You are narrowing the debate from your original post, which was far broader than your one-line restatement here.
I know your position, it was a rhetorical question. See the following posts for further discussion on that.
OK, in order to assess the evidence lets be clear on what is being asked here. You need to define what metrics are important to you and what sort of evidence would be acceptable. What does productivity mean? what is a “life outcome”. We have to define our terms.
The two massively important metrics that are easy to get would be coverage and costs per head. Other we may consider could be practical accessibility. These may act as a decent proxy for productivity and life outcomes seeing as if you can’t get healthcare or it won’t cover you then of course those are going to be adversely affected. Can they be measured directly though? I’m not sure.
Also, to allow for confounding factors you’d have to compare across broadly similar countries that operate the different systems. To do that we are once again driven to compare the first world countries, Europe and the USA.
If you want an unqualified success you’re not going to find one in either the public or private sector. But as I’ve already said, the NHS for all its failings is extremely good value for money and attempts to privatise it have been met with heavy public resistance. In fact, some of its worst failings were down to efforts under Thatcher and Major to outsource some of its support functions - most notably, privatising the cleaning services resulted in a marked decrease in cleanliness in hospital wards.
But you’re taking away the wrong message. The fact that the Indian government ran things badly doesn’t mean that all governments run things badly (or at least worse than the private sector). All it means is that the Indian government runs things badly. Letting “the market mechanism do its job” is what’s causing the problems in the US at the moment and is the reason vast numbers of people get no health care at all apart from minimal emergency care.
Have you read any of this thread? To quote one of Novelty Bobble’s posts about the NHS as an example:
In short: it’s cheaper, more efficient, more effective, covers everyone, and doesn’t prohibit the free market from competing. Of course it’s not perfect but what is?
Indeed, the default model the GOP uses to attack UHC is the UK’s NHS, precisely becasue it is the furthest removed from the USA model. In fact, it’s the only one without any kind of personal insurance component, I believe.
The fact that no one in mainstream US politics is considering anything remotely like the UK model seems to not be relevant, the fact is it’s SOCIALIZED MEDICINE!
Wow. You really blindsided me with that. Sheesh. Read my posts. Law and order and infrastructure are clearly defined public or quasi-public goods. The case for government/social provision is clear cut.
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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.
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My personal position is that basic healthcare should be provided for children(on the grounds that it is a quasi public good) and the very poor(on moral grounds, because especially in India, there is nothing close to equality of opportunity). And I’m not necessarily saying no insurance at all. If a market for health insurance can stand on its own merit (without being tied to mandated universal coverage, or perhaps employer provision of health insurance as it seems to be in the US) then I have absolutely nothing against it. It’s just the nature of the healthcare insurance business that makes me think it isn’t all likely that such a market will function. Aside from that, yes, out of pocket medical expenditure.
Firstly, though there may have been some evolution of this thread so far, and the typical misunderstandings inherent in internet discussion, bldysabba has been engaging in a genuine way. (that isn’t a backhanded compliment BTW, so many of these threads end up badly) That makes a refreshing change. And there are very important questions to ask, even if we are unlikely to come an agreement on the answers.
Secondly, it may be that bldysabba’s question really is and needs to be narrower than we appreciate. If the moral argument is not up for discussion then perhaps it only really makes sense to think of how this applies to India and the specific challenges of free-market vs UHC in that context. In which case…I’m at a loss as I don’t know.
But the best healthcare system for the US (or other first-world countries) is a different argument than the best healthcare system for India. If we’re talking specifically about India then that’s a whole other ball of wax
I’m pretty sure having most people pay medical expenses out of pocket would result in a lot more unnecessary deaths and disabilities, widows and orphaned kids, beggars and street crime. Like you have in India, actually, in comparison to the UK.
Ah, see, in Spain one of the pieces of data that gets reported every month is variation in the amount of “people actively contributing to our UHC system” - when the chunk of variation linked to immigration is significant (be it up or down, the implosion of the construction bubble led many people to return home sooner than they’d planned to), that gets reported, as does data on m:f ratio, temp vs perm vs self-employed and others.
There have been some people here who’ve tried to play the “they’re coming here to mooch off our SS!” key, but it’s broken, since “they” contribute to that SS; there have been some cases of immigrants trying to abuse things by getting expensive surgery to relatives who would never be considered dependents under Spanish law (no, you can’t claim your mother’s second cousin as a dependent!) but it’s been very rare.
Mind you, it’s possible that part that “oh noes they’re mooching!” key is broken is that Spain has been an emigrant or passer-by country through much of the 19th and 20th century; finding a Spaniard who does not have at least one group of second cousins (or closer) living abroad is actually rare. We do know that when we go abroad to work we pay taxes wherever, we do know that when people come here to work they do pay taxes here.
The corruption of the Indian system and racism are two issues which are separate of whether UHC is better than job-dependent or uninsured medicine. They can affect each other, but if corruption was a reason to say “government can’t ever do [insert job here] because ours is corrupt”, there’s several dozen countries where the government shouldn’t even be allowed to paint roads… does that mean no government should be allowed to paint roads?
True enough, although I wasn’t really married to any of the terms I used. My point was that you could effectively argue that any and everything should be paid for ‘by the government’ which is essentially socialism
Running health care for all shouldn’t even be a twinkling in governments eye. Now if you want to legislate the way private insurers have to operate, I’ll listen.
The fastest way to a man’s heart is his stomach. Do things for the relatively poor (or people who could conceive themselves as poor) and you endear yourselves to them for a time. This is what politics of late has become.
Your beliefs are irrelevant. “It’s not good because I don’t like it” is effectively a circular argument.
As far as “unaffordability”, feel free to peruse the numbers I posted on the first page of this thread. What is “unaffordable” about a system which would cover every citizen for a fifth of the cost of covering 75% of them?
shouldn’t? what a strange choice of words. Surely you want your government to be making the most efficient use of your tax dollars. Why would you reject a solution out of hand even when it has proven to be better than your current system and decidely not a stepping stone to socialism (note…the UK has become less socialist since the inception of the NHS, not more).
I think we are back to that previously mentioned gut reaction. I don’t think your opposition to UHC is based on a rational argument and I’m not sure what evidence would convince you otherwise.
As for legislation, how about fixing a maximum policy price, mandating a minimum coverage, getting rid of lifetime limits, setting a maximum deductable for all, specifying exemptions for those on welfare and other vulnerable groups, setting up an independent clinical body to judge which treatments go to whom, taking away the insurance company’s ability to refuse coverage…? Those would get you on the road to a fair system and wouldn’t stop those that can pay more getting better and quicker treatment. Everyone is happy (apart from the health insurance companies)
It appears (from other posts as well) that it’s the second part that’s your main concern.
That’s fine, from a philosophical POV.
But claiming it’s unaffordable is rather bizarre. We have several examples of nationalized health care systems which provide US equivalent health care at significantly reduced prices. And several examples of other services government can provide at significantly lower cost (roads, policing, fire departments, militaries, schools, infrastructure, among others).
While there may be a philosophical debate about whether government should provide public services or not, there’s not much of a debate that government can provide several services much more efficiently than private industry can.
It’s unamerican right? No one quite knows why or how but it’s unamerican, perhaps like John Wayne was a True Amercian and Malboro the smoke of True Men.
There are a few other reasons why car insurance is different. Though the purchase of car insurance is required in the US, there is a pretty low cap on payouts except in very unusual situations where someone is injured. Plus, for most incidents, if a guy didn’t buy car insurance and totals his car, that is his tough luck. Medical ethics - and the law - require treatment of the guy dying in your waiting room money or not. Willingness to pay medical insurance is a lot higher also, given that your life is at stake.
But you often don’t know who is more susceptible to health problems. Smokers are, and they get charged more. I’m 60 and have spent exactly one night in a hospital my entire life (not counting when I was born) but it turned out I have a heart condition.
UHC appears to provide better outcomes for less money than the current US mostly free market system. How is that not a net benefit to society?
There are several models of UHC, from NHS in Great Britain to private but single payer plans in lots of other places. The single payer plan we have in the US, Medicare, is very efficient.
Without a right to life none of those other rights means a lot.
The reason I asked the question is that it is impossible to discuss this unless you understand basic premises. Now, members of society have a claim to others time for many things. We have a military to protect our life and our freedom. We have police who risk their lives to protect our lives and property. In both these cases society extracts money from its members (by force as an extremist anti-taxer would say) to pay for this. UHC is not all that different. Cops don’t protect only those people who can afford them - why should doctors?
Of course we are talking about insurance. Price a car model out of my budget, I don’t buy it, and the market works fine. Price a cancer treatment out of my budget and I either bankrupt myself to live or I die. Slight difference there.
As I said, rational economic actors will only buy insurance when the expected value is in the range of the cost. There if fuzziness about uncertainty of the actual expected value and the profit of the insurers. Insurance companies will only sell insurance to those they can make a profit on. If our expected values were constant throughout our life, there would be no issue. But the expected value of insurance is a lot lower for a young person than an old person. Let the young people out of the market and the price for the older person skyrockets. In fact this very thing is happening in California. As insurance prices go up, more and more people drop out of the market leaving fewer and fewer people in - people characterized by having high expected costs. This caused the insurance companies to request massive rate increases. It turns out they had a minor arithmetic problem, but the market will inevitably result in this kind of problem.
My father-in-law is 95. His group insurance just kicked him out because he is the last surviving member of the group. Do you think he could get health insurance which is any way affordable without Medicare - which is mandated, by the way.
Do you have any evidence that UHC damages people? I’ve seen various counts on the number of people in the US who died unnecessarily because of lack of access to health care. I think that is more of a social cost than raising the taxes on the rich slightly, but maybe I’m just being sentimental.