I have written and rewritten a reply to this, but any response I give will be too overtly political for this forum and I promised I wouldn’t go there. This is a shame perhaps, as I would otherwise answer at least some of your objections.
My wife also has a horrible thing, for which she is treated by the NHS. By your model she would be abandoned, for we cannot, and never have been able to afford private health care (and we are in a better position than many in this country) (I know you are not advocating personally for this )
So I’ll just say that many ways or running a country are possible and affordable, but the choices made are always made by a few, and that few either are, or are funded by, a small group of people who have most of the cash already, so it’s no surprise that choices tend to benefit those making the choices (and their backers) the most. I see that as (regrettable) side of human nature.
I once again point everyone to the model established by the NHS, which was effective and sustainable for many years, as long as the will to maintain it genuinely existed. Sadly it no longer does.
Remember, it’s not supposed to be “other peoples’ money” it is supposed to be all our shared wealth and prosperity, otherwise we abandon a large proportion of the popn. to dying untreated of often easily treatable diseases.
Meantime I wish your wife (and all of us) the very best of health, however it may be funded
well, yes, and that’s my point. Insurance works best (in any area, not just health) works best if the risk and benefit is shared amongst all.
the more we allow insurance companies to reduce the pool, the less useful (to society, as opposed to individuals) that insurance becomes.
i would even suggest that e.g. insurance companies that only insure a certain age group of driver is a bad idea for society, even though it benefits the smaller pool with lower premiums.
So following your line of reasoning people who by choice are “safe drivers” should share the cost of car insurance drivers with those that don’t. And with health insurance those that chose to work to get ahead in life should share the health insurance cost of those that do the bare minimum to get by?
It is discouraging when discussions like this end up as arguments between extreme positions. This should not be a simplistic argument between socialism and capitalism because any reasonable solution to designing effective and efficient health care systems must combine elements of both.
If you haven’t looked at the U.S. Constitution recently, you may have forgotten (as did I) that the drafters of the document wanted to "form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity… It doesn’t say “promote the welfare of only those people who have enough money to afford it,” so some type of program that depends on society to look out for the welfare of everyone, including those who are poor or disabled, needs to be part of the plan.
Good arguments can be made for what could be called “competition with a safety net” - neither pure socialism nor pure capitalism. The 2-tier system that has evolved in Canada and the U.S. system of Medicare for older citizens (supplemented if you can afford it by other insurance) would be examples of this approach. Even within traditional Medicare, hospitals and health care professionals can compete for patients by working to provide better care so that they can attract more patients. The arguments for reduced paperwork demands on providers in any system are strong, and the dirty little secret behind the “efficiency” of private vs. public insurers is that private plans too often use paperwork to justify denial of care, which keeps costs down and profits up.
We certainly aren’t going to create the perfect health care system on an audio forum, but it would be wise to promote realistic solutions to this major societal problem rather than continuing to argue over whether either socialism or capitalism on its own can solve this problem.
An American policy wonk dies after a lifetime specializing in public health issues. When he gets to heaven, he’s told he’ll have an audience with God, of whom he can ask one question. So he thinks about it carefully, and when his time arrives, he asks God, “will we ever have universal health care in America?” “Yes,” God replies, “but not in my lifetime.”
e.g. I am disabled (and have been for some time. I cannot work).
Also note that in many instances those that are working the hardest (2 / 3 jobs, no time of their own, etc. etc.) are paid the least and suffering the worst health and healthcare.
I try not to take an extreme view, and I don’t have a problem with capitalism or socialism, just the extreme forms of both.
But very specifically on healthcare:
“Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune the cost of which should be shared by the community.”
Again, this quotation, in just 20 words, demonstrates the absurdity of paying for healthcare. Why should someone with more money deserve to live longer than someone with less? Why should lack of means have any affect on health and well-being?
Also note - (just to prove I’m not anti-capitalist) that second quote is a link to a tea towel you can buy with this quote on
Privately-owned hospitals may turn away patients in a non-emergency, but public hospitals cannot refuse care . … This means that a public hospital is the best option for those without health insurance or the means to pay for care .
According to federal law, under the Emergency Medical Treatment and Labor Act, any patient who is hospitalized needing emergency care must be treated regardless of the circumstances, including that person’s insurance status or ability to pay. Providers can be fined and even prosecuted for violations of the statute.
A lot of us already know this. But sometimes it tugs better on heartstrings–or guilt–to pretend this doesn’t exist.
I think that is part of the healthcare workers oath but not sure.
I do know that if you go to the ER you will not be refused service and billing is negotiable once issued. My daughter in law is an NP at a nearby public (for profit) hospital system.
What seems strange is that they operate on a 1% to 2% net profit margin. That’s way too close to the edge for me.
Interesting (and yes this is not shouted about) - how does that play out for “non-emergency” stuff (genuine question)?
e.g. a hernia, or one of the many other “elective” bits of surgery, which could potentially include cancer ops etc. that are not ER stuff, but still have a massive effect on someone’s life?
Also mental health care etc.
Does it also get done for free in extremis, or do they wait until it is an emergency (which is often too late to actually save or extend their life)?
Again - genuine question, I don’t live in the US
These are the kind of things that are taking longer and longer in the UK as the NHS is slowly wound down, meaning more and more folks suffer (and often die) whilst waiting.
Hmmm - looks like it will fix you if you fall over, but not do any proactive stuff.
I have never had to use an ER, so my question stands.
If I have a strange lump I’m concerned about, or Diabetes, or Epilepsy, or any other long term condition, if I can’t pay, I don’t get treatment until it is too late.
(And I do know folks in the US with this kind of stuff, sometimes they die simply because they can’t afford the treatment).
Effectively, if I and my family lived in US, I would be dying or dead by now, or am I missing something?
It’s a sobering thought.
(and not a specific dig at the US either - the UK is heading this way it seems)
Yes, of course, although a lot of people more knowledgeable than you or I strongly disagree with both Mr. Friedman and you.
These include rejecting Mr. Friedman’s definitions of liberty, etc. which, if not accepted, undermine his analysis. Some additionally label Mr. Friedman a socialist, which illustrates how there appears not to be a clear definition of socialism.
I am far from being a socialist, but find the “inherently flawed” belief to be just that; a belief, not an absolute inviolate truth.
A statement which does not assist the discussion.
But I am interested in your comment regarding history. Do you assert there has been a true socialist society? If so, which? And how do you define socialism?
Agreed. And the discussion of socialism has taken us far afield of how best to pay for health care.
It means exactly as much as @speed-racer 's initial parallel declaration.
Note I make no comment as to who is, or is not, more knowledgeable than Mr Friedman, just more knowledgeable than @speed-racer and I - which is a low bar.
I know. I’m just bored. The weather is crummy and Fedex LOST my Pass phono preamp. ROAR!!!
Oh–and I have a masters in economics and Milton thought issues much further through than most.
)
