The article does raise an interesting point in that most people don't necessarily see food as an inalienable right that people shouldn't need to pay for.
But to counter that point our government has set up a system of farm subsidies and management to ensure affordable food is available to pretty much anyone... and even those who don't have the money get food stamps.
Seems like the government tries to do the same thing with the health sector, yet it still costs more than most people can reasonably afford. It seems like there are clear market pressures and competition in food production that drives the price down to a minimum. That does not seem to be the case with health care.
I thought that was an interesting point as well. I'm having trouble coming up w/ full argument but one point is that there's huge differences btwn food and healthcare.
When you only have $20 to spend on food for the week, you don't need to go to the government for help. You can cook and eat rice and beans all week. That's what I did in college.
The difference w/ healthcare is there's no rice and beans of cancer treatment or ER visits. People aren't regularly given a decision between death and going to a fancy restaurant.
It's pretty easy to institute the life changes needed for you to go from not having enough food to survive on a daily basis to having enough to survive.
You can't go from not having enough to treat cancer to having enough to treat cancer easily or ever in many cases. This is like saying FEMA should be a for profit institution. Getting cancer is no different than having a tornado level your home. No amount of picking yourself up by the bootstraps will get you back on track. This is why we have a social safety net. Healthcare is no different.
There is no right to food in the US. But there sure as hell is in the majority of the world [0]. It is widely agreed that you shouldn't need to pay for the minimum amount of food to survive, the rest is gravy.
As for the way costs are different in the health sector :-
With food it is a very simple supply demand structure with limited demand and low and predictable skill required for supply.
Health has a near unlimited demand, high and unpredictable skill is required for supply.
Farm subsidies aren't a bad idea, either. There are advantages to retaining food production within your borders, and without them, you'd probably be importing a lot more of what you eat and there are security risks there. Food has downward pressure on pricing due to external markets, and subsidies address that.
Healthcare has no such external downward pressure on pricing. The vast majority are not going to import their medical care from Mexico, South America or Asia because it's expensive at home. If you as a government want to increase access by reducing prices on healthcare, you simplistically have two ~~options~~ (edit: methods). One, increase the supply side, more facilities, doctors, and critically, more training for those new doctors (that's a big bottleneck now, since residencies are almost all funded by medicare, and that limits how many med school slots can exist initially). Two, create a taxpayer funded single payer system - a monopsonist, who is by definition not a price taker. Realistically you need to implement both options, since #2 can only impose price up to some economic limits, and those limits are determined by #1 since the current health system can't actually service everyone without significant sacrifices around wait. If you implement #2 fully and #1 to the point where you have capacity to treat everyone that objectively needs care in a timely manner, then you've implemented a functioning right to health care.
Lots of economic handwaving in there for sure, but that's how you extend the farm subsidy parallel to healthcare, and realize it's much more complicated for healthcare.
First of all some people do think food is a right !
Second generally speaking all but the poorest can at least find some kind of food to purchase or get donated even if it's not perfect
For healthcare it's totally different with treatments costing thousands of of dollars plus, doctor visits out of the question without insurance for many (and even with) and monopolies on drugs and treatments contributing to vastly higher prices in the US than many other countries.
We may not have "death panels" but we definitely have insurance "no-men" aplenty (and high deductibles) to effectively deny people (especially the poor) decent care
This article is pretty wrong IMO there is no example in the US of "free-market" care to compare anything to.
I would say the government is doing something similar, but still mostly different. The overwhelming majority of food decisions still involve end users economizing on resources and providing quick feedback, etc. People mostly understand what they can do to reduce their food costs, and what the tradeoffs are, and obviously-inefficient providers are quickly spotted and competed away.
While not some kind of "pure" free market, it retains the basic form of one, where the government adjustments are the exception, not the rule.
In contrast, the government's role in health care is pretty much defining the system, and you don't have most of the market mechanisms that exist in health care: where people are "doing it wrong", it's not obvious at all, but hidden behind various layers people just accept as given.
Despite any implementation problems, I don't believe that someone should have a worse chance of keeping their life in the face of disease just because they are not as wealthy. That alone means that society is considering some people's lives more important than others, which is not a society that I would like to live in.
>That alone means that society is considering some people's lives more important than others
No it doesn't. Healthcare does not happen through some fictitious consensus of "society". It happens through individuals interacting one with one another and forming a natural order. To claim that healthcare is a "right" ultimately means healthcare providers are slaves.
It's incredibly difficult to rectify free will with every person is equally valuable. The correlation of that is all behavior is equally virtuous, be it reading, getting high, or punting babies off bridges.
I would settle for a communally accepted floor we don't let people fall below.
But life isn't fair. We didn't create this problem, it just is. What we can do is work on solutions. So what are those solutions? You can't bury your head in the sand and pretend that the worlds resources aren't finite.
This. This is the crux of the issue in discussions such as this. Of course we all want Utopia. Just because some of us have disagreements about how to get there doesn't mean that we're heartless bigots.
(I'm not implying anyone in particular here has said this, but this is often where these discussion end up).
The conclusion of the article is a bit ridiculous. tl;dr healthcare isn't a right because we can only spend a finite amount.
Yeah, ok, but that dismisses priority entirely. Scarcity is still in play, so you treat the immediate needs first. I think we do have capacity in the healthcare system to do it that way. The author of the article basically bucketed a sprained ankle and a stroke in the same category, and concluded, nope, we don't have enough money to treat all that cancer, heart attack, stroke and scrapes and bruises equally, so it can't be a right. I guess, but who's really arguing for the right to get an ace bandage right now? Just because we have to prioritize access doesn't mean healthcare can't be a right. Today we prioritize by medical need and by who can pay. Single payer means everyone can pay, so prioritize by medical need. The right can be subject to objective need.
I agree the author makes the wrong inferences from the situation, but her points do often go overlooked in the debate: people make a big deal about "omg, someone died because they couldn't afford [more] health care", even though this will always be true, in every system, even the best ones -- you can't save everyone.
(Similarly, the rhetoric around "death panels" was toxic made this insight harder to accept.)
Medicine is but one of many areas where you can do everything right, make all of the right decisions, and still end up with the bad outcome. I've never accepted it as a good reason to not try to achieve a goal that I otherwise think to be a good one.
The other obvious example is law. Everything can be done correctly and you may be right, but nobody commands the jury. Yet there it is, the 6th Amendment (if you're in the US, that is), with that right to a lawyer in instances where you may be deprived of life or liberty!
I've had the opposite experience. When talking about the problems of the US health care system compared to national health systems, the number one thing I hear is that ours is much more expensive and achieves worse results. One of the primary motivations behind people who want to nationalize health care is to reduce costs. Everyone is thinking about costs.
The comparison to food is misleading. With food, there's an aligned interest. People go to the store and buy your product. If they aren't satisfied, they buy something else. With health care, most people have few choices. They get whatever plan is assigned by their employer or whatever they can afford within their limited market, often one or two possibilities. Then they go to the hospital, often the only one in the area, which in most cases won't tell them how much it will cost to be treated.
There's no free market, no choice, no aligned interests. The interests of the insurance companies are aligned against them. People are paid to deny as many claims as possible. It often takes years of legal battles to get anything paid out, even when it's legitimate.
Because even preventative care is unpredictably expensive, most people wait to be treated until the problem is most expensive to treat.
>I've had the opposite experience. When talking about the problems of the US health care system compared to national health systems, the number one thing I hear is that ours is much more expensive and achieves worse results. One of the primary motivations behind people who want to nationalize health care is to reduce costs. Everyone is thinking about costs.
Yes, you can reduce costs and get more per dollar invested; it's still a fallacy to believe that one system will eliminate the problem of people dying because someone refuses to throw further resources at them.
Basically, the article is a strawman fallacy. It paints national health care supporters as people who think, as you said, that health care as a human right would mean that everybody gets treated no matter how expensive. Nobody thinks that. The goal is to reduce the amount of people who are sick and dying as much as possible. We have data on that in the form of the performance of various systems and their impact on health.
The US is still the world's economic superpower, but it's health care system is rated below Dominica and Costa Rica.
So was I just imagining all the people repeating the line that 'no one should die because they can't afford health care'? Or do you not see how that condition also exists in all the countries that do it right?
>The US is still the world's economic superpower, but it's health care system is rated below Dominica and Costa Rica.
What is this replying to? What did I say that contradicted this or suggested otherwise, or merited a re-run of "everything wrong with health care in the US" as if I disagreed? I was addressing a specific fallacy, not somehow claiming that everything the US is wine and roses.
That low ranking is related to the first thing you're saying. It's what drives advocates of national health care, not the idea that nobody will die.
When people are talking about deaths of people who can't afford health care, they're talking about people who don't have the resources to ever get care, the people who don't catch things in the early stages when they're easily treatable and find out too late that their condition has become terminal. The point of national health care isn't to eliminate all treatable deaths no matter how expensive, it's to improve care and accessibility so that it's in a place that aligns with the resources society could reasonably support. When we look at much poorer nations being able to provide much better care, we see that there's a problem that needs to be addressed. That's what people are talking about, not eliminating all deaths.
Those are all great, subtle distinctions to make. They're also completely different arguments from, and not at all conveyed by "lol poor people die from lacking health care in the US but not Europe".
But it's not a business, not in its current implementation. Right now it's a implicit government protected monopoly for lots and lots of things. Case in point: EpiPens which are in the news today. When the government makes it hard to develop alternatives but doesn't pay for the monopoly it creates, it's neither a business nor a right. It's a disaster yet that's where we find ourselves today.
"People need a lot of things. You’ll die without food long before you’ll die without health care, and yet few people say we need to “take the profit motive out of farming”."
"Why is health care Special"
I tell you why healthcare is special. You cannot buy healthcare at the cost of food. I can buy ramen noodles and survive for cheap. Sure it is not the best but I won't frikin die. But If I get cancer and cannot afford a 100k Bill (yes, I know a family member who got that bill) , I will die. See ?
Again, people are talking about making Healthcare a right in America is mostly due to the fact that it is too expensive and difficult to deal with. If that was not the case and healthcare becomes as cheap as food, I bet people will stop the whole "healthcare is a right" movement. I would.
EDIT: Read this fun fact [0]. The average cost of health insurance is $17,500 PER FAMILY . Now this means that you may get covered for diseases such as Cancer but that does not mean you won't get a huge bill even after insurance. Now imagine you had no insurance and you get cancer.
Compare this to average cost of food [1] for a family of 4
Try to eat ramen noodles for the rest of your life and see how your health goes. Most health issues today are directly related to diet. However, processed food and snacks are much cheaper (ramen noodles) than healthy alternatives. McDonald's is a lot cheaper than going to the store and cooking a meal. So no, food is not cheaper when you try to compare it against healthcare.
I used ramen noodle as an example. There are plenty types of food that you can buy for cheap. Are you really telling me that for a family of 4, your grocery bill will be $1500/month ? That is the average cost that I was paying out of pocket for a good plan (with low deductibles etc). And yes, I have kids which makes it absolutely critical to have a really good plan.
My grocery bill for 4 of us goes about $500/month and that too when we are not really into coupons and stuff.
I wasn't arguing healthcare, I was arguing your analogy. Food is a right but so is air. However, the quality of it drastically affects your health. 2 major points...cost of healthcare is insane, and paying $500+ on food is a car payment which is a lot for families which children in central and southern U.S. Often highly processed food is pretty cheap in which you are able to buy higher quantities of but is not so good for your long term health.
I hear this argument continuously, but it does not convince me. You imply that McDonalds is bad. Why is it so? Mostly because it's very calorie dense, not because it's actually bad for you. In that respect, McD does its job very well, too well even, but it's not the food itself that is bad, its over consumption.
How bad are ramen for you anyway? Consuming it as a large part of your diet, within your caloric intake and getting the rest of your needed vitamins from different sources (fruits, supplements even), would you get sick with time? Why are certain foods labeled as "bad" automatically? t seems this gets repeated Ad nauseam but most always, the accusation is unsubstantiated.
It is encouraging for me to see my opinion on this reflected in your comment, I find it very worrying that it is so common for people to seemingly blindly accept the popular narrative on this issue. (Well, I guess I find it worrying if people seem to blindly accept the popular narrative for any issue, really).
Are you trying the imply that eating a double bacon cheeseburger with a coke and fries is healthy for you?? I do agree with you on consumption, but when was the last time you heard of someone having health issues because they over ate on fresh fruits and vegetables? In my comment I was more referring to farm fresh compared to the highly processed food that is much cheaper.
That's not true -- for any given health situation, there is a range of options, with different resource costs and different health benefits and risks (some strictly worse in all respects). It's not like Moses comes from the mount with tablets that say "the only way to treat that condition is with this resource that happens to cost exactly $100k".
(Obvious caveat about what options you can consider in emergencies.)
The average American can live a relatively healthy lifestyle off of $10/day in food expenses preparing their own meals (unless you live in high-cost regions). The majority of cancer diagnoses occur after 50 years of age.
Assuming you start earning an income at the age of 20, if you stuck $10 under your mattress daily (the same amount that you could for relatively healthy meals) you would have $109,500 by age 50. Switch to health insurance (found a plan in my state for $129 that does provide for cancer coverage - your situation may differ) and throw the rest into a dollar-cost-averaging investment account and the situation is even brighter.
There's a difference between "too expensive and difficult to deal with" and "I have no plans in place to deal with it nor the desire to implement them". And while that makes sense (most humans are hungry at regular intervals and sick at irregular intervals and thus budget accordingly) you shouldn't pretend like the average citizen is ever prepared for anything outside of their routine - with the exception of buying "gifts" for themselves, which they are more than capable of budgeting for.
I think our system is far from perfect, but if you're going to pretend that the cost of food dramatically outweighs the cost of paying for health care I really worry for your health due to lack of nutrition.
Health care should probably not be a right, but universal heathcare has a lot to recommend it from a social and economic policy perspective.
For example, people who can't afford to see a doctor will eventually end up in the ER, at enormous cost that can't be recouped, and that could likely have been prevented.
Also, having a maximally large healthy working population is something that has a direct economic impact
>...and Health Care is how one stays alive, therefore health care should be a right.
Non sequitur. 'Right to life' means that no one can interfere in a normal functioning of your body without your consent. It does not mean that someone has to interfere in order for you to stay alive.
If I truly have such an absolute right to life, then the State should expend infinite resources in order to attempt to keep me alive forever. No expense should ever be spared.
"People need a lot of things. You’ll die without food long before you’ll die without health care, and yet few people say we need to “take the profit motive out of farming”."
I'll say this too when I get a $65,000 bill at the grocery store.
The current problem is the pricing is completely non-transparent hence consumers cannot choose based upon price. No one knows what anything costs until a bill arrives much, much later. In addition, it is extremely opaque how the numbers on the bill are arrived at.
That's not the only problem. For example, another problem is that consumers cannot choose based upon price because they are frequently in an emergency situation. Another is that they can't choose based upon price because they are locked into a health insurance plan which negotiates reasonable prices only with preferred providers.
There are no free markets where price transparency doesn't exist.
Even surgeons can't predict what prices will be for a procedure.
Healthcare, because of the complexity of understanding how the body works, is a natural local monopoly.
Are you going to shop around for a better deal on a quadruple bypass when you already trust your surgeon? How would you know if the cheaper surgeon was as good?
Healthcare insurance suffers from the classic agency problem and has no incentive to keep costs low over the long term because they take ~7% off the top for a pass through transaction.
Health care is not a right, neither is education, food, or access to the internet.
These are all things that people at some point or another have claimed as "inalienable human rights".
There is always a cost benefit analysis here. Should we perform this extremely expensive treatment to give somebody a few days in agonizing pain, or maybe save a few dozen other people with a simple, straightforward procedure?
The painful part is realizing that no matter what, people with more resources (money or otherwise) will have better (and longer) lives on average then people without resources. There is no way to legislate that away. See Venezuela for an example of that.
> Should we perform this extremely expensive treatment to give somebody a few days in agonizing pain, or maybe save a few dozen other people with a simple, straightforward procedure?
Does the current system in the US evaluate that?
We could also go back to feudalism, people accross history and the world have gained rights against the wealthy minority, and I think healthcare for everyone should be something US citizens fight for now.
(It's a bit of a marxist reading of history, but in this case it works)
Did you read the article at all? Evaluating the cost/benefit analysis is completely toxic and forbidden completely.
The NHS does that and denies it, and the last election they tried to call Obamacare "death boards".
We are in fuedalism right now, we just don't recognize our lords as explicitly.
And you can't "fight for healthcare for everybody". Healthcare is a scarce resource, and not everybody gets it. It's the nature of scare resources. If you have to provide healthcare to all, something else will get cut. Education? Food subsidies? Housing stipends? You pick your poison and don't think that we can just produce things out of thin air.
And the two marxist societies in the world are suffering. (DPRK and Venezuela) They've only been able to make everyone equally miserable, except for those in the ruling party.
That's not an either-or situation. Health care, food, clothing and shelter are rights and businesses.
The rights are positive rights, in other words they must be provided, and cost resources to provide. (In contrast to negative rights like freedom of expression, where it costs resources to take the right away from you)
As positive rights (aka obligations), they must be rationed. Welfare et al provides enough money to pay for basic food & shelter but not for caviar and mansions. The article is a very reasonable discussion of why it's harder to ration health care, but the conclusion (and title) doesn't necessarily follow.
This idea of "positive" rights is a dangerous, illiberal notion. Who incurred an obligation to provide healthcare to others? The answer is no one -- not individually or collectively.
Healthcare is a service, like any other service performed by human beings in society with one another. If it isn't performed as charity, then it is performed when the parties involved strike a deal. The alternative is that one person's "positive right" is another's positive slavery.
Agreed. I think it's a little damaging to use that word.
If it requires someone else to provide it - it's NOT a right because that would infringe on another's rights. It's that simple.
It may be the right thing to do to provide it inexpensively, however.
At the same time - so many people don't exercise, eat crap, get obese and diabetes or other preventable diseases and then overload the system with expenses. I'm not sure how you solve this issue.
Me neither, not completely anyway. But there are dozens of things I think might help.
-Make medical debt non-dischargeable if you incur it without insurance. (Encourage everyone to make an accurate accounting of the risk they are putting on themselves and the system without insurance).
-Require price lists of common procedures and tests from providers. (Competition on price).
-Close the medicaid gap.
-Publish insurance standards and require providers to accept all insurance that meet those standards. (This would allow smaller players into the insurance market spurring competition -- it would also be very difficult to pull off -- perhaps tie it to providers that get federal money in some way).
-Incentivise staying healthy by giving rebates for good health.
-Incentivise not using health care by giving rebates for not using it over some period of time.
-Incentivise shopping around by giving rebates based on finding providers/treatments/prescriptions that are below the average. Penalize those that are above some threshold by dinging future rebates.
And on and on. I don't think there is one solution. I think we need to try a bunch of things and keep what works.
> People need a lot of things. You’ll die without food long before you’ll die without health care, and yet few people say we need to “take the profit motive out of farming”. (...) Why is health care special?
Why is healthcare special? Because juicing someone's wallet when they are down on their luck is one of the worst things you can do.
Yes, healthcare is not cheap. And the resources we have to pay for it are finite. We don't understand everything, and ultimately we will all lose the battle to death.
So why do we fight? Because we want to live. And most of us want to see those whom they love live too.
The money argument is especially bad though, because in terms of outcomes (whether you measure longevity, or not dying of preventable diseases, or not getting more messed up during treatment), the US scores pretty bad. Yet we spend the most of any country (per GDP)[1]. Other countries such as the UK, France or Germany spend less, do contain costs and have better outcomes.
What making it a business does is reduce overall efficiency. If the major actors have the ability to take advantage of the final customer's weakness while maintaining a fiduciary responsability to generate profits, then money that is spent for the purpose of getting well gets diverted into pure profits.
Exhibit A: drugs. In France drug companies negotiate a market price with the payor (government). They are still able to turn a profit in that market alone. Not a huge one but decent. They then take the same drug, patent it in the US and sell it for 4x to 6x the price. Keep in mind the R&D was already paid for. So that is pure profit (minus marketing and regulatory compliance costs).
It'd be nice if we were in a place where the main ideas in this article, providing the health care people can afford and no more, were somewhat applicable. Unfortunately people in the US literally cannot afford any health care of any kind, aside from over-the-counter items like Band-Aids and cough syrup and those kinds of items won't get you very far. Forgetting this, or leaving it out of the article entirely as the author of this article does, is dangerous and misleading.
It seems obvious but the article forgets to mention that since health care is so expensive and no one can afford it, everyone buys health insurance. Even health insurance has become expensive to the point that no one can afford it, people need a larger organization to help purchase this insurance on their behalf (like their employer or now, the government). Now we've reached the point were even that has become too expensive. The guy in the cube next to me broke his hand skate boarding and is spending almost 1/10th of his salary on covering the cost and he's employed.
For sure, the history of health insurance and health care in the US is complicated and it's not as straightforward. But that is where things are today: unless you are wealthy or work for a wealthy company, health care is the kind of expense that can balloon out of control, despite purchasing insurance. In my opinion, that is what people object so vigorously to: spending money on health insurance (and a lot of it) and still having to miss car and mortgage payments so that they can give more money to doctors and pharmacies and hospitals to keep their spouse or children or themselves alive. You can choose to skimp on food, few of us would choose to willingly lose a loved one because "we can't afford it."
If I had to choose what should be made non-profit, my first choice would be insurance companies. By definition, for-profit companies would like to make more profit every year. There's a clearly unhealthy co-dependency between insurance companies, pharmaceutical companies and hospitals. Fixing it all in one swoop is probably impossible, but one way to make health insurance non-profit is to make it government run. We can't seem to get that done, so now the government is trying to join workplaces in helping people to buy insurance. It's the simplest and probably the only legal solution so that's the one that is being pursued in the US. We'll see how it goes.
The question the article is asking isn't matched by the headline, or the conclusion. The points raised in the article come down to this idea - if we, as a society, want to make sure everyone has access to health care, then we need to decide how to handle the limited resources available. That's true whether you think of health care as a right or not.
When you have a NHS you are agreeing on a single standard of care as a nation. The problem that the author illustrates is that it is difficult to have an honest dollars and cents conversation about what that standard of care should be. It certainly can't be 'whatever is necessary at any cost' without bankrupting the program. Where the dollars do get spent will be determined by political expediency rather than individual choice. As with most government programs the incentives will be with what's popular rather than what is effective. Politicians will get elected to put more money towards $cause of the day$.
Also consider the moral hazard involved with national healthcare combined with our two party system and electoral process. Who would be surprised if Iowa and New Hampshire end up with more hospitals per capita than other states? What if CA and NY end up with a lions share of the healthcare dollars? What if they don't?
IMHO, the right way to run a NHS for the US would look very different than the UK's NHS. Perhaps something similar to a minimum wage. I.E. A federal minimum standard of care that is uncomfortably low, with state and private coverage able to build on top of that as determined at a local level. But we have to be able to look at something like a "death panel" and say 'yes of course that would be necessary'. Until we can have honest conversations about varying standards of care, we won't see meaningful healthcare reform in the US.
> You’ll die without food long before you’ll die without health care, and yet few people say we need to “take the profit motive out of farming”
Yes, and the reason few people say that -- even while people do argue for regulation to limit certain commercial practices in farming that they view as harmful to food availability, affordability, and/or quality -- is because you don't see monopolies on basic foodstuffs in the developed world being used to drive prices on foods that people rely on so high that many people, even with the safety net provided by government, can't afford essential foodstuffs in a first-world nation like the US.
That is, because, problematic as it is, the combination of private for-profit business and government regulation operating in food markets is working adequately well, such that people are less likely than is the case for healthcare in the US to perceive that the model under which it is provided is broken, inadequate for the needs of society, and essential to fundamentally reform.
History has shown, more than once, that when the systems of delivering food are perceived to be as broken as the US system of delivering healthcare is now perceived to be, people do clamor -- often violently -- for change.
The government pays farmers to burn their crops, as to destroy competition and raise prices. The government, with the ACA, taxes insurance companies great amounts and uses that money to pay for the government care; the quality of the company's care goes down, then.
I know everyone's busy re-iterate the usual health care talking points, but I this part interesting: McArdle says that she went on to a British talk show to talk about NHS and Obamacare, and the host and opponent both refused to deny that NICE does what it actually does: a CBA on treatments and recommends for/against them to the NHS.
(Obama tried to set up IPAB to do the same thing.)
>>...Britain had achieved cost-effective treatment for everyone, at the cost of some people missing very expensive treatments that might help them. I was rather congratulating myself on this answer, because NICE is beloved of health wonks everywhere; Obamacare’s Independent Payment Advisory Board (IPAB) is an attempt to sort of replicate it. Pointing out something the British health system can do that the American system can’t, and doing so in dryly factual tones, seemed like a good way to endear myself to the British audience.
>>The other guest, a British health official, interrupted to basically accuse me of lying; the British health system, he said, did no such thing.
>>Now I reiterate: I had not called NICE a death panel, or said that it was bad; I had simply described what NICE does, which is keep the NHS from blowing its budget on very expensive treatments that deliver relatively little value per pound spent. You can read NICE describing what NICE does on its website; the description is not significantly different from the one I gave. Being told that this was flat out wrong was surreal. Things got even more surreal when I began again to explain what NICE does, thinking that perhaps I had been unclear, and the host interrupted me and said something like “As you know, that’s false.”
But that should validate the difficult politics of health care -- even in a country that gets it (mostly) right, it's because everyone has incorrect beliefs about what it actually does and how it actually controls costs.
Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.
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[ 3.1 ms ] story [ 129 ms ] threadBut to counter that point our government has set up a system of farm subsidies and management to ensure affordable food is available to pretty much anyone... and even those who don't have the money get food stamps.
Seems like the government tries to do the same thing with the health sector, yet it still costs more than most people can reasonably afford. It seems like there are clear market pressures and competition in food production that drives the price down to a minimum. That does not seem to be the case with health care.
When you only have $20 to spend on food for the week, you don't need to go to the government for help. You can cook and eat rice and beans all week. That's what I did in college.
The difference w/ healthcare is there's no rice and beans of cancer treatment or ER visits. People aren't regularly given a decision between death and going to a fancy restaurant.
You can't go from not having enough to treat cancer to having enough to treat cancer easily or ever in many cases. This is like saying FEMA should be a for profit institution. Getting cancer is no different than having a tornado level your home. No amount of picking yourself up by the bootstraps will get you back on track. This is why we have a social safety net. Healthcare is no different.
As for the way costs are different in the health sector :-
With food it is a very simple supply demand structure with limited demand and low and predictable skill required for supply.
Health has a near unlimited demand, high and unpredictable skill is required for supply.
[0] https://en.wikipedia.org/wiki/Right_to_food
Healthcare has no such external downward pressure on pricing. The vast majority are not going to import their medical care from Mexico, South America or Asia because it's expensive at home. If you as a government want to increase access by reducing prices on healthcare, you simplistically have two ~~options~~ (edit: methods). One, increase the supply side, more facilities, doctors, and critically, more training for those new doctors (that's a big bottleneck now, since residencies are almost all funded by medicare, and that limits how many med school slots can exist initially). Two, create a taxpayer funded single payer system - a monopsonist, who is by definition not a price taker. Realistically you need to implement both options, since #2 can only impose price up to some economic limits, and those limits are determined by #1 since the current health system can't actually service everyone without significant sacrifices around wait. If you implement #2 fully and #1 to the point where you have capacity to treat everyone that objectively needs care in a timely manner, then you've implemented a functioning right to health care.
Lots of economic handwaving in there for sure, but that's how you extend the farm subsidy parallel to healthcare, and realize it's much more complicated for healthcare.
For healthcare it's totally different with treatments costing thousands of of dollars plus, doctor visits out of the question without insurance for many (and even with) and monopolies on drugs and treatments contributing to vastly higher prices in the US than many other countries.
We may not have "death panels" but we definitely have insurance "no-men" aplenty (and high deductibles) to effectively deny people (especially the poor) decent care
This article is pretty wrong IMO there is no example in the US of "free-market" care to compare anything to.
While not some kind of "pure" free market, it retains the basic form of one, where the government adjustments are the exception, not the rule.
In contrast, the government's role in health care is pretty much defining the system, and you don't have most of the market mechanisms that exist in health care: where people are "doing it wrong", it's not obvious at all, but hidden behind various layers people just accept as given.
No it doesn't. Healthcare does not happen through some fictitious consensus of "society". It happens through individuals interacting one with one another and forming a natural order. To claim that healthcare is a "right" ultimately means healthcare providers are slaves.
So teachers are slaves? As are judges? etc.
I would settle for a communally accepted floor we don't let people fall below.
(I'm not implying anyone in particular here has said this, but this is often where these discussion end up).
Yeah, ok, but that dismisses priority entirely. Scarcity is still in play, so you treat the immediate needs first. I think we do have capacity in the healthcare system to do it that way. The author of the article basically bucketed a sprained ankle and a stroke in the same category, and concluded, nope, we don't have enough money to treat all that cancer, heart attack, stroke and scrapes and bruises equally, so it can't be a right. I guess, but who's really arguing for the right to get an ace bandage right now? Just because we have to prioritize access doesn't mean healthcare can't be a right. Today we prioritize by medical need and by who can pay. Single payer means everyone can pay, so prioritize by medical need. The right can be subject to objective need.
(Similarly, the rhetoric around "death panels" was toxic made this insight harder to accept.)
The other obvious example is law. Everything can be done correctly and you may be right, but nobody commands the jury. Yet there it is, the 6th Amendment (if you're in the US, that is), with that right to a lawyer in instances where you may be deprived of life or liberty!
The comparison to food is misleading. With food, there's an aligned interest. People go to the store and buy your product. If they aren't satisfied, they buy something else. With health care, most people have few choices. They get whatever plan is assigned by their employer or whatever they can afford within their limited market, often one or two possibilities. Then they go to the hospital, often the only one in the area, which in most cases won't tell them how much it will cost to be treated.
There's no free market, no choice, no aligned interests. The interests of the insurance companies are aligned against them. People are paid to deny as many claims as possible. It often takes years of legal battles to get anything paid out, even when it's legitimate.
Because even preventative care is unpredictably expensive, most people wait to be treated until the problem is most expensive to treat.
Yes, you can reduce costs and get more per dollar invested; it's still a fallacy to believe that one system will eliminate the problem of people dying because someone refuses to throw further resources at them.
The US is still the world's economic superpower, but it's health care system is rated below Dominica and Costa Rica.
>The US is still the world's economic superpower, but it's health care system is rated below Dominica and Costa Rica.
What is this replying to? What did I say that contradicted this or suggested otherwise, or merited a re-run of "everything wrong with health care in the US" as if I disagreed? I was addressing a specific fallacy, not somehow claiming that everything the US is wine and roses.
When people are talking about deaths of people who can't afford health care, they're talking about people who don't have the resources to ever get care, the people who don't catch things in the early stages when they're easily treatable and find out too late that their condition has become terminal. The point of national health care isn't to eliminate all treatable deaths no matter how expensive, it's to improve care and accessibility so that it's in a place that aligns with the resources society could reasonably support. When we look at much poorer nations being able to provide much better care, we see that there's a problem that needs to be addressed. That's what people are talking about, not eliminating all deaths.
http://www.nytimes.com/2016/08/24/upshot/the-epipen-a-case-s...
"Why is health care Special"
I tell you why healthcare is special. You cannot buy healthcare at the cost of food. I can buy ramen noodles and survive for cheap. Sure it is not the best but I won't frikin die. But If I get cancer and cannot afford a 100k Bill (yes, I know a family member who got that bill) , I will die. See ?
Again, people are talking about making Healthcare a right in America is mostly due to the fact that it is too expensive and difficult to deal with. If that was not the case and healthcare becomes as cheap as food, I bet people will stop the whole "healthcare is a right" movement. I would.
EDIT: Read this fun fact [0]. The average cost of health insurance is $17,500 PER FAMILY . Now this means that you may get covered for diseases such as Cancer but that does not mean you won't get a huge bill even after insurance. Now imagine you had no insurance and you get cancer. Compare this to average cost of food [1] for a family of 4
[0] http://www.ncsl.org/research/health/health-insurance-premium...
[1] http://www.cnpp.usda.gov/sites/default/files/CostofFoodFeb20...
The two industries aren't even remotely close to be able to make a comparison like that. Why not let healthcare operate as a free(er) market?
you may say that patents are crimping the "free" market but who is really going to vote to delete those from health care ?
And even if they were removed, there are many other ways the big companies will stifle competition to keep profits high.
Sometimes something bigger than a corporation needs to step in and this IMO is one of those times/places
Any Epi-Pen competitor has to be FDA aproved, that takes years of investment.
The government the gets to decided if the product gets to consumers.
It just recently killed a competitor so Epi-Pen can raise prices.
My grocery bill for 4 of us goes about $500/month and that too when we are not really into coupons and stuff.
How bad are ramen for you anyway? Consuming it as a large part of your diet, within your caloric intake and getting the rest of your needed vitamins from different sources (fruits, supplements even), would you get sick with time? Why are certain foods labeled as "bad" automatically? t seems this gets repeated Ad nauseam but most always, the accusation is unsubstantiated.
(Obvious caveat about what options you can consider in emergencies.)
Assuming you start earning an income at the age of 20, if you stuck $10 under your mattress daily (the same amount that you could for relatively healthy meals) you would have $109,500 by age 50. Switch to health insurance (found a plan in my state for $129 that does provide for cancer coverage - your situation may differ) and throw the rest into a dollar-cost-averaging investment account and the situation is even brighter.
There's a difference between "too expensive and difficult to deal with" and "I have no plans in place to deal with it nor the desire to implement them". And while that makes sense (most humans are hungry at regular intervals and sick at irregular intervals and thus budget accordingly) you shouldn't pretend like the average citizen is ever prepared for anything outside of their routine - with the exception of buying "gifts" for themselves, which they are more than capable of budgeting for.
I think our system is far from perfect, but if you're going to pretend that the cost of food dramatically outweighs the cost of paying for health care I really worry for your health due to lack of nutrition.
...and Health Care is how one stays alive, therefore health care should be a right.
Non sequitur. 'Right to life' means that no one can interfere in a normal functioning of your body without your consent. It does not mean that someone has to interfere in order for you to stay alive.
http://abcnews.go.com/US/story?id=90611&page=1
http://articles.chicagotribune.com/1996-03-01/news/960301023...
I'll say this too when I get a $65,000 bill at the grocery store.
Healthcare, because of the complexity of understanding how the body works, is a natural local monopoly.
Are you going to shop around for a better deal on a quadruple bypass when you already trust your surgeon? How would you know if the cheaper surgeon was as good?
Healthcare insurance suffers from the classic agency problem and has no incentive to keep costs low over the long term because they take ~7% off the top for a pass through transaction.
Health care is not a right, neither is education, food, or access to the internet.
These are all things that people at some point or another have claimed as "inalienable human rights".
There is always a cost benefit analysis here. Should we perform this extremely expensive treatment to give somebody a few days in agonizing pain, or maybe save a few dozen other people with a simple, straightforward procedure?
The painful part is realizing that no matter what, people with more resources (money or otherwise) will have better (and longer) lives on average then people without resources. There is no way to legislate that away. See Venezuela for an example of that.
Does the current system in the US evaluate that?
We could also go back to feudalism, people accross history and the world have gained rights against the wealthy minority, and I think healthcare for everyone should be something US citizens fight for now.
(It's a bit of a marxist reading of history, but in this case it works)
The NHS does that and denies it, and the last election they tried to call Obamacare "death boards".
We are in fuedalism right now, we just don't recognize our lords as explicitly.
And you can't "fight for healthcare for everybody". Healthcare is a scarce resource, and not everybody gets it. It's the nature of scare resources. If you have to provide healthcare to all, something else will get cut. Education? Food subsidies? Housing stipends? You pick your poison and don't think that we can just produce things out of thin air.
And the two marxist societies in the world are suffering. (DPRK and Venezuela) They've only been able to make everyone equally miserable, except for those in the ruling party.
The rights are positive rights, in other words they must be provided, and cost resources to provide. (In contrast to negative rights like freedom of expression, where it costs resources to take the right away from you)
As positive rights (aka obligations), they must be rationed. Welfare et al provides enough money to pay for basic food & shelter but not for caviar and mansions. The article is a very reasonable discussion of why it's harder to ration health care, but the conclusion (and title) doesn't necessarily follow.
Healthcare is a service, like any other service performed by human beings in society with one another. If it isn't performed as charity, then it is performed when the parties involved strike a deal. The alternative is that one person's "positive right" is another's positive slavery.
Does a person have the 'Right' to be rescued from a car accident that would surely kill them without help when it is in other people's power to do so?
No. BUT at some point I think it is fair to expect certain behavior from others living in civilized society.
A Right? Probably not. But Reasonable Expectation doesn't have the same punch as a slogan.
If it requires someone else to provide it - it's NOT a right because that would infringe on another's rights. It's that simple.
It may be the right thing to do to provide it inexpensively, however.
At the same time - so many people don't exercise, eat crap, get obese and diabetes or other preventable diseases and then overload the system with expenses. I'm not sure how you solve this issue.
-Make medical debt non-dischargeable if you incur it without insurance. (Encourage everyone to make an accurate accounting of the risk they are putting on themselves and the system without insurance).
-Require price lists of common procedures and tests from providers. (Competition on price).
-Close the medicaid gap.
-Publish insurance standards and require providers to accept all insurance that meet those standards. (This would allow smaller players into the insurance market spurring competition -- it would also be very difficult to pull off -- perhaps tie it to providers that get federal money in some way).
-Incentivise staying healthy by giving rebates for good health.
-Incentivise not using health care by giving rebates for not using it over some period of time.
-Incentivise shopping around by giving rebates based on finding providers/treatments/prescriptions that are below the average. Penalize those that are above some threshold by dinging future rebates.
And on and on. I don't think there is one solution. I think we need to try a bunch of things and keep what works.
> People need a lot of things. You’ll die without food long before you’ll die without health care, and yet few people say we need to “take the profit motive out of farming”. (...) Why is health care special?
Why is healthcare special? Because juicing someone's wallet when they are down on their luck is one of the worst things you can do.
Yes, healthcare is not cheap. And the resources we have to pay for it are finite. We don't understand everything, and ultimately we will all lose the battle to death.
So why do we fight? Because we want to live. And most of us want to see those whom they love live too.
The money argument is especially bad though, because in terms of outcomes (whether you measure longevity, or not dying of preventable diseases, or not getting more messed up during treatment), the US scores pretty bad. Yet we spend the most of any country (per GDP)[1]. Other countries such as the UK, France or Germany spend less, do contain costs and have better outcomes.
What making it a business does is reduce overall efficiency. If the major actors have the ability to take advantage of the final customer's weakness while maintaining a fiduciary responsability to generate profits, then money that is spent for the purpose of getting well gets diverted into pure profits.
Exhibit A: drugs. In France drug companies negotiate a market price with the payor (government). They are still able to turn a profit in that market alone. Not a huge one but decent. They then take the same drug, patent it in the US and sell it for 4x to 6x the price. Keep in mind the R&D was already paid for. So that is pure profit (minus marketing and regulatory compliance costs).
[1] http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS?year_high...
It seems obvious but the article forgets to mention that since health care is so expensive and no one can afford it, everyone buys health insurance. Even health insurance has become expensive to the point that no one can afford it, people need a larger organization to help purchase this insurance on their behalf (like their employer or now, the government). Now we've reached the point were even that has become too expensive. The guy in the cube next to me broke his hand skate boarding and is spending almost 1/10th of his salary on covering the cost and he's employed.
For sure, the history of health insurance and health care in the US is complicated and it's not as straightforward. But that is where things are today: unless you are wealthy or work for a wealthy company, health care is the kind of expense that can balloon out of control, despite purchasing insurance. In my opinion, that is what people object so vigorously to: spending money on health insurance (and a lot of it) and still having to miss car and mortgage payments so that they can give more money to doctors and pharmacies and hospitals to keep their spouse or children or themselves alive. You can choose to skimp on food, few of us would choose to willingly lose a loved one because "we can't afford it."
If I had to choose what should be made non-profit, my first choice would be insurance companies. By definition, for-profit companies would like to make more profit every year. There's a clearly unhealthy co-dependency between insurance companies, pharmaceutical companies and hospitals. Fixing it all in one swoop is probably impossible, but one way to make health insurance non-profit is to make it government run. We can't seem to get that done, so now the government is trying to join workplaces in helping people to buy insurance. It's the simplest and probably the only legal solution so that's the one that is being pursued in the US. We'll see how it goes.
Also consider the moral hazard involved with national healthcare combined with our two party system and electoral process. Who would be surprised if Iowa and New Hampshire end up with more hospitals per capita than other states? What if CA and NY end up with a lions share of the healthcare dollars? What if they don't?
IMHO, the right way to run a NHS for the US would look very different than the UK's NHS. Perhaps something similar to a minimum wage. I.E. A federal minimum standard of care that is uncomfortably low, with state and private coverage able to build on top of that as determined at a local level. But we have to be able to look at something like a "death panel" and say 'yes of course that would be necessary'. Until we can have honest conversations about varying standards of care, we won't see meaningful healthcare reform in the US.
Yes, and the reason few people say that -- even while people do argue for regulation to limit certain commercial practices in farming that they view as harmful to food availability, affordability, and/or quality -- is because you don't see monopolies on basic foodstuffs in the developed world being used to drive prices on foods that people rely on so high that many people, even with the safety net provided by government, can't afford essential foodstuffs in a first-world nation like the US.
That is, because, problematic as it is, the combination of private for-profit business and government regulation operating in food markets is working adequately well, such that people are less likely than is the case for healthcare in the US to perceive that the model under which it is provided is broken, inadequate for the needs of society, and essential to fundamentally reform.
History has shown, more than once, that when the systems of delivering food are perceived to be as broken as the US system of delivering healthcare is now perceived to be, people do clamor -- often violently -- for change.
(Obama tried to set up IPAB to do the same thing.)
>>...Britain had achieved cost-effective treatment for everyone, at the cost of some people missing very expensive treatments that might help them. I was rather congratulating myself on this answer, because NICE is beloved of health wonks everywhere; Obamacare’s Independent Payment Advisory Board (IPAB) is an attempt to sort of replicate it. Pointing out something the British health system can do that the American system can’t, and doing so in dryly factual tones, seemed like a good way to endear myself to the British audience.
>>The other guest, a British health official, interrupted to basically accuse me of lying; the British health system, he said, did no such thing.
>>Now I reiterate: I had not called NICE a death panel, or said that it was bad; I had simply described what NICE does, which is keep the NHS from blowing its budget on very expensive treatments that deliver relatively little value per pound spent. You can read NICE describing what NICE does on its website; the description is not significantly different from the one I gave. Being told that this was flat out wrong was surreal. Things got even more surreal when I began again to explain what NICE does, thinking that perhaps I had been unclear, and the host interrupted me and said something like “As you know, that’s false.”
That person was clearly true. It's a deeply unpopular idea over here though, even though very few meds are recommended against on pure cost grounds.
Article 25.
Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.
http://www.un.org/en/universal-declaration-human-rights/inde...