Monday, February 16, 2009

Would You Want Government-Provided Health Care During A Recession?

I wouldn't. I wouldn't want my life to hang in one end of the balance, and the state or national budget to hang in the other end.

I don't believe the British and Canadians are stupid people. I don't believe they intentionally created failing medical systems. But they have. Why we think we could do any better than they have is far beyond me. Talk about arrogance! They've had decades to fine-tune their systems, and look what they get for it. Click on the socialism tab below for more. And then think about that kind of system in an economic downturn....


mmazenko said...

Would you be willing to accept a base-level health care system from the government with the right/freedom to purchase any additional coverage and care you want? I'd take that during any economic conditions, and I'd prefer it during a recession.

It works in Switzerland, Norway, Sweden, Taiwan, Germany, etc. I am always dismayed by health-reform critics near-myopic focus on Canada and Britain. Yes, their systems are flawed. No, I don't want to create that? However, I understand that America is not Canada or Britain, and just because they made mistakes doesn't mean we will. That's fallacious logic. Americans do things better - I have at least that much faith in us.

Don't just blame socialist systems in the downturn. Private insurers ration care as much, if not more, than socialized systems. My family just switched its HSA coverage for the fifth time in five years because of rate hikes. And we use almost no health care. Premiums went up dramatically for three people who filed no claims in five years. If you haven't encountered this, you either have tremendous coverage or you've been quite fortunate in your health care claims. I hear a lot of Republicans pushing HSAs as the solution, though strangely none of them actually use/depend on them.

Blend public and private. Provide people basic coverage, and then allow them to purchase any additional coverage/care they desire, and can afford. It's called the FEHBP, and it could be offered to all 300 million Americans. It's also been offered through the Healthy Americans Act, also known as the Wyden-Bennett Plan.

Anonymous said...

What I'd like to know is who gets the waivers on the various rules and limitations? Who are the folks who don't have to wait for specialists and expensive tests and procedures?

While I'll grit my teeth and accept the reality that government officials at the top of the heap enjoy that benefit, I'd like to know just how far, in Canada and England and other countries with socialized medicine systems, the benefit of political rank extends? It's a issue I've not heard discussed at all.

I can understand supporters of socialized medicine being quiet on the subject since one of the implied, if never promised, selling points of socialized medicine is egalitarianism. But why aren't conservatives hollering about the inevitable politicization of medical care that *will* occur under a socialized medicine system?

That has me puzzled.

Darren said...

I don't see a blending of public and private as a good solution. I think you're far more likely to get the worst of both worlds rather than the best, but I admit that's merely a bias I have.

I'd rather see HMO-type health insurance go away. When I was a kid my railroad worker dad (Teamsters) had only catastrophic/emergency room coverage for us. I'd like to see local doctors' offices again, or small clinics in Wal*Mart. It seemed to work in the past....

Anonymous said...

Darren: I think what we have is already a blending of the public and the private. And I also agree that insurance for catastrophic illnesses should be the only way to go - we shouldn't need insurance to cover routine office visits. Yes, an office visit can run a couple hundred bucks, but so do car and home repairs - and those are not covered.

The problem comes with peope with chronic conditions, I think, and how to address that.

Anonymous said...

You sure about Switzerland, Norway, Sweden, Taiwan, Germany, etc. Mike?

If I were to go probing into the coverage/costs/atrocities of their systems with even the modest degree of attention I've focused on Canada and England you think there'd be a markedly different result? I don't. I don't think that there's some way in which you can arrange the deck chairs on the Titanic to prevent it from sinking and I don't think there's any combination or permutation of socialized medicine in which the inevitable, ugly results don't occur.

There will be a gradual increase in the budget allotted to administration just as there has been in the public education system and for the same reason; without the discipline of the market the administrative hierarchy is required to take on the job of supplying organizational discipline. Since supplying discipline is a tough job they'll, in general, do a lousy job, just as has occurred in the public education system until finally the slovenliness of the organization rises to the level of public notice.

Of course by then things have gotten pretty awful.

While you are correct that private insurers put limits on the care they'll pay for those limitations don't exist because of the lesser limitations enjoyed by someone else. As I've written before, in a private system I don't get lousier care *because* Bill Gates gets better care but in a socialized system I sure as heck do get lousier care because the president, and every other person with political influence, gets better care.

Anonymous said...

Because obviously, the best idea is a system where your ability to pay determines your health.

Anonymous said...

The Consumer Product Safety Improvement Act of 2008 is the best, recent example of government overreach. Now do you really, really want the government to have its paws on your insurance?
The gov. plans overseas have on thing in common. They place limits on the cost of medical care. Yes you can purchase additional care plans, and then we are back where are now. I can hear stories about the "under-insured" because not everyone will be able to afford these above the basic plans.
And, if we do adopt a plan of this type, then that means our medical care, including drugs and equipment will come under government cost regs.
Then who will supplement all those expensive foreign plans we read about. Who do you think is propping up these insurance plans in Germany and other places?

mmazenko said...


Are you sure about the difference between you and Bill Gates? I know he gets different care than those with less money. The emergence of "boutique doctors" who offer premium care, at nearly unreachable fees for the average American, and no waiting in lines for anything is a prime example. The other is workplace plans differing on wealth of company.

I have several friends who work for Microsoft. They have no premiums, no co-pays, and can get any test from any specialist at any time for nothing out of pocket. They have their own doctors. They also make multiple six-figures.

I, on the other hand, am insured by Kaiser through my school district. Thus, I had to give up my personal doctor and use theirs, use their labs, and can only get treatments they (not my private doctor) approve. I had an asthma specialist and a dermatologist, but now their GP says, "Oh, I can handle all that." I'm also stuck with them, as pre-existing conditions prevent me from seeking care on the open market for anything less than astronomical premiums.

Their family plan was so expensive - $1700 out of pocket each month - that I have switched my family to a catastrophic HSA, though I don't have any extra funds for the actual account. Thus, I have moderate premiums with exhorbitant deductibles. Luckily, my family is rather healthy.

Thus, there is a huge difference between the pay "afforded" Bill Gates and the common man. Clearly, your hypothetical examples don't pan out with my (nor 100 million Americans') reality. Sadly, that is the case with ideology - especially libertarian ideals.

Oh, and I am sure about Taiwan, having lived there for five years, and Switzerland with close family friends and family who visits regularly. The others follow the same model with statistically the same results.

Anonymous said...

Yes, I am sure about the difference between Bill Gates, myself and President Obama.

Bill Gates doesn't get better medical care then I because I get less expensive medical care then Bill Gates but President Obama most assuredly does get better medical care then I because I get less expensive medical care he does. How could it be any other way?

Tax-supported institutions exist on the basis of the zero-sum game of taxation. I'm a dollar poorer because a farmer or business man or welfare recipient somewhere is a dollar richer. I get slightly less expensive medical care to pay for the more expensive medical care afforded those who make our laws.

The worst thing about the unequal access to medical care inherent in socialized medicine is that, within limits, it's defensible.

After all, shouldn't we the people be assured that our elected representatives will be able to perfrom their duties because they have access to the best of medical care? And isn't it equally clear that those closest to them such as their spouse/children should have similar access to cost-is-no-object medical care and for the same reason? And their siblings and parents and security detail and office staff as well? And those who've made large contributions to their re-election campaign fund?

Donalblain wrote:

> Because obviously, the best idea is a system where your ability to pay determines your health.

Obviously. Perhaps you could explain why political influence is a better means of determining access to health care? That would be a more useful exercise then sarcasm.

mmazenko said...

Actually, you may be a dollar poorer because you have concrete roads to drive on, water that's not filled with malaria, an electrical grid that was effectively managed across public/private property, a policeman/paramedic/fireman to answer your call in any emergency, and a military beyond any other country's dreams to protect your interests tirelessly.

Darren said...

But he's *not* a dollar poorer because Gates can afford better health care. You're changing the metric here.

mmazenko said...

Actually, I think he changed it by switching focus to the farmer, businessman or welfare recipient being "a dollar richer." That wasn't about health care - it was complaining that all the government does is redistribute wealth, which is false. I'm not a dollar poorer from taxes - I give my dollar in expectation that the government uses it to pay for what I described - although they sometimes give it to Chrysler and GM - Aagh!

However, I do like my roads, my police, my electric grid, my clean air/water, and my military. So, I'll pay the dollar, and if the government redirects it where I don't want, I'll vote and get involved in the government myself, as I did with a recent run for city council. (lost by the way - but pushed an agenda in the news and debates that was picked up and supported by the winning candidates - so I won in a way).

Anonymous said...

Mike's not so much moving the goalposts as he's widening them, i.e. if you're against tax-paid medical care then to be consistent you must be against tax-paid road construction, tax-paid malaria suppression, tax-paid electric grid, tax-paid police/fire/paramedics and a tax-paid military as well. If you're opposed to all that stuff then you must be nuts and I don't have to deal with you or your arguments.

The fly in that ointment Mike is that since you're not determining what consists of consistency I can sigh heavily and accept that there's probably no good way around a tax-paid military....

Everything else though - police, fire, paramedics, road construction and electrical grids, not to mention mass transit - have all been managed successfully via private enterprise and in a number of cases, substantially more successfully via private enterprise then via government.

But that's getting us away from the central point I was making, a point that's truer and more dangerous in the case of medical care then in any of the other facets of society in which government has elbowed aside private players. That point is that the largely unspoken assumption of socialized medicine is the assumption of egalitarianism - that Bill Gates *won't* get better medical care then I.

It's a false assumption and so obviously false that proponents of socialized medicine reflexively shy away from the entire line of discussion. They don't want to even attack the idea because making the inherently undemocratic nature of socialized medicine a subject of discussion means coming up with reasons why government officials won't be tempted, and won't give in to the temptation, to see to their medical needs and the medical needs of those closest to them before they see to the needs of the public.

It's a fool's errand.

Who'd believe that a government official would courageously and selflessly abide by government guidelines that deny a loved one medical care when, by bending a rule or calling in a favor, they can access that medical care? No one except ideologues and those ideologues know they'd have a hopelessly tough time convincing anyone else. So better to not even discuss the issue, to change the subject and hope it never becomes necessary to discuss it.