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

[Saryctos]

Is this the same argument you make when discussing our relatively uncorrupt police force, our fire departments, and the protections we have against dangerous drugs and foods?

 

You are not "legally bound" to pay for anything in particular, except, of course, your taxes. The distribution of those tax dollars is decided upon by our congress. That is expressly articulated in our founding documents (Article I, Sections 2 & 8), the articulated motivations and support of which can be found in the Federalist papers (specifically, numbers 30 through 36). The congress shall have the ability to levy taxes.

 

The issue here is how said taxes get spent. We spend it on weapons. We spend it on infrastructure. We spend it on police and fire departments, and we spend it on intelligence, and farms, and clean water. We spend it on safety inspections for our foods and drugs, and we spend it on things which make our society better as a whole.

 

Regardless of what we spend it on, we are legally bound to provide those funds. Congress shall have the ability to levy taxes, as well as the power to determine how that money gets spent.

 

 

Why then, when we begin to discuss healthcare, an existential requirement for many, a moral imperative for some, does the argument become about "my dollar" and "my obligation," yet those same arguments aren't levied when discussing all of the other expenditures resulting from the collection of our tax dollars?

I find my problem is that healthcare is very much like other wealth redistribution programs we have, in that it's just money changing hands with minimal (if any) gain for those who paid it. Additionally I feel that the current payment structure for the healthcare industry is terribly broken. Any government involvement would almost set in stone the failing system as is, with a lot of bureaucratic obstacles to change it.

 

 

Would you rather do that so much that you'd be willing to stand up and support that alternative approach in the face of opposition?

Absolutely. I feel that money spent on healthcare is far more justifiable than many other programs we currently finance.

[The Bear's Key]

WAS IT FREE?. Who paid for those Doctors/Surgeons Educations, the Hospitals or the high tech equipment in the. Who paid for your office calls, medications, your hospital stay and no doubt some cost while recovering?

The rub: they pay for it and yet can afford everything we can. Perhaps more. Does anyone go bankrupt in UK from paying medical taxes?

[Pangloss]

We just have to list out the problems in the system and attack them head on (apply directly to the forehead). Think of a problem in healthcare and follow it to the logical end of what causes this problem. NOT what these problems cause, but what allows them to continue. Don't worry about if the problem is solvable, just find out what is the core "problem" with any situation. What feeds these problems? Are they getting worse? Staying the same?

 

A thoughtful and interesting post. Thanks Saryctos.

[The Bear's Key]

Think of a problem in healthcare and follow it to the logical end of what causes this problem. NOT what these problems cause, but what allows them to continue. Don't worry about if the problem is solvable, just find out what is the core "problem" with any situation. What feeds these problems? Are they getting worse? Staying the same?

I second that.

 

One core problem is: 4 healthcare lobbyists for every member of Congress. Under those conditions, any solution that emerges -- universal or pure market -- will likely just end up going to crap.

 

Lobbyism has got to be cut many notches to a level of power below ours, the citizens.

[ParanoiA]

The intended thrust of my point is that the logical outcome of the approach supported in the previous several posts is the mandate that those in poverty get lesser (or zero) care' date=' whereas those who are financially stable will receive great care. This includes people in poverty through no fault of their own, as well as people in poverty as a direct result of their medical issues (also, no fault of their own in many/most cases).

 

Or, you know... we could just tell all of those diabetics and cancer patients out there that they'll just have to live with the financial consequences of being ill and having a condition requiring medical attention... That it's nobody else's problem. Sucks to be you....

 

Yeah... I suppose that's one approach that an "advanced" civilization might select.[/quote']

 

Ok, I didn't answer your initial request for clarification because I couldn't figure out where in the hell you got the idea we were all fat, dumb and happy about government provided information being the salvation of our Healthcare industry. We just all agreed it was a great idea. We didn't roll our sleeves down and leave the work site. I guess I can't speak for ecoli and Skeptic, but I didn't get the idea they were settling on that as a "solution" either.

 

Second of all, like Pangloss, I dispute the the word "deserves" as well. I realize you said this was merely "poor word choice" but that phrasing is used a lot in this kind of discussion. It's a false appeal and is a disingenuous argument. Not saying you're making that argument, but it's easy to say the same thing with different words. Inferring a value judgement on the poor by denying the notion of having a right to other's property is no path to a solution.

 

We just have to list out the problems in the system and attack them head on (apply directly to the forehead). Think of a problem in healthcare and follow it to the logical end of what causes this problem. NOT what these problems cause, but what allows them to continue. Don't worry about if the problem is solvable, just find out what is the core "problem" with any situation. What feeds these problems? Are they getting worse? Staying the same?

 

A very logical approach to problem solving. Yes, I agree. Nice post.

[bombus]

WAS IT FREE?. Who paid for those Doctors/Surgeons Educations, the Hospitals or the high tech equipment in the. Who paid for your office calls, medications, your hospital stay and no doubt some cost while recovering?

 

If Good Health is a right, then doing anything not considered healthy should be a criminal offense. Playing some sport (you might get injured), driving a car (might be involved in an accident), working (pick a problem) eating/drinking (pick the product) over indulging per your personal physical structure. Top this off with parental responsibility who should have aborted you, knowing some genetic combination might have given a 10% possibility of this or that. Your health issues are personal and the responsibility should be yours (once 18 or so) to get the best of what you were born with, in the world you live in...

IMO.

 

Of course it's not FREE (hence my use of inverted commas), but I didn't have to actually pay for it myself at the point of delivery. Everyone in the UK pays National Insurance, essentially a tax paid direct to the government to fund the National Health System, welfare payments and govt. pension.

 

For most of us it works out far cheaper than private medical insurance - basically because the NHS is run not-for-profit. As a proportional tax the richer one is the more one contributes so it takes into account ability to pay (even people on welfare contribute). Despite some problems, it really is a fantastic system. Whether you have an ingrowing toenail or cancer, all treatment is 'free'.

 

Re personal responsibility, there are debates about this (should smokers get treatment for lung cancer, or fat people get heart operations etc) but one thing it does do is encourage the government to look at ways of encouraging people to lead healthier lives. It doesn't stretch as far as encouraging people to stop people playing sports or enjoying their lives though!

Edited April 10, 2009 by bombus

[jackson33]

Of course it's not FREE (hence my use of inverted commas), but I didn't have to actually pay for it myself at the point of delivery. Everyone in the UK pays National Insurance, essentially a tax paid direct to the government to fund the National Health System, welfare payments and govt. pension.

 

For most of us it works out far cheaper than private medical insurance - basically because the NHS is run not-for-profit. As a proportional tax the richer one is the more one contributes so it takes into account ability to pay (even people on welfare contribute). Despite some problems, it really is a fantastic system. Whether you have an ingrowing toenail or cancer, all treatment is 'free'.

 

Re personal responsibility, there are debates about this (should smokers get treatment for lung cancer, or fat people get heart operations etc) but one thing it does do is encourage the government to look at ways of encouraging people to lead healthier lives. It doesn't stretch as far as encouraging people to stop people playing sports or enjoying their lives though!

 

Tens of thousands of pounds, means at least 20k (about US$30k). Not sure what your Tax Rate is for the health system, but most range in the 1-2%. You will likely never repay the system for the services rendered. However, the security factor alone, in your case is worth a great deal and I am not here to argue what already exist.

 

I do not know the intricacies of needs in the UK or in fact the limitation on migrations under the European Union, if even applicable. What I do know is what people that have studied in England, were/are British Subjects and since become advocates opposing UHC for the US. Mark Steyn the most often quoted, Stuart Varney with Fox Business another and hundreds of testimonials of people that have left socialist governments of various degree from around the world, migrating to the US for just that reason.

 

The population in the UK was around 50M in 1950 (US 140M) and today in the UK 61M (51M in England, 8M+ in London) and 306 million in the US. We have one State alone with 36M (California), one area with 20 million (LA/Orange County) with entirely different medical needs than probably 20 other States and any two cities may have completely different medical needs. I just don't see how any current National System could possibly unite all these differences into one viable program.

 

Responsibilities under your definition is the epitome of my arguments and from two angles. If a person wishes to Smoke, do drugs, drink excessively, drive a motor cycle over 30 auto, play football it is not then the my responsibility to protect them from the effects of their choice. Then, I do smoke, did drive a truck, even owned a small trucking company (when the profession was rated second most deadly) paid the exorbitant insurance cost and todays tobacco tax, but do not hold or think I should be given universal acceptance to what effects this has or will cause on my health.

 

Oh yes; Our poor people (medicaid) and those on SS/Medicare, which are paid cash benifits also pay a portion for what is already furnished health care.

CHIP's or most child care is not and those not recieving any assistance simply go to the nearest clinic or Hospital for health aid, ingrown toenail to a heart attack.

 

Bear's Key; Nobody files chapter 13, for paying Insurance Cost and filing does not absolve TAX debt to government in the US. (agreements can and often arranged while under chapter 13).

 

Each State has it's own system, I'll use Michigan for this;

 

Among consumer chapter 7 debtors who file on a typical day, there are about:

 

-- 133 who owe at least $75,000 in credit card debt;

 

-- 191 others who owe between $50,000 and $75,000 in credit card debt;

 

-- 32 with over $50,000 in medical debt;

 

-- 18 who owe at least $500,000 in unsecured debt;

 

-- 500 who are either retired or disabled;

 

-- 200 who are age 70 or older.

From; http://www.freshstartbankruptcylawyers.com/Michigan-Bankruptcy-Laws-Bankruptcy-Court.htm

 

 

Note on a typical day 700 of 1000 filings under chapter 7 are either retired or disabled or over the age of 70.

 

Chapter 7

 

Liquidation Under the Bankruptcy Code

 

The chapter of the Bankruptcy Code providing for "liquidation," ( i.e., the sale of a debtor's nonexempt property and the distribution of the proceeds to creditors.)

 

What this infers to me is salvation of transferable estate values, not the afford ability of medical services or what was previously an expense. That is the person or the executor of a persons estate drains the asset value first, then files to make that person eligible for certain care not covered under Medicare (special assisted or full service institutions). It is a guess (I Don't know) but feel the same stuff goes on in the UK where certain services are not available under their Health care Program, but will be under circumstances no matter how achieved.

[JohnB]

Some interesting points have been brought up, but what is making the debate difficult seems to be the American tendency to see things in only black or white. Free market v Socialism. The colour "grey" does exist, you know.

 

Some of the comments are amusing.

believe me, we've heard the freaking left wing mantra chanting centralization and efficiency like republicans mumbling tax cuts. Yes, iNow, we understand why you all find socialism so fascinating.

Since I'm arguing for iNows side (Which must be a first:D) I can only assume that this type of comment includes me. For the record, I'm right wing, as I thought most would have assumed by now. When UHC first came to Australia I was against it, regarding it as socialism and all the other epithets I see in this thread.

 

I came to realise that it isn't socialism, just a benefit of living in an advanced nation.

 

But try to peel your eyes away from the moral glory of spending other people's money for a second

Spurious argument. This comment would also apply to those arguing for spending on schools, defence, police or any one of the areas that a gov spends money on.

 

Now then as to "taxes" and the whole "I don't want to pay for other guy" argument. This is missing the obvious reality, you already are. Your gov spent $2.4T last year on health care, that is your tax money.

 

I watched the entire program that ecoli linked to and find it gratifying that the US is finally coming to the "small clinic" solution that all Australians have enjoyed for 30 years or so.

 

While we do have UHC, it is truly a mixed system. Small clinics like those shown in the program exist all over, they are actually the norm here not the exception. Having a quick look at the "Yellow Pages" for Brisbane (pop 1.1 million) I find 22 pages of General Practitioner Doctors, virtually all working from local clinics. The only difference between ours and the one shown in the vid is that we wander into a Medicare office and get a rebate on the consult.

 

The larger clinics (6-8 Doctors) have their own X-ray equipment and are quite capable of doing small outpatient surgical procedures.

 

The third of ecolis links:

http://www.jpands.org/vol13no1/larson.pdf

does indeed contain horror stories, but let's look at it dispassionately.

From the article:

This is reality in Malmo, Sweden’s third largest city. To see a

physician the 280,000 residents of Malmo have to go to one of two

local clinics before they can see a specialist.

Two clinics? That is disgusting. But let's compare here.

Malmo 250,000 people 2 clinics.

Brisbane 1,100,000 people.

Using the Locality Guide which lists clinics by suburb, there are 20+ clinics in the "A"s alone. It's hard to tell how many there actually are as many list themselves as servicing the surrounding suburbs as well as the one they are in. AFAIK, there are no suburbs without a clinic and many have more than one. I can say that there are easily 100+ Private Medical Clinics in Brisbane and I can go to any one of them without fear or favour.

 

Consequently ecolis worry about fully "socialised" healthcare is probably very valid. However the complaint doesn't apply to mixed systems. Apples and Oranges.

We have one State alone with 36M (California), one area with 20 million (LA/Orange County) with entirely different medical needs than probably 20 other States and any two cities may have completely different medical needs. I just don't see how any current National System could possibly unite all these differences into one viable program.

I see where you are coming from, however as I said in a previous post, under our system the Federal money is given to the States to spend. I think that this is the answer you are looking for as it puts the responsibility onto the States to spend the money wisely.

 

Your bankruptcy figures are interesting but devoid of detail. What did all those who filed for Credit Card debt spend the money on? It is at least possible that the reason for the Credit Card debt was medical expenses, is it not? The figures might be skewed.

 

Even if they aren't 32 people every day are filing for bankruptcy because of medical debt. This is unheard of in the rest of the developed world.

I find my problem is that healthcare is very much like other wealth redistribution programs we have, in that it's just money changing hands with minimal (if any) gain for those who paid it. Additionally I feel that the current payment structure for the healthcare industry is terribly broken. Any government involvement would almost set in stone the failing system as is, with a lot of bureaucratic obstacles to change it.

I just don't see where "wealth redistribution" comes into it. Your Federal gov is already paying 3 times as much per capita than ours is for no better outcome, in fact a worse outcome in virtually every area.

 

Considering a different "mixed" system doesn't have to mean more taxes, just spend the money you already do more wisely.

 

I would think the first thing you need to address is the number of lobbyists, that number is obscene.

 

A note on efficiency. The Australian Federal gov spent some $34 B last year with admin costs of $900 M (which I think is still a bit high) but that is still only a 2.6% admin cost. I would call that "efficient", wouldn't you?

 

Yes, I've become an advocate of our system, especially as i think it would be a good model for you to start with. It's a good mix of "Public" and "Private" and there is no shortage of Medical Insurance Companies an Australia and they all make a profit. (Some say too much)

 

But why not look for yourself?

http://www.medicare.gov.au/about/whatwedo/medicare.jsp

Medicare is Australia’s universal health care system introduced in 1984 to provide eligible Australian residents with affordable, accessible and high-quality health care.

 

Medicare was established based on the understanding that all Australians should contribute to the cost of health care according to their ability to pay. It is financed through progressive income tax and an income-related Medicare levy.

 

Medicare provides access to:

 

free treatment as a public (Medicare) patient in a public hospital, and

free or subsidised treatment by medical practitioners including general practitioners, specialists, participating optometrists or dentists (for specified services only)

What Medicare covers.

The benefits you receive from Medicare are based on a Schedule of fees set by the Australian Government. Doctors may choose to charge more than the Schedule fee.

 

Out-of-hospital services

Medicare provides benefits for:

 

1. consultation fees for doctors, including specialists

2. tests and examinations by doctors needed to treat illnesses, including X-rays and pathology tests

3. eye tests performed by optometrists

4. most surgical and other therapeutic procedures performed by doctors

5. some surgical procedures performed by approved dentists

6. specified items under the Cleft Lip and Palate Scheme

7. specified items for allied health services as part of the Enhanced Primary Care (EPC) program—contact Medicare on 132 011 for more information

You can choose the doctor who treats you for out-of-hospital services.

 

In-hospital services

Public Patient

If you choose to be admitted as a public (Medicare) patient in a public hospital, you will receive treatment by doctors and specialists nominated by the hospital. You will not be charged for care and treatment, or after-care by the treating doctor.

 

Private Patient

If you are a private patient in a public or private hospital, you will have a choice of doctor to treat you. Medicare will pay 75 per cent of the Medicare Schedule fee for services and procedures provided by the treating doctor. If you have private health insurance some or all of the outstanding balance can be covered.

 

You will be charged for hospital accommodation and items such as theatre fees and medicines. These costs can also be covered by private health insurance.

(Emphasis and point numbers mine.)

 

You're welcome to look around the site. That is what we have and it provides a level of service equalling or in most cases exceeding the service in the US. And does it for 1/3 the cost of your current system.

[iNow]

Consequently ecolis worry about fully "socialised" healthcare is probably very valid. However the complaint doesn't apply to mixed systems. Apples and Oranges.

 

<...>

 

I just don't see where "wealth redistribution" comes into it. Your Federal gov is already paying 3 times as much per capita than ours is for no better outcome, in fact a worse outcome in virtually every area.

 

Considering a different "mixed" system doesn't have to mean more taxes, just spend the money you already do more wisely.

 

This point seems so obvious and clear to me. It's true, and it demonstrates just how everyone keeps talking around the issue and dismissing discussion with silly labels and forced ideologies.

 

What better argument does one need to get past these tired old arguments of labeling and move forward with the suggestion that the US can provide Universal Health Care right now? The numbers alone defeat the socialism and free market false dichotomy which keeps rearing its ugly head in this debate every time it's raised.

 

 

That is what we have and it provides a level of service equalling or in most cases exceeding the service in the US. And does it for 1/3 the cost of your current system.

 

QFT

[The Bear's Key]

WAS IT FREE?. Who paid for those Doctors/Surgeons Educations, the Hospitals or the high tech equipment in the. Who paid for your office calls, medications, your hospital stay and no doubt some cost while recovering?

The rub: they pay for it and yet can afford everything we can. Perhaps more. Does anyone go bankrupt in UK from paying medical taxes?

 

Nobody files chapter 13' date=' for paying Insurance Cost and filing does not absolve TAX debt to government in the US. (agreements can and often arranged while under chapter 13). [/quote']

I mentioned tax not as a cause of bankruptcy...rather as an illustration for comparison.

 

Two systems: one universal, the other not. The first you pay taxes, the second you pay insurance. The first is unlikely to break your wallet, the second often does and even causes people to file bankruptcy -- 11,680 a year filing in the state of Michigan alone (with over $50,000 in medical debt).

 

According to your figures. But imagine adding the other 49 states. That's a lot of freakin people. Do you see how in the UK (or Australia), paying the tax for universal healthcare causes far less of the bankruptcy filings of the U.S. due to healthcare bills -- even after having paid insurance?

Edited April 11, 2009 by The Bear's Key

[ParanoiA]

JohnB, you've misunderstood me. I was leveraging balance to the exchange with ecoli and iNow. In context, my statements were about putting down the pro-socialist ideology for a second and just listen to ecoli's point on competition. Not a rejection of the universal approach.

 

My point being that we must stop it with dismissing the concerns of each side - the capitalists and the socialists, for generality's sake. And that's in keeping with my theme that we do something better and different. And I think we start by acknowledging the strengths and weaknesses of each - for real.

 

I don't dispute much of anything in your post and I can only guess you missed my tentative support of a universal approach. My hangup is about the mechanics and not exchanging one set of problems for another. I want to see innovation, not repeat performance.

 

Our current system is as socialist in-effect as the NHS, well, for the ones that can afford it that is.

[jackson33]

I mentioned tax not as a cause of bankruptcy...rather as an illustration for comparison.

 

Two systems: one universal, the other not. The first you pay taxes, the second you pay insurance. The first is unlikely to break your wallet, the second often does and even causes people to file bankruptcy -- 11,680 a year filing in the state of Michigan alone (with over $50,000 in medical debt).

 

According to your figures. But imagine adding the other 49 states. That's a lot of freakin people. Do you see how in the UK (or Australia), paying the tax for universal healthcare causes far less of the bankruptcy filings of the U.S. due to healthcare bills -- even after having paid insurance?

 

Percentage wise most BR are filed by older folks and IMO for a variety of estate reasoning. In short it's the poor person answer to a living trust for those with with wealth. Keeping to the Health Care problem, we have about

7 MILLION, auto accidents every year in the US, resulting in somewhere around 40k Deaths, many more injuries and many involve LONG term care, say for life. Then we do have 'by choice' a large number of the 21-55 age group (where most uninsured are) that lose their bet with the odds, get sick or injured or the traditional 3-5/6% of unemployed (lost insurance or the funds to buy) that become sick or disabled while w/o insurance. (remember by law they have the right to maintain insurance, if under a policy while working).

 

Michigan courts handle at least 265,000 Chapter 7's a year, not to mention the less common 11's and 13's for individuals. Of these and not distinguished are a large number of failed business ventures and I would bet most these involve some local/State/Federal Tax problem, not even excused by bankruptcy. Michigan economy has really been hurt over the past ten years of so, but even 11.6k of the 265k, seems rather low where a $50k medical debt is a contributor. As for all the States (Michigan has 10+ million people, about 1/30th the total) so your talking 350,000 Nationwide filings, think about 1/3rd the average failing of business alone, a drop in the bucket.

 

The UK and especially Australia are not the US or necessarily like any of our 50 States and 5 territories. This is my argument and the point of feeling people in one State will not want to responsible for people in other States. Frankly, in States like California, folks outside metropolitan areas are not happy being taxed for city life problems and prevalent in NYC and everything else which is called up-state NY. Then go back to State on State and under Federal, half the population KNOWS they are paying for many the needs of the other half and with UHC this will be taken to extremes. We also have pre-existing problems in our SS and HC services set up under previous government, which are NOT sustainable today. Adding to these future problems with larger numbers is building a class war fair scenario, nobody wants...

[bombus]

The following short excerpt comes from democracyandsocialism.com.

 

Interesting reading:

 

The first ever American Human Development Report launched on July 17, 2008, by Oxfam America, finds that although the US spends more per capita on health care than any other nation in the world (5.2 billion dollar daily), its citizens live shorter lives than citizens of virtually every western European and Nordic countries.

 

The US has a higher percentage of children living in poverty than any of the world’s richest countries. The US ranked 34th in the survival of infants to age. There are huge gaps in living standards and quality of life among different US states. The US ranked 42nd in global life expectancy. Some Americans are living anywhere from 30 to 50 years behind others when it comes to issues we all care about: health, education and standard of living.

 

Suicide and murder are among the top 15 causes of death in the US. Although the US has 5% of the global population, it contains 24 % of the world’s prisoners.

 

The report concludes that even though the US is one of the most powerful and rich nations in the world, it is woefully behind when it comes to providing opportunity and choices to all Americans to build a better life.

 

Despite an almost cult-like devotion to the belief that unfettered free enterprise is the best way to lift Americans out of poverty, the report points to a rigged system that does little to lessen inequalities.

---

Merged post follows:

Consecutive posts merged

Our current system is as socialist in-effect as the NHS, well, for the ones that can afford it that is.

 

That's a good'un!

Edited April 12, 2009 by bombus
Consecutive posts merged.

[jackson33]

 

I see where you are coming from, however as I said in a previous post, under our system the Federal money is given to the States to spend. I think that this is the answer you are looking for as it puts the responsibility onto the States to spend the money wisely.

 

Your bankruptcy figures are interesting but devoid of detail. What did all those who filed for Credit Card debt spend the money on? It is at least possible that the reason for the Credit Card debt was medical expenses, is it not? The figures might be skewed.

 

Even if they aren't 32 people every day are filing for bankruptcy because of medical debt. This is unheard of in the rest of the developed world.

 

I just don't see where "wealth redistribution" comes into it. Your Federal gov is already paying 3 times as much per capita than ours is for no better outcome, in fact a worse outcome in virtually every area.

---------------------------------------------------------------------

 

 

The probability is your Federal distributes funds according to population, mandates a great deal of policy and any short falls either are made up by the State or they reduce/delay services. All indications from your post it's reduced services...

 

I'll make this up on the fly; In the US we have 365 Congressional Districts, each with between 6-800k people. LA and Orange Counties California have around 25 Districts, where Alaska, Montana, Wyoming and four other STATES have one district. Our Insurance Companies would love to set up any district with some form of Group Policy (something close today already exist with Auto/Home/Fir/Flood and other forms of insurance).

 

With one Company per one district, you can bet the top 10-30 Financial Institutions that carry Health Insurance would fight over probably 250 of these districts contracts (say good for a 10 year period). There would be little trouble with another 100 districts, with somewhat higher cost (exist under tax structures today) and maybe 65 that would be to costly for any one Company to handle. If no acceptable bids were received (probably for cost per person) the district could accepts dual insurance

from two sources. Point being a district responsibility, governed by the State. A deductible insured by one at a higher price for up to 10% of all cost and the primary covering 90%, either based on first cost or all cost. There are so many potential ways to go, it would be hard to explain...

 

I would like to see Medicare/Medicaid go private with in some program, including disability. States today are the arbiter of Federal spending and there is no incentive to restrict access by the State, quite the opposite. SS, which was at one point optional in the US (two Texas Counties do not participate, with remarkable results from an alternative system) and there has been talk of privatizing SS. It is probably to late, as of this year. more is going out than coming in and 8-10 years ahead of previous estimates.

 

Redistribution is commonplace, even with the private sector. The difference is, government has no means to increase the value of premiums, does have the authority to distribute as seen fit and is 100% totally unregulated. They make up the regulations to fit their desires to maintain power and possibly control over the populace. The private sector, is responsible to their consumer under contract law, has no more right to break those contracts than the customer and HAS a means to increase the value of paid premiums. It's no different than buying stock or a portion of some company, which you would do hoping they increase in value and/or pay a dividend/premium, which is the persons choice to participate in some manner. Our taxes are an investment to the operation of government (Local/State/Federal) to whats expected by each government as has been set out under State/Federal Constitutions, Local Charters and sets of laws in each State or under the Federal Jurisdiction.

 

Again; Home/Auto/Business/Life, many others including all kinds of Health Insurance are available with in the private sector TODAY. Most work just fine including MOST of the Health programs. You and UHC proponents keep coming back to cost per person in the US. I would suggest, the cost includes thousands of programs, for programs around the world or around the US and once again to the 20-30 millions folks not citizens (legal/illegal) who take advantage of laws the medical industry must follow, not to mention mandates by one or another government on what is required or that medical facilities are obligated to by

little restriction in tort law to question...We have a several thousand mile boarder with Mexico and Canada, hundreds of towns, especially along the Mexican Boarder that have relied on American Health Care for a hundred years, paid for or not. We also have a large number of affluent folks, who spend billions each year non essential non-medical problems (Cosmetic Surgery/Sex Change), have routine visits for psychiatric assistance and a very large prison population all of which get class A medical attention...

[Pangloss]

In the US we have 365 Congressional Districts

 

Minor correction: 435.

[JohnB]

JohnB, you've misunderstood me. I was leveraging balance to the exchange with ecoli and iNow. In context, my statements were about putting down the pro-socialist ideology for a second and just listen to ecoli's point on competition.

Rereading your post I can see how it (if actually spoken) could be said in an "exasperated" tone. From the ROW perspective it looked like another attempt to reduce things to black and white.

 

I accept your point about not instantly dismissing the points of the opposing side. However it would be harder to dismiss them if the opposing side actually answered the questions put to them.

 

Simply put: "In a free market, "for profit" system, who is going to insure or otherwise look after the "unprofitable" section of the populace?"

 

The answer of course is "Nobody". This will lead to more bankruptcies, another strain on the court system. More people in poverty and homeless which will increase your crime rate as they try to survive. More death and disease.

 

A true "free market, for profit" simply will not work. The other side of the coin is that, as ecoli has posted links to, total "socialist" medicine doesn't seem to work that well either. But nobody is advocating "socialist" medicine, are they? The UHC proponents are advocating a mixed system, I know I certainly am.

 

Frankly some of the "free market" proponents arguments remind me of the socialists during the 70s and 80s. They would espouse at great lengths how the world would be a wonderful place with the fall of capitalism and the rise of global socialism. The system would work much better. They couldn't tell you how or why, but they just "knew" it would.

 

The quote from Bombus is right, it is an almost "cult like devotion" which is seemingly apparent to everybody except Americans.

 

The UK and especially Australia are not the US or necessarily like any of our 50 States and 5 territories. This is my argument and the point of feeling people in one State will not want to responsible for people in other States. Frankly, in States like California, folks outside metropolitan areas are not happy being taxed for city life problems and prevalent in NYC and everything else which is called up-state NY. Then go back to State on State and under Federal, half the population KNOWS they are paying for many the needs of the other half and with UHC this will be taken to extremes.

So you're basically saying that Americans are a bunch of selfish b*stards who wouldn't p*ss on their neighbour if he was on fire, is that it?

 

No, you're not us, you have your own problems. But guess what, so do we. We cover a continent the same size as the US and have only 22 million people to pay for it. No other nation on earth has had the need for something like the Royal Flying Doctor Service. In no other nation do you need the ability to fly people 1,000 km for a CAT scan. We do it because we can afford to put a scanner in every town with 60 people.

 

Do you think we don't have rivalry between the States and regions of States? Of course we do. Country people aren't fussed on their taxes going to pay for city things and city people aren't too happy with paying for country things. People bitch and moan all the time.

 

However we all as a nation understand that there has to be some give and take. Country New South Wales has a lot of sheep, Queensland has coal and cattle, Western Australia has bucketloads of Iron Ore, Victoria has,......., Victorians. We are many facets of the one nation, so there is give and take.

The probability is your Federal distributes funds according to population, mandates a great deal of policy and any short falls either are made up by the State or they reduce/delay services. All indications from your post it's reduced services...

"Reduced Services"? Where did you get that? I would point out that even if that were true, then our "reduced services" are still better than the American "full services".

 

Our funding is not distrbuted on a per capita basis but more as a function of both population and size. Our largest State, Western Australia is 50% larger than Alaska and all the others bar Victoria and Tasmania are bigger than Texas. Victoria is slightly larger than Minnisota and Tassie is a bit smaller than South Carolina.

 

Consequently funding is based on giving the widest coverage. Working solely from population would be inequitable as there would be more Hospitals in some cities than in some States.

 

[Aside] This "district" thing. Is this why Washington DC is "District of Columbia"? [/Aside]

You and UHC proponents keep coming back to cost per person in the US. I would suggest, the cost includes thousands of programs, for programs around the world or around the US and once again to the 20-30 millions folks not citizens (legal/illegal) who take advantage of laws the medical industry must follow, not to mention mandates by one or another government on what is required or that medical facilities are obligated to by

How about instead of "suggesting" you find some figures to back it up? We've been quoting them, at best your "suggestion" is an opinion, nothing more.

 

As to the 20-30 million illegals, that's funny. Are you suggesting that so much is spent on the healthcare of those 20-30 million, that it drives the average up for the other 270 million to 3 times the ROW level?

We also have a large number of affluent folks, who spend billions each year non essential non-medical problems (Cosmetic Surgery/Sex Change), have routine visits for psychiatric assistance

All paid for by their insurance, which being affluent, they can afford, so what?

and a very large prison population all of which get class A medical attention...

So do ours. They may be prisoners, but that doesn't make them sub human. They also get full Optical and Dental care while incarcerated. We do this because the fact of their incarceration means that they can't go elsewhere for the treatment.

Again; Home/Auto/Business/Life, many others including all kinds of Health Insurance are available with in the private sector TODAY. Most work just fine including MOST of the Health programs.

Again:

Less Doctors

Less Nurses

Fewer Hospital Beds

Higher Infant Mortality

Lower Life Expectancy

Higher Cost per capita

Over 11,000 people in Michigan declaring Medical Bankruptcy every year.

1.5 million Americans losing their homes over medical costs every year.

 

I would suggest that the last thing you could say is that they "work just fine", wouldn't you?

 

From a Reuters Article 2005

WASHINGTON - Half of all U.S. bankruptcies are caused by soaring medical bills and most people sent into debt by illness are middle-class workers with health insurance, researchers said on Wednesday.

 

The study, published in the journal Health Affairs, estimated that medical bankruptcies affect about 2 million Americans every year, if both debtors and their dependents, including about 700,000 children, are counted.

"About half cited medical causes, which indicates that 1.9 to 2.2 million Americans (filers plus dependents) experienced medical bankruptcy,"

"Among those whose illnesses led to bankruptcy, out-of-pocket costs averaged $11,854 since the start of illness; 75.7 percent had insurance at the onset of illness."

(Emphasis mine.)

Bankruptcy specialists said the numbers seemed sound.

 

"From 1982 to 1989, I reviewed every bankruptcy petition filed in South Carolina, and during that period I came to the conclusion that there were two major causes of bankruptcy: medical bills and divorce," said George Cauthen, a lawyer at Columbia-based law firm Nelson Mullins Riley & Scarborough LLP.

so your talking 350,000 Nationwide filings, think about 1/3rd the average failing of business alone, a drop in the bucket.

A drop in the bucket? Your Congress doesn't think so. Bill H. R. 901 says in part:

This Act may be cited as the ‘‘Medical Bankruptcy Fairness Act’’.

Section 707(b) of title 11, the United States Code,

10 is amended by adding at the end the following:

11 ‘‘(8)(A) No judge, United States trustee (or

12 bankruptcy administrator, if any), trustee, or other

13 party in interest may file a motion under paragraph

14 (2) if the debtor is a medically distressed debtor or

15 an economically distressed caregiver.

Someone obviously thinks it's a serious matter.

 

Now I must be fair.

 

The study quoted by Reuters I mentioned earlier was refuted in a later piece in "Health Affairs" 2006.

 

However this was comprehensively refuted by the authors of the original study here. They quote previous studies with similar findings as Exhibit 1.

However, as is pointed out in a following article "Bankruptcy is the Tip of a Medical-Debt Iceberg" and I quote:

Given health care cost trends, it is likely that the ranks of the uninsured will continue to grow. Health insurance premiums increased 73 percent between 2000 and 2005, while workers’ wages increased 15 percent and the general rate of inflation was approximately 14 percent.

So costs up 73% and wages up 15%, yep that is increasingly affordable.

Another national survey found more than fifty-eight million U.S. adults at high risk of incurring medical bills they might not be able to afford. This figure included more than forty million adults who were uninsured for all or part of the previous year and 17.6 million adults with private insurance reporting substantial problems paying their medical bills.

So even with insurance a large percentage of your population still has "substantial problems" paying medical bills.

Fully half of those with private insurance and medical debt had household incomes of more than $40,000; among this group, one-third were college graduates or had postgraduate educations.

People with medical debt—both uninsured and those with private insurance—are much less likely than those without debt to fill a prescription, see a specialist when needed, or visit a doctor or clinic for a medical problem, and they are more likely to skip a needed test, treatment, or follow-up.

The sick just keep getting sicker, don't they?

Families also trade medical debt off for other types of debt. In the same survey, one in five medical debtors took on large credit card debt or a loan against their home to pay medical bills.

Well now we know what those silly people were putting on their plastic, don't we? Do you want to reconsider your bankruptcy statistics yet?

 

How about some more from that 2005 report?

"Most were average Americans who happened to get sick," he says. "Health insurance offered little protection. Families with coverage faced unaffordable co-payments, deductibles, and bills for uncovered items like physical therapy, psychiatric care, and prescription drugs. And even the best job-based health insurance often vanished when prolonged illness caused job loss -- precisely when families needed it most. Too often, private health insurance is an umbrella that melts in the rain."

His report shows that during the two years prior to filing for bankruptcy:

 

40% lost telephone service

19% went without food

54% went without needed doctor or dentist visits because of cost

43% did not fill prescriptions because of cost

15% had taken out second or third mortgages to pay for medical expenses

1/3 continued to have problems paying their bills following bankruptcy, including paying their mortgage/rent and utility payments

Even after filing for bankruptcy a number (3.1%) were turned down for jobs, 5% were turned away on apartment rentals, and 9% were rejected for car loans

 

These aren't the homeless FCOL, these are average, middle class Americans who are getting royally screwed.

 

To sum up:

 

I believe the proponents of UHC have conclusively shown that there is a good case for it. That it can and does work in other nations, delivering better services for a lower cost than anything the US has tried.

 

The "Anti" case can be dismissed on the basis of their arguments:

1. "It's not my responsibility". Personal argument. Just because you might be a selfish b*stard, doesn't mean all Americans are.

2. "It's socialism". No, it's not. Unless you use a different definition than the rest of the planet does.

3. "America is different." Big woop, we're all different, deal with it.

4. "America is special". Did it ride on the bus with the other "special" kids to nationhood school?

5. "We already have World Class service". Provided you don't actually compare your service to the rest of the world, I suppose you do.

6. "It will stifle innovation". Since not all breakthroughs and innovations come from the US this is demonstratably untrue.

7. "We don't want to copy others, we should be able to find an even better system." Yes, you might. But how many will die or face financial disaster while you look? Copy somebody else while you look for the better system, it's a win win that way.

 

(3 and 4 are particularly worrying as they imply an inability for America to solve the problem. I personally have more faith in Americans than that.)

 

Face it boys, we've got the figures and facts, all you have are emotional arguments. You're on a hiding to nothing.

 

It might seem odd for an Australian to be arguing so hard for a purely US thing, but I think you deserve to have a health system that is world class. I'm arguing that you should have all the things that Australians take for granted.

 

Furthermore, you must admit that if someone slightly to the right of Attila the Hun like me can agree with that Global Warming Alarmist, Pinko, Lefty, Tree Hugging, SOB iNow on this topic, then we might just have a point.

[bombus]

Wow, good post JohnB!

 

I recently half watched (I had to wrote a report so didn't see it all) a documentary about the US healthcare system on UK TV. I must say, I was appalled. In one case it appeared that a young woman with cancer couldn't get treatment because she didn't have medical insurance (she was too poor to afford it - living in a trailer etc). Does that really happen in the US? I missed the ending so maybe everything was OK and the documentary was just trying to up the drama!

 

If such things do happen, how can the richest nation on earth justify that sort of behaviour? One might as well be poor and ill in a third world country.

 

Apparently Cuba, despite it's poverty, has one of the best health systems in the world, basically because the Government thinks that healthcare is a fundamental right and takes top priority. I know that the British NHS and Cuban 'NHS' have collaborated on research projects.

 

The British NHS has also been asking how can Cuba give such good healthcare for just £7 per head in 2000 (!?). The article below is worth a look. It reckons Cuba has as many Doctors as the UK but with a fifth of the population!

 

http://www.guardian.co.uk/society/2000/oct/02/NHS.futureofthenhs

Edited April 13, 2009 by bombus

[ParanoiA]

Simply put: "In a free market, "for profit" system, who is going to insure or otherwise look after the "unprofitable" section of the populace?"

 

This, if for no other reason, is the reason why I entertain a universal type approach. As I stated before, the classical free market can't really work without all of the forces in play, and unless we're willing to let people suffer without service then we're creating the imbalance that undermines it. So if we're going to put people ahead of profit, which is entirely called for on the subject of healthcare, then yeah, that's the government's charge, I'd say.

 

Otherwise, you have the mess we have now - a socialist bubble within a capitalist framework that not everyone has access to. It's sad, because it filters the insured with capitalist methodology, and then for those who get covered, choice is effectively taken away with "In Network" requirements, which feels like socialism. The shit end of both.

 

I propose we flip that around. A more socialized/universal framework that covers everyone and effectively cultivates competition and innovation within that market. That has to be done structurally. Bonus packages and incentives is not good enough. It needs to effect someone's food supply, if you know what I mean. That's what makes men create consistently: necessity, not lust.

 

I prefer we continue to exploit that dynamic in whatever universal system we establish.

---

Merged post follows:

Consecutive posts merged

Does that really happen in the US? I missed the ending so maybe everything was OK and the documentary was just trying to up the drama!

 

If such things do happen' date=' how can the richest nation on earth justify that sort of behaviour? One might as well be poor and ill in a third world country.[/quote']

 

Yes it does happen and that's why we're talking about it. I think it should be a fundamental privilege, like transportation, education and etc - a staple institution that can redirect our cult like devotion to capitalism to the network within it.

 

The video shows some examples of systems doing that in one way or another, and lessons to be learned from all of them.

Edited April 13, 2009 by ParanoiA
Consecutive posts merged.

[iNow]

I shared another video about some real stories in the US back in post #62. It shows just how real it is in the US.

 

 

For those of you who watched and enjoyed the special in the OP, Sick Around the World, here is the follow-up which was on this week:

 

Sick Around America

http://www.pbs.org/wgbh/pages/frontline/sickaroundamerica/

 

 

 

It was this one which really got me going and pushed me to open a dialog here with you all.

 

Watch here:

http://www.pbs.org/wgbh/pages/frontline/sickaroundamerica/view/

[jackson33]

John; I'll go on with this discussion, but one thing you are assuming is totally incorrect. What is good for you, your Country, your traditions and culture or anyone else and theirs, IS NOT MY ARGUMENT. It's MY OPINION, based on my understanding of the US Constitution, the history of THIS people, the traditions and the laws set over time. Frankly, I am personally pleased to hear anyone talk good about their systems (health or others issues) and worry only when people from this country seem so hateful of their heritage or what made them the privileged 'homo sapians' on this planet. I call it Individualism and a level playing field for each person to achieve what ever their ambition, drive and talents will allow....

 

http://www.chcf.org/documents/insurance/HealthCareCosts06.pdf

 

Requires Adobe, 24 pages but worth a read...IMO. Gives some historical understanding to when and where health care became an issue or when this care began to increase. A couple things to note; Chart page 3, 1960 annual National Overall Cost was 26B, compared to todays 2.4T with about twice the people. Today we spend about 14B alone on Cosmetic Surgery and like it or not give medical service on request by law. Pick your own source on what these estimated cost are, but hundreds of Hospitals, even non-profit have simply folded up shop, gone private or into a specialty not required to service emergencies. http://findarticles.com/p/articles/mi_qn4190/is_20070831/ai_n19502805/

 

As a proponent of Immigration Reform, it's hard for me to argue restricting the use of American Facilities for Mexican Nationals, but yes it does drive up the cost of service, under supply/demand if nothing else. Were talking about

2-4 million living in Mexico daily, that visit legally through check points and receiving service, where no questions can be asked, even if they cared to ask. Then up to 20 million, scattered through out the country doing work Americans probably will no longer do but do get sick, have accidents, domestic issues or what ever it takes to require medical attention. Near 7000 people die alone in the US EVERY DAY, 2.5 million a year, 1/8th your total population, and I have no idea how many get injured or sick in any one day.

We have over 1 million legally enter this country each year, have legal work programs, school student exchange programs, the largest diplomatic representation on the planet and a host of programs allowing certain people into the country for emergency reasons, temporarily or permanently. I am sure you and most industrialized countries have similar programs, but I assure you nothing near the figures of the US. Admittedly, some are required to have and maintain 'International Insurance' and many have sponsors agreeing to pay unexpected cost.

 

The long and short of UHC in the US, not mentioned (that I know of) is the current Globalization of Business activity. As the only Country where Corporations/Business, still offers insurance under some system of co-payment, business is handicapped to compete with those foreign competitors have no such expense. We have held a 'productivity' level or efficiency over most for many years, but this is fading where aged factories and models have been utilized.

 

I would have liked a constructive discussion on my 'District Insured Program' for use in the US, using the correct number of districts. (will address that figure later). Anyway you look at it, people are going to pay the Government or the Insurance Company for the medical needs of the total. I feel localizing where needs do differ, those persons will pay for their problems, opposed to everyone being responsible for everyone else. That takes away incentives which are essential to quality or a desire to be the best. As for Private Sector vs. Government, until government creates a means to take funds and increase the value of those funds, IMO it's not arguable.

 

ParanoiA; My 365 district error was more than minor. As many post I've offered on Congress that 435 should have rolled out without a thought and then to dissect it to 365 borders the error on dementia, which us older folks always worry about. Any way yes you are correct 435 and I'll place the dissections at 250-125 and 60.

 

Setting the dynamics of a FUTURE US Health Care System, is the argument, not that one will happen. Once established, Act one FDR New Deal, Act two Johnson's Great Society it becomes American Policy and to be built on. What's being proposed is New Deal II and a final act to National UHC.

 

Frankly what is established or has been established elsewhere is dependent on the society it exist in. The US has built a social/economic society/structure around an ever increasing population, where these internals are fighting themselves. Conservatives have for some reason opposed immigration or the same people the Corporate World has encouraged into this country for 50-60 years and yet opposes UHC to protect the same business that requires them and would support that increasing population. Liberal thinking is to increase the population however achieved, but to limit business or their ability to access a working class (higher wages/cost/taxes). Neither in my opinion is making much sense.

 

We have an aging population, like it or not and with age comes an increase in medical needs, which will cost more and more regardless of who pays what or collects from who, those cost. Mentioning dementia, we have 78M baby boomer's, and expectations are by 2050 for up to 17M Americans with Alzheimer's alone, there are other forms of dementia, in the US. I don't know if you have checked out cost per Nursing home resident but it can be 6-8k per month per patient, plus other medical treatments or medications for the current KNOWN 5 or so million around today.

 

An interesting article on Australia and the problem;

http://www.smh.com.au/articles/2003/05/27/1053801395981.html

 

In the US; http://www.globalaging.org/health/us/2007/alzheimers.toll.htm

 

I don't really like going here but it's important when Government is the last resort for medical assistance IMO. Euthanasia is Governments only alternative when funding for something becomes impossible, for whatever the reason. It happens every day already with insurance when body parts are just not availably or where some personal habit (drugs/alcohol/smoking/age) are considered in who gets what or who is first serviced.

[JohnB]

jackson, not ignoring you, just taking time to put together some more complete ideas.

[JohnB]

jackson, I don't know that the actual numbers are of value sometimes. In a given area of medicine you will probably have 10 times as many sufferers as we do, but you also have 10 times as many people to pay for treatment facilities.

 

It's more about percentages then total numbers, if you get my drift. To that end, it should actually make the job of providing care easier for you than it is for us. To have a DI machine/population ratio of 1 per million means that we would have 22 machines in the entire nation whereas you would have more than that in some cities. We already fly people 1,000 km for a scan because we can't afford more machines.

 

As to district based insurance, I see a number of problems. Firstly, it is a modification of your current system, which isn't working. At some point, like a car, you have to admit the problem, junk the old one and start afresh. Frankly that is what I think you should do.

 

Secondly, why cut the US up into little chunks? Let the insurance companies vie for business across the entire nation. I just can't see a logical reason for restricting their market, they should be able to provide service across state lines.

 

After all, isn't the basic premise of UHC that all Americans should have roughly equal access to facilities? This is only possible if the insurance companies and service providers aren't restricted to states or districts.

 

Thirdly, districts are political divisions that change over time. It is manifestly unfair for someone to have their insurance cover changed without their consent simply because the districts borders have been redrawn.

 

Fourthly, as I understand your system, most districts don't have an infrastructure system in place as this is provided by the various State and County Depts. Moving to District based would incur many costs and duplications of effort as "District Health Depts" would have to be created and maintained.

 

These admin costs are already too high with the pdf you linked to showing them at 7% for the current system, so adding more admin will only cause the costs to go up. Remember that Oz runs at circa 3% for doing the same job.

 

You nations culture is different from mine. The whole "States Rights" psychosis is very strange to me. Bottom line is, that if you lot want UHC for all Americans, then the States will have to give up some rights. They will have to rise above their petty small time differences and act in concert for the benefit of all Americans.

 

I do think that a system administered by the State Health Depts will have the best chance for you. They already have an established infrastructure that can be used for the new system.

 

I can think of a few reasons to model your new system on ours.

 

Firstly, our "rebate" style system is probably closer to what the US psyche will accept. Nobody here or in the US would accept govt mandated items.

 

For example, neither nation would accept a UHC system that allowed only the mandated type of spectacle frames. It isn't govs business what type of frame or lens I want for my glasses. A far better option is for the gov rebate to pay say $200 for new glasses. (or maybe 70%) This means that I can freely choose my lenses and frame from what is available in the market and is within my budget.

 

A rebate style system also encourages people to ask about costs. In one of the vids linked to previously, it was put up as something amazing that Drs had a fee scale on the front counter. This is standard under our system. Drs always discuss costs of procedures with patients, it is a basic consumer right to be informed of the costs of a product. You wouldn't buy a car without knowing the information of costs, would you? Why should healthcare be different?

 

Another reason for adopting a modified Aus system is that we have done a lot of the legwork already. In our "Shedule of Fees", which lists what the feds will pay for for each operation/test/whatever we've worked out what it costs to have a CAT scan/whatever and what the rebate will be. The purchase/running costs of such things should be roughly comparable between our nations so you could use our schedule as a baseline to work from, modifying it to suit your needs.

 

Rebates could be made available from your local Social Security Office thereby using existing infrastructure to administer the system.

 

You'll notice that for the basics, the Insurance industry has been cut out of the loop. My readings on your system show that around half of the money spent by the US fed gov is going to the insurance companies. Instead, the money goes straight to the hospitals (or actually the State gov responsible for the hospital) or directly to the consumer. This puts pressure on the hospitals to be very exact when assessing prices, rather than your current system where nobody seems to know the actual price of anything.

 

Another benefit is that under our system, even as a private patient in a private hospital, the feds cover 70% of the cost. This means that Insurance companies are covering the "Gap", the difference between the sceduled fee and what the hospital actually charges. The bottom line of this is that where you now need cover for a $100,000 procedure, this gets reduced to $30,000 "Gap" coverage. Obviously this leads to a reduction in premiums for all concerned.

 

You'll notice that at no point in this system is anybody "forced" to do anything. I have the free choice of whether to be insured or not, the main difference being whether it bothers me to share a ward with 3 other guys. It doesn't, so I don't. Note that by making this decision I take the responsibility to pay for my glasses in full, out of my own pocket. If I had insurance the company would pay. But I'm not going to pay $500 per year for something that costs me $300 every two years. It's my choice.

 

Doctors and Hospitals are not "forced" in any way to hold their fees down to the "scheduled" ones. They can charge whatever they want, but the rebate amount will stay the same. I am not tied in any way to my job, I can choose to change at any time without penalty. Nor am I effected if I move from city to city or to another State. I have complete freedom in this respect.

 

One plus for you for the change is that as you say there are a number of disused hospitals spread over the US. (The TV series "Scrubs" is filmed in one.) These could be reopened by the State govs as part of the change. Which gives the others impetus to compete with the new ones.

 

One thing is that there will be a great wailing and gnashing of teeth from the Drs and Insurance companies proclaiming the end of the world. Drs will leave, Insurance companies will close, the usual doom and gloom. Ignore it. We had the same things here when we started. We still have Drs and Hospitals and Insurance companies.

 

By all means work out the system that is best for you, I'll add comments about what I think, but ultimately the choice is yours.

 

By rough figures, you are spending about $1.5 T more than you need to. (When you look at the per capita figures) So I think it would be reasonable to chuck another $20B at reopening hospitals and the like and to change to a different system.

 

There is one cultural change that you will need to make. Americans will have to act and behave in a manner that is based on what is good for all Americans, not just their own tiny part of it. I said it before regarding govs, but it also applies to people. Anything else will divide your nation.

 

UHC is a benefit of living in an advanced society, the developed world knows this and acts on it. It means that all our citizens should have a better standard of living than those in the second and third world. A society and standard that those nations can look to and emulate for the benefit of all citizens of all nations.

 

The "Commonwealth of Nations" that Australia and others belong to has as it's most basic requirement for membership that a nation must be a Democracy.

 

I put it to you that the definition of a developed nation must include: incorrupt police, fair and just legal systems, fire services, nation wide education, free elections and UHC, as these things benefit all citizens of the nations they exist in.

 

Cheers.

[jackson33]

John; Actually we have 14/15 times the people and no doubt individual medical problems (306M/21M). It's not the numbers or percentages that concern me, but quality that UHC would bring to the US. Many times said we are already losing quality, especially outside the major medical facilities which for reason are going specialized in fear of UHC.

 

On complex diagnostic equipment, think your talking about MRI Machines, can cost well over a million each (US, Canadian or your$), can weight 7/8 tons and require complex structures to house/maintain. It's not so much the cost but the potential use for the equipment in the first place. I live in a little town of 30K in NM and we do have one, built INTO the largest medical center in 100 miles any direction, probably servicing 100k people. They advertise for patients, probably charge less than then insurance would allow and have no waiting list. Transferring the patient is a whole lot more practical than building the facilities in small Hospitals, where use would be limited. Am sure Australia will acquire more, as the cost comes down on these units, then the cost to use.

 

My district solution was made up while writing it, but have followed up with some emails, phone calls with some approval. At least in Texas. This would probably not have worked in Australia, like I think it could here, because populations there are fairly well concentrated, certainly compared to the US. I don't think their is any one district with out at least one major hospital, many having several to dozens, but where limited in numbers to one district there are many districts (LA, NYC, Houston Etc.). Then every insurance agency could bid on any or all districts and the option to accept one policy or another would fall on the people or local government, then for those that wish private insurance. IMO, 200 plus districts (all seven single district States and most rural areas), would see an instant drop in Private Insurance cost of 25 to maybe 50 percent, where their cost reflect local problems and current medical problems. Today when you apply for a General Medical Policy, say 200$ deductible, your cost is based on all similar policies around the US, where problems can wildly vary.

 

List of fees; Again in the US, the cost per any service is based on local conditions. In large towns, some services (Dentures, Eye Glasses) can be extremely low compared to small town USA. A small town may be supporting a business model (cost of equipment/personnel etc) based on a small consumer base, while metropolitan areas have large population to draw from. On the other hand where small town USA, generally have new doctors or ones nearing retirement or frankly not the best available and services are less expensive. Then we already have Medicare/Medicaid where cost of service is thought limited, but actually has increased cost well over half the industry. Where a hospital room once cost $50-80 per day, Medicare limited to 3-500/day can cost 550 (the limit plus co-payments). By nature a Hospital will charge the limits if some one will pay. To break this down 500 now paid by the Government and then the patient still paying that 50.00. This basically the point of my argument, in that Government dictates that room cost, but in effect sets the standards for Insurance and individuals

 

The end objective to any system is the availability to service at a reasonable cost. Reasonable rent in NYC is 3-4k/month and for the same in ST USA is about 500.00. It may cost you 2M/month for a good size retail shop in NYC and 10k for the same in a small town. Now enter quality, which has the best quality, likely both are equal, with a customer base (potential income).

When government gets involved or the benefit/service is based on one figure, your forcing an arbitrary and artificial value for at least most of the rest. Example in the US; SS payments are based on wages paid to every person over a minimum of 40 quarters or ten year minimum work time then increased according to quarters paid into by the benefactor. This on average works out to 1000 to 1200$ per month per worker, which will sustain existence in many places (rent/food/moderate life style), but not pay a weeks rent in some places. I am rambling now, but hope you see the connection between Federal government involvement verses State or Local which are based on completely different cost...

 

Common Wealth of Nations vs. Union of States....

http://en.wikipedia.org/wiki/Commonwealth_of_Nations

 

What if some one suggest to you, that all 53 members, should be involved in some activity that could only harm Australia in some way or that your PM suggested the other 52 States should bend to the needs of one Australian problem? Say Health Care, which in India (example) certainly is having problems. I understand the Charter is not equal to a Constitution, but the US Constitution provided many limitations of the Federal to PROTECT the States from the Federal. The States were and technically still are Independent, sovereign, States (Even used the word Nations under the early 20th Century). Would you suggest Australia is being irresponsible members of the Commonwealth or unpatriotic to the Charter (agreement) to oppose the Universal Commonwealth Medical System??? Have copied some problems in India for you consideration...

 

 

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Healthcare in India

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AIIMS' students educating slum dwellers in Delhi about water-borne diseases.

Healthcare in India is the responsibility of constituent states and territories of India. The Constitution charges every state with "raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties". The National Health Policy was endorsed by the Parliament of India in 1983 and updated in 2002.[1]

Although India has eradicated mass famines, half of children in India are underweight, one of the highest rates in the world and nearly double the rate of Sub-Saharan Africa. Water supply and sanitation in India continue to be abysmal; only one of three Indians has access to improved sanitation facilities such as toilet. India's HIV/AIDS epidemic is a growing threat. Cholera epidemics are not unknown. The maternal mortality in India is the second highest in the world.

Providing healthcare and disease prevention to India’s growing population of more than a billion people becomes challenging in the face of depleting resources. 2.47 million people in India are estimated to be HIV positive. India is one of the four countries worldwide where polio has not as yet been successfully eradicated and one third of the world’s tuberculosis cases are in India [2].

According to the World Health Organization 900,000 Indians die each year from drinking contaminated water and breathing in polluted air [3]. As India grapples with these basic issues, new challenges are emerging for example there is a rise in chronic adult diseases such as cardiovascular illnesses and diabetes as a consequence of changing lifestyles [4].

There are vast disparities in people’s health even among the different states across the country largely attributed to the resource allocation by the state governments where some states have been more successful than others. Better efforts are needed by the local governments to ensure that the health services provided are actually reaching the poor in worst-affected areas.

http://en.wikipedia.org/wiki/Healthcare_in_India

[iNow]

I'm curious to hear the opinions of others. I don't personally think the posts above negate the powerful points made by JohnB. It seems to me that JohnB's points are some of the strongest arguments yet for universal healthcare. Does anyone reading this agree/disagree?

[CharonY]

Whether I agree or not (well actually I do) I have to applaud JohnB for his well-thought-out posts to a topic that is a magnet for knee-jerk responses.