Health care - administrative incompetence

[xjx388]

So not only do you acknowledge your "catastrophic savings" ideas and your fiscal/personal irresponsibility arguments are bunk, you have no answer to solve the problem in the present. I see.

Not bunk, it's what I do right now. Unfortunately, in your case, there is no solution in the present.

You do realize that health care cannot possibly be a free market, nor is it able to be treated as a free market, right? You've read the posts in this thread showing you that, yes?

I've read people's opinions, but I haven't seen hard data to back it up. Sure, they've quoted that the US is more expensive, but their arguments don't necessarily follow from that fact.

You do understand that the more people included in an insurance system the payout costs needed are spread even more thin, yes? Why wouldn't we have the largest coverage pool possible and include the entire populace?

Because one payer has not incentive to control costs. Did you not read my Milton Friedman quote?

You also did not answer all of my questions. Here's one more:

How is it we are to encourage startup businesses if those starting one cannot possibly hope to have their business survive an illness?

I don't believe that one cannot possibly hope that. We started a business. If doc gets sick, we have voluntarily paid for plans in place to pick up the slack.

The point above is that more market innovation and competition is a good thing. Stifling business opportunities due to medical catastrophe is not the way to achieve healthier economy.

A good thing unless it's a healthcare business, apparently.

But honestly, your arguments are coming down to valuation of a person based on their income. If I don't make enough to pay for my medical needs, then what, I should die or go bankrupt?

Untrue. I value people by what they contribute to a business or a society. Pop stars contribute much less than doctors and teachers don't you think? If I can't afford my operation, I go without. It's as simple as that. I'm not saying I deserve operations because I'm rich. I don't make enough to pay what you had to for your care. If my current plan doesn't do it for me, I have to accept that I will die. Why should I force anyone else to pay for my problems?

 

[kellyb]

That's about the size of it. I can't go to jail for not paying my premium.

Well, I do respect your POV even though I see things differently. I think Ducky being dead would be a greater (much greater!!!) moral wrong than taxes being stolen from the rest of us.

 

[kellyb]

If my current plan doesn't do it for me, I have to accept that I will die. Why should I force anyone else to pay for my problems?

You could get into a car wreck and have your life saved in the ER/ICU etc at a price that exceeds your catastrophic plan.
You'd have to repeal the law about ER-care for all to avoid all risk of having your life saved at the expense of others.
But I guess you think ER's shouldn't offer that sort of care, either.

But, this conversation is getting depressing, so I'm out.

Merry Christmas, y'all.

 

[Agatha]

If I can't afford my operation, I go without. It's as simple as that. I'm not saying I deserve operations because I'm rich. I don't make enough to pay what you had to for your care. If my current plan doesn't do it for me, I have to accept that I will die. Why should I force anyone else to pay for my problems?

I honestly find that view repugnant. If you had the health problems Ducky has, but don't happen to have a cool $1.2mil stashed away, you think you should die? Does this apply to say, one of your children? Or what about Ducky - he should just die because he doesn't have $1.2mil, but does have cancer?

Do you feel the same about the fire department? Do only rich, taxpaying individuals deserve to have their houses saved from fires, while those who don't pay tax (so are relying on others being 'forced' to pay) should just put up with their houses being burned to the ground?

I think there's an unbridgeable gulf between those people who see themselves as part of a cohesive society (the sort of thing you dismissed earlier as a 'rosy-cheeked utopia') and those who have no compassion for other people. If this is your morality, I am glad I don't share it. Because you would, it seems, see people like me and Ducky die before you pay LESS than you do now.

 

[Bob001]

In a one-payer system, how is American society going to budget for your complex and high-cost health care?

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The basic premise of insurance is that no particular person can know what ills might befall him in a given month or year, but the needs of a large group of people can be reliably predicted: A certain percentage will contract lung cancer, a certain percentage will fall in front of buses, and if the group is large enough a few people will develop those rare, one-in-a-million diseases that doctors put their own names on. That's how private insurance companies operate now, and that's how universal care systems work around the world. There is no reason to think that the total national outlay for health care under a single-payer system would need to be more than it is now, when all insurance premiums, private payments and unreimbursed and donated care are added together, and there is every reason to believe that reducing administrative costs from 24% down to 6% or less, promoting preventative care and early treatment among the currently uninsured, and eliminating the profit motive that allows insurance company chiefs to pay themselves billion-dollar bonuses would actually reduce total health care expenses. It works elsewhere, in fact almost everywhere else; there's no reason why it couldn't work here.

 

[Ampulla of Vater]

I honestly find that view repugnant. If you had the health problems Ducky has, but don't happen to have a cool $1.2mil stashed away, you think you should die? Does this apply to say, one of your children? Or what about Ducky - he should just die because he doesn't have $1.2mil, but does have cancer?

Do you feel the same about the fire department? Do only rich, taxpaying individuals deserve to have their houses saved from fires, while those who don't pay tax (so are relying on others being 'forced' to pay) should just put up with their houses being burned to the ground?

I think there's an unbridgeable gulf between those people who see themselves as part of a cohesive society (the sort of thing you dismissed earlier as a 'rosy-cheeked utopia') and those who have no compassion for other people. If this is your morality, I am glad I don't share it. Because you would, it seems, see people like me and Ducky die before you pay LESS than you do now.

There are a few things that factor into this debate. One of which is the problematic immigration policies currently held by the U.S. I see first-hand the "undocumented aliens" receiving care on a daily basis at the local hospitals who give bogus addresses such as gas stations, non-existent addresses and/or addresses of random unrelated people. This makes it very difficult for me to want to pay for 'those less fortunate' because there is absolutely no attempt to pay for oneself or even tell the truth. Not to mention you are referring to an unlimited, ever-increasing population.

Additionally, there is an element of the government exceeding its limits should the US go to a single payor system. The fear is that if the government is on the hook for healthcare then the government might just decide you are eating too many Big Macs, cookies, salty notes, etc.

For those who argue their governmental single payor system is the best, I'd be willing to bet your country does not let people in by the thousands to suck off the system.

 

[Agatha]

There are a few things that factor into this debate. One of which is the problematic immigration policies currently held by the U.S. I see first-hand the "undocumented aliens" receiving care on a daily basis at the local hospitals who give bogus addresses such as gas stations, non-existent addresses and/or addresses of random unrelated people. This makes it very difficult for me to want to pay for 'those less fortunate' because there is absolutely no attempt to pay for oneself or even tell the truth. Not to mention you are referring to an unlimited, ever-increasing population.

So you are already paying for them to receive care; and nothing would change if you opted for a universal system, is that right?

Additionally, there is an element of the government exceeding its limits should the US go to a single payor system. The fear is that if the government is on the hook for healthcare then the government might just decide you are eating too many Big Macs, cookies, salty notes, etc.

And yet, after over sixty years of a universal, single payer system, that doesn't happen here. There are regular campaigns to promote healthy living and healthy eating, but people are not denied care on the basis of their lifestyle (except in a very few, well documented cases where the results of that lifestyle means surgery will kill them, eg the morbidly obese, or for alcoholics who cannot abstain from alcohol prior to a liver transplant).

For those who argue their governmental single payor system is the best, I'd be willing to bet your country does not let people in by the thousands to suck off the system.

According to our right-wing press, we do: http://www.timesonline.co.uk/tol/news/uk/article7107598.ece

2.2m illegal immigrants (their upper estimate) is on a par, as a % of our 60m population, as the 11m illegal immigrants (per Wiki) is as a % of your 300m population. About 3.6% of the population in both cases.

 

[Bob001]

... I see first-hand the "undocumented aliens" receiving care on a daily basis at the local hospitals who give bogus addresses such as gas stations, non-existent addresses and/or addresses of random unrelated people. ... .

This is flat-out fraud that should be aggressively prosecuted, which would be much easier if both liberals and conservatives weren't so bitterly opposed to the idea of a national ID card. I personally think it would enhance my freedom to have a document that proves I am who I say, and that prevents anyone else from claiming to be me. But that's a whole different debate.

Additionally, there is an element of the government exceeding its limits should the US go to a single payor system. The fear is that if the government is on the hook for healthcare then the government might just decide you are eating too many Big Macs, cookies, salty notes, etc.

The federal government today operates at least three national single-payer health care systems: Medicare, for most people over 65; veterans hospitals and related services; and Tricare, for active-duty and retired military and their families. Federal civilian employees are covered by private insurance plans that are closely regulated by federal officials. None of them forbids cigarette smoking, Big Macs, etc. There's no reason to imagine that Americans would elect a Congress that would permit that to change.

 

[Ampulla of Vater]

So you are already paying for them to receive care; and nothing would change if you opted for a universal system, is that right?

<snip>

This is going to prove difficult to evaluate because I would suppose "already paying for them" would include padded fees supposedly in use in the current system. I would say this though, if a universal healthcare system would supposedly cut costs, then why not use the savings as opposed to raising taxes, adding a VAT, etc?

 

[Ampulla of Vater]

The federal government today operates at least three national single-payer health care systems: Medicare, for most people over 65; veterans hospitals and related services; and Tricare, for active-duty and retired military and their families. Federal civilian employees are covered by private insurance plans that are closely regulated by federal officials. None of them forbids cigarette smoking, Big Macs, etc. There's no reason to imagine that Americans would elect a Congress that would permit that to change.

And I believe Medicare is pretty much broke. Not sure about Tricare etc. but since Tricare's payments are 90% of Medicare's in most areas I would suppose they operate just like Medicare and are broke as well.

 

[Ampulla of Vater]

2.2m illegal immigrants (their upper estimate) is on a par, as a % of our 60m population, as the 11m illegal immigrants (per Wiki) is as a % of your 300m population. About 3.6% of the population in both cases.

<snip>

This is a whole other debate but there are some estimates of over 20 million illegal immigrants currently in the U.S. Although I did read where many are leaving the U.S. due to the bad economic conditions.

 

[Rolfe]

Is there any chance any of this might get addressed?

Your utopian vision of brotherly love and compassion and rosy cheeked common folk enjoying a show at the cinema is appealing, but we both know the world doesn't work that way.

Er, it does here. I was describing actual reality, as she is right where I'm sitting.

Your suggested solution to healthcare costs was for people on limited incomes to forego all the little pleasures of life to prioritise saving for a possible, hypothetical healthcare requirement in the future. I was pointing out that this would lead to a pretty miserable existence, even when healthy. No money to spend on any little luxuries, just sit and look at the growing savings pot you daren't touch because you don't know when you might break a leg or go down with systemic lupus. Some American Dream!

It's no utopian vision to point out that where I live, this isn't a consideration at all. Nobody needs to worry where the funding for any future healthcare needs is going to come from, because it's sorted. And nobody appears to bear any ill will towards the people who find themselves in the position of needing that healthcare.

And I see no disadvantage whatsoever in the fact that this system doesn't include your valued "personal responsibility".

I also developed this argument further, to examine the possible economic consequences of people actually doing what you want them to do. Everything beyond the basic necessities of food and shelter becomes a luxury item, only to be purchased by those who already have sufficient savings to cover any possible future healthcare need for themselves and their dependants. How big a market is that going to be? Damn small.

Instead of people getting out there and spending, "spending our way out of the recession" as some economists put it, everyone is salting away every penny they possibly can. Almost nobody is buying consumer goods, entertainment, maybe even higher quality food. Are they even maintaining their homes? What is more important, fixing the roof or having the money to pay for the heart bypass I might need in 20 years time?

It would strangle large sectors of the economy. It would be catastrophic.

These were the points I was making, and I think I made them fairly plainly. That you could only respond by accusing me of being "emotional" is somewhat telling, I think.

How so? In a free market, if enough people choose not to buy commodity x because it's too expensive, then the price of commodity x has to come down.

Let's just elaborate a bit more on this. You want a lot of people to choose not to buy healthcare, because it's too expensive, so that the price will come down.

Oh, that's nice. How many people have to suffer and die because they've had to forego the treatment they needed, before this utopia (and this one really is unrealistic) comes to pass?

However, you overlook another important economic consideration. The price of a commodity cannot come down below the cost of production, or at least not long-term. If a producer cannot sell their product at a profit, then they will simply stop selling it. They'll move into a different market.

Or, as someone else remarked, the product becomes a luxury, niche item. You want a replacement hip? Well, I want a penthouse in Manhattan, tough.

Oh dear.

Rolfe.

 

[Ampulla of Vater]

Let's just elaborate a bit more on this. You want a lot of people to choose not to buy healthcare, because it's too expensive, so that the price will come down.

Oh, that's nice. How many people have to suffer and die because they've had to forego the treatment they needed, before this utopia (and this one really is unrealistic) comes to pass?

However, you overlook another important economic consideration. The price of a commodity cannot come down below the cost of production, or at least not long-term. If a producer cannot sell their product at a profit, then they will simply stop selling it. They'll move into a different market.

Or, as someone else remarked, the product becomes a luxury, niche item. You want a replacement hip? Well, I want a penthouse in Manhattan, tough.

Oh dear.
Rolfe.

Is healthcare really a right? It is one's duty to take care of himself but is it one's duty to take care of another? I personally do not think it should be forced upon someone to take care of another. Americans are one of the most charitable people in the world. I personally give to many charities and am very generous with people in need but I do not think I should be forced to take care of someone else. If someone has no food are you going to force the grocery store to give them food? Assistance should be voluntary, not forced.

And your assertion that people without insurance and without money go without healthcare is ludicrous. If it wasn't against the law I could name 25 people in my town who received 'free' healthcare just today. There are already laws in place requiring hospitals to treat people regardless of their ability to pay.

You are also misleading regarding people not buying healthcare in an effort to force the prices down. It is not a matter of buying it or not buying it but rather a matter of which company you purchase it from. THIS is what causes the prices to come down - competition between companies.

 

[kellyb]

And your assertion that people without insurance and without money go without healthcare is ludicrous.

http://news.harvard.edu/gazette/sto...s-annually-linked-to-lack-of-health-coverage/

Nearly 45,000 annual deaths are associated with lack of health insurance, according to a new study published online today by the American Journal of Public Health.

ETA: What the hell difference does it even make if, at the end of the day, the only argument that really matters is that 'taxation is theft' and the ultimate immoral act and thus it's not ever going to be on the table? Nevermind that we could get our health care spending under control by emulating the NHS, and just open up Medicare for all without even raising taxes.

But no, that would still involve "socialized medicine", and would thus be seen as a step towards Stalinism, so, sorry, no, not on the table.

Good god.

 

[Uncayimmy]

I also have a very different philosophy than most posters here. I don't want to overly burden anyone with my health care. If I get cancer and I can't pay for it myself, I'm OK with the fact that I will die. I'm going to die anyway, right? As for my kids and wife, that's a little harder to admit to, but the concept remains. I'm loathe to stick my hand in your pocket to take care of my problems. If you volunteer your help out of the kindness of your heart, that's one thing and I'm appreciative. I'll pay you back any way I can. But I don't think the government should threaten you with incarceration to pay my medical bills.

Well, at least this post makes your position abundantly clear. I would have at least a modicum of respect for it if you were coming from a tax-free society. The reality is, though, is that the USA is already part socialist. Every country is to some degree or another. You already benefit from the tax dollars of other people. We all do. People are "threatened with incarceration" for not paying taxes to support the roads you drive on. Tax dollars ensure that your home and office were built according to safety codes. Tax dollars insure that the large sum of money you put in the bank every month will be there. Tax dollars regulate that insurance company with whom you have catastrophic insurance to ensure that they will actually be able to pay your bills should the need arise. And if they go belly-up, tax dollars are going to bail out them and therefore you.

Hell, the college your wife attended before med school is heavily funded by tax dollars. It seems that you're okay with people being "threatened with incarceration" so that your wife could get an education. She also did her med school and residency in systems that received tax dollars. It seems you were okay with people being "threatened with incarceration" so that you and she have a job.

And yet here you are, inexplicably in my mind, telling us you'd rather let you and your family die than have tax dollars spent on your behalf for medical expenses. Here's a clue: Even if you pay 100% out of pocket, an incalculable amount of tax money will have been spent on your behalf already.

 

[Uncayimmy]

Is healthcare really a right?

<snip>

There are already laws in place requiring hospitals to treat people regardless of their ability to pay.

Hmm...

You are misstating the law. Federal law only requires emergency rooms to stabilize people in need of emergency care without inquiring about ability to pay. Federal law doesn't require any treatment beyond stabilization, and if it's not an emergency, you can be dumped (unless state law says otherwise).

You're still responsible for the bill, which is going to be much higher because emergency rooms cost a hell of a lot more to run. It also means that people with easily treated, non-emergent conditions will not seek proper treatment (often for cost reasons). That (say) simple cut becomes gangrenous, and next thing you know we (all of us) are footing the bill for surgery and a hospital stay because we didn't want to pay for a routine visit and $5 worth of antibiotics.

Is that in any, way, shape or form a sane way of running a railroad?

 

[kellyb]

It's a cold day in hell when I and UnkaYimmy agree (especially on anything health care related!), but that day is here, nevertheless.

 

[Gandalfs Beard]

It's a cold day in hell when I and UnkaYimmy agree (especially on anything health care related!), but that day is here, nevertheless.

I know! Me too. Weird isn't it?

GB

 

[Uncayimmy]

2.2m illegal immigrants (their upper estimate) is on a par, as a % of our 60m population, as the 11m illegal immigrants (per Wiki) is as a % of your 300m population. About 3.6% of the population in both cases.

To be fair, the Wiki number is 500,000 to 700,000, which makes the USA having 3X the number. I don't know much about UK illegal immigration, but the issues in the USA are somewhat different. Both have issues with people who enter the country legally overstay their visas. The USA has a big problem with people entering illegally in the first place. The financial barrier to entry is nil at the Mexican border, which means we get a number of financially destitute illegals. There's at least a financial barrier in getting into and out of the UK, which makes it quite different than what we (I'm in Arizona) encounter.

Furthermore, in many border states we are practically bilingual. Everything I get from the government (voter pamphlets, school memos) is written in Spanish and English. I see billboards and business signs in Spanish every day. You can actually get by pretty well in Arizona without knowing English. I'm supposing the same isn't true for the UK. This contributes to the ease in which illegals can enter/exit border states, which happens a lot.

It's going to be a very real problem in getting nationalized health care under those circumstances. I don't mean to derail this thread into a discussion about illegal immigration, but it will be a big factor in getting anything pushed through.

I should note that my state in the last election approved an amendment that seems (as best as I can tell) to give Arizonans the right to opt out of any federal health care program even if it's mandatory. How that might work out legally is another matter, but people in my state are so concerned about the possibility they want to take preemptive measures. I voted against it.

 

[Gandalfs Beard]

To be fair, the Wiki number is 500,000 to 700,000, which makes the USA having 3X the number. I don't know much about UK illegal immigration, but the issues in the USA are somewhat different. Both have issues with people who enter the country legally overstay their visas. The USA has a big problem with people entering illegally in the first place. The financial barrier to entry is nil at the Mexican border, which means we get a number of financially destitute illegals. There's at least a financial barrier in getting into and out of the UK, which makes it quite different than what we (I'm in Arizona) encounter.

Furthermore, in many border states we are practically bilingual. Everything I get from the government (voter pamphlets, school memos) is written in Spanish and English. I see billboards and business signs in Spanish every day. You can actually get by pretty well in Arizona without knowing English. I'm supposing the same isn't true for the UK. This contributes to the ease in which illegals can enter/exit border states, which happens a lot.

It's going to be a very real problem in getting nationalized health care under those circumstances. I don't mean to derail this thread into a discussion about illegal immigration, but it will be a big factor in getting anything pushed through.

I should note that my state in the last election approved an amendment that seems (as best as I can tell) to give Arizonans the right to opt out of any federal health care program even if it's mandatory. How that might work out legally is another matter, but people in my state are so concerned about the possibility they want to take preemptive measures. I voted against it.

It really does come down to the political/economic ideology of those in power. so it's not that much of a derail to point out that the economic factors that drive "illegal" immigration are the same economic factors that drive our health care system.

The wealthy have bought off most of our democratic institutions. They are unwilling to spend public money on public services (they would rather grab it for themselves and not contribute their fair share to the pot). And they benefit from driving down wages by outsourcing jobs and bringing in cheap and compliant labour. Another related issue is that Capital is legally entitled to cross borders without regulation, yet people aren't (hence their compliance with the unfair labour practices of those that benefit the most from their services). And let's face facts, the current economic model as it stands would collapse without this pool of cheap "underground" labour.

So unless we're willing to discuss the competing ideologies of Class Warfare, we're not going to get a handle on any of these financial issues related to health care distribution policies.

A single payer system is perfectly feasible in the US, if US policies weren't driven by Right Wing Corporate Ideologues.

The populist wing of the Right Wing are right to holler about "taking back the country." The problem is that they don't understand that it's the Right Wing Corporatists they need to "take the country back" from. Instead they believe the Corporate Propaganda that it's the "Socialists" who have stolen the country.


GB