single-payer system ... singled out

[volatile]

It's interesting that you defend that position I just laid out in every other realm. But not here. But that's because it doesn't seem like a loss of freedom when you're the one behind the gun.

Your post is basically a nonsensical rant, but this bit bears quoting as it highlights another question that you've repeatedly been asked but never responded to.

Already in this thread, and in all the previous threads, Rolfe in particular has been at pains to explain just how recipients of UHC are not, in any way, less "free" than our American counterparts, and are in a large number of ways in fact more free - we have the freedom to move jobs without fear of losing healthcare cover, for example.

So we'll ask you again - what freedoms do you, under the US healthcare system, enjoy that are denied to us poor commies in the rest of the civilised world?

 

[Rolfe]

I would like there to be a baseline level that everyone has access to. What that baseline should be is not something we will all agree on, and I would likely set it lower than you, not because I want poor people to get worse coverage but because there are costs (including opportunity costs) to raising that baseline level. And in fact, we already have a baseline. It's well below what you want, but it's there.

So I want a baseline, I'd probably set it lower than you would, but I'd also like it to be possible for almost everyone to purchase care above that baseline. I'm not actually a heartless bastard, I'm just a regular bastard.

So I don't see where that differs from the position in Britain. Except that you seem to want to set the standard level of care lower for US citizens (who are paying lots of money) than it is for British citizens (who are getting a pretty good bargain when you get down to it).

I'm intrigued to know why you want to set the baseline level of care lower than it is in Britain (which is about where I'd imagine Architect would probably set it). What costs are we incurring by providing the service we do, "including opportunity costs"?

Medical insurance is not especially expensive here, and for a reason. The insurers know that they are not going to be required to pay out for any emergency treatment, or for ordinary routine GP appointments. The insurance is generally only invoked for non-emergency consultant appointments and subsequent treatments.

Nevertheless, not many people actually buy their own health insurance. The reason is that all the insurance buys you is a private room in a swanky hospital, and the procedure done at a time convenient to you (yes, often sooner). For most people, it doesn't seem worth it. The idea of buying insurance to pay for procedures that are not clinically necessary, such as extra MRI scans and so on, doesn't enter anyone's head. I suspect that even in the USA, if a similar system were in force, most people would sooner or later come to the conclusion that they'd rather keep their money in their pockets than pay for unnecessary tests and unnecessarily expensive drugs.

The other option is to pay for a procedure to be done privately out of your own savings. My mother did this when (for very particular reasons) she was going to have to wait over a year for cataract surgery. My mother is a clergyman's widow on a small church pension. Nevertheless she had the £3,500 it was going to cost, and she decided to spend her money. Was it worth it for that 13 months of better sight? Who knows. But she had the freedom to choose.

This is how it actually works, in practice. I'm really quite hazy about how your proposal would work in practice.

Rolfe.

 

[Rolfe]

Already in this thread, and in all the previous threads, Rolfe in particular has been at pains to explain just how recipients of UHC are not, in any way, less "free" than our American counterparts, and are in a large number of ways in fact more free - we have the freedom to move jobs without fear of losing healthcare cover, for example.

So we'll ask you again - what freedoms do you, under the US healthcare system, enjoy that are denied to us poor commies in the rest of the civilised world?

I'm just bumping this above my previous post because I don't want it to be lost.

Not that I have much hope of an answer, I've asked Beerina that question multiple times, and he's never replied.

Rolfe.

 

[Ziggurat]

So I don't see where that differs from the position in Britain. Except that you seem to want to set the standard level of care lower for US citizens (who are paying lots of money) than it is for British citizens (who are getting a pretty good bargain when you get down to it).

You say that like all americans are paying lots, but that's simply not the case.

I suspect that even in the USA, if a similar system were in force, most people would sooner or later come to the conclusion that they'd rather keep their money in their pockets than pay for unnecessary tests and unnecessarily expensive drugs.

Which is where low-cost high-deductible plans come in. There are other ways to create an incentive to cut costs.

This is how it actually works, in practice. I'm really quite hazy about how your proposal would work in practice.

You're comparing an actual system you have experience with to a few ideas of someone who is not an expert in healthcare. Of course what I say is going to be a little hazy.

 

[martu]

Ziggurat in the UK I am covered by the NHS for anything that happens to me but I also work in finance where private medical care is the norm as a taxable benefit (above a certain pay level anyway) so I am fortunate to have another option of a private room, immediate treatment and so on if I want to.

How is this different to the US system exactly?

 

[volatile]

Ziggurat in the UK I am covered by the NHS for anything that happens to me but I also work in finance where private medical care is the norm as a taxable benefit (above a certain pay level anyway) so I am fortunate to have another option of a private room, immediate treatment and so on if I want to.

How is this different to the US system exactly?

In the US, you wouldn't be covered by the NHS if anything happened to you, your healthcare costs would necessarily be higher to receive even just a fraction of the cover you now get for nothing* and you'd still run the risk of not having enough coverage given dire enough circumstances.

But hey.... you'd be "more free". Somehow. Apparently.


*at the point of use.

 

[volatile]

--- nm

 

[martu]

In the US, you wouldn't be covered by the NHS if anything happened to you, your healthcare costs would necessarily be higher to receive even just a fraction of the cover you now get for nothing* and you'd still run the risk of not having enough coverage given dire enough circumstances.

But hey.... you'd be "more free". Somehow. Apparently.


*at the point of use.

This I how we see it but Ziggurat must see it differently. Surely? Otherwise where is the argument? To reiterate:

I get private care like she does in the US but I also have a safety net no matter what my wage. In the US this safety net only exists for the poorest . The total cost to the country is less.

How is this not better Ziggurat?

 

[Rolfe]

You say that like all americans are paying lots, but that's simply not the case.

Perhaps I expressed myself badly. Overall the USA as a country is spending proportionately a great deal more on healthcare than we are in Britain. And yet, in discussions about how to widen access to healthcare, you still want its citizens to receive a lower level of basic service than British citizens receive, for a lot less money.

And I suspect that most Americans are indeed paying "lots", at least those that aren't on the absolute poverty line, and those that haven't decided not to carry health insurance at all and have fortuitously not fallen ill with a big-ticket healthcare need. I think it was KellyB who said the she was paying over 50% of her family income in medical insurance.

Which is where low-cost high-deductible plans come in. There are other ways to create an incentive to cut costs.

You say that like it's a good thing? Selling an insurance policy to low-income people which guarantees that they will have to pay out a great deal of money if they have the misfortune to fall ill? I agree, such plans are better than those with a low upper limit on total spending, but they can still be a one-way ticket to bankruptcy.

Why are you so keen on people being liable for large amounts of money if they happen to fall ill with a serious disease?

You're comparing an actual system you have experience with to a few ideas of someone who is not an expert in healthcare. Of course what I say is going to be a little hazy.

Well, perhaps hazy was being too polite. Why do you want to set the benifits available through a universal healthcare system below "what the patient actually needs, according to his or her physician"? I agree that this "needs" bit has some wiggle-room, particularly as regards heroic interventions in end-of-life care, but for most situations it's clear enough.

I also note you missed some bits out of my post in your reply. I'm still curious about this

there are costs (including opportunity costs) to raising that baseline level

part. What costs are we incurring by setting the baseline where it is, and what do you mean by "opportunity costs"?

Rolfe.

 

[Rolfe]

This I how we see it but Ziggurat must see it differently. Surely? Otherwise where is the argument? To reiterate:

I get private care like she does in the US but I also have a safety net no matter what my wage. In the US this safety net only exists for the poorest . The total cost to the country is less.

How is this not better Ziggurat?

What he said.

Rolfe.

 

[boooeee]

Well... let's turn this upside down.

Why do you think every other developed country on Earth can provide universal healthcare more cheaply than the USA can provide care for a few? In light of that, I'd hazard that the answer to your question is "probably quite a lot".

Really? Why would means testing be a significant driver of costs? Just to give you an idea of the gap we're trying to close, US per capita costs are $6,102. The rest of the countries shown in the graph run around $3,000 per capita. So that's about a $3,000 per capita difference. US population is about 300 million. That works out to about 1 trillion dollars. If means testing is a significant chunk of that, then you're doing it wrong. As Ziggurat pointed out, the IRS has to do it anyway. Also, Germany does it. Heck, even the NHS does it for prescription drug copays.

Healthcare in the US is ridiculously expensive. I don't deny that. But it's not due to means testing. And, as Praktik's graph shows, it is not due to the fact that we don't have enough government-run healthcare. For whatever reason, publicly funded healthcare in the US seems to be just as ridiculously expensive as privately funded. I have some thoughts on why that may be, but I am going to take a look at Professor Yaffle's link first.

 

[Rolfe]

Prof. Yaffle's link is very interesting indeed. Unsurprisingly it's not just one thing that's responsible for the high spending. Means testing is one part. (Actually, though, the means testing for the prescription tax isn't all that costly - the person collecting the prescription self-certifies as to whether they are liable to pay the tax or not, by signing a small form attached to the prescription printout. There is a list of exempt categories on the form. I don't know how much checking gets done though.)

It seems to me that pricing up every procedure in order to bill the patient exactly must be a costly exercise. And all the paperwork flying around between insurance companies and healthcare providers. Nevertheless even that didn't come out as a huge percentage of the total overspend.

Nevertheless, it seems to me that if your healthcare costs, as a country, as a percentage of GDP, are up to twice what they are in other developed countries, and yet you still have a significant proportion of your population who find they are not entitled to healthcare that they need, you have to be doing something wrong.

Rolfe.

 

[Ziggurat]

You say that like it's a good thing? Selling an insurance policy to low-income people which guarantees that they will have to pay out a great deal of money if they have the misfortune to fall ill? I agree, such plans are better than those with a low upper limit on total spending, but they can still be a one-way ticket to bankruptcy.

No. A high deductible plan can have a deductible cap of only a few thousand dollars. Couple that with health savings plan (so that any money you spend on that deductible is tax-free), and you're not looking at bankruptcy unless you're also stupid with your money. But if you're stupid with your money, you don't need a health care crisis to get you in trouble.

Why are you so keen on people being liable for large amounts of money if they happen to fall ill with a serious disease?

I'm keen on people taking responsibility for themselves. Can I correctly characterize your position as you being keen on the state babysitting all its citizens? No, that would be unfair, because even if I think that's the outcome, that's not your goal. Do me the courtesy of likewise not impugning my motives.

 

[ponderingturtle]

This I how we see it but Ziggurat must see it differently. Surely? Otherwise where is the argument? To reiterate:

It is about ideological purity. Messy facts get in the way.

Ideological purity is better than some heretical system, it has to be it is ideologicaly correct.

 

[ponderingturtle]

No. A high deductible plan can have a deductible cap of only a few thousand dollars. Couple that with health savings plan (so that any money you spend on that deductible is tax-free), and you're not looking at bankruptcy unless you're also stupid with your money. But if you're stupid with your money, you don't need a health care crisis to get you in trouble.

Works for the healthy, what about the sick? You know the people who need to spend thousands of dollars a month now to get insurance if they can find it?

 

[Professor Yaffle]

Stupid people don't deserve healthcare?

 

[Ziggurat]

Works for the healthy, what about the sick? You know the people who need to spend thousands of dollars a month now to get insurance if they can find it?

This has already been addressed: if you've maintained coverage, you can't be turned down or denied if you change coverage because of an existing condition. So don't let your coverage lapse. The sob stories mostly come from people who thought they could get away with not paying for health insurance, and found out the hard way that they were wrong.

 

[Ziggurat]

It is about ideological purity. Messy facts get in the way.

Why are you engaging in an ad hominem attack against me?

 

[martu]

This has already been addressed: if you've maintained coverage, you can't be turned down or denied if you change coverage because of an existing condition. So don't let your coverage lapse. The sob stories mostly come from people who thought they could get away with not paying for health insurance, and found out the hard way that they were wrong.

To be clear, you are happy that these people suffer to teach them a lesson am I right?

 

[Ziggurat]

To be clear, you are happy that these people suffer to teach them a lesson am I right?

No, you are wrong. To suggest that I'm happy about anyone's misery is an insult, and should be beneath you.