Health care

The U.S. Health Care Market

Various Systems In The US

The VA system

The July 17 edition of Business Week has a very interesting article (unfortunately requiring paid subscription to view online) about the VA in the United States. They present a detailed and convincing argument that the VA system is currently the best functioning medical system in the U.S. (Note, the VA is a government institution). This was a bit of a surprise to me, both because the VA has a poor reputation (stemming from the early '90s, when it was so bad that it was almost shutdown, but instead was dramatically reformed), and because I have previously argued very much along the lines of Millenniumman. However, they do give some indications as to why. The biggest reason why economic theory has suggested (and in practice, it has usually occurred) that private enterprises will be more efficient than public ones is that the incentives for efficiency are better. However, the VA has very deliberately set about to create the right incentives for improved performance. They have increased individual responsibility and accountability, as well having a system where they get one lump sum of money and get to keep any money saved due to efficiencies (such as preventative care). This is different from the current insurer/hospital scene in the private medical world, where often it is the insurer who reaps benefits if the hospital saves money, while the hospital is paid more based on numbers of patients and procedures.

San Francisco

• What do you think of the public health care initiative being considered in San Francisco? Read this article in the San Francisco Chronicle for information about the initiative.

(Why) Is the US Health Care Market Broken? How To Fix It

Why do our employers choose our healthplans? What is the effect of this?

• Collective health care is possible in a free enterprise system, and no one is forced into an inefficient program.
  • Why hasn't it occured? The only (or at least dominant) form of collectivism is via Employment. Are you suggesting a different form of collective health care? What would that be? How could we stimulate the market to allow it? Clearly there are many people who want some form of Health care but don't recieve it. How can the market be made to serve them?
• I am a college professor and I believe that high costs and low quality are the result of lack of competition. We now have a system where health care plans are selected by employers, rather than individuals. We should move to a system where individuals select from competing providers. Our employers don't pick our stock broker, our bank, or other service providers. Why should they pick our health care provider? Individuals (not employers) should get the tax deduction for purchasing health care. All individuals should be required to purchase health insurance (unless they can prove they have the resources to pay out of pocket). The state can subsidize low-income individuals and families, but they have to be able to use their subsidies in a competitive market. 66.32.47.112 22:13, 9 July 2006 (UTC)
• I am also a professor (math). I think the difficulty here is that insurers do not want to insure individuals, they want to insure groups of individuals. See if I am an insurer, and say I offer great Cancer coverage. Then everyone who has cancer (or is pre disposed to it) is going to try their darndest to get on my plan, and I will be screwed. So I don't want to do that, I want to insure a group of people who couldn't choose there insurance Like a group of employees. The problem is that health isn't random, and as genetic screening gets better it is more and more deterministic. This lack of choice, which destroys the market, seems to be endemic to it.

Prescription Drug Prices And International Relations

• By collectivising health care services in universal healthcare systems these systems can exert more pressure on drugs companies to lower prices and better value for money. Most every other government in the world negotiates price controls on their drugs. This means that those who don't (i.e the U.S.) end up paying for most of the development costs, while the other countries only pay the production costs. "One example: the commonly prescribed cholesterol-lowering drug Lipitor..., made by Pfizer. In the United States, the full retail price is about $76 dollars for a month’s supply. The exact same drug costs $55 dollars in Canada and just $43 dollars in Italy." (Taken from CBS.com).
  • Many smaller countries with universal health care, such as Finland, are smaller customers of drug companies than some large US health insurance companies. If small countries are capable of bargaining for lower prices, why can't large insurance companies do the same?
    • An excellent question! They don't seem to be. Also, what happens to those without insurance? How do they negotiate? Do the poorer among us then subsidize the richer's drugs?
    • Perhaps it's because nationalised health care systems have a monopsony in their respective markets, and US health insurance companies don't. If Finland refuses to buy Lipidor for more than $40, and the drug company doesn't accept the offer, then they have no alternative way of selling to the Finnish customers. That market is then dead to them. Therefore, they still prefer to sell at a lower profit margin for $40 rather than not to sell at all. On the other hand, if Kaiser Medical in the US refuses to pay more than $40, then the drug company can simply reject the offer and sell to Blue Cross Medical for $70, because it knows that Lipidor patients have the choice to switch from Kaiser to Blue Cross.
  • Drug development is a global endevour, and the majority of the scientists who work for drug companies come countries outside of the US (even if they live in the US), where they recieved a free university education. In most rich nations, apart from the US, university education is either free or heavily subsidised. Thus, those non-US nations are already indirectly contibuting more tax money to drug research than the US is. It only seems fair that they should pay less for the product.
    • The U.S. spends twice as much as Europe (as a percentage of GDP) on Higher education: "The EU invests 1% of its GDP in this domain, versus a figure in excess of 2% across the Atlantic" -- State of European Higher Education, By Prof. Eric Cornuel, Director General of EFMD. So if you want to use this as a criterion for a "fair" price than the US should be spending half as much on drugs. Personally I think this is a little silly. The US, like Italy, should be trying to get drugs for its citizens as cheaply as possible.
      • This is irrelevant. What is relevant is how much tax money Europe spends on drug research, either directly or indirectly. This number is higher in Europe, both in absolute and relative terms. Why? people who buy drugs in Europe are already funding Pharmacology/Chemistry/Biotechnology graduates with their tax money. People who buy drugs in America are to a much lesser extent. Therefore it only seems fair that Europeans should spend less money on drugs.

Possible Solutions

Price Fixing

Should the US choose, as most other countries do, to negotiate lower prices on drugs. For instance should the US pass a law stating that No company can sell a prescription drug in the United States for more than the average price in the other G-7 countries? (They are of course free not to sell the drugs at all here.)

• If the US chooses to negotiate a price for drugs, it will not encourage these companies to accept lower margins. They will attempt to pass the added cost burdens off on another corner of the market, which is not price-fixed. If there is no one else to shoulder the burden, the drug companies will simply stop developing expensive drugs. Profits must be protected; they provide the incentive to innovate.
  • This is a danger I agree. However, there are many countries in the world. So even we joined the other countries in "price-fixing" we would still be left with a market, just with say 100 consumers. What is occuring is that we in the US, have voluntarily weakened our bargaining position. Its as if Wal-mart decided that instead of buying its supplies itself, it would allow all of its employees to just go off to the hardware store down the road and find something cheap. Such a stupid Walmart would not survive. We might end up with more interesting Walmart supplies (although I suspect they would mostly be the same old supplies in more interesting colors), but Target would eat stupid Walmarts lunch. We cannot make the drug market free. Nearly every other country is bargaining on the behalf of its citizens and businesses. Why should the US be the stupid Walmart? Can we afford to? If every other country gives its businesses a 10% (healthcare) headstart can the US really afford to compete in this way. If we continue to pay the development costs for the entire world we will no longer be able to make cars, computers or much of anything.
    • I don't think Wal-Mart is a good example, because most of their goods are at the lower end of the quality spectrum. It is however rediculous how the US gov't wont negotiate lower prices, however the prices should not be forced upon the drug companies. Monopolies create bad situations no matter if its a private company or the government.
    • I'm not sure I understand your objection to Wal-Mart in the example. I do agree that no company should be forced to supply the drugs for the price. If they don't want to supply them they don't have to. However its hard to see why this would occur since they are already supplying the drugs at this price to the other G-7 countries (excluding Russia).
    • Though a Wal-Mart comparison is an interesting concept, the quality of the product has largely deteriorated. While this may be acceptable for less important items (e.g. Toys), today only the most price conscious consumer would seek a durable item such as a television at Walmart.

Competition and less regulation would also lower drug prices

Drugs are an item with a high fixed (development) cost, and a low marginal cost (production). If the European countries, like Italy, say they will only pay 43 dollars for Lipitor (and they do). Then Pfizer will say ok, and push the devolpment cost into the "free" U.S. market. Thus we pay 76. How will competition alleviate this problem? Its true that the monopoly profits (due to patents) available to Pfizer will cause other drug companies to make other cholesterol drugs. This might bring the price down. However we will continue to pay all of the development costs for the ENTIRE world under this system.

An export tariff on drugs

• This is a consequence of foreign regulation, not domestic deregulation. The United States could adopt a system of punitive tariffs for those countries which mandate unfairly low prescription drug prices. All consumers should share in the development costs of drugs and medications.
  • Lets be clear about what you are proposing. Nearly every other country in the world negotiates for drug prices. You are proposing that we put punitive tariffs on EVERY OTHER COUNTRY IN THE WORLD. What would be the effect of that? What would the WTO say? The result is clear. The other countries will respond with punitive tariffs on US goods, probably backed by the WTO. They are not going to stop negotiating drug prices. We are the worlds largest market, but we are a small fraction of the world. You can't beat em all.
    • What alternative would you propose? The United States cannot afford to subsidize the medical costs of the entire world, and refusing to pay is not a viable solution if we value continued rapid treatment innovations. A national surcharge on all prescription drug exports (to provide windfall relief for the American drug consumer) seems a reasonable approach given the circumstances. Such a tax should include drugs manufactured outside the United States by American companies for international distribution, of course. I see no reason why this should be any less acceptable than the Chinese deliberately deflating the value of their currency to encourage investment, or the OPEC countries deliberately inflating the cost of oil to maximize profit distribution. It is an acceptable exercise of national sovereignty.
      • I agree with what the person said above about punative tariffs leading to even bigger problems. Italy is a perfect example of how a company will sell their drugs cheaper if a country negotiates with them for a lower price. I propose a much more simple suggestion than your tariffs. Make it an open market, with all the private insurence companies trying to negotiate for better prices if they want to (which some, strangely enough, don't seem to put much effort into) and each government doing the same. If a drug company doesn't want to sell its drugs to a country that isn't willing to pay what they see is a fair price, then fine, don't sell them the drugs. If the drug companies don't want countries like Canada to sell their drugs to Americans they can just limit their supply to a level that will cover Canadian needs. All this bickering about tariffs and such is really baffling to me. BOTH sides seem to want some form of governmental control or another, saying that the free market isn't getting us a good result. Well the market here really isn't free. I say we really put it out there, have all parties vie for the best prices they can get, and I bet we'll see a drop in prices.
      • Are you arguing that the U S government should also negotiate for drug prices for its population. Or every other government should negotiation, and here the private insurers should negotiate? As far as I can tell the second is what we have. What reform are you suggesting to "make the market free".

Health care loans, like Student Loans

The government could create a special classification of medical-use loan, as outlined above, which would be explicitly long-term and low-interest. Defaulting on the loan would jeopardize the consumers continued and future reciept of healthcare coverage, providing incentive to pay off the balances. And persons could be required to use their regular monthly salaries as collateral to "secure" the loan, if employed. The student loan system is an excellent proof-of-concept for this proposal. It is profitable and efficient.

This is a false analogy. A student loan is essentially a mortgage. You borrow money and invest it in something valuable (the education), which acts as the security against the loan. Then you use that education to earn extra money and pay back the loan in future. When you get a loan to pay for treatment of a disease, you have gained nothing. You are in the same position as the guy who wasn't sick, except you have more debt to pay back. This system wouldn't work. Nobody would be prepared to lend money to people with low incomes and serious diseases.137.222.40.132 20:38, 14 September 2006 (UTC)

Public Health Care Around the World: Compared and contrasted with the US system

United Kingdom

In the united kingdom the National Health Service (NHS) was put into operation in 1948. Introduced by Labour health minister Nye Bevan, it is based on the concept that completely free healthcare should be available on the basis of citizenship rather than the payment of fees or insurance premiums.

The UK health care system is almost unique in the world in that both health insurance and health provision are state-run and under control of a single, national organisation. Anyone who is a legal resident in the UK is automatically elligible to free NHS healthcare, whether a UK citizen or not; this contrasts most other European nations where health provision is linked to insurance contributions and certain groups (such as the self-employed) are excluded from universal health care unless they pay contributions out of their own pocket. The UK private health sector is one of the smallest in the world by market share. Few UK citizens are covered by private health insurance plans, and the ones that are only use them as a supplement to the NHS.

Italy

In Italy we have public health care, but you can also choose private care. Public health care can be very slow in some regions, but most of people in Italy prefer public health care because of its higher standards of quality. When people do choose private healthcare they do so mostly for having shorter waiting times and, sometimes, a better non-medical housing and treatment. In Italy public health care is often closely integrated with Universities and research centers, so you can get the state of the art in medicine. The somewhat slower speed of the public system might be endemic to it being public, but it may also be just be because it is Italian.

Canada

http://en.wikipedia.org/wiki/Canadian_and_American_health_care_systems_compared

Attributable Positions On Healthcare

Groups

The Unity Movement

The Unity Movement started out of a desire to get the nation to focus on crucial issues that affect the welfare and future of America instead of important but divisive issues like Flag Burning, Abortion, and Gay Marriage. One of the crucial issues for the Unity Movement is health care. (The others are Terrorism, the National Debt, Foreign Oil Dependence, India and China, Nuclear Proliferation, Global Climate Change, the Political Corruption, Education, and the disappearance of the American Dream for so many of our people.)

The goal for the Unity Movement on health care (as with other crucial issues) is to articulate a National Agenda explaining what the really important issues in the US are and why they are important. In mid 2008 there will be a national online convention with at least 20,000,000 people who elect a centrist presidential ticket that has offered a platform giving answers to these issues.

The Unity Movement is holding online discussions on the subject of health care in a variety of places:

• The Unity08 Shoutbox has a thread on Universal Healthcare.

• The Shoutbox another thread on health insurance company waste and lobbying influence.

• • Flag burning an "important" issue? You people have very strange priorities.

Perspectives

What's your perspective?

As a way of starting a deeper conversation around Health care, please post your "Perspective" below. This will give us a clear structure for looking at all the diverse and interesting perspectives we all hold. Each Perspective may be formatted as follows:

"I am _______, and I believe _______."

What counts is what we believe. I am may be used to put your statement in context.

Remember to "sign" your comment with four tildes (~~~~)

• I'm a university student, and I believe that an optimal solution to reduce strain on the system would be to provide public healthcare as part of a welfare system for individuals below a certain income level. With my current path in life, I would be able to afford health care for myself so I see no reason why I shouldn't pay for it. On the other hand, someone with 2 kids on a $30,000 a year income shouldn't have to watch one of those kids die because they can't afford that $5,000 operation. -220.9.84.66 23:22, 6 July 2006 (UTC)

• I am a college professor and I believe that high costs and low quality are the result of lack of competition. We now have a system where health care plans are selected by employers, rather than individuals. We should move to a system where individuals select from competing providers. Our employers don't pick our stock broker, our bank, or other service providers. Why should they pick our health care provider? Individuals (not employers) should get the tax deduction for purchasing health care. All individuals should be required to purchase health insurance (unless they can prove they have the resources to pay out of pocket). The state can subsidize low-income individuals and families, but they have to be able to use their subsidies in a competitive market. 66.32.47.112 22:13, 9 July 2006 (UTC)
  • I am also a professor (math). I think the difficulty here is that insurers do not want to insure individuals, they want to insure groups of individuals. See if I am an insurer, and say I offer great Cancer coverage. Then everyone who has cancer (or is pre disposed to it) is going to try their darndest to get on my plan, and I will be screwed. So I don't want to do that, I want to insure a group of people who couldn't choose there insurance Like a group of employees. The problem is that health isn't random, and as genetic screening gets better it is more and more deterministic. This lack of choice, which destroys the market, seems to be endemic to it.Joecoffey 19:37, 10 July 2006 (UTC)

• My best friend's father, Steve, is a biology teacher who suffers from multiple sclerosis. This is a cronic and debilitating disease that has no cure and will eventually kill him. Steve is no longer able to do his job full time and soon he will require 24 hour care. Here in the UK, if you have MS you have zero chance of being taken on by a private insurance company. In other words, if it wasn't for the public health service, he would would not be able to recieve any treatment at all and suffer tremendously. Some of you may say, yes, we know life isn't fair, but why should I pay for Steve's treatment? Here is why: because chronic diseases could happen to all of us, and therefore all of us should also share the risk. Besides, it's only a small contribution because chronic diseases are rare. Why not rely on charities for such extreme cases? Imagine if you were diagnosed with MS tomorrow (the diagnosis really does come out of the blue). Can you imagine the humiliation of relying on the whim of charities, who have no obligation to help you, or even begging for their help? Why did he not get a private cover against MS in advance? Yes, some would argue that it is his fault for not doing that, but how many of us are really covered against all possible diseases?

A private health care system caters for the healthy and a public health care system caters for the sick. Klafubra 09:46, 14 July 2006 (UTC)

• The health care debate boils down, as so many issues do, to the question "Am I my brother's keeper?" As much as people fight for the contrary, the answer seems to be yes in all cases. I am a college student, and I believe that health care should be a main prerogative for the United States. More and more people are contracting diabetes and heart disease. This is in large part because of our outdated food policy that makes high fructose corn syrup and saturated fats from soy beans the cheapest food available.

What we need in this country is a universal program for health insurance, and a smart food policy. The government should create its own insurance system, like medicare, that would cover every American. However, the plan that makes most sense to me would involve the government issuing health care cards to everyone with a social security number, and people could use these cards for services instantly, like a debit card. Every service would be covered and paid for within seconds, and finally an American could get sick in the US and be able to worry more about his/her health than how to pay for the visit to the hospital. According to Richard Kimball, Jr., CEO of health technology company HEXL, telemedicine is a way in which doctors and patients can work together using modern devices to help treat or prevent illnesses. In this case, even the less fortunate can benefit from healthcare without paying too much.

Naturally, there is the problem of defrauding the government in this system. There should, therefore, be extremely harsh punishments for falsifying records, or doing anything else that would make it possible to extract unwarranted funds from the government. Furthermore, there should be audits of healthcare institutions in order to catch any fraudulent charges. But because health care is such a time sensitive issue, I believe that it is more important that services are received quickly rather than waiting for the government to verify every transaction before a surgeon can operate.

As I mentioned before, a food policy that makes sense is also vital to this system. If we begin to decrease the number of patients with diabetes, we do more than help those millions of people. We will end up helping everyone because there will be a great deal of pressure taken off of the health care system. Diabetes is a disease that is chronic, and it is deadly, but not instantly the way so many diseases are. Many people live well into their 60s and 70s after having the disease for many years. But those years are spent in and out of hospitals, and racking up medical debts. If we can cure the societal reasons for diabetes, and not just attempt to cure the disease, we will have shorter lines in emergency rooms, more free beds in our hospitals, and billions of dollars that are saved along with the personal well being of millions of Americans.

Please comment, debate, and discuss. We need a better health system in the US, and I am not at all satisfied with what has been presented to the American people so far by the presidential candidates. Sdaitch 16:57, 11 November 2007 (UTC)

I agree with every word. Chadlupkes 17:02, 11 November 2007 (UTC)

DEBATE: The Right To Healthcare

Is some level of health care a human right? What level?

In the US right now, there is an existing standard: If you are in an emergency situation the state will not let you die.

• People should be entitled to essential health care as a right, not a priviledge.
  • What is essential health care? Which services should be "essential"?
    • It is true that a line must be drawn somewhere, and that this line is abitrary. Should the state pay for plastic surgery? And if yes, in what cases? Only in case of disfigurement? But that fact alone is not a justification for abolishing universal health care completely. Like most things in a democracy, what is regarded as "essential" is determined by consensus and public opinion, and will vary from country to country. The same problem applies to most other "inalianable rights" (eg. where do you draw the line between libel and freedom of speech; why is carrying a pistol a basic right, but not rocket-propelled grenade laucher, etc.).
    • I think the difference here is that unless some basic level of care can be delineated we cannot afford universal health care. If we continute in the US, throw every technology at the patient approach, we simply can't afford it.
    • I agree, I was simply wondering what people think. Could we codify through some basic principles a minimal set of care that say 70% of people would accept as necessary. That is what you are going to need in order to get such "universal care"

Pro Universal Healthcare

• Responsibility and control of our health care services should not be left to profit driven shareholders, but rather by people who are both representative and accountable to the users of the healthcare services.
  • Responsibility and control of so vital a service should be left to the most affected party, since they will have the greatest incentive to govern wisely. In this case, individual patients (not the "all citizens" collective, since most people at any given time are healthy) are those most affected by changes in healthcare policy, therefore they should be given control.
    • This is a totally reasonable position. However we should consider a few possible difficulties:

1. How are individual citizens in control under the current system? You do not choose your health insurance, your employer does (if you are lucky). Further this lack of choice seems to be endemic to the system. Insurers cannot allow you to choose your own insurance. When you do choose say your doctor on what information do you make your choice? (Really I would like to know, because its usually a complete crap shoot for me)

• • • I agree, which is why I am advocating the moving away from an insurance-based system. Let us be realistic: a system of insurance-companies as coverage providers is always a form of public health care, whether it is "nationalized" or "privatized." Regarding the choice of ones doctor, there a number of approaches individuals could take, including accessing public records and AMA reviews. Speaking personally, I am most comfortable with "family doctors," who have a history of treating either me or my loved ones.

1. Further Health Insurance is a natural monopoly. Insurers are in large part negotiators. They negotiate both for price of operations, drugs etc..., but also in theory they should negotiate for large scale changes like the computerization of medical records.

• • • • Again, I agree. The core problems are endemic to health insurance itself, whether public or private. The problems are simply more exaggerated under nationalized systems.

1. Given that it doesn't seem that individuals are making choices (at least to me I would like to explore how this can be improved) how high are the transaction costs we are incurring for having multiple insurers? It seems to me they are quite large, however we should attempt to quantify them or at least describe them.

• By collectivising health care services in universal healthcare systems these systems can exert more pressure on drugs companies to lower prices and better value for money. Most every other government in the world negotiates price controls on their drugs. This means that those who don't (i.e the U.S.) end up paying for most of the development costs, while the other countries only pay the production costs. "One example: the commonly prescribed cholesterol-lowering drug Lipitor..., made by Pfizer. In the United States, the full retail price is about $76 dollars for a month’s supply. The exact same drug costs $55 dollars in Canada and just $43 dollars in Italy." (Taken from CBS.com).
  • Such pressures will not encourage these companies to accept lower margins. They will attempt to pass the added cost burdens off on another corner of the market, which is not price-fixed. If there is no one else to shoulder the burden, the drug companies will simply stop developing expensive drugs. Profits must be protected; they provide the incentive to innovate.
  • This is a danger I agree. However, there are many countries in the world. So even we joined the other countries in "price-fixing" we would still be left with a market, just with say 100 consumers. What is occuring is that we in the US, have voluntarily weakened our bargaining position. Its as if Wal-mart decided that instead of buying its supplies itself, it would allow all of its employees to just go off to the hardware store down the road and find something cheap. Such a stupid Walmart would not survive. We might end up with more interesting Walmart supplies (although I suspect they would mostly be the same old supplies in more interesting colors), but Target would eat stupid Walmarts lunch. We cannot make the drug market free. Nearly every other country is bargaining on the behalf of its citizens and businesses. Why should the US be the stupid Walmart? Can we afford to? If every other country gives its businesses a 10% (healthcare) headstart can the US really afford to compete in this way. If we continue to pay the development costs for the entire world we will no longer be able to make cars, computers or much of anything.
• The cost of health care is extremely expensive. Why do we need companies to profit on top of this by denying coverage for necessary procedures to unlucky and unfortunate citizens?
  • The same argument could be made for any expensive item. In general profit is necessary to motivate change in a market. The argument which must by made by a National Health Care advocate is that somehow the health care market is different than say the car market.
    • The health care market is different because health is a matter of life and death, and cars aren't. Profit-motivated universal health care is possible, if health care provision is private but health insurance is public and compulsory. This is successfully practiced in many countries such as Austria, which is world class both in medical research and medical facilities.
• Collective problems require collective solutions. Many public health issues are collective problems and cannot be tackled by individuals. One example: Some vaccinations for communicable diseases only work if herd immunity is established. The maths behind this is fairly complex, but it turns out that for some partial protection vaccinations, if only 70% of the population is vaccinated the disease will spread to everyone, but if 90% is vaccinated the disease will be eradicated. In other words, your protection does not only depend on your own vaccination but also on the vaccination of others. If by public demand only 70% get a jab, it is right (and in the interest of the majority) for the government to intervene to encourage incraesing that number to 90% (eg. by offering free vaccines).
• If it can be argued that the healthcare market is a natural monopoly, then health should be controlled by that state like any other natural monopoly, because the state ultimately acts in the interest of voters, and private enterprise in its own interest. In absence of competition, a private enterprise is more inefficient than a functioning government.

Rebuttal

• The "right" to health care infringes upon other's rights.
  • Which rights?
    • Ammedment IV of the U.S. Constitution. The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no Warrants shall issue, but upon probable cause, supported by Oath or affirmation, and particularly describing the place to be searched, and the persons or things to be seized.
      • The application of this is pretty unclear here. Do you mean some right against taxation?
      • Or you could say that the amendment infringes on health care rights... The argument works both ways. Why should the above be any more valid? Just because it was written on some "official" piece of paper?
      • This ammendment has nothing to do with taxation, or any other infringement. Its about search and seizure. If he, or someone else, doesn't give an explanation I am going to remove the reference. Universal healthcare will be expensive though.
        • Seizing my income, "tax dollars", in exchange for no benefit for many, some benefit for others.
          • I understand your point, however it has no relation to this ammendment. Or rather the constitutionality of the income tax has long been established. So I would like to find a way to express this perfectly valid point without referencing this ammendment. Universal health care will be expensive, and we should definitely discuss its cost and the effect of its cost. In addition for some I think it goes against their version of "the american way" --- that I make my money and you make yours. We should discuss this.
          • So, how do we create a system that has benefit for everyone? I'm willing to pay extra so that my next door neighbor's children have access to health care services so they can play with my kids without my kids getting sick. The only way I have a guarentee that my rights are respected is if I in turn respect the rights of others. And everyone has the right to life, liberty and the pursuit of happiness. Health care is necessary for life, being healthy is necessary for liberty (people don't want you going out when you're sick), and I don't know about you, but I'm not very happy when I'm sick. I'll help you if you help me. That's how communities work. Chadlupkes 20:53, 17 July 2006 (UTC)
• Free enterprise is more efficient than government, and often more receptive to the citizens real desires, due to competition.

• We need companies to profit to drive our economy. It is a slippery slope to say "why do we need for entities to be able to do this" in governance.

Against Universal Healthcare

• • • Remove government incentives and regulations which subsidize the insurance industry while inhibiting the financial services industry. Health care costs can be served by ad hoc lenders via low-interest, long-term loans, in the same way that ad hoc lenders have given most everyone the opportunity to own their own cars and homes.
      • Why will the lender provide such a loan? A mortgage and a car are both secured loans -- if you can't pay they don't mind too much they just take your house and sell it. Thus the risk to the lender is low. The loan you are suggesting is unsecured, like a credit card. The risk to the lender is quite high, and as a result the interest on the loan is commesurably high. People can already put their medical procedures on their credit cards. It usually leads to bankruptcy though. Are there specific regulations government regulations preventing these loans? How are they different from credit cards? Do you want the government to back them? What happens when people can't pay -- this will occur quite often? Does the creditor take their other assets? Is their credit rating destroyed? Further you should realize that an insurance company serves both as a distributor of risk, and as a negotiator for the consumer against the provider. You will lose both of these functions, and I think the market will be even less efficient. (I can discuss why if you like)
        • Many of your questions are answered in the paragraphs that follow. I would be interested in hearing why you believe the market would be less efficient under a lender system, however.
  • I think the difficulty here is that insurers do not want to insure individuals, they want to insure groups of individuals. See if I am an insurer, and say I offer great Cancer coverage. Then everyone who has cancer (or is pre disposed to it) is going to try their darndest to get on my plan, and I will be screwed. So I don't want to do that, I want to insure a group of people who couldn't choose there insurance: Like a group of employees. The problem is that health isn't random, and as genetic screening gets better it is more and more deterministic. This lack of choice, which destroys the market, seems to be endemic to it.
    • • • • What are we supposed to be choosing? Right now we can choose which insurance CEO we make rich, instead of being able to choose any doctor or go to any hospital. Universal Coverage would deal with the payments for health care choices, not limit the choices themselves. We're so familiar with how HMOs operate that we can't imagine anything else. What if you could go to any doctor, and not be worried about how you were going to pay for it? That's the system I want to see. I want to be able to choose my own doctor, and not have to look through a list provided by my insurance company to see which ones I am allowed to visit. That's where choices are being limited in the current system, and it's the most important choice their is when it comes to the issue of finding someone to help you get healthy.
• The government is almost always less efficient than private enterprise.
  • The government is always less efficient than a functioning market. Does the health care market function properly? That is the question before us.
    • There's a piece missing. What is the objective of the health care market? Is it to make the health care companies money, or is it to ensure the health and well being of the people it serves? Which of these goals is more important? If a company denies a needed treatment to an individual and saves thousands of dollars, is that an "efficient" outcome? Until we know what the objective of a market is, it's jumping the gun to try to say how well it is working towards that objective. Chadlupkes 15:50, 27 September 2007 (UTC)
  • This statement is difficult to prove. For example if efficiency is defined as producing desired effects, surely a government provided healthcare service like the NHS in the UK is more efficient as more people are able to use it and therefore are healthy where they wouldn't otherwise be? On the other hand it depends on what level of care people get - perhaps you could argue that private healthcare gives a better standard of care?
  • A point to ponder - the cuban health care system which provides a similar life expectancy of it's citizens as the US costs significantly less - healthcare spending per person per annum is $251 in Cuba vs $2,389 in the UK and $5,711 in the US.
    • Life expectancy is a poor measure of the performance of a healthcare system. Given a good diet, vaccinations and plenty of excercise most people make it beyond 60, healthcare or no healthcare. What you should be comparing is the standard of living of the minority that fall seriously ill, not the lifespan of the healthy majority. For instance, what is the cancer survival rate in Cuba vs. USA?
      • Prostate cancer shows a low five years relative survival rate when compared with the USA, but its observed rate is comparable with Puerto Rico's. Figures for mouth and lung cancer were comparable with the corresponding figures of the USA and Europe. Breast and cervix cancers rates are comparable with the European mean and the blacks in USA. [1]
  • Universal public heath care and free enterprise are not mutually exclusive, if health provision is private, but health insurance is public.
  • Efficiency isn't the purpose of public health care, the purpose is to provide a basic level of care for those who can't afford private.
• Why punish the healthy by forcing them to pay higher taxes to cover other citizens who perhaps either make unhealthy choices, or go to the doctor over every cough or sneeze?
  • Doesn't health insurance "punish the healthy" in the same way? Are you arguing for the right not to carry insurance? Is this really a widespread desire? The reason you should not have such a right is that we are not prepared to have you die in the street. Therefore when you are truly dying we will take care of you, but then it will be too late. And we will only be able to prolong you suffuring, expensively.
    • No, it doesn't so long as it's voluntary. It's one thing to opt-in to a system in which you may lose, it's quite another to be forced.
      • I am forced to pay for Auto Insurance, and can't drive without it. I am forced to pay taxes that go for government operations that I don't agree with. It's a price I'm willing to pay, and in return I get to live in this society. If someone doesn't want to be forced to pay something, they can leave. Or they can get active trying to change the priorities of the government.
• Universal Healthcare can lower the standards of health care for those who can pay.
  • Many countries also allow private insurance on top of the governmental insurance. Is there an objection to this?
    • Yes: Government insurance is provided by force.
      • Government insurance would be guaranteed, while optional coverage forces us all to pay emergency room costs for people who can't get any other care. It's less expensive to pay for a doctor visit than an emergency room.
• In countries where National Healthcare programs have been adopted, the system has been characterized by long wait times, high costs, and average to below-average quality of care. Private care providers typically overshadow their public counterparts in nationalized environments, providing superior care without lengthy waits for those who can afford it.
  • Can you provide evidence to support these claims? Google a bit and collect some here, so we can discuss its meaning. For instance we might start with the following wikipedia articile which compares the US and Canadian systems, which live at two extremes in the private, public spectruom. http://en.wikipedia.org/wiki/Canadian_and_American_health_care_systems_compared
    • The Fraser Institute concludes that Canada spends the most on healthcare among OECD countries, while ranking below-average on quality-of-care indeces[2].
      • From the article you quote:"This new study compares Canada to other OECD countries that also have universal access, publicly-funded health care systems. Seven indicators of access to health care and outcomes from the health care process are examined: four relate to access to high technology equipment, and three relate to health outcomes. Many of the countries examined produce superior outcomes in health care and at a lower cost than Canada. " This was a study comparing Canada to other countries with universal public health insurance. Among these countries apparently Canada fared badly in this study. However since (at least according the studies discussed in the wikipedia article) Canada still fares better than the US, this just means that the lower end of the "universal" countries fares better than us.
      • In addition, where are the long lines of people trying to move into the US so they can take advantage of our wonderful health care system? They don't exist.
  • You are not comparing like with like. In those countries, private health care insurance is a lot more expensive than public health care insurance, so of course standards are higher. The comparison we should be making is whether private provides better value for money than public.
  • No, the mistake is far more basic. The study is comparing universal care countries amongst themselves. It doesn't apply to the U.S. at all. I am removing this study, or placing it a proper context if he doesn't explain why it is here.

Further, a number of independent media reports conclude that Canadians can expect "quicker, better"[3] healthcare from private institutions. Which is the only reasonable explanation for the rapid rise of private providers following the 1997 Supreme Court ruling overturning the national monopoly. If Canadians could receive free healthcare from national providers, why would they pay out of pocket for treatment at private clinics, unless such treatment was superior?

• • What percentage of Canadian treatment takes place at private clinics

I have no doubt that private treatment will sometimes be superior than public, especially if one is willing to pay enough. The question is whether a public "baseline" service is useful, whether it will provide in the majority of cases good care at a lower price. This is not an all or nothing question.

---

In the civilized world, the health issues are overwhelmingly LIFE STYLE ISSUES. Any government or collective responsibility for health care inherently means government/collective control and limitations on one's lifestyle. Do you want the government to dictate/control your sex activity? Your eating activity? Your recreational activity?

Some of you think "Oh, I'm superior to others and I will be able to control the way others pig out on fast food. Well guess what. There are more of them than there are of you and they will tell you who you can and cannot sleep with. Or how often. Even scarier is that campaign donors will have leverage to skew the regulations to favor their branded product over the product of their rival. Pork producers will win or beef producers... or maybe they will gang up on chicken producers and vegetarians. Hamburger joints will squeeze out those who think outside the bun.

Oh what a terrible web we weave when first we start to regulate. spintreebob

• This an interesting theoretical point. Do such controls exist in countries with single payer systems?

---

Monopoly enterprises are inherently less efficient than operations in a competitive environment. This is an accepted principle of elementary economic theory. And the current system of health care coverage (insurance-based) is inherently monopolistic, in that profitability requires insurance providers to cover large, statistically healthy groups of individuals, without threat of outside competition. If the healthcare system, as it presently exists, allowed individuals to select between competing providers at the consumer level, then the healthy would consistently flee from a provider who was covering the sick (since this coverage would drive costs up), causing a cyclical string of bankruptcies and further encouraging insurance companies to find creative ways of not paying out benefits. The industry would become impossibly unprofitable and ineffective. Any perceived existing access inefficiency in the American healthcare system is typically a consequence of individuals failing to procure coverage, rather than providers failing to provide it. Everyone has reasonable access to quality healthcare under competitive plans, both individual and through their employer. However, many opt out, rather than pay monthly for a potential benefit somewhere down the road. Individuals have a hard time rationalizing paying now for potential benefits later.

The fundamental problem with the healthcare industry, then, is its over-reliance upon the traditional model of insurance, which is fundamentally anticompetitive. Under this model, consumers have no incentive to procure healthcare coverage when they are healthy (since they end up paying out of pocket for the healthcare costs of others), while insurance companies have no incentive to provide coverage for the sick (since they stand little chance of recouping their gross losses in the sick persons lifetime). Nationalizing the system simply removes consumer and provider choice, but does not and cannot address the core issues. We sacrifice our fundamental freedoms of association and the important protections of personal property in order to salvage an irreperable and inefficient system.

Proper healthcare reform must remove existing government regulations and incentives which needlessly prop up the insurance industry, while allowing banks and financial institutions to step in with "on-use" lender plans. Under such a system, individuals would pay out-of-pocket for routine medical care and standard annual checkups, which would lead to an immediate boost in both the efficiency and competitiveness of the general-care sector, driving these costs down. If diagnosed with a serious illness, individuals would turn to lenders for cash-loans to cover the medical expenses. These loans would operate under a special, tax-free category (for both lenders and lendees), with only the sick being eligible. The loans would be collateral-free, but would supercede any bankruptcy or death protections (meaning upon death, ones heirs would inherit the unpaid medical debt). This proposal eliminates the need for consumers to opt-in when they are getting the least benefit, and the need for providers to opt-in when they are providing the least benefit. Instead, consumers only incur a monthly medical payment if they have used, and gained some benefit from, the medical system, and it is in the interest of providers to provide coverage for those who need it most, the sick (since only the sick will need the large and lucrative cash loans), as opposed to the heathly. The medical industry, as well, will benefit from the increased efficiency of dealing with consumers on an individual, cash-only basis. The influx of competition, and removal of the vast insurance bureacracy, will drive costs immediately lower.

For the poor and the unemployed, the existing national welfare service (the Social Security Administration) could provide temporary assistance with existing medical payments (or provide low-interest, long-term loans for immediate medical assistance, as in the student loan system). The cost-savings from the elimination of Medicare and Medicaid (which typically run overbudget) could be used to fund the increased Social Security payouts, and the tax relief passed on to consumers from these two programs will provide the economy with a healthy boost and likely recoup a large share of any potential future monthly medical bills.

• Are you seriously suggesting that heirs should be forced to inherit debt? What if the heirs themselves can't pay it back and just accumulate more interest? Will the debt be passed down the generations? So you would like to return back to the good old days of blood fued? What about the "fundamental freedoms" you were talking about?

• Why will the lender provide such a loan? A mortgage and a car are both secured loans -- if you can't pay they don't mind too much they just take your house and sell it. Thus the risk to the lender is low. The loan you are suggesting is unsecured, like a credit card. The risk to the lender is quite high, and as a result the interest on the loan is commesurably high. People can already put their medical procedures on their credit cards. It usually leads to bankruptcy though. Are there specific regulations government regulations preventing these loans? How are they different from credit cards? Do you want the government to back them? What happens when people can't pay -- this will occur quite often? Does the creditor take their other assets? Is their credit rating destroyed? Further you should realize that an insurance company serves both as a distributor of risk, and as a negotiator for the consumer against the provider. You will lose both of these functions, and I think the market will be even less efficient. (I can discuss why if you like)
  • It is a general misconception that secured loans are "low risk" for the lenders by virtue of their being secured. Generally, the lender stands to lose substantially if the loan defaults and the collateral is collected. There are the collection costs, the legal costs, and the reduced margins at auction. In effect, securing a loan only reduces the losses. It does not offset them. What principally offsets risk with mortgages (and, to a lesser extent, auto loans) are their legislative and practical differences, NOT the security provided by collateral (which only mitigates losses, but does little to lower the risk of loss in and of itself).
    • I am HIGHLY suspect of this conclusion. You will need to provide some evidence. It may be true that when a house is foreclosed upon the sale of the house does not, on average cover the cost of the loan. However this fraction is I suspect high. In any event "mitigating risk" is the same as reducing it. Whether the bank recieve 100 pennies on the dollar is irrelevant.

Defaulting on credit card payments is unlikely to result in signifigant civil action being taken against you, and filing bankruptcy can invalidate the debt.

• • • Because the loan is unsecured.

Also, one can easily live without his credit cards. Mortgages and auto loans, on the other hand, are expedited through the legal system, difficult to nullify, and each provides a vital service.

• • • They are difficult to nullify because you will lose your house. You can file bankruptcy and walk away from your home too.

One cannot reasonably survive in most cities without a home, and an automobile.

• • • So?

Further, credit card debt is short-term and high-interest (as required by law),

• • • No credit card rates do not have a legal floor they have a legal ceiling. How are they "short term", except that it is extremely stupid to carry them longer. Do you mean that there is no predefined payment schedule? This will have only a moderate impact on the loan
    • which encourages consumers to default. Home and auto loans are long-term, low-interest (again as required by law),

What law are you speaking about?

which reduces the likelihood that the consumer will stop making payments. Finally, both the lenders and the consumers are offered a number of signifigant tax benefits and cash subsidies for completeing home loans, which further offsets the risk. The government could create a special classification of medical-use loan, as outlined above, which would be explicitly long-term and low-interest. Defaulting on the loan would jeopardize the consumers continued and future reciept of healthcare coverage, providing incentive to pay off the balances. And persons could be required to use their regular monthly salaries as collateral to "secure" the loan, if employed. The student loan system is an excellent proof-of-concept for this proposal. It is profitable and efficient.

• • • I am fairly certain these are backed by the government. This is why the interest rate is low (they are essentially secured by the Government in place of collateral) Is this what you are proposing? You also cannot escape them via bankruptcy.

The loans are unsecured, but lender risk is minimized (and incentive to provide loans therefore maximized) thanks to an industry-generous set of regulations, incentives, and subsidies.

Rebuttal

• There is only limited and inconclusive evidence that government efficiency in healthcare is less than private enterprise.

Wikia links

• Health Wikia