No, ‘Every Other Developed Country’ Does Not Have Single-Payer Health Care
How often had you heard that “every other developed country has single-payer health insurance”? So often that I have lost count. How often have you heard that those single-payer health systems provide superior health care at lower costs? Again, so often that I have lost count.
Yet when you actually start to dig around, you discover that there is a wide range of health care systems in other developed countries — and many of them are not single-payer at all, at least in the way that Britain or Canada is.
Singapore, for example, has a mandatory savings system called Medisave, similar in purpose to the Health Savings Accounts that Americans are encouraged (but not required) to open. And while the Singapore government does pay for basic health care, it also allows patients to spend their own money to upgrade their hospital rooms. It also offers optional catastrophic health insurance. Not American-style, but definitely not single-payer.
Singapore also works aggressively to control behavior-related medical costs in a way that would lead to hyperventilating lawsuits in America. Homosexual sex is still an imprisonable crime in Singapore — hence, relatively low AIDS rates. Singapore is also the world’s top executioner, at least partly because various drug dealing charges carry the death penalty.
It’s a pretty controlling place — they only recently legalized chewing gum. I suppose if we were prepared to exercise that level of control over our population, we could also get our health care costs down.
Germany is another country often touted by the single-payer advocates, but it isn’t single-payer, either. About 92 percent of the country has health insurance that private employers are required to provide, with peculiarly enough, civil servants and the self-employed using private health insurance (which is apparently mandatory). Surprisingly, 0.3 percent of the German population is not insured at all: either the very rich and those so poor that the government directly provides health care.
What about health outcomes? It is very easy to assume that America is typical of developed nations, and thus our high mortality rates must be because we lack single-payer health insurance. We really aren’t demographically typical — some of those differences are genetic and some are behavioral.
Obesity is a major factor in determining mortality in morbidity rates, and Americans are more likely to be obese than people in other developed countries (although Britain is catching up fast). For example, 33 percent of American women are obese, compared to 19 percent of Canadian women. Is this cultural or genetic?
It may be both. In the U.S., 35.7 percent of blacks are obese, compared to 23.7 percent of non-Hispanic whites and 28.7 percent of Hispanics.
It’s great that somebody has finally taken the trouble to look at the facts!
A couple of facts come to mind: Denmark has a single-payer system, and life expectancy in Denmark is the same as in the USA. (It is actually shorter by a few months for Danish women than for American women.)
Mr. Cramer’s observations about the German system are accurate.
In fact, should the U.S. alter its approach, it wouldn’t be a bad thing at all to give some aspects of this system a serious look for applicability in the U.S.A..
One thing I’d emphasize about the German system is that, while citizens are “required” to possess health coverage, it does so in a way that
correctly understands the concept of “insurance” :
to spread the risk, with the objective of lowering costs for the individual.
The goal is mediocrity for this administration. We need to strive for the superpower status.
I lived in Europe (Sweden & France) for many years. Most Euro-govts have tried and backed off all-govt, all-the-time medical care (healthcare is another thing, you know). They started out with the pedal to the metal, now they’ve more or less got the pedal right for each nation’s statist precepts, but they run into eco-hills which can drastically change the ride on the ups and downs.
The only way to achieve the infinitely sensitive control on the pedal is to LET THE INDIVIDUAL DO IT, STUPID!
ALL kinds of insurance don’t spread risk, they encourage oversubscription to let other people pay for something you don’t need anyway, so that those who really need medical intervention get rationed or nixed entirely.
In individualist America we let you EARN AND PAY FOR WHAT YOU GET IN THIS LIFE!
one thing I never see mentioned but that should be is this.
When people complain about the increase in cost of Medical Care, they forget that Medical Care can cure and heal sickness and injuries that in the past would be untreatable and fatal.
IE, CNBC has been showing a factoid on the bottom of their screen showing that in 1970 7% of GDP went to health care, now it is 16%. What is not mentioned is that in 1970 if you had a heart attack, you died quickly, today you will live another 30 years but need follow up care.
The cheapest patient to treat is a dead body….
Clayton helps put the lie to the drumbeat from the left as they push single payer like a new religion. My favorite mantra the socialists repeat is the “Every other western industrial nation has national health care.” Think about that and what it means. I guess we are supposed to adopt the superior systems of France and Spain so that our unemployment permanently hovers at 10% or worse and we can all wait in line for a mediocre level of care.
A small minority of our citizens don’t have health care and want it. You don’t throw away the most innovative, high quality, health care system in the world to cover a small minority of citizens. You find a way to get them an affordable option.
Make sure that you write your congress person a personal letter or email telling them respectfully why you don’t want the trillion dollar proposal. Tell them why you like the coverage you have. My Congress person has heard from me several times.
3. Conservative1:
The goal is mediocrity for this administration.
the goal is not mediocrity. it is about full control.
You wouldn’t have a list of those alleged ills, would you?
I have been trying for decades now to get a Socialist to detail just what is wrong with the US health care system. So far, no takers.
The closest I have come is a vague whine about people getting left out. When I point out that EVERY health care system leaves someone out, that the difference in America is those left out are selected on the basis of money while in Socialized Medicine the selection is done by some bureaucrat on the basis of political correctness, the Socialist slinks off to whine elsewhere.
America has the BEST health care system in the World.
That statement can be supported by statistics as well as the long line of non-americans coming to America for health care.
It is expensive, the most expensive in the world. There is direct relationship between cost and effectiveness. You get what you pay for, especially in the field of medicine.
I have no objections to socialized medicine. I object to the way it’s being sold to America and it’s citizens.
The advocates of socialized medicine are claiming that the citizens will get the current high standard of medicine for a reduced cost. A Lexus for the price of a Cobalt. Who wouldn’t want that? It is called bait and switch and it’s illegal.
What we have here is an administration that is willing to use illegal sales tactics to defraud the American Citizens.
Eventually the American citizens will figure this out and there will be ‘ell to pay, Berry.
Since the average American would back up if it was explained to them that the cost of health care will go down as the same rate as the quality of that health care goes down, this administration doesn’t want to do that. Instead they are using bait and switch on the citizens and good old fashioned Chicago arm twisting on the congressional representatives of those citizens.
WHY? What is their goal? It’s not health care. If Health care was the object, then they would be working on a way to pay for what we got now. No, there is some other objective here. I’m not smart enough to figure it out……Yet.
More data please. Explain to me what is wrong with the current, state of the art, top of the line, health care system we have.
Higher infant mortality rates are strongly correlated to illegitimacy, and the US has A LOT of that.
Higher adult mortality rates are correlated to higher homicide rates, and the US has more homicide than most developed countries. Our healthcare system is not to blame for murders.
Asian societies are more conscious about the quality of their diets. This too, is another behavior related data item that has nothing to do with the medical system. Most of the higher costs of the American systems are related to awfully heavy litigation costs and end of life costs (not AIDS and drug use). Other countries are not so litigious – again behavior related.
There’s plenty of behavior modification we can do to control costs and mortality. But will we?
Infant mortality statistics are also skewed by the way in which they are collected. US rates are inflated (or other nations’ deflated) by the fact that most other developed nations write off as “stillbirths” what in the US would be live births followed by infant deaths. Depending on the nation, infants that don’t live for X days, or die in NNICU, or were born premature, never show up in the infant-mortality stats.
It’s also worth mentioning that IM and median life-expectancy are useful rough guides for judging Third World nations, but statistically pretty useless when it comes to developed nations, which are crowded into a pelleton right at the top. If you instead start to compare first-world outcomes across a broad range of treatable medical conditions, the US consistently comes out ahead.
A small minority of our citizens don’t have health care and want it. You don’t throw away the most innovative, high quality, health care system in the world to cover a small minority of citizens. You find a way to get them an affordable option.
A government health insurance pool (not subsidized by taxes) might be one approach, with a refundable tax credit equal to the cost of that coverage would provide a way to make sure that those who are too poor to buy health insurance could do so. To raise the money to pay for this we would probably need to tax employee provided health insurance benefits that exceeeded that level. There’s really no reason why health insurance benefits are not taxed, while salaries are.
But I’m even less happy with the way in which advocates of single-payer falsely portray hybrid systems as “single-payer” and the differences in health care outcomes as entirely the result of differences in the health care system.
It is simplistic, and I do believe the objective of Obamacare is, by and large one of control rather than one of care and would lead to the destruction of competition in the marketplace.
Paul Ryan (Wisconsin congressman) seems a very bright & engaged guy.
Paul Ryan torches ObamaCare on MSNBC
Clayton,
Thanks for the additional posting. I would need alot more detail before I would agree to tax benefits. If the system stayed completely private and if Medicare and Medicaid were eliminated and replaced by a private insurance coverage, I might agree.
Thank you for your information which aids understanding and discussion.
The closest I have come is a vague whine about people getting left out.
There are two serious problems with the level of uninsured in America, and you don’t even have to be a whiny leftist to be concerned about these problems.
1. People that aren’t insured are still getting health care–but those of us who are insured are subsidizing those who are not insured. Public hospitals get the money from taxes; private hospitals get it from cost-shifting onto the insured. At least some of the uninsured can afford health insurance, but see no reason to pay for it–and why should they? If you are young, in good health, you know that a real emergency will get you health care.
2. Because so many of the uninsured are using emergency rooms for what should be done through a primary care physician, it is terribly inefficient, and costly medical care. Even worse, waiting until someone is so sick that you take them to the emergency room means that some problems that could be solved before things get bad–aren’t. This is inefficient, causes great suffering, and drives up health care costs.
Infant mortality rates are not reported in
a standard way. Many countries do not report
extreme underweight or certain date premature
deaths. There is no common yardstick. The
US reports all births and since the above
examples are most at risk suffers in comparison.
The source of information is also suspect-
notice Cuba will always report a lower than
US rate-try to verify that independantly.
No argument the statistics from the Black
community inflate the US figures.
The government should be the insurer of
last resort to provide quality care to those
who fall through the cracks in an easy to
understand unified fashion and to guaranty
a basic standard of care for all.
I would need alot more detail before I would agree to tax benefits.
Ask yourself: would you rather tax health insurance benefits above, say $400 a month (about the level required to fund a basic group health insurance system), or have the government running our health care system?
If the system stayed completely private and if Medicare and Medicaid were eliminated and replaced by a private insurance coverage, I might agree.
When pigs fly. Medicare is sacrosanct, because the elderly vote at about twice the level of the general population.
It would be nice if the article had gone one step further and actually compared costs of those single payer/hybrid systems. How are these government-run systems funded?
There is no such thing as “free” medical care. It is going to cost someone something at some time or another. Perhaps the unemployed n’er-do-well who is satisfied with living at poverty level won’t pay anything, but his tab will be picked up by someone else, via taxes.
It would have also been helpful if the article talked about litigation and tort reform. Since our (lawyer) legislators seem reluctant to include any kind of tort (litigation lawyers) reform into the bill they are drafting, it would have been great to see how these other government-run systems handle litigation against doctors, hospitals, and pharmaceutical companies.
Tanstaafl @ 12,
You and many others are putting your finger right on what it is about. Additionally, it’s about the President’s legacy. It’s funny, but Clement Atlee the PM who socialized Great Britain is not revered in that country as a national hero. The President doesn’t seem to understand that if he does these socialist agenda items he will not likely be revered or loved.
Over time the European nations have begun to back away from government control. Both Sweden and Norway have reduced the amount of the governments consumption of GDP over the last 10 years or so. They understand that a vibrant private sector is necessary for revenue production. The President and his liberal friends in Congress don’t understand how this economic relationship works. They don’t understand the dynamic. To them it’s a zero sum game where the private sector must be punished to create a fellowship of the miserable. They don’t realize that if the private sector expanded,its creation of excess tax revenue could be siphoned off to fund all their do good ideas and voters probably wouldn’t care.
In the long run we are lucky they think so staticly. If they understood, conservatives would be in real trouble and out of power for a very long time.
Cramer: “To raise the money to pay for this we would probably need to tax employee provided health insurance benefits that exceeeded that level. There’s really no reason why health insurance benefits are not taxed, while salaries are.”
Perhaps because the employer has already adjusted the employees wages to compensate for the cost of the health insurance. For example, the insurance may cost $400/month. The employee could potentially make $4,000 per month, but he actually will make $3,600.
Taxing health benefits (the word itself, “benefit” denotes a gift or bonus) would be to punish the middle class, yet once again, as they are the ones working in the type of jobs that provide these benefits.
Clayton,
I agree that medicare can’t be removed. I was speaking idealisticly.
Government policy creates alot of the market distortions. People see rising cost and don’t understand that we can now treat conditions that you would die from 20 years ago, but it is very expensive. Government control of cost will kill incentive, competition, and innovation. I want more of those three things, not less. In every other industry those factors are beneficial. Health care is no different. The government could mandate portability and no denial for preexisting conditions and create a tax credit for obtaining insurance on a more individual or family basis. That would push more insurers into the market. It would also allow me to bargain better for care than I can now.
Taxing health benefits (the word itself, “benefit” denotes a gift or bonus) would be to punish the middle class, yet once again, as they are the ones working in the type of jobs that provide these benefits.
The proposal that both Bush and McCain made involved taxing health insurance benefits that exceeded $5000 a year. This means that most people’s health insurance benefits would probably not be taxed. I pay $374 a month right for COBRA continuation coverage–so that’s a pretty good indicator of what my former employer was providing me in terms of health insurance benefits. Many employers don’t even provide coverage that expensive.
There is no such thing as “free” medical care. It is going to cost someone something at some time or another. Perhaps the unemployed n’er-do-well who is satisfied with living at poverty level won’t pay anything, but his tab will be picked up by someone else, via taxes.
1. Not everyone who is uninsured is an “unemployed n’er-do-well.” Many are people who are working, but perhaps not well paid. Some are people who had good jobs, but can’t find employment now. I’m on COBRA continuation coverage right now; come May, I will be looking at having to buy individual health insurance for at least twice the cost of group health insurance. The government has set things up right now to make it effectively impossible for group health insurance plans to be set up outside the context of employment or labor unions.
2. There are a lot of people who can’t get coverage because of pre-existing conditions. This doesn’t make them lazy; it makes them unfortunate.
It would have also been helpful if the article talked about litigation and tort reform. Since our (lawyer) legislators seem reluctant to include any kind of tort (litigation lawyers) reform into the bill they are drafting, it would have been great to see how these other government-run systems handle litigation against doctors, hospitals, and pharmaceutical companies.
There’s no question that litigation plays a part in our health care costs, especially doctors over testing, to make sure that they won’t get sued for having missed a problem. But I’m skeptical that this is a major cost. I understand that limiting pain and suffering awards to $250,000 in the Medical system had no significant impact on malpractice insurance costs.
Perhaps because the employer has already adjusted the employees wages to compensate for the cost of the health insurance. For example, the insurance may cost $400/month. The employee could potentially make $4,000 per month, but he actually will make $3,600.
Generally, all fringe benefits (vacation, sick pay, health insurance, workmen’s compensation coverage, state disability insurance) are worth about 30% on top of your salary. But not being able to participate in a group health insurance plan as you get older becomes more and more valuable. If there were any permanent, full-time jobs for someone my age within 50 miles of where I live, I would jump at the chance right now.
“The government has set things up right now to make it effectively impossible for group health insurance plans to be set up outside the context of employment or labor unions.”
Would fixing just that solve a lot of the problem?
I know people who make a lot more money than me and are uninsured. They could afford individual health insurance if they budgeted for it but they prefer to spend their money else where.
Clayton,
You are lucky to pay what you do. My employer pays about 16 K a year to cover my family of 4. I really like our coverage that has deductibles on visits and drugs, but covers the big things. I just recieved major life saving surgery from the best surgeon in our region of the country. The out of pocket has come to about 1500 so far. I have not seen the surgeon’s bill or that for the hospital stay but it must be immense. In my oppinion that is how health insurance should work. We pay for the smaller stuff and the insurer covers the huge expenses.
As long as this discussion with the author is rolling along, let me ask this. How does the government get around Dr.- Patient privilege which seems to be violated repeatedly by Congress’ various plans? Every code of evidence I know of contains this privilege which would be violated or “waived” if the government was a repository of health care info on each American. The potential for abuse is great. I am very uncomfortable with this intrusion. What say you?
Most of Americans want the reform of the medical care. But make no mistake about it – conservatives are against DUMB reforms, reforms that will make things worse.
Here is a nice summary of how a medical reform should proceed. Just 5 steps, and the costs will be cut:
http://hyphenatedamericans.blogspot.com/2009/05/how-to-slash-medical-costs-in-6-easy.html
i was born and raised in germany. 1965 i went to the usa and became later a citizen. in germany there is “flicht versicherung” for people making up to certain amount of money. flicht versicherung means an obligation to have an insurance. after the base income people are free to have an insurance or can have a private insurance. the obligated insurance (flicht versicherung) for workers is called “Arbeiter Versicherung” and for office workers “Barmer Ersatz Kranken Kasse” . i was the member of both insurances! it is regulated that the worker pays halve the insurance and the employer the other halve. In case of unemployment or between jobs one caries still an insurance.if this system is not good enough for americans let’s make it better. my friend is a medical dr, they never would kill patient’s based on age or other reasons! their “Hypicratic Oath” would prevent it anyway. i like to know where these so called experts got the information from? if we would have started 15 years ago we would have 15 years of experiences and we could have improve it already. mr. bush would have done a good job?
i have another question. what kind of insurance company does congress and government workers have and who pays for it? they pay very little!
I, for one, would rather have a government bureaucrat between me and my doctor than an insurance company auditor between me and my doctor.
then not only are you a fool, you are a damn fool.
Canadians can also upgrade their hospital rooms.
It would save billions if our country would let dozens of Rx drugs go OTC. How many doctor visits are simply to get drugs? Why can’t an American walk into the pharmacy and buy Cipro, Valtrex, Steroids or Viagra? Just yesterday I spent 3 hours to get some earache medicine. In Mexico and many other countries all these drugs are available without seeing a doctor. Since Monistat went OTC, it has probably saved half a billion in doctor visits.
All the doctors have unlisted home phones and their recorded messages say “if this is an emergency, call 911″. How many billions does that cost?
FYI when antibiotics were introduced, the AMA got the whole system changed whereas before you could get practically anything from your pharmacist. The facetious reason was that we were too stupid to use them properly. They keep predicting that the bacteria would be able to evolve into superbugs, but to my knowledge, the only case of that happening, after 60 years, is because of the poor sanitation in hospitals.
29. Bill Menge:
I, for one, would rather have a government bureaucrat between me and my doctor than an insurance company auditor between me and my doctor.
OK, I’ll bite. Why?
“The government has set things up right now to make it effectively impossible for group health insurance plans to be set up outside the context of employment or labor unions.”
Would fixing just that solve a lot of the problem?
No, it would solve some of the problem. Sending illegal aliens back home would solve some of the problem as well. No individual fix solves everything–but we can start to tackle each of these items one by one–and each item could be a 30 page bill, not 1000 pages that no one but the lobbyists will read.
I know people who make a lot more money than me and are uninsured. They could afford individual health insurance if they budgeted for it but they prefer to spend their money else where.
There are certainly people in that situation. I cringe at making health insurance mandatory–but the alternative is to scrap the current requirement that all hospitals provide emergency care regardless of ability to pay.
if we would have started 15 years ago we would have 15 years of experiences and we could have improve it already. mr. bush would have done a good job?
President Bush did make a proposal for a tax credit for health insurance (not the current >7.5% AGI deduction, which is far less generous) intended to assist the uninsured to get insurance. He also proposed repealing the current restrictions that prevent association health plans from crossing state boundaries, which would have simplified the creation of group health insurance plans for small businesses and trade groups. But special interests managed to prevent either proposal from getting through Congress.
FYI when antibiotics were introduced, the AMA got the whole system changed whereas before you could get practically anything from your pharmacist. The facetious reason was that we were too stupid to use them properly. They keep predicting that the bacteria would be able to evolve into superbugs, but to my knowledge, the only case of that happening, after 60 years, is because of the poor sanitation in hospitals.
Not true. Part of why augmentin is now widely used for sinus infections is because some of us managed to breed amoxicillin-resistant bacteria!
Every code of evidence I know of contains this privilege which would be violated or “waived” if the government was a repository of health care info on each American. The potential for abuse is great. I am very uncomfortable with this intrusion.
What? Our government abuse its authority? That could never be!
27. The problem is that not all doctors are ethical enough to obey the Hippocratic Oath. If they were, there would be no abortions for lack of providers (abortion is specifically banned in the Oath). The other problem is that if the Policy is enacted, the ethical doctors may have no choice but to retire in order to avoid partaking in the evils of the Policy. They can’t force doctors to euthanize patients due to age or disability, but they can keep doctors who refuse from being able to practice medicine at all.
Hi Clayton,
I missed this today but did read everything. A good post that I’d like to comment on later. I hope it stays up for awhile.
And it sounds to me like you’re starting to weave your way through the maze of buying private insurance as one of the self employed. Best to you and I mean that. It ain’t no picnic. And as you do so, please try to think of a diabetic or someone else with a pre existing condition going through the same process.
Last week the President attacked pediatricians for performing unnecessarcy tonsilectomies. I have yet to see any proof that this is anything more than a myth, or at a maximum, an extremely rare abuse.
I just learned that Ms Pelosi attacked the insurance industry claiming a conspiracy to do in the Congress’ fecklesss scheme to create a national medical fellowship of the miserable. This follows by a few months her groundless claim about the CIA repeatedly lieing to Congress about enhanced interogation.
If Democrats value their credibility they better get The Speaker back on her medication. Most Americans like the health care supplied by their insurer. That includes private insurers. I for one am happy with mine as are all 15 of my coworkers, most of whom happen to be liberals.
The Democrats appear less and less rational on Obama Care with each passing news cycle. They are lashing out and look desperate. How completely predictable. Americans are waking up and they don’t like the Democrat scheme one bit.
I have now learned that Reid, Durban and the other incompetent socialists who form the Democrat leadership cadre are claiming that the media created the August deadline that is going to pass without a healthcare vote in Congress.
Let’s set the record straight. It was President Obama who repeatedly stated that if something was not done right away we would suffer further crisis and our economy would wither ever more without health care reform immediately. He is the one who established artificial urgency. The MSM merely performed their usual role of reducing analysis of the August date to a “whose winning, whose losing” contest as the date approaches with no vote scheduled. The liberals did everything they could to get a vote, but were sunk by the blue dogs, at least for now.
The Democrats control every aspect of government by a wide margin. They have no one to blame but their incompetent leaders. If they want to throw away a sure thing they should make sure they pass Cap and Tax as well. Can you say 12% unemployment? Can you say mass exodus of US manufacturing employers? Talk about an unforseen tectonic shift to the Republicans in 2010! Aw, Ben Nelson and a few others will be too smart to let that happen.
What a bunch of buck passing bufoons. They are dealt a fullhouse and throw the pair in hopes of pulling the fourth face card. Then they try to blame others when their strategy fails. Pelosi, Hoyer, and Waxman stooges all. Aw,why do bad things happen to good people?
There is no way the US is going to transition to a fully government run single payer health care system. Even if the majority of people wanted to make the change, it would be way to complicated. Basically, the government needs to provide a way for people to obtain affordable health insurance, which is what the law makers are trying to do. The main reason we should do it is because as the richest nation, we should show compassion to the poor and sick. I also believe health care reform will keep American businesses more competitive. Who should pay? Each according to his means. The poor and middle class are feeling rather strapped these days. That leaves the richest Americans. Bill Gates and Warren Buffet have indicated that it is time shift some of the tax burden to the wealthiest Americans, and I believe them.
Medicare is sacrosanct, because the elderly vote at about twice the level of the general population.
This is one thing I do not understand: most Americans are against “socialized medicine” (rightly, in my opinion), yet they expect to be covered by Medicare when they’ll get old and will most need medical care.
Clayton Cramer:
being able to participate in a group health insurance plan as you get older becomes more and more valuable. If there were any permanent, full-time jobs for someone my age within 50 miles of where I live, I would jump at the chance right now.
… and this is another problem that I see with the current system: it discourages self-employment and entrepreneurship.
Logical lady at 41,
Here are two issues with your post. The government has shown over two trillion dollars in “compassion” since LBJ and the great society.The results are poor. The government has created a permanent underclass through this “compassion” and broken apart minority families. Some compassion.
You want to fund this by taxing the rich. These are the people who employ and invest in other people and innovation. They are not all as rich as Buffet and Gates, who are a tiny minority of the supper wealthy. When they are taxed they can do other things with their hard earned money.
Your compassion creates more misery. If you want to actually do something about poverty, I suggest you employ some people and include health care insurance as a benefit. That is true compassion on a measurable scale.
And it sounds to me like you’re starting to weave your way through the maze of buying private insurance as one of the self employed.
Yup. And while I was concerned about this issue, and aware of it, before losing my cushy job at HP, it certainly has sharpened my level of concern, no question about it!
I’ve been arguing for some reforms of the current system for several years now. I was disappointed that when Bush proposed one set of incremental improvements several years ago (with respect to AHPs), the combination of labor unions (who didn’t want small businesses to be able to provide non-union workers with health insurance) and health insurers (who didn’t want competition from a new set of interstate group health insurance plans) killed it in Congress. This is something that while largely driven by Democrats, also included too many Republican members as well.
Every one should take a look at Taiwan’s health care system.
http://content.healthaffairs.org/cgi/content/full/22/3/77
And two points I’d like to stress.
“you discover that there is a wide range of health care systems in other developed countries — and many of them are not single-payer at all”
Yes, but most are “some form” of a single payer/public plan.
“… and this is another problem that I see with the current system: it discourages self-employment and entrepreneurship.”
No question about it. And self employment and entrepreneurship are the backbone of our economy. I’m glad to see so many are beginning to understand this.
And best to you Clayton, in your journey to find affordable insurance. I went through the same thing with a daughter who is deaf and un insurable for her deafness issues. It sucked.
I, for one, would rather have a government bureaucrat between me and my doctor than an insurance company auditor between me and my doctor.
OK, I’ll bite. Why?
Because you can vote the government bureaucrat out of office if you don’t like it. He answers to you and doesn’t profit by denying claims or coverage.
The insurance company bureaucrat, on the other, you have no say. He answers only to the shareholders, who profit immensely by denying claims and only insuring healthy people.
Something I have never seen questioned I’d like to bring up.
Is there any evidence that doctors who enter into their field because of high pay are any better than doctors who enter into their field because they want to cure sick people?
It seems to me there is no shortage of med school applicants, and I fail to see the connection that higher pay draws better docs.
My neighbor is GP and makes 75K a year and is an excellent doctor.
Because you can vote the government bureaucrat out of office if you don’t like it. He answers to you and doesn’t profit by denying claims or coverage.
The insurance company bureaucrat, on the other, you have no say. He answers only to the shareholders, who profit immensely by denying claims and only insuring healthy people.
The problem is that you, individually, can’t do anything about that bureaucrat. If lots and lots of others who feel shafted agree, yes, you might be able to vote out whoever is President–but that won’t probably change the bureaucrat, and it is uncertain whether it will cause any policy change. At least if you have an individual health insurance plan, you have some hope of changing to a plan that you are happier with, and without having to get 51% of the population to agree with you.
Of course, changing plans isn’t easy, and if you have a pre-existing condition, perhaps not practical. But it is easier than voting out a government that has made a bad decision that only affects you and the other 400,000 families with a deaf child.
Is there any evidence that doctors who enter into their field because of high pay are any better than doctors who enter into their field because they want to cure sick people?
It seems to me there is no shortage of med school applicants, and I fail to see the connection that higher pay draws better docs.
My neighbor is GP and makes 75K a year and is an excellent doctor.
If someone wants to become a doctor primarily to get rich, maybe he wouldn’t be a great doctor. But getting there is a long process. Undergrad premed is tremendously high pressure; when I was a chemistry major, many of the other students taking freshman chemistry were premed, and not surprisingly, they were not thrilled to have me screwing up the curve for them. (The first three exams I scored 100, 100, and 94; the class averages were 46, 43, and 38.) At UCLA, where a friend was premed, premeds were sabotaging each other’s chemistry lab experiments to lower the class averages.
Medical school is incredibly demanding; residency is hard (abusive, actually); and there are huge debts associated with completing medical school.
Once you start working, you know that at least occasionally, someone is going to die because of a mistake that you make–or at least, the next of kin are going to believe that your mistake caused it.
Tell someone who has the ability to be a doctor, “When you complete all this struggle, you will make the same money as a computer geek–but with no prospect of getting rich in a startup.” And why should they work so much harder?
Money isn’t everything, but if you have to work as hard as a doctor to get there, there better be something of a reward for the hard work.
Because you can vote the government bureaucrat out of office if you don’t like it. He answers to you and doesn’t profit by denying claims or coverage.
Yeah, and you can ask your employer to switch insurance providers to one who will cover the claim. Also, what guarantee do you have that you, specifically, will be able to vote that bureaucrat out of office?
Your view of how government bureaucracy works is child-like in its innocence. As Mark Twain allegedly said, “Never lose your illusions. They are all you really have.” He may well have been thinking of you.
That leaves the richest Americans. Bill Gates and Warren Buffet have indicated that it is time shift some of the tax burden to the wealthiest Americans, and I believe them.
It’s too late: the top 1% of taxpayers pay about 40% of all income taxes.
“At least if you have an individual health insurance plan, you have some hope of changing to a plan that you are happier with”
Not really. Most have no choice of their insurer. It is chosen by ones employer.
And the self employed? It’s nearly impossible to change. And if you have less than perfect health it is impossible.
And let’s focus on the second part of my claim.
The insurance company bureaucrat has a fiduciary duty to his shareholders to maximize shareholder wealth. And a proven winner to do so is to only insure healthy people and deny claims. It is built into the system for them to treat people lousy. And we all know that health insurance choices are limited, if available at all. A pretty sweet deal for insurers. And they are profiting immensely under it.
It is easy to see why they are fighting reform tooth and nail. And let’s face facts. Health insurers are financing this anti reform battle.
Max Baucus has taken in $3 million from the health care industry. Evan Bayh’s wife has earned $2 million sitting on the boards of health care companies the past two years. And these are supposed to be two of the “good guys” on the side of serious reform.
“top 1% of taxpayers pay about 40% of all income taxes”
So what. They earn 20% of the income and seem to getting along just fine.
And they contribution to payroll taxes as a percentage of income is dramatically less than the average guy. Dramatically less.
I came from Taiwan. We have government health insurance system. It covered all citizens and legal residents. The cost is under control because givernment regulation. Our doctors and medical system are very well known in Asian and mant cpeople from China or south asian come to Taiwan for medical procedures because the advanced skill and good price. The government actuall pay for doctors to learn the most advanced medical procedures oversea. We actually make money from our foreign patients. We use the most advanced medicine to treat patients.Doctors make decent money , more than average , but not allowed to chage $175 per visit(regular and it constitutes as $2100 per hour????). The average salary in Taiwan is about 75% of US average salary. The average monthly insurance is $20(USD) per person.You can schedule a doctor appointment immediately or walk in any govenment run medical center to see a doctor for any reasons. You don’t need to worry about lossing job and no health care. My sons who born and grew up in US were so impressed by the public run healthcare in Taiwan. They (now, after their own experienced during visiting) say that it is a shame for US, as the most developed country and also richest country does not care the necessity of its citizens and allowed special interest groups contol majority of people’s life and death. I am all for President Obama, he at least has heart to make a change for majority of this contry, not think about relection or popularity. History will tell.
So what. They earn 20% of the income and seem to getting along just fine.
And they contribution to payroll taxes as a percentage of income is dramatically less than the average guy. Dramatically less.
That’s the substance of your argument, “They seem to be getting along fine?”, so, accordingly, they are supposed to provide goods and services for you?
There’s a good chunk of the population that makes more than me and I would be ashamed of myself if I wanted one thin dime of what they have. I just want the government to get out of my way of making more. That’s the American way.
You also realize that those payroll taxes also lead to lower replacement incomes when those high-earners go to collect Social Security, right? A low-earner replaces about 60% of his/her pre-retirement income with Social Security benefits, while a high-earner replaces about 20%. At best, your argument about the percentages paid into the payroll tax system is a wash, then, which leaves us back with the original income tax point.
yang:
Reading your post made me miss my Asian friends.
Us stupid Amercans need to get off our high horse and realize that quite a few countries do quite a lot of things BETTER than us. And health insurance is one of them.
The models that work well are out there. It’s just that we have a certain party that is protecting insurance company profits at all costs.
Anyways, welcome to the U.S. of A.!
“That’s the substance of your argument, “They seem to be getting along fine?”, so, accordingly, they are supposed to provide goods and services for you?”
No, I’m getting along just fine thank you. I am very comfortable paying my own way.
The should, however, pay more income tax if they earn more. Duh!
venividivici:
“I just want the government to get out of my way of making more.”
Do you mean getting out of the way of building interstate highways, and getting out of the way of customs inspections, and bank regulations, and the SEC, and the Consumer Product Safety Commission, and federal meat inspectors, and air traffic control, and National Parks, and the post office, and the EPA, and so on.
Turn off Limbaugh. He’s nothing but a lardass drug addict profiting off the lesser educated. He is not to be taken seriously and no one with a lick of sense does.
The should, however, pay more income tax if they earn more. Duh!
Actually, if rich people have better investment options than dubious “investments” in paying taxes, it is preferable for society as a whole that they undertake those investments rather than pay higher taxes. The fact that you think this is a “duh” argument shows the superficiality of your understanding of the concept of opportunity cost.
Do you mean getting out of the way of building interstate highways, and getting out of the way of customs inspections, and bank regulations, and the SEC, and the Consumer Product Safety Commission, and federal meat inspectors, and air traffic control, and National Parks, and the post office, and the EPA, and so on.
It’s more the “and do on” part that I object to, which comprises a huge chunk of the budget.
Turn off Limbaugh
Throw away your Marx.
It’s just that we have a certain party that is protecting insurance company profits at all costs.
Health insurance company profits are around 5 cents on the dollar, which is not a huge return by any stretch. Much lower than the profit margins at law firms that sue doctors under dubious malpractice claims, about which the current health care reform bills do nothing.
Facts are stubborn things.
Great ideas and writing, Clayton.
It’s just that we have a certain party that is protecting insurance company profits at all costs.
You mean the Democrats? As I mentioned early, when Bush proposed loosening AHP rules to make it easier to get more small businesses able to offer group health insurance, it was both Democrats (doing what labor unions wanted) and Republicans (doing what health insurance companies wanted), that stopped it.
“At least if you have an individual health insurance plan, you have some hope of changing to a plan that you are happier with”
Not really. Most have no choice of their insurer. It is chosen by ones employer.
Did you notice that word “individual” in there?
There’s clearly some room for reform, and separating health insurance from employment would be one area that would be helpful. Assuming that the government will look out for the interests of voters is like assuming that health insurance companies care about something besides profits.
We also have to get rid of some lies. 1. While there may be 50 million uninsured in the country, 10-15 percent of them are illegal aliens. 10-15 percent of them could have affordable health insurance but choose not to. 10-15 percent of them could already be enrolled in a current government program but are to lazy or unwilling to apply.
In addition, why do people think that they should be able to buy insurance after they have a condition. You can’t buy life insurance after you are dead so, get the insurance when you are young and healthy and then you would not have a problem.
How is the government going to solve the problem when they are actually the problem now? Why do you have four current government systems that pay the lowest rate of reimbursement possible to the doctors while the private insurance companies pay the highest. And government is going to fix this? Not in my lifetime.
John
And let’s face facts. Health insurers are financing this anti reform battle.
Where’s my check?
Sorry, jharp, your Marxist/Leninist agitprop of greedy capitalists screwing over the proletariat don’t square with reality.
Two studies I saw showed that approximately 10-14% of insurance claims are intially denied, and that at least 70% of those were easily reversible.
A second study described the reasons for most denials, and claimed that at least 78% of all denials were computer-generated and were the result of missing/incomplete information on the claims. There was no greedy capitalist pig behind them, just a computer program which kicked the claim back because the data supplied didn’t work or was missing. Beep, card read error, try again.
And if you think a system proposed by Obama and his kind, (“maybe they don’t need the treatment, they can just take a painkiller”) will lead to less, and not more denial of treatment, you’re delusional. At least insurance companies are non-ideological, which is more than can be expected from the fascists peddling the latest manifestation of their uncontrollable lust for totalitarian control.
As for Taiwan, let them open their 23 million population up to 1 million+ immigrants a year demanding free medical treatment and see how that works out for them. They can provide for their own defense again China while they’re at it.
No, I’m getting along just fine thank you. I am very comfortable paying my own way.
The should, however, pay more income tax if they earn more. Duh!
They do, however, pay far more income tax than I do, even as a percentage of income. Could the rich pay more? Sure. Should they do more to help the poor? For many, yes. But there’s a reason that rich people fund the Democratic Party–because it alleviates their guilt about wealth far more cheaply than doing something directly to help the poor.
We also have to get rid of some lies. 1. While there may be 50 million uninsured in the country, 10-15 percent of them are illegal aliens. 10-15 percent of them could have affordable health insurance but choose not to. 10-15 percent of them could already be enrolled in a current government program but are to lazy or unwilling to apply.
Of the 46 million uninsured, it is likely that about 8-9 million are illegal immigrants–who are usually paid so poorly that they can’t afford health insurance. Their employers are socializing the costs of hiring illegal immigrants and pocketing the benefits. This is why the Democrats refuse to take any action to exclude illegal immigrants from the health care plan, and refuse to take action to punish employers who knowingly hire illegal immigrants. The Democrats are the party of Birkenstock Fascism.
There’s no question that at least some of those who are uninsured can afford coverage. I was surprised that in Idaho, about 4% of the uninsured had incomes exceeding $50,000 a year. (In Idaho, that’s a pretty comfortable income, even if you are raising a family on it.) Some may have pre-existing conditions that are preventing them from purchasing insurance, but some are young, and see no reason to buy insurance. But for most of the uninsured, there simply isn’t enough money to buy it. Of course, if illegal aliens weren’t driving down wages, some of these better off of the poor uninsured could afford coverage.
Clayton E. Cramer:
It’s just that we have a certain party that is protecting insurance company profits at all costs.
You mean the Democrats?
No, I mean the republicans. And I’ll openly admit they have some democrat collaborators.
No, I mean the republicans. And I’ll openly admit they have some democrat collaborators.
Yes, almost the entire Democratic House membership. Funny notion of “some.”
“But for most of the uninsured, there simply isn’t enough money to buy it.”
The same Census numbers that produce the 47 million show that 30% have 25-50k, 20% have at 50-75K income, another 20% at least 75k. And the Census empasizes that income is often undereported and does not include non-cash benefits like food stamps and subsidized housing, etc. Other crunchinhg of the raw numbers show a large number (>40% if I recall) who own their own home, have two cars, etc. The notion that people in these categories cannot afford it is nonsense. Maybe not one with low deductibles and out of pocket maxes, but certainly one to hedge against major financial loss, which after all, is what insurance is for. It is not “I pay a few bucks only at the point when I seek medical care and then someone else pays for it all”.
Then of the rest we have a quarter of the total 47M who are altready eligible for existing govt programs but don’t enroll. Basically, this entire “crisis” involves non-citizens, most in the country illegally. A manufactured crisis to use a pretext for totalitarianism, which is quite obviously the model for every single thing the Democratic party does.
So Jharp, does Taiwan provide free medical care to non-citizens. No? Didn’t think so.
#71
It’s ironic, isn’t it, that the people who claim that the problem of the uninsured is too complex to leave to “market forces” are the same people who give you the most simplistic “facts” about the uninsured, in order to justify their schemes.
Clayton E. Cramer:
No, I mean the republicans. And I’ll openly admit they have some democrat collaborators.
Yes, almost the entire Democratic House membership. Funny notion of “some.”
_________________________________________________
What planet are you on? The House isn’t even a slight problem.
It’s Senators Baucus, Nelson, and Landrieu.
Landru:
“So Jharp, does Taiwan provide free medical care to non-citizens.”
Taiwan doesn’t provide free medical to it’s own citizens so I highly doubt if they do for non citizens.
“But for most of the uninsured, there simply isn’t enough money to buy it.”
The same Census numbers that produce the 47 million show that 30% have 25-50k, 20% have at 50-75K income, another 20% at least 75k.
$50K in Idaho means that you can afford health insurance for your family; $50K in some places that I have lived means that it is likely to be a very serious struggle. There is an enormous difference in the cost of living in the U.S.
I will agree that there are people who can afford health insurance but refuse to buy it, and there are others who could afford it if they spent less on marijuana, alcohol, and tobacco.
… and this is another problem that I see with the current system: it discourages self-employment and entrepreneurship.
To the left, that’s a feature, not a bug.
Clayton E. Cramer:
… and this is another problem that I see with the current system: it discourages self-employment and entrepreneurship.
To the left, that’s a feature, not a bug.
______________________________________________
Clayton,
You’re losing it. Leftists very much favor self-employment and entrepreneurship.
I’m as left as they come and have worked for myself for 25 years.
Clayton,
Isn’t there a movement among insurers to sign up professional associations as group health customers? Anyone with a membership in something like the IEEE can probably get insurance through the organization at a group rate, no? Or even alumni associations. I thought that was happening precisely because so many professionals were becoming contractors or starting their own businesses and these kinds of policies were easier for the actuaries to price because the characteristics of the group are fairly well known. I remember seeing a presentation by a gentleman who was an independent financial advisor with a pre-existing condition and he got insurance through some professional association and advised others in the audience to look into it if their own situation was similar.
“Taiwan doesn’t provide free medical to it’s own citizens so I highly doubt if they do for non citizens.”
Then don’t cite it as a model for the US to follow until they do, since the US currently does both. A small country that does not not admit millions of people into its borders each year, both legally and illegally, cannot be compared with the US.
80. Landru:
“Taiwan doesn’t provide free medical to it’s own citizens so I highly doubt if they do for non citizens.”
Then don’t cite it as a model for the US to follow until they do, since the US currently does both.
80. Landru:
“Taiwan doesn’t provide free medical to it’s own citizens so I highly doubt if they do for non citizens.”
Then don’t cite it as a model for the US to follow until they do, since the US currently does both.
________________________________________________
Really? The U.S. government provides free medical care to it’s citizens and non citizens alike?
I had no idea. So that several hundred thousand dollars I’ve spent on health care over the past 2 decades I could have gotten for free?
Put the crack pipe done.
Clayton,
You’re losing it. Leftists very much favor self-employment and entrepreneurship.
I’m as left as they come and have worked for myself for 25 years.
You are mistaken, then. Labor unions worked hard to prevent expansion of AHPs across state lines because it would have made it easier for small businesses to provide group health insurance. And there is nothing that the left hates more than people who are figuring out clever ways to get rich.
Really? The U.S. government provides free medical care to it’s citizens and non citizens alike?
It certainly provides free medical care through the Medicaid program, and to the extent that much emergency room care costs are written off as uncollectable, yes it does.
What planet are you on? The House isn’t even a slight problem.
It’s Senators Baucus, Nelson, and Landrieu.
You are discussing the problems of Obamacare. I was discussing the problems of making group health insurance more available when Congress refused to pass such improvements several years ago.
Isn’t there a movement among insurers to sign up professional associations as group health customers? Anyone with a membership in something like the IEEE can probably get insurance through the organization at a group rate, no? Or even alumni associations. I thought that was happening precisely because so many professionals were becoming contractors or starting their own businesses and these kinds of policies were easier for the actuaries to price because the characteristics of the group are fairly well known. I remember seeing a presentation by a gentleman who was an independent financial advisor with a pre-existing condition and he got insurance through some professional association and advised others in the audience to look into it if their own situation was similar.
I can’t recall seeing any such offering from any organization of which I am a member. NRA? Not that I recall. Mensa? Not that I recall. If you can provide a list of such organizations, I would be very, very interested.
I did some checking, and found that there are some organizations that provide group health insurance–but at least the first one that I checked turns out to be a more complex than I had hoped. The Writers Guild of America is one such organization–but the rules for becoming a full member are a bit more complex than I had hoped. There is the National Association for the Self-Employed, but so far this looks more like a marketing scheme for individual health insurance than a group health plan. I am having trouble finding any such plans.
“Isn’t there a movement among insurers to sign up professional associations as group health customers? Anyone with a membership in something like the IEEE can probably get insurance through the organization at a group rate, no? Or even alumni associations. I thought that was happening precisely because so many professionals were becoming contractors or starting their own businesses and these kinds of policies were easier for the actuaries to price because the characteristics of the group are fairly well known. I remember seeing a presentation by a gentleman who was an independent financial advisor with a pre-existing condition and he got insurance through some professional association and advised others in the audience to look into it if their own situation was similar.”
After 50 years of doing nothing you come up with this, “Isn’t there a movement”.
Unbelievable. Really. That’s what this debate has come to?
I’ve been trying to find some of the group health insurance offered by professional associations; it seems to be about as common as hens’ teeth. The National Association of the Self-Employeed’s group health insurance program is really what the salescritter called an “individual group health insurance plan.” Deductible: $5000. For someone my age: $450 a month. That’s not a bad deal, but it’s about what I would get from going out and buying an individual high deductible health insurance plan.