why are you against universal healthcare?

[Asguard]

That sounds more like crowding out.
http://en.wikipedia.org/wiki/Crowding_out_(economics)

In the specific sense it refers to as being the correct use of the word, no its not. Its not a drop in consumer demand caused by an increase in tax. If you mean reduction in private spending because goverments are spending it then DUH. However if thats what your talking about then you compleatly missread my post.

Lets say that total health expenditure in the US is 1000 (it can be 1000 gold coins, 1000 tons of gold, or 1000 cocnuts for all i care, its just an example)

Of that 1000, 10 come from the goverment and 990 come from people and companies. The goverment decides to increase its share of that 1000 by 490. Now you would expect to see either a total expenditure of 1000 still and "private" contribution fall to 500 OR you would expect to see total expenditure rise to 1490 but that isnt what the OECD statistics show. Insted total expenditure would now become 900 (or 800, the exact amounts dont matter its a principle im trying to show). The important thing though is the level of care indicators actually STAY at the same rates as you were on for the 1000 OR ACTUALLY INCREASE.

This isnt a bad thing, actually its a very good thing (except if you happen to be a private health insurer)

Goverment expenditure in health care is deflationary in both the direct costs of health AND in the burden these costs cause the community there by increasing other compnay profits and peoples take home wages.

 

[pjdude1219]

You only get 47 million if you include illegal aliens. And President Obama specifically said illegal aliens wouldn't be covered. Remember, that's what prompted thet rude Republican to yell, "LIar!"?

So your calling someone on your side of the evidence bs? does that mean we can ignore it in its entirity?

 

[joepistole]

Very well. Instead of trying the silly shotgun approach that congress has been taken, efforts should be made to regulate THOSE costs instead.

I am not a fan of cost regulation. I would rather make the industry more competitive by eliminating trust exemptions; elimination of government restrictions limiting the number of individuals who can receive medical trainning; and opening up the prescription drug markets giving consumers the right to purchase prescription drugs from overseas - from places like Canada. Unfortunately, these are ideas the industry would rather have us forget about. But it would make the industry more competitive and more affordable.

Additionally, there has to be some enforced ethics. For example, if a physician owns a lab they tend to order more lab tests. In this case the physician has a conflict of interest. Those conflicts need to be eliminated as well. I think the bill proposed by the Democrats is better than nothing. It does, according to CBO, reduce projected deficits. But it needs to go a lot further to achieve the aforementioned goals.

 

[EntropyAlwaysWins]

In the specific sense it refers to as being the correct use of the word, no its not. Its not a drop in consumer demand caused by an increase in tax. If you mean reduction in private spending because goverments are spending it then DUH. However if thats what your talking about then you compleatly missread my post.

Lets say that total health expenditure in the US is 1000 (it can be 1000 gold coins, 1000 tons of gold, or 1000 cocnuts for all i care, its just an example)

Of that 1000, 10 come from the goverment and 990 come from people and companies. The goverment decides to increase its share of that 1000 by 490. Now you would expect to see either a total expenditure of 1000 still and "private" contribution fall to 500 OR you would expect to see total expenditure rise to 1490 but that isnt what the OECD statistics show. Insted total expenditure would now become 900 (or 800, the exact amounts dont matter its a principle im trying to show). The important thing though is the level of care indicators actually STAY at the same rates as you were on for the 1000 OR ACTUALLY INCREASE.

This isnt a bad thing, actually its a very good thing (except if you happen to be a private health insurer)

Goverment expenditure in health care is deflationary in both the direct costs of health AND in the burden these costs cause the community there by increasing other compnay profits and peoples take home wages.

Crowding out isn't about the government increasing its share of the total spending on X, its the decrease in private spending on X that is of a larger magnitude than the increase in government spending on X.
It's not a decrease in costs, its a distortion of spending patterns.

You are attributing the decrease in spending to the increase in government spending theoretically leading to a reduction in costs but the increased government expenditure has to come from somewhere.
That somewhere is either via taxation or from borrowings (which would then be repaid via taxation).
So even though the total expenditure on healthcare may fall, you aren't really decreasing the cost to the community because of the increased tax burden to pay for both the health care they would buy anyway, plus at least one other layer of bureaucracy that wasn't in the picture previously.

You can reduce the end user cost of something by paying for it via taxation but that doesn't actually reduce the cost of it, and is not a good idea from the perspective of incentives.

Also, I'm not at all convinced that increasing the level of government involvement in healthcare will lead to an improvement in quality (or at least not to the extent that quality would increase with a reduction in government involvement).
Privatisation generally leads to an increase in quality and a decrease in costs, whereas nationalisation generally has the opposite effect.

 

[joepistole]

Privatisation generally leads to an increase in quality and a decrease in costs, whereas nationalisation generally has the opposite effect.

On this I would generally agree with you. However, in order to improve quality and reduce costs, free market forces must not be constrained as is currently the case in the United States.

It is also important to note that most nations including industrial nations have not nationalized their healthcare (Great Britian excepted). They have instead converted to a single payer system. There is a big difference.

 

[EntropyAlwaysWins]

On this I would generally agree with you. However, in order to improve quality and reduce costs, free market forces must not be constrained as is currently the case in the United States.

So reducing (or ideally, eliminating) the constraints on the free market seems like the obvious solution to me.

It is also important to note that most nations including industrial nations have not nationalized their healthcare (Great Britian excepted). They have instead converted to a single payer system. There is a big difference.

Point taken, however one would expect that to be similarly inefficient for similar reasons (large bureaucracy, information problem, etc).

 

[pjdude1219]

So reducing (or ideally, eliminating) the constraints on the free market seems like the obvious solution to me.

I don't know about you but I am leery in putting things that effect people's lives to such a magnitude in the hands of something so capricious as the market.

 

[joepistole]

I don't know about you but I am leery in putting things that effect people's lives to such a magnitude in the hands of something so capricious as the market.

Markets, specifically free markets, are not all bad PJ. I take it you have not had problems getting food to eat or clothes to wear. Those are all the product of free competitive markets. It is when industry colludes with government to skew the markets so that one side wins (industry) and one side looses (consumer) that you have problems and such is the case in the US.

 

[pjdude1219]

Markets, specifically free markets, are not all bad PJ. I take it you have not had problems getting food to eat or clothes to wear. Those are all the product of free competitive markets. It is when industry colludes with government to skew the markets so that one side wins (industry) and one side looses (consumer) that you have problems and such is the case in the US.

the market only works when people are willing and/or able to walk away. with health care they are not. Their is near infinite demand because of that which would cause prices to sky rocket.

 

[joepistole]

So reducing (or ideally, eliminating) the constraints on the free market seems like the obvious solution to me.).

Agreed, but it is not going to be easy or very practical because of the 10th Admendment (states rights issues). A good deal of market manipulation occurs at the state level as well. The disentanglement of this industry from government is not going to be easy or fast.

Point taken, however one would expect that to be similarly inefficient for similar reasons (large bureaucracy, information problem, etc).

Even so, it appears to beat the heck out of the US system in terms of quality and efficiency.

 

[Asguard]

Crowding out isn't about the government increasing its share of the total spending on X, its the decrease in private spending on X that is of a larger magnitude than the increase in government spending on X.
It's not a decrease in costs, its a distortion of spending patterns.

You are attributing the decrease in spending to the increase in government spending theoretically leading to a reduction in costs but the increased government expenditure has to come from somewhere.
That somewhere is either via taxation or from borrowings (which would then be repaid via taxation).
So even though the total expenditure on healthcare may fall, you aren't really decreasing the cost to the community because of the increased tax burden to pay for both the health care they would buy anyway, plus at least one other layer of bureaucracy that wasn't in the picture previously.

You can reduce the end user cost of something by paying for it via taxation but that doesn't actually reduce the cost of it, and is not a good idea from the perspective of incentives.

Also, I'm not at all convinced that increasing the level of government involvement in healthcare will lead to an improvement in quality (or at least not to the extent that quality would increase with a reduction in government involvement).
Privatisation generally leads to an increase in quality and a decrease in costs, whereas nationalisation generally has the opposite effect.

um no, thats illogical. The tax burden is EXACTLY the sum total of the health care budget and not 1 $ more. It CANT be anymore, you dont have the goverment comming along and saying "well we need 1% for the health budget so we will tax you 5% for health" thats inncorect. Yes there is generally a budget surplus but thats from the WHOLE budget and you could just as easerly (and just as incorectly) claim that came from defense expenditure as health. When the OECD rate expenditure they include ALL costs INCLUDING the health department itself and im sorry but if you dont think there is any bureaucracy in the US system your compleatly WRONG. Its just for the US system there is a profit margin on EVERY SINGLE LEVEL.

In Australia there are really 3 systems. The private health insurance and private hospitals, the Medicare system and the public hospital system.

Public hospitals are paid for by the states, and the doctors ect are all public employees (there are SOME contracted out services like for instance laundry goes to Spotless). There for the only profit margins that are included are the ones for the contracted services and the companies which surply the medications and equiptment.

Now if we flip to the private sector there is a profit margin at EVERY level.

Now lets say the profit margin is 10% (to pull a figure out of my ass). There for Spotless charge x (cost of service) + 10% and in the public sector thats the cost to the public for laundry. In the private sector on the other hand the cost of laundry is ((x * 110%)(spotless) * 110%) (Hospital) * 110% (insurance company) AT LEAST (assuming there is no subcontracting going on)

THAT is where the goverment options cut costs, the further down the chain you put the money in the cheeper health becomes and the greater the govermental share the more downward pressure the goverment can applie to the companies to reduce profit margins.

One way they did this in GP services (which are private companies paid for by medicare) is bulk billing. If a GP agreed to bulk bill then they got the money directly from medicare as soon as the form came in (now its even quicker because the medicare card can just be swiped like an ATM card). In return the GP couldnt charge even $1 more to the pt. If they chose to charge ABOVE the medicare rebate (ie charge the pt as well as medicare) they could freely do that BUT the goverment wouldnt pay ANYTHING directly to the GP. Instead the ENTIRE amount had to be paid by the pt UP FRONT who then had to go and stand in a que at medicare to get the goverment portion back as a rebate.

What effect did this have? Insted of the pt having to find $10 they now had to find $60 and the time to stand in a medicare office to get that money back. This makes GPs who charge above the rebate VERY unpopular and there for market compition favors those who only charge the goverment for there service. Ie downward pressure on prices Its one of the ideas im most proud of the goverment for thinking up.

It will ALWAYS cost more to do things in the private sector than it will for goverment and this is bourne out by a recent move by the SA goverment which was oposed by the Public Sector Doctors association (rather than the AMA who represent ALL doctors, this union only represents those who work in the public sector). Because of doctor shortages there are some specialties which are increasing there waiting lists (practically for most things the waiting lists are almost non existant but for a few specalites its to long because there are very few doctors in these specilites). As a stop gap measure the state goverment was thinking about either a) hiring a private company (i belive one from the US but im not sure) to come into the public hospitals (so using public facilities and staff) and run extra procidures or b) to contract these out directly to the private hospitals. In both cases the pts would still be public pts and the costs come out of public funding not the pts purse. BOTH options turned out to be MASSIVILY expensive compared to the costs of doing it with public sector staff in a public hopsital. Why? because of the companies profit margins which arnt there for goverment

 

[iceaura]

If you simply covered the entire population of the US with a single payer system of standard first world quality, using any of the several standard European or other comparable arrangements, you would have about that much extra of your gross available for other expenditures or whatever.
”
I'd like to see some hard, reliable source to confirm that claim.

You've seen dozens.

European countries that provide universal first world medical care do so using about 10% of their GDP, on average.

The US currently uses 18%, to provide partial coverage. That percentage is increasing, and will pass 20% in a couple of years. The percentage of coverage is shrinking.

These numbers are in almost universal, everyday, common circulation. They have been published repeatedly in the Wall Street Journal, the New York Times, and every major newspaper or news magazine in the country AFAIK.

The difference is 8%. Notice that we are completely ignoring the fact that the US per capita has at least half again more GDP in the first place, so the difference in absolute cost is more like 12% of US GDP wasted. We are accepting, in other words, much higher US expenditures on medical care as unavoidable and for the best.

That 8% is paid by you and every other economically productive US citizen. Whether it is a fraction of your taxes, your prices, your fees, or whatever, it is being extracted from the US total production you contribute to.

 

[EntropyAlwaysWins]

I don't know about you but I am leery in putting things that effect people's lives to such a magnitude in the hands of something so capricious as the market.

Yet you have no objection to placing it in the hands of bureaucrats and elected officials who have no training in this area nor any personal stake in the matter? who have no interest in or inclination to behave in your best interests?

the market only works when people are willing and/or able to walk away. with health care they are not. Their is near infinite demand because of that which would cause prices to sky rocket.

Those arguments apply equally to food production, and almost as much to clothing and housing/shelter.
Government involvement in those industries has invariably resulted in worse outcomes, please explain why I should expect healthcare to be any different?

 

[EntropyAlwaysWins]

Agreed, but it is not going to be easy or very practical because of the 10th Admendment (states rights issues). A good deal of market manipulation occurs at the state level as well. The disentanglement of this industry from government is not going to be easy or fast.

I'm not arguing that such a course of action would be easy, just that it is the best course of action.

Even so, it appears to beat the heck out of the US system in terms of quality and efficiency.

Even so, I recall Fraggle arguing that the size of the bureaucracy of such a scheme increases with the square or even the cube of the population, meaning such a proposal would be ruinously expensive in the long run for a country the size of the United States.
He went on to say that if one were to implement such a scheme it would make more sense to implement it at the state level, so as to control costs and allow states to compete with each other.

 

[pjdude1219]

Yet you have no objection to placing it in the hands of bureaucrats and elected officials who have no training in this area nor any personal stake in the matter?

whop says they wouldn't be trained. and they would be the ones having a say the doctors would.

who have no interest in or inclination to behave in your best interests?

why wouldn't they have people's best interests in mind. they wouldn't have any other concerns that would conflict. it sounds to me you've taken to the corporate line that those who would stand to lose by actually caring for our citizens are presenting

Those arguments apply equally to food production, and almost as much to clothing and housing/shelter.
Government involvement in those industries has invariably resulted in worse outcomes, please explain why I should expect healthcare to be any different?

Well first off you have other options in those. beef to expensive buy chicken. this companies shirts to much go to another one. this fabric to costly go to another. housing is the only one that the analogy works with and that only loosely. Right because Upton Sinclairs' The Jungle was written after the government got involved. In every other country that has universal health care. It costs less with better outcomes

 

[EntropyAlwaysWins]

um no, thats illogical. The tax burden is EXACTLY the sum total of the health care budget and not 1 $ more. It CANT be anymore, you dont have the goverment comming along and saying "well we need 1% for the health budget so we will tax you 5% for health" thats inncorect. Yes there is generally a budget surplus but thats from the WHOLE budget and you could just as easerly (and just as incorectly) claim that came from defense expenditure as health. When the OECD rate expenditure they include ALL costs INCLUDING the health department itself and im sorry but if you dont think there is any bureaucracy in the US system your compleatly WRONG. Its just for the US system there is a profit margin on EVERY SINGLE LEVEL.

I don't know if you've been paying any attention to US politics recently but the US government has been pretty consistently running large deficits for virtually every year for the last few decades.

In Australia there are really 3 systems. The private health insurance and private hospitals, the Medicare system and the public hospital system.

I live in Australia, I know we have a different system.
This thread is about the US system, not the Australian one.

Public hospitals are paid for by the states, and the doctors ect are all public employees (there are SOME contracted out services like for instance laundry goes to Spotless). There for the only profit margins that are included are the ones for the contracted services and the companies which surply the medications and equiptment.

Now if we flip to the private sector there is a profit margin at EVERY level.

Profits are the "success signal" for a business, it is information that tells them to either continue producing at current levels or increase them.
Losses are the "failure signal" for a business, it is information that tells them they are producing too much and to lower their levels of production or stop altogether.

If profits are very large than this is also a signal to other entrepreneurs that the market wants more of this product and that they should go into business in this industry.
The large profits are what creates the competition that then drives down prices and hence profits.

Profits are not simply wasted money they are the signals that the market uses to determine the correct level of production and the correct price for a given good or service.

http://en.wikipedia.org/wiki/Economic_equilibrium

Now lets say the profit margin is 10% (to pull a figure out of my ass). There for Spotless charge x (cost of service) + 10% and in the public sector thats the cost to the public for laundry. In the private sector on the other hand the cost of laundry is ((x * 110%)(spotless) * 110%) (Hospital) * 110% (insurance company) AT LEAST (assuming there is no subcontracting going on)

THAT is where the goverment options cut costs, the further down the chain you put the money in the cheeper health becomes and the greater the govermental share the more downward pressure the goverment can applie to the companies to reduce profit margins.

This kind of action, while apparently helpful, wouldn't even be relevant if government didn't also drive *up* profit margins by artificially reducing the supply of health care, via licensing, etc.

One way they did this in GP services (which are private companies paid for by medicare) is bulk billing. If a GP agreed to bulk bill then they got the money directly from medicare as soon as the form came in (now its even quicker because the medicare card can just be swiped like an ATM card). In return the GP couldnt charge even $1 more to the pt. If they chose to charge ABOVE the medicare rebate (ie charge the pt as well as medicare) they could freely do that BUT the goverment wouldnt pay ANYTHING directly to the GP. Instead the ENTIRE amount had to be paid by the pt UP FRONT who then had to go and stand in a que at medicare to get the goverment portion back as a rebate.

What effect did this have? Insted of the pt having to find $10 they now had to find $60 and the time to stand in a medicare office to get that money back. This makes GPs who charge above the rebate VERY unpopular and there for market compition favors those who only charge the goverment for there service. Ie downward pressure on prices Its one of the ideas im most proud of the goverment for thinking up.

While I agree that keeping costs down is helpful, this kind of action, as mentioned previously is in place to combat the effects of other government policies that reduce the supply of healthcare and thus increase the price.
Also, reducing the end user costs, i.e., the out of pocket costs, is possible by paying for the product via taxation, that in and of itself doesn't reduce the costs, and, as i've said before, is not a good idea from the perspective of incentives.

It will ALWAYS cost more to do things in the private sector than it will for goverment and this is bourne out by a recent move by the SA goverment which was oposed by the Public Sector Doctors association (rather than the AMA who represent ALL doctors, this union only represents those who work in the public sector). Because of doctor shortages there are some specialties which are increasing there waiting lists (practically for most things the waiting lists are almost non existant but for a few specalites its to long because there are very few doctors in these specilites). As a stop gap measure the state goverment was thinking about either a) hiring a private company (i belive one from the US but im not sure) to come into the public hospitals (so using public facilities and staff) and run extra procidures or b) to contract these out directly to the private hospitals. In both cases the pts would still be public pts and the costs come out of public funding not the pts purse. BOTH options turned out to be MASSIVILY expensive compared to the costs of doing it with public sector staff in a public hopsital. Why? because of the companies profit margins which arnt there for goverment

Firstly, the shortages are the result of government interference in the market.
Secondly, why would you assume that bringing in staff from overseas cheap?

 

[Ganymede]

Wrong thread.

 

[EntropyAlwaysWins]

whop says they wouldn't be trained. and they would be the ones having a say the doctors would.

The people who should be having a say is the patients, by choosing between competing health care providers and competing treatments.

why wouldn't they have people's best interests in mind. they wouldn't have any other concerns that would conflict. it sounds to me you've taken to the corporate line that those who would stand to lose by actually caring for our citizens are presenting

Right. Bureaucrats are somehow different from everyone else in the world and immune to all conflicts of interest.

A business in a free market has an incentive to satisfy its customers, otherwise it wouldn't make any money and would go out of business. So it's incentive line up with the interests of it's clients.
They have a constant feed back loop of information from their customers as to how satisfied they are with the product; profit equals success, loss equals failure. They must correct the situation if they are taking losses or they will go out of business.

A government agency has no such incentive to satisfy its "clients", its funding is principally or entirely from taxation, so it lacks the feed back loop of information that a business has in the form of profit and loss.

A business can only increase the amount of resources available to it by satisfying its customers, a government agency can increase its available resources by lobbying for more funding.

The incentives of the bureaucrat are not the same as the businessman or the worker.
The "success signal" for the bureaucrat is an increase in funding and power, the "success signal" for the businessman is an increase in revenue. They both are succeeding by gaining more resources but only one of them is forced to satisfy his customers in order to achieve this.

Well first off you have other options in those. beef to expensive buy chicken. this companies shirts to much go to another one. this fabric to costly go to another. housing is the only one that the analogy works with and that only loosely. Right because Upton Sinclairs' The Jungle was written after the government got involved. In every other country that has universal health care. It costs less with better outcomes

Competition is what drives down costs and increases quality in a market, if the government restricts the degree or competition (typically by artificially reducing the supply) than you end up with high prices and low quality.
If you want low prices and high quality, than don't restrict the market.

 

[Asguard]

who said goverment limits numbers of doctors? god you say you live in Australia but you have NO idea how doctors are trained do you? why exactly do you think the goverment THREATENED the AMA with moving medical schools into the universities?

Because the universities DONT TRAIN DOCTORS. They produce medical degrees yes but the specialties require training at the medical colleges. Who controls the medical colleges? Well the MEMBERS of those colleges do, ie the doctors who have previously been trained there. That is a MASSIVE conflict of intrest.

The goverment pays for the training, the goverments are the ones who need the graduates of those colleges but the colleges themselves are under the control of the other graduates which means the insentive is to train LESS specialists rather than MORE because every single one of those graduates will be compeating for a job with the people who are running the colleage. What would the difference be if it was moved to the universities? well university places are decided by a) goverment funding (for HECS places) and b) industry requirements. If the goverment needs more teachers trained they just give the uni's more money for teaching degrees. The goverment can do that for Batch of med\ Batch of Surgury but that would make no difference because they have limited control over the number of internships and even less control over the post grad training places.

Please get your facts straight before you look like a compleate ass

 

[pjdude1219]

The people who should be having a say is the patients, by choosing between competing health care providers and competing treatments.

They don't always have the ability too hence the need for doctors to have a say.

Right. Bureaucrats are somehow different from everyone else in the world and immune to all conflicts of interest.

no but if they don't have an incentive to dick people over than gernerally they won't.

A business in a free market has an incentive to satisfy its customers, otherwise it wouldn't make any money and would go out of business.

so than why so businesses that treat their customers as a necessary evil?

So it's incentive line up with the interests of it's clients.

No they don't. a for profit inncentive is to make as much money as possible for as little cost to them while a cunsumer incentive is to get as much product for as little cost as possible.

They have a constant feed back loop of information from their customers as to how satisfied they are with the product; profit equals success, loss equals failure. They must correct the situation if they are taking losses or they will go out of business.

A government agency has no such incentive to satisfy its "clients", its funding is principally or entirely from taxation, so it lacks the feed back loop of information that a business has in the form of profit and loss.

first off any government UHC will have some sort of direct funding from its users. secondly this entire notion is based on people will fuck youy over for shits and giggles. i just don't buy into it.

A business can only increase the amount of resources available to it by satisfying its customers, a government agency can increase its available resources by lobbying for more funding.

so?

The incentives of the bureaucrat are not the same as the businessman or the worker.
The "success signal" for the bureaucrat is an increase in funding and power, the "success signal" for the businessman is an increase in revenue. They both are succeeding by gaining more resources but only one of them is forced to satisfy his customers in order to achieve this.

The business has to make sure it can get enough people to pay its costs the government employee having his funding based on taxation links his incentive to a strong all around economy.

Competition is what drives down costs and increases quality in a market, if the government restricts the degree or competition (typically by artificially reducing the supply) than you end up with high prices and low quality.
If you want low prices and high quality, than don't restrict the market.

So than why do countries with Universal health care spend less and have better care? The free market doesn't ensure low costs or high quality. It only ensures that demand and supply reach equalibriam. plus given the lack of perfect info the market cannot function properly in regards to health care.