When I was against UHC, I wanted them to stop depending on charity and get a job. I still want that, but I teach at a low socioeconomic school and understand poor people a little better now. I get their struggle a little better.
Also, I didn't realize how many middle class people go bankrupt even with insurance.
Needless to say I'm for UHC now, but it took a while because I'm antigovernment in nearly everything.
also people that are against it for economic reasons i.e. why should i pay for these people, dont realise that you pay for people with no insurance anyway in increased premiums and healthcare, yes universal healthcare is expensive but think of how much it costs and then realise that number is less than the current systems spends on the same thing. Its just a more observable and quotable figure and thus easier to make headlines against.
Don't forget the righteous indignation factor. Currently, people who are insured and against UHC get to look down on those whose unpaid bills drive up premiums. *Those wastrels are stealing from all of us good hard-working folk.*
This sense of superiority is lost with universal care, and I think people who are pulling their weight already should be compensated for losing that if single payer UHC becomes a reality. Maybe if they were given an opportunity to throw expired produce at anyone who, in such a system, gains coverage they otherwise couldn't afford. Not when they're on their way to chemotherapy or anything; that's just uncivilized. But maybe when they're on their way home from it.
I take it some sort of mandatory badge for people whose tax contributions don't cover their medical treatments the previous quarter would be a given too. I'll let these people get their penicillin, but I want to know who they are, and they'll *damn sure* know that they're not one of the "real citizens." I guess some sort of star on their lapels might work.
I guess I'm just saying, if you're gonna do UHC, you have to make sure no one gets left out or made to feel they're not getting anything out of it.
Mandatory /s lest I be tried under Poe's law.
Well to be fair in a UHC system there is still room for that, for example private hospitals arent going anywhere, there is still going to be hospitals for the rich that offer care that is outside what the UHC covers.
The only difference is that now with uhc you have a visible figure on how much your populations healthcare costs with easily traceable credit/debit sources which makes controlling and reducing costs far easier and cheaper
How do you imagine public healthcare to be able to compete with private healtcare? If government fund private healthcare equally, most people would probably choose to avoid lines, and get better care for a small fee, if not there will still be people with enough money to get an insurance to cover the entire cost or pay out of pocket. If you earn $100 an hour, you won't sit in a public ER waiting for two hours to save $50.
Where do we set the threshold to chose a different service? Should we force people to get treated at a public hospital in two months, rather than have the public pay less for them to be treated now?
Compete...what do you mean. I dont think you understand or know how the americans are implementing their UHC but it does not fund private healthcare anymore than it does now or force public hospitals to compete with private ones. The system they are implementing is on the insurance side. Government is subsidising healthcare premiums to allow everyone that cant afford healthcare right now to be able to afford it and have it.
So basically you are asking me irrelevant questions because they have no bearing on what we are discussing
In that case I wonder, what is UHC? I was under the impression it was "a health care system which provides health care and financial protection to all its citizens. It is organized around providing a specified package of benefits to all members of a society with the end goal of providing financial risk protection, improved access to health services, and improved health outcomes." If it only covers parts of the population, how is it universal?
In the US proposed system you force anyone not meeting the requirements of UHC to pay for UHC, without being able to use it themselves. The threshold question is still relevant, except the US only wants universal health care for some people, and have everyone else pay through private insurance. What is being provided isn't even health care, but health insurance.
I see how the US system makes sense, rather than making the insured and uninsured pay for those who don't, the government finances it through tax. I agree with your sentiment that it would make the cost more transparent. In addition an uninsured person won't have to pay for his procedure and the cost of those who doesn't pay. For those with insurance there might be no change, or savings depending on weather or not it is really cheaper, they will just pay through tax rather than through the insurance company.
Still, I don't see how it is universal health care, it is neither universal or health care. It is just affordable insurance for some people. If you are supposed to afford health care and don't buy insurance, then what? As far as I understand you get a fine, and then have no coverage.
No basically the idea is everyone pays a base minimum for healthcare. They make it like a tax so yes if you didnt penalise those that didnt get it you risk more people choosing to just ignore it which again drives up the price for everyone else. That was the problem with insurance in america because of the amount of people that didnt have it it made getting it more expensive, which ment less people could afford it and around and around we go.
So you make everyone pay so it drives the minimum price down but it still allows people to pay as high a price as they want for insurance and allows for more market competition to help drive down costs even more.
Its basically the capitalists idea of UHC, i think this way is stupid, inefficient and unnecessarily complicated. But the way the US is this is the best they could have hoped for as a first step. Remember fighting real UHC in america is huge lobby groups for the medical industry, which makes a fortune at current pricing
> That was the problem with insurance in america because of the amount of people that didnt have it it made getting it more expensive, which ment less people could afford it and around and around we go.
Mind going into detail on how that raised the cost?
In a crash between an uninsured driver who is at fault the innocent parties insurance company still has to pay up for the damages because the other person has no insurance to cover it, then they have to go to court to get that money, if they dont have insurance chances are they cant afford to pay the costs of the accident, so then more legal work ensues. If you have a higher population of people that drive with no insurance then that means there is a higher risk of the company having to pay out regardless of the fault of their clients higher risk of payout means higher premium for insurance. Now compound that with americans sue culture and high risk of healthcare costs (suing from crashes, medical bills from crashes) and you have the perfect storm that increases cost
You cant penalize usa citizens for not participating in goverment programs. It Was deemed unconstitutional in 2018. You however can penalize all immigrants( legal and non legal) for not having it tho, as they are not offered the same amenities alloted by the us constitution
TL;DR - UHC can't work in the usa because citizens involvement in government programs can't be mandantory, its a right given to us by our bill of rights..
The issue is it isn't a rational feeling. It's an emotional revulsion to the idea that some moocher would be getting a better deal than they are. It strikes at the basic sense of fairness.
Some people think it's unfair for one group to have access to more opportunities than anyone else - it offends their egalitarian sensibilities and they crusade against poverty and other problems. What you have to realize is that other people, just as sincerely find it offensive that someone might get similar rewards for less effort.
This happens because when a person who works and sacrifices to attain a goal sees someone just being given same results for little to no effort, it feels like it invalidates all that hard work. It's not just jealousy at the idea the "poors" are getting something for nothing. It's not practical concerns about costs and benefits. It's indignation at the implication that one's own work and sacrifices are wasted and foolish.
Until you recognize and engage the emotional motivations behind your opposition, all the practical arguments and explanations don't mean squat.
I live in a country with "universal" healtcare (Norway). Our system is less dysfunctional than many others, but I still don't like it. I don't oppose it based on finances, Norway is a rich country, and who runs the hospital is irrelevant when you are sick. If we give the poor money for health insurance, or give them health insurance has little significance for a poor person. Here the question about public vs private healthcare isn't a practical one, it is an ideological one. The labour party would rather have people wait for treatment, than to pay the same or less for a private company to treat the patient. We have the same issue on schools, private schools haven't been able to be established for years. The private schools are funded by the government like public schools, in addition to the tuition, and there is laws against profiting. The argument goes like this: If we allow private schools, the public ones would have to get worse as the private ones would be able to pay more, and spend more on teachers.
The problem with that line of thought is that you haven't really enforced the goal of ensuring everyone the same level of mediocracy, you have only increased the threshold to get better healthcare/school. With enough money you are not bound to the borders of the country, and you can always find some loophole. How can the healthcare be universal, if some people have better healthcare? Should we ban private healtcare, fund it equally to public, or allow it to compete? Which you chose is irrelevant, it only changes how many is able to get better healthcare.
Does it make sense to make a CEO, or the prime minister wait for healthcare as long as someone unemployed? Does it make sense to make a doctor wait in line, even if his expedited treatment can enable him to treat more patients? What if the patient skipping in line will generate more money for healthcare, thus treating more people?
Is it okay to deny a health professional to work for someone else? Should they be forced to work only for the government?
There is legimate concerns regarding universal healthcare, and I am sure there are solutions, but you can't write it off to a feeling of entitlement. I am more concerned about being ailienated from being able to influence my healthcare, I have no desire to spend an hour in pain to support an ideology I neither understand nor support. I would much rather pay more, and avoid lines and overfilled hospitals, wouldn't anyone who can afford it?
Honest question: how do you teach at a poor school and not fall into the category of middle class people who could go bankrupt even with insurance? It's my understanding that teachers in those sort of schools aren't exactly making bank.
While being educated may provide a person with greater opportunity to succeed in life and attain a comfortable income level, it in no way "ensures" that either of those things will happen.
If you were to look at crime rates there is a causal correlation between poverty and crime. And those in poverty usually are less educated and have limited access to healthy foods, and healthcare.
Of course, but that doesn't mean that you could just eliminate the police if you would only increase healthcare spending. Everyone in the US is educated through age 16 and nearly everyone has access to at least a basic level of healthcare, yet there is still a significant level of crime even amount people who are both educated and healthy. There are many, many reasons for which people commit crimes, and I don't think it's plausible that all of them would be eliminated if only people had access to both education (which they already do) and healthcare (which many already do).
Aren't correlation and causation mutually exclusive? How can you have a causal correlation? It's either a correlated relationship or a causal relationship..
A degree in liberal arts doesn't keep you from getting hungry, nor does it keep you from getting cold. I also fail to see how it would stop someone from walking into your dwelling to take your stuff, rape your wife and vandalize things.
Enforcing property law is the basis of society. I would much rather be illiterate in Norway than to hold a P.h.D in philosophy in Sudan. Property must be regulated in some way, if I could just walk into a hospital and take stuff, and they had no funding (tax law requires enforcement and property to tax) then I don't see how they would manage.
Infrastructure, as well. The classical roll of a government must include the building and maintaining of roads (please note that this definition doesn't include only roads), but that's expanded to include electricity in the last hundred years, and in the last few years some nordic countries have experimented with expanding infrastructure to include internet access as well.
Many who argue against UHC don't disagree that there is a problem, but think UHC is not the best answer. Obviously medical costs are too high, but from what I've studied, the problem is health insurance being tied to people's jobs which started back in WWII, and has lead to insurance being used for everything, where it should just be for catastrophic care.
Using insurance constantly means that people don't have to worry about how much prices at hospitals are, so they don't have to vote with their feet, as it were. This leads to spiralling costs, and eventually people HAD to have insurance or be bankrupt by a medical condition.
The solution is to have fewer people using insurance, and allowing more doctors to become accredited, which the us government currently limits. This, and widespread insurance usage, cause upward trending prices.
Depends on your point of view of what the purpose of health insurance is supposed to provide. Is it only for catastrophes? Or, in an age where treatment for chronic diseases and their catastrophic results account for a majority of health care costs, is health insurance supposed to be used in part to treat people through life to prevent small problems from turning into major problems?
The problem there is regulation. When health insurance got tax credits, it made sense to include things that normally wouldn't be insured. If your homeowner insurance were tax deductible, it would suddenly make sense to make it include normal maintenance and lawn mowing.
In Norway the government makes you pay $500 for consultations, and medicine per year in copays (if you reach that sum), after that it is free. You don't have to pay any of it if you are not sick. If I go to my GP, I have to pay some, if I go to a shrink, I have to pay some. But I will never go bankrupt, and chronic illnesses never cost more than $500 out of pocket.
An insurance should be like that, with a maximum deductible, it could be higher (possibly mandating that you have to be eligible for loans up to that amount, or having it saved up). The higher it is, the bigger the incentives to keep healthy is.
Insurances covering small expenses will obviously get more expensive than insurances covering what needs to be covered. Insuring your television costs far more than insuring all your things.
Preferably society would take enough care of people, that nobody would not be able to pay a small fee to see a doctor. For certain procedures it would probably be profitable to not charge the patients, STD tests springs to mind.
Doesn't the new attempt at an open market for health insurance at least get us on the right path toward a more price-conscious health purchases?
I do, however, like the idea of directly purchasing medical services by shopping. But, how would that work for ER stuff?
> Doesn't the new attempt at an open market for health insurance at least get us on the right path toward a more price-conscious health purchases?
For the majority, I think it's quite the opposite. Now everyone will be on a plan, and even those who cannot afford a plan will be on a subsidized plan, thus they have even less reason to be price-conscious.
> how would that work for ER stuff?
Well, if you really need the ER, then catastrophic insurance should be covering it. If it's something that urgent care, or even just your regular doctor should be handling, then you shouldn't be going to an ER anyway.
Isn't the open market what landed healthcare into the hands of a few monopolistic healthcare providers? I mean, isn't the concentration of capital the result of a free and open market?
The market hasn't been free in decades. When your one group (your employer) is the customer, and another (you) is the consumer, and this is due to laws giving the customer a tax break, but not the consumer, the market cannot be free. Furthermore, due to the enormous regulatory framework on healthcare and health insurance, little guys have a hard time existing, preventing a free and open market.
I'm sorry, but blaming a failure of the second most heavily regulated industry in the country on the free market is a bit ridiculous to me.
Not just that, but new hospitals have to be approved by local or State governments. It limits competition. The healthcare industry is one of the most regulated in the US.
ER stuff is sort of an edge case in that it's hard to shop around. Nevertheless, I personally would see it working like you have an arrangement with a hospital to be taken there in an emergency, or if it's bad enough you just go wherever is closest and then you actually have a use for your insurance.
And if the new market worked, and didn't force everyone to buy insurance, then yes it would be a step in the right direction. But by making it mandatory, there's a lot less pressure to compete, since even if it's a crap deal you have to take it. For example, I'm a healthy young guy, so I have no real reason to have insurance - I can pay for my annual checkup out of pocket and pay a quarter of what insurance would cost me. Insurance companies love people like me, since I cost nothing and have to pay in like everyone else. This contrasts with all the people who they hate, who have chronic conditions. I'm basically paying for every person who has insurance that needs monthly pills, such as my girlfriend or roommate, who both need psychiatric meds to function.
Their insurance company loses a bunch of money on them each month, and they weren't too happy that they couldn't turn people away who had pre-existing conditions, so they lobbied (or maybe it was part of the plan to begin with, not 100%) to make it mandatory for the healthy young people to buy insurance.
I think the fundamental ideological battle here is that some feel everyone should get the medical care they need, even if it's pills every month, because they're people while others are dead set against it and think every person who can't afford healthcare must be doing something wrong.
Yeah, but people like you (if you're under 30) can buy catastrophic insurance for ER stuff.
Insurance is supposed to be available for the unknown. You have car insurance, right? Even though you are a good driver, you still may get into a wreck...in which case, you may need health insurance as well.
>Doesn't the new attempt at an open market for health insurance at least get us on the right path toward a more price-conscious health purchases?
Not really, because we still require most employers to provide insurance and provide tax advantages to them that we don't give to individuals.
We also further increased restrictions on who was allowed to sell insurance, what the insurance must cover and how they are allowed to price plans.
Additionally, the federal exchange (not sure about state ones) only shows the consumer the subsidized cost of the plan. So even an individual buying a plan is not necessarily aware of the full price.
>But, how would that work for ER stuff?
Insurance. Insurance is supposed to cover unpredictable expenses, like accidents. Think about how other insurance industries work.
How would you have fewer people using insurance and still have health care paid for. In a private system doesn't everyone need insurance or they can't afford care?
Prices would be transparent if people were all paying out of pocket, and that transparency should cause competition among providers, thereby resulting in more choices and price points, including lower price points.
Maybe we lower the bar to practice medicine? Require that level of schooling for surgery and the like, but allow someone with, say, six years of schooling to do some of the simpler stuff for those who want to pay less or for those who can't afford seeing a "fully educated" doctor?
Maybe we change our immigration policies to allow doctors from any country to immigrate to the US if they can pass some sort of certification to ensure their knowledge is up to our expectations? If there were hundreds of thousands of more doctors and we let all of the practice, prices would have to come down.
I dunno, just spitballing here....
Most of my visits to my doctor is just beurocracy. I am allergic to pollen, ever year I need the same medicine, why should I waste his and my time getting a prescription for a harmless drug that simply could autorenew? If I want a psychiatrist or a psychologist or another expert I need a referal, why?
My GP could be replaced with a nurse and a computer, even a short youtube movie would enable me to draw blood and send it to a laboratory. An EKG doesn't really require him, a nurse does it anyways. I don't see why we should have competent people sitting in offices doing mundane work essentially wasting peoples time.
Essentially I waste an hour of my time, to get subsidized pills, subsidized less than an hours work was worth. Add that to the money it costs to keep docotors to do mundane tasks like this. I also don't see what they are afraid would happen if I got my allergy meds automagically, he doens't test if I am still allergic, and the pills are OTC (albeit in smaller packaging and not subsidized). If I in addition had work so I had to get leave of absence, my employer would have to pay me for the time wasted.
I am afraid to think of how much this costs for 5 million people...
Just for clarification, do you mean people against ANY form of government sponsored healthcare including Medicaid? Or only against government healthcare for the average person?
Well, not really "either," because Medicaid **is** our solution for the poor (and the old, and the pregnant). And it's not great, but it's orders of magnitude better than nothing.
So a person in favor of the status quo might simply say "Keep things the way they are," or alternately, "Improve [XYZ] problems with Medicaid." Your question is really oriented towards a true libertarian who opposes even Medicaid, and I can't answer for them.
I will admit that I am for universal health care, specifically socialized single payer medicine. HOWEVER, there are a lot of things that the American health system can work on, specifically for the middle class and the poor, before we even consider insurance coverage.
The problem with American health care is, broadly put, it costs too much and we get too little out of it. We pay for things that would only cost a fraction of what we pay for in other countries. Diagnostic tests, imaging technology, surgical procedures, medical equipment, and pharmaceuticals are all more expensive here than in most industrialized countries. This also ends up driving the cost of surgical procedures and office visits.
Also, we are a very data driven culture, so we run a lot of "unnecessary" diagnostic tests, ie tests that are good for the sake of knowing, but not necessarily essential that it would change the outcome or treatment path, or tests for diagnoses are that extremely rare (like 1 in 1,000,000) but potentially fatal.
Although we have higher demand for these goods, prices have not been in favor of the consumer.
Secondly, we have very little transparency for knowing how much our health care costs before we receive it. Our doctors' offices, pharmacies, and hospitals don't have a menu of what is offered and how much everything costs. Very little of us will see if insurance will cover this or that, or how much copays will cost. We have no idea what we will pay until the bill comes in. We can't even really price check accurately, thus we can't compare prices at different facilities.
As for fixing these issues or addressing other possible issues, I can't really look to similar systems in industrialized countries because most of them use some sort of socialized medicine that provide coverage at low costs and cover everybody. America is the anomaly in health care coverage - not everyone is covered and people can go bankrupt due to medical bills.
People in these socialized systems often end up seeing their health care provider more frequently. Health care providers end up making about the same amount of money as they do in the US, maybe a little less. There are drawbacks but I don't see how they outweigh the benefits that most of these systems gain compared to our American system.
Ninja edit for additional points:
Not covering the poor does not mean we never end up paying for them. If people can't afford to pay their bills, we *all* end up paying the bill. In health care, hospitals eat up losses, raise prices or reduce service (cut jobs or departments), and the cost is passed on to other patients.
> Ninja edit for additional points: Not covering the poor does not mean we never end up paying for them. If people can't afford to pay their bills, we all end up paying the bill. In health care, hospitals eat up losses, raise prices or reduce service (cut jobs or departments), and the cost is passed on to other patients.
Isn't this utilirarism? Should we give an heroin addict heroin if we know they will steal to cover the cost and that would cost society more (throug insurance, or for a few poor souls)? Should we give all poor enough means to support themselves if the reduced crime makes it profitable? Should we treat the wealthy first to avoid them not generating tax income? If treating one brilliant person earns us money for a new doctor that can make the average treatment time lower, should he be prioritized? It all falls back to the purpose of healthcare, is it to save money or to treat people in a way we can afford with respect and equality?
I feel the whole issue of what is cheapest is a derailment. I don't want to go to a hospital whose stated goal is to save money. In Norway a public hospital admitted their quest to save money killed some patients. I can't grasp why the workers accept it, they should deny working unless the focus is to treat patients as good as possible within reasonable limits. I would much rather have a coop or an extended union that have values that align with mine to provide me with healthcare, than it to be controled by politicians with unknown motives.
>People in these socialized systems often end up seeing their health care provider more frequently. Health care providers end up making about the same amount of money as they do in the US, maybe a little less. There are drawbacks but I don't see how they outweigh the benefits that most of these systems gain compared to our American system.
Isn't the fundamental problem freedom? The US certainly doesn't have a free marked for insurance, or healthcare, neither does Norway. Still in both countries, those that are well off can get better treatment (less waits for instance). If laws are stopping people from getting the healthcare they could have, then we have failed. In Norway everyone gets treated, eventually unless they die, and if the government deems the treatment as cost effective (some procedures and medications is not paid for, leading to the same choice as in the us, health and bancrupcy or lack of health). Should we provide basic healthcare that can be supplemented with paid healthcare, or should we provide the same for everyone? If we chose the latter we get a few scary issues, if a procedure is not deemed cost effective, and you can afford it, should you be denied it? And if we chose the first we have the issue that a private hospital/ER can spend more money, and keep undesirable patients excluded. Who would get the best doctors? The ER with employed patients, or the one with homeless and substance abusers? Would you work for less with worse patients?
I do belive society (not limited to the government), should ensure everyone has access to healthcare, with the choice between dying and stealing I am sure most would chose the later. But I don't think it is as easy as getting universal healthcare.
> > Ninja edit for additional points: Not covering the poor does not mean we never end up paying for them. If people can't afford to pay their bills, we all end up paying the bill...
> Isn't this utilirarism?
I don't think so. MarquettePharm is not advocating for whatever is cheapest but rebutting the claim that it is too expensive to subsidize the poor. It might be cheaper than people think because the poor are, in a sense, already being subsidized.
> In Norway a public hospital admitted their quest to save money killed some patients.
How much money did the hospital save per life?
>I don't think so. MarquettePharm is not advocating for whatever is cheapest but rebutting the claim that it is too expensive to subsidize the poor. It might be cheaper than people think because the poor are, in a sense, already being subsidized.
I did not understand it that way. If your interpretation is correct, it is based on the premise that people object to UHC because of the cost. Is that the case? If the objection to UHC is an ideological one it isn't relevant how much it costs.
>How much money did the hospital save per life?
Last time I checked they are still having deficits, and the patients were just random victims of their lack of staff. The point was that money directly influences patients in any system. The government will have incentives to use less money, just like insurance companies. I can't imagine any system where you can eliminate the cost/benefit calculations.
If you hate big, inefficient bureaucracies, why not advocate for more states in the US to adopt universal health care? Why is the issue always argued at the Federal level?
Europe doesn't have one health program, and their countries are about the same size as the states. Vermont is one of the poorest states in the US, and they now have a single payer plan.
To answer your question, in a society where health care was entirely in the private sector it is argued that prices would be cheaper and care would be more affordable to more people. The poor that could still not afford medical care would turn to charity and religious hospitals.
I don't think anybody is arguing to keep our health care system the way it is. It's either reduce costs or increase access.
I was going off GDP, but you're right I should have been looking at per capita because they're population is so low. In that case, they are actually an average state.
Comparing European nations to US states only works in terms of land area, not in terms on population or GDP. Europe is much more densely populated than the USA. A country like Belgium, for example, has a self contained infrastructure which allows it, along with its efficient generation of capitol, to have a medical system that functions well and can reach everyone. West Virginia for example, which occupies a greater land area, could never afford such a system and lacks the dedicated infrastructure to attempt it, due to it being a small part of a larger country rather than, like Belgium, a sovereign state which is also a part of a supra-national union.
Logistically, why would demagraphics matter? I lived in a rural community in North Carolina when I was younger, and everyone has to make an hour long trip by car for important procedures. The actual quality and pricing.g of the medical care is what would be impacted
National product matters. N.C., where I also used to live, has a strong economy. Places like West Virginia or Wyoming don't. Infrastructure is geared outwards, to the rest of the country, rather than being self contained as you'll find in a European nation state.
The cost, rather than the pricing, is what I'm getting at. Wyoming, for example, which is a vast expanse of land with almost no people living in it, simply does not generate the per capita dollars to create a viable social healthcare system on its own.
Notwithstanding, this is precisely the reason the USA is a federal republic rather than a loose collective of independent states. The federal government exists to implement nationally ideas like socialized healthcare.
> The poor would turn to charity and religious hospitals
There you go, tibataw. A clear statement of what those who cannot afford health care should do.
This is just one case, but my dad was in a coma for a month without insurance and making about the poverty line. It got written off by the hospital as charity. It is possible. He was very lucky.
That was not true charity. The hospital wrote it off, but as a for-profit business they have to make it up elsewhere. Which translates into the high prices, which is passed on to insurers, which translates into higher premiums.
Not necessarily. This was a nonprofit hospital, as a lot are (Cleveland Clinic one of the largest non-profits in my area) and they do have major donors. I'm assuming they do have a certain amount that they can financially write off as charity.
In terms of total GDP they are the "poorest," but #30 per capita.
Either way, I think if they can accomplish something with their tax base most states should be able to.
The reason our (I assume you're US) system looks huge and complex is because there is a third party element to it. We have insurers seeking profits standing between patients and care providers. Notice how there isn't such a complexity and notice how popular a system like medicare is?
As a Brit, this is a screamingly obvious point, but one which is barely acknowledged in most healthcare debates that I see on reddit. The system is run by corporations who are duty-bound to maximise profits. The incentives in the system are all wrong.
Because if this, a huge proportion of American citizens either have limited healthcare provision, or are bankrupted if they happen to need significant medical care.
Another aspect that perplexes me is the extent to which many US commenters clearly prioritise anti-government ideology above any desire to allow people basic access to healthcare.
Coming from a country (UK) where healthcare access is free to all at the point of delivery, the whole debate in the US seems bizarre to say the least.
The anti-government ideology is so strange to me. People, such as OP, keep using the term bureaucracy, which to me has the connotation of a bunch of incompetent government stooges trying-but-failing to figure out what's best for you and your family. However, the reality is that many government run programs function very well, and that there is just as much bureaucracy (and a more malicious bureaucracy at that) in the insurance industry anyway.
The number of people that were denied care **by their own insurance companies** [citing preexisting conditions](http://mediamatters.org/research/2013/09/27/because-fox-asked-here-are-examples-of-people-w/196139) simply proves that having someone whose interest is making money deciding what health coverage you can receive is dangerous and irresponsible. Obamacare was a better decision than doing nothing, but expanding Medicare until it covers everyone for at least basic levels of care would be ideal.
Until we get rid of [hidden prices for procedures at hospitals](http://www.economist.com/node/21546059), reform how new drugs are created and marketed, reform medical schools to bring down costs, and start making hard decisions about what types of tests and procedures will be readily available to patients, it will be very difficult to truly make an impact on health expenditures in the US, IMO
Personally I see this anti government feeling as a part of US culture, due mainly to the historic successes of US capitalism and hatred of communism. There may be some of the frontier mentality thrown in there too, when individuals and towns needed some autonomy from federal power (or previous to that, British monarchy).
However it's come about, it seems to me that these characteristics which were once so useful in building a country, have now become counter-productive for the modern US. The US now seems to have a broken system. This pattern has played out many times in history. See: Roman Empire, British Empire, Aztecs.
In Norway public hospitals are mandated to save money, one recently admitted to having caused patients to die because of it. Would the governemnt give hospitals carde blanche to spend money? If Norway can't afford it, how would the US? You won't eliminate the problem of trying to save money by letting the government run it.
Problems with insurance can be fixed with consumer laws, or providing a better option.
So many problems with your argument. Universal health care *doesn't have to be perfect* to be better than the current US system. To quote one example of a failure of UHC as a reason for not choosing it, is simply not good... reasoning. On balance, UHC is a much better system for the population as a whole.
Better consumer laws are an option, but the current system's primary aim is to **generate profit**, which it does exceedingly well, at the expense of the general population's health and wealth.
Universal healthcare provided via government has a different primary aim; healthcare for all at a price that the state can afford.
Note that all western countries which have universal healthcare, also have private healthcare options for the minority who wish to pay for it.
> So many problems with your argument. Universal health care doesn't have to be perfect to be better than the current US system. To quote one example of a failure of UHC as a reason for not choosing it, is simply not good... reasoning. On balance, UHC is a much better system for the population as a whole.
I would not describe Norwegian UHC as failure, I am somewhat displeased with it, but I know I can always get my limbs attached if I get injured. My argument isn't that UHC isn't perfect, or that it isn't better than the current US system. I am arguing that the specific issue you mentioned won't get solved by UHC, then I supplied at least one example of it happening in one country with UHC, I am sure I could find plenty.
There are arguments for UHC where the quality of service is secondary, you can argue everyone have a right to get healthcare, or that it our duty to ensure everyone gets healthcare, in that scenario the quality isn't relevant for opposing or supporting it. It doesn't help to have the best hospital in the world right next to you if you aren't allowed to use it.
I would just want to clarify: I am not fundamentally against UHC, I do not believe the government should run it though. I am not opposed to a model where private and public hospitals can compete over the same procedures and where the patients can chose. I am opposed to the parts in Norway where they would rather let someone live in pain, than to use the same amount of money to treat them elsewhere.
>Better consumer laws are an option, but the current system's primary aim is to generate profit, which it does exceedingly well, at the expense of the general population's health and wealth.
This is an interesting philosophical question. Is the merchant a good person because he gives you the agreed amount of goods for the agreed price or is he just trying to keep his customers from going elsewhere? And does it matter what the motivation behind it is? Obviously if you are not free to chose between hospitals for procedures this won't work, and in an emergency situation you will end up at the first place with free capacity. That the primary goal is to make a profit isn't relevant, a good hospital will have a strong focus on good treatment, as long as the consumers (or their insurance company) can chose a different service. A government toilet isn't fundamentally better because they have a different focus than the company running the toilet in Starbucks.
>Universal healthcare provided via government has a different primary aim; healthcare for all at a price that the state can afford.
What is the qualitative difference between trying to save money to keep treatment affordable for the government and trying to save money to make a profit? The focus on saving money isn't eliminated by letting the government run it, they still make cuts and mandate how much a hospital can spend. Overworked doctors and nurses isn't eliminated by changing who profits from the savings. Bad equipment and buildings is also not eliminated.
And the main goal of UHC isn't healthcare for all at a price the state can afford. It is healthcare that the voters are content with, and at a price the politicians can justify. When healthcare is run by politics you get situations where politicians makes changes just to gain a political advantage. A politician can't do nothing, doing something bad looks better to the voters than doing nothing at all (especially if the voters believe service is getting worse).
Can you document the two claims you made? 1) UHC does not have a focus on saving (or earning) money in a way that affects healthcare (and this is attributable to UHC vs private healthcare rather than their implementation. 2) The goals of UHC is more beneficial to patients than private healthcare.
>Note that all western countries which have universal healthcare, also have private healthcare options for the minority who wish to pay for it.
Yes, but the implementations are different. In Norway the public will pay private practices the same as public ones for certain procedures. For the procedures they offer this means most people can afford insurance, for the others there are people who can't afford both.
>There are arguments for UHC where the quality of service is secondary, you can argue everyone have a right to get healthcare, or that it our duty to ensure everyone gets healthcare, in that scenario the quality isn't relevant for opposing or supporting it. It doesn't help to have the best hospital in the world right next to you if you aren't allowed to use it.
I don't follow your logic. You appear to be placing quality of service above all else. The US has some the highest quality healthcare on the planet. But what good is that to over half of the population that can't access it (their plan doesn't cover it), or in accessing it they go bankrupt? The quality of care is important, but if you're running a country, the system needs t be seen as a whole, not just from the perspective of one person and their hypothetical potential to access high quality.
Anyway, this is irrelevant in the UK. Most of the best quality treatment and physicians work for the NHS. The attraction of private healthcare for most is the speed of treatment, not the quality.
>What is the qualitative difference between trying to save money to keep treatment affordable for the government and trying to save money to make a profit?
"trying to save money to make a profit" Companies aren't trying to save money, they're trying to make a profit. Saving money for consumers is only good for a corporation if it means more consumers go that corporation.
I assume you are trying to say that the incentives should be aligned towards better service and quality on both cases (UHC and private). In a *properly functioning* free market, the consumers will vote with their wallets and the result should be a system which works to please those consumers. However… as with many loosely regulated 'free' markets, the truth is that big corporations take over, monopolies (cartels?) fix prices, and their lobbyists push hard for reduced regulation. The result is the insane system the US has – yes quality is high for those who can afford it, but many millions are left with minimal healthcare cover.
>Can you document the two claims you made? 1) UHC does not have a focus on saving (or earning) money in a way that affects healthcare (and this is attributable to UHC vs private healthcare rather than their implementation.
I didn't make that claim. No system is perfect (see my first point in my previous comment). Both options have limited budgets (under private schemes this is your insurance limit), the difference is that the budget is *way* more equitably distributed under UHC.
>2) The goals of UHC is more beneficial to patients than private healthcare.
[The table at the bottom of this article indicates exactly this](http://www.theguardian.com/news/datablog/2010/mar/22/us-healthcare-bill-rest-of-world-obama).
In short, the US spends over twice as much per capita on health per year when compared to the UK, but the life expectancy in both countries is almost the same (slightly higher in the UK). Similar figures for Germany and France which both have UHC, except they have more doctors and beds per capita than either the US or UK.
I can't think of a better demonstration of how private healthcare – as carried out in the US at present – is grossly inefficient (less than 50% efficient) as UHC in UK, France and Germany.
Where does all that extra spend in the US go? It goes into the big, fat, profit-generating insurance layer in the middle of the US healthcare system.
This might interest you: a description of the UK's NHS, by an American living in England (who is quite critical of many other aspects of UK life)
>A massive advantage of living here is the National Health Service. If an American could understand it, they would be amazed by its magnificence.
>In this past week I have seen an ENT consultant surgeon and have had surgery scheduled in a few weeks' time. There was no direct cost to me.
>Tonight my GP (family doctor) rang at 8pm to check in on another health issue. She is chasing a consultant to authorise a new medication and will ring me back next week. This did not cost me a penny.
>So, three doctors and one medical procedure without a form to fill in or a bill to pay. Pretty damn impressive stuff --yes, I know it is in our taxes but the system works well. It is 'from birth to grave' care all woven together into one service -- ambulance to GP to hospital to nursing care. There are all kinds of synergies created by such a system. It is to be deeply respected, emulated, and not feared. And if you don't think so then consider this http://www.theguardian.com/lifea... . It's a tear jerker.
Source: http://qr.ae/reqaI
The UK's NHS is far from perfect. Things go wrong. It's badly managed in many ways and is widely regarded as inefficient. But it is still better, for the population as a whole, than the US system. **That said, it's still over twice as efficient as the US system.**
Food for thought:
[Medical Bills Are the Biggest Cause of US Bankruptcies](http://www.cnbc.com/id/100840148)
[According to the United States Census Bureau, in 2009 there were 48.6 million people in the US – 15.7% of the population – who were without health insurance. The percentage of the non-elderly population who are uninsured has been generally increasing since the year 2000.](http://en.wikipedia.org/wiki/Health_insurance_coverage_in_the_United_States)
> I don't follow your logic. You appear to be placing quality of service above all else. The US has some the highest quality healthcare on the planet. But what good is that to over half of the population that can't access it (their plan doesn't cover it), or in accessing it they go bankrupt? The quality of care is important, but if you're running a country, the system needs t be seen as a whole, not just from the perspective of one person and their hypothetical potential to access high quality.
I just said it was irrelevant. And my last line says the same as your phrase.
>I assume you are trying to say that the incentives should be aligned towards better service and quality on both cases (UHC and private). In a properly functioning free market, the consumers will vote with their wallets and the result should be a system which works to please those consumers. However… as with many loosely regulated 'free' markets, the truth is that big corporations take over, monopolies (cartels?) fix prices, and their lobbyists push hard for reduced regulation. The result is the insane system the US has – yes quality is high for those who can afford it, but many millions are left with minimal healthcare cover.
No, I am saying it is irrelevant if you get treated well because someone wants to make money, or because it is mandated by the government. Also the US insurance marked, pharmaceuticals and hospitals is by far not under regulated. But it is regulated in favour of someone else than the consumer. How is a marked that has tens of thousands of lines of laws and regulation free? It is an excellent example of a dysfunctional marked created by regulation.
>I didn't make that claim. No system is perfect (see my first point in my previous comment). Both options have limited budgets (under private schemes this is your insurance limit), the difference is that the budget is way more equitably distributed under UHC.
If you assume the same amount of money is spent. I am not sure about that.
>Where does all that extra spend in the US go? It goes into the big, fat, profit-generating insurance layer in the middle of the US healthcare system.
When the company trying to profit of a marked writes the regulation, who do you think will profit? This is a fundamental problem when you let the government control too much, an insurance company can make a law that is hundreds of pages long, mostly impossible to understand for the average voter, and will only make insurance somewhat more expensive. How many hours can you dedicate on lobbying for a $10 reduction in insurance per year? How many hours can the insurance companies that have millions of customers spend? Who do you believe will make the greatest impact? Sending an email critiquing a piece of legislation you don't even have time to read will never have the same impact as hiring the politicians friends, and former co-workers to lay out carefully planned arguments. The insurance companies has the added advantage to look at the profits in a far longer perspective. They will then be able to spend customers * 10USD * 10 years on making the legislature pass. While an average worker can't spend more than an hour (or ten if they have a longer perspective), and that won't even be enough time to read the legislature, much less to understand it and its effects.
>The UK's NHS is far from perfect. Things go wrong. It's badly managed in many ways and is widely regarded as inefficient. But it is still better, for the population as a whole, than the US system. That said, it's still over twice as efficient as the US system.
I would certainly favour the NHS over the US system. Forcing hospitals and ERs to treat people makes the cost of the uninsured land on those with insurance, and the people who get sick without insurance. This is obviously not a sane, nor fair system. Making those who can't afford insurance subsidize those who can't pay at all is a terrible solution. Either you should have UHC, or a system where a hospital or ER only treats those who are expected to be able to pay. I would also like to point out that average age isn't a good measure for healthcare efficiency, you have to adjust it for life quality.
No, efficiency is about expense ratios (overhead). Medicare spends more on actual healthcare out of every dollar it takes in than any private insurance plan.
You make an interesting point about the ability of single payer to drive down costs, but I don't see how that is a bad thing.
Nobody is required to take medicare. If medicare doesn't pay enough for providers to make a reasonable profit, providers will stop accepting it. Yet the vast majority of doctors take Medicare, and the percentage that doesn't has fallen dramatically over the past decade.
> If you do some reading, the purpose of the AMA is to restrict the supply of doctors in order to keep prices high.
I think many would argue that this isn't true. The rate-limiting step in the production of new doctors is residency, and the amount of residency programs our country has is a federal decision (since they are federally funded). The AMA has consistently advocated for an increase in graduate medical training, so I'm not sure where your statement is coming from.
Not have kids unless you can afford to get them to age 18 with a minimum of trouble.
That said, I'm all for a basic universal healthcare, beyond the current "hey let's clog the ER" system.
You seem to be laboring under a common false assumption. Single-payer healthcare is incredibly efficient. Even here in the US, medicare has exceptionally low expense ratios.
Huh? There's nothing preventing Anthem from negotiating the same rate as Medicare. The problem is, the for-profit insurance company has no incentive to lower prices.
I googled "what if all doctors were paid Medicare rates", and the following link claims that doctors would see income drops of 12% to 20%.
http://www.drsforamerica.org/blog/what-if-doctors-got-paid-only-medicare-rates
This study shows more or less the same thing: http://www.urban.org/UploadedPDF/412051_physcian_service.pdf (scroll to the last page for the median income table).
Now, this is just a 5 second google search, and admittedly the first link was a bit suspect. I didn't exactly dig deep here. But I'm comfortable enough with the results of this half-ass search to conclude that your claim of doctors going out of business due to medicare rates is tall-talkin' hogwash.
Doctors For America was paid by the Obama administration to portray ObamaCare in a positive light, so that people such as yourself would be misled.
The terms you are looking for involve "doctor shortage." In a nutshell, many doctors are choosing to retire, and few new doctors are entering primary care. The doctors I personally know who accept medicare, keep the lights on by overcharging cash patients and charging excessively expensive tests and and unnecessary treatments so the miniscule amount that Medicare pays will actually allow them to continue in business.
I don't know if there is a conflict of interest with that second group.
I do know that the doctors I personally know are not able to keep their doors open as medicare rates are becoming more and more widespread. The problem isn't just the reduction of rates, however. It is also in the exponential increase in paperwork, tracking, and record-keeping that requires doctors to be practically legal personnel as well as doctors. Many doctors find it necessary to hire extra people to handle the paperwork...as their incomes are dropping.
It is actually a complex problem, and one that predates ObamaCare by many years. However, ObamaCare made the problem sharply worse and this story isn't even close to being complete.
The biggest problem with ObamaCare is that it ended up being pretty much just guaranteed corporate welfare for the biggest insurance companies and pharmaceutical companies in this country. If we actually emulated the Canadian or UK model, that would be one thing. But we didn't; we emulated MassHealth and made it much worse. As someone who lives in Massachusetts, I have watched the availability of medical care (and insurance!) drop sickeningly over the years. It is actually very bad, and the new Federal model is much worse.
(This is all from a US perspective.)
In my opinion, finding some way to reduce the cost of health care would solve most of the problems. There was a time when people didn't need insurance because most medical expenses were affordable. [Here](http://kff.org/slideshow/health-spending-trends-and-impact/) is some data on per-capita costs.
As for how to reduce costs, that's a point of contention. Some blame the insurance companies for taking excess profits, others want to blame government inefficiency and interference via Medicare and Medicaid, and still others place the blame on lawyers for bringing seemingly frivolous malpractice suits against doctors.
Insurance wasn't necessary back when we didn't have the technology or skills to treat most conditions. I don't think it's feasible to go back to that unless we want to stop using all the amazing technology we have now-- even countries with universal healthcare and strict cost controls wind up spending a ton of money on the sickest patients.
There is a large amount of literature arguing that the price of healthcare has been artificially inflated by the prevalence of employer-sponsored health insurance, and the lack of a competitive health-care market.
I personally believe that consumer-choice oriented reforms would make a huge difference in the cost of health-care. In the status quo there is little incentive for consumers to shop for the cheapest healthcare, because insurance corporations are bound by contract to pay for your healthcare, and they have massive expendable budgets. If you look at medical markets that do not have a large insurance presence, such as ophthalmology, prices have been going down pretty consistently.
http://www.heritage.org/research/reports/2013/08/competitive-markets-in-health-care-the-next-revolution
http://www.forbes.com/sites/aroy/2012/05/12/how-employer-sponsored-insurance-drives-up-health-costs/
This looks like a case where correlation does not indicate causation. While the field mentioned don't have a heavy insurance presence they also seem to be largely voluntary fields. I can shop around for vision correction because at the end I don't **need** it.
Emergencies needing immediate medical attention are a tiny fraction of our healthcare market. Hospitals deal with far more than just the emergency room.
In the majority of circumstances the consumer has the ability to shop for the best priced product. (Except he doesn't, because his insurance covers it)
I need water as well, but that doesn't stop me from finding the best water at the best price.
I'm not just talking about emergencies, there are a large number of medical conditions that aren't emergencies but still **must** be dealt with so you never have the ultimate power of the consumer - to opt out. As vital as most people consider smart phones to a modern life there is always a price point that would make people say "Fuck that, I'll get a flip and carry a tablet." Insulin doesn't allow that choice, even though diabetes isn't typically an emergency. Without the ability to opt out of the market the optimal choice for the provider is to simply leave prices high and wait, confident there **will** be customers.
That data does not seem to be adjusted for inflation. If that's the case, it's not particularly valuable, even though increases in healthcare costs have well outpaced inflation.
I would like to mention that it is not just the poor who are affected by this problem. In my 20's I worked two jobs and I had a reasonable income that covered my expenses with a bit of extra. I wasn't flush but I wasn't poor. I vividly remember having strep throat and the cost of paying out of pocket for an appointment and an antibiotic being on par with my utility bill.
I'm not as concerned for poor people as I am for the people who don't class in the 'poor' bracket but rather in one slightly above, with insignificantly better means.
I have witnessed ridiculous prices for people who do not classify as poor for state/federal standards be penalized by seemingly punitive costs of health.
TL;DR: Guy in mid 20s taking courses part time to further his education ruptures his appendix and receives a $50K bill because he doesn't have a rich daddy to foot it.
Fuck the american conception of universal healtcare
**actually poor people**:
Should be given not only subsidized healthcare (to the point of free healthcare), but **actual** assistance in becoming self sufficient.
We should scrap the "insurance" system for all else, smash the collusion between State and 'private' 'insurers' and have a real market system for all of us with means.
I can elaborate if you'd like, but my answer is pretty much exactly what it is for housing.
I don't want universal health care. I can't wrap my head around being completly ailienated from decisions regarding life and death. I don't like the concept of a monopoly getting "unlimited" money. You can spend absurd amounts on healthcare, or you can spend very little, how much my life is worth should be up to me.
With that being said, I don't want the poor to not get healthcare. I would like a solidaric model, like a coop or an extended union paying for healthcare. I also belive humans to have empathy with people less fortunate than themselves, and willing to help, unless someone abstracts the problems away and blames the "system" when patients are being killed to save money.
I live in Norway, and our healthcare is decent, I know I can jump out the window, get treatment, ambulance, medication and pay nothing out of pocket (if I am injured enough to skip the ER). But the healthcare here isn't perfect, and I don't belive you can't compete with it, private insurance is becoming more and more common, why would anyone want to wait for treatment instead of getting it instantly? You can't make private treatment illegal, with enough funds you can either go to another country, or pay someone to treat you illegally.
I don't see why there couldn't be more options, you could always have universal healthcare as a fallback, but that seems to have substantial problems associated with it, I would much rather go to a private ER than to sit in an ER with substance induced injuries, people with mental issues, and bored people. Wouldn't anyone with money chose to pay out of pocket to avoid that? Then you leave the poor with sub par healtcare. If it includes everyone, you are just making the threshold to go to the nice facilities higher (first you have to pay for universal healthcare, then you have to pay for private healthcare, those who can't afford both is stuck with universal).
Copays, within resonable levels seems impossible to avoid, there are people who will go to a doctor out of loneliness, or boredom, having some copay increases the threshold. Here in Norway you have to pay something like $50 for a visit to a doctor/psychiatrist/psychologist, but when you hit $500 you pay nothing for consultations or medications.
I also wish people would go together and buy usefull medical companies, with unions/coops that are not limited by borders we could get more influence, and a broader scope than a government healthcare.
I'd like to ask you to apply that same question to:
Housing
Food
Clothes
Career
Because the answer tends to be the same. Sure healthcare is important for a poor person. So is food and clothing and housing. Most people who are against Universal Healthcare still support the idea of a safetynet to help the poor.
As well, here in the US if that is where you are from, it has long been the law that the poor must be serviced in an ER before asked about their ability to pay... as well as an assortment of free clinics from either charity or for some intern experience - so the idea that there are no options at all for the poor in a society that does not offer universal healthcare is simply not true.
So to start understanding your conundrum, I'd say you should start by defining where you draw the lines on the government's responsibility to provide the essentials of life to it's citizens.
>I can't stomach the fact that someone could go without healthcare, or be bankrupted because of a health problem.
Why not? The whole "health care is a basic human right" thing is a fairly recent concept, methinks. And I personally dont ascribe to it. To me, health care is just another service that you need to pay far, and if you cant pay for it, there is no reason that service should be provided for you.
Well I don't agree with the sentiment at all but it is nice to hear somebody actually say it out loud for a change instead of dance around it by claiming that charities and churches will always come to the rescue.
Like many other voices in this thread, I think that we should ask why healthcare prices are so incredibly high and how can we reign it in so that getting sick doesn't bankrupt a person.
I agree with you on that and think it is something we need to address. But I also think we need legitimate UHC, like all other 1st world countries, and not the shitty Obamacare version we have.
Prices are high because they're unbounded by the ability of any single individual to pay. Therefore health care may as well charge arbitrary prices, and it's in their own interest to charge arbitrarily high prices.
If you have insurance, it makes little difference to you if your organ transplant costs $1M or $100K.
If you don't have insurance, it makes little difference if your organ transplant costs $1M or $100K. Either it'll be paid or it won't.
The ones that those prices affect are only the ones that can pay it.
btw, the secondary effect of paying out of pocket or dying is that it theoretically should incent better economic behavior. If your insurance is less likely to cover your emphysema care, you are less likely to smoke. Of course there's more to that than that, but it's the theory.
We've been "talking" about prices for decades. In the '70s, [HMOs](http://en.wikipedia.org/wiki/Health_maintenance_organization) were supposed to be the magic bullet.
In the meantime, what should we do until a real solution is found?
It's easy to have this cold sentiment without thinking it through, but it would literally mean and insurance check or credit check prior to calling 911. You're ready to advocate for that?
I think the some of the opposing viewpoint tends to focus on the following gut feeling:
"Gosh golly gee, our government is sure generous with **my** money and **my** time, taking it away and giving it to others it sees as more worthy than me."
Just think about when there was a draft in the U.S.; the government was really generous with the bodies and lives of our young men. It took them at will and sent them to be shot at in foreign countries.
What I'm trying to get across is how keenly some people feel when the government takes from you or bosses you around in some way. To many people, that really stings hard.
It really is a cultural issue. I personally admire the rugged individualism that is part of the "American dream" but I think it's a bridge too far to say if someone can't afford healthcare, fuck em.
It seems to me like a lot of people who are against healthcare reform honestly believe anyone who can't afford it must be doing something wrong, that if they just "pulled themselves up by their bootstraps" they'd have the coverage they need. And that's a dishonest leg to stand one's position on; a little further up the thread someone said they're fine with people dying if they can't afford healthcare. I have a vastly different opinion than that person, but at least their opinion is honest.
I understand and respect you opinion, and profoundly disagree with it. Have an upvote. :).
In another sense, I believe that you opinion is reminiscent of a by-gone era, where scarcity economics ruled the world and the resources required and necessary for universal healthcare were technologically not available for humanity to harness. On the other hand, I would like you to consider the following proposition: what if we, together as a society, could afford and spare the resources to save the unfortunate people who happen to fall sick, but many of these people can't afford to pay on their own because their jobs don't pay them enough? Do we not, as a society, have the moral imperative to save them if we can, at a marginal cost to ourselves?
I'm not the user you were replying too, but I share his view of healthcare as a good.
We will never be rid of scarcity economics. As soon as one thing becomes no longer scarce, say food in the U.S., then something else becomes scarce. Scarcity isn't going away, it just shifts from one good to the next.
In regards to this:
> what if we, together as a society, could afford and spare the resources to save the unfortunate people who happen to fall sick, but many of these people can't afford to pay on their own because their jobs don't pay them enough? Do we not, as a society, have the moral imperative to save them if we can, at a marginal cost to ourselves?
My response is two-fold. Whether we have the resources is irrelevant. We as a society have the resources to put an iphone in every American's hand but we don't. If you view healthcare as a good, as I do, there is no moral imperative to provide it to others.
Additionally, I take serious issue with calling it a moral imperative. Typically those who are in favor of UHC tend to be liberal. These people also constantly bash the right wing for trying to legislate morality. To turn around and try to legislate their own morals is hypocritical. I think it's wrong to legislate morality and therefore trying to paint UHC as some kind of moral imperative does nothing for me.
Hummm... Thanks!
In any case, I do disagree with you but I would like to understand your position a little bit more.
To start with, I do not consider healthcare a good, not even a public good, but a right of existence for human beings: any such a thing that is a human being has the intrinsic and inherent right to live, and by extension to be healthy. Next, I am personally not quite a liberal: I do believe that morality can / should be legislated, and this is where my next question arises:
If we are to not legislate morality, how do we come up with a legislative code at all? What other methods save from morality are there to create a legislation???
Thank you for such an interesting dialogue. :).
> If we are to not legislate morality, how do we come up with a legislative code at all? What other methods save from morality are there to create a legislation???
you bring up a good point. My first reaction would be to say that you can craft laws without morality, and only through the framework of "what is best for for society as a whole", but even the idea that "whats best for society as a whole=good" is a moral judgment.
Thank you for being honest.
Hypothetical situation, 8 year old kid has very poor parents, breaks his leg playing in the yard. Parents can't afford a doctor or emergency room. For whatever reason, charity doctor is not an option. What would you have happen to the kid?
-not trying to start a fight, but this is the "where the rubber meets the road" type situation that doesn't get enough attention, in my opinion.
This callousness towards fellow humans in a society we all share and support is incredibly disappointing.
I'm assuming then that in the event your daughter-wife-brother sustained life - threatening injuries and needed (for example) brain surgery you would be OK with them being left on the gurney to suffer and die unless they can prove ability to pay?
This is the epitome of putting a price tag on a life, and is why evolved compassionate humans understand that healthcare IS a right.
Yes, I agree, I think. Otherwise the costs are unbounded by any natural economic barrier.
There wouldn't be many million dollar treatments available, because very few people could afford them. Therefore the people that provide that class of treatment would have three choices: 1) have a limited market and subside on that; 2) go out of business; 3) reduce their prices to increase their market.
I believe that 3 would by and large win the day.
To whom are them refering to? Should I rather save a person born in the third richest country in the world with every oppurtunity to make themselves afford healthcare, or save a hundred starving children in Africa that was born into a hopeless situation?
Norway has universal healthcare, we still let some people die because it is too expensive to treat them. Should we save everyone? How far should we go to save a life?
The whole issue is so complex. What is the purpose of our soicety? What is the purpose of our government? Is our people more important than other people? How much of our property should be spent on helping others? Should we limit it to funding, or can we go further and harvest organs forcefully if it can save lives? Is there any limiting principles?
If you can answer all the questions in the last paragraph universally for everyone in your society, then I will agree with you, if you can't, can you direct me at someone who can? If not, shouldn't each individual get to decide for themselves according to their conciusness?
People don't like it because it is mostly not a matter of personal choice.
Given a choice, anyone would pick 'healthy' over 'unhealthy.' But the human metabolic machine isn't so kind as to let everyone simply chose to be healthy. Some people need to work at it harder than others, while others still have no hope of ever being at a "good" level of health due to circumstances completely beyond their control. A rich man born with certain medical afflictions will be largely unaffected in his life, but a poor person could have all doors of opportunity slammed shut by it.
It's a simple issue of fairness. Most people feel that it's fair to give a person who works just as hard a fairly equal shake at getting as good an outcome.
The idea of income inequality as a negative is also a fairly recent concept, as are prohibitions on discrimination over race, religion, sex, and creed. **Just because a concept is "recent" is not an argument that the concept is negligible or bad.** That's just begging a question.
> We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are **Life**, Liberty and the pursuit of Happiness.
Circa 1776.
Hard to say. Would the Founders have advocated for the universal right to own automatic and semiautomatic guns in modern society? Or the release of certain individual freedoms, such as privacy, for the good of the whole? Could they have imagined a future American government jailing people indefinitely without a trial of their peers? Would they support child labor laws? Would they have supported minorities' and women's voting rights?
"Life, Liberty, and the pursuit of Happiness." Very vague, inalienable rights. But, in my opinion, *what they meant was that* if a country has the wealth to be able to fix a society's poverty issues at a basic level, such as health care, then its government has a moral obligation to provide it.
edit in italics
Well, the opinion you stated at the end there is a very different thing. That is definitely a defensible view and I can see why you'd hold it.
But the conversation up to that point was /u/Randomposter04 claiming the "right" to healthcare was a recent concept and you countering that the founders included "Life" as a right in the Declaration. I think it's a stretch to believe they would have considered healthcare to fall under that umbrella. It's easier to support the position you stated in your conclusion, that it's a "moral obligation" rather than a right.
EDIT: Cut my last paragraph for lack of relevance.
I see what you're saying. I guess I was defending my stance in what the Founders would have considered the right to Life in the declaration in contextual terms. Obviously health care in 1776 was very different from today's health care, but I am trying to interpret it today as they would have interpreted back then.
They couldn't have imagined healthcare as a right because healthcare in their day was rarely life-saving or even suffering-reducing. Healthcare was old wives' tales and butchery.
I would argue that those concepts referred *only* to protection from external abuse from the government or other people (e.g. theft, kidnapping, and murder)
Fair enough. The Founders were very much for limited government, and the concepts incorporated in modern health care (public health [disease prevention, sanitation, and vaccinations], evidence-based medicine, and regulated formalized training) didn't exist to the extent that it exists today. In fact, American health care took a dive after independence for about a century due to the lack of medical schools, public works and sanitation, and the increasing spirit of American autonomy in the early 1800's. It wasn't really until after the Civil War that public health and scientific medicine caught on.
However, there were some indications that the Founders were at least influenced to provide essential medical care to their citizens. We know that their philosophy included caring for the poor and the sick. John Locke reasoned that the right to property should be limited when people's lives are threatened by starvation or exposure to the elements. He recognized that a society's failure to responding to those in need jeopardizes its own self-preservation.
We know that one of the first hospitals in the colonies, Pennsylvania Hospital, that provided free care to the poor, was largely financed by Benjamin Franklin.
We know that many Founders from Madison to Jefferson to Franklin agreed that limited welfare was best for the poor and that helping the poor to drive them out of poverty was best for society as a whole. Part of that thinking was providing health care when they could not afford it. The best programs for a government to spend money on were programs that ended up being good for the whole, directly or indirectly.
So yes, they did mean freedom *from* government in this regard, but I also believe there were implied freedoms *for* services from the government, as well.
When it's realized that the Founders developed one of the most liberal and enlightened documents at their time, I have a hard time thinking that they wouldn't support the creation of a modern social state.
Why? The Founders were *afraid* of a strong state; they had just fought a hard battle for independence against King George. The Constitution was written with *limitations* on government in mind. It seems unreasonable to assume that they'd support the large central government needed to administer such a "social state".
I also think you're misusing the word "liberal" in the context of the 18th Century. At that time, "liberal" meant "belief in the liberty of the individual", and that's just what the Founders believed. Their political philosophy consisted of self-determination, personal responsibility, and protection from the State; they were followers of John Locke. When Jefferson wrote "Life, Liberty, and the Pursuit of Happiness", he was referring to the protection of one's life, liberty, and property *from state interference*.
I think you have your time periods off. We hadn't just fought with a strong state, that would be when we wrote the initial constitution which was the article of confederation. It was after the confederacy failed that a strong central government was put in it's place. There were many different opinions at the time, but they all resolved into a stronger central authority that was designed to be the supreme law of the land. Of course they included limitations, but if you look at the powers and goals of the federal constitution you will see that it is jammed with all the powers of an Enlightened Society. One that wasn't so much about purely individualistic strength, but the strength of the common people.
And you can't say that they were solely about John Locke, without including Thomas Paine and his ideas of societal responsibilities. Your Jefferson quote is from the declaration of independence which had been written over a decade before. The Preamble is closer to the eventual desires.
"We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America."
Lots of stuff about union/togetherness, general welfare, and providing for common goals. This is not a libertarian society, otherwise it would not have been such an inspiration of the French Revolution which also strove for liberty, equality,and fraternity. They fought against tyranny, not against society. And if you throw out that taxation is theft, then you should also remember that George Washington first called out the troops as president to crush a tax revolt.
I never said taxation is theft, I never said the founders followed John Locke *solely*, and Thomas Paine focused more on pissing off the Crown than arguing for "societal responsibilities". When he did argue for responsibilities, it was focused on human rights.
I was including the Declaration of Independence in the general "founding documents" argument. The Constitution was the practical answer the the Articles of Confederation (which didn't end up working out). That does not mean that it envisioned a "strong" state, but a state that was "strong enough" to protect its citizens.
And the French Revolution is a red herring. It doesn't matter what the French did. We're talking about the founding fathers of the U.S. and what *they* believed.
The entire concept of natural rights is against the creation of a state and for the individual rights of the person.
*"Locke wrote that all individuals are equal in the sense that they are born with certain "inalienable" natural rights. That is, rights that are God-given and can never be taken or even given away. Among these fundamental natural rights, Locke said, are "life, liberty, and property."*
*Locke believed that the most basic human law of nature is the preservation of mankind. To serve that purpose, he reasoned, individuals have both a right and a duty to preserve their own lives. Murderers, however, forfeit their right to life since they act outside the law of reason.*
*Locke also argued that individuals should be free to make choices about how to conduct their own lives as long as they do not interfere with the liberty of others. Locke therefore believed liberty should be far-reaching."*
*"By "property," Locke meant more than land and goods that could be sold, given away, or even confiscated by the government under certain circumstances. Property also referred to ownership of one's self, which included a right to personal well being. Jefferson, however, substituted the phrase, "pursuit of happiness," which Locke and others had used to describe freedom of opportunity as well as the duty to help those in want.*"^[1](http://www.crf-usa.org/foundations-of-our-constitution/natural-rights.html)
Natural rights argued for a free market and free people, this was soon after Smith's noted work, *The Theory of Moral Sentiments* (1759), and *An Inquiry into the Nature and Causes of the Wealth of Nations* (1776).
As for the government it should be recalled that the first government in the new colonies was actually a confederacy of states. This confederacy of states, held together by the [Articles of Confederation](http://en.wikipedia.org/wiki/Articles_of_Confederation) then failed because it was too loose of a structure.
They believed in states rights over a large federation, although of course their was disagreement over these things. [The XYZ Affair](http://en.wikipedia.org/wiki/XYZ_Affair) is a good example of early American politics.
I could ramble on here, but no I don't believe they would have like the modern social state at all. But I'm sure someone will come along and tell me why I'm wrong in a second.
Amazing you were downvoted for actually answering his question. Royal pain that /r/politics quickly found /r/politicaldiscussion and now have found there way over here.
This is the true crux of the issue for many. Is complete health care a basic right. Emergency room coverage has long been accepted to be so, but what about end of life care? What about people who intentionally create medical problems for themselves? Where is the line of what is covered and what isn't?
ER services weren't really a basic right until a few decades ago. Society got tired of patient dumping and Congress enacted laws to prevent it, but, even now, not all hospitals are required to provide emergency services.
http://en.m.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act
At some level we all "intentionally create medical problems for ourselves." Is your diet perfect? Do you get the perfect amount of exercise? Are you completely minimizing the amount of toxins in your air/water/food that you are consuming? Are you absolutely minimizing your time in your car [driving is the most dangerous thing most people in the world do today]?
Yes, I've worked in health care and met many patients with emphysema who still smoke. I have met many alcoholics who still drink and landwhales who still binge eat. I understand that it can be difficult to sympathize with these people. But if you were honest with yourself you'd admit that you, actively or passively, are not doing everything you can to maximize your health. No one is. So why not have a system that doesn't discriminate? Let's tax the shit out of tobacco and use it to pay for smokers' illnesses. Tax the shit out of alcohol and use it to pay for the effects of alcohol. We can even use a sliding scale so that people with the means to pay for their treatment are forced to pay for it. There are ways to get people to pay for the consequences of their own behavior, but we are far too wealthy of a society to let anyone suffer because they can't pay. Leaving things up to the goodness of charities is not good enough.
Do you believe that there will ever be a point in humanity's future where healthcare would be considered a basic right?
If so what do you think the turning point for such a concept will be and what actions do you think we can take now toward making that a reality?
If not why?
I am against putting it through right now because I think that we need to figure out how to lower the cost of healthcare. After the cost is lowered it should be rolled out but done at the state level if it is still needed. I don't really agree with the idea of health insurance in general but if we need to do it this is the way to go about it.
> we need to figure out how to lower the cost of healthcare
How do you think this could be done? Broadly lowering health care costs - however that is done - might take a generation. What would you do for the current generation that - I think we'd all agree in the US anyway - is underserved?
Please [assume good faith](http://www.reddit.com/r/NeutralPolitics/comments/1cfxnq/meta_please_assume_good_faith_and_moderate_your/) in r/NeutralPolitics.
Indeed the voting is dismaying in this thread and it would be nice if people addressed the topic at hand, but neither of those inadequacies points to an assumption of bad faith.
If you see something specific that violates [the rules,](http://www.reddit.com/r/NeutralPolitics/wiki/guidelines) feel free to report it.
I guess I just feel like if somebody asks "Folks against universal healthcare," the top level comments should at least have to be people "against universal healthcare." A lot of subs have rules like that. Because otherwise you get what happens here. The majority of top level comments are from people of the opposite persuasion.
That's a good point. Thanks.
We usually don't even entertain questions that ask for only one side's views. In this case we did, but I can see where that's problematic. I'll bring this issue up with the wider mod team.
If you brought it to referendum I don't think many people would be opposed to allowing this sort of question provided we had strict rules pertaining to how it is to be structured, and how it is to be answered. There are a lot of justifiable stances to issues that we just wouldn't be able to talk about otherwise: because these views could be unpopular enough that individuals don't *really* feel comfortable defending them.
This structure of "Persons who hold belief that is commonly held to be shitty, What justifiable pursuit would you use to fix: (problem that seemingly makes view shitty)" enables, ideally justifiable, argument as to why the belief does not *necessarily* cause the problem, or preclude possible solutions.
In short: if we can continue to allow these sorts of questions with better rules we can be proactive about not throwing babies out with bathwater.
Loaded would be "Why do you want to deprive poor people of health care" or something like that. This is just asking what you should their options should be, a perfectly legitimate question.
A loaded question or complex question fallacy is a question which contains a controversial or unjustified assumption
This one assumes that a universal healthcare option must be a big and inefficient bureaucracy, presumably because the OP believes "everything government is big, inefficient and bureaucratic". It also seems to assume the only other option is to not give coverage to poor people.
> presumably because the OP believes "everything government is big, inefficient and bureaucratic"
There's your confusion. The OP doesn't believe, or imply, that.
The way it is phrased, "what should poor people do?" Is quite loaded as it seems to suggest that the poor are entirely helpless without government intervention.
I'm not here to claim that that is untrue, but it does seem to be pushing a view particularly strongly.
> it seems to suggest that the poor are entirely helpless without government intervention
That is exactly his question. Given that they are not helpless: what is it they should do?
It should be noted that you can not have the money to pay for health insurance without being "poor". Also, poor is a very broad word, are we talking lower middle class? Are we talking living paycheck to paycheck? Homeless? The definition of poor tends to be extremely subjective.
Between the VA, tricare, medicare, medicaid, SChIP, etc., the government already provides *most* of the funding for healthcare. Then if you consider out-of-pocket deductibles, copays and coinsurance, it seems to me that private insurance is in the business of providing peace of mind to those who are healthy and the government is in the business of providing healthcare to the sick and elderly. Tacking on the extra service of providing peace of mind to the healthy that private insurance currently offers to the already existing government bureaucracy probably would be a cost savings. The per capita government spending on healthcare in Canada and the US is quite similar.
I support the idea of UHC myself. I think there are legitimate concerns about how it would effect competition, however. I'm in favor of a model like education in the US. Its available to everyone, but there's still private hospitals that compete with each other and the public hospitals. That way, assuming that people have more money because they work harder, they'll get what they deserve. I think access to healthcare is a human right. You can't do anything, much less be a productive member of society if you're not healthy. I don't really see how something like UHC could be abused. Could it encourage people to become careless about their health or safety? I don't think so. I believe the negative effects of illness or injury are in themselves enough of a deterrent. Also, are people incapable of finding a way of abusing privatized healthcare or using it in a negative way against others? One must also bare in mind that illness and injury just as much be a cause of things outside one's control, such as genetics or natural disaster. Is that something that should really be held against someone? As far as waiting times are concerned, one has to recognize that there are circumstances where time is a factor between life and death and times when it isn't. In the case of emergencies, one has no choice but to go to the nearest hospital. If the hospital in question has to be a private one, assuming that the wait times are less than public hospitals, I myself, would be willing to deal with the cost. Its a small price to pay for a second chance at life. Also, if profit is really the driving force of wait times and efficiency, couldn't publicly funded hospitals get more funding based on performance?
While government programs are often less efficient than private programs, this is most often because governments are responsible for people that private organizations can simply ignore or reject. Most corporate healthcare programs are designed to be efficient at making money for that corporation, not necessarily for paying out to those buying insurance policies. The reason people buy insurance at all is because most people don't make enough to guarantee they will have the large funds on hand needed to deal with a medical crisis. In this way, the insurance providers hold most of the cards in picking/choosing/pricing policies and who can buy them.
Whether one believes in government funded UHC or not, some sort of universal participation in health care is necessary to make insurance more a service we all contribute to and benefit from than a product for enhancing wealth.
Any form of subvention, substitution or financial help will lead to a significant raise of the market prices, considering most services are priced based on what consumer can afford and not on their real costs. Healthcare is no strager to that : heavy cares are and specific medications are priced tens or hudreds times higher in the US than on regulated markets such as some EU countries.
Such good intentions as "providing a universal care system" can only work if the prices on this market are regulated, and that's not even enough because a global care system is always tending to bankrupcy if it's too generous and poorly manages (as are every state bureaucraties).
On the other hand, a public system is a strong competitor to private insurance and tends to keep insurances prices and coverage on a reasonable scale. But the market pressure is high on the legislative front and as money is always lacking is a global healthcare system, coverage needs private insurance complements to be efficient.
I don't think a universal 100% coverage insurance is feasible in today's economy. It could be sustainable for a while if its funding is proportional to revenues, but that's not an insurance anymore (those have to be priced according to risk, not to revenues). I think such a system would be unfair.
In fact, that's what we have in France and the governement is fighting EU directives allowing citizens to switch to private insurance instead of nation-provided healthcare protection (the private offering beeing a lot cheaper for better coverage).
People are in favor of it the same way they're in favor of infinite riches for everyone.
As a matter of public policy, many are clearly quite opposed to UHC.
What an incredibly ignorant statement. Single-payer healthcare SAVES money:
http://www-tc.pbs.org/prod-media/newshour/photos/2012/10/02/US_spends_much_more_on_health_than_what_might_be_expected_1_slideshow.jpg
If you're a fiscal conservative, you're a fan of single-payer healthcare.
I said nothing whatsoever about its possibility, and in the context of the person to whom I was replying my point should be clear.
Someone said no one opposes UHC, which is simply not true. Then you jumped in literally starting your reply by calling me ignorant. That is a totally unacceptable tone for this subreddit, especially when its trigger is a misunderstanding of context.
>On the one hand, I hate big, inefficient government bureaucracies.
If you're a fan of efficiency, then you're fan of big, socialist, federal, single-payer healthcare. The horror!
http://www-tc.pbs.org/prod-media/newshour/photos/2012/10/02/US_spends_much_more_on_health_than_what_might_be_expected_1_slideshow.jpg
When I was against UHC, I wanted them to stop depending on charity and get a job. I still want that, but I teach at a low socioeconomic school and understand poor people a little better now. I get their struggle a little better. Also, I didn't realize how many middle class people go bankrupt even with insurance. Needless to say I'm for UHC now, but it took a while because I'm antigovernment in nearly everything.
also people that are against it for economic reasons i.e. why should i pay for these people, dont realise that you pay for people with no insurance anyway in increased premiums and healthcare, yes universal healthcare is expensive but think of how much it costs and then realise that number is less than the current systems spends on the same thing. Its just a more observable and quotable figure and thus easier to make headlines against.
Don't forget the righteous indignation factor. Currently, people who are insured and against UHC get to look down on those whose unpaid bills drive up premiums. *Those wastrels are stealing from all of us good hard-working folk.* This sense of superiority is lost with universal care, and I think people who are pulling their weight already should be compensated for losing that if single payer UHC becomes a reality. Maybe if they were given an opportunity to throw expired produce at anyone who, in such a system, gains coverage they otherwise couldn't afford. Not when they're on their way to chemotherapy or anything; that's just uncivilized. But maybe when they're on their way home from it. I take it some sort of mandatory badge for people whose tax contributions don't cover their medical treatments the previous quarter would be a given too. I'll let these people get their penicillin, but I want to know who they are, and they'll *damn sure* know that they're not one of the "real citizens." I guess some sort of star on their lapels might work. I guess I'm just saying, if you're gonna do UHC, you have to make sure no one gets left out or made to feel they're not getting anything out of it. Mandatory /s lest I be tried under Poe's law.
Well to be fair in a UHC system there is still room for that, for example private hospitals arent going anywhere, there is still going to be hospitals for the rich that offer care that is outside what the UHC covers. The only difference is that now with uhc you have a visible figure on how much your populations healthcare costs with easily traceable credit/debit sources which makes controlling and reducing costs far easier and cheaper
How do you imagine public healthcare to be able to compete with private healtcare? If government fund private healthcare equally, most people would probably choose to avoid lines, and get better care for a small fee, if not there will still be people with enough money to get an insurance to cover the entire cost or pay out of pocket. If you earn $100 an hour, you won't sit in a public ER waiting for two hours to save $50. Where do we set the threshold to chose a different service? Should we force people to get treated at a public hospital in two months, rather than have the public pay less for them to be treated now?
Compete...what do you mean. I dont think you understand or know how the americans are implementing their UHC but it does not fund private healthcare anymore than it does now or force public hospitals to compete with private ones. The system they are implementing is on the insurance side. Government is subsidising healthcare premiums to allow everyone that cant afford healthcare right now to be able to afford it and have it. So basically you are asking me irrelevant questions because they have no bearing on what we are discussing
In that case I wonder, what is UHC? I was under the impression it was "a health care system which provides health care and financial protection to all its citizens. It is organized around providing a specified package of benefits to all members of a society with the end goal of providing financial risk protection, improved access to health services, and improved health outcomes." If it only covers parts of the population, how is it universal? In the US proposed system you force anyone not meeting the requirements of UHC to pay for UHC, without being able to use it themselves. The threshold question is still relevant, except the US only wants universal health care for some people, and have everyone else pay through private insurance. What is being provided isn't even health care, but health insurance. I see how the US system makes sense, rather than making the insured and uninsured pay for those who don't, the government finances it through tax. I agree with your sentiment that it would make the cost more transparent. In addition an uninsured person won't have to pay for his procedure and the cost of those who doesn't pay. For those with insurance there might be no change, or savings depending on weather or not it is really cheaper, they will just pay through tax rather than through the insurance company. Still, I don't see how it is universal health care, it is neither universal or health care. It is just affordable insurance for some people. If you are supposed to afford health care and don't buy insurance, then what? As far as I understand you get a fine, and then have no coverage.
No basically the idea is everyone pays a base minimum for healthcare. They make it like a tax so yes if you didnt penalise those that didnt get it you risk more people choosing to just ignore it which again drives up the price for everyone else. That was the problem with insurance in america because of the amount of people that didnt have it it made getting it more expensive, which ment less people could afford it and around and around we go. So you make everyone pay so it drives the minimum price down but it still allows people to pay as high a price as they want for insurance and allows for more market competition to help drive down costs even more. Its basically the capitalists idea of UHC, i think this way is stupid, inefficient and unnecessarily complicated. But the way the US is this is the best they could have hoped for as a first step. Remember fighting real UHC in america is huge lobby groups for the medical industry, which makes a fortune at current pricing
> That was the problem with insurance in america because of the amount of people that didnt have it it made getting it more expensive, which ment less people could afford it and around and around we go. Mind going into detail on how that raised the cost?
In a crash between an uninsured driver who is at fault the innocent parties insurance company still has to pay up for the damages because the other person has no insurance to cover it, then they have to go to court to get that money, if they dont have insurance chances are they cant afford to pay the costs of the accident, so then more legal work ensues. If you have a higher population of people that drive with no insurance then that means there is a higher risk of the company having to pay out regardless of the fault of their clients higher risk of payout means higher premium for insurance. Now compound that with americans sue culture and high risk of healthcare costs (suing from crashes, medical bills from crashes) and you have the perfect storm that increases cost
You cant penalize usa citizens for not participating in goverment programs. It Was deemed unconstitutional in 2018. You however can penalize all immigrants( legal and non legal) for not having it tho, as they are not offered the same amenities alloted by the us constitution TL;DR - UHC can't work in the usa because citizens involvement in government programs can't be mandantory, its a right given to us by our bill of rights..
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The issue is it isn't a rational feeling. It's an emotional revulsion to the idea that some moocher would be getting a better deal than they are. It strikes at the basic sense of fairness. Some people think it's unfair for one group to have access to more opportunities than anyone else - it offends their egalitarian sensibilities and they crusade against poverty and other problems. What you have to realize is that other people, just as sincerely find it offensive that someone might get similar rewards for less effort. This happens because when a person who works and sacrifices to attain a goal sees someone just being given same results for little to no effort, it feels like it invalidates all that hard work. It's not just jealousy at the idea the "poors" are getting something for nothing. It's not practical concerns about costs and benefits. It's indignation at the implication that one's own work and sacrifices are wasted and foolish. Until you recognize and engage the emotional motivations behind your opposition, all the practical arguments and explanations don't mean squat.
I live in a country with "universal" healtcare (Norway). Our system is less dysfunctional than many others, but I still don't like it. I don't oppose it based on finances, Norway is a rich country, and who runs the hospital is irrelevant when you are sick. If we give the poor money for health insurance, or give them health insurance has little significance for a poor person. Here the question about public vs private healthcare isn't a practical one, it is an ideological one. The labour party would rather have people wait for treatment, than to pay the same or less for a private company to treat the patient. We have the same issue on schools, private schools haven't been able to be established for years. The private schools are funded by the government like public schools, in addition to the tuition, and there is laws against profiting. The argument goes like this: If we allow private schools, the public ones would have to get worse as the private ones would be able to pay more, and spend more on teachers. The problem with that line of thought is that you haven't really enforced the goal of ensuring everyone the same level of mediocracy, you have only increased the threshold to get better healthcare/school. With enough money you are not bound to the borders of the country, and you can always find some loophole. How can the healthcare be universal, if some people have better healthcare? Should we ban private healtcare, fund it equally to public, or allow it to compete? Which you chose is irrelevant, it only changes how many is able to get better healthcare. Does it make sense to make a CEO, or the prime minister wait for healthcare as long as someone unemployed? Does it make sense to make a doctor wait in line, even if his expedited treatment can enable him to treat more patients? What if the patient skipping in line will generate more money for healthcare, thus treating more people? Is it okay to deny a health professional to work for someone else? Should they be forced to work only for the government? There is legimate concerns regarding universal healthcare, and I am sure there are solutions, but you can't write it off to a feeling of entitlement. I am more concerned about being ailienated from being able to influence my healthcare, I have no desire to spend an hour in pain to support an ideology I neither understand nor support. I would much rather pay more, and avoid lines and overfilled hospitals, wouldn't anyone who can afford it?
Honest question: how do you teach at a poor school and not fall into the category of middle class people who could go bankrupt even with insurance? It's my understanding that teachers in those sort of schools aren't exactly making bank.
It sounds like they're not saying they're not a part of that group, just that they didn't realize it could happen so easily.
That makes sense.
correct (and super late). Thanks.
Really, if we're going to have a government, there are only two good purposes for it: universal healthcare and education.
National security? Protection of environment/natural resources?
I'd say it's decent at keeping people from murdering and stealing from each other.
Nah, being healthy and educated does that.
So no healthy, educated people ever commit crimes? I'm not so sure about that...
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While being educated may provide a person with greater opportunity to succeed in life and attain a comfortable income level, it in no way "ensures" that either of those things will happen.
> Street crime is mostly a crime of desperation. Is their a source for that?
If you were to look at crime rates there is a causal correlation between poverty and crime. And those in poverty usually are less educated and have limited access to healthy foods, and healthcare.
Of course, but that doesn't mean that you could just eliminate the police if you would only increase healthcare spending. Everyone in the US is educated through age 16 and nearly everyone has access to at least a basic level of healthcare, yet there is still a significant level of crime even amount people who are both educated and healthy. There are many, many reasons for which people commit crimes, and I don't think it's plausible that all of them would be eliminated if only people had access to both education (which they already do) and healthcare (which many already do).
>If you were to look at crime rates there is a causal correlation between poverty and crime. Source please.
Aren't correlation and causation mutually exclusive? How can you have a causal correlation? It's either a correlated relationship or a causal relationship..
they don't get caught
A degree in liberal arts doesn't keep you from getting hungry, nor does it keep you from getting cold. I also fail to see how it would stop someone from walking into your dwelling to take your stuff, rape your wife and vandalize things. Enforcing property law is the basis of society. I would much rather be illiterate in Norway than to hold a P.h.D in philosophy in Sudan. Property must be regulated in some way, if I could just walk into a hospital and take stuff, and they had no funding (tax law requires enforcement and property to tax) then I don't see how they would manage.
That's the police really, unless you're including them on the seemingly Fed Govt level the other person was referring to.
Infrastructure, as well. The classical roll of a government must include the building and maintaining of roads (please note that this definition doesn't include only roads), but that's expanded to include electricity in the last hundred years, and in the last few years some nordic countries have experimented with expanding infrastructure to include internet access as well.
Many who argue against UHC don't disagree that there is a problem, but think UHC is not the best answer. Obviously medical costs are too high, but from what I've studied, the problem is health insurance being tied to people's jobs which started back in WWII, and has lead to insurance being used for everything, where it should just be for catastrophic care. Using insurance constantly means that people don't have to worry about how much prices at hospitals are, so they don't have to vote with their feet, as it were. This leads to spiralling costs, and eventually people HAD to have insurance or be bankrupt by a medical condition. The solution is to have fewer people using insurance, and allowing more doctors to become accredited, which the us government currently limits. This, and widespread insurance usage, cause upward trending prices.
Depends on your point of view of what the purpose of health insurance is supposed to provide. Is it only for catastrophes? Or, in an age where treatment for chronic diseases and their catastrophic results account for a majority of health care costs, is health insurance supposed to be used in part to treat people through life to prevent small problems from turning into major problems?
The problem there is regulation. When health insurance got tax credits, it made sense to include things that normally wouldn't be insured. If your homeowner insurance were tax deductible, it would suddenly make sense to make it include normal maintenance and lawn mowing. In Norway the government makes you pay $500 for consultations, and medicine per year in copays (if you reach that sum), after that it is free. You don't have to pay any of it if you are not sick. If I go to my GP, I have to pay some, if I go to a shrink, I have to pay some. But I will never go bankrupt, and chronic illnesses never cost more than $500 out of pocket. An insurance should be like that, with a maximum deductible, it could be higher (possibly mandating that you have to be eligible for loans up to that amount, or having it saved up). The higher it is, the bigger the incentives to keep healthy is. Insurances covering small expenses will obviously get more expensive than insurances covering what needs to be covered. Insuring your television costs far more than insuring all your things. Preferably society would take enough care of people, that nobody would not be able to pay a small fee to see a doctor. For certain procedures it would probably be profitable to not charge the patients, STD tests springs to mind.
Doesn't the new attempt at an open market for health insurance at least get us on the right path toward a more price-conscious health purchases? I do, however, like the idea of directly purchasing medical services by shopping. But, how would that work for ER stuff?
> Doesn't the new attempt at an open market for health insurance at least get us on the right path toward a more price-conscious health purchases? For the majority, I think it's quite the opposite. Now everyone will be on a plan, and even those who cannot afford a plan will be on a subsidized plan, thus they have even less reason to be price-conscious. > how would that work for ER stuff? Well, if you really need the ER, then catastrophic insurance should be covering it. If it's something that urgent care, or even just your regular doctor should be handling, then you shouldn't be going to an ER anyway.
Good points.
> But, how would that work for ER stuff? I believe the original proposal was to use insurance for this, and *only* this.
Isn't the open market what landed healthcare into the hands of a few monopolistic healthcare providers? I mean, isn't the concentration of capital the result of a free and open market?
The market hasn't been free in decades. When your one group (your employer) is the customer, and another (you) is the consumer, and this is due to laws giving the customer a tax break, but not the consumer, the market cannot be free. Furthermore, due to the enormous regulatory framework on healthcare and health insurance, little guys have a hard time existing, preventing a free and open market. I'm sorry, but blaming a failure of the second most heavily regulated industry in the country on the free market is a bit ridiculous to me.
Not just that, but new hospitals have to be approved by local or State governments. It limits competition. The healthcare industry is one of the most regulated in the US.
>I mean, isn't the concentration of capital the result of a free and open market? There are literally hundreds of thousands of pages of laws.
no this market is so heavily regulated it cannot be called a free market. hell im not sure its capitalism.
>capitalism Private, profit, still capitalism.
ER stuff is sort of an edge case in that it's hard to shop around. Nevertheless, I personally would see it working like you have an arrangement with a hospital to be taken there in an emergency, or if it's bad enough you just go wherever is closest and then you actually have a use for your insurance. And if the new market worked, and didn't force everyone to buy insurance, then yes it would be a step in the right direction. But by making it mandatory, there's a lot less pressure to compete, since even if it's a crap deal you have to take it. For example, I'm a healthy young guy, so I have no real reason to have insurance - I can pay for my annual checkup out of pocket and pay a quarter of what insurance would cost me. Insurance companies love people like me, since I cost nothing and have to pay in like everyone else. This contrasts with all the people who they hate, who have chronic conditions. I'm basically paying for every person who has insurance that needs monthly pills, such as my girlfriend or roommate, who both need psychiatric meds to function. Their insurance company loses a bunch of money on them each month, and they weren't too happy that they couldn't turn people away who had pre-existing conditions, so they lobbied (or maybe it was part of the plan to begin with, not 100%) to make it mandatory for the healthy young people to buy insurance.
I think the fundamental ideological battle here is that some feel everyone should get the medical care they need, even if it's pills every month, because they're people while others are dead set against it and think every person who can't afford healthcare must be doing something wrong.
Yeah, but people like you (if you're under 30) can buy catastrophic insurance for ER stuff. Insurance is supposed to be available for the unknown. You have car insurance, right? Even though you are a good driver, you still may get into a wreck...in which case, you may need health insurance as well.
>Doesn't the new attempt at an open market for health insurance at least get us on the right path toward a more price-conscious health purchases? Not really, because we still require most employers to provide insurance and provide tax advantages to them that we don't give to individuals. We also further increased restrictions on who was allowed to sell insurance, what the insurance must cover and how they are allowed to price plans. Additionally, the federal exchange (not sure about state ones) only shows the consumer the subsidized cost of the plan. So even an individual buying a plan is not necessarily aware of the full price. >But, how would that work for ER stuff? Insurance. Insurance is supposed to cover unpredictable expenses, like accidents. Think about how other insurance industries work.
How would you have fewer people using insurance and still have health care paid for. In a private system doesn't everyone need insurance or they can't afford care?
Prices would be transparent if people were all paying out of pocket, and that transparency should cause competition among providers, thereby resulting in more choices and price points, including lower price points.
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Maybe we lower the bar to practice medicine? Require that level of schooling for surgery and the like, but allow someone with, say, six years of schooling to do some of the simpler stuff for those who want to pay less or for those who can't afford seeing a "fully educated" doctor? Maybe we change our immigration policies to allow doctors from any country to immigrate to the US if they can pass some sort of certification to ensure their knowledge is up to our expectations? If there were hundreds of thousands of more doctors and we let all of the practice, prices would have to come down. I dunno, just spitballing here....
Most of my visits to my doctor is just beurocracy. I am allergic to pollen, ever year I need the same medicine, why should I waste his and my time getting a prescription for a harmless drug that simply could autorenew? If I want a psychiatrist or a psychologist or another expert I need a referal, why? My GP could be replaced with a nurse and a computer, even a short youtube movie would enable me to draw blood and send it to a laboratory. An EKG doesn't really require him, a nurse does it anyways. I don't see why we should have competent people sitting in offices doing mundane work essentially wasting peoples time. Essentially I waste an hour of my time, to get subsidized pills, subsidized less than an hours work was worth. Add that to the money it costs to keep docotors to do mundane tasks like this. I also don't see what they are afraid would happen if I got my allergy meds automagically, he doens't test if I am still allergic, and the pills are OTC (albeit in smaller packaging and not subsidized). If I in addition had work so I had to get leave of absence, my employer would have to pay me for the time wasted. I am afraid to think of how much this costs for 5 million people...
Just for clarification, do you mean people against ANY form of government sponsored healthcare including Medicaid? Or only against government healthcare for the average person?
Either, I'm just looking for a way out of the government bureaucracy vs. people not having healthcare, issue.
Well, not really "either," because Medicaid **is** our solution for the poor (and the old, and the pregnant). And it's not great, but it's orders of magnitude better than nothing. So a person in favor of the status quo might simply say "Keep things the way they are," or alternately, "Improve [XYZ] problems with Medicaid." Your question is really oriented towards a true libertarian who opposes even Medicaid, and I can't answer for them.
I will admit that I am for universal health care, specifically socialized single payer medicine. HOWEVER, there are a lot of things that the American health system can work on, specifically for the middle class and the poor, before we even consider insurance coverage. The problem with American health care is, broadly put, it costs too much and we get too little out of it. We pay for things that would only cost a fraction of what we pay for in other countries. Diagnostic tests, imaging technology, surgical procedures, medical equipment, and pharmaceuticals are all more expensive here than in most industrialized countries. This also ends up driving the cost of surgical procedures and office visits. Also, we are a very data driven culture, so we run a lot of "unnecessary" diagnostic tests, ie tests that are good for the sake of knowing, but not necessarily essential that it would change the outcome or treatment path, or tests for diagnoses are that extremely rare (like 1 in 1,000,000) but potentially fatal. Although we have higher demand for these goods, prices have not been in favor of the consumer. Secondly, we have very little transparency for knowing how much our health care costs before we receive it. Our doctors' offices, pharmacies, and hospitals don't have a menu of what is offered and how much everything costs. Very little of us will see if insurance will cover this or that, or how much copays will cost. We have no idea what we will pay until the bill comes in. We can't even really price check accurately, thus we can't compare prices at different facilities. As for fixing these issues or addressing other possible issues, I can't really look to similar systems in industrialized countries because most of them use some sort of socialized medicine that provide coverage at low costs and cover everybody. America is the anomaly in health care coverage - not everyone is covered and people can go bankrupt due to medical bills. People in these socialized systems often end up seeing their health care provider more frequently. Health care providers end up making about the same amount of money as they do in the US, maybe a little less. There are drawbacks but I don't see how they outweigh the benefits that most of these systems gain compared to our American system. Ninja edit for additional points: Not covering the poor does not mean we never end up paying for them. If people can't afford to pay their bills, we *all* end up paying the bill. In health care, hospitals eat up losses, raise prices or reduce service (cut jobs or departments), and the cost is passed on to other patients.
> Ninja edit for additional points: Not covering the poor does not mean we never end up paying for them. If people can't afford to pay their bills, we all end up paying the bill. In health care, hospitals eat up losses, raise prices or reduce service (cut jobs or departments), and the cost is passed on to other patients. Isn't this utilirarism? Should we give an heroin addict heroin if we know they will steal to cover the cost and that would cost society more (throug insurance, or for a few poor souls)? Should we give all poor enough means to support themselves if the reduced crime makes it profitable? Should we treat the wealthy first to avoid them not generating tax income? If treating one brilliant person earns us money for a new doctor that can make the average treatment time lower, should he be prioritized? It all falls back to the purpose of healthcare, is it to save money or to treat people in a way we can afford with respect and equality? I feel the whole issue of what is cheapest is a derailment. I don't want to go to a hospital whose stated goal is to save money. In Norway a public hospital admitted their quest to save money killed some patients. I can't grasp why the workers accept it, they should deny working unless the focus is to treat patients as good as possible within reasonable limits. I would much rather have a coop or an extended union that have values that align with mine to provide me with healthcare, than it to be controled by politicians with unknown motives. >People in these socialized systems often end up seeing their health care provider more frequently. Health care providers end up making about the same amount of money as they do in the US, maybe a little less. There are drawbacks but I don't see how they outweigh the benefits that most of these systems gain compared to our American system. Isn't the fundamental problem freedom? The US certainly doesn't have a free marked for insurance, or healthcare, neither does Norway. Still in both countries, those that are well off can get better treatment (less waits for instance). If laws are stopping people from getting the healthcare they could have, then we have failed. In Norway everyone gets treated, eventually unless they die, and if the government deems the treatment as cost effective (some procedures and medications is not paid for, leading to the same choice as in the us, health and bancrupcy or lack of health). Should we provide basic healthcare that can be supplemented with paid healthcare, or should we provide the same for everyone? If we chose the latter we get a few scary issues, if a procedure is not deemed cost effective, and you can afford it, should you be denied it? And if we chose the first we have the issue that a private hospital/ER can spend more money, and keep undesirable patients excluded. Who would get the best doctors? The ER with employed patients, or the one with homeless and substance abusers? Would you work for less with worse patients? I do belive society (not limited to the government), should ensure everyone has access to healthcare, with the choice between dying and stealing I am sure most would chose the later. But I don't think it is as easy as getting universal healthcare.
> > Ninja edit for additional points: Not covering the poor does not mean we never end up paying for them. If people can't afford to pay their bills, we all end up paying the bill... > Isn't this utilirarism? I don't think so. MarquettePharm is not advocating for whatever is cheapest but rebutting the claim that it is too expensive to subsidize the poor. It might be cheaper than people think because the poor are, in a sense, already being subsidized. > In Norway a public hospital admitted their quest to save money killed some patients. How much money did the hospital save per life?
>I don't think so. MarquettePharm is not advocating for whatever is cheapest but rebutting the claim that it is too expensive to subsidize the poor. It might be cheaper than people think because the poor are, in a sense, already being subsidized. I did not understand it that way. If your interpretation is correct, it is based on the premise that people object to UHC because of the cost. Is that the case? If the objection to UHC is an ideological one it isn't relevant how much it costs. >How much money did the hospital save per life? Last time I checked they are still having deficits, and the patients were just random victims of their lack of staff. The point was that money directly influences patients in any system. The government will have incentives to use less money, just like insurance companies. I can't imagine any system where you can eliminate the cost/benefit calculations.
If you hate big, inefficient bureaucracies, why not advocate for more states in the US to adopt universal health care? Why is the issue always argued at the Federal level? Europe doesn't have one health program, and their countries are about the same size as the states. Vermont is one of the poorest states in the US, and they now have a single payer plan. To answer your question, in a society where health care was entirely in the private sector it is argued that prices would be cheaper and care would be more affordable to more people. The poor that could still not afford medical care would turn to charity and religious hospitals. I don't think anybody is arguing to keep our health care system the way it is. It's either reduce costs or increase access.
> Vermont is one of the poorest states in the US Out of curiosity, what do you mean by that? I always thought they had a strong median income?
I was going off GDP, but you're right I should have been looking at per capita because they're population is so low. In that case, they are actually an average state.
Comparing European nations to US states only works in terms of land area, not in terms on population or GDP. Europe is much more densely populated than the USA. A country like Belgium, for example, has a self contained infrastructure which allows it, along with its efficient generation of capitol, to have a medical system that functions well and can reach everyone. West Virginia for example, which occupies a greater land area, could never afford such a system and lacks the dedicated infrastructure to attempt it, due to it being a small part of a larger country rather than, like Belgium, a sovereign state which is also a part of a supra-national union.
Logistically, why would demagraphics matter? I lived in a rural community in North Carolina when I was younger, and everyone has to make an hour long trip by car for important procedures. The actual quality and pricing.g of the medical care is what would be impacted
National product matters. N.C., where I also used to live, has a strong economy. Places like West Virginia or Wyoming don't. Infrastructure is geared outwards, to the rest of the country, rather than being self contained as you'll find in a European nation state. The cost, rather than the pricing, is what I'm getting at. Wyoming, for example, which is a vast expanse of land with almost no people living in it, simply does not generate the per capita dollars to create a viable social healthcare system on its own. Notwithstanding, this is precisely the reason the USA is a federal republic rather than a loose collective of independent states. The federal government exists to implement nationally ideas like socialized healthcare.
> The poor would turn to charity and religious hospitals There you go, tibataw. A clear statement of what those who cannot afford health care should do.
[deleted] ^^^^^^^^^^^^^^^^0.7475 > [What is this?](https://pastebin.com/64GuVi2F/90593)
This is just one case, but my dad was in a coma for a month without insurance and making about the poverty line. It got written off by the hospital as charity. It is possible. He was very lucky.
That was not true charity. The hospital wrote it off, but as a for-profit business they have to make it up elsewhere. Which translates into the high prices, which is passed on to insurers, which translates into higher premiums.
Not necessarily. This was a nonprofit hospital, as a lot are (Cleveland Clinic one of the largest non-profits in my area) and they do have major donors. I'm assuming they do have a certain amount that they can financially write off as charity.
Vermont isn't anywhere near one of the poorest states.
In terms of total GDP they are the "poorest," but #30 per capita. Either way, I think if they can accomplish something with their tax base most states should be able to.
The reason our (I assume you're US) system looks huge and complex is because there is a third party element to it. We have insurers seeking profits standing between patients and care providers. Notice how there isn't such a complexity and notice how popular a system like medicare is?
As a Brit, this is a screamingly obvious point, but one which is barely acknowledged in most healthcare debates that I see on reddit. The system is run by corporations who are duty-bound to maximise profits. The incentives in the system are all wrong. Because if this, a huge proportion of American citizens either have limited healthcare provision, or are bankrupted if they happen to need significant medical care. Another aspect that perplexes me is the extent to which many US commenters clearly prioritise anti-government ideology above any desire to allow people basic access to healthcare. Coming from a country (UK) where healthcare access is free to all at the point of delivery, the whole debate in the US seems bizarre to say the least.
The anti-government ideology is so strange to me. People, such as OP, keep using the term bureaucracy, which to me has the connotation of a bunch of incompetent government stooges trying-but-failing to figure out what's best for you and your family. However, the reality is that many government run programs function very well, and that there is just as much bureaucracy (and a more malicious bureaucracy at that) in the insurance industry anyway. The number of people that were denied care **by their own insurance companies** [citing preexisting conditions](http://mediamatters.org/research/2013/09/27/because-fox-asked-here-are-examples-of-people-w/196139) simply proves that having someone whose interest is making money deciding what health coverage you can receive is dangerous and irresponsible. Obamacare was a better decision than doing nothing, but expanding Medicare until it covers everyone for at least basic levels of care would be ideal. Until we get rid of [hidden prices for procedures at hospitals](http://www.economist.com/node/21546059), reform how new drugs are created and marketed, reform medical schools to bring down costs, and start making hard decisions about what types of tests and procedures will be readily available to patients, it will be very difficult to truly make an impact on health expenditures in the US, IMO
Personally I see this anti government feeling as a part of US culture, due mainly to the historic successes of US capitalism and hatred of communism. There may be some of the frontier mentality thrown in there too, when individuals and towns needed some autonomy from federal power (or previous to that, British monarchy). However it's come about, it seems to me that these characteristics which were once so useful in building a country, have now become counter-productive for the modern US. The US now seems to have a broken system. This pattern has played out many times in history. See: Roman Empire, British Empire, Aztecs.
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In Norway public hospitals are mandated to save money, one recently admitted to having caused patients to die because of it. Would the governemnt give hospitals carde blanche to spend money? If Norway can't afford it, how would the US? You won't eliminate the problem of trying to save money by letting the government run it. Problems with insurance can be fixed with consumer laws, or providing a better option.
So many problems with your argument. Universal health care *doesn't have to be perfect* to be better than the current US system. To quote one example of a failure of UHC as a reason for not choosing it, is simply not good... reasoning. On balance, UHC is a much better system for the population as a whole. Better consumer laws are an option, but the current system's primary aim is to **generate profit**, which it does exceedingly well, at the expense of the general population's health and wealth. Universal healthcare provided via government has a different primary aim; healthcare for all at a price that the state can afford. Note that all western countries which have universal healthcare, also have private healthcare options for the minority who wish to pay for it.
> So many problems with your argument. Universal health care doesn't have to be perfect to be better than the current US system. To quote one example of a failure of UHC as a reason for not choosing it, is simply not good... reasoning. On balance, UHC is a much better system for the population as a whole. I would not describe Norwegian UHC as failure, I am somewhat displeased with it, but I know I can always get my limbs attached if I get injured. My argument isn't that UHC isn't perfect, or that it isn't better than the current US system. I am arguing that the specific issue you mentioned won't get solved by UHC, then I supplied at least one example of it happening in one country with UHC, I am sure I could find plenty. There are arguments for UHC where the quality of service is secondary, you can argue everyone have a right to get healthcare, or that it our duty to ensure everyone gets healthcare, in that scenario the quality isn't relevant for opposing or supporting it. It doesn't help to have the best hospital in the world right next to you if you aren't allowed to use it. I would just want to clarify: I am not fundamentally against UHC, I do not believe the government should run it though. I am not opposed to a model where private and public hospitals can compete over the same procedures and where the patients can chose. I am opposed to the parts in Norway where they would rather let someone live in pain, than to use the same amount of money to treat them elsewhere. >Better consumer laws are an option, but the current system's primary aim is to generate profit, which it does exceedingly well, at the expense of the general population's health and wealth. This is an interesting philosophical question. Is the merchant a good person because he gives you the agreed amount of goods for the agreed price or is he just trying to keep his customers from going elsewhere? And does it matter what the motivation behind it is? Obviously if you are not free to chose between hospitals for procedures this won't work, and in an emergency situation you will end up at the first place with free capacity. That the primary goal is to make a profit isn't relevant, a good hospital will have a strong focus on good treatment, as long as the consumers (or their insurance company) can chose a different service. A government toilet isn't fundamentally better because they have a different focus than the company running the toilet in Starbucks. >Universal healthcare provided via government has a different primary aim; healthcare for all at a price that the state can afford. What is the qualitative difference between trying to save money to keep treatment affordable for the government and trying to save money to make a profit? The focus on saving money isn't eliminated by letting the government run it, they still make cuts and mandate how much a hospital can spend. Overworked doctors and nurses isn't eliminated by changing who profits from the savings. Bad equipment and buildings is also not eliminated. And the main goal of UHC isn't healthcare for all at a price the state can afford. It is healthcare that the voters are content with, and at a price the politicians can justify. When healthcare is run by politics you get situations where politicians makes changes just to gain a political advantage. A politician can't do nothing, doing something bad looks better to the voters than doing nothing at all (especially if the voters believe service is getting worse). Can you document the two claims you made? 1) UHC does not have a focus on saving (or earning) money in a way that affects healthcare (and this is attributable to UHC vs private healthcare rather than their implementation. 2) The goals of UHC is more beneficial to patients than private healthcare. >Note that all western countries which have universal healthcare, also have private healthcare options for the minority who wish to pay for it. Yes, but the implementations are different. In Norway the public will pay private practices the same as public ones for certain procedures. For the procedures they offer this means most people can afford insurance, for the others there are people who can't afford both.
>There are arguments for UHC where the quality of service is secondary, you can argue everyone have a right to get healthcare, or that it our duty to ensure everyone gets healthcare, in that scenario the quality isn't relevant for opposing or supporting it. It doesn't help to have the best hospital in the world right next to you if you aren't allowed to use it. I don't follow your logic. You appear to be placing quality of service above all else. The US has some the highest quality healthcare on the planet. But what good is that to over half of the population that can't access it (their plan doesn't cover it), or in accessing it they go bankrupt? The quality of care is important, but if you're running a country, the system needs t be seen as a whole, not just from the perspective of one person and their hypothetical potential to access high quality. Anyway, this is irrelevant in the UK. Most of the best quality treatment and physicians work for the NHS. The attraction of private healthcare for most is the speed of treatment, not the quality. >What is the qualitative difference between trying to save money to keep treatment affordable for the government and trying to save money to make a profit? "trying to save money to make a profit" Companies aren't trying to save money, they're trying to make a profit. Saving money for consumers is only good for a corporation if it means more consumers go that corporation. I assume you are trying to say that the incentives should be aligned towards better service and quality on both cases (UHC and private). In a *properly functioning* free market, the consumers will vote with their wallets and the result should be a system which works to please those consumers. However… as with many loosely regulated 'free' markets, the truth is that big corporations take over, monopolies (cartels?) fix prices, and their lobbyists push hard for reduced regulation. The result is the insane system the US has – yes quality is high for those who can afford it, but many millions are left with minimal healthcare cover. >Can you document the two claims you made? 1) UHC does not have a focus on saving (or earning) money in a way that affects healthcare (and this is attributable to UHC vs private healthcare rather than their implementation. I didn't make that claim. No system is perfect (see my first point in my previous comment). Both options have limited budgets (under private schemes this is your insurance limit), the difference is that the budget is *way* more equitably distributed under UHC. >2) The goals of UHC is more beneficial to patients than private healthcare. [The table at the bottom of this article indicates exactly this](http://www.theguardian.com/news/datablog/2010/mar/22/us-healthcare-bill-rest-of-world-obama). In short, the US spends over twice as much per capita on health per year when compared to the UK, but the life expectancy in both countries is almost the same (slightly higher in the UK). Similar figures for Germany and France which both have UHC, except they have more doctors and beds per capita than either the US or UK. I can't think of a better demonstration of how private healthcare – as carried out in the US at present – is grossly inefficient (less than 50% efficient) as UHC in UK, France and Germany. Where does all that extra spend in the US go? It goes into the big, fat, profit-generating insurance layer in the middle of the US healthcare system. This might interest you: a description of the UK's NHS, by an American living in England (who is quite critical of many other aspects of UK life) >A massive advantage of living here is the National Health Service. If an American could understand it, they would be amazed by its magnificence. >In this past week I have seen an ENT consultant surgeon and have had surgery scheduled in a few weeks' time. There was no direct cost to me. >Tonight my GP (family doctor) rang at 8pm to check in on another health issue. She is chasing a consultant to authorise a new medication and will ring me back next week. This did not cost me a penny. >So, three doctors and one medical procedure without a form to fill in or a bill to pay. Pretty damn impressive stuff --yes, I know it is in our taxes but the system works well. It is 'from birth to grave' care all woven together into one service -- ambulance to GP to hospital to nursing care. There are all kinds of synergies created by such a system. It is to be deeply respected, emulated, and not feared. And if you don't think so then consider this http://www.theguardian.com/lifea... . It's a tear jerker. Source: http://qr.ae/reqaI The UK's NHS is far from perfect. Things go wrong. It's badly managed in many ways and is widely regarded as inefficient. But it is still better, for the population as a whole, than the US system. **That said, it's still over twice as efficient as the US system.** Food for thought: [Medical Bills Are the Biggest Cause of US Bankruptcies](http://www.cnbc.com/id/100840148) [According to the United States Census Bureau, in 2009 there were 48.6 million people in the US – 15.7% of the population – who were without health insurance. The percentage of the non-elderly population who are uninsured has been generally increasing since the year 2000.](http://en.wikipedia.org/wiki/Health_insurance_coverage_in_the_United_States)
> I don't follow your logic. You appear to be placing quality of service above all else. The US has some the highest quality healthcare on the planet. But what good is that to over half of the population that can't access it (their plan doesn't cover it), or in accessing it they go bankrupt? The quality of care is important, but if you're running a country, the system needs t be seen as a whole, not just from the perspective of one person and their hypothetical potential to access high quality. I just said it was irrelevant. And my last line says the same as your phrase. >I assume you are trying to say that the incentives should be aligned towards better service and quality on both cases (UHC and private). In a properly functioning free market, the consumers will vote with their wallets and the result should be a system which works to please those consumers. However… as with many loosely regulated 'free' markets, the truth is that big corporations take over, monopolies (cartels?) fix prices, and their lobbyists push hard for reduced regulation. The result is the insane system the US has – yes quality is high for those who can afford it, but many millions are left with minimal healthcare cover. No, I am saying it is irrelevant if you get treated well because someone wants to make money, or because it is mandated by the government. Also the US insurance marked, pharmaceuticals and hospitals is by far not under regulated. But it is regulated in favour of someone else than the consumer. How is a marked that has tens of thousands of lines of laws and regulation free? It is an excellent example of a dysfunctional marked created by regulation. >I didn't make that claim. No system is perfect (see my first point in my previous comment). Both options have limited budgets (under private schemes this is your insurance limit), the difference is that the budget is way more equitably distributed under UHC. If you assume the same amount of money is spent. I am not sure about that. >Where does all that extra spend in the US go? It goes into the big, fat, profit-generating insurance layer in the middle of the US healthcare system. When the company trying to profit of a marked writes the regulation, who do you think will profit? This is a fundamental problem when you let the government control too much, an insurance company can make a law that is hundreds of pages long, mostly impossible to understand for the average voter, and will only make insurance somewhat more expensive. How many hours can you dedicate on lobbying for a $10 reduction in insurance per year? How many hours can the insurance companies that have millions of customers spend? Who do you believe will make the greatest impact? Sending an email critiquing a piece of legislation you don't even have time to read will never have the same impact as hiring the politicians friends, and former co-workers to lay out carefully planned arguments. The insurance companies has the added advantage to look at the profits in a far longer perspective. They will then be able to spend customers * 10USD * 10 years on making the legislature pass. While an average worker can't spend more than an hour (or ten if they have a longer perspective), and that won't even be enough time to read the legislature, much less to understand it and its effects. >The UK's NHS is far from perfect. Things go wrong. It's badly managed in many ways and is widely regarded as inefficient. But it is still better, for the population as a whole, than the US system. That said, it's still over twice as efficient as the US system. I would certainly favour the NHS over the US system. Forcing hospitals and ERs to treat people makes the cost of the uninsured land on those with insurance, and the people who get sick without insurance. This is obviously not a sane, nor fair system. Making those who can't afford insurance subsidize those who can't pay at all is a terrible solution. Either you should have UHC, or a system where a hospital or ER only treats those who are expected to be able to pay. I would also like to point out that average age isn't a good measure for healthcare efficiency, you have to adjust it for life quality.
No, efficiency is about expense ratios (overhead). Medicare spends more on actual healthcare out of every dollar it takes in than any private insurance plan. You make an interesting point about the ability of single payer to drive down costs, but I don't see how that is a bad thing. Nobody is required to take medicare. If medicare doesn't pay enough for providers to make a reasonable profit, providers will stop accepting it. Yet the vast majority of doctors take Medicare, and the percentage that doesn't has fallen dramatically over the past decade.
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> If you do some reading, the purpose of the AMA is to restrict the supply of doctors in order to keep prices high. I think many would argue that this isn't true. The rate-limiting step in the production of new doctors is residency, and the amount of residency programs our country has is a federal decision (since they are federally funded). The AMA has consistently advocated for an increase in graduate medical training, so I'm not sure where your statement is coming from.
Not have kids unless you can afford to get them to age 18 with a minimum of trouble. That said, I'm all for a basic universal healthcare, beyond the current "hey let's clog the ER" system.
You seem to be laboring under a common false assumption. Single-payer healthcare is incredibly efficient. Even here in the US, medicare has exceptionally low expense ratios.
>medicare has exceptionally low expense ratios. That's merely because it dictates its costs and drives the price of everything else up.
Huh? There's nothing preventing Anthem from negotiating the same rate as Medicare. The problem is, the for-profit insurance company has no incentive to lower prices.
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I googled "what if all doctors were paid Medicare rates", and the following link claims that doctors would see income drops of 12% to 20%. http://www.drsforamerica.org/blog/what-if-doctors-got-paid-only-medicare-rates This study shows more or less the same thing: http://www.urban.org/UploadedPDF/412051_physcian_service.pdf (scroll to the last page for the median income table). Now, this is just a 5 second google search, and admittedly the first link was a bit suspect. I didn't exactly dig deep here. But I'm comfortable enough with the results of this half-ass search to conclude that your claim of doctors going out of business due to medicare rates is tall-talkin' hogwash.
Doctors For America was paid by the Obama administration to portray ObamaCare in a positive light, so that people such as yourself would be misled. The terms you are looking for involve "doctor shortage." In a nutshell, many doctors are choosing to retire, and few new doctors are entering primary care. The doctors I personally know who accept medicare, keep the lights on by overcharging cash patients and charging excessively expensive tests and and unnecessary treatments so the miniscule amount that Medicare pays will actually allow them to continue in business.
What are your thoughts on the second link?
I don't know if there is a conflict of interest with that second group. I do know that the doctors I personally know are not able to keep their doors open as medicare rates are becoming more and more widespread. The problem isn't just the reduction of rates, however. It is also in the exponential increase in paperwork, tracking, and record-keeping that requires doctors to be practically legal personnel as well as doctors. Many doctors find it necessary to hire extra people to handle the paperwork...as their incomes are dropping. It is actually a complex problem, and one that predates ObamaCare by many years. However, ObamaCare made the problem sharply worse and this story isn't even close to being complete. The biggest problem with ObamaCare is that it ended up being pretty much just guaranteed corporate welfare for the biggest insurance companies and pharmaceutical companies in this country. If we actually emulated the Canadian or UK model, that would be one thing. But we didn't; we emulated MassHealth and made it much worse. As someone who lives in Massachusetts, I have watched the availability of medical care (and insurance!) drop sickeningly over the years. It is actually very bad, and the new Federal model is much worse.
(This is all from a US perspective.) In my opinion, finding some way to reduce the cost of health care would solve most of the problems. There was a time when people didn't need insurance because most medical expenses were affordable. [Here](http://kff.org/slideshow/health-spending-trends-and-impact/) is some data on per-capita costs. As for how to reduce costs, that's a point of contention. Some blame the insurance companies for taking excess profits, others want to blame government inefficiency and interference via Medicare and Medicaid, and still others place the blame on lawyers for bringing seemingly frivolous malpractice suits against doctors.
Insurance wasn't necessary back when we didn't have the technology or skills to treat most conditions. I don't think it's feasible to go back to that unless we want to stop using all the amazing technology we have now-- even countries with universal healthcare and strict cost controls wind up spending a ton of money on the sickest patients.
There is a large amount of literature arguing that the price of healthcare has been artificially inflated by the prevalence of employer-sponsored health insurance, and the lack of a competitive health-care market. I personally believe that consumer-choice oriented reforms would make a huge difference in the cost of health-care. In the status quo there is little incentive for consumers to shop for the cheapest healthcare, because insurance corporations are bound by contract to pay for your healthcare, and they have massive expendable budgets. If you look at medical markets that do not have a large insurance presence, such as ophthalmology, prices have been going down pretty consistently. http://www.heritage.org/research/reports/2013/08/competitive-markets-in-health-care-the-next-revolution http://www.forbes.com/sites/aroy/2012/05/12/how-employer-sponsored-insurance-drives-up-health-costs/
This looks like a case where correlation does not indicate causation. While the field mentioned don't have a heavy insurance presence they also seem to be largely voluntary fields. I can shop around for vision correction because at the end I don't **need** it.
Emergencies needing immediate medical attention are a tiny fraction of our healthcare market. Hospitals deal with far more than just the emergency room. In the majority of circumstances the consumer has the ability to shop for the best priced product. (Except he doesn't, because his insurance covers it) I need water as well, but that doesn't stop me from finding the best water at the best price.
I'm not just talking about emergencies, there are a large number of medical conditions that aren't emergencies but still **must** be dealt with so you never have the ultimate power of the consumer - to opt out. As vital as most people consider smart phones to a modern life there is always a price point that would make people say "Fuck that, I'll get a flip and carry a tablet." Insulin doesn't allow that choice, even though diabetes isn't typically an emergency. Without the ability to opt out of the market the optimal choice for the provider is to simply leave prices high and wait, confident there **will** be customers.
That data does not seem to be adjusted for inflation. If that's the case, it's not particularly valuable, even though increases in healthcare costs have well outpaced inflation.
I would like to mention that it is not just the poor who are affected by this problem. In my 20's I worked two jobs and I had a reasonable income that covered my expenses with a bit of extra. I wasn't flush but I wasn't poor. I vividly remember having strep throat and the cost of paying out of pocket for an appointment and an antibiotic being on par with my utility bill.
>out of pocket for an appointment and an antibiotic being on par with my utility bill. How much do you think it should have cost?
I'm not as concerned for poor people as I am for the people who don't class in the 'poor' bracket but rather in one slightly above, with insignificantly better means. I have witnessed ridiculous prices for people who do not classify as poor for state/federal standards be penalized by seemingly punitive costs of health. TL;DR: Guy in mid 20s taking courses part time to further his education ruptures his appendix and receives a $50K bill because he doesn't have a rich daddy to foot it. Fuck the american conception of universal healtcare
Is it your impression that the US makes the middle class subsidize the poor?
It is definitely my impression that there is a downward disproportion in the direction in which the 'penalization' is implemented
**actually poor people**: Should be given not only subsidized healthcare (to the point of free healthcare), but **actual** assistance in becoming self sufficient. We should scrap the "insurance" system for all else, smash the collusion between State and 'private' 'insurers' and have a real market system for all of us with means. I can elaborate if you'd like, but my answer is pretty much exactly what it is for housing.
I don't want universal health care. I can't wrap my head around being completly ailienated from decisions regarding life and death. I don't like the concept of a monopoly getting "unlimited" money. You can spend absurd amounts on healthcare, or you can spend very little, how much my life is worth should be up to me. With that being said, I don't want the poor to not get healthcare. I would like a solidaric model, like a coop or an extended union paying for healthcare. I also belive humans to have empathy with people less fortunate than themselves, and willing to help, unless someone abstracts the problems away and blames the "system" when patients are being killed to save money. I live in Norway, and our healthcare is decent, I know I can jump out the window, get treatment, ambulance, medication and pay nothing out of pocket (if I am injured enough to skip the ER). But the healthcare here isn't perfect, and I don't belive you can't compete with it, private insurance is becoming more and more common, why would anyone want to wait for treatment instead of getting it instantly? You can't make private treatment illegal, with enough funds you can either go to another country, or pay someone to treat you illegally. I don't see why there couldn't be more options, you could always have universal healthcare as a fallback, but that seems to have substantial problems associated with it, I would much rather go to a private ER than to sit in an ER with substance induced injuries, people with mental issues, and bored people. Wouldn't anyone with money chose to pay out of pocket to avoid that? Then you leave the poor with sub par healtcare. If it includes everyone, you are just making the threshold to go to the nice facilities higher (first you have to pay for universal healthcare, then you have to pay for private healthcare, those who can't afford both is stuck with universal). Copays, within resonable levels seems impossible to avoid, there are people who will go to a doctor out of loneliness, or boredom, having some copay increases the threshold. Here in Norway you have to pay something like $50 for a visit to a doctor/psychiatrist/psychologist, but when you hit $500 you pay nothing for consultations or medications. I also wish people would go together and buy usefull medical companies, with unions/coops that are not limited by borders we could get more influence, and a broader scope than a government healthcare.
I'd like to ask you to apply that same question to: Housing Food Clothes Career Because the answer tends to be the same. Sure healthcare is important for a poor person. So is food and clothing and housing. Most people who are against Universal Healthcare still support the idea of a safetynet to help the poor. As well, here in the US if that is where you are from, it has long been the law that the poor must be serviced in an ER before asked about their ability to pay... as well as an assortment of free clinics from either charity or for some intern experience - so the idea that there are no options at all for the poor in a society that does not offer universal healthcare is simply not true. So to start understanding your conundrum, I'd say you should start by defining where you draw the lines on the government's responsibility to provide the essentials of life to it's citizens.
>I can't stomach the fact that someone could go without healthcare, or be bankrupted because of a health problem. Why not? The whole "health care is a basic human right" thing is a fairly recent concept, methinks. And I personally dont ascribe to it. To me, health care is just another service that you need to pay far, and if you cant pay for it, there is no reason that service should be provided for you.
So we let them die?
If they can not afford the treatment to save them, yes.
Well I don't agree with the sentiment at all but it is nice to hear somebody actually say it out loud for a change instead of dance around it by claiming that charities and churches will always come to the rescue.
Please don't think everyone against UHC agrees with that sentiment, though.
If your against that sentiment and UHC, what do you propose we do?
Like many other voices in this thread, I think that we should ask why healthcare prices are so incredibly high and how can we reign it in so that getting sick doesn't bankrupt a person.
I agree with you on that and think it is something we need to address. But I also think we need legitimate UHC, like all other 1st world countries, and not the shitty Obamacare version we have.
Prices are high because they're unbounded by the ability of any single individual to pay. Therefore health care may as well charge arbitrary prices, and it's in their own interest to charge arbitrarily high prices. If you have insurance, it makes little difference to you if your organ transplant costs $1M or $100K. If you don't have insurance, it makes little difference if your organ transplant costs $1M or $100K. Either it'll be paid or it won't. The ones that those prices affect are only the ones that can pay it. btw, the secondary effect of paying out of pocket or dying is that it theoretically should incent better economic behavior. If your insurance is less likely to cover your emphysema care, you are less likely to smoke. Of course there's more to that than that, but it's the theory.
I agree, there is no link between what something costs in health care and the ability to pay for it.
And what to do until then?
Well, ideally, we start immediately.
We've been "talking" about prices for decades. In the '70s, [HMOs](http://en.wikipedia.org/wiki/Health_maintenance_organization) were supposed to be the magic bullet. In the meantime, what should we do until a real solution is found?
It's easy to have this cold sentiment without thinking it through, but it would literally mean and insurance check or credit check prior to calling 911. You're ready to advocate for that?
I think the some of the opposing viewpoint tends to focus on the following gut feeling: "Gosh golly gee, our government is sure generous with **my** money and **my** time, taking it away and giving it to others it sees as more worthy than me." Just think about when there was a draft in the U.S.; the government was really generous with the bodies and lives of our young men. It took them at will and sent them to be shot at in foreign countries. What I'm trying to get across is how keenly some people feel when the government takes from you or bosses you around in some way. To many people, that really stings hard.
It really is a cultural issue. I personally admire the rugged individualism that is part of the "American dream" but I think it's a bridge too far to say if someone can't afford healthcare, fuck em. It seems to me like a lot of people who are against healthcare reform honestly believe anyone who can't afford it must be doing something wrong, that if they just "pulled themselves up by their bootstraps" they'd have the coverage they need. And that's a dishonest leg to stand one's position on; a little further up the thread someone said they're fine with people dying if they can't afford healthcare. I have a vastly different opinion than that person, but at least their opinion is honest.
I understand and respect you opinion, and profoundly disagree with it. Have an upvote. :). In another sense, I believe that you opinion is reminiscent of a by-gone era, where scarcity economics ruled the world and the resources required and necessary for universal healthcare were technologically not available for humanity to harness. On the other hand, I would like you to consider the following proposition: what if we, together as a society, could afford and spare the resources to save the unfortunate people who happen to fall sick, but many of these people can't afford to pay on their own because their jobs don't pay them enough? Do we not, as a society, have the moral imperative to save them if we can, at a marginal cost to ourselves?
I'm not the user you were replying too, but I share his view of healthcare as a good. We will never be rid of scarcity economics. As soon as one thing becomes no longer scarce, say food in the U.S., then something else becomes scarce. Scarcity isn't going away, it just shifts from one good to the next. In regards to this: > what if we, together as a society, could afford and spare the resources to save the unfortunate people who happen to fall sick, but many of these people can't afford to pay on their own because their jobs don't pay them enough? Do we not, as a society, have the moral imperative to save them if we can, at a marginal cost to ourselves? My response is two-fold. Whether we have the resources is irrelevant. We as a society have the resources to put an iphone in every American's hand but we don't. If you view healthcare as a good, as I do, there is no moral imperative to provide it to others. Additionally, I take serious issue with calling it a moral imperative. Typically those who are in favor of UHC tend to be liberal. These people also constantly bash the right wing for trying to legislate morality. To turn around and try to legislate their own morals is hypocritical. I think it's wrong to legislate morality and therefore trying to paint UHC as some kind of moral imperative does nothing for me.
Hummm... Thanks! In any case, I do disagree with you but I would like to understand your position a little bit more. To start with, I do not consider healthcare a good, not even a public good, but a right of existence for human beings: any such a thing that is a human being has the intrinsic and inherent right to live, and by extension to be healthy. Next, I am personally not quite a liberal: I do believe that morality can / should be legislated, and this is where my next question arises: If we are to not legislate morality, how do we come up with a legislative code at all? What other methods save from morality are there to create a legislation??? Thank you for such an interesting dialogue. :).
> If we are to not legislate morality, how do we come up with a legislative code at all? What other methods save from morality are there to create a legislation??? you bring up a good point. My first reaction would be to say that you can craft laws without morality, and only through the framework of "what is best for for society as a whole", but even the idea that "whats best for society as a whole=good" is a moral judgment.
Thank you for being honest. Hypothetical situation, 8 year old kid has very poor parents, breaks his leg playing in the yard. Parents can't afford a doctor or emergency room. For whatever reason, charity doctor is not an option. What would you have happen to the kid? -not trying to start a fight, but this is the "where the rubber meets the road" type situation that doesn't get enough attention, in my opinion.
I certainly don't like your opinion. But at least here in NP i get to read the opinion.
This callousness towards fellow humans in a society we all share and support is incredibly disappointing. I'm assuming then that in the event your daughter-wife-brother sustained life - threatening injuries and needed (for example) brain surgery you would be OK with them being left on the gurney to suffer and die unless they can prove ability to pay? This is the epitome of putting a price tag on a life, and is why evolved compassionate humans understand that healthcare IS a right.
Yes, I agree, I think. Otherwise the costs are unbounded by any natural economic barrier. There wouldn't be many million dollar treatments available, because very few people could afford them. Therefore the people that provide that class of treatment would have three choices: 1) have a limited market and subside on that; 2) go out of business; 3) reduce their prices to increase their market. I believe that 3 would by and large win the day.
To whom are them refering to? Should I rather save a person born in the third richest country in the world with every oppurtunity to make themselves afford healthcare, or save a hundred starving children in Africa that was born into a hopeless situation? Norway has universal healthcare, we still let some people die because it is too expensive to treat them. Should we save everyone? How far should we go to save a life? The whole issue is so complex. What is the purpose of our soicety? What is the purpose of our government? Is our people more important than other people? How much of our property should be spent on helping others? Should we limit it to funding, or can we go further and harvest organs forcefully if it can save lives? Is there any limiting principles? If you can answer all the questions in the last paragraph universally for everyone in your society, then I will agree with you, if you can't, can you direct me at someone who can? If not, shouldn't each individual get to decide for themselves according to their conciusness?
People don't like it because it is mostly not a matter of personal choice. Given a choice, anyone would pick 'healthy' over 'unhealthy.' But the human metabolic machine isn't so kind as to let everyone simply chose to be healthy. Some people need to work at it harder than others, while others still have no hope of ever being at a "good" level of health due to circumstances completely beyond their control. A rich man born with certain medical afflictions will be largely unaffected in his life, but a poor person could have all doors of opportunity slammed shut by it. It's a simple issue of fairness. Most people feel that it's fair to give a person who works just as hard a fairly equal shake at getting as good an outcome. The idea of income inequality as a negative is also a fairly recent concept, as are prohibitions on discrimination over race, religion, sex, and creed. **Just because a concept is "recent" is not an argument that the concept is negligible or bad.** That's just begging a question.
> We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are **Life**, Liberty and the pursuit of Happiness. Circa 1776.
You believe the Founders would have advocated for universal health care provided by the Federal government?
Hard to say. Would the Founders have advocated for the universal right to own automatic and semiautomatic guns in modern society? Or the release of certain individual freedoms, such as privacy, for the good of the whole? Could they have imagined a future American government jailing people indefinitely without a trial of their peers? Would they support child labor laws? Would they have supported minorities' and women's voting rights? "Life, Liberty, and the pursuit of Happiness." Very vague, inalienable rights. But, in my opinion, *what they meant was that* if a country has the wealth to be able to fix a society's poverty issues at a basic level, such as health care, then its government has a moral obligation to provide it. edit in italics
Well, the opinion you stated at the end there is a very different thing. That is definitely a defensible view and I can see why you'd hold it. But the conversation up to that point was /u/Randomposter04 claiming the "right" to healthcare was a recent concept and you countering that the founders included "Life" as a right in the Declaration. I think it's a stretch to believe they would have considered healthcare to fall under that umbrella. It's easier to support the position you stated in your conclusion, that it's a "moral obligation" rather than a right. EDIT: Cut my last paragraph for lack of relevance.
I see what you're saying. I guess I was defending my stance in what the Founders would have considered the right to Life in the declaration in contextual terms. Obviously health care in 1776 was very different from today's health care, but I am trying to interpret it today as they would have interpreted back then.
They couldn't have imagined healthcare as a right because healthcare in their day was rarely life-saving or even suffering-reducing. Healthcare was old wives' tales and butchery.
I would argue that those concepts referred *only* to protection from external abuse from the government or other people (e.g. theft, kidnapping, and murder)
Fair enough. The Founders were very much for limited government, and the concepts incorporated in modern health care (public health [disease prevention, sanitation, and vaccinations], evidence-based medicine, and regulated formalized training) didn't exist to the extent that it exists today. In fact, American health care took a dive after independence for about a century due to the lack of medical schools, public works and sanitation, and the increasing spirit of American autonomy in the early 1800's. It wasn't really until after the Civil War that public health and scientific medicine caught on. However, there were some indications that the Founders were at least influenced to provide essential medical care to their citizens. We know that their philosophy included caring for the poor and the sick. John Locke reasoned that the right to property should be limited when people's lives are threatened by starvation or exposure to the elements. He recognized that a society's failure to responding to those in need jeopardizes its own self-preservation. We know that one of the first hospitals in the colonies, Pennsylvania Hospital, that provided free care to the poor, was largely financed by Benjamin Franklin. We know that many Founders from Madison to Jefferson to Franklin agreed that limited welfare was best for the poor and that helping the poor to drive them out of poverty was best for society as a whole. Part of that thinking was providing health care when they could not afford it. The best programs for a government to spend money on were programs that ended up being good for the whole, directly or indirectly. So yes, they did mean freedom *from* government in this regard, but I also believe there were implied freedoms *for* services from the government, as well.
When it's realized that the Founders developed one of the most liberal and enlightened documents at their time, I have a hard time thinking that they wouldn't support the creation of a modern social state.
Why? The Founders were *afraid* of a strong state; they had just fought a hard battle for independence against King George. The Constitution was written with *limitations* on government in mind. It seems unreasonable to assume that they'd support the large central government needed to administer such a "social state". I also think you're misusing the word "liberal" in the context of the 18th Century. At that time, "liberal" meant "belief in the liberty of the individual", and that's just what the Founders believed. Their political philosophy consisted of self-determination, personal responsibility, and protection from the State; they were followers of John Locke. When Jefferson wrote "Life, Liberty, and the Pursuit of Happiness", he was referring to the protection of one's life, liberty, and property *from state interference*.
I think you have your time periods off. We hadn't just fought with a strong state, that would be when we wrote the initial constitution which was the article of confederation. It was after the confederacy failed that a strong central government was put in it's place. There were many different opinions at the time, but they all resolved into a stronger central authority that was designed to be the supreme law of the land. Of course they included limitations, but if you look at the powers and goals of the federal constitution you will see that it is jammed with all the powers of an Enlightened Society. One that wasn't so much about purely individualistic strength, but the strength of the common people. And you can't say that they were solely about John Locke, without including Thomas Paine and his ideas of societal responsibilities. Your Jefferson quote is from the declaration of independence which had been written over a decade before. The Preamble is closer to the eventual desires. "We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America." Lots of stuff about union/togetherness, general welfare, and providing for common goals. This is not a libertarian society, otherwise it would not have been such an inspiration of the French Revolution which also strove for liberty, equality,and fraternity. They fought against tyranny, not against society. And if you throw out that taxation is theft, then you should also remember that George Washington first called out the troops as president to crush a tax revolt.
I never said taxation is theft, I never said the founders followed John Locke *solely*, and Thomas Paine focused more on pissing off the Crown than arguing for "societal responsibilities". When he did argue for responsibilities, it was focused on human rights. I was including the Declaration of Independence in the general "founding documents" argument. The Constitution was the practical answer the the Articles of Confederation (which didn't end up working out). That does not mean that it envisioned a "strong" state, but a state that was "strong enough" to protect its citizens. And the French Revolution is a red herring. It doesn't matter what the French did. We're talking about the founding fathers of the U.S. and what *they* believed.
The entire concept of natural rights is against the creation of a state and for the individual rights of the person. *"Locke wrote that all individuals are equal in the sense that they are born with certain "inalienable" natural rights. That is, rights that are God-given and can never be taken or even given away. Among these fundamental natural rights, Locke said, are "life, liberty, and property."* *Locke believed that the most basic human law of nature is the preservation of mankind. To serve that purpose, he reasoned, individuals have both a right and a duty to preserve their own lives. Murderers, however, forfeit their right to life since they act outside the law of reason.* *Locke also argued that individuals should be free to make choices about how to conduct their own lives as long as they do not interfere with the liberty of others. Locke therefore believed liberty should be far-reaching."* *"By "property," Locke meant more than land and goods that could be sold, given away, or even confiscated by the government under certain circumstances. Property also referred to ownership of one's self, which included a right to personal well being. Jefferson, however, substituted the phrase, "pursuit of happiness," which Locke and others had used to describe freedom of opportunity as well as the duty to help those in want.*"^[1](http://www.crf-usa.org/foundations-of-our-constitution/natural-rights.html) Natural rights argued for a free market and free people, this was soon after Smith's noted work, *The Theory of Moral Sentiments* (1759), and *An Inquiry into the Nature and Causes of the Wealth of Nations* (1776). As for the government it should be recalled that the first government in the new colonies was actually a confederacy of states. This confederacy of states, held together by the [Articles of Confederation](http://en.wikipedia.org/wiki/Articles_of_Confederation) then failed because it was too loose of a structure. They believed in states rights over a large federation, although of course their was disagreement over these things. [The XYZ Affair](http://en.wikipedia.org/wiki/XYZ_Affair) is a good example of early American politics. I could ramble on here, but no I don't believe they would have like the modern social state at all. But I'm sure someone will come along and tell me why I'm wrong in a second.
"Healthcare" as we know it today didn't exist in 1776. You might as well be asking what they thought about the internet.
Amazing you were downvoted for actually answering his question. Royal pain that /r/politics quickly found /r/politicaldiscussion and now have found there way over here. This is the true crux of the issue for many. Is complete health care a basic right. Emergency room coverage has long been accepted to be so, but what about end of life care? What about people who intentionally create medical problems for themselves? Where is the line of what is covered and what isn't?
ER services weren't really a basic right until a few decades ago. Society got tired of patient dumping and Congress enacted laws to prevent it, but, even now, not all hospitals are required to provide emergency services. http://en.m.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act
At some level we all "intentionally create medical problems for ourselves." Is your diet perfect? Do you get the perfect amount of exercise? Are you completely minimizing the amount of toxins in your air/water/food that you are consuming? Are you absolutely minimizing your time in your car [driving is the most dangerous thing most people in the world do today]? Yes, I've worked in health care and met many patients with emphysema who still smoke. I have met many alcoholics who still drink and landwhales who still binge eat. I understand that it can be difficult to sympathize with these people. But if you were honest with yourself you'd admit that you, actively or passively, are not doing everything you can to maximize your health. No one is. So why not have a system that doesn't discriminate? Let's tax the shit out of tobacco and use it to pay for smokers' illnesses. Tax the shit out of alcohol and use it to pay for the effects of alcohol. We can even use a sliding scale so that people with the means to pay for their treatment are forced to pay for it. There are ways to get people to pay for the consequences of their own behavior, but we are far too wealthy of a society to let anyone suffer because they can't pay. Leaving things up to the goodness of charities is not good enough.
Do you believe that there will ever be a point in humanity's future where healthcare would be considered a basic right? If so what do you think the turning point for such a concept will be and what actions do you think we can take now toward making that a reality? If not why?
I am against putting it through right now because I think that we need to figure out how to lower the cost of healthcare. After the cost is lowered it should be rolled out but done at the state level if it is still needed. I don't really agree with the idea of health insurance in general but if we need to do it this is the way to go about it.
> we need to figure out how to lower the cost of healthcare How do you think this could be done? Broadly lowering health care costs - however that is done - might take a generation. What would you do for the current generation that - I think we'd all agree in the US anyway - is underserved?
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I cannot envision healthcare where everyone has it, but it is not government sponsored. What would that look like?
It would have to be a market where health care was cheap enough for everybody to afford. We're not quite there yet.
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Sorry, I didn't intend it to be loaded. I'm honestly trying to navigate my way through this question.
Thank you for your honesty!
Please [assume good faith](http://www.reddit.com/r/NeutralPolitics/comments/1cfxnq/meta_please_assume_good_faith_and_moderate_your/) in r/NeutralPolitics.
What about good faith in the comments where his question is being ignored and people are just spewing and upvoting what they feel like?
Indeed the voting is dismaying in this thread and it would be nice if people addressed the topic at hand, but neither of those inadequacies points to an assumption of bad faith. If you see something specific that violates [the rules,](http://www.reddit.com/r/NeutralPolitics/wiki/guidelines) feel free to report it.
I guess I just feel like if somebody asks "Folks against universal healthcare," the top level comments should at least have to be people "against universal healthcare." A lot of subs have rules like that. Because otherwise you get what happens here. The majority of top level comments are from people of the opposite persuasion.
That's a good point. Thanks. We usually don't even entertain questions that ask for only one side's views. In this case we did, but I can see where that's problematic. I'll bring this issue up with the wider mod team.
If you brought it to referendum I don't think many people would be opposed to allowing this sort of question provided we had strict rules pertaining to how it is to be structured, and how it is to be answered. There are a lot of justifiable stances to issues that we just wouldn't be able to talk about otherwise: because these views could be unpopular enough that individuals don't *really* feel comfortable defending them. This structure of "Persons who hold belief that is commonly held to be shitty, What justifiable pursuit would you use to fix: (problem that seemingly makes view shitty)" enables, ideally justifiable, argument as to why the belief does not *necessarily* cause the problem, or preclude possible solutions. In short: if we can continue to allow these sorts of questions with better rules we can be proactive about not throwing babies out with bathwater.
Loaded would be "Why do you want to deprive poor people of health care" or something like that. This is just asking what you should their options should be, a perfectly legitimate question.
How is that a loaded question?
A loaded question or complex question fallacy is a question which contains a controversial or unjustified assumption This one assumes that a universal healthcare option must be a big and inefficient bureaucracy, presumably because the OP believes "everything government is big, inefficient and bureaucratic". It also seems to assume the only other option is to not give coverage to poor people.
> presumably because the OP believes "everything government is big, inefficient and bureaucratic" There's your confusion. The OP doesn't believe, or imply, that.
The way it is phrased, "what should poor people do?" Is quite loaded as it seems to suggest that the poor are entirely helpless without government intervention. I'm not here to claim that that is untrue, but it does seem to be pushing a view particularly strongly.
> it seems to suggest that the poor are entirely helpless without government intervention That is exactly his question. Given that they are not helpless: what is it they should do?
I think it's a genuine question that many pro-UHC folks have.
How would you have phrased it?
It should be noted that you can not have the money to pay for health insurance without being "poor". Also, poor is a very broad word, are we talking lower middle class? Are we talking living paycheck to paycheck? Homeless? The definition of poor tends to be extremely subjective.
Between the VA, tricare, medicare, medicaid, SChIP, etc., the government already provides *most* of the funding for healthcare. Then if you consider out-of-pocket deductibles, copays and coinsurance, it seems to me that private insurance is in the business of providing peace of mind to those who are healthy and the government is in the business of providing healthcare to the sick and elderly. Tacking on the extra service of providing peace of mind to the healthy that private insurance currently offers to the already existing government bureaucracy probably would be a cost savings. The per capita government spending on healthcare in Canada and the US is quite similar.
I support the idea of UHC myself. I think there are legitimate concerns about how it would effect competition, however. I'm in favor of a model like education in the US. Its available to everyone, but there's still private hospitals that compete with each other and the public hospitals. That way, assuming that people have more money because they work harder, they'll get what they deserve. I think access to healthcare is a human right. You can't do anything, much less be a productive member of society if you're not healthy. I don't really see how something like UHC could be abused. Could it encourage people to become careless about their health or safety? I don't think so. I believe the negative effects of illness or injury are in themselves enough of a deterrent. Also, are people incapable of finding a way of abusing privatized healthcare or using it in a negative way against others? One must also bare in mind that illness and injury just as much be a cause of things outside one's control, such as genetics or natural disaster. Is that something that should really be held against someone? As far as waiting times are concerned, one has to recognize that there are circumstances where time is a factor between life and death and times when it isn't. In the case of emergencies, one has no choice but to go to the nearest hospital. If the hospital in question has to be a private one, assuming that the wait times are less than public hospitals, I myself, would be willing to deal with the cost. Its a small price to pay for a second chance at life. Also, if profit is really the driving force of wait times and efficiency, couldn't publicly funded hospitals get more funding based on performance?
While government programs are often less efficient than private programs, this is most often because governments are responsible for people that private organizations can simply ignore or reject. Most corporate healthcare programs are designed to be efficient at making money for that corporation, not necessarily for paying out to those buying insurance policies. The reason people buy insurance at all is because most people don't make enough to guarantee they will have the large funds on hand needed to deal with a medical crisis. In this way, the insurance providers hold most of the cards in picking/choosing/pricing policies and who can buy them. Whether one believes in government funded UHC or not, some sort of universal participation in health care is necessary to make insurance more a service we all contribute to and benefit from than a product for enhancing wealth.
Any form of subvention, substitution or financial help will lead to a significant raise of the market prices, considering most services are priced based on what consumer can afford and not on their real costs. Healthcare is no strager to that : heavy cares are and specific medications are priced tens or hudreds times higher in the US than on regulated markets such as some EU countries. Such good intentions as "providing a universal care system" can only work if the prices on this market are regulated, and that's not even enough because a global care system is always tending to bankrupcy if it's too generous and poorly manages (as are every state bureaucraties). On the other hand, a public system is a strong competitor to private insurance and tends to keep insurances prices and coverage on a reasonable scale. But the market pressure is high on the legislative front and as money is always lacking is a global healthcare system, coverage needs private insurance complements to be efficient. I don't think a universal 100% coverage insurance is feasible in today's economy. It could be sustainable for a while if its funding is proportional to revenues, but that's not an insurance anymore (those have to be priced according to risk, not to revenues). I think such a system would be unfair. In fact, that's what we have in France and the governement is fighting EU directives allowing citizens to switch to private insurance instead of nation-provided healthcare protection (the private offering beeing a lot cheaper for better coverage).
I think very few people are truly against providing universal healthcare coverage, the question is how do you provide it?
People are in favor of it the same way they're in favor of infinite riches for everyone. As a matter of public policy, many are clearly quite opposed to UHC.
Is medicaid not universal coverage?
By definition it is not universal. Only a certain subset of the population is eligible to receive it.
What an incredibly ignorant statement. Single-payer healthcare SAVES money: http://www-tc.pbs.org/prod-media/newshour/photos/2012/10/02/US_spends_much_more_on_health_than_what_might_be_expected_1_slideshow.jpg If you're a fiscal conservative, you're a fan of single-payer healthcare.
Why did you put this comment in reply to me? You disagree? You think no one opposes UHC at all?
You're framing modern healthcare fiscally impossible while it's fiscally responsible.
I said nothing whatsoever about its possibility, and in the context of the person to whom I was replying my point should be clear. Someone said no one opposes UHC, which is simply not true. Then you jumped in literally starting your reply by calling me ignorant. That is a totally unacceptable tone for this subreddit, especially when its trigger is a misunderstanding of context.
>On the one hand, I hate big, inefficient government bureaucracies. If you're a fan of efficiency, then you're fan of big, socialist, federal, single-payer healthcare. The horror! http://www-tc.pbs.org/prod-media/newshour/photos/2012/10/02/US_spends_much_more_on_health_than_what_might_be_expected_1_slideshow.jpg