Affordable catastrophic coverage usually goes with very high deductibles. So there are two problems:
What about the set of people who are going to face high healthcare costs before they get to save enough to pay the deductible - even with government help? Does the government make up the difference, or do they go bankrupt, just like today?
Your plan if very inefficient. In a good universal system, money is extracted to just cover the healthcare costs for this year. In your system, money gets locked up to cover possible costs in future years, and to be safe there has to be a cushion. Clearly this savings has to be safe and liquid, so you are looking at very low interest rates. This money can be better used for higher return investments.
Of course you still have the problem of self-rationing, where people may make poor long term decisions (not going for that checkup or to checkout some suspicious growth) to preserve their savings - decisions that might cost more in the long run.
It is health care providers, too, to the tune of about $4 billion.
But it is not a monetary cost, which is what we are talking about.
Well, potentially. However, things like vaccinations are available now paid for by the government, and the record of people taking advantage of it and thereby saving the taxpayer money is not particularly good (cite).
Biggest little word in the world - if.
I guess the bottom line for me is, if we are going to contain health care costs in the US, we need some form of rationing, either de facto or de jure. I have more faith in an insurance company to say, in essence, “no, your grandmother has to die in order to save money” than I do an elected official.
There are four situations in which money is spent -[ol][li]Spending your own money on yourself or your family. In that case, you want the best bargain you can find - the most value at the lowest cost.[]Spending your money on someone else. Then, you want the lowest cost, and quality is a secondary consideration.[]Spending someone else’s money on yourself. There you want the best, and damn the cost.[*]Spending someone else’s money on someone else. Then, who cares?[/ol]The taxpayer under UHC is in category 2. The consumer under UHC is in category 3. (This is the problem of the commons that comes up so often.) The politicians under UHC are in category 4. [/li]
UHC is a step to get health care as much away from category 1 as possible.
How Factual is this article? (Granted, the source isn’t exactly unbiased)
Basically, France, Great Britain, Germany, Canada, and our own VA system all offer better healthcare (less wait times, get to see the doctor more often), and spend less per capita than the rest of us.
If any of this is true, why wouldn’t any fiscal conservative prefer UHC over our current system?
This is how these discussions always go. Conservatives view with alarm UHC, and say that it will be horrible and expensive. People like you post data that says otherwise. They either ignore it or tell us that we’re so different from Canada and England that it doesn’t apply. Then they will say that UHC in these places rations care and give anecdotes about how their Aunt Petunia had to wait six months for her bunion to get fixed. Then Dopers who live in these places say that actually they don’t wait, it works very well, and they sure don’t want our system.
There - I’ll just post this at the beginning of every thread and we can all save a lot of effort.
But the real answer to your question is that if conservatives admitted that a government program could be more efficient than our private one, no matter how much evidence there is for it, their head would explode. Shodan would rather have a person working for a health insurance company, who gets a bonus for increasing its profit, decide on your care than someone working for the government, who has no incentive to reduce care, and is pushed by politicians who won’t want to get letters from constituents about how their children got turned away.
Yes. “if” we can manage to somewhat replicate any one of the dozens of currently operational UHCs that provide top notch health care for less cost, we’ll save money
“if” we’re too stupid to copy someone else’s effective health care system, then it will cost more.
BTW, feel free to let me know how to bargain hunt my health care. AFAIK, I’m stuck with whatever provider my employer gives me, at the price they’ve negotiated, and the doctors within their plan.
I suppose I could quit my job and only interview with companies that have the “right” health care provider (which ever one that is) and promise not to change providers next year.
Canada uses waiting lists (PDF) to avoid this problem. This is their form of de facto rationing.
Put it this way - if we implement UHC in America such that we will allocate no more, in total, than we are now spending, and further guarantee somehow that this total will not increase faster than general inflation - no matter what, we will not increase - then I might support it.
But demand for health care in the US is almost infinite. Surveys tend to find that people are, in general, satisfied with the quality of their own health care, but not that of others. So people are going to expect that UHC provides them with the same level of care. If we provide the same level of care to the currently uninsured, then it seems almost inescapable that costs will rise. Or we can spread the same amount of spending over more people, especially those who are currently uninsurable because of chronic conditions. Health care for those folks is going to cost more. So we have to shift even more spending away from those who are now receiving care and towards those who are not.
So we can spend more and cover everyone at the same level, or spend the same and cover everybody at a decreased level.
My preference would be to cover everyone at a decreased level.
One of the major causes of higher health care spending is that we spend a lot of money on patients in the last year of their lives (cite - PDF). Thus we could save money if we simply allowed people to die sooner. Again as mentioned, I have a great deal more confidence in an insurance bureaucrat saving money to say “No” than I do a politician who wants to be re-elected.
That’s a good start, though. It might be helpful to broaden the question a bit. Instead of asking if it will be cheaper, we should ask if it will be BETTER.
Better as defined by the economic surplus of the consumer, or utility - cost.
Cheaper doesn’t necessarily mean better, as you reference above. There is a cost to waiting. There is a cost to pain. There is a huge cost, of course, to somebody dying if they don’t get the treatment they need. There is also a cost to people not getting the treatment they want, even if others will claim they don’t need it.
None of these costs generally get counted, or counted correctly, in the arguments to UHC. The only cost that is estimated is the cost-of-operations of UHC itself.
Never said that. All of those things are only essential in the sense that we need some form of them to get by, but a free market generally supports us quite well is providing options and the ability to pick and choose what you like. For food, I can live on bread and water, however if I have the money and inclination I can afford lobster and caviar. For housing I can rent a cheap place or buy a big mansion, depending on my income. For cars I can buy an Aston Martin, a Lexus or a Honda. All of these options do the same thing for me in the end, I just choose the one I want based on what I can afford and would like to have.
For health care, I don’t have any choice. If I’m sick, I have to get treated. It’s not like I can shop around for different options when I have a brain tumor or heart cancer. Not, in any case, in the same way that I can shop around for cars or food. There are generally only a select few options I can go for with health care, and generally they come down to what a doctor or team of doctors thinks are my best chances of overcoming my illness. This simply doesn’t work in a capitalist system, and that’s why I’d rather have elected officials who are beholden to their constituents overseeing health care than private companies who are beholden to shareholders.
I hate to say it but cite? I see this all the time. Where has it been conclusively shown that on average the free market is always better than government oversight? I’m sure that for some areas this is true but I just can’t see it for others. Do you want the army to be privatized? Police? Fire fighters? Water and sewers?
You’ve said that a few times but I think you are arguing one side. That’s fine, just admit it.
I’d not given this too much thought. Mostly I figured that this would really only be an issue at the time of the switch, not for people who come up under it, so the gvt should probably step in there to make the switch smooth.
I’m not talking about going to BoA and opening up a savings account. But nevertheless the money needs to be safe, yes. As to how liquid it needs to be in practice, I’m not sure about that. It’s not a checking account, overall.
I haven’t come up with this proposal on my own, I read about it elsewhere and found it appealing. Thank you for this criticism. I will have to think about it.
This is not a “problem” I am particularly concerned with. People doing what they want with their own money is not something I usually consider a problem unless it gets pathalogical overall. People wasting their money is a fact of life.
Even assuming your assertion is correct and all UHC countries have better life expectancies than the US, there could be a variety of reasons for this. Better diet. Different life styles. Less violence. Genetics. Statistical anomaly due to some other factor.
I must disagree with you here, and some facts would seem to be at odds with your analysis:
According to OECD data, the United States spent $6,102 per capita on health care in 2004 — more than double the OECD average.
Why the difference? It’s not number of visits, or hospital stay times:
I had to go to a doctor in Italy once. The front desk called and made an appt. for the same afternoon. The doctor’s office had no receptionist; just him, a desk, and an examining room. I think I paid about $20 cash for the visit and that was that. Very little overhead. Compare that to the US where it is almost impossible not to have full time staff dealing with insurance payments.
As someone else mentioned, rationing is a given. In the US we ration by income level, I’d much rather ration by medical necessity. Wouldn’t you?
We’re spending more than anyone else, and the cost is going up faster than inflation now. If our free market worked as well as the claims, we wouldn’t be having this conversation. I believe that the free market is always the first and preferred solution to this kind of thing - but we need to be open to cases where it fails us, and not avoid corrections and improvements purely from ideology.
First, I have seen similar surveys, so I won’t ask you for a cite. But I have also seen surveys showing Americans are dissatisfied with our health care system. This is similar to the polls showing that most people are fed up with Congress, but think their Congressperson is just fine.
Second, you have an implied premise that our system is maximally efficient - not perfect, but better than alternatives. As has been mentioned a million times, early intervention under a UHC system can prevent expensive problems later - problems which we all pay for, one way or another. That is one method of savings. Second, we can get rid of the tremendous and inefficient health care bureaucracy. We’ve been through the size of this before. The real bottom line is that competitive analogs show that it is possible to get better outcomes for less money.
Consider the guy proposing a new product which is more expensive and less powerful than the competitors’ products. (Don’t laugh - I worked for AT&T and people did this all the time.) Any competent manager would tell this guy to go back and figure out how the competitors managed to do it better. That is what all these threads boil down to, really.
So we can spend more and cover everyone at the same level, or spend the same and cover everybody at a decreased level.
The current system isn’t working, is it? I do agree that this is a possible source of savings, but often we can’t tell for sure when the last year of someone’s life is. Still, this would be a great debate to have out in the open as a decision made by all of society, with the costs and benefits laid out. if we choose to spend a lot of money on this kind of thing, in a UHC system that money will come from taxpayers. That seems fair, since we all have the chance of being a beneficiary of it.
However, do you think an insurance company exec wants to be the target of news stories about how he didn’t pay so Granny died? If he knuckles under, secure that his competitors will, he’s going to be happy to have a good reason to raise his rates and thus his profits.
There certainly could be, however when most UHC countries have better life expectancy, better infant mortality and lower cost than us, I have no choice but to be skeptical of the right’s argument that UHC will increase our cost and reduce the quality of our healthcare.
Quoted for truth. The FACTS say that UHC countries have better health and lower costs. Simply waving your hands about and either ignoring the facts, or saying “but this would not work for the US” is unconvincing.
If a salesman called on you, and said though his product was rated by several rating agencies as being more expensive and poorer quality than others, it was still a good deal because the rankings were unfair and the nameplate was fancy, what would you say to him?
My daughter is in Germany for the year, and though she is still covered by mine, the German system is so inexpensive and simple that we paid for it instead of trying to figure out how to make my coverage work there. That’s the free market in action.
You were thinking of the average case. I deal with these distributions all the time, so I naturally think of the ends of the curve. The other end, those people who never get sick, would do fairly well under your system, since they get all their money back when they go on Medicare.
Actually, that is exactly the way to run it. I participate in a pre-tax health reimbursement account, where I put in money pre-tax and get it back when I spend my own money on healthcare - for things like co-pays and uncovered drugs. It comes with a debit card which you can use to buy the appropriate drugs. If you have a savings account, no matter where it is held, isn’t it better to give a card instead of filling out paperwork to get your money back?
The problem is that unless we let people with big problems die, it becomes all our problem. Nothing is going to force people to go to the doctor in a timely fashion, but we could at least eliminate money as an excuse. My insurance pays 100% for preventative treatment, so they clearly think paying more for this is a savings.
That’s an excellent point about correlation/causation.
End of life treatment, (or the lack of it ) doesn’t necessarily increase/decrease life expectancy. It might, however, affect their quality of life at the end.
It also raises a broader point. Populations are different. The demographics in Japan are much different than the US. I’m pretty sure, that Americans, for example, are much fatter than the rest of the world. Factors like this may play a bigger role in the costs of healthcare than the type of system we use.
If we have people who live unhealthy lifestyles, then we will spend more on healthcare, regardless of the system. The only way to decrease the unhealthy lifestyle cost is to forcibly change lifestyles, which is one of the slippery slopes of NHC.