- an american citizen break his leg, he is not insured. Do you A: let him die B: take care of him ?
if your answer is A - you are a terrible person, but you hold a consistent position. if your answer is B - the only question that remains is what is the most economic, efficient way to take care of this person ?
b is universal health care. if you think you can do A with emergency care, consider how inefficient and expensive this is, and who ends up paying for it.
Unfortunately this simplistic model plays out like insurance doesn't exist.
Any tragedy works like this: a fire, a life lost to chance, etc. The point of insurace is to pay beforehand to reserve a fund and to distribute the chances in a pool.
One more argument: normally its spoken as is government is the solution to this problem, but the government does not prevent the legs from breaking in this analogy. It just decides B for you and everyone else.
I'm a Belgian national, living in France (under the French health care regime). If I need medical assistance while I'm in in Spain or Germany, the care will be reimbursed per the local rules, by the French health care system.
Quoting Wikipedia:
The European Health Insurance Card (or EHIC) is issued free of charge and allows anyone who is insured by or covered by a statutory social security scheme of the EEA countries and Switzerland to receive medical treatment in another member state free or at a reduced cost, if that treatment becomes necessary during their visit (for example, due to illness or an accident), or if they have a chronic pre-existing condition which requires care such as kidney dialysis. The term of validity of the card varies according to the issuing country.
The intention of the scheme is to allow people to continue their stay in a country without having to return home for medical care; as such, it does not cover people who have visited a country for the purpose of obtaining medical care, nor does it cover care, such as many types of dental treatment, which can be delayed until the individual returns to his or her home country. The costs not covered by self-liability fees are paid by the issuing country, which is usually the country of residence but may also be the country where one receives the most pension from.[1]
It only covers healthcare which is normally covered by a statutory health care system in the visited country, so it does not render travel insurance obsolete.
My position is to take care of that person, like weve been taken care of visiting while other countries, but trying to avoid the illegal/undocumented immigrant strawman for clarity.
I would say yes. I've read where the UK does this as do other countries. Of course, any mass migration for free health care would bankrupt us, so we would need some sort of protection against that.
So let's talk about healthcare in the US. Don't Britons have a moral obligation to get taxed and that money get sent to the US to pay for the US healthcare system?
The underlying reasoning for universal healthcare is based on a principle, does this principle end at the US border, which I'm told is just some arbitrary, meaningless line right?
If it's not clear, my tongue is firmly in my cheek as I say that, but where it isn't in my cheek is when I'm telling you some people don't just buy your simple pro-universal-healthcare argument wholesale, especially when you refuse to defend it against valid questions like this.
I live in the US and I pay taxes in the US, so yes - healthcare for US citizens/residents paid for by US/citizens residents ends at the borders.
If there is a better, more efficient system that is morally right (i.e. provides basic healthcare for it's citizens) than universal healthcare I would like someone to propose it ?
Why is it morally right for me to contribute to healthcare for someone who lives in America but doesn't pay taxes, but not morally right to pay for someone who lives in a different country and doesn't pay taxes?
It might be a little hard for you to understand - but on the other side of the USA is... another country ! And they are free to do whatever they want, which in the case of developed countries is universal health care !
Ah, the confidence of a young liberal, it fills the heart with hope !
I'll offer some advice, although I doubt you think you have much more to learn in life. If you're walking around looking for donations or support towards a cause, perhaps mocking those who may not share the identical philosophical beliefs as you isn't the optimum approach.
My mom got injured while hiking in a country with universal care. She hobbled to the next town, found a clinic, and got treated. Then she wanted to pay. First, the person at the clinic said: "What do you mean, you don't pay for health care." My mom explained that she was from another country. It turned out they didn't even have the means to take her money.
Treating a few foreigners for free might actually be cheaper than setting up a billing system.
Evidently she was not hiking in Canada, where they definitely will treat you and then make sure you the tourist does pay the sizeable (though not USA exorbitant) bill. The Canadian system in fact does have many payers; federal, provincial, private insurers, are all payers.
I'm a Canadian, but accidentally let my health card lapse right around the same time I had a fall that tweaked my wrist. At the clinic I went to, they explained that I would have to pay cash for the visit and to keep the receipt because it would be reimbursed by the provincial ministry of health once I got my card renewed.
Had a visit with a GP, he sent me next door for Digital X-Rays, and then I went back to to the GP where he looked at them and sent me home with a brace (no break).
GP visits: $25
X-Rays: $25
Brace: $15
I don't think I ever ended up submitting the receipts to SaskHealth... Just wasn't that big of a concern :)
I'm a Canadian, living in America and therefore not a benefactor of Canada's healthcare system, even if I'm visiting Canada. On a trip to Canada a near car accident caused abdominal pain for my pregnant wife and a subsequent trip to urgent care to confirm if everything was OK. The bill was $600.
Most UHC countries have reciprocal deals where a citizen of one has all the same rights as a citizen of the other when travelling. Its just a lot cheaper than having to ship people around or delay treatment or all the paperwork.
The US has no such deals because it does not have a UHC system to deal with. However, most UHC systems that do not charge aren't going to pay out for setting up a billing infrastructure for the occasional American. The ones with co-pays etc already have a billing structure in place, and may charge you. Or not, it would be pretty mortifying to have to charge someone for health care.
If you are a legal resident, you are covered. If you are a visitor it depends on what deal your national UHC system has with the nation you are visitng. Normally there would be little reason to go to a foreign country for treatment.
Fine. Sidewalk, in the middle of a restaurant, in your livingroom, at the airport. Pick a location and then feel free to explain what selection criteria make ignoring the injuries of another moral.
I am not currently actively or passively ignoring anyone's injuries. I'm a trained first responder, registered organ donor, and actively lobby my local, state, and federal government for universal healthcare and robust international humanitarian aid. It is instructive to note that two attempts to shift goalposts and distract with trivia have been made while nobody seems willing to take a crack at what is a very simple question.
You haven't helped care for my injuries. Lobbying for international (paid for by others) is like calling a taxi when you've got an injured man by the road and telling the cabdriver to deal with it.
You intentionally confuse turning a blind eye with limited ability to render aid, further attempting to obfuscate the central question. Again I am not that easily distracted. Last time, for the cheap seats, what criteria make ignoring others' injuries a moral choice?
The most economically efficient way to pay for B is to allow the free market to drive the cost of care so low that the person is either able to pay for it, or the cost through charity is trivial. This has the double benefit of not attempting to rectify one moral wrong (person does not receive care) by committing another (violent coercion by the state).
The most economically efficient way to pay for B is to allow the free market to drive the cost of care so low that...
Talking about free market efficiencies is a bit like talking about the effect of Newtonian forces on a spherical cow. Very useful to learn from in an undergrad setting but rarely sufficient to capture real world systems.
What you actually want from policy is something like a trajectory toward the best expected result in existing markets over reasonable times. This is much more practical than a provably optimal result in an oversimplified model. Models can be very useful, but the map is not the territory.
>What you actually want from policy is something like a trajectory toward the best expected result in existing markets over reasonable times.
What I don't want from policy is you* deciding for me what results should be aimed for and then forcing me to maximize your personal pet project. If you have good arguments that something should be funded, you don't need to force me to do it.
*: The you here is proverbial. Feel free to insert Donald Trump as an example of the type of person who would have a say in my healthcare options.
I suspect this comment is largely mistargeted, policy is in no way equivalent to force, though some policies may engage it.
Unless you are arguing for a fairly pure form of anarchism (good luck with that, if so) you have policy work and the desire to improve it. It is a reasonable expectation that doing so empirically will vastly outperform doing so ideologically in any scenario like healthcare reform.
The point of this report is that the empirical evidence contradicts your hypothesis. These sorts of broad-strokes, ultra-rationalist arguments should be set aside whenever data is available.
Data is available on rapid price inflation that coincides with central planning initiatives in the US. Data also exists showing the systemic risks to nations created by these systems, such as the looming global demographic crisis created by the combination of social welfare systems and the baby boom.
We aren't talking about those abstract ideas, we are talking about health care and it's associated access and cost. As such, the data shows us the United States fares worse than similar countries on the measures of access and cost (both to the individual and the state)[1]. The United States also has the most "free market-like" system of comparable countries. How can it be that costs are so high and outcomes are no better if we are closer to a free market than others?
Causes of price inflation and the looming demographic crisis are not "abstract ideas."
For literally decades the US did not open a single medical school due to lobbying from the medical industry. Even though we've tried to reverse the trend since the 90s, there are still fewer medical schools today than there were 100 years ago. When the government decides how many doctors there will be, it may get the number right or it may get the number wrong. But that's nothing akin to "free market-like." And it's a major part of the explanation why US doctors make 2x+ what their counterparts in countries like Germany make.
During the New Deal era regulations wage caps were put on workers in the hopes of staving off inflation. Employers, wanting to entice good employees to work for them sought to get around these wage caps by offering health insurance. This then spread like wildfire, coincides with the time healthcare inflation separated from general inflation, and began the trend towards a lack of price transparency.
Most of the differences in outcomes between us and other wealthy nations amount to lifestyle/culture much more-so than affordability and availability. Americans are very obese. Not having to pay a copay to visit the doctor is not going to change that. But obesity means we'll have more problems with newborns, lower life expectancy, etc.
> there are still fewer medical schools today than there were 100 years ago... it may get the number right or it may get the number wrong... And it's a major part of the explanation why US doctors make 2x+ what their counterparts in countries like Germany make.
> Most of the differences in outcomes between us and other wealthy nations amount to lifestyle/culture much more-so than affordability and availability. Americans are very obese. Not having to pay a copay to visit the doctor is not going to change that. But obesity means we'll have more problems with newborns, lower life expectancy, etc.
> During the New Deal era regulations wage caps were put on workers in the hopes of staving off inflation. Employers, wanting to entice good employees to work for them sought to get around these wage caps by offering health insurance. This then spread like wildfire, coincides with the time healthcare inflation separated from general inflation, and began the trend towards a lack of price transparency.
Except, of course, in the countries where it didn't spread like wildfire. Why all this crazy post-hoc history-building when you can just... empirically observe how the natural experiment played out?
Your modus operandi in this thread is the start with an ideology and then derive conclusions that are often wholly inconsistent with observed reality. There's nothing wrong with premises or theory-building, but when the data flatly contradict your conclusions... well, that's the difference between reality and fantasy.
By your link we're 52nd in doctors per capita. That's not great. Plus I'd already noted that we've made a concerted effort to undo the damage since the 90s. Are you suggesting that supply and demand has no impact whatsoever on the wages doctors are capable of demanding? Do you believe that artificially restricting the supply for decades has had no impact on wages whatsoever?
Higher adolescent pregnancy rates, higher rates of HIV, etc.
=== Most experts estimate that modern medical care delivered to individual patients—such as physician and hospital treatments covered by health insurance—has only been responsible for between ten and twenty-five percent of the improvements in life expectancy over the last century. The rest has come from changes in the social determinants of health, particularly in early childhood.===
So best case scenario access and affordability to healthcare accounts for about 25% of improvements in life expectancy. Except the majority of people already have access to healthcare in the US. It's not as available and affordable as we'd like, and we're talking about how best to improve availability and affordability, but it's a tiny fraction of the problem of why US health outcomes are so bad.
It's clear you still don't understand my critique.
> By your link we're 52nd in doctors per capita. That's not great.
I think this sort of argument is innumerate. Statistical sciences provide us with many ways of testing the correlation between "value of care per dollar spent" and "average doctor salary".
None-the-less, I am tempted to point out that Cuba is #2 on this metric ;-)
Regarding the rest of your post, consider actually reading that New Yorker piece. The things you think it says, it DEFINITELY does actually not say.
== And it's a major part of the explanation why US doctors make 2x+ what their counterparts in countries like Germany make.==
That is a nice thought, fortunately NPR has done the actual reporting on this. It seems like the answer is government interference [1]:
"But the biggest reason German health costs are so much lower, experts say, is that doctors are paid less. This largely reflects Germany's concerted efforts to keep costs down over the past two decades."
On administrative costs it seems like government mandates on benefits and payment rates keep those costs 50% lower. Also, they have an employer-based system:
"On top of that, administrative costs are almost 50 percent lower. That's not because the German health system is simple and streamlined. With its employer-based system, multiple insurers and ever-changing rules, German health care is as complicated in many ways as the U.S. system. But administration is much simpler because nearly everybody gets the same benefits, payment rates are uniform and virtually everybody is covered."
==Most of the differences in outcomes between us and other wealthy nations amount to lifestyle/culture much more-so than affordability and availability.==
You have provided no evidence to back up this claim. What makes you so certain that it's true?
==Not having to pay a copay to visit the doctor is not going to change that.==
Might this encourage more people to visit health providers more frequently? This might lead to earlier detection/treatment and lower long-term costs. Why have you dismissed this potential outcome?
>"But the biggest reason German health costs are so much lower, experts say, is that doctors are paid less. This largely reflects Germany's concerted efforts to keep costs down over the past two decades."
Yes, this supports my statement. I said the medical lobby has artificially constricted the supply of doctors. Limited supply means higher wages. I'm not familiar with the German system, they may have done other things such as price fixing to keep wages lower. Personally, I'd prefer having "too many" doctors. This would give me more personal choice to choose the one I like the most while simultaneously keeping prices reasonable.
>You have provided no evidence to back up this claim. What makes you so certain that it's true?
===Most experts estimate that modern medical care delivered to individual patients—such as physician and hospital treatments covered by health insurance—has only been responsible for between ten and twenty-five percent of the improvements in life expectancy over the last century. The rest has come from changes in the social determinants of health, particularly in early childhood.====
>Why have you dismissed this potential outcome?
As noted above the majority of improved health outcomes are not the result of access to healthcare at all. Let's be generous and use the highest percentage in the stat provided above: 25%. So now we're only at 25% of healthcare gains at all, and the fraction of that that isn't actually affordable either by the individual themselves, through their insurance coverage, or provided by charity. We're talking a really tiny fraction of gains here.
== I said the medical lobby has artificially constricted the supply of doctors.==
In the free market, money equals influence. As long as AMA determines who is/isn't a doctor, they have an incentive to make it as hard as possible to become a doctor.
==The rest has come from changes in the social determinants of health, particularly in early childhood.==
Now you have to prove that free and easily accessible access to health care won't have a positive impact on the social determinants of health. It stands to reason that part of America's reluctance to visit doctors is rooted in the historical costs associated with visiting doctors. If we can remove that stigma through cheaper and more accessible care, it stands to reason that we can improve the social determinants of health over the long term.
Here's an example: In Canada, one can visit a dietician as part of their health insurance, this could have a positive impact on obesity, which would lead to healthier population.
> Here's the first article that came up when I googled the subject... [cites article laying down the case for increased social welfare funding, which doesn't even justify the stated claim]
Oy... talk about (not quite) winning a battle but losing the war.
Also, this whole methodology toward argumentation just reinforces the top-level critique. The important word in "start with the data" is not "data", it's "START". I.e., begin by understanding the problem. Then solve the problem. Don't walk around with a hammer trying to bash things.
I would argue it is coercive, but so is the property system underpinning the market in the first place. Adding a redistribution element to a system of private property doesn't introduce violent coercion, it merely changes how it is being used to allocate resources.
As Adam Smith wrote: "Civil government, in so far as it is instituted for the security of property, is in reality instituted for the defense of the rich against the poor, or of those who have some property against those who have none at all."
That quote doesn't mean what you think it means. Taken in context, that quote is talking about the origins of civil government and how it is often corrupted as stated in that quote. It is used as an argument for why there must be a separation of powers to ensure fair judgement and protect the property rights of both the poor and the wealthy.
Regarding "violent coersion of the state", by this, I assume you mean.. taxes.
At this point in the world's history, we are not individuals who can wander off into the wilderness on our own, to live and die as God might have intended. We are members of a vast, global social fabric. We benefit from it. We pay into it. There's no way to avoid the coersion/evils or really deny the benefits/goods that this society provides. We can only discuss things relatively speaking, on a whole, in balance.
I think a productive use of our time is thinking about (and experimenting with) how information technology could better support our emerging social fabric so that we could make the best collective decisions: that is, enable even more personal freedom.
States in and of themselves aren’t moral under your framework because they can only exist by threat and use of force.
But some of us are interested in solutions for the real world instead of the debating the merits of unfeasible utopias.
I, too, would enjoy a stateless peaceful utopia of equitable commerce, but that has zero bearing on how we should decide public policy. Foraging for utopias is the same kind of naïveté Marxists trot out again and again and were it ever enacted at scale it would lead to the same kind of human suffering.
It would be difficult to impossible for me to try to think of every feasible scenario in a HN post, but here's some off the top of my head: national defense, stopping people from physically harming others, enforce voting rights, establish trade agreements with other nations, etc.
I don't see how you can define the state taking money from the wealthy to buy healthcare for the poor as violently coercive but not also define a corporation withholding necessary care from a poor person as violently coercive.
If you are able to help them, and you refuse to do so unless they do something for you (i.e. labour to earn money to pay your fees) then it is absolutely coercive.
By that measure any salary a doctor demands, whether it's paid for by the patient or the state, is coercive. Or for that matter, any salary any person demands in exchange for work is coercive. I feel like it ceases to have a useful meaning when used in this way.
It's only coercive when we're talking about the means to survive. If you offer someone a choice between death or some action, you are coercing them to act.
And I don't think that "ceases to have a useful meaning". I think it just doesn't let you argue that your system is better based on absence of "coercion".
I don't believe for a second that you understand the word "coerce" to be limited only to situations of life and death.
Do you or do you not believe that doctors in the UK are coercing the government by demanding a fair salary in exchange for the lifesaving services they provide?
>I don't believe for a second that you understand the word "coerce" to be limited only to situations of life and death.
I don't think it's necessarily limited to that, but I do think all such situations are coercive. Whether someone is having a gun pointed at them, or being denied healthcare, they are being coerced. That said, I do think most coercion does ultimately amount to the threat of death or suffering, even if it becomes very indirect in practice.
>Do you or do you not believe that doctors in the UK are coercing the government by demanding a fair salary in exchange for the lifesaving services they provide?
Trying to evaluate the actions of individuals in a wider system is not very helpful. Are the doctors being coercive? Yes. But they're also being coerced in turn by the individuals they rely on for survival (i.e. the people they buy food from) so it's hard to ascribe blame. It's the system as a whole which is coercive.
And this is my point. Both market based healthcare and state provided healthcare rely on coercion to function, so you can't distinguish them morally on that basis.
The only hypothetical system I know of that would actually be free of coercion would by something like anarcho-communism, where people have free access to the means of survival, and it is produced by people's free choice to work for the benefit of others. But I'd guess you think such a system wouldn't work.
>And this is my point. Both market based healthcare and state provided healthcare rely on coercion to function, so you can't distinguish them morally on that basis.
Can you honestly not see the moral distinction between me intentionally shooting you with a gun and me not applying first aid after someone else has intentionally shot you with a gun?
I disagree with the asymmetry. Withholding care isn't actually 'doing nothing' and has the ability to be violent or coercive. Take a life-saving but expensive pill. 'Doing nothing' in the case of someone who needs but can't afford the pill would be actually doing nothing - that person could waltz in, walk behind the counter, take the pill, swallow and walk out. Bada-bing bada boom, problem solved no violence or coercion. Healthcare providers don't actually do that though, someone who tried to walk in and take the pill would be met with violence in order to prevent them from accessing the pill until they had paid. That violence is coercive.
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Since the mods are rate-limiting me, here's my reply to your post below:
>Otherwise every person in every situation who demands to be paid for their work, including doctors who demand to be paid by the state in a universal healthcare system are all being coercive.
I agree that this is coercion.
>When taken to that level, the word coerce ceases to have a useful meaning.
Well no, when taken to that level coerce retains it's meaning perfectly, it just happens to illustrate that the market system has coercion baked into almost every aspect. Here, this guy says it better than I can:
But there is no neutral construction of “coercion” that would ever support such a distinction. As Hale aptly demonstrates, coercion occurs when there are “background constraints on the universe of socially available choices from which an individual might ‘freely’ choose.”
In a world of scarcity, all economic rules–including rules that create private property ownership, contract laws, and so on–impose background constraints on the universe of choices individuals can make (e.g. the choice to move into a building and sleep in it without paying anyone anything). When we talk about the economy, we are not arguing about whether we want coercion. We are arguing about what coercion we’d like.
Demanding to be paid for your work is not coercive. Otherwise every person in every situation who demands to be paid for their work, including doctors who demand to be paid by the state in a universal healthcare system are all being coercive. When taken to that level, the word coerce ceases to have a useful meaning.
- an american citizen break his leg, he is not insured. Do you A: let him die B: take care of him ?
if your answer is A - you are a terrible person, but you hold a consistent position. if your answer is B - the only question that remains is what is the most economic, efficient way to take care of this person ?
b is universal health care. if you think you can do A with emergency care, consider how inefficient and expensive this is, and who ends up paying for it.