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« Terrorism: does it call for a response of armed conflict or law enforcement? | Main | Bush and Kerry: abandon all hope, ye who enter. . . . »

September 10, 2004

Comments

I think that more people need to realize that we already pay to have health insurance for everyone, so why not go ahead and socialize the whole system? What I mean is, if a person without health insurance has a medical emergency, accident, etc, and they can't pay the bill, we pick up that cost anyway. Poor person w/o insurance -> Hospital bill unpaid -> Hospital charges other customers more (or for public hospitals, nibbles up some more tax dollars) -> Insurance rates rise. We also have Medicare and Medicaid, for the poor and elderly folks, so we're already being taxed for a good lot of it.

I've always thought we should just have a health insurance tax, and use it to fund a national healthcare system. Build it right into your tax return. Self-employed people pay their own tax, and businesses will pay the tax for their employees (and get a deduction). Then you could give people tax breaks for preventative care (having regular physicals, vaccinations), and you could add extra taxes to smokers (and overweight people, yeah, I'd probably pay a little more too!).

Like with medicare, doctors, hospitals, and other providers would submit their claims to the government, and get reimbursed. And you could always have 'extra' medical care available to those who can afford it, paid for privately. What would be nice is if Kerry would come up with some hard numbers, show us how he thinks his plan will actually work (without creating some monster deficit).

David

Prof--

Why should Sen. Kerry wait until he is elected until "sending" such a package to the Hill? Isn't he already there? Doesn't he think that if Congress would pass such an item, he can get it done now and then come back and say: "Hey, cheap Health Care, that was my proposal. I will do more from on high." Is it because then the incumbant can say it was my decision, too, or are these guys too chicken to do it themselves, knowing it doesn't stand a chance of passing?

BTW, this is not a Kerry bash, I had the same problem with Dole in '96. But if you want to help the country, should credit matter? Isn't it more credible to do it rather than say "I'll start on day one"?

Sorry, had to vent.

Craig

I know nothing about Kerry's health plan, but:

The theoretical cost-savings of insurance comes from collecting risk, so, yes, more people in the pool means lower real costs (which are different from pure health care dollar costs).

Also, having more people involved makes both collective action and efficiencies of scale more likely.

Ann

If all that is done is to sign up more healthy people for insurance, then you're right that there shouldn't be any aggregate savings, only a different distribution of costs.

If we socialize the whole system, past experience indicates that quality of care will go down and waiting times will go up. We could control costs, but only by giving everyone less. Look at the waiting times for needed surgery in Canada and the U.K. - I read recently that the average waiting time for an urgent heart bypass, such as Clinton's, is 2 weeks, while "voluntary" bypass waiting times are more like 10 weeks.

So, with a National Health Service, any aggregate savings would come from a strict reduction in quality of care, while this would be at least partly offset by lower efficiency. You can argue "economies of scale", but it's hard to imagine that there are great economies of scale in going from, say, 10, 20 or 30 providers to one and only one provider for a country as big as the U.S. But the reduction in competition in going from 10 providers to one and only one provider, with no recourse at any time, would be enormous. When has one huge monopoly ever been strictly more efficient?

We're confusing two separate issues: should you require everyone to get health insurance, thus spreading out the distribution of costs, and should you eliminate any and all competition and choice by having one huge bureaucratic monopoly health provider? The first might make sense, not only in terms of spreading out costs but also in shielding those few healthy people that experience an unexpected problem. I would argue that those people should be allowed to carry only major (catastrophic?) coverage - i.e. only if costs go above, say, $10,000 in any one year.

The second question - should we eliminate all competition, ban all choice of coverage, and force everyone to deal with the same bureacracy that has no incentives to improve - is pretty clear. This system has never worked well in terms of delivering quality care. And, socialized health care in Canada and the U.K. has done as well as it has partly by free-riding off of the U.S. system. We've come up with most of the advances in health care, establishing "state of the art", which they adopt many years later (if it's cheap). If the U.S. goes to one national health provider, who will we free ride off of? Not Canada.

M. wolff

Can a Canadian add something to this.
Our health care system is in a shambles. Our Fed. gov't just promised another $41.m to the 10 provinces and three territories. We have a real shortage of doctors, nurses, technicians because 15 years ago they cut back on training to save money. I l ive in the Prov of Sask. north of the Montana/dakota border. In the past ten years opur Prov. gov't has closed 52 hospitals. We have just about 1million people living here.
Wait times: knee or hip replacement..1 - 5 years. \Cardiac; emergancies get you in right away but other wise a wait of 6 months to over a year.
We have one pediatric surgeon in Regina. One Eye surgeon. Our health care is unsustainable.It's paid for with our taxes and heavy taxes of "the rich" and businesses. Politicians, atheletes and celebrities can get help right away.We are not allowed to pay for our own care....MRI's operations etc, I went to Minot, N. D. to have my knee joint replaced and it cost me a bundle. I have a neighbor who relly spit nails at me for that! LOL
We are not supposed to have private care facilities but Quebec is allowed .
Good luck with the elections
One Canadian who really likes America and it's people

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