Here comes your socialized health care...sort of...

[MasterBlaster]

Martha:

Let me turn it around...


How much of the relatively high quality/high access health care are YOU willing to give up so that others may have care ?

[Cool Dood]

Originally Posted by Martha

You guys that don't support a national healthcare system or more regulation of the insurance market, what do you propose?

I don't have all the answers, but living under a healthcare system that's about as broken as one can be, I think pretty much anything else is at least less bad.

Do you think things are fine the way they are?

No, but I think it's misplacing the blame to believe the U.S. system needs more government involvement.

Are you concerned about healthcare for the poor? If so, how would you provide the care?

Yes. That seems to me what one of the useful purposes of government is. I don't think most free marketeers object to government providing services and products to the poor, for which everyone else pays individually. I support providing food and shelter and others to the poor free of charge, but that doesn't mean I think it's a good idea to make all farming, supermarkets, construction, and so on, produced and consumed solely through a socialized monopoly. That's kind of insane, and I think it's just as insane to do that with medicine, which surely is as important as food and shelter.

What about those who are uninsurable? How would you address that problem?

Well, somebody who can't get the money or the financing for a residence still needs shelter, and qualifies for government assistance. Wouldn't being uninsurable be one usable benchmark for whether someone qualifies for government healthcare?


You asked a bunch of questions, now can I ask one? Why is it so shocking and unthinkable that some people should advocate a free market in health care? I'd imagine most people have no similar problem with free markets that exist in so many other areas of life, for things that are more important than health care, less important, equally important, similar in a thousand ways, different in a thousand ways, etc. Many, like food, are also matters of life and death. So why is healthcare alone sacrosanct? Just curious...

[Martha]

Originally Posted by MasterBlaster

Martha:

Let me turn it around...


How much of the relatively high quality/high access health care are YOU willing to give up so that others may have care ?

I asked first.

I am not sure I have to give anything up. Money? I am ok with some more tax dollars going to healthcare. Waiting periods for certain procedures that don't have serious consequences? OK. I can have my bunions fixed later. Given the amounts we spend as compared to other countries, I think we could do this without costing us a lot more.

[MasterBlaster]

The way I look at it is that yes we can trade downward in quality and immediate access to get much better universal coverage.

Maybe that's what we should move to however everyone should know and understand the issue(s) before we jump into something.

For most people that have coverage now that's a very hard thing to sell.

[Martha]

Cool Dood, I am not quite sure where you are coming from. Are you suggesting subsidized healthcare for the poor and uninsurable? If so, I can live with that. I wouldn't be thrilled because subsidies are subject to whims of whatever government is currently in power. This is what Minnesota does and our Republican governor keeps trying to make cuts. The federal and state governments have cut back medicaid. You don't get coverage just because you are poor. Subsidies are not popular right now.

I would prefer to have everyone in the same boat. But my grandfather was a communist.

[Brat]

The real problem is that the cost of treatment of the uninsured is shifted to the insured or paying patients. *Hospitals aren't permitted to wheel the patient to the door when they can't pay, and govt isn't paying for the cost of care. *

Goes back to my plan for basic health insurance for all and if someone wants more coverage they can buy a higher level of coverage.

[Martha]

Originally Posted by MasterBlaster

The way I look at it is that yes we can trade downward in quality and immediate access to get much better universal coverage.

Maybe that's what we should move to however everyone should know and understand the issue(s) before we jump into something.

For most people that have coverage now that's a very hard thing to sell.

I have seen nothing to indicate to me that quality would suffer. How about us educating more doctors and nurses?

It isn't a hard sell to me in any event and I am concerned a lot of the hard sell is not based on fact but supposition.

[MasterBlaster]

Well I'm not going to get in a point-by point debate on healthcare... So this is my last post on this matter (at least today)

Yes we could trade all that hospital duplicate effort, insuarance company burden, for a single-payer more efficient system that would insure everybody.

However that efficient system may require people to wait to get that cat-scan or that bypass surgery because that efficient system doesn't have much slack in it.

And then just maybe they'll say that for certain chronic cases or advanced illness cases that they'll limit how much of a burden they can put on the system's overall efficiency.

To suggest that there will not be trade-offs is not realistic.

[Cool Dood]

For what it's worth, if you take a broader view then even in Canada not all parts of the healthcare system are socialized, and in general there's no problem with the parts that aren't: there are no waiting lines for medical equipment produced by Canadian companies; there are no shortages of food and freely exchanged health items (e.g. herbs), which can be bought cheaply and universally across the country (food is one of the most essential aspects of anybody's health -- should we nationalize that, too?). It's only the stuff that's done through the government where everything costs too much, is unavailable, and generally operates the way they do things in North Korea.

Originally Posted by Martha

Cool Dood, I am not quite sure where you are coming from. Are you suggesting subsidized healthcare for the poor and uninsurable? If so, I can live with that.

Well, yes, I think any civilized country should ensure that all of its citizens have access to basic life necessities.

I wouldn't be thrilled because subsidies are subject to whims of whatever government is currently in power. This is what Minnesota does and our Republican governor keeps trying to make cuts. The federal and state governments have cut back medicaid. You don't get coverage just because you are poor. Subsidies are not popular right now.

But then surely you wouldn't want to apply 100% subsidies to everyone and turn the whole system into something that's subject to the whim of a single provider? That's one of the benefits of everyone paying individually to individual providers (or insurers) instead of paying into one huge pot that pays one huge decision maker: if a provider in a multi-provider system makes dumb cuts that you think are idiotic, you can move to a different provider; in a free market, new providers can make a profit by providing service in a way you want more than some other provider.

There won't be a perfect solution for those who are too poor to cover their own expenses, and converting everybody else to the subsidy system is not something that will change that -- it will just subject millions more people to the whims of stupid politicians.

I would prefer to have everyone in the same boat. But my grandfather was a communist.

And I can sympathize with that feeling -- I think inside we all have at least a little bit of a communist, but good intentions don't necessarily make good policy...

[Martha]

Originally Posted by MasterBlaster

Well I'm not going to get in a point-by point debate on healthcare... So this is my last post on this matter (at least today)

Yes we could trade all that hospital duplicate effort, insuarance company burden, for a single-payer more efficient system that would insure everybody.

However that efficient system may require people to wait to get that cat-scan or that bypass surgery because that efficient system doesn't have much slack in it.

And then just maybe they'll say that for certain chronic cases or advanced illness cases that they'll limit how much of a burden they can put on the system's overall efficiency.

To suggest that there will not be trade-offs is not realistic.

Yes, both you and I have gone through this debate before and it is hypothetical so we can't reach a conclusion. So if you agree to a system of subsidies so that everyone gets insurance, I'll agree to that as a compromise.

[justin]

Guaranteed issue high-deductible health insurance for all. You pay a premium unless you can't (a la medicaid - income limitations maybe higher, maybe lower, dunno).

When you go to the doc, you pay the insaurance company negotiated rate.

Maybe throw basic preventative care in there with a copay.

I'm not happy about the current system, but feel it would be pretty fair if everyone paid the negotiated rates that insurance companies. Indigent folks could pay for a $5000 triple bypass surgery much easier than they could pay for a $30000 triple bypass surgery.

[sgeeeee]

Originally Posted by MasterBlaster

The way I look at it is that yes we can trade downward in quality and immediate access to get much better universal coverage.

. . .

I think this may be very misguided. Some of the analysis I've seen indicates that much of the cost and effort in our current system goes to heroic medical attempts to save the lives of people who are going to die within the next few months regardless of how the procedures turn out. I'm willing to give that up.

I think we have far too many medical administrators who look at a patient's records and say, "The important thing to remember is that the patient is fully insured." They then procede to run up astonomical bills. The motivation is clear. A medical system based on capitalism will find ways to produce profit -- not health.

[Brat]

Originally Posted by sgeeeee

I think this may be very misguided.* Some of the analysis I've seen indicates that much of the cost and effort in our current system goes to heroic medical attempts to save the lives of people who are going to die within the next few months regardless of how the procedures turn out.* I'm willing to give that up.

I couldn't agree more. We need to make the 'basic care' standard clear, if you want heroic measures you need to buy additional coverage.

[farmerEd]

Originally Posted by MasterBlaster

To suggest that there will not be trade-offs is not realistic.

As far as Massachusetts attempting to extend health-insurance to almost everyone in the state, I just don't see where that makes it "socialized" health-care. I live in Mass, I have a BC/BS policy that I pay for...more state money may go to subsidize private policies for poor folks, but it changes ZERO about my plan...I still have BC/BS...I still go to the doctors that I want. Even the folks that may end up getting it for free, also choose their doctors, and in some cases the insurance company they want to use.

Nobody is being forced to see a doctor that is on the payroll of the state...where is the "socialized healthcare"? I don't see it.

Both the highway system and the military are a lot more "socialized" than the plan being proposed in Massachusetts will ever be.

[tomz]

Originally Posted by sgeeeee

I think this may be very misguided. Some of the analysis I've seen indicates that much of the cost and effort in our current system goes to heroic medical attempts to save the lives of people who are going to die within the next few months regardless of how the procedures turn out. I'm willing to give that up.

According to many studies of healthcare costs in this country, 20-30% of the patients account for 70-80% of the cost. *Also, most of a person's healthcare costs come in the last year or 2 of one's life. *There are 46 million uninsured people under 65 in this country. *Hospitals can't refuse to treat someone without insurance. *Cost shifting to patients with commerical insurance is a common practice in hospitals to pay for care for the uninsured. *One of the reasons the MA plan got off the ground is that the costs for providing this care have gotten way out of hand.

Did anyone see the recent episode of the Sopranos where the ambulance driver who took Tony to the hospital was accused of doing a "wallet biopsy?" *He checked Tony's wallet to see if he had an insurance card. *Since Tony had one, he was taken to a decent hospital. *If he hadn't had one, he would have been taken to the county hospital and would have probably died.

If you are interested in understanding more about healthcare in this country, check out http://www.thehealthcareblog.com/the_health_care_blog/. *It has a lot of good info. *Just for the record, I worked in hospital information systems for almost 20 years so I've seen what's behind the curtain.....It's not something to be proud of.

[lets-retire]

!--The socialization protion comes in when the poor people think they are entitled to the same procedures responsible people receive. First it's life saving procedures (no problems), then it slowly becomes I need Viagra. Eventually it morphs into I need these breast implants. My insurance pays for all of these. I also have a full time job that required several years of education after high school. The poor who are working at entry level jobs, because they choose not to grow up and become a responsible citizens of the country, are not entitled to the same benefits I am. If they want the same procedures then go to school, grow up, and work your butt off, otherwise shut up and enjoy your poverty. You chose to live that life.

The military has seen that providing medical for everyone for everything is too expensive and has started to farm some of that benefit out. There are few military emergnecy rooms open 24/7. A lot of bases have gone to a clinic and refer patients to civilian doctors for operations.

As shown in the Soviet Union, if everyone receives the same benefits no matter how hard they work nobody has an incentive to work hard. Why work hard if your not going to get ahead?

[kramer]

For a lot of detailed information on health care policy and economics from a free market point of view, two economics professors from George Mason university keep up a blog at:

http://cafehayek.typepad.com/hayek/health/index.html

They allow anyone to comment and there are lots of interesting comments pro and con on each entry.

I thought this was an interesting factoid from an OECD study:

the percentage of the respondents in need of elective coronary bypass who had been waiting for more than three months was 0% in U.S., 18.2% in Sweden, 46.7% in Canada, and 88.9% in the United Kingdom.

I think many people do not realize that in a country like Britain, you still would want health insurance as an early retiree, since few want to be at the whim of such a system where care is rationed by forced waiting for even necessary procedures. My company employs many people in Britain and it offers them all health insurance as a benefit, just like in the US (although the employees pay much higher taxes in Great Britain according to the employee I transferred from there -- he and his family have decided to live here now).

I am assuming that someone posted on this board the recent NY Times article on how the Canadian health care system is coming apart at the seams? On the blog, there is a pointer to a 24 minute video on the Canadian system:

http://www.onthefencefilms.com/video/deadmeat/

I have not seen it (hey, I still work for a living), and obviously it is strongly opposed to their system. Maybe someone could comment.

Kramer

[sgeeeee]

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