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> I’d still prefer the state over private insurance companies (Medicare is well run and popular). And I vote accordingly. Thats perfectly reasonable, but no ne
by conanbatt 8y ago
> I’d still prefer the state over private insurance companies (Medicare is well run and popular). And I vote accordingly.
Thats perfectly reasonable, but no need to make a single payer system for that. Just allow medicare to compete in the open market. Thats a much smaller program with a lot less risk.
Unfortunately the chances of such a plan to succeed are nil. Thats why big healthcare reform proposals want to strong-arm the position, with single-payer proposals. Its true medicare is popular, but remember it's free insurance for its patients today. If you eliminated the medicare payroll tax and made it a monthly payment, I assure you old people will not have the same opinion on the topic.
- deleted 8y ago[deleted]
- vertex-four 8y agoThe NHS “competes in the open market”, so to speak - you pay taxes to get free healthcare for everyone, then you can get private insurance which picks and chooses what it wants to treat and dumps complex cases back on the NHS. Routine treatment is also dealt with by some combination of the NHS and private pharmacies (for flu jabs etc), generally speaking. Unsurprisingly, private health insurance is not very popular here. It’s mostly just something people get through work. And I’ll remind you that we spend less per capita on our healthcare than the US does. I’m sure that if there was actually demand to meet that spending, private insurance here would happily eat it up - but there just doesn’t seem to be.
- conanbatt 8y agoIf you get private health insurance, do you get your NHS contribution back? Thats what would make it "competing" in the open market. If you have to pay for it no matter what, there is no competition, there is double charging.
- vertex-four 8y agoThere isn’t double charging, because private health insurance universally doesn’t cover the same things as the NHS does, and universally depends on the NHS to work with for anything they think might be too expensive to cover. Given that we spend less money on healthcare than countries that do have healthcare “on the open market” like you suggest, I’d say this is a system that obviously works. If there were an imbalance between what those countries provide and what we provide, and people were willing to pay for it, you’d see private healthcare providers successfully taking more money (up to what Americans spend) to make up the gap in service - but they’re not. Do you have an explanation for why that’s not happening?
- conanbatt 8y agoIf there are general practicioners in the private market in the UK, that means their patients pay for the NHS and also for the private GP, thus double charging. Particularly with your primary care provider, continuity is important in medical care, not everything is replaceable like a cog. > Given that we spend less money on healthcare than countries that do have healthcare “on the open market” like you suggest, I’d say this is a system that obviously works. Sorry but this is a ludicrous claim. Argentina spends 2% less of GDP than the UK, and 70% of its care is private. And not only that, it gives free healthcare services to other countries, including organ transplants.
- yardie 8y agoThen the private insurers would be incentivized to recruit healthy patients and dump chronically ill customers into Medicare. I know this because I’ve already heard HR complain about too many pregnancies in a year caused the company contributions to go up.
- conanbatt 8y agoThis is a real economic problem: adverse selection. But universal coverage doesnt solve it, it just makes everyone pay.
- toomuchtodo 8y agoThat’s exactly what insurance is for, to spread the risk among the entire pool of participants. And the best way to expand the pool as large as possible is with universal healthcare (ie “everyone”). Everyone pays because everyone should pay.
- conanbatt 8y ago> Everyone pays because everyone should pay. But if everyone pays the same you just conceded the entire victory to adverse selection: people that do not participate in a risk pays for the risk in someone else. The most obvious demonstration of this effect is double-paying in countries that have both private and public healthcare services: you pay twice, once for the public you don't use, and then for the private one.
- toomuchtodo 8y agoSociety has some costs you can’t opt out of.
- conanbatt 8y agoThat a common and fine approach, but that doesnt make it cheaper, it makes it a whole lot more expensive. From my point of view, lowering the expense is the #1 priority. Expanding coverage, and adding new layers of taxation for it will increase expenditures. There are also many alternatives to adverse selection, my favorite is high deductible plans.