Personally, I am on the fence. Ideologically (as a classical liberal/socially-liberal libertarian)
Once upon a time there was this guy who used to post a lot here and is an economist, and is far more libertarian and conservative than I am, maybe you remember the guy? He made the point that he could not leave his current employer, because he had a pre-existing medial condition. So tell me, as just a libertarian thing, we'll leave the rest for later, is it better for the liberty, or worse for the liberty, of the individual person, if they are compelled to remain with an employer because of the threat of loss of medical insurance coverage?
I'm seriously not trying to be snarky here, but I feel like it's going to sound that way. Seen another way, nearly half of healthcare is going to people with such serious conditions that they're dying. Isn't that where healthcare should go?
I do get your point (and I think it was a point in a Democratic debate recently?) that some treatments for an 80yr-old really are not only a waste, but reducing quality of life while not extending it, and somewhere on the spectrum are judgment calls where even the patient themself, their close family, and their doctor disagree about what if anything should be done.
This is an arguable point. But the counter argument is, given that resources are not unlimited, does it not make sense that resources are used where they provide the greatest return on investment? You might respond something like "it's his money, he should spend it like he wants." But does that hold up to examination? An 80 year old man and a 15 year old boy need a kidney transplant. The man can afford it, the boy cannot. But the man is, at least for most of it, relying on Medicare. Which means the taxpayer. And the man is not going to contribute any more to the economy. So it's actually the taxpayer paying, and not getting anything back. And if the man has insurance paying for a part of it, I can guarantee that that insurance premium that the man paid doesn't cover the full cost of a kidney transplant. Insurance doesn't work that way. Insurance aggregates costs and risks. For every 80 year old man who gets a kidney, 1000s do not. So every other person who pays into that insurance subsidizes the cost of that man's kidney.
Now that's what any insurance program is: Those who use less subsidize those who use more. And this is acceptable because no one really knows in advance who is the less and who is the more. So you roll the dice, and you take your chances.
But if that boy got the kidney, he'd be able to finish school, get a job, and spend 50 years adding to the economy. But if he doesn't, then he's going to spend 30 odd years on welfare dragging down the economy. Which mean that you, the taxpayer, are made worse off because the man got the kidney instead of the boy. In economics this is called a "negative externality". What that means is that people who are not voluntarily part of a transaction are nonetheless responsible for part of the cost of that transaction. What that means is, that you, who is neither that man, nor that boy, are made poorer by the system as it currently exists.
Do you not feel that you deserve some say in the situation?
@Arwon posted this:
What he didn't post was that the US also gets less value for the dollar spent than any other country. So what does that tell you? Compared to just the next country on the list, 5 cents on every dollar the United States makes, just flat out ceases to exist, for no other reason than the broken nature of the system. Now if 5% of your pay just flat out ceases to exist, and if 5% of American GDP just ceases to exist, don't you think that maybe, just maybe, you'd be better off if you had 5% more take home pay every year? If America had 5% more take home pay every year?
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Now this is actually more complex than that. As the failures of the payment system are only part of the problem. Now the failures of the payment system are in fact a major part of the problem. The insurers don't want to pay any more than they have to. But there are limits on what they can refuse to pay. So what you actually have is an army of bureaucrats in the insurance companies who are in a constant state of warfare with an army of bureaucrats in the care providers offices fighting WW1 style trench warfare over what will and will not be paid. Half the people in a typical medical office are clerks arguing with insurance companies. And that is expensive. And this is to a large extent what eats up America's excessive medical costs.
Unless the US federal government steps in, and uses it's 800 pound gorilla presence on the matter, no player in the system, no combination of players in the system, have the might to change this.
But that's not the only excess cost driver. Another is the simple capitalist profit motive. In short, there is no participant in the system which is not made better off by driving costs higher. Patients want more care. Providers want more billable hours. Pharma want more drug pushing. Testing firms want more tests. Testing equipment makers want more tests. Insurers want more bureaucracy (the reason for this is that insurers are often rate regulated for limits on rates of return. Like with cost plus contractors in the military, if you are limited on the
rate of return that you can get, you can still maximize
quantity of return by increasing your costs.) So everyone in the system gets what they want if costs are maximized. Everyone except the taxpayer. The taxpayer, the government, is the only player in the system who really has an incentive to control costs. But in the US system, the government just does not have the level of power necessary to force costs controls. In theory it could. But in practice that would take legislation that is not forthcoming.
What is needed is a system with a budget. If you got a billion dollars a year to spend, and only that, and you got so much tasks to accomplish, then you're going to find a way to squeeze that billion, and get as much done with it. If you've got a blank check, you're going to spend every penny you can possibly squeeze out of it.
I hear about doctor shortages in other countries. In the US there tends to be nurse shortages. If M4A becomes reality, how many more doctors do we need, based on people going to see doctors where currently they don't? For better or for worse, the prospect of thousands of dollars (if uninsured) or dozens of dollars (if insured) keeps a downward pressure on the willingness to see doctors.
OK, so one cost driver in the US is provider shortages. This is a very difficult problem to address, in that the capacity to train new providers has limits. And it is the professional organizations of the providers who are responsible for that. By making medical training exceptionally expensive. By making training far more difficult to complete than is justified by need. By making it too difficult for immigrants to qualify to be providers. These things limit free market competition, and in so doing allow providers to charge higher prices.
Off the top of my head, pros include covering people and relieving businesses of the burden either giving them an advantage or leveling the playing field with foreign competition. Otoh right now government run health care systems are subsidized by the 'market', people who pay out of pocket or with private insurance pay more so old timers on Medicare pay less. That disguises the real costs of such programs.
This is a good point that others didn't follow up on. Employer provided health coverage is an economic disadvantage for American employers compared to the employers of other nations. So it costs the US jobs, thus lowering US pay levels, and constraining US economic growth. Which is to say, this is another aspect in which the nation of the US is poorer and weaker because of the current system.
