From what I've read, medicare's overhead is about 5.2% Administrative cost on most private insurances run anywhere from 10-12% So the over head on the federal program is minimal. I'll attempt to find the study I was reading and post it to back up these figures. Being disabled and having received medical care in several countries, I can only find fault in the prices charged in the United States. The care is fantastic, but it is no better then anything I received in Japan, France or Canada. The only difference I see is the actual cost of the ER visits and Medications. In Japan with NO insurance what so ever, my Ambulance ride, ER visit and a follow up the next day cost me about $350USD. This is Less then I pay after medicare pays its parts of my bill in the USA. Why can a Japanese Hospital charge $5USD for a drug, and Cleveland Clinic Charge $75-100? What justifies the change in price? Both of the drugs come from the same company, and the same factory even in some cases. They have the same ingredients. What the justification for Charging $500+ For an Ambulance ride? Why can the private Japanese system deliver the same care for a small fraction of the price it would cost me in the United states? Why Can Canada and France do it too? Why is the united states unable too? Ok, Obviously I would love the pre-existing condition stuff to be wiped away. I think it sucks because I can't afford the medical insurance I need to be a productive member of society. I can get a job, and be dropped from Medicare get sick and declare bankruptcy. OR, I can stay on SSID until I die. I'd rather be a productive member of society, trust me.
No, actually nothing changes. He assumed that I would get hit by a car or "Shoot my face off." While both are a possibility, they haven't happened. His assumption of possible future events does not make them correct. In the mean time I've paid an extraordinary amount in taxes over my life to enable people to have a free roof over their head, free food, and I continue to pay property taxes to educate their toe headed children.
Example: you get into a car crash and are knocked unconscious. EMS arrives on scene and sees you laying there. They're not going to check what kind of insurance you have, or if you're on Medicaid, they're going to stabilize you and take you to the nearest trauma center. Your treatment at the hospital, the ambulance ride, all of that is going to cost somebody money, and if you don't have insurance, who foots the bill? We do. Now, of course the odds of something like this happening are pretty small. Even over the entire lifetime of a person the odds are still fairly small, but they are non-zero. Which means a central planner mandating insurance coverage (or a public option, whatever you want to call it) isn't just efficient, it's also fair. EDIT: Shegirl is right, the car crash is a bad example because car insurance is mandated by law. But think about a world where there were no laws mandating that drivers carry insurance coverage. In a broad sense, that's what we have now with medical insurance (although by no means is the comparison perfect, I understand.)
link This is from the heritage foundation, which can be pretty partisan, so take it for what it's worth. The larger point, the way I see it, is that with something this complicated it's possible to skew the numbers any way you want. But my instincts tell me that the private sector will have much more motivation to be as efficient as possible than the government will.
Using a car accident and car insurance isn't the best example for this side of the argument because medical is required by law. As a whole, we all know any insurance isn't obtained for the expected but the opposite. If we could see into our crystal balls we would avoid trauma all together. Unfortunately mine often times is on the fritz. I have insurance to cover my ass for many things, none of which I can predict will or will not happen. Houses burn down, cars are totalled and people need medical care at some point. Toytoy, you mean to tell me that in the event of you getting sick with something really bad you're just going to wilt away alone in your house and not seek any care?
Yep. I've actually weighed the cost of health insurance vs. my quality of life. If I can't be my idiotic self doing something stupid, life really isn't worth living. It's simple mathematics. I can spend X amount every month for health insurance in case I get sick and immobile. Or I can spend that money having fun. In the end I'm pretty sure if I was lying in a hospital bed and pissed off at life I would not think the money spent to keep my ass alive in a hospital was worth it. It should've been spent on booze and strippers. They're much more entertaining then a hospital room.
I more or less agree with everything said here. Now, I might be a ruthless capitalist enemy of the proletariat, but even I am not suggesting that we reduce taxes to zero, jump in our money pits, and raise the prices of everything just so we don't have to look at the poor anymore. I think that the government could and should have a prominent role in health care and can do so without it becoming a nanny state. Sure, I think forcing everyone into a government-run medical program because some people are uninsured would make about as much sense as forcing everyone to live in a government-run housing project because some people are homeless. But catastrophic, oneoff events that occur rarely and are inordinately costly? Sure. It's the classic perfectly insurable case. Caring for people who cannot or do not take care of themselves? Absolutely. Public externalities such as inoculations for contagious diseases are yet another area where the government could and should step in. Transparency in drug manufacturing is another useful example of government involvement. But you still have to address the fundamental misalignment between supply and demand present in our current system, which none of the current proposals are doing. Allowing competition between states would be a big step forward. Why shouldn't companies be allowed to operate across state lines? Tort reform is another good example. Allowing consumers to choose between different regulatory environments will strengthen this reform. Healthcare tax credits and health savings accounts are another way to put the purchasing decisions back into the consumer's hands. If consumers aren't paying for products out of their own budget, you’re never going to get discipline in the market.
I live in Australia, where we have universal free healthcare. Like thatone mentioned earlier, doctors visits, hospital visits, surgery etc, is all free. I do believe we have to pay for ambulance transfers. There is the option of private health insurance, which I have never bothered to take out because our government hospital system works fine for me. Are there problems? You bet ya! In the state I live (New South Wales) we are almost bordering on a hospital crisis with a shortage of nurses and hospital staff. However, I can get into to see a GP within a few hours, and the longest I have waited to see a specialist was 4 weeks (partly due to the fact I made the appointment around Christmas.) If you receive welfare in Australia (which is a whole other issue) you are also entitled to cheaper medication via the Pharmaceutical Benefits Scheme. I received a student allowance when I was at university so I was entitled to the PBS. I was paying something ridiculous like $3.30 for 3 months supply of diabetes medication. It is so interesting to me however, that many of you don't see healthcare as a right. Yes, we pay a LOT of tax. (I think I'm in the 36c per dollar tax bracket) but I also know that if anything ever happens to me, I will be supported by the government health care system and our welfare system.
I don't understand the logic here. "Sure, I give $20,000 to the government, but I can see the doctor for free in a month." Again, this all boils down to how much freedom you're willing to give up for the security you get in return.
I think he's just trying to illustrate the absurdity of thinking of expensive, highly sophisticated services as being magicked to your local hospital by some government fairy. The government does good, just with other people's money. I don't have a problem with that in the least, but I think its an important point to make. Econ 101. There is no free lunch.
The first argument you make here has a technical name: moral hazard. The moral hazard is this idea in insurance where if you don't pay the full price of something you won't be careful with it. Think of the car you own compared to the rental car you used in Mexico. You don't give a shit about the rental car because you don't have to pay the costs of fucking with it. Moral hazard doesn't apply to health care. You don't gain any utility from the consumption of medicine. I'm pretty healthy right now. And chemo is worth a fuck ton of money. Yet I don't go on chemo. People ONLY consume health care when it is useful. There is pretty much never a time a consumer should go to a hospital and think, "I could get antibiotics for my staph infection but it's expensive and I have some polysporin at home." That, in my view, is a fundamental failure of a health care system, when people have to opt out of necessary medical treatment because they can't afford it. However, you also write about doctors over-prescribing medicine. This can (and does) happen. And the reasons it happens are really complicated. Part of it is the pay structure that exists with most private insurance in the US where the doctor gets paid for the health care he provides, not the health care he doesn't, which creates a strong incentive to stick patients in MRI's unnecessarily (usually by telling the patient they "need" to). There are also a bunch of problems with the way malpractice works where doctors have strong incentives to never miss anything for fear of getting sued which causes doctors to over prescribe tests. From what I have read, there are some places in the US (the Mayo clinic, apparently) where these things are pretty much not a problem and doctors don't over prescribe. As for regulations, I'm sure you would love to live in the 1800's when half of the medicine out there was snake oil and you didn't know what had mercury in it. All those regulations exist for reasons. A free market where you can sell anything as medicine would be a fucking death trap. And one thing about this that people often misunderstand: spending more on health care isn't necessarily bad. It makes sense to spend a continually larger percentage of GDP on health care if you get sufficient benefits from it. Most modern procedures that are super expensive have real benefits, that, if you value a life high enough (I have read figures for lifetime QALYs at 7-10 million) are worth it.
Out of the vast majority that are uninsured, they choose to spend more money on non-essentials than what it would cost them for basic health insurance (new car leases, expensive cell phone plans, booze, etc). Simple argument 1 There has never been a government funded operation that has run as efficiently as its private counterpart. Simple argument 2 What is not to understand? People nowadays feel entitled to the belongings of others because we have enabled that attitude and have been gradually cultivating it over the past decades with all the free handouts. When doing charity work in lower income areas, I have people demand I buy them and their kids the essentials (food etc.) while they spend their entire paychecks on luxury items (big screen tvs, new rims). It insane.
Your argument could extend to any use of tax dollars towards any cause in which not every single taxpayer benefits, which, I'm sorry to inform you, is the way EVERY government expenditure works. Why should a hick in the hills pay for a road near your house? He sure as hell doesn't have a car to drive on it, and he doesn't directly benefit from you being able to, and yet that is what his tax dollars go towards. Why don't you just condemn the whole system of taxation while you're at it? Or the system of insurance? Both are ALWAYS spending the funds of the population towards the needs of a smaller subset of that population, so your complaint applies equally. The logical conclusion to the thought process you've stated is to eliminate insurance in its entirety, eliminate government programs in their entirety, eliminate taxation in its entirety, and revert to a tribal form of a series of microgovernments in which each person spends money ONLY on what they need/want to without any sense of community spending towards greater goals. The United States has far too large of a population to be able to sustain such a non-government, and, were the people to accept such a set up, the country would simply dissolve and cease to exist. You, in essence, are making an argument for stone age, pre-community economics. Hell, the model of economics your argument supports isn't even as sophisticated as multicellular organisms are to biology.There's a reason you're much bigger, stronger, smarter, and more capable of accomplishment than an amoeba, and yet here you stand proposing amoebas to have the right idea. Quite frankly if you don't like the government spending your money then you don't have to give the government your money, but you'll probably wind up in prison "living off of the hard work of others.".
I don't understand how you can say moral hazard doesn't apply to health care, especially with what you say later in your post. Of course there's a bunch of unnecessary health care I would get if someone else was paying for it and it was completely free to me. Every time I get a cold I would get free drugs for it instead of riding it out. And while I may seem pretty healthy, if it was free I would go apeshit hypochondriac and get a barrage of tests to find out for sure I don't have some lurking tumor or anything. Now obviously I wouldn't get life-saving surgeries when I don't need them, but there are plenty of health care services I can take advantage of if they're free that I wouldn't otherwise.
My main concern with reform is how it affects healthcare professionals and the quality of treatment patients receive. 1. Do you really want the government in control of your healthcare? I agree; Private Insurance does a shitty job. I can't count the number of times Insurance Physicians Who Haven't Treated a Person Face To Face In Years And Probably Have Basic Knowledge About Orthopedics or PT denied treatment that led to a condition/injury worsening. Some of our patients are in physical therapy in order to avoid surgery. Some, thanks to insurance, have appointments cut off at 10 or 12 visits when they haven't fully addressed the specific issue. So, actually these Insurance Cos are costing everyone MORE money because they now have to pay for surgery and post-surgical rehab. Conversely, I've seen insurance companies approve patients for 16 visits when their condition calls for 4-6. I wish we could give their unused visits to people who really need them. Insurance companies are the devil. There's no logic involved. I despise them, and I loathe anyone who intelligently chooses to work for them. But, why would someone outside of the private sector have any incentive to do any better? Government has already fucked up our schools and education policies. I fear giving it control over healthcare would result in a situation 10 times worse than our current one. 2. If the bill passes I picture everyone with Medicare, and that scares me. Medicare pays a considerable amount less than insurance, and it comes with a LOT of laws and regulations that don't always make sense to either the patient or the HC professional. Less coming in = salary cuts and downsizing (which would probably result in a lower quality of treatment). As someone who's taking out loans for a doctorate I have little to gain financially as things stand right now. Obviously, I'm not doing this for the money. Unless I get into administration or manage my own clinic I will never make enough to justify a doctorate. I will be paying off student loans for the rest of my life. I can't imagine cutting my maximum (but still realistic) potential salary by a fourth and having those same loans. I'm not sure if it would be worth it, and I would reconsider my career plans. I think a lot of people would. I don't like insurance, but our current solution is terrible. There has to be a better way to change. I despise what my government is doing to my generation and the next.
Clean water is a right Access to education for children is a right Why shouldn't access to health care be a right as well?
I am skeptical of this. It might be true, but I suspect it's not true right now. There aren't magic cold stopping drugs that both work and are super expensive so you otherwise wouldn't get them (if they cost $10, it would be an efficient outcome to buy them and not miss a few days work where you would produce more than $10 worth of whatever it is you do). And maybe you would go apeshit hypochondriac for a bunch of free tests, but they're not free, even if they don't cost any money. They use up your time and aren't fun. I mean, if you could sign up for a bunch of free colonoscopies, would you? You have to fast for 24 hours, take a really strong laxative and have a probably very unattractive doctor stick a camera up your pooper. I will get them every three years once I hit 40 and will hate every minute of it (I am, through my parents, predisposed to colon cancer; most people need tests every 5 years after 50). Medical tests are overwhelmingly unpleasant. Perhaps if plastic surgery was included in universal health care people would just do that for fun. But it's not, and I don't think anyone is advocating it. Except for the very few actually crazy hypochondriacs, I think there is no/very little patient driven moral hazard. Doctors have problems with over prescription, but those can be solved with the right pay structure and regulations.