PerciFlage wrote: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.
).