Stossel Solves the Health Crisis with Capitalism

[David Wong]

I read as much as I could of the thread, then realized it had split, so pardon my ignorance if this has been covered.

Healthcare costs are high for a lot of reasons. But we're so much better off, medically, than ever before in history.

So, if the uninsured create external costs or hidden tax on responsible people who pay for medical insurance, and don't lead dangerous or unhealthy lifestyles, isn't that just a fact of life?

We must treat the sick and injured regardless, so if it's in the form of public healthcare, where we are taxed heavily, or in the form of free market healthcare, where we are taxed in a hidden way when rates and procedure costs go up, what's the difference?

The only difference is how much it costs everyone, whether it's public tax, or private rate increase right?

Correct, if we are not to become a society who simply lets the chronically ill, genetically unlucky and dysfunctional people all die in the streets.

 

[Policenaut]

This is a sort of tangent but isn't it somewhat hypocritical to be using revenues from alcohol and tobacco to fund health care?

 

[quixotecoyote]

This is a sort of tangent but isn't it somewhat hypocritical to be using revenues from alcohol and tobacco to fund health care?

I think it has a sense of poetic justice to it.

People are going to drink and smoke. Period. Trying to stop them has horrible public policy consequences as alcohol prohibition did way back when and as other drug prohibitions are doing now.

I think keeping them legal, but using taxes on them to ameliorate the problems they cause is a fitting solution.

 

[Rolfe]

We must treat the sick and injured regardless,

Kevin, you just went up an inconcievable number of points in my personal estimation. (Yeah, I've been reading the ancap thread.)

so if it's in the form of public healthcare, where we are taxed heavily, or in the form of free market healthcare, where we are taxed in a hidden way when rates and procedure costs go up, what's the difference?

The only difference is how much it costs everyone, whether it's public tax, or private rate increase right?

I suspect that from your point of view any taxation is "heavy", so I'll leave that one.

I think, basically, that's about it. Though as you're not actually treating everyone in the USA at the moment, I dread to think what it would cost you if you did that, without doing anything to the structure of healthcare delivery.

And it seems to be getting to the point where the costs are an issue not just on an individual level, but at a national economic level. US companies are competing in the international market with foreign companies who don't need to spend any of their resources on providing healthcare insurance for their staff. And the burden is sufficient that competitiveness is being damaged. One of the links posted stated that General Motors spends more on employee health insurance than it spends on steel.

Rolfe.

 

[ponderingturtle]

I suspect that from your point of view any taxation is "heavy", so I'll leave that one.

I think, basically, that's about it. Though as you're not actually treating everyone in the USA at the moment, I dread to think what it would cost you if you did that, without doing anything to the structure of healthcare delivery.

Yes and no. Everyone is treated, it is that the poor have to put up with conditions until they become serious enough to be life threatening and require treatment. This also raises the cost of the treatment but what are you going to do go socialist?

And it seems to be getting to the point where the costs are an issue not just on an individual level, but at a national economic level. US companies are competing in the international market with foreign companies who don't need to spend any of their resources on providing healthcare insurance for their staff. And the burden is sufficient that competitiveness is being damaged. One of the links posted stated that General Motors spends more on employee health insurance than it spends on steel.

Rolfe.

Sure it is cheaper to have stuff made in many other industrialized nations than here because of the health care costs.

 

[Rolfe]

Yes and no. Everyone is treated, it is that the poor have to put up with conditions until they become serious enough to be life threatening and require treatment. This also raises the cost of the treatment but what are you going to do go socialist?

Actually, I don't think everyone is treated. I was thinking particularly of the woman at the start of the Stossel film, who found herself uninsured with breast cancer through no fault of her own, and who was simply not having the follow-up treatment she required. (She implied that she had the option to spend every penny she had then try to get on Medicaid, but she didn't see this as something she was prepared to do, for reasons of self-respect as much as anything it seemed.) Saying that she can go to A&E when the cancer actually breaks through the skin isn't really saying that she's getting treatment.

I think people like her are so often forgotten about by the pro free market lobby.

Sure it is cheaper to have stuff made in many other industrialized nations than here because of the health care costs.

I think that's the point. If everyone was spending 15% of GDP on healthcare it woudn't matter so much. But when you competitors aren't, then you're definitely going to start noticing it at some point.

Rolfe.

 

[Chaos]

And the ones with the chaotic lifestyles, who can't cope and can't pay, and get the diabetes anyway - do you treat them?

Rolfe.

Can you please get that fixation on me allegedly not wanting people to get treated out of your system, and adress what I´ve actually said?

If people can´t pay, they couldn´t have paid the regular premium either. So what happens with them now? Are they treated or not?

 

[Rolfe]

Sorry if I seem to be fixating on you. Not intended that way. Just trying to find out how this suggestion you're making would actually work out in practice.

I mean, you could say that they'd have had no option but to have paid, because their payment was in the form of a tax on the booze and the ciggies and the Big Macs that contributed to their problems.

That would have been informative. If it was what you were proposing.

The thing is, asking how such people are treated at the moment simply gets us back to the fact that the USA has a socialised medicine service at the moment, and people in that category are picked up by it.

Rolfe.

 

[ponderingturtle]

Actually, I don't think everyone is treated. I was thinking particularly of the woman at the start of the Stossel film, who found herself uninsured with breast cancer through no fault of her own, and who was simply not having the follow-up treatment she required. (She implied that she had the option to spend every penny she had then try to get on Medicaid, but she didn't see this as something she was prepared to do, for reasons of self-respect as much as anything it seemed.) Saying that she can go to A&E when the cancer actually breaks through the skin isn't really saying that she's getting treatment.

I think people like her are so often forgotten about by the pro free market lobby.

Sure it is not effective but it is treatment. But you have to remember most people are happy to ignore people like her. That and then complain about how long the waits are to get treatment for cancer in canada.

It does seem that most americans really do think that they put long waits on people getting nessacary treatments in nations with universal health care.

 

[ponderingturtle]

Can you please get that fixation on me allegedly not wanting people to get treated out of your system, and adress what I´ve actually said?

If people can´t pay, they couldn´t have paid the regular premium either. So what happens with them now? Are they treated or not?

The thing is that you can not talk about responcibility unless you are willing to talk about letting people die in the streets for not having the money and/or not making the choices you want them to.

 

[Chaos]

Sorry if I seem to be fixating on you. Not intended that way. Just trying to find out how this suggestion you're making would actually work out in practice.

I mean, you could say that they'd have had no option but to have paid, because their payment was in the form of a tax on the booze and the ciggies and the Big Macs that contributed to their problems.

Um... in a UHC system, everybody is included, aren´t they? What gave you the idea they wouldn´t be?

So, to use both my examples, everybody with a BMI above X who pays UHC taxes/premium pays extra taxes/premium; everybody is covered, except (over here) for those above the income threshold, who can opt out and buy private insurance to cover themselves.

That would have been informative. If it was what you were proposing.

The thing is, asking how such people are treated at the moment simply gets us back to the fact that the USA has a socialised medicine service at the moment, and people in that category are picked up by it.

Rolfe.

Again I don´t see what your problem is. I wrote, several times, what I´m proposing, you adress something completely different.

To reiterate:

I do not suggest and have never suggested that anyone would lose UHC coverage for their behavior.

I suggest that those who make decisions likely to be detrimental to their health (such as smoking) are in some way made to pay for the risk of extra burden they place on the insured community. That might be via higher taxes/premiums for those with a very high BMI (obviously, with loopholes for those who suffer from a condition not their fault which causes this), and/or taxes on items that damage one´s health such as alcohol or cigarettes or Big Macs.

I also suggest right now that those who take very good care of themselves, for example by taking advantage of regular check-ups at the dentist´s, are rewarded for this, for example with a lower deductible or lower tax/premium rate.

I do not claim that it is always possible to decide with certainty if a specific behavior is detrimental to one´s health, or to design a premium hike or a consumer tax in such a way as to discourage exactly that behavior. (for example, sitting in front of the TV for too long is not healthy; however an extra tax on TVs might not be the right answer)

 

[Rolfe]

Now that you've explained it more clearly, I don't have any real objections in principle. However, I could envisage practical problems, such as people bickering endlessly about whether they should get an exemption because their obesity isn't their fault.

Taxing the high-risk food/drink/cigarettes seems to be quite a popular option already, though there are those who oppose it. Handing fat slobs on benefits a higher tax bill seems less likely to work though, with those already receiving tax exemption due to low income still likely to pay nothing.

Rolfe.

 

[Ivor the Engineer]

Taxing the high-risk food/drink/cigarettes seems to be quite a popular option already, though there are those who oppose it.

<snip>

And far simpler to implement while achieving a similar goal of trying to make the unhealthy pay more for their risky lifestyle.

Basing payments on biometric data which can change considerably from year to year would require a huge amount of expensive measurement and bureaucracy to keep everybody's file up to date.

 

[ponderingturtle]

And far simpler to implement while achieving a similar goal of trying to make the unhealthy pay more for their risky lifestyle.

Basing payments on biometric data which can change considerably from year to year would require a huge amount of expensive measurement and bureaucracy to keep everybody's file up to date.

Not to say that you are encouraging people to drop a lot of weight right before they are evaluated. So they go on a crash diet if they are close enough to the line. So you are encouraging less healthy behavior by your desire to make unhealthy behavior pay more.

 

[blutoski]

Not to say that you are encouraging people to drop a lot of weight right before they are evaluated. So they go on a crash diet if they are close enough to the line. So you are encouraging less healthy behavior by your desire to make unhealthy behavior pay more.

I'm in agreement about this. Poor health is its own punishment.

When I read through the examples of people who died from abusing ephedra products, a theme recurred. People were desperate to lose weight and obtain secondary benefits of low BMI such as reduced cholesterol counts. The reason: they needed to pass the physical in order to get private insurance.

Means testing sounds great on paper, but in practice, it can lead to unintended consequences that negate the expected benefits.

 

[blutoski]

I think that's the point. If everyone was spending 15% of GDP on healthcare it woudn't matter so much. But when you competitors aren't, then you're definitely going to start noticing it at some point.

As a matter of fact, some US senators raised this concern about competitiveness.

Specifically, they consider Canada's universal healthcare to be an unfair competitive advantage when an auto manufacturer is thinking about opening plants. They argue that it makes the Canadian plants cheaper to operate (true) and assert that this constitutes an unfair subsidy under NAFTA.

 

[Toke]

Specifically, they consider Canada's universal healthcare to be an unfair competitive advantage when an auto manufacturer is thinking about opening plants. They argue that it makes the Canadian plants cheaper to operate (true) and assert that this constitutes an unfair subsidy under NAFTA.

Don´t companies pay higher taxes in Canada, and get a bargain on healthcare?

What about education?
Would well educated workers be an unfair advantage too.

 

[Rolfe]

Hmmm. Because you choose to pour money down the toilet and your competitor doesn't, that can be called "unfair competition"?

They're struggling. Will they consider stopping pouring money down the toilet? No I didn't think so either.

Rolfe.

 

[Chaos]

Now that you've explained it more clearly, I don't have any real objections in principle. However, I could envisage practical problems, such as people bickering endlessly about whether they should get an exemption because their obesity isn't their fault.

Doubtlessly. There are always people who bicker endlessly. But most cases will be clear either way, and soon enough there will be enough case law to settle most of the rest.

Taxing the high-risk food/drink/cigarettes seems to be quite a popular option already, though there are those who oppose it. Handing fat slobs on benefits a higher tax bill seems less likely to work though, with those already receiving tax exemption due to low income still likely to pay nothing.

Rolfe.

I didn´t say it was perfect... just that it might be better than what we have now.

When you say "tax exemption", you mean "income tax exemption", right? You are not saying these people pay no sales tax, or do you?

 

[Rolfe]

When you say "tax exemption", you mean "income tax exemption", right? You are not saying these people pay no sales tax, or do you?

Correct. I meant income tax. That's why the sales tax on the unhealthy items is probably the best practical approach.

Now, just wait for all the howls of, why should moderate drinkers/Big Mac eaters/whatever be penalised for the sins of the few? Ignoring of course that the moderate consumers won't be paying much extra tax on their moderate consumption.

Rolfe.