In universal care you dont get access to 'clinical trials and research and things like that, where people need access to leading-edge potential treatments'
You are also not eliminated the need to get funds, you are changing who you are asking them from. And let me tell you that government officials are seldom generous.
Clinical trials are mostly free for the patients who are chosen for them. But I think what you’re saying is government healthcare won’t pay for experimental treatment (currently in a trial stage). However, that is true even for private insurance here in the US. My regular insurance doesn’t cover experimental treatments. I have a separate add on that pays for some experimental treatments.
Access to leading-edge potential treatments is a minor concern in health care: few need it, fewer qualify, and fewer are helped. Even then, your statement is false: leading edge medical research is carried out in all countries with universal health care.
The U.S. has an infant mortality rate worse than 43 other countries because large numbers of pregnant women can't access routine prenatal care. That's but one example of what real health care concerns are like.
Can't. The U.S. has well documented problems with the working poor being unable to afford insurance or qualify for medicare; even if they qualify, medicare is not universally accepted (because it doesn't pay market rates) and there's no legal requirement for medical professionals to do so.
No, Government officials in the US are afforded socialized medicine. "The Federal Employees Health Benefits (FEHB) Program is a system of 'managed competition' through which employee health benefits are provided to civilian government employees and annuitants of the United States government."
Strange contradiction: you are show a case on how federal workers have an undue benefit in comparison to the population, which is what my original argument was. This program seems to be about selecting insurances tho, not an actual insurance. It's tangential.
No, I'm saying it's strange having the people in charge of the government touting a privatized health program for the entire nation except themselves. If private care was so much better than socialized government care, why are the senators, the house members and everyone in the armed forces so staunchly in favor of keeping their socialized care? Don't you think if socialized medicine was murder and death panels and bad outcomes and high costs, that the senators and house members would be on private plans? Why are they so in favor of staying on the government's program? Is it because socialized medicine is in fact better than private care?
Further if they don't want to get off the socialized program because it's better than the private plan, why don't they work towards extending that to the average citizen like every other developed country in the entire world? Political expediency probably.
This program is about selecting insurance, it doesnt provide healthcare. It doesnt have doctors that work for the program, its just an insurance selection scheme.
Don't worry about the senators: they are all using private healthcare. Probably even the opposite of your speculation: if they use state solution due to their age, its medicare advantage.
I was mistaken, on two counts. One being the FEHB and what it is, you're right; also the FEHB was replaced with exchanges as part of the affordable care act, although the government does subsidize them. Of course many of them are old enough to end up in Medicare.
Absolutely wrong. There's nothing that says people living under a socialized medical system don't have access to clinical trials. Government is an extension of the people. If you want generosity you vote for generosity. In Canada, where I grew up, it works wonderfully. In the rest of the civilized world, it works wonderfully. There's no reason it won't work in America. Moving to America the scariest thing in the world was giving up my OHIP card (my Ontario government socialized medicine card). Still is, honestly.
The US has substantial incoming medical tourism. If it really were strictly worse to european alternatives (more expensive or lower quality) europeans would not go to the US.
The existence of .eu-to-.us medical tourism is utterly orthogonal to the availability of research in those countries. If you honestly took ten minutes to try, you'd be able to find dozens, if not hundreds of trials in every .eu member state, plenty of which are at least comparable to, if not more advanced than what's available in the US.
I could go to .eu or .in or .mx or .th, or any of dozens of other countries, to get access to medical treatments and procedures that are by many, if not most, measures superior to their alternatives available here, but which aren't available here (just one, token example: RISUG), or are vastly more expensive here, but have comparable — or, again, better — outcomes there.
Most of those places offer varying degrees of socialized, if not universal, medicine.
It means there are things the US healthcare provides that universals systems don't, and in a practical way that affects people, not purely in the world of ideas.
The great folly of the world universal is that it implies everything would be available, and its a step in the opposite direction: a set of things will be made available, and the things that aren't will be delivered by the private market. Private care is still a thing in most universal care countries. And even with private and public, us still produces something for people that could get free treatment.
How, exactly, has regulation driven the price of a drug we've had for decades up hundreds, even thousands, of percent, most of which increase happened after it was out of patent protection?
Fascinating that drugs in Canada are perceived as so much cheaper than in the US, and yet, you know that Canada doesn't have a socialized prescription drug program? Instead, provincial health programs negotiate drug prices. You know who can't do that? Individuals. Also, Medicare.
The medicare example is quite an interesting one as well. The US doesn't have the political momentum to let medicare negotiate pharma prices, and before such a basic thing is even changed, you want to hand over the entire health care insurance industry to the government?
Yes. At some point making tiny adjustments to an overwhelmingly backwards and world-leadingly inefficient system is going to be harder than starting fresh.
Totally different things. It's like saying if I tweak this nob and it goes bad, well, why should I switch to a completely different system three counties down? Especially when that totally different system three counties down works for every other developed nation in the entire world. And also some of the developing ones. You should be defending why the American system is better than every other country in the world in spite of their lower costs, better access and better healthcare and better outcomes across the board. Private care in the US costs two times as much per capita as socialized care in Canada, doesn't cover everyone, and yet Canada's outcomes are better and Canada places higher in WHO rankings.
Making small adjustments to a doomed system is just akin to rearranging the deck chairs on the Hindenburg.
I'm suggesting maybe fixed-wing aircraft that aren't full of Hydrogen.
The american health system is worse than other countries for intense regulatory capture and regulation, thats my assessment and one shared by many economists in the healthcare space. Socialized programs dont resolve that. Having medicare for all does not abolish patent law, or creates doctors out of thin air, or reduces the cost of medical school, those are recognized problems. The socialized medicine plan is mostly hiding away the cost and paying it all through taxes: not making it cheaper. That way, the only way you can do it cheaper is by reducing the state offering.
You will not get the canadian health insurance by signing a law that says you will. You will get the american version of it.
Please bear in mind medicare itself is also more expensive than canadian health services as it is, thats what the american state gives out.
>> The american health system is worse than other countries for intense regulatory capture and regulation, thats my assessment and one shared by many economists in the healthcare space.
I addressed where cost savings come from in another post you may have missed, another reply to your comment with specific examples, we can take that over there.
>> You will not get the canadian health insurance by signing a law that says you will.
Funny, that’s how we got ours in Canada in the 1970s, you should read up on it and on Tommy Douglas. No need to be defeatist.
We had a for profit system, and it was the worst, so we changed it. I’m not sure why America would be incapable of that when we weren’t. Further as in Canada, the system can be defined as the federal government requires minimum standards of care and the states execute in the way that makes sense for them.
Obviously Medicare is more expensive. America doesn’t have a free market for healthcare. The young, healthy and cheap to insure obtain cover in the private markets. All the worst customers (the sick, the old, the dying) are removed from the market and their care is already socialized. This is the definition of a manipulated market: privatized gains, socialized losses. The cost to cover for Medicare will drop substantially when the healthy pay for the sick directly the way it’s supposed to work.
It wasn't an example. Instead of answering, you moved goalposts and asked "why don't you import stuff from Canada".
However you look at your "example", it's not good for the US.
- Canada has universal healthcare
- Canada has government regulations
- Despite all that, insulin in Canada costs less than in the US
So the original question still remains and is valid: why is insulin in the States so damn expensive? Given that the US is one of the largest insulin manufacturers in the world. And it's produced by literally the same companies.
The main driver for EU-US medical tourism is the much weaker regulation in the US. In the best case, people from the EU travel to the US for innovative new treatments that aren't yet available in the EU; more often, they're suckered into paying huge amounts of money for quackery.
The US has a similar relationship with Mexico; there are a string of clinics along the Mexican border offering unproven cancer treatments that would be difficult or impossible to market under US regulations.
That doesn't mean those tourists are getting effective or even safe treatment. It just means the US hospitals are good at marketing to desperate and wealthy people.
Because governments dont spend nearly as much as private investment into the medical field, and have a very different alignment in terms of costs/revenues.
The second part of the sentence alludes to something I did not intend to imply.
> Because governments dont spend nearly as much as private investment into the medical field...
Are you not aware of how much fundamental drug and medical research is actually conducted on the taxpayer's dime at the university level, and then exclusively licensed to private enterprise for commercial exploitation?
I've seen a number of sources make a compelling case that "big pharma"'s number one line item is marketing, not research.
At great cost to society. There should be no federal funding on this. This is one of the gravest reasons why healthcare is so expensive in the U.S. It subsidizes big corpo, big hospitals, then subsidizes richest employees, eliminating the most basic price mechanisms for competition.
Not only does it do all the subsidizing, but it also makes it expensive by putting extremely costly regulation.
But thats a whole topic on its own: government funding of healthcare research is not efficient and does not make it cheaper in any way.
Big Pharma's #1 expenditure is always going to be protect its patent monopoly process with the FDA.
You have a fascinating perspective on medicine and research. Research should be paid for by the people and made available in the public interest. If a private entity does pay for the research they are entitled to protect their inventions for 20 years via the patent program. That doesn't mean buyers or buying organizations shouldn't be allowed to negotiate.
Research should be paid by the people with an interest to pay for research. And the government should put as little stops and costs into that process as possible.
I would find it better that patents in pharma were eliminated, but also that the FDA approval process should be optional. If you want to save lives, you need to loosen up.
Oh, I see, having a conversation here probably won't be very productive. "If you want to save people, you should just let people try any old untested medical device, procedure or supplement, and wish them the best if that's what they want." That's how you kill people. There's a reason we have an FDA approvals process and it's not because the barbershop surgeons and snake oil salesmen were doing so well that big government needed to step in and ensure we didn't save so many.
You also kill people by not giving them the medication they would want to get, or making it to expensive for it to exist. There is no "clean-hands" solution on this.
> here's a reason we have an FDA approvals process and it's not because the barbershop surgeons and snake oil salesmen were doing so well that big government needed to step in and ensure we didn't save so many.
Yes, the 1920's of medical licensing, restricting doctors supply, hospital grants etc. You can see how medical expenses became an issue right after that.
I wonder what happened to the slope of the graphs for rates of various adverse outcomes over time did right around then, too. I think price, by itself, is an absurdly meaningless metric. If it gets more expensive, but gets better, that's potentially worthwhile.
What's happening in the US healthcare system now, however, is that it's on the order of twice or more as expensive as anyone else's — and climbing — with worse outcomes than many of those, and are getting worse.
No matter your views on who should pay for it, you can't be in favor of that.
Imagine if every late-night "male enhancement" pill was instead a cancer treatment. That's what the world of snake oil salesmen was like. That's the world you're advocating for. God help us all if you get your way. It's like how the rivers dont catch fire anymore so we don't need an EPA </scarcasm> I bet you the costs of disposing of dangerous waste products went up exponentially after the EPA was established, and yet, nobody cares because it's better all around.
The world of people advocating for ineffective cures is already here, you have homeopathy, and you also have plenty of actual pharma that have much bigger placebo effects than clinical effects, or the overstated claims about the latest diet, paleo, keto, pescatarian, vegan, vegetarian, gluten-free.
Can you imagine having diets having to be clinically approved by the FDA? 10 years plus billions of dollars to say you should eat less sugar.
When someone dies because they can't afford insulin, they are paying with their life for your sense of security.
But! There is also a way to satisfy your desires, and satisfy mine. You buy your FDA approved drugs, and the ones that don't want to...don't. You get your security, and I get cheap medication.
No, I get medication and you get unregulated death pills.
Mine cost more under your model than they do now because lower volumes will drive up prices. The market further segments, only the wealthy can afford real medicines and the poor, barely able to afford medicine in the US as is are forced to risk their lives on unregulated garbage snake oil. This is just a way to kick the poor harder but with extra steps.
You're not giving them insulin either, you're giving them who knows what. That's the problem. Regulations aren't there to hold the little guy down, they're there because life was the worst before, and little by little, we pushed back until it was pretty good.
It's a pointless argument. This is right up there with Antivaxx and crypto enthusiasm, and it's a libertarian pipe dream. You acknowledge the lack of regulation has led to a pile of worthless garbage and your argument is let's keep doing more of that, instead of lets regulate the homeopathic medicines and male enhancements, and yes, diets. If you want to claim your diet is effective, then we should have that statement approved. It'd kill the industry because they're largely all baloney. And I'd be totally ok with that.
We live in a society, believe it or not, and yes your unregulated garbage does interact with my regulated medicine via market economics. As I explained. You're basically just arguing we accelerate the path to Elysium. That's an argument you can make, though let's be honest about it.
I dont know the UK health intimately to compare confidently. I can tell you what it looks like with Argentina. that has universal care. Normally anyone with a dime goes private. Public is a lower-quality, cheaper service.
That system is great for the poor, most expensive to middle class.
I can also tell you what I think are reasons why US healthcare is so expensive, and they are not fixed by universal care programs.
How is universal care going to reduce the shortage of primary care doctors?
How is universal care going to eliminate patents for pharma?
How is universal care going to make non-profit hospitals cheaper?
How is universal care going to eliminate fee-for-service, which has the administrative costs that are the woes of care providers?
How is universal care going to reduce healthcare spending?
Medicare is justs as opaque, and also distortive: Medicare costs 11k a year, but retirees pay less than half its cost as it is.
The main reason pricing is opaque is because patients dont have freedom to compare between insurance companies, and because insurance companies are not a good model for frequent care. If you had High-deductible plans, you would make a much better system but people hate those plans.
You need a big change in popular sentiment to make pricing work well. (i am all for HDPs)
With a high deductible plan they still will give you no estimate or something like "between 1000 and 200000 dollar". All actual prices that got paid need to be published.
Transparency is kind of irrelevant, if I'm bleeding out unconscious somewhere in the street, I'm in no position to make hospitals compete for my business. This isn't buying a new cell phone, these are peoples' lives.
Transparency is important to choose any service and care is one of them. The vast majority of healthcare services are not urgent. There's a case for price insensitivity for emergency care, but that is also resolved by choosing insurance before hand: the same way there is price sensitivity to life insurance.
A bigger problem to me than transparency is distortion: the value of the service being public means little if the patient is not paying for it. A patient that has 20% co-insurance or 20$ copay have completely different price sensititivities. They are also price-insensitive when they select insurance because they get it through the employer that picked it and payed it for them.
As a patient, the price tag on a service is relevant to you depending on insurance: validating insurance is much more important than seeing the price.
A socialized medicine scheme will have the same problem: if a patient is shielded from the actual cost of the visit, then he is more likely to use it and thus over-use it.
Complex dermatology assessment in Ontario (A020)? $49.95CAD
I visited family in Canada and went in without insurance for a small hour-long outpatient procedure. Nothing major. They billed me $90CAD ($67USD) -- and were incredibly apologetic they charged me in the first place.
>>> A socialized medicine scheme will have the same problem: if a patient is shielded from the actual cost of the visit, then he is more likely to use it and thus over-use it.
That's the most patently absurd argument proponents of the current model utilize. This isn't some ice cream shop. Nobody goes to the doctor and demands one of each with sprinkles. If I told you all your healthcare was free what on earth would you get done?! Are you planning on shattering your femur just to maximize the value you draw from the system? If the answer is some legitimate healthcare procedure, go with God, you have my full support. If not, I'd imagine this is similar to the "5 million illegals voted last time" -- did you see one? nope! But I know in my gut they're there. Feel free to cite me some studies though.
Especially as under socialized systems medically unnecessary treatments such as purely cosmetic plastic surgeries aren't covered, for exactly this reason. This risk is further limited because most socialized systems use a Kaiser-type model where a primary care physician refers you to a specialist. Self-referring to a specialist is a very private medicine thing -- you're not a doctor, you've got no medical training, you have no idea whether you should be using the valuable time of a specialist -- let alone which one, so we defer that decision to someone who is: your GP or primary care physician. More waste reduction, cost reduction, efficiency improvement.
This horse has been beaten so long its basically a horseburger now; these are very much solved problems. By all means, have at those windmills though.
Most Americans can’t afford $500 in case of an emergency, which is why high deductible plans are a non starter to provide coverage. For them a $5000 deductible is as good as not being covered in the first place.
Health insurance costs 800$ a month so not having 500$ means you dont have insurance. Thats another level of poverty, for the which there is medicaid and a different set of programs and way to deal with those cases.
That's not true. First of all $800/month is what you'd expect to pay if you were young and healthy and with moderate deductibles. Good luck being older or sicker. The $500 that I'm referring to is $500 beyond what they budgeted for after their monthly expenditures. No, Medicaid doesn't always apply to these people, you should look into it. It also requires extreme levels of financial hardship. Medicaid takes a lien against your house to recover their costs. Not to mention the donut hole for whom having their house taken isn't even an option. It's brutal.
When I said most of America, I meant it. It's fifty seven percent of America. [1] Are you going to put them all on Medicaid and take their houses? I thought you were arguing for private cover :) This is the kind of thinking that pushes up costs. Creating barriers to seeking care early makes everything more expensive as the longer you wait, the more it costs to resolve.
Let's be rational about this. The US median individual income is $39,336. [2] Your take-home pay would be approximately $2614 per month after tax assuming you save nothing toward your retirement. Taking out $800 leaves you with $1814. The US median rent is $1500 per month [3]. This leaves you with $314 for food, gas, transportation, electric, water and sewer combined. And this is the best possible case: you're single. Then you want them to handle a $5000 deductible?!
It doesnt change the math to charge 5000U$S in advance through a payroll tax, than to have a 5000U$S deductible afterwards. The key metric is if the healthcare services are better utilized and are cheaper.
Sorry, would you require everyone get a raise in the amount of their health insurance benefits? Sounds like interventionist overreach into the free market to me. Remember how the 2017 tax windfall for companies would yield huge raises for everyone, but instead, only lead to stock repurchases? What makes you think this would be any different?
Since you also suggested in a different thread that it'd no longer be tax deductible, that $5000 would drop immediately to $3000 or less -- $250/mth. That's still dancing on a razor's edge.
Your key metric of "cheaper" and "more available" and "better utilized" is provably solved with a socialized model. There's no active private care model that outperforms one of the OECD socialized models, or else you'd have at least mentioned it by now. Instead, we keep revisiting unsubstantiated ideological libertarian talking points. I've got real world implementations to support my theories.
(1) How is universal care going to reduce the shortage of primary care doctors?
I don't know enough about the reason for the shortage of doctors but I'd go out on a limb and say its probably not because they don't get paid enough.
(2) How is universal care going to eliminate patents for pharma?
It won't, and it shouldn't. Patents for pharma don't preclude successful implementations of universal healthcare anywhere else. There's a perception that in Canada "drugs are cheap" -- prescription drugs administered outside of hospitals largely aren't covered by OHIP. Provinces act as bulk buying groups and negotiate prices with pharma companies. You want to partake in the market, great, let's figure something out. It works surprisingly well. Patents are your temporary monopoly on creating an invention in exchange for sharing it with the world.
(3) How is universal care going to make non-profit hospitals cheaper?
By regulating fees for services, by lowering the price of drugs via negotiation and bulk purchase agreements, by eliminating marketing budgets, by eliminating insurance billing departments and by capping executive compensation. Hospitals and doctors are public servants elsewhere in the world, not elite rockstars who can bill as they so choose. That doesn't mean they're not well compensated.
Oh, and by socializing malpractice insurance. In the US high-cost states OBGYNs pay $85-200K/yr just in medical malpractice insurance. [1] In Ontario it's around $70K CAD.
(4) How is universal care going to eliminate fee-for-service, which has the administrative costs that are the woes of care providers?
By having a single table of rates that apply to everyone. Ideally with a single payer. This makes billing much, much easier.
(5) How is universal care going to reduce healthcare spending?
Everything I indicated above put together. If you want a concrete example Medicare does most of the above (they can't negotiate drug prices, and they're not single payer, and they haven't socialized malpractice insurance) but they're substantially more efficient. Medicare spends 2-5% of the budget on administrative, where private plans spend 12-18%. That's without recognizing some of the other savings I pointed out. [2]
Further to (2) by affording preventative care to everyone, people in the early stages of serious diseases can obtain preventative care and coverage thereby eliminating expensive treatments later on. In the US if you walk into a hospital near death they're required to look after you -- not so much if you walk in seeking preventative care. Imagine if they spent the $5 early on to treat you instead of the tens of thousands when you're near death? It's yet another reason why universal healthcare is a good, cheaper thing to have.
Since you specifically wanted me to answer about this topic: Preventative care has some nuance. Increased preventative services are not necessarily better, there is an actual ongoing debate about annual physicals in the medical community (http://time.com/5095920/annual-physical-exam/)
From an economic perspective, its not clear pushing for preventative will lower cost or increase quality. (many times it even has negative value, as reassuring a patient of being healthy when they aren't).
Fundamentally, if preventative cares are good people will naturally choose to invest in their own health. There is research showing that people are pretty good about healthcare utilization if they bear the cost (except poor peoeple)
You're absolutely right about that. Also with regards to increased frequency of tests; finding the inflection point between where the risk and adverse effects of false-positive tests out-weight the benefits of early detection. Point taken.
> I don't know enough about the reason for the shortage of doctors but I'd go out on a limb and say its probably not because they don't get paid enough.
So not cheaper.
> It won't, and it shouldn't. Patents for pharma don't preclude successful implementations of universal healthcare anywhere else.
So not cheaper.
> By regulating fees for services, by lowering the price of drugs via negotiation and bulk purchase agreements, by eliminating marketing budgets, by eliminating insurance billing departments and by capping executive compensation. Hospitals and doctors are public servants elsewhere in the world, not elite rockstars who can bill as they so choose. That doesn't mean they're not well compensated.
Rationing. (It makes it cheaper, but also reduces the amount of care given out). Shutting down hospitals is probably not the way to go on the space, but its one way to reduce spending.
> By having a single table of rates that apply to everyone. Ideally with a single payer. This makes billing much, much easier.
Also rationing. If you have a single table of rates, you can get 3 results: you pay less than today, and thus you will have rationing of services (for example, less convenient locations, less services, etc), you pay the same (so no gain) or you pay more (more spending). Billing is a big pain, but billing medicare is the biggest pain of all. Medicare pays less and has more admin costs for providers, which is a big part of why its not covered.
Its virtually impossible in the US to force doctors into single rates, so what you would get is that insurance has very low coverage, and cash-pay will dominate healthcare services.
> Everything I indicated above put together. If you want a concrete example Medicare does most of the above (they can't negotiate drug prices, and they're not single payer, and they haven't socialized malpractice insurance) but they're substantially more efficient. Medicare spends 2-5% of the budget on administrative, where private plans spend 12-18%. That's without recognizing some of the other savings I pointed out. [2]
Medicare uses these statistics with great trickery. First of all, medicare does not do collections administration: its hidden in other government agencies that collect the payroll tax. Second of all, these statistics have some other biases like using total cost of spending but not per patient, where medicare is actually not that much ahead. And finally but not least, what people will always love about medicare is that its dirt cheap to the patient: the average social security benefit is 1400~, and the standard premium of medicare is 135. But turns out that medicare costs about 11k a year per patient: if you took away 1000 out of those 400, you would not find great support for medicare from retired people!
Finally but not least, medicare services have severe rationining elements, and potentially cost shifting: doctors make 1/2 with medicare than without. This means that: doctors that offer medicare are the ones starving for patients, and doctors that take a bit of medicare are actually putting some of the cost unto regular insurances.
You can forcefully restate your opinions all day long, but facts are facts. The first world countries that offer socialized medicine do strictly better than the US on basically every metric. Pick one. Access to treatment? Better. Infant mortality? Better. Mothers mortality? Better. Life expectancy? Better (the US used to be 1 year above average, it's now 2 years below, and falling). Bankruptcies due to medical bills? Better. They’re also cheaper. Your opinions do not line up with reality.
America’s at the bottom of the OECD for many of these things, and at the top by a country mile for cost. [1]
There's no medicare statistics trickery lol, all those government services being leveraged have to do almost nothing incrementally to support medical fees. They're still collecting payroll taxes, they're still collecting income taxes, one way or the other. By your own measure this makes the work they do duplicative of the insurance industry making the insurance industry the wasteful one. This is also failing to take into account the waste of employers managing employee healthcare -- why on earth are they doing that?
OF COURSE medicare is expensive we already addressed that in another thread. The US doesn't have free market healthcare. The young, healthy and cheap are forced into expensive market plans, privatizing the gains, while the old, sick and poor are handed off to the government to look after, socializing the losses. It's absurd. The young, healthy and wealthy should be paying for the old, sick and poor. You can’t saddle the socialized program with all the worst customers, hamstring it’s ability to negotiate drug prices then point to how much it costs.
Doctors in Canada make hundreds of thousands of dollars per year providing socialized cover. They're civil servants. They do fine. So what if it's less than doctors are paid now, the question is are they compensated fairly, and they are.
Last I couldn’t help but notice you totally sidestepped my point about reduced costs by offering preventative care.
> You can forcefully restate your opinions all day long, but facts are facts. The first world countries that offer socialized medicine do strictly better than the US on basically every metric. Pick one. Access to treatment? Better. Infant mortality? Better. Mothers mortality? Better. Life expectancy? Better (the US used to be 1 year above average, it's now 2 years below, and falling). Bankruptcies due to medical bills? Better. They’re also cheaper. Your opinions do not line up with reality.
Why doesn't medicare, the already socialized medicine of the US, have the same results as socialized medicine in other countries?
> There's no medicare statistics trickery lol, all those government services being leveraged have to do almost nothing incrementally to support medical fees
You could also use payroll taxes to pay private insurance, that's not a benefit of medicare, it's a benefit of the current tax implementation that is granted monopolistically to medicare. I know of at least one country that collects payroll taxes that go to private health companies.
The question is: is medicare administration truly cheaper that private administration for the same service.
> This is also failing to take into account the waste of employers managing employee healthcare -- why on earth are they doing that?
Because the federal government makes it tax exempt to give healthcare through the employer, which is a 260 billion a year regressive tax benefit, denounced and criticized decades ago by prominent economists. You dont need to socialize medicine to stop that, you just need to stop handing out federal money. In fact, the tax-subsidy is higher than the combined profits of all insurance companies together.
> The US doesn't have free market healthcare.
Glad we agree on that one!
> The young, healthy and cheap are forced into expensive market plans, privatizing the gains, while the old, sick and poor are handed off to the government to look after, socializing the losses. It's absurd.
The poor also pay medicare taxes for the rich. The sick that don't make it to retirement ages pay medicare tax their entire life and die before receiving any benefit. Taxes always have this thing that they make things unfair for someone by law.
Adverse selection and information asymmetry are real issues, but socialized medicine brings other issues like reduced coverage, rationing, etc. I am always surprised how the debate over healthcare ends up being arguing about capitalism as a method of efficient economic organization. It works for almost everything else, yet the arguments for socialized medicine are like arguing capitalism doesn't work. Its bonkers, and easy to refute because otherwise you would have to argue the same for food, for education, for transport, for everything, and none of those work better run by the government.
> ...Doctors in Canada make hundreds of thousands of dollars per year
To make doctors in the US root for socialized medicine, the state will have to offer greatly increased income. Thats how it happened historically in europe a century ago. Considering the AMA has killed socialized medicine laws multiple times in history, I would say the "screw the doctors" policy has a high chance of failure.
>>> Why doesn't medicare, the already socialized medicine of the US, have the same results as socialized medicine in other countries?
Again, we addressed this. It's literally all the old, sick and dying in a single pool allowing private insurers to be profitable. It's not comparable. It's like asking why a government-run fire insurance program that takes in only buildings that are already on fire is expensive. They only insure buildings already on fire against fire damage and they're not allowed to negotiate the price of water used to put the fires out. That's not how risk pooling works. It's not insurance, it's just a structured payouts program for the country's worst customers.
>>> You could also use payroll taxes to pay private insurance, that's not a benefit of medicare, it's a benefit of the current tax implementation that is granted monopolistically to medicare. I know of at least one country that collects payroll taxes that go to private health companies. The question is: is medicare administration truly cheaper that private administration for the same service.
Now the government is being leveraged to further enrich private industry instead of the people. The incremental cost is almost nothing. The only distortion of statistics here is that the private insurers don't have to deal with bad customers because they get socialized away (poor to Medicaid, old and sick to Medicare). I'm pretty sure you're thinking of Switzerland, which is the second-most expensive country in the OECD (they still manage to cover everyone, though).
And yes, it's cheaper, every other country shows that. Even the "$32T" cost estimate of medicare for all is actually lower than what's being spent today over the same time period.
>>> Because the federal government makes it tax exempt to give healthcare through the employer, which is a 260 billion a year regressive tax benefit, denounced and criticized decades ago by prominent economists. You dont need to socialize medicine to stop that, you just need to stop handing out federal money. In fact, the tax-subsidy is higher than the combined profits of all insurance companies together.
Yes I agree, it's regressive and should be removed. Socializing cover is good for other reasons as stated above.
>>> Glad we agree on that one!
Definitely :)
>>> The poor also pay medicare taxes for the rich. The sick that don't make it to retirement ages pay medicare tax their entire life and die before receiving any benefit. Taxes always have this thing that they make things unfair for someone by law.
Yep, that's not ideal. It should be charged progressively like it is in other countries.
>>> Adverse selection and information asymmetry are real issues, but socialized medicine brings other issues like reduced coverage, rationing, etc.
It doesn't, though. Rationing is fine. There's either not enough to go around or you make the pool bigger, both are options. It's explicit, it's done fairly and it's done impartially. Rationing by making care too expensive is cold and unfair. I'm also unclear on why you think there's a finite pool of medical care.
Either way your argument holds no water when every other program in the OECD is socialized, cheaper, and performs better on every metric.
>>> To make doctors in the US root for socialized medicine, the state will have to offer greatly increased income. Thats how it happened historically in europe a century ago. Considering the AMA has killed socialized medicine laws multiple times in history, I would say the "screw the doctors" policy has a high chance of failure.
Doctors in Canada hated the idea of socialized medicine in the 1970s too. You won't find a single one speaking out against it today. It was a huge fight. And yet, the entire country loves their system. Everyone in America hates theirs. There's something to this. Take a deep breath, it'll be okay. 60-75% of Americans are now interested in a public plan [2].
Tommy Douglas who championed socialized medicine in Canada was in 2004 named the greatest Canadian haha. [1]
FWIW, a socialized option does not preclude private care. Single payer isn't the only way forward, many European countries offer two-tier care. Australia offers two-tier care. If you're so sure that private care is less expensive, better and more efficient, why not allow it to compete with a government run plan? I speculate that it's because it's just not.
Sorry, man, you're on the wrong side of this one. The evidence shows it.
You are also not eliminated the need to get funds, you are changing who you are asking them from. And let me tell you that government officials are seldom generous.