People don't value what's free

[auntpurl]

I live in the UK. Healthcare is free here and university used to be free.

People go to the doctor for seriously ANYTHING here. They go to the doctor when they have a head cold, when they have a little cut, when their child has a cough for one day. The GPs talk about it in the media all the time. The amount of waste in the NHS is unbelievable. Now, I appreciate the NHS because I lived for years in the States without health insurance, but I don't waste my GP's time. The only time I go to the doctor is when I think what I have might kill me. I am in favour of making it cost £10 to go to the doctor here, fee waived if you are truly poor. That would eliminate SO MANY time wasters.

University is a bit different, because the requirements to get in to university here used to be a lot higher - that went hand in hand with the free tuition. But there were lots of kids here back then who messed around and didn't work hard at university because it was free, so who cares?

I'm NOT in favour of university costing as much as it does, either here or in the States, but it should cost SOMETHING. A university education has value, and it should BE valued. By having to pay for it. Again, fees waived for the truly poor. And lower the cost, and make the student loan fees easier to pay back.

But I think free=you don't really value what you get. Everything I have in my life that's worth anything, I've worked hard for. I'm happy to accept help, and I think as a society we should make it EASIER for people to be healthy and get an education. But not free.

[DFab420]

1. Ancedotes from across the pond not withstanding, are you really begrudging people for seeing a doc?

Or for going to university?

Also monetary value =/= real value.

This is a fairly corporatism view of the world and I'm not sure has a place in a democratic website..

[auntpurl]

3. Yes, I absolutely begrudge people who waste doctors' time.

The NHS is drowning in debt at the moment, and the Tories will use any excuse to privatise the whole system. I begrudge people who don't value what they have, and work hard to keep it.

And I begrudge students who messed around and didn't value their free university, because the end of that was fee-paying universities, which now we ALL have to live with.

You can call that view what you want. I am not anti-corporation. I am a moderate Democrat. I know this place has been taken over by the far left at the moment, but that's not really representative of MOST Democrats' views. There are a lot of people in the middle.

[artislife]

29. What about those who need a doctors note just to have a sick day

Good friend of mine told me, nothing was shittier than feeling kind of shitty and having to sit in the waiting area so they could get a sick note from the doctor. This was a requirement of their job, if they took off any days for being sick.

[auntpurl]

42. It is a law in the UK that employers ask for a doctors note after 5 days off sick.

Pretty straightforward to make a statute like that in the States. Before 5 days, no note needed. That's a national law, as far as I know.

[Autumn]

71. We are not that lucky here. I missed a half day and needed one for work.

These politicians here will look out for their sponsors but not the people any law benefiting the people is not a pretty straightforward task. Look up Right to Work, it's not that at all. Regarding your OP. If I didn't have to pay almost 600 dollars a month out of pocket to buy insurance I could see paying a small fee to go to the Dr. Sadly I do both since I have a monthly premium, deductible and and a co pay , it's not 15 dollars either. How nice that you don't have to pay exorbitant prices for a product you can't afford to use.
You know here in America people die because they can't afford to go to the Dr. People go bankrupt due to high medical bills, they put off treatment because sometimes it's a choice between medication or a roof over their head. If our citizens had that I think here we would value it, I don't know your age but I'm guessing you have no fucking clue what it's like to be sick and not be able to afford to go to the Dr or get medication. Entitlement is lecturing Americans who want for their citizens what you have, don't value and you don't seem to want. Clueless, you have no idea what it is like to not be able to afford medical care .

[auntpurl]

74. I am American.

I lived for many, many years working minimum wage with no health insurance. And I have the (historic) debt collectors to prove it.

It shouldn't be the way it is for you. But it shouldn't be free either. There is something in between.

[Autumn]

77. It won't be free, our taxes would pay for it. As it is our tax dollars pay for those

who qualify for subsidies under the ACA. How long has it been since you have had to pay for medical treatment here in the states?

[Hassin Bin Sober]

64. I have a friend who wound up partially paralyzed because he dropped a dresser on his toe.

No insurance. So why go to the doctor for "something that's not going to kill you" eh?

Just a sore toe.

If he had gone to the doctor for his sore foot, they would have X-rayed his foot and saw the bone chip.

I once stepped on a big nail and besides the tetanus shot, the doc X rayed my foot to make sure I didn't chip a bone. Silly, I thought, but I'm not a doctor.

My buddy ended up with a bone infection and an abscess on his spine. He woke up one morning and couldn't move. He spent two days on the floor calling for help. Almost died. He has to cath himself for the rest of his life and just moved up from a walker to a cane.

I know two people that almost died from tooth abscesses. One is on the lung transplant list. He though he just had a cold and sore neck. And he HAS insurance. But why bother the doc, eh?

That's the thing about doctors. sometimes they find big problems with little symptoms.

Btw, the guy with the abscessed spine cost you, me and everyone else a shit ton of money. How much is 6 weeks in the hospital, 3 surgeries and a life time of disability payments? I figure at least $500k. How much is that versus a "nuisance" visit for a sore toe?

[Ash_F]

73. Do you have hard statistics to prove this narrative accounts for the debt?

I am not dismissing you, but as an American, I can tell you a little bit about the "welfare queen" false narrative that we have.

[TheBlackAdder]

92. I, for one, value free things: Air free of pollutants, Water free of toxic fracking solution!

[redruddyred]

107. i think this is a legitimate PoV

but i've also heard other reasons for the NIH's financial problems, for example outsourcing work to independent contractors as per the american model.

texas used to have really cheap education back in the day and people used to fuck around for years because their parents could float it. then again there were young adults like my mom who forged residency and put in 100 hour weeks to graduate without debt.

i think a sliding scale system is great until your rich parents are like "fuck you our exotic vacations are more impt".

[Fairgo]

5. Gonna have to agree

Privilege is blind to real need. "Why are you crying in hunger? I just ate." There are inefficiencies in every system. This is no reason to replace the basic mechanism (health care for all) with another (profit for a few) under the guise of some Thatcher starch collar protestant work ethic bullshit. You will still have abuse, ten fold in fact, and you will create oceans of misery.

[auntpurl]

8. I'm not advocating trashing the NHS.

But a small fee to go to the doctor would make the system a LOT of money and eliminate time wasters. As I said, it would be waived for people who really can't afford it.

I am American and yes I do have a standard North East work ethic. In the UK, I'd be Labour, not Lib Dem. In America, I am a moderate Democrat. Really no Thatcherism here - I am very pro-union, pro-business, and pro-trade.

And as far as American healthcare, the ACA is already in place and can be improved. If Bernie couldn't even make single payer work in Vermont, how is it supposed to work nationally? That's not even considering how he would get it passed.

[riderinthestorm]

44. You've forgotten your civics class. Sanders is a US Senator

And had zero ability to get UHC passed in VT. That's the VT governor's and VT legislature's job.

It failed because UHC needs to include a much bigger pool of participants than small VT has to make it viable. In fact that debate only highlighted that it can work if/when.the entire US participates.

[auntpurl]

55. Do you have a link for that?

Sincerely asking, not snark. I'd like to read about that.

[theaocp]

2. You are welcome to change your system all you like.

However, what you are advocating is still considered "getting something for nothing" over here. This, despite the fact that nothing is "free". I want my food industry folk, for example, taken care of by our overall taxes, as they prepare our goddamn FOOD and should not be sick while doing so. If they feel their sniffles are worthy of burdening our health system, I want them to jet over to the GP pronto.

[auntpurl]

4. We pay a fortune in taxes for the NHS

And that's in a little tiny country like the UK, by the way. I can't imagine the federal burden single payer would put on the taxpayer. The ACA is a good system and can be improved, just like Hillary wants to.

Americans would seriously faint if they had the kind of tax burden Brits do.

I am American, by the way. So your system is still my system, even if I don't live there.

[theaocp]

19. Faint at how much our defense budget is by comparison.

http://www.telegraph.co.uk/news/uknews/defence/11936179/What-are-the-biggest-defence-budgets-in-the-world.html

I bet you could have the UK's cut, too, and give that money to your beleaguered NHS. Or you could pay taxes AND a "small cost" on top of it. It's not about lack of money. It's about where your money is allocated.

[auntpurl]

46. Changing the defense budget in America is going to be an uphill battle

If some can be siphoned off, great. But getting that passed through congress would be...nearly impossible I would think. The savings will all come off that backs of soldiers who need good armour and proper equipment. They definitely wouldn't be cutting back on the big purchases.

[Autumn]

69. It might be your system but you don't have to use it do you?

What do you pay in taxes per month? 600 dollars or more a month?

[delrem]

87. So you aren't complaining that it's "free", you're compaining about "taxes".

So it boils down to the usual long-nosed right-wing complaint, begrudging the fact that the extremely poor get health services when they don't pay taxes, so they get it on your dime, "for free"? Then making up the stories "those people go to the doctor for a cough! for a minor cut! Those nasty welfare cheaters, taking my money!"

So you, a US citizen living over there, want to drag their system down to the US level.
Why don't you just return to the US?

[redruddyred]

108. mostly that sort of thing is viral

and has nothing to do with access to medical care. most of the time! she'll just tell you "rest and recuperate".

what i think we DO need is strengthening of laws in right to work states so that can't just fucking fire you if you get the flu. ESPECIALLY if you work in food service. ESPECIALLY if you only miss like two days. at that payrate can't justify doc visit.

i think paid sick leave is a stupid idea but when you factor in the costs associated with (paying someone to certify you sick) then suddenly seems more reasonable.

[lumberjack_jeff]

6. People only value health when it costs as much as a house?

I wonder what parts of their brains must be shut off to believe crap like this?

[dana_b]

9. thank you. And since when is paying taxes "free"?

we will all pay for this "free" health care. But those who don't make as much money will pay much less than those who make much more money.

[auntpurl]

14. At the point of purchase, it's free.

When people have to make the decision to go to the doctor and beg for antibiotics for their head cold (which as I'm sure you know has no effect on the cold AND leads to antibiotic-resistant superbugs), they don't have to consider any cost. That leads to so much waste.

[dana_b]

34. I'm a nurse

and so I understand the antibiotic situation. But I respectfully disagree about the single payer situation, auntpurl. I find you to be one of the more respectful Hillary supporters and therefore don't have you on ignore.

After seeing some of my patients who suffered for months on end on the bone marrow transplant ward having to have BAKE SALES to raise money so that their kids can have necessary treatments, I will always support single payer health care. People literally doing Go Fund Me pages so that they raise money for their children to get treatment. That is unconscionable, imo.

[auntpurl]

49. Sincere question: are they not eligible for ACA?

I thought everyone was covered on the ACA - could not be denied for pre-existing conditions?

Surely bone cancer would be covered by every insurance policy? I am sincerely asking - if I'm wrong tell me!

[dana_b]

59. I know. It doesn't cover enough

Some of these kids have been in the hospital for months and depending on the ACA that they have, it only covers so much of their treatment(s).

Some didn't have the ACA. They had insurance from work and again, they only covered so much of their child's treatments. It's awful, auntpurl. These families have put in so much time and money into it and they are going broke. On top of all of this, they have used up all of their vacation/personal time off and are losing money if they have to take off to be with their kids.

[auntpurl]

61. That is awful.

So sorry to hear that. I did not know that they ACA only covers so much of a treatment. I hope that is something both candidates are looking at fixing. Those poor kids.

[dana_b]

62. I agree with you

and thanks for the considerate conversation.

[Autumn]

70. Sure it's covered, if you can afford to pay your share. If you can't no worry, just have a bakesale.

[redruddyred]

109. american hospitals brewing superbugs very quickly too

although i think the problem is tyson and other big meat producers

[auntpurl]

10. Uh, no.

I said people don't value what's FREE. There's a pretty big sliding scale between paying £10 to go to the doctor and buying a house.

[lumberjack_jeff]

60. There's a big scale between £10 to go to the doctor

and an average $23,215 annually... just for insurance, not counting copays and deductibles.

[phantom power]

72. +1,000,000

[demmiblue]

7. It isn't free. Duh.

[auntpurl]

11. No it isn't. It costs an absolute fortune.

The taxes here are insane - imagine what they'd be like in the States.

But at the point of purchase, it's free. It's why people are so happy to waste doctors' time.

[demmiblue]

28. Lol, ok. You do realize you are on a Democratic board? n/t

[auntpurl]

52. I sure do.

Even GPs in super-liberal England are in favour of charging a fee for service:

http://news.sky.com/story/1189651/a-and-e-visits-third-of-gps-back-10-charge

[arcane1]

78. Beats the hell out of paying insurance premiums only to have coverage denied.

[jwirr]

113. When you say it costs a fortune compared to our system in

the USA have you considered how many people here are not covered? In the UK it is my understanding that everyone is covered. And you talk about the UK being small but isn't London the largest city in the world? Land size does not count.

[hibbing]

102. Nothing is free

I loathe to see this "free healthcare, free college", it is paid for by taxes. You never hear anyone refer to roads, schools, or any other public service as free. I think it is a way to smear the idea of socialized services that every other modern country provides.


Peace

[Wilms]

12. "People go to the doctor for seriously ANYTHING here."

Do you have any links about these people?

[auntpurl]

16. Sure.

http://www.theguardian.com/healthcare-network/views-from-the-nhs-frontline/2015/jul/13/wasting-gps-time-no-i-cant-prescribe-you-new-shoes

http://www.independent.co.uk/life-style/health-and-families/health-news/charge-10-to-keep-timewasters-away-from-ae-units-say-gps-9035741.html

There's loads more, if you need them.

[Wilms]

35. Thanks. Interesting to note.

The second article was recommending a small co-pay if it is a non-issue.

I think many nations systems include a co-pay. I wonder if that helps cut down on unneeded visits.

[auntpurl]

56. It definitely does. There's been research.

That's what I was saying in my OP - my point about not valuing things that are free. There's a huge continuum between "Free" and "Costs a fortune". I'm a Democrat - I want things to be CHEAP and EASY to access. But not free.

[Wilms]

67. Might have been an idea to come in with that research.

Perhaps a multi-prong effort could be made to reduce these incidence.

Is it really that BIG a problem, though.

Anecdotal story...

I took an elderly neighbor to the doctor (he was on his way out from cancer but still moving around). He came out of the office with pep in his step and a lifted gloomy mood. I was impressed and asked if the Dr. gave him a B12 shot or something else. He told me, "no". He said, "We just talked."

I'll never forget that.

[jwirr]

114. So how do you feel about Medicaid and Medicare?

[kiva]

13. I really think you are in the wrong place.

If you google 'conservative' you'll probably find a discussion board that more closely reflects your views.

[auntpurl]

18. I've been posting on DU since 2002

but thank you for your concern.

[kiva]

27. And why does that matter?

When you post Republican talking points on a Democratic board it doesn't matter how long you've been posting.

[Jesus Malverde]

58. No Kidding...nt

[ibegurpard]

15. That's nice

Perhaps you can work on importing the Republican Party to the UK and leave our politics to us?

[auntpurl]

22. It's only my opinion.

It's no secret I'm a moderate. There are actually lots of us in the Democratic party.

[stillwaiting]

32. Your OP is not moderate. It's conservative. nt

[ibegurpard]

53. Indeed

[auntpurl]

65. I'm fiscally conservative, yes.

Socially very liberal. Foreign policy moderate. At least, that's how I always come out in the quiz things.

Funnily enough, I seem to be in line with a LOT of American Democrats. Including a certain lady who's running for President. So I don't think I'm all that unusual. On DU, yeah. At the moment, (and often) this place is FAR to the left.

[ForgoTheConsequence]

82. So go find a libertarian website.

It isn't "far left" to think a person should be able to see a doctor without facing financial devastation. You have no clue what "far left" is.

[Autumn]

93. The perfect conservative. Lecturing some to accept crumbs while you feast at a banquet.

[jwirr]

116. Autumn have I told you lately that I love you.

[Autumn]

117. Ae- shucks, not lately, I love you too

[jwirr]

118. TY

[delrem]

105. You're a US expat living in a country with the best universal plan in the world,

according to some, and a plan that's certainly "up there" according to all.

And you piss on it, complaining about "high taxes". In a post designed to help stop such a thing happening in the USA.

You seem to be clueless.

Not "moderate" or "extreme", but just clueless about the social issues that a single payer universal health care plan addresses.

[Kip Humphrey]

17. so, should we charge for High School?

[auntpurl]

26. Of course not.

A basic education should be free for everyone. A university education is a privilege, and leads to better-paying jobs. It has value, and it should BE valued.

[Kip Humphrey]

37. I agree with Bernie and disagree with you. 50 years ago, you may be right but no longer.

Today, a BA or BS is very comparable to a HS degree 50 years ago when it comes from the benefits derived.

[beedle]

45. a basic education ...

in the 1800's was what? Grade 4, 5?

In the early to mid 1900's it was 7 or 8

In the late 1900's high school

in the 21st century, after the the 'digital revolution' (maybe bigger than the 'industrial revolution', certainly a quicker one) what would you consider a 'basic education'?

Life goes on ... conservatives (or 'moderates' as you might like to call them) don't.

[BigMin28]

86. earning a dgree...

You say "A university education is a privilege, and leads to better-paying jobs. It has value, and it should BE valued."


It is valued even if it is free, ( paid for with taxes) because it is earned. No one hands you a degree. You have to work for it.
I believe anyone who can do the work and earn the degree ought to have the chance. And they should not have to mortgage their future to do it.

[nadinbrzezinski]

20. Hypocondriacs go to the ER here instead

and it costs a LOT MORE by the way.

And people going to the doctor for a head cold. We actually have done that, why? WORK REQUIRES A DOCTOR'S NOTE.

I will add, if you have a head cold and you are a diabetic, you should consider "wasting" the time of your GP by the way.

[auntpurl]

30. People go to A&E here too. You know why?

Because they can't get an appointment at their GP office, because of all the time wasters!

http://www.theguardian.com/healthcare-network/views-from-the-nhs-frontline/2015/jul/13/wasting-gps-time-no-i-cant-prescribe-you-new-shoes

http://www.independent.co.uk/life-style/health-and-families/health-news/charge-10-to-keep-timewasters-away-from-ae-units-say-gps-9035741.html

[nadinbrzezinski]

31. And... so let me see

go to the ER or go to the GP? And you hardly addressed that work requires a doctor's note to accept the fact that you need time off becuase you are sick.

Look we get it, you think your NHS is free, it is not. And people do appreciate the service. NHS could establish fast clinics, like the Navy for example, has done, to take care of head colds and doctor's notes.

[alarimer]

94. We get 5 days total without a note.

Any more and you have to have one.

I get around it by using other types of leave (comp time, personal leave).

But I agree that it is silly to need a doctor's note for a cold. Mostly I stay home with a cold to avoid infecting others (and also because feeling crappy makes me unproductive).

[nadinbrzezinski]

98. Tom's place of employment requires one for 3

Five triggers fmla, which definitely requires one

[katsy]

21. Adults understand these programs aren't "free"

They're paid for by taxes.

Explain why, if NHS is so horrible, they deliver top notch medical care to all, at roughly 1/3 the cost of care in the US. And everyone is covered in GB. Everyone.

http://www.businessinsider.com/an-american-uses-britain-nhs-2015-1

An educated citizenry brings its own rewards to the economy and democracy. There's no open-ended "play to fail" in Bernies college tuition plan. There will be standards. Tuition free public universities would help US students compete globally. Tuition has made a college education unreachable for too many talented young people. It will work. It worked for k-12 and will work for public univerdities for kids that understand the value of an education.

[auntpurl]

36. K-12 is basic education. Everyone should get that.

Interestingly, the UK is forcing all its schools to become "academies", effectively privatising the whole system. Even the US hasn't gone that far yet.

But university education is a privilege and leads to higher paying jobs. It has value, and it should BE valued.

Re: an educated citizenry: there is no guarantee that that educated citizenry will stay in the States and lend their expertise to the economy there. Why do you think so many European countries (which have free/cheap tuition costs) are bemoaning talent/brain drain?

The NHS is on the verge of collapse because of the top-notch care they provide. Junior doctors get paid less than a sales associate at IKEA and are currently striking at regular intervals to protest. And we are a TINY country compared to the US. The NHS is also seeing the same kind of talent drain, because unless you really believe in public health, you'll sure as hell move somewhere where you get paid a LOT to be a doctor.

[redruddyred]

110. your junior doctors suck

what is the equivalence here, residency? no one complaining so loudly this side of the pond; pay rate is comparable and they have thousands of dollars in student debt as well.

the entitlement is incredible, if they were really qualified for the work they'd be grateful to do something which is challenging and serves society! i know i would.

[Tierra_y_Libertad]

23. I'm sure rich people avoid doctors for minor ailments and demand to pay tuition.

Man sees a cop arresting an old man for stealing food out of a dumpster:

Passerby: Why are you arresting that starving old man?

Cop: He's stealing food out of a dumpster.

Passerby: He's just a poor man trying to find something to eat.

Cop: It has nothing to do with class. I assure you, if I saw a rich man stealing food from a dumpster, I'd arrest him.

[litlbilly]

24. go ahead and make people in the UK pay for healthcare like us and see how that goes.

[auntpurl]

38. Not like you, but SOMETHING. GPs are in favour of it.

http://news.sky.com/story/1189651/a-and-e-visits-third-of-gps-back-10-charge

[litlbilly]

41. I dont think the UK is a good model because you have the same or close to the same

inequality that we have. Have to look at many other countries to get a good read on it.

[whatchamacallit]

25. This may be the dumbest rationale for denying Americans a better life I've seen on DU

So you'd be happier with our broke-ass health and education systems?!? Lordy.

[auntpurl]

40. No, something in between.

The ACA can be improved and expanded, and the NHS can start charging £10 for a doctor's visit. Both those changes are rational and good for the citizenry AND the healthcare system.

As far as education, I don't think the system is broken. I think it can be made cheaper and easier for people to go to university, but I don't think it should be free.

[litlbilly]

43. NO it cant, as long as the insurance companies are involved, where they just take peoples money

basically for no reason.

[whatchamacallit]

99. You're a real brit?

So what changes do you propose for your own system to make it "more appreciated"?

[beedle]

33. Nonsense.

Most people don't go to the doctor for no reason. There are a few, but those are the exceptions.

But even if they do, the more you go to the doctor for minor issues the more you save in preventing more serious complications from not going to the doctor because it costs too much.

prevention saves money, and seeing a doctor before a minor issue gets out of control is called 'prevention'.

Name me a 'free' healthcare system in the world that costs more than the 'capitalist' healthcare system in the USA .... surely with all those 'free' healthcare countries out there to study, there must be at least one of them paying more than the US because of people visiting their doctor too much?

Right wing republican talking points.

[FlatBaroque]

39. I have been thinking the same thing, auntpurl

for example, I have no appreciation for the free air that I breathe. I feel like I would appreciate oxygen more if it hurt a little bit in the wallet to breathe. Thanks for bringing this important perspective to my attention.

[whatchamacallit]

100. Lol!

[raging moderate]

47. For a rich person with an independent income, everything is free by this definition.

They aren't out there working their brains out, their guts out, their hearts out, or their ligaments out of their moorings. Money just comes to them. In fact, usually they don't even have to use money. They wave a card and sign a paper or a screen, and other people even carry it to wherever they want it to be. It's like they have a magic wand. So maybe they should be forced to do actual physical work to earn medical care or college credits. As most of us are. One time, long ago, I suggested to a well-dressed lady that the military draft might possibly be replaced by a national service draft for everyone just out of high school, to do menial jobs in food service, yardwork, and janitorial work. She was horrified at the idea of her precious ones cleaning toilets. Yeah, but it was plenty good enough for the likes of me, wasn't it?

[beam me up scottie]

48. Wow I hear the same thing about people on welfare from tea partiers.

They're always going on and on about the moocher class and how they don't appreciate anything because they don't work for it. These diatribes are usually followed by whining about how their taxes shouldn't be used to pay for free stuff.

[riderinthestorm]

50. Sanders is proposing tuition free college. All other costs would still be on the student

Like books, housing, food, and all the other usual University fees.

[Sivart]

51. The only time I go to the doctor is when I think what I have might kill me.......

That statement right there completely disqualifies you from having anything of value to say regarding anyone's health care.

End of discussion.

[Maedhros]

54. Meh. Conservative talking points. [n/t]

[wendylaroux]

57. just stop nt

[suffragette]

63. There's a reason your POV is called the MYTH of Moral Hazard

That's because it is incorrect in so many ways.

http://www.newyorker.com/magazine/2005/08/29/the-moral-hazard-myth

What Nyman is saying is that when your insurance company requires that you make a twenty-dollar co-payment for a visit to the doctor, or when your plan includes an annual five-hundred-dollar or thousand-dollar deductible, it’s not simply an attempt to get you to pick up a larger share of your health costs. It is an attempt to make your use of the health-care system more efficient. Making you responsible for a share of the costs, the argument runs, will reduce moral hazard: you’ll no longer grab one of those free Pepsis when you aren’t really thirsty. That’s also why Nyman says that the notion of moral hazard is behind the “lack of enthusiasm” for expansion of health insurance. If you think of insurance as producing wasteful consumption of medical services, then the fact that there are forty-five million Americans without health insurance is no longer an immediate cause for alarm. After all, it’s not as if the uninsured never go to the doctor. They spend, on average, $934 a year on medical care. A moral-hazard theorist would say that they go to the doctor when they really have to. Those of us with private insurance, by contrast, consume $2,347 worth of health care a year. If a lot of that extra $1,413 is waste, then maybe the uninsured person is the truly efficient consumer of health care.

The moral-hazard argument makes sense, however, only if we consume health care in the same way that we consume other consumer goods, and to economists like Nyman this assumption is plainly absurd. We go to the doctor grudgingly, only because we’re sick. “Moral hazard is overblown,” the Princeton economist Uwe Reinhardt says. “You always hear that the demand for health care is unlimited. This is just not true. People who are very well insured, who are very rich, do you see them check into the hospital because it’s free? Do people really like to go to the doctor? Do they check into the hospital instead of playing golf?”

For that matter, when you have to pay for your own health care, does your consumption really become more efficient? In the late nineteen-seventies, the rand Corporation did an extensive study on the question, randomly assigning families to health plans with co-payment levels at zero per cent, twenty-five per cent, fifty per cent, or ninety-five per cent, up to six thousand dollars. As you might expect, the more that people were asked to chip in for their health care the less care they used. The problem was that they cut back equally on both frivolous care and useful care. Poor people in the high-deductible group with hypertension, for instance, didn’t do nearly as good a job of controlling their blood pressure as those in other groups, resulting in a ten-per-cent increase in the likelihood of death. As a recent Commonwealth Fund study concluded, cost sharing is “a blunt instrument.” Of course it is: how should the average consumer be expected to know beforehand what care is frivolous and what care is useful? I just went to the dermatologist to get moles checked for skin cancer. If I had had to pay a hundred per cent, or even fifty per cent, of the cost of the visit, I might not have gone. Would that have been a wise decision? I have no idea. But if one of those moles really is cancerous, that simple, inexpensive visit could save the health-care system tens of thousands of dollars (not to mention saving me a great deal of heartbreak). The focus on moral hazard suggests that the changes we make in our behavior when we have insurance are nearly always wasteful. Yet, when it comes to health care, many of the things we do only because we have insurance—like getting our moles checked, or getting our teeth cleaned regularly, or getting a mammogram or engaging in other routine preventive care—are anything but wasteful and inefficient. In fact, they are behaviors that could end up saving the health-care system a good deal of money.

[auntpurl]

66. Very interesting article; thanks for posting it.

On the other hand, GPs in the NHS right now are in favour of asking for a small fee. They are the ones on the front lines, so I respect their opinions.

http://news.sky.com/story/1189651/a-and-e-visits-third-of-gps-back-10-charge

But your article was really food for thought. Thanks.

[suffragette]

76. On the other hand, more info from article you posted

http://news.sky.com/story/1189651/a-and-e-visits-third-of-gps-back-10-charge

Helen Stokes-Lampard, from the Royal College of General Practitioners, said: "Charging patients for the use of emergency departments would put us on the slippery slope towards the Americanisation of healthcare - where only those who can afford it get the care and attention they need.

"Doctors have a duty to provide healthcare to patients regardless of their ability to pay.

"Patients seek healthcare when they are at their most vulnerable and if they attend A&E, it is usually because they don't know where else to turn.

"Emergency departments are really struggling but the way to solve the crisis is to adequately fund general practice, so that family doctors can provide more care for patients in the community.

[lumberjack_jeff]

97. Exactly this. n/t

[denverbill]

68. #1, health care in the UK costs less than in the US and gets better results.

#2, why do I always hear people say "Now, of course, I don't use free stuff just because it's free, but OTHER people do". Like anybody really wants to go to the doctor's office and hang out in a room full of coughing, sneezing people, and take time off from work to do so. The biggest argument against this argument is that you opted yourself out of it, just as everyone else who makes this point does. The actual number of people who abuse free health care is negligible and obviously doesn't impact the cost of care as much as putting profit above people does or the cost of care in countries with national health care would always be higher than ours, not lower.

#3, They privatization of higher education in the US is destroying it. Instead of state colleges and universities with high standards and low costs, we now have vouchers that can be spent at worthless private colleges who advertise for students with slick commercials and leave them saddled with enormous debts. I don't think a degree from Trump University is more highly valued than a degree from any free university that has competitive admissions.

[raging moderate]

83. You are so right; Republicons are delusional about most people's doctor visits.

Last edited Mon Mar 28, 2016, 09:21 PM - Edit history (1)

It is delusional to believe that working class people have a childish desire for attention from a doctor, or a childish desire to get free stuff without working for it. Poor people are no more prone to that sort of behavior than rich people.

[EndElectoral]

75. What a load of hogwash. I've spoke with many Brits who love their health care and education.

btw...it isn't really free you do know that right? There's such a thing called taxes.

[ForgoTheConsequence]

79. People are shielded from real costs here in the US also.

But that is completely fucking irrelevant to someone who files bankruptcy for getting sick, or someone with a high deductible plan that allows a problem to fester because they cant find the cash to pony up upfront.


OP is completely ignorant. Take it to a British Conservative forum.

[Trajan]

80. Another conservative voice in DU

How wonderful is that?



CLICK!

[daleanime]

81. Which must be why Hillary won't let us see her speeches.....

she knows we won't value them properly if we don't cough up $250,000 ourselves.

[delrem]

84. Well, you'd better work to end the UK's NHS then!

From wiki:

In a 2014 report ranking developed-country healthcare systems, the United Kingdom was ranked the best healthcare system in the world overall and in the following categories: Quality of Care (i.e. effective, safe, coordinated, patient-oriented), Access to Care, Efficiency, and Equity.[3][4] The UK's palliative care has also been ranked as the best in the world.[5] On the other hand, in 2005-09 cancer survival rates lagged ten years behind the rest of Europe,[6] although survival rates continue to increase.[7][8]
In 2015, the UK was 14th (out of 35) in the annual Euro health consumer index. It was criticised for its poor accessibility and "an autocratic top-down management culture".[9] The index has in turn been criticized by academics, however.[10]
The total expenditure on healthcare as a proportion of GDP in 2013 was 8.5%, below the OECD average of 8.9% and considerably less than comparable economies such as France (10.9%), Germany (11.0%), Netherlands (11.1%), Switzerland (11.1%) and the USA (16.4%).[11] The percentage of healthcare provided directly by the state is higher than most European countries, which have have insurance-based healthcare with the state providing for those who cannot afford insurance.[12][13]
_______________________

That sounds terrible! So I can understand why you fight against it and want the UK to emulate the USA's superior system!

[Avalux]

85. Hey auntpurl, I have a little story for you.

About 18 years ago now, I was a single mom raising 3 daughters and lost my job, then my home because I couldn't afford to live there anymore. My daughters and I 'lived' in an extended stay hotel for a good 3 months before I was able to rent a 2 bedroom apartment, thanks to the kindness of friends and family.

I also used food stamps and medicaid for my girls until I got on my feet and got another job, which took almost a year.

I for one am forever grateful for everything I was given for FREE so that my girls and I didn't end up homeless. You have no idea.

I don't agree that a person should wait until they think they have something that will kill them before going to the doc. It's great that you can go for anything, and that's how it should be. Health care is a basic human right.

So yeah - I disagree with your blanket statement that people don't value free stuff. Maybe some don't, but I'm sure many, many others do, especially when they're in a dire situation.

[ThePhilosopher04]

88. The value is the actual education received by the student. Right wingers seem to gloss over this.

As for healthcare. The point is for people to have access to see a doctor when they feel the need to. Again, right wingers fail to acknowledge this.

[ljm2002]

89. You say that doctors "talk about it in the media all the time"...

...(the fact that many people make too many visits to the doctor).

Here in the States, on the other hand, what we talk about in the media is (a) our health care costs per capita far exceed those of any other nation, with relatively dismal outcomes, statistically speaking; (b) we still have 30 million people who are completely uninsured; (c) for many if not most of those who do have insurance, it is expensive, inadequate, and the out of pocket expenses are so high that they avoid using it except for emergencies or catastrophic illnesses; (d) the most common cause of bankruptcy in this country is medical bills, and within that number, MOST of them actually HAD insurance, it just wasn't adequate when a major illness or accident struck.

So while what you say may have some validity, I'd still much rather have your problems than the ones we have in this arena.

Now as to university, by the time I attended, in California, they were already starting to charge nominal tuition to in-state students, but it wasn't much. But I still had to work, on top of the loans and grants I got. IOW, you still gotta live. Free tuition doesn't mean you don't still have to do the work to stay in school, now, does it? And plenty of kids whose PARENTS pay high tuitions, screw up and party all the time in college. So I think your analysis is a bit simplistic.

[delrem]

91. "Seventy two per cent of people declared the NHS to be "a symbol of what is great about Britain

"Seventy two per cent of people declared the NHS to be "a symbol of what is great about Britain and we must do everything we can to maintain it"

The NHS: even more cherished than the monarchy and the army
http://www.newstatesman.com/politics/2013/01/nhs-even-more-cherished-monarchy-and-army

______________

As compared to this OP's anecdotes from a US expat living in the UK and begrudging their "high taxes".

[delrem]

90. You are a US American expat, and your opinion doesn't map with general UK opinion.

14 JANUARY 2013
The NHS: even more cherished than the monarchy and the army

http://www.newstatesman.com/politics/2013/01/nhs-even-more-cherished-monarchy-and-army

"The NHS beat both the monarchy and the Olympics to take gold in the patriotism stakes, as Ipsos-Mori's polling for British Future's new State of the Nation 2013 report, published today, shows. The army ranked second, when pollsters asked people which institutions made people proudest to be British, with Team GB taking bronze, nudging the royals off the podium altogether.

The NHS was most popular with Britons from all backgrounds, being top for both white and non-white Britons, and across social classes, though the oldest segment of the population put the monarchy first, and the under-24s the army.

Seventy two per cent of people declared the NHS to be "a symbol of what is great about Britain and we must do everything we can to maintain it" while one in five (21 per cent) saw it as "a great project for its time, but we probably can not maintain its current form"."

________________________

So cry us a right-wing river about those awful "taxes".

[LostOne4Ever]

95. There is more money to save via prevention than by letting minor conditions deteriorate. nt

[delrem]

104. This is why countries with single payer universal basic plans quickly highlight prevention.

It's such a no-brainer, once an universal plan is enacted.

When a country enacts a single payer universal basic health care program it introduces a paradigm change, and from my experience (Canadian) it changes the consciousness of the whole people. Thus e.g. even the right-wing parties in Canada don't challenge the existence of the single payer universal basic plan. The right-wing aims to make it more "two tiered" and to kill it in a death of a thousand cuts, but even at that they have to be very careful because such plans, once in place, are almost universally cherished by all voters for the good, relatively inexpensive, across the board results. So there is no mainstream political party in Canada that's against it, that would utter the kind of extreme right-wing arguments that Hillary trots out.

I'll put it this way: it's a relief to one's conscience, to know that one belongs to a society, a culture, that cares for all, even the most disadvantaged, and wants to give all a fair chance.

[ky_dem]

96. Yes I certaintly don't value my right to vote or right to free speech

given that I don't pay for them. Also the UK spends a little more than half what the US does per capita on healthcare - so if there's waste in the NHS system, it pales in comparison to what we're dealing with

[elleng]

101. People who understand how things work know that 'things' provided by government

are NOT free; we pay for them.

[DisgustipatedinCA]

103. I know of some insurance companies who would love to take your nation into their embrace.

Be careful what you ask for.

[redruddyred]

106. i agree with you, to a point.

considering how low wages for hs graduates are, something has to give.

i wouldn't be supporting bernie if i thought, in this economic climate, it were possible to get a job and support oneself thru school and not graduate thousands of dollars in debt. or even make classes at all while working multiple low-wage jobs.

the reality is there's a new economy and we can no longer justify only publicly supporting education thru 12th grade. were we to raise standards for an hs diploma then maybe you might have an argument!

[gollygee]

111. I need a dislike button

I love the idea of people being able to go to the doctor for anything. A friend whose teenager daughter had some mild symptoms went to the doctor even though it "was nothing" and it turned out she had lupus. I'm glad my friend has good insurance and enough money to pay for the doctor she was OK with taking her daughter to the doctor for something mild. Now her daughter is able to get treatment sooner. How nice if everyone could do that.

[jwirr]

112. Aunty Purl over here when we go to the doctor for anything

we call it preventative medicine. We have found that if you wait until it gets worse it costs more.

As to the kids messing around at college because it is free. I suggest you visit the USA - many kids mess around and pay a hefty sum for it over here. That happens when they first leave the nest (home) and start to feel the freedom for the first time in their lives. I don't think it has much to do with how much it costs to go to college.

[killbotfactory]

115. Yes, yes. It's much better for people to only go to a doctor when they think they are going to die

Because they can't afford getting hit with a high deductible.

[Avalon Sparks]

119. For every person that goes to the doctor for every little thing

I would imagine a fairly equal number that wouldn't go unless they think they are dying...

These are generally outliers....

I'd venture the majority would use Dr visits appropriately.


in my circle of people I know, friends and family, I don't anyone that likes to go to doctor, nor does so for minor things....they only go when they are really sick. It's a pain in the butt to get in, miss work, and have to sit in the waiting room and take a chance catching something.

Just my two cents