Healthcare is a lottery. If you're 30 years old, your healthcare needs for the year might be $0 or $1,000,000. Trying to make basic income cover that doesn't make sense.
The common complaint I've seen against this (aside from general complaints against redistribution) is that it forces the general populace to pay for the poor health choices of smokers and other such bad habits. I think this is a relatively minor issue, but if necessary, penalty taxes/fees can alleviate the concerns of people legitimately bothered by this.
It is not minor at all. Depending on how you look at it, smoking either costs the health care industry billions (in treatment of the living) or saves them billions (on premature death). Compound this by: diet, exercise, stress, and socialization problems and you see that the lottery has a lot of knobs and buttons, most of which will only be effective if people get effective health care their entire life.
[1] Considering killing someone before they're born saves the cost of them and any children they would statistically have. So if we wiped out everyone we'd save all the money ever spent on healthcare.
[1]https://fullfact.org/economy/does-smoking-cost-much-it-makes...
[1] http://taxfoundation.org/blog/state-cigarette-tax-rates-2014
For health issues I think this type of pressure is a positive social force.
So really, those who multiply the fastest win the resource war of the future? Or having kids is somehow constrained now through other hoops, like a "procreation license."
Possibly, though better educated and better off people tend to have fewer children so there are other ways to limit population beyond strict China or Ender's Game style limits.
Or maybe asteroid mining will finally break and crash the whole materials economy making everything but space, food, and water extremely cheap.
Universal BI leads to universal resource control.
Smokers don't die healthy. The "saving money" bullshit is literal propaganda from the smoking industry.
Here's an actual meta study on the costs: http://www.tobaccoinaustralia.org.au/chapter-17-economics/17...
>Third, Collins and Lapsley estimate the net costs of smoking, taking into account both those costs that are made greater and those that are reduced because of current and past tobacco use. For example, smoking increases some health care costs because of the higher prevalence of diseases caused by smoking (in smokers and ex-smokers who are still alive). These are the gross health care costs attributable to smoking. However, certain other health care costs are lower than they otherwise would be because of the premature deaths of many people who smoked over the past 40 years. These people did not live to use health care that they otherwise would have, so Collins and Lapsley subtract the costs that would have been incurred from the gross health care costs attributable to smoking in order to estimate the net cost. Similarly, in terms of labour (production) costs first costs that are made greater by smoking are estimated. For example, the time spent undertaking domestic duties because a home-maker is ill or has died prematurely is costed assuming domestic help will be hired. Then, savings due to reduced consumption—for example, household spending on food and clothing—are subtracted because these costs will be lower when there are fewer people in the household as a result of smokers dying earlier.
>Collins and Lapsley estimated that in 2004–05 the total cost of smoking in Australia was $31.5 billion
The NHS doesn't seem to incentivize prevention of diabetes in the UK. To quote 'UK Diabetes': "Diabetes is the fastest growing health threat of our times and an urgent public health issue. Since 1996, the number of people living with diabetes has more than doubled. If nothing changes, it is estimated that over five million people in the UK will have diabetes.". This disease largely results from personal choices often made on the basis of misleading information.
The one does not follow from the other. Just because it's predictable does not mean it's stable: you can modulate demand by, for example, making people jump through bureaucratic hoops or wait in long queues to get care.
...as we have seen in far too many countries with universal healthcare (leading those with the means to seek healthcare from other, more market-driven systems...which in turn leads to those without the means to receiving sub-standard care, or quality care subject to bureaucracy and long queues.)
In short, it's a self-licking ice cream cone. (But this is quite the tangent from the BI discussion - wherever your opinion falls on the matter, universal healthcare is an entirely different thing indeed.)
If you want your 21st century healthcare, you also gotta let go of outdated notions such as that addiction is a "poor health choice" (seriously kind of makes me angry typing that).
The kicker is, health insurance companies will use any pre-existing condition to get out of paying for just about everything. So, for example, if I wound up getting poly-cystic kidney disease, my insurance company would use the fact that I donated a kidney as a pre-existing condition to get out of paying for it. Even though it's completely unrelated and can't cause PKD. It's an out in their mind and they're going to take it.
Health insurance and medical care in the US is absurdly corrupt. That's why I wasn't allowed to leave the hospital without buying a walking boot from their provider. And their provider billed my insurance company $700. And the insurance company paid them $400. And then the provider billed me $100 and threatened to send me to collections if I didn't pay them. All for a walking boot that didn't fit, that I didn't use, and that I could have purchased from Amazon.com for $53 with free shipping.
Only if they are below the maximum premium profit-to-cost ratio (20/80), otherwise, they are going to have to refund the excess anyway, due to other provisions of the ACA.
That 30 year old individual with the $1m healthcare bill for the year in a for-profit system might well have only cost a public system (e.g. in Canada) $200k for the same standard of care, but with less additional financial stress impacting their ability to recover from their illness, and with no bills, phone calls, rejections, negotiations, and arguments after the fact.
It's just another example of how a uniform, public system works better.
After reading on the experiences of people from European countries and Canada in the 'OMG I had a valve replaced' forum (yes, there's a site just for that -- valvereplacement.org), the level of care that I received was significantly better than what is typical of public health systems.
Oh, and last week I needed to see the doc for a sore throat, and I was in the same day. Queues are a regular thing in public systems.
What do you pay for health insurance? How many people in the lower levels of society could afford to pay what you pay for healthcare? Do you have an employer that provides you with healthcare benefits?
I agree that healthcare in many countries could be greatly improved, but at least in many of those systems you could just walk into an hospital to start the process.
The reality is that you're in a privileged position, and it may not seem like it to you but there are a huge number of people out there for whom your situation would be effectively a bankruptcy trigger. And that's even assuming that their company lets them off work long enough to get treatment and recovery, which, in at-will states, doesn't seem like a thing that's likely to happen for a lot of the working-class.
For rich people/folks with wonderful insurances the other countries with public healthcare have private care in private hospitals, and it's of the same class — with one-on-one nurses and good food.
(Which is not to say that I disagree with you, though I do think that there are actually three different cost categories of health care:
1. Routine/preventative/minor care. Probably best dealt with as out-of-pocket costs.
2. One-time catastrophes, like "I broke my arm" or "I got pneumonia." Probably best dealt with as insurance.
3. Long-term or lifelong large expenses, like "I have HIV" or "I have MS." Probably best dealt with as a government program.
But then you'll have a lot of problems with the boundary cases.)
We already have a national individual mandate for health insurance with specific coverage rules which has made decisions about this; essentially, a mature BI would cover expected out-of-pocket costs plus insurance premiums in that system.
(That's not to say further reform of that system isn't possible or desirable, with or without BI, just that, given the existing system, there seems to be a fairly natural way that healthcare within that system fits into BI.)
(Not sure why I jumped to that conclusion, except that perhaps a basic income system appeals to the same economic minimalism that an out-of-pocket health cost system does.)
http://www.reuters.com/article/us-preventive-economics-idUSB...
http://www.statcan.gc.ca/pub/82-003-x/2015012/article/14295-...
http://www.thehoopsnews.com/effectiveness-of-mammograms-vast...
It's a complex subject, and a few articles aren't the final word one way or the other. My opinion is based on various things I've read over the past couple of decades (most of which I can't summon up right now) and conversations with various medical professionals in my family and social circle, and my overall worldview (as anyone's must be).
It seems there are preventative measures that are cost effective, and there are others that are not. So really, this indicates a need to determine a threshold. Perhaps we determine that we can afford to pay up to $50,000 per QALY, and cover any care that falls within that limit. So, we'd have coverage based on its efficiency rather than whether it is considered preventative or treatment or maintenance. The idea being to get the maximum amount of healthy years of life out of whatever amount of money we as society are willing to put toward healthcare. This could also be extended to programs outside of direct care, like some of those articles suggest, which encourage and support healthy activity in a way that still falls within the $/QALY target.
Of course, I expect it would be a bear to fairly study every possible treatment and program to determine its efficiency, especially factoring in a changing environment which is bound to change the efficiency of any given treatment from year to year.
Still, at a minimum, we should be grabbing those low-hanging fruits, where we can gain healthy years for a very low cost.
[1] https://en.wikipedia.org/wiki/RAND_Health_Insurance_Experime...
Yeah, it is called brainwashing. I worked in insurance and was all tickled to see them offering "wellness" benefits. I was all "Oh, yay, the world is turning into a better and more clued place!" Then I went to the meetings. These were purely a sales gimmick. That's it.
You encourage people to go to their annual check up and they feel like you actually care. It breeds employee loyalty. It mostly does very little for actual health outcomes. If you actually want better health, you are better off promoting exercise, healthy eating, sanitation, etc. in place of preventive medical screenings.
Free-as-in-beer health care ensure more people going to the doctor for more crap, reducing availability and quality for the average person.
But being unsure where my next meal will come from, I can't even visit a clinic to get a test done.
I keep praying to get some money so I can go check myself before I leave my young family without a caregiver.
So yes, whatever you guys argue here today. Make sure people like me in future can be cared for. And that they don't have to worry about food, shelter, Healthcare.
Like you said, you absolutely don't want to leave your family without a caregiver.
When you live in Africa, you have different problems.
Either way, I was buttressing this point
> even a small personal cost can encourage people to ignore warning signs and not seek aid until the problem has become severe and expensive
This is a pretty terrible idea. Even programs in the current day that are trying to make consumers feel their healthcare costs (like HSAs and their required high-deductible PPO plans) often or always cover preventative care at 100%.
Preventative care is precisely the kind of care that people are most likely to skip to save on some money, and at the system-level this just means much more costly healthcare. Regardless of how you structure your healthcare system, increasing the cost of the actual care itself is a horrible idea.
This seems like a terrible idea. If someone, for example, notices a new mole, they are much less likely to get it checked out if it is an out-of-pocket expense. Obviously, most of the time it'll be fine, but it could also be skin cancer that was easily treatable but has now metastasised and will be hugely expensive to treat.
How, specifically, would it do so compared to the actual system that exists now in the US?
Those with money pay too much for insurance because those without insurance are only covered at the last stages, when it becomes inhumane (by anyone's definition) to deny them care (which is also the most drastic and expensive level of care for a problem) which is then 'written off' and padded in to the 'prices' asked for other services.
A LOT of medical costs are actually sunk fixed op-ex. Big expensive machines that cost deferentially little to use or not (but always coast a lot to have the option of using), drugs and other supplies that have shelf lifes, etc.
Labwork presently requires a lot of humans, but much of it could also be converted to automation and human review, lowering the per unit cost; if there were incentive to make such technology.
It's also a major bit of administrative overhead to have to haggle with different insurance companies, hound patients for billing, and in general worry IF someone will pay and how much.
I suppose the closest parallel is what I recall hearing happened to auto-insurance rates when those became mandatory.
Another close parallel would be what would happen if everyone in the San Francisco Bay Area were to suddenly receive an additional 500 USD/month housing allowance for living in the area. I would expect occupancy prices to go up by ~500 USD and the general quality of housing anyone current has to remain the same otherwise.
(And incidentally, that's a great argument for replacing almost all taxes with taxes on land rent: any extra money people have left over after paying taxes etc goes to bid up housing costs. Lower taxes and you get higher housing costs. A land tax can recover the lost revenue---and it's really hard to hide land and evade the tax.)
With a competitive insurance market, you charge people a premium related to their expected healthcare costs. Some people have chronic diseases, and their expected healthcare costs are way beyond what they can likely afford.
However you regulate, insurance companies will always try to find a way to cream off the lowest risk customers to offer them the cheapest deal, progressively chipping away at the idea of collective insurance until it breaks.
Private health insurance is broken not only in practice but also in theory.
With car and home insurance, the products can go their entire lifecycle without burning down, being robbed, or smashing into a tree.
With healthcare, a person is going to need it, and it incapacitates them when they don't get it. Personally I'm for treating healthcare as we treat most regional monopolies that everyone needs - make it a public utility. You'll need healthcare just like you'll need water and electricity.
Not really, at least not at the current stage of technology.
During most of your life, healthcare is more like a lottery, ie you might never need it.
When you are old, something will eventually get you. And a lot of health care costs are spend on these end-of-life conditions. Alas, our massive spending at the end doesn't actually help very much: they mostly give you a few more month of suffering. (For things like cancer etc.)
For a lot of people hospice care is both cheaper and provides a better quality of life. (Some in-law of mine went from hospital care to hospice care when the cancer treatments got worse than the disease.)
See eg http://www.cato-unbound.org/2007/09/10/robin-hanson/cut-medi... for a similar argument.
That's like saying you don't really need electricity until later in the day, when it's more in demand for everyone. Should we treat electricity use as a lottery?
In fact, people should be using healthcare more, as a preventative measure (for reasons you just said), but because we treat it like car accidents and house fires and lotteries it's stuck in remedial mode.
See eg http://www.theguardian.com/society/2012/feb/08/how-doctors-c...:
> How doctors choose to die
>When faced with a terminal illness, medical professionals, who know the limits of modern medicine, often opt out of life-prolonging treatment. An American doctor explains why the best death can be the least medicated – and the art of dying peacefully, at home
To be clear, there are a few different kinds of health care along multiple dimensions, like
- price
- expected mean utility (as measured in quality adjusted life-years gained)
- variance of utility (which I am ignoring here)
I am saying that at current state of technology, if we exclude the expensive stuff with near zero or even negative utility, the remaining demand for big items fits an insurance model rather well.
Yes, I agree that we should probably do more preventive interventions---like exercise, decent nutrition, vaccinations, etc. These are mostly cheap.
And even though they are good for people already, the insurance company might very well decide to just pay for them (and perhaps even pay people extra on top with discounts etcs to nudge them even more) to save itself money in the long run.
https://en.wikipedia.org/wiki/Quality-adjusted_life_year
EDIT: There's of course also expensive treatments that provide a lot of quality adjusted life years, but the need for these are more like a lottery. (Eg treatment after a car accident or massive burn, or certain treatable cancers.)
The proper way to make these sorts of decisions is by passing laws that make the transfer payments explicit, not disguising them in byzantine insurance regulations.
Alas, politics is the art of the possible, and hypocrisy is a valuable tool.
For example, using the data from: http://pages.stern.nyu.edu/~adamodar/New_Home_Page/datafile/...
and looking at the After-tax Lease & R&D adjusted margin, The software industry is at 24% (8th place) and the Insurance industry is at 11.51% (37th place).
Just like Hollywood never makes a profit, you can't use profit margin to measure what the cost savings would be in moving to national healthcare system.
Presenting, perhaps, a different take: basic income can cover insurance which does account for the 0-1mil total distribution via actuarial science.
Either, because insurance companies charge them more.
Or, if insurance companies are not allowed to charge them a special price, healthy people will be reluctant to pay for (now) overpriced (for them) insurance.
One clever technical way out is to have your parents buy insurance for you before you are even conceived. This way, because neither the buyer nor the seller of insurance knows what's coming, it's not a market for lemons. (And if the parents genes make this kind of insurance too expensive, because it's expected that you inherit some defects, perhaps they should rethink their decision to procreate with each other. (Just like couples with sickle-cell-anemia on both sides are already advised.))
But of course, people will not be that farsighted, and we don't want to penalize people for their parents making stupid decisions, like not to buy insurance, more than necessary.
So in actual life, a basic version of an NHS like system plus optional extra insurance you can buy seems like the most sensible policy.
I have lived in a country with universal healthcare. Its not that cheap, my portion of taxes that went to healthcare was about the same as the highest cost Kaiser plan. But Kaiser (thus far) is leaps and bounds better than the care received.
Where I am from you make an appointment with a doctor, and they will almost certainly be 30-60 minutes late for it. Then when you do get in the room with them, they will give you 15 minutes max because thats all the government pays for. Similarly every person I know who needed something done is on a waiting list. For months and a small number for years.
People complain about the cost of US healthcare, but if you can pay for it then it does seem excellent.