The U.S. Health Care Debate

[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.

[Husar]

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.

Why do you hate freedom?

[Beskar]

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)

[Alexander the Pretty Good]

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

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.

[Alexander the Pretty Good]

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.

Like welfare with more collateral damage.

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

[Alexander the Pretty Good]

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.

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...

[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...

[KukriKhan]

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...

Hahahahahahahahahahahaha!

:inhale:

Hahahahahahahahahahahahaha!

[Alexander the Pretty Good]

Hahahahahahahahahahahaha!

:inhale:

Hahahahahahahahahahahahaha!

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.

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

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

[Louis VI the Fat]

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

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.

[Evil_Maniac From Mars]

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

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.

[Xiahou]

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.

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.

(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.

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.

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?

[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.

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.

[rory_20_uk]

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

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.

[Papewaio]

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.

Essentially if it is elective and not health related (health including psychological as mentioned) then it should be paid by the individual. I would include gall stones within the non-elective state funded side of the equation. If a patient wants there own Dr or single room then that is a user pays (private health) add on.

[Louis VI the Fat]

Bankruptcy, social Darwinism, and the War on the American Middle Class:

NIGHTMARES OF AMERICAN MEDICAL#CARE

As someone who has lived roughly half my life in the United States and half in Canada, and as an economist by profession, I think I can provide a vivid sketch of American healthcare.

There actually is no system.
There is private health insurance for most middle-class people, and the tradition, not a requirement, is that this is paid by your employer as an employee benefit.
Since there are about 1,500 insurance companies looking for this business, the nature and quality of the policies vary immensely.

For a privileged cut of the population – those working for the government and large corporations and legislators – the benefits are very good, and they get excellent medical care.

As you may imagine, the quality and quantity of the benefits goes down as you move down the prestige scale. For a more typical office worker, there will usually be many limits on the policy. Examples: an annual $1500 deductible; a 15-20% deductible for each procedure; and, in some cases, coverage that is as low as 60% of costs.

This is why health care is the single largest cause of personal bankruptcy in the U.S. Inflation in fees and costs by the health-providing industry means that a single-day as an outpatient with some relatively minor procedure – has a full cost on the order of $7,000 when all the bills are in.

Spoiler Alert, click show to read: 

I say ‘when all the bills are in’ because the patient for weeks after the procedure will receive bills: from each doctor, from the anesthetist, from the hospital, from laboratories, from the ambulance company, etc. There will be items on your bill, on a long computer list, like $150 for the use of a scissors or $10 for some aspirins in a cup.

Under some insurance policies, you pay and are later reimbursed. This can still cause a cash crunch where the bills are high. Under other policies, the bill you receive will be for the residual after separate billing to your insurance.
In any case, if you do not pay the balance fairly promptly, your file will be turned over to a collection agency who will then hound you daily for the money.
There are invariably disagreements with the insurance company over specifics. You usually have an 800-number where you will often wait a long time to talk to call center about the issue. Because of the complexity of the terms of a given policy, you will have to be well-informed even to discuss your point.
On some policies, even pretty decent ones, you are required to call an 800-number before going to the emergency room to get the insurance companies permission for what you are doing. Otherwise, you will pay the emergency-room bill yourself.

But even for pretty good insurances, typically policies have lifetime limits on benefits. If you are struck with something really seriously expensive, you will reach the end of your benefits.
Note the fact that very good to excellent coverage for upper-middle class and government people effectively silences those who would be active in changing the system.

This is a key reason why the healthcare chaos never becomes a burning political issue. It also provides a lever to be used if someone, as the Clintons did, wants to reform things. Upper middle-class people were directly appealed to, being told in a barrage of ads that the excellent level of their care would be reduced, a very effective ploy.

For many of the privately insured however, benefits range from mediocre to terrible. America has more than forty million with no benefits, but a statistic never given, and more important, is the huge number of under-insured.
Note that you can approach some companies to buy your own insurance if your employer provides none. Because you are not part of pool in these circumstances, your fees will be very high. The benefits are also likely to be poor to mediocre.

The industrial sector of the U.S. has badly declined for decades, and with its decline the opportunity for decent, employer-paid insurance for most working people. The growth sector of the economy is services, and these places typically offer poor or no insurance. Of course, many of these are the infamous McJobs.
People in non-union factory or middling office jobs or much of the service industry get benefits so limited that a serious event can throw them into bankruptcy. This is how the policies, where they are available, are priced low enough for such employers to afford.

There are many other disturbing elements in this national healthcare chaos.
For example, your private health records are in the hands of private insurance companies, and this is marketing information in which they trade for profit.
It is possible for your private health-care information to disqualify you from employment somewhere else.
People with better policies hang desperately on to their jobs for fear of losing coverage in middle-age, just when you most need it.
Morality enters American health care, as some private companies will not cover procedures such as abortion.

You may have a policy with which you are quite satisfied, but for some reason, usually cost-cutting, your employer may change insurers suddenly. You will be faced with a whole new set of qualifiers, requirements, 800-numbers, deductibles, and limits. And this can happen a number of times in your career, and it is very unsettling.

Companies deeply concerned about costs will gradually work their way down from excellent policies to mediocre ones. You must adjust accordingly.
There are hundreds off details not possible to cover outside of a major essay. As an example, not many years ago, if you lost your job, you, in most cases, immediately lost your insurance. Too bad if you or your child had chronic needs. Now, there is a time-limited bridging mechanism – for which you must apply, fill out forms, and pay – that allows you to be insured until you secure your new job with new insurance.

The chaos includes often-impoverished county hospital emergency wards for the really poor. These will still try getting some degree of payment out of you according to your means. In general, the care in such places is poor. There is the Veterans’ Administration system for qualified ex-soldiers. There is Medicare for retired Americans, a system whose benefits are completely inadequate to modern needs. If you retire without a supplemental insurance – either paid by your past employer in a good job or by yourself in other cases – you may face serious problems.

There is the Medicaid system for poor Americans. It is an extremely complex system, and the extent and nature of benefits vary considerably from state to state. If you move from one state to another you can lose coverage for the services you were using before. Again, depending on the state, you may be required to make co-payments for services. You really do have to be needy to qualify for benefits, and your means are examined in detail. For some Medicaid services, officials are entitled to recover expenses from a beneficiary’s estate.
Private hospitals in the U.S. – generally the best but not always – are in various jurisdictions required to take a certain quota of non-insured patients. This quota is never generous. The cost of this effectively gets dumped onto the insured, increasing the cost of insurance.

This also leads to some bizarre results. Suppose you are an uninsured person picked up on the street by an ambulance after an accident. The ambulance will be calling ahead to the nearest hospital to see whether they can take another uninsured. If the answer is no, another hospital is called. This continues until there is a taker, however, by that time, you may expire in the ambulance, a not uncommon event.
Imagine the horrors as an uninsured person, whether a citizen or a visitor from abroad, of getting mugged in the United States? First, there is the horror of the mugging or rape or assault, and then the horrors of dealing with the Medical Kremlin.

This brief review gives you a realistic sketch of healthcare in America. If you are young and healthy, you need not be overly concerned. Of course, it is precisely the pool of young and healthy people that insurers love, because their employers pay but the employees don’t use many benefits. That is why institutions like the high-tech industry or huge multi-national corporations have such good policies. They get used comparatively little.

Note the fact that very good to excellent coverage for upper-middle class and government people effectively silences those who would be active in changing the system.

This is a key reason why the healthcare chaos never becomes a burning political issue. It also provides a lever to be used if someone, as the Clintons did, wants to reform things. Upper middle-class people were directly appealed to, being told in a barrage of ads that the excellent level of their care would be reduced, a very effective ploy.


The entire ‘system’ segments the population into many different pools, from low risk with excellent benefits to high risk with terrible benefits. It truly is medical Social Darwinism, organized by lawyers and financiers.

link

[Louis VI the Fat]

Do you dislike socialised healthcare? Do you insist on individual freedom? Then don't take your cue from socialist countries like Canada and the UK. There are other options:

An understanding of how France came to its healthcare system would be instructive in any renewed debate in the United States.

That's because the French share Americans' distaste for restrictions on patient choice and they insist on autonomous private practitioners rather than a British-style national health service, which the French dismiss as "socialized medicine."

link

[Adrian II]

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.

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.

[HopAlongBunny]

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

[Lemur]

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?

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?

[rory_20_uk]

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

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.

[KukriKhan]

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.

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

[Hosakawa Tito]

Exerpt from the link in my earlier post:

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.

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.

[rory_20_uk]

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?

[Meneldil]

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?

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"

[Kralizec]

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.

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

[Evil_Maniac From Mars]

Having a military is not essential for a nation

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

[LittleGrizzly]

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...

[Evil_Maniac From Mars]

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

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.

[LittleGrizzly]

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 !