I feel like I’m talking past you and most of the other posters. This stuff is incidental. You’re not addressing the basic question. Is there any reason to say socialised health care in itself is desirable, beyond subjective considerations of morality? The dozens of posters were giving me information that stated why European systems are better than the American. I can’t get into that debate because I don’t know enough about either.
My question is more fundamental. Voyager’s response was substantive. Very few of the others have been, which is why I’m ignoring them rather than get bogged down in talking about something that had nothing to do with my original question. I think the reason this is happening is that for most posters, their only example of a non universal/socialised system is America. So they immediately think of this situation boiling down to America vs. Europe, whereas I’m not coming at it from that perspective. Sure, maybe America’s system is fucked up, but why is that considered to be the only way non universal healthcare can work?
I can give an example of how India’s system functions. Now obviously, Indian healthcare is very far from being the best in the world. But it is cheap. We have a ‘universal’ government run free healthcare system, but until a few years ago, approximately 80% of all spending on health was private, because the government system is screwed up beyond belief. You probably couldn’t walk into a government hospital in India. (I have, into literally hundreds. I worked on a consulting project with the government to improve service delivery in hospitals )
So because of this failure there’s a thriving private sector. And treatment is reasonably cheap because there is competition and there is demand from people who cannot afford to pay, but cannot pay a lot. And they also do not have the government to pay for them or insurance. But that demand exists and is unfulfilled, which is causing companies to innovate and look for ways to serve this market with lower costs and reasonable quality. Here’s the economist article again, which basically fleshes out what I’ve written in this paragraph.
In a socialised or universal healthcare system on the other hand, the incentives for doctors and hospitals would not lie solely in lowering costs or improving services. The incentive there would be to lobby government for higher premiums. It would cause what seems to me to be an unnecessary distortion in the market. Is there any compelling reason for this distortion to exist, aside from subjective interpretations of morality?
I’m sorry but this stuff that you handwave away is speaking exactly to the point of your original question.I’ve re-read your first post and you seem to be shifting the goalposts. Is it because you are noting the groundswell of opinion and it is ideologically unpalatable to you?
The American vs Europe debate is exactly the one you should be listening to if you really want to understand. There are plenty on this board who have experienced UHC in various formats and can compare it directly the USA. Why always the USA? because it is one of the few first world countries to have a system that isn’t UHC.
So those who have experienced both have valuable input make and can offer opinion on societal benefits and costs, which system they prefer and why they think it works.
In order to fully comprehend the options open to you and the potential solutions to India’s problems then you’d be well advised to look at “best practice” elsewhere, as well as noting the deficiencies. Especially if you are consulting on the damn thing.
But first things first, do you think everyone should have equal access to healthcare regardless of their ability to pay? because to my mind, that is a question of morality and will shape the solutions for delivery.
They are already required to spend 80-85% of their premiums on health care services. If they cut their “non-doctor” expenses in half they could, at best, give a 7-10% price break. Cutting those expenses would, almost definitely, result in crappier service than you already get. Is that an option you would take?
The problem isn’t so much the operation of the insurers, it’s the existence of the insurers. The very structure of the industry has lead us to have a dysfunctional, high cost market for health care service.
Universal health care is better because it’s spreads the risk, of the high need user, over the largest group. This means no one is going to ‘over tax or bankrupt’ the system. It is the best, most cost effective way of spreading the risk. No one need be denied coverage. If you also couple this with a ‘not for profit’ model, like fire stations, or policing services, you can achieve the lowest possible cost to user for universal coverage. One insurer, is one set of universal forms, an amazing savings just in itself.
The other efficiencies are costs that are reduced when people address health issues when they first arise, instead of waiting till they are life threatening and an emerg must take them.
The advantages to the ‘marketplace’ are people do not stay trapped in jobs, they are free to shift about, they lose less time to illness. Savings to all social services are to be realized largely because families do not fall into poverty when illness strikes them. No one loses their retirement funds, or their child’s college fund, or their house, because they have the misfortune of being stricken by illness. All those people fall into the social safety net, much more expensive than just giving them affordable health insurance. Personally, I think this is the single biggest cost savings and benefit to society or the marketplace, but no one ever seems to focus on it.
These are realities that exist outside of the morality of helping the ill or in need.
I think in the end that’s the reason why UHC exists where it does - because it’s considered moral rather than because of any other advantages it’s believed to have over the alternatives (although I do believe it’s preferable regardless of morality).
I also think advantages one way or the other are largely irrelevant to the US stance against UHC. The biggest reason for not having it there is it’s too “socialist”.
And you’re looking at anecdotal failings and ignoring some monumental successes. The Indian public sector is notorious for its corruption and inefficiency (which, I believe, is a hot topic in India at the moment). You seem to think that all other governments are just as bad. While I would be hard-pressed to argue that any bureaucracy is as efficient or customer-focused as it ought to be, many of them are a heckuva lot better than India’s.
I’ve experienced both the US and UK healthcare systems and had good and bad care under both. While the good care in the US is extremely good, I’d still take the NHS model any day.
I agree, As is often mentioned on this board “you can’t reason someone out of a position they didn’t reason themselves into” And that goes for this as well. Point out the economical savings and logical arguments all you want but that gut feeling against it still hold sway in the USA. I wish that weren’t the case.
It may be a generational thing. The old guard may have to die off before reason can take over, or some other national crisis may tip the balance (As the second world war did here in the UK)
I don’t know that you mean this as broad as you state but to use that same logic, there should also be universally provided day care, mortgage payments and HEB coupons.
Of course, the reverse of this logic suggests that we should have no soup kitchens, no homeless shelters, no food stamps, and no public schools. Can’t afford the cost of food, shelter and education for your kids? I guess you should have gotten yourself a better job.
The day care part doesn’t exist, but don’t the other two exist in some related form?
For low income families, there’s certainly housing assistance and WIC.
At least it’s universally provided in the same sense there’s universal health care in the form of emergency rooms, so there’s a societal recognition that food and shelter should be provided for all children, at least, even if the quality of the aid may or may not be all that high.
What about money back to the parents whose kids learn nothing? Bush got a law saying kids must learn. Now Obama is letting the states that failed to get off.
I want health care that works better than our public schools.
I don’t see how I’ve shifted the goalpost one inch.
See, if you’d been reading any of my posts thus far, you’d know this is the question I want answered. In the VERY post that you’ve quoted, I have reiterated that this is the question that I want answered. Morality is subjective. Is there empirical evidence out there that makes the case for access to healthcare regardless of ability to pay? In terms of productivity, life outcomes etc. ?
Which monumental successes are you referring to? Please point me to them. So far, the most successful somewhat large system I’ve found is the Japanese one. All others, including the oldest one in Germany, cannot be regarded as unqualified successes. Neither can the Japanese one really, but there don’t seem to be any big points against it.
It strikes me that it would be very interesting to hear from a Brit who has experienced an Indian private hospital and the NHS. While it would be anecdotal and wouldn’t necessarily tell us much either way, it would be an interesting perspective.
And sure, the Indian bureaucracy is hella bad, but it’s improved in recent years. You know why they’ve improved? Because they’ve had a whole lot of areas in which they had no business being removed from their ambit. They no longer have power over everything that happens. It’s easier/possible for them to do the more limited jobs they have(which is their core job of governance), it is easier for their political masters to measure their performance, and they let the market mechanism step up and do the job in areas where the government doesn’t belong. I’m wondering if Healthcare is another one of those.
I will reiterate once again. I am not ideologically opposed to universal healthcare. I don’t believe there is a moral argument to be made for it, as most posters here do. But that isn’t productive ground for debate. They can tell me I’m misanthropic, I can tell them they’re hypocrites who don’t know the realities of life in a poor country. It gets us nowhere.
This was in the OP(although maybe it wasn’t clear enough), and I’ve just repeated it to Novelty Bobble in the post above, but is there an argument to be made, aside from the moral one, for equal access to healthcare regardless of ability to pay?
(tip of the hat to Novelty Bobble for the wording)
It’s better, because it’s more cost effective than having people fall into the social safety net.
When people lose their retirement savings, who do you think picks up the tab? One way, or the other, (Medicade, subsidized housing, etc) it’s the tax payer. When your wife’s health crisis, costs your kids a college education, who’s going to pay? The tax payer, through grants to disadvantaged students. When a person lands in emerg with expensive care needs that could have been entirely avoided with early intervention, the tax payer pays for that, too. When medical costs take your home, now an entire family is homeless, who pays for shelters, soup kitchens, welfare. Tax payers.
It’s just flat out cheaper, to give people access to health care, than to pay the consequences and pick up the tab, for not doing so.
Now, who’s changing the subject here? I was never arguing about “Scandinavian homogeneity”. I argued against your undocumented and very broad claim that
If you want to dismiss my arguments by trying to change the discussion to nitpicking about Scandinavian conditions, be my guest. But by doing so, you’re also showing quite clearly that your original very broad generalization - about publicly founded systems and ethnic homogeneity in general - doesn’t have a leg to stand on.
Correct me if I’m wrong, but you’re advocating a system with no insurance at all, where people just pay out of pocket for their medical expenses? Except some basic healthcare for children.
As a Brit, I do find it amusing that you’ve concentrated on the Scandinavian systems. Because frankly the Swedish (not sure about the other bits of Scandinavia) system is slightly closer to the US idea than the much more socialist British system. Namely, in the UK you just turn up and get treated. In Sweden you have to pay, although unlike the US it is capped at 900 SEK/year. The charges recently changed so I’m not sure, but I think an Akuten/ER/A&E/Casualty visit costs 300 SEK.
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