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Singapore, USA, and Health Care

BigRat
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1/22/2013 8:56:34 PM
Posted: 3 years ago
I know I am treasonous for suggesting that the pre Obama USA health care system wasn't a total, laissez faire free market. But, there is a reason I think this. I also think that other systems, in particular Singapore, are much closer to a free market than the USA.

Okay, there are ways to measure these things. I found the WHO report (from 2009). It turns out that the government finances only 33% of health care in Singapore. By comparison, the government finances 46% of health care in supposedly "free market" USA, 70% in Canada, 77% in Germany, 80% in France, 87% in the UK.

So, you are right about one point, Canada's system is pretty private by European standards. But, I never disputed that.

You can talk all you want about how x, y, and z works in each system and how the USA is really much more "free market" than Singapore. But, in the end, we have to have a way to measure these things. This seems like the best measure there is if you want comparable data.

The only other way I could see measuring this would be to look at what percentage of a system is financed by out of pocket spending. Here, we could see how much the consumer paid for directly and thus was influenced by market forces.

If we did this, we could see that the USA is 13% financed by out of pocket expenditures. On the other hand, Singapore is 63% (not a typo) out of pocket.

This really gets to the core of the issue. Singapore's system really is a model of market based health care reform because, instead of having large insurance companies or government buying health care, they have consumers. This means consumers have an incentive to be cost concious in their buying decisions. In other words, it works like a market.

Link to the WHO report here:

http://www.who.int...
BigRat
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1/22/2013 9:03:53 PM
Posted: 3 years ago
Also, I remember somebody mentioning Malta as a counterexample to Singapore.

I don't see how this works:

1.) Health spending is 8.4% of GDP in Malta compared to 3.3% in Singapore. Singapore is MUCH better at controlling costs.

2.) Malta's system is 77% government financed. That is about the same as Germany. Sure, it is a pretty "public" system but less so than France and the UK. It really isn't too unusual on that account.

3.) If you look at out of pocket spending, Malta is 21% financed by out of pocket spending (which is much more than the 13% in the USA). This means that the consumer is directly responsible for more of the cost of their health care than in the USA. In this odd way, one could argue that Malta's system is closer to a real market oriented system than the USA (although both are very far away).
CarefulNow
Posts: 780
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1/23/2013 11:09:01 AM
Posted: 3 years ago
At 1/22/2013 8:56:34 PM, BigRat wrote:
I know I am treasonous for suggesting that the pre Obama USA health care system wasn't a total, laissez faire free market. But, there is a reason I think this. I also think that other systems, in particular Singapore, are much closer to a free market than the USA.

No, not Singapore in particular. I've stated thrice now that there are tens of countries whose governments finance a smaller fraction of healthcare than Singapore. According your own source, they all have bad healthcare, far worse than Canada's, which is probably why you've been ignoring that point. Total laissez-faire doesn't exist, and no one claimed it did. Pre-Obama US healthcare is, however, more privatized than "free market" Swiss healthcare (which you've suspiciously stopped talking about) and nearly as privatized as Singapore's, according to your own metric.

So, you are right about one point, Canada's system is pretty private by European standards. But, I never disputed that.

No, but you did use Canada as an example of a bad healthcare system even though, as your data suggests, it's bad because it's too privatized.

You can talk all you want about how x, y, and z works in each system and how the USA is really much more "free market" than Singapore. But, in the end, we have to have a way to measure these things. This seems like the best measure there is if you want comparable data.

What's the point of comparing data with such variable meaning? Singapore has a unique healthcare system, in which private spending overwhelmingly takes the form of compulsory saved, means-tested co-pays to public insurance. Few countries on either side of the private (or out-of-pocket) share axis regulate private spending to anywhere near that degree. So, while Singapore's healthcare system may serve as a model for an alternative form of government control (as I said, it's pretty much first-stage socialism), its inclusion in the international comparison negates the private (or out-of-pocket) share axis's relation to laissez-faire.
malcolmxy
Posts: 2,855
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1/23/2013 11:26:01 AM
Posted: 3 years ago
Help me out here, because if a single-payer, universal healthcare system with the government as the only collector of healthcare taxes/premiums (whatever you want to call them) where they institute price controls to keep healthcare costs below the market equilibrium price is your idea of a free market for healthcare, then I am also for a free market in healthcare, because what I described is what they have for healthcare in Singapore.
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BigRat
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1/23/2013 5:06:25 PM
Posted: 3 years ago
At 1/23/2013 11:26:01 AM, malcolmxy wrote:
Help me out here, because if a single-payer, universal healthcare system with the government as the only collector of healthcare taxes/premiums (whatever you want to call them) where they institute price controls to keep healthcare costs below the market equilibrium price is your idea of a free market for healthcare, then I am also for a free market in healthcare, because what I described is what they have for healthcare in Singapore.

Actually, my idea of a free market in health care is a place where consumers pay directly for their care, instead of governments or large companies.

I never said Singapore is an example of laissez faire health care. However, I do hold that Singapore's system is the closest to this in the first world.

In Singapore, 63% of the health care spending is directly by consumers. This is in contrast to about 10 to 15% in the other countries I mentioned (including the USA).

This means that, in Singapore, consumers have a direct stake in how health dollars are spent and therefore an incentive to shop for both cost and quality. That is part of the reason they spend such low amounts on health care (less than 4% of GDP).

In the end, what I advocate is a health care system with more out of pocket spending. Singapore is an example of a system with MUCH more out of pocket spending as a percentage of total health costs and it seems to work.

PS: I did not "stop talking" about Switzerland. Switzerland is about 30% out of pocket, much more than the USA or any of the other countries.
BigRat
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1/23/2013 5:36:16 PM
Posted: 3 years ago
At 1/23/2013 11:09:01 AM, CarefulNow wrote:
At 1/22/2013 8:56:34 PM, BigRat wrote:
I know I am treasonous for suggesting that the pre Obama USA health care system wasn't a total, laissez faire free market. But, there is a reason I think this. I also think that other systems, in particular Singapore, are much closer to a free market than the USA.

No, not Singapore in particular. I've stated thrice now that there are tens of countries whose governments finance a smaller fraction of healthcare than Singapore. According your own source, they all have bad healthcare, far worse than Canada's, which is probably why you've been ignoring that point. Total laissez-faire doesn't exist, and no one claimed it did. Pre-Obama US healthcare is, however, more privatized than "free market" Swiss healthcare (which you've suspiciously stopped talking about) and nearly as privatized as Singapore's, according to your own metric.

So, you are right about one point, Canada's system is pretty private by European standards. But, I never disputed that.

No, but you did use Canada as an example of a bad healthcare system even though, as your data suggests, it's bad because it's too privatized.

You can talk all you want about how x, y, and z works in each system and how the USA is really much more "free market" than Singapore. But, in the end, we have to have a way to measure these things. This seems like the best measure there is if you want comparable data.

What's the point of comparing data with such variable meaning? Singapore has a unique healthcare system, in which private spending overwhelmingly takes the form of compulsory saved, means-tested co-pays to public insurance. Few countries on either side of the private (or out-of-pocket) share axis regulate private spending to anywhere near that degree. So, while Singapore's healthcare system may serve as a model for an alternative form of government control (as I said, it's pretty much first-stage socialism), its inclusion in the international comparison negates the private (or out-of-pocket) share axis's relation to laissez-faire.

1.) There are a lot of individual points you can make about why one system is more "market oriented" or "private" than another. But, in the end, you need to have some measure. The most logical measure, at least that I know of, would be what percentage of a system is private versus government financed. The USA system is 54% private and the Singapore system is 67% private. That is a significant difference. The other measure I think could be justified (out of pocket spending) shows Singapore being much more market oriented than the USA system.

2.) Switzerland is about 40% privately financed. That is less than the USA and Singapore and more than all of the other countries mentioned. However, their system is about 30% out of pocket. Using that metric, they are second to Singapore. I think a better word than market oriented may be "consumer driven". I would say that Singapore and Switzerland are both more "consumer driven" than the USA as well as the other countries.

3.) If you are going to argue that Canada's system, which is only 30% private, has weaknesses because of too much privatization, then you need to show that the UK system, which is only 13% private, is the best system here.

4.) In the end, I think consumer driven is a much better word to use. Singapore's system is clearly the most consumer driven here (63% out of pocket). And, I think, Switzerland is a distant second (30%). All the other countries including USA are distant thirds (somewhere from 5 to 15%).

My view is that the problem in health care is that we give too much power to large entities. These can be either governments or large insurance companies. I think the best way to reform health care is to return power to the consumers. The USA system was 50% out of pocket in 1960 and health care only consumed about 5% of GDP. Now, it isnt only 13% out of pocket and takes up more like 18% of GDP. More evidence that more out of pocket spending means less overall spending.

Singapore's system is far from a total free market. However, it is by far the closest to being driven by consumers, and the results are favorable.
CarefulNow
Posts: 780
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1/23/2013 8:54:29 PM
Posted: 3 years ago
At 1/23/2013 5:36:16 PM, BigRat wrote:
1.) There are a lot of individual points you can make about why one system is more "market oriented" or "private" than another. But, in the end, you need to have some measure. The most logical measure, at least that I know of, would be what percentage of a system is private versus government financed. The USA system is 54% private and the Singapore system is 67% private. That is a significant difference. The other measure I think could be justified (out of pocket spending) shows Singapore being much more market oriented than the USA system.

That's part of my point. In addition and related to Singapore's private spending being abnormally regulated, it's abnormally out-of-pocket. So you can't conclude from Singapore's efficiency that it's due to privatization. Singapore's private share of spending, on the other hand, isn't unique. You should be focusing on the deplorable healthcare systems that have similar private shares of spending but that regulate them in a more normal, more laissez-faire way. Alternatively, you could lower your arbitrary bar and observe that the US system is rather privatized and is the least efficient, Canada's is somewhat less privatized and somewhat more efficient, and so on.

2.) Switzerland is about 40% privately financed. That is less than the USA and Singapore and more than all of the other countries mentioned. However, their system is about 30% out of pocket. Using that metric, they are second to Singapore. I think a better word than market oriented may be "consumer driven". I would say that Singapore and Switzerland are both more "consumer driven" than the USA as well as the other countries.

Consumer financed, perhaps, but that financing is compulsory (more like a ride than a drive). And again, the Swiss system is extremely inefficient. And again, Singapore isn't the system with the most private spending; it's the system with the most private spending out of the systems that work.

3.) If you are going to argue that Canada's system, which is only 30% private, has weaknesses because of too much privatization, then you need to show that the UK system, which is only 13% private, is the best system here.

No, because I understand that one system is not a scientific sample. That said, the NHS is certainly more efficient than any system we've discussed, except perhaps for Malta's, Singapore's, or Cuba's.
malcolmxy
Posts: 2,855
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1/23/2013 9:19:13 PM
Posted: 3 years ago
At 1/23/2013 5:06:25 PM, BigRat wrote:
At 1/23/2013 11:26:01 AM, malcolmxy wrote:
Help me out here, because if a single-payer, universal healthcare system with the government as the only collector of healthcare taxes/premiums (whatever you want to call them) where they institute price controls to keep healthcare costs below the market equilibrium price is your idea of a free market for healthcare, then I am also for a free market in healthcare, because what I described is what they have for healthcare in Singapore.


Actually, my idea of a free market in health care is a place where consumers pay directly for their care, instead of governments or large companies.

I never said Singapore is an example of laissez faire health care. However, I do hold that Singapore's system is the closest to this in the first world.

In Singapore, 63% of the health care spending is directly by consumers. This is in contrast to about 10 to 15% in the other countries I mentioned (including the USA).

This means that, in Singapore, consumers have a direct stake in how health dollars are spent and therefore an incentive to shop for both cost and quality. That is part of the reason they spend such low amounts on health care (less than 4% of GDP).

In the end, what I advocate is a health care system with more out of pocket spending. Singapore is an example of a system with MUCH more out of pocket spending as a percentage of total health costs and it seems to work.

PS: I did not "stop talking" about Switzerland. Switzerland is about 30% out of pocket, much more than the USA or any of the other countries.

Oh, so you think the government price controls are the best art of the Singapore Health System.

Noted.
War is over, if you want it.

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BigRat
Posts: 465
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1/23/2013 10:36:55 PM
Posted: 3 years ago
At 1/23/2013 9:19:13 PM, malcolmxy wrote:
At 1/23/2013 5:06:25 PM, BigRat wrote:
At 1/23/2013 11:26:01 AM, malcolmxy wrote:
Help me out here, because if a single-payer, universal healthcare system with the government as the only collector of healthcare taxes/premiums (whatever you want to call them) where they institute price controls to keep healthcare costs below the market equilibrium price is your idea of a free market for healthcare, then I am also for a free market in healthcare, because what I described is what they have for healthcare in Singapore.


Actually, my idea of a free market in health care is a place where consumers pay directly for their care, instead of governments or large companies.

I never said Singapore is an example of laissez faire health care. However, I do hold that Singapore's system is the closest to this in the first world.

In Singapore, 63% of the health care spending is directly by consumers. This is in contrast to about 10 to 15% in the other countries I mentioned (including the USA).

This means that, in Singapore, consumers have a direct stake in how health dollars are spent and therefore an incentive to shop for both cost and quality. That is part of the reason they spend such low amounts on health care (less than 4% of GDP).

In the end, what I advocate is a health care system with more out of pocket spending. Singapore is an example of a system with MUCH more out of pocket spending as a percentage of total health costs and it seems to work.

PS: I did not "stop talking" about Switzerland. Switzerland is about 30% out of pocket, much more than the USA or any of the other countries.

Oh, so you think the government price controls are the best art of the Singapore Health System.

Noted.

Of course, I never said anything to that effect.

But, obviously you need to be intellectually dishonest to win arguments.
BigRat
Posts: 465
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1/23/2013 10:49:05 PM
Posted: 3 years ago
At 1/23/2013 8:54:29 PM, CarefulNow wrote:
At 1/23/2013 5:36:16 PM, BigRat wrote:
1.) There are a lot of individual points you can make about why one system is more "market oriented" or "private" than another. But, in the end, you need to have some measure. The most logical measure, at least that I know of, would be what percentage of a system is private versus government financed. The USA system is 54% private and the Singapore system is 67% private. That is a significant difference. The other measure I think could be justified (out of pocket spending) shows Singapore being much more market oriented than the USA system.

That's part of my point. In addition and related to Singapore's private spending being abnormally regulated, it's abnormally out-of-pocket. So you can't conclude from Singapore's efficiency that it's due to privatization. Singapore's private share of spending, on the other hand, isn't unique. You should be focusing on the deplorable healthcare systems that have similar private shares of spending but that regulate them in a more normal, more laissez-faire way. Alternatively, you could lower your arbitrary bar and observe that the US system is rather privatized and is the least efficient, Canada's is somewhat less privatized and somewhat more efficient, and so on.

It isn't "abnormally regulated". The USA's private spending is regulated a lot too. Every system is a combination of public spending and highly regulated private spending. Singapore just has much more of the latter and less of the former. And, yes, the composition of the private spending (by the way out of pocket spending is private) matter a lot. My main point here is that I admire the way Singapore finances their system (mostly by out of pocket private spending). You can talk all about regulations and such, but in the end Singapore's method of finance is very much market oriented.

Also, the whole idea that more private systems are less efficient is ridiculous. The USA isn't unusually innefficient. It is just a bad system among other bad systems. The reason, by the way, that the USA is so bad is governmental distortions on how we purchase private insurance. Yes, this means that, like Singapore, the USA government plays a big role in private spending as well.


2.) Switzerland is about 40% privately financed. That is less than the USA and Singapore and more than all of the other countries mentioned. However, their system is about 30% out of pocket. Using that metric, they are second to Singapore. I think a better word than market oriented may be "consumer driven". I would say that Singapore and Switzerland are both more "consumer driven" than the USA as well as the other countries.

Consumer financed, perhaps, but that financing is compulsory (more like a ride than a drive). And again, the Swiss system is extremely inefficient. And again, Singapore isn't the system with the most private spending; it's the system with the most private spending out of the systems that work.

First off, whether or not the financing is compulsory doesn't matter for this point per say. I don't love the idea of compulsory out of pocket spending, but it is MUCH better than a governmental agency making purchasing decisions.

And, the Swiss system is actually one of the better systems. They cost about the same as France and Canada as a share of GDP but have higher quality care. If you have a different view, please provide evidence.


3.) If you are going to argue that Canada's system, which is only 30% private, has weaknesses because of too much privatization, then you need to show that the UK system, which is only 13% private, is the best system here.

No, because I understand that one system is not a scientific sample. That said, the NHS is certainly more efficient than any system we've discussed, except perhaps for Malta's, Singapore's, or Cuba's.

Okay, the NHS is actually about the worst system of the bunch. They are also the least private which would lend support to the hypothesis that governments really shouldnt be in the health care business.

I know your going to object, but let me make some points:

1.) I know how cost efficient folks think the NHS is. But, guess what, the NHS has had really high cost growth in recent years. Much higher cost growth than even the USA. So, if controlling health inflation is the goal, the NHS is more an example of what not to do.

2.) `And, I also know that progressives like to claim that waiting times and shortages are merely "right wing myths". But, they really aren't. They are actually pretty bad. I know we have to wait sometimes here in the USA. But, compared to the NHS, we get very quick care and the quality happens to be much better.

This all me brings me back to a central point. The NHS is the oldest and most government run system among the first world countries. And, as it turns out, it really doesn't work very well. Even many advocates of single payer have admitted as much.

Oftentimes, it takes a while to see the bad effects of bad governmentn policies. But, the NHS is an example of this. And, it will just get worse.
CarefulNow
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1/24/2013 12:27:46 AM
Posted: 3 years ago
At 1/23/2013 10:49:05 PM, BigRat wrote:
It isn't "abnormally regulated". The USA's private spending is regulated a lot too. Every system is a combination of public spending and highly regulated private spending. Singapore just has much more of the latter and less of the former. And, yes, the composition of the private spending (by the way out of pocket spending is private) matter a lot. My main point here is that I admire the way Singapore finances their system (mostly by out of pocket private spending). You can talk all about regulations and such, but in the end Singapore's method of finance is very much market oriented.

Name another system whose private spending predominantly takes the form of compulsory saving for co-pays to public insurance...and that's what we call abnormal. Even if other countries' private spending were as regulated, which it isn't, they're clearly not regulated the same way. So, a round of applause for Singapore, but there's absolutely no evidence that the success of its healthcare system is to do with anything but the way its private spending is regulated.

First off, whether or not the financing is compulsory doesn't matter for this point per say. I don't love the idea of compulsory out of pocket spending, but it is MUCH better than a governmental agency making purchasing decisions.

It's not compulsory spending, it's compulsory saving for co-pays to public insurance. If you love neither that idea nor its equivalent by higher taxation, go to India like I said.

And, the Swiss system is actually one of the better systems. They cost about the same as France and Canada as a share of GDP but have higher quality care. If you have a different view, please provide evidence.

I already told you I prefer cost to be measured per capita; it's not more expensive to take care of rich people, it's more expensive to take care of more people. I've been consulting WHO, just like you, and gapminder.org. Both show the Swiss system to be the second most expensive by the appropriate measure. As for "quality" (surely you mean outcomes; quality doesn't mean much when its limited to a few), WHO ranked France first in the world when it was less privatized than it's ever been since and Switzerland twentieth when it was more privatized than it's ever been since. So if you have mitigating evidence, I'm all ears.

Okay, the NHS is actually about the worst system of the bunch. They are also the least private which would lend support to the hypothesis that governments really shouldnt be in the health care business.

No, Cuba's system is the least private and by far the least expensive.

1.) I know how cost efficient folks think the NHS is. But, guess what, the NHS has had really high cost growth in recent years. Much higher cost growth than even the USA. So, if controlling health inflation is the goal, the NHS is more an example of what not to do.

The UK's government share of health spending has also been stagnant in recent years, whereas the US' has increased dramatically. Anyway, cost is only one side of efficiency, so until I see evidence to the contrary I have no reason to believe the NHS isn't still superior, much less that its decline can be generalized to public healthcare per se.

2.) `And, I also know that progressives like to claim that waiting times and shortages are merely "right wing myths". But, they really aren't. They are actually pretty bad. I know we have to wait sometimes here in the USA. But, compared to the NHS, we get very quick care and the quality happens to be much better.

Nope. Source please.
BigRat
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1/24/2013 1:03:54 AM
Posted: 3 years ago
At 1/24/2013 12:27:46 AM, CarefulNow wrote:
At 1/23/2013 10:49:05 PM, BigRat wrote:
It isn't "abnormally regulated". The USA's private spending is regulated a lot too. Every system is a combination of public spending and highly regulated private spending. Singapore just has much more of the latter and less of the former. And, yes, the composition of the private spending (by the way out of pocket spending is private) matter a lot. My main point here is that I admire the way Singapore finances their system (mostly by out of pocket private spending). You can talk all about regulations and such, but in the end Singapore's method of finance is very much market oriented.

Name another system whose private spending predominantly takes the form of compulsory saving for co-pays to public insurance...and that's what we call abnormal. Even if other countries' private spending were as regulated, which it isn't, they're clearly not regulated the same way. So, a round of applause for Singapore, but there's absolutely no evidence that the success of its healthcare system is to do with anything but the way its private spending is regulated.

Why is this so hard for you to understand?

Basically, there are three entities that could be purchasing insurance: large private organizations, the state, or consumers.

Even if the state forces saving, it is still ultimatley the consumer purchasing the heatlh care.

Now, if I am not mistaken, you favor the state (or government) being the main buyer of health care.

That is just not the way it is in Singapore. In fact, it is less that way in Singapore than in the United States.

I hold the view that the best way to purchase health care is through consumers, as is done in Singapore. And, it works pretty well. It works better at controlling costs than any single payer system I know of.

That is really all this boils down to.


First off, whether or not the financing is compulsory doesn't matter for this point per say. I don't love the idea of compulsory out of pocket spending, but it is MUCH better than a governmental agency making purchasing decisions.

It's not compulsory spending, it's compulsory saving for co-pays to public insurance. If you love neither that idea nor its equivalent by higher taxation, go to India like I said.

Why India?

India is still a fairly statist place (though less so than they once were).

And, I don't really have that big of a problem with forced savings. I like it a lot more than taxation.


And, the Swiss system is actually one of the better systems. They cost about the same as France and Canada as a share of GDP but have higher quality care. If you have a different view, please provide evidence.

I already told you I prefer cost to be measured per capita; it's not more expensive to take care of rich people, it's more expensive to take care of more people. I've been consulting WHO, just like you, and gapminder.org. Both show the Swiss system to be the second most expensive by the appropriate measure. As for "quality" (surely you mean outcomes; quality doesn't mean much when its limited to a few), WHO ranked France first in the world when it was less privatized than it's ever been since and Switzerland twentieth when it was more privatized than it's ever been since. So if you have mitigating evidence, I'm all ears.

Here's why per capita is a bad measure. Cuba spends about $674 per capita on health care. In contrast, your beloved UK system spends $2815 per capita on health care. Now, using your measure, we could conclude that Cuba is more than 4 times as effective at controlling health costs as Britain is. Now, I know some like to claim the Cuban system is good, but is it really that good????

No, richer countries demand more health care... because they have more money. So, we measure health care spending as a share of GDP. I can guarantee that almost every economist and health expert would agree with me here.

And please, don't make me explain that WHO report again. The fact that you folks bring up some 12 year old report in every health care debate shows how little evidence you have on your side.


Okay, the NHS is actually about the worst system of the bunch. They are also the least private which would lend support to the hypothesis that governments really shouldnt be in the health care business.

No, Cuba's system is the least private and by far the least expensive.

Well. I didn't see this.

If you want to argue that the Cuban system is great because of low per capita spending, then you are literally either too uninformed or too dishonest to even continue discussion with.


1.) I know how cost efficient folks think the NHS is. But, guess what, the NHS has had really high cost growth in recent years. Much higher cost growth than even the USA. So, if controlling health inflation is the goal, the NHS is more an example of what not to do.

The UK's government share of health spending has also been stagnant in recent years, whereas the US' has increased dramatically. Anyway, cost is only one side of efficiency, so until I see evidence to the contrary I have no reason to believe the NHS isn't still superior, much less that its decline can be generalized to public healthcare per se.

Well. When a system is 87% public, I find it hard to blame the private sector.

And, is it at all a coincidence that rising heatlh care costs didn't start in the USA until the governemnt started playing a bigger rrole?


2.) `And, I also know that progressives like to claim that waiting times and shortages are merely "right wing myths". But, they really aren't. They are actually pretty bad. I know we have to wait sometimes here in the USA. But, compared to the NHS, we get very quick care and the quality happens to be much better.

Nope. Source please.

Do you dispute this or not?

Again, if you do, you really are not worth debating with.
malcolmxy
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1/24/2013 2:08:55 AM
Posted: 3 years ago
At 1/23/2013 10:36:55 PM, BigRat wrote:

In Singapore, 63% of the health care spending is directly by consumers. This is in contrast to about 10 to 15% in the other countries I mentioned (including the USA).

Oh, so you think the government price controls are the best art of the Singapore Health System.

Noted.


Of course, I never said anything to that effect.

But, obviously you need to be intellectually dishonest to win arguments.

Yes you did. You simply didn't realize it. You are advocating for Singapore, whose health system is:

A. Universal, single payer (completely through the government, and not private industry, which is inherently inefficient, right? Private business in an open market will ALWAYS yield a better result, won't it?)
B. Funded through a forced taxation (couldn't the individual who earned this money better decide what to do with it than leave it in a tyrannical, government controlled inefficiency fund?)
C. Kept low in price to everyone via a stringent policy of government price controlling and gaming of the market (which will lead to more bad stuf than I can even begin to list)

And, of those three fundamental tenets of the Singapore system, you chose to call out the low cost to the consumer...kept that way via gov't price controls.

ERGO

The Government price controls must be the part of this plan you favor most.

If not, how do either the universal nature or inefficiency of holding earned capital in arrears (FORCED PRACTICE - one cannot opt out, and we all know that someone who earns a paycheck will best know how to spend it for themselves and society at large.)

If it's not price controls, then which of the other two tenets is it?

Sorry if that one was the one which seemed most logical to me. Please explain where my error was?

and also how I could so confuse this system you equate with the free market principals (even if it ain't quite there) you know will always lead to a net public good when it appears to me as if Singapore simply has a smart, decisive government and should be (and is) the model for everything I would look for in socialized medicine?

How the heck did that happen?
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CarefulNow
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1/24/2013 1:39:40 PM
Posted: 3 years ago
At 1/24/2013 1:03:54 AM, BigRat wrote:
Now, if I am not mistaken, you favor the state (or government) being the main buyer of health care.

No, I favor the state eliminating care-according-to-ability-to-pay by any means. Singapore's compulsory savings, means-testing, subsidies and public hospitals accomplish that by making everyone able to pay. Most socialized systems accomplish it by slightly different means, combining the compulsory payment and the means-testing in the form of taxation. So the difference in "government share of healthcare spending" is basically a technicality.

India is still a fairly statist place (though less so than they once were).

Not by your chosen metric. Its tax revenue (%GDP) is far lower than Singapore's, so it's no surprise that its government share of health spending is too. I chose India because you wanted a large population. If you meant closer to the US population, the closest of those with more privatized healthcare than Singapore's is the Philippines. Pack your bags.

Here's why per capita is a bad measure. Cuba spends about $674 per capita on health care. In contrast, your beloved UK system spends $2815 per capita on health care. Now, using your measure, we could conclude that Cuba is more than 4 times as effective at controlling health costs as Britain is. Now, I know some like to claim the Cuban system is good, but is it really that good????

No, because its outcomes aren't as good as the UK's. It's a poor Latin American country. If Latin Americans demanded the same healthcare as Europeans, there'd be nothing left over for food. Cuba is probably more efficient at healthcare than the UK (it's certainly more efficient than its neighbors), just not as much more efficient as you implied by citing cost only.

No, richer countries demand more health care... because they have more money. So, we measure health care spending as a share of GDP. I can guarantee that almost every economist and health expert would agree with me here.

WHO evidently doesn't. %GDP might be good if you're trying to get an idea of how important health is to a country, but it's useless for the question of efficiency. The rich demanding more healthcare doesn't change the fact that it doesn't cost them any more to obtain a given level of care. Anything they demand above that will, if the system is indeed efficient, manifest itself in outcomes as well as cost.

And please, don't make me explain that WHO report again. The fact that you folks bring up some 12 year old report in every health care debate shows how little evidence you have on your side.

I believe it's the last time WHO ranked the healthcare systems, probably because of the complex nature of healthcare outcomes (in my opinion, their formula is actually biased in favor of markets, but its the authoritative source so what can you do). I understand how old it is, which is why I make sure to relate its outcome rankings to what government share of health spending and health expenditure per capita were at the time. What, did privatization only recently become a good idea?

Well. When a system is 87% public, I find it hard to blame the private sector.

But you said healthcare cost growth. Wouldn't the appropriate measure then be the change in government's share?

And, is it at all a coincidence that rising heatlh care costs didn't start in the USA until the governemnt started playing a bigger rrole?

It must be, because, as you say, they're rising at a slower rate than in the UK, where the government's role hasn't increased. And newsflash: rising is what healthcare costs do. Singapore, for instance, has seen similar "inflation".
Greyparrot
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1/24/2013 1:47:33 PM
Posted: 3 years ago
America's health care hasn't been free market since the government decided to 'regulate' the private insurer industry. With the levels of corruption in this country it is no wonder why even simple measures to fix healthcare fall so short compared to Canada, who has much less corruption. (just look at Bush's whacked up prescription care coverage)
Contra
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1/24/2013 3:43:53 PM
Posted: 3 years ago
The U.S. government pays for 60% of total health care costs.

Single payer systems allocate resources through waiting lines. Consumer driven health care markets rely on prices for efficient allocation of resources.

When something is "free", demand spikes. But, lets not take my word for it. Lets look at the cold, true facts:

- In England, citizens on average take 1 ambulance trip to the hospital per year, of which 91% are for non-emergency purposes. [1]

- "Long waiting lists for coronary artery bypass grafting are associated with considerable mortality." - from a Swedish study. [2]

- More than 50% of people in Sweden have to wait longer than 3 months for surgery. [3]

- "Only half of ER patients are treated in a timely manner by national and international standards, according to a government study." This is in Canada. [4]

- "It has been estimated that a Swedish-style single-payer health insurance system in America would cost the median-income household some $17,200 per year in health care taxes." [5]

- If we look on a per patient basis, Medicare administrative costs are 48.4% higher compared to private insurance in the year 2000. [6]

- In France, the single payer model that many liberals and left wingers seek to emulate, its system is "on the verge of bankruptcy", requires 40% of gov't revenues, and needs to be financed by a 20% payroll tax on all workers. [7]

- France also has a huge problem with doctor shortages. [8]

- Single payer systems reduce medical research by an average of $17-22 billion per year, or about 10-13 less drug launches per year. [9]

- In Canada again, waiting lists are "routinely jumped by the famous and politically well connected." This is from the Canadian Fraser Institute. [10]

So, these facts have established that single payer systems 1) cause the costs of health care to skyrocket, 2) increase waiting times for care, and 3) reduces the innovation and quality of health care. They also violate individual rights and put patients on death panels.

A free market in health care has the built in incentives to provide us with a high quality health care system.

Consumer choice would direct resources only to good doctors, who are capable of helping their patients.

Medical innovations would improve our standards of life, and the quality of health care as a whole.

Costs would by cut by ending the web of paralyzing regulations and taxes, and through market competition and choice.

If we want a high quality health care system that improves our standards of living, is filled with innovation and medical research, is affordable, and allows individuals to have the freedom to choose what health care they want, we need to restore a consumer health care market.

Single payer systems violate liberty by forcing people to pay for health care. They are unfair because the wealthy and political cronies can jump the the waiting lists. They would destroy the economy by raising taxes by astronomical levels, of which would have to hit the middle class and the poor.

Sources:

[1] http://tinyurl.com...
[2] http://tinyurl.com...
[3] http://tinyurl.com...
[4] http://tinyurl.com...
[5] http://tinyurl.com...
[6] http://tinyurl.com...
[7] http://tinyurl.com...
[8] http://tinyurl.com...
[9] http://tinyurl.com...
[10] http://tinyurl.com...
"The solution [for Republicans] is to admit that Bush was a bad president, stop this racist homophobic stuff, stop trying to give most of the tax cuts to the rich, propose a real alternative to Obamacare that actually works, and propose smart free market solutions to our economic problems." - Distraff

"Americans are better off in a dynamic, free-enterprise-based economy that fosters economic growth, opportunity and upward mobility." - Paul Ryan
CarefulNow
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1/24/2013 4:37:40 PM
Posted: 3 years ago
At 1/24/2013 3:43:53 PM, Contra wrote:
A free market in health care has the built in incentives to provide us with a high quality health care system.

There are two major problems with that thesis:

1) It ignores pre-existing wealth inequalities. One who spends twice as much does not effect healthy persons; he effects one healthy person with a facelift.

2) It ignores the fact that individuals by nature act according to short-term interests. That's why Singapore, which mandates saving well in excess of average healthcare needs, is the only functional system in which consumers pay the greater part of cost.
malcolmxy
Posts: 2,855
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1/24/2013 4:54:41 PM
Posted: 3 years ago
At 1/24/2013 3:43:53 PM, Contra wrote:
The U.S. government pays for 60% of total health care costs.

Single payer systems allocate resources through waiting lines. Consumer driven health care markets rely on prices for efficient allocation of resources.

When something is "free", demand spikes. But, lets not take my word for it. Lets look at the cold, true facts:

- In England, citizens on average take 1 ambulance trip to the hospital per year, of which 91% are for non-emergency purposes. [1]

- "Long waiting lists for coronary artery bypass grafting are associated with considerable mortality." - from a Swedish study. [2]

- More than 50% of people in Sweden have to wait longer than 3 months for surgery. [3]

- "Only half of ER patients are treated in a timely manner by national and international standards, according to a government study." This is in Canada. [4]

- "It has been estimated that a Swedish-style single-payer health insurance system in America would cost the median-income household some $17,200 per year in health care taxes." [5]

- If we look on a per patient basis, Medicare administrative costs are 48.4% higher compared to private insurance in the year 2000. [6]

- In France, the single payer model that many liberals and left wingers seek to emulate, its system is "on the verge of bankruptcy", requires 40% of gov't revenues, and needs to be financed by a 20% payroll tax on all workers. [7]

- France also has a huge problem with doctor shortages. [8]

- Single payer systems reduce medical research by an average of $17-22 billion per year, or about 10-13 less drug launches per year. [9]

- In Canada again, waiting lists are "routinely jumped by the famous and politically well connected." This is from the Canadian Fraser Institute. [10]

So, these facts have established that single payer systems 1) cause the costs of health care to skyrocket, 2) increase waiting times for care, and 3) reduces the innovation and quality of health care. They also violate individual rights and put patients on death panels.

A free market in health care has the built in incentives to provide us with a high quality health care system.

Consumer choice would direct resources only to good doctors, who are capable of helping their patients.

Medical innovations would improve our standards of life, and the quality of health care as a whole.

Costs would by cut by ending the web of paralyzing regulations and taxes, and through market competition and choice.

If we want a high quality health care system that improves our standards of living, is filled with innovation and medical research, is affordable, and allows individuals to have the freedom to choose what health care they want, we need to restore a consumer health care market.

Single payer systems violate liberty by forcing people to pay for health care. They are unfair because the wealthy and political cronies can jump the the waiting lists. They would destroy the economy by raising taxes by astronomical levels, of which would have to hit the middle class and the poor.

Sources:

[1] http://tinyurl.com...
[2] http://tinyurl.com...
[3] http://tinyurl.com...
[4] http://tinyurl.com...
[5] http://tinyurl.com...
[6] http://tinyurl.com...
[7] http://tinyurl.com...
[8] http://tinyurl.com...
[9] http://tinyurl.com...
[10] http://tinyurl.com...

Why does every comparable country with a universal, single payer plan have a better standard of care, lesser costs, and lesser costs bore out by the government?

I'll support your ideas in other markets, but this market in particular doesn't appear to work like the rest of the markets where your ideas might be true.

Any idea why that is?
War is over, if you want it.

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BigRat
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1/24/2013 8:12:54 PM
Posted: 3 years ago
At 1/24/2013 2:08:55 AM, malcolmxy wrote:
At 1/23/2013 10:36:55 PM, BigRat wrote:

In Singapore, 63% of the health care spending is directly by consumers. This is in contrast to about 10 to 15% in the other countries I mentioned (including the USA).

Oh, so you think the government price controls are the best art of the Singapore Health System.

Noted.


Of course, I never said anything to that effect.

But, obviously you need to be intellectually dishonest to win arguments.

Yes you did. You simply didn't realize it. You are advocating for Singapore, whose health system is:

A. Universal, single payer (completely through the government, and not private industry, which is inherently inefficient, right? Private business in an open market will ALWAYS yield a better result, won't it?)
B. Funded through a forced taxation (couldn't the individual who earned this money better decide what to do with it than leave it in a tyrannical, government controlled inefficiency fund?)
C. Kept low in price to everyone via a stringent policy of government price controlling and gaming of the market (which will lead to more bad stuf than I can even begin to list)

And, of those three fundamental tenets of the Singapore system, you chose to call out the low cost to the consumer...kept that way via gov't price controls.

ERGO

The Government price controls must be the part of this plan you favor most.

If not, how do either the universal nature or inefficiency of holding earned capital in arrears (FORCED PRACTICE - one cannot opt out, and we all know that someone who earns a paycheck will best know how to spend it for themselves and society at large.)

If it's not price controls, then which of the other two tenets is it?

Sorry if that one was the one which seemed most logical to me. Please explain where my error was?

and also how I could so confuse this system you equate with the free market principals (even if it ain't quite there) you know will always lead to a net public good when it appears to me as if Singapore simply has a smart, decisive government and should be (and is) the model for everything I would look for in socialized medicine?

How the heck did that happen?

First off, you are quite misinformed about Singapore. But, let me just start by saying that forced savings is VERY different than taxation.

And, what I admire in Singapore is the way the FINANCE their health care. Instead of having government directly buy health care, as they do in single payer systems, consumers do most of the buying.

This makes the system very consumer driven.

Again, you are very misinformed.
BigRat
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1/24/2013 8:19:23 PM
Posted: 3 years ago
At 1/24/2013 1:39:40 PM, CarefulNow wrote:
At 1/24/2013 1:03:54 AM, BigRat wrote:
Now, if I am not mistaken, you favor the state (or government) being the main buyer of health care.

No, I favor the state eliminating care-according-to-ability-to-pay by any means. Singapore's compulsory savings, means-testing, subsidies and public hospitals accomplish that by making everyone able to pay. Most socialized systems accomplish it by slightly different means, combining the compulsory payment and the means-testing in the form of taxation. So the difference in "government share of healthcare spending" is basically a technicality.

Okay. So if you support Singapore's system, can we agree that forced savings and having consumers pay for health care is better than having a single payer system?

By the way, your contention that the difference is merely a technicality is about the most misinformed thing that has been said here. Believe it or not, people will call you when you make BS statements like that.


India is still a fairly statist place (though less so than they once were).

Not by your chosen metric. Its tax revenue (%GDP) is far lower than Singapore's, so it's no surprise that its government share of health spending is too. I chose India because you wanted a large population. If you meant closer to the US population, the closest of those with more privatized healthcare than Singapore's is the Philippines. Pack your bags.

Would you stop saying stupid things please?

"Pack your bags."...

In order to make snide comments, you need to actually have said something intelligent. You did not meet that standard.


Here's why per capita is a bad measure. Cuba spends about $674 per capita on health care. In contrast, your beloved UK system spends $2815 per capita on health care. Now, using your measure, we could conclude that Cuba is more than 4 times as effective at controlling health costs as Britain is. Now, I know some like to claim the Cuban system is good, but is it really that good????

No, because its outcomes aren't as good as the UK's. It's a poor Latin American country. If Latin Americans demanded the same healthcare as Europeans, there'd be nothing left over for food. Cuba is probably more efficient at healthcare than the UK (it's certainly more efficient than its neighbors), just not as much more efficient as you implied by citing cost only.

Lol. When someone is defending Cuba, you can be rest assured that their position is very, very stupid.


No, richer countries demand more health care... because they have more money. So, we measure health care spending as a share of GDP. I can guarantee that almost every economist and health expert would agree with me here.

WHO evidently doesn't. %GDP might be good if you're trying to get an idea of how important health is to a country, but it's useless for the question of efficiency. The rich demanding more healthcare doesn't change the fact that it doesn't cost them any more to obtain a given level of care. Anything they demand above that will, if the system is indeed efficient, manifest itself in outcomes as well as cost.

And please, don't make me explain that WHO report again. The fact that you folks bring up some 12 year old report in every health care debate shows how little evidence you have on your side.

I believe it's the last time WHO ranked the healthcare systems, probably because of the complex nature of healthcare outcomes (in my opinion, their formula is actually biased in favor of markets, but its the authoritative source so what can you do). I understand how old it is, which is why I make sure to relate its outcome rankings to what government share of health spending and health expenditure per capita were at the time. What, did privatization only recently become a good idea?

Well. When a system is 87% public, I find it hard to blame the private sector.

But you said healthcare cost growth. Wouldn't the appropriate measure then be the change in government's share?

And, is it at all a coincidence that rising heatlh care costs didn't start in the USA until the governemnt started playing a bigger rrole?

It must be, because, as you say, they're rising at a slower rate than in the UK, where the government's role hasn't increased. And newsflash: rising is what healthcare costs do. Singapore, for instance, has seen similar "inflation".

Okay. I honestly don't see a point of going on here. Your points have gone from interesting to very stupid. I don't waste my time debunking such obviously misinformed claims.
CarefulNow
Posts: 780
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1/26/2013 2:11:32 PM
Posted: 3 years ago
At 1/24/2013 8:19:23 PM, BigRat wrote:
Okay. So if you support Singapore's system, can we agree that forced savings and having consumers pay for health care is better than having a single payer system?

The data doesn't rule it out, but it doesn't prove it either. As a collectivist, not a communist, I'm more inclined toward a Singapore-type system, especially in the context of subsidies and taxes on the commodities affecting health.

By the way, your contention that the difference is merely a technicality is about the most misinformed thing that has been said here. Believe it or not, people will call you when you make BS statements like that.

I would hope they would call me out on my BS, particularly if they explained why it was BS. My reason for supporting public healthcare is that the leading alternative, in standard free market fashion, puts the old at the mercy of their former selves and leaves the poor helpless. Singapore succeeds where the free market fails by taxing income, calling it savings, and charging according to means. So yes, its differences from formally public healthcare are quite trivial based on what I consider important.

Lol. When someone is defending Cuba, you can be rest assured that their position is very, very stupid.

If you have a point that rises above Cuba's status as national enemy number one, make it.

Okay. I honestly don't see a point of going on here. Your points have gone from interesting to very stupid. I don't waste my time debunking such obviously misinformed claims.

Again, I'm getting my information from WHO and gapminder.org, neither of which you've discredited and at least one of which you've used yourself. Given that the information is correct, it would indeed be a waste of time to try to debunk it. The only thing that confuses me, given your admittance that you have nothing further to contribute, is why you don't just shut the f*ck up.
Contra
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1/26/2013 2:32:01 PM
Posted: 3 years ago
At 1/24/2013 4:37:40 PM, CarefulNow wrote:
At 1/24/2013 3:43:53 PM, Contra wrote:
A free market in health care has the built in incentives to provide us with a high quality health care system.

There are two major problems with that thesis:

1) It ignores pre-existing wealth inequalities. One who spends twice as much does not effect healthy persons; he effects one healthy person with a facelift.

I don't see how this is relevant.

2) It ignores the fact that individuals by nature act according to short-term interests. That's why Singapore, which mandates saving well in excess of average healthcare needs, is the only functional system in which consumers pay the greater part of cost.

There are various ways to implement this while having a private health care system. We could have a national or state level catastrophic insurance program (not my approach), make people set aside a portion of their income for health care expenses, etc.

I believe that people are rational enough to set aside some of their income to put it in their personal health savings account (which would remain tax exempt).

Another possibility, which I think is a good idea is to incentivize saving by using the tax code. A flat tax, of 15%, as well as a dollar by dollar tax deduction for saving cash in their personal HSA.

To say it better, with a deduction up to $1000, someone could reduce their taxes by $1000 by putting that same amount of cash towards future health care expenditures.

So yes, a private health care market can work fine, and we can incentivize saving for future health costs.
"The solution [for Republicans] is to admit that Bush was a bad president, stop this racist homophobic stuff, stop trying to give most of the tax cuts to the rich, propose a real alternative to Obamacare that actually works, and propose smart free market solutions to our economic problems." - Distraff

"Americans are better off in a dynamic, free-enterprise-based economy that fosters economic growth, opportunity and upward mobility." - Paul Ryan
Contra
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1/26/2013 2:46:11 PM
Posted: 3 years ago
At 1/24/2013 4:54:41 PM, malcolmxy wrote:
At 1/24/2013 3:43:53 PM, Contra wrote:

Why does every comparable country with a universal, single payer plan have a better standard of care, lesser costs, and lesser costs bore out by the government?

First, costs are lower because they slash doctor pay, hold down costs by limiting access to care, and because it is simpler - one bureaucracy transfers tax revenues towards the payment of people's health care.

A private health care market could be simpler through basic competition though, having sellers of health care list their prices, and insurance only covering catastrophic care.

I'll support your ideas in other markets, but this market in particular doesn't appear to work like the rest of the markets where your ideas might be true.

That is good.

Any idea why that is?

FDR's tax exemption in WW2, which incentivized the use of health insurance to cover basic care, which made costs skyrocket, people not exposed to their costs.

Insurance to cover basic health care complicated things, and this as well as a myriad web of regulations and mandates have complicated health care, and raised costs and limited competition, all harming people's physical and fiscal health.

Gov't licensing, which has often not helped, and made things worse.

The FDA, limiting the access of drugs, and made the cost of drugs and medical goods skyrocket, and is a corrupted institution.
"The solution [for Republicans] is to admit that Bush was a bad president, stop this racist homophobic stuff, stop trying to give most of the tax cuts to the rich, propose a real alternative to Obamacare that actually works, and propose smart free market solutions to our economic problems." - Distraff

"Americans are better off in a dynamic, free-enterprise-based economy that fosters economic growth, opportunity and upward mobility." - Paul Ryan
BigRat
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1/26/2013 4:10:17 PM
Posted: 3 years ago
At 1/26/2013 2:11:32 PM, CarefulNow wrote:
At 1/24/2013 8:19:23 PM, BigRat wrote:
Okay. So if you support Singapore's system, can we agree that forced savings and having consumers pay for health care is better than having a single payer system?

The data doesn't rule it out, but it doesn't prove it either. As a collectivist, not a communist, I'm more inclined toward a Singapore-type system, especially in the context of subsidies and taxes on the commodities affecting health.

In other words, your more inclined towards a Singapore-type system except for the part that makes it unique (high amounts of forced savings and direct consumer purchasing of health goods).


By the way, your contention that the difference is merely a technicality is about the most misinformed thing that has been said here. Believe it or not, people will call you when you make BS statements like that.

I would hope they would call me out on my BS, particularly if they explained why it was BS. My reason for supporting public healthcare is that the leading alternative, in standard free market fashion, puts the old at the mercy of their former selves and leaves the poor helpless. Singapore succeeds where the free market fails by taxing income, calling it savings, and charging according to means. So yes, its differences from formally public healthcare are quite trivial based on what I consider important.

Forced savings is not, has never been, and never will be the same thing as public health care.

Saying they are effectively the same thing is a new level of ignorance.


Lol. When someone is defending Cuba, you can be rest assured that their position is very, very stupid.

If you have a point that rises above Cuba's status as national enemy number one, make it.

I have to admit that I admire your consistency. If progressive policies were good, Cuba should be a paradise.

Most progressives acknowledge that Cuba is a hellhole but still hold that progressive policies help human development (two contradictory positions).

I at least appreciate that you take progressive thinking to the inevitable conclusion.


Okay. I honestly don't see a point of going on here. Your points have gone from interesting to very stupid. I don't waste my time debunking such obviously misinformed claims.

Again, I'm getting my information from WHO and gapminder.org, neither of which you've discredited and at least one of which you've used yourself. Given that the information is correct, it would indeed be a waste of time to try to debunk it. The only thing that confuses me, given your admittance that you have nothing further to contribute, is why you don't just shut the f*ck up.

No, you aren't. You are citing really old reports that offer a subjective interpretation of data.

I have plenty more to contribute, but I see no reason wasting my time debating someone who thinks:

1.) Health spending per capita is a better measure of how cost effective a system is than Health spending as a share of GDP.

2.) Cuba is an example of a well run health care system.

3.) Canada's system only has problems because of too much private involvement.

4.) Forced savings is effectively the same thing as taxation.

5.) Singapore's system has more government involvement than the USA and most other systems.

These are not credible positions. I don't waste my time debating whether or not evolution is correct because it obviously is. I would love to further discuss this. But, you take ridiculous positions that no informed or intellectually dishonest person would take.

So, stop wasting my time.
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1/26/2013 4:14:27 PM
Posted: 3 years ago
At 1/26/2013 2:32:01 PM, Contra wrote:
I don't see how this is relevant.

It's relevant by virtue of your use of "us". Given money's diminishing marginal utility and the unilateral acquisitions of property to which we ultimately owe the greater part of inequality, the conflation of a system incentivized to serve money with one incentivized to serve us is no minor mistake.

There are various ways to implement this while having a private health care system. We could have a national or state level catastrophic insurance program (not my approach), make people set aside a portion of their income for health care expenses, etc.

There are already systems that approximate that, Switzerland and now the US being the closest, and they're terribly inefficient. And it's a wonder why one who doesn't trust government to use monopoly and/or monopsony power in the interest of the people who elect it trusts it to determine how much money they hand over to the for-profit alternatives.

I believe that people are rational enough to set aside some of their income to put it in their personal health savings account (which would remain tax exempt).

If by "some" you mean the crucial "enough", you have no basis for that belief. As biological beings, humans are genetically self-interested, which implies favoritism of fertility, sacrifice of childhood and old age.

To say it better, with a deduction up to $1000, someone could reduce their taxes by $1000 by putting that same amount of cash towards future health care expenditures.

That amounts to subsidizing healthcare in proportion to income; the real world has found it more efficient to subsidize it according to need.

So yes, a private health care market can work fine, and we can incentivize saving for future health costs.

If there were any a priori reason to preserve capitalism, then, yes, tempering it at its most extreme consequences would be the way to go. But fortunately there's no reason to be constrained by that criterion.
CarefulNow
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1/26/2013 5:07:56 PM
Posted: 3 years ago
At 1/26/2013 4:10:17 PM, BigRat wrote:
In other words, your more inclined towards a Singapore-type system except for the part that makes it unique (high amounts of forced savings and direct consumer purchasing of health goods).

I was referring to the non-healthcare commodities that promote or disrupt good health. But Singapore absolutely subsidizes healthcare, which provides crucial incentives for the co-pays you call private healthcare.

Forced savings is not, has never been, and never will be the same thing as public health care.

Of course not. Forced savings for private healthcare, as in the highly inefficient Swiss system, clearly isn't public healthcare. It's only when those forced savings are for co-pays to a public insurer, as in Singapore, that it's public healthcare.

I have to admit that I admire your consistency. If progressive policies were good, Cuba should be a paradise.

By Latin American standards, it is a paradise (which is remarkable, given the crushing sanctions), especially in terms of healthcare (which is remarkable, given how little it spends on it). I told you where my data comes from, so when you're ready to do more than mock me, you know where to start.

I at least appreciate that you take progressive thinking to the inevitable conclusion.

As I said, I'm a collectivist--not a Cubist, not a progressive. If Cuba worked perfectly, I would have to re-examine my collectivist principles. But it doesn't. It just has an extremely efficient healthcare system by objective standards, and I repeat my as-yet ignored invitation that you prove me wrong.

No, you aren't. You are citing really old reports that offer a subjective interpretation of data.

I feel I've adequately addressed the criticism from age by asking you the begged question: when exactly did privatization become a good idea? The interpretation of the data is indeed, necessarily, subjective; however, absent an explanation as to how WHO's is biased against privatization, and absent alternative criteria, how exactly do you expect me to believe you when you assert the superiority of the privatized systems?

I have plenty more to contribute, but I see no reason wasting my time debating someone who thinks:

Don't you think I know what I said? Again, if you can't offer a counterargument, shut the fvck up.
BigRat
Posts: 465
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1/26/2013 5:10:39 PM
Posted: 3 years ago
At 1/26/2013 5:07:56 PM, CarefulNow wrote:
At 1/26/2013 4:10:17 PM, BigRat wrote:
In other words, your more inclined towards a Singapore-type system except for the part that makes it unique (high amounts of forced savings and direct consumer purchasing of health goods).

I was referring to the non-healthcare commodities that promote or disrupt good health. But Singapore absolutely subsidizes healthcare, which provides crucial incentives for the co-pays you call private healthcare.

Forced savings is not, has never been, and never will be the same thing as public health care.

Of course not. Forced savings for private healthcare, as in the highly inefficient Swiss system, clearly isn't public healthcare. It's only when those forced savings are for co-pays to a public insurer, as in Singapore, that it's public healthcare.

I have to admit that I admire your consistency. If progressive policies were good, Cuba should be a paradise.

By Latin American standards, it is a paradise (which is remarkable, given the crushing sanctions), especially in terms of healthcare (which is remarkable, given how little it spends on it). I told you where my data comes from, so when you're ready to do more than mock me, you know where to start.

I at least appreciate that you take progressive thinking to the inevitable conclusion.

As I said, I'm a collectivist--not a Cubist, not a progressive. If Cuba worked perfectly, I would have to re-examine my collectivist principles. But it doesn't. It just has an extremely efficient healthcare system by objective standards, and I repeat my as-yet ignored invitation that you prove me wrong.

No, you aren't. You are citing really old reports that offer a subjective interpretation of data.

I feel I've adequately addressed the criticism from age by asking you the begged question: when exactly did privatization become a good idea? The interpretation of the data is indeed, necessarily, subjective; however, absent an explanation as to how WHO's is biased against privatization, and absent alternative criteria, how exactly do you expect me to believe you when you assert the superiority of the privatized systems?

I have plenty more to contribute, but I see no reason wasting my time debating someone who thinks:

Don't you think I know what I said? Again, if you can't offer a counterargument, shut the fvck up.

Okay. I'm done here. You've embarrassed yourself enough.

Does anyone, perhaps with a bit more knowledge and intellect than carefulnow, have any points to make?
malcolmxy
Posts: 2,855
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1/26/2013 5:54:37 PM
Posted: 3 years ago
At 1/24/2013 8:12:54 PM, BigRat wrote:

First off, you are quite misinformed about Singapore. But, let me just start by saying that forced savings is VERY different than taxation.

MY MONEY. I KNOW how to use it more efficiently than the government does, don't I? What happens to any positive balance when I die?

Sounds like a tax to me. How is it different?


And, what I admire in Singapore is the way the FINANCE their health care. Instead of having government directly buy health care, as they do in single payer systems, consumers do most of the buying.

Who sets the price? From whose account does the payment come from?

They seem to have a good Socialist Healthcare program there, but it is no less Socialist.


This makes the system very consumer driven.

At prices set by the government. At those prices, of course it's consumer driven.


Again, you are very misinformed.

Please note any incorrect statements I've made and explain HOW they are incorrect, not just that they are.
War is over, if you want it.

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BigRat
Posts: 465
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1/26/2013 11:10:36 PM
Posted: 3 years ago
At 1/26/2013 5:54:37 PM, malcolmxy wrote:
At 1/24/2013 8:12:54 PM, BigRat wrote:

First off, you are quite misinformed about Singapore. But, let me just start by saying that forced savings is VERY different than taxation.

MY MONEY. I KNOW how to use it more efficiently than the government does, don't I? What happens to any positive balance when I die?

Sounds like a tax to me. How is it different?


And, what I admire in Singapore is the way the FINANCE their health care. Instead of having government directly buy health care, as they do in single payer systems, consumers do most of the buying.

Who sets the price? From whose account does the payment come from?

They seem to have a good Socialist Healthcare program there, but it is no less Socialist.


This makes the system very consumer driven.

At prices set by the government. At those prices, of course it's consumer driven.


Again, you are very misinformed.

Please note any incorrect statements I've made and explain HOW they are incorrect, not just that they are.

Okay, well if you think that forced savings and taxation are the same thing, let us agree to this:

1.) You will abandon support for single payer in favor of a Singapore style forced savings. I support that.

2.) You will endorse shifting social security and unemployment insurance to forced savings accounts. I support that.

3.) You will endorse shifting virtually all transfer programs to forced savings programs.
I support that.

Good, it looks like we agree on a lot.

Unless, of course, you think forced savings is different from taxation. I certainly do. But, if you see no distinction, you might as well go with the one that gets bipartisan support.
CarefulNow
Posts: 780
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1/27/2013 12:52:22 PM
Posted: 3 years ago
At 1/26/2013 11:10:36 PM, BigRat wrote:
Unless, of course, you think forced savings is different from taxation. I certainly do. But, if you see no distinction, you might as well go with the one that gets bipartisan support.

What? Obamacare's mandate only survived judicial review by being reconceived as a tax, courtesy of there being no difference between a mandate and a tax.