Many conservatives did believe, in theory, in socialized medicine, before the coming of the Lord God Almighty, the Indefatigable, the Irresistible, whose wrath stretches across this nation to smite any who disbelieve in his Holy Crusade. All Good Conservatives now seek to shrink the Unholiness that is the State (death be upon its brow) and to free American Enterprise by deregulating our Holy Job Creators; or they are not Good Conservatives, but unpersons who will be quietly cut from History by the Great Author and Perfecter of the One True Faith. So long as the Lord God Almighty, the Indefatigable, the Irresistible is capable of cutting a check, our God-Fearing Conservatives will oppose any expansion of the power of the god-hating and diabolical State (death be upon its brow).
More seriously, it’s really hard to take a principled stand for socialized medicine when outfits like Americans for Prosperity will destroy your political career. The political careerists who have managed to keep their careers in the GOP have largely had to be true believers or true bootlickers; there’s always some young, dumb ideologue who actually believes in radically free markets to take your place.
The point I was trying to make was that when an entity is paying for something, they can have incentives to impose conditions on that payment, whether public or private. I acknowledge that is not how Canada does it, per wolfpup’s description and that’s fine. I’m not saying that will always be the case. The example was private enterprise engaging in that type of behavior but the motivation would exist in the public sphere as well. It was one of the main arguments used when pushing for helmet laws, for example.
The basis of the thread in my view is whether Republicans will eventually accept UHC. I don’t think adopting the view that health care is a human right is necessary for that. If the goal is to persuade others to accept UHC, including Republicans, I’d say holding as a requirement that this view of health care as a right is counterproductive. We can have UHC without holding healthcare as a right.
As for the poor and uninsured die in the streets - that would be bad. When a subscription fire protection service isn’t paid and they allow a house to burn down, that’s also bad, at least for the people impacted. It’s one of the reasons I’d be okay with UHC. My desired application would be something in the form of an entitlement where a minimum level of insurance for catastrophic coverage is provided, and leave everything else alone as much as possible.
Not exactly. Yes, scarcity generally means that as something is consumed it would become more expensive, but this doesn’t necessarily create an externality. Presumably between two people who agree to a transaction, pricing will reflect the relative utility. But if one party doesn’t agree, but instead is forced into the transaction, they may shift some of the costs of that transaction to others. That shifting is the externality.
Ok. I think reasonable people can disagree on that and likewise, I’m typically not a fan of outcome based judgment. Consider in the legal system the standard of “beyond a reasonable doubt”. One of the principles is that as a society we’d rather let 10 guilty people go free than 1 innocent person be convicted. Or consider evidence that is obtained illegally. Other than how it was obtained, there can be evidence of a crime that is iron clad and conclusive, yet if obtained illegally it would be thrown out and a clearly guilty person could go free. The principle is that allowing illegally obtained evidence would create bad incentives and to dissuade that we remove the motivation to obtain evidence illegally. Is that principle worth a bad guy going free? At times we adopt certain principles because we think ultimately they yield better overall results. At times there are things that are instead simply first principles.
Anyways, I do believe the argument in favor of UHC can be won and Republicans may adopt the view in the future. I don’t think the current slate of arguments (in general, not in the thread) have been very effective.
I don’t dispute that. But while my knowledge of the inner workings of Medicare is limited, the point I was trying to make (perhaps not very clearly) is that there is a subtle but very important difference between Medicare and the single-payer that I’m familiar with in terms of the clinical autonomy of the doctor-patient relationship and the extent to which the doctor is empowered as a trusted gatekeeper to the medical system. For example, reading the government Medicare site, there is a section stating that Medicare coverage is based on three main factors: (1) Federal and state laws, (2) National coverage decisions made by Medicare about whether something is covered, and (3) Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.
There is a different section that discusses the situation where a doctor may not be sure whether a particular procedure will be covered in the patient’s specific case, and suggests requesting a pre-approval to make sure of coverage.
Now maybe I’m not understanding these things correctly, but they strike me as distinctly opposed to what I’ve frequently described as the “unconditional” coverage of single-payer, meaning in essence that if your doctor thinks you need it and there is a billing code for it, then it’s covered. Furthermore, Medicare seems to require substantial deductibles and co-pays, and I seem to recall that there are specific other limitations such as a limited number of days of hospitalization that will be covered.
All of those things are the sorts of differences I was alluding to, although the primary one is the degree to which, in single-payer, the payment system removes itself from virtually all clinical decision-making.
They may have incentives, but those incentives are going to go nowhere if there is no mechanism to implement them (cf.- my comments about the unconditional nature of single-payer coverage). In the long run they are also going to go nowhere if the citizens of a free democracy don’t want them. Governments in both our countries already try to do things “for our own good” but those efforts are unrelated to health care payment systems, and just take the form of common-sense legislation like seat belt laws and advertising initiatives to encourage us to adopt healthier lifestyles. There is no evidence anywhere that UHC in any form leads to government tyranny.
I disagree on the limited scope of that last point because I think a civilized and wealthy society owes its citizens a great deal more than minimal insurance for catastrophic coverage. But I’m happy to see that we seem a lot closer to agreement on UHC than I would have imagined. For my part, I’m willing to acknowledge that the concept of a “right” means different things to different people and some might have a very specific narrow interpretation of the word, so perhaps some other description might be more appropriate to use in the health care debate. To me it’s just a shorthand way of expressing the obligation of society to its citizens.
You mentioned basic principles several times as foundational guidelines for policy. While I don’t agree with your “limited government” principle because our politics are very different, I understand it and respect it as a valid position. But health care policy can also be defined in terms of foundational principles, and what the libertarian-leaning limited government side has to come to terms with is what to do when those principles are in conflict. The principle that I would advance for health care, if we put aside “basic human right” as being a phrase that is off-putting to some, would be in terms of a paraphrase of one of the reader comments to the Medicare article that jsgoddess linked earlier – I’ve just changed a few words around. The writer begins by asserting that we shouldn’t call health care a “right” because that word is subject to interpretation and manipulation. Instead, he says, (paraphrased):
… we should describe good health care coverage as a necessity so basic that our society cannot properly function and thrive if all do not have it. Universal coverage is the real freedom that conservatives keep harping on, because the guarantee of decent health care no matter what will liberate millions of Americans from the scourge of health care insecurity. When everyone is assured of good health care coverage, they will become empowered consumers, better workers, better students, and healthier and more productive citizens benefiting each and every American.
I doubt the systems work very differently in determining what they will pay for. “Medically necessary services are not defined in the Canada Health Act. The provincial and territorial health care insurance plans consult with their respective physician colleges or groups. Together, they decide which services are medically necessary for health care insurance purposes.” From https://www.canada.ca/en/health-canada/services/canada-health-care-system.html
No. The GOP are moving away from social liberalism, not toward it. Don’t mistake the present GOP for a normal political party. They have a business model based on taking minority opinions and extracting donations from those with an economic interest in the unpopular. The more popular UHC becomes, the harder the GOP will fight against it, and the more consistent the donations from the finance industry, trial lawyers, and the like will be.
Did you travel here from the 1980’s? The present GOP will happily pursue the destruction of such third rails. While pragmatic politicians recognized the futility of opposing these big programs, young conservatives of my generation, like Paul Ryan, were well-indoctrinated from childhood to hate their existence. I know, I was one of them. See, we hate being told there are things we can’t do.
Canada has ‘socialized medicine,’ and also it had Rob Ford. Your concerns sound unfounded and paranoid.
But the talking point I often hear is, hey, America is so danged rich and prosperous that it’s absurd that we alone among the advanced and developed nations of the world haven’t gotten around to this yet. We’re not just the place where illegals try to flood in to escape whatever shithole they’re fleeing; we obviously come out ahead in that comparison, but we’re also the curiosity among the ‘wealthy countries in the industrialized world that are functioning and thriving’.
How do we square this new pitch with people confusedly looking around and then replying, er, no; looks to me like we’re functioning and thriving, what?
If I’m taking Trump as some kind of authority on the matter, (a) he’s already making America great again, and (b) a key step there is getting rid of job-killing Obamacare where Obama lied to you – remember that? – he lied to you, he said if you liked what you had you could keep it; but I make good deals, I make the best deals, we should repeal and replace job-killing Obamacare, or just repeal it and then replace it; or just leave it be and watch it implode, people will realize how much they’d prefer to buy quality insurance across state lines, believe me, believe me.
And if I’m not taking Trump as an authority, then, uh, shrug?
The NHS doesn’t have a bunch of officials routinely second-guessing “medical necessity” in any given individual case. Funding is through block contracts and budgets, and it’s up to the doctors to decide what’s medically necessary in any individual case.
I know I’m a heavy participant in this thread and I’m loathe to moderate where I am also involved so as to avoid any appearance of impropriety. However, this comment does stand out. Please try and remain civil.
A lot of people, on this message board and others, seem to forget that there are members from countries that already have UHC or similar type plans. That’s why it shocking to read “It will never work!” or “We will be forced to run 5 miles a day” when clearly it works, and those people from countries that it works don’t have to run 5 miles a day, or else they probably would have mentioned it by now.
Don’t jump the gun. Most Western countries have only had UHC for 50 years or so. Those forced physical labor laws could be just around the corner. After all, New York did try to ban the big gulp. Can mandatory 5k runs be far away?
As an American I am, like you, puzzled by those of us who ignore or deny the evidence of other countries.
I suppose I shouldn’t be puzzled, considering how many of us seem to routinely ignore or deny evidence of everything from climate change to the failure of trickle down theory.
I think many of them have fallen for the propaganda put out by those who profit from the current system.
I don’t know, but I’d hazard a guess and say none. That’s not really my point though. I’m saying intrusion with no stated limit tends to drift towards more intrusion. How many times has a monument with the 10 commandments at a federal building led to state established religion? I’d say none, but as a rule the country is opposed because of the principle. There are probably lots more examples where we push back against seemingly minor things because they are either affiliated with or representative of other non-minor things we are opposed to.
With the passage of the ACA, it is now permissible to force everyone to purchase a private service. I think that’s pretty terrible and it wasn’t the case 10 years ago. Unless the argument is that there will be no further intrusion, ever, then I don’t think pointing out that the most excessive intrusions on the spectrum have not come to pass is meaningful.
And I’ve never made the argument that UHC or even single payer would never “work”. I think it’s a given that it would work. I simply don’t like the outcome.
Here’s one thing I learned from you that I didn’t know previously. Private health insurance isn’t allowed in Canada, except for some limited types of things. Is that right?. That could be good or bad depending on your perspective, but I personally think removing that choice is bad. That is much more interventionist than simply providing a certain level of insurance, and then letting people make their own choices otherwise. Again, I don’t see that as one step away from 5k runs, but it’s more intrusive than I would like.
But here’s the thing, that’s not true. It’s true for some people, yes. But generally the US is doing quite well so I think that defeats that principle. Once health care coverage is deemed this type of necessity, the first thing that comes to mind is that there are other much more acute necessities like food and shelter. If we say health care is a necessity so we should provide it, then we should also provide food and shelter. Maybe you think that’s a good idea, maybe not. But the articulated principle isn’t sufficient to support one but not the others.
On Tuesday I went into the hospital for my check up with the cardiologist. I had an ECG first. Then face-time with the cardiologist as he went over the results. An improvement over last time: so my cardiologist stretched the next appointment out to a year from now. (I had been meeting the cardiologist a week after my stay in hospital, followed by a month, followed by two months, followed by six months.) Total cost out of pocket: $4.00 for car parking.
When I went to sleep last night I used my CPAP machine: that keeps me sleeping soundly each night. I had sleep apnea. It wasn’t diagnosed until after my stay in hospital. Total cost out of pocket for the CPAP machine: $0.00.
I’m overweight. The doctors know it. I know it. I’m working to get my weight down.
What hasn’t happened though is that I haven’t been refused medical care because I don’t run 5 miles/day. Because if any government that has UHC tried to implement a policy like this there would be riots. The sort of right-wing organizations that would advocate this sort of policy are on the extreme fringes in UHC countries. The fundamental problem with the United States is that these people are not in the fringes, but are running your government. And they would implement a “run 5 miles/day” not because it made any sort of scientific/medical sense: but as some sort of punishment.
The ACA was an important first step towards proper universal health care in America. It was done in a way that wasn’t too “left-wing” that it was acceptable to most Americans, and it was really the only way to get it started IMHO. But lets just make it clear: nobody anywhere else in the world worries about the government implementing a “run 5 miles/day” policy. That is a uniquely American problem.
Bone, you’re making what is known as a slippery slope argument regarding government intrusion. The problem with that type of argument is that either side can use it.
Suppose we totally privatize healthcare; no regulations; completely laissez faire. Why stop there? Let’s privatize fire, police, roads, highways, defense, everything. Once you start making things private, where will it all end! Why not do away with government entirely?
Let me be clear. I am not making that argument. It’s not valid, and neither is it valid the way you’re using it. It seems obvious, at least to me, that some things are best done privately (most things, actually) and some are better off socialized.
That being said; would you be okay with insurance companies requiring people to run 5 miles a day in order to purchase insurance? Just how intrusive should corporations be allowed to be? Would you be okay with government regulations preventing that?
It’s a bit more nuanced than that, and there’s a very good reason for it.
Health care is the responsibility of the provinces and they can manage it how they like. The Canada Health Act sets out a national vision of health care that is simply a condition for provinces to qualify for federal health care transfer subsidies. Any province whose voters elect a government that feels its citizens are better served with a different system is free to opt out and adopt whatever system they want. It’s notable that none have done so and it’s never been an election issue that I know of since the enactment of the CHA, either provincially or federally.
The reason for this condition in the CHA is born out of experience and is one that I’ve alluded to often, perhaps using the “wolves howling at the door” metaphor for the big US insurers – the ones who were here before in ravenous packs and then lobbied hard against Saskatchewan’s efforts to introduce single-payer, along with the AMA, using all manner of fraudulent scare tactics.
These guys would totally devastate the Canadian health care landscape by creating a two-tier system that would draw all the best medical professionals out of the public system and would inevitably become a corporatized for-profit system of coupled insurance and health care delivery for the rich and leave the public health care system for the rest of us a poor second cousin. European countries – even those with the most socialized health care systems like the UK – can tolerate such two-tier systems because arguably they have a stronger European sense of social solidarity but most importantly because they don’t have such a vast number of wolves howling at the door right beside them, and the wolves are not so very frighteningly large and ravenously aggressive. Their private insurance systems are al very small part of the overall system. The enormous US health care industry right next door to Canada is nothing less than a juggernaut barely held at bay by an international border.
If this sounds like stifling “competition”, remember we’ve already agreed that the free market model doesn’t work for health care. There is one thing that might make a private insurance option viable in Canada, and might even get me to support it, and ironically that would be if the US adopted UHC and preferably single-payer as its predominant system of health insurance. It would cull this ravenous parasitic health insurance industry that threatens both countries but is currently quarantined within the US, and drastically reduce its threat as the insurance companies either left health care altogether or adapted to new and different and highly regulated business models.