I disagree; government regulatory practice is mainly taking some of the worse edges off the inherently broken model of "healthcare as insurance". I'm thinking particularly of major conditions. I think regular office visits could probably be paid for out of pocket, but the real money is going towards hospitals, and that's also where free-market solutions don't work at all.
In particular, I don't see how an unregulated system would solve the correlation-across-lifetime problems. A friend of mine was born with a congenital heart defect, a "preexisting condition" since birth. In a free market, it actuarially makes little sense to sell him insurance at any kind of affordable rate, because the uncertain event already happened (he lost a particular lottery at birth). And in a really free market, that would apply to many more people, because rational insurance companies would require genetic screening before allowing coverage (which they currently can't), allowing them to uncover all sorts of less obvious genetic lottery losers. Put differently, the random risk being insured is, in large part, entire lifetimes, which the insurance market cannot handle, particularly if you think individuals should have some kind of choice (vs. some kind of setup where parents have to buy their offspring's lifetime health insurance pre-conception).
Risk pooling across a large corporation's employees is sort of a hack to approximate the needed across-population risk pooling, in the absence of a true socialized risk pool. That hack has let he U.S. hobble through much of the post-WW2 era, since a large percentage of Americans had employment-for-life at large companies, but it's poorly suited to a world of freelancers and job-hopping.
>I disagree; government regulatory practice is mainly taking some of the worse edges off the inherently broken model of "healthcare as insurance".
But the government put some of those edges there in the first place. The biggest reason you have to have insurance in the US now is without it you're going to pay 5x what the insurance company pays for the same procedure. Because they're buying medical care in bulk and you're not.
One way you could deal with that is form a co-op to negotiate prices the same way insurance companies do, but without the insurance part. But you can't, because it's illegal.
Risk pooling is supposed to happen at the insurance company level, not at, e.g., the corporate level. i.e. the insurance company is pooling risk across a lot of individual clients. That this only sort of happens now is an offshoot of the regulatory system. Of course, a large company will always be able to negotiate slightly better rates.
In a free market, whenever it is financially rational to insure someone, it would happen. So, someone probably couldn't get insurace that covers their preexisting condition (which wouldn't be fair to the insurer), but they could get coverage for other things.
And that's the way it should be. Nobody should force someone else to take care of them. People are not owed anything by the universe.
Having been denied insurance because of a procedure that I underwent to make me considerably more healthy, I call bullshit. How do you "not cover" the result of a procedure that impacted every aspect of my life while covering everything else?
Naked capitalism and healthcare can't work together (and this coming from somebody who strongly believes the government has way too many fingers in way too many pies). The priorities are too far out of whack; but that doesn't mean capitalism shouldn't have a significant role to play.
I do think government regulation (in particular, the tax benefit for companies providing insurance) have made the situation far worse than it needs to be. I talked to an insurance broker after the Obamacare vote. He told me every insurance company in my state was dropping policies for 19 year olds, since they had no say who they covered. Talk about incentivizing good behavior...
In the end, it's an incredibly complex problem that should not be handled in at the Federal level, if for no other reason than there are too many competing needs.
I do think government regulation (in particular, the tax benefit for companies providing insurance) have made the situation far worse than it needs to be.
In the end, it's an incredibly complex problem that should not be handled in at the Federal level
Then you are arguing on the wrong side.
You are like the Republican Party. You argue that one thing is practical, but another thing is moral. You cede the moral high ground to the other party. Ironic, since the moral high ground ought to be yours.
How do you "not cover" the result of a procedure that impacted every aspect of my life while covering everything else
If it's that important, why don't you just pay for it? Why do you point a gun at me and force me to pay for your procedure? If our medical system were free, it would be as efficient as the veterinary system, and the cost reduction would be commensurate. So, you see, the moral is the practical.
Naked capitalism and healthcare can't work together
Neither can capitalism and clothing, consumer electronics, toothpaste, food, transportation. I mean, everywhere we have tried capitalism, it has failed. Everywhere we have tried socialization and regulation, it has worked. Why don't we apply the model of the Soviet Union to our healthcare system? That is obviously a pro-healthy choice. </friendly_sarcasm>
I'm not "arguing on the wrong side". When you have 300 million people, you have a choice: rule by fiat or slice things into smaller pieces, because 300M people are never going to agree. State populations, on the other hand, are much more closely aligned, making an intractable problem at the federal level tractable at the state level (like many other problems). I'll get back to the government regulation in a minute, but first...
I'm not asking "you" to cover my procedure. I'm asking to be allowed into a shared risk pool at any cost due to having had a procedure. Regardless, when you buy into a shared risk pool, guess what, you have to share the risk. You can't say "I'm not sick, so I shouldn't have to pay for sick people." Your option is to buy in or not. As a personal insurance companies have smiled upon, a person has their choice to not buy in or not; for those of us they frown at, we don't have choice to buy in (short of being part of a corporate plan).
And that gets back to where the regulation has caused problems: it's set the entire industry up to have insurance companies be the customers of medical care instead of individuals, leading to all kinds of weird incentives.
For healthy people and relatively rich people, naked capitalism would be fine for healthcare. However, government is (well, should be;) about more than just building roads and bombers. It should be an embodiment of a shared responsibility we have to each other. I put reasonable[1] levels of healthcare in that shared responsibility.
I think a single-payer system, especially in the US, would fail horribly. I think we need more competition and not less. I think, most importantly, the customer for medical care (ie the person who ultimately sees the bill) should be the individual (failure of any price consciousness is another part of what got us into this situation).
But I also think everybody should have access to good quality care at prices they can afford. Today, there is an entire middle-class (not "The Middle-class") that makes too much for medicaid and too little for insurance that are just screwed. Have cancer? Too bad if you want to fight it, because one dose of the medication costs more than you make in a day. That is just inhumane and pure capitalism doesn't care. So the alternative is to quit your job so you can qualify for medicaid, but even that sucks (for bureaucratic, lack of competition, and lack of price sensitivity reasons) and is worse for the patient and our economy both.
So I believe capitalism plays a very important role in this, but I don't think, by itself, it can solve it. My perspective on this shifted a lot after going to work for myself and not being able to provide healthcare for my children after my COBRA ran out.
1. Being kept alive for years on a ventilator is nowhere near reasonable.
Ah, well that's where we disagree. I can't control what genes I'm born with, and I don't think there's anything wrong with socializing those risks across the population. Let's say there's a 1% risk of me being born with some condition. I think it's perfectly fair for me to pay 1% of the cost of treating that condition, whether I'm born with it or not. I don't see why I should pay 100% the cost if I get unlucky in the genetic lottery, or 0% if I get lucky. That's just upping the ante on a bet I wasn't even around to make. And that's the kind of pooling insurance usually does, but the mechanics of this particular risk are very hard for insurance to pool, because it happens to take place before I'm sentient enough to purchase insurance, unlike a tree falling on my house.
If anything, it strikes me as exceptionally petty and greedy for people who have the misfortune not to need to undergo surgery for a congenital heart disease to be angry about having to pay for their 1/risk chance of it.
I mean, I'm not even arguing anything particularly leftist here: F.A. Hayek made basically this argument.
I can't control what genes I'm born with, and I don't think there's anything wrong with socializing those risks across the population.
What's wrong with it is that you're initiating force against me, and making my life manifestly worse.
I mean, as someone who can pay for my own healthcare, this is what I get out of socialized medicine in the US:
(1) Less money to spend on my own healthcare issues
(2) Regulations that prevent my doctors from taking care of me in the best possible way
(3) Regulations that prevent me from getting the best medicine
(4) Anything medical is done in an extremely expensive and wasteful way
That's what you're doing to me, in order to instill your notion of what is "perfectly fair."
The U.S. medical system does not work effectively for the same reasons that the Soviet economy did not.
It's likely only going to keep getting worse with Obamacare.
You know, these posts sound a lot like "I've got mine, screw you."
Am I rare in that I wouldn't mind paying a little more if it'd mean that the country would be legitimately happier/healthier? Whether that be socialized healthcare, single-payer, or any combination.
Then just do it. It is unfortunate that Obamacare is forcing you to get insurance, but I'm sure you can find a medical plan with a ridiculously high deductible (specifically for people who are wealthy[1]) that will cost you next to nothing[2] and, similar to life insurance, protect you and your assets if something catastrophic happens.
1. I'm making no judgement about whether you are wealthy or just choose to pursue no healthcare.
You cover a lot of ground here -- socialized medicine, Obama, government regulation, "initiation of force", the fall of the Soviet Union. But just to select one:
"...as someone who can pay for my own healthcare..."
What should be done about the people who cannot?
Your profile reveals that you're an Ayn Rand fan; I don't believe Rand provided an answer to this question, other than to posit that harnessing the collective resources of society to address it, in any way, destroys essential freedom. Do you propose that "The Virtue of Selfishness" would be an effective and moral organizing principle for modern society?
In a free market, whenever it is financially rational to insure someone, it would happen.
Which is why healthcare-as-insurance is so perverse.
So, someone probably couldn't get insurace that covers their preexisting condition (which wouldn't be fair to the insurer), but they could get coverage for other things.
Would you perhaps like to volunteer at a hospital some time? Maybe you could explain objectivist principles to parents with children born with 'pre-existing conditions' like spina bifida or taysach's syndrome? Explain that they'll have to deal with a child's debilitating illness without financial aid? Maybe you could read Atlas Shrugged during storytime at a children's cancer ward? You could explain to all of those little 'Takers' how unfair their treatment is to their parent's insurance companies?
If you want to make an intellectual point, don't say something mocking and hyperbolic. Be honest about what you really believe. Be willing to defend it.
Say, "I demand that you practice altruism. I am going to force you to be good, by my definition of good, at the point of a gun."
I would want to help someone with spina bifida, but I would not want to do it because you force me to at gunpoint, while simultaneously creating a system where I myself can't get the healthcare I can actually pay for.
When I read things like this, it makes me so glad I live in the UK and don't have to endure any of this free market bullshit when it comes to health. The system you describe is just so chillingly brutal and callous.
The NHS is not perfect (as some of your tales of woe cherry-picked from right-wing newspapers suggest), but its core mission is essentially that of compassion and fairness: to provide medical care to each member of the population regardless of their financial circumstances.
Any health care system that does not aspire to that ideal is by its very nature horrendously biased against the poor.
(By the way, you should be more careful with the articles you choose to believe. For example, the research cited in the one titled "NHS death rates four times higher than US" did not show any such thing - it was a comparison between one UK and one US hospital, on a relatively tiny cohort of 1000 patients, showing a mere 7.5% difference in post-operative death rate. It is ridiculous to extrapolate this data to the entire health care systems of two countries.
This is typical of Daily Mail spin on such research - you'd be much better off not citing that newspaper at all due to its inherent bias against the NHS.)
I don't think one could conceive a metaphor more archetypal of the US than "done at the point of a gun" -- but what do you mean by that, in terms of the UK health system?
In particular, I don't see how an unregulated system would solve the correlation-across-lifetime problems. A friend of mine was born with a congenital heart defect, a "preexisting condition" since birth. In a free market, it actuarially makes little sense to sell him insurance at any kind of affordable rate, because the uncertain event already happened (he lost a particular lottery at birth). And in a really free market, that would apply to many more people, because rational insurance companies would require genetic screening before allowing coverage (which they currently can't), allowing them to uncover all sorts of less obvious genetic lottery losers. Put differently, the random risk being insured is, in large part, entire lifetimes, which the insurance market cannot handle, particularly if you think individuals should have some kind of choice (vs. some kind of setup where parents have to buy their offspring's lifetime health insurance pre-conception).
Risk pooling across a large corporation's employees is sort of a hack to approximate the needed across-population risk pooling, in the absence of a true socialized risk pool. That hack has let he U.S. hobble through much of the post-WW2 era, since a large percentage of Americans had employment-for-life at large companies, but it's poorly suited to a world of freelancers and job-hopping.