Stossel Solves the Health Crisis with Capitalism

[Rolfe]

Originally Posted by DaN K. StAnLeY

No, I said I'd be less free than if I could opt-out without being punished. Does it completely escape you that some people may not want anything to do with others?

OK. But you wouldn't be any less free under a universal healthcare system than you are at the moment. In fact you'd be more free.

Now please watch what you're saying about not wanting anything to do with others. Any minute now someone is going to annoy you by accusing you of being perfectly relaxed about the idea of people dying in the street, so long as you aren't compelled to contribute anything to their care. Now we know you don't really feel that way, because you've told us so. But it does rather sound as if the system you seem to desire might end up having that effect.

Care to explain yourself a bit better?

Rolfe.

[Darat]

Originally Posted by Rolfe

Oh, I think it is. Remember the poll tax protest? Didn't those people go to jail for refusing to pay that? Or some of them anyway.

But there was another choice for those people - they could have left the UK.... No one forces us to stay in the UK. (And no snarky comments Rolfe! )

Originally Posted by Rolfe

...snip...

I just don't see where the US and the US are so different here. Dan already pays a proportion in tax to fund other people's healthcare, and I suspect he'd end up in jail if he persistently refused to hand that over. So what's different about the UK?

Oh yes, that in that situation the tax he's objecting to is being spent on something he is actually entitled to benefit from.

I'm trying to find out why he sees that as a loss of freedom, but I'm not getting an answer.

Rolfe.

I don't disgaree - it was one of the questions I asked him hundreds of posts ago, one he still can't answer.

[DaN K. StAnLeY]

Quote:

As the article linked to above shows, non-insured babies are more likely to die. Since MarkCorrigan's parents did not have him insured under your system his probability of dying would have been higher than under the NHS (never mind some of the other UHC systems around which have even better statistics than the UK's NHS has managed to achieve).

You're assuming now, and you know what happens when you assume don't you??

[Rolfe]

Mark Corrigan tells us a personal story not entirely dissimilar to Abigail's. I haven't ever had an answer about whether there's any possible care Abigail might have received if she'd been a US citizen instead of a little Scottish girl. Or whether Abigail would have been guaranteed to receive that care if her parents had been American, even if they'd been on a low income or unemployed.

Originally Posted by DaN K. StAnLeY

Thanks for sharing that story. It is very probable that you would have also survived in the US, and you're family could keep their house.

Dan, would you explain the mechanisms through which this outcome could have been achieved in the US?

Originally Posted by DaN K. StAnLeY

total: 4.93 deaths/1,000 live births UK

total: 6.3 deaths/1,000 live births US

Not much of a difference.

My God, I might be going to say something I'd regret here. Not much difference????? This is a staggering 28% higher infant mortality in the USA. I honestly had no idea. Given that there is inevitably an irreducible number of neonatal deaths that no amount of care can save, this is absolutely appalling.

One extra death for every 730 live births.

Sorry, I have to go away and calm down for a bit.

Rolfe.

[Francesca R]

Originally Posted by Darat

No one forces us to stay in the UK.

I don't tend to like this argument much. At some point you have to consider the system "closed", in that you can't get out of it. If no country offers you immigration and the conditions you want, short of setting yourself adrift in international waters equipped for 70 years or so (avoid the East African coast and a lot of other places though), you're stuck. I prefer admitting that if you don't like the system and you can't change it, then too bad.

[Rolfe]

Originally Posted by Darat

But there was another choice for those people - they could have left the UK.... No one forces us to stay in the UK. (And no snarky comments Rolfe! )

No. No snarky comments. I support NHS Scotland and I support NHS England and I support NHS Wales and I support NHS Northern Ireland. Wholeheartedly. And I support full reciprocity between them, as now, irrespective of any political or constitutional outcome.

However, I don't think it's helping this discussion to point out the bleedin' obvious that if you don't like the way we do things you can leave. That's not a reasonable option for most people for many reasons.

And you're just confusing Dan.

Rolfe.

[DaN K. StAnLeY]

Quote:

OK. But you wouldn't be any less free under a universal healthcare system than you are at the moment. In fact you'd be more free.

Now please watch what you're saying about not wanting anything to do with others. Any minute now someone is going to annoy you by accusing you of being perfectly relaxed about the idea of people dying in the street, so long as you aren't compelled to contribute anything to their care. Now we know you don't really feel that way, because you've told us so. But it does rather sound as if the system you seem to desire might end up having that effect.

Care to explain yourself a bit better?

Rolfe.

I DO care if people "die in the streets", but I also recognize someone elses right to not care. Soc-HC forces people under law to pay and assumes that if there weren't a law everyone in need would be left to die.

[Darat]

Originally Posted by DaN K. StAnLeY

You're assuming now, and you know what happens when you assume don't you??

Assuming what?

[Professor Yaffle]

So if there were a system in your country in which contributions towards the healthcare of the uninsured were entirely voluntary, you would contribute (and be happy to pay a much higher portion of your income, as volunteers would also be covering the share of those who have opted out).

[DaN K. StAnLeY]

Quote:

My God, I might be going to say something I'd regret here. Not much difference????? This is a staggering 28% higher infant mortality in the USA. I honestly had no idea. Given that there is inevitably an irreducible number of neonatal deaths that no amount of care can save, this is absolutely appalling.

One extra death for every 730 live births.

Sorry, I have to go away and calm down for a bit.

Rolfe.

Yes, and the only reason these numbers are different is because those babies didn't have insurance. I think you DO need to go calm down. Maybe not sit by your computer everyday and wait for someone to argue about UHC with.

[DaN K. StAnLeY]

Quote:

Assuming what?

A whole lot.

[DaN K. StAnLeY]

Quote:

So if there were a system in your country in which contributions towards the healthcare of the uninsured were entirely voluntary, you would contribute (and be happy to pay a much higher portion of your income, as volunteers would also be covering the share of those who have opted out).

If we didn't want to have Medicare/aid we could vote it out at any time and start discharging people tomorrow. What makes you think a significant number of people would opt out? Are Americans more evil than other people?

[Rolfe]

Originally Posted by DaN K. StAnLeY

Yes, and the only reason these numbers are different is because those babies didn't have insurance. I think you DO need to go calm down. Maybe not sit by your computer everyday and wait for someone to argue about UHC with.

I make no assumptions as to the reason for this astoundingly higher neonatal mortality rate in the US. I merely observe that this is the nation which is regarded as being the most technologically advanced and indeed the most "civilised" in the world, and wonder what the hell is wrong.

Rolfe.

[Darat]

Originally Posted by Francesca R

I don't tend to like this argument much.

...snip...

I pretty much agree with you, but in my experience ideologues accept these types of extremes in their arguments so I can't see how they can refute the fact that we do have this fundamental choice.

[Rolfe]

Originally Posted by DaN K. StAnLeY

If we didn't want to have Medicare/aid we could vote it out at any time and start discharging people tomorrow. What makes you think a significant number of people would opt out? Are Americans more evil than other people?

Nope. But they're not a bunch of plaster saints either. In every single developed first world country, there is compulsory taxation of the better off in order to fund the healthcare of the poor and needy. Because it is recognised that if this is left to private charity, the funding will firstly be insufficient, and secondly will be diverted to "cuddly" causes away from the nastier ones.

You seem to be assuming that the vast majority of Americans are saints. I suggest the evidence is that they're no different from anybody else.

Rolfe.

[Professor Yaffle]

Originally Posted by DaN K. StAnLeY

If we didn't want to have Medicare/aid we could vote it out at any time and start discharging people tomorrow. What makes you think a significant number of people would opt out? Are Americans more evil than other people?

So if only evil people would opt out of paying their fair share in a voluntary system, what's wrong with a compulsory system. Why should I care if a vanishingly small number of evil people are forced to do something they don't want to do. Not doing it makes them evil right?

[Rolfe]

Originally Posted by Darat

I pretty much agree with you, but in my experience ideologues accept these types of extremes in their arguments so I can't see how they can refute the fact that we do have this fundamental choice.

OK, point has been put. Now can we continue the discussion on the assumption that people have the right to remain in their native country and still disagree with its policies?

Rolfe.

[Darat]

Originally Posted by Rolfe

OK, point has been put. Now can we continue the discussion on the assumption that people have the right to remain in their native country and still disagree with its policies?

Rolfe.

Of course, unless someone brings up "freedoms" again....

[MarkCorrigan]

Originally Posted by DaN K. StAnLeY

If we didn't want to have Medicare/aid we could vote it out at any time and start discharging people tomorrow. What makes you think a significant number of people would opt out? Are Americans more evil than other people?

....I don't understand.

You would personally contirubute, yes or no?

Some people would not contribute, yes or no?

In order for the (not entirely up to standard) level of healthcare available to those on medicaid/care to be continued under your proposed system then those who do contribute would have to pay more, yes or no?

Why is this situation better?

Also, please descibe by what mechanisms that my parents, in my situation (remember, I have to have continual healthcare and will do for the rest of my life. In fact, I'm due another operation in 5-10 years dependant upon how well the last one went and will be in that situation for the rest of my life, meaning assuming I live to 80 I will need an aditional 3-6 operations, all of which would be exceedingly costly despite the increasingly commonplace nature of these operations meaning no insurance company would touch me with a bargepole) would be able to continue their standard of living without being driven onto another form of government assistance at the very least.

Do keep in mind, the operations that saved my life were not available for the brother of someone I knew in school who was born a mere 6 months before me.

[Rolfe]

Hmmm, totally charity-funded system.

Never generates sufficient cash for this sort of need. People who would pay a small amount in a tax-based system, pay nothing because they are strapped for cash and see it as the responsibility of the rich people. Rich people think they're some sort of bloody saint if they make a big, flashy donation, get their name engraved on the neonatal cot or whatever it is, but in fact the amount of the donation still might be less than they'd have paid on their large income if it had been taxed.

People choose which healthcare charity they donate to, and they want their money to go to the neonatal cots or the MRI scanner, and geriatric psychiatry ends up with nothing.

Healthcare competes with other charities, so one day a lot of people decide that they're going to give the money to the Somalia appeal, or the Pakistan earthquake appeal, or maybe the dog and cat home.

And there are people who won't donate at all. In any system. If you allow them to opt out, they will. So everybody else's contributions have to be higher to make up for that.

The only vague possibility that I could see would be to send people an optional tax bill. You would be told the total amount of tax the government thinks you should pay, all broken down and hypothecated to different purposes. Healthcare, education, policing, defence and so on. You would tick the boxes of the things you wanted to contribute to, and send a cheque for only that proportion (which will of course be higher than in a compulsory system, as the government will have figured out what proportion of the population won't pay, and hiked the nominal amount accordingly). And there would be no comeback if you didn't pay anything.

Sounds great. I wonder why no country actually follows this system?

Rolfe.

[Darat]

Originally Posted by Rolfe

...snip... Rich people think they're some sort of bloody saint if they make a big, flashy donation, get their name engraved on the neonatal cot or whatever it is, but in fact the amount of the donation still might be less than they'd have paid on their large income if it had been taxed.

...snip...

Also they will impose conditions on how their money is to spent, Maternity wing provided by a rich and devout Catholic? Well forget single mothers having access to it!

[Ivor the Engineer]

Originally Posted by DaN K. StAnLeY

<snip>

Does it completely escape you that some people may not want anything to do with others?

No, but it seems to escape you that letting everyone do exactly as they want has never worked in the past, does not work now and will not work in the future, even if you close your eyes tightly and wish really, really hard that it can.

[Rolfe]

Originally Posted by DaN K. StAnLeY

Yes, and the only reason these numbers are different is because those babies didn't have insurance. I think you DO need to go calm down. Maybe not sit by your computer everyday and wait for someone to argue about UHC with.

Dan, as I said, I don't have the data to know why these numbers are different. I'm just shocked that in the biggest and best superpower in the world, the place very rich people go to for treatment (which you think proves that it has the best healthcare in the world), one more child is dying for every 730 births than in my own country, whose system you so despise.

I also observe that this is likely to be an underestimate of the problem in many areas. You see, in Britain everybody is entitled to the standard of care they need. Mark, and Abigail, both came from fairly well off middle-class families. But we can use them as examples, because we know that the system doesn't discriminate against the children of the unemployed, or those on the minimum wage. Thus we know that our neonatal mortality is relatively even across the social classes and geographical areas, and probably absolutely even if you can correct for non-medical factors such as maternal smoking and drinking.

However, I suspect I'd be right if I assumed that the neonatal death rate in the USA is no worse than in Britain, and possibly even better, if you only look at the children of the middle classes and the affluent. I'd be astonished if this were not the case. Thus this one extra death per 730 live births overall, will be happening in the poorer communities. Depending on how the demographic is split, it might even be as much as one extra dead baby per 500 births, or even fewer, on the wrong side of the tracks.

I can't say whether or not this has anything to do with insurance cover. What do you think?

Rolfe.

[Rolfe]

Originally Posted by Ivor the Engineer

No, but it seems to escape you that letting everyone do exactly as they want has never worked in the past, does not work now and will not work in the future, even if you close your eyes tightly and wish really, really hard that it can.

You know what? I used to think the way Dan does, when I was about 16. But I thought my ideas through to their logical conclusions. I also looked around me and saw how things actually worked, and observed that there were often consequences I hadn't foreseen, but which with hindsight were predictable.

Why should I be forced to obey my parents, pay my taxes, go to school, drive on the left side of the road, wear a seat belt and so on and so forth. Wouldn't it be wonderful to be FREEEEEEE! I even at one point speculated that it might be better to be in jail because absolute compulsion might feel paradoxically freer than social pressures.

I was an idiot.

As I said, I thought things through, and more importantly I observed how things actually worked. And I changed my mind about a lot of things.

Dan isn't 16.

Now I'm not hanging around this thread because I want to debate universal healthcare, not any more. We've gone into the matter in enough detail that I understand the Americans' objections really and truly are entirely ideological, not practical. I'm hanging around because I find the psychology of the opposing argument fascinating.

Rolfe.

[Rolfe]

Originally Posted by Rolfe

Dan, you repeatedly say that you'd "lose" freedom if you were participating in a universal healthcare system.

Originally Posted by DaN K. StAnLeY

No, I said I'd be less free than if I could opt-out without being punished. Does it completely escape you that some people may not want anything to do with others?

All right. This has nothing to do with the merits or otherwise of a universal healthcare system.

We've established beyond any dispute that in a universal healthcare system (certainly in Britain) we are not deprived of any freedom at all that US citizens enjoy.

We've also estabilshed beyond any doubt that there are areas in which we enjoy more freedom than US citizens currently enjoy.

(We've also established that we get better health outcomes for a lot less expenditure and stuff like that, which seems not to matter really.)

It seems as if Dan is looking at any change to the current US system primarily from the point of view of whether it will render him (hypothetically) more free than he is at the moment, in just this one tiny little aspect. He wants to be free not to contribute to anybody else's healthcare.

Overall health outcomes don't matter.
Cost to the economy doesn't matter.
All the other lesser freedoms we've discussed that come with participating in a universal system don't matter.

The absolute pre-requisite for any system is that each individual should be free not to contribute in any way to anybody else's healthcare.

And if Dan can't have that, then he won't consider any change at all.



Rolfe.

[MarkCorrigan]

Originally Posted by Rolfe

You know what? I used to think the way Dan does, when I was about 16. But I thought my ideas through to their logical conclusions. I also looked around me and saw how things actually worked, and observed that there were often consequences I hadn't foreseen, but which with hindsight were predictable.

Why should I be forced to obey my parents, pay my taxes, go to school, drive on the left side of the road, wear a seat belt and so on and so forth. Wouldn't it be wonderful to be FREEEEEEE! I even at one point speculated that it might be better to be in jail because absolute compulsion might feel paradoxically freer than social pressures.

I was an idiot.

As I said, I thought things through, and more importantly I observed how things actually worked. And I changed my mind about a lot of things.

Dan isn't 16.

Now I'm not hanging around this thread because I want to debate universal healthcare, not any more. We've gone into the matter in enough detail that I understand the Americans' objections really and truly are entirely ideological, not practical. I'm hanging around because I find the psychology of the opposing argument fascinating.

Rolfe.

I think that it's in the American mindset, partly.

There seems to be, and forgive the overarching simplification here as I am fully aware of the variety of opinions in America, an assessment that Socialised Healthcare IS a loss of freedom.

Even if it's pointed out that it would only be an alteration of the system currently in place, there exists some wiggle room for which those against government intervention in all things can insist that there WOULD be an appriciable difference beyond the obvious increase in standards for the lower classes in the US. It seems born to me, and I am aware I am playing armchair sociologist, of two seperate things within the American psyche. The feeling that America IS the best nation of the world that I would consider a form of nationalism, and the paranoid fear of "Communism" brought on by the echos of the Cold War.

The belief in the USA as being a saviour of sorts, and truely having the best of everything in the world really does seem all pervasive to an outsider viewing their media. This frankly child-like notion seems itself to influence the idea that since the US is a Superpower (and best in the world) everything the US does is therefore the best way. Thus Universal healthcare, as practiced by the inferior nations of the world, would not be the right move. It would be to the detriment of the US because the current system is de facto the optimal one.

Secondly, the fact that such a system is Socialised leads to obvious (if false) comparisons with the USSR. The fact that a system with the word "Socialist" in the title, however incorrect this self application was, will lead to immediate suspicion by a number of Americans. This is not entirely without reason of course, given the horrors of the USSR, but since the comparison is not entirely accurate, there is a serious issue here.

Of course, being British and only having temporary, if extended exposure to the US internal systems and civil society I could be entirely wrong, and if shown to be so (with evidence) I will of course retract.

[Francesca R]

Originally Posted by Darat

I pretty much agree with you, but in my experience ideologues accept these types of extremes in their arguments so I can't see how they can refute the fact that we do have this fundamental choice.

Busted--you're clearly no better than the terrorists.

[Francesca R]

Originally Posted by Rolfe

Dan isn't 16.

Now I'm not hanging around this thread because I want to debate universal healthcare, not any more. We've gone into the matter in enough detail that I understand the Americans' objections really and truly are entirely ideological, not practical. I'm hanging around because I find the psychology of the opposing argument fascinating.

I'm gonna hang around and see if any info emerges about whether or not the Beatles had formed before you stopped being an idiot . . .

Sorry, sorry .

Egad, I wonder if I'm about to get reported by two people all at once

[Rolfe]

Originally Posted by MarkCorrigan

The belief in the USA as being a saviour of sorts, and truely having the best of everything in the world really does seem all pervasive to an outsider viewing their media. This frankly child-like notion seems itself to influence the idea that since the US is a Superpower (and best in the world) everything the US does is therefore the best way. Thus Universal healthcare, as practiced by the inferior nations of the world, would not be the right move. It would be to the detriment of the US because the current system is de facto the optimal one.

I think you've essentially nailed it. This reflects my Tennessee friend's attitude, while she was struggling to stay alive and to stay working while suffering from systemic lupus. She was immeasurably worse off than she would have been in Britain, both because she lacked automatic healthcare entitlement, and because of the employment legislation. However, she was quite touchingly grateful that she lived in America, because she was convinced that she would not have got the medication she needed in any other country. Entirely on the grounds, so far as I could tell, that America was self-evidently best at everything, so she must be getting the best.

Dan's repeated references to "soc" healthcare are quite telling. It seems incredible to me that anyone could be quite so naive as to reject anything involving pooling resources for the greater good, on principle, simply because of attitudes formed in the Cold War, but it does seem as if that's what's happening.

Rolfe.

[Rolfe]

Originally Posted by Francesca R

I'm gonna hang around and see if any info emerges about whether or not the Beatles had formed before you stopped being an idiot . . .

Oh yes. Definitely.

Rolfe.

[Francesca R]

Well snap. There's a coincidence!

[3point14]

This is doing my head in.

Taxation is a fact of life.

If my government chooses to spend the funds it raises on keeping it's poulation healthy then I'm all for that.

The opposing argument of FREEDOM!!! when taken to it's logical conclusion is that there should be no taxation at all, isn't it?

I have to say, Dan, that I really can't wrap my head around your position at all.

[Rolfe]

I'm still trying to understand Dan.

He wants to be free to refuse to contribute to anyone else's healthcare. Not that he definitely will refuse, you understand, because he's not a bad person really, he just wants to have the right to refuse.

In that case you have to abolish Medicare and Medicaid. You can't fund them from taxes, because that doesn't allow people the right not to contribute. So they're gone.

He will grudgingly accept the existence of health insurance, so long as he has the right not to participate. He'll even participate, because he recognises that there's no prospect that he would be able to pay for a big-ticket item of health expenditure if he needed it. (Well, until somehow the free market brings the cost of the sort of care Mark received down to about the same as a Big Mac, but he still hasn't explained how that can possibly happen, or how he'll persuade any doctor to remain in the USA if they're being paid the same as someone asking "do you want fries with that?")

But that's OK, because it's voluntary.

Theoretically, it's voluntary. But practically? You don't know if you're going to need a heart transplant. You do know that you won't possibly be able to afford to pay for one if you do. You've also abolished Medicare and Medicaid (see above). So what happens if you exercise your right not to participate in any risk-sharing scheme, and then you get sick with something expensive?

You die.

But that's OK, that's my choice, says Dan (sorry, can't find the post, but he did say it).

Maybe we should examine the implications of this?

Rolfe.

[ponderingturtle]

Originally Posted by DaN K. StAnLeY

No, but we'd be more free if we could.

So then doctors should be able opt out of treating patients who can't pay. Or are you forceing only doctors to pay for this treatment?

[ponderingturtle]

Originally Posted by DaN K. StAnLeY

What if I don't want to pay for someone elses HC?

So if you are not a heart surgeon you are exempt from having to pay, or can heart surgeons refuse to treat people with lethal heart conditions?


What right does anyone have to make them pay and work for that procedure?

Being left to die in the street is the only solution.

[ponderingturtle]

Originally Posted by Darat

You are now just repeating yourself. As has been explained a few times there is no way unless you remove the concept of insurance from your health system that you can avoid paying for other people's health-care.

Also the mandated treatment does that as well. IF a hospital loses money being forced to treat patients who can not pay, they have to charge those who can pay more.

[ponderingturtle]

Originally Posted by DaN K. StAnLeY

total: 4.93 deaths/1,000 live births UK

total: 6.3 deaths/1,000 live births US

Not much of a difference.

Um you do know that is 22.25% difference or that 1 in 5 of those deaths is preventable.

[Professor Yaffle]

Originally Posted by ponderingturtle

Being left to die in the street is the only solution.

This is a major oversimplification.

Many people would die in their own homes.

[Francesca R]

Nonsense--they would have sold those already to pay for some treatment.

[ponderingturtle]

Originally Posted by DaN K. StAnLeY

I DO care if people "die in the streets", but I also recognize someone elses right to not care. Soc-HC forces people under law to pay and assumes that if there weren't a law everyone in need would be left to die.

So you are for removing laws that prevent hospitals from doing that and restricting their freedom.

Essentially you want it to happen, but you will feel bad about it.