Universal health care in the U.S.

Universal health care for those in the US illegally   70 votes

  1. 1. Should those who are in the US illegally be covered under a universal health care program?

    • Yes, comprehensive coverage should be paid for those in the US illegally at taxpayer expense
      18
    • Yes, but only for visits to an emergency room or free clinic
      26
    • No, those in the US illegally should be required to purchase private health insurance out of their own pocket
      26

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344 posts in this topic

 

I though they changed the law allowing you to carry all/part of any unused balance forward to next year

Depends on the plan. AFLAC, for example, does not allow you to carry it all over so you end up buying a 10 year's supply of contact lenses or something.

 

Nothing involving the health insurance system in the US is designed to help the user. Only the provider benefits

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If the rich want to pay extra to have a private room during a hospital stay then I 'spose that's OK-ish.

It's going to have to be OK. I don't know if you've noticed, but all the people screaming about "socialized" health insurance and its evils in America are the wealthy and/or people who have insurance already. They think they're going to lose their posh coverage and get the same treatment as poor people. Gotta throw them some kind of bone to pacify them.

 

The presidential candidates are already falling all over themselves, telling people that if they like their current coverage, they can keep it under universal health care.

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It's going to have to be OK. I don't know if you've noticed, but all the people screaming about "socialized" health insurance and its evils in America are the wealthy and/or people who have insurance already. They think they're going to lose their posh coverage and get the same treatment as poor people. Gotta throw them some kind of bone to pacify them.

Nah. I think you will find a lot more people screaming about it than that. I am by no means wealthy and the prospect of a socialized health insurance scares the crap out of me over here.

 

How are they going to provide sufficient resources to provide adequate healthcare for the 50 million Americans who will suddenly be entitled to it? It is hard enough trying to find a GP or Paediatrician now without having to wait 2 months for that first appointment so I dread to think how it will be in the future. Oh, I know, you will find more and more medical staff opting to serve private patients only as the hassles will be fewer, the rewards greater and the wealthy will continue to have that personal touch.

 

It's going to be a nightmare and I ain;t sticking around to experience it that's for sure

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There are just as many Americans who need health coverage now as there will be if/when universal health care entitlement comes to America. Universal coverage would probably mean fewer people in the emergency rooms for standard treatment, too.

 

Then again, I don't live in California (yet). I'm sure the overall problem of getting health care there is much more extreme than in the rest of the country.

 

By the way, you might find more doctors for children if you look them up under "Pediatrician." ;)

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Do we know what the current spending is per person in the German system? What I am getting at is that it is possible that low-income earners may already be subsidized, i.e., they may be paying much less in health insurance premiums than they are consuming in health care. They may in fact be subsidized by the middle portion of the income distribution- I don't know without more data.

Another relevant question is, at what income level are those who are no longer young and single still using private insurance? PI is known to have huge adverse selection problems here.

 

Crawlie correctly points out that if you are going to ask Americans to pay more for health insurance or in income tax to subsidize insurance for others, you will have to give them more than just "solidarity". If health care is completely free or largely subsidized for people who have no incentive to control costs, regardless of what their income is, you will simply continue to see costs rise and and ever-increasing burden on people who are in fact hardly wealthy. This is not an argument to not cover anyone, it is merely raising concern about keeping costs from exploding and/or supply failing to keep up with demand.

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Conquistador, health care-related costs for everyone are going to rise anyway, regardless of whether universal coverage becomes a reality. I think Americans are finally beginning to get this. They are paying ever-higher taxes to subsidize people who have no insurance. Many analysts (and I've got not time to look them up) estimate that the costs of going to universal coverage, even if some people have to be directly subsidized by the government, will be the same or less for individuals than staying with the system we have. Which Crawlie calls criminal, and he's right.

 

So why not get a system of universal coverage running, and see what happens in a few years? I don't think we can just leave things the way they are. If there are lots of people who are obviously taking advantage of the benefits, and the costs are unmanageable, the system will have to be tweaked again. I don't expect them to get it right the first time, at any rate.

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There is an absolute and dire need to get everyone covered comprehensively (largely a problem of adverse selection) but also within that mandate but also to take steps which will reduce moral hazard (related to lack of cost control) ans the sheer waste associated with the balky administration of the system.

 

Considering that health care is already over 15% of US GDP, cost explosions are too big a risk to ignore within the context of designing a system of universal coverage that would be, as cinzia points out, intended to control costs while ensuring everyone is covered. We already know the issue of cost (i.e., lack of incentive for consumers and health care providers to control costs) within a universal system is going to be a problem, why wait until it spins further out of control to begin to address it (when it will be even more difficult to deal with)? An additional reason to deal with cost issues the first time around is the sheer difficulty of dealing with such complex legislation and its implementation- look at how election cycles and legislative calendars conspire to wipe important issues off the agenda that need to be addressed simply because someone needs a campaign issue instead of actually solving a serious problem. Look at how difficult it is to deal with competing interest groups- how many times can their positions be reconciled given electoral schedules and the known problems with lobbying in the US legislative process.

 

http://www.opinionjournal.com/editorial/fe...ml?id=110010374

http://www.barackobama.com/issues/healthcare/ (interesting and important to note, among other things, that Obama's plan incorporates deductibles and co-pays).

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The USA already has the highest spend as a whole economy on health yet millions of people without health care.

That is becasue the high spend of USA Inc. is very unfairly distributed.

 

The notion that universal health care does not square with "cost down" is INSTANTLY disproved by the current USA situation.

 

For middle income earners in America I would not expect over time the financial burden for healthcare to significantly increase becuase of universal health care.

I can see it increasing for rich Americans and the employers contributions.

 

Putting it quite bluntly: Should the owners of the farms in California and Florida that (knowingly) employ "illegal" labor be able to duck the social resonsibility of making a contribution to the well being of the workers who pick the fruit?

 

Regarding Germany. depending on your status as an employee or self employed, whther you have dependents and the precise level of your income it can happen for someone on a lower income to be paying more as a percentage of income or in real money terms into the health care system than someone on a higher income.

 

This is becasue the richer are allowed to "opt out" of the public health care system, a loophole I think should be closed.

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The USA already has the highest spend as a whole economy on health yet millions of people without health care.

That is becasue the high spend of USA Inc. is very unfairly distributed.

 

The notion that universal health care does not square with "cost down" is INSTANTLY disproved by the current USA situation.

There are a number of dysfunctions in the US system that raise costs, e.g., the very high cost of malpractice insurance , and which are not instantly solved by a move to a universal system. It cannot be assumed that a universal system will be less costly, nor does the US situation "prove" that universal care it and of itself without reforms of what is dysfunctional about the current system would be less expensive for the US- and the cost for the US, not the cost elsewhere is the relevant metric here when we are discussing the US. Let's deal with the underlying dysfunctions as part of a move to universal coverage.

It is inaccurate to say that all of these people are without health care. Beyond emergency services and free clinics, a significant number of these people decline coverage via their jobs or don't sign up for Medicaid and SCHIP. That's not to say that there are no problems to be remedied, but if someone doesn't sign up for coverage that would be provided to them by state/federal governments or decides to cut corners and decline employment-based coverage which they could afford, or decide not to purchase some private insurance that they could afford (this should have been made tax deductible long ago) the blame lies with them.

 

 

For middle income earners in America I would not expect over time the financial burden for healthcare to significantly increase becuase of universal health care.

I can see it increasing for rich Americans and the employers contributions.

That's a pretty expansive set of statements, given we don't know the details of a universal system in the US, and given that health care spending is anyhow expected to rise sharply in the years to come, meaning that to prevent a rise in costs for the middle class, universal care would have to provide more than just a one-off savings, it would have to keep health care expenditures under the rate of wage growth for the middle class. It is very difficult to plausibly imagine such a scenario, particularly because there are not enough high-income earners and businesses that don't have the lobbying power to shift the burden onto ordinary employees to avoid a rise in financial burden for the middle class. Do you really think that the most pecuniarily powerful interests in the US are going to limply take on a ever-increasing larger burden in health care financing that exceed their wage or profit growth? The likely result would be a slow fall in middle class wages in real terms, and perhaps even nominal if inflation remains low.

 

 

Putting it quite bluntly: Should the owners of the farms in California and Florida that (knowingly) employ "illegal" labor be able to duck the social resonsibility of making a contribution to the well being of the workers who pick the fruit?

Absolutely not. The only question is how much of a contribution you ask them to make, and I would be concerned about the effects on the wages of the workers on the "social responsibility" as well. A large burden would anyhow encourage more mechanization in agriculture.

 

 

Regarding Germany. depending on your status as an employee or self employed, whther you have dependents and the precise level of your income it can happen for someone on a lower income to be paying more as a percentage of income or in real money terms into the health care system than someone on a higher income.

 

This is becasue the richer are allowed to "opt out" of the public health care system, a loophole I think should be closed.

This is the omnipresent issue of adverse selection. I don't disagree with you; however, I see two problems. You want those currently with private insurance to pay much more then they currently do by being forced into the public system, and you want them to accept the somewhat (albeit not drastically lower) quality of public insurance, all in the name of "solidarity". What will you give these people in return? Solidarity isn't going to sway them.

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Solidarity isn't going to sway them.

I don't really give a shite.

 

I'm not having a go at anyone personally as the german system is set up to encorage it.

But far too many people have got out of making their fiar share to the health system for too long.

Particuarly of course, plenty of TTers.

 

When you pay tax or effective tax, it's not about "what's in it for me?" but about what's in it for the good of society.

Today it might be poor ilegal immigrant who needs heart surgery, tomorrow it might be the CEO of Siemens.

And as health care should be a universal social good, we should ALL pay for it for EVERYONE in our society.

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MT, why don't we take a poll and see if those with private health insurance would give it up, and willingly pay more for public health insurance? Of course, there is no way we could be sure only those with private health insurance would participate, nor could we be sure that we would get at least 30 responses from the target group.

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Let's do a poll to see if a lot of rich people would like to pay 1% income tax too eh? :rolleyes:

 

It's not about always playing to the short term aspirations of the better off but to society as a whole.

 

Under a universal health care system the vast majority would gain.

If only as in the case of Crawlie's colleague above that face bankruptcy within 90 days for getting cancer.

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MT, I think you really need to acknowledge the holes in what it seems you are suggesting, and, although it is going off on a tangent to say this, going to an extreme which is neither part of the discussion nor realistic doesn't add anything. No one is talking about 1% income tax (maybe the UAE is, but that would be a tax hike for them) so let's toss out that red herring.

 

The problem with what you are suggesting is that you want people to agree to a cut in take-home salary along with a reduction in the quality of their health care, plus the prospect that any cost future cost increases (very likely) for health care in Germany will be bourne by them alone (unless their income is sharply reduced or eliminated) and not the whole of society. Don't you think that would make them uneasy and resistant to such a change in policy?

 

BTW, who is currently subsidizing those who are unemployed or so poorly remunerated that they do not pay enough in health care premiums to cover the expense of the health care they consume? It isn't a knock on them, it just a question to discern who is disadvantaged by the current system.

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Isn't it true that once you have private health insurance in Germany, you must always take the private insurance? No switching to public once you get some kind of expensive disease?

 

Doesn't this mean, in practice, that your private plan might save you some money when you are young and healthy, but it will probably catch up with you later and you will end up paying more for your private insurance? I know many friends who took the private insurance and then had a baby and ended up shelling out a lot more money for pediatric care than I did with the public plan.

 

It was a scandal, actually, the kind of unnecessary (as it turned out) high-end treatment my daughter got on the public plan, completely covered by the insurance. But that's for another topic.

 

Anyway, in America it will come down to choices. People are going to have to be offered a lot of choices for their health care plans, even if there's not a hell of a lot of difference, really, among the choices. Nobody wants to feel that the government is making these choices for them ahead of time. So there will probably have to be some kind of choice to have private plans, as well as riders for the public plans like you can get in Germany.

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The point is, is it alone the opinions of those who would lose (either in terms of a lower net financial income or "lower quality" health care services)

who should decide whether or not the universality of health care is extended? I say no. It's a descision to be made by society as a whole, including those who will benefit.

 

I don't agree that under a universal health care system, the provision of care would be worse.

You might end up sharing a hospital room. You might end up waiting a few weeks for a non urgent appointment

with a specialist etc etc but the health care in itself wouldn't be any worse in itself.

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Yes, health care providers in Germany over treat their patients.

It's a gravy train that needs to be stopped to get health costs down.

 

If one divides the total sum of health care by the number of taxpayers to give a flat rate % to be paid

in contributions and everyone was an equal consumer of health care goods, then yes, the richer would be subsidising the poorer.

And what is wrong with that?

 

Pay a couple of bucks extra off your pay check to know that you will NOT ever be getting invoices for several hundred dollars.

Or that if one day, God forbid, you got cancer and were heading for bankruptcy in 90 days.

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The point is, is it alone the opinions of those who would lose (either in terms of a lower net financial income or "lower quality" health care services)

who should decide whether or not the universality of health care is extended? I say no. It's a descision to be made by society as a whole, including those who will benefit.

And those affected can use their right to free speech to lobby to keep the current system in place if they wish. This is a consensus-driven society, MT, you know that. Don't you think the best solution is one that takes everyone's interests into account?

 

 

I don't agree that under a universal health care system, the provision of care would be worse.

You might end up sharing a hospital room. You might end up waiting a few weeks for a non urgent appointment

with a specialist etc etc but the health care in itself wouldn't be any worse in itself.

MT, I am not saying the above things you mention are the end of the world; however, frankly, they would constitute a lower-quality product for those who currently have private insurance. What concessions are you willing to offer them to give up private insurance and pay more for public (for those who would)?

 

EDIT: MT, I am not complaining about the concept of health insurance, nor am I complaining that some people subsidize others; however, I am suggesting that you consider the interests of all sides. Do all of the health care premiums paid in the public system cover everyone's health care? Or are the unemployed and poorly remunerated subsidized by the middle class?

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And those affected can use their right to free speech to lobby to keep the current system in place if they wish.

And by Jesus do they lobby!

 

The private insurance companies who know they can only turn a profit by providing health care exclusively to the better off.

The drugs companies who'd rather churn out "new" and costly drugs in the western world to protect their profits.

The section of the medical industry who do very well thankyou out of the current set up.

 

But they DON'T have a monopoly on the deicion making process.

 

 

Don't you think the best solution is one that takes everyone's interests into account?

Sometimes that happens but not in this case.

The interests of the scum above and the majority of the populaton are diametricly opposed.

 

 

Do all of the health care premiums paid in the public system cover everyone's health care? Or are the unemployed and poorly remunerated subsidized by the middle class?

In a truly egalitarian system, the total cost would be divided so that everyone paid X %.

In money terms the rich would be subsidising the poor maybe, but what's wrong with that?

 

How are the public German kasse surviving right now? JUST!

Rising employment, the €10 charge, massive efficiencies, greater restrictions on people leaving the kasse etc are keeping them afloat.

I think they have huge long term debts for which the federal government has to guarantee them.

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