Free Insurance For Everyone!... Oh, Really?
How much are you willing to pay to insure your neighbors... even if you don't like them very much? 
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http://www.nytimes.com/2007/03/01/wa...hp&oref=slogin
\ http://www.nytimes.com/2007/03/01/wa...hp&oref=slogin
Comments
The NY Times article cited is clearly asking the question "how much more would you be willing to pay." That being said, the point may be well made that Americans would be willing to pay more in taxes for guaranteed health insurance. But I think the article was woefully naive on the amount more they were proposing.
According to NIH, 2006 health care expenditure was 2.1 trillion dollars, 16% of US GDP. Assuming 300 million Americans, this works out to about $7000 per person. According to the same NIH report, Medicaid spending was $315 billion, Medicare was $418 billion. Lets be generous and assume total government spending in 2006 to $800 billion. This still leaves about $1.3 trillion in spending, or about $4300 per person. I don't think many people would be willing to pay that much more.
In truth, the numbers would be more skewed because of the progressive nature of the income tax system. According to the congressional budget office (see table 1B), in 2001, the top 20% of taxpaying Americans paid 65% of total Federal tax liability. If we apply this same proportionality to the additional tax burden at hand, it means that 60 million Americans would be paying 65% of that 1.3 trillion. This works out to $845 billion or $14080 per person in the uppermost 20%. The true number is actually even higher because the total number of taxpayers is fewer than 300 million.
Naturally this argument does not take into account any additional shifting of the Federal Budget to cover the additional expense. Nor does it take into account any tax liability on corporate interests. I don't mean to portray nationalized health care as a non-starter, but the issue is much more complex than a handful of New Yorkers saying they would pay an additional $500 per year.
Nice numbers but health care costs could come down as cost shifting ( insured patients paying more to off set losses from uninsured) would be eliminated. This would be profound at hospitals where large numbers of uninsured are treated.
If Health Insurance premium collection and claim management administration was consolidated into one entity cost savings would be significant. A single claim payor system is the way to go. Health Care Providers would still be chosen by Patient.
... and the "best and brightest" will continue to look somewhere other than medicine for thier careers....
People stopped going into medicine for the money thirty years ago. It's hard to argue that's for the worse.
You are so right.
You're also forgetting that we're already paying that much for health care. Much is coming directly out of our pockets, the rest indirectly deducted from our pay in the form of employment-related insurance. The latter may be more subtle than direct taxes, but it's no less real. And if you have insurance, you overpay because you need to subsidize the many people with expensive bills and no insurance. If we shift the payments over to taxes, we all pay and we all benefit. No worries about being stuck in a job because you're sick or never being able to get coverage again after being diagnosed with a sebaceous cyst. All that aside from the enormous savings we could reap from shifting from a system where most bills are paid by entities with 20% overhead (private insurers) to one with 4% overhead (like Medicare). 16% x $1.3T = $200 billion/year.
You have some good thoughts there, but there are other issues. Right now, we have one of the most advanced (if not the most advanced) medical techology/care on the planet. Not everyone is covered, but I'm speaking of the actual care itself. People from all over the world come here to be treated. One of the reasons for this is the private financial incentives (salaries) for doctors. In many other nations, doctors are not paid as well as in the US...not by far. This leads to highly motivated and skilled surgeons here.
For example, the average salary for a cardiovascular surgery is about $500,000. I can't find good data on, say, a comarable position in Canada, but the research I've done seems to indicate it is considerably less. Personally, my own sister has gone to the doctor overseas and has said it is completely different in terms of access (fewer hours to take appointments) and the care was not as comprehensive. I believe she went in Germany. (just in the way of information, my sister's politics make the most liberal posters here look like Ronald Reagan. Seriously).
I realize this is mostly anecdotal, but what I'm getting at is the fear that a socialized system will harm what is good about the system we have. My worry is that it will destroy the incentives we have built-in for excellent care. "Free" healthcare would also presumably push demand through the roof, which would result in higher costs.
In addition, we haven't had the debate about whether or not we should cover everyone, whether it's "free" or not. Some consider it a basic human right to have access to health care. I'm not sure I agree. Where does "free" stop? I mean, I break my foot...OK...that's clear. But what about my decision to have an endoscopic back procedure instead of full open surgery? Will that be allowable? What about LASIK eye surgery? Still free? I just wonder what the limits would be.
Last, it would seem to me that a good compromise might simply be legislation limiting healthcare premiums to something affordable (which apparently there is zero politcal will to do). A proposal like that coupled with what Bush is proposing in terms of a tax deduction for those that have to purchase their own insurance may just work.
In the end (at least in my opinion), the government shouldn't mandate someone's participation in such a socialized system, nor tax the living shit out of its population to pay for it. It also shouldn't be The Nanny, making sure that people aren't being stupid by failing to take advantage of any program like I mentioned above.
"Free" healthcare would also presumably push demand through the roof, which would result in higher costs.
The counterpoint would be that nobody likes going to the doctor.
...we haven't had the debate about whether or not we should cover everyone...
As the current news headlines declare our fallen soldiers deserve our respect AND care.
Our fellow citizens should not be abandoned when medical care is needed because Numerals on a Page don't add up. Numerals on a Page has not limited our recent foreign policy adventures for domestic security and the pursuit of domestic happiness.
In the private sector an increasing market is perceived as an opportunity. It is no less an opportunity to serve our neighbors/citizens/patients/customers with care and compassion they are due as fellow humans. There is no lack of intelligent and compassionate people willing to train and pursue careers in Health Care. The only limitation is our national will to make health care available.
Who among us is willing to say NO to others when they are vulnerable beyond their control. Are you willing to look into the eyes of a sick person and tell them you do not care what happens to them?
My soul does not allow me to say that. Does yours? These answers will guide us to be the people we want to be.
Before we redestribute the cost of the insurance, it would be good re-examine the current system, cut out a lot of the fat, and change it such that it encourages preventing problems before they start rather than looking how to pump out more money out of your wallet!
The real kicker is going to be allocation under a government system (Medicare, now, is a good example). If you scream loud enough, you get better care. If you're poor and disadvantaged (on paper) you get better care. If you know somebody, you get better care.
What a national health care system will mean is that care will be rationed. That's what it means anywhere else that has it. Right now it's rationed based on price and ability to pay, and in some instances based on charity for special cases. Figure out what indicator will be used to ration under a federal/political system, sit on it early, and you'll be "rich" when the time comes.
It's all about the economics of it.
The counterpoint would be that nobody likes going to the doctor.
Demand goes up when cost goes down. Especially in health care. And one of the reasons employer paid plans are going up dramatically is usage. You can take that to the bank.
SDV2001:
...we haven't had the debate about whether or not we should cover everyone...
As the current news headlines declare our fallen soldiers deserve our respect AND care.
Our fellow citizens should not be abandoned when medical care is needed because Numerals on a Page don't add up. Numerals on a Page has not limited our recent foreign policy adventures for domestic security and the pursuit of domestic happiness.
In the private sector an increasing market is perceived as an opportunity. It is no less an opportunity to serve our neighbors/citizens/patients/customers with care and compassion they are due as fellow humans. There is no lack of intelligent and compassionate people willing to train and pursue careers in Health Care. The only limitation is our national will to make health care available.
Who among us is willing to say NO to others when they are vulnerable beyond their control. Are you willing to look into the eyes of a sick person and tell them you do not care what happens to them?
My soul does not allow me to say that. Does yours? These answers will guide us to be the people we want to be.
This is a cheap, emotional argument. I love how you essentially are saying that one can't be a good, compasionate person without supporting universal healthcare. As if you and yours have some kind of monopoly on morality.
The question is one of providing free health care or health insurance to everyone. While this is done in many countries, there is little LEGAL basis for it here in the US (not that it couldn't happen or couldn't be made legal).
Secondly, "sick people" can get critical care at hospitals. They can't be turned away, actually. Coupled with immigration troubles, it's one reason our ER's are stressed financially.
Demand goes up when cost goes down. Especially in health care. And one of the reasons employer paid plans are going up dramatically is usage. You can take that to the bank.
No.
No one likes going to the doctor.
Do you like going to the doctor any more than you absolutely have to?
No.
No one likes going to the doctor.
Do you like going to the doctor any more than you absolutely have to?
It's hard to make such a general statement that based on most people's experience would seem true. Many people do not like to go to the doctor, but there is a large population that are big users, some are abusers, of health care. These people really drive up the cost for everyone.
One of my employees works for the local ambulace service as an EMT. The stories she tells are amazing. Runs to people's homes *just to check blood pressure*. Runs to homes and patients refuse to go to the hospital for a variety of reasons (you mean uncle Joe can't ride in the ambulance with me!). One way state's try to reduce medicaid utilization is by co pays and that is coming on like gang busters.
Any form of nationalized health care will have to deal with this issue.
No.
No one likes going to the doctor.
Do you like going to the doctor any more than you absolutely have to?
Shawn,I'm sorry but you're completely and utterly wrong about this. I am telling you....low costs lead to increased usage. As a the son of teachers, I would think you'd have some knowledge of this with contract negotiations/healthcare and what not. Our premiums went up 30% in one year because of usage, for example.
Not all people go to the doctor only when they get sick. There is, in fact, a social phenomenon/compondent in the senior community where people spend and plan their day around going to various doctors several times a month. That is just one example.
Otherwise, people tend to use healthcare services more when they cost little or nothing. I know I'd hesitate a lot more to go to family doctor for back pain or anxiety or a sore throat if it cost me $100 every time. But since it's $5 and scrips are $10-20 no matter what drug in the world I get(almost), who cares? I have a bad back too...and yes, I go to the doctor for it. But I have no problem scheduling a percutaneous decompression and series of injections as they pretty much cost me nothing. Not that I don't need it, but I'd think twice if the price was $1000 per injection and $5000 for the other procedure Wouldn't you?
people tend to use healthcare services more when they cost little or nothing.
I don't think that assumption is right.
Physician visits would certainly increase among those with poor health coverage or none at all. That's certainly foreseeable (and a good thing for that matter). But for the rest of us? I hardly think it'll make much of a difference. I'm pretty sure I read something saying just that.
The real kicker is going to be allocation under a government system (Medicare, now, is a good example). If you scream loud enough, you get better care. If you're poor and disadvantaged (on paper) you get better care. If you know somebody, you get better care.
What a national health care system will mean is that care will be rationed. That's what it means anywhere else that has it. Right now it's rationed based on price and ability to pay, and in some instances based on charity for special cases. Figure out what indicator will be used to ration under a federal/political system, sit on it early, and you'll be "rich" when the time comes.
It's all about the economics of it.
I don't think that assumption is right.
Physician visits would certainly increase among those with poor health coverage or none at all. That's certainly foreseeable (and a good thing for that matter). But for the rest of us? I hardly think it'll make much of a difference. I'm pretty sure I read something saying just that.
I agree increases of office visits would occur because the less affluent are so price sensitive they defer until a small problem becomes a big problem. Thus the big problem costs way more. That is also true for the example SDW2001 uses about consideration of treatment for a bad back. If the back problem is neglected because of price, disability might result in unemployment and then there is the issue of lifetime public and private disability payments.
Remember the Fram oil filter commercial:
You can pay me a little now or a lot later.