Socialised health care: Why is it scary?

[Sawbones79]

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

There is still a powerful thread of Calvinism woven into the culture here. Whether they acknowledge the origins of the belief or have stripped away the overt religious wrapping, a large number of Americans believe that success in the material world is simply an indicator of being a better person, somehow. The older view is that this superiority is based on spiritual "election", a perq for predestined salvation in the afterlife. Today the more common view is the Protestant Work Ethic, the idea that more effort and dedication to one's job yields better material results in this life. Thus, if anyone isn't doing well financially, it's their own fault.

I personally think that this also translates into issues of race. There are still a large number of Americans who don't want to have the money taken from their wallets and the food taken from their children's mouths to support "fake" Americans. There is a long history of panic about the Other here, whether its illegal people or "welfare queens" taking services and money they don't deserve. My perception of Sweden is that you have a stronger ethic of egalitarianism than the U.S. does, and fewer racial and ethnic divisions to exploit in fighting egalitarian policies. Here, most people want to be above their competitors, and many still see non-whites as not quite right. And that's not even considering the few remaining dead-enders who don't even think non-white people are fully human.

There is also the frontier myth of the completely independent, self-reliant individual. The viewpoint that says that "I'm on my own, no one will help me survive, so I owe them nothing" has now defeated the alternative perception that "we're out in the wilderness together, and we must help each other survive or we'll perish one by one". The parts of the country where you Swedes settled in large numbers had more of the latter view, but even that is going away.

Also, as Alferd Packer hinted, part of the opposition to universal health insurance is the fear that some of it will be used to cover birth control and abortion. There is still a massive opposition to reproductive rights in this country. I would say that this is not a primary reason for opposition to universal health insurance, but would be in the top ten.

Yet more food for thought on a subject I'm rather ignorant about, thanks! I'd always thought the "american way" thinking was the main stumbling block for UHC, and the reproductive health issues to be the bogeyman of a small clique of religious wackjobs. Seems that was an oversimplification.

 

[This is The End]

Often can seem to be a case of cutting off their own nose to spite themselves since UHC systems consistently cost less per person than the USA system and provide at least equal if not better outcomes.

The US has public schools (13 years worth, from when each citizen is 5 to when they are 18).

You would think that health care is equally as important as education.

We have all grown up with public schools (we've had a respectable school system here for nearly 100 years now). So those who freak out when they hear "public health care" must just be too accustomed to "public schools" to react similarly.

 

[Travis]

I suspect a Venn Diagram of people who oppose UHC and people who advocate for abolishing public schools shows great overlap.

By the way what is everyone's issue with the DMV? I've never run into problems with my local one.

 

[Darat]

...snip...

By the way what is everyone's issue with the DMV? I've never run into problems with my local one.

Cultural meme - we have them over here, they tend to persist long after the real issue that started the meme has passed or been solved. We often see them about the NHS in the UK, many folk can go years and years without interacting with such organisations so they aren't exposed to the actual situation. Mind you I've heard people complaining about the NHS and long waiting times even when telling a tale about how their family/friend has had great treatment with no waiting! Rationality does not come into it.

 

[GStan]

The US has public schools (13 years worth, from when each citizen is 5 to when they are 18).

You would think that health care is equally as important as education.

We have all grown up with public schools (we've had a respectable school system here for nearly 100 years now). So those who freak out when they hear "public health care" must just be too accustomed to "public schools" to react similarly.

I think that's only part of the reason. The level of federal control and funding necessary for UHC is far greater than the level of federal control over the public school system. While the federal goverment does mandate some standards and provide some funding, public schools are mostly administered and funded at the state/county/local level of government. I think you would find that those strongly opposing UHC would overlap those who, while not necessarily opposing a public education system, oppose any increase in federal authority over the public education system.

 

[Professor Yaffle]

I think that's only part of the reason. The level of federal control and funding necessary for UHC is far greater than the level of federal control over the public school system. While the federal goverment does mandate some standards and provide some funding, public schools are mostly administered and funded at the state/county/local level of government. I think you would find that those strongly opposing UHC would overlap those who, while not necessarily opposing a public education system, oppose any increase in federal authority over the public education system.

I wouldn't say the necessary funding is *far* greater for health than it is for education. Here are the UK figures:

Health Care £123.8 billion
Education £93.3 billion
http://www.ukpublicspending.co.uk/

And there's no reason why healthcare couldn't be managed on a state level, with reciprocal agreements, like we have in Europe.

 

[MarkCorrigan]

GStan, how much control do you think the government would have?

How much do you think the UK government has over the NHS?

 

[Travis]

Cultural meme - we have them over here, they tend to persist long after the real issue that started the meme has passed or been solved. We often see them about the NHS in the UK, many folk can go years and years without interacting with such organisations so they aren't exposed to the actual situation. Mind you I've heard people complaining about the NHS and long waiting times even when telling a tale about how their family/friend has had great treatment with no waiting! Rationality does not come into it.

I think part of the problem is that no one that is at the DMV wants to be there. So everything that happens there is 10x's worse in their own estimation of things. Funnily enough fewer people criticize the publicly funded library system perhaps because people in libraries want to be there.

OMG I had to wait for like twenty minutes at the freaking DMV!

Wow, I totally got that new book and it only took thirty minutes!

 

[GStan]

I wouldn't say the necessary funding is *far* greater for health than it is for education. Here are the UK figures:

Health Care £123.8 billion
Education £93.3 billion
http://www.ukpublicspending.co.uk/

And there's no reason why healthcare couldn't be managed on a state level, with reciprocal agreements, like we have in Europe.

Sorry, perhaps I wasn't clear. I meant that the portion of financing that would come from federal funding (in the US) for UHC would, IMO, be much greater than the portion of public education financing that comes from federal funding. For example, for the 2004-05 school year, the US federal government contributed only 8.3% of the $536 billion total spent on K-12 education. I haven't reviewed any specific UHC, or even UHC-lite, proposal in any sort of depth, but again IMO, I think such a plan in the US would have to be federally funded at a far greater rate than that.

http://www2.ed.gov/about/overview/fed/10facts/index.html

 

[GStan]

GStan, how much control do you think the government would have?

How much do you think the UK government has over the NHS?

I don't want to ignore your legitimate questions, but I don't think I'm sufficiently informed about any proposed UHC plans in the US, or the existing NHS in the UK to give a meaningful answer. The best I could do right now is to say in answer to number 1, significantly more than it has right now, and to number 2, probably less than what I would assume.

 

[L.Y.S.]

Socialized health care is only scary because people don't take the time to find out about it. And when one does find out about it, they learn that the social benefits far outweigh the social deficits. Nothing is perfect, but it’s better than our purely unregulated market based model that current exists, that’s for sure.

 

[uk_dave]

Found this interesting, for anyone who wants some background on the NHS (though the site is a little...ugly!)....

http://www.nhshistory.com/

The genesis of the NHS stretched back into the 19th Century. Even then some believed that access to health care was part of the structure of a civilized society. Some municipalities, such as the London County Council, had the ambition to run hospitals as well as utilities. Hospital charities had been supported by the benevolent while socialists such as the Webbs argued for a state system or the insurance principle - pay in advance when well to provide for the care needed when sick.

We take the National Health Service for granted now, but it is only 60 years ago that health care was a luxury not everyone could afford. It is difficult for us to imagine what life was like without ‘free’ health care and the difference that the NHS made to people's lives. The same services were available the day after the creation of the NHS as the day before, no new hospitals were built nor hundreds of new doctors employed. But poor people who often previously went without medical treatment now had access to services, instead of relying instead on dubious and sometimes dangerous home remedies or the charity of doctors who gave their services free to their poorest patients.

A while ago there was a BBC programme about the 60th anniversary of the NHS and (I think) based on the book quoted from above.

ETA: Why do some people think it's not scary to be without a UHC system?

 

[The Greater Fool]

I believe the fear is that many people equate UHC and their local underfunded Urban Free Clinic... Long waits, crowds, overworked staff, etc.

While Medicare has it's issues, it would be a pretty good start. People are already able to pay for additions, which leaves free market in the mix.

UHC doesn't need to be achieved in one fell swoop. Right now, with the current employment issues, it would make sense to put anyone receiving Unemployment into the Medicare system. That alone would probably take a big chunk out of the number of uninsured folks.

 

[Flo]

Socialized health care is only scary because people don't take the time to find out about it. And when one does find out about it, they learn that the social benefits far outweigh the social deficits. Nothing is perfect, but it’s better than our purely unregulated market based model that current exists, that’s for sure.

Yes, but there remains that word "socialized", with all its creepy implications ...

 

[brodski]

Socialized health care is only scary because people don't take the time to find out about it. And when one does find out about it, they learn that the social benefits far outweigh the social deficits. Nothing is perfect, but it’s better than our purely unregulated market based model that current exists, that’s for sure.

You don't have a purely unregulated market. Many of the problems of the american system are due to the regulation/ Of course that regulation also prevents many other, perhaps worse, problems for arising.

 

[GreyArea]

Great post. I especially agree with the Calvinism and frontier myth parts.

Yet more food for thought on a subject I'm rather ignorant about, thanks!

Thank you/you're welcome, to both of you.

I'd always thought the "american way" thinking was the main stumbling block for UHC, and the reproductive health issues to be the bogeyman of a small clique of religious wackjobs. Seems that was an oversimplification.

Again, I don't think this is the main reason opponents of UHC are opposed. The leading reasons have already been discussed in this thread. But I think opposition to reproductive rights is a major reason for a few of them. About two percent, if this poll is any guide. (Not that PPACA was UHC, mind you.)

If people in this thread read any link, read the one above. The poll asked about sixteen reasons for opposing the Affordable Care Act, and reports how many people cited each of them as their main reason.

My understanding of U.S. public opinion is that majorities support access to both health care and abortion. It looks like it's moved closer to 50-50 recently, but may be strengthening again.

Support for birth control is stronger, including support for it being covered by health insurance plans. But some people here don't even want that available.

The minority that opposes abortion has been a very noisy and adamant one for a long time. Since the 1970's they have been very thorough at preventing a single penny of tax money going to abortion, and (of course) they are still not satisfied. Look up the "Hyde Amendment", as well as the repeated investigations of the organization Planned Parenthood, to mention two examples.

The conflict had an effect on Obama's health insurance legislation.

...the House — with surprising support from 64 Democrats — amended its health care bill to include language by Representative Bart Stupak, Democrat of Michigan, barring the use of federal subsidies for insurance plans that cover abortion. Lawmakers like Ms. Slaughter, who advocate for abortion rights, found themselves in the uncomfortable position of voting for the larger health bill even though the Stupak language was in it.

http://www.nytimes.com/2009/11/29/weekinreview/29stolberg.html?pagewanted=all

This snapshot of abortion laws in several countries may be of interest for comparing the U.S. to other countries, including Sweden:
http://pewforum.org/Abortion/Abortion-Laws-Around-the-World.aspx

My point about culture refers to background beliefs that (in my view) prejudice a person to oppose a general idea, and they'll later find specific reasons to oppose specific policy proposals.

 

[NoahFence]

Having read through a number of "libertarian" threads around here, I'm puzzled at the horror an vehemence some posters exhibit towards "socialised", i.e. tax-financed and/or state-managed health care.
Working in a prime example of a health care system that's not only tax financed but also under political control, I have some difficulties understanding the gut-wrenching horror some people seem to feel about providing health care this way. Could anyone kindly explain this viewpoint to me?
(For the record, I'm not in any way opposed to privately financed health care coexisting with a state-run system, which may seem obvious but is actually a rather controversial issue in Sweden).

It's a "slippery slope" argument.

In other words, stupid.

 

[leftysergeant]

The investor class is scared stupid that, if we find out that we do not need them to run health insurance, we might realize that we don't really need them for a lot of other infrastructural stuff, like the internet.

OMFG! THE SKY IS FALLING!

 

[Malcolm Kirkpatrick]

...(I)n the UK like in all the other UHCs we leave it up to medically trained people to do kidney transplants not government officials....

Ummmm....Here.

The calculations are complicated, but imagine that a cancer treatment costs $100,000 and that it extends the life of the average patient by four years. That means the cost of the treatment per year gained is $25,000.

Now imagine that for part of those four years the patient will be in pain and bedridden. NICE might figure the quality of that life at 50 percent of perfect health. Under NICE's formula, that would make the drug half as cost-effective. In other words, the result would be $50,000 per quality-adjusted year gained.

NICE has set a maximum that it will spend on a treatment: about $47,000 per quality-adjusted year gained.

NICE tends to assume, without always performing calculations, that most common treatments are cost effective -- including insulin for diabetes, cholesterol-lowering drugs for heart disease, and kidney transplants.

Instead, NICE analyzes only selected therapies, such as expensive new drugs that may extend life at the end of life. It has calculated that some of the more expensive drugs meant to slow the progression of Alzheimer's Disease and some cancers fall below the cost-effectiveness threshold. In such cases, NICE says, the NHS shouldn't pay for the drugs.

NICE chairman Michael Rawlins acknowledged that his agency's decisions deprive some patients of drugs that may extend their lives by several months or more.

"We do recognize that the end of life is a very special time," Rawlins said. "[It] allows people to attend weddings, see a grandchild born, seek forgivenesses."

But he argued that if Britain spends a lot of money at the end of life, "we're going to have to deprive other people of cost-effective care." Rawlins said that might mean spending less money at the beginning of life -- and might result in a higher infant mortality rate.

So government officials are involved. They are just out of sight.

...UHC systems consistently cost less per person than the USA system and provide at least equal if not better outcomes.

Depends on how one measures outcomes. Aggregate age-adjusted mortality figures provide only loose indicators of quality. If young people in country A spend their free time in the gym and library while yong people in country B spend their free time hang gliding and base jumping, "quality of (emergency room) care" will have little to do with the difference in age-adjusted longevity statistics for that age group.
Seems to me, between-country differences in "outcomes" for a given condition depend on differences in access to diagnostic services, use of diagnostic services, and effectiveness of diagnostic services and in differences in access to treatment, use of treatment, and effectiveness of treatment. Resources dedicated to one of these are not available for others (an MRI operator is not, in general, a surgeon). Further, resources available for medical care generally are not available for parks, schools, or baroque concerts. At some point, for most of us, someone will decide that an additional __X__ days of life are not worth the expense of an additional __$Y__ dollars in medical services. The argument between socialsists and free marketeers turns on who makes that decision (and under what incentive structure: spending your own money or someone else's; impoverishing one family immediately or the nation, eventually), not on whether that decision gets made.

There are no economies of scale in the medical care or health insurance industries that would justify a State role in these industries beyond the role that the State plays in the home appliance industry or the sporting goods industry: an initial assignment of title to resources and stable contract law. The "public goods" argument for tax subsidization of "health insurance" (or any other charity) contains a flaw: institutional oversight is a public good and the State itself is an institution. Therefore, oversight of State functions is a public good which the State itself cannot provide. State (government, generally) assumption of responsibility for the provision of the public good of charity transforms the free rider problem at the root of public goods analysis but does not eliminate it.

Solyndra. Detroit public schools.

...I'm puzzled at the horror an vehemence some posters exhibit towards "socialised", i.e. tax-financed and/or state-managed health care.
Working in a prime example of a health care system that's not only tax financed but also under political control, I have some difficulties understanding the gut-wrenching horror some people seem to feel about providing health care this way. Could anyone kindly explain this viewpoint to me?

I recommend
Friedman: Capitalism and Freedom.
Hayek: The Constitution of Liberty (Read the whole thing. One chapter specifically addresses State-funded health care).
Any econ reference on "moral hazard" and "deadweight loss due to taxation".

 

[Professor Yaffle]

NICE is funded by but independent of the government and mostly made up of medically qualified peopleand people who have run health boards etc. IE not politicians.