single-payer system ... singled out

[Ziggurat]

Indeed. In fact, that's the last thing you need! But in your proposed system a health care crisis will get you in trouble, whereas under the NHS, it won't.

Saving people from any bad consequences of their own mistakes is not a function I need government to perform.

 

[Matthew Best]

So as far as you're concerned, stupid people do deserve a lesser standard of care?

 

[Ziggurat]

So as far as you're concerned, stupid people do deserve a lesser standard of care?

People who make mistakes should not be insulated from paying any consequence for their mistakes at my expense.

 

[Rolfe]

I have this awful feeling of deja vu all over again. Only the name to the left is different.

Yes, some people are stupid. That's not a criticism or an insult, it's a fact of life. We're not all born with IQs of 160. It's pretty complacent to sit there with your naturally keen intellect, able to work out the consequences of all your choices and never make any mistakes, and just wash your hands of those born without such an advantage.

Now keen intellect doesn't just confer foresight, it's usually quite handy in the earnings stakes as well. Bright people tend to have relatively high earning power. Conversely, the less bright, those lacking the ability to foresee the consequences of their actions, also tend to have lower earnings. And thus more pressure on the household budget.

And yet these are the very people you demand should have the skills of a PhD in Health Economy, in order to provide for a potentially very very expensive future event which may actually never happen. You ask them to forgo not just luxuries but perhaps some of the things that make life tolerable at all, in order to ensure that this hypothetical need is covered.

And if they fail in that, if they make a poor choice, maybe get conned by an insurance salesman who pushes an unsuitable product on them, then you're quite comfortable with that. Then, they develop diabetes, or breast cancer, or congeestive heart failure. And they have no means to provide.

And all you can think of is "your expense".

How nice for you, to be so complacent in your own superiority.

Rolfe.

 

[Rolfe]

I think we need to consider this "my expense" bit again. Assuming you're earning, and paying taxes, and paying into an insurance policy, and I think perhaps you said you were also saving aggressively against possible future healthcare costs.

That's a lot of expense you've got there.

Now maybe the USA is incapable of running a universal healthcare system for the sort of price Britain can do it. But I'm damn sure it can run a universal healthcare system for the sort of money already being spent on healthcare in the USA, in total. That, frankly, is a level of funding beyond the wildest dreams of any other developed country.

So, even if you insist that your taxes would go up, remember that your other costs would go down. No need to pay into an insurance policy. No need to ring-fence savings for possible healthcare needs. You too get to access the universal system. You too get a free lunch, if you want to look at it that way. Your own total healthcare expenditure would not increase, and might well decrease.

So why do you persist in seeing healthcare provided to others as being at your expense? It's swings and roundabouts. You might be getting healthcare at their expense, if you need something very complicated!

If you have a good brain, and a good income, then you have a lot of advantages. Probably a nice house, and a nice lifestyle, and nice holidays, and plenty to spend on your hobbies and interests, and very probably an interesting and fulfilling job. Great. You deserve it.

People without such a good brain, and thus often without such a good income, will never have these advantages in their lives. Why not enjoy your good fortune in that respect, and just chill out at the possibility that people in the latter group might not also be facing a bleak and miserable outlook when they become ill.

Rolfe.

 

[Ziggurat]

Yes, some people are stupid.

You will note that I have never referred to people as stupid in this thread. I have always and only referred to decisions as stupid. The difference is important. Smart people can (and do) make stupid decisions. And even nominally stupid people (whatever that means) can (and do) avoid making stupid decisions. The repeated attempts to recharacterize my statements regarding decisions to one regarding people is dishonest.

My brother's girlfriend was one such smart person who made a stupid decision: she went without health insurance because she didn't want to pay the cost. She felt like she couldn't afford it, but she could: she just didn't want to cut back on her spending in order to do so. She and my brother went skiboarding, and my brother broke his arm. Fortunately he had health insurance. When they mentioned the tale to my mother, and casually said it was a good thing that he broke his arm and not her, my mother gave them a mouthfull. That girlfriend has since purchased health insurance. She got lucky, and that's good: I'm not looking to punish anyone. But if it were the other way around, if she had in fact been the one to break her arm, I would not want to be forced to help pay for her mistake. But that mistake had nothing to do with her intelligence. That wasn't what she lacked.

You ask them to forgo not just luxuries but perhaps some of the things that make life tolerable at all, in order to ensure that this hypothetical need is covered.

Oh please. There are damned few people so destitute that buying health insurance will make their lives truly miserable. This is an appeal to emotion, and a weak one at that.

And if they fail in that, if they make a poor choice, maybe get conned by an insurance salesman who pushes an unsuitable product on them, then you're quite comfortable with that.

Thanks for not only introducing a new issue, but assigning me a particular position on that issue which I have never expressed. Way to keep the discussion honest.

How nice for you, to be so complacent in your own superiority.

Oh shut up already. Given that you're the one telling me what kind of health care system I should prefer (you will note I never suggested you couldn't or shouldn't prefer whatever system you wanted), you're in no position to lecture me about feeling superior.

 

[Rolfe]

I'm trying to understand you. You seem to want people punished for bad decisions. You seem to want people to have to make sacrifices in order to meet a possible future need that may never arise. You seem to resent the idea that some of your precious money might go towards the healthcare of people who might make bad decisions.

You never did explain about the extra costs including opportunity costs in implementing a universal healthcare system. I genuinely struggle to see where you're coming from.

Life's chancy enough as it is. There are so many places where a bad decision can be made. But at least in Britain and every other country in the developed world, healthcare isn't really one of these places.

Do yo really think it's bad for the moral fibre of the nation to live in the security of knowing that they don't really have to make decisions and provisions in the area of healthcare? Is that what this is all about?

What disadvantages do you think we labour under in Britain, under this decadent system where bad decisions aren't punished, simply because that sort of bad decision isn't really on the agenda?

Rolfe.

 

[Rolfe]

I think this is where there's the major parting of views.

It was Nye Bevan the founder of the NHS, who remarked - with understandable anger - that there were racehorses in the UK which received better standards of medical treatment than people. The NHS was formed specifically to ensure across the board, equal access to free at the point of delivery treatment. It has, for all its flaws, clearly been successful.

I consider such access to healthcare to be not just a mark of any mature society, but a right for the citizens of any such state together with (and in no particular order) education, freedom of speech and thought, and equal treatment under the law. As far as I can tell, these views are fairly typical not just of my country but also the rest of the UK generally. I further note in passing that not a single mainstream political party has sought to take a different stance, ditto the churches.

For the avoidance of doubt, my politics would be considered centre-right in UK and EU terms, notwithstanding my party of choice being SNP and hence centre-left. I'm not particulary socialist, although in threads like this I end up feeling that some think we're all in bed with the Reds.

Oh yes, and what he said. Pretty much verbatim. Except possibly a bit more socialist.

Rolfe.

 

[Ziggurat]

I'm trying to understand you.

No you're not. You're assuming motives on my part. That doesn't help you understand me at all.

You seem to want people punished for bad decisions.

No. This isn't about punishment. Punishment requires someone with agency to actively inflict it. That's not the case here. What I want is not punishment for anyone, for any reason. What I want is to avoid creating moral hazards at the expense of people who are not making mistakes.

You seem to want people to have to make sacrifices in order to meet a possible future need that may never arise.

Well, yes. I believe in car insurance too, and would not want that socialized.

 

[Ziggurat]

Oh yes, and what he said. Pretty much verbatim.

Even the bit about the horse? That's still baffling to me.

 

[elbe]

What I want is not punishment for anyone, for any reason. What I want is to avoid creating moral hazards at the expense of people who are not making mistakes.

I was not familiar with that term before, so I learned something new today, but it makes me wonder: Isn't health insurance at risk for creating that too? If I have health insurance I may be more willing to participate in activities that may injure me than otherwise, such as sports.

Really, though, I fail to see that much of a distinction between the american health insurance system and the UK's system where the government pays for (almost) everything. In both cases people are paying their insurer, through taxes or to the company, so in case they need health care they are covered. It also makes me think of how insurance companies can negotiate lower prices at hospitals because they control a segment of their market, ie if blue cross says they won't cover expenses at a particular hospital that hospital may lose a large income, so couldn't a single insurer (the government) negotiate even better rates because they control the entire market share? Obviously balances with the need for health providers to make a good enough income to retain staff and draw in new people.

 

[Ziggurat]

I was not familiar with that term before, so I learned something new today, but it makes me wonder: Isn't health insurance at risk for creating that too? If I have health insurance I may be more willing to participate in activities that may injure me than otherwise, such as sports.

To some degree, yes. But not enough to worry me (among other things, you still pay a price, in discomfort even if not in dollars, for getting injured).

It also makes me think of how insurance companies can negotiate lower prices at hospitals because they control a segment of their market, ie if blue cross says they won't cover expenses at a particular hospital that hospital may lose a large income, so couldn't a single insurer (the government) negotiate even better rates because they control the entire market share? Obviously balances with the need for health providers to make a good enough income to retain staff and draw in new people.

With only one provider, how do you find the balance? If Blue Cross takes too hard a line on price, then they won't get as much service. If a competitor is more lax on price, they'll get more service. Customers can trade off higher prices for more flexible service, and the flow of customers will give the insurers information about how to strike that balance. Where does that information come from if there's only one provider?

 

[Rolfe]

Even the bit about the horse? That's still baffling to me.

What, that Nye Bevan said that about racehorses? I believe he did.

And whether you find it baffling or not, as a veterinary surgeon I agree with the sentiment.

Rolfe.

 

[Ziggurat]

What, that Nye Bevan said that about racehorses?

No, I don't doubt the quote. Rather, I find it baffling that it's a cause for concern of any kind, except perhaps to racehorse owners.

 

[balrog666]

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.

Bwaaaaaaaaaaaaahahahaha!

The US is already spending over 2 trillion on medical and healthcare related services. Which parts will you cut and how many people will you dump into unemployment to reduce current costs and how will that improve the delivery of medical services?

 

[Rolfe]

To some degree, yes. But not enough to worry me (among other things, you still pay a price, in discomfort even if not in dollars, for getting injured).

Exactly. And why doesn't the same apply to universal healthcare?

With only one provider, how do you find the balance? If Blue Cross takes too hard a line on price, then they won't get as much service. If a competitor is more lax on price, they'll get more service. Customers can trade off higher prices for more flexible service, and the flow of customers will give the insurers information about how to strike that balance. Where does that information come from if there's only one provider?

And yet somehow we manage. Goodness knows how.

The population is exposed to the dreadful moral hazard of not having to make hard choices and sacrifices to provide for possible future healthcare needs. Nobody has to worry where the next quadruple bypass or insulin shot is coming from. Nobody has to tell their children that there won't be a holiday next year because Daddy has to pay the insurance excess for treating their appendicitis.

I don't know how we manage, really. We must be a bunch of complete degenerates....

Rolfe.

 

[balrog666]

So as far as you're concerned, stupid people do deserve a lesser standard of care?

More productive people are willing to pay for a better standard of care. And a better standard of food, water, housing, and pretty much everything else they spend money on.

Why would you want to deprive them of the right to spend their own money in such a fashion? How does that improve anything for you or anyone else?

 

[Rolfe]

Bwaaaaaaaaaaaaahahahaha!

The US is already spending over 2 trillion on medical and healthcare related services. Which parts will you cut and how many people will you dump into unemployment to reduce current costs and how will that improve the delivery of medical services?

You didn't read Professor Yaffle's link, did you?

So now you want to go on paying twice as much as you need to for medical care in order to keep people in jobs that are otherwise redundant?

And you think I'm left-wing?

Rolfe.

 

[Ziggurat]

Exactly. And why doesn't the same apply to universal healthcare?

Because it's a much bigger problem, and the moral hazards involve far more than the decision to play tackle football rather than tag football.

And yet somehow we manage.

I never said one couldn't.

 

[KoihimeNakamura]

Because he isn't. The goal is 'government and private', and you can pay for the private one i you want.