Health care is a competitive market, or at least it should be. If I don’t like my doctor, I should be able to go to another one. If a doctor is bad enough he goes out of business. I don’t like my insurance company, I should be able to choose another one. If not enough people choose them then the insurance company goes out of business. If there is a need that is not being met by the existing players than a new individual or company can step in to fill it, making profit along the way.
Why do you think that? You can’t throw a rock in GD without hitting three socialists and a commie.
How did O’Reilly bait Sharpton? Say O’Reilly asked Sharpton “how much will I have to pay in taxes” back during the 2004 primaries? Perfectly valid question.
Sure. Medicare, for example, does a far better job of providing universal coverage to its target population than the private health insurance industry does, and with lower overhead costs. The US Postal Service provides far better geographical coverage for letter delivery, at much lower costs, than private courier firms or FedEx. (I’m not clear why you think the Postal Service shouldn’t count in this comparison: it’s a bona fide federal government agency, even though it runs (usually) on its own profits rather than being taxpayer-supported.) And Mtgman already offered the example of superior technical advancement in government agencies such as NOAA and USGS as compared to the private sector.
That doesn’t compute: if you’re suggesting that our largely-privatized healthcare system is inefficient due to government involvement and regulation, then you have to explain why many single-payer systems such as those in Scandinavian countries, which have even more government involvement and more regulation, are more efficient and cheaper.
Sure there’s waste in government programs, and I’m not defending it. But I don’t know where you get the idea that there’s necessarily less waste in market systems. Not only is there internal waste within individual firms (although admittedly competitive pressures provide good incentive to minimize it), but there’s waste when the less efficient firms get driven out of business, workers sit around unemployed and idle, etc. The whole capitalist cycle of boom and bust is incredibly wasteful.
We just tend to ignore most of that waste because it doesn’t actually show up on the balance sheets of the successful companies, which are what we tend to use as our yardstick to evaluate the whole market system. In other words, the private-sector waste is largely externalized.
Well, my point is that it all depends on what the “something” is. If it’s something that private industry isn’t managing to do at all, or can’t do with acceptable levels of universality or fairness, then the bar for efficiency has been set pretty low.
When I go to buy a car, there is a basic alignment of interests between me and the car dealer. I want to buy a car that I will like and he wants to sell me a car that I will like. Sure, he may want me to pay a bit more than I want to pay, but market competition on both sides (i.e., I can go to other dealers; he can get other customers) will keep that under control. To the extent that he might want to try to unload a lemon on me, there are “lemon laws”, plus I can learn a lot by inspecting the car or having a more qualified person inspect it, plus he has a reputation to protect.
However, in health insurance, there is a fundamental non-alignment of interests because the insurance company will make the most money by simply trying to cherry-pick the healthiest part of the population…and on the other hand, I’ll want to get the most comprehensive insurance possible exactly if I am the least healthy. Of course, this sort of problem exists in other types of insurance too, e.g., a bad driver will have more problems getting, or will pay a lot more for, car insurance. However, I think in this case most of us will agree that this is rightfully mainly their own problem. Many of us, however, will not agree that because someone is unlucky enough to have severe health problems, they should not get adequate insurance to pay for it. I.e., many of believing such shared risk is appropriate in a civilized society.
A second problem is that in health care reimbursement, there are huge economies of scale that can be realized through having a certain amount of uniformity. As a doctor friend in Vancouver once explained to me, in his practice of several doctors they had one person who spent a portion of her time handling reimbursement issues. He said that in similar sized practices he knew in the U.S., they had several people working essentially full time to handle the reimbursement.
But you’ll take out 10-hardcore and 30-softcore libertarians in the process.
Well, I outlined one example here, but I think that news release does at least outline the basic reasons…and you can presumably read the full article in the NEJM for more details. I suppose one could posit that the added expense has something to do with our own government although it seems like sort of a perverse argument and still basically begs the question about why countries that have a larger government role in health insurance manage to do things much more efficiently.
Sure. I don’t think it’s ever been suggested that the provision of health care services should be a government monopoly, or shouldn’t use competitive markets.
The trouble is, though, that there are certain needs that no new player steps into fill, or not enough new players to make the price affordable, such as the provision of health insurance to people with pre-existing conditions. The insurance companies simply don’t make enough profit off them, and prefer to cherry-pick healthier and cheaper clients.
So an important social need, namely universal access to health insurance coverage, is not being successfully met by the market. This is a classic case of something market forces can’t supply, but government can.
Mind you, this doesn’t have to mean that even health insurance must become strictly a government monopoly. There are plenty of parallel public/private insurance systems, where the government guarantees a basic level of taxpayer-funded health coverage to all, and those who can afford it buy more extensive health insurance plans from private insurance companies on top of that.
If you seriously think that many of the inhabitants of GD are truly comparable to hardcore socialists and communists, you have led a very sheltered life indeed.
Under the private system you don’t ahve that freedom.
If you don’t have a job you probably won’t have healthcare
Health insurance providers pick and choose which doctors you can see
Insurance providers pick which treatments you can get
Your employer picks your insurer
In a democratic system we change things with our votes and by complaining. In a market system we change things by not buying products. Both are representative systems.
health care shoudln’t be a competitive market because it is an infrastructure system, no different than education or roads. Poor and upper middle class people share the same highway, police force, fire departments and the same colleges because everyone needs infrastructure.
Yeah you can. At 3:45 we all leave SD and get together at the nearest coffee shop and compare our beards to see whose looks most like Trostky, you’re just posting during ‘reeducation’ hour. Come back at 4.
<hippie wannabe>My decision not to apply to the University of Seattle was based entirely on the fact that the ‘official’ interview was at one of five Starbucks in a two-mile radius.</hippie wannabe>
GST in Canada is 7% nationwide. Most provinces have sales tax of about the same percentage.
Not that it means much. There’s all sorts of hidden taxes in every country that don’t come up on an easy chart.
And exceptions too-- how much do the very rich in the U.S. and Canada pay on their income? Very little, because dividends are taxed at a lower rate. And under a new Bush administration proposal, they’d pay nothing.
The problem with that view is that it is only partially true.
The private sector only cares about profit. It doesn’t care about the who, what, when, where, how or why of profit. If Pfizer and Blue Cross can make more money manufacturing chemical weapons for Syria than fighting disease they will go into that business. That is why the private sector is not superior to the public sector for things like medicine.
For example, we currently have 9 SSRIs on the market (selective serotonin reuptake inhibitors) so there is definately not a shortage of SSRIs to take for depression/anxiety. A tenth SSRI will make the company billions of dollars as depression is a disease that is chronic, requires perpetual treatment and that people in the western world can afford to treat. However a vaccine for malaria, a vaccine for AIDS or an antibiotic that can defeat drug resistant strains will only make a few million for the company. So companies end up working on unnecessary drugs instead of lifesaving drugs because they don’t care about the who/what/when/where/how/why of how they get profits or who they have to help or not help. Governments, since they are accountable to voters, do care about the who/what/when/where/how/why of what is getting accomplished and who is getting helped. Voters would not stand for the government spending life saving medical research funds on unnecessary drugs.
The health coverage issue is another factor. Supposedly a minority of people make up the majority of healthcare costs. Insurance companies would respond to this by creating an inverse relationship between coverage and health, ie the more healthy you are and the less you need healthcare, the more likely they are to give it to you. The more likely you are to need it the less likely they are to offer it to you. How is that efficient? That is like nike throwing its shoes to people that already own 8 pairs and refusing to sell shoes to people that have no pairs.
ALso, the uninsured pay more for healthcare than the insured. Those with insurance get negotiated charges for their healthcare. Blue Cross says to a doctor “I know you charge $100 for this procedure, but if you only charge $70 I can supply you with a large amount of customers” so the doctor goes along with that. However the uninsured do not have this option, and since insurance is related to income the private sector has created a situation where the more money you have (ie, if you are insured since insurance is related to income) the less you pay for medical procedures. The working poor and those with low incomes pay more for the same procedures.
For-profit hospitals cost Medicare an additional $732 per enrollee, or an extra $5.2 billion, in 1995 alone… The editorial also notes that substantial prior research confirms that for-profit hospitals are 3 to 11 percent more expensive and spend more on overhead and administration while hiring fewer nurses, providing less charity care, and providing patients with fewer hospital days than not-for-profit facilities.
For example, two recent studies have found death rates 6 to 7 percent lower at private non-profit hospitals and 25 percent lower at teaching hospitals than at for-profit facilities.
for-profit hospitals provide lower quality care while charging higher prices than not-for profit facilities. The editorial, which accompanies a study on the impact of investor-ownership on Medicare costs, comes just three weeks after the publication of research showing that investor-owned HMOs scored lower on every single one of 14 quality measures and spent 48 percent more on overhead and profits than not-for-profit HMOs.
Something I do not think has been looked at in this thread. If the US were more progressive would the priorities for spending be the same anyway? Healthcare and education would obviously get boosted substantially. But I suspect a lot of things might get cut as well.
Simply adding what you imagine cots to be to the existing tax take does not seem to make a lot of sense. Let us imagine (for example) that a progressive US cuts military spending as a proportion of GDP to the more realistic levels of other progressive nations. That frees up a huge sum immediately
And here I thought monopolies were bad. Not terribly difficult to make a profit when you’re the only provider of a highly sought service. And can regulate yourself.
Except there are many, widely acknowledged, structural efficiency issues to do with free market systems.
One is parastic marketing. If a market is at near-saturation point, then the only way for a company to gain customers is to poach them from other companies. So Company A spends $100m trying to attract customers from Company B and Company B spends $100m trying to attract customers from Company A and they both end up with the same number of customers but $200m poorer.
Another is the duplication of R&D costs. Each company has to spend money developing the same thing, essentially in secret and duplicate each others efforts. Since government research has no profit motive, information can be shared freely which can sometimes lead to significantly faster development.
Third is the tragedy of the commons or demerit goods. Private companies will tend to overproduce things like pollution since they do not have to pay for the effects (unless a regulation system like Kyoto is introduced)
Finally, there are issues with interoperability and standards. Each company has a vested interest in promoting it’s own standard in order to gain a competitive advantage but this leaves devices which are unable to interact with each other seamlessly.
