Socialised health care: Why is it scary?

[FattyCatty]

I basically agree with how you characterize the opposition to UHC in the US but I think that such a belief, as you are describing it, is really an illusion. Private insurers are going to provide service based on a cost benefit analysis just like a public insurer would and it won't be the patient who gets to select what will be covered but the private death panel, as some would put it.

Not to mention that their cost-benefit analysis has to allow for making an [exorbitant] profit, which need not be the case under UHC.

By the time you get around to disagreeing with them on an issue of coverage you're often already sick and wondering why they won't cover a specific treatment. At this point, it's too late to switch insurers anyway. Even if they covered what you were looking to get it would likely get treated as a preexisting condition and you'd be SOL.

Another good reason for UHC. No need to worry about whether you can take a better/different job and risk losing health coverage because you have a pre-existing condition.

And the cost benefit if the insurer is a for profit company is in regards to their bottom line not the most effective or efficient medical treatment. In the UHC in England (that is under terrible threat by our right wingers) we know exactly how such decisions are made and we even have a right to legally challenge such decisions.

<snip>

Exactly. In a for-profit company, many decisions are made based on profit motives, not for health/medical reasons.

Why are private death panels better than public?

Good question. Why should my ill health enrich the blood-suckers who run for-profit health insurance?

 

[iknownothing]

But while I'm not outright opposed to socialized health care... yeah I will admit when the topic comes I think of all the hours I've spend quagmired in the beauracracy of our other government provided services and have a sort of cold chill go down my spine. A hospital run like the DMV would be the closest thing I can imagine to pure Hell.

I'm thinking of all the hours I've spent quagmired in the bureaucracy of our insurance company. I don't know why people think huge corporations are somehow any better than a comparable government entity. I guess the magic of free markets somehow is supposed to filter down through all the layers of a corporation?

I mean, I made the mistake of making my daughter's 6 month well child check only 2 months and 28 days (IIRC) after her 3 month WCC. So they denied payment, because see I was supposed to have waited at 3 full months. Nevermind the fact that the doctor only does well child checks on certain days, and I got her in on the closest available day to her 6 month birthday. Nevermind the fact that they are paying for the same number of well child checks, regardless of what date each is performed. Then we began the circus of calling and getting someone to agree to get the payment approved, and then a month later getting another bill because that person didn't. Calling again, same story. Repeat again. Finally did get that approved and paid by the insurance company. But they certainly wasted a lot of time and resources attempting to deny it. Not the glowing model of efficiency that private companies are supposed to provide. And that's just one example off the top of my head.

The trouble with that is that the point at which the insured discovers they disagree with the decisions made by their insurer is normally at the point they become sick.

At this point it's too late to change insurers.

And then there's the fact that we really have little choice on insurance companies anyway. You get whatever insurance is available at whatever job you can land. Maybe in a better economy, or if you've got job skills that are really in demand, you can choose your job to get the insurance company you want. (And then if they decide to change insurers the following year, your choice is negated.)

Actually buying private insurance yourself, other than what's provided at work, is out of reach of all but a few people.

I wonder as a test of my surmising above - do private insurance companies in the USA publish their cost benefit analysis so that a customer can make an informed choice between companies?

I don't know, but again that would only matter to those people in Human Resources who make the decisions about which insurance company to choose. Consumers have very little say in that.

One factor that hasn't been touched on much in this thread is U.S. culture.

Great post. I especially agree with the Calvinism and frontier myth parts. I think a lot of people think that they are successful because they've worked so hard & pulled themselves up by their bootstraps, etc., and willfully ignore how much luck they've benefited from.

 

[Skepticemea]

No, we don't. Or at least, it's not a conversatino I've ever had. I think that's probably a uniquely American point of view, if I'm honest.

In addition, alcohol and tobacco are (horror of horrors, oh the untamed theft of it all, it's all so unfair because it's just wealth redistribution, waaah, waah, waah*) taxed. I'm pretty sure (but I'm open to being corrected) that the taxes collected from ciggarettes more than cover the extra burden on the NHS for the same.







(*Not directed at you GStan!)

According to this site:

http://www.taxstampforum.com/programme/46-overview-of-the-2nd-tax-stamp-forum

£8bn in cigarette duty, £8.4bn in alcohol duty in 2010.

 

[3point14]

According to this site:

http://www.taxstampforum.com/programme/46-overview-of-the-2nd-tax-stamp-forum

£8bn in cigarette duty, £8.4bn in alcohol duty in 2010.

Thanks.

I have no idea what the financial costs of smoking/drinking are, but a good 15% of the budget seems like it would be enough to cover the damage.

 

[ponderingturtle]

Bingo.

I'm surprised it took this long for someone to figure this out. The fear is that UHC will simply bankrupt every man, woman, and child, and the fear is justified by the appalling, criminally negligent invoices you've seen.

When the health care debate began, I just naturally assumed that the primary thrust would be aimed at deflating the bloated and swelling cost. I couldn't have been more wrong. Over 2000 pages of turgid regulations failed even to attempt to address the real problem, that problem being the bloated and swelling cost of health care in the U.S., as opposed to other countries which can actually have UHC without bankrupting themselves.

Too much money against it to have reforms that reduce cost. No special interest group is advancing it so no one in government cares enough to do the kind of restructuring of the economy that is needed.

 

[Cobalt]

Is is scary because of the perception, true or not, that the US government is woefully inefficient.

 

[ponderingturtle]

Sarcasm aside, addressing those who do live in a country with UHC, I have to admit that my natural reaction to UHC does include something resembling this sentiment, minus the religious overtones. Thinking about UHC, it does piss me off to think that everyone would be required to pay, for example, for the lung cancer treatments of life long smokers.

For those of you that do live under UHC, does the thought ever gnaw at you or disturb you to think "Damn, we could be doing this alot cheaper if people didn't willfully and knowingly poison themselves smoking, drinking, overeating, etc."?

Or parents who knowing the risks of their genes have kids anyway with costly genetic disorders.

 

[Darat]

You mean you don't get the lady with the clipboard asking if you have an Advance Directive, making sure you sign that you've seen the privacy notice, making you sign permission for them to be paid, signing that they told you this, that, and the other? And the one collecting the co-pay to be seen in the emergency room?

I suppose if they've given you enough of the right drugs in the A&E department you might imagine such fantasy figures!

 

[GStan]

Or parents who knowing the risks of their genes have kids anyway with costly genetic disorders.

I understand the point you are trying to make, but this is not a good analogy. The knowledge that you have some kind of genetic anomaly that may result in children with costly genetic disorders is not equivalent to the knowledge that smoking is detrimental to you your health.

 

[jdp]

I'm thinking of all the hours I've spent quagmired in the bureaucracy of our insurance company. I don't know why people think huge corporations are somehow any better than a comparable government entity. I guess the magic of free markets somehow is supposed to filter down through all the layers of a corporation?

I suspect it could under the right conditions but the problem is that the market for health care, and health care insurance, is different from just about any other market.

For example, if I call an ambulance, I am not going to be comparison shopping ambulatory services. Nor am I going to comparison shop the hospital that I am being transported to. Individuals are much less willing to cap expenditures for health care than they are for say a new TV or car. The service contracts are complicated and written in such a way that they can easily be voided by the company, legally or not. It's also not easy for either you or your family to mount a legal battle for coverage when you're hospitalized. And as has been noted, even when you're healthy, options for coverage aren't that good to begin with.

So competitive pressures just aren't there.

 

[Toontown]

Too much money against it to have reforms that reduce cost. No special interest group is advancing it so no one in government cares enough to do the kind of restructuring of the economy that is needed.

If what you say is true, then color me very afraid of UHC.

 

[ponderingturtle]

If what you say is true, then color me very afraid of UHC.

When you are talking about cost reductions as say 5% of GDP there is no way for it not to cost jobs and income. Now they are not productive jobs but jobs none the less.

 

[uruk]

~snip~
I've had many visits to the local, private hospital. It's already run like a bad DMV. I have also in my youth spent time in military dispensaries. I have to say that the private hospital suffers in comparison. I doubt that the government would make it worse.

I have to second this, the hospitals in my neck of the woods are horrible places to get health care. You have to wait for hours to see any doctor in the emergency rooms. The nursing staff is rude and uncaring and the doctors are bordering on incompetent.

This whole notion that private indusrty is necessarily more efficient is laughable. A badly run privatized industry will still survive especially if there is no other competition or any place else to go.

A privatized industry can be just as badly run as a government agency

 

[uk_dave]

I have to second this, the hospitals in my neck of the woods are horrible places to get health care. You have to wait for hours to see any doctor in the emergency rooms. The nursing staff is rude and uncaring and the doctors are bordering on incompetent.

This whole notion that private indusrty is necessarily more efficient is laughable. A badly run privatized industry will still survive especially if there is no other competition or any place else to go.

A privatized industry can be just as badly run as a government agency

Yeah but, to be fair, if you took away the legal requirement for hospitals to treat emergency cases regardless of ability to pay, the result would be extremely nice for all those insured people.

 

[Emukt]

What drives me nuts is the fact in the USA, due to insurance, we are so tied to our jobs. I know many people want to leave their jobs and try their hand at starting up a small business. But they can't because their job provides HC for their families.

And how much mark-up are we paying of the cost of goods and services for HR people to manage a medium to large company's HC for the employees. Even a small business person could be better spending the time they spend looking into HC for their small staff, if they chose to provide it. If I ran a 100 person company that made telescopes - I'd want to worry about awesome telescopes, not managing the outside needs of my workers.

I think we'd see better companies, both small and large, if we adopted UHC.

 

[Travis]

I've met people who will never support UHC unless there is a guarantee that no abortions will ever be covered.

But then again I live in community that tried to do away with it's fire department using the logic that only bad people cooking up meth have house fires. That was only stopped when it was pointed out that wildfires threaten everyone including the God Fearing Church Goers.

 

[jdp]

I've met people who will never support UHC unless there is a guarantee that no abortions will ever be covered.

But then again I live in community that tried to do away with it's fire department using the logic that only bad people cooking up meth have house fires. That was only stopped when it was pointed out that wildfires threaten everyone including the God Fearing Church Goers.

Why would they do away with the Fire Department when it could have just been privatized?

 

[Delvo]

In many American communities, the local fire department is not a government entity but a private one funded by either donations or fees paid directly to the fire company instead of through any government.

Some functions that you might think of as police functions are also carried out by private security companies as well. For example, if you see someone in a uniform standing guard at a place where a high crime rate might be expected, like a low-price grocery store in a poor neighborhood, then that person might be a cop whom the police department has posted there instead of assigning to a mobile patrol, but (s)he's more likely to be privately paid for by the grocery store itself.

* * *

In general, the jobs of the police and the military services tend to strike people as things that should/must be done by government, not based on whether that or private companies would be more efficient at it, but based on security being the government's job, its main justification to even exist... because those are functions which should represent and serve society as a whole, not the competing wills of distinct parts of it.

I, for example, believe a government-run military system is the only way that makes sense to run a military system, but for the above kind of reasons, not efficiency, which is a completely separate issue. That doesn't stop me from acknowledging that the government's process for selecting & procuring equipment has a pattern of causing various programs to exceed their budgets & deadlines, sometimes wastes resources on projects that shouldn't even be done at all, and even interferes with sound tactical/strategic decision-making based on political silliness. It's just that the inefficiency of a government-run operation is worth putting up with for functions that simply have to be government duties anyway.

Justifying putting up with government inefficiency (and bad decision-making) in the case of health care would require a large paradigm shift toward thinking of health care, like security, as a government duty. That's not only a psychological threshold to cross, but also a technical and legal one, because health care, unlike security, is not in the Constitution or state & local constitutions & charters.

Without this function being an inherent government duty like security is, that leaves efficiency as a sensible basis for making a choice, even though it doesn't apply to functions that are fundamental government duties and must be so whether they're done efficiently or not.

The only problem then is that, even if a competitive private health care system would be more efficient than a government one, we don't have such a system, and political reality is that we never will, regardless of how good it might be in some theory. What we have is a chimera, a tangle of government interferences & attachments obscuring an underlying private structure, and the choice we face is between THAT and a more fully government-run system. So, regardless of whether a private or public system would be more efficient, efficiency alone still points toward a public one, because anything's better than the chimera.

 

[FattyCatty]

<snip>
Justifying putting up with government inefficiency (and bad decision-making) in the case of health care would require a large paradigm shift toward thinking of health care, like security, as a government duty. That's not only a psychological threshold to cross, but also a technical and legal one, because health care, unlike security, is not in the Constitution or state & local constitutions & charters.

I don't agree with you here, because for some people (such as myself) there is not "paradigm shift toward thinking of health care, like security, as a government duty." I do think of it that way, there is no "psychological threshold to cross," because I'm already in that room of belief. I think many other people are, as well. This is a real dividing line in basic belief about the purpose of our government.

I also disagree that there is a "technical and legal one, because health care, unlike security, is not in the Constitution...." In fact, I find security (i.e, common defense) and health care (as part of general welfare) mentioned in the same places. They are found in the Preamble to the Constitution:

We the people of the United States, in order to form a more perfect union, establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity, do ordain and establish this Constitution for the United States of America.

and in Article I, Section 8, Clause 1:

ARTICLE I
LEGISLATIVE DEPARTMENT​

Section 8. Clause 1. The Congress shall have Power to lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States.

I am not alone in interpreting "general welfare" to include health. In 1966, Ellis v. City of Grand Rapids, the United States District Court for the Western District of Michigan said:

...When Thomas Jefferson authored the Declaration of Independence, he changed the triology of prime inalienable rights of man from "life, liberty and property," as enunciated in the Magna Charta, to "life, liberty, and the pursuit of happiness."
<snip>
Thomas Jefferson included the health of a free people as a specific right in "our pursuit of happiness," when he said:

"Without health there is no happiness. An attention to health, then, should take the place of every other object."
<snip>
The health of the people was in the minds of our forefathers when they wrote the Preamble of the Constitution of the United States:"We the People of the United States, in Order to form a more perfect Union, * * * promote the general Welfare * * *."
The health of free people is forever present in the minds of free men.<snip>
Promotion and improvement of our people's health is a corresponding duty to our inalienable right to the "pursuit of happiness;" it is a fundamental obligation of governments, national, state [*573] and local, instituted among men to secure man's inalienable rights. The Congress of the United States and the state legislatures of the several states have in a multitude of ways established means to provide and care for the health of the people.

Our Presidents and Governors likewise have urged and executed laws for the improvement of public health.[4], [5], [6]. In the words of Mr. Chief Justice Warren in McGowan v. State of Maryland, 366 U.S. 420, 444-445, 81 S.Ct. 1101, 1115, 6 L.Ed. 2d 410 (1961):

"Throughout this century and longer, both the federal and state governments have oriented their activities very largely toward improvement of the health, safety, recreation and general well-being of our citizens."<snip>
Thus, we see that the concerted effort for renewal and expansion of hospital and medical care centers as a part of our nation's system of hospitals, is as a public service and use within the highest meaning of such terms.

Surely this is in accord with an objective of the United States Constitution: "* * * promote the general Welfare."

In the last half of the second decade of the twentieth century, it is far too late to deny that hospital service for the benefit of all the people, whoever they may be, is not a public service, and that the use of properties and facilities for health purposes is not a public use.

The overwhelming weight of history is to the contrary.

Without this function being an inherent government duty like security is, that leaves efficiency as a sensible basis for making a choice, even though it doesn't apply to functions that are fundamental government duties and must be so whether they're done efficiently or not.

I believe that "this function," health care, is an "inherent government duty," as explained above. Therefore, it is not necessary to consider efficiency as the basis for deciding on UHC.

The only problem then is that, even if a competitive private health care system would be more efficient than a government one, we don't have such a system, and political reality is that we never will, regardless of how good it might be in some theory. What we have is a chimera, a tangle of government interferences & attachments obscuring an underlying private structure, and the choice we face is between THAT and a more fully government-run system. So, regardless of whether a private or public system would be more efficient, efficiency alone still points toward a public one, because anything's better than the chimera.

So, from different ideas of what the duty of the government is, we arrive at the same place.

 

[Cain]

In the end, their aversion to it probably has more to do with political aesthetics rather than rationality. In other words, what appeals to them is the purity of the free market.