Universal Health Care in the US. Yea or Nea?

[Rolfe]

IIRC, almost all universal healthcare systems are less expensive as a fraction of GDP than the far from universal US healthcare system*.

Well, yeah. That's where a lot of the arguments fall down. We get various posters foaming at the mouth in fury that any universal healthcare proposal would be funded by "ripping money out of their wallets". They explicitly pity us for having all that money "confiscated".

But when we look at what actually happens, we find that US citizens are having just as much money "ripped from their wallets" or "confiscated" right now, as we are - if not more. The main difference is that while we actually benefit from that tax take in being able to access the service provided, most US taxpayers can't.

Rolfe.

 

[Francesca R]

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.

So refuse to treat those whose "health outcome" it is difficult to improve anyway, to get the best average for your group of physicians (or group of patients). Team up with other physicians who do the same (move your practice if the rules make it hard) so that that is more likely. You're running into unintended consequences and having to adapt and complicate the rules of your proposed system (much like in "What would be the effects of . . . ?")

The real challenge is in selecting health outcome measures which motivate physicians to behave in a way which benefits society.

Certainly, but nonetheless this proposal does not better align interests. It is not going to ever be in the interest of a patient to pay as much as possible for health and it is not going to ever be in the interest of the physician to earn as little as possible delivering it. Bargaining between the two parties suffers from asymmetric information so that's no resolution to determining the price. Price-setting from a central authority is therefore what we end up with. You are concerned that by paying for service delivered, this authority doesn't get value for money because this introduces unwanted incentives. In reality, it selects for the least unwanted of a range of unavoidably adverse incentives. That might be judgement/opinion in the end, but the present method avoids the extra red tape and jumping through loopholes that your added complexity ushers in, and I submit that it is cheaper for the same level of efficiency, or more efficient for the same cost.

To be precise--where your attempt to align interests actually falls down is that the patient's interest is that she gets well, but the physician's interest is that the person she treats gets well according to the audit.

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

What would you use?

 

[Toke]

Who ignores that? Perhaps you mistake a "reluctance to rely on the voluntary expression of professional pride and self-respect as the only possible motivator in every case" for ignorance. After all, wouldn't that be rather wishful thinking?

Easy now, it was not meant that personally.
I just feel the incentive thing is being overdone.

My problem is that our current goverment have the idea that everything must be documented and measured.
It means that teachers and nurses are spending more and more of their time on, to them, pointless paperwork.
That hurts their professional pride and their loyalty to the employer.

There are good arguments that the strike among nurses were caused by this.
As they did not feel respected at their job, they wanted a higher pay.

My last company were far gone in making company procedures for all situations and jobs. It made people feel put upon, and were one of the reasons I left.
Ok, there were no "safe job analysis" sheet for using the loo, but there were one for using the sink afterwards.

Have you read of teaching for the test?

 

[Francesca R]

I just feel the incentive thing is being overdone.

My problem is that our current goverment have the idea that everything must be documented and measured.

I would agree with some of that, but many economists (I'm not one BTW--no degree in it anyway) think that measuring targets is to use very clumsy incentives--namely the incentive that you are being monitored so you better do a good job.

What has been raised in this thread is the incentive provided by paying for service delivered (which Ivor the Engineer criticised) and then paying for measured health outcome (which I criticised--partly because it shares more of the beaurocracy miasma that you allude to, IMO). Both are qualitatively different incentive schemes from an ephemeral "Big Brother is measuring/targeting" one though.

 

[Toke]

I guess you could get problems with both.

paying for service delivered: You get clinics that overtreat to write a bill.
measured health outcome: Sounds very complicated, and who will take the hopeless patients.

There were talk of linking teachers pay to the grades of their classes.
That would cause a major infight among teachers for the good classes.


As for monitored, you are always monitored.
If I install buttons on the brigde for the firepump, I better have them connected to the swichbox for the pump. (its a long way to draw a cable)
Saying the parrot is just resting will not work.

 

[Ivor the Engineer]

So refuse to treat those whose "health outcome" it is difficult to improve anyway, to get the best average for your group of physicians (or group of patients).

That is not an option. Refusal to treat is based on objective medical criteria.

Team up with other physicians who do the same (move your practice if the rules make it hard) so that that is more likely.

Move it where? Physicians are given financial incentives to work in health black-spots.

You're running into unintended consequences and having to adapt and complicate the rules of your proposed system (much like in "What would be the effects of . . . ?")

The 'rules' are not complicated:

1) Refusal to treat has to be based on objective medical criteria.

2) Groups of physicians are rewarded based on the health outcomes of groups of patients. How this is divided up can be worked out locally using a performance appraisal process.

3) Financial incentives are provided to physicians to work in locations or specialties which have patient demographics which result in significantly poorer health outcomes than other locations or specialties.

 

[Francesca R]

The 'rules' are not complicated: 1) [ . . . ] 2) [ . . . ] 3) [ . . . ]

And 1--3 are on top of what you already had!

 

[Ivor the Engineer]

And 1--3 are on top of what you already had!

What other 'rules' have I specified?

 

[Segnosaur]

I'd be curious about how the numbers would change if people were asked "Do you want a single-payer system, but to fund it we will raise your taxes".

We need national health care. 47 million people in the USA lack health insurance.

Yes, a lot of people are uninsured. Of course, many of them A: actually choose to be uninsured even if they could afford health care, or B: are recently hired and will eventually be on their employers health plan once some sort of waiting off period occurs.

I'm not going to deny that many people in the U.S. will suffer hardships due to health care costs. But every system is going to have problems.

I am aware my taxes would be raised. However, I figure that is better than paying $100+ a month for some useless plan that covers only 20% of the cost of a doctor's visit (I'm speaking of your basic yearly checkup.) My work only offers that plan.

You're assuming a national health care plan would only raise your taxes by roughly the same amount. What if they implemented some sort of national health care plan, but raised your taxes by $400 (yet still didn't cover everything)? Would you be any better off than paying for your own private insurance that was comprehensive?

Approximately $4400 per taxpayer gets spent by the government on health care in Canada. That's almost $400 per month.

http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=media_13nov2008_e

Oh, and by the way, while you're complaining that your health care plan only covers a doctor visit, keep in mind that many people in Canada can't even find a family doctor, and if they need specialized treatment, they can spend months or years on waiting lists.

 

[Toke]

Are you trying to argue for private healthcare as the cheapest?
This is from your link.

International comparisons
Among 25 countries that have comparable accounting systems in the Organisation for Economic Co-operation and Development (OECD) in 2006, the latest year for which data are available, spending per person on health care remained highest in the United States (US$6,714). The U.S. was followed by Norway (US$4,520), Switzerland (US$4,311) and Luxembourg (US$4,303). Canada was in the top fifth of countries in terms of per person spending on health, spending US$3,678 per person, which was similar to seven other OECD countries, including France, Germany, the Netherlands and Austria. The lowest per capita expenditures were seen in Turkey (US$591) and Mexico (US$794).

The us spend the most and still have 47 million uncovered.
And no, I dont think they are just between jobs or dont want healthcare even through they could afford it.

 

[Rolfe]

You're assuming a national health care plan would only raise your taxes by roughly the same amount. What if they implemented some sort of national health care plan, but raised your taxes by $400 (yet still didn't cover everything)? Would you be any better off than paying for your own private insurance that was comprehensive?

Have you totally missed the posts explaining that some if not most countries which provide universal healthcare manage to do it by spending slightly less money (on a pro rata basis) than the US currently spends on Medicare and Medicaid?

Rolfe.

 

[Ivor the Engineer]

Have you totally missed the posts explaining that some if not most countries which provide universal healthcare manage to do it by spending slightly less money (on a pro rata basis) than the US currently spends on Medicare and Medicaid?

Rolfe.

An interesting article about the creation of the NHS:

http://www.independent.co.uk/life-s...ing/features/the-birth-of-the-nhs-856091.html

...One of the fears underlying the Conservatives' opposition to the NHS was that when treatment was free, the feckless poor would rush in to strip the chemist shops of every pill on the shelves, then head for the dentists' surgeries to have their mouths filled with gold and silver. At first, it appeared that this might be happening. Spending during the NHS's first year vastly overshot the budget, and the prime minister, Clement Attlee, went on the radio to plead with people not to overburden the service.

The vast expense of the enterprise brought Bevan's ministerial career to a premature end. In 1951, the new Labour chancellor, Hugh Gaitskell, insisted on prescription charges, breaching Bevan's principle that care must be free. This incensed him.

Bevan had argued that the huge initial expense was the result of years of under-provision, when the dying bequeathed their spectacles to relatives who could not get prescriptions. By 1951, he had apparently been proved right, because the rush had died away, and he felt charges were a punishment unjustly imposed on patients who had behaved responsibly.

What Bevan and his allies failed to foresee was how advances in medical science would forever push up costs. After 60 years, it seems no amount of money will satisfy the infinite demand for better NHS care.

Soon after Bevan's resignation, the Labour government fell, their places taken by the Conservatives, who had opposed the creation of the NHS. Among the new Tory MPs was Charles Hill, the doctors' leader, now on the fast track to the cabinet. The issue of whether health care should be paid for out of general taxation was back on the agenda.

A Cambridge academic, Claude Guillebaud, led a committee to look at different ways to pay for the nation's health. To the government's surprise, the committee reported that the NHS was efficient, cost-effective, and deserved more money. The Tories accepted it with reasonably good grace, and did their best to forget they had ever opposed the NHS's creation. The principle of a free health service for all, paid for out of general taxation, had been won. The people had come to love their free NHS so much that no one could take it away.

I'm not sure about the last sentence.

 

[Toke]

I hope it is sure in my country.

 

[balrog666]

Regarding a not-atypical US response to the universal health care debate . . . it does seem that a lot of Americans accept that their health provision is inadequate and too expensive, but when (usually) Europeans argue that some European systems are superior, that is just too hard to swallow for many Americans. More fool them.

Y'all seem to forget that, aside from the multitude of state, county, local and independent "health care" systems here that all dominated or heavily influenced by fed policies, the US Federal Government already directly runs at least four major and independent medical service systems providing a substantial portion of the delivery said of medical services in the US.

And they are disasters.

And, almost without exception, anyone who has had to rely on them, hates them with a white-hot passion.

So we know exactly what the US government has to offer with respect to medical services and we don't want any part of it and we sure don't want it to be our only option.

.

 

[balrog666]

Have you totally missed the posts explaining that some if not most countries which provide universal healthcare manage to do it by spending slightly less money (on a pro rata basis) than the US currently spends on Medicare and Medicaid?

Rolfe.

Are you suggesting that the US could expand Medicare and Medcaid to cover everyone and yet save money doing it?

.

 

[Toke]

So the us is incapable of getting public systems to work?
It works in europe, americans are not that much dumber*.


*As in administrative traditions/pratices. (am I prejudiced?)

 

[Toke]

Are you suggesting that the US could expand Medicare and Medcaid to cover everyone and yet save money doing it?

.

If you compare to europe, Yes.
Maybe american administrative skills are even worse than soviet ones.

 

[ponderingturtle]

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

!

If memory serves it is paid for mostly by private individuals, it is only those who can not afford the relatively low cost premiums who get goverment assistence in buying it.

REmember in america we pay about twice what other countries do per capita for the privilege of such an efficient system.

 

[Toke]

REmember in america we pay about twice what other countries do per capita for the privilege of such an efficient system.

Come on, the insurance companies got to make a living too.

 

[ponderingturtle]

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

Of course, it punishes people who choose to get the lavish and expensive diseases like cancer. If you can't afford it you shouldn't get the disease.