Reframing "socialism" into "natural human rights"

[wolfpup]

@UltraVires

I think all posters here agree that capitalism generally works better. I don’t think we have command control communists here. So since we agree on the general principle, what is unique about health care delivery that would make health care an exception to the general rule?

Because medically necessary health care is not a commodity like a washing machine or a car, in which the capitalist economy churns out a wide variety of models at widely differing prices, and you get what you can afford to pay for. Health care is not like that; not practically, ethically, morally, or in any other way. It’s not a commodity product, it’s an essential service, and it’s the obligation of every civilized society to ensure that every citizen has access to the best possible health care, and to pay for it collectively either through taxes or some combination of taxes, premiums, and subsidies. I don’t care if the health care provider system is for-profit market-based (in fact I favor it, though we might quibble about the drawbacks of for-profit hospital corporations). But the payer should either be the government or, as in Germany, highly regulated third parties. Private insurance for medically necessary health care is not a legitimate business; at best it’s the proverbial square peg in a round hole whose primary objective and fiduciary responsibility is to avoid paying for a patient’s care, but at its worst, it’s criminal racketeering that kills people or drives them to bankruptcy.

@UltraVires

To answer your question, though, it would “work” in the sense that all government programs work—mediocre, slow shitty service, a thousand forms, and inefficient resource allocation. As we agree generally, why not let the free market provide a better service? What is the constraint that prevents it?

What are these thousand forms you’re talking about? You seem to be describing the present mess. I live in Canada with single-payer health care, and here in Ontario literally the only form I have ever seen related to health care is the one I sign every five years to renew my health card. It’s a trivially simple form that mainly just confirms that I live here and am a legitimate resident. I suppose there was one I signed in the hospital pre-surgery stating that the risks had been explained to me, if that counts. But that’s it. The streamlined efficiency of single-payer is one of its major strengths. All my doctor has to do when I visit is enter my name, card number, and billing code(s) into an automated system, and it’s done. She is strict about missing appointments, though, and one time when I forgot, she sent me a bill for $35. Trying to pay it at the office on my next visit was hilarious, since they have no facilities for billing patients for anything. The receptionist took it and stuck it in a drawer with a puzzled expression and for all I know it’s still there.

[UltraVires]

@iiandyiiii

If the market controls health care, there will always be the incentive to deny treatment to the needy, because such treatment costs the insurance companies money. And most needy folks won’t have the resources to go toe-to-toe with the insurance companies, or the resources to pay doctors directly. That’s what the profit motive does – it motivates the denial of treatment. Take the profit motive out of necessary medical care and there’s no more motive to deny treatment.

We could combat this by taking away from insurance the payment for typical services and passing strong “reasonable expectations” laws for companies selling catastrophic insurance.

In case you were going to say it, that’s not socialism. Capitalism should be regulated. If I say I am selling your catastrophic health insurance, I shouldn’t be able to bury a clause in page 484 of the agreement that you clicked on that says “This policy covers nothing.” That’s Libertarian capitalism which AFAIK, nobody except extreme right/left wingers agree with. There is nothing wrong with society requiring honest dealing between people and we generally do it except when it comes to adhesion contracts. I agree with consumer protection laws. Unequal information harms free markets.

[wolfpup]

@UltraVires

Ok, here’s the difference. When the state accuses you of a crime, they are attempting to take away your liberty. That is an affirmative action against you. In order to do that, it is only fair (if you are poor) that the same state, including the taxpayers in it, fund a reasonable defense so that you can rebut the charges.

It really isn’t 100% for the benefit of the defendant. It is not in the state’s interests to incarcerate innocent people, and without a public defender, the state may well do so due to the defendant’s ignorance or indigence.

If we contrast that with health care, the state is not responsible for making a person sick, so no corresponding duty arises.

There is no difference. It may not be the state making the accusation, it could be a malicious individual. The state is no more “responsible” for that than if you get sick. In both cases there are institutions that should intervene on your behalf; in the latter case, it’s medical intervention that’s required, and it should be a collective responsibility because it’s not merely your liberty you may lose, it may be your life.

[wolfpup]

I’ve said it before, but I think some of those advocating free-market health care should have a look at this book.

[Ravenman]

@UltraVires

Ok, here’s the difference. When the state accuses you of a crime, they are attempting to take away your liberty. That is an affirmative action against you. In order to do that, it is only fair (if you are poor) that the same state, including the taxpayers in it, fund a reasonable defense so that you can rebut the charges.

It really isn’t 100% for the benefit of the defendant. It is not in the state’s interests to incarcerate innocent people, and without a public defender, the state may well do so due to the defendant’s ignorance or indigence.

If we contrast that with health care, the state is not responsible for making a person sick, so no corresponding duty arises.

You aren’t denying it is socialism. Sounds like you’re saying it is justified socialism. Or, perhaps that things you don’t like get labeled socialism, and things you do like get labeled fairness.

[str8cashhomie]

@UltraVires

Another poster opined that in health care, you never know how much you will need and when you will need it. I never know when my house will burn down, when the engine will blow up in my car, or when some drunk without insurance will crash into me. None of those circumstances demand a top down government approach.

The problem is the opposite, you often do know that you’re going to have prohibitively high healthcare costs possibly for years. And your insurance company knows it.

If you consider Obamacare, in which (in theory) people are required to have health insurance, insurance companies are required to give someone with a preexisting condition the same coverage as a healthy person and (in theory) the federal government and the states team up to pay for people who can’t afford to buy private insurance, then sure, but it’s really a far stretch from a real free-market solution.

[davidm]

Is anyone here against Medicare?

From my experience with my mother, and now myself, it seems to work just as well as private healthcare.

Have I experienced a few issues with it here and there? Sure, but no more than I’ve experienced with private insurance in the past. No system is perfect.

So why should Medicare be restricted to only the elderly or disabled?

Regarding the idea that healthcare workers would become slaves; in all respect that sounds like a talking point rather than a serious argument. When a doctor or nurse treats a Medicare patient are they a slave to that patient?

[Little_Nemo]

@UltraVires

And we have a million industries in the United States that operate under free market principles that are vastly superior that government owned or paid for ones. Why is health care so different that it cannot operate under free market principles?

My answer (back in post #108) is the same as when you asked the question the first time. You quoted my post in one of your posts so you must be aware of what I said.

[Gyrate]

@puddleglum

Which numbers are you referring to? Medicare in the US is not much cheaper per capita then private insurance per capita, and Medicaid outcomes in the US are worse than on private insurance.

Medicare and Medicaid at present are not UHC. Try again.

As for numbers, one can find all sorts of studies and comparisons using all sorts of metrics. Here’s one from 2017.

@UltraVires

To answer your question, though, it would “work” in the sense that all government programs work—mediocre, slow shitty service, a thousand forms, and inefficient resource allocation.

Actually, the NHS is far more efficient and better at resource allocation than the fragmented US system. The service I’ve had has been swift and excellent - you may wait longer for non-urgent procedures but even then there’s a separate private system if you want to pay to jump the queue. Oh, and I can see my GP or see a specialist without filling in a single form - apart from having to sign the back of my prescription, the price of which is going up in April to a whopping £9.15 per prescription (that’s just under US$12 at today’s exchange rate), no matter what it’s for. How many forms do **you **have to fill out each time you see a doctor?

This whole “the government is terrible at running everything and the private sector would do it better” tenet remains untrue. For services where outcomes and accessibility supersede profit margins, the government is exactly the entity to run such things.

@UltraVires

If we contrast that with health care, the state is not responsible for making a person sick, so no corresponding duty arises.

The state isn’t responsible for buildings catching fire either. Should we leave those to be fixed via the free market as they used to be in various cultures? Because it kind of didn’t work very well - it was grossly inefficient, subject to massive abuse on both sides of the equation, and meant that those unable to pay for a fire service had to suffer and simultaneously put those around them at risk due to the lack of treatment. Hmmm…sounds familiar…

[iiandyiiii]

@UltraVires

We could combat this by taking away from insurance the payment for typical services and passing strong “reasonable expectations” laws for companies selling catastrophic insurance.

In case you were going to say it, that’s not socialism. Capitalism should be regulated. If I say I am selling your catastrophic health insurance, I shouldn’t be able to bury a clause in page 484 of the agreement that you clicked on that says “This policy covers nothing.” That’s Libertarian capitalism which AFAIK, nobody except extreme right/left wingers agree with. There is nothing wrong with society requiring honest dealing between people and we generally do it except when it comes to adhesion contracts. I agree with consumer protection laws. Unequal information harms free markets.

If I understand correctly, such regulations already exist. And they don’t stop insurance companies from doing everything they can to deny treatment – often successfully. I have good insurance, and I’ve had the same insurance for 5 years, but I’ve had to call them multiple times every year so far because they’ve tried to deny coverage. Sometimes it gets cleared up but sometimes they hold firm and say that a particular visit or treatment wasn’t necessary and thus won’t be covered. And we have to pay for it. Luckily, we can afford it, but many, many families can’t.

[Shodan]

@Max_S

@UltraVires

If every patient was Medicare or Medicaid, no doctor could survive at those reimbursement levels.

Cite?

The losses of U.S. hospitals from treating Medicare patients escalated sharply in 2012, when Congress included Medicare in its budget sequester, and they have remained high since. About three-fourths of short-term acute-care hospitals lost money treating Medicare patients in 2016, according to the Medicare Payment Advisory Commission (MedPAC), an independent agency established to advise the U.S. Congress on issues affecting the Medicare program.

Regards,
Shodan

[Ravenman]

So is your answer to have Medicare pay doctors more, and increase taxes accordingly; or get rid of Medicare somehow?

[Shodan]

I thought the idea was that doctors would just have to accept the lower Medicare rates, and somehow cut costs so they could stay in business.

Regards,
Shodan

[Ravenman]

@Shodan

I thought the idea was that doctors would just have to accept the lower Medicare rates, and somehow cut costs so they could stay in business.

You’re complaining that Medicare isn’t working right, so how would you fix it?

[Gyrate]

For starters, you wouldn’t have to pay all those people to assess Medicare eligibility on a person-by-person and procedure-by-procedure basis.

[Shodan]

Medicare works currently because patients have supplemental insurance, and because doctors can make up the difference by charging their other patients more. But we were talking about implementing M4A.

If we allow private supplemental insurance, then we don’t save money on administrative costs, and we don’t reduce costs overall. Then liberals will complain about people who can’t afford supplemental insurance, so either the government raises reimbursement rates, either directly or indirectly, and we don’t reduce costs overall. Or we don’t allow private insurance, and then doctors and hospitals lose money on most of their patients, because there is nobody else to charge more.

It isn’t that Medicare isn’t working - it’s that if you eliminate the things that allow it to keep working, you are trying to implement a form of price fixing.

We need to implement some form of rationing. Death panels, IOW.

The usual comeback is that we already have rationing, because the middle class and rich get healthcare that poor people can’t get. That’s a good model. The middle class and rich people shouldn’t get that healthcare.

Sorry your mother has congestive heart failure, but she’s 78. We aren’t going to do much except keep her comfortable. Sorry, but your baby weighed less than 2500 grams, so we aren’t going to do much to keep her alive. No, you can’t have statin drugs - they don’t increase life expectancy. Maybe that medication works 10% better, but it costs twice as much. You will have to make do. You need to see the doctor? Sure - the next appointment open is three weeks from next Thursday. You need a hip replaced? You can get along with a walker for a couple years until the orthopedist has an opening.

And nobody - left, right, or center - is going to do that.

Demand for health care is nearly infinite. Trying to continually increase supply and availability to meet that demand is a fool’s errand. You want to discourage people from going to the doctor, or getting MRIs, or taking medications. Because that costs money.

A large amount of medical expenses over the course of a lifetime is incurred during the last six months of life. And that money is sunk cost, from the government’s point of view - they don’t get better and go back to work and pay taxes.

Regards,
Shodan

[iiandyiiii]

Yet somehow, many advanced countries do health care much, much better than we do, with lower costs and superior outcomes. I wonder if it’s maybe possible and reasonable to look at how they do it, and maybe use some of those lessons to improve our system?

[Little_Nemo]

@Shodan

Demand for health care is nearly infinite. Trying to continually increase supply and availability to meet that demand is a fool’s errand. You want to discourage people from going to the doctor, or getting MRIs, or taking medications. Because that costs money.

It’s like the way people started setting their houses on fire when the fire department began providing free service. Everyone remembers what a mess that was.

[Shodan]

@Little_Nemo

It’s like the way people started setting their houses on fire when the fire department began providing free service. Everyone remembers what a mess that was.

No, it isn’t actually like that at all. It’s more like the fact that Obamacare was supposed to reduce ER visits because people would go to their PHPs instead, and then both ER visits and PHP visits went up. More available means more utilization. It’s like that.

@iiandyiiii

Yet somehow, many advanced countries do health care much, much better than we do, with lower costs and superior outcomes. I wonder if it’s maybe possible and reasonable to look at how they do it, and maybe use some of those lessons to improve our system?

Absolutely. What countries have actually cut health care costs by implementing a given system? Not compared with other countries - compared with the same country. What countries have done that?

Because that’s what is being suggested needs to be done in the US.

Spending the same amount under UHC won’t save any money (duh). Covering more people with the same spending also won’t save any money (duh again) and is highly unlikely, given that people tend to use more of something when they are insulated from cost at the point of sale, and especially if they think someone else is footing the bill.

So, by all means, name a few countries that changed their health care systems, and then over the next five or ten years saw their overall spending go down compared to before implementation. Let’s learn from them.

TIA.

Regards,
Shodan

[Ravenman]

@Shodan

So, by all means, name a few countries that changed their health care systems, and then over the next five or ten years saw their overall spending go down compared to before implementation. Let’s learn from them.

TIA.

Why don’t you name a few countries that have changed their heatlhcare systems that you would consider as part of this universe of cases.

TIA!