Universal Health Care: No Sick Joke

Small businesses—and large—have trouble attracting the best job candidates because of the high price of health care. Entrepreneurship demands nationalized medical insurance. Pro or con? NEW! PODCAST: Our debators respond to your reader comments. Down or listen online

Pro: Cure for the Uninsured

Since 2000, employer-sponsored health insurance premiums have risen by an average of 73%. For small firms, they’ve more than doubled. This rapid run-up in costs, plus pressures from an increasingly globalized economy, is causing firms of all sizes to pull back from offering health benefits. In 2000, 67% of nonelderly Americans had employer-sponsored health insurance. Just 63% do today.

Large companies increasingly hire workers on a contingency basis through contract houses, temp agencies, or contracts with self-employed people. This allows companies to reduce the number of workers with benefits. Small firms have always faced higher premiums per person than large firms and so have been far less likely to offer health coverage. Since many are new, they feel especially reluctant to provide a fringe benefit that’s more than doubled in cost in just the last six years.

Moreover, many startups exist as virtual companies: They’re groups of self-employed associates, rather than employees. This means they must find health insurance on their own, which costs even more than employer-group coverage.

For 20 years, the services sector, where small firms are the norm, has generated employment growth in the U.S. This, plus employer resistance to rising premiums, has transformed who’s uninsured. Today, almost 60% of the U.S.’s 46 million uninsured are 19 to 45 years old. Significantly, a quarter of all 25- to 34-year-olds and one-fifth of all 35- to 44-year-olds are uninsured. Both those figures have doubled in the last 25 years.

We need to recognize this sea change and create a universal coverage plan. The real question is: How will we finance it? A starting point is to recognize that universal coverage involves a social compact—and individuals should be required to enroll.

Second, individuals and companies should contribute; firms reap large benefits from having a healthy workforce. The federal government would raise funds to subsidize lower-income households and cover most of the expenses of people with extremely high medical costs. Universal coverage can easily include private health plans. But unless we reconfigure the financing, private health insurance will soon exist only for a fortunate, small minority.

Con: No Right to “Free” Health Care

The cause of the U.S. health-care mess is governmental interference. The solution, therefore, is not more governmental control, whether via nationalized medical insurance or a government takeover of medicine.

Health insurance costs so much today because the government, on the premise that there exists a “right” to health care at someone else’s expense, has promised Americans a free lunch. When a person can consume medical services without needing to consider how to pay for them—Medicare, Medicaid, or the individual’s employer will foot the bill—demand skyrockets. The $2,000 elective liver test he or she would have forgone in favor of a better place to live suddenly becomes a necessity when its cost seems to add up to $0.

As the expense of providing “free” health care erupts accordingly, the government tries to control costs by clamping down on the providers of health care. A massive net of regulations descends on doctors, nurses, insurers, and drug companies. As more of their endeavors are rendered unprofitable, drug companies produce fewer drugs, and insurers limit their policies or exit the industry.

Doctors and nurses, now buried in paperwork and faced with the endless, unjust task of appeasing government regulators, find their love for their work dissipating. They cut their hours or leave the profession. Many young people decide never to enter those fields in the first place.

What happens when demand skyrockets and supply is restricted? The price of medicine explodes. What was once to serve as a free lunch for everyone becomes lunch for no one.

The solution? Remove all controls. Recognize each citizen’s right and responsibility to pay for his or her own health care, and return to insurers the entrepreneurial freedom to come up with innovative products.

True freedom would bring health care into the reach of the average U.S. citizen again—just as it has done for other goods and services, such as computers, cell phones, and food.

Opinions and conclusions expressed in the BusinessWeek Debate Room do not necessarily reflect the views of BusinessWeek, BusinessWeek.com, or The McGraw-Hill Companies.

Reader Comments

logic

I'm sorry Onkar, but you're exactly wrong about the source of paperwork that's driving physicians up the wall. I am a physician, as is my wife. It's the bizarre, nonstandardized information demands of private-sector insurance companies that drive us crazy. The amount of actual government paperwork (DEA renewals and the like) is trivial compared with the massive hair ball of private-sector forms, ever-mutating, that are dropped upon us like so much dung.

Quite honestly, a single-payer health-care system would be a godsend for docs like me. One set of forms, period. Life would be sweet(er).

Ed McClelland, Albuquerque, NM

Interesting article. One concept that will work well is outlawing health insurance. This would accomplish a lot of good. With no health insurance, prices would drop to unheard of lows. The power of the buyer would return to this market. Folks would find other ways of financing their health care. The efficiency of the market would improve.

Smiley

Insurers come up with innovative products? I've had employer-sponsored health coverage for years, and the only innovations I've seen from the health insurance industries involve charging more and more each year while providing less and less coverage.

And single-payer coverage and other "socialist" schemes have worked quite well in many European countries as well as Canada without the dire results predicted by the free-market-is-God crowd.

Joe

This is a no-brainer, a health security tax paid jointly by the employer and employee (like Social Security), and every citizen and legal resident is covered. The super-rich are free to pay for their own gated hospitals, and illegal aliens must pay for their own care or be deported.

The con article is a joke unless we want a society where the law of the jungle rules. What a right-wing nut-case this guy is.

Kevin

It's amazing how all the comments make no mention of the underlying theme of universal health care: the subordination of one group to another. Why should I pay for my neighbor's health care when I have to take care of myself? Instead of an honest argument about why I should sacrifice my property to others, i.e., those who didn't earn it, we are forced to listen to these ad hominess, emotional, and dubious static-driven substitutes for reasoning. Joe is right about one thing--"this is a no-brainer"--especially for those who evade the real issue.

Daniel

Re Logic's comment, Onkar said "each citizen’s right and responsibility to pay for his or her own health care," not "private-sector insurance companies." His basic argument seems to be stop leaning on government and insurance companies to pay for one's own medication.

Your next argument will be that "people cannot afford the procedure/medication without the help" If the price becomes unreasonable in the free market, no one will pay the doctors for the procedure, forcing them to lower prices to stay in business. The price of procedures is inflated due to the insurance company and government pressures in the first place. Or there are always loans, savings plans, or other financial routes for clients to use to pay for the procedures or medication they need.

Dan Edge

Papa Joe is a no-brainer.

If socialized medicine is superior to the more capitalistic U.S. system, why do so many come to the U.S. for medical treatment each year? Why is this not reciprocated? Why don't U.S. citizens flood across the border to Canada for medical treatment? The Canadians come over here in droves, not wanting to wait six weeks for Big Brother to grant them an appointment to get an MRI.

I don't have health insurance, but when I need to see a doctor, I make an appointment for the next day. If Papa Joe gets his way, I'll have to wait in line to get my blood pressure meds refilled.

Bravo to Onkar Ghate for telling it like it is. Down with socialized medicine.
--Dan Edge

Paul Hsieh, MD

As a practicing physician, I can attest to the fact that what Onkar Ghate writes in the "con" article is exactly right.

The distortions of the market caused by the government policies in Medicare and Medicaid percolate through the semi-private insurance sector. Doctors fees through the "private" sector are now routinely pegged to a percentage of Medicare, because the government is the 800-pound gorilla in health economics. What we currently have is at most a semi-free market, and the problems of the current system are due to the government regulations, not the free market component.

The tax laws giving favorable advantage to employer-based health benefits disincentivize people from purchasing innovative Health Savings Accounts, as profiled in the recent Business Week article at: http://www.businessweek.com/magazine/content/07_22/b4036086.htm.

Government mandates on insurance prevent carriers from providing low-cost high-deductible catastrophic care, which is what insurance should be (just like it is for fire insurance or automobile insurance)--namely a protection against rare but expensive problems. The current system of insurance is more of a system of pre-paid care. Health insurance should not cover routine visits any more than car insurance covers regular oil changes.

Laws restricting interstate insurance competition also prevent portability and lock people into their current jobs for fear of losing their current coverage.

More government in the form of a "single-payer system" or government mandates (a la Massachusetts) merely worsen the problem. Attempts by governments in other countries and other U.S. states to guarantee a so-called "right" to health care have merely led to worse patient outcomes and higher costs.

Forcing everyone into a government-run system of medicine just because some people are uninsured would be just as wrong as forcing everyone into a government run housing project just because some people are homeless.

The free market provides better products at cheaper prices, something that anyone who has recently purchased a DVD player knows. Consumers take that for granted in fields like home electronics. And in the sectors of medicine that are relatively free, the same thing happens--just witness the steady improvement in quality and decrease in prices for Lasik procedures and cosmetic surgery. If similar free-market policies were adopted for the rest of American medicine, the cost savings and quality-of-life improvements for Americans would be incalculable, with ordinary working-class Americans benefiting the most.

A free market in medicine is the only way Americans can get the high-quality affordable health care they need and deserve.

vzeebjtf

What is "the law of the jungle"? That each of us is responsible for his own life, and may not enslave others to support him? If so, I vote with the "right-wing nut case."

William Sekerak

Ghate has it right. Simply observe the markets with the most regulation, and it is obvious what controls accomplish.

Education, medicine, housing, energy--need I say more?

"HR"

Onkar is partially correct in his assessment. But for the largesse provided by a combination of government subsidies, and the granting of monopoly powers to the pharmaceutical, legal, and medical industries, the cost of health care would have stayed more within the reach of many more people. I would even venture to say that medical insurance would probably still be correctly called “hospitalization.” (“Hospitalization” insurance was what they called it when the costs of long-term hospitalization were the only financially catastrophic consequence of seeking medical care. Now even minor outpatient surgical procedures can cause many people to fall into bankruptcy.)

It is a long-established economic fact that suppliers produce for their own benefit and demanders seek benefits according to the opportunity costs they are willing to give up in exchange for the benefits they might gain from a transaction. Such transactions are an ecological event in that the transacting parties must take their relative positions and personal assessments of the various personal outcomes resulting from the transaction (and the contexts in which it occurs). Such is “deep planning”—too deep for outsiders to meddle with in the hopes of increasing the outcome in terms of value. Outside meddlers can only drive up the costs involved and hence lower the marginal utility to be gained by either party.

Since it is the transacting parties who are seeking value and giving up the opportunity costs of any alternatives and since meddling unduly reduces everyone’s profit (i.e., value), it is best to leave the transactors alone to work matters out for themselves.

I don’t see the ethical value of wanting to reduce the value to be gained by the transactors in any transaction by meddling in it. I am speaking from principle here. I am not sure of the intricacies of the minds of people who would interfere. I never understood the need for such interference. But many smarter people than I see such a need. Such meddlers have always espoused high philosophies as justification for their meddling. This is why I am not a philosopher.

The Ayn Rand “objectivist” crowd, though they give nodding acquiescence to the need to remove “subsidies,” rarely, if ever, speak to the evils of government-sanctioned monopoly powers. (Notice that there is no mention of medical deregulation in the “con” article.) This is because objectivists and other neo-cons in general have no problem limiting the responsibility of persons by promiscuously granting the “right” of incorporation to all comers. It is easy for them to so promiscuously sacrifice the damage recovery rights of victims on the cross of “tort reform.” They say it is OK to limit by law the right to establish one’s own name in a profession of his choosing, rather than allowing him to establish himself by proof of his abilities before his peers.

The liberals are no better with their cries for subsidies and more ubiquitous regulation—with their mindless emphasis on the “more” in the “more regulation” than anything else.

The fact is that until we stop eating one another, humanity will stay in its insane state of mutual cannibalism. Only a few of us see it. Unfortunately, Ayn Rand’s life became a waste because her not quite finished work has become a mere religious tool for the superstitions of the neo-cons. They will probably have their aristocracy of wealth—but not one of earned honor.
H.R.

Mark

The only "mindless idealism" that I see in these two angles--particularly in the comments section--is that of the "free market" junkies whose consistent argument is that they're entitled and others aren't.

To suggest that you shouldn't have to pay for your neighbor's health insurance because "he didn't earn it," is obscene. It's a fairy tale to think that you yourself are not dependent upon others in your life.

Insurance companies do need to be abolished. A single-payer system is a step in the right direction, but one prone to abuse--though much less so than a free market in which availability is controlled solely by the producers.

The answer is a free market for the producers, but not for the buyers. The government could buy drugs from the companies but control the distribution of them. This way, producers could easily make their cost back by selling in bulk to a guaranteed buyer, and the government's lack of interest in profits would eliminate market manipulation and consumer abuse.

Not free health care--just a system that thrives, as all markets suppose to do, on supply/demand equilibrium rather than quarterly profits.

RPannier

I always find these stories about why we shouldn't have universal health care quite amusing. Why do you think all these Canadians are crossing the borders? Universal health care provides less. The government screws it up.

I've lived in Korea for eight years, and prior to that, I lived in Europe for two and before that, I was in the U.S. Army. In the 10 years of living abroad I have always paid into universal health care, and the longest I've ever waited to see a doctor was one hour and 45 minutes. I pay $216 a month for health care that covers the my wife, my two daughters, and me. An office visit is about $7 (depending on the exchange rate) and my prescriptions run $3 to $7.

Health care rates in the U.S. are ridiculous. The quality of health care per dollar spent is almost the worst of any post-industrialized nation. Yes folks, those evil, godless, Socialist Swedes, Danes, Norseman, and French have better-quality health care than the USA does.

To Dan Edge, does the term "medical holiday" mean anything to you? Thousands of Americans travel to Thailand and other places around the world to get quality medical care at better prices. It's sad when it's cheaper to buy a plane ticket to Bangkok, stay in a hotel, have knee surgery, do rehab, and fly back to the U.S.

your ol pal

The "con" argument reminds me of the two guys being chased by a jaguar in the jungle, and one says to the other, all I have to do is run faster than you. How pathetic is this self-serving, I-got-mine attitude? And of course, as long as health care is provided by the employer, we are all indentured servants and they own us, yes?

Richard Parker, MD

As a practicing physician, I wholeheartedly agree with Onkar Ghate’s excellent analysis of the evils of government regulation in health care. Dr. Ghate is correct in pointing out that it is government controls that have caused the skyrocketing cost of health care we are seeing. He is also correct in pointing out that the solution is therefore not more government control via nationalization of the insurance or health-care industry, but rather a free-market system that brings back the incentive to produce quality health care at affordable prices.

The desire to force "free" health care via government takeover is not driven by any noble desire to bring affordable health care to America—there is ample evidence such attempts have failed miserably in countries where it has been instituted (such failures are typically evaded or ignored by those who cry out for "free" health care enforced at the point of the government’s gun). The motivation for government-enforced health care is pure power lust, and the type of evil that simply enjoys seeing suffering for the sake of suffering.

Sean

I love the argument that says if health care is free, everyone's going to be rushing to the hospital or doctor. This logic is the same that says having police and a fire department is going to cause an increase in crime and arson. Give me a break.

As for you doctors who offer your opinion as fact: You presently enjoy a monopoly that would make U.S. Steel blush. Don't piss on my leg and tell me it's raining. As long as you profit without competition from the pain and suffering of your neighbors, I render your opinion worthless. Your interests are not in healing--they are in your bottom line and any argument that says "you have no right to health care" pretty much bears that out.

This is the type of evil that enjoys seeing suffering for the sake of profit.

Jim in DC

I can't understand how anyone could support a system with 100+ major insurance companies with disparate payment, billing, and patient record-keeping systems. Each of those companies has corporate boards, corporate headquarters, CEOs making millions, and stockholders who want their cut. The insurance companies don't provide a service that actually heals anyone. They exist purely to make money and have no incentive to provide equal care to everyone who pays into the system.

Every major industry has gone through a period of significant mergers to try to squeeze out inefficiencies. I think the health-insurance business is probably closer to the banking industry than most analysts have considered. Banks merged like crazy during the 1990s. Health insurance is a transactional business that needs to consolidate.

Nick

This was the same debate France had. They chose socialized medicine. We all see the results--unless you're one of those politically correct dingdongs who needs to constantly lie to make your point. In case you're dense enough to miss the point: The rest of the world comes to the U.S. for health care when possible. Not the other way around.

Jerry Hoehn

First of all, let's get something straight. It is not accurate to call it universal health care; this name is deceptive and dishonest. "Universal" is another way of saying "government controlled," and the word "care," the true meaning of the word care, is not something that you can force a doctor to provide. Care is voluntary; it presupposes a voluntary relationship between a doctor and a patient. The word "care" can only legitimately be used within the context of a private health-care system, because it is only under such a system that this concept actually exists. Government can force people to do a lot of things but it cannot force a doctor to care for someone in the true sense of the word "care."

Let's call it what it really is: a government compulsory medical system. It is a system under which Washington bureaucrats are given more latitude over how our hospitals are run than physicians.

Everybody is greedy, especially senators and congressmen; they take greed to a whole new level that most businessmen cannot even fathom. Anyone who thinks bureaucrats will not get their kickbacks under a government compulsory medical system has obviously not been watching the news for several years. A free market system doesn't eliminate greed; it just keeps it under control.

The reason heath care is so expensive is that socialists have already basically gotten what they wanted on a smaller scale. For a long time, the federal government has required hospitals to treat anyone who appears at an emergency room whether or not they can pay. If someone is having a heart attack, for example, the emergency room responds, even though officials may find out later that the person is an indigent; this has been going for years and guess who has been paying the bill? You, in the form of higher insurance premiums.

Someone has to pay for the endless supplies, sophisticated equipment, the medicines, the salaries, and other expenses required to treat an uninsured heart patient. That person is you. This is why your health insurance is so expensive. If you think insurance premiums are expensive now, you have only had a taste. When everybody, in effect, is forced to become an indigent patient, your high insurance premiums will take the form of significantly higher taxes. You will just be sending your check to the IRS instead of your insurance company, but it will be a much larger check. The same indigent patients who do not pay for health care now will become indigent patients under a government plan who will not pay taxes. We'll have roughly the same number of taxpayers (formerly insurance customers) paying into the system--except now we introduce that wonderful concept of government waste and we all go broke as a result. If our government can make a hammer cost $1,000, imagine what they can do to the price of Xanax.

If anyone thinks that the fantastic American achievements in health care technology will still be possible under a government compulsory medical system, would you bet your life on it? We still have a whole slew of diseases that need a cure; and are you really willing to mess with the engine of a system that has cured more diseases than any other system in history? Do you really believe that investors are going to continue taking incredible risks to produce a drug like Xanax with the knowledge that their great invention might just be taken away from them "for the common good"?

tgolferman

The world is currently competing with China. China provides no health-care services for a vast majority of its population. China by recent accounts either manipulates its currency for unfair advantage in trade or somehow has magically undervalued its currency. Labor in China has virtually no rights. We (the rest of the world) are struggling with health-care cost increases because our health care system overhead is huge, but the number of jobs that add value to a product are moving to China, and the pie available to pay for health care is shrinking. We have a few choices: Go to universal health care, start manipulating our currency for an unfair advantage and there will be a big enough pie to pay for health care, or forget about health care as a country and be responsible for own own health and when it's your turn to go, you go.

Aside from accidents that require health-care services, aren't we all suckers if we're willing to pay higher insurance premiums and deductibles because of the person that puts garbage in his or her body and doesn't exercise? Why should everyone else have to pay for others' negligence? Either we all pay universally through the tax system or we scrap this broken system and stop paying for these insurance company castles and medical institution cathedrals along with the waste, fraud, and abuse normally associated with an industry this size.

Roger

I live in Germany and am self-employed and privately health-insured. This insurance is expensive, subject to an increasing deductible depending upon frequency of use, and may be canceled should the insurance company determine that I am abusing it. So, essentially, I have to guard against major calamities, and pay routine medical expenses out of pocket, typically at triple the rate a physician would charge the publicly insured recipients (most wage-earners).

The "success" of the socialized medical system can be estimated by considering that my several physician friends all agree that the socialized medicine side of their operations is permanently bankrupt, that they depend on guys like me to keep from having to close their offices.

So, in paying my insurance and paying for minor problems out of pocket, I am de facto already subsidizing the less healthy or fortunate.

The "success" of the socialized medicine system can further be estimated by the government's recent consensus, that it is "unfair" for guys like me to get "better" benefits than others get in the compulsory socialized sector. Which brought to pass a law instituting a complicated "load-sharing" formula in the near future between the public and private health-care sectors, against economic experts' warnings that this will raise everybody's costs. Guess who was right? The economists: The first stage of reforms has already raised prices. Guess who will benefit? Hint: Not the doctors or the patients or the pharmaceutical companies. Ah yes, the 300+ public insurers with top-heavy management salaries and inefficient management structures who have to date run up the biggest public health-care deficit since Count Bismarck founded the system in the late 1800s. And somebody else benefits: the politicians who will "trade" their "efforts" in this "grand reform" for more votes in the next election. That's who. Question: Isn't buying votes illegal?

Next question: "Is that what you want in the USA?" Double taxation of the rich, increased taxation of the poor, reduced benefits for all, but another well-paid term in office for the politicos who sold you this bogus bill of goods? Your choice. Chose wisely.

For my part, I second Mr. Onkar Ghate--for his correct economic theory, correct predictions, correct ethics. Ethics, you ask? Yes, because although I may chose to accept an obligation to act as "my brother's keeper," should he be in a tough spot, I have no right to impose this burden on anybody else.

Joseph Conrad

The high price of health care in the U.S. derives from the cost of shortcomings in the performance of corporate and health-care provider business and operating processes.

Corporations large and small continue to compete and succeed in the marketplace "on the cheap." They believe having a two-tier wage-and-benefits hiring system (newer workers get lower wages and benefits) and outsourcing are the most effective ways to control labor costs. They're willing to sacrifice the experience and expertise of skilled workers in favor of less experienced and less expensive, more compliant younger workers. All they have to do is dumb down the tasks to be performed.

Corporations would rather blame poor performance on rising labor and health-care costs--and outsource--rather than examine their business, operating, and decision-making processes. U.S. corporations in particular are extremely averse to self-perception and changing behaviors based upon its results. Stated another way, U.S. corporations--regardless of size--would rather outsource, hire young, and buy new software and equipment to throw at a problem than simplify (cut steps), optimize (define and cut costs), and then accelerate (with new software) their business processes and supply chain. Doing is much easier than thinking and then doing.

Today, everybody wants to cut costs and hire the best. But most are totally unwilling to take the time and make the effort to examine and revise their business processes and systems. Moreover, most believe labor cost reduction and new software will save them from their own stupidity, arrogance, and lack of vision.

K Prasad

We should remember that all those countries with universal health care are not as affected by America's obesity. The results of poor diets and lack of exercise in this country account for a large part of health-care costs. This is not a burden to be placed on your neighbor.

Maybe we should entitle everyone to healthy food and gym memberships first?

Mike V.

A few facts, which are irrefutable:

1. Today, both health-insurance companies and health-care providers in the U.S. are both heavily regulated by the federal and state governments. We do not have a free market now. Our current system is a mixture of socialism and capitalism. So, anyone who is angry about the current system should not claim that medicine and health insurance have failed under the free-market system, and that socialized medicine is now the only answer. Rather you should claim that the mixed economy is failing, and you should try to identify which element--the market or the government--is the poison and which is the nutrition.

2. Capitalism, in general, has created the highest standards of living in human history. All the traditional essentials of human life, food, clothing, and shelter, are available in greater abundance under capitalism than under any government directed social-economic system. To the extent that a free market has been allowed to operate, the highest standards of health care in human history have also resulted in the United States and Westernized countries.

3. The primary motivation of medical-care providers and insurance companies are, and ought to be, no different from from any other business or profession, i.e., to provide the best quality product or service for the consumer in order to make the greatest profit. Or to put it another way, to make the most profit over the long term, doctors and insurance companies should provide the best-quality services possible.

billd

The government is already the 800-pound gorilla. If you add up payments to health care from Medicare, Medicaid, the VA system, and federal and state employees health insurance, you will get about 60% of total health-care spending.

So you Libertarian types say that the answer is to develop a free market. It's not going to happen. Get over it. Eliminate Medicare? Right. Try it.

At this point, I think the best plan is to emulate the French. They deliver a far superior result at a much lower cost.

To do nothing is unacceptable. This will become the big issue in the next Presidential election.

Frank

Yes it's true that rich people come to the U.S. for extra special treatment, but I am a hard-working American who cannot afford it.

I lived in Windsor, Canada, next to Detroit for 20 years and had great health care. One of Windsor's problems was working Americans coming over with bogus I.D. cards to get that free health care.

If your system is so good, why are Americans going to Canada to steal theirs?

I also lived in Europe and if you never have, how can you say its system is inferior? If you go, try asking the regular Joe on the street if he would rather pay for yours.

Also, why are we the only industrialized nation on the planet without a national health system? Do you think it's because America knows better?

You are so arrogant, you probably answered yes.

Uninsured

The anagram of "Onkar Ghate" is "Khan Rat Ego."

Onkar, something you may have not considered while you are driving your Mercedes AMG SL550 over the bodies of street urchins and listening to "Ride of the Valkyries":

Since hospitals are free to charge non-negotiated (i.e., unlimited) rates to those without insurance, how is someone making $30,000 a year and just getting by financially supposed to pay for a $250,000 appendectomy?

You may be a heartless human being.

Lothar Schwarz

Capitalism is the main reason we are paying so much for health care. We need more restrictions on hospitals, pharmaceuticals, and doctors in regard to how much they can charge, with prices so high--especially for prescriptions. We are paying five times as much for the same medication, so I would say socialized medicine is better and cheaper. And send Dr. Ghate away.

Xander. O

I am still reeling from the Onkar Ghate comparison between inexpensive computer retail products and health care. Even at their most expensive, early computers and cell phones never cost for the average person the same amount chemotherapy does in real dollars. And no retail product is equal to one's life. The constant, ideologically illogical argument that a market will provide in all circumstances is blind. And blindness is a health problem.

Angela

This is a case where everyone knows where the problem is but is afraid to say it. We are so afraid of the words "socialized medicine" that we go around in circles trying to find a solution under free enterprise that doesn't exist. Once we leave the insurance and the employer out of the equation, the solution is simple: Think of health care in the same terms we think of elementary education. Taxpayers fund a basic service available to anyone for free. And for those who have the money to spend or simply like to feel apart from the crowd, there is the private school and in the case of health care, doctors in private practice and private hospitals with the amenities of a country club, if that is what they want.

Mike Jones

After spending 35 years in the health-insurance industry, I have seen many changes. The main problem is no one has come up with a good solution for providing health insurance to the consumer. Government is not the answer. That would only make everything more expensive, and the care would suffer. How anyone of sound mind can believe that the government can do things better than the private sector is beyond me--just a bunch of people who want a free lunch.

ron

Speaking for mental-health private practitioners, I can tell you the providers are having their reimbursements cut each year--5% chopping off 5% or added paperwork or more requests for additional authorized sessions. Working with family practitioners, I find that they are finding the same thing to be true for their practices. When there is an announcement of an increase, it takes a long time to get down to the practitioners and often the raise is minimal--in fact, often less when you count the new additional requirements to "prove" medical necessity or evidence-based practice. Most providers are considering other options or are looking for different careers. The people making the most money are those at the middle companies, the managed care organizations (MCOs) and the health maintenance organizations (HMOs). As far as the practice of capitalism, it stops before it reaches the private practitioners.

Edward Elgar

Dear American Friends:
I live in Britain. For 20 years, I worked and paid taxes for National Insurance, partly for the National Health Service. I am now unable to work because of serious health problems, which are unlikely to abate. The prognosis is long-term incapacity (or should that be indigency?) My medicine is not "free." It is funded by the insurance premiums I paid for 20 years as part of my contract between citizen and state.

Rob Johnson

Have any of you been to the dentist lately? It's $5,000 for a bridge, $435 for two cavities. Where do the less fortunate go?

Alec

The pro-deregulation crowd exists on intellectual dishonesty. First, most government regulations were at the behest of the insurance and medical industries specifically to increase their profits. The pharmaceutical and insurance lobbies are immensely powerful in DC.

Second, the anecdotal information about people traveling to the U.S. for health care only pertains to the wealthy. The wealthy don't have a health-care crisis, or really any sort of crises. That's the beauty of being wealthy. Rich people from other countries can and do come to America for treatment, but middle- and lower-income Americans can't get access to the same level of care, and that's the problem.

RIch, MD

One of the basic problems with health-care statistics is that the general health of a population is multifactorial. When you read that people in the U.S. are less healthy, have higher rates of infant mortality, etc., you must understand that much of the disease present in the U.S. is due to lifestyle choices, not lack of health care.

Even if health care was "free," do you think the obesity problem in the U.S. would disappear or even decrease? Drug and alcohol abuse, lack of two-parent households, terrible diets, and education problems all contribute negatively to our nation's health--and not because health care is lacking. If you look deeply at the numbers, you will see that, for example, after being diagnosed with cancer, people in the U.S. actually do much better overall than our counterparts in socialized-medicine countries. I work in our health-care field. It is not perfect, but in general it works.

Julie Z.

If hospitals can charge the uninsured an unlimited amount for procedures, the staff at Martin Luther King Jr. Harbor Hospital in Los Angeles should have been falling over one another to help Edith Rodriguez when she arrived in the emergency room. But no, this public hospital, begun "as the result of a community need," let her bleed to death on the floor over the course of 45 minutes.

Had she not relied upon "free" services and instead had gone to a private hospital that must deliver a quality product because it competes for business, she would have been treated, and she might be alive today. In debt, perhaps, but alive. You who say that placing a dollar value on a human life is heartless, there is the value of your socialized medicine.

Robert Batt

For a debate on health-care issues, let me throw this one into the discussion. Why do employers provide health benefits at all? They don't provide car insurance or home insurance. It's breaking the backs of even the largest corporations. It creates have's and have not's, those with benefits and those without. The health-care crisis is not the fault of U.S. corporations.

What should replace it, and what about the windfall corporations would get by not providing benefits? There are many ideas out there, so let the debate begin. Just get health care off the employers' backs.
Robert B

Texas

The only answer for providing access to group health insurance for all of our population regardless of income level is single-payer health insurance. The free-market system is dysfunctional. It is manipulated by insurance companies whose only desire is to maximize profits while minimizing care expenditures. Drug companies oppose block negotiation of drug prices, because their profits are higher if they divide and conquer.

I see several people claiming to be doctors posting fictitious undocumented claims that the government is the one responsible for the high cost of medicine in the U.S. I find it difficult to believe legitimate physicians can seriously believe the drivel they are preaching unless they happen to be employed by a pharmaceutical or insurance company.

Single-payer health insurance is the only workable solution to our health crisis. It's working in Canada and France, and it will work for us.

Susan Burrows

I'm with Ghate. It is the big government interference that has created this monster in health care. Let economics take its course and keep the government out. We will survive and be better off for it.

Rick

Can we please stop using BS political rhetoric to try and confuse people about a proposed government takeover of one-third of the American economy. Single-payer means the government takes over health care. Universal health care means the government takes over health care. At the very least, please just call it exactly what it is, socialized medicine. Proponents of socialized health care do not use those words, because they scare the hell out of the average American, and rightfully so. Americans are terrified by the prospect of our government taking over health care exactly because we have seen what a horrible job it has done in so many other areas, and how absolutely corrupt some of our politicians are.

Nom D Plume

To all the free-market ideologues who have posted here, a few facts to you from somebody who actually learned economics in a real PhD program rather than from Rush Limbaugh or Ayn Rand:

First, there is no such thing as a market free of government intervention. No market can function without secure property rights, and who guarantees those? Hate to tell you, it's the government.

Second, it is a myth that we are always collectively better off if everyone acts in his or her own narrow self-interest. There are lots of reasons why the market might not perform up to its ideal. Any time the market price fails to capture all relevant costs, the market will produce the wrong outcome. Air pollution is a perfect example. If polluters were forced to pay for the full health and environmental impact of their pollution, there would be a lot less of it. But can't the market solve the problem through tradable pollution credits, you say? Guess who sets the caps, regulates the market, and monitors compliance? Your good old friend the government.

What's the government doing when it intervenes in this way? It's weighing the interests of a small number of polluters against the interests of all the rest of us. This is a valid and important role of a representative government: It's where we come together to make decisions about things that affect all of us. It might not always work the way it should, but then neither does the market. Welcome to the messy real world.

So let's examine that great U.S. health care system. Rich Canadians and Europeans go to the U.S. for their health care; isn't that proof that it's the best system in the world? What nonsense. It's only proof that it's the best system for the few people with enough money to afford it. Ask average Canadians or Europeans if they would trade their system for the U.S. one. Then wait for them to stop laughing.

The true test of any system is how well it serves the whole population, not the select few. The U.S. spends far more per capita on health care than any other advanced nation, yet has among the worst health-care outcomes. I have a hard time believing this can all be attributed to "lifestyle choices," as suggested above. Having lived in the U.S., Germany, and France, I must say the U.S. system doesn't always measure up. If we would drop our dogmatic adherence to some cartoon version of economics (market = good; government = bad), we might actually find a pragmatic solution that is better than what we have now.

Another person in the system

This discussion has focused largely on health-care financing while almost totally ignoring the many other facets of the health-care industry that contribute to spiraling costs.

We have created an environment of patient entitlement that is devoid of personal responsibility.

We have created an environment that encourages unreasonable expectations; it is not surprising that 30% of Medicare expenses are for treatment within the last six months of a patient's life.

We have created an environment in which the threat of litigation is used to manipulate providers into performing unnecessary, pointless, or futile services.

We have created an environment in which the lion's share of reimbursements goes to those who are exposed to the least liability.

We have created an environment in which the true costs are concealed from those receiving services and the service providers are, in many instances, prohibited from attempting to pursue the recovery of these costs.

We have created an environment in which people expect providers to follow free-market principles while simultaneously imposing onerous regulations upon them (e.g. the obligation to continue to provide treatment once it has started).

The severe imbalances in the health-care system must be fixed before it will be possible to control costs.

Brant Gaede

This is about freedom, above all the freedom of doctors to practice medicine. It is also about the freedom of consumers to buy medical treatments and services.
--Brant Gaede

Jeff

Canada and France decided to socialize their health-care systems, because they did exactly what we are doing now; they regulated and slapped so many controls on the industry that the marketplace lost its efficacy in creating efficiencies. They regulated and regulated and regulated, and strangled the marketplace to death; then they turned around and blamed the marketplace for all of the problems.

Today American hospitals and the medical industry in general are heavily regulated. The more regulated they get, the more inefficient our health system becomes. Our government is like a big fat water hose extinguishing the fire of an incredibly brilliant, agile, and efficient marketplace. You see this innovation working amazingly well every day in other sectors of our economy that are not so heavily regulated. No one is proposing a government takeover of the computer industry, where prices are dropping like a stone.

I can only hope that we will not do what these other countries have done and essentially give up on a free market that has provided us with so much incredible innovation, and essentially go back to the dark ages of an all-powerful government and suffocating economic controls--where the “Federal Health Management, Preventive Medicine, and Wellness Preservation Subcommittee” has to hold two weeks of hearings to decide whether or not I get a blood transfusion.

Bill

To respond to one of the previous contributors to this discussion, I don't believe that someone needs a PhD in economics, or to listen to Rush Limbaugh, or read Ayn Rand books to see that our government cannot and should not take over the American medical industry. One only need to take a trip to the Post Office, Department of Motor Vehicles, any government-run school, or a government-run hospital to see that our government is completely incapable of doing a good job at almost anything. This is just common sense.

A PhD in economics is a good thing to have, but it is not required to make simple decisions such as this.

Bolden

It's amazing to see the different opinions between patients and doctors. Let's face it, people want to live their lives any way they want to and then get cheap drugs to fix their lifestyle-created problems. Obviously, there are people who do live their lives properly and still get sick or hurt, but the vast majority of problems are created by us. If people spent a little more on their health (money, time, and energy), they would be a lot healthier and this would be a non-issue. The problem is that people seem to delegate responsibility for their own health to their doctors or their neighbors instead of themselves. Wake up, and realize our habits are our own worst enemy.

Bolden

By the way, preventive medicine is an oxymoron, because drugs can only treat problems when they arise, and when used to try to "prevent" something from happening, the toxic chemicals only create other problems.

Zora

I think the average person who advocates universal health care simply doesn't understand what it takes to become a doctor in the U.S. Doctors are people, very hard-working people. They do not endure their rigorous training just to turn around and serve others for free. They are not priests.

There are four years of medical school to complete that will set back every aspiring MD an average of 150K. Then there are three to seven years of residency in which they generally make less than 60K. There is a huge up-front investment in time and money that the most qualified people will not be willing to make if the U.S. switches to a universal health-care system. These individuals would instead be attracted to other high-paying fields such as engineering, law, etc. Thus, the "doctors" of the future would effectively be middle-management types who graduated from local technical colleges.

I think I'll go ahead and pay a little extra to be treated by the guy who scored 1500 on his SAT and graduated as his class valedictorian.

Marco

Anyone who is an advocate of universal health care should go get sick in Canada or Europe. Only then will you see how "wonderful" government health care is. The system here in Quebec is expensive to the taxpayer, guarantees a 4- to 10-month wait to see most specialists, and promises long waits in emergency rooms. I am Canadian by birth, American by choice. I have lived through the horrors of universal health care, and I have to say that I would prefer to pay out of pocket medical expenses in the U.S. vs. free medical in Canada.

The problem I see with universal health care is that since there are no up-front costs (co-pays) associated with doctor visits, the public tends to abuse the system. Also, Canada’s policy on price fixing has forced a portion of its medical talent to move elsewhere. My statements are not meant to criticize the medical talent in Canada--the doctors, nurses, and support staffs are very professional. However, the problems associated with Canadian medical care start at the government level. Thank you, government of Canada.

Sonia

Zora makes an interesting point about the high cost for doctors to get an education. In turn, doctors must charge a great deal of money to repay loans and achieve a decent standard of living.

In France, most doctors go to public universities that are subsidized like most other educational institutions. As a result, obtaining an M.D. costs them almost nothing, and they do not have to charge patients an arm and a leg just to make ends meet.

Having lived in both the U.S. and France, I far prefer the health-care system in France, where the patient's well-being comes first, regardless of (in)ability to pay for care.

Smiley

In what fantasy world do people go to the hospital just because it's free? I've gotten MRIs, X-rays, and several other medical tests. It's really unpleasant at best. Unless I actually believed I needed to, I wouldn't subject myself to visits to a hospital or even doctors' offices. Certainly there are hypochondriacs who will do exactly what everyone fears, but public policy can't be designed around a handful of losers.

e angus

Medicare pays a primary-care physician $7 less than the cost of overhead for a simple visit but pays procedural specialists $2,429 dollars an hour, and the primary care physician is stuck with all the onerous paperwork and night calls.

John

Having lived with the British NHS and the American health-care "system," I can tell you flat out that the British system is far superior.

While in Britain, my daughter came down with appendicitis. We phoned 999 (British 911). The ambulance was there in 10 minutes, they rushed her to the local hospital, and she was examined, medicated, and on the operating table within half an hour.

She was kept in for a week, in a private room, since she had been close to peritonitis and they wanted to make sure that no complications arose.

After this, she was allowed home with a nurse visiting daily for the first week until it was clear that she was recovering rapidly.

The cost of all this to me? Well, higher UK taxes. At my earning level, that was about 32% overall, but the cost of the treatment itself was zero. Not a penny, and they even offered us a bus pass to visit her in hospital.

Now that sounds a little better than lying on the emergency-room floor, vomiting blood, and being allowed to die, as happened recently in the U.S.

The American medical system is a complete disgrace and anyone, like the Rand-ists, who claim that all people should pay for their own treatment obviously have never been poor and without coverage. What an abysmally selfish and stupid attitude. Let's just let poor people die then, shall we, even though one of their children may be the next Einstein.

Europeans, even the British, live longer, live healthier, and live happier than Americans. And for those who claim American medicine is the best there is, think again. There are plenty of Americans going to Europe for treatments they can't get here at any reasonable price.

In fact, more Americans are emigrating to Europe than Europeans are immigrating to the U.S., for which the American medical "system" must be held at least partly to blame.

John

Zora brings up an interesting point. America is the only country in the world where people become doctors with the prime purpose of making a lot of money.

Add to that the cost of American university education and you have a situation where even someone who went into medicine as an avocation (and yes, Zora, there are such people, even in the home of the selfish and the land of the greedy) have to make huge amounts of money just to stay ahead of the interest payments on their education.

True, European doctors make far less money, but they aren't burdened with huge education costs either, and almost all of them approach medicine as an avocation, rather than a wealth-creation scheme.

Face it: Making money off other people's being sick is just plain immoral.

Lafayette

OG: Health insurance costs so much today because the government, on the premise that there exists a "right" to health care at someone else's expense, has promised Americans a free lunch

Yes, it is called a "birthright." Ever hear of it? From having read the rest of your screed, I think not.

So, here's some instruction: A birthright is intrinsic; that is, we are born with it. We have, according to the Declaration of Independence, an intrinsic right to "life, liberty, and the pursuit of happiness." Mind you, happiness is not guaranteed, but its pursuit is.

So, what does this clarion call to birthrights institutionalized in our Declaration of Independence mean? First of all, you think it means liberty is the right to refuse government intervention in the market mechanism, because it distorts the mechanism and makes whatever goods and services are provided too expensive.

One can also interpret the "life and liberty" as the intrinsic right to a guarantee of life and its quality--that is, health care throughout our lives. Yes, liberty implies freedom of choice, but there exist remarkably good health-care systems that allow choice and deliver care at far less than rip-off prices. This article mentions one, France's.

Why do the French pour so many of their tax dollars into supporting this system (because even though a payroll tax provides some funding, most still comes from the state)? Because they perceive it a fundamental right of birth that medical care should be available to all, and at a reasonable cost. Just like justice is available to all, defense of the nation is for everyone, secondary schooling is afforded to all, etc.

There are services that should be, no doubt, provided by the private market mechanism. But where that mechanism has proven dysfunctional--in services that are considered crucial, even strategic to life (and the pursuit of happiness)--the market mechanism needs fixing. More than fixing, it needs a heart transplant.

A nation cannot fix its health-care system if that system has dysfunctional market pricing, which means uncontrolled pricing due to a perpetual excess of demand over the supply of health-care services (remedial treatment, convalescence, preventive controls).

To control pricing, one need only increase supply. But the supply of health-care services has proven to be inelastic. Why? The cost of educating and training medical staff. Fix that problem, and maybe one can get a better handle on market forces. One does not simply press a button and turn out a dedicated, competent nursing staff overnight.

Good luck. It is near a mission impossible to expand the supply of trained medical staff in the short run. It will take decades to generate an adequate supply of competent health-care services staffs.

Jerry

Doctors do not make money off people's illnesses; they make money by helping sick people and making them feel better so they can lead happier lives. I'm not sure how anyone could reasonably call this immoral. Making money from hurting people--like a hitman does--is immoral. What is really immoral, and I mean grossly immoral, is making doctors servants of the state, telling what to do, how to do it, who to treat, when to treat them, etc. These professionals did not work to get where they are in life to become lowly government employees. To propose such a punishing and horrible imposition on our doctors, the best doctors in the world, is immoral on a whole new level. That is just plain evil.

Tom

So where do "birthrights" stop and providing for your own needs start? In a socialist economy everything--food, transportation, housing, and a job--is a "birthright." What we have found from experience is that socialist/Communist governments do a horrible job of delivering all of these "birthrights."

The word "birthright" is very scary. It is a word socialists love because they can use it to pull the wool over the eyes of the uneducated and the poor. They use this kind of language to fabricate ridiculous arguments for everything from free health care to a free automobile for every citizen.

Health care is not a birthright any more than food, clothing, and shelter. In no way, shape, or form did the Founding Fathers indicate they advocated anything but a very limited government. It doesn't take a genius to extrapolate from their writings that they would be strongly opposed to government taking over 33% of the American economy.

Pierre

Then French system is a "hybrid." And it is deteriorating fast, mostly due to the fact that the Muslim-Arab population is abusing the system: family allowances, unemployment benefits, and so on.

One positive aspect is that the French government curbs the appetites of international drug companies and controls the price of medicine. On average, the cost of a month's supply of prescription medicine in France only gets you 10 days in the U.S.

richard

Of course, the issue is not free health care but rather universal access. The discussion leaves off on a major price policy that is also to blame for U.S. prices, i.e. the astronomical costs of medical schools. Do not expect to be able to create a universal health-care system with nurses paying $24,000 in tuition and doctors paying several times that. And of those who bleat about what they know not, I have lived the U.S. model, the German model, the Austrian model, and now the British model. They all have merits, but I have only been without cover in one country.

Zac

I have just one comment. I cannot believe that no one has absolutely pounced on John from Britain's comment. He claims he pays 32% of his pay for health care, and seems to think this is a bargain. If you tack 32% onto existing taxes, do you think this is cheaper than the health insurance cost currently being paid? Thirty-two percent is an astronomical number and completely unacceptable. If John makes 60K a year, that means in essence he is paying $1,666.66 per month for health insurance. If he was about 40 and his wife was the same age, he could get full coverage here in the U.S. for him and two children for less than $500 a month. Government guaranteed insurance for three times the current rate--where do I sign up?

Stan

Another British taxpayer here. I think John meant that he paid 32% of his total income in taxes. It certainly would not be 32% for health care alone.

There is always excess demand for health care. It has to be rationed some way, either through queuing or through price. The latter means that 50 million citizens of the most powerful--and one of the wealthiest--countries in the world have no health-care coverage. I would find that totally immoral, but it's your country.

You do have to wait for minor operations on the NHS, but if it's serious, you will always be dealt with immediately.

Barnett

The comment about 32% was about his total tax load. NHS is actually one of the cheapest systems in the West, and consequently has many problems due to aggressive cost cutting and price restrictions. However, that is now beside the point, as he is not paying 32% for that care.

The problem with so many proponents on here is their support of a complete government takeover (á la NHS) or a completely free-market system (á la--oh, that doesn't really exist anymore). You don't need to do one or the other. You can take our system and basically rearrange the financial workings of it to make it more equitable and effective, while meeting that market requirement of having all care be available at some cost. The scare is that socialized medicine will eliminate access to care in the pursuit of equity among citizens; however, that need not be the case. Structure a new system around the French one, where there is not only an extensive public presence in the delivery system but also an ability for a private market to provide special and experimental treatments, and with some tinkering you can get what you want.

Perfection as is pursued by the extreme ends is never achievable. Instead, work to come as close as you can while giving everyone a clearer head and some more workable guarantees.

Sonia

Pierre
June 19, 2007 05:19 PM
The Muslim-Arab population is abusing the [French] system: family allowances, unemployment benefits, and so on.

Family allowances (CAF) and unemployment benefits (ASSEDIC*) are not linked to health care (CPAM), so the comparison seems a bit dodgy to me.

In any case, it would be interesting to see the data that supports your statement. Could you provide a link or some other reference please?

*Only people who have actually been employed can actually receive unemployment benefits.

Warren

I've lived under the Canadian system, and I'm living in the U.S., and I will say that they both work OK, with the Canadian being better if you have nothing catastrophic and the American being better if you are not poor.

That being said, why is this such a crisis in the wealthiest country in the world? Why is it that so many European countries seem to get it right? Yes, there are exceptions, but what happened to cause so much of this current crisis in the last 30 years?

Could it be liability? The tech race? Dare we admit that other countries with a more "socialized" system are working better than ours?

I believe we all have to contribute to our health. At least give children decent health care. It is a right if we make it that.

Lauren

Bad, bad idea. With socialized medicine, you're encouraging even more illegals to flood in. I am incredibly skeptical that modern politicians and "intellectuals" are simultaneously encouraging amnesty and socialized medicine. And on this forum, many people have been speaking of how "rich" we are. We've lost about 15% share of the world's GNP since the middle of last century, completely paralleled with the advancement of social programs. It's not only the debate of helping out a couple poor folks; we're really talking about disintegration of the working principles of our nation. I'm reading The History of Money--great book. Every time, a powerful centralized government will bankrupt its own people in exchange for more power. They get power through your heart-strings--education, health services. The argument always comes back to how one would be icy to deny people these "human rights." Please, the mockery that they have made of education is sad at best.

Newton

Why does everyone assume "socialized" health care means price controls, wage controls, more bureaucracy, excluded benefits, etc. There are countless ways the U.S. government can make health care more accessible and more affordable. My personal suggestion is to have the U.S. government act as a universal PPO. Every person who is in the U.S. legally (citizen, tourist, PR, work visa, etc.) gets a health ID card. Any time someone obtains a health service or product (doctor's visit, prescription drugs, etc.), she shows her health ID card, pays 10% (or some other small percentage) of the total price, and the U.S. government reimburses the other 90% to the health-care provider. In this way, free-market competition is preserved, along with the autonomy of doctors, dentists, hospitals, pharmacies, etc. and the direct cost of health care is brought down for everyone. The U.S. government can pay for such a program by repealing many corporate and business tax breaks that lengthen and complicate our tax code.

Barnett

Lauren, what in the world are you talking about? Our share of world GNP may have gone down, but that's because the rest of the world has gotten much richer and better at economic production. World GNP (or more correctly, GDP) has increased substantially, along with our own GDP. GDP per capita has increased considerably as has overall wealth, median income, purchasing power, and so on.

Jerry

OK, let's at least stop putting the word socialized in quotes; that is exactly what it is called when government takes over the health-care system in a country. Why would anyone believe that our government is capable of doing this? People need to stop worshipping at the altar of Washington, D.C., and expecting government to fix all of the problems in their lives. Do you really think our government can maintain a massive database of millions of health care records? Hell, we can't even get the CIA and the FBI to use one single database. Our government cannot, and should not, be in the IT business; they have done an absolutely awful job of this in the past. I find it amazing that anyone would think they could do it now. It seems that there are some people who will push this whole government takeover of health care thing no matter how much compelling evidence is presented to show that our government is simply not capable of doing it. Even if it were capable, it is still morally wrong to use physical force to make one person pay for another person's health care. Our government can't do anything right; look at the disastrous situation at our government-run hospitals. Look at the disaster our government has made of Social Security. Look at what a disaster they have made of the war with Iraq. Based on these things alone, why in the hell would we let our government take over 1/3 of the American economy, and make it infinitely more powerful?

Jared Rhoads

The real question is not, as Dr. Swartz claims, "How will we finance [a universal coverage plan]?" That question takes for granted the conclusion that it is proper for government to involve itself in health care in the first place, which has not been established and cannot be established by reference to any rational definition of government.

Dr. Ghate's solution to restore individual rights places the debate where it belongs: Should man survive by extorting goods and services from others, or by trading with them voluntarily?

Jared Rhoads
Director
The Lucidicus Project

Steve

I think you are all afraid of suffering a little pain, getting old, and dying. I've read the majority of posts, and no one has asked the most fundamental question of all: How much health care can we afford? The amount spent on health-care technology and the delivery of this technology and improved methods is tremendous. Can we afford it?

Early in the discussion, the comparison to the electronics industry was used. A personal computer that is three times faster than anything built, could withstand a 100-foot drop, and could recognize my voice with great accuracy could be produced and sold within a year. Of course, we won't see it, because it would cost $50,000 and no one will buy it. But in health care, the money keeps pouring in, because we all have a "right" to access any great discovery. Why? Where do we draw the line?

By the way, any MD that is for total government health care, please get in front of the line for limiting your salary to $95,000 a year. If you think that is unfair, talk to the teachers who work just as long and hard as you.

Margaret

A nationwide survey by the authoritative Pew Research Center found that 65% of Americans support "government health insurance even if taxes increase." Even among those identified as social conservatives, 59% support a tax-financed government system. For other groups, the percent supporting were: populist conservatives (63%), conservative Democrats (73%), and "liberals" (90%). Only one group, enterprisers (libertarian conservatives), did not provide majority support (24%). (Pew Research Center, "Beyond Red vs. Blue," 5/10/05.)

Since some people would not want universal health care, they can opt out while the majority of American workers can choose to pay higher taxes with universal health care. In my opinion, this can be administered by the local and state government, which usually can make better decisions on the local level than the federal government. Furthermore, employers would not have to offer health insurance as an employment benefit. Instead they could offer higher wages and have access to a higher-level playing field with the rest of the industrial countries that have universal health care.

Mark

I lived in Canada for 35 years, then Europe for two and the USA for the last 12. Being upper middle class means that I have had good health care through my U.S. HMO but I did not have any problems in Canada or Holland either.

My complaint about the Canadian system was just that there should be some co-pay (since initiated), because we would always get too much medical attention. Doctors always wanted to refer you to specialists to double-check even if they were 99.5% sure you were fine or their diagnosis was correct. It does not cost you anything, so why not? They take no risk, their brothers in stethoscopes got some business, and the government pays anyway. This drives up the cost, and there used to be little acting as a regulator. As previous posters stated, regardless of the stories you may hear about Canadians' having to wait for a special test or flying to the USA for immediate treatment, ask the population if they would trade for the US. system, and you will hear laughter.

Doctors in Holland do not make high salaries. They have a good high-tech medical system, but they also have local GPs who work out of their house and support a few blocks around them. They make house calls and know the patients personally. Education is not expensive, so they just need the grades and aptitude to become a doctor. They also need the desire to help people, because they won't get rich. Again, few people would ever consider switching to the U.S. model.

I chose an HMO in the U.S., because it seemed the closest to Canadian care. No paperwork or administrative hassles and costs as long as you were using their own facilities. When they didn't have the equipment of specialist, they could send you to another facility and they worried about it, not me. So far, no problems and I am satisfied. I am very right wing (a Libertarian conservative in fact) on financial issues, but in this case, I see government involvement being necessary in the long run. All the research I have found on health-care cost shows that multiple administrative layers and systems plus the legal system supporting law suits against "rich" doctors and companies are primary contributors to the outrageous health-care costs in the USA. I can afford it, but the idea that 50 million people below my means may have to choose between their children's health and all of their life savings and assets bothers me.

A single government-regulated health program for high-cost procedures seems like a reasonable step. Yes, my taxes will go up some, but my employer will save a lot and I can get some of that back in higher wages or other benefits.

Charge back substantial amounts to people with lifestyle-induced problems if you want. Smokers, the obese or too thin, recreational-drug users, and heavy drinkers can all share some additional financial responsibility, and I won't complain.

I do get tired of hearing fanatical tirades from both sides of this debate coming from people who really don't have much experience or knowledge beyond the anecdotes they choose to listen to.

random

Oddly enough, no one seems to ask why a surgery can cost $250,000 or the price of a 2,000-square-foot house in an upscale suburb of a nice city.

When companies want to know why something is expensive and how to fix the issue, they don't fall into hysterics, rely on anecdotal information, or pound their chest about how they're the best company in the world and every other company's way of doing things is wrong and stupid. Instead, they do an audit and track down what makes up the costs of the product or service they're buying; they're getting down to its very basics.

Why do you have to pay a quarter of a million for surgery? What are the drivers? What makes up the costs? What sets that cost? Why? How can it be controlled or modified? Is it the doctor? The patient? The insurance companies? The lawyers? The government? All of them stumbling over one another with conflicting, duplicating policies? Why does a hospital room cost $1,200 a day and a pill cost $15?

Until someone does a full cost analysis on what really drives the costs of health care rather than make non sequiturs--such as "if the government is paying for 60% of health insurance in the U.S., it must be the government's fault that it's so expensive because the government always sucks eggs--or indulging in paranoia or nationalistic rhetoric, we'll be stuck with the problem of ever-more expensive health care because nobody wants to put in the time for an honest analysis of the situation.

Drive-by punditry is a form of entertainment for the politically fanatical. It's not an analysis or a solution. In fact, it's an antithesis of one.

Brad - USCorporateWellness.com

Obviously, as a national corporate wellness company, we've got a dog in this fight, but I'm glad to see that the majority of readers appear to "get it." Going to a national health-care system only shifts the dollars; it doesn't effectively address the problem. Until we consistently create ways for individuals to take personal responsibility through encouragement, tools, and accountability, the costs will continue to climb. And national plan or not, the dollars are still there.

Prashant

"Nationalizing" already brings up the fear of a Venezuela-type takeover of oil company installations.

Onkar: I have one question for you: How many people enjoy going to the doctor's or the dentist's? Most people go when they actually fall sick. Most people would rather spend time with family, work at improving their business, or volunteer for a good job. Only people whose doctor recommends a $2,000 liver test would go for it; regular people who can't tell where Washington, D.C., is on a world map are hardly smart enough to ask for something like that on a whim.

Maybe, Onkar, you like to go and visit your doctor instead of spending time with your family.

Jack Lohman

The costly middleman insurance bureaucracy consumes 31% of health-care costs without ever laying a healing hand on the patient. A Medicare-for-all system could extend first-class coverage to 100% of the population for the same dollars we are spending today. If the politicians were not receiving $100 million from the health-care industry, we'd have fixed health care long ago.

Jack Lohman
Business Coalition for Single-Payer Healthcare

Joe

Here is an innovative idea. Let the marketplace exists but on one condition: No medical insurance company can borrow money from the stock market nor can pharmacy companies borrow money from stock market.

Daryl

I want to clear up one of the most misleading arguments against universal health care/socialized health care, based on my personal experience with Britain's NHS, the Irish system, and America's health-care system.

It's extremely misleading to claim that socialized medicine restricts choice, or that "Big Brother" tells you what to do. It's not as if the government replaces the insurance company and decides which procedures and treatments you can and can't have, quite the opposite in fact. Yes the government is involved in setting up the system and distributing funds, but your health and your health-care decisions are yours to make, with the advice of your doctor. And you can go to whichever doctor you choose.

Compare this to a market- and insurance-based system in which your insurance company can approve or deny claims and thereby approve or deny your right to treatment.

It's simplistic and very 1950s Red Scare to argue that free market equals choice and socialized medicine equals restriction. The only choice missing in socialized medicine is the freedom to choose an insurance company, but that's only because you don't need one anymore.

Shawn

I think there there some additional things we need to look at:

- People are dying and not being treated because they have no health insurance.

- Companies like GM, Ford, and Chrysler are losing money because health-care costs in the U.S. are out of control. This is making U.S. companies less competitive year after year, and eventually companies will move more operations off shore where it is more cost competitive and health care costs are much, much lower.

- Quote from the movie Sicko: "If you can afford to kill people, why can't you afford to help people?"

- Living in the U.S. is becoming extremely expensive with health-care insurance premiums, student load debt soaring, and real estate costs out of control.

We need to come up with a solution now. Otherwise, this country will be left with no companies that want to operate here, people dying because they have no health insurance, and an unproductive workforce that is stressed with health-care costs. We need to end our narcissistic and selfish ways. Otherwise it will come around and bite us in the rear end while the rest of the world leaves us in the dust.

Socialist Frog

The "basic" French health insurance is compulsory with a regulated price proportional to earnings for the middle class--independent of the individual health risks. The prices of the basic treatments are heavily regulated. People buy extra insurance as they like and can. The quality is rather good (for instance, life expectancy is higher than in the States).

Of course, the situation is far from perfect. Because of the aging population, medical progress, overconsumption by the patients, and overprescription by the doctors, the GNP share of health keeps increasing (though it is much less than in the U.S., partly because highly skilled workers are paid less in France than in the U.S.).

Most French think that providing this safety net is maintaining our society the way we love it. Of course, that's a political choice and other choices are possible.

Some economic theory for the "extreme free marketers":

A. As game theory (for instance) shows, having the choice is not always in your interest. As for the insurance of people with differing risks, it is well-known that freedom will lead to:

1) healthy people refusing to contribute, and some of them then free-loading in the ER; and
2) the ruin of the insurance companies that are the slowest in pricing out riskier people and therefore will get all of them.

B. Health care is an informational nightmare:

1) People won't reveal how risky they are--even if they know it.
2) Doctors won't reveal how good they or the treatments they recommend will be for the given patient--even if they know it
3) Let us not even speak of the complexity of the provider/insurer/patient relationships, which is attested to by the fastest bureaucracy in the world.

Finally, it is a strange to read free-marketers suggesting that economic freedom requires forbidding many people from buying what they want--that is, health insurance.

Graham

What if you didn't have to worry about getting sick? I mean, even those of us with health insurance can't be 100% sure we will receive the benefits we are entitled to. Why? The companies have a vested interest in increasing profits. Many of them are bound by law (by their shareholders) to increase profits. You could actually hold stock in a company that will deny you coverage.

Think about that for one second. We are weighing a company's profits against the welfare of our population. This is insane. Wake up and do something. To contact your government officials:
http://www.usa.gov/Contact.shtml

Mark

Why should socialist, Marxist, and Communist be forced to stop at the total socialization of medicine?

Why not put the United Nations in charge of truly universal medicine without borders?

Just think of a world where auto insurance, property insurance, life insurance, and every other type of insurance is run by the government.

What about a world where the government completely controls the press, religion, the allocation of financial capital, and real estate?

Just think of what socialization has done for Russia, China, and North Korea.

Heaven on Earth?

Where can I get an insurance policy that protects me from the harm caused by the government?

After medicine is socialized in this country, going to the DMV will be like Disneyland.

Daryl

Mark,

The difference is that health care is an essential service, like the police and the fire department. It's a ridiculous McCarthy-type step to assume universal health care is one step toward land redistribution.

The "socialization" of medicine has nothing to do with "socialist, Marxist, and Communist" forces. Problems in Russia, China, and North Korea come from totalitarian governments.

Many, many countries, like Britain, France, Italy, and Spain, have "socialized" medicine and democratic systems that in some cases work better than those of the U.S.

Michael Pierone

France is being billed as the best health-care system in the world. Just one problem: It isn't.

How about a real-life example? In August 2003, 15,000 elderly died in French hospitals because of a heat wave.

A heat wave? You can't walk into an American hospital that doesn't have air conditioning, but apparently you can die from heat in a French hospital quite easily. How does the World Health Organization give a top rating to a country whose hospitals can't keep 15,000 elderly from dying in one summer from heat?

I guess France's socialized medical program can't afford modern medical devices like air conditioners even though they spend upward of 9% of their GDP on health care. I regard 15,000 deaths of elderly patients from heat in French hospitals as a rather severe failure of the French health system.

France's health-care system may be better than ours, but I'd avoid being sick and elderly there in the summer.

Daryl

In defense of the French health-care system--which I'm not holding up as perfect--that heat wave was off the charts. The absence of air conditioners wasn't because the health-care system couldn't afford them; it was because they never thought they'd need them. It was the same across the whole country, not just in hospitals but in people's homes, too.

The reason you can't walk into a U.S. hospital (or office, apartment building, etc.) without seeing air conditioning is because it's generally hotter in America, and people routinely use air conditioning. I'd never even seen--much less needed--an A/C unit until I moved to the U.S.

So yes, the heat wave exposed many problems with French health care and the government's response to emergencies (e.g., the government was too slow in declaring a state of emergency and too many health-care workers were on simultaneous vacation), but it's misleading to say "France's socialized medical program can't afford modern medical devices like air conditioners even though they spend upward of 9% of their GDP on health care." It was a crisis they never thought they'd have to face.

Still, 15,000 deaths was a failure, and the French viewed it as such and took steps to be better prepared should there be another heat wave. But 18,000 Americans die every year because they're uninsured, so surely America should consider that a failure of the system and take the appropriate steps.

Jack

Where is all the money going? Not on new drugs, because as we know, insurance companies will not pay for them. Not on new surgeries, not to the health-care providers. Look at insurance company profits and what they pay their CEOs: up to a billion, yes, a billion dollars to United Health's last CEO. The system is riddled with corruption and volumes of stupid paperwork insurance companies pay staff to read and file. Of course everyone can have access to health care in this country, but only when insurance companies are prepared to curtail their outrageous profits.

Phoenix

There are numerous things wrong with our current health-care system. I don't know about you out there, but my income has not gone up 67% or 76% as the cost of medical things has in the last few years. In fact, right now I am unemployed yet expected to pay $600 per month for insurance that only covers 40% of the cost of any care I get. Yet I guarantee you the CEOs of these insurance companies get their money and benefits. We pay for these CEOs' salaries. I guarantee you they do not work harder than their employees do, yet we pay them like they do. If they did not have employees to do the work, they wouldn't even have a job.

The CEOs should lower the cost of our care, pay more for the medical procedures we have to have, and take a substantial cut in salary, based on their actual performance. U.S. citizens deserve to have a reasonably priced health-care system, better customer service from these insurance companies (they need to realize that without us they would not have a job), a medical person who actually makes the decisions about the medical care we need (instead of decisions based on the approval of a nonmedical clerk or nonmedical CEO), better priced premiums, and total elimination of "preexisting conditions" from all insurance. These are just a few things on my chest about our health-care problems.

Me

Onkar, are you nuts? Maybe if the industry would stop selling us crap we don't need, we wouldn't demand and consume it.

Malagent.com

RE: Maybe if the industry would stop selling us crap we don't need, we wouldn't demand and consume it.

Maybe if people stopped demanding and consuming junk they don't need, the industry would stop selling it.

Just because something is advertised does not mean you have to buy it. I see many drug advertisements, and I don't use any of them. A lot of other people do use them though.

David

Onkar:

"When a person can consume medical services without needing to consider how to pay for them..."

Are we supposed to run a cost/benefit analysis on all of our health needs? Even the unexpected ones? What if someone has a heart attack or breaks a leg or has a major car accident? How realistic is it for people to just say that they won't receive treatment because they can't afford it? I cannot imagine someone saying, "You know, I think this bone sticking out of my leg will eventually heal itself. Besides, I need to pay rent this month."

Health care is not a regular good or service, so the same market forces shouldn't apply. I've never heard of any persons dying because they couldn't afford an iPhone or a car wash.

Heather Shirley

Will free health-care for children increase population growth?

I believe the No. 1 priority of the globe should be to protect the habitability of the Earth's land, air, water, and atmosphere. I believe the second priority of the globe should be to aspire to end terrorism and wars. In my view, the third priority should be public health.

I am against any form of Universal health-care system (free health care for young people) in our country for a couple reasons:

1) People who are planning a family should be planning on their budget as well. Their budget should include how many children they themselves can afford to pay for, not the taxpayers.
2) It may be possible that people who are planning families will produce more offspring if the health care is free. I do not think a population growth is needed at this time, even though the elderly are holding on to life longer than ever and they rely on the younger to do daily basic toileting, etc., for them.

I am opposed to any universal health-care plan.

-Heather Shirley

Justin

It's so sad to read this. We Americans are lazy. We put trust in those making the most compelling arguments rather than question their motivations. The most compelling arguments are the most compelling because they are backed by boatloads of money, the boatloads of money that are being squeezed out of us through health-care/insurance costs. Their goal is to get us so dizzy that it is much easier to just agree with them. And they are extremely successful at this. Just ask why so many Americans voted for Bush. Are we learning our lessons? I don't think we are.

Socialized health care is the answer. The opponents are either bought, lazy, or uneducated--which unfortunately accounts for the majority of Americans.

So go ahead now, you Sean Hannitys, accuse me of being unpatriotic. Put your spin on it.

Joe

According to the BLS webpage, real earnings have declined by roughly 25% in the past 30 years. Have you ever heard of a concept called inflation? Of course GDP, GDP per Capita, and median income will increase, but this does not mean that the value has increased along with the meaningless number.

LAW

In response to Heather Shirley...

What you stated does make sense, but you neglected to mention all of the unplanned pregnancies that can be avoided because that uninsured 19-45-year-old population can now go to the MD and get the birth control that they otherwise believed they couldn't afford.

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