First, I would note that the NHS is not mentioned in your wikipedia cite. Also in the wikipedia cite, it says the following must be present to be considered Social Insurance:
*Social insurance is any government-sponsored program with the following four characteristics:
the benefits, eligibility requirements and other aspects of the program are defined by statute;
explicit provision is made to account for the income and expenses (often through a trust fund);
it is funded by taxes or premiums paid by (or on behalf of) participants (but additional sources of funding may be provided as well); and
the program serves a defined population, and participation is either compulsory or so heavily subsidized that most eligible individuals choose to participate.[1]
Social insurance has also been defined as a program whose risks are transferred to and pooled by an often government organisation legally required to provide certain benefits*
So, which one of those characteristics does not apply to the NHS? I thought it was defined by statute, provisions made for funding & expenses, funded by taxes and premiums, and compulsory participation. It also transfers and pools risks (ex: Cancer survivors aren’t required to pay their actuarial value of future health costs).
I searched google for the cite, as per your instructions. Its your cite. If the cite isn’t giving you the answer you want, then be more specific.
Did you just decide to ignore the bit I quoted? Shall I quote it again for you?
With the NHS the beneficiary’s contributions to the program **are not **taken into account. Its a welfare program, not social insurance, because it"pays" recipients based on need, not contributions. It doesn’t matter how much you pay into the NHS: you get the treatment you need.
Exactly. Employment Insurance and CPP are “social insurance” programs by this definition. If I don’t pay into them, I never get anything. If I did pay into them, then what I get out of them is directly based on what I paid in. If I didn’t pay enough to meet the thresholds, I get nothing.
With medicare in Canada, I don’t ever have to pay anything, yet I get exactly the same medical treatment as anyone else. It’s not tied in any way to me paying taxes or premiums or any other contributions. It’s a government programme, plain and simple. Same as police, fire and education. I pay taxes to support them, but my right to call on those services is in no way linked to having paid taxes.
The reason I raised this point is just to emphasise that as long as people talk about “health insurance” they are implicitly buying into a certain funding paradigm: premiums, eligibility, co-pays, and deductibility.
But that’s not how systems like Canadian medicare and British NHS work. And we don’t think of them using the model of insurance. We think of them as government programmes. That’s a different paradigm and it affects they way we think about health services, in a quite different way than it seems to me that Americans on this board think about health services, which in my view brings in automatic limitations and problems to the analysis.
In addition to there not be specific contributions, there’s no special trust fund for health care in Canada. Sure, there’s an appropriation for helath care in the government budgerts. But there’s also appropriations for police. And fire fighting. And schools. And universities. And the military. The list goes on and on. A line appropriation in the appropriation Acts is just a funding statement. It’s not a special fund or trust dedicated to that public service.
Again, different from CPP and EI. There are special trust funds for those two programmes. The EI and CPP premiums that employees and employers pay go into those funds, not into general revenue, and are used to pay EI benefits and CPP premiums to people who have paid into the funds, meet the minimum contribution limits, and now have a claim according to the terms of their employement statuts or their age. Health care funding is completely different: no special fund, and everyone is elgible, regardless whether they’ve ever paid a single sou of taxes to the general revenue fund.
I was talking about the wikipedia link in your other post. You linked to wikipedia. I pasted the language from that link. So, again, how does the NHS not meet that definition in wikipedia? I’ll paste the exact language in again:
Social insurance is any government-sponsored program with the following four characteristics:
the benefits, eligibility requirements and other aspects of the program are defined by statute; ** (I think the NHS meets this requirement, as it’s defined by statute)**
explicit provision is made to account for the income and expenses (often through a trust fund); (I think the NHS meets this requirement)
it is funded by taxes or premiums paid by (or on behalf of) participants (but additional sources of funding may be provided as well); (The NHS meets this requirement)
and the program serves a defined population, and participation is either compulsory or so heavily subsidized that most eligible individuals choose to participate.(In this case, the “defined population” are the citizens of Great Britain, and it’s compulsory. So, the NHS meets this definition.)
Given that the NHS meets all of that criteria, I think we’re in the clear to call it social insurance.
I quoted from the very same Wikipedia cite that you are citing from.
It meets the criteria you list. BUT IT FAILS when beneficiary’s contributions to the program are taken into account.
It makes a very clear distinction between what is and what isn’t social insurance. It states Medicare is social insurance, and Medicaid is welfare. Do you disagree?
It very clearly makes the argument that the NHS isn’t social insurance.
Here is another editorial that makes the exact same case.
The NHS isn’t social insurance. Its welfare. I can’t find a single cite (using google, as you suggest) that calls the NHS social insurance. And thats because it isn’t no matter how much that you insist that it is.
The conservative solution to everything is to turn America into a libertarian nation. It doens’t matter if doing that makes problems better or worse, the goal is to make reality match ideology, not to solve problems.
As communism and Islamism have shown, trying to put reality in a very small box so reality will match a very narrow ideology creates a ton of problems. Reality is too big and too complex to ever be forced to match an ideology so narrow.
I’d be in favor of conservative health care solutions if they resulted in higher quality care for less money. But from what I can see, none of their solutions do. They are all just anti-statist, libertarian agendas masquerading as solutions to serious problems.
The current republican solution to our health care problems is to leave the broken and overpriced system in place, but let people but shitty insurance that doesn’t cover you when you get sick. That is the GOPs magical solution.
The funny thing, however, is that people who supposedly have this ideology elected Donald Trump. And with that vote, what are we getting in the way of “libertarian” agenda? We still have our armies all over the world. We have increased our deficits/debt with a tax cut. We are actually paying more premium subsidies than before under the ACA rules, because Trump stopped paying CSR, and companies re-priced. We have gone into trade wars by raising tariffs, which apparently will also lead to multi-billion dollars of more subsidies for farmers. Overall spending is higher, both domestically and military. We are now advocating to the world on behalf of Russia to get back into the G-7.
Oh, I almost forgot that the “libertarians” voted for a guy who wants to separate babies from their parents at the border, and put them in internment camps.
Soooooo…Hip hip hooray for small-government libertarianism.
OK, I see where you’re coming from. However, I think Medicaid is welfare because the recipients have to be poor or disabled (need-based, not compulsory, and therefore welfare). The NHS is available for everyone regardless of need, and essentially compulsory. It’s different than Medicaid in that regard. So, I don’t agree that the wikipedia link rules out the NHS at all.
I think the NHS meets the 4 criteria listed in the wikipedia link that you linked. You agreed with me in your post, and admitted that yourself when you said, “It meets the criteria you list”. It seems to meet those criteria, according to both of us. If that is the definition of social insurance, and we agree on that, then the NHS meets that definition.
However, your other links do seem to make a distinction between the NHS & social insurance. So, I might be wrong then. Perhaps the wikipedia link and its 4 criteria (the only criteria that it lists) aren’t described correctly within wikipedia. If that’s the case, then I’ll back off. You won’t see many people admit they were wrong on any board. Remember this post.
OK, so I found a link that discusses the difference between the NHS & SHI. It seems to be the financing. The “general tax” funding of NHS separates it from SHI, which is funded by contributions from earnings (usually). This seems to be a little nitpicky to me, but I can understand the difference in that people “see” their contribution in SHI, whereas they might not see the % of their taxes that pay into NHS. This might show up, also, in the form of an SHI trust fund, although a trust fund isn’t necessary for the existence of SHI. The other differences in how benefits are delivered, NHS vs SHI, seem to be less definitional, and more in the weeds. I think the key is how we “fund” these systems. Interesting read.
The OP focuses on per capita spending but of course much of that is not directly out-of-pocket. If federal spending on healthcare outpaces household spending, individuals may not notice it as much, but of course government revenue or deficits would have to increase to cover it.
I was curious about household spending. Here’s a Pew analysis of household expenses from BLS CE that includes healthcare spending. The median household spent 3.9% of income on healthcare in 2014 but only 2.1% in 1996.
For the OP, I would note that the number of Americans paying for medical treatment in foreign countries have increased exponentially as health care prices have risen. Currently, it is estimated that between 1 and 2 million Americans go abroad for healthcare each years.
Additionally, it is estimated that there are about 2 million cases of Americans getting prescriptions filled in Canada, and 600 000 cases of Americans obtaining health care in Canada using fraudulent credentials.
Note that these last are older numbers, and as these things are crimes, they are not that easily surveyed. Its not something most people readily admit to.
If healthcare costs keep growing, I would expect more and more people to go abroad for treatment. This would lead to less business for American hospitals. Since many types healthcare has very little price elasticity, the American health care providers can compensate by raising prices.
Insurance companies will probably begin to offer plans including care abroad.
This should primarily affect the middle classes. The really rich don’t care about cost that much and the poor can’t afford to go off to Mexico or Costa Rica for medical care even if it is cheaper than in the USA.
While I generally agree with you, there are a couple of points here I find to disagree with what I’ve generally thought to be the case.
The difference in lifespan between the US and Switzerland is about 4 years. Places like Italy, Spain, Sweden and Israel are 3 years ahead. How many 18-year olds do you suppose the US has to lose every year to crazy dangerous, self-destructive stuff to create a 4 year difference in lifespan? 3 years?
Curiously, other nations with better rates of infant mortality also have lower rates of maternal mortality. And under-5 mortality. And most interestingly, often lower rates of stillbirth. How do these nations record those babies that the US tries to save, if they are neither recorded as stillbirths nor live births?
Also, infant mortality is for comparison purposes generally recorded using the WHO definition of live birth, which can be found in* ICD-10: International Statistical Classification of Diseases and Related Health Problems, 10th revision * WHO.
They use standard definitions of stillbirths and neonatal mortality rates. Definitions of perinatal mortality may vary. There is guide with standard forms for registering deaths in health care facilities or the community. Available online.
Hospitals using other definitions and non-WHO forms have their numbers weighed down compared with those who do use them.
And in case you are wondering, I don’t believe adjusting between different developed nations standards are actually that difficult for professional statisticians.
But of course, there are all those heroic US physicians fighting to save babies, which is very very expensive. Whereas all those evil European physicians just record them as dead, when they have no issues with money, the scallywags.
Seriously, how does that narrative work again? American doctors spending massive amounts of money to save infants that other developed nations give up, despite them not having an issue with justifying spending. And this would be a large enough factor to generate the differences recorded between America and the rest of the OECD?
Now, the actual reasons for the high American infant mortality is very well known. You have far more preterm births than other developed nations, and American disadvantaged groups make up a large part of the difference. As far as I know this is neither obscure nor debated much.
And you still seem to have a much larger spending problem than all those nations that have an older population and longer lifespans.
I would say that the goal of the fiscally conservative faction is to eliminate every program that uses taxpayer dollars to directly benefit individuals…because redistribution, because socialism. It’s OK to give taxpayer dollars to corporations because that’s different.
But they will never be honest about this goal, instead they find other disingenuous reasons to object to social programs.