The U.S. Health Care Debate

[Louis VI the Fat]

While it gets into very sparse detail, the article makes the system sound promising

The nice people over at the embassy translate lots of stuff for curious Americans.

http://ambafrance-us.org/IMG/pdf_Uni...ustainable.pdf

Not all is rosy, of course. As the questions about sustainability above and the more brief and factual article below show.

France is often seen by liberals as the ideal system. It has universal health care, with few waiting lists. France has the highest level of satisfaction with their health care among all European countries. How can this be? What is their secret?

France provides a basic, universal health insurances through large occupation-based funds. The General National Health Inusrance Scheme covers 83% of French workers, while other occupational specific (e.g.: for agricultural workers, for the self employed, for miners, etc.) cover the remainder. About 99% of individuals are covered by this universal health insurance system.
However, France utilizes more market-based ideas than most people realized. Copayment rates for most services are 10%-40%. About 92% of French residents have complementary private health insurance.

In essence, the French system avoids widespread rationing because, unlike true single-payer systems, it employs market forces. Even the OECD says that the “proportion of the population with private health insurance” and the degree of cost sharing are key determinants of how severe waiting lists will be.
Insured. About 99% of French residents are covered by the national health insurance scheme.
Cost. France is the third most expensive health care system (~11% of GDP).

http://healthcare-economist.com/2008...-world-france/

[Beskar]

The thing about waiting lists is that they need to build more hospitals to meet the demand and also that fact everybody can get healthcare treatment, opposed to people simply not getting any treatment as they can't afford it.

[Adrian II]

Not all is rosy, of course. As the questions about sustainability above and the more brief and factual article below show.

The French system is very expensive and probably unaffordable in the long term. Besides, drug prescription and use in France are insanely (and irresponsibly) high. On the plus side, the availability and 'bedside manner' of French doctors are exemplary and chronic diseases like for instance diabetes are fully covered under the system.

Like I said before, health is a common good just like public order or fire prevention. It only works well if it works for everybody. And the key to a good system is socialised funding, not socialised medicine (or state medicine).

[Strike For The South]

We spend a trillion dollars on various programs and have nothing to really show for it. Quite frankly that's retarded.

What we're doing is not working and anyone who can't see that is either and idoit or an imbecile.

How we fix the problem is a whole nother problem entirely but I think we can start with some common sense solutions.

I agree with Adrian; for everyone or no one. One of our problems is all our bloated programs which hamstring everyone and only cater to a few people who fit a mold that is probably outdated.
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[Lemur]

Let's not forget the bureaucratic overhead incurred by all of these organizations trying to shift the costs off onto each other. Can't find the linkie, but I clearly recall reading that something between 7%–10% of all healthcare costs are created by this shuffle.

I know this: Costs are rising geometrically, and neither the nurses, doctors or patients are seeing that money. Too many parasites.

[ICantSpellDawg]

The French system is very expensive and probably unaffordable in the long term. Besides, drug prescription and use in France are insanely (and irresponsibly) high. On the plus side, the availability and 'bedside manner' of French doctors are exemplary and chronic diseases like for instance diabetes are fully covered under the system.

Like I said before, health is a common good just like public order or fire prevention. It only works well if it works for everybody. And the key to a good system is socialised funding, not socialised medicine (or state medicine).

I agree to some extent. The Common good is best served by individual responsibility and consumer choice. Find a way to make that happen and we may find more common ground.

[Adrian II]

The Common good is best served by individual responsibility and consumer choice.

With all due respect, this thread has advanced beyond slogans. We are talking about the pros and cons of certain systems such as the French one. There is a wealth of English language information about it. So why don't you read up on it and join us?

[Lemur]

The AMA reverses its position. Again.

The new president of the American Medical Association, which represents the interests of the nation’s doctors, said Wednesday the group is open to a government-funded health insurance option for people without coverage.

Dr. J. James Rohack told CNN that the AMA supports an “American model” that includes both “a private system and a public system, working together.”

In May, the AMA told a Senate committee it did not support a government-sponsored public health insurance option.

[Xiahou]

The AMA reverses its position. Again.

The new president of the American Medical Association, which represents the interests of the nation’s doctors, said Wednesday the group is open to a government-funded health insurance option for people without coverage.

Dr. J. James Rohack told CNN that the AMA supports an “American model” that includes both “a private system and a public system, working together.”

In May, the AMA told a Senate committee it did not support a government-sponsored public health insurance option.

I wonder what sort of blackmail that involved?

[Hosakawa Tito]

I've been hearing about this local situation on talk radio for several days now from the health care debate side as well as the "everybody needs a passport, enhanced driver ID" border control side. It's finally been reported in the local paper so I could provide a link.
Thank goodness the Border Patrol does have flexibility in enforcement for these type of emergencies, and hopefully this particular case has a happy ending.

Ontario is Canada's most populous province, and I find it troubling that this type of situation arises as frequently as it does. It receives more press now than in the past because of the need for passports, passport cards or enhanced driver ID's, where in the past all one had to do is verbally declare their residence and move on.

Whatever the outcome of the drive to change the US healthcare system I hope we don't end up with too many situations like this on our side of the border.

[Adrian II]

Whatever the outcome of the drive to change the US healthcare system I hope we don't end up with too many situations like this on our side of the border.

I dont buy your talk radio stuff. Every time I speak to American friends lately, I thank heaven that we don't have your health care system over here. The mere thought that I might develop a cancer or a heart condition and my entire family would go broke because, hey, the insurance company just retracted some clause or cut my entitlement on some technicality... I'd rather die without treatment than see my family go bankrupt and end up in the gutter. The New York Times had some harrowing stories yesterday, and there must be many millions, judging by the figures. A friend of mine in New York just lost his job and insurance, then lost his leg in an accident. Since he had a small melanoma that was removed twenty years ago, no US insurance company will admit him for a decent premium.

What does your talk radio say about people like him?

EDIT

Another beauty here: six out of ten Americans skip or delay health care for financial reasons.

Apreil 2009 - The April Kaiser Health Tracking Poll finds that six in ten Americans continues to say that they or a member of their household have delayed or skipped health care in the past year. A solid majority of the public believes health care reform is more important than ever because of current economic problems.

The country’s overall economic problems have not dampened their interest in pursuing health care reform: a solid majority of the public (59%) believes health care reform is more important than ever compared with the thirty-seven percent who say we can’t afford health reform because of economic problems.

The most common actions taken due to costs were substituting home remedies or over-the-counter drugs for doctors visits (42%) and skipping dental care or check ups (36%). Additionally, three in ten (29%) did not fill a prescription for medicine and two in ten (18%) cut pills in half or skipped doses.

And what do you think will happen in the majority of these cases? The health issues will pop up in worse form and require much more expensive treatment. Way to go, guys.

I wonder how many people in the US are calculating right now: shall I get that essential treatment this year and sell my home to pay for it, or shall I die and let my family inherit the home?

[Lemur]

Wal-Mart comes down in favor of the Obama plan, whatever it turns out to be. Interesting.

[Xiahou]

Wal-Mart comes down in favor of the Obama plan, whatever it turns out to be. Interesting.

Sounds like they're betting on it not happening and trying to ride a good PR wave in the mean time....

"We are entering a critical time where those of us who will be asked to pay for health care reform will have to make a choice on whether to support this legislation. The choice will require employers to consider the trade off of a coverage mandate and higher taxes for the promise of a reduction in health care cost increases. We also believe that a mandate must be accompanied by provisions that will reduce health costs and dramatically improve the value we get for our health care dollar.

"And the promise of savings in the bill must be more than just words. The bill should contain 'trigger' provisions that guarantee that promised savings take place both for the federal government and for employers who provide insurance. Walmart believes that if we support a mandate and are being asked to pay higher taxes, we should be assured in return, that savings will be real."

[Crazed Rabbit]

Wal-Mart comes down in favor of the Obama plan, whatever it turns out to be. Interesting.

What a fabulous way to get rid of all your small-store competitors with the extra government costs and regulations.

CR

[rory_20_uk]

What a fabulous way to get rid of all your small-store competitors with the extra government costs and regulations.

CR

"But the mandate doesn't require small businesses to provide health insurance"

The article even states this. Talk about a knee jerk response...

[Major Robert Dump]

Sounds like they're betting on it not happening and trying to ride a good PR wave in the mean time....

No, they hope it will cause the other retailers to go broke, since they already offer more insurance than most retail companies and for all intents halfway there when it comes to the Obama plan and all the others will have to play catch-up. It's the Wal-Mart way.

[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

[Crazed Rabbit]

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.

Gee, almost sounds like a failure of the system.

"But the mandate doesn't require small businesses to provide health insurance"

The article even states this. Talk about a knee jerk response...

Well, not now. And just how small is small? 10 employees, 50, 100?

Any way, it's going to hurt their smaller competitors. Like regional chains that liberals in the US are always whining are getting driven out of business by Walmart. And then said idiots demand a slew of more regulations that will hamper the smaller stores more than Walmart.

CR

[ICantSpellDawg]

I think that we can all agree that healthcare in the US is broken and needs to be reformed. Very few people don't believe that there is a major problem with our system. As I don't see health-care as a God provided right, but rather a recent man-made privelage, I expect that there would be problems with a modern system that would cover 300 million people without stealing from the wealthy to pay for people who don't care enough to provide for themselves or their families.

We all agree, but where some of us are open to keeping the problems going - but stealing a rich man's wallet to pay for the system, others recognize that the underlying problems need to be resolved before "who is paying" will matter in the long term.

We don't know what we are paying for. Simply using someone elses money to pay for it as a solution is just adding to the the inequity and long term unsustainability of the system. Lets resolve the issues that can be resolved in short order. Once this happens, we can leave it up to the States like we leave auto and home insurance etc; some have State backed options, others don't.

We are starting to rely on hairbrained, massive, unread, partisan, treatises as legislation. Peoples hired hands don't even read the bills anymore. We are spending more money on things that we understand less in the hopes of solving problems.

[Crazed Rabbit]

In the UK, some people are suggesting a fee for visiting the doctor:

The Social Market Foundation said the only way for the NHS to cope was to raise taxes to put more money into the system, limit demand or work more effectively.

The NHS is already looking to make savings and the think-tank said there was little appetite for tax rises.

Instead, they said charging for GPs would be a good way to reduce demand.

Report author David Furness said: "It would get people thinking twice about whether the visit was essential.

"If we don't introduce rationing like this, there will be rationing by stealth through waiting lists, crumbling hospitals and poor quality services."

CR

[Lemur]

The truth, which I've never seen any politician admit, is that rationing of some sort is not only inevitable, it's already in place. Everywhere. The only question is how do you implement it.

[Xiahou]

The truth, which I've never seen any politician admit, is that rationing of some sort is not only inevitable, it's already in place. Everywhere. The only question is how do you implement it.

If I can buy as much of something as I can afford, it's not rationing... or am I missing your meaning?

Edit:
Unsurprisingly, the current Democrat proposal is basically a turd.

Though President Obama and Democratic leaders have repeatedly pledged to alter the soaring trajectory -- or cost curve -- of federal health spending, the proposals so far would not meet that goal, Elmendorf said, noting, "The curve is being raised." His remarks suggested that rather than averting a looming fiscal crisis, the measures could make the nation's bleak budget outlook even worse.

That completely undercuts the administration's argument for hurriedly ramming this bill through Congress. According to the CBO, the cost of doing nothing would indeed be cheaper than rushing through the current proposals- not the other way around, as has been suggested.

If we're going to do this, can we at least take some time and try to put a little thought into it? How many times are artificial deadlines and threats of impending doom going to be used to rush bills through Congress (often before they can even be read)?

[Lemur]

If I can buy as much of something as I can afford, it's not rationing... or am I missing your meaning?

Unless you are independently wealthy and wish to blow your fortune on medical treatment, your healthcare choices are rationed by your insurance company.

According to the CBO, the cost of doing nothing would indeed be cheaper than rushing through the current proposals- not the other way around, as has been suggested.

If we're going to do this, can we at least take some time and try to put a little thought into it?

Sounds good to me. Where are the experts, the visionaries, the eggheads who can really examine this problem? Shouldn't there be blue-ribbon commissions or something, or are we already past that? Rushed, sloppy reform sounds worse than no reform at all.

As broken and untenable as I think our current system is, I despair of the congresscritters improving on it.

[Hosakawa Tito]

[QUOTE=Lemur;2292688]Unless you are independently wealthy and wish to blow your fortune on medical treatment, your healthcare choices are rationed by your insurance company.


Sounds good to me. Where are the experts, the visionaries, the eggheads who can really examine this problem? Shouldn't there be blue-ribbon commissions or something, or are we already past that? Rushed, sloppy reform sounds worse than no reform at all.

As broken and untenable as I think our current system is, I despair of the congresscritters improving on it.[/QUOTE]

The best way to achieve that is to demand the congresscitters to be in it. same with their pension plan & cola's.

[ICantSpellDawg]

Unless you are independently wealthy and wish to blow your fortune on medical treatment, your healthcare choices are rationed by your insurance company.


Sounds good to me. Where are the experts, the visionaries, the eggheads who can really examine this problem? Shouldn't there be blue-ribbon commissions or something, or are we already past that? Rushed, sloppy reform sounds worse than no reform at all.

As broken and untenable as I think our current system is, I despair of the congresscritters improving on it.

I've never had my treatment "rationed". I spend around $800 a month (Plan, Meds, co-pays, etc) and get whatever I need. I get numerous procedures every year. Empire blue Cross has been pretty good. I'm worried because I can't pay more than $800 per month and the rate of increase is faster than I am earning by a mile.

Health Care is broken partially because of adverse selection in the private system, partially because there is a veil over the prices that have an indirect but eventual impact on premium.

The system is broken because the care is becoming too expensive for anyone to afford. There is no magic bullet to solve this. Make a government plan and you've gotten rid of adverse selection, but they have no intention of increasing transparency, which will just mean that in a few years we have an even more broken government plan.

[Lemur]

A coherent political analysis from Klein:

There are problems with the Democrats' approach to health care. It places too much of a burden on employers. The House bill is quite deficient when it comes to changing the incentives for doctors and hospitals (which is the only real hope for controlling costs). But the Republicans have absolutely no credibility on this issue. Indeed, they have spent 30 years allowing the current system to deteriorate or actively making it worse (caving to Pharma on the Medicare drug plan, for example).

This is the moment for the Democrats to demonstrate that they can lead and legislate. If they can't bring this off, they will--rightly--be back in electoral trouble before long.

[KukriKhan]

So. Just watched POTUS's Kabuki press conference, where he said that Doc's over-prescribe drugs and treatment based on compensation schedules, and that Big Pharma overcharges by 50%, based on their recent cave-in to reduce drug costs. Oh, and suggested that a blue-ribbon panel of unelected, administration-appointed medical experts outta decide what treatment should be provided to what patient, and that he, being POTUS, would not reduce his personal medical plan to a level commensurate with that of an "average" American. And that the reason for the big hurry is that if you don't set deadlines "in this town (DC)", things never get done.

Since the bills are still being crafted in congressional commitees and aren't even on the floor for vote (and therefore details are still speculative and negotiable) I can only regard this media event as not directed at me at all, but rather to the congresscritters.

Q: Do we (citizens and taxpayers) pay for this network coverage? I watched it on C-Span, which I pay for on my cableTV bill.

Maybe a day will come when a POTUS will have a press conference where mid-question by Helen, POTUS will say "And by the way, have you made a will yet? Go to LegalDocuments.com for a cheap, state-recognized document. Meanwhile, Helen, as to Iran....".

Q: Did POTUS O sell health care reform to the citizens?

[Crazed Rabbit]

My dad heard about one provision where, after age 65 and every five years thereafter, you'd have to meet some government appointee and get counseling or something on your health. Needless to say, he is not pleased with that kind of crap.

Oh, and suggested that a blue-ribbon panel of unelected, administration-appointed medical experts outta decide what treatment should be provided to what patient

More stupid government enforced decisions, here we come!

One problem is states deciding what has to be included in health insurance plans, taking choices away from the consumer, and forbidding (IIRC) people to buy health insurance from companies in other states. And rules limiting how much more companies can charge unhealthy lifestyle people. Because giving people choices about what they want to buy and letting there be incentives to be healthy is much too rational for the dems!

CR