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Before you complain that I'm a socialist who wants to take away your freedoms and your money, what follows is just a thought experiment. I start with the premise that the government of the United States, against all odds, declares universal healthcare a basic right.

Obviously no one has figured out how to pay for universal healthcare in a way that society can swallow. So today's thought experiment imagines that ALL options are on the table except raising taxes, just to make this interesting.

As President Obama has pointed out, there might be some savings involved with covering everyone. At the moment, two-thirds of all bankruptcies are caused by medical bills. If that problem goes away, society saves a bundle.

If we assume a so-called single payer option goes into effect, which means the government offers an insurance program in competition with private insurers, we could eventually see some drops in prices. If you prefer keeping your private insurance company, the only change you would see is a lower bill.

A big benefit of universal healthcare insurance is job mobility. At the moment, lots of people stay at suboptimal jobs because switching jobs would mean losing healthcare for themselves or their families. That's a huge drag on economic efficiency. I suppose wages might creep up if people feel more freedom to job hop, and there would be some extra training involved for all the fresh meat, but on balance I'm guessing job mobility is a boost to the economy, and potentially a big one.

Another economic benefit from universal healthcare coverage is that doctors can catch problems early, before they become more expensive to treat. That's a winner all around.

A big downside of insuring everyone is that in the short run there wouldn't be enough doctors to go around. One solution is to recruit qualified doctors from overseas. If they can pass the same tests as American doctors, they're in. I have to think we'd have plenty of doctors in that case. Then the shortage becomes the problem of other countries.

Next, we legalize doctor-assisted euthanasia, under strict medical guidelines. A disproportionate amount of healthcare costs go toward the last few months of life, when the patient is getting very little bang for the buck. I don't know anyone who wouldn't want the option for himself.

Then we require junk food to be labeled like cigarettes, and make it a national priority to decrease our exposure to unhealthy food. People still have to eat, so perhaps the fast food outlets could make the same profit from offering convenient food that is healthy, even if it isn't as tasty and addicting. The government could bully or legislate unhealthy foods out of our diets if it needed to.

Next, the government could start to push the benefits of exercise. And I don't mean the hand-waving they do now. I mean a serious push, until couch potatoes start feeling like flag burners. Exercise could become a matter of national pride.

The government could tax cigarettes into the realm of novelty. Remember, this is the imaginary world of the thought experiment. If universal healthcare is mandated, and you don't want to wait ten months to see a doctor like you do in Canada (allegedly), then society has to make some hard choices.

The government could also require your doctor to treat patients by e-mail, as my HMO already does. That probably saves 10% on patient visits right off the top. Once hi def cameras are more ubiquitous, you should be able to e-mail photos of your bruises and suspicious moles to your doctor too. And I have read that there is a lot of progress in various types of home medical monitors that can send info to your doctor. That should help.

Imagine also that employers who offer health insurance have to treat cohabitation just like marriage. If you're shacking up with someone, you have the option of being on their insurance plan, no further questions asked. Employers currently don't discriminate against married employees even though their families cost extra to insure. This simply extends that benefit to non-traditional familes.

I can also imagine a loosening of the rules for what a Nurse Practitioner can do without a doctor's direct supervision. Between the Internet and a Nurse Practitioner, patients can eliminate a lot of doctor visits.

Most of what I mentioned here is thoroughly impractical because of lobbyists, morons, bad leadership, superstition, and our addictions to unhealthy behavior. It's just interesting to imagine what universal healthcare would look like if it were a constitutional right and raising taxes was off the table.

 
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+1 Rank Up Rank Down
Oct 5, 2009
Let's see here, in the middle of the worse recession of my lifetime (I'm 23) I work 4 days a week delivering pizzas (i only work more than 8 hours one day a week) and I still make ends meet pretty well. Granted, I live in Texas (the only state still worth a damn other than Virginia, but I like to think that we are the more relevant of the two), but I'm still able to afford healthcare, to live in an apartment with just one roommate and his girlfriend (I pay a larger percentage of the rent than either of them), to drive a car, and to type this blog comment on a quad core (octo if you count the virtual cores) computer hooked up to a 42 inch plasma screen television (high def with proper cables of course). Capitalism, what an Fing atrocity! Oh the humanity!!!!
 
 
Oct 5, 2009
"How does employer-sponsored health care hurt job mobility?"


FOr every entrepreneur "freed from the shackles of his former job" there will be about 20 people who decide that they can work less and produce less now that the government is paying for their healthcare costs. Most of us here at the lower end of the income scale work to live. We don't live to work. I would in fact work less if I didn't need the money. Any government assistance simply allows people to work less, leading to even lower productivity and even less resources to be redistributed. The power of the market is that people have to input things to take things out. If they get healthcare without having to pay for it, why should they work any harder than they have to?
 
 
Oct 5, 2009
"How does employer-sponsored health care hurt job mobility? Here is a simple example:

You currently have a job that covers healthcare for your family, including your spouse who has around $50k/year medical bills due to a chronic condition. You find the job boring, and have a great idea for starting a new company. Your options:

1. Stay with your boring job, keep your health insurance
2. Start your new company, become an entrepreneur, find new health insurance.

Now, under #2, how much do you think that will cost? Well, since your spouse has around $50k/year medical bills, they're likely to charge a minimum of $70k/year. Think that's going to influence your decision? Also, under #2, your former health insurer will be really, really happy. It simply makes no sense that you are required to change insurance when you change jobs. Furthermore, if your current doctor doesn't work with your new insurance company, you need to change doctors.

Whether you're starting the next Google or a taco truck, this is a major issue. People who have high family health care costs find it difficult to switch jobs.

(yeah, i know under COBRA you can buy your former company's policy at their rates for 18 months, but after that you're starting anew)"


Duh! Of course free healthcare simplifies things for the individual. That's missing my point entirely. I'm discussing the effect on the economy based on the actions of individuals who are insulated from risk by the government. In the example you've provided, you're basically saying that the government should subsidize the risk of entrepreneurs. Maybe that is a good idea in some cases, but if you let people start businesses without bearing the full risk, a lot of economic waste occurs. Instead of risk being born by entrepreneurs, it will be born by the government. "I might not make enough money" is an Fing great reason for NOT starting a business. We can't all start our own company and be successful. Resources are limited and the more that go towards businesses, which would be failing without the government's assistance, the less that can be used for purposes that produce more value than they cost. WHy does nobody else here understand this amazingly simple point?
 
 
Oct 4, 2009
It's amazing how most of what you said is already implemented in, hang on, Romania!
Save for the fast-food notices, we do all that. And somehow, we get by.
 
 
+1 Rank Up Rank Down
Oct 1, 2009
@WATYF:

First off - nice trick, adding VAT to income tax, makes it look a bigger contrast, because the casual reader will compare that big number to their income tax rate alone without VAT (especially as you don't mention that you've included VAT in your number)

Second - you can't simply add those numbers. To take the example of Austria (50% top rate tax, 20% VAT, apparently giving your '70%' figure) - if you've already paid 50% in income tax, you've only got 50% of your income to spend on goods and services. Even if all those goods and services are liable to VAT at 20%, you can only spend 10% of your TOTAL income on VAT. So the combined rate is 60%, not 70%.

Third - I didn't find evidence in a quick check, but all these apparently high rates of tax will be top rates - paid only by the highest earners, and only on earnings above a certain threshold. Most won't pay this rate at all, and those that do will not be paying that rate on their entire income.

I'll agree that some of these rates do look excessive (58% top rate in Denmark does seem extreme, even if it does only apply to a minority). But in the UK we manage to fund our NHS fine on much lower rates of tax, so it must be possible.
 
 
+3 Rank Up Rank Down
Oct 1, 2009
"The reality is, huge taxes would be necessary to make what you're proposing even conceivable and human nature would make it infeasible (to someone who's actually using their brain). This is what we see in Europe and Canada. This is why we see supply shortages (long waits) and high taxes (in the 70%'s in some European countries)..."

WTF??? Where do you get your information from?

For the record: In the UK your first $9,656 is tax free, the next $55,680 is taxed at 20%, anything over that at 40%. There is also 11.8% National Insurance (Social Security) on earnings between about $9,000 and $55,000. VAT (equivalent to GST) is 15%, but excludes groceries, childrens clothes and some other stuff. Nothing is taxed at anything like 70%, and nor is it in any other European country that I'm aware of (apart from specific products that are highly taxed to dissuade use, i.e. tobacco, alcohol, road fuel).

There are waiting times for some non-emergency treatment, but if you don't like this you can still buy insurance, and it's MUCH cheaper than US health insurance.

But, and here's the clincher, EVERYBODY GETS THE HEALTHCARE THEY NEED, WHEN THEY NEED IT, REGARDLESS OF HOW RICH OR POOR THEY ARE. No-one is ever in a position where they won't go to a doctor because they can't afford it. Nobody goes with a condition untreated because they bought a cheapo insurance policy they didn't fully understand that doesn't cover that condition. No-one finds they can't get insurance, or insurance becomes very expensive, because of a pre-existing medical condition. In Europe this is considered a fundamental principle of life in a civilised and developed country, and is entirely beyond question. We wouldn't have it any other way.

And where do you get the idea our economies are collapsing??? We were doing just fine, thank you, at least until a bunch of American banks collapsed and brought down the world economy with them, after they traded mortgages to people who couldn't afford to pay them (probably because their health insurance was so expensive, or they'd gone broke because they had to pay for treatment they weren't insured for...).
 
 
Sep 30, 2009
" @ tkwelge Sep 30, 20009

the thumbs down i gave (#4) is due to the assumption that people are lazy arses who'll tolerate boring jobs even when they are finally unshackled from sub-optimal or truly intolerable employment by access to truly effective & truly accessible portable health insurance. then there's the assumption that people can only be motivated to work for $$. the further assumption is that $$ is the best compensation or even the only compensation for work."

It's not that people are lazy, it's just that they balance work with their free time, so as to maximize their quality of life. Plus, who are these people who are "shackled" to a crappy job because of health care? What makes the alternative choices "better" jobs, especially since they don't offer health care, or even the money to cover health care costs as part of its compensation? I mean, the market allocates a certain amount of compensation for certain types of labor for a reason. Offering universal health care won't make the labor force more productive. It will allow people to work in less productive jobs simply because they won't require the extra compensation to pay for their healthcare. Scott's description of labor mobility misses the point of labor markets entirely. I'm simply saying that you can't have your cake and eat it too. Universal healthcare may be the right thing to do, but it sure will have economic impacts that will probably be negative. Skewing the labor/compensation markets is one of those impacts.


 
 
-1 Rank Up Rank Down
Sep 30, 2009
@ tkwelge Sep 30, 20009

the thumbs down i gave (#4) is due to the assumption that people are lazy arses who'll tolerate boring jobs even when they are finally unshackled from sub-optimal or truly intolerable employment by access to truly effective & truly accessible portable health insurance. then there's the assumption that people can only be motivated to work for $$. the further assumption is that $$ is the best compensation or even the only compensation for work.
 
 
+1 Rank Up Rank Down
Sep 30, 2009
wikipedia says:

"Including spending for the wars in Iraq and Afghanistan, Homeland Security, and Veteran's Affairs, defense spending was approximately $800 billion, or 32% of 2008 tax receipts"

So during war time, defense spending is 32% of tax RECEIPTS. Also, since most military spending occurs at the national level, it appears bigger than if you took it as a percentage of state and national spending. And as I said, most of this money is not going to the "military industrial complex" but to civil servants and soldiers paychecks and health benefits as well as R&D. I'm all for shrinking the cost of the military and finding ways for it to save money, but I just don't like the way that people like you say things to make it look as if the US is some sort of military dictatorship.
 
 
Sep 30, 2009
"Bottom line, the total government expenditures on the military are more than half of the entire federal budget."

I question the validity of your numbers. I'm pretty sure that more studies are needed, and similar tricks could be used to show that we pay more for other programs. For example, most of "education" spending comes from the state level, so it appears that we don't spend that much education when you only look at the National budget. Conversely, most military spending comes from the national level, making it appear more costly as most people only really look at the national budget rather than every little state budget. Plus, in your own points, you show that most of military spending isn't bombs and tanks but personnel and benefits. If you're the kind of person who believes that the government can "create" jobs or support people's benefits, you should love the military. Also, like NASA, we benefit from lots of R&D that starts out supplying equipment for military tactics, then turns into something that makes civilian's lives more practical. It's really all perception, but I'd still like to see a real analysis of the numbers that you mentioned.
 
 
-1 Rank Up Rank Down
Sep 30, 2009
I don't know why I got so many thumbs down.

Scott's argument: Universal healthcare will lead to more job mobility, because people won't be "stuck" in a job to pay for their healthcare.

My argument: That's like saying if we had universal housing, people would not be "stuck" in a job to pay for their mortgage. The truth is, that universal healthcare would make the cost of living appear artificially small, thus leading to people working less and taking lower paying jobs than they otherwise would have to take. The effect on the economy would be less people working and more people working in less productive jobs. How am I wrong!!!??? Pls tell me before you just give me three thumbs down.
 
 
Sep 29, 2009
There's an easier way to pay for universal healthcare: ship everyone who believes in universal healthcare to Canada (britian, cuba, whatever) and put land mines along the US-Canada border to prevent people from coming back. Canada foots the bill and the people who get shipped north now have prime real-estate as soon as global warming kicks in full swing.

Seriously though, if you believe that universal healthcare is so important, why not just move to an english speaking country that already has it? Why force it on people who don't want it? Freedom to choose and liberty means other people have a right to make their own decisions even if you don't like them.

Furthermore why not first try to find ways of lowering the high costs of medicine such as tort reform and innovations to reduce the cost of medicine and medical equipment, particularly for chronic illnesses.
 
 
Sep 29, 2009
So much of the problem we face is in spending. The medical industry layered with overspending. I found an article in which 23 different medical professionals from various areas and practices were interviewed, and at least half of them, individually, commented on the gross over spending of the medical, and pharmaceutical industries.
http://www.ourblook.com/component/option,com_sectionex/Itemid,200076/id,8/view,category/#catid107
Many people are afraid of regulation, but the medical industry could certainly benefit from a good dose of regulating. And I couldn't agree more with finding a way to assimilate information and communication technologies.
 
 
Sep 29, 2009
As an outside observer its actually quite amusing to see the passion (putting it mildly) that you American's have over these issues.

Is this really that complicated?

How about this, as the supposed greatest country in the world you should be able to provide healthcare to all your citizens.

Each person, going by there social security number, gets a certain amount of free healthcare per annum. Say $500 per annum (example figure only) of free healthcare for whatever you want. (nothing fancy like rolling it over or transferring it, possibly have unused credit as a tax deduction but anything fancy leads to abuse) and if you go above that you A) either pay for it yourself or B) apply to have additional costs covered. Yes this would mean a bureaucratic decision . But is it really that hard to make the correct decision between giving more healthcare to a lifelong smoker who does this every year or to someone who hasn't gone over their allocation once and needs it because they broke their leg.
Maybe the health credits you have could build up over time so 10 years of no claims would give you $5,000.

If you wanted something more then the public optionc stop mooching and get private healthcare, ie health insurance or pay for it yourself.

Is it really this complicated?
 
 
-5 Rank Up Rank Down
Sep 29, 2009
"A big benefit of universal healthcare insurance is job mobility. At the moment, lots of people stay at suboptimal jobs because switching jobs would mean losing healthcare for themselves or their families. That's a huge drag on economic efficiency. I suppose wages might creep up if people feel more freedom to job hop, and there would be some extra training involved for all the fresh meat, but on balance I'm guessing job mobility is a boost to the economy, and potentially a big one."

If they offered you 10 dollars an hour but no health coverage, nobody would take the job, because the return on labor would be too low for people who required 10 dollars an hour plus health coverage to live, but with universal, guaranteed health care, more people would sit in these less productive jobs, because they wouldn't need more compensation to cover health care costs. In other words, more people will sit in lower paying, less productive jobs, because they won't NEED more money. Like if the government guaranteed you healthcare, housing, and food, you'd really only need to work another 15 hours a week to pay for your entertainment. Thus less workers inputting resources and services into the economy combined with similar or higher levels of consumption. I mean, did you not thing about this for 10 minutes, Scott!?!?!?
 
 
-2 Rank Up Rank Down
Sep 29, 2009
"A big benefit of universal healthcare insurance is job mobility. At the moment, lots of people stay at suboptimal jobs because switching jobs would mean losing healthcare for themselves or their families. That's a huge drag on economic efficiency. I suppose wages might creep up if people feel more freedom to job hop, and there would be some extra training involved for all the fresh meat, but on balance I'm guessing job mobility is a boost to the economy, and potentially a big one."

If they offered you 10 dollars an hour but no health coverage, nobody would take the job, because the return on labor would be too low for people who required 10 dollars an hour plus health coverage to live, but with universal, guaranteed health care, more people would sit in these less productive jobs, because they wouldn't need more compensation to cover health care costs. In other words, more people will sit in lower paying, less productive jobs, because they won't NEED more money. Like if the government guaranteed you healthcare, housing, and food, you'd really only need to work another 15 hours a week to pay for your entertainment. Thus less workers inputting resources and services into the economy combined with similar or higher levels of consumption. I mean, did you not thing about this for 10 minutes, Scott!?!?!?
 
 
0 Rank Up Rank Down
Sep 29, 2009
From the LA Times, no less:
"In Canada, a move toward a private healthcare option":
http://www.latimes.com/news/nationworld/nation/la-na-healthcare-canada27-2009sep27,0,5111855.story
 
 
-1 Rank Up Rank Down
Sep 29, 2009
You asked what universal health care would look like if it was a universal right and raising taxes was off the table. Hmmm, you're increasing demand, you can't easily increase supply (you think you can increase supply to compensate by bringing in foreign docs, but you're not accounting for the fact that 45% of doctors already here said they would quit or retire early if Obamacare is passed.) Mathematically, there is only one possible result: rationing. And severe rationing at that. (And as for those foreign docs, you think it's difficult getting technical support from offshore call centers that barely speak English now?)
 
 
Sep 29, 2009
Dear Scott, You PINKO COMMUNIST LIBERAL!
Ok, feel better? Good. Now that that's over with, I'm a Canadian EH, so I automatically believe I am morally superior to any American, including my 3000 American cousins, some of whom I even know by name. By that I mean that I now, apparently, defined not as a citizen of a country that loves snow in winter and is fond of a sport that is played on frozen water with sharp blades placed on your feet, and a wooden stick in your hand as you chase a solid piece of vulcanized rubber while indescriminately slamming head-first in to your opponent. Now I'm defined as a citizen of the country known as "Healthcaria" or 'the Socialist Republic of North America."
Frankly, that's bunk. I'm Canadian, which means that my forefathers were really Americans who rejected this whole 'republic' nonsense put forward by Washington, Jefferson and Adams, and decided to take off, eh, to the land across the Niagara River. It's here that we decided to invent hockey, to take out our frustrations on each other because, after the first generation, our forefathers couldn't tell if we were Americans, Canadians, or just plain lost and confused. We settled, though, on Canadian because we knew it would piss you guys off, eh, since we rejected anything with the word 'American' in it. We then invented good beer (not that Budweiser crap you guys call 'beer'), basketball, and healthcare.
At any rate, because of the violent nature of our sports (well basketball is not really a sport, but then if it's not played on ice, what is?) it's natural, with the amount of pain we love to inflict on people, and have inflicted on ourselves in turn, that National Healthcare has become a priority for us Canucks. That, and beer, which, of course, is the first thing applied to any injury, to dull the pain and because, well, it works.
Anyhow, I know there are rumours that it takes 10 months or years to see a doctor but that is hogwash. I can go to any number of clinics when I get sick, and most are usually within a mile of my house, in two different directions. They are usually close to the beer stores too, which is convenient, though it would be more convenient if we sold beer at 7-11's the way you Americans do. That said, the thought that I could potentially break my neck, need a hemmeroid cut out, or my fingers stitched back on after falling on the ice, in hours, really helps me out.
It's called triage. It's also called 'being taxed up the yin yang' to pay for all this stuff. Trust me. If you need treatment NOW just mention 'blood' and you'll be fixed up quick. IF you mention 'tummy ache' be prepared to wait since, unless you have stomach cancer, you CAN wait. Broken bones? Depends on which one but you can see a doctor at a clinic almost instantly, or drive by the emergency ward of the hosptial and they'll set you right. And if it's long-term care, well, usually within a few weeks or months, depending on the need and urgency of the problem, you'll be taken care of, fully and freely.
Don't get me wrong, it's not perfect but then what is? At least, though, you don't have some greedy HMO deciding to fund the attachment of only three of the four fingers that got cut, so they can enjoy their trip to Aruba and a bigger corporate bonus. I also don't have to argue too much with my medical practioner about my 'need' to get a cyst removed because it 'is probably not cancerous' when, in fact, it might be; they might schedule it in several weeks hence, but so what as long as it is benign and not a painful hinderance? If I needed a hip replaced or something serious, to the front of the line I go, with all the care and attention that I need to get well.
This, of course, is on top of any private additional coverage I might get from my employer to cover things like drugs (which are already cheaper than in the US), dental care, or time off due to severe illness. Again, it's not perfect and you do notice it come pay time, but it works and works quite well, eh.
So, guys, make up your minds, I say. Either swallow your paranoia of "Socialism" creeping through the backdoor of medicare, OR do the next best thing and let us Canadians annex you. Frankly that last option is not very appealing to us, though. While we do like Americans (in our patronizing, Canadian way, eh!), we really don't like your beer. Bud may be good for you guys, but the thought of it entering our market freely and corrupting our good Canadian suds is appalling. Besides, how many of you guys really know how to play hockey anyways?
Cheers,
I.M. Ulysses.
 
 
Sep 29, 2009
Going to reply to specific points:

"At the moment, two-thirds of all bankruptcies are caused by medical bills. If that problem goes away, society saves a bundle."
Society is still paying for it. Remember, it's from tax dollars.

"If we assume a so-called single payer option goes into effect, which means the government offers an insurance program in competition with private insurers, we could eventually see some drops in prices. If you prefer keeping your private insurance company, the only change you would see is a lower bill."
There are better ways to increase competition, like dropping the restriction on buying health insurance in-state only. A government plan would most likely leech customers from private insurers until they go under completely. Not to mention there is no chance that a government run system would cost less than the equivalent private run system.

"At the moment, lots of people stay at suboptimal jobs because switching jobs would mean losing healthcare for themselves or their families."
That's a fair point, but mostly caused by health insurance being primarily employer-provided rather than bought directly by the consumer. This goes back to a period of wage freezes imposed by the government, during which employer benefits such as health care were introduced in order to offer competitive wages while getting around the freeze. Consumers would be best served by a return to handing their health care themselves.

"Another economic benefit from universal healthcare coverage is that doctors can catch problems early, before they become more expensive to treat."
I don't see how that follows at all. Just smoke and mirrors from Democrats. Changing the flow of money to include the government does not automatically increase prevention measures.

"Next, the government could start to push the benefits of exercise. And I don't mean the hand-waving they do now. I mean a serious push, until couch potatoes start feeling like flag burners. Exercise could become a matter of national pride."
And what, install exercise monitors in homes that raise your taxes if you do not comply?

"The government could tax cigarettes into the realm of novelty."
Really this had pretty much already occurred. Plus, tobacco taxes very often go towards health care costs. Cut that stream of revenue and taxes will be raised elsewhere to make up for it.
 
 
 
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