Adequacy + Catastophe = Efficiency?

January 21, 2008 8:46 PM

The universal coverage debate comes down to one, simple question: why does health insurance pay for checkups when car insurance doesn't pay for oil changes?

The Health Care Crisis and What to Do About It
England is rationing care
The US suffers from rising costs (pdf) and bureaucratized inefficiencies
The Road to Universal Coverage
Blame the Boomers

posted by anotherpanacea (119 comments total)

why does health insurance pay for checkups when car insurance doesn't pay for oil changes?

That question makes no sense.

But, yeah, insurance. I'll read the articles. I hope that question doesn't actually show up.
posted by The Deej at 8:50 PM on January 21, 2008

Car insurance also doesn't pay for the damage that results from not changing your oil.

The theory is that regular checkups increase the chance of early detection of disease, and diseases are easier and cheaper to treat if they're detected earlier, so covering checkups overall reduces the cost of the program.
posted by Steven C. Den Beste at 8:53 PM on January 21, 2008 [9 favorites]

Why is it if I go to the doctor without insurance I have the pay 2 to 5 times more, but if I go to a body shop and say, "I'd rather my insurance company not hear about this" I will pay half to a fifth as much?
posted by Kid Charlemagne at 8:55 PM on January 21, 2008 [18 favorites]

From the main article: "When it is easier to fly halfway around the world than to be seen at a medical clinic, we have a problem."

Don't worry Mr. Writer Guy. Your friendly neighborhood DHS office is working hard to make travel just as difficult as your specialist visit.
posted by chime at 8:55 PM on January 21, 2008 [2 favorites]

That question really pisses me off. My home insurance can replace my home but life insurance doesn't bring me back to life. Comparing two different types of insurance is stupid.
posted by Octoparrot at 8:57 PM on January 21, 2008 [8 favorites]

So, are you suggesting health insurance policies shouldn't cover checkups? We can do that.
posted by TwelveTwo at 8:58 PM on January 21, 2008 [3 favorites]

why does health insurance pay for checkups when car insurance doesn't pay for oil changes?

It isn't at all clear how it comes down to this question. As far as I can tell, the point of this contrast, made almost in passing late in the article, is that what we have is not health insurance, it's prepaid healthcare, so it's in their interest to deny you as much service as they can. By providing you with regular checkups they head off bigger costs later. The car insurance thing is almost irrelevant, because most people don't claim for engine failure due to a lack of maintenance, they claim for theft and accident, and maintenance has little or no bearing on these.

England is rationing care

And HMOs aren't? At least the NHS is about providing care, as far as it can. The U.S. insurance system is about denying it.
posted by George_Spiggott at 8:59 PM on January 21, 2008 [7 favorites]

"When it is easier to fly halfway around the world than in order to be seen at a medical clinic, we have a problem."

FTFY
posted by George_Spiggott at 9:00 PM on January 21, 2008

England is rationing care

Isn't any country where health care costs money effectively rationing care?
posted by mullingitover at 9:03 PM on January 21, 2008 [5 favorites]

Kid C ... you are dead on.

Last year we had an insurance company that offered online breakdowns. It was frightening to see what the doctor/provider charged vs. what was paid by the insurance company.

It is insane.

I needed an cat scan for something. The insurance company was charged $1,000 and paid $300. When I asked how much I would have to pay I was told $1,000. This was a lab not affiliated with a hospital.
posted by zymurgy at 9:03 PM on January 21, 2008

England is rationing care

Capitalism, or, market forces, rations medical care as well.
posted by Avenger at 9:08 PM on January 21, 2008

why does health insurance pay for checkups when car insurance doesn't pay for oil changes?

And while we're asking important questions, why does health insurance pay for checkups when renters insurance doesn't pay me to clean my dishes?

Why does health insurance pay for checkups when libel insurance doesn't pay me to punch politicians in the face?

Why does health insurance pay for checkups when flood insurance doesn't pay me to take baths?
posted by Astro Zombie at 9:09 PM on January 21, 2008 [5 favorites]

When it is easier to fly halfway around the world than to be seen at a medical clinic, we have a problem.

No. When we seriously consider the airline industry as a positive model of customer service and efficiency, we have a problem.

Airlines. Seriously? Seriously?
posted by Cool Papa Bell at 9:12 PM on January 21, 2008 [4 favorites]

In 1907, a typical doctor visit cost about a day's wages. Today, a typical urgent care visit costs about $120, and a specialty clinic about twice that. In other words, about a day's wages (at least in some parts of the country).

Demand for medical care is going up, not down, and yet the price remains the same. Hmm. Some people might call that an economic miracle, rather than a catastrophe.
posted by Cool Papa Bell at 9:15 PM on January 21, 2008

Last time, I promise...

Clearly, our health care system is outrageously antiquated in comparison to aviation and other services. Why?

Ooh! Ooh! I'm going to guess that despite incredible technological advances in the aviation field in the last 100 years, us silly humans and our stupid diseases have remained about the same for the last 10,000 years!

Humans suck! Airplanes are cool!
posted by Cool Papa Bell at 9:17 PM on January 21, 2008

...but life insurance doesn't bring me back to life.

My insurance agent has misled me.
posted by davejay at 9:18 PM on January 21, 2008 [4 favorites]

why doesn't health insurance pay for food and dental insurance for toothpaste when car insurance doesn't pay for oil changes?
posted by moxiedoll at 9:20 PM on January 21, 2008

Capitalism, or, market forces, rations medical care as well.

With capitalism, you can always buy whatever amount of medical care you decide you can afford.

Rationing means someone else decides what you get.

Capitalism doesn't decide shit. If someone comes along and decides to offer heart surgery for five bucks a pop ... then heart surgery costs five bucks, no matter what "capitalism" thinks.
posted by Cool Papa Bell at 9:22 PM on January 21, 2008

With capitalism, you can always buy whatever amount of medical care you decide you can afford.

You can't be serious? The whole point of market forces is rationing.

Have you ever noticed that you don't always have as much money as you'd like?
posted by pompomtom at 9:28 PM on January 21, 2008 [3 favorites]

Because I'm slightly more sentient that an '84 Toyota Hilux?
posted by mattoxic at 9:32 PM on January 21, 2008

Capitalism doesn't decide shit. If someone comes along and decides to offer heart surgery for five bucks a pop ... then heart surgery costs five bucks, no matter what "capitalism" thinks.

I'm sorry, but you're delusional. Capitalism will always move toward the highest prices the market can bear. If something is underwritten by government, there is no such need.
posted by Astro Zombie at 9:33 PM on January 21, 2008

The Catalyst article makes a brief aside about Starbucks screwing employees for benefits, and I don't think that's true at all, even historically, and it's certainly not fair to compare them to Walmart, where they go to great lengths to cap people before 40h for the express purpose of screwing them out of bennies -- Starbucks used to offer full health-care benefits to employees who worked even 240 hours in three months. You had to pay, but I have to pay for mine now -- it's not like Starbucks offered a particularly raw deal, especially for the retail world.

I found that particularly jarring.
posted by dmz at 9:34 PM on January 21, 2008

Astro Zombie -- not true. In free markets prices tend to lower until profits disappear. Prices rise only in monopolies or limited competition.
posted by empath at 9:35 PM on January 21, 2008

When we seriously consider the airline industry as a positive model of customer service and efficiency, we have a problem.

Relative to the health care industry? Yes, that's a fucking problem.

With capitalism, you can always buy whatever amount of medical care you decide you can afford.

Unless you have a "pre-existing condition", then you can just die in a gutter like all the other pieces of shit that failed the genetic lottery.
posted by dirigibleman at 9:36 PM on January 21, 2008 [1 favorite]

Americans are mental. That's the health issue you need to address first. I draw this conclusion because no sane citizenry in a developed country would even think to question the necessity of a national health service.
posted by Abiezer at 9:38 PM on January 21, 2008 [10 favorites]

Astro Zombie -- not true. In free markets prices tend to lower until profits disappear. Prices rise only in monopolies or limited competition.

We were talking about capitalism, not the extended libertarian fantasy of a free market.
posted by Astro Zombie at 9:42 PM on January 21, 2008 [17 favorites]

why does health insurance pay for checkups when car insurance doesn't pay for oil changes?

Car insurance insures the body of the car. It does not insure the engine.
posted by flarbuse at 9:42 PM on January 21, 2008

I live in Australia, where we have universal medical care.

It's weird when we watch American shows and see people talking about paying to go see a doctor, or talking about not being able to afford to go see a doctor. I remember when I was younger seeing an episode of Friends where Rachael had to go to hospital and the first thing she had to do was fill out her insurance information; when she revealed she didn't have any she was worried and ended up committing insurance fraud to get treatment. Confused the hell out of me at the time. Saddens me now.

While there exist private practices here in Australia where you can pay to see a doctor who doesn’t bulk bill (translation; doesn’t get paid by the Government to treat you), the fact is that the idea of paying to get essential medical treatment is an entirely foreign idea to me and most of my countrymen. And truly, it saddens me that a country like the US, which has such a large economy compared Australia, doesn’t have universal health care. Seems to me, an ignorant outsider, that your Government is far too busy spending money on nukes, warships and, well, wars... to worry about the medical needs of its poorest citizens (let alone its citizens) back home. It is sometimes said that a country can be judged on how it treats its poorest citizens. On this test, the US fails badly.

I said this in another thread. Things won't change over there until you guys start demanding better standards from your Government. While you continue to let these fucks walk all over you, nothing will ever change. Complacency really will get you nowhere.

So it seems to me that the universal coverage debate comes down to one, simple question. It's not "why does health insurance pay for checkups when car insurance doesn't pay for oil changes?" It's "why doesn’t your Government provide you with even the most basic of services when it's up to its ears in money?"
posted by Effigy2000 at 9:44 PM on January 21, 2008 [21 favorites]

The fact that health care is a for-profit enterprise is all the evidence you need that they system needs a complete overhaul.

It's not that some people get sick. We ALL get sick. We will ALL die. Most of us with some expensive attempt at medical intervention. So why would we permit a system wherein a handful of people can get rich limiting care and jacking up prices?
posted by JWright at 9:54 PM on January 21, 2008

Cars don't poop.
posted by meehawl at 10:02 PM on January 21, 2008

Prices rise only in monopolies or limited competition

Even in fantasy libertarian land prices may rise due to, say, growing competition for inputs from other producers... but by all means, don't let that get in the way of your dogma.
posted by pompomtom at 10:08 PM on January 21, 2008

Health insurance should NOT pay for regular checkups, Healthcare plans might, but insurance is a specific type of risk management, and as soon as it changes to pay for expenses that everybody suffers, (or is run for profit), it collapses like the philosopher's dream house of cards that it is.

Insurance is meant to pay for extreme situations. If 100 people who each have a 1/100 chance of suffering a horribly debilitating expense purchase insurance, one of them has a debilitating expense, gets the money pot, and everything works out, (or you get really unlucky and all of the 100 suffer the expense, and it doesn't work).

Healthcare plans are great, and universal healthcare would be awesome, but these things are not insurance! As soon as you start to merge them with insurance, you get a system where everybody is marketed addictive designer drugs in an inflated and badly structured market, while the 14 year olds who need liver transplants, (the people in situations that insurance was created to rectify), are quietly shoved out the backdoor for Restless Leg Syndrome hypochondriacs who are being enabled by a very flawed system. People who need $100,000 immediately for life-saving reasons are never, ever as profitable as people who will pay $100ish annually for perceived comfort, provided it is subsidized based on their income.

So, yeah, what the article said. After you get thru the boring first half of it.

And also, really, you think Americans are not demanding enough of their government? I think we're being shepherded by much more competent marketers and social scientists than you. Pray that Australia never looks profitable to these bloodsucking subhumans, because I guarantee there are enough stupid people there, or anywhere else, to manipulate.
posted by SomeOneElse at 10:08 PM on January 21, 2008 [3 favorites]

CPB wrote: "With capitalism, you can always buy whatever amount of medical care you decide you can afford."

Fixed that for you, etc.

Yes, I can buy however many 747's "I decide" that I can afford -- which happens to be exactly zero. Saying that "You can have as many widgets you can afford" is the same as saying "You can have only x number of widgets on your income" -- a ration in all but name. The invisible hand rations out goods, serivces and resources based on the perceived worth of the recipients, i.e, their income.

Hardly anyone can afford regular doctor visits, and only the super-rich can afford the regular dialysis treatment that my dad goes through 3 times a week. If it weren't for Medicare -- rationing it out to my father -- it would instead be "rationed" to only those who could afford the $30,000 per month price tag -- and my dad would be dead.

The idea behind universal healthcare (and, more broadly, socialism) is that the State will collect some resources and redistribute them -- not based on people's perceived worth (their wealth) or lack therof, but based on the notion that all human beings have intrinsic worth, including those who cannot afford the things they need to live.

For what its worth, I see this shaping up to be the next huge battle in American life -- not just private pay vs. universal care, not even capitalism vs. socialism, but something deeper, something I like to call "Moneyism vs. Humanism". One side believes that money, or The Market, is and should be the ultimate arbiter of life, morality, the environment, justice, and so on, while the other side believes that money and markets should just be some tools (among many) to improve and enlighten the human condition.

In the meantime, if you hope or otherwise forsee an eventual domination of healthcare by the Market, I would sincerely suggest saving your pennies, since, as you age the chance of getting a cancer diagnosis approaches unity, while (in our current state of affairs) the chance of finding affordable cancer treatment approaches zero.
posted by Avenger at 10:11 PM on January 21, 2008 [13 favorites]

When it is easier to fly halfway around the world than to be seen at a medical clinic, we have a problem.

This is because you're a fucking moron.

It's more difficult to be seen at a medical clinic because everything happens to you. They need your urine and your blood and your history, and to listen to your heart and your chest and so on. Nobody else's blood or urine or lung sounds will do. So, duh, there are lots of people and steps.

To use your stupid analogy, when you're in the clinic, you aren't just the passenger, you're also the airplane. And from the point of view of the airplane, "getting seen" at the airport involves lots of people doing lots of different steps all involving your pretty little fuselage and takes a lot of time, just like getting seen at the clinic.
posted by ROU_Xenophobe at 10:16 PM on January 21, 2008 [1 favorite]

Effigy2000, were we walking all over Howard when he introduced the medicare safety net? Or pulled millions out of dental care? What about the benifits of the private health rebate that has only really upped the price of health insurance?

Universal health coverage is a sad shadow of itself, though yeah, I'd hate to be poor and sick in the US, and Zimbabwe
posted by mattoxic at 10:24 PM on January 21, 2008

I have a $40 co-pay for check-ups with my group HMO. Who's paying for it again? Maybe I should get my check-ups from EZ-Lube, I think they're have a $15.99 special right now.
posted by Brocktoon at 10:26 PM on January 21, 2008

"And also, really, you think Americans are not demanding enough of their government? Pray that Australia never looks profitable to these bloodsucking subhumans, because I guarantee there are enough stupid people there, or anywhere else, to manipulate."
posted by SomeOneElse at 4:08 PM on January 22

One thing I forgot to mention about the Australian health care system is the Pharmaceutical Benefits Scheme (PBS). This scheme ensures that people on welfare (which, unlike the US, does not run out after six months) and people who are retired who need access to life saving medication (and sometimes designer drugs, like Viagra) can get the medicine on the cheap. Often you can get medicine that would cost you a few hundred bucks for only $2 to $5.

During the darkest days of the Howard Government, a conservative Government that was recently turfed out in favour of the more left leaning Labor Government, Australia entered into negotations with the US for a Free Trade Agreement. Wikipedia explains what happened when the PBS was raised in the context of the AUSFTA.

"While the scheme is very effective at keeping many drug prices low, pharmaceutical corporations in both the US and Australia are wary of the operation of the scheme, since they argue that higher drug prices are necessary to fund the costs of research and development. The American pharmaceutical companies claim that in enjoying low-cost medicines, Australians are essentially "freeriding" on the costs of research performed in the US.

While companies have in particular criticised the process by which drugs are listed on the PBS, claiming that it lacks transparency, public health advocates have claimed that calls for transparency are merely an effort by drug companies to gain greater control over the process of listing. To a large degree the existing limitations on the transparency of the process are those that have been imposed by the industry itself.

Disquiet about the Pharmaceutical Benefits Scheme led to speculation that the American side would lobby heavily for its abrogation as an integral component of a free trade agreement."

Labor, which was in Opposition at this time, was able to block legislation in the Senate since, at the time, it had the numbers (in alliance with the minor parties and some independents). It eventually allowed the AUSFTA to be passed; on the proviso that the Government insert an amendment in enabling that would allegedly safeguard the PBS. The Government relented, amended the legislation, and the AUSFTA came into effect.

The US pharmaceutical industry was not pleased. Indeed, in January 2006, it was reported that the government was considering repealing the amendments as a result of pressure from the US pharmaceutical industry. I don't think that this ever happened because as much of a prick Howard was, the Australian people would have torn him apart limb from limb had he allowed this.

So yeah. I think you guys don't demand enough from your Government, because as the whole saga I just related to you shows, when a Government knows its people won't stand for something that makes them way worse off, all the profit seeking bloodsucking subhumans, marketers and social scientists won't matter one cent.
posted by Effigy2000 at 10:26 PM on January 21, 2008

Carol Connelly: Fucking H.M.O. bastard pieces of shit!
Beverly Connelly: Carol!
Carol Connelly: Sorry.
Dr. Martin Bettes: It's okay. Actually, I think that's their technical name.

-- As Good As It Gets, 1997

posted by George_Spiggott at 10:30 PM on January 21, 2008 [1 favorite]

I honestly don't know why the poor don't just vote themselves national health care. I guess they're just stupid. A lot of stupid poor people are opposed to "hand outs" to the marginally more poor, I suppose, but they all pay hardly any income tax anyway, so it's not their problem.

Health care spending, as a percentage of GDP, is completely out of control in the US, and hopefully universal health care can bring it under control. I'm not thrilled with subsidizing poor people's idiocy, but I suppose it's going to happen directly or indirectly, at least until we can replace them with robots.
posted by "Tex" Connor and the Wily Roundup Boys at 10:31 PM on January 21, 2008 [1 favorite]

I am opposed to building a nation of impoverished robots.
posted by Astro Zombie at 10:34 PM on January 21, 2008 [1 favorite]

"Effigy2000, were we walking all over Howard when he introduced the medicare safety net? Or pulled millions out of dental care? What about the benifits of the private health rebate that has only really upped the price of health insurance?"
posted by mattoxic at 4:24 PM on January 22

There was anger and disquiet, yes, but not riots in the street, as there should have been. I think the reason for that was largely because people still felt relatively secure knowing that despite the changes, you'd still be able to get essential health care when you needed it. You'd have to look harder for a bulk billing doctor, sure, but you could find one. You still knew you could get life saving treatment at hospital, insurance or no.

People didn't riot because while, as you say, universal health coverage in this country is a sad shadow of itself, at the end of the day we're still better off than a lot of other countries. Like the US.
posted by Effigy2000 at 10:36 PM on January 21, 2008

Effigy2000, I feel you're painting a rosier picture of the Australian situation than it actually is. There's plenty of GPs who don't bulk-bill, the percentage has increased dramatically over the last 20 years, and waiting lists for GPs who do bulk-bill have also increased. Additionally, outside a couple I know who are semi-retired, both types are working longer clinic hours.

Anecdotal point: the last time I needed to see a doctor in a reasonable hurry (i.e. not life threatening, but bad enough that I wasn't going to wait any longer than I had to), I rang my regular GP at 9am. The first appointment I could get was 2 days later at 7pm. Other bulk-billing clinics within a 30 minute drive weren't taking any new patients except on a demonstrated needs or referral basis. By contrast, I got an appointment at a local cash-up-front clinic for 7pm that night.

To be honest, while we do still have a sort of socialised medical system, we've also imported some of the worst characteristics of both the US & UK systems. You can blame the government and the AMA for that - everybody I know, be they doctors, nurses, or laypeople, certainly do - but that doesn't change the fact that from the average patient's POV we're worse off than we were 5, 10, 20, or 30 years ago.

Complacency really will get you nowhere.

This amuses me. We Australians really are some of the most complacent people on Earth. When was the last time we, as a whole, really stood up for something we believed was important? Worker's rights? Nope, not really, x 2 or 3. Indigenous issues? Nope again - a few thousand people walked across a few bridges one day, went back home, felt good about watching themselves on TV, then forgot about it until next year. Human rights? Nope, unless we felt really really sorry for them - and then, only the ones who are prepared to become real Australians. Unless they're good at sports, and even then we'll turn on them at the least sign of "un-Australian-ness"...
posted by Pinback at 10:47 PM on January 21, 2008

Goddam, you people don't understand the terms "rationing" and "market forces," do you?

Rationing is when someone from the government says, "I'm sorry, you can't have that operation because we decided you can't and if you don't like it, screw you, you can't go anywhere else because we made it illegal to do so."

Not-Rationing is when someone from the insurance company says, "I'm sorry, we won't pay for that operation because it costs X dollars and if you don't like it, I guess you can take your money elsewhere because we really can't stop you so maybe if I want to stay in business I shouldn't be charging X dollars hmm why don't you sit down, sir?"

And if you don't understand that, I can't help that you fell asleep in Economics class.
posted by Cool Papa Bell at 10:49 PM on January 21, 2008

The first article is not that well written, but it does contain some good points. Such as the fact that in the current US system, there is little incentive for both preventative care (undercut by the pull-quote about car insurance) or innovation. His solution is government funded healthcare, but he doesn't really convince me that that's the solution, only that it's a solution.
posted by cell divide at 10:50 PM on January 21, 2008

Not-Rationing is when someone from the insurance company says, "I'm sorry, we won't pay for that operation because it costs X dollars and if you don't like it, I guess you can take your money elsewhere because we really can't stop you so maybe if I want to stay in business I shouldn't be charging X dollars hmm why don't you sit down, sir?"

hehe, you've obviously never dealt with a health insurance company!
posted by cell divide at 10:51 PM on January 21, 2008

I fell asleep in econimics class because I could not afford the medication to treat my narcolepsy.
posted by Astro Zombie at 10:51 PM on January 21, 2008 [3 favorites]

Even in fantasy libertarian land prices may rise due to, say, growing competition for inputs from other producers... but by all means, don't let that get in the way of your dogma.
posted by pompomtom at 1:08 AM on January 22 [+] [!]

Oh fuck off. I misspoke. I meant that profits only rise in monopolies and limited competition. I'm not even libertarian. That's just macro-economics 101.
posted by empath at 10:54 PM on January 21, 2008

I meant that profits only rise in monopolies and limited competition.

Both of which are very common in capitalism.
posted by Astro Zombie at 10:56 PM on January 21, 2008

I fell asleep in economics class becazzzzzzzzzzzzzzzzzzzzzzzzz
posted by CitizenD at 11:00 PM on January 21, 2008

What disgust me is that in the U.S., the so called "Liberal" candidates idea of universal health care seems to be getting everyone covered by private health insurance. When an insurance company can decide what treatments you get rather than a doctor, we're hardly better off than we were in the first place.
posted by fishmasta at 11:04 PM on January 21, 2008 [1 favorite]

Why do we park in a driveway and drive on a parkway?
posted by boo_radley at 11:05 PM on January 21, 2008

I feel as though a major plank of any politician must be that insurance companies may not deny treatment that doctors have determined might be useful. I can't believe we are in a situation where pencil pushers make life or death medical decisions, in many cases over the recommendations of the doctors.
posted by Astro Zombie at 11:06 PM on January 21, 2008

Pinback - would you rather have slobering masses chanting "Australia #1! Australia #1!"?
posted by porpoise at 11:06 PM on January 21, 2008

Both of which are very common in capitalism.

Well, no shit. The stock market depends on that. I was taking issue with this statement.

Capitalism will always move toward the highest prices the market can bear.

Which is quite simply not true. It depends on how open the market is, the barriers to entry, etc. Commodoties tend to the lowest possible price the market will bear. It's only markets like health care where there are huge barriers to entry, inelastic demand and very few choices for consumers where prices get out of control.

I'm fairly certain that there is no way to restructure the health care market to drive prices downward through market forces without killing a lot of poor people. Which is why I'm, in fact, in favor of socializing medicine entirely.
posted by empath at 11:07 PM on January 21, 2008

If car insurance covered things that could by caused by a lack of regular maintenance you'd bet your ass oil changes would be covered. Health insurance companies cover checkups because it's much cheaper to put someone on a low cholesterol diet than to find out they have blocked arteries years later and that they require heart bypass surgery.

It's all about the money. In the end most things are.
posted by sideshow at 11:08 PM on January 21, 2008 [1 favorite]

Well, then we agree. Let us hug.
posted by Astro Zombie at 11:09 PM on January 21, 2008

And if you don't understand that, I can't help that you fell asleep in Economics class.

In fairness, saying that a procedure costs too much at price $X can mean two different things.

It could mean the efficient cost really is $X, but some people who want the procedure don't have $X. That is, there is no way to spend less than $X and get people do voluntarily do everything that needs to be done to make the procedure. If you paid the doctors less, they'd quit. If you paid the equipment manufacturers less, they wouldn't make the equipment at all. If you paid the owners of the hospital less, they'd take their capital elsewhere. In such a case, when someone wants or needs the procedure but doesn't have the money to pay for it, you get all sorts of messy moral issues with some people saying "it's our obligation to pay," some people saying "it's the wealthy's obligation to pay," and still others saying "fuck him, he's a dick."

On the other hand, maybe you could get everyone necessary to do their part for the procedure for far less than $X, but various regulatory, scarcity-induced, and other inefficiencies are keeping the price at $X. In such a case, it's worth inquiring whether we can get the price a little closer to what it has to be.

Personally, I suspect a lot of health care in the US costs a lot more than it has to, and I want to try a centralized system because I think the health care market isn't working--it's not keeping prices at anywhere near their efficient level.
posted by "Tex" Connor and the Wily Roundup Boys at 11:09 PM on January 21, 2008

Commodoties tend to the lowest possible price the market will bear.

Which, now that I think about it, is also the highest price the market will bear. That's why it's called equilibrium. I suppose it's just a matter of emphasis.
posted by empath at 11:10 PM on January 21, 2008

Personally, I suspect a lot of health care in the US costs a lot more than it has to, and I want to try a centralized system because I think the health care market isn't working--it's not keeping prices at anywhere near their efficient level.

I wouldn't ordinarily be in favor of centralizing the system, except there's no possible way that an inefficient government bureaucracy could be more inefficient than the insurance industry.
posted by empath at 11:13 PM on January 21, 2008 [1 favorite]

American citizen living in UK.

Currently deathly ill, walked into an NHS clinic yesterday, saw a doctor, got a prescription, walked out, walked to pharmacy, filled prescription, went home and was ill some more.

total cost, 0.

There isn't a comparison. I've had access to the best health care available in the US. My dad is an Ear, Nose and Throat Doc so I always got access to the best surgeons.

It doesn't matter. Having a system that provides, a social safety net.. It's a whole different ballgame.

IF the US wants to play with the realities of the 21st century, someone, somewhere is going to have to admit there might be a common social good. Something slightly better than the "Fuck you if you're poor, it's your own fault".

And it might be time to look at whether somethings are appropriate for financial gain. Pure capitalism is interesting in theory, but to what end? Do you factor morality into it? Does the market decide?
posted by Lord_Pall at 11:30 PM on January 21, 2008 [7 favorites]

I don't know much about health care & insurance so maybe this is a stupid question and not in the scope of this discussion but I thought the whole reason why there's HSA accounts is to control the cost. So in this case, people do pay for their own checkups but also, people are more cost conscious about their medical decisions, which, the theory goes, then will make the system more efficient.

Or is there something I'm missing?
posted by vocpanda at 11:40 PM on January 21, 2008

That's just macro-economics 101.

Yes. Precisely. 101.
posted by pompomtom at 11:46 PM on January 21, 2008

UK citizen living in American.

Fucking hell this healthcare business is a lot of hassle and paperwork and worry, especially if you change jobs, and fucking hell is it scary feeling if you wonder what happens should you be caught between coverage or in some bureaucratic paperwork gap or whatever.

On the plus side the decor is generally nicer.
posted by Artw at 11:56 PM on January 21, 2008 [2 favorites]

total cost, 0.

No, it cost a lot more than that. I don't mean to pick on you, but what you said illustrates very well the ideological gap between the pro- and anti-universal health care groups in the US.

Health care will always be costly. It will never cost 0. The question is whether we want to force some people to buy health care for other people, and if we do, who do we want to force to pay?

Part of the problem, I think, is that in some ways health care isn't a normal "social good." Other highly visible government expenditures have clear benefits beyond the direct recipients (if indeed there even are direct recipients). It's easy to see how roads, schools, police, and the military can all make the country as a whole better for everyone. One can conceptualize how the government can use its monopoly on regulations to create goods that would be difficult or impossible for individuals to create.

There's disagreement (e.g. libertarians), but I think a lot of people see the value of certain government services.

Health care doesn't fit quite this same model. In a great many cases, health care seems to provide a merely individual benefit to the treated individual and his or her friends and family. Employer-provided health insurance can be perceived as covering the "highest worth" individuals--the ones whose incapacitation due to untreated illness would create the worst side effects.

Quite frankly, I think a lot of people see no reason except compassion to provide health care for many people, and people don't like being forced to be compassionate. It may be a value alien to you, but it's important to understand it to really engage the people on the other side of this debate. Some people have a deep hostility to being forced by the government to personally support others.

Calling it greed is too simplistic, I think. People may be quite willing to build the country as a whole at great personal expense, but being forced to support another individual tastes too bitterly of servitude, perhaps. It strikes me that such people aren't necessarily bad sorts, and calling them uncivilized, barbaric, greedy, etc. is unlikely to win their support.
posted by "Tex" Connor and the Wily Roundup Boys at 12:02 AM on January 22, 2008 [1 favorite]

Going somewhere Lord_Pall was kid of going... I think:
It is not right that a society that provides a lawyer for free will not provide a doctor for free.

Make every possible other thing a pure market forces thing if we must, but please, not this.

I'm willing to agree that the Federal government is not the most efficient, best agent, etc... But, let's create the one that can be... It's important.
posted by OneOliveShort at 12:15 AM on January 22, 2008

It is not right that a society that provides a lawyer for free will not provide a doctor for free.

Whatever legitimacy the criminal justice system has is grounded in the notion of a fair trial. When the vast machinery of the state is arrayed against you, it would be fundamentally unjust to deprive you of representation.

The criminal justice system is an artifact of government, though. It is created by government, and government is consequently obligated to assure a minimum standard of fairness.

People don't get sick and die because of government, though. People got sick and died before the very first government was instituted, and they'll continue to get sick and die after the last government has been thrown down and our mutated decedents are picking over bones in a radioactive wasteland.

Government didn't create sickness and death, so its obligation to fix it is somewhat less clear.

I don't think comparing doctors to lawyers is a good analogy.
posted by "Tex" Connor and the Wily Roundup Boys at 12:26 AM on January 22, 2008

People didn't riot because while, as you say, universal health coverage in this country is a sad shadow of itself

People also, by and large, have no idea how bad it is in the USA, and thus no idea that they're dancing beside a cliff, not a ditch. I think you really have to have lived in the USA for some time to appreciate just how insanely bad things can be. Like, medieval Europe bad.

(Funnily enough, so many people in the USA don't realise how bad it is in the USA either, because they're trained to believe the USA is the best, and likewise haven't lived elsewhere, so they assume that other countries must fare no better, though maybe "fare no better" in different ways).
posted by -harlequin- at 1:26 AM on January 22, 2008

I think a lot of people see no reason except compassion to provide health care for many people, and people don't like being forced to be compassionate.

One argument to that is simple numbers.

We can either pay (via taxes) $40 for some bum to go see a doctor.

OR...

We can save our precious $40 and instead pay (via health insurance) $4000 for same bum to be rushed into ER due to condition left untreated for too long, that could have been prevented by seeing a doctor for $40 when it first appeared. Bum does not pay his ER bill, we do.

My, uh, compassion tells me that I'm richer if I just pay the bum's doctor $40 to treat him.

(Plus, the bum gets an antibiotic cream, instead of an amputation).
posted by -harlequin- at 1:35 AM on January 22, 2008 [3 favorites]

you can't go anywhere else because we made it illegal to do so

Where does this exist?
posted by Armitage Shanks at 3:38 AM on January 22, 2008

You can't insure a car against wear-induced engine failure. If you could, then a smart insurer would allow claims for oil changes, since paying out a small amount for those claims would cost it a lot less than paying out large amounts for new engines.

Prevention is generally much cheaper than cure.

Socialized medicine operates very much like a huge mutual insurer. Because it's a mutual, nobody's skimming the top off the premiums pool for private profit. On the other hand, you can't lose your insurance for having pre-existing conditions, so the aggregate risk is higher. On the other other hand, the available funds pool is inherently massive, so you don't need as much provision for uncertainty. So there are endless handwaving arguments available to ideologues on both sides of the socialized medicine debate.

All the handwaving in the world, though, can't get rid of the facts: Australia and England both have socialized medicine; the US doesn't; US health expenditure per capita is higher, and its aggregate health outcomes are not as good due to the number of people denied access to timely health care. Socialized medicine is demonstrably, not theoretically, cheaper and better than a system relying solely on private insurance.
posted by flabdablet at 3:43 AM on January 22, 2008 [3 favorites]

The idea behind universal healthcare (and, more broadly, socialism) is that the State will collect some resources and redistribute them -- not based on people's perceived worth (their wealth) or lack therof, but based on the notion that all human beings have intrinsic worth, including those who cannot afford the things they need to live.

Not quite. "Universal" Healthcare, as envisioned in this thread, is based on the notion that only Americans have intrinsic worth, including those who cannot afford the things they need to live. Not all human beings. Just Americans. Universal Healthcare plans assert that Person A in California has a humanitarian obligation to Person B in Mississippi, but not to Person C in Botswana. But it is not a common bond of humanity that unites A and B - it is the accident of geography that places them within the same legal jurisdiction. This is why opponents of universal healthcare tend to be strong individualists - not because they are selfish (though they may be), but because they believe a human being's rights and responsibilities should be based on his individual characteristics, not his group identity.
posted by hoverboards don't work on water at 4:17 AM on January 22, 2008

Health care will always be costly. It will never cost 0. The question is whether we want to force some people to buy health care for other people, and if we do, who do we want to force to pay?

Americans pay about the same amount in their taxes towards healthcare as other developed nations. Around $4000 per year. The difference is the average American sees nothing for this, it goes into Medicare and things like that, whereas in other countries that same amount covers everyone. So basically, you are already forced to buy healthcare for other people, it's just that you don't get included in that "other people" category.

One thing I forgot to mention about the Australian health care system is the Pharmaceutical Benefits Scheme (PBS). This scheme ensures that people on welfare (which, unlike the US, does not run out after six months) and people who are retired who need access to life saving medication (and sometimes designer drugs, like Viagra) can get the medicine on the cheap. Often you can get medicine that would cost you a few hundred bucks for only $2 to $5.

PBS covers everyone, you just pay a little more ($30?). There is nothing stopping drug companies selling their drugs on the open market in Australia at any price they name. Why they hate the PBS is that the Government uses its bargaining power as a major purchaser of medicines to negotiate better prices. Since no-one in Australia is prepared to buy non-PBS drugs this essentially makes them the only buyer, but hell, and if your drug isn't on PBS it won't sell.

The drug companies hate this, they are used to being able to say "Pay $5000 or die", in this case the Australian Government replies with "We would have better healthcare outcomes for the population as a whole if we spent that money on this other drug over here, we will however offer to pay you $1000". They also do annoying things like link their offered price to the demonstrated effectiveness of the drug.

The most interesting part of Sicko for me was the bit about some bill to pay for, I think, veterans medicines? But they were just going to pay whatever the drug companies asked, so essentially it was just a way of pumping money directly in to the drug companies.
posted by markr at 4:26 AM on January 22, 2008 [2 favorites]

To agree with the other Aussies here, part socialized medicine is a good compromise.
If I am poor I get high quality treatment for no cost at the point of delivery. If I am rich I may have the same. At this point we each pay a bit in taxes for this (about 8%). On top of this the rich, or profligate poor, can pay extra either directly out of pocket, or via health insurer, for immediate care or care that includes more amenity (my friend at a private hospital after a birth had a private room and smoked salmon breakfast, for example, but no lesser -medical- care).
As a percent in GDP Australia pays for 100% coverage, admittedly with some non-life threatening delays, at about the same rate the USA pays for medicaid and veterans care.
Yes, I expect there are elements of the US system that cost more, such as liability insurance and the overhead of making a reasonable financial return to HMO stockholders, but a semi-socialized system offering 100% care delivered by the state costs no more in taxes than what people in the US currently pay for potentially bankrupting emergency coverage through taxes.
I don't believe the US will ever change, there is a big chip on the shoulder insisting it is the right system because it is the US system, but it could offer universal healthcare, plus additional cover for the rich today for no extra money if they nationalised, and removed the investor profit motive.
And it would probably be better for the US economy as a whole (less sick people) even though it would hurt the HMO lobbyists (fewer Ferraris) badly.
posted by bystander at 4:29 AM on January 22, 2008

Not-Rationing is when someone from the insurance company says, "I'm sorry, we won't pay for that operation because it costs X dollars and if you don't like it, I guess you can take your money elsewhere because we really can't stop you so maybe if I want to stay in business I shouldn't be charging X dollars hmm why don't you sit down, sir?"

That last bit - where the insurance man wants to keep you as a customer? That doesn't happen. Ever. If you've got a serious medical condition, or even an indicator associated with one, the insurance companies would love for you to go away. The only difference between your "rationing is" definition and the current game is the word 'government'. If you have a serious medical condition, you aren't going to be able to go to a different insurer, because none of them want to cover you. McCain, Giuliani, and Thompson probably can't buy individual health insurance.

The health insurance industry has no beneficial effect on health care. None. The average family health insurance premium was $1000 a month last year. I don't know what percentage of that reaches actual health-care providers, but it's certainly less than would be the case without insurance companies' profit-taking. The situation is getting worse.
posted by Kirth Gerson at 5:07 AM on January 22, 2008 [2 favorites]

boo_radley: Try that again after peak oil.
posted by davemee at 5:17 AM on January 22, 2008

So everyone agrees that the reason health insurance pays for checkups is so that poor, uninsured people can get checkups rather than clogging the nation's emergency rooms? Must have been the post-time: y'all are Aussies who have never been to an American emergency room.
posted by anotherpanacea at 6:11 AM on January 22, 2008

why does health insurance pay for checkups when car insurance doesn't pay for oil changes?

Why do so many people take better care of their cars than they take care of their bodies?
posted by ZenMasterThis at 6:18 AM on January 22, 2008

Lord_Pall, I would suggest that you don't waste your time talking to these people.
posted by chuckdarwin at 6:32 AM on January 22, 2008

I honestly don't know why the poor don't just vote themselves national health care. I guess they're just stupid.

It's because most of them have "national" healthcare. I have health insurance, technically the price gets added to my nominal salary, but it's part of my 'compensation'. So since most Americans have health insurance, and they don't think they'll loose it. (They may be in for a surprise when they go to the hospital)

But yes, they're stupid. And all three of the Democratic "universal" healthcare plans proposed this year are stupid, so it's not like there is actually anyone for poor people who want healthcare to vote for, at least no one who the national media deems as "serious". Kucinich has a single payer program.

The bottom line is that health insurance companies have a stranglehold on congress.
posted by delmoi at 6:40 AM on January 22, 2008 [1 favorite]

I can't believe I read the whole thing, disagreeing with much of it, and in the end he comes to the same conclusion as me anyway.
posted by fungible at 6:45 AM on January 22, 2008

being forced to support another individual tastes too bitterly of servitude, perhaps.

Wow - you are a hard-ass.

Health care isn't cupporting individuals any more than roads or building standards support individuals. It's about ensuring consistent access to something the many consider a basic human right - the access to health care.

Are rich people more worthy of fair justice? Do only the rich deserve the right of free speech or free assembly? So why are the rich the only ones who deserve to see a doctor?

The simpe fact is that by throwing out all the useless overhead associated with health insurance companies, the Canadian system achieves significantly lower per-capita health care costs. We get aiting times in exchange, but not to the extent that people are dying en masse. Fewer people have died from waiting in Canada than have dies due to lack of ability to pay in the US.

Personally, I'd rather the government pay for heathcarew than for a foreign invasion. It tastes too bitterly of opression.
posted by GuyZero at 6:51 AM on January 22, 2008

Fact is our system is sooo screwed up no one knows where to start. First you would need to find a way to make this system run easier, identify all of the processes. AKA organize the mess. 2 - find out what parts are not needed and remove them. AKA simplify. 3 - Start improving areas that we intend to keep, va computers and such. EG have computerized forms that everyone in the office can see so you don't have to give the same story to 40 different people. They could read the computer screen and say "Hey I see your lungs are bothering you" Also humans are prone to errors, computers are prone to the patient's errors. They will have no one to blame but themselves if an error does occur. 4 - Once you have finished overhauling this infrastructure, see if it works. I'm sure if we removed 15 to 16 steps out of the 31 steps mentioned in the article things would greatly improve. Also maybe we could add a few steps in there. As for health care for the un-insured, people are given welfare and WIC right? They are probably the people that need health care the most. Give them a government health care card. I know it wouldn't be perfect or universal but it would be a start. Just my two cents, feel free to comment all you want.
posted by Mastercheddaar at 7:24 AM on January 22, 2008

Health care isn't cupporting individuals any more than roads or building standards support individuals. It's about ensuring consistent access to something the many consider a basic human right - the access to health care.

This isn't clear to me. I don't think roads and building standards are "basic human rights" in the first place. They're goods that arguably most efficiently provided by the government.

Are rich people more worthy of fair justice? Do only the rich deserve the right of free speech or free assembly? So why are the rich the only ones who deserve to see a doctor?

This is a poor analogy. Like I already mentioned, the justice system is an artifact of government, so the government's responsibility to assure it's fairness is not hard to see.

As for free speech and free assembly, neither requires subsidization. That's a huge difference that you're simply ignoring. The more appropriate analogy is asking whether the rich are the only ones who "deserve" an offset printer or a particular venue. It's not a matter of "deserve" at all. It's a matter of believing that ultimately people are responsible for caring for themselves.

Now, you clearly disagree, and you do think that people have a right to be cared for by other people, but you have to recognize that not everyone feels the same way. A lot of people in this country simply don't recognize human rights that force some people to work for the personal well-being of others, and their position on this may be wrong, but it's not absurd.
posted by "Tex" Connor and the Wily Roundup Boys at 7:29 AM on January 22, 2008

It's about ensuring consistent access to something the many consider a basic human right - the access to health care.

Throw out the rights argument. While the idea that individual citizens have a responsibility to the general welfare works for me, it obviously doesn't for some individualists, and I don't particularly care, because we're at the point where it seems likely a state-run entity could work better than the current insurance industry.

Why do we have a mostly public road system? Partly because it's more effective than a private one would likely be. There are several measures that seem to show other countries with public insurance do better than we do. Pragmatics alone would seem to dictate we oughta seriously look in to what they're doing.
posted by namespan at 8:24 AM on January 22, 2008

"There is no such thing as society" - Margaret Thatcher. Pretty much all you need to know.
posted by Rumple at 8:28 AM on January 22, 2008

we're at the point where it seems likely a state-run entity could work better than the current insurance industry

A bunch of monkeys flinging rancid shit at each other could do a better job than the current insurance industry...
posted by chuckdarwin at 8:59 AM on January 22, 2008

Tex: Well, I could perhaps buy your argument that Americans resent paying for other people's health care if it weren't for the fact that Medicare and Medicaid weren't so well supported among the populace in the United States (last I checked they were hovering around 75% each.) So it's not like socialized medicine is an alien concept in the United States, nor one that Americans have an inherent distaste for.

As for those analogies presented to you, I agree that none of them are strong, so I'll throw this one out to test it's logical strength: how would denying universal health care be different from denying access to clean drinking water?
posted by Weebot at 9:09 AM on January 22, 2008

I should clarify: By clean drinking water, I mean clean, public drinking water.
posted by Weebot at 9:10 AM on January 22, 2008

why does health insurance pay for checkups when car insurance doesn't pay for oil changes?

Because car insurance is far more similar to life insurance than it is to health insurance.
posted by Afroblanco at 9:25 AM on January 22, 2008

why does health insurance pay for checkups when car insurance doesn't pay for oil changes?

Nthing ALL the folks above who call out the particular question above as hella-dopey. Because there are like 88 comments, and I haven't had time to read them all, forgive me if someone else has offered this simple answer to this "simple" question, but here goes:

Auto insurance is LIABILITY insurance. The purpose of auto insurance is to protect OTHERS who may be injured (or whose property may be injured) by the consequences of YOUR use of your automobile (be it negligent or accidental).

Health insurance is PERSONAL insurance. The purpose of health insurance is to protect YOU and YOUR FAMILY from becoming injured by natural cause, by disease, or by neglect of your own health.

Therefore, car insurance doesn't pay for oil changes because oil changes are not PROXIMATE causes of the damage that car insurance insures against.

However, health insurance pays for checkups because checkups can identify and (they sometimes) prevent the PROXIMATE causes of the damage that health insurance insures against.

And I can only hope that anotherpanacea posted this question in jest, so I offer this response for those folks out there (like me) who haven't had the time to scroll through this interesting, but long, conversation.

Is there a public health component to universal health care? Yes, there is. But the world of automobile insurance is a poor model for demonstrating the public health component to universal health care.

What are the best models for demonstrating the public health component to universal health care? Well, the rate of infant mortality in the U.S., for one. And the general lack of health in nations with underdeveloped health care infrastructures and support, for two.

The best argument for universal health care? Pandemic flu. Much better than "hey, I got a great rate for my auto insurance!"
posted by deejay jaydee at 9:30 AM on January 22, 2008

Hoverboards wrote: Universal Healthcare plans assert that Person A in California has a humanitarian obligation to Person B in Mississippi, but not to Person C in Botswana. But it is not a common bond of humanity that unites A and B - it is the accident of geography that places them within the same legal jurisdiction. This is why opponents of universal healthcare tend to be strong individualists - not because they are selfish (though they may be), but because they believe a human being's rights and responsibilities should be based on his individual characteristics wealth, not his group identity.

A very slight fix for you.

Yes, a Universal Healthcare plan for the United States will not be "truly" Universal, as North Koreans, Saudis and others will not be covered while living in their own country. This is because they don't live under the jurisdiction of the State providing said resources. Maybe if we had an International State with the ability to tax and distribute resources that wouldn't be a problem.
posted by Avenger at 9:35 AM on January 22, 2008

Yes, a Universal Healthcare plan for the United States will not be "truly" Universal, as North Koreans, Saudis and others will not be covered while living in their own country. This is because they don't live under the jurisdiction of the State providing said resources. Maybe if we had an International State with the ability to tax and distribute resources that wouldn't be a problem.

Western-style healthcare is far too expensive for everybody in the world to have it. Selection by wealth is one way to ration it. Others ways are selection by nationality, or race, or political connectedness. Those who don't make the cut must rely on charity, and the individualist approach is to direct your charity to those you think deserve it most. The American universal healthcare approach is to direct it to Americans, who are probably somewhere towards the bottom of the global neediness scale.
posted by hoverboards don't work on water at 10:17 AM on January 22, 2008

The British system makes more sense because, at least most of the time, the rationing is done rationally--ie, the evidence supports it, we'll pay, if not, we won't.

It also makes sense in that if you want to go private, you can, so there's no rationing at all for rich people.

The opponents of national health care in the US have always tried to scare the middle class and the rich with fears of mandatory rationing and no option to go private-- but now we're experiencing rationing in order to make profits for people, rather than rationing to keep taxes down. I think people would prefer the latter-- and they'd get more for their money because right now people make money by denying care and those people's jobs would be lost under national healthcare (some would be needed to do things like the UK's National Institute on Health and Clinical Excellence.
posted by Maias at 10:22 AM on January 22, 2008

A lot of people in this country simply don't recognize human rights that force some people to work for the personal well-being of others,

It is the sickness of America that most Americans believe they owe nothing whatsoever to society.

However, if you read the article (you did read the article, right?) you'll see that this has nothing whatsoever to do with the author's argument.

He claims that the system isn't working for anyone and there is no way to fix it without massive changes.

If I'm sick, I'm just unable to negotiate effectively with my provider to get the best and cheapest care. Massive graft and incompetence is built into the system, most of the money is not used to provide health care. Pharmaceutical companies spend more money on promoting their drugs than researching them; vanishingly small quantities of money are spent on preventative care; having any sort of major uninsured illness is financially catastrophic for everyone other than the ultra-rich, yet all sorts of hard-working, productive individuals are simply unable to afford health coverage.

The fact of the matter is that the United States is a very rich country. It could choose to spend its money to make its citizens well -- instead it spends the money on warfare. The US has been at war continuously for over 60 years -- and during that time, infant mortality amongst African-Americans has been at third world levels.

What the insanity of "I don't want to give any of my money to anyone" (aka "I don't want to be forced to work for the well-being of others") fails to realize is that everyone benefits from such a scheme.

Perhaps you end up being well your whole life and never use these services -- but isn't such a boon worth any amount of money? More likely, if we had rational services trying to do the best for everyone instead of trying to extract as much money in profit as possible, you'd be taking advantage of the single payer's desire to cut costs by providing as much preventative care as possible without even really paying attention and you'd be a healthier person overall.

I've experienced Canadian health care, and I've also experienced American health care with the best possible insurance. There is no comparison. It's the overall attitude that when you are sick, you go to a doctor because it's not a big deal that keeps the overall health in Canada very good, even taking into account the difficulty of providing adequate health care to the indigenous people who present the double challenge of being disadvantaged and being geographically scattered.
posted by lupus_yonderboy at 10:25 AM on January 22, 2008 [3 favorites]

Western-style healthcare is far too expensive for everybody in the world to have it.

That's ridiculous crap. The world can't afford bloated US-style health care. Reasonable if stripped-down western-style health-care is perfectly attainable on a third-world budget, look at Cuba or Costa Rica.
posted by lupus_yonderboy at 10:33 AM on January 22, 2008 [1 favorite]

Pharmaceutical companies spend more money on promoting their drugs than researching them;

Worse than that, they often develop the drugs with massive government support, then the government grants and protects their patents so they can charge us a fortune for them. We end up paying for the drugs twice.
posted by George_Spiggott at 11:35 AM on January 22, 2008

why does health insurance pay for checkups when car insurance doesn't pay for oil changes?

how hard is it to change your oil?
posted by mano at 12:21 PM on January 22, 2008

Rationing is when someone from the government says, "I'm sorry, you can't have that operation because we decided you can't and if you don't like it, screw you, you can't go anywhere else because we made it illegal to do so."

When you find a country that has made private healthcare illegal, let me know. And when you find a country other than a dictatorship that prevents its citizens travelling abroad for treatment, let me know.

We had a big thrash over this not so long ago, so I'm not keen to get sucked in again. For me it boils down to: if you believe that questions of people living and dying should NOT be handled on a risk-shared, socialised basis, available to all, then I cannot understand where you get your morals from. Nothing personal, I just can't conceive of a situation where it is thought OK for poor people to die from curable illness because richer people are worried about how quickly they can see the doctor.

I'm a European, and proud of it. Now, you carry on with a chat about how us evil Europeans are strangling enterprise with our hateful socialism and how the Ay-rabs are going to take us over and soon we'll all be seventy and how we're only free because of America entering the second world war. I'll just settle down with my universal health care and not-that-much-higher tax rates, and leave you to it.
posted by athenian at 12:24 PM on January 22, 2008

When you find a country that has made private healthcare illegal, let me know.

Canada, more or less. There are some private clinics in some provinces, but they are legally dubious. Not that I disagree with your conclusions though.
posted by ssg at 12:29 PM on January 22, 2008

Canada, more or less.

Nope. Private clinics cannot be part of the public system, it's all or nothing. But that's it. Which means that it's very hard for a private clinic to generate enough business to make it worthwhile. But set up a private clinic by all means. I hope you bill enough to pay for your marketing department.
posted by GuyZero at 12:34 PM on January 22, 2008

as delmoi pointed out, kucinich is the only candidate for single-payer. the other plans are more of the same. i wonder how much the health care establishment has donated to the obama and clinton campaigns...
posted by blendor at 12:52 PM on January 22, 2008

interesting thing about Canada is that the establishment of public health care was aggressively fought by the medical establishment, and the current head of the CMA has made it his mission to destroy the system (my words, not his, of course).

in fact, Dr. Brain Day founded the first private surgery in Canada.

http://www.brianday.ca/
posted by klanawa at 1:08 PM on January 22, 2008

GuyZero: I think the issue is actually pretty complicated, which is why I used the qualifier "more or less". For example, there was the Supreme Court decision of a couple years ago indicating that Quebec could not prevent private payment for insured procedures because Quebec was not providing timely service within the public system. Presumably, if Quebec was providing timely service within the public system, then that decision would have been different. In other words, because Quebec was failing to uphold the Health Act, other sections of the Health Act (the ones forbidding private payment) were deemed to be invalid. Its a complicated legal issue, with the federal government and each provincial government seemingly holding different interpretations of the Health Act, but I don't think your simple interpretation enjoys broad support by any stretch.
posted by ssg at 1:14 PM on January 22, 2008

And yet Canadian voters would lynch any politician that dared to dismantle the Canada Health Act.
posted by GuyZero at 1:18 PM on January 22, 2008

ssg: I'm familiar with that and it is an interesting complication to the issue of private vs public. I think it's the right decision as I personally believe that the courts made that ruling to try to motivate the provinces to fix the problems with wait times.

My point was regarding the operation pf private clinics within Canada. There is no law barring a doctor from starting a private clinic and charging whatever he wants for his services. There is a law preventing him from billing both the patient and the province. I think this is a fair law and my point is that there aren't really enough people willing to pay for fully private services to justify the cost. Now, this isn't really true as there are a handful of completely private clinics in Canada, but there isn't a market for them on a wide basis. But there is nothing legally dubious about these private clinics.

If what you're saying is that it crosses the line when the Supreme Court decision is used to force provincial medical programs to send people to private clinics that would normally not qualify to bill to OHIP (or whatever), I agree it's a odd situation, but I don't think it's legally dubious.
posted by GuyZero at 1:25 PM on January 22, 2008

We can save our precious $40 and instead pay (via health insurance) $4000 for same bum to be rushed into ER due to condition left untreated for too long

The fact is most Americans want to get back to the moral place where "or we could just let him die for nothing" can be spoken aloud without it being utterly revolting. Baby steps.
posted by Lentrohamsanin at 1:39 PM on January 22, 2008

why does health insurance pay for checkups when car insurance doesn't pay for oil changes?

Oh and to answer this question, because when cars get sick enough we write them off and throw them out.

It's sad that the basic question in this essay compares a human life to a lump of metal and plastic.
posted by GuyZero at 2:02 PM on January 22, 2008

GuyZero: I think you have misread what happened in the Quebec case. The plaintiffs were asking for the right to pay themselves (or be paid) for services that would normally be covered under the provincial health plan. The case wasn't about extra-billing, because no one is trying to bill the provincial health plan for the services. Here is an article from the CBC that gives a pretty good overview.

If the provincial health plan provided timely service, it would be against the law to open a private clinic in Quebec. Yes, some provinces seem to be allowing private clinics to operate as long as they don't bill both the province and their clients (and interpreting the Health Act and/or their provincial laws the way you do), but that doesn't mean that it is a settled issue or that there are no laws dealing with the matter. At least in Quebec before the Supreme Court decision, the law was pretty clear: no private billing at all.
posted by ssg at 3:40 PM on January 22, 2008

interesting thing about Canada is that the establishment of public health care was aggressively fought by the medical establishment

The same thing happened in Britain in 1948, when the NHS was established. The British Medical Association (now one of the NHS's staunchest defenders) fought and fought against the proposals for doctors' pay. Eventually Bevan, the Health Secretary, had to agree to a very generous financial settlement that allowed doctors to be independent contractors rather than state employees. When asked how he had stopped the BMA's complaints, he said "I stuffed their mouths with gold".

But set up a private clinic by all means. I hope you bill enough to pay for your marketing department.

In the UK, BUPA, Nuffield and a few other private health insurance companies do OK business in 'top-up care' - providing slightly more comfortable or quicker care for minor and moderate ailments, but leaving the big stuff to the NHS.
posted by athenian at 3:48 PM on January 22, 2008

Fact is our system is sooo screwed up no one knows where to start.

There's a system? What system? I can't seem to see anything systematic going on in US healthcare. Oh, you mean the profit-making system. Yeah, United HealthGroup and the others are very systematically making money. But delivering care, not so much.
posted by Mental Wimp at 4:11 PM on January 22, 2008

As for those analogies presented to you, I agree that none of them are strong, so I'll throw this one out to test it's logical strength: how would denying universal health care be different from denying access to clean drinking water?

A competitive, private household tap water market would be an absolute nightmare from an infrastructure standpoint. Would the different providers each set up their own purification plants and lay parallel pipes using individually negotiated easements?

What a mess. I don't think the analogy works, since health care doesn't present such massive infrastructure and right of way difficulties that justify government involvement.
posted by "Tex" Connor and the Wily Roundup Boys at 4:40 PM on January 22, 2008

It worked just fine in Vicorian london!

(apart from all the cholera)
posted by Artw at 4:45 PM on January 22, 2008

“Cars don't poop.”

Everybody poops

“Seems to me, an ignorant outsider, that your Government is far too busy spending money on nukes, warships and, well, wars... to worry about the medical needs of its poorest citizens (let alone its citizens) back home. It is sometimes said that a country can be judged on how it treats its poorest citizens. On this test, the US fails badly.”

Wait, now hold on just a minute there. Nothing wrong with being an outsider.
posted by Smedleyman at 5:29 PM on January 22, 2008

why does health insurance pay for checkups when car insurance doesn't pay for oil changes?

Oil changes have no effect on car crash claims.
Checkups do affect (reduce) health care claims.

Surely there are better arguments for universal coverage?
posted by asusu at 5:45 PM on January 22, 2008

"why does health insurance pay for checkups when car insurance doesn't pay for oil changes? "

Besides being a complete non-seqitor this statement is also false. You can buy car insurance that covers everything including routine maintenance. Many corporations take advantage of this service to make budgeting easier.

Heck, one of the places I've contracted the motorpool contract even included gas for X many kilometres and weekly service including washing and washer fluid.
posted by Mitheral at 6:59 PM on January 22, 2008

In most European systems, there is a part private/part public scheme. I can go to a top specialist (say neurologist) at the university hospital and wait eight weeks, or I can have a "private" visit with same doctor (in same hospital, same exam room, with same staff, same service) in three weeks. How it works is:

the mutuality (universal health care) pays me about 35 $ back of the visit either way. They simply don't care what option I choose: they have a "nomenclature" which says: we pay 35 $ for a general visit to the neurologist.

If I go "public", I pay 40 $, thus 5 $ out of my own pocket
If I go "private", I pay 50 $ (or 60 or 70, depending), thus 15 $ out of my own pocket

If the neurologist does an exam with some machinery, there's a nomenclature for that too. Say the hospital charges me 150 $ for the exam. Mutuality will pay 120 $ (it's usually something like 3/4ths or 2/3ds of the amount).

It's up to me to what doctor I go, and it's up to the doctor what treatment/exams I get, based on medical necessity. At no point does a bureaucrat enter the proceedings to say: "you can't have this procedure" or "you can't see this doctor" or whatever.

The only point where there's any rationing done is when doctors organizations and government/mutualities decide on the nomenclatures. It never enters the patient/doctor realm. That's what "socialized" medicine means for most civilized people around the world. Reports about "waiting lists"/"rationing"/... are usually greatly exaggerated.
posted by NekulturnY at 3:49 AM on January 23, 2008

"What a mess. I don't think the analogy works, since health care doesn't present such massive infrastructure and right of way difficulties that justify government involvement."

Health care does present massive infrastructure difficulties, and thinking about water as primarily a right-of-way concern is unnecessary.

The infrastructure concerns are problems such as ensuring adequate coverage for areas where it might not be commercially feasible to run an unsubsidized hospital or clinic (the rural Dakotas, for example) but where people should still be able to receive some care, the adequate supply of emergency care in disasters or epidemics, the allocation of research dollars for illnesses that are public health threats but not profitable (much of this is done through CDC and NIH grants)…

Fundamentally, health care is a public good, and it's unfortunately undervalued and undernoticed in America, and we could have a much better infrastructure than we currently have. I've seen that you've argued in favor of universal health care in this thread, though I disagree with some of your underlying assumptions about the role of government (which is where most of the "crypto-con" friction comes from on my side, I'd surmise), but I fear that an over-emphasis on the purely economic gains that could be made by adopting a universal healthcare system leaves the policy questions too open to short-term quibbling; I believe that cost-benefit analysis needs to be applied to the question of how best to provide universal health care, but I do not believe that cost-benefit analysis is the reason why we need universal health care. I believe that two of the central remits of a government are to provide for health and prosperity of citizens, and I believe that universal health care falls under that remit.
posted by klangklangston at 12:11 PM on January 23, 2008

I know I'm late to the party, but it took me a week to read all these comments...
Anyway, something I haven't seen pointed out is the stranglehold the AMA has on medical schools. A lot of arguments against national healthcare talk about supply and demand, but fail to see that the supply is being rationed. You can argue all you want about quality, but I really don't think we'd see a drop off if we increased the number of seats at med schools by 10 or 20%. There's a lot of bright kids out there with the will to be a doctor that can't get into med school.
posted by Crash at 1:00 PM on January 23, 2008

I do not believe that cost-benefit analysis is the reason why we need universal health care

Quite so. Supporting universal health care is just one of those things that anybody who can think clearly already does.

However, cost-benefit analysis, along with the demonstrable superiority of existing socialized health care systems around the world, are absolutely the best arguments to use against people so mired in ideology that they've lost their grasp of the bleedin' obvious. You can argue endlessly with me, but it's hard to argue with results.
posted by flabdablet at 3:39 PM on January 24, 2008