It would be refreshing to have a conversation with someone who holds such a position that was willing to say that hospitals should turn uninsured and poor people away at ERs and let them die in the streets. Its at least more honest.
You won't ever hear them suggest people should die in the streets - why that'd be just unhospitable!
They'll instead say - "why don't they have insurance? Why don't they get a job so they have health insurance? Why should I have to pay for people that don't feel like working when I go to work every day without complaint?"
If you suggest all the myriad of reasons the trapped impoverished don't have a job, they'll counter with "those are obstacles to getting a job, sure, but it's not impossible."
If you point out that many people have jobs that don't offer health insurance, you'll either get a sarcastic reply about Obamacare, or the question "why don't they just get a better job? Why don't they go to night school and get a degree?"
Empathy has been replaced by the desire to be infallible in debate.
Take a non-strawman like Paul Ryan, who is in every way a typical Republican, and his proposal is not to abandon Medicaid, but to make it into an Obamacare-like system whereby people are provided subsidized insurance.
Ah, Paul Ryan.
>There’s nothing inherently wrong with high-risk pools, but they have to be adequately funded in order to work properly because the people in them are so expensive to care for. Many states had high-risk pools before Obamacare was enacted, but they charged much higher premiums than normal and excluded coverage for certain services. The federal government also had a high-risk pool temporarily, but it grew too expensive and had to cap enrollment. According to some estimates, the $10 billion a year allocated in the AHCA would still not be enough.
https://www.theatlantic.com/health/archive/2017/03/the-bigge...
> Unless the amount of the credit is linked to the cost of coverage comparable with what people received under the Affordable Care Act (and subject to indexing), it will represent a reduction in coverage (or higher costs if people want to "buy up"). If people will be reduced to buying catastrophic coverage, their deductibles may be larger, not smaller than they were under Obamacare policies. That's a step backward for many Americans, who complain that the deductibles are too high already. Moreover, depending on the differential between the credit for older and younger Americans, older people (who use more health care) may wind up paying more.
>Equally problematic is the use of health-care saving accounts in lieu of the subsidies available on the Obamacare exchanges. If working-class people do not have the extra income to contribute (albeit on a pre-tax basis), once again they will be worse off than they were previously.
> Without massive new taxes to pay for it, it's hard to deliver more coverage for less. In other words, Republicans promised more and are delivering arguably less than Obamacare does.
http://www.chicagotribune.com/news/opinion/commentary/ct-pau...
Then again this goes against my theory that socialized aid should come directly in the form of the thing needed - voucher for healthcare, food (or very specific food vouchers), rent free housing or vouchers for housing, rather than cash which is a bit silly to give to someone the government failed to give good financial education to (speaking from experience here...)
There's a reason theres a huge market for under the table financial management among the trapped impoverished.
It's a bit like assuming grocery stores must give away food to anyone or people will starve in the streets. In fact, there's other ways to get food to those in need.
2. Charities. You can start your own: give 5% of your income to underinsured. For example:
http://www.philanthropyroundtable.org/almanac/hall_of_fame/j...
At the urging of Frederick T. Gates, perhaps his most trusted philanthropic adviser, Rockefeller became increasingly devoted to medical research. In 1901, he funded the Rockefeller Medical Research Institute in New York City. Modeled on the Institut Pasteur in France and the Robert Koch Institute in Germany, it was the country’s first biomedical institute, soon on a par with its European models. The results were dramatic. Within a decade, it created a vaccine for cerebrospinal meningitis and had supported the work of America’s first winner of a Nobel Prize in medicine. Today, known as the Rockefeller University, it is one of the leading biomedical research centers in the world. Twenty-four Nobel Prize winners have served on its faculty.
But don't force charity on others who may be struggling.
Having worked in non-profits extensively, it's also disingenuous to claim that non-profits answer to anyone other than their primary donors, whose priorities are frequently not aligned with regular people.
2. Charity has had thousands of years to solve societal problems, yet it didn't. What you're describing is a pipe dream.
Within the span of a less than a century, countries around the world have addressed healthcare effectively such that care is available to most, if not all.
[1] https://en.wikipedia.org/wiki/Martin_Shkreli#Daraprim_price_...
That's a shockingly high amount, especially if you don't get healthcare out of that.
16% of my taxes go to pay for my health care system, which covers the whole country. For someone on a median income that's 3% of their income. For someone on a top 10% income that's 4.15% of their income.
To spend 5% of your Gross Income on the NHS in the UK, you have to pay 31% in total taxes, that's an income of £75k, that's circa top 5% income.
But there is an issue in certain areas of people using ERs like a GP because the ER can't legally turn people away due to EMTALA
A lot of people seem to think ERs are simply required to treat everyone, which is not even close to true.
The difference is that healthcare costs are so outrageous, that the "people who can't afford healthcare" bucket includes families solidly in the middle and even upper-middle classes. Which includes most of the nation.
I do believe that making hospitals publish their prices would be a good start. The first thing I think that would do is bring to light the difference in price between paying in cash versus using insurance. From there we could make arguments why the same service has a 10x to 100x difference in price depending on how or who pays for it.
- Compulsory basic insurance (private or public) (Switzerland)
- Private insurance + equalization pool (Netherlands)
- Compulsory HSA + government price fixing (Singapore)
- Socialized general coverage + private supplementary coverage (France)
I will admit that I have not read up on those countries healthcare plan but I think it is a lot more complicated than saying lets copy X countries plan. If you made a big change there would be a lot of second and third order effects that we would have to deal with and we may not like those out comes.
I could see California residents arguing why they should pay for the medical expenses of tourist.
I don't think anyone in the discussion thread is advocating carbon copying another country's healthcare.
I think that both we and everyone in this discussion can agree that what we are doing now is not working and is unsustainable. We are just arguing over the best way to fix it. I personally believe that easy (cheap) money makes things unaffordable where is seems everyone else wants to spend or devote more tax dollars to an already broken system. I would just like to fix the root problem and not the symptoms.
Are you suggesting that healthcare legislation should be drawn up in a vacuum? It's important to compare and contrast the benefits and pitfalls of other countries' systems. It's really all we have to go off of evidence-wise. It's also good to look at them for inspiration. There are a lot of different ways the public and private sector are being combined to make far more cost-effective healthcare systems than in the US. You are correct that some might not work in the US; that sort of reasoning needs to be weighed into whatever overhaul happens.
> I would just like to fix the root problem and not the symptoms
What are you suggesting as the root issue?
The main point to my arguments is that cheap money makes things expensive. Meaning is the government or somebody else subsides healthcare it will get more expensive. Because why not. Hospitals are trying to compete with other hospitals so they want the biggest budgets for paying the best doctors and newest equipment and technology. So why not charge just a little more then you need to get that. Then the next year comes around and the hospitals need more money so they charge just a little be more this year and it goes on and on.
You could probably start to fix things by making everyone publish their prices and charging the same price for cash as they would to insurance. From there things would start to unwind.
We could point finger all day long about who is responsible but at the end of the day nothing changes. I think politics at this point is more about entertainment then anything.
Not everyone gets cancer, the medical insurance profit model is predicated on a bet that most people won't. The more people in the coverage pool, the less likely you will be paying out for every single person.
Socialized care is just the expansion of that model to encompass the entire country's citizen population. What would have been privately-captured profit from people that were healthy members of the pool can instead be used to reduce the premiums paid by all members of the pool.
Another example is eye surgery. Originally the procedure was expensive but now it is more affordable because it is not covered by insurance. Comparatively, plastic surgery is relatively affordable because it is not normally covered by insurance.
Reducing or eliminating health insurance would also eliminate a lot of the medical administrators that provide zero care but due incur a cost due to their salaries.
As far as getting rid of the profit motivation but capturing the profits and giving it to those without health insurance I believe that you would also eliminate any reason to innovate and create new drugs.
I will admit that if you got rid of health insurance tomorrow that there would be a lot of short term pain. But I also believe that in the long run people would be better off because they would be able to afford there healthcare.
Using a different example look at the cost of college. I believe that we could fix that problem one of two ways. The first way would be to get rid of government loans and grants. The other way would be to allow people to file bankrupcy for student loans. The first way would attack the problem by getting rid of easy money. Because easy money makes things expensive. The second way could work by shifting the risks of the loans from the student to the banks. The problem with this solution would probably make it harder to pay for degrees that don't pay well.
To summarize my arguments, cheap money makes things expensive and is destroying almost everything is this country.
Edit: added the college example.
I would argue that rights are things that we declare by agreement as a group, not physical objects or measurable qualities. Of course healthcare is not currently a right; we haven't made it one. The question is: "Should healthcare be a right?"
Too much could be written about this argument but to me a right can't be provided by someone else's labor.
Now that I think about it, a right is also something that can't be taken away. No one should be able to prevent your free speech (1st Amendment), defend yourself (2nd Amendment), or violate your privacy (4th Amendment) without due process.
In this case no one is preventing someone from being able to care for themselves. We are just arguing over who pays for it. It is probably a bad example but everyone has the right to use the roads for transportation. We just don't have the right to the car, insurance, and gas.
Edit: Added more comments
https://en.wikipedia.org/wiki/Negative_and_positive_rights
You're also touching on the difference between Natural and Legal Rights.
You can't have rights without guaranteeing action. My right not to be tortured requires all sorts of individual and societal interventions in order to fulfill. There's no classification of rights into positive/negative and certainly no difference in validity between the two.
Even the Singapore model (which looks capitalistic on the consumer end) relies on huge amounts of government price-fixing on the hospital side of things.
(I guess more so in areas where freestanding urgent care is a less interesting investment)
There's even hospitals that provide urgent care style care (and billing!) in their ERs, undermining the argument that this isn't viable.