# Universal Health Care **URL:** \ **Category:** Great Debates\ **Created:** [February 23, 2010, 5:44am UTC](https://boards.straightdope.com/t/universal-health-care/530091 "2010-02-23T05:44:59Z")\ **Posts on this page:** 11\ **Page:** 1
**Author:** ![pyrrhios](https://avatars.discourse-cdn.com/v4/letter/p/35a633/32.png) [@pyrrhios](https://boards.straightdope.com/u/pyrrhios)\ **Post date:** [February 23, 2010, 5:44am UTC](https://boards.straightdope.com/t/universal-health-care/530091/1 "2010-02-23T05:44:59Z")
Sorry, I know this is old, but I’ve trolled the MBs trying to find a place to put this question, or an answer to it, and finally gave up. I read or heard somewhere that we pay twice as much for half the care in the country as in most other countries. I don’t remember where, maybe from watching the movie Sicko. I know better than to take such statements at face value, but I decided to do a little research. I found that we were ranked somewhere around 37th in the world for the effectiveness of our health care system, and that for the year 2007, the health care industry was about 2.2 trillion dollars and that about 900 billion of that was paid for through medicare, medicaid, VA and other miscellaneous health programs. I also ran into other analyses on the message boards here, so I assume are valid, that there is about $800 billion in waste in our health care industry, so it seems that claim of one half for the price of two is not implausible; and that Medicare is presumably supported/will be supported through deficit spending. I am also assuming that having fewer different types of bureaucracies doing the same thing would help eliminate waste; taxes would be raised, offset by less private insurance costs; insurers would contract with the government to administer; and supplemental insurance would be available for those who want/can afford. OK, ok, I tried to do as much research on the topic as I could. I’ve also worked in the health care system for 8 years, and I really don’t care about whether capitalism is more moral than socialism or communism or whatever other economic models there may be. Economies don’t have morals. I’m looking for information and policies that achieve the desired result of a successful health care system. The U.S. Constitution mandates, “to promote the general welfare”, and since financial stress causes illness (humor-ish), wouldn’t that mean we have a national and fiducial responsibility to move to a more socialist model? ---
**Author:** ![Kimstu](https://avatars.discourse-cdn.com/v4/letter/k/ecd19e/32.png) [@Kimstu](https://boards.straightdope.com/u/Kimstu)\ **Post date:** [February 23, 2010, 6:16am UTC](https://boards.straightdope.com/t/universal-health-care/530091/2 "2010-02-23T06:16:12Z")
AFAICT, there is no dispute that a single-payer system is a lot cheaper to administer than our current patchwork system. As [this 2004 article notes](http://www.medicalnewstoday.com/articles/8800.php), > [@](#): > > The administrative structure of the U.S. health care system consumes a large share of health spending. In 1999, administrative spending consumed at least 31.0 percent of health spending, according to a report in today’s New England Journal of Medicine. In contrast, administrative costs in Canada, which has had a national health program since 1971, are about 16.7% of health spending. […] > > The huge gap in administrative costs between the U.S. and Canada arises from their differing mechanisms of paying for health care. While Canada has a single insurance plan, or “single-payer”, in each province that pays the bills for everyone, the U.S. has a complex and fragmented payment structure built around thousands of different insurance plans, each with its own regulations on coverage, eligibility, and documentation. > > The participation of private insurers raises administrative costs. The small private insurance sectors in Australia, Canada, Germany, and the Netherlands all have high overheads: 15.8%, 13.2%, 20.4% and 10.4% respectively, far higher than the 1% to 4% overhead of public insurance programs. Functions essential to private insurance but absent in public programs - e.g. underwriting, marketing, and corporate services - account for about two-thirds of private insurers’ overhead. In addition, private insurers have incentives to erect administrative hurdles - by complicating and stalling payment they can hold premiums longer, boosting their interest income. Such hurdles also discourage some patients and providers from pursuing claims. > > A fragmented payment structure is intrinsically more expensive than a single payer system. For insurers, it means the duplication of claims processing facilities and reduced insured-group size, which increases overhead. > > Fragmentation also raises costs for providers who deal with multitudes of different insurance plans - at least 755 in Seattle alone. This means providers must determine each patient’s insurance coverage and eligibility for a particular service, and keep track of varying co-payments, referral networks, approval requirements and formularies. In contrast, Canadian physicians send virtually all bills to a single insurer using a simple billing form or computer program, and may refer patients to any colleague or hospital. However, it’s not clear that any achievable reform at present would actually involve a true single-payer system, and it would cost a lot to make health insurance truly universal, because we’ve got so many people currently uninsured. And there is a strong sentiment among some Americans that it would be [unfair to meet these costs through progressive taxation:](http://www.realclearpolitics.com/articles/2009/07/17/pay_up_utopia_aint_free_ya_know_97505.html) > [@](#): > > President Barack Obama once promised to spread the wealth. How about spreading the responsibility, as well? Let the everyday citizen feel the cost of these gazillion-dollar legislative miracles. “Promote the general welfare” is a very suspect concept in some quarters these days. The antitaxers are strongly committed to the idea that the only thing the government is truly called upon to do in that regard is cut spending, cut taxes, and get out of the way. ---
**Author:** ![Sage\_Rat](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/sage_rat/32/399_2.png) [@Sage\_Rat](https://boards.straightdope.com/u/Sage_Rat)\ **Post date:** [February 23, 2010, 6:20am UTC](https://boards.straightdope.com/t/universal-health-care/530091/3 "2010-02-23T06:20:35Z")
1. Yes, we spend about double per person for health care. 2. Expanding to universal health care is unlikely to decrease spending on its own unless we go to a single-payer system–which is not something that will happen since it destroys an entire industry. It probably won’t significantly raise spending either, though. 3. A single payer system is unnecessary. There are nations with private insurance as the main method of health coverage and they are paying half what the US is. 4. [http://assets.opencrs.com/rpts/RL34175\_20070917.pdf](http://assets.opencrs.com/rpts/RL34175_20070917.pdf) (PDF) ---
**Author:** ![Lok](https://avatars.discourse-cdn.com/v4/letter/l/e8c25b/32.png) [@Lok](https://boards.straightdope.com/u/Lok)\ **Post date:** [February 24, 2010, 3:51am UTC](https://boards.straightdope.com/t/universal-health-care/530091/4 "2010-02-24T03:51:06Z")
Sage, Canada has a single-payer system, and has had for over 2 decades now. But they still have private insurance companies. The UK has another, very different system, with everyone covered by the government, but they still have private insurance companies. The idea that switching to a single-payer system would “destroy an entire industry” is completely wrong. ---
**Author:** ![Sage\_Rat](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/sage_rat/32/399_2.png) [@Sage\_Rat](https://boards.straightdope.com/u/Sage_Rat)\ **Post date:** [February 24, 2010, 4:05am UTC](https://boards.straightdope.com/t/universal-health-care/530091/5 "2010-02-24T04:05:14Z")
> [@Lok](#): > > Sage, Canada has a single-payer system, and has had for over 2 decades now. But they still have private insurance companies. The UK has another, very different system, with everyone covered by the government, but they still have private insurance companies. The idea that switching to a single-payer system would “destroy an entire industry” is completely wrong. Yes, but you would need to remove private insurance entirely, in the US, to decrease spending. If you leave it as it is, you have the same issue as we do now, the majority of people handing more money than is necessary over to health coverage, inflating the prices so that the government has to pay the same, high prices. Medicaire and Medicaid aren’t paying half of what private insurance does. The problem isn’t with who is managing coverage, it’s with how many people are looking at the price tag with an eye towards health. If you fix that, there’s really nothing more to do. You might as well just leave everything as it is, so as not to disrupt the market. If you want to expand coverage to everyone, sure you can either mandate that private insurance accept everyone or expand public health coverage to anyone who can’t afford private, but that is a separate issue from cost. ---
**Author:** ![Lok](https://avatars.discourse-cdn.com/v4/letter/l/e8c25b/32.png) [@Lok](https://boards.straightdope.com/u/Lok)\ **Post date:** [February 25, 2010, 1:25am UTC](https://boards.straightdope.com/t/universal-health-care/530091/6 "2010-02-25T01:25:07Z")
Sorry, still do not see a need to get rid of private insurance. Canada switched from a system just like ours, to their present single-payer system, and did not get rid of their insurance companies. But they spend less money per person than we do anyway. So the idea that we would need to get rid of them does not follow. They would change from offering basic coverage, to cover high end stuff, like private rooms, not waiting inline for doctors according to need, etc. The insurance companies should actually jump at it, they would not need to worry about taking care of Joe Average that has 2 kids needing braces, 1 with a broken arm, and allergies. They would offer premium services to the wealthy, and charge an arm and a leg for it, but not have to pay out as often. ---
**Author:** ![Mighty\_Mouse](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mighty_mouse/32/7776_2.png) [@Mighty\_Mouse](https://boards.straightdope.com/u/Mighty_Mouse)\ **Post date:** [February 25, 2010, 1:54am UTC](https://boards.straightdope.com/t/universal-health-care/530091/7 "2010-02-25T01:54:41Z")
> [@Lok](#): > > Sorry, still do not see a need to get rid of private insurance. Canada switched from a system just like ours, to their present single-payer system, and did not get rid of their insurance companies. But they spend less money per person than we do anyway. So the idea that we would need to get rid of them does not follow. > > They would change from offering basic coverage, to cover high end stuff, like private rooms, not waiting inline for doctors according to need, etc. The insurance companies should actually jump at it, they would not need to worry about taking care of Joe Average that has 2 kids needing braces, 1 with a broken arm, and allergies. They would offer premium services to the wealthy, and charge an arm and a leg for it, but not have to pay out as often. The government announces, from tomorrow all citizens will pay for two loaves of bread per day, and can pick up their bread from the government bakery, which will bake the bread in giant super-efficient factories. Six kinds of bread will be available, including options for the lactose intolerant, people with nut allergies and celiac disease. You also get up to six cakes per year with 250 different combinations of flavors, decorations and shapes. You pay for this whether you get it or not. And muffins and bagels too. Bakeries and supermarkets were overjoyed at this announcement, because now they can get out of the pesky everyday bread business and concentrate on the high margin wedding cake and fancy pastry market. No reason at all to believe that employment in the commercial bakery sector will fall at all. If providing health “insurance” for basic services was not profitable, insurance companies would not provide it. There are already companies that provide higher levels of service, all the way up to “concierge health care” for executives and celebrities. It is a tiny tiny fraction of the health insurance industry. ---
**Author:** ![Lok](https://avatars.discourse-cdn.com/v4/letter/l/e8c25b/32.png) [@Lok](https://boards.straightdope.com/u/Lok)\ **Post date:** [February 25, 2010, 2:27am UTC](https://boards.straightdope.com/t/universal-health-care/530091/8 "2010-02-25T02:27:49Z")
There is a difference between saying the industry will shrink or change and saying it _has_ to disappear, which is what **Sage Rat** is saying. ---
**Author:** ![pyrrhios](https://avatars.discourse-cdn.com/v4/letter/p/35a633/32.png) [@pyrrhios](https://boards.straightdope.com/u/pyrrhios)\ **Post date:** [March 2, 2010, 11:38pm UTC](https://boards.straightdope.com/t/universal-health-care/530091/9 "2010-03-02T23:38:28Z")
> [@Kimstu](#): > > AFAICT, there is no dispute that a single-payer system is a lot cheaper to administer than our current patchwork system. As [this 2004 article notes](http://www.medicalnewstoday.com/articles/8800.php), > > _ **redacted** _ > “Promote the general welfare” is a very suspect concept in some quarters these days. The antitaxers are strongly committed to the idea that the only thing the government is truly called upon to do in that regard is cut spending, cut taxes, and get out of the way. That’s part of my point. I consider a healthy economy as part of “promote the general welfare”. Our current health care industry is an integral part of our unhealthy economy. ---
**Author:** ![Euphonious\_Polemic](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/euphonious_polemic/32/3002_2.png) [@Euphonious\_Polemic](https://boards.straightdope.com/u/Euphonious_Polemic)\ **Post date:** [March 2, 2010, 11:46pm UTC](https://boards.straightdope.com/t/universal-health-care/530091/10 "2010-03-02T23:46:21Z")
> [@Mighty\_Mouse](#): > > The government announces, from tomorrow all citizens will pay for two loaves of bread per day, and can pick up their bread from the government bakery, which will bake the bread in giant super-efficient factories. Six kinds of bread will be available, including options for the lactose intolerant, people with nut allergies and celiac disease. > > You also get up to six cakes per year with 250 different combinations of flavors, decorations and shapes. You pay for this whether you get it or not. And muffins and bagels too. > > Bakeries and supermarkets were overjoyed at this announcement, because now they can get out of the pesky everyday bread business and concentrate on the high margin wedding cake and fancy pastry market. No reason at all to believe that employment in the commercial bakery sector will fall at all. This is a sad caricature of UHC, which bears no resemblance to reality as it stands in many countries right now. It is conveniently made of straw though, so you could use it to stuff your mattress or something. ---
**Author:** ![Stoneburg](https://avatars.discourse-cdn.com/v4/letter/s/df705f/32.png) [@Stoneburg](https://boards.straightdope.com/u/Stoneburg)\ **Post date:** [March 3, 2010, 12:23am UTC](https://boards.straightdope.com/t/universal-health-care/530091/11 "2010-03-03T00:23:22Z")
> [@Mighty\_Mouse](#): > > The government announces, from tomorrow all citizens will pay for two loaves of bread per day, and can pick up their bread from the government bakery, which will bake the bread in giant super-efficient factories. Six kinds of bread will be available, including options for the lactose intolerant, people with nut allergies and celiac disease. > > You also get up to six cakes per year with 250 different combinations of flavors, decorations and shapes. You pay for this whether you get it or not. And muffins and bagels too. > > Bakeries and supermarkets were overjoyed at this announcement, because now they can get out of the pesky everyday bread business and concentrate on the high margin wedding cake and fancy pastry market. No reason at all to believe that employment in the commercial bakery sector will fall at all. > > If providing health “insurance” for basic services was not profitable, insurance companies would not provide it. There are already companies that provide higher levels of service, all the way up to “concierge health care” for executives and celebrities. It is a tiny tiny fraction of the health insurance industry. Wouldn’t a significant part, probably having the only relevant skills, of the people working bakeries be employed by the new and super efficient bakery?