# Why is socially provided universal healthcare 'better'? **URL:** \ **Category:** Great Debates\ **Created:** [February 8, 2012, 12:09pm UTC](https://boards.straightdope.com/t/why-is-socially-provided-universal-healthcare-better/612181 "2012-02-08T12:09:40Z")\ **Posts on this page:** 20\ **Page:** 13
**Author:** ![bldysabba](https://avatars.discourse-cdn.com/v4/letter/b/ecccb3/32.png) [@bldysabba](https://boards.straightdope.com/u/bldysabba)\ **Post date:** [February 24, 2012, 11:48am UTC](https://boards.straightdope.com/t/why-is-socially-provided-universal-healthcare-better/612181/241 "2012-02-24T11:48:38Z")
> [@conurepete](#): > > Is there evidence that in a country with no health care other then what individuals can pay out of pocket, people take better care of themselves? I would accept data like evidence of self pay for vaccines, lower smoking and mother and child surviving birth, but longevity and morbidity/mortality are also good. > I have not seen anything showing this. Thanks for posting. I don’t know how long you’ve been following the thread. Have you read [this](http://boards.straightdope.com/sdmb/showpost.php?p=14765735&postcount=188) post? If you haven’t do me a favour and check it out? I’m trying to establish why the cost of healthcare, which primarily benefits the individual who receives it, should be borne by society. For this, if health expenditure is being borne out of pocket, it doesn’t matter whether individuals are taking better care of themselves. (Although if they take significantly worse care of themselves because of out of pocket expenditure, that would be reason to rethink) > [@conurepete](#): > > Try grabbing the low hanging fruit and cite France, where the population smokes way more then Americans. So there is socialized medicine and people making choices to smoke. (this is me providing the cite Banquet bear asked from you. I know it is a little weak, but discussions move better when we support arguments instead of refusing to cite until the other guy goes first ) But that isn’t my position. I actually do only want a cite from the other side. I’m perfectly happy to be convinced about this issue. ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [February 24, 2012, 11:49am UTC](https://boards.straightdope.com/t/why-is-socially-provided-universal-healthcare-better/612181/242 "2012-02-24T11:49:22Z")
Dude, sorry but the only country I’ve lived in where I had to pay out of pocket costs for everything was the US. I can’t tell you about my personal experiences in Morocco because I haven’t been in Morocco. And saying “some parts of medicine should be socialized but others should not” is something every country with UHC does - Spain covers anything considered “necessary for the patient” but not anything considered “optional”. Your definitions of “necessary” are much more limited than ours, but then, I haven’t seen you dispute any of the assertions about sick people being less productive and more likely to make others sick. ---
**Author:** ![bldysabba](https://avatars.discourse-cdn.com/v4/letter/b/ecccb3/32.png) [@bldysabba](https://boards.straightdope.com/u/bldysabba)\ **Post date:** [February 24, 2012, 12:00pm UTC](https://boards.straightdope.com/t/why-is-socially-provided-universal-healthcare-better/612181/243 "2012-02-24T12:00:56Z")
> [@Banquet\_Bear](#): > > …so what you are saying (using your figures from your cite) is that maybe 30% of the (Indian) population can afford to pay out of pocket. What about the other 70%? > > It isn’t viable if only 30% of the population can afford it. > > So, from what you have just written: the Indian health care system is a prime example of one where universal healthcare should be implemented? If it is pointless discussing India: why are you discussing India? Because I’ve shown that a large healthcare market exists that is providing affordable (to a middle class segment) healthcare services paid out of pocket. For that purpose, the Indian example is sufficient(because even this small segment of population served is as large as or larger than most countries). For the population that cannot afford it(which nominally has universal health care btw), there’s a number of policy actions that are needed, but that’s another 5 threads. > [@](#): > > Your assertion mate. These are your words, are they not? “Providing free healthcare is just a moral hazard that encourages people to not take care of themselves.” > > Can you provide a cite for a country that provides free (at the point of delivery) healthcare where people do not take care of themselves? I’ll retract it as soon as I get a cite for the argument in response to which I made this assertion. ---
**Author:** ![bldysabba](https://avatars.discourse-cdn.com/v4/letter/b/ecccb3/32.png) [@bldysabba](https://boards.straightdope.com/u/bldysabba)\ **Post date:** [February 24, 2012, 12:11pm UTC](https://boards.straightdope.com/t/why-is-socially-provided-universal-healthcare-better/612181/244 "2012-02-24T12:11:15Z")
> [@Nava](#): > > And saying “some parts of medicine should be socialized but others should not” is something every country with UHC does - Spain covers anything considered “necessary for the patient” but not anything considered “optional”. Your definitions of “necessary” are much more limited than ours, but then, I haven’t seen you dispute any of the assertions about sick people being less productive and more likely to make others sick. I have disputed the one about them being more likely to make others sick. At least, I dispute that healthcare is what is necessary to prevent the spread of diseases. IMO, preventing the spread of disease is as much(or more) about quarantine, education, vaccination and sanitation than it is about treatment. And those are valid things to socialise. As for sick people being less productive, sure they are, but as before, I’d appreciate a cite, or even an analysis, showing that it is a net boost to productivity if every sick person is provided socialised healthcare. ---
**Author:** ![Banquet\_Bear](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/banquet_bear/32/373_2.png) [@Banquet\_Bear](https://boards.straightdope.com/u/Banquet_Bear)\ **Post date:** [February 24, 2012, 12:38pm UTC](https://boards.straightdope.com/t/why-is-socially-provided-universal-healthcare-better/612181/245 "2012-02-24T12:38:50Z")
> [@bldysabba](#): > > Because I’ve shown that a large healthcare market exists that is providing affordable (to a middle class segment) healthcare services paid out of pocket. …all you have shown is that some people can afford to pay for health care out of pocket. Well, duh. Does a large healthcare market exist in India? Yep. Does it provide affordable health care to everyone? No. Does it provide to a majority of the population? Nope. Does it provide affordable healthcare to a tiny segment of the population? Yep. Is this true of any country that has a free-market system? Yep. You don’t need to look at India to prove this assertion: so if you agree that India should provide universal health care, whats the debate? > [@](#): > > For that purpose, the Indian example is sufficient(because even this small segment of population served is as large as or larger than most countries). Not larger by percentage: the US middle class is 49% of the population (cited above) whereas the Indian middle class (as cited by you) is only 20% of the population. The segment of population that can afford out-of-pocket healthcare is actually smaller than other countries if your numbers are to be believed. > [@](#): > > For the population that cannot afford it(which nominally has universal health care btw), there’s a number of policy actions that are needed, but that’s another 5 threads. So do you think that the 70% of the Indian population that cannot afford out-of-pocket healthcare should have universal healthcare or not? > [@](#): > > I’ll retract it as soon as I get a cite for the argument in response to which I made this assertion. Or you could, you know, retract it because you know perfectly well you can’t prove it? Its not a great debating tactic to assert something you know you can’t prove and that you are literally conceding is incorrect just to prove a point. ---
**Author:** ![RickJay](https://avatars.discourse-cdn.com/v4/letter/r/bb73d2/32.png) [@RickJay](https://boards.straightdope.com/u/RickJay)\ **Post date:** [February 24, 2012, 3:08pm UTC](https://boards.straightdope.com/t/why-is-socially-provided-universal-healthcare-better/612181/246 "2012-02-24T15:08:16Z")
> [@bldysabba](#): > > Sure. Objective truth only gets determined by interaction with the real world. It has no meaning outside of that, which is where the discipline has been fucking up over the last few years. What aspect of the discipline of economics has been fucking up? There’s this ongoing insistence of people to assert that recessions are a failure of economics as a science, which is precisely like saying that the Japanese nuclear power plant failure was the failure of physics as a science. The nuclear power plant was a failure of engineering, politics, and business - there was no mistake over any of the aspects of SCIENCE. Nobody came away from that surprised that uranium is radioactive. The day politicians start actually following the general advice of mainstream economic thought is the day pigs fly. It’s never happened before and will never happen ever, as near as I can tell. ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [February 24, 2012, 3:14pm UTC](https://boards.straightdope.com/t/why-is-socially-provided-universal-healthcare-better/612181/247 "2012-02-24T15:14:29Z")
> [@bldysabba](#): > > Because I’ve shown that a large healthcare market exists that is providing affordable (to a middle class segment) healthcare services paid out of pocket. For that purpose, the Indian example is sufficient(because even this small segment of population served is as large as or larger than most countries). For the population that cannot afford it(which nominally has universal health care btw), there’s a number of policy actions that are needed, but that’s another 5 threads. **Banquet Bear** already touched on this, but frankly this doesn’t make any sense. The whole _point_ of universal health care is to take care of “the population that cannot afford it”. Under most universal health care systems, private health insurance and/or providers continue to exist to serve the 1, 2 or 20%. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [February 24, 2012, 5:21pm UTC](https://boards.straightdope.com/t/why-is-socially-provided-universal-healthcare-better/612181/248 "2012-02-24T17:21:41Z")
> [@conurepete](#): > > Try grabbing the low hanging fruit and cite France, where the population smokes way more then Americans. So there is socialized medicine and people making choices to smoke. (this is me providing the cite Banquet bear asked from you. I know it is a little weak, but discussions move better when we support arguments instead of refusing to cite until the other guy goes first ) Bad example. The smoking rate in the US fell independently from changes in the health care system. The rate fell when the toxic effect of smoking was proven and government started doing something about it, starting with banning TV advertising and continuing with banning of smoking in many enclosed places. There is also now a big change in the social view of smoking. I really don’t think any level of insurance is going to make up for dying of lung cancer. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [February 24, 2012, 5:41pm UTC](https://boards.straightdope.com/t/why-is-socially-provided-universal-healthcare-better/612181/249 "2012-02-24T17:41:20Z")
> [@bldysabba](#): > > Providing free healthcare is just a moral hazard that encourages people to not take care of themselves. If you knew you may have to bear high costs for your own health, you would be more watchful of your health and fitness. Early intervention definitely need not be prohibitively expensive in an out of pocket expenditure system either. And you’re assuming that healthcare is socialised, so ‘it costs the healthcare system more’. If healthcare isn’t socialised, why care about how much it costs? First, countries with universal health care systems have better outcomes in terms of life expectancy than countries without, so the assertion that “free” healthcare somehow causes people to let themselves go is contradicted. There are a few other economic problems with your view. First, someone paying for preventative care is investing against an uncertain outcome. Studies have show that the discount rate people use for this kind of activity (pay now for a reward later) is much higher than what you would expect - 70% - 100% in some cases. Second, there is of course the high probability that your doctor will say you are fine and you should exercise more, so the outlay can be seen as a waste - especially if you have paid for several good checkups. So assuming that people will pay out of pocket (and make the effort to schedule an appointment) is not the way people behave. Insurance has another benefit. Most programs I have been on force you to choose a doctor when you sign up - so when I need a checkup a big hurdle has already been crossed. Insurance companies have been paying 100% for checkups for a while, and not out of the goodness of their hearts. If they thought that not paying would provide increase prevention and lower downstream costs they would not do this - and they have the data. Plenty of people in the US - and India - are without healthcare. I invite you to find a study showing they are healthier. I know there are other factors involved. BTW, the cost of care in India has to be considered in the light of general cost of living. My company has a design center in India, and some engineers have moved from California there. They take an immediate 50% pay cut, and I suspect they are still relatively better off than they were here. > [@](#): > > Sure being healthy means a person can carry on working and paying taxes into the system, but what makes you assume that this is a net benefit to society? In a normal market, any income the doctor/hospital makes from treating him would also be taxed. And if he cannot afford the procedure but gets the treatment under socialised healthcare, the taxes that he would have continued to pay into the system would have been less than the money that went into treating him. > One way your point would hold is if you consider lifetime tax payments. But how many people get struck by life threatening illnesses early or in the middle of their working life? What percentage of these people successfully continue with a productive career? Those figures would make convincing arguments. We already have socialized medicine for people at the end of their careers, so you can remove them. And you can’t just consider taxes. Workers also add productivity to the economy, and that is also lost if they die early or are absent from their job due to illness. However, I’m not sure what your argument is. Prevention is relatively cheap, so is going to pay off not just in taxes earned but also in the reduction of the load on the system. How much savings would there be if we didn’t have to build another hospital because the number of seriously sick people has been reduced? Or do you mean it would be cheaper to let people who can’t afford care to die? Maybe, but that isn’t a society I’d want to live in, nor anyone else I know of. ---
**Author:** ![Saint\_Cad](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/saint_cad/32/18907_2.png) [@Saint\_Cad](https://boards.straightdope.com/u/Saint_Cad)\ **Post date:** [February 24, 2012, 6:07pm UTC](https://boards.straightdope.com/t/why-is-socially-provided-universal-healthcare-better/612181/250 "2012-02-24T18:07:22Z")
> [@KneeSid](#): > > A huge problem with America today is without insurance you wait to get treated. It’s obviously much cheaper to treat a heart attack about to happen, than to wait till after it’s done, but that is what happens. Actually the big problem is that medical costs are based on deep pocket insurance companies paying the bill. That’s why in the 90’s I got hit with a $150 bill for a doctor telling me my toe was infected and no treatment or prescription or a $300 bill for my son for an urgant care doctor to tell me WTF do you want me to do about a broken tooth? (BTW BCBS told me to take him to urgant care then refused to pay the bill since it was only a suggestion). The assumption was I’m sure that it would be paid by the insurance according to their cost schedule. I considered it really lucky when I found a low-cost clinic to give my son a $50 physical while I was out of work. The price point makes it impossible for non-insured people to go to the doctor. And because of this insurance prices … ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [February 24, 2012, 6:24pm UTC](https://boards.straightdope.com/t/why-is-socially-provided-universal-healthcare-better/612181/251 "2012-02-24T18:24:03Z")
It’s the opposite, actually. The costs are based on insurance companies _not_ paying the bill. As you note, insurers reimburse providers according to a fee schedule, and providers deal because otherwise they’ll lose the insurers’ business. They don’t care about losing uninsured business, hence the price gouging. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [February 24, 2012, 6:36pm UTC](https://boards.straightdope.com/t/why-is-socially-provided-universal-healthcare-better/612181/252 "2012-02-24T18:36:46Z")
> [@Really\_Not\_All\_That\_Bright](#): > > It’s the opposite, actually. The costs are based on insurance companies _not_ paying the bill. As you note, insurers reimburse providers according to a fee schedule, and providers deal because otherwise they’ll lose the insurers’ business. > > They don’t care about losing uninsured business, hence the price gouging. I wonder what part of market power people don’t understand? In the rest of their lives, they know that buyers of mass amounts of any good or service get a discount. Why do they think that in health care the one off customer would get better rates than the insurance customer - especially because he is usually unable to shop around. Your average conservative would say that **Saint Cad** should have shopped around for the low cost provider of chipped tooth services - and broken bones and everything else. Sure, you can do that for physicals or cosmetic surgery, but the former is not where the cost is. And your low cost provider of a physical could be the high cost provider of care if they find anything wrong. We in company plans, especially for big companies, benefit because our companies have market power also. ---
**Author:** ![Novelty\_Bobble](https://avatars.discourse-cdn.com/v4/letter/n/a3d4f5/32.png) [@Novelty\_Bobble](https://boards.straightdope.com/u/Novelty_Bobble)\ **Post date:** [February 24, 2012, 6:43pm UTC](https://boards.straightdope.com/t/why-is-socially-provided-universal-healthcare-better/612181/253 "2012-02-24T18:43:51Z")
> [@Banquet\_Bear](#): > > The 50 million people figure you chose to use was determined by NACER, while the world bank use a figure of 20 million people: or 20% of the population. Apologies if I’ve missed something fundamental here… but wouldn’t 50 million and 20 million represent 5% and 2% of the Indian population respectively? What with there being a billion Indian citizens? Would this not also change the weight of the argument by an order of magnitude as well? ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [February 24, 2012, 6:46pm UTC](https://boards.straightdope.com/t/why-is-socially-provided-universal-healthcare-better/612181/254 "2012-02-24T18:46:31Z")
You haven’t missed anything; **Banquet Bear** missed a zero. 😃 ---
**Author:** ![Kearsen](https://avatars.discourse-cdn.com/v4/letter/k/82dd89/32.png) [@Kearsen](https://boards.straightdope.com/u/Kearsen)\ **Post date:** [February 24, 2012, 8:58pm UTC](https://boards.straightdope.com/t/why-is-socially-provided-universal-healthcare-better/612181/255 "2012-02-24T20:58:01Z")
> [@Voyager](#): > > I wonder what part of market power people don’t understand? In the rest of their lives, they know that buyers of mass amounts of any good or service get a discount. Why do they think that in health care the one off customer would get better rates than the insurance customer - especially because he is usually unable to shop around. > Your average conservative would say that **Saint Cad** should have shopped around for the low cost provider of chipped tooth services - and broken bones and everything else. Sure, you can do that for physicals or cosmetic surgery, but the former is not where the cost is. And your low cost provider of a physical could be the high cost provider of care if they find anything wrong. > > We in company plans, especially for big companies, benefit because our companies have market power also. We have company plans as well. You know what I found? I can be insured for much less (as a single family candidate) Why you might ask considering we are in a group plan. Here is why: I’m healthy, a non-smoker and not a woman Also as an individual, I can be denied coverage, something most group plans will give you a certain period to not be. (denied that is) In light of that, I can see why people think the universal payer idea is likely to cost them more money than currently. As an aside it is also quite possible that with the purchasing power you adhere to the costs may be sufficiently cut to drop even ‘my’ insurance costs. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [February 24, 2012, 10:04pm UTC](https://boards.straightdope.com/t/why-is-socially-provided-universal-healthcare-better/612181/256 "2012-02-24T22:04:26Z")
> [@Kearsen](#): > > We have company plans as well. You know what I found? I can be insured for much less (as a single family candidate) > Why you might ask considering we are in a group plan. Here is why: I’m healthy, a non-smoker and not a woman > Also as an individual, I can be denied coverage, something most group plans will give you a certain period to not be. (denied that is) > > In light of that, I can see why people think the universal payer idea is likely to cost them more money than currently. > > As an aside it is also quite possible that with the purchasing power you adhere to the costs may be sufficiently cut to drop even ‘my’ insurance costs. That’s the mandate problem. You may pay less now, but in 10 or 15 years you would be paying a lot more. If you compared your coverage to that of some startup where everyone is young, I bet you’d still lose. You can be denied, you can be dropped. I can’t be. My old company had a requirement to take health insurance unless you could prove you were covered under a partner’s coverage to avoid this kind of thing. My current coverage is a lot cheaper for me than anything I can get outside - though I’d probably be rejected at this point. I get top notch coverage at a relatively low price. ---
**Author:** ![PrettyVacant](https://avatars.discourse-cdn.com/v4/letter/p/49beb7/32.png) [@PrettyVacant](https://boards.straightdope.com/u/PrettyVacant)\ **Post date:** [February 24, 2012, 11:32pm UTC](https://boards.straightdope.com/t/why-is-socially-provided-universal-healthcare-better/612181/257 "2012-02-24T23:32:34Z")
One of the thing that seems pretty weird from outside the US is that the debate is mostly focused on now, this circumstance, this employer, the here and now - and how it relates to you. Given the system, I guess it kind of makes sense to not think about parental needs in the years ahead or grandchildren, or even generations of your direct family not yet born. Anyone who lives in the first world but outside the US knows how that will work out for their family. That’s really very cool. ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [February 25, 2012, 12:41am UTC](https://boards.straightdope.com/t/why-is-socially-provided-universal-healthcare-better/612181/258 "2012-02-25T00:41:44Z")
We’re very much a “here and now” sort of people. That’s why we got to the moon in 9 years but can’t build a structure that won’t need to be torn down in 40. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [February 25, 2012, 12:54am UTC](https://boards.straightdope.com/t/why-is-socially-provided-universal-healthcare-better/612181/259 "2012-02-25T00:54:14Z")
> [@PrettyVacant](#): > > One of the thing that seems pretty weird from outside the US is that the debate is mostly focused on now, this circumstance, this employer, the here and now - and how it relates to you. > > Given the system, I guess it kind of makes sense to not think about parental needs in the years ahead or grandchildren, or even generations of your direct family not yet born. Even worse, the politicians who want to “reform” Medicare say that it won’t kick in for 10 or 20 years in the hopes, I guess, that anyone 45 or younger won’t mind getting screwed when they hit retirement age. ---
**Author:** ![PrettyVacant](https://avatars.discourse-cdn.com/v4/letter/p/49beb7/32.png) [@PrettyVacant](https://boards.straightdope.com/u/PrettyVacant)\ **Post date:** [February 25, 2012, 7:49am UTC](https://boards.straightdope.com/t/why-is-socially-provided-universal-healthcare-better/612181/260 "2012-02-25T07:49:35Z")
> [@Really\_Not\_All\_That\_Bright](#): > > We’re very much a “here and now” sort of people. That’s why we got to the moon in 9 years but can’t build a structure that won’t need to be torn down in 40. You’re very much a manipulated and indoctrinated people. And yes, that’s an equally crass and foolish thing to say. [Previous page](https://boards.straightdope.com/t/why-is-socially-provided-universal-healthcare-better/612181.md?page=12) [Next page](https://boards.straightdope.com/t/why-is-socially-provided-universal-healthcare-better/612181.md?page=14)