I started a new gig a few months back. (Yahoo for the economy) My company insurance plan only covers me, not my spouse or child. I was completely floored, but started doing research into the cost of health care. When I found out how much it cost for basic health care for them I had no idea how EXPENSIVE it really was!
My god, how do people with minimum wage jobs, with no benefits, afford such a thing? Most people I know have to deal with their normal expenses, but this is going to be the second largest expense in our budget.
If Canada and a number of other nations have Nationalized Health Care, how come the US does not and does anyone see it in the forseable future?
Many don’t have health insurance. However, at the very least a person can show up at the emergency room and they have to be treated, regardless of their ability to pay. Certainly not an ideal situation by any means, but you don’t have people dying because they couldn’t go the hospital for their heart attack.
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Everything has a tradeoff. Sure we can have nationalized health care as in Canada. But then you have rationing of health care as well. You have cases of people waiting months for care.
Here in the U.S, there are about 25-30 million people without health insurance (if my numbers are wrong, please feel free to correct them. That’s about 10% of the population. Roughly 90% of the population does have some form of health insurance. While there certainly should be something done to boost that number, I’m not convinced that nationalizing health care is the answer.
But you might only get a few nitroglycerin pills and sent on your way. Which may inturn mean you come back 6 months later for more treatment. And on until you die. Nice way to go there.
But the well insured can get the premium care that they can afford.
But of that 90%, how many are underinsured or poorly insured? I know my “health insurance” blows. It’ll only help if an asteroid hits me and I’m in the hospital for up to like $1,000,000. If I get a broken leg, well heck, that’s however much the doctor and friends charge minus 20% or something.
I think a baseline health insurance for all Americans would be great. Something that ensures preventative care especially. You can opt out for private insurance and get a tax credit for it. Or you can buy plans that add on to the government’s plan.
Nationalized healthcare is inevitable in the US. It’s only a matter of time because the current system cannot be maintained in the context of a global economy. The absolute quality of care would probably decline somewhat, but the average quality would increase as measured by infant mortality and lifespan. It will probably begin incrementally as an expansion of eligibility for Medicare to allow more and more people to “buy in.”
This would make society more productive by freeing workers to pursue jobs and entrpreneurial opportunities without fear of losing insurance coverage for themselves and/or family members.
From an outsider’s perspective, I must agree with Jonathan but for a different reason; namely that of advances in screening.
Consider: it would be economically beneficial for an insurance company to be able to predict the future needs of their customers as accurately as possible, in order that the premiums could be set at a competitive level. The best way of doing this would be to run a full genetic scan on the saliva used to seal the envelope containing the application form.
The subsequent options are either [ul][li]Ban all forms of genetic investigation, thus forcing premiums up to levels unsustainable for most and leading to evermore underhand methods of determining your family’s medical history. Allow insurance firms full disclosure.[/ul][/li]
One can see where this leads. It is already the case that serious illness effectively means you can never get affordable insurance again. And which idiot firm is going to insure someone with cancer or heart disease in his/her genes, or risk bankruptcy by not stipulating a genetic test accompanies any application?
With better screening, but without universal insurance, the utter horror of having to sell one’s house for cancer treatment will simply be left to an accident of birth. It would even affect a person’s entire life, not just past middle age: Would you marry someone and take out a mortgage with them if you might very well have to sell the house later in life and end up with nothing?
I totally agree with you. For my family to have insurance through my husband’s company, we’d have to pay more than all our other bills combined (rent, car payment, electricity, cable, etc.) Luckily, I’m still on COBRA from his last job and my son has individual insurance. This brings it down to a slightly more manageable cost - only our rent and car payment combined. The COBRA runs out in October and I cannot get individual health insurance - I have lupus that’s been in remission for 12 years. We’ll be leaving the country before that happens, partly because we just can’t afford health care in the U.S. anymore. I’ll still be voting, though.
I’m curious about something: how do libertarians approach this issue? How would the free market affect those people who, right now, desperately need affordable health insurance? Or, alternately, how would the market change the nature of medical treatment to allow for positive changes in this arena? Would SentientMeat’s point about screening change any of this?
Now, I WAS eligible, while working at Kmart, to obtain some coverage, however, it wouldn’t cover “pre-existing conditions”, which was what I really needed:
The main problem I have with nationizled health care is that the people that smoke, drink, are overweight, and eat junk food will pay the exact same for health care that the people who excercise, eat healthy and don’t smoke or drink.
The individual buying healthcare services has no direct incentive to shop for price, and even if he did he has no way of doing so. When was the last time you saw a hospital, a doctor or drug company advertising their services or products on price? (Except, possibly, those that do elective procedures such as facelifts, breast augmentations and tummy tucks, which comsumers pay out of their own pockets.)
Hell, if someone always picked up your restaurant tab, would you order the cheapest thing on the menu?
Compounding the problem, healthcare consumers usually know very little about which services they actually do and do not need, so they rely on their doctors to tell them what care to get and where to get it.
Rocky definitely has something there. The simple fact is that the existence of health insurance distorts the market. It disconnects the consumer from the cost of the service. In addition, by paying higher prices for services in doesn’t provide a market-based incentive for healthcare providers to attempt to gain efficiencies to control costs.
And here’s my own example:
LASIK. I started looking at it seriously in the late 90s (I think). AT that point it was advertising for c.$2500 per eye. All through 99 and 2000 I listened to the ads and watched the price decline as more providers enterted the market.
When I got it done (Jan 3, 2001) both eyes cost me $2100. So over 2 years or so the price for that specific healthcare service declined 50%.
I don’t have the numbers but it wouldn’t surprise me if insurance-covered healthcare went up 20% over that same span of time.
But you pay for them anyway. As noted above, the uninsured can go hit the ER and not get turned away. That’s not free. Those costs are paid either by your taxes, or by higher rates charged by the hospital to paying customers and/or their insurance companies. And in many cases you pay MORE, because the uninsured don’t get preventive care. The ER visit typically costs society, one way or another, a lot more than the prevention.
There are a few other cost drivers: First, because the US is one of the only countries without price controls on pharma, Americans tend to subsidize Rx costs for the rest of the world. Second, direct-to-consumer drug advertising has created incredible demand for certain drugs, even though those drugs are trivially different than earlier versions which have subsequently “gone generic”.
Also, our health care system has a ton of administrative overhead built into it. The HIPAA regulations were supposed to help this, but IMHO they have so far made the administrative load worse. Most successful managed care insurors pay 84-88% of the revenue they take in as medical costs; the rest goes to overhead and profit. (The 84-88% number is called the Medical Loss Ratio or MLR; the amount that goes to overhead but not profit is the Administrative Loss Ratio or ALR. The rest, often less than 2%, is profit - if there’s any at all.) Then, the hospitals and physicians pay a ton of overhead, processing claims for all the different insurance companies, etc.
Say what you will about Medicare, but their ALR is only 2%. The other 98% pays for health care. Medicare needs some serious modernization, particularly in regards to getting patients into Disease Management and Case Management programs. But ultimately I think the minimum Medicare age is going to have to drop from 65 to zero. The cost trends now simply cannot be sustained.
This is absolutely correct. however, one of the biggest factors driving costs up is innovation. That is, there are simply more and more sophistocated medical treatments available. How are we going to address this with midicare? Say what you want about hospital, doctor, and pharmisutical profits, but much of them go into developing better and better medical treatments.
One other point. I remember reading several years ago that meicaid and medicare led to most hospitals turning into for profit organizations. That is, before those programs most hospitals were non profit organizations. Since then, almost all of them are for profit. I’ll have to try and look that up.
Seems unlikely, but possible. I’ll be interested to see what you dig up. There are certainly for-profit giants like HCA out there, but I think they’re still the exception. Here in my state, almost all hospitals are non-profit. I think this is true of all academic medical centers, church-affiliated systems, etc.
I wonder if you’re thinking about health plans, as opposed to hospitals? There has been a substantial change there, with the Blue Cross/Blue Shield plans and derivitaves (Anthem, Wellpoint, the first iteration of Health Net, etc…) being the best examples. But I’m not sure why the existence of Medicare and Medicaid would have driven the decision.
Just to put some numbers in play for those that don’t know just how much these things cost…
My company pays for health insurance coverage for the whole family. Our rates have just gone up another 20% this year to give a total cost of $10,000 per year for the family. This does not include dental coverage (another $1,200) or vision. As a portion of our budget, we have seen the cost quadruple in the last 6 years. We’ve finally had to ask the employees to pay 10% of the costs.
Being from the UK, I long for the day when the US has “socialized medicine”. I see nothing wrong in a system where there is public health available for all, and you can supplement that with private medicine/insurance for those that are happy to pay extra for it. (The UK is different from Canada, where I believe the private option is unavailable).
