No, it's not.
There's a subset of the left that has that ambition, but there's a subset of the left that subscribes very hard to the idea that doing so is improperly aiding the wealthy (even though “eliminate means testing” mostly means “consolidate means testing into the tax system rather than duplicating the income verification function redundantly across various programs plus the tax system”.)
Now, it's true that the thought leadership on the left is mostly in the former group, and the public figures talking up the latter position are mostly center-right neoliberals. But they are using the specific rhetoric they are using because it appeals to a wide swathe of the rank-and-file left and allows them to seem progressive when what they are actually doing is defending the ability of the rich to preserve advantages that exist for them in the status quo system while blocking progress to universal access. (And that's true whether it's healthcare or college funding or whatever else.)
You paint a very abstractly wonderful picture, so let's assume yes and benevolent if rationing is to be expected given the finite tax base. I still need more details before I get on board with your plan.
First of all, my employer and I pay through the nose for my decent healthcare right now. Under your universal single-payer healthcare system, will I still be able to pay quadruple-through-the-nose to buy supplemental insurance such that I can still continue to get halfway decent service when I want it? Or, am I going to be stuck with everyone else waiting for rationed care out of fairness?
Also, are you planning to cap salaries of doctors and profits of hospitals and insurance companies out of fairness? (You think it's hard to get quality specialist care now??)
A different opinion from yours goes something like this: US health care is so expensive and inaccessible to 10% of the population because government got involved. The federal government twisted the HC system into a bureaucratic pretzel with no market forces to control costs. The absurd system we have now is a consequence of letting busybody crusaders and insurance company cronies write the laws.
I am not saying that viewpoint is accurate, but it's worth getting diverse voices into the discussion so that we don't wind up with an unhealthy progressive monoculture here on HN.
If we talk to each other like friends that have differing opinions, then we can find lots of little improvements that a majority of us can agree on, like maybe up-front pricing in hospitals or tort reform. If we can bring costs down and make health care more accessible to more people, then maybe we won't feel forced to take risky steps like forcing everyone to cede their personal health care choices to indifferent government pencil pushers.
Reaching out to you as a friend, I feel we both want the same thing - to have the maximum number of people possible receive quality care. I feel we're both frustrated that the current system is so unfair in so many ways.
I'm not opposed to setting up a safety net, as long as it doesn't get out of hand cost-wise or turn into a racket for the cronies. I'm thinking like mending broken bones, treating infections, vaccinations, most generics, and addiction treatment all should be abundant, cheap and/or free. Panacea it would not be with a fixed budget so that as a program it cannot grow to crony levels. You could sell me on providing basic health services like that because it just makes sense economically and public health-wise.
And I hope you're not opposed to weeding out waste, fraud, and abuse as one approach (of many) to fix a broken system. If we can get costs demonstrably down, maybe you'd even be open to deep cuts in existing nondiscretionary programs like medicare that have insane unfunded liabilities and will eventually crush us.
Maybe there is a middle ground that satisfies between us politically such that we can move forward together rather than lurching crazily right and left every 8 years.
The basic principle is that the Australian Federal Government subsidises healthcare by a fixed amount for each procedure. So iirc, it was AUD$45 for a visit to the GP. That's enough for some GP practices to be able to offer a free service (referred to as "bulk billed" because they only billed the government). Obviously those services become popular, so to get a free appointment you have to wait a while. Or, you can pay a bit yourself to get an appointment with a doctor who charges more than the government rate and are therefore less in demand.
In Australia I could usually get an appointment next day if I paid $25-50 or so. In the UK it was usually a 1-2 week wait, but free.
This goes for everything (except dental care for some reason, I don't know what's up with that). So an X-Ray costs $200, or nothing if you can wait until next week. And so on.
Health insurance covers the additional costs, and I paid $25/month for a plan that meant if anything serious happened I'd be liable for the first $250. And it also gave me dental cover, so I could claim some (but not all) of my dental care from my health insurance - a net gain for me most years.
The other interesting system that NZ has is something called ACC which also pays for rehabilitation and loss of income when someone has an accident. If you are paralysed and can no longer work then ACC will pay you something like 80% of your income until you manage to find another job. That could be for the rest of your life.
my employer and I pay through the nose for my decent
healthcare right now [...]
Under your universal single-payer healthcare system,
will I still be able to pay quadruple-through-the-nose
to buy supplemental insurance
I don't know how much US insurance costs your employer, but I assume it's several times more, rather than several times less, than mine pays!
After all, in the UK private medical insurance doesn't have to cover ambulances or emergency surgery or pre-existing conditions or chronic illnesses or old age or organ transplants or childbirth.
You also likely make half what I make and that's before taxes (my wife is from the UK, I looked at jobs over there and rural US IT salaries can beat London IT salaries). I prefer my deal to yours.
But yes, one thing that's tough for Europeans who haven't lived in the US to comprehend is that Americans really do prefer being able to buy a bigger TV to having proper security when it comes to health care.
The average cost for someone with cancer and an employer sponsored plan in the US is around $6000 per year. That's $500 a month.
https://www.cheatsheet.com/health-fitness/how-much-you-can-r...
Both my parents had cancer and survived in US, so I do know from first hand experience. They did not get ruined financially.
That said, I do support healthcare for all in the US.
Yeah, but that's irrelevant if you have to use an out of network provider in an emergency situation, or if you need a treatment that your insurance provider refuses to cover.
This is where the government is supposed to step in. Nobody is in any position to predict where they will be taken for emergency care, and copays for random amounts is essentially ransom.
>If I got cancer in the US I'd have be forced to live in a tenement block. take public transport and eat cheap food just like if I was "lucky" in the UK.
That's an interesting perspective on public transport. Public transport is a far more pleasant way to get around London than driving :)
But, no, you could end up in a far worse situation than that in the US. Medical costs are very unpredictable and bear no relation to your wealth. You could easily end up bankrupt and unable to pay for vital medical treatment. I realize that most Americans like to live in complete denial of this fact, but it's inarguably true.
Also, even taking what you say at face value, it's quite incredible that you're satisfied with this. Why should you have to take a massive hit in living standards just because you get sick?
That's true, but then I'd be talking about salaries that aren't double of what is offered in London but 5 or 6 fold higher. I own my home and support my wife and daughter by myself in a low crime suburban area in the US, that isn't possible anywhere I could find in the UK. Did I also mention I didn't go to college?
>But, no, you could end up in a far worse situation than that in the US. Medical costs are very unpredictable and bear no relation to your wealth. You could easily end up bankrupt and unable to pay for vital medical treatment.
When you get that sick you end up on socialized medicine, SSDI and medicaid cover those costs at that point. Also while you will receive medical bills you don't actually have to pay them while hospitals are not allowed to refuse you life saving treatment.
>I own my home and support my wife and daughter by myself in a low crime suburban area in the US, that isn't possible anywhere I could find in the UK.
I'm not sure what you're saying at this point. I grew up in a low crime suburban area in the UK. My Dad worked, my mom stayed at home. They owned the house. My Dad works as a programmer.
>When you get that sick you end up on socialized medicine, SSDI and medicaid cover those costs at that point.
Erm, no. You will not likely meet the eligibility requirements for medicaid. That's just wishful thinking. If that's how the system worked, medical bankruptcies wouldn't happen.
>Also while you will receive medical bills you don't actually have to pay them while hospitals are not allowed to refuse you life saving treatment.
They're not allowed to refuse you life-saving emergency treatment. They sure can refuse to give you chemo, refuse to give you reconstructive surgery if you've been badly burned, etc. etc.
It's astonishing how unaware you are of how the health system works your own country. America has a lot of work to do on this issue.
You really could suddenly end up with a $500,000 medical bill. It's tough to face up to that fact, but it is a fact. https://www.nbcnews.com/health/health-care/first-kidney-fail...
I've seen 75k USD salaries commonly in London and 400k+ is not unheard of in fang companies.
>Erm, no. You will not likely meet the eligibility requirements for medicaid. That's just wishful thinking. If that's how the system worked, medical bankruptcies wouldn't happen.
If I have money and insurance why do I need assistance? The disaster situation you were describing seemed to imply that I would no longer be working and have insurance. If I'm working and have insurance I'll just pay my copays and get care that way. If I have no income due to a disability, I'd get SSDI and medicaid.
>They're not allowed to refuse you life-saving emergency treatment. They sure can refuse to give you chemo, refuse to give you reconstructive surgery if you've been badly burned, etc. etc.
Care to cite a time where that ever happened?
You're just comparing a typical dev salary in London to an unusually high dev salary for NYC or SF. I don't see what insight you hope to gain by doing that. (The people making big money as software developers in London work as independent consultants rather than employees, by the way, as it's more favorable from a tax point of view and - lol - you don't have to worry about not having health insurance.)
>If I have money and insurance why do I need assistance?
Because you don't have enough money. There's no cap on medical bills. See for example the article I linked to regarding the $500,000 bill for dialysis. The person in question had insurance.
>Care to cite a time where that ever happened?
Holy crap, you really mean it. It happens all the time, as you can find out just by googling. Hospitals are under no obligation to give you chemo if you can't pay for it.
https://www.upi.com/Health_News/2016/06/03/Study-One-quarter...
https://www.webmd.com/cancer/news/20170221/many-younger-canc...
If you make much less than that in SF or NYC, there is no point in living in such an expensive place. Go make that London salary working in a rural area of the US.
>Because you don't have enough money. There's no cap on medical bills. See for example the article I linked to regarding the $500,000 bill for dialysis. The person in question had insurance.
From your article: "A few days after the treatments began, an insurance case manager called the Valentines warning them that since Fresenius was out-of-network, they could be required to pay whatever the insurer didn’t cover. The manager added that there were no in-network dialysis clinics in Montana, according to Jessica’s handwritten notes from the conversation. (The insurance company disputes this, saying that its case manager told Jessica there were no in-network dialysis clinics in Missoula.)
Jessica repeatedly asked both the dialysis clinic staff and the insurer how much they could expect to be charged, but couldn’t get an answer.
Then the bills came."
So basically, insurance said they would not pay for the clinic this person selected and since they have zero agency they kept going and got the bill that they were told they were going to get. So sad. Did they actually pay the bill? Of course not. They took a credit hit.
>Holy crap, you really mean it. It happens all the time, as you can find out just by googling.
What was one individuals name who this happened to. Not a study. Not "we think it happens". What is the persons name?
The median household income in New York is $50,000. I would rather live in London than in a rural area of the US - thanks. You talk as if people have no preferences besides maximizing the salary to cost of living ratio.
> So basically, insurance said they would not pay for the clinic this person selected and since they have zero agency they kept going and got the bill that they were told they were going to get.
I can’t figure out exactly what you’re trying to say here. It seems you are trying to find some way to convince yourself that these people deserved to get a $500,000 bill so that you can kid yourself that this could never happen to you. Yes, it’s their fault for failing to fly to another state in the middle of a medical crisis to find an in network provider, in the absence of any clear information regarding treatment costs from from medical staff or the insurance company.
> Did they actually pay the bill? Of course not. They took a credit hit.
We don’t know from the article how much they ended up paying. In any case, taking a credit hit is not a trivial thing. In your earlier comments, for example, you clearly placed a large value on home ownership. It’s difficult to buy a home with bad credit.
>What was one individuals name who this happened to. Not a study. Not "we think it happens". What is the persons name?
This article collects a number of stories involving named individuals:
https://www.bustle.com/p/these-20-stories-refute-the-idea-th...
https://pnhp.org/excessdeaths/health-insurance-and-mortality...
There's a documentary about the Mayo clinic on netflix. In it, a woman finally recieves a diagnosis of her mysterious and debilitating illness, of which she is pretty sure she would die from without diagnosis or treatment. She responds to initial treatment, which makes her hopeful the quality of life will finally approve. Then she no longer has money, and cannot have treatment anymore. She leaves the clinic and we never know what happens to her.
https://www.theguardian.com/us-news/2017/jun/24/us-healthcar...
https://www.patheos.com/blogs/dispatches/2018/10/15/study-45...
https://www.nap.edu/catalog/10367/care-without-coverage-too-...
https://www.bustle.com/p/these-20-stories-refute-the-idea-th...
??? There are studies that directly show that not having insurance is deadly.
There was a program, they didn't use it until the end, he was going to die anyway. He did not die due to lack of medical care.
I'm not going to go through each one, give me your best example.
>??? There are studies that directly show that not having insurance is deadly.
Also that tobacco doesn't cause cancer, guess what those studies have in common?
No, please do tell me exactly what those studies have in common, with citations.
You asked for something that isn't rumor and second hand stories. I provided. Now you move the goalposts and ask for my single best story. Please clarify your behavior and your motivations in engaging in this discussion: Do you actually wish to process data that is contrary to your belief on how the world functions?
Who says we need massive governmental spending in healthcare? Why governmental healthcare authorities of course! I'm skeptical, especially when the specific examples provided don't match up with the rhetoric.
Also the burden would not even be that people die from lack of healthcare in the US, it would be that more people die from lack of healthcare in the US than people die from healthcare rationing in the UK. He's a case of someone who actually died from that[0].
Can you cite specific studies, their specific researchers, and their specific funding grants?
"Also the burden would not even be that people die from lack of healthcare in the US, it would be that more people die from lack of healthcare in the US than people die from healthcare rationing in the UK"
This is not what you claimed. Please clarify the contradiction between your statements.
"I live and work in rural US and suddenly I can afford a lot more than I could if I had one of those jobs I found after an internet search for London" does not pass the bar you expect other people's evidence to. Not by a long shot.
For example, can he buy a typical hip surgery, which over time is likely? CLL treatments? Medical transport should it be necessary? Hire a nurse? Get a broken limb in a cast?
... Not lose a job because they cannot get to it for a month because of bum leg?
Cost of each of these can be actually checked ahead of time, for UK and for US. Including a split between in network vs out network in the US.
If people are dying, we can count deaths due to causes that would be preventable in UK and in the US, as well as cost in each case.
I can tell you rural Kazakhstan can pay 5 times more than the same job in US. But without giving you details it will seem like an exaggeration or flat out lie. It's not, just a cherry picked example.
If a study comes up with figures that don't have particular names attached (data protection and all that) then unless you have some evidence to disprove it we can take it at face value. Fighting it with empty hands and generic unverifiable counterarguments feels like trying to save face.
"Who?"
"This guy tweeted about it"
"I'm going to need more than that"
"Here is a study where they claim it happens in aggregate"
"Who died specifically and what were the circumstances of that death"
"PEOPLE ARE DYING"
pretty much how this debate goes every single time
On one hand you talk about London (very specific), on the other it's "rural US" (97% of US!). Nothing about the actual job or its conditions, what you looked at to compare, etc.
I mean it's absurd to discredit a study with sources and actual figures but try to pretend your claim looks like anything more than an impulse comment.
The difference isn't as clear cut as it seems on the surface.
I used to work in the bay area but ultimately decided to come home. Here in NZ in the tech industry I earn a couple of hundred thousand which is admittedly less than I'd learn in the US but while things like employment protection aren't important to me right now I also take comfort by the fact that if I get hit by a car ACC will cover my loss of income and rehabilitation, I simply don't have to worry about getting sick or injured. I also take comfort by the fact that everyone, be it a barista or a barrister, has the same perks (like four weeks paid leave, sick leave) and protection that I do.
Another example: a company I worked for in NZ was a US multinational, they did a big restructure where they laid off thousands. Because of employment law most of the lay offs were people in the US, South America, and Asia. Europe and New Zealand were almost completely unscathed, it was just easier.
Are they really the same job? Are the 2 salaries/conditions representative of the job or you just got lucky? Are they actually identical (what happens if you're sick for 6 months?)? Are the salaries that you could find published on the internet representative for London? What's "rural" US? Are you working from home for a big company or do you have to be on site? If you have to work in your town/suburb what other career opportunities are available for you and your family there compared to London? You may be happy with your salary now but if there's no room to grow, or you have no choice if you lose you job/company goes bust, then it's not quite ideal.
I understand you may not want to provide details about your personal life but as it stands you have anecdotal evidence that may or may not be based on flawed data (cherry picked examples or low quality information), while everyone else supported their claims with actual links.
Just in case: I'm not British, nor do I live there.
As far as I know, no presidential candidate is proposing to stop people from buying private medical insurance, so your worries seem entirely unfounded in fact. Even in the UK, you can get private medical insurance if you want to.
I don't believe a functional health care market where providers must compete on price and quality is as static as the system we have now. The "rationing" you describe that we have today is because we don't have a functional market or insurance system.
> As far as I know, no presidential candidate is proposing to stop people from buying private medical insurance, so your worries seem entirely unfounded in fact.
Rewatch the debates and listen to the policy statements and their implications, I don't think you're correct.
I think it's a terrible mistake to treat this as a wonky policy issue rather than an urgent ethical issue. That conception of things is part of the reason that it's been so hard to reform the system.
> I don't believe a functional health care market where providers must compete on price and quality is as static as the system we have now. The "rationing" you describe that we have today is because we don't have a functional market or insurance system.
I've read through this a couple of times but can't really make any sense of it. As long as people have to pay for their own treatment, people with more money will be able to get better treatment. That's a form of rationing, and it wouldn't go away if the "market" were to get more "efficient".
>Rewatch the debates and listen to the policy statements and their implications, I don't think you're correct.
If one of the candidates is proposing to ban private health insurance, it should be easy for you to reference a statement to this effect.
Your passion is admirable, but no need to insult, friend. I'm not a policy wonk, I just disagree with you. I don't have the same faith in government's ability to deliver services as you do. America is especially bad at delivering services, given our tendency towards crony capitalism and a disengaged public. It is possible to make things worse than they are now with totally well-meaning, but flawed, economic and social policies.
> it should be easy for you to reference a statement to this effect.
I searched on DDG, got tons of good hits for "debate ban private health insurance" and I picked the first link. The socialists (who aren't looking too hopeless in the polls and actually stand a chance at being the nominee) want to run things soup to nuts, no surprise here. Harris walked it back afterward, Sanders stood his ground and beat her over the head for a lack of conviction.
https://www.reuters.com/article/us-usa-election-harris-idUSK...
> Harris and U.S. Senate colleague Bernie Sanders were the only two candidates to raise their hands during Thursday night’s second Democratic debate when asked, "Who here would abolish their private health insurance in favor of a government-run plan?"
> On Wednesday night, U.S. Senator Elizabeth Warren of Massachusetts and New York City Mayor Bill de Blasio were the only two candidates to raise their hands when asked if they would scrap private insurance.
Please just watch the debates and don't give anyone a pass. I'm counting on you and others to not pick an unelectable wacko to run against Trump. Full disclosure, I didn't vote for Trump (or Hillary) in 2016.
You're really selling the US short if you think that it can't implement any one of the multitude of healthcare systems that exist in other first world countries - all of which are superior both in terms of outcomes and in terms of basic decency. This kind of pessimism is just a convenient excuse for doing nothing while people are dying.
I believe there will come a time when the right to healthcare is no more up for debate than, say, women's right to vote (no longer a "policy" issue). But, clearly, we're not there yet. You still seem wedded to the idea that the system has to be set up in such a way that a person's access to health care is significantly limited by their wealth. Thus, only certain basic treatments will be "abundant and/or free" even in your ideal conception of how the system should work! And you talk about giving the "maximum possible" number of people in the US access to high quality care - as if this maximum were somehow obviously less than 100%! When you can't get care, it's "rationing". When 15% of the population can't get it because they're too poor, then, well, gee, that's just the market at work I guess.
The bottom line here is that Americans still see healthcare as a job perk rather than as a right. That's ethically obscene, but it's still the mainstream point of view, so you're by no means alone. If you are happy with your own personal situation at present, then by all means sit out elections and float pie in the sky market-based schemes as alternatives to actionable policy proposals that would actually make a difference.
> Ethical disagreements exist. You may not think that this is an urgent ethical issue, but I do. I'm not going to say that your position is ethically acceptable just because it would make you feel better - sorry.
Yes, we do disagree. But, we have to go forward together by dealing with each other honorably and not operating from the default assumption that the other is below reproach or sub-human in their thinking. We need to hammer home that the perfect should not be the enemy of the good (myself included.)
We have to make deals and compromise to implement any policies that will be durable and maintain their original spirit. Think Medicare and SS as examples of big compromise bills that lasted, and the ACA as a contra-example. If you don't believe in your bones that we need to compromise on the big stuff, then life will be full of disappointments.
> superior both in terms of outcomes and in terms of basic decency
What about our obesity epidemic, isn't that a factor contributing to our outcomes? Do all countries use the same measure when tallying outcomes? What are our comparative outcomes for health care at the extremes? Like, when your twins are born 2'10" and 2'11" respectively and still live and are healthy after 7 years?
I'm sorry, but respectfully, that talking point is so cherry-picked, and ignores so many factors, that it is meaningless. It is only intended to shock and to shame. Reality is more complicated than just "outcomes are worse." Do not insult my intelligence.
> I believe there will come a time when the right to healthcare ...
Medicare turns people away all the time, it's actually hard to get them to pay a claim. A right is a only truly a right when it can't be denied. Just start asking simple questions, and the 'HC as a right' concept falls apart.
Like, which health care procedures are a right and which are elective? Sex reassignment isn't a right ... this year ... maybe next year ... until the Republicans take power again ... see what I mean? A service like health care isn't so simple, nor black and white, as you paint it.
I do not believe you can make your "100% covered" math work AND pay doctors and hospitals such that they will continue to work for you such that you don't wind up with a doctor shortage and induce rationing.
I do believe that my "maximum possible" can reach an effective "100% covered". Think of how cheap technology and process changes can make things over time. The world is not a static system, it's dynamic and fluid! For example, Amazon.com, a recent phenomena, is being described as an anti-inflationary force across the entire economy because they are so effective at driving down costs and haggling on prices!
> pie in the sky market-based schemes
Come now... Consider there is no rationing of food. Food on store shelves regularly goes bad and we have to throw it out, we produce such an abundance.
Consider the US manufactures 8x the amount of clothes that actually gets sold. If it weren't for Africa taking, basically for free, all of our excess clothes, we would be incinerating the excess at the end of each fashion season.
Consider veterinary services and how much affordable they are relative to comparable human health care. Like, vet services paid out-of-pocket, no insurance at all affordable. Why? How?!
Consider health care and student loans - both seeing spiraling cost increases. What's the connection? Heavy government involvement and crony influence.
What I'm saying is ...
Market forces perform! Pay people up to what the market will bear, and you'll never have a shortage of workers to provide a service. Then, encourage competition and allow people to shop based on price and quality. Next, the market will control for excess and will find a stable value for each service that will be as optimal as it can get. Finally, if you can ease up on regulations, then the cost of providing a service goes down further and businesses will reinvest in themselves, which can further lower the costs.
It's economics. The model for how to unleash market forces and make services cheap and accessible exists in standard textbooks.
The fact that health care is currently expensive and people's lives hang in the balance makes this discussion more than just economics. I think that's mainly what you are driving at. And I respect your passion in that regard. Honestly, I get you on that! Your whole paragraph there is full of bitterness for me, but why can't you get me, friend?
I'm passionate too AND I don't want anyone to suffer! Like, no one normal wants other people to suffer. You know that, right? Finally, if it is true that I actually want to alleviate suffering just like you ...
You may respond that poor people would still be covered by Medicare. But your skepticism of the efficiency of the government should extend to its ability to reliably identify the people who need assistance. And if you are ok with the government paying for some people's healthcare, it seems to me that you've given up the main principle. Why not just have a public option open to anyone, and let "the market" compete with that? If the government is as useless as you say, insurance companies should have nothing to fear.
The problem with student loans in the US is arguably a lack of government regulation. In the UK, for example, there are very strict regulations on interest rates and the repayment schedule. Although student loan debt is still a drag on the younger generation, it doesn't bankrupt anyone.
If you are still looking for inconsistencies in my position, then you haven't yet accepted that I want to find compromise solutions. I am ok with not getting everything I want. We're all walking inconsistencies anyway.
That said, you are right to call me out on that and student loans because I slipped into talking points mode, which was a futile attempt at one-upsmanship. I'm never going to convince you my opinion is the right one, and vice-versa. All that matters is we both have an accurate understanding of the other's worldview so we can discover where the give and take can happen.
> Why not just have a public option open to anyone, and let "the market" compete with that?
My answer is just another weak talking point regarding US states that have tried that and failed. The private market in those states predictably collapsed because employers took the opportunity to dump employees onto the state run plan. Which was, of course, the goal and no one is fooled.
The story ends sadly however, the state tax base couldn't support everyone dumped on the public option and virtually no one remained on the private plans to subsidize the public ones. So, the public options got scrapped. States can't run a debt like the Federal government can, so their plans have to square financially or the whole apple cart gets upturned. There's the harsh reality for ya! <mic drop>
And that was the most pathetic, cherry picked story with zero details that didn't include counter-stats about the thousands of mothers and children getting health care for the first time in those states, etc etc. You sank my battleship! Did I just change your mind about single payer? Of course not, and that's fine by me.
I just hope you are softening to the idea that someone who disagrees with you is not automatically an ogre, and can be well-meaning. There is far too much distrust driving factions in our society, when it is easy to find so much common ground if we just talk.
My position is: the market left to do its thing produces goods/services that are cheap and plentiful. Yours is, I think: the market has no soul and there is corporate greed/corruption and the market will always have losers, so we need to intercede and level the playing field for people. Please correct me if I got you wrong.
See, we both have solid points that the other must certainly agree with - the evidence is clear on both sides. What is not obvious is that one position does not negate the other. There is a right balance to be found between the two.
Here's how we balance as I see it: we don't dare make policy that wrecks the market so we keep the bounty -and- we don't dare leave people to suffer and die when we have all this bounty. BOTH! Not one at the expense of the other. Cautious, tuned, scientific, numbers based, avoid failures from history, and give ourselves grace that we're doing our best and we'll never reach Utopia.
> Poor people get crap healthcare while rich people get great healthcare
The world is not static. Today's crap healthcare and over the counter meds are impossible, miraculous health care if you compare with what people experienced historically. Caesar lived less healthfully than the American lower class. How can we get more good stuff into more people's hands more efficiently?
MRI's won't ever be as cheap as paper clips, but in twenty years TCFT hand scanner technology will make MRI's a blip in history and you will even be able to buy a consumer-grade scanner for a few hundred bucks at Walgreen's. Ok, I made that up, but hopefully you get the point that greater things are coming than the things we have now.
Isn't this just a weaselly way of saying that you're perfectly fine with poor people getting much worse care than rich people? What does it matter that they're getting better care than rich people did 100 years ago?
>Ok, I made that up, but hopefully you get the point that greater things are coming than the things we have now.
I'm sure that is a great comfort to uninsured patients with stage 3 cancer! We could just give them the care they need right now, but I guess it's better to wait some indeterminate amount of time till the market brings the cost of chemotherapy down to $100/month.
>My position is: the market left to do its thing produces goods/services that are cheap and plentiful. Yours is, I think: the market has no soul and there is corporate greed/corruption and the market will always have losers, so we need to intercede and level the playing field for people. Please correct me if I got you wrong.
As far as compromise is concerned, I don't really see any room for it here. There are many ways to provide universal health coverage. I have not insisted on a single payer system at any point in this discussion. However, it seems that what you want to compromise on is not the means of delivery, but the universality itself. In all of your long and irrelevant discourse on various economic points, I don't detect any concrete statement of what it is about the current system in the US you don't like, and how you'd actually propose to change it. So it seems to me that you de facto support the current system.
Not even Communism. To fight status itself is to fight human nature. People will always try to obtain benefits and pass them down to their children.
200 years ago, all medicine was hospice care. Allocating resources to an industry for which there is infinite demand for - staying alive - will be difficult.
Will it? The NHS does an ok job. Not perfect by any means, but much better than the US.
I don't demand perfection, just something significantly better than a situation where 15% of the population are uninsured. Do you think that is so terribly difficult?
Why do you want to fight, friend? Maybe you perceive moral superiority such that it's easier to tear down than cooperate. Like I said before, that's a recipe for disappointment. Improvements in health care matters because that's a trend that is apparently still continuing. What am I missing?
And I'm not fine with cancer, another insult! Don't you get me yet, my friend?
I do know we're going to definitively cure cancer soon such that the treatment doesn't break the bank as it does today. Until that happens, let's work to bring down the costs AND help out people who can't afford what services are on offer today. Why not both?
> what it is about the current system in the US you don't like
I don't like how the health care insurance covers everything. The cheap stuff should be out of pocket so that individuals shop on price for those services and we build a competitive marketplace on the simple stuff.
I want up-front pricing for services in hospitals, and if I am of sound mind, I must opt into services before they are delivered. Finding out what services cost after I get them is one of the scammiest features of the current system.
I don't like how drug prices are artificially inflated in this country by Medicare and Washington cronies.
If I were a dictator, I'd mandate everyone who takes a salary must save some percentage (6-8%) of every paycheck in a personal medical savings account the way that Singapore does. If you get health services, you have to pay the full freight for the services out of your account, encouraging market forces. When that account runs out, you're screwed.
It's not taxed, and you can leave your account to your heirs. You can also buy catastrophic health insurance so you're not screwed in the event of a big event. The government offers low-income people additional catastrophic health insurance options and charities help pick up the rest of the slack.
We can't force that kind of mandatory savings in the US, it's unconstitutional. But, if we could go the mandatory MSA + catestrophic health insurance route, we would maximize market forces and yield results close to universal coverage that results-wise goes far beyond anything you can propose.
See? I've thought all about it.
I could just as easily say, "you have no realistic plans for controlling costs while delivering high quality service in abundance." But I suspect the life and death aspect of health care is an overriding priority for you, and delving into cost/waste/fraud/abuse is a non-starter. I believe that access to health-care in name only (a.k.a. government-induced rationing) is no health-care at all, though. Affordable, effective, abundant: pick 3.
So, no more insulting my intelligence, and please assume good faith, my friend!
The fact that the cost of cancer treatment may go down in future is totally irrelevant to the question of how we pay for people's cancer treatment today. As far as I can see you only bring it up as a means of dodging the question of how poor people can get cancer treatment now. Rather than indicate how this might be possible now under the system you envisage, you talk about how it might be possible 100 years hence. You may whine about me taking the moral high ground, but can't you see how crass it is for you to play down people's present suffering on the grounds that people 100 years hence may be better off? What sort of reaction were you expecting to comments of that nature?
The concept of "catastrophic" health insurance transparently makes no sense. Any insurance plan that doesn't cover all the expensive treatments is next to useless. So obviously, no-one (either insurers or patients) can save very much money by nickel and diming patients for inessential treatments. Indeed, if these "catastrophic" plans don't cover screenings and other preventative measures, they'll probably end up increasing everyone's costs in the long run.
Bizarrely, you seem to think that the main problem with the current system is that people have too much coverage. This makes so little sense that I'm unable to engage you on that point. This is particularly so given that you are simultaneously so vague about the nature of the system that you favor and so unwaveringly certain that it would deliver better "results" (if, of course, we ignore all the poors).
The countries that pay less for drugs are the countries with a greater level of centralisation and government control. Drug companies are behemoths, and it takes another behemoth to negotiate a good deal.
>I could just as easily say, "you have no realistic plans for controlling costs while delivering high quality service in abundance."
I can point to plenty of existing systems that do this. E.g., the healthcare system of pretty much any European country.
> You've written a lot without addressing the key point. It seems that you are fine with poor people getting much worse care than rich people. At least, you've declined several opportunities to indicate that you're not fine with this, and none of the suggestions that you're making would make things any better for Americans who currently lack insurance. Indeed, you're quite clear about what happens to people who can't pay up: "When that account runs out, you're screwed." Charming.
I said that blunt thing on purpose, partly to draw you out and get you to express yourself, and partly to express my philosophy.
I am not fine with disparity, I just don't believe we can eliminate it through top-down, central planning or through collectivization. That's my bottom line; we probably won't ever bridge this philosophical chasm between us. But I appreciate having the opportunity to explain myself conversationally to you.
Expanding my thoughts a little, in my opinion government is particularly bad at addressing inequity because on the ground there is zero incentive for individuals in government to fully solve problems - that would put government workers out of a job. Yes, some people get aid, there's some salve for the hurt, but on the whole government spending on "programs" tends to be a racket for cronies.
I don't expect you to agree, just explaining my thoughts. If you want to provide contrary notions, and give some depth to your worldview, I'd like to hear it. I would like to know how we solve the problem of poor and rich getting the same quality services without also degrading the services.
Regarding the "screwed" comment - guilty as charged - that was too harsh. Here's the nagging concern that drives my thinking: when there is a natural disaster and community, family, and government structures are stripped away, people are forced to fend for themselves. If they haven't prepared for disaster mentally and with provisions, they can die needlessly.
So, I favor a government whose policies encourage self-sufficiency and resilience that will lead to a robust populace that can be free and happy in their own situation and not make themselves prostrate to others for their survival. Dependency, like debt, is slavery. Freedom is totally worth the trouble we put people through.
In my dictator scenario, I envisioned forced savings for routine medical bills, optional catastrophic health insurance for the unexpected huge claims, and freedom to shop for providers as the route to "well-nigh universal" health care.
You would need to be my advisor though, because there are always destitute people in any society that have no income and have no insurance. We'd would need to provide for them somehow. I'm open to haggling on various points. ;)
> The fact that the cost of cancer treatment may go down in future is totally irrelevant to the question of how we pay for people's cancer treatment today.
Yeah, it's an awful problem! You sound very fed up and in a rush to see action especially on cancer. What would you do as dictator to address this? Make me your trusted advisor!
I observe cancer treatments are at least improving and we're getting better outcomes. We should at least look for ways to lower costs to make treatments available to more patients. It's not a perfect solution, but it's a start.
> The concept of "catastrophic" health insurance transparently makes no sense.
We just see the utility of insurance differently than you do. I see it as a backstop, not a catch-all. I want people to pay out of pocket for the simple stuff so they search for and demand lower cost options. That lets the market deliver the goods.
> Bizarrely, you seem to think that the main problem with the current system is that people have too much coverage.
No, I don't think that. The US definitely has a dysfunctional way of covering the poor however (emergency rooms that take all comers.) I would love to see some fixes there, because the system we have now encourages the poor to suffer with easily treatable conditions and is very inefficient economically. It's easy to make rational arguments about delivering health care services to the indigent. Frankly, I think such arguments are unassailable.
My position is that health care in the US is overregulated and lacking market forces that could control costs. I don't believe a single-payer system in the US would be accompanied by deregulation, and therefore costs would continue to rise.
> The countries that pay less for drugs are the countries with a greater level of centralisation and government control. Drug companies are behemoths, and it takes another behemoth to negotiate a good deal.
I have heard this argument before and never understood why the blame isn't placed 100% on government. What you describe should have happened decades ago.
Medicare and Medicaid covered 37% of health care costs in the US in 2017.[1] That is HUGE buying power, they can set the worldwide prices for drugs. Noone who is in power at the federal level seems at all interested in negotiating.[2]
That's a very interesting article that takes years to get to the money quote:
> No Negotiation, the Price Is Set
> The major reason for the disparity in pricing is that the United States lacks any sort of central or universal healthcare system or agency that regulates across the board cost. In contrast, negotiations of drug prices between governments and pharmaceutical companies are routine in Canada, most European nations, and most countries in the Middle East and Far East. They have centralized authorities to negotiate more favorable prices with manufacturers, and some also have drug formularies and advisory boards that put restrictions on the use of new and expensive medications.
Wow, sounds good, what's the hold up?? From later on:
> However, by law, the federal government cannot negotiate for Medicare drug prices or obtain any sort of volume discounts.
It was Medicare Part D where the feds jumped deep into the prescription business and this mischief got started. High drug prices in the US is baked into the plan. And there's no incentive to fix the problem because everyone is on the take.
This is where you and I are, I hope, arm-in-arm. Medicare should negotiate with these drug companies such that all Americans get drugs at rates offered to comparable countries! Abolish that corrupt law. I'm not even talking about price controls, I just want the same or better deal that every other country negotiates.
But, Democratic and Republicans are attached like barnacles to the special interest money and that bad law is a worth a fortune. This isn't an abstract issue: people are suffering and dying today because of cronyism. Awful realities like this destroy my faith in government, especially federal. If I am wrong on this, I would love to have you explain it to me.
Thank you again for being so peaceable in your reply. I felt very relaxed replying to you this time.
[1] https://www.cms.gov/research-statistics-data-and-systems/sta...
A couple of the variants of Medicare-for-All, including Sanders’, would prohibit normal private health insurance (they would allow private plans for certain non-core benefits, but those aren't what people talking about private medical insurance are mostly talking to about.) I mean, technically, they don't prohibit buying plans, only selling them, but...
> Even in the UK, you can get private medical insurance if you want to
As far as I know, no Presidential candidate is campaigning on a healthcare plan based even loosely on what the UK currently does.
This is a bit of a long paste, but people don't generally understand the differences:
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There are three measures for welfare-state regime stratification: conservative, liberal and social democratic. For the conservative welfare-state regimes, the traditional societal class model is a prevalent idea, but also the rejection of capitalism. Which leaves conservatism between the market based ideology of liberalism and the social democratic wish for social leveling. EspingAndersen distinguishes between two branches of conservatism: corporatism and etatism. Corporatism is described as a response to industrialism and its effects: social fragmentation and individualization. In modern societies, corporatism is described as "...built around occupational groupings seeking to uphold traditionally recognized status distinctions and use these as the organizational nexus for society and economy". Corporatism was mostly influential in the continental European nations, as a response to the Church’s strong position. Etatism, on the other hand, focuses on the primacy of the state. Esping-Andersen illustrates etatism with Bismarck’s wish to tie workers directly to the state with social benefits, instead of tying workers to the guilds, as in the corporatist model. Today, etatism can be traced in two areas of welfare state stratification, where one is giving generous welfare provision to civil servants, giving state servants an elevated position in society, as in countries such as Austria, Germany and France. The other area where etatism can be noted today is the relatively generous poor-relief or income protection, based on the idea of noblesse oblige.
The liberal response to the conservative ideas of etatism was the opposite. The state and the stratified society were seen as something that had gotten in the way of market emancipation, and in extension, individual liberty. Social policy were to be replaced by the market in order to achieve social leveling, not to eliminate aid, but to have a less active state. Today, liberalism does accept income-tested social benefits, although it is associated with social stigma to be a social assistance beneficiary. Due to the core liberal idea of the smallest state possible, benefits are usually means-tested and modest, given only to those that are genuinely poor, creating the stigma. The liberal welfare-state system is based on the notion that those who are entrepreneurial and self-reliant should be rewarded. Social insurances exists, but they are privately held and paid for.
The socialist movement started as a response both to conservative and liberal reforms. The most important notion of socialism was to change the societal stratification and achieve social leveling. The primary target was to change the means-tested poor laws since they created a stigma within the proletariat and that beneficiaries were disenfranchised. The social democratic idea of universal benefit system as a prolongation of democratic rights was most evident in the Scandinavian countries and particularly in the Swedish "People’s home". The universal benefit system came to include even the middle-class in order to "preserve the solidarity of a universalistic welfare state". A universal benefit system denotes a system where social aid is for everyone. This picture is somewhat simplified, although benefits are universal in general, and more general than the means-tested system where only a limited group qualifies for benefits. Moreover, the socialist movement focused on the concept of solidarity and in extension, one of its most distinctive features: centralized bargaining trough trade unions.
---
Do Capitalist Welfare States Still Consist of ”The Good, the Bad and the Ugly?” http://lup.lub.lu.se/luur/download?func=downloadFile&recordO...
Both are vulnerable to being hijacked. Financial variant can be driven into the ground by others cutting corners or essentially exploiting workers - plain corporatism. The democratic bottom up variant shares the vulnerabilities vs demagoguery but makes it harder to counter, though also more expensive to pull off. Also does nothing against special interests or basic greed.
(USSR was actually etatist conservative bureaucracy rather than socialism.)
America needs two periods with Democrats: the first one won with/by centrists, who then fix up the electoral system issues (gerrymandering, FPTP, voter suppression, campaign financing) and the second period where the left wing fixes the societal issues (income/wealth inequality, healthcare, "free speech" allowing people to walk with Swastikas).
We got legal weed though, so there's that.
https://www.cbc.ca/news/politics/trudeau-electoral-reform-ja...
That's both true and misleading. The decisive factor in Presidential elections is base turnout. Obviously, the states where the outcome is least certain are most decisive, but this doesn't make centrism a particularly winning general election strategy for either party, which is why the Republicans haven't nominated a centrist Republican in decades, and the Democrats have consistently underperformed where they naturally should perform from party ID (including taking into account he state-by-state distribution), despite nominating candidates from the center-right neoliberal wing in every Presidential election since 1992.
> and with the current system the centrist Democrats do have a point
No, they don't. Their point is literally “We should keep doing the thing that we've been doing and expect that doing so will result in something other than the results it keeps producing.”
> America needs two periods with Democrats: the first one won with/by centrists, who then fix up the electoral system issues (gerrymandering, FPTP, voter suppression, campaign financing)
Why would centrists Democrats—who use all those things to argue for why progressives must vote for them instead of actual progressive candidates (and despite the fact that that strategy manifestly doesn't work)—want to fix any of those things and thereby terminate their own argument for dominance within the party?
You might as well expect Republicans to fix them; they have just as much (that is, negative) incentive to do so.
Never mind that the average wait time to see a doctor in Canada is almost 20 weeks, and that tens of thousands of Canadians cross the border to the US every year to avoid that wait...
There are tradeoffs with everything. Personally I think people should proactively try to live healthier lives - the medical establishment is about making money, not making you healthier.
The other major side benefit of that is our society might be able to afford the overall cost of healthcare - it's not looking too good at the moment!
The way this is stated is very misleading. The average time to get surgery is 20 weeks. This varies a lot by what kind of surgery you're talking about[1]. The average waiting time to see a doctor in the ER is measured in hours, with 27% of Canadians waiting 4 hours or more[2].
As a Canadian, I'm tired of Americans shitting on Canada's health care system and spreading misinformation to score political points. It's not perfect, but I'll take it over the financial devastation wrought by the US system any day.
Edit: Also, let's not forget that US citizens regularly cross the border into Canada so they can afford basics like insulin[3].
[1] https://globalnews.ca/news/3084366/q-a-how-long-are-medical-...
[2] https://www.cbc.ca/news/health/medical-wait-times-up-to-3-ti...
[3] https://www.cbc.ca/news/canada/windsor/bernie-sanders-insuli...
Daniel E. "Danny" Williams, QC a Canadian politician, businessman and lawyer who served as the ninth Premier of Newfoundland and Labrador between November 6, 2003, and December 3, 2010. [1]
Abdullah bin Abdulaziz Al Saud was King of Saudi Arabia and Custodian of the Two Holy Mosques from 2005 to his death in 2015. [2]
Moses Veerasammy Nagamootoo is a Guyanese politician and writer who has been Prime Minister of Guyana since 2015. [3]
[1] 'Danny Millions' Williams heads south for heart surgery
https://www.thestar.com/news/canada/2010/02/03/danny_million...
[2] Waldorf-Astoria Bumps Guests for King Abdullah's Entourage / The Room Is Booked, Until the Hotel Says It Isn’t
https://www.nytimes.com/2010/12/14/business/14road.html
[3] Prime Minister Nagamootoo to Undergo Heart Surgery in the United States
https://www.thewestindianonline.com/prime-minister-nagamooto...
edit: typo; rephrased sentence
This is not an oft brought point when discussing the merits of the U.S system despite its failings and short comings.
Also:
The Fraser Institute, a Canadian public policy think tank,
estimates that 52,513 Canadians received non-emergency medical
treatment in the U.S. and other countries in 2014, a 25
percent jump from the roughly 41,838 who sought medical care
abroad the previous year.
In citing those numbers in its 2015 report, "Leaving Canada for
Medical Care," the organization said difficulties in obtaining
timely medical care at home is, increasingly, leading Canadians
to seek it abroad. "It is possible [they] may have left the
country to avoid some of the adverse medical consequences of
waiting for care, such as worsening of their condition, poorer
outcomes following treatment, disability, or death," the report
says. "Some may leave simply to avoid delay and to make a quicker
return to normal life."
Canadians could expect to wait 9.8 weeks for medically necessary
treatment after seeing a specialist in 2014, the researchers found,
three weeks more than the time physicians considered to be
clinically "reasonable."[1]
Canadians Increasingly Come to U.S. For Health Care / Crossing the Border for Care
https://www.usnews.com/news/best-countries/articles/2016-08-...
So those numbers are definitely not optimal compared to many other countries, but your claim about the average being almost 20 weeks is completely ridiculous. You're entitled to your own opinions, but you are not entitled to your own facts. And if your opinions are based on your own facts, don't expect to be taken seriously in any reasonably educated company.
Now, according to [2], the US fares well on two metrics: waiting time to see a specialist and waiting time to elective surgeries. Unsurprisingly, both of these are conditional on already having gotten a referral and/or having decided to book the appointment or operation. That is, most of the time, if you have decided you can afford it! Indeed, cost barriers were by far the highest in the US, as measured by the fraction of people who skipped treatment or medication due to cost.
[1] https://globalnews.ca/news/3251833/canada-has-some-of-the-lo...
[2] https://www.cihi.ca/sites/default/files/document/text-altern...
I've needed to go see my doctor - usually I can't get a same day appointment. Sometimes I can get a 'next day' - usually it's "pick some time in the next week or two". Am I now "having to wait"? It's been this way for me my entire life in the US (more than 40 years I can remember), across different states, political leadership and insurance companies.
I needed a procedure by a specialist last year. Regular checkup produced "this is serious - I'm referring to you ABC for procedure X - we need to get this done ASAP". It was still more than 2 weeks before the specialist could see me. There was an option of seeing someone else sooner, but it would have meant a 2 hour drive. That was possible but very inconvenient, and we decided that the 2 week period was acceptable vs the alternative.
Does everyone else in the US get same day service for everything they need, and I've just been wholly unlucky my entire life in multiple regions of the country? Or, do we actually have 'wait times' just like everyone else?
Regardless, people fall ill through no fault of their own all the time. I am very healthy and very active, but right now for all I know I could have a brain tumour. Your response is so stereotypically American: just ignore the problem and encourage people to take responsibility over something they by definition have little control over in the first place.
[0] https://www.ctvnews.ca/mobile/health/health-care-wait-times-...
[1] https://globalnews.ca/news/3251833/canada-has-some-of-the-lo...
[2] https://www.fraserinstitute.org/studies/waiting-your-turn-wa...
This is just false.
The number you're referring to is from here: "Specialist physicians surveyed report a median waiting time of 19.8 weeks between referral from a general practitioner and receipt of treatment—shorter than the wait of 21.2 weeks reported in 2017. This year's wait time is 113% longer than in 1993, when it was just 9.3 weeks."
It's for receiving treatment from a specialist (surgery, etc.) not 'seeing a doctor'.
Somewhere around 40% of Canadians reported being able to see their primary care physician the same day. Very few reported a wait of longer than 7+ days.
Many parts of Canada are very remote. The average waiting time for someone in a major city is not as long as that.
Keep in mind that Canada may be huge, but has less people than California, and most of them are concentrated in a handful of places.
Anecdotal: my wife's wait for an orthopedic surgeon was 3 days... but was in a city 1.5 hours away.
Here in Austria it's even easier, I can go directly to my family doctor at any time and wait ~hour with no appointment necessary. Xrays, or other things are usually possible same day and even elective surgery that improves quality of life is free and is plannable within a couple months with the recovery time as paid leave from work.
As such you can not directly compare a system where going to the doctor costs money with one where it does not.
This is one of the biggest problems with the US system: Nobody knows the extent of the unserved need, and what that ends up costing society in lost productivity (never mind the human suffering) because people avoid healthcare services they know they can't afford.
But we can compare Canada to other socialized systems, and many do more with less and still end up with shorter wait times.
The vast majority of the worlds healthcare systems also do not prevent people from going private.
Most places also allow you to buy your way past the queues. As such, the difference is stark: Most places you have the choice of waiting, and paying much less, or paying for private services and get seen as quickly as those who can afford it do in the US while a large number of people in the US has no access to a lot of healthcare services at all.
Want to bet whether the people who can't afford to buy healthcare services would prefer waiting 20 weeks - or any amount of weeks - to get treated vs. getting no treatment at all?
Now consider that average US spending per taxpayer in the US on Medicare and Medicaid is substantially higher than the per taxpayer spending to fully fund universal healthcare in the UK for example. And then on top of that Americans buy private insurance since most are not covered by Medicare and Medicaid.
Most Americans pay twice. Meanwhile in the UK only 10% find it worthwhile "paying twice" by having private insurance, even though most private insurances in the UK are very cheap for the simple reason that there's simply no demand for replacing A&E, ICU type services, and relatively little demand for covering private GP services (most people can be seen by their GP quickly, and a private consultation on occasion is cheap), so the insurances mostly cover seeing a specialist quickly if the NHS has a waiting list, or getting surgery quicker if the NHS has a waiting list.
This is what I really don't get about the US debate: The poor regulatory regime basically mean Americans are already paying enough towards healthcare to provide universal coverage via taxes alone if the regulations were properly reformed. A start would simply be to remodel Medicare after e.g. the NHS model, and allow it to exercise its market power to drive down costs, and use the savings to extend coverage.
As it stands, the inadequacy of the US healthcare system is largely down to corporate welfare in the form of regulations that actively prevent the government from providing cost-effective healthcare services.
If it were believed that the ambitious left were going to implement free healthcare by bringing actual costs down into line with the rest of the world they could probably muster bipartisan support in a few years. But I bet their plans don't do that - eliminating means testing and more handouts are are just avoiding the real issues.
[0] https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...
Leaving aside the question of old age and focusing on healthcare for people of working age, it is almost always cheaper to intervene earlier, and it helps people get back to work sooner. The case is even stronger in children where healthcare gets to determine if they get to live a decent life or not.
Not to mention the benefits of time saved fighting back and forth over bills.
A little bit of cost control pushing people onto the cheaper versions of insulin and things like that, in the manner of the UK National Institute for Clinical Excellence would help. This is also what every private insurer does, but people go bananas when contemplating the idea that the government might do it.
Oh, and pharma marketing needs reining in. Some of the people who were marketing opiates should be jailed for the damage they've done.
Compare to e.g. the UK where the NHS does not just negotiate on generics, but also use the considerable value of their contracts for generics or drugs that can easily be substituted to drive down prices on other drugs by bargaining on combined contract values.
To get a ballpark for economic factors, let's try to figure out what the total value of absolutely all goods and services transacted, at market value, per year in the US and then divide that by the national population. I think if you asked the average person what they thought this figure would be, most would put it in the hundreds of thousands. Some might even put it in the millions. Fortunately it's really easy to figure out exactly what the answer is. It's precisely what the GDP/capita captures. It's about $62,000. And we're already chopping 27% of that in taxes to fund our current [generally underfunded] programs, so you can drop it down to $45k.
That is, as hard as it is to believe, the entire economic product of the country. Our unimaginable achievements - both social and personal can make it hard to realize how little we actually have. So you need to fund all the grand ideas you have in proportion to this keeping in mind that it doesn't mean you have $45k per person to spend. That is the entire economic product of the country.
This is why it's much easier to have a grand vision than to actually think about implementing it. Taxing the rich is hardly a solution because it again misses out on just how little we really have. If you go and just take 100% of Bezos' wealth from him, all $150 billion, that works out to about $470 per person - for one year. And he is exponentially richer than most rich. By the time you get to stripping the 20th richest person of all his wealth, you're down to $10s of dollars. Not too long after that, you're down to pennies per person. And that is, again, just money for a single year. These grand ideas need neverending annual funding.
---
This is why even in places like Norway, which has extensive national wealth due to a mixture of a small population and large sums of nationalized oil money, it's not just free everything for everybody. Solving all of these issues requires much more than just a desire to solve them. The reason I mention this is because I think this shared desire is something that often gets lost in today's increasingly polarized world. We all want the same things; it's just we disagree on how to get there.
I think you've misunderstood the nature of government spending. It's not like the government destroys that 27% when it spends it: the money is just redirected from where it might have gone (i.e. consumer spending) to other places (like the maintenance of roads and hospitals). You've forgotten about the circular flow of income.
Besides, GDP per capita as a measure of the productive capacity of a country actually misses quite a lot. Suppose I run a drug company, and I charge $10k / year for a drug that's cheap to manufacture (so there are no worries about the price of intermediate goods or the value that I add). That's 10k per annum that I'm adding to GDP.
But if a competitor offers a generic version of the same drug at ten dollars a year, putting me out of business, that $10k / year diaappears from the GDP figure.
It's easier to think about these things in terms of labor than in terms of money - money is too abstract and it's easy to make logical errors.
Imagine we have a 100% labor/service economy. Each time money changes hands, it means that that much "value" of labor has been exerted. In this sense, it is clear that the GDP is an accurate representation of precisely how much "value" or labor is being exerted in total across the country each year.
If each time money changes hands, the government takes 27%, that means that 27% of all labor exerted in the economy goes to the government, and is spent, permanently. Money is finite in the same sense that labor is finite in this example.
> But if a competitor offers a generic version of the same drug at ten dollars a year, putting me out of business, that $10k / year diaappears from the GDP figure.
No, then the consumer would put that 10k / year towards some other purpose instead, and it would still show up in the GDP.
But the labour goes towards a government program. If the program is absolutely worthless, then you're right: nothing of value was created and 27% of GDP was "spent". But if the service was just as valuable as what each worker would have done, then nothing is lost. The reality is probably somewhere in-between. Some work is wasted as a result of bureaucracy, but otherwise the government makes good use of its taxes.
> No, then the consumer would put that 10k / year towards some other purpose instead, and it would still show up in the GDP.
GDP measures value added to an economy. If the price of a product drops, it adds less value. Consider the cost of adding a column of numbers in the era before computers (done by a trained clerk) vs today, where the cost is effectively zero. We don't account for all clerical work that has been automated away in the GDP figures anymore because it's essentially free.
I agree. I'm not saying government programs are useless. The person you replied to was simply saying that we only have $62,000 a year to spend on each person (and that's all of the resources in the entire economy) and it sounded to me like you were disagreeing and saying we had more than that.
> GDP measures value added to an economy.
I agree.
> If the price of a product drops, it adds less value.
By what definition of value? Are you just defining value as being equal to the price? In a utility-based sense, I think GDP does measure value added to the economy.
> We don't account for all clerical work that has been automated away in the GDP figures anymore because it's essentially free.
In some cases, the GDP might not change if the cost of goods has only gone down, sure, but GDP is a useful figure only relative to the cost of goods. This is how we compare the GDPs of different countries with different currencies.
Even $100k can have zero utility if you need cancer treatment that is more expensive than this.
This is because service costs are usually not negotiable, and especially not privately if you have zero power.
Deriving utility from money directly is an exercise in futility.
In comparison, items can be used for the intended purpose, meaning they have utility for that and related purposes.
Money has unknown utility depending on prices and other various factors.
Without specifying purpose and other constraints you cannot actually talk about utility of any asset.
PPP adjusted GDP is better, because it relates money value to a certain basket of goods which have utility for certain common life purposes. However, the basket typically skips critical pieces like shelter (housing), clothing or indeed weighted averages of medical care. (Medical care is especially tricky because it is very heavy tailed in cost. Low probability events have huge costs, which means in normal average they're hidden. What is needed is the likelihood of a person hitting any of the expensive conditions, which can be had by binning expensive ones together.)
Not to mention if a service is paid by taxes, PPP essentially should count the cost by using the tax value split among all the free services. If it is gated conditionally, then likelihood of that condition has to be counted in. (E.g. free for people making $x or less.)
The great majority of Americans nevertheless do have houses, healthcare, education, sustenance, childcare and jobs. This suggests that the economy can provide these things and that also providing them to the small proportion currently without them is probably feasible.
Making them 'free' and involving taxes just rearranges the payments involved. It doesn't require producing much more than America already does.
The challenge is to do this without damaging incentives and the economy or creating moral hazard (free riders). That's the difficulty.
If the freeriders drain less from the system then it costs to perform measures to counteract them, the system is effective.
Switzerland is by no means a socialist utopia. You don't get a free house, or are somehow guaranteed a high paying job (who was even arguing that?).
But when it comes to healthcare everyone is in the same pot. I.e. you contribute the average for a person your age and share the risk across the population, as it should be imo.
We could absolutely stop people going bankrupt when they get cancer.
This includes subsidies for housing, basic necessities, and healthcare insurance.
My father's entire family, who have literally said that being homeless should be a capital crime because it proves how useless you are.
Yes, bad people do exist. Why is this still a surprise to conservatives?