American economic dominance

[Northwestcoug]

This is a very good post- probably your best ever! Most political issues are similar in that they include various tradeoffs wrt security vs freedom etc.

Thanks!

I tend to think some level of a socialized medicare for all would be good in the US. Perhaps Wuap might take up my facebook bandwidth complaining that poor people don't get as good looking teeth as rich people and how if we only made perfect teeth part of the medicare for all then all poor people would feel better about themselves. Their driving records would improve as they would stop getting into accidents having long face looking at themselves in the their rearview mirrors as they drive. They would find better paying jobs with their prettier smiles and suddenly there would be no need for welfare in any form by just fixing all the poor folks teeth! Berkley professors would get gazillions in government grants, thus keeping their R1 status and their sports teams in a better conference than BYU's, to generate studies and "data" about the good that experts know would follow if we just made poor kids mouths as ascetically attractive as rich kids mouths.

I...think?

[Goatnapper'96]

I've thought about this for a bit, and I really believe the health care debate is more of a philosophical rather than a practical one for most people. The fundamental issue is whether or not a country believes health care is a human right or not. For those governments that believe it is, some form of universal heath care is mandatory. Funding questions flow from that premise, including rationing however you want to define it. For those who see it as more of a privilege to live with the availability of 'top-notch' health care, governments can and will decrease funding for health care social nets. There is an implicit compromise that as long as excellent health care is available to most people, there will be those who get left behind.

Spoiler alert: realities in both types of government fall short of their ideals. In this day and age an American on disability who is developing pneumonia will choose not to go to the hospital because they can't afford it (real current story from an acquaintance!). Whole swaths of specialty care can opt out of seeing medicare or medicaid patients. And there is no denying that the quality of health care many people get is dependent on their income or lack thereof. And I don't think it's debatable that most Americans are OK with those realities. Whether it triggers some brain stem reflex of individual freedom or a the pros outweigh the cons for many, a complete transition to socialized medicine is a non-starter. If health care expenses continue to get more prohibitive, that may change.

That doesn't let countries with some form of socialized medicine off the hook. Someone on my curling team had heart bypass surgery a year ago, yet there aren't enough specialists here for him to get routine follow-up. And it took him a long time just to get a primary care provider after moving here. If health care is a right, there will be a constant fight about adequate funding, which in the future will only get worse as it gets more expensive. As I've said before living in a rural area on an island presents a government constant headaches to fund health care, but once the decision is made that it is a basic human right, you're kind of stuck with that. But since universal health care plays so much into the Canadian ideal many here accept real deficiencies. If adequate health care coverage becomes a problem for more here, that may change.

This is a very good post- probably your best ever! Most political issues are similar in that they include various tradeoffs wrt security vs freedom etc.

I tend to think some level of a socialized medicare for all would be good in the US. Perhaps Wuap might take up my facebook bandwidth complaining that poor people don't get as good looking teeth as rich people and how if we only made perfect teeth part of the medicare for all then all poor people would feel better about themselves. Their driving records would improve as they would stop getting into accidents having long face looking at themselves in the their rearview mirrors as they drive. They would find better paying jobs with their prettier smiles and suddenly there would be no need for welfare in any form by just fixing all the poor folks teeth! Berkley professors would get gazillions in government grants, thus keeping their R1 status and their sports teams in a better conference than BYU's, to generate studies and "data" about the good that experts know would follow if we just made poor kids mouths as ascetically attractive as rich kids mouths.

[Green Monstah]

I don’t know what the right answer is. Or that there is one. I do know that I’m paying 10% of my salary (which is not particularly small) for a high deductible plan that I’ll almost never get coverage through—but it does give me access to an HSA, so all is not lost!

[Bo Diddley]

But at least when someone is about to die from lack of access (or long wait times) to rationed healthcare under a single payer system, that person can get some comfort from knowing that wealthier people are suffering and dying from the same lack of access.

Well, at least the rich and poor can finally agree on something. "The wait times are terrible!" Perhaps bringing the rich and poor together in this way of shared dying is truly the first step in healing the divide.

[Jeff Lebowski]

Single payer systems seem to be the most fraught and inefficient. I believe there are other systems in Europe that aren't the crap show that the UK and Canada are.

You guys may be right that public outcry will push the country towards a worse healthcare system. But I'm not sure a pure single payer will ever fly. But I'm certain that the quality and ultimately access to care will suffer as a result. Truly free market elements infused into our system is greatly needed. Especially for more routine and established services.

But at least when someone is about to die from lack of access (or long wait times) to rationed healthcare under a single payer system, that person can get some comfort from knowing that wealthier people are suffering and dying from the same lack of access.

[USUC]

Single payer systems seem to be the most fraught and inefficient. I believe there are other systems in Europe that aren't the crap show that the UK and Canada are.

You guys may be right that public outcry will push the country towards a worse healthcare system. But I'm not sure a pure single payer will ever fly. But I'm certain that the quality and ultimately access to care will suffer as a result. Truly free market elements infused into our system is greatly needed. Especially for more routine and established services.

[Bo Diddley]

The relative pros and cons of universal and less than that health care are not fixed in time. I respect the argument that despite its major structural flaws, the US system works better for its population than other forms of health care. But that isn't set in stone. Your and my kids' generation are having a difficult time paying for health care, but it is only going to get worse. The US eclipses other developed countries in health care spending per capita, and it's not even close. And the trend is increasing. Irrespective of the undeniable benefits to society this level of health care spending brings, there simply isn't the tax base to continue at this pace, or the political will to force private insurance to provide affordable coverage. There will be a reckoning, probably sooner than later, when the country will have to decide how to reign in health care spending it can't afford. Some might call it rationing.

Other OECD countries are just biding time though. They are doing better holding the line on per capita spending, but there will be constant pressure to fund increasingly expensive health care innovations. And their citizens will not be too happy when there isn't enough money to provide ever higher standards of care to them.

Every way I think of this, there are no easy answers--no slam dunk course of action. But I do think everyone should have access to basic health care, even if that means I have to wait longer for my own.

I agree there will be some sort of breaking point where enough is enough and something drastic has to change.

Or maybe AI and robotics finally come of age and we can scale up health care access that way. Is that science fiction?

[Northwestcoug]

I also remember individuals between the ages of 18-26 were very much against the mandatory requirement to pay for insurance. I remember this being a big sticking point of it being a mandate and not free or available to anyone who wants it and those who opt out didn’t have to pay.

one item that I think that has been great was the ability to keep our children on our health insurance plans longer that before and the inability for insurance plans unable to deny treatments for specific health conditions.

The outlawing of preexisting conditions is an undeniable good that came with the ACA. I can't believe it took that long. I was a freshman in the dorms when I had an asthma exacerbation. I had some insurance that the university required I pay for (? Deseret), so I didn't think much of going to the ER and getting nebulizer treatment. I'm sure I had a copay but I went on my way, happy I wasn't on the hook for more. A couple of weeks later I got a call from the insurance company stating that since I had a history of asthma the insurance wouldn't cover that ER visit. But they were oh so helpful allowing me to pay it back in installments.

[Northwestcoug]

I'm still not sure how I feel about universal health coverage. The UK system should give anyone pause. Still, I have heard other European countries do a better job. I'm just not connected to people to get that firsthand feedback like I am to people in the UK.

On the other hand, I have seen how my own kids have struggled with paying for insurance. Here in the US, health care is still rationed, but there seems to be a divide between those who can afford it and those who can't. Even if they have health insurance, it might only serve as a catastrophic cap of sorts. As a soldier, I am probably the most privileged. I haven't paid a dime for health care for many years.

I wonder if looking at it in supply/demand terms is helpful. Is healthcare zero sum? How much more can we increase resources?

The relative pros and cons of universal and less than that health care are not fixed in time. I respect the argument that despite its major structural flaws, the US system works better for its population than other forms of health care. But that isn't set in stone. Your and my kids' generation are having a difficult time paying for health care, but it is only going to get worse. The US eclipses other developed countries in health care spending per capita, and it's not even close. And the trend is increasing. Irrespective of the undeniable benefits to society this level of health care spending brings, there simply isn't the tax base to continue at this pace, or the political will to force private insurance to provide affordable coverage. There will be a reckoning, probably sooner than later, when the country will have to decide how to reign in health care spending it can't afford. Some might call it rationing.

Other OECD countries are just biding time though. They are doing better holding the line on per capita spending, but there will be constant pressure to fund increasingly expensive health care innovations. And their citizens will not be too happy when there isn't enough money to provide ever higher standards of care to them.

[frank ryan]

I'm disappointed we didn't get the promised death panels.

Obama failed to deliver. Maybe it was Palin sounding the alarm that changed things!

[dabrockster]

I'm disappointed we didn't get the promised death panels.

Ha! Gotta head to Canada for such things..

[BigPiney]

I'm disappointed we didn't get the promised death panels.

[dabrockster]

I do remember increased wait times after ACA.

I also remember individuals between the ages of 18-26 were very much against the mandatory requirement to pay for insurance. I remember this being a big sticking point of it being a mandate and not free or available to anyone who wants it and those who opt out didn’t have to pay.

one item that I think that has been great was the ability to keep our children on our health insurance plans longer that before and the inability for insurance plans unable to deny treatments for specific health conditions.

[Bo Diddley]

There is plenty of data that supports it.

one reason I think this is the case is people in countries with universal healthcare (even if it is shitty) get more access to routine healthcare.


I really think Obama care helped a ton and something more along the lines of strengthening that program rather fully socialised medicine.

I do remember increased wait times after ACA.

[frank ryan]

I ran the universal healthcare question through the AI at work, and it tried to tell me the UK had better mortality outcomes than the US, using an under age 75 treatable mortality rate that it called the gold standard used by health economists. It also indicated that peers had better outcomes than both of us. I think that illustrates how misleading statistics are.

I asked it to play devils advocate and provide counter points. Interesting exercise. Among other things, it points out that the US excels at cancer treatment and subsidizes the rest of the world with medical R&D.

I asked it to summarize what it was saying:

There is plenty of data that supports it.

one reason I think this is the case is people in countries with universal healthcare (even if it is shitty) get more access to routine healthcare.


I really think Obama care helped a ton and something more along the lines of strengthening that program rather fully socialised medicine.