4 ms·

There's no free lunch. If the government is paying for it, it's not free of charge. And in this country, there's a long record of exponential price costs when t

by r_smart 10y ago

There's no free lunch. If the government is paying for it, it's not free of charge. And in this country, there's a long record of exponential price costs when the government is the customer. Our premiums would go up, they'd just be called taxes then. You could maybe nationalize all the hospitals or something and make doctors government employees, but I don't think we'd like the outcome. Just the transition would be a nightmare. And that's ignoring the legal aspects of it. It's not so easy as just waving your hand and saying "Free Healthcare! Free for everyone!"

kennydude 10y ago
> but I don't think we'd like the outcome The NHS is fantastic.
- talmand 10y ago
  The NHS may be fantastic for one country, doesn't mean it would be for another.
  - Ntrails 10y ago
    I'm pretty sure it would be fantastic for the majority - but not for a vocal minority who have a large amount of power.
    - talmand 10y ago
      I would agree for the most part.
    - r_smart 10y ago
      Milton Friedman has some interesting points about welfare programs and how they interact with immigration. Particulary, that you can have massive unchecked immigration, or extensive welfare programs, but the two don't interact well. The NHS is probably a good example. The UK has historically had low to moderate rates in immigration and the NHS. The US has had a ton of immigration, but no NHS. It seems like half of the country wants to have unchecked immigration and extensive welfare programs, but the consequences of that kind of policy will quickly become bankrupting. I would imagine that vocal minority would be fine with a single-payer system. Again, look at what happens to pricing when the government is your sole customer. And given the influence they can wield, it would be a bonanza for them.
      - abritinthebay 10y ago
        > look at what happens to pricing when the government is your sole customer. Based on the available evidence for healthcare: it drops like a stone because the sole customer has all the leverage.
        AnimalMuppet 10y ago
        You already see this with Medicare. For some treatments, they reimburse less than the doctor's direct costs. But if you try to do that with all the doctor's customers, it doesn't work.
        brianwawok 10y ago
        I mean, it will work. That is not working because you have Medicare interacting with private practice doctors.. the same problems with ACA + private health insurance offices. If the government directly pays the Doctor a salary.. he doesn't care what the "profit" on a procedure is. In fact, base his pay on how good his outcomes are and how efficient he is.. i.e. pay him more to do better. Then we don't need to worry about some doctors not offering some procedures, because they are paid by salary and not salesmen. Right now private practice doctors are salesmen. They are compensated MORE for selling unnecessary procedures. If the they can sneak it by the insurance? They do it.
        r_smart 10y ago
        That's the nationalization I was referring to earlier. Also, government workers are rarely held to a high standard and rarely fired, so why you think that's going to happen with healthcare when it doesn't happen anywhere else is beyond me. Most doctors make a salary, they don't care what the 'profit' on a procedure is. They probably don't even know what most of the stuff costs. It's like college professors and textbooks. Also, who's worrying about some doctors not offering some procedures?
        abritinthebay 10y ago
        There is no healthcare in the US where the government is the sole (or even primary) customer. So using anything from the US as a counter example is going to fall flat.
  - kennydude 10y ago
    If it's implemented correctly, an american national health service would work fine. If anything, it'd do some good to the country (healthcare being shockingly high on reasons for people defaulting)
    - talmand 10y ago
      >> If it's implemented correctly That's the problem, I have trust issues with the people in power being capable of doing such a thing.
      - brianwawok 10y ago
        On the flip side, the current system is totally broke. Get to free universal healthcare, then iterate on it to make it better and better. You have to move to make progress.
        AnimalMuppet 10y ago
        The current system is bad in many ways, all right? I think we can agree on that. But it's not so bad that it can't get much worse. Getting worse is not abstract - it translates into people dying needlessly. (So does the current system being bad.) "Just change something" is only good advice if you're currently at a local minimum. And "iterate rapidly to improve" doesn't work when each change takes an act of Congress. In particular: The last change was, what, six years ago? And the last change before that was, what, in the 1970s? You may only get one or two more chance to change this in your lifetime.
        r_smart 10y ago
        This is a hugely important point that people seem to miss. The US government is huge and frequently gets things wrong, and when they do, it's a political failure to admit it later. Furthermore, there's no real punishment for anyone that screwed up. That's a problem, and that's why fixing this is so hard.
        r_smart 10y ago
- r_smart 10y ago
  I agree with you. The NHS is fantastic (so far as I know). But I'm talking about the US and how things work here. I just don't think it would work out.
brianwawok 10y ago
It could be. Take all our money we spend in various healthcare programs already. Take 20% off our military budget. Boom, free healthcare for everyone.
- r_smart 10y ago
  If we're already spending that money on healthcare as it is, how are you going to take it and spend it on healthcare and have it be less money? And why do you think that expanding that program to cover everyone in the country is going to come out to be 20% of the military budget? What percentage of the population is already covered by the existing programs? I took the money I use to pay rent, and the used it to pay rent. Boom free rent? I'm sorry, but that's kind of what your argument sounds like to me.
  - brianwawok 10y ago
    > If we're already spending that money on healthcare as it is, how are you going to take it and spend it on healthcare and have it be less money? We aren't. That part is constant. > And why do you think that expanding that program to cover everyone in the country is going to come out to be 20% of the military budget? We can do the math if we want. Perhaps it will take 50% of the Military budget. Perhaps people earning more than 50k will need to pay a new tax that is more or less equal to what they currently pay in health insurance premiums. The math can be made to work. > I took the money I use to pay rent, and the used it to pay rent. Boom free rent? I'm sorry, but that's kind of what your argument sounds like to me. No more like - You spend $600 a month on smoking, and $600 a month on rent. Quit smoking, BOOM, free rent. At the end of the day, your costs dropped $600 which was the price of your rent.
    - r_smart 10y ago
      >We can do the math if we want. Perhaps it will take 50% of the Military budget. Perhaps people earning more than 50k will need to pay a new tax that is more or less equal to what they currently pay in health insurance premiums. The math can be made to work. It's the handwaving that's the frustrating part. What amount of the military budget is it? How are you going to charge me a new tax equivalent to my current healthcare that's going to cover me and at least one other person (just under half in the country actually pay income tax). That still sounds like magic thinking. Taxes would have to go up, how could they not? Or you gut the military, and even then I don't think it would necessarily be enough. Add in the push to completely ignore illegal immigration, and accord them the rights of citizens, and agree with that policy or not, you have to acknowledge the cost will go up even more. It's easy to handwave the numbers. It happens a lot, but it's not a trivial detail. It has real consequences. What happens when the US Navy is no longer patrolling trade routes? Or when younger generations are crushed by a combination of increased tax burden and school loan debt?

by r_smart 10y ago

kennydude 10y ago

> but I don't think we'd like the outcome The NHS is fantastic.

talmand 10y ago
The NHS may be fantastic for one country, doesn't mean it would be for another.
- Ntrails 10y ago
  I'm pretty sure it would be fantastic for the majority - but not for a vocal minority who have a large amount of power.
  - talmand 10y ago
    I would agree for the most part.
  - r_smart 10y ago
    Milton Friedman has some interesting points about welfare programs and how they interact with immigration. Particulary, that you can have massive unchecked immigration, or extensive welfare programs, but the two don't interact well. The NHS is probably a good example. The UK has historically had low to moderate rates in immigration and the NHS. The US has had a ton of immigration, but no NHS. It seems like half of the country wants to have unchecked immigration and extensive welfare programs, but the consequences of that kind of policy will quickly become bankrupting. I would imagine that vocal minority would be fine with a single-payer system. Again, look at what happens to pricing when the government is your sole customer. And given the influence they can wield, it would be a bonanza for them.
    - abritinthebay 10y ago
      > look at what happens to pricing when the government is your sole customer. Based on the available evidence for healthcare: it drops like a stone because the sole customer has all the leverage.
      - AnimalMuppet 10y ago
        You already see this with Medicare. For some treatments, they reimburse less than the doctor's direct costs. But if you try to do that with all the doctor's customers, it doesn't work.
        brianwawok 10y ago
        I mean, it will work. That is not working because you have Medicare interacting with private practice doctors.. the same problems with ACA + private health insurance offices. If the government directly pays the Doctor a salary.. he doesn't care what the "profit" on a procedure is. In fact, base his pay on how good his outcomes are and how efficient he is.. i.e. pay him more to do better. Then we don't need to worry about some doctors not offering some procedures, because they are paid by salary and not salesmen. Right now private practice doctors are salesmen. They are compensated MORE for selling unnecessary procedures. If the they can sneak it by the insurance? They do it.
        r_smart 10y ago
        That's the nationalization I was referring to earlier. Also, government workers are rarely held to a high standard and rarely fired, so why you think that's going to happen with healthcare when it doesn't happen anywhere else is beyond me. Most doctors make a salary, they don't care what the 'profit' on a procedure is. They probably don't even know what most of the stuff costs. It's like college professors and textbooks. Also, who's worrying about some doctors not offering some procedures?
        abritinthebay 10y ago
        There is no healthcare in the US where the government is the sole (or even primary) customer. So using anything from the US as a counter example is going to fall flat.
- kennydude 10y ago
  If it's implemented correctly, an american national health service would work fine. If anything, it'd do some good to the country (healthcare being shockingly high on reasons for people defaulting)
  - talmand 10y ago
    >> If it's implemented correctly That's the problem, I have trust issues with the people in power being capable of doing such a thing.
    - brianwawok 10y ago
      On the flip side, the current system is totally broke. Get to free universal healthcare, then iterate on it to make it better and better. You have to move to make progress.
      - AnimalMuppet 10y ago
        The current system is bad in many ways, all right? I think we can agree on that. But it's not so bad that it can't get much worse. Getting worse is not abstract - it translates into people dying needlessly. (So does the current system being bad.) "Just change something" is only good advice if you're currently at a local minimum. And "iterate rapidly to improve" doesn't work when each change takes an act of Congress. In particular: The last change was, what, six years ago? And the last change before that was, what, in the 1970s? You may only get one or two more chance to change this in your lifetime.
        r_smart 10y ago
        This is a hugely important point that people seem to miss. The US government is huge and frequently gets things wrong, and when they do, it's a political failure to admit it later. Furthermore, there's no real punishment for anyone that screwed up. That's a problem, and that's why fixing this is so hard.
      - r_smart 10y ago
r_smart 10y ago
I agree with you. The NHS is fantastic (so far as I know). But I'm talking about the US and how things work here. I just don't think it would work out.

brianwawok 10y ago

It could be. Take all our money we spend in various healthcare programs already. Take 20% off our military budget. Boom, free healthcare for everyone.

r_smart 10y ago
If we're already spending that money on healthcare as it is, how are you going to take it and spend it on healthcare and have it be less money? And why do you think that expanding that program to cover everyone in the country is going to come out to be 20% of the military budget? What percentage of the population is already covered by the existing programs? I took the money I use to pay rent, and the used it to pay rent. Boom free rent? I'm sorry, but that's kind of what your argument sounds like to me.
- brianwawok 10y ago
  > If we're already spending that money on healthcare as it is, how are you going to take it and spend it on healthcare and have it be less money? We aren't. That part is constant. > And why do you think that expanding that program to cover everyone in the country is going to come out to be 20% of the military budget? We can do the math if we want. Perhaps it will take 50% of the Military budget. Perhaps people earning more than 50k will need to pay a new tax that is more or less equal to what they currently pay in health insurance premiums. The math can be made to work. > I took the money I use to pay rent, and the used it to pay rent. Boom free rent? I'm sorry, but that's kind of what your argument sounds like to me. No more like - You spend $600 a month on smoking, and $600 a month on rent. Quit smoking, BOOM, free rent. At the end of the day, your costs dropped $600 which was the price of your rent.
  - r_smart 10y ago
    >We can do the math if we want. Perhaps it will take 50% of the Military budget. Perhaps people earning more than 50k will need to pay a new tax that is more or less equal to what they currently pay in health insurance premiums. The math can be made to work. It's the handwaving that's the frustrating part. What amount of the military budget is it? How are you going to charge me a new tax equivalent to my current healthcare that's going to cover me and at least one other person (just under half in the country actually pay income tax). That still sounds like magic thinking. Taxes would have to go up, how could they not? Or you gut the military, and even then I don't think it would necessarily be enough. Add in the push to completely ignore illegal immigration, and accord them the rights of citizens, and agree with that policy or not, you have to acknowledge the cost will go up even more. It's easy to handwave the numbers. It happens a lot, but it's not a trivial detail. It has real consequences. What happens when the US Navy is no longer patrolling trade routes? Or when younger generations are crushed by a combination of increased tax burden and school loan debt?