Club Sandwich
Note: This is my opinion only. I believe Jim and Donna and the other participants here will be in general agreement with this, but until they officially sign on let’s keep this as being solely the opinion of Lee.
The always-brilliant Cato Institute have come up with an idea. Since many people on the right are warming to the idea that some form of suckle-at-nanny’s-ample-teat statism is necessary to provide healthcare to Americans, they’ve come up with a novel counterweight: The Anti-Universal Coverage Club. Here are the rules.
1. Health policy should focus on making health care of ever-increasing quality available to an ever-increasing number of people.
2. To achieve “universal coverage” would require either having the government provide health insurance to everyone or forcing everyone to buy it. Government provision is undesirable, because government does a poor job of improving quality or efficiency. Forcing people to get insurance would lead to a worse health-care system for everyone, because it would necessitate so much more government intervention.
3. In a free country, people should have the right to refuse health insurance.
4. If governments must subsidize those who cannot afford medical care, they should be free to experiment with different types of subsidies (cash, vouchers, insurance, public clinics & hospitals, uncompensated care payments, etc.) and tax exemptions, rather than be forced by a policy of “universal coverage” to subsidize people via “insurance.”
This is where I am coming from. Moore has done this country a service by pointing out the glaring flaws in our system. The question now becomes, do we use ingenuity and intelligence to come up with a novel solution? Or do we merely sign up to become nothing more than the latest country to buy into the great socialist lie?
Update from JimK
I like #1. Makes sense.
I like the second sentence in #2. I agree that government would make a horrible, bloated, expensive mess out of a single-payer system. I disagree with the blanket (and rather simplistic) proclamations in the second half of #2. I am starting to think a basic package required by all is a smart idea. It works for car insurance, there is an economic model from which to begin. I know - health is not driving. But it is a model, or an idea, from which to begin. Government doesn’t manage to screw that up too badly, and there’s no evidence in the National Review article to suggest that it’s absolutely a given that such a system would fail due to lobbying.
We could of course kill all the lobbyists. But that’s a whole other discussion. :)
I get #3 in theory, but we do not live in a pure libertarian fantasy world. We’re required to carry all sorts of insurance for all sorts of reasons. Health care in this country is a big burden on the federal coffers. With some level of basic care that CANNOT be removed by an over-zealous insurance adjuster, general health in America would improve over the next generation or two. Healthier people produce more, grow the economy better and cost the government less in the long run.
I feel like #3 is a pure libertarian’s “We shouldn’t have a standing army” or “The IRS is illegal and I’m my own country now” fantasy. Some kind of system that gives basic care to all WILL happen, and we need to find out the smartest, cheapest and most effective way to make it happen before someone slips a single-payer system past our noses. If anyone thinks that a bill like that couldn’t be passed without huge public outcry preventing it, may I remind you about Moore’s discussion of the USA-PATRIOT Act? It might be the only real true thing in F911: No one read the damn bill. Regardless of how you feel about it, we barely heard a whisper about it before it was law, and it was passed without anyone reading it...it was that complex and confusing. Anyone think special magic universal coverage for all will be any less of a boondoggle? Also, as far as passing things no one wants, can I call your attention to the current amnesty sham in Congress? Americans are vehemently opposed to this bill but the kings and queens on Capitol Hill are bound and determined to do for the peasants what they won’t do for themselves.
If #3 is to be remotely possible, a person would have to demonstrate either remarkable health, or the means to pay the bills on their own in order to opt out. Otherwise we’d be right where we are now: A system where the poor decide not to get any coverage and instead rely on hospitals and emergency care facilities and then don’t pay the bill. Or, they go on Medicare or Medicaid depending on age.
I’m all about #4. We need pilot programs all over the country to experiment with systems and learn how to provide the best care possible for the least amount of money (and stress on the patient).
Something Cato forgot to add as a possibility: We could try to reform the industry we have, find out EXACTLY why it’s so ridiculously expensive and find ways to reduce the numbers, while at the same time closing some of the loopholes that insurance companies use to deny necessary and needed care to patients. That may not work in the end, but it is an idea worth exploring.
And dat be my $0.02.
Comments
Lee the NHS, despite is many failings, is lightyears better than the United States’ model.
In any case, I beleive the answer to your conundrum is a simple means test.
If an individual or family earn a household income above a certain level, they are penalised for not having private insurance. Thats how we do it here in Australia.
Everyone contributes between 0.5% and 1% of their annual income to the public health system (called the medicare levy). Every year when you lodge your income tax return, you have to state whether you have private health insurance or not, if you earn a large income, and you do not have private health insurance, (that is, you rely on the public system even though you are wealthy enough not to) you are penalised a further 0.5% on top of your normal medicare levy.
Since this system was introduced here, numbers of citizens with private health insurance have increased dramatically.
We also have a secondary, a ‘carrot’, to compliment the ‘stick’ I just mentioned. Those who pay for private health insurance get a rebate from the government, to offset the cost. The rebate is smaller than what the government would have paid if you relied on the public system, saving them money, and it is means tested as well, so that filthy rich people cannot take advantage of it.
3. In a free country, people should have the right to refuse health insurance.
This is something I’ve never quite understood.
It’s illegal to drive without insurance.
It’s illegal to drive drunk.
It’s illegal to smoke crack, weed and hash, snort coke, shoot heroin, etc.
Why should the option to decline healthcare be held so sacred? Be seen as something positive?
Why on earth is that a good thing?
No, really. Please explain why. I seriously don’t get it.
the NHS, despite is many failings, is lightyears better than the United States’ model.
You would do well make sure that people know that is your opinion, and not throw it out like it was a provable, objective fact.
I utterly disagree. And that’s my opinion.
It’s illegal to drive without insurance.
It’s illegal to drive drunk
Driving drunk is pretty obvious. If you are impaired behind the wheel you could cause a large wreck, injure or kill other people.
Auto insurance, is also not so much a thing for your individual protection. If you are in an accident where your car is damaged, hell you don’t need to really go through your insurance to pay for the repairs if you don’t want to, at least I think. And considering how many people I see in the city driving around with horribly damaged cars, I’d say I’m right. However if you are in a car accident, that involves other people, and you are the guilty party in the accident then it could end up being your insurance paying for the repairs to the other damaged cars.
I think—yes, my opinion only—that being able choose to go without health insurance is similarly inappropriate. If you get in an accident or get seriously ill, it can put you in massive debt, affecting more than just yourself.
I have, over several years, heard that particular point thrown out as if it were a foregone conclusion, a no-brainer: in a free country people should be able to choose to go without health insurance. There. ‘Nuff said. End of argument.
Maybe I don’t get it because I’m not American. Maybe if I grew up there, I’d get it. But I didn’t, and I don’t. So I’m asking, why is having the option to do without health insurance seen as a good thing?
Before you fix healthcare you have to fix immigration. Whether you go to a socialized system like England, or modify the existing system, the increase in population due to immigration has to be taken into account. If there’s no way to control the number of people who enter the country, there won’t be any way to plan for future expansion. This isn’t a rant against illegal immigration, it’s just the way I see it.
Belcatar, you make an excellent point. It will also require some tort reform as well.
This is NOT an easy thing that Americans are being asked to consider. It might be one of the more monumental projects this country will ever attempt, as it affects each and every person here, all 302 million of us, give or take 10-40 million illegal immigrants. :)
toby I’ll also add that I do not in anyway agree with the requirement of people having auto insurance. I’m not even sure if its a national mandate, or if its one of those feds bullying the states with “if you don’t require everyone to have car insurance we’ll withhold money.” Its required in my state and I don’t agree with it.
I just presented an argument for why it might be a requirement.
And if I still do go into debt for medical bills, its still none of the government’s fucking business.
That’s one of the problems with Moore’s films. He’ll take a complex problem that can’t be solved with one easy step and simplify it until it’s a black-and-white issue. Then he can paint the side that agrees with his simplistic view as the “good guys” and the people who disagree as “bad guys.”
You can’t separate economics, environment, population, and big, bloated, corrupt, nearly bankrupt government from the problems with health care. But that’s exactly what Moore seems to be doing in his film. Britain doesn’t have hordes of people sneaking in, and Cuba has hordes of people trying to sneak OUT, but none of this is mentioned. Things like that would muddy the water.
I think that if we concentrated on fixing basic problems, like keeping the government from spending more money than it takes in, and following that example ourselves, a lot of these complex problems would probably become a whole lot easier to solve.
I think that if we concentrated on fixing basic problems, like keeping the government from spending more money than it takes in, and following that example ourselves, a lot of these complex problems would probably become a whole lot easier to solve.
I wonder if it interest advocates of socialized medicine that an American family of 4 pays more in interest on the national debt that they do on health insurance? Maybe this is what we need . . . a huge unfundable universal health care system drowning the government that created it in a flood of ever-increasing interest payments and medical costs.
You know, the other day I was sitting here thinking about what I’m going to do with that extra $500 or $600 a month I will be saving on health insurance since liberals are so hell-bent on funding it for me with national universal health care system. I can’t buy a condo at the beach because of rising sea levels. I can’t buy a new house or SUV because I might go carbon positive. I can’t invest it in the stock market because I would be supporting greedy corporations making obscene profits.
I guess I’ll just buy some treasury notes and help suck the national coffers dry.
Also, Social Security, Medicare and Medicaid make up 40% of government outlays. So they already pay twice as much for THOSE services as they pay for federal debt interest, which as you said is already more than their insurance.
I don’t think immigration is as big a problem as you might think.
If you look at it this way;
The biggest problem for any government paid health system over the next 40 years will be the western world’s aging population. The baby boomers are getting old now.
As the population bubble moves into old age, theres going to be more elderly than there are young people to pay tax.
The leads to other problems like skills shortages in skilled workforce areas in the economy, leading to sluggish productivity growth and all sorts of other problems.
The most immediate way to solve the aging population and skills shortage problem is to encourage the legal immigration of skilled workers , and get to a position where illegal immigrants can be forced to pay tax if they cannot be forced to return to their homelands (for whatever reason).
In many ways immigration, both legal and illegal is seen by economists as an opportunity to offset the very real emergency they is resulting from low birth rates in the western world, and its resulting aging population.
Illegal immigration will increase the burden on social services that target the elderly and disabled, a system that is already strained and already lacking whatever contributions they might have made as legal workers in the interim. People in their financial situation could barely begin to pay the back taxes they would owe in such a scenario.
Sorry for two posts in a row, I just thought this would interest you.
It comes from the blog of a Social Democrat by the name of Professor John Quiggin. He was discussing the legacy of Thatcherism after Tony Blair, given that Tony Blair was essentially seen as Margaret Thatcher, with a human face, but the new guy Gordon Brown, and even David Cameron, the Tory leader are both in favor if what was seen under Tatcher and Reagan ad ‘big government intervention’.
He makes the interesting point that all the privatisation and opening up of our economies over the years has led to more government bureacracy, more laws and law enforcement channels. Privatisatiuon and so -called small government initiatives by Reagan and Thatcher have lead to more government in other areas.
In light of this, he makes this point:
In other respects, though, the battle over the size and role of the state seems to have gone fairly conclusively to the social democrats. The central institutions of the social-democratic settlement, such as the NHS, public education, and redistributive transfer payments are not only still in place but are growing in importance. It seems far more likely that the US will implement socialized medicine (at least in the form of universal public insurance) than that the UK will abandon it.
I don’t think we should stop allowing people to immigrate to the U.S. I think we need to have more control and more information. Legal immigration is great; it injects new life, new ideas and new energy into our country. But if we can’t project how many people are going to be here, we can’t make any plans for universal coverage.
Question for our Canadian friends: How does your country handle immigration? I don’t know anything about the laws north of the border.
To answer Belcatar’s question, immigrating to Canada can be a very lengthy, expensive process. Even more so than with the US. Even in the case of bringing a foreign spouse into the country is a pretty lengthy process. Not to mention that both the Canadian citizen and his/her spouse must be able to deposit $10,000 CAD in an account. You can end up waiting over a year. As far as regular immigration goes, i only know that it is also an expensive process with a long wait period, but am not sure how much more, or less, difficult it is.
And a question: Why is it that Americans keep using the UK and Canada as a measuring stick for nationalized health care? Sure, you see other countries pop up occasionally, but far less often. Both systems have their good points, but even within Europe, the NHS is kind of a joke. The system is pretty effective overall, but has more short comings than other national health care schemes. Every nationalized health care systems has its flaws, but stacked up against the US system, the cost-benefit for the consumer is far greater. Abuse of the system is one of the biggest problems (not the other horror stories that are being bandied about on here or on talk radio), which has led to countries like Germany to phase in a co-pay system. Plus, not all nationalized health care systems take the same approach as Canada or the UK.
Also, in Germany, there are multiple state-subsidized insurance companies, along with private companies. One can choose for themselves. Your company pays for a portion of the monthly fee and you pay a portion as well. Very similar to the system here in that regard. The co-pay was designed to curb abuse within the system, and as the payment steadily increases, it is having its desired effect. Not enough for some, but good enough to keep a lot more money in the system. You still have people that are denied treatment, but you also have cases where people are awarded crazy amounts of money for their treatment. However, you don’t have near the number of people that are denied treatment or coverage. In fact, everyone must have health insurance. You don’t have to pay a fine if you don’t have it and you can just as easily decide not to register for it as long as you’re not employed or are not receiving government assistance. You can also be denied coverage for a pre-existing condition for an amount of time if you change from private insurance to state-subsidized insurance.
One interesting turn of events that has taken place over the last several years is that people are opting out of their private insurance, which as in the US, can become more expensive as you age and require more services, to switch back to state-subsidized insurance. Private providers are also more likely to deny treatment than state-subsidized providers.
Basically, my point is that there are many other models to look at and take from than Canada’s and NHS. We have a problem and we need a solution. We can’t just keep sitting and waiting for the perfect solution to come along as we are doing with immigration legislation. We wait and fight and wait and fight and, meanwhile, the problem is worse than it has ever been and we’re no closer to solving the issue than we were 10 years ago. Nobody is going to be completely happy with any solution to either of these problems, but some amount of action has to be taken. Like it or not, health care and immigration policy over here is a big joke. It’s absolutely pathetic.
With health care, we really need to watch the system we have more closely and regulate it. We regulate almost every other industry in the US, despite our free-trade mantra, and the health industry should be no different. What matters is that everyone have access to health care and that children are covered. If adults want to take their chances, that’s all fine and good, but nobody should be allowed to gamble with the life of a child. Those that truly can’t afford health care should receive a subsidy from the government, not receive automatic free coverage. those that absolutely can’t afford any coverage and want it, should be able to get Medicaid as they do now. The option should exist for those that want it. We also need to put caps in place for the amount of medical expense a household is expected to take on. Nobody should ever have to file bankruptcy due to medical expenses. Seriously.
Lastly, as a person with a chronic illness who has lived in a country with nationalized health care and the US, I’d take my chances in a country with the former. Although imperfect, at least I wouldn’t continuously owe 15% or more of my monthly income for my treatment, despite the fact I have pretty good insurance. If you’d like a home-grown model on which to base any reform, use the VA system. Remember I said “model.” Good luck to everyone and I look forward to reading more mind-numbingly polarized debate by both sides of this issue.
I was reading an article on a nother blog earlier saying it is not uncommon for Britons go to France for health care.
Everything I have heard says France’s is above par, though I don’t know how theirs works.
Posted by Toby on 06/27/2007 at 01:15 PM (Link to this comment | )
“Maybe I don’t get it because I’m not American. Maybe if I grew up there, I’d get it. But I didn’t, and I don’t. So I’m asking, why is having the option to do without health insurance seen as a good thing?”
Its part of it… like JimK mentioned, its part of the libertarian mindset that no one should tell you to do anything (which I like btw)… and its a pervasive attitude that holds sway in parts of even non libertarians thoughts (re: its a meme over here).
But anyway, even though I am a full-blown libertarian… I think your right (the argument against compulsory insurance doesn’t hold up). If the public is going to get stuck paying your medical bills if you become ill, buy your own darn insurance… It’s a fine line between freedom and entitlement. If your 24, you can probably afford $65 a month for blue cross major medical vs. going out to a club one less time a month. So, spend your own money on it vs. expecting the public to cover you if you become sick.
Posted by gorgatron on 06/28/2007 at 10:41 AM (Link to this comment | )
And a question: Why is it that Americans keep using the UK and Canada as a measuring stick for nationalized health care?
English.
1) More English speakers come here to bother us about our system so we concentrate more on learning about their systems to fact check their claims.
2) We can easily get info on line about them since their records.. and the newspapers.. are in English…
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It’s got nothing to do with Stalinist Russia. My fear is that the American health system will turn into the NHS.