Free Market and Socialized Medicine - why not both?

[pinkwaxfish]

I am convinced that the free market would provide the best health care system if it were ever allowed to do so. Of course, we've had nothing like a free market in health care since the 1950s. First there were 'maximum wage' laws post WW2 that were meant to encourage hiring, but instead resulted in employers adding benefits like health insurance. Then health insurance became an entrenched interest, and insurance providers arranged for the government to leave that benefit untaxed, so it became standard. Then Medicare came about and kind of ruined everything.

Since the 1950's, state and federal agencies have added a huge maze of regulations governing all aspects of health care, making it into a paperwork nightmare that is total nonsense for doctors and patients. And lawyers have found that the courts are willing to award millions to people who want to sue their doctors. This in turn has resulted in higher costs, much more conservative medical practices, and a closed industry for providers of medical products.

States require insurance companies to cover all sorts of health issues, making insurance more expensive for everyone, especially healthy people. Now the federal government is getting in on that game too.

And all the while, the government keeps finding more ways to fund this mess. Governments now pay more for health care than consumers.

All this is to say we don't have a free market system at all. The USA just has its own uniquely stupid take on socialized medicine, and Obamacare is only making it more convoluted.

But it's a fantasy to think we could ever undo it. Voters aren't smart enough, the elderly benefit too much, and the interests are too powerful for us ever to unravel this mess and return to a free market system which would provide affordable, high quality health care for everyone.

What about a compromise? What if free market advocates drafted a plan where these things happened?
1) The US adopted a national health service, entirely funded by the government, ala Britain.
2) The same bill that created the national health service creates protected free market space for people who want to provide health care for a profit. The bill says that, so long as there is a national health service, there must also be space in the market for people to provide for-profit services with little to no regulation in a buyer beware environment. No federal, state, or local governments could restrict the activities of these companies, other than holding them to the law as it applies to every citizen. Voluntary interactions between patient and provider could be protected and they could do what they want.

That way, there would be a fully socialized system, which is what the voters want, and which we're already paying for, and there would be an opportunity for people to opt out of it if they're willing to pay.

 

[dblack]

This would have been a much better approach. But it doesn't give the corporatists centralized control over our health care - which in my view is the core motive of ACA and related reform efforts.

 

[Oddball]

Free Market and Socialized Medicine - why not both?

Because socialism relies upon coercion and and central control, while the free market utilizes consent and decentralized choices.

 

[Political Junky]

Free Market is available in some countries that have single payer, for those who want a private room and gourmet meals.

 

[boedicca]

Free Market and Socialized Medicine - why not both?

Because socialism relies upon coercion and and central control, while the free market utilizes consent and decentralized choices.

I'll add to that the promoters of Socialized Medicine will use the political process to rent seek/seek subsidies from the Free Market Medical Providers.

 

[pinkwaxfish]

Free Market and Socialized Medicine - why not both?

Because socialism relies upon coercion and and central control, while the free market utilizes consent and decentralized choices.

I'll add to that the promoters of Socialized Medicine will use the political process to rent seek/seek subsidies from the Free Market Medical Providers.

I'm sure that this is true, but I think, in the absence of a better solution (and I don't see anything good coming down from Washington anytime soon), I think some degree of protection for free market providers is possible. I'm thinking of how China legislated free markets in their special economic zones, and even though rent seekers and interest groups interfered in predictable fashion, they still got a lot of good out of those special economic zones.

 

[KissMy]

Who would ever pay for health-care after the EMTLA became law. After a while people started gaming the system & screwing the people with insurance or actually paid their medical bills.

 

[boedicca]

Because socialism relies upon coercion and and central control, while the free market utilizes consent and decentralized choices.

I'll add to that the promoters of Socialized Medicine will use the political process to rent seek/seek subsidies from the Free Market Medical Providers.

I'm sure that this is true, but I think, in the absence of a better solution (and I don't see anything good coming down from Washington anytime soon), I think some degree of protection for free market providers is possible. I'm thinking of how China legislated free markets in their special economic zones, and even though rent seekers and interest groups interfered in predictable fashion, they still got a lot of good out of those special economic zones.

In other words, you are advocating for a system in which the Private Providers have to pay protection money to politicians in order to minimize how much they are looted by Cronies.

 

[KissMy]

Free Market is available in some countries that have single payer, for those who want a private room and gourmet meals.

What about a key employee who needs medical services right away instead of waiting for all the Medicaid riff-raff to be serviced first. Canada & other countries have a real problem with wait times.

Wait times for patients 'worsening' You have to wait more than 6 months for knee surgery. That is really fucked-up when you have work to do.

 

[TakeAStepBack]

For the very simple reason that everyone would still have to pay the national system tax. They would never agree to people opting out. So free enterprise can not co-exist. Who would pay a heavy tax to fund the national system, and then pay again for a free system. The competition isn't there to keep such a free market option viable. It would quickly become a second choice monopoly. Because it would be those opposing the national service, but paying, and those who can't afford both.

 

[KissMy]

For the very simple reason that everyone would still have to pay the national system tax. They would never agree to people opting out. So free enterprise can not co-exist. Who would pay a heavy tax to fund the national system, and then pay again for a free system. The competition isn't there to keep such a free market option viable. It would quickly become a second choice monopoly. Because it would be those opposing the national service, but paying, and those who can't afford both.

Yes - That first Obamacare bill was a single payer government monopoly nightmare. The version that actually passed seems to allow people to keep their private health-care. The EMTLA freeloaders are the ones who will now have to pay their way making cost go down on us who have been paying their way all along. I got a check back from my health insurance company because treatment cost were lower than they had been & the new law makes them refund our excess premium if they did not actually spend 80% of it on healthcare. They can only keep up to 20% for management, profit & dividends.

 

[TakeAStepBack]

That's not what we're discussing cork. But good observations? Start a thread.

 

[pinkwaxfish]

I'll add to that the promoters of Socialized Medicine will use the political process to rent seek/seek subsidies from the Free Market Medical Providers.

I'm sure that this is true, but I think, in the absence of a better solution (and I don't see anything good coming down from Washington anytime soon), I think some degree of protection for free market providers is possible. I'm thinking of how China legislated free markets in their special economic zones, and even though rent seekers and interest groups interfered in predictable fashion, they still got a lot of good out of those special economic zones.

In other words, you are advocating for a system in which the Private Providers have to pay protection money to politicians in order to minimize how much they are looted by Cronies.

I suppose so, yes, but with the caveat that this is a proposal meant to deal with the reality that government will never back out of health care, no matter how persuasive we are that a free market is better.

 

[pinkwaxfish]

For the very simple reason that everyone would still have to pay the national system tax. They would never agree to people opting out. So free enterprise can not co-exist. Who would pay a heavy tax to fund the national system, and then pay again for a free system. The competition isn't there to keep such a free market option viable. It would quickly become a second choice monopoly. Because it would be those opposing the national service, but paying, and those who can't afford both.

But I think this does happen. We do pay a heavy tax to fund a national system now, and people spend extraordinary amounts of money on whatever health care they can get their hands on outside of the system in a desperate attempt to get some sort of decent medical attention. Right now, only alternative health is free from onerous regulation so it can thrive, and people go to acupuncturists and chiropractors in droves.

 

[Dragonlady]

Yes - That first Obamacare bill was a single payer government monopoly nightmare. The version that actually passed seems to allow people to keep their private health-care. The EMTLA freeloaders are the ones who will now have to pay their way making cost go down on us who have been paying their way all along. I got a check back from my health insurance company because treatment cost were lower than they had been & the new law makes them refund our excess premium if they did not actually spend 80% of it on healthcare. They can only keep up to 20% for management, profit & dividends.

Close, but no cigar. The first version had a government policy option, not a monopoly. People could keep their existing insurance or go to the government option. The Republicans were having none of that and the government option was taken off the table. The big fear, I think was that everyone would stampede to the government option and the insurance companies would be forced to lower prices or go out of business.

In Canada we have a mix of government and free market. The doctors have private practices and people are free to chose whoever they want. Doctors run their practices at their own discretion, but they bill OHIP (in Ontario) for all patient visits at rates negotiated between the province and the CMA. Each province runs it's own health insurance program, but all must conform to the Canada Health Act which was the founding legislation for Canadian health care. "Extra billing", that is billing the patients over and above the OHIP fee schedule, is not allowed.

Testing labs and clinics are also owned and operated by private corporations. Our pediatrician is a partner with others in a Children's After Hours Clinic, in addition to his private practice. Most hospitals are municipally owned but there are others which are privately owned. Of the big downtown Toronto hospitals, I think Mt. Sinai is privately owned, St. Michaels belongs to the Catholic Church, but Toronto General, Toronto Western, and Sick Kids are municipally owned. Again they bill OHIP for patient stays and there are no co-pays for treatment.

Each person working in Ontario pays $25.00 per month to OHIP via payroll deduction. In addition, Ontario employers pay the Employer Health Tax based on their employees' salaries. The rates of tax vary from .98% on total remuneration less than $200,000, up to 1.95% for remuneration in excess of $400,000.

OHIP covers doctor visits, lab tests, and hospital stays (and all charges related thereto) but there are no co-pays, no pre-approvals are required, and patients complete ZERO paperwork. Doctors, clinics, labs and hospitals have a list of approved drugs and treatments, and reimbursement rates. Prescription drugs and dental care is not covered except for seniors and those on welfare, and chiropractors, physio therapists (other than in the hospital), and eye examinations are not covered at all. It should be noted OHIP does not cover plastic surgery unless medically necessary, in-vitro fertilization, or other elective treatments.

For those things which OHIP doesn't cover, we have supplemental insurance through a private insurance company (ours is Manulife) which covers prescriptions, dental, semi-private hospital rooms, physio therapy, massage therapy, chiropractors and eye glasses. We have a plastic swipe card which looks like a credit card and when we go to the dentist or pharmacy, they swipe and that automatically bills our insurance company. Again there is no paperwork to complete, but there is a co-pay of 15% on the dental, and $5 per prescription. Pre-approvals are recommended (but not required) before major dental work, but otherwise not. We do have to complete claims forms for places which don't accept the swipe card, but the insurance companies have all agreed to use the same standard claim form so they're easy to fill out.

Payment for supplemental insurance varies. Some employers pay it all, some pay part, and some pay nothing, making the group insurance available to their employees at the company's rate and remitting premiums on their behalf. The law firm I worked for used to pay for my coverage, and I paid the additional amount to cover my family. That was $120 per month. When I retired, we switched to my husband's supplemental but his employer pays nothing. We pay $190 per month for that. We could purchase our own individual insurance but the group is cheaper.

The government sets hospital budgets, negotiates rates of reimbursement with doctors, labs and hospitals, and appoints health care professionals to regional boards to
co-ordinate services throughout geographic areas. They also process and pay all OHIP claims from doctors, clinics labs and hospitals. But they otherwise stay completely out of the doctor/patient relationship.

Advantages: It's seamless. There are no limits or caps on treatment. If I get sick, I call the doctor, go to his office, get treatment, go home and get well. I don't have to fill out paperwork, or fight with the insurance company over what they will and will not pay, and neither does my doctor. My doctor doesn't have to hire a third party billing company to manage his collections. He shares a receptionist and a nurse with two other doctors and the receptionist handles all of the billing. Similarly, hospital billing departments are the smallest department in the hospital, because of the ease and simplicity of the billing process. The result is that administration costs for medical care in Canada are less than half what they are in the US. Doctors who have practiced in both countries have said that they make more money in the US, but they get to keep more of what they make in Canada, and without the hassle of pre-approvals and fighting with insurance companies, they can spend more time seeing patients. Malpractice premiums are also lower.

Canada spend just over $4,000 per capita on health care per year, a little more than half what the US spends. We have universal coverage and we have access to any hospital or treatment facility with space for us. I know a lot of doctors and hospitals in the US won't accept Medicare or Medicaid patients. That's not allowed in Canada. Doctors and hospitals can't opt out.

Disadvantages: Lets talk about waiting times since that's already been mentioned. Yes, it's an issue but reading the link that was posted, these are regional, not systemic issues. Joint replacement is, admittedly slow due to a shortage of orthopedic surgeons. Reading the link, I gather there are no orthopods in PEI (a Province smaller than Rhode Island). Of course it's easy for me so say this because my Province got a A across the board on wait times.

New or experimental treatments are not covered and it takes time to get them listed. You can apply for a special permit from the Minister of Health to get the treatment you want covered but the process is slow and you're probably further ahead to just go to the US and pay for it yourself, if you can afford it.

There are also shortages of primary care physicians in some remote regions and the government is offering incentives to doctors who chose to practice in low density areas of northern Canada. Costs are increasing, and resources are not. As the Boomers age, this situation is not going to get better, but the US is also facing similar issues.

Myths about Canadian Heath Care: There are not and have never been "death panels" in Canada nor is treatment rationed. My husband's 90+ plus year old grandmother was treated for cancer with surgery and chemotherapy in the late 1990's, even though she had advanced Alzheimers and wasn't expected to live for much longer before she was diagnosed with cancer, and no longer recognized us when we visited. My mother-in-law, who is now 85, just had a consultation an orthopod for a hip replacement. I was shocked that she got in to see him in under 5 weeks.

Waiting times have been grossly exaggerated, which is not to say there aren't problems in some fields, especially orthopedic surgery. Is the system perfect - no, not even close, but Canadians, overall love their health care. More than 80% of Canadians are very or somewhat satisfied with their health care.

We have lower child mortality rates, and Canadians live longer than Americans, in part because we get regular check-ups and preventative care.

Do people go to the US for treatment? Yes they do, but not that many. There are just as many Americans coming to Canada for treatment - it's cheaper, the quality of care is just as good, and we have some of the most advanced medical research in the world going on here.

Would our system work in the US? At this point, I don't think so. Doctors would never agree to the pricing regulations, and the insurance companies will never give up their massive profits.

 

[KissMy]

Yes - That first Obamacare bill was a single payer government monopoly nightmare. The version that actually passed seems to allow people to keep their private health-care. The EMTLA freeloaders are the ones who will now have to pay their way making cost go down on us who have been paying their way all along. I got a check back from my health insurance company because treatment cost were lower than they had been & the new law makes them refund our excess premium if they did not actually spend 80% of it on healthcare. They can only keep up to 20% for management, profit & dividends.

Close, but no cigar. The first version had a government policy option, not a monopoly. People could keep their existing insurance or go to the government option. The Republicans were having none of that and the government option was taken off the table. The big fear, I think was that everyone would stampede to the government option and the insurance companies would be forced to lower prices or go out of business.

I stopped reading your post at this paragraph. Go read H.R.3200 page 6 & I forget what other pages right now. It was designed to kill off all health insurance companies forcing everyone onto the "government option"! If someone became uninsured at any point in time for any reason, they had to go onto the government plan & could not go back to private insurance.

This would cause people to get knocked off insurance companies causing them to lose more & more revenue until they went under causing all their customers to instantly be thrown into the "government option" where they would remain trapped.

The was no OPTION in the "government option" Now there is an option even if you are on the government plan. If you get tired of being treated like government sheeple, you can get private insurance & leave that mess behind.

 

[KissMy]

...Wait times. Yes, it's an issue but reading the link that was posted, these are regional, not systemic issues. Joint replacement is, admittedly slow due to a shortage of orthopedic surgeons. Reading the link, I gather there are no orthopods in PEI (a Province smaller than Rhode Island). Of course it's easy for me so say this because my Province got a A across the board on wait times.

New or experimental treatments are not covered and it takes time to get them listed. You can apply for a special permit from the Minister of Health to get the treatment you want covered but the process is slow and you're probably further ahead to just go to the US and pay for it yourself, if you can afford it.

There are also shortages of primary care physicians in some remote regions and the government is offering incentives to doctors who chose to practice in low density areas of northern Canada. Costs are increasing, and resources are not. As the Boomers age, this situation is not going to get better, but the US is also facing similar issues.

Ok I read the rest.

That shit ain't going to cut it here in the USA. Also if we imposed the government system here & had longer wait times, you Canadians would not be able to simply run over here to the USA to get treated because you would have to wait here also. This would further burden your system with all the Canadian people currently being treated here in the USA.

 

[Dragonlady]

That shit ain't going to cut it here in the USA. Also if we imposed the government system here & had longer wait times, you Canadians would not be able to simply run over here to the USA to get treated because you would have to wait here also. This would further burden your system with all the Canadian people currently being treated here in the USA.

Canadians are NOT go to the US in large numbers for treatment - that's another myth the medical lobby tells you to make you so you'll be frightened of changing over to a single payer system.

A lot of Canadians travel to the US and sometimes they get sick while they're there, just as Americans get sick and are treated when they come to Canada. Other than a couple of high-profile politicians, I personally don't know a single person who has gone to the US specifically for medical treatment, but I know of a lot of people who have gotten sick or injured in the US while there for business, visiting family or on vacation, including a close friend whose husband had a heart attack while they were in Florida. When his condition stabilized, he returned to Toronto where he was treated at the Schulich Heart Treatment Centre, one of the leading heart research centres in the World:

About Schulich Heart Centre - Sunnybrook Hospital

A lot of Americans come to Toronto for treatment there. My friend said her husband absolutely did not want to be treated in Florida, and commented that the standard of care there was inferior to what he received at home.

Thousands of elderly Canadian "snowbirds" winter in Florida and Arizona so yes, lots Canadians do receive medical treatment in the US but studies show that three quarters of Canadians who seek medical treatment in the US, went to the US for other reasons.

Conversely, thousand of Americans cross the border into Canadian to obtain AFFORDABLE health care, including Sarah Palin:

Palin Admits To Travelling To Canada For Health Care | ThinkProgress

If Canadian health care was as bad as you make it out to be, Canadians would be screaming for US style health care but they're not. In fact over 80% of Canadians LOVE their health care, myself included, and we've fought vigorously to keep US style health care out of Canada.

You people are nuts to put up with all pre-approvals, caps, co-pays and all of the other shit you're clinging to. Insurance companies are your friends until you have a claim and then their primary goal is to mitigate that loss and keep their payout to the least amount possible. Insurance companies are making your treatment decisions by limiting what tests and treatments they will cover and what they won't.

I may have a wait a bit longer, but nobody tells my doctor how to test or treat his patients.

 

[KissMy]

That shit ain't going to cut it here in the USA. Also if we imposed the government system here & had longer wait times, you Canadians would not be able to simply run over here to the USA to get treated because you would have to wait here also. This would further burden your system with all the Canadian people currently being treated here in the USA.

Canadians are NOT go to the US in large numbers for treatment - that's another myth the medical lobby tells you to make you so you'll be frightened of changing over to a single payer system.

Report: Thousands fled Canada for health care in 2011

"The nonpartisan Fraser Institute reported that 46,159 Canadians sought medical treatment outside of Canada in 2011, as wait times increased 104 percent — more than double — compared with statistics from 1993."

 

[Greenbeard]

I stopped reading your post at this paragraph. Go read H.R.3200 page 6 & I forget what other pages right now. It was designed to kill off all health insurance companies forcing everyone onto the "government option"! If someone became uninsured at any point in time for any reason, they had to go onto the government plan & could not go back to private insurance.

Bullshit. Not only did H.R. 3200 not saying anything anywhere about forcing anyone to choose the public option, it explicitly clarified that no one is ever required to enroll in the public option.

SEC. 229. ENROLLMENT IN PUBLIC HEALTH INSURANCE OPTION IS VOLUNTARY.
Nothing in this division shall be construed as requiring anyone to enroll in the public health insurance option. Enrollment in such option is voluntary.

That bill's been dead for over three years and yet the lies linger on.