Health Care

As the health care legislation passes the House, I was reading up on what the Health Care changes proposed are at a conceptual level. I found this table on wikipedia useful (Full article here)

Nationalized health care proponents:

• In most cases, people have little influence on whether or not they will contract an illness. Consequently, illness may be viewed as a fundamental part of what it means to be human and, as such, access to treatment for illness should be based on acknowledgement of the human condition, not the ability to pay^{[61][62][63][64]} or entitlement.^[65] Therefore, health care may be viewed as a fundamental human right itself or as an extension of the right to life.^[66]
• Since people perceive universal health care as free, they are more likely to seek preventative care which, in the long run, lowers their overall health care expenditure by focusing treatment on small, less expensive problems before they become large and costly.^[67]
• A universal health care system allows for a larger capital base than can be offered by free market insurers (without violating antitrust laws). A larger capital base "spreads out" the cost of a payout among more people, lowering the cost to the individual.
• Universal health care would provide for uninsured adults who may forgo treatment needed for chronic health conditions.^[68]
• In most free-market situations, the consumer of health care is entirely in the hands of a third party who has a direct personal interest in persuading the consumer to spend money on health care in his or her practice. The consumer is not able to make value judgments about the services judged to be necessary because he or she may not have sufficient expertise to do so.^[69] This, it is claimed, leads to a tendency to over produce. In socialized medicine, hospitals are not run for profit and doctors work directly for the community and are assured of their salary. They have no direct financial interest in whether the patient is treated or not, so there is no incentive to over provide. When insurance interests are involved this furthers the disconnect between consumption and utility and the ability to make value judgments.^[70] Others argue that the reason for over production is less cynically driven but that the end result is much the same.^[71]
• The profit motive in medicine values money above public benefit.^[72] For example, pharmaceutical companies have reduced or dropped their research into developing new antibiotics, even as antibiotic-resistant strains of bacteria are increasing, because there's less profit to be gained there than in other drug research.^[73] Those in favor of universal health care posit that removing profit as a motive will increase the rate of medical innovation.^[74]
• Paul Krugman and Robin Wells say that in response to new medical technology, the American health care system spends more on state-of-the-art treatment for people who have good insurance, and spending is reduced on those lacking it.^[75]
• The profit motive adversely affects the cost and quality of health care. If managed care programs and their concomitant provider networks are abolished, then doctors would no longer be guaranteed patients solely on the basis of their membership in a provider group and regardless of the quality of care they provide. Theoretically, quality of care would increase as true competition for patients is restored.^[76]
• Wastefulness and inefficiency in the delivery of health care would be reduced.^[77] A single payer system could save $286 billion a year in overhead and paperwork.^[78] Administrative costs in the U.S. health care system are substantially higher than those in other countries and than in the public sector in the US: one estimate put the total administrative costs at 24% of U.S. health care spending.^[79] It might only take one government agent to do the job of two health insurance agents.^[80] According to one estimate roughly 50% of health care dollars are spent on health care, the rest go to various middlemen and intermediaries. A streamlined, non-profit, universal system would increase the efficiency with which money is spent on health care.^[81]
• About 60% of the U.S. health care system is already publicly financed with federal and state taxes, property taxes, and tax subsidies — a universal health care system would merely replace private/employer spending with taxes. Total spending would go down for individuals and employers.^[82]
• Several studies have shown a majority of taxpayers and citizens across the political divide would prefer a universal health care system over the current U.S. system^[83][84][85]
• America spends a far higher percentage of GDP on health care than any other country but has worse ratings on such criteria as quality of care, efficiency of care, access to care, safe care, equity, and wait times, according to the Commonwealth Fund.^[51]
• A universal system would align incentives for investment in long term health-care productivity, preventive care, and better management of chronic conditions.^[67]
• The Big Three of U.S. car manufacturers have cited health-care provision as a financial disadvantage. The cost of health insurance to U.S. car manufacturers adds between USD 900 and USD 1,400 to each car made in the U.S.A.^[86]
• In countries in Western Europe with public universal health care, private health care is also available, and one may choose to use it if desired. Most of the advantages of private health care continue to be present, see also Two-tier health care.^[87]
• Universal health care and public doctors would protect the right to privacy between insurance companies and patients.^[88]
• Public health care system can be used as independent third party in disputes between employer and employee.^[89]
• A study of hospitals in Canada found that death rates are lower in private not-for-profit hospitals than in private for-profit hospitals.^[90]

Free market health care proponents:

• Health care is not a constitutional right.^[91][92] Thus, it is not the responsibility of government to provide health care.^[93]
• Free health care can lead to overuse of medical services, and hence raise overall cost.^[94][95]
• Universal health coverage does not in practice guarantee universal access to care. Many countries offer universal coverage but have long wait times or ration care.^[96]
• The federal Emergency Medical Treatment and Active Labor Act requires hospitals andambulance services to provide emergency care to anyone regardless of citizenship, legal status or ability to pay.^{[97][98][99][100]}
• Eliminating the profit motive will decrease the rate of medical innovation.^[101]
• It slows down innovation and inhibits new technologies from being developed and utilized. This simply means that medical technologies are less likely to be researched and manufactured, and technologies that are available are less likely to be used.^[102]
• Publicly-funded medicine leads to greater inefficiencies and inequalities^[101][103] Opponents of universal health care argue that government agencies are less efficient due to bureaucracy.^[103]Universal health care would reduce efficiency because of more bureaucratic oversight and more paperwork, which could lead to fewer doctor-patient visits.^[104] Advocates of this argument claim that the performance of administrative duties by doctors results from medical centralization and over-regulation, and may reduce charitable provision of medical services by doctors.^[92]
• Converting to a single-payer system could be a radical change, creating administrative chaos.^[105]
• Data on liver and heart transplants suggest that access to transplants (especially the sickest patients) and outcomes in the US are as among the best in the world.^[106]
• The extra spending in the US is justified if expected life span increases by only about half a year as a result.^[107]
• Unequal access and health disparities still exist in universal health care systems.^[108]
• The problem of rising health care costs is occurring all over the world; this is not a unique problem created by the structure of the US system.^[96]
• Universal health care suffers from the same financial problems as any other government planned economy. It requires governments to increase taxes as costs rise year over year.^[109] Empirical evidence on the Medicare single payer-insurance program demonstrates that the cost exceeds the expectations of advocates.^[110] As an open-ended entitlement, Medicare does not weigh the benefits of technologies against their costs. Paying physicians on a fee-for-service basis also leads to spending increases. As a result, it is difficult to predict or control Medicare's spending.^[108] The Washington Post reported in July 2008 that Medicare had "paid as much as $92 million since 2000" for medical equipment that had been ordered in the name of doctors who were dead at the time.^[111] Medicare's administrative expense advantage over private plans is less than is commonly believed.^{[112][113][114][115]} Large market-based public program such as the Federal Employees Health Benefits Program and CalPERS can provide better coverage thanMedicare while still controlling costs as well.^[116][117]
• National health systems tend to be more effective as they incorporate market mechanisms and limit centralized government control.^[96]
• Some commentators have opposed publicly-funded health systems on ideological grounds, arguing that public health care is a step towards socialism and involves extension of state power and reduction of individual freedom.^[118]
• The right to privacy between doctors and patients could be eroded if government demands power to oversee the health of citizens.^[119]
• Universal health care systems, in an effort to control costs by gaining or enforcing monopsonypower, sometimes outlaw medical care paid for by private, individual funds.^[120][121]