How to make public healthcare sufficient?

[AspieAlly613]

I think that the best solutions have to be motivated by a desire to help people get health care, not a desire for wealthy people to have less money.  When ideas for public healthcare are listed alongside ideas such as "let's increase taxes on people who have more than a certain amount of money because I don't like how much money they have" and "let's put a tax on stock market investments because I don't like how much money people can make by doing that" it raises some natural concerns.  It makes it sound like you're motivated by people's relative welfare in comparison to others, rather than the actual level of what they have access to.

 

Some ideas that have been floating around in my mind:

 

• Let people make more informed risk-aversion-for-profit decisions by allowing individual health savings accounts.
• Remove the disincentive for those health savings accounts by forcing hospitals to charge their stated price for a given procedure rather than allowing insurance companies to negotiate a lower price only for their patients.  This should have the effect that the negotiations will lower everyone's prices to a reasonable, fair level.
• Everyone who's dissatisfied with the current health insurance structure should band together to make their own mutually owned health insurance company.  If even 10% of the population joins, that will rival the insurance giants like United and Aetna.
• To optimize the level of risk aversion policyholders can get, they should be allowed to arrange lifelong policies, not policies that get renewed every year based on your annual level of health.
• There is realistic belief that part of the high cost of healthcare is that hospitals are keeping too high a profit margin.  Let's try to fix this by building more hospitals, owned by the state/local government if no private investor will do it.
• There is realistic belief that part of the problem is that there aren't enough doctors because the cost of medical school is too high.  Let's institute state government-run medical schools that instead of charging $150,000 up front, charge a percentage of their graduates' future income in excess of, say, $40,000/year.
• Let's pattern medicaid off of section 8 housing:  The government decides "no more than X% of your income should go to health insurance".  If market rate for a basic plan is higher than that, the government pays the difference.  If you want a more advanced plan, you are only responsible for adding on the difference in costs between your desired plan and a basic plan.  Note that the insurance company still gets their money, so there's no danger to them.  It's just that the policyholder pays what xe can and the government pays the difference.  (SNAP food benefits work similarly, I think.)

[gisiebob]

2 hours ago, AspieAlly613 said:

I think that the best solutions have to be motivated by a desire to help people get health care, not a desire for wealthy people to have less money.  When ideas for public healthcare are listed alongside ideas such as "let's increase taxes on people who have more than a certain amount of money because I don't like how much money they have" and "let's put a tax on stock market investments because I don't like how much money people can make by doing that" it raises some natural concerns.  It makes it sound like you're motivated by people's relative welfare in comparison to others, rather than the actual level of what they have access to

guess what. systemic and planned inequality is the reason that healthcare is considered a luxury to be sold only to those who can afford it. things are only sold at prices that get paid, that's the free market, right?

[Knight of Cydonia]

5 hours ago, AspieAlly613 said:

I think that the best solutions have to be motivated by a desire to help people get health care, not a desire for wealthy people to have less money.  When ideas for public healthcare are listed alongside ideas such as "let's increase taxes on people who have more than a certain amount of money because I don't like how much money they have" and "let's put a tax on stock market investments because I don't like how much money people can make by doing that" it raises some natural concerns.  It makes it sound like you're motivated by people's relative welfare in comparison to others, rather than the actual level of what they have access to.

 

Some ideas that have been floating around in my mind:

 

• Let people make more informed risk-aversion-for-profit decisions by allowing individual health savings accounts.
• Remove the disincentive for those health savings accounts by forcing hospitals to charge their stated price for a given procedure rather than allowing insurance companies to negotiate a lower price only for their patients.  This should have the effect that the negotiations will lower everyone's prices to a reasonable, fair level.
• Everyone who's dissatisfied with the current health insurance structure should band together to make their own mutually owned health insurance company.  If even 10% of the population joins, that will rival the insurance giants like United and Aetna.
• To optimize the level of risk aversion policyholders can get, they should be allowed to arrange lifelong policies, not policies that get renewed every year based on your annual level of health.
• There is realistic belief that part of the high cost of healthcare is that hospitals are keeping too high a profit margin.  Let's try to fix this by building more hospitals, owned by the state/local government if no private investor will do it.
• There is realistic belief that part of the problem is that there aren't enough doctors because the cost of medical school is too high.  Let's institute state government-run medical schools that instead of charging $150,000 up front, charge a percentage of their graduates' future income in excess of, say, $40,000/year.
• Let's pattern medicaid off of section 8 housing:  The government decides "no more than X% of your income should go to health insurance".  If market rate for a basic plan is higher than that, the government pays the difference.  If you want a more advanced plan, you are only responsible for adding on the difference in costs between your desired plan and a basic plan.  Note that the insurance company still gets their money, so there's no danger to them.  It's just that the policyholder pays what xe can and the government pays the difference.  (SNAP food benefits work similarly, I think.)

Ooooor switch to some kind of universal healthcare like the rest of the developed world?

[AspieAlly613]

4 hours ago, gisiebob said:

guess what. systemic and planned inequality is the reason that healthcare is considered a luxury to be sold only to those who can afford it. things are only sold at prices that get paid, that's the free market, right?

We sell necessities, too.  In theory, we make sure that in case of emergency, when people can't afford those necessities, we all pitch in.  Later in my monologue (which was so long I can't blame you for not reading the whole thing or making the connection between a later point and the leading paragraph) I referenced SNAP and section 8 housing.  I do not believe those systems to work perfectly every time, but I think that fixing those flaws would be better than removing the industries entirely.  (I could go on about the flaws of trying to optimize for equality, but that would derail the conversation.)

[daveb]

12 hours ago, AspieAlly613 said:

In theory, we make sure that in case of emergency, when people can't afford those necessities, we all pitch in.

In theory? Maybe. In reality, all too often not. And many of us believe that "depending on the kindness of others" shouldn't have to be the case, especially for what I consider a basic need like healthcare. And even more so in the case of a country like the US that is quite well-off. We can spend billions on things like military hardware and (often apparently senseless/useless/endless) wars, without a squawk from a lot of people, but mention universal healthcare and they lose their heads. We should be thanking doctors, nurses, teachers, and the like for their service, too.

[Skycaptain]

It's simple. Legalise all narcotics, encourage smoking, make seat belts and airbags in cars illegal, likewise earthing electrical appliances. Encourage euthanasia. This way we'll kill off most of the population before they require expensive treatment. 😋😋😋😋

 

Because of society's advancements people are living longer, and their care is more expensive. Ultimately the time will come where we have to decide, if healthcare costs more than projected income will we have to declare people "beyond economic repair" and scrap them as we do a badly crashed car? 

[natsume]

The doctor comes In and says "health insurance has declared you totaled" and jams a syringe in your arm.

[AspieAlly613]

7 hours ago, natsume said:

The doctor comes In and says "health insurance has declared you totaled" and jams a syringe in your arm.

"totaling" is based on the cost of care exceeding the value of the original.

 

So, who wants to come up with an estimate for that in this case?  SOUNDS FUN!!!  Almost as fun as watching people's faces when they listen to how the calculation is performed.

 

 

[natsume]

Wow, really?

You seem to know a lot. Tell us more about your idea to create the affordable care act/obamacare again. It would be even better if you used the Wikipedia entry on the affordable care act. I hope they gave you credit...

 

[uhtred]

The underlying problem is that the medical industry can provide an unlimited amount of medical care for an unlimited amount of money.  We need a good way to figure out when care is too expensive and cannot be afforded.   

[gisiebob]

On 1/8/2020 at 7:13 AM, uhtred said:

The underlying problem is that the medical industry can provide an unlimited amount of medical care for an unlimited amount of money.  We need a good way to figure out when care is too expensive and cannot be afforded.   

I disagree. there limited space and limited personnel, but assuming a limit in this problem is money will always end up with with people who care  about money deciding how care is distributed.

[uhtred]

2 hours ago, gisiebob said:

I disagree. there limited space and limited personnel, but assuming a limit in this problem is money will always end up with with people who care  about money deciding how care is distributed.

Money represents real resources.   We can build an unlimited number of medical test machines, do endless test, perform very complex procedures on the very elderly.  At some point the total resources of society are not sufficient to cover that cost. 

 

 

Imagine if everyone had a multi-million $ MRI machine built around their bed, were scanned every night and a team of doctors looked over the scans for any problems.  We would catch more cancers and other problems - but there simply is not enough money (eg reources) to build hundreds of millions of MRI machines and to pay people to analyze the results.  The improvement in health is not worth it

[gisiebob]

4 hours ago, uhtred said:

Money represents real resources.   We can build an unlimited number of medical test machines, do endless test, perform very complex procedures on the very elderly.  At some point the total resources of society are not sufficient to cover that cost. 

 

 

Imagine if everyone had a multi-million $ MRI machine built around their bed, were scanned every night and a team of doctors looked over the scans for any problems.  We would catch more cancers and other problems - but there simply is not enough money (eg reources) to build hundreds of millions of MRI machines and to pay people to analyze the results.  The improvement in health is not worth it

you are arguing against something I was not arguing for.

[thyristor]

Sorry guys, I've been noticing that there is some activity on this thread, but I've been to unfocussed to read and reply since it takes thinking. So, let me catch up with what you've all been suggesting and thinking.

 

Quote

I think that the best solutions have to be motivated by a desire to help people get health care, not a desire for wealthy people to have less money.

Agree. First you need to examine the needs you have, then you have to fund accordingly. As stated in another thread recently, my political orientation is to the left, but I've never felt any bitterness about other people having a lot of money, however that does not go for the superrich, where money just becomes grosse...

 

 

Quote

• Let people make more informed risk-aversion-for-profit decisions by allowing individual health savings accounts.

I don't really understand this semantically. Are you saying people should be saving money on a normal bank account, only that it's reserved for medical bills?

 

Quote

• Remove the disincentive for those health savings accounts by forcing hospitals to charge their stated price for a given procedure rather than allowing insurance companies to negotiate a lower price only for their patients.  This should have the effect that the negotiations will lower everyone's prices to a reasonable, fair level.

I don't really understand that either or the connection to the first point. Ok, hospitals (or clinics or whatever) should have a fixed price for a procedure that shouldn't be negotiated; agree. I'm not sure whether hospitals in Sweden negotiate with insurances, I also don't understand how they can offer these jump-the-line insurances, since the hospital should not even ask you which insurance you have. Obviously, if insurance companies negotiate prices, individuals might have to pay more, because ultimately, five surgeries cost as much as five surgeries and not as much as one surgery and four underpaid surgeries. But it's by no means sure that a fair level (as in equal for everyone) is a reasonable level.

 

Quote

• Everyone who's dissatisfied with the current health insurance structure should band together to make their own mutually owned health insurance company.  If even 10% of the population joins, that will rival the insurance giants like United and Aetna.

Agree! Being more effective by handling large volumes is certainly beneficial as a method, but devastating as an all ruling principle. Goes for companies, food production, datagathering etc. More diversity is good, and I believe that world peace will be a state of things where people can choose companies more freely than today where many aspects of life are totally ruled by a handful of giant companies.

 

Quote

• To optimize the level of risk aversion policyholders can get, they should be allowed to arrange lifelong policies, not policies that get renewed every year based on your annual level of health.

Agree. Is this again an American thing? I sure had to state my health level when I first signed the policy, but the price is only augmented by normal inflation rate or else increased service level or so, that applies to everyone. They haven't asked me about my health state ever since.

 

There is a risk that we soon will have fitness watches and apps on our phones that report directly to health insurance companies. Obviously, the technique, just like dynamite, can be used to do good (research, prevention, incitement to do more sports...) or bad (punishment for not doing sports, big data misuse, wearing several other peoples watches during your daily run...).

 

Quote

• There is realistic belief that part of the high cost of healthcare is that hospitals are keeping too high a profit margin.  Let's try to fix this by building more hospitals, owned by the state/local government if no private investor will do it.

Good thought, doesn't help in Sweden

 

Quote

• There is realistic belief that part of the problem is that there aren't enough doctors because the cost of medical school is too high.  Let's institute state government-run medical schools that instead of charging $150,000 up front, charge a percentage of their graduates' future income in excess of, say, $40,000/year.

In Sweden, college and university are free of charge (for Europeans). In addition, Swedish permanent residents and citizens are intitled to roundabout 8000 kronor/month (about 800 Euro), of which 2000 are actually just given, and 6000 are a loan, which you start repaying six months after you get a job I believe.

 

I'm not updated on whether we have enough doctors or not. But many doctors have started working for companies that offer hospital and health centers to hire a doctor. So, first, wages are not keeping up, doctors leave, companies hire them for a higher wage, health centers re-hire them for an even higher wage. What can I say.... I'm not bitter that someone has more money than average. But this is nothing but inefficient. The middle hand that pulls of the extra money (be it in pure profit, or plain wages for the people administrating the whole party), it's profiting on tax money and/or creating nonsense jobs, that money should better fund jobs that do the work that society needs.

 

Quote

• Let's pattern medicaid off of section 8 housing:  The government decides "no more than X% of your income should go to health insurance".  If market rate for a basic plan is higher than that, the government pays the difference.  If you want a more advanced plan, you are only responsible for adding on the difference in costs between your desired plan and a basic plan.  Note that the insurance company still gets their money, so there's no danger to them.  It's just that the policyholder pays what xe can and the government pays the difference.  (SNAP food benefits work similarly, I think.)

Agree with the first part, but firstly there will be debates about what is the minimum to be covered with a basic plan; second, insurance companies might be trying to increas the cost for their basic plan, knowing that the state will pitch in, hence skimming off money from those whose income is just a little higher than for X% to be less than the basic plan; third, you don't close gaps, richer people can still afford better health care than poor. There might be some luxury health care that I don't mind being for richer people, but like I said, it will be an ever ongoing debate about what is basic. From comments above, I see that entire fields of healthcare are not naturally seen as 'basic' (vision, cancer, hearing, etc; how can cancer not be basic? It's not that you can control not getting it, and it litterally kills you when you have it and don't treat it, how is this considered an add-on?).

 

And fourth: the government pays the difference. Ok, that is the idea of "everyone pitching in when there is an emergency". I like that idea and it builds on paying taxes, since "everyone" can not be assumed to be everyone's next door neighbour, but "everyone" must be an organized institution, hence, the government. I also sympathise with the idea that you cannot 'milk' the wealthy for tax money beyond reason. The essential question is: how much help is needed (in this case: how many people in the country will need funding for their basic plan, and how much funding?), and how much money does that make per taxable citizen and what is a reasonable percentage of one's income to pay for exactly this (helping others get a basic plan) for the taxable citizen with the least income, and how much must the percentage rise for taxable citizens with subsequently higher income?

 

On 1/7/2020 at 6:03 PM, daveb said:

And many of us believe that "depending on the kindness of others" shouldn't have to be the case, especially for what I consider a basic need like healthcare. And even more so in the case of a country like the US that is quite well-off. We can spend billions on things like military hardware and (often apparently senseless/useless/endless) wars, without a squawk from a lot of people, but mention universal healthcare and they lose their heads. We should be thanking doctors, nurses, teachers, and the like for their service, too.

As mentioned above, it must obviously be organized. But yes, it's a poor indictment to mankind that we are eager to spend money at all on creating health problems.

[thyristor]

 

 

 

On 1/7/2020 at 8:52 PM, Skycaptain said:

It's simple. Legalise all narcotics, encourage smoking, make seat belts and airbags in cars illegal, likewise earthing electrical appliances. Encourage euthanasia. This way we'll kill off most of the population before they require expensive treatment. 😋😋😋😋

Uh..... addicts need care, lung cancer needs care, paralyzed people need care, and my ex always said, when he didn't wanna break the circuit before tinkering with electrics in the house: it merely tickles a bit in your fingers.

 

Quote

Because of society's advancements people are living longer, and their care is more expensive. Ultimately the time will come where we have to decide, if healthcare costs more than projected income will we have to declare people "beyond economic repair" and scrap them as we do a badly crashed car? 

Ultimately the time will come where money is not the issue. Let's hope we find ways to manage life and society so that people actually die from age instead of from sickness.

 

On 1/9/2020 at 11:34 PM, uhtred said:

Money represents real resources.

Disagree on "represent". Nowadays money is largely made up out of nothing. And somehow, private business always get loans to make large investments on the terms that it "pays off", which means, they who give credit do so in order to get more money, money exists for its own sake, although it cannot be eaten, sawn into clothes (especially not creditcards and bitcoins), or lit to warm the house. The government, on the other hand, always has to deal with money as a limited resource. Well, that limited resource (coming from taxpayers that get their wage from that company who invests in something (shoppingmall for example) for made-up money. So, the amount of money for healthcare ultimately corresponds to the amount of credit givers who want to increase their buiness. Or something like that. I might be in deep waters here, I'm not an economics professor, but I just see so little sense in our current economic system, and it's not a grudge on the rich, I promise, it's just that money is not logic to me as it functions today. And I hate things that are not logic.

 

Quote

Imagine if everyone had a multi-million $ MRI machine built around their bed, were scanned every night and a team of doctors looked over the scans for any problems.  We would catch more cancers and other problems - but there simply is not enough money (eg reources) to build hundreds of millions of MRI machines and to pay people to analyze the results.  The improvement in health is not worth it

I like to reduce things to an individual level for thinking. Let's say a person can spend x% of their time and money on their health, some of which is preventing, some is curing and let's make that person a reasonably healthy one, that is, the flu now and then, some headache, maybe one or two major issues like, idk, knee transplant and a stent, maybe one permanent issue, let's say diabetes; the major issues' costs spread out over a reasonable number of years of income. This is sort of what we see as the goal for the average. Some people are healthier than that, some are less healthier, but the average could be this, if we boil it down to an individual. It sounds reasonable to me, and what I'd expect from life. If society as a whole spends more than that x% of it's total workhours and money on health, then something is wrong, cos that indicates that we have more sickness on average than we consider reasonable. So, obviously, we can't have five doctors for each person, that'd correspond to an individual spending 5x8 hours each day on their health. But all those things are incredibly hard to calculate I guess...

[uhtred]

10 minutes ago, elisabeth_II said:

SNIP

 

Disagree on "represent". Nowadays money is largely made up out of nothing. And somehow, private business always get loans to make large investments on the terms that it "pays off", which means, they who give credit do so in order to get more money, money exists for its own sake, although it cannot be eaten, sawn into clothes (especially not creditcards and bitcoins), or lit to warm the house. The government, on the other hand, always has to deal with money as a limited resource. Well, that limited resource (coming from taxpayers that get their wage from that company who invests in something (shoppingmall for example) for made-up money. So, the amount of money for healthcare ultimately corresponds to the amount of credit givers who want to increase their buiness. Or something like that. I might be in deep waters here, I'm not an economics professor, but I just see so little sense in our current economic system, and it's not a grudge on the rich, I promise, it's just that money is not logic to me as it functions today. And I hate things that are not logic.

 

snip

 

I think money is complicated, but not really irrational. The way I think of it:

 

Money is a way to keep track of value.   In its simplest form, if you have 3 sheep and I have 3 bushels of corn, I could trade the bushels for sheep without any money involved.  OTOH if we decide that a sheep is worth $3, an a bushel of corn is worth $3, then I could buy your sheep, and you my corn with the same final result.  

 

The trick with money is that it allows more complex transactions: you could sell one of your sheep in a market, take the money and the buy some corn, and maybe some barley, and a rake.   Without money you would be walking all over town with your sheep.  Clearly inconvenient.  Worse they guy selling rakes would need to have a knowledge of the value of a sheep.  As transactions get complex, the advantage of money becomes clear. 

 

Who sets the price:  That is the eternal question. Lots of things have been tried, but letting the "market" sets the price seems to work best.  So you ask "who will give me $1 for a sheep, $2,  etc.  Eventually you find the maximum price *someone* is willing to pay for your sheep.    In the real world, that happens sort of behind the scenes, but any time you go shopping, you are doing that - deciding on the value of the things you want to buy, and deciding how much you are willing to pay for them. 

 

Now add capital and it gets more complicated. Imagine I've just finished learning to be a carpenter.  I know how to build furniture, but I don't have tools .  So I ask around, will someone give me $100 to buy tools so I can open a shop.  They will probably want more than $100 back because there is some risk my shop will fail.  So I find the person who will take the least amount in return to loan me $100 now.  That extra is interest.   Again in a large society there are lots of people borrowing money, from lots or people lending it. 

 

Corporations don't really change the picture - they are just a bunch of people who have joined together to invest their money in tools (or other capital).  Sometimes they are wealthy, other times its investments from relatively poor people through their savings plans.

 

Where does money come from? Long ago it was rare precious materials like gold. The problem was that people spent too much effort finding gold - which itself wasn't very useful.  So in the modern world, governments "create" money.  They can create as much as they want - but if they create money, the existing money has less value.  If everyoen has $1000,000, when you sell your sheep, they will be willing to pay more than $100 for a sheep, and so you have inflation.  If a government isn't careful, inflation can become insane, where billions of dollars isn't enough to buy a candy bar.  So the government carefully monitors the economy, and decides how much money to create to keep things running as smoothly as possible. 

 

Often its best to think in terms of resources use, not "money".  If people want a new hospital, that requires concrete,  and construction workers, and medical equipment.  Lots of *real* stuff.   The "cost" of the hospital, a sum of the costs of all those things is just a way to describe it in a way that you can work with. 

 

Where everything breaks down is if someone controls a vital resource (water, health care etc) and no one else can provide that - so they can raise their price as much as they want.   Governments are supposd to break up those monopolies 

 

Another failure is if say someone decides that everyone should have as many sheep as they want.  If you, as the sheep vendor, know that the government will buy your sheep at any price, how much will you charge ....... probably a LOT.

 

 

[thyristor]

35 minutes ago, uhtred said:

So in the modern world, governments "create" money.  They can create as much as they want - but if they create money, the existing money has less value.  If everyoen has $1000,000, when you sell your sheep, they will be willing to pay more than $100 for a sheep, and so you have inflation.  If a government isn't careful, inflation can become insane, where billions of dollars isn't enough to buy a candy bar.  So the government carefully monitors the economy, and decides how much money to create to keep things running as smoothly

That was a very well worded description of all the logical aspects of money. 😃 But, nowadays, not only governments create money. Banks do. They happily transfer money between accounts within the whole banking market with any number of trailing zeros they like, and they charge people interest, that is what they live on. They don't hand out loans corresponding to the amount of money others are saving, that was the past. So, who sets the price for the sheep? The price usually depends on two aspects, the one aspect are the resources it takes to produce it/ship it. The other aspect is the value it has to the one who needs or wants it. Resources have been pushed down, cos most stuff is made by machines, and where labour still is involved, it's often done in low-wage countries. With a low cost, it's up to the vendor to ask: who will pay 1$, 2$, 3$ etc., even if the cost represents 50c. Many objects don't even have a 'cost', like apartments. The chainhouse my ex and I bought, was built back in 1980, it's cost nowadays is solely maintainance and monthly saving for larger maintainance, which the buyer takes over. The house could be sold for 0$ if it didn't have a value for the buyer (and vendor, who obviously needs to be able to afford other housing). But the values are totally depending on trending factors like site. I know it's not the whole truth, but we do have problems in our monetary system.

 

 

35 minutes ago, uhtred said:

Often its best to think in terms of resources use, not "money".  If people want a new hospital, that requires concrete,  and construction workers, and medical equipment.  Lots of *real* stuff.   The "cost" of the hospital, a sum of the costs of all those things is just a way to describe it in a way that you can work with. 

Yep. Those things that we need, they tend to amount to very high costs compared to their value for us, as opposed to the things that can be made by low-wage workers abroad, which tend to have costs as only some small percentage of the value we imagine them to have. Somehow, humanity needs to grow up and realize that fast value is not good value. Like fast energy (sugar) is not good energy.

 

35 minutes ago, uhtred said:

Where everything breaks down is if someone controls a vital resource (water, health care etc) and no one else can provide that - so they can raise their price as much as they want.   Governments are supposd to break up those monopolies 

 

Another failure is if say someone decides that everyone should have as many sheep as they want.  If you, as the sheep vendor, know that the government will buy your sheep at any price, how much will you charge ....... probably a LOT.

Yea, government sort of decided that even 19 year olds have a right to buy their own apartment so they make incitements for building (need I say Polish builders in Sweden) and for banks to give out loans.

 

Sorry, I think I'm a bit too tired for writing meaningful things, I feel like just babbeling. The moneything might seem a bit off topic, but it's not. One thought I've been having is actually to replace the accumulative monetary system with a sort of karma system where the wage you earn has an expiry date, and you can only have between 0 and 1. As long as you have 0.5 or more, you are entiteled to whatever you need. When it sinks, you need to go to work. It's not a very well developed idea yet, feel free to PM, open another thread or discuss it on Pax Talk (disclaimer: newly started forum), but the essence being, that the basic needs such as health care, should be totally lifted out of the monetary system we have right now. The basic stuff should run with a different system. Somehow. I neeeed to sleep now. 😴 /Visionary