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[GreatJustice]

If we all agree that everybody should be able to get treatment for medical conditions, why does anybody support a system that allows that not to happen?

(A) That's a massive oversimplification and

(B) In a world of scarcity there will always be people who are untreated for medical conditions, be it in the US or England or Canada

Some form of rationing has to occur in some way, be it through costs or through long waiting lists/no treatment period.

I think a lot of the furor will die down once the real meat of it actually gets implemented in 2014, and people see what the actual numbers are for their specific situation. As with most new government proposals, it's the opacity of the whole equation that makes it scary. There's no simple calculator they can go to and see how it's going to affect them. And because it has to apply to so many people, there's a slew of variables in the calculation that make it tricky for even informed people to calculate.

Want to know what I think will happen if it isn't repealed almost immediately and furor dies down?

-Costs will initially drop from the increase in coverage/new laws, everyone will be happy
-After a while, costs will increase drastically from the poorly thought out long term effects (which will increase demand for needless medical services even more than before)
-Costs (or waiting list times depending on what the governing administration does) will reach absurd levels and the loudest voices will blame the evil free market system for the problems
-The US will adopt a fully government controlled system, whereupon people will cease to blame "the system" and simply believe that the only solution to the problem is shoveling more money at it

This is, of course, assuming the US doesn't undergo a major ideological shift and the younger, more charismatic 2024 equivalent of Ron Paul gets elected or something like that, which I find highly unlikely at the moment.

I think that the rational for an individual to put up with forcibly increased medical costs, for him, is that it could increase the efficiency of the country's economy. If you have to make a sacrifice for a more efficient system then ultimatly it might pay you back in the end due to increased economic activity in the country as a whole making it better for you.

To call the single payer system "more efficient" is quite funny. I've got friends who spent hours waiting for treatment for things as basic as hives only to get kicked out due to a shortage of space. As poor as the American system is, I have yet to hear of that ever occurring in their hospitals.

[kaenneth]

Insurance companies WANT you to have regular checkups, as it prevents larger expenses later.

[kaijyuu]

Anyone else get the urge to punch people who claim people visiting the hospital when they have a problem (perceived or real) is somehow a bad thing? 'Cause I certainly do.

[Mr. Palau]

Insurance companies WANT you to have regular checkups, as it prevents larger expenses later.

Preventative care does not cut costs, in most cases and over the long run. While some visits may discover a problem that could become major later, most do not.
http://abcnews.go.com/blogs/politics/2009/08/congressional-budget-expert-says-preventive-care-will-raise-not-cut-costs/
http://www.politifact.com/truth-o-meter/statements/2012/feb/10/barack-obama/barack-obama-says-preventive-care-saves-money/
http://healthblog.ncpa.org/confirmed-again-preventive-care-does-not-save-money/
http://www.npr.org/templates/story/story.php?storyId=106097107
(I sort of feel like that whenever I say something that is not immediatly aknowledged as true I have to drop links to assure people.)

I think that the rational for an individual to put up with forcibly increased medical costs, for him, is that it could increase the efficiency of the country's economy. If you have to make a sacrifice for a more efficient system then ultimatly it might pay you back in the end due to increased economic activity in the country as a whole making it better for you.

To call the single payer system "more efficient" is quite funny. I've got friends who spent hours waiting for treatment for things as basic as hives only to get kicked out due to a shortage of space. As poor as the American system is, I have yet to hear of that ever occurring in their hospitals.

This conversation is about Obamacare, which contians no public option.

Now If you'll excuse me I have to find a post from the SCOTUS to Hear ObamaCare Case thread to actually showcase my suggestion. I should really just archieve that post or something.

[GlyphGryph]

To call the single payer system "more efficient" is quite funny. I've got friends who spent hours waiting for treatment for things as basic as hives only to get kicked out due to a shortage of space. As poor as the American system is, I have yet to hear of that ever occurring in their hospitals.

And as free market as some other countries are, I've heard the same things happen there. Let's be honest, single payer doesn't mean more efficient, de facto, but it certainly CAN be more efficient if properly implemented.

Simply compare the cost, speed, and quality of service provided by a variety of other single-payer nations and you'll see the difference.

It's all about implementation.

[Mr. Palau]

Here they are, spoilered by post, for your convienence.

Spoiler (click to show/hide)

Palau, healthcare does not operate like the market for sneakers or other widgets.  Market forces will NOT keep costs down.  It's not the government that's creating the perverse incentives, it's inherent to what's being delivered.  Government programs have a track record of being vastly better at providing both quality and efficiency in the healthcare sector.

I never said government is raising the cost, I said it was the insurance based healthcare system in general that raises costs. Insurance insulates you from the price of the product you are buying and stops competion in healthcare providers for lower costs. Insurance is the biggest reason that healthcare doesn't work like a market.

The main reason health care doesn't work like a normal market is that it is both an investment and a consumer good, you invest in your health by making you healthier and you consume drugs to protect you investment. However if we are talking about Healthcare providers then for the most part you can treat health care as a consumerable good, because many of the investment parts of healthcare like surgery to solve a chronic illness can also be assesed as cures for the disease instead of an investment in your future health.

In China and India, where due to the lack of government healthcare there is downward pressure on healthcare prices, you can get a quality MRI for 10% of the cost in America*, in terms of Purchasing Power Parity which doesn't accout for currency exchange rates. Which is appropriate in this case because you would ahve to bring thos emodels to America in order to recieve health care at that cost.
*http://www.economist.com/node/17961922
Leting people see what they are really paying for their healthcare, while still recieving almost all the healthcare they would normally get, would drive down costs drasticly. You are correct, currently market forces do not keep costs down, they drive them up, because people believe that a more expensive doctor must be a better doctor and better treatments always cost more,  and they are largely insulated from the costs by their insurance, which allows and almost encourages doctorss to raise costs.

Spoiler (click to show/hide)

Where people do have efficient healthcare is where the government nationalizes the whole damn thing and only mandates for healthcare services that are effective while taking advantages of economies of scale.  This is not speculative thinking.  Look at the damn real world results and the conclusion is inescapable.

Oh yeah because Switzerland doesn't exist, I forgot, I am sorry. 
http://www.forbes.com/sites/aroy/2011/04/29/why-switzerland-has-the-worlds-best-health-care-system/
Oh yeah I forgot that Switzerland has had less healthcare cost growth than the UK even though the UK has the NHS, but that’s not possible because Switzerland clearly doesn't exist.
Oh and it has a fully private system, but Norway pays more even though the government controls their healthcare.
Not to mention that cost of healthcare in the Swiss system is accelerating less than the OCED median, and accelerating less than that of Canada.
But I'm sorry because obviously free markets don't work, cost controls in a private system don't work, only the government works, clearly. 

If this were true then the uninsured would have more efficient healthcare.  But they don't.  And they don't in China either.  Healthcare is not a normal good.

Consider for instance if I was paying for an unconscious loved one to get an MRI out of pocket.  Exactly how am I going to control costs here?  Shrug and let them die?  Travel back in time and encourage the hospital to get another MRI machine?  Travel to another hospital which faces the exact same market pressures?  Healthcare is made up of a million little "market" interactions like this and in the vast majority of spending I as a consumer am virtually powerless.  Consumers in aggregate are virtually powerless.  That's why we need to government to act as our collective mechanism.

The uninsured don't have more efficient care because what service they do receive comes from a system that is used to dealing with patients who have insurance, and I never said that the uninsured in America would have more efficient healthcare you attempted to extrapolate to that conclusion based on my premises without taking into account the difference in the markers.

You would control costs by finding the cheapest MRI, those people in China and India didn't let their loved ones die, nor did they go to an expensive MRI, at least in the case of the ones that could afford an MRI scan as the governments don't provide universal coverage I only use this as an example as it is the only market that really has cost cutting forces at work.

Yes in terms of individual interactions you don't make a difference in any kin of market, your sole decision only hurts a company’s profits by a few thousand dollars at most, unless you are a millionaire out there buying yachts. If you create a market where it is possible for the consumer to accurately judge the quality and cost of a procedure, or at least the cost as the quality of healthcare is very hard to judge, then you create a system that will naturally drive costs down due to normal consumer behavior.

Market forces are great where there are channels for them to control costs.  Those channels do not exist in healthcare and have never existed in healthcare.  Free markets are nice but they don't operate on magic.  They have to deliver the results through real life transactions.

Which is why there are proposals to create channels instead of just use the blunt force of monopoly power to crush costs, which is ultimately only a short term solution as it discourages medical innovation that would ultimately lower costs further or develop new treatments or drugs due to the lack of profit in the market. Monopoly power curbs doctors salaries, leading to less qualified doctors and thereby lesser quality healthcare.

The free market is absolutely awful, from a moral perspective, when lives are on the line. Ask any of the dozens of species humans have hunted to extinction. More generally, any evolutionary strategy (which, yes, is the concept that underlies how the free market is supposed to work) is morally unacceptable when you have the opportunity to implement an alternative, and the failure condition is the death of a person, as it is here.

Those strategies only help the winners, not the statistical majority of losers who get to go right ahead and die. I can't really be any clearer about why I don't think healthcare should be a market.

Where the hell are you guys pulling death from? The only thing we are talking about is the ability to decide how much you are going to pay for care through consumer choice! You will get your care in any of the proposal I put forth!  I mentioned the government would cover expensive procedures, Ideally, which includes most life threating ones! The cost savings will help the poor more than the rich, who already have enough money to buy all the care they want!

Oh and by the way humans hunted species out of existence before the free market was even a concept in the mind of Adam Smith.

Oh and Singaporeans live longer, have healthier children, pay much much less on healthcare than Americans do.
http://www.american.com/archive/2008/may-june-magazine-contents/the-singapore-model
One sweet model.

Spoiler (click to show/hide)

quote author=mainiac link=topic=105423.msg3143823#msg3143823 date=1333111324]
Switzerland does exist.  They just don't do a great job controlling healthcare costs:

http://www.who.int/countries/che/en/
http://www.who.int/countries/gbr/en/

AFAIK they spend the second most per capita.

If we are talking about a comparison to England that because the Swiss GDP per capita is 7,000$ higher at PPP per person than English GDP. Richer people spend more on healthcare than poorer people do. Switzerland's Healthcare costs are inflating at a slower rate than GB, as you can see in Forbes if you didn't just shoot the messenger. 
https://www.cia.gov/library/publications/the-world-factbook/geos/uk.html
https://www.cia.gov/library/publications/the-world-factbook/geos/sz.html
Oh and Luxembourg and Norway spend more per capita, WHO has data on that too.
http://apps.who.int/ghodata/?vid=1901

And the Singapore model is government health insurance!  The government sets the prices.  The government provides the funding.  It's not strictly single payer but it resembles it very much.

As I said before if you look at the actual data the conclusions are inescapable.  But if you are getting your information from Forbes then you have only yourself to blame.

No it's a government mandated savings account, which since it is only your own savings account is not insurance. The government sets the prices much, much less than countries with socialized medicine or single payer do. The government mandates YOU fund your savings account, and only tops off the savings accounts of the population when it comes to catastrophic care and 10% of the population for primary care.  It is not a single payer system, as there is no insurance system it is based off a savings account.

This system allows consumers to drive costs controls. The government publishes the price of common medical services and you take a look at the common price, and then find the hospital that offers the best mixture of quality and price. You are not insulated from the costs of your decisions because it comes out of your medical savings account. However if you have a heart attack the price of care doesn't matter because the government will cover that. That doesn't reduce the cost of catastrophic care but it puts great down-ward pressure on the price of primary care.

If you look at the actual data Singapore has one of the best healthcare systems in the world, as the World Bank summarized much more elegantly than I could:
"The World Bank, in a paper assessing Singapore’s health system, says the results of 3M, with its supplementary programs to protect the poor and to address potential market failures in health financing, “have been impressive, with excellent health outcomes, low costs and full consumer choice of providers and quality of care.”
http://www.american.com/archive/2008/may-june-magazine-contents/the-singapore-model

Sorry about the tone in the last post, you just sounded so patronizing I couldn't help but be sarcastic.
[/quote]

Spoiler (click to show/hide)

Further more: "The Singapore government spent only 1.3 percent of GDP on healthcare in 2002, whereas the combined public and private expenditure on healthcare amounted to a low 4.3 percent of GDP." That means the private sector expenditure on health care was 3% of GDP, which is 230% higher than the government percentage of GDP, about as free market as Medicare, yeah.
http://econlog.econlib.org/archives/2008/01/singapores_heal.html

So if Forbes doesn't convince me a libertarian think tank will?

I'll admit that my numbers before were outdated but this guy is just pulling stuff out of his ass and it does not correlate to what the WHO found at the same time.  Look here:
http://apps.who.int/ghodata/
Click Health Systems -> Health Financing -> Health Expenditure Ratios

Wonderful data from all over for 2009.  Scroll down to Singapore.  Government expenditures were 41.5%.  So they do win the prize for having one of the few systems in the world with lower government share then the US.  But it's not like the government isn't the major player here.

Yeah didn't consider the Forbes-Libertarian connection  , hey it the first good article in the google search don't kill me for it.

The guy's data is form 2002, so obviously some things have changed. What I don't know what is though is why Singaporeans get more healthcare form the Gov now then 2002, as their standard of living increased you would have expected them to receive more private care, all else equal. The only thing I can think of is an increase in treatments covered, expanded coverage of the population, increased costs in the Gov healthcare sector vs. the private healthcare sector, and increases in subsides of already covered treatments to the already covered population.

And then consider what you get in the "private" funding.  It's mandatory contributions to a government administered account.  The government dictates the prices that you pay with "your" money.  The government provides a backstop for you if your account runs dry.  And the government plays a key role in deciding whether or not you should get expensive treatments.  Patient initiative never even enters into the decision making process.  The only part that is truly out of pocket is the co-pay.  We have co-pays here in the US.

Well yeah it is a difined contribution plan to a government account, but thats only to force you to save enough many so you don't need insurance and can see the price of what you are using and try to save money on things you don't really need. The Singaporean government issues prices for government services, which forces the private sector to compete in order to do it at lower cost. They really set a benchmark, because if I can get my medication for 500 from the gov, why go to a private sector provider for 600? I think that thing about expensive treatments is true of your healthsavings account, as well as any other government provided care. Of course if you pay out of pocket for the expensive care you can get it. Patient initiative influences the decision making process of individuals who fund their health savings accounts from their own money, so they try to avoid treatments that don't over a good cost-benefit ratio in order to save money. Yeah everyone who has subsidized care doesn't get to choose.  Co-pays and as I mentioned before expensive treatments are out of pocket.

But this is away from the central point which is that Singapore has some very, very crucial differences from everywhere else that drives it's success.  It's a country that is vastly wealthier then it's surroundings and can afford to hire manpower for a pittance.  They can hire however much migrant labor they need for their economy.  They can get doctors from abroad because the low wages of the poor keep the cost of living down for the rich.  It's a place where 15% of the households are millionaires but they still have a reputation for low labor costs.  If you wanted to emulate Singapore you aren't just going to need to set up health savings accounts, you'd need to completely redevelop American society.  You'd need to kick out all the high wage American workers and import a bunch of low wage workers from elsewhere.  You'd need to shed the rural parts of the country in the name of efficiency and just hold onto places like New York, the Bay Area, etc.  Then attract some highly paid Europeans and Canadians with all the cheap labor they could want.  It's not a good model for our country.  You might as well ask why we can't emulate the cheap costs of Singapore's portside loading and unloading facilities.

If you want the personal responsibility with a government backstop model without the cheap labor then you are looking at Switzerland or the Netherlands or (partially) Germany.

Actually it appears that most of Singapore's cheap labour in the healthcare sector are sourced domesticly. There are horror stores apperantly.
http://forums.salary.sg/income-jobs/793-how-life-doctor-singapore.html
The pay is pretty much the same for low-level doctors as in the West, but they work a ridiculious amount of hours. Read the big post in the first thread, he explains it pretty well. As you will see throughout the rest of the thread, many of the higher level doctors are paid either the same or better. The reason costs are so low is that
http://en.wikipedia.org/wiki/National_University_of_Singapore, National University of Singapore forces students to either work for the healthcare system for 5 years, or pay a huge sum of money in order to be able to go get any other job. So this bonded labour is avalible at a very low cost, relative to other doctors pay, to the system. Since they make up the bulk of the work force, and are unable to bargin or leave, they lower wages for every other relativly unskilled doctor. Its like the situation in the late Roman Empire where the masses of slaves lowered the wages of poor free men due to their low cost over time.  It is actully like slavery, in that it is forced labor.
And he isn't lying the government website says it too.
http://www.nus.edu.sg/registrar/edu/UG/fees.html
You know if having doctors work slave's hours I don't think I want healthcare as cheap and as good as Singapore. Its all ways too good to be true  . Why don't any of the proponents of single payer bring this up when conservetives raise the Singaporean health care system as a counter example ?

Also i apoligize for the disparaging tone some of my posts had, you are clearly very inteligent. If anything appears condescending here, it was not intended and I apoligize.

Spoiler (click to show/hide)

Singapore is 80% government paid, 20% copay.  It's about as freemarket as Medicare.

And apparently the metric for the success in switzerland is that the fail but not as hard as they should?  Wow, way to go free market?

I would assume that you got the 80% government paid statistic at http://www.moh.gov.sg/content/moh_web/home/costs_and_financing.html
the website of the Singaporean government. If you examine the page you will see that "The public sector dominates the acute care sector, delivering 80% of the care in this sector. The primary care sector is dominated by private sector providers, which account for about 80% of the market." Clearly not what you are stating, and official government statistics. 

Further more: "The Singapore government spent only 1.3 percent of GDP on healthcare in 2002, whereas the combined public and private expenditure on healthcare amounted to a low 4.3 percent of GDP." That means the private sector expenditure on health care was 3% of GDP, which is 230% higher than the government percentage of GDP, about as free market as Medicare, yeah.
http://econlog.econlib.org/archives/2008/01/singapores_heal.html

Again the reason Singapore's system works is that it allows consumer choice to cut costs in the primary care market, which makes up the vast majority of the healthcare market and when properly provided drastically reduces costs down the line. The efficient primary care providers, drastically reduce the costs Singapore would otherwise face. Primary care is really the only area in healthcare that functions like a proper market, when it comes to acute and chronic care the costs are just too high to enable a person to exercise consumer choice. By taking advantage of the market based nature of primary care Singapore is able to reduce costs in healthcare sectors that do not respond to the pressures of consumer choice.

Irregardless, we shouldn't be forced to pay a company for a product. It just allows for too many problems to pop up as far as quality and abuse go. Efficiency is hardly reason enough for a hand wave when you look at the problems that could come out of having a 100% mandatory product on the market. Few companies would be efficient to the benefit of the customer.

So I take it that you don't drive?  Because state laws in all 50 states require you to have auto insurance.

Constitution wise states are exempt. All powers not enumerated to the federal government, including forcing you to purchase insurance, are relegated to them. To be a Devil's advocate.

I thought very little actually.  I haven't heard the Singaporean healthcare system discussed very much in the past.

There are some interesting similarities between what you shared about their system and the way things work in the US.  Interns are horribly underpaid in the US and internship is perquisite.

Also I totally called this ruling in March.

government can do better, and I'm not okay with the justifications for why I have to, or with the governments ability to create these sort of mandates on behavior in general. This is, to put it simply, unprecedented in scope, if not in function, on a national level.

Actully if you change the word from "Penalty" to "Tax" it would be total alright, so it is merely an issue of sematics really. The federal government has national tax and spend authority, this would simply be a tax on people with out health insurance. It's totaly precedented then, and it's function would be much smaller than other taxes.

This is just a big deal over nothing when it comes to the constitutional question. Unfortanatly the govvernment could provide tax credits to people who provide proof of eating their broccoli, and you would give it over voluntarily so it wouldn't violate privacy, so at the end of the day you must eat your Broccoli!

Although I did not call chief justice roberts.

*wow that's a four page long post.

[Mr. Palau]

*sorry got a 504 error and assumed it hadn't gone through, but appearently it did.

[GreatJustice]

To call the single payer system "more efficient" is quite funny. I've got friends who spent hours waiting for treatment for things as basic as hives only to get kicked out due to a shortage of space. As poor as the American system is, I have yet to hear of that ever occurring in their hospitals.

And as free market as some other countries are, I've heard the same things happen there. Let's be honest, single payer doesn't mean more efficient, de facto, but it certainly CAN be more efficient if properly implemented.

Simply compare the cost, speed, and quality of service provided by a variety of other single-payer nations and you'll see the difference.

It's all about implementation.

Certainly, some single payer systems are far more efficient than others. That's hardly in question. However, it's a bit odd to look at a world of variations of single payer systems (barring, in a very limited and convoluted sense, the US), see a variety of problems, and come to the conclusion "Well, it looks like the single payer system is the only solution to THIS problem!".

Even ignoring efficiency for a moment, the single payer system is quite vulnerable major problems if the government itself has economic problems whereas a free market system should have enough providers to somewhat avoid that. Case in point, Greece once had one of the best systems in the world, but it was funded through debt and imports of drugs from other countries. Now that Greece is going through economic trouble, basic necessities so far as healthcare goes (eg. Aspirin)  are effectively nonexistent and are only available to the absolute richest who import directly from other countries.

It's also worth noting that in almost all countries, the least regulated healthcare sectors/surgeries are also those that experience the fastest price declines and technological improvement. Case in point, laser eye surgery in the US, something that isn't covered by insurance, has declined in price by around 30% while simultaneously increasing in quality since it's introduction. Meanwhile, veterinarians in Canada provide some positively stellar quality for relatively cheap costs, especially compared to what people get. I honestly wouldn't be too surprised if there was more advanced medical equipment around the country for animals than for humans.

[Mr. Palau]

It's also worth noting that in almost all countries, the least regulated healthcare sectors/surgeries are also those that experience the fastest price declines and technological improvement. Case in point, laser eye surgery in the US, something that isn't covered by insurance, has declined in price by around 30% while simultaneously increasing in quality since it's introduction. Meanwhile, veterinarians in Canada provide some positively stellar quality for relatively cheap costs, especially compared to what people get. I honestly wouldn't be too surprised if there was more advanced medical equipment around the country for animals than for humans.

Well that is because those surgeries are naturally more inclinded to be affected by market forces. A laser eye surgery is voluntary, postponeable, and gives you time to shop around for the lowest cost and highest quality surgery. That is not true of most healthcare, where the patient does not have enough knowledge to make effective decisions. Also they might need the surgery now, and not have time to shop around.

I mean, hell I could just quote Maniac from the SCOTUS thread. He made very effective, and much more robust arguments than the above.

[GreatJustice]

Well that is because those surgeries are naturally more inclinded to be affected by market forces. A laser eye surgery is voluntary, postponeable, and gives you time to shop around for the lowest cost and highest quality surgery. That is not true of most healthcare, where the patient does not have enough knowledge to make effective decisions. Also they might need the surgery now, and not have time to shop around.

(A) A disproportionate amount of surgery is of the variety that you have plenty of time and options before you actually need it, yet those don't have the same decreases in cost or increases in quality. Certain heart surgery procedures, for example. Those times where it is absolutely urgent are those times where insurance actually makes sense and what it was originally intended for (eg. you get hit by a truck and require immediate surgery)

(B) Under a single payer system, you literally have no choice in the matter whatsoever, whereas under the worst case scenario of a "market system" you at least have some choice. If the only hospital in your area that does heart surgery is known for being a hospital of terrible quality, unless you plan on going very far away you are going to have to endure it (this isn't a hypothetical, either; the hospital in my area that handles heart surgery has a reputation for poor conditions and is avoided at all costs by anyone who is capable of doing so)

[Bauglir]

If we all agree that everybody should be able to get treatment for medical conditions, why does anybody support a system that allows that not to happen?

(A) That's a massive oversimplification and

(B) In a world of scarcity there will always be people who are untreated for medical conditions, be it in the US or England or Canada

Some form of rationing has to occur in some way, be it through costs or through long waiting lists/no treatment period.

I do understand the practicalities of the situation. I was being deliberately simple because the post was intended to deal with ideology - whether or not private industry is the optimal way of getting the most people decent healthcare is something worth debating, but not quite what I was getting at there. Instead, it's intended to address people who argue that it's unfair to pay for somebody else's healthcare.

You can have a system where some people pay for services they don't get, or you can have a system where people don't get the service. There are certainly degrees here; not all alternatives to private insurance are equal, obviously. But to argue that it's unfair to pay for another person's healthcare requires acceptance that you're arguing that some people should suffer and die because they don't have money, regardless of practicality (and regardless of the number of people who willingly chose not to save money or purchase insurance and are suffering the consequences of that choice - I'm talking about people who didn't have the option).

[Mrhappyface]

It's not like we're living during the Black Plague and there's the corpses of the poor clogging the streets. Everyone technically gets care, it's just payed up front.

[Bauglir]

It's not payed up front. If you have insurance, you're paying for a lot more than the care. If you don't you're paying after you receive services (often without knowledge of how much they cost), or you're unable to pay and the rest of the population has to make it up for you. Additionally, not everyone gets care - just people with emergency conditions. Only the ER can't turn patients away for an inability to pay. At any rate, we don't have a system in place that concludes that it's morally correct for people who don't have money to die for it. So either that goal needs to be efficiently supported, or it needs to be abandoned. Right now, we're trying to cling to two mutually exclusive ideals, and it's destroying us (at least in this aspect of our society).

Ideal 1: Everyone should be able to receive the healthcare they need; nobody should suffer needlessly through circumstance.

Ideal 2: Nobody should be able to get a free ride, cheating others out of the resources they worked for; everybody should pay according to what they take.

Both of these ideals are, obviously, subject to practical considerations, but once you strip those away to figure out what people want, we're left with these choices. You can't have both. I, for one, think the first is far more important than the second.

[GreatJustice]

I do understand the practicalities of the situation. I was being deliberately simple because the post was intended to deal with ideology - whether or not private industry is the optimal way of getting the most people decent healthcare is something worth debating, but not quite what I was getting at there. Instead, it's intended to address people who argue that it's unfair to pay for somebody else's healthcare.

They have a point, there. Using the "people have to pay for healthcare because it's a public service option", you can simply stroll along that path of logic to reach "people have to pay the government to make bread" and "people need to pay for the government to make shoes". The most annoying thing about it is that once a government seizes control of an industry, it becomes nigh impossible to remove it since "anti-government owning everything" people have to argue against non-sequiturs that run along the lines of "If the government didn't run the shoe factories, we wouldn't have any shoes!" and other such nonsense, as though people, upon discovering that they won't be received a free pair of shoes every six months, will say "Damn, I guess myself and millions of others are doomed to lives without shoes since the government doesn't make em anymore, may as well lay down and die".

You can have a system where some people pay for services they don't get, or you can have a system where people don't get the service.

Strictly speaking, the US right now has a system where people pay for services they don't get already, counting Medicare, Medicaid, and the insurance they very likely have.

There are certainly degrees here; not all alternatives to private insurance are equal, obviously. But to argue that it's unfair to pay for another person's healthcare requires acceptance that you're arguing that some people should suffer and die because they don't have money, regardless of practicality (and regardless of the number of people who willingly chose not to save money or purchase insurance and are suffering the consequences of that choice - I'm talking about people who didn't have the option).

Again, you're acting like the present American system that operates through insurance companies paying for everything makes sense and is the only alternative to a single payer system. Before the 1960s, healthcare was exceptionally affordable and generally paid out of pocket (workplace subsidies for healthcare insurance and associated changes in what insurance covered had started from around WW2 on, but hadn't quite kicked in yet alongside Medicare and Medicaid). If someone needed emergency treatment and couldn't pay for it, they would be treated first and the cost handled later. Cases of people being thrown out on the street when found incapable of paying were practically unheard of. True, this relied on the good will of the doctors, but then most people are generally decent regardless of whether they are legislated to be so or not.

Of course, some people are so utterly irresponsible that it's practically a crime for everyone else to have to pay for their expensive surgery, and indeed even in single payer systems you find cases where the government will restrict treatment for someone (smokers come to mind). This isn't an especially clear cut issue.

[Bauglir]

They have a point, there. Using the "people have to pay for healthcare because it's a public service option", you can simply stroll along that path of logic to reach "people have to pay the government to make bread" and "people need to pay for the government to make shoes". The most annoying thing about it is that once a government seizes control of an industry, it becomes nigh impossible to remove it since "anti-government owning everything" people have to argue against non-sequiturs that run along the lines of "If the government didn't run the shoe factories, we wouldn't have any shoes!" and other such nonsense, as though people, upon discovering that they won't be received a free pair of shoes every six months, will say "Damn, I guess myself and millions of others are doomed to lives without shoes since the government doesn't make em anymore, may as well lay down and die".

While you may have a point about the non-sequiturs, I don't think the slope here is particularly well-greased. In addition to being a public service, it's one that is crucial to life for many of the people who require it, is extremely expensive, often unpredictable, and the burdens associated with it are unevenly distributed throughout society.

Strictly speaking, the US right now has a system where people pay for services they don't get already, counting Medicare, Medicaid, and the insurance they very likely have.

I know. If we are going to have programs like that, we might as well attempt to optimize the system toward ensuring people get healthcare when they need it - which, I believe, involves making sure that hospitals treat people who show up, end of story. There are practical issues in making that happen, obviously, but that's what I believe to be the morally correct objective.

Again, you're acting like the present American system that operates through insurance companies paying for everything makes sense and is the only alternative to a single payer system. Before the 1960s, healthcare was exceptionally affordable and generally paid out of pocket (workplace subsidies for healthcare insurance and associated changes in what insurance covered had started from around WW2 on, but hadn't quite kicked in yet alongside Medicare and Medicaid). If someone needed emergency treatment and couldn't pay for it, they would be treated first and the cost handled later. Cases of people being thrown out on the street when found incapable of paying were practically unheard of. True, this relied on the good will of the doctors, but then most people are generally decent regardless of whether they are legislated to be so or not.

No, I'm not, but the single payer system is the one I prefer and the present insurance-based system is the one I particularly oppose, so I'm naturally going to spend most of my time talking about them. Other systems seem even less practical to implement; for instance, what you brought up assumes health care costs go down, which seems unlikely. If nothing else, insurance companies don't want that to happen because it gives people an incentive not to have insurance (this is obviously a perversion of all sense and decency, since you'd expect that having to pay out less on each claim would be considered optimal, but since a premium necessarily has to be greater than the expected cost for that contract holder, you wind up with a situation where every person with insurance is a net win for the industry).

Of course, some people are so utterly irresponsible that it's practically a crime for everyone else to have to pay for their expensive surgery, and indeed even in single payer systems you find cases where the government will restrict treatment for someone (smokers come to mind). This isn't an especially clear cut issue.

In principle, I don't really care how somebody wound up with cancer, I'd still prefer it get treated (if the patient actually wants treatment, obviously) than not. "You did something that, in retrospect, was pretty stupid - so you are going to die or have your life ruined" is not really a moral position to me. In practice, you're right, ensuring that the system works is probably going to require some restrictions on how often certain avoidable problems can be treated before the patient has to start paying more, and I'll accept that as a necessary matter of practicality.