Why people are afraid of universal health care

[bilby]

Why pay more? You can’t buy ethics!

Sure you can. You can get a vacant block in Romford for as little as £165,000 freehold.

https://www.onthemarket.com/for-sale/land/essex/

 

[Bomb#20]

Given the current price paid for healthcare in the US compared with other OECD nations UHC, the question will rather be "Which people will benefit, from their taxes rising by less than their insurance payments fall?" - and the answer could well be 'Everybody', if the system is structured appropriately.

No nation on Earth spends as much per capita on healthcare as the USA, and no OECD nation has such a low life expectancy for each per capita dollar spent. Clearly there's room for a US UHC system to be both cheaper and better than her current arrangement.

https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita

This is true, but it's not the whole picture. Part of the reason the U.S. pays so much per unit health improvement, and the other OECD countries pay so little, is that the American people's expenditures are massively subsidizing health care consumption in the rest of the world. The U.S. does a disproportionate share of medical research, because the crazy-ass prices we pay incentivize it. All the countries with cheap medical care are free-riding on a train of innovation that would dry up if America adopted those countries' models. In exchange, our sick people tend to get newly invented treatments first. Is that a bargain worth making? Depends on point of view. Just be careful what you wish for.

How America Subsidizes the World’s Medicine

Changes to domestic drug pricing policies can make foreign countries pay a larger share

www.discoursemagazine.com

... “[f]rom 2014 to 2018, U.S.-headquartered enterprises produced almost twice as many new chemical or biological entities as European ones, and nearly four times as many as Japan.”

The foundation also notes that “private research [into developing] new drugs in the United States [accounts for] a significantly higher percentage of GDP than in the rest of the world.” ...

... The reforms may or may not be worth the consequences, but we shouldn’t ignore the tradeoffs altogether by insisting that the U.S. should embrace a European-style single-payer healthcare system. Their “free” healthcare is a myth—Americans are paying for it.​

 

[bilby]

In my experience, much of "new" drug development consists of finding ways to make a bioequivalent molecule to an existing 'blockbuster' medication, that has sufficent differences from the original so as to persuade the regulators that it doesn't infringe the patent.

This can be anything from making a new molecule that fairly well duplicates the active segments of the original, creating a new drug in the same class, which may have subtly different effects on patients; To finding a way to make an anhydrate of an existing drug, which while it is distingushable in the lab from the original, is biologically identical, as exposure to living tissue immediately causes it to absorb water and convert to the patented formulation.

How valuable this "new" drug research is to anyone not seeking a quick buck from doing an end-run around the patent rights of their competitors is highly questionable. Certainly much of it is of very marginal benefit to patient health, though it can be an effective way to loosen the (arguably excessive) constraints caused by the monopoly rights granted to patent holders, and to thereby reduce costs to the healthcare system (but not necessarily to the patients themselves).

TL;DR - it's complicated, and far from certain that the rest of the world benefits from high priced healthcare in the US. Certainly the USA doesn't benefit much if such a subsidy really exists. Perhaps we would all be better off if each country paid it's fair share of research costs.

 

[Spacetime Inhabitant]

Given the current price paid for healthcare in the US compared with other OECD nations UHC, the question will rather be "Which people will benefit, from their taxes rising by less than their insurance payments fall?" - and the answer could well be 'Everybody', if the system is structured appropriately.

No nation on Earth spends as much per capita on healthcare as the USA, and no OECD nation has such a low life expectancy for each per capita dollar spent. Clearly there's room for a US UHC system to be both cheaper and better than her current arrangement.

https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita

This is true, but it's not the whole picture. Part of the reason the U.S. pays so much per unit health improvement, and the other OECD countries pay so little, is that the American people's expenditures are massively subsidizing health care consumption in the rest of the world. The U.S. does a disproportionate share of medical research, because the crazy-ass prices we pay incentivize it. All the countries with cheap medical care are free-riding on a train of innovation that would dry up if America adopted those countries' models. In exchange, our sick people tend to get newly invented treatments first. Is that a bargain worth making? Depends on point of view. Just be careful what you wish for.

How America Subsidizes the World’s Medicine

Changes to domestic drug pricing policies can make foreign countries pay a larger share

www.discoursemagazine.com

... “[f]rom 2014 to 2018, U.S.-headquartered enterprises produced almost twice as many new chemical or biological entities as European ones, and nearly four times as many as Japan.”​

​

The foundation also notes that “private research [into developing] new drugs in the United States [accounts for] a significantly higher percentage of GDP than in the rest of the world.” ...​

​

... The reforms may or may not be worth the consequences, but we shouldn’t ignore the tradeoffs altogether by insisting that the U.S. should embrace a European-style single-payer healthcare system. Their “free” healthcare is a myth—Americans are paying for it.​

USA is not the only country that does medical research, so that part of your argument is massively wrong factually.
Plus American research is very inefficient as they always pad costs tremendously.
Also, talking about nations subsidizing other nations. Australia subsidizes USA billions of dollars each year with military purchases and large subsidies to energy companies, some of which are American owned. Also subsidize Britain with medical insurance companies like Bupa and many betting companies like Bet365 that are allowed to operate in Australia and whose profits go to Britain.

 

[Emily Lake]

Whether to have an NHS or a mixed public/private medical system is a hard technical problem of economics.

Is it?

Which is cheaper, or more efficient, I can see as a hard technical problem of economics.

Whether to make cost, or efficiency, or something else - popularity amongst patients, for example; Or effectiveness in reaching those least able to provide for their own care - that is a problem of moral philosophy.

Where does your morality fall on putting tens of thousands of people out of work because you've intervened to eliminate an entire sector of the economy?

That's life. No sector of the economy is entitled to exist if it is no longer required; Ask the British coal miners, or the ostlers, farriers, and livery stable owners.

Selective compassion that allows you to disregard the negative impact of pet policies is always so enlightening.

Fuck those people, as long as you get what you think is right. Fuck the entire economy, put tens of thousands of people out of work with no alternative for them, but hey, no big... you get UHC and you can thumb your nose at the plight of the "collateral damage". No big.

 

[Emily Lake]

No nation on Earth spends as much per capita on healthcare as the USA, and no OECD nation has such a low life expectancy for each per capita dollar spent.

That’s the inconvenient truth that billions of dollars are spent to conceal, despite being as plain as black and white.

We could save a whole bunch of money as a country if we 1) stopped funding the vast majority of research for new drugs and treatments that the rest of the globe benefits from and 2) stopped subsidizing the cost of drugs for the rest of the planet and 3) stopped counting abortions and miscarriages against our life expectancy calculation.

Honestly, this is the same short-sighted argument that comes up with respect to US military spending. Yes, the US spends a metric fuck-ton on the military. And non-Americans really love to point that out as some kind of shortfall of the US while blithely ignoring that you benefit from our military, and from our willingness to support our allies, to be the force in the water and in the air that keeps our allies safe.

Maybe your countries should pick up a fair share of the tab for both health care and military?

 

[Elixir]

stopped counting abortions and miscarriages against our life expectancy calculation.

Wut?!
Cite required. Are people required to report miscarriages to you? Do you calculate their lifespan starting at conception? So they have to record the dates of their sexual activity for your perusal? WHO DOES THAT, Emily?
WTF.

I believe are still exercising your irrational support for laws that YOU KNOW kill people, and benefit NOBODY.

 

[laughing dog]

Whether to have an NHS or a mixed public/private medical system is a hard technical problem of economics.

Is it?

Which is cheaper, or more efficient, I can see as a hard technical problem of economics.

Whether to make cost, or efficiency, or something else - popularity amongst patients, for example; Or effectiveness in reaching those least able to provide for their own care - that is a problem of moral philosophy.

Where does your morality fall on putting tens of thousands of people out of work because you've intervened to eliminate an entire sector of the economy?

That's life. No sector of the economy is entitled to exist if it is no longer required; Ask the British coal miners, or the ostlers, farriers, and livery stable owners.

Selective compassion that allows you to disregard the negative impact of pet policies is always so enlightening.

Fuck those people, as long as you get what you think is right. Fuck the entire economy, put tens of thousands of people out of work with no alternative for them, but hey, no big... you get UHC and you can thumb your nose at the plight of the "collateral damage". No big.

I think you are going a bit overboard there. Would you feel the same way if cures for the cold, cancer, and all genetic disorders were found and threw all those people out of work as well? Industries and jobs come and go in a dynamic economy. Civilized countries try to help those displaced by such changes, but such changes occur.

 

[Emily Lake]

Whether to have an NHS or a mixed public/private medical system is a hard technical problem of economics.

Is it?

Which is cheaper, or more efficient, I can see as a hard technical problem of economics.

Whether to make cost, or efficiency, or something else - popularity amongst patients, for example; Or effectiveness in reaching those least able to provide for their own care - that is a problem of moral philosophy.

Where does your morality fall on putting tens of thousands of people out of work because you've intervened to eliminate an entire sector of the economy? Where does your morality fall on figuring out how to fund UHC, and which people are harmed by increased cost burdens that they would be faced with in the form of taxes they don't currently pay?

Your responses assumes a certain type of UHC which need not be the case. There is no reason to expect that necessarily tens of thousands will be put out of work or that the increased cost would necessarily be onerous.

I'm anxiously awaiting your proposal for a UHC solution that does NOT eliminate the Health Insurance sector, as well as Insurance Brokers.

Just for consideration... United Health Group has 400,000 employees split between Optum and United Health Care. UHC is the insurance arm. Even if only a quarter of those employees work for the insurance side, that's still 100,000 people. Elevance (formerly Anthem) has about 100,000. Centene has about 60,000. Aetna has around 40,000. Blue Cross and Blue Shield are a bit more challenging to pin down, as they're essentially regional licensees... but all told (excluding Elevance) probably on the order of 80,000 to 100,000. There are several other large insurers that I'm not even going to look up.

So we're talking about more than 400,000 people who are employed in the health insurance sector.

That's a big part of why I favor making the delivery of health care a government-run system, but retaining the private market for packaging. I'm all for a minimum benefit level being required, as well as subsidization of premiums based on income and cost. To me, that's the least disruptive solution.

 

[Elixir]

Whether to have an NHS or a mixed public/private medical system is a hard technical problem of economics.

Is it?

Which is cheaper, or more efficient, I can see as a hard technical problem of economics.

Whether to make cost, or efficiency, or something else - popularity amongst patients, for example; Or effectiveness in reaching those least able to provide for their own care - that is a problem of moral philosophy.

Where does your morality fall on putting tens of thousands of people out of work because you've intervened to eliminate an entire sector of the economy? Where does your morality fall on figuring out how to fund UHC, and which people are harmed by increased cost burdens that they would be faced with in the form of taxes they don't currently pay?

Your responses assumes a certain type of UHC which need not be the case. There is no reason to expect that necessarily tens of thousands will be put out of work or that the increased cost would necessarily be onerous.

I'm anxiously awaiting your proposal for a UHC solution that does NOT eliminate the Health Insurance sector, as well as Insurance Brokers.

Just for consideration... United Health Group has 400,000 employees split between Optum and United Health Care. UHC is the insurance arm. Even if only a quarter of those employees work for the insurance side, that's still 100,000 people. Elevance (formerly Anthem) has about 100,000. Centene has about 60,000. Aetna has around 40,000. Blue Cross and Blue Shield are a bit more challenging to pin down, as they're essentially regional licensees... but all told (excluding Elevance) probably on the order of 80,000 to 100,000. There are several other large insurers that I'm not even going to look up.

So we're talking about more than 400,000 people who are employed in the health insurance sector.

That's a big part of why I favor making the delivery of health care a government-run system, but retaining the private market for packaging. I'm all for a minimum benefit level being required, as well as subsidization of premiums based on income and cost. To me, that's the least disruptive solution.

There’s a labor shortage. If they have skills they’ll get jobs. Some interim assistance may be required.
In any event, getting the nation to equal quality outcomes at equal per capita cost of any UHC Country, would save more than enough to pay a couple million people to stay home.
Or the insurance folk can do like millions of farmers, metal workers and coal miners have done before them. If they’re enterprising they could probably still make bank as advisors; I know that they have helped me out pretty much. Just having access to a system does not guarantee that patient will make the best choices for their health and lifestyle…

 

[Emily Lake]

The thing that gets me about the whole debate is that here in 'Murica, we claim to be the best at everything...and in some cases rightly so. We're the richest country hands-down,

In terms of total GDP, sure. But not per capita. The US is up there, definitely, but not the top dog.

have the most powerful military by a long shot, and the stereotypical "we sent a man to the Moon" thing.

Universal healthcare? "Ooh...that's a nut we can't crack. May as well just leave it up to the private sector!"

As the talking point goes, almost every other "first world" country on the planet has some form of universal/national health care, but for some reason the "greatest country in the world" not only can't figure out how to come up with something to equal those other systems, but can't make something better? I'd think that the "America is best in the world at everything" types would take that as a challenge. Sadly, no.

It depends entirely on whether or not the average american believes that Universal Health Care is the best in terms of being able to deliver both needed and desired care.

Tomorrow morning, I'm going in for a CT scan that my doctor ordered. I'll probably have to pay out of pocket because the lab is not "in network." Later, I'll be going to pick up equipment for an at-home sleep study, because despite what my pulmonologist said, an in facility visit is "not medically necessary." The private sector insurance company is overriding my doctor and making medical decisions for me based on profit margins. This can't be the best way to do things, right?

At-home is generally preferred for a few reasons.

First: Facilities are vectors for secondary infection - so if there's an effective treatment option in an outpatient facility, that will be preferred to an inpatient facility on clinical grounds; if there's an at-home option that is effective, that will be preferred to an outpatient facility. Whenever you have a reasonable option to do a procedure or study in your own home, you should take that option - the risks are much lower for 1) in home, 2) professional office, 3) outpatient facility, 4) inpatient facility.

Second: Most in-home studies have better results because most people sleep better in their own home and own bed than in a medical facility. People who do facility studies tend to sleep poorly, and will often need to repeat the test on another night in order for the doctor to get reliable results.

Third: Facilities charge significantly higher amounts than in-home do. And while you might be willing to pay more, it's not just you who would bear that cost. The higher charged amount gets spread around to everyone else with insurance as well, which drives up everyone's costs.

So all in all, by doing an in-home study, you reduce your risk of secondary infection, you are more likely to get a normal night's sleep which produces better study results, and it costs both you and everyone else less money.

Contrary to popular assumption, most coverage decisions made by insurers are NOT driven by profit. They're driven by a combination of clinical efficacy and aggregate affordability for policyholders. At the end of the day, having you do an in-home sleep study *is* the best way to do it.

 

[Emily Lake]

I'd prefer to address this via ethics rather than morality.

I guess you will have to explain the difference.

Morality is based on your personal beliefs of right and wrong, and they're highly subjective. Ethics are more clearly defined, and are limited in scope to a particular area or community.

Religions work off of morality. Doctors, Lawyers, and (hypothetically) government officials work off of Ethics.

Morality is what allows some companies to refuse to cover oral contraceptives through their employer benefits; ethics is what requires that insurance companies provide a means for those employees to access oral contraceptives outside of their employer's coverage. Morality is what allows a priest to refuse to perform religious wedding ceremonies for a same-sex couple; ethics is what obligates the clerk to issue a marriage license to a same-sex couple regardless of the clerk's personal feelings about the matter. Morality is what allows a lawyer to personally think their client is a piece of shit; ethics is what requires that lawyer to represent their client to the best of their ability and not undermine the case based on their personal feelings.

Ethics requires adherence to practice standards, comportment expectations, and behavior regardless of whether your personal beliefs see them as moral or not.

 

[Emily Lake]

Morality should be included in all economic discussions. By pure economic standards, we would just kill all prisoners who get a life sentence. Incurable disease? Kill the patient. Disabled child requiring lifetime care? Kill the child. Slavery? Sure!

I'd prefer to address this via ethics rather than morality.

For most of my life, I supported capital punishment. I still have no moral objection to the death penalty in some very particular situations. At heart, I still think it's more compassionate for both the prisoner and the public to execute those who would otherwise be held without liberty for their entire remaining life. You know why I support LWOP? Because it actually costs less than the various options the US uses for execution. That's the only reason.

Incurable diseases that can be effectively managed are certainly no reason to euthanize the patient - but terminal disease, especially ones that cause either immense pain or significant cognitive deterioration? Those I 100% support a person's right to choose to end their own life with support and compassion. I think it's an absolute travesty that we treat our pets with more care and dignity than we do humans.

For most situations, parents are happy enough to care for a severely disabled child. But there may also be instances where an infant is so disabled that they won't have any meaningful quality of life, and requiring that their parents must suffer twofold seems to lack compassion. It's certainly not something I would support being used with abandon, but I also don't think it should always be disallowed. I'd prefer that such decisions be made prior to birth whenever possible. Consequently, that means allowing for medically justified terminations of pregnancy after viability, which I fully support.

Slavery? I suppose no post is complete without a leap into absurdity, so I guess I shouldn't be surprised.

All those are the most economical ways to pay the least money support society, unless you include morality.

Actually, my views on those situations are informed by my own morality. Those ARE moral perspectives.

Ethics is what creates the comprehensive and shared expectations for all people in each of those situations regardless of their own morality. In many of those cases, it's ethics that creates the guidelines that means I don't get to have my morality imposed on other people.

I am curious about your views, however.

Incurable diseases - do you believe that it is moral to do everything possible to extend a person's life regardless of their wishes, and regardless of their suffering? Do you believe it is moral to deprive humans of the choice to end their own suffering when their condition cannot be cured or meaningfully improved?

Severe disability - do you believe it is moral to force a mother to carry a severely disabled child to full term, and then raise that child, rather than allowing her to terminate the pregnancy?

 

[Emily Lake]

In my experience, much of "new" drug development consists of finding ways to make a bioequivalent molecule to an existing 'blockbuster' medication, that has sufficent differences from the original so as to persuade the regulators that it doesn't infringe the patent.

Your experience is limited.

Don't get me wrong - there's a lot of shenanigans from Pharmaceutical companies, but I'm not going to go on a rant about albuterol today.

What you're missing in your "experience" are things like treatment and preventive medicines for HIV, cures for Hep-C, gene-therapies for a host of cancers and congenital conditions. The FDA approves a whole host of novel drugs every year, and a substantial portion of the original research and clinical trials for those drugs happen in the US, and are subsidized by the US.

 

[Emily Lake]

USA is not the only country that does medical research, so that part of your argument is massively wrong factually.

Bomb#20 didn't say that only the US does medical research. He said that the US does a disproportionate share of the research - which is factually true.

Plus American research is very inefficient as they always pad costs tremendously.
Also, talking about nations subsidizing other nations. Australia subsidizes USA billions of dollars each year with military purchases and large subsidies to energy companies, some of which are American owned. Also subsidize Britain with medical insurance companies like Bupa and many betting companies like Bet365 that are allowed to operate in Australia and whose profits go to Britain.

Australia buying military arms, systems, planes, etc. from the US isn't subsidizing the US. It's purchasing a higher quality of good than you are capable of designing and manufacturing on your own. And we happen to like you, so we're willing to sell to you.

We paid the cost for the research and development of those arms. You're benefiting from our investment.

 

[Emily Lake]

I believe are still exercising your irrational support for laws that YOU KNOW kill people, and benefit NOBODY.

What the fuck laws do you think I support?

 

[Elixir]

It depends entirely on whether or not the average american believes

Bingo.
What the average american believes is what they are told by vested parties. That’s why we’re paying through the nose for a substandard product. If we didn’t, it would be hard to sell the myth that we don’t need UHC because they couldn’t afford the airtime or lobbying.
I’m in a pissy mood. The last time I ran around like I had to today, was after United Healthcare Advisors gave away all my info and I had to change a bunch of passwords, flood of scam messages and emails …
Fortunately no damage done but what a PITA.

 

[Elixir]

What the fuck laws do you think I support?

I’m assuming you haven’t changed your mind? Still need a law against optional late term abortion?
Why? Or did I misunderstand you?

 

[laughing dog]

Whether to have an NHS or a mixed public/private medical system is a hard technical problem of economics.

Is it?

Which is cheaper, or more efficient, I can see as a hard technical problem of economics.

Whether to make cost, or efficiency, or something else - popularity amongst patients, for example; Or effectiveness in reaching those least able to provide for their own care - that is a problem of moral philosophy.

Where does your morality fall on putting tens of thousands of people out of work because you've intervened to eliminate an entire sector of the economy? Where does your morality fall on figuring out how to fund UHC, and which people are harmed by increased cost burdens that they would be faced with in the form of taxes they don't currently pay?

Your responses assumes a certain type of UHC which need not be the case. There is no reason to expect that necessarily tens of thousands will be put out of work or that the increased cost would necessarily be onerous.

I'm anxiously awaiting your proposal for a UHC solution that does NOT eliminate the Health Insurance sector, as well as Insurance Brokers.

German style just requires people to have health insurance.

Just for consideration... United Health Group has 400,000 employees split between Optum and United Health Care. UHC is the insurance arm. Even if only a quarter of those employees work for the insurance side, that's still 100,000 people. Elevance (formerly Anthem) has about 100,000. Centene has about 60,000. Aetna has around 40,000. Blue Cross and Blue Shield are a bit more challenging to pin down, as they're essentially regional licensees... but all told (excluding Elevance) probably on the order of 80,000 to 100,000. There are several other large insurers that I'm not even going to look up.

So we're talking about more than 400,000 people who are employed in the health insurance sector.

That's a big part of why I favor making the delivery of health care a government-run system, but retaining the private market for packaging. I'm all for a minimum benefit level being required, as well as subsidization of premiums based on income and cost. To me, that's the least disruptive solution.

400,000 people is not much for the US economy to absorb if it came to that. Even a million is not too much for an economy the size of the US's to absorb. If it came to that, there is nothing to stop the US from providing transition assistance for those displaced.

And, I would expect that a UHC that is entirely public to have to absorb some of employees from the private sector.

 

[Emily Lake]

Wut?!
Cite required. Are people required to report miscarriages to you? Do you calculate their lifespan starting at conception? So they have to record the dates of their sexual activity for your perusal? WHO DOES THAT, Emily?
WTF.

Why do you always have to be so hostile and nasty, Elixir? Why do you have to immediately jump to egregiously insulting insinuations?

Anyway... infant mortality has a material impact on life expectancy calculations, and not all countries measure infant mortality in the same way. There are a lot of variations within the US even. For example, some countries don't include premature deliveries below a certain threshold in their infant mortality calculations, even if the infant was alive momentarily upon delivery. The US has a high rate of premature deliveries, and we expend a lot of effort on NICU cases - even when we know that the likelihood of survival is extremely low. Many cases that the Us counts as live births get recorded as miscarriages in other countries, because it was very premature and lived only a short while.

There are a lot of factors that influence life expectancy calculations, that aren't driven by the health care system itself. Differences in calculations for infant mortality is one of the known contributors. More challenging to capture are things like the degree of immigration - both legal and otherwise, as well as whether or not those immigrants use the health care that is available to them.

In AZ, the hispanic and native american populations just don't use health care except for injuries and major emergencies. Even though first nations people get IHS coverage, the utilization is extremely low across the board, and it's fairly common that by the time someone actually goes to a clinic, they're much sicker than they would have been had they been seen sooner. This means that a lot of treatable conditions end up causing preventable deaths. The same thing is true with hispanic populations - they're extremely difficult to get vaccinated, they don't make use of available prenatal care though they have coverage. We have a large population of hispanic citizens who qualify for medicaid but will not use those services, we have a lot who would qualify for a full premium subsidy through ACA and don't sign up. The same thing was true of chinese and korean populations when I lived in WA - they simply would not get coverage, and if coverage was provided through their employer, they just didn't use it.