The U.S. Health Care Debate

[ICantSpellDawg]

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.

[ICantSpellDawg]

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?"

[Lemur]

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

[Husar]

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.

[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.

[KukriKhan]

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.

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".

[Seamus Fermanagh]

...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.....

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.

[rory_20_uk]

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

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.

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.

[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?

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

[KukriKhan]

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?

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

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.

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

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.

[Lemur]

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

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."

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

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.

[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.

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

[Alexander the Pretty Good]

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.

[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)

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.

[Evil_Maniac From Mars]

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

and I think Cuba is second.

[Alexander the Pretty Good]

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.

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...

[Crazed Rabbit]

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

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

[Melvish]

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

It use to be in the 70's and 80's (good old days: no waiting time & all drugs are covered) but in the last 2 decades it came crashing down because of all of the abuse the system had taken. Irresponsible change by the governments (like the flawed Private&Public partnership) and ... how to say this without sounding too xenophobic : lots of peoples came to Canada, get welfare while they stayed then get threaded for free then move away to a sunnier country or stay and 'enjoy' a life on welfare (the money is waisted on them because they don't pay taxes). There is also lack of doctors: get free education then leave the country and make big buck and enjoy easier work down south. Sometime i think we should do like the military: we pay your education but you have to give X years of service to the community in return (of course peoples who pay for their education are free to go where-ever they wish).

[Banquo's Ghost]

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.

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.

[Philippus Flavius Homovallumus]

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.

[Marshal Murat]

Talk about starting a bombshell, eh? I figure since Congress has adjourned for the summer, we can take a look back at what they've done concerning Healthcare. To my knowledge, the current legislation has passed through the House committee concerning it, but lying in wait until Congress re-convenes.

I'm not going to pretend that I know much about Healthcare reform, because I don't. I especially don't know or understand anything that's happening concerning the current bill (which is causing some frustration amongst voters) and I figure I'm more lost than most because I haven't had to worry about health insurance. So I figure I'll get some education.

SO, what I want to get from y'all is

1. What exactly is the current Congress Healthcare Bill doing for Americans? What are the parts of the Bill?

2. I know Switzerland has a pretty sweet system, what makes that system "sweet"? Conversely, what makes the American system "bad" or "broken"?

[rory_20_uk]

Here is a link to a page that has a good number of articles looking at healthcare in different ways. Of course they've got an agenda, but that is mainly "see how bright we are! Hire us to sort it out" so in the way you're looking at it they're pretty neutral.

[Banquo's Ghost]

I have merged this new thread with the existing one.

[Marshal Murat]

Thank you BQ

[Lemur]

The status quo rocks!

Our six-month-old daughter cost over $22,000.

You’d think, with a number like that, we must have used fertility treatments—but she was conceived naturally. You’d think we went through an adoption agency—but she is a biological child. So surely, we were uninsured.

Nope. Birthing our daughter was so expensive precisely because we were insured, on the individual market. Our insurer, CareFirst BlueCross BlueShield, sold us exactly the type of flawed policy—riddled with holes and exceptions—that the health care reform bills in Congress should try to do away with. The “maternity” coverage we purchased didn’t cover my labor, delivery, or hospital stay. It was a sham. And so we spent the first months of her life getting the kind of hospital bills and increasingly aggressive calls from hospital administrators that I once believed were only possible without insurance.

[Ariovistus Maximus]

So, I'm no economist, but I think that Universal Health Care would be easy to exploit.

I'd be glad to hear from supporters of the system as to whether or not my issues are realistic:

1. There would be a tendency for people seriosly needing care to be overlooked or forced to wait.

I would cite in examples Canada, where some patients have died while on the waiting list for major operations, and England, where there is a law that patients cannot be in the waiting room for longer than 4 hours, and as a result sometimes patients have to be left in the ambulance they arrived on.

(These could be rumors as I am not especially tuned in to Canada or the UK.)

2. There could be a tendency for people who really don't need aid to skim off the system. The idea being similar to wellfare, where people who could easily go out and get jobs apply for wellfare simply because it's easier.

Thus, couldn't the system be flooded with moochers and slobs, thereby wasting resources and denying aid to those who really need it?

I mean, look at any such program in the world. If you offer it as FREE, there will be a lot of people who ordinarily wouldn't be interested in it, but just come because it's free and they want to make a buck or because they're lazy.

3. It would not be hard at all for the system to be used as almost a weapon against opposition.

"You don't agree with my policies? Fine! I'll put you on the waiting list for a kydney transplant until you croak. Problem solved."

And it wouldn't have to be some kind of high-level conspiracy either. Supporters of the current administration just happen to be higher on the list by and large...

4. Obviosly it's a considerable amount of money to spend, especially considering the success of other recent measures...

5. In any kind of organization, a thing will become more awkward and sluggish as it becomes larger and more complicated. This would tie in with #1.

As a thing grows larger, there is less time and less resources available to pay as great of attention to detail. The best you can do is compartmentalize it, but it still isn't as efficient.

As in business. A great big corporation simply doesn't have the diversity and flexibility of several small companies. In short, it's like putting all your eggs into one basket.

So why are we in a big rush to put the whole system under one management? Sure, it can regulate easier, and perhaps you would avoid some problems that way, but you would also become less effective in general.

Beauracracy tends to become sluggish as it grows, you know? Look at any other government agency? They often become downright sloppy. Do we really want health care like that, or do we think "Oh, it will work THIS time (even though it hasn't worked before)."

Take schools, for instance. Does anybody want to take the side that public schools are turning out really fine students these days, and that any public school kid is better off than in private school?

[Ironside]

So, I'm no economist, but I think that Universal Health Care would be easy to exploit.

I'd be glad to hear from supporters of the system as to whether or not my issues are realistic:

1. There would be a tendency for people seriosly needing care to be overlooked or forced to wait.

I would cite in examples Canada, where some patients have died while on the waiting list for major operations, and England, where there is a law that patients cannot be in the waiting room for longer than 4 hours, and as a result sometimes patients have to be left in the ambulance they arrived on.

(These could be rumors as I am not especially tuned in to Canada or the UK.)

Long waiting lists are a problem, but all systems have flaws. Your currently one is rather the opposite of an exception, as you rank low on many indirect measurements for health care quality (child mortality, life expectancy etc). Never heard about that ambulance thingy (not from Canada or UK though)

2. There could be a tendency for people who really don't need aid to skim off the system. The idea being similar to wellfare, where people who could easily go out and get jobs apply for wellfare simply because it's easier.

Thus, couldn't the system be flooded with moochers and slobs, thereby wasting resources and denying aid to those who really need it?

I mean, look at any such program in the world. If you offer it as FREE, there will be a lot of people who ordinarily wouldn't be interested in it, but just come because it's free and they want to make a buck or because they're lazy.

Here it's a lot of nominal fees, partially to cut down, partially because most patients aren't particaullary sick. Wisiting the doctor cost about 10-15 dollars. We also have a "high cost protection", making the highest yearly sum you possibly pay about 870 dollars (divided into 4 different posts, that is hospital care and doctor visits, pharmacies, medical equipment at home and sick travels), no matter how sick you are.

Besides, healthcare is oddly enough something healthy people don't usually abuse.

3. It would not be hard at all for the system to be used as almost a weapon against opposition.

"You don't agree with my policies? Fine! I'll put you on the waiting list for a kydney transplant until you croak. Problem solved."

And it wouldn't have to be some kind of high-level conspiracy either. Supporters of the current administration just happen to be higher on the list by and large...

Well, except from if media would even hint about something like this, the scandal would be bad enough to bring down a political party (as it's the equvivalent to murder of political opponents), unless you know for certain your doctor's political alignment the doctor could do it today.

Besides, anybody important enough for it to be viable are usually rich and/or gotten media attention.

4. Obviosly it's a considerable amount of money to spend, especially considering the success of other recent measures...

Tricky one. By taxes probably yes, by the total money in your wallet probably no, unless it a huge failure. You got the most expensive health care in the world atm. And it doesn't pay the bang for the buck.

5. In any kind of organization, a thing will become more awkward and sluggish as it becomes larger and more complicated. This would tie in with #1.

As a thing grows larger, there is less time and less resources available to pay as great of attention to detail. The best you can do is compartmentalize it, but it still isn't as efficient.

As in business. A great big corporation simply doesn't have the diversity and flexibility of several small companies. In short, it's like putting all your eggs into one basket.

So why are we in a big rush to put the whole system under one management? Sure, it can regulate easier, and perhaps you would avoid some problems that way, but you would also become less effective in general.

As mentioned, you already get very little bang for your bucks. And while a larger organization is more rigid, it can also reap benefits of it's size. Less paralell jobs and easier for regulating oversite for example, something more important in health care than in the normal market.
Evidently, companies prefers to fusion sometimes and somehow I suspect that it is not to be less efficient and thus less profitable.

[Ariovistus Maximus]

Long waiting lists are a problem, but all systems have flaws. Your currently one is rather the opposite of an exception, as you rank low on many indirect measurements for health care quality (child mortality, life expectancy etc). Never heard about that ambulance thingy (not from Canada or UK though)

True; so I guess it's about whether we want a flawed governmental system or a flawed private system.

Besides, healthcare is oddly enough something healthy people don't usually abuse.

Yes, that makes sense. Mooching meds is perhaps not so lucrative as wellfare.

Well, except from if media would even hint about something like this, the scandal would be bad enough to bring down a political party (as it's the equvivalent to murder of political opponents), unless you know for certain your doctor's political alignment the doctor could do it today.

Besides, anybody important enough for it to be viable are usually rich and/or gotten media attention.

True enough, but keep in mind that we're talking about a permanent system.

Thus, the health care plan might work under one administration, but could be easily turned around by the next.

Tricky one. By taxes probably yes, by the total money in your wallet probably no, unless it a huge failure. You got the most expensive health care in the world atm. And it doesn't pay the bang for the buck.

And the problem is, not only might the ideal Socialised Medicine program be rather expensive, but who knows what kind of madness we'll actually get???

I don't think anyone (in a healthy state of mind) is under the illusion that our legislative body is composed of saints by any means.

[Ironside]

Yes, that makes sense. Mooching meds is perhaps not so lucrative as wellfare.

Mooching meds would require that you got a doctor who's very generous with his prescriptions and an actual selling market. If medical drugs are fairly cheap, why buy them black?

True enough, but keep in mind that we're talking about a permanent system.

Thus, the health care plan might work under one administration, but could be easily turned around by the next.

Considering how stiff the resistance is for this one, I would hardly call it easy to turn around.

And the problem is, not only might the ideal Socialised Medicine program be rather expensive, but who knows what kind of madness we'll actually get???

I don't think anyone (in a healthy state of mind) is under the illusion that our legislative body is composed of saints by any means.

Comparing what the US pays in health care costs (about 15% of the GDP) compared what the rest of the western world pays (about 10%), you have a pretty good shot of firing them all on grounds of incompetence if they fail to get it cheaper. They do have a considerble margin to play around with.

[Centurion1]

But our current health care bill includes social security which is possibly the worst run organization in the history of mankind