Hawaii Scraps Universal Health Care for Children
This is hardly surprising: Hawaii has had to drop its universal health plan for children because people who could afford to insure their children decided instead to let the state assume their responsibility. From the story:
Hawaii is dropping the only state universal child health care program in the country just seven months after it launched. Gov. Linda Lingle's administration cited budget shortfalls and other available health care options for eliminating funding for the program. A state official said families were dropping private coverage so their children would be eligible for the subsidized plan.See, when the government takes over, we think it is a right and we begin to take less care of our own obligations, expecting others to pay our way. Plus, the benefits were way too generous, free except for a $7 copay per visit! No wonder people decided to foist the responsibility for their kids' care onto the state!
"People who were already able to afford health care began to stop paying for it so they could get it for free," said Dr. Kenny Fink, the administrator for Med-QUEST at the Department of Human Services. "I don't believe that was the intent of the program."... State health officials argued that most of the children enrolled in the universal child care program previously had private health insurance, indicating that it was helping those who didn't need it.
We can't give health care away. As much as I wish it were otherwise, it just doesn't work.
posted by Wesley J. Smith @ 3:39 PM
20 Comments
20 Comments:
Dear Wesley:
As a Canadian I wish that our healthcare system did work.
It is always better for a nation to have healthcare for everyone, but it creates a system with long-lines and waiting lists, doctor shortages - many people do not have a family physician, and it creates an incentive for futile care theory to spread like cancer.
The best system is one where people have access to affordable healthcare and those who can afford to buy their care can do so.
Alex Schadenberg
Uh, why didn't the state just raise the taxes? If a private insurer wasn't suffering from budget shortfalls, they'd just raise the premiums, so why doesn't the state?
Oh wait, I know. Because state leaders are elected, and any tax increase would pretty much ensure the opposition would win the following election, given the opposition to taxation that so many Americans seem to have.
I'd prefer to live with high taxes in exchange for free healthcare for all.
Sorry, that should read "if a private insure was suffering from budget shortfalls", but I think that was obvious.
Joshua: Free health care for all breaks the bank and leads to over utlilization, breaking the bank even further. It also would result directly in invidious rationing in which the politically weak would be denied treatment, while the politically strong would always have full coverage.
The best answer is a mixed system, what I once called a combination of Nader and Forbes. Also, I think the Medicare Prescription Plan is a good model for national coverage.
I still don't get why the bank isn't just made stronger, such it can withstand full utilisation without breaking. That's how the United Kingdom does it.
Joshua: The NHS is a wreck. Read my NHS Meltdown series--and I don't write on all the stories. It is a complete wreck.
"I still don't get why the bank isn't just made stronger..."
I still don't get why people think it's that simple, as though money grows on trees, or perhaps only on government trees.
Joshua, here's a report from Tennessee's comptroller about how TennCare, which isn't as ambitious as Hawaii's plan, had to be reined in before it bankrupted the state.
TennCare Briefing
"Last summer, Governor Bredesen asked stakeholders to hire McKinsey & Company to analyze TennCare. McKinsey identified structural problems (Part I) and outlined strategic options (Part II). Found that TennCare, if left unchecked, will consume 91% of new tax revenues in 2008. The result: Virtually no new dollars would be left over for education and other priorities."
"I still don't get why people think it's that simple, as though money grows on trees, or perhaps only on government trees."
Well, healthcare is bought either through tax funds in a health system, or through private money through a private insurer. Either way, people are paying for healthcare.
The only reason universal healthcare could be more expensive than private healthcare is that more people will be using it, and more often. I'm fairly sure that private healthcare would end up being more expensive in the long run, as people would be paying money that would be going to profits for the insurer.
So, now I'm off to read Wesley's NIH series to see if I can work out why the government can't pay for healthcare.
Ah, sorry NHS. You know what I meant.
Ok, I read through a bunch of articles here titled 'NHS Meltdown' (which must have been going on for a while now, and yet most doctors and politicians still seem to be supporting it). And most other European countries have similarly majority socialised systems.
Anyway, I can't see any problem that couldn't be solved by raising the health budget. Lots of problems with rationing (and how those decisions are made) and waiting lists and so on, but that just appears to be all because health is underfunded. Seems to me to be a problem with people being selfish - not wanting to pay money to save another person's life, and voting accordingly.
The Government Health care system has as many working in support & administration as they have in the field. Meanwhile excessive trips to Drs. are bound to increase strain on the system to. Also mixed in to the core of the financial strain is the fact that Drs offices are billing on visits so simple thinks like yearly prescriptions for a patient that will be on something like celebix, blood pressure pills are written up one 30 pill batch at a time so that the Dr. gets a visit each month just to fill out prescriptions. Drs know how to milk the system to since they usually are of pretty high intelligence. I am under Canadian Health Care but it has some serious financial issues . Those issues get to be a heavier tax burden for us Canadians year to year.
More money might not be the answer, Joshua. I checked some numbers for the UK's NHS program, and their current annual budget is above 90 billion pounds, up from 34 billion less than a decade ago. The entire British budget currently around 618 billion pounds, so health services appear to have gotten worse in the UK despite NHS expenditures rising from 5% to 15% of the budget.
The problems with the NHS appear to be structural - large amounts of money lost in a gigantic bureacracy, misplaced priorities and a general lack of humanity. Throwing money at the problem is unlikely to improve them.
Sparcvark, correct me if I'm mistaken, but I read somewhere that even though the UK is now spending more of their GDP on healthcare than a decade ago, they are still spending less than the OECD average.
And I don't know if bureaucracy, misplaced priorities or lack of humanity are any different in a private system. All that would be different is which bureaucracy is doing the inhumane prioritising - the government or large insurance companies.
I can't find any OECD figures, but the UK's GDP is in the 1.2 - 1.5 trillion pound range, so the NHS alone is about 7% of GDP - private expenditures would have to be added to that.
Still, the NHS does not appear to have improved despite a near-tripling of its budget. More money alone won't solve the problem.
One of the hidden costs of a completely publicly-funded healthcare system is that the government loses its adversarial role in policing the industry. Whatever you think of insurance companies, they can't make laws or set policy. When government takes control, they inherit the cost and resource problems, but can set policy and laws to save money. Hence, the sinister policies being pushed in the NHS that Wesley has been documenting.
I think the current US system needs reform, but nationalizing the healthcare system is not the way to go.
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OECD data can be found here: http://www.oecd.org/health/healthdata
I've got access through my university, and it can be seen that the UK spends 8% of their GDP on Healthcare (including both private and public - 87% of all health spending in the UK comes through the public system).
In comparison, the United States spends 15.2% of GDP on healthcare, with 45% of that coming through public funds.
That data was from 2005 though, because I can't see any newer data on the OECD site. The only OECD countries that actually spent less than the UK in 2005 were Ireland, the Czech Republic, Slovakia, Poland, Korea and Mexico. Every other country was spending more.
Now, as for the legal aspects, how many people can sue an insurance company for an alleged criminal offence and actually win the case? As far as I see it, both the government and the insurance agencies can be just as sinister.
Wesley, thanks as always for your great blog. That said, I thought this statement was a bit harsh on the parents who put their kids on the program but could afford heath care:
"See, when the government takes over, we think it is a right and we begin to take less care of our own obligations, expecting others to pay our way."
Is a parent who can afford private school '[taking] less care of [their] own obligations' because they send their kid to public school? I don't think so. We are our government and if we decide something should be socialized, whether it be roads, fire stations, education, health-care for children or health-care overall, since our taxes pay for it, we're not ignoring our own resposibility by using the socialized services.
Of course I agree with your on the disaster socialized health-care is, but I don't fault those who make use of it when their government implements it. I fault those who voted for politicians who enacted it.
Ken: Good challenge. But I think there is a material difference. Ensuring that all kids get a good education has for more than a hundred years been considered a state responsibility. That is where a lot of our property tax money goes. And we all have a stake all kids receiving a good education. It permits everyone to have a chance at fulfilling the American Dream.
I don't think health insurance is in the same category. One of the strengths of the USA, it seems to me, is that we are to take care of ourselves and our own for the necessities of life, undergirded by a safety net for those who have difficulties.
But this paradigm is being turned on its head. If we all lean on the government for things such as health care when have the ability to handle our own needs, we will become less self reliant and the government will go broke.
Wesley, how much chance do you have at fulfilling the American Dream if your dead, or heavily burdened with repaying the treatment that saved your life?
If anything, it should be the other way around - states should pay for health care, and parents should pay for education. I don't see why a free education is a right but free access to healthcare is not.
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