I am from the US, but I don't think it invalidates the discussion from people who aren't American. After all, if we want to talk about how terrible other countries' healthcare systems are compared to ours and that our healthcare system is the best in the world, I think it's reasonable to have people to talk about the other side of it.
The basic discussions and opinions about how a healthcare system should run, or things like socialized medicine, are discussions that anyone can be involved in.
The interesting thing to me is despite Switzerland being the conservative example du jour, they do in fact, have a mandate as well. Innsurance companies are required to offer, and you are required to obtain (either from insurance companies or the government) a standard high deductible healthcare plan. There is also a governmental provision for tax exempt national health savings accounts to provide that $2500. Whether you wish to purchase supplemental plans is up to you.
I don't know that it's the "conservative example du jour," as most Republicans are crying about "socialized medicine" in the sense of a government-run program. Their argument-boat gets sunk pretty quickly when they examine the Swiss version. They don't utilize a public option, but rather, mandate everyone must be insured (similar to car insurance), and that out-of-pocket costs for the individual cannot exceed a reasonable amount, which I believe is ~8% of income. Part of the problem with health insurance, is that when there is no personal cost associated with it, it gets abused. Still having to pay at least a portion of what one uses is a good way to balance that.
The real secret to their program, is that they have take away the "profit driven" incentive of both providers and insurers. While one can still have private supplemental insurance, the mandatory program is not profit driven, so the burden is on providers to provide appropriate care, and insurers to keep costs down. It's clear that America needs a working health care system -- it is not, however, as black and white as Republicans and Democrats want Americans to believe. Republicans seem to think the status quo works just fine. Democrats believe we need a universalized form of Medicare. There are other options, and in 1994, Switzerland created one of them.
Part of the problem with health insurance, is that when there is no personal cost associated with it, it gets abused.
Really. Explain how. And remember that there are at least a few people involved in this thread who live in countries that have health care with no out-of-pocket expenses for care, so we will keep you honest.
I don't know that it's the "conservative example du jour," as most Republicans are crying about "socialized medicine" in the sense of a government-run program. Their argument-boat gets sunk pretty quickly when they examine the Swiss version. They don't utilize a public option, but rather, mandate everyone must be insured (similar to car insurance), and that out-of-pocket costs for the individual cannot exceed a reasonable amount, which I believe is ~8% of income. Part of the problem with health insurance, is that when there is no personal cost associated with it, it gets abused. Still having to pay at least a portion of what one uses is a good way to balance that.
The real secret to their program, is that they have take away the "profit driven" incentive of both providers and insurers. While one can still have private supplemental insurance, the mandatory program is not profit driven, so the burden is on providers to provide appropriate care, and insurers to keep costs down. It's clear that America needs a working health care system -- it is not, however, as black and white as Republicans and Democrats want Americans to believe. Republicans seem to think the status quo works just fine. Democrats believe we need a universalized form of Medicare. There are other options, and in 1994, Switzerland created one of them.
Interesting. I'd research this more. Again, I'm not for mandatory coverage or a national option, but if I had to compromise...this looks interesting.
I'm not speaking for other countries, but rather, in the United States with regards to the no personal cost = abuse. Look at how well Americans treat systems for which they do not have to pay for things. Maybe in other countries the "share" system works, but in America, people tend to abuse things for which there is no cost to them. Have you ever seen a public restroom? I'm sure the people that piss all over public restrooms wouldn't do the same in their own house.
Do you really expect the general American public not to abuse healthcare, when you see them destroying common-areas like public parks, etc?
I'm curious to know what "abused" means in this context too. Are we talking about a whole pile of unnecessary surgeries and prescriptions, or is it more, "I have a sniffle, better go to the ER," that you're thinking about here? Say what you will about slow service times, but a five hour wait (not really typical in my experience, but that's the general public perception) is a fairly strong disincentive in the case of the latter. It might not cost you money, but the time and effort involved in getting out to see a doctor for a cold is usually enough to keep a person home in bed with some NyQuil instead.
Again, you understand that under a single payer system, we would still be paying for healthcare, just through taxes. And it would also be up to the provider and an oversight organization to make sure there aren't gross abuses. Until the Affordable Care Act, there were really no attempts to curb fraud in Medicare. That doesn't mean that needs to be the case.
I'm not speaking for other countries, but rather, in the United States with regards to the no personal cost = abuse. Look at how well Americans treat systems for which they do not have to pay for things. Maybe in other countries the "share" system works, but in America, people tend to abuse things for which there is no cost to them. Have you ever seen a public restroom? I'm sure the people that piss all over public restrooms wouldn't do the same in their own house.
Do you really expect the general American public not to abuse healthcare, when you see them destroying common-areas like public parks, etc?
If you're going to rest your argument on the idea that Americans, by and large, are just worse human beings than what you find in countries with socialized medicine, I'm not going to fight you on that point, but your fellow citizens may object to your level of cynicism.
Again, you understand that under a single payer system, we would still be paying for healthcare, just through taxes. And it would also be up to the provider and an oversight organization to make sure there aren't gross abuses. Until the Affordable Care Act, there were really no attempts to curb fraud in Medicare. That doesn't mean that needs to be the case.
Oh, and another American distinctive, from an outside view, is that you really seem to spend a whole lot more time worrying about whether or not there's some possible way that some hypothetical person could take advantage of the system than you do worrying about seeing to it that the people who actually, legitimately do need help are able to access it in a timely and sensible manner. A shift in focus from abusers to the legitimate users of the system might go a long way towards creating a more just and sensible system. Could even save the whole works a pile of cash too, but nearly anything would be less expensive than the current program, so that almost goes without saying.
There are both kinds, both through the emergency room abuse, but also, tremendous amounts of unnecessary procedures and prescriptions. The system is upside down, because the provider/insurer is still making profit from this. The main issue is that we need to take the profit-driven model out of basic insurance.
I'm not arguing a "single-payer" system. Do me a favor, do a little investigation into how the Swiss do things. I'll even provide a link. Their system has several companies compete for short term programs, buying up essentially chunks of "care provision," which they agree to pay for under contract. However, they do not get paid more for more procedures, so the bidding is pretty well thought out. It's a little more complicated, but essentially, providers put different services into several "pots" and bidding goes on offering contracts to pay for these services. I'm not arguing for expanded Medicare.
I agree that the profit-driven model is a major problem that needs to be addressed, I just don't see how that could ever be compatible with American corporate culture getting involved in the process. It almost seems like a Marxist solution would be necessary, a total tear-down of the current system that eliminates health insurance companies completely and puts the whole thing in government hands, leading into a gradual rebuilding of the system based on the Swiss model you presented. Of course, the second you use the M-word, 99% of Americans will completely tune out or turn against you, so I'm pretty much stumped about the question of implementation in the American context.
Abuse of health care happens already -- anecdotally, there are people that call for ambulances/go to the emergency room constantly, especially for minor issues. Additionally, frequently, hospitals will perform unnecessary procedures both under the CYA-policy, but also, because MRIs are expensive and they need to pay it off somehow. I'm not saying visits have to be share-costed to a ridiculous portion, but if even everyone simply had co-pays for all visits of maybe $5-10, and someone reviewed their procedures for necessity, maybe the system would work both more efficiently and quickly.
There are both kinds, both through the emergency room abuse, but also, tremendous amounts of unnecessary procedures and prescriptions. The system is upside down, because the provider/insurer is still making profit from this. The main issue is that we need to take the profit-driven model out of basic insurance.
Are you sure you're not talking about the current American health insurance model here? People to to the ER because they can't afford a doctor visit, and then they stiff those who pay for insurance with the bill. Doctors prescribe medicine like candy. That's how things are in America now.
Here's how things are in Canada: Doctor visits and emergency care are free, but medicine and elective procedures are not, nor are specialists (including dentists). At the beginning of the month I went to my doctor about two specific moles that sometimes cause me problems, and last Friday he removed those two plus another one and stitched me up at no cost to me. In 2 days I go back to have my stitches out, and it will cost me parking. It was free for me because it was medically indicated; had I just been getting them removed cosmetically because I felt like it, I would have had to pay. However, since the funding for all that care comes out of taxes in the first place, it's not actually free at all; everyone pays into it every time they buy anything at a store. So the care isn't free, and elective procedures are doubly not-free. My doctor gets paid the same amount whether he removes my moles or not, so performing unnecessary procedures is not in his best interest. This abuse of the health care system that you're worried about simply doesn't happen.
It does happen here. Many of the "abuses" I used as an example (though anecdotally) were from people covered by Medicare/Medicaid. Maybe it "simply doesn't happen" in your sphere of life, but it does happen here. I do not think a government-run solution is right for America. I think a government mandate that everyone must be insured is the right approach for America. And co-pays and deductibles is one way to make sure people are sensible about how they use healthcare. If a person is really sick, they are only liable for their deductible, which is reasonable, but still requires a fair investment of personal income. Ditto insurance premiums. I don't believe the United States Government is capable of running an efficient, well-staffed health program. They can't even pass a budget on time.
I just feel like this conversation has turned into a horse. One that's been deceased for a while. And people aren't sparing the rod.
Summary: Me: I think the Swiss system is good, and would like to see it implemented in America. Other: No it's not! Me: Reason 1 Other: No it's not! Me: Reason 2 Other: No it's not! ... Me: *sigh* Reason 458 Other: No it's not!
In your conversation with me, which is what Izzi was responding to, you haven't been saying anything of the sort; rather you've been trying to convince me that if medical care is free, it will be abused. I'm telling you that in places where medical care is "free" (but it's really not), it doesn't get abused. Then you said "the free care here does get abused" and Izzi said "abuse will happen regardless." That conversation had nothing at all to do with the Swiss system.
I was still stating why I believe the Swiss system is better than a "public option." I have this nagging suspicion that if the United States implemented a public option, it wouldn't be 100% of people paying into it, but more like half that pay for the other half. At least under the Swiss system, everyone pays *something* proportional to their means, but it's still more than *nothing.* Also, when one looks at the fraud of billing companies, I have a feeling they'd be more easily caught under a Swiss-type system than Medicare.
