# Why no free healthcare?
**URL:** https://boards.straightdope.com/t/why-no-free-healthcare/275609
**Category:** Great Debates
**Created:** [November 19, 2004, 5:03am UTC](https://boards.straightdope.com/t/why-no-free-healthcare/275609 "2004-11-19T05:03:13Z")
**Posts on this page:** 20
**Page:** 4
### Author:  [@Sam\_Stone](https://boards.straightdope.com/u/Sam_Stone)
#### Post date: [November 19, 2004, 4:12pm UTC](https://boards.straightdope.com/t/why-no-free-healthcare/275609/61 "2004-11-19T16:12:53Z")
**Muffin** said:
> [@](#):
>
> When compared to Americans, Canadians live longer, live healthily longer, pay less individually for health care, pay less through our taxes for health care, and overall devote less of our GDP for health care. That’s what socialized health care is about in Canada – better health for all for less cost.
>
> Canadians live longer than Americans:
> 79.3 years = Canadian life expectancy (2001)
> 77.0 years = American life expectancy (2001)
>
> Canadians enjoy better health longer than Americans:
> 69.9 years = Canadian healthy life expectancy (2001)
> 67.4 = American healthy life expectancy (2001)
>
> Canadian individuals and insurers do not pay as much as American individuals and insurers:
> 28 = Canadian private expenditure on health as % of total expenditure on health (2000)
> 55.7 = American private expenditure on health as % of total expenditure on health (2000)
>
> Canadian taxpayers do not pay as much for health care as the American taxpayers:
> $1826 = Canadian per capita government expenditure on health in international dollars (2000)
> $1992 = American per capita government expenditure on health in international dollars (2000)
>
> Less of Canada’s GDP is spent on health than the USA’s:
> 9.1 = Canadian total expenditure on health as % of GDP (2000)
> 13 = American total expenditure on health as % of GDP (2000)
>
> World Health Organization stats: [http://www.who.int/whr/2002/annex/en/](http://www.who.int/whr/2002/annex/en/)
Here’s the problem with your analysis - it’s measuring the wrong thing. Just because Canadians live longer does NOT mean we get better health care. There can be lots of cultural, genetic, and environmental factors that cause Canadians to have longer lifespans. For example, Americans have the third highest incidence rate for cancer in the world, and one of the highest incidence rates for heart disease. Maybe it’s because Americans are generally fatter than people in other countries?
The important measures are more specific than that. For example, what is the average life expectancy of a Canadian with various forms of cancer, and how does that compare to Americans? What’s the life expectancy of a Canadian with heart disease? What’s the overall life expectancy of Canadians _who are being treated inside the health care system_?
Once you start zooming in on the details, Canads’s health care system does not look as rosy as the picture you’re painting. For example, breast cancer survival rates are significantly higher in the U.S. than in Canada.
Another measure of health care (and this is where socialized medical systems often ration, and therefore don’t do very well) is the treatment of chronic non-life threatening medical problems. Arthroscopic surgery, hip replacements, that sort of thing. Blow out a knee in Canada, and you will be limping in pain on average six months to a year. In some provinces, it’s much worse. Waiting lists for hip replacement in some provinces can be two years. How do you think Grandma in the wheelchair feels about that? Two years is a long time to wait when you may only have ten years of active life left.
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### Author:  [@Capt.Ridley\_s\_Shooting\_Party](https://boards.straightdope.com/u/Capt.Ridley_s_Shooting_Party)
#### Post date: [November 19, 2004, 4:21pm UTC](https://boards.straightdope.com/t/why-no-free-healthcare/275609/62 "2004-11-19T16:21:22Z")
Socialised medicine isn’t the only alternative to a badly organised private health service. There’s always remforming it.
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### Author:  [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)
#### Post date: [November 19, 2004, 4:26pm UTC](https://boards.straightdope.com/t/why-no-free-healthcare/275609/63 "2004-11-19T16:26:16Z")
> [@bouv](#):
>
> Geez, I leave for nin hours and my damn thread goes to two pages!
>
> OK, let me correct myself, I realize nothing is free, and tazes _might_ go up (although evidence presented by some people seems to say the opposite.)
>
> Some of the arguments against universal health care are because you can’t choose your doctor (or, at the very best, the choice is limited.)
>
> Well, look at this scenario:
>
> Everyone in America, when born, gets the “Patriot Plan” (cause you know government officials would name it something like that.) This plan is similar to other European countries and Canada’s. There is a limit in which docotor’s you can go to based on your area and what you are going for. But, to the best of the government’s ability, there will br a board certified doctor you can go to in your area (provided at least one exists in your area.)
>
> Well, let’s look at my insurance, which, BTW, is considered to be one of the best in the nation (Blue Cross Blue Shield.)
>
> If I have a problem, I need to go to an insurance approved doctor or hospital. If I go to an outside hospital for an emergency, then my insurance will still cover it, but if I go for any other reason, I have a much bigger deductible (over twice as much.) The only reason I can even do tis is because I pay for the best insurance my comnay offers. If I went for the cheapets one, I would have NO coverage in any hospital outside my area. I also cannot have my insurance pay for a doctor’s visit if he is not a covered doctor. Well, no problem, you say, because insurance companies will make sure there is a doctor in your area, right? Heh…nope. I like in Saranac Lake, NY. Using my insurance companies handy-dandy doctor search, I find out there are NO doctors in my area I can visit and be covered. The main reason is because I work for a company based out of VT, but work and live in NY. if I had socialized/universal care, I could be assured there would be a doctor in my area to see me.
>
> And as to wanting better healthcare from the insurance providers, well, that’s all well and good for you, because you can afford it/have a good enough job to get it from. What about the 40 M without any coverage? Or the many more millions with crappy coverage? They would certainly be better off. And just because there would be a universal service, doesn’t mean you have to use it. If you want to pay more (and the evidence suggests you WOULD be paying more) for better coverage, than go right ahead! We can have a mix! Maybe there could even be tax breaks for people who opt to get private coverage. But to those who can’t afford the private coverage, the universal healthcare would be a godsend. There. Everyone is happy. And taxes might even go down!
Yeah, a PPO or HMO limits your choice of doctors and as far as I can tell not many other countries ‘prohibit’ having a choice in doctors. Maybe i’m wrong though. As far as rationing in the US we already have that. If you can afford it you get it, if not then you don’t. I hear people in the US complain about 6 week waiting lists in Canada but they are silent when it comes to chronic illnesses in the US that never get treated due to lack of money. Plus insurance companies fight to avoid paying for anything so that is another form of rationing.
And opting out of the system to get private coverage is allowed in many industrialized nations, and it would work here too. And even if a person had both universal coverage and private coverage they’d still end up saving money over our system in the US that gives 1/3 of the public either no insurance or inferior insurance. Plus in the US people are chained to their job because of health insurance, other industrialized nations don’t worry about that. Plus the added expense of around [$7356](http://abcnews.go.com/Health/Insurance/wireStory?id=15019) per employee for healthcare makes the US non-competitive in the international market. The article says $10,217 but 72% of that is employer paid so its $7356 a year spent by employers.
Taxes would probably stay the same if you adopted the system(s) like those in Australia, but private costs would go down and wages would theoretically go up since businesses could avoid paying that $7356. Since americans work about 1900 hours a year that 7k translates into about a $3.87/hr wage increase. Plus on top of that $7356 in wage cuts the employee pays on average $2860 a year in premiums, so thats another $1.50 in wages.
[Here](http://www.washingtonpost.com/ac2/wp-dyn/A34899-2004Mar5?language=printer) is the article about how consumer goods cost more in the US due to insurance costs.
Sadly the system in the US is too ingrained for these radical changes but at least the rest of the developed world follows them.
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### Author:  [@SentientMeat](https://boards.straightdope.com/u/SentientMeat)
#### Post date: [November 19, 2004, 4:38pm UTC](https://boards.straightdope.com/t/why-no-free-healthcare/275609/64 "2004-11-19T16:38:56Z")
All valid points, **Sam** , but everywhere else people look at the waiting list and _opt to pay privately_ if they find it unacceptably long. Canada is the only country I know of which, bizarrely IMO, _forbids_ the private option. (I suspect that Canada only finds this a tenable position because it has the US on its doorstep, offering Canadians that choice).
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### Author:  [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)
#### Post date: [November 19, 2004, 4:39pm UTC](https://boards.straightdope.com/t/why-no-free-healthcare/275609/65 "2004-11-19T16:39:42Z")
> [@Sam Stone](#):
>
> **Muffin** said:
>
> Here’s the problem with your analysis - it’s measuring the wrong thing. Just because Canadians live longer does NOT mean we get better health care. There can be lots of cultural, genetic, and environmental factors that cause Canadians to have longer lifespans. For example, Americans have the third highest incidence rate for cancer in the world, and one of the highest incidence rates for heart disease. Maybe it’s because Americans are generally fatter than people in other countries?
>
> The important measures are more specific than that. For example, what is the average life expectancy of a Canadian with various forms of cancer, and how does that compare to Americans? What’s the life expectancy of a Canadian with heart disease? What’s the overall life expectancy of Canadians _who are being treated inside the health care system_?
>
> Once you start zooming in on the details, Canads’s health care system does not look as rosy as the picture you’re painting. For example, breast cancer survival rates are significantly higher in the U.S. than in Canada.
>
> Another measure of health care (and this is where socialized medical systems often ration, and therefore don’t do very well) is the treatment of chronic non-life threatening medical problems. Arthroscopic surgery, hip replacements, that sort of thing. Blow out a knee in Canada, and you will be limping in pain on average six months to a year. In some provinces, it’s much worse. Waiting lists for hip replacement in some provinces can be two years. How do you think Grandma in the wheelchair feels about that? Two years is a long time to wait when you may only have ten years of active life left.
As opposed to the US where you may spend your life on a bad knee if you can’t afford the price of treatment? You can buy private insurance in canada if you think the coverage is inferior, nobody is forced by law to stick with the state sponsored healthcare system if they don’t want as far as I know.
There is an article about some of the shortcomings of each system.
[http://www.healthfinder.gov/news/newsstory.asp?docID=518746](http://www.healthfinder.gov/news/newsstory.asp?docID=518746)
Breast cancer survival rates are higher in the US than in Europe. They are 89% in the US and 82% in Canada.
[http://www.4woman.gov/news/dec304.htm](http://www.4woman.gov/news/dec304.htm)
[http://www.cancer.ca/ccs/internet/standard/0,3182,3172\_367655\_39066503\_langId-en,00.html](http://www.cancer.ca/ccs/internet/standard/0,3182,3172_367655_39066503_langId-en,00.html)
Even so, I do not think that this really justified all the faults in the US system like the higher premiums or the fact that 100 million people have inferior coverage.
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### Author:  [@Jonathan\_Chance](https://boards.straightdope.com/u/Jonathan_Chance)
#### Post date: [November 19, 2004, 4:40pm UTC](https://boards.straightdope.com/t/why-no-free-healthcare/275609/66 "2004-11-19T16:40:01Z")
Good luck to that.
Let me redirect this a little bit with a question:
I keep hearing that the ‘socialized’ or ‘government provided’ healthcare of the Canadian and other European systems provided lesser care at more expense, etc.
If that’s the case why don’t I hear about public complaints and uprisings to replace those systems?
In other words…is there a Euro and Canadian version of the SD where repealing such a system is endlessly discussed and debated?
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### Author:  [@DrDeth](https://boards.straightdope.com/u/DrDeth)
#### Post date: [November 19, 2004, 4:52pm UTC](https://boards.straightdope.com/t/why-no-free-healthcare/275609/67 "2004-11-19T16:52:15Z")
> [@Muffin](#):
>
> In Canada we do not pay higher taxes for health care than Americans (see my previous post). In Canada we have personal doctors of our own choice.
In America- when I switch Insurance- I also have a a personal Doctor of my own choice. Just that that list of whom to choose from might not include my previous family doc from another Insurance plan. Since I have Canadian relatives- the same complaint was poored into my ears when you switched- not all the Doctos opted in and not all the Doctors were available to all.
Now, if you start- they give you a list of Doctors do they not? Have not a few opted out? Are not some procedures and specialists generally outside the scope? Don’t tell me that every Doc in Canada will take any patient? :dubious:
If Canada didn’t have universla coverage- they’d pay less taxes- no doubt. Same with Britian or any othe rnation. Thus,- you pay more in taxes that you would without the “free” healthcare. And- the “free care” you get in Canada seem to be not as good as what you’d get under a normal American Inurance plan’s care.
Yiou can’t compare what the USA spends- becuase the USA does have “free” healthcare- but only for that % of thepopolation most likely to be sick. Our poor are treated at County General ERs, and our Elderly get Medicare… The uSA also has to spend a _tiny_ bit more on military than some nations. Again- no doubt we’d have to pay higher taxes to get Universal Socialized healthcare.
Look- Large companies buy inurance for their workers (often charging them a %). Some of these companies get the economies of scale you get with a small nation. Thus- by buying insurance through your Employer- you already get better healthcare than you would in natiosn with Socialized healthcare- and likely cheaper. If you are very poor here in the USA- you get second rate healthcare- but you pay nothing. If you are elderly you get Medicare. So- who isn’t covered? Poor- covered. Working- 75% covered. Elderly- covered. In other words- a Universal health plan would only add coverage for that 35% of those who work and don’t get insurance at work (and a number of them get insurance throught their families, or are so poor or old as to qualify for one or the other two).
Thus, if we wanted Universal health care- it would be for that 20% or so of dudes that work and don’t have insurance. Not a big Lobby, I am afraid. And it would cost everyone else more, and they’d generally get less.
So- that’s why we don’t.
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### Author:  [@Zsofia](https://boards.straightdope.com/u/Zsofia)
#### Post date: [November 19, 2004, 5:43pm UTC](https://boards.straightdope.com/t/why-no-free-healthcare/275609/68 "2004-11-19T17:43:43Z")
> [@Paul in Saudi](#):
>
> In the American (lack of a ) System, I may have saved buckets of money by not going to the doctor for each hangnail, over a lifetime the savings could have gone for my heart transplant. Under a universal system, I would have been forced to pay for (the ability to) see (ing) the doctor for minor stuff.
>
> So under a universal system we are paying for lots of minor treatments. In the American system we are encouraged to avoid expensive medical care if we can. Which is more efficient?
>
> The savings could have been used to pay for a my heart transplant (or more likely a nice trip to Mexico).
>
> We have seen time and time again around the world that when medical care is “free” (to the user) the demand for this care goes up, apparently without limit. (Is there any population anywhere in the world that does not keep all its doctors busy?)
Isn’t that one of the arguments _for_ universal health care? I don’t have health insurance now. If I had a suspicious mole on my back, I couldn’t afford to get it looked at without cutting back somewhere else, so I probably wouldn’t. It would cost the government a few hundred dollars, probably less, to remove this mole now and take a look at it. In five years when my malignant melanoma has gone system-wide and I _have_ to suck it up and go to the hospital, how much will treatment cost?
Prevention is almost always dramatically less expensive. It’s preventative medecine that’s always first to go when you have bad or no insurance, however. It would be much cheaper for _everybody_ if people _did_ go to the doctor for “little things”. If health care were easy and “free” for everybody, maybe you’d never _need_ that heart transplant because it might not have gotten that far. Better care overall would make the total cost of health care _cheaper_, I think.
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### Author:  [@GorillaMan](https://boards.straightdope.com/u/GorillaMan)
#### Post date: [November 19, 2004, 5:53pm UTC](https://boards.straightdope.com/t/why-no-free-healthcare/275609/69 "2004-11-19T17:53:28Z")
> [@Sam Stone](#):
>
> Here’s the problem with your analysis - it’s measuring the wrong thing. Just because Canadians live longer does NOT mean we get better health care. There can be lots of cultural, genetic, and environmental factors that cause Canadians to have longer lifespans. For example, Americans have the third highest incidence rate for cancer in the world, and one of the highest incidence rates for heart disease. Maybe it’s because Americans are generally fatter than people in other countries?
You miss one of the essential points about socialised healthcare - that treatment and prevention are both integral to its operation. Socialised healthcare includes public education about obesity, providing advice on quitting smoking or on treating alcoholism, and not just waiting until one organ or another gives out. With private care, there’s less integration between all these aspects of helping people stay well - a private hospital doesn’t exactly have a vested interest in making sure less people are walking through its doors!
Yes, you’re right that simply comparing life expectancy is prone to oversimplification - but it’s a good indicator of the overall health of a country, and the overall health of a country is a good indicator of the quality of healthcare.
> [@Jonathan Chance](#):
>
> I keep hearing that the ‘socialized’ or ‘government provided’ healthcare of the Canadian and other European systems provided lesser care at more expense, etc.
>
> If that’s the case why don’t I hear about public complaints and uprisings to replace those systems?
>
> In other words…is there a Euro and Canadian version of the SD where repealing such a system is endlessly discussed and debated?
I didn’t realise that we were all American on this board :wally …
But seriously…the reason there isn’t a populist desire for abandoning our systems is because it’s a near-universal view that healthcare is a right, one that should be available according to necessity. Sure, the NHS has problems, which cause politicians all sorts of problems, but nobody seriously thinks that the population as a whole would get better healthcare in a private system.
Of course (as has been mentioned already), people can still choose to buy private insurance and treatment should they want to. But _forcing_ that on everybody would actually be a lessening of the overall range of choice.
In any case, this thread has already thrown up all the debunking necessary about socialised systems having a higher overall cost, so the only question is whether they provide a worse overall service - and that has to compare to the _average_ experience of an American, not just the typical experience of those with insurance.
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### Author:  [@Sam\_Stone](https://boards.straightdope.com/u/Sam_Stone)
#### Post date: [November 19, 2004, 6:00pm UTC](https://boards.straightdope.com/t/why-no-free-healthcare/275609/70 "2004-11-19T18:00:54Z")
**SentientMeat** said:
> [@](#):
>
> All valid points, Sam, but everywhere else people look at the waiting list and opt to pay privately if they find it unacceptably long. Canada is the only country I know of which, bizarrely IMO, forbids the private option. (I suspect that Canada only finds this a tenable position because it has the US on its doorstep, offering Canadians that choice).
I agree completely. Alberta has been fighting to allow limited private clinics to offer people a private option, and the federal government is fighting it tooth and nail. It makes no sense to me to disallow the option of private health coexisting. of course, the demagogues claim that this will lead to a two-tier system where all the best doctors go into the private system, and the bad ones will stay within the public system. As far as I can tell, this claim is largely without merit, and it ignores the reality that without such a system our best doctors _go to the United States_ instead.
As a pragmatist, I can see public pressure growing in the U.S. for public health care. If it happens, I hope the system retains as many market controls as possible, and doesn’t turn into a universal entitlement. Options for U.S. health care improvements are:
1. Medical savings accounts.
2. A universal system, with deductibles and low-income exceptions. A middle-class family can afford a $200 deductible for minor surgery, and it will offload a lot of pressure on the system.
3. Means-tested health care relief. Basically, this amounts to extending free health insurance to the ‘working poor’, and leaving everything else alone.
4. Catastrophic health care relief, or caps on maximum payouts, scaled by income. The horror story we hear all the time is the uninsured person who has his family’s life savings wiped out and loses the house and everything else because of a serious chronic condition or required major surgery. So keep the system completely market-driven, but allow people to apply for catastrophic relief. For instance, if you earn $20,000, perhaps you pay for your own treatments up to $1,000. If you make $200,000, you can pay for your own treatments up to $20,000. Make it progressive, because the rich can generally afford to pay a bigger percentage of their income than can the poor.
5. Tax credits for health insurance. Scale them however you want to provide enough incentive to get the ‘working poor’ to carry their own health coverage.
6. Regulatory reform. This includes things like allowing people to carry health insurance from job to job, medical malpractice limits, etc.
Canada went all-out for a free public system, and now we’re seeing a lot of problems and a lot of pressure to start moving back somewhere towards the middle where the market can work. The U.S. doesn’t need to make our mistakes to improve its health care system.
What you CAN’T do is provide ‘free health care for everyone’. No one can afford that much health care. And contrary to some posts above, health care demand is NOT price inelastic. There have been plenty of studies on price elasticity in health care, and while some things are inelastic (emergency treatment for trauma, for example), other things are VERY elastic. For example, I had to go to the emergency room a couple of years ago after throwing out my back. I waited in pain for hours before someone could look at me, and I spent the time studying the other patients. Many of them, the doctors knew on a first-name basis. They were chronic abusers of the system. Some were drunks or homeless, who routinely fake illnesses to get a cot and a warm place to sleep. There were several of these types on gurneys in the hallways.
I know other people who rush their kids to the emergency room every time they have a sniffle or a mild fever. They get free meds, and what the hell, it’s free.
Other treatments are very price elastic as well. For instance, I have flat feet. They’ve bothered me for years, but I’ve never done anything about it. Well, my insurance policy now covers podiatrist treatments, so I went and got some custom orthotics. $450 bucks. If it weren’t for the added coverage, I probably would never have done it. The same can be said for all kinds of treatments. Before I had eyeglass coverage, I’d make do with the same pair of glasses for years. Now I get new ones every year or so, because they’re free.
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### Author:  [@Gaudere](https://boards.straightdope.com/u/Gaudere)
#### Post date: [November 19, 2004, 6:16pm UTC](https://boards.straightdope.com/t/why-no-free-healthcare/275609/71 "2004-11-19T18:16:27Z")
[Moderator Hat ON]
Don’t use the Putz smilie to insult people in GD, Gorillaman. Please read the rules sticky at the top of this forum.
[Moderator Hat OFF]
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### Author:  [@GorillaMan](https://boards.straightdope.com/u/GorillaMan)
#### Post date: [November 19, 2004, 6:24pm UTC](https://boards.straightdope.com/t/why-no-free-healthcare/275609/72 "2004-11-19T18:24:10Z")
Sorry - didn’t mean it as an insult (and hadn’t noticed that part of the sticky before)
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### Author:  [@DSeid](https://boards.straightdope.com/u/DSeid)
#### Post date: [November 19, 2004, 7:00pm UTC](https://boards.straightdope.com/t/why-no-free-healthcare/275609/73 "2004-11-19T19:00:54Z")
I’m getting into this iteration of this debate late and many of the points have already been made, but a little repetition aint too bad. Besides I have a few novel points too. 🙂
No, “health care for all” would not be free. It would cost. The question is which would cost more?
Our current irrationing of healthcare? Where, as has been pointed out catestrophic problems are still taken care of when someone just shows up in an ER but the cost effective care that would have prevented such a problem is not provided for many. And that inflated cost is passed along. Where US companies are at a competitive disadvantage because of the exploding price of providing healthcare to employees. Where more and more Americans gamble and go uninsured because they cannot afford it individually and the company no longer can afford to provide it either. Where the people who can afford it the least are the only ones expected to pay full retail for both healthcare itself and for insurance.
Or a more rational approach that throws out the intrinsinicly flawed employer based model and figures out another way\*? One that accepts basic healthcare for all not only as a right but as a cost effective tactic for our economy.
Why do we not have some system that provides for this? Many reasons.
The case that it is more cost effective to provide basic healthcare for all has been inadequately made.
The case that basic healthcare for all is a right like education and protection by police has not been made well enough.
Because the prospect of “rationing” is so scary to many that they’d rather accept irrationing of healthcare.
Because many powerful organizations have too much invested in the status quo and most proposals fail to consider their interests. If the big players all fight it (insurance companies, Big Pharma, organized medicine) then it will not occur. Any serious proposal must be pragmatic and provide a solution that keeps the big players in the game.
\*My “another way” proposal is in my following post.
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### Author:  [@bouv](https://boards.straightdope.com/u/bouv)
#### Post date: [November 19, 2004, 7:21pm UTC](https://boards.straightdope.com/t/why-no-free-healthcare/275609/74 "2004-11-19T19:21:37Z")
> [@DSeid](#):
>
> The case that basic healthcare for all is a right like education and protection by police has not been made well enough.
Not been made well enough? Well…I guess since it doesn’t exist, it hasn’t been made well enough. But it’s right there in writing, plain as day:
> [@Declaration of Independance](#):
>
> We hold these truths to be self-evident that all men are created equal, they are endowed by their creator with certain unalienable rights, that among these are **life** , liberty, and the pursuit of happiness.
(bolding mine.)
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### Author:  [@DSeid](https://boards.straightdope.com/u/DSeid)
#### Post date: [November 19, 2004, 7:24pm UTC](https://boards.straightdope.com/t/why-no-free-healthcare/275609/75 "2004-11-19T19:24:27Z")
**Sam** has it partially right. But several things must occur at the same time to keep all the players on board.
[ol]
[li]Mandatory health insurance similar to mandatory auto insurance. Everyone must have some basic healthcare insurance package and provide documentation thereof on their tax return. Insurers get more customers. Employers can provide this coverage or not. But as will be seen, there will no longer really be any incentive for them to do so.[/li][li]Insurers must offer one product for one price. No cherry picking allowed. (exceptions made for healthcare habits by choice such as smoking.) No price inflation for the individual purchaser compared to mega-corp. This point reduces the insurers costs while keeping them all on the same competitive basis. It allows the individual to purchase a less expensive product on their own and maintain the same product year after year insted of having to swith payers with the company plan each year and repeat all the paperwork and other hidden costs all over again.[/li][li]Sliding scale tax credits. From a truely no charge system for the destitute, to tax credits of varying size down to zero for those above a certains means.[/li][li]Tort reform. Med-mal is not major driver of medical costs but it is a driver and tort reform, while insufficient by itself, is necessary to keep prices down and accessibilty to healthcare up. [/li][/ol]
The insurers are still in the game with more customers than before. Their costs, mandated by the fact that the other guy is cherry picking so they gotta do it even better, are reduced. Customer turnover is, potentially reduced. They win.
Health insurance coverage for a basic package is close to universal (some will be scofflaws I am sure) Overall costs are down because the costs inherent in an uninsured population are reduced.
Individual costs are affordable both secondary to that last effect and by sliding scale tax credits. Healthcare coverage is portable. The individual can still choose between a bare bones basic package or HMO or deluxe go whereever you want to go whenever you want package (as long as they are willing to pay the price). The individual wins.
Employers are spared the cost of providing health insurance coverage and the disincentive of providing it. They can compete better internationally. Business wins. Our economy wins.
Pharma sees little change. They win.
Doctors still have the same footing in negotiating with payors as previous but with a higher fraction of patients having private coverage rather than uninsured or government insured. Less defensive medicine and fewer frivilous lawsauits. They win.
It makes sense. So it will never happen.
---
### Author:  [@clairobscur](https://boards.straightdope.com/u/clairobscur)
#### Post date: [November 19, 2004, 7:26pm UTC](https://boards.straightdope.com/t/why-no-free-healthcare/275609/76 "2004-11-19T19:26:04Z")
> [@Jonathan Chance](#):
>
> In other words…is there a Euro and Canadian version of the SD where repealing such a system is endlessly discussed and debated?
I assume you know the answer : no, though reforming it is a constantly debatted issue, dismantling the public healthcare system isn’t considered here.
---
### Author:  [@DSeid](https://boards.straightdope.com/u/DSeid)
#### Post date: [November 19, 2004, 7:28pm UTC](https://boards.straightdope.com/t/why-no-free-healthcare/275609/77 "2004-11-19T19:28:57Z")
**bouv** the right to education aint in The Declaration either. Yet we accept that society should provide it. Rights are what we decide they should be in our society. Rights have not been a static beast since The Declaration but fluid. As we have evolved as a culture we have expanded what we consider to be rights. You can disagree over my assertion that such should be a right, but quoting The Declaration fails to make the point.
---
### Author:  [@Polerius](https://boards.straightdope.com/u/Polerius)
#### Post date: [November 19, 2004, 7:31pm UTC](https://boards.straightdope.com/t/why-no-free-healthcare/275609/78 "2004-11-19T19:31:15Z")
> [@John Mace](#):
>
> People come to the US for medical treatment. How often to you hear of Americans going somewhere to obtain medical treatment unavailable here? The only instances are those where the government has not apporved of the procedure.
Many procedures are not exactly ‘unavailable’ in the US, but if we consider that somethings are so expensive as to be virtually unavailable, then, yes, there are Americans who go abroad to obtain medical treatment ‘unavailable’ in the US.
[Tourism companies luring Americans with surgery-vacations](http://www.talkaboutsupport.com/group/alt.support.breast-implant.sisters/messages/1703.html)
> [@](#):
>
> the pair traveled to Mexico to have plastic
> surgery - joining the ranks of “medical tourists” who are venturing
> outside the United States for cosmetic surgery and other procedures
>
> …
> Kent, of Birmingham, Ala., counters that many countries have
> well-trained doctors and clean facilities. And she preferred her stint
> in a Mexican hospital to an outpatient procedure in the United States,
> she said.
>
> “This was a three-day hospital stay, where you are monitored and all
> of that constantly,” Kent said. “I thought that just sounded a whole
> lot better.”
>
> Pat Marino, the U.S. agent for the company that arranged Kent’s
> face-lift, said clients are usually lured by the $6,000 cost. That
> compares with Texas price tags of about $10,000 to $15,000 for the
> procedure, according to Rohrich.
> …
>
> Advocates say their treatments can be significantly cheaper than
> similar surgeries in the United States. And they say their patients
> can benefit from longer hospital stays and more personalized attention
> than is typical here.
>
> Critics argue that it’s very difficult for patients to evaluate the
> credentials of doctors or the quality of surgical facilities in other
> countries. And they warn that patients may struggle to find follow-up
> care if problems arise after they return home.
---
### Author:  [@Liberal](https://boards.straightdope.com/u/Liberal)
#### Post date: [November 19, 2004, 8:04pm UTC](https://boards.straightdope.com/t/why-no-free-healthcare/275609/79 "2004-11-19T20:04:59Z")
> [@DSeid](#):
>
> **bouv** the right to education aint in The Declaration either. Yet we accept that society should provide it. Rights are what we decide they should be in our society. Rights have not been a static beast since The Declaration but fluid. As we have evolved as a culture we have expanded what we consider to be rights. You can disagree over my assertion that such should be a right, but quoting The Declaration fails to make the point.
If you’re deciding for me, then it’s not my right; it’s your permission.
---
### Author:  [@DSeid](https://boards.straightdope.com/u/DSeid)
#### Post date: [November 19, 2004, 8:13pm UTC](https://boards.straightdope.com/t/why-no-free-healthcare/275609/80 "2004-11-19T20:13:19Z")
::rolls up sleeves::
Ah **Lib** but de facto it is a right by practice and by law. If I am working in an ER and someone comes rolling in critically ill I _cannot_ just refuse to treat them. Even in my capacity as a general pediatrician, if I am on call for the ER I am obligated to provide care for anyone who rolls into the ER and either needs admission and is without a pediatrician or who requires follow up care. That is the standard in our society and I would be punished in a variety of ways if I deviated from that standard. We accept by matter of expected practice that a critically or “emergently” ill person deserves care without regard to ability to pay. We accept that some standard of healthcare is a right. We just apply that right in an irrational manner.
::keeps sleeves rolled up just because he like how it feels that way but runs out to take care other business any way::
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