Draginol Draginol

Be wary of "free" health care

Be wary of "free" health care

The problem with universal healthcare

The universal health care issue is such an emotionally charged issue that it's difficult to have a rational discussion about it. The problem with universal health care isn't specific to health care but rather to any solution that involves 100% coverage.

So to try to move the discussion away from a hot topic like health care, let's instead look at it in a way that more people will understand without emotion kicking in.

After being elected emperor, I decide everyone should have a television.  Because I have only so much to pay for these televisions, everyone receives a 35 inch TV.  After all, we couldn't afford to give everyone 60 inch plasma TVs and 35 inch TVs are pretty good.

So now everyone has a 35 inch TV.  But what about those people who want a plasma TV? Well, the price has gone up because you no longer have economy of scale working in your favor. Enough people are satisfied with the 35 inch TV that sales of the higher end ones plummet and so the cost of higher end TVs goes way up.

You then end up with a small group of rich people who get the big plasma HDTVs and the rest have the "free" TV.  But what's wrong with that?

Well it gets worse. So time passes and because sales of the higher end TVs are so low, the TV manufacturers have cut back on R&D.  And since the government has agreed to give everyone 35 inch TVs, there's no incentive for the manufacturers to lower their price on those TVs. In fact, they can slowly increase the cost on those TVs over time since, after all, what is the government going to do about it? And what does the government care anyway when "Caring" is measured in dollars spent, not results (look at federal education spending).

So rather than having seen increasing sales of higher end TVs in our reality that would bring the cost of older generation TVs down, we instead are stuck with these 35 inch TVs year after year after year.

This is precisely what happens in socialistic countries. The more socialistic it is, the slower the improvements are. Why make 1 inch thin, 75 inch HDTV displays when few people will buy them? Why even try when you know that the government is going to buy millions of the 35 inch displays each year?

Over time, the result is that we all end up with crummier TVs. At first, it wasn't so bad, everyone got a free 35 inch TV. Not too shabby. But by taking individuals making their own purchase choices out of the equation we effectively eliminate the incentive to innovate. 

We also effectively limit competition.  If the government goes with a single supplier such as Sony (or worse, builds its own TVs) then other TV producers will effectively be driven out of business or to the fringes. Or if the government goes with a confederation of providers, you end up with an artificial competition with only 1 buyer -- the government and the rest colluding on price (which is what happens in other industries).

Now this example is obviously an over-simplification. But you get the general idea. Any system that guarantees 100% coverage is artificial by definition and results in a slowing of improvement and quality of service. After all, in a capitalistic market, you can walk away - you can choose not to buy a product or service. But in a socialistic market, you are forced to buy -- you have to pay your taxes.

The reason why the United States enjoys the best material standard of living in the world is because it made a fundamental cultural decision long ago: Individual are on their own.  As a culture, we have decided that we can live with a small percentage of people failing utterly so that the rest of society can move forward. It sounds harsh and cruel on the surface but the alternative is a system in which all people are treated equally cruel.

Improvements in health, medicine, consumer goods, and services are almost always the result of individual initiative and the best way to encourage that is to create a system of self-interest -- where individual initiative is rewarded. That the selfishness of the individual benefits society.  That is, in effect, the goal of regulated capitalism.

In the United States, most people have health care. In fact, over 90% of the people in the United States either have health care or could easily afford it if they chose to. That is an impressive accomplishment in a capitalistic society such as ours.

It is a system that enables someone who is diagnosed with a heart condition to get in and have surgery within that week. It allows someone (like me) who wants to get Lasik to get an appointment and have it done within a couple of weeks. It allows someone who has the flu to make an appointment and get in that day to see the doctor. And it does this at a relatively reasonable cost.  And it does this with an incredible array of improvements being made technologically all the time (most improvements come from the United States btw -- nations with socialized health care make relatively little medical progress and find their improvements largely as a result of taking advantage of breakthroughs from the USA).

So the question you have to ask yourself is, how much are you willing to give up so that the last 10% of the citizenry receive "free" health care (free in the sense that you're paying for it). Keep in mind, right now, most Americans literally pay nothing for their healthcare. It's part of their job compensation and they don't have to claim it as taxes (and many companies let you opt out of it and take it as direct money compensation). Whereas a "free" system means you'll be paying it in taxes not just for yourself but for others too. And for vastly inferior service and a slowing rate of improvement.

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Reply #26 Top
If universal health care is so bad then why do the people who live in Canada, Sweden, Switzerland, Australia, Norway, United Kingdom, etc., all have a greater life expectancy than those who live in the US?

Here is some info on how good the US health care system really is:

-The United States ranks 23rd in infant mortality.

-The United States ranks between 50th and 100th in immunizations depending on the immunization. Overall US is 67th, right behind Botswana.

-The United States spends at least 40% more per capita on health care than any other industrialized country with universal health care.

-Federal studies by the Congressional Budget Office and the General Accounting office show that single payer universal health care would save 100 to 200 Billion dollars per year despite covering all the uninsured and increasing health care benefits.

-Single payer universal health care is not socialized medicine. It is a health care payment system, not a health care delivery system. Health care providers would be in fee for service practice, and would not be employees of the government, which would be socialized medicine. Single payer health care is not socialized medicine, any more than the public funding of education is socialized education, or the public funding of the defense industry is socialized defense.

-71% of doctors believe that managed care has caused quality of care to be compromised.


Reply #27 Top
Ok...there are some problems with your blog here. For starters, it's fallacious to compare TVs (or any mass produced item produced for a market) with a program aimed at raising overall health AND lowering overall cost. A socialized health care system's goal is not to a) take away choice, b) syphon money from R&D, or c) any of the other stuff you were talking about. Socialized health care's goal is, and always has been, to prevent further, higher costs by employing preventive measures. Even as it stands now, without institutionalized national health care (although we have it in practice), you present a fallacious argument.

I will grant you some of the other rhetoric you've got there about 'socialistic' countries. However, I will point out, as I've had to do before, that we have never realized the existence of a fundamentally socialist state. But, I'm sure you were talking about the Soviet Union, because that's what people always talk about when they think they know how socialism works, so I feel I can address this issue. Say this with me -- The Soviet Union was NOT a socialist country. By its admission, it was a communist state, which is different. However, they weren't really communist, either. And...IF I were to allow your use of these 'socialistic' states, I would point out that no country has ever undergone such wide, pervasive technological advancement as Russia did under Soviet rule. (No, not even here in the US with our digital revolution. In the Soviet Union, we're talking about taking a bunch of people who can't even read, and who are practically still banging rocks together, and within a decade turning the state into a machine that could combat, and eventually defeat through massive resource allocation, the Nazi war machine.)

What you would do well to consider is how much you are already paying for the lack of health care in this country. Make no mistake about it, when people in the US need...I mean, really, really need health care...they get it. That's the way it works. (Trust me, I work in the health care field.) And you pay for it, at an increased rate, because the physicians and insurance companies (my side), pass the loss on to those consumers who can 'afford' it. And, yes, opting into pre-tax payments for health care benefits is sweet and pretty, but small business...which has fueled and continued to fuel economic growth in this country...cannot afford to offer health coverage...AND, having opted into a pre-tax health care plan, I can tell you that I don't get it for free. When my tax dollars are diverted to pay for this 'free' health care, it does affect my after tax income, and it also affects my overall tax rate as dollars are diverted from other public works.

Don't get me wrong here, Jacko, socializing a health care system isn't something you can just walk into. Far from it. But, and you can mark my word on this, an economy as bloated as ours, and as bloated as ours will need to be to compete in the markets of the near future, cannot burden the weight of uninsured and underinsured citizens. (By the way, if people were looking at this debate seriously, the question of being underinsured would pop up in this discourse more often.)

And, anyway, if you're complaining about losing some PRODUCT or commodity value by socializing health care, I would say "So Fuckin' what." So maybe we have to divert money to treating indigent people with TB and HIV, instead of...what?...pumping ten year olds full of Zanax? Zoloft? Prozac? Ritalin?

It's a bit hypocritical for a nation such as ours, with a generation of children being prescribed into drug abuse, and an obesity rate that blushes the Romans, to even be discussing this subject. If our recent history has proven anything, it's that Americans are not capable of making rational, well-informed decisions regarding their own health care. If we were, then we wouldn't be in the predicament we're in -- Crying and complaining about how we will afford to pay to treat preventable diseases.
Reply #28 Top
Jonathon Ellis:

You're wrong about the lawyers and insurance. Here's why: insurance is a measure of shared risk. So, malpractice insurance is a shared risk pool among doctors for the mistakes they make and the consequences of those mistakes. This is not McDonald's coffee we're talking here. The doctors could start their own malpractice insurance company the way many companies have their own private healthcare plan for employees.

Some doctors in Boston a few years ago tried this. But the problem is, doctors make mistakes quite often. The plan failed. Especially in this "get 'em in, get 'em out" medical system which is more interested in expediency than health care. Yes, the awards are high when mistakes occur, but blaming lawyers fees for doctors' mistakes is like blaming the horses for the farmer leaving the barn door open.

Reply #29 Top
I'd like to extend Not a Moron's line of argument a bit: what's lacking is a reasoned philosophy of health care based on why a society (e.g., my own, Canada) wants people healthy.

On the why side of things, at minimum I think North Americans can generally agree:
a) people who are healthier tend to be more productive in their endeavours (e.g., work, learning, hobbies, etc.) than people who are not, and
b) we have compassion for those suffering from ill health.

How the society values each component above will ultimately affect what kind of philosophical approach will be taken towards health care. For example:

I argue that Canadians as a society place equivalent value on the above two propositions: our view is that people with equivalent ill health should have an equivalent opportunity for treatment with an emphasis on resources being placed where the greatest need is.

What I've just said is not a policy or an implementation of health care -- merely the philosphical basis upon which those two can arise.

Canadian policies on health care have (for the most part in most places) been focussed by the legislative statement of this philosphy, the Canada Health Act (Link). Responsibility for delivering health care is primarily on the provinces (regions) whereas the maintenance and enforcement of the guiding principles is a federal matter.

What's gone "wrong" with the way Canada has put together health care?
- entry into the health care system is theoretically low: clogging up the works at the primary points of care (family doctors and emergency access). This has lead to both artificial (e.g., premiums, user fees) and market (e.g., fewer family physicians) barriers to entry being erected
- people with resources (i.e., money) who want to the ability to speed their access to health care are artificially discouraged from doing so, e.g., most private care is accessible only by the highest income/power groups (e.g., pro atheletes, very rich) who have the influence and wherewithal to ignore or avoid public resentment
- no one has ever found an effective way to "bill" people such that access remains universal (i.e., everyone essentially pays the same) but those who actually use the system realise the extent of their added burden (e.g., how much money and time it costs the rest of us)
- due to historical reasons, certain aspects of medical care are entirely private (e.g., dental for non-seniors) with a large proportion of the population neglecting their health in these areas relative to their financial resources
- we have lost many health care professionals to other jurisdictions (e.g., USA) due to frustrations with relative compensation and/or responsiveness of the system

What are people "happy" with in the Canadian system?
- once you're into the treatment phase (i.e., past the entry points) the system is as modern and (most importantly) as effective as anywhere in the world
- research into both high impact (e.g., cancer, heart problems) and relatively low incident (e.g., in Canada, AIDS) diseases is active and leading edge due to rigorous public and private funding
- economies of scale in purchasing have lead to benefits like relatively low drug prices
- relative to most of the world, we have a very healthy population except for the "first world" diseases like obesity
- finally, given that mental health is an important aspect of overall health, it would be wrong to trivialize the comfort that knowing that ill health doesn't mean poor treatment or financial disaster wherever you are on the income scale

What seems to be the "same" as with our southern neighbours?
- intellectual property rights and process w/rt to genetics and pharmaceuticals is still somewhat of a jumble due to political uncertainty about the fundamental issues
- clashes between commerce and science and politics over environmental and health issues has made a hodge podge of preventative measures
- policy and practice for lifestyles detrimental to good health are fragmented, inefficient and ineffectual, e.g., life insurance has premiums that scale with respect to lifestyle, but no equivalent "punishment" is available at the primary care end even though it's demonstrable that these people will (sooner or later) place a disproportionate burden on the system
- costs of the system relative to GDP appears to be rising alarmingly -- how much you believe this depends on how much you believe that the total cost of health care has been accurately measured

To put things in a more accessible perspective ...

1. Person A is a high flight sysadmin. Shaped like a ya pear, with the temperament of a cornered badger and the appetite and hygiene of a starved, dyspeptic goat, he is a legend in the technical community. Works seemingly all the time and is the underpinning of a large company's IT infrastructure. Compensated well enough to be immovable. Surprisingly still single.

2. Person B is a professional activist. Between trying to discover colourful phrases to rhyme with "hemp" and worrying about the nutcase who swears he'll go insane if he hears Kumbya again [me], he runs a vegan "cafe" with his significant other. Constantly worries that his kids are being taught to be faceless cogs of the machine. Hasn't needed (and doesn't believe in) the "white man's medicine".

To the Canadian system, if these two have the same medical problem, then they should have the same chances of getting treated.
Reply #30 Top
Interesting article. Of course, I don't agree.
This has led to a scenario where, in poor urban areas, the hospital ER becomes the primary care physician.

This kind of scenario has to be more expensive than doctor's visits.

Insurance companies are very powerful here. There won't be free health care for everyone.

Reply #31 Top
Doesn't Canada use price controls on drugs?

The long wait times in Canada are the manifestation of a simple economic law: price ceilings create shortages.
Reply #32 Top
I agree with your arguement addressed in this article and I shall add another arm too it . How many people are aware right here in the USA prisoners have better healthcare then most of us average middle class! Why? Because of a 1976 Supreme Court ruling taken to the extreme.

I think it's incredibly sad that if you know you have a health condition whether serious life threatening/superficial all you need to do is commit a crime if you cannot afford healthcare to get excellent coverage right down to beverely hills dermatologists!

This is ludicrous to me ! There is a brief article in Reader's Digest That's Outragous column siting these as just a few adding in Dialosis treatment for those on death row costing more $120,000 annually down to a man who commited armed robbery recieving a heart transplant $900,000 at the cost of CA taxpayers while 3,600 others on the list that were law abidding citizens with HMO's some passing on as they waited for their turn. Maybe if they hadn't had such strong values they could have survived.....sad isn't where our priorities lay it disgusts me.


I currently do not have healthcare coverage unfortunately but I am not whinning to the world to pay for it for me nor commiting a crime with the knowledge of heh let me make sure I get all my healthcare appointments in before my 1year or less is up.

Which is the case our elderly that paid their taxes all their lives are not covered for dental or eye they pay for that they pay for their hearing aids yet all these things are covered for our criminals that are serving time. We cover their gender change issues costing tax~payers $3,000 a month for hormone treatments ect....If we do not they take us to court stating it's cruel unusual punishment.

Why is all of this ok?

Heh maybe Martha Stuart knew all this besides her tips and weighed out she would actually save more if she got all her appointments in while she serves her 5 months.

~Have a good day~

~Peace,Love,Health & Happiness~ Extended to all
Reply #33 Top
Doesn't Canada use price controls on drugs?


Here's Health Canada's little blurb on the cross border pharmaceuticals issue (Link).

The long wait times in Canada are the manifestation of a simple economic law: price ceilings create shortages.


You're assuming the price ceiling is relatively low which creates the incentive for maximal consumption -- I agree with this in general (and already said so above -- though probably not as clearly as it should've been). But this has always been one of the fundamental problems of health care: how to price it within reach of everyone society decides should have health care. In Canada, that's pretty much everybody.
Reply #34 Top
A few years ago, one of my friends was the recipient of a gift of hit 'n run goodness from a car. While he was not in a car. Messed him up very, very badly. They hauled him off to a hospital, of course. The guy who hit him was never caught. He didn't have a fraction of the money necessary to pay for an extended recovery period in a hospital. He wound up claiming to be homeless in order to dodge the bill. Unethical? Yeah, it was. But, if I was in the same situation, hurt badly through no fault of my own and staring down a decade or so of paying a hospital for patching me back together, I can't say that I'd have done differently.

My father, driving along an interstate on a rainy night, got run off the road by a swerving truck, hit a tree, got banged up a little from the high-speed impact despite the seatbelt and airbag. In fact, the seatbelt bruised one of his kidneys. A week after the accident, I get a call in the middle of the night that he's in hefty pain and needs a lift to the hospital, so I take him. We sit in the ER for an hour or so, doctor comes by, sticks him with a bag full of painkillers. Another hour or so, they wheel him off for some scans, and I go to bed. They found the whole kidney issue, gave him meds for it, problem solved. Hospital bills him twenty grand. His health insurance covered about half that. If his car insurance hadn't had injury coverage, he'd have been stuck with ten grand to pay out of pocket, but as it is I think he wound up paying about one grand thanks to having multiple layers of insurance. If he hadn't had that health insurance, he'd have been obligated to pay eleven thousand dollars for one night in a hospital. That's more than some people make in a year here.

If you need medical help, you should receive it, simple as that, without worrying about whether your insurance company will screw you on the bill or the hospital'll take possession of your house if you can't pay. You shouldn't be sitting in the lap of luxury and getting elective surgery for free, certainly, but if there is a genuine risk to a person's life, there is an obligation in a nation to come to that person's aid.

By the same token as socialized medicine, we already have socialized emergency services. Are we suffering from a bad quality fire department? Does the coast guard only rescue rich people when their boats break down? No, these people do their jobs and do them well. So why, if the fireman who pulls you out of your wrecked car doesn't send you a bill, should you be looking at paying ten grand when a hospital finishes the job by stopping all the blood from leaking out of you?

Right now we have a system where the insurance overcharges the patients (and then turns around and overcharges the doctors for malpractice insurance), the hospital overcharges everyone, the pharmacorps overcharge everyone, and the end user gets screwed from three different directions. That system needs to go. I approve of free trade, right up to the point at which people get to freely exploit other people. That's the point where it's time for the government to step in, kick some ass, and set things back to a reasonable and proper level. Getting the leeches out of healthcare is all I want to see, because there's nothing wrong with paying a reasonable amount for getting treatment. But if going to socialized medicine is the step it will take to get needed reform, then I'll support it.
Reply #35 Top
Your thesis is incorrect as I read it.

You mix the idea of "universal coverage" with HOW that can be achieved (ie everything through state-controlled entry points vs. the ability of the health care recipient to choose the best service). These are entirely different arguments, but by mixing them togther, these two issues become confused.

1. Generally, universal coverage is only universal - in countries providing government paid-health care - to a minimum standard (just like your HMOs, right?), not to the brightest and newest of whatever is out there.

2. Providing service only through state-mandated price/entry points (again, similar to an HMO) reduces the innovation that's built into the system.

These are very different arguments, and very different issues. This issues need to be de-coupled before anyone can say exactly what the problems are (and how to solve them) with both universal health care, and HMOs.

One obvious difference, as has been pointed out, is the cost. Countries with socialized medicine pay about 10% of their national income (and its a lower per person national income than in the USA) to health care, while the US pays about 15% of their national income (again, thats also a higher national income per person). Add to the fact that probably 10% of Americans under-utilize their health care (that is, according to what they need), then the costs are even higher on an absolute basis.

All this, without significantly better health outcomes in the US. What gives?

JW

Reply #36 Top

The only way you can get 100% of coverage in a society is if it is mandated by a government. I don't see any other way. And as soon as any product, good, or service is mandated to be made available to everyone then market forces go out the door and the results become predictable.

What I describe here, btw, isn't really that theoretical, it's essentially what has happened in socialistic countries (such as the Soviet Union and Eastern Europe and to a lesser extent western europe).

Health care in the United States is significantly better - if you have decent insurance. It's hard to really take anyone seriously who tries to argue otherwise.  This has been documented thoroughly elsewhere about the long lines.  The simple fact is, the horror stories people hear of having to wait months or years for a critical operation simply don't happen in the United States.  We also pay significantly more for health care in the United States as well but that is the choices of millions of individuals rather than the choice of a handful of political elites - most of whom have no experience in business reality.

Reply #37 Top
Hell people talk about job losses, but if something like this became a reality, doctors, nurses, assistants, clerks, etc. would be out of job because they would have to work at the hospital or certified location for treatment as authorized by the Feds.

Sure complain about job losses but support a government measure that creates more job losses is that even sane?

- GX
"I have no answers to your questions, but I can question your demands." - Motto Inspired by Laibach's WAT
Reply #38 Top
Health care in the United States is significantly better


Not true. Study after study has shown very little differences in health outcomes between the two countries. There was just a recent news article I read documenting a study in a peer-reviewed journal to that effect. I'll try to find the link. While their are, without a doubt, problems in the Canadian health care system, overall outcomes visa-vie the US isn't one of them.

JW
Reply #39 Top
Here's something to consider: "Is US health really the best in the world?" (Link)

Note the link is to the PubMed citation -- the actual journal is at JAMA (registration is free but required for archived articles).

No conclusions are reached on why the United States (among its economic peers) ranks so low in the health indicators -- the article goes out of its way to emphasize that nothing certain can be concluded with the data at hand, much of it contradictory. It does raise some interesting points though:

1. It is inconclusive that getting treatment from a specialist naturally results in a better outcome.
2. The high availability of advanced diagnostic technology (e.g., tomography, MRI, etc.) in the USA (second to only Japan) seems to lead to more aggressive pursuit of treatment. This is not necessarily a good thing, as, by contrast, Japan's health indicators are higher whereas the resulting rate of treatment from the diagnostic imaging was much lower than the USA.
3. It is demonstrable that the ratio of primary care physicians to the general population results in better health outcomes. However, there is some evidence that says the opposite is true given a high ratio of specialists to patients or primary care physicians.
4. States with a more equitable distribution of income tend to show greater access to primary care.
Reply #40 Top
Jay, it depends on how you define "better". For me, waiting for care is unacceptable. Insured Americans, and nearly all Americans are, can get fast, effective health care. That's the bottom line for me.
Reply #42 Top

Reply #41 By: carlos (Anonymous) - 10/20/2004 2:42:27 PM
Explain Canada, U.K,Japan ect.


What about them? There have been other threads on this. Their healthcare is worse than ours. IE: Long waits, rationed care, blah, blah, blah.
Reply #43 Top
Draginol....Well written old man.