Re: buggy-whip manufacturers.
How exactly does this ‘free-rider’ thing work? People pretending to be sick? People having free hips put in just for the hell of it? What? It certainly isn’t providing health care to people who need it but haven’t ‘paid’ in some way. That’s just ‘providing health care’.
I’m not within 5 light years of believing this is actually a problem rather than a hyperbolic extension of free market ideology into an area where it doesn’t apply.
I answered this post assuming that by “free riders” you meant “hypochondriacs,” but now realize that may not make sense. Most Americans already have free health-care, but is hypochondria already a significant problem?
And whatever “free riders” does mean, wouldn’t it already be a problem? Once Medicare or employer insurance compensation is withheld, the healthcare is free anyway, so I really don’t understand why your concern about “free riders” is not a matter of morality.
Please do explain, jtgain.
There are some unflattering possibilities. For example, right-wingers who hate socialized medicine might deliberately break legs etc. to flood the system and make it fail. But that’s not what you meant, is it?
And one is left with a huge confusion, no matter what “free riders” are. One big complaint is that Americans who need care will instead be executed by the “death panels.” And you’re also worried that Americans who don’t need care will flood the system with their “free riding”? Is this consistent?
May I address you personally, jtgain? My prose is harsh, partly to amuse, but partly because harsh words can have strong effect. Your argument is really and truly flawed. See beyond the harshness of my prose, and fight your ignorance!
Note that someone with a good insurance plan in the USA could do exactly that too. If your insurance is covering your medical bills, it doesn’t matter for you whether it’s a private or public insurance. So, if someone expects that in countries with UHC people will abuse the system by seeing a doctor/going to the hospital every other day, he should expect the same to happen for American people with a good insurance plan.
Somehow, I suspect that well covered Americans don’t spend all their free time in the doctor’s office anymore than people covered by an UHC system do. If anything, as already mentioned, people tend to see a doctor less often than they really should(*) (see here all the IMHO threads going like “I’ve some weird ailment, I don’t care about seeing a doctor, advice please?”. You could read the same on a French message board despite the UHC system).
(*) In fact I’ve been recently been guilty of that. Symptoms didn’t seem particularly worrying and I thought about mentioning them in passing while seeing the doctor for some other reason. Unpon hearing that I had those symptoms for several months, the doctors jumped to the ceiling, asked me why on Earth I was thinking for not mentioning them for so long, and had me go through a bazillion exams (for my defense I had absolutely no clue that these symptoms could reveal a variety of very severe, sometimes lethal, conditions, including cancer, heart disease, kidney failure and what not…)
My husband and I are guilty of under-visiting our doctor, too. Going to the doctor isn’t a fun experience; it’s not terrible or anything, but we don’t go just for fun - we go when we, as intelligent adults, feel there is a need for us to go. Of course there are people here who abuse the system; I don’t think they’re a large segment of the population, though.
You could point out to your friend that if the US were to import the UK system - NHS with private top-up - the US would save $1 Trillion overall every year. You could also ask your friend how she would cope if both she and her husband lost their jobs and were unemployed for an extended time.
Yes, hypochodriacs are a problem. Particularly for the EMS (ambulance) system where it is a common enough, and serious enough, problem to have spawned a different usage for the term frequent flyer.
Then you would predict that Medicare would have a low user satisfaction rate, since it is basically UHC run by government flunkies. Why don’t you look that up and get back to us?
BTW, people who work for large companies don’t have much choice either. If I don’t want to enroll in an HMO I have exactly one insurance company I can choose. And it gets changed from year to year based on what the company negotiates. I’m far more concerned with choice of doctors, which would be preserved in any likely US UHC system.
You should play “Like a Rolling Stone” for her. If by some chance she and her husband lose everything, and she has a pre-existing condition, she’d get really screwed under the old system.
Health care, like everything else, is a finite resource. Something has to give. Either you will give everyone less care, or you will pay more because you need more of the resource for everyone (i.e. you need more doctors, more facilities, more equipment, etc)…or you give everyone the care, but time is where you get the slippage (i.e. you give everyone care over a longer period of time). Unless you posit infinite resources though something, somewhere has to give.
That said, I don’t have a major problem with a single payer system or UHC, depending on how it’s implemented. I think that, realistically, it’s going to be harder to implement in the US than folks think, and that it will cost a hell of a lot more than our current system (at least initially), and that what we’ll end up with is a system that makes the folks who currently have healthcare less happy with the new system, while balancing that with making folks who currently don’t have formal healthcare and rely on emergency treatment more happy. I don’t know if making a lot of folks slightly (optimistically) less happy is worth making a minority (though significant in number) of folks more happy is worth it, but I’d be willing to give it a shot, depending on what the actual plan was to put it in place, realistically, in the US. In general I see a lot of pie in the sky and rosy glasses view of how we’d go about doing it.
As compared to the current system, this is not a con, but just status-quo for most Americans. They have a choice only of whatever insurance company and plan their employer chooses. Large companies may offer several options that are seldom competitive in terms of providing the same coverage, usually the options cover some range from bare-bones to Cadillac plans at increasing cost to the employee. Small employers typically offer at most one option.
If both spouses work at different companies, they may be able to make some choice that way, but many companies have rules about which spouse is required to cover the kids, so choice is eliminated. My company actually does this, not sure of rules as I don’t have kids.
Wait, you take preventative care (one of the smallest, most cost effective elements of health insurance) and paint the whole thing as being “not insurance” because soem element of it is not really actuarially determined?
Almost all high deductible plans have FREE preventative care and I don’t know anyone with chronic illness that woudl require require routine prescription refills that think that a high deductible plan is a good idea. High deductible health plans are a good idea if you are only looking for catastrophic health care coverage. And if you only get sick occassionally, thre simply isn’t much comparison shopping.
Some central planning bureaucrat sets those prices today. See, bureau of medicare and medicaid services.
Besides the experience of other industrilized nations with UHC is exactly the opposite of what you describe.
We aren’t getting universal healthcare because we have a party that believes in small government regardless of whether or not a bit more government would be good for the nation. Of course this party didn’t beleive this until fairly recently.
I think you are confusing freeriding and overconsumption. A well insured patient is as likely to engage in overconsumption as one that has universal healthcare. It is a problem associated with insurance, not UHC.
Health care is not a “normal good” and doesn’t behave like one.
I agree with your second paragraph, but not this one. Health care is not very elastic. Make shoes free, and some people will buy an almost unlimited number of shoes. Make healthcare effectively free, and few people will choose to spend much of their time at the doctors. People don’t check themselves into the hospital. The number of hypochondriacs is overwhelmed by the number of doctor avoiders, most likely, and doctors can easily put in screens (like relatively cheap nurse screenings) to avoid the worst of the problems. In any case, we probably would be seeing it with Medicare patients already.
Most health care economists (yes, that is an actual discipline) favor moving over to the German system. Bismark model employer-provided health care with the kinks ironed out.
Today, government health care in the US includes Medicare, Medicaid, the Children’s Health Insurance Program, VA, IH, etc. Each with their own bureaucracies. For which the American tax payer pays -not surprisingly, more than the average European tax payer does for their single government program covering everyone and its one set of bureaucrats! In total, the government-funded programs cover roughly 1/3 of the US population. This group includes the most expensive demographics, the old and the too sick to work.
The remaining 2/3rds tend to be the people healthy enough to be taxpayers.
So how much does the USA spend on government health care?
Just short of $ 4000 per citizen per year. Or 9 % GDP. Thats more than Canada spends on government health care. Its more than the UK spends per person. More than Japan, France and Germany. Government health care in the USA is already more expensive than in UHC countries that cover everyone!
And the US has the economic advantage of size.
No, never. I cannot really see how that would be possible. You know what we do in our surgery in Norway when a patient walks in, in the way of insurance and bureaucracy? We ask the patients name. Thats it.
Also, what stops you from getting insurance if you want it? Just because we have UHC doesn’t mean you can’t spend your money on insurance if you want. The insurance companies are happy enough to sell, even if they do occasionally run into trouble because they can’t actually show a benefit to what they’ve sold.
Some UHC countries, such as Switzerland, Germany and the Nederlands run use insurance as the delivery vehicle for UHC. They are loosely known as Bismark-model countries.
True. However, a well insured patient is actually much, much more likly to engage in overconsumption than a UHC patient. In the insurance scenario, the part bearing the cost of the treatment -the insurance company- is entirely removed from doctor-patient interaction. There is** no** brake there. In the UHC scenario, there is the hospitals budget generating a cost/benefit analysis on behaf of the patient. This stops a lot of medically unneccessary work.
Overprovision is one of major drivers in US health care overspending (roughy 34 % of the excess, from memory)
One thing that I can see happening with UHC is that it puts pressure on the government to start to looking after its citizens a bit more. This could eventually result in the government encouraging a healthier lifestyle and discouraging corporations who might want to do things that aren’t necessarily good for people’s health. I think that’s why libertarians hate the idea.
Not sure of this would be a pro or a con though. To me it’s a pro.
Aha! So that’s where you’ve been keeping your death panels!
When Bush was governor of Texas, he brought death panels to Texas: section 166.046 of the Texas Health and Safety Code(HEALTH AND SAFETY CODE CHAPTER 166. ADVANCE DIRECTIVES).
Just having cradle to grave insurance makes for better long term health decisions. When an insurance company decides what to cover for free and what to subject to a deductible or copay, they do not take into account costs that they expect to be covered by medicare.
So if there were a disease that only manifests after the medicare eligible age, they will not make cover preventative care for that but if the insurance company covered you to the end of your life, they would be much more diligent about preventing a lot of the old age chronic diseases.
I don’t see why this wouldn’t apply to state funded care. In fact I know it does apply in the UK - preventing disease is far less costly to the tax payer than only treating diseases when they become very serious. Plus it keeps your tax-paying work force healthy and productive. Win win.
Weeeeeeellll…that’s actually something that’s beginning to be pretty hotly debated. It may turn out that “preventing disease” is more expensive, keeping them alive to require expensive custodial care due to Alzeheimer’s, strokes or end stage renal disease, rather than letting people die younger and faster of heart attacks and diabetes.
It’s not being debated very loudly, because it leads to death panel accusations, of course.
Still, it has nothing to do with UHC, per se. Even with a focus on perhaps-more-expensive preventative care, they’re spending less in the UK than we spend here. But preventative medicine is a whole 'nother sticky wicket…maybe they could be spending even less by encouraging obesity, alcoholism and smoking!
Saving money is a great reason to support UHC. But don’t go too far with that argument, or you turn into a monster. Saving money must always be balanced with providing humane care.