Universal Health Coverage

[ecoli]

How about the guy who works every single day from age 18 to 64, averaging $50,000 a year, till on his 65th birthday, when he is all set to retire, made in the shade, he keels over and croaks.

 

That's $145,700, up in smoke!

That's the inherent risk of buying any insurance.

[Mr Skeptic]

That's the inherent risk of buying any insurance.

 

But a retirement plan isn't insurance!

[Realitycheck]

But a retirement plan isn't insurance!

 

Actually, it technically is.

 

Federal Insurance Contributions Act (FICA) tax

[Realitycheck]

McCain proposes a dollar for dollar tax credit for health insurance, side-stepping the 2% of AGI itemized deduction, for those who even qualify by itemizing. Quite a massive proposition, if you ask me.

 

http://online.wsj.com/article/SB122506862956370705.html?mod=googlenews_wsj

 

I can't believe that they have not had it this way all of this time. That is unthinkable. To think, that the motives behind Self-Employment Pension deductions and IRA deductions and Moving Expenses deductions have been valued higher than health insurance to help keep you alive and productive for all this time. It is really unthinkable.

Edited October 28, 2008 by agentchange
multiple post merged

[Mr Skeptic]

But a retirement plan isn't insurance!

Actually, it technically is.

 

Federal Insurance Contributions Act (FICA) tax

 

Oh, I get it now. It is insurance against not dying.

[Realitycheck]

Some insight from another board.

 

Also, there are economies of scale:

Running costs for NHS this year: aprox £62 million. That is, around £1000 (slightly under $2000) per person, per year

(All figures from Wikipedia unless otherwise noted)

 

Amount spent on private health insurance by US citizens: aprox. $2.3 trillion

Medicare/Medicaid budget for this fiscal year: $558.1 billion

Combined total: aprox. $2.86 trillion

Number of uninsured Americans: 46.6 million, 15.9% of population (2005, from cbpp.org)

 

Aproximate cost to cover all Americans under NHS model (not counting set-up costs): aprox $600 billion

Aprox cost to cover all Americans under French model (generally accepted as world's best, not counting set-up costs): aprox $900 billion

Number of British and French citizens without health cover: 0

 

Funds spent on administration by private insurers: average 20-30%

Admin costs for NHS (fiscal year 1999/2000): 6.1% (including pensions and benefits)

 

Things not covered by NHS

Elective abortions (the NHS covers those considered medically or psychologically necessary)

Framces for eyeglasses beyond the purely functional (used to be disgusting but are now quite fetching)

Dentistry (oversight)

 

Out-of-pocket expenses under NHS

£7 fee for each prescription filled as a contribution to drug cost (the young, old and poor are exempt)

The occasional over-the-counter bottle of asprin, antacids, etc (you could get that from your doctor but why bother?)

 

Difference in quality of care is minimal. Two differences that are apparent to anyone who's used both is that the NHS uses mostly generic drugs (to keep costs down) and NHS hospitals tend toward functionally spartan rather than luxurious (again, to keep costs down).

[ParanoiA]

But how many who have actually used both the NHS and the American system, then prefer the NHS? Severian does not have good things to say about NHS, and nobody has responsed to this.

 

Reminds me of republicans blinding themselves with the terror delusion. If it's a good system, then by all means, defend it. Let's hear how his experience was unique and how his comparisons are invalid. He claimed to have utilized several different Healthcare systems, the NHS being the worst.

 

I'm primed to hear a good American centralized healthcare plan, but I have ZERO interest in duplicating anyone else's on the planet. Just trading one set of problems for another is not a solution. That just makes the cost look nice. People are more important than costs. Human beings deserve the best, even if it costs double in comparison to other systems.

[Mr Skeptic]

Health insurance just seems like one of the things that the free market might not provide particularly well. If you consider that the insurance companies are for profit, they benefit from screwing you over as much as they are allowed (by law and consumer backlash). It is to their advantage to appear deceptively good.

 

Another thing they do is spend a lot of money figuring out who has a higher risk of what. While this is important if we are to charge the unhealthy more for being unhealthy, if people are guaranteed to get treatment when absolutely necessary, it turns out to be wasted since some people cannot afford, choose not to get, or are rejected for, health insurance. In any case, the money spent to determine who has higher risk is money that does not go to actual care, only to distributing the costs more fairly. However, it might turn out to be less fair but cheaper for the government to ignore different people's risks and just give them treatment.

[npts2020]

C'mon now its taken many years of tuff negotiating to get the "deal" we now have in America. All those who think American health care doesn't cost too much raise your hands.

[iNow]

I'm primed to hear a good American centralized healthcare plan, but I have ZERO interest in duplicating anyone else's on the planet.

 

Why the desire to re-invent the wheel? If someone has found something which works, or which works better than what we currently have, why not use it ourselves?

[Riogho]

I refuse to vote for Obama because of this issue. He was asked if every american should have health coverage, and he said 'yes, healthcare is a right to every american'.

 

Health care has never been, and never should be, a right.

 

Freedom of Assembly

Freedom to Bear Arms

Freedom of Speech

Freedom of Press

Freedom of Religion

 

 

Those are basic human rights because they are what makes you, you. And they are FREE.

 

The minute a 'right' costs someone else something, it is not a right. If you can't do it for yourself, than you don't deserve it. We need to keep what is ours, earn what is ours, and stop asking for what is someone elses.

[iNow]

Part of me wonders how your views will change if you or a loved one ever gets extremely sick and can't afford treatment.

[Riogho]

My family is in 250,000 dollars of debt due to a scolliosis surgery that was performed on my sister. That is more than our house is worth.

 

Just because it completely sucks balls, doesn't make universal healthcare RIGHT.

Something can be good, or nice, and still not be right.

[Realitycheck]

Economies of scale. For every one who has $250,000 of work done, another 20 will not get seriously ill. Obviously, they will never collect it but they are obligated to perform it. Why be a part of such a screwy system, where everything is done harikari and inefficiently?

 

Hospital does work.

Patient can't pay for it.

Hospital batters credit.

Hospital hires collection agency.

Hospital charges more for other patients to make up for the loss.

Hospital receives funding from other avenues - Medicare, Medicaid, etc.

Hospital eventually gets paid.

 

Why treat you if they are just going to kill you with debt? Why not be a part of the system?

[ParanoiA]

Why the desire to re-invent the wheel? If someone has found something which works, or which works better than what we currently have, why not use it ourselves?

 

Because it's arguable about what is better, what is not. There is *not* a system rolled out anywhere on the planet that everyone agrees, hands down, is the right system. There's always some list of pros and cons and that's why we have these long drawn out debates between them all. It's not universally agreed about anything. Maybe for you and those that think like you, but not for me and those that think like me, or don't think like you.

 

So, that amounts to swapping problems, without a decrease in total problems, and most certainly not worth the astronomical cost and heart ache of switching over.

 

So, let's live up to our reputation. Let's attempt our own system, learning from our mistakes and learning from other country's mistakes, and take the next evolutionary step in centralized healthcare. That's how humans advance in any endeavor. You take the lessons of the past, good and bad, and forge the future appropriately.

 

I refuse to vote for Obama because of this issue. He was asked if every american should have health coverage' date=' and he said 'yes, healthcare is a right to every american'.

 

Health care has never been, and never should be, a right. [/quote']

 

Why does it have to be a right for the government to be involved? I suppose you could make the case that the government's only job is too enforce rights. In that case, where do they get off establishing currency? Who said you had a right to state sanctioned money? To have your burning house rescued? Since when do you have a right to clean air? Clean water? Roads?

 

I know you're mainly responding to his insistance that it be a right, and I guess I can agree with you to a certain extent. But I hardly see how that invalidates the need for centralized healthcare. And keep in mind, I didn't say "socialized" and I also am no fan of our current sham of a system which also is not a free market.

 

I'm not entirely sure what I'm advocating just yet, but healthcare needs to be dealt with, some of which some legal structure could fix - like the pharmaceutical scam. McCain is "sort of" tackling the issue of tax exempt health insurance currently enjoyed only by the employer (if you attempt to buy your own presently, there is no tax incentives for you) - but he's doing it by making it taxable for everyone and then offering a $5,000 refundable credit to offset that increase in taxes.

[CharonY]

But how many who have actually used both the NHS and the American system, then prefer the NHS? Severian does not have good things to say about NHS, and nobody has responsed to this.

 

Well I have been in the US and the German system at least. Based on that I have to say that in Germany I have to pay less and at least for what I needed the treatment in Germany was better. I do think that the German system (mandatory insurance for everyone, either private public) is more expansive than the UK system, however I the overall cost for my coverage in the US is roughly four times the amount of that in Germany (for my income group).

[ParanoiA]

Well I have been in the US and the German system at least. Based on that I have to say that in Germany I have to pay less and at least for what I needed the treatment in Germany was better. I do think that the German system (mandatory insurance for everyone, either private public) is more expansive than the UK system, however I the overall cost for my coverage in the US is roughly four times the amount of that in Germany (for my income group).

 

Well let me be a little more clear in my intent with that statement - I meant more along the lines of performance. We all know that our healthcare system costs way more than the NHS, and probably everywhere else. What I'm asking about is what we get for that money.

 

Do we pay more but get better service? Better talent? Better this and that? That's why I made the comment that humans deserve the best, regardless of cost. I'm trying to get past that for a minute and look at performace. Where are we getting the best results - and I don't just mean fatality rates, there a million factors that can effect that and have nothing to do with healthcare facilities.

 

And after we agree on most favored performance, perhaps we can then look at how to make it more efficient, the right structural changes to steamline costs without sacrificing that performance.

[Pangloss]

IMO universal health care isn't a right, it's an investment.

[Saryctos]

What I'm asking about is what we get for that money.

 

We get to keep our doctors after they get sued for malpractice(which in turn have to pay insurance costs which is passed on to the customer).

We get healthy illegal occupants(Illegal to turn away emergency patients, even if they can't pay, which in turn increases costs for everyone else).

We(healthy people) get to pay for the old and sick through shared costs of insurance.

Health insurance in this country is run exactly like social security. The young pay for the old, hoping that there will be enough people to pay for them once it's their turn.

 

The problem with the healthcare industry is the insurance. There needs to be a better way to pay for the care that doesn't involve as much waste spending. Think of the costs that could be eliminated by cutting out the insurance industry, there's plenty of money spilling out the edges. If all the money being spent on healthcare went to the actually entities providing the care think how much the cost would go down.

 

There's also regulation issues(iirc; I remember talking with my paramedic roommate about this, so I'm not sure if it's well rooted in fact, or just sentiment from doing the med school thing)

It sounds like there is no 'thrift' healthcare. You'll always be paying for the best and greatest that's available in your area. There is a ethical thing about allowing cheaper service on the market, in that it creates a rift between 'poor care', and 'rich care'. Which is certainly an arguable point, but I feel that having lower end care would be better than none at all.

 

There's a lot wrong with the healthcare system in this country, and very little with the actual care. The big gaping holes stem from the framework in which we're trying to make it work.

[ParanoiA]

Insurance has long been my biggest issue with Healthcare. It is largely responsible for the framework that creates this socialized bubble in our market. And that's also why I reject insurance based resolutions right on their face.

 

Insurance also doesn't promote responsibility from the end user. The "cloud in the sky" covers it all. And then, of course, the hospitals take it out on them to recoup costs lost on those uninsured and unable to pay the high costs due to the uninsured...rinse and repeat.

 

So we certainly agree there. But again, you're talking money - you're not talking about care or performance. I keep hearing that our healthcare system rocks in terms of care, quality of service, talent and so forth. If that's really true, then I don't want to lose it. And it would seem to somewhat justify the inflated cost, at least to some of us that desire that quality.

[CharonY]

Well let me be a little more clear in my intent with that statement - I meant more along the lines of performance. We all know that our healthcare system costs way more than the NHS, and probably everywhere else. What I'm asking about is what we get for that money.

 

Darn I made a lengthy post and then apparently it did not get posted. Just a short recap:

From what I have seen so far (I had visited physicians and had to have blood analyses done for the same condition in the US and Germany), the quality was equal or even better in Germany.

 

While I did no see much of a difference on the primary care level (I assume the individual differences to be higher than the differences between countries), I have to add that I had an average waiting time on most doctors that I called before I could get an appointment as a new patient. The longest I had to wait for a specialist (not primary care ) in Germany was one week. For primary care physicians my average wait time was around half a week.

 

 

Also in Germany I had not only faster and cheaper access to specialists. but I was also not limited to whom I went. In contrast I could only visit those that were in my plan.

Also in my experience the German specialists were better. I did read up on recent research beforehand and could discuss it with the German specialists (two different ones in different cities), whereas in the US they tended to be upset when introducing the new data (also only with a N=2), or trying to discuss some fine points (a bit strange considering that I live in a University city with a lot of academics).

 

At the very least, at least in this area I could not see anything in the US system to be superior, neither quality of the medical specialists, nor treatment.

 

However one of the biggest difference was the bloodwork. In Germany either the primary physician took it and sent it in, or the specialist (or hospital) did it directly and I got results in 1-3 days. In one case I even got a phone call in the evening the same day, because I mentioned that I had to attend to a conference the next day.

 

In the US I am limited to certain labs (according to my plan), I get results for precisely the same tests roughly a week later, and the first 6 or seven times they always screwed up at least one of the test. For instance by doing the wrong one, or testing the same value twice (one by a cheaper by inaccurate means and a second time with the one normally used) and then "forgetting" a parameter that they actually should have tested. Beside that apparently the communication with my plan provider was not optimal as it may be the case that for some obscure reason I may have to pay for 400$ for a bloodwork (that I incidentally could have done myself with a ~60$ kit) by myself. I assume that this will eventually be resolved, but again, I never had that kind of hassle in Germany.

(Did I already mentioned higher co-pay here..?)

 

I did heard a number of times the argument that the US system is more expensive, but also has a higher quality. Is there any statistics at all that supports that notion? Mostly I hear that it is sometimes even inferior. I would like to have a comparison with Japan, for instance, which has IIRC one of the best medical infrastructures of the world.

[ParanoiA]

Well that's a pretty thorough testimonial and it doesn't fall on deaf ears. I'd like to get some stats on Germany's system, it sounds impressive. I'm curious how plural a consensus is on the matter.

[john5746]

I did heard a number of times the argument that the US system is more expensive, but also has a higher quality. Is there any statistics at all that supports that notion? Mostly I hear that it is sometimes even inferior. I would like to have a comparison with Japan, for instance, which has IIRC one of the best medical infrastructures of the world.

 

Probably get the best boob jobs and latest viagra pill in the world. Preventative care? nah.

[Realitycheck]

I did heard a number of times the argument that the US system is more expensive, but also has a higher quality. Is there any statistics at all that supports that notion? Mostly I hear that it is sometimes even inferior. I would like to have a comparison with Japan, for instance, which has IIRC one of the best medical infrastructures of the world.

 

There should be some of that in here.

[CharonY]

Sorry to drag this old thread out, but I would like to share another anecdote here. Recently a colleague of mine (postdoc) found a lump in her breast. Initial mammography show that it could be something serious, so she wants to see an expert. The waiting time is over two weeks. But this is not the bad news. The bad news is that her funding changed and with she has to change the health provider. Now the bad news. Now that she is marked as having a precondition (although no final diagnosis has been provided as she is still waiting for an appointment) no one wants to taker her in. At least no one that she could afford on a postdoc salary.

Bottom line is that she is going to abandon her project (which was actually very promising) and leave the US just in order to get a fast diagnosis that she actually can afford. Of course her situation might be a bit special, but I have to say that if I have to choose between a system in which you get screened out due to precondition and that is so bloody expensive that you have to chose between health insurance and paying your rent and a system where my taxes are higher, yet I can afford insurance AND rent... well my choice is pretty much clear.

 

Sorry for the rant but I am kind of pissed of at that.