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Just wanted to voice a quick thought I have on health care in the US and hopefully get some feedback from Americans who are more familiar with the topic than me.
It doesn't look like a good public health care plan will be able to pass congress. Single payer had to be thrown out the window early and now it looks like even a public option will have trouble passing. Whatever compromise that ends up passing sounds like a tiny modification of the competently broken system instead of a needed fix from the ground up.
A lot of the protests in the public come from teabaggers from the southern states and a lot of the protests from within congress come from republicans and libertarians, some of who think that government run health care would be unconstitutional and that it's a state-level issue.
Why don't the democrats and progressives in the US just go on that line too? Let each state pay for their own health care and let those states who want to implement public health care do so. The blue states can cut their costs by half and get full coverage and the teabaggers can do as they please.
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If the state were to pay for their own health care, who would pay for it? More taxes? Middle class?
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On September 30 2009 09:29 TheFeared wrote:
If the state were to pay for their own health care, who would pay for it? More taxes? Middle class?
I guess either the same way the plan currently going through congress is planned to be funded or let the states decide for themselves how they are going to fund it. Maybe the same way medicare/medicaid is already funded or just raised taxes for the already filthy rich.
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I don't like the idea of richer people paying much more than less rich people. I mean of course it depends on how you got your wealth but if you worked hard for it I don't think you want to fork it over just like that.
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On September 30 2009 09:50 Foucault wrote:
I don't like the idea of richer people paying much more than less rich people. I mean of course it depends on how you got your wealth but if you worked hard for it I don't think you want to fork it over just like that.
I don't see how this is relevant to my question or the topic.
+ Show Spoiler + I would however argue that capitalism itself and its inherent distribution of wealth is as much a construct as any form of redistribution added on top of it. I don't think someone is entitled to the money they earn before taxes just because capitalism has originally distributed it that way. Wealth only exists within society and is only created by cooperation. Unless you were born in the forest alone and never interacted with another person, you owe your success partly to society. Also I don't see how a system that gives the richest 1% of the population a majority of the wealth can be considered good for society or efficient in any way if not combined with something else.
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States all (well most, I think California and a couple others might be an exception?) have to balance their budgets each year. They can't deficit spend. Considering that the states generally have very little to do with health care currently aside from implementing federal programs with federal money (again, a couple exceptions - Vermont has a pretty good program, from what I hear), they basically have no money to start with to get state run health care going. Many are going through deep cuts to current obligations like education and such right now due to the recession. Aside from large tax increases to fund an entirely new program, which is politically impossible even in most blue states, there's no money to do it at the state level. The Federal government could in theory do some deficit spending to get the program started and expect to come out cost neutral in the long run based on reduced costs to Medicare/Medicaid, but that seems not to have enough political support.
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On September 30 2009 10:16 Macavenger wrote:
States all (well most, I think California and a couple others might be an exception?) have to balance their budgets each year. They can't deficit spend. Considering that the states generally have very little to do with health care currently aside from implementing federal programs with federal money (again, a couple exceptions - Vermont has a pretty good program, from what I hear), they basically have no money to start with to get state run health care going. Many are going through deep cuts to current obligations like education and such right now due to the recession. Aside from large tax increases to fund an entirely new program, which is politically impossible even in most blue states, there's no money to do it at the state level. The Federal government could in theory do some deficit spending to get the program started and expect to come out cost neutral in the long run based on reduced costs to Medicare/Medicaid, but that seems not to have enough political support.
Thank you. I asked the same question on Reddit and got similar answers there. Seems kind of dishonest from the people of the right who think it's unconstitutional and should be be run on a state level if any when the states don't have the power to effectively carry out such a plan.
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Here are a couple of the answers I got on Reddit:
I can't speak for every state, but I know my own - New Hampshire - isn't exactly doing great in terms of the budget. And since states don't really have the same ability that the federal government has to borrow money shamelessly, it is more of a direct concern.
I don't know, maybe you are right. If one state started offering its citizens health care, maybe others would follow. But until the issue is dealt with on a national scale, the health care industry in our country isn't going to change.
Its an excellent question and for every minute I spend thinking about it, I change my mind about it. Maybe another redditor will have a more enlightened view on the issue than I.
Well, there are a couple problems in execution of that idea. Although I do like the concept myself. First of all the States to not have the power to coin money so either the states would need to raise taxes (most states require voter approval to raise taxes so good luck with that...California anyone?) or the states would get the money from the federal government which give the federal government all the leverage it needs to tell the states exactly how to operate their health care systems. The later is the exact reason why the drinking age is 21 in almost every state because the federal government threatened to take away tons of highway funding if the "recommended" drinking age wasn't followed.
It seems like a good idea to have states compete by choosing to offer, or not offer universal health insurance, but it's not as easy as you'd think. I live in Kentucky, which tends to be near the bottom whenever measurements of education, health, employment, etc, are made. But, the state and local governments here have done very well for their citizens over the last couple of decades by attracting two major employers to the state - Toyota makes most of the US Camrys, Venzas and Avalons here, and UPS uses Louisville as their air hub. Both businesses have had a large spin-out effect, where related businesses thrive nearby. In both cases local govts here had to compete with other states to entice these businesses to locate here.
But, here's the key difference WRT healthcare - to entice employers to come here, the state govt largely just had to build some roads and runways, and also forgo some future tax revenue as an incentive. To cover the immediate cost of subsidizing health insurance for low income people who lack it, state govts would be required to spend a lot of cash up front, which they routinely lack, as someone else noted.
Maybe the biggest difference between any spending by a state govt vs the federal govt is this - only the latter can print its own currency, and thereby manipulate its value. The US federal budget has almost always been run with a deficit, while most state constitutions require a balanced budget, every year. So, the feds can keep printing money to pay for new spending, at least until China &co stops buying our debt. To cover a new health insurance program, the state governments would have to make large, offsetting budget cuts elsewhere, or have big tax increases. The former are already happening due to the weak economy, and the latter are political suicide.
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My question is why nobody considers a completely private system. Perhaps because this would involve fixing the judicial system such that everyone and their mother isn't filing lawsuits and especially medical/malpractice lawsuits all the time. Hopefully it would also involve a complete overhaul of the ridiculous medical school and licensing system in this country. There is a lot of potential wealth (read: jobs/opportunities) that gets completely stifled by the ridiculous bureaucracy of the government/FDA/hospitals/insurance companies. The end result is that the consumer--those who need healthcare (EVERYONE!)--loses, and loses badly.
I'm in agreement that the system is horrendous and needs to be changed, I simply think the president wants to change it in the wrong direction.
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On September 30 2009 10:26 Ingenol wrote:
My question is why nobody considers a completely private system. Perhaps because this would involve fixing the judicial system such that everyone and their mother isn't filing lawsuits and especially medical/malpractice lawsuits all the time. Hopefully it would also involve a complete overhaul of the ridiculous medical school and licensing system in this country. There is a lot of potential wealth (read: jobs/opportunities) that gets completely stifled by the ridiculous bureaucracy of the government/FDA/hospitals/insurance companies. The end result is that the consumer--those who need healthcare (EVERYONE!)--loses, and loses badly.
I'm in agreement that the system is horrendous and needs to be changed, I simply think the president wants to change it in the wrong direction.
Some people do want a completely private system. However, it's ingrained into (world) culture as a whole at this point to look to the government to answer questions of "basic need" (farm subsidies, welfare programs, etc.) and it's always bit hard to challenge the establishment.
Secondarily, it's been sort of demonstrated that there is no such thing as a completely private system, due to the lobbying system. I don't think anyone likes lobbyists (although most of us tend to demonize "the other guys" and ignore the ones who are working "for us" atm), but they're pretty much as old as government. Way back in ancient Rome the Senate gave up fighting and officially appointed some lobbyists to work for "the people" (they were called tribunes), which was sort of a good idea because Roman peasants got the worst deal ever, but after a few years they realized they could buy off the tribunes who would then buy off voters with parties and free bread and stuff. After a while you got Roman big business buying lobbyists and getting them appointed to government positions too... sound familiar?
Finally, many people are worried that a deregulated medical industry (and to completely privatize it it would have to be essentially deregulated, otherwise it's just outsourcing it under government rules) would get even worse than what we've currently got. I'm not sure of the truth of this myself, but given what we've seen in the financial industry, I think it's wise to be cautious.
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As an American who now lives in a country with socialized medic... I gotta say, you are all dumb as fuck. Seriously, Americans are a few notches below retard when it comes to how easily they scare with words like "communism" etc.
Either way, the level of care, cost of care, etc here is fantastic. Yeah, I pay a little more in taxes for it. But I'd pay more in the American system (as it currently is) with vastly more stress for it.
I think the point Americans simply aren't getting is that it boils down to two choices.
1. Do you want a private, publicly traded, for-profit running your healthcare?
OR
2. Yes, the government is bloated and fucking stupid, potentially inept event; however, as elected officials worried about public opinion do you want them running your healthcare?
Sure both choices are sweaty balls, but choice 1 is profiters who will cut whatever is needed and rob you in the name of paying a dividend to their share holders, while choice 2 at least doesn't have ill-will when they fail.
I'll take failing due to stupidity over purposely doing harm to score a bonus paycheck.
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Some version of what you propose has been tried already in a few states. Most recently we have the example of Massachusetts. To give you a flavor of the plan and how it turned out see these articles from the Boston Globe:
April 4th, 2006.
Every Massachusetts resident would be required to have health insurance on July 1, 2007, under a landmark healthcare bill the Legislature could send to Governor Mitt Romney as early as today.
The bill also creates an entity to administer the new subsidized healthcare program and to help businesses and individuals find suitable plans.
As for the requirement on individuals, those who don't get coverage would first lose their personal income tax exemption. Eventually, they could face a yearly fee to the state equal to half of the lowest-cost available insurance plan.
''No other state in the country has advanced healthcare to this degree both in coverage and quality, and it's something that I think every member of the Legislature will be able to be very proud of," said state Senator Richard T. Moore, an Uxbridge Democrat and lead Senate negotiator.
Three years it seems Mass is scraping the "most advanced" system in the country: July 17th, 2009.
The 10-member commission, which includes key legislators and members of Governor Deval Patrick's administration, voted unanimously to largely scrap the current system, in which insurers typically pay doctors and hospitals a negotiated fee for each individual procedure or visit. That arrangement is widely seen as leading to unneeded tests and procedures.
Instead, the group wants private insurers and the state and federal Medicaid program to pay providers a set payment for each patient that covers all that person's care for an entire year and to make the radical shift within five years. Providers would have to work within a predetermined budget, forcing them to better coordinate patients' care, which could improve quality and reduce costs.
Sadly, it seems fair to say the plan now looks like a failure. Worse yet, in many ways it was the blueprint for the plan proposed in Congress, so its implications are huge. More people should pay attention to this story.
While we're on health care, see these awesome charts with international comparisons of spending per capita in the past 15 years: click me!!!
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Profit, Healthcare, Quality.
Pick two.
I gotta say, you are all dumb as fuck.
If the people could vote for health care like they vote for a president - it would have passed long ago. There are large pockets of stupid, but the main obstacle is Congress.
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the main problem with public healthcare in the US is setting it up. the resources required to do so would outweigh the benefit gained.
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I'm all for universal healthcare in the U.S. It works great in Europe and Canada, and they seem to be quite content even though they have large taxes.
The U.S. is the only western country that still does not have universal healthcare. Let that sink in.
EDIT: Think of all the other socialized things in the States. We have the mail service, public schools, and libraries. I'm sure you could think up a few more if you thought about it. Just my two cents.
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Might make it hard to travel between states.
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oh hi did somebody mention anything about how this topic has been beaten to death already?
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America sucks. We're happy to deficit spend on getting our troops killed and on invading other countries and on building big killing machines and on renditions and secret prisons, but we can't deficit spend to keep everyone healthy. Let's face it, our politicians and obscenely wealthy overlords stand to lose entirely too much if the scam that is the US health insurance medical-industrial complex is dismantled. Fuck it let's move to Canada.
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The US can just borrow more money from abroad to finance it. What´s the problem?
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I am a college student working part time and thus, I cannot afford health insurance.
Am I doing something wrong? Would it be 'bad' for the government to provide me with basic health insurance?
Also, its mostly the right wing nuts who are delaying progress. Watch the live political channels sometime and pay special attention to how Republicans constantly throw wrenches that have nothing to do with healthcare to slow progress down. People call Americans 'idiots', but its really the minority who are messing it up for everyone.
Its really depressing to know that my health and even life are at risk because big companies care more about money than the service they provide.
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On September 30 2009 10:09 DrainX wrote:Show nested quote +On September 30 2009 09:50 Foucault wrote:
I don't like the idea of richer people paying much more than less rich people. I mean of course it depends on how you got your wealth but if you worked hard for it I don't think you want to fork it over just like that.
I don't see how this is relevant to my question or the topic. + Show Spoiler + I would however argue that capitalism itself and its inherent distribution of wealth is as much a construct as any form of redistribution added on top of it. I don't think someone is entitled to the money they earn before taxes just because capitalism has originally distributed it that way. Wealth only exists within society and is only created by cooperation. Unless you were born in the forest alone and never interacted with another person, you owe your success partly to society. Also I don't see how a system that gives the richest 1% of the population a majority of the wealth can be considered good for society or efficient in any way if not combined with something else.
I'm not saying capitalism is good and I was arguing based on the fact that the western world has a capitalistic system. The notion of owing your success to society is an argument that largely depends on which political ideas you think should be dominant in society. Surely everyone depends on society in many ways but you could also say that socialism is a political construct and exactly how much you owe or should owe to society is very relative. Some of the richest people in america also own huge companies, which in turn employ many people, so just looking at individual wealth doesn't necessarily give you a valid picture of how effective a society is.
I'm not saying capitalism is the best system but I'm taking a very realist approach to this. And I definately prefer capitalism to a socialist, collectivistic society where the the interest of the group replaces individualism.
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Say no to public healthcare please, it won't solve any problems at all.
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I really like your elaborate reason to say no to public healthcare, Kiarip. It was inspiring and definitely turned around my opinion on what I think of it. In fact, I haven't been in touch with it too much, but thanks to you I really know what's going on and why one shouldn't support it.
What I hear on the media doesn't sound too bad in my book, but then again I don't know enough really do have a true opinion on it.
It is surprising tho, it seems like every American gets clairaudient as soon as someone drops the S-bomb, it's like moving a lever in their brains. And its even more surprising that Americans still fear the socialist system, even though it is proven to be not functional (or at least not not the way people approached it until now).
However it looks to me that the real issue is abandoned and parties fight with the fear and hope of Americans.
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^ Dude. What is it supposed to accomplish?
Give Healthcare to everyone by raising the taxes? How is that good?
Obviously, most of it is going to come out of the pockets of rich, and these are in fact the steps that lead to the dreaded "socioeconomic equality," but forget about that I'll argue that some other day. It's just the type of stuff that drives all capitalist investors overseas, which is just what we need in these economic times right?
How about instead of trying to bandage the problem out the pockets of the rich, we actually look at the real problem here. Why is insurance so expensive? Are insurance companies making huge profits? No they're not, if they were they could make even more money by cutting the rates, and insuring a huge part of America which is currently uninsured for the most part.
The real problem is the civil court system, and it needs to be reworked. That's where all these ridiculously high costs of healthcare come from. If a doctor makes a mistake he gets sued for money than he could possibly have (hence the extremely high malpractice insurance) instead of a regulated un-inflated compensation/fine/license suspension/jail sentence (like it should be.) Same goes for the pharmaceutical system. It's broken, because a HUGE COMPANY can be sued BROKE by a handful of cases which should have ended in a regulated compensation, and punishment for individuals that were at fault.
What the hell does public healthcare solve? It just plunges the nation into a deeper national debt, feeds the useless bureaucracy, and reduces the already abysmal bargaining power that people have in this matter.
edit:
I'm generally really tame and impartial on such political issues, mainly due to being a total pessimist about these things, but it's pretty obvious that the Libertarians have the more or less correct stand on this issue.
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On October 03 2009 13:12 Kiarip wrote:
Obviously, most of it is going to come out of the pockets of rich, and these are in fact the steps that lead to the dreaded "socioeconomic equality," but forget about that I'll argue that some other day. It's just the type of stuff that drives all capitalist investors overseas, which is just what we need in these economic times right?
It's also coming out of the pockets of our current children and our future children. Our current children because the primary benefactors of a universal health care system will be the retiring baby boomer generation...paid by taxes of working individuals. Future children because every public sector dollar spent is at the expense of a private sector dollar; a public sector dollar will always be more inefficient versus a dollar which would otherwise be used to grow the economy better.
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On September 30 2009 09:29 TheFeared wrote:
If the state were to pay for their own health care, who would pay for it? More taxes? Middle class?
The US has more people uninsured for healthcare than Canada does people (living here).
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On October 03 2009 13:12 Kiarip wrote:
The real problem is the civil court system, and it needs to be reworked. That's where all these ridiculously high costs of healthcare come from. If a doctor makes a mistake he gets sued for money than he could possibly have (hence the extremely high malpractice insurance) instead of a regulated un-inflated compensation/fine/license suspension/jail sentence (like it should be.) Same goes for the pharmaceutical system. It's broken, because a HUGE COMPANY can be sued BROKE by a handful of cases which should have ended in a regulated compensation, and punishment for individuals that were at fault.
You are completely wrong. Every estimate of the total costs associated with malpractice in terms of total health care expenditure I've seen has fallen under 2%.
I'm tired of all this libertarian, free-market wankery - last I checked, Taiwan's public health plan had the lowest overhead costs of any system, and it's government run. Private insurance has higher administrative costs than public options. You can keep repeating your stupid axioms, but empirical evidence runs contrary to your assertions. I got news for you: Any large organization is subject to bureaucratic inefficiencies. This includes private health insurance companies.
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On October 03 2009 19:51 Underwhelmed wrote:Show nested quote +On October 03 2009 13:12 Kiarip wrote:
The real problem is the civil court system, and it needs to be reworked. That's where all these ridiculously high costs of healthcare come from. If a doctor makes a mistake he gets sued for money than he could possibly have (hence the extremely high malpractice insurance) instead of a regulated un-inflated compensation/fine/license suspension/jail sentence (like it should be.) Same goes for the pharmaceutical system. It's broken, because a HUGE COMPANY can be sued BROKE by a handful of cases which should have ended in a regulated compensation, and punishment for individuals that were at fault.
You are completely wrong. Every estimate of the total costs associated with malpractice in terms of total health care expenditure I've seen has fallen under 2%. I'm tired of all this libertarian, free-market wankery - last I checked, Taiwan's public health plan had the lowest overhead costs of any system, and it's government run. Private insurance has higher administrative costs than public options. You can keep repeating your stupid axioms, but empirical evidence runs contrary to your assertions. I got news for you: Any large organization is subject to bureaucratic inefficiencies. This includes private health insurance companies.
And a large government such as the US one will always have moer bureaucratic inefficiencies than a a large organization, what's your point?
As for the malpractice expenditure, it may be directly responsible for only 2% of the cost, but every other expense of pharmaceutical companies is related to the company's risk due to the risk of failure of its products, and a large portion of that is tied to the legal fees, and compensations involved in the civil court cases.
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I'm all for universal healthcare in the U.S. It works great in Europe and Canada, and they seem to be quite content even though they have large taxes.
It works great? How do you think limited medical resources get allocated amongst the population when it's free at the point of consumption? What sort of incentives do you think this creates towards medical staff when it comes to patient treatment? The government budget allocated towards nation healthcare is not unlimited. And no, many people are not content with the large taxes, which is why wealth management institutions are so popular and many of the rich like to leave the country.
My question is why nobody considers a completely private system. Perhaps because this would involve fixing the judicial system such that everyone and their mother isn't filing lawsuits and especially medical/malpractice lawsuits all the time. Hopefully it would also involve a complete overhaul of the ridiculous medical school and licensing system in this country. There is a lot of potential wealth (read: jobs/opportunities) that gets completely stifled by the ridiculous bureaucracy of the government/FDA/hospitals/insurance companies. The end result is that the consumer--those who need healthcare (EVERYONE!)--loses, and loses badly.
I'm in agreement that the system is horrendous and needs to be changed, I simply think the president wants to change it in the wrong direction.
I think the bureacracy is a serious problem. The AMA also happens to do an excellent job of keeping many willing people out of the medical profession and thus their wages high. It should be illegal to sell/promote false services or goods, but not to practice medicine without a license as long as you make it clear. The choice, ultimately, is the patient's.
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Not gonna argue with your links, you brought evidence but I disagree with the method it was acquired.
Most efficient in the world? Maybe cheapest. But they are still borrowing money from banks in order to fund this, and their healthcare is relatively subpar overall.
Also Taiwan is a pretty small country, so the obviously the bureaucratical inefficiencies are not on the same scale there as they are in the US.
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If you have evidence that the majority of expenses stem from costs associated with malpractice, feel free to present it.
Lowest overhead costs = efficiency. You could argue about various methods to measure efficiency, but I think you'll find it hard pressed to argue Taiwan's system is less efficient than privatized health care in the US, where administrative costs run about 15-20+%.
As for the accusation of "subpar", Taiwan has a slightly lower infant mortality rate than the US, and just slightly lower total life expectancy. There are other statistics I haven't looked up, but if you investigate I'm sure they'll be comparable to any other industrialized nation.
Most importantly, Taiwan's system covers nearly 100% of the population - in the US, nearly 20% is uninsured, and that doesn't include the percentage that is underinsured. Despite your implication that their system is somehow unsustainable, Taiwan's per capita expense is much, much lower than the US'. Invariably people will point out that the US has the most advanced treatment in cancer, AIDS, etc, which I suppose has an element of truth to it. However, what good is this advanced treatment if only a small subsection of the population is able to afford it? You can't just focus on the peak performance of the system, you have to examine how it averages across the population.
By the way, thanks for conceding that it is size that determines the amount of bureaucracy, not some magical "government" switch.
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Healthcare is needed, especially in a country that is considered a superpower should have that luxury, no? I think instead of trying to find a source to pay off the healthcare, America needs to find a way to reduce the costs of healthcare. One could start by reducing the salary of doctors (they get paid too much)
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EPT
