Would universal healthcare be more expensive or less than the current US system?

[Crocodiles_And_Boulevards]

After seeing several of my family members struggle with severe injury and debilitating chronic disease, I’ve become familiar with the incredible battle many fully insured Americans wage with their insurance companies. I can’t imagine what it must be like for the uninsured or less-than-fully covered. My Aunt and Uncle’s premiums have stopped their lives completely.

My question has probably been debated before, but I’d like to know what the current state of the argument is, particularly framed by the economic crisis. Basically, I’ve thought about it and it seems to me that UHC might actually help our budget, but I’m definitely no expert. Some of the arguments against our current system that I could think of are as follows:

[ol]
[li]Health care costs have traditionally strangled businesses (this is one of the arguments against unions, too).[/li][li]Health care costs are likely built into many American products, which must hurt our competitiveness.[/li][li]Many other industrialized countries have UHC, which makes them more competitive.[/li][li]The severe cost of health care for an individual or family likely causes many conditions to be ignored or treatment delayed. This might cause more disease and increasingly severe and expensive problems due to lack of preventative care.[/li][li]Employer-provided insurance keeps people (like my uncle) in a job they don’t want.[/li][li]Finally, a gut-feeling argument, it seems like if health care is a for-profit model then for every $1 an American should have to spend to get adequate care, he actually has to spend more than $1 so that someone can pocket the rest. Otherwise, how do these HMOs and hospitals turn such incredible profits?[/li][/ol]

Those were all I could think of on my own, but feel free to point out others.

My main question, I suppose, is whether things like I listed above make UHC economically advantageous to our budget. Or does the competitive nature of our system somehow keep us ahead of the pack in terms of overall care?

[Grumman]

@Crocodiles_And_Boulevards

• Health care costs have traditionally strangled businesses (this is one of the arguments against unions, too).

• Health care costs are likely built into many American products, which must hurt our competitiveness.

Businesses would still have to pay health care costs via taxes, which means that health care costs are still going to be built into many American products. Just because it’s run by the government doesn’t mean the costs disappear.

• Many other industrialized countries have UHC, which makes them more competitive.

Do you have proof that universal healthcare is responsible for this efficiency?

• Employer-provided insurance keeps people (like my uncle) in a job they don’t want.

In what Bizarro-universe is it a bad thing that his employer is providing him with a competitive level of compensation? When he decides that the benefits he receives do not outweigh however much he doesn’t want that particular job, he’s free to quit.

• Finally, a gut-feeling argument, it seems like if health care is a for-profit model then for every $1 an American should have to spend to get adequate care, he actually has to spend more than $1 so that someone can pocket the rest. Otherwise, how do these HMOs and hospitals turn such incredible profits?

What makes you think that government-run health care is going to be any better? A private company at least has to provide a service better than no health insurance at all, while a single-payer system means that the government can force you to buy an inferior product you don’t want, need or use.

[sailor]

@Crocodiles_And_Boulevards

My question has probably been debated before

You can say that again.

but I’d like to know what the current state of the argument is

People continue to disagree. That is the “current state”.

I am not going to take one side or the other of the argument but…

[quote]
[li]Health care costs have traditionally strangled businesses (this is one of the arguments against unions, too).[/li]
[li]Health care costs are likely built into many American products, which must hurt our competitiveness.[/li]
[li]Many other industrialized countries have UHC, which makes them more competitive.[/li][/quote]
This makes no sense. You think UHC is FREE? As in NO one pays for it? Businesses and individuals can pay for it directly, through insurance, through taxes, whatever. But the country is paying for their health care costs one way or another. A company in Europe may not pay for Health care directly, they just pay higher taxes directly.

[quote]
[li]The severe cost of health care for an individual or family likely causes many conditions to be ignored or treatment delayed. This might cause more disease and increasingly severe and expensive problems due to lack of preventative care.[/li][/quote]
Might be true. It might also be true that where healt care is free people waste resources by going to the doctor for lots of unnecessary things. It seems quite a few old people go to the doctor just to get some attention.

[quote]
[li]Employer-provided insurance keeps people (like my uncle) in a job they don’t want. [/li][/quote]
Probably true. I am not sure we have a duty to help people find jobs they want but it might be the case that this enhances productivity. Of course, European systems might have this in their favor but they have rigid labor laws which work in the opposite direction.

[quote]
[li]Finally, a gut-feeling argument, it seems like if health care is a for-profit model then for every $1 an American should have to spend to get adequate care, he actually has to spend more than $1 so that someone can pocket the rest. Otherwise, how do these HMOs and hospitals turn such incredible profits? [/li][/quote]
I absolutely hate this argument. You realize it could be made about any service or product and that it is the basis of communism? Get rid of the capitalist and things are cheaper! Except that it does not work that way at all. In fact, it mostly works the opposite way. We say in Spanish that “it is the eye of the owner what fattens the horse”. It is the interest of the owner which makes the company prosper and grow. And the only way for a company to prosper and grow is to provide valuable services or products. Once you do not have that incentive there is no incentive to be efficient or to provide a good service. Do you think food would be cheaper in America if the government took over all food production and removed all the profit the farmers and food production industry makes?

When you have a government-run or controlled industry you have much more bureaucracy. Much more need to cover formalities (and your own butt) than to be efficient. After all, if they need more money they can just raise taxes. So now you have a primary gateway doctor who looks at you and gives you a ticket to get an Xray and a ticket to see the trauma doctor and a ticket to see the nerve doctor and a ticket to get a blood analysis and a ticket to get a … And the whole thing takes forever.

Look at all the government contracts in Iraq. The waste, corruption and inefficiency are just staggering.

I am not arguing for or against UHC but your arguments hold little water with me. I suppose there are very good arguments in favor of UHC but yours are not some of them.

[flickster]

[quote=“Crocodiles_And_Boulevards, post:1, topic:487175”]

[li]The severe cost of health care for an individual or family likely causes many conditions to be ignored or treatment delayed. This might cause more disease and increasingly severe and expensive problems due to lack of preventative care.[/li][/QUOTE]

Or you could place your trust in politicians to decide who is worthy of treatment and who’s not.

[LouisB]

Is the VA an example of UHC? Is the VA an example of ‘socialized’ medicine? Do military service people on active duty pay for their medical care or is it a benefit of their employment? Do Senators and Congressmen pay for their own health care or is it a government funded benefit? These are real questions, not rhetorical; I don’t know the answers.

[Cheesesteak]

@Grumman

In what Bizarro-universe is it a bad thing that his employer is providing him with a competitive level of compensation? When he decides that the benefits he receives do not outweigh however much he doesn’t want that particular job, he’s free to quit.

The bad part is that one pretty much HAS to work for a company that provides health care in order to get affordable health coverage. I happen to know someone in the midst of a divorce, but may not finalize it right away because she would lose her health care coverage, and cannot possibly afford the ridiculous cost of personal coverage.

I believe we spend more on health care, per person, than any other country. Yet, we still have millions of people without coverage, who don’t get regular checkups, and only get emergency treatment. We have families going bankrupt over health care costs. We don’t have world leading life expectancy or the best infant mortality rate, and we’re not even in the discussion, except to wonder why our stats are so bad.

I think the idea that our system (non-UHC) is better needs to be supported by some kind of facts, either better results or lower cost, and we have neither.

[newcomer]

From Canadian perspective, isn’t the condition of Universal Healthcare, regulation of medical costs? Having been in US for a couple of years, I can tell that value ratio (cost of the service over quality of service) is very high. So, my some sort of simple thinking on it is that the big elephant in the room is the question of regulation where Goverment prescribes the cost of every procedure.

Main reason with US uninsured is the market approach to an area of human activity that suffers from many non-market forces. Or… ?

[erislover]

I am not a fan of universal heath care in the sense that’s normally intended. I’d rather let people decide for themselves if they want health care. The government should mandate the creation of private savings accounts useable for health care expenses only (until, say retirement). Below a certain threshold, the government can add its own funds to create funds available for everyone. But I don’t want the insurance company’s dictators replaced by the government’s dictators. Let my doctor and I decide on my health care, mmkay?

Catastrophe insurance + mandatory savings = people control their own health care, the way it should be while still being universal “coverage”

[tagos]

@erislover

Let my doctor and I decide on my health care, mmkay?

That’s pretty much how it works in the NHS in the UK up to including being able to pick from a range of hospitals. There is also private health insurance for those that want extra cover, shorter waiting times and private hospitals.

There is an independent body called NICE that somewhat controversially is able to make judgments on the cost benefits of expensive drugs but unlike private insurers they are politically accountable and subject to public pressure.

Sure - there is effectively rationing of health care but that is equally true of private systems and I’d much rather have this rationing debatable as part of the political process than leaving it to those looking to turn a profit.

I have no doubt that you can buy the best health care in the world in the USA but you can buy the finest health care in the UK also. And we have universal coverage. No one is bankrupted by an illness or has to leave conditions untreated due to being unemployed.

Our system is by no means perfect and how to improve/reform it is a live political issue but in that regard we do not have powerful lobbyists distorting the political debate.

As a society we long ago agreed that access to health care free at the point of delivery, irrespective of employment status, income or savings is an important citizens right.

How to deliver on this right, what is the most efficient mix of public and private delivery is a political issue but any party that tried to replace the NHS with the current American system would be committing political suicide for a generation.

We’ve seen it and we don’t like what we’ve seen.

[DrCube]

@LouisB

Is the VA an example of UHC? Is the VA an example of ‘socialized’ medicine? Do military service people on active duty pay for their medical care or is it a benefit of their employment? Do Senators and Congressmen pay for their own health care or is it a government funded benefit? These are real questions, not rhetorical; I don’t know the answers.

The VA has a tiered payment model, taking into account how much you can afford and what your “priority” is; e.g. poor, disabled war veterans pay less and get higher priority than healthy middle class peacetime veterans.

Army health care was free to all active duty soldiers and their dependents. It was a horrible bureaucratic system with long waits and angry, overworked doctors, although they treated the dependents a little bit better. I just used it for sick call and a few minor illnesses though; it was probably a godsend for people with expensive, chronic conditions.

I don’t know about Congressmen.

@Crocodiles And Boulevards

Finally, a gut-feeling argument, it seems like if health care is a for-profit model then for every $1 an American should have to spend to get adequate care, he actually has to spend more than $1 so that someone can pocket the rest. Otherwise, how do these HMOs and hospitals turn such incredible profits?

Doctors are people too, not robots. If you don’t pay them, they will not work, same as any other human.

I agree that administrative costs are abhorrent and unnecessary, but somebody somewhere has to make a profit off of your illness, or you will not get treated. That’s not unfair, that’s life.

[Shodan]

@newcomer

Main reason with US uninsured is the market approach to an area of human activity that suffers from many non-market forces. Or… ?

Or the fact that consumers of health care are shielded from seeing what it costs.

I think UHC by definition will have to cost more than what we spend now. After all, there are a significant number of currently uninsured that will be covered, and the downward pressure exerted on spending by the fact that health care providers lose money treating the uninsured would be removed.

For UHC to be the same cost or cheaper, there have to be inherent savings in UHC that cannot be accessed any other way, that would more than pay for the larger numbers of people covered.

Regards,
Shodan

[Syntropy]

@erislover

But I don’t want the insurance company’s dictators replaced by the government’s dictators. Let my doctor and I decide on my health care, mmkay?

Why do people buy into election year rhetoric? We have a universal healthcare plan. It is called Medicare. Most other large insurance companies in this country base their rules on Medicare rules. Those rules are decided by DHHS. The government. What makes you think the government is not making decisions on your healthcare? Additionally Medicare patients make decisions with their doctors all the time. Sometimes it is based on what is and is not covered. So are decisions made by patients with private insurance. Could you explain the difference other than the fact that one is tax payer funded?

Catastrophe insurance + mandatory savings = people control their own health care, the way it should be while still being universal “coverage”

From what I have seen of your posts you believe in allowing people to decide what to do with their money. Why do you believe telling them they must set aside a certain amount of savings instead of feeding their families or putting a roof over their head is going to go over better than having the money taken out in advance? For that matter can you tell me the difference? “Mandatory savings” = tax.

@sailor

Might be true. It might also be true that where health care is free people waste resources by going to the doctor for lots of unnecessary things. It seems quite a few old people go to the doctor just to get some attention.

As opposed to people who put off seeing a doctor because they don’t have coverage and end up costing the tax payers even more because they’re uninsured and wind up in the emergency room? I’m all for cutting waste but your what if is less quantifiable than the drag of uninsured on our current system.

[tagos]

@DrCube

I agree that administrative costs are abhorrent and unnecessary, but somebody somewhere has to make a profit off of your illness, or you will not get treated. That’s not unfair, that’s life.

Covering administrative costs from the health dollar is not the equivalent of making a profit. The profit comes on top of admin costs. The question is to what extent does using market forces deliver the best health per dollar return and for whom.

In the UK we’ve been trying to reap the benefits of market forces by using internal market mechanisms to get the NHS internally competitive as well as opening up the delivery of NHS services to private actors.

The success is mixed and the Private Finance Initiative whereby the private sector build and service hospitals for profit has resulted in some spectacularly poor buildings and now things are going tits up economically a demand for a public bail-out.

Doctors and Consultants are extremely well paid (on top of their private income). A General Practitioner will pull down in excess of £100,000 a year (150k dollars or so). Consultants even more. On top of this they get superb pensions and have not racked up 6 figure debts training.

Plus all their private consultancy income. They are not hurting.

[Cheesesteak]

@Shodan

For UHC to be the same cost or cheaper, there have to be inherent savings in UHC that cannot be accessed any other way, that would more than pay for the larger numbers of people covered.

All these countries that have UHC in one form or another are already cheaper than us. UHC is not uncharted territory, where we need to sit around and wonder how it might work, there are dozens of currently operating examples to examine as closely as we want.

[DrCube]

@tagos

Covering administrative costs from the health dollar is not the equivalent of making a profit. The profit comes on top of admin costs. The question is to what extent does using market forces deliver the best health per dollar return and for whom.

I’m not sure what the real difference is between an employee investing time and expertise and a shareholder investing money and taking a risk. In both cases, the investors need to be compensated. But in the first case the compensation is considered a cost in wages, while the second case it is considered profit. Many “profits” are also reinvested into the company in order to fund growth. My point is that none of this is a bad thing, even in the health care industry, and I resent the emotional appeals on the subject.

There may be debatable details in the system, but “profit” doesn’t equal “waste” and/or “evil”, even in the case of poor old Granny’s arthritis medicine.

[tagos]

@Cheesesteak

All these countries that have UHC in one form or another are already cheaper than us. UHC is not uncharted territory, where we need to sit around and wonder how it might work, there are dozens of currently operating examples to examine as closely as we want.

The big difference between the USA and European systems (and I offer this without judgement) is that underpinning the debate is different values.

The USA has a strong individualist value system that puts more of an emphasis on individual provision and if you can’t provide for your own health care then that is your own concern.

Sure - there is a very basic, last resort safety net but nothing comparable to a comprehensive collective provision like the NHS.

And that’s the way you like your society - and to be sure this individualist approach in general has helped to create great wealth at the cost of extremes of income. More collectivist economies do not have the same economic dynamism. Each is a political and social choice societies have made, nothing wrong with it at either end but that’s why we end up talking past each other in these debates.

It’s not Right and Wrong, it is differing societal values/assumptions.

[scule]

@Shodan

I think UHC by definition will have to cost more than what we spend now. After all, there are a significant number of currently uninsured that will be covered, and the downward pressure exerted on spending by the fact that health care providers lose money treating the uninsured would be removed.

For UHC to be the same cost or cheaper, there have to be inherent savings in UHC that cannot be accessed any other way, that would more than pay for the larger numbers of people covered.

Regards,
Shodan

You say this and yet the evidence shows differently:

http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=media_13nov2008_e

Scroll down to “International Comparisons”. The US pays more per person than any other country in the industrialized world, without having UHC. Why? Because of insurance companies and the notion of health care being a for-profit industry. I never really get why people think governments are so bad at running things. The truth is, I don’t trust a private company to provide me with essentials. And health care is an essential. So give me government oversight and open, public discussion on the issue and I guarantee it will be run better than some private company can ever do so, simply because the people get to voice their opinions and output is not dictated by profit.

[J_Cubed]

Here’s why we need Universal Health Care: Imagine you’re the wealthiest person in the country. You have a team of private doctors all to yourself. Being wealthy, you decide to go to a nice restaurant for dinner. However, even nice restaurants are run on a thin profit margin, so the back room staff are not highly compensated. Unbeknownst to you, the dishwasher is working with a drug-resistant flu that he picked up while waiting with his daughter in the ER. Since he had to take time off to go with her, he can’t afford to take time off now, and unfortunately, your water glass just all coughed on. Now your spat-n-monocle-wearing ass has a disease that even your fancy doctors can’t effectively treat.

[XT]

Health care costs have traditionally strangled businesses (this is one of the arguments against unions, too).

I don’t know how true it is that the costs have ‘traditionally strangled businesses’, but even assuming for a moment that it IS true, what then? The money for UHC has to come from SOMEWHERE after all…where exactly do you think the majority of it would come from assuming you let business off the hook in the new system? They would have to raise taxes quite a bit in order to make up for the huge chunk business currently pays (not that THIS would happen), otherwise it would be moot, no?

Health care costs are likely built into many American products, which must hurt our competitiveness.

Well…ok. A lot of sunk costs are built into American products. However, those same sunk costs are built into other countries products too. Again though how do you get around this in some future plan? The money has to come from somewhere after all. It’s not going to be free just because the government is running the show, and unless the government is able to cut out something fairly major (like, say, Defense and maybe Education) this is just going to add more costs onto the governments balance sheet.

Many other industrialized countries have UHC, which makes them more competitive.

Well, I don’t know if this is true at all. I don’t think that industrialized countries with UHC ARE necessarily more competitive with the US on a manufacturing basis. Countries who are doing a lot of the current manufacturing (like India and China) don’t really have the levels of health care generally associated with the standards either here or in Europe.

The severe cost of health care for an individual or family likely causes many conditions to be ignored or treatment delayed. This might cause more disease and increasingly severe and expensive problems due to lack of preventative care.

Well, that’s probably true enough. And for those individuals such a UHC system would probably cost less. I know of this first hand as I went through this with one of my children who was born with an AV defect and a host of other problems. However, what you have to ask yourself is…would it be cheaper/better for the majority? Or would this basically benefit a minority of people and over all give less care or more expense to the majority? I’d say that’s the crux of the debate.

Employer-provided insurance keeps people (like my uncle) in a job they don’t want.

Having to pay the bills keeps people in a job they don’t want as well. Life, unfortunately, is tough. I sympathize with your uncle as I’ve been in his boat, but having UHC won’t magically make it possible for folks to leave their current jobs and find better one’s.

Finally, a gut-feeling argument, it seems like if health care is a for-profit model then for every $1 an American should have to spend to get adequate care, he actually has to spend more than $1 so that someone can pocket the rest. Otherwise, how do these HMOs and hospitals turn such incredible profits?

They don’t turn incredible profits, not compared to other businesses. We have the worst of both worlds with our current system. It’s sort of a mish mash of privatized and highly regulated and government controlled and subsidized…which of course increases the costs to what they could be. However, I remain unconvinced that UHC would cost any less or provide any better OVERALL care to the majority. I have no doubt that it will cost less to some, and provide better care to some…but I have never seen an convincing data showing that it will be better or cheaper for the vast majority who currently have insurance.

-XT

[SenorBeef]

@Grumman

In what Bizarro-universe is it a bad thing that his employer is providing him with a competitive level of compensation? When he decides that the benefits he receives do not outweigh however much he doesn’t want that particular job, he’s free to quit.

If I may take a guess - he may have developed a chronic expensive condition while on his current insurance. If this happens, aren’t people essentially locked into the same job for the rest of their life? Having to switch insurances through employers or seek insurance on their own can result in either outright rejection or premiums that are unaffordable.

@Shodan

Or the fact that consumers of health care are shielded from seeing what it costs.

I think UHC by definition will have to cost more than what we spend now. After all, there are a significant number of currently uninsured that will be covered, and the downward pressure exerted on spending by the fact that health care providers lose money treating the uninsured would be removed.

For UHC to be the same cost or cheaper, there have to be inherent savings in UHC that cannot be accessed any other way, that would more than pay for the larger numbers of people covered.

Regards,
Shodan

You’re ignoring the cost that society already pays for the uninsured when their medical problem gets bad enough as to require emergency treatment. Unless, as a society, we’re willing to say “you don’t have insurance, we’re going to let you die in the ER”, then this is a cost on society. You’re unfairly stacking the deck to discount this.

So giving some basic insurance to those people that’d give them care that reduced the number whose problem got so bad they required expensive emergency treatment could potentially be a net savings in itself.

And on top of that are issues like hugely reduced beaurocratic costs, etc.

I used to be staunchly anti-universal healthcare. In part because most advocates use the dumbest arguments - “shouldn’t health care be a right?!” is laughable and completely unappealing to me.

But recently I’ve seen convincing arguments that it’s simply in society’s best interest to treat it as infrastructure like roads or schools - it creates a net economic benefit, provides for better quality of life for a lot of people, reduces the chance that someone is going to be broke their rest of their lives because they developed a chronic condition, etc. Essentially - if we can pay less and get more by switching to UHC, I find that pretty compelling. I’m not certain that’s the case yet, but the data isn’t what you might expect.