Defend Private Healthcare

[thesyntaxera]

The absurdly litigious climate has been, in large part, fostered by the lack of a universal health care system. Let's say some dude slips and falls and breaks his leg, and he doesn't have medical insurance. He needs to go to the hospital and is eventually charged $20,000 for the services he receives. He is now in the hole $20,000 that he really can't afford. So, he sues the building/store owner/ city or whoever to recover these medical costs, even if he thinks it was just an accident as he really needs the money to pay off the hospital. He goes before a jury, they sympathize with his plight, and he gets some cash. And this cycle continues.

On the other hand, the same guy breaks his leg in Canada but has no $20,000 medical bill. He recognizes it as just an accident, but doesn't have a huge financial incentive to sue, so he gets on with his life without suing. And therefore you don't have a huge litigitious climate.

Exactly. When you remove the cost factor to the recipient it streamlines the whole process. It could also be one of the reasons why malpractice insurance is cheaper in countries that supply free medical services as well.

 

[Ivor the Engineer]

<snip>

You say it is presuming no such thing and then you post something that does appear to be presuming just such a thing.

Why do you presume the only way for a doctor to make money from his/her medical knowledge and skills is by treating patients?

 

[Francesca R]

What makes you think it's just Americans? Do you truly believe that Canadians, British, Australians, Dutch, French, etc. wouldn't do the same thing if their system permitted it? If you believe that, then explain why Americans are so inherently different.

It's nothing to do with being Americans, it has to do with simple human nature, and a system with a huge, exploitable loophole.

And this is hardly limited to the medical industry. It affects every major industry in the country. It indicates a need for tort reform, not for socialism.

With respect to the healthcare business--nonsense. It is because American healthcare has a less optimal incentive structure than most of Europe. With that comment you appear to join the list of people who "defend" the US system by attempting to point out that universal health care does not work any better. Again, nonsense.

 

[Francesca R]

Fee for service is a conflict of interest. Refusing to treat patients based on their ability to pay is incompatible with medical ethics. The hybrid system for NHS GPs that Francesca seems to prefer raises another moral hazard: get as many patients through the office doors to maximise revenue at the minimum expenditure. Effective treatment becomes secondary!

That's right I prefer it. It is superior to both "fee regardless of whether you serve or not" and "if you can't pay, no service". There exists no system with perfectly aligned interests. It is a question of rigging the incentives so that the price system delivers the best outcome that is compatible with society's moral preferences.

 

[Francesca R]

With respect to the healthcare business--nonsense. It is because American healthcare has a less optimal incentive structure than most of Europe. With that comment you appear to join the list of people who "defend" the US system by attempting to point out that universal health care does not work any better. Again, nonsense.

ETA--your post is probably saying no such thing, actually. So please disregard that /apologies.

However, tort reform is less of a need if the system is set up so that tort injury is not likely to be your first recourse. If you denounce changing the system (to universal health care) on some doctrinarian principle ("because it's socialism") then, well, I think you have the blinkers on.

 

[Ivor the Engineer]

Francesca, may I ask what your profession is?

(I have an idea, but I don't wish to jump to conclusions.)

 

[Ivor the Engineer]

That's right I prefer it. It is superior to both "fee regardless of whether you serve or not" and "if you can't pay, no service". There exists no system with perfectly aligned interests. It is a question of rigging the incentives so that the price system delivers the best outcome that is compatible with society's moral preferences.

Strangely my terms and conditions are not "fee regardless of whether you serve or not", but "salary if you serve, fired if you don't".

I have little chance of earning significantly more money (excluding standard yearly pay rises), yet I am expected to continue to innovate for the company and its shareholders. And I do, because by and large I enjoy my work.

Do you really think the NHS would struggle to find competent, enthusiastic people to fill jobs paying £40000 to £100000 (depending on job role and responsibility) per year?

 

[Francesca R]

Strangely my terms and conditions are not "fee regardless of whether you serve or not", but "salary if you serve, fired if you don't".

Ok then. That's "service-related" compensation and whereas the system has moved significantly towards "performance-related" compensation.

Do you really think the NHS would struggle to find competent, enthusiastic people to fill jobs paying £40000 to £100000 (depending on job role and responsibility) per year?

I think that performance-related compensation should and does find more of them, and improves the quality of service delivered.

 

[ponderingturtle]

It happens to be today's news but does not prove anything. Some spectacular advances are bound to happen outside US. Thesyntaxera's post is much more convincing -- it is true that US life expectancy is 24th in the world despite 2nd largest per capita health care expenditures.

Wait, who out spends the US in health care?

 

[ponderingturtle]

Partly, yes. Food is a necessity, and most modern countries recognize that people who can not afford it should receive sufficient assitance from the state not to go hungry. Nobody thinks that state assistance should pay for caviar, and very few think that caviar should be banned because some people can not afford it.

So when is living and not being in pain a right vs a luxury?

 

[boooeee]

In regards to private healthcare, much is made of how much the US spends per capita on healthcare, relative to other OECD countries, with the blame often placed on our private healthcare system.

It is true that in 2006, the US spent $6,102 per capita, compared to France, which spent $3,159, and the UK, which spent $2,508 (Source)

However, of the $6,102 that the US spent, 44.7% was publicly financed. That works out to $2,728. That's already more than the UK and very close to what France spends. Publicly financed healthcare in the US primarily covers the poor (Medicaid) and seniors (Medicare).

What I take away from this is that healthcare in the US is expensive, regardless of public or private delivery, and that blaming the private system for our high cost of healthcare doesn't really hold up.

So, why is our healthcare so much more expensive? Is our delivery system that much more inefficient than European-style systems?

Are we somehow subsidizing the cost of developing medical technology for the rest of the world? To me, that is the best argument in defense of private healthcare. Unfortunately, it seems hard to come up with evidence either way to answer that question. Any links would be appreciated.

 

[jimbob]

Wait, who out spends the US in health care?

The Marshall Islands on a per-capita basis

 

[jimbob]

Is there any evidence that backs this statement up, or is this just a blanket assumption based largely on a personal bias against national health systems?

The fact is:
http://student.pnhp.org/content/what_about_physician_salaries.php

Salaries are not that different...


If a person is only practicing medicine because it makes them a lot of money then perhaps they should be doing something different for a living. These debates almost always seem to revolve around the idea of income and who is making more, when it seems the most logical and certainly the most humane position is one that values human life more than money.

The United States is one of the most, if not the most expensive health care systems in the world...
The US Health Care system: Best in the World, or just the most expensive?
http://dll.umaine.edu/ble/U.S. HCweb.pdf

The World Health Organization's ranking of the world's health systems:
http://www.photius.com/rankings/healthranks.html

The US is 37th.

The WHO life expectancy Rating:
http://www.photius.com/rankings/healthy_life_table2.html

The US is 24th.

WHO Health Performance Ranking:
http://www.photius.com/rankings/world_health_performance_ranks.html

The US is 72nd.

WHO Total Health Expenditures as % of GDP, 2002-2005 - Country Rankings:
http://www.photius.com/rankings/total_health_expenditure_as_pecent_of_gdp_2000_to_2005.html

The US is number 2, after the Marshall Islands.


So, the quick summary is that countries with National Health Insurance have better care all around, and have lower spending compared to completely private systems. Also, that wage differences aren't that significant.

Here was my earlier analysis of this:

It gets better than that:

The US state spends a similar amount on healthcare to the UK state, and in 2004 (at least) a higher proportion of its GDP than the UK....

So more tax was spent on healthcare in the US than the UK.

Yup: some further evidence from an earlier thread:

The US state alone spends more of its GDP on healthcare than the UK: for as system that is far form universal.

The death rate is higher in the US too, and not all can be explained by higher gun ownership:

In answer to the assertion that the rest of the world is freeloading on the US medical research, which is lowering death rates, a lot of the mortality and morbidity is preventable with better primary healthcare.

 

[Beerina]

So, why is our healthcare so much more expensive? Is our delivery system that much more inefficient than European-style systems?

Are we somehow subsidizing the cost of developing medical technology for the rest of the world? To me, that is the best argument in defense of private healthcare. Unfortunately, it seems hard to come up with evidence either way to answer that question. Any links would be appreciated.

It would be interesting to see the statistics. Some people claim a big chunk is dealing with all the paperwork, others say that's not an issue.

Some say it's drug costs, others say that's not really an issue.



At the very least, though, since we don't have laws mandating this or that price for things, that the companies developing them do charge more than they otherwise would because the rest of the world doesn't kick in to reward their hard work.


Shame!



If the Twilight Zone teleported the US, Europe, and the rest of the world to different planets, I think the stats show the US's medical technology would pull ahead of Europe's or the ROW's.

What benefit, then, of socialized medicine?


But because the world shares medical tech, such a massive and obvious problem never shows up. A person with cancer and no insurance in front of the cameras today is worth millions dying fifty years from now because a cancer cure was delayed by two decades.

It's a sickening version of compound interest.

 

[volatile]

Beerina - do you have any evidence for that ludicrous statement at all? I continue to be perplexed why you remain so ideologically committed to a worse, more expensive, less effective system.

 

[Ivor the Engineer]

Beerina - do you have any evidence for that ludicrous statement at all? I continue to be perplexed why you remain so ideologically committed to a worse, more expensive, less effective system.

No, he got it from the Cato institute.

The Cato Institute is a libertarian think tank headquartered in Washington, D.C.

The Institute's stated mission is "to broaden the parameters of public policy debate to allow consideration of the traditional American principles of limited government, individual liberty, free markets, and peace" by striving "to achieve greater involvement of the intelligent, lay public in questions of (public) policy and the proper role of government." Cato scholars conduct policy research on a broad range of public policy issues, and produce books, studies, op-eds, and blog posts. They are also frequent guests in the media.

ETA: He also seems to be unable to separate the development of healthcare from the provision of healthcare, believing providing equity in the latter will negatively affect the former.

 

[ponderingturtle]

The Marshall Islands on a per-capita basis

Becuase of the high rate of Leprosy?

 

[ponderingturtle]

But because the world shares medical tech, such a massive and obvious problem never shows up. A person with cancer and no insurance in front of the cameras today is worth millions dying fifty years from now because a cancer cure was delayed by two decades.

It's a sickening version of compound interest.

Not really. Look at all the people dying from diseases that can be cured now, that no one cares about.

This also takes it as an assumption that the US health care system is much better at medical innovation than other systems. You would expect the US to develop many new medical technologies for the same reason the US develops many new technologies of all kinds. Being the weathiest and most advanced nation on earth.

 

[ponderingturtle]

ETA: He also seems to be unable to separate the development of healthcare from the provision of healthcare, believing providing equity in the latter will negatively affect the former.

he also totaly ignores the falures of the current methods of distributing health care.

Think of the millions of lives in africa that could be saved every year for a small percentage of the US health care budget. It is a sickening form of compound intrest.

 

[Darat]

Lets see, patchwork system that is not truly nationalized: Check - we have primary care trusts (303 in England alone) that set their own priorities and decide whether or not to fund certain treatments.

Underfunded - some would say it is, some would say it isn't. I think few would argue that the huge additional resources committed in recent years have been matched by a corresponding increase in results.

...snip...

Put me in with the "few" - I have been a regular "customer" of the NHS since I was 13 and the difference that I have seen over the last 10 years or so is, well the only word I can think of is revolutionary. The standard of care has just leaped beyond recognition.