Universal health care for California

Politics International Politics
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A question for fans of the market: any objection to collective action in the market?

[quote=“Robert Reich”]House Democrats are pushing a bill to require Medicare to negotiate drug prices. So far, so good. But in what appears to be a bow to the political clout of Big Pharma, the bill does not authorize Medicare to drop from its approved list drugs on which manufacturers fail to offer good deals.

This is like Wal-Mart telling its suppliers, “We’re going to use our bargaining clout to get from you the lowest prices for our customers—but regardless of what price you offer we’ll still carry your product in our stores.” What kind of incentive is that?

The Department of Veterans Affairs gets a 25 percent discount on drug prices for veterans because if a drug company won’t give a big discount, Veterans Affairs won’t include the drug in its plan. Medicare recipients will only get these kinds of savings if Medicare can do the same—walk away from a drug manufacturer that won’t deal.[/quote]

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We can do what every other Western nation has done: implement a universal health care program where pre-existing conditions are not constraints to receiving medical care. The great thing about living in a democracy is that we can direct our whining to our elected leaders, who can either implement the changes we demand or lose their jobs, and make room for new leaders who will listen to the citizens.

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An important piece in this week’s economist which speaks directly to the discussions in this thread: economist.com/world/na/displ … id=8522104.

“Forcing everyone to buy insurance is probably the only way to avoid the ‘adverse selection’ problem that plagues health-insurance markets. Younger workers in good health avoid buying coverage, leaving higher-risk people in the insurance pool, thus driving up premiums. And if the uninsured workers fall really ill, they become free-riders on the others, since hospitals are required to treat them at public expense: had they been treated earlier, they might have been cured more cheaply.”

Eminently sensible in the best tradition of the eco. Face the facts team: if you want to avoid spending a bucket of money on health care and leaving a significant proportion of your population outside the health system, government compulsion is probably the only way to go.

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[quote=“guangtou”]An important piece in this week’s economist which speaks directly to the discussions in this thread: economist.com/world/na/displ … id=8522104.

“Forcing everyone to buy insurance is probably the only way to avoid the ‘adverse selection’ problem that plagues health-insurance markets. Younger workers in good health avoid buying coverage, leaving higher-risk people in the insurance pool, thus driving up premiums. And if the uninsured workers fall really ill, they become free-riders on the others, since hospitals are required to treat them at public expense: had they been treated earlier, they might have been cured more cheaply.”

Eminently sensible in the best tradition of the eco.
[/quote]

The problem with this approach: does it guarantee that the insurance you buy (under duress) is any good? Will the insurance company pay up if you have a pre-existing condition? If I do have said pre-existing condition, will the insurance company raise my rates to a ridiculous level, demand a huge co-pay plus a big deductible (all standard procedures in the USA).

The Economist also mentioned Hillary Clinton’s disastrous health insurance experiment. Yes, it was disastrous, but they didn’t say why. It was a disaster because of the attempt to involve private insurance companies in it. The companies pretty much wrote the legislation, which was brain-dead on arrival, and that was the idea. They wanted to sabotage it, and they did. Even supporters of universal health care wound up voting against it.

If you want to provide universal coverage and coerce everyone into paying for it, then a national (or at least state) insurance program is the only answer. People will pay for it with their taxes. I just don’t believe anything else will work. If somebody can point out a government coerced private insurance scheme that actually provides universal health care and really works, I’d love to hear about it.

As for The Economist providing “eminently sensible advice,” I have to choke on that one. I can remember a few years ago when they proposed home self-diagnosis as a solution. That is, everyone would take home diagnostic kits (kind of like those pregnancy testing kits), do their own lab work, and send the results over the Internet to a doctor who would email them a prescription. No need for an office call. What a great idea! “Having pains in the chest? Then try our do-it-yourself electrocardiogram. Only $9.95, plus shipping and handling.”

Blessedly, the author didn’t mention anything about self-surgery. It was one of the most boneheaded articles I’ve ever read. Wish I could find the link for that one, but it was more than five years ago, and I no longer have that article on hand.

cheers,
DB

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Not so sure that this is the best approach.
Make cheaper private health care available to those without insurance by taxing those with “too much”.

[quote=“NYT”]Bush to Urge New Tax Plan for Health Care Coverage

President Bush intends to use his State of the Union address Tuesday to tackle the rising cost of health care with a one-two punch: tax breaks to help low-income people buy health insurance and tax increases for some workers whose health plans cost significantly more than the national average.
[…]
The basic concept is that employer-provided health insurance, now treated as a fringe benefit exempt from taxation, would no longer be entirely tax-free. Workers could be taxed if their coverage exceeded limits set by the government. But the government would also offer a new tax deduction for people buying health insurance on their own.
[…]
White House officials say the health tax plan would neither increase spending nor reduce tax revenues. Supporters say it would expand coverage to some of the 47 million uninsured. But critics say it would, in effect, tax people with insurance to provide coverage to those without it.[/quote]

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Interesting piece off the CBC, thats in Canada, on ER waiting times. Prolly not much different than in the bigger cities in the USA. Thats just a guess on my part though.
[url=http://www.cbc.ca/canada/toronto/story/2007/01/25/er-waits.html]
Study sheds light on ER wait times in Ontario
Visits can range from 1 hour in small cities, to more than 9 in bigger ones
Last Updated: Thursday, January 25, 2007 | 3:00 PM ET
CBC News

Ontarians typically waited one to four hours in the province’s emergency rooms over a recent one-year period, although wait times in some larger cities stretched past nine hours, according to a new study.

Half of visits to emergency rooms in small hospitals didn’t last longer than 1.1 hours, indicates the study by the Canadian Institute for Health Information.

Half of visits to large hospitals, typically found in big urban centres, lasted between 2.8 and 3.6 hours, the study suggests.

In 10 per cent of cases, a visit to a small emergency room stretched out past 3.2 hours, while 10 per cent of visits to big emergency rooms dragged on beyond 9.3 hours.

The institute based its findings on data from April 2005 to April 2006 at nearly every emergency room in Ontario — 167 in total.

“I think one of the values of this report is that it gives people in Ontario a clear picture of how long people are waiting,” researcher Greg Webster told CBC News Online on Thursday, a day after the release of the study.

He said the point of the study is not to judge hospitals or evaluate how their emergency rooms are doing. Instead, the study strives to provide a breakdown of numbers.

Here’s how long ER visits lasted:

* Large teaching hospitals: Half of ER visits were over in 3.6 hours (10 per cent in 9.3 hours).
* Large community hospitals: Half over in 2.8 hours (10 per cent in 7.5 hours).
* Medium hospitals: Half over in 1.5 hours (10 per cent in 4.2 hours).
* Small hospitals: Half over in 1.1 hours (10 per cent in 3.2 hours).

Ontario’s biggest hospitals — teaching hospitals that train medical students, and large community hospitals — typically handled more than 30,000 emergency room visits a year. The hospitals are based in cities including Toronto, Windsor, Ottawa, London and Hamilton.

The study looked at 68 big hospitals, which handled 70 per cent of all of Ontario’s emergency room patients.[/url]
Lot more article at link.

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Doesn’t sound so horrible. As you said, that’s about on par with any big city in the US. The article also says smaller hospitals have wait times of just over an hour.

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When compared to the USA, one thing that should be noted is that many US hospitals are shutting down their emergency rooms. That because ERs are big money losers. The major reason for this is because US law says that you cannot deny treatment to anybody who enters an ER (regardless of ability to pay). Thus, the ER has become a sort of “free clinic” for illegal aliens and other people who have no medical insurance. Since Canada has universal health insurance (for Canadian citizens, at least), I would assume that this is less of a problem there. However, I fully confess that I’ve never personally explored Canada’s medical system.

I am familiar (indeed, too familiar) with Taiwan’s ERs, and I can report that waiting times are short and service is generally very good. It does vary by hospital and depends on who is on duty, but in most cases, I’ve had nothing to complain about. Waiting time to see a doctor is typically 10 minutes.

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Physicians for a National Health Program is a nonprofit organization of 14,000 physicians, medical students and health professionals who support single-payer national health insurance.

The U.S. spends twice as much as other industrialized nations on health care, $7,129 per capita. Yet our system performs poorly in comparison and still leaves 46 million without health coverage and millions more inadequately covered.

This is because private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment though a single nonprofit payer would save more than $350 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.

Single-payer national health insurance is a system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private.

pnhp.org/