Socialised health care: Why is it scary?

[Mobyseven]

Mainly because of the absolute amazing levels of inefficiency our government shows in other services.

Maybe this is just a difference in American culture. I'm not being snarky or sly here, I mean it. Do other countries have some kind of uber-efficient post offices and DMV equivilents that make them more willing to trust their governments to get them a new kidney on time?

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.

A serious question: Why is it so common for people to make the point of comparison for government run institutions the DMV, and not, for instance, NIST, the CDC or the IRS (which all seem to run reasonably competently, even if the tax code in the US makes actually doing taxes an apparent nightmare)?

The DMV isn't even a federal organization, so far as I'm aware.

 

[JoeMorgue]

A serious question: Why is it so common for people to make the point of comparison for government run institutions the DMV, and not, for instance, NIST, the CDC or the IRS (which all seem to run reasonably competently, even if the tax code in the US makes actually doing taxes an apparent nightmare)?

Fair question.

For me at least the difference is that the CDC, IRS, NIST, etc aren't service based ("service based" isn't exactly the phrase I'm shooting, for but it's close. Personal based? Something in that ballpark if that makes any sense) industries. People don't have to personally deal with the IRS once a year and never with the CDC if they are lucky.

Again I'm seriously not trying to be snarky or sarcastic here, but I can't personally think of any government agency that people have to deal with on a routine basis that aren't generally seen as massively inefficient.

And to be fair perhaps it is simply just a matter of perception because of that, I'm certainly not discounting that possibility. The average person is going to have to deal with the DMV and the Post Office a lot more then they are going to have to deal with the CDC.

 

[uk_dave]

In that case, why not have privatised police service?

You could pick and choose which service to use, provided your insurance company agree. Might be useful for some crimes, who knows?

 

[Mobyseven]

Fair question.

For me at least the difference is that the CDC, IRS, NIST, etc aren't service based ("service based" isn't exactly the phrase I'm shooting, for but it's close. Personal based? Something in that ballpark if that makes any sense) industries. People don't have to personally deal with the IRS once a year and never with the CDC if they are lucky.

Again I'm seriously not trying to be snarky or sarcastic here, but I can't personally think of any government agency that people have to deal with on a routine basis that aren't generally seen as massively inefficient.

And to be fair perhaps it is simply just a matter of perception because of that, I'm certainly not discounting that possibility. The average person is going to have to deal with the DMV and the Post Office a lot more then they are going to have to deal with the CDC.

Who is in charge of the fire departments in the US? Or the police? (Though I admit to not knowing how competent those departments are perceived to be.)

 

[JoeMorgue]

Yes we can point at things the government can do efficiently.

But this argument works the other way as well.

Why not let the government run everything? Why not socialized food distribution, housing, vehicles?

I personally don't want government health care anymore then I want to live in government housing or drive a government mandated vehicle or eat government food. Personal freedom is very important to me.

That being said I am realistic. I understand how many people are suffering due to the inability to get health care. I'm many unpleasant things but heartless is not one of them.

If we are going to have socialized health care I don't think it's unreasonable of me to demand my money be used in the most efficient way possible.

 

[Sawbones79]

Mainly because of the absolute amazing levels of inefficiency our government shows in other services.

Maybe this is just a difference in American culture. I'm not being snarky or sly here, I mean it. Do other countries have some kind of uber-efficient post offices and DMV equivilents that make them more willing to trust their governments to get them a new kidney on time?

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.

You're not being snarky at all, and input like this is why I started the thread.
There's lots of beaurocracy in Swedish health care, to be sure, but basically none of it is handled at patient level. Low availability (except for very serious conditions) IS a problem around here, but since the propensity to seek medical aid seem to swell with increasing availability, that's not a clear-cut issue.

 

[ponderingturtle]

Mainly because of the absolute amazing levels of inefficiency our government shows in other services.

Maybe this is just a difference in American culture. I'm not being snarky or sly here, I mean it. Do other countries have some kind of uber-efficient post offices and DMV equivilents that make them more willing to trust their governments to get them a new kidney on time?

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.

That is why we need to take the military away from the incompetents right?

Any beurocratic system can be inefficient it is not at all unique to governments. And why do you think comparing the DMV to trying to get an insurance company to pay for something that it is the DMV that is the beurocratic nightmare?

 

[TragicMonkey]

Because human nature inclines more towards selfishness than to mathematics.

 

[FattyCatty]

Mainly because of the absolute amazing levels of inefficiency our government shows in other services.

It's not just the Federal government that can be inefficient. State and local governments are more than capable of great inefficiency, as are businesses. As ponderingturtle says, think of insurance companies (especially private health insurance companies) for an example of inefficiency.

Maybe this is just a difference in American culture. I'm not being snarky or sly here, I mean it. Do other countries have some kind of uber-efficient post offices and DMV equivilents that make them more willing to trust their governments to get them a new kidney on time?

Remember that the USPS contracts out a lot of its work to private companies (and it is not a typical government organization). DMVs are state-run, and many are examples of how the states can be incredibly inefficient.

I think that UHC would be wonderful for our country. Letting citizens go without health care and medicine is contrary to my idea of America. I haven't heard any arguments against UHC that have made sense to me.

Overall, I prefer that the Federal government be in charge of health care. I think that makes the most sense in terms of getting equal care from state to state. Anytime state's rights rears its ugly head, you can count on people getting screwed in some states.

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'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.

 

[Mobyseven]

Yes we can point at things the government can do efficiently.

But this argument works the other way as well.

Why not let the government run everything? Why not socialized food distribution, housing, vehicles?

Because the standards at which government can reasonably operate falls short of private industry in some (or many) cases.

Healthcare is one of those things where governments are able to do the job as well as private industry, and I'd wager it has something to do with the fact that the way people 'consume' healthcare is very different to how they consume other goods and services.

Keep in mind that some of the things you listed are managed on some levels by the government (at least in Australia): there is government housing, for example. It's not provided as a luxury, however, but as a necessary for people who are otherwise unable to find or afford private housing.

The key difference between the two things is that while government housing is of subpar quality (by necessity), healthcare is not. As Lionking has mentioned, there are things like longer wait times for elective surgery and private rooms; but no one is going to be refused cancer treatment because they couldn't afford it, or be sent into debt due to an emergency room visit.

It's all about what society is willing to prioritize; given the obvious advantages to having a healthy population the resistance to healthcare reform overall in the US always blows me away, let alone the reluctance to adopt any of the multitude of successfully implemented UHC plans from around the world.

 

[GStan]

I don't find it scary. Its not something I'm a proponent of, and not something I would personally choose to have the government do, but I definitely don't find it scary. There are enough examples of UHC working at least reasonably well around the world to alleviate fears that UHC in the US would signal the end of personal freedom and capitalism.

 

[3point14]

I think that the US find socialised health care scary because, as I'm coming to realise, the US simply can't afford it.

In my job I see medical invoices from all around the world, the difference in price and procedure between the US and everywhere else (and the line really is that stark) is amazing.

Social healthcare is attainable in most of the western world because it's financially viable.

Social healthcare simply doesn't seem to be obtainable in the US because of the incredibly inflated costs charged by the US healthcare industry.

As ever, I could be wrong.

 

[bonzombiekitty]

I really don't see what the problem is with a system that provides public benefits for a level of care, with stricter limits on treatment as you move down the severity level, while allowing individuals to purchase private insurance to go beyond that care.

My system would be something like this:

Emergency or immediate life threatening situation (i.e. need surgery NOW or else you'll die) - public insurance covers costs, no limits on where that care takes place or anything like that. It's an immediate, emergent issue to save your life, no arguing about costs or treatment there.

Longer term critical care - your life is not in immediate danger but still at risk, public insurance can still cover it, but some limits start getting put into place. For example, if you can be moved safely and there's a cheaper hospital with an available bed and similar levels of care can be given there, you can get moved there.

Serious care - your life is not really in danger, but it's an issue that does need to get addressed before it becomes a serious issue, especially one that limits your ability to work. Public insurance can cover it, but put limits as to where & how that care is given.

Basic primary care - Regular, routine things like doctor visits. Again, public insurance can pay but there can be stricter limits as to where and how that care is provided.

At all levels, except the top level (since it's paid for fully), an individual can opt to go their own route in care, which the individual pays for out of pocket and/or via private insurance, less a portion paid for by the public insurance.

In a scheme like that, you get the best of both worlds. A safety net system that will cover you if you do not have insurance and your own private insurance to cover better care. Sure, under strictly the public system, there may be strict limits on where and what care you can get, but it's better than having nothing at all.

 

[ponderingturtle]

I think that the US find socialised health care scary because, as I'm coming to realise, the US simply can't afford it.

In my job I see medical invoices from all around the world, the difference in price and procedure between the US and everywhere else (and the line really is that stark) is amazing.

Social healthcare is attainable in most of the western world because it's financially viable.

Social healthcare simply doesn't seem to be obtainable in the US because of the incredibly inflated costs charged by the US healthcare industry.

As ever, I could be wrong.

At least some of those costs are because of the beurocratic fighting between hospitals and insurance companies. And actually reducing our spending to levels of any reasonable country will hurt. You can not move 5% of the GDP and not hurt people.

 

[Sawbones79]

I think that the US find socialised health care scary because, as I'm coming to realise, the US simply can't afford it.

In my job I see medical invoices from all around the world, the difference in price and procedure between the US and everywhere else (and the line really is that stark) is amazing.

Social healthcare is attainable in most of the western world because it's financially viable.

Social healthcare simply doesn't seem to be obtainable in the US because of the incredibly inflated costs charged by the US healthcare industry.

As ever, I could be wrong.

This might be silly question, but would you consider the "expensive for what you get" health care you describe here to be caused by large profit margins, ineffectivity, excessive use of expensive treatments/diagnostics or perhaps something else entirely?
The reason I'm asking is that in my personal experience, the privately run (but still mainly tax-financed) clinics do seem to overuse extensive diagnostic tools such as MRIs and diagnostic arthroscopies. Perhaps this is due to high patient expectations, I don't know (the nasty, biased alternative is that such procedures carry large profit margins and small risks).

 

[BobTheCoward]

The problem is, essentially, death panels.

State run health care involves making decisions on what services can be covered. If the system is anyway fair, it is a panel of experts. You and I see these as good things. If they paid for every service without regard to efficacy, a lot of people will die from the lack of money going around. However, people do die from not receiving services that are not paid by state health care.

Thus, state run health care takes your money, pays for services you disagree, and when you reach a very personal decision about the best course four your health care, the state will not pay for it. Also, they keep your money and make you keep on paying for it. In a private system, if you disagree with the services, you can quit, and don't have to keep paying.

Unlike other federal government services conservatives hate (IRS, EPA, NLRB), this one is far more intrusive. It is the federal government dictating very personal decisions that affect your family (healthcare), and then dictating how much you will pay for it.

 

[Sawbones79]

The problem is, essentially, death panels.

State run health care involves making decisions on what services can be covered. If the system is anyway fair, it is a panel of experts. You and I see these as good things. If they paid for every service without regard to efficacy, a lot of people will die from the lack of money going around. However, people do die from not receiving services that are not paid by state health care.

Thus, state run health care takes your money, pays for services you disagree, and when you reach a very personal decision about the best course four your health care, the state will not pay for it. Also, they keep your money and make you keep on paying for it. In a private system, if you disagree with the services, you can quit, and don't have to keep paying.

Unlike other federal government services conservatives hate (IRS, EPA, NLRB), this one is far more intrusive. It is the federal government dictating very personal decisions that affect your family (healthcare), and then dictating how much you will pay for it.

What vital treatments can not be provided by state run health care? In my experience, those who get the short end of the stick in our system tend to be those who can achieve a small but noticable improvement from new and very costly drugs, such as biological anti-rheumatic medications. In some parts of Sweden, such medications are not used in general health care due to the high cost involved, with the result that patients are not optimized in their treatments.
However, I've yet to see a patient die prematurely due to treatment being whitheld for economic reasons.

 

[Bikewer]

Some portion of the inflated costs are due to the necessity of providing emergency care for the uninsured.
Years ago, 60 minutes did a segment on a fellow who was shocked at the bill (paid by his insurance) for a routine gall-bladder removal.
He demanded, and got, an itemized bill. He then proceeded to wrangle with the hospital over each item.
Finally, the hospital admitted that much of the bill was overcharged so that they could provide service to the uninsured.
I understand that a typical shooting victim will accumulate hundreds of thousands of dollars worth of emergency treatment and intensive-care.
In the case of common inner-city "gang" shootings, these bills are just a write-off.

We all know that the emergency room is the defacto primary-care facility for the indigent and the uninsured. By law, ERs must provide such care.

 

[bonzombiekitty]

Perhaps this is due to high patient expectations, I don't know (the nasty, biased alternative is that such procedures carry large profit margins and small risks).

That's part of it. There's a misconception by patients that more tests == better care. However, there's no indication that is the case. In fact, it looks like more tests => worse care.

We can look at the blood test for prostate cancer as an example. The blood test is cheap, relatively painless, and accurate. Except it's TOO accurate. Even if the test comes back as positive, many times the cancer is basically benign - the patient will die of natural causes well before the cancer would be an issue. So a patient who tests positive ends up going under a needless set of treatments, which can have some severe side effects that outweigh the benefits of the cases that were caught and would have been deadly. More and more studies are saying doctors should NOT do this test unless there's other risk factors present. However, patients will insist on it and/or doctors will suggest the test anyways out of fear of being sued if the person should have malignant cancer but didn't get tested.

Same thing happened recently when it came to mammograms. Recently a study was published that said that it's not a good idea to do mammograms so early and often without other risk factors being present (for reasons similar to the prostate cancer test). There was a HUGE uproar over it.

 

[Sawbones79]

That's part of it. There's a misconception by patients that more tests == better care. However, there's no indication that is the case. In fact, it looks like more tests => worse care.

We can look at the blood test for prostate cancer as an example. The blood test is cheap, relatively painless, and accurate. Except it's TOO accurate. Even if the test comes back as positive, many times the cancer is basically benign - the patient will die of natural causes well before the cancer would be an issue. So a patient who tests positive ends up going under a needless set of treatments, which can have some severe side effects that outweigh the benefits of the cases that were caught and would have been deadly. More and more studies are saying doctors should NOT do this test unless there's other risk factors present. However, patients will insist on it and/or doctors will suggest the test anyways out of fear of being sued if the person should have malignant cancer but didn't get tested.

Same thing happened recently when it came to mammograms. Recently a study was published that said that it's not a good idea to do mammograms so early and often without other risk factors being present (for reasons similar to the prostate cancer test). There was a HUGE uproar over it.

Great example on the PSA, and an example where expert panels are highly useful. A couple of years ago, PSA was closed to being used as a screening procedure, but should now only be used as a diagnostic tool (combined with proper rectal palpation) when there's heredity or clinical symtoms that indicate a possible prostate tumour.