A big part of the problem in the original article is that of TOO MUCH CARE being provided regardless of cost without much consideration for whether the care is worth providing. One plausible concern about adopting "universal care" in the US is that it will make a bad situation worse, even further insulating patients from the cost of the care provided to them and thus making it more likely that we waste effort on extremely expensive procedures that don't do any good.
Now, certainly one might IMAGINE putting rules in place such that this didn't happen, but that doesn't mean such rules will get put in place or will actually work as intended given our generally messed-up political process.
> Now, certainly one might IMAGINE putting rules in
> place such that this didn't happen, but that doesn't
> mean such rules will get put in place or will
> actually work as intended given our generally
> messed-up political process.
Isn't the assumption that universal health care will have no rules just as based in speculation as the idea that it will?
'Universal health care' is a pretty broad term. Most discussions that aren't about particular implementations are meaningless.
>Isn't the assumption that universal health care will have no rules just as based in speculation as the idea that it will?
The problem is what's acceptable in terms of denying care is very dependent on culture. In the UK people accept that the NHS doesn't pay for a heart transplant when the patient is 80 years old. In the US people expect every intervention to be provided (if the patient wishes) up to the moment that person dies. Universal care isn't going to change that attitude, at least not for a generation or two.
The most likely outcome of universal care in the US is a two-tiered system, where the national system pays for some subset of the things that can be done, and people buy private insurance to cover what they're used to getting now.
That's what the UK has - there is the NHS for everyone, free at the point of delivery, and there is a smaller private health care sector where you can get anything you can pay for.
No, I'm sure it'll have rules intended to control costs and reduce unneeded care, but our regulatory history suggests the rules won't work as advertised. And that doesn't seem speculative at all - it's a dead certainty. Because the problem we have is NOT that individuals pay for health care, it's that health care is ludicrously expensive and ineffective and over-regulated and not subject to significant market competition on price or quality. Merely changing who writes the checks won't fix the other stuff which is the core of the problem.
In every other field, new technology makes production of goods cheaper. Even in medicine, if you look at the parts where people pay without insurance - LASIK, plastic surgery, dentistry, veterinary medicine - costs get cheaper over time. The parts of medicine that tend to get ever more expensive are the parts that involve third-party payment.
The book _Priceless_ has some decent suggestions for mechanisms that might help improve matters even given the existing (terrible) constraints we face.
> The parts of medicine that tend to get ever more expensive are the parts that involve third-party payment.
Medicine has a problem with third party payments that are invisible to consumers, coupled with insurance premiums invisibly negotiated by employers, coupled with ridiculous regulations that have created an enormous amount of dislocation of the economic incentives that would tend to drive prices down. In short, government got involved. What's our national solution? More government involvement.
See any similarities between health insurance, retirement planning (Social Security), "free" healthcare (Medicare & Medicaid), student loan programs and the cost of college education, or maybe in the home loans that caused the housing disaster?
Disaster after disaster is caused by applying heavy-handed Federal Government "solutions" to problems better solved by individuals, free markets, or at worst local and state governments.
Since there's already Medicaid for the poor and no hospitals deny care now... your statement would appear to be incorrect.
I don't mind funding a worst-case-scenario safety net for the most vulnerable in the society. I don't mind some serious legislation aimed at fixing the real problems with healthcare in this country. The law passed by the Democrats in 2009 was a useless counterproductive disaster.
I work at an urgent care. We routinely turn away people who are uninsured or have Medi-Cal (California medicaid) AND are unwilling to an upfront fee for the evaluation. So we see the uninsured but only if they pay. I see no difference in the chief complaints, but the uninsured generally wait quite a bit longer, and therefore often need not 5 times as much care, but 100 times as much.
Now, certainly one might IMAGINE putting rules in place such that this didn't happen, but that doesn't mean such rules will get put in place or will actually work as intended given our generally messed-up political process.