UHC: Has to be affordable, high-quality, and also *not* have long wait times

That is a bit meaningless once one finds that under Obamacare more than 80% are very or somewhat satisfied with the coverage. As pointed before, coverage will likely see insurers still continuing even after a single payer system is in place.

Dunnow man, it will probably be full of riders.

Spanish regional healthcare systems either pay a flat monthly fee, pay nothing (Red Cross, DYA, other voluntary organizations) or pay for the ambulance, its maintenance and the salaries of the EMTs, nurses and doctors. No per-ride payments. While the EMTs are permanently assigned to ambulances, the doctors and nurses are from the ER or after-hours duty and go on the ambulance only when the nature of the call makes it more logical.

Wait times in other countries are not what you think they are.

In fact, when I was in Japan and I wanted to see my doctor, I saw him pretty much whenever the hell I wanted. Sure, he took 2 days off and had his father or his partner see me instead, but I saw a doctor whenever I wanted and didn’t need to wait 5 weeks for an appointment like you do here – just to be clear, waiting 1-2 months for an appointment in most countries…is fucking insane.

Your argument makes great sense for car insurance. And I might extend it to items like contraceptives if available at low cost without prescription. However applying these ideas to healthcare is wrong for at least two major reasons.

First: Preventative care is good. I hope this isn’t too simple-minded a concept for someone protesting philosophical matters like “complete free market laissez faire capitalism with no restrictions” but concrete simple matters can be important! Preventative care is good.

Recall the old proverb: [del]A stitch in time saves nine[/del] Simple treatment for a minor wound can save a hospitalization for cellulitis or septicemia. Discouraging low-income people from tending to the simple wound may be a profit-making opportunity for the hospital, but will not strike health-care experts as good policy for society.

Second: The U.S. health insurance industry currently provides employment for Many Hundreds of Thousands of people (yes, that’s Hundreds of Thousands with an H and a T; don’t forget the M for many) to help decide whether to pay for a treatment and how much to pay. This is a big reason why U.S. health-care is so much more expensive than it is in the developed democracies.

It sounds like in your proposed system, the patient would pay for the doctor to examine and clean the wound, and perhaps pay for the antibiotic … unless it were an expensive antibiotic? I suppose the kind doctor might even say “Let me prescribe a more expensive medicine so your insurance will pay;” although among the hundreds of thousands of insurance adjusters one might catch on to this ploy.

No, I think you’d better review what others have written here about single-payer systems and derive a more informed understanding about “ridiculous cost increases and deadweight losses.”

My car insurance covers yearly checks. There’s policies addressed to professional drivers which cover ITV (government-mandated checks). Because with cars and trucks too, making sure the vehicle is in good condition is better than having to call an ambulance when there’s already blanket-covered bodies on the side of the road.

And I call BS. In 2009. the top concern of Americans was healthcare costs. Do you honestly think if our insurance coverage was so great, we’d have been so worried? Remember that before Obamacare protections, all sorts of people couldn’t get health insurance due to the crappy tricks those wonderful insurance companies played, like denying coverage to people with pre-existing conditions. Yeah, those were the good ol’ days, all rightee. :rolleyes:

That’s why most countries call it Universal Health Coverage - it’s not insurance, it’s healthcare.

Preventive care can reduce costs by catching problems early. Also, people with many chronic conditions do need on-going care that includes doctor visits as part of medical coverage. Taking care of peoples’ need are the point, not “deadweight”.

Most people are happy with this health insurance because most people are healthy enough not to need a lot of care and thus have no notion how their “good” insurance will likely let them down if they have a serious illness or accident or condition requiring major surgery.

There’s a reason so many bankruptcies in the US are a result of medical costs.

Because there is ample evidence that other systems provide care to more people for less money and better results.

I don’t know about Ontario, but I found a good costing of Norwegian ambulance services here. The language is not english, but page 10, table 4 shows costs for ambulances in the districts in the southeast of Norway by kilometer and minute.

At a conversion rate of 7 Nkr to 1 (Thats a 10-year average) it is about 10 - 13 per kilometer, or 5 $ per minute. Given that this is Norwegian wages, gas costs etc, I think cutting that by half would be a reasonable approximation of costs elsewhere.

Note that this is Norways most population-dense area.

This is in one of the arguments that gets brought up against a third-payer model, and why doing without is more efficient. Claims, claims adjudication, liaising, negotiations,etc adds a vast amount of bureaucracy, and the billing aspect of US healthcare has been estimated to cost just short of 500 billion per year. Not too far off what the US military costs.

Roughly 600 000 people.

Just to throw something into the point about ambulance costs above: the NHS in England spends about £2bn a year on ambulance services, and most recently had just under 11m calls and just under 7m turnouts. I work that out to about £270 per call-out. Granted, performance is suffering as budgets aren’t keeping up with demand, and/or demand isn’t being managed tightly enough. But even spending more to get to better performance levels isn’t going to get anywhere near $3000: how on earth are they costing that out?

https://www.nao.org.uk/wp-content/uploads/2017/01/NHS-Ambulance-Services.pdf

The amount charged above the (let’s round it off) $300 base cost is to cover the operating costs for all the rides they don’t get money for because the people transported either can’t or won’t pay for it.

Missed the edit window: As far as I can make out on a skim, the Norwegian costs above include the air ambulances. So average costs for car-based ambulances should be a bit lower.

Unloading that cost onto a random member of the public who has had an accident, is in a position of emergency and may not even be conscious seems to lack some aspect of fairness.

But it’s inevitable in the sort of system the US has - ambulance services and emergency rooms need a certain amount of money to operate and that means they have to charge those who pay for the services enough to cover those who can’t or won’t pay. And many, maybe most ambulance services and ERs in the US are not publicly funded.

Are Bloomberg a bunch of lefties? I don’t think they are, but from their freshly-released report on the health of nations:

The US is at 35. Costa Rica is right above you and feeling like they should climb down discretely before you take offense. Croatia is a bit higher, didn’t they have a big fucking war not so long ago?

Let’s just use contraception as one example. It is something that is easily affordable for the vast majority of women. Why does it make sense to take money from these women in the form of taxes, pass it through the hands of a bureaucrat (assuming a single payer system) and then use that money to pay for “free” contraception?

First, you lose any market pressures that would otherwise exist to keep prices down. Since it is “free” to the consumer, she does not do any comparison shopping nor does she care what the actual cost of the contraception is. There is no downward price pressure. Every store will charge what the government reimbursement rate is, not a penny more or a penny less.

Without these market forces, how does the bureaucrat know what price to allow? If it is too high, then we are wasting even more money. If it is too low, then drug manufacturers have no incentive to invest in R&D for better contraceptives, possibly even a pill for men.

Why do all that, involve third party payers and the like, when the price is not a problem for most women. Yes, absolutely have a social safety net for the poor, but leave it at that. When the overwhelming majority of women can afford contraception, enacting a large government program for that is wholly unnecessary. Do we really need for Bill Gates’ wife or daughter to get “free” contraception?

But preventative care you say, because paying the cost for contraception is much better than paying for the cost of raising a child. What in the world ever happened to free choice and personal responsibility in this country? Freedom itself is based upon using that freedom responsibly. I do not subscribe to the notion that without “free” contraception that unwanted pregnancies would skyrocket.

Before the 1960s, there was no pill form of contraception, but people survived then.

But your point is taken that there will always be irresponsible people who do not clean a wound, or use contraception, so that we must take some steps to prevent the greater harm. But we do not need to look at the overwhelming minority of people who act irresponsibly and create a system that treats the majority of people who act responsibly in the same manner. That is an enormous waste, inefficiency, and yes, a deadweight loss.

Further, those who are irresponsible will still have unwanted children even with “free” contraception as we know all too well.

Now, I understand that contraception isn’t the entire health care system, but we can see some of the unique things about it, and that is a big part of my objection to single payer. We put it all under the umbrella of “health care” when there are differences in how to distribute contraception, treating a flesh wound, having major surgery, or having emergency transportation and surgery. To treat them all as if they were the same because they deal with human health is another mistake.

:smiley:

I’m not sure of the reason for the grin. Was it because of a perceived insensitivity that males have no obligation to also be a part in using contraception? If so, I was referring to the pill form that is only available by prescription, and due to the fact that women are uniquely situated by biology to be the ones most interested in not carrying a child that they are not ready to have.

Condoms are also very inexpensive and not covered by insurance.

I don’t know where the grin came from, but excuse me this is not the Pit, it takes a man to think that “the pill form” is cheap, easy to get, and the perfect solution to excess-fertility issues, especially in the US. Please put as much poison as you can on the word “man”.

#notallmen,thankOgette

Except for…

Sounds like downward price pressure to me. As the main provider of healthcare, the government can negotiate with the drug companies to keep prices low. As indeed it does in the NHS and most other UHC countries.

Conversely, that “market pressure” doesn’t really exist in the US in many cases as the market is not elastic. We’re not talking cellphones or cars here. This is less of an issue for contraception but for many drugs if a company holds the patent on the medication or device that treats your condition, you can’t shop around and your options are 1) buy it, or 2) suffer and/or die. Some medical conditions can be treated with a variety of options but not all, or necessarily even most.

Furthermore, a sizable percentage of what your medicine money goes to is advertising. In many cases you end up paying twice as much for your pills to the privilege of watching those endless television ads (and also for your doctor to get his free junket to Vegas and a bag full of “free samples” to hand out). That right there is an “upward price pressure”.

There’s this thing called “negotiation” that businesses and governments both do. And when the healthcare provider has a lot of leverage, as in UHC systems, the amount of gouging is minimized but R&D continues unabated.

People survived back when smallpox and polio were common too. Let’s try to set the bar a little higher.

Our system today takes money from insurance premiums and passes it through those in profit-making insurance companies to pay for “free” contraceptives, which is much cheaper, right? Except for those not covered.

I must have totally missed the female contraceptive aisle at my drug store. You do realize that this stuff is prescribed, right? And that one size doesn’t fit all - both in the literal and figurative sense. I’m pretty sure that when my wife was on contraception she didn’t get a price list, and the method she used was based on her needs. She has Masters in reproductive physiology, so she understands this stuff better than most.
The government, having market power, can do a lot better negotiating prices your average consumer - and especially your average consumer not covered today by insurance.
Remember, it was the Republicans who prevent Medicare from negotiating for lower drug prices.

Government contracts are negotiated all the time without market forces. You can’t buy a fighter off the shelf. The different drug companies have incentives to give their best prices. Anyhow, if you think that the “free” market drives prices down in the present situation, I invite you to check out the prices of ED drugs.

In any remotely fair tax system Bill Gates would be paying far more than he would if contraception cost for his daughter. I don’t know about the Koch’s, but he’d be thrilled with the idea. I have a vasectomy so for my family we’d be paying more for this than we get in direct benefit. I’d be thrilled also, since it would tend to make a greater percentage of children wanted. Also, the minority of women who can’t afford contraception are the ones where the impact of an accidental child would be greatest. A vast majority of people are employed - that doesn’t make unemployment insurance unnecessary.

I would think that even the most fanatic proponent of rational actor theory wouldn’t think it applies where sex is involved. Anyhow, if free choice is such a great thing, I’ll trade free contraception for free and easily available abortion on demand. I bet the Republicans would eat that right up.
For me I’d much rather have free contraception than abortions - which should be last resort.
In any case, overworked women who don’t get time off to see their doctor are going to rely on condoms and hope for the best.
BTW the fertility rate before birth control was higher than today. You really want to go back then?