General Question

queenzboulevard's avatar

Is public healthcare a bad idea?

Asked by queenzboulevard (2549points) September 24th, 2008

I think that it is a good idea, although I have heard many reasons why it would be awful.

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33 Answers

augustlan's avatar

Too many variables. Public healthcare could come in many different guises, and each plan differs. In general, I think it would be good, but I’d need more information to say specifically.

tinyfaery's avatar

It depends on how it’s all planned out. I’m sure we can rely on the government to fuck it up though.

ckinyc's avatar

I think it is a good thing because you might have to wait a month or two to see a specialist. The different is you will be taken care of eventually. At least that is the case in Hong Kong.

Did anyone see Sicko?

wundayatta's avatar

What the heck is public health care? If you’re talking about forcing the medical profession to work for the government, then I think it’s a bad idea. If you’re talking about taxpayers financing the health insurance system, I think that is a great idea.

Right now, the only public health care I know are those clinics that serve poor people who don’t know they are eligible for Medicaid. They are too often staffed by public servants who see their positions as make-work jobs. Because their patients have bad insurance, they usually can’t get the services they need, anyway. I do not want that to become the system for everyone. Instead, I’d rather that everyone had the best insurance, and then we could all have the best care, currently reserved for members of Congress.

Snoopy's avatar

We already have “mini” versions of what I think you are talking about: Medicaid, Medicare and SCHIP.

I presume you are meaning healthcare for everyone. It is a great idea. How to go about paying for it and administer it is where we start to get stuck in the muck.

While Sicko was interesting, it wasn’t exactly neutral. (Please don’t think I am picking on you ckinyc…...I have seen several people reference it on similar threads… that isn’t directed at you…...).

wundayatta's avatar

Administering it would be no problem. We’d use existing insurance companies. There’s no need to reivent that infrastructure.

Paying for it also has a simple solution: a payroll tax.

The only problem with that is on the political side.

The plan is revenue neutral, but it looks like a tax increase. That’s because people don’t realize how much employers are paying to provide them with health coverage. My employer pays 15,000 a year for my family coverage. I chip in for a little of that, but most of it is paid by the employer. Now, if I had a 4% payroll tax, and my emplyer didn’t have to spend a dime on insurance for me, then most likely he would keep a little for himself, but turn the rest over to me in salary. I get a 12,000 raise, and the cost is an additional 4% of my pay? I’ll take that deal any day!

For lower income folks who are insured, the deal is even better. The only people who have to pay more are those who work for employers who do not insure. But they get the best health insurance coverage in the world in exchange for a 4% increase in taxes. Anyone who doesn’t take that deal is a fool!

Of course, as we all know, far too many taxpayers and voters are, indeed, fools who let ideology and emotion cut little holes in their pocketbooks, so all the coins can trickle out into the greedy hands of the wealthiest Americans.

tWrex's avatar

If you want to see why we shouldn’t have public healthcare, go to your local VA Hospital. Better yet, come to any of the ones here in Illinois. That my friend is exactly why we shouldn’t have public healthcare.

Not to mention can anyone think of any government program that has been run successfully?

wundayatta's avatar

People should not be talking about public healthcare. What we are talking about is the funding source for health insurance. The health care provider system would remain as it currently is. The VA, if it wanted to compete with private providers, would have to do a better job. But it would no longer be the only place a vet could go to. The same thing is true with all public health clinics. They can compete, and the market will decide if they stay in business.

However, if we’re talking about efficiency; currently health insurers are managing health funding with about 88 to 90 percent of every dollar going for health care services. Medicare does it with 98 cents out of every dollar going to health care services. So you see, at some things, Government is much more efficient. Don’t hold me to those numbers, because the last time I did this work was probably 7 years ago, but the principle is the same even now, if the disparity hasn’t gotten worse.

tWrex's avatar

@daloon Good points and good to know! Thanks for clearing that up.

Bri_L's avatar

Are some of the cost issues faced due to the incredible costs of the elements involved to begin with.

For instance, medicine, medical supplies, doctor’s insurance, doctor’s summer homes?

wundayatta's avatar

The biggest area of unnecessary cost is administrative costs. There are thousands of insurance companies, and they all have different rules, and that requires every doctor to have a staff of at least two people, plus a nurse, most likely. The two people spend almost all their time on filing paperwork. Well, it’s hard for a single doctor to afford this, and that’s why we are seeing so many practices merged together, and affiliating with hospital systems. This is less true in rural areas, but generally true everywhere.

Docs are no longer automatically getting rich. They are now, in most cases, employees, not small business people. They are being forced to see more people in fewer time. The assembly line is being speeded up. There is a doctor’s union. Expect to see more people joining it.

Some docs are trying to fight back by setting up these boutique practices. Folks pay $2000 per year and they can see the doc as much as they like, and get as much time as they like. In this way, the doc doesn’t need to handle insurance at all, and doesn’t need to hire administrative staff, except to handle medical records. If the doc goes digital with medical records, even that person may become unnecesssry. You’d still need an appointments secretary and a nurse or PA.

Anyway, administrative overhead would be nearly eliminated when you only have one insurer for everyone in the country. The savings from that alone would allow us to offer insurance to every person (not just every citizen). The benefits package would be larger than anyone currently has (it would fully cover dental, long term care, durable medical equipment, alternative medicine, mental health care).

The thing is, access to care would start driving down medical expenditures further. There a set of conditions called ambulatory care sensitive conditions; things like diabetes; where if you get care in a physician’s office early on, you save on a hugely expensive hospitalization, later, if people wait until they can’t ignore it any longer to go to the emergency room.

Good dental care, believe it or not, reduces heart disease, and is correlated with longer and healthier life spans. Free smoking cessation and exercise plans also reduce many health risks, and reduce the cost of medical care, overall. There are huge advantages to a healthy population: fewer days lost to sickness, fewer people worrying about how to care for elderly parents; less disease being transmitted in the workplace or at school if immunizations are “free” for everyone.

None of this is free, of course. It has to be financed via taxation. But the taxes would be lower than the amount you currently lose from your paycheck so your employer can pay for health insurance premiums. If your employer passes their savings onto you, you make out better under a single-payer system.

So, we don’t need to sweat the small stuff, like malpractice insurance and medical profits, and conspicuous consumption. There’s gonna be a lot of money for that. More than enough.

The only problem, of course, is the insurance industry. They do not like anyone meddling with their gravy train. But the way I see it, their profits are legalized stealing. I have no sympathy. And anyway, they can work for us, managing the system. They won’t have to lay off everyone. They just won’t get to play with premiums while they’re waiting to pay for health care.

Bri_L's avatar

I should clarify the doctor’s summer thing was a joke. I don’t know one way or another on that.

XrayGirl's avatar

disaster for sure

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augustlan's avatar

I’m thinking somebody has been using drugs.

jpasq03's avatar

I don’t think it’s a good idea.
Then everything has to go through the government, and adding more red tape and people to slows things down. Then it’s their plan or else, and we are supposedly about choice and freedom. If you think it’s expensive now wait till it’s free for everyone. The bill isn’t even being read, and who knows what’s in it.

bea2345's avatar

I speak as a consumer on a pension. All my life I had a private doctor for everyday health maintenance: the annual checkup, the occasional minor illness. For major events, like my pregnancy, and cancer treatments, I depended on the public health system. Recently I learned that the cancer has returned. Although the diagnosis and preliminary surgery were done privately, the long term treatments – radiation, chemotherapy – will be done by the public health services. Public health services in Trinidad and Tobago are good, but not very good. But they can be, and have been, a good deal worse. If you make it your business to know how it works, and what questions to ask, you can make it work for you. Long term private health care is simply not affordable.

As long as private health care is out of the reach of a significant proportion of the country, then public health is the way to go. You cannot afford the dislocation that will be caused by gross inequality, especially in a world where information is cheap and accessible.

augustlan's avatar

@bea2345 Sorry to hear about your cancer returning. Best of luck to you!

bea2345's avatar

Thanks :)

bea2345's avatar

@augustlanPublic healthcare could come in many different guises It is interesting that a question that receives much attention is that of equality of treatment. Would there be 2-tier medicine, one paid for by the state for Joe Bloke and another, more expensive, for the wealthy? Almost certainly. But if the state mediated services meet a minimum standard of care, that should not matter as long as people are vigilant of their rights. It is access that matters, access to information, to good options for care, to professionally trained people in well equipped facilities, that matters. You should not have to die because you cannot afford twice weekly kidney dialysis, or become blind because glaucoma drugs are beyond your budget.

bea2345's avatar

@daloon – just an idea. If your country decides to go the route of having a public health service, there are two ideas that are absolutely essential. One is to discourage moonlighting among the medical and nursing staff. You work in a public hospital, or public health system, you cannot have a private practice. Two, you must have a list of essential drugs.legislated for use in hospitals and health services nationally. The point of this is to allow the hospital administrator and the patient to put out their money to the best effect. It will not prevent the doctor from prescribing expensive medicines but such lists (the WHO publishes them all the time) do lead one to cheaper alternatives if necessary and they help to keep the pharmaceutical firms in line.

westy81585's avatar

The government can’t run healthcare? You want a prime example of something they run just fine, take a look at our military. It’s the best/most efficient in the world. And honestly, for all the crap the post office and DMV are getting, I’ve NEVER in my life had a bad experience with either. And the post office competing with UPS and Fedex is a great example of low cost not-for-profit government not beating the private sector (UPS controls around 90% of the shipping market).

And everyone is complaining about “socialized medicine” having all these downfalls and being terrible… take a look here I believe you’ll find the US ranked 37th worldwide (behind such great nations as the United Arab Emirates, Chile, Coasta Rica, and Columbia). Who’s ranked #1? All mighty evil terrible socialized health care France. In fact, all the big “socialized” countries that come up as argument against a government plan (Sweden, the UK, Switzerland, France, Germany, etc) are ALL at LEAST 10 ranks higher than the USA.

And lastly, the plan in question isn’t even a government take over. It’s a government option. None of the private plans would be forced to close, except for the ones that refused to bring their prices down to reasonable/fair levels.

The Republicans are fighting this purely because it’s what Obama wants, and if they can stop him, they’ll probably regain power. That’s why they make up all these lies about Death Panels, concentration camps, elderly/sick people being denied healthcare, etc. When they’re out of ideas, all they have is fear mongering, and damned if they don’t use it a lot.

Bri_L's avatar

The post office isn’t a government agency is it?

westy81585's avatar

@Bri_L Yes it is. Postal workers are federal employees, and it’s a federal service paid for by taxes and postage.

augustlan's avatar

I thought it was a public/private partnership of some kind. Off to ask AstroChuck!

AstroChuck's avatar

@westy81585- You would be 100% incorrect. The USPS gets all of its revenue from the sale of stamps and other postal sales. We receive no revenues from taxes whatsoever.

AstroChuck's avatar

@Bri_L- We are a government agency. And although our checks come from the United States government, it comes from a seperate fund (which is good because a few years back when there was no federal budget signed we still got paid while other federal employees got issued I.O.U.s). Think of the USPS as quasi- federal as we are run more like a utility than other government agencies.

AstroChuck's avatar

It makes me laugh (in a sad kind of way) the way that so many people see government. The cancerous Reagan presidency turned government into a bad word and the lemmings have bought into it. You neo-con drag the word through the mud. How is it that so many couldn’t possibly tolerate a not-for-profit government plan but be so willing to put life and death decisions in the hands of some giant corporation that is looking to make as much profit off the health of others and be fine with it? It boggles the mind. You’ve drunk the Kool-Aid. You better pray it doesn’t make you sick.

westy81585's avatar

@AstroChuck I stand corrected. But it’s still a federal agency, and a successful one.

Bri_L's avatar

Thanks guys! I was grossly misinformed!

I am going to go postal on his….. Sorry. Never mind.

AstroChuck's avatar

@westy81585- I don’t know what you mean by successful. Have you been reading anything about the state of the USPS lately? We’re a sinking ship.

westy81585's avatar

@AstroChuck I have every faith the post office will survive, it has for how long now? It’s just facing a down time. They’ll find a way I’m sure.

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