Brad Wardell's views about technology, politics, religion, world affairs, and all sorts of politically incorrect topics.
The problem with universal healthcare
Published on September 23, 2004 By Draginol In Politics

The universal health care issue is such an emotionally charged issue that it's difficult to have a rational discussion about it. The problem with universal health care isn't specific to health care but rather to any solution that involves 100% coverage.

So to try to move the discussion away from a hot topic like health care, let's instead look at it in a way that more people will understand without emotion kicking in.

After being elected emperor, I decide everyone should have a television.  Because I have only so much to pay for these televisions, everyone receives a 35 inch TV.  After all, we couldn't afford to give everyone 60 inch plasma TVs and 35 inch TVs are pretty good.

So now everyone has a 35 inch TV.  But what about those people who want a plasma TV? Well, the price has gone up because you no longer have economy of scale working in your favor. Enough people are satisfied with the 35 inch TV that sales of the higher end ones plummet and so the cost of higher end TVs goes way up.

You then end up with a small group of rich people who get the big plasma HDTVs and the rest have the "free" TV.  But what's wrong with that?

Well it gets worse. So time passes and because sales of the higher end TVs are so low, the TV manufacturers have cut back on R&D.  And since the government has agreed to give everyone 35 inch TVs, there's no incentive for the manufacturers to lower their price on those TVs. In fact, they can slowly increase the cost on those TVs over time since, after all, what is the government going to do about it? And what does the government care anyway when "Caring" is measured in dollars spent, not results (look at federal education spending).

So rather than having seen increasing sales of higher end TVs in our reality that would bring the cost of older generation TVs down, we instead are stuck with these 35 inch TVs year after year after year.

This is precisely what happens in socialistic countries. The more socialistic it is, the slower the improvements are. Why make 1 inch thin, 75 inch HDTV displays when few people will buy them? Why even try when you know that the government is going to buy millions of the 35 inch displays each year?

Over time, the result is that we all end up with crummier TVs. At first, it wasn't so bad, everyone got a free 35 inch TV. Not too shabby. But by taking individuals making their own purchase choices out of the equation we effectively eliminate the incentive to innovate. 

We also effectively limit competition.  If the government goes with a single supplier such as Sony (or worse, builds its own TVs) then other TV producers will effectively be driven out of business or to the fringes. Or if the government goes with a confederation of providers, you end up with an artificial competition with only 1 buyer -- the government and the rest colluding on price (which is what happens in other industries).

Now this example is obviously an over-simplification. But you get the general idea. Any system that guarantees 100% coverage is artificial by definition and results in a slowing of improvement and quality of service. After all, in a capitalistic market, you can walk away - you can choose not to buy a product or service. But in a socialistic market, you are forced to buy -- you have to pay your taxes.

The reason why the United States enjoys the best material standard of living in the world is because it made a fundamental cultural decision long ago: Individual are on their own.  As a culture, we have decided that we can live with a small percentage of people failing utterly so that the rest of society can move forward. It sounds harsh and cruel on the surface but the alternative is a system in which all people are treated equally cruel.

Improvements in health, medicine, consumer goods, and services are almost always the result of individual initiative and the best way to encourage that is to create a system of self-interest -- where individual initiative is rewarded. That the selfishness of the individual benefits society.  That is, in effect, the goal of regulated capitalism.

In the United States, most people have health care. In fact, over 90% of the people in the United States either have health care or could easily afford it if they chose to. That is an impressive accomplishment in a capitalistic society such as ours.

It is a system that enables someone who is diagnosed with a heart condition to get in and have surgery within that week. It allows someone (like me) who wants to get Lasik to get an appointment and have it done within a couple of weeks. It allows someone who has the flu to make an appointment and get in that day to see the doctor. And it does this at a relatively reasonable cost.  And it does this with an incredible array of improvements being made technologically all the time (most improvements come from the United States btw -- nations with socialized health care make relatively little medical progress and find their improvements largely as a result of taking advantage of breakthroughs from the USA).

So the question you have to ask yourself is, how much are you willing to give up so that the last 10% of the citizenry receive "free" health care (free in the sense that you're paying for it). Keep in mind, right now, most Americans literally pay nothing for their healthcare. It's part of their job compensation and they don't have to claim it as taxes (and many companies let you opt out of it and take it as direct money compensation). Whereas a "free" system means you'll be paying it in taxes not just for yourself but for others too. And for vastly inferior service and a slowing rate of improvement.


Comments (Page 2)
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on Sep 23, 2004

No, the 44 million figure is the # of people who reported 1 day in the past year without healthcare. That includes most people who switched jobs.  Of that 44 million, only half of them are chronically (i.e. without health insurance the entire previous year).  There are only 20 million Americans who don't have health care at all all year round.

Of that 20 million, about half of them could afford it if they really wanted to. So that leaves you 10 million people out of a population of 300 million who don't have health care and can't afford it. And there is some number of people in there who qualify for medicaid but haven't filled out the forms.

We live in a population of 300 million people. 10% of 300 million is 30 million people. So it's actually considerably more than 90% of the population that has or could afford health insurance easily.

800k families file for bankruptcy each year due to health insurance.  Well, again, how many families are there in the United STates? I don't have the # here but I believe it's something like 80 million families.  That's 1%.

I don't see why the entire society should suffer with long lines and beauracracy to help 1% of families and less than 10% of individuals.

on Sep 23, 2004
Excellent article Draginol! There is a "tug-of-war" effect occuring here as well and our healthcare system is the rope. You hit upon one side of this "tug-of-war" in your reply when you discussed personal priorities; an excellent point! The other half of this "tug-of-war" involves frivolous lawsuits. Too many people with too many lawyers trying to milk everything they can from the Healthcare System. This in turn causes insurance prices to shoot thru-the-roof which in turn makes it harder for JoeUser to cover his/her family's insurance needs. By cutting back on these unnecessary lawsuits the price of healthcare would drop tremendously. Maybe our Healthcare System needs some care of it's own for a change.
on Sep 23, 2004
Based on my own experiences I'd agree with you Draginol on this one. In Australia we introduced universal medicare somewhere around 30-40 years ago. Since then successive governments have failed to adequately fund the system and we're now left with a system where patients might have to wait 6-12 months for non-essential operations and where we cannot get enough nurses to fill demand because the pay is too low.

But one point I do disagree with is your point about innovation. Australia is still an important player in several medical technologies, particularly to do with heart surgery and cancer research. It's just that the scientists and researchers compete for government grants for research in addition to trying to find a commercial backer. This has the added benefit of research in areas that might otherwise be thought commercially unviable. Communist Russia was a pioneer in corrective eye surgery, despite its appalling social record. I guess what I'm saying is that socialist systems don't necessarily mean an end to innovation. It's monopolies that do that, and a socialist system doesn't have to involve a monopoly.
on Sep 23, 2004
Where are you getting this figure where you write "In the United States, most people have health care. In fact, over 90% of the people in the United States either have health care or could easily afford it if they chose to"? Doing a quick search on the Internet to see what kind of coverage Americans had got me this (http://www.usatoday.com/money/industries/health/2004-08-26-uninsure_x.htm) which might add up to what you are saying, depending on how you define "easily afford." Sorry, the link button wasn't working for me.
on Sep 23, 2004
"Universal health care" is an emotionally charged phrase these days. It means many things to many people. But we already DO have universal health care, depending on how you define it. Hospitals cannot, by their very charge, refuse to provide emergency treatment to anyone, even if that person is "medically indigent," the fancy phrase for unable to pay their bill. This has led to a scenario where, in poor urban areas, the hospital ER becomes the primary care physician.

If I said to you that, by adopting a "single payor" plan, we could save millions or even billions of dollars, would you feel the same way? Even if that payor was the Federal government? Single payor insurance could successfully cap costs, by setting rates. It could eliminate or reduce the huge administrative costs in health care. Did you know that Medicare, a Federally administered program is more efficient in containing administrative costs for providing health care than private insurances? Source: http://www.massnurses.org/single_payer/definitions.htm

"Portion of health care expenditures consumed by clerical and technological support for filing and re-filing claims, denial/payment of claims, advertising, executive salaries. While Medicare administrative costs take only about 2-3 percent of their expenditures for administration costs, the lowest percentage for any private insurer is 14 percent."

Hospital billing departments and the attendant record keeping personnel often out number physicians. They are generally the second largest department, after nurses.

We, as a nation, adopted private insurance as a cost containment measure. It has failed miserably. Quality of care has decreased, while costs have gone up. The current system just flat out doesn't work. We would be far better off getting rid of the bureaucracy and adopting a universal, I mean "single payor," system.
on Sep 23, 2004
Let us put our heads together to reform it instead of just quick fixing it with socialized healthcare.


hear, hear!

on Sep 23, 2004
Draginol:

One of the things you omitted in your article is the relative amount of money spent on healthcare in the world. The United States pays close to 15% of it's disposable income on healthcare versus countries like Canada and England that spend around 10%. Also, the sources of payment include both private plans (like companies) as well as government spending (like medicare).

The problem is that regardless of this fact, healthcare costs are rising at an 11% rate per year. GM is now saying, in an article by Dorrie Levin on Bloomberg that healthcare costs will soon overwhelm all profits made by the company. Retirees have even more pressing problems with costs, especially related to prescription drug plans. Poor people (the 30 million you refer to in the thread) use the emergency room as the doctor's office.

The bottom line is that a change is needed to keep costs within reach of inflation. Does this mean longer waiting times and sacrifice on the part of patients in terms of service? Probably. Would you rather GM goes out of business?
on Sep 23, 2004
Seems to me that if we took Shakespeare's advice and killed all the lawyers, just about anyone could afford health insurance since the cost of the care itself would go down dramatically. My father in law is a family practicioner, and I'm pretty sure malpractice insurance (even though he has never been sued) is larger than all his other costs put together.
on Sep 23, 2004
My personal belief is that we should give a dollar for dollar tax credit for everything an employer contributes to employee wages and benefits. That would be a better system to get coverage that is closer to universal, in my opinion.
on Sep 23, 2004
or a charitable organization such as Ronald McDonald House,


Just for the record, Ronald McDonald House (which is an EXCELLENT organization, by the way) helps with housing families of children in hospitals, not with the medical expenses themselves.
on Sep 24, 2004
If universal health care is so bad then why do the people who live in Canada, Sweden, Switzerland, Australia, Norway, United Kingdom, etc., all have a greater life expectancy than those who live in the US?

Here is some info on how good the US health care system really is:

-The United States ranks 23rd in infant mortality.

-The United States ranks between 50th and 100th in immunizations depending on the immunization. Overall US is 67th, right behind Botswana.

-The United States spends at least 40% more per capita on health care than any other industrialized country with universal health care.

-Federal studies by the Congressional Budget Office and the General Accounting office show that single payer universal health care would save 100 to 200 Billion dollars per year despite covering all the uninsured and increasing health care benefits.

-Single payer universal health care is not socialized medicine. It is a health care payment system, not a health care delivery system. Health care providers would be in fee for service practice, and would not be employees of the government, which would be socialized medicine. Single payer health care is not socialized medicine, any more than the public funding of education is socialized education, or the public funding of the defense industry is socialized defense.

-71% of doctors believe that managed care has caused quality of care to be compromised.


on Sep 24, 2004
Ok...there are some problems with your blog here. For starters, it's fallacious to compare TVs (or any mass produced item produced for a market) with a program aimed at raising overall health AND lowering overall cost. A socialized health care system's goal is not to a) take away choice, syphon money from R&D, or c) any of the other stuff you were talking about. Socialized health care's goal is, and always has been, to prevent further, higher costs by employing preventive measures. Even as it stands now, without institutionalized national health care (although we have it in practice), you present a fallacious argument.

I will grant you some of the other rhetoric you've got there about 'socialistic' countries. However, I will point out, as I've had to do before, that we have never realized the existence of a fundamentally socialist state. But, I'm sure you were talking about the Soviet Union, because that's what people always talk about when they think they know how socialism works, so I feel I can address this issue. Say this with me -- The Soviet Union was NOT a socialist country. By its admission, it was a communist state, which is different. However, they weren't really communist, either. And...IF I were to allow your use of these 'socialistic' states, I would point out that no country has ever undergone such wide, pervasive technological advancement as Russia did under Soviet rule. (No, not even here in the US with our digital revolution. In the Soviet Union, we're talking about taking a bunch of people who can't even read, and who are practically still banging rocks together, and within a decade turning the state into a machine that could combat, and eventually defeat through massive resource allocation, the Nazi war machine.)

What you would do well to consider is how much you are already paying for the lack of health care in this country. Make no mistake about it, when people in the US need...I mean, really, really need health care...they get it. That's the way it works. (Trust me, I work in the health care field.) And you pay for it, at an increased rate, because the physicians and insurance companies (my side), pass the loss on to those consumers who can 'afford' it. And, yes, opting into pre-tax payments for health care benefits is sweet and pretty, but small business...which has fueled and continued to fuel economic growth in this country...cannot afford to offer health coverage...AND, having opted into a pre-tax health care plan, I can tell you that I don't get it for free. When my tax dollars are diverted to pay for this 'free' health care, it does affect my after tax income, and it also affects my overall tax rate as dollars are diverted from other public works.

Don't get me wrong here, Jacko, socializing a health care system isn't something you can just walk into. Far from it. But, and you can mark my word on this, an economy as bloated as ours, and as bloated as ours will need to be to compete in the markets of the near future, cannot burden the weight of uninsured and underinsured citizens. (By the way, if people were looking at this debate seriously, the question of being underinsured would pop up in this discourse more often.)

And, anyway, if you're complaining about losing some PRODUCT or commodity value by socializing health care, I would say "So Fuckin' what." So maybe we have to divert money to treating indigent people with TB and HIV, instead of...what?...pumping ten year olds full of Zanax? Zoloft? Prozac? Ritalin?

It's a bit hypocritical for a nation such as ours, with a generation of children being prescribed into drug abuse, and an obesity rate that blushes the Romans, to even be discussing this subject. If our recent history has proven anything, it's that Americans are not capable of making rational, well-informed decisions regarding their own health care. If we were, then we wouldn't be in the predicament we're in -- Crying and complaining about how we will afford to pay to treat preventable diseases.
on Sep 24, 2004
Jonathon Ellis:

You're wrong about the lawyers and insurance. Here's why: insurance is a measure of shared risk. So, malpractice insurance is a shared risk pool among doctors for the mistakes they make and the consequences of those mistakes. This is not McDonald's coffee we're talking here. The doctors could start their own malpractice insurance company the way many companies have their own private healthcare plan for employees.

Some doctors in Boston a few years ago tried this. But the problem is, doctors make mistakes quite often. The plan failed. Especially in this "get 'em in, get 'em out" medical system which is more interested in expediency than health care. Yes, the awards are high when mistakes occur, but blaming lawyers fees for doctors' mistakes is like blaming the horses for the farmer leaving the barn door open.

on Sep 24, 2004
I'd like to extend Not a Moron's line of argument a bit: what's lacking is a reasoned philosophy of health care based on why a society (e.g., my own, Canada) wants people healthy.

On the why side of things, at minimum I think North Americans can generally agree:
a) people who are healthier tend to be more productive in their endeavours (e.g., work, learning, hobbies, etc.) than people who are not, and
we have compassion for those suffering from ill health.

How the society values each component above will ultimately affect what kind of philosophical approach will be taken towards health care. For example:

I argue that Canadians as a society place equivalent value on the above two propositions: our view is that people with equivalent ill health should have an equivalent opportunity for treatment with an emphasis on resources being placed where the greatest need is.

What I've just said is not a policy or an implementation of health care -- merely the philosphical basis upon which those two can arise.

Canadian policies on health care have (for the most part in most places) been focussed by the legislative statement of this philosphy, the Canada Health Act (Link). Responsibility for delivering health care is primarily on the provinces (regions) whereas the maintenance and enforcement of the guiding principles is a federal matter.

What's gone "wrong" with the way Canada has put together health care?
- entry into the health care system is theoretically low: clogging up the works at the primary points of care (family doctors and emergency access). This has lead to both artificial (e.g., premiums, user fees) and market (e.g., fewer family physicians) barriers to entry being erected
- people with resources (i.e., money) who want to the ability to speed their access to health care are artificially discouraged from doing so, e.g., most private care is accessible only by the highest income/power groups (e.g., pro atheletes, very rich) who have the influence and wherewithal to ignore or avoid public resentment
- no one has ever found an effective way to "bill" people such that access remains universal (i.e., everyone essentially pays the same) but those who actually use the system realise the extent of their added burden (e.g., how much money and time it costs the rest of us)
- due to historical reasons, certain aspects of medical care are entirely private (e.g., dental for non-seniors) with a large proportion of the population neglecting their health in these areas relative to their financial resources
- we have lost many health care professionals to other jurisdictions (e.g., USA) due to frustrations with relative compensation and/or responsiveness of the system

What are people "happy" with in the Canadian system?
- once you're into the treatment phase (i.e., past the entry points) the system is as modern and (most importantly) as effective as anywhere in the world
- research into both high impact (e.g., cancer, heart problems) and relatively low incident (e.g., in Canada, AIDS) diseases is active and leading edge due to rigorous public and private funding
- economies of scale in purchasing have lead to benefits like relatively low drug prices
- relative to most of the world, we have a very healthy population except for the "first world" diseases like obesity
- finally, given that mental health is an important aspect of overall health, it would be wrong to trivialize the comfort that knowing that ill health doesn't mean poor treatment or financial disaster wherever you are on the income scale

What seems to be the "same" as with our southern neighbours?
- intellectual property rights and process w/rt to genetics and pharmaceuticals is still somewhat of a jumble due to political uncertainty about the fundamental issues
- clashes between commerce and science and politics over environmental and health issues has made a hodge podge of preventative measures
- policy and practice for lifestyles detrimental to good health are fragmented, inefficient and ineffectual, e.g., life insurance has premiums that scale with respect to lifestyle, but no equivalent "punishment" is available at the primary care end even though it's demonstrable that these people will (sooner or later) place a disproportionate burden on the system
- costs of the system relative to GDP appears to be rising alarmingly -- how much you believe this depends on how much you believe that the total cost of health care has been accurately measured

To put things in a more accessible perspective ...

1. Person A is a high flight sysadmin. Shaped like a ya pear, with the temperament of a cornered badger and the appetite and hygiene of a starved, dyspeptic goat, he is a legend in the technical community. Works seemingly all the time and is the underpinning of a large company's IT infrastructure. Compensated well enough to be immovable. Surprisingly still single.

2. Person B is a professional activist. Between trying to discover colourful phrases to rhyme with "hemp" and worrying about the nutcase who swears he'll go insane if he hears Kumbya again [me], he runs a vegan "cafe" with his significant other. Constantly worries that his kids are being taught to be faceless cogs of the machine. Hasn't needed (and doesn't believe in) the "white man's medicine".

To the Canadian system, if these two have the same medical problem, then they should have the same chances of getting treated.
on Sep 24, 2004
Interesting article. Of course, I don't agree.
This has led to a scenario where, in poor urban areas, the hospital ER becomes the primary care physician.

This kind of scenario has to be more expensive than doctor's visits.

Insurance companies are very powerful here. There won't be free health care for everyone.

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