- One free eye exam each year covered by Medicare (to obtain your latest prescription, and check for all eye disease).
- Ability to go into an optical store and buy contact lenses/glasses if you tell them your prescription.
Only if you're over 65! Otherwise its one exam every three years for a standard exam. [1]
It's been a while since my last check, but last time I went they did try upselling to some more advanced scan that wasn't covered by medicare.
Either way, still think we're doing something right in Australia but having this base coverage for everyone.
[1] https://www.humanservices.gov.au/individuals/subjects/whats-...
(And for non-poor people we can cut out the middle-men: just let them pay for their eye check out of pocket. Instead of having them pay a levy, have some layers of bureaucracy, and then give it back to them in the form of eye checks.
(Note: this is not an argument against medical insurance as insurance against unforeseeable, big events. It's only an argument against indirecting payments for small-ish, routine and predictable items.))
There's no good reason for healthcare that everybody needs to be locked behind a prohibitive money gate.
So what's the argument that suggests poor people need to be given healthcare, but not bread?
I suggest to just give them money, and then they can buy the bread and healthcare they need.
(And that's a general principle.
However giving goods and services directly does make sense for non-excludable public goods. Eg don't give poor people money to procure national defense. Just provide national defense directly with tax payer money.)
You (deliberately?) misread the parent's comments. It was not very long, and it centered on the word "both".
> I suggest to just give them money, and then they can buy the bread and healthcare they need.
Elsewhere you wrote that "unforeseeable, big events" should still be covered by insurance, but I don't think you understand that if people don't have enough money, even getting regular checkups and medication can be pretty "big" from the affected person's perspective. If two people are scraping by on a universal basic income that is enough for basic shelter and food, and one of those people regularly needs checkups or medication for some chronic condition, then you are screwing over one of those people.
This isn't about the freedom to choose not to be chronically ill, because there is no such freedom. Neither is it about the freedom to choose not to be treated for chronic medical conditions. There is no such freedom, the word for that "choice" is "torture".
To be more clear: if society spends X dollars per year per poor person on direct financial transfers, and Y dollars per year per poor person on in-kind services, I am suggesting to move to a system of giving the poor person (X+Y) dollars in direct financial transfers.
Is that better?
About the latter part of your comment:
Yes, that is a real problem. There are (at least) two reasonable approaches that leave insurance as insurance:
First, you can just give the chronically ill or disabled person more welfare money.
Or, second, if you are a purist for equality: enter a very long running insurance contract, before you develop a chronic condition. Because then there's still uncertainty, and uncertain conditions are insurable. In the strictest form, your parents would make the arrangements before conceiving you.
BUT: I do gladly concede that for serious enough conditions just handing out medical services might be a reasonable choice. I don't know. But that doesn't say much about routine check-ups for healthy people.
> enter a very long running insurance contract, before you develop a chronic condition. Because then there's still uncertainty, and uncertain conditions are insurable. In the strictest form, your parents would make the arrangements before conceiving you.
I guess this is a complicated way of saying the same thing as I did, except that "your parents" are "the law"?
Your parents are your parents. They have skin in the game.
People with heritable diseases would presumably pay more for that kind of pre-insurance. (That's pretty similar to how the church in Cyprus apparently asks couples to get tested for Thalassemia genes before marrying them: if both parents have a single copy of the recessive allele, the children run the risk of sickle cell anemia.)
> Where I live (Austria), everybody (modulo a few exceptions and quirks that shouldn't exist) has state-mandated health insurance. If we go to the doctor, of course the doctor gets paid, but not directly out of our pockets. The system is simple, and it works. I don't understand why you discount this possibility. It's the best model.
I grew up in Germany with a similar model. The various European models look good compared to the American mess we hear so much about. The Singaporean system is superior, even if not perfect.
They didn't have the Praxisgebühr for fun in Germany. (https://de.wikipedia.org/wiki/Praxisgeb%C3%BChr)
I believe you mean "bread OR healthcare".
To quote myself: if society spends X dollars per year per poor person on direct financial transfers, and Y dollars per year per poor person on in-kind services, I am suggesting to move to a system of giving the poor person (X+Y) dollars in direct financial transfers.
And you'll find politicians lack that resolve.
However, this ain't an all or nothing game:
You can move some in-kind services to money payment without moving all. Eg it should be possible for politicians to refrain from handing out annual eye exams.
A Medicare levy, while not ideal, is a fair system. You don't pay it if you don't pay tax, it is proportionate to your income, and it allows a basic level of care for those who need it. Everybody needs eye checks. Poor people get them for free. People earning an income pay for them.
Could you back that up? Are you talking about a specific country, or all manners of private healthcare?
As far as I can tell, the least regulated bits of healthcare systems that people pay out of pocket for tend to have done the best in terms of cost control.
Eg few if any insurances around the world pays for laser eye surgery. And it's one of the few common healthcare procedures whose costs have dropped massively in recent decades.
> A Medicare levy, while not ideal, is a fair system. You don't pay it if you don't pay tax, it is proportionate to your income, and it allows a basic level of care for those who need it. Everybody needs eye checks. Poor people get them for free. People earning an income pay for them.
That seems like a good argument in favour of taxing the well-to-do to give the poor money. That's a fine decision for a democracy to make.
But I don't see the argument of forcing the poor to spend that money on healthcare instead of letting them decide what's best for themselves. Do you know what they need better than them?
In terms of letting the poor spend it on what they like, I disagree. You aren't giving them money. You're giving them healthcare. In my opinion, people are not entitled to money. But I do think they are entitled to good health if it can be at all given to them.
I'd say that if as a society we want to help (poor) people, we should do whatever provides the most bang for the buck; ie the highest quality of life improvement at the lowest burden to the rest of society and the smallest disincentive effects.
But yes, if you explicitly want to restrict what poor people can do, then your position is a consistent one.
I don't know that an elective procedure is the best example, but it's still an example. One counter is prescription drugs. My insurance would only allow a small number of tablets for my migraine medication because the cost for them was so artificially high. When I called the insurance company to ask why they wouldn't pay for the number of tablets that I needed, I was told that my doctor should do a better job of controlling the number of migraines that I get. Where do I get this medication now that I don't have insurance? From countries that have socialized medicine, and the cost is substantially less. Unreasonably high costs for prescription meds in the US is not unusual. I recently had to take doxycycline for Lyme disease. Back in 2012, this cost 6 cents per dose. That price increased by over 6,000 in one year, just as Lyme cases were also skyrocketing.
In any case, the socialized health care probably doesn't cover the drugs that get to exported to foreigners like you?
> Unreasonably high costs for prescription meds in the US is not unusual.
Yes, that's a separate problem.
Enabling (re-) imports is an important safety valve. Medical tourism is another.
Ideally, the US would fix their healthcare system. But I wouldn't hold my breath.
Maybe I'm misunderstanding, but large markets (socialised healthcare systems) can negotiate a fair market price for medications. This is something that the US system prevents.
Have a look at mebendazole. It's on the WHO list of essential medication. It's old so available as generic.
In the UK this costs a few pounds per tablet. https://bnf.nice.org.uk/medicinal-forms/mebendazole.html
In the US it currently costs $440 (about £340) per tablet.
There are many similar examples: Americans pay huge amounts for medications that should be cheap.
There's probably a legal reason why someone can't just set up a company to buy mebendazole in bulk in the UK and ship it to the US and sell it for eg $200 per tablet?
Almost all developed countries have socialized healthcare. What countries do you have in mind?
Singapore has some of the best healthcare outcomes in the world, and costs about half as much as a share of GDP per capita as the British NHS.
Where the American system seems to combine the worst of public and private healthcare, Singapore combines the best.
In the Singaporean system individuals use a health savings account to pay for small, routine health care costs. The insurance part of the system only kicks in for larger, costlier, uncertain items.
There's plenty of subsidies for poor people, too.
See eg https://www.nytimes.com/2019/04/22/upshot/singapore-health-s... for an American perspective. There's also plenty of easy to find material on the web.
I especially like that doctors usually have a list with price ranges for their most common items hanging out prominently. Very transparent.
The aspect of the system that I wanted to highlight is that routine care is paid for out of the health savings account (Medisave), and not out of the insurance portion.
Another interesting aspect is that the bill you get for treatments always mentions the total cost and any subsidies you are getting. All very transparent.
There's also always a co-pay as a matter of principle, even if it's just a few dollars.
They also quantify the degree to which private providers can "recover" costs for pre-existing conditions. E.g. mandatory wait-out periods and relatively minor penalties, and then they have to provide full cover.
But beyond some of those items, they pretty much let the private providers run it as a business. You can decent cover for as low as $60, but if you want additional benefits and ad-hoc medical spending-money, you pay more obviously. Some of them even have packages that are reduced based on they person's salary to make it more affordable for low-income families.
The idea of giving cash is, frankly, asinine. The objective is not to increase the recipients spending power, but to reduce health problems population wide, reducing expensive medical interventions and productivity-draining disability.
That line of thought can be used to justify a huge amount of intrusion into people’s lives.
Giving them a specific good is equivalent to giving them money, but forcing them to only spend it on something you approve of.
Some amount of "paternalism" is good for society. Someone likened health to car maintenance, but I can tell you that of the drivers I know, zero of them would get their car the yearly technical check unless it was explicitly illegal to drive that car otherwise. I'm starting to believe we should have something similar in places with public healthcare - there should be a set of free, mandatory, noninvasive checkups to screen for diseases that don't have symptoms noticeable by patients, and there should be a way to compel everyone to take those tests. It would be better for everyone's well-being, would save public healthcare a lot of money, and the doctors could stop attaching unrelated tests to getting prescriptions for glasses or birth control.
With cars, there are greater third-party effects (i.e. your car failing and crashing into someone else), so it makes sense to require a certificate before one is allowed to use public roads.
Of course, in practice the government would probably come up with silly layers and restrictions on how to use the money etc.