I feel that choice is an important part of it. That is, when you’re sick there isn’t a lot of choice as to what you do about it–you either get the treatment that works, or you ignore the problem and hope it goes away. Most other necessities have a much wider range of options, and you can choose which one depending on how much you want to spend. Cars can range from a few hundred for a beater to a few hundred thousand for the fanciest vehicles. You also didn’t respond to my question about maintenance care–I’m curious where you think that would fall.
I don’t think everything should be free, but I do think there’s a lot of room for improvement in getting Americans access to not only affordable emergency care, but also routine care that can be very necessary for an individual to function normally in society.
I won’t claim to have the answers, and I do think that you’re on the right track for a market-based solution. I just feel that there are two major problems with the American system as it stands, and your solution may only fix one of them.
It’s possible to write the law so that the government can control costs.
OTOH, it’s possible to write the law so that health care costs are kept high by law, to prevent any losses by the industries affected.
It’s also possible that once socialization happens, the government has an interest in saving money long-term & changes things.
But most significantly, “high costs” is a relative term. What the nation can bear to spend per person is greater than what a single person with income below the median can afford.
Add to that the loss of uncertainty in ability to pay, & there’s a sort of psychological weight lifted from the collective consciousness.
But we don’t have a free-market health care system. They say 40 million Americans are uninsured; that means 263 million Americans are insured. I don’t think those people would indulge themselves with more hospital visits when universal health care is implemented.
The solution then would be to make sure the health care system covers preventive measures. Things like vaccinations, mammograms, blood tests (STD, cholesterol, etc), preventive medication (e.g. blood pressure medication) all cost money if you don’t have insurance, but can delay or prevent conditions that require far more costly procedures.
How many of those insured have co-pays? How many treatments are not covered by insurance, but would be covered in a public health system?
And are you cool with the way insurance companies try to control costs?
If the health care is free, will people go out of their way to get the preventative treatments?
Here’s a better idea: Cover catastrophic care only, but make preventative treatments free. Now people have an incentive to do the preventative stuff, because it will save them money.
So the principle is that if you have to do something, the government should pay for it? That the only things we should pay for ourselves are those things which are optional? Whatever happened to the concept of personal responsibility?
If my car breaks down and I don’t live near a bus route, I’m in a world of trouble. I don’t really have a choice but to fix my car. Should the government provide free car repairs? Or should I have saved some money in case my car breaks down?
If the government did offer free car repairs, what do you think that would do to the savings rate? What effect do you think it would have on the level of maintenance people give their cars? What do you think it would do to the price of car repairs and the quality of those repairs? How much pressure do you think mechanics’ organizations would put on their representatives to distort the legislation in ways that increased their profits?
Part of being a citizen is managing your own affairs. Saving for emergencies and being able to care for yourself in times of trouble are basic, fundamental duties of citizenship. Every time the government offers another safety net or takes on responsibility that is rightfully yours, it encourages poor behaviour.
By all means, let’s make sure that no one’s life is destroyed by catatrophic medical bills. A diagnosis of ALS or cancer should not be a financial disaster that would wipe out anyone who wasn’t a millionaire. Let’s protect people from that.
But the notion that everyone should go through life with the government paying for all their medical bills is not just ridiculous, it’s destructive to society. It rewards the most irresponsible and punishes the responsible. It puts everyone on the hook for their neighbor’s behavior.
Another thing it will do is give the government a justification for many other intrusions on liberty. Once the tab for your health care is picked up by the government, the government will claim it has a right to limit your behavior if they deem it increases your medical costs.
Well, at first we could let people who CAN afford it, buy into the current government plan. I know I could afford it… I guess that would solve the issue for 30-40% of the current uninsured which is a start.
The unemployment in Prague is less than 2% and while I don’t know the overall health, I am sure it is on par with the US.
Just FWIW, I called from Nevada to my doctor in Prague on Friday and had an appointment Monday (which was the fastest I could get there on a plane). My wait time has never been more than one day in the Czech Republic, UAE, Thailand, Cambodia or Australia.
Do the studies address everything that affects health care in those countries? You know, all the things I’ve been listing that noone is responding to?
You know that how?
Uh, OK. Simply because people in other countries don’t gripe about what they have doesn’t mean their quality of care is near as good as ours. Particularly if we quit innovating here and exporting it there.
You know, it’s quite obvious that you haven’t bothered to do more than read whatever the pro-UHC folks tell you. “Enough income to ensure we have enough doctors”? You are “pretty sure these countries have something like the FDA”? You “doubt there is more griping about wait times and access”?
Yes. I am paying for myself. You are selfish because you want to use my money to pay for a plan you think sounds good, to cover people who cannot be bothered to be responsible for themselves.
You guess? Do you really think that your situation makes up that big of a percentage of the uninsured population?
I thought your point was that having a UHC would make us all healthy - if the average person in Prague is in the same shape as the average person in the US, they aren’t all that healthy.
So you think there is a big group of people who have health insurance, but stay away from the doctor because they don’t want to pay the co-pay? Perhaps, but for those people, I suspect the time it takes to see the doctor (i.e. the necessity to take time off from work) is just as big a deterrent. And that’s not going to go away with universal health care.
I don’t know, how many?
I’m not sure what this means, could you explain?
You think people get screened for cancer not because they are concerned about their health, but because they can’t afford cancer treatment?
Isn’t every treatment preventative for something more serious? Healthy diet can prevent the need for cholesterol medication, but cholesterol medication can prevent the need to get an angioplasty, and an angioplasty can prevent a heart attack, etc. (OK, I’m not sure if that’s medically true, but I think the general idea is.)
Well, I personally know three other people in the US who are in my position (able to afford, but can’t buy insurance), and another who was in this position and decided to move to Spain.
So yeah, I think happening to know 4 other people like this means it is common enough. There are lots of people who are uninsured, unable to buy insurance, and not poor.
I’d like to buy insurance without costing you or anyone else any money, but it’s not for sale.
OK, to make this totally scientific, I don’t know anyone at all who would like to be able to buy insurance, and who could afford it, but cannot. So, yeah, I think not knowing anyone at all in that position means it isn’t common at all.
Except, you have insurance. Your only problem is you don’t want to live where you live. And apparently you don’t even have to live there to get that insurance, you just can’t use it here. For that I should pay for a billions of dollars experiment?
curlcoat, I think your questions are important, but how have you possibly been so actively involved in this thread without citing any data supporting your side of the argument? There’s plenty on the national health care side (I’ll go ahead and broaden this from UHC to just some kind of national), but no one has provided any studies of counter-arguments yet. I would assume that they exist, but my google-fu is weak and when I search for this topic on Google I just get articles in support of UHC/NHS.
Sam Stone, I had a question or two upthread about your plan but I think you missed it. Also, I had a few questions about your elective surgery cite. Anyway, for you:
According to your cite, the theoretical (and very reasonable) cause for the high wait times is an increase in demand in relation to surgical capacity caused by NHS-type systems reducing the price on elective surgery. Fine. But can’t that same assumption be used to argue that demand is artificially reduced in the US due to high prices? In other words, that demand for elective surgery is low in the US because people can’t afford it, which translates into lower wait times?
This is a quote from your cite:
“At worst, waiting times can lead to deterioration in health, loss of utility and extra costs. However, one surprising result is that there is little evidence of health deterioration from a review of studies of patients waiting for a few months for different elective procedures across a range of countries. Moreover, such patients are quite tolerant of short and moderate waits, although the general public often expresses more concern about waiting.”
and also:
“First, there is surprisingly little evidence of deterioration in health during waiting in most of the studies reviewed, which cover a variety of procedures, a variety of waiting times, and a variety of countries. That may have been because waiting times are typically shorter for the more acute conditions, such as coronary artery disease. Also, surgeons may be quite good at triage – that is at re-prioritising patients whose conditions become unstable or deteriorate. Secondly, there is evidence of considerable tolerance of short and moderate waiting, as reported above. Naturally, that is less true in relation to coronary artery disease than it is in relation to cataracts. Third, a couple of studies of patients’ willingness to pay for reductions in waiting, suggest that there is relatively moderate willingness to pay - perhaps around ₤65 (or $100) for a reduction in waiting of one month, at current price levels. Fourth, however, there is some evidence of differences across countries in tolerance of waiting. On the positive side, a few studies suggest that some patients get better while waiting and no longer require surgery. More important, the savings in terms of avoided excess surgical capacity from maintaining waiting lists may be substantial (Feldman, 1994).”
What do you think about that interesting tidbit?
What exactly qualifies as elective surgery in any case, and how do those same countries compare to the US waiting times/overall care for crucial catastrophic illness (particularly for the uninsured)?
In any way you look at it, the report you cited does not seem to call these waiting times a catastrophic flaw in these health care systems. There’s no proof of reduced care (quite the contrary), nor any implication of a crisis. The strongest assertion made against wait times for elective surgery is that it is (by polling) the most unpopular aspect of those systems. If waiting times for elective surgery is really the biggest concern about the health systems in those countries, that sounds like a huge improvement over the list of complaints we haev here.
Also, the authors suggest that great strides in reducing wait times and tinkering with patient prioritization systems has occurred in most systems with more improvements possible. Furthermore, the report says that only HALF of OECD countries have waiting time concerns. What say ye?
Yes, I have insurance as long as I am not living in the USA. If I move back to the US, no more insurance… and if I visit the US, no insurance either (but I can use it again after my holiday).
I just remembered that Sam Stone also doesn’t like our current system. Therefore, the above points I’m really pushing towards the other anti-NHS posters in this thread. I think Sam Stone actually is interested in pursuing the economic argument fully.
Because I don’t need to. You want something new, something that I will have to pay for, something that has basically not been proven to work here, so it is up to you to convince me that it is a good idea.
I’m not surprised. The idea of living responsibly and taking care of oneself has become quite unpopular in the last couple-three decades. However, I have yet to see any articles in support of the UHC that weren’t flawed.
My Google-fu is fairly weak as well, plus I’m on dial up so I don’t really feel like digging thru a bunch of pages at the speed of a garden snail…
The US will probably end up with some sort of UHC in the near future, since the country seems to be run by people that think that everyone should have everything, no matter what stupid selfish irresponsible decisions they may make. Personal responsibility, gratification delay and living within one’s means are all foreign concepts to the children of the Me generation.
I agree completely, and said so in a previous message. In fact, I would think this is self-evident. In a free market system, prices rises until they reach the market-clearing price, at which point supply and demand are in balance and there are no shortages.
That doesn’t necessarily mean people in a free system can’t afford elective surgery - it means that when forced to choose between elective surgery and other goods they can buy with their money, they opt for the other goods. You’ll note there doesn’t seem to be a shortages of BMWs, either. But there sure would be if the government promised a free BMW to everyone.
My point was not that everyone gets all the care they want in a free market system. My point was that if you don’t have prices to control demand, you will have to control it in another way. Governments typically do that by imposing waiting lists, intentionally limiting the supply of ‘bottleneck’ devices like MRI scanners, by creating shortages of doctors because they aren’t willing to pay the true market price for them, or by simply disallowing certain procedures for people who don’t meet a qualification schedule. For example, in the UK now, the elderly have to buy hip replacements on the private market. The health care system will no longer cover them.
It’s the proponents of public health care who are promising the free lunch - cheaper health care, access for all, equal standards of care, and similar waiting lists. They seem to think that the free market is horribly inefficient, and that if only government would take over there would so much savings that it would pay for everyone else’s health care without hurting the care of those who can already afford it.
This is not surprising, since we’re talking about elective surgery in this particular case. I have to wonder about the loss of utility, though. I’m not sure how they are defining it, but I’d have to say that someone who has to wait several years for cataract surgery, like my mother did, has a significant loss of utility during that period. The same goes for an elderly person who has to wait several years for a hip or knee replacement, as my grandmother did. She could hardly walk during that time. But no, her health didn’t actually deteriorate because of the wait - she just lived in pain.
If we study waiting times for non-elective surgery, we might find a different result.
To understand this, we’d have to know exactly what the elective procedures are. If you put me on a waiting list to get a mole removed from my back, I doubt I’d be willing to pay very much to cut the waiting time by a month either. On the other hand, my mother had a white cane and couldn’t watch her favorite TV programs and needed help to pay her bills and take care of her home. I’d say she would have paid quite a lot to get rid of that waiting time.
No doubt. In countries with a high degree of social planning, waiting lists are common. Hell, in the Soviet Union standing in queues was a way of life.
Let’s see how well that works out in New York.
“Do nothing and hope it gets better” does not sound like the basis of a high quality health care system to me. That’s pretty much what Henry VIII had.
But it does have the benefit of being cheap. I’m sure the bean counters love that form of ‘treatment’.
I answered it above. Several countries with waiting lists for critical surgery have found their survival rates plummeting.
Waiting for pain-relieving surgery is by definition reduced care. My grandmother spend years as an almost-cripple. Then she got her knee surgery and felt like a new woman. Unfortunately, she died of a stroke a couple of years after that. Those years she waited for surgery to enable her to walk again prevented her from doing the traveling she saved her entire life for, and then after the surgery she never got the chance. I’d say there was substantial social cost involved in that waiting list, wouldn’t you?
I’m not saying the current system is perfect. Far from it. I’m saying that when thinking about to fix it, be very careful about throwing away essential market mechanisms that effectively control supply and demand.
You know how many of these countries are doing it? By re-privatizing health care. Canada is looking more and more to private clinics and extra-fee services. In Britain, treatments like hip replacements are again privatized. Maybe the U.S. can learn from that and not get rid of the market in the first place. In other countries, co-pays and deductibles are being introduced to control demand. Which is pretty much what I advocated in my earlier message.
First, the point of discussing the uninsured with respect to wait times isn’t to discuss demand. It’s to suggest that we need to be adjusting the report to account for those uninsured, and any others who forego the surgery altogether because of the cost. If you have 100 people who need surgery, in a UHC country the breakout would be:
70 surgery right away / 30 surgery after 4 months
In the US, it’s:
80 surgery right away / 5 surgery after 4 months / 15 never get surgery at all
Comparing the first two numbers while ignoring the last number gives you a skewed view of the effectiveness of the health care system.
Second, WRT price vs. rationing. I think the value of “price” as a demand control is overstated in this market. The individual consumer sees very little of the real price, because he’s shielded by his insurance coverage. The insurance coverage is usually bought by the corporation, so the purchase decision is based on the cost of the coverage, not the cost of the healthcare itself. Those without coverage generally don’t do anything until it becomes a major health concern.
The decision to “purchase” healthcare, like a doctors visit, surgery, or prescription is not based so much on the real cost of those things, but the need. When people do price shop, and make decisions on the cost instead of the medical need, you get really bad shit happening*. When you have major health concerns, people with and without coverage just get what they need any way they can, there’s very little thought personally on how to get it cheaper. If it’s made available they take it, and deal with the cost later, either by paying it off and making themselves “health care poor” or just not paying at all.
My Grandmother-In-Law had her doctor change one of her medications because the old med wasn’t covered by her insurance and the new med would be. Her kidney failure and month long stay in the hospital recovering has sort of soured me on the idea that we should look to pricing** as a way to manage healthcare.
** I say this as a person who’s job title includes the word “Pricer”.
