Bay 12 Games Forum

8/10

GreatJustice, that's the total spending.  The total spending is higher because the federal government is paying for so much more care because it's serving the older, sicker population that get's more care.

Your logic still doesn't follow. Yes, the federal government naturally pays more as it serves the elderly and those prone to sickness through Medicare. That has absolutely nothing to do with related price increases caused by the influence of the government on the market or any other related issues.

While the cost of medical care is outpacing medical inflation it's outpacing it faster in the private sector then in the government sector.

That isn't medical inflation, that's the total inflation as measured by the CPI. Besides that, as a percentage, the US government's share of healthcare spending has steadily increased since 1964, as has (heavily regulated and controlled) private insurance over out of pocket spending. The costs of Medicare and associated programs have also increased by leaps and bounds as a percentage of GDP. However, this incredible growth in healthcare expenses only really began to take off after US government interventions. Whether or not there is a difference in costs between heavily controlled private spending and government spending (which, by the way, I expect direct proof of) is ultimately irrelevant as to whether the government is more efficient or not.

Frankly the way you have been drawing conclusions to this point show me that I don't want to waste my time arguing with you anymore.  But if you actually want to learn the truth of the matter try finding an apples to apples comparison for yourself.

"Stop using charts, inferences and evidence you big bully! Unsubstantiated claims and allegations are the only things we accept on this side of town!"

Just condense the basics/medium details from your posts.
To be honest I couldn't tell the differnce between critique and suggestion.

Alright.

-The US govt stops subsidizing insurance through employers, and it stops mandating what insurance should cover (though state governments are responsible for that).

-People pay for the bulk of their healthcare out of pocket, which keeps costs comparatively low as opposed to people paying through the weird insurance system the US has presently (as a lot of cost comes from people spending 100x what they need on drugs that decrease the odds of potential problems by 1% compared to cheaper drugs and similar such situations).

-The US government sells off the hospitals it presently owns and resists the urge to try to get involved again.

-Medicare/Medicaid are ended at some point (a politically unpopular decision to make, but a necessary one regardless of one's political views as both programs are becoming black holes into which more money produces less quality and drives prices up)

-The AMA has its monopoly on medical licensing removed.

-The FDA is majorly reformed, if not altogether replaced.

That basically covers it. Again, articles and charts can be provided on request (as I've found some that will work for what my previous chart did).

Is it worth pointing out that America has the sovereign debt crisis and an economic crisis and a crappy healthcare system?  I don't think France's economic problems are linked to it having a decent healthcare system, is what I'm getting it

The US doesn't have a sovereign debt crisis because the US Dollar happens to back everything and thus gives the Americans a lot of leeway in terms of debt. In the long term, yeah, the US shouldn't get into debt, but they can get away with far more so long as everyone backs their money with American money. Anyway, the problems of American debt and economic problems have entirely different causes and solutions.

Also, France's healthcare system isn't the only factor, but the French welfare state is the big driver for French debt. It's not like they're spending everyone on the military like the Americans since the Americans effectively pay for their defense.

Saying that sovereign debt crises and healthcare costs are linked wouldn't pass the laugh test for arguments if this wasn't all so tragic.  Healthcare costs are a smaller part of GDP in every other country in the world but the US.  So they are being driven into bankruptcy by how much money they are saving?  There are even some countries where government healthcare spending is lower then in the US because of how inefficient our current system is.  If any country is being driven into debt crises by healthcare costs, it's the US.  In fact we wouldn't any deficit or long term debt problems in this country right now if our healthcare costs were in line with the rest of the world.

Again, the US gets away with a lot more presently because it's the lender of last resort. Furthermore, the US also benefits from still being the world's largest economy, and it has a variety of tricks that can change it's debt levels if it so wants (Clinton's favourite trick was to shuffle money out of Social Security and into the hands of the government directly and then brag about the surplus he'd generated). That's hardly a positive thing, but American economic problems are mostly unrelated to this thread.

The rest of the world, meanwhile, can't afford anywhere near as much as the Americans can, especially since most of them pay for their healthcare directly through the government whereas a comparatively smaller share of American healthcare is paid through Medicare and so on. Furthermore, it's basically undeniable that excessive spending on welfare state projects is responsible for the bulk of the debt of those countries mentioned, the exception being Japan (which is in debt because of lots of expensive failed stimulus projects, in turn in response to a 20 year recession caused by a lot of weird economic and fiscal policies in Japan, again a story for an entirely different topic).

But they aren't actually being driven into debt crises in the first place.  The only countries facing debt issues right now are EU countries that are stuck in high unemployment due to the pigheadedness of the ECB.  That's not a debt crises, that's a central bankers being morons when they could solve this problem anytime crises.  Countries with better debt outlooks then ours are in crises because the ECB isn't doing it's job.  Of these exactly one is due to entitlement costs, Greece.  Does it need to be said that a tiny country which was cooking the books and rife with corruption isn't as good a comparison as say, France or Canada or the UK?

The ECB is, indeed, capable of using a variety of tricks to temporarily improve the situation of the Euro members in trouble. However, due to the incredible precariousness of the Euro right now, such an action would probably destroy the Euro in the long term and create an entirely new bag of problems, ones quite a bit worse than debt crises (which can at least be solved over a long period of time in a variety of ways).

I mean my Ideal healthcare system is the one Singapore has. It insures everyone and allows market forces to work much more efficiently in the healthcare market than any other model. They have a simple, socialized medical plan for everyone. That makes up around 42% of the healthcare market. The blan can provide anything you could ever need, at decent quality and price.

The really ingenious thing is that not only does the socialized medical plan insure that everyone is covered, but it also encourages competition in the private healthcare market. You see, if the government can give you a basic physical exam for 5$ (not actual price, just made up for the simplicity of the example), than private providers are forced to either do it for 4$ or improve the quality of the exam (unless you are an irrational individual and only see private providers  ). Whats great is that the governmnet can subsidize the basic exam, using taxpayer dollars of course, and thus make it cheaper, while the private porivders cannot and are thus forced to improve efficiency (in terms of both price and quality) or cut profit margins in order to survive. Unlike many socialized plans, this actually makes healthcare providers more innovative.

Also, they don't rely on insurance as much as other countries do. A key part of their socialized healthcare plan is that no service is provided free of charge, no matter how poor you are (although the subsides get pretty large so the cost can be very, very small.), this is done to discourage overconsumption of healthcare. Instead of having people pay out of pocket for the public care, since there is no insurnace for that, you are mandated to save a certain percentage of your income in a government sponsered health savings account (it is topped off by the government if you are too poor to meet the minimum requirements). Since you want to keep as much of your own money as possible, you try to control costs where ever possible.

There are also private healthcare insureers to cover private healthcare costs. This is pretty much the only flaw I can see in the system. The private insurance insulates the consumer from costs and drives up healthcare inflation. If I had my way, there would be no insurance and your Medisave account, the government medical savings account I mentioned earlier, would be used to pay for your private healthcare costs. That would make you think a lot mroe before you spend any of your money.

I picked singapore because it has the what looks to be the most efficient helathcare model. Not only was it ranked 6th, out of 191 of all the world's health care systems by the WHO. Here is the list of the top ten, for comparision.

1. France (single payer)
2. Italy (mixed private public. Part of it is socialized and then other private providers. 75% public.)
3. San Marino (no idea, could not find it. Probably the same as Italy as San Marino is a mirco-naiton surronded by Italy.)
4. Malta (socialized, with private insurance and a some private providers [don't need many on a tiny island.])
5. Andorra (single payer)
6. Singapore (you should know by now)
7. Spain (mostly socialized.)
8. Oman (socialized.)
9. Austria (socialized, can purchase private insurance.)
10. Japan (single payer.)

Now, lets break it down. 3 have single payer systems, 3 (counting San Marino) have Mixed private and public, and 4 have socialized systems. Not a single one is fully priavte. Now I for one find it impressive that Singapore can be on that list, given it's low median GDP per capita (median being what most of the people can expect to make instead of just the average. [I can't actually find numbers on median GDP per capita.]). Even though singapore's average GDP per capita is ~59,000$ at PPP, that is not the case for the average Singaporean. 1 in 6 Singaporeans are millionaires, the highest for any country, which vastly distorsts the average GDP per capita numbers. The fact that it can be up there with rich countries (and Oman, which can afford this thnaks only to their oil wealth.) is pretty damn impressive.

No country in the world has a fully private healthcare system (and that would be including the USA), so showing off how highly rated non-private healthcare systems are is a bit like a mid 17th century demographer coming to the conclusion that, because almost all of the richest/most successful countries are presently controlled by emperors or kings, the only way a country can be successful is to be ruled by an emperor or king. Ignoring that,

-Half of those countries listed are undergoing massive sovereign debt problems, which deals with that side of things rather simply (similarly, Greek healthcare was once one of the best in the world because cost was ignored, but it ultimately came crashing down to practically third world standards)
-Of those not undergoing debt or economic problems, four are micronations and thus aren't really comparable in terms of health service due to the different logistics involved (Though it is worth noting that Singapore has a nominally freer market in healthcare compared to the US in many respects, and is certainly far more streamlined)
-The remaining country is Oman, but from what I can find it's healthcare system isn't exceptional by any means with a life expectancy of 74ish and not much notability

Finally, the rating was compiled by WHO, the same people who were stupid enough to treat Swine Flu as a "pandemic" and panicked in a distinctly unauthoritative fashion when given a chance to look into things rationally, and thus should be taken with a mountain of salt.

While you may have a point about the non-sequiturs, I don't think the slope here is particularly well-greased. In addition to being a public service, it's one that is crucial to life for many of the people who require it, is extremely expensive, often unpredictable, and the burdens associated with it are unevenly distributed throughout society.

One could make a similar argument for food under the right conditions, but few would advocate a Food Bureau to ensure everyone is given as much food as they "require".

I know. If we are going to have programs like that, we might as well attempt to optimize the system toward ensuring people get healthcare when they need it - which, I believe, involves making sure that hospitals treat people who show up, end of story. There are practical issues in making that happen, obviously, but that's what I believe to be the morally correct objective.

But what if the hospitals are incapable of treating everyone who shows up due to a lack of resources? Again, this is hardly a problem unique to the US. There are several instances in Canada (and I'm sticking to Canada for the time being since I actually live here) of ambulances being turned away from hospitals due to a lack of space or shortage of doctors.

No, I'm not, but the single payer system is the one I prefer and the present insurance-based system is the one I particularly oppose, so I'm naturally going to spend most of my time talking about them.

But by doing so, you're creating a false dilemma that is hardly likely to have ideal results. Choosing between the present American system and the single payer system is a bit like choosing between Fascism and Communism; you might find the merits of one to outweigh the problems of the other, but there are lots of unexplored options that make far more sense.

Other systems seem even less practical to implement; for instance, what you brought up assumes health care costs go down, which seems unlikely.

Again, I would be greatly appreciative if anyone could find the chart I was referring to, but the absurd increases in healthcare costs didn't really begin until the mid 1960s while LBJ was passing his Great Society programs. The only reason it would seem unlikely is because all the countries of the world have hopped on a bandwagon of government controlled healthcare in some way.

If nothing else, insurance companies don't want that to happen because it gives people an incentive not to have insurance (this is obviously a perversion of all sense and decency, since you'd expect that having to pay out less on each claim would be considered optimal, but since a premium necessarily has to be greater than the expected cost for that contract holder, you wind up with a situation where every person with insurance is a net win for the industry).

Indeed, established insurance companies have a tendency to be quite crooked. But then, Obamacare isn't really a single payer system at all, it's a fascist system that basically functions as single payer for the average American but market based for the insurance companies.

Anyway, the major problem that arose regarding insurance is that the government simultaneously encouraged businesses to give workers insurance benefits (due to price and wage controls restricting the higher wages that could be offered during WW2) AND forced insurance companies to cover things that quite frankly make them function less like insurance companies and more like healthcare brokerage firms. A lot of problems that exist today simply wouldn't if insurance companies functioned the way they were designed for, by providing very large amounts of money in the event of unforeseen disaster (that would be a previously healthy person contracting a deadly disease through no fault of their own, being hit by a car, having unexpected heart problems, etc). The vast majority of expenses relating to healthcare would be long term things that one would have plenty of time to look over and consider (doctors visits, non vital surgery, medication, etc) while those that came up suddenly would be covered by insurance companies (who would have an incentive to gain a reputation for setting up deals with high quality hospitals and would be able to pay out far more/without as much weaseling because they wouldn't be covering small time things anymore).

In principle, I don't really care how somebody wound up with cancer, I'd still prefer it get treated (if the patient actually wants treatment, obviously) than not. "You did something that, in retrospect, was pretty stupid - so you are going to die or have your life ruined" is not really a moral position to me. In practice, you're right, ensuring that the system works is probably going to require some restrictions on how often certain avoidable problems can be treated before the patient has to start paying more, and I'll accept that as a necessary matter of practicality.

In principle, saving life in general is usually agreed to be a good thing. However, again, scarce resources. It would also be a good thing if everyone on Earth had vast tracts of land, customized mansions, and the highest quality of food and entertainment. Do you spend your set budget on saving a single smoker with advanced cancer, knowing that even then the chance of survival is middling, or do you spend that money on equipment for lung surgery? Do you focus on saving the elderly with heart problems, or middle aged workers with injuries on the job? It's never going to be that clear cut, mind, but someone is always going to get thrown under the bus no matter what system you have. In the US, that would primarily be the poor unable to afford insurance at all, and those with preexisting conditions. In Canada, that would mostly be the youth with immediate issues that require hospital treatment, the elderly, especially the elderly requiring complex surgery, and those too poor to afford to go to the States if they find the waiting list in Canada too long. A market system would hardly solve the problem altogether, as you still have a fixed number of resources that can be used. However, in the longer term, the problem is self correcting; the more profitable option would generally be the one given, and thus the provider would have more money to spend on whatever was prioritized for the hospital.

I do understand the practicalities of the situation. I was being deliberately simple because the post was intended to deal with ideology - whether or not private industry is the optimal way of getting the most people decent healthcare is something worth debating, but not quite what I was getting at there. Instead, it's intended to address people who argue that it's unfair to pay for somebody else's healthcare.

They have a point, there. Using the "people have to pay for healthcare because it's a public service option", you can simply stroll along that path of logic to reach "people have to pay the government to make bread" and "people need to pay for the government to make shoes". The most annoying thing about it is that once a government seizes control of an industry, it becomes nigh impossible to remove it since "anti-government owning everything" people have to argue against non-sequiturs that run along the lines of "If the government didn't run the shoe factories, we wouldn't have any shoes!" and other such nonsense, as though people, upon discovering that they won't be received a free pair of shoes every six months, will say "Damn, I guess myself and millions of others are doomed to lives without shoes since the government doesn't make em anymore, may as well lay down and die".

You can have a system where some people pay for services they don't get, or you can have a system where people don't get the service.

Strictly speaking, the US right now has a system where people pay for services they don't get already, counting Medicare, Medicaid, and the insurance they very likely have.

There are certainly degrees here; not all alternatives to private insurance are equal, obviously. But to argue that it's unfair to pay for another person's healthcare requires acceptance that you're arguing that some people should suffer and die because they don't have money, regardless of practicality (and regardless of the number of people who willingly chose not to save money or purchase insurance and are suffering the consequences of that choice - I'm talking about people who didn't have the option).

Again, you're acting like the present American system that operates through insurance companies paying for everything makes sense and is the only alternative to a single payer system. Before the 1960s, healthcare was exceptionally affordable and generally paid out of pocket (workplace subsidies for healthcare insurance and associated changes in what insurance covered had started from around WW2 on, but hadn't quite kicked in yet alongside Medicare and Medicaid). If someone needed emergency treatment and couldn't pay for it, they would be treated first and the cost handled later. Cases of people being thrown out on the street when found incapable of paying were practically unheard of. True, this relied on the good will of the doctors, but then most people are generally decent regardless of whether they are legislated to be so or not.

Of course, some people are so utterly irresponsible that it's practically a crime for everyone else to have to pay for their expensive surgery, and indeed even in single payer systems you find cases where the government will restrict treatment for someone (smokers come to mind). This isn't an especially clear cut issue.

Well that is because those surgeries are naturally more inclinded to be affected by market forces. A laser eye surgery is voluntary, postponeable, and gives you time to shop around for the lowest cost and highest quality surgery. That is not true of most healthcare, where the patient does not have enough knowledge to make effective decisions. Also they might need the surgery now, and not have time to shop around.

(A) A disproportionate amount of surgery is of the variety that you have plenty of time and options before you actually need it, yet those don't have the same decreases in cost or increases in quality. Certain heart surgery procedures, for example. Those times where it is absolutely urgent are those times where insurance actually makes sense and what it was originally intended for (eg. you get hit by a truck and require immediate surgery)

(B) Under a single payer system, you literally have no choice in the matter whatsoever, whereas under the worst case scenario of a "market system" you at least have some choice. If the only hospital in your area that does heart surgery is known for being a hospital of terrible quality, unless you plan on going very far away you are going to have to endure it (this isn't a hypothetical, either; the hospital in my area that handles heart surgery has a reputation for poor conditions and is avoided at all costs by anyone who is capable of doing so)

Quote from: GreatJustice on June 29, 2012, 05:22:46 pm

To call the single payer system "more efficient" is quite funny. I've got friends who spent hours waiting for treatment for things as basic as hives only to get kicked out due to a shortage of space. As poor as the American system is, I have yet to hear of that ever occurring in their hospitals.

And as free market as some other countries are, I've heard the same things happen there. Let's be honest, single payer doesn't mean more efficient, de facto, but it certainly CAN be more efficient if properly implemented.

Simply compare the cost, speed, and quality of service provided by a variety of other single-payer nations and you'll see the difference.

It's all about implementation.

Certainly, some single payer systems are far more efficient than others. That's hardly in question. However, it's a bit odd to look at a world of variations of single payer systems (barring, in a very limited and convoluted sense, the US), see a variety of problems, and come to the conclusion "Well, it looks like the single payer system is the only solution to THIS problem!".

Even ignoring efficiency for a moment, the single payer system is quite vulnerable major problems if the government itself has economic problems whereas a free market system should have enough providers to somewhat avoid that. Case in point, Greece once had one of the best systems in the world, but it was funded through debt and imports of drugs from other countries. Now that Greece is going through economic trouble, basic necessities so far as healthcare goes (eg. Aspirin)  are effectively nonexistent and are only available to the absolute richest who import directly from other countries.

It's also worth noting that in almost all countries, the least regulated healthcare sectors/surgeries are also those that experience the fastest price declines and technological improvement. Case in point, laser eye surgery in the US, something that isn't covered by insurance, has declined in price by around 30% while simultaneously increasing in quality since it's introduction. Meanwhile, veterinarians in Canada provide some positively stellar quality for relatively cheap costs, especially compared to what people get. I honestly wouldn't be too surprised if there was more advanced medical equipment around the country for animals than for humans.

If we all agree that everybody should be able to get treatment for medical conditions, why does anybody support a system that allows that not to happen?

(A) That's a massive oversimplification and

(B) In a world of scarcity there will always be people who are untreated for medical conditions, be it in the US or England or Canada

Some form of rationing has to occur in some way, be it through costs or through long waiting lists/no treatment period.

I think a lot of the furor will die down once the real meat of it actually gets implemented in 2014, and people see what the actual numbers are for their specific situation. As with most new government proposals, it's the opacity of the whole equation that makes it scary. There's no simple calculator they can go to and see how it's going to affect them. And because it has to apply to so many people, there's a slew of variables in the calculation that make it tricky for even informed people to calculate.

Want to know what I think will happen if it isn't repealed almost immediately and furor dies down?

-Costs will initially drop from the increase in coverage/new laws, everyone will be happy
-After a while, costs will increase drastically from the poorly thought out long term effects (which will increase demand for needless medical services even more than before)
-Costs (or waiting list times depending on what the governing administration does) will reach absurd levels and the loudest voices will blame the evil free market system for the problems
-The US will adopt a fully government controlled system, whereupon people will cease to blame "the system" and simply believe that the only solution to the problem is shoveling more money at it

This is, of course, assuming the US doesn't undergo a major ideological shift and the younger, more charismatic 2024 equivalent of Ron Paul gets elected or something like that, which I find highly unlikely at the moment.

I think that the rational for an individual to put up with forcibly increased medical costs, for him, is that it could increase the efficiency of the country's economy. If you have to make a sacrifice for a more efficient system then ultimatly it might pay you back in the end due to increased economic activity in the country as a whole making it better for you.

To call the single payer system "more efficient" is quite funny. I've got friends who spent hours waiting for treatment for things as basic as hives only to get kicked out due to a shortage of space. As poor as the American system is, I have yet to hear of that ever occurring in their hospitals.