I live in Ontario so I have social healthcare now, but if I could choose I think the semi-private or 2 tiered system is the best. If you have money and want to spend it on faster/better treatment, the option is there. If you don't you still get treatment. It may cost more overall to those who choose to use the private side, but you know that going in and have a choice. It's the lack of choices that bothers me the most about social healthcare. Sure the taxes suck as well especially if you don't regularly require the use of the services, but after a few years you become desensitized to that...
You and TX are correct, I have not had the pleasure, I rescind my previous statement about that being a benefit.
The "engine" of the financial crisis was the collapse of the housing bubble, and the housing bubble was largely an effect of government intervention in the marketplace to increase home ownership, especially among low-income families. To get lending institutions to give loans to people with bad credit (i.e., people who can't afford them) the Government had to offset the risks by establishing institutions like Fannie Mae and Freddie Mac. While corporate corruption is real and a factor, the sub-prime mortgage crisis would never have happened without the government interventions of the Clinton and Bush administrations. That is a different debate, however. I am not so much of a libertarian that I think we should let people starve to death, or lose vital care because of prohibitive costs. I am fine with the government paying for certain services, I just don't want them to provide them. As for the article you link in your second reply, I am not sure how it rebuts anything I wrote.
Apologies for going off topic, so I'll spoiler my response, but this is really just not accurate. Long answer: Spoiler Source: http://www.ritholtz.com/blog/2011/1...ow-the-facts-of-the-economic-crisis-stack-up/. "•Nonbank mortgage underwriting exploded from 2001 to 2007, along with the private label securitization market, which eclipsed Fannie and Freddie during the boom. Check the mortgage origination data: The vast majority of subprime mortgages — the loans at the heart of the global crisis — were underwritten by unregulated private firms. These were lenders who sold the bulk of their mortgages to Wall Street, not to Fannie or Freddie. Indeed, these firms had no deposits, so they were not under the jurisdiction of the Federal Deposit Insurance Corp or the Office of Thrift Supervision. The relative market share of Fannie Mae and Freddie Mac dropped from a high of 57 percent of all new mortgage originations in 2003, down to 37 percent as the bubble was developing in 2005-06. Nonbank mortgage underwriting exploded from 2001 to 2007, along with the private label securitization market, which eclipsed Fannie and Freddie during the boom – Source: University of North Carolina at Chapel Hill •Private lenders not subject to congressional regulations collapsed lending standards. Taking up that extra share were nonbanks selling mortgages elsewhere, not to the GSEs. Conforming mortgages had rules that were less profitable than the newfangled loans. Private securitizers — competitors of Fannie and Freddie — grew from 10 percent of the market in 2002 to nearly 40 percent in 2006. As a percentage of all mortgage-backed securities, private securitization grew from 23 percent in 2003 to 56 percent in 2006" Really long answer: go read "All the Devil's are here" - http://www.amazon.com/All-Devils-Are-Here-Financial/dp/1591843634
I'll third or fourth the Aussie 2-tier system, particularly after talking to many yanks in the past months where this had come up (I've been traveling for a while, and am currently in Boston). I've been interested in how your system works as I'm planning to move here for work in the near future. Being healthy and in my mid-20s I'm not overly concerned but shit can happen. In my personal experience with emergency medical care, which is minimal, I actually have received better treatment in the public system. Several years ago I broke a wrist in a motorbike crash and went to a public hospital where I was promptly xrayed and patched up. I then returned every 1-2 weeks for follow up xrays and consults. These were all digitized and kept on computer storage which saved lugging around films and everyone I needed to see was in the same hospital (radio, ortho and physio). I did not pay a cent for any of this. Six months later I was hit by a car (bike again) and copped a broken ankle. I went to a private hospital closer to home and had to wait longer, get traditional film xrays and see an ortho offsite. This inconvenient when you can't walk. They offered no physio followup, I had to seek and pay for my own, and also had xray and ortho bills. Some of this could have been covered by our public road insurance but I fell just shy of the threshold to claim. All in all it cost 6-700 to get back on my feet. I realise this is trivial compared to serious health problems, but I feel that treatment in public hospitals can be quite adequate and in some cases superior. I have basic private cover at home as I can afford it (and it offers a tax break on the Medicare levy) but have reasonable confidence in the public system as well. I think emergency health care is not something that should be denied to people simply because of economic reasons especially in a wealthy country. If you've got the cash to pay for treatment above and beyond a basic level then by all means go for it. However, all our health systems will need a shakeup in coming years with aging boomers who will come down with cancer, diabetes, cardiovascular and degenerative diseases in particular. All of these require long term, expensive treatment and will be a huge burden. Coupled with population growth plateaus (in developed countries) significant innovation in both treatment and care delivery will be needed.
I just had dinner with a buddy who had a really bad car accident in November. It wasn't his fault, and he racked up $250,000 in medical expenses. His insurance carrier denied the claim, and he was forced to sue. Now, essentially his life is ruined. He can't change jobs, move to another city and because he's potentially $250k in debt, he can't buy a house, another car or start graduate school. He's determined if he's on the hook for the full bill, he's actually better off unemployed because he could potentially claim financial hardship or bankruptcy. So, in addition to losing some of the function of his legs, he now can't buy a house, continue his education, and has basically went backwards in his contribution to society. The best case scenario is that he forces them to pay the claim (and the legal fees, adding at least another $50k to this clusterfuck's total) and he would still be on the hook for $20,000. A small price to pay for saving one's life, but the guy makes about $40k and $20k will take him years to choke down. This whole ordeal has probably ruined him financially and has certainly closed the brief window he had to advance his career, education and status. I say this to illustrate a counterpoint to the abusive user argument. In the private system, abuse is far more sinister and damaging, and it costs society tremendously in terms of lost opportunities and reduced capacities.
Out of curiosity do you know why, specifically, they denied the claim? That sucks balls though, I can't think of an insurance policy I've read (which to be fair is a limited amount of policies) that wouldn't cover that even if it was his fault. The only thing I can think of is if he has an HMO/EPO type plan, was brought to an out of network hospital and they somehow didn't code it as an emergency.
I feel for your buddy, but about 100 000 people are killed very year in the US health system by accidental infections. Most of these deaths are quite easily preventable by sanitary procedures, but they simply aren't followed in most hospitals. How on earth is this possible? Because there isn't a working marketplace in operation to put poor practices out of business. Look, when hospitals get their money from insurance companies or the government, they are incentivised to provide the services that net them the biggest payout from that third party, not what gives you value for money. Thus the healthcare sector is skewed towards more costly solutions, and an ever growing share of public expense. Also, bulk buyers like government and insurance companies tend to treat procedure X as fungible across providers and offer a standard payout, whereas there always exist many subtle quality differences between different providers. It is on these differences the selection of the marketplace operates, reproducing factors (including price) people value and ditching the ones they don't. If you love healthcare, set it free. The cost of LASIK has dropped 80% in relatively few years, the same could be done with just about every other procedure.
I see what you're saying, but I disagree with the use of LASIK, or for another example, fake tits as a comparison. You have several alternatives to LASIK, like contacts or eyeglasses. You can shop around for fake tits, even going to Costa Rica or Singapore to lower the total cost. When you break both your legs in a car crash in a rural area, there are few alternatives to the course of treatment provided and the value of services rendered will be extremely high compared to the alternative (y'know...death). I completely agree that the incentive process in healthcare is up-fucked, but realistically there is no perfect way to do it. There is a better way than relying on a completely private enterprise, because when it goes bad the complaint isn't "oh, some asshole spent a lot of the government's money on a preventable incident", it's "having an accident drop-kicked me into poverty and ruined my life." What I was trying to illustrate is the social costs of the issues with the public system are more easily absorbed than the private one. An interesting aside, my grandmother tried to do LASIK in 1994, and the doctor who did the procedure was inebriated and completely ruined her vision. She was legally blind from that day forth thanks to a complete fuck of a practitioner. Also, didn't the cost of LASIK drop because the technology got cheaper and easier to use? I'm not completely sold on the idea that the cost dropped because the government left it alone.
You don't need a freakin' marketplace to stop these practices. It's already happening; Medicare and Medicaid will not pay for infections caused in the hospital, and as a result, hospitals are now scrambling to put hand hygiene compliance measures in place. If insurance companies do not have to pay for infections caused by poor hospital practices, the hospitals will clean up their act. There is no good way to for a marketplace to effectively function for a good with an almost completely inelastic demand. LASIK is not a good example. A very large chunk of the services a hospital provides are either services that people cannot effectively shop for (i.e. emergency services), or services that people are ill-prepared to shop for (i.e. specialty services).
downndirty I didn't use LASIK as an example because I think it is comparable with a triple bypass in the realm of necessity for the patient, just as an illustration that prices on procedures can and do come down when the marketplace operate. You are absolutely right that the technology improved, but for people to innovate, engineer and adopt new technology, there must be an incentive in place. If LASIK had been deemed a basic human right, you can bet the farm these improvements would not have been found. I agree with you that it is important not to lose sight of social costs of lack of access to healthcare, such as being left in financial ruin due to an unexpected emergency. To use our friend hotwheelz as another example, the amount of care he will require to fulfil his (no doubt substantial) potential is probably above and beyond what any family can afford. As chronic disability is hard to cover by private insurance, there might be a market failure here, and I don't really mind the state stepping in such circumstances. In short, the problem isn't really some public spending to alleviate genuine human suffering, it is finding a way to avoid causing massive and large-scale human suffering by perverting the incentive process in the marketplace. It is to my mind proven beyond any reasonable doubt that intelligent design doesn't work in nature and it doesn't work in the economy. Knowledge is scattered and expensive, and we have no choice but relying on emergent order. Binary Government reform is without exception a slow, inflexible and cumbersome process because it relies on centrally noticing, finding, gathering and acting on dispersed and scattered information. That is why people had to stand in line to get bread and shirts in the USSR, and we have to stand in line to get healthcare in the West today. And there are no goods with a demand so inelastic that there is no competition. "Food" is inelastic because if you do not get it you die, but it is cheap because there is a relatively free market in place. While you can't shop around for emergency services after you have been hit by a truck, you can shop around for insurance providers before hand. Genuinely catastrophic events are the only thing you should insure against. Having insurance cover routine expenses is a recipe for dramatically inflated costs.