This is the Government that You Want to Run Health-care?

[volatile]

What part of "nationalize" don't you understand?

Errrm... What?

Nationalisation would involve the state buying the "assets of healthcare investors", not seizing them.

 

[balrog666]

The benefits uncertain?

Which bit of "costs you less, but gives you more" don't you understand?

Yes I understand your assertion but repeating it does not make it true.
What parts are you going to cut to lower current costs while at the same time "expanding" coverage?

What are you talking about? Is the UK, France, Sweden, Australia or any other country with national health "bankrupt"? What, exactly, is your issue with unionisation, and how would this be "ugly"?

I see lots of (paranoid) assertion, but not much evidence.

Cultural differences - in the USA we have lots of government employee unions and they are a huge drag on the cost structure of government services. Why would nurses and lab technicians not want to share in the bounties of working at the government teat?

 

[balrog666]

Errrm... What?

Nationalisation would involve the state buying the "assets of healthcare investors", not seizing them.

"Buying" implies a willing buyer and willing seller and an agreed upon price.

Eminent domain proceedings here (public seizure of private property) are almost never conducted at market prices and almost never are conducted against willing sellers.

 

[volatile]

Yes I understand your assertion but repeating it does not make it true.

What parts are you going to cut to lower current costs while at the same time "expanding" coverage?

You've heard of "economies of scale", right?

The fact of the matter is that you, as a US taxpayer already pay more for Medicaid than we do for a much more comprehensive, broader, deeper system. It is possible. Manifestly, as it is done is numerous countries with hugely disparate cultures.

Cultural differences - in the USA we have lots of government employee unions and they are a huge drag on the cost structure of government services. Why would nurses and lab technicians not want to share in the bounties of working at the government teat?

Isn't part of your argument that people earn more under private systems? Now you think they'll earn more under a government-run system? Which is it?

Please, I am honestly still interested in knowing, just roughly and in your estimation, how much UK-level healthcare would cost me in the US? Just a rough figure.

 

[volatile]

"Buying" implies a willing buyer and willing seller.

Eminent domain proceedings here (public seizure of private property) are almost never conducted at market prices and almost never are conducted against willing sellers.

The exchange of a negotiated price for goods and services is "buying", not "seizing".

 

[volatile]

ETA: From another thread, I have the ballpark figure you were so unwilling to provide:

It certainly does go up. That is why people can't afford health insurance. I work for a school district. In 2002, If an employee elected to take full family coverage with a $100 deductible, the plan would cost $986 per month. The district provided about $430. So, the individual would pay out of pocket about $540 per month.

Today, the same policy costs $2076. The district pays about $510. So, if a person elects for this coverage, they pay about $1550 out of their pocket per month These rates are icreased directly proportional to the use of the people in our district. So, every claim that is put in, results in a proportionally increased rate so that the insurance company will always make money.

This example is a group rate, but I assume that the same sort of thing is done on an individual basis as well. Bottom line is VERY simple. Insurance companies will NEVER lose money. If claims are submitted, premium goes up. No claims submitted, premiums go up less.

So, for a level of coverage far less than in the UK, with a "deductible" (excess?), Kev's students pay $1,550 PER MONTH.

In the UK, everyone gets a much better level of coverage, and it costs the public purse the equivalent of $3,000 per person PER YEAR.

How do these numbers not drive you to an apoplectic rage? Why does this not make you feel hard done by, angry and cheated?

 

[balrog666]

The exchange of a negotiated price for goods and services is "buying", not "seizing".

A seizure conducted under eminent domain proceedings is not buying except in some arcane legal distinction.

 

[balrog666]

ETA: From another thread, I have the ballpark figure you were so unwilling to provide:




So, for a level of coverage far less than in the UK, with a "deductible" (excess?), Kev's students pay $1,550 PER MONTH.

In the UK, everyone gets a much better level of coverage, and it costs the public purse the equivalent of $3,000 per person PER YEAR.

How do these numbers not drive you to an apoplectic rage? Why does this not make you feel hard done by, angry and cheated?

Better is debatable, to say the least.

A $100 deductible means you personally pay the first $100 in cost - just as with car insurance. Frankly choosing a $100 deductible for a family coverage policy is just foolish.

However the price of $2000/mo indicates other factors are at work in addition to the poor choice of deductible; most like a pre-existing condition.


Rage? Angry and cheated? Who has been cheated here when they made the decision to purchase such a policy? Sounds to me like they could have saved $2000/mo by going without insurance at all.

Gosh, would you be just as enraged to find out they were paying $2000/mo for a mortgage or an SUV or rare wine? If not, why not?

 

[volatile]

http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=482678&#doc482678

"Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries. This report—an update to two earlier editions—includes data from surveys of patients, as well as information from primary care physicians about their medical practices and views of their countries' health systems. Compared with five other nations—Australia, Canada, Germany, New Zealand, the United Kingdom—the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. The U.S. is the only country in the study without universal health insurance coverage, partly accounting for its poor performance on access, equity, and health outcomes. The inclusion of physician survey data also shows the U.S. lagging in adoption of information technology and use of nurses to improve care coordination for the chronically ill."

 

[volatile]

Better is debatable, to say the least.

A $100 deductible means you personally pay the first $100 in cost - just as with car insurance. Frankly choosing a $100 deductible for a family coverage policy is just foolish.

That's what I meant by "excess" earlier. "Excess" is the UK term. We have no such transaction in our healthcare. We pay NOTHING in nearly all circumstance. That's what "free at the point of use" means.

However the price of $2000/mo indicates other factors are at work in addition to the poor choice of deductible; most like a pre-existing condition.

Pre-existing conditions have no effect on the level or price of the care you receive in the UK.

Rage? Angry and cheated? Who has been cheated here when they made the decision to purchase such a policy? Sounds to me like they could have saved $2000/mo by going without insurance at all.

You are paying $1,500 a month for less than we, collectively, get for $3,000 each a year. You're getting ripped off.

 

[balrog666]

http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=482678&#doc482678

"Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries. This report—an update to two earlier editions—includes data from surveys of patients, as well as information from primary care physicians about their medical practices and views of their countries' health systems. Compared with five other nations—Australia, Canada, Germany, New Zealand, the United Kingdom—the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. The U.S. is the only country in the study without universal health insurance coverage, partly accounting for its poor performance on access, equity, and health outcomes. The inclusion of physician survey data also shows the U.S. lagging in adoption of information technology and use of nurses to improve care coordination for the chronically ill."

So a lack universal health insurance automatically ranks us lower since that was one of the metrics used. Oh, yeah, that makes sense.

 

[volatile]

So a lack universal health insurance automatically ranks us lower since that was one of the metrics used. Oh, yeah, that makes sense.

You'll note that it comes lowest on quality, and is the costliest, even though you lack comprehensive cover. You are paying more and getting less, as I keep trying to explain.

The experiment's been done. Your system doesn't work, whatever metric you pick. It's more expensive, less efficient, leaves the poor to die, discourages the seeking of treatment and leads to a more unhealthy population. It. Doesn't. Work.

Now, you seem for some weird ideologically dogmatic reason to be content with that. Thus: Would you care to explain why, in clear, unambiguous terms? What, exactly, are your oppositions to nationalised healthcare systems?

 

[jimbob]

Balrog, I assume that you are not in the bottom economic quartile. I also guess that you do not use medicaid.

So you are paying slightly more of your taxes than me to provide inadequate provision only for poor people, and then you (or your employer) have to pay for whatever healthcare provision you want.

I pay slightly less tax and this provides coverage that is universal. I am sure that you could get better healthcare than the NHS if you pay enough, but then so can I.

The difference is that it is usually not worth it, because the NHS is usually adequate, so I am getting a better personal deal for my tax pounds than you are getting for your tax dollars.

If we expand this and look at the broader picture, the most vulnerable in society in the UK are getting far better coverage than the most vulnerable in the US. And although I am paying for part of that, I am also getting cover for myself which you probably aren't.

Maybe that is the difference between the US and the UK. I would be unhappy paying tax so that other people get medical coverage, but not me.

I pay for the NHS and I use the NHS. The US taxpayer pays for medicaid and tends to be excluded from it.

ETA: I suspect that most of the Brits here would be unhappy paying to supply a service for someone elses benefit, that they could use, but which they are excluded from by virtue of being wealthy enough to pay tax for it.

 

[jimbob]

From Volatile's link in post #330

Equity: The U.S. ranks a clear last on all measures of equity. Americans with below-average incomes were much more likely than their counterparts in other countries to report not visiting a physician when sick, not getting a recommended test, treatment or follow-up care, not filling a prescription, or not seeing a dentist when needed because of costs. On each of these indicators, more than two-fifths of lower-income adults in the U.S. said they went without needed care because of costs in the past year.

This is for JdG:

On each of these indicators, more than two-fifths of lower-income adults in the U.S. said they went without needed care because of costs in the past year.

 

[balrog666]

You'll note that it comes lowest on quality, and is the costliest, even though you lack comprehensive cover. You are paying more and getting less, as I keep trying to explain.

The experiment's been done. Your system doesn't work, whatever metric you pick. It's more expensive, less efficient, leaves the poor to die, discourages the seeking of treatment and leads to a more unhealthy population. It. Doesn't. Work.

Now, you seem for some weird ideologically dogmatic reason to be content with that. Thus: Would you care to explain why, in clear, unambiguous terms? What, exactly, are your oppositions to nationalised healthcare systems?

I disagree with anything being nationalized. Government interfering in the free market is never a good idea.

 

[balrog666]

Balrog, I assume that you are not in the bottom economic quartile. I also guess that you do not use medicaid.

So you are paying slightly more of your taxes than me to provide inadequate provision only for poor people, and then you (or your employer) have to pay for whatever healthcare provision you want.

I pay slightly less tax and this provides coverage that is universal. I am sure that you could get better healthcare than the NHS if you pay enough, but then so can I.

The difference is that it is usually not worth it, because the NHS is usually adequate, so I am getting a better personal deal for my tax pounds than you are getting for your tax dollars.

If we expand this and look at the broader picture, the most vulnerable in society in the UK are getting far better coverage than the most vulnerable in the US. And although I am paying for part of that, I am also getting cover for myself which you probably aren't.

Maybe that is the difference between the US and the UK. I would be unhappy paying tax so that other people get medical coverage, but not me.

I pay for the NHS and I use the NHS. The US taxpayer pays for medicaid and tends to be excluded from it.

ETA: I suspect that most of the Brits here would be unhappy paying to supply a service for someone elses benefit, that they could use, but which they are excluded from by virtue of being wealthy enough to pay tax for it.

I suspect that you might indeed be getting a better deal with your pounds than I am with my dollars (that is, at this point - I would have argued otherwise a few decades ago) but I think it's too late to change the game here without a huge cascade of worse problems. And, as with the Ponzi scheme of Social Security, while one cannot escape the game, that doesn't mean I should help to make it worse.

And, yes, short sighted and foolish employers (particularly those involving unions) want to lower their costs by dumping medical costs onto the government - I would prefer to place it with the individual and let them make their own decisions. I am not smart enough to make everyone else's decisions for them; nor do I believe that any politicized bureaucracy can handle the job as well as the free market.

 

[volatile]

I disagree with anything being nationalized. Government interfering in the free market is never a good idea.

Even if you get better quality, cheaper healthcare, for everyone? Even if rates of health are better, survivability of cancer is better, infant mortality is lower, poor people don't die because they can't access healthcare and people aren't bankrupted by their health needs? National health services provide better care, cheaper.

I honestly cannot understand how you can say that nationalised healthcare "is never a good idea" when the evidence to the contrary is overwhelming. That's called dogmatism, and it's rightly frowned upon round here.

I'll ask the question that is always appropriate in the face of such rabid ideology - what would it take to change your mind?

 

[volatile]

I suspect that you might indeed be getting a better deal with your pounds than I am with my dollars (that is, at this point - I would have argued otherwise a few decades ago) but I think it's too late to change the game here without a huge cascade of worse problems. And, as with the Ponzi scheme of Social Security, while one cannot escape the game, that doesn't mean I should help to make it worse.

Social Security is not a Ponzi scheme. There's a current thread on this elsewhere.

And, yes, short sighted and foolish employers (particularly those involving unions) want to lower their costs by dumping medical costs onto the government - I would prefer to place it with the individual and let them make their own decisions.

What if that individual is too poor to "make the decision" to get comprehensive health cover?

I am not smart enough to make everyone else's decisions for them;

You'd rather decisions as to clinical need be made on the basis on what the individual can afford, or what the individual requires? The "free market" system forces the former.

nor do I believe that any politicized bureaucracy can handle the job as well as the free market.

The facts prove you wrong. You have a free-market solution; it leaves poor people dead. Is this some sense of the word "better" never previously encountered?

I understand that you're wedded to this weird hyper-individualist ideology, but if you'd step out of the dogmatic corner you've painted yourself into and actually look at this objectively, you'll see that the facts on the ground do nothing but massively undermine your position at every single level.

What you're essentially proposing to me is the following question: Would I like to swap a system where I will never, ever have to worry about the cost of any healthcare predicament, minor or major, that may befall me, for one where I have to spend the entirety of my monthly income on an insurance scheme which, even after a "deductible", will not cover a fraction of what I currently receive?

Errrmmm.... let me think about that for a microsecond.

 

[Rolfe]

Yes, the problems associated with transitioning to a NHS type system are large and the benefits uncertain.

In particular I find the idea of initiating a new class of protected government workers (doctors, nurses, lab workers, technicians) abhorrent. As government workers, will they be protected from malpractice or outright incompetence? Will they unionize like other government workers and bankrupt the state even further? It looks like a very ugly situation to me.

Yes, the problems of transition would clearly be great. And frankly the longer you leave it the worse it gets! However, I tend to see that as a challenge. And it doesn't have to be an NHS-type system you adopt. There is a wide variety of solutions to the universal healthcare conundrum worldwide, why not have a look at some of them?

Benefits uncertain? For pity's sake, look outside your own borders and smell the benefits!

Protected government employees? Oh, drop the dogma. I think volatile answered that anyway. You think these people could negotiate even higher salaries in an NHS-type system? Get real! Bankrupt the state? Have you really not been listening? We're not sitting here on our bahookies speculating, we've been doing it for 60 years. The state is not bankrupt. We spend a significantly smaller proportion of our GDP on healthcare than you do. For substantially better results, seen on a population basis.

To repeat. No excess (deduction? what's a "co-pay"?). No upper limit on care. No exclusions based on either pre-existing conditions or family history. Everything from your antenatal care to your heart transplant. For everybody. From the rocket scientist to the severely disabled baby born to the unemployed single mother.

And you think this is an "ugly situation"? Really?

We pay less of our income in tax to get all this than you do to fund Medicare/Medicaid, from which you derive no benefit. (I still have trouble believing that, but others assure me it's true.) You then have to shell out another considerable proportion of your income, so that you can have some benefits. Which involve excesses, limits and exclusions.

What situation is it you're calling "ugly" again?

And you asked about malpractice suits. Of course you can bloody sue them! Sue the pants off them! Now, should you win, where does the money come from? Well, same place it comes from in the USA when someone gets a huge malpractice settlement. From the healthcare system. (In your case, from the doctor's insurance company, which got it from the premiums paid by all the doctors, who got it from the fees they charged to the patients' insurance companies, who got it from the patients.) The main difference is the settlement will be smaller. Partly because we don't have such crazy legal settlements for anything, but partly because - oh yes, the costs of future healthcare for the wronged party are not an issue, because the NHS will just go right on picking them up.

And I'll just mention Abigail again.

Rolfe.

 

[Rolfe]

What you're essentially proposing to me is the following question: Would I like to swap a system where I will never, ever have to worry about the cost of any healthcare predicament, minor or major, that may befall me, for one where I have to spend the entirety of my monthly income on an insurance scheme which, even after a "deductible", will not cover a fraction of what I currently receive?

Errrmmm.... let me think about that for a microsecond.

What he said.

Your dogma is condemning you to some really serious disadvantages, Balrog - you do know that don't you?

Rolfe.