I’m putting this in Great Debates because I know it’ll turn into an argument. I’m lacking the time and the inclination to really argue either side, but I really want to see what people think.
There’s a very large segment of people here and elsewhere who hate the idea that government could be providing their health-care. The arguments vary, but it comes down to the idea that they will be forced to pay more for worse service. Okay.
I live in Canada, in a system that is continuously criticised by our citizens for being slow, expensive, and inefficient. While my personal experiences don’t bear that out, I’m willing to concede that it’s true, if only for the sake of discussion. The solution, some argue, is privatisation.
Now, I know next to nothing about the American system, which is the classic example of private health-care. Because I know so many people who want to move in that direction, it must be a pretty great set-up.
What makes it great? I’m ignorant. My goal isn’t to secretly have people realise flaws or anything. I’m genuinely curious what draws so many to privatisation, since I’ve never experienced private care.
It’s a bit less than “classic”, seeing as there are large components of publicly-funded care, including Medicaid, Medicare and the Veterans Administration system.
As to problems in the Canadian system, about which I know little, maybe you can explain what the major complaints are (delays in specialized/primary care? Rationing?) so we can decide if the current American system is doing better.
Sorry, by “classic,” I meant that it’s the system that gets pointed to when people are promoting (or defending) privatisation. Are there other famous private systems?
From what I understand, people don’t like paying the levels of taxes that they do for the health-care they receive. Waiting lists, especially for “non-essential” surgeries, can get excessive–years long, in fact. Rural services are rapidly decreasing, at least in the prairies.[sup]1[/sup] Plus, a lot of alternative treatments, like acupuncture, aren’t covered, so you have to pay for them yourself. That’s a few off the top of my head, anyway.
This might be more of a personnel issue than a public/private one.
Talking about “the government providing health care” makes it sound (at least to me) like the government would take over what the doctors and hospitals are currently doing, or at least be in charge of them, which is a scary thought. What’s actually being proposed (which makes a lot more sense) is to have the government take over what the private insurance companies, and/or what the private employers who provide health insurance as a benefit to their employees, are currently doing.
Do you have a car? Have you experienced private care for your car? That is, when it needs maintenance or service or new tires or whatever, do you take it to the place of your choice and pay out of pocket? If you don’t like the job they do, can you easily take your business elsewhere? Can you decide, based on your own priorities and values, how much money is worth putting into your vehicle? If you drive like a maniac or cheap out on regular maintenance, do you have to foot the bill for costly repairs?
I think that, at least in theory, the advantages of “private care” in medicine are supposed to parallel the advantages to “private care” in something like auto service. (If this doesn’t apply to you, you might replace something else, like computer service or veterinary care or even daily food, for automotive service in my analogy.)
I’m not saying I personally buy the analogy or that I’m a big advocate of privatization in health care, but it’s an interesting perspective.
(Even more far-fetched analogy, though it does speak to America’s tradition of rugged individualism and self-reliance: America has never had a national health service just like America has never had a national church.)
I work in Canadian healthcare and while I have minor issues with it, in general I find it excellent. The people with whom I work constantly mention the following priorities when discussing what to do: Best patient care, cost, standard of practice, safest thing to do for the patient.
I have participated in the US system as a patient. I found one portion of it to be excellent, which is the military delivery of healthcare, which is very similar to Canadian healthcare. In my limited exposure US civilian healthcare has been adequate, but not impressive.
The problem with the current system is not that we have a free market in healthcare, but that our market is far from free. The incentive systems are all screwed up. Patients have to go with the insurer that their employer mandates, regardless of how they are treated. Insurers try their best to avoid paying for medical procedures, but it’s doctors who are harmed by this, not the patient. Doctors try to do as many procedures as possible, but it’s the patient, not the insurer, that takes the fall.
Basically, you have the patient, the insurer, and the doctor. In every combination, A gets to decide how much B screws over C, rather than having his actions feed back on himself. No wonder the market is screwed up.
One way to fix this would be to have doctors bill by time, not procedure, and have insurance be an after-the-fact reimbursement of a percentage of the costs. If a doctor does too many procedures, they eat the costs and the patients go elsewhere. If the insurer fails to pay up on time, the patient picks another insurer. THAT’s the way the free market is supposed to work.
That’s the crux of it for me. Every “How horrible would it be if the government made health decisions?” falls flat for me considering that I have never had any medical procedure done for me of greater complexity than prescribing amoxicillan for a throat infection that wasn’t dabbled in by the insurance companies.
Doctor thinks I need a test done? Insurance doesn’t think it needs to be done. They won’t pay for it because they don’t agree with it. Doesn’t matter what the medical professional you chose thought – insurance says “nope” unless you want to shell out for the whole thing out of pocket. Of course, those prices are set with the assumption that insurance will be picking up the lion’s share of it.
Doctor wants to prescribe a medication? Insurance doesn’t think you need that medication. Despite what the doctor thought was best for you, the insurance company thinks you need to first try this medication over the counter followed by this cheap knock-off prescription medication. If those don’t work, come back in six months and we’ll discuss the one your doctor thought you needed.
Over and over, it’s the same thing. The insurance companies are in it for one reason only – to make money for themselves. Which is a perfectly valid reason to open a business (arguably, it’s the only reason to open a business). But I haven’t heard a good reason yet why entrusting my medical care to an industry whose only goal is to squeeze as much profit out of me as possible is better than entrusting it to the government.
Theoretically, Jophiel, it could be good, if insurance companies competed with each other to reduce costs. But the current system has you stuck with whatever insurer your company provides. In this system you can’t switch to Awesome Insurance Group if you wanted, no matter how Awesome they may be. So companies have no incentive to provide good service. (Instead, they wastefully compete with each other to woo corporate clients, which is inherently a zero-sum game).
That’s why many non-UHC supporters think that simply delinking healthcare from employment would make a big difference, making insurers compete in customer satisfaction rather than sweet-talking corporations. Sometimes a change in incentives is all it takes.
(This wouldn’t, unfortunately, remove the wasteful adversarial relation between doctors and insurance. One thing at a time.)
One good model for healthcare is Singapore, which with its usual technocratic zeal has a system of universal insurance but high co-payments (up to a point). This means that if you spend on medicine, you will pay part of the cost, and gives consumers an incentive to only get the healthcare they need, fighting price inflation. Under the current system patients don’t really pay for their own procedures; it’s all covered by insurance. So they have no incentive to refuse any medical procedures, however quackish
This is a good thing. I would be infuriated if my government were paying for ineffective psuedoscientific bullshit. And I’d be annoyed if my insurance company attmepted to steer me away from legitimate medical treatment to try to give me a cheap placebo.
In Britain they have government-run homeopathy clinics that do nothing useful, but it saves the government money when idiots choose to use those rather than demand actual medical treatment. That Canada has the decency not to succumb to that sort of bullshit is to its credit, not detriment.
Meanwhile here’s a takedown of the French healthcare system, one usually touted by UHC proponents:
Remember that healthcare costs are partly a result of lifestyles and genetics. Countries benefit not just by having good healthcare systems, but from having a healthy population (see Japan, which has a crappy universal healthcare system but a population that it’s cheap to treat in general.) US healthcare-bashers like to quote infant mortality statistics, but the fact is that if you compare the white US population with Europe, the US comes out ahead. Blacks, for genetic reasons, have a higher incidence of miscarriages and infant mortality, and if you make the demographics proportional the critics’ case collapses. It’s more fair to compare Scandinavia to, say, Minnesota, than it is to compare it to the US as a whole.
I have a question for the Canadians here. This might be a silly question but do you have private health care at all in Canada? Do you have such things as “private” hospitals who serve those with insurance or can afford to pay for it themselves?
I was familiar with the New Zealand system (although luckily never really needed it) until I moved to the US. In NZ you can buy private health insurance which supplements the public system. I used to have a policy with Southern Cross. It mostly meant that if I needed surgery I could get it done quickly at a private hospital rather than having to go on a waiting list (depending on urgency) to get it done for free at a public hospital. I don’t know what it costs today but it was very cheap compared to US standards, something like $40 NZD per month. I signed up for it because it was part of a package from my employer at the time and then I continued to pay for it myself after I left.
Various things I’ve read suggest that Canada is different in that “public” health care is the only health care. That might be complete nonsense so I’d appreciate clarification.
The Singaphore system is probably a better example, my understanding of the American system is that it’s a botched patchwork with huge government intervention, just in different areas then normal.
What a bunch of garbage. No one with a functioning brain cell would have read that beyond the first “myth”:
**
Canada’s health care system is “socialized medicine.”
False. In socialized medical systems, the doctors work directly for the state. In Canada (and many other countries with universal care), doctors run their own private practices, just like they do in the US. The only difference is that every doctor deals with one insurer, instead of 150. And that insurer is the provincial government, which is accountable to the legislature and the voters if the quality of coverage is allowed to slide.**
This guy failed economics and basic logic. “I’m not a thief. I stole nothing. I was just borrowing that money. I even left an IOU.”
I cant speak for the other 9 provinces, but its never been nessasary in Ontario to have a private clinic and pay per visit. We simply go to New York or Michigan and step into one of the facilities there. People were getting MRI’s and other long wait time items in Ontario, at that time* and the American doctors would email the results to the Canadian facility.
I had heard this sometime in the nineties , I assume its still ongoing but cant cite it.
Why is it that people get health insurance through employers in America, anyway? I don’t understand that. We don’t have to buy food from a company store. We get money, and we spend that where we want.
As this simplified time line shows, paradoxically the New Deal created an opening for private insurers to appear and industry found that it was not only convenient, but it also helped control workers more IMO.
The reason why I say that nowadays the current health care that we have can be appreciated only by a medieval feudal lord, is that as soon you or a member of your family develops a condition, you become in practice a serf to your company.
Because as soon as you decide to change jobs for any reason it is likely that you will not get the same coverage elsewhere. And we have not touched on the fact that anyone going to business on their own gets hit with higher health care costs than if he or she would by continuing to work in a large company.
Just for freedom reasons alone, I say that we need to have at least an optional government health plan that allows Americans the opportunity and the freedom to start their own companies.
Why does it have to be a government plan? Why don’t we get rid of employer health insurance tax credits, so that they won’t have an incentive to cover their employees, and people will have their pick of private insurers?
