You can't make a bunch of for profit companies act in the best interest of users. We keep trying and failing. Healthcare is a basic human right, and should be provided free of charge to everyone.
And being offended over someone pointing out the uncivilized healthcare in the USA rather than being at the awful healthcare system is so productive, yes?
Yes. Because I don't care for the divisive nature of the comment. If the person can learn to refrain from such childish comments in the future then I would find it productive.
Besides, my opinion of the comment has no bearing on my opinion of the healthcare system in any way. I can be offended by both at the same time thank you very much.
While I agree with you, one thing that absolutely drives me nuts with this argument is scale.
Norway Pop. 5M (approx)
Finland Pop. 5M (approx)
England Pop. 53M (approx)
Canada Pop. 35M (approx)
United States Pop. 318M (approx)
The scale is way off from many other countries who have implemented the kind of healthcare reform being talked about.
When you get to hundreds of millions of people all kinds of issues arise that you don't see elsewhere.
China and India are the only countries more populous than the United States and I'd be nervous to experience their health care system. In fact you have to go quite far down the population list to get a first world country where that kind of healthcare is being implemented (happy to be proven wrong here)
We already have the healthcare system in place, and it already works well. The problem is cost. While it's impossible to say what the cost driver is, when you look at the performance of companies in the healthcare sector, you'll see they're doing extremely well, outpacing the S&P500 by 50% over the past decade. [1]
So at least some large portion of this cost increase is going into the pockets of executives and shareholders.
There's no free lunch. If the government is paying for it, it's not free of charge. And in this country, there's a long record of exponential price costs when the government is the customer. Our premiums would go up, they'd just be called taxes then. You could maybe nationalize all the hospitals or something and make doctors government employees, but I don't think we'd like the outcome. Just the transition would be a nightmare. And that's ignoring the legal aspects of it.
It's not so easy as just waving your hand and saying "Free Healthcare! Free for everyone!"
Milton Friedman has some interesting points about welfare programs and how they interact with immigration. Particulary, that you can have massive unchecked immigration, or extensive welfare programs, but the two don't interact well.
The NHS is probably a good example. The UK has historically had low to moderate rates in immigration and the NHS. The US has had a ton of immigration, but no NHS. It seems like half of the country wants to have unchecked immigration and extensive welfare programs, but the consequences of that kind of policy will quickly become bankrupting.
I would imagine that vocal minority would be fine with a single-payer system. Again, look at what happens to pricing when the government is your sole customer. And given the influence they can wield, it would be a bonanza for them.
You already see this with Medicare. For some treatments, they reimburse less than the doctor's direct costs. But if you try to do that with all the doctor's customers, it doesn't work.
I mean, it will work. That is not working because you have Medicare interacting with private practice doctors.. the same problems with ACA + private health insurance offices.
If the government directly pays the Doctor a salary.. he doesn't care what the "profit" on a procedure is. In fact, base his pay on how good his outcomes are and how efficient he is.. i.e. pay him more to do better. Then we don't need to worry about some doctors not offering some procedures, because they are paid by salary and not salesmen.
Right now private practice doctors are salesmen. They are compensated MORE for selling unnecessary procedures. If the they can sneak it by the insurance? They do it.
That's the nationalization I was referring to earlier. Also, government workers are rarely held to a high standard and rarely fired, so why you think that's going to happen with healthcare when it doesn't happen anywhere else is beyond me.
Most doctors make a salary, they don't care what the 'profit' on a procedure is. They probably don't even know what most of the stuff costs. It's like college professors and textbooks.
Also, who's worrying about some doctors not offering some procedures?
There is no healthcare in the US where the government is the sole (or even primary) customer. So using anything from the US as a counter example is going to fall flat.
Well, some would say that based on available evidence that government-based price controls doesn't always turn out well. Especially for people trying to obtain the product or service under said price control.
Firstly, the US is different, and the way it would get structured would be different.
Second, what evidence do you have that it would be cheaper in those countries than if they were using a private medical system? Are there numbers from before the NHS was put together? That would be an interesting analysis.
As a foreigner I always think of the US as having extremely restricted immigration. Is this the "Mexico problem" or are the legal migrant numbers also very high?
Historically, no, immigration has been fairly open as compared to much of the world. The laws and influx have changed from time-to-time, but it hasn't seemed coming to America was that difficult. Recently it's tightened up, but I only say historically as to relate to the comment you are responding to. America has the highest number of immigrants by a large factor, depending upon the source you trust.
Although, becoming a citizen has become a chore because it takes too freaking long for so many.
Of course, this is from the viewpoint of a citizen so take that into account as I don't see it from the other side.
This is pretty spot on. I honestly don't remember the legal immigration numbers off the top of my head, I think it's something like a million, certainly hundreds of thousands a year, and as you point out, illegal immigration numbers are all over the map (I think the range is something like 10 - 30 million total, not annual but don't quote me). It is important to remember that the US is huge, so it's not the same as Germany taking in 500,000 people by any stretch of the imagination.
If it's implemented correctly, an american national health service would work fine. If anything, it'd do some good to the country (healthcare being shockingly high on reasons for people defaulting)
On the flip side, the current system is totally broke. Get to free universal healthcare, then iterate on it to make it better and better. You have to move to make progress.
The current system is bad in many ways, all right? I think we can agree on that.
But it's not so bad that it can't get much worse. Getting worse is not abstract - it translates into people dying needlessly. (So does the current system being bad.) "Just change something" is only good advice if you're currently at a local minimum. And "iterate rapidly to improve" doesn't work when each change takes an act of Congress.
In particular: The last change was, what, six years ago? And the last change before that was, what, in the 1970s? You may only get one or two more chance to change this in your lifetime.
This is a hugely important point that people seem to miss. The US government is huge and frequently gets things wrong, and when they do, it's a political failure to admit it later. Furthermore, there's no real punishment for anyone that screwed up. That's a problem, and that's why fixing this is so hard.
I agree with you. The NHS is fantastic (so far as I know). But I'm talking about the US and how things work here. I just don't think it would work out.
If we're already spending that money on healthcare as it is, how are you going to take it and spend it on healthcare and have it be less money? And why do you think that expanding that program to cover everyone in the country is going to come out to be 20% of the military budget? What percentage of the population is already covered by the existing programs?
I took the money I use to pay rent, and the used it to pay rent. Boom free rent? I'm sorry, but that's kind of what your argument sounds like to me.
> If we're already spending that money on healthcare as it is, how are you going to take it and spend it on healthcare and have it be less money?
We aren't. That part is constant.
> And why do you think that expanding that program to cover everyone in the country is going to come out to be 20% of the military budget?
We can do the math if we want. Perhaps it will take 50% of the Military budget. Perhaps people earning more than 50k will need to pay a new tax that is more or less equal to what they currently pay in health insurance premiums. The math can be made to work.
> I took the money I use to pay rent, and the used it to pay rent. Boom free rent? I'm sorry, but that's kind of what your argument sounds like to me.
No more like - You spend $600 a month on smoking, and $600 a month on rent. Quit smoking, BOOM, free rent. At the end of the day, your costs dropped $600 which was the price of your rent.
>We can do the math if we want. Perhaps it will take 50% of the Military budget. Perhaps people earning more than 50k will need to pay a new tax that is more or less equal to what they currently pay in health insurance premiums. The math can be made to work.
It's the handwaving that's the frustrating part. What amount of the military budget is it? How are you going to charge me a new tax equivalent to my current healthcare that's going to cover me and at least one other person (just under half in the country actually pay income tax). That still sounds like magic thinking. Taxes would have to go up, how could they not? Or you gut the military, and even then I don't think it would necessarily be enough. Add in the push to completely ignore illegal immigration, and accord them the rights of citizens, and agree with that policy or not, you have to acknowledge the cost will go up even more.
It's easy to handwave the numbers. It happens a lot, but it's not a trivial detail. It has real consequences. What happens when the US Navy is no longer patrolling trade routes? Or when younger generations are crushed by a combination of increased tax burden and school loan debt?
A major percentage of the problems with US health insurance and medical industry is directly due to government interference in the marketplace. We saw an example of it with the housing market crash that dragged the economy down with it. You can see the same thing happening today with the runaway costs of universities.
I would prefer they just take a step back for a while.
Why is it a common assumption that the government can fix, with more government, the problems government created? Maybe fixing the damn problem is for the government to reduce its involvement in the problems it created?
What works for one doesn't always work for the other. I think it would be quite easy to do such comparisons to determine that. It worked for that area of 10 million people so surely it should work just as nicely with that area of 300 million people.
The government didn't create the problem. They have just been unsuccessful at combating the real issue.
The issue is our entire healthcare system is for profit and there is no market driver to reduce costs. Insurance companies collude with the AMA, hospitals, and pharmaceutical companies to raise prices on all aspects of healthcare.
The government needs to create that driver to reduce cost, since the industry is unwilling to. This could be many things, from public hospitals that provide free or low cost care (reducing the need for insurance), to creating a mutual insurance company whose charter is to minimize healthcare cost (creating competition in the marketplace).
My head explodes at this comment. You want to determine if people live or die just based on the charity they can get. How fucking barbaric is that? What do we live in, the 15th century?
I call Hyperbole. Its lots more complicated than that.
There likely will never be endless free healthcare for everybody. Until then its rationed. How do you do that?
As my old minister used to say, we can have all the morals we can afford.
I'm also in favor of reasonable free healthcare for everybody, to a point. Because, enlightened self-interest. Its cheaper to have a healthy populace, for everybody.
So some middle ground is necessary, between blue-sky endless free healthcare, and a free market.
Sure. Lets set a limit of 1 million dollars per year per person. May leave a gap for the double lung transplant cases, and we can work on a solution for those. But it will get 99.9999% of the country awesome healthcare for free. That is a reasonable starting point.
You are rich? Fly to that other country for immediate treatment.
There are pros and cons to everything. The trick is to find the middle ground that suits the most people possible the best it can. I'm just not convinced a total government solution is best for everybody across the board.
As someone who currently has coverage, I would be in the "rich category" and fly somewhere else for treatment, with funds I saved paying healthcare bills.
(I worked on the healthcare.gov rescue team and now run a healthcare startup running a clinical study with UCSF Cardiology.)
I think what's needed is likely more than outreach: there are two big problems with the insurance market right now that prevent competition.
First, the barriers to entry to start a new health insurance company are incredibly high. There have been four health insurance startups (Oscar, Clover, Bright, SeeChange) launched in the last several years. SeeChange went out of business. Bright has yet to launch. Oscar and Clover are active in a handful of markets, but for 90+% of people, their choices are limited to the insurers that existed before the ACA.
Why is it so hard to start a new health insurance company? First, it requires $50m+ in reserve capital to get a state license before you can sell your first policy. Second, once you're in business, your ability to negotiate prices with hospitals is determined by your scale, so new entrants are at an inherent disadvantage: they're negotiating on behalf of perhaps 10,000 members. United, in comparison, negotiates on behalf of 70 million people. There's an inherent vicious cycle here of worse prices => fewer members => worse prices.
Second, the Affordable Care Act built in several financial mechanisms--risk adjustment, reinsurance, and risk corridors--to stabilize premiums. Some of those are being defunded by Congress, and so the result is that in some places, premiums are destabilized; in others, insurers are withdrawing entirely. Our general political disfunction is now having a very specific and negative impact on people's lives.
Does this mean government regulation is all bad? I don't think so. There are certainly places where repealing regulation could help create a competitive market, but also places where adding carefully-crafted regulation could promote competition.
For example, passing a law requiring hospitals to charge all insurers the same rate (they can set the rate to whatever they like) would mean that new insurers are competing on a level playing field with the giants. Functioning reinsurance would lower the reserve capital requirements for a new insurance startup to stay in the market for long enough to build a membership base.
With those two changes, would level of competition and innovation in health insurance be the same as in photo sharing apps? Not quite. Healthcare is a complex business. But I think we could get substantially closer to that level of innovation, and that would be good for everybody.
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[ 4.7 ms ] story [ 119 ms ] threadBesides, my opinion of the comment has no bearing on my opinion of the healthcare system in any way. I can be offended by both at the same time thank you very much.
Norway Pop. 5M (approx) Finland Pop. 5M (approx) England Pop. 53M (approx) Canada Pop. 35M (approx) United States Pop. 318M (approx)
The scale is way off from many other countries who have implemented the kind of healthcare reform being talked about.
When you get to hundreds of millions of people all kinds of issues arise that you don't see elsewhere.
China and India are the only countries more populous than the United States and I'd be nervous to experience their health care system. In fact you have to go quite far down the population list to get a first world country where that kind of healthcare is being implemented (happy to be proven wrong here)
So at least some large portion of this cost increase is going into the pockets of executives and shareholders.
[1] https://personal.vanguard.com/us/funds/snapshot?FundId=5485&...
It's not so easy as just waving your hand and saying "Free Healthcare! Free for everyone!"
The NHS is fantastic.
The NHS is probably a good example. The UK has historically had low to moderate rates in immigration and the NHS. The US has had a ton of immigration, but no NHS. It seems like half of the country wants to have unchecked immigration and extensive welfare programs, but the consequences of that kind of policy will quickly become bankrupting.
I would imagine that vocal minority would be fine with a single-payer system. Again, look at what happens to pricing when the government is your sole customer. And given the influence they can wield, it would be a bonanza for them.
Based on the available evidence for healthcare: it drops like a stone because the sole customer has all the leverage.
If the government directly pays the Doctor a salary.. he doesn't care what the "profit" on a procedure is. In fact, base his pay on how good his outcomes are and how efficient he is.. i.e. pay him more to do better. Then we don't need to worry about some doctors not offering some procedures, because they are paid by salary and not salesmen.
Right now private practice doctors are salesmen. They are compensated MORE for selling unnecessary procedures. If the they can sneak it by the insurance? They do it.
Most doctors make a salary, they don't care what the 'profit' on a procedure is. They probably don't even know what most of the stuff costs. It's like college professors and textbooks.
Also, who's worrying about some doctors not offering some procedures?
Even IF that's the case it's still wildly better than the current system.
Second, what evidence do you have that it would be cheaper in those countries than if they were using a private medical system? Are there numbers from before the NHS was put together? That would be an interesting analysis.
Although, becoming a citizen has become a chore because it takes too freaking long for so many.
Of course, this is from the viewpoint of a citizen so take that into account as I don't see it from the other side.
That's the problem, I have trust issues with the people in power being capable of doing such a thing.
But it's not so bad that it can't get much worse. Getting worse is not abstract - it translates into people dying needlessly. (So does the current system being bad.) "Just change something" is only good advice if you're currently at a local minimum. And "iterate rapidly to improve" doesn't work when each change takes an act of Congress.
In particular: The last change was, what, six years ago? And the last change before that was, what, in the 1970s? You may only get one or two more chance to change this in your lifetime.
Also, iteration and government intervention don't really mix, as has been pointed out.
Take all our money we spend in various healthcare programs already. Take 20% off our military budget. Boom, free healthcare for everyone.
I took the money I use to pay rent, and the used it to pay rent. Boom free rent? I'm sorry, but that's kind of what your argument sounds like to me.
We aren't. That part is constant.
> And why do you think that expanding that program to cover everyone in the country is going to come out to be 20% of the military budget?
We can do the math if we want. Perhaps it will take 50% of the Military budget. Perhaps people earning more than 50k will need to pay a new tax that is more or less equal to what they currently pay in health insurance premiums. The math can be made to work.
> I took the money I use to pay rent, and the used it to pay rent. Boom free rent? I'm sorry, but that's kind of what your argument sounds like to me.
No more like - You spend $600 a month on smoking, and $600 a month on rent. Quit smoking, BOOM, free rent. At the end of the day, your costs dropped $600 which was the price of your rent.
It's the handwaving that's the frustrating part. What amount of the military budget is it? How are you going to charge me a new tax equivalent to my current healthcare that's going to cover me and at least one other person (just under half in the country actually pay income tax). That still sounds like magic thinking. Taxes would have to go up, how could they not? Or you gut the military, and even then I don't think it would necessarily be enough. Add in the push to completely ignore illegal immigration, and accord them the rights of citizens, and agree with that policy or not, you have to acknowledge the cost will go up even more.
It's easy to handwave the numbers. It happens a lot, but it's not a trivial detail. It has real consequences. What happens when the US Navy is no longer patrolling trade routes? Or when younger generations are crushed by a combination of increased tax burden and school loan debt?
I would prefer they just take a step back for a while.
Why is it a common assumption that the government can fix, with more government, the problems government created? Maybe fixing the damn problem is for the government to reduce its involvement in the problems it created?
The issue is our entire healthcare system is for profit and there is no market driver to reduce costs. Insurance companies collude with the AMA, hospitals, and pharmaceutical companies to raise prices on all aspects of healthcare.
The government needs to create that driver to reduce cost, since the industry is unwilling to. This could be many things, from public hospitals that provide free or low cost care (reducing the need for insurance), to creating a mutual insurance company whose charter is to minimize healthcare cost (creating competition in the marketplace).
You are poor? You die.
You are rich? Here is a nice bed and 3 doctors to care for you.
I do not want to live in that world. I do not want my children to live in that world.
There likely will never be endless free healthcare for everybody. Until then its rationed. How do you do that? As my old minister used to say, we can have all the morals we can afford.
I'm also in favor of reasonable free healthcare for everybody, to a point. Because, enlightened self-interest. Its cheaper to have a healthy populace, for everybody.
So some middle ground is necessary, between blue-sky endless free healthcare, and a free market.
You are rich? Fly to that other country for immediate treatment.
There are pros and cons to everything. The trick is to find the middle ground that suits the most people possible the best it can. I'm just not convinced a total government solution is best for everybody across the board.
In the current world, not everyone gets treatment.
I think I will take these problems over the current.
That is, until you have to sit in severe pain for six months.
I think what's needed is likely more than outreach: there are two big problems with the insurance market right now that prevent competition.
First, the barriers to entry to start a new health insurance company are incredibly high. There have been four health insurance startups (Oscar, Clover, Bright, SeeChange) launched in the last several years. SeeChange went out of business. Bright has yet to launch. Oscar and Clover are active in a handful of markets, but for 90+% of people, their choices are limited to the insurers that existed before the ACA.
Why is it so hard to start a new health insurance company? First, it requires $50m+ in reserve capital to get a state license before you can sell your first policy. Second, once you're in business, your ability to negotiate prices with hospitals is determined by your scale, so new entrants are at an inherent disadvantage: they're negotiating on behalf of perhaps 10,000 members. United, in comparison, negotiates on behalf of 70 million people. There's an inherent vicious cycle here of worse prices => fewer members => worse prices.
Second, the Affordable Care Act built in several financial mechanisms--risk adjustment, reinsurance, and risk corridors--to stabilize premiums. Some of those are being defunded by Congress, and so the result is that in some places, premiums are destabilized; in others, insurers are withdrawing entirely. Our general political disfunction is now having a very specific and negative impact on people's lives.
Does this mean government regulation is all bad? I don't think so. There are certainly places where repealing regulation could help create a competitive market, but also places where adding carefully-crafted regulation could promote competition.
For example, passing a law requiring hospitals to charge all insurers the same rate (they can set the rate to whatever they like) would mean that new insurers are competing on a level playing field with the giants. Functioning reinsurance would lower the reserve capital requirements for a new insurance startup to stay in the market for long enough to build a membership base.
With those two changes, would level of competition and innovation in health insurance be the same as in photo sharing apps? Not quite. Healthcare is a complex business. But I think we could get substantially closer to that level of innovation, and that would be good for everybody.
Right?