# Heath care: explain 'the mandate' to me. **URL:** \ **Category:** Great Debates\ **Created:** [November 8, 2009, 11:39am UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797 "2009-11-08T11:39:48Z")\ **Posts on this page:** 20\ **Page:** 3
**Author:** ![Ruminator](https://avatars.discourse-cdn.com/v4/letter/r/b9bd4f/32.png) [@Ruminator](https://boards.straightdope.com/u/Ruminator)\ **Post date:** [November 9, 2009, 5:26pm UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/42 "2009-11-09T17:26:40Z")
> [@Broomstick](#): > > So what? Even if US providers charge more we don’t get as good results, so what the hell justifies the higher costs? I wouldn’t use the word “justify” as it implies a value judgment. The costs are a combined result of the unique circumstances of USA… high costs for doctors, medical education, lawsuits, malpractice insurance, drug research, medical research, treatment expectations, bad dietary habits, all contribute to health care costs. > [@](#): > > And don’t _we_ have a government deficit? Yet our results for healthcare are worse than those other countries. You have not demonstrated that government budget deficits are relevant to the results of a health care system. Deficits are relevant because no money means no health care. (Or to be more precise, health care that’s provided by govt. There will always be health care for those who barter if govt finances causes their currency to become worthless.) The “success” of UHC doesn’t just include delivering the health care from doctor-to-the-patient. It also includes the financial foundation that continues paying for the whole thing – year after year – generation after generation. Explain how deficits could NOT be relevant for delivering a sustainable health care system? > [@](#): > > We don’t cap salaries in any other profession, why single out doctors? > We don’t cap tuition for any other school, why single out medical schools? To be clear, I wasn’t proposing to cap their salaries. I’m just making a point that legislation with zero solutions to the supply side does not make UHC cheaper. > [@](#): > > Yet all these other professions, businesses, and schools manage to trundle along despite this lack of caps. Why is this only a problem in medicine? Because teaching a child that 2+2 = 4 is far cheaper than replacing an artificial knee or chemotherapy. We also don’t deliver babies at home by borrowing a neighbor’s grandmother with a bucket of hot water. No, we have come to want that baby delivered in a hospital room with a surgical staff. That’s $10,000+ these days to deliver a baby. The costs are very expensive for all services we put under the umbrella term “health care”. > [@](#): > > Wouldn’t increased demand for suppliers result in more medical schools and doctors if you’re working under free market principals? Do we not _already_ import doctors, nurses, etc. from other countries? Only if medical schools did not have a monopoly on school admissions and licensing to certify a subset of people we choose to call “doctors”. There is no monopoly that limits the number of teachers, engineers, or plumbers. I find it hard to believe you’re not aware of this if you’ve “done the research.” Importing a ton of cheaper foreign doctors might help. If you’re adding 16% (46 million) to the health care system then I guess you also need to add at least 16% capacity across the entire chain of health care delivery: 16% more doctors, 16% more hospitals, 16% more MRI and CAT scan machines, etc, etc. Does the federal legislation add 16% more MRI machines? But that’s adding 16% just to try to keep prices where they are now… which is already too high. So maybe we need 40% more doctors, nurses, hospital beds, etc to really lower prices down. Does the proposed federal legislation have a way of magically producing 40% more supply-side (capcity) health care? No, because we’re retarded and we prefer to focus on this middle layer called health insurance. And let’s say you did accomplish the huge cultural shift to move more humans into the medical industry so that you have the 40% increase in doctors. Now that means you have less people pursuing other important topics. Scientists researching solutions to global warming or engineers inventing cars that run on alternative fuels or geneticists analyzing DNA to prevent birth defects. A huge makeover of society does not come for free — there is a hidden tradeoff somewhere. > [@](#): > > Well, how about the _fact_ that so many other countries cover everyone for less money with better results? You’re going around in circles. Those countries cover with “less money” because they have less COSTs. To add insult to injury, even though their supply-side costs of health care are less, they STILL can’t fully pay for it and run deficits! I do realize that this complete-picture analysis doesn’t matter to most people. Most people who favor Medicare don’t even realize that it’s [insolvent](http://www.google.com/search?hl=en&rls=en&q=medicare+insolvency). > [@](#): > > The primary purpose of the military is not to provide healthcare but to kill people and break things i.e. wage war, or be prepared to wage war. You have not demonstrated that healthcare costs are responsible for high military costs as opposed to, say, overruns on advanced weapons systems. When I used “single-payer” for the military, I meant single-payer for the “military” services and supplies, not the health-care services. We have a single payer for army boots, tanks, helicopters, fighter jets, nuclear missiles, and soldier salaries. And yet, even with all the “efficiencies” of having the govt be the “single payer” for all of that, our military costs more than all other countries combined. ---
**Author:** ![Euphonious\_Polemic](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/euphonious_polemic/32/3002_2.png) [@Euphonious\_Polemic](https://boards.straightdope.com/u/Euphonious_Polemic)\ **Post date:** [November 9, 2009, 5:33pm UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/43 "2009-11-09T17:33:24Z")
> [@Desert\_Nomad](#): > > One huge problem with the current mandate is that if you live outside the US, you still have buy insurance - except it will not be valid outside the USA. > > So if it passes as written, my wife and I get to pay a $3800 per year fine because we have to buy insurance, but no insurance company will issue it to us as we have a foreign address. I’m going to need to see a cite for this. It certainly should no’t be the case for Americans living and working in Canada, as they will continue to be covered under their provincial health plans. Is there a Tax Treaty where you live? Many countries have one. And **Desert Nomad** … If you’re paying 50,000/year in US federal tax, then my handy tax calculator says you are grossing around 200k/year. (assuming no tax treaty) Congratulations to you for doing so well! ---
**Author:** ![gonzomax](https://avatars.discourse-cdn.com/v4/letter/g/e8c25b/32.png) [@gonzomax](https://boards.straightdope.com/u/gonzomax)\ **Post date:** [November 9, 2009, 5:46pm UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/44 "2009-11-09T17:46:14Z")
> [@Ruminator](#): > > I wouldn’t use the word “justify” as it implies a value judgment. The costs are a combined result of the unique circumstances of USA… high costs for doctors, medical education, lawsuits, malpractice insurance, drug research, medical research, treatment expectations, bad dietary habits, all contribute to health care costs. > > Deficits are relevant because no money means no health care. (Or to be more precise, health care that’s provided by govt. There will always be health care for those who barter if govt finances causes their currency to become worthless.) The “success” of UHC doesn’t just include delivering the health care from doctor-to-the-patient. It also includes the financial foundation that continues paying for the whole thing – year after year – generation after generation. > > Explain how deficits could NOT be relevant for delivering a sustainable health care system? > > To be clear, I wasn’t proposing to cap their salaries. I’m just making a point that legislation with zero solutions to the supply side does not make UHC cheaper. > > Because teaching a child that 2+2 = 4 is far cheaper than replacing an artificial knee or chemotherapy. We also don’t deliver babies at home by borrowing a neighbor’s grandmother with a bucket of hot water. No, we have come to want that baby delivered in a hospital room with a surgical staff. That’s $10,000+ these days to deliver a baby. The costs are very expensive for all services we put under the umbrella term “health care”. > > Only if medical schools did not have a monopoly on school admissions and licensing to certify a subset of people we choose to call “doctors”. There is no monopoly that limits the number of teachers, engineers, or plumbers. > > I find it hard to believe you’re not aware of this if you’ve “done the research.” > > Importing a ton of cheaper foreign doctors might help. If you’re adding 16% (46 million) to the health care system then I guess you also need to add at least 16% capacity across the entire chain of health care delivery: 16% more doctors, 16% more hospitals, 16% more MRI and CAT scan machines, etc, etc. Does the federal legislation add 16% more MRI machines? > > But that’s adding 16% just to try to keep prices where they are now… which is already too high. So maybe we need 40% more doctors, nurses, hospital beds, etc to really lower prices down. Does the proposed federal legislation have a way of magically producing 40% more supply-side (capcity) health care? No, because we’re retarded and we prefer to focus on this middle layer called health insurance. > > And let’s say you did accomplish the huge cultural shift to move more humans into the medical industry so that you have the 40% increase in doctors. Now that means you have less people pursuing other important topics. Scientists researching solutions to global warming or engineers inventing cars that run on alternative fuels or geneticists analyzing DNA to prevent birth defects. A huge makeover of society does not come for free — there is a hidden tradeoff somewhere. > > You’re going around in circles. Those countries cover with “less money” because they have less COSTs. To add insult to injury, even though their supply-side costs of health care are less, they STILL can’t fully pay for it and run deficits! > > I do realize that this complete-picture analysis doesn’t matter to most people. Most people who favor Medicare don’t even realize that it’s [insolvent](http://www.google.com/search?hl=en&rls=en&q=medicare+insolvency). > > When I used “single-payer” for the military, I meant single-payer for the “military” services and supplies, not the health-care services. We have a single payer for army boots, tanks, helicopters, fighter jets, nuclear missiles, and soldier salaries. And yet, even with all the “efficiencies” of having the govt be the “single payer” for all of that, our military costs more than all other countries combined. The military is hardly the place to look for fiscal responsibility. It is the playground of the corrupt and the wasters of tax payer money. They reward contracts to whomever they want with provisions that guarantee profits and paying for cost over runs. Any attempt to reform gets beaten down by powerful lobbyists and those with access that give huge campaign donations. In health care a single payer would wield huge power over the suppliers and could keep prices down. It would require vigilance to keep them honest though. ---
**Author:** ![Euphonious\_Polemic](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/euphonious_polemic/32/3002_2.png) [@Euphonious\_Polemic](https://boards.straightdope.com/u/Euphonious_Polemic)\ **Post date:** [November 9, 2009, 5:52pm UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/45 "2009-11-09T17:52:18Z")
> [@Ruminator](#): > > You’re going around in circles. Those countries cover with “less money” because they have less COSTs. To add insult to injury, even though their supply-side costs of health care are less, they STILL can’t fully pay for it and run deficits! Yes, the countries with single payer systems have less costs, because they are more EFFICIENT. There are not MRI machines and techs sitting around idle in multiple hospitals because they’re “competing” with each other. There are not layers and layers of bureaucrats pushing paper around and trying to deny claims. Each doctor does not have to have a specialist billing administrator who deals with multiple plans and companies. Given time, you will hopefully become more efficient too. And about running deficits? Here are the figures for Federal Budget SURPLUSES in Canada: Multiply by about 10 to get a comparable per capita figure for the US 2002: 7 billion 2003: 9.1 billion 2004 1.5 billion 2005 13.2 billion 2006: 13.8 billion 2007: 9.6 billion 2008: 10.2 billion And this was at the same time as income taxes were lowered. ---
**Author:** ![Ruminator](https://avatars.discourse-cdn.com/v4/letter/r/b9bd4f/32.png) [@Ruminator](https://boards.straightdope.com/u/Ruminator)\ **Post date:** [November 9, 2009, 5:55pm UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/46 "2009-11-09T17:55:30Z")
> [@gonzomax](#): > > The military is hardly the place to look for fiscal responsibility. It is the playground of the corrupt and the wasters of tax payer money. They reward contracts to whomever they want with provisions that guarantee profits and paying for cost over runs. Any attempt to reform gets beaten down by powerful lobbyists and those with access that give huge campaign donations. > > In health care a single payer would wield huge power over the suppliers and could keep prices down. It would require vigilance to keep them honest though. It’s amazing that you don’t even realize your own paragraph refutes your conclusion. Allow me to swap the words “military” with “health care industry” in your text: > [@Ruminator rewrite](#): > > The health-care industry is hardly the place to look for fiscal responsibility. It is the playground of the corrupt and the wasters of tax payer money. They reward contracts to whomever they want with provisions that guarantee profits and paying for cost over runs. Any attempt to reform gets beaten down by powerful lobbyists and those with access that give huge campaign donations. > > In the military a single payer would wield huge power over the suppliers and could keep prices down. It would require vigilance to keep them honest though. You’ll see it sounds just as credible (or just as ridiculous!) ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [November 9, 2009, 6:30pm UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/47 "2009-11-09T18:30:41Z")
> [@What\_the](#): > > Perhaps because it isn’t really the same. > > You do not have to insure your car against damage to it… you do have to insure against damage that you might do directly to someone else or their property. But - by maintaining health insurance, you’re protecting others from the damage that a sudden illness on your part will wind up hitting their pockets via an uncompensated trip to the ER, unpaid doctor bills, loss of ability to hold a job because you couldn’t get the care you needed, loss of income because you died too young, loss of tax revenue from said income… I’ve got a friend whose mother died at age 50ish - when she had 15 years left of working time - because she didn’t have health insurance and couldn’t spare the cash to see a doctor. It turned out to be something that could have been corrected, instead she died suddenly. By making health insurance affordable, you eliminate the situation where a family has coverage through Medicaid, for a chronic condition - and the parent can’t afford to take a job because it’d be JUST enough to bump them above the Medicaid threshold but not enough to afford health insurance. Again - you’re eliminating someone from the working pool, eliminating their tax revenue and their spending, and keeping a burden on the public health assistance pool. Who’s paying for that? You and I are. Mandating health insurance simply makes it clearer who’s paying for what. ---
**Author:** ![The\_Tooth](https://avatars.discourse-cdn.com/v4/letter/t/c67d28/32.png) [@The\_Tooth](https://boards.straightdope.com/u/The_Tooth)\ **Post date:** [November 9, 2009, 7:44pm UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/48 "2009-11-09T19:44:13Z")
> [@Ruminator](#): > > When I used “single-payer” for the military, I meant single-payer for the “military” services and supplies, not the health-care services. We have a single payer for army boots, tanks, helicopters, fighter jets, nuclear missiles, and soldier salaries. And yet, even with all the “efficiencies” of having the govt be the “single payer” for all of that, our military costs more than all other countries combined. Are you suggesting this is because of the manner in which defense contracts are handled and not because of some other factor such as, off the top of my head, the sheer quantity of bombs and guns and missiles the US feels it needs? ---
**Author:** ![Ruminator](https://avatars.discourse-cdn.com/v4/letter/r/b9bd4f/32.png) [@Ruminator](https://boards.straightdope.com/u/Ruminator)\ **Post date:** [November 9, 2009, 8:17pm UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/49 "2009-11-09T20:17:28Z")
> [@The\_Tooth](#): > > Are you suggesting this is because of the manner in which defense contracts are handled and not because of some other factor such as, off the top of my head, the sheer quantity of bombs and guns and missiles the US feels it needs? You misinterpreted what I wrote but your sentence almost got the meaning. It is because of the other factors unrelated to single-payer that costs are high. An example of unrelated factor is the “sheer quantity of bombs” like you said. People believe single-payer magically introduces wonderful efficiencies that pay for UHC. Single-payer doesn’t do that. What people forget is that any cost savings of single-payer will be dwarfed by increased future demand for escalating expensive health-care services. The military used to pay soldiers with paper checks. Now it’s electronically done with direct deposit. Did that “efficiency” pay for the military upkeep? No. Harvard University used to keep paper records in filing cabinets on its students. It’s all electronic now and email has made progress reports, syllabus, etc all paperless. Does Harvard tuition cost less now? Banks replaced tellers with ATMs and went to electronic check clearing with the Check21 law. Have bank fees gone down? The US Post Service implemented zip+9 and electronic barcodes for machine sorters. Has the price of a stamp gone down? What do all the above money-saving myths of reduced paperwork have in common? Why did absolute costs not go down? Because the world doesn’t remain a static picture while that one cost (such as paperwork) goes down. We fight more expensive wars. More kids compete and pay to get into Harvard. We send more junk mail. All these new activities dwarf paperwork savings. Can anyone name a significant multi-billion dollar industry that costs less today because of increased efficiencies through reduced paperwork? So there’s a projection that we’ll “save” $300 billion with single-payer reducing bureaucracy paperwork. Why do we delude ourselves with this nonsense? What historical event can we point to that gives us confidence that this will happen? ---
**Author:** ![Ruminator](https://avatars.discourse-cdn.com/v4/letter/r/b9bd4f/32.png) [@Ruminator](https://boards.straightdope.com/u/Ruminator)\ **Post date:** [November 9, 2009, 8:28pm UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/50 "2009-11-09T20:28:59Z")
> [@Euphonious\_Polemic](#): > > Given time, you will hopefully become more efficient too. Sure, if we’re naive, we’ll believe this. > [@](#): > > And about running deficits? > > Here are the figures for Federal Budget SURPLUSES in Canada: Multiply by about 10 to get a comparable per capita figure for the US Well, #1 You’ve got $700+ billion in debt you’re trying to pay back, so surplus has to be placed into context of that hole #2 Your govt officials predict deficits for the next 2 years at least #3 you are a net exporter of oil (the USA is not) #4 you don’t have 100 million Mexicans directly south of your border to strain your UHC #5 you pay less for many of your prescription drugs because USA citizens pay more #5 even with all those economic advantages, you’re still swapping out components of public health care with privatized care to save money So no, I don’t think it’s instructive to “multiply Canada’s situation by 10” to see where the USA could be. ---
**Author:** ![Ludovic](https://avatars.discourse-cdn.com/v4/letter/l/7ab992/32.png) [@Ludovic](https://boards.straightdope.com/u/Ludovic)\ **Post date:** [November 9, 2009, 8:36pm UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/51 "2009-11-09T20:36:10Z")
> [@](#): > > Heath care: explain ‘the mandate’ to me. Well, when a man really loves another man… ---
**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:** [November 9, 2009, 8:53pm UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/52 "2009-11-09T20:53:17Z")
> [@Ruminator](#): > > I wouldn’t use the word “justify” as it implies a value judgment. The costs are a combined result of the unique circumstances of USA… high costs for doctors, medical education, lawsuits, malpractice insurance, drug research, medical research, treatment expectations, bad dietary habits, all contribute to health care costs. I don’t buy the argument that the USA is very unique. Do you think doctors are free in other countries? Do you think there is no cost to medical eduction in other countries? Do you think no other country has lawsuits or malpractice? I can’t believe you’re serious when you imply other countries have no drug research or medical research. You think people people in France or New Zealand don’t have “treatment expecations” and that none of them have bad dietary habits? You’re arguing that the US is some sort of unique snowflake. It just isn’t so. > [@](#): > > The “success” of UHC doesn’t just include delivering the health care from doctor-to-the-patient. It also includes the financial foundation that continues paying for the whole thing – year after year – generation after generation. By that yardstick our current “system” is a dismal failure and only getting worse. The free-market approach to health care is a _failure_. A system that routinely requires people to choose between bankruptcy and/or life-long destitution and _death_ is immoral and hideous. It is beyond my comprehension that anyone can view what we have as good, much less superior, to what has been demonstrated to work elsewhere. > [@](#): > > Explain how deficits could NOT be relevant for delivering a sustainable health care system? You are laboring under the assumption that health care should operate as a profit making business. It should be a public service, such as fire fighting or police coverage, which are tax-supported for the benefit of all. While deficits can have an impact they do not in the same way that would for a private business. > [@](#): > > To be clear, I wasn’t proposing to cap their salaries. I’m just making a point that legislation with zero solutions to the supply side does not make UHC cheaper. Rather than whine about how terrible UHC is, then, why don’t you describe the sort of legislative solutions required to make it work? > [@](#): > > Because teaching a child that 2+2 = 4 is far cheaper than replacing an artificial knee or chemotherapy. You are completely ignoring such complex industries as, say, nuclear engineering or the maintenance of something like the GPS constellation of satellites, both of which are much more complex than “2+2 = 4” and arguably on par, if not exceeding, knee replacement. Again, such complex industries manage to exist and educate people without all the interference you claim is necessary. > [@](#): > > No, we have come to want that baby delivered in a hospital room with a surgical staff. That’s $10,000+ these days to deliver a baby. The costs are very expensive for all services we put under the umbrella term “health care”. Actually, quite a few women DON’T want to deliver their babies in the hospital - yet in many cases their private insurance won’t cover anything _but_ that, thereby reducing their options to one and only one method thing, which is no choice at all. Not to mention that if a women become pregnant while not insured _no private insurance company will cover that birth_ - not only lack of choice, but lack of access as well. Oh, yeah, great “system”. :rolleyes: On the other hand, with UHC EVERY women is covered throughout EVERY pregnancy… and there is incentive to offer options other than hospital delivery _when appropriate_, such options almost always being less expensive. > [@](#): > > Only if medical schools did not have a monopoly on school admissions and licensing to certify a subset of people we choose to call “doctors”. There is no monopoly that limits the number of teachers, engineers, or plumbers. There is nothing preventing YOU from opening up yet another medical school. That’s like saying “engineering schools have a monoply on school admissions and licensing to certify a subset of people we choose to call “engineers”” It’s nonsensical. There are American students who go abroad to study medicine - there is a recent thread on entering medical on this forum right now discussing the pros and cons of doing just that, and pitfalls to watch for. There are limited number of schools that train teachers, engineers, plumbers, etc. yet no one is claiming these school have a “monopoly”. > [@](#): > > I find it hard to believe you’re not aware of this if you’ve “done the research.” You just find it inconceivable that someone can look at the facts and draw a different conclusion than you do. > [@](#): > > Importing a ton of cheaper foreign doctors might help. If you’re adding 16% (46 million) to the health care system then I guess you also need to add at least 16% capacity across the entire chain of health care delivery: 16% more doctors, 16% more hospitals, 16% more MRI and CAT scan machines, etc, etc. Does the federal legislation add 16% more MRI machines? Again, there are flaws in your reasoning. First of all, with a mandate requiring ALL people to “buy in” to the system you might indeed raise the overall numbers paying premiums by 16% _but not all of those people will require services_. A subset of those people are _healthy_ and will NOT require additional system capacity. Second - many hospitals currently have empty beds. With people being discharged far sooner than in the past the _inpatient_ system has excess capacity in some areas (of course, some areas do not, but system-wise there is available slack). 16% rise in demand again does not automatically mean you need to add hospital beds by 16%. Third, the US uses FAR more medical imaging than other countries, with no discernible difference in outcomes. In most places if you sprain your ankle you _don’t_ get an MRI… only in the US has that sort of thing become standard, rather than what is resorted to when conventional/conservative treatments don’t work promptly. The US is OVER supplied with MRI, CAT, and other such things and a 16% rise in patient population will simply be served by that excess capacity. No need to add more. > [@](#): > > But that’s adding 16% just to try to keep prices where they are now… which is already too high. Except that paying for that oversupply of technology is part of what drives prices up! We are all to ready to spend money on _technology_ but god forbid we spend even a _dime_ on _people!_ We need more nurses and home care aides before we think of buying more CAT and MRI machines. > [@](#): > > And let’s say you did accomplish the huge cultural shift to move more humans into the medical industry so that you have the 40% increase in doctors. Now that means you have less people pursuing other important topics. With unemployment currently running 10%+ (even higher by some calculations) lack of people does not seem to be a problem. Perhaps we should retrain some of these unemployed people to perform those other “important topics” and tasks. > [@](#): > > Scientists researching solutions to global warming or engineers inventing cars that run on alternative fuels or geneticists analyzing DNA to prevent birth defects. A huge makeover of society does not come for free — there is a hidden tradeoff somewhere. Any yet… much of the cutting edge work being done on alternative fuels, genetics, etc. are being done _outside the US_ - in those very countries with UHC. > [@](#): > > You’re going around in circles. Those countries cover with “less money” because they have less COSTs. Yes - they spend less and get better results. _Why is that?_ > [@](#): > > To add insult to injury, even though their supply-side costs of health care are less, they STILL can’t fully pay for it and run deficits! No, they pay for it out of taxes. Oddly enough, most people in Europe and Australia I talk to are, well, not _happy_ to pay taxes but _willing to do so_ for having health insurance from cradle to grave that can never be canceled. ---
**Author:** ![Ruminator](https://avatars.discourse-cdn.com/v4/letter/r/b9bd4f/32.png) [@Ruminator](https://boards.straightdope.com/u/Ruminator)\ **Post date:** [November 9, 2009, 9:04pm UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/53 "2009-11-09T21:04:37Z")
> [@Broomstick](#): > > There is nothing preventing YOU from opening up yet another medical school. Do you understand how the AMA restricts the # of incoming doctors, and accreditation of schools? You can’t just grab an empty building and hang a shingle out front saying you’re a medical school. If you don’t understand the basics of this mechanism, the rest of your post is not even worth arguing… such as… > [@Broomstick](#): > > You are laboring under the assumption that health care should operate as a profit making business. It should be a public service, such as fire fighting or police coverage, which are tax-supported for the benefit of all. While deficits can have an impact they do not in the same way that would for a private business. Government deficits are unrelated to whether health care should be profit or non-profit. Also, I didn’t say that health care should be a profit based business. Your post is so incoherent that I’m having doubts you understand what “deficits” or “American Medical Association” actually means. And another incoherent mess …this time with math… > [@Broomstick](#): > > First of all, with a mandate requiring ALL people to “buy in” to the system you might indeed raise the overall numbers paying premiums by 16% but not all of those people will require services. A subset of those people are healthy and will NOT require additional system capacity. … and the current population covered by health insurance ALSO do not all require services with today’s corresponding capacity. Your math reasoning is flawed. ---
**Author:** ![filmore](https://avatars.discourse-cdn.com/v4/letter/f/7993a0/32.png) [@filmore](https://boards.straightdope.com/u/filmore)\ **Post date:** [November 9, 2009, 9:15pm UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/54 "2009-11-09T21:15:28Z")
> [@Ruminator](#): > > People believe single-payer magically introduces wonderful efficiencies that pay for UHC. Single-payer doesn’t do that. > > What people forget is that any cost savings of single-payer will be dwarfed by increased future demand for escalating expensive health-care services. I agree with this. Which ever side you’re on you need to realize that this is the truth. If we have UHC, we need to lower people’s expectation about the level of care they can receive. Not all care is for life threatening injuries. Many minor injuries can incur thousands in costs. Here’s a real-world example I went through. I hurt my ankle jogging. I let it heal, but it would start hurting every time I went jogging. [ul] [li] **If I have insurance** – I go to an orthopedic specialist. He takes X-rays. He orders an MRI follow up. Discovers small bone cyst under the cartilage. Schedules a $15,000 orthoscopic surgery with genetically grown cartilage. Prescribes 3-6 months of rehab. Total cost: $20k or more.[/li][li] **If I don’t have insurance** – Orthopedic specialists won’t see me without insurance or prepay. I go to the clinic. They tell me to ice it and let it rest. It flares up every time I run. I go back to the clinic but they tell me there’s nothing they can do. I learn to live with my sore ankle. Total cost: ~$500.[/li][/ul] If UHC is implemented, everyone is going to expect the best level of care for all medical problems. It’s important to make a distinction between “I need care to save my life” and “I need care to make me more comfortable”. To be economically feasible, UHC would need to be limited to life saving treatments. ---
**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:** [November 10, 2009, 12:01am UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/55 "2009-11-10T00:01:22Z")
> [@Ruminator](#): > > Do you understand how the AMA restricts the # of incoming doctors, and accreditation of schools? The AMA has zero control over osteopathic medicine - open more osteopathic schools. They tend much more heavily towards general care than the allopaths, and general physicians are exactly the ones we need right now. Nor does the AMA have any authority over foreign medical schools. With only about 20% (at most) of practicing allopathic physicians as AMA members the organization is rapidly losing clout. > [@](#): > > You can’t just grab an empty building and hang a shingle out front saying you’re a medical school. Where do you get “grab an empty building” from “open a medical school”? > [@](#): > > If you don’t understand the basics of this mechanism, the rest of your post is not even worth arguing I am asking you to support the claims you are making, which you are failing to do. Instead, you are questioning my “credentials”, which is not the point here. I have made no claims. You have. Yet you will not defend them. I have to wonder if that’s because, deep down inside, you know you are incapable of doing so either from lack of evidence of lack of knowing where the evidence is. Please prove me wrong by providing _actual support_ for your claims. ---
**Author:** ![Ruminator](https://avatars.discourse-cdn.com/v4/letter/r/b9bd4f/32.png) [@Ruminator](https://boards.straightdope.com/u/Ruminator)\ **Post date:** [November 10, 2009, 12:45am UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/56 "2009-11-10T00:45:58Z")
> [@Broomstick](#): > > The AMA has zero control over osteopathic medicine - open more osteopathic schools. You conveniently leave out that osteopaths have a harder time securing residencies than their MD counterparts. There are other dynamics around DOs that prevent them from being a slam dunk solution to the doctor supply problem. I wouldn’t expect you to volunteer what those issues would be. > [@](#): > > I am asking you to support the claims you are making, which you are failing to do. > Yet you will not defend them. I already have. I claim that other countries have not solved how to balance their budget with UHC. You can read the countries govt budget reports for such evidence. You can read statements about health reform cutbacks from finance ministers of UHC countries such as France and Germany in liberal publications for further evidence. And to clarify, I didn’t say that what the USA has is a superior situation. I’m saying that mandating that everyone pay into a “gigantic risk pool” and/or implementing “single-payer” _does not_ reduce UHC costs. People want to believe that so badly that they just convince themselves it’s true without actually thinking about it. I do believe in reforming health care. I just don’t believe the focus on INSURANCE solves anything. People look to other countries thinking that is the proof that insurance is the bogey man. You can’t just analyze their insurance coverage; you have to consider their entire chain of health care and tradeoffs (long waits). > [@](#): > > Instead, you are questioning my “credentials”, which is not the point here. I’m not questioning whether you have a PhD medicine. I’m questioning whether you even understand the points of a debate, regardless of whether you agree with them or not. > [@](#): > > I have made no claims. …and this is another example of your incoherence. Re-read your own posts: you have made claims. ---
**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:** [November 10, 2009, 1:12am UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/57 "2009-11-10T01:12:16Z")
> [@Ruminator](#): > > You can’t just analyze their insurance coverage; you have to consider their entire chain of health care and tradeoffs (long waits). Europeans, Australians, etc all have access to emergency care. In the US if you do not have insurance _your wait may be infinite_. If it’s not _immediately_ life-threatening then you have _no access_ unless you have either insurance OR lots of money on hand. Have a hernia? In the US, if you don’t have insurance or cold hard cash _you will NEVER get it fixed_. My husband, with a life-long history of urological problems due to a birth defect, had to wait TWO YEARS for access to a urologist due first to 8 months with no insurance, then a further 16 months of our current insurance stonewalling our requests for him to be seen. You don’t think TWO YEARS is a long wait? You don’t think people in the US have long waits? If you don’t have insurance _you don’t even get to stand in line!_ I’ll trade Canadian/European/Australian wait times for what we’ve gone through any day. ---
**Author:** ![Wall6ly](https://avatars.discourse-cdn.com/v4/letter/w/ed655f/32.png) [@Wall6ly](https://boards.straightdope.com/u/Wall6ly)\ **Post date:** [November 10, 2009, 3:07am UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/58 "2009-11-10T03:07:15Z")
I’ll be the first to admit I don’t know enough about economics to say about what will happen if the US switches to UHC. It seems from the debate that it will either turn into a land of happiness or spontaneously erupt into flames and zombies. Regardless, I live outside the US and have gone through all the stages, uninsured, private insurance, and finally UHC. Obviously, uninsured was the worst. I worried every time I got sick. Eventually, I got a bad toothache which didn’t go away and had to go to the doctor, just a cavity that had gone on way too long but required much more work and drilling than if I’d simply gone earlier. I paid out of pocket, but if I hadn’t been able to, it would have cost the govt. Insured was better, but I had a couple occasions where they didn’t cover that kind of treatment, or (because I was forgetful) didn’t mail the receipt soon enough. The UHC is by far the best, it costs double the private insurance, but half is subsidized by my job (all employers are required to do this), so it costs the same to me. I’ve never worried about being sick since then. And no, I don’t go to the doctor more often, nor to I demand MRIs and IV drips every time I go. I think the change will probably be rough on the American economy, but if it can survive WW1&2 and a couple of great depressions, it can survive a health care overhaul. And I can vouch that I live healthier and with much stress under UHC. ---
**Author:** ![Euphonious\_Polemic](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/euphonious_polemic/32/3002_2.png) [@Euphonious\_Polemic](https://boards.straightdope.com/u/Euphonious_Polemic)\ **Post date:** [November 10, 2009, 3:22am UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/59 "2009-11-10T03:22:28Z")
> [@Ruminator](#): > > Sure, if we’re naive, we’ll believe this > > Well, > #1 You’ve got $700+ billion in debt you’re trying to pay back, so surplus has to be placed into context of that hole Your hole is bigger, proportionally, so this is a moot point. > [@Ruminator](#): > > #2 Your govt officials predict deficits for the next 2 years at least See point above. Your deficits are still bigger , even though we have dreaded public healthcare, which you claim will lead to financial ruination > [@Ruminator](#): > > #3 you are a net exporter of oil (the USA is not) American exceptionalism argument - so you’re a poor country now? > [@Ruminator](#): > > #4 you don’t have 100 million Mexicans directly south of your border to strain your UHC Another American exceptionalism argument. > [@Ruminator](#): > > #5 you pay less for many of your prescription drugs because USA citizens pay more I call BS on the reason we pay less. > [@Ruminator](#): > > #5 even with all those economic advantages, you’re still swapping out components of public health care with privatized care to save money I also call BS on this one. We are not “swapping out” components. We’re looking for the right blend of public and private to save maximum money and resources. We’re interested in the best system, not an ideologically pure system. **Ruminator** , the point is that your argument that changing your medical system will inevitably lead to deficits is proven wrong by Canada’s having achieved budget surpluses for 12 years. Your only argument is American exceptionalism. “It can’t work here like it does everywhere else because we’re America.” ---
**Author:** ![Euphonious\_Polemic](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/euphonious_polemic/32/3002_2.png) [@Euphonious\_Polemic](https://boards.straightdope.com/u/Euphonious_Polemic)\ **Post date:** [November 10, 2009, 3:51am UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/60 "2009-11-10T03:51:47Z")
Oh, and about your point #4, **Ruminator** : I wonder if you could provide a cite that the proposed health coverage plan includes illegal immigrants, or would cover “100 million Mexicans” who live in Mexico. Thanks for the cite. ---
**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:** [November 10, 2009, 4:00am UTC](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797/61 "2009-11-10T04:00:44Z")
You know he won’t give the cites - all he has is exceptionalism, gut feelings, and talking points. If he had something to back up his claims he would have posted it by now. [Previous page](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797.md?page=2) [Next page](https://boards.straightdope.com/t/heath-care-explain-the-mandate-to-me/516797.md?page=4)