This seems to me to be an argument in favor of increasing the supply of radiotherapy equipment rather than a criticism of UHC. For such a life-threatening condition as cancer, I think patients should pursue the best treatment immediately. If health care were not subsidized in some way, and the corresponding higher prices reduced demand for radiotherapy, then those who choose to get the therapy (because they can afford it) would not have to wait as long (in comparison the the current situation), but that would only be because some people wouldn’t choose to pursue radiotherapy immediately.
While I think wait times might be an effective way of rationing treatment for other, less serious conditions, I emphatically believe that cancer patients should receive the best treatment possible immediately. That is to say, if there are wait times for cancer treatment, I think it is an indictment of the current medical supply rather than of UHC itself.
I agree. Insurance is a service the public sector can provide at a lower cost than private companies. Since public insurance is universal, there is no need to prescreen or calculate risk. There are no dividends or shareholders to worry about which eliminates a major cost.
The only reason private health insurance companies have lasted this long is because they have the financial resources and political clout to hinder any effort for a public universal system.
Why? Private insurance isn’t efficient or cost effective. The government has to subsidize the cost of private health insurance so employers can offer it to workers.
The larger U.S. population should be a cost advantage for a public insurance pool.
I think this is the one point Sam Stone is missing (and to answer one of your questions, Sam, I don’t think free repairs would change the level of maintenance people give their cars because having your vehicle break down is a pain in the ass, especially if you rely on having your own transportation. Cost and quality are already issues in the free market approach.) Demand for healthcare isn’t affected nearly as much by cost as it is by a person’s health–a diabetic isn’t going to stop buying insulin just because the price goes up, because for them it’s a necessity to maintain a reasonable quality of life. If that person is only covered in the event of a catastrophe, then by the time they can get care their ability to take care of themselves and be a productive member of society may already be permanently hampered.
Health is a permanent maintenance program, if done right. Society does not benefit from only taking care of the worst case scenario–we’re all better off by preventing it from happening in the first place, both in terms of societal costs and monetary costs.
That first link is a great tool, Annie, thanks. What I see when reading it is that, with the exception of Switzerland, every one of these countries exhibits one or more of the concerns expressed by myself and others in this thread as a large challenge at this time.
Emphasis added. Switzerland has it’s own special problem:
That is, in Switzerland the very people who can least afford it pay the most to get it, just like in the United States.
How is the US going to avoid these problems with a big bang start-up of UHC when countries that have been practicing and perfecting the system for years can’t?
No, they pay a higher percentage of their income… just as they do for milk and eggs.
If I earn $500/week I spend a high percentage of my income on everything compared to someone earning $1000/week.
In a national system, everyone would pay the same (perhaps tiered by age). We wouldn’t have nearly 50 million people without insurance. Surely these 50 million people are not all living in poverty.
Then why aren’t they paying for insurance? It doesn’t go both ways. One the one hand, they’re too poor to afford it, on the other hand they’re not. Which is it?
And you’re right, the very people who can least afford it are paying more proportionally than those who can. Even so, they’re paying more than the folks in the other socialized medicine countries - enough so that it is a burden on the middle and lower classes.
In my case, and that of several friends, I am very much above the poverty line, but have a pre-existing condition that makes me uninsurable at any price… the insurers consider me an automatic decline.
Group plans are a matter of money in some cases. Because my company only employs 2 people in my state, the quoted costs for group plans have been in the area of $3,000 per employee per month. What couple can afford $72,000 per year for insurance?
The only one of these problems the US doesn’t already have is the aging population one, thanks to immigration. Medicare is an issue because of the steadily increasing costs. I don’t see not paying for cosmetic surgery and ineffective techniques as a problem myself. Nurse do a lot more than they used to, which makes sense, since you should always use the least expensive resource who can do the job.
Actually, your list demonstrates that government systems are as concerned with increasing efficiency as private ones, which is heartening.
I used to vote, but am always outvoted by people that are either believing the lies, voting with their emotions and/or are just completely without a clue. Such as the folks that voted yes on Prop 8 because they were lied to about how it would affect their children.
Private insurance stratifies people into risk classes to determine the cost of premiums. Insurance companies succeed by excluding the riskiest people, and for private health insurance risk is sick people. A universal health system doesn’t exclude people; therefore, private and universal insurance have fundamentally different goals. I am not sure why screening to calculate individual risk is the best way to determine cost for a universal system. But I do agree evaluating and controlling cost is important. It makes sense to identify groups with a higher risk for preventable illnesses and focus on eliminating the conditions or risks linked to those illnesses.
I think it is counterintuitive to pay for a profit driven health care system that strives to deny care and exclude the sick.
Despite the myth spread by the media’s corporate shills and shock jocks, it seems to me that the Right is making this into a class issue not progressives. There is no defense for the 17% tax rate paid by the richest Americans compared to the 25-30% tax rate paid by people earning astronomically less. No one wants to rip off the rich or make them pay more than their fair share of taxes.
People have legitimate concerns and fears about UHC. The universal models used in other developed countries are not free of problems, but if you compare cost, quality of care, life expectancy, infant mortality, and other indicators, the U.S. health care system ranks last. Something has to be done because the cost is unsustainable and without reform, the U.S. health care system will collapse.
Several people in this thread seem to be ignoring the frequently cited evidence that our current health care system is the one ripping us off. And, so far, none of them have provided an ounce of support for their claim that it would cost the average family more than the current system. Mostly, the counter-argument has consisted of putting their fingers in their ears and going “Na na na na na! Can’t hear you!”
C’mon, if even Sam Stone thinks the current system is bilking us (and I’ve always thought Sam was pretty pro-market) then it must mean the data is at least against the current system, if not necessarily supportive of a NHS.
If you’re going to continue the argument that funding an overhaul of the health care system is more expensive and more of a rip off than the current system, then you need to provide something to back your claims up.
Then let’s look at some data that suggests it’ll cost a little more than you think:
Massachusetts discovered that subsidizing the uninsured cost roughly twice the initial estimates.
Pennsylvania has shown that it’s obviously not as simple as some would think. The plan there isn’t even universal, though it does make a point of taxing small business owners that don’t offer insurance 3% more. The politicians call it a “fair share assessment” but that seems like a fancy euphemism for “penalty”.
Wisconsin recently scrapped a univeral health care proposal that would have cost $3 billion more than the state collects in taxes each year, despite the introduction of an additonal 14.5% employment tax, as well as “1.25 a pack increase in the cigarette tax, a 10% hike in the corporate tax, and new fees on cars, trucks, hospitals, real estate transactions, oil companies and dry cleaners.”
So there’s three examples of an attempt at some sort of universal care, that didn’t work, didn’t save money, and cost people more money through additonal taxes. More importantly, I’m not pointing at some system in another country, but rather the systems that have been tried in America.
Please point to the UK and tell me again how much better it is because it’s cheaper. That’s because the UK doesn’t develop new drugs, instead it pay for those it decides are cheap enough, and fucks over people who need drugs not on the approved list. I know the counter point will be something like “the insurance companies do that tooooooooo!” True, it happens, but if my insurance company doesn’t pay, I have the option of being willing to pay for it on my own. In the UK, it would mean that I’d get to pay for that, plus the rest of my care for the rest of my life.
That’s okay though, because I’m getting better care for less money, right? Wrong. In 2005 the UK maximum wait of 6 months for elective surgery was redefined to become the minimum. 13 weeks max for other surgeries became the minimum at the same time, to save money. By contrast, when I had my gall bladder electively removed in the U.S. last year, I made the appointment on a Monday and had surgery the following Friday.
Lastly, the comparison between Medicare overhead costs and insurance company overhead costs aren’t as accurate or simple at the folks who have repeatedly recited them. The “3%” overhead is hugely understated(PDF), because it does not take into account the cost required to collect the revenue, the cost to comply with Medicare regulations, the cost of buildings and salaries of some employees. Some have even contended that Medicare doesn’t spend enough. In 2001 the Government Accountability Office found (PDF) that the Medicare establishment had the second lowest rated efficiency, management criteria, and accountability among the agencies surveyed.
So what is your suggestion? How do we insure the 50 million people that don’t have it?
The unemployment rate in my county is 11%, most of these people do not have insurance as there is no option for COBRA when the company you were working for goes under.
There is talk now of one of the hospitals closing too.
For starters, we don’t do it right now. We’re going to need to see the effect of the bail out and stimulus packages and determine whether we have a viable economy. We’re already putting the bill on the credit card, and it’s crazy to add to that debt until the economy stabilizes. While we wait for that, we can prepare.
Every single proposal for UHC talks about how costs will have to be controlled. Cost reduction is a central plank in the UHC platform, yet nobody talks about how to reduce those costs beyond vague representations that we’ll save money on administration costs. Try getting the small programs (Medicaid, Medicare, etc.) functioning efficiently and at less cost. If part of the staggering health care cost is, as has been stated, largely due to differing forms, methods of recording data, etc. require a standard and see if that reduces costs and work from there. Invest in the equipment that is in short supply and so expensive to use to reduce the costs of testing. In other words, instead of proposing legislation based on shaky ass theories of finance, work to drive health care costs into the reach of more people, and then see what can be done to help the rest - at less cost.
Instead, the pro-UHC folks seem to want to throw the system in place and see what happens. That’s a major problem for three reasons. First, if it does cost more it’s going to drive taxes ever higher, and not just on the rich. That pool of money is only so big, and as great as the rhetoric sounds about taxing the evil rich folks, that pool will empty. When it does, the additional burden will slide right down the scale to the rest of us. Remember, one state that implemented UHC discovered that the cost was double the initial projections. Do we want to find that out nationwide in a couple of years?
Secondly, if the plan is plopped into place wholesale there is no way back, and I suspect we may want one if costs are not addressed prior to putting the plan into place. There is no politician in America that will stand up and say, “sorry folks, we managed to screw this up, and we’ll killing the program.” That’s one of the reason Medicare has been able to waste its way along for so long. I’ve heard about “reducing the costs of Medicare” for as long as I can remember, but it hasn’t been done. Let’s prove that we can do that before risking our entire health care system. If we don’t, is there any reason to believe we’ll do it after?
Third, we would throw away the chance for a reorganization of health care in this country that is well planned, well thought out, and implemented in pieces in order to ensure we’re doing it right. I’m not against health care for all, forever, I’m just against tossing a shitload of money at this problem and seeing what sticks. We’ve done that twice in the past 6 months, even if you don’t count the automakers. What do we have to show for it? If you want UHC, make sure it is the cheaper, better, more efficient system you claim it is. THEN put it in place.
I hope I see it come soon… in the not-too-distant future, I may lose my foreign residency status. Then I choose between being an illegal alien with affordable health care or moving back to America with none. Being illegal sounds ok I think. Personally, I think the big push for UHC will come as the unemployment rates starts hitting 20% in places. When the number of uninsured hits 100 million, some action will get taken… although we will be in a serious depression by then.
welby, these plans aren’t examples of public universal health care. This is the type of universal care private insurance would like implemented. Subsidizing the cost of private insurance is the most expensive, inefficient solution. The federal government already subsidizes employer provided private insurance. There is no reason to publicly fund a failing system that pays multimillion dollar salaries to executives for maximizing profits. Private insurance companies also have added administrative costs for reviewing claims, denying payment, and harassing doctors.
The government can pay civil servant salaries for administrative work and eliminate unnecessary paper pushing.
Medicare is not a good plan to use for evaluating cost, either. This is a plan for the elderly, a population that needs and uses the most health care. Furthermore, Medicare has the added cost of Bush’s publicly funded giveaway to the pharmaceutical industry.
Bush, or maybe the pharmaceutical industry, designed a prescription drug plan that increased cost for seniors and profits for pharmaceuticals by allowing the drug companies set price. Bush didn’t even negotiate market price for drugs. All of the universal health care systems in other countries negotiate drug prices. It’s what insurance companies do. It’s what any smart business does.
Finally, Bush took a government program for seniors and turned it into a poorly designed, complicate, partially privatized, mess. Most of the Medicare plans offered are managed by private insurers and there has been documented fraud and misuse of public funds at the expense of seniors.
UHC can be as expensive or as inexpensive as we like, so it’s impossible to answer the question. The more we budget for it, the more and better services it can provide. For those countries with UHC where people are pointing out long waiting periods and less amounts of MRIs per population, that situation is a result of budgeting less overall money per capita than insured people in our country get. If those UHC countries budgeted the same amount per capita, they too would have no queues and more MRIs.