The Morality of a Single Payer Health Care System

[Vonsalza]

No, that’s not right. Not broken, simply burdened with a minimum built in cost that each insured person must pay the cost of -viz. the average cost of end of life care. The actual costs of end of life care for an individual is highly variable (hence insurable) and the rest of lifetime health care is highly variable and hence insurable.

Yeah, fact of the matter is that most of us, statistically, will “check out” from heart disease or cancer. I read somewhere that the average course of treatment for those diseases runs $200K-$400K per person. Virtually no one is going to save that sort of “scratch”, so it needs to be insured. And since literally everyone would have reasonable expectation of need for this insurance, everyone should pay.

We see regimes like these everywhere in the developed world except for the US, oddly, where the per-person medical spending is higher than anywhere on the planet for sizable countries.

Thank God, a single payer system for the US seems all but inevitable. I think it’ll happen next time the Dems control the government…

…and it always oscillates back, eventually.

 

[Vonsalza]

The insurance companies would never let that happen, it would destroy their entire industry overnight.

Nah, the smart money is already prepping for it. Many expect that eventually all citizens will be on Medicare and private companies will sell gap-coverage and insure the 20% liability costs so you ultimately pay a deductible of the deductible, with private insurance.

Lots of companies are moving out of the health insurance game.

 

[Vonsalza]

When people talk about single payer, I notice they don’t realize it means making everyone in healthcare a Govt employee.

Simply not true, Theo. You can do “single payer” by employing everyone and owning all the hospitals, sure.

-Or-

You do it like several other countries where the facilities are still privately owned and the government acts as the insurer.

 

[Vonsalza]

Not necessarily. If we don’t insist on state of the art tech to keep us alive no matter what, once our bodies are clearly wearing out, the end of life could be much simpler.

Everyone I’ve seen with this approach that actually died in the hospital drastically changed their tune before their death.
When you’re eyeball-to-eyeball with the reaper, most do what they can to back him off.

Had an extremely wealthy family member pass this year. He was one of the “if I’m incapacitated, just let me die” types.

When it came time, he wanted them to try everything to keep him going.

 

[GEddie]

Not necessarily. If we don’t insist on state of the art tech to keep us alive no matter what, once our bodies are clearly wearing out, the end of life could be much simpler.

And [rant] if we ate healthfully instead of artificial junk, and fasted occasionally as we are designed to do, we would live much longer and would need fewer nursing homes and extended stays in hospitals. [/rant off].
Of course this doesn’t apply to everyone as many people do have unavoidable illnesses and accidents, but you can’t ignore your health your whole life and then expect medical miracles at enormous cost to rescue you.

.

Systems have to take on human life as it exists, not as we wish it to be.

Like it or not, most human beings are not going to become fruitarians or take up fasting as a routine part of life, except for very limited religious reasons. Everybody will continue to eat, sleep, drink, etc, as they see fit.

And even if someone were prepared inwardly to “die with dignity” (an oxymoron phrase if I ever heard one), their families may well have other ideas.

ICXC NIKA

 

[Rau]

Yeah, fact of the matter is that most of us, statistically, will “check out” from heart disease or cancer. I read somewhere that the average course of treatment for those diseases runs $200K-$400K per person. Virtually no one is going to save that sort of “scratch”, so it needs to be insured.

While many people’s cause of death might be “heart disease/failure”, for many of those, no or minimal end of life treatment arose - the person’s heart simply fails.

Certainly, we do face a conundrum as more sophisticated and costly health care / life saving options become available to preserve the life of those who are, naturally, closer and closer to death.

 

[Rau]

The insurance companies would never let that happen, it would destroy their entire industry overnight.

Not necessarily. In some countries, there exists, by design, a dual public and private system. Everybody contributes to the public system. Australia is an example of this arrangement.

 

[Rau]

Simply not true, Theo. You can do “single payer” by employing everyone and owning all the hospitals, sure.

-Or-

You do it like several other countries where the facilities are still privately owned and the government acts as the insurer.

Right. Even if the bulk of hospitals are publically owned, the state is unlikely to run doctor practices, path labs, medical imaging practices, allied health care practices, pharmaceutical supply chains and the like.

 

[EasterJoy]

I don’t see why there would be anything immoral about a single-payer health care system any more than there would be something immoral about a road system that doesn’t include any toll roads. The point is that there isn’t anything immoral about a system based on health insurance any more than there is something immoral about toll roads, either.

Likewise, when any system is set up, it has to be done in a way that is just and sustained in a way that is just. There are ways that are more fair or less fair, but there is not just one single way to do it in a way that is sufficiently fair and compassionate.

 

[Vonsalza]

While many people’s cause of death might be “heart disease/failure”, for many of those, no or minimal end of life treatment arose - the person’s heart simply fails.

Hey, not a problem Rau! For the low cost of probably $100K+ you can have a ventricular assist device put in that does your pumping for you!

They just remove part or all of your ventricles (which is most of your heart), affix the device, and off you go!

Batteries not included*

 

[EasterJoy]

And the whole structure is lopsided to begin with, because of the nature of insurance.

Insurance is sold against finite risks – not certainties. If every driver crashed, there could be no car insurance. If every building burned, there could be no fire insurance.

But every human body is certain to fail catastrophically and expensively.

So the only way to make money insuring the human body is to exclude almost everybody. The system comes out of the box broken.

ICXC NIKA

There are lots of ways to die inexpensively: die instantly in an accident, such as the people who die while taking a selfie too carelessly or who fall asleep at the wheel, die instantly of a heart attack or a stroke–not by any means rare, either–and so on.

Insurance companies cover primary and preventive health care because it is cheaper than when the patient delays seeking care until the symptoms warrant care that the insurance company will pay to treat.

Having said that, human nature argues in favor of of a sliding-scale co-pay, regardless of whether the insurer is public or private. People avoid care they need if the cost is too high, which is more expensive in the end, but over-use the health care system and treat it without much regard if it is free.

More to the point, we are a nation who thinks there is something wrong when someone living in a wealthy and civilized nation dies or suffers an unnecessary disability for want of easily available care because of inability to pay. We need to decide how much care everybody ought to get and then decide how we are going to pay for it. If it if part of the societal contract that no one is going to be allowed to rot in the street with a treatable condition because he or she is poor, then it has to be part of the social contract that we’ll all get together and decide how to pay for that, just as we do for the police we have because we’re not willing to put self-defense wholly in the hands of the populace.

 

[GEddie]

Hey, not a problem Rau! For the low cost of probably $100K+ you can have a ventricular assist device put in that does your pumping for you!

They just remove part or all of your ventricles (which is most of your heart), affix the device, and off you go!

Batteries not included*

“Blessed are the pacemakers, for they shall receive plutonium batteries.”

Methinks the same would hold for what you are describing.

ICXC NIKA

 

[GEddie]

There are lots of ways to die inexpensively: die instantly in an accident, such as the people who die while taking a selfie too carelessly or who fall asleep at the wheel, die instantly of a heart attack or a stroke–not by any means rare, either–and so on.

The thing is of course that none of us have any say at all of how we fall into the shadows; and, even if one’s dying is rapid and without high medical costs, they might well have incurred enormous body-failure short of death prior to that time.

ICXC NIKA

 

[Theo520]

Simply not true, Theo. You can do “single payer” by employing everyone and owning all the hospitals, sure.

-Or-

You do it like several other countries where the facilities are still privately owned and the government acts as the insurer.

So you are not proposing that we emulate the NHS? Which country then.

 

[rossum]

So you are not proposing that we emulate the NHS? Which country then.

There are plenty to pick from: Canada, France, Australia, Germany, Norway and so on. There are a lot of different national systems out there, and most of them are cheaper than the US system, which usually comes out among the most costly.

I get all those “Canadian Meds” spam e-mails, and I live in the UK! That is probably a sign that the US system is expensive.

rossum

 

[Theo520]

There are plenty to pick from: Canada, France, Australia, Germany, Norway and so on. There are a lot of different national systems out there, and most of them are cheaper than the US system, which usually comes out among the most costly.

I get all those “Canadian Meds” spam e-mails, and I live in the UK! That is probably a sign that the US system is expensive.

rossum

Australia has a lot going for their system, it’s a good mix of public vs private care. Having a solid private component is what sets it apart from the UK and Canada.

The high cost of US meds is about Govt regulation and really independent of the system. The cost of meds could be dropped without any change in our healthcare delivery or insurance system.

 

[Brendan]

As you weren’t in Britain, Canada or the US, I wouldn’t imagine that they would have been available for assistance.

If something is a “right”, verily it falls upon the government to enforce that.

A government has an obligation to recognize that right, but does not the govnerment of the UK, or Cananda recognize a right of that Tanzanian girl to health care. If so, how do they enforce it?

As it was in Europe in centuries past! That is probably the most fundamental reason “Healthcare for Profit” was never really the default model in the “Old World”. Tribal shamans passed the torch to the Roman State which passed the torch to the Catholic Church - all largely not-for-profit models.

But with the modern separation of Church and State, the Church can no longer compel you to tithe in the same way the state compels you to pay your taxes. As such, the Church doesn’t have the money for it.

Governments do.

I remember what Mother Teresa said to one of her sisters, who was concerned about financing a new convent " Don’t worry about money, God has plenty of that"

The question becomes, does a government facilitate that. Governments, by definition are focused on their voters. So how does the government of a country that is rich provide healthcare for citizens of poor countries. If we look at the democratic socialist model, that would be a tax on rich health care systems to support poor, or non existant health care systems.

I really do not see that happening. The UK government would not stand at having a third of the NHS budget diverted to the developing world, nor Canadian OHIP.

So I don’t agree with you, in that governments would seek to enforce the right to health care.

 

[Vonsalza]

A government has an obligation to recognize that right, but does not the govnerment of the UK, or Cananda recognize a right of that Tanzanian girl to health care. If so, how do they enforce it?

Tragically and simply, she has to be within the borders of the UK or Canada. Frankly, the question here is a simple one. National sovereignty.

I remember what Mother Teresa said to one of her sisters, who was concerned about financing a new convent " Don’t worry about money, God has plenty of that"

Luke 14:28 “Suppose one of you wants to build a tower. Won’t you first sit down and estimate the cost to see if you have enough money to complete it?”

So how does the government of a country that is rich provide healthcare for citizens of poor countries.

Governments are limited by the extent of their sovereignty, I’m afraid. If you want Canadian treatment, you need to be in Canada.

If we look at the democratic socialist model, that would be a tax on rich health care systems to support poor, or non existant health care systems.

That’s not a “democratic socialist model” for taxation, that’s how taxation simply works. The rich carry most of the load. Under progressive taxes, they pay more. Under flat taxes, they pay more. Only fee simple taxes would provide the taxational equality you seem to seek (errantly, if I may add). I think you might be advocating for a world government?

I really do not see that happening. The UK government would not stand at having a third of the NHS budget diverted to the developing world, nor Canadian OHIP.

Respectfully, this is irrelevant. Governments are largely limited, again, to where they govern.

So I don’t agree with you, in that governments would seek to enforce the right to health care.

We see it happening all the time. It’s getting ready to flip in the US. I’m reasonably certain, good or bad, that the next democrat administration will do just that.

 

[SuperLuigi]

Hey, everyone. I have wondered about this for quite some time. What would the Catholic stance be on a single payer healthcare system here in the United States (or anywhere else for that matter)? The Catholic Church is against socialism and a single payer healthcare system would be a form of socialism so would it be an immoral form of health care or would it be something that would be good? Has the USCCB ever spoken on the subject of single payer healthcare systems? Have any Popes (including Pope Francis) ever said anything? Has the Vatican or the Magisterium in general ever said anything on the subject? I would just really like to know whether this is something that is compatible with Catholic teaching because I think it is something I would support if it is compatible with Catholic teaching.

It doesn’t work well at all, especially outside of primary care.

The reason why a lot of countries have universal health care is because by default the USA pays their defense bill with its nuclear navy and long-range air force. So they have more money to waste on experimental social-type programs in their cultural decadence.

Aside from that, universal health doesn’t work well because it means the national government is delivering a product. Governments do not nor will they ever (barring a completely new evolution of humanity) bring a quality product simply because they have no incentive to do so.

Since this will not happen, those who fight for universal health care (often as a means to virtue-signal good intentions despite actual results) have to resort to the usual, non-logical arguments of suggesting you want to kill grandma (even though universal health care is more likely to do that), you hate the poor, selected disadvantaged groups ect.

The problem in principle is cost. The governments control cost by rationing care and deciding who gets what. Since it’s not checked by the free market where someone who doesn’t provide a good service would make less money or go out of business, there is no incentive for the government to care----no matter many times the politicians say they do.

If you’re talking about America, think of it like this: If you like the VA Clinic, you’ll like universal health care. People are covered in terms of bureaucratic paperwork, but coverage is not the same as access in a government system.

 

[SuperLuigi]

There are plenty to pick from: Canada, France, Australia, Germany, Norway and so on. There are a lot of different national systems out there, and most of them are cheaper than the US system, which usually comes out among the most costly.

I get all those “Canadian Meds” spam e-mails, and I live in the UK! That is probably a sign that the US system is expensive.

rossum

The reason why the US healthcare system is expensive is because the government is too involved already, in small part because of terrible tort law backed by trial lawyers unions.

The reason why other countries have cheaper (and often less accessible services) is because the USA covers much of what would be their defense budget.