Healthcare

[PerciFlage]

I get the impression that most (90% or so?) of posters here are based in the United States. Perhaps those of you who are could help an outsider understand the backlash against socialised, single-payer healthcare models?

It is my understanding that US healthcare spending per capita is, both in terms of overall dollars spent and public tax dollars spent, higher than just about anywhere else in the world, even after income per capita is controlled for.

I can see the benefits of a private and insurance-led system - choice for patients, potentially shorter waiting times and nicer facilities - but it seems to me that the downsides massively outweigh these benefits. A centralised model brings economies of scale (e.g. drug companies bidding to supply the health care system of an entire country rather than the patients of a particular provider), cuts out a large number of middlemen (insurance companies, brokers, hospital operators - all of whom are profit driven and not necessarily motivated to keep costs per patient to a minimum), and severely limits the likelihood of people becoming bankrupt through ill health.

Given that the socialised model seems like such a slam dunk to me, what am I missing that means people champion the insurance model and decry single-payer?

[Ivellious]

I tend to believe that outright socialism isn't a perfect model, but in terms of universal healthcare, I am completely in favor of it. As far as I'm concerned, the proposed model of having private health insurance available, but also having a government-run guarantee that you can have insurance even if you can't afford it privately.

Frankly, in this day and age, it is sad to me that so many Americans basically think we should screw the poor people without health insurance so that the rich don't have to pay as much. As far as I'm concerned, no one should have to be turned away from a hospital because they have no insurance, and no health insurance company should be able to turn away customers with pre-existing health issues. Both of these are addressed in the new health care reform. While I don't pretend to know everything about the bill, making sure everyone (and I mean everyone) in this country has access to proper medical treatment should be a priority, and it is good to see the process of implementing this begun.

[RickD]

I can't wait until B. W. sees this thread.

[B. W.]

I get the impression that most (90% or so?) of posters here are based in the United States. Perhaps those of you who are could help an outsider understand the backlash against socialised, single-payer healthcare models?

It is my understanding that US healthcare spending per capita is, both in terms of overall dollars spent and public tax dollars spent, higher than just about anywhere else in the world, even after income per capita is controlled for.

I can see the benefits of a private and insurance-led system - choice for patients, potentially shorter waiting times and nicer facilities - but it seems to me that the downsides massively outweigh these benefits. A centralised model brings economies of scale (e.g. drug companies bidding to supply the health care system of an entire country rather than the patients of a particular provider), cuts out a large number of middlemen (insurance companies, brokers, hospital operators - all of whom are profit driven and not necessarily motivated to keep costs per patient to a minimum), and severely limits the likelihood of people becoming bankrupt through ill health.

Given that the socialised model seems like such a slam dunk to me, what am I missing that means people champion the insurance model and decry single-payer?

Unlike other countries that have a single payer system - the US single payer system ACA is anything but. It was designed on a progressive distribution model. What that means is that, a few folks pay for all the care. In other words, so you can grasp this better, think of 40 percent paying for 60 percent of those that don't pay. Our Federal tax system is based upon this model - let use an arbitrary number to illustrate what I mean say about 50 percent pay federal income taxes and the other do not pay any at all. So 50% of vote can be purchased with promises of goodies from the Fed while the other 50% foot the entire bill - all under the disguise of fairness and social justice - of course.

In other countries everyone pays - not just a few. Next, our tax law maze was designed to help those with money not pay taxes, while those who don't pay - don't pay - while the rest end up paying for those who don't pay any (or just pay very little which by the way, they get back at the end of the year as a Tax Return). It is a Ponzi Scheme to say the least if not less...

Highly unfair. That is the progressive model and ACA is built upon this logic. Younger folks pay the highest for health care to avert the cost of those few who don't pay anything - the well off - pay their own way and the rest, well, are stuck footing the entire bill. Put in this way: the so called 30 % who pay nothing are added in with the illegal immigrants amnesty policies put in law so the ACA (Obama Care) covers them, without cost, then you have about 35 percent paying the cost for 50 to 60 percent who don't pay anything -- all done in order to secure votes for the Democrat party to rule...

That is an over simplification of the matter but I hope you get the idea that it all comes down to a few paying the total cost for many who are't paying anything all done to secure votes.

We should have some sort of Federal flat tax rate for all people, businesses, and corporations with no deductions or loophole in the Federal tax law. Then, some sort of a national health care coverage might be fair, but until then, the whole system is very corrupt, deceptive, and diabolical in scope and nature. It needs to be abolished. The goal of the leftist -Democrat leaning party is actually communism with a smiley face attached to hide its fascist hands. That is why folks are so angry.

Now when you have a president who orders govt employees of the park service - to make life as unpleasant as possible for people, fences off open air memorials, closes parks, has deliberately schemed with attorneys to keep the death benefits from being to paid to service personal who recently died in war from being received,uses the IRS to silence persons from organizing to vote and target for unending tax audits for those that oppose the Democrat regime, silence of right of free speech, hold amnesty day rally for illegal immigrant on the same open air mall where our own vets and people are not allowed to go, force elderly and visiting foreigners tourist to leave Yellowstone National Park by armed staff - just to force the opposition party to submit to their twisted will, you have a problem.

....think of it for a moment, if the Democrats use the Parks to throttle US citizens now, what will they do next with health care enforced by the IRS tax agency?

A 26-year-old university graduate, Ashley Dionne, made the headlines with her open letter telling how Obama Care has raped my future. That says it all.

All I am hearing privetly is how pissed off Americas are getting at the powers that be. People are angry...

You in Europe maybe used to this with all the monarchs you all have had in your past history.

This was one reason Jefferson wrote the Declaration of Independence -- please read it copied below:

The Declaration of Independence

IN CONGRESS, July 4, 1776.

The unanimous Declaration of the thirteen united States of America,

When in the Course of human events, it becomes necessary for one people to dissolve the political bands which have connected them with another, and to assume among the powers of the earth, the separate and equal station to which the Laws of Nature and of Nature's God entitle them, a decent respect to the opinions of mankind requires that they should declare the causes which impel them to the separation.

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.--That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, --That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness. Prudence, indeed, will dictate that Governments long established should not be changed for light and transient causes; and accordingly all experience hath shewn, that mankind are more disposed to suffer, while evils are sufferable, than to right themselves by abolishing the forms to which they are accustomed. But when a long train of abuses and usurpations, pursuing invariably the same Object evinces a design to reduce them under absolute Despotism, it is their right, it is their duty, to throw off such Government, and to provide new Guards for their future security.--Such has been the patient sufferance of these Colonies; and such is now the necessity which constrains them to alter their former Systems of Government. The history of the present King of Great Britain is a history of repeated injuries and usurpations, all having in direct object the establishment of an absolute Tyranny over these States. To prove this, let Facts be submitted to a candid world.

He has refused his Assent to Laws, the most wholesome and necessary for the public good.
He has forbidden his Governors to pass Laws of immediate and pressing importance, unless suspended in their operation till his Assent should be obtained; and when so suspended, he has utterly neglected to attend to them.
He has refused to pass other Laws for the accommodation of large districts of people, unless those people would relinquish the right of Representation in the Legislature, a right inestimable to them and formidable to tyrants only.
He has called together legislative bodies at places unusual, uncomfortable, and distant from the depository of their public Records, for the sole purpose of fatiguing them into compliance with his measures.
He has dissolved Representative Houses repeatedly, for opposing with manly firmness his invasions on the rights of the people.
He has refused for a long time, after such dissolutions, to cause others to be elected; whereby the Legislative powers, incapable of Annihilation, have returned to the People at large for their exercise; the State remaining in the mean time exposed to all the dangers of invasion from without, and convulsions within.
He has endeavoured to prevent the population of these States; for that purpose obstructing the Laws for Naturalization of Foreigners; refusing to pass others to encourage their migrations hither, and raising the conditions of new Appropriations of Lands.
He has obstructed the Administration of Justice, by refusing his Assent to Laws for establishing Judiciary powers.
He has made Judges dependent on his Will alone, for the tenure of their offices, and the amount and payment of their salaries.
He has erected a multitude of New Offices, and sent hither swarms of Officers to harrass our people, and eat out their substance.
He has kept among us, in times of peace, Standing Armies without the Consent of our legislatures.
He has affected to render the Military independent of and superior to the Civil power.
He has combined with others to subject us to a jurisdiction foreign to our constitution, and unacknowledged by our laws; giving his Assent to their Acts of pretended Legislation:
For Quartering large bodies of armed troops among us:
For protecting them, by a mock Trial, from punishment for any Murders which they should commit on the Inhabitants of these States:
For cutting off our Trade with all parts of the world:
For imposing Taxes on us without our Consent:
For depriving us in many cases, of the benefits of Trial by Jury:
For transporting us beyond Seas to be tried for pretended offences
For abolishing the free System of English Laws in a neighbouring Province, establishing therein an Arbitrary government, and enlarging its Boundaries so as to render it at once an example and fit instrument for introducing the same absolute rule into these Colonies:
For taking away our Charters, abolishing our most valuable Laws, and altering fundamentally the Forms of our Governments:
For suspending our own Legislatures, and declaring themselves invested with power to legislate for us in all cases whatsoever.
He has abdicated Government here, by declaring us out of his Protection and waging War against us.
He has plundered our seas, ravaged our Coasts, burnt our towns, and destroyed the lives of our people.
He is at this time transporting large Armies of foreign Mercenaries to compleat the works of death, desolation and tyranny, already begun with circumstances of Cruelty & perfidy scarcely paralleled in the most barbarous ages, and totally unworthy the Head of a civilized nation.
He has constrained our fellow Citizens taken Captive on the high Seas to bear Arms against their Country, to become the executioners of their friends and Brethren, or to fall themselves by their Hands.
He has excited domestic insurrections amongst us, and has endeavoured to bring on the inhabitants of our frontiers, the merciless Indian Savages, whose known rule of warfare, is an undistinguished destruction of all ages, sexes and conditions.

In every stage of these Oppressions We have Petitioned for Redress in the most humble terms: Our repeated Petitions have been answered only by repeated injury. A Prince whose character is thus marked by every act which may define a Tyrant, is unfit to be the ruler of a free people.

Nor have We been wanting in attentions to our British brethren. We have warned them from time to time of attempts by their legislature to extend an unwarrantable jurisdiction over us. We have reminded them of the circumstances of our emigration and settlement here. We have appealed to their native justice and magnanimity, and we have conjured them by the ties of our common kindred to disavow these usurpations, which, would inevitably interrupt our connections and correspondence. They too have been deaf to the voice of justice and of consanguinity. We must, therefore, acquiesce in the necessity, which denounces our Separation, and hold them, as we hold the rest of mankind, Enemies in War, in Peace Friends.

We, therefore, the Representatives of the United States of America, in General Congress, Assembled, appealing to the Supreme Judge of the world for the rectitude of our intentions, do, in the Name, and by Authority of the good People of these Colonies, solemnly publish and declare, That these United Colonies are, and of Right ought to be Free and Independent States; that they are Absolved from all Allegiance to the British Crown, and that all political connection between them and the State of Great Britain, is and ought to be totally dissolved; and that as Free and Independent States, they have full Power to levy War, conclude Peace, contract Alliances, establish Commerce, and to do all other Acts and Things which Independent States may of right do. And for the support of this Declaration, with a firm reliance on the protection of divine Providence, we mutually pledge to each other our Lives, our Fortunes and our sacred Honor.

Note - Transcription is on Public Domain

All that is needed is an update to address the new american king... instead of old King George of 1776....
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[PerciFlage]

We should have some sort of Federal flat tax rate for all people, businesses, and corporations with no deductions or loophole in the Federal tax law. Then, some sort of a national health care coverage might be fair, but until then, the whole system is very corrupt, deceptive, and diabolical in scope and nature. It needs to be abolished. The goal of the leftist -Democrat leaning party is actually communism with a smiley face attached to hide its fascist hands. That is why folks are so angry.

That matches my perception of Obamacare - in hiving off a middle ground between two opposing groups, they've ended up pleasing neither group. The only real winners in Obamacare are the healthcare professionals who will be benefiting from the fresh influx of cash.

My initial question wasn't really about Obamacare, though - I was more interested in the people who champion the existing model over a single-payer system. Leaving the crock that is Obamacare out of the equation, why is the current system so widely favoured? Or is my perception incorrect, and the majority of US citizens would actually favour a genuine single-payer model over the pre-Obamacare situation?

[B. W.]

We should have some sort of Federal flat tax rate for all people, businesses, and corporations with no deductions or loophole in the Federal tax law. Then, some sort of a national health care coverage might be fair, but until then, the whole system is very corrupt, deceptive, and diabolical in scope and nature. It needs to be abolished. The goal of the leftist -Democrat leaning party is actually communism with a smiley face attached to hide its fascist hands. That is why folks are so angry.

That matches my perception of Obamacare - in hiving off a middle ground between two opposing groups, they've ended up pleasing neither group. The only real winners in Obamacare are the healthcare professionals who will be benefiting from the fresh influx of cash.

My initial question wasn't really about Obamacare, though - I was more interested in the people who champion the existing model over a single-payer system. Leaving the crock that is Obamacare out of the equation, why is the current system so widely favoured? Or is my perception incorrect, and the majority of US citizens would actually favour a genuine single-payer model over the pre-Obamacare situation?

They probably would favor a honest system that fixes the problems but you have in the USA two political party's and one has a Machiavellian attitude codified into practice by Sun Tzu's - Art Of War - win at all coast mentality. The Democrats view all who oppose them as the ENEMY and fair GAME to be Destroyed by any means possible - win at all cost. You can't keep governing a Republic like that and this exposes their true course on their true motives.

For decades - the Dem's have been stereo-typed as - for the little guy and the Repub as Out of touch rich guys - greedy exploiters...of the little guy.

It does not matter historically that the Dem's were the major Slave holding party before the 1860 Civil War and after crafting resistance to the Civil Rights movement - then changing over to a new all inclusive Govt plantation model for all the little guys. The Repub freed the Slaves and pushed for Civil rights and seek the best for the little guy, then they changed to an establishment party that seeks to grab defeat from the jaws of victory and remain a country club that desires the Dem's plantation model - we call them Rhino's. They rule the party now.

The reason why the polls reflect so poorly on the Repub's is how the Rhino's are working with dem's to destroy Conservative and Tea Party Repub's. People are fed up with the loser mentality of the elitist Rhinos. It is not that all people hate republicans it is dissatisfaction of the Repub's establishment's continued policy to snatch defeat from the jaws of victory and their Rhino-ness turncoat-ness that folks are angry with. We vote to be represented and we are not. The Dem's lie to enslave and put all on the plantation. Rhinos agree with the Dem's. And the Little guy wants our country back.

To the folks in Washington -politics is viewed as a game to see who wins at all cost - winning for the party is the issue - not what is best for all Americans or for America. So as for health care, that issue demonstrates this. Yes, we need health care refrom but not from ONE PARTY who seeks to enslave.

I wrote this on a commentary:

Well think of it for a moment, if the Democrats use the Parks to throttle us now, what will they do next with health care enforced by the IRS?

It is proven now - Whitehouse to IRS - target those that oppose the Dem's - prevent =Tea Party folks from legally organizing during an election and anyone who dare questions der Leader... Why, they want to play in the big leagues - we'll squash em through ridicule, demonizing, and character assassination cause that is pure politics. That is the mindset of the Dems and the Rhino's. Heck with what is best for America rather what best to win at all cost for the Party. With that attitude that keeps fiddling these folks may wake up one day and there will be no more America or free ride on the govt gravy train.

Ideas have consequences as do votes...

Hope this helps explain the current state of affairs a bit better albeit in a more simplified form for expedience.

People do want honest Health Care reform - not 20,000 pages plus bill that pits people against each other just to secure future elections for either party vote pandering politicking.
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[Jac3510]

We should have some sort of Federal flat tax rate for all people, businesses, and corporations with no deductions or loophole in the Federal tax law. Then, some sort of a national health care coverage might be fair, but until then, the whole system is very corrupt, deceptive, and diabolical in scope and nature. It needs to be abolished. The goal of the leftist -Democrat leaning party is actually communism with a smiley face attached to hide its fascist hands. That is why folks are so angry.

That matches my perception of Obamacare - in hiving off a middle ground between two opposing groups, they've ended up pleasing neither group. The only real winners in Obamacare are the healthcare professionals who will be benefiting from the fresh influx of cash.

My initial question wasn't really about Obamacare, though - I was more interested in the people who champion the existing model over a single-payer system. Leaving the crock that is Obamacare out of the equation, why is the current system so widely favoured? Or is my perception incorrect, and the majority of US citizens would actually favour a genuine single-payer model over the pre-Obamacare situation?

It's not that people are in favor of the current system. Pretty much everyone agrees it needs to be fixed. (Here's a solution I would endorse.) It's that we oppose Obamacare, and it's that we oppose single-payer systems. The reasons for the former are obvious, the reasons for the latter are simple enough. They necessarily lead to government-directed rationing, long waits for necessary procedures, extremely high taxes, and a huge increase in government control. Americans, as a whole, tend to favor less government and lower taxes. It is, of course, a fact that a very large segment of our population also likes our entitlements. That's a problem. We can't have both an entitlement state and a limited government. You have to go one way or the other. Right now, we are trying to straddle the fence, so to speak, and under all the debates going on, that's what this is all really about.

[PerciFlage]

They necessarily lead to government-directed rationing, long waits for necessary procedures, extremely high taxes, and a huge increase in government control.

Rationing is a problem in any healthcare system that doesn't have unlimited funds. Whether it's the government deciding not to make a given drug available under a public healthcare system or insurers explicitly or de facto ruling out certain treatments and conditions, some people will find themselves having to go without treatment or else paying for treatment out of their own pocket.

Waiting times and taxes are likewise a function of resources - shorter wait times can be bought at the cost of higher taxes, so some kind of value judgement needs to be made on whether shorter average waiting times and lower taxes for the insured are more important than higher taxes and longer average wait times but with the same care available universally.

I guess the issue of government control is pretty crucial to understanding American attitudes towards provision of healthcare. For philosophical and historical reasons it is much more a feature of American than European politics, and as such factors into the healthcare debate to an extent that it doesn't over here.

[url=http://distributistreview.com/mag/2011/ ... re-system/]

That's an interesting article, thanks. Monopolies are important whichever side of the socialised/privatised fence you find yourself on - profiteering is toxic whenever it meets fundamental necessities. Of course there's a separate debate to be had about whether the benefits of a government engaging in collective bargaining outweigh or are outweighed by the efficiencies of a free market, but when people are introduced into the equation who add no value but who skim a lot of the cream, that's a recipe for disaster. It's a disaster that affects just about every healthcare system in the world today.

[Jac3510]

Rationing is a problem in any healthcare system that doesn't have unlimited funds. Whether it's the government deciding not to make a given drug available under a public healthcare system or insurers explicitly or de facto ruling out certain treatments and conditions, some people will find themselves having to go without treatment or else paying for treatment out of their own pocket.

Look more carefully at what I actually wrote:

• They necessarily lead to government-directed rationing

You are basically arguing that rationing is intrinsic to any system, which is true (depending on how we define the term 'rationing'), but therefore we ought not object to it in any given system. You thereby simply dismiss the actual critique, which is directed against government-directed rationing.

Of course, it is not at all obvious or true that just because rationing (what you really are talking, about, though, is the direction of limited resources) is intrinsic to all systems that it is okay in any given system. It is precisely because rationing is a problem that we need to take steps to ensure that the system imposing the rationing is the most appropriate, least-corruptible, and fairest system possible. And on that count, the government far and away fails all such tests.

Now, you certainly don't have to agree with the critique, but you do need to understand that it is what lies behind the resistence to single-payer systems.

Waiting times and taxes are likewise a function of resources - shorter wait times can be bought at the cost of higher taxes, so some kind of value judgement needs to be made on whether shorter average waiting times and lower taxes for the insured are more important than higher taxes and longer average wait times but with the same care available universally.

Even if you were right here, the same would apply here as just above. But I don't think you are right. Taxes are, by virtue of what they are, something only the government can impose. Thus, the less the government is involved in healthcare, the less it needs to be funded, and the less taxes must be imposed. Therefore, for those of us who believe in a low-tax, limited-government state, single-payer and related systems are not viable healthcare options.

The issue with wait-times is complicated, but the fact is that, for all of the problems with the US system, it has far shorter wait times than its European counterparts. Whatever evils we can cite concerning a private insurance system, there is no doubt that one such evil is not that long waits are typical. I can tell you this from experience. I work as a hospital chaplain assigned to a Long Term Acute Care Unit (LTAC). We accept both private pay (insurance) and public pay (Medicare/Medicaid). The average length of stay for a patient on our unit is 28 days. It is, however, extremely difficult to get those on public systems out the door. They have to wait much longer than our private pay patients for various treatments, especially for access to rehab facilities. The idea of putting everyone on what is essentially Medicaid absolutely terrifies me, since I see it and work with it every single day. So, on this point, you are just factually incorrect.

That is not to say, again, that you have to agree with me or that you have to give up your appreciation for single-payer systems. It is not to say, in and of itself, that our current system is preferrable in the final analysis to single-payer based on this one issue. It is, however, to say that one issue that we have to consider is that single-payer systems have longer-wait times on average than our current systems, and that's part of the cost/benefit analysis that has to be done when deciding which system one supports. For many Americans, this is a major issue, and it is a major reason for the resistance to such a program. So agree or disagree with their conclusion, that's the reality you would do well to at least understand.

I guess the issue of government control is pretty crucial to understanding American attitudes towards provision of healthcare. For philosophical and historical reasons it is much more a feature of American than European politics, and as such factors into the healthcare debate to an extent that it doesn't over here.

Quite right, and for all the talk of "American exceptionalism," this really is a core issue. Americans, just because of our historical DNA, tend not to like government control. Now, that is slowly changing, and we are becoming more European in our mindset. But that changing mindset is, I believe, the very issue that is at the root of the Left/Right debate in this country. For instance, we all want to help the poor (although leftists demonize conservatives by saying we don't). The disagreement is how to best go about helping them. Leftists want to do it through various degrees of government control, whereas those on the right tend to want to use the private, free market to encourage such help.

Once again, you can side with leftists philosophically, of course, and you can thereby think that the American tradition (which, I'll say again, is and has been changing on this matter for several decades now) is wrong. But what you would do well to do is at least recognize that this is the issue.

That's an interesting article, thanks. Monopolies are important whichever side of the socialised/privatised fence you find yourself on - profiteering is toxic whenever it meets fundamental necessities. Of course there's a separate debate to be had about whether the benefits of a government engaging in collective bargaining outweigh or are outweighed by the efficiencies of a free market, but when people are introduced into the equation who add no value but who skim a lot of the cream, that's a recipe for disaster. It's a disaster that affects just about every healthcare system in the world today.

Quite right. I just happen to think that it is both a moral and economic imperative to do away with all monopolies. To the extent that any system allows them, they promote corruption. And that, by the way, is one of the reasons I don't like heavy government presence, because where there is government there is always monopoly, if for no other reason than no other entity has the power to (legally) force you to behave in a certain way at the point of a gun.

All of this is why I believe in a very weak central government. More generally, I think power should distributed as wide as possible in all situations. I think monster mega banks are bad for the world economy. I think major companies like Walmart are bad for the world economy. Power should never be centralized. Everything should be as local as possible (which is also why I am such an ardent supporter of a pro-family agenda). Take the current debate over campaign finance in American politics. The whole reason this matters is that government is so powerful. If the central government was relatively weak and all the major power was invested at the local level, then the campaign finance issues would mostly go away. Sure, lobbiests could push their agenda, but to what end? They might turn this or that decision maker in their favor, but how far would that influence go? Not far at all, and it would be powerfully counterbalanced by the influence the local constituency would have over their own representatives.

[PerciFlage]

The issue with wait-times is complicated, but the fact is that, for all of the problems with the US system, it has far shorter wait times than its European counterparts. Whatever evils we can cite concerning a private insurance system, there is no doubt that one such evil is not that long waits are typical. I can tell you this from experience. I work as a hospital chaplain assigned to a Long Term Acute Care Unit (LTAC). We accept both private pay (insurance) and public pay (Medicare/Medicaid). The average length of stay for a patient on our unit is 28 days. It is, however, extremely difficult to get those on public systems out the door. They have to wait much longer than our private pay patients for various treatments, especially for access to rehab facilities. The idea of putting everyone on what is essentially Medicaid absolutely terrifies me, since I see it and work with it every single day. So, on this point, you are just factually incorrect.

That is not to say, again, that you have to agree with me or that you have to give up your appreciation for single-payer systems. It is not to say, in and of itself, that our current system is preferrable in the final analysis to single-payer based on this one issue. It is, however, to say that one issue that we have to consider is that single-payer systems have longer-wait times on average than our current systems, and that's part of the cost/benefit analysis that has to be done when deciding which system one supports. For many Americans, this is a major issue, and it is a major reason for the resistance to such a program. So agree or disagree with their conclusion, that's the reality you would do well to at least understand.

I think we are more in agreement here than my previous post has led you to believe. I wasn't saying that single-payer systems have better waiting times, but that in the insurer-led model the shorter waiting times are only available to those with insurance. The trade off in a universal healthcare system isn't that people who currently enjoy private provider waiting times would move to suffering Medicaid level waiting times, but rather that some (most?) people currently with insurance would move to suffering European level waiting times, which are somewhere in between those two extremes.

So the cost/benefit is on the one hand some people having exceptionally short waiting times and others having dismally long ones, versus everyone having the same decidedly middling waiting times. If there were only those two options available then I'd plump for the socialised model every time, but I can see the many downsides of the model and I can see that the American model of yore can be improved with methods that are neither Obamacare nor European.

[PerciFlage]

PS - I missed that your critique was aimed at "government-control" rather than rationing per se. Apologies.

I wouldn't argue that government is the best or even a good means of dividing up limited resources, but I could see a case for it being the least worst option when subject to appropriate checks and balances. I'd be entirely open to alternative suggestions of better/even less worse methods - free of politicking, free of industry lobbying, free of value-sapping/value-neutral profiteering, as efficient as possible, fairly funded and fairly distributed.

[Philip]

I'd be entirely open to alternative suggestions of better/even less worse methods - free of politicking, free of industry lobbying, free of value-sapping/value-neutral profiteering, as efficient as possible, fairly funded and fairly distributed.

Here, on EARTH? As designed by HUMAN BEINGS?

Good luck with that!

Maybe on some other planet, perhaps - or maybe, Fantasy Island - hear it has great healthcare, but no one can find it on a map.

[PerciFlage]

Yeah, I had a hint of desperation in my voice as I was typing all that. My voice was getting weaker, more highly pitched and more plaintive between every comma.

[Jac3510]

PS - I missed that your critique was aimed at "government-control" rather than rationing per se. Apologies.

I wouldn't argue that government is the best or even a good means of dividing up limited resources, but I could see a case for it being the least worst option when subject to appropriate checks and balances. I'd be entirely open to alternative suggestions of better/even less worse methods - free of politicking, free of industry lobbying, free of value-sapping/value-neutral profiteering, as efficient as possible, fairly funded and fairly distributed.

I'd agree there are no good options, but I'd also argue that the government is about as far from the worst as you can get, given the fact that power corrupts. Sure, it might work if we had a benevolent dictator, but we don't and we never will (until Jesus comes back, of course ).

That's why the best way to go about this is to decentralize as much as possible. The goal is to take human selfishness and make it work against itself, i.e., competition = good, no monopolies, etc. Government has a role in all this, but that role is limited to playing referee and enforcing contract law (speaking of domestic issues, here). Looking to healthcare in particular, the problems with the American system, to the extent that we have them, is largely already due to government ineptitude. Once upon a time, people bought their own health insurance and paid directly for their own services. But then, due to very high taxes, employers figured out they could offer health insurance as a benefit, which effectively increased a person's income without them having to claim it as such. Now we have the phenomenon of employer based insurance, which, among many, many other reasons, lies close to the heart of the skyrocketing cost of healthcare.

Anyway, all debate aside, I hope some of this has helped with your initial quarry. We tend to oppose single-systems because our heritage doesn't like big government.

[PerciFlage]

In terms of fairness to the underprivileged, I tend to favour a strong central government in certain areas. Legislation, taxation and public spending (in health, education, and infrastructure) are all things I believe should be controlled or overseen centrally. Partially this is to save some of the redundancy that comes with replicating functions across different local groups, but mainly it's as a way to ensure at least some level of average prosperity across a country - poorer areas benefit from the wealth of more flourishing ones, and self-perpetuation is mitigated or at least slowed down. I favour a degree of local control in the above areas of spending, with budgets allocated and the limits of latitude in their distribution defined centrally.

Regarding localism as a way to combat corruption and lobbying, I actually think local government is more vulnerable to lobbying in many ways. Central government gives industry and other lobbyists a single point to focus all of their efforts, but local government gives industry the chance to exploit often cash- and time-strapped bodies.

As an example of this, a recent healthcare reform in the UK has been to shift a lot of commissioning powers away from dedicated local and central groups and into the remit of local GPs (family physicians - I'm not sure to what extent the GP acronym is common currency in the States). Now, in one analysis this is a very good thing - GPs have good, direct experience of the ailments and grievances of patients in their area. On the other hand they lack some of the specialist skills needed for commissioning (forecasting medium and long term health trends, commissioning ancillary services such as IT), and need to fit their regular practice alongside these new responsibilities. In addition to this, GPs are only very weakly and indirectly accountable to the people who their commissioning decisions affect.

All of this has led to a widescale employment of consultancy from the private sector, from firms which have even less accountability to the public than GPs do, and which run the gamut from "mildly concerning" to "big red flag" in terms of the conflicts of interest arising from their ties to the pharmaceutical and other healthcare related industries.

The point I'm trying to make in an overly circuitous way is that transparency and accountability of government is much more important than weak versus strong, local versus central. Short of an entirely benevolent dictator, what we want from government is one that works efficiently, which represents the desires of the majority without impacting the needs of minorities, and which can be easily but not spuriously be turfed out when shown to fail. Both highly central and highly local models have failings and successes in this regard, and I'd be tempted to say that the division is largely a red herring compared to the real problem - the need to constrain corruption (both tacit and explicit) as far as possible.

We've run at a bit of a tangent here.