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A well written article but it seems mostly like a re-hash of the basic argument for government provided healthcare, not something addressing large, pressing pro

A well written article but it seems mostly like a re-hash of the basic argument for government provided healthcare, not something addressing large, pressing problems facing implementations of public healthcare. I'll be the first to advocate the right to be treated, but this needs to be done extremely carefully. For example: - Government is notoriously inefficient. How can we fix government bureaucracy in a sector that requires speed ("Can we operate now?") and offers lean margins? - Modern insurance companies pay top dollar for mathematical modeling and financial services. Will/Can the government do this? - Does a morbidly obese person qualify for a life-saving liposuction on the tax-payers dime? - Do you perform life saving abortions on the tax-payers dime? - Do you tax progressively based upon risk and past history? If yes, does that mean that the poor are unfairly taxed vs. the rich since the rich have better quality care? If not, should someone who is a health nut be taxed the same as those who dismiss their body? Private companies can throw away people's morals, prejudices, philosophies. If you don't like it, don't buy it. But once you introduce government (and something mandatory) you encounter issues that were never even remotely related before. A lot more needs to be discussed on this topic than just "it's like flood insurance". Edit: Formatting

raganwald 14y ago
Now that you explain it like that, I see it's impossible to provide cost-effective health care for a nation of people with anything except staggering inefficiencies. I don't know why this isn't obvious to me, sitting here in Toronto. I clearly haven't thought this through. ;-)
- pdeuchler 14y ago
  I can't tell if you are being sarcastic or not, but I'm just going to respond as if you are. Could it be impossible to provide cost effective insurance against "Acts of God" aka "Nature" to a nation of people without staggering efficiencies? I think it's a very real possibility that this could be a pipe dream right now for a country the size of the United States. Why is it so hard to believe that we may not ever be able to mitigate Nature? If you would like to draw comparisons between the US and Canada, the U.S. has 315 million people with a 34% obesity rate. Canada has 33 million people with a 24% obesity rate. That's a difference of ~99,231,174 obese people. If you notice, that difference is actually three times larger than Canada's entire population. I highly doubt we can apply very much of the implementation from Canada to the United States. The wheel very well may need to be re-thought. This is the equivalent of scaling any startup. Anyone can write a twitter clone in a couple hours, it's really not that hard. However, it takes some serious thinking, engineering, thought and complexity to scale that simple CRUD app to millions of users. Your comment seems rather like the owner of a small business complaining that the CEO of a Fortune 500 company can't control his employees as well as he can.
  - raganwald 14y ago
    Well, here's the thing. I agree with both of us. I know the Canadian system works. You agree that it works for Canada, but you say there are differences between the countries. I agree with that too. I explain it to myself the same way I explain people living in Winnipeg. People aren't perfectly rational utility-seekers. They won't get up and move away from Winnipeg to avoid a flood. Likewise, they won't flood across the border into Canada to get our health care. You can say there aren't enough jobs or something, but the fact is we take as many immigrants as we possibly can these days, we'd love to have lots of Americans. But they don't come to Canada. So one explanation is that people aren't perfectly rational in the sense that would drive them to seek out better health care or to move away from Winnipeg. Once you accept that, you can accept that people might not like the idea of spreading the cost of health care across a population through taxation. Never mind if I think it's rational, I also think it's rational to move off a flood plain. Or any of a dozen other explanations for why it might not work in the US. It might not! I honestly don't think private insurance works very well, but I can readily accept the argument that public insurance might be worse in the US. Once you accept that we sweat and love and sing patriotic songs and write mean things about each other on the Internet and all these other human things, you have to accept that the best we can hope from a blog post is to provoke questions rather than provide answers.
sets13 14y ago
I think those are an interesting set of questions, but for the most part easily answered by "What does the law currently say?" - Public health care has absolutely no say on the speed with which a doctor can decide whether life saving surgery is required. In fact I would imagine that knowing that the surgery will be paid for regardless of whether the patient has a job or not might make this decision faster. - The government pays for top end mathematical talent in other sectors (security) so it stands to reason that if it were necessary, they could in health care as well. Again though, removing the private insurance part of the equation would probably remove the need. - Obviously yes, just like any other person who requires surgery to live. - Again, obviously yes. Current laws allowing abortions make this a non-issue. I understand some people are morally or religiously opposed to abortion, but we are governed by the laws of the society we live in. If that is a problem the answer is to change those laws, not to ignore them. -There are any number of taxing schemes that could subsidize public healthcare but I have never seen one that introduced a progressive tax based on health history (kinda defeats the point?). I would imagine that if the majority of the other countries in the first world can figure this one out, the US probably could too. I think questions like these are intentionally meant to bring up emotional responses and generate controversy around what could be a really simple decision (either way).
- pdeuchler 14y ago
  I'm really not meaning to bring up "emotional responses", I'm merely trying to give some people with different opinions a voice. Also, you seem to think I'm advocating we do not perform life-threatening procedures, which I'm not. I'm questioning who pays for them. Does the public, including those who find abortion morally reprehensible, pay for those abortions? Does the public pay for a liposuction that could have been avoided with diet and exercise? People seem to forget that this isn't a question of doing procedures or not, this is about who foots the bill for that procedure.
  - sets13 14y ago
    I don't think you are advocating anything, so there is nothing personal here, just for the record. I think that we need to divorce ourselves from the specific procedures, and just talk about life saving health care. If we were to adopt public healthcare, the public would pay for life saving health care that is legally allowed. Then we can apply that framework to specific procedures, which for both your examples means yes, it would be done. You would not be paying specifically for the girl down the street to have an abortion. You would be paying your taxes, some small part of which may be applied to save her life in the event it is necessary, using whatever legal procedures are required. While you are right, that this is in part about who foots the bill, the other thing it is about is helping people live healthy lives without going bankrupt, which is a uniquely American problem in the first world.

raganwald 14y ago

Now that you explain it like that, I see it's impossible to provide cost-effective health care for a nation of people with anything except staggering inefficiencies. I don't know why this isn't obvious to me, sitting here in Toronto. I clearly haven't thought this through. ;-)

pdeuchler 14y ago
I can't tell if you are being sarcastic or not, but I'm just going to respond as if you are. Could it be impossible to provide cost effective insurance against "Acts of God" aka "Nature" to a nation of people without staggering efficiencies? I think it's a very real possibility that this could be a pipe dream right now for a country the size of the United States. Why is it so hard to believe that we may not ever be able to mitigate Nature? If you would like to draw comparisons between the US and Canada, the U.S. has 315 million people with a 34% obesity rate. Canada has 33 million people with a 24% obesity rate. That's a difference of ~99,231,174 obese people. If you notice, that difference is actually three times larger than Canada's entire population. I highly doubt we can apply very much of the implementation from Canada to the United States. The wheel very well may need to be re-thought. This is the equivalent of scaling any startup. Anyone can write a twitter clone in a couple hours, it's really not that hard. However, it takes some serious thinking, engineering, thought and complexity to scale that simple CRUD app to millions of users. Your comment seems rather like the owner of a small business complaining that the CEO of a Fortune 500 company can't control his employees as well as he can.
- raganwald 14y ago
  Well, here's the thing. I agree with both of us. I know the Canadian system works. You agree that it works for Canada, but you say there are differences between the countries. I agree with that too. I explain it to myself the same way I explain people living in Winnipeg. People aren't perfectly rational utility-seekers. They won't get up and move away from Winnipeg to avoid a flood. Likewise, they won't flood across the border into Canada to get our health care. You can say there aren't enough jobs or something, but the fact is we take as many immigrants as we possibly can these days, we'd love to have lots of Americans. But they don't come to Canada. So one explanation is that people aren't perfectly rational in the sense that would drive them to seek out better health care or to move away from Winnipeg. Once you accept that, you can accept that people might not like the idea of spreading the cost of health care across a population through taxation. Never mind if I think it's rational, I also think it's rational to move off a flood plain. Or any of a dozen other explanations for why it might not work in the US. It might not! I honestly don't think private insurance works very well, but I can readily accept the argument that public insurance might be worse in the US. Once you accept that we sweat and love and sing patriotic songs and write mean things about each other on the Internet and all these other human things, you have to accept that the best we can hope from a blog post is to provoke questions rather than provide answers.

sets13 14y ago

I think those are an interesting set of questions, but for the most part easily answered by "What does the law currently say?" - Public health care has absolutely no say on the speed with which a doctor can decide whether life saving surgery is required. In fact I would imagine that knowing that the surgery will be paid for regardless of whether the patient has a job or not might make this decision faster. - The government pays for top end mathematical talent in other sectors (security) so it stands to reason that if it were necessary, they could in health care as well. Again though, removing the private insurance part of the equation would probably remove the need. - Obviously yes, just like any other person who requires surgery to live. - Again, obviously yes. Current laws allowing abortions make this a non-issue. I understand some people are morally or religiously opposed to abortion, but we are governed by the laws of the society we live in. If that is a problem the answer is to change those laws, not to ignore them. -There are any number of taxing schemes that could subsidize public healthcare but I have never seen one that introduced a progressive tax based on health history (kinda defeats the point?). I would imagine that if the majority of the other countries in the first world can figure this one out, the US probably could too. I think questions like these are intentionally meant to bring up emotional responses and generate controversy around what could be a really simple decision (either way).

pdeuchler 14y ago
I'm really not meaning to bring up "emotional responses", I'm merely trying to give some people with different opinions a voice. Also, you seem to think I'm advocating we do not perform life-threatening procedures, which I'm not. I'm questioning who pays for them. Does the public, including those who find abortion morally reprehensible, pay for those abortions? Does the public pay for a liposuction that could have been avoided with diet and exercise? People seem to forget that this isn't a question of doing procedures or not, this is about who foots the bill for that procedure.
- sets13 14y ago
  I don't think you are advocating anything, so there is nothing personal here, just for the record. I think that we need to divorce ourselves from the specific procedures, and just talk about life saving health care. If we were to adopt public healthcare, the public would pay for life saving health care that is legally allowed. Then we can apply that framework to specific procedures, which for both your examples means yes, it would be done. You would not be paying specifically for the girl down the street to have an abortion. You would be paying your taxes, some small part of which may be applied to save her life in the event it is necessary, using whatever legal procedures are required. While you are right, that this is in part about who foots the bill, the other thing it is about is helping people live healthy lives without going bankrupt, which is a uniquely American problem in the first world.