The U.S. Health Care Debate

[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...

[rory_20_uk]

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?



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

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.

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

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.

[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).

[Evil_Maniac From Mars]

Irresponsible change by the governments (like the flawed Private&Public partnership)

If I recall correctly, Alberta, which uses a partnership similar to this, is one of the better provinces in Canada for healthcare.

[Melvish]

If I recall correctly, Alberta, which uses a partnership similar to this, is one of the better provinces in Canada for healthcare.

Yes they fixed the biggest flaws by using strong regulations.
One of the flaw i was making allusion is like : private clinics giving higher priority for botox injection than cancer screening test because the former net bigger profit.

The biggest problem we face now is that a vast proportion of doctor leave Canada, so the waiting time are very long and finding a family doctor is near impossible.

585 doctors departed in one year

[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.