# Would universal healthcare be more expensive or less than the current US system? **URL:** \ **Category:** Great Debates\ **Created:** [February 24, 2009, 8:01am UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175 "2009-02-24T08:01:17Z")\ **Posts on this page:** 20\ **Page:** 11
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [March 5, 2009, 8:24pm UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/201 "2009-03-05T20:24:06Z")
> [@Raygun99](#): > > Other than an emergency subsidy after the 9/11 attacks, the USPS hasn’t received government money in [26 years](http://209.85.173.132/search?q=cache:s99a_87fG6sJ:postcom.org/public/worksharing/facts.pdf+usps+self-funded&hl=en&ct=clnk&cd=2&gl=ca&client=firefox-a) and routinely makes [huge profits](http://usgovinfo.about.com/b/2008/02/12/postal-service-turns-a-profit-in-q1.htm). According to [this](http://usgovinfo.about.com/blpostalservice.htm), the USPS gets around $96 million annually. That link also points out that the postal service isn’t really a government program any more. ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [March 5, 2009, 8:31pm UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/202 "2009-03-05T20:31:26Z")
> [@Voyager](#): > > BTW, notice that private Medicare insurers are more expensive than the public one. I’m not totally sure if that is because their costs are higher or because Bush was ripping off the public once again, but there are many cases where the government runs things more efficiently than private enterprise. Did you check to see if the private Medicare policies cover more/cost less per visit than the public plan? The public plan sucks, which is why those who could afford it get a private suppliment plan. Medicare is a great example of how the US government cannot run a healthcare plan cost effectively. ---
**Author:** ![Cheesesteak](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cheesesteak/32/3694_2.png) [@Cheesesteak](https://boards.straightdope.com/u/Cheesesteak)\ **Post date:** [March 5, 2009, 8:33pm UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/203 "2009-03-05T20:33:57Z")
> [@curlcoat](#): > > Except, you don’t know that. Actually, I do know that because every study done on the cost of health care identifies the US as having the highest cost and every other industrialized nation with UHC at a lower cost. > [@](#): > > Just looking at bare facts doesn’t tell the whole story - how much of the taxes an individual pays from any given country go to support their UHC? What is the quality of care? What is the average income for a doctor? Where do they get their drugs and medical equipment? Do they have anything like the FDA? What are their wait times? Do they have access to everything medicine offers? Taxes - I imagine quite a high percentage. Of course, per capita, it’s still going to be less than a US resident pays for health care. Quality of care - AIUI, fairly good. There doesn’t seem to be any systemically greater griping than we have about our system, and I’m pretty sure the vast majority of folks who have UHC are thoroughly uninterested in changing to our system. Income - don’t know, don’t care, just as long as doctors get paid enough to ensure we have enough doctors. Drugs and equipment - the same places we get them FDA - I’m pretty sure these countries have some type of governmental agency like the FDA. Wait times and access - Again, I doubt there is more griping about that than there is here with our system. > [@](#): > > No, what I really want is for people to actually think about this rather than just stomp their feet and point at some other country for “proof”. I know it’s too much to ask people to stop being selfish, but the least you all can do is recognize the realities and actually attempt to prove that a UHC here wouldn’t end up costing me more and/or provide less. WE are selfish because we want everyone to have coverage and you’re not selfish because you want to be damn sure it’s not going to cost YOU more money. ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [March 5, 2009, 8:39pm UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/204 "2009-03-05T20:39:45Z")
> [@Voyager](#): > > Bingo. This is the A Number One reason why UHC is inherently cheaper - it spreads the risk over a wider pool. That’s insurance 101. The only way an insurer with a smaller base can match one with a larger base is to throw high risk participants to the sharks. This is so simple, people! It may be cheaper for those who now cannot/choose not to afford insurance, but it is not cheaper for those who can, since by spreading out the pool to those who can only pay a small premium, we end up subsidizing them. Just as my current insurance premiums are subsidizing, for others, maternity, alcohol/drug rehab, children’s health and all the other things I will never use. At least in that case, everyone is paying a relatively high premium and there are no additional costs. **And** , I can opt out any time I want. ---
**Author:** ![Cheesesteak](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cheesesteak/32/3694_2.png) [@Cheesesteak](https://boards.straightdope.com/u/Cheesesteak)\ **Post date:** [March 5, 2009, 8:41pm UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/205 "2009-03-05T20:41:16Z")
> [@Sam\_Stone](#): > > I keep hearing this asserted, but the data that is offered to back up this assertion is always some aggregate measure of per-capita health care spending, correlated with dubious stats like like expectancy. > > To truly decide whether market-based health care is more or less efficient than govenment-run health care, your analysis is going to have to do the following: Sam, if someone actually did a study to control for these things, and presented a cogent argument that our health care is better / more efficient than other industrialized nations, I’d listen. As it stands, I don’t know of any such study, and the anti-UHC arguments are all along the lines of “the government sucks / the free market rules”. > [@](#): > > - Account for the ‘free rider’ problem. The U.S. system encourages research and spending on new techniques and treatments. There are far more ‘early adopters’ of new treatments in the U.S. This is very expensive. Then when the procedures are perfected and the cost is driven down, other countries adopt them. The same goes for drugs - American consumers disproportionately pay the R&D cost of new drug development. If you don’t mind my saying, this alone is a good reason to look into government controlled health care. US residents pay through the nose so that everyone else in the world gets new drugs and treatments at a dirt cheap, government controlled price? Fuck that, and fuck them, let them pay their fair share, and I’ll take my low cost drugs and treatments, thanks. ---
**Author:** ![Sam\_Stone](https://avatars.discourse-cdn.com/v4/letter/s/ecccb3/32.png) [@Sam\_Stone](https://boards.straightdope.com/u/Sam_Stone)\ **Post date:** [March 5, 2009, 8:44pm UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/206 "2009-03-05T20:44:10Z")
Regarding wait times, here’s a report that compares wait times for elective surgery in 12 OECD countries: [Elective Surgery Waiting Lists (PDF)](http://www.oecd.org/dataoecd/24/32/5162353.pdf). For example, Table 2 shows the percentage of patients who had to wait more than 4 months for elective surgery. In 2001, the numbers are: ```auto Australia 23% Canada 27% New Zealand 26% United Kingdom 38% United States 5% ``` That’s a huge difference. The U.S. is really an outlier in that group. How much extra does it cost to ensure that level of access for elective surgery? Any analysis that compares the costs of health care has to take such factors into account. Another way waiting lists decrease cost is by lowering demand. If you’re thinking of elective surgery, and are told that if you go through the laborious process of qualifying for it and you’ll still have to wait six months to get it, you might decide not to get it at all. There is hard statistical evidence which shows that waiting lists lower demand. Also, maintaining low wait times means having to carry excess capacity, because demand is not steady. So a guarantee of low wait time means some health resources will on average be under-utilized. This drives up cost. ---
**Author:** ![Sam\_Stone](https://avatars.discourse-cdn.com/v4/letter/s/ecccb3/32.png) [@Sam\_Stone](https://boards.straightdope.com/u/Sam_Stone)\ **Post date:** [March 5, 2009, 8:48pm UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/207 "2009-03-05T20:48:06Z")
> [@Cheesesteak](#): > > If you don’t mind my saying, this alone is a good reason to look into government controlled health care. US residents pay through the nose so that everyone else in the world gets new drugs and treatments at a dirt cheap, government controlled price? Fuck that, and fuck them, let them pay their fair share, and I’ll take my low cost drugs and treatments, thanks. Are you assuming that you’re still get to be early adopters under a government-run health care system? It seems to me much more likely that the government will disallow exotic treatments and extreme, expensive measures. And the pace of medical innovation will slow down. As for drugs, the drug manufacturers aren’t going to make them for free. New drugs are expensive because developing them is expensive. Again, my guess is that a public health care system in the U.S. would do what other systems do - disallow the use of expensive new drugs, mandate generics when possible, and demand alternative treatments to expensive drug regimes. Again, this is going to damage the pace of innovation in drug manufacture. There are no free lunches. ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [March 5, 2009, 8:49pm UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/208 "2009-03-05T20:49:11Z")
> [@Cheesesteak](#): > > Yet, somehow, every industrialized nation (except the US) has this large inefficient bureaucracy and they’re ALL more efficient than the US system. > > Every. > > Single. > > One. > > Tell me again how, “logically”, government run medical care is less efficient than privately run medical care, because that argument never gets tired. Other nations’ governments Are. Not. The. USA. Look at the facts at how well the US goverment runs Medicaid, Medicare and the VA and then get back to us with cites on how well they are doing there. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [March 5, 2009, 8:58pm UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/209 "2009-03-05T20:58:36Z")
> [@welby](#): > > I’m saying it will cost more because it will. The savings you claim come from eliminating the for-profit bureaucracy and replacing it with a government one - _government is not efficient._ You can’t replace one large, inefficient bureaucracy with another, larger one and claim that it’ll be more efficient. Medicare/Medicaid are rife with fraud, waste, and rising expenses - spending nearly [doubled](http://www.publicintegrity.org/investigations/broken_government/articles/entry/1063/) under your personal Satan’s watch and the program _still_ has finance problems. The VA can’t properly care for a few million ex-soldiers, as evidenced by the problems at Walter Reed and the anecdotal evidence supplied by my twice decorated, wounded in Iraq I brother. All three of these programs are government run fiascos, and you want me to buy into yet another? [url=[http://www.webmd.com/medicare/news/20071016/medicare-rx-plan-overhead-too-high](http://www.webmd.com/medicare/news/20071016/medicare-rx-plan-overhead-too-high)] Here is a study comparing costs for the prescription program from insurers vs government. Almost all cites I’ve found are partisan one way or another - WebMD isn’t. > [@](#): > > The report concludes that administrative costs run nearly six times higher in private insurance companies than in Medicare’s traditional fee-for-service programs. According to the report, $4.6 billion went to into administrative costs and other company expenses in fiscal year 2007. Nearly $1 billion of that amount was steered toward insurance company profits, the report concludes. > > The report also criticizes insurers for gaining smaller cash rebates from drug companies than the Medicaid health program for the poor typically receives. > > “The program’s inflated administrative costs and meager drug rebates will cost taxpayers and seniors $15 billion this year alone,” Waxman says in a statement I will agree with you in one regard - administrations who feel that government is inefficient can make it so by hiring incompetents. That explains the VA fiasco - it used to be very efficient. So was FEMA before it was run by a political hack. > [@](#): > > Overhead per capita is one consideration, but would you rather your request for care to circulate through an office of 10 or an office of 1000? Economy of scale is one thing, but my current economy of scale (my private insurance provider) does not include in my premium the cost to carry an additonal 14 percent of the insured pool. Yours does. How is that less expensive? Office size was an example of economies of scale, and has nothing to do with the insurance pool, which is statistical. Actually my data would probably be safer in an office of 1,000 which is more likely to have rigid rules and checks. But that is of course irrelevant. > [@](#): > > You might not like what we have now, but we insure roughly 86% of our population with the finest medical care in the world. The expense goes to pay for breakthrough treatments for diseases considered uncurable 25 years ago. If that money goes away, where exactly do you expect the next breakthrough to come from? Do you think insurance companies fund medical research? Try the government funded NIH. How about drugs? The drug companies spent far more on advertising than on research. A UHC system, like in Europe, would eliminate advertising, and could cut prices without cutting research. Sure we miss the opportunity to freak out about restless toe syndrome of boncus of the concus or any of the rare diseases they’ve developed drugs for and want to encourage people to have, but I think we’ll do just fine. Like I said, it is easy to cut costs (not that we do) if you through 14% to the sharks. Some of that 14%, by the way, are healthy people who can reasonably bet that their average health care costs will be lower than insurance costs. So, adding them to the pool would decrease fees on average, though they will no longer be able to game the system. Since the uninsured people cost the system anyhow when they get seriously sick, and since a UHC system will make it easier for them to get preventative treatment, or get treated early, it will save money. Unless you want to turn them away from the ER, that is. > [@](#): > > Finally, you have just as much data as I do on how expensive the whole thing will be: none. Sure theories abound, but theory isn’t fact and can only be proven by experimentation. If this experiment fails, what’s the back out plan? No data? We’ve got plenty of data, including just north of us. We have mediocre results (cite that we have the best healthcare in the world please - there are plenty of counters in this thread already) and we pay more than anyone - even if we just consider government expenditures. And this is fine with you? Oh yeah, I’ll just push the button and get > [@](#): > > I’m saying it will cost more because it will. Sure Medicare costs are going up. So are my private insurance and healthcare costs. Medicare’s overhead is much lower than private insurance. You’ll see rightwing explanations, of course. Medicare average reimbursement is higher. Duh - it covers the highest risk population. It doesn’t consider the cost of administration at point of service. Sure, but my medical group spends a lot on staff dealing with private insurance also, which isn’t included either. The government pays for collecting the money out of another pocket. In group plans, the employer collects the money, not the insurance company. I’ve seen overhead numbers around 3% for Medicare and 11% for private insurance. Under a UHC system the overhead will no doubt come down still more. So, arguments for costs being reduced: economies of scale. Bigger risk pool. Reference to other countries with better results at lower cost. Elimination of insurance company profit, and insurance company overhead to reject claims. (My son-in-law was part of this overhead last year.) Arguments for higher costs: We’d start having to give care to people not getting it now. Government is inefficient because it just is. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [March 5, 2009, 9:00pm UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/210 "2009-03-05T21:00:13Z")
> [@curlcoat](#): > > Other nations’ governments > > Are. > > Not. > > The. > > USA. > > Look at the facts at how well the US goverment runs Medicaid, Medicare and the VA and then get back to us with cites on how well they are doing there. So, France and Italy are more efficient than the US. :rolleyes: Right. Medicare overhead is 3%. See above. ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [March 5, 2009, 9:00pm UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/211 "2009-03-05T21:00:41Z")
> [@Sam\_Stone](#): > > Regarding wait times, here’s a report that compares wait times for elective surgery in 12 OECD countries: [Elective Surgery Waiting Lists (PDF)](http://www.oecd.org/dataoecd/24/32/5162353.pdf). > > For example, Table 2 shows the percentage of patients who had to wait more than 4 months for elective surgery. In 2001, the numbers are: > > ```auto > > Australia 23% > Canada 27% > New Zealand 26% > United Kingdom 38% > United States 5% > > ``` > > That’s a huge difference. The U.S. is really an outlier in that group. How much extra does it cost to ensure that level of access for elective surgery? Any analysis that compares the costs of health care has to take such factors into account. > > Another way waiting lists decrease cost is by lowering demand. If you’re thinking of elective surgery, and are told that if you go through the laborious process of qualifying for it and you’ll still have to wait six months to get it, you might decide not to get it at all. There is hard statistical evidence which shows that waiting lists lower demand. > > Also, maintaining low wait times means having to carry excess capacity, because demand is not steady. So a guarantee of low wait time means some health resources will on average be under-utilized. This drives up cost. Remember, elective surgery isn’t cosmetic surgery - it is anything other than emergency-gotta-do-it-now-or-you’ll-die. So, do you want to take a chance on having to wait four months for a surgery to, say, relieve severe pain? To check out that lump? Gotta go - see you all later. ---
**Author:** ![welby](https://avatars.discourse-cdn.com/v4/letter/w/d78d45/32.png) [@welby](https://boards.straightdope.com/u/welby)\ **Post date:** [March 5, 2009, 9:01pm UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/212 "2009-03-05T21:01:05Z")
> [@Cheesesteak](#): > > As an aside, you’re bitching about paying for the coverage of 40 million people, while admitting that the high cost of our system funds research so that billions of people across the world have access to new treatments at half the price we pay. > > Why don’t we stop funding research for the entire world, we’ll have oodles of money left over to pay for poor folks to get decent care. Curlcoat and Sam addressed your imaginary economic arguments, so I’ll take this one: How exactly to you propose to work this? Close off foreign markets to drug companies? Close our borders so that drugs can’t be sent overseas? Hide the research? I mean, in a perfect world this argument may make sense, but you’re not in a perfect world. The perfected drugs that we pay for the research on also generate revenues when sold around the world - it’s not like we pay for them and then send them to every hospital int he world for free. In effect, the only way to “stop funding research for the entire world” woudl be to stop medical research altogether, leaving our current medical system static. Brilliant! :rolleyes: ETA: > [@](#): > > If you don’t mind my saying, this alone is a good reason to look into government controlled health care. US residents pay through the nose so that everyone else in the world gets new drugs and treatments at a dirt cheap, government controlled price? Fuck that, and fuck them, let them pay their fair share, and I’ll take my low cost drugs and treatments, thanks. If you don’t mind my saying, that’s sort of my feeling about the unisured? I work hard and pay more taxes so that a bunch of other people get new drugs and treatments at a dirt cheap, government controlled price? Fuck that, and fuck them, let them pay thier fair share, and I’ll take my reasonably priced HMO, thanks. ---
**Author:** ![Raygun99](https://avatars.discourse-cdn.com/v4/letter/r/6f9a4e/32.png) [@Raygun99](https://boards.straightdope.com/u/Raygun99)\ **Post date:** [March 5, 2009, 9:31pm UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/213 "2009-03-05T21:31:30Z")
> [@Sam\_Stone](#): > > Regarding wait times, here’s a report that compares wait times for elective surgery in 12 OECD countries: [Elective Surgery Waiting Lists (PDF)](http://www.oecd.org/dataoecd/24/32/5162353.pdf). > > For example, Table 2 shows the percentage of patients who had to wait more than 4 months for elective surgery. In 2001, the numbers are: > > ```auto > > Australia 23% > Canada 27% > New Zealand 26% > United Kingdom 38% > United States 5% > > ``` Isn’t that number affected by the amount of Americans that can’t even get that elective surgery, because they don’t have insurance, their HMO won’t pay for it, or they simply can’t afford it? That’s what this discussion is about at its core. ---
**Author:** ![Cheesesteak](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cheesesteak/32/3694_2.png) [@Cheesesteak](https://boards.straightdope.com/u/Cheesesteak)\ **Post date:** [March 5, 2009, 9:43pm UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/214 "2009-03-05T21:43:30Z")
> [@Sam\_Stone](#): > > Another way waiting lists decrease cost is by lowering demand. If you’re thinking of elective surgery, and are told that if you go through the laborious process of qualifying for it and you’ll still have to wait six months to get it, you might decide not to get it at all. There is hard statistical evidence which shows that waiting lists lower demand. Not having health insurance is also going to be a major factor in reducing one’s demand for elective surgery. The 14% of the population that has no insurance isn’t even going to get on the waiting list, because they can’t afford surgery at all. These other countries have a fair percentage of wait times over 4 months, we have our share with wait times of forever. WRT the free riders and the US health system providing the impetus for all significant medical research… How about the various governments discuss the type of funding and payments that are available for experimental programs, and agree on payments that allow funding, instead of the US paying out the ass, and every other country paying the minimum possible? ---
**Author:** ![Cheesesteak](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cheesesteak/32/3694_2.png) [@Cheesesteak](https://boards.straightdope.com/u/Cheesesteak)\ **Post date:** [March 5, 2009, 9:45pm UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/215 "2009-03-05T21:45:25Z")
> [@welby](#): > > If you don’t mind my saying, that’s sort of my feeling about the unisured? Feel anyway you want about them, just don’t tell me that I’m the selfish one. ---
**Author:** ![LilShieste](https://avatars.discourse-cdn.com/v4/letter/l/9f8e36/32.png) [@LilShieste](https://boards.straightdope.com/u/LilShieste)\ **Post date:** [March 5, 2009, 9:51pm UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/216 "2009-03-05T21:51:39Z")
> [@Raygun99](#): > > Isn’t that number affected by the amount of Americans that can’t even get that elective surgery, because they don’t have insurance, their HMO won’t pay for it, or they simply can’t afford it? That’s what this discussion is about at its core. I was thinking the same thing. ISTM that the “waiting lines argument” tries to demonstrate why it’s a bad idea to allow people to have access to medical attention that they might need. It’s only a tangential argument against UHC. That is, the same problem would arise - without UHC - if a large influx of people started seeking medical attention, and paid for their own visit. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [March 5, 2009, 9:54pm UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/217 "2009-03-05T21:54:41Z")
> [@welby](#): > > If you don’t mind my saying, that’s sort of my feeling about the unisured? I work hard and pay more taxes so that a bunch of other people get new drugs and treatments at a dirt cheap, government controlled price? Fuck that, and fuck them, let them pay thier fair share, and I’ll take my reasonably priced HMO, thanks. Wealthy European nations are like the group of uninsured who can pay but don’t want to. Make them pay, I say. Poor third world nations are like those who are uninsured because they can’t afford insurance. Give them a break. ---
**Author:** ![Sam\_Stone](https://avatars.discourse-cdn.com/v4/letter/s/ecccb3/32.png) [@Sam\_Stone](https://boards.straightdope.com/u/Sam_Stone)\ **Post date:** [March 5, 2009, 10:22pm UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/218 "2009-03-05T22:22:51Z")
> [@LilShieste](#): > > I was thinking the same thing. ISTM that the “waiting lines argument” tries to demonstrate why it’s a bad idea to allow people to have access to medical attention that they might need. It’s only a tangential argument against UHC. > > That is, the same problem would arise - without UHC - if a large influx of people started seeking medical attention, and paid for their own visit. Yes, there is no doubt that having to pony up your own funds for your own health care reduces demand. Absolutely. I’m sure that’s a big reason why waiting lists for elective surgery are shorter in the U.S. But you’re missing the point - the point is that you aren’t getting something for free by going to a public health insurance model. In a private health care system, prices act to control demand, just like in every market. So what happens if you eliminate prices, and give everyone free health care? Demand goes up, and cost goes up. If you have free health care and want to maintain the same level of service for everyone, you will need a hell of a lot more hospitals, doctors, and nurses. You will have to increase supply until it matches demand. In the absence of prices, the only things that can limit demand are the intangibles - waiting times, hassle, fear of treatment, laziness, whatever. So to be honest, you have to realize that what you’re advocating is elminating prices, and then controlling costs through rationing. Every country I know of that has public health care either has to ration care through waiting lists, or through formulas that are applied to limit eligibility for certain procedures. In many countries with public health care, there are certain life-saving procedures that will simply not be available to you if you don’t meet the criterion on some qualification schedule the government provides to doctors. Denmark and Sweden have taken another tack - they guarantee a waiting time, and if your wait exceeds it they offload you to a private health care provider on the government’s dime. This might work for a while, but eventually this will remove the government’s ability to control demand unless they make the government waiting list maximum very long (it’s already much longer than the average for the U.S.) I find most public health care arguments dishonest, including Obama’s. Most make the claim that by reducing waste and inefficiency, everyone can get public health care at no extra cost, or even lower overall cost, without sacrificing treatment speed and quality. But in engineering we have a phrase that goes, “You can have it fast, you can have it cheap, and you can have it with high quality. Pick any two.” That statement is borne of the reality that there are no free lunches. And any claims that reducing waste and inefficiency will cover the increased demand of public health care are suspect because they never consider the inefficiency that government brings to the table. Finally, there’s one good reason why the U.S. will not be able to manage health care as well as many other countries - its form of government is ill-suited to federal management. In parliamentary democracies, which decribe most of the countries with public health programs, the party is unified and generally votes as a bloc. In Canada, we have extremely strong party discipline. This shelters individual members from criticism from their own constituents, and generally we don’t vote people in and out based on what they’ve done locally - we vote for or against the party. This allows the government a freer hand to do what’s best for the entire country and eliminates a lot of NIMBYism. In the U.S., you have a system of representation in which votes are all free votes, and individual members of Congress are held responsible for their votes by their constituents. That’s why there’s so much pork in the U.S., and why difficult problems like nuclear waste cannot be solved when other countries like France dealt with them more easily. It’s also why lobbyists have so much power in the U.S. - they can influence individual votes. It’s much more likely in the U.S. that new regulation or government programs will be captured by special interests and rent-seekers. For example, we have a system in Canada where the rich provinces like Alberta pay equalization payments to the poorer provinces, as a sort of large-scale welfare program. Do you think you could ever pass a law in the U.S. that requires New York to write multi-billion dollar annual checks to Alabama to help equalize social outcome? If if you did, how many quid-pro-quos would supporters have to agree to in order to gain support of the ‘have’ states? How many federal projects would have to be promised to those states? How many regulations would have to passed which have the effect of benefiting the ‘have’ states in order to buy their support? A U.S. public health care system will be driven largely by powerful interests who have the ear of powerful senators and congressmen on the appropriations committees. Every time someone tries to close a hospital in a region that is over-supplied it will be fought tooth-and-nail. ‘Compromises’ will always trend towards increased spending, not less (“If you don’t vote to remove my hospital, I’ll vote for another to be built in your district”). ---
**Author:** ![Mighty\_Mouse](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mighty_mouse/32/7776_2.png) [@Mighty\_Mouse](https://boards.straightdope.com/u/Mighty_Mouse)\ **Post date:** [March 5, 2009, 10:35pm UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/219 "2009-03-05T22:35:43Z")
> [@Voyager](#): > > Wealthy European nations are like the group of uninsured who can pay but don’t want to. Make them pay, I say. Poor third world nations are like those who are uninsured because they can’t afford insurance. Give them a break. We have no ability to make Western Europe and Japan pay their fair share of the costs of medical advances, because their marginal cost pricing is enough to get the drug and device companies to sell in those markets. The only way we can get the benefits to poorer countries who are not even able to pay the marginal production cost + the delivery costs is for us to subsidize it. This seems like adding insult to injury. We are already subsidizing the rich. Because we are, you want us to subsidize the poor as well. ---
**Author:** ![Sam\_Stone](https://avatars.discourse-cdn.com/v4/letter/s/ecccb3/32.png) [@Sam\_Stone](https://boards.straightdope.com/u/Sam_Stone)\ **Post date:** [March 5, 2009, 10:48pm UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/220 "2009-03-05T22:48:16Z")
> [@Jayn\_Newell](#): > > My biggest concern would be the gap you have left between no medical treatment and catastrophic medical treatment where people have to fend for themselves. Especially for maintenance things–does the government program cover the diabetic’s insulin, or do they have to find a way to pay for it themselves until complications set in and the government program picks it up\*? I’m not sure if what you’ve proposed would really be much better than what we have now, because that gap already exists. The idea of nudging people to save towards healthcare sound good on paper, but I can’t help but wonder what effect it would have on the lower classes (I’m not even going to guess here–my experience is far too limited). What is your goal here? Is it to make sure that no one is bankrupted by health issues? Or is it to make health care completely free for everyone, all the time? If the latter, why? There are lots of necessities of life that are not free. Why shouldn’t housing be free? Or food? Or clothing? You can’t live without any of these things, yet you are still expected to pay for them. The point is that prices force people to choose what they value most, and therefore help allocate goods and services more efficiently. The cost of a health care system in which everyone gets everything for free would be orders of magnitude greater than the cost of health care if everyone was responsible for paying for routine health care. Another thing prices do is drive good behavior. People take care of their teeth in part because going to the dentist is expensive. Make dentistry free to all, and you’ll get worse tooth care. It’s important to put the costs on the individual as much as possible. for these reasons. A good example of the kind of system I’m talking about is the way dentistry is managed in Canada. Major dental procedures like reconstructive surgery or surgery to remove oral cancers are covered by our health care system. But routine fillings and caps are not. Dental insurance which covers this gap is widely available and fairly cheap, because the insurers know their downside risk is capped. They aren’t going to be on the hook for a million dollars worth of treatment if they pick the wrong person to insure. The dentists themselves are in private practice, and operate out of their own offices and hire their own staff. As a result, dental care in Canada is excellent. There are almost no waiting lists for routine care - if I had a toothache, I could be in to see a dentist somewhere within an hour or two. Dentists compete with each other and offer different services and environments to attract patients. As for costs… A couple of years ago I had to go to the emergency room for a back problem. I sat there for about three hours before I could get anyone to even look at me. When they did, they took me in and gave me an X-ray and let me lie on a gurney in a hallway for an hour while they developed and examined the X-ray. I got a grand total of about half an hour of a doctor’s time. The interesting part was that I didn’t have my health card with me, so they had to bill me until I could present the card, so I got a chance to see what they billed the government for that service. It was $800. In comparison, I recently spent an afternoon in a dentist’s chair. I had anaesthesia, was attended at all times by a dental assistant and the dentist in a private room wth a flat-screen TV to watch during the time I wasn’t under. They took several dental X-rays as well. The cost for that was about $600, paid by my insurance company. I had no waiting time at all to see the dentist. This all works because there are still market forces at play in dentistry in Canada. [Previous page](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175.md?page=10) [Next page](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175.md?page=12)