Socialised health care: Why is it scary?

[brodski]

Bobthecoward, why are government death panels more scary than the private death panels which already exist? Assuming that socialized medicine does not outlaw private provision, the only differnce wrt to death pannels will be their increased accountability under the public option.

 

[3point14]

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).

My insight isn't really that great, I just see the numbers, I don't really have access to the why of it.

I would note that (practially) every part of the medical costs in the US are invoiced separately, so there's an invoice for the ambulance, one for the consultation, one for the MRI, one for the room and nursing, one for the prescription costs etc. Each of these invoices will have their own associated admin costs and this would drive up costs compared to other countries that seem to issue one or two invoices to cover the whole of the costs.

In addition, doctors in the US seem to earn an awful lot more than doctors elsewhere. Perhaps this is due to the way that the training is structured in the US. anyone that's had to pay a six or seven (guessing) figure sum to become a physician is going to charge what they can (and with the AMA limiting the number of doctors they actually train, this can be a lot). In other countries where the training of doctors is more subsidised by the state the physicians are (probably) in less debt after training and (perhaps) feel a little happier earning a little less as their training has been paid for by the state.

As ever, mostly guessing.

 

[uk_dave]

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 high costs are due to:

1. Hospitals and Doctors have to market themselves. This costs money.

2. Litigation is rife because so many people are without adequate cover or face co-payments, so that suing a doctor or hospital for any perceived wrongdoing is attractive and there are plenty of ambulance chasing lawyers out there who will facilitate this.

3. Non payment by 'emergency' patients. Someone has to pay for those expensive doctors, drugs and facilities. If a large proportion of the population has no alternative but to go bankrupt when faced with massive bills then those costs are going to be passed on to others, such as insurance companies.

4. Expectations of the insured - If you can actually afford good insurance then you become more demanding. You're paying for this, you'll damn well get what you want!! Got a cold? I want antibiotics!! I want a private room! I want treatments even if their effectiveness may not be proven in my case! And because the insurance companies market themselves to the consumers patients as being the ones who will happily pay out for all your medical needs, then that is how they are to be judged by their potential customers.

And, of course, it's easier to say 'yes' to the demands of your insured customers when you prevent a large proportion of uninsured from even being able to ask.

UHC may not be perfect, as the current scandal regarding the treatment of the elderly shows in the UK. But, at least the government has the right to make spot checks and can demand improvement.

And, even better, you hold the government responsible. I can fully understand why politicians might not want UHC, and it has nothing to do with economics. They don't want you to kick them out of office after four years if they **** it up.

 

[Toontown]

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.

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.

 

[Mobyseven]

In a private system, if you disagree with the services, you can quit, and don't have to keep paying.

I must say I find this statement...implausible at best. Sure, you can technically stop paying your private health insurance premiums: but that just means you won't have health insurance anymore. You can swap insurers, but if you've already been diagnosed or have started treatment I find it unbelievable that an insurer would be willing to cover you for that before you've even started paying premiums to them.

 

[Sawbones79]

The high costs are due to:

1. Hospitals and Doctors have to market themselves. This costs money.

2. Litigation is rife because so many people are without adequate cover or face co-payments, so that suing a doctor or hospital for any perceived wrongdoing is attractive and there are plenty of ambulance chasing lawyers out there who will facilitate this.

3. Non payment by 'emergency' patients. Someone has to pay for those expensive doctors, drugs and facilities. If a large proportion of the population has no alternative but to go bankrupt when faced with massive bills then those costs are going to be passed on to others, such as insurance companies.

4. Expectations of the insured - If you can actually afford good insurance then you become more demanding. You're paying for this, you'll damn well get what you want!! Got a cold? I want antibiotics!! I want a private room! I want treatments even if their effectiveness may not be proven in my case! And because the insurance companies market themselves to the consumers patients as being the ones who will happily pay out for all your medical needs, then that is how they are to be judged by their potential customers.

And, of course, it's easier to say 'yes' to the demands of your insured customers when you prevent a large proportion of uninsured from even being able to ask.

UHC may not be perfect, as the current scandal regarding the treatment of the elderly shows in the UK. But, at least the government has the right to make spot checks and can demand improvement.

And, even better, you hold the government responsible. I can fully understand why politicians might not want UHC, and it has nothing to do with economics. They don't want you to kick them out of office after four years if they **** it up.

Lots of points there I hadn't thought about. Of course, with socialized health care comes the problem of different hospitals considering different procedures to be cost-effective. For example, my clinic doesn't do hip resurfacing treatments due to large early-revision rates and small added benefits compared to standard hip replacements, but how do you explain to a patient why his buddy in Stockholm got an operation we won't perform, when they pay the same level of health care tax?

 

[Alferd_Packer]

It's really very simple.

UHC means that sinners won't have to pay for their sins.

under UHC, you can be treated for an STD with no financial consequences.

This will lead to more premaritial sex.

{/sarcasm}

 

[BobTheCoward]

Bobthecoward, why are government death panels more scary than the private death panels which already exist? Assuming that socialized medicine does not outlaw private provision, the only differnce wrt to death pannels will be their increased accountability under the public option.

If you can't answer your own question, you probably don't understand conservatism (which I am not one of, but I understand their perception), or libertarianism ( if I need a label, that best matches).

You place more weight on the social contract and efficiency. They place more weight on the ethical belief that health choices should be handled on a per-family basis. The advantage of a private system, is that if you disagree with the firm's decision, you can elect not to use their service and not pay. If you disagree with everyone's decisions, you can elect not to pay for any healthcare at all.

At this point, you are probably thinking, "That is insane! You are worse off! How is that even better!" Well, there must be something that you would accept worse outcomes over ethical reasons. Take that weighting of your values, and shift it to a conservative weighting. You will be as anti-government healthcare as them.

 

[uk_dave]

Do those conservative beliefs extend to the ambulance service?

"I don't agree with the colour of them there ambulances (ambulanci?) so I'm not going to contribute to them. What? Well I don't need an ambulance right now so......."

 

[BobTheCoward]

I must say I find this statement...implausible at best.

Doesn't matter. It is a question of whether on this issue values are more important than outcomes.

In this case, the ability to make this decision for one's family is more important than the actual health outcome. In extreme versions you see it in the prayer for wealth or prayer for health religious conservatism.

There must be some issue where you place values over outcomes? Have you never had a, "give me liberty, or give me death," moment?

 

[BobTheCoward]

Do those conservative beliefs extend to the ambulance service?

"I don't agree with the colour of them there ambulances (ambulanci?) so I'm not going to contribute to them. What? Well I don't need an ambulance right now so......."

Many ambulances in America are ran by private companies. I guess it already has.

 

[uk_dave]

Many ambulances in America are ran by private companies. I guess it already has.

Interesting. How do they make the money with which to function?

Ambulance services operating on a private/for profit basis have a long history in the U.S. Often, particularly in smaller communities, ambulance service was seen by the community as a lower priority than police or fire services, and certainly nothing that should require public funding. Until the professionalization of emergency medical services in the early 1970s, one of the most common providers of ambulance service in the United States was a community's local funeral home.[7] This occurred essentially by default, as hearses were the only vehicles at the time capable of transporting a person lying down. Funeral home ambulance operations were sometimes supplemented by 'mom and pop' operations, which weren't affiliated with funeral homes but rather operated on much the same basis as a taxi service. There were no national standards for ambulance services and staff generally had little, if any, medical training or equipment, leading to a high pre-hospital mortality rate.[citation needed] Such companies continue to operate this way in some locations, providing non-emergency transport services, fee-for-service emergency service,[8] or contracted emergency ambulance service to municipalities, as in the public utility model.[9] During the late 1970s and early 1980s, more than 200 private ambulance companies in the U.S. were gradually merged into large regional companies, some of which continue to operate today.[10] As this trend continued, the result was a few remaining private companies, a handful of regional companies, and two very large multinational companies which currently dominate the entire industry.[11][12] These services continue to operate in some parts of the U.S., either on a fee-for-service basis to the patient, or by means of contracts with local municipalities. Such contracts usually result in a fee-for-service operation which is funded by the municipality on a supplementary basis, in exchange for formal guarantees of adequate performance on such issues as staffing, skill sets, resources available, and response times.[13]

http://en.wikipedia.org/wiki/Emergency_medical_services_in_the_United_States

 

[Toontown]

Doesn't matter. It is a question of whether on this issue values are more important than outcomes.

In this case, the ability to make this decision for one's family is more important than the actual health outcome. In extreme versions you see it in the prayer for wealth or prayer for health religious conservatism.

There must be some issue where you place values over outcomes? Have you never had a, "give me liberty, or give me death," moment?

Yeah, I just had one.

"Give me exorbitantly priced health insurance, or give me death. And force me by law to pay for it. Or give me death."

 

[3point14]

The advantage of a private system, is that if you disagree with the firm's decision, you can elect not to use their service and not pay. If you disagree with everyone's decisions, you can elect not to pay for any healthcare at all.

(SNIPPED A BIT)

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.

 

[BobTheCoward]

Interesting. How do they make the money with which to function?



http://en.wikipedia.org/wiki/Emergency_medical_services_in_the_United_States

I knew someone who drove one out here. They charge the insurers (read: Medicaid) for everything. They even charge by the towel. He thought his company was totally evil.

 

[BobTheCoward]

(SNIPPED A BIT)

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.

You say trouble, they say freedom has consequences. If you read between the lines, they are also saying, "Feature, not bug."

 

[3point14]

You say trouble, they say freedom has consequences. If you read between the lines, they are also saying, "Feature, not bug."

If that which a customer expects to be covered isn't then that's not freedom. That's either mis-selling, sharp practice or incompetence on the part of the customer.

 

[uk_dave]

If that which a customer expects to be covered isn't then that's not freedom. That's either mis-selling, sharp practice or incompetence on the part of the customer.

Companies don't mis-sell things. Especially not financial things like insurance, pensions or loans.

oh........


....I'll get me coat.

 

[GStan]

It's really very simple.

UHC means that sinners won't have to pay for their sins.

under UHC, you can be treated for an STD with no financial consequences.

This will lead to more premaritial sex.

{/sarcasm}

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."?

 

[Darat]

...snip...

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.

Again UHCs throughout the world are much more efficient than the USA in regards to dollars spent in the healthcare industry per head so if what you are interested in is efficiency (in regards to dollar spent per head per outcome) then you should want a UHC.

You also seem to be under a false impression of what a UHC means, there are models of working UHC systems that are entirely run by private companies, the government just provides the money, there are others like the UK in which it is a combination of private companies and public services. Pretty much every country has a different way of providing UHC.