Which Health Care System do you prefer?

[Kazarogkai]

I must ask what type of system do you personally prefer? You already know what I would personally rather have.

Also why would a National health insurance model be so difficult to implement in the USA, wouldn't it just be effectively medicare for all?

The short term shocks to the economy as all those half a million workers employed in the healthcare insurance industry would likely be unemployed is the biggest hindrance in this case. It is not impossible to implement, just that the Bismarck Model is even easier to adopt (although serious reforms on price regulations and making the insurance industry non-profit are needed, as well as adding an additional safety net for the poor). On the other hand, the Beveridge Model would be very hard for the US to implement since it would require the nationalization of all hospitals and the like.

As for me, I'm torn between the Bismarck Model and the NHI system. I would say the Bismarck Model has the best record so far; you have countries like France, the Netherlands, Switzerland, Japan, Singapore etc. on that system, and these are all countries known for splendid healthcare. On the other hand, I do find the Bismarck Model to be a bit bureaucratic and overly complex and the idea of a simple single payer system is attractive for that reason. Because I don't want hospitals and healthcare services to be government-run, the Beveridge Model is out of the question.

The main caveat I have with single-payer systems, both the Beveridge Model and the NHI one, is that many of the countries under those system (think the UK and Canada) seem to have inferior healthcare to the countries under the Bismarck Model. Satisfaction among patients is also lower.

So as of yet I'm still undecided, which is partly why I started this thread to begin with. All I can say is not the Beveridge Model.

This is true for it would technically involve nationalizing the health insurance companies . I would propose the implementation of a negative income tax and the government compensating said now unemployed health insurance workers to help them get on their feet.

How do you feel about my system? National Health Insurance for the most part but with local state(government) run clinics providing primary care. I think something like this could theoretically be implemented in certain states like say California or in the New England area.

[ErVaReAn rEpUbLiC]

Ironically it's also one of the highest in public spending. Things are really messy over there.

The problem is not a lack of money. The problem is we do not spend it well. There are literally so many government agencies in the federal government that the federal government does not know how many there are. The federal government desperately needs to be reformed and streamlined.

The problem is we have many redundant agencies doing the same things, that fight each other for funds.

Yes, I'm aware of that. This is hardly isolated to healthcare. The US government spends as much or more on welfare as a share of GDP than Canada, Australia, and Switzerland, with significantly worse outcomes. Public spending on education is also higher than many developed countries.

I've never said the problem was a lack of money.

[ErVaReAn rEpUbLiC]

The short term shocks to the economy as all those half a million workers employed in the healthcare insurance industry would likely be unemployed is the biggest hindrance in this case. It is not impossible to implement, just that the Bismarck Model is even easier to adopt (although serious reforms on price regulations and making the insurance industry non-profit are needed, as well as adding an additional safety net for the poor). On the other hand, the Beveridge Model would be very hard for the US to implement since it would require the nationalization of all hospitals and the like.

As for me, I'm torn between the Bismarck Model and the NHI system. I would say the Bismarck Model has the best record so far; you have countries like France, the Netherlands, Switzerland, Japan, Singapore etc. on that system, and these are all countries known for splendid healthcare. On the other hand, I do find the Bismarck Model to be a bit bureaucratic and overly complex and the idea of a simple single payer system is attractive for that reason. Because I don't want hospitals and healthcare services to be government-run, the Beveridge Model is out of the question.

The main caveat I have with single-payer systems, both the Beveridge Model and the NHI one, is that many of the countries under those system (think the UK and Canada) seem to have inferior healthcare to the countries under the Bismarck Model. Satisfaction among patients is also lower.

So as of yet I'm still undecided, which is partly why I started this thread to begin with. All I can say is not the Beveridge Model.

This is true for it would technically involve nationalizing the health insurance companies . I would propose the implementation of a negative income tax and the government compensating said now unemployed health insurance workers to help them get on their feet.

How do you feel about my system? National Health Insurance for the most part but with local state(government) run clinics providing primary care. I think something like this could theoretically be implemented in certain states like say California or in the New England area.

I must ask, why government run clinics? In what way are they preferable to privately run and publicly funded clinics?

Also, I'd like to hear more details about the negative income tax. Specifically what is the threshold (i.e. when do you stop receiving tax subsidies) and what is the subsidy rate?

[Novus America]

The short term shocks to the economy as all those half a million workers employed in the healthcare insurance industry would likely be unemployed is the biggest hindrance in this case. It is not impossible to implement, just that the Bismarck Model is even easier to adopt (although serious reforms on price regulations and making the insurance industry non-profit are needed, as well as adding an additional safety net for the poor). On the other hand, the Beveridge Model would be very hard for the US to implement since it would require the nationalization of all hospitals and the like.

As for me, I'm torn between the Bismarck Model and the NHI system. I would say the Bismarck Model has the best record so far; you have countries like France, the Netherlands, Switzerland, Japan, Singapore etc. on that system, and these are all countries known for splendid healthcare. On the other hand, I do find the Bismarck Model to be a bit bureaucratic and overly complex and the idea of a simple single payer system is attractive for that reason. Because I don't want hospitals and healthcare services to be government-run, the Beveridge Model is out of the question.

The main caveat I have with single-payer systems, both the Beveridge Model and the NHI one, is that many of the countries under those system (think the UK and Canada) seem to have inferior healthcare to the countries under the Bismarck Model. Satisfaction among patients is also lower.

So as of yet I'm still undecided, which is partly why I started this thread to begin with. All I can say is not the Beveridge Model.

This is true for it would technically involve nationalizing the health insurance companies . I would propose the implementation of a negative income tax and the government compensating said now unemployed health insurance workers to help them get on their feet.

How do you feel about my system? National Health Insurance for the most part but with local state(government) run clinics providing primary care. I think something like this could theoretically be implemented in certain states like say California or in the New England area.

The Bismark model seems to get better outcomes.

And even California has no interest in running a single state wide system of hospitals. Massachusetts prefers Birsmark, Vermont NHI. The states do not want to manage primary care.

It is better to let the states implement the entire system, and choose their own model. The best model for Vermont is not necessarily the best to Texas.

So just have the government provide funding and set some oversight to prevent abuses, but give the states freedom to do as the please. But no state has seriously ever proposed a Beveridge model.

Remember no state even has a single police force, healthcare, fire department or library. All public services in the US are highly decentralized and partially privatized even at the state level.

[Novus America]

This is true for it would technically involve nationalizing the health insurance companies . I would propose the implementation of a negative income tax and the government compensating said now unemployed health insurance workers to help them get on their feet.

How do you feel about my system? National Health Insurance for the most part but with local state(government) run clinics providing primary care. I think something like this could theoretically be implemented in certain states like say California or in the New England area.

I must ask, why government run clinics? In what way are they preferable to privately run and publicly funded clinics?

Also, I'd like to hear more details about the negative income tax. Specifically what is the threshold (i.e. when do you stop receiving tax subsidies) and what is the subsidy rate?

As far as a negative income tax you could go with a Fair Tax. But the federal government is incompetent in the US too large and diverse for a single national system.

Federal funding and state implementation (with states being able to us Bismark, NHI and even Beveridge ) are the only workable system for the US.

[ErVaReAn rEpUbLiC]

I must ask, why government run clinics? In what way are they preferable to privately run and publicly funded clinics?

Also, I'd like to hear more details about the negative income tax. Specifically what is the threshold (i.e. when do you stop receiving tax subsidies) and what is the subsidy rate?

As far as a negative income tax you could go with a Fair Tax. But the federal government is incompetent in the US too large and diverse for a single national system.

Federal funding and state implementation (with states being able to us Bismark, NHI and even Beveridge ) are the only workable system for the US.

Having each state implement its own model should in theory incur larger administrative costs than a centralized system...

[Kazarogkai]

This is true for it would technically involve nationalizing the health insurance companies . I would propose the implementation of a negative income tax and the government compensating said now unemployed health insurance workers to help them get on their feet.

How do you feel about my system? National Health Insurance for the most part but with local state(government) run clinics providing primary care. I think something like this could theoretically be implemented in certain states like say California or in the New England area.

I must ask, why government run clinics? In what way are they preferable to privately run and publicly funded clinics?

Also, I'd like to hear more details about the negative income tax. Specifically what is the threshold (i.e. when do you stop receiving tax subsidies) and what is the subsidy rate?

That is more or less an inspiration from the barefoot doctors of china more or less, I was thinking it would be a little cheaper having a couple clinics here and there and would guarantee especially in poor rural areas that people have access to atleast basic healthcare services. Typically clinics are not set up in remote places like that requiring the residents to have to travel large distances for even basic services like vaccinations, pregnancies, prescriptions, etc.

I haven't really worked out the details exactly but I was thinking something like $6,000-$12,000 give or take with with a subsidy rate of 100% so that all citizens will be guaranteed that basic amount. For those who make above the threshold It will effectively be a tax write off with only the money made above that being taxed. freeloaders will be an issue but I am willing to accept that.

Sorry for veering your thread into a discussion about taxes. Maybe we should take this to the telegrams if you prefer?

[Novus America]

As far as a negative income tax you could go with a Fair Tax. But the federal government is incompetent in the US too large and diverse for a single national system.

Federal funding and state implementation (with states being able to us Bismark, NHI and even Beveridge ) are the only workable system for the US.

Having each state implement its own model should in theory incur larger administrative costs than a centralized system...

Yes. In theory. In practice however state implementation does better. The highways are even state managed.

Besides lowest administrative costs is not the be all and end all. I would rather have a slightly more costly system that works than a cheaper one that is horrible.

The VA is all federal. And it is not good. Nor cheap. Administrative costs are tight despite it being one system. Bigger systems do not always have lower administrative costs, the reverse is often true with governments and corporations.

Haveing only one clothing size and type would be cheaper, but nobody would want that.

Decentralization is different than redundancy. Redundancy is what drives up administrative costs. The government of two different cities are not redundant, as they cover different areas. Their duties do not overlap. Having two governments fighting for control of one city is obviously a horrible idea however.

[Kazarogkai]

This is true for it would technically involve nationalizing the health insurance companies . I would propose the implementation of a negative income tax and the government compensating said now unemployed health insurance workers to help them get on their feet.

How do you feel about my system? National Health Insurance for the most part but with local state(government) run clinics providing primary care. I think something like this could theoretically be implemented in certain states like say California or in the New England area.

The Bismark model seems to get better outcomes.

And even California has no interest in running a single state wide system of hospitals. Massachusetts prefers Birsmark, Vermont NHI. The states do not want to manage primary care.

It is better to let the states implement the entire system, and choose their own model. The best model for Vermont is not necessarily the best to Texas.

So just have the government provide funding and set some oversight to prevent abuses, but give the states freedom to do as the please. But no state has seriously ever proposed a Beveridge model.

Remember no state even has a single police force, healthcare, fire department or library. All public services in the US are highly decentralized and partially privatized even at the state level.

I have strong dislike of Americas intense amount of federalism, I believe in a strong centralized government to run the affairs of the nation. Mind you I do still believe Local governments have their place like trash collection and as electoral districts, but still never the less.

[Kazarogkai]

Having each state implement its own model should in theory incur larger administrative costs than a centralized system...

Yes. In theory. In practice however state implementation does better. The highways are even state managed.

Besides lowest administrative costs is not the be all and end all. I would rather have a slightly more costly system that works than a cheaper one that is horrible.

Haveing only one clothing size and type would be cheaper, but nobody would want that.

Not a great argument considering the cruddy state of said system. National Insurance pretty much can work for everyone for the federal government has the funding and means to do it without too much issue. There is a reason why we have only a single military rather 50 of them.

[Novus America]

The Bismark model seems to get better outcomes.

And even California has no interest in running a single state wide system of hospitals. Massachusetts prefers Birsmark, Vermont NHI. The states do not want to manage primary care.

It is better to let the states implement the entire system, and choose their own model. The best model for Vermont is not necessarily the best to Texas.

So just have the government provide funding and set some oversight to prevent abuses, but give the states freedom to do as the please. But no state has seriously ever proposed a Beveridge model.

Remember no state even has a single police force, healthcare, fire department or library. All public services in the US are highly decentralized and partially privatized even at the state level.

I have strong dislike of Americas intense amount of federalism, I believe in a strong centralized government to run the affairs of the nation. Mind you I do still believe Local governments have their place like trash collection and as electoral districts, but still never the less.

Strong centralized government is hard to implement on any large scale. Look at China. In theory they have one centralized government but in practice the provinces have vast independent power.

And the US is too big and diverse. People will not agree on how the system should be run and will fight over it and run it into the ground. (See pretty much everything solely federal).

One giant ship is not better than a fleet of many ships.

And the US is federal, we always have been and always will be. You have to make government meet the nature of the people. You cannot force the people's nature to change to meet the needs of the government.

[Novus America]

Yes. In theory. In practice however state implementation does better. The highways are even state managed.

Besides lowest administrative costs is not the be all and end all. I would rather have a slightly more costly system that works than a cheaper one that is horrible.

Haveing only one clothing size and type would be cheaper, but nobody would want that.

Not a great argument considering the cruddy state of said system. National Insurance pretty much can work for everyone for the federal government has the funding and means to do it without too much issue. There is a reason why we have only a single military rather 50 of them.

There had not been enough invested in the highways but they are still pretty good in most cases. And do you really think the Feds can do it better? What have they ever done well? The VA? the DEA?

300 million people will not agree. Decentralization is absolutely necessary when a country gets large enough. Again China tried to centralize but it is de facto very federal.

Actually we have 51+ militaries (National Guard) And the military is highly decentralized and in the case of the guard, state administered.

[Kazarogkai]

I have strong dislike of Americas intense amount of federalism, I believe in a strong centralized government to run the affairs of the nation. Mind you I do still believe Local governments have their place like trash collection and as electoral districts, but still never the less.

Strong centralized government is hard to implement on any large scale. Look at China. In theory they have one centralized government but in practice the provinces have vast independent power.

And the US is too big and diverse. People will not agree on how the system should be run and will fight over it and run it into the ground. (See pretty much everything solely federal).

One giant ship is not better than a fleet of many ships.

And the US is federal, we always have been and always will be. You have to make government meet the nature of the people. You cannot force the people's nature to change to meet the needs of the government.

Sad but mostly true, maybe if we kick out the south and all parts not within the continental USA(Puerto Rico, Alaska)...

I am with the ancients on this one, a city state is the greatest of them all.

[ErVaReAn rEpUbLiC]

I must ask, why government run clinics? In what way are they preferable to privately run and publicly funded clinics?

Also, I'd like to hear more details about the negative income tax. Specifically what is the threshold (i.e. when do you stop receiving tax subsidies) and what is the subsidy rate?

That is more or less an inspiration from the barefoot doctors of china more or less, I was thinking it would be a little cheaper having a couple clinics here and there and would guarantee especially in poor rural areas that people have access to atleast basic healthcare services. Typically clinics are not set up in remote places like that requiring the residents to have to travel large distances for even basic services like vaccinations, pregnancies, prescriptions, etc.

I haven't really worked out the details exactly but I was thinking something like $6,000-$12,000 give or take with with a subsidy rate of 100% so that all citizens will be guaranteed that basic amount. For those who make above the threshold It will effectively be a tax write off with only the money made above that being taxed. freeloaders will be an issue but I am willing to accept that.

Sorry for veering your thread into a discussion about taxes. Maybe we should take this to the telegrams if you prefer?

You have a good point about the rural situation. If the situation is very bad with access to healthcare in certain rural areas I'm open to the idea of Beveridge-style clinics, though I'd prefer to avoid it. Though I think there should generally be enough demand for healthcare even in rural areas that privately run clinics should find it profitable to run those.

As for taxes it's ok, I don't really consider it off-topic since welfare policies is a related topic to healthcare. I do wonder though, if the subsidy rate is 100%, isn't it a universal basic income system rather than a negative income tax? I think the subsidy rate has to be below 100% for it to be a negative income tax.

[Novus America]

Strong centralized government is hard to implement on any large scale. Look at China. In theory they have one centralized government but in practice the provinces have vast independent power.

And the US is too big and diverse. People will not agree on how the system should be run and will fight over it and run it into the ground. (See pretty much everything solely federal).

One giant ship is not better than a fleet of many ships.

And the US is federal, we always have been and always will be. You have to make government meet the nature of the people. You cannot force the people's nature to change to meet the needs of the government.

Sad but mostly true, maybe if we kick out the south and all parts not within the continental USA(Puerto Rico, Alaska)...

I am with th ancients on this one, a city state is the greatest of them all.

The drug war and DEA is another example where centralism fails. Our centralized drug policy has failed miserably.

The city state becomes prey to others. So city states ally. Become federations. Hence why federalism. It allows the local government of city states with the security of numbers.

So instead of making the US smaller why not improve the federal system? I like federal systems but the US system does need serious reform as their is too much overlap. States doing federal things and Feds doing state things. We need a clearer seperation of powers.

So in a health care system federal duties would have to be limited and clearly dilineated to prevent overlap and redundancy.

Again decentralization is not redundant. San Francisco's goverment is not redundant with San Diego's. Their duties do not overlap. Having two seperate governments ruling over the entirety of one city is redundant. And would be horrible. Unfortunately this what we have at the federal level, seperate departments and agencies doing the same thing in the same area.

In a sucessful federal systems duties need to be clearly dilineated to prevent redundancy. And the federal and local governments need to work together, not against each other. Unfortunately in the US we need a lot of work to solve these issues.

[ErVaReAn rEpUbLiC]

Having each state implement its own model should in theory incur larger administrative costs than a centralized system...

Yes. In theory. In practice however state implementation does better. The highways are even state managed.

Besides lowest administrative costs is not the be all and end all. I would rather have a slightly more costly system that works than a cheaper one that is horrible.

The VA is all federal. And it is not good. Nor cheap. Administrative costs are tight despite it being one system. Bigger systems do not always have lower administrative costs, the reverse is often true with governments and corporations.

Haveing only one clothing size and type would be cheaper, but nobody would want that.

Decentralization is different than redundancy. Redundancy is what drives up administrative costs. The government of two different cities are not redundant, as they cover different areas. Their duties do not overlap. Having two governments fighting for control of one city is obviously a horrible idea however.

The thing is that the Bismarck Model is very decentralized in itself, with all the hundreds of sickness funds. Japan even has community funds. And hospitals and other services are still privately run and not centralized by the federal government, to avoid VA-style failures. I am open to states implementing their own healthcare systems though. I just question whether it's generally worthwhile in this case.

[Prussia-Steinbach]

The Out-of-Pocket Model. It'll prevent lazy moochers from getting healthcare that they don't deserve while keeping waiting lists short for people like me.

Clearly the capitalist parasite who gained his by trading stocks is more entitled than the man who works long hours in a warehouse performing back breaking labor to support his family and can't afford healthcare since he is paid jack shit. I like how presumptuous you are an consider yourself part of the non-moocher club.

Ever heard of Stephen Colbert?

Hint: He's a satirist.

[Novus America]

That is more or less an inspiration from the barefoot doctors of china more or less, I was thinking it would be a little cheaper having a couple clinics here and there and would guarantee especially in poor rural areas that people have access to atleast basic healthcare services. Typically clinics are not set up in remote places like that requiring the residents to have to travel large distances for even basic services like vaccinations, pregnancies, prescriptions, etc.

I haven't really worked out the details exactly but I was thinking something like $6,000-$12,000 give or take with with a subsidy rate of 100% so that all citizens will be guaranteed that basic amount. For those who make above the threshold It will effectively be a tax write off with only the money made above that being taxed. freeloaders will be an issue but I am willing to accept that.

Sorry for veering your thread into a discussion about taxes. Maybe we should take this to the telegrams if you prefer?

You have a good point about the rural situation. If the situation is very bad with access to healthcare in certain rural areas I'm open to the idea of Beveridge-style clinics, though I'd prefer to avoid it. Though I think there should generally be enough demand for healthcare even in rural areas that privately run clinics should find it profitable to run those.

As for taxes it's ok, I don't really consider it off-topic since welfare policies is a related topic to healthcare. I do wonder though, if the subsidy rate is 100%, isn't it a universal basic income system rather than a negative income tax? I think the subsidy rate has to be below 100% for it to be a negative income tax.

https://www.flfairtax.org/Documents/Whi ... y-2014.pdf

Have you seen this proposal?

Also I agree on some rural clinics, but like you say if everybody has insurance they will be created. But this is also best dealt with locally. Alaska is totally different than Connecticut in this regard.

[Novus America]

Yes. In theory. In practice however state implementation does better. The highways are even state managed.

Besides lowest administrative costs is not the be all and end all. I would rather have a slightly more costly system that works than a cheaper one that is horrible.

The VA is all federal. And it is not good. Nor cheap. Administrative costs are tight despite it being one system. Bigger systems do not always have lower administrative costs, the reverse is often true with governments and corporations.

Haveing only one clothing size and type would be cheaper, but nobody would want that.

Decentralization is different than redundancy. Redundancy is what drives up administrative costs. The government of two different cities are not redundant, as they cover different areas. Their duties do not overlap. Having two governments fighting for control of one city is obviously a horrible idea however.

The thing is that the Bismarck Model is very decentralized in itself, with all the hundreds of sickness funds. Japan even has community funds. And hospitals and other services are still privately run and not centralized by the federal government, to avoid VA-style failures. I am open to states implementing their own healthcare systems though. I just question whether it's generally worthwhile in this case.

Well as you point out Japan has local implementation. But I would rather have state implementation so Vermont and Colorado can have a NHI if they want. One federal system prevents that.

The US is just so big and diverse. Plus 50+ systems is actually fewer than many countries.

[The Serbian Empire]

I well and truly prefer the NHI model.

We have the Beveridge model here in New Zealand and, frankly, it doesn't work - the hospitals are underfunded, waiting lists can literally last for years, nurses aren't paid what they deserve to be paid (and so frequently have to go on strike) - and this is true of other health systems such as the NHS in Britain.

The Bismarck Model seemed attractive at first, but there's that old saying about too many cooks spoiling the broth that comes to mind. Plus I'm inherently opposed to payroll taxes and other hidden costs on employers.

The NHI model therefore seems to combine the need for universal access to healthcare, with the fact that private healthcare providers have been shown to have faster response times and better quality healthcare outcomes than government funded services.

The health system still performs well when compared internationally, and is very cheap.

However, National has cut over $1 billion in real funding from health care funding over their time in Government. The issues with the health system are not due to its model, but because its budget has not been properly funded.

The best way to improve the health system is to elect a Labour government.

But Labour is little more than Tories attempting to be more tolerant to immigrants.

[ErVaReAn rEpUbLiC]

https://www.flfairtax.org/Documents/Whi ... y-2014.pdf

Have you seen this proposal?

No, I haven't. The prebate, I assume you receive even if you earned zero income and paid zero in taxes? And everyone receives the same amount regardless of their income (or lack thereof)? In that case it's basically a universal basic income system, albeit a very limited one.

[The Serbian Empire]

The problem is not a lack of money. The problem is we do not spend it well. There are literally so many government agencies in the federal government that the federal government does not know how many there are. The federal government desperately needs to be reformed and streamlined.

The problem is we have many redundant agencies doing the same things, that fight each other for funds.

Yes, I'm aware of that. This is hardly isolated to healthcare. The US government spends as much or more on welfare as a share of GDP than Canada, Australia, and Switzerland, with significantly worse outcomes. Public spending on education is also higher than many developed countries.

I've never said the problem was a lack of money.

The problem is people who don't trust science. The South has long had a problem with distrusting science.

[Novus America]

https://www.flfairtax.org/Documents/Whi ... y-2014.pdf

Have you seen this proposal?

No, I haven't. The prebate, I assume you receive even if you earned zero income and paid zero in taxes? And everyone receives the same amount regardless of their income (or lack thereof)? In that case it's basically a universal basic income system, albeit a very limited one.

Yes you would receive it regardless. So it is almost like a basic income but limited to prevent people from eschewing work. Because everyone who buys any item pays tax on that item.

Now personally I would not adopt the Fair Tax exactly. I would keep and estate tax and personal income tax on very high earners as they buy less in proportion to their income. Say 23% on income over one million with capital gains and inheritance counted as income. (23% being the consumption tax). The prebate makes it progressive, as they are still getting taxed on their spending but not benefiting much from the prebate.

But my proposal would further reduce the tax burden on the middle class.

More directly on topic, how would you fund a health care system? Sales tax, income tax, corporate tax etc?

[Conscentia]

Why doesn't the poll allow changing your vote? What if you change your mind? Or made a mistake?
Why doesn't it have an "Other (Please Explain By Post)" type option?

[ErVaReAn rEpUbLiC]

Why doesn't the poll allow changing your vote? What if you change your mind? Or made a mistake?
Why doesn't it have an "Other (Please Explain By Post)" type option?

This is my first poll thread... but oh well.