News Why not free universal healthcare if

[Benzoate]

OK, check it out, you take out a loan for bail and get it back when you make your court date and then pay the bail bondsman back plus fee/interest. But, if they give you less than you borrowed, then the bailbondsman doesn't get all his money back. The criminal may be spending years in jail, HE CAN'T PAY HIM BACK. This begins to affect anyone needing a loan because the rates will go thru the roof to cover defaulted loans. Think about it. If money needs to be given to a victim, the victim can sue for it. That's how it's done.

you are right ; I can see if the victim gets life in prison or the death penalty. If he is served a limited sentence of a finite number of years, then he is able to pay the loan.

 

[vanesch]

I'm undecided on the issue. It might not be the worse thing to have .gov require insurance, similar is done now in the US for auto liability insurance. But I am far from sanguine about it. Just another step towards the nanny state?

As you correctly point out, it is of the same kind as the required auto liability insurance, although it goes further. As the fee of the mandatory public health insurance is (for the same services) proportional to revenue, it is ALSO a kind of tax, in that it imposes some kind of solidarity (the rich pay a bit for the poor), while the car insurance is flat fee of course (well, not depending on your wealth, but rather on your objective risk factor).

But in both cases (actually more so for the health care) it is a relatively SMALL fee which can cover a potentially LARGE expense, and which, as your example points out, nobody can be sure not to need one day. In other words, to avoid a small expense, people who would refuse a minimum coverage do something objectively stupid. In any case, it is a small (relatively to your wealth) fee, it is not going to avoid you buy a bigger house, or go on a fancier holiday or anything, and you run a serious risk that one day, you have a SERIOUS problem. That's why it is objectively stupid: the gain you get from refusing it doesn't weight in with the potential danger you put yourself into.

As to the nanny state, I'm also against law enforcement that *obliges* you to BEHAVE in a safe way (as long as you're not increasing the risk for others of course). Nobody can determine how much pleasure you get from smoking, and whether or not you are willing to sacrifice your health for the pleasure of smoking, say. So although for most people, this is a stupid action, as you cannot quantify the "gain" (pleasure in doing so), you cannot objectively show that it is stupid.

But the insurance fee is really small, so you can quantify it. The gain isn't big, it is equal to the fee.

 

[Schrodinger's Dog]

Well being all pedantic and precise, in the UK the amount you pay never meets the amount you take out, in all but the highest earners. So although you pay a little extra in tax to cover this, you are actually partially subsidized, rich or poor, unless you are substantially rich, or unusually healthy.

 

[mheslep]

One thing is sure: a system that provides for ALL NEEDS for FREE has been tried, it's called communism, and we've seen that it doesn't work very well.

Agreed, though there are many that would not; the idea being that the political theory of communism would have worked just fine but for Stalin et al getting in the way and mucking it all up.

But I think the gist of this discussion is: can we morally accept in a modern society, that there are people who aren't able to provide in their BASIC needs (that means that they are put in a life-threatening situation, otherwise the needs aren't basic), and that we let them just rotten, while others are enjoying crazily superfluous luxuries ? Is it morally acceptable that a 5-year old kid is not getting any food, has no clothes, must walk in the rain and hasn't any place to hide, just because his parents are poor ?

There are many other moral dependencies here but those aside for the moment, my opinion: no its not acceptable. -Though I tend to view these problems morally when addressing my neighbors or those I can reach out to in the Good Samaritan sense, not the whole society (whatever that is) at one time.

Of course, overall wealth will probably decrease a bit (according to some economic theories) if we do that. Yes, we will be a bit less rich if we do so. Yes, the economy will work a bit less good if we tax, take away some motivation, etc...

First, I think the implied proposition of a tax a little, help as a linear relationship is not the case. US Welfare before the reform of the 90's was a good counter example. The actual help provided to the user tends to place exponentially growing demands on the supplier, not linear, while at the same time creating unintentional dependencies in the user. Second, government is just inherently not a mechanism that is well suited for putting roofs over peoples heads. You, I, or some group of volunteers can perhaps, but not government.

But it may be a political choice that that is an acceptable price to pay in order to solve some moral dilemma.

I'm skeptical that political choices solve moral dilemmas. The domains are too different.

 

[W3pcq]

I would think that a socialized health care plan wouldn't hurt the economy, or our growth. First of all, most people will be paying overall less money, taxes and all, for their health care. This leaves you extra money to invest and buy. Health care would be provided for everyone, so we would a larger amount of healthy people able to work. We would have less people going bankrupt. The extra tax we would need to pay would amount to much less than the cost of insurance, even without deductibles.

I don't think this is an issue of poor people not being able to provide for themselves so much as it is people making it practically impossible for them to do so. This isn't a moral issue of whether the rich should support the poor, but more of an issue of should rich insurance companies be exploiting everyone.

In cuba an inhaler cost you 15 cents. In the US it cost you almost $100. Why do we need to have a middle man making such ridiculous profit margins off of things that people need to be healthy.

Then you have Hillary who wants to have government mandated private insurance. So now we are not only going to have corporations praying off of our health needs like vampires, but they will be doing so with more protection from our government. Get ripped off or go to jail. Hardly a solution.

 

[mheslep]

I would think that a socialized health care plan wouldn't hurt the economy, or our growth. First of all, most people will be paying overall less money, taxes and all, for their health care. ...

We already have socialized heath care in the form of Medicaid, Medicare where .gov pays. These do hurt the budget and thus the economy and the costs continue to grow rapidly. Why would you want more of that?

 

[turbo]

We already have socialized heath care in the form of Medicaid, Medicare where .gov pays. These do hurt the budget and thus the economy and the costs continue to grow rapidly. Why would you want more of that?

These services are trying to operate in a medical system that is extremely over-priced due in great part to the insurance industry and the drug companies. Don't you ever wonder why drugs made in the US are so cheap in Canada that seniors pay to make cross-border bus trips to get their prescriptions filled? If the entire populace were covered by a single-payer system, the savings to medical practices would be significant. In addition, preventable diseases could be caught and treated earlier, reducing or eliminating the need for late-stage intervention (the most costly option in almost all cases) which preserves quality of life, extends life-span and helps keep people productive.

 

[W3pcq]

We already have socialized heath care in the form of Medicaid, Medicare where .gov pays. These do hurt the budget and thus the economy and the costs continue to grow rapidly. Why would you want more of that?

One problem is that any gov program could be described as "hurts the budget". If we did all the math and found that X% increase in taxes was sufficient to make a well working health care system for all, and we ok the tax increase, who is to stop the government from spending too much money somewhere else and stealing from the health budget to increase another budget elsewhere.

That is why we may want to have a system where there is a specific medical tax paid yearly which goes into an exclusive medical fund.

It would be much like what goes on today with our private system except that it would be "fair", hopefully. Basically, all that would happen is that we would eliminate the middle man.

 

[mheslep]

These services are trying to operate in a medical system that is extremely over-priced due in great part to the insurance industry and the drug companies. Don't you ever wonder why drugs made in the US are so cheap in Canada that seniors pay to make cross-border bus trips to get their prescriptions filled?

Canada PMPRB imposes price controls on the drugs, as do many other countries, so that they in effect free ride on the American consumer, that's why.[1] Are you arguing for price controls in the US too?

If the entire populace were covered by a single-payer system, the savings to medical practices would be significant. In addition, preventable diseases could be caught and treated earlier, reducing or eliminating the need for late-stage intervention (the most costly option in almost all cases) which preserves quality of life, extends life-span and helps keep people productive.

There is much wrong w/ the US system, but why all this faith in single payer when there's ample evidence that its unwarranted?
"[URL
Supreme Court of Canada: Chaoulli v. Quebec 2005[/URL]:

...The evidence in this case shows that delays in the public health care system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public health care. The evidence also demonstrates that the prohibition against private health insurance and its consequence of denying people vital health care result in physical and psychological suffering that meets a threshold test of seriousness...

[1] http://www.policyalternatives.ca/documents/National_Office_Pubs/2007/Canadian_Drug_Prices.pdf"

 

[AsianSensationK]

... the United States military and NASA is funded directly through our taxes? I must admit I am not very knowledgeable of what will happen to the quality of our healthcare system if funding was supported through taxes. I know socialized medicine works in some parts of the world and is terrible in other parts of the world. Frankly , I do not think we as taxpayers should forced to pay for others peoples health care costs just because they are to lazy to go out and exercise and keep a healthy diet. But on the other hand , if we can afford to send rockets and satellites to space and to planets that costs up to billions of billions of dollars in taxes, not to mentioned contiunue to expand new NASA programs like their Robotics programs, then why can't we provide universal healthcare to every citizen? Do we really need to continue to expand our military? We already supposedly have the best military in the world and in history.

I've recently learned the central limit theorem is a pretty important concept to use in insurance. If people have similar expected value of claims and variance of claims, then we can use a normal distribution to approximate the aggregate. But we have many different types of risk classes out there. Do we need to separate people into different risk classes and model them with different curves?

How do we charge people in the less expensive risk classes so that we can cover the more expensive risk classes? Presumably a flat rate won't cut it. And it doesn't seem like those in the more expensive risk classes can really afford insurance. That's the reason we wanted to create a universal program in the first place. So do we bill the people at all? Do we put a limit on claims? A deductible maybe?

And don't think that the fees for this kind of program will be smaller than premiums in private insurance. Overhead dramatically increases with a large government program. You'll still have to collect at least the expected value of claims from the people with any program (regardless of who you take them from) plus overhead. The government might even want to make a point of covering something like 90 - 95% of aggregate claims. Taxes might dramatically increase, especially for those in less risky classes who would otherwise be paying less.

Finally, the population changes. People are born, people die, people get old, people get fat, people lose work, get different jobs, move to different areas. This continuously affects the model. You have to update it, and chances are the aggregate costs of the programs will change. In fact, this is a good place to point out that aggregate claims are random. What happens if we don't collect enough to meet claims one year? Denials?

There's a lot to account for with large programs like this.

 

[mheslep]

I've recently learned the central limit theorem is a pretty important concept to use in insurance...

Its important to note that a large part the payments system in health care that's labeled insurance is really not. Insurance as you allude to above is the practice of covering the unexpected. The current system pays in large part for every day known expenses and is thus mislabeled.

 

[W3pcq]

Kind of a catch 22. Government health care will end up underfunded and mismanaged, private health care will end up exploiting us, jacking up prices and charging the most they possibly can without losing money. I guess that private may be better for the wealthy because they can afford outrageous prices and they want to shop around. Now i see the moral problem.

Why not have government health care to those who buy in(pay health tax), and still let the private sector offer practices as an alternative for people with extra cash? I guess if you pay your health tax, you get your meds at "canadian prices" and can still get private care whenever you want. If you don't pay health tax, you must pay for insanely high priced meds and must pay for all your health bills ie. no insurance company.

 

[AsianSensationK]

Its important to note that a large part the payments system in health care that's labeled insurance is really not. Insurance as you allude to above is the practice of covering the unexpected. The current system pays in large part for every day known expenses and is thus mislabeled.

Hmm...What are the everyday expenses you're referring too?

 

[mheslep]

Hmm...What are the everyday expenses you're referring too?

All generic medical care. Every general check up minus a $20 copay. Flu shots. Every day prescriptions minus a copay. All of these known expenses are paid for by health 'insurance'. Insurance, in the common sense, is something that protects us against the unlikely but involves large losses if they do occur as in major catastrophes. Health 'insurers' are in large part just middle men to enable use of the employer based health care tax exemption.

 

[AsianSensationK]

That's a good point.

It makes me think universal health insurance might actually do more of the stuff we expect insurance to do, and not just the middle men stuff.

 

[mheslep]

As you correctly point out, it is of the same kind as the required auto liability insurance, although it goes further. As the fee of the mandatory public health insurance is (for the same services) proportional to revenue, it is ALSO a kind of tax, in that it imposes some kind of solidarity (the rich pay a bit for the poor), while the car insurance is flat fee of course (well, not depending on your wealth, but rather on your objective risk factor).

But in both cases (actually more so for the health care) it is a relatively SMALL fee which can cover a potentially LARGE expense, and which, as your example points out, nobody can be sure not to need one day. In other words, to avoid a small expense, people who would refuse a minimum coverage do something objectively stupid. In any case, it is a small (relatively to your wealth) fee, it is not going to avoid you buy a bigger house, or go on a fancier holiday or anything, and you run a serious risk that one day, you have a SERIOUS problem. That's why it is objectively stupid: the gain you get from refusing it doesn't weight in with the potential danger you put yourself into.

As to the nanny state, I'm also against law enforcement that *obliges* you to BEHAVE in a safe way (as long as you're not increasing the risk for others of course). Nobody can determine how much pleasure you get from smoking, and whether or not you are willing to sacrifice your health for the pleasure of smoking, say. So although for most people, this is a stupid action, as you cannot quantify the "gain" (pleasure in doing so), you cannot objectively show that it is stupid.

But the insurance fee is really small, so you can quantify it. The gain isn't big, it is equal to the fee.

Some data coming in from Mass. Romney Mandatory Care.

No health insurance? Face fines
Failure to subscribe can cost residents up to $912 a year

Massachusetts has begun imposing stiff fines on residents who, for whatever reason, fail to purchase health insurance.

The program is the enforcement end of the state's universal health-insurance plan – and the fees reach up to $912 a year.

The state health-insurance initiative, signed into law by former Gov. Mitt Romney, has been compared to Democratic presidential candidate Hillary Clinton's national universal health-care plan – especially on the enforcement side.

The penalties apply to anyone deemed able to afford health insurance by the Commonwealth Health Insurance Connector Authority, the state agency that oversees the entire program.

 

[W3pcq]

The idea of having a penalty for not buying health insurance seams dangerous to me. They could raise their prices as high as they want, and if you can't pay, they take your house, take your car, bankrupt you etc. If we have a capitalist health care system then we ought to have the right to buy or not buy services. That is one of the only ways to keep prices within affordability. If they charge too much, people who can't afford it won't buy it. If people don't buy it, they lose customers. That and competition are the two factors that regulate price.

 

[vanesch]

That is why we may want to have a system where there is a specific medical tax paid yearly which goes into an exclusive medical fund.

Eh, yes of course. In fact, what happens in many European countries, is that this fund is always in the red, and must hence get extra money from the "big tax pot". In other words, the "minimum insurance" goes in the specific health care pot, but its expenses are bigger than its incomes, so it is compensated for by general tax money. That's why you usually get out on average as much as you put in (which can never work for a real private insurance!).

 

[vanesch]

Why not have government health care to those who buy in(pay health tax), and still let the private sector offer practices as an alternative for people with extra cash?

That's actually how it works with most European countries, except that they don't let you opt out from the governement system: you pay in any case your contribution. Even if you go to private practices, the public system will reimburse you what you would have paid (more or less) if you went to a public hospital (in other words, where it would have been essentially "free" or almost free). If you want to go to a more expensive private clinic, no problem, but you won't get more out of the public pot (even a bit less). However, you can (and most people do) take on top of that a private insurance which will cover (part of) these higher expenses, according to different terms depending on the insurance you took. Here you're totally free.

If you go to a doctor, there are those doctors that align themselves on publicly fixed tariffs, and there are those that set their own tariffs ; a doctor has to announce in which category he plays. Doctors are encouraged to align themselves on the public tariffs (I don't know the system exactly, but I think, with fiscal advantages etc...).
By the public insurance you will get partly refunded the fixed tariff (minus something). If you went to a more expensive doctor, then you pay the difference (even a bit more), again, unless you've taken a private insurance against it.

For instance, in France, a normal doctor's visit is publicly fixed to 21 Euros. If I go to a doctor aligned on the public tariff, I get back 20 Euros. My personal doctor is not in this system, and asks 31 Euro for a visit, and I get back 16 Euro from the public insurance (so a bit less than if I went to a doctor that was aligned). My private insurance doesn't take that into account, so I pay the 15 Euros difference.

 

[vanesch]

The idea of having a penalty for not buying health insurance seams dangerous to me. They could raise their prices as high as they want, and if you can't pay, they take your house, take your car, bankrupt you etc.

No, in Europe it is fixed by government, and proportional to your income. It is a very small fraction of your income, much less than income taxes. If you get a salary, then it is even taken from it before you get the salary, so you don't even have to do anything! You cannot get a fine for not paying it, it is taken "at the source". Your employer is responsible for this handling. If you are unemployed, with an unemployment aid, this is taken care off also. It is only when you drop out of the system (unemployed, no income) that you have a problem. Then you can only rely on public health service.
If you have your own business, well, that's different then, you have to do the paperwork yourself.

 

[mheslep]

No, in Europe it is fixed by government, and proportional to your income. It is a very small fraction of your income, much less than income taxes. If you get a salary, then it is even taken from it before you get the salary, so you don't even have to do anything! You cannot get a fine for not paying it, it is taken "at the source". Your employer is responsible for this handling. If you are unemployed, with an unemployment aid, this is taken care off also. It is only when you drop out of the system (unemployed, no income) that you have a problem. Then you can only rely on public health service.
If you have your own business, well, that's different then, you have to do the paperwork yourself.

Vanesch: Is this recent in the EU? Some time ago the EU was like Canada in the 90's in which there was the govt. run heath care system paid for largely by taxes. There was no other mandatory sign up as you were onboard just by being a citizen. So now in the EU, this mandatory sign up involves fees in addition to your taxes?

 

[Schrodinger's Dog]

The idea of having a penalty for not buying health insurance seams dangerous to me. They could raise their prices as high as they want, and if you can't pay, they take your house, take your car, bankrupt you etc. If we have a capitalist health care system then we ought to have the right to buy or not buy services. That is one of the only ways to keep prices within affordability. If they charge too much, people who can't afford it won't buy it. If people don't buy it, they lose customers. That and competition are the two factors that regulate price.

Well if you can't afford to pay because you are unemployed then you don't have to. And you never get bankrupted by national insurance, because it is a percentage of what you earn, not what you don't.

Eh, yes of course. In fact, what happens in many European countries, is that this fund is always in the red, and must hence get extra money from the "big tax pot". In other words, the "minimum insurance" goes in the specific health care pot, but its expenses are bigger than its incomes, so it is compensated for by general tax money. That's why you usually get out on average as much as you put in (which can never work for a real private insurance!).

In the UK the expense is seldom more than the recompense. It's subsidised, but the cost isn't actually that great and because the GDP outlay is low, it isn't even that significant.

Vanesch: Is this recent in the EU? Some time ago the EU was like Canada in the 90's in which there was the govt. run heath care system paid for largely by taxes. There was no other mandatory sign up as you were onboard just by being a citizen. So now in the EU, this mandatory sign up involves fees in addition to your taxes?

It does indeed, but they are not that high, and are graduated based on earnings, for example those who pay the higher tax bracket only pay a flat 1% national insurance, as the rest is covered by their taxes. So the outlay isn't actually significantly higher. Although of course it is somewhat more. That is the UK system though.

 

[W3pcq]

Well if you can't afford to pay because you are unemployed then you don't have to. And you never get bankrupted by national insurance, because it is a percentage of what you earn, not what you don't.

Actually I was talking about mandated private insurance.

 

[Schrodinger's Dog]

Actually I was talking about mandated private insurance.

Which is a stupid idea frankly. Should make it part of taxes if it's going to be mandatory, saves admin costs.

 

[mheslep]

Resurrecting this thread to collect some sources:

b) Do you have a source for this claim? Is this problem long-lasting and widespread, or only isolated to a small number of cases or specific treatment types, and for a short-period? AFAIK, in India, services in government hospitals aren't denied, and the treatment time is usually reasonable.

o UK Average wait for surgery 220 days
o 10,000 people in UK waited 15 mos for surgery. Economist magazine of London, pg 55, April 13, 02
o UK woman whose cancer surgery was postponed until it had to be canceled because it became inoperable during delays. Economist, Nov 24, 2001, pg 52.
o Supreme Court of Canada: Chaoulli v. Quebec 2005:

...The evidence in this case shows that delays in the public health care system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public health care. The evidence also demonstrates that the prohibition against private health insurance and its consequence of denying people vital health care result in physical and psychological suffering that meets a threshold test of seriousness...

 

[cristo]

Resurrecting this thread to collect some sources:
o UK Average wait for surgery 220 days
o 10,000 people in UK waited 15 mos for surgery. Economist magazine of London, pg 55, April 13, 02
o UK woman whose cancer surgery was postponed until it had to be canceled because it became inoperable during delays. Economist, Nov 24, 2001, pg 52.

1. This data is 8,7 and 6 years old, respectively. A lot has happened to the NHS in this time.
2. One case (i.e. the last one) does not prove a trend.

 

[drankin]

Average wait is 220 days for surgery is 220 days!?? That certainly wouldn't work in the US.

My father-in-law had to have a kidney removed recently due to the beginnings of cancer. He was in and out within 4 days. No cancer now. 220 days and he wouldn't be with us.

 

[mheslep]

It depends on your definition of "universal healthcare." I would define it to mean that one can obtain the same level of healthcare from the hospitals, regardless of the amount of money you have, or position in society you hold. With the NHS, for example, this is the case.

Certainly a government can attempt to force a system where there is equality of some result, healthcare denial for instance. I decline to call waiting around for surgery for six months any kind of an acceptable result for mainstream healthcare.

That there is a private healthcare for those that choose not to take up the NHS healthcare is regardless.

Not sure what you mean by 'is regardless', but that's my b), inclusion of private/market care, for people that refuse to tolerate the NHS. Health in the UK is not universally provided by the government. Nor would I completely accept that healthcare is universally available from the government in the UK, as that would mean a test at 100% of the population, and given the strains on the current system at partial use I believe NHS is incapable of supporting 100% use over time.

 

[mheslep]

1. This data is 8,7 and 6 years old, respectively. A lot has happened to the NHS in this time.

And to EU healthcare in general during the same period: its increasingly provided by private/market sources, less by the government.
http://www.reuters.com/article/latestCrisis/idUSL08617092
http://en.wikipedia.org/wiki/Health_care_reform#The_Netherlands

 

[misgfool]

I decline to call waiting around for surgery for six months any kind of an acceptable result for mainstream healthcare.

Apparently to measure performance of healthcare system you need to get statistics. We can measure performance as the queue length but I would see life expectancy, child mortality or average of sick days out of work a better indicator of a functioning healthcare system.

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