Socialized Health Care in the USA

[kandrathe]

I think a market solution would serve you better than what you have, but substantially worse than even a mediocre single-payer system. But as is obvious from the current wrangling, the politics of this decision are tied in knots. "Courageous" folk like Max Baucus, who speak their own minds, and also happen to take more money than anyone else from Insurance and HMOs are making sure that reform dies on the floor, and the rents from the current system still flow into corporate coffers.

I'm not sure what makes a "single payer government run system" better. It just means that there are price controls making providing health care uniformly less lucrative for providers, and prioritized waiting lists for services which result in rationed care where the oldest and sickest die rather than get care. Right?

The burden of administering plans remains the same. Yes, you do cut out that whole actuarial science of managing risk, but will cost more in that people will not self ration the amount of health care they consume. Everyone uses more when the apparent cost is free. I don't hear of hordes of people heading north or south of the USA border to get "better" health care. The fact is that the USA probably has the best health care on the planet, in fact, the best health care that money can buy.

The evidence of international health care costs is out there to look at. Nobody in the OECD enjoys less health care for more money than the US currently does, but pretty much every other country has either some kind of single payer or socialized medicine. Unless you think that Americans are just fundamentally less efficient than every other developed country, I think it's safe to say it's your system at fault. Maybe moving in completely the opposite direction from more successful models will work, but it certainly doesn't sound like the safe way to go.

Ok, the cost of HEALTH INSURANCE is high, when you compare it per capita to what is paid by government run systems. Our system is upside down in expectations. The prices are set artificially high, because the other government programs, Medicare, and Medicaid have set limits on the price they will pay for almost every charge. In order to balance the losses, clinics, hospitals, and other care givers charge rates at the 200% to 400% of cost level across the board. Medicare, and Medicaid automatically refuse to pay, and then enter into arbitration with the provider to negotiate a compromise, while the insurance company will either outright pay, or also choose to barter for a fair price. The uninsured are billed for the jacked up amount, and if they are rich are soaked for the higher price, or when they are unable to pay will be nagged by collection agents for months until it is eventually written off.

The problem is clear. If beer was free, we'd drink all the time.

As with any other commodity, the individual must somehow pay an amount that is proportional to what they use. The problem started when prices were lower, and employers were convinced by unions, or calculated that they could attract better employees by offering health insurance as a part of the benefits package. This is especially attractive for employers, since the government allows companies to write off the costs on their taxes. Even this level of insulation of costs from the consumer, results in an artificially high use of the service, and thus artificially driving up the demand, and thereby the costs. So, 60/40 plans and copays are an attempt to reintroduce the consumer to the realities of paying for their own consumption.

And, if you want to factor in insurance, which is the aggregation of risk, then the cost of insurance should relate to your health history. Like, with your car insurance. If you get into many accidents, your rates go up. This provides the incentive to use only what you need, and to keep yourself healthy to prevent disease. The people in the USA are very unhealthy, and perhaps a part of the reason for this is that they no longer bear the financial burden of their illness.

Next, the government is interfering in employer offered plans. The plans are not portable across state boundaries, which limits the competition. And, each state regulates by force of law what must be offered in the employer plans. These mandates are political hot potatoes that legislatures use to gain constituency brownie points. If employers were allowed to offer a slim plan that covered catastrophic illness (heart attack, strokes, cancer, car accidents, etc), along with some general wellness coverage (yearly doctor exams), then the costs of those plans would be extremely affordable. Yes, some people might opt to for a plan that includes AIDs/STD testing coverage, birth control, alcohol/substance abuse treatment, psychiatric, etc. But, then, they should expect to pay higher rates for that level of insurance.

Who is John Galt?

More importantly, where is he hiding? Galt's Gulch, perhaps, to escape from this dystopian nightmare. Me too, once the USA achieves the equal distribution of poverty being crafted by the "everyone gets a free lunch (... and then we'll get some future generation to pay for it)" crowd in power for the past few decades. We, in the USA, should be ashamed of our deficit spending and national debt. The concept of national borrowing was as a short term measure to adjust for extraordinary circumstances (e.g. war (not world policing), depression), but for us its become the status quo. Tarp money, cash for clunkers, psudo-stimulus, are just ways of transferring the mistakes of the present onto the backs of future workers.