why not universal healthcare?

Great Debates
101

[QUOTE=jsgoddess]
I echoed your phrasing. You hand-waved serious, fact-based objections to “free market” medicine as based on emotion.

You’re coming at this from a political idealism perspective where if it’s free market, it’s better. I’m coming at this from a pragmatic perspective where if it works, it doesn’t matter if it’s a free market, socialism, tutti-fruttism, or hoodoo.

[/QUOTE]

[Then a big post by **Sam Stone ** that just basically repeats what jsgoddess said, with not much rebuttal or deserved reply until:]

[QUOTE=Sam Stone]
Life expectancy has a lot of do with things that have nothing to do with the health care system - eating habits, exercising habits, intrinsic health of the population, work habits, sleep habits, drug use, etc. If you want to measure the actual health care system, look at the life expectancy for the subset of people who are actually IN the system.
[/QUOTE]

Speaking of tutti-fruttism, you are comparing apples and oranges, and cherry picking. :slight_smile:

Of course people who are in a system that already cherry picks will show statistics that are as good or better than in a system that includes everybody! What I see here is an attempt to minimize the problem that the current system is not supporting everybody, and it is becoming a drag on the economy. Not just on the part of the GDP, but on the capability of the US to keep jobs or for foreign corporations to consider the US as a location to put up a business.

102

The reasons we don’t have UHC in America has very little to do with ideology and more to do with the difficuties of getting from a system which has had decades of investment in health care system to take advantage of rationing by money, to a system that would cover everyone, a situation no country that has UHC now had ever had to do.

I’m a CFO who negotiates our health care program which covers our companies employees in NW USA, and has employees in the metro Seattle area and employees in rural Idaho. We are self-insured, so I get a lot of data regarding our employees medical activity, some things I’ve learned:

The same medical procedures are far more expensive in Seattle metro than they are in rural Idaho. From what I’ve read, our experience is fairly typical. Unit costs in health care are not driven by typical supply and demand you get in a free market. The more expensive Seattle metro costs are not driven by less availablity, there is in fact much more availability. It is driven by investment, the medical industry has done a terrific job of generating demand and higher prices from those who have the means to pay.

That is why the whole ‘the US spends more on health care and gets less results’ notion really misses the point about why the government isn’t able to simply copy say Canada’s plan. The number of people who get better care for lower personal cost in the US still far outnumber the people who would get better benefit/cost under a UHC system. The one thing our elected officials completely understand is that a good number of people vote their pocketbook. It also helps that the medical insurance industry and the health care industry have good influence, but if a plan was developed that would benefit more people than it than it would financial hit, we would have seen it by now. Unfortunately, the continuing the current system does more to widen the gap between the ‘haves’ and the ‘have nots’ than it does to move more ‘haves’ into ‘have nots’.

Why is Bush’s plan DOA? The Dems claim that businesses would drop their health coverages right away. They are almost certainly right. They understand the number of people who would eventually have to pony up more will punish everyone who got behind Bush’s plan will be quite high.

103

Sam Stone, you must have missed this the first time, but it’s not fair to compare socialized medicine with the US system because the US spends almost twice as much money on health care. What would happen to the Canadian and UK wait lists if the UHC budget was doubled?

104

Absolutely we need universal health care in the US.

For those arguing against it, I have some general questions:

What benefit is there in requiring most people to get their health insurance through their workplace? Why should it be an employer’s responsibility in the first place? How does this help business? Some places will compete for labor by offering better benefits but wouldn’t they rather not need to bother at all? Why should an employer have to go search for and buy insurance for their employees? What sense is there in having a business plunk down a bunch of money for it and then have someone in the human resources department have to spend all kinds of time managing it? How is this more efficient than universal health care?

Furthermore, what benefit do we get by having insurance companies involved in providing health care in the first case? They are simply a middleman which would likely not be needed under universal health coverage. They generally do not add any value other than you might save a little money on a competing plan, often with a lesser benefit as well. But they do not compete with one another on providing far better care - that is basically up to the health care provider. In fact, to be profitable, they must DENY claims. The less they need to pay out the more they make, thus there is an incentive for them to restrict us from getting the level of health care that doctors want to provide but are not always able to. Yet they generate a lot of profit despite adding little to a system that could be paid for in other ways. They have many tiers of health plans where if we have universal health care there is only one level of care - it should be the same as our representatives in congress, the taxpayers employees, get. This would greatly streamline the system if it’s simply up to the doctor to do what needs to be done without having to find out what someones coverage options are. How is the current way of doing health care through insurers more efficient than UHC?

Insurance companies generate tens of billions of dollars a year in overhead and administrative costs (CEO golden parachutes included), upwards of 20% of their operating costs for some. Compared to Medicare or the VA whose overhead is far below that of private insurers. Less than 5% of operating costs I believe.

On the other hand, if they all have to compete for profits from a single payer wouldn’t they need to be much more competitive? Wouldn’t this level the playing field and require them to provide some sort of additional services for a federally mandated level of care and yet keep costs down? Could they make the health care system more efficient if their very survival in the health care market was at stake?

105

And here in Pennsylvania, in one of the more rural districts that I know of, it’s 36,000$, plus health insurance that is fully paid by the district, plus retirement benefits.

No a thousand times. I want to keep what I’ve got now.

Doesn’t your university have a student health service? Look on the bill that your parents are probably getting and check for the health services fee. Most universities I know of have something like that so that students who aren’t covered under their parents’ insurance can get access to low-cost health care.

Yeah Medicare works so well that my grandmother chooses to buy private insurance and prescription drug coverage.

I never said ‘through their workplace’.

Again, you may call waiting lists efficient, but I don’t.

My health insurance is worth every penny.

106

[QUOTE=catsix]
Again, you may call waiting lists efficient, but I don’t.
[/QUOTE]

Why?

In all seriousness, what about “Waiting lists” is worse than any other way of allocating a given resource? Any health care system you care to mention is going to ration health care one way or another.

Aren’t you at least a *little bit * interested in finding a way to save all that tax money you’re pissing away?

107

Haven’t you been listening?

I’m currently paying an amount I consider reasonable for service I’m very happy with. I don’t have to wait on a list to see a specialist, and when I do need one I can pick one at any time.

You keep saying that socialist health care will cost me less and be better than what I’ve got.

Prove it.

108

[QUOTE=catsix]
I’m currently paying an amount I consider reasonable for service I’m very happy with. I don’t have to wait on a list to see a specialist, and when I do need one I can pick one at any time.
[/QUOTE]

It’s all about you, then? What about the 40+ million uninsured? I think this thread has shown that most of them probably can’t just go out and buy coverage. What’s wrong with a health system that covers people who need coverage, and allows you to purchase whatever extra coverage you want? It’s not as if anyone is suggesting that you will be forced to accept lesser coverage.

109

Actually, I think most of the ‘problem’ is that a very large number of people put a low priority on health insurance, but then want someone else to pony up when their poor planning comes to bear.

And that ‘system’ you’re talking about has to be paid for by someone. That someone will be me, not the people who currently refuse to pay for their own health insurance, and so at any rate, I’ll be paying more for no gain.

Not worth it to me.

110

[QUOTE=catsix]
Actually, I think most of the ‘problem’ is that a very large number of people put a low priority on health insurance, but then want someone else to pony up when their poor planning comes to bear.
[/QUOTE]

So people who have no insurance have only themselves to blame? Unemployed people probably don’t have $400 to $1000 per month to spend on health coverage. Minimum wage workers who are employed by businesses that do not offer health coverage probably cannot afford it. If health insurance premiums were affordable, you might have a case. But health insurance is simply out of reach of many people, as others have posted.

I’d very much like to have an Aston-Martin Vanquish. Do I not have one because paying a quarter-million dollars for a car is not high on my list of priorities? Or is it because I simply cannot afford to pay a quarter-million dollars for a car? Perhaps it’s a bit of both. But mostly the latter. So it is with health care coverage. Everybody wants it, but it’s too expensive for millions of people.

111

[QUOTE=InvisibleWombat]
I believe you need a bachelor’s degree (at least) almost everywhere. I was responding to Magiver’s statement that “In the United States you can stumble out of High school without learning a thing and still get a job starting at $30,000/year the very next day.” The starting salary for a brand-new teacher with no experience and a BS or BA degree here is $19,500 plus healthcare benefits. Unskilled construction work is around $9 to $11 per hour. Very few kids “stumble out of high school” into a $30K job here unless they’re very talented at something or they know somebody. If there’s a good $30K job, they’re competing with people that have degrees and/or years of experience to get it.

That’s why it chaps me when people gripe about the local economy being so bad, and then go shop and Wal*Mart; shipping their money off to Arkansas instead of keeping it here (not to mention supporting the destruction of local business that supported our economy).
[/QUOTE]
You’re way off on your figures. I cited the salary range for a teacher in my area. This is what you’d get in Billings Montana.

And a $9 job (starting wage) will bring in $30,000 if you work a 56 hr week. At $11/hr you need only work a 48 hr work week. I’m quoting starting wages. not what you make in a couple of years. At those wages you can easily afford health insurance.

Walmart or other discount stores increase the purchasing power of those wages. That’s why people shop there. It creates a higher standard of living and that’s why immigrants are still pouring into this country.

Now if you want to make more than $30k a year then spend a month roofing for someone else to learn the trade and then start your own business. You’ll need a vehicle to haul materials and a ladder. Your tools consist of a hammer, a snap line and a tack hammer.

But the unseen problem with a high school education is that you can’t force someone to learn even the basics. If you can’t do something as simple as making change then why would an employer hire you.

112

They might not be able to afford the plan I have, but I’d be willing to bet that if they can insure a car they can afford some sort of catastrophic coverage and going to an urgent care clinic rather than an ER.

They choose not to.

113

[QUOTE=catsix]
They might not be able to afford the plan I have, but I’d be willing to bet that if they can insure a car they can afford some sort of catastrophic coverage and going to an urgent care clinic rather than an ER.

They choose not to.
[/QUOTE]

My total insurance premium for three cars and two motorcycles for a year equals one or two months of coverage mentioned by people in this thread. And others have pointed out that the lower premiums mentioned do not match their experiences. And it has been pointed out that some people cannot get private health coverage for any price.

Catastrophic coverage would not cover doctor’s visits that might prevent a condition from becoming catastrophic. It makes much more sense for the American economy, for businesses, and for the people to be kept healthy than it does to allow illnesses or conditions to advance to the point where they become (expensive!) ‘catastrophes’.

Show me a plan that covers doctor’s visits (preventative health care) for $100/month, and I’d be more inclined to agree that it’s affordable. (Although there’s still the problem that some people can’t afford even $100/month.)

You keep saying that you like your plan, you can afford your plan, and you don’t want to change your plan. How do propose to cover people who are not in such a fortunate situation as yourself, and can’t afford the coverage you so enjoy?

114

[QUOTE=Magiver]
And a $9 job (starting wage) will bring in $30,000 if you work a 56 hr week. At $11/hr you need only work a 48 hr work week. I’m quoting starting wages. not what you make in a couple of years. At those wages you can easily afford health insurance.

[/QUOTE]

You’re assuming that full-time employment is widely available. Many of the employers that I see offering entry-level and low-end jobs, go to a great deal of trouble to offer as few full-time jobs as possible.

115

There is an interesting article from the BBC, Caring for America’s Health.

Some quotes for the article :-

116

[QUOTE=catsix]
Actually, I think most of the ‘problem’ is that a very large number of people put a low priority on health insurance, but then want someone else to pony up when their poor planning comes to bear.

And that ‘system’ you’re talking about has to be paid for by someone. That someone will be me, not the people who currently refuse to pay for their own health insurance, and so at any rate, I’ll be paying more for no gain.

Not worth it to me.
[/QUOTE]

You are paying more right now. In any case I foresee that change will not at all dispose of private health care, so don’t listen to the FUD people.

And it is insulting to say people have no access by blaming poor planning or low priority, Incidentally my family is helping, but I am not a kid, I’m 40, with a grant and loan I’m back in college, but it is a private one and they usually expect that you have coverage. I had health care in the previous job, but last year some classes conflicted with the job, so a switch to part time came, but then I lost the coverage. I expect I will get coverage again soon, but in virtually all other developed countries this would not be an issue.

Looking at my family and coworkers I can say that out of 40 or so people I know 10 have issues with preexisting conditions, coverage goes away or premiums go higher if the healthy partner loses a job. One in law has a wife in disability and to find a job that could cover her too took 3 years.

I remember also in a previous discussion that small companies are suffering unfair disadvantages when the insurance companies give a break to larger companies that have more workers. In a recent thread one poster mentioned a couple of small business owners that on occasion had to go without health care because the premiums for the workers got so high, in a small private high school I worked, the principal/owner had trouble paying for her medication, she decided it was better to keep the teachers insured. Then I do remember locally a woman that decided starting her own business was not worth it when she compared the premiums her company paid with the premiums the same HMO was asking to her alone. IOW the current system is already discouraging new enterprises. Moving to the global scale, one can notice that other countries then have an unfair advantage over us, and this advantage will get worse if nothing is changed.

117

[QUOTE=catsix]
Haven’t you been listening?

I’m currently paying an amount I consider reasonable for service I’m very happy with. I don’t have to wait on a list to see a specialist, and when I do need one I can pick one at any time.

You keep saying that socialist health care will cost me less and be better than what I’ve got.

Prove it.
[/QUOTE]

But you DO have “socialist health care.” The United States pay more public money, and takes more in in taxes, to support public health care than any other country in the world. If I am not mistaken, it’s also #1 in per capita expenditures. And yet, in a feat of almost Olympian incompetence, all that money covers health care for only a fraction of the population.

How many times does it have to be explained before you’ll get the message? You’re paying for a completely separate “socialist” (what the heck is socialist health care, anyway? Vaccinations given by political officers?) NOW.

You’re talking about this as if it’s just a theoretical state. **But that’s what you’re already doing. **

118

[QUOTE=mks57]
You’re assuming that full-time employment is widely available. Many of the employers that I see offering entry-level and low-end jobs, go to a great deal of trouble to offer as few full-time jobs as possible.
[/QUOTE]
I would imagine that most hourly workers who work 56 hours a week are working two part-time jobs, not one full-time job with overtime.

For years I worked at jobs where a lot of part-time hourly workers were needed, and I would estimate that at least 1/2 of the HS graduates we hired were working a daytime job, as well (our hours were mostly evening/weekend). Some worked a regular 40-hour day job, and picked up a few evening/weekend hours for extra dough, and some worked about 1/2 & 1/2 between the two jobs, but in the vast majority of the cases, the point was to get more than 40 hours.

119

Bolding mine. No wonder even conservatives are jumping on the UHC bandwagon. THAT’s alarming!

120

[QUOTE=RickJay]
But you DO have “socialist health care.” The United States pay more public money, and takes more in in taxes, to support public health care than any other country in the world. If I am not mistaken, it’s also #1 in per capita expenditures. And yet, in a feat of almost Olympian incompetence, all that money covers health care for only a fraction of the population.

[/quote]

It’s not a tiny fraction - it’s a significant fraction. And it’s also the fraction of the population that consumes the most health care money, BY FAR. Medicare covers the elderly, and the elderly use the health care system far, far more than do younger people.

The U.S. spends about 2 trillion on health care. The Medicare budget in 2007 is projected to be 397 billion, or almost 20% of all health care spending. Add to that spending through Medicaid, the Veteran’s Administration, and other government health programs, and you have a significant percentage of the health care system under direct control of the government.

And that 2 trillion counts a lot of health care spending that wouldn’t be affected even if you went to a completely socialized system. It included things like eyeglasses, cosmetic surgery, over the counter drugs, etc. If you look at just the hospital system, the U.S. government’s influence is even greater than the 20% mentioned above.

This is one reason why it’s unfair to consider the U.S. health care system to be a failure of free-market health care - it’s a mixed-model system in which government money and regulations are a major driver. But somehow in these threads it’s always held up as an example of the failed free market, and therefore the only solution is more government.

How about indexing Medicare to income? Let old rich people fend for themselves. How about having deductables tied to income, so the poor can still get health care without bankrupting themselves, while the rich pay more?

Other factors in the U.S.'s higher spending on health care:

  • the quality of service is higher than in almost any other country. No one disputes that if you have the money, you can get better care in the U.S. than almost anywhere else.

  • The private system allows wealthy people to spend extravagent sums on care. Fancy private rooms, private doctors, extremely expensive treatments to prolong life, etc.

  • Liability insurance. 28 billion dollars a year. 4-5 billion paid out in claims.

  • More facilities. For example, the U.S. has 38 MRI machines per million population. Canada has 1.7. In the U.S., you can get an MRI scan the next day if you want one. In Canada, be prepared to be put on a waiting list.

  • Demographics. The U.S. population is not very healthy compared to many in the world. They’re fatter and exercise less than average. This has nothing to do with the health care system, but it adds an extra burden on it.

I have no doubt the system has some serious structural problems as well. The Bureaucracy in the U.S. seems out of control. But no doubt a good chunk of this comes from the very mixed-model nature of health care funding. There are so many tax breaks, subsidies, and regulations regarding who pays and how much that it forces a huge, wasteful bureaucracy to deal with it all.