The U.S. Health Care Debate

Am I missing the other thread on this? Where is it?

Anyway, healthcare is a big and intimidating question in the U.S. Many on the left would like to see a single payer plan, many from the center left would like a hybrid system that will eventually turn into a single payer plan (maybe with private suplementals)

The right is confused, and rightfully so. We are tasked with coming up with a plan that is new and will be hard to sell. What is very important is that we first find out what the main prolems are:

A. Exponentially rising cost.
This is the most important aspect of the discussion. Cost of premium is a real concern for most Americans, but that is due to the cost of care in the first place. One reason that cost is so radically out of control is a lack of transparency. co-payments, while used as a tool to give the insured an incentive have become relatively meaningless in relation to cost. As an example; I could visit doctor A and pay $20 or I could visit doctor B and pay $20. Actual cost to the insurer would msot liekly be very different - both doctors may have the same level of proficiency, but one costs much more than the other. As it stands today, there is no real way of knowing as the insured and no real reason to care in the short term. In the long term, this ignorance of cost leads directly to higher premiums. A way needs to be developed to adequately give an incentive to the insured to go with the value and what works - but they need to be ably to quantify it and feel the benefit and consequence of wasteful medical spending.

Another problem with rising costs is that, contrary to assumption, insurance companies prefer higher medical costs. the higher the cost, the higher the premium and the larger the percentage of your income they can expect, giving rise to company growth and investment. Even if they are payign more, thsi is offset by the amount that they will charge in the long run. I'd rather make 8% of 100 than 12% of 10.


I've got quite a bit more I wrote a whole list I-VII at home, but I'm at work now, so I'll try to post more her when I get home. I focus on insured pools, adverse selection, current working plans etc.

Anyway, I watched a bit of the Obama show last night and was not impressed. He really isn't that great at explaining detailed plans. Most of it seemed to be "why not?"

Was his telethon last night? Missed it. Does anybody know if an actual proposal has been put forward?

We have a commission here that tests medications for their effectiveness, weighs that up against the price etc. and then decides which the ensurance companies have to pay for, if a new medication has essentially the same effect as an old one wrapped into a new package with a higher price tag, then they will decide the insurance companies only have to pay for the old one etc.
Of course this system is criticized as well but it might help keeping the premiums down, here you usually get the impression that insurances would rather not pay at all anyway. :sweatdrop:

I'm just guessing from your response, but you haven't had much contact with Health Insurance companies, have you, Gelatinous Cube? 'Cause you're glossing over a whole lot if you have.

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Originally Posted by Gelatinous Cube

Mmm.. healthcare debate. I've always sympathized more with Democrats than Republicans on most issues, but the whole universal healthcare thing... :inquisitive:

I believe tax breaks or some other form of subsidizing cheap Health Insurance is the way to go. The Canadian or British model is not. Doctors go to school for 12 years to do the very difficult and specialized job that they do. They deserve the pay--on top of that, the pay is necessary to keep incentive for people to keep wanting to be doctors. Health Insurance is the easy out. You pay less to go to the doctor, the doctor still gets his giant paycheck.

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In the UK doctors take 6 years to qualify. Where do your lot waste the other 6 years?
The pay incentive is there to help in part cover the vast bills that doctors have after over a decade in training; the pay is also more than in most european countries. These are not struggling to get doctors.
If the UK / Canadian way isn't to your liking - and it ain't perfect - then look at Switzerland: Americans pay 17% GDP, Swiss yet 12% their outcomes are better than America's.

~:smoking:

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Originally Posted by Lemur

I'm just guessing from your response, but you haven't had much contact with Health Insurance companies, have you, Gelatinous Cube? 'Cause you're glossing over a whole lot if you have.

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Well, he's a young man in an organization that provides the largest socialized medical care in the world. So, the whole thing is likely kinda theoretical for him.

In the end, this issue is not even about health care at all, right? Rather, the issue is "insurance".

I'm a firm believer that Medical Care is one of the "big three" along with Law Enforcement, and Fire & Rescue. It should be free at the point of use. That could either mean that A: it comes direct from your taxes, or B: everybody pays for state health insurrance that does not go up if you use it and is affordably low to begin with.

After all, you wouldn't expect to have to pay the fireman to put our house out or save your child, you shouldn't have to pay a state Doctor for his services, either.

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Originally Posted by Philipvs Vallindervs Calicvla

I'm a firm believer that Medical Care is one of the "big three" along with Law Enforcement, and Fire & Rescue. It should be free at the point of use. That could either mean that A: it comes direct from your taxes, or B: everybody pays for state health insurrance that does not go up if you use it and is affordably low to begin with.

After all, you wouldn't expect to have to pay the fireman to put our house out or save your child, you shouldn't have to pay a state Doctor for his services, either.

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If you're storing petrol in open containers and go around the house smoking I do think you should pay for cleaning up the resulting explosion.

Similarly with healthcare. There are some risks we can't alter in our lives for certain diseases be it gender, ethnicity or other underlying genetic problem, but the vast majority we can, be it the drunk morons that come in on Friday night to the 45 year old drinker / smoker / no exercise / high fat diet for the last 30 years who'se finally had his overdue heart attack.

There are several ways of doing this. A tax on alcohol / tobacco that is ring-fenced for the healthcare, these people should pay more insurance - in the same way that if I drive a Ford Fiesta I'll pay significantly less insurance than if I choose to drive a Nissan GTR - and / or a charge for attending A&E. £5 or £10 still means about a 90% subsidy by the state assuming no treatment is required, but at least this discourages the true timewasters. If you've had an MI then £10 for over £1,000 treatment is still the bargain of the century.

~:smoking:

There are several ways of doing this.

I don't completely disagree with your first suggestion, I don't think we should charge at the medical end of the scale but when they actually buy the product. So alcohol and cigerettes for example should have tax on them at the point of purchase. I don't think alcohol does but considering ive heard figures of around 75% of the price of a pack of cigerettes is tax i think cigerettes more than make up for thier bruden on the health service (the fact that that money doesn't go to the health service is the goverments fault) Alcohol in comparison seems quite cheap, junk food also, is dirt cheap for the harm it causes long term.

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Originally Posted by Philipvs Vallindervs Calicvla

I'm a firm believer that Medical Care is one of the "big three" along with Law Enforcement, and Fire & Rescue. It should be free at the point of use. That could either mean that A: it comes direct from your taxes, or B: everybody pays for state health insurrance that does not go up if you use it and is affordably low to begin with.

After all, you wouldn't expect to have to pay the fireman to put our house out or save your child, you shouldn't have to pay a state Doctor for his services, either.

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You may not have to pay the fireman to put out the fire in your house, but you or your insurance company will have to pay for the damages to the house.

Safeway, the US company, has had success in keeping insurance payments for their employees steady - as in not increasing while the rest of the nation does. They've done that by providing incentives, ie lower insurance prices, for healthier employees. The result is healthier employees and non-increasing costs. But they are still limited in the size of incentives they can provide to healthy employees.

In Texas they had success in putting a lid on malpractice payoffs.

Of course, Obama wants to go with neither of these two proven methods.

We should allow insurance companies/employers to charge unhealthy employees the full amount more that it costs to insure them (ie charge a smoker $1400 more per year instead of being limited to charging only $300 more per year compared to a non-smoker [approximated costs, of course]), and pass a federal law putting a lid on malpractice payoffs.

CR

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Originally Posted by Gelatinous Cube

...I'm in the Military, and currently dealing with a very serious injury to my foot--the treatments and surgeries for which are entirely free to me.....

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You paid your taxes, just as did the rest of us, and that's what paid for your "free" healthcare. The contract is simple: you agree to risk getting your *** shot off to protect mine and my neighbor's, and we agree to pay for your healthcare. No gripes here about that.

But NOTHING IS EVER FREE. TANSTAAFL is a universal norm.

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Originally Posted by Gelatinous Cube

Even though I'm a smoker, I agree with this.

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I'm on-board too. I'm convinced that my vices (cigarettes, beer) will probably statistically not only shorten my life, but also make end-of-life measures more expensive. I'll pay for that, for the privilege of indulging my bad habits.

But again, we're not talking about health care here, we're talking about insurance, and betting with or against "the odds", and putting down the appropriate ante into the insurance "pot".

-edit-
I have a (:crosses fingers:) stellar driving record: no accidents or citations in 44 years and 2.5 million miles driven. Yet I know that I will pay more to GEICO to insure a fire engine red convertible Corvette, than I will for a beige tudor ford escort. The Corvette will cost more to replace, and it's a both citation- and accident-magnet.

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Originally Posted by KukriKhan

I'm on-board too. I'm convinced that my vices (cigarettes, beer) will probably statistically not only shorten my life, but also make end-of-life measures more expensive. I'll pay for that, for the privilege of indulging my bad habits.

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They don't, tho. The 'smokers should pay' garbage is just a guilt trip. If you get lung cancer and die of it, you'll spend 6 months in a hospital dieing on pain meds around age 70. If you live to 98 with full blown Alzheimer's you'll need round the clock care, often costing as much as 7-8k a month until you finally pass. Plus, you paid more into the healthcare kitty with all your sin tax contributions from buying your cigarettes (I know you get your's from the Ukraine, but you get the idea).

Whether it's more expensive or not, it shouldn't matter. Should homosexual men pay more for insurance since their lifestyle puts them at higher risk for disease? Should blacks pay more for their higher incident rates for heart conditions? How about the obese? You eat more than two cheeseburgers a week and you better pay, fatty. What about scuba divers and their burden on emergency care?

:dizzy2:

Make it honestly universal or don't bother at all, sez I.

I like how Gelantinous Cube pretty much has the free universal healthcare option because he is in the army, but is against it. In America, isn't it 60% cannot afford Health Insurance? I remember seeing Americans get chemo-treatment then stay in tents outside the hospital as they couldn't afford to have a bed on the inside due to the costs.

Basic and Essential Healthcare should be free as a human right. However, if you want cosmetics or anything like that, you pay for it. (outside grievous injury and other things)

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Originally Posted by Proletariat

They don't, tho. The 'smokers should pay' garbage is just a guilt trip. If you get lung cancer and die of it, you'll spend 6 months in a hospital dieing on pain meds around age 70. If you live to 98 with full blown Alzheimer's you'll need round the clock care, often costing as much as 7-8k a month until you finally pass. Plus, you paid more into the healthcare kitty with all your sin tax contributions from buying your cigarettes (I know you get your's from the Ukraine, but you get the idea).

Whether it's more expensive or not, it shouldn't matter. Should homosexual men pay more for insurance since their lifestyle puts them at higher risk for disease? Should blacks pay more for their higher incident rates for heart conditions? How about the obese? You eat more than two cheeseburgers a week and you better pay, fatty. What about scuba divers and their burden on emergency care?

:dizzy2:

Make it honestly universal or don't bother at all, sez I.

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The opinion essay about the Safeway insurance said that it cost the company $1400 more per year to insure a smoker. I can't speak for whatever method they used to come up with that number. They also did do health check-ups on employees, so obese people did pay more.

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In America, isn't it 60% cannot afford Health Insurance?

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:inquisitive:

No. Much, much less.

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I like how Gelantinous Cube pretty much has the free universal healthcare option because he is in the army

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No, he doesn't. He earned that healthcare and it was not free.

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Basic and Essential Healthcare should be free as a human right.

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Why should it be a right for a sick person to take money from others to get care for themselves?

CR

Why should it be a right for a sick person to take money from others to get care for themselves?

Because whereas some animals leave thier sick to look after themselves we like to think we are above that.

It remains one of the world's great mysteries - how come Americans pay fifty to 100 percent more for healthcare than the rest of the developed world, but have results that are not, shall we say, stellar.
And healtcare and rising costs aren't very rosy in Europe, Canada and Japan to begin with.


To throw in a thought - would you pay 10% of your annual income, for your entire life, to add eightteen months to your life spend in ill health at the age of 81? Cause basically, that is what we are doing.


Prole - I take it you naughty girl still haven't given up smoking? :smoking:

Neither have I. One day, one day...:shame:

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Originally Posted by Louis VI the Fat

It remains one of the world's great mysteries - how come Americans pay fifty to 100 percent more for healthcare than the rest of the developed world, but have results that are not, shall we say, stellar.
And healtcare and rising costs aren't very rosy in Europe, Canada and Japan to begin with.


To throw in a thought - would you pay 10% of your annual income, for your entire life, to add eightteen months to your life spend in ill health at the age of 81? Cause basically, that is what we are doing.


Prole - I take it you naughty girl still haven't given up smoking? :smoking:

Neither have I. One day, one day...:shame:

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Not me, man. I don't demand much of myself, but I do insist on honesty when I'm talking to myself. And the truth is: I will continue with the smokes until it hurts too much. So far, it doesn't. I offer supportive words of admiration to anyone who quits smoking, but I know, deep down inside, that I never will. Except when I also quit breathing, of course.

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Originally Posted by Prole

(I know you get your's from the Ukraine, but you get the idea).

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Heh. You should see the huge black-bordered warning they put on their packs. I assume it says something like: "This chit gon' kill you, Comrade."

So yeah, I'll pay for the privilege of being left to my own neferious devices.

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Originally Posted by Gelatinous Cube

Uhm, unless you have a terrible doctor, the results are hardly less than stellar.

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I think Louis is referring to common indexes of a nation's health; infant mortality, life expectancy, etc. On most measures we don't do well. Last I heard we were 36th in results and number on with a bullet in costs. I'll let a more statistically-inclined Orgah hunt down the numbers. Like Barbie says, "Math is hard."

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Originally Posted by Gelatinous Cube

Universal healthcare can't work for America, but examples of nearly universally affordable health insurance have occured in the past, and can occur again.

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I don't understand why universal or "single-payer" healthcare simply can't work in the U.S.A. I'm not saying it's the best solution, or arguing that we should adopt it, but to flatly state that it cannot work here is interesting, and requires elaboration on your part. Every other major industrialized nation has some sort of universal healthcare. Japan, Germany, Taiwan, France, Sweden, Finland, France, South Korea, Australia, Britain, Netherlands ... the list goes on. And let's not forget the Canucks.

If just about every first-world nation can make it work, why is it flatly impossible here? I'd like to hear your reasoning.

Well, for one, a public plan would likely be able to drive drug costs down, as other nations have. But the US currently pays for most of drug R&D through higher drug prices in our country. So if the public plan was successful at lowering drug costs, we'd destroy a lot of the R&D budgets for drug companies. The other nations that have public entities negotiating low drug prices get away with it because us Americans are currently picking up the tab.

I'd love for someway to force all those free-loaders to pay higher prices, so we in the US could pay lower prices.

As for not working; even the recent democratic plan would leave some 30 millions or so uninsured. Over half of the amount of people who are not insured right now.

CR

America has decided two things. One, that we don't want capitalism any more. Two, that we have infinite money.

Lets live it up. Bring it on. Free healthcare and insurance and prescriptions for everyone.

If I remember right, Canada has the best healthcare in the world and I think Cuba is second. (This is on average per citizen)

Anyway, America can remove money from its over inflated defence budget to fund it easy. It's sad you rather pay more money in killing people than saving lives.

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Originally Posted by Beskar

If I remember right, Canada has the best healthcare in the world

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:dizzy2:

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and I think Cuba is second.

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:inquisitive:

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Originally Posted by Beskar

If I remember right, Canada has the best healthcare in the world and I think Cuba is second. (This is on average per citizen)

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https://i275.photobucket.com/albums/...-819731_50.jpg

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Anyway, America can remove money from its over inflated defence budget to fund it easy. It's sad you rather pay more money in killing people than saving lives.

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If I'm reading the budget summary right we spent about $600B on the DoD and about $1T on Social Security + Medicare + Medicaid in 2008. I'm far from sure that I read it right, but we're already paying more in welfare programs than in killing people. Course, I'd like to drastically cut the killing people part, but when you have infinite money, who freakin' cares...

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Originally Posted by Beskar

If I remember right, Canada has the best healthcare in the world and I think Cuba is second. (This is on average per citizen)

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Really? In Canada, people die on waiting lists. Some pay thousands of their own money so they can travel to the US and buy treatment because they don't want to wait for years.

Cuba - maybe you should consider the possibility that such claims are propaganda.

CR

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Originally Posted by Crazed Rabbit

Well, for one, a public plan would likely be able to drive drug costs down, as other nations have. But the US currently pays for most of drug R&D through higher drug prices in our country. So if the public plan was successful at lowering drug costs, we'd destroy a lot of the R&D budgets for drug companies. The other nations that have public entities negotiating low drug prices get away with it because us Americans are currently picking up the tab.

I'd love for someway to force all those free-loaders to pay higher prices, so we in the US could pay lower prices.

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:inquisitive:

I thought you were a free market sort of fellow? Maybe a different system would force drug companies to reduce their current extortionate prices? For example, the British system of NICE (a quango that assesses treatments for the NHS on grounds of cost-benefit) has often rejected a drug for use in the health service because its cost per quality life year is too high - and amazingly - assuming their subsequent "moral" crusade in the papers fails - the drug company concerned often drops its price or comes to a deal.

I think there is great scope for reducing drug costs and therefore medical costs across the globe. Not least because nations fund vast universities which could be doing a great deal of public research for the benefit of many.

I am intrigued to understand more about the US system because of Lemur's thread in The Other Place. As far as I know, our resident prosimian is a intelligent middle class professional. A couple of weeks ago, he tried amateur surgery during which his fingers came off worst. Despite the severe risk of tetanus, infection etc, he could not face the potential cost of having a quick check up and asked for advice on this forum. IIRC, he cited the fact that to claim on his insurance would cost him a great deal of time and hassle, if it was paid at all. Moreover, he noted that it was not possible to change the insurance company to a more supportive one.

The issue about people being uninsured under the system is certainly one concern. But if people who are insured feel so constrained by its workings that they won't even get a simple check up, there is a whole other problem.

Is it actually true that it is difficult/impossible to change one's insurer? How then does the market drive efficiency through choice? Is it true that check-ups like the example above are fraught with concerns and possible costs so that preventative examinations are foregone - thus increasing the likelihood of major (and far more costly to the system) interventions later? Is it true that Lemur is too manly and therefore disdained the ministrations of kindliness when lesser mortals would have fled to the doctor weeping like little girls?

I would be interested in the answers to the above to inform my understanding of the debate.

I'm inclined to agree. Monday I have to call my GP to tell him one of my friends has Swine 'flu. I will likely get swabbed and then have anti-virals. It's not going to cost, and because I don't work I don't pay National Insurrance right now.

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Originally Posted by Proletariat

They don't, tho. The 'smokers should pay' garbage is just a guilt trip. If you get lung cancer and die of it, you'll spend 6 months in a hospital dieing on pain meds around age 70. If you live to 98 with full blown Alzheimer's you'll need round the clock care, often costing as much as 7-8k a month until you finally pass. Plus, you paid more into the healthcare kitty with all your sin tax contributions from buying your cigarettes (I know you get your's from the Ukraine, but you get the idea).

Whether it's more expensive or not, it shouldn't matter. Should homosexual men pay more for insurance since their lifestyle puts them at higher risk for disease? Should blacks pay more for their higher incident rates for heart conditions? How about the obese? You eat more than two cheeseburgers a week and you better pay, fatty. What about scuba divers and their burden on emergency care?

:dizzy2:

Make it honestly universal or don't bother at all, sez I.

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Smokers don't just kill themselves. They also help kill others. In this way they are worse than Heroin users who generally just kill themselves.

Blacks aren't renowned for heart disease. That is persons from the Indian subcontinent. This is an unalterable genetic factor.
Obesity is a choice, as is scuba diving. These should pay more.

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Originally Posted by Crazed Rabbit

Well, for one, a public plan would likely be able to drive drug costs down, as other nations have. But the US currently pays for most of drug R&D through higher drug prices in our country. So if the public plan was successful at lowering drug costs, we'd destroy a lot of the R&D budgets for drug companies. The other nations that have public entities negotiating low drug prices get away with it because us Americans are currently picking up the tab.

I'd love for someway to force all those free-loaders to pay higher prices, so we in the US could pay lower prices.
CR

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Generic drugs are cheap, and slightly worse. The cycle is that healthcare costs a load. When you get ill, since it's cost a fortune you want the best, not the most cost efficient. One drug is 5% better and twice the cost? Great - bring it on. Treatment was massively expensive, and so is insurance.

Lots of R&D is done in Europe, but all with the eye to the American market.

~:smoking:

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Originally Posted by Proletariat

Make it honestly universal or don't bother at all, sez I.

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Commie!

Spoiler Alert, click show to read: 

But I agree, this whole complicated system based on risks is a really weird capitalist's dream as it would also require significantly more bureaucracy than a simpler system, and we all know bureaucracy is bad and costs way too much money.

Concerning the whole choice thing, joining the military in the US is also a choice, does that mean soldiers would have to pay the most? Don't let patriotism get in the way of your judgement here...

AS far as I am aware, soldiers get free healthcare, and support after discharge. So it's a non-issue with the employer picking up the tab.

Massive detail into lifestyle would be difficult, but considering here in the UK most of the needed data is held by GPs it would be very simple to develop quite complex pictures about health. Would some lie? Probably. But as with all insurance it is invalidated if falsification is found.

~:smoking:

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Originally Posted by rory_20_uk

AS far as I am aware, soldiers get free healthcare, and support after discharge. So it's a non-issue with the employer picking up the tab.

Massive detail into lifestyle would be difficult, but considering here in the UK most of the needed data is held by GPs it would be very simple to develop quite complex pictures about health. Would some lie? Probably. But as with all insurance it is invalidated if falsification is found.

~:smoking:

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You've hit on another aspect of the talked-about but not yet written down plan over here: cut costs by digitizing med records, the easier to share patient history and treatment among Docs.

Makes sense to avoid duplication of effort, but many are worried about the security of such a system, and the use of the info by gov't, insurance and employer groups to deny treatment, coverage, or even employment, based on risk actuarial tables.

Why hire a 40-year old welder for your factory, if his father, mother & grandfather all died of heart attacks in their late 40's?

-edit-
Just thought I'd throw in this BBC story about an entire village smoking cigarettes one day every year.

Here's a take from a former Canadian doctor. Like BG, I was also concerned and disgusted that Lemur felt the need to doctor himself with that hand injury rather than jump through hoops with his insurance company. I think Kukri was on the money when he said it appears to be more of an insurance problem than a health care one. I really don't know what a viable solution would be, but something needs to be done. A not for profit health insurance company for those that don't have any sounds like a good idea to keep costs down, but will it eventually lead to all employers just dumping their health plans for employees and forcing most people into this government plan?

From a personal stand point, if what this doctor says about the Canadian health care system is true about waiting lists for CT/MRI scans... I'd not have survived that brain aneurysm several years ago.

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Originally Posted by Husar

Concerning the whole choice thing, joining the military in the US is also a choice, does that mean soldiers would have to pay the most? Don't let patriotism get in the way of your judgement here...

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There is a bit of a difference between smoking and joining the military, and American soldiers certainly should enjoy subsidized health insurance because:

1) They are working for their country in one of the most difficult jobs it offers.
2) There is a large difference between working in a necessary job and killing yourself with junk food.
3) For all the things that they sacrifice it is the least that we can do in return.

Some thoughts:

The litigation culture in the US drives up healthcare costs. This is partly owing to individual risks not being socialised. In Europe, if you become disabled, welfare will take care of you. In the US, somebody responsible must financially compansate you. (To put it very schematically, but the mechanism is there, and not just in healthcare)
Are European healthcare costs shifted to social welfare costs? Americans by contrast pay less for welfare, more for healthcare. Is a good deal simply a matter of where costs appear? I lack numbers, but I expect so.
(There are pro's and con's to either system. For the proponents of individual responsibility - which always at first glance sounds the more reasonable choice - the following joke, that I unfortunately don't know how to tell well: a man falls down on a New York pavement in agony, grabbing his heart with his hands. One man rushes towards him, another flees the scene. The former is a lawyer, the latter a doctor)


Surely, (insurance for) litigation can not account for several percent of GDP? Litigation is rampant in the US, but it can not account for the huge gap in healthcare spending between the US and other developed nations. I need numbers. (We are in dire need of statisticians and number crunchers in this thread!)


Capitalism has two meanings. Free market, and putting the interests of corporations first. American families suffer because they believe that what is good for corporate America, is ultimately good for them. The medicinal-industrial complex knows otherwise.
Free markets are great, therefore corporations will do anything to destroy them. The federal government ought to resume control of the healthcare market and put better incentives into place. Currently, they work to the disadvantage of the people.


The US scores very low on international healthcare comparison lists. Infant mortality and the like. Yet, America also scores near the top on other lists. I think this is more a matter of income distribution than healthcare. Simply put, poor babies die out of want, and the well-to-do have a $100.000 heart surgeory.
This is a cultural difference, a political and societal choice. Not a matter of disorganised healthcare.

Corporations are not free-market, as they take protection and privileges from the state.

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Originally Posted by Louis VI the Fat

Surely, (insurance for) litigation can not account for several percent of GDP? Litigation is rampant in the US, but it can not account for the huge gap in healthcare spending between the US and other developed nations. I need numbers. (We are in dire need of statisticians and number crunchers in this thread!)

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I think malpractice insurance for one doctor can be in excess of $100,000 per year. So even if they never get sued, simply insuring against it can put them in dire finances.

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Capitalism has two meanings. Free market, and putting the interests of corporations first. American families suffer because they believe that what is good for corporate America, is ultimately good for them. The medicinal-industrial complex knows otherwise.
Free markets are great, therefore corporations will do anything to destroy them. The federal government ought to resume control of the healthcare market and put better incentives into place. Currently, they work to the disadvantage of the people.

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The Federal government very rarely helps the free market instead of corporations (see the latest tobacco bill, AKA The Phillip Morris Protection Act). Almost every time they put in a regulation it will help corporations and bind the free market. This is because 1) Politicians are dim witted morons who understand very little economics 2) They are eager to grab money for their districts, even at the expense of the nation 3) They are fond of giving privileges to special interests that support them.

There is probably a good deal the Feds could do to help simply by removing onerous restrictions, though I can't point out specifics.

I'd recommend reading the paper Hosakawa Tito linked to, as it shows the importance of allowing profits.

CR

It needs to be fixed.

Where does this story come from that 'people in Canada die on waiting lists' whereas this doesn't happen in the US? Can anyone show me where it says that in the US people don't die waiting for crucial treatments?

EDIT
Or any other country for that matter?

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Originally Posted by Adrian II

Where does this story come from that 'people in Canada die on waiting lists'

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From a Canadian doctor who moved to Minneapolis because he can make obscene amounts of money there. He's now trying to convince the Americans that they mustn't adopt the Canadian healthcare system. Because, erm...the US system is good for the patients.

No, really, it is good for Americans.

Really.

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Originally Posted by Louis VI the Fat

From a Canadian doctor who moved to Minneapolis because he can make obscene amounts of money there. He's now trying to convince the Americans that they mustn't adopt the Canadian healthcare system. Because, erm...the US system is good for the patients.

No, really, it is good for Americans.

Really.

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I see. So it comes from someone who practices social darwinism in the guise of medicine, a bit like our rory?

There's absolutely no valid reason to explain why members of the military have free healthcare and other people don't.
Breach of equity of the worst kind. Nationalism is definitely stupid.

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Originally Posted by Meneldil

There's absolutely no valid reason to explain why members of the military have free healthcare and other people don't.
Breach of equity of the worst kind. Nationalism is definitely stupid.

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Why do you hate freedom? :rolleyes:

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Originally Posted by Gelatinous Cube

But to say it's a breach of equity that the Military should offer me outstanding healthcare? :inquisitive:

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I believe Meneldil is saying it's a breach of equity that you need to sign up to bomb foreigners in order to get free state healthcare.

My apologises to my earlier post. It was something I read some where and remembered it. I will however, post a proper source and proper results.

Best Healthcare in Rank according to the World Health Organization 2000 report.

1 France (Universal Healthcare Insurance System)
2 Italy (Universal Healthcare State-funded)
3 San Marino (Universal Healthcare State-Funded)
4 Andorra (Universal Healthcare Insurance System)
5 Malta (Universal Healthcare State-funded)
6 Singapore (Universal Healthcare Hybrid of Public and Private)
7 Spain (Universal Healthcare State-funded)
8 Oman
9 Austria (Universal Healthcare State-funded)
10 Japan (Universal Healtcare Insurance System)
...

37 United States of America (Does not have a Universal Healthcare System) (72nd by overall level of health)

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Originally Posted by Gelatinous Cube

I think it's the total opposite. You shouldn't look at it like it's state healthcare. It's not. It's employer-provided healthcare, subsidized by the government. The Army is a non-profit organization, after all.

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Like welfare with more collateral damage.

Though then again, it certainly is for-profit for all the "defense" contracts we no-bid to people.

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Originally Posted by Meneldil

There's absolutely no valid reason to explain why members of the military have free healthcare and other people don't.

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It strangely makes sense within the US system. Your employer pays your healthcare insurance. Great healthcare benefits are one of the perks of joining the military - together with education. Both not readily accessible to all in the US.

The system makes a person beholden to her employer for healthcare insurance. Power is the reverse of what it ought to be. To me, not corporations, but people ought to be the focus of society. Citizens should be free and healthy, at least, independent in access to healthcare. Then employers can bid for the services of these healthy, independent and free citizens - on their knees.

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Originally Posted by Gelatinous Cube

Nobody joins the Army on behalf of the Corporations that equip the military. Similarly, the military does not work for corporations. The Army works for the President. The President works for the people who elected them.

I really do appreciate the conspiracy theories, but the Army is hardly anything sinister. Uniformed opinions abound.

:inquisitive:

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Technically the President works to get re-elected, which only sometimes coincides with the best interests of the people who elected him (which is only sometimes a slim majority of the people who pay the taxes that fund his military).

But regardless, the military is a state organization, and healthcare it provides is state healthcare. Hell, you have separate state hospitals if you'd prefer it.

Furthermore, what does it say about the military that recruitment goes up when the economy is bad? Maybe it's not all about "defending" America and apple pie...

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Originally Posted by Adrian II

Where does this story come from that 'people in Canada die on waiting lists' whereas this doesn't happen in the US? Can anyone show me where it says that in the US people don't die waiting for crucial treatments?

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I don't think as many people die waiting for them - more may die because they can't pay for them. My point is that Canada's system is no great advantage over our current one.

CR

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Originally Posted by Crazed Rabbit

I don't think as many people die waiting for them - more may die because they can't pay for them. My point is that Canada's system is no great advantage over our current one.

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I think CR has hit on a very important distinction. My argument is as follows:

(1) The appetite for healthcare is infinite.
(2) No society can appease all healthcare needs and wants and survive.
(3) Therefore, rationing of some sort takes place in every market.

In our society, that rationing takes place in two ways: Either you are uninsured and must decide what you can afford, or you are insured badly, and must decide what level of bureaucratic hell you wish to endure.

Personally, I'd rather see the rationing hashed out in a more public way, but that's just me.

And since most don't see combat, it's a pretty sweet gig. Sure, you got to do the king's bidding for a few years, and it might be a bit unpleasant at times, but then you get the king's shilling...

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Originally Posted by Alexander the Pretty Good

And since most don't see combat, it's a pretty sweet gig. Sure, you got to do the king's bidding for a few years, and it might be a bit unpleasant at times, but then you get the king's shilling...

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Hahahahahahahahahahahaha!

:inhale:

Hahahahahahahahahahahahaha!

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Originally Posted by Meneldil

There's absolutely no valid reason to explain why members of the military have free healthcare and other people don't.

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Yes, there is, as I pointed out above. But it is like that almost everywhere - members of the military of Canada also get extra benefits of that nature.

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Originally Posted by KukriKhan

Hahahahahahahahahahahaha!

:inhale:

Hahahahahahahahahahahahaha!

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Oh come on. I could get an air force job no problem. If you've ducked the PBI, all you have to do is get through boot camp.

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Mechanics still fix the crap we break, medics still fix the people we break, desk jockies still fix our paperwork problems...

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So what's the big deal? You get better healthcare despite being comparable to civilian jobs.

How much better is the pay when you account .mil healthcare and all expenses paid world tours?

I assume that mechanic also gets combat theater bonuses as well?

Not my problem. None of you guys should be in theater because we don't have any reason to be there.

Can't make war without soldiers.

You joined an organization that hasn't made war to defend the United State since 1945.

:shrug:

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Go to Bagdhad some time and ask your average citizen if he's happy to see us pulling out. That answer will almost universally be "No."

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There's a difference between having wanted us to invade in '03 and wanting us to leave now. I'm sure the Iraqis agree whole-heartedly with the "you break it you bought it" line of thinking, as they are currently broken. But I don't know if they'd all say they wanted breaking in the first place.

I'm not saying our intentions are bad, at least on the part of the average servicemen and women. But the road to hell (and apparently financial ruin) are paved with good intentions, not to mention foreign civilians we've delivered high-explosive liberty to.

I'm Canadian but I know a few Americans :p

In one case; friend has absolutely stellar health insurance-has heart attack falls of bike and spends an uncomfortably long time on hot pavement; rushed to hospital, resuscitated, treated for burns; the receiving hospital was not covered by his plan - 3/4 of a million for treatment; fortunately he did get shipped to a hospital under his coverage for recovery.

I shudder to think that that is the "best health care" in the world; how many ppl plan for $750,000 dollar hit? how many can afford it? and this, despite having coverage that costs more than my yearly income! I hope Obama injects some sanity into American Health Care.

Whoa, this is a thread about healthcare, not Iraq, not Bush, not soldiers, except as regards their healthcare. I don't mean to be both a rules geek and a stick-in-the-mud, but the GC-ATPG exchange seems to be wandering far afield.

Just gonna re-state my position:

• The appetite for healthcare is infinite.
• No economy can sustain "full" healthcare for everyone at all stages of their lives.
• Ergo, some sort of rationing is not only inevitable, it's the reality. Everywhere.

So the only real question is "How would you like your triage served, sir?"

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Originally Posted by Lemur

Just gonna re-state my position:

• The appetite for healthcare is infinite.
• No economy can sustain "full" healthcare for everyone at all stages of their lives.
• Ergo, some sort of rationing is not only inevitable, it's the reality. Everywhere.

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This is something that concerns me deeply, especially here in Europe. We have all of these fancy healthcare systems set up, but as more and more people become older, and as our population pyramid inverts more and more, we have less workers paying for more people needing the services. These health and welfare systems already cost a fortune, they already consume large portions of our financial resources. Just how are we going to keep paying for them? Will we go into debt? Will we have to cut services? What is the price that I, or more importantly my descendents are going to end up paying for the continued maintenance of such extravagant systems?

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Originally Posted by Lemur

Just gonna re-state my position:

• The appetite for healthcare is infinite.
• No economy can sustain "full" healthcare for everyone at all stages of their lives.
• Ergo, some sort of rationing is not only inevitable, it's the reality. Everywhere.

So the only real question is "How would you like your triage served, sir?"

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So...

• You agree with the idea of scarcity
• See point one
• Prices are a method of rationing

Excellent! Another free marketer. :yes:

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Originally Posted by Meneldil

There's absolutely no valid reason to explain why members of the military have free healthcare and other people don't.
Breach of equity of the worst kind. Nationalism is definitely stupid.

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There is absolutely a valid reason. It's a benefit provided by the state to help encourage people to sign up for the armed forces. It's essential for a nation to have armed forces, therefore it's essential for the nation to compensate their military well enough to maintain adequate numbers, it's really as simple as that.

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Originally Posted by Lemur

(1) The appetite for healthcare is infinite.
(2) No society can appease all healthcare needs and wants and survive.
(3) Therefore, rationing of some sort takes place in every market.

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The demand for anything is infinite when price is removed as a consideration. As it stands, our health "insurance" makes about as much sense as grocery insurance. Why not let people buy grocery insurance- or better yet, have it provided by their employer. You can go to the grocery store as often as you want and you'll pay the same premium for your insurance no matter what. What do you think would happen to the price of groceries?

What I think we need to do is 1) divorce health insurance from employment. It should be something you can choose based on your personal needs/preferences and it should be something you can continue to purchase regardless of who your employer is- or even if you're employed at all. 2) I think insurance should actually be insurance- against catastrophic events. If I get the sniffles, I should be able to pay out of pocket for a doctor's visit and antibiotics. If I'm in a car wreck and severely injured, insurance should kick in. We could probably engineer some kind of tax credit the goes into something like a health savings account that people could use on non-insurance type expenses. Each year, anything that you haven't spent you can pocket. Give people some real incentives to keep healthcare costs down. :yes:

Do most people even know what a doctor's visit costs? I'm sure people know what their copay is, but do they know or even care what the total cost is?

Immunisation has a benefit for not just the individual, if enough of the population has it a disease can be stopped in its tracks because it can't find vectors to viable hosts. So immunisation of most diseases should be subsidised by the state.

What I think the healthcare system should be aiming for is outcomes. Increase the health of society. Take a more holistic approach. Put more medicos in per dollar and less bureaucrats. Make it harder to sue for accidents and easier to prosecute malicious Drs (less monetary gains and more criminal)... malpractice insurance should go down as it should be harder to sue for accidents. While actual criminal actions should be handled by the state, no vigilante justice by suing.

Allow the state to handle emergency and the private system to handle boob jobs.

Okay.

Not an in-depth study but why does the USA private insurance system cost the gov't more (per capita) than the Canadian gov't insurance system? If you cover less ppl (proportionately) by spending more money, this speaks to a very peculiar transfer of resources. Efficient? How?

No doubt beneficial to some segment of society

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Originally Posted by Papewaio

Allow the state to handle emergency and the private system to handle boob jobs.

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Whilst I agree with this, sadly there's a massive amount of grey between these two cases. Even with these two there's some variance. And it is the case that State would be free?

For example, although most women have boob jobs to, uh, uplift their self image, there are some who have very unequal breasts and this causes significant psycological distress. Then there's post cancer / trauma or even infection.

And if someone is having recurring flare ups of gall stones, it would over time be cheaper to whip it out once and have a 3 day inpatient stay than have attacks every few months requiring far more state resources.

~:smoking:

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Originally Posted by Xiahou

Do most people even know what a doctor's visit costs? I'm sure people know what their copay is, but do they know or even care what the total cost is?

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Based on my experience with my Insurer From Hell, I can tell you what the doctor says the visit costs, what his employer says the visit costs, what my insurer says the visit costs and what I'm told at the paperwork station about its cost. The cool thing is that you get four wildly different answers.

If you think HSAs are the way, with some sort of catastrophic insurance to gild the lily, cheers. How would you address people with chronic illnesses? Pay for treatment until they can't anymore? Then what?

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Originally Posted by Lemur

How would you address people with chronic illnesses? Pay for treatment until they can't anymore? Then what?

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They die. Just like they do anywhere else in the world when they can't afford treatment. OK, often this is for things that are pitifully easy to treat.

Living beyond one's means now can also mean living for too long, unless the burden should just fall on the young exponentially whilst the elderly and infirm have 24 hour care from healthcare professionals plus meds and the rest.

Healthcare economics is an area where hard decisions have to be faced.

~:smoking:

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Originally Posted by rory_20_uk

They die. Just like they do anywhere else in the world when they can't afford treatment. OK, often this is for things that are pitifully easy to treat.

Living beyond one's means now can also mean living for too long, unless the burden should just fall on the young exponentially whilst the elderly and infirm have 24 hour care from healthcare professionals plus meds and the rest.

Healthcare economics is an area where hard decisions have to be faced.

~:smoking:

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Blatantly stated, this is nevertheless the decision facing the US electorate and their rep's.

Exerpt from the link in my earlier post:

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The United States is unique among nations in that it was
originally based upon the value of individual liberty: freedom from
coercion. No individual or government had a presumptive claim to
the property or labor of others.
Liberty requires rights. Rights are a just claim to freedom of
action. The original rights as recorded were “negative” in that they
implied the absence of interference. The only individual obligation
was to refrain from interfering with others. In contrast, positive rights
impose an obligation for someone to do something for others. The
Bill of Rights is a list of negative rights.
A “right to health care” implies that someone has to provide it.
But what of the liberty rights of physicians, nurses, and other medical
workers? Or the property rights of taxpayers and entrepreneurs?
Some rights must be abrogated to meet the demands of a positive
right. President Obama and other politicians who call a professional
service a “right” do not understand the founding principles of the

United States.

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I find it difficult to argue this statement. However, I agree that something needs to be done without driving us into bankruptcy.

Regarding the WHO health performance rankings, I wonder if they polled people's satisfaction with their health care system by asking those that actually use it, the chronically ill or those with debilitating conditions that aren't immediately life threatening but are very painful and affect quality of life. Access to a waiting list is much different than access to health care, and for some health care delayed is health care denied.

In the US the COBRA Laws & EMTALA require that any person who comes to the emergency room must be examined and/or treated regardless of the person's ability to pay.

What if people present to ER with hip pain for example.

An X-ray shows the hip is wrecked. Severe loss of joint space - the bones are basically rubbing on each other.

To treat:

Up the pain meds.
Admit for a joint replacement.

Which one is undertaken?

~:smoking:

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Originally Posted by Papewaio

Immunisation has a benefit for not just the individual, if enough of the population has it a disease can be stopped in its tracks because it can't find vectors to viable hosts. So immunisation of most diseases should be subsidised by the state.

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This principle does not apply to immunisation only.

Society as a whole benefits from a high level of general health, hygiene, prevention and disease control. Like fire prevention and the maintenance of public order, health is a common good, not a private issue.

That's why health care systems with socialized funding compare favourably to health care systems based on private funding. Lemur and Louis already pointed to longevity, infant mortality and related criteria. Only three OECD member states have no universal health care: the US, Turkey and Mexico. On most relevant indicators in the latest comparative OECD study Health at a glance 2007, those three are at the bottom of the table. For a rich country like the US this should be unthinkable, but it is the truth. Infant mortality, age expectancy, mortality from heart disease and stroke, all cancers, low birth weight and infant mortality, you name it - in all instances the US rates well below the OECD average or well below expected outcome based on GDP.

Sorry guys, your system stinks because it is based on private funding. Socialised medicine (also known as state health care) has its drawbacks as shown by the NHS, but that is not the same as socialised funding.

Switch to socialised funding, cut costs, live longer and send your kids to a school where not one in three kids has missing teeth and one in ten has problems due to premature birth, obesity &cetera.

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Originally Posted by Gelatinous Cube

I'll be the first to say that the Army makes someone out of touch with the civilian world. I still get culture shock when I go on leave--and it gets worse every time, especially after Iraq. But to say it's a breach of equity that the Military should offer me outstanding healthcare? :inquisitive:

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Yes, it is. If the military is the only state organization that receive free healthcare, I don't see how you could claim otherwise.

I don't care what's your job, where you'd been fighting and what not. You signed up, for I guess a few reasons. You're doing your job, which involve getting shot at. That's dangerous and brave, but that's what you signed up for.
Having a military is not essential for a nation, it's essential for the US, because of their honestly war-focused foreign policy and their role as a superpower. That doesn't change the fact that a soldier shouldn't have more rights than the average citizen.

That's kind of funny if you think about it. American right-wing people keep claiming universal and free healthcare is crap and would doom their entire country, but when it comes to the army, it's the fair reward for a dangerous job and serving your country. Talk about hypocrisy.

I guess we're kind of getting used to it by now
- "The state shouldn't offer free healthcare. Except for the military"
- "The state shouldn't rule our lives. Except when it comes to abortion and homosexuals"

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Originally Posted by Meneldil

Yes, it is. If the military is the only state organization that receive free healthcare, I don't see how you could claim otherwise.

I don't care what's your job, where you'd been fighting and what not. You signed up, for I guess a few reasons. You're doing your job, which involve getting shot at. That's dangerous and brave, but that's what you signed up for.

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Uh, how is that unequal? Someone working for the IRS may not get the same health care benefits, but that's because of his own career choice - he could have signed up for the military, but decided not to despite the health care.

I suppose one could argue that the military shouldn't pay for medical treatments that have no relation to the work done, but suggesting that getting shot isn't any different from a sprain limb after doing construction work is pretty daft

:balloon2:

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Originally Posted by Meneldil

Having a military is not essential for a nation

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Yes, it is, and if it isn't immediately, it will be.

Yes, it is, and if it isn't immediately, it will be.

Costa Rica seem to have done okay for themselves, and without the expense of an armed forces...

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Originally Posted by LittleGrizzly

Costa Rica seem to have done okay for themselves, and without the expense of an armed forces...

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Fifty years is a paltry amount of time. Eventually they will need a military.

Spoiler Alert, click show to read: 

Ignoring the fact that their police force is fairly powerful and retains some military equipment.

Im not saying never have a military, But tell me what threat should they be worried about requiring the build up of thier military now ?

If the situation changes in 50 years time sure. As things stand they have saved themsleves 50 years of unnessecary expense, and i see them saving themselves another 50 years of unnesecary expense... all to the benefit of Costa Ricans and the dismay of wargamers and military enthusiasts !