When a person gets a life threatening disease they ought not worry about whether or not their treatment will leave their family in penury. This is especially so in a nation as wealthy as the U.S. The American healthcare system is immoral and I hope it drastically changes.
Americans need to change their underlying notions of what it means to be a society. An author was once made fun of for suggesting that it takes a village to raise a child. When it comes to public funding for public goods we tend to worry about some poor person getting something they don’t deserve. The go it alone I’ve got mine, fuck you attitude is unhealthy.
Until we change our collective view in what the purpose of a government and society is things won’t change significantly. Even so called champions of progressivism in the U.S. Senate voted against allowing the importation of medicine from Canada. It seems the public interest is subordinate to private interests and often times with immoral consequences.
> It seems the public interest is subordinate to private interests and often times with immoral consequences.
This perspective of public vs private interest is rather puzzling to me -- it's more a matter of short-term vs long-term thinking. In the long-term, it's in the private interest of those having sustainable companies to have a broad base of educated and healthy workers to employ. The short-term interest of any single firm has a different calculus, but all private companies would benefit from a stronger public education and health system.
The goal of government, in my opinion, is to focus on long-term objectives: ensuring a sustainable healthy and educated population.
It's similar case for education. It's not that I'm paying for someone else's kids school so much as I'm paying so that one day, when I need a smart educated nurse to take care of me... it'll likely happen at a reasonable price because there are so many educated people who have decided to be nurses.
> In the long-term, it's in the private interest of those having sustainable companies to have a broad base of educated and healthy workers to employ.
Immigration affects this calculation significantly.
If your long game is to be an attractive destination to healthy educated immigrants, investing in the "land of opportunities" mythology has better ROI than investing in universal healthcare.
> If your long game is to be an attractive destination to healthy educated immigrants, investing in the "land of opportunities" mythology has better ROI than investing in universal healthcare.
Sure, but it's not a dichotomy either. I suspect they both have better ROI than average for government spending.
If you want to attract, say, a young PhD with a spouse and kid, the guarantee of healthcare for the family - even if they change jobs - is a huge selling point. Anecdotally at least, I've known several international students who left the US after college for Canada, France, or England and cited this as a factor. (The ridiculous artificial barriers like "go home to file this form and come back" don't help either.) And with non-open immigration, e.g. the Canadian model, there's no special economic burden to this approach.
Well, in this age, good luck finding enough "healthy, educated immigrants" who do not find the state of US healthcare system absolutely bonkers.
Maybe that's a good thing. Invite enough educated immigrants, and America will have more people saying "You know what, my country had a saner healthcare system thirty years ago when ordinary people couldn't afford air conditioners. What the hell is wrong with you America?"
My problem with you isn’t that you want to fund long term interests, my problem with you is that you want to force me to fund your idea of long term interests with your preferred long term fund (i.e. whatever our moronic legislators can cook up).
It’s not about the goals, it’s about the coercion.
Isn’t this part of being a member of a society? Sometimes laws and goals of society don’t align with yours. So advocate for your goals and participate in society.
Sometimes one decides to leave the country because the misalignment of goals becomes intolerable. But there is no substitute for a properly functioning government. At least not at our current level of our collective psychology.
I would assume that if you live on someone’s land, you would agree that their property rights mean you must pay rent, otherwise you must move.
The government is sovereign over the the land of the nation. If you live there, you must pay “rent” in the form of taxes. You aren’t respecting the property rights of the nation otherwise. You can always move.
I agree with the long term / short term dichotomy.
I believe the same dynamic is at work WRT the concentration of wealth in the US. I understand the short term desire to accumulate wealth. I do it myself. It seems to me that if trends continue, there will be less and less income for the other 99% to spend. (Yes, I'm mixing income and wealth here because I believe that the desire to increase wealth on the part of the wealthy results in downward pressure on income for the rest of us.) In my Econ 101 class they spoke of the velocity of money - how much gets spent. It seems to me that the velocity has to go down as earnings go down and at that point, the ability to accumulate wealth would start to decrease.
(These thoughts ignore the possibility that those who are not wealthy could provoke social upheaval. I don't know if that's a real possibility.)
I think it is a possibility, the wealthy are building doomsday bunkers. There is writing on the wall, they just need to outlast the uprising and then come out and buy up everything really cheap.
> The goal of government, in my opinion, is to focus on long-term objectives: ensuring a sustainable healthy and educated population.
You can't ensure health unless you have wealth in the first place. You can see that things moved in that order in the past 300 years: the more wealthy a country was, the longer people lived and the better they could face different conditions. The greatest strides against mortality were accomplished long before the welfare state as an expression ever existed.
You should read the article more carefully. Poorer countries are working under difficult constraints, but leaving $1 on the table because you don't want to spend 10 cents is not helpful. There is a line of thought poorer countries are poor because they don't invest in healthcare, education, infrastructure, ... and that the real problem is governance.
>This perspective of public vs private interest is rather puzzling to me -- it's more a matter of short-term vs long-term thinking.
I actually think a long-term vs short-term view is insufficient. Let's step away from firms and take the case of the rich and the poor individual. For the poor individual it is in their interest in the short and long-term interest to have universal healthcare. For the rich individual, it is in their short and long-term interest to prevent universal healthcare. According to the investment theory of party competition [1] this rich vs poor divide becomes reflected in our politics as both parties vie for the donations of the wealthy.
- an american citizen break his leg, he is not insured. Do you A: let him die B: take care of him ?
if your answer is A - you are a terrible person, but you hold a consistent position. if your answer is B - the only question that remains is what is the most economic, efficient way to take care of this person ?
b is universal health care. if you think you can do A with emergency care, consider how inefficient and expensive this is, and who ends up paying for it.
Unfortunately this simplistic model plays out like insurance doesn't exist.
Any tragedy works like this: a fire, a life lost to chance, etc. The point of insurace is to pay beforehand to reserve a fund and to distribute the chances in a pool.
One more argument: normally its spoken as is government is the solution to this problem, but the government does not prevent the legs from breaking in this analogy. It just decides B for you and everyone else.
I'm a Belgian national, living in France (under the French health care regime). If I need medical assistance while I'm in in Spain or Germany, the care will be reimbursed per the local rules, by the French health care system.
Quoting Wikipedia:
The European Health Insurance Card (or EHIC) is issued free of charge and allows anyone who is insured by or covered by a statutory social security scheme of the EEA countries and Switzerland to receive medical treatment in another member state free or at a reduced cost, if that treatment becomes necessary during their visit (for example, due to illness or an accident), or if they have a chronic pre-existing condition which requires care such as kidney dialysis. The term of validity of the card varies according to the issuing country.
The intention of the scheme is to allow people to continue their stay in a country without having to return home for medical care; as such, it does not cover people who have visited a country for the purpose of obtaining medical care, nor does it cover care, such as many types of dental treatment, which can be delayed until the individual returns to his or her home country. The costs not covered by self-liability fees are paid by the issuing country, which is usually the country of residence but may also be the country where one receives the most pension from.[1]
It only covers healthcare which is normally covered by a statutory health care system in the visited country, so it does not render travel insurance obsolete.
My position is to take care of that person, like weve been taken care of visiting while other countries, but trying to avoid the illegal/undocumented immigrant strawman for clarity.
I would say yes. I've read where the UK does this as do other countries. Of course, any mass migration for free health care would bankrupt us, so we would need some sort of protection against that.
So let's talk about healthcare in the US. Don't Britons have a moral obligation to get taxed and that money get sent to the US to pay for the US healthcare system?
The underlying reasoning for universal healthcare is based on a principle, does this principle end at the US border, which I'm told is just some arbitrary, meaningless line right?
If it's not clear, my tongue is firmly in my cheek as I say that, but where it isn't in my cheek is when I'm telling you some people don't just buy your simple pro-universal-healthcare argument wholesale, especially when you refuse to defend it against valid questions like this.
I live in the US and I pay taxes in the US, so yes - healthcare for US citizens/residents paid for by US/citizens residents ends at the borders.
If there is a better, more efficient system that is morally right (i.e. provides basic healthcare for it's citizens) than universal healthcare I would like someone to propose it ?
Why is it morally right for me to contribute to healthcare for someone who lives in America but doesn't pay taxes, but not morally right to pay for someone who lives in a different country and doesn't pay taxes?
It might be a little hard for you to understand - but on the other side of the USA is... another country ! And they are free to do whatever they want, which in the case of developed countries is universal health care !
Ah, the confidence of a young liberal, it fills the heart with hope !
I'll offer some advice, although I doubt you think you have much more to learn in life. If you're walking around looking for donations or support towards a cause, perhaps mocking those who may not share the identical philosophical beliefs as you isn't the optimum approach.
My mom got injured while hiking in a country with universal care. She hobbled to the next town, found a clinic, and got treated. Then she wanted to pay. First, the person at the clinic said: "What do you mean, you don't pay for health care." My mom explained that she was from another country. It turned out they didn't even have the means to take her money.
Treating a few foreigners for free might actually be cheaper than setting up a billing system.
Evidently she was not hiking in Canada, where they definitely will treat you and then make sure you the tourist does pay the sizeable (though not USA exorbitant) bill. The Canadian system in fact does have many payers; federal, provincial, private insurers, are all payers.
I'm a Canadian, but accidentally let my health card lapse right around the same time I had a fall that tweaked my wrist. At the clinic I went to, they explained that I would have to pay cash for the visit and to keep the receipt because it would be reimbursed by the provincial ministry of health once I got my card renewed.
Had a visit with a GP, he sent me next door for Digital X-Rays, and then I went back to to the GP where he looked at them and sent me home with a brace (no break).
GP visits: $25
X-Rays: $25
Brace: $15
I don't think I ever ended up submitting the receipts to SaskHealth... Just wasn't that big of a concern :)
I'm a Canadian, living in America and therefore not a benefactor of Canada's healthcare system, even if I'm visiting Canada. On a trip to Canada a near car accident caused abdominal pain for my pregnant wife and a subsequent trip to urgent care to confirm if everything was OK. The bill was $600.
Most UHC countries have reciprocal deals where a citizen of one has all the same rights as a citizen of the other when travelling. Its just a lot cheaper than having to ship people around or delay treatment or all the paperwork.
The US has no such deals because it does not have a UHC system to deal with. However, most UHC systems that do not charge aren't going to pay out for setting up a billing infrastructure for the occasional American. The ones with co-pays etc already have a billing structure in place, and may charge you. Or not, it would be pretty mortifying to have to charge someone for health care.
If you are a legal resident, you are covered. If you are a visitor it depends on what deal your national UHC system has with the nation you are visitng. Normally there would be little reason to go to a foreign country for treatment.
Fine. Sidewalk, in the middle of a restaurant, in your livingroom, at the airport. Pick a location and then feel free to explain what selection criteria make ignoring the injuries of another moral.
I am not currently actively or passively ignoring anyone's injuries. I'm a trained first responder, registered organ donor, and actively lobby my local, state, and federal government for universal healthcare and robust international humanitarian aid. It is instructive to note that two attempts to shift goalposts and distract with trivia have been made while nobody seems willing to take a crack at what is a very simple question.
You haven't helped care for my injuries. Lobbying for international (paid for by others) is like calling a taxi when you've got an injured man by the road and telling the cabdriver to deal with it.
You intentionally confuse turning a blind eye with limited ability to render aid, further attempting to obfuscate the central question. Again I am not that easily distracted. Last time, for the cheap seats, what criteria make ignoring others' injuries a moral choice?
The most economically efficient way to pay for B is to allow the free market to drive the cost of care so low that the person is either able to pay for it, or the cost through charity is trivial. This has the double benefit of not attempting to rectify one moral wrong (person does not receive care) by committing another (violent coercion by the state).
The most economically efficient way to pay for B is to allow the free market to drive the cost of care so low that...
Talking about free market efficiencies is a bit like talking about the effect of Newtonian forces on a spherical cow. Very useful to learn from in an undergrad setting but rarely sufficient to capture real world systems.
What you actually want from policy is something like a trajectory toward the best expected result in existing markets over reasonable times. This is much more practical than a provably optimal result in an oversimplified model. Models can be very useful, but the map is not the territory.
>What you actually want from policy is something like a trajectory toward the best expected result in existing markets over reasonable times.
What I don't want from policy is you* deciding for me what results should be aimed for and then forcing me to maximize your personal pet project. If you have good arguments that something should be funded, you don't need to force me to do it.
*: The you here is proverbial. Feel free to insert Donald Trump as an example of the type of person who would have a say in my healthcare options.
I suspect this comment is largely mistargeted, policy is in no way equivalent to force, though some policies may engage it.
Unless you are arguing for a fairly pure form of anarchism (good luck with that, if so) you have policy work and the desire to improve it. It is a reasonable expectation that doing so empirically will vastly outperform doing so ideologically in any scenario like healthcare reform.
The point of this report is that the empirical evidence contradicts your hypothesis. These sorts of broad-strokes, ultra-rationalist arguments should be set aside whenever data is available.
Data is available on rapid price inflation that coincides with central planning initiatives in the US. Data also exists showing the systemic risks to nations created by these systems, such as the looming global demographic crisis created by the combination of social welfare systems and the baby boom.
We aren't talking about those abstract ideas, we are talking about health care and it's associated access and cost. As such, the data shows us the United States fares worse than similar countries on the measures of access and cost (both to the individual and the state)[1]. The United States also has the most "free market-like" system of comparable countries. How can it be that costs are so high and outcomes are no better if we are closer to a free market than others?
Causes of price inflation and the looming demographic crisis are not "abstract ideas."
For literally decades the US did not open a single medical school due to lobbying from the medical industry. Even though we've tried to reverse the trend since the 90s, there are still fewer medical schools today than there were 100 years ago. When the government decides how many doctors there will be, it may get the number right or it may get the number wrong. But that's nothing akin to "free market-like." And it's a major part of the explanation why US doctors make 2x+ what their counterparts in countries like Germany make.
During the New Deal era regulations wage caps were put on workers in the hopes of staving off inflation. Employers, wanting to entice good employees to work for them sought to get around these wage caps by offering health insurance. This then spread like wildfire, coincides with the time healthcare inflation separated from general inflation, and began the trend towards a lack of price transparency.
Most of the differences in outcomes between us and other wealthy nations amount to lifestyle/culture much more-so than affordability and availability. Americans are very obese. Not having to pay a copay to visit the doctor is not going to change that. But obesity means we'll have more problems with newborns, lower life expectancy, etc.
> there are still fewer medical schools today than there were 100 years ago... it may get the number right or it may get the number wrong... And it's a major part of the explanation why US doctors make 2x+ what their counterparts in countries like Germany make.
> Most of the differences in outcomes between us and other wealthy nations amount to lifestyle/culture much more-so than affordability and availability. Americans are very obese. Not having to pay a copay to visit the doctor is not going to change that. But obesity means we'll have more problems with newborns, lower life expectancy, etc.
> During the New Deal era regulations wage caps were put on workers in the hopes of staving off inflation. Employers, wanting to entice good employees to work for them sought to get around these wage caps by offering health insurance. This then spread like wildfire, coincides with the time healthcare inflation separated from general inflation, and began the trend towards a lack of price transparency.
Except, of course, in the countries where it didn't spread like wildfire. Why all this crazy post-hoc history-building when you can just... empirically observe how the natural experiment played out?
Your modus operandi in this thread is the start with an ideology and then derive conclusions that are often wholly inconsistent with observed reality. There's nothing wrong with premises or theory-building, but when the data flatly contradict your conclusions... well, that's the difference between reality and fantasy.
By your link we're 52nd in doctors per capita. That's not great. Plus I'd already noted that we've made a concerted effort to undo the damage since the 90s. Are you suggesting that supply and demand has no impact whatsoever on the wages doctors are capable of demanding? Do you believe that artificially restricting the supply for decades has had no impact on wages whatsoever?
Higher adolescent pregnancy rates, higher rates of HIV, etc.
=== Most experts estimate that modern medical care delivered to individual patients—such as physician and hospital treatments covered by health insurance—has only been responsible for between ten and twenty-five percent of the improvements in life expectancy over the last century. The rest has come from changes in the social determinants of health, particularly in early childhood.===
So best case scenario access and affordability to healthcare accounts for about 25% of improvements in life expectancy. Except the majority of people already have access to healthcare in the US. It's not as available and affordable as we'd like, and we're talking about how best to improve availability and affordability, but it's a tiny fraction of the problem of why US health outcomes are so bad.
It's clear you still don't understand my critique.
> By your link we're 52nd in doctors per capita. That's not great.
I think this sort of argument is innumerate. Statistical sciences provide us with many ways of testing the correlation between "value of care per dollar spent" and "average doctor salary".
None-the-less, I am tempted to point out that Cuba is #2 on this metric ;-)
Regarding the rest of your post, consider actually reading that New Yorker piece. The things you think it says, it DEFINITELY does actually not say.
== And it's a major part of the explanation why US doctors make 2x+ what their counterparts in countries like Germany make.==
That is a nice thought, fortunately NPR has done the actual reporting on this. It seems like the answer is government interference [1]:
"But the biggest reason German health costs are so much lower, experts say, is that doctors are paid less. This largely reflects Germany's concerted efforts to keep costs down over the past two decades."
On administrative costs it seems like government mandates on benefits and payment rates keep those costs 50% lower. Also, they have an employer-based system:
"On top of that, administrative costs are almost 50 percent lower. That's not because the German health system is simple and streamlined. With its employer-based system, multiple insurers and ever-changing rules, German health care is as complicated in many ways as the U.S. system. But administration is much simpler because nearly everybody gets the same benefits, payment rates are uniform and virtually everybody is covered."
==Most of the differences in outcomes between us and other wealthy nations amount to lifestyle/culture much more-so than affordability and availability.==
You have provided no evidence to back up this claim. What makes you so certain that it's true?
==Not having to pay a copay to visit the doctor is not going to change that.==
Might this encourage more people to visit health providers more frequently? This might lead to earlier detection/treatment and lower long-term costs. Why have you dismissed this potential outcome?
>"But the biggest reason German health costs are so much lower, experts say, is that doctors are paid less. This largely reflects Germany's concerted efforts to keep costs down over the past two decades."
Yes, this supports my statement. I said the medical lobby has artificially constricted the supply of doctors. Limited supply means higher wages. I'm not familiar with the German system, they may have done other things such as price fixing to keep wages lower. Personally, I'd prefer having "too many" doctors. This would give me more personal choice to choose the one I like the most while simultaneously keeping prices reasonable.
>You have provided no evidence to back up this claim. What makes you so certain that it's true?
===Most experts estimate that modern medical care delivered to individual patients—such as physician and hospital treatments covered by health insurance—has only been responsible for between ten and twenty-five percent of the improvements in life expectancy over the last century. The rest has come from changes in the social determinants of health, particularly in early childhood.====
>Why have you dismissed this potential outcome?
As noted above the majority of improved health outcomes are not the result of access to healthcare at all. Let's be generous and use the highest percentage in the stat provided above: 25%. So now we're only at 25% of healthcare gains at all, and the fraction of that that isn't actually affordable either by the individual themselves, through their insurance coverage, or provided by charity. We're talking a really tiny fraction of gains here.
== I said the medical lobby has artificially constricted the supply of doctors.==
In the free market, money equals influence. As long as AMA determines who is/isn't a doctor, they have an incentive to make it as hard as possible to become a doctor.
==The rest has come from changes in the social determinants of health, particularly in early childhood.==
Now you have to prove that free and easily accessible access to health care won't have a positive impact on the social determinants of health. It stands to reason that part of America's reluctance to visit doctors is rooted in the historical costs associated with visiting doctors. If we can remove that stigma through cheaper and more accessible care, it stands to reason that we can improve the social determinants of health over the long term.
Here's an example: In Canada, one can visit a dietician as part of their health insurance, this could have a positive impact on obesity, which would lead to healthier population.
> Here's the first article that came up when I googled the subject... [cites article laying down the case for increased social welfare funding, which doesn't even justify the stated claim]
Oy... talk about (not quite) winning a battle but losing the war.
Also, this whole methodology toward argumentation just reinforces the top-level critique. The important word in "start with the data" is not "data", it's "START". I.e., begin by understanding the problem. Then solve the problem. Don't walk around with a hammer trying to bash things.
I would argue it is coercive, but so is the property system underpinning the market in the first place. Adding a redistribution element to a system of private property doesn't introduce violent coercion, it merely changes how it is being used to allocate resources.
As Adam Smith wrote: "Civil government, in so far as it is instituted for the security of property, is in reality instituted for the defense of the rich against the poor, or of those who have some property against those who have none at all."
That quote doesn't mean what you think it means. Taken in context, that quote is talking about the origins of civil government and how it is often corrupted as stated in that quote. It is used as an argument for why there must be a separation of powers to ensure fair judgement and protect the property rights of both the poor and the wealthy.
Regarding "violent coersion of the state", by this, I assume you mean.. taxes.
At this point in the world's history, we are not individuals who can wander off into the wilderness on our own, to live and die as God might have intended. We are members of a vast, global social fabric. We benefit from it. We pay into it. There's no way to avoid the coersion/evils or really deny the benefits/goods that this society provides. We can only discuss things relatively speaking, on a whole, in balance.
I think a productive use of our time is thinking about (and experimenting with) how information technology could better support our emerging social fabric so that we could make the best collective decisions: that is, enable even more personal freedom.
States in and of themselves aren’t moral under your framework because they can only exist by threat and use of force.
But some of us are interested in solutions for the real world instead of the debating the merits of unfeasible utopias.
I, too, would enjoy a stateless peaceful utopia of equitable commerce, but that has zero bearing on how we should decide public policy. Foraging for utopias is the same kind of naïveté Marxists trot out again and again and were it ever enacted at scale it would lead to the same kind of human suffering.
It would be difficult to impossible for me to try to think of every feasible scenario in a HN post, but here's some off the top of my head: national defense, stopping people from physically harming others, enforce voting rights, establish trade agreements with other nations, etc.
I don't see how you can define the state taking money from the wealthy to buy healthcare for the poor as violently coercive but not also define a corporation withholding necessary care from a poor person as violently coercive.
If you are able to help them, and you refuse to do so unless they do something for you (i.e. labour to earn money to pay your fees) then it is absolutely coercive.
By that measure any salary a doctor demands, whether it's paid for by the patient or the state, is coercive. Or for that matter, any salary any person demands in exchange for work is coercive. I feel like it ceases to have a useful meaning when used in this way.
It's only coercive when we're talking about the means to survive. If you offer someone a choice between death or some action, you are coercing them to act.
And I don't think that "ceases to have a useful meaning". I think it just doesn't let you argue that your system is better based on absence of "coercion".
I don't believe for a second that you understand the word "coerce" to be limited only to situations of life and death.
Do you or do you not believe that doctors in the UK are coercing the government by demanding a fair salary in exchange for the lifesaving services they provide?
>I don't believe for a second that you understand the word "coerce" to be limited only to situations of life and death.
I don't think it's necessarily limited to that, but I do think all such situations are coercive. Whether someone is having a gun pointed at them, or being denied healthcare, they are being coerced. That said, I do think most coercion does ultimately amount to the threat of death or suffering, even if it becomes very indirect in practice.
>Do you or do you not believe that doctors in the UK are coercing the government by demanding a fair salary in exchange for the lifesaving services they provide?
Trying to evaluate the actions of individuals in a wider system is not very helpful. Are the doctors being coercive? Yes. But they're also being coerced in turn by the individuals they rely on for survival (i.e. the people they buy food from) so it's hard to ascribe blame. It's the system as a whole which is coercive.
And this is my point. Both market based healthcare and state provided healthcare rely on coercion to function, so you can't distinguish them morally on that basis.
The only hypothetical system I know of that would actually be free of coercion would by something like anarcho-communism, where people have free access to the means of survival, and it is produced by people's free choice to work for the benefit of others. But I'd guess you think such a system wouldn't work.
>And this is my point. Both market based healthcare and state provided healthcare rely on coercion to function, so you can't distinguish them morally on that basis.
Can you honestly not see the moral distinction between me intentionally shooting you with a gun and me not applying first aid after someone else has intentionally shot you with a gun?
I disagree with the asymmetry. Withholding care isn't actually 'doing nothing' and has the ability to be violent or coercive. Take a life-saving but expensive pill. 'Doing nothing' in the case of someone who needs but can't afford the pill would be actually doing nothing - that person could waltz in, walk behind the counter, take the pill, swallow and walk out. Bada-bing bada boom, problem solved no violence or coercion. Healthcare providers don't actually do that though, someone who tried to walk in and take the pill would be met with violence in order to prevent them from accessing the pill until they had paid. That violence is coercive.
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Since the mods are rate-limiting me, here's my reply to your post below:
>Otherwise every person in every situation who demands to be paid for their work, including doctors who demand to be paid by the state in a universal healthcare system are all being coercive.
I agree that this is coercion.
>When taken to that level, the word coerce ceases to have a useful meaning.
Well no, when taken to that level coerce retains it's meaning perfectly, it just happens to illustrate that the market system has coercion baked into almost every aspect. Here, this guy says it better than I can:
But there is no neutral construction of “coercion” that would ever support such a distinction. As Hale aptly demonstrates, coercion occurs when there are “background constraints on the universe of socially available choices from which an individual might ‘freely’ choose.”
In a world of scarcity, all economic rules–including rules that create private property ownership, contract laws, and so on–impose background constraints on the universe of choices individuals can make (e.g. the choice to move into a building and sleep in it without paying anyone anything). When we talk about the economy, we are not arguing about whether we want coercion. We are arguing about what coercion we’d like.
Demanding to be paid for your work is not coercive. Otherwise every person in every situation who demands to be paid for their work, including doctors who demand to be paid by the state in a universal healthcare system are all being coercive. When taken to that level, the word coerce ceases to have a useful meaning.
If you think the private healthcare system is immoral, you should take a look at the 100% government ran healthcare system that is the VA. You literally couldn't make up worse things than their administration has been caught doing with little or to consequence.
If the VA is the best the US government can do, with some of the most sympathetic citizens, then it is incapable of doing better than our private system.
> You literally couldn't make up worse things than their administration has been caught doing with little or to consequence.
I literally could. The scandals you're referring to basically come down to them having been cooking books about care records. Bad, but not exactly in the realm of "literally nothing worse" hyperbole.
In fact the VA tends to produce health care outcomes that are well within the range of US citizens in the same income bracket (which is to say, not great relative to the rest of hte industrialized world, but not bad) at a cost that is much less than that of private insurance.
Really, you could do a lot worse. The criticism of the VA tends to be very similar to the criticism of the NHS in the UK. It's valid as far as it goes, but... neither UK citizens nor US vets are suffering serious catastrophes here. They're getting care and living decent, healthy lives by any reasonable standard.
Also the problems with the VA generally stem from the reality that US politicians "support the troops" right up until they're home and maybe not so enthusiastic about the war anymore.
The VA was a good system not too long ago, but the past couple decades has seen it get extremely underfunded in a starve the beast strategy. It used to be a black eye in the Republican's view of healthcare, but they sure fixed that.
The VA is much the same as all the other US healthcare setups. A system with the controls taken off, trying to operate in a jungle of different systems and bureaucracies.
IN most nations with a VA-style (Beveridge) setup, there is great media interest in the least failing or hint of scandal. And they mean politicians lose a lot of votes. The VA hasn't enjoyed that feedback system until recently.
> The VA was a good system not too long ago, but the past couple decades decades has seen it get extremely underfunded in a starve the beast strategy. It used to be a black eye in the Republican's view of healthcare, but they sure fixed that.
While it's tempting to blame any failure of national healthcare on Republicans, this is simply not factually accurate.
It's been at least two generations since the VA was anything resembling a good model for healthcare, and it's not simply the Republicans to blame for that, nor is it merely a problem of funding.
I mean, sure, the defunding started in the early 80s with Reagan, but we only started to see the effects of that in the past 20 years or so.
And sure, I blame the neoliberal third way Democrats as much as the Republicans. Their whole "let's move the party right and follow the Republicans" really muddies the waters here.
> I mean, sure, the defunding started in the early 80s with Reagan, but we only started to see the effects of that in the past 20 years or so.
The problems with the VA date back to the 60s, although they've accelerated in the last couple of decades.
> And sure, I blame the neoliberal third way Democrats as much as the Republicans. Their whole "let's move the party right and follow the Republicans" really muddies the waters here.
It sounds like you're rather committed to the belief that right-wing ideology is responsible for destroying otherwise-viable public healthcare models. There are plenty of other places where the data might support that belief. The VA is not one of those cases; the VA has gone from bad to worse over the last 50 years, and it's not simply a partisan problem.
"Quality of Care in VA Health System Compares Well to Other Health Settings"
A lot of the bad press around it's deficiencies are because it, as a public institution, publishes a lot of information that the private healthcare system isn't required to publish.
And yes, having been from Newt Gingrich's district, and seeing the failed 1994 HEART act, that ended up being turned into Romneycare, and then morphed into the ACA (in order to steal the Republican's thunder in 2012), yes I do blame the right wing for the current state of healthcare.
> First off, the VA isn't as bad as you're making it out to be.
From your own link, which is a press release by the firm which sponsored the research:
> Researchers say there were few studies [included in this meta-analyis] to evaluate equity, efficiency and patient-centeredness, and that the quality of the available studies vary.
Incidentally, those are three of the four main issues for which people typically criticize the VA.
In other words, that meta-analysis more or less confirms that the VA probably does well at the things people already knew it was good at doing, without looking into any of the areas where it's known to have problems.
> From your own link, which is a press release by the firm which sponsored the research:
I mean, it's the Rand Corporation. It's not like it's some fly by night 'you pay us and we'll say whatever you want' firm. The link to the real study is right there.
> Incidentally, those are three of the four main issues for which people typically criticize the VA.
That statement was for the whole study, including the private side. Once again, the VA publishes quite a bit of this information, when was the last time you saw average wait times for the private side?
> I mean, it's the Rand Corporation. It's not like it's some fly by night 'you pay us and we'll say whatever you want' firm.
...okay? The point is that the primary reference itself shows that the study isn't relevant to this conversation at all: by its own account, it doesn't attempt to investigate the issues that we're talking about. It doesn't attempt to study the issues that make the VA a bad model for healthcare (and have since the 60s).
What makes you think universal healthcare would be any different? If you recognize the VA's failings, and you blame Republicans for it, what's to stop them from doing it to every "good" idea you have?
If a few motivated politicians can ruin the lives of millions those politicians shouldn't have that power in the first place.
>What makes you think universal healthcare would be any different?
Because America isn't the entire world and there are many places where socialized healthcare of various forms have been very successfully implemented for a long time. The idea peddled by conservatives in America that the only options for socialized healthcare are inevitable failure or tyranny is simply, demonstrably nonsense.
It's exactly this kind of parochial, limited mindset that needs to change.
Oh yes. Everyone who disagrees with me has a limited mindset. You could have used your open mind to read about a European (within this comment thread) who is having trouble with "the right" in his country:
> This is a principal reason why the US was crossed off my list of countries where I would work and live. I fight against the privatization that is occurring within healthcare in my native country, Iceland. We used to have the Scandinavian model but decades of attacks from the right-wing Independence Party has broken our healthcare system. The next phase described by Chomsky is handing it over to private capital since people are outraged that it doesn't work anymore. I'm sickened by the development and feel a little like an old man screaming at the desert wind.
It's exactly your kind of Utopian mindset that needs to change. Please read the news of countries other than the US. You might be surprised at the amount of controversy that surrounds universal healthcare systems.
Alfie Evans didn't have a brain anymore, and would have probably been pulled even quicker in the US system. Insurance agencies are quick to deny funding.
No, in the first place, you shouldn't have a significant percentage of elected officials in the government who will fuck up any government in an effort to prove that government doesn't work.
If you do have that, then it is highly unlikely that your country will be able to implement a health care system that is competitive with Canada, Japan, Netherlands, etc.
But beyond that, it's very unlikely that your country will be able to implement other fundamentals, such as uncontaminated drinking water, safe schools, etc.
In other words, if your country has three branches of government, and the party that controls the executive, legislative, and judicial branches really is willing to fuck up any government in an effort to prove that government doesn't work... then, I'm afraid you are really pretty fucked.
That's a single argument in favor of what appears to be some call to remove power from government. The easy counter example is Medicare - we have universal healthcare already for people over the age of 65. Would you say that because the VA doesn't work great in your judgement (people are already coming up with counterexamples within that thread) that we should shut down Medicare?
> Until we change our collective view in what the purpose of a government and society is things won’t change significantly.
So yeah, if we don't change our collective view, then the republicans (or whomever) will continue to undercut these government run programs as much as possible for their broken ideology.
For a large number of different outcomes, the VA is superior to private care. It has a disproportionate footprint because "The VA does something bad!" is national news, while "SmallSizeMidwestCity Memorial does something bad!" isn't.
It's not perfect, by any means, and struggles with cost constraints (veterans are sympathetic, but sympathetic doesn't mean well supported), but many of its quality outcomes are superior.
Your getting downvoted for this, and I have no idea why.
Have other folks actually stepped inside a VA facility? Many of them are old/outdated/underfunded it's true. But some of them truly do offer superior care to a typical private hospital (in staff, facilities, and outcomes). The VA system could use significant improvement, absolutely. But if the fear-mongering 'worst case scenario' is that everyone gets VA levels of healthcare, that's still a huge win for all of America. That's a great baseline standard to start with, that no one should ever fear falling below.
If an uninsured American is critically injured, the options today are "A: Die" or "B: Bankruptcy". Having a new option "C: Universal VA-levels of healthcare" would be a win for literally every American, even for Americans who are lucky enough to already have great private insurance and who would never need/use this option themselves.
> But some of them truly do offer superior care to a typical private hospital
Which ones? Because that has not been my experience at the hawaii facility. From my appointment time being written down on a piece of paper then they send me my actual appointment date a few months later to the doctor being an hour+ late, my personal experiences have been subpar.
Add in how doctors/nurses at multiple hospitals do comically incompetent things like reusing insulin pens/colonoscopy bags/not washing equipment, the general sense of incompetence when they lose my records every few years, or talking to my buddies who got out and ended up working at the VA and have told me that they'll never get treated there, and I do not have the same sense of "superior care" that you're talking about.
If I want hep C, I'll go to the VA. If I want medical care, I'll go anywhere else or just not go to a doctor.
"Add in how doctors/nurses at multiple hospitals do comically incompetent things like reusing insulin pens/colonoscopy bags/not washing equipment"
I work in hospital infection control research - if you think your private hospital isn't making many of those same mistakes, I have some very bad news for you...
My dad is a veteran and now uses the VA for everything he can now.
His first experiences weren't that great, but you could easily tell it was because they were understaffed and underfunded.
Once they got to the point where he could start seeing specialists and whatnot, everything since then was a breeze.
He had a surgery on his stomach. It wasn't life threatening, but he was in some pain. The VA was able to get him an appointment with a Dr. and schedule the surgery within a few days to a week or so.
He also needed eye surgery. This one he had to wait for his eye to get to a certain point before surgery. The VA was able to get him to see an eye Dr the same day he went in for something else. Then less than a month later he was going to go in for surgery but something came up so he had to have it rescheduled. They were able to reschedule the surgery for the following week.
I would consider this a success story. He was hesitant on getting the eye surgery because of costs that were told to him by the previous company, but the VA told him he would not be paying anything, and he didn't.
This is one of the straw men that is often brought up. There are a million reasons why the VA is messed up, most of which have NOTHING to do with healthcare.
Congress has underfunded our troops for decades, related to healthcare and not. Something as simple as body armor is often purchased with personal money. A woman that works for me is high up in the Marines and I hear stories that disgust me. I do not know how Congress gets away with this. The stories are out there, but the American people seem to not give a you know what.
Please don't conflate the problems of the VA with Universal Healthcare.
I'm curious why there are more than one public health system. There's the VA, the IHS (Indian Health Services), and of course medicare/medicaid. Why are these not all the same system? It's not like we're different species....
edit, If this is a benefits/paperwork thing, then shouldn't that be separate from the care provider network?
It's the nature of the beast, in the US, I think. I believe if there were a Universal system, all of the others would go away. That would be a good thing.
> "If the VA is the best the US government can do..."
It's not the best Uncle Sam can do. It's the best it wants to do. It's the (minimal) "best" is has to do.
Sure there's plenty of verbal grandstanding - by both politicians, the public, and the private sector (e.g., NFL) - about supporting the vets and their families, but actions speak louder than words. (Verbally) supporting the vets is good branding. It's that simple. That's all it takes.
Put another way, if the US brought back the draft and the armed forces made up a wider cross-section of society (i.e. poor, rich and in between) priorities would change. Actions would speak louder than the words.
No, because it's free, but 1/3 of Medicare recipients opt to receive their coverage through private insurers that typically add on additional coverage, an indicator that Medicare alone is not enough for a large segment of the population, or that they prefer a private insurer even with government subsidization.
Excellent. We are in agreement that the American government can and does provide a health insurance program that covers lots of people and has the property that people don’t seek to leave it.
Perhaps the idea that everyone be covered in such a system is not so far fetched.
Why would anyone refuse free money? Are you sure you understand the parent's point? They are taking the money but using private networks, which indicates they prefer private providers.
In the absence of Medicare/Medicaid there would not be universal coverage for the elderly. The elderly do not advocate dismantling this coverage. The coverage is a government program. We are in agreement that a U.S. government program can cover lots of people and maintain the property that those people don’t want to the program to be dismantled. It’s not, then, hard to imagine everyone being covered by such a program.
I did not support the ACA but I use the healthcare exchange because it is in my best interest to do so. I get free money from others to pay for my family's health insurance. In fact, I get a 100% subsidy. But the reason I get a 100% subsidy is because I am affluent enough to live comfortably on only a small portion of my income and funnel the rest into tax-advantaged accounts that reduce my AGI to a fraction of my actual income. It would thus not be in my interest to advocate the ending of the ACA. This is the same reason the elderly (who are the wealthiest cohort) do not wish to see Medicare/Medicaid dismantled. But is this what's best for society? Everyone gaming the system to benefit at the expense of everyone else?
I feel sorry for you that you think this way. There’s a reason Medicare came into being. It simply isn’t profitable to treat people near the end of their lives. One illness, calamity is enough to wipe out a lifetime of savings and leave one penniless. The absence of a government program for providing healthcare to the elderly would be horrific and immoral. Some things ought not be profit driven. You wish to make our already horrible system into something worse.
I’m glad your view does not prevail. I would hate to live in a country in which the majority shared this opinion.
How can it both be unprofitable to treat people near the end of their lives yet also wipe out a lifetime of savings? If end of life care transfers the life savings of the elderly to the providers, that sounds quite profitable. Why shouldn't the elderly pay for these services? They have most of the money! And the dying have the least use for it whereas the young (whom you would tax for these services) have plenty of life and obligations yet to pay for. How is taxing the poor to pay for the healthcare of the rich moral?
How can it both be unprofitable to treat people near the end of their lives yet also wipe out a lifetime of savings?
It's unprofitable for an insurance company to insure someone near death and still provide a decent level of services. It's why there used to be pre-existing condition exclusions and why health insurance companies like Aetna went out of their way to try to deny claims.
Also, if the expense of coverage is greater than the amount of money a person has then it won't be profitable to treat them whilst still bankrupting the person.
I doubt that people actually doing this are concerned with the morality of it, just the profitability. It’s not moral, but it’s easy, because they’re old and dying and desperate. I don’t think there’s more to it than the usual greed and expediency.
> We are in agreement that the American government can and does provide a health insurance program that covers lots of people and has the property that people don’t seek to leave it.
People literally are leaving it, to the fullest extent that they legally can.
It's not a small number, either. About 40% of Medicare patients aren't on the government-run system at all, and that number has consistently grown over the years.
They supplement it, I don't believe they are leaving it, unless they are wealthy and can afford to pay out of pocket because they want to use a doctor that is not participating in the medicare program. Do you have a cite?
> They supplement it, I don't believe they are leaving it, unless they are wealthy and can afford to pay out of pocket because they want to use a doctor that is not participating in the medicare program. Do you have a cite?
No, this is wrong. Private Medicare plans fully replace Original Medicare. If you are on a privately-managed Medicare plan, you receive none of your benefits from Original Medicare (the government-run program).
Unfortunately, you're still subject to some of the care delivery restrictions that Medicare sets, which means people moving from privately-managed plans (without Medicare) to Medicare Advantage (privately-managed Medicare plans) will typically experience a drop in coverage, because private insurers tend to be more forgiving with these limits.
> they want to use a doctor that is not participating in the medicare program
I'm not sure what you're referring to here. Though yes, one of the big advantages of Medicare Advantage is that it's dramatically easier to find in-network providers, even for Medicare Advantage plans that don't cost anything out-of-pocket above what Original Medicare does.
> No, this is wrong. Private Medicare plans fully replace Original Medicare.
Uh, no. "Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans." [0] So although the Advantage plans are privately managed, the premiums are subsidized. I don't think this counts as "leaving" Medicare.
> Uh, no. "Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans." [0] So although the Advantage plans are privately managed, the premiums are subsidized. I don't think this counts as "leaving" Medicare.
By that logic, there's no way to leave Medicare, because you can't stop paying taxes for it or "disable" your eligibility for it (and all of the restrictions that Medicare eligibility brings for people on private insurance).
People leave Medicare to the full extent allowed by law. Unless you want to claim that people using school vouchers for private schools is a demonstration of their satisfaction with the public school system in their area, you can't view their use of Medicare Advantage as a demonstration of their satisfaction with Original Medicare either.
> people using school vouchers for private schools is [not] a demonstration of their satisfaction with the public school system in their area
It certainly doesn't indicate dissatisfaction with the fact that the money for those vouchers comes out of tax receipts! The primary education system is a single-payer system, and the use of vouchers doesn't change that.
> It certainly doesn't indicate dissatisfaction with the fact that the money for those vouchers comes out of tax receipts!
You're basically arguing a tautology: Because there's no legal way to fully opt out of the system if they dislike it, people can't leave it (by your definition), and you're then saying that, because people don't fully leave the system, that means they don't dislike it.
40% of people choose not to use Medicare, to the extent that's legally possible. The program that they choose to use instead outperforms Medicare on every key performance indicator (medical outcomes, cost, patient satisfaction), while also underperforming the same private insurers on those same indicators. It takes some real contortions to look at that data and use it as evidence in favor of a single-payer system, or even evidence that patients like Medicare, but if you're fully committed to interpreting available data in a way that supports that end goal, I guess that's all we can really say.
In both cases — Medicare Advantage and vouchers — people are accepting a government subsidy in a form that allows them more choice than the default form. You're the one trying to make some kind of point based on that. I see it as evidence of nothing more than the fact that people like to have choices. I'm not arguing that it proves that they like the system as a whole; I'm just rejecting your claim that it somehow proves that they don't. I do tend to agree that a system that allows them those choices is better than one that doesn't.
> The program that they choose to use instead outperforms Medicare on every key performance indicator (medical outcomes, cost, patient satisfaction), while also underperforming the same private insurers on those same indicators.
Cost to whom? I don't see how Medicare Advantage can cost less to patients than Medicare; nor does it seem likely that the premiums for a private plan are less than the subsidized Medicare Advantage premiums. (Re the latter, I guess you didn't see my other reply to you: https://news.ycombinator.com/item?id=16979926)
> Cost to whom? I don't see how Medicare Advantage can cost less to patients than Medicare
How do you think Medicare works? Do you think that, once you're covered by Medicare, you just show up at a doctor or hospital, flash your government-issued Medicare card, and receive free treatment for any covered services, without having to pay anything out of pocket?
(For the record, that is not how it works. Medicare is not free for patients. Premiums are neither your only nor your largest expense.)
My mother is supplementing her medicare with insurance. GAP insurance is I think what she calls it. I mean I'm sure what you are describing exists, but it's not universal.
> My mother is supplementing her medicare with insurance. GAP insurance is I think what she calls it. I mean I'm sure what you are describing exists, but it's not universal.
I am talking about Medicare Advantage. Medigap is different.
What I am talking about isn't "universal", but it's what about 40% of Medicare patients use in 2018. It's not universal because people have to choose to opt into Medicare Advantage, but it's an option for everyone: everyone[0] who's eligible for Original Medicare is eligible for Medicare Advantage.
[0] well, there are a couple of small exceptions, but I'm 100% sure your mom doesn't fall into those categories, based on what you've already said
> No, because it's free, but 1/3 of Medicare recipients opt to receive their coverage through private insurers that typically add on additional coverage
They don't simply add on coverage; they replace it. Most people on Medicare Advantage don't opt for coverage above what Medicare itself can provide - they simply receive their benefits from a private entity instead of Medicare, because Medicare provides such a bad experience for patients.
While you may have a good argument against a "single-manager" health care system, this doesn't seem like an argument against a single-payer system. In fairness, I guess a lot of existing universal-coverage systems, such as the UK's NHS, are also single-manager (someone will correct me if I'm mistaken), but the very existence of Medicare Advantage shows an alternative possibility. I think that, far from being an argument against single-payer, it shows how single-payer can be made to work even better, through premium subsidies (and, I would guess, reinsurance for catastrophic losses) to private insurance companies, for those who are willing and able to pay additional premiums for better care.
The NHS is what is called a Beveridge style system. I think that is what you mean by single managed. Similar systems are used in Spain, the Nordics, etc. They are often managed at local levels though and may include private hospitals and treatment that gets reimbursed by the payer at the same level as public ones. The VA is an example of this type of system although other nations have far more oversight and performance control than the VA does.
A competing setup is the Bismarck style of insurance company administered management, either for-profit or non-profit. Germany, the Nederland's, Switzerland, etc runs this sort of system. Always with a lot of legislation and safeguards to ensure that people do not fall outside the system. It is similar to the US employer-provided insurance setups.
Other systems are National Insurance, as used in Canada and Japan. Similar to Medicare. Canada is fairly unique in its hostility to private provision.
And then there is out of pocket, like rural Africa does it. That's basically like being uninsured and not qualifying for Medicaid.
Thing is, the US accumulated massive bureaucracy and costs by h\trying to run every system at the same time with little attempt at standardization and lots of billing and gatekeeping. Everyone else picked one system and stuck with it, letting private providers fill in the gaps. (Except Canada for the last)
> I guess a lot of existing universal-coverage systems, such as the UK's NHS, are also single-manager (someone will correct me if I'm mistaken), but the very existence of Medicare Advantage shows an alternative possibility. I think that, far from being an argument against single-payer, it shows how single-payer can be made to work even better, through premium subsidies (and, I would guess, reinsurance for catastrophic losses) to private insurance companies, for those who are willing and able to pay additional premiums for better care.
I don't think you understand how Medicare Advantage works. There's really nothing about it that suggests a single-payer system would work. The premiums are not subsidized. (Reimbursements are, but that's a separate matter.)
Medicare is the fullest extent to which people can legally opt out of Medicare, short of claiming religious exemptions (rare), working for a foreign government while in the US (rarer and legally questionable for citizens), or surrendering US citizenship altogether (drastic). Medicare Advantage outperforms Original Medicare on the top performance indicators (medical outcomes, cost, patient satisfaction), though underperforms the same exact private insurers on those same metrics, despite the latttermost also being saddled with the burden of subsidizing Original Medicare reimbursements.
If you still want to advocate for single-payer healthcare on philosophical grounds, okay. But from an empirical standpoint, Medicare is not the place to look for data to support that stance.
I already quoted from medicare.gov [0], but I'll repeat: Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans.
Private entities contract with Medicare to provide insurance that covers what Medicare covers (and perhaps more). Would said insurers cover everyone that Medicare covers in the absence of Medicare? The answer is no.
How many of these people on private Medicare plans pay for Medigap? Everyone who get kicked off a private plan can go back to the original Medicare. Your point is disingenuous. Medicare is the universal insurer of last resort for elderly. Their lives would be much worse without this last resort insurer.
> Medicare is the universal insurer of last resort for elderly. Their lives would be much worse without this last resort insurer
That's a far cry from "people don't seek to leave Medicare", which is literally the original claim. By and large, people do seek to leave it, to the extent that they can, both legally and financially.
Yes, for people who can't access anything better, having Medicare is better than literally nothing, but nobody's arguing that. That doesn't mean that Medicare provides a good model of what would best suit everyone else, and that's the relevant question when talking about a single-payer system.
If you want to talk about a single-payer system and use Medicare as an example in support of it, you have to address the fact that privately managed plans consistently outperform Medicare on the top three performance indicators, and that patients themselves prefer all the alternatives to Medicare except "no coverage at all".
> Do Medicare recipients seek to leave it? That’s a government run healthcare system.
Since you asked - yes, yes they do. Medicare patients can opt to receive their inpatient/outpatient benefits from a private insurer in lieu of traditional Medicare benefits, and an increasing number of people do so.
Privately managed Medicare plans, incidentally, outperform Medicare on the three key performance indicators: medical outcomes, cost, and patient satisfaction.
The point isn’t really to compare it to the current best that the US governmeny can do. With the US’s historic view on universal/“free at the point of access” health care it is hardly surprising that the VA is a mess. What you should compare it to is the best that other governments have done, in which case there are many examples of excellent universal healthcare from public insurance based all the way through to the UK’s NHS - which does an excellent job despite below inflation budget increases and endless media hyped scandals.
The VA is far from perfect and is really noticeably worse than many other country's nationalized health systems. But it's not obviously worse than private health insurance in the US and generally veterans are as happy with their health care as other people. I think the VA example tends to dispel the notion that single payer would save that much money but it works about as well as other approaches, of which the US has way too many.
> The VA is far from perfect and is really noticeably worse than many other country's nationalized health systems. But it's not obviously worse than private health insurance in the US and generally veterans are as happy with their health care as other people
If you want to convince people to support a single-payer system, this is quite possibly the worst argument you could use. Any veteran or anybody who has had any experience whatsoever with the VA will instantly assume you don't know what you're talking about.
The VA is, on the whole, atrocitous. There are a couple of regions which do relatively well, because the system is federated, but on the whole, it's almost universally considered to be a disaster, even by people who are supportive of the program's existence.
If you want to convince people that a single-payer system wouldn't end up like the VA, start by acknowledging the problems with the VA, not denying them.
> The VA is, on the whole, atrocitous. There are a couple of regions which do relatively well, because the system is federated, but on the whole, it's almost universally considered to be a disaster, even by people who are supportive of the program's existence.
Yeah, this is bullshit. The VA and its effectiveness has been studied quite a bit. Its quality has been found to generally exceed the quality of private hospitals. The media and conservatives paint this idea that the VA is "atrocious" but it has no basis in reality.
The scientific evidence for universal healthcare is overwhelming. The only "controversy" -- exactly like the "controversy" around climate change -- exists within people who have carefully decided to ignore the evidence and buy into the propaganda. The problem here is not the VA. The problem here is that many Americans have abandoned reality.
> Its quality has been found to generally exceed the quality of private hospitals. The media and conservatives paint this idea that the VA is "atrocious" but it has no basis in reality.
That's certainly one way to summarize the research around the VA, but it's a highly misleading one. It's easy to cherry-pick the metrics on which the VA performs well, but they're not representative of the big problems that the VA has: massive disparity between regions, accessibility of care, timeliness of interventions, adherence, and so forth. This is why VA hospitals have dramatically worse patient satisfaction rates than their non-VA counterparts. (They actually got in trouble a couple of years ago for misrepresenting and hiding the data around this for a while, until independent studies were done which forced them to admit that they'd redefined their internal metrics to make themselves look better).
As someone who has experience with Medicare and the VA, both on a personal level and on a professional level, nothing makes me more skeptical of arguments advocating single-payer healthcare than people willfully ignoring the vast documented problems that exist with both of those systems. That doesn't mean they're not fixable problems. If you want to advocate for single-payer healthcare and argue why these problems could be fixed in a single-payer system, fine. But don't go around pretending that they don't exist - you can't fix a problem by ignoring it and hoping it will go away.
Your response to scientific studies that demonstrate the VA actually provides better care than private counter parts is to dismiss them all as dishonest cherry picking. You offer up no studies or data of your own. You have no evidence for your claims except vacuous appeals to personal anecdote. You've somehow reached the conclusion that the entire VA, a $200 billion dollar program that cares cares for ten million of Americans, is "atrocious" based on ... what?
I think this pretty much proves the point.
The point here by the way is not that the VA is perfect. Nobody has claimed that, though you seem to keep insisting that people must admit something they don't claim. The actual evidence we do have shows the VA has problems but still offers better care so I'm not sure how we're "ignoring" anything. It seems like you're the one ignoring the plain facts and have chosen to buy into a convenient falsehood. Until people like you are willing to even look at the evidence -- and the evidence for universal healthcare is overwhelming at this point -- real discussion is pointless.
> Your response to scientific studies that demonstrate the VA actually provides better care than private counter parts is to dismiss them all as dishonest cherry picking. You offer up no studies or data of your own.
To be entirely honest, you alluded to research around the VA (but did not offer up any studies or data of your own). I responded by alluding to research around the VA which provides a different conclusion (but did not offer up studies or data either, although I did at least state the actual metrics used to draw said conclusion).
> Until people like you are willing to even look at the evidence -- and the evidence for universal healthcare is overwhelming at this point -- real discussion is pointless.
We're not discussing scientific evidence here. At best we're discussing your interpretation of (possibly-scientific) research that you've seen in the past but haven't actually named.
There is one point on which we do agree, though: that it's pointless to continue. It's pointless for me to continue a discussion with someone who starts a thread with bold claims and no supporting data, and then criticizes someone who responds in kind for the exact same thing. To be honest, it's also pointless to continue discussions of healthcare policy on Hacker News beyond a certain point too, because of the inherent political makeup of the site. Even the most well-researched comments which reference primary sources alongside research published in peer-reviewed journals are routinely downvoted because they express skepticism of monopsonic healthcare models. Instead, the top comments are usually low-effort criticisms that contain no rigor, depth, research, or citations, but do contain witty, biting criticisms of US healthcare and political soapboxing. In that sort of environment, there's not much of an incentive for people with domain knowledge who've studied these issues to participate in earnest.
So I guess that's one thing we can agree on: the futility of continuing this comment subthread.
This is a lie. By virtually every measure the VA is the most cost effective and best quality care that Americans can get.
* The VA is very cost effective. It is much cheaper than any private sector health plan or Medicare. Instead of buying into the propaganda go straight to the source [1] and look at the actual facts.
* The VA enjoys very strong customer satisfaction. You wouldn't know this because the media and conservatives work together to denigrate the VA every chance they get but you should actually talk to people on the VA plan. Surveys of actual VA customers [2] indicates they're quite happy with their free, comprehensive government healthcare. (Shocker.)
* Study [3] after study [4] has shown that VA hospitals are better than private, profit-driven hospitals.
Most Americans would kill for VA coverage. It far exceeds anything they will ever receive unless they make it to the 1%. And this is why it's so very important to keep spreading this lie that the VA is this gross, evil system where all the patients are just waiting to die and ignored by incompetent and indifferent government bureaucrats.
And this is the real problem. You can't have real discussions about health care in America because, frankly, most Americans don't live in the real world. They've been led to believe objective nonsense and you simply can't build anything off such a foundation.
The VA has gotten a lot of bad headlines, but I work with a vet who absolutely loved the VA. He brags about the quality and speed of his healthcare all the time. This is in Charlotte, NC. Different offices might be different.
The thing with the VA isn't that it's all bad. It's that the percentage of completely inept people seems higher than in a normal hospital.
Normal hospitals don't have multiple scandals of reusing insulin pens on different people, reusing colonoscopy bags, killing people, paralyzing people and periodically losing all of our records.
A lot of veterans who are covered by the VA are like me. Technically covered because of service connected disabilities, but I will never use it.
Again, this is not true. Read the studies comparing VA care to private care. You're actually better off going to a VA hospital than most private hospitals.
I've been to a VA hospital. My brother/dad/uncle have been to the same VA hospital. Our experiences have all been poor.
If you were told that you'd get an appointment some time in the future and they sent you a notice randomly in the mail a few months later, you probably wouldn't be happy with the service. If your doctor was over an hour late, you wouldn't be happy. If you had a friend that was paralyzed after a spinal tap (my dad's buddy) then you probably wouldn't hold the VA in high regard.
You are the first veteran I've ever met who had good experiences at the VA and who doesn't know anyone that has been crippled by the VA.
>If your doctor was over an hour late, you wouldn't be happy.
Doctors aren't on time in privatized offices either. It's always a long wait for me. But you're right about the not being happy about it.
>If you had a friend that was paralyzed after a spinal tap (my dad's buddy) then you probably wouldn't hold the VA in high regard.
Yes, but that happens in private hospitals as well. They aren't all that great in the US either.
>f you were told that you'd get an appointment some time in the future and they sent you a notice randomly in the mail a few months later, you probably wouldn't be happy with the service.
Ya that sucks. Private industry has solved the scheduling problem with DSS and template based schedules. My uncle didn't have a good experience with the VA either. He had dementia and the nurse questioned him about it and he said "I have diabetes," which he did, but he didn't know what was going on. The nurse of course said, "we don't treat diabetes," or something like that and sent him away. All the while his sister was telling her about the dementia, she just didn't want to hear it.
I could tell you horror stories about private hospitals too and how after being admitted, they shipped him to a nursing home an hour away wearing nothing but a gown in winter. No calls, no nothing.
I guess the bottom line is right now, the US sucks at healthcare, period. I'm sure being a highly politicized wedge issue doesn't help matters much. (The VA, universal healthcare, skyrocketing costs in the private industry, etc).
> He brags about the quality and speed of his healthcare all the time. This is in Charlotte, NC. Different offices might be different.
The VA is run in a federated fashion, so there is a massive variation in how well they operate.
The problem with the VA isn't that literally every hospital is terrible. The problem is that:
(1) a lot are bad
(2) the bad ones are really terrible
(3) the bad ones are consistently bad over time, with no success in improving them
Part (3) is the really damning one, because it's not like there haven't been efforts to fix the issues with the VA. But because the US is such a heterogeneous country, the successes of Portland don't translate well to Memphis.
> When a person gets a life threatening disease they ought not worry about whether or not their treatment will leave their family in penury.
You can't start any economic argument by saying that paying any cost is a must. You will get fleeced.
It is not true that universal healthcare pays for everything. The most expensive and experimental treatments will not be covered ever by the system, and it shouldnt.
It is a well known fact that all medical care systems ration care. A person in America who gets cancer, say, often times faces bankrupt and financial ruin. The same can not be said of people in other wealthy nations.
I fail to see your point. All healthcare systems ration care. Not all of them lead to financial ruin at the rate the American healthcare system does. My statement stands. A person ought not face financial ruin. It may be the case that there aren’t enough resources to treat the disease it this does not negate the belief that they shouldn’t face financial ruin.
The logical consequence of this is that any cost must be paid. And if the person cant pay it someone else does. So if someone gets a rare cancer whose treatment has 1% effectiveness and costs millions, it should be paid by someone else.
The principle is wishful thinking, not economics. We as people every day make trades of our life for money. We pick a means of transportation riskier than other to save some money, we choose to use a bike to be physically healthier in the long run but expose to short term risks. We eat those cheese french friends with a beer, or smoke. Etc etc.
We are no strangers to paying our pleasures with our life.
- It is the tendency of all men to magnify their own services and to disparage services rendered them, and private matters would be poorly regulated if there was not some standard of value. This guarantee we have not (or we hardly have it), in public affairs.
Americans often believe that universal healthcare is this pristine ideal that will solve everything, but thats because you haven't analyzed the consequences of it and its real life consequences.
The problem of healthcare in the us is not public-vs-private, its the extreme regulatory environment.
Your first paragraph is false and indeed can not be true in any system that rations care. All health care systems ration care since no soceity has enough resources to cover and pay for all possible needed health services. Here resources includes number of qualified workers.
I think you have half a point. A lot of people favoring universal care say things like "health care is a right". I would much prefer the statement that "basic health care is a right". We don't want to talk ourselves into a system where we feel obliged to try to cover absolutely everything.
They don't face financial ruin, unless they don't have health insurance and or they opt for various drugs that aren't covered by their plan. Before everyone screams that all things should be covered please consider that due diligence has actually been done and the drug was considered to either not be effective or not needed based upon other existing treatments.
I am fighting my insurance company right now on a charge that I didn't have health insurance when I used their services this January despite having enrolled last September.
The idea that once you have insurance the problems just magically go away is wishful thinking. These companies are predatory and stupid, and if I hadn't taken the time to read every single line for the 4-page, 10-pt font bill they sent me I wouldn't have even known they were charging me as though I was uninsured.
The idea of universal care is that everyone have insurance. Before Obamacare my sister got cancer. She wasn’t lucky enough to have an employer nice enough to provide insurance through her job. Even people with insurance often times face financial ruin. Especially before Obamacare was enacted.
> They don't face financial ruin, unless they don't have health insurance
In the age of high deductible plans I'm not sure this is accurate. For many Americans the $5,000+ for a deductible each year is unsustainable, especially if someone on the plan has an ongoing issue or they have to meet the deductible multiple times (changing jobs or an issue than spans calendar years).
>They don't face financial ruin, unless they don't have health insurance
Without the ACA, this wasn't possible for millions of people. With the ACA it was still too expensive for millions of people. With the ACA minus the individual mandate it will be too expensive for even more.
Also before the ACA, health care plans came with yearly and lifetime coverage limits. Coverage limits that were far below what care would cost in many cases. So even with insurance you could still face financial ruin.
I feel like throw-away statements like this almost come out of a different era, like the platform Reagan ran on, "government isn't the solution, it's the problem" or whatever.
They're claims that are so simply phrased, people can repeat them without thinking critically about them, but if you do, and start unpacking them, the claims are either wholly unsupported, or unknowable.
"Taxes == get fleeced" ... no. Or, at least, not as a matter of course. Maybe some taxes are bad, or unfair, but we can judge each tax on its merits.
"Government program provides worse services" ... no. Or, at least, not as a matter of course. Maybe some things the private sector does better? But a huge swath of civic life relies on government services because, well, that's by definition what government provides, the building blocks of civic life.
> "Taxes == get fleeced" ... no. Or, at least, not as a matter of course. Maybe some taxes are bad, or unfair, but we can judge each tax on its merits.
Sure. I pay private healthcare and i also pay a medicare tax. Im already getting fleeced for a service I don't use.
> "Government program provides worse services" ... no. Or, at least, not as a matter of course. Maybe some things the private sector does better? But a huge swath of civic life relies on government services because, well, that's by definition what government provides, the building blocks of civic life.
Government is just unable to provide something more efficiently than the private market, it has to be a very particular case for that to be true. What i can do is provide services no market can provide. (like security, legal, etc). A private legal system would run afowl, private armies would be civil war, etc. But thats not because the government is efficient,its because it cant be provided otherwise. I would never call 3.6 trillion defense spending efficient.
The argument in favor of public run healthcare is that private healthcare is unable to do it not that the government is better at doing it.
I can tell you feel passionately about this, but your feeling that you're being ripped off by your taxes isn't going to translate well to any sort of workable policy.
>>You can't start any economic argument by saying that paying any cost is a must. You will get fleeced.
>Paying taxes isn't getting fleeced.
I think it's fair to accurately address the arguments being put forth, rather than reinterpreting them. Taxes are necessary, and I don’t think any serious person would argue otherwise. The problems come when we get into the details:
Conflating local, state, and federal governments with their respective tax regiments only serves to muddy the waters. Additionally, conflating property, income, and capital gains taxes compounds the problem.
Scaling anything from 60M people to 300M is non-trivial (just ask Twitter, which is pretty simple).
Arguing for a collectivist approach in the US (which was partially founded on individualism), seems to betray the entire reason for our independence from Europe (the old country) in the first place.
Let Europe do Europe, and America do America.
Edit: Just to be clear, individual European countries are 20% of the population of the US at best, so it makes more sense to compare them with US states (e.g. The state of CA is the 6th largest economy in the world). Top-down policies do more harm than good in such a large heterogeneous place as the lower 48.
I've never seen a plausible explanation of why a health care system would work for 60 million (UK) but not for 300 million (US).
Bodies are mostly the same, they break down in mostly the same ways. There isn't a lot of mystery in providing care, either. Nor a lot of mystery in how you'd fund it.
We just aren't doing any of that, cause our politicians are bought so very, very cheaply, and enough people are enriching themselves in small ways through small grifts that changing the system would impact a lot of people who are just well-off enough to be listened to.
>I've never seen a plausible explanation of why a health care system would work for 60 million (UK) but not for 300 million
Scaling advanced systems to large numbers of users is very difficult and is the reason Facebook is worth ~1/2 Trillion dollars.
"James Madison argued, especially in The Federalist No. 10, that what distinguished a direct democracy from a republic was that the former became weaker as it got larger and suffered more violently from the effects of faction, whereas a republic could get stronger as it got larger and combats faction by its very structure."
<our politicians are bought so very, very cheaply, and enough people are enriching themselves
If this were true, we should arbitrage this value-mismatch and create a market for buyers and sellers of this powerful, political influence. "cheaply"? As the saying goes, "Extraordinary claims, require extraordinary evidence."
It is possible that the lawmakers share the same views as the for-profit/non-profit corporate execs, just like I agree with Green Peace(i.e. lobbyists) that we should end the practice of whaling significantly. The sovereign nation of Japan disagrees.
The services could be worse but aren’t necessarily worse. It’s foolish to think that any government service is worse than a private one. Also, universal healthcare doesn’t necessarily mean government run.
It’s foolish to believe that private enterprise is always more efficient than a government run program and it’s foolish to think that government is always more efficient. One should not live in a world of such extremes.
Sometimes government is the efficient solution. Sometimes private enterprise is.
Like the real life experience of those private Russian mercenaries who went up against the US military in Syria?
Some things governments simply do better; health care is one of them. Denying that fact in the face of the mountain of supporting evidence is nothing but dogma.
It's not a great comparison for a lot of reasons (not least of which the first being that Medicare is legally not able to negotiate drug prices), but despite all of that, yes Medicare is dramatically more efficient.
Medicare is the core of all regulatory and pricing issues in the healthcare space. And if medicare were expanded to the entire population of the us, its expenditures could be 40-45% of gdp.
> Medicare is the core of all regulatory and pricing issues in the healthcare space.
I can't see a reasonable argument for that.
> And if medicare were expanded to the entire population of the us, its expenditures could be 40-45% of gdp.
Even with a naive covered-population-number based extrapolation that ignores that Medicare currently covers the elderly, who tend to have greater medical needs than average, that's not right; national health expenditures are about 18% of GDP, Medicare is about 20% of NHE, and Medicare currently covers around 15% of the population, so a naive population-based extrapolation would put Medicare-for-all at about 24% of GDP.
Medicare is the reason there is fee-for-service, which is the biggest administrative overhead design if there is one. Also all private insurance works based of of medicare in the rates they pay, the way they code themselves etc.
On the extrapolation, of course they are all simplistic and wrong, both mine and yours. You are capping the NHE of GDP to cap medicare, as if the expansion of medicare were going to eliminate out of pocket or private health. Because it doesnt, if it replaced only half of expenditures, the 24% becomes 33%.
Its true Medicare takes care of older patients, but also private insurance subsidizes medicare all along the path to that because it pays more than medicare to every provider, which means on the pool of patients, the medicare patients tend to represent losses and the rest profit. Furthermore there is the argument that if medicare expanded 7 fold, it would also be less efficient the bigger it gets, which is true of private and public organizations alike.
We cant know, its messy and even expert economists cannot get this right: but it has to be in the order of magnitude of 25 to 40% of gdp. That is state-crushing expenditures.
> On the extrapolation, of course they are all simplistic and wrong, both mine and yours. You are capping the NHE of GDP to cap medicare
No, I'm not, I'm using the current expenditures as the projection baseline. I'm clearly not using the current NHE share of GDP to cap Medicare because the projection (24% of GDP) is greater than the current NHE share of GDP.
> as if the expansion of medicare were going to eliminate out of pocket or private health.
No, you made a claim about Medicare expenditures being 40-50% of GDP if it covered the whole population, not other expenditures. Now you're moving the goalposts (and still not supporting your mutating guess with any actual concrete basis.)
> We cant know, its messy and even expert economists cannot get this right: but it has to be in the order of magnitude of 25 to 40% of gdp.
Well, that's a sudden drop in your estimate of what now seems to be total NHE from your earlier claim that Medicare expenditures alone would be 40-50% of GDP. Another round of this and you'll be conceding costs below the current 18% of GDP.
Not only is universal healthcare more moral, it has been demonstrated as more economically efficient many times over. You only need to start by comparing the per-capita costs paid for healthcare in the US vs every other modern nation in the world. The US pays more than double the average of the other nations and we get much less performance for it. There are no modern nations that pay as much as the US in absolute terms, nor as high a percentage of our GDP.
The other nation's systems have mixes of full nationalized care to administrative combinations of private insurance, so there is some leeway there. But all of them contain public controls on the cost of drugs and procedures. And that demonstrably works with both better prices, and better outcomes in total measures like life expectancy.
Edit: Btw the PBS article is from 2012, with data up to 2010. In later years, US life expectancy has had years which it has dropped, and even when growing, it lags the nations modern peers (while approaching nations such a Mexico..). There are some forces there that aren't all healthcare, but healthcare is central to life expectancy...
> When it comes to public funding for public goods we tend to worry about some poor person getting something they don’t deserve. The go it alone I’ve got mine, fuck you attitude is unhealthy.
1/3 of our GDP goes to "the village". We spend trillions every year on the things you want most. Education, healthcare, environmental protections. You name it; we spend money on it!
70 million people use medicaid. 44 million people use medicare. 22 million veterans eligible for the VA. 22 million government employees who receive healthcare benefits paid for by the state.
We are drowning in the healthcare spending you pretend doesn't exist.
Our spending on healthcare is grossly and immorally inefficient. A change is needed. One reason for the ineffiency is that public welfare is subordinate to special interests. All universal healthcare systems in the world are cheaper on a per capita basis than the American system. A change is needed. I’m not advocating for more money. I’m advocating for a change in perspective by our leaders.
That's true, but since there is an example (tens of them, actually) where it does work well, then the prior should be that it could and should work in the US, and if one thinks it wouldn't work in the US, it should come with an explanation.
The US has less than 400M people, the EU has more than 500M, so you are factually wrong.
The EU is divided to states, just like the US; healthcare is locally managed with reciprocity between the EU members. Which gives you a model for a scalable US implementation if you desire.
You are entitled to your own opinion, but you are arguing against facts. The US is smaller population wise.
I didn't say that the US was larger than the EU...
I said the US is significantly larger than any one country in the EU, and each country in the EU has its own health care system. What is being discussed in this thread is a US-wide health care system, which is definitely not equivalent to what is currently happening in the EU.
Each country in the EU has its own health care system, but in most senses they are regulated EU wide, and reciprocate with each other - if a French person needs urgent care in Italy, he will get it, and the distinct single payer systems will do the accounting. Said French person can also legally move to Italy, and will be covered by Italian single payer system from day one.
The EU has only one medical "FDA"-like authority, which is - in fact - a huge problem for the UK post Brexit because they have to set one up for themselves now.
The EU has, effectively, a EU-wide health care system. It is more federated than the US, by virtue of only recently become a union. It is also less uniform because of different history, tradition, and languages. These are things that make it harder to build than a US-wide, and yet, it works and is significantly more efficient than the US, while catering to more people.
Of course the existing US-wide health care system is not equivalent; it is dysfunctional. You claim, but fail to demonstrate, that a functional one cannot be built, despite example in the EU that faces harder objective conditions.
Good straw man yourself! You did claim that whatever works in the EU has no reason to work in the US, and I only
Asked why not.
Also, the French man will get treated because of EMTALA but might be bankrupt by the event. It’s just that they buy/get insurance before they come (usually through their credit card issuer).
That, even if true, does not support your argument. You need to show that the inefficiency in a universal care system in a country as large as the U.S is greater than the current system that we have. The evidence is that this is not true.
I don't need to show that, as I am not the one advocating a fundamental restructuring of the status quo.
You need to show that the policies implemented in other countries will continue to work efficiently at the scale of the US, as you are the one advocating that course of action.
"This policy worked well in [some place that is not the US]" just isn't good enough.
You can't definitively conclude anything about example B from the results of example A if the two examples are different.
That's not what I'm saying though. All I'm asking is for you to show me how you will mitigate the problems that will crop up when you try to implement a similar system to the UKs at the scale of the US, because the US has 5x the population of the UK. That's not a negligible difference in scale, and if this can't be shown at all, that is a problem.
You assert that problems will crop up, but fail to mention which problems. You are arguing that any data anyone brings up is irrelevant, without bringing up any data.
You keep comparing the UK to the US, but a much more apt comparison is e.g. UK to CA, and the entire EU to the entire US. UK has twice the population of CA, and better bang/buck and health outcomes. EU compares similarly to the entire US.
The EU is at this point in time, a federation slightly more disjoint but ultimately of similar structure to the US.
Why not build an independent single payer healthcare system in each US state, with reciprocity among them? That is directly comparable to the european system, and has been shown to scale and work efficiently and well.
Never said otherwise. I made the statement in response to the view that government run necessarily means inefficient. Clearly the converse is true. There are lots of examples.
>Our spending on healthcare is grossly and immorally inefficient.
Yes, because it goes to treat chronic preventable (voluntary) conditions and to keep rich old people alive for a few hours or days longer. The way to handle those freeloading on the system is to abolish the system, not increase its scope.
Social security age keeps on rising as baby boomers retire.
America is the wealthiest country on the planet, yet the country where most people go bankrupt or commit suicide because they can’t afford healthcare costs. US spends astronomic amounts on weapons development than keeping its citizens healhy and happy.
Fermi was right. We’ll eventually destroy ourselves before we find another intelligent civilization. May be the great filter is that no one in the universe got healthcare right and they vanished. /s
Universal healthcare benefits people with no coverage, which is good, but it also, in the case of nationalized healthcare, i.e. not privately run, leads also to lower quality care for people already with coverage where experience is people who can afford it, will when other than the most routine things, seek private care.
Given that, it looks like a two tiered system might work best. One which works like the current system and also another for the not quite indigent but can’t afford the current system (indigent are covered by Medicaid).
What works well outside of the US is that the single-payer government run (or at least government mandated) provides a standard level of care, which more often than not includes wellness and life threatening care (and a lot in-between), and one can buy additional coverage in the private market - but the basic standard care is considered a right, and doesn't disappear just because you have some additional coverage.
When you look at other modern nations, all with better performing healthcare systems than the US, there is a mix of arrangements. The common factor is public gov't control of drug prices and procedures. The arrangement of how the administration of the care is allocated varies all across the spectrum, from fully nationalized, to hybrids, to mostly private administration. But I'm inclined to think that public health experts setting cost ceilings by drug & procedure is the critical element.
Apparently doctors should only work for the public good and accept (relatively) piddling wages but startup tech bros and VCs are absolutely entitled to their billions.
I couldn't agree more. I don't think U.S. has a real progressive party, the choices are off the rails conservatism, or conservative lite. IMO, a progressive/liberal is concerned someone might go hungry, a conservative is concerned that they might miss out because someone got some food they didn't earn/deserve.
Back in 2004 when John Kerry was running for POS (that's President of the United States, he-he), he had a great idea (that I'm sure came from elsewhere, but a good idea is a good idea). The US government would become the "insurer of last resort" and cover catastrophic claims above a certain amount:
For his efforts, he was practically called a "Commie" by the Republican party, despite the fact that the proposed mandates were fairly mild and the plan worked within the existing employer-provided health insurance system. It was a good crack at the ~20% of the population that accounts for the majority of healthcare spending, and eliminates the possibility of someone losing their home and savings because of a serious illness. Plus, I'm sure that the levers could be tweaked a bit to get better outcomes.
There was a good comment(I have it saved somewhere) explaining this quite well - some places in the world(European nations mostly) got so fucked over by history, over and over and over again that as societies they realized you cannot "pull yourself by your bootstraps" and provide for yourself in all circumstances. Just in the 20th century it was possible to see your country ravaged by two world wars, change ideologies three times, change the dominant religion and ownership of land between major powers few times in just few decades.....the societies have realized that the only way to make it work is by providing certain services to everyone, free of charge, purely because they are citizens with no strings attached(and no, this has nothing to do with communism). Meanwhile, in US, the "pioneer" ideal still reigned - anyone could achieve anything, given enough hard work. That ideal didn't exist in Europe at the time, or was crushed so thoroughly its destruction echoed through society - you could be the most hardworking person in Europe, but if someone decided they were going to pillage your land, rape your family and send you all to concentration camps - that was going to happen. No amount of positive thinking and hard work was going to prevent it. So yes, to my granparents it's absolutely obvious that everyone should have equal chances - healthcare should be funded by the state, as should education and child-bearing. They still get really upset over the fact that despite all education being 100% free in this country students still have to pay for their own housing - why should they? The state wants to have well educated citizens, why the hell should the students be paying anything to study. Once again, this has nothing to do with communism, but I am sure Americans would label it as such.
The US and Europe are not really great comparisons for a bunch of reasons, but the fundamental one is that Europe has been at Malthusian population limits for a long time, whereas North America has had an essentially unlimited, unpopulated frontier that new people could move to and create lives for themselves.
Thus, the American notion of pulling your self up by your bootstraps was a workable one. Since North America was first colonized by Europeans, Americans have moved west and made a future for themselves and their descendants by using hard work to harvest the bounty of nature. But Europe has been full for thousands of years. You can't just move West, work some land, and raise a family; there are already other people wherever you would want to go.
This is a principal reason why the US was crossed off my list of countries where I would work and live. I fight against the privatization that is occurring within healthcare in my native country, Iceland. We used to have the Scandinavian model but decades of attacks from the right-wing Independence Party has broken our healthcare system. The next phase described by Chomsky is handing it over to private capital since people are outraged that it doesn't work anymore. I'm sickened by the development and feel a little like an old man screaming at the desert wind.
>When a person gets a life threatening disease they ought not worry about whether or not their treatment will leave their family in penury. This is especially so in a nation as wealthy as the U.S. The American healthcare system is immoral and I hope it drastically changes.
If no one has to worry about the monetary effects of their health choices, poor health choices are incentivized and those who make poor choices are subsidized by those who make good health decisions. The vast majority of healthcare spending in the US is already on preventable chronic conditions yet everyone keeps gorging themselves further into obesity, diabetes, hypertension, CVD, etc. Almost no one is against paying into a risk pool that hedges against unforeseen health problems even though they may never directly benefit. If I pay my entire life to cover someone else's cancer, that's fine with me. What we are sure as hell opposed to is a creating an entire system based on perverse incentives that punishes people doing their best to save their pool from spending on them and rewards those whose voluntary actions are the driving force behind increased costs. And the US healthcare industry is not some libertarian wild west show, it is highly regulated and dominated by the edicts of CMS yet the state of the public's health continues to worsen in ways our forebears who optimistically, though naively, created these programs could never imagine.
Thank you for exemplifying the attitude I decried. I wish people like would leave the U.S. Live elsewhere. Escape the burden of possibly having your tax dollars help someone else by emigrating.
I invite you to do likewise. We will be quite well enough without ignorant busybodies posturing as moral crusaders hectoring us into enabling further deprivation of our property and liberty.
As the good book says, "For the love of money is the root of all evil". I'm not posturing. I actually do have a moral code that I try to abide by. The fact that all other wealthy nations provide what is colloquially called "universal healthcare" is an indication that yours is the abhorrent view. It would be worth your while to consider why your view, in just about all other advanced nations, is considered a fringe one.
In my country we do have single payer health care, but I wouldn't step foot into a state hospital unless I would have a terminal disease.
The infrastructure is old and crumbling, people get infections during operations and walk out more sick than they entered.
Sometimes you are asked to bring your own medicine, and basic medical supplies because hospitals don't provide you with anything. The system is overcrowded and no one gives a shit about you unless you bribe them.
I think the key-word is functioning universal health care.
While I do support paying for universal health care and think it is a basic necessity of a civilized country, you need a good culture and competent people to make it work.
I think a good culture makes shit work, not the process itself. (just like applying Scrum / Agile won't make you solve anything without the right people)
"I think a good culture makes shit work, not the process itself"
Ya this is genius. I also think this is why no finite amount of laws can solve corruption issues.
> Sometimes you are asked to bring your own medicine, and basic medical supplies because hospitals don't provide you with anything. The system is overcrowded and no one gives a shit about you unless you bribe them.
Sounds like Venezuela, which I would not hold up as a gleaming example of good governance.
Universal health care is a euphemism for the poor and sick getting their medical care subsidized by the wealthy and healthy.
Morally, caring for the sick seems like the right thing to do, but it's like when I hear Bernie Sanders call for "free college education": he doesn't mean free, he means the wealthy subsidizing it for others.
Universal health care implies just distributed costs, but the focus should be on bringing down costs so the payments don't have to be so astronomical.
For example:
-Nurses could do a lot of things doctors do now, and for a lot less money, but MDs refuse to cede any authority.
-Medicare should be allowed to negotiate drug prices.
-Hospitals should pre-publish costs upfront before you accept care rather than saddle you with 100K in bills later on.
All of these things would help bring down cost but for political reasons we don't do them. Instead it's just about making wealthy people (which, for the record, I am not) pay more to cover for it.
Even if caring for the sick is just it shouldn't be accomplished just by a wealth transfer (to be fair, the ACA had some provisions to bring down the cost of care, but not nearly enough).
There's some serious mental gymnastics going on here to justify that the US spends 2x the next country per capita on health care expenditure and still doesn't manage to pay for all its citizens. Especially when the federal government has already taken all its worst customers (the old) and thrown them into a socialized pool (medicare) without anyone to balance out the risk.
Wasn't there a writeup recently that wealth distribution isn't materially distinguishable from luck? [1] Your argument that the healthy/rich subsidize the poor/sick is tantamount to saying the unlucky should fend for themselves. That's an easy argument to make if you're lucky. Your luck may turn at any moment, and then if it does, you're SOL.
Further, if the moral argument falls flat for you, the self-centered argument is that if someone is too poor to get their horrifyingly contagious disease treated until its too late and it spreads to you, you're still sick, and you may still die, cover or no cover. It's why the fire department is socialized -- if the fire spreads to your house, it still burns does it not?
Especially as you argue you're not particularly well off necessary, you should be the strongest advocate for yourself, and therefore, for socialized medicine.
The world is moving there -- at least towards a two-tier system -- and this argument is on the wrong side of history.
[EDIT] I also wanted to throw in there the self-centered argument for socialized higher education. If you believe in the value of a college education, then you believe it will increase the productivity of that individual. A more productive individual makes your country more competitive, boosts GDP, moves the markets higher relative to that of other countries. This in turn benefits the wealthy who likely hold equities. Speculative, of course, but the argument seems consistent to me.
> There's some serious mental gymnastics going on here to justify that the US spends 2x the next country per capita on health care expenditure and still doesn't manage to pay for all its citizens.
I'm not exactly sure what you mean by this.
The US does spend a lot more, and doesn't cover everyone. If I understood the parent post, (part of what) it's saying that the US needs to focus on lowering costs, because otherwise, the fact that there is so much spending even now, is going to cause trouble. And more trouble than comparable countries, because the price in the US is so much higher.
I'm not sure if you're disagreeing with this, or what? Do you assume that if the US covered everyone, it would be cheaper? Would be great if you could clarify :)
> The US does spend a lot more, and doesn't cover everyone.
The US does spend a lot more, _because_ it doesn't cover everybody.
The use-value of private health care in the the US is:
- delta (getting treated, slow painful death and/or bankruptcy)
whereas most places it is more like:
- delta (private room in fancy building, non-private room in an oldish building)
If you were a salesman, and you sold the first product for less than 5x the price of the second, you would deserve to be sacked on the spot. How could a profit-seeking economic system be so inefficient that it would fail to extract a large portion of that value from the customer?
> he US needs to focus on lowering costs
Why would a profit-seeking system seek to lower costs when high costs led to higher prices that still get paid? Any CEO suggesting such a thing would be sacked by the board the same day.
Do the math; costs are about 3x what they should be, but 85% of the market still pays them. 3 * 0.85 > 1 * 1.0.
Sure, my bad, in re-reading I can see how this wasn't clear.
I meant along the lines of: I can't see how allowing medicare to negotiate drug prices, letting nurses do more of what doctors do and publishing prices gets the US medical system anywhere close to a 50% reduction in per capita spend, or gets the US any closer to covering 100% of the population. The US should do each of these. Each would make a difference.
What the country needs, though, is real reform.
And also, yes, socialized medicine is dramatically more efficient. Medicare's overhead is only 2% whereas that of private insurance is 18%. Just knocking that off the top would bring the US per capita expenditure much more in line with the OECD.
It wouldn't. Those are 3 examples, just to prove my point about how we seem to focus exclusively on how paying for the cost of care but seemingly don't bat an eye on bringing down the costs, where there seems to be a lot of room for improvement.
If the costs were not so high, paying for it for everyone would not be as difficult to implement.
Centralized systems are more efficient when they're smaller. The bigger a centralized system becomes, the more you need to spend on intermediary layers of bureaucracy that don't actually help achieve whatever goal it is you're going for (in this case, medical care).
The US has ~330 million people. The US has ~13 million undocumented immigrants. The US is the size of Europe. You're not going to magically get the efficiency of European countries 1/10 the size by having single-payer/universal health care.
Imagine trying to have a single health care system for all of Europe. It would not be nearly as efficient as you think it would be.
Does that mean we can't significantly bring down the cost of care in the US? No, we absolutely can. But a national system in the US is never going to be as efficient as any European country's national system. It's impossible to maintain the same level of efficiency when the scale increases exponentially.
Right, and states are free to enact single-payer/universal health care for their residents if they so wish. In fact, you might want to look at the Massachusetts health care system.
But implementation at a state level is obviously not what this thread is about.
For a US-wide health care system you need US-wide infrastructure/bureaucracy. This decreases efficiency.
I'm down with this -- this is how Canada's system is run. Each province provides insurance for its residents meeting the requirement to provide a socalized system as defined in the Canada Health Act. States should provide the socialized system, the federal government should mandate a public option exists (either single payer or two-tier) and the basic rules that govern one.
That completely goes against the idea of economies of scale. If smaller organizations were inherently more efficient, mom-and-pop stores would be beating Walmart and people running online stores out of their garage would be beating Amazon.
"Economies of scale" isn't a universal idea that you can apply to literally any industry/sector.
Unfortunately, medicine is not retail. Otherwise are lives would be a lot simpler. Would it be more efficient to introduce Amazon-like policies to medicine. For sure. But unlike Amazon fulfillment centres, you can't just close all the hospitals in a city and build a mega hospital 1 hour outside the city and expect anyone to go along with that.
Pretty much everything that can be "economically scaled" in the medical industry already has been -- the drugs you are receiving to treat X condition in NY and WA are probably going to be from the same company. The MR machines you use in TX are the same brand as the ones used in PA. This means those things are cheaper than they would be if they were being produced by "mom and pop" shops. Economies of scale are already in play. It's all about fixed vs. variable costs.
My point was about admin. When the scale of an organization goes up, the admin costs go up, not proportionally to the value that this admin provides. It's necessary if you want to get bigger, but not proportionally useful. With a national health system, the number of doctors you need will not go down. The number of imaging devices you need will not go down. But the amount of centralized bureaucracy you need WILL go up.
> Do you assume that if the US covered everyone, it would be cheaper? Would be great if you could clarify :)
Yes, that's exactly true. A lot of countries cover everyone, at a far lower cost per capita. Universal healthcare lowers costs. The evidence simply isn't on the side of the libertarian argument. Universal healthcare has been tried, in many, many countries, and it works just fine.
There isn't a single country you can point to, including and especially the United States, that has "free market" healthcare and gets better outcomes at lower cost than universal healthcare countries.
Universal healthcare doesn't necessarily lower costs - countries that have universal healthcare also tend to pay less for healthcare. Correlation does not equal causation, especially since the arrow arguably goes in the other direction here - in other words, the US would have universal health care if our costs were in line with other first world countries. If that second possibility is the case, implementing universal healthcare in the US might be ruinously expensive...
As for better outcomes, I think that depends on how you define "better" - if I'm remembering correctly the US is still at the top for "healthcare outcomes of the rich and powerful". That's a different criteria, and probably the one most important to the people with the ability to cause change - namely, the rich and powerful!
> Wasn't there a writeup recently that wealth distribution isn't materially distinguishable from luck?
Some researchers in Italy created a computer model of human talent and ran a simulation. Not sure you can model talent, but more importantly that argument means no one is really successful, just lucky. Steve Jobs: no talent. Jeff Bezos: no talent. Barack Obama: no talent. All just luck.
> If someone is too poor to get their horrifyingly contagious disease treated until its too late and it spreads to you, you're still sick, and you may still die, cover or no cover
Again, I'm not wealthy, so these taxes would not affect me. But I'm not sure you're correctly modeling transmission vectors for communicable diseases.
> If you believe in the value of a college education, then you believe it will increase the productivity of that individual...This in turn benefits the wealthy who likely hold equities
You're saying rich people should pay really high taxes because poor people getting an education will cause the stock market to go up? Uh...not sure that's how it works.
I believe everyone who wants one should have access to a college education. But just declaring it 'free' and raising taxes on one group doesn't seem like a sustainable strategy.
> Steve Jobs: no talent. Bezos: no talent. Obama: no talent.
I'm definitely not saying that. What I am saying is that their talent had to be coupled with an immense amount of luck, being in the right place at the right time, and things falling in line just right for them.
> Again, I'm not wealthy, so these taxes would not affect me. But I'm not sure you're correctly modeling transmission vectors for communicable diseases.
They would absolutely affect you -- you'd get medical care. It's also not fair to say you don't pay taxes even if your marginal tax rate is 0% as your employer pays ~15% of your salary on top in payroll taxes, and your employer could also be taxed to provide healthcare as some countries do. Even San Francisco follows such a model with Healthy SF.
> You're saying rich people should pay really high taxes because poor people getting an education will cause the stock market to go up? Uh...not sure that's how it works.
A quick google search yielded all sorts of great reading material on how that could work [1], [2] and [3].
Of course correlation is not causation and if you reject that data, the reality is you participate in a society -- would you rather your peers be uneducated or educated? Healthy or sick? Terrible roads or good roads? Drinkable water? On fire? Ultimately those of the highest means have the highest responsibility to that society to give back.
Obviously, I'd like everyone to be healthy and with an affordable education. But our universe is finite and someone has to pay for these services. Just blindly assuming we can tax all wealthy people into total equality seems like a pipe dream to me.
Hence, I'm arguing that instead of just blind wealth transfers from one group to the collective we should focus a lot more energy on bringing the cost of care down.
Just like we should be focusing a lot more energy on bringing the cost of college down.
I don't think we should tax the wealthy into equality, I believe in income and wealth inequality -- its the incentive and reward structure an economy should have. However, it's only moral and right when coupled with a meaningful quality of life for the lowest end, and only when coupled with social mobility. Socialized medicine and the safety net allows for risk taking, allows the poor to build businesses without the fear of death in the event of failure.
Cost of care goes down when you stop wasting money on advertisement, CEO bonuses, and people whose job it is to deny claims. Cost of care goes down when you provide preventative care that's necessary and affordable. When you dont have people without insurance wandering into the ER at the last possible second who could have been treated for pennies on the dollar earlier on. All the data we have on Medicare backs this up, even though its an awful example for reasons I cited above.
Further if you claim that we can't afford to cover everyone, you're going to need to back up your claims because every other country in the OECD would disagree with you.
tl;dr: Income/wealth inequality is a good incentive, when the poor don't die, starve and can live well, and have the opportunity to move up. Socialized medicine enables this.
Just want to point out that part of the reason for larger healthcare spending per capita is probably that healthcare spending is mostly for services and US GDP per capita is 1.5x most other developed countries (excluding small countries whose economy is majority natural resource extraction). In other words, incomes are higher in the US, so health care is automatically more expensive.
You make lots of bad assumptions. But if you are going to get all nihilist about it, go all in. Your wealth is predicated on the government that ensures it’s value. Nothing you “own”, including money, is “yours” except by virtue of the laws and under threat of force from whatever relevant powers exist in your locality be they corporate, military, or organized crime. You benefit greatly from the “power transfer” that enables you to keep your wealth. So your assertion that “wealth transfer”—if that’s the petty way you need to think about it—is fundamentally immoral is exceedingly hollow when it’s predicated on the same government that transfers power to you on a regular basis.
My wealth? Didn't I just say above I'm not wealthy?
Just because the state provides benefits (self-defense, rule of law, etc) doesn't preclude you from ownership rights, not really following your argument there.
Taxing one group and providing the benefits to another is a wealth transfer, however unappealing the idea sounds to you.
How is not favoring selective taxation "nihilist"? If I were a nihilist I'd believe in nothing and favor no taxes at all.
You're passionate, I get it, I want sick people taken care of too, but I don't really see how your arguments add up.
>Just because the state provides benefits (self-defense, rule of law, etc) doesn't preclude you from ownership rights, not really following your argument there.
Its a fundamental different view of reality and especially society. We are animals, we have no rights and not duties. We do what we want. Things like ownership are derived not from some concept of rights, but from power. We combine our power through government, and in doing so grant the ability to own things. Theft is wrong, not for a moral reason, but because we decided to punish those who steal.
This view doesn't completely reject the notion of rights and duties, because we can still use the concept of such to determine how we run our combinations of power. But it does do away with the assumption they inherently exist. It becomes something of a more philosophical question, much like asking does math exist outside of humanity (or any other intelligence that is able to understand the concept of math).
> Universal health care is a euphemism for the poor and sick getting their medical care subsidized by the wealthy and healthy.
You might have a point if the US system didn't cost taxpayers more for worse care. The US government pays more per capita for health care than other systems, but doesn't provide universal coverage.
I'm from a country that has public health and free college education (Finland).
I much prefer paying bit more in taxes than having to have a bad conscience knowing that a lot of the people living in my country would not have the same options as myself.
I'm not exceedingly wealthy but I make more than the statistical average employee.
You're missing the entire thesis of the article. The thesis is that Finland (et al)'s education and healthcare systems are more efficient because they are socialized. Given one binary comparison between condition A and condition B (Finland vs. US), some causal speculation is justified. Given dozens of such comparisons, all coming out to the same result, your case becomes anti-empirical.
soru's comment on this thread provides one nice rational model that tries to explain why. But the much more important point is that our rationalizations are slaves to the empirical data. Not the other way around.
> Given dozens of such comparisons, all coming out to the same result, your case becomes anti-empirical.
As others in this thread have pointed out, Finland vs. US is not a good comparison, Europe vs the US would be. We can socialize medicine in individual states with good results (see: MA) but US-wide? With 332+ million people? With all the differences in costs of living in different parts of the country?
When the EU rolls out a single-payer system for the entire Eurozone then we'll have something to compare against but the entire nation of Finland has less people (5.7 million) than New York City (8 million) and is a monoculture, to boot.
Given that the mishmash of european systems has much wider variance probably than US internal schemes do, I find the argument 'but US is too" complex not entirely convincing.
Given how much of the current scientific and technological context of our civilization comes from the US, and there are lot of single payer schemes working in other countries, I would find the "we don't want to" argument more convincing than "it's too complex for us".
Anyway, I don't know the nuts and bolts of any of the health care systems but generally when political will manifests itself people are capable of all sorts of things if they are within the realm of the laws of physics.
It's not like health care was rocket science. The best bang for buck comes from providing just the cheapest things modern medicine has come with within the reach of all. It's not surgeries and MRI machines and all that capital intensive stuff. A nurse with a basic kit could achieve all sorts of improved health outcomes in his/her patients.
Everytime I see a dicussion of socialized healthcare in the US I remember Firefighters and chuckle. Historically speaking, a couple of years ago, Firefighting in parts of the US was a private enterprise, that meant that, if you did not pay for your firefighting insurance, and your house caught a fire, firefigthers who were there to put down your neighbours fire would let your house burn to the ground.
In one hundred years, society will be laughing at the current system that let's people die, or ruin their life financially because they got Crohns disease and aren't able to pay them or to be attended because they don't have the means to.
It is just that some societies are not as mature as others.
Do you think this is related to Finland being much, much, much more homogeneous demographically than the US?
I was going to say "ethnically homogeneous", but that isn't even the core of the issue. The US has populations with vastly divergent cultural backgrounds and outlooks (there's even a few types of white people); it's harder to argue that Hassidim in NYC should care for Crips in outer LA.
Uh, I have no idea when the concept of perceived fairness brakes down. But that's not the point in the end. Universal services like school and healthcare make sense because they improve the quality of life for everyone.
I suppose the core issue is that there is trust that the public funds are used in proper way.
I don't understand the 'US is too large to X' arguments. I thought the states are sufficiently independent to handle most things distinctively from the federal level. But I don't know enough of how US works to discuss this beyond it looks odd. Couldn't e.g Oregon implement something, and if it works, then other states could just copy the model. From the outside the concept of distinct state level governments sound like they could provide great platform for innovation and experimentation. But maybe they are bogged down in federal legislation and partisan politics?
As a healthy wealthy individual, more than happy to pay for sick people that cannot afford healthcare to become healthy. It is in my direct interest to have as little sick people as possible in the country where I live.
In the US we pay more for less. Our system is nonsensical. Whether it's tax or premiums, doesn't matter, the overall cost is crazy, the system is unfair, and the final quality is low. Just look at life expectancy.
Then do it. Literally no one is stopping you. If every rich person who expressed this sentiment would kick in some real money it might make a difference.
> Universal health care is a euphemism for the poor and sick getting their medical care subsidized by the wealthy and healthy.
Is it? I would have thought it is the commonwealth looking after the people that make it! Surely for countries with large sovereign wealth funds (especially those derived from the country's natural wealth), it makes sense to care for the people for which it is meant to provide!
The whole redistribution lens is a very specific way of looking at things.
In countries with "universal healthcare", there is a big incentive from the organization paying the costs of exams to emphasis preventive care because ultimately, they won't run a deficit every year.
And usually, it has a big bargaining power because its decide if if will reimburse the medicine or not.
Similarly, there is a big incentive to reduce tobacco, alcohol consumption and obesity, because it has a big cost shared by everyone paying to the common fund.
So I would say that universal health care has the same incentive to reduce the overall cost, that a multi payer system.
> In countries with "universal healthcare", there is a big incentive from the organization paying the costs of exams to emphasis preventive care because ultimately, they won't run a deficit every year.
Does medicare do that? They stand to profit the most out of preventative care.
There isn't really. In this case, the organization paying the cost has the power to confiscate whatever it needs from the citizens to fund its expenses. They are not operating with the financial motivational pressures of a business or even a non-profit organization.
All of government is a big cost shared by everyone paying into the common fund. That doesn't seem to have created any incentive at all to control spending. Quite the opposite in fact.
>Universal health care is a euphemism for the poor and sick getting their medical care subsidized by the wealthy and healthy.
Have you ever worked in the US healthcare system? I worked for a medical diagnostics lab and spent a couple weeks in our billing department shadowing them at one point, we were writing off a minimum of 100k/day (and that is a very conservative estimate based on the 1 billing person I shadowed) in services for indigent patients.
So the US healthcare model as it stands is a euphemism for the wealthy and healthy subsidizing the poor and sick in an insanely inefficient way.
> So the US healthcare model as it stands is a euphemism for the wealthy and healthy subsidizing the poor and sick in an insanely inefficient way.
Don't really understand this line. The US model itself is a euphemism? What?
I have no doubt that indigent patients get a break from a lot of facilities, but my question would be: why are those services so expensive in the first place? Why is it totally impossible for a person making a reasonable income to pay for a service like healthcare by themselves? You seem to be assuming the costs for your lab are totally normal and legit and wow, isn't it amazing the breaks we give people, but maybe your lab could be charging a lot less than it is for its services?
I don't know obviously, you work there, I don't, I'm just pointing out the underlying issue.
> Universal health care is a euphemism for the poor and sick getting their medical care subsidized by the wealthy and healthy.
Correct me if I'm wrong, but the wealthy and healthy (who have health insurance) are already paying for the poor and sick, aren't they? Hospitals can't deny care to the poor and sick, so they inflate the costs of the wealthy insured to compensate for the poor's ER visits.
Universal health care would mean moving more ER visits to a primary care physician in a clinic, effectively _reducing_ the overall burden that the healthy and wealthy pay.
Insurance is inherently about distributed costs. That's the whole point. People who don't suffer whatever event they're insured for end up paying for those who do.
Exactly. It's also not a tax mandated by the state, which is the key difference between insurance and universal health care.
If America wants to introduce UHC, great, but let's be honest about what it is, and let's understand it's going to be prohibitively expensive unless we bring costs down first.
Would you make the same argument against universal education? Spending on healthcare is not zero-sum, the linked article argues that there is good evidence that universal healthcare increases GDP, benefitting the entire economy.
"Economists at the World Bank used to call spending on health a “social overhead”, but now they believe that it speeds up growth, says Timothy Evans, one of its senior directors."
Where in my comment did I write the government should provide no financial benefits for its citizens?
No idea where you're coming from with that.
The question is: should the government pay for everyone's healthcare? Universal health care sounds amazing except no one has a plan to pay for it, at least in the U.S. where our system is outrageously expensive.
If your plan is just to tax a small group of earners to pay these astronomical fees, good luck with that.
More realistically we have to bring the costs of healthcare down, but that seems to get little to no attention.
> More realistically we have to bring the costs of healthcare down
Given that places where government pays for everyone's healthcare, in the developed world, get compsrsvle outcomes at much lower per capita and per GDP cost than the US system, I don't see that an idea opposed to universal healthcare so much as a motivation for it.
You're assuming they have much lower costs because of socialized medicine -- that's not necessarily the case.
But my broader point is just that universal health care is not an honest description of what it is, and our costs are so great we're unlikely to ever implement such a wealth transfer.
It's a lot less pie-in-the-sky IMHO to focus on bringing costs down. UHC could help in some ways but it's a broad assumption to make that if say Medicare paid for everything prices would just automatically start to drop.
I've seen people take this view, and their view crumble as soon as they get a life-threatening condition and receive (mostly) free healthcare (in Australia). If I'd been born in the US, I'd be dead by now.
When the issue of universal health care comes up with regards to US policy I often see those emotional arguments pulling on the heart strings. Unfortunately, this is a distraction.
I know this sounds cold, but it comes down to money. Healthcare in America is expensive. The problems appear to be commonly identified by various forms of research and including things like pricing inefficiencies of drugs, malpractice insurance, and administrative inefficiencies.
The problem isn't as simple as blaming medical insurance providers, pricing, or fees. The problems appeared be directly associated to the processes in place, or in the case of drug prices missing pricing regulation. Drug pricing regulation does exist for the VA which has a set pricing schedule, but everybody else gets to pay more.
In order for universal healthcare to come into fruition in the US these cost inefficiencies have to be addressed. If universal healthcare is important for you then these financial and administrative problems are what you should solve for.
I don't think emotional arguments are a distraction, they're the whole point. This is a moral issue. Other countries manage to have universal healthcare and it doesn't break the bank. In fact, they spend less per person. The fiscal argument is the distraction.
Disingenuous? You think people arguing that it's immoral for someone to die because they were born poor are not actually sincere in their argument? Tell me, what is my evil ulterior motive? Do I actually just want to increase taxes for the hell of it?
Of course its not a sincere argument: I believe that you can believe it, but its insincere at least to yourself to say that the reason healthcare should be universally provided through government is for the poor. If you cared for the poor the argument is to make food stamps for healthcare services, not universal. Universal is also for yourself. So yes, it is disingenuous to say that which is best for your is also best for the poor.
Reminds me to the typical argument that college should be free so poor people can go, but ultimately, middle class and up go. Healthcare is similar: the richer live longer, which means they live more of the most expensive healthcare years.
It's like garbage collection, it's just something the government provides as a service to all citizens.
Whether it's regressive or progressive entirely depends on the tax used to pay for it. If everyone has to pay exactly the same, it's regressive, as poor people are impacted much more than rich people. If it's a proportion of income, it's progressive.
In the UK our national insurance, which pays for our universal healthcare, social welfare and pensions, is actually a regressive tax, it's 12% on the first £46k you earn, then 2% after that (something like your first £6k is actually tax free). I don't know why people don't make a bigger deal out of this given that the NHS is suffering at the moment.
> In the UK our national insurance, which pays for our universal healthcare, social welfare and pensions, is actually a regressive tax, it's 12% on the first £46k you earn, then 2% after that (something like your first £6k is actually tax free). I don't know why people don't make a bigger deal out of this given that the NHS is suffering at the moment.
Are you arguing that NHS is not a benefit to the poor? Because its a regressive tax? So eliminating NHS is actually in benefit of the poorer classes.
No, I replied and rapidly edited out a few words of my original reply to try and make it clearer, but seem to have done the opposite. The last sentence initially started with "Interestingly". My original meaning of the last paragraph was "here is an interesting, related, factoid. The UK happens to have a regressive tax to pay for the NHS".
My main point is that governments are free to provide the same service to rich and poor without that being regressive or disproportionately favouring the rich. For example, bin collection, policing, national defence, fire safety, etc.
A universal health service can simply be another collective service. If you want more because you're rich, in the UK we also have private healthcare services you can pay for, much like you can pay for a cleaner in addition to your bin collections or a body guard in addition to the police or national defence or pay to install fire suppression in addition to the national fire service.
What makes it regressive or not is how it is taxed for.
> "Nobody should go hungry, so everyone should be able to eat anywhere they want and not look at the tab".
This is a violation of the most oft-ignored HN guideline: "Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize."
What the moral argument side is saying is that it is immoral for a country this rich to not provide socialized healthcare up to a certain level. What level, specifically? I don't know. I'm guessing it would probably include a diabetic's insulin, and would not include a smoker's lung transplant. The point is, (according to the argument you're disagreeing with) there is a level and it should be higher than it is now.
What you did with your straw-man quote - "everyone should be able to eat anywhere they want and not look at the tab" is set the level at infinity, so that the argument is trivially wrong and easy to defeat. You've done the same elsewhere: "The logical consequence of this is that any cost must be paid" and "If its rationed then some people are going to be left out, and the moral argument crumbles, as people that need it don't get it." This doesn't get us anywhere.
Try, before responding to an argument, paraphrasing it such that the person who you're arguing with would agree. If you can't do that - if you can't restate their position in a way that they would say, "Yeah, that is indeed my position" - then you don't understand it well enough to argue against it.
Lets do that excercise "It is immoral for wealth to exist in a way that, properly distributed, would solve the fundamental necessities of people. Thus, wealth should be confiscated until this goal is achieved for morality"
And I answer "the very application of that goal will be immoral because it will take from all and give to all, and will do so unevenly on both ends while also destroy a part of everything levied."
> "It is immoral for wealth to exist in a way that, properly distributed, would solve the fundamental necessities of people. Thus, wealth should be confiscated until this goal is achieved for morality"
I don't believe anyone in this thread would say, "Yes, that is what I was arguing." I don't believe you do either. Stop trying to jujitsu random passersby in to discussing your preferred topic with you and the downvotes will abate.
"It is morally wrong that someone can die from X because they're poor" is a fine point to make. There's nothing wrong with moralizing in that sense, IMHO.
The problem is when you add "And therefore the presence of profit making entities must be the cause". That inserts a moral argument as a substitute for identifying the core problem. I think that's the kind of error you're making here:
>Other countries manage to have universal healthcare and it doesn't break the bank. In fact, they spend less per person.
True, but there are differences other than the universal coverage. The same things that lead, in the US, to bureaucratic bloat and 700% markups on saline, may very well also torpedo those systems!
I think it's a reasonable point for the parent to criticize the kind of moralizing that doesn't attempt a legitimate root cause of why health care spending is so ineffective in the US.
However there is a trust issue here, how can Americans truly trust their government to implement it right when the same government cannot get the VA right and worse there seems to be active opposition within the VA and government to right it?
Throw in the BIS run systems which make the VA look good and its a very hard sale.
A lot of the cost of medical care is because there are too many limits on competition for both services and insurance. It certainly needs reform but to get the trust of the people it must prove it can run what it has
Healthcare is expensive because of the three-way symbiosis between insurance companies, drug companies and regulation that is designed to only take care of the aforementioned.
We _ALREADY_ spend more than enough on healthcare as a nation to fully fund healthcare for everybody. It's just that, unlike in other countries, our current system routes that spending to various for profit entities that don't involve actually providing care.
tldr; Lack of funding is not a legitimate argument against providing healthcare to Americans.
Doesn't that suggest health care in America is too expensive? Increasing funding to an inefficient system doesn't sound like a sustainable or extensible solution.
You will also find other governments with public healthcare make a complete mess of itself.
What makes health care expensive in the US is not public vs private, its the regulatory framework on everything. On drugs, on hospitals, on insurance, on doctors, on malpractice, etc.
While true, in healthcare, a lot of the incentives that for-profit entities experience are put in place by the government. For example, a lot of the economics around pharma are driven by patent laws.
But that also means that if you could fix the cost bloat, it would be much easier to provide universal coverage, and that trying to do the latter before addressing the former is bound to fail.
Costs are high for many reasons, but having for profit companies whose own overheads far exceed those of public options (such as Medicare) are the the most obvious contributor.
If private insurace cost as much as medicare you wouldnt still have rising cost of healthcare. Medicare has less admin cost but also they pay the least to providers.
I would not adovcate for public health in the us before the government fixes medicare.
The point I usually see is that the US government healthcare spending per capita is comparable that of other developed countries with universal healthcare.
Seems like you have the cart before the horse. Universal health care would be a way to address those inefficiencies and solve those financial and administrative problems.
Does the healthcare marketplace of every civilized country of the world outside of the United States not count as research or an experiment in real life consequences?
No, I don't think these alternate examples are relevant. I suspect, and this is not my field of expertise, the largest differentiator is history. The US has been developing its health care system, uninterrupted, longer than other nations.
It is much easier, politically, to build a great system if you start from scratch and have excellent examples at hand of what not to do as compared to modifying a deeply entrenched system in current operation.
> The US has been developing its health care system, uninterrupted, longer than other nations.
The NHS is 70 years old, and it partly exists because Welsh coal miners set up cooperative insurance schemes. These worker's medical aid societies started in the early 19th century.
>The US has been developing its health care system, uninterrupted, longer than other nations.
Can you describe this vis-a-vis England or France? I am confused as to how you think the US has been at healthcare longer or how an interruption occurs.
France was conquered roughly 70 years ago. England was not conquered, but I suspect WW2 had a near significant impact upon domestic government operation. According to Wikipedia the US health system has roots that go back much further without noticeable disruption: https://en.wikipedia.org/wiki/Health_insurance_in_the_United...
Other countries’ socialized systems didn’t just pop into existence fully formed. I’m pretty sure the health care industry in other countries is about as old as ours.
That's true but have an example in the US, universal healthcare is provided by the US government, if you are over 65, it's called Medicare for people who have paid into the system while under 65 and a few others. People over 65 are free to buy insurance and pay for their own healthcare, thanks to ACA.
"The US has been developing its health care system, uninterrupted, longer than other nations." I don't understand this. How do you define Health care system? because we have care institutions that predates the foundation of the USA.
I've always wondered to what extent the high cost of health care in the US is subsidizing universal health care in other countries. If it actually costs millions of dollars to create and test a single medication, but that medication is cheap in other countries and expensive in the US, universal health care in the US may drive up the actual cost everywhere else.
Economically speaking I am ok with that. Easier access to a product universally will lower its cost per consumption on average even if that average is a price spike for certain locales. This is a way of saying the outcome benefitting the most people isn't necessarily universally beneficial.
Universal healthcare is not a silver bullet, in certain Eastern European Countries we pay a large amount of our salary in taxes so that we have universal healthcare and yet you still have to give "gifts" to every nurse and doctor that treats you unless you want the bare minimum treatment and care. Doctors can also intentionally botch surgeries if you fail to pay up. Not so much that it can be called malpraxis though.
We've managed to exactly formalize this system, and yet somehow it's viewed as less bad because it's an industry. America has managed to legitimize corruption.
Universal health care doesn't require government coercion. Many more people in the US would have access to health care, including insurance for catastrophic events, if the state and federal governments stopped interfering in the supply side. The same groups that use force to prevent new hospitals being built, restrict the number of doctors, prevent nurses and nurse practitioners from treating many problems they're more than qualified to address, and disallow insurance being sold across state lines say that the solution to the problems they created is more government. It's almost like they have an ulterior motive.
Big government programs raise taxes and decrease liberty. To quote Penn Jillette, "Why not err on the side of a little more freedom?"
Many people would also lose access to health care. Remember when a pre-existing condition meant you were fucked for life? It wasn’t that long ago.
Fully privatized, deregulated systems can work out great for people who are lucky enough to avoid financial hardships, bad planning, or being born into bad circumstances. I’d rather not just screw everybody else.
You're operating under the assumption that insurance companies would continue acting as they do now, even if there is much more competition.
Insurance companies shouldn't want to deny you coverage just because you have a pre-existing condition. They most likely would just charge you more, because you're at a higher risk of costing them money.
Of course they’ll just charge you more. That’s how it was before, too. But when the premiums are so high that you can’t possibly pay them, there’s no real difference between that and being denied.
Wow good points. I’m sure those tens of thousands of people a year who die due to lack of health insurance are so glad nobody got coerced into helping them out. What a useful definition of liberty, that allows the richest country on earth & in history to deny its citizens preventative care so that they end up dying of easily preventable diseases. We have the liberty to beg on GoFundMe! Health insurance companies have the liberty to insert themselves as middlemen to suck up profits for pushing cash around and denying care!
To not quote a fucking TV magician, “Why not err on the side of every first world nation except us?”.
You should consider refuting his argument instead of countering with a rant.
>Many more people in the US would have access to health care, including insurance for catastrophic events, if the state and federal governments stopped interfering in the supply side.
I really don’t care about how to slightly tweak our current unjust system to make it slightly less bad. The fact that it’s unjust (hence why I’m calling out his moral arguments) makes any details a irrelevant. Like asking “How could the trains to Auschwitz have been more efficient - why won’t you debate me on this?” (Sorry for Godwin’s law-ing)
There are alternatives that are picking up support, like Medicare for all, that are worth more time and energy discussing.
Penn Jillette also believes global warming is a conspiracy. No nation with free market health insurance has universal healthcare, so as the person making an extraordinary claim, it's on you to come up with proof.
Well, he spouts whatever makes a youtube video gets hits. Without research or background. He is an entertainer after all. What he actually believes is probably unknown.
That's a fairer criticism, although I disagree. You could say "what he actually believes is unknown" about anyone, really. He makes his views quite well known, at least from what I've followed him.
Still, I think replying to someone's quoting Penn with the equivalent of "well he denies climate change, so why would we listen to him?" is pretty pointless for a debate, especially when what you say is wrong! We might as well throw out the ability to quote anyone, since basically everyone has some view that someone disagrees with.
Ok maybe he's saying what he thinks when he posts those rant videos on whatever subject. But in them he appears shallow and sophomoric. I think he's smarter than that, so I disbelieve they really reflect his opinions.
Just going to throw this out there. Non universal health care is analogous to half the roads in a city being toll roads. Society can still function and you can mostly get to where you're going but it's not close to efficient.
Why are toll roads not close to efficient? In my state the toll roads are by far the nicest best maintained roads and the tolls are extremely reasonable and collected without having to slow down or stop at a booth.
Who collects the tolls? Is it a private company or a government body with motive different than maximum profit?
For example in Poland we got the most expensive toll motorways in Europe because a private company owns them and continues to demands exorbitant prices for passage with nobody to stop it.
> Who collects the tolls? Is it a private company or a government body with motive different than maximum profit?
Private company with motive different than maximum profit. Motive: not to get subsumed and punished by the government allowing them to do this...then second motive is maximum profit. That primary motive one is an important one in all of these non-competitive industries, and can't even have a private vs public discussion without including it. Otherwise, it's just corruption/apathy and it's a different problem.
They work for highway, bridges etc. I think OP was suggesting something like every road in a city being a toll road, with a different toll per road. How much infrastructure would be needed to make this drivable, get the different road owners their money, make sure that each road owner is maintaining it.
Better to have these huge number of interconnected roads maintained by one group responsible for them.
Imagine your city is a grid...N/S streets are numbered, E/W streets are lettered.
Toll roads wouldn't be efficient if 5th-18th ave are toll roads (operated by multiple companies/agencies) and then Fst-Hst and Ost-Xst were also toll roads. You'd never be able to get across the city.
Except if you have interoperability laws in effect (like in Switzerland you can take a bus, a boat, or a train with the same ticket, yet they are different companies).
Interestingly I live in a country (Japan) where all the highways are privatized and made into toll roads. Driving 3 hours to the next big city over costs nearly as much in gas+tolls as taking the high-speed rail (which takes half the time). To me for transport making costs transparent actually makes things more efficient.
Also in Japan here. Healthcare definitely has issues here but overall positive for the entire nation. I was at first shocked by tolled highways everywhere but id you think about it it’s actually a brilliant move to encourage more rail transport which works out for everyone.
This isn't a great analogy. Many anti-sprawl urban planners actually say this is exactly what we should be doing to encourage more efficient (denser, more urban) development.
2. I can get an MRI in the USA within 3-5 days (sometimes next day), virtually anywhere in the country.
Canada (universal health care) wait times to receive MRI(self-reported by the government): over 90 days in some cases. In the richest and most populous province of Ontario, only 41% of patients got scanned within the targeted time: http://www.hqontario.ca/System-Performance/Wait-Times-for-Di... (you might have to select Adult MRI instead of the default Adult CT)
If you were diagnosed with a possible brain tumor/cancer requiring an MRI to confirm, would the 50 to 90-day difference in MRI and diagnosis result in a measurable difference in outcome, if you did in fact have a tumor?
> 2. I can get an MRI in the USA within 3-5 days (sometimes next day), virtually anywhere in the country.
AFAIK you can do that anywhere in Europe as well, provided that you pay out of pocket, or that you have purchased extra coverage to do that -- the cost of which is usually a fraction of similar coverage in the US.
(Also AFAIK, you weren't able to pay out of pocket in Canada for that 20 years ago - I don't know if that has changed).
> If you were diagnosed with a possible brain tumor/cancer requiring an MRI to confirm, would the 50 to 90-day difference in MRI and diagnosis result in a measurable difference in outcome, if you did in fact have a tumor?
The 50-90 days number quoted is, AFAIK, related to non-urgent things. I know two people who got it within 24 hours when there was suspicion of a tumor.
> 2. I can get an MRI in the USA within 3-5 days (sometimes next day), virtually anywhere in the country.
You can get that in Germany as well and don't even have to pay anything for it. And I'm speaking out of experience because my girlfriend was diagnosed with a brain tumor: If you have sudden symptoms (like a seizure in her case) or a threating disease you basically get all appointments within 2-3 days.
So far her total co-payment for 18 months of treatment, 3 hospital stays with surgeries, about 10 MRIs, radiation and chemo therapy and daily medicacion is about $300.
And since she can't work at the moment because of her illness she gets a monthly payment ("Krankengeld") by the public health insurance which is about 90% of her last after-tax salary and lasts for 78 weeks. Since you already have to worry enough about your illness you shouldn't have to worry about money as well.
> If you were diagnosed with a possible brain tumor/cancer requiring an MRI to confirm, would the 50 to 90-day difference in MRI and diagnosis result in a measurable difference in outcome, if you did in fact have a tumor?
I would assume in a case like this that they'd move you to the front of the MRI line.
When I had an abdominal CT scan in the USA, I paid cash for it. $262 on my VISA card, paid at time of service.
If I'd had insurance with 90% paid, I would have ended up paying about 10% of $2K, because that is the "retail" price and a typical policy at that time covered 80-90% of the "costs". Plus I would have had to pay into the insurance scam for several months to have had coverage.
I'm not really sure that you know what you are talking about...
No, 41% of patients of Ontario who needed an MRI, which is a small subset of the population. Meanwhile in 2016 you had 28 million Americans under 65, that's 10.4% uninsured [0]. I'm sure 10% less people would cut the waiting lines in Ontario a bit.
So yeah, fuck those 28 million, they're not rich, let them suffer if they get ill!
OK. An ER is a very expensive facility. It is fitted out with staff and equipment to handle almost any conceivable trauma or life-threating condition. That all amortizes into a baseline cost-per-patient. If you go there for something that requires just an ice pack, you are wasting a very expensive resource.
It's like calling for a helicopter to take you across town and wondering why it isn't as cheap as a taxi.
Maybe part of the problem is the mindset "banged my head on a table, time for the ER"
???
If you're young and healthy and you lightly bang your head on a table, you don't need the ER! It sounds like she wasn't even concussed! Sure, get checked out by a doctor, but this isn't a life or death situation, so don't clog up ER triage with your BS.
That's like breaking your toe and calling an ambulance.
Maybe. But possible one in a hundred times, the "banged head on table" could lead to complications. I'm familiar with such a case.
Somehow, everywhere in the developed world except the US, people can go to the ER-or-equivalent (many places have 24-hour clinics/triage centers that would send you to an ER only if needed) after they've banged their heads, and 99% of the time be told "go home, it's fine" without being bankrupt. I would say the problem is with how the US healthcare system is run.
People go to "ER-or-equivalent".
Immediately mentions a place that is not the same as ER that the US also has (clinics).
As I said -- she was wrong to go to the ER. She lives in NJ. I know for a fact there are loads of clinics she could've gone to and been sent home with a clean bill of health for $50 copay.
I left NYC 5 years ago. But at the time I was living there, there was essentially no option other than an ER after 3pm (and very few before).
And my point is that the European system does not require you to make decisions in such a case. You just go and get checked without going bankrupt.
Where I live now I have 3 hospitals within 20 minute drive, one of which is walking distance, and 20 triage/clinic locations. I can go to any; I prefer the triage because they are quicker and nicer.
Yes, you are correct -- with a socialized system, you don't need to worry about "triaging yourself". But that is not a good thing. You don't want patients to mis-utilise the services available to them, just because they are free and therefore they don't need to worry about the associated costs.
Ambulances / ERs / MRI / etc -- these things are EXPENSIVE to operate. It's too bad, but it's the truth. Just because you can use them in the UK or wherever doesn't mean you should, and there is nothing to disincentivise people from this because they're not footing the bill (directly, that is). I literally wrote my undergraduate dissertation on various ways the cost of MRI could be brought down, and it's not an easy problem, regardless of who is paying for it. Getting medical care that you don't need is no small thing in the scheme of things.
At the time I lived in NYC (2007-2013), Me and family had needed urgent care services 3 times. In all three times, we called insurer (Aetna once, United twice), and they told us to go to ER because there is no better option.
Things may be different now, last time I visited manhattan a few months ago indeed there were several walk-in clinics between 8th street and 23th that weren't there 5 years ago, but (at least from the sign on the window), not all accepted all insurances, and none had a chargemaster listed outside, which means there's a nontrivial possibility one would go bankrupt going into them.
> Just because you can use them in the UK or wherever doesn't mean you should, and there is nothing to disincentivise people from this because they're not footing the bill (directly, that is).
That's true. And if people did misuse them significantly, I'm sure the (dis)incentive structure would be put in place. But it turns out that most people in the UK and EU and other places are not jerks, and do not call an ambulance needlessly.
It is a mathematical certainty that there is always a false-positive / false-negative tradeoff; The US system (and your recommendation) prefers false negatives, the EU system and other single payer systems prefer false positives. And .. what do you know? Bang for buck, single payer systems triumph greatly, have lower infant death, and higher life expectancy.
There are lots of problems you can avoid when you are able to regularly get a checkup from your doctor.
Also not everything is only a cold and having someone who can check early for complications might save a lot of lives or prevent people from far worse conditions.
Last but not least: Access to mental health services like cognitive behavior therapy that replace or supplement only eating pills might help a lot of folks with addiction and raises productivity.
We found that insurance led to increased access to and utilization of health care, substantial improvements in mental health, and reductions in financial strain, but we did not observe reductions in measured blood-pressure, cholesterol, or glycated hemoglobin levels.
> This is a nice sentiment, but would you quantitatively argue that this is a good investment?
Yes. You learn about your behavior, the reasons you act like you do and learn tools to avoid the traps in the future.
Effectiveness might depend on the problem but this is probably studied - it's a powerful toolbox to combat problems and most countries use it successfully to replace the initial medication for issues like depression.
I've lived in countries that have socialized medicine and ones without and my experience was dramatically different. I was always taught that socialized medicine was better. However I never got half decent care until I bought private health insurance.
My whole life I've been on government healthcare plans, across various countries. Imagine my shock when the first time I called my private health insurance provider at 34, it worked well. They chose the clinic I would go to, when I arrived to my appointment I was immediately ushered in to meet a physician. The physician was able to diagnose many problems within a couple of minutes, and I was asked to call my insurance company back so they could approve a series of tests and treatments.
I waited half an hour for approval and I then immediately saw two different doctors and had an x-ray all before leaving the building.
The clinic is interested in actually treating me and giving me the best care possible so that I don't come back. This ensures they get repeat business from my insurance company. Socialized medicine never gave me that kind of care or expediency in my life. The problems were all fixed.
One of the problems I've had for 10 years. Doctors were never able to diagnose it properly or it was "come back in 2 weeks, try this medicine, try that, etc." They were not interested in treating me they were interested in seeing me again and again because they were getting paid by the state.
I'm sure there are anecdotes to the contrary but I am completely sold on private healthcare. It's also fantastically cheaper. In Germany for example I was paying 800/month for healthcare, half "paid by my employer", which would really be my money. My current private healthcare costs about 380/year.
Diagnosed immediately, immediate care. I can buy as much or as little as I want and don't have to subsidize others. I'm encouraged to stay in shape and healthy.
You will quickly find the limits of private healthcare once a surgery or advanced treatment is necessary. Usually that it is not covered in your plan. Heck, even relatively simple specialist interventions will go beyond coverage.
In many countries they are great at routine care, no doubt, as they're just not overcrowded and that is the main reason for problems in public systems.
If you shift all the crowd there... well... they degrade much quicker and worse than public.
So, apples to apples. Fully public vs fully private systems.
You could say compare German system with US system which are almost completely mirror images except German one is many times cheaper.
Not true. For the small amount I am paying I am covered for one major surgery in a hospital per year. Hopefully I never have to use it. If I need two major surgeries in one year well then I'll pay for it. Sounds like I've got bigger issues.
More than one surgery per year I'm covered for surgery in the medical vehicle. So if I'm going beyond that, I think I'll take the extra 9220 that I'm saving every year and risk it! Call me crazy I think most of that money is going toward treating fat people and drug users.
I don't know where you live now but private insurance is much cheaper in countries with universal healthcare. Probably because the insurance company only pays for "extras" that the existing system doesn't. They don't pay for ambulance rides for example.
Also, universal healthcare does not mean private insurance does not exist.
No need to fight over which one gets to be called number 1. Both are components of a whole vision; a healthy, thriving populace, building off the successes of one another to create a better experience for everyone, rich and poor alike.
It's important to have a central, regulated allocation of some resources for a society as large as America-- and for that matter, any society. The point of group living (where any society is group living) is that everyone has a safe place to return to and can count on at least most of the other members of the group to help them out when they need it. The point of universal healthcare is that you pool your money with everyone else so that when you get sick, you get care, and when your neighbor gets sick, he doesn't spread his infectious disease to you, and when someone else in your work place gets sick, you spend less time making up for their missing days.
You need an organization that can utilize resources derived from the whole of the economy to provide service to the whole of the populace. Ideological prejudice against “government programs” obstructs getting this good work done.
I'm saying this for political reasons - since healthcare literally is defense of the people's physical well being, I'm suggesting a branding and messaging change not arguing for overall priority re-adjustments against other issues (education, etc)
Yes, health care is important, if not morally necessary in the 21st century.
That said, it's also (imo) a proxy. The more accurate metrics are things like infant mortality rate (IMR), longevity, etc. KPIs that measure actual health and health outcomes. Access isn't necessarily the key.
Take for __example__ the USA. We now have the vast majority of the population covered. We spend more and more (and more)on healthcare. Yet, IMR is climbing. It's predicted that the current generation(s) will die younger. And finally, obesity is so widespread it's been mentioned as a threat to nation security.
Point being, (as stated) healthcare is a proxy (even for the countries that have it). I would imagine there are 5 to 10 KPI's that measure __health and wellness__ that would be more accurate (and likely paint a different impression).
Healthcare isn't a panacea. Yes, it's necessary. But benefits come from health (and wellness / prevention) and not just care.
Editorial: Discussing health care without also discussing (personal) health is a fool's errand. Championing healthcare is great for buying votes, but it's only part of the picture.
The big riddle is how do you get the health care costs in the U.S back in line with the rest of the world, which doesn't necessarily have single payer. I'm a big fan of Singapore's public/private hybrid which delivers excellent results for a very low percent of GDP. We spend double as a percent of our GDP on health care vs all other developed nations.
"More than 80 percent of the hospital beds in Singapore are in public hospitals, and those hospitals are cut into different “wards” with different levels of amenities: A-class wards provide unsubsidized care but have single rooms and air conditioning, while C-class wards are overwhelmingly subsidized but are set up like shared dormitories with common toilets. There are a number of ward levels in between, too, all with a sliding scale of comfort and subsidization. So both A-ward patients and C-ward patients are paying for their own care, but the prices they’re paying are very, very different, because the government is absorbing the direct cost of care in the C-wards."
Not saying common toilets are unacceptable but it's things like that which would be a big adjustment/shock to the American system of being used to mostly individual rooms with meal service, etc.
Isn't it better to design health care system based on some form of score, very much like credit score in financial systems? The healthier you live, the less you pay.
Obviously someone who drinks alcohol regularly, smokes regularly, is overweight, ... would be a burden on health care system (in long run) compared to someone who lives with a healthy life style. Why would they both pay the same amount? In a credit-based system the former pays more.
Making some exceptions in such a system is just fine. Not everyone has cancer. Insurance company can easily pay the full amount for these people. It is not the major cost for system.
How do you know how often someone smokes or drinks? How do you determine what level of smoking/drinking is harmful enough to merit higher premiums? How do you dispute the insurance provider's claim that your cancer is really your fault because you chose to live in a city with bad air?
Spoiler: the talk shows that statistically the Nordic countries lead the world in millionaires and billionaires / capita, and in rags-to-riches. The talker offers the opinion that this is because its of the strong social safety net, education and healthcare.
Living in Scandinavia of course I like to hear this ;)
Or maybe it's the very high resource/population ratio?
The petroleum sector accounts for 40% of Norway's exports.
Fishing is 10% (!) of Norwegian exports.
Both of these things have an incredibly high extraction efficiency in the modern era. It would be nice to believe it's the social safety net, but I don't think that hypothesis is backed up with much evidence. The much more obvious reason is staring Scandinavia in the face. I'm intrigued to see how Norway does when the rest of the world stops using petroleum and goes vegan.
Sweden, without oil and without much fishing, is also doing really well per-capita etc.
On the ground, the welfare state approach seems the plausible explanation.
And how will Norway do post-oil? Really rather well, it seems, because of its sovereign wealth approach which contrasts strongly with eg the Texas approach.
I've about given up on per-capita studies whose results rely on cultural differences too (but of course can't account for them). We have to accept places are different in more ways than population size. It's like saying where in the world is it easiest to have blonde hair.
A dissenting opinion: in The Netherlands, with pretty awesome universal healthcare, >50% of healthcare costs are made for 600k 65+ yr olds. That in a country of 17 million. It's 28 B€ for this small group in 42B€ total cost.
The social value of catastrophic health insurance is huge. The cost of universal cradle to grave care is catastrophic and untenable within 20 yrs.
Source (in Dutch, from a government regulatory agency), looking across healthcare categories:
If you get cancer, would you rather be treated in the US or Europe? Survival rates are significantly higher in the US, so I know what I'd choose. And yeah, I'll pay more, too, because I want high quality doctors.
If you don’t get cancer, where would you rather live? Life expectancy is significantly higher in Europe for lower average cost of medical care. There’s not necessarily a conflict between checkups and chemo, and surely some of the difference is due to population-level differences in poverty, diet, and lifestyle. But it’s worth remembering that it can be rational to trade slightly worse specialty care for better general care.
The OECD reports numbers that include public expenditures. I'm not sure where I'd even look to find the precise methodology, but at some point you have to trust that the experts know what they're doing and are reasonably impartial. And sure, Sweden's overall tax rate is probably a lot higher, but they are providing a lot more services than the US government with that money beyond just healthcare. So the choice probably isn't between ~30% tax rate with private healthcare[2] and ~60% tax rate with public healthcare; even if the full ~$10,000 health care expenditures per capita were spent on taxes instead, that's only about a 17 percentage point increase on the per capita income of $60k.
I think you misunderstand the statement. I wasn't referencing the comparison of the tax costs of different public healthcare systems. But while we're on that subject, I'm willing to bet that your VA comparison isn't per capita, or placed against GDP, rendering it useless.
What I was referencing was the per capita or per household total cost of healthcare. The comparisons that say western countries with universal healthcare have "lower costs" generally omit the increased tax burden.
If I make $100k a year, for example, and pay ~30% in taxes, but also pay ~$15k a year for total family medical expenses, including premiums, I'm still making out better than if I pay ~60% in taxes, but get "free" healthcare.
> As a percentage of GDP, the UK spent less on healthcare than USA, Japan, France and Germany and a similar percentage to Canada. The USA spent the most on healthcare as a percentage of GDP at 16.6%.
If you exclude private insurance the US still pays a lot, at about 8.2%
The US has by far the largest spend per capita, yet has average life expectancy.
You misinterpret or spin the data from your link. Look again and you'll see that, as far as compulsory spending goes the US and UK spend roughly the same percentage of GDP on "healthcare". What is "healthcare" as defined in this PR piece from the UK government? Where do factors like average wait time to see a specialist or have surgery weigh in?
I could take those same numbers and say, "The United States does a better job of assisting it's poorer citizens into the highest quality healthcare in the world, all while allowing all its people the complete freedom to control their own health outcomes."
For the record, I'm not a health libertarian, but I'd sure as hell take it over health authoritarianism, and the UK government proved that's what they have last week.
> Look again and you'll see that, as far as compulsory spending goes the US and UK spend roughly the same percentage of GDP on "healthcare"
Yes, that's the point. The US government spends more on healthcare, but that huge spend doesn't cover the whole population.
> "The United States does a better job of assisting it's poorer citizens into the highest quality healthcare in the world,
Why does the US have such poor mortality figures if health care is so good and if everyone can access it?
> but I'd sure as hell take it over health authoritarianism, and the UK government proved that's what they have last week.
In the US cases of medical futility the doctors announce their plan to remove life support and if the parents disagree they have to go to court to stop it happening.
In the UK the doctors need to get the agreement of the parents, and if the parents don't agree the doctors have to go to court. In that court process the family can get legal aid (if they meet the financial test) - Alfie Evan's parents went through 7 legal firms, and they had expert counsel of a well respected silk and two juniors. But also Alfie had his own legal representation.
Alfie Evans had 16 months of excellent health care, followed by robust legal protection to make sure his best interests were looked after. His family are poor. He wouldn't have got anything like this in the US.
> But also Alfie had his own legal representation.
What?! How does an infant/toddler receive legal representation arguing for the plug to be pulled, outside of the wishes of his parents?! That is the very definition of authoritarianism.
> He wouldn't have got anything like this in the US.
Absolute nonsense spread by someone who has no knowledge of the American system. A child like Alfie is given free medical care from one of many charity hospitals with some of the best doctors in the world, and other charities house the family, for no cost, during treatment. You know, like the Vatican offered, and the parents accepted, but apparently you're government decided it was time for Alfie to die.
> How does an infant/toddler receive legal representation arguing for the plug to be pulled, outside of the wishes of his parents?!
The child is not property. The child is a human, and has human rights. Those rights are protected. The child has his own independent legal representation to look after its best interests.
This system has been tested by international courts -in Europe- and they've found it works to protect the rights of the child.
> You know, like the Vatican offered,
No. The vatican offered the same end of life care he was getting, with the additional burden of a long difficult journey.
> A child like Alfie is given free medical care from one of many charity hospitals
I've already linked a page in this thread that shows this to be false.
You keep saying "government", but the UK government wasn't involved in any of the cases (apart from the EU ones).
> The child is not property. The child is a human, and has human rights. Those rights are protected. The child has his own independent legal representation to look after its best interests.
How humane of your government to decide that a toddler must starve to death.
Have you ever had a naso-gastric tube fitted? It's not pleasant. Doing this in order to prolong life when the case is medically futile is cruel.
Also, it's far better that the hospital has to go to the courts to get permission to do this than the situation in the US: the doctors announce their plan and the parents then have to go to court to stop it happening.
> What?! How does an infant/toddler receive legal representation arguing for the plug to be pulled, outside of the wishes of his parents?! That is the very definition of authoritarianism.
So, arguing the doctors' point of view of a terminally ill child's best interests is "authoritarianism", and arguing the parents' point of view is not? OK.
Simple answer to your question: It is for _doctors_ to assess if there is any realistic hope of recovery from an illness and if not, when palliative care is the best option. They're not perfect but it's the best that we have.
Terminal illness happens to us all eventually, you have to face that. It happens to children too sometimes, you have to face that too.
The higher taxes aren't there to cover healthcare costs though. The amount you pay in taxes for universal healthcare are lower than what you pay in the US for non universal public healthcare that you don't even use.
Europe these days, at least I'd be treated like a human being and not a cash cow.
Survival rates in the USA were better in the 1960s but most of the OECD now has much lower mortality rates from a diagnosis of cancer than the USA. One exception is the UK but the margin is very narrow.
What the USA is good at is over-treatment which can extend life expectancy of a cancer patient a little bit (days, weeks on average) but you could argue the quality of life is not there. This is a direct a bi-product of an extremely inefficient health system which is designed to make as much money as possible for all of the participants rather than treat patients.
As a percentage of GDP health care spending in the USA is completely out of control.
But are you really treated more humanely in Europe? Instead of a cash cow, you're a statistical number that determines where you will get placed in the queue and how long you'll wait. In the US, you at least have the potential for autonomy to pay the best doctor you can find you to treat you as soon as possible. That autonomy (or illusion thereof if you're a cynic) is a core component of the American identity. That feels more human to me.
However, I do agree spending is completely out of control. A big reason is because Americans are extremely unhealthy. Many are obese, don't exercise, and eat like shit. I think those people should be punished with large insurance premiums, instead of being treated equally to someone who proactively takes care of their health and has a higher chance of long-term survival. What's left of the insurance market does still respond to those incentives. There's some fits and starts with this in insurance (e.g. step trackers) but these are values and habits that need to be instilled in people from youth. That is an area I can see the state stepping in, and something they're better equipped to handle than a complex healthcare system.
Genetic diseases are a different case, and should be treated differently. There is a huge opportunity for prevention through genetics, but everyone raises a stink because of the "eugenics" bogeyman. This is an area where I agree with the transhumanist types in that we should really be taking a close look at our genetics and taking a scientific approach to improving them for longevity. I'd love to see a Manhattan Project for life extension.
The main problem I see with universal healthcare, besides the stupid communistic utopianism, is that it doesn't really fix the underlying problems with the incentive structure. I think we could agree that the incentive structure should revolve around proactive physical fitness and the early prediction and prevention of disease, not pills and palliative care. From my perspective, it looks like European governments are struggling and failing with their systems. They're slow to treat people and are not innovating in medicine at a high level. Yes, corporations want to extract wealth from individuals with high prices but so do government agencies with high taxes. And governments have much less incentive to innovate; they tend to ossify.
My point is, Americans have other options other than universal healthcare. I think we should not settle for the European-style socialist system because it relies on a religious holdover manifest in a secular world: that if we treat everyone equally we'll all be magically saved. Instead, Americans should draw from our founding principals of individual autonomy and manifest destiny to form a healthcare system that embodies our ideal future.
Europeans also have private care, if they so desire and can afford it.
I've lived in the US and in more than one country with universal healthcare, and know quite a few people in similar situations. Some prefer living in the US, but I'm not familiar with a single person who, given a choice, would take the US model over the European model. Do you?
I wonder if "better cancer outcome in the US" is actually a result of selection bias, because the really poor people don't even get diagnosed, e.g. the money quote from [0]:
"""Danielle Scott, an employee at the store where Savastano bought the winning lottery ticket, told WABC that Savastano used the money for a visit to the doctor because he was uninsured. It was then he learned he had cancer, she said. """
Yes, let's turn a multifaceted, fairly objective article into a narrowminded, single-issue catchphrase, and introduce a false dichotomy that isn't even close to the content of the article. It seems like a lot of work just so you can keep beating your chest, or do you have an actual point to make?
Survival rates are higher as they are detected earlier. So this should be - where would I rather have my cancer detected. But again it is not that clear:
Which makes sense if you can pay. But for low income house holds it's a decision between live long poverty or death.
Here in Germany I am pretty glad that whatever I have I can go to a doctor or hospital and not get a single bill for it. Tops I have to pay 5€ for a prescription even if the drug is 120€ normally. And surely even in universal health care systems standards can be very high. It's a matter of investment.
"Our results suggest that cancer care in the United States did not always avert deaths compared to Western Europe, and when it did avert deaths, it often did so at substantial cost."
"Survival rates are significantly higher in the US, so I know what I'd choose."
Uh, something is going to kill me anyway. And the percentage difference isn't that high. I'd much rather have everyone state funded healthcare than a bit higher statistical chances for myself.
You won't be able to pay unless you're filthy rich.
A second of care costs something on the order of $40...
Medication costs, simple drug imatinib. $28000/annum vs $1000/annum (USA vs Poland, 2000, PPP adjusted.) Control checks, thousands dollars difference and they're the exact same.
It has the benefit of being supported by the state, yet nowhere has it obsoleted private healthcare (except for places where the government outright criminalizes private healthcare). There is something rotten in Denmark.
Ah yet another time to remind US citizens they are needlessly dying at worst or massively overpaying for health at best.
The health care of system of the US is insane and has malignant cost disease. If they scrapped everything and adopted a universal health care system where the government simply pays for health care of everyone up to a standard of care above which there is quickly diminishing returns, they could do so without increasing current federal levels of health spending, since US government health spending is already large by the standards of other countries that take the single payer approach. If you want more health care than this, you can buy private insurance, except now because all consumers are weighing up whether it's actually worth it given they have most of their health care covered by the government, the insurance/health system has much less cost disease.
This is how health care works in sane countries. Countries where rational policy discussions cannot get totally derailed by the magical word "socialism".
What makes you think most people in power really care about productivity of the domestic population at this point? High productivity is something that is purchased from abroad these days.
Alfie Evans was allowed to die based on unanimous, qualified medical evidence that was placed before the judiciary, which is entirely separate from the government. This ridiculous idea of "the government putting him to death" that's doing the rounds in the US media at the moment is disgustingly disingenuous and, what is worse, factually far from the mark.
Alfie's parents, at no point, owned his life. He did, and every qualified, trained medical professional agreed that it was not in HIS interests to be kept alive with no realistic hope of recovery. It's dreadfully sad and I don't in the least blame the parents for wanting a different outcome, but this is Terri Schiavo all over again with the added media abuse of the fact that it's a child to further their own agenda.
The case of Alfie seems quite independent of Universal Health Care. There is no particular reason why the implementation couldn't have permitted Alfie's parents to take their child to Italy or anywhere else. If anything, the case of Alfie seems more related to CPS, Child Protective Services. That is, when should the state intervene to protect children from their parents.
The fact that the healthcare was paid for by the Government had absolutely nothing to do with that case. A healthcare decision had to be made for a patient that was not able to make the decision themselves. When the doctors thought that the decision that the parents were making on behalf of the child was against the best interests of the patient they asked the courts to make a judgement of what should be done. The same thing can happen in countries with private healthcare and the same thing would have happened in the UK if they were in a private hospital.
>> A healthcare decision had to be made for a patient that was not able to make the decision themselves
Yes - it was made for the patient against the patient's legal guardians - his own mother and father. The government-run system overruled the patient's legal guardians.
This is precisely the issue at hand: a loss of freedom resulting from a healthcare system ultimately ruled by the government itself. The government has final say over healthcare decisions.
Again, the fact that the court made a decision for the patient has nothing to do with how the healthcare system of the country is funded. Courts and the legal system make decisions about children's lives against the wishes of parents all the time. Courts remove children from parents that they deem unfit. Courts decide that one parent or the other should have sole custody of the child against the wish of the other and many more examples.
Quite frankly I'm much more scared of a system where a parent has complete and absolute control over a child no matter what than one where a court can step in and overrule a decision of a parent. The doctors and courts owe their duty of care to the patient not to the parents.
>> No, the medical professionals, i.e. doctors do.
The UK doctors punted, agreed. But Italian doctors believed different treatments were warranted. The Italian government gave the boy citizenship.
In a private healthcare system, the parents would be free to pursue that. But in the state-run system of the UK, there was no such freedom. Alfie Evans died last Monday.
> But Italian doctors believed different treatments were warranted
Again no.
"The Italian hospital had acknowledged it could not find a cure, but had proposed maintaining Alfie’s life for about two weeks while doctors tried to investigate his condition."
There are no treatments - even that seems to be agreed.
> In a private healthcare system, the parents would be free to pursue that
If they could afford to write a blank cheque for open ended life support. Any insurance would defer to the consensus of medical opinion and cease treatment. They would have ceased cover long before the 2 year trail of court cases and appeals all the way up to rejection from the European Court of Human Rights (not part of the EU or UK govt).
I was indeed misinformed. Reading several news articles, not one mention that all that was left of his brain was water and spinal fluid. I only see that in the court transcripts, and that assessment was done from brain scans over several months.
Given this new evidence, I change my opinion on this: the state-run healthcare did offer the best advice.
(The question of state-run medical systems restricting freedom still applies here, even though the freedom would simply have been different end-of-life care.)
So, you might not know this but the doctors were not allowed to carry out their plan without a court order. The hospital needed to get the agreement of the court in order to turn off life support.
Contrast this with the US, where the hospital can announce the plan, and the parents have to sue to stop it happening.
That feels substantially worse.
Especially because in the UK the parents will have legal aid available to pay for their legal representation (Alfie's parents went through seven firms of solicitors) and because the child will have their own independent legal representation.
A UK court ruled he could not seek treatment elsewhere, and was ordered off life support. That's not misinformation, it's reality.
edit Downvoted for citing a verifiable fact. This is a remarkably emotional, politically-charged thread. Comments and voting in this thread are driven not by logic and reason, but by emotion and political bias.
There was no treatment to be had in Rome, they were just going to hook him up to a life support machine. The doctors in Rome, being doctors, are professionals, so they never once suggested they would be able to cure or even treat his condition.
The court effectively ruled that 'further treatment for Alfie would be "unkind and inhumane"', that "continuing life-support treatment would not be in the best interests of Alfie" that it "is not lawful that such treatment continue".
This has little to do with universal healthcare, and is more a case of justice (purportedly - I'm not trying to be a judge myself here) protecting a children from its parents.
"But I came, on the consensus of every doctor from every country who had ever evaluated Alfie's condition, to the inevitable conclusion (following 7 days of evidence) that Alfie's brain had been so corroded by his Neurodegenerative Brain Disorder that there was simply no prospect of recovery. By the time I requested the updated MRI scan in February, the signal intensity was so bright that it revealed a brain that had been almost entirely wiped out. In simple terms the brain consisted only of water and CSF. The connective tissues and the white matter of the brain that had been barely visible 6 months earlier had now vanished entirely and with it the capacity for sight, hearing, taste, the sense of touch. All that could be offered by the Bambino Gesu Hospital in Rome was an alternative palliative care plan. An end of life plan. And so, on a true deconstruction of the issues, it is that that this case has been about: what is the appropriate end of life plan for Alfie?"
This is not a matter of health care. It’s a matter of who gets the last word in childs matters. A court can decide that the parents actions or decisions cause harm to the child and take custody of the child at the request of any concerned person. In this case, the concerned person were the doctors.
Without diving into the decisions in that particular case, this is in general something I consider good. There are parents that abuse their children. It’s also something that may lead to unacceptable outcomes, the law is always imperfect.
He wasn't put to death. The poor child was already brain dead. You could have left him on a machine to make his lungs go up and down forever but he was no longer there.
I agree if Italy had agreed to take him then they should have let him move him.
When you have an unconditional "right" to consume someone else's labor, the inevitable result is tyranny, rationing and the force of government determining outcomes.
Alfie Evans got 16 months of world class health care.
When he got to the point where treating him was futile and doctors wanted to turn off life-support they needed to get the agreement of the parents. Because the parents didn't agree the hospital needed to go to court. The hospital was not allowed to go ahead without a court order giving them permission. This is unlike California and Virginia, where the doctors announce the plan and then the parents have to sue to stop it happening.
For the court process the parents had excellent legal representation paid for by the state. The parents went through seven firms of solicitors and a counsel team of top class silk plus two juniors, because they disagreed with the legal advice each firm gave them. They eventually wound up being represented by the CLC - someone who isn't a solicitor gave them terrible legal advice.
On top of that Alfie had his own, independent, legal representation. This is because Alfie was a human, and humans have rights, and we protect human rights that are enshrined in our law and in international law.
The courts had the power to get independent medical advice, which they did. Every single doctor agreed - treatment was futile; Alfie had no brain; he was going to die and die soon.
The courts decided that it wasn't possible to say that further treatment would not cause more pain and suffering to Alfie, and they ordered that it was in his best interests to remove life support. It's important to note that no hospital was offering anything other than end-of-life care.
The parents disagreed, and took the case up through appeal, then supreme court, then Europe, and back again. This is many different judges, and the all agreed: it was in Alfie's best interests to let him die. (Europe agreed that Alfie's best interests had been kept in mind.
The court cases are available online, and you should read them, because they are short and easy to read and the principles are clear: everything has to be done in Alfie's best interest; the parent's views are important but they don't own Alfie.
So, you seem to say that we did it wrong, and that the US would do it better.
In the UK the hospital had to go to court.
In eg California that is reversed. The doctors tell the family they're going to stop treatment, and the family have to go to court to stop the hospital. Who pays the legal bills for the family? Who pays the legal bills for the child?
You'll get no concessions from a political ideology that refuses to disassociate from, or even recognize the existence of, extremist elements on it's side of the spectrum.
You don't need universal or publicly funded healthcare for this.
You just need it to become the norm for employers not to provide healthcare insurance.
So for example (and I am NOT saying we should actually do this) if they would simply pass a law forbidding employers from including health coverage as part of their compensation packages, then everyone would be buying their own insurance (on exchanges or wherever) and startups along with every other business would be relieved of the burden.
Stories about who is winning an election, or about how many votes a candidate is going to lose because of some comment she made during her campaign are not of interest.
But there is a difference between politics and policy. The effects of various policies and how to construct policy to achieve a given effect are topics that will be of great interest to most hackers. Hacking society is what legislators do all day long. That's why you see stories like this one getting upvoted.
This article conflates public "essential health" services with universal, state-run healthcare. It also uses nondescript graphs, in image form and with no link to source data, to make sweeping, "correlation equals causation" points about universal health care and life expectancy.
This is an article trying to make an ideological case rather than to discern truth.
"This is an article trying to make an ideological case rather than to discern truth."
Generally Economist is unashamedly political. That's what makes it so good - they don't try to hide the fact that they take a stand. They give you the facts and their arguments, and then it's up to the reader to digest it.
If you disagree with some of the points, I suggest you send them a letter. The letters section of Economist is one of the high points of the magazine as well - they publish rebuttals and corrections no matter how far they stray from the magazines core claim as long as the letter is well written and sanely argumentative.
Americans need to change their underlying notions of what it means to be a society. An author was once made fun of for suggesting that it takes a village to raise a child. When it comes to public funding for public goods we tend to worry about some poor person getting something they don’t deserve. The go it alone I’ve got mine, fuck you attitude is unhealthy.
Until we change our collective view in what the purpose of a government and society is things won’t change significantly. Even so called champions of progressivism in the U.S. Senate voted against allowing the importation of medicine from Canada. It seems the public interest is subordinate to private interests and often times with immoral consequences.