Let me point out the obvious fact that healthcare is never free. The real question is what is the best method of delivering healthcare that provides the best result for the money that the society wants to spend on the health of its citizens. By almost any measure the American healthcare system is one of the most inefficient systems in the developed world. For the money we spend America should have the best results by any possible method of measuring outcomes. We should have the longest lifespan, the lowest infant mortality, eyc, etc. What I believe is that fundamentally we have a two tier system in America. I would bet that if results of American healthcare were broken down by income it would become very obvious that for the wealthy the American system is the best in the world, while for the poor we have one of the worst systems in the developed world. We as a country basically have two choices if we want results to improve for the bottom of the income scale. We can spend more to improve care for the bottom of the scale or we can take steps to average out the results across classes which means the the top tier will probably have poorer results than previously. Or of course we can just maintain the status quo and blame those with bad health for overheating, not getting enough exercise, drug usage, etc,etc.
According to your theory a system entirely funded by the government that eliminates health insurance totally should be the most efficient. Your option three forgets that the government taxes healthcare companies and that most if not all insurance requires copays so that at best option three should also include option two. And you also know that the percentage of companies that offer insurance to employees has been dropping for decades and that copays have been increasing over time.
The US government has zero dollars to fund healthcare services though government insurance programs like Medicare and Medicaid. It must tax the people to obtain income to fubd expendatures, The people must be paid by employers and all income in the United States originates with the enterprise (company) based upon the labor of the workers that produce goods and provide services (i.e. the GDP of the United States). Even the VA relies on taxation of income that originates with the enterprise (business) and it's "socialized" medicine that doesn't rely on "insurance" but instead direct funding from the federal government that owns the clinics and hospitals and directly employs the health service providers. The cash flow for "government" is the longest of all the cash flows related to health care (or any) services and it's the most expensive why to fund health care services for the individual because of that.
There's another option when I look at the different forms of health care I've had during my lifetime. The best health care I've had is with employer provided group health insurance that covered out-patient services, hospitalization, eye care, dental, and prescription drugs. Yes, there was a small percentage of the premium I had to pay sometimes for "preferred plans" but others were 100% paid for by the company (generally HMO plans). There were also minimal copays with a maximum annual limit for services. Next I'd rank the VA as being very good although there is a problem with under-staffing and a lack of facilities. It covers hospitalization, out-patient services, and eye care but the dental plan must be paid for by the veteran. There are some co-pays depending on income. Medicare pretty much sucks. It only covers hospitalization under Part A because all of the other services are basically paid for by the enrollee. I've never had private health insurance because I was always covered by my employer under a group plan except when I was unemployed and then I couldn't afford private health insurance. I've never had Medicaid although I understand it covers everything except dental and eye care but I could be mistaken. If I was to pick an option it would be for an employer mandate that requires all employers to provide health insurance for employees because employer paid health insurance provides the best possible health care services in America and group health insurance is the least expensive option for private health insurance.
You would appear to be changing your criteria for efficiency of money for your original erosion theory each time money changes hand to a criteria based on something called " length og cash flow" I would just point out that several countries have single payer systems through the government and these plans are I arguably vastly less expensive than our system and do sliver better overall results.
your experience with employer paid healthcare seems to indicate you were a salaried employee and they usually have superior healthcare. But extrapolating your experience to all employer plans is dubious at best. And employers have been reducing employee healthcare coverage for decades.
Before ANY system can work, a thorough review of health care COSTS has to be undertaken. As anyone who has ever had the misfortune of being involved with the medical supply racket and had to pay for an item on their own would know. Or has fallen into a freakin' into a prescription drug 'donut hole' would know. From sun up to following sun up, those people exist to rip you off.
In some respects this is a comparison of apples and oranges because many of these countries, such as the UK, also depend on private health insurance in addition to their single payer system. We also see those from countries like Canada coming to the US because of the long delays in obtaining many medical services. Finally it also compares countries where 100% of the people have "health insurance" with the United States where only 90% have health insurance when comparing results. The results when just the "insured" are compared shows that the US has better health results but the uninsured in the US skew the results. The uninsured is the problem for the US and not the private health insurance industry. There's another fundamental problem that economists point out. There's so much money involved in the private health insurance industry today that converting to a single payer system would result in an economic recession that would dwarf the 2008 recession. We could have initiated a single payer system soon after WW II but with unions that pushed for employer group insurance in the 1950's through the 1970's we went down a different road. We're so far down that road today that it's fundamentally irreversable.
Except for a management position I had working for Lockheed between 1979-1981 I was always hourly. I held a technical (hourly) position and not a professional (salary) position and I did that by choice. I earned more working hourly because I worked a lot of overtime during my career. Yes, with the systematic right-wing destruction of the unions from the 1970's that really began to take it's toll under the Reagan adminstration we've seen more of the costs of employer group health insurance coverage being pushed off onto the employee but the coverage is still excellent at least in aerospace where I was employed. It was the unions that really lead the effort to create employer funded group health insurance during the 1950's and 1960's and with the eroding loss of union power at the hands of Republicans that gain for the workers of America is being lost.
Can someone take a look at the powers delegated to congress in article I, section 8 of the constitution and point out which of those powers would enable congress to establish a national health care system?
Just my experience in the corporate world where my insurance was totally covered by the corporation with zero copay, annual total, and I mean total physical, and dental also totally covered. My employees in the union had nothing even close.
Ruled on the constitutionality of a national health care system that doesn't yet exist? How prescient.
It's just that employer paid health insurance is a little alien to me. It does happen but only at upper management level.
