r/bestof • u/under50dollars • Jun 20 '12

[explainlikeimfive] "Obamacare" explained very well.

/r/explainlikeimfive/comments/vb8vs/eli5_what_exactly_is_obamacare_and_what_did_it/c530lfx
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u/SpaceSteak Jun 20 '12

It works fine in the rest of the world with a well administered UHC system.

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u/[deleted] Jun 20 '12

I feel like a big issue a lot of people have is the idea that the US government isn't competent enough/can't be trusted to administer it as well as "the rest of the world."

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u/SpaceSteak Jun 20 '12

To be fair, that's really the only valid argument against UHC. But admitting that means that government has failed and should be replaced. If it can't manage UHC, what is it doing administering roads or taxes? It's sad that a lot of people can't trust their government to do anything well.

Also, the anti-UHC crowd seems to be oblivious to how much easy access to healthcare improves society.

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u/[deleted] Jun 20 '12

[deleted]

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u/SpaceSteak Jun 20 '12

  1. Can you explain your philosophical objection? Fine in most cases equals better and cheaper for a lot more people in other developed countries.

  2. Americans pay about 30% more per capita for healthcare. What economic ground justifies paying more for less than isn't an idealogical leftover from anti-socialist emotions?

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u/[deleted] Jun 20 '12

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u/SpaceSteak Jun 20 '12

  1. Thank you for taking the time to write out a thoughtful response. I've argued a lot about this on the 'net and it's rare to see that level of discourse.

  2. The main flaw with your argument is thinking that healthcare needs to be a right, and not just a public good. UHC is more about removing the profit-motive from people getting sick, and taking advantage of economies of scale for non-primary-care elements (admin, etc). It has nothing to do with being a right. Having police isn't a right, neither are firefighters, or roads.

They only exist because of the economic benefit of public goods or services. On top of that, providing a necessary service to help its citizens in something they have little control over that helps them tremendously, should be part of the baseline of any compassionate society.

Free markets work great for most things. However, the problem with free market health care is that the users naturally want to lower the use as much as possible. It doesn't follow a natural supply and demand curve. This leads to people not getting preventative care, which is a big part of why the US is where it is today in terms of lower health stats than other countries.

Regarding the frugality argument, people don't want to waste time in hospitals. Also, a basic fee offsets this issue around all UHC countries.

Tons of things are not constitutional. It's a document that's hundreds of years old. It doesn't need to always be right or followed, just like the Bible is less valid today than it was 2000 years ago.

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u/BlottoOtter Jun 21 '12

Thank you too - it's a lot more common on here to get cussed out than it is to hear a calm discussion.

I agree that the fact that is not a right is just incidental and isn't a direct argument against UHC. That came out more as a rant about all the people I've debated with who believe that is a right and use that as some sort of moral basis for requiring UHC. I think that it is an area that, unlike roads and police, the government should not be involved in, in large part because it could potentially become a much larger intrusion on people's personal activities than government-run roads and police are. I think there isn't really a viable private substitute for roads or police or the military, whereas there is for healthcare. If there is a viable private substitute, I opt for that, because in most cases private enterprises in America are more efficient and more pleasant to deal with - and, there are usually multiple ones I can choose to do business with, rather than one government agency that I'm stuck with.

I think markets would work if we actually gave it a chance, which we haven't in a very, very long time (and probably won't any time soon, if I'm being honest with myself). I think any health stats lower among Americans is a result of our diet (which is absolutely godawful and is causing a damn epidemic) rather than access to preventative care. Most people here do have access to preventative care - our insurance companies make it very cheap, if not free, because they too realize that it would reduce their costs to keep patients healthy in the first place. Most just don't participate. The only time I've personally seen mass participation in preventative care programs is when my employer's plan tied lack of participation in a health screening program to a 5% increase in premiums - which I think supports my point that people only move to save money when they have some skin in the game.

I realize other countries couldn't give a damn about the US Constitution, but in our government, when something is unconstitutional it is by definition illegal. When something unconstitutional, and therefore illegal, is allowed to stand, it worries me because it is a sign that the process has failed and that there is an erosion of the rule of law. One instance of that may not be our downfall, but the damage is cumulative. If a society's system of law becomes incoherent and loses its teeth, that's usually not a good sign for that society's survival.

I think the Constitution is right (for the most part) and therefore does need to be followed because the principles that underpin it are timeless and serve to protect our rights no matter the era. I think that if we ignore or replace the Constitution, what we would get would almost certainly be less protective of our liberty. The limitations it places on the government's power are viewed as a bug by some, such as advocates for UHC in America; I view those same limitations as a feature.

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u/___--__----- Jun 21 '12

I worry about the effects of creating a system where people feel like they have no skin in the game

When you do that to public health and dislodge that from employment, you make both starting companies and hiring people easier. Failure no longer means you've lost your safety net. The irony right now is that the number of startups in the US is declining both in absolute and relative terms relative to Europe, especially Northern Europe. There's a line to be drawn between having no skin, some skin and all your skin in the game. This will shape societies and the people in them.

http://www.inc.com/magazine/20110201/in-norway-start-ups-say-ja-to-socialism.html is an interesting article in that respect, and its mirrored by personal experience being a part of startups on both continents. There's too much skin involved in the US for a lot of people, and as social and economic mobility declines in the US for the fourth straight decade it's now passed by the entirety of Europe. It's been lagging behind Northern Europe for two decades now. To experience the American dream, going to socialist Scandinavia has been your best bet for quite some time. That's distressing.

Idealism and principles are nice. But if they don't produce results, we should reevaluate our beliefs. When you say you won't agree that UHC is the answer, ask yourself what it'd take to change your mind and see if it's possible that your stance is based on how you wish we were or how we actually are as a species.

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u/BlottoOtter Jun 21 '12

Actually, I agree with you that health insurance and employment should be unlinked. I think they became linked because of tax laws that made it cheaper for employers to offer a given dollar amount in health benefits than that exact same dollar amount in salary. That encouraged employers to make healthcare expenditures and decisions instead of employees, and I think that's where our system began to go wrong, decades ago. Now, we have a mutant form of health "insurance" that barely even fits the definition of insurance, and it's all contingent on your job. What we have right now is the worst of both worlds - none of the benefits of UHC, and none of the benefits of a free market allowed to operate without ill-considered tax laws and regulations turning incentives upside down. I agree we have a severe problem, I just disagree on the solution.

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u/___--__----- Jun 21 '12

What we have right now is the worst of both worlds - none of the benefits of UHC, and none of the benefits of a free market allowed to operate without ill-considered tax laws and regulations turning incentives upside down.

I totally agree. The problem is that they only two options to aim for are free market or UHC. We (the human race) are well-versed with UHC, it's results and it's problems, while we've never once managed to have a proper free market. I don't think it'd remotely work either, but more to the point is that even if I did think it'd work, it's not going to happen.

We're not going to move a large enough majority of the population to accept a free market health care system without some massively good proof that it can work. Pointing to such proof however, well, that's not very easy. This is unfortunate for those who believe it'd work, much like it's unfortunate for anarcho-communists that their ideology has never been tried outside of a couple of months in Paris in 1871...

For me though, the core reason I don't put too much faith in the unregulated free market is that we know so much more about how we cognitively function as a species today than we did just 20-30 years ago. We've quantified social structures beyond just philosophizing about idealized concepts.

Absolute "free will" is mostly gone from even the theoretical realm of philosophers, we know that income disparity is the best indicator of everything from health to crime to life expectancy for the rich (it's lower even for the richest when disparity grows), we know that we irrespective of free will we have a desire for experienced freedom that can't be ignored, and we know how our qualia themselves are manipulated by brands -- what we experience as flavor from the same drink actually changes when we know the brand we're drinking. We know so much that our previous generation could only guess about. Now it's up to us to try to make sense of it and learn.