Universal Healthcare in the US

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haut
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Universal Healthcare in the US

Postby haut » Sat Jun 21, 2008 4:40 pm UTC

In the US, an estimated 42% of adults have inadequate or no health insurance (link). With global warming, energy availability, and international conflict, I think this is one of the most important issues facing the US right now. Healthcare is a quality of life issue and universal access provides more benefits than just providing the underinsured with the same benefits as the currently insured. The system in the US is broken right now because we pay more than double per capita than most other first world countries (link) yet have fewer people with access to care and poorer health statistics, such as life expectancy and infant mortality.

I recently watched Frontline's Sick Around the World (online here: link, which was a very good comparison of different countries' healthcare systems and what may work in the US. I would highly recommend it for some background info to the discussion.

I think that the biggest obstacle to universal coverage is the cost. I think that we need to get healthcare costs under control - in addition to them being twice as high as they ought to be, they are growing at a staggering rate. Unfortunately, reducing the amount we pay to any group involved is going to be a huge battle (for the obvious reasons). Our insurers have much higher administrative costs than public systems (link) and our doctors make much more money. Malpractice insurance is high due to lawsuits, so doctors perform procedures that would have otherwise been deemed medically unnecessary except for the fear of being asked about it in a courtroom, further driving up costs (and doctor's income). We also pay more for drugs, devices, and in general have more diagnostic equipment. Obviously cutting the amount we spend on every aspect of healthcare can have negative impacts on innovation and incentive to improve, but I think we can cut enough costs out to retain high quality care while providing coverage for everyone.

I would not like this discussion to be about whether the US should have a system of universal healthcare coverage, rather how it could/should be implemented. There is not a single-issue solution to this problem - a comprehensive plan is needed to provide this. I don't expect a consensus plan, but I think we can come up with some very good ideas that could be used to create a solid plan.

------------------------------------
I did some searching and found some healthcare discussions (such as one on Canada's system), but no threads about this topic. If there is another thread on the same topic, please lock or merge with this one.

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Malice
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Re: Universal Healthcare in the US

Postby Malice » Sat Jun 21, 2008 6:09 pm UTC

haut wrote:I think that the biggest obstacle to universal coverage is the cost. I think that we need to get healthcare costs under control - in addition to them being twice as high as they ought to be, they are growing at a staggering rate. Unfortunately, reducing the amount we pay to any group involved is going to be a huge battle (for the obvious reasons). Our insurers have much higher administrative costs than public systems (link) and our doctors make much more money. Malpractice insurance is high due to lawsuits, so doctors perform procedures that would have otherwise been deemed medically unnecessary except for the fear of being asked about it in a courtroom, further driving up costs (and doctor's income). We also pay more for drugs, devices, and in general have more diagnostic equipment. Obviously cutting the amount we spend on every aspect of healthcare can have negative impacts on innovation and incentive to improve, but I think we can cut enough costs out to retain high quality care while providing coverage for everyone.


1. The uninsured need small, cheap things--like regular checkups, antibiotics, etc.--more than they need massive expensive surgeries.
2. The best way to lower the cost of health care is to shift our entire focus toward preventative medicine. If you lower Bob's blood pressure today, you don't have to give him a heart transplant tomorrow. It's cheaper, easier, and better for our overall health.
3. Offer doctors the benefit of a government job in exchange for a lower salary. These benefits include equipment, government malpractice insurance, a steady paycheck, and (most enticing) never having to turn down a patient because an HMO said so or because they can't afford to get well. Pay them a salary with bonuses for making people healthier instead of stapling their income to the number of unnecessary procedures they perform.
4. Subsidize the high cost of medical school, in order to increase our population of doctors and other medical personnel.
5. Switch to public administration of health care, with a simple, streamlined bureaucracy; one which is easily accessible by the public, open to scrutiny, and not allowed to deny anyone vital health care.

My only other suggestion is dealing with the high cost of medication, but I'm not sure how to do that, barring price fixing, which I'm not sure is a good idea.
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Re: Universal Healthcare in the US

Postby Gunfingers » Sat Jun 21, 2008 6:16 pm UTC

Socialized healthcare works. I know this because other countries do it and it works there. It's possible that beause many medical innovations come from the US (How many? Hell if i know. I wouldn't even know where to begin finding out) socializing our healthcare would slow innovation across the globe, but since no one is talking about socializing the pharmaceuticals industry i'm not that concerned.

That said, it turns out privatized healthcare works too. I get health insurance through work, so i went to eHealthInsurance to find out how much it would cost if i didn't. For just me i could afford health insurance easily. All the bells and whistles for about $100/month. I tried it with an imaginary family and found that it roughly quadruples to about $400/month for really good insurance. Not easily affordable anymore, but certainly affordable. Of course these are just quotes off a website without having any background information. It's a baseline, and could be significantly higher or significantly lower depending upon your location in the country and your health status. US also provides Medicaid to provide a hand up to the impoverished who cannot afford insurance, and we provide SCHIP because there's no reason children should suffer for their parents' poor financial management. These are the only social support programs done federally that i'm aware of (except medicare, which only helps a small subset of the population), though i'm sure many states have others as well. Many hospitals also have walk-in clinics, where a person can get looked at by a doctor for free. Some states also have laws forcing hospitals to provide emergency life-saving care, regardless of a person's ability to pay for it. This has the side-effect of leaving that person stuck with a bill they can't pay. See next paragraph for how much i care.

Basically this is one of those areas where you'll find that the culture in the US is just different from that of Yerp and Canadia. Unless lives are on the line we don't generally concern ourselves with other people's problems. Personally, i'm all for privatized health-care. I have no interest in personally paying for our national inability to put down the damned doughnut.

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Durandal
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Re: Universal Healthcare in the US

Postby Durandal » Sat Jun 21, 2008 7:44 pm UTC

I live in Canada. I like the system, it works, but there are long wait times, especially for specialists.

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Vaniver
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Re: Universal Healthcare in the US

Postby Vaniver » Sat Jun 21, 2008 8:12 pm UTC

haut wrote:In the US, an estimated 42% of adults have inadequate or no health insurance (link).
You read your data wrong. Look at this chart- it suggests that 86.5% of Americans have access to a core set of services. Or did you mean something else by inadequate?

haut wrote:The system in the US is broken right now because we pay more than double per capita than most other first world countries (link) yet have fewer people with access to care and poorer health statistics, such as life expectancy and infant mortality.
You're judging the US system by equality of access- an approach which automatically results in the suggestion that we should switch to universal health care. The US system treats the people it does treat very well- nearly every standard that doesn't include "equality of access" puts the US at the top.

haut wrote:I think that we need to get healthcare costs under control - in addition to them being twice as high as they ought to be, they are growing at a staggering rate.
Why are healthcare costs rising?

One reason is that we're coming up with new, expensive surgeries and treatments. There's no reason to expect this to inflate average healthcare costs much by itself- the presence of cars that cost over a million dollars don't impact the mean price of car sales in the US much.

Another reason is that the supply of doctors is artificially low, thanks to the AMA. It's already tough to get an appointment quickly- when you increase the number of people seeking doctor's visits by 72%,* what do you think will happen to wait times and the amount that doctors charge?

Another important reason is that we've got big-pocket buyers and a health-care system that gets paid based on how much treatment they provide, not how healthy their patients are. Why would a doctor suggest a $10,000 operation when he could suggest a $30,000 operation?** Now the new and expensive treatments become problematic.

haut wrote:I would not like this discussion to be about whether the US should have a system of universal healthcare coverage, rather how it could/should be implemented.
But what if the best way to implement it is "don't implement it?" Even if it isn't, it's important to have the general objections to universal health care on hand, so that you know what pitfalls you need to avoid with your design.

Malice wrote:2. The best way to lower the cost of health care is to shift our entire focus toward preventative medicine. If you lower Bob's blood pressure today, you don't have to give him a heart transplant tomorrow. It's cheaper, easier, and better for our overall health.
The US routinely scores as having the best, or close to best, preventative medicine access/use in the world. Obviously we could be better- it'd be nice to see more people taking their obesity seriously, and I'm sure there are some clever ways we could make checkups cheaper and (thus) easier to access.

Malice wrote:4. Subsidize the high cost of medical school, in order to increase our population of doctors and other medical personnel.
Alternatively, lower the standards for becoming a doctor and becoming an accredited medical school. You'll get more doctors (pretty important since you want to deliver more care without increasing prices), and there's no reason to believe overall quality will drop significantly. If there is reason to believe that the current skill threshold for doctors is well-set,*** then it makes sense to add another level between a doctor and a nurse or start elevating nurses- Wal-mart's health clinics are a positive development, and any universal-care system needs to either duplicate that or have hideous wait times.

Which brings us to an important point- you are not going to get health-care system innovation by switching to a universal system. Right now there's no**** research going on into whether or not hospitals are effective. Does it make a difference if you keep someone for observation 5 days as opposed to 2 weeks? How much do yearly physical examinations actually improve health? What processes can be automated without much loss (or even with gain)?*****

A properly designed universal system will try to encourage innovation- but it'll end up like curriculum innovation in education. It swings back and forth with education theory, but not with actual test results- if some school districts decided "we're going to use X method of teaching math" and other districts decided "we're going to use Y method of teaching math," then you would know within a few years which method is better (for various kinds of students; no reason to believe one size will fit all). Likewise, nation-wide changes in healthcare will be difficult to implement (it's easier to open one Wal-mart clinic than four thousand Wal-mart clinics) and subject to politics instead of entrepreneurs chasing results. Every now and then you do get benefits for having a national system (if, for example, the heart-attack system I brought up is implemented nation-wide by fiat, your system is working well. But why would we assume that a political body centered in Washington would get things right more often than they get them wrong?).


*If we accept your number of 42% uninsured, an increase from 58% to 100% is a rise of 72%. There are strong reasons to not accept that number, as pointed out before, but I find it amusing when people say "healthcare costs are too high, we need to almost double the number of buyers."
**Doctors are not villainous people. But they are not saints. Any profession with information asymmetry will result in the experts overcharging the inexpert.
***Does anyone know how the AMA decides how many doctors there should be, and what performance is thus necessary?
****As far as I know- there could be some. There is research going on in to how to make hospitals more efficient- but on a minor scale.
*****The example that I like to bring up is from Malcolm Gladwell's Blink, in which he brings up the case of cardiac arrest patients being admitted to a hospital. A group of statisticians took the data from the last several years of patients to figure out which datapoints were relevant- it turned out that only three actually mattered, and so they could replace doctors doing far more than 3 tests with nurses following a flow-chart. Costs went down significantly, quality of care went up- but doctors objected to being made irrelevant.
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Re: Universal Healthcare in the US

Postby Gunfingers » Sat Jun 21, 2008 8:37 pm UTC

Vaniver wrote:
haut wrote:In the US, an estimated 42% of adults have inadequate or no health insurance (link).
You read your data wrong. Look at this chart- it suggests that 86.5% of Americans have access to a core set of services. Or did you mean something else by inadequate?


Respondents were identified as underinsured if they spent 10 percent of more of their income (or 5 percent if they were low-income) on out-of-pocket medical expenses, or if they had deductibles that equaled 5 percent or more of their income.


So, y'know, statistics will mean whatever you want them too, i guess.

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Re: Universal Healthcare in the US

Postby Flying Betty » Sat Jun 21, 2008 8:39 pm UTC

Gunfingers wrote:
That said, it turns out privatized healthcare works too. I get health insurance through work, so i went to eHealthInsurance to find out how much it would cost if i didn't. For just me i could afford health insurance easily. All the bells and whistles for about $100/month. I tried it with an imaginary family and found that it roughly quadruples to about $400/month for really good insurance. Not easily affordable anymore, but certainly affordable. Of course these are just quotes off a website without having any background information. It's a baseline, and could be significantly higher or significantly lower depending upon your location in the country and your health status. US also provides Medicaid to provide a hand up to the impoverished who cannot afford insurance, and we provide SCHIP because there's no reason children should suffer for their parents' poor financial management. These are the only social support programs done federally that i'm aware of (except medicare, which only helps a small subset of the population), though i'm sure many states have others as well. Many hospitals also have walk-in clinics, where a person can get looked at by a doctor for free. Some states also have laws forcing hospitals to provide emergency life-saving care, regardless of a person's ability to pay for it. This has the side-effect of leaving that person stuck with a bill they can't pay. See next paragraph for how much i care.
...
I have no interest in personally paying for our national inability to put down the damned doughnut.




You're also assuming that you'll apply for those health plans and get accepted. The US health care system is fine for people who are young and healthy and just need a little bit of preventative care. Major accidents, and major diseases, cost more than any average person can afford to pay.

Once you have a preexisting condition, it is next to impossible to get affordable coverage from a private company. So if you get hit by a bus (which happens to healthy people) or get a brain tumor (which can also happen to otherwise healthy people) you essentially have to stay working for the same company for the rest of your life since you'll probably get denied coverage by anyone new because they'll likely be paying more for you then you'll be paying into the system. Private insurance is about risk mitigating for the insurance companies rather than helping people. Try to get homeowner's insurance in Florida. You're pretty much screwed because the cost to them is likely to be more than what people are paying in.
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Re: Universal Healthcare in the US

Postby Gunfingers » Sat Jun 21, 2008 8:47 pm UTC

Actually under those circumstances you get the government funded health care you hippies are dreaming of: medicare*. Unless you thought i was talking about competely privatized healthcare, instead of american healthcare. In that circumstance you are indeed screwed.


*I think. Wikipedia doesn't really describe what actually is a disability, so in the case of the brain tumor at least i'm not sure it'd be covered. Really if you've got an inoperable brain tumor paying the bills isn't really your biggest concern.

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Re: Universal Healthcare in the US

Postby Malice » Sat Jun 21, 2008 9:29 pm UTC

Gunfingers wrote:*I think. Wikipedia doesn't really describe what actually is a disability, so in the case of the brain tumor at least i'm not sure it'd be covered. Really if you've got an inoperable brain tumor paying the bills isn't really your biggest concern.


Why not? When I die, I don't want to leave my family crippled by hundreds of thousands of dollars of debt for ultimately useless medical bills.
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Re: Universal Healthcare in the US

Postby Varsil » Sat Jun 21, 2008 9:32 pm UTC

Insurance also has the problem that you pay for it before you get the service, and once you need it for anything major, you're no longer a customer they want to keep in future. So, at the point where you want to make a claim, it is in their best interests to do their best to deny you, remove your coverage or just drag their heels while they hope you die in the meanwhile. This means that even those with insurance can't be confident (under the US system) that they will actually be covered when major bills come in. This isn't a problem with the socialized insurance system here in Canada.

And, as has been mentioned, the only way for an insurance company to cover people who are sickly (say, a diabetic, who is at much higher risk of various expensive problems) is by balancing that with healthy people (who are likely to pay into the system and never recover what they put in). You can achieve that if you're using a socialized insurance system, but if you're a private insurer it's in your best interests that /someone else/ cover those people. Whether anyone actually does isn't your problem, so the net result is that people with preexisting conditions either can't get insurance, or else can only get insurance that basically covers nothing (ie, if there is any way they can say that your preexisting condition remotely contributed, it's not covered).

Socialized medicine also has advantages in terms of minimizing the impact of a potential bioweapons attack, not that this is likely. If seven people get sprayed with something lethal and infectious, you don't want four of them to avoid the hospital because they don't have coverage. You want all of them going in to get treatment and getting into quarantines. This is a really minor point, though.

Disadvantages? Well, when it's socialized medicine you always have to worry about the government shaving dollars off of it to fund something else, or just trying to gut it for political reasons (ie, that they're wanting the system to fail to replace it with private medicine). There's always a battle over 'medically necessary' versus cosmetic/unnecessary procedures in terms of what is covered.

Socialized medicine doesn't solve all problems by any means, but I think it is a lot better than private systems.

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Re: Universal Healthcare in the US

Postby Gunfingers » Sat Jun 21, 2008 9:34 pm UTC

Malice wrote:
Gunfingers wrote:*I think. Wikipedia doesn't really describe what actually is a disability, so in the case of the brain tumor at least i'm not sure it'd be covered. Really if you've got an inoperable brain tumor paying the bills isn't really your biggest concern.


Why not? When I die, I don't want to leave my family crippled by hundreds of thousands of dollars of debt for ultimately useless medical bills.


I was just being glib, calm down. :P

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Re: Universal Healthcare in the US

Postby Freakish » Sat Jun 21, 2008 11:27 pm UTC

Durandal wrote:I live in Canada. I like the system, it works, but there are long wait times, especially for specialists.


But only if you have the time to wait.
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Re: Universal Healthcare in the US

Postby haut » Sun Jun 22, 2008 12:32 am UTC

Whew - there are a lot of good responses - I'll try to keep up with the quality. This is my first post to an xkcd forum and it's very refreshing to see these thoughtful responses.

First of all, it seems like the 42% un/underinsured statistic caused a lot of excitement. The Commonwealth Fund on "underinsured":
Respondents were identified as underinsured if they spent 10 percent of more of their income (or 5 percent if they were low-income) on out-of-pocket medical expenses, or if they had deductibles that equaled 5 percent or more of their income.

The definition of underinsured is obviously subjective (and the importance of having 14% of adults underinsured will vary based on political views), but if we remove them, there is still a 28% level of uninsured adults. We can argue about the statistics until we're blue in the face, but it won't prove anything in the end.

I think that some people may have read "universal healthcare" as "socialized healthcare." I think that a socialized system like the UK's NHS is an option but not what I'm trying to get to. I'd like to get to a point where everyone in the US has adequate healthcare coverage (regardless of preexisting condition) and can afford it, even if there is a medical emergency. This can mean anything from a totally socialized system to Mitt Romney's system of requiring basic health insurance (like with car insurance) or anything else that achieves this. I think that a universal healthcare system would one day be seen like the public education system, whose existence is not a contentious issue because of the fundamental need it serves to society. Based on today's society and what it takes to succeed, I think that education and healthcare should both be considered part of the unalienable rights of life, liberty, and the pursuit of happiness.

Vaniver wrote:
haut wrote:I would not like this discussion to be about whether the US should have a system of universal healthcare coverage, rather how it could/should be implemented.

But what if the best way to implement it is "don't implement it?" Even if it isn't, it's important to have the general objections to universal health care on hand, so that you know what pitfalls you need to avoid with your design

I think that this is a good point, but I think this is addressed in the above definition of universal healthcare. The goal is everyone has coverage and medical expenses should not bankrupt anyone.

About Gunfingers' price quotes - I know that my aunt's family of 4 (2 healthy middle-aged adults and 2 teenagers) were paying $1200/month for private insurance similar to my corporate group insurance. Using the amount my employer contributes and my premium, it costs $700/mo for myself and my wife for our insurance (we are mid 20's). I think that the coverage provided in Gunfingers' search are likely less than provided by a standard HMO/PPO plan (and of course less than the other first-world countries with universal coverage).

Vaniver wrote:Another reason is that the supply of doctors is artificially low, thanks to the AMA. It's already tough to get an appointment quickly- when you increase the number of people seeking doctor's visits by 72%,* what do you think will happen to wait times and the amount that doctors charge?

This is an excellent point and one that I've heard before, but haven't seen a source. I think that it's important to remember that the AMA represents doctors, not the health of the country's citizens. By reading their website, I'm not convinced that they actually want universal coverage because they don't want anything to lower doctors' income. If one of the largest costs has to stay at its current level, how can we afford to cover those that already can't pay? The AMA argues that anything that lowers the incomes will drive away the talented people to other professions. It is my opinion that only having people who want to practice healthcare become doctors (rather than those chasing the $) might be a good thing. Teachers are on the other end of the spectrum and I've had some excellent teachers who are making very little (for their education level) but teach because they are passionate about the job. I don't know if teacher quality would improve with big boosts in incomes. Doctors can make much less money and still have a very "well-paying" job. One obstacle is that doctors are highly respected in US society, so if doctors say they just have to make their current income or people will suffer in care, people in general will believe them.

Vaniver wrote:Another important reason is that we've got big-pocket buyers and a health-care system that gets paid based on how much treatment they provide, not how healthy their patients are. Why would a doctor suggest a $10,000 operation when he could suggest a $30,000 operation?** Now the new and expensive treatments become problematic.

Another excellent point - it seems like in US healthcare there is a huge conflict of interest when it comes to recommending care. Physicians and dentists can recommend more procedures to make more money. Optometrists can prescribe contact lenses that they know can't be purchased from mail order companies or Walmart to guarantee the income, even if it isn't the best treatment option. I would doubt that the doctor's income is never considered in a care decision. Since the majority of these decisions are made when insurance companies will pay the bill (the big-pocket payers), the patient won't feel the impact so it would be easy to argue that no one is hurt.

About the rising costs - are these expensive surgeries and treatments actually improving public health? We are still far behind in many statistics - are other out of control factors (such as US obesity) the cause of these poor stats?

I'm going to propose a few aspects of an attainable system with coverage for all:
- Electronic medical records - do what Taiwan does and set up a national system to manage records, appointments, prescriptions, etc. (see the Frontline documentary for reference)
- Decouple insurance from employment - this relieves the burden on our companies and enables care to continue when out of work
- Doctors have salaries with income incentives for improving healthcare stats of patients (like with NHS)

What are yours?

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Re: Universal Healthcare in the US

Postby Malice » Sun Jun 22, 2008 3:21 am UTC

haut wrote:This can mean anything from a totally socialized system to Mitt Romney's system of requiring basic health insurance (like with car insurance) or anything else that achieves this.


Perhaps it's just because I'm not familiar with his proposal, but that sounds ridiculous. That's like "solving" world hunger by requiring everyone to keep enough food in their homes at all times. If I'm too poor for insurance, I'm too poor for insurance.
If you don't have car insurance, you can't drive. What do you do to people who don't have health insurance? Put them in jail until they can magically afford it?

Anyway. I'll cut the rant short, pending an explanation of this proposal.

--

I believe Vaniver mentioned wait times. First, any health care system, regardless of who pays it, can be designed and run poorly or well, resulting in high wait times or low ones.
Secondly, the difference between the two scenarios is, that extra 72% is either making everyone else wait longer, or they're dying on the fucking street. Whining about wait times in a universal health care system is--well, it's remarkably cold-hearted, to say the very least.
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Re: Universal Healthcare in the US

Postby Varsil » Sun Jun 22, 2008 3:26 am UTC

Freakish wrote:
Durandal wrote:I live in Canada. I like the system, it works, but there are long wait times, especially for specialists.


But only if you have the time to wait.


Though wait-list times are prioritized on the basis of urgency and importance. So the people who are really screwed by wait times aren't people who need (say) open-heart surgery this week or they're going to die. It's the people who need a hip replacement and who keep getting their surgeries bumped back for stuff deemed more urgent, and who are suffering quality-of-life problems in the meantime.

Malice wrote:
haut wrote:This can mean anything from a totally socialized system to Mitt Romney's system of requiring basic health insurance (like with car insurance) or anything else that achieves this.


Perhaps it's just because I'm not familiar with his proposal, but that sounds ridiculous. That's like "solving" world hunger by requiring everyone to keep enough food in their homes at all times. If I'm too poor for insurance, I'm too poor for insurance.
If you don't have car insurance, you can't drive. What do you do to people who don't have health insurance? Put them in jail until they can magically afford it?


Well, there have been good designs of this sort of system and bad designs. A good design is requiring everyone to have health insurance, paying for it for the people who are poorest, and heavily regulating health insurers so that they can't deny people based on pre-existing conditions and the like.

A bad implementation is just requiring health insurance without doing that other stuff, which is the sort of drunken crazy you only get among deranged hobos and politicians. And, truth be told, that's not really fair to the hobos.

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Re: Universal Healthcare in the US

Postby haut » Sun Jun 22, 2008 6:13 pm UTC

Malice wrote:Perhaps it's just because I'm not familiar with his proposal, but that sounds ridiculous. That's like "solving" world hunger by requiring everyone to keep enough food in their homes at all times. If I'm too poor for insurance, I'm too poor for insurance.
If you don't have car insurance, you can't drive. What do you do to people who don't have health insurance? Put them in jail until they can magically afford it?


Mitt Romney's plan was passed in the state of Massachusetts in 2006 and as of the end of last year residents were required to have insurance or they lose their personal income tax deduction on their 2007 taxes. By the end of 2007, ~67% of uninsured Massachusetts residents obtained insurance and I'm sure this number will go up. As for the "too poor" aspect - if you are below a certain level the premium is subsidized. Also employers with >10 employees that don't contribute to health care are assessed a fee. There are likely changed regulations (maybe not being able to deny someone?) for the insurance companies providing these individual plans, but I haven't seen anything. There is a lot of information here, on the state of MA's Commonwealth Connector site. The system seems to have improved the access, but I don't know if it has has an impact on the cost of healthcare. The system has its pluses and minuses but it does attempt to provide universal access and should achieve 100% coverage at some point.

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Re: Universal Healthcare in the US

Postby Vaniver » Sun Jun 22, 2008 10:00 pm UTC

Gunfingers wrote:So, y'know, statistics will mean whatever you want them too, i guess.
Thanks, I missed that bit of the website (I don't remember his link going to where it goes to now).

Malice wrote:I believe Vaniver mentioned wait times. First, any health care system, regardless of who pays it, can be designed and run poorly or well, resulting in high wait times or low ones.
Secondly, the difference between the two scenarios is, that extra 72% is either making everyone else wait longer, or they're dying on the fucking street. Whining about wait times in a universal health care system is--well, it's remarkably cold-hearted, to say the very least.
If you were running an overworked health care system, who would you cut service to first?

Spoiler:
Probably the best answer is "people about to die," because that's generally where dollars spent return the least in health improvements. But that's not an answer most people are likely to be happy with. Instead of ordering things by impact, things will get ordered by urgency- the squeaky wheel gets the grease. So preventative care and regular checkups will decline, which will probably cause the number of people with critical conditions to increase, further cementing the permanent crisis mode that medicine will be in.

Wait times, especially for preventative medicine, can have a serious impact on overall health- and focusing on preventative medicine in an overworked system requires abandoning more urgent cases.


So, I definitely agree that, if the choice was between adequate health care for all and adequate health care for 60% at roughly the same marginal cost, it would be disturbing to see a society with so little compassion that it would choose the second. But the cost for adding the remaining 40% to the customer base will probably not be two thirds of the current cost for 60%.

To look at it another way, "we can't afford health care" and "health care is too expensive" are two related, but distinct, problems. Fixing the second will fix some/most of the first (you'll still get those without incomes that are unable to afford health care, no matter how cheap, but it seems that we have programs in place that can help deal with that). Fixing the first without fixing the second will probably make the second even worse- either prices will skyrocket, or you'll have to resort to price controls, which is almost always a sign that your plan has gone horribly wrong.
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Re: Universal Healthcare in the US

Postby diamonds » Mon Jun 23, 2008 4:16 am UTC

Gunfingers wrote:Socialized healthcare works. ...
That said, it turns out privatized healthcare works too. ...

Good points, +1 Insightful.
Except these two.

Socialized health care, well it works, strictly speaking, but it is hardly ideal. In fact, it is very far from ideal. It suffers all the problems that private health care does, you don't spend your own money. When you don't spend your own money, you spend it carelessly. Anyone on insurance, how much did you spend on your last check up? Try asking your doctor. Will they know? Likely not. When insurance starts covering everything, you stop caring--You stop charging the minimum for an audience of patients and families and the poor, and you start charging as much as you can wherever you can for the audience of companies and governments paying for it. This isn't going to change with public coverage.

Secondly, no one considers where this money is coming from. The people who propose this encourage "freedom" and "liberty," but really they are words foreign to those people. The US government isn't a communist nation, or totalitarian, but a Republic (democracy), a government of the people. So it becomes even worse then spending a corporation's money, you are spending the peoples money, taking it from tax payers and redistributing it, people start going to the ER for every little thing they could treat themselves at home, and phone their doctors office about, and more public money is wasted. Economic freedom is no different then freedom of speech, civil liberties, or other freedoms. (As an aside, this is the same reason why sanctions on countries like Iran are a bad idea: sanctions hurt the people, when the real target is the government, also consider that big governments flourish in a depression or bad economy, look at FDR or Hitler.)

One of the catch phrases for social medicine I hear is "take the profits out of health care," which is absolutely and completely wrong for a number of reasons. US law requires patients are given treatment regardless of ability to pay, and if they aren't, you have a problem in the Executive branch, not a shortage of legislation. Secondly, profit is a very good thing. Profits are what drive a capitalistic economy to efficiency. A great majority of medical innovations come from private American industry. Not public funds, not social medicine countries, but companies. What about doctors? What encourages them to do a good job? Additionally, when you can hold doctors and hospitals responsible for their job, they will take measures to prevent mistakes. One hospital instituted insurance for procedures, all follow ups and related medications included in the cost, and it had the additional benefit of standardizing procedures more. That is capitalism in action.

And specific to the US, "universal" social health care would very badly hurt our health care which is the best in the world (ignore cost, yes, it is, stop saying otherwise). We could see most of the innovations that give Americans some of the best cancer survival rates disappear quite quickly.

Believe it or not, there used to be a time when you paid in cash for your regular appointments and check ups! It kept costs down! Amazing! Then government started regulating the industry (to "benefit" workers, nothing major), which drove up costs, which in turn produced calls for... you guessed it, more regulation. It is crazy. Health care is the only sector there is where insurance covers everything, even if you don't need it. Imagine if your car insurance covered oil changes, even gas, what would the cost would be?

Yes, we need less corporate industry in health care. You do not get that by changing to government run industry.

I do think we need protection for all individuals, against things they cannot control, which is one of the benefits of social medicine. Previous cancer, current disease, genetics, family history, nothing like that should affect your insurance rates. If we are created equal, we need to get treated like it. Things you could acceptably charge for would be drugs (non-prescribed/illegal/tobacco/alcohol), what food you eat (if I get a discount for eating, well, that is capitalism at work for your health :D), living conditions (Asbestos, depends I guess, idk), Job maybe (haven't looked into the affects of what might happen if that was the case), etc.
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Re: Universal Healthcare in the US

Postby e946 » Mon Jun 23, 2008 4:00 pm UTC

diamonds wrote:Socialized health care, well it works, strictly speaking, but it is hardly ideal. In fact, it is very far from ideal. It suffers all the problems that private health care does, you don't spend your own money. When you don't spend your own money, you spend it carelessly. Anyone on insurance, how much did you spend on your last check up? Try asking your doctor. Will they know? Likely not. When insurance starts covering everything, you stop caring--You stop charging the minimum for an audience of patients and families and the poor, and you start charging as much as you can wherever you can for the audience of companies and governments paying for it. This isn't going to change with public coverage.

Secondly, no one considers where this money is coming from. The people who propose this encourage "freedom" and "liberty," but really they are words foreign to those people. The US government isn't a communist nation, or totalitarian, but a Republic (democracy), a government of the people. So it becomes even worse then spending a corporation's money, you are spending the peoples money, taking it from tax payers and redistributing it, people start going to the ER for every little thing they could treat themselves at home, and phone their doctors office about, and more public money is wasted. Economic freedom is no different then freedom of speech, civil liberties, or other freedoms. (As an aside, this is the same reason why sanctions on countries like Iran are a bad idea: sanctions hurt the people, when the real target is the government, also consider that big governments flourish in a depression or bad economy, look at FDR or Hitler.)


Someone above said that one of the most important parts of any universal health care system would be reducing costs. If a trip to the ER costs half as much in the future as it does now, is it really so bad (I mean financially -- the other problems are obvious, but this is just an example) if people visit the ER twice as often?

One of the catch phrases for social medicine I hear is "take the profits out of health care," which is absolutely and completely wrong for a number of reasons. US law requires patients are given treatment regardless of ability to pay, and if they aren't, you have a problem in the Executive branch, not a shortage of legislation. Secondly, profit is a very good thing. Profits are what drive a capitalistic economy to efficiency.


The problem is a conflict of interests. You say yourself that profit is a very good thing, and paying money to fund visits to the doctor lowers profits. It is thus in the insurance companies' best interest to refuse treatment left and right, while it would be in the best interest of a government entity to serve the people.

A great majority of medical innovations come from private American industry. Not public funds, not social medicine countries, but companies. What about doctors? What encourages them to do a good job? Additionally, when you can hold doctors and hospitals responsible for their job, they will take measures to prevent mistakes. One hospital instituted insurance for procedures, all follow ups and related medications included in the cost, and it had the additional benefit of standardizing procedures more. That is capitalism in action.


Doctors are not wholly (financially at last) encouraged to do a good job. Private doctors stand to gain a hell of a lot more by recommending a more expensive surgery, prescribing medicine the patient doesn't need, scheduling visits that my not be necessary. If doctors were paid based on how healthy they made someone (This may just be an ideal though, considering it would be exceedingly hard to do this), they would have the same incentive to help people, and costs would go down.

Believe it or not, there used to be a time when you paid in cash for your regular appointments and check ups! It kept costs down! Amazing! Then government started regulating the industry (to "benefit" workers, nothing major), which drove up costs, which in turn produced calls for... you guessed it, more regulation. It is crazy. Health care is the only sector there is where insurance covers everything, even if you don't need it. Imagine if your car insurance covered oil changes, even gas, what would the cost would be?


If that analogy were correct, gasoline would be the equivalent of food and an oil change would be the equivalent of OTC medicine, none of which are covered or should be covered.

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Re: Universal Healthcare in the US

Postby Vaniver » Mon Jun 23, 2008 4:34 pm UTC

e946 wrote:Someone above said that one of the most important parts of any universal health care system would be reducing costs. If a trip to the ER costs half as much in the future as it does now, is it really so bad (I mean financially -- the other problems are obvious, but this is just an example) if people visit the ER twice as often?
If costs are reduced by half, then yes, it's comparable to today's economic burden if people visit the ER twice as often- but reducing costs is not something the government can do by waving a wand. We need a lot more doctors, and they don't spring up overnight (well, they can if we let them immigrate in larger numbers)- and government action to increase the supply of medical services is very different than government action to increase the demand for medical services.

e946 wrote:it would be in the best interest of a government entity to serve the people.
If you're optimistic about the government and pessimistic about businesses, is there any suggestion that's likely other than "give the problem to the government?"
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Re: Universal Healthcare in the US

Postby Malice » Mon Jun 23, 2008 5:41 pm UTC

Vaniver wrote:
e946 wrote:it would be in the best interest of a government entity to serve the people.
If you're optimistic about the government and pessimistic about businesses, is there any suggestion that's likely other than "give the problem to the government?"


You have four options. Please correct me if there are more choices here.

1. If you can afford health care, you pay for it yourself. If not, you die. Sucks to be you.
2. A middleman company (HMO) spreads out the cost by taking on you and many other people, the majority of which are healthy at any given time. It's cheaper than health care, but if you can't afford it, you die.
3. The government pays for everybody, essentially acting as a mandatory HMO, paid for out of taxes, with the added benefits of accountability and proper motivation.
4. Aliens come down and make us immortal.

Are there other options in this problem? Either we pay for our own medical care, or we get special organizations to pay most of it for us, or we get the government to pay all of it for us. Am I missing something?

If not, we can evaluate these three choices. 1 doesn't work, too many people die. 2 doesn't work. It's not a matter of pessimism, it's a matter of fact. The fact is, our health statistics resemble those of a third-world country, our costs are through the roof, and people are dying or going into horrific debt because corporations are required by law to put profit over the health of their customers.
3 might work--it seems to work just fine for all the other first-world countries--and if it doesn't work, it can be fixed. With votes. You can't vote out a corporation.
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Re: Universal Healthcare in the US

Postby Gunfingers » Mon Jun 23, 2008 5:52 pm UTC

Well there's the option we use in the US, which is basically just an amalgamation of the first three options (and, to some CTers, the fourth as well) which amounts to lopping off the "if you can't you die" part at the end. Read my first post in this thread for a basic idea on how it works.

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Re: Universal Healthcare in the US

Postby Vaniver » Mon Jun 23, 2008 6:55 pm UTC

Malice, those choices are oversimplifications when results are altered by minor policy differences. As indicated before, there are a lot of things I would change about our health care system- but I think that its problems stem from bad system design. Just changing who pays for things won't fix the cause of the problem, and may make it worse.

Malice wrote:The fact is, our health statistics resemble those of a third-world country
Again, only if you heavily weight equality of access. According to the CIA, our estimated infant mortality for 2008 was 6.30 compared to the EU's 5.84. [src] Not that significant a difference, especially when you consider the world has an infant mortality rate of 42.64.
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Re: Universal Healthcare in the US

Postby Varsil » Mon Jun 23, 2008 7:02 pm UTC

Vaniver wrote:Again, only if you heavily weight equality of access.


Which probably depends on the degree to which you, people you know about, and people who you care about are in the category of people with good access as opposed to people with poor access.

According to the CIA, our estimated infant mortality for 2008 was 6.30 compared to the EU's 5.84. [src] Not that significant a difference, especially when you consider the world has an infant mortality rate of 42.64.


Yeah, but the appropriate comparison group is other first-world nations, not the world in general. The latter comparison is going to include a lot of nations with no money (and thus very little health care). Saying that your house is safer than one which is on fire doesn't mean much.

Edit to add: I also notice, looking at your source, that the "EU" there includes some nations that are very poor comparators with the US (for instance, Romania). If you look at the countries that are better comparators only, they are better still than your cited figures and the difference is very profound.
Last edited by Varsil on Mon Jun 23, 2008 7:09 pm UTC, edited 1 time in total.

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Re: Universal Healthcare in the US

Postby Gunfingers » Mon Jun 23, 2008 7:03 pm UTC

Well it was specifically in response to a remark that the US's healthcare is like that of a third world country.

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Re: Universal Healthcare in the US

Postby Vaniver » Mon Jun 23, 2008 7:09 pm UTC

Varsil wrote:Which probably depends on the degree to which you, people you know about, and people who you care about are in the category of people with good access as opposed to people with poor access.
There are people I care about in both, but there are more in the "good access" category.

Varsil wrote:Yeah, but the appropriate comparison group is other first-world nations, not the world in general. The latter comparison is going to include a lot of nations with no money (and thus very little health care). Saying that your house is safer than one which is on fire doesn't mean much.
So, my US-EU comparison is... inappropriate why?

[edit]
Varsil wrote:Edit to add: I also notice, looking at your source, that the "EU" there includes some nations that are very poor comparators with the US (for instance, Romania). If you look at the countries that are better comparators only, they are better still than your cited figures and the difference is very profound.
Yes, I'm aware that there are tiny nations out there with great health statistics. But it's ridiculous to compare, say, Iceland to the U.S. when just the New York City metropolitan region has 59.5 times the population of Iceland.

The US's statistics are somewhat worse than many nations with socialized healthcare. It's about 1.5 more deaths per 1000 born than the UK, and about 3 more than France. But we still come back to the central point that socialized systems will almost always score better under equality of access than non-socialized systems, and so asking which health-care system is "better" depends heavily on how you measure better.
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Re: Universal Healthcare in the US

Postby Varsil » Mon Jun 23, 2008 7:24 pm UTC

Vaniver wrote:The US's statistics are somewhat worse than many nations with socialized healthcare. It's about 1.5 more deaths per 1000 born than the UK, and about 3 more than France. But we still come back to the central point that socialized systems will almost always score better under equality of access than non-socialized systems, and so asking which health-care system is "better" depends heavily on how you measure better.


I think that a proper consideration here requires a couple more assumptions: A well-run socialized system (as opposed to one run by a corrupt or inept government) with substantial resources. This knocks most of the potential comparators out of the running (including Cuba--it's an aberration and not a good example).

That said, I don't think it would be unfair to say that any nation without a socialized health care program would have a very high infant mortality rate. The US isn't a counterexample to that claim because it /does/ have a socialized health care program--they're just set at a really low level.

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Re: Universal Healthcare in the US

Postby Berni » Tue Jun 24, 2008 1:59 am UTC

Doctors are not wholly (financially at last) encouraged to do a good job. Private doctors stand to gain a hell of a lot more by recommending a more expensive surgery, prescribing medicine the patient doesn't need, scheduling visits that my not be necessary. If doctors were paid based on how healthy they made someone (This may just be an ideal though, considering it would be exceedingly hard to do this), they would have the same incentive to help people, and costs would go down.


This is probably the most substantial argument against privatized health care I've seen.

The major problem is that with other products, people are able to shop around and make their own decision. However, with health care, it can often be risky (putting your life in your own hands!) or really hard (medical school isn't several years worth of training for nothing) to trust a second opinion that tells you a surgery isn't worth it, because hey, you'll be fine. With the way information travels these days, though, I see no reason that more and more people will be able to make decisions of that type for themselves, especially if they're paying for certain things themselves instead of, "who cares, insurance will cover it". Beyond education, I don't see a real solution, except maybe a third party to dispense advice. (Maybe give -this- job to the government.)

Truth be told, when I look at the U.S. Government, the last thing I think is, "they need to be responsible for even more".

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Re: Universal Healthcare in the US

Postby haut » Tue Jun 24, 2008 2:37 am UTC

diamonds wrote:And specific to the US, "universal" social health care would very badly hurt our health care which is the best in the world (ignore cost, yes, it is, stop saying otherwise). We could see most of the innovations that give Americans some of the best cancer survival rates disappear quite quickly.


Can you outline the statistics that you are using to make the assessment of the US having the best health care? From many of the statistics deemed important by medical professionals and healthcare policy analysts, the US is not the best. When access to care is factored in, the US looks worse than most other developed nations (we don't even need to get into cost). Based on the data I've seen, my vote would probably be for Japan as having the best. Maybe in the US its the case where the people with adequate insurance have stats equal to or better than other developed nations, but because the un- and underinsured are so numerous, they are bringing our rankings down as a country. I would highly recommend the Frontline documentary to get an idea of what other first-world countries' healthcare systems look like and how they operate to maximize quality while ensuring equal access.

Vaniver wrote:
e946 wrote: it would be in the best interest of a government entity to serve the people.

If you're optimistic about the government and pessimistic about businesses, is there any suggestion that's likely other than "give the problem to the government?"

Private health insurers in the US have about a 12% overhead compared to the ~4% of Medicare. In this case, I'd rather have the government running the show since they have shown that they operate more efficiently. I'm not against a program that involves private companies (it would be far less disruptive to those employed in the healthcare industry), I just want it to work better than our current system. In the Frontline documentary, they mentioned that the private companies in Switzerland had about 5% overhead, which is primarily due to smart regulation enabling competition without degrading quality of care. When it comes to profit driving quality and efficiency, I don't know if it applies in all fields of medical services.

Medical device and drug development is driven by profit and this seems to work very well - I would not like to see a system that removes this incentive to innovate. A reference I read a while ago (sorry, can't find a link) estimated drug company profits at 1% of the total healthcare bill. Even if the profits magically went away, not much would change in terms of overall cost, plus we lose any innovation in these fields.

The insurance industry is a tricky one to justify that the profits are actually improving their service. The way it should work is the company assesses the risks and costs of its claims and collects a premium from the customer (based on the risk/cost assessment) in exchange for a guarantee that if something happens, it will be paid for. Some companies will take more risk and collect less money and may get more customers, thus where the competition comes in. The way it really works is they collect the premium, but will do whatever is necessary to deny any claims. They build in as many technicalities possible and since they have more resources, they will often succeed in this denial of payment. It seems like the profits in this industry come more from denying (justifiable) claims than in taking on more risk. All of this denial takes more resources as well, which is driving these overhead costs. The profits for the doctor are also an interesting situation. More procedures is more money to them, but it is not necessarily better care. I think profits have their place in healthcare, but not necessarily in all aspects.

Vaniver wrote:If costs are reduced by half, then yes, it's comparable to today's economic burden if people visit the ER twice as often- but reducing costs is not something the government can do by waving a wand. We need a lot more doctors, and they don't spring up overnight (well, they can if we let them immigrate in larger numbers)- and government action to increase the supply of medical services is very different than government action to increase the demand for medical services.

I would not necessarily say "need" more doctors - here is a link to the # of doctors per 1000 people in other countries. We are certainly low on average, but we are nestled up with Canada and the UK. I would definitely want more doctors, however, since increased supply would help to lower the costs.


In countries with socialized healthcare systems, there are still private healthcare providers. Private hospitals and practitioners still exist, but they have a much smaller patient base as they are competing with a "free" system. In the US public school system, you can choose to not use it and send your kids to a private school, but you will have to pay for it. If a socialized system were introduced, employers could still offer private plans as perks to compete with other companies for your talent.

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Re: Universal Healthcare in the US

Postby Akula » Tue Jun 24, 2008 4:13 am UTC

My biggest problem with nationalizing health care in the US is that the proponents of such a move do not comprehend the costs involved. Yes, many countries with a socialist system pay less per capita. This does not mean that these per capita costs will translate to a similar system in the US. Anyone who's taken basic business classes should understand the concept of economy and diseconomy of scale. Costs do not change linearlly with the amount of production. Rather, costs change geometrically with production. At first, costs decrease exponentially with production. Then, as the size of a system continues to increase, more overhead, bureaucracy, and administration is required - costs go back up at an exponential rate.

So if we simply transplant the system used by, say, France (since everyone thinks their system is all hot shit) into the US, a country nearly ten times the size, the costs are not neccesarily going to be ten times as high, the same per-capita. The costs could be a hundred times as high, ten times per capita.

Like most things, I take a federalist approach. Let the states do it. If they want state run medicine, fine. If they want unregulated freemarket capitalist medicine, fine. We'll have 50 different experiments going on to get an idea of what works best. And each one can be custom tailered to each states specific needs. If changes need to be made, it's easier to change a small state wide program then a bloated federal one. If a program is an epic disaster, it's contained to one state, instead of foisted on the entire country.
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Re: Universal Healthcare in the US

Postby BlackSails » Tue Jun 24, 2008 6:02 am UTC

Rather than type out an incredibly long rant:

In the current legal and social climate: Nay nay nay, a thousand times nay.

You don't need a long rant, but some support/explanation of your position would be good. This is SB, after all. - Hammer

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Re: Universal Healthcare in the US

Postby Malice » Tue Jun 24, 2008 5:24 pm UTC

Akula wrote:Like most things, I take a federalist approach. Let the states do it. If they want state run medicine, fine. If they want unregulated freemarket capitalist medicine, fine. We'll have 50 different experiments going on to get an idea of what works best. And each one can be custom tailered to each states specific needs. If changes need to be made, it's easier to change a small state wide program then a bloated federal one. If a program is an epic disaster, it's contained to one state, instead of foisted on the entire country.


Sounds good to me, except for two things. I think that once you give states the power to do that, it's hard to take that back--ie., pick the best system out of 50 and force everyone else to follow it.
And I think you'd run into a lot of border-jumping problems. Much easier to cross state lines than it is to enter Canada or go to Britain.

In addition, a universal health care service makes sense economically as an investment in the (physical and economic) health of the workforce (and those around them). That's not going to work nearly as well for a state; New Jersey could spend five years curing Mr. Brown's cancer, on the principle that he will then work and pay taxes--only once he's cured he decides to move to Florida.
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Re: Universal Healthcare in the US

Postby Gunfingers » Tue Jun 24, 2008 5:54 pm UTC

Well the whole idea is that the states choose whether they want it. You don't force it on them. If one state has a system that works 'best' then other states will imitate it. Or not. Whatever, it's their call.

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Re: Universal Healthcare in the US

Postby 22/7 » Tue Jun 24, 2008 6:17 pm UTC

haut wrote:
diamonds wrote:And specific to the US, "universal" social health care would very badly hurt our health care which is the best in the world (ignore cost, yes, it is, stop saying otherwise). We could see most of the innovations that give Americans some of the best cancer survival rates disappear quite quickly.


Can you outline the statistics that you are using to make the assessment of the US having the best health care? From many of the statistics deemed important by medical professionals and healthcare policy analysts, the US is not the best. When access to care is factored in, the US looks worse than most other developed nations (we don't even need to get into cost). Based on the data I've seen, my vote would probably be for Japan as having the best. Maybe in the US its the case where the people with adequate insurance have stats equal to or better than other developed nations, but because the un- and underinsured are so numerous, they are bringing our rankings down as a country. I would highly recommend the Frontline documentary to get an idea of what other first-world countries' healthcare systems look like and how they operate to maximize quality while ensuring equal access.
Cost = availability. Ok, that's not really accurate. But availability is a function of cost. As cost goes up, availability goes down. Costs here are high, and thus, due to our current system, availability is low. What you've written above is extraordinarily misleading.
Totally not a hypothetical...

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Re: Universal Healthcare in the US

Postby Vaniver » Tue Jun 24, 2008 10:29 pm UTC

haut wrote:The insurance industry is a tricky one to justify that the profits are actually improving their service.
Free access to a single-payer system is probably the least bad way to improve health-care access,* but you still run into a lot of tricky situations when decided what should be covered. If we cover diseases with a known risk factor for smoking, does that increase the prevalence of smoking? If we deny coverage for those diseases to people who smoke, will we be unfairly denying some treatment?** What about something less clear-cut, like type 2 diabetes?

haut wrote:I would not necessarily say "need" more doctors
Right, "need" was probably too strong. But a plan to improve healthcare in the US that doesn't include more doctors is probably an incomplete plan.

Malice wrote:In addition, a universal health care service makes sense economically as an investment in the (physical and economic) health of the workforce (and those around them).
Well, that's only true if the return is higher than the cost, by standard market interest rates. My guess is that a lot of its return is not in dollar form- and so the argument for it swings on whether or not voters are convinced by its purported political and social gains.

*If you believe that people with low incomes are competent decision-makers, then subsidizing incomes does more good. But if we're just concerned with health, it's better to just provide health care access.
**It's possible to get lung cancer while being a regular smoker from something other than your smoking; it's just probably not what happened.
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Re: Universal Healthcare in the US

Postby Malice » Wed Jun 25, 2008 12:27 am UTC

Vaniver wrote:
haut wrote:The insurance industry is a tricky one to justify that the profits are actually improving their service.
Free access to a single-payer system is probably the least bad way to improve health-care access,* but you still run into a lot of tricky situations when decided what should be covered. If we cover diseases with a known risk factor for smoking, does that increase the prevalence of smoking? If we deny coverage for those diseases to people who smoke, will we be unfairly denying some treatment?** What about something less clear-cut, like type 2 diabetes?


No, see, that's the thing. You don't deny anybody. That way you ignore all those questions.
Any debate about smoking is generally going to be phrased as, "You're going to get cancer and die," not, "you're going to get cancer and it's going to cost a lot of money and who's going to pay for that, hm?". In other words, I doubt it would increase smoking, any more than having insurance companies cover it does.

The situation in The Simpsons where Homer's like, "Who cares if I run into oncoming traffic? We're in Canada! Free healthcare!" is not, shall we say, realistic.
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mercurythief
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Re: Universal Healthcare in the US

Postby mercurythief » Wed Jun 25, 2008 12:47 am UTC

First they will come for your cigarettes, and then they will come for your donuts.

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Vaniver
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Re: Universal Healthcare in the US

Postby Vaniver » Wed Jun 25, 2008 12:57 am UTC

Malice wrote:No, see, that's the thing. You don't deny anybody. That way you ignore all those questions.
How do you do that with finite resources?

Do you deny fraudulent claims?

Malice wrote:The situation in The Simpsons where Homer's like, "Who cares if I run into oncoming traffic? We're in Canada! Free healthcare!" is not, shall we say, realistic.
Decisions are made on the margin. If you decrease the cost of something, you encourage it, and if you increase the cost of something, you discourage it. It might not be very elastic, and the argument for health-related behavior being inelastic* is probably the strongest such argument. But, to the best of my knowledge, no one has looked very hard at the numbers involved (given the difficulties in doing so, that's unsurprising).

Probably the best proxy would be to look at the effects of cigarette prices on smoking prevalence, although that has a number of flaws.

*If being sick isn't disincentive enough, why would we expect having to pay for it to be disincentive enough?
I mostly post over at LessWrong now.

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Varsil
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Re: Universal Healthcare in the US

Postby Varsil » Wed Jun 25, 2008 1:14 am UTC

Vaniver wrote:
Malice wrote:No, see, that's the thing. You don't deny anybody. That way you ignore all those questions.
How do you do that with finite resources?

Do you deny fraudulent claims?


You deny fraud, and you deny claims that aren't actually medical needs (ie, a boob job). Note that in Canada no money trades hands at the hospital when it's covered by insurance. It's the doctors that file the claim. So as a private citizen I can't really defraud the socialized insurance, in that if I send them a letter saying "I totally had ankle surgery, I need my money back", they have a good laugh and throw it in the trash. So a hospital can commit fraud, but it's a lot more risky for them.

And you don't get infinite demand with zero cost. Medical needs are self-limiting. People don't show up at the hospital and say, "Hey, can I get some free chemotherapy? No, I don't have cancer, but it's free, right?" You also have the usual thing where the doctors serve as gatekeepers, too. You can't just have morphine because you feel like it.

Vaniver wrote:Decisions are made on the margin. If you decrease the cost of something, you encourage it, and if you increase the cost of something, you discourage it. It might not be very elastic, and the argument for health-related behavior being inelastic* is probably the strongest such argument. But, to the best of my knowledge, no one has looked very hard at the numbers involved (given the difficulties in doing so, that's unsurprising).

Probably the best proxy would be to look at the effects of cigarette prices on smoking prevalence, although that has a number of flaws.


If you want to affect people's behaviour by raising costs, you really need to do it by raising the immediate costs. Costs that are delayed way into the distance play very little role in people's decision-making (because humans are shitty decision-makers, really). Hell, assuming that people are rationally making the decision to smoke because the costs are insufficiently high seems a little crazy to me. This is emphasized by the point that almost all smokers start while they are teenagers, when their brains are still developing the ability to do things like long-term planning.

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Re: Universal Healthcare in the US

Postby Kendo_Bunny » Wed Jun 25, 2008 1:48 am UTC

Probably one of the best ways to lower healthcare costs is to educate people about how insurance works. Medical malpractice suits that award millions of dollars drive up healthcare costs across the board. To show how this works, how about taking John Edwards famous cerebral palsy case?

He claimed that cerebral palsy could be prevented from performing C-sections early. There's a reason doctors didn't like performing C-sections- it's more complicated, more expensive, and more risky for both the baby and the mother. It also has absolutely no effect on whether the child has cerebral palsy or not. However, millions were doled out after the trial. To recoup their losses, insurance companies raised premium prices on general Obstetrics. However, because of the junk science made truth, doctors felt that if they didn't perform a C-section and the child was born with cerebral palsy, they could be sued into oblivion. So they began performing more C-sections- increasing mortality for delivering women. Dead mothers also fetch quite a chunk from the insurance companies, so premiums were raised even higher. Doctors who couldn't afford insurance went out of business (including the doctor who delivered me). Doctors who were left needed to raise their own prices to handle the insurance costs, plus, now that they had fewer peers, people had fewer options.

I know people are entitled to a jury of their peers, but I think a good chunk could be taken out of the out-of-control medical costs by requiring a jury of scientists and physicians for medical malpractice suits, and heavy fines for knowingly frivolous suits.

I'm generally opposed to anything that would expand the government at all, but I do think we need to give doctors at least the same student loan breaks that we give teachers- probably more.


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