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Just been dealing with the pharmacy and our health insurance
Can anyone give me an example of ANY problem that we'd have with socialized medicine that we don't have right now with our current health care system?
I mean, if I'm going to have to go through byzantine, bizzare, arbitrary bureaucracy and have to bang my head against walls and argue with people to have simple, commonsense health care taken care of, I'd like to at least know that it was available to everyone.
I mean, if I'm going to have to go through byzantine, bizzare, arbitrary bureaucracy and have to bang my head against walls and argue with people to have simple, commonsense health care taken care of, I'd like to at least know that it was available to everyone.
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As for 'making it up whole cloth'. No, I'm not. Many socialized systems of medicines assing you a health care provider. They assign what services are available. In many, you can't even opt to pay for additional services. That wouldn't, after all, be fair to let the rich jump in line. And even when you can go see another doctor, you've got a long wait ahead of you. So, I think the analogy of decreasing choice even further is legit. Is it partly theoretical? Yes. But I don't think it's farfetched either. Unless you've got a specific plan you want to present, it's a bit hard to refute something as nebulous as the original post.
As for your points 1 and 2, mobility has nothing to do with it, nor the example of 'school choice' you give. I'm pointing out that your choices get even further narrowed by government intervention. It is -always- what happens, both with socialized systems abroad and with other fields where we have tried it at home. Show me one system of socialized medicine where people have shorter waits, more treatment options, and more choice in providers than we do here.
America offers the highest quality health care in the world. It isn't perfect, and I'd like to see some changes to make it better. But socializing it isn't going to do that. It will make it worse.
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Who do you mean by "we"?
Lis and I had exactly one choice in health care provider for our psych meds. And it wasn't the doctor we wanted to see, it wasn't someone we'd ever heard of.
In what way do Lis and I have choice, when our insurance company directed us to see Dr. Bayard, with no other options?
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As for choice in your specific instance? I don't know. Can you choose different insurance provider? You also have the choice to pay out-of-pocket. Under a socialized system, there's no evidence to indicate you'd have more choices. And the OOP option would be diminished as the increase in taxes would eat up some of the income that could make it possible to use that OOP option.
I agree the current system is less than ideal. What do you think of the HSA idea? It would definitely provide you with more options than the current one w/o socializing things.
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The notion appears to be if individuals are paying out-of-pocket they'll economize and that individual consumers can negotiate better prices than collective groups. [This cartoon is one of the more cynical criticisms I've seen...]
Group insurance balances out costs among a large patient pool. In the last several years, for-profit insurance has been trying to cherry-pick their clientele, to only attract the healthiest so they can avoid paying for the people who truly need the health insurance. My gut reaction is that this kind of plan appeals most to the young and healthy, who anticipate few health expenses. [What *does* happen if something major happens and the account gets overdrawn? SOL? Or will there be a safety net? Too cruel without the safety net, and if there is an adequate safety net, why do we need the HSAs?]
Ian, if you want to do more reading on this, I've got a mess of links for you, though I haven't sifted them for quality or authority, but we've got some further reading if you're interested.
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My first job with medical insurance came when I was 24. Now, I don't think it would meet the average I sited above so I'm going to assume it was only paying 2k a year in ins. premiums. I was on that job for a year, but I didn't go to the doctor except for a routine check up. The cost billed to the insurance company was 60.00 + my 15.00 co-pay. That's 75.00. There's also the premium for catastrophic health insurance. Let's say around 400.00 a year.
So let's say I had an HSA. I'd have had 2000.00 in the bank because I was young and didn't contribute. I had to take out 75.00 (we're going to assume no price drop due to HSAs) and that left me with 1925.00. I went to the dentist twice at 60.00 per visit. So that's another 120.00 deducted. That leaves me with 1805.00. Take out the catastrophic and we're down to 1405 At this point, I could take the money out and pay normal income tax on it. Or just leave there. I'm going to leave it there.
The next year, I changed jobs. Now, it took 3 mo. for my ins. to kick in. But with an HSA, I'd have been able to keep that 1405.00 and use it if something happened. Nothing did, and at my new job my healthcare contribution was probably higher than average. But I'm going to use the average number of 4K a year. Now, I only got 9 mo. of coverage that year, so that's 75%. That means 3k. My HSA now has 4405.00 in it. Less the same 195.00 for physical and teeth cleanings. That leaves us with 3810.00 after the catastrophic.
I stay in the same position for another year. I get the full 4K and I haven't used any of that money again that year, save for the same check up and teeth cleanings. So I'm at 8005.00. Then, disaster strikes. I lose my job. Fortunately, that 8005.00 is mine. I start doing contract work, so my real dollar income is up, even if my benefits are down. I don't add more to it, reasoning I don't know if this contract thing is going to work out and I need to pay my bills. I forego one teeth cleaning and the checkup, so I'm still at 7910.00. Maybe not too smart, but I'm 27 and healthy and in reasonably good shape so I take the gamble.
(More coming in an additional reply)
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My next year at UPS, I go to the doctor once for a sore throat. So that's an extra 80.00 visit added to my normal 195.00. So I'm down to 6690.00. Add in my annual 5k and I'm up to 11,690.00. That's a pretty good little hedge.
I change jobs again. My insurance is about the same as UPS and kicks in after 30 days. That was almost a year ago so I'm going to assume the year is finished for purposes of this example (and because this is getting long). This year I've been to the doc. twice besides a checkup. That's 375.00. I spent another 300.00 on a chiropractor. So that's 675.00. I only get 4583.00 this year due to losing a month. That leaves me with 15,990.00 sitting in HSA.
Now, I've not bothered figuring interest. Or taking out costs of meds as I didn't really spend that much on meds. I think, once since I started working 7 years ago I got a prescription medication, so I'm going to call that even. Regardless, I'd be sitting with almost 16K in an account and should I start having medical problems I can use that, and if it gets near the bottom, I can use my catastrophic insurance, say if I get cancer or have a heart attack or something like that. This ignores my wife's income and insurance. My point though is this: if people have it, they have their 20s which are typically low health-care expenditures to build up a cushion so that as later in life problems get more serious/expensive/likely, they are better prepared to handle it.
Now, I don't know Ian's finances or medical expenses. But his major complaint seems to be choice. And HSA would undeniably give him more choice than he currently has, at no additional expense to himself or to anyone else. It's just removing some of the blocks on money that's already there, freeing it up to go where it is treated best, as defined by Ian instead of a pencil-pusher in the gov't or at some insurance company.
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First is that "young equals healthy."
There has never been a year of my life in which I've consumed less than a thousand dollars of health care. And most years have been significantly more. My medications are over $200/month alone. And have been for most of my life.
In addition, I've never earned more than $10,000 in a single year.
Under your plan, I'd be dead.
Now, this may or may not be a downside of your plan from your point of view, but I assure you that, from my point of view, it is. I'm afraid that I cannot support any plan under which I'm dead.
Another assumption that you are making is that I have the ability to make better decisions about my own health care than a pencil pusher in the government or at some insurance agency.
Why? Actual assignment of health care risk is a significantly complex technical specialty. Why would I be better at it than someone trained in it?
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Why would you be better at it than a pencil pusher? Precisely because it would be your life on the line. I think you're perfectly capable of picking a doctor or other health care provider that will meet your needs.
I did make a presumption though, that if someone has insurance of some kind from their work, they'd be able to use that money for an HSA. Or to choose their own healthcare instead of having to go with what their employer provides.
Another point I didn't make is that if someone with an HSA takes money out for non-medical purposes, they'd have to pay an income tax on it. As benefits of this kind are currently taxed, that additional revenue could be channeled into helping people who are having trouble. You well know I'm not fond of taxes, but I'd find that tolerable as a) the subsidy is self-selecting b) the self-selectors are people taking risks of their own choosing.
I'd also presume that necessary medical treatment would be provided as it is now. The problem with socializing systems like this is that it doesn't bring the people at the 'bottom' up, it just drags the people in the middle down and makes it even worse for the people at the 'bottom' and I don't think that helps anyone.
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One of Gladwell's commenters made an excellent point:So which is preferable: everybody gets (say) 70% of what they want, or the top 1% gets 100% of what they want because they have the money for it, most people get (say) 60-80% of what they want, and 20% of the population gets nothing
Mind you, the richest of the rich will always be able to get what they want. That's true in medicine, that's true in other aspects of life. Even when abortion was illegal, wealthy women could fly abroad to get abortions, while poor women without those opportunites couldn't, regardless of who had the more meritorious case.
Also, the costs of insurance in this country, private and company-provided, are rising faster than inflation. Just to break even, companies are increasing the amount the employee pays anad reducing the benefits. We're all paying more for less. And why? One of the reasons is because insurance is a for-profit industry. Their primary goal is making money, not public health. Another reason healthcare costs are so high is because of all the uninsured people, who can't afford preventative maintenance so only get care when matters become acute enough to require a (much more expensive) emergency room visit. And since they can't afford that either, those costs are distributed to the rest of the patient population.
One last point: employer-provided healthcare puts us at an economic disadvantage with foreign competition. Domestic manufacturers must pay for their workers' insurance, which invariably means they have to charge more than foreign companies whose healthcare costs are absorbed by the government...
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As for the 'for profit' motive, name me a government program that has decreased in costs over the years? Yeah, didn't thinks so. That argument won't carry any water.. There are problems with the current insurance scheme. I've suggested an alternative that won't cause scarcity the way socialized systems proveably do in every case.
The largest problems with increasing healthcare costs are the overhead from filing insurance. This is a bureaucratic cost that a government run system would only increase. The second is from people like the Prell Girl who file ridiculous lawsuist, use junk science to award their clients millions and thereby drive malpractice insurance costs through the roof, and lastly the cost of uninsured emergency room visits. HOWEVER, the largest chunk of those who use the ER for healthcare and are driving costs up there are illegal immigrants. Not poor citizens who are eligible for medicaire and medicade.
Lastly, where the hell do you think the money comes from for 'the government' to pay for that healthcare? Do you think the congress can just defacate the extra money into their hand? That money has to come from somewhere. Which means taxes. Which means that more money is taken from the wealthy and corporations that already pay more than their fair share. And that's money that isn't invested in capital and expansion and innovation and research. The increased costs of regulation and the stifling effect on innovation that government run systems always create would far outstrip any competitive drag healthcare costs are having on our companies. Besides, the HSA solution answers this far more effectively than would socializing.
Further, if we follow this line of thinking, why not just close down the grocery stores and turn that over to the government. Everyone needs to eat, right? How about housing too? Let's make that government run. Then we can all live in wonderful places like Bed-Stuy or Cabrini Green. Oh! Oh! Clothing, let's let the government handle clothing all of us. We can all be dressed in the latest Wal-Mart fashions then.
The biggest reason not to socialize healthcare is this: It isn't the government's job to provide for your needs. When government tries to do more than that it is immoral, because it must take from one group to give to another. And that's wrong. Wether you're pushing fundie christian biblical precepts or east coast progressive social justice, using the force of government to make other subscribe to your morality is immoral.