FOR universal healthcare

[thRob]

makes sense to me, thanks for clarifying.

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[167649]

Yes, because you haven't looked at the logistics of it to understand how impossible it is.

The money to pay for the health care has to come from somewhere. And there is no current model that will work well for the US. Europe works because of the ridiculously high taxes. Americans already don't like income taxes - trying to get them to pay 50% is not going to happen. We can't use Canada's system because it just doesn't work - people wait way too long for care there. I had to do some research on it for a paper a few years ago - I can get a homeless person at my free clinic into the local county hospital for an MRI faster than the average Canadian citizen can get an MRI.

When it comes down to it - the US already has universal health care. Its called the ER. People go in for things that would typically be "primary care" all the time. If they need it they get their follow-ups. The hospital ups the charges to paying customers to cover all the people who don't pay.

We have "universal healthcare" just no one calls it that.

Am I saying our system is perfect? Not at all. But when people jump from what we have now to concluding we should have "universal healthcare" its laughable. Yes the system needs reform. But a single-payer model that is plausible in the US has yet to be found. And no matter how much Hilary wants to claim it will happen - its not going to happen any time soon.

You have done your homework and you are unlike most people in that you understand the cost shift that occurs in health care, in that we are already paying for the uninsured. What you do not understand is that the cost shift is VERY damaging to our economy, and TERRIBLY inefficient because most of it is transferred not to our pockets directly, but is shifted to our consumer market. Your right that the current setup is not perfect, but it actually falls far from it. Keep in mind we spend more money on HC per capita than anyone else.

Since I have brought this point up previously and a lot of people do not read up very well on HC reform and thus don't understand, I will elaborate as best i can:

As the post pointed out, uninsured patients usually check into an ER if they have an acute chrisis which needs medical attention. These chrisisis often arise because they could not recieve earlier interviention, as they are uninsured. This is especially true with one of these four chronic diseases: CHF, CAD, diabetes, asthma (75% of what we spend on health care goes to one of these four, and heart disease is our number one killer). The acute chrisis which arises from one of these diseases is very, very costly, and costs much more than treating the condition early. So the hospitalization of these patients tends to be very pricey.

The hospital must pay for this treatment somehow, it could bill the uninsured patient to bankruptcy and never get the full reimbursment from many. But it has to pay its overhead, hospitals have bills. As the poster already said, the cost for the acute care of uninsured patients is shifted (as it has to be shifted) to the payers. We currently have three payer groups for all intensive purposes: government, private payers, and employer groups. The cost cannot be shifted to the government, because those programs are restricted (you cannot just upcharge medicaid). The cost is partially shifted to private payers directly, but not most of it, because most of this group is not treated in the ER on a regualar basis like the uninsured, they get their care in offices. So most of the cost is shifted to the employers, who's coverages are usually based on hospital systems. The hospitals simply charge them more to cover the cost.

This is why it is damaging to our economy. GM, for example, is one of the major corporations that bears the brunt of this shift, as it insures a lot of employees. In total, it spends more money on insurance than it does on steel. When you buy an american car, up to 3,000$ of that ultimately goes to insurance. Compare that to only a few hunderd dollars for a toyota. So, to cover this cost, GM has to do one of three things: A)Increase the price of the car. In this case, it usually does not do this because it has to fiercly compete with japanese and european automakers, but in other industries it is as simple as making all of us pay more for the product. B) Decrease the quality of it's product and cut overhead elsewhere. Usually, car makers in america are doing this. Other industries do it too and have a lackluster product. This is obviously not good news for economy regardless, but especially true if there are significant foreign competitors, like the auto industry. C) Drop insurance for it's employees. This is also happening on an increasing basis, and in all cases, this is the most damaging, because it further contributes to the problem in the first place, like a snowball effect. Furthermore, with GM, because a lot of it's employees are unionized, dropping insurance means moving the plant to mexico. I dont want to open up a new can of worms here, but wage increases are not the only substantial incentive to offshore factories and take jobs away from americans.

The auto industry is not the only one, of course, but one of our largest industries and a fine example. Starbucks spends more money on health insurance than it does on coffee beans. Virtually all american corportaions that insure it's employees are hit by this cost shift. So they charge us more, lower product quality, or drop insurance which can contribute to the problem in a whole lot of ways. Very inefficient system, and ends up costing our economy very dearly. Becuase we do not have UH, you are paying more for everything from cars to coffee, american companies are put at huge disadvantages to foreign competitors, and americans loose jobs. The cost shift to the consumer market is not the way to pay for people who could otherwise not afford medical care.

The good news: these corporatons are the UH advocate's biggest ally. These companies are not stupid, and they are starting to realize what is going on. Drug and insurance industries are not the only ones which have lobbying power. So anyone who says these companies will forever block UH because of their $$ in congress, think again, because some pretty big guns are starting to line up with UH.

Another common misconception, is that UH = government takeover of system. Not true. Entirely different things. You can probably tell I am for UH because of the economic benefits. But I do not think our government should control 1/7 of our economy in some huge monstrocity of a monopoly. And we can design a system that incorporates existing infrastructure, hold people accountable for lifestyle decisions, and covers everybody without a government takeover. This would be much more effective and much more economically efficient than the current system.

 

[SomedayOrtho]

My beef with universal healthcare is the potential that choice could be taken away from people wishing to go to a specific doctor as can be the case with current HMOs and PPOs. I want to be able to go to whatever doctor I want and don't want to be told by the government that I have to go to a specific place.

Also, think of the burden on tax payers. My aunt and uncle live in Australia which has socialized healthcare and they pay taxes that are out of this world. Then, since the government coverage isn't sufficient to their needs they also have to go out and buy additional coverage at yet more added cost.

It would be nice if the government would raise taxes on the wealthiest 1-2% of the nation but we all know that won't happen regardless of political party since the richest of the rich are the ones who ultimately fund political campaigns.

Furthermore, in the essence of preserving choices I think the government should be able to offer low cost health insurance plans to those individuals who don't meet the requirements of medicaid but still can't make a decent living wage.

Oh, and let's not forget the possiblity of increasing the regulations on insurance companies.

 

[novawildcat]

My beef with universal healthcare is the potential that choice could be taken away from people wishing to go to a specific doctor as can be the case with current HMOs and PPOs. I want to be able to go to whatever doctor I want and don't want to be told by the government that I have to go to a specific place.

And where is this freedom of choice that we have now with our current system? The Government Accountability Office (GAO) found that

-in 9 states Blue Cross and Blue Shield held over 50% of the market share for health insurance

-and in almost every state, the single largest insurer in the state held over 40% of the market share for insurance.


Health insurance and health care in America easily fits the defintion of a market run by an oligopoly. This has resulted in limited choices for consumers and higher costs. People are afraid of UH "because it will limit choice", but in reality we already live in a oligopolist system with limited choices already!

 

[badasshairday]

And where is this freedom of choice that we have now with our current system? The Government Accountability Office (GAO) found that

-in 9 states Blue Cross and Blue Shield held over 50% of the market share for health insurance

-and in almost every state, the single largest insurer in the state held over 40% of the market share for insurance.


Health insurance and health care in America easily fits the defintion of a market run by an oligopoly. This has resulted in limited choices for consumers and higher costs. People are afraid of UH "because it will limit choice", but in reality we already live in a oligopolist system with limited choices already!

LOL, I was about to say that. Where is our freedom now? In California, Kaiser is a huge monster that almost everyone uses. And you guys know about HMOs.

 

[armybound]

Most people around here drive Ford trucks, does that mean it's their only option? Are all car insurance companies represented equally?

 

[novawildcat]

Most people around here drive Ford trucks, does that mean it's their only option? Are all car insurance companies represented equally?

Of course not, but in reality how many options do you really have to choose from? Not many. Many people get their insurance through their company that they work for, and most of the time that is the only insurance that is offered at all. Almost every company around where I live uses Blue Cross and Blue Shield for health insurance. When you have 1, 2, 3, or even 4 companies controlling almost 100% of health insurance plans in a state personal choice is definitely limited. How many times have you heard of stories where patients get treated for an emergency but find out that their insurance won't cover it because the hospital they went to "was out of network"? Personal choice is definitely limited within the current system we have for health care. Also, in case if you haven't noticed, huge insurance firms have been buying up and consolidating with smaller insurance companies for years now.

In many ways health insurance does indeed draw parallels with car insurance. For example how many car insurance companies would insure someone who has a history of accidents, speeding tickets, and drunk driving? Probably not many and if there were any that would insure someone with that kind of record, you can be sure that that person would be paying premiums out the wazoo. Health insurance companies do the same thing. They routinely deny people health insurance coverage who have a history of things like heart problems, diabetes, MS, cancer, etc. because they pose a high risk to their long term profits. I am asking you, do you find this very ethical? Is it right to deny people insurance or have them pay astronomically high premiums if they have a history of health problems that might even be out of their own control? What is a person to do who is layed off from a previous job, loses their insurance, and has a history of health problems? Finding health coverage can be extremely difficult if not impossible for them. Even if they do find health coverage, the premiums might be financially crippling.

 

[NoUse4aName1286]

What in the world are you talking about? Have you ever taken a basic course in economics? GDP is the same as income by definition.

GDP of Japan 2006=4.2 trillion USD. Population Japan ~123 million. 6.6% of 4.23 trillion= roughly 277 billion USD spent on health care. Divided by ~123 million= $2300 USD PER PERSON IN JAPAN SPENT ON HEALTH CARE. Hey guess what $2300 is roughly 6% of $34,000 (which is roughly the average income in Japan). So yes, you can compare the amount of % of GDP spent on health care between countries because when you do, all you are really comparing is how much in total income countries are spending on health care because GDP and income are the same thing.

GDP US ~13 Trillion in 2006. Population US ~300 million. 14.5% of GDP spent on health care. 14.5% of 13 trillion divided by ~300 million people= roughly $6300 per person in the US for health care. And the funny thing is not everyone gets health care in the US,so in reality, for those who do get health care the average cost for health care for them is actually greater than $6300!

Fine hten, your mathematical superiorty wins out, but you did ignore the Eastern/Western medicine part, though I admit, we are probably still paying more.

 

[novawildcat]

Fine hten, your mathematical superiorty wins out, but you did ignore the Eastern/Western medicine part, though I admit, we are probably still paying more.

Dude, you and I are really arguing for the same thing😉.

You argue that we should examine the $ amount spent on health care per capita divided by the average income which is just

$ on health care per capita/ income per capita. But remember GDP is the same as income so


$ on health care per capita/ income per capita= $ on health care per capita/ GDP per capita

I say all you have to do is just look at % of GDP of a country spent on health care. it is very easy then to find out how much is spent on health care in $ terms-

total GDP x % of GDP spent on health care= total $ amount spent on health care.

Now divide both sides by the total amount of people in a country. You now have

GDP per capita x % of GDP spent on health care = $ spent per capita on health care.

divide by GDP per capita. THus you have

% of GDP spent on health care=$ spent per capita on health/ GDP per capita

which is the samething you are arguing for!

The conclusion is that it doesn't really matter how many people live in a country, all you have to do is compare the % of GDP spent on health care between countries to gain insight into how much each country is spending on health care.

 

[armybound]

They routinely deny people health insurance coverage who have a history of things like heart problems, diabetes, MS, cancer, etc. because they pose a high risk to their long term profits. I am asking you, do you find this very ethical?

Ethics is a difficult question here. As a (future) health care provider, do I think it's ethical to deny care because of someone's past? Of course not.

But health insurance companies aren't in the business of delivering healthcare, they're in the business of trying to help people afford healthcare. They're also in the business of making money. So is it unethical for them to try to make a profit while trying to keep costs minimal (or at least reasonable) for everyone else? I don't know. I don't know business ethics, but it doesn't necessarily seem unethical to me, from a business standpoint. From a "I'm a human being" standpoint, of course it's wrong.

 

[etf]

Ethics is a difficult question here. As a (future) health care provider, do I think it's ethical to deny care because of someone's past? Of course not.

But health insurance companies aren't in the business of delivering healthcare, they're in the business of trying to help people afford healthcare. They're also in the business of making money. So is it unethical for them to try to make a profit while trying to keep costs minimal (or at least reasonable) for everyone else? I don't know. I don't know business ethics, but it doesn't necessarily seem unethical to me, from a business standpoint. From a "I'm a human being" standpoint, of course it's wrong.

i think part of the problem is that we aren't really talking about "insurance" per se, but rather subsidized healthcare. insurance to me is basically a tool for protecting against a catastrophic loss - if my home burned down or my car was totaled in an accident, i wouldn't have the money to replace it, so I have insurance. But I don't make claims for broken windows (on my house or car), because making these kinds of claims makes my rates go up - i just eat the cost. similarly, we want health insurance to cover the $100 it costs to see a doctor. but would spending $100 pose that much of a hardship, when it comes to your health? to a lot of people, probably yes, but it's still better than having to fork over $300,000 a year if you ever have to go on myozyme.

 

[armybound]

i think part of the problem is that we aren't really talking about "insurance" per se, but rather subsidized healthcare. insurance to me is basically a tool for protecting against a catastrophic loss - if my home burned down or my car was totaled in an accident, i wouldn't have the money to replace it, so I have insurance. But I don't make claims for broken windows (on my house or car), because making these kinds of claims makes my rates go up - i just eat the cost. similarly, we want health insurance to cover the $100 it costs to see a doctor. but would spending $100 pose that much of a hardship, when it comes to your health? to a lot of people, probably yes, but it's still better than having to fork over $300,000 a year if you ever have to go on myozyme.

I understand where you're coming from, and it makes sense.

Your last sentence kind of confuses me though. Are you suggesting that $100 doctor visits should be subsidized, since people will have a hard time affording them, or that they should still have to pay the $100?

 

[etf]

I understand where you're coming from, and it makes sense.

Your last sentence kind of confuses me though. Are you suggesting that $100 doctor visits should be subsidized, since people will have a hard time affording them, or that they should still have to pay the $100?

my last sentence confuses me as well. i think that the $100 should be subsidized for the poor - maybe not completely free, but bring it down to a nominal $5 or so. actually, that's currently my co-pay for kaiser, and even with this extremely low barrier for entry for me, i still don't see the doctor as often as i should. so in a sense, it doesn't seem that (at least in my case) access to care necessarily means better health outcomes.

 

[armybound]

my last sentence confuses me as well. i think that the $100 should be subsidized for the poor - maybe not completely free, but bring it down to a nominal $5 or so. actually, that's currently my co-pay for kaiser, and even with this extremely low barrier for entry for me, i still don't see the doctor as often as i should. so in a sense, it doesn't seem that (at least in my case) access to care necessarily means better health outcomes.

yeah, I think those of us that can afford healthcare can afford our annual $75 checkup instead of paying the insurance companies to subsidize it and having to pay for the paperwork and what not. Having a deductible more like car insurance might help us out a bit in the healthcare world. It might lower costs for insurance a bit.

 

[NoUse4aName1286]

Dude, you and I are really arguing for the same thing😉.

You argue that we should examine the $ amount spent on health care per capita divided by the average income which is just

$ on health care per capita/ income per capita. But remember GDP is the same as income so


$ on health care per capita/ income per capita= $ on health care per capita/ GDP per capita

I say all you have to do is just look at % of GDP of a country spent on health care. it is very easy then to find out how much is spent on health care in $ terms-

total GDP x % of GDP spent on health care= total $ amount spent on health care.

Now divide both sides by the total amount of people in a country. You now have

GDP per capita x % of GDP spent on health care = $ spent per capita on health care.

divide by GDP per capita. THus you have

% of GDP spent on health care=$ spent per capita on health/ GDP per capita

which is the samething you are arguing for!

The conclusion is that it doesn't really matter how many people live in a country, all you have to do is compare the % of GDP spent on health care between countries to gain insight into how much each country is spending on health care.

I follow you. And yeah, we are arguing the same thing:😎

 

[Wylde]

http://www.youtube.com/watch?v=X_Rf42zNl9U

 

[Funky]

It's common knowledge that the cost of healthcare is increasing in the US but is it increasing as much in other countries?

 

[jochi1543]

It's common knowledge that the cost of healthcare is increasing in the US but is it increasing as much in other countries?

Yes, it's increasing everywhere, regardless of the insurance scheme. Mostly as the result of expensive medical advances, which are also only used by a very small portion of the patient population - however, the costs are distributed to other patients, as well.

 

[Funky]

Yes, it's increasing everywhere, regardless of the insurance scheme. Mostly as the result of expensive medical advances, which are also only used by a very small portion of the patient population - however, the costs are distributed to other patients, as well.

so you would say that proportionately the US's increase in healthcare costs is the same as the rest of the country?

 

[gotmeds?]

I think there a lot of people in the U.S. who choose not to have insurance, e.g. young adults who don't want to spend the money and who think they're made of steel. Sure, there lots of kids who are uninsured, which sucks, and sick people who get screwed by insurance companies who don't want to take the risk.

I think the system needs to emphasize personal responsibility, and if you don't realize the importance of having the coverage, than whose fault is it?

i don't think healthcare is a right

Damn those 47 million healthy young people who choose not to have insurance!

And for that matter damn all those irresponsible moochers with insurance who go bankrupt because they can't afford to pay their medical bills.

How about a little accountability folks? Hey, let me ask you something, Mr. Personal Responsibility: of all the years you've had health insurance as an adult, how many of them have your parents paid for?

 

[Gut Shot]

This is, without question, the most intelligent thread on this topic that has ever been born in pre-allo.

 

[AZFutureDoc]

I would like to remind everyone that a larger percentage of this country says they are happy with their provision of healthcare than most others.

 

[8744]

I think there a lot of people in the U.S. who choose not to have insurance, e.g. young adults who don't want to spend the money and who think they're made of steel. Sure, there lots of kids who are uninsured, which sucks, and sick people who get screwed by insurance companies who don't want to take the risk.

I think the system needs to emphasize personal responsibility, and if you don't realize the importance of having the coverage, than whose fault is it?

i don't think healthcare is a right

Aarrggg! No no no. This is patently false. Currently, every child from a low-income family can be covered by his state's respective CHIP program. Families who are not low income can, almost by definition, afford a couple of visits to the pediatrician and some crummy antibiotics a few times a year except that their parent's spending priorities may be a little skewed.

I repeat, not being insured is not the same as not having access to medical care. Every pediatrician I have ever seen will take checks, cash, or Visa for a visit. If you are really worried then you can secure a high deductible policy for your kids which is cheaper than dirt because, and this is the part that blows SDN pre-med minds, it doesn't cover routine things that most people could pay for easily if they weren't conditioned to pay 100 bucks a month for cable but not a dime for their medical care.

Comprehensive medical insurance that covers everything for everybody whether they could pay for it themselves or not: Ridiculously expensive and wasteful.

Major medical insurance that covers large ticket items like hospital stays and legitimate Emergency Department visits: Very reasonable for most people most of the time.

Not to mention that comprehensive insurance above all other things has created the huge confused beast that it American medicine, a system where money is wasted in large truckloads to the extent that, at least for my part, I would estimate that seventy percent of the money that has flowed through my hands may as well have been flushed down the crapper.

I weep for your generation.

 

[8744]

CHIPs, by the way, is the one of the biggest scams in the history of our nation. It is a huge program addressing a non-existent problem, essentially providing free medical care to the millions of children who not only don't need it but whose parent could cough up a little if they really thought medical care was a priority. It's principle purpose is to justify the construction of hundreds of "Childrens Hospitals" and Pediatric Emergency Departments to reap the federal bounty.

 

[circulus vitios]

Universal health care = idiots with a splinter going to the ER because who cares, it's free!

 

[ANF1986]

I had no idea there were so many socialists on this board. Look, we dont need to see the charts to know that socialized medicine DOESNT WORK in the long term. All we have to do is look back to history and we see that socialism in almost any form be it "single payer" or otherwise is UNSUSTAINABLE. Yes, the system does start out paying benefits, but any socialized system given a long enough period of time degrades to the point of needed benefits outweighing available capitol to pay for them.

What do these countries do to pay for these benefits? They engage in fractional-reserve banking. Meaning they print paper money based on absolutely nothing and say that it is worth X amount. This leads to inflation which is an indirect tax on the middle class people. It degrades the purchasing power of their currency meaning their money buys less goods and services. Whether or not you raise income taxes to 50% in the USA or not is rather inconsequential, as the hidden inflation tax takes the money from the people anyway. It is an appealing way for beauraucrats to tax the middle class without them knowing it, and without having to sacrafice popularity by raising taxes directly.

There is a very simple equation in politics. When government gets involved, costs go up and quality goes down! Nothing thus far has been found that is as productive and efficient as the free market capitolist system. The free market is what encourages innovation and efficiency. As well, a free market system where doctors can earn HIGH salaries attracts the BEST qualified people in that particular field(medicine in this case).

The government cannot even efficiently issue you a drivers license, and you people want to acquiesce control over your HEALTH to a government beauraucrat with no healthcare experience? The United States Constitution was designed such that government had a MINIMAL role in our lives. If government gets involved in control over our healthcare then we ultimately become less free as a society. It will be one more aspect of our lives that we acquiesce control of to Uncle Sam.

The United States model of government is about personal accountability. The INDIVIDUAL is emphasized, and not big brother. A nice statistic that people who advocate these socialist policies like to throw out there is that 45 million people in America do not have healthcare. That statistic fails to mention that 1/3 of that 45 million are people who are between jobs and will be covered within 90 days. That statistic also takes into account the many illegal aliens living within our borders, who are here illegally, and entitled to NONE of our government services what so ever. A distinction must also be made about whether or not you believe that healthcare is a fundamental human right. I follow the Constitution of the United States strictly, and no where in there did I see an amendment which stated the full burden of your healthcare costs rest upon the tax payers.

I will close in saying this, a government big enough to give you everything you want is big enough to take it all away.

 

[p30doc]

When government gets involved, costs go up and quality goes down!

How come we spend double per capita compared to other countries and they have universal healthcare schemes and we don't. We are also ranked something like 40 in the world in healthcare quality by the WHO. I am not sure if universal healthcare is the answer for our country, but something must be done the current system is broken.

 

[Gut Shot]

Universal health care = idiots with a splinter going to the ER because who cares, it's free!

Funny, I was just perusing the results of the latest Commonwealth Survey (Shoen C. et al. Health Affairs, 26:w717-w734, 2007), which compared a litany of data from seven developed nations.

Percentage of those surveyed who had zero ER visits in last two years:

Netherlands - 82
Germany - 79
New Zealand - 72
United Kingdom - 69
Australia - 67
United States - 63
Canada - 60

The usage of ERs correlated inversely with ease of access to primary care. See what happens when you look at actual data before spouting off?