For information, here in Germany, from where I run my startup which itself is a UK Limited, I provide my employees with full health insurance (teeth, sick days, everything), pension, unemployment insurance, etc. for basically €700/month for an after tax salary of about €2500/month.
As soon as you start to factor in all the costs of insurance, etc., doing business in the old Europe is pretty cheap. Even in Denmark, where I lived and worked for a while, you get everything included from the state and as a startup founder, this is really great.
I believe in free market for a lot of things, but not for health insurance.
what I don't like on european (interpolating from czech, but it's probably quite similar everywhere in europe) health and welfare insurance is that you generally can't opt-out from that. Complete opt-out is probably bad idea, but I would like to pay insurance only when I actually have income, not be obliged by law to pay what equates to half of my other expenses every month. It seems fair to me to roll these "insurances" into income tax, as it is essentially nothing different from income tax (although logic of caps is different on income tax and this "insurances").
I'm perfectly willing to pay significantly more than is obligatory, but only when my income for given period allows that.
In Germany, Denmark and France (the only places I was employed for more than 3 years), if you have no incomes, you are automatically covered. Of course as a consultant, if you have no incomes in a given month, you still need to pay. If you do not want, you need to switch to officially unemployed for the month, which is not worth it.
Why don't you believe in a free market for health insurance? Forcing
people to pay into a health insurance is kind of scammy - let's say
that I have a genetic condition that is certain to kill me rapidly at
age 30. I want to live my life to the fullest, and I'd rather not be
forced to buy health insurance that protects me from things like adult
onset diabetes, alzheimer's, cancer, parkinson's, etc, that I'm just
not going to get. Why should I be forced to pony up for other people's
healthcare, too? What do I owe those bastards who get to live twice
as long as I am and beat me up and teased me on the playground in
middle school?
The more insidious thing about universal healthcare is that it really
screws over most minorities. Minorities tend to have diseases that are
not as well researched as those found in ethnic majorities (or certain
minorities which are disproportionately represented in the medical
research community). Moreover, drug testing -for safety and efficacy-
in minorities is very scant, and it is sometimes the case that adverse
reactions to drugs occur in minorities that do not occur in the ethnic
or racial majorities. Of course to find that out you need
statistically relevant sample sizes, and the way drug safety testing
is done is by recruiting on college campuses - you can see the
potential problem here - and even still some minorities that are
overrepresented on colleges are, for whatever reason, underrepresented
in testing pools. So as a minority, one might be paying into a system
that disproportionately treats diseases that one would not be getting,
or with different pathologies, and for which the treatments may be
completely ineffective or even dangerous due to lack of study.
Then there is this problem. What if those who decide health coverage
decide that heterozygous genetic condition X is covered (and it's
expensive). Two parents who are carriers now can decide, hey we can
afford to have kids - after all it's their right. So now everyone is
saddled with the burden of their selfish choice. Or, we can restrict
their liberty by prohibiting all such pairs of parents from
reproducing. Whereas if they are responsible for the cost of their
children's care, then the simple answer is they might think twice
about having children and if they are foolhardy enough to, there is a
1 in 4 chance they get dinged with the cost of coverage.
Ultimately, any governmental (i.e. non-free-market) health insurance
plan must either explicitly discriminate between individuals or, if
universal, implicitly discriminate between individuals. The perverted
consequence is, ultimately, going to be a transfer of wealth from the
poor (via inflation) to those who have the right genetic
predisposition to conditions which are decided to be covered by the
powers that be.
Keep in mind that 'free market' != 'for-profit'. You can have
nonprofit insurance companies, and healthcare charities, in a 'free
market' system. What free market means is that the consumer has a
choice of where to go for their services. If you are saying that you
don't like 'free market healthcare' you are saying that in the
aggregate, the population is too stupid to make responsible,
cost-effective decisions about their own health. If that is the case,
who or what group of people could possibly be so enlightened and
all-knowing to correctly orchestrate all those choices from the full
society on down to the individual level? And how might we shield
society from the hubris of our godlike health chancellor/council?
> why don't you believe in a free market for health insurance? Forcing people to pay into a health insurance is kind of scammy - let's say that I have a genetic condition that is certain to kill me rapidly at age 30. I want to live my life to the fullest, and I'd rather not be forced to buy health insurance that protects me from things like adult onset diabetes, alzheimer's, cancer, parkinson's, etc, that I'm just not going to get. Why should I be forced to pony up for other people's healthcare, too?
Don't you think that your argument might be somewhat flawed if the most plausible scenario you can come up with is this?
I'm terribly sorry for you if you don't believe that protecting the rights of minorities and corner cases is important.
If you don't believe the section about minorities, then you are pulling a denial of science that is far worse than any climate science denier. There are two 'canonical' heterozygous recessive diseases that are covered in every high school biology textbook - cystic fibrosis and sickle cell anemia. Sickle cell anemia affects mostly people of west african descent. Cystic fibrosis mostly affects people of askenazi jewish descent. Sometimes I wonder why do we have high standards of care and treatment protocols, and are racing toward a cure for CF, while sickle cell anemia even has, an admittedly crude, known treatment (for a decade now) that still has languished in regulation. Why don't we have better research on SCA to figure out how to treat it?
...and the way to encourage research into SCA is to make sure most people that suffer from it are unable to pay for whatever treatment gets developed, by denying them healthcare? You've made the point that some diseases disproportionately affect minorities, but the step that gets us from "unaffordable healthcare"=>"treating more minorities" seems lacking.
> Why don't you believe in a free market for health insurance?
There are two main reasons. First of all, as someone mentioned it in another thread here a few days ago, healthcare does not follow the rules of supply and demand, since people would pay anything for survival. You're never going to say that "ah this treatment is a bit overpriced; I think I'll get more value for my money if I'll just die instead". It's ridiculous. Second, there are various domains where the short term interests of various parties do not coincide with the long terms interests of everyone, hence regulation is needed. This is not political theory, it's game theory, it is nothing to do with personal opinion. It's a fact.
> Let's say that I have a genetic condition that is certain to kill me rapidly at age 30
You probably don't want to die then at 25 after not receiving a treatment after having car accident.
> Why should I be forced to pony up for other people's healthcare, too?
It's called compassion and it is a cornerstone of our civilization.
> The more insidious thing about universal healthcare is that it really screws over most minorities.
I don't know about that. I am not a doctor so I don't know whether such conditions really exist, but my gut feeling is that almost all of the stuff people get treated for are universal across various minorities.
> What if those who decide health coverage decide that heterozygous genetic condition X is covered...
I think this must be a fundamental, antagonistic difference between our world views. As a European conservative, I truly believe that no life is unnecessary, no life is wasted.
> ultimately, going to be a transfer of wealth from the poor (via inflation) to those who have the right genetic predisposition to conditions
Most of the things people get treated for have nothing or almost nothing to do with genetic conditions. There is no gene for suffering a car accident. While having unlucky genes could decrease the chances of survival, ultimately everyone can get cancer.
While I agree with some of what you say, I take issue with the following:
> You're never going to say that "ah this treatment is a bit overpriced; I think I'll get more value for my money if I'll just die instead".
No one is rationally arguing this. The free-market point-of-view is that multiple providers will offer you treatment, and you can select, based on quality, price, provider's reputation etc. etc. what best fits your needs.
Over and over in this debate I see this fallacy that a free-market system says "You pay this price or you die." If a procedure can be made cheaper or more effective, a variety of providers is going to scramble to provide it.
The difficulty we face in the U.S. is that there is no real competition in healthcare. As others have pointed out, the people making the purchasing decisions are not the people with a vested interest in the affordability and quality of healthcare, and price/quality signals are obscure at best, and typically hidden altogether.
You, as a consumer, can't make rational healthcare decisions when your insurance is selected by your employer, your doctor is chosen by your insurer, and your treatment is chosen with an eye toward liability rather than effectiveness.
1. Health care does follow the rules of supply and demand. It's erroneous to claim otherwise.
2. Many if not most health care costs are not emergency services, and they include many elective non-emergency procedures, diagnostics, mental health issues, drugs etc. A lot of costs come from behavioral choices and are preventable by responsible individuals.
"Emergency care represents less than 3 percent of the nation’s $2.1 trillion in health care expenditures while covering 120 million people a year."
3. Regarding compassion - Hospitals are not staffed with nurses, doctors, advanced medical services based on compassion -- all that costs money, labor and raw materials, and takes investment, education, specializations and entreneurship- all of which are not achieved through compassion.
Economics and finance applies regardless of intention (ie. compassion).
"Most of the things people get treated for have nothing or almost nothing to do with genetic conditions."
Almost completely incorrect. Got the flu? Well that's because the flu virus latched onto a receptor that let it get into your respiratory cell. That receptor could be mutated in you.
Got into a car accident? The surgery is painful. They're going to give you an anaesthetic. Your response to the anaesthetic is going to be governed by genetics. The pharamacokinetics - how much anaesthetic you'll need - governed by genetics. Maybe the current standards of care will kill you.
"While having unlucky genes could decrease the chances of survival, ultimately everyone can get cancer."
Thanks for making my point for me. Cancer is extremely genetic. Got a mutation in BRCA? You're going to have an elevated (or possibly reduced) risk of breast and prostate cancers. And especially, individual cancers' response to drug treatments is going to be partially stochastic and highly dependent on the underlying genetics.
"As a European conservative, I truly believe that no life is unnecessary, no life is wasted."
Hypothetical: You see, I'm a biomedical engineer (true). Let's say I build a machine that can keep anyone alive. The machine is great, the quality of life for the user is awesome. And it's such a great machine, it works indefinitely. Here's the catch. To operate the machine takes 400 barrels of crude oil a day. There's no way around this. Now. If health care is a right, and no life should be unnecessary or wasted, then do people have a right to this machine?
Just to be clear, I don't think that no life is unnecessary or wasted, I just don't think that health care is a right, and I think that people need to accept the fact that they are going to die someday, and it's not such a horrible tragedy if medicine cannot save them, even if a possible cure existed and the only reason why they couldn't get access to it due to money. Obviously, I am not heartless and I think that situation should be minimized, via charitable actions - and I think that any system that tries to cover everyone will wind up costing everyone more and having rapidly diminishing returns in the face of reality, and will also really screw over corner cases. If such a system has the capacity to appropriate money from people against their will and the authority to make decisions for people, then the costs and the injustices will pile up even faster.
you know what. I know someone is going to criticize me for my hypothetical. So I'm going to just say, this is not far from reality (although it is not the reason why US healthcare costs so damn much). In 2004 Novartis reported that they were making the anticancer drug discodermolide. From scratch. (http://pubs.acs.org/doi/abs/10.1021/op034130e) This process started from petrochemical feedstocks and largely used chromatographic purification steps. According to FDA regulations, chromatographic media must be discarded after each use and basically cannot be efficiently recycled. The amount of resources that went into producing 60 grams of this drug is staggering - keep in mind that it is estimated that in the known universe only about 6 milligrams total of the material exists. Unless this was some sort of sick PR stunt, Novartis clearly thought that in the short term it could actually make enough for this drug to be profitable (it failed phase I trials on safety grounds, which gives you an idea of how bad an idea this was in the first place since to fail a safety trial on a cancer drug means your candidate really sucks). But the question of long-term sustainability of medical care is going to become very real in the not too distant future, whether or not this country and others gets the cost of our medical care down due to its structural problems.
Whether or not we like it, the issue of health care rationing is going to but up against the problem of limited global resources.
>It's called compassion and it is a cornerstone of our civilization.
compassion does not occur when someone forces you to pay into a system. If you want to be compassionate, pay out of your own pocket. Do not take out of someone else's pocket for charity and pat yourself on the back for being 'compassionate'. That is the opposite of compassion, it is total selfishness.
> Why should I be forced to pony up for other people's healthcare, too?
This entire argument is predicated on the idea that people who decide not to buy insurance will actually stay home when they get so sick that they feel their life is in danger, instead of going to the hospital.
History has shown that's not the case; they end up in the emergency room with no insurance, and end up being a cost that hospitals have to recoup via higher rates for the people that have paid for their insurance.
"History has shown that's not the case; they end up in the emergency room with no insurance, and end up being a cost that hospitals have to recoup via higher rates for the people that have paid for their insurance."
No. That is not "history". This is a recent phenomenon. This sort of thing was not generally occurring 30 years ago.
Affordability was quite different 30 years ago, perhaps that's why this is a relatively recent phenomenon. It doesn't really matter what the situation was 30 years ago though, because the trend over the past decade has been that uninsured people go to the emergency room when they're very ill.
I assume they didn't lay down and die at home 30 years ago either.
"the trend over the past decade has been that uninsured people go to the emergency room when they're very ill."
I really don't understand that. I was unemployed for a few months last fall when I went to go take care of a friend who was dying of cancer, and during this time I got a really terrible case of giardia from drinking poorly purified tap water (the US is rapidly becoming a third world country). I went to a local medical clinic and got to see a doctor the same day, for about a half hour and it cost me $35. Heck, I even offered to pay the actual cost of $55 but they insisted i pay the lower rate because I was unemployed (I think they get some extra kickback from the local government if they report unemployed people coming in). The wait was relatively short and I got a scrip for a drug that worked. The clinic really did a good job of taking care of low income individuals at very reasonable cost.
I'm really not certain why there is such a need to go to emergency rooms when there are great places like this. Are people just misinformed about their options, or are places like this few and far between? I don't know.
No, they went to emergency rooms, and got pro bono care. It wasn't even charged to someone else's account! Or they worked out simple payment plans directly with the hospital.
Do you genuinely believe that pro bono care comes at no cost? That the doctors and nurses opt not to get paid for the time that they deal with people who don't have insurance? That the electricity company doesn't charge to keep the lights on when there are uninsured people being cared for? That the landlord says "eh, 20% of your patients didn't have insurance, how about a reduction in your rent this month"?
Simple payment plans don't really work out when an emergency visit to the hospital can easily cost more than $100,000.
of course I don't believe that. The question is how best to handle that cost? Through voluntary action or through an inefficient behemoth of a bureaucracy. I'm going to get overtly political here, but I have to say: I cannot honestly believe that a country that fails to successfully take care of osama bin laden without slaughtering millions of innocents along the way, has any hope of managing something as delicate as individual healthcare needs for 300 million.
Our healthcare market is arguably freer than that of other industrialized countries. Our quality of health care is much, much worse, although I'll grant you that the much larger standard deviation means that the outcome is sometimes better (which is why the very rich like to come here for their healthcare). Generally, when somebody argues that the reason a given approach has failed is that it hasn't been tried hard enough, they're laughed at.
More specifically, if you've never had a child with a serious illness (such as my son with kidney disease) and you haven't tried the healthcare systems of several countries (as I have), then your opinion is worthless as well as illogical. Try comparison shopping in situations where you really fucking need it, then get back to me.
That is a very strong statement. My point is you haven't proven it. I certainly sympathize with your situation, but neither that nor your evidence prove that the free market is impossible according to the laws of reality. Just don't overstate your position.
> Generally, when somebody argues that the reason a given approach has failed is that it hasn't been tried hard enough, they're laughed at.
I know - I would say the same thing about socialism.
> Our healthcare market is arguably freer than that of other industrialized countries.
It's not one dimension. Maybe the way in which the US is not free causes the problems that aren't seen in countries with more powerful rulers. We have to look deeper than one dimension.
I disagree. The above post does not add anything but propaganda to the discussion. The US has had decades to prove what the poster said was true and utterly failed. "Scammy socialist" health care has utterly won.
No, you don't get to call something propaganda just because you disagree with it. Plenty of people can come up with proof for all sorts of points of view, I don't think you're special here.
Edit: The other side can say the same thing, and now you're stuck with two ends who call each other propagandists and thus refuse to take each other seriously, which is a stalemate. What good does that do anybody?
No, again, there is no "other side". There is no first world country that has anything approaching a "free market" health care system. I'm not aware of anything like that working anywhere in the world at all.
So, yes, someone jumping out and saying "duh, people sure are stupid, of course we should be using <insert something that has never worked anywhere it has been tried>" is not "just an opinion to disagree with", it's propaganda.
I disagree with the parent (I think health insurance should be mandatory), but I upvoted the post because I think it contains several arguments that add to the discussion (for example the part with minority health issues being less well researched is correct), and because I dislike the practice of downvoting a post based solely on whether one agrees with the expressed opinion or not.
As soon as you start to factor in all the costs of insurance, etc., doing business in the old Europe is pretty cheap. Even in Denmark, where I lived and worked for a while, you get everything included from the state and as a startup founder, this is really great.
I believe in free market for a lot of things, but not for health insurance.