Universal Health Care in the US. Yea or Nea?

[inquiringone]

Is that so inevitable? In another thread like this, people did some research into current expenditure. It was discovered (much to everyone's general astonishment) that the proportional tax take on US citizens which pays for Medicare and Medicaid (which most of those paying the taxes cannot personally access) was actually slightly greater than the proportional tax take on UK citizens which pays for the whole NHS, which everyone, taxpayer or not, pauper or millionaire, can access.

Now obviously the NHS is not the only system. You have a fair variety of systems to choose from when deciding how to fix your healthcare. But it certainly seems that at least one of these systems can deliver universal care for slightly less money (per skull, or as a percentage of GDP) than you're currently paying for your very limited-access safety-net provision.

Rolfe.

I just assumed the whole "your taxes will rise" thing was inevitable. I'd like to see a link to your figures. You just gave me an excellent rebuttal to the libertarians' favorite argument against universal health care. (The whole "ZOMG socialized medicine! Teh Evilz!" is nonsense and not worth dignifying with a response.)

 

[inquiringone]

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.

By the way, this quote is taken from your link. "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 USA spends $2300 more per person than Canada in health care costs and we don't even have universal health care.

As for waits for doctors, I had to wait three months for a routine physical from my former doctor. The public clinic actually has a lot shorter waiting time (try a month, but that is because I have a trip coming up and could not go during the time they wanted me to come in.)

 

[Bob Blaylock]

Well, I live in a system where we pay 50+% income tax in return for free education and healthcare. We don´t have to buy health insurance or save up for college.

The basic idea is "to each according to need, from each according to ability" or something like that.

You do know where that quote comes from, don't you?

In a free society, government does not consume the majority of everyone's income. If government takes more of your earnings from you than what it lets you keep, then you are not a free citizen; you are a slave.

 

[Tsukasa Buddha]

You do know where that quote comes from, don't you?

In a free society, government does not consume the majority of everyone's income. If government takes more of your earnings from you than what it lets you keep, then you are not a free citizen; you are a slave.

Yes, because governments are alien entities completely separate from control of the taxpayer. And why the arbitrary setting of half for defining slaves? I believe to be a slave it must be all.

 

[Ivor the Engineer]

<snip>

In a free society, government does not consume the majority of everyone's income. If government takes more of your earnings from you than what it lets you keep, then you are not a free citizen; you are a slave.

But at least Toke and his compatriots are the happiest slaves in the world.

http://en.wikipedia.org/wiki/Denmark#Economy

Denmark's market economy features efficient markets, above average European living standards,[39][40] and high amount of free trade.

Denmark has a GDP per capita higher than that of most European countries, and 15-20% higher than that of the United States.[41] Denmark is one of the most competitive economies in the world according to World Economic Forum 2008 report, IMD, and The Economist.[42] According to World Bank Group, Denmark has the most flexible labor market in Europe; the policy is called flexicurity. It is easy to hire, fire, and find a job. According to rankings by OECD, Denmark has the most free financial markets in EU-15 and also one of the most free product markets, owning to liberalisation in the 1990s.

Around 2.9 million residents are in the labor market. The proportion of tertiary degree holders is one of the highest. GDP per hour worked was the 10th highest in 2006 and unemployment at 2.3 percent. Denmark has an advanced telecommunications infrastructure. Denmark has a company tax rate of 25% and a special time limited tax regime for expatriates.[43] The Danish taxation system is both broad based (25% VAT, not including excise, duty and tax) and has the world record for income tax rates (minimum tax rate for adults is 42% scaling to 63%, population average for 2006 was 49.6%).[44]

 

[Bristow42]

What I have see and hear about how American health system is terrible. Yes I did watch Sicko Michell Moore Doc. But a friend of mine broke his leg, he had travellers insurance. As soon as he got to the hospital they wouldn't treat him until he signed paper work relating to this insurance. As they were putting on the cast, they said he had to pay $4,000 US, extra on his insurance. He said he would as soon as they had finished treating him. He didn't have the money. That night after they gave him some pain killers, he called a Taxi and left, when back to his motel got his bags and caught a plane back to Australia. When he got home he went straight to the Emergence ward and got his leg reset. The Doctor asked who had set the brake, he told him the story. The doctor said you are lucky you came back, because they had no set the leg properly or cleaned the worn. It could of turn septic. The moral of the story don't get sick in the USA.

 

[Darat]

...snip...

In a free society, government does not consume the majority of everyone's income. If government takes more of your earnings from you than what it lets you keep, then you are not a free citizen; you are a slave.

Why can't free people decide to organise themselves as they wish?

Not picking on you in particular but there does seem to be quite an idealogical base to many of the nay sayers objections in regards to some form of universal health-care.

Ideology is not a bedmate of critical thinking.

 

[Zep]

You do know where that quote comes from, don't you?

In a free society, government does not consume the majority of everyone's income. If government takes more of your earnings from you than what it lets you keep, then you are not a free citizen; you are a slave.

Hello??

*taps microphone*

Is this thing on?

One, two, one two...

OK.

Bob, did you actually read what I wrote about Australia's Medicare system? I'm not seeing that you did.

That it costs me a 1.5% levy? And my overall income tax burden, this included, is under 30% (I'm just an average wage earning Joe.) So it's a tiny proportion of my overall tax burden. Sure, I whinge about what the various governments do with my tax dollars - who doesn't! But comparing to how much I pay for medical treatment and how simple it is to obtain versus the current US system...we look askance at you, seriously.

As I said and as other have said, it's not really a financial issue. As I said, the Australian scheme was introduced by a hard-nosed fiscally conservative (nay, notoriously tight-arsed) government because it was a better financial proposition than the US-style alternative being considered. I did say forget the "socialist dreamers" crap-fest, didn't I. And Australia is not exactly gulag-infested Stalinist-slave territory, I think you will agree. Yes? So again, leave that argument go.

The real issue seems to be that some in the US seem to be unable to let themselves imagine that a public service body can actually do something useful for the people they are legislated to serve. Apart from all the useful public services already part of US daily life...

No-one says you have to have a global medical support system exactly like the UK or Canadian or Australian or Norwegian one. These are just examples of modern small-GDP countries that do have something workable in place that does not automatically require 50%+ taxation. You guys have brains and can solve plenty of difficult problems (like how to fly to the moon and back) - use them! How about you make it a blue-sky green-field problem for the incoming government to examine and solve.

Oh looky! That's already on the agenda... Better get on board, Bob, if you want to have your say.

 

[Ivor the Engineer]

<snip>

You guys have brains and can solve plenty of difficult problems (like how to fly to the moon and back) - use them!

<snip>

I believe that was in a large part due to German rocket scientists.

 

[Flo]

A very good article in the NewYorker:

GETTING THERE FROM HERE How should Obama reform health care?
by Atul Gawande

….. wherever the prospect of universal health insurance has been considered, it has been widely attacked as a Bolshevik fantasy—a coercive system to be imposed upon people by benighted socialist master planners.

[...]

True reform requires transformation at a stroke. But is this really the way it has occurred in other countries? The answer is no. And the reality of how health reform has come about elsewhere is both surprising and instructive.

In Great Britain

The program proved successful and lasting, historians say, precisely because it was not the result of an ideologue’s master plan. Instead, the N.H.S. was a pragmatic outgrowth of circumstances peculiar to Britain immediately after the Second World War.

In France, in the winter of 1945, President de Gaulle was likewise weighing how to insure that his nation’s population had decent health care after the devastation of war. […] With an almost impossible range of crises on its hands—food shortages, destroyed power plants, a quarter of the population living as refugees—the de Gaulle government had neither the time nor the capacity to create an entirely new health-care system. So it built on what it had, expanding the existing payroll-tax-funded, private insurance system to cover all wage earners, their families, and retirees.

Switzerland, because of its wartime neutrality, escaped the damage that drove health-care reform elsewhere. Instead, most of its citizens came to rely on private commercial health-insurance coverage. When problems with coverage gaps and inconsistencies finally led the nation to pass its universal-coverage law, in 1994, it had no experience with public insurance. So the country—you get the picture now—built on what it already had. It required every resident to purchase private health insurance and provided subsidies to limit the cost to no more than about ten per cent of an individual’s income.

Social scientists have a name for this pattern of evolution based on past experience. They call it “path-dependence.”

 

[Rolfe]

I just assumed the whole "your taxes will rise" thing was inevitable. I'd like to see a link to your figures. You just gave me an excellent rebuttal to the libertarians' favorite argument against universal health care. (The whole "ZOMG socialized medicine! Teh Evilz!" is nonsense and not worth dignifying with a response.)

The thread is here, and it's quite recent. I'll try to find it for you later, or perhaps someone else can - actually, I think there might have been two simultaneous related threads going on.

Volatile, I think, was the one who found most of the evidence. He did make a mistake initially, in factoring in the costs of private medical care in addition to the state-funded component. So it's the later part of the discussion you want, once the mistake has been corrected - that's when we figured out that yes, the cost to the US taxpayer of Medicare and medicais is indeed slightly more on a pro-rata basis than the cost of the NHS to the UK taxpayer. Try a PM to Volatile.

Also, refer to Zep's post below yours regarding the Australian situation.

Wait a minute, I just got this month's payslip in.

• Tax paid 17.4%
• National Insurance paid 9.0%
• Company pension payment (voluntary) 4%
• The bit I get to spend 69.5%

National insurance is (at least theoretically) the part of our "tax" that goes towards providing the universal retirement pension. Given that the company pension is voluntary (I choose to take advantage of the free money attached), then in fact I get to keep over 70% of my gross income. And I'm in the "higher rate tax" bracket.

I don't actually know what percentage of the tax take goes to the NHS. Considering all the other stuff they do with it, like building Trident submarines and invading Iraq and maintaining Buckingham Palace and its occupants, it can't be that high though.

I have no health insurance at the moment, because I don't need it. I know that the NHS is there if I get sick or injured, and in the event that I want something done faster than the NHS is prepared to do it (as my mother did, when she was caught up in a delay caused by a the forced closure of a ward in the eye hospital), the system has allowed me to keep enough of my income to accumulate sufficient savings to be able to pay BUPA to do it up front.

I don't know how much the average US citizen gets to keep of his or her monthly wage packet, but is it really so much more than I do?

Rolfe.

 

[Rolfe]

Yes, we have discussed this topic a few times and I value your input to the discussion.

However, the last time this came up as an actual proposal here*, it called for a one-size-fits-all minimalist solution of absolute tyranny, including prohibition from changing medical service plans, severe penalties for both doctors and patients who went outside the New World Order Solution (that's a slight joke BTW), and federal bureaucratic control of all medical colleges, doctor and nurse training, doctor specialization, and GP practices - Medicare for everyone plus extra controls and all but enslaving any practicing doctors.

That is what I want to avoid.

ETA: * And by here, I mean the USA not the forum.

Help me out here. You're saying that so far, the only actual proposal that has been put forward by US government is a highly restrictive one which you and many others view with disfavour. With you so far.

Then you're saying, because of this, you are absolutely adamant that you want nothing at all to do with any universal system at all. Total hard-line no. Regardless of all the examples you've been given of countries with universal systems that are nothing at all like the proposal you so abhor.

That's reasonable, how, exactly?

And so does everyone else here except those who already need very expensive medical care at a price of FREE.

Somehow, I doubt that last bit quite a lot. Many many people, in the USA just as well as anywhere else, have the imagination and foresight to realise that while they may be healthy now, all that could change in a moment. And would feel better if they knew that there was a system in place that was less likely to leave them stranded with no resources.

Not everyone who is in favour of universal healthcare is a scrounger.

Rolfe.

 

[Francesca R]

The thread is here, and it's quite recent.

This one? You and Balrog666 were active on it. But its signal:noise ratio is miniscule (in general) IMO for other reasons.

http://www.internationalskeptics.com/forums/showthread.php?t=106255

 

[Segnosaur]

That's a worthless analogy, unless you claim the other categories are as unimportant compared to responsiveness as a stereo system is compared to the motor.

So, do you? The other three are:
1) Overall Level of Health
2) Distribution of Health in the Populations

The problem with rating a health care system on those 2 points is that they rely (in part) too much on factors that are outside the control of doctors/hospitals.

For example, overall level of health might depend on how well the average citizen cares for themselves, and Americans have a reputation (perhaps deserved, perhaps not) for having a poor diet/exercise habits.

Distribution of health may have a little more to do with the actual health care system, but when you're dealing with a country as large/populous as the U.S., you're likely to get a lot more variation between those that are healthy and those that are not. For example, in the U.S. you have native populations living in remote areas who do not do as well as people living in urban centers. The poor health of Native Americans may be due to their remote location and sociological factors rather than significant problems in health care.

http://query.nytimes.com/gst/fullpage.html?sec=health&res=9400E4D71331F932A15755C0A9669C8B63

3) Distribution of Financing

This IS an area where the U.S. would be rated lower than other countries. I've never denied it. But it doesn't speak of the quality of the health care itself.

And earlier you mentioned "faster adoption of new technology" as a benefit of greater responsiveness. Only the category of "Responsiveness", as defined in the article, does not include that. Did I miss it, or did you make it up?

It may not be in the original article, but I didn't make it up. (

And in the U.S., they have a rule that if people show up to the emergency room they have to be treated (regardless of whether they have insurance).

Unfortunately, for many illnesses (like cancer) by the time you're in a bad enough state to get into the emergency room it is either already too late or much more expensive.

I was responding specifically to a claim about how people in socialized systems got emergency treatment when they needed it. I was pointing out that people in similar situations in the U.S. also get treatment.

I wasn't trying to talk about non-emergency situations.

Actually it is pretty much guaranteed that in a for-profit system patients will be prioritised based on their ability to pay. The existing universal healthcare systems may not always be succesful in sorting their patients by need, but they're a hell of a lot more likely to succeed at it than any for-profit system.

I never denied people in a for-profit system would have the richer people get priority. What I've always said is that having for profit elements in a health care system might improve the health care system on average.

I do want to emphasize something that I mentioned a long time ago but might have been lost... I do not think the U.S. system is perfect. I do not even think the U.S. system is the best in the world. What I do dislike is people claiming an all "socialized" system (only taxpayer funded) like we have in Canada is somehow the best way to go. Its not. I think the best systems are the ones that mix private and public elements, as most Western countries have adopted. I'm only trying to debunk the arguments that people have criticizing the American system that I think are unfounded.

 

[Segnosaur]

By the way, this quote is taken from your link. "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 USA spends $2300 more per person than Canada in health care costs and we don't even have universal health care.

Perhaps you've missed all the posts made since I posted that link.

I've never denied the U.S. has an expensive health care system. On the other hand, according to the WHO, they also have the most responsive health care system. So, they're paying a lot for health care, but most people, if they want it, can get treatment much more quickly than they can here in Canada. Having that added capacity costs money.

As for waits for doctors, I had to wait three months for a routine physical from my former doctor.

Yup, and the last time I had a full physical I had to wait 4 months (if I remember correctly, its been several years). I can get a faster appointment if its for something like a blood test (I have borderline high cholesteral), but those aren't exactly full exams.

Not only that, many people are unable to actually find a doctor up here in Canada... 15% don't have a regular family doctor, and Canada ranks last among the G8 in the ratio of doctors to patients.

http://www.macleans.ca/article.jsp?content=20080103_101501_5548

You may have trouble paying for your doctor, but you have a better chance at actually finding one than you would if you were here in Canada.

 

[balrog666]

Help me out here. You're saying that so far, the only actual proposal that has been put forward by US government is a highly restrictive one which you and many others view with disfavour. With you so far.

Then you're saying, because of this, you are absolutely adamant that you want nothing at all to do with any universal system at all. Total hard-line no. Regardless of all the examples you've been given of countries with universal systems that are nothing at all like the proposal you so abhor.

That's reasonable, how, exactly?




Somehow, I doubt that last bit quite a lot. Many many people, in the USA just as well as anywhere else, have the imagination and foresight to realise that while they may be healthy now, all that could change in a moment. And would feel better if they knew that there was a system in place that was less likely to leave them stranded with no resources.

Not everyone who is in favour of universal healthcare is a scrounger.

Rolfe.

We already have a mix of public and private medical services.

MedicAid was created to provide cheap (or free) medical services to the "poor". Medicare was put into service to cover the medical service costs of retirees and the disabled. The VA covers veterans. The INHS covers Indians and certain others. They are all colossal failures and subject to the whims and games of politicians at both the federal and state level.

And Federal meddling in hospital regulations has caused many of them to close their emergency rooms and limit other services.

And Federal meddling in health insurance has priced it out of the reach of low income workers.

But ... maybe this time they will get it right. Yeah, right - let's roll the dice with 15% of our economy on that idea.


Now consider as a simple contrasting idea that Congress could expand Medicare/Medicaid to cover everyone without insurance. They could do it today. Almost without effort. Without much opposition. And without introducing any new programs, agencies, administrative offices, or disrupting any other private plans. And they could fund it with a minor tweak to the Medicare taxes already deducted from the paychecks of all workers. Wouldn't that solve all, or most of, the problems liberals are bleating about?

And yet that isn't what they are proposing - why do you think that is?

 

[Darat]

Because they know that is not cost effective?

 

[Rolfe]

G'Kar, I don't understand a word of that. I thought you had a very low opinion of Medicare/Medicaid, and the last thing you wanted was "more of the same".

However, you seem now to be changing your position to discussing viable options for universal healthcare. Great. This seems to me to be a huge step forward.

Proceed.

Rolfe.

 

[Blue Mountain]

MedicAid was created to provide cheap (or free) medical services to the "poor". Medicare was put into service to cover the medical service costs of retirees and the disabled. The VA covers veterans. The INHS covers Indians and certain others. They are all colossal failures and subject to the whims and games of politicians at both the federal and state level.

What metrics are you using to be able to declare these programs colossal failures?

And Federal meddling in hospital regulations has caused many of them to close their emergency rooms and limit other services.

And Federal meddling in health insurance has priced it out of the reach of low income workers.

What sort of government meddling are you referring to? Links to stories from respected sources such national newspapers or ABC/CBS/NBC would be useful, if for no other reason than to show us you can actually back up these statements.

Now consider as a simple contrasting idea that Congress could expand Medicare/Medicaid to cover everyone without insurance. They could do it today. Almost without effort. Without much opposition. And without introducing any new programs, agencies, administrative offices, or disrupting any other private plans. And they could fund it with a minor tweak to the Medicare taxes already deducted from the paychecks of all workers. Wouldn't that solve all, or most of, the problems liberals are bleating about?

And yet that isn't what they are proposing - why do you think that is?

Has the current administration proposed anything yet, or merely indicated that it wants to do something about it?

 

[Zep]

We already have a mix of public and private medical services.

MedicAid was created to provide cheap (or free) medical services to the "poor". Medicare was put into service to cover the medical service costs of retirees and the disabled. The VA covers veterans. The INHS covers Indians and certain others.

This is not the same as "universal health care". It is just private insurance-based cover made available to the wealthy at market-driven rates, plus a few spotty bits of helping out from the government for a few very select groups. There's gaps...BIG gaps...in that model. Big truck-sized gaps. Gaps as big as Grand Canyon. So of course there's going to be problems such that it's seen as a failure.

I'm rather hoping you can see that this is not "universal health care" in that every (qualifying) citizen is not covered for medical basics.