Universal Health Care in the US. Yea or Nea?

[Ivor the Engineer]

It can be the same with your lawyer, plumber, fund manager, insurance salesperson, [ . . . ] Bad advice and service can be ruinous in all of these.

Except none of those people are as likely to kill you as a physician.

Do you have any idea why this isn't used? Anywhere?

(*Imagines "No Cure? No Fee!" billboards*)

Yes, very clever Francesca. If you were paying attention you would have noticed in my previous post I did say:

I would suggest anyone who wants to try though to not throw a spanner in the works at the very start by giving physicians a personal financial incentive to provide treatment to any particular individual.

The financial incentives for physicians would be related to the health outcomes of large groups of patients, not individuals.

 

[Francesca R]

Except none of those people are as likely to kill you as a physician.

So what? Faulty plumbing could kill you. I'm not sure how likely death by health professional is in comparison but there seems no reason for completely different considerations.

The financial incentives for physicians would be related to the health outcomes of large groups of patients, not individuals.

And you don't know why this might be an awful idea? (And you didn't mention "large groups" in respect of health outcomes, but that doesn't change things)

 

[Ivor the Engineer]

So what?

Some might think it sensible to focusing more effort on mitigating greater threats to their well being.

And you don't know why this might be an awful idea? (And you didn't mention "large groups" in respect of health outcomes, but that doesn't change things)

Rather than feigning disbelief at my stupidity, please just tell me.

 

[Francesca R]

Rather than feigning disbelief at my stupidity, please just tell me.

It still doesn't align interests which is what you wanted to achieve. I have an incentive to decline treating anyone less likely to get well. You could pressure me to sign up to a "cab rank" code of ethics or even legally require it, but that is hardly different in principle from the hippocratic oath. If you don't think that the latter has enough bite in the face of competing incentives, I don't see why the former would in the face of the altered (still misaligned) incentives.

ETA--Also someone has to "audit" every patient some time after treatment and evaluate the added health value the physician provided relative to an unknown counterfactual in order to determine the value of the invoice to whoever pays the physician. ("Tell them you're much better and you qualify for my loyalty bonus . . .")

 

[balrog666]

Well there are actualy many systems. One part of some systems is that private companies can not make a proffit on their basic level of insurance, the one that is mandated for people to have.

So, they then have an incentive to inflate their actual costs to use up the available funding ...

Or, if they are really denied the ability to make a profit on a specific plan, why would they even play in such a rigged game in the first place?

?

 

[Demigorgon]

As long as the members of Congress that enact such a system are required to use it, then yes.

Otherwise - no way in hell.

 

[Toke]

Universal Health Care could mean many things, the version we have in denmark works reasonable well. I don´t see why americans do not deserve something similiar.

 

[Ivor the Engineer]

It still doesn't align interests which is what you wanted to achieve. I have an incentive to decline treating anyone less likely to get well. You could pressure me to sign up to a "cab rank" code of ethics or even legally require it, but that is hardly different in principle from the hippocratic oath. If you don't think that the latter has enough bite in the face of competing incentives, I don't see why the former would in the face of the altered (still misaligned) incentives.

ETA--Also someone has to "audit" every patient some time after treatment and evaluate the added health value the physician provided relative to an unknown counterfactual in order to determine the value of the invoice to whoever pays the physician. ("Tell them you're much better and you qualify for my loyalty bonus . . .")

That's not the sort of scheme I had in mind at all. There is no advantage for any one physician refusing to treat a particular patient, because bonus payments would be calculated over groups of physicians, so it is in the physicians' interest to make sure all patients get treated appropriately.

All patients do not need to be audited, only a random sample. The real challenge is in selecting health outcome measures which motivate physicians to behave in a way which benefits society.

 

[quixotecoyote]

My wife and I have had to pay thousands of dollars on every medical issue as our insurance finds loopholes to wiggle out of paying what it is supposed to be paying; pretending it never got confirmation from physicians, that it never got the seven separate faxes documenting preexisting conditions, that our dozen unanswered calls weren't returned in time for the deadline, etc. Since we can only afford insurance through her work, its this or nothing. After all that, I'd like to live in a system that isn't motivated to deny you care to save money.

 

[ponderingturtle]

What is so special about medicine? And if you give them no financial incentive then they have an incentive to provide as little treatment as they can get away with (this is not to say what their response to this incentive will be, but it will be there)

So you have proven that volunteer ambulance corps do not exist.

People are not the perfect little sociopaths that ecconomics dictates.

 

[ponderingturtle]

So, they then have an incentive to inflate their actual costs to use up the available funding ...

Or, if they are really denied the ability to make a profit on a specific plan, why would they even play in such a rigged game in the first place?

?

Ask them. I do not know the details of such systems. But if you are buying basic insurance from a company you might well get suplemental insurance from the same company.

By these theories america has the most efficient health care system in the world. Except that when you measure it, it doesn't. So either A you accept that your theory is wrong, or B you yell about the evidence.

I wonder why there is so much of the ecconomic woo that B represents wrapped up in this issue.

 

[Francesca R]

So you have proven that volunteer ambulance corps do not exist.

People are not the perfect little sociopaths that ecconomics dictates.

Didn't read, did you?

 

[balrog666]

Universal Health Care could mean many things, the version we have in denmark works reasonable well. I don´t see why americans do not deserve [to have] something similar [imposed on them].

Fixed it for you.

 

[Toke]

Where do you get the imposed from?

 

[Bob Blaylock]

This is the United States of America, not the Союз Советских Социалистических Республик. This nation was not founded on the idea that Big Brother is there to take care of us all as if we are children. It is up to us to work to earn our living, and to use the wages that we thus earn to buy the things we think we need.

We do not expect Big Brother to take all of our earnings in taxes, and then to provide us with whatever housing, food, transportation, clothing, and such that it deems us to need. There's no reason why medical care should be any different than these other necessities of life.

A democracy is always temporary in nature; it simply cannot exist as a permanent form of government. A democracy will continue to exist up until the time that voters discover that they can vote themselves generous gifts from the public treasury. From that moment on, the majority always votes for the candidates who promise the most benefits from the public treasury, with the result that every democracy will finally collapse due to loose fiscal policy, which is always followed by a dictatorship.

—Alexander Tyler—​

 

[Darat]

It still doesn't align interests which is what you wanted to achieve. I have an incentive to decline treating anyone less likely to get well. ...snip...

That could be overcome by not just using "did the patient get well" as the measuring tool.

 

[DC]

....

A democracy is always temporary in nature; it simply cannot exist as a permanent form of government. A democracy will continue to exist up until the time that voters discover that they can vote themselves generous gifts from the public treasury. From that moment on, the majority always votes for the candidates who promise the most benefits from the public treasury, with the result that every democracy will finally collapse due to loose fiscal policy, which is always followed by a dictatorship.

—Alexander Tyler—​

i doubt that.

in Switzerland, on 28. November 2004 almost 75% of the voters, voted in favor of a Value added tax .

 

[balrog666]

i doubt that.

in Switzerland, on 28. November 2004 almost 75% of the voters, voted in favor of a Value added tax .

How else would they fund their public medical-services system?

!

 

[quixotecoyote]

How else would they fund their public medical-services system?

!

Beats me, but it sure looks like democracy is still existing.

 

[Blue Mountain]

This is the United States of America, not the Союз Советских Социалистических Республик. This nation was not founded on the idea that Big Brother is there to take care of us all as if we are children. It is up to us to work to earn our living, and to use the wages that we thus earn to buy the things we think we need.

We do not expect Big Brother to take all of our earnings in taxes, and then to provide us with whatever housing, food, transportation, clothing, and such that it deems us to need. There's no reason why medical care should be any different than these other necessities of life.

Your reasoning breaks at the bolded part. Housing, food, clothing, and (to a very large extent) transportation needs are pretty much the same for everyone. Once the basics are taken care of, everything added is essentially luxury.

Not so with health care. It's asymmetric from one person to the next. One of my grandfathers lived to ninety and I don't ever recall him having been admitted to hospital for anything more serious than a minor injury. My other grandfather had two strokes and two heart attacks in seven years. The second stroke killed him at 74.

Further, it's difficult to predict how your health will be from one year to the next. One week you're fine, then you're in an automobile accident that leaves you a quadriplegic. One month you're in good health, then your doctor notices a change in your T-cell levels and you're diagnosed with cancer. One day you're doing swimmingly, then you're in hospital for a month recovering from a heart attack that nearly kills you.

Further, in the US, by and large your health care options are tied to your employment. If you're suddenly unemployed, you're also without health care unless you can afford the COBRA payments. Good luck with that if your job paid peanuts.

Consider the case of one guy featured on a documentary that aired on PBS a few months ago ("Condition Critical"). He had worked for many years in job as a doorman that probably didn't pay all that well. He was diagnosed with liver disease (apparently completely unrelated to alcohol.) The place he work for terminated his employment shortly thereafter (isn't "at will" employment just wonderful?), and he immediately lost his medical insurance. Now he was sick, unemployed and basically unemployable, with no way of paying his medical bills.

Wonderful system you've got there in the US, I must say.