What would be the best healthcare system?

[cpwill]

Of course. Did you read the link? They don't think they could make a profit by selling across state lines.

... Then they would be replaced by companies who can.

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[Surrealistik]

Incidentally, while it includes features that Westerners would probably have issues with, the Singaporean system is probably one of the best in the world.

Most Republicans (and their donors) would probably howl and cry over it despite the extensive privatization given it involves a great deal of government price setting and subsidy, including public insurance.

It also gives among the best healthcare in the world - we pay a lot, and get a lot.

Compare, for example, your chances of surviving with Cancer if you are diagnosed in the United States v if you are diagnosed in Great Britain. Cancer is expensive, aye. But here, we treat it more, and absorb the cost.

Overall health outcomes and expectancy is more important than survival rates for individual cancers, and access means nothing if you can't afford or otherwise actually get the care you need.

 

[Dittohead not!]

... Then they would be replaced by companies who can.

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by charging more for premiums.
Singapore, as you said, is a success story. They're a pretty small country to benefit from selling across state lines it seems to me.

 

[DA60]

A government health care system as a fall back with a full, free enterprise health care system and ZERO government interference in the private healthcare system/insurance (outside of fraud laws).

I would like to see the government 'fall back' system to offer full healthcare for children, veterans and the disabled AND only basic healthcare for everyone else - with charitable hospitals to make up the difference for those outside of children/veterans/the disabled.
BTW, the government system would fully cover adults ongoing conditions they first got when they were 'children' (under 18)...like MD, for example.

Basically, a free-for-all, free enterprise system for those who want it/can afford it with government/charitable healthcare for those who cannot.

 

[cpwill]

Most Republicans (and their donors) would probably howl and cry over it despite the extensive privatization given it involves a great deal of government price setting and subsidy, including public insurance.

I think you might be surprised. We already subsidize the poor. Doing so in a manner that incentivizes them to still make cost-conscious decisions is simply wise.

Overall health outcomes and expectancy is more important than survival rates for individual cancers, and access means nothing if you can't afford or otherwise actually get the care you need.

Not if you are comparing health systems qualitatively. It's not (for example) the fault (or to the credit of) the Japanese health care system that Japan's populace eats lots of fish and seaweed, nor is it the fault of the American healthcare system that we import large numbers of immigrants whose health tends to mirror that of their countries of origination. It's not the Indonesian health care systems' fault that they lost lives to a tsunami, or the Iraqi health care systems' fault that ISIS is a bunch of genocidal psychos.

If you want to compare the quality of health care systems, you have to measure the actual relative quality of health care provided.

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[Dittohead not!]

A government health care system as a fall back with a full, free enterprise health care system and ZERO government interference in the private healthcare system/insurance (outside of fraud laws).

I would like to see the government 'fall back' system to offer full healthcare for children, veterans and the disabled AND only basic healthcare for everyone else - with charitable hospitals to make up the difference for those outside of children/veterans/the disabled.
BTW, the government system would fully cover adults ongoing conditions they first got when they were 'children' (under 18)...like MD, for example.

Basically, a free-for-all, free enterprise system for those who want it/can afford it with government/charitable healthcare for those who cannot.

Unless that sort of system could dramatically lower the costs, only the top 1/10 of 1% could afford it. Oh, most of us could afford to go to the doctor, but get diagnosed with diabetes, heart disease, or cancer and you need hundreds of thousands of available cash.

 

[Surrealistik]

I think you might be surprised. We already subsidize the poor. Doing so in a manner that incentivizes them to still make cost-conscious decisions is simply wise.

Yes, the US subsidizes the poor, but the GOP constantly works to eliminate or further limit such subsidy. Perhaps they like the idea of mechanisms that encourage the poor to make cost-conscious decisions, but the real question is would the GOP and more importantly its controlling donors (especially big pharma, health insurers and health providers) get on board with a system like Singapore's which features so much direct government dictation and private sector interference despite their history of constant aggression against both things?

Not if you are comparing health systems qualitatively. It's not (for example) the fault (or to the credit of) the Japanese health care system that Japan's populace eats lots of fish and seaweed, nor is it the fault of the American healthcare system that we import large numbers of immigrants whose health tends to mirror that of their countries of origination. It's not the Indonesian health care systems' fault that they lost lives to a tsunami, or the Iraqi health care systems' fault that ISIS is a bunch of genocidal psychos.

If you want to compare the quality of health care systems, you have to measure the actual relative quality of health care provided.

I agree it's silly to use life expectancy as the only measure, but that's not what I'm talking about; even with respect to relative quality and outcomes US spending isn't nearly proportionate to its results, nor does that excess spending yield clearly superior overall outcomes.

This is a pretty good comparison tool for looking into these (and other) national metrics:

Statistics for Health > Quality of health care system
Countries Compared by Health > Quality of health care system > Health care system index. International Statistics at NationMaster.com

Then of course there is the problem that even if the US health system actually enjoyed superior outcomes, those outcomes again mean little if they can't actually be afforded by the majority of the populace; access to quality care is not equivalent to receipt of that care.

 

[antiquity]

Of course. Did you read the link? They don't think they could make a profit by selling across state lines.

... Then they would be replaced by companies who can.

It only stands to reason if insurance companies could sell across state lines it would increase their insurer base thus both spreading the cost over more people while driving down the cost overall and increase their profits.. Folks this isn't rocket science, nor political wrangling like the left wants it to be.

 

[cpwill]

by charging more for premiums.

Goodness. You mean, over time, prices would stabilize both supply and demand, and we would end up with a market in which more people were supplied with higher quality goods and services for less money?

Huh. Is there any other market for something humans have to have in order to survive, where we could compare the results for nationalization v private markets?

Singapore, as you said, is a success story. They're a pretty small country to benefit from selling across state lines it seems to me.

True enough - though those weren't really the aspects I was highlighting. Singapore requires all residents to have catastrophic health insurance - and it also requires all residents to fund their HSA's, from which the majority of medical expenditures are made. Those who are poor are subsidized, but not enough to create dependency or punish work.

 

[DA60]

The one where the government butts out for everyone but those who cannot afford healthcare.

EVERYTHING the government does - it does INCREDIBLY inefficiently/wastefully.

 

[antiquity]

The one where the government butts out for everyone but those who cannot afford healthcare.

That is why we have Medicaid.

EVERYTHING the government does - it does INCREDIBLY inefficiently/wastefully.

No argument from me on that.

 

[<alt>doxygen]

Keep in mind that America's healthcare is more expensive than any other in the world.

If there was an easy answer...

There are too many leeches that add no value in the middle of the system, and they have enormous lobbying power. That stranglehold needs to be broken before meaningful change can take place. Don't let the "stakeholders" and their lobbyists get involved in the process of coming up with a solution. They gave us Medicare-D and the ACA. Anyone think those are cost effective?

 

[Surrealistik]

Huh. Is there any other market for something humans have to have in order to survive, where we could compare the results for nationalization v private markets?

Totally absurd and disingenuous and not at all comparable. Extensive government involvement in healthcare has been proven successful from Singapore to France.

True enough - though those weren't really the aspects I was highlighting. Singapore requires all residents to have catastrophic health insurance - and it also requires all residents to fund their HSA's, from which the majority of medical expenditures are made. Those who are poor are subsidized, but not enough to create dependency or punish work.

Mind that Singapore does have a full subsidy level for the unemployed.

The true major stumbling block to the adoption of a system like Singapore's (or indeed any other major paradigm shift in healthcare that involves extensive increments in government subsidy and control) is key donors (and thus their parties, Dem and Republican alike) would never go for it; there's too much money and too much autonomy to lose for them.

 

[cpwill]

Yes, the US subsidizes the poor, but the GOP constantly works to eliminate or further limit such subsidy.

The GOP (occasionally) tries to improve these programs, which at current, often help trap people in. That being said, this is a side-complaint, and a non-sequitur. Shifting the manner in which we subsidize the poor to make them cost conscious is wise policy.

Perhaps they like the idea of mechanisms that encourage the poor to make cost-conscious decisions, but the real question is would the GOP and more importantly its controlling donors (especially big pharma, health insurers and health providers) get on board with a system like Singapore's which features so much direct government dictation and private sector interference despite their history of constant aggression against both things?

The GOP's controlling donors of Big Pharma?

Uh.

Open Secrets.Org: Pharmaceuticals



They're pretty much donating to both sides of the aisle. And if you think that big business is against big government. :lol: Well, that's Cute

You are also, I think, missing the amount of government dictation already occurring in our health market - from insurance premiums to drug prices to treatment prices, the Federal and State governments have heavy role as price-setters and supply-limiters (or boosters).

I agree it's silly to use life expectancy as the only measure, but that's not what I'm talking about; even with respect to relative quality and outcomes US spending isn't nearly proportionate to its results, nor does that excess spending yield clearly superior overall outcomes.

Now, you could argue that it's disproportionate to our superior results, sure. That is rather subjective - how much is getting a knee replacement 6 months earlier worth? We seem to think it's worth an awful lot - especially when we are spending other people's money.

This is a pretty good comparison tool for looking into these (and other) national metrics:

Statistics for Health > Quality of health care system
Countries Compared by Health > Quality of health care system > Health care system index. International Statistics at NationMaster.com

No, this is a stupid measurement. The US healthcare system is worse than the Philippines? :lol:

I don't see where they talk about their inputs, or what they are actually measuring. Given that they have arrived at a ridiculous result, that's probably to avoid being mocked.

Then of course there is the problem that even if the US health system actually enjoyed superior outcomes, those outcomes again mean little if they can't actually be afforded by the majority of the populace; access to quality care is not equivalent to receipt of that care.

The fact that we have such higher cancer survival and treatment rates is precisely because that care is being accessed by the majority of the populace. Otherwise, they wouldn't impact the statistics.

I wholeheartedly concur that there is a sharp distinction between "access to health insurance" and "access to / receipt of health care". In places that feature lengthy waiting lists, for example, 100% of the populace may have access to insurance - but their ability to actually receive care is sharply limited.

 

[Surrealistik]

The GOP (occasionally) tries to improve these programs, which at current, often help trap people in. That being said, this is a side-complaint, and a non-sequitur. Shifting the manner in which we subsidize the poor to make them cost conscious is wise policy.

It's not a side-complaint or non-sequitur; the propensity of the GOP for systemically hollowing out and cutting subsidies to the poor on a sustained basis demonstrates the unlikelihood that they would ever go for as sweeping and wholesale an increment in subsidy of the poor as featured in Singapore's healthcare system, nevermind the direct government controls involved.

The GOP's controlling donors of Big Pharma?...

They're pretty much donating to both sides of the aisle. And if you think that big business is against big government. :lol: Well, that's Cute

The true major stumbling block to the adoption of a system like Singapore's (or indeed any other major paradigm shift in healthcare that involves extensive increments in government subsidy and control) is key donors (and thus their parties, Dem and Republican alike) would never go for it; there's too much money and too much autonomy to lose for them.

I was concerned with the GOP exclusively in that response as they were the focus of that response.

You are also, I think, missing the amount of government dictation already occurring in our health market - from insurance premiums to drug prices to treatment prices, the Federal and State governments have heavy role as price-setters and supply-limiters (or boosters).

The problem is a combination of extensive regulatory and governmental capture/corporate pork barrelling, including limits on what the government can negotiate, and extensive general market fragmentation as compared to singlepayer countries.

Now, you could argue that it's disproportionate to our superior results, sure. That is rather subjective - how much is getting a knee replacement 6 months earlier worth? We seem to think it's worth an awful lot - especially when we are spending other people's money.

Actually the cronyist health system set up riddled with regulatory capture seems to think it's worth an awful lot; it is utterly plagued with corporate federal and state level distortions. Your average person doesn't set this market so much as big corporate interests that enjoy disproportionate sway with the government on both sides of the aisle.

Also you've yet to actually demonstrate that the US system features consistently and roundly superior results and outcomes on average to other industrialized countries. Even when it comes to cancers, which you like to cite, its dominance isn't absolute.

I don't see where they talk about their inputs, or what they are actually measuring. Given that they have arrived at a ridiculous result, that's probably to avoid being mocked.

Try clicking through the categories of health metrics; the explanation for each is quite plain and evident at the top.

Further, you can consult any number of list compilers or indices and none save the utmost partisan will put the US anywhere near the top. I would be very interested in seeing what sourcing you can come up with that awards the US a top aggregate score vis a vis other industrialized first world countries.

The fact that we have such higher cancer survival and treatment rates is precisely because that care is being accessed by the majority of the populace. Otherwise, they wouldn't impact the statistics.

I wholeheartedly concur that there is a sharp distinction between "access to health insurance" and "access to / receipt of health care". In places that feature lengthy waiting lists, for example, 100% of the populace may have access to insurance - but their ability to actually receive care is sharply limited.

Again, it's not all about the cancer survival and treatment rates, but about the general efficacy of the healthcare system, and there isn't much to suggest the overall superiority of the US health care systems vs others in terms of typical outcomes for typical people.

Second, though waiting lists and rationing are existent in SP health care systems (rationing also exists in the States on the basis of your wallet's content), triage processes routinely ensures timeliness of care for non-electives/non-essentials. This can even include subsidy and coverage for treatment in other countries if necessary.

 

[Dittohead not!]

Goodness. You mean, over time, prices would stabilize both supply and demand, and we would end up with a market in which more people were supplied with higher quality goods and services for less money?

Huh. Is there any other market for something humans have to have in order to survive, where we could compare the results for nationalization v private markets?




True enough - though those weren't really the aspects I was highlighting. Singapore requires all residents to have catastrophic health insurance - and it also requires all residents to fund their HSA's, from which the majority of medical expenditures are made. Those who are poor are subsidized, but not enough to create dependency or punish work.

We should adapt Singapore's system to our own nation. It makes a lot of sense.
What doesn't make sense is the old, tired, meme that, "Oh, if only we'd allow insurance companies to sell across state lines, everything would be OK." Sure. let's continue to allow sales across state lines, but let's not think for a moment that's a health care plan that will work. There is no panacea.

 

[SocialD]

IOW, you Cannot Afford Health Insurance without ACA or other Subsidy.
There is NO "$40" a month plan that is going to pay you BEANS when you need it.
Who the hell would sell a 40 a month policy that didn't have a 5K deductible and and 1K payout cap?
LOL
How is the Ins co supposed to make any money?
How does $40 a month cover any serious medical condition.. AND.. Ins co Profit?
Let's be clear... YOU would end up being a Ward of the taxpayers under any such meager policy.

4K a year is a very good rate.
And about what other OECD (30 Industrialized rich) countries spend per capita for their health care.
A so-called "market rate" plan in this country... Higher by at least 2K-4K. IOW, 6K-8K

LOL I kind of laugh because because what you are saying describes the current plan except that its more expensive.

Here is the very cheapest plan ACA plan from healthcare.gov if I were to sign up. I just checked.
Estimated monthly premium $336.63
Deductible $6,650
Out-of-pocket maximum $7,150

Copayments / Coinsurance
Emergency room care: 50% Coinsurance after deductible
Generic drugs: $35
Primary doctor: $45 Copay before deductible/50% Coinsurance after deductible
Specialist doctor: 50% Coinsurance after deductible

Estimated total yearly cost
$4,299

If you didn't notice the current plan I mentioned under the ACA on healthcare.gov .. the one with the 336.00 a month premium has a $6700 deductible.
So for the typical stuff , one or two doc visits a year maybe I need some antibiotics or something once a year I get nothing from this plan. I paly the premiums then I contribute toward a deductible which I will never satisfy.
its there if something really bad happens... that's called a catastrophic plan and that's what the 40$ one 7 years ago was. it was pretty much the same coverage as this.

 

[cpwill]

We should adapt Singapore's system to our own nation. It makes a lot of sense.
What doesn't make sense is the old, tired, meme that, "Oh, if only we'd allow insurance companies to sell across state lines, everything would be OK." Sure. let's continue to allow sales across state lines, but let's not think for a moment that's a health care plan that will work. There is no panacea.

The only people I'm aware of out there claiming that there is a panacea are the Single Payer folks, and a (very few) of the (very) minimalist/anarcho folks. Selling across state lines isn't intended to be a cure-all; it's intended to help reduce costs a bit.


Some adapted form of Singapore's would be wise - the problem becomes, you have to force Americans to do responsible things, like save up for their own expenses. The message "nah, don't worry about the future and we'll just charge someone else when it gets here" is generally pretty popular, here.

 

[Dittohead not!]

The only people I'm aware of out there claiming that there is a panacea are the Single Payer folks, and a (very few) of the (very) minimalist/anarcho folks. Selling across state lines isn't intended to be a cure-all; it's intended to help reduce costs a bit.


Some adapted form of Singapore's would be wise - the problem becomes, you have to force Americans to do responsible things, like save up for their own expenses. The message "nah, don't worry about the future and we'll just charge someone else when it gets here" is generally pretty popular, here.

You got that one right. People just don't plan for the future effectively, as witness the number of people carrying credit card balances and paying that outrageous interest rate.

So, how can that sort of a mindset be countered?

 

[cpwill]

It's not a side-complaint or non-sequitur...

1. Yes, it is a non-sequitur, when it is your response to "we already subsidize the poor".

2. If you think Republicans wouldn't like to streamline how we do that to reintroduce market forces, reintroduce low-cost catastrophic coverage, and start shifting our people off of the government teat by having them save for their own medical expenses with money that is theirs, that they get to keep.... then I think you have them confused for perhaps the more minimalist elements of the Libertarian party, and I would urge you to take a look at, for example, the reforms that Indiana put through under Governor Mitch Daniels. Name me the GOP Senators who have come out against HSA's.

3. Price controls aren't what makes the Singaporean system efficient - we have price controls here, however stupidly - what makes their system efficient is that patients always have financial skin in the game, and so they are incentivized to make cost-effective decisions.

The problem is a combination of extensive regulatory and governmental capture/corporate pork barrelling, including limits on what the government can negotiate, and extensive general market fragmentation

..... Sort of. Having choice and competition isn't a bug, it's a feature, and the Government already imposes "negotiation" and price control via the Medicare/Medicaid reimbursement schedules - that it doesn't do so with Drugs notwithstanding. But you are correct that extensive regulation and government capture add needlessly to complexity and cost.

Actually the cronyist health system set up riddled with regulatory capture seems to think it's worth an awful lot

Actually I'm pretty sure it's the people waiting who are in pain or facing early death due to delay who think it's worth an awful lot.

you've yet to actually demonstrate that the US system features consistently and roundly superior results and outcomes on average to other industrialized countries.

Absolute? No - simply very good at actually treating people. We are bad at how we go about paying for it.

Try clicking through the categories of health metrics; the explanation for each is quite plain and evident at the top.

At the top it says: "Health Care Index is an estimation of the overall quality of the health care system, health care professionals, equipment, staff, doctors, cost, etc."

Oh. Yes. Well. Wow. They really dived into the nitty-gritty, there, didn't they? Hope no one drowns in all that raw data.


Click on a country, and you'll see them counting in fertility rates, obesity rates, infant mortality rates (which are gathered differently in different countries, wildly impacting the comparative outcome), five different kinds of life expectancy rates (which I think we already agreed was a bad metric), and.... hilariously, online polling, from which they derive technical statistics on things like modernized equipment.

Further, you can consult any number of list compilers or indices and none save the utmost partisan will put the US anywhere near the top.

I would tend to look at actual healthcare provision - so how are we at providing treatment to those who are sick and injured. Life expectancy is pretty problematic, unless you get narrowly defined, such as "for someone who has been diagnosed with breast cancer" or "for people over the age of 70". I don't claim that we are the best. I claim that an index that puts nations like the Philippines, the United Kingdom, Estonia, and Nepal ahead of us are idiotic.

though waiting lists and rationing are existent in SP health care systems (rationing also exists in the States on the basis of your wallet's content), triage processes routinely ensures timeliness of care for non-electives/non-essentials.

:lol: yeah. "elective" surgery gets put off - because the incentives for government workers aren't market incentives.

So, instead, you get things like: NHS managers are deliberately delaying operations as they wait for patients either to die or go private in order to save money.

It happens with Government employees in this country, too.

 

[cpwill]

You got that one right. People just don't plan for the future effectively, as witness the number of people carrying credit card balances and paying that outrageous interest rate.

So, how can that sort of a mindset be countered?

Generationally, and with government force in the mean-time. We need to start introducing financial literacy into high school curricula, and wait for the Baby Boomers and anyone else dumb enough to have picked upon the "If It Feels Good Do It, Don't Worry About The Results" mantra to die off.

While we do that, we'll have to force people to save. I would also stop incentivizing debt.

 

[Dittohead not!]

Generationally, and with government force in the mean-time. We need to start introducing financial literacy into high school curricula, and wait for the Baby Boomers and anyone else dumb enough to have picked upon the "If It Feels Good Do It, Don't Worry About The Results" mantra to die off.

While we do that, we'll have to force people to save. I would also stop incentivizing debt.

Other than introducing financial literacy into the high school curriculum, that sounds a lot like forcing people to be responsible. I'm not sure that would work.

Tax breaks for savings accounts? Taxes on credit card balances?

At one time, interest could be deducted from taxes. At least that ended, except for mortgage interest.

 

[cpwill]

Other than introducing financial literacy into the high school curriculum, that sounds a lot like forcing people to be responsible. I'm not sure that would work.

The American people have been weaned off of liberty. They'll have to be weaned back.

And making people take financial literacy classes is forcing them to do something, too. It's just something we don't mind doing so much.

Tax breaks for savings accounts? Taxes on credit card balances?

At one time, interest could be deducted from taxes. At least that ended, except for mortgage interest.

Eh. I wouldn't mind the former - Taxing credit card balances would be pretty problematic, as you would just add to the downward cycle.

I'd take off the mortgage interest deduction. Businesses can write off interest as well - get rid of that, and we'll have a somewhat smoothed-out business cycle.

OR, we could shift (which would be wise) from taxing income to taxing consumption.

 

[Dittohead not!]

The American people have been weaned off of liberty. They'll have to be weaned back.

And making people take financial literacy classes is forcing them to do something, too. It's just something we don't mind doing so much.



Eh. I wouldn't mind the former - Taxing credit card balances would be pretty problematic, as you would just add to the downward cycle.

I'd take off the mortgage interest deduction. Businesses can write off interest as well - get rid of that, and we'll have a somewhat smoothed-out business cycle.

OR, we could shift (which would be wise) from taxing income to taxing consumption.

If you want to discourage something tax it.
Which is a problem with the income tax - we don't want to discourage people from earning income.
We do want to encourage home ownership, which is why we have a mortgage tax deduction, but then we really should encourage people to pay off those mortgages as soon as possible, too, so it's counterproductive there.

I consumption, rather than production, were taxed, then every savings account would be a tax free account.

The problem is, the tax would have to be pretty high to produce enough revenue without cutting back the size of government substantially. No one wants to do that, even if it's what should be done. A high tax on consumption would really make it difficult for people with low incomes.

 

[PIPEWRENCH]

Keep in mind that America's healthcare is more expensive than any other in the world.

I like single payer for everyone from the homeless street walker to the president. Everyone treated equally. Of course there will be financial limits unfortunately. Everyone cannot have millions of dollars worth of treatment unless everyone pays in millions of dollars. However basic healthcare for everyone would be a vast improvement over what we currently have even with limits. I think people should have the option to purchase higher limits of health care.