One of the political buzzwords today is "socialized medicine". It would tend to mean a government run, owned, and controlled system of medicine. People often use the term to mean any number of things, but that's the full definition. For instance, if the government does not own any of the organizations that provide service, but pays for everything, it's 'single payer', and that payer is the government. If it controls AND pays, but does not own, that's the economic "fascist" model, where government allows private ownership, but controls all nearly all aspects of an or all industry.
Examining why some argue for it:
1. Ideological grounds - Anti-profit, anti-corporate, pro-socialized. These ideologues believe that government is morally superior to individual choice and free-will trade and association.
2. The "clueless-ologues". Many have little grasp of how the system works at present, and thus, have no idea what's wrong, or how to fix it, so they just prefer someone to make a one-type-fits-all program and shoehorn them into it. Many see this as a chance to offload their costs to someone else, or at least feel that they'll find financial benefit.
3. Social critics... These people look at other nations and live by the 'grass is greener on the other side' motto. They can't really explain any of this, but they're relatively certain and search for usually trivial arguments for their case. Generally, these people have no analytical skills and so make decisions without evidence.
4. And there's others, with a wide array of motivations. Mostly these are personal in some way and really aren't relevant to the discussion.
A quick rundown of the common arguments...
1. "It's cheaper elsewhere". Well, it may or may not be. Nobody knows, because nobody can do a full cost analysis. This argument will be referenced again.
2. "It works better elsewhere". Well, again, it may or may not be. Nobody really knows, because it's very difficult to quantify the factors that affect longevity and "health". Again, this will be dealt with in more depth.
3. "the immorality of letting people die because of cost of treatment". For some reason, the people who make this complaint completely ignore the fact that all nations with socialized or similar systems ration expensive treatements, and often allow people to die for purely financial reasons. No nation can afford "everything for everybody". Though, in the overall scheme of things, the US comes the closest.
Then, the common arguments against it...
1. Immense cost. Transferring the spending authority for health care from individuals to Congress results in a VERY large increase dollars spent by Congress. Nobody can point out to me ANYTHING that Congress does that is highly efficient. The examples of inefficiency and pointless and rampant waste are everywhere and nearly overwhelming in size, number, and pervansiveness.
2. The removal of market forces from health care. Honestly, there's very little now, and this will be addressed later, again.
3. It's a huge expansion of government at a time when government spending and mandates and sponsored agencies are responsible for a world-wide financial upheaval. Why add more of the cause of our problems financially?
One of the most common cited arguments for the "pro" side is that other nations spend less and have "better" statistics. Sadly, this argument is based upon pure fiction. It has a number of presumptions that are absolutely not true.
1. Health care systems are the determining factor for longevity. Demonstrably false. Numerous studies have determined that within the overall factors for longevity, the system of health care is well down the list. Diet, lifestyle, genetics, pollution, stress, for instance, all rank higher in importance than does who pays for your doctor - or even if you see a doctor at all.
2. Published numbers for health care spending are accurate. Demonstrably false. Not even the governments of the US, Britain, and Canada can accurately predict need, cost, nor account for cost-shifting and beaurocratic obscurity. Thus, all numbers are "estimates".
3. Regardless of the system, people will require, get, or consume the same quantities. Again, this is demonstrably false. Numerous trials in the US alone demonstrate that incentives can greatly affect the quantity of consumption, with no measureable change in overall outcome.
So, if the US spends more per capita and doesn't live as long as average, does it indict the health c are system? Well, no. In fact, statistically, it's near meaningless. Personally, on the other hand, the system is a huge factor. More explanation later.
So, let's look at what people complain about for the US health care system:
1. It's expensive. to which, one HAS to respond: "define expensive". Medicare says that on average, it spends 25,000 the last year of an enrollees life. Medicare is a massive cost-shifting program (government reimburses under cost of service, making everyone else pay more), so it would be more accurate to say that the last year of life costs about 75,000+ for those who have the means to pay. And, for most intents and purposes, it accomplishes minimal at extending life.
2. Too many people "not covered". If you wish to say that too many people don't voluntarily choose to save or budget for medical bills, this is true. Insurance, however, is the source of our problem, not the answer.
What's wrong with socialized medicine?
1. No market forces to control costs.
2. Invasive government tends to be overbearing.
3. Very poor results. More on this later.
What's wrong with insurance?
1. The definition of insurance
1 a: the business of insuring persons or property b: coverage by contract whereby one party undertakes to indemnify or guarantee another against loss by a specified contingency or peril c: the sum for which something is insured
2: a means of guaranteeing protection or safety <the contract is your insurance against price changes>
Insurance should be a risk sharing factor. But most health insurance today is not insurance. Instead, it's a menu of pre-paid or partially paid services combined with a description of what isn't paid for. Most buyers of health insurance are actively shopping for health care services... from an insurance company. That would be like buying your car from Geico, by negotiating with them a monthly premium not just for your liability, but also what kind of car, what options on the car, how it will be serviced and how much gas provided, and then Geico buys the car you drive. That would be stupid. And so is most health care insurance.
Why is it so? It's a result of wage and price controls, and a continued tax policy designed to bind health care to employment. During WWII, the government instituted wage controls. Since nobody could pay more than X, employers started finding things the government could NOT control or limit, to attract and reward employees. Paid vacations, special days off, pre-paid medical, even pre-paid cars and education allowances and many, many other things were offered.
After WWII ended, and the wage controls were at an end, corporate and personal income tax rates were astronomical. However, Congress had enacted a gazillion deductions, including health care costs for employers. So, it was more cost effective for the employer to pay all your medical bills, than to pay you more and let you fend for yourself.
In the ever-present effort for employers and businesses to find the most financially beneficial arrangement, tax laws and policy have very tightly bound health care spending to the employer's bottom line. Until the 80's, the tax rates and deductions were often 60 to 90+ percent of the cost, meaning it was nearly free for employers to provide health care insurance, but not for employees to be paid more and buy their own.
Now, it has become "cultural" in that people expect it. Not that it's even a smart thing, but since it's customary, and still the favored arrangement by the IRS, it has become very widespread. The last couple of Democrat administrations have attemptd to force ALL health care payments to employers. This would even further compound the wrongness.
2. Insurance is a third party to the service AND payment. It merely adds a measure of inefficiency. Doctors and hospitals and so on hire people whose sole job it is to find ways to bill more items for the same services rendered. Often, office procedures are based upon giving you far more procedures than needed, just so they can bill insurance for more services that you did not need. This is the common and normal operating procedure for ALL "third party payers", including government.
3. Insurance companies at as large purchasing blocks, but treat you as individual buyers. Whatever they might save is never passed to you.
4. Health insurance systems come between the consumer and provider, limiting both in what they can and can't do. They often pick your doctor, what services you can get, and at the same time, undercompensate the provider.
What's RIGHT about the US health care system?
1. Incredibly responsive. You can get any needed services almost anywhere pretty much immediately. From life flights to ER care to high technology to even expensive diagnostic tools, it is more available with less wait than anywhere else in the world.
2. Very effective. With state of the art diagnostics, fast response, the world's highest levels of research and trials, and access to almost any drug, procedure, technology, or knowledge to exist concerning health care, the cure or survival rates in the US exceed those of just about everywhere, as it concerns serious medical issues like cancer, heart disease, etc.
3. Ubiquitous. Even if you live in a remote area, long travel to find and use specialists and/or technology is rarely needed.
These three factors, in fact, very much mirror the same qualities found in our food industry. We already have most of the factors and outcomes that are provided by the free market. What we need is the cost discipline, a higher level of consumer involvement, and a more knowledgeable relationship between a person's health, service providers, and the ability to make an interested and informed judgement about costs, effectiveness, and the ability to protect one's self from catastrophic loss at reasonable rates.
Given the above... How do we analyze what should be done?
1. What works? The argument that the UK spends X per capita and we spend Y per capita and that theirs is less doesn't contain enough information. Consider the following:
Overall spending / population = X per year per capita. Let's refine that a bit.
An unknown number of services * the population = overall spending.
Given the above, how do you solve for cost per service? You can't. What matters TO YOU is what it costs to see the doctor when y ou're ill. Not whether or not everyone seeing the doctor all year divided by the population is higher or lower than some other country. After all, what you NEED is to have services available when you need them, and the means of affording it. That's how you decide "What works".
2. How do you maximize financial efficiency? Again, you have to go to "what works". What does work? Here in the US, it's our food industry. Unless you live in the absolute tiniest and most remote parts of the country, you have several places to choose from for your food needs, within each one most products have at least two, and sometimes up to 10 competing brands of the same thing. You don't buy "food insurance" to "protect you" from high priced food, do you?
We have laws to ensure that the label says is what's in there. And the rest, is purely the free market competing for your dollars. There's no huge rant that there's no "food insurance" to feed the poor who can't budget for food, is there?
How are costs "controlled" in a single payer or socialized system? By controlling wages and limiting services. Rationing is your basic answer. How do public systems "economize"? They cut service providing staff and cut services provided. How does a for-profit system "economize"? They cut beaurocracy and overhead, and try to increase the proportion of people who directly provided billable services.
I have a local VA Hospital. This hospital has been through many rounds of "budget cuts", and each time, they don't trim the overhead, they simply stop providing services. When a state government has a budget deficit, what they cut first? Police, fire, ems, education. And only "officers, employess, and teachers". never "administrators, managers, and beaurocrats".
No government owned agency has ever been known to continually seek how to provide the most services for the least cost. Nope, they endlessly work at attempting to justify increased budget allocations, and often deliberately mis-direct resources to justify not cutting or even increasing the budget is necessary just to "maintain" what they're doing.
Please don't try to argue that a GOOD administration will reverse this trend. It's as old as the Pharaohs of Egypt. Records of infighting and struggles to obtain higher allocations of money exist from then till now.
So, what can we do?
1. Introduce the forces of the open market as they apply to informed consumers voluntarily choosing their provider and voluntarily choosing what they will and will not pay for.
I, for one, will not go to a doctor that insists that I have to pay them to weigh me, take my temperature, measure my height, hair, assess my skin and skeleton and otherwise do a whole physical each time I visit, even if it is just one week apart. Well, if I pay the bill, that is. If the insurance pays, I only care about the time lost.
So, place the patient in the direct situation of being a consumer in an informed marketplace. Require medical care to be financially transparent. In other words, to know what something will cost before I choose to do it or have it done.
2. Disconnect health care and employment. There's no more reason your employer should be involved in your health care choices than in your house, car, or food choices. This requires a tax policy change and an overall public focus on individuals, rather than a blanket and ill-defined "covered" status like we do now, equating insurance with "all required and needed services".
3. Disconnect insurance and "service" and "provider" choices. Instead, make insurance a risk sharer, so it doesn't pay the first dollar, and not in the position to pay all of anything until it reaches a level of "very high" to the insured. Also, other than general categories, to not limit your services or choose them for you. The business of insurance requires that risk be assessed and born at a premium that costs more than the overall pool's costs. Insurance needs to work like your car or home or other liability insurance, where risk is shared, and once triggered, is mostly automatic.
4. Deal with low income people in a fashion similar to food stamps or other 'entitlement' type benefits. Not designing the whole system to "fix" them, but design a system to work within what works for the vast majority. - Like we do for food, for instance.
5. Provide tax incentives for people to save for future needs.
Some notes:
Health insurance costs and availablility, even the general quality, have minimal impact on statistical outcomes involving overall longevity, mortality, etc. When it does matter, is when it is YOU that is affected.
If you have cancer growing in you, and the system prohibits you from immediate access, the statistics are irrelevant. Only you and the doctor should be making decisions. However, public paid systems make the individual irrelevant, and turn decisions into arbitrary cost numbers and rationing to make the books balance. This completely contradicts the "morality" argument. No nation has "everything for everyone". It makes financially based decisions about who lives and who dies. Who suffers, and who gets cures. Compare that with what has been described above. Where, if you wish, you can choose to indebt yourself for those extraordinary measures. Not just expect them, or just be the outcome of random policymaking by actuarial tables designed to balance some low level flunky's books over the years.
A high level of complaints about the American health care system are not about the doctor, the hospital, or other provider, it's about tangles with insurance and pre-paid plans, where decisions are turned over voluntarily by the consumer of the service - the patient - to someone whose job it is find a way to tell you "No." and let you die.
The only difference, in that case, is that in the case of our system now, you can go around it. In Canada, for instance, the beaurocrat holds absolute power over life and death for you, and you can't even make the choice to spend your entire savings to save your life or your wife's or child's life unless you leave and come to America.
There's ways to radically improve what we have now, both in financial efficiency and in terms of the patient's direct involvement and decisionmaking. Let's do that. The precedents exist, and are proven winners the world over.
Here we go again. Did you NOT get yelled at by the Mods for this? Why, yes, I believe you did.