Debate:Socialized healthcare

This is a Debate page. Feel free to add your own spin on the story. Please keep it civil! This debate was created by Dream.

Initial foray and responses

I personally dislike socialized healthcare, so possible bias warning. But honestly, the quality of healthcare in Colombia is not better than it is in the US or Canada, or even just below that of Britain. The WHO rankings are not a particularly good measure. dream^ing _{Hail Eris!} 15:07, 5 March 2009 (EST)

A perfectly acceptable thought, but what counter system do you offer? What other ranking system (apart from the WHO) would you use? and on a personal note, what do you have against a system where people don't go bankrupt because they get hit by a bus (that was meant as a real question, not a sarcastic one... I guess my own bias is showing) SirChuckB^{Call the FBI} 15:17, 5 March 2009 (EST)

I don't get why people are so scared of socialized medicine. It does not really make your costs go up (as far as taxes) cause a fully socialized system you don't pay the 400 / month I pay for health insurance. that 400 (or much much less, actually. Like 20-50 a month) would go to taxes to pay for socialized medicine. when did socialized meds become the boogie man. Can I ask, dream, what you find specifically wrong with socialized medicine?^{— Unsigned, by: WaitingforGodot / talk / contribs}

Try this. USA is 24th in life expectancy:www.photius.com/rankings/healthy_life_table2.html, and 2nd in health expenditure: http://www.photius.com/rankings/total_health_expenditure_as_pecent_of_gdp_2000_to_2005.html. Hardly value for money. Broccoli 15:31, 5 March 2009 (EST)

You there! Yes, you. Greenery. See your talk page re coursework panicking. EddyP 15:33, 5 March 2009 (EST)

Life expectancy is a horrible measure of health care for a variety of reasons. All sorts of health choices affect life expectancy: diet (fried foods are more common here than in other countries) and activity level are two major influences. Smoking and other unhealthy activities affect it as well. Higher murder and accident rates also increase death. On the other hand, the return on investment per dollar might not be high, but using more expensive treatments that might only slightly prolong life (days or weeks) may be worth it to the people undergoing them, even if they are vastly expensive for the returns they give. Anyway, the main point is that life expectancy is in many ways more dependent on culture than quality of healthcare (assuming a baseline level of healthcare). dream^ing _{Hail Eris!} 19:41, 7 March 2009 (EST)

Godot--it is received dogma among Americans that the government is inherently incompetent and corrupt, and cannot do ANYTHING right. (Except run jails, an army, and the FCC, of course.) Therefore, Private Enterprise (All Hail Adam Smith!) is the ONLY system that can possibly administer health care. Counterexamples like Sweden, France or Canada do not count, as they rely on the bizarre quirks of the inscrutable European brain fnord. --Gulik 16:29, 5 March 2009 (EST)

I am not sure off the top of my head what would be a better ranking system, although I may look into it to see what else there is. On the face of it, I think the weighting seems off though, as even a poor person is generally better off in America or Canada than in Colombia.

As to socialization, I am a libertarian. As a rule, I have a bit of distaste for anything involving force, although using it to take care of others is not too big of a deal for me, compared to the vast majority of things the government does. As a future doctor, I dislike socialization because I think it can lead to decreased innovation and physician autonomy. As a rather internally contradictory libertarian, I work with the government constantly (my lab's funding comes from the NIH and the DoD, mostly). I've found working with the DOD far more painful than working with insurers (most of whom need to be destroyed for breach of contract, if not legally, than ethically), in terms of how painful it is to deal with their bureacracy. I also work with the one actual socialized healthcare system we have, the VA Medical Centers. They are a horrid example of what socialized medicine can be, of course, but they are an example of exactly how the American government has been doing it wrong. I don't want that, or anything like it.

There are good examples of socialized medicine. I still do not prefer them, for overly complex ethical reasons, but they are certainly not a bad alternative. Debating the merits of various forms of socialized medicine is not the main reason I was responding, however. I just wanted my personal views up front. I think the problems with the WHO ranking are independent of my views on health care systems, however, I realize that they might be unconsciously influenced by them. dream^ing _{Hail Eris!} 16:45, 5 March 2009 (EST)

Oh, there is one other reason that I dislike socialization, unrelated to economic freedom. If medicine is socialized, it is in the best interest of the country to disallow choices that increase your health risks. Not all countries with social medicine do this, but certain cities already make it harder to get trans-fat or smoke (even around just other smokers). I am overweight, and while I am trying to lose weight, I like to be able to eat whatever I think is best. I think the trends towards controlling what we eat will gain ground in America under a single payer system (the type of universal healthcare I like least). I honestly don't think my health should be anybodies business except myself, my wife, and my doctor. And, of course, when I have kids, them too. And when medicine is socialized, there is a legitimate public stake in my health. I'm just not really okay with that. dream^ing _{Hail Eris!} 16:52, 5 March 2009 (EST)

Of course, and don't get me wrong, I understand everything you're saying.... As a crazy left winger, here's my view on most government regulation issues: It would be great in the government didn't have to get involved, but it has been proven time and time again that they need to. Businesses are just not willing or not able to regulate themselves. I think the whole healthcare debate comes down to this: is healthcare a basic human right or a commodity to be bought and sold. I think it's a right, and therefore, everyone should have equal coverage. On that note, I was in a debate the other week and totally schooled some guy. He made a comment about how if we accept government healthcare, what's to stop poor people from demanding the government buy them computers and cars. I replied, nobody ever died from lack of car. :-) SirChuckB^{Call the FBI} 17:02, 5 March 2009 (EST)

I hold to the view that anything that requires action on another persons part, generally, is not a right. Healthcare falls into that rubric. Of course, I think everyone should have healthcare and that it is our responsibility to help people in need; it's just not a right. As to regulating themselves, I honestly rather see doctors have more bargaining power (such as forming union-like arrangements) to fight insurance companies (where much of the blame for poor care rests). As an aside, one of my main interests is working with poor families with developmentally delayed children. They can't pay well, but I certainly intend to provide the best possible care. They don't have a right to it, but that doesn't mean the right thing to do isn't to help them! dream^ing _{Hail Eris!} 18:39, 5 March 2009 (EST)

Back to the WHO thing a bit. Note that they have stopped doing this ranking (last one was 2000) due to the complexity. The problem is (as I see it?), there are so many metrics that can be looked at, and have to be weighted against each other, that doing an across the board comparison becomes impossible. Dumb example - odds are a "third world" country might have very low cancer deaths, due to everyone dying before they can get cancer. Also less obesity, perhaps, due to less food access. Anyway, obvious metrics are things like infant mortality and life expectancy, but then there's the "stuff in the middle" - cancer survival rates, heart attack survival rates, "down time" due to major things like broken bones or appendicitis (say), "wait times" for less than urgent (but not 'elective") care, percent of population with easy access to various low and high level care, and on, and on, and on... ħuman 17:05, 5 March 2009 (EST)

Wow, dream. Ok. you actually have *real* thoughts about this, and have clearly looked it up. I was waiting for more of the "long lines" "impersonal service" "old buildings" that I hear from my dad each week. Not understand that I call to schedule a doctor's appointement and it takes me 4 months here, for routine work (here, Denver). Thanks for your thoughts. I'm going to read up on them as a real argument, not a straw man one.--En attendant Godot_{"Such is life."} 17:08, 5 March 2009 (EST)

Sorry, but I feel very strongly about this issue. Two examples here Dream:

1) A few years ago, a friend of a friend arrived on vacation in the US, staying with my friend in one of the largest cities in the US. She had a terrible fall, was taken to hospital, checked, scanned and X-rayed, and discharged from the ER with a broken spine after about two hours because she didn't have qualifying insurance. There was no evident spinal cord damage. She was sent to public hospital and was discharged from there five days later in a wheelchair for my friends to look after, with no help. They became unwitting carers for a spinal injury patient. After six months in their house in a wheelchair, with a nurse (that they had to provide at their own cost), she was able to return to her home country, where she has recovered well. Presently, she received a bill for her health care to the tune of more than $125k. She has baled on her responsiblities and will never return to the US.

2) Last year, an elderly friend had a terrible fall in Ireland (my home country), and spent six months in hospital. She was well cared for. There was no bill. When she returned home finally, a public health care nurse attended to her dressings every two days for months, until the wound healed. There was no bill. She also paid nothing for her drugs.

Now, having lived and worked in both countries, I can confirm that the total tax and healthcare take from my paycheck in the US is higher, despite Ireland's higher taxes. So - what's wrong with this picture? The health of a nation and the quality of life of its people is measured by more than money - it is how a civilised nation is measured. A nation, like the US, that does not take care of the health of its citizens, or its guests, is not a civilised nation. The health care system in the US is an utter fiasco, and the sooner the Government runs the entire thing the better. I'll gladly shift the hundreds of dollars I spend every month from the insurers to the Government in taxes to do so. Wooo! More taxes! yes! DogP 17:38, 5 March 2009 (EST)

I have a similar story, when I had an accident in the US despite being insured out of my arse, I received substandard treatment to the point where when I returned to the UK the doctors who saw me couldn't believe I was treated in a New England hospital, and not some third world country. Thanks to the treatment I got, I now have chronic pain whenever I walk more than a few miles in a day or have to spent more than a couple of hours standing.

Now, I don't know that the treatment I received was typical exactly. I just went where the ambulance took me, it is possible that I didn't get the pick of local health care choices. All I know is that I got a raw deal from the doctors I saw, and the bill for it was frankly ridiculous. --JeevesMkII ^{The gentleman's gentleman at the other site} 18:08, 5 March 2009 (EST)

Those are certainly sad stories of where the healthcare system failed you. I'm sorry to hear them. I just disagree about appropriate solutions. Also, on an unrelated note, although Ireland has higher taxes, I believe they actually rank very high on CATOs economic freedom scale. Not sure though. To revisit the issue of me being overweight: I think that I should be free to eat what I want (although I'm trying hard not to!). I also don't feel that it is morally permissible for me to force anyone to help pay for any additional costs I might incur because of my lifestyle choices. In Denmark, for example, I've seen many people smoking, far more than in Boston where I live. I don't know, but I imagine Denmark has socialized healthcare. I think it's great that people are still allowed to smoke, but I am not sure it's actually right for them to choose to, considering the costs. (Barring a study I've heard about that obese people and smokers cost less overall, I am assuming the opposite because there probably are lifestyle choices that raise costs, whether or not being a fat smoker is one of them). dream^ing _{Hail Eris!}

I think this is entirely wrongheaded reasoning. Which do you consider worse, that you might because of your lifestyle end up paying less than your fair share for the health and well being of the nation, or that some other man dies because he is unable to pay for treatment that he urgently needs?

You can make the same argument about anything that is paid for communally. If you choose to live in a dangerous neighbourhood, you're probably not paying your "fair share" of council tax for the policing provided to you. Similarly, if you don't install smoke detectors, then maybe your choice means more work for the fire brigade at a later date. Maybe you drive many thousands of miles more on the country's roads than the average motorist, but don't pay a penny more in road tax. You may believe all these things are unfair, but we know either from common sense or bitter experience that the private sector alternatives for these things are worse. Nobody wants to live in a nation where justice is contingent on your ability to pay for it, nor does anyone believe that people in high crime areas should be asked to shoulder the cost of the additional policing they receive. No one wants to live in a world where the only consideration in the provision of transport is the ability to profit from that provision. And we definitely don't want to go back to private fire brigades. That was a disaster from start to finish.

As for your freedom, what you'll find is that indeed in countries with social medicine they do try to minimise costly behaviour such as smoking. However, that's mostly accomplished with the carrot rather than the stick. In the UK, the NHS has discovered it's far cheaper to help smokers to quit early for example than to treat them for the chronic and life threatening problems that smoking causes. To this end, there are now a whole range of different options to help people quit, all free at the point of access. They've invested heavily in advertising these services to the general public emphasising that it's not only good for the country, but good for the individual too in terms of saving money and staying healthier. The only time the stick is ever used is, as with second hand smoke in the workplace, your choice negatively affects a third party.

So, to sum up, your concerns are baseless and single payer healthcare systems are demonstrably better at providing an increased standard of living. Considering how much the US spends for substandard health care, wouldn't it be prudent to be at least commissioning studies to look at the possibility? --JeevesMkII ^{The gentleman's gentleman at the other site} 19:18, 5 March 2009 (EST)

I think both are horrible. My concerns are not baseless, just rooted in a different ethical system. I do think freedom trumps quality of life, but it isn't something I'm going to spend time working on. Personally, I'm happy to dedicate my life to helping others, but I think forcing other people to do that is wrong. And it might not surprise you to learn that I think that about other communal goods as well. I'd rather it all be voluntary. I care about some things more than others though. dream^ing _{Hail Eris!} 19:37, 5 March 2009 (EST)

Gah! That's like saying "I like to breathe, but I don't think other people should be forced to draw breath." Health care isn't a little optional thing that makes your life better. It is essential if you value your life at all. There can be no coercion the state or the private sector could possibly apply that's going to be more effective than "if you don't get this treatment, you'll probably die." Everyone needs it, the only possible debate is what is the most cost effective way to provide heath care? This "voluntary" idea of yours is simply nonsense. Especially now what you're saying is that you aren't a libertarian, but an anarchist, and not even the sort of anarcho-syndicalism that I can see might have some slim chance of working. You're a rugged individualist type anarchist, possibly the worst idea in history of political thought. --JeevesMkII ^{The gentleman's gentleman at the other site} 19:52, 5 March 2009 (EST)

The "coercion" surrounding healthcare is not that care is forced on the sick, rather that the government "robs" the rest of the population to care for the sick.-- Antifly ^{Now with 50% less retirement!} 19:55, 5 March 2009 (EST)

Food and water are also necessary for survival. I also think that it is best to use charity instead of force to obtain them for those that cannot afford it (and normal markets for those that can). There are things the government can do in minarchist societies without initiating force (I hate that clunky phrase). Revenue can be gained legitimately from a variety of methods, and people can donate to government. But, I do sometimes lean more towards anarchism, just not all the way there. I do tend to lean towards individualist schools of thought, though, as I think they are the most realistic, within low to no government situations. I'm not entirely sure why you think that's the worst idea in political thought (authoritarianism, anyone? Stalinism? Most of the fascist philosophies?) but you are welcome to that opinion. Hyperbole isn't really useful though. dream^ing _{Hail Eris!} 22:02, 5 March 2009 (EST)

I would add that the "sick and injured" tomorrow could include any of that population. ħuman 21:00, 5 March 2009 (EST)

(EC)I understand the libertarian argument that coercion is always wrong. I don't understand your secondary argument about discouraging "cost raising" behaviour. So far the only examples you have given are smoking bans and limited availability of various foodstuffs. I have never come across the latter. As to the former, Tobacco taxation exists in America as much as it does anywhere else. The standard rationale for taxing tobacco is the same for taxing booze and gambling, it's easy money. I'm not arguing that this is a good rationale, but it definitely isn't done to keep the healthcare system rolling along. We (our society that is) think it's a good idea to tax vice. Smoking bans also have nothing to do with keeping healthcare costs down. They have everything to do with protecting those who don't want to inhale smoke from being forced out of public spaces. Again, I'm not defending it, but there is no healthcare cost component to the argument. I may have misapprehended your meaning but it seems you are simply wrong on these points.-- Antifly ^{Now with 50% less retirement!} 19:30, 5 March 2009 (EST)

Sorry to sound unlearned, but what does (EC) mean? As someone who loathes second-hand smoke, I do not agree that all of it is to prevent second-hand smoking. If that were the case, there would still be smoking sections in restaurants, or businesses would be allowed to be smoking only. I would avoid them, but my friends could go to them and smoke in peace. Of course, it is for public health, still, much as are proposed trans-fat bans and the like, not to save money. We don't have full socialized healthcare where I live though, so it wouldn't make as much sense to anyway. The problem is, besides protecting people from themselves, if each taxpayer is on the line for other peoples health, taxpayers would have a direct financial interest in how much that care costs. I am not saying it will happen, just that it very well could, and I would find that a very practical downside. dream^ing _{Hail Eris!} 19:42, 5 March 2009 (EST)

"(EC)" just means "edit conflict." When someone edits a page before you can post you comment, the software alerts you by making you type it again. Usually we just copy and paste below the offending commenter, and use (EC) to denote that we have not read anything that was posted at the same time.

To your second hand smoke comments: Sure, I agree that the bans are too much. But there is a principled case for banning smoking in any government/public owned location. Private businesses should be able to make their own decisions as well, but the argument for banning smoking is always the second-hand smoke argument and never the "health care cost" argument. I do live in a country with full health coverage, and not only is no one making the "we all have a financial stake in each other's habits" argument, that is clearly not the intention of our government.-- Antifly ^{Now with 50% less retirement!} 19:52, 5 March 2009 (EST)

If I was unclear, my apologies. I also agree that people shouldn't be allowed to smoke in truly public locations. I know many countries are as you describe. In America, we have a trend where things are banned for our own good (such as drugs or transfat). Some refer to it as being related to some of our historical puritanical heritage as a young nation. I think that would be magnified once there was another justification to ban things as well. Both public health democrats and economic conservatives would be likely to support such measures. dream^ing _{Hail Eris!} 19:59, 5 March 2009 (EST)

This is starting to smack of wishful thinking. You can make the argument that governments will use healthcare as an excuse to regulate every aspect of our lives until the cows come home, but the facts just don't bear you out. I have already pointed out that tobacco doesn't help your case. Transfat you may have a point on (I actually had to google it, turns out its still legal here, but under consideration). But you lose on the drugs front as well. Show me a country with a liberal drug policy and I will show you a socialized health care system.-- Antifly ^{Now with 50% less retirement!} 22:10, 5 March 2009 (EST)

It's not wishful thinking, it's just worrying about unintended consequences. Like you said, countries with socialized health care often have liberal drug policies. Perhaps America is weird, politically (as was my point by mentioning the "puritanical heritage"). I would love to be wrong, but I really wouldn't be surprised if socialized medicine was used as an excuse to further eliminate unhealthy activities (and gain support from new segments of the electorate that otherwise would have opposed it). I may be wrong. That would be fine, but I am just not convinced that with new sin taxes being proposed (a tax on non-diet soda is likely to be shot down in New York, for example), American culture is currently in a place where there wouldn't be appeal to saving money and limiting unhealthy behavior. Both are fairly popular. dream^ing _{Hail Eris!} 22:20, 5 March 2009 (EST)

Sorry if I flew off the handle a little. I thought you were making an argument against socialized healthcare. If you are just worrying, then worry away. But bear in mind that the worries you have presented thus far have little basis in fact. You could be right that America is an exceptional case (certainly American culture is exceptional and influences all political deliberations and outcomes).-- Antifly ^{Now with 50% less retirement!} 22:30, 5 March 2009 (EST)

Society's stake in individual health

Whatever system of health care is extant in a society, there is always a stake in individual health. Sickness causes loss of worked hours and loss of quality of life for an expanding circle of people, as does injury. The nature of the health care system is irrelevant to this argument, disease, injury, and the effects of difficult aging reduce the productivity and general happiness of any society in proportion to their extent. Reducing them makes life better for all, no matter what the system (OK, expect for the very rich, who are completely isolated from the rest of our shit). ħuman 22:52, 7 March 2009 (EST)

Boutonierre

Just adding a handy edit button to make it easier for people to continue. ħuman 21:01, 5 March 2009 (EST)

While we've got a short intermission here, I wanted to say that I like this thread. I disagree with Dream, but it's still fascinating to read the discussion, and even though pretty much every user seems to be disagreeing with him, he's not getting angry or making ad hominem attacks or anything. There's something about seeing a page that starts with "Debate:", and isn't filled to the brim with parodists. It's great! We need more debate threads. Dreaded Walrus 02:46, 6 March 2009 (EST)

As a political actor...

I just wanted to clarify something about my personal position as a political actor (voter, activism, etc), as opposed to my ideal political philosophy. The two tangle together in the debate above, but they are somewhat separate in reality.

To me, socialized medicine has many downsides, as well as many upsides. I would prefer not to have it, especially in the form of a single payer system (universal coverage with socialized costs for the poor is an option I VASTLY prefer; I think it has far fewer of the downsides and could work quite well). I have an ethical opposition to most government spending, but healthcare isn't something I'd waste my effort or voter capital trying to change, much like I'm okay with them funding research. I don't think the government should, but of all the things they are doing, it's least upsetting. In fact, if they are going to fund all sorts of programs I find utterly without value, valuable things like advancing science and taking care of people without insurance seem near necessary. In fact, I would fight for (some forms of) universal coverage if we could combine it with reducing other programs that I think are far less the governments business. As a pure governmental expansion, though, I dislike it. dream^ing _{Hail Eris!} 09:25, 6 March 2009 (EST)

Those who've experienced it

I've heard all the arguments from both sides but, the deciding factor for me is that I know lot's of people who live under private healthcare schemes who want socialised medicine but practically none the other way round. Ask the most fervent right winger in the UK whether the NHS should be scrapped and (s)he'll say 'over my dead body'. Ditto for France Eire, Sweden... Silver Sloth 10:29, 6 March 2009 (EST)

I think that is certainly a valid point (although I do imagine there are SOME (even if almost none) people who would still like to get rid of it. One thing to keep in mind, however, is that people value something more once they already have it. Behavioral economists and psychologists have fun with this all the time. So people are less likely to be happy giving something up than perhaps the happiness they would gain by gaining it originally. Just a thought to keep in mind. dream^ing _{Hail Eris!} 10:43, 6 March 2009 (EST)

I always thought that this was strange. To hear the right-wingers here in the U.S. you'd think that the plague is and has been ravaging the U.K., Canada, etc. for decades now. My opinion is that it just comes down to selfishness and hardheartedness. --Edgerunner⁷⁶_{Save me Jebus!} 10:46, 6 March 2009 (EST)

My biggest wish is a system that "rewards" people for doing yearly checkups, going to the doctor at the slightest sense of something "wrong". Yet John McCain himself said this is *bad* behavior. That people who have free medical care "will go to the doctor more". Well, that's what I want. If i can catch your heightened blood sugars before they become diabetes, isn't this the best for you and the medical system? If i can notice that your blood pressure is up, and get it under control before you have the heart attack, havn't I saved you and the system thousands and thousands of dollars. Reports from around the country say people like me, with really crappy insurance (though at least it's something) put off trips to the doctor, which makes McCain happy, I guess.--En attendant Godot_{"Such is life."} 10:52, 6 March 2009 (EST)

Management

How does one deliver health care free at point of delivery?

Private systems are based on buying insurance. The insurance company pays bills covered by the policy. In essense free at point of delivery. The problems is that insurance companies want to make a profit so want to minimise risk of pay-outs.The wealthy and healthy can afford it and secondly are less of a risk so are likely to get insurance. The less well-off generally can't afford it, and the unhealthy have difficulty getting it because they generate costs.

Public systems are solidarity based. Generally from each according to ability, to each according to need. Paid either through general taxation and/or insurance payment to a government regulated scheme. Payments are usually deducted from income based on ability to pay. The greater the income the greater the payment. Those on transfer or low incomes usually have their contribution paid by the government.

Such systems generate a huge amount to cover all. Provision may be from private providers. The management of the scheme negotiating fees with the providers. The more efficiently the providers can deliver at the agreed fees, the greater their profit. Hence market forces at work. As a large scale purchaser of medicines and drugs the management of the scheme can also negotiate competitive rates, or stipulate using generics where they suffice.

A further advantage of such systems is that unions/employers don't have to negotiate for health care which incurs costs on businesses. Not just for current employees but also for retirees. The more retirees the higher the cost that has to be paid from current earnings. Causes US auto manufacurers a big headache. Businesses free from such hassles are more competitive globally. Employees don't have the mental anguish of worrying about health care provision if they lose or change their job. Happier workers are more productive which makes businesses more competitive globally.

Debates in countries with 'socialized health care' generally revolve around the best way to manage such systems.

What I'd like to know is how a private (no government interference) system can deliver affordable health care to all free at point of delivery?

Or do those who support private provision accept that its simply tough shit for those who can't afford or can't get it? Auld Nick 11:09, 6 March 2009 (EST)

in regards to the above comment, coming from Queensland Australia, where we have socialized health care, i am curious to know how in countries like the U.S. with privatised health care, Emergency treatment is done. do you have to pay for an ambulance, or emergency department treatment?^{— Unsigned, by: Individual / talk / contribs}