Economic Pros & Cons of US UHC

[epepke]

Thoughts? (Rational ones appreciated)

The biggest pro is that we are already paying for it, but we're paying for it by the most expensive possible mechanism.

I just got out of the hospital, where I spent a week. I got a cat scan on the first day, got treated, got an endoscopy, got my 900 ml cyst (which was constricting my stomach) in my pancreas drained, and the food wasn't too shabby either. The vegetables were fresh (mostly).

These things were probably sequelae of my pancreatitis, which I wrote about five years ago.

This is all probably going to be written off, and even if it isn't, I don't have to declare bankruptcy, because medical debts don't really count in the same way. Either it will be written off through official channels, or I just won't pay for it.

The trouble is that I had to go the most expensive route: checking into the Emergency Room. They have to treat you. Every time I've done that, which is four so far, I've gotten first class treatment. In fact, better treatment than I got when I had COBRA. Sometimes I've paid what I could afford at the time, but nothing really bad happened to me when I couldn't pay.

Now, help for chronic conditions is harder to get than for acute conditions. Still, I'm going to go to the evening clinic at the same hospital chain for followups. And there are lots of places to get free drugs, not all of which are charities. Some grocery stores with pharmacies use free drugs as loss leaders to get you into the store, in the hopes that maybe you'll buy some pastrami.

This is one of the things I find extremely difficult to explain to Europeans, who seem to think that people in the US are denied treatment right and left due to inability to pay. Really, though, unless you want an experimental treatment that even a UHC wouldn't pay for (but gives Michael Moore a stiffie), if you check into an ER, the law says that you have to get at least basic treatment. All of the hospitals I've checked into gave me the Full Monty, under conditions indistinguishable from those given to people who could pay.

Again, treatment for chronic conditions is harder to get, and I do not mean to minimize the plight of those who have them, including me. Still, there is a hell of a lot more free treatment in the US than you would imagine from watching Sicko.

I'm in favor of some sort of UHC, not only because it would be better, but because it would be much cheaper. Of course, it would have to be a good one. I've heard that Germany's system works, and I've also heard good things about the French system. However, all things considered, I would rather be poor and sick with the US non-system than with the NHS. I have considerable experience with the NHS, mostly because of my parents, and I'd rather not have it over here.

I am not saying this because of some sort of idiot national pride, but because of what I've seen and experienced.

 

[Rolfe]

Yeah, but remember how shocked I was about the lack of aftercare with your pancreatitis? Turning a newly-diagnosed diabetic loose with a bottle of insulin is crazy. You could have killed yourself with it when the transient diabetic state resolved!

Malcolm simply hasn't figured out that it's simply a matter of efficient use of money and resources. At the moment you're pouring cash down the drain for no better outcomes than countries spending half that. Other countries can provide a complete universal healthcare service on the tax you guys have to pay just for Medicare and Medicaid.

In theory, you could pay no more tax, and provide universal healthcare, and then leave everyone free to take out extra insurance as well if they felt like it.

And Malcolm goes on about moral hazard and medical tourism and promoting competition. That's the sort of head-in-the-sand ideology that got you into this mess in the first place.

Rolfe.

 

[Malcolm Kirkpatrick]

...Malcolm simply hasn't figured out that it's simply a matter of efficient¹ use of money and resources. At the moment you're pouring cash down the drain for no better outcomes than countries spending half that. Other countries can provide a complete universal healthcare²...

1. Efficient? Like the State-monopoly school system? Like the Post Office? Yah.
2. I did not notice that the universe was sick.

..service on the tax you guys have to pay just for Medicare and Medicaid. In theory, you could pay no more tax, and provide universal healthcare, and then leave everyone free to take out extra insurance as well if they felt like it.

You mean, the government is cheating us? Seems to me that's a good reason to avoid giving members of them any more authority.

...And Malcolm goes on about moral hazard and medical tourism and promoting competition. That's the sort of head-in-the-sand ideology that got you into this mess in the first place.

Huh? Moral hazard names a large category of observed behaviors. So also is medical tourism an observed behavior. It's head-in-the-sand attachment to the healing power of organized violence (the State) that makes people blind to these facts.
Also, the interpersonal style in which advocates for State-monopoly enterprise argue hardly inspires confidence that they will behave with compassion on the job.

 

[rustypouch]

1. Efficient? Like the State-monopoly school system? Like the Post Office? Yah.
2. I did not notice that the universe was sick.You mean, the government is cheating us? Seems to me that's a good reason to avoid giving members of them any more authority. Huh? Moral hazard names a large category of observed behaviors. So also is medical tourism an observed behavior. It's head-in-the-sand attachment to the healing power of organized violence (the State) that makes people blind to these facts.
Also, the interpersonal style in which advocates for State-monopoly enterprise argue hardly inspires confidence that they will behave with compassion on the job.

So what's so great about healthcare in the US that is worth twice that of healthcare in other countries? I've never heard a straight answer for that.

 

[mike3]

(Rolfe): "It costs far more to prevent certain people from getting the treatment they need, than it would cost simply to treat them, no questions asked."
Here's my treatment for certain people:...
1. Maybe. Maybe not. In earlier threads we noted the occurance of medical tourism, where residents of countries with State "guaranteed" care travel abroad and pay out of pocket for imaging services and surgeries that are either not covered or for which there are (sometimes lethal) wait times. Where do the direct payments for such services appear in the national cost accounting?
2. Maybe. Maybe not, again. Moral hazard is a growing cost of entitlement programs.
3. Aggregate cost and aggregate longevity statistics provide only loose indicators of individual cost of services and quality of services.

1. How many get this "wait" slam vs. how many get nothing at all?

2. Who do you actively deny treatment to?

 

[epepke]

Yeah, but remember how shocked I was about the lack of aftercare with your pancreatitis? Turning a newly-diagnosed diabetic loose with a bottle of insulin is crazy. You could have killed yourself with it when the transient diabetic state resolved!

Yeah, I do. I'm gratified that you remember.

But what of it? I was shocked about the septic conditions that my father experienced, in the Intensive Therapy Unit at University College Hospital, the same unit the nurses told me was designated for George Bush Sr. I'm talking encrusted dirt on the baseboards/wainscottings, no air conditioning, air filtration, or positive pressure. When it got hot, they opened the windows to the London air, without even fly screens, and the nurses laughed about how all the patients got a yellow skin infection.

At least, turned loose with a bottle of Lantis and later switching to oral Metformin, I didn't die. My father did, from an infection he caught there.

But what of it? Is there some sort of National Pride Reality Show where you get to win something? The NHS isn't Nu-Perfect either. And when I told Brits about the lack of air conditioning or filtration, the only sympathetic responses I got were about comfort.

In theory, you could pay no more tax, and provide universal healthcare, and then leave everyone free to take out extra insurance as well if they felt like it.

Certainly. Probably less tax. I want a UHC with a single payer, but I want a good one, not one where the facilities resemble an ancient high school.

And Malcolm goes on about moral hazard and medical tourism and promoting competition. That's the sort of head-in-the-sand ideology that got you into this mess in the first place.

Not really. The reason the US is in a mess is that there is no system. There are only a series of mismatched ad hoc principles. Hospitals have to provide services, and this practically guarantees insurance fraud to pay for it, which drives up the price of insurance, and so on and so forth. There is no health care system.

I have a girlfriend with a leg waiting for a femoral replacement and hinged knee. Her insurance will pay for any surgery, unlimited, but it won't pay for the rehab. That requires Medicare and Medicaid, and she makes too much money for the Medicaid. Which is stupid. However, the rehab place says that they won't kick her out, because everything resets at the first of they year. Which is also stupid.

I'd like a system, but I want it good. I want the sterility and attention to detail that you get in the US or Germany or Japan. I want it cheap and paid for. I don't want it so that someone like Thatcher can gut it for political gain. But how to achieve it? It isn't so simple.

 

[portlandatheist]

Wouldn't one of the more significant impacts of UHC on the US economy to make US companies more competitive in the global market? Think about it, when you buy a car made in America, not only are you paying for the expensive labor involved but the health care of the workers as well. If those costs were taken away from the corporations and put into the realm of taxes and the public sector, it would drive down costs for corporations trying to compete in the global market to produce goods and services.

 

[epepke]

Wouldn't one of the more significant impacts of UHC on the US economy to make US companies more competitive in the global market?

Yes.

 

[Rolfe]

I seem to remember you said your father's death was quite some years ago? There was a time when the NHS in Britain was shockingly underfunded, and some pretty dire stuff has been reported for that period. From about 15 years ago, funding has been increased to be much more in line with other universal healthcare systems, that is about 8% of GDP. More recent experience would be very unlikely to encounter the conditions your poor father was subjected to.

Indeed it highlights the fact that universal healthcare systems have to be funded to a respectable level. However, current experience tends to suggest that 8 to 10% of GDP will deliver you a decent package, covering everyone. Expending 16% not to cover everyone is right off the curve.

Rolfe.

 

[balrog666]

Let's see ... the US government currently spends about $800 billion to run and/or fund Medicare, Medicaid, the VA hospital system, and the Indian Health System doling out substandard medical care to ~100 million people.

So for only an additional $2000 billion/year we could deliver that same substandard model of medical service to everyone else in the US. As long as *ALL* the private sector doctors, nurses, orderlies, technicians, etc. agree to work for Leviathan, meaning a significant cut in pay and benefits while working directly for and within federal bureaucratic management and directives. Which is not going to happen.

And, oh, what happens to all the owners (corporate or otherwise) of those clinics, hospitals, labs, and other facilities? Do they get bought out? Subsidized? Co-opted? Nationalized?

And, oh, oh, let's all hope those new federal employees don't unionize to raise their pay!

Alas, too bad the government is already broke and that raising an additional $2000 billion in taxes from the private sector is impossible.

 

[uk_dave]

Let's see ... the US government currently spends about $800 billion to run and/or fund Medicare, Medicaid, the VA hospital system, and the Indian Health System doling out substandard medical care to ~100 million people.

So for only an additional $2000 billion/year we could deliver that same substandard model of medical service to everyone else in the US. As long as *ALL* the private sector doctors, nurses, orderlies, technicians, etc. agree to work for Leviathan, meaning a significant cut in pay and benefits while working directly for and within federal bureaucratic management and directives. Which is not going to happen.

And, oh, what happens to all the owners (corporate or otherwise) of those clinics, hospitals, labs, and other facilities? Do they get bought out? Subsidized? Co-opted? Nationalized?

And, oh, oh, let's all hope those new federal employees don't unionize to raise their pay!

Alas, too bad the government is already broke and that raising an additional $2000 billion in taxes from the private sector is impossible.

Okay, so those are your cons?

Where'd the $2000billion figure come from?

And perish the thought that people who have responsibility for the health of others, including making life or death decisions should be properly rewarded.

ETA: Or 'compensated'. I liked that how when a recent report into private sector ceo pay indicated that they had all awarded themselves massive rises, it was termed 'compensation'.

 

[Malcolm Kirkpatrick]

Wouldn't one of the more significant impacts of UHC on the US economy to make US companies more competitive in the global market? Think about it, when you buy a car made in America, not only are you paying for the expensive labor involved but the health care of the workers as well. If those costs were taken away from the corporations and put into the realm of taxes and the public sector, it would drive down costs for corporations trying to compete in the global market to produce goods and services.

No. Where do you think "taxes" come from? Martians? Ultimately, productive people pay all taxes, in any system. Subsidies to the auto industry or solar panel industry (in the form of subsidized health benefits) would allow US auto makers or solar panel manufacturers to undersell foreign competitors (other things being equal), but would make the industries that paid for those benefits less competitive.

 

[fitzgibbon]

So what's so great about healthcare in the US that is worth twice that of healthcare in other countries? I've never heard a straight answer for that.

You have some really sexy commercials telling you how much money can buy. Bit of a female dog if you don't have the money though

 

[Delvo]

We'll start with the cons, because the only items I can think of are:

1. A perceived increase in taxation to pay for it.

Not just perception, but unavoidable certainty. Even with no change in total costs, money that is currently going through insurance companies would need to be redirected through the government instead, and the only way for that to happen is with more tax.

Of course, if you don't have to pay for expensive private medical insurance or your employer doesn't have to pay it on your behalf and can pass that money on to you as a part of your wages, it may well be possible that it will cost you no more if not less than it does right now.

Almost nobody would end up coincidentally paying the same amount as before, because two people with the same job and income can currently choose plans with different details and different costs from the same insurer, and because at least some people who currently pay nothing would also be included in the tax increase.

The fact that there are people who currently pay nothing, and others who currently pay more than average, creates an interesting complication in the process of switching over. Switching to tax as the funding mechanism, with the total amount of money being the same, would be likely to cut costs for those who are rich enough to already be choosing to pay more than average, while increasing costs for those who already had the most reason not to be paying already... unless you made a point of applying the tax in a very lopsided way which would amount to deliberate wealth transfer.

That was part of the problem with the Obama bill. Making getting medical insurance a legal requirement means ordering the poorest people to pay money they haven't been paying and in a lot of cases can't pay. Even if you do simultaneously order insurance companies to offer coverage for as little as $50, that's still $50 that the uninsured weren't paying before. The only difference with a government-run system instead of a still-private-but-just-more-complicated one is that you'd just be taking the money from them instead of ordering them to pay, which is really just a technicality.

Freer movement of labour - employees don't have to stay in a job because it gives them health care coverage which may not be available with another employer.

This would create chaos in the job markets at first while employers tried to figure out how much to adjust wages/salaries in reaction to the drop in "benefits" to offer employees. (And companies that have so far been offering low wages/salaries but making up for it with good side-benefits would have to adjust more than those that have so far been offering weak side-benefits but paying higher wages/salaries, so you'd be tipping competition in some companies' favor against others.)

 

[fitzgibbon]

Ultimately, productive people pay all taxes

Of course you assume that all productive people are productive all the time. Not necessarily a given in today's economic climate. Shall you go the pound-foolish route because the temporarily not-productive are without the penny?

 

[Malcolm Kirkpatrick]

Of course you assume that all productive people are productive all the time.

I make no such assumption. People, not corporations, ultimately pay taxes. Some people are net tax payers and some are net tax recipients. If "tax" is interpreted broadly, as a government-mandated surrender of resources, then many people too poor to pay income taxes pay very high taxes.

 

[balrog666]

Okay, so those are your cons?

Where'd the $2000billion figure come from?

And perish the thought that people who have responsibility for the health of others, including making life or death decisions should be properly rewarded.

ETA: Or 'compensated'. I liked that how when a recent report into private sector ceo pay indicated that they had all awarded themselves massive rises, it was termed 'compensation'.

Yeah, cons.

That would be math - look it up.

Yes, let it perish because we can't let the free market reward most those best at doing their jobs!

CEO pay? Right, as if someone managing 40,000 employees got there by being a rubber-stamping-bureaucrat!

 

[tyr_13]

Yeah, cons.

That would be math - look it up.

Yes, let it perish because we can't let the free market reward most those best at doing their jobs!

CEO pay? Right, as if someone managing 40,000 employees got there by being a rubber-stamping-bureaucrat!

Well that certainly was a well thought out and informative response. (Guess what emoticon I couldn't put at the end here because you used them all?)

 

[balrog666]

Well that certainly was a well thought out and informative response. (Guess what emoticon I couldn't put at the end here because you used them all?)

Feel free to address my earlier post.

 

[tyr_13]

Feel free to address my earlier post.

What, you have the others on ignore or something?