC. Not even close. Only 2 developed countries have a higher per capita cost, AND they cover 100% of their citizens. The reason to go to UHC is our system absolutely sucks. By far the most expensive, with only middling quality. Whatever the republicans are calling their cluster of a plan, it is only going to make things much, much worse. We DON’T HAVE TO INVENT SOMETHING. There are 10 (at least) UHC countries with cheaper and better quality care. ---
**Author:** ![Grim\_Render](https://avatars.discourse-cdn.com/v4/letter/g/a87d85/32.png) [@Grim\_Render](https://boards.straightdope.com/u/Grim_Render)\ **Post date:** [July 7, 2017, 10:29pm UTC](https://boards.straightdope.com/t/healthcare-vs-other-necessities/790667/39 "2017-07-07T22:29:04Z")
> [@ishamael69](#): > > Yes. If it were free, I assume no one would ever be against it. Well, few would be anyway. > > So, proponents of UHC: Why is taxpayer provided healthcare regarded as something that the federal government should provide for everyone, as opposed to taxpayer provided food, taxpayer provided clothing, taxpayer provided water, or taxpayer provided housing? One of the most fundamental works of economics was Adam Smiths _“The Wealth of Nations”_. In many ways it laid the foundations for the modern understanding of market forces. In it, some areas are singled out as not suited for market delivery. Adman Smith identifies, as I remember it, contract adjudication, and military defense as unsuited for market delivery. Later, health care has been identified as another area that is unsuited for markets and better suited for government provision. The reasons are many, some simple and some quite complicated. Health Care Economics is an entire specialized field in economics. However, there isn’t much debate that market forces do not work well as a delivery mechanism. There is a considerable body of evidence from real-world healthcare all of which supports this. Both comparing national UHC systems to nations lacking such systems, and from nations trying to market-provide things like dental. Which generally results in soaring prices and inefficient delivery. As nations aspire to leave the developing world and enter the developed world, as a matter of course they set up a UHC system. South Korea and Taiwan were, I think the most recent ones. But both India and China are working on getting there. No-one contemplates copying the US model, nor do anyone move off a UHC model once instituted. They may tinker and reform, but the economics at that point are pretty simple, and there is the US providing a cautionary tale. ---
**Author:** ![Grim\_Render](https://avatars.discourse-cdn.com/v4/letter/g/a87d85/32.png) [@Grim\_Render](https://boards.straightdope.com/u/Grim_Render)\ **Post date:** [July 7, 2017, 10:37pm UTC](https://boards.straightdope.com/t/healthcare-vs-other-necessities/790667/40 "2017-07-07T22:37:09Z")
> [@steatopygia](#): > > I’ll give you a so what. > > For the one hundredth and first time. The US government is already paying for a substantial amount of the healthcare in the country. 34% get some form of Medicare/caid. > > So you would think the US government would pay approximately 34% of the per capita cost of a country with UHC. > > Not even close. Only 2 developed countries have a higher per capita cost, AND they cover 100% of their citizens. I would like to clarify that a bit. Only two countries have higher\*\* government expenditure\*\* per capita. And they cover 100 % of the population for that expenditure, where the US only covers 28 % on government healthcare. No country has anything like the US total healthcare costs, either per capita or as a percentage of GDP. > [@steatopygia](#): > > The reason to go to UHC is our system absolutely sucks. By far the most expensive, with only middling quality. > > Whatever the republicans are calling their cluster of a plan, it is only going to make things much, much worse. We DON’T HAVE TO INVENT SOMETHING. There are 10 (at least) UHC countries with cheaper and better quality care. There are 40-odd developed nations all of which have significantly cheaper health care expenses than the US. You might want to take the ones that are basically city-states out of that list though, they have significant advantages. How many of them have **better** health care depends a bit on how you define better, but for most definitions over half of them should manage to clear that bar. [Previous page](https://boards.straightdope.com/t/healthcare-vs-other-necessities/790667.md?page=1) [Next page](https://boards.straightdope.com/t/healthcare-vs-other-necessities/790667.md?page=3)