Who should pay the healthcare costs of the uninsured?

[Evo]

Moonbear pointed out the problem that, I think, most are missing. Hospitals really do bill things like $10 kleenex boxes and major insurance companies pay rates like $1.25 and the hospital accepts that. The uninsured person is stuck with the whole $10. And this is done on most things. Some physicians are fighting back by setting prices at the standard insurance reimbursement rate, but that is still few and far between.

Yes, but like in the link to the hospital I posted, they will make "reduced fee" arrangements. Of course they are going to ask full price first, they are a business, but you can negotiate them down. In the case of the un-insured 19 year old I mentioned, when he checked out, they had a pre-prepared "package" of forms to file to get his expenses paid and they helped him fill them out. They want money, they don't care who they get it from, and they know they aren't going to be successful going after an unemployed 19 year old, so it behooves them to assist the patient in seeking financial help.

 

[mheslep]

Good points... however you're missing the key ingredients to rights... that is the "facilitation of human rights" and that is what a government is bound by law to do... facilitate the right to free speech, and facilitate the right to assembly.

Whoa, I think you are far over inflating the facilitate balloon here. There is only one function for which government was originally granted a reason to exist by the US framers: to insure life/liberty/property, in pursuit of which the federal government is tasked to provide for the common defense and the states are to provide a police function and thereby protect life and limb. All the other rights enumerated in the US ten amendments are there specifically to stop government (federal or state) from infringing them and not in any way to task government with facilitating them. I don't care to have the government facilitate any of those 10 amendments, it merely needs to take heed that it does not infringe itself.

This is why you see police separating certain factions at assemblies... they are (apparently) facilitating the right to assemble in a peaceful fashion.

Good point, but the peaceful part is the only job the government has there - state/local protection of life/liberty. The cops shouldn't be doing anything else providing protection.

Are you telling me that the right to freedom of speech is impinging upon a librarians right to unemployment... We do not infringe on the rights of doctors, nurses etc... by employing them to provide health care to the population. We facilitate the rights of humans to receive adequate and quality heath care. This involves employing and paying 150 grand a year to doctors or a fee schedule that matches their patient load.
There are no laws that prohibit a doctor's right to practice privately, elsewhere, perhaps in a country where human health issues are a gold mine for the private and commercial interests of incorporated clinics.

I'd say its very clear at least in the Ca. case that a doc's rights to freely pursue his/here interests are impinged. They're Canadian citizens. As such they should have a right to freely practice their profession in they're own country without being told by the government what they're worth. Imagining no rights are impinged since they're free to leave is tantamount to banning free speech locally and claiming no rights are violated because there is free speech elsewhere, let them go elsewhere if they want to rabble rouse. If you (wisely) allow private care in parallel with the state plan which allows those who can afford it a better deal, well then you are walking away from the original idea that health care is a right. Either it is a right meaning no one can be deprived in any way of the same care enjoyed by the next guy (ala speech, right to life/liberty), or it is not.

The cowardly Hyenas always go for the weak and injured in the population.

Absolutely, the life/liberty/property proctection argument. This is why, the only strong reason why "Governments are instituted among Men". When the government starts getting big into other things the Hyenas just buy themselves a seat the table, makes it much easier for them.

 

[baywax]

Whoa, I think you are far over inflating the facilitate balloon here. There is only one function for which government was originally granted a reason to exist by the US framers: to insure life/liberty/property, in pursuit of which the federal government is tasked to provide for the common defense and the states are to provide a police function and thereby protect life and limb. All the other rights enumerated in the US ten amendments are there specifically to stop government (federal or state) from infringing them and not in any way to task government with facilitating them. I don't care to have the government facilitate any of those 10 amendments, it merely needs to take heed that it does not infringe itself.
Good point, but the peaceful part is the only job the government has there - state/local protection of life/liberty. The cops shouldn't be doing anything else providing protection.
I'd say its very clear at least in the Ca. case that a doc's rights to freely pursue his/here interests are impinged. They're Canadian citizens. As such they should have a right to freely practice their profession in they're own country without being told by the government what they're worth. Imagining no rights are impinged since they're free to leave is tantamount to banning free speech locally and claiming no rights are violated because there is free speech elsewhere, let them go elsewhere if they want to rabble rouse. If you (wisely) allow private care in parallel with the state plan which allows those who can afford it a better deal, well then you are walking away from the original idea that health care is a right. Either it is a right meaning no one can be deprived in any way of the same care enjoyed by the next guy (ala speech, right to life/liberty), or it is not.

Absolutely, the life/liberty/property proctection argument. This is why, the only strong reason why "Governments are instituted among Men". When the government starts getting big into other things the Hyenas just buy themselves a seat the table, makes it much easier for them.

Canada doesn't allow lobbyists to sit at the table. Lester B. Pearson started the universal health care act and the student loans act back in the mid 1900s. This was based on the model that was started by Tommy Douglas who was then premier of Saskatchewan. Douglas enjoyed great success with the idea. But, as I've pointed out, it wasn't a law that governed the health of 300 million people... it was in Saskatchewan with perhaps just a few million. Then Lester Pearson introduced it to all of Canada which was still a nation of only about 22 million or so.

You'll note that the universal student loans act and the universal health care act were instituted at the same time... these acts facilitate the right to quality of life. Quality of life ensures a strong nation and its a win win situation.

Its the same principal governing both education and health. With education offered free and health offered free people's quality of life is somewhat guaranteed to be bettered by both initiatives.

It may be that the whole idea justified "income tax" to begin with. Since it really was a war measures act to collect income tax and was actually supposed to be abolished by definition, after the war (providing we won the war) perhaps being able to offer something of value to the tax payer such as free health and education helped to maintain the perception of value for the money in Canada.

I really don't have a grasp of the state and federal roles in your amazingly complex country of the United States. The American rules for football are enough to put me off! Just don't •••• with Hockey rules... ok?! But, in Canada the Feds send money to the Provincial govts to facilitate the medical act. Each province has the right to distribute the cash as they see fit... as long as everyone it their province is adequately covered for health insurance. Let's remember we have only 8 provinces and 3 territories.

Alberta probably has no premium for its citizens... no monthly bill. And they have no prov. sales tax either. That's because they've allowed Exxon, Shell, Chevron etc... and some Chinese players to dig the •••• out of their tar sands... threatening the health of their citizens with contaminated water sources... while collecting royalties from these companies. But other provinces charge a premium from their citizens because they are the "have not" provinces and need to add to the Fed. govt's health care payments.

I haven't addressed the other points in your post. There are huge issues that arise out of either system. The public funded system leaves much to be desired. The privately funded system leaves even more to be desired.

If we dug up stats on the number of people wandering the streets with mental health problems we'd probably match each other per capita. The fact that these people are left to fend for themselves is a major drain on the economy of the federal and (state), civic, provincial budgets. Police spend 50 percent of their budgets answering calls concerning the un-cared for mentally ill. This means close to 50 percent of crime is a direct result of no medical care or shelter for the mentally impaired. This also means the budget for police is being bled by the lack of funding for this condition when the police could be nice and busy facilitating the right to peaceful assembly... which is a right we don't have in Canada!

 

[TVP45]

Yes, but like in the link to the hospital I posted, they will make "reduced fee" arrangements. Of course they are going to ask full price first, they are a business, but you can negotiate them down. In the case of the un-insured 19 year old I mentioned, when he checked out, they had a pre-prepared "package" of forms to file to get his expenses paid and they helped him fill them out. They want money, they don't care who they get it from, and they know they aren't going to be successful going after an unemployed 19 year old, so it behooves them to assist the patient in seeking financial help.

I quite agree that, for an unemployed 19 yo, they will negotiate. But, for a 35 yo, earning $30k a year with $50k equity in his house, 2 cars, and a modest IRA, tain't going to happen nearly as fast. That, of course, may be a regional thing - I have little knowledge out side the Atlantic central area.

 

[TVP45]

Whoa, I think you are far over inflating the facilitate balloon here. There is only one function for which government was originally granted a reason to exist by the US framers: to insure life/liberty/property, in pursuit of which the federal government is tasked to provide for the common defense and the states are to provide a police function and thereby protect life and limb. All the other rights enumerated in the US ten amendments are there specifically to stop government (federal or state) from infringing them and not in any way to task government with facilitating them. I don't care to have the government facilitate any of those 10 amendments, it merely needs to take heed that it does not infringe itself.
Good point, but the peaceful part is the only job the government has there - state/local protection of life/liberty. The cops shouldn't be doing anything else providing protection.
I'd say its very clear at least in the Ca. case that a doc's rights to freely pursue his/here interests are impinged. They're Canadian citizens. As such they should have a right to freely practice their profession in they're own country without being told by the government what they're worth. Imagining no rights are impinged since they're free to leave is tantamount to banning free speech locally and claiming no rights are violated because there is free speech elsewhere, let them go elsewhere if they want to rabble rouse. If you (wisely) allow private care in parallel with the state plan which allows those who can afford it a better deal, well then you are walking away from the original idea that health care is a right. Either it is a right meaning no one can be deprived in any way of the same care enjoyed by the next guy (ala speech, right to life/liberty), or it is not.

Absolutely, the life/liberty/property proctection argument. This is why, the only strong reason why "Governments are instituted among Men". When the government starts getting big into other things the Hyenas just buy themselves a seat the table, makes it much easier for them.

I think you have confused Mr. Jefferson's writings with those of Mr. Madison. The original ten amendments, commonly called the Bill of Rights, did not apply to the states until after the Civil War (1866 I believe). Mr. Madison specifically tried to make them apply through the so-called "Lost Amendment", but that was removed by the convention prior to approval of the Constitution. Thus, freedom of religion, for example, did not exist in all states until the 1820s, and freedom of political speech did not exist in all states until after the Civil War.

 

[mheslep]

I think you have confused Mr. Jefferson's writings with those of Mr. Madison. The original ten amendments, commonly called the Bill of Rights, did not apply to the states until after the Civil War (1866 I believe). Mr. Madison specifically tried to make them apply through the so-called "Lost Amendment", but that was removed by the convention prior to approval of the Constitution. Thus, freedom of religion, for example, did not exist in all states until the 1820s, and freedom of political speech did not exist in all states until after the Civil War.

I meant that most of the states had their own rights protections installed in their own state constitutions. That Bill of Rights for instance, was the Virginia Bill of Rights. And yes in 1866 the 14th amendment to the US constitution enforced federal prohibitions on the states governments as well. I emphasis the word 'prohibitions' here, not facilitations. The amendments are loaded w/ phrases like 'congress shall pass no law', the government ... 'shall not', rights are reserved to the people, etc.

 

[mheslep]

I agree to leave hockey alone. However:

Canada doesn't allow lobbyists to sit at the table

They've slipped by you, the sneaky bastards, and these are only the ones who officially signed up:
http://lobbyist.oico.on.ca/Integrity/RegistrationGeneral.nsf/MainFramesWeb?OpenPage"All of the medical stake holders, docs, nurses, etc in there, along w/ big oil and gas. Google query quickly shows plenty of cases where their money is getting to the pols.

 

[baywax]

I agree to leave hockey alone. However:

They've slipped by you, the sneaky bastards, and these are only the ones who officially signed up:
http://lobbyist.oico.on.ca/Integrity/RegistrationGeneral.nsf/MainFramesWeb?OpenPage"All of the medical stake holders, docs, nurses, etc in there, along w/ big oil and gas. Google query quickly shows plenty of cases where their money is getting to the pols.

The link is to a govt of Ontario document. Ontario is a province. That province holds the nation's capital but its really just a province. I can see where you're at with this, we have medical staff on the health minister's payroll and they are the door into the govt.'s deal making and regulating. The Medical Association of Canada and the MA of each province is fairly vigilant about what policies are acceptable or not... and what treatments are good or not. We do not dodge incredible finds like Vitimine D and all its benefits just so a pharmaceutical company can sell its anti-depressants or its designer anti-growth hormones for cancer. We don't shrink from using the Hyperbolic Chambers to heal diabetics wounds rather than hiding its benefits and going with some designer drugs made by Pfizer. This is because there are doctors in the Associations who have a conscience and see the need to unburden the whole system with generic drugs and home remedies... and this is because they are assured a salary from the govt... they're not bound to anyone company, institute or group of incorporated doctors... or the humungous entanglement of insurance companies you deal with in your incredibly beautiful and dawn early light of a place... America.

But I know for a fact Monsanto and big Oil have had a go at our polly wolly doodle all day ministers of state. How else could they be riddling our country with contaminated soils and water and genetically modified cannola, etcetra... not to mention the cloned beef and mad cow. I don't mean to be protectionist but... that's why we have a military. To protect quality of life. That's why we facilitate the health act... to protect quality of life... that's why we have an education act... protecting quality of life.

If we just let the free market educate our children... how well would that work? If the free market comprised our military... would that look like Blackwater to you? How about if we just let the lobbyists run the country... if they aren't already!

 

[gravenewworld]

Apparently.

You have said that if you aren't insured you can't get medical treatment without going bankrupt, that is really not true. No one is saying that medical expenses can't become overwhelming, but it is not the scenario you are painting that without insurance there is no help. Here is an example of what I am talking about
Quote:
Healthcare for all New Yorkers
Paying for your healthcare

Financial concerns should not keep New Yorkers from seeking the healthcare their families need. At HHC we are committed to helping our patients find financial assistance, whether through a low or no cost insurance program or through a reduced fee arrangement.

HHC offers its patients the opportunity to examine a variety of payment options. Click below to learn more:

HHC Options - HHC's own financial assistance and charity care program
MetroPlus - An HHC subsidiary which offers health plans under Medicaid, Child Health Plus, Family Health Plus and MetroPlus Gold
HHC hospitals accept a variety of other health insurance plans.
http://www.nyc.gov/html/hhc/html/access/paying.shtml

So you point out a city program? State/city programs vary widely state by state. The example you pointed out isn't true everywhere else in the country. I know for a fact that here in PA, if you don't have insurance you can get coverage by the state for about a $30 deductible per month, however the waiting list to get coverage through the state for the uninsured is 1-2 years long because of limited funding! What are you supposed to do until then?

Those living outside of NYC in NY state are also restricted by income for state health coverage. A family of 4 is only allowed to make $32 K a year (and the middle class are one of the fastest rates of growing un and underinsured).

See above. As I mentioned previously, if the medical expenses aren't emergency, you would have agreed to the expense, so a creditor would have a better chance of collecting. What percentage of the medical debts were for emergency medical treatment that the patient hadn't previously agreed to? Also, many people aren't aware of the help available to them, although it's unusual for a hospital nowdays to not offer assistance in finding ways of being paid. Bankruptcy is an all too easy way of getting out of paying off debts, but courts are starting to crack down and make it harder to file for bankruptcy. Just because people aren't aware of the help available to pay for medical expenses doesn't mean they aren't there.

What does it matter? Emergencies don't care if you have insurance or not, they could happen to anyone at anytime. So basically what you are saying is that if you are uninsured and ever in a car accident, have a mishap at work, or slip and fall and break a leg you are SOL. http://www.latimes.com/business/la-fi-bluecross13feb13,0,4778416.story

Blue Cross halts letters amid furor

Its request to doctors for data that could lead to policy rescissions was widely criticized.
By Lisa Girion and Jordan Rau, Los Angeles Times Staff Writers
February 13, 2008Facing a torrent of criticism Tuesday, Blue Cross of California abruptly halted its practice of asking physicians in a letter to look for medical conditions that could be used to cancel patients' insurance coverage.

http://query.nytimes.com/gst/fullpa...932A05751C1A9669C8B63&sec=&spon=&pagewanted=2

H.M.O.'s to Drop Many Elderly and Disabled People

http://www.latimes.com/business/la-fi-insure9nov09,0,3065397,full.story?coll=la-home-center

Health insurer tied bonuses to dropping sick policyholders

By Lisa Girion, Los Angeles Times Staff Writer
November 9, 2007

One of the state's largest health insurers set goals and paid bonuses based in part on how many individual policyholders were dropped and how much money was saved.

http://www.latimes.com/business/la-fi-insure17apr17,0,3901131.story

Insurer allowed to drop Realtors' health coverage

Lisa Girion, Los Angeles Times Staff Writer
A judge ruled Monday that Blue Shield of California could cancel group health insurance for the California Assn. of Realtors, apparently dooming it to the growing list of organization-sponsored health plans that have died in recent years, leaving people uninsured.

Interesting, BCBS did the same exact thing to my company.

Need I go on?

 

[mheslep]

Interesting, BCBS did the same exact thing to my company.

Did your company drop all health care coverage plans when it lost BCBS, or did it get another? What's so exceptional about BCBS?

 

[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.

⚛​

 

[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.

⚛​

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.

⚛​

 

[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.

⚛​

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.

⚛​

 

[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.

⚛​

 

[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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