…[compared to the United States] income plays a larger role in buffering children’s health from the
effects of chronic conditions in England. We find no evidence that the
British National Health Service, with its focus on free services and
equal access, prevents the association between health and income from
becoming more pronounced as children grow older.
Here is the paper. Of course equity is not the only argument for single payer systems. Here is part I of the series, concerning Canada and the (possible) continuation of the health-income gradient there. Many of you were skeptical about the reported result, but here is further evidence. Most of all, the determinants of health are not well understood; that is itself a sobering fact no matter what your policy point of view.
I really don’t think the egalitarian issue is so important to leftists like myself. What is more important, and hence is lifted in priority after the cost-benefit analysis, is the construction of a base floor of benefits for the lower/lowest cohorts of society. As long as the bottom is getting a “sufficient” amount of health care, I don’t much care what excess the top helps itself to. If you care about costs primarily, then that’s one obvious place to look. As I mentioned previously though, any society that can fund an endless Iraq war to the tune of 100s of billions of dollars a year without sacrifice is not financially constrained.
“f that is the case why aren’t we talking about expanding Medicade to cover all uninsured people, rather than having the government occupy the whole field in a universal health care program?”
In principle *I* would have no problem with this. The problem is the actual implementation; does this approach achieve a health care floor in rough equivalence to that of other wealthy countries all of which have universal coverage? I haven’t seen that argument made yet. Ezra?
Yes, I too fully support making the unmotivated not escape responsibility for their own welfare! They can get their own heating and cooling, thank you very much. And the poor are free from the burdens of income tax — let’s add some income tax along with the withholding to show them what for!
Plus they aren’t using those Sixth Amendment rights anyways. Public defenders are far too good for them!
More seriously, while sympathetic to the notion of motivating the poor to be *not* poor, often its not merely a matter of motivation. I think a modern society does require a minimum standard of education and reasonably safe living conditions. I’m not sure how you “motivate” people into middle class lifestyles by jacking up their heating bill.
DU
Medicaid already covers the poor. IMHO the one expansion that might make sense would be to expand it the chronically ill or those who can show that they have been turned down by multiple health insurance companies because of existing condition. These people could be charged for the coverage in means tested manor.
I do not know how you would avoid, in this case, having the insurance companies drop anybody after having to pay for their first big bill but it is an idea. Maybe it would lead to health insurance that pays a set amount on diagnosis? Which might be good.
Jeffrey,
And what if single payer did none of those things? What if it really doesn’t reduce costs? What if people are still bankrupted by costs that the government program will not cover? And I don’t know how you even accomplish (c) since someone, somewhere, has to actually say no at some point, if you have any hope of accomplishing (a), so you will always have arguments about what will be covered, and what will not.
John Dewey wrote:
“Liberals will help the unmotivated far more if they would simply help the rest of us show the unmotivated that we have confidence in their abilities. Instead, we continue to hear how a segment of the population cannot make it on their own.”
To a certain extent are many poor people saying “all those good things are not worth the effort”. Are are many poor people by their actions saying “I am content with very little” or for example saying “I value my money and leasure more than health insurance”. Or is it beyond human control are people born to a level of diligence. IMO at least some people are can be motivated externally.
Also a funny thing IHOM is that the biggest motivation to work hard to get into the middleclass for many is not wanting to live in a “bad area”, that is an area where poor people live.
Makes me wonder would more police help. Would more police make people more happy to live in a poor area.
>And if someone wanted to get private insurance on top of the basic universal coverage, they’d be free to do so.
Which is only useful if the public delivery system hasn’t decided it needs to strongarm most providers into effectively making a nearly absolute choice between public and private billing.
Floccina, I’ve also wondered about why poor people live in high-crime areas. He in Greater Boston, a two-bedroom apartment goes for about $1200/month in high-crime Roxbury and between 1100-1200/month in bucolic Melrose, where I live. Throw in the added bonus of much better schools and less expensive staples at the supermarket, as well as not dodging bullets on a regular basis.
The bottom line is there are people caught up in a cycle of making rotten choices in life, and our welfare state aids and abets this behavior!
Yancey,
Pretty much every country in the world with the exception of the US has a single payer system and they spend less per capita and they get results that are as least as good, so it should be possible to implement such a system here. The contrary position – that it wouldn’t work in the US – relies on the claim that the US is exceptional which I find unpersuasive.
Floaccina,
I had Canada and New Zealand and Australia more in mind than
Honduras. I had an interesting talk with some people in Australia last winter about their health care system. They told me that the public hospital were actually way better than the private ones. They also said that when Australia switched to a single payer system (I think in the 1970s) the insurance companies and other interested parties trotted out the same stories we hear in the US about how it would be a disaster. Didn’t turn out that way of course, not has it in any other wealthy country.
Floccina,
Setting a cap on taxpayer paid for medical expenditures as a fraction of GDP is fine with me.
And I agree (as I’m sure most people do) that a single payer system would not solve all social ills. It just would be a lot cheaper and fairer and less complicated than our current system and would achieve the same health benefits.
“we are allowing the unmotivated to escape responsibility for their own welfare.”
This (mis)-belief cuts right to the heart of deciding what kind of society you want to live in.
Assume everyone who is poor is lazy and thus 100% responsible for their own misery – do we, as a society, let these people die on the street or do we attempt to help them in some manner?
Do we let people perish because they weren’t “motivated” enough? How do you define “enough?”
Do we let people perish because they weren’t “motivated” enough? How do you define “enough?”
I think you are defining “people” too broadly.
I don’t have free access to the paper so have not read it. Did they consider the possibility that families have less income because they have sick children, and not the reverse. It is often asserted that even the existence of children lowers women’s income, and therefore family income. It seem reasonable that a child with health problems would have an even greater effect on earnings.
Russell L. Carter: “he has asserted that it is good for small business if big business enjoys preferential government subsidy explicitly biased against small business, that is the employee health insurance deduction.”
Please do not combine your misconceptions with my arguments and then refer to the silly result as “incoherent”.
The federal tax deduction for health insurance is not a benefit for business. It is a benefit for workers. Do you not understand business accounting and taxation, Russell?
If business paid employees more cash instead of health benefits, business would still deduct the cash compensation as an expense before computing income. It is the employee who derives a benefit from insurance that he does not get from cash. Federal income taxes are withheld from cash compensation but not from health insurance compensation.
All employees – those who work for small businesses as well as those who work at large businesses – receive the benefit of the tax shield on health insurance. It is not a government bias for large businesses.
What you are ranting about is the economies of scale that large businesses enjoy. A large business can negotiate better health insurance rates, more luxurious furnishings, lower rents, volume discounts on materials and services, more attention from government officeholders, and on and on. Certainly large businesses have huge advantages over small ones. And yet the small businesses continue to flourish.
Walmart and Dell and Southwest Airlines and FedEx and Wendy’s were all once small businesses that did not enjoy the economies of scale you refer to as “bias”. And they all competed successfully against Sears and IBM and Braniff and the Post Office and McDonald’s.
If your background is business or economics, surely you are able to distinguish government granted business advantage from simple economies of scale. Or is your background something else?
Jeffrey Miller,
I don’t see why it is valid to point to other countries as proof for why we would spend less, since many of the factors that let those countries spend less evolved along with their medical systems and medical care itself- the US has evolved differently. To transplant, let us say, France’s system to the US would involve far more than just using the same financing system.
Their systems developed in a different era, and their citizens have different experiences and expectations than Americans. I could just as easily argue that a government system in the United States would cost more than we spend now for all the reasons that Americans are different from Canadians and Europeans.
Jeffrey Miller the more I think about your position on healthcare the more I think we should feel con’ed ripped and and betrayed by our politicians. Our politicians already spend more money per capita than the French politicians do on healthcare and the politicians in France cover everyone.
Posted by: Matt Levin
“”we are allowing the unmotivated to escape responsibility for their own welfare.”
This (mis)-belief cuts right to the heart of deciding what kind of society you want to live in.
Assume everyone who is poor is lazy and thus 100% responsible for their own misery – do we, as a society, let these people die on the street or do we attempt to help them in some manner?
Do we let people perish because they weren’t “motivated” enough? How do you define “enough?”†
No one Assumes that everyone who is poor is lazy. No one assumes that everyone is anything.
But let us consider some things:
There are lots of blind people, deaf people, people with diabetes, people with asthma, epileptics, people crippled from birth, people without legs or arms, even stupid people who are middle class so what is this mysterious thing that keeps those diligent people who strongly desire wealth to be poor in the USA?
Also what is fair, that the diligent should have there money taken and given to the less diligent at the demand of the less diligent? I do not want to seem un-charitable, I like to help the poor. But I find it is far more difficult to help the poor Americans than the poor in poor counties just giving poor Americans money usually does not help much. Counseling can sometimes help.
Floccina: “There are lots of blind people, deaf people, people with diabetes, people with asthma, epileptics, people crippled from birth, people without legs or arms, even stupid people who are middle class”
You are soooo correct.
IMO, the absolute worst “help” we can provide for disabled people is to implant in their minds the idea that they cannot make it on their own – that they are dependent on the rest of us for their lives. Welfare saps the self-confidence of the very people it seeks to help. Why bleeding hearts cannot understand that is just a complete mystery to me.
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