Instead of socialized medicine...how about

Great Debates
41

I think this is the wrong way to analyze the question. The question is whether you think people should have health care when they need it. If you don’t, then let the free market handle it. If you do, then you have to look at whether free markets can accomplish that goal.

The food industry is highly regulated and subsidized. This is your free market example?

Board certifications are designed to address an information assymetry problem. It is difficult for most people to determine the competency of a health care provider. Part of this is because patient records are generally confidential, so the public just can’t pour through everyone’s chart to determine who is getting bad health care. You could try using malpractice claims as a proxy for competence, but a number of claims don’t ever reach the courts and a number of times the cases are sealed. Medicine is a highly complex field, and as the speciality gets more complex, it becomes more difficult to determine competency.

What board certification is an attempt to do is set a floor for competency, in order to reduce the chances that people will be injured by their health care providers. It also is an attempt to make sure that if they are injured, the health care provider will have enough insurance to cover the claims.

Now, we can argue as to whether medical boards do their job well, or if they can be improved in specific ways. But your solution does nothing to address the underlying problem.

You seem to be assuming that physician costs are what are driving medical costs up in this country. My understanding is that physician wages are being depressed. If I’m correct, then eliminating the physician isn’t going to make much of an impact over the long haul.

Aside from this, once again, there is a huge information assymetry problem when it comes to medication. It is difficult for many people to know in advance how they will react to medications, particularly addictive ones. One of the purposes of the perscription system (and there are a number) is to reduce the likelihood of medication injuries. You haven’t proposed any way that this problem would be solved under your system.

Another purpose of the perscription system is to limit the scope of 3rd party injuries. For example, the perscription system reduces the ability of a caregiver to accidentally give medication to his ward that causes injury. It also reduces the likelihood that someone will get doped on something and go out for a spin in their car. Now, it doesn’t prevent these things entirely, but without a perscription system, my guess is that these would be much worse.

Without a perscription system, drug manufacturers would be exposed to so much legal liability, that I can’t imagine anyone bothering to manufacture certain types of drugs anymore. Why would anybody manufacture, say, morphine, when they would routinely face lawsuits stemming from people out there who use the drug improperly?

How do you know the tests are needless? Insurance companies (whether private or public) have tremendous pressure and incentives to cut costs. Do you really think your insurer is happily forking over money for unnecessary testing?

The purpose of insurance is to pool risk. Some people will be very health all their lives and then die suddenly (as in a car accident). Others will be very ill and rack up medical expenses in the hundreds of thousands. None of us knows where we’ll end up, but most people cannot afford to self-insure for hundreds of thousands of dollars. How do you propose to pool risk if insurance companies are eliminated?

How do you stop the drunk from performing heart surgery without some sort of certification?

42

I’ve been to a good number of countries also without national health insurance and with virtually no effective regulations on health care providers. I’ve found that pharmaceuticals are usually cheap, one can pay lots for good health care, but the overall level of health services are abysmal.

It’s like most aspects of Libertopia: somewhere in the world, one can find always find a place where doctors are unregulated, or where guns are plentiful, or where roads aren’t built by the government, or where poor people are left to their own devices. These places always suck.

I can’t imagine why people would travel the world, see all the problems out there, and come back saying: “We need to adopt those policies, because they’ll work here.”

43

Can you name a single real-world example of what you’re describing, outside the Third World?

44

Dental care is weird but I imagine that it makes sense to some one , I had a dentist give me two quotes , one for a root canal at 1k and yanking the tooth for a hundred bucks , the tooth got evicted.

Declan

45

That’s probably more a result of advances in technology. 45 years ago my father had a blood clot in his leg, which spread various places. He was in the hospital for months. (Since he was working for the UN in the Congo, cost was not an issue.) A few years ago, when he was nearly 90, he had another clot. A stent was put in and he was in the hospital for two nights. Lots of surgeries are done out-patient these days. Even insurance covered procedures are becoming more efficient - but there are more of them, for things untreatable in the past. My wife had her retina reattached. It was fairly expensive, true, but in the past there would be less cost since she would have gone blind in that eye.

46

Yes indeed. Here it is..

I don’t have a cite about what percentage of people refuse to go for checkups. If it was that big, the insurance companies would notice, I bet. There is also the problem of someone with a minor complaint that could turn into a big problem if they don’t go because of money. We had a thread a while back about a Doper who was trying to avoid hospitalization for a major heart problem because of lack of insurance and lack of pay when sick. (That’s a different problem.)

My life insurance is cheaper because I don’t smoke. Auto insurance now won’t cover accidents in certain conditions. But I agree that such things shouldn’t be mandatory, but rather done through education, which is working pretty well in the US. Anti-smoking laws here are more for the protection of others than for the protection of the smoker. (Or that’s the justification.)

Sure. People go bankrupt for all kinds of reasons. Do you want me to repeat the percentage who get into trouble because of health care costs again?

Yup, both you and the homeless guy downtown are free to sleep under a bridge. I fail to see why forcing a ten year old kid (or an adult) to forgo a visit to the doctor to check out something worrisome is limiting his freedom. I don’t think I’d feel one bit freer if my job didn’t provide healthcare. I suppose the person getting foodstamps and not starving, the way they used to 50 years ago, is having his freedom abridged also. There are plenty of ways these people are going to experience financial risk even if healthcare is covered, so you can feel good about that.

47

But employers are the consumers of insurance. I have two choices - an HMO and a PPO, so I don’t have a lot of choice here. When my employer was going to switch, they could compare every insurer, and had full time people on it. They made a more informed choice than I could have, and had a lot more negotiating power. My insurance tells me how much less they pay the doctor than the standard rate. Do you think I could get that discount?

The government doesn’t pay for any of mine - how does Medicare and Medicaid affect my free market choices?

And that of course explains why foreign single payer systems are cheaper with better results than ours. How many cites do we have to give you people for you to open your eyes? Medicare is more efficient than private insurance in terms of overhead. I cited that already. I feel like I’m waving a fossil in front of a creationist - no matter how often I give evidence, they still won’t open their eyes to look at it.

48

But they are not the consumers of health care. It makes no sense to have a third party pay a fourth party for a service consumed by you.

I’m not saying go without insurance. I’m saying that individuals should purchase their own insurance.

Well, there have been some studies that link the astounding growth in the cost of health care to the advent of government health care programs like Medicare.

Government also affects your free market choice by heavily regulating the industry. It limits the number of doctors, nurses, and health care facilities. It forces insurance companies to cover certain ailments. It sets rates. All these things drive up the price of your health care and reduce your choices.

Because your “evidence” is bogus. Medicare is only slightly more efficient in terms of overhead than private insurance. Furthermore, many things considered “overhead” for private insurance don’t exist for Medicare, so it’s not really a fair comparison. Cite. There are also a variety of studies that illustrate that, yes, socialized medicine does control cost, but produces long wait times and higher mortality rates. Cite.

I know your frustration about how people refuse to look at the evidence.

It is my understanding that the vast majority of health care consumed in the U.S. is not for emergency care. If it’s not emergency care, you can shop around for it. Furthermore, I’m fine with individuals purchasing insurance. I think that if we removed the government subsidy for employer-sponsored care we’d have people actually purchasing true health insurance – high deductible policies to cover truly emergency or unexpected incidents. That’s the way the system should work.

49

First of all, employer paid health care is not at the mandate of the government, but comes purely from private companies making deals with employees and insurance companies. Do you want government to get involved in banning this?

Second, my employer also pays into my 401(K). Is that also offensive to you for some reason? They pay life insurance also. We have the common menu of benefits, where I get a certain amount of dollars, choose what I want, and pay more if I go over. (And get money back if I go under, which is not likely.) Exactly how is this bad, or any different from them giving me the money? Like I said, they choose better than I do. Do you doubt this is possible? If so, I hope you don’t own any mutual funds, which is also accepting that experts can choose better than we can.

Now, some people have said that employer paid insurance was a mistake, since it took the pressure off the need for government paid single payer plans. I think a case can be made for that, but I doubt that’s where you are going.

Medicare started in 1965 or so, and I remember the ads decrying it and predicting doom if it was enacted. I don’t remember any talk of a health costs crisis for over 20 years after this. I have heard people complaining that Medicare doesn’t pay enough, so doctors must charge more for other patients, but that would just increase the drive for efficiency, wouldn’t it? That would be a plus from your perspective - and mine too, in fact.

Does government limit the number of doctors, or does the AMA? We have a nursing shortage, and a problem is not enough slots in nursing schools. The reason for that, for California colleges, is that every student gets the same amount from the state, and since it costs more to train a nurse, the colleges lose money. They’re working on special grants for nursing education, to remedy this. A while back nurses were not being paid well, but it seems this has turned around - free market at work. California does have minimum numbers of nurses required, but that is the opposite of what you claim, and is necessary so that facilities don’t cut back on nurses to increase profit at the expense of patients.

Government does set rates for what it pays for - not for anything else. I know forcing companies to cover birth control is controversial, but for anything else I’m not aware of regulations - though it would make sense to force insurance companies to be more or less equivalent, to avoid surprises.

It would have been nice if your second cite had given actual numbers on the summary page.
Here’s one directly comparing Canada to the US - especially useful since Canada used to have our kind of health care coverage. Here’s another about infant mortality rates ansd life expectancies for more countries. Forget about
Cuba - I actually only care about comparable countries.
As for Medicare, we’ve been through this and I still fail to see how the salaries of some government managers make up for the huge difference in this gigantic program.

Oh, the irony!

Then all those without employer sponsored health insurance should be running out to buy it right now. I’ve already mentioned how early visits save money in the long run - how would your plan address this? How would making it relatively more expensive for employees to get insurance help anything? If private cases exerted downward pressure on prices, we’d see that now. Actually, the reverse is true since those with less likelihood of needing insurance don’t get it, leaving the pool full of people who will need it, making the insurance more expensive. Thus the move for mandating insurance.

50

No, it shouldn’t be banned. However, it also should not be subsidized like it is today. Either individuals should receive the same tax breaks corporations get for purchasing health care or the employer tax breaks should be eliminated. The government has subsidized the employer-sponsored health insurance model and that’s the reason it is so prevalent today.

You might want to read Amy Finkelstein’s work on how Medicare spending affected overall health care spending in the U.S.

Government limits doctors, nurses, and other health care professionals through licensing. In many states it also limits the number of health care facilities through certificates of need. Many states also limit what types of procedures certain professions can do.

If you are unaware of the huge number of mandates put on health insurance by state legislatures, then you really need to do some reading on how health insurance works in the U.S.

Of course, infant mortality is measured differently in the U.S. than in other nations. And, controlled for things like murders and car accidents (things that have little to do with our health care system), U.S. life expectancy rates do quite well.

Again, if you think that’s all there is to this question then you need to do a little more reading.

Again, eliminate government policies that prevent health insurance from being real insurance (insurance pays for high cost, low probability events, not routine care). Eliminate government barriers which prevent nurses and others from opening quick care clinics. Let health care consumers have the freedom to choose and health care professionals have the freedom to meet these choices. Right now the government places huge roadblocks in the way of this happening (usually at the behest of doctors and other professionals who do not want competition).

I’m not saying this would be perfect. We’d obviously need some sort of subsidy for the lowest-income people to obtain care or insurance. But it would fix many of the problems of our current system as well as avoid the problems and higher taxes that come with single-payer systems.

51

I listed other reasons why segments of the health care market exhibit price inelasticity. I can list more, but you’ll probably ignore those as well: treatments for which there is low demand (so there will be few practicioners), specialities which require advanced training (and also, consequently have few practicioners).

Really? How do you shop around for goods or services that are exhibiting monopoly or oligopoly behavior? Treatments that are under patent protection are going to be subject to very little price competition.

I should also point out that there is an area between immediate emergency care and completely elective care. The shorter a time frame required for treatment, the less ability there is to shop around.

And what should happen under your system is that people who need insurance will be dumped by their insurance companies. There is little-to-no financial incentive for an insurance company to insure someone who is going to need expensive treatment. Under your system, a lot of people will be walking around uninsured.

52

Indeed people are, in effect, being tortured into doing business with entities that are under little market pressure to lower their prices.

How about we create a separate sector whereby the currently uninsured can get affordable healthcare, but subject to certain limitations? I’m thinking of some sort of combination of the OP’s plan and government employees providing care.

53

I’m uninsured, and the idea of “government employees providing care” gives me cold chills. I was married to Mr. SCL for 5 of the 8 years he was in the Army, and the wide range in competence of the doctors I saw during that time frame was nothing short of astounding. I had an outstanding hand surgeon, but then there was the doctor who lanced a huge boil on the inside of my thigh and told me “I don’t write for pain meds.” Not “You don’t need pain meds” but that he didn’t prescribe them under any circumstances. There was the doctor how called a tech in at 3am to do an MRI when he thought I had had a stroke. Then there was the dentist who (after having a discussion in my hearing about how to bend the anesthetic needle to inject through the roof of my mouth and try to hit that nerve) yelled at me to “stop crying, you’re making me nervous”.

Not all doctors can graduate at the top of the class. :wink:

54

Eh, that’s a matter of new technology becoming cheaper. Nothing to do with some imaginary general tendency of markets to lower prices of established procedures.