Should the US Start with the Premise that it WILL Provide Universal Healthcare?

[iNow]

Should the US start with the premise that it WILL provide universal healthcare and work from there?

 

 

A great special on PBS Frontline tonight, called Sick Around the World.

 

You can watch the entire program for free online via the following:

http://www.pbs.org/wgbh/pages/frontline/video/flv/generic.html?s=frol02p101&continuous=1

 

 

The timing of tonight's episode couples well with a report released yesterday by the White House:

 

 

The Cost of Inaction

 

http://www.healthreform.gov/reports/inaction/

The United States spent approximately $2.2 trillion on health care in 2007, or $7,421 per person. This comes to 16.2% of GDP, nearly twice the average of other developed nations.

 

Health care costs doubled from 1996 to 2006, and are projected to rise to 25% of GDP in 2025 and 49% in 2082.

 

The proportion of spending attributable to Medicare and Medicaid in the health system is expected to rise from 4 percent of GDP in 2007 to 19 percent of GDP in 2082 <

more at the link

>

 

 

Obviously, we need to decrease costs and control our approach such that we only spend money on proven technology. Doctors, hospitals, and most importantly, insurance companies would need to be forced to have caps on cost (at least, I think so).

 

The program linked above covers these issues well. We seem to be experiencing a confluence whereby business owners, insurance leaders, doctors, and citizens are all ready to make something positive happen here in the United States as pertains to health coverage. Between the tough economy and the health summits being held with all stakeholders at the White House, we may actually be ready to push through this issue which has been discussed now for decades, yet repeatedly failed.

 

The political will to accomplish great things is available to us.

 

 

Now, my questions to you... Should we act on that will, or squander it? Should we make universal healthcare in the US our starting premise and go achieve it, or should we settle for status quo and tired old arguments which prevent us from moving forward? What will it take, and are you willing to make some personal sacrifices for the greater good? Should people have to choose between school and survival, and is it okay to explore alternative ideologies to ensure we care for our collective brothers and sisters, mothers and fathers, sons and daughters?

 

Your thoughts?

Edited April 1, 2009 by iNow

[Pangloss]

Should the US start with the premise that it WILL provide universal healthcare and work from there?

 

No.

 

I think the correct approach is exactly what Obama is doing -- overhaul and reform the system, but maintain private enrollment. Deal with the cost problem through regulation. Force the insurance companies to obey accounting and behavior standards that every other company in America is held to. Force drug companies to either spread the research cost, marketing cost, and PROFIT to ALL customers, or allow us to participate in the same deals that Canada et al get and STFU about their profit margin.

 

Socialism is not an answer, it's a cop-out.

[bascule]

Socialism is not an answer, it's a cop-out.

 

Universal single-payer healthcare is not socialism

[iNow]

Socialism is not an answer, it's a cop-out.

 

I respect you enough, and trust your knowledge enough, to listen to any well supported argument you make. However, I ask that you offer something more than empty platitudes and labels with a derogatory intent to support your intended point.

 

It works in other countries. We're one of the few classically "advanced" civilizations still failing to care for its people.

 

Let's learn from the best known methods of these other nations who manage to do this successfully and take the most useful parts from each so we can make it work here.

 

 

Should the US start from the premise that we WILL provide universal healthcare and work from there? If yes, then how might we do it? If no, then why not?

[padren]

I have strong reservations as to the effectiveness that a private system can get costs under control. The free market is great at making companies more fit in a competition for market share and profit, but the insurance system seems to employ an inverse invisible hand pressure: the less a company can cover a patient upon catastrophic illness the more money it makes.

 

When you read polls regarding people being happy with their coverage, it's usually people who haven't had any serious issues - until I see a poll that covers how happy people are with their providers after being stamped as "unprofitable" due to monthly benefits needed being greater than monthly premiums (due to diabetes, cancer, or other long term debilitating illness) I am uncertain how well the private system can work.

 

There is a financial incentive for providers to find loop holes or reasons why a "trouble patient" should not be covered, and if they are successful they increase their profit, and push the costs off onto families, debt collectors, the tax payer (when ERs are used for non-ER services) and effectively just push their burden onto society. The cost of scanning every instance of expensive use (even after determining the procedure is important via doctors) to determine if they can pass the buck has to be a heavy drag on the system.

 

Honestly to me, our current system makes about as much sense to me as making fifty phone calls to fight to get your police insurance to cover the cost of officers responding to your house being burglarized as they try to make the claim the burglars had a pre-existing intent to rob you from before your policy's start date.

[Pangloss]

I respect you enough, and trust your knowledge enough, to listen to any well supported argument you make. However, I ask that you offer something more than empty platitudes and labels with a derogatory intent to support your intended point.

 

Hey come on, you asked me for my honest opinion and I gave it to you. Are you saying I misunderstood the question? Because it sounds like from some of your posts above that you DO want to talk about universal coverage as an entitlement.

 

Should people have to choose between school and survival, and is it okay to explore alternative ideologies to ensure we care for our collective brothers and sisters, mothers and fathers, sons and daughters?

 

But whatever the case may be, that certainly wasn't an attempt to denigrate your opinion. And I'm a little insulted by the bit about "empty platitudes". Yeesh.

 

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Universal single-payer healthcare is not socialism

 

No it's not, but iNow seems to wants to talk about guaranteeing universal coverage as a starting point. A guarantee. My opinion is that it's a mistake to guarantee coverage first. We need to fix costs first and then make the system as attractive as possible, and THEN see if we still have a problem. If we don't then we can move forward and this isn't an issue. We've already solved the problem of childhood coverage, so fixing the problem first makes sense, IMO.

 

That's the point I was trying to make. But it's just my opinion.

Edited April 1, 2009 by Pangloss

[bascule]

My opinion is that it's a mistake to guarantee coverage first. We need to fix costs first and then make the system as attractive as possible, and THEN see if we still have a problem.

 

Well, socializing medicine would certainly help in fixing costs... literally.

[Sisyphus]

When you read polls regarding people being happy with their coverage, it's usually people who haven't had any serious issues

 

I'm sure that's the case. Anyone who's actually had to deal with health insurance in a serious way can see how ridiculously broken our system is. Horror stories seem to be the rule, not the exception. Basically, even if you are insured and paying hefty bills every month, you can expect them to try to bankrupt you anyway if anything serious happens to you.

 

I don't know if we need to have universal healthcare as a starting premise, but I do think we at least need to accept from the beginning that we are going to demolish the status quo. If I worked in the health insurance industry, I'd be trying to get the hell out while I still could.

[Saryctos]

How can we rip the insurance element out of health care? It's clearly the cancerous tumor in our medical system. If you're uninsured you're screwed! There's no reason to keep the costs low to appeal to those who only want to pay when they actually need something(strange idea right?)

It's not just health insurance either, the massive amount of malpractice lawsuits increase the cost of insurances that hospitals and doctor's have to pay, which is then passed on to the consumer...who only notices a small increase on their individual cost because it's spread on to everyone through the great equalizer!(insurance)

 

The health insurance racket is worked out in almost the same way of Social Security. You pay upfront(20-30s) in an effort to pay less when you've reached old age(I know the number of insurances that do this is not uncommon, but I can't remember the proper number).

 

Add to that the "ethics" debates about offering sub-standard service at reduced cost(which some people would prefer), but this is labeled as lacking ethics, because then you're essentially offering a service for "the poor".

 

Medications themselves are a whole other issue which unfortunately I don't have time to spout off about because my break was over 3 minutes ago =/

[ParanoiA]

Should the US start with the premise that it WILL provide universal healthcare and work from there?

 

Absolutely not. There's enough of that around, we need to be diverse. The US is in the unique position and still retains enough independent spirit that we can contribute to mankind by being innovative and not settling for ordinary, less than impressive solutions.

 

Let those countries play it safe, we need to come up with something new. Insurance is a sham. Strong arming employers to pay for arbitrary expenses like health insurance, is a sham (might as well require them to provide soap and a newspaper).

 

Come on, we're smart people with an incredible pool of intellect - we're probably the smartest, certainly most knowledgable, humans to have ever lived (speaking globally). Why do we have to copy ideas developed by our ancestors? Can't we do better than that?

 

I think we can. I don't know that we will. But I know we most certainly won't if we work from a premise that undermines any truly ground-up innovation. I have no desire to follow here.

[waitforufo]

I feel no moral obligation to provide health care to able bodied adults or their dependents. I do not feel that others are morally obligated to provide me or my dependents with health care.

 

When I am able, which has been the majority of my life, I voluntarily provide charity to those in need. I work hard to make sure that those receiving my charity are not able bodied adults.

 

I am interested in plans, private sector or government, that reduce my health care costs. I am weary of government programs because they seem to emphasize providing assistance to dead beats. I am also weary of government health care programs because such government programs tend to take pride in forcing all users to feel like dead beats on the dole. Think I'm wrong? When was the last time you had a tetanus shot or a vaccination? Well in Washington State it is almost impossible to get a private doctor to give you one. You have to go to the government clinic wait forever in room full of people with critters jumping off of them while some reforming crack addict administers injections to her former drug addict friends while loudly reminiscing with them about their good old junky days. After putting up with this for two hours I decided it would be better to risk having lock jaw and left.

 

With regard to private health care it, it has always worked just fine for me and my family. This includes all the medical care for bringing three children in to this world, two surgeries for my wife, one for my son, and three for me. The only problem I have ever had is that one insurance company had the habit of denying full coverage for service provided by hospital support staff. They often claimed that these health care providers were "out of plan." It never took more than a toll free phone call to correct these problems.

 

Has my health care cost me out of pocket? Yes, but the plans I have been involved with never said they would cover 100 %. You see, I don't think I am entitled to the necessities of life. I also don't think other people are entitled to my money unless they have provided me with a service or they are my direct dependents.

Edited April 1, 2009 by waitforufo

[iNow]

Hey come on, you asked me for my honest opinion and I gave it to you. Are you saying I misunderstood the question? Because it sounds like from some of your posts above that you DO want to talk about universal coverage as an entitlement.

Thank you for coming back and editing this post. Your original language was frustrating, so I ignored it when I read it last night, but I see that you updated it since then, and I wanted to acknowledge that I appreciate that.

 

 

 

No it's not, but iNow seems to wants to talk about guaranteeing universal coverage as a starting point. A guarantee.

 

The idea being that we "set the goal," then we figure out a way to attain it. As mentioned in the OP, this thread was inspired by the Frontline special, where they asked that exact question.

 

I'm thinking about this like "reach for the stars, and you may eventually get to the moon." If we set our expectations low, then the outcome will be even lower.

 

I happen to think that health coverage should be guaranteed for everyone, having been at the difficult/existential end of healthcare and coverage decisions on numerous times myself as a diabetic... and have really been put in difficult spots repeatedly despite my tremendous work ethic and contributions. One should not be forced to choose whether they can pay for the medications they need to survive or pay for food for their kids. I feel strongly that, as an advanced civilization, we need to some basic safety nets in place for all people... That is is a right, not a privilege.

 

Again, I think we should start from the premise that everyone deserves universal coverage and work from there, but I understand that others disagree. I'm looking to better understand that disagreement so we can improve our pathetically broken system and move forward together.

[Pangloss]

Well you're welcome, but I'm still frustrated with you about that "empty platitudes" comment. I don't think it was fair. I supported my argument with key points about the insurance industry and marketing-versus-research costs in the drug industry, and I followed up with what I felt was a reasonable concern. I felt run-over by your post, the way you threw that at me and then restated the question as if I didn't exist was very insulting.

 

That is is a right' date=' not a privilege.

 

Again, I think we should start from the premise that everyone [b']deserves[/b] universal coverage and work from there, but I understand that others disagree. I'm looking to better understand that disagreement so we can improve our pathetically broken system and move forward together.

 

Bolded to show that I was in the correct ballpark. I'm not accusing you of desiring socialism, but this shows that my concern is on-subject and a reasonable point of discussion.

 

That's great, iNow. We can start by not calling replies that express concern about socialism "empty platitudes". There's nothing "empty" about this argument:

 

I think the correct approach is exactly what Obama is doing -- overhaul and reform the system, but maintain private enrollment. Deal with the cost problem through regulation. Force the insurance companies to obey accounting and behavior standards that every other company in America is held to. Force drug companies to either spread the research cost, marketing cost, and PROFIT to ALL customers, or allow us to participate in the same deals that Canada et al get and STFU about their profit margin.

 

If we don't fix the system before enacting an entitlement then my concern is that the system will become almost impossible to repair. A perfect example of this is the way the entitlement of Medicare -- which we cannot change without a massive and incredibly unpopular intervention -- allows drug companies to charge the US taxpayer for their profit margin (R&D, marketing, and pure profit) and then give discounted drugs to Canada and other customers. And we've been stuck in that situation for years! Why? Because medicare is on the entitlement side of the budget -- practically untouchable, both by law and by public opinion.

 

Make health care an entitlement without fixing the problem and the same thing would happen -- massive profits guaranteed by law, with no ability to change anything without a massive and incredibly unpopular intervention.

 

That's my concern.

[john5746]

Again, I think we should start from the premise that everyone deserves universal coverage and work from there, but I understand that others disagree. I'm looking to better understand that disagreement so we can improve our pathetically broken system and move forward together.

 

I don't understand how anything that requires the servitude of another could be considered a right. On the other hand, the government acts like it is a right for any criminal or POW. I think with universal coverage, we would need to narrowly define what services are really covered. Preventative measures should be favored over expensive life saving treatments. Currently, we seem to have the worst of both worlds. Its harder for a self employed citizen to get a routine check up than an illegal immigrant can get emergency care.

[iNow]

I think the correct approach is exactly what Obama is doing -- overhaul and reform the system, but maintain private enrollment. Deal with the cost problem through regulation. Force the insurance companies to obey accounting and behavior standards that every other company in America is held to. Force drug companies to either spread the research cost, marketing cost, and PROFIT to ALL customers, or allow us to participate in the same deals that Canada et al get and STFU about their profit margin.

What about those people who are broke precisely because they got sick? How does lower costs help them if they're already in debt from caring for their health?

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I'm sure that's the case. Anyone who's actually had to deal with health insurance in a serious way can see how ridiculously broken our system is. Horror stories seem to be the rule, not the exception. Basically, even if you are insured and paying hefty bills every month, you can expect them to try to bankrupt you anyway if anything serious happens to you.

 

I don't know if we need to have universal healthcare as a starting premise, but I do think we at least need to accept from the beginning that we are going to demolish the status quo.

Absolutely agree. My concern is that simple "tweaks" here and there to the existing approach will barely scratch the surface. We pay more and get less, and people are getting sicker, meaning they also have to pay even more later for more catastrophic care.

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unfortunately I don't have time to spout off about because my break was over 3 minutes ago =/

 

I wonder if you'll come back to continue your thoughts. You clearly have thought about this quite a bit, but I'm not entirely sure where you stand or what you think is an acceptable approach.

 

Also, did you catch the special to which I linked in the OP?

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Come on, we're smart people with an incredible pool of intellect - we're probably the smartest, certainly most knowledgable, humans to have ever lived (speaking globally). Why do we have to copy ideas developed by our ancestors? Can't we do better than that?

 

Just because an idea is old doesn't necessitate that it's bad. I am, however, completely open to ideas on how to do things better, because right now, things are heinous and pathetic with our health system.

 

Like I mentioned above, I'm hardly a crack smoking lazy ass, but I was in a really rough position very recently in my life due to a bad streak of luck. I literally had to choose between eating and insulin, and I find that unacceptable. I was one of the lucky ones, as I was able to make it work (insulin is not as expensive as something like heart surgery, for instance). What gets my ass chapped is that I've seen how well it can work elsewhere, and I wonder why we don't make ours work by following similar models/approaches. I don't care if someone raises the specter of socialism, I care about collective advancement. There's no need to reinvent the wheel, but we may need to reinvent our ideas about right and wrong, our focus on a greater good, and other Spock-like logic systems. (The good of the many outweighs the good of the few)

Edited April 2, 2009 by iNow
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[ParanoiA]

What about those people who are broke precisely because they got sick? How does lower costs help them if they're already in debt from caring for their health?

 

Maybe we could extend the SCHIP funding to include vice crimes as well. "Hey there kiddo. As soon as we bust somebody screwin' a hooker, we'll getcha' that kidney".

[iNow]

I feel no moral obligation to provide health care to able bodied adults or their dependents. I do not feel that others are morally obligated to provide me or my dependents with health care.

And you're not alone in that. That's a pretty major mindset that I just disagree with. I've found that it's only those who have never struggled personally with this issue that tend to be so okay with the sentiment that health care is a privilege, not a right. I am glad to hear that you've managed to navigate the system so successfully in your life thus far, but I think you're outlook would be different if you'd personally experienced the more difficult side of it (note comments above by Padren and Sisyphus for context).

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Well you're welcome, but I'm still frustrated with you about that "empty platitudes" comment. I don't think it was fair.

And you're right. That wasn't fair. I ignored the meat of your post, and focused on the closing. That wasn't fair, and I apologize.

 

My larger concern was that, especially so early in this potentially exciting thread, someone was already dismissing the idea as socialism and moving on. I want to hear actual arguments, not mere labels of socialism. I should have been more clear when responding.

 

 

Make health care an entitlement without fixing the problem and the same thing would happen -- massive profits guaranteed by law, with no ability to change anything without a massive and incredibly unpopular intervention.

A valid concern, but I think the risk could be mitigated with proper planning and smart protocols.

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I think with universal coverage, we would need to narrowly define what services are really covered. Preventative measures should be favored over expensive life saving treatments. Currently, we seem to have the worst of both worlds.

Here, we are in perfect agreement, but I am not yet willing to completely dismiss the need for life saving treatment options as part of whatever new approach is followed.

Edited April 2, 2009 by iNow
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[Pangloss]

What about those people who are broke precisely because they got sick? How does lower costs help them if they're already in debt from caring for their health?

 

You mean in terms of what approach will create more such people? It's a reasonable question. If we adopt Obama's plan then costs are fixed and that shouldn't happen anymore, but I guess that even then we'll surely have cracks people can fall through.

 

Perhaps something that's similar to unemployment compensation might be useful here. In that program people who quit their jobs don't get squat, but people who are terminated for no fault of their own are entitled to a limited, temporary assistance. We could do something similar for health care -- not to be cold about it, but productive people should not be lost to GDP when they can be turned around and made productive again. That's what safety nets are all about.

 

We already have COBRA, but it only lasts 18 months and dumps the whole cost on the employee (often many times what they were paying). It might be worth revisiting that issue, even if we do resolve the overall health care cost problem.

 

(And thanks for you know what.)

[waitforufo]

And you're not alone in that. That's a pretty major mindset that I just disagree with. I've found that it's only those who have never struggled personally with this issue that tend to be so okay with the sentiment that health care is a privilege, not a right. I am glad to hear that you've managed to navigate the system so successfully in your life thus far, but I think you're outlook would be different if you'd personally experienced the more difficult side of it (note comments above by Padren and Sisyphus for context).

 

I may be reading Padren incorrectly but by "serious issues" I believe he is referring to significant medical problems. I have had significant medical problems. Problems that have required surgery and rehabilitation. My private insurance covered my "serious issues" exactly how the policies said they would. No, I was not covered 100% so I did experience a financial sting. But then again I was not willing to pay more for additional private insurance. In my personal pursuit of happiness I am willing to accept certain risks such as setbacks due to medical problems so that I can afford enjoyment in other aspects of my life. My right to pursue happiness is not a guarantee of attaining happiness.

 

The "right" to medical care you mention above is simply a license for involuntary servitude.

 

With regard to the post of Sisyphus, I have not found that "horror stories seem to be the rule, not the exception." Yes, people complain about their coverage, but people complain about the price of gasoline as well. Do people have a right to moderately priced gasoline? I actually find the people more often complain about incompetent doctors and medical facilities. In my job I travel the world and find that people in countries with socialized medicine complain more than people here regarding doctors and medical facilities.

 

Your statement about my ability to "navigate the system so successfully" implies that I have either been skillful or lucky. Neither is the case. I either bought insurance privately or received it through my employment. When I needed medical care, the insurance worked as my policy said it would. Since this is true for virtually everyone I know, it must be quite simple for people to be so skillful or lucky.

 

Now I do know people who have no insurance. (In my early twenties I myself had no medical insurance.) Those people are making choices in their pursuit of happiness. For example I notice that they drink, eat in restaurants, go on vacations, smoke cigarettes, and enjoy marijuana. I hope their choices work out for them.

 

As I mentioned in my previous post I have a hard time with people who think their mere existence entitles them to the benefits of my labor or wealth. I do however make exception to those that are not able bodied. So if you had ability, were stupid enough not to have insurance, and became seriously injured, out of kindness I do believe such dead beats should be considered for charity. If they receive charity, they should be grateful and not complain about the quality of their care. They rolled the dice and should live with the outcome.

 

People without ability should be provided medical care by a kind society. This includes people, particularly children, in poverty or those who would be put into poverty by chronic illnesses. Again those people should be thankful they live in such a kind society.

 

Finally with regard to your comment "never struggled personally", perhaps you assume too much. I find that people who have had great struggles in life expect others to struggle with similar vigor.

[iNow]

I think you make a mistake in assuming that it is only dead beats and losers who would benefit from such a system, and I take issue with your implication that "simply pulling oneself up by their bootstraps" is enough to get through major health issues and debt problems related to care for ones health.

 

What did you think when you got done watching the special linked in the OP? What stood out to you the most, and what points did you find factually lacking?

[waitforufo]

I think you make a mistake in assuming that it is only dead beats and losers who would benefit from such a system, and I take issue with your implication that "simply pulling oneself up by their bootstraps" is enough to get through major health issues and debt problems related to care for ones health.

 

Perhaps you missed the following in my previous post.

 

People without ability should be provided medical care by a kind society. This includes people, particularly children, in poverty or those who would be put into poverty by chronic illnesses. Again those people should be thankful they live in such a kind society.

 

 

What did you think when you got done watching the special linked in the OP? What stood out to you the most, and what points did you find factually lacking?

 

I have not yet seen the program, but I do look forward to it.

[Saryctos]

Well, I ended up taking the time to watch the Frontline link in the OP(sorry for not really addressing your point directly in my first post). I liked the video, and I definitely think it's worth the time, if for nothing else than to get a single perspective on multiple systems. Thanks for sharing.

 

I took the time after each segment (witch was broken down by country visited) to pause for a bit an jot down some notes on what I thought was a usable mechanic, and other things that I believed could work in the US, or the we could even improve upon.

 

I'll start off by saying that I agree with many of the people interviewed in the program that said that healthcare is a right of the people. Every person on the planet deserves a fair shot at the available technology to help them extend their lives, or in some cases make them worth living. Doesn't matter if you're a small child with no ills to your name, or a habitual smoker breathing in your Camel's through your trachea port. The line for me gets drawn however, in that I don't think anyone should be forced[i/i] to pay more than is necessary for their own care.

 

I shouldn't need to be insured to be healthy. If I want an MRI on my foot because I'm paranoid about fictitious gremlins in my bones, and the only thing that'll calm me down is an MRI, I should be able to pay for that out of pocket the same as if my life really did depend on it, it's the exact same test regardless of motivation. The time, energy, equipment, and staff capable of humoring this request costs far more than it's actual value. One of the reasons that this fictitious example would never work out well, is that you simply can't just go and get an MRI from some MRI depot. It's regulated to all hell, on top of probably not being able to get what you want(an MRI by request) even if you did, good luck pulling in just a scan without an analysis, which is where the money starts to add up quite a bit.

 

A few years ago I got an ekg for some troubling chest pain. Turned out there was nothing to worry about and only cost about $75. However, the cost of the facility and the "analysis of the EKG" brought the total closer to $300. (I'm not insured, simply because I won't buy into this insurance sham) Now don't expect me to go into price breakdowns or rages about the cost of things, because this is completely anecdotal and doesn't matter so much as an example to work with.

If I wanted to just "get an EKG" and take it home with me and have my roommate(a senior medic) look at it for me, it would've cost only the visit to the doctor's room and the small cost of a nurse placing 12 little pieces of sticky tape on me (Heck, I've read enough medical stuff off the shelf to know where to put the stickies myself, could've just said "hey can I pay to use some of your EKG paper?"). Would've been in and out, minimal cost to me, minimal time for the medical staff, which would allow them to get in more patients who perhaps actually needed their expert opinion instead of having one laying around the house.

 

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You can't do that at all in the current system. The doctor would be liable for lawsuit if he didn't look at the EKG himself first to ensure I wasn't going to die in the next day or so. Making medical staff liable for things they weren't asked to do is a little crazy in my book. And there's plenty of similar regulations that force doctors and nurses to perform duties they don't necessarily have to do, all for the sake of covering their asses. Now this I believe is a unique American problem. Not that other countries can't have malpractice cases(can they?) but more so the amount of legislation that forces additional costs to the consumer and thrusts work onto the healthcare system. This is the kind of bloat that we have to face in the US system as it stands, even if the cost side of things gets worked out better with some new plan.

****

 

Before I lapse into a ramble(hopefully I haven't yet =) I'd like to look at the Frontline episode a little more. The other countries' plans have plenty of opportunities that we could benefit from. The one that struck me the hardest, and oddly enough first! Was the increase in pay to the British GPs for healthy patients. It seems like a great premise, rewarding doctors for keeping people healthy instead of profiteering of those stuck perpetually hacking and sneezing. It's a good use of market forces to reduce the margins for being a greedy disease monger.(although admittedly those not making tons of incentive money aren't evil, they might have just caught a bad draw on the clientele)

 

The Japanese system sounded great, and the downsides they have seem like they would work themselves out if it were in the US. The idea of fixed costs got me thinking quite a bit. The premise of equal pay for equal services sounds like a good idea, but the immutable costs that applied to EVERY hospital is just a bad way of doing it. The cost of operations between multiple states and cities is just far too great for some master list to dictate the terms. A procedure or test in LA is going to cost many times that of a hospital or clinic in Detroit. There's just no way they could charge the same without losing customers(the D), or going bankrupt(LA). Plus if you stock your staff with top of their class physicians but you still have to charge the same as the guy who wrangled the fresh out of med school barely passed their licensing exams there's going to be problems. I could see a light system of price control working though. Some ingenious way for allow the price on things to be controlled to a degree, but allow the prices to fluctuate by some measure. What that is, I couldn't say, I'm not THAT guy. What I do know is that there would be plenty of people capable of finding a variety of methods to make it work without penalizing the health industry as would a completely fixed system.

 

The no-profit restriction on healthcare insurers, which was a strong undertone in all these plans, is indeed needed if you want to make an insurance based system work. If you take out the profit, you minimize the inflation caused by the basic principles of insurance bringing in more money than it gives out.

 

 

Prescription medications. Too much advertising. Too much cost associated with what is produced with so little. I feel the same sentiment against drug companies as I do any digital rights management advocates. On one hand you do have the fact that development costs money. Then we see that the cost to do it yourself once the information becomes available makes the cost almost negligible. How do we balance freedom of information with profitability? It's not just a drug question, it's the next greatest market dilemma. With the ability to disseminate ideas, recipes, digital copies so quickly and easily, how to we proceed forward in this kind of market where it costs the developers of these ideas a great deal of time in contrast to the materials needed to recreate their efforts?

[iNow]

Thank you for providing such an outstanding contribution, Saryctos. I strongly agree with the basic premise of restricting profits for healthcare insurers, as well as rewarding doctors instead for healthy patients like they do in the UK. As per the fixed costs idea, that is a little stickier, but I see it more about setting a consistent baseline for all providers to work from.

 

I also appreciate your closing sentiments. As information becomes more available, the DIY approach becomes much more viable, but it seems to remove some of the incentive from the idea originator. I'll need to chew on that one. Excellent post. Thank you.

[Mr Skeptic]

Should the US start with the premise that it WILL provide universal healthcare and work from there?

 

Yes. Not necessarily because it is a good idea (though I think it is) but because it is the reality, and acknowledging it would be more efficient. What I mean is that if you absolutely need medical treatment, they are required to give it to you even if you can't pay for it. But if the government would pay for everyone's treatment such people could get far cheaper preventative measures, a healthier and cheaper solution.

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And as for health insurance, it is extremely hostile to people who have the stuff that they bought insurance for in the first place, actually happen (ie, a really expensive condition -- something that costs far more than they paid in insurance). This is to some degree unavoidable due to the free market pressure for profits. Government, on the other hand, needs to worry more about its people's health and satisfaction than about profit, so despite my libertarian tendencies I think that they would be better at health coverage than private alternatives.

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And on a constitutional note, the question of health care becomes, does your right to life and/or pursuit of happiness (depending on the severity of the disease) override others' right to pursuit of happiness (the doctors currently forced to provide care regardless of whether you can pay, or the taxpayer money to pay for others' health care if universal health care were adopted)?

Edited April 3, 2009 by Mr Skeptic
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[JohnB]

A couple of points.

 

1. Universal coverage can be viewed as nothing more than a very big health insurance company, or like car insurance.

 

Each year I pay for it in my taxes and almost always don't get that money back. If I make a small claim, I pay an excess, just like i would in a car accident. In the case of a major claim, the "Insurance" company pays the lot.

 

2. A major problem area in universal coverage is the grey "Elective" area. How do you judge the "quality of life" part of the surgery? Which of two hip replacement patients needs his "more"? It's in this grey area that most complaints come from.

 

3. As has been said, malpractice suits drive up costs, but many don't make the connection that it also increases demand for services. To cover his ares, the MD will order all sorts of tests simply so as not to leave hinself open to suit. He can never be asked "Why didn't you order the ABC test?" simply because he always orders it for the CYA factor.

 

This in turn drives up the costs to the insurance companies and therefore premiums.

Think I'm wrong? When was the last time you had a tetanus shot or a vaccination? Well in Washington State it is almost impossible to get a private doctor to give you one. You have to go to the government clinic wait forever in room full of people with critters jumping off of them while some reforming crack addict administers injections to her former drug addict friends while loudly reminiscing with them about their good old junky days. After putting up with this for two hours I decided it would be better to risk having lock jaw and left.

Then you need a better system. Last time I had a tetanus shot was about 12 years ago. I walked into my local GPs practice (without an appointment) waited about 20 minutes and got my shot. If I wanted a booster tomorrow, I could walk in and get it. How long i would wait would depend on how busy they are, so I'd probably just make an appointment for Sunday instead.

 

Nobody wants to get sick on their holidays, but the idea of visiting the US makes people afraid of getting sick if holidaying there.

 

If any uninsured US citizen came to Oz on holidays and had a heart attack on the beach. We'd call an ambulance, or a chopper if need be, get you to hospital and get you well again. No matter how long it took. Once you were well, we'd say "Enjoy the rest of your holiday."

 

What would happen if things were reversed? Which system is the more humane?