Who should pay the healthcare costs of the uninsured?

[mheslep]

If we just let the free market educate our children... how well would that work?

It works quite well actually, considerably better than the public schools by all kinds of metrics - if you can afford it. I favor programs to make it affordable, but that's another discussion, we're veering off health care...

 

[mheslep]

I note in the http://www.euro.who.int/document/Obs/EuroObserver6_1.pdf" . Japan also has 100's to 1000's of private insurers though I can't locate a population percentage. More interestingly, on checking the full report backing the EO article, many of these plans do not entail an employer based tax exemption - the original problem since WWII w/ the US system.

 

[baywax]

It works quite well actually, considerably better than the public schools by all kinds of metrics - if you can afford it. I favor programs to make it affordable, but that's another discussion, we're veering off health care...

Its simply a matter of congruency... if we're going to tout the "better quality of life for the nation's children" line with govt. sponsored education and govt. paid for military protection but Health is left out in the cold for the free market, then it is a contradiction and somewhat dysfunctional. The military get (basically) free medical aid... does every citizen have to join the military to get subsidized health coverage?

 

[mheslep]

Its simply a matter of congruency... if we're going to tout the "better quality of life for the nation's children" line with govt. sponsored education and govt. paid for military protection but Health is left out in the cold for the free market, then it is a contradiction and somewhat dysfunctional. The military get (basically) free medical aid... does every citizen have to join the military to get subsidized health coverage?

There's the other side of that argument: If health care must be run by the government why not our life giving food? Government grocery stores? And housing? Transportation, clothing, on, and on. With regards to the military, as I have some background there I can say that, as an organization the military is one of the most inefficient beasts you'll ever encounter, especially the Army. Its the high levels of motivation and dedication that none the less make it go.

 

[CaptainQuasar]

There's the other side of that argument: If health care must be run by the government why not our life giving food? Government grocery stores? And housing? Transportation, clothing, on, and on. With regards to the military, as I have some background there I can say that, as an organization the military is one of the most inefficient beasts you'll ever encounter, especially the Army. Its the high levels of motivation and dedication that none the less make it go.

I have to point out that the government does run, or at least substantially fund, quite a lot of that stuff. Bailouts of Amtrak and airlines, HUD and all sorts of housing development, food stamps, rationing during wartime, etc. It's not quite so free market, especially when some executives can come up with a good enough excuse to siphon off some government money.

Publicly funded and managed healthcare is no more incongruous than publicly funded and managed police departments and firefighting. If we can make the police, the fire departments, and the military run (not to mention get into regulating things like professional baseball) we can make a healthcare system run. Certainly for the same amount we're paying for it now.

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[mheslep]

I have to point out that the government does run, or at least substantially fund, quite a lot of that stuff. Bailouts of Amtrak and airlines, HUD and all sorts of housing development, food stamps, rationing during wartime, etc. It's not quite so free market, especially when some executives can come up with a good enough excuse to siphon off some government money.

Disagree, it does not run quite a lot in relation to the size of those sectors. We're talking in this thread about the possible take over of the entire health system. Funded by and possibly produced by the government. There's nothing remotely like that in transportation or housing, both of which are trillion dollar industries. The government's millions and billions are only pocket change contributions to those industries. And note that (HUD, etc) most of that is government underwriting, some subsidies here and there, it is not the government actually employing the professionals and running the system as health is in say, Canada, UK.

Publicly funded and managed healthcare is no more incongruous than publicly funded and managed police departments and firefighting. If we can make the police, the fire departments, and the military run (not to mention get into regulating things like professional baseball) we can make a healthcare system run. Certainly for the same amount we're paying for it now.

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Medicaid/Medicare is a an example of what you're asking for, in part. Does that 'system run'? Yes the the cost of the current system is a disaster. Eliminate the employer based health tax exemption. Health care need have no connection w/ employers.

 

[baywax]

There's the other side of that argument: If health care must be run by the government why not our life giving food? Government grocery stores? And housing? Transportation, clothing, on, and on. With regards to the military, as I have some background there I can say that, as an organization the military is one of the most inefficient beasts you'll ever encounter, especially the Army. Its the high levels of motivation and dedication that none the less make it go.

The Captain has a point... I couldn't believe my eyes seeing some baseball dudes up in front of the Congressional Committee. What's with that? War On Drugs!?

If you think the organization of the military is a nightmare, try govt. run health care. It is the weakest link. You have these "open" institutes carrying heroin, morphine, all manner of uppers and downers and absolutely no security. There are people running into the hospital pharmacies with shotguns, just taking what they want. Then you've got the monopolies trying their damnedest to corner the health market with their products (photocopiers, computers, tongue depressants etc..) and you've got big big anomalous companies trying to steer the focus of an entire patient and doctor population toward one focus in an attempt to bleed as much govt cash as possible into their coffers.....come to think of it... it does sound like the military! Of course all of this simply deteriorates the quality of care and life for the "main concern"... the patient.

I'm just saying that sure, the free market system of services works very well for the people who have the money to pay for it. How many Americans have that money? What is the ratio of under funded to the well to do. Does this ratio warrant scraping Govt. funded Education and does it warrant not even thinking about Govt funded Health care?

Here's the utopian ideal that the Canada Health Care Act and Education Act is working toward: At some point the majority of people will have attained such fine physical and mental health that they will be able to manage their own financing and their own Health Care. By this I mean people will reach a level of education (and we're approaching that) where they care very well for themselves so that the burden of the masses will fall off of the system and only the stragglers will be in need of subsidiary assistance. This way the burden of Health Care will and is slowly lightning on the back of the average Tax Payer.

 

[CaptainQuasar]

Medicaid/Medicare is a an example of what you're asking for, in part. Does that 'system run'? Yes the the cost of the current system is a disaster. Eliminate the employer based health tax exemption. Health care need have no connection w/ employers.

If Medicaid/Medicare is a partial example, the healthcare systems of every other modern country in the world are full examples. Compared to them does the current U.S. system run? They have pioneered it for us and worked out almost all of the kinks. For once it ought to be us picking the fruit of other countries taking all the risks beforehand.

And no, to answer your question, Medicaid/Medicare does not run.

The thing for me is that given the current state of things it's hard to imagine that a move to socialized medicine could result in anything but an improvement. Particularly with almost a century of information and preexisting models to go on, even if we screw something up in the implementation that has already been screwed up elsewhere.

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[mheslep]

...I'm just saying that sure, the free market system of services works very well for the people who have the money to pay for it. How many Americans have that money?...

Well this debate has been held before and by my betters. My take on it was generally the reverse: throughout history the rich and well born always had access to their needs and then some; it was only the wide introduction of the free market system that made the basic needs of life affordable to the millions through its productivity and efficiency boons. Indeed, let's have a safety net for the unfortunate who can't manage, but I don't see that as any reason for completely turning a society away from free market capitalism.
Edit: important to note here that both government and big business are the enemies of free markets

 

[mheslep]

If Medicaid/Medicare is a partial example, the healthcare systems of every other modern country in the world are full examples. Compared to them does the current U.S. system run? They have pioneered it for us and worked out almost all of the kinks. For once it ought to be us picking the fruit of other countries taking all the risks beforehand.

Agreed, certainly it makes since to observe other systems, including their free market reforms. See post https://www.physicsforums.com/showpost.php?p=1615103&postcount=102" for some of the free market reforms underway. France now 85% private. Dutch going 100%

The thing for me is that given the current state of things it's hard to imagine that a move to socialized medicine could result in anything but an improvement. Particularly with almost a century of information and preexisting models to go on, even if we screw something up in the implementation that has already been screwed up elsewhere.

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Agreed again. Current system is probably worse than some form of socialized medicine.

Milton Friedman and R. Kuttner http://www.prospect.org/cs/articles?articleId=10764":

MF: We have the worst of all of all worlds on that score

RK: I couldn't agree with you more. We have the worst mix of government and private, I could not agree with you more.

MF: We ought to have much more private or much more government.

RK: Well, to the extent that government is involved at all it ought to be doing a better job than its doing now. I am entirely in agreement.

As discussed up thread the current US system is not much of a free market system, harking back to government intervention in WWII. We should actually try a real free market system before considering it tried and broken.

 

[CaptainQuasar]

Well this debate has been held before and by my betters. My take on it was generally the reverse: throughout history the rich and well born always had access to their needs and then some; it was only the wide introduction of the free market system that made the basic needs of life affordable to the millions through its productivity and efficiency boons. Indeed, let's have a safety net for the unfortunate who can't manage, but I don't see that as any reason for completely turning a society away from free market capitalism.

Good points about the efficacy and boons of markets, they have done many great things and are responsible for much of our wealth.

I would agree with the idea of continuing the free market healthcare experiment if it was, say, 1965. But at this point it has been so many decades and the U.S. healthcare market has created a number of secondary markets and industries that have ballooned and grown incredibly rich, with relatively little to show for it.

They've more than had their chance but the players in that industry have chosen to line their pockets rather than make free market healthcare work - and they've actively interfered with the government and legislation to do so. Way more than three strikes: they're out. Time to scrap it all and try what's already working everywhere else.

If we go over to socialized medicine and find ourselves pining for the glorious days of free market healthcare in some way or another we can take a step back in the free market direction. But the free market approach has totally failed us, in many cases lethally.

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[CaptainQuasar]

As discussed up thread the current US system is not much of a free market system, harking back to government intervention in WWII. We should actually try a real free market system before considering it tried and broken.

Okay, you've intrigued me. In the Dutch case, are they really going 100% free market, no government involvement at all?

And is it actually possible for a Dutch person to end up with no healthcare at all? Because of course, in a 100% free market that would be possible. That's the kind of thing I think we ought to avoid, even if it takes socialist measures to avoid it.

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[baywax]

Well this debate has been held before and by my betters. My take on it was generally the reverse: throughout history the rich and well born always had access to their needs and then some; it was only the wide introduction of the free market system that made the basic needs of life affordable to the millions through its productivity and efficiency boons. Indeed, let's have a safety net for the unfortunate who can't manage, but I don't see that as any reason for completely turning a society away from free market capitalism.
Edit: important to note here that both government and big business are the enemies of free markets

I see your point. It is the free market that has brought incredible innovations and decreasing prices to the people. Take generic drugs for example. And what you say about govt and monopolies is true in that case... where they want these very cheap copies abolished so they can "claw back the costs of development" at the expense of the consumer/patient (in terms of loss of Quality of Life).

I think we're on a similar path in that we both want a population of "self-reliant" citizens. Whether they are self-reliant because they can pay for their treatments on their own or because they have avoided most treatments because they are educated and maintain their health to begin with isn't as much of a problem. Especially when you compare the nightmare of national debt or deficit that occurs in a country that isn't keeping up with the demands of an unhealthy population and subsequently an unhealthy Health Care system.

Let me just say this, mind you... any company or foreign country that contaminates part or all of a country with lead paint, petro-chemical contaminants, nuclear waste, etc... should be immediately held accountable for the health of the citizens directly involved with the contamination. This should be facilitated by the government in that lawyers and investigating doctors should be dispatched post haste upon any notice of this occurring. The perpetrators need to pay all health care costs for the victims of their contamination and all subsequent generations should receive the same care, paid for by the same perpetrators. This would look something like the Tobacco Industries payouts of the 1990s but it would have to extend to future generations.

A strict policy like this would actually cover many of the people who are "left behind" by the Govt Med icare programs. That's because most of the really bad contaminations that occur take place in areas that are not deemed worthy of careful stewardship of the land and the people... basically in places where very poor people live.

In the case of China's poorly regulated and lethal (lead painted toys etc..) export business (or is it deliberate?) China would be made to take full responsibility of any health issues and environmental issues arising there.

 

[mheslep]

I would agree with the idea of continuing the free market healthcare experiment if it was, say, 1965. But at this point it has been so many decades and the U.S. healthcare market has created a number of secondary markets and industries that have ballooned and grown incredibly rich, with relatively little to show for it.

They've more than had their chance but the players in that industry have chosen to line their pockets rather than make free market healthcare work - and they've actively interfered with the government and legislation to do so. Way more than three strikes: they're out. Time to scrap it all and try what's already working everywhere else.

Arg. Again, employer based health care ~ forced by the government is not much of free market system. Its a 3rd party payer system. It has to go. No one pays their doctor (above the silly copay), so they don't care what it costs.

Okay, you've intrigued me. In the Dutch case, are they really going 100% free market, no government involvement at all?

Dutch reformed their system circa '06. Its a 100% private system, w/ mandatory coverage:
http://healthcare-economist.com/2007/09/07/wsj-on-the-dutch-health-care-system/"

* All individuals must be insured
* All individuals purchase health insurance on the private market
* Individuals can choose to get their health insurance through their employer–if the option is available–but the employer does not have to offer health insurance. If the employer does not offer health insurance or if an individual is unemployed, then they must purchase health insurance on the private market.
* Health insurers are free to charge each individual any price they please for health insurance. Of course, market forces limit the price that the insurers can charge the consumers before they switch to another plan. After the reform was implemented, however, there was significant consolidation in the health insurance market and now there are only four or five large plans. This may reduce the amount of price competition in the market.
* The cost of health care is more transparent to consumers since they see the price they are charged for health care. In most national social health insurance programs, individuals do not know the value of health care they receive since the amount of money they pay into the system is proportional to their income and thus unrelated to actuarially fair value of health insurance.
* Health insurance is subsidized by the state. “Insurers get risk-equalization payments for patients with about 30 major diseases.” Thus, people who are sicker receive a larger state subsidy than healthy individuals.

That goes for the US system too.

http://www.iht.com/articles/2007/10/30/business/health.php"

The Swiss and Dutch health care systems are suddenly all the rage in the United States. They have features similar to proposals by at least two presidential hopefuls, and next month the top U.S. health official will visit Switzerland and the Netherlands to take a look.

The Netherlands is a particularly good model for the United States, Helms said, because it has solved two basic problems: moving from an employer-based system to one in which individuals buy their own insurance and subsidizing care for the poor.

Thats the key. Dump the employer based system. I'd sign up for this deal tomorrow.

 

[CaptainQuasar]

Doesn't sound like too bad an idea, mheslep. I definitely think that some sort of feedback loop on costs is important, whatever system we end up with. Though I'm skeptical that forcing individuals to buy insurance is really that much more of a free market than forcing employers to buy it, and this of course gives up drug-company leverage and the other benefits of a single-payer system.

One note though - and this may have been mentioned before as well, there's about a hundred comments I haven't read - I'm sure the Dutch implementation is different, but this sounds somewhat like what Mitt Romney implemented in Massachusetts while he was governor. I live next door in New Hampshire and I at least hear a lot of wailing and gnashing of teeth, though I haven't sought out and read any analysis of how it's going. So implementation details may be important, though I'm sure they could be worked out.

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[mheslep]

...Though I'm skeptical that forcing individuals to buy insurance is really that much more of a free market than forcing employers to buy it, and this of course gives up drug-company leverage and the other benefits of a single-payer system.

Here's an example of the difference: http://healthcare-economist.com/2006/04/25/markets-at-work-lasik/" , which is not covered by employee insurance plans. It now has the highest patient satisfaction of any surgery. 1998 price was $2200, now its $1350.

... this sounds somewhat like what Mitt Romney implemented in Massachusetts while he was governor. I live next door in New Hampshire and I at least hear a lot of wailing and gnashing of teeth, though I haven't sought out and read any analysis of how it's going. So implementation details may be important, though I'm sure they could be worked out.

Yes it does sound like Mass. at least in the mandatory coverage sense, and I believe I read somewhere that Romney et al were influenced by these budding Euro private systems. The gnashing must in part highlight the hyping of the '45 million' uninsured figure that's cavalierly tossed around to emphasize the 'heartlessness' of the current system: many of those 45m are 20 somethings that could care less about health care insurance at any cost if it detracts from daily beer intake. Now they're forced to play and hence some of the gnashing.

The major problem is that even the most creative state system can not escape the federal tax deduction for employee based health. I'm curious as to results of the Mass. system.

 

[mheslep]

Here's Romney's Op Ed piece explaining the Mass system. Its a good read.

Health Care for Everyone?
We've found a way.

...I assembled a team ... and asked them first to find out who was uninsured, and why. What they found was surprising. Some 20% of the state's uninsured population qualified for Medicaid but had never signed up. So we built and installed an Internet portal for our hospitals and clinics: When uninsured individuals show up for treatment, we enter their data online. If they qualify for Medicaid, they're enrolled.

Another 40% of the uninsured were earning enough to buy insurance but had chosen not to do so. Why? Because it is expensive, and because they know that if they become seriously ill, they will get free or subsidized treatment at the hospital.

Im particularly interested in this part:

We have received some helpful enhancements. The Heritage Foundation helped craft a mechanism, a "connector," allowing citizens to purchase health insurance with pretax dollars, even if their employer makes no contribution. The connector enables pretax payments,

have no idea how that works. Edit: ah, now I see. The connector, which is the state setting up a giant clearing house, also looks close enough to an 'employer' in the eyes of the fed. so that anyone buying private health also gets the tax break; no employer need be involved. Just not as much of a http://www.heritage.org/research/healthcare/wm1035.cfm?renderforprint=1"

The only disadvantage is that the federal tax-breaks for individually purchased health insurance are not as large as those for employer-group coverage.

 

[baywax]

The Dutch system sounds like the rules for automobile insurance. Fairly simple arrangement and the insurers definitely benefit.

If we looked at the number of uninsured drivers on the road in the USofA would we get a picture of how many people would be insured for medical if the same rules applied?

 

[CaptainQuasar]

Here's an example of the difference: http://healthcare-economist.com/2006/04/25/markets-at-work-lasik/" , which is not covered by employee insurance plans. It now has the highest patient satisfaction of any surgery. 1998 price was $2200, now its $1350.

Yeah, but that's, like, the only example, right? I've never heard another one cited.

I certainly think that reducing costs is great but I think that some of the feedback mechanisms they're able to mandate in socialized healthcare systems are good too. If you saw Sicko they had the bit talking about how British doctors' compensation is partially based on how well they perform. Whether we go with a publicly-funded system or the sort of thing you're talking about that sort of feedback mechanism is more important than shaving a few hundred dollars off of an elective procedure like Lasik surgery.

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[CaptainQuasar]

By the way, the tax break thing you're talking about is something you can get around by forming a small business and getting a small group insurance plan, I do that myself. Unfortunately only some states have mandated that insurance companies must offer small group insurance plans for a single person, though; in many states you need two people.

But of course, I don't think that anyone should have to do that.

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[gravenewworld]

When you force EVERYONE to buy health insurance and when insurers MUST insure everyone who applies, that is not the "free market". The Dutch government also subsidizes insurance for people who can't afford insurance, which is once again, NOT the free market.

 

[mheslep]

Yeah, but that's, like, the only example, right? I've never heard another one cited.

http://www.bmj.com/cgi/content/full/312/7036/922" , here and there. UK dentistry was forced to privatize as the NHS through it out; many US cases where plans don't include dentistry.

Whether we go with a publicly-funded system or the sort of thing you're talking about that sort of feedback mechanism is more important than shaving a few hundred dollars off of an elective procedure like Lasik surgery.

Few hundred dollars? Thats a 38% decrease during the same time that insured heath costs were doubling(at least). I'm arguing for the application of those principles across the board to a $2trillion dollar US system.

 

[mheslep]

By the way, the tax break thing you're talking about is something you can get around by forming a small business and getting a small group insurance plan, I do that myself.

Good on ya. Same here some years ago.

 

[CaptainQuasar]

Few hundred dollars? Thats a 38% decrease during the same time that insured heath costs were doubling(at least). I'm arguing for the application of those principles across the board to a $2trillion dollar US system.

That just seems to me like Enron saying, “but look, those expense reports for all the champagne and caviar weren't doctored! That part of the books isn't crooked!” It's impressive in a small way and it does show promise for market forces to increase efficiency. But when people have died because of the other problems, and the entire population is affected to the point that our average lifespans are years shorter than elsewhere, it's way too little, too late. Far more important to get a working system in place and even if we end up spending a few million extra on a national scale, start shaving costs down and nipping and tucking the financials afterwards.

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[Evo]

and the entire population is affected to the point that our average lifespans are years shorter than elsewhere, it's way too little, too late.

What country are you referring to? Once you take out the low infant mortality rate in the US, which ironically is due to the higher incidence of carrying pregnancies to live birth, the US has one of the highest life expectancies in the world.

 

[CaptainQuasar]

What country are you referring to? Once you take out the low infant mortality rate in the US, which ironically is due to the higher incidence of carrying pregnancies to live birth, the US has one of the highest life expectancies in the world.

I'm sure it's true of the world in general. But in Sicko - which I'll point out is not my source for all healthcare information, though it is for this particular point - they said that the average lifespan in the U.S. is something like three years shorter on average compared to the average lifespans in other first-world countries. That's why I said “by several years”, I know that our average lifespan is decades longer than that of many 3rd world nations, certainly.

Another point they made was that the rate of incidence of many diseases, including fatal ones, is higher in the U.S. than in other first-world countries.

But the deaths I was talking about are ones where someone dies during the course of fighting with a health insurance company to be approved for a medical procedure, which is something I've read reports of in many different places.

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[gravenewworld]

I'm sure it's true of the world in general. But in Sicko - which I'll point out is not my source for all healthcare information, though it is for this particular point - they said that the average lifespan in the U.S. is something like three years shorter on average compared to the average lifespans in other first-world countries. That's why I said “by several years”, I know that our average lifespan is decades longer than that of many 3rd world nations, certainly.

Another point they made was that the rate of incidence of many diseases, including fatal ones, is higher in the U.S. than in other first-world countries.

But the deaths I was talking about are ones where someone dies during the course of fighting with a health insurance company to be approved for a medical procedure, which is something I've read reports of in many different places.

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https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html


According to the CIA the US ranks 45 in the world for life expectancy.

 

[Evo]

https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html


According to the CIA the US ranks 45 in the world for life expectancy.

Like I said, you have to adjust for infant mortality. When you look at life expectancy after the age of one, the US is among the highest.

https://content.nejm.org/cgi/content/abstract/333/18/1232?ck=nck

While the United States reports every case of infant mortality, many other countries do not. For example, a 2006 artilce in U.S. News & World Report states, "First, it's shaky ground to compare U.S. infant mortality with reports from other countries. The United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths. In Austria and Germany, fetal weight must be at least 500 grams (1 pound) to count as a live birth; in other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless. And some countries don't reliably register babies who die within the first 24 hours of birth. Thus, the United States is sure to report higher infant mortality rates. For this very reason, the Organization for Economic Cooperation and Development, which collects the European numbers, warns of head-to-head comparisons by country." [2]

http://en.wikipedia.org/wiki/Infant_mortality

 

[mheslep]

Like I said, you have to adjust for infant mortality. When you look at life expectancy after the age of one, the US is among the highest.

https://content.nejm.org/cgi/content/abstract/333/18/1232?ck=nck

If you also take out homicides and other non heath care related deaths, http://blogs.wsj.com/numbersguy/does-the-us-lead-in-life-expectancy-223/" . EDIT: the general point is that since their are so many non health care factors to control life expectancy is not a good way to compare countries.

 

[mheslep]

But the deaths I was talking about are ones where someone dies during the course of fighting with a health insurance company to be approved for a medical procedure, which is something I've read reports of in many different places.

Hmm. Agreed, no question there are serious problems w/ people falling through the current US system, though its not clear to me at all what the numbers are on that, esp. given posts above from Evo et al. My quick response to the state run system is to point again to, say, the old Dutch state health system circa 1990 (also described in the link above): the Dutch provided only 1/3 the number of heart transplants per capita than did the US. Thats 3x people dead because of the rationed health care. But of course we've discussed rationing of health care again and again. What I generally don't understand is the theme of 'X is broken, and providers of X are all greedy Enron types, let's have the government run it instead, that will be much better'. Its illogical to my mind. People in government come from the society (one in every six now in the US) and are just as fallible as those in free enterprise, but those in the government don't get fired or go out of business for poor performance. Perhaps folks in govt. are not quite as much corrupted by money, but I believe they very much are corrupted by power and the larger the govt. the more so.

 

[CaptainQuasar]

My quick response to the state run system is to point again to, say, the old Dutch state health system circa 1990 (also described in the link above): the Dutch provided only 1/3 the number of heart transplants per capita than did the US. Thats 3x people dead because of the rationed health care.

That math doesn't work out. We would need to know the per capita rate of heart disease in each population,the fatality rate among those who didn't get heart transplants, and whether the Dutch health care system simply paid for people to get the heart transplants done next door in Belgium or France or something because Dutch hospitals weren't doing that procedure frequently, to figure out whether and how many people died due to the differences.

What I generally don't understand is the theme of 'X is broken, and providers of X are all greedy Enron types, let's have the government run it instead, that will be much better'.

I don't think that's everyone's primary rationale. It isn't mine. My rationale is primarily that someone shouldn't have to worry so much about how they're going to get healthcare when they need it, the same way they shouldn't have to worry if firefighters are going to come when their house is on fire or whether there are police around to stop criminals.

You don't have to stop and think about what kind of service you're going to request or how much it's going to cost before you call 911 for the police or fire department but you do if you're going to call an ambulance. And though I think there definitely ought to be some cost-minimizing feedback loops in place the whole picking plans, reviewing coverage, calculating co-pays, worrying that claims might be rejected, appealing claims that are rejected, having to get pre-authorizations for things, etc. is way too much. Not to mention HIPPA rules and releases.

A buddy of mine and his wife had a daughter born prematurely with all sorts of intensive care problems. Along with all kinds of specialists on the medical side of things, the health insurance company also assigned him a case worker to help with all the paperwork!

Another thing for me is that in political discourse in this country “socialized healthcare” has been a demonized term for decades. I remember hearing it when I was a little kid. “You don't want to be a pinko commie baby eater, do ya? 'Cause that's what socialized medicine will get ya! There will be Soviet troops in the streets!” (kidding and being melodramatic, obviously)

Well, to echo a thread elsewhere on the site today, the Cold War is over and we don't have to worry about being too red any more. Just because it's socialized doesn't mean it's bad.

Maybe it won't be so much better, or maybe it will. It's worked out pretty well in lots of places. My personal experience is with the UK. I have relatives over there and I was always surprised at the speed and quality of medical care they would receive, including in once case a home care nurse who visited weekly for several years. I originally thought they probably had some special deal, because they'd both worked in government. But after seeing Sicko and asking them questions I found that it was the same National Health Service that's provided to all UK citizens.

I would also ask: what's wrong with giving it a try? If it's really going to be inefficient and problematic the numbers will show it and we can just switch back to plodding down the market-based privatized route we've been trying for decades. I mean, you're citing a case of the Dutch doing exactly that, mheslep. If the Dutch can do it why can't we?

Worst case: we try it and switch back. Best case: we all actually get to stop worrying about insurance and coverage and copays and get to just worry about being healthy.

⚛​

 

[dr_d_is_cool]

i think the question is answered by ethics. ur helping save someone for death/discomfort or watever, so that should make it a little better. and also put urself in his/hers shoes and then rethink, they may not be uninsured by choice, they may be too poor to afford it, and who are we to say that they don't deserve treatment. and we pay tax, once we payed the tax, its not our money anymore, the government can do with it what they want, assumingly its for the better of our country,,, but of course sometimes its not
this can only be answered by personal opinion and every argument put forward is valid

 

[D H]

I would also ask: what's wrong with giving it a try? If it's really going to be inefficient and problematic the numbers will show it and we can just switch back to plodding down the market-based privatized route we've been trying for decades. I mean, you're citing a case of the Dutch doing exactly that, mheslep. If the Dutch can do it why can't we?

Worst case: we try it and switch back. Best case: we all actually get to stop worrying about insurance and coverage and copays and get to just worry about being healthy.

That is a very optimistic worst case. Worst case is decades of ever decreasing and ever more expensive health care before the government and the governed finally admit that universal health care was a dreadful experiment.

I predict that universal health care in the US will be a bonanza for some entrepreneurial Central American or Caribbean nation that sets up camp as an expatriate medical facility for upper class Americans who want to keep getting high-quality health care.

 

[gravenewworld]

Like I said, you have to adjust for infant mortality. When you look at life expectancy after the age of one, the US is among the highest.

You keep claiming this but where is the proof? Show me a table or set of data of comparing life expectancy across countries starting from something like age 1, 5, or 10.


If you look up the US life tables created by the CDC, even if you measure life expectancy at 1 years old, the life expectancy goes up by only 1/2 a year. Not a real drastic change.

https://content.nejm.org/cgi/content...18/1232?ck=nck

Yah, that is if you make it 80.

I can do the same exact thing and tell you to look at the life expectancy at age 65. After all, that will discount any effects of infant mortality. Also people at age 65 are less prone to die from accidents, murders, and general violence.

http://www.bc.edu/centers/crr/issues/ib_21.pdf

Look at the OECD data in the report. The US is still behind many countries in life expectancy at 65, ESPECIALLY for women.

Among the 30 developed
countries that comprise the Organization for
Economic Cooperation and Development (OECD),
American life expectancy at age 65 for both males
and females falls in the middle of the group. More
than that, we are not expected to catch up anytime
soon. The improvement in U.S. life expectancy, as
projected by the Social Security Administration,
implies that a 65-year-old American woman in 2050
will live about as long as a 65-year-old Japanese
woman lives today.

 

[fourier jr]

here's a story about the latest study recommending state-run, socialized medicine for the US, this time from Taiwan:

Experts call for health cover in U.S., cite study

Wed Feb 20, 2008 8:20am EST

HONG KONG (Reuters) - Experts called for universal health insurance in the United States, citing a study in Taiwan that showed it increased life expectancy and closed the gap between those who were most healthy and least healthy.

In a commentary published in the Annals of Internal Medicine, the experts said Taiwan's experience lent "credence to the argument that the United States should join other industrialized nations in ensuring universal health insurance coverage".

"Our failure to introduce national health insurance undermines access to care for millions and is a major factor in health outcome disparities and highly preventable deaths in the United States," wrote Karen Davis, of The Commonwealth Fund, and Andrew Huang, of Duke University Medical Centre.

Their call accompanied an article in the same journal on a 10-year study in Taiwan that showed that universal health insurance raised life expectancy.

However, the Taiwan researchers considered the improvements to be modest and called for more aggressive disease prevention programs to reduce lifestyle-related illnesses, such as cancer.

"Two risk behaviors among men in Taiwan, smoking and betel quid chewing, remained high after the introduction of national health insurance," the Taiwan researchers wrote.

http://www.reuters.com/article/healthNews/idUSSHA36232320080220

 

[CaptainQuasar]

That is a very optimistic worst case. Worst case is decades of ever decreasing and ever more expensive health care before the government and the governed finally admit that universal health care was a dreadful experiment.

But, uh, that's what's going on right now. The result of our current experiment in health care of the last several decades is that we have the most expensive health care in the world. You're saying that the most pessimistic outcome you can think of is that we screw it up worse than everyone else in the world has and end up with the same state of affairs we have now. Which, as mheslep has pointed out, the Dutch have demonstrated is a problem it's straightforward to get out of.

I think the inflexibility the “Socialized medicine??11 The sky would fall‼‼” scare tactic leads to is more of a problem than any particular practical issue in any health care solution.

⚛​

 

[TVP45]

There is also the question of the social contract. I am one of the millions of Americans who cannot obtain health insurance at anything approaching a payable premium because I have asthma. It may indeed be the "free market" approach to demand that I fend for myself, yet I have paid school taxes for over 40 years without using those schools, I have paid taxes to support research institutions and military development that I did not directly benefit from, and I served in the armed forces while many did not. In a modern democratic society, there is a "tit-for-tat" which has to exist in order for that society to function. There is no number of police who can maintain civil order if that social contract breaks down.

 

[mheslep]

There is also the question of the social contract. I am one of the millions of Americans who cannot obtain health insurance at anything approaching a payable premium because I have asthma. It may indeed be the "free market" approach to demand that I fend for myself,

The reason you can't afford the help is largely because there is little in the way of a free market. BTW, I don't know of any free market health expert that proposes there should not be a safety net to catch the hard cases - like asthma.

yet I have paid school taxes for over 40 years without using those schools,

Thats a gross inequity IMO, no one should be forced to pay those taxes. Especially at the public university level, the better off are supported by the poorer.

I have paid taxes to support research institutions and military development that I did not directly benefit from,

Yes you did. You might say that the cost was far out proportion to the benefit, or that special interests ripped off the system while delivering it, but you did directly benefit.

and I served in the armed forces

Thank you for your service.

 

[mheslep]

There's a misinterpretation appearing over and over in this thread: that big business, by nature of being private, is necessarily the equivalent of free market enterprise. It is not. Especially when business and government get too close, its highly unlikely that free markets win the day.

 

[CaptainQuasar]

Related to TVP45's comment (and I repeat the thanks for your service, TVP45) I have a question for you, mheslep. And though I'm certainly biased about which overall solution we ought to try first, I'm genuinely curious to hear what answer you have found to this in studying free-market health systems.

And the question is - in a real free market system, wouldn't it be the case that not only people like TVP45 with asthma or other costly pre-existing conditions, but also any individual whose health care costs exceed the premiums they pay would basically be the hot potato amongst whatever companies are footing the bill? (Something like health insurance companies, I would assume.) The most certain way to ensure commercial success, for the companies that actually do the paying for health care services, is always going to be to make sure that individuals do not transit into the category of costs-more-than-they-pay (hopefully via encouraging preventive care, but the incentive will be there to not pay for expensive, needed, procedures) and that existing costs-more-than-they-pay individuals are moved off of their rolls.

That's true in any kind of insurance and it's one of the main reasons why the insurance industry is so heavily regulated in general. And even if we were to come up with something that's different from insurance, the situation above is going to have to be the dominant factor in the risk management scenarios of whatever class of company ends up paying for the actual care.

I would think that must be a pretty large category of people. Isn't the “correct” operation of the market, as it were, going to be to minimize the resources routed to that class of people, as if they're business units that are non-essential cost centers - business units that cost more than the revenue they generate? Won't you need government intervention for that entire class of people? And if you need government involvement for such a large number of people, how free-market can any practical system ever get?

⚛​

 

[mheslep]

That is a very optimistic worst case. Worst case is decades of ever decreasing and ever more expensive health care before the government and the governed finally admit that universal health care was a dreadful experiment.

But, uh, that's what's going on right now.

No, only half right. D H said under socialist health care costs would increase and service would decrease.. Yes the current US costs are increasing so that affordability is down, but overall service is not by any means decreasing (as the evidence overwhelmingly says it does under socialized health care, or anything else). US doctors have MRI machines popping up like the Star Trek tribbles episode.

...You're saying that the most pessimistic outcome you can think of is that we screw it up worse than everyone else in the world has and end up with the same state of affairs we have now. Which, as mheslep has pointed out, the Dutch have demonstrated is a problem it's straightforward to get out of.

California alone has 36millon people, the Netherlands has only 16m. Also the Netherlands, compared to the US, is monolithic in terms of ethnicity, race, and background. In '06 France was almost burned to the ground by indignant and entitled young people who for years enjoyed jobs from which they could not be fired for almost any reason. The new labor bill stopped that, gasp, and http://en.wikipedia.org/wiki/2006_labour_protests_in_France#March_28" in the streets.

I think the inflexibility the “Socialized medicine??11 The sky would fall‼‼” scare tactic leads to is more of a problem than any particular practical issue in any health care solution.

Given the evidence I say its not the detractors of socialized medicine that are naive, but instead the 'why not try it' proponents. There have been numerous severe problems mentioned throughout this thread. I am unclear on exactly which system you proposed the US copy, but you do say its not the Dutch (failure fallback) so I assume you mean the socialized state care ala UK's NHS. This thread has grown large so I'll recap some of the issues. The main economic problem w/ socialized anything:

The real cost of producing any handout will always increase rapidly as the demand increases without check. It matters not who the 3rd party payer may be. If the 3rd party (insurer/government) stops paying the increase, the supplier will inevitably start limiting the quality of the service or good.

Examples:
http://www.fraserinstitute.org/commerce.web/newsrelease.aspx?nID=4967"
http://www.oecd.org/dataoecd/5/27/26781192.pdf" , pg 3.
https://www.physicsforums.com/showpost.php?p=1609935&postcount=57"

My Italian fiance's father was diagnosed with lung cancer. Socialized medicine. They diagnosed him from a single x-ray and scheduled him for chemotherapy. Ooops, x-rays can't determine the difference between the two types of lung cancer and he was given the wrong treatment. He was almost killed because he was also given a near lethal dose of chemo by mistake. When I urged my fiance to raise a rucus, his father was put on a 6 month waiting list to get an MRI, which was at the other end of the country.

http://healthcare-economist.com/2007/09/07/wsj-on-the-dutch-health-care-system/"

In most national social health insurance programs, individuals do not know the value of health care they receive

Pic of France '06: Why not try it?
http://en.wikipedia.org/wiki/Image:Frenchriot-18-mar-06.jpg

 

[gravenewworld]

There's a misinterpretation appearing over and over in this thread: that big business, by nature of being private, is necessarily the equivalent of free market enterprise. It is not. Especially when business and government get too close, its highly unlikely that free markets win the day.

Name me ONE big free market. Just ONE, that has absolutely 0 government influence. Hint: they only exist in some utopia on paper.IN a 100% free market health care system an insurance company would have every right to deny someone health coverage if they were too much of a liability to their profits.Here is a free market for you:

http://economics.about.com/library/graphics/demand1.bmp
So tell me in this 100% free market, what do all the people who lie on the demand curve below equilibrium levels do? Also one of the assumptions of a free market is that firms that supply goods can enter and exit freely from the market. This would never happen in the real world for something like health insurance. Firms can't enter at will due to huge start up costs.

The free market is overrated.

 

[TVP45]

The reason you can't afford the help is largely because there is little in the way of a free market. BTW, I don't know of any free market health expert that proposes there should not be a safety net to catch the hard cases - like asthma.


Thats a gross inequity IMO, no one should be forced to pay those taxes. Especially at the public university level, the better off are supported by the poorer.


Yes you did. You might say that the cost was far out proportion to the benefit, or that special interests ripped off the system while delivering it, but you did directly benefit.


Thank you for your service.

Thanks for the thoughtful reply. I was not in any sense complaining, especially since I am currently smart enough to handle this. My point was I do feel an obligation to my fellow citizens - after all, we were all sojourners in a strange land once - and I willingly pay (and don't ever cheat) on taxes as the dues I owe a civilized society. I may vote against them at times but I pay them.

But, lots of people are not smart (or lucky) enough and so we see, as in the housing foreclosures where disgruntled homeowners simply trash their foreclosed houses, that the social contract does have to be taken into consideration. A night in a big city ER quickly convinces one that there is a hell of a lot of very expensive care given to relatively minor illnesses; if we turn that off for lack of funding, where do those folks go? How long will they tolerate it?

 

[fourier jr]

Americans should only pay for the roads that they use. Why not? But then they'd have to keep people who didn't pay for those roads off them, and to do that they should hire Blackwater or some other army. & if someone comes along with a bigger/better army the people who own the road should get nuclear weapons, but who would want to live in a society like that?

 

[CaptainQuasar]

mheslep quoted:

The real cost of producing any handout will always increase rapidly as the demand increases without check. It matters not who the 3rd party payer may be. If the 3rd party (insurer/government) stops paying the increase, the supplier will inevitably start limiting the quality of the service or good.

And how exactly does this not apply to a non-socialized system? That quote mentions insurers right there. Any “free market” system that actually adequately insures everyone would face the same problem that is described above. If theoretically people knowing the costs of medical procedures would fix that… then, drum roll please… we build a socialized system that tells people what the care costs! We don't need to try to build the first broadly successful free market system in the history of human kind just to try to get people informed of and responding to costs.

If what you wrote above really the summation of all of the arguments and evidence people have been able to assemble in the course of this 150-post thread, that's pretty underwhelming, and I'm glad I didn't go through and read it all. (Thank you for the summation, by the way.) It actually surprises me that you put that together and spoke as if it was daunting or something.

All you've got is some inconvenient waiting periods - which I can't imagine result in unusually high fatalities or complications, because if there were numbers like that around you'd be quoting those instead - an anecdote that except for the MRI thing could easily have happened in the U.S., and something about people not knowing the costs of their care? That's the justification you would use to claim that entertaining a publicly-funded health care system is naïveté?

And you prop that stuff up next to a picture you got off of Wikipedia of a burning car that was taken during labor / unemployment riots in the banlieues? You're pretty much making my point for me that opposition to socialized medicine is carried out via scare tactics.

⚛​

 

[mheslep]

Related to TVP45's comment ...I'm genuinely curious to hear what answer you have found to this in studying free-market health systems.

And the question is - in a real free market system, wouldn't it be the case that not only people like TVP45 with asthma or other costly pre-existing conditions, [...] would basically be the hot potato amongst whatever companies are footing the bill? (Something like health insurance companies, I would assume.) The most certain way to ensure commercial success, for the companies that actually do the paying for health care services, is always going to be to make sure that individuals do not transit into the category of costs-more-than-they-pay (hopefully via encouraging preventive care, but the incentive will be there to not pay for expensive, needed, procedures) and that existing costs-more-than-they-pay individuals are moved off of their rolls.

That's true in any kind of insurance and it's one of the main reasons why the insurance industry is so heavily regulated in general. And even if we were to come up with something that's different from insurance, the situation above is going to have to be the dominant factor in the risk management scenarios of whatever class of company ends up paying for the actual care.

I would think that must be a pretty large category of people. Isn't the “correct” operation of the market, as it were, going to be to minimize the resources routed to that class of people, as if they're business units that are non-essential cost centers - business units that cost more than the revenue they generate? Won't you need government intervention for that entire class of people? And if you need government involvement for such a large number of people, how free-market can any practical system ever get?

Excellent question. For focus, let's just discuss the chronically ill here. Since insurance (in the traditional, economic sense) is bought to cover the unexpected i.e. bike wreck, get cancer, then yes agreed it doesn't make sense to insure conditions stemming from chronic conditions, which by their nature are always there. So here is a case that warrants a government subsidy - part of the safety net. I don't favor insurance regulation and mandates, that just drives up the cost. The idea (published) I favor is still market related. Offer the insurance market a government subsidy to cover the chronic conditions. Works like this: Federal govt sets up a pool of money to subsidize chronic illness. Our proud Vet TVP45 or a diabetic goes out into the market place to buy health insurance. Say the usual non-chronic healthy (otherwise same conditions) pays $Xk/yr. Fed steps in, "insurance company, you can dip into this pool of $ if you cover TVP45 for conditions related to his asthma. We'll pay you $3X on top of TVP's $Xk/yr". (Maybe TVP can improve the guess - I don't know what the multiplier is of asthmatic costs vs the general population.)

Now let's scope this problem in finer detail to answer the size question. The chronically ill include many conditions like AIDs, but Asthmatics and diabetics dwarf everything else by number: Asthmatics 25 million, diabetics 15m, say 40 million chronically ill. Recall though that this chronic care subsidy is just to cover problems related to the chronic problem, like blindness from diabetes, this is not blanket coverage like medicare. If TVP45 breaks his neck bungie jumping the tax payer is off the hook, the regular insurer pays the tab. Chronic care subsidy would then be ~40m x 3Xk/yr. Thats $120B if X=1, still a fraction of the $2 trillion in health care spending. Obviously keeping the general insurance cost X low is an issue, but that's for another post.

There's a similar precedent for this kind of thing in auto insurance (at least in my state) where those that have a couple too many speeding tickets to get regular coverage are put into a state backed special insurance category, otherwise the auto insurers would never pick you up. Everybody's happy.

 

[mheslep]

mheslep quoted:

And how exactly does this not apply to a non-socialized system? That quote mentions insurers right there. Any “free market” system that actually adequately insures everyone would face the same problem that is described above.

In the context of the original post insurers means employee based insurance w/ associated tax exemption. There's very little free market about it that, as the users don't have much choice of insurance, the insurance is highly regulated, and the user's rarely see a doctor bill.

If theoretically people knowing the costs of medical procedures would fix that… then, drum roll please… we build a socialized system that tells people what the care costs!

Knowing would only help marginally. You have to know and pay to get the free market effect of "searching for the highest possible value at the lowest possible cost." What do I care about costs if the government pays, even if they can tell me the cost. It is free to me at the point of service, and just as the quote says I am going to try and get as much of it as possible until I'm checked, driving the cost through the roof until the govt. imposes rationing.

All you've got is some inconvenient waiting periods - which I can't imagine result in unusually high fatalities or complications, because if there were numbers like that around you'd be quoting those instead - an anecdote that except for the MRI thing could easily have happened in the U.S.

Come on, clik through and read the thing. Yes of course mistakes happen in the US its a big problem. Thats not main point. Its clear in this case that the father w/ cancer was either going risk death from the MRI wait, or go to another country for help.

And you prop that stuff up next to a picture you got off of Wikipedia of a burning car that was taken during labor / unemployment riots in the banlieues? You're pretty much making my point for me that opposition to socialized medicine is carried out via scare tactics.

Please stay on point. I am clearly not speaking there about implementing state care, I'm speaking to the suggestion that it could be just done away with when there's no example in modern history of doing away with any thing that cost $2 trillion. Your point was principally 'lets try socializing this massive economic sector, if it doesn't work we can just drop it as others have'. The French labor law was example of exactly that, the elimination of a very large universally government provided system for which millions had come to believe was their unassailable right. The riot posts were completely justified. (Not saying were French )

 

[mheslep]

Name me ONE big free market. Just ONE, that has absolutely 0 government influence.

Hint: they only exist in some utopia on paper.

Semiconductors. $216B. 5 orders of magnitude improvement in 30 yrs. Also entire 1st 140 years of US economic history government was involved in only 10% of the economy.

 

[CaptainQuasar]

mheslep - thank you for some cogent analysis of my hot potato question above. I do think that market-based mechanisms like what you describe ought to be part of any solution public or private. And it's good to know that even when you're proposing 100% free market there's still that level of government involvement to protect the disadvantaged players to some degree.

In response to your other post, there are lots of points to it which I'll respond to below. But my overall assessment is that this is an underwhelming set of questionable assertions to base calling naïve the people who disagree with you, especially next to your Chicken Little “The sky will fall!” story and picture of a burning car. If this really is the sum of it, as far as I see there's no reason whatsoever not to go forward with a national health plan immediately.

And another thing - I know it wasn't you who referred to any socialized medicine plan as an “experiment”, when it's what we've got most of the evidence and data about as opposed to no real systemic data at all on the theoretical fix-everything free-market solution, but doing so is absurd and pejorative and another example of how the campaign against socialized medicine can more easily be identified by common tactics rather than reasoning.

In the context of the original post insurers means employee based insurance w/ associated tax exemption. There's very little free market about it that, as the users don't have much choice of insurance, the insurance is highly regulated, and the user's rarely see a doctor bill.

I understand that. I just don't think that there's any magic way a free market system would be better able to deal with the problem without ending up denying a pretty substantial number of legitimate claims, and hence requiring government intervention on a large scale and possibly ending up back in a situation similar to what we've got now, so I don't regard a free market solution as an automatic fix to that.

Something we definitely don't want is one of the anecdotes portrayed in Sicko, where a guy cut off two of his fingers and had to choose between them, choosing the least expensive one to reattach and losing the other.

If they successfully incentivize doctors and other health care workers to increase quality in these national health systems there are equivalent ways to incentivize the patients of the healthcare system to pursue lower costs. Think of airline frequent flyer miles; that isn't a market (or if it is, it's one that could be easily implemented within a socialized medicine system), but although it isn't a market the airlines and their partners are able to get people to jump through all sorts of hoops in pursuit of frequent flier miles. I would say that programs like this would probably actually work better within a socialized medicine system rather than trying to achieve that sort of result across a patchwork of different companies.

Knowing would only help marginally. You have to know and pay to get the free market effect of "searching for the highest possible value at the lowest possible cost." What do I care about costs if the government pays, even if they can tell me the cost. It is free to me at the point of service, and just as the quote says I am going to try and get as much of it as possible until I'm checked, driving the cost through the roof until the govt. imposes rationing.

I'm skeptical that this really is an automatic outcome of every sort of care provided under an nationalizes system is drastic shortages in every category. If that really was the case I think there would be quite a lot more data to support is. I'm also skeptical that in the current system the same sort of thing isn't happening. For example, in some years past I worked as a nurse's aide and I know there was a tremendous shortage of nurse's aides and nurses that I'm pretty sure is still going on today. And of course we may lack some data on our current system because people don't even try to get procedures or services their health insurer has denied or which they otherwise can't afford.

Yes, some people behave this way in response to something that they think is all-you-can-eat, but it's pretty easily dealt with. Just think of it: commercial companies offer free deals all the time and they're somehow able to control these sorts of people.

I think the kind of incentive program I talked about before should be integral to any solution public or private and be used to encourage preventive care and other things. At some point we really need to have a nationally standardized health records system and it would be trivial to build up the infrastructure for an incentive program along with it.

Come on, clik through and read the thing. Yes of course mistakes happen in the US its a big problem. Thats not main point. Its clear in this case that the father w/ cancer was either going risk death from the MRI wait, or go to another country for help.

I clicked through and read all of them including the PDF. These just aren't any sort of justification to call the people who disagree with you naïve.

Please stay on point. I am clearly not speaking there about implementing state care, I'm speaking to the suggestion that it could be just done away with when there's no example in modern history of doing away with any thing that cost $2 trillion.

Sure there are. Every large military force ever raised in the last century amounted to that in today's dollars and gave suckling teats for all sorts of defense industry companies and jobs for millions of people, and there weren't riots when we went back down to normal levels and the contractors got cut off and the soldiers and other workers lost their jobs.

Why aren't we going to have people rioting and burning cars when we transition from our current system to your free market system if it's so inevitable with any large change? Why won't the insurers who specialize in group policies go nuts and we'll find ourselves with insurance salesmen smashing our car windows and turning them over and setting them on fire? Oh, let me guess, because there's going to be a place for them in your new system. Obviously any other transition would be handled the same way.

I've got to say, it's pretty darn arrogant for you to make a the-sky-will-fall-but-just-in-the-case-of-socialized-medicine claim, upload a photograph from a riot of all things, and then say I'm going off topic to point out that this is a completely slimy scare tactic.

⚛​

 

[CaptainQuasar]

Semiconductors. $216B. 5 orders of magnitude improvement in 30 yrs.

How long was it, again, before you could buy a PC-compatible processor from anyone other than Intel? (and IBM, while the reciprocal licensing deal lasted.) And surely you're familiar with the concept of companies intentionally making things obsolescent? Or making proprietary components and systems that interoperate only with each other and not with those of their competitors? Much of the progress that has been made in standardization has been the result of the efforts of a few very large and powerful consumers (like the U.S. government!) - a complete contradiction of the perfect free market scenario. The success of the semiconductor industry is by no means attributable strictly market dynamics, much less market dynamics of a perfect market.

I think that example would have some relevance if health care was also something that you had to throw away every year and buy a new one. But it isn't.

Also entire 1st 140 years of US economic history government was involved in only 10% of the economy.

Robber barons of steel, oil, coal, and railroads establishing monopolies and occasionally becoming so wealthy that the federal government had to borrow money from them (J.P. Morgan), major exploitation in the manner in which land and mineral rights were purchased from Native Americans (specifically the occasions when it was purchased, of course, there were many instances when it was not), a different currency in each state, industrial indenture of workers and child labor, http://en.wikipedia.org/wiki/The_Jungle" type stuff with sausage and hot dogs manufactured with sawdust as an additive… not a really great example of a free market itself, nor a positive depiction of the effects of laissez faire.