Just a thought about American health care

The, umm, argument about American health care is that it\’s very expensive, isn\’t it? At least in part?

And the people who are pointing to this as proof that the American health care system is very bad indeed are the same people who say that:

1) We should all pay more for our food because cheap food is very bad indeed.

2) We should all be paying more for our energy because cheap energy is very bad indeed.

Might we, at some point, be able to get them to make up their minds? Is cheap bad or expensive bad?

23 thoughts on “Just a thought about American health care”

  1. I think the point is that the American system leaves mlllions of poor Americans with no health cover at all, and gets them into huge debt when they have pregnancies or any other chronic condition.

    Added to that, the Medicare and Medicaid programs are largely Ponzi schemes paid for by taxpayers, and which will go bust as the Baby Boomers retire.

    One of the reasons for the expensiveness of the system is that when someone is perceived to have made a mistake or failed to have made a medical test, then the hospitals get sued. So large amounts of money are spent defending medical staff from lawsuits and still more is spent commissioning lots of unnecessary tests to forstall those lawsuits.

    As far as I can tell Obama wants to be able to provide basic health care cover for everybody. The questions are: who gets to pay and who loses?

    Tim adds: “mlllions of poor Americans with no health cover at all”

    Not quite. No health care insurance. Turn up at any ER and you get health care. A subtle yet important distinction.

  2. “As far as I can tell Obama wants …”: hard to tell, isn’t it, when he’s left the writing of the competing bills to Congress?

  3. Typical clever manoeuvre Tim, but come on, you’re clever enough to see what’s going on here.

    For imagine: you wouldn’t mind paying a cheap price for food which was of bad *quality*, would you? But if you were forced to pay a much higher price for that same bad quality food, it wouldn’t look so great, would it?

    I think what galls a lot of people about American healthcare is not just the fact that it’s not cheap, but that it’s abundantly rubbish in addition to being not cheap.

    Which seems reasonable, no?

    Tim adds: Well, as I’ve written elsewhere, American health care is, by one measure, very much the best in the world. May or may not be the right measure for your preferences but that’s another matter.

    http://www.examiner.com/examiner/x-14795-Page-One-Examiner~y2009m8d16-America-has-the-best-health-care-in-the-world

  4. Clarification:

    “abundantly rubbish” from the perspective of the c.46 million without healthcare, and the people even poorer than that who rely on medicaid and medicare.

    The people at the top end, of course, enjoy a wonderful system. Lucky them.

    Tim adds: Nope, still wrong. Medicare (for the old) is pretty damn good actually. Medicaid (for the poor) ain’t so much, this is true. But Medicare is almost certainly better than the NHS.

  5. ““abundantly rubbish” from the perspective of the c.46 million without healthcare INSURANCE”

    – because I don’t want to leave any gaps for you to exploit, eh Tim 😉

  6. Tim adds: Nope, still wrong. Medicare (for the old) is pretty damn good actually. Medicaid (for the poor) ain’t so much, this is true. But Medicare is almost certainly better than the NHS.

    And its going to bankrupt the US (although it will have to join the queue to do that) unless its dramatically reduced in scope and cost. Medicaid and Medicare are a disaster waiting to happen.

  7. “Not quite. No health care insurance.”

    Not quite. No heath care insurance cover. Pre-existing conditions, treatment caps, uncovered illnesses, etc.

  8. The ‘same people’ is doing a lot of the work here.

    But it’s worth noting that you believe oil is too cheap at its extractable free market price, and that it should be taxed to raise the price. And you also, one assumes, believe US healthcare is too expensive, in that it is largely government-regulated and thus more inefficient than if it was a true free market.

  9. The major reason for the high cost of US health insurance is, as one might expect, government interference. Many instances are addressed (although in a slightly different context) here.

  10. At comment 1: “pregnancies or any other chronic condition”

    There are a number of cheap cures for chronic pregnancy.

  11. Paul Sagar, prm,

    Never mind the 17 million of the 46 million with household incomes over $50k (of which 9 million have incomes over $75k). Many of these people choose to foot health bills as and when they arise.

    Americans spend a lot more on healthcare than we do. Big deal. As people get richer they spend more on healthcare (in the UK we are artificially prevented from doing so), and as Robert Fogel points out here while discussing exactly this (http://www.amazon.co.uk/Escape-Hunger-Premature-Death-17002100/dp/0521808782) , Americans are much wealthier than we are.

  12. A good post, and a good example of why some of the most vocal critics of the US health system can’t be trusted.

    To non-US citizens living in first world countries like Britain and the UK, the US healthcare debate is turning into a very handy ideological weapon – it allows them to draw attention away from the abundant failures of socialised medicine by talking about the real or imagined failures of free market healthcare, as occurs in the US.

  13. “The people at the top end, of course, enjoy a wonderful system. Lucky them.”

    They also tend to have huge mansions, fast cars, yachts and beautiful mistresses. Life isn’t fair, eh, Paul?

  14. “They also tend to have huge mansions, fast cars, yachts and beautiful mistresses. Life isn’t fair, eh, Paul?”

    No, it isn’t. And to a certain extent, it always will be such.

    Yet it’s a further question as to what extent it ought to be unfair, surely? And we might think that perhaps leaving 40+million people uninsured in the richest country in the world is a little too far.

    I’m not saying it is. I haven’t argued for that, so I can’t. What I am saying is that your point about life being fair is simply an observation of the world.

    Which is fine. But I get the impression you were trying to imply that something more follows from that…

  15. “Tim adds: Nope, still wrong. Medicare (for the old) is pretty damn good actually. Medicaid (for the poor) ain’t so much, this is true. But Medicare is almost certainly better than the NHS.”

    Well i find this claim about Medicare being better than the NHS dubious. But no matter. Let’s say you are right.

    What about the c.46million who don’t qualify for Medicare?

    Tim adds: It’s rather more than 45 million who do not qualify for Medicare. With a couple of exceptions Medicare is only for the old folks….

  16. Healthcare costs money: doctors and the equipment they use are expensive. If you care about your health you will ensure that you are able to pay for it, out of your own pocket or via insurance. If you don’t, why should taxpayers be forced to pay for your neglect?

    If some Americans want to spend a lot of money on their healthcare, this doesn’t mean that those who don’t want to spend any of their own money, have a right to a similar level of healthcare without paying anything.

    The whole point of the US system is that you choose yourself how much to spend on your own healthcare. The fact that many choose not to spend anything is a feature, not a bug. Only irretrievably statist thinking would use those who choose not to care for their own health by taking out health insurance as an argument for the State to do what they choose not to do themselves.

    Sure, insurance is expensive, because healthcare is expensive. But if you choose to spend money on booze, cigarettes, wide-screen tvs or cars, don’t complain that you can’t afford health insurance. It’s a question of priorities.

  17. The whole point of the US system is that you choose yourself how much to spend on your own healthcare.

    I want to spend 8% of my income to receive the same kind of outcomes I’d expect in the UK. But in the US, I’d need to spend closer to 20% of my income to get that level, because the system is so drastically inefficient.

  18. Oh, @JonnyN, making a bizarre assertion (a country with PPP gdp per capita of c$45k is ‘much richer’ than a country with c$38k, rather than ‘slightly richer’) usually requires a link to a source, not a link to the opportunity to buy the source for 44 quid.

  19. “…And we might think that perhaps leaving 40+million people uninsured in the richest country in the world is a little too far.”

    For how many of those 40 million is it their own personal choice to remain so?

  20. America is a low tax country, where you get to choose what you spend your money on. This philosphy of government is rooted deep in the psyche of Americans, which is why they are, by-and-large, willing to uphold a system that leaves 10% of the population without long term health care provision (which you do not get at an ER unit).
    In contrast Sweden has wonderful health care, totally paid for by the government. So good, indeed, that there is practically no private medical care in Sweden. But – Sweden is a country of high taxes and zero choice. Once people in Sweden have paid all their taxes, they cannot affort private health care.
    In this country, we cannot make up our minds what we want – low tax with personal choice, or high tax and the government looks after us. So, like Buridan’s ass, we starve between two systems that work well if we are prepared to commit to them.

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