The same basis that we decide the government is responsible for anything–we tell them to, through our democratic process.
Of course, I’m not in favor of government-run health care. I am in favor of the government changing the regulations of the health care market to improve it.
Nearly everyone is a bit of an overstatement. Half the participants in the hijack did, and half didn’t. I didn’t express an opinion, but said that all disagreements stem from exactly the point you later made.
But since you brought it up, please tell me why it is proper for government to fund police power to protect our population from those with lethal weapons, no matter how much money the potential victim has, but it is not proper to protect all from viruses or bacteria with lethal weapons?
Well, seems you have two choices.
Provide health care only to citizens who can pay for it. Those who cannot are shown the door…they’ll just have to cope, MacGuyver something for themselves or suffer/die.
Provide health care to everyone.
#1 is pretty reprehensible and not even feasible. What is you are surfing, whack your head and wash up on shore unconscious. Strangers take you to the hospital but all you have on is your swimsuit. No proof you can pay a dime and you are unconscious with a gaping head wound. Toss you on the street since it is impossible to determine if you can pay? Treat you and when you wake up, after your $250,000 brain surgery, they find you can’t pay then who pays?
#2 is what we have today. Even with no ability to pay an ER has to see you. You and I pay for that. We pay for it through higher costs for services, higher insurance premiums and taxes.
So, if you are going to provide health care for everyone, and someone has to pay, how do you do it? The current system is a clusterfuck. Charity cannot do it. Private business certainly cannot do it.
The only agent who can draw money from all citizens and dole that money back out is the government. If you provide health care to everyone then everyone should pay in (devil is in the details there). The government is the one that can do that.
I’ve seen the 3% profit figure bounced around in several threads. My dad (an accountant for a major corporation) was always fond of saying that he could make a company show whatever amount of profit or loss you wanted, all legally, depending on how you did it. An exaggeration perhaps, but still one should not put too much faith into reported profits.
In addition, the amount of profit does not take into account the amount spent by the variety of insurance companies on expenses. Sure the profit may only be 3%, but don’t forget how much is spent on middle and senior management expenses for private insurance companies. Don’t forget the amount of money spent by doctors’ clinical practices on staff to decode the variety of insurance companies rules and regulations. Essentially, lets forget about talking about how much “Profit” is made, and instead focus on the amount of waste caused by the increase in administration costs in the US.
All health systems will have to use some form of rationing, especially in an era of increasingly expensive technologies in medicine. The question is: how should care be rationed, and who makes the decisions? One way is to ration care based on how much money you have, or whether or not your employer provides insurance. No money or no insurance? Go to the back of the line.
Another way is for medical professionals decide on rationing and triage. Want a full body MRI, because you think your liver feels funny? No, sorry. Pissed off because the poor guy in ER with chest pains is being seen before your important hemorrhoids ? Tough. And more problematically, do you want your elderly father with terminal cancer to get top notch knee surgery with a very low probability of success? Might not happen. Even if you’re rich. They’ll might just do it for younger patients with a higher probability of a successful outcome, and a better chance to live longer and be mobile. This is often what pisses people off - if they have the money, then dammit, they want to be able to buy whatever they want.
But in an effort to sway the popular opinion away from deciding this question in the affirmative, we can assert that it’s not the right role for government to have. Can’t we?
Certainly - fill your boots, as they say. I would hope that these efforts would focus on factual information, and would steer away from mischaracterizing problems that do exist with a publicly funded healthcare option. (Not to imply that you would do such a thing Bricker --far from it.)
For example - public health insurance paid for by taxes and available to every citizen will certainly result in wait lists for certain procedures. In some systems, you are unable to “buy your way” out of the waiting list. This may be problematic to some. It will NOT, however, lead to government run death camps for the elderly.
Of course. But I don’t think who’s running the system is as important as the outcomes of the system. We can ensure health care access to everyone with or without a government-run system. (Or we could decide not to ensure everyone with or without a government-run system.) We can fund the health care system independently of who is running it. The allocation system can be setup however we’d like, and what we choose doesn’t depend on who’s running the system.
For rational debate about health care, whether the organizations and institutions are public or private is a separate issue and a distraction from health care.
Firstly, please forgive and correct me if I mischaracterise anyone in my responses:
Pleonast
Pleonast makes the reasoned argument that regulation can achieve the desired outcomes, once we have decided what those outcomes are. My contention would be that regulation can only motivate - either by reward or punishment - changes in behaviour. There are lots of other motivations depending on how we set up the economic exchange of healthcare “goods”, so the economics has to come into the argument.
Bricker
Bricker asks the very valid question does the government have an obligation to give healthcare to those who can’t pay for it (or I assume, can’t insure against health risks - but this is an addition by me not Bricker). There are two reasons the government might. (A) Because a certain level of healthcare is a right, not a commodity. (B) Because a certain level of healthcare is a social good, not an individual good.
(B) is trivial to prove - sanitation and vaccinations for an individual have empirical health benefits for the rest of the individuals in the society. Since (B) is true, the question isn’t whether there is a government obligation, but how MUCH healthcare we have an obligation to provide. I would argue that most societies have an expressed preference NOT to have significant minorities dying of readily preventable or treatable diseases or injuries. We criticise other societies on this basis.
Whack-A-Mole and Voyager
You seem to agree that we should have as a goal a certain level of healthcare available for everyone. Where do you think this level should be set, and do you think people should be able to buy their way above it?
There are many parallels in education. In Australia (where I am from originally) we allow privately funded, government subsidised high school education. One of the arguments is that it costs the government less to subsidise a private place than to fully fund a public place, and the money saved can be spent on better public schools for those who can’t or don’t choose to buy a private education. We have a similar principle for health insurance - private insurance and care injects funds into the system, which is better for all participants, both public and private. You have to give people an incentive to inject their own money though, and the only incentive you have available is above-average care.
My point is that health care in the US is, technically, already available universally in the US. Unfortunately the current method is a mess and stunningly inefficient and staggeringly expensive. Our system of private insurance, which has been with us all along, has produced this colossal mess.
As such, arguing for the status quo is a non starter. It is disingenuous and people who support it are either outright liars or willfully ignorant. The evidence for the mess is manifest. It is unambiguous. It is the 800 pound gorilla in the room with us.
As I mentioned before we have two choices.
Provide health care only to those who can pay for it themselves (by whatever combination of out-of-pocket and employer means).
Provide health care to all.
#1 is simply not feasible. Even if someone is morally bankrupt enough to tell anyone who cannot write a check to just go die on the street we can come up with endless scenarios of just how it is a hospital determines you can pay before rendering service. It is easy to contemplate a situation where Bill Gates is not able to be identified as someone who could pay and is left to bleed out.
#2 we already do today.
So of those two would we have?
It really has to be #2. Who would deny a kid who was hit by a car medical treatment just because she was unable to pay?
So, the question to me then is how to do what we are already doing and make it efficient?
Remember, we already are paying for it and paying through the nose. A lot of medical visits are via the ER which is hugely expensive compared to a doctor’s office visit which may be able to deal with many (not all) cases the ER now sees. Worse, people wait because they cannot afford a doctor till the problem is so bad the ER is now what they really need. Expenses go through the roof.
Again, it is without doubt that the system today is jaw droppingly inefficient and jaw droppingly expensive. We are all paying through the nose. Cost of premiums have risen 73% in (IIRC) the last nine years!
Read the above paragraph again.
There is no way to see how private insurance can be the solution here. None. They have had their chances for decades. They led us to this mess and there is absolutely zero reason to suppose they can all of a sudden be the solution.
IMO the only option is to put in place a system that forces private insurance to provide the service they presumably should have all along. The only route I see to that is a Public Option.
Now, can rich people access better care if they want? Sure.
But remember what we are talking about here. The vast majority of hospital health care professionals are great in this country (I hem here because there are always a few fuckups in any group…by-and-large they are excellent). The “bottom” is pretty darn good with this lot. They have to be if for no other reason than liability to themselves and who they work for.
Now, if Cancer Specialist Doctor X is the best of the best of the best and wants to charge $1 million per visit she can do that. If some rich person is willing to pay that then that is their own lookout. Nothing wrong with it but no insurance, private or public, will be footing that bill.
So, rich folk are free to access the super-duper best. The rest of us will muddle through with the thoroughly professional and highly trained majority of doctors and nurses and do fine.
Well, I think it’s a statecraft issue, so that’s sort of politics. So “politics free zone” is a problematic limitation.
Direct government spending from tax. Health care has historically been handled by charities, & medical ethics are framed along need-based criteria. Trying to impose a fee-for-service paradigm for the sake of moral hazard is unnecessary, as there are other responsible ways of rationing already in place; & generally frustrating to the populace when they see what other countries (rich & poor) get for “free.” Until we go to tax-based funding, the cries will continue.
Traditional medical ethics. Triage principles, based on the need of the patient & the resources required.
Past that? I don’t know. All else being equal, I’d favor the person with less life insurance & more dependents. 
Prestige. Fund it through the NIH or the like, give the developers good grants & glowing press. Money can buy you a few luxuries, but hominids live for status.
What I find interesting is that there seem to be physician shortages across the English-speaking world. Not our mixed system, nor the Canadian Medicare system, nor the UK’s socialized system, is training enough doctors. But in fact, physicians trained in any of these countries or South Africa can work in any of the others. So it just takes one country’s bad med school policy to bring all of the others down; & it just takes one country’s proactive medical education policy to bring them all up.
We need to do the actual work of opening more schools, more slots, training more physicians, & we need to tax-subsidize it. Let that be an American export, Og knows we need some more.
I am most certainly NOT paying through the nose right now. And I won’t be unless UHC passes.
The same arguments you are making could apply for food. Food prices have gone up over time. Some food is cheap, some expensive. Some people cannot afford food. They cannot afford even $1 to buy a double cheeseburger at McDonalds… they can afford exactly $0. Since people die without food, why not guarantee everybody free food?
Who could possibly be against enacting laws to make our government feed everybody for free?
Well, if the govt is handing out food for $0, then a lot of businesses go out of business pretty quickly. And there’s a lot of people taking the food without ever paying into the system. Some of them waste the food since it is free. I don’t really like seeing someone take 10 extra unnecessary meals (or medical tests), but okay we’re “saving the world” here, so let’s go with that.
But instead of $1 per meal, suppose it costs $100 to $1000. Why so expensive? Well, you have to admit health care is going to cost more because the workers are more highly trained than fast food workers. Also, since this is government run, there’s going to be some inefficiencies and waste. Also, some people can’t tolerate regular food, they need the hyper expensive hypo-allergenic gourmet stuff. Or they say they do. Who are you to deny them what they say they need?
But what about the people who don’t have houses or cars or designer clothing? Free houses and cars and designer clothing for all!
The cost of them running it is 30 % . They are gobbling up a huge proportion of the money in mismanagement and exec salaries . Social Security is run on a sliver of what insurance companies gobble up.
Do not accept the creative book keeping of corporations.
http://vancouver.injuryboard.com/miscellaneous/private-health-insurance-profits-soar.aspx?googleid=230780 Here is an example.
Very few 1st world societies are happy with the idea of allowing their citizens to die of starvation, and most do something about it. This doesn’t need to be handing out of free food. The typical method is to give the poorest citizens the means necessary to buy food from private sellers. It’s not enough to buy expensive or non-cost-effective food.
Don’t get snarky, no one claimed we were saving the world. In ANY insurance system you have some people giving more than they take, and some taking more than they give. That’s the whole point - to spread the consequences so no one faces catastrophic risk. And ANY health care system faces the risk of people using too much of the service (because it appears “free”) or not making enough use of preventative care (because it doesn’t seem worth the cost).
Government doesn’t have a monopoly on inefficiencies and waste. Arguably, in health care the main sources of waste are unnecessary tests and treatments, due to irrational demand on the part of the patients and a fear of liability on the part of the care providers. Don’t mock government waste unless you have an alternative proposal which better reduces waste.
Ok, I’m done with civilised response, because I’ve reached the end of your hypothetical and you still haven’t made a reasoned argument.
With no insult or disparagement to the poster, this last statement is not an argument that is typically the product of a brain capable of reasoned discourse.
Thanks for joining the debate. You’re absolutely right that “politics free zone” is a misnomer, but it’s hard to fit “let’s avoid partisan complaints about particular extant systems or proposals, and talk about what would make a good solution” into a title bar.
I’m not sure I agree. A lot of medical care is by-appointment, and it is mostly a mix of diagnosis and treatment. Until you have the diagnosis, you can’t ration or prioritise, so it is often self-selecting who gets medical care for hayfever symptoms, and who thinks that pneumonia isn’t worth bothering the doctor about.
Personally, when I want to see a General Practicioner it is because I am concerned enough about something that I want to see someone within 24 hours and that person should be a Doctor. I get very frustrated if the GP has appointments booked solid for the next week or I can only see a nurse. How did all these people know in advance they would need medical assistance?
I think some sort of system to combat moral hazard is necessary. My favorite is rationing of false alarms, like in tennis. You have a choice of quick access to a doctor, or triage through a nurse. If you demand the doctor quickly, and it turns out to be something that would have been more appropriate with an advance appointment or a nurse, you score a strike. If it turns out that it was a reasonable request, you lose nothing. Too many strikes, and every visit goes through triage.
Really interesting point you raise about supply of Doctors. A sub-note is the huge disparity in doctor income, not based on a skill or experience gradient, but on the type of practise, type of patient, and specialty.
This is one of the silliest things I have read in the health care debate in a long time, and that is saying a lot.
The various brain drains that have taken place pretty much disprove your assertion that people live for status.
Slee
Comparing interest on CD and the percentage that income is of revenue is a bad analogy. Even comparing profit percentage of business in different industries doesn’t make sense.
The cooperative that I belong to “Group Health” which is a non-profit has a profit percentage (different terminology in non-profit) of about 3%. I’m not sure that a comparison between a non-profit and a for profit insurance is valid.
Perhaps what we need to do is apply the concept of “Economic Profits” that economist use. If I remember correctly from my college econ courses, economic profits result when there are not competitive markets or when markets are not in equilibrium. A drug maker with a patent on a very useful drug would be said to generate economic profits. Others are bared form producing and selling the drug eliminating market competition. Once the patent expires and others produce the same drug the price drops like a rock.
So perhaps the question is: are there economic profits in the Health Insurance Industry? Not a black and white answer. My two cents are that competition doesn’t work well in health insurance markets and the related provider markets. And/or that the free market competition in these markets tend to result outcomes other that more and cheaper medical insurance coverage. For example, excluding unhealthy participants or denying claims is more profitable than pursuing more efficiency and quality. I’m sure that the real truth is much more complex.
However, If there were regulations that took off the table, exclusion of coverage and aggressive claims denial, then perhaps the markets would work differently.
If you believe as I do that because of the baby boomers moving through the system that our economy will not be able to give everyone all that medical care that they might want, how do you allocate? This is very big gorilla indeed.
Yeah? How so?
The “best” way in terms of efficiency is probably none of the above, but rather paying for medical expenses like you pay for most things: out of pocket. Insurance works best when it only covers catastrophic loss, using it as a middle man to pay for health care expenses with a one time cost of sub-$10,000 means you have an insurance company involved in virtually every major or minor health care decision.
I think using a myriad system of private insurance mixed with some public insurance is one of the worst ways to fund regular health care costs. I tend to think health insurance should exist for catastrophic needs, and I believe there should be both private companies offering coverage and a public option for people below a certain income threshold (this would be funded by a payroll tax.)
Essentially prioritize the patients who have the greatest need. A guy getting a procedure done to correct a chronic non-life threatening issue would get lower priority than someone who needs immediate cardiac surgery, for example.
Exactly the way we do it now. You have public dollars floating research as well as private companies doing research for a profit. I tend to think doing both creates a good environment for innovation. I think there are even cases where we can clearly say society has been better off when there has been direct competition between public and privately funded research teams.
Everyone should be required to carry catastrophe coverage. If you’re above a certain income threshold this would be provided by a private health insurance company, below a certain threshold it’d be provided by the government.
Routine medical care should be paid for out of pocket, however again there should be a system in place to pay for the routine medical needs of people below a certain income threshold.
I tend to believe it needs to genuinely just be an income threshold and not an income + asset threshold. If someone is not making very much money they shouldn’t have to sell all their assets to qualify for the government program.
I take care of my health and don’t rely on doctors. Any medical issues I have, I take care of myself. And it is a sure bet that I would do some research beforehand to make sure I don’t overpay if I’m using my own money. Never been in a hospital. If I had to go, I would gladly pay my own way if that meant I never have to pay your way. Ever.
On the other hand, if UHC passes, millions of people would be taking out millions of dollars more than they put in. And I would have to pay my portion of it. I don’t know about you, but I don’t have an extra million dollars laying around to give to random strangers. This is what I call “paying through the nose”.
But judging from the other posters in this thread, they seem to have this kind of cash, so now I know to whom to refer those outstretched hands.
Oh, and regarding the claims of obscene profits, how do you explain the industry being ranked 86th in profitability? Here’s a convenient link. Shouldn’t we go after any of the other 85 more profitable industries first, since they’re clearly raping the American people more?
How come UHC works out to a much smaller fraction of the GDP while providing better outcomes, and high satisfaction, if it’s so expensive?