Socialized medicine?

[Margam]

In reading about the Democratic candidates' positions, I noticed that many of them are pushing for some sort of universal health coverage. I don't quite know how I feel about this.

It makes me nervous when you take capitalism out of anything. Once you do that, there goes competition and incentive. I think that would be a big blow to overall healthcare. There would be less incentive for new drugs and new medical procedures. Doctors would not be able to set their own fees.

On the other hand, being an uninsured person, I know that if something bad happened to me, I would be in a real jam. It does motivate me to take care of myself. I exercise and try to eat right, but if something like cancer hit me, I would not have many options.

I guess the real question should be what has happened to make health care so exspensive?

[geni]

How would universal health coverage stop drug companies from having an insentive to find new drugs?

The cost of healthcare? The £200 million it takes to create a new drug these days and medical negligance claims.

[Ed]

Originally posted by Margam
In reading about the Democratic candidates' positions, I noticed that many of them are pushing for some sort of universal health coverage. I don't quite know how I feel about this.

It makes me nervous when you take capitalism out of anything. Once you do that, there goes competition and incentive. I think that would be a big blow to overall healthcare. There would be less incentive for new drugs and new medical procedures. Doctors would not be able to set their own fees.

On the other hand, being an uninsured person, I know that if something bad happened to me, I would be in a real jam. It does motivate me to take care of myself. I exercise and try to eat right, but if something like cancer hit me, I would not have many options.

I guess the real question should be what has happened to make health care so exspensive?

Welcome.

Lawsuits for one thing. The cost of premiums will jack up costs. In a related way, most Dr.'s seem terrorized that they will misdiagnose so you get batteries of tests. Ca-ching.

We had a discussion on aspects of this a while back. I think that there is an ultimate safety net, that is to say if you cannot afford it, you will get treatment.

What worries me about universal care is the fact of yet another bureaucracy. I recall an article a while back that in the UK there were more bureaucrats than hospital beds.

[WildCat]

Originally posted by Ed
We had a discussion on aspects of this a while back. I think that there is an ultimate safety net, that is to say if you cannot afford it, you will get treatment.
BS. You won't even be able to get a doctor's appointment w/o health insurance. I know, I've tried!

Sure, you can go to the emergency room. Not really an option unless you're bleeding to death. Don't bother if you have an ear infection or other non-life threatening disease.

Unless you can somehow get into a pool (and most likely you can't) private health insurance is a scam. As soon as you get a really costly disease (such as cancer) they'll raise your rates so high you won't be able to make the payments and they'll drop you. Now, I could afford the $350 a month it would cost to get private health insurance, but for the reason above I don't bother. I don't need it for a cold or other minor problems after all, only the big ones. Get a real problem and you're still screwed. I'm better off just putting that $350/month in the bank.

Edited to add: I've been unable to get a doctor's appointment even though I have excellent credit and was willing to give a credit card #. The system here is screwed up big time. The very poor can go to a free clinic, but the middle class gets screwed. It's only going to get worse.

[Cleon]

Originally posted by Ed

What worries me about universal care is the fact of yet another bureaucracy. I recall an article a while back that in the UK there were more bureaucrats than hospital beds.

I don't think there are any more bureacrats (proportionally) in Britain's health care system than in the US.

The difference is in a public system like the UK's, they're employees of the state system, and in the US they're privately employed. Think how many paper pushers there are in the various hospitals, doctor offices, health insurance providers (Blue Cross/Blue Shield, Health America, Kaizer Permanente, etc. etc.), malpractice attorneys and THEIR staff, to say nothing of malpractice insurance companies (another industry in itself), then there are the government bodies; FDA, medical license boards, etc. etc.

When all is said and done, our bureacracy is probably just as big, if not bigger--it's just not all state directed.

[shecky]

Originally posted by WildCat

BS. You won't even be able to get a doctor's appointment w/o health insurance. I know, I've tried!

This has not been my experience. Cash pay patients seem to get preferred treatment. And maybe even a break in price! Of course, that assumes you have the actual cash to pay.


Originally posted by WildCat

Sure, you can go to the emergency room. Not really an option unless you're bleeding to death. Don't bother if you have an ear infection or other non-life threatening disease.

Actually, the ER becomes the de facto primary health care for too many non insured. Which is dumb, inefficient, and so on. But it happens.

Originally posted by WildCat

Unless you can somehow get into a pool (and most likely you can't) private health insurance is a scam. As soon as you get a really costly disease (such as cancer) they'll raise your rates so high you won't be able to make the payments and they'll drop you. Now, I could afford the $350 a month it would cost to get private health insurance, but for the reason above I don't bother. I don't need it for a cold or other minor problems after all, only the big ones. Get a real problem and you're still screwed. I'm better off just putting that $350/month in the bank.

I agree here. Since I lost my insurance, I've decided to put the money away into a fund for long term care, if and when I may need it. Regular doc visits come out of pocket, which is pricey, but I'm wagering cheaper than insurance in the long run.


Originally posted by WildCat

Edited to add: I've been unable to get a doctor's appointment even though I have excellent credit and was willing to give a credit card #. The system here is screwed up big time. The very poor can go to a free clinic, but the middle class gets screwed. It's only going to get worse.

Find a new doctor. Some of these problems are really just extrememly poor planning among office managers. This is a HUGE problem in my area, where most docs are owned my the local big state university, which is a unbelieveable clusterf**k of a bureaucracy. My old doc was impossible to get a hold of, because his office had a near inoperable phone system, high staff turnover, a scheduling system that should have been trashed decades ago, and so on. And the doc was unable to implement any changes on his own.

These problems have led to a trend of docs leaving that system to set up leaner independent practices. This does have a cost, as the local hospital is run by the university and the business is still controlled by the university. Some docs have even gone to cash only practices and somehow manage to have no problem scheduling patients even same day. And they're so busy, some are not taking new patients!

I think it's impossible to predict how socialized medicine will affect the system. In some ways, I find it difficult to think it'll get worse. The last insurance coverage I had was limited to docs that had the worst management problems, unrelated to actual insurance coverage insurance related. If it would allow my current doc to be reimbursed for my visits, would seem much easier to swallow.

[Cain]

A few random comments off the top of my head.

Is the system we have today really capitalistic?

Don't we spend more as a percentage of our GDP than other countries with universal care? In the U.S. I think it's around 14% compared with 9% in Canada. _The American Prospet_ did a story comparing per capita costs and we're already spending more than countries like Sweden, England, France, and Canada (but less than Norway). There can be umpteen millions of different causes, but the argument that universal healthcare would be necessarily costly are false. Although I'm not sure what room Republicans have to now complain about spending.

Most importantly, healthcare is one of those areas of the economy -- like education, courts, roads -- that's prone to market failure.

In an earlier post I cited Nicholas Barr's excellent text _The Economics of the welfare State_ (p. 283):

-Much (though not all) the information is technically complex, so that a person would not necessarily understand the information even if it were available (Cain's note: unlike the technical knowledge required for purchasing a car, which IS available through magazines, the Internet, friends).

-Mistaken choice is costlier and less reversible than with most other commodities.

-An individual generally does not have time to shop around if his condition is actue (contrast the situation with a car repair, which can be left until the car owner has enough information and can afford the repair).

- Consumers frequently lack the information to weigh one doctor's advice against another.

-Health and health care have strong emotive connotations -- for example, ignorance may in part be a consequence of fear, superstitition, etc.

Besides, even if a Democrat did get elected (unlikely) and continued to push for universal healthcare (unlikely), the Republicans would not tolerate the legislation (likely). At best there would probably be a compromise to cover all children.

[Nikk]

Originally posted by Cleon


I don't think there are any more bureacrats (proportionally) in Britain's health care system than in the US.

The difference is in a public system like the UK's, they're employees of the state system, and in the US they're privately employed. Think how many paper pushers there are in the various hospitals, doctor offices, health insurance providers (Blue Cross/Blue Shield, Health America, Kaizer Permanente, etc. etc.), malpractice attorneys and THEIR staff, to say nothing of malpractice insurance companies (another industry in itself), then there are the government bodies; FDA, medical license boards, etc. etc.



Years ago, probably when Clinton was an office, I read an article which claimed that the cost of running the billing mechanisms in the US health system would pay for the entire British health service. Your population is almost 5x ours of course.

European socialised systems are far from perfect but seem to produce results ( to the extent that health can be measured ) as good or better than those in the US for less money.

Infant mortality rates in the US for example are worse than those of all West European countries and in some cases more than 100% worse. This is an average of course. Infant mortality rates for Blacks in US cities approach third world standards ( or at least Romanian standards ).

[Cleon]

Originally posted by Nikk


Years ago, probably when Clinton was an office, I read an article which claimed that the cost of running the billing mechanisms in the US health system would pay for the entire British health service. Your population is almost 5x ours of course.


Doesn't surprise me one little bit. We have an entire industry built around billing--I $%^ you not! And that's not even taking into account collections.


European socialised systems are far from perfect but seem to produce results ( to the extent that health can be measured ) as good or better than those in the US for less money.

Infant mortality rates in the US for example are worse than those of all West European countries and in some cases more than 100% worse. This is an average of course. Infant mortality rates for Blacks in US cities approach third world standards ( or at least Romanian standards ).

Beyond the usual hostility to having the government actually do anything besides bombing the occasional third-world country, I confess I really don't understand many Americans' hostility to universal health care. At minimum the Europeans' systems are comparable to the US in terms of efficiency. Most studies show them to be more effective in many ways. I just don't get it.

[Zero]

If you don't have insurance, you will get treated at the emergency room, at 3 times the cost of just going to a GP and paying $50 for an office visit. Since we(the taxpayer and insurance holder) end up paying for poor people's visits anyways, in higher costs, wouldn't it be cheaper to pay $50, instead of $150? That is my personal argument for some sort of universal healthcare.

[corplinx]

I think socialized medicine is a square peg for a round hole for America.

Socialized medicine seems to work best in a country with a good income base and static or negative population growth.

Perhaps some of the US states with static population growth could swing it.

For the record, universal healthcare was a big disaster here in Tennessee. It stinks, there is no obivious solution, and now we are in the precarious position of not being able to get rid of it since no government official wants to pull the rug out from under the people covered by TennCare.

Socialized medicine could work at the national level, but if we gamble wrong it could be disastrous. I would like to see some hard details and studies on the effects of proposed plans.

"Socialized Medicine" sounds great. The actual plans people propose usually suck.

[Zero]

Originally posted by corplinx
I think socialized medicine is a square peg for a round hole for America.

Socialized medicine seems to work best in a country with a good income base and static or negative population growth.

Perhaps some of the US states with static population growth could swing it.

For the record, universal healthcare was a big disaster here in Tennessee. It stinks, there is no obivious solution, and now we are in the precarious position of not being able to get rid of it since no government official wants to pull the rug out from under the people covered by TennCare.

Socialized medicine could work at the national level, but if we gamble wrong it could be disastrous. I would like to see some hard details and studies on the effects of proposed plans.

"Socialized Medicine" sounds great. The actual plans people propose usually suck. Yesh, but TennCare was a retarded system, as you might know from experience.

I think it is a good idea in principle, but like you I have reservations about implementation.

[shuize]

Japan has socialized medicine. It's great for minor problems.

I scalded myself with some boiling water recently. Nasty burn, but certainly not life threatening. Every doctor's visit, including antibiotics, runs about $5.00 US.

The flip side involves the total lack of accountability. For example, here in Japan a few years back a local English teacher died from a mysterious illness. She had visited the hospital several times including the emergency room the night before she died but the doctors just couldn't figure out what was wrong. Here were her symptoms: Sudden weight loss. Thirsty. Weak ... Hmm. Diabetes maybe?

It wasn't a case of knowing what was wrong but just not being about to help. They didn't know and sent her home anyway.

Anecdotal. But that's my experience with socialized medicine.

[Zep]

Out of curiosity, can someone in the US give us an idea of how much money in the federal health budget went towards actual productive medical practice (hospital buildings & ammenities, procedures, emergencies, medical staff, research, etc), and how much went on non-productive activities (superfluous layers of administrators & accountants, legal teams, lobbyists, marketeers, etc).

The impression I'm getting is that the former is slowly but surely being outcosted and overwhelmed by the latter. But I'd like to work with some facts, please.

[Malachi151]

Originally posted by Margam
In reading about the Democratic candidates' positions, I noticed that many of them are pushing for some sort of universal health coverage. I don't quite know how I feel about this.

It makes me nervous when you take capitalism out of anything. Once you do that, there goes competition and incentive. I think that would be a big blow to overall healthcare. There would be less incentive for new drugs and new medical procedures. Doctors would not be able to set their own fees.

On the other hand, being an uninsured person, I know that if something bad happened to me, I would be in a real jam. It does motivate me to take care of myself. I exercise and try to eat right, but if something like cancer hit me, I would not have many options.

I guess the real question should be what has happened to make health care so exspensive?

I could support a socialized basic level of care system.

As far as I know none of the candidates are proposing to eliminate private healthcare, only to offer state services.

I would definately not support the elimination of private healthcare, that would be moronic.

I think it would be good if the state could enter into the game as one of the competators though, which may help to bring down the prices for private care.

[corplinx]

Well, I think we might as well brace ourselves in the US for some sort of social healthcare experiment. You can only have government much so much with liability, regulation, paperwork, process management, standards, and such before you make healthcare cost so much that the only way to provide basic service is to have government do it.

[Zep]

By way of comparison, Australia went to a socialised medical style in the mid-1970's. It started out fairly basic, and in the intervening years to now, it has been through a number of changes, some good, some bad, and of course there have been the inevitable glitches and system ripoffs, etc. But, by and large, it would be fair to say that it has worked reasonably well, although it certainly had (and has) its critics!

However, the current conservative government has been trying to minimise government involvement in health spending (as a way of trimming budgets, etc). So they have been pushing for some time to get people to switch to private health insurance, in the same fashion as is done in the USA (we were told it was working very well...!). Alas, after many millions of public-purse dollars spent in promoting the change, this move was so spectacularly UNsuccessful that more people have been pulling OUT of private insurance than have been joining. I may also be right in saying that some private funds have been wound up as a result.

We keenly await the next round of hilarities with our public tax dollars...

[corplinx]

The big problem with a public/private system is that inevitably government stack the deck in favor of itself through regulation.

[Theodore Kurita]

I believe 100% in Socialized medicine.

It would work in the United States.

The only thing though is, in order to provide for it, the federal government would have to increase the Federal Income Tax dollars coming in.

To put it bluntly, the feds will have to increase taxes.


Then again, that is not so bad is it.

More money for the government to spend...

Who knows.

Maybe if the Bush Tax Cuts are repealed, income taxes are slightly increased, and there are more tax brackets, it might just eliminate the deffecit that the current administration has created.

[Zep]

Originally posted by corplinx
The big problem with a public/private system is that inevitably government stack the deck in favor of itself through regulation. Is that not happening already, indirectly? I would imagine that existing state and federal taxes and legislation to do with medical insurance and health administration are already keeping a number of people off the street at Uncle Sam's expense...

[Zep]

Originally posted by Theodore Kurita
I believe 100% in Socialized medicine.

It would work in the United States.

The only thing though is, in order to provide for it, the federal government would have to increase the Federal Income Tax dollars coming in.

To put it bluntly, the feds will have to increase taxes.


Then again, that is not so bad is it.

More money for the government to spend...

Who knows.

Maybe if the Bush Tax Cuts are repealed, income taxes are slightly increased, and there are more tax brackets, it might just eliminate the deffecit that the current administration has created. I asked above for a breakdown of funding already being spent, but divided into two camps: the costs of the actual practice of medicine, and the overheads associated with dealing with the problems inherent in the current system.

[Theodore Kurita]

Originally posted by Zep
I asked above for a breakdown of funding already being spent, but divided into two camps: the costs of the actual practice of medicine, and the overheads associated with dealing with the problems inherent in the current system.

You can find all of this info at these 2 links:

http://aspe.hhs.gov/

http://www.whitehouse.gov/omb/budget/fy2003/budget.html

[svero]

I've been to hospitals all over the world. The best care I've received is at private hospitals. They're particularly good in poorer countries where the cost is reasonable. US hospitals have excellent service but extremely inflated prices. A trip to see a Dr. in Denver cost me over 2000$ for what would have been a 25$ visit in Thailand at a private modern hospital with similar quality care. So the real question to me is... How can Americans keep the level of quality service they have now but reduce the price of the system to patients? (and to business assuming savings were passed on).

Certainly the inflated costs are not entirely due to actual costs, but rather to policies, bureaucracy etc... Why should perscription drugs cost Americans much more than they do Canadians? Why shouldn't govt programs be allowed to negotiate better prices with drug companies? If these sorts of govt regulations pervade the entire medical system then that's probably what needs to be changed first. Aside from capitalism.. Are there other incentives and programs could be put in place to motivate hospitals to keep doing a good job on care but at a lower cost? Should there be limits placed on the amount of money a hospital can make? How would it be policed? I don't have the answers but I'm pretty convinced that US citizens aren't getting their money's worth. They're being overcharged.

Having lived in Canada many years I can't say that socialized medicine would be beneficial to the quality of health care. In Canada the quality of health care is extremely poor. Long waits, poor doctors, inefficient systems etc.... U.S. care is far far better from my experience having used both.

[Zep]

Can anyone tell me why, when I go to the White House Office Of Management and Budget, Table of contents (http://www.whitehouse.gov/omb/budget/fy2003/budget.html) that there is nothing found behind any of the links...indicative?

Wait a sec...just a single pdf...

[SteveGrenard]

The OMB liks seem to work here:

http://www.whitehouse.gov/omb/

[Zep]

Originally posted by SteveGrenard
The OMB liks seem to work here:

http://www.whitehouse.gov/omb/ Thank you, Steve. That does seem better. The other PDF document would seem to be nothing more than an apologia with a few meaningless numbers thrown in.