Monday, July 27, 2009

Health care, cars, and your local fire department

Is health care something like a car, which most of us think we can have only if we can afford one, or like having a fire department available to put a fire out if your house in burning down, which is and, we think should be paid for by the government.


Anonymous said...

Not much of an analogy in the direction it was intended, I think.

First, not all cities pay for fire department services by taxation alone. Service calls are billed-- to the fire insurance or to the home owner.

That situation would be more like a state owned and operated hospital that billed patients individually for their care, even though taxes paid for some of its overhead.

Second, health care in the US includes a lot of coverage for non-catastrophic, non-emergenc care. That would be like expecting the fire department to do most of your home repairs and maintenance.

So, health care may be something the government should cover in many instances, but, as it is implemented in much of the developed world, it is a much more comprehensive thing in its interaction with human illness than any fire department would dream of doing with the variously distressed homes in their district.

Steven Carr said...

'That would be like expecting the fire department to do most of your home repairs and maintenance.'

A good analogy.

Real estate from Toronto said...

The government never pays for the health care. It's you who does, either directly through premiums (private) or through taxes (public).

The real question is: should the health care be made available to those who would not be able to access it in the case of private mode?

In other words: should each pay for themselves or should the money of most be used for the better good of all people?


Anonymous said...

Of course Victor probably thinks the rich should be taxed so that all can have cars, but leave that alone for the moment . . .

Another problem would be that when many houses are on fire, firemen pick and chose which ones they will save and spend their resources on. If you're not deemed worthy of the effort, you don't get firemen at your house. I know this first hand living in SoCal and dealing with all the fires. I also used work for insurance companies doing fire damage remediation, so I have first hand knowledge. What was interesting was to watch the news during the fires. You would see home owners trying to fight fires at their home while fireman were there, but chose to save another house. The firemen interviewed said they had to make choices on where to spend their minited resources (and one thing we know from liberals, 'cause they harp on it, is that resources are finite).

Gordon Knight said...

I don't see how the limited resources point applies especially to a public system. It applies to any sort of system.

It is true that in the end "we" pay,but there are different ways of paying. You can have a system as we have now, in which some people, like me, have good insurance coverage, others less good coverage, others no coverage at all. In this system, I pretty much get what I want and its no pain to my pocketbook. But for everyone else, the situation is horrific. There are those who think they have insurance, have paid for years, and then are no longer covered because of some technicality. Then there are those who have no insurance at all, who thereby avoid visiting a physician except in cases of dire need (and often, in the not-so-cheap emergency room). The latter practice not only affects the uninsured, but everyone else (lots of sick people roaming the streets. sort of like your neighbors house on fire).

Note that when we pay collectively for health care, the payments are made in a equitable fashion (at least they could be, given a fair tax code). Also such payments would be spread out much further, so the overall cost to the individual would be less.

I can go on in this vein, but a chief difficulty with the current system is that private insurance is motivated entirely by profit, and the profit motive conflicts with the welfare of patients. It pays not to cover people who are likely to get sick. It pays to remove people from coverage when they have huge bills.

Only a kind of worshipful attitude towards capitalism can explain to me why anyone would not want, ideally, a single payer system. Its like socialists thinking we should nationalize the hot dog stands because public ownership is a good thing--an attitude we saw also in the weird practice of having private companies run prisons.. etc.

I know there are those who think: screw those who can't pay. what is mine is mine! But Ayn Rand was just wrong (and quite inconsistent with Christianity, for those who have that committment).

Mike Darus said...

Our current system is much more socialized than we may want to admit.

Insurance is a type of privatized socialism. The relatively many healthy people pay premiums that pay for the costs of the few that are sick. In large grops this works well, in small groups the risk increases that there will be too few healthy people to pay the cost of the potential many sick people.

Hospital emergency rooms also have a socialized element. They have a legal mandate to not turn people away. They recover the costs of those who are unable to pay from those who are able to pay by increasing their fees.

Ilíon said...

Even that's not the right analogy to capture the false and tendentious leftist/liberal "rights" assertion -- and which "right" will be severely rationed once it's accepted by our society to be a "right." Though I expect that "women's reproductive health rights" will never be rationed or curtailed by the "liberals"

Ilíon said...

If you have the "right" to "health care," that means that someone else has the duty to provide it.

And what is the most politically expedient way for (any) government to "ensure" and "provide" your "right" to "health care?" Why, it is, of course, to make doctors and nurses into public slaves. This, of course, means that within less than half a generation there will be far fewer doctors and nurses than now. For, who willingly and freely enters into servitude, especially public servitude? (If you think US slavery was bad, you don't know about the State slaves in ancient Rome.)

Rasmus Møller said...

Some numbers for comparison with Denmark (my native country) from the year 2000...

Health costs per citizen
DK: 2512 $ ~ 8.3 % GDP
US: 4499 $ ~ 13 % GDP

Individual part of health expenses
DK: 18 %
US: 55 %

Percentage of population covered
DK: 100 %
US: 85 %

More details for the specially interested, see f.ex. here and here

I am naturally partial to my native system, and I realize that economic efficiency and universal coverage are not the only relevant parameters. Nevertheless it can be fruitful for discussion to have actual counterexamples to your current system.

Ilíon said...

Except, of course, that we'll always be comparing apples to oranges.

For instance (and assuming that those percentages for each country are considered by the respective governments to be accurate), I'm quite sure that figures for Denmark do not include "down time." The time prospective patients sit around *waiting* for health-care is *also* an expense, but it's a hidden expense, and it doesn't get counted anywhere ... despite that it is paid by the individual and by the society.

Moreover, *everyone* in the US has access to "health care." There is a vast difference between having insurance and having "health care."

Gordon Knight said...

Everyone in the US has access to health care?

Well, that is true in the sense that no matter how poor you are, the emergency room will still take care of you, (1) this is true because of a law (Socialism!) and (2) its hardly the best way to deal with unhealthy people.

Ilíon said...

And, of course, the only "answer" you leftists-in-sentiment can ever see to any problem caused and/or exacerbated by "socialism" is more (and deeper) socialism and compulsion and governmental control of the lives of ostensibly free-born so-called citizens.

The only "answers" you people can ever see is to turn citizens into subjects and wards of the all-encompassing State.

Anonymous said...

One difference between publicly and privately run enterprises is that public ones are publicly accountable. They not only have to account for costs, but also account for the way they’re serving their function in society. It’s not always as simple as calculating shareholder equity. That’s what is at the heart of the injustices in the current insurance system. It’s also the reason people support fire departments as a public enterprise. Even the volunteer ones are supported by the community, in order that they be accountable to the people they serve. It would seem the enterprises protecting the health of people might benefit from the same oversight we give enterprises that protect the buildings we live in.

Rasmus Møller said...

Ilion, you are right that you get new, "improved" problems with a tax-funded system.

- waiting lists are one of them.
- new expensive treatments come slowly
- special interest groups plead for "fair share"
- hospitals are constantly cutting back to avoid deficits

The health expenses vary from survey to survey - I picked the survey with the smallest difference. Another strange thing is that the GDP % was about equal 25-50 years ago, but since 25 years the budget growth rate has been much higher for the US than for DK (and most of EU).

The tax-funded system does make for a more relaxed, stress-free life.

Believe it or not, you get used to taxes, if you have the feeling that most people pay like you do, and that it is spent reasonably. I guess I find civil liberty much more important than economic liberty, but I respect that many people like you differ.

BK said...

I see the analogy, but I think that the analogy fails. The reason that fire departments are publicly funded (as I understand it) is that the fire department used to come out to the house and ask people to pay before they would put out the fire. If the person couldn't pay, the fire department would go home. That was obviously wrong and a danger to the other buildings.

Health care, unlike fire care, has historically been paid in advance under a plan. In most cases, health care is individual, and the harm caused from the failure to receive medical care would ordinarily be suffered by one individual. But if there was a risk of contagion that would hurt the entire community if care wasn't provided, then the government could step in.

There is no such option of offering fire insurance because everyone would simply not pay recognizing that any fire is a threat to the community that the government would have to handle to prevent the possible greater harm.

So, I don't think that health care should be paid by the government.

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