Just to set the context for the debate. I’m not American, and have no interest in getting pigeonholed into one side or the other of the crazy ideological divide y’all have going on over there. This is not springing from any interest in what’s happening in the US(with which I have only passing familiarity).
Where it is coming from is that I often see people in debates automatically assuming that a spreading out of healthcare* costs, whether through insurance or a public system, is a good thing. I’d like to find out why this is.
There are two aspects that I see in this. One is the subjective interpretation of morality. That it is wrong to let other people suffer. This isn’t really up for debate in as much as how you feel is pretty much all there is to it. However, I’d be interested in knowing how much of your opinion on the issue is influenced by whether you think it is morally superior to provide universal healthcare. I, for one, don’t think there is anything inherently moral in making sure someone has healthcare even if they personally can’t afford it.
The other aspect is the actual benefit/loss to society. I think this offers slightly more productive ground for debate, if one leaves sentiment behind. For instance, an argument can be made that universal health insurance frees people up from having to worry about potentially catastrophic medical costs, and makes them more productive. An example of the other side of the argument is that it prevents properly functioning markets from forming(which would be regulated. I’m not libertarian either) and thus causes a net drag.
This sort of actual benefit/loss to humankind of universal healthcare is what I’d like to understand. Which side do you come down on? Why?
*Just to clarify, healthcare is not the same thing as public health. Things like sanitation, vaccination etc. have clear and massive positive externalities for minimal expenditure. That’s a cut and dried case for public action
When I worry about my health, all I have to worry about is my health. I don’t have to worry about money. Likewise, when I worry about money, I don’t have to factor in my health - which means that I know that whatever monetary or career choices I make, my health is covered. This makes life a whole lot less worrisome.
From a societal and moral standpoint, it’s better to provide a means for people to be able to live and function even when they do not have the individual means to afford the costs involved.
From an empirical and objective standpoint, the system we have in the US achieves poorer outcomes at grreater costs when compared to other systems in place around the world.
Increased labour market flexibility (I can move between jobs quite readily, without even thinking about things like employer sponsored health insurance for me or my dependants), more aggressive preventative medicine, fewer health related bankruptcies, etc.
Both of these are a benefit for UHC. A not-often talked about benefit of UHC is that if you don’t have assured health care, you often end up in a sub-optimal job due to insurance concerns, which is less productive for the economy.
“But why not just get good insurance if you’re so worried about it?” say some people. But private insurance has incentives to cheat on their legal contracts on the vulnerable in order to save money. So even if you buy great health insurance at tremendous expense, you might not get what you paid for when you need it. The only way to be ensured of health care is to be a multimillionaire.
So, because of the dysfunctionality of the private health care market, a public single payer system is both more productive and a better-functionig “market”.
It encourages people to get treatment when they need it, rather than carrying on with a disease or injury and doing themselves more harm (or, worse, spreading a communicable illness).
And it’s more efficient in that it removes the insurance companies from the middle of the doctor-patient relationship (where they obstruct care and take a share of the money to do it) and removes the need to have an entire staff just to complete insurance paperwork. You’ll have heard about how the US spend more per capita on healthcare than many countries and yet gets less. This is part of the reason why.
And finally it’s just better overall for society as a whole for its members to be healthy, in the same way that it’s better for them to be educated (despite what Rick Santorum thinks). Healthy, well-trained workers are good for the economy.
Private insurance companies make a zillion dollars providing health insurance. That profit requires more expensive health care overall to maintain.
In America, the number one reason people go bankrupt is due to medical bills. Socialized health care immediately fixes that.
Also, socialized medicine allows poor people to get better preventative treatment, which is less expensive than emergency treatment. The USA has great emergency medicine, but it’s overburdened because people can’t afford to take care of minor issues before they become major ones.
The need for health care varies widely. I made it through into my early 60’s with little or none except for my dental care. Others are having many expensive procedures in that time. While my fortune may be partly due to my prudence, I think it was largely luck. So since you may or may not have huge medical bills, it makes sense to pool the risk through private insurance or the state. Which is best?
Both suffer from the tragedy of the commons. We have the doctors in charge of deciding what care we need. Very few people pay large copays and have little incentive to question whether they need a given procedure. They also lack good information. It was only after I had a $50,000 stent installed that I learned the heart attack rate was about the same with or without a stent if using drugs to control blood pressure and cholesterol. So with the stent, I am taking a couple of statins, Lisinopril, plus very expensive Plavix.
After having some tumors removed in emergency over Labor Day weekend, my regular doctor is insisting on a major surgery to make sure the cancer doesn’t spread. This is after a 1 1/2 years of ignoring my symptoms. It is like she waited until it got bad enough to require major surgery in order to get a fat referral fee. Only yesterday under orders of my new doctor did I get the scan to see if the cancer had already spread. Neither she nor the surgeon had said anything about checking to see if I already had a terminal condition. Perhaps spending a fortune on an operation and going through a lengthly recovery that my quality of life might never be the same again would be stupid if I am going to die of something else soon. A very expensive lock on the barn door after the horse is gone.
While I trust the private sector to be more efficient, who pays for health care is less important than junking the current system.
When I managed a factory, I had many salesman wonder in and propose remedies for problems. I also had a budget. If anything was over $1000, I had to document it was cost effective and whether it would be a fixed asset. We also have accounts and lawyers determining how much of their service we need. Some times I went with the salesman’s ideas, and sometimes not.
Actually, it makes your(figuratively speaking) life easier. Somebody has to worry about where the money is going to come from. In a universal insurance setup, that money comes from the healthy people. In a government provided setup, that money comes from taxpayers or future generations. Why shouldn’t the sick person or their family worry about it?
I’m not sure this is true. It may well be of course. But is there any evidence that beyond basic public health interventions like sanitation and vaccination, trying to ensure that everybody - no matter what their ailment, their ability, their achievements (or lack thereof) and their age - can live and function, is beneficial to society? Morally, YMMV.
I don’t know much about the US system, even though I have picked up some bare-bones knowledge from the dope. Regardless of the specific problems of the US system though, what I’m trying to get at is not ‘What will allow the US to provide everyone healthcare cheaply?’, but more ’ Why is mandatory/public health insurance or healthcare for everyone desirable in the first place?’
I think employer sponsored health insurance is an artifact of the US system if I’m not wrong. Could you explain your points about more aggressive preventative medicine? As for fewer bankruptcies, my point to Alessan remains. Somebody pays the costs. What is the net positive for society if someone other than the sick person and/or their family does it?
Your points don’t make sense outside of the US I think. Health insurance isn’t necessarily tied to employment. Nor is good healthcare limited to multi-millionaires. Great healthcare may be, but not good healthcare. And why is a public single payer system a better functioning market? It’s a better insurance market, sure, by preventing the problem of self-selection, but why for healthcare overall?
Sorry, what is the ‘it’ that you’re speaking of? Could you define it? I didn’t exclude insurance from the delivery of universal healthcare earlier, yet you seem to be speaking of some mode of service delivery that provides universal healthcare yet excludes insurance. Is it public healthcare provision you speak of?
So your contention is that Health is a public good. In a limited sense, I agree with you. But my limits are placed at basic public health interventions which can demonstrably give maximum output for minimum investment. A good example is deworming of school children in developing countries. It has been conclusively shown to have the sort of definite positive impact I think you’re speaking of. Where would you place your limits?
What causes the American system to be so expensive? India has very good hospitals where middle class people can get treatment without becoming bankrupt. It’s a strain for sure, but not back breaking. At least according to the Economist magazine, this is because Indian Hospitals manage to be more efficient. Why’re you looking to solve an expensive healthcare system by spreading the cost? What’'s the root cause of the high expenses? Is it perhaps possible to reduce the costs instead of socialising them?
You’re making some important points through your personal experience here, but I’m not able to comprehend them. Would you care to restate?
It is here. But even if it weren’t, it’s more economical to be able to invest your millions of dollars than to save them in the offhand chance you get an expensive disease. (Because if you get an expensive disease, health insurance won’t pay).
Great healthcare provides benefits when you need them without having to worry about being summarily dropped when you get cancer, and to do that, you need to be independently wealthy.
Health insurance, on the other hand, pays out the majority of claims, but denies just enough of them to ensure a healthy (ha!) profit margin. Which is “good” for most people, but I’d hate to be the one stuck with a million-dollar cancer bill without insurance which got arbitrarily dropped.
Because they will often be overwhelmed by it for no fault of their own.
Because it’s cheaper and produces a better result.
The fact that they can. And anyone can get sick.
And if society has no benefit for you, why support it? If society is going to treat you like an expendable asset, then why not lie, cheat, steal, break any law you can get away with? Giving people a reason to feel obligated to society, to feel that they are getting something in return for supporting it increases social stability.
No, because individuals will pay whatever is necessary for them to stay alive. Health care providers are in the position of a man with a gun to your head; they can demand as much as they like and you’ll pay because the alternative is death.
Because as you yourself pointed out, you have the problem of adverse selection in health insurance. It simply works better if everyone’s in the pool; if they’re not, it doesn’t work for shit.
It may not be, but that’s not what people are saying, really. They say “socialized medicine” but nobody is seriously suggesting that; what they really mean, but tend to inaccurately state, is socialized health insurance. Canada, to use my country, doesn’t have socialized medicine. We have socialized health insurance. My doctor doesn’t work for the government. The nearby hospital isn’t owned by the government. Indeed, the health insurance system isn’t even total - it doesn’t cover dentistry or, for most people, drugs.
Other countries (than the US) provide their citizens with equal or better health outcomes for the fraction of the cost of the US market-based system. That’s because we spend more than twice as much on administration.
The UK NHS costs about $8 billion a year to administer (and British MPs are constantly promising to cut administrative costs). In the US, wasted administrative healthcare spending alone is as much as $120 billion. The total cost is somewhere in the $300-$400 billion range (same link), depending on what you count as administrative costs.
I don’t know what the additional total cost of private voluntary/supplemental health insurance administration is in the UK. BUPA, which controls half of the market, has UK/North American revenues totaling $2.1 billion. We’ll pretend that every dollar of that was spent in the UK, and that BUPA’s UK administrative costs are the same as in Ireland (12%). Taking 12% of $12 billion and doubling it, we get a very rough total cost of private health insurance administration for the entire UK of $0.5 billion. So, adding that to the NHS figure, we get an extremely conservative (ie., too high) total cost of UK health administration of $8.5 billion.
Multiply that by five, since the UK has one fifth the population, and we see that the cost of the UK NHS and supplemental private system is just over one seventh that of the US system on the low end and just over one tenth on the high end.
So, fuck the moral and philosophical arguments; our system sucks, and just about anything would be better.
In some ways I think the moral argument for universal healthcare (or more specifically a tax supported single payer system) is similar to some of the arguments against the death penalty. Nobody wants serial rapists alive just as nobody wants to pay for healthcare for obese glue-sniffers, but killing (or refusing to save) people strips society of a level of human decency.
I’m not a very charitable person. I’m very healthy, so I suspect I’ll never get out as much as I put in to the NHS. But this is one of those instances where everybody deserves a certain level of human decency and respect whatever they’ve done previously.
As others have noted UHC does make a lot of practical sense too but the fundamental basis of the concept IMO is moral.
The average American pays more for health insurance than people in other countries and gets, at best, equivalent health care outcomes (and usually worse). So why not try a system that’s proven to be more economically efficient, even for the average person?
“Better” is a subjective term and depends what your criteria for “better” is.
Universal healthcare has the benefit of providing some level of health care to anyone who needs it. Left completely to the free market, there will undoubtably be some people who simply could not afford health care at all.
Also, it case people are unaware, we already do provide some level of universal health care in this country (USA). It’s called the ‘emergency room’. Poor people figured out a long time ago that the local hospital is required to treat anyone who shows up with an emergency. Of course that ‘emergency’ is often a runny nose, chronic sickness, minor injury or other ailament that would be more appropriately handled by a local physician.
The downside of universal health care is, of course, the “free rider” effect and “moral hazard”. That is to say, some people wll always require more out of health services than they put in. People will also use health services more often instead of taking preventative measures that would reduce their need for them in the first place.
Indeed, health care is already somewhat “socialized” in that it is mananged by insurance companies, instead of the government. The problem is that insurance is tied to your employer and is generally non-transportable.
Personally, I think it should be more like car insurance where you have to have it (unless you qualify not to because you are super-poor or something) and it is not tied to your employer or state.
…and I know that others have the same freedom from tying all their decisions into the same interconnected web. It’d be nice to be able to not think about healthcare costs over healthcare alone.
If my catasrophic healthcare costs are 1 million and my neighbor’s catasttrophic healthcare costs are 1 million, is it better that we both go bankrupt paying it ourselves or is it better we help each other out a little through our taxes and we’re both covered?
This definitely does happen in UHC countries, but far less than the doomsayers would have it. And of course its effect is massively diluted by the number of people who don’t abuse the system. In the UK it really is a minor issue (I’ve read a few commentaries by GPs who say a few old people abuse the system and book appointments because they’re lonely), and certainly nowhere near as big an issue as some American politicians would have you believe.
But if you get rid of the insurance component altogether you remove a big chunk of the cost, making it much more efficient.