single-payer system ... singled out

[Ziggurat]

And taxes are just dreamed out of mid-air, are they?

Strawman.

They don't get developed by, say democractically elected governments?

If the majority agree to force someone to pay, that person is still being forced to pay. Hell, they're being forced to pay even if they want to pay. That's why it's tax and not voluntary donation. Do you honestly not understand this? Democracy is a useful check on the powers of taxation, and help ensure that taxation usually is not excessive and is used for purposes that most people will like, which means that taxation in a democracy is far more likely to be justified than under non-democratic government. But nothing about that indicates in any way, shape, or form that taxation isn't still forcing other people to pay for something.

 

[Rolfe]

For most of what you list, the answer about the difference has already been given: externalities.

But if we are to judge whether or not something should be provided by the government solely on the basis of its importance, why don't you advocate for a national meal service? Surely you don't want people starving in the streets, do you, Rolfe? The government could to a far more efficient job at distributing nutritionally healthy food, and reduce all that redundancy and waste from all those different restaurants. If you're hungry, just go into a government-run food outlet and ask for a meal, no need to waste money on processing bills for each customer. How can you advocate having restaurants when children are starving in the Congo? It's wasteful: you're paying far more than you need to for your food, while others are starving. Surely the UN can do a better job at distributing food than this mess of independent restaurant chains.

Or perhaps such a comparison is shallow and meaningless. Just like your list.

Oh, why shallow? Just because you don't want to address the comparisons?

You know, maybe it would be better just to go back to the thread linked to earlier, because we've been over all this already, including the National Food Service.

Architect covered one aspect of this, so I'll look at another.

We do ensure that nobody should be starving in the streets. No, we don't distribute healthy food that many people would ignore. No, we don't give everybody "food stamps", just to deduct the value from their pay slips. We allow everyone a basic income free of tax, before any tax has to be paid, and the general idea is that this will allow them to eat. If they still fall below the income required to allow them to eat, then we give them more money. It's called social security.

I understand the USA does much the same.

Maybe you think free food outlets are a better way to organise it, and you're free to make that argument. But that's just about the mechanism. We already have a system that is designed to ensure that everyone can eat.

Rolfe.

 

[lomiller]

Except those aren't generally the terms on offer.

Please explain? When you get sick you either need to pay for medical care or suffer serious consequences, how you pay for it may be optional but paying for it is not.

 

[Ziggurat]

And once again: you pay double what we do, Ziggy, for levels of overall care which are - at best - comparable.

And you think that our costs will come down to your level if we would just adopt universal health care? Sorry, I simply don't believe it. Our medicare costs already match your total costs. Extending government coverage will increase government costs. We will not end up with the cost levels you have, but with something substantially larger. If someone can get medicare costs in line, then (as I already said) I'll reconsider. And that's worth doing regardless of what happens to the rest of the system. But until that happens, I simply have no reason to think that Washington can do a better job at running a much bigger system.

 

[Rolfe]

But nothing about that indicates in any way, shape, or form that taxation isn't still forcing other people to pay for something.

You say that like it's a bad thing?

We have already established that people pay less under a universal single payer systems. If you are still paying less why would you care if there is someone else out there paying a lot less? Are you saying you would willing to pay more for your healthcare just to be sure there no one else is getting theirs for free?

Sounds like it. He wants everyone to pay the full amount of their healthcare costs - or so I gather from the enquiries as to whether someone would be paying enough in VAT to cover their medical costs.

Ziggy, would you really rather pay much, much more for your own healthcare, just so you could be sure nobody else was getting anything cut-price?

Rolfe.

 

[Ziggurat]

Please explain?

Insurance. Insurance is a voluntary contract, and the choice of whether to enter into that contract or not does not generally happen when you're in the emergency room. One can (and many do) choose to refrain from entering such a contract.

 

[Rolfe]

And you think that our costs will come down to your level if we would just adopt universal health care? Sorry, I simply don't believe it. Our medicare costs already match your total costs. Extending government coverage will increase government costs. We will not end up with the cost levels you have, but with something substantially larger. If someone can get medicare costs in line, then (as I already said) I'll reconsider. And that's worth doing regardless of what happens to the rest of the system. But until that happens, I simply have no reason to think that Washington can do a better job at running a much bigger system.

OK, this is where we came in. We've been round this ride a few times.

So the great US of A is incapable of doing what every other developed first-world country can do. And perhaps your main dealbreaker is a horror that anyone might get something they haven't paid for in full, even if that someone might be you.

O.... K....

Rolfe.

 

[Ziggurat]

You say that like it's a bad thing?

It is frequently a necessary evil, but yes, it's a bad thing.

Ziggy, would you really rather pay much, much more for your own healthcare, just so you could be sure nobody else was getting anything cut-price?

Of course not. Which is why I have never expressed this opinion. But I would pay more in order to be able to have a choice in the matter of my own healthcare. Furthermore, I simply don't believe that government-run health care in the US would provide me with significant savings. Medicare costs indicate to me that this is just not what would happen. You can cite NHS costs till the cows come home, but until I see Washington handling the health care they already control with competence, I have no reason to assume they won't, and every reason to think they will, make a similar mess of any universal health care system.

 

[Ziggurat]

So the great US of A is incapable of doing what every other developed first-world country can do.

You tell me why you think our government can dramatically expand the number of people it covers without significantly increasing costs. Sorry, but that's simply not credible.

And perhaps your main dealbreaker is a horror that anyone might get something they haven't paid for in full, even if that someone might be you.

No, this is not a correct summary of my position at all.

 

[lomiller]

And you think that our costs will come down to your level if we would just adopt universal health care?

Not immediately, but in the long term there is no compelling reason why the US should need to spend more per person then the other universal health care systems out there.

A Our medicare costs already match your total costs. .

Medicare isn’t part of a universal system, so it’s not a good test of how a universal system would perform.

If someone can get medicare costs in line, then (as I already said) I'll reconsider.

Medicare is hampered by the systemic inefficiencies in the US system, I don’t see how you can expect to fix Medicare without fixing the things that make medical care in the US expensive to begin with.

 

[lomiller]

Insurance. Insurance is a voluntary contract,

Let me stop you right there. Insurance is how you pay for your care. It doesn’t make the care itself any more volentary.

 

[Rolfe]

But I would pay more in order to be able to have a choice in the matter of my own healthcare.

What choice do you want that we don't have in Britain under our system? I can't think of any. I've even got the choice to pay more if I really, really want to.

Furthermore, I simply don't believe that government-run health care in the US would provide me with significant savings. Medicare costs indicate to me that this is just not what would happen. You can cite NHS costs till the cows come home, but until I see Washington handling the health care they already control with competence, I have no reason to assume they won't, and every reason to think they will, make a similar mess of any universal health care system.

Well, as ever, it comes back to lack of faith in the competence of your own government, so much so that you'd rather go on paying twice what we do and getting less rather than give it a whirl.

Glad our guys, scum of the first water though they may be, have at least managed better than that,

Rolfe.

 

[Ziggurat]

Well, as ever, it comes back to lack of faith in the competence of your own government, so much so that you'd rather go on paying twice what we do and getting less rather than give it a whirl.

That's quite the euphemism for what could happen if an attempt at government-run health care doesn't work out well. And you still haven't offered any reason beyond, dare I say it, faith that Washington would provide health care more efficiently than it does now when asked to provide it to a far larger group. Even if they merely stay at the same levels of efficiency and don't get worse (which, given the track record for expanded government in Washington, is not what I would bet on), we still won't end up with something as cheap as the NHS.

 

[Ziggurat]

Let me stop you right there. Insurance is how you pay for your care. It doesn’t make the care itself any more volentary.

Your position really boils down to the belief that it’s better to be forced to pay $2 to a private individual then it is to be forced to pay $1 in tax.

How to pay for it is what this debate is about. If I buy insurance, I haven't been forced to pay anyone.

 

[ddt]

Our medicare costs already match your total costs.

Let's see why.

1) Medicare is meant, a.o., for people over 65. Those people on average need more health care than the average citizen.

2) Let's look at Medicare Part D, the drugs part:

As of January 2006, the expected per capita drug spending was $2,250, making the total cost of the program $42.75 Billion.[6] This budget compares with revenues of $54 Billion for Pfizer and $48.6 Billion for Johnson & Johnson, the two largest pharmaceutical companies.

and:

By the design of the program, the federal government is not permitted to negotiate prices of drugs with the drug companies, as federal agencies do in other programs. The Veterans Administration, which is allowed to negotiate drug prices and establish a formulary, pays 58% less for drugs, on average, than Medicare Part D.

Well, yes, if Congress lets themselves run over by Pfizer et al. to pay whatever Pfizer fancies, no wonder that it costs an arm and a leg. There has been some outrageous lobbying to get the "no negotiation clause" into the Medicare bill.

 

[Rolfe]

Wow. "As cheap as the NHS." If you spend more (and you probably will), no, it won't be that cheap. If you try really, really hard, you might get close to that good value for money.

Does the fact that all the Brits here would take the NHS in a heartbeat as opposed to coping with the vagaries of your system not tell you anything?

Rolfe.

 

[ddt]

Well, as ever, it comes back to lack of faith in the competence of your own government, so much so that you'd rather go on paying twice what we do and getting less rather than give it a whirl.

Glad our guys, scum of the first water though they may be, have at least managed better than that,

Subsequent to my previous post, this reminds me of a quote of Aneurin Bevan. When people expressed doubts whether doctors would want to work in a socialized health care system, he riposted: "we'll shower them in gold".

 

[Rolfe]

Wasn't it "I stopped their mouths with gold?"

Then the BMA negotiators got to work, and it was platinum....

Rolfe.

 

[lomiller]

How to pay for it is what this debate is about.

Nothing I have seen you say so far suggests you are arguing for a fully universal system that simply gives you a choice of how to pay. You certainly haven't presented any outline of how a system could be based on voluntary insurance and still be universal.

If I buy insurance, I haven't been forced to pay anyone.

No, but you are paying for a lot of people who have haven't paid for insurance and ended up being treated at inflated cost in an emergency room, who have sought insurance only after they had known medical costs, or who have had to declare bankruptcy. If you really are arguing for a universal system, these costs still need to be paid for the people who choose not to get insurance.

IMO, however you are not arguing these people should receive care that is built into the price of your own insurance, clearly you are arguing they should not receive care at all. This means no insurance = no health care and insurance is not optional, you buy it or face serious consequences.

 

[Ziggurat]

Well, yes, if Congress lets themselves run over by Pfizer et al. to pay whatever Pfizer fancies, no wonder that it costs an arm and a leg. There has been some outrageous lobbying to get the "no negotiation clause" into the Medicare bill.

If that's really the problem, then why not fix that first? Demonstrate that it will make a difference. And if that's not possible because Congress is too beholden to the drug companies, well, why on earth would that change by going to government-run health care for everyone? That would exacerbate the problem, because drug companies would have even more reason to lobby Congress, since Congress's decisions would have even more impact on their bottom line.

This is not a reason to adopt UHC. It is, rather, a reason to insist upon fixing Medicare before trying to tackle UHC.