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The actual experience in the US has been that healthcare functioned best when it was closest to a free market, and the more we socialize it, the worse it gets.

by javert 12y ago

The actual experience in the US has been that healthcare functioned best when it was closest to a free market, and the more we socialize it, the worse it gets. (We have been slowly socializing it for many decades through regulation.) You can argue that we haven't been socializing it "properly," but the way we are doing it is just the way government works in the US, and that's not going to change. In general, we don't have an efficient, honest, effective government, so it can't do anything right on a large scale. Though there are some exceptions, those are exceptions. Look at the Obamacare website scandal. That is the rule.

eli_gottlieb 12y ago
>The actual experience in the US has been that healthcare functioned best when it was closest to a free market, When was this? >the way we are doing it is just the way government works in the US, and that's not going to change. That's some nice fatalism you've got there. >In general, we don't have an efficient, honest, effective government, so it can't do anything right on a large scale. Except for all the things you forget to mention, or even to think of as government programs, because they tick quietly away, working perfectly, in the background.
venomsnake 12y ago
In US you have socialized the costs. Not the healthcare system. I think the only social type of medicine in US is the VA (they have the purse, their own hospitals and staff IIRC) and last time I read their costs of delivered product were much lower that the US average.
- forkandwait 12y ago
  Socialized some of the costs. Some systems in the US, especially Kaiser, are basically a socialized system supported by premiums, and seem to work pretty well.
  - deleted 12y ago
    [deleted]
- Shivetya 12y ago
  lets be honest, the VA is not a shining example of health care. Much lower costs are not worth it considering the stories coming out of the VA.
- anon13434 12y ago
  The VA is not a good example of a working system though, it has been heavily in the news for denying timely treatment, see http://en.wikipedia.org/wiki/Veterans_Health_Administration_scandal_of_2014 http://en.wikipedia.org/wiki/Veterans_Health_Administration_...
  - ceejayoz 12y ago
    Pre-Iraq/Afghanistan the VA was considered quite effective and people were very satisfied with their treatment there. A massive influx of injured/disabled soldiers from those wars (where death has largely been replaced by wounds thanks to good body armor) without a parallel ability to scale treatment up probably hurt them more than poor administration.
  - dlp211 12y ago
    Bad press about a few VA clinics does not mean that the entire system is garbage. In fact, as recently as last year, veterans rated their satisfaction with VA care higher than the general public rates private care[1]. Also according the the Inspector General, while no one denies that delays in care happen at the VA (it should be noted that delays happen in the private sector as well), that the deaths at those hospitals can not be directly linked to the delay in care[2]. Finally, my anecdotal evidence: I am highly satisfied with the care that I receive at the VA. I have 20% disability due to a significant loss of peripheral vision in my right eye. I am scheduled yearly for an annual physical including urine and blood work, a field scan with my eyes to test regressions, and two general appointments with an optometrist. I also have free access to nutritionists and weight support groups since weight management can be an issue for veterans. Is it perfect, no, but I have never felt that I didn't get the care that I needed in a reasonable amount of time. [1] http://www.va.gov/opa/pressrel/pressrelease.cfm?id=2537 http://www.va.gov/opa/pressrel/pressrelease.cfm?id=2537 [2] http://online.wsj.com/articles/no-deaths-caused-by-delays-at-phoenix-va-hospital-watchdog-finds-1409077499 http://online.wsj.com/articles/no-deaths-caused-by-delays-at... edit: formatting
forkandwait 12y ago
Downvoted, here is why: I find your statements to be over general to an almost crazy degree -- "the actual experience"? Everywhere? "In general we don't have an honest effective government" -- really? Got data? Etc, etc. Also, I would be interested in specific metrics of worse and better -- you make the claim it is worse because of regulation, which you imply is basically the same as socialized funding (which it isn't). So where is the data? No offense, but this sounds like canned right wing bullshit rhetoric straight off Fox News. Granted, there is plenty of canned rhetoric on all "sides" to go around, but that doesn't make this any better.
- zo1 12y ago
  "Granted, there is plenty of canned rhetoric on all "sides" to go around, but that doesn't make this any better." The problem is that certain sides get way less flak for "canned rhetoric". Particularly populist viewpoints.
ArkyBeagle 12y ago
So we can't but Canada can? As straining-of-credulity as such a bumper-sticker is, isn't that the logical conclusion? Very Serious People ( with whom I happen to agree) actually say such things in "Fragile By Design". Calomiris/Haber are good writers and good thinkers. They do not call out medical nor political leadership there, but it's not exactly a stretch. It's a short drop from this to the view of America from "V for Vendetta".
- deleted 12y ago
  [deleted]
  - ArkyBeagle 12y ago
    Very good point - although you'd think it would be possible to have models and feedback for models that would scale. I expect the "higher GDP" tells us a lot. I first discussed this with my Dad when we took one of us the the Emergency Room for stitches ( it just wasn't a summer as a kid without a bike wreck or something leading to stitches ) and I was shocked by the bill - in 1972. I'd be pressed to find the reference, but people have shown that proportional percent of income ( in the aggregate, GDP ) spent on medical care has been consistent between countries. I hold that employer-based health care has turned out more sour than it perhaps once was because employment has gotten weirder. That arguably was not true in, say 1950. But medicine was also smaller then.
    - dalke 12y ago
      > I'd be pressed to find the reference, but people have shown that proportional percent of income ( in the aggregate, GDP ) spent on medical care has been consistent between countries. There's a couple of tables related to that at http://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_%28PPP%29_per_capita http://en.wikipedia.org/wiki/List_of_countries_by_total_heal... . US is an outlier, with a total health expenditure of 17.7% of GDP. Otherwise, yes, most similar countries (Germany, France, etc.) spend between about 8 and 11% of GDP.
      - 12y ago
johan_larson 12y ago
There is very little about the health care industry, at any level, that is "free market". The government funds much of the basic research that generates new medicines and medical devices and then regulates which ones can be sold. It works hand in hand with medical professional associations to determine who can practice medicine and in what capacity; it also funds residencies, the crucial gateway to becoming a physician. It pays for a hefty portion of medical care (for the young, the old, the very poor, and veterans) directly and regulates how the rest is paid for (out of pocket, through employer-provided insurance, or privately purchased insurance). There are a few islands of private industry in healthcare, but between the regulation and the direct payments, it's a government sea. Barring the most radical dissolution of the current system, the question isn't whether the government should be involved, but how.
- wtbob 12y ago
  You're right that the current healthcare industry is far from a free market, but javert too is right that the golden age of American healthcare was when it was far closer to a free market. Interestingly, the golden age for physicians' personal wealth was during the socialisation phase, as they were able to pocket fees increasingly paid by insurers, leading to a quintupling in income. They went from lower-middle class at $50,000/year in 2010 terms to $250,000 in 2010 terms. Doors anyone seriously suspect that we'll ever get back to $50,000/yr physicians? This illustrates why industries are often keen to socialise: they can guarantee outsize personal success. What our system absolutely rewrites is radical dissolution.
  - vacri 12y ago
    When were doctors ever 'lower-middle class' in any western society?
    - jasonisalive 12y ago
      Any time right up until the 1950s I would say. I don't know what you'd call the status of mid-19th century doctors in Britain, for example, but they definitely weren't upper class.
CamperBob2 12y ago
It's not a free market if you're forced to participate in it. Which we all are, by virtue of being alive.
- dantheman 12y ago
  You mean like food, housing, etc? Free markets don't mean they're optional, it means that participants interact freely and voluntarily.
  - CamperBob2 12y ago
    Not really. Every human being can survive with the same minimal allotment of food and housing, but that's not true of health care. Some people will use very little while some will use a lot more through no fault of their own.
    - zo1 12y ago
      You're still free to choose who you get healthcare from. It's like saying the food/farming industry isn't a free market because "some people will use very little while some [fat people] will use a lot more through no fault of their own." It's a ridiculous argument, and sounds more along the lines of Peter Joseph's "structural violence" mantra. The whole "you're not truly free until you get all this free shit given to you so you can be free to do nothing/be lazy". Granted, it isn't actually a truly free-market, anyways. Government subsidies, minimum prices, etc, all distort the market and affect peoples' actions.
      - CamperBob2 12y ago
        I hear what you're saying and agree in part, certainly where things other than health care are concerned. Both sides of the argument are deeply flawed. The fact remains, though, that we in the US pay more for our health care and get less in return for it than residents of countries with real "socialized medicine." We are indisputably doing it wrong. We owe it to ourselves to consider the problem more deeply than we can by comparing it to traded commodities like food and housing.

by javert 12y ago

eli_gottlieb 12y ago

>The actual experience in the US has been that healthcare functioned best when it was closest to a free market, When was this? >the way we are doing it is just the way government works in the US, and that's not going to change. That's some nice fatalism you've got there. >In general, we don't have an efficient, honest, effective government, so it can't do anything right on a large scale. Except for all the things you forget to mention, or even to think of as government programs, because they tick quietly away, working perfectly, in the background.

venomsnake 12y ago

In US you have socialized the costs. Not the healthcare system. I think the only social type of medicine in US is the VA (they have the purse, their own hospitals and staff IIRC) and last time I read their costs of delivered product were much lower that the US average.

forkandwait 12y ago
Socialized some of the costs. Some systems in the US, especially Kaiser, are basically a socialized system supported by premiums, and seem to work pretty well.
- deleted 12y ago
  [deleted]
Shivetya 12y ago
lets be honest, the VA is not a shining example of health care. Much lower costs are not worth it considering the stories coming out of the VA.
anon13434 12y ago
The VA is not a good example of a working system though, it has been heavily in the news for denying timely treatment, see http://en.wikipedia.org/wiki/Veterans_Health_Administration_scandal_of_2014 http://en.wikipedia.org/wiki/Veterans_Health_Administration_...
- ceejayoz 12y ago
  Pre-Iraq/Afghanistan the VA was considered quite effective and people were very satisfied with their treatment there. A massive influx of injured/disabled soldiers from those wars (where death has largely been replaced by wounds thanks to good body armor) without a parallel ability to scale treatment up probably hurt them more than poor administration.
- dlp211 12y ago
  Bad press about a few VA clinics does not mean that the entire system is garbage. In fact, as recently as last year, veterans rated their satisfaction with VA care higher than the general public rates private care[1]. Also according the the Inspector General, while no one denies that delays in care happen at the VA (it should be noted that delays happen in the private sector as well), that the deaths at those hospitals can not be directly linked to the delay in care[2]. Finally, my anecdotal evidence: I am highly satisfied with the care that I receive at the VA. I have 20% disability due to a significant loss of peripheral vision in my right eye. I am scheduled yearly for an annual physical including urine and blood work, a field scan with my eyes to test regressions, and two general appointments with an optometrist. I also have free access to nutritionists and weight support groups since weight management can be an issue for veterans. Is it perfect, no, but I have never felt that I didn't get the care that I needed in a reasonable amount of time. [1] http://www.va.gov/opa/pressrel/pressrelease.cfm?id=2537 http://www.va.gov/opa/pressrel/pressrelease.cfm?id=2537 [2] http://online.wsj.com/articles/no-deaths-caused-by-delays-at-phoenix-va-hospital-watchdog-finds-1409077499 http://online.wsj.com/articles/no-deaths-caused-by-delays-at... edit: formatting

forkandwait 12y ago

Downvoted, here is why: I find your statements to be over general to an almost crazy degree -- "the actual experience"? Everywhere? "In general we don't have an honest effective government" -- really? Got data? Etc, etc. Also, I would be interested in specific metrics of worse and better -- you make the claim it is worse because of regulation, which you imply is basically the same as socialized funding (which it isn't). So where is the data? No offense, but this sounds like canned right wing bullshit rhetoric straight off Fox News. Granted, there is plenty of canned rhetoric on all "sides" to go around, but that doesn't make this any better.

zo1 12y ago
"Granted, there is plenty of canned rhetoric on all "sides" to go around, but that doesn't make this any better." The problem is that certain sides get way less flak for "canned rhetoric". Particularly populist viewpoints.

ArkyBeagle 12y ago

So we can't but Canada can? As straining-of-credulity as such a bumper-sticker is, isn't that the logical conclusion? Very Serious People ( with whom I happen to agree) actually say such things in "Fragile By Design". Calomiris/Haber are good writers and good thinkers. They do not call out medical nor political leadership there, but it's not exactly a stretch. It's a short drop from this to the view of America from "V for Vendetta".

deleted 12y ago
[deleted]
- ArkyBeagle 12y ago
  Very good point - although you'd think it would be possible to have models and feedback for models that would scale. I expect the "higher GDP" tells us a lot. I first discussed this with my Dad when we took one of us the the Emergency Room for stitches ( it just wasn't a summer as a kid without a bike wreck or something leading to stitches ) and I was shocked by the bill - in 1972. I'd be pressed to find the reference, but people have shown that proportional percent of income ( in the aggregate, GDP ) spent on medical care has been consistent between countries. I hold that employer-based health care has turned out more sour than it perhaps once was because employment has gotten weirder. That arguably was not true in, say 1950. But medicine was also smaller then.
  - dalke 12y ago
    > I'd be pressed to find the reference, but people have shown that proportional percent of income ( in the aggregate, GDP ) spent on medical care has been consistent between countries. There's a couple of tables related to that at http://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_%28PPP%29_per_capita http://en.wikipedia.org/wiki/List_of_countries_by_total_heal... . US is an outlier, with a total health expenditure of 17.7% of GDP. Otherwise, yes, most similar countries (Germany, France, etc.) spend between about 8 and 11% of GDP.
    - 12y ago

johan_larson 12y ago

There is very little about the health care industry, at any level, that is "free market". The government funds much of the basic research that generates new medicines and medical devices and then regulates which ones can be sold. It works hand in hand with medical professional associations to determine who can practice medicine and in what capacity; it also funds residencies, the crucial gateway to becoming a physician. It pays for a hefty portion of medical care (for the young, the old, the very poor, and veterans) directly and regulates how the rest is paid for (out of pocket, through employer-provided insurance, or privately purchased insurance). There are a few islands of private industry in healthcare, but between the regulation and the direct payments, it's a government sea. Barring the most radical dissolution of the current system, the question isn't whether the government should be involved, but how.

wtbob 12y ago
You're right that the current healthcare industry is far from a free market, but javert too is right that the golden age of American healthcare was when it was far closer to a free market. Interestingly, the golden age for physicians' personal wealth was during the socialisation phase, as they were able to pocket fees increasingly paid by insurers, leading to a quintupling in income. They went from lower-middle class at $50,000/year in 2010 terms to $250,000 in 2010 terms. Doors anyone seriously suspect that we'll ever get back to $50,000/yr physicians? This illustrates why industries are often keen to socialise: they can guarantee outsize personal success. What our system absolutely rewrites is radical dissolution.
- vacri 12y ago
  When were doctors ever 'lower-middle class' in any western society?
  - jasonisalive 12y ago
    Any time right up until the 1950s I would say. I don't know what you'd call the status of mid-19th century doctors in Britain, for example, but they definitely weren't upper class.

CamperBob2 12y ago

It's not a free market if you're forced to participate in it. Which we all are, by virtue of being alive.

dantheman 12y ago
You mean like food, housing, etc? Free markets don't mean they're optional, it means that participants interact freely and voluntarily.
- CamperBob2 12y ago
  Not really. Every human being can survive with the same minimal allotment of food and housing, but that's not true of health care. Some people will use very little while some will use a lot more through no fault of their own.
  - zo1 12y ago
    You're still free to choose who you get healthcare from. It's like saying the food/farming industry isn't a free market because "some people will use very little while some [fat people] will use a lot more through no fault of their own." It's a ridiculous argument, and sounds more along the lines of Peter Joseph's "structural violence" mantra. The whole "you're not truly free until you get all this free shit given to you so you can be free to do nothing/be lazy". Granted, it isn't actually a truly free-market, anyways. Government subsidies, minimum prices, etc, all distort the market and affect peoples' actions.
    - CamperBob2 12y ago
      I hear what you're saying and agree in part, certainly where things other than health care are concerned. Both sides of the argument are deeply flawed. The fact remains, though, that we in the US pay more for our health care and get less in return for it than residents of countries with real "socialized medicine." We are indisputably doing it wrong. We owe it to ourselves to consider the problem more deeply than we can by comparing it to traded commodities like food and housing.