Run a Google search for any variation of the phrase "socialized health care" and experience a great barrage of links like this one, this one, this one, this one, and well, you get the picture. There are mass quantities of information, personal reflection, opinion and analysis available when one tries making the case for or against socialized health care.

As suggested by the topic's description, there are many names for this issue: Nationalized Medicine, Socialized Health Care [sometimes Healthcare is a single word], etc. Please mentally lump them together to assume medicine is being provided by the state for the purpose of discussing socialized health care in this debate.


Questions for Debate:

1.) So could socialized health care work for America? Why or why not?

2.) What are the economic advantages? The disadvantages?

3.) Are there alternatives to socialized health care and if so, how viable are they?

A very complex subject....

Accoridng to the National Coalition on Health Care, the cost of health care in the US for 2005 was over $2 trillion, or $6700 for every man, woman and child in the US.

The average premium for a family of four was $11,500. For a single person the average premium was $4,200.



In other words, the average family is catching a break with the current system: costs are $6700 per person, but individuals pay $4200 and the average family of four pays $2875 per person.

Costs are increasing, premiums are also increasing (makes sense...).

Of course, in a system such as this, some people will benefit disporportionately (the uninsured who require certain services) while others will pay much more than they get back or not received required services (the uninsured with certain chronic ailments).

That was my factual introduction, now onto the questions:

1.) So could socialized health care work for America? Why or why not?

I'm sure it could work in some sense of the word, but that isn't the real question. The real question is "Could it work better than the current system?" For some people, the answer is clearly yes. If you are denied insurance currently, it would help you. If you don't have insurance and you want it, it would work better for you.

HOWEVER, if you are the average person, who receives $6700 worth of services for $4200, it probably wouldn't work for you.

2.) What are the economic advantages? The disadvantages?

Here's the rub: who pays?

How do we pay for this new system? Is everyone required to pay a base rate (ala Social Security) or it is a "progressive" system where we soak the rich? Obviously, given who the advocates of the changed system are, the latter is much more likely.

How much money will we save by removing the profits that health care insurance companies. The health care industry was lambasted in 2004 for its less than 5% profit margin. So if we got rid of that additional cost, we could reduce health care costs by 5%.

The numbers I cite above are for treatments that are currently provided. Of course, we can't stop there (so say UHC advocates). Barak Obama wants to have universal mental health coverage. He wants to cover all children to age 25. He wants to eliminate insurance companies' ability to limit denial of coverage for pre-existing conditions. To his credit, he does not want to abolish private health insurance although he portrays himself as wanting to sign universal health care coverage in TV ads. He says all this AND he claims the average person can save $2500 per year on insurance premiums. Now there's a trick: more coverage for less money! It is a bit confusing what Obama will do.

Hillary Clinton's plan is just as amorphous. She says people will have choices. Everyone is covered. Everyone pays less. Everyone gets not only more coverage, but better coverage. At least she is honest about soaking the rich to pay for it: she wants to give everyone a tax credit and make "rich people" pay the bill. God I love Democrats! I don't have to pay for nothin' and I get stuff for free! Plus she bills the entire scheme as a net tax cut. Brilliant!

Of course, the lower two income quintiles already pay a negative effective tax rate (income tax). The middle quintile pays an effective rate of 2.8%. The fourth quintile pays only 6.8% of their income in federal income tax. The upper quintile is unfairly only paying 14.5% of its income! (The top 0.1% pays over 19%). This unfair system must stop! We must tax those that are already paying more, well, more.


3.) Are there alternatives to socialized health care and if so, how viable are they?

The current system where the average person receives more in services than they pay in. Of course, those extra costs are paid for by the government, which is funded by the top quintile already.

1.) So could socialized health care work for America? Why or why not?

Ahhh... my favorite subject of all time is back.

It could work. There are a lot of hurdles to making it work the way it should, though - I'm looking at you, Congress. There are so many powerful interests out there that don't want change, and so many pockets to line... Sometimes I think that nothing big will get done in this country before substantial campaign finance reform is enacted.

I am aware of the concerns of those that fear a government "blank check" system, and I share those same fears. People will take advantage if they are given unlimited access to medical care. But a plan that incorporates a mandatory co-payment should keep people from abusing the system. Small enough so that anybody could scrape up the copay if they needed care, but big enough to hurt a little. There are plenty of ways to tweak things to make them work better.

2.) What are the economic advantages? The disadvantages?

Make no mistake - we are all paying for universal health coverage right now, in some fashion. Some unfortunate people pay for their premiums directly. Employers pay for a lot (and the number is falling). Government pays the insurance premiums for their employees, plus they pay for Medicare and Medicaid. The uninsured, all 45 million of them, let the hospitals pick up the cost of their emergency room visits. But one way or another, all of these costs are already passed on to all of us. So why not make it official, and hopefully, a lot more efficient? I like the idea of a government-payer plan as baseline insurance. If people want the super deluxe insurance package, they should be free to buy it from insurance companies.

Businesses would love to be out from under the health insurance burden. That seems like a no-brainer to me. (Why don't the free-market folks ever bring that point up?) Plus, you get a healthier work force with 100% coverage. Production lost to illness should decline. All good stuff.

So the big advantages are increased efficiency (hopefully), and fairness. The disadvantage is the risk of a poorly run system, with high costs and long lines. (Ted will tell you more about the disadvantages shortly.)

3.) Are there alternatives to socialized health care and if so, how viable are they?

You've seen the alternative. If you have insurance and your employer picks up the tab, things look rosy. If you pay your own premiums, you may be grumbling, but at least you can afford insurance. If you are uninsured, things probably aren't so great right now, and the free market isn't about to help you out until you become profitable to insure.

Most of us here are probably insured. I doubt that anyone here has health insurance any better than mine (my Ph.D. wife gets the same insurance as the MDs at the Cleveland Clinic - free Lasik!), and I'm willing to trade that in for universal health care. I've seen what happens to families that aren't insured, or who have to pay a percentage (which, BTW, is worthless insurance) - some injury or illness eventually comes up, then the bills come in, and then they're sunk. Hello, bankruptcy! - but only after years of struggling with the bills. Then, they call me, the local divorce attorney, because money troubles have ruined their marriage, and borrow money from their parents to pay my bill. That's your free market solution. The hidden costs are everywhere.

It appears that your facts are a bit skewed there, Amlord. Read your own linked quote again - notably this section,and please take note of the highlighted portion:

What you're failing to take into consideration is the fact that this is only the employer portion of the bill. Employees generally pay a portion of their own premium as well. In fact about $1200 a year for individuals, and about $3000 for family coverage, as stated in your own link, right here:

And none of this takes into account that those with health insurance not provided by their employer can cost quite a bit more. Why? Because group policies for companies, industries, unions, etc., cost less because there is a larger pool of people to collect premiums from, and to help spread the potential risks involved.

It also doesn't take into account those who have have insurance, but are what we call under-insured. For example, an employer "paid" policy that only covers the "room and board" and doctor fee of a hospital stay, but not the lab and clinic work, or the prescriptions. And these kinds of policies are becoming more and more prevalent, as employers look for ways to lower their healthcare costs.

1.) So could socialized health care work for America? Why or why not?


Well, I think I've already shown that even those with insurance are paying quite abit more than $4200 a year, so it looks like it would help a lot more people than you might think.

2.) What are the economic advantages? The disadvantages?


Well, under a single-payer system, it wouldn't be just the insurance company profits that would be eliminated, but many of their associated costs. Under Medicare for example, administrative costs are largely reported at about 2%, while insurance companies administrative costs run between 20% to 25%.

Now to be fair, I've seen studies that say that some of Medicare's costs are hidden, and are actually closer to 5.5%, and the insurance companies at about 9%. But the insurance companies get their numbers that low by not including advertising and sales costs into the equation, which generally run in the 5% to 10% range. Let me ask - how many ads for Medicare have you seen on TV lately, versus ads for various and sundry health insurance companies? Yeah, that's what I thought..... Then add on that extra 5% for the profit margin.

Even if we use the most favorable numbers for the insurance industry, and the worst numbers for Medicare, insurance costs run more than twice as much as a single payer system, and possibly three times higher.


All sarcasm aside, Amlord, Obama's plan or something similar just may be able to swing those premium savings, and more. Why? Because of that risk pool we talked about earlier. Yes, lower-middle class income folks will need to have their insurance subsidized, or get tax credits for a portion of it, and poor folks may get it completely paid. But, insurance companies under a mandatory insurance purchase system like Romney put into place in Massachussettes, would be gaining 45 million new customers, all currently without health insurance of any kind.

So, advantages? Lower premiums, for one. Also, how much are we losing in GDP as a country each year to bankruptcy? Because nearly 50% of bankruptcies these days occur due to medical bills that can't be paid. The lower the bankruptcy rate, the less expensive retail goods can be, because companies don't have to write off the losses.

3.) Are there alternatives to socialized health care and if so, how viable are they?


Gee, another misconception. What a shock...

All of those extra costs are not covered by the government, and funded by "the rich", Amlord. Far from it. In fact you and I pay for a lot of that "extra cost" in higher healthcare and insurance costs. How? Well, being uninsured, or even under-insured certainly does not mean that you are "poor enough" or "old enough" to qualify for Medicare or Medicaid. So, what happens? Hospitals, doctors, labs, etc., all raise their cash fees for those who can afford them, and fees charged to insurance companies, to cover potential losses, when a fair number of those uninsured/underinsured can't pay the bill. They have to cover their losses somehow.

About the only alternative, as you point out, is what we currently have. Of course the current system is producing costs rising at multiples to inflation and cost of living increases, and more and more people and businesses each year being forced to do without health insurance, put off health needs, or go broke trying to pay for healthcare. Some choice, huh?

On the other hand, I have a plan, I developed in discussions on another thread, that utilizes more of a private-sector solution, that just might work. I'll be glad to post it, if anyone's interested.

John,

Your post typifies those on the pro-UHC side of this issue.

The question remains: WHY will costs be lower? Okay, we take 5% out for health insurance company profits, so there's a savings (hopefully you don't own stock in those companies...).

How can we say that the long-term cost will go down? We can surmise that more preventative care will lead to fewer health problems, but why don't patients WITH health care use those opportunities at present?

If the government was the one providing care, how would IT choose on which procedures to cover and which NOT to cover? Or would any conceivable measure be used to treat every ailment?

How will it be paid for? Currently, we have individuals paying their own way with the government subsidizing the uninsured. The move to the new system will certainly cost more from the public funds, $2 trillion more in fact. Where is that $2 trillion going to come from? Are we going to double everyone's taxes?

NiteGuy:


Okay, so we add those on (I'm not sure if that is correct or not, but let's say it is):

Average individual pays in $5600 for $6700 worth of care, average family pays in $14500 for over $26000 worth of care. Recall, that is insurance premiums, of course there are costs above and beyond that (co-pays, prescription costs, etc) that are above and beyond according to individual needs. On a personal note, I received my W2 today and I paid $2574 last year for family coverage health, dental and vision.

Of course the above numbers include costs not directly associated with caring for yourself or your family. Yes it includes paying for the uninsured. But who are the uninsured? Mostly 1st and 2nd quintile wage earners (2nd, I'd wager) who won't pay for their future care either. So it's a wash.

As for the Health Insurance companies paying 10% of their income to sales and advertising: geez that's $200 billion a year. That's a lot of advertising. Sorry, I just don't see that as being accurate. Maybe, but if it is, there is going to be a lot of health insurance salesmen and marketers that will be needing jobs.

I didn't say that costs would be lower, although that is possible. IF costs were to go down, I think it would come from the efficiency of having UHC in place as opposed to the mishmash we have now. Also, if you believe that the government can be more efficient overall than insurance companies (I believe), there could be some savings there. The point of my post is that UHC would be worth the cost.

Long-term costs are hard to predict, but insurance companies aren't keeping costs down today. What good are they? I think the government can do a better job of keeping prices down, and everyone will pay the same amount. No longer will the uninsured be hit with higher bills for the same procedure than insurance companies pay. Those bills are completely out of line with reality.

The government already has some experience in running this kind of operation, so I don't think that outlining what procedures would be covered would be a big problem. (And remember, when we talk about Medicare and Medicaid, we are talking about the least profitable people, the ones the insurance companies won't touch, so that should be factored into any discussion of government efficiency and cost-per-person comparisons.)

Where will the money come from? Well, I think that businesses will benefit greatly - there is some of the money right there, passed on in the form of better pay, lower prices, lower costs of compliance, etc. (good, sound Republican reasoning!). Hospitals would be freed from their burden of treating the uninsured, so they would presumably lower prices (another Republican assumption, but I'll use it anyway). Those families that pay for insurance now would be relieved of that huge burden, and those otherwise uninsured Americans that would be facing financial ruin would be OK. All that is paid for with, yes, taxes, but at least the burden is spread out among everyone.

You can't just point to higher taxes without also admitting that there would be real financial relief for many people and businesses. As I outlined in my last post, we already pay for health care, directly or indirectly. So where are the added costs of UHC?