Internal thought processes which I’ve tried to explain. (although, clearly, unsuccessfully for at least to some of the posters)
I apologise for pissing you off, it certainly isn’t my intention.
You didn’t have to choose such an obviously frivolous example to illustrate the point though. Again, this seems like an argument that is logically consistent but fails the test of “reasonableness”
On one hand a population that is entertained or bored
On the other a population that is alive or dead.
A better example would be education. We think an education is a right and provide that base level for everyone, by way of tax income, as a way of making society more effective.
I don’t know what your definition of ‘middle class’ but I suspect it’s rather wealthier than mine.
Most middle-class people I know couldn’t come up with $25,000 in enough time to get the treatment (some would be able to as a loan, though this would be made more difficult by the ill person being, er, ill), and England has a much higher average income than India. I’m willing to bet most Indians can’t actually afford it at all.
By you definition of a public good, yes, socially-provided healthcare can be one:
Encouraging preventative care and early intervention saves a lot of money treating that illness. It also lessens the likelihood of contracting other illnesses related to the main illness and its treatment (such as illnesses arising from the weak immune system during bone marrow transplants), which also saves the health system money.
Being healthy means that the person can carry on working and paying taxes into the system (supporting healthcare) rather than taking resources out.
A unhealthy person is more likely to have an an accident (due to a fit, heart attack or tiredness due to illness) than a healthy one (obviously it can happen to healthy people too, just less often), either harming themselves or other people.
I think there are other ways that giving people healthcare actually saves the healthcare system money, but the first two points are really enough.
shrug The UK NHS is experiencing some of the same inflationary pressures as everywhere else. The cost of most drugs which become available today is hundreds or thousands of times that of older drugs when they became available, partly because virtually every drug launched today is a niche product. The same is true for the Canadian private-provider system.
Costs are certainly rising much less quickly in the US, though.
While homogeneity isn’t particularly relevant to what we’ve been talking about, here’s apeer reviewed paper(pdf) that shows ethnic homogeneity is a significant variable in public spending. Places that are more homogeneous have higher public spending.
Yep that seems like a reasonable approach.
It is pretty much what we have in Australia, although everyone chips into the Medicare system and those on higher wages pay more not only as an amount but also % of income. I can also afford private insurance which I have on top of standard care.
There have been times in my life and of people I know that they could not have afforded private health care, it is good to know that they will get excellent care and not go bankrupt just because they got cancer.
Poor people get a health care card which gets them “free” health care.
Sorry, I must have entirely missed this post earlier. Saw, it after Sisu’s post. Sure it is a frivolous example, but I didn’t intend for it to be analogous. I only wanted to show you that we’re talking about different things. I’m talking about the impact of healthcare on society, and you’re talking about the impact of healthcare on health. I was only trying to illustrate that difference. And just the fact that you don’t immediately think that there is any difference tells me a lot about your(and possibly other people’s) thinking on the issue.
Most Indian middle class families would be able to come up with 25k USD for treatment. According to this report(pdf), middle class households in 2005(50 million people) had a disposable income between 200,000 to 1 million Indian rupees. To me, a disposable income that high suggests these households could in one year cover the 1.2 million Indian rupees needed for the most expensive procedure on the earlier list, which was probably anyway inflated for international customers.
Also, I’m not holding out the Indian healthcare system as a paragon of some sort. Much to my dismay, the Indian government has of late started making health insurance a tax deductible for employers. Predictably, now that the costs are being spread out, costs of medical procedures have shot up in the last couple of years. What is interesting is that many doctors will ask if you have insurance or not, and if you don’t, will proceed to treat you at the old, low rates, clearly showing that the lower rates are worth their opportunity cost.
Your other points are good arguments if they hold, but persuasive evidence that they do would be nice. As it stands, I could just flip them around on you.
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?
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.
A lovely bit of just-world, blame-the-victim reasoning there. If only those children with cancer had just taken better care of themselves, their parents wouldn’t be going bankrupt right now!
And yet it is. Which is the problem we are seeking to address.
Picture any group health insurance plan. Now extend it to everybody. That’s how it works.
Well, the ones who die for lack of affordable health care definitely don’t.
I don’t know what you’re on about. I was asking for evidence to support Sam’s points, and demonstrating counter-points that are just as valid from a theoretical standpoint.
“Think of the poor children!” is all well and good as an emotional appeal, but fails beyond that. Sure the world isn’t just. And it isn’t the child’s fault that he/she has cancer. But why should that child’s cancer be society’s responsibility? And this is not a rhetorical question.
Could you explain your point about group insurance please?
And yes, the ones who die because of a lack of free healthcare will surely not be continuing with productive career. Hence I asked if we had any evidence that can lead us to believe this constitutes a net drag on society?
Maybe because, in the mind of some of us, society should not only be governed by purely economical motivations, but that a certain amount of empathy should also factor in when society decides what is good and what is bad for itself?
Just a bleedin-heart liberal’s gut feeling, mind you.
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.
So 80% of the population aren’t middle class: which leads me to believe that this “middle class” really isn’t the middle class. In the US definition: roughly 49% of the population are “middle class”, so I suspect the definition of middle class being used by your cite means something completely different to how the rest of us would define it.
So you’ve proven that 20% of the population wouldn’t have a problem finding 25K in a hurry. I don’t think that would be different over here either.
But what percentage of the population wouldn’t be able to afford $25 K USD for treatment? Surely this is more relevant than just looking at what the “middle class” can afford.
Can you provide a cite for a country that has socialized health care that where the population: encouraged by the moral hazard that is free (at the point of delivery) healthcare, have decided not to take care of themselves?
It’s a perfectly valid viewpoint to have, and if that’s your major reason for advocating socialised healthcare, it’s good for me to know and keep in mind. It is also a viewpoint that I can understand. I am not an unfeeling robot. It isn’t a great avenue for reasoned debate though, as I mentioned in the OP also. If I had to counter it, with my own gut feeling, I’d say that socialising those parts of healthcare that are a private good(by the economic definition) inflates the prices that the market can bear. By extending the costs of healthcare even to people that do not demand it, it introduces a distortion that reduces the need to serve the market as it exists and does greater damage than good in the long run.
Sorry, I’d lost sight of this thread for a while.
Preventative care is also covered under “health services”. In the US, I had to pay to get vaccinated; I had to pay to see a doctor or nurse and for the vaccine, and this after paying for insurance which only covered healthcare and came with a thick smallprint booklet on what was and was not covered. In Spain, I have to see my doctor or nurse.
Last month I got a yearly at my local Public Healthcare Center. Half an hour with the nurse; tetanus shot; blood work; five minutes with the doctor (“perfect bloodwork results, stay like that” doesn’t require a lot of time to be said). Out of pocket costs: zero. The out of pocket costs would have been the same if I’d needed any other tests. I can’t tell you how much of the money I pay to Seguridad Social each month goes toward healthcare without dredging up some stats, since it isn’t only healthcare: it also covers retirement, unemployment assistance and other social services. And it covers vaccination programs in schools which are compulsory, and vans going to barrios where kids don’t attend school to get them vaccinated.
People are more likely to see a doctor when it doesn’t run the risk of meaning a big chunk of income, and more likely to get vaccinated when there’s an organization trying to get them vaccinated than when it’s completely voluntary.
No, it’s not my major reason for advocating public health care, those are more in line with Nava’s recent arguments.
But “that” is definitely my primary knee-jerk reaction to
which I interpret as a heartless and brutal opinion disguised as a question.
No it isn’t more relevant. I was trying to show SciFiSam that affordable healthcare was possible if an out of pocket expenditure was used to pay for healthcare. This is why I pointed out that the Indian private healthcare system, which exists to serve the middle class, operates at price levels that the middle class is able to afford. The most expensive procedure listed at an Indian hospital, is a procedure that the Indian middle class can, at a pinch, afford. Out of pocket expenditure, in other words, is not necessarily an immediately unviable approach to healthcare.
India’s a developing country. It makes no sense to see how much of our population can afford healthcare. In fact, in India there are far more compelling reasons to provide universal healthcare to improve equality of opportunity. In fact, in India universal healthcare does nominally exist. It’s pointless to discuss India’s case unless you have something specific uou can focus on.
I don’t need to. I’ll retract the statement as soon as I get a cite for the one in response to which it was made.
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.
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 )
Sigh. As I’ve mentioned in the OP, and numerous times since, I consider vaccination to be a perfectly good candidate for socialising costs. Immunity is non-excludable. I don’t have a view on annual screening examinations as part of a public health system. It’s an interesting system, and I’ll be looking it up.
I’m also a little sick of everybody beating on the US system as though it is the paragon that I’m holding up. Sure the US system sucks. That’s because (as far as I can tell) of historical baggage, third party health insurance and the legal system. It has little to do with the actual costs of providing health care.
Instead of insurance, tax deferred medical savings accounts and out of pocket expenditure would allow the market to work much better. (Public health services would exist independently of this, providing those services that have the characteristics of public goods (as per the economics definition) like vaccination, education about health, sanitation, possibly mandated annual screenings).
…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?
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?