Socialised Healthcare

[Darat]

(By the way great discussion folks - one of the best threads I've read in ages.)

Just to add that I am for universal health-care as a matter of principle - the fact that it seems to be cheaper and more efficient than non-universal systems is a bonus as far as I am concerned. I consider it as necessary for the type of society I wish to live in as universal education, universal police system, universal justice system and so on.

Where I am pragmatic is that I'm not interested in one particular approach to deliver that universal care - it would seem that the best systems are a mixture from private and "socialised" (and by the way talk about a deliberate misuse of a word for idealogical reasons) medicine.

 

[Darat]

A quick, dumb question for those who live in countries with universal healthcare:

If someone has injuries which are clearly caused by another person (for example, I punch someone and break his jaw), do the taxpayers have to pick up the tab, or is the person at fault made to cover the costs?

What if I break my wrist in addition to his jaw? Is my own injury covered?

On the whole the answer is that the health care required is made available to everyone regardless of "fault" and it is rare that anyone will have to pay anything toward their medical treatment.

However there are few quirks in the UK system - such as if you are responsible for a RTA you will be build for any ambulance services that were required (albeit this would be covered by our universal car insurance system...)

 

[toddjh]

On the whole the answer is that the health care required is made available to everyone regardless of "fault" and it is rare that anyone will have to pay anything toward their medical treatment.

Well, obviously healthcare would be made available. I was just wondering if people would be held financially responsible after the fact.

If not, that's something that would really rub me the wrong way. As a taxpayer, I'd be prepared to pay for medical costs associated with, say, a random illness, or a car accident caused by a mechanical failure or something. But I'd just as soon not pay for a guy who breaks his neck in a car crash because he was driving drunk, or heart disease treatment for a guy who eats pizza five times every day. I don't like the way that sort of system would deemphasize personal responsibility.

Of course, I suppose some sort of fix could be incorporated into a universal system. And conversely, it's not like a free market system is perfect in that regard either, especially since most people get their insurance through their employer, so competition isn't really as much of a factor.

 

[Corsair 115]

I just have a problem with people insisting that they aren't being forced to pay into health care... Yes, they are forced. We just have to decide whether that force is a good thing.

But you're implying that the force issue alone is reason enough to invalidate any sort of publically funded system (at least, that's how your and CaptainManacles' comments come across to me).

In which case the question of settling which force is acceptable becomes very important. Why would publically funded health care be unacceptable force but public education or the military or any of a number of government programs be acceptable force?

Seems to me there has to be something more substantial to an argument against publically funded health care than using the narrow and exception-ridden force argument.

 

[JoeEllison]

I've found the arguments in favor of this position very unconvincing. Universal healthcare is paid for, in part or in whole, by increased taxation. I might be willing to believe that extra taxes are an acceptable price to pay, but the assertion that they don't qualify as the government taking money from its citizens against their will -- or at least unconcerned with their will -- is frankly ludicrous. That's what taxation is. It's not optional, at least around here.

The whole idea that taxation should be thought of as a form of or the nearest thing to theft... that's the ludicrous assertion. Here's the way you should look at it: citizenship has its benefits, and its responsibilities. Taxes are part of the responsibility, and refusing to pay or avoiding paying taxes is a sign of a lousy citizen.

That being said, a form of universal healthcare is already being paid for in America, in the most inefficient way possible. You're paying too much for it, I'm paying too much for it... so why not go to a much more efficient system, where we pay up front and pay less, instead of paying on the back end and paying much more? Aren't oil changes cheaper than replacing engines? So why isn't preventative medicine paid for up front obviously cheaper than paying for emergency medicine and expensive treatments for preventable diseases?

We're paying for it either way, and only a fool would value that "choice" over being "forced" to pay a smaller overall amount.

 

[Darat]

Well, obviously healthcare would be made available. I was just wondering if people would be held financially responsible after the fact.

If not, that's something that would really rub me the wrong way. As a taxpayer, I'd be prepared to pay for medical costs associated with, say, a random illness, or a car accident caused by a mechanical failure or something. But I'd just as soon not pay for a guy who breaks his neck in a car crash because he was driving drunk, or heart disease treatment for a guy who eats pizza five times every day. I don't like the way that sort of system would deemphasize personal responsibility.

...snip...

What you are saying is that you don't support the idea of a universal health-care system. I would say the idea of a universal health-care system is just like say a universal police and universal justice system - even the "worse" of us still get fair access to it.

 

[toddjh]

The whole idea that taxation should be thought of as a form of or the nearest thing to theft... that's the ludicrous assertion. Here's the way you should look at it: citizenship has its benefits, and its responsibilities. Taxes are part of the responsibility, and refusing to pay or avoiding paying taxes is a sign of a lousy citizen.

Yes, I do think that people who believe that "no taxation" is a core American value seem to forget the part about "without representation" from time to time.

That being said, a form of universal healthcare is already being paid for in America, in the most inefficient way possible. You're paying too much for it, I'm paying too much for it... so why not go to a much more efficient system, where we pay up front and pay less, instead of paying on the back end and paying much more? Aren't oil changes cheaper than replacing engines? So why isn't preventative medicine paid for up front obviously cheaper than paying for emergency medicine and expensive treatments for preventable diseases?

I hope you're talking to someone else or playing devil's advocate, because that's pretty much exactly what I said in my first post (higher up the page).

 

[toddjh]

What you are saying is that you don't support the idea of a universal health-care system. I would say the idea of a universal health-care system is just like say a universal police and universal justice system - even the "worse" of us still get fair access to it.

Well, like I said, access isn't the issue here. I'm absolutely in favor of people being treated promptly and well, regardless of the circumstances. It's the after-the-fact book balancing that concerns me.

 

[Spock Jenkins]

But I'd just as soon not pay for a guy who breaks his neck in a car crash because he was driving drunk, or heart disease treatment for a guy who eats pizza five times every day. I don't like the way that sort of system would deemphasize personal responsibility.

Most health insurance policies in the U.S. will cover gastric bypass surgery these days. I don't think that's a universal vs. private issue. It is, however, and issue of what insurance should and should not cover.

My basic thought is that if you can't help it - insurance should cover it. Prior conditions such as birth defects, diabeties, cancer, should be covered.

If you simply have no self control and are morbidly obese as a result - I don't feel my premiums should cover your gastric bypass surgery, etc. But where to draw the line? Your 5 slices of pizza a day example. How does one determine that a person isn't just genetically pre-disposed to arterial blockage and actually confirm that it's poor diet and lack of exersize that are to blame?

We start crossing a line of government (or health insurance) having too much of a say in how we lead our private lives. If I was out binge - drinking and wind up with alchohal poisoning - should your premiums cover me, or am I liable?

It's almost cheaper just to pay up than to tie up the courts with lawsuits disputing the details.

 

[toddjh]

How does one determine that a person isn't just genetically pre-disposed to arterial blockage and actually confirm that it's poor diet and lack of exersize that are to blame?

True, and when there are practical difficulties like that, I think the system should err on the side of caution.

However, not everything is that ambiguous. For example, the accident caused by drunk driving, or the broken jaw from the assault. Injuries caused during the commission of a crime seem pretty cut-and-dried to me, and it surprises me that the government doesn't want to hold people accountable for things like that.

 

[fls]

Can you name a system where it isn't? I'm not sure how that would work.

For example, some of the European systems use mandatory purchase/contribution towards private health insurance or non-governmental organizations. The insurance or fund providers are regulated so that everyone obtains standard coverage. The government pays for the premiums/contributions of low income residents, children, the unemployed, etc.

Linda

 

[Spock Jenkins]

Aren't oil changes cheaper than replacing engines? So why isn't preventative medicine paid for up front obviously cheaper than paying for emergency medicine and expensive treatments for preventable diseases?

Sure seemed obvious when congress enacted legislation in the 1970's that created Health Maintenance Organizations (HMO's) as an alternative to traditional medical insurance. Create a type of insurance that encourages people to get their routine physicals and other such "maintenance" treatments. That way we'll catch illnesses earlier and reduce the need for emergency medicine and expensive treatments. Since everyone is healthier overall - this would serve to control the rising cost of healthcare in this country.

Congress really nailed it that time.

Of course now congress considered the error of their ways and enacted legislation that made HSA's (Health Savings Accounts) possible. These operate under exactly the opposite theory. Pay out of pocket for all the reasonably priced little things. As an added bonus - you can set this out of pocket money aside tax free. That way people will be more selective about when it is or is not necessary to go to the doctor. Sure - they have insurance in place in case something catostrophic happens - but they won't be inclined to stop in for a kleenex everytime they blow their noses like that silly HMO idea. This should control the rising cost of healthcare.

But the cost of healthcare is still sky-rocketing. Could be part of the reason why many people aren't so inclined to give them another stab at it.

Back to the government we go. Third time's a charm, right?

 

[toddjh]

For example, some of the European systems use mandatory purchase/contribution towards private health insurance or non-governmental organizations. The insurance or fund providers are regulated so that everyone obtains standard coverage. The government pays for the premiums/contributions of low income residents, children, the unemployed, etc.

Gotcha. That seems like a distinction without a difference to me, though. The word "mandatory" is the part I keep focusing on.

 

[Spock Jenkins]

True, and when there are practical difficulties like that, I think the system should err on the side of caution.

However, not everything is that ambiguous. For example, the accident caused by drunk driving, or the broken jaw from the assault. Injuries caused during the commission of a crime seem pretty cut-and-dried to me, and it surprises me that the government doesn't want to hold people accountable for things like that.

But if the person that broke my jaw can't afford to pay - why should I not be as entitled to treatment as the next person? Why should the hospital be obligated to eat the cost? That guy started it, not me. Prove otherwise.

Not trying to be too cynical (maybe a little), just playing devils advocate. For what it's worth - I agree with the point you're making. I just wonder if it's possible to find any kind of line of personal responsibility that the majority agree on and that no lawyers will jump all over once we try enforcing.

 

[toddjh]

But if the person that broke my jaw can't afford to pay - why should I not be as entitled to treatment as the next person? Why should the hospital be obligated to eat the cost?

I wasn't arguing that the hospital should eat the cost. But somebody has to eat the cost. I think it's best if that person is the person responsible for the injury or illness. However, if it's too difficult or ambiguous to determine that, I think it's obvious the government will have to eat the cost (just like the do already, from the sound of things).

That guy started it, not me. Prove otherwise.

Presumably the facts of the case would've already been proved to the satisfaction of a court of law by this point, in the assault trial.

 

[kallsop]

You seem to be under the impression that there is not private medicine in the UK.

I lived there for 25 years and know a little about it LOL. Barely survived the NHS, which is more than many of my friends and family can say

I love folks that assume they know you from 10 words on a forum. Better yet, if you don't hold their opinion, you must be dumb. Awesome logic!

So, if we want to make smug xenophobic jokes about a nation with bad teeth, who should we pick on, the Brits or the Americans?

Show your work.

Care to take a guess why Austin Powers has ugly teeth, and the world finds it so funny?

 

[IchabodPlain]

In terms of quality of service and success, I think the US is either at or near the top in virtually all categories. In cancer for instance, the Lancet Oncology (thelancet.com/journals/lanonc/article/PIIS1470204507702462/abstract) recently did a study between the US and Europe in survival rates for all cancers and cumulatively ranked the US #1. 22 of the top 50 largest pharmaceutical companies are based in the US, which total 825,000+ jobs
en.wikipedia.org/wiki/List_of_pharmaceutical_companies
We have more doctors, and greater access to new technologies (MRI's, CT scanners, etc) as well as less waiting before we see a doctor, are diagnosed, begin treatment, or undergo surgery.

We do pay more for care, which makes some bit of sense, as quality products usually are expensive. But you must keep in mind that the government also underwrites 50% of all healthcare costs in the US. Taxpayers cover veterans, elderly, low income earners, and some children federally, and some states have other plans of their own. Also, the number one priority with public systems is cost control. This has lead to hospitals not washing sheets as often which made patients ill (and also killed some) telegraph.co.uk/news/main.jhtml?xml=/news/2007/04/25/nmrsa25.xml
These cost controls rear their head in the form of rationing services (waiting lists), and price controls. Price controls force less new products into the market, because companies do not want to invest the risk into a new product when they know their return will have an artificially low ceiling. This has forced many pharmaceutical companies out of socialised countries (UK has 3 in the top 50, France has 1). To remedy this, governments undertake huge tech spending programs which run over-budget costing the taxpayers even more. (news.bbc.co.uk/nolpda/ukfs_news/hi/newsid_4630000/4630712.stm)
People need a device to bring them into a market, to compete for the lowest price, this is the only way you can reduce costs by not denying services. Yes, sometimes you do not have the convenience to 'shop around', but sometimes you do.

The 47 million uninsured is also not entirely accurate. 12 million are illegal immigrants, 9 million earn $75,000+ per year, and 12 million are eligible for government programs but do not enroll.
ncpa.org/pub/ba/ba568/ba568.pdf

As long as Americans have the 2nd Amendment, Marlboro men, Corvettes, and a love affair with McDonald's, socialised care will be a disaster.

 

[jimbob]

You also need to look at what the costs are:

Some OECD data
(Tables Here (PDF)

page2:

Chart 1: Health expenditure as a percentage of GDP,
2002

US: 14.5% of GDP
Switzerland: 11.2% of GDP (next highest)

in 2002, the US spent nearly 50% greater proportion of its GDP on healthcare than other countries, and still managed to miss musch of the population out.

The system seems very expensive compared to some governmental systems. And for patchy coverage of the population.

 

[Segnosaur]

I know I bowed out but since this was directed specifically to me I thought I would jump back in for just a moment. The figures I quoted include people covered by government programs and people with their own private insurance. 15% of US citizens do not have any coverage be it private or through a government program.

Once again, let me explain (just because you seem to have trouble understanding this)....

Just because a person isn't covered by insurance, does not mean that they will not get health care.. I really don't know how to make it clearer than that.

Ever hear of the term "out of pocket"? Some people can and do pay for their own health care expenses. They would fall into your 15%, yet their health care spending is still counted in the per-capita costs.

I could also point out that many of those 15% people are newly employed, yet not at a point where their health insurance becomes active, so they're not suffering from any sort of long-term lack of coverage.

 

[Skeptic Ginger]

Having just read through this thread for the first time, it's interesting to see the division of attitudes on both sides of the debate.....

Addressing your free market leads to innovation argument, allow me to add some insight regarding free markets and drug innovations.

Much of the R&D in new drugs goes to make copycat drugs which are expected to take a portion of the known market share rather than producing a drug which the market for it is an unknown quantity. This does not necessarily lead to a better product, just a better marketed product.

We desperately need new antibiotics, anti-virals, anti-fungals, etc., for the growing drug resistant infectious organisms. But when a new anti-infective is developed, providers need to be very conservative with it to prevent rapid resistance from developing. In other words, you save it for highly drug resistant infections.

While that will eventually return a sure profit, the time from investment to return can be unknown and could be long. The investment would then be tied up not making a return for a while and other drugs would be expected to make instant profits the minute they reach the market.

There is little incentive in the private market to invest in new antibiotics currently. Drug resistant organisms will become widespread such as they currently are with TB and MRSA before pharmaceuticals will decide to invest in the R&D to develop new drugs to treat these infections. We are about to see the results of that market failure real soon. Complete 100% drug resistant TB has recently emerged and drug resistant MRSA bacteria are beginning to acquire more virulence in addition to just being hard to treat.