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Journal eglamkowski's Journal: On nationalized health care 34

The government ALREADY runs the two biggest health care systems in the country. Medicare and the Veteran's Administration. Both are failures, and have been for a long time:

In 1965, when medicare was first introduced, they estimated that in 1990, it would cost $9 billion. The actual amount spent in 1990 ended up being $66 billion. In 2000 the cost of medicare was $200 billion. It is clearly out of control. Just you wait to see how much the new prescription drug plan ends up REALLY costing!



And that's all just medicare. When it comes to the VA, ask a veteran just how good a service he gets from the Veteran's Administration and the VA Hospitals. Oh wait, it may be hard to find such veterans, since 90% of eligible veterans choose private insurance! Why in the world do you suppose that is, choosing insurance they have to pay for out of their own pocket over insurance that doesn't (directly) cost them a penny...

But still, people push for nationalizing health care despite these two proven failures. Why in the world do you NHS supporters fancy that a third system be successful? Why would a universal health care system magically work, when the track record is one of PROVEN failure?

You're just engaging in so much wishful thinking with no real foundation in reality.

Sure, the VA may be underfunded, but the government can't pay for social security, either. What makes you think they can come up with the cash for a universal health care system? You think the VA system is underfunded, a universal health care system would go bankrupt almost immediately.

Look at the amount of corruption and fraud in medicare - to the tune of billions per year. A universal system would be subject to abuses the likes of which have never been seen in this country. Costs will rapidly spiral out of control beyond even what the most conservative folks estimate (Medicare sure has!). It will go bankrupt quickly. I don't even want to contemplate the impact that would have on the health care we do have today.

The health care industry today represents 14% of the GDP. The government already controls 20% of the US GDP. Do we really want the government to control 1/3 of the US economy? And once the government has control of health care, they will NEVER let it go.

Assuming a third program can succeed where two others have failed is just pure folly. Assuming the third program will succeed on the grounds that it will be even bigger than anything the first two attempted is the sheer height of insanity. That's not a guarntee for success, that's a prescription for catastrophic failure that will make the Great Depression look tiny.

Gee, medicare is failing, so let's create a VA system that's even bigger! Because it's bigger, it'll be bound to succeed!

Oops, the VA hospitals are failing, so let's create a new universal system that's bigger still! Surely it won't also fail! It's BIGGER! Just like the VA was bigger than Medicare! And look how well it worked out.

You people who advocate nationalized health care frighten me.

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On nationalized health care

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  • Why would a universal health care system magically work, when the track record is one of PROVEN failure?

    Because, this time, a compassionate conservative (wink wink) will do it right!

    Sorry, I'm feeling particularly sarcastic today.
  • I wouldn't exactly say I'm for nationalized health care. But I'm not so sure that medicare is the complete failure you make it out to be. While Medicare may cost way more than anticipated, that appears to be due to factors other than inefficiency. I think it's interesting to note that public health plans worldwide are generally more efficient at delivering input dollars to health care services than private health plans are. I have a comment on the subject with a number of links here, [slashdot.org] and a link to an articl
    • Efficiency in delivering input dollars to health care services is half the story. The other half is, how good are the health care services that it buys?
      • Well, yeah. There's more to the efficiency equation. But at our (private) clinic, we deliver the same services to all customers, including Medicaid subscribers. We just bill different payors.

        We are a bit rare that way. Public reimbursements are so low that many private clinics choose not to service Medicaid subscribers as patients at all. The patients those clinics turn away then have to find a private practice that accepts them or go to a county public health clinic to get (often poor) service. If the publ
        • Why would quality of care be lower at a health department? The providers, from nurses aides to the docs are certified just the same as a private practice. The medicines they prescribe are the same as a private practice doc would. So what makes it different? What makes you think nationalized health care wouldn't sink to the levels of care that you think a health department provides now?
          • Well, gosh. Now that you mention it, you're right! Maybe JesseL up there had better show some proof that public health services are less good than private ones, eh?

            That was my point, actually. :-)

            Our docs don't deliver different services based on payor. There's some variance due to drug formularies and whatnot, but generally speaking an office visit is the same for all patients. This is probably more-or-less true for private clinics generally. And as you say, there's no reason to think that public clinics a
            • There are several issues here:

              1) if the government is paying for it, they decide how much they are going to pay. This depends on exactly how much control over the system the feds decide to claim, of course, but if all doctors and nurses wind up as government employees, then salaries become federal decisions. If the feds don't pay as much as private doctors can make now, the incentive to become a doctor will be diminished for many, thus the quality of doctor's has the potential to fall sharply. This has a
              • Fair enough. But... none of that applies to Medicaid as it currently exists.

                (From the provider's point of view, it's basically just another payor with slightly-more-peculiar-than-average rules and poor reimbusements. So far as I know, Medicaid does not employ any providers nor require that patients see particular providers. It's market forces which restrict patients' choice of providers, 'cause not all providers will work for Medicaid's low reimbursements.)

                That all might apply to some hypothetical nationali
                • I've got no comment on medicaid since it is a state level program, not a federal one. Yes, it has federal aspects to it, but it's primarily state driven.

                  So we're talking past each other here...
                  • Well, all right. Let's look at Medicare then.

                    First, there's efficiency... what percentage of input dollars are lost to overhead (and fraud, etc.) instead of spent on healthcare? The WHO's report surely included the VA, Medicare, and Medicaid when it stated that public systems tend to run around 4% overhead. Since Medicare is such a huge expense, that overall 4% number is probably pretty close to Medicare's efficiency number... if it is dramatically less efficient, it'd take a whole lot of super-efficient pu
            • Medicaid is a state program and I don't have a problem with it in the context of my original complaint, which is directed at a FEDERAL program.

              Consider also:

              Logic cannot support the premise that health care is a right. Health care is a service that is administered by another human being with the requisite skills and knowledge. To claim that healthcare as a "right" is to claim a right to the services of the health-care provider. In effect, this means you are claiming a "right" to a portion of that person's l
              • "Medicaid is a state program and I don't have a problem with it in the context of my original complaint, which is directed at a FEDERAL program."

                Medicaid is a Federal-State partnership; the feds provide a lot of the funding and set a lot of the rules. I strongly suspect that everything I have said about Medicaid also applies to Medicare, but I have no experience with it so I'm not addressing it.

                (VA... that's a different story. They are a provider as well as a payor. As Jules said in Pulp Fiction, "it's not
  • I see it all the time but i don't get it. How does anyone think that a government can manage anything any better than any other group of people (including private industry, charities, mafia, sewing circles, etc.)? The only thing that government can do that no one else can, is to throw you in jail if you don't go along with them.
    • Well, ideally (and I've yet to see any government that is this ideal) they also provide an organization without a profit motive. The problem is that instead of the profit motive, they have a power motive. What would be far better is a government that doesn't have either a profit or a power motive- or maybe no motives at all. I'm talking about automation of course- big if-then-else expert systems that give us answers to complex questions about what government can and can't provide- and that do nothing els
      • I wouldn't want 100% automation. At the very least, people who are at the thresholds of the various categorizations into which the process would ultimately have to place people should be reviewed by a human.
        But even then I'm not really very comfortable with it.
        I'd rather people just be allowed to provide for their own health care as they see fit. No government involvement at all.
        • I'd rather people just be allowed to provide for their own health care as they see fit. No government involvement at all.

          Well, the current system shows that idea is ripe for the plucking- what that will guarantee is a field day for the type of people who think that charging $400 for a pill that cost them $.20 is moral. Health care is complex enough to have it's own natural barriers to entry, secrecy until after the fact about cost, and maybe worst of all, a severe lack of competition. All of these mean
    • I'm content to concede military as a government function. Private individuals can't raise the kind of money needed to fund a private, modern army capable of providing for national defense.
      Even Microsoft doesn't have enough money to do it.
      • Private individuals do raise the kind of money needed to fund our national defense. Where else would the money be coming from?
        • Bush's 2007 budget has proposed $439 billion dollars for defense.

          Who in the world can come up with that kind of money for a private army?


          Sure, collectively we all can contribute a little bit and raise that much, but that's exactly what the government does, and it's one case I feel the government is ok to take on that role as doer.
          • So, some things are just too important not to strongarm everyone into participating? I'm afraid that line of reasoning will never sit right with me.
            • Are you suggesting that we could have/should have relied upon privately raised armies and navies to defeat the Japanese Empire in WWII? Surely you jest!

              National defense is something of a unique endeavor. Thus I allow it an exception for being done at the federal level.
              • I don't really see what's so outrageous about the idea of independantly funded, commited, citizenry taking on and defeating an invading nation with an apparently superior military. It's how this nation was born.

                There are also cliched examples like Vietnam and Afgahnistan. Before you point out that they were backed by well-funded superpowers, let me point out that they also didn't have anything like the native technical, economic, and industrial bases that the US enjoys.

                Of course, having a national defense s
              • I think you're missing the point he's trying to raise, a purely defensive army is cost achievable for a private group. An offensive army is what casues problem since we don't practice total war anymore.

                Total war in the sense of wipe the other dude off the face of the earth, enslave their populace and drain their land of resources, not that I'm advocating going back to that standard.
                • And yet, in another WWII style situation, a privately funded army would not be capable of achieving the necessary goal. Simply keeping the Japanese off of US soil wouldn't have been enough. The Japanese would have LOVED if that's all we did. They would have picked up colonies over the whole Pacific and Asia, and then eventually when they were strong enough they could have attempted an invasion of the USA. And since we're eliminating US offensive capability completely, that leaves Germany free to complet
  • In 1965 we had a functioning border control system, and illegal immigrants were not allowed to participate. By 1990 that had completely flip flopped- and by 2006 Medicare is being wiped out by 11-12 million people who shouldn't be on it.

    The other thing is that when you compare Medicare to Private Insurance, it's a complete success- 2% overhead (as in, 98 cents of every dollar that goes to Medicare is spent on health care for the recipients) compared with 15-20% overhead (depending on the company and how m
    • It's 2% only if you don't include the cost of fraud, waste, mistakes, mismanagement and incompetence as "overhead". Tack that $12 Billion dollars on as "overhead" and it won't look so good.

      Yeah, you get these problems in private health care too, but they have a strong incentive to reduce and eliminate it as much as possible, which the federal government does not (and they don't) and ultimately you can sue private companies and individuals over such things. You can't sue the US Government unless they speci
      • It's 2% only if you don't include the cost of fraud, waste, mistakes, mismanagement and incompetence as "overhead". Tack that $12 Billion dollars on as "overhead" and it won't look so good.

        Actually, since $12 billion is about 18% of $66 billion, that makes it look EXACTLY THE SAME as the worst private insurance companies.

        Yeah, you get these problems in private health care too, but they have a strong incentive to reduce and eliminate it as much as possible, which the federal government does not (and they
      • "It's 2% only if you don't include the cost of fraud, waste, mistakes, mismanagement and incompetence as "overhead". Tack that $12 Billion dollars on as "overhead" and it won't look so good."

        So you're saying that there's $12 billion in annual fraud in Medicaid? I have no idea of the truth of that claim, but let's take it as a given.

        A quick search on google finds a claim [seniorjournal.com] that Medicaid cost Federal and State governments combined about $300 billion per year around 2004. $12 bilion is about 4% of $300 billion.
  • Why would National Healthcare work third time around? Because when its instituted it will have to. The biggest burden on business and government at every level right now is the cost of benefits for workers. The University system in Oregon is currently spending Half of its budget on insurance. I may be wrong, its been known to happen, but the biggest drain on the US economy is insurance. So either force insurance companies into being not for profit, or something radical will have to change for the conti
    • Of course, the whole problem was created by government in the first place. So asking the government to fix the problem they created is.. um... a disaster waiting to happen.


      Once upon a time, people paid for their own health care out of their own pocket.
      During WWII, FDR mandated a wage freeze. One of the ways businesses were able to get around the wage freeze was with "benefits", health care coverage being chief among them. This eventually created the expectation that individuals should no longer hav
      • Government IS the problem.

        Assuming that you are 100% correct, and that having National Healthcare is the worst possible scenario. What do we do about spiraling health costs? How do we keep insurance from draining so much of our household incomes? Frankly, the only solution I see is Ntional Healthcare, but if there is an alternative, then I really would like to be able to mull it over.

        • Stop corporate political donations, that would help.

          Holloway's campaign finanace bill:
          If you are an eligible voter, you are an eligible contributer of unlimited funds to a political campaign, otherwise, piss off.
        • Buy insurance that will only cover catastrophic problems. Going to the doctor every time you (by which I mean "you" generically, not necessarily you personally) have a sniffle is far more expensive than that $10 copay you have. But, since you don't see any more than that $10 (or $20 or whatever minimal amount it may be), you don't understand the true cost of the visit, so you think nothing of it. And thus you keep going to the doctor for trivial things when it isn't really necessary or warranted, not rea

Riches cover a multitude of woes. -- Menander