Having been on here for a long time, I don't remember seeing any actual posts on universal healtcare, I even did a basic search just in case I had possibly completely missed it.
I was curious what everybody thinks about having some sort of universal healthcare system be it for all people, or for unemployed, or for minors (such as the system Vermont has).
As I've seen it, the basic argument against having a universal healthcare system is that "It won't work" as people point to Canada...which...I actually see as not too bad of a system. The second argument against having a universal healthcare system lowers the general quality of the medical infrastructure, yet again, pointing at Canada, and many say that "Ours works just fine."
Before I go on, I'll have to say that I am for some sort of change in the health care system, I think anybody that says our Healthcare system "works just fine" has either a) been living a sheltered life, b) is completely ignorant or c) a combination of the two. Our health care system leaves almost all temp/seasonal workers uninsured as well as the vast majority of small business owners (for example, my father being the 'owner' of our farm does not have the money to insure himself or me, in which we've been pretty much uninsured since 1993, while my uncle, who is an 'employee' of the farm has insurance for himself and his family which is mostly paid by my father).
My question is what is everyone's take on healthcare, should we or should we not do something to attempt to reform at least parts of our healthcare system to at least better protect minors, or perhaps adopt something close to an already working system such as the one in Canada, or one of the European nations? Satyagraha
Posted by imogen (Member # 5485) on :
Or Australia's... actually, you'd be better to copy our medicare system from the 1980s - it's been hacked up a bit in recent years.
[random aside] I found out recently that France, along with some other European nations, offers a reciprocal medicare system with Australia - so if I go over there and need hospital care all I have to do is show my medicare card, and it's all free! Pity I found this out *after* I broke my arm... [/random aside]
I do think America needs universal healthcare. The cost of your hospital system is absolutely astounding to anyone coming from a standpoint of universal, or subsidised healthcare. My little sister fell over at Disneyland a couple of years ago and needed 10 stitches. They cost A$1000 - $100 a stitch! And this was including the hefty discount the hospital gave us because my mother is a doctor.
This compares to the French system: 2 months ago I had 5 x-rays, an emergency consultation and a plaster cast - for 56 euros. And it was fast, efficient and very friendly.
Posted by Frisco (Member # 3765) on :
Instead of universal health care, I think people should realize that they shouldn't rely on other people to bail them out and start saving for emergencies.
Children should be an exception. I applaud Vermont's system.
I would agree with a voluntary tax for health care, though. If you pay it, you should reap the benefits. I'd agree even more wholeheartedly if the tax were stored in a personal account so as to prevent abuse of the system.
Posted by Richard Berg (Member # 133) on :
There are several improvements to be made to the current system first:
Divorce health insurance from job status. People will naturally want to bargain collectively with insurance providers using the same economic power currently afforded large employers, perhaps even leveraging the favorable statistics of their position. Thankfully, the banking industry already solved this problem; it's called a credit union.
Raise deductibles significantly. You don't make an insurance claim when you change your oil, nor should you when you get an ear infection. Insurance is to ensure against unsustainably large losses. Use it as such and watch premiums drop through the floor.
Standardize claims systems, preferably electronically. Doctors shouldn't be spending 2+ days a week cooped their office. Medicare/caid, that means you too.
Cap noneconomic damages sanely. This is already being done, with dramatic improvements in malpractice insurance.
Enforce government intellectual property developments. Billions of dollars in research is financed by the taxpayer which lead to billion-dollar patents held by private companies. Either cut off NIH funding to drug-related research, or pursue such grants much more vigorously and with applied techniques so as to produce potential reagents that would lie in the public domain.
Etc. etc. etc.
Tidbit for conservatives who don't want to pay for poor people's healthcare: you already are. Overpaying, even. To wit: hospitals are required to treat patients in need of acute care regardless of their ability to pay. These costs get rolled into every visit you make, and probably not distributed nearly as nicely as they would be through the tax system. Moreover, by only treating immediate symptoms, this method ignores the benefit of preventative medicine that would curtail future losses dramatically. Oops.
Posted by HollowEarth (Member # 2586) on :
Modification to the system yes, wholescale conversion to a government run socialized system, no.
You don't see people flocking to places with socialized medicine for their medical care, do you? You don't see americans waiting for needed but elective surgery do you?
Posted by AvidReader (Member # 6007) on :
Many of the Fortune 500 companies no longer pay for health insurance, they pay for health care. They found they were paying more for insurance than the actual medical bills. The insurance company was only retained to file the paperwork.
The big push for a national health care plan in Congress is not actually to help the poor. It's to help the big corporations who are paying lots of money and would like to stop.
There are two problems with universal health care. One, there must be a larger number of workers than retirees. I believe the Swiss are the ones who currently have problams in this area. With the Baby Boomers set to retire and the birth rate down, this could be a problem. The second is emergency services take up so much time, elective surgeries have a low priority. That's why many Canadians and Europeans come to America and pay for it. It's quicker and easier.
The problem with insurance is it's cold. People who work and make a decent wage can afford it. Everyone else just has to suffer. Some kids can go to the doctor and get checkups several times a year. Other kids suffer with minor ailments until they have to go to the emergency room.
So is it better for some people to have wonderful healthcare while many people have almost none? Or is it better to give everyone inadequate healthcare all the time so everyone is equal? Sounds like the proverbial rock and a hard place to me.
We might be able to do universal care for the basics with insurance covering everything else, but that leaves us only slightly better off than we are now and paying a lot more to boot.
Posted by Synesthesia (Member # 4774) on :
I have no healthcare whatsoever and it frightens me. My job would provide it if I worked there for 3 years, but I really don't want to work there for 3 years. We nearly went on strike because they wanted to take 40 bucks a week out of our checks for it. Out of a 98 dollar check. So getting seriously ill scares me. I still have a bill hanging over my head from when I passed out and had to go to the emergency room and get charged 200 dollars just to be told it was just a cold! Posted by mackillian (Member # 586) on :
I currently have health insurance that covers maintenance for my chronic illness. I do pay a deductible for treatment at the beginning of each yet. This treatment allows me to stay out of the hospital and work and contribute to society successfully. If I lost my insurance coverage, I would also lose my current fuctioning health level.
Universal health care would remove the specter hanging over people of losing maintenance treatment for chronic illnesses. These people aren't hangers on looking for other people to pay their way. They often DO save for payment of treatment. I have a bank account set aside for only my medication and medical appointments. I pay a lot, nearing $200 per month on medical expenses. Were I to pay full cost of my medications, each would be at least $100/month. The idea that my push for universal health care is that I want others to take up my expenses is insulting. It isn't like I purposely got my illness. But if I had to pay for my medical expenses without insurance I would break even because I make $25,000/year and work in a health care field.
Posted by matt (Member # 236) on :
HollowEarth, you're right, we do have less waiting periods here in the U.S. than in Canada...however, the author of this article makes an interesting observation at the end: "To the multitudes of uninsured individuals in the United States, waiting for first-rate care is better than no care at all."
I don't know where I stand on this issue. I do agree with the point, previously made, that the government should be more proprietary of research results in order to get some money back when results of its studies are used to pad the pocketsof pharmaceutical companies. That said, I wouldn't want to stifle reseearch into new and better treatments, which that _may_ do. I feel that universal healthcare _should_ be a priority here (I know folks say people shouldn't depend on others to "bail them out", but I also feel it's unethical to have a treatment for a condition and to have to withhold it only b/c someone is unable to pay for it.) What I don't know is, how would we pay for a change of that magnitude?
Posted by Synesthesia (Member # 4774) on :
And how can a person save money for healthcare when they HAVE no money? When they live paycheck to paycheck? A lot of people simply don't realize how many Americans work 1 or 2 jobs and still can't make ends meet.
Posted by matt (Member # 236) on :
Oh, and mack makes another good point to my argument against saying we are "bailing people out" by providing universal insurance...where _would_ people with chronic conditions fit in? It's not possible for them to cover all costs associated with care in many cases, so what would you have us do in those cases? Frisco, the voluntary tax you mention, how would you set that up? If you just mean a tax-deferred savings account that could only be applied to medical expenses, those already exist (and are a great idea, but you still bump up against people being unable to save that much money.)
Posted by mackillian (Member # 586) on :
I think Richard Berg has it right. I didn't read everything else here yet. But I had this thought about how we could do a national test case of whether this would work.
As those of you who work for small businesses know, your health insurance costs more and covers less than what is offered to employees of large companies. That's if you actually HAVE company-sponsored health insurance. The insurance industry says this is because their risk is spread over a larger pool of people.
Granted.
Now, let's set up a giant insurance pool for all small businesses. Theoretically, if there was a nationwide pool for small businesses to join, their insurance costs would be lower than the best rates given to the biggest firms. In fact, we could simply negotiate that or go with different providers.
This would also have the salutatory effect of goosing in the economy a bit because most new job creation in every recovery comes from small businesses.
The only downside is for the insurance industry itself because it wouldn't be able to charge the outrageously large premiums it currently does.
But this might be made up in larger numbers of insureds overall since many business that can't afford insurance now would become part of this pool.
If it works here, maybe we could find a way to offer the same lowered premiums to unemployed persons or have their coverage paid for by the state as part of welfare or something?
Also, Richard is right that we should have catastrophic coverage and long-term care coverage (including meds). We shouldn't have coverage for stuff like the flu or ear infections. If they get out of hand, that's a different story.
But just getting blood tests currently costs $151. My insurance actually disallows about 1/2 of that. If I had to pay it myself, I'd end up getting charged the full amount, I bet.
So, we need some sort of "reasonable and customary" fee structure in place too so that people aren't gouged for the things they need routinely.
Posted by mackillian (Member # 586) on :
We'd also have to put caps on awards in malpractice suits. Doctor are often put in situations where the amount they pay out in liability insurance premiums can be more than their earned income.
Posted by matt (Member # 236) on :
by caps on rewards, you do mean caps on punitive damages, right? Too many times I see people arguing "Oh, it's not fair to cap such-and-such's damages at $x because their medical bills were $x+y." They don't seem to understand that (as I understand it) the push to limit damages is a push to cap punitive damages, but to leave non-punitive damages (which would cover any costs incurred as a result of negligence/malpractice) uncapped.
Posted by mackillian (Member # 586) on :
Yup.
Posted by Bob_Scopatz (Member # 1227) on :
I totally agree, just so long as the law also sets limits on Dr.'s insurance premiums that can only be exceeded for selected "high risk" physicians (i.e., those with too many claims proven against them).
Florida's legislature was all set to pass punitive damage caps and the insurance industry said "that's nice, but we're not lowering premiums."
I think the two have to go hand in hand.
Posted by Miro (Member # 1178) on :
I saw this thread and handed the computer (a laptop) over to my mom. She's been working on this stuff for years. She thinks the discussion is great.
If you're interested, check out her reports: www.iom.edu/uninsured Posted by ak (Member # 90) on :
I say if we can't afford health care in this country then we certainly can't afford government healthcare! Seriously, any time you try to go to the government, or any government sanctioned monopoly, for anything at all, it's a wasteful, time consuming, hair pulling nightmare. Just imagine what health care would be like!
There are 2 places people can go here in town to get government health care. Cooper Green hospital, and the VA (for veterans). Both of them are completely dreadful. Seriously, nobody would go to either if they had any alternative.
So, should my tax bill be raised by a huge amount so that I can have that? No, thanks!
I really think my vet is wonderful. I would so go to him if he were able to treat people. I think we'd get better healthcare in this country if we moved toward LESS insurance, managed care, etc. and back towards just paying directly for things ourselves. I understand that can't be possible for things like heart surgeries or whatever but it does seem like my cats get better medical care for far less money than my dad did, for instance.
Posted by fugu13 (Member # 2859) on :
Considering there are plenty of countries where government sponsored healthcare doesn' equal hideous inefficiency, I think your position is untenable.
Furthermore, I find this idea that what government waste does exist is so different from business waste amusing. Businesses have a long history of excesses as well, and I'm not just referring to the dot com boom, which involved orders of magnitude of waste more than the government.
Posted by ak (Member # 90) on :
Talking to people in countries where they have government sponsored health care leads me to the opposite conclusion. There are long waiting lists for needed surgeries, etc. Many people end up going to private healthcare instead. So they pay twice. It's a very bad idea, I think. The health care system in the U.S. is bad and getting worse all the time, but it's still far superior to government healthcare.
Posted by pooka (Member # 5003) on :
Utah is supposed to have coverage for all children. But we fall between the cracks of not making enough for this but too much for that.
I think the system in Canada is more like the school system in America. There is free public education, and it works for a lot of people, but if you are well off enough to go private I don't see why you need your tax money back.
[ February 21, 2004, 03:25 PM: Message edited by: pooka ]
Posted by Robespierre (Member # 5779) on :
quote: Businesses have a long history of excesses as well, and I'm not just referring to the dot com boom, which involved orders of magnitude of waste more than the government.
And what happened to those businesses? A good many of them are now no longer IN business. The private sector has an incentive to not waste, the feds do not.
Posted by fugu13 (Member # 2859) on :
Government has no incentive not to waste? Inter-department competition and public oversight certainly are incentives not to waste; there have been numerous instances of public officials brought up on criminal charges for siphoning money, for instance.
Also, there are plenty of businesses which waste that stay in business for a long time. All that's required is that the waste be less than the amount required for market entry and it be a constant across the market they're in (pretty common, as the waste is often for perks to executives), and they're still more efficient than incoming competitors. There is no incentive not to waste in general, only to avoid so much waste that your competitor will out compete you -- and if you personally benefit from the waste in the industry, there's no reason to cut it. When collusion benefits all the actual people making the decisions, it doesn't matter if its to the detriment of the fictional people (corporations) and those they stand for.
Posted by Robespierre (Member # 5779) on :
quote: Also, there are plenty of businesses which waste that stay in business for a long time.
And since they are not spending my money, this is not my business.
Posted by Annie (Member # 295) on :
It's nice to think that we'd get better care if we payed for everything ourselves, but the fact is that there will always be people who can't afford it.
My mom hasn't been to a dentist in over 20 years. She simply can't afford to pay for a visit and in the job's she's had, dental insurance is always considered a luxury. That's ridiculous. My siblings don't get regular checkups or physicals. And we're not that bad off compared to a lot of American families.
When corporations can get by with giving people 39 hours of work a week so they don't have to get benefits, when a mere checkup is $40 to $50, when a mother can't go to the dentist because all her spare income goes to keeping her children healthy, we know our system is broken.
I don't care that the rich in this country have access to "first-rate" and prompt health care - there are far too many who have to choose between living with an abcessed tooth and not being able to pay rent.
Our country ranks 44th in the world for access to healthcare. That is unacceptable.
I'm willing to wait for non-urgent procedures to see that everyone has the right to see a doctor. If I need to accept "second-rate" service so the children of an unemployed family can as well, sign me up.
Posted by BYuCnslr (Member # 1857) on :
quote:There are long waiting lists for needed surgeries, etc
The same thing could be said for waiting lists in the United States. Satyagraha
Posted by Robespierre (Member # 5779) on :
quote: I'm willing to wait for non-urgent procedures to see that everyone has the right to see a doctor. If I need to accept "second-rate" service so the children of an unemployed family can as well, sign me up.
You are welcome to accept whatever kind of service you like. When you advocate government forced healthcare, you remove any choice in the matter. You are making everyone pay, whether they choose to or not. This is not something that the Federal Government is allowed to do.
Which is worse, people paying for their own health care, even if this means some will go without, or more government oppression, and a destruction of the private sector drug industry in this country? Will you be one of the many that will demand that the flow of bio-tech jobs over-seas be stopped?
Posted by Annie (Member # 295) on :
How is this any different from "forcing" people to pay for public education, or national parks, or paved roads, or nuclear missiles, or missions to Mars, or....?
Posted by matt (Member # 236) on :
quote:The same thing could be said for waiting lists in the United States
I don't believe that's not entirely true, or at least not in the same context. If you look into it, you'll see that there is definitely more of a tendancy in most countries with socialized medicine to have longer waiting lists for procedures than in the U.S. You also can't say that
quote:I'm willing to wait for non-urgent procedures to see that everyone has the right to see a doctor
, b/c then it becomes an argument of what do you consider non-urgent. Many people go on waiting lists of several months in other countries for procedures that can be performed within a day or two here, and are considered at least somewhat urgent.
You certainly can point out that there are waiting lists for many procedures in the states; however, many of them have to do with availability of things like organs for transplant, more than with any economic policies. (Unless you consider making it illegal for people to sell their organs an "economic policy", I guess. But that's a whole other debate.) I'm still all for universal healthcare in some form, but unless someone comes up with a way to substantially improve upon other countries' models, I take it for granted that that would mean longer waits for many consultations/procedures.
Posted by Bob_Scopatz (Member # 1227) on :
good point.
There's a fairly good argument to be made for providing basic health care to ALL just so that we don't have a local ready pool of disease vectors in our midst. How's that for liberal, humanitarian, etc...?
BUT...let's get real here. For a business to operate in a healthcare environment it HAS to make a profit. That means it has to charge MORE for the services than it pays. If it is a publicly traded company, it is also expected to INCREASE its profits annually, without interruption, or its stock tanks and the company is in trouble.
You might believe that this market-based system is ideal in that it would force health-care providers to be lean and efficient. And you would be right if it also meant that they were unable to cheat.
The fact that cheating is easier than making things work right introduces a whole new wrinkle to this debate. I think it is important, when you consider the costs of a privatized healthcare system (as we already have and it is demonstrably failing...) that you also consider the costs of monitoring it, prosecuting the offenders, and finding ways to ensure that everyone is getting the care they are supposed to have, not the care that will look good on a balance sheet.
And essentially, it forces me to look elsewhere for a solution.
In fact, universal healthcare is precisely the kind of thing that government SHOULD be doing.
Could it be better run than the VA hospitals? I bet it could. Of course, it should also be said that there are some wonderful VA hospitals out there. And it should be said that VA hospital funding was, for many years, set at a fraction of what an equivalent private hospital's funding would've been. In effect, VA hospitals ran more efficiently and gave better care, right up to the point where the system started collapsing from underfunding and neglect.
Now it's bouncing back.
State and county health facilities are another matter altogether. Just remember when you walk through the doors of a county hospital that they are the only places left that are truly obliged to treat all comers, regardless of ability to pay. The private hospitals that give so much better care are able to do so because they have found ways to shunt the indigent out of their facilities. The lone exception is trauma cases, and even that is "managed" away from the private, for profit hospitals if they can get away with it -- happens in areas where there's no trauma protocol in place -- large swaths of the country, by the way.
Posted by Robespierre (Member # 5779) on :
quote: How is this any different from "forcing" people to pay for public education, or national parks, or paved roads, or nuclear missiles, or missions to Mars, or....?
Excluding nuclear missles, I see no difference at all.
Posted by Robespierre (Member # 5779) on :
quote: privatized healthcare system (as we already have and it is demonstrably failing...)
A better term would be "highly regulated healthcare system."
quote: Could it be better run than the VA hospitals? I bet it could.
What makes you think the feds would get it right?
quote: The private hospitals that give so much better care are able to do so because they have found ways to shunt the indigent out of their facilities.
Market driven innovation cannot be substituted for. Among many things, the Soviet Union taught us that. State run industries fail to innovate on any useful scale.
Posted by Xaposert (Member # 1612) on :
I think universal health insurance coverage is one of those things that there really isn't any good argument against, but people nevertheless oppose it because it's different from the way we have done things in the past. It sounds kinda like socialism and socialism is supposed to be bad, so we shouldn't have it. Or it sounds like an expansion of the government beaurocracy, so we shouldn't do it. That's the idea - but I don't see much evidence to support it.
Universal health insurance is no more socialistic than public schools, police, the postal service, or government-maintained roads. There is a reason why certain industries are run by government monopolies: Often because it's far more efficient to do so, as in the case of roads, or the postal service, or police. In the case of the police, dividing resources between a bunch of competing police agencies is only going to decrease the effectiveness of the police, and waste those resources. Some innovation might result from the competition, but the downsides of competition far outweight the benefits in those instances.
Universal healthcare is pretty similar. People tend to think one big beaurocracy is inefficient, but in doing so they forget why beaurocracies were created in the first place and are adopted in almost all major organizations. While they are wasteful, they are far LESS wasteful than total disorganization. In this case, the system now is a bunch of individual units trying to do the same things without any organization or uniformity. Placing them all into one beaurocracy is a bit like combining a bunch of police stations into one combined force - it's going to allow the same resources to go a lot further. Or, in other words, it's going to get you more healthcare for less money.
This is the single-payer system I'm talking about, mind you. Having the government control ALL aspects of health care would be a different matter. There's a certain amount of innovation that's necessary on the actual provider end of the matter - making competition a necessity. But as far as paying the bill goes, there is a lot less benefit to competition between insurance companies.
Posted by Bob_Scopatz (Member # 1227) on :
quote:Market driven innovation cannot be substituted for. Among many things, the Soviet Union taught us that. State run industries fail to innovate on any useful scale.
Ugh...And Enron taught us nothing?
Please! Market-driven anything only works well if the players aren't cheating. If you remove the incentives favoring cheating, then you no-longer have pure market-driven anything.
The Soviet Union failed for lots of reasons, not a lack of innovation. Just consider: 1) Their space program was every bit as good as ours, if not better in some respects. 2) They had nukes that could kill us just as many times over as ours could kill them. 3) They actually kept the peace in Bosnia 4) Cuba's literacy rate is higher than the US' 5) The infant mortality rate was lower in the Soviet Union than it currently is in any of the remnants. Cuba's is very low...
Now, I'm not saying that I want to live under a Soviet-style system. It was very corrupt and dissent wasn't tolerated.
But frankly, I think the luster of supply-side capitalism has been extremely tarnished of late and American-style capitalism has shown itself to be: 1) Hard to implement elsewhere. 2) Not nearly as self-correcting as it's boosters would have us believe. 3) not exactly loyal to America. 4) Filled with corruption (Boeing, Enron, Merrill Lynch...) 5) Prone to boom and bust cycles.
I'm imagining call centers in India fielding medical questions from "subscribers" in the US. I see a reluctance to order tests or procedures. And I see allocation of resources based on perceived "worth" of the patient. Elderly, disabled and low income are going to get different levels of care (lower) than everyone else.
How can I know that?
Look at HMOs and multiply.
Posted by Bob_Scopatz (Member # 1227) on :
Mark this...
I predict that if we go the privatization route to achieve nationwide health care/coverage, the country will legalize euthanasia within 5 years.
Posted by Richard Berg (Member # 133) on :
But we don't have vertically integrated schools or police. In fact, the best-performing school districts are usually the smallest.
Don't get me wrong, I think *more* national monopolies would be nice in some cases. The postal system's architecture makes sense because the underlying task (national distribution) can't be split up, save for the "last mile" (which *is* handled independently). Natural monopolies arise horizontally, too: each house is never going to have more than one coaxial, copper, gas, and power line, so giving companies "ownership" of it is pretty silly. (The /content/ offered over each is another matter, of course).
But with healthcare, I think the power structures need to be broken down further than they are, not the other way around. Nurses and pharmacists should be able to prescribe drugs and run tests independently. The cost/benefit of funnelling every single case through an M.D. just doesn't add up. Patients should be able to shop for services by price, location, and customer reviews in minutes instead of weeks; the technology is more than available, as anyone buying a motherboard can tell you. (While you're at it, ask the Taiwanese what such competition does for price pressures, and Newegg about the paramount importance of customer service when margins get universally low.) We should see little talking geckos during every ad break preaching the gospel of lower premiums.
Edit: that was for Xaposert, discussing the general landscape of things. Does government fit in somewhere? Sure. As noted in my first post, it's more efficient to ensure the welfare of the bottom tier up front than to play catch-up later. But top-down monopoly? I don't think so.
quote:I predict that if we go the privatization route to achieve nationwide health care/coverage, the country will legalize euthanasia within 5 years.
I see what you mean, and agree with the underlying sentiment. Without going too OT, though: does assisted suicide really deserve to be over the line? (I'm talking about notarized waivers and such, not "oops, I gave him the red pill today.") If my permanent outlook were reduced to eating through a tube while watching reality TV, I know I'd be first on the list.
[ February 22, 2004, 01:15 AM: Message edited by: Richard Berg ]
Posted by Robespierre (Member # 5779) on :
quote: Ugh...And Enron taught us nothing?
Apparently so. The lesson to take from Enron is that if you try to cheat, you only end up failing, as Enron did.
quote: Market-driven anything only works well if the players aren't cheating.
So in a non-market economy no one would cheat, right? Since there would be nothing to gain?
In a market driven economy, cheating one of the quickest routes to failure. If the public loses trust in your product, they stop buying it. If the public loses trust in a federally mandated healthcare monopoly, what does it do? If you guessed "put up with it", you guessed correctly. In a nationalized system, there would be absolutely no reason to be honest, as cheating woudl be the only way anyone would be able to get ahead, what with there only being one payer, the feds, who never run out of money or demand better service.
quote: The Soviet Union failed for lots of reasons, not a lack of innovation.
Wow, I guess the last 13 years of economic chaos and oligarchy in Russia were just the result of evil market forces, right? Communism didn't have anything to do with their backwards inefficient economy?
quote: 1) Their space program was every bit as good as ours, if not better in some respects.
Good by what measure? What have the russian people gained from it? Prestige? When you are freezing to death with no food, prestige doesn't help you very much.
quote: 2) They had nukes that could kill us just as many times over as ours could kill them.
Communism works!
quote: 3) They actually kept the peace in Bosnia
Ask the bosnians if they want Tito back, or the country of Yugoslavia back.
quote: 4) Cuba's literacy rate is higher than the US'
If only we could match the progressive people friendly policies of Cuba.
quote: Now, I'm not saying that I want to live under a Soviet-style system. It was very corrupt and dissent wasn't tolerated.
Is that the only reason? It seems insignificant when compared to all those wonderful advances you could trade your freedom for.
quote: capitalism has shown itself to be: 1) Hard to implement elsewhere.
Where?
quote: 2) Not nearly as self-correcting as it's boosters would have us believe.
Aren't all the problems of evil capitalism solved by government intervention? WHat about the FDA, FCC, FAA, etc? Haven't those federal agencies eliminated the problems of free-markets? Or are there not yet enough controls and regulations for the benefits of socialism to kick in?
quote: 3) not exactly loyal to America
?
quote: 4) Filled with corruption (Boeing, Enron, Merrill Lynch...)
Corruption and corruption fighters. As we all know, the Soviet system was much less corrupt. Like when they looted the foodstocks of the Ukraine. They did that, causing the deaths of millions, because they were looking out for the greater good.
quote: 5) Prone to boom and bust cycles.
This is caused by government tinkering in the money supply. Neat huh? The Federal Reserve tries to play the system to promote the greater good. But since Alan Greenspan is not omniscient, he cannot possibly know everything that happens in our economy, so he has to guess. Did he guess wrong in the late ninties by allowing too much easy money? You be the judge.
quote: I see a reluctance to order tests or procedures.
I see someone switching health plans, something which is impossible under your system.
quote: I see allocation of resources based on perceived "worth" of the patient.
In your system, I see allocation of resources based on political pull.
quote: It sounds kinda like socialism and socialism is supposed to be bad, so we shouldn't have it. Or it sounds like an expansion of the government beaurocracy, so we shouldn't do it. That's the idea - but I don't see much evidence to support it.
So nationalizing more than 1/7th of the economy is not socialism? And socialism is just "supposed" to be bad? There isn't much evidence to support the idea that nationalizing a big chunk of the economy would create new beaurocracy?
quote: Some innovation might result from the competition, but the downsides of competition far outweight the benefits in those instances.
Why hasn't this concept proven true anywhere in the world? Why is it that free markets are where the best science and innovation always come from?
quote: In this case, the system now is a bunch of individual units trying to do the same things without any organization or uniformity.
Stupid people, why don't they just let the government decide how to spend their money? Obviously the beaurocracy knows what's best.
quote: There's a certain amount of innovation that's necessary on the actual provider end of the matter - making competition a necessity.
Wow. So since competition causes innovation, why should we shield the people from it?
quote: But as far as paying the bill goes, there is a lot less benefit to competition between insurance companies.
Why? Does removing the one force causing them to innovate allow them to innovate faster or better?
Posted by Xaposert (Member # 1612) on :
quote:So nationalizing more than 1/7th of the economy is not socialism? And socialism is just "supposed" to be bad? There isn't much evidence to support the idea that nationalizing a big chunk of the economy would create new beaurocracy?
There's not much evidence to support the idea that that new beaurocracy would be bad.
And no, nationalizing one particular industry that is uniquely suited for a government monopoly is not socialism. The postal service is not socialism, for instance.
quote:Why hasn't this concept proven true anywhere in the world?
Because actually, it has. Just look at the examples I gave above - postal service, police, public schools, highways, etc. Competition among highway builders might create some sort of innovation, but it would pretty much eliminate the possibility of making a highway system like we have today, under the current government monopoly. Thus, yes, sometimes competition has more drawbacks than benefits.
quote:Why? Does removing the one force causing them to innovate allow them to innovate faster or better?
Well, there is really very little innovation necessary when it comes to insurance. You collect money and you pay it out. There's a little, but when you compare it with the massive increase in inefficiency that hundreds of competing medical insurers creates in terms of conflicting proceedures, paperwork, options, etc., it's just not worth it.
Posted by Robespierre (Member # 5779) on :
quote: There's not much evidence to support the idea that that new beaurocracy would be bad.
You keep saying not much. What in your mind is the evidence(not much of it, of course) that it would be bad?
quote: And no, nationalizing one particular industry that is uniquely suited for a government monopoly is not socialism.
You can deny it all you like, but nationalizing an industry IS an example of socialism. You remove market forces, and set up government dictated monopolies. Whether or not you find it "suited" to such treatment is irrelevent.
quote: public schools,
This is the saddest joke of all. If our healthcare system were run with the efficiency and effectivness of the public schools, we would be about as well off as haiti.
quote: Competition among highway builders might create some sort of innovation, but it would pretty much eliminate the possibility of making a highway system like we have today
Why not apply this same logic to every industry? Why not nationalize the computer industry? Couldn't it be run much better by the government?
quote: There's a little, but when you compare it with the massive increase in inefficiency that hundreds of competing medical insurers creates in terms of conflicting proceedures, paperwork, options, etc., it's just not worth it.
So a government run program would eliminate conflicting proceedures, paperwork, and options? Yeah, its about time we got rid of those pesky options.
Posted by Xaposert (Member # 1612) on :
quote:What in your mind is the evidence(not much of it, of course) that it would be bad?
Well, the general feeling by some that more government is bad might be one piece of limited evidence.
quote:You can deny it all you like, but nationalizing an industry IS an example of socialism.
Well if you consider ANY nationalization of ANY industry socialism, then I don't see how anyone could not support socialism to some degree - except perhaps those who'd rather not have firemen, policemen, mail, military defense, transportation, or any other services the government currently provides that could not effectively exist in a competitive market.
If you're gonna define socialism so broadly, it's hard to see what, if anything, is wrong with it - at least at that limited level.
quote:Why not apply this same logic to every industry? Why not nationalize the computer industry? Couldn't it be run much better by the government?
Oh come on man - you can answer this one without my help!
quote:So a government run program would eliminate conflicting proceedures, paperwork, and options? Yeah, its about time we got rid of those pesky options.
That's conflicting paperwork, conflicting options, and conflicting proceedures - and yes, a single beaurocracy unifies such things, and thus simplifies the system. That's why beaurocracies exist.
I mean, people might not like dealing with the IRS, but imagine what it would be like if there were a thousand different tax collecting agencies, all competing, all with different proceedures, each with different rules and rates, and where people would switch from one to another with every job change. It would be a massive mess.
Posted by Xaposert (Member # 1612) on :
Also, I'd like to also point out that there is not much more monopolistic about a single-payer universal health care system than our current system. It would be mistaken to say an employer-based health insurance system is a free market, as far as the individual's options go. For most people, their place of work has a monopoly on their health care plan. If their office has a plan, they pretty much have to take that one to get decent rates. The only difference with universal health care is that the government has the monopoly over your health care options, rather than your boss.
Posted by AvidReader (Member # 6007) on :
quote: Competition among highway builders might create some sort of innovation, but it would pretty much eliminate the possibility of making a highway system like we have today, under the current government monopoly.
Slight correction here. While government decides which roads to widen and when, private builders still compete for the contracts. Only the planning is controlled by the government. At least here in Florida.
The problem with either government or private businesses running our healthcare is cronyism. State Road 200 in Ocala was constantly under construction for well over a decade. We always refered to it as the Brother-in-Law Construction Co cause only someone's brother-in-law could get away with that kind of inefficiency. Eventually, someone must have gotten tired of it because the builders were fined large amounts a day until the project was finished. It was done in about a month. But if the state hadn't started fining, they would probably still be building.
Governemnt insurance still doesn't make any sense to me. Government health care is different. Health care puts my tax dollars at work now, not in the pockets of the insurance company. But again, if someone's brother-in-law is granted all the government contracts, we're no better off than we are now.
Posted by Zamphyr (Member # 6213) on :
Can someone who is in favor of a national healthcare system please explain to me exactly how it will be better than what we have now ? Is the arguement only over everyone being garuanteed coverage or is there something else I'm missing ? So far that's what this thread is mostly: either you're in favor of or against mandatory medical coverage. I guess what I'm really interested in knowing is how the government will be able to run a better healthcare system without me losing the majority of my take home pay.
So far Richard Berg has been the only person to offer actual improvements that can be made to our current system. Thank You Does anyone else have any realistic (not just "get rid of insurance companies") ideas on how the current system can be improved ? Note: Robespierre is exempt from this comment because his answer would be eliminate ALL regulation, which is not realistically feasible. Robes, if you have SPECIFIC regulatory barriers you would like to see removed, please explain (without using the words free market or competition )
As far as I can tell, other countries limit their costs in the following ways: Limiting lawsuits Capping perscription drug charges Capping doctors/nurses salaries
I'm probably missing a lot there so, non-US residents, please chip in, especially if less than half of your salary is going to your government in the form of taxes.
From the pro-national side, the only cost measure so far seems to be one of size, ie. a national beaurocracy will streamline costs. I'm extremely skeptical of this. If it was purely scale, couldn't one of the states try a state run medical system ? I'd love to see it tested out. You can't just point to another country and say "See, it works." They have different laws. I see Vermont mentioned. Can someone specify what they provide for minors there ? It doesn't seem to have bankrupted them.
*returns to lurking*
Posted by Robespierre (Member # 5779) on :
quote: Well, the general feeling by some that more government is bad might be one piece of limited evidence.
My point with that question was, if you see a little of the evidence, why don't you accept it? Do you think there is any justification for there to be more gov. in our lives?
quote: except perhaps those who'd rather not have firemen, policemen, mail, military defense, transportation, or any other services the government currently provides that could not effectively exist in a competitive market.
In a civilized society, we delegate our right to use force to defend ourselves to the government. This is how we avoid anarchy. However, the mail and transportation sectors of our *federal* government are socialist. And no, they don't exist in a competitive market, it is illegal for any other service to deliver letters to individual's houses.
quote: If you're gonna define socialism so broadly, it's hard to see what, if anything, is wrong with it - at least at that limited level.
The IXth and Xth amendments preclude the federal government from getting involved in things that are not specifically included in the constitution. Those are the last 2 amendments to the *bill of rights*. I don't think we should be changing or ignoring either of them. Socialism denies the individual any right of self determination.
quote: Oh come on man - you can answer this one without my help!
You're absolutely right I can, but I want to hear you defend why we should not nationalize our computer industry. What is your reasoning?
quote: and yes, a single beaurocracy unifies such things, and thus simplifies the system.
We have a fundamental disagreement here, I think we will be able to patch this one up.
quote: imagine what it would be like if there were a thousand different tax collecting agencies, all competing, all with different proceedures, each with different rules and rates, and where people would switch from one to another with every job change. It would be a massive mess.
Actually, there already is competition among companies who will prepare your taxes. They do a pretty good job of reducing the complexity, all you have to do is bring them a small stack of documents, and they figure it all out for you.
quote: It would be mistaken to say an employer-based health insurance system is a free market, as far as the individual's options go. For most people, their place of work has a monopoly on their health care plan.
This is not true at all. If I wanted to opt out of my work plan, and purchase my own health care insurance, I am free to do so. By having companies negotiate health care plans, the workers have the *option* to use their collective barganing. However, when unions collectively bargan for wages, they DO have a monopoly, as the workers are obliged to remain in the union, and abide by its terms by force of law.
quote: Robes, if you have SPECIFIC regulatory barriers you would like to see removed, please explain
The FDA is currently the biggest hurdle to lowering the price of Rx type drugs. It is a needless beaurocracy which adds many millions to the cost of developing drugs. Even if we don't want to trash it all together(which I do), we should at least allow those with terminal diseases to try out new drugs if they want. That would be a very minimal reform. Much red tape should be eliminated as well.
I would also like to see some sort of control placed on the legal system which is currently being used to extort doctors and hospitals out of much of their money. Perhaps if we forced the loser to pay legal fees, we would see fewer frivilous lawsuits.
Posted by Bob_Scopatz (Member # 1227) on :
quote: Prestige? When you are freezing to death with no food, prestige doesn't help you very much.
So, we shouldn't have a space program either because there are people who are starving or don't have heat this winter?
See, two can play the game of just taking EVERY statement to a ridiculous extreme.
I'm not praising communism, but I'm also not saying that laissez faire capitalism is great either.
Basically, if you are a have-not, communism is a lot better. If you have a lot of stuff, capitalism is better.
As for the take home lesson from ENRON, it seems to me that the real lesson is that when cheaters are EVENTUALLY CAUGHT after building up a bubble in the stock market, our economy can go to hell for 3 or 4 years. Those guys had a worse effect on the economy than the WTC & Pentagon attacks did.
By analogy, you would say that the eventual capture and punishment of a rapist shows that the system works. Don't worry that there are others out there who haven't been caught, may never be caught.
The fact that our government was in bed with the Enrons just makes things worse.
I guess that's not corruption though. That's just good for business, and that creates jobs and we should all just shut up and wait for our 401K's to come back up.
Posted by Bob_Scopatz (Member # 1227) on :
The problem I have with the economic impetus for euthanasia is that we'll be making the decision for all the wrong reasons -- to save money.
And if it comes to that, do we think there won't be pressure on the old and infirm to make way for the rest of us?
I can see the advertisements now. You get any one of a set of "flagged" diagnoses and suddenly your HMO is sending you a pamphlet "Thinking of moving on?"
[ February 22, 2004, 12:22 PM: Message edited by: Bob_Scopatz ]
Posted by mackillian (Member # 586) on :
Wow, that could explain the latest letter I got from my insurance company...
Posted by BYuCnslr (Member # 1857) on :
quote:Actually, there already is competition among companies who will prepare your taxes. They do a pretty good job of reducing the complexity, all you have to do is bring them a small stack of documents, and they figure it all out for you.
Because this one is going very far off topic, I'll just answer it. He's not talking about tax preperation agencies such as H&@ Block, he's talking about tax collection agencies, aka the IRS. Satyagraha
Posted by Ryan Hart (Member # 5513) on :
I think euthanasia is a good idea because people should be able to pass from life with grace and with dignity. That's the entire goal of doctors who deal with terminally ill patients.
As for the health system, I think sweeping insurance reforms are vitally necessary.
Posted by AvidReader (Member # 6007) on :
quote: I would also like to see some sort of control placed on the legal system which is currently being used to extort doctors and hospitals out of much of their money.
Actually, it might help to cut down on the extortion of doctors in general. It's one of the few professions where you're expected to work 12 hour days for free for a year before you can actually make any money. Even after the internship, many doctors work long days in hospitals trying to make life better for the rest of us. Maybe hospitals should be forced to treat doctors like human beings instead of indentured servants.
The real problem with government healthcare is how do we get Mac and others with chronic diseases provided for as they should be without paying for every hypochondriac and legal junkie?
How many people did you know this winter that went to the doctor and got antibiotics for a cold or flu? Pills can't cure a virus. It has to go away on its own. The vast majority of Americans refuse to take responsibility for their own health. We eat badly, refuse to exercise, smoke, stay stressed, and then when we inevitably become sick, we expect the doctor to make it all better with a magic pill.
Maybe we should try better education and some kind of government fund for people with chronic illnesses. We'll still end up paying for some scam artists, but at least it won't be the majority of the country. And those in need could get the help they deserve quickly.
Posted by sndrake (Member # 4941) on :
quote:I think euthanasia is a good idea because people should be able to pass from life with grace and with dignity. That's the entire goal of doctors who deal with terminally ill patients.
The big flaw in that statement is the assumption that a lack of euthanasia is the most important obstacle to "grace and dignity" in dying. Getting comprhehensive palliative care - at home - is much more important. And more expensive.
Posted by ClaudiaTherese (Member # 923) on :
Some guys are aware that the State Children's Health Insurance Program (SCHIP) under Title XXI of the Social Security Act has made mandatory the provision of basic coverage to all children on a state-by-state basis. For several years now. In all states.
Some guys are depressed by the lack of interest in actual data shown by most guys who enter into these discussions. As if, you know, the facts of the matter are really irrelevant to discussions of public policy, because we all know what some uninformed person wishes/believes to be true must be true, because reality obviously bends to their mindsets.
Some guys just don't have it in them to argue the same points over and over again, as it doesn't seem to make much of a dent in the collective density of the American mind on this matter.
[ February 22, 2004, 04:29 PM: Message edited by: ClaudiaTherese ]
Posted by sndrake (Member # 4941) on :
"Facts," said Don Quixote, "are the enemy of truth!" (Not the only thing he got wrong - although there's a point to be made about what facts are relevant.)
"Never underestimate the power of very stupid people in large groups" -- John Kenneth Galbraith
Posted by Storm Saxon (Member # 3101) on :
Facts are simple and facts are straight Facts are lazy and facts are late Facts all come with points of view Facts donīt do what I want them to Facts just twist the truth around Facts are living turned inside out Facts are getting the best of them Facts are nothing on the face of things Facts donīt stain the furniture Facts go out and slam the door Facts are written all over your face Facts continue to change their shape
---David Byrne
Posted by ClaudiaTherese (Member # 923) on :
If I were a different guy (say, someone not bothered by the niceties of accuracy), I would ignore the international survey of patient care satisfaction carried out by the Harvard Department of Public Health regarding Canada, US, New Zealand, UK, and Australia.
Just because it shows that "Similar proportions of the public in all five countries rate the quality of overall medical care, physician care, and hospital care as "excellent," with Canada being the highest in all categories [emphasis added]," is no reason not to believe that Canadians are more satisfied with their system, in general, than US citizens are. What is a wealth of data compared to one or two (or three or four) anecdotes?
sndrake: *mournful look
Slap me if I step into this conversation again. I have been infected by the workaholic / can't-get-away-from-my-job meme.
[ February 22, 2004, 04:24 PM: Message edited by: ClaudiaTherese ]
Posted by ClaudiaTherese (Member # 923) on :
You know, Stormie, facts can look pretty darn twistable until you view the alternative.
There's nothing like wild speculation and raw opinion for bendability, truth-wise.
[*slaps self to save sndrake the trouble]
[ February 22, 2004, 04:21 PM: Message edited by: ClaudiaTherese ]
Posted by Storm Saxon (Member # 3101) on :
edit: We are all clear that my previous post wasn't in any way, shape or form making an actual statement on health care, yes? I just thought it was a contest to see who could post the best quotes relating to facts.
[ February 22, 2004, 04:27 PM: Message edited by: Storm Saxon ]
Posted by ClaudiaTherese (Member # 923) on :
Okay, I'm better now. I love you, Stormie. Posted by Storm Saxon (Member # 3101) on :
Screw you all who don't think virtual kisses and hugs are as good as the real thing.
at you, CT. Posted by John L (Member # 6005) on :
quote:Some guys just don't have it in them to argue the same points over and over again, as it doesn't seem to make much of a dent in the collective density of the American mind on this matter.
And some guys have learned to see the practicality of some others' points, and have accepted that the others' arguments are valid.
I'm not sold gung-ho on the idea, CT, but with some proper measures taken to insure the economic integrity of the nation without a great revolution-like upheaval, I could agree to such changes. And you have the credit for leading me to that view.
Posted by Xaposert (Member # 1612) on :
quote:Can someone who is in favor of a national healthcare system please explain to me exactly how it will be better than what we have now?
Benefit #1:
It would be better because it will result in less taken out of the average paycheck every week. It will increase the taxes taken out of that check, but this will be more than offset by the elimination of having to pay for employer-provied healthcare coverage.
It will do this because a single government health insurance plan is more efficient that thousand competing plans. This is because: (1) Standardized proceedures, if done correctly, should eliminate a lot of the waste generated by the complexity of our current system. (And when I'm talking about this, it not only includes that actual costs incurred by health insurance companies, but also the costs currently incurred by employers administrating health care plans, the time it takes for individuals to monitor their own plans and options, and the time and effort it takes for hospitals/doctors/etc to navigate the many different insurance programs out there.) (2) Insurance is unique in that risk is one of the largest costs, and that risk drops the larger the pool of participants is. So, whereas smaller companies cannot afford the risk of certain demographics without charging high prices, a national 300 million person plan will be able to minimize the cost.
Benefit #2:
It eliminates the problem of uninsured people. An uninsured person is not just a problem for himself, but for society at large, because ultimately we will have to pay for his poor health. A small problem might be treatable now for a low cost, but if that person waits because of no health coverage, it may result in a problem that will cost a lot - and it may be Medicare that gets stuck paying that price in the end.
A person without health care not only is in danger himself, but also costs the rest of us, because current laws obligate us to care for him if something does happen to him.
quote:If it was purely scale, couldn't one of the states try a state run medical system ? I'd love to see it tested out. You can't just point to another country and say "See, it works." They have different laws.
Yes, a state test could work - but people would still claim that it would never work on a national level, just as you're claiming we can't do the same thing in America that those other countries have had successes with.
I, for one, don't see why we just don't test it on the whole nation. It's not like it's impossible to go back if it fails. (Not like invading a country, for instance.)
[ February 22, 2004, 04:54 PM: Message edited by: Xaposert ]
Posted by sndrake (Member # 4941) on :
**am strangely relieved that CT slapped herself**
Slapping those who would grow up to be women was not a behavior that was encouraged when I was growing up. It is an inhibition I am oddly reluctant to be free of.
(Yes, I know you were joking - so am I)
Hope I didn't make too light of the facts - facts can be misused and misapplied. But that is a separate issue from ignoring highly relevant facts that are available to be used to inform and enlighten (gonna see if that flies tomorrow.).
Posted by mackillian (Member # 586) on :
Did anyone know that the United States has an uninsured population greater than the entire population of Canada?
Posted by Richard Berg (Member # 133) on :
quote:Getting comprhehensive palliative care - at home - is much more important.
To you. I'd much rather my spouse take some time off in Tahiti* than pay for someone to clean my bedpans.
*or give the kids a downpayment on a house, or whatever; throwing $1k+/day away so that I can extract the absolute maximum number of hours on Earth isn't my idea of fun
You're welcome, Zamphyre. I hope others can acknowledge the potential of the private sector, but if things have to be nationalized it's not the end of the world or anything. When we make our first alien contact nobody will care which agency their grandfather sent his checks to. (Sci-fi tangents are allowed on an OSC board, I'm assuming...)
Posted by sndrake (Member # 4941) on :
Wow, Richard, where did you get those dollar figures from?
And, for the record, I don't think families should have to go broke getting decent care at any time in their lives. Also, the vast majority of people who say "I wouldn't want to live if..." end up carrying on anyway when they actually get there. Not saying you'd be one of them, but thought you might want to know.
Hey, what you want to do is your own business. I'm increasingly unsure that government-authorized professionals have any business taking away the freedom of anyone who attempts or is talking about attempting suicide. Similarly, I'm very against government authorization of professionals to oversee the killings of certain suicidal individuals based on age, disability and illness.
Carving out euthanasia as a "right" for a small minority isn't a "clinical" matter - it's a value judgment.
[ February 22, 2004, 10:12 PM: Message edited by: sndrake ]
Posted by ClaudiaTherese (Member # 923) on :
John, you keep me alive, dude.
Posted by Richard Berg (Member # 133) on :
It depends, of course. If you have a terminal cancer patient with no mobility and poor immunity but no immediate medical needs, an in-home nurse + drugs + special chair etc. etc. may run "only" $40/hr + overtime as needed + equipment. If you have a patient with late-term coronary disease, bouncing in and out of the ICU, with the final days spent on a heart-lung machine awaiting a replacement aortic valve, you're talking at least $10k per day. (Just to cite two cases I have some connection with). The average is somewhere in between, clearly.
Let's be careful about tossing around "euthanasia," as it implies lack of patient consent. Passing the barbiturate overdose across the table, and/or respecting a living will in my consciousness' absence, is all I ask.
Hmm, maybe I need to go back and turn my second post into bullet points too. I thought the stuff about lower standards for auxiliary services would invite controversy. (It's a libertarian viewpoint, after all ).
[ February 22, 2004, 10:26 PM: Message edited by: Richard Berg ]
Posted by John L (Member # 6005) on :
And you keep me aware, CT.
Posted by ClaudiaTherese (Member # 923) on :
John, I just figured out who you remind me of: the guys on Mythbusters. It's that eclectic mix of sharp intelligence, gritty urban cool, and likes-to-blow-things-up debunkism. You would be awesome at that show.
sndrake, I have successfully recaptured my email account! I'll email you in the morning.
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