The Babylonians are coming

[sirus_virus]

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It wouldn't be a farce to say that you could pay for the system without a tax hike. It would be a farce to say that it can't be done. There is more than enough money in the system. People keep repeating that - we spend more than anyone to begin with. Much of it goes to CEOs of for-profit health systems, overhead for the 500 different versions of forms that need to filled out for reimbursements, extra costs for emergency care b/c lack of use of PCP, the multiple softwares that people have to use for e-records that ends up defeating the purpose of e-records, the increased cost of pharmaceuticals because we subsidize research for the rest of the world and b/c each individual health system is too small to make a dent in the price, and multiple more cost-ineffective issues. Regardless of your view of whether universal coverage is culturally compatible with the American public and medical professionals, the argument that there isn't enough money in the system is bankrupt.
-S

What are you trying to say? Are you saying we could go to a single payer system without increasing taxes? Where in the world is the money going to come from? You make it sound like it is just as easy as grabbing the box of cash we were spending on this system and dumping it on another system. "Money in the system" is not the same thing as "available money", "what we spend" is not the same as "what the government spends". If we want a single payer system then "we" have to give the government a significant amount of extra money with the hope that they won't mismanage it like they have done with everything else, and that is what people are not ready to commit to.

 

[OncoCaP]

What are you trying to say? Are you saying we could go to a single payer system without increasing taxes? Where in the world is the money going to come from? You make it sound like it is just as easy as grabbing the box of cash we were spending on this system and dumping it on another system. "Money in the system" is not the same thing as "available money", "what we spend" is not the same as "what the government spends". If we want a single payer system then "we" have to give the government a significant amount of extra money with the hope that they won't mismanage it like they have done with everything else, and that is what people are not ready to commit to.

Instead of paying health insurance premiums we (and our employers perhaps, if they are part of this system) would pay a health insurance tax. The tax might even be less than U.S. individuals and their companies currently spend (since the average developed nation with a single payer system spends half of what the U.S. per person).

We are already spending more than anyone else and this money isn't helping us necessarily. Just move the money into a single payer system and quit wasting it.

http://www.nationmaster.com/graph/hea_hea_car_fun_tot_per_cap-care-funding-total-per-capita
Healthcare Expenditure Per Capita By Country -- The Top Ten Spenders
#1 United States: $4,631.00 per capita <<<----- Lots of waste here --> switch to single payer
#2 Switzerland: $3,222.00 per capita
#3 Germany: $2,748.00 per capita
#4 Iceland: $2,608.00 per capita
#5 Canada: $2,535.00 per capita
#6 Denmark: $2,420.00 per capita
#7 France: $2,349.00 per capita
#8 Belgium: $2,268.00 per capita
#9 Norway: $2,268.00 per capita
#10 Netherlands: $2,246.00 per capita

 

[sirus_virus]

Instead of paying health insurance premiums we (and our employers perhaps, if they are part of this system) would pay a health insurance tax. The tax might even be less than U.S. individuals and their companies currently spend (since the average developed nation with a single payer system spends half of what the U.S. per person).

We are already spending more than anyone else and this money isn't helping us necessarily. Just move the money into a single payer system and quit wasting it.

http://www.nationmaster.com/graph/hea_hea_car_fun_tot_per_cap-care-funding-total-per-capita
Healthcare Expenditure Per Capita By Country -- The Top Ten Spenders
#1 United States: $4,631.00 per capita <<<----- Lots of waste here --> switch to single payer
#2 Switzerland: $3,222.00 per capita
#3 Germany: $2,748.00 per capita
#4 Iceland: $2,608.00 per capita
#5 Canada: $2,535.00 per capita
#6 Denmark: $2,420.00 per capita
#7 France: $2,349.00 per capita
#8 Belgium: $2,268.00 per capita
#9 Norway: $2,268.00 per capita
#10 Netherlands: $2,246.00 per capita

And what is your plan when that gets mismanaged and faces bankruptcy like all the other government run programms? Stop research? Reduce number or doctors? stop employing new technologies and drugs? raise taxes?

 

[OncoCaP]

And what is your plan when that gets mismanaged and faces bankruptcy like all the other government run programms? Stop research? Reduce number or doctors? stop employing new technologies and drugs? raise taxes?

I'm in favor of having private health insurance as a backup. Private health insurance has a role, but it shouldn't provide the basic healthcare coverage that everyone needs because their profits make the system too expensive and their policies prevent too many people from getting coverage.

For example, in Spain, they have public health coverage, which generally works pretty well in the cities. However, in the more rural areas, the public coverage is not acceptable in some cases, and people have private health insurance for those cases. Thus, a Spaniard may use the public health coverage for a heart stent (e.g., because the particular hospital in question only takes the public insurance), but use private coverage to see a family doctor for an ear infection sooner rather than 2 months from when they need the help. Similarly in Canada, there is private health insurance coverage available. I know very little about private health insurance in Canada, but my expectation is that it is for people who don't want to wait 6 months to have a prostate surgery or 2 years to see a neurologist.

 

[sirus_virus]

I'm in favor of having private health insurance as a backup. Private health insurance has a role, but it shouldn't provide the basic healthcare coverage that everyone needs because their profits make the system too expensive and their policies prevent too many people from getting coverage.

For example, in Spain, they have public health coverage, which generally works pretty well in the cities. However, in the more rural areas, the public coverage is not acceptable in some cases, and people have private health insurance for those cases. Thus, a Spaniard may use the public health coverage for a heart stent (e.g., because the particular hospital in question only takes the public insurance), but use private coverage to see a family doctor for an ear infection sooner rather than 2 months from when they need the help. Similarly in Canada, there is private health insurance coverage available. I know very little about private health insurance in Canada, but my expectation is that it is for people who don't want to wait 6 months to have a prostate surgery or 2 years to see a neurologist.

It is illegal.

 

[OncoCaP]

It is illegal.

That may be changing (in any case, I personally would support having it as a backup):

http://www.cbc.ca/canada/story/2005/06/09/newscoc-health050609.html
Top court strikes down Quebec private health-care ban
Last Updated: Thursday, June 9, 2005 | 9:33 PM ET
CBC News
The Supreme Court of Canada ruled Thursday that the Quebec government cannot prevent people from paying for private insurance for health-care procedures covered under medicare.
In a 4-3 decision, the panel of seven justices said banning private insurance for a list of services ranging from MRI tests to cataract surgery was unconstitutional under the Quebec Charter of Rights, given that the public system has failed to guarantee patients access to those services in a timely way.

As a result of delays in receiving tests and surgeries, patients have suffered and even died in some cases, justices Beverley McLachlin, Jack Major, Michel Bastarache and Marie Deschamps found for the majority.

The Quebec government reacted by saying it would apply immediately for a stay of between six months and two years before the decision takes effect, given the chaos it could cause in the delivery of medical services in Quebec.

*****

I looked online and it appears that you can purchase private health insurance in Canada:

http://www.canadian-family-medical-plans.com/
Health & Dental Insurance for Canadians

Are you looking for a medical dental plan similar to those offered to people employed through a company?

We have teamed up with Manulife Financial to offer the same plan that many companies and large associations offer but with no membership or company affiliation. Take advantage of the stability and efficiencies of being part of a group with over 1 million members in Canada.

The Canadian Family Medical Plan offers these advantages at no additional cost. Get a quote now.


http://www.eridlc.com/hr-laws/index.cfm?fuseaction=hrlaws.private&country=canada
Private Health Insurance Plans

In Canada, the term, private health services plan, ordinarily applies to some or all of the following:
extended medical insurance, such as prescription drugs and semi-private hospital rooms
dental benefits
vision or eye care benefits

http://www.canadian-healthcare.org/page4.html
Private Health Insurance
While the health care system in Canada covers basic services, including primary care physicians and hospitals, there are many services that are not covered. These include things like dental services, optometrists, and prescription medications.

Private health insurance plans are usually offered as part of employee benefit packages in many companies. Incentives usually include vision and dental care. Alternatively, Canadians can purchase insurance packages from private insurance providers.

The main reason many choose to purchase private insurance is to supplement primary health coverage. For those requiring services that may not be covered under provincial health insurance such as corrective lenses, medications, or home care, a private insurance plan offsets such medical expenses.

While private insurance can benefit those with certain needs, many Canadians choose to rely exclusively on the public health system.


http://www.capmag.com/article.asp?ID=4271
Why Canadians Purchase Private Health Insurance
by Walter Williams (June 20, 2005)

America's socialists advocate that we adopt a universal healthcare system like our northern neighbor Canada. Before we buy into complete socialization of our healthcare system, we might check out the Canadian Supreme Court's June 9th ruling in Chaoulli v. Quebec (Attorney General). It turns out that in order to prop up government-delivered medical care, Quebec and other Canadian provinces have outlawed private health insurance. By a 4 to 3 decision, Canada's high court struck down Quebec's law that prohibits private medical insurance. With all of the leftist hype extolling the "virtues" of Canada's universal healthcare system, you might wonder why any sane Canadian would want to purchase private insurance.

Plaintiffs Jacques Chaoulli, a physician, and his patient, George Zeliotis, launched their legal challenge to the government's monopolized healthcare system after having had to wait a year for hip-replacement surgery. In finding for the plaintiffs, Canada's high court said, "The evidence in this case shows that delays in the public healthcare system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public healthcare. The evidence also demonstrates that the prohibition against private health insurance and its consequence of denying people vital healthcare result in physical and psychological suffering that meets a threshold test of seriousness." Writing for the majority, Justice Marie Deschamps said, "Many patients on non-urgent waiting lists are in pain and cannot fully enjoy any real quality of life. The right to life and to personal inviolability is therefore affected by the waiting times."

http://www.bluecross.ca/
Supplementary health plans for individuals, families, seniors and employers of all sizes continue to be the specialty of the Blue Cross Member Plans. The plans provide supplementary health and dental benefits, including prescription drugs, vision care, semi-private & private hospital rooms, short and long term disability, emergency medical travel, ambulance, home nursing, chiropractic and life insurance.

http://www.fasken.com/web/fmdwebsit.../$File/PRIVATEHEALTHINSURANCE.PDF!OpenElement

Contrary to myth, it is only provincial legislation, not the Canada Health Act, that prohibits
private insurance contracts from covering medical services that are funded by medicare.
Aside from Quebec, five provinces (Alberta, British Columbia, Manitoba, Ontario and Prince
Edward Island) prohibit private insurance from covering medically necessary services. The
remaining four provinces do not.
The existence of these restrictions pre-dates the Canada Health Act. The Quebec ban was
introduced in 1970. Ontario has prohibited private insurance from covering publicly-insured
health services since 1969.

If private health insurance was of genuine concern to successive federal governments, then the
Canada Health Act could have been amended to stop the practice. The fact that six provinces
already impose their own bans should be immaterial; after all, four provinces do not prohibit such
private insurance, and an ostensible goal of the CHA is to maintain consistent national standards.
Some argue that the Canada Health Act creates a practical barrier to private insurance of
medically necessary services (at least in provinces that still charge premiums) because provincial
health plans must be run on a non-profit basis, making it difficult for private plans to compete.
An additional disincentive is that doctors who receive fees from the public health care system
may not "extra bill" (that is, charge prices exceeding the medicare rates and seek private payment
of the difference).

 

[sirus_virus]

That may be changing (in any case, I personally would support having it as a backup):

http://www.cbc.ca/canada/story/2005/06/09/newscoc-health050609.html
Top court strikes down Quebec private health-care ban
Last Updated: Thursday, June 9, 2005 | 9:33 PM ET
CBC News
The Supreme Court of Canada ruled Thursday that the Quebec government cannot prevent people from paying for private insurance for health-care procedures covered under medicare.
In a 4-3 decision, the panel of seven justices said banning private insurance for a list of services ranging from MRI tests to cataract surgery was unconstitutional under the Quebec Charter of Rights, given that the public system has failed to guarantee patients access to those services in a timely way.

As a result of delays in receiving tests and surgeries, patients have suffered and even died in some cases, justices Beverley McLachlin, Jack Major, Michel Bastarache and Marie Deschamps found for the majority.

The Quebec government reacted by saying it would apply immediately for a stay of between six months and two years before the decision takes effect, given the chaos it could cause in the delivery of medical services in Quebec.

And that is the problem with too much government control.

 

[OncoCaP]

And that is the problem with too much government control.

Yes, agreed. There should be a private insurance option for those who want to pay extra for it (no doubt they would need to meet other eligibility criteria as well). However, a public system provides the basics, albeit with long wait times if it is underfunded like the Canadian system. I don't think that the European systems have the same wait times that Canada does, but again, I'm not sure about that. There are disadvantages to any system. The system we have in the U.S. now seems worse to me.

Any system can be mis-managed. The following reference shows wait times by country (for those that report them). Several countries with single-payer systems do have excellent wait times (much better than Canada, for example). Thus, while a single-payer system can lead to nation-wide underfunding of healthcare and long wait times, this is not a certain outcome. There are many factors that come into play:

http://www.oecd.org/dataoecd/15/52/35028282.pdf

Models 1 and 2 suggest that the availability of acute care beds decreases significantly
the probability of observing waiting times. This is also true for the availability
of practising specialists, as shown by Model 2. This is not the case for the
availability of practising physicians in Model 1. Despite the coefficient being negative
(as expected), it is not significantly different from zero. Similarly, Models 3
and 4 show that higher health expenditure (public and total, respectively) reduces
the probability of observing waiting times. The coefficient associated with the percentage
of older populations is not robust across the different specifications.

 

[sirus_virus]

Yes, agreed. There should be a private insurance option for those who want to pay extra for it (no doubt they would need to meet other eligibility criteria as well). However, a public system provides the basics, albeit with long wait times if it is underfunded like the Canadian system. I don't think that the European systems have the same wait times that Canada does, but again, I'm not sure about that. There are disadvantages to any system. The system we have in the U.S. now seems worse to me.

In those Europen countries, the actual delivery of healthcare sucks. If you are really sick you will be fresh out of luck. They however do a good job at making sure you don't get sick to begin with hence the "preventive" approach which anyone can adopt in any system. Wait times? Yes they have that in abundance. I experienced it first hand in the U.K. If you read about the evolution of the U.K healthcare system, you will find out that they have resorted to subcontracting more surgeries and procedures to private contractors. They even had to raise GPs pay by 63% just to get extra help. Why do you think the Canadians are fighting for the ability to buy private insurance?

Keep in mind also that in some of those countries, you don't get to choose when you want to discontinue treatment if you are terminally ill. If you are deemed a burden to the healthcare system, they will simply pull the plugs and save their money. So the system is cheap for everyone collectively, but it could really suck individually.

Final point that you need to keep an eye on is, that non of those healthcare systems are healthy financially. Some of them are on the verge of bankruptcy because there is a finite amount of control you can exert on a system and still expect growth and improvement. Healthcare costs will continue to rise in all industrialized nations due to advances in science and technology. You can save money by being stagnant, but who really want to be left behind, and your society will inevitably demand the best healthcare available. They won't want to pay more taxes(your only source of funding), so you end up cutting everything including access, or go bankrupt.

 

[OncoCaP]

In those Europen countries, the actual delivery of healthcare sucks. If you are really sick you will be fresh out of luck. They however do a good job at making sure you don't get sick to begin with hence the "preventive" approach which anyone can adopt in any system. Wait times? Yes they have that in abundance. I experienced it first hand in the U.K. If you read about the evolution of the U.K healthcare system, you will find out that they have resorted to subcontracting more surgeries and procedures to private contractors. They even had to raise GPs pay by 63% just to get extra help. Why do you think the Canadians are fighting for the ability to buy private insurance?

Keep in mind also that in some of those countries, you don't get to choose when you want to discontinue treatment if you are terminally ill. If you are deemed a burden to the healthcare system, they will simply pull the plugs and save their money. So the system is cheap for everyone collectively, but it could really suck individually.

Final point that you need to keep an eye on is that non of those healthcare systems are healthy financially. Some of them are on the verge of bankruptcy because there is a finite amount of control you can exert on a system and still expect growth and improvement. Healthcare costs will continue to rise in all industrialized nations due to advances in science and technology. You can save money by being stagnant, but who really want to be left behind, and your society will inevitably demand the best healthcare available. They won't want to pay more taxes(your only source of funding), so you end up cutting everything including access, or go bankrupt.

Good points. This isn't an easy problem to solve. There are some countries that do seem to be doing well in terms of the viability of their healthcare system, but the U.K. (and Canada's) doesn't appear to be one of them.

I like this somewhat "balanced" contrasts of the arguments:
http://www.balancedpolitics.org/universal_health_care.htm
Should the Government Provide Free Universal Health Care for All Americans?

Yes:The number of uninsured citizens has grown to over 40 million.
Health care has become increasingly unaffordable for businesses and individuals.
We can eliminate wasteful inefficiencies such as duplicate paper work, claim approval, insurance submission, etc.
We can develop a centralized national database which makes diagnosis and treatment easier for doctors.
Medical professionals can concentrate on healing the patient rather than on insurance procedures, malpractice liability, etc.
Free medical services would encourage patients to practice preventive medicine and inquire about problems early when treatment will be light; currently, patients often avoid physicals and other preventive measures because of the costs.

No:
There isn't a single government agency or division that runs efficiently; if they can't run an office such as the DMV efficiently, how can we expect them to handle something as complex as health care?
"Free" health care isn't really free since we must pay for it with taxes; expenses for health care would have to be paid for with higher taxes or spending cuts in other areas such as defense, education, etc.
Profit motives, competition, and individual ingenuity have always led to greater cost control and effectiveness.
Government-controlled health care would lead to a decrease in patient flexibility.
Patients aren't likely to curb their drug costs and doctor visits if health care is free; thus, total costs will be several times what they are now.
Just because Americans are uninsured doesn't mean they can't receive health care; nonprofits and government-run hospitals provide services to those who don't have insurance, and it is illegal to refuse emergency medical service because of a lack of insurance.
Government-mandated procedures will likely reduce doctor flexibility and lead to poor patient care.
Healthy people who take care of themselves will have to pay for the burden of those who smoke, are obese, etc. A long, painful transition will have to take place involving lost insurance industry jobs, business closures, and new patient record creation.
Loss of private practice options and possible reduced pay may dissuade many would-be doctors from pursuing the profession.
Like social security, any government benefit eventually is taken as a "right" by the public, meaning that it's politically near impossible to remove or curtail it later on when costs get out of control.

... (more to read here for those who are interested) ...

*********
My strong preference is "Yes" (single-payer) but I realize that there are many downsides to a universal healthcare system. My preference is also for having private insurance as a backup. I like public education as a model. Public school is 'good enough' for most people, but obviously not a great option if you live in Louisiana, for example. Those who want to or need to will send their kids to a private school or homeschool them as a 'backup plan.' Despite its serious flaws and shortcomings, most people agree that having a public education system (as opposed to private only) is the right thing to do. Same goes for healthcare ... most people want a public system, even though it will be far from perfect. Similarly with a public healthcare system, there needs to be a private funding system for those people (hopefully small percentage) whose needs are not met by the public system.

 

[group_theory]

The main problem with universal coverage is that people will have to shoulder the burden of the ills.

Car insurance works by insuring lots of low-risk drivers, and the occasional accidents/claims is a low percentage of those insured. Life insurance works by insuring lots of people (or healthy people) and only have to do a one-time payout.

Health insurance is different. People expect insurance coverage to pay for routine office visits, routine bloodwork, for drugs, etc. You don't see this in the auto insurance industry (have the autoinsurance pay for scratches, oil change, routine state inspection, etc). And if someone does do this, his/her premiums goes up to try to adjust the risk.

There are a lot of people in the US who are obese. There are a lot of children in the US who are obese. There are people who abuse alcohol. There are a lot of people who have substance abuse problems. There are a lot of people with mental health issues. There are a lot of noncompliant diabetics. There are a lot of smokers out there. Will they have to pay more under the single-payer system than someone who is young and relatively healthy? And what if they can't afford it - are they still entitled to healthcare? And who picks up the cost?

If you have one person with cancer, the cost to treat can easily run into 6 or 7 figures. Now you can distribute that expense to 100 or 1000 healthy people and that expense isn't too bad. But there are a lot of sick people out there, who will need expensive treatment. There are a lot of people who need chronic treatment. There is only so much distribution of expenses to go around before the expense per individual is beyond what is sustainable to most people.

You also have to consider the current state of mind - people don't want to assume personal responsibility when it is convenient to them. Someone who smokes will still want the latest, most effective treatment for their lung cancer. A long-time alcoholic will still want a new liver. A noncompliant diabetic will still want a new kidney. And there are people who are 98 years old whose family want everything possible done in the ICU ... those ICU nurses, RT, TPN, pressors, antibiotics, intensivists - they cost $$$. But that's the mentality currently of a lot of people in America - and as a result, it increases healthcare expenditure beyond the maxium return for the money spent ... into inefficiency range

 

[OncoCaP]

The main problem with universal coverage is that people will have to shoulder the burden of the ills.

Car insurance works by insuring lots of low-risk drivers, and the occasional accidents/claims is a low percentage of those insured. Life insurance works by insuring lots of people (or healthy people) and only have to do a one-time payout.

While there are some similarities between car insurance and health insurance, there are a lot of important differences. If you total your son's car (you own it) by driving it into your home or a tree on your own property -- nobody cares (as long as you comply with any homeowners association rules and your car is paid for). When you don't treat your child's pneumonia because you thought it's a waste of money, you'll be charged by the police for child neglect/abuse and possibly do jail time. Comparing your car to a person's health is a weak analogy at best.

Health insurance is different. People expect insurance coverage to pay for routine office visits, routine bloodwork, for drugs, etc. You don't see this in the auto insurance industry (have the autoinsurance pay for scratches, oil change, routine state inspection, etc). And if someone does do this, his/her premiums goes up to try to adjust the risk.

Health insurance is different because a human life and a car don't have the same value. Also, we are free to dispose of cars. We can't just "dispose" of human lives. Also, there is little danger that a "scratch" on a car is going to be fatal for that car. On the other hand, routine bloodwork may reveal a life-threatening condition. If the person doesn't catch that condition early, it may be very expensive to treat. Thus, it is often in the insurance company's best interest to pay for immunizations, routine physicials, etc., because it's a small investment that offsets a potentially large expense of hospitalization and aggressive treatment.

There are a lot of people in the US who are obese. There are a lot of children in the US who are obese. There are people who abuse alcohol. There are a lot of people who have substance abuse problems. There are a lot of people with mental health issues. There are a lot of noncompliant diabetics. There are a lot of smokers out there. Will they have to pay more under the single-payer system than someone who is young and relatively healthy? And what if they can't afford it - are they still entitled to healthcare? And who picks up the cost?

There are also a lot of people who are just plain stupid (jumping off trees, inserting metal objects into themselves). Based on the best information that I have (comparing our costs to those of other countries), we will not have to pay more. In fact, we might pay less.

http://www.pnhp.org/
"The U.S. spends twice as much as other industrialized nations on health care, $7,129 per capita. Yet our system performs poorly in comparison and still leaves 46 million without health coverage and millions more inadequately covered.

"This is because private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment though a single nonprofit payer would save more than $350 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.

Some advocates argue that by streamlining the system, we'll be able to pay for everyone's care -- including the care of the very unwise.

If you have one person with cancer, the cost to treat can easily run into 6 or 7 figures. Now you can distribute that expense to 100 or 1000 healthy people and that expense isn't too bad. But there are a lot of sick people out there, who will need expensive treatment. There are a lot of people who need chronic treatment. There is only so much distribution of expenses to go around before the expense per individual is beyond what is sustainable to most people.

Yes, true. Depending on the health of our population and efficiency of a single-payer system, there might need to be rationing of the public health care dollars by some lottery or whatever, and I'm actually in favor of private health insurance available as a supplemental for those who can & want to spend extra money on their health.

You also have to consider the current state of mind - people don't want to assume personal responsibility when it is convenient to them. Someone who smokes will still want the latest, most effective treatment for their lung cancer. A long-time alcoholic will still want a new liver. A noncompliant diabetic will still want a new kidney. And there are people who are 98 years old whose family want everything possible done in the ICU ... those ICU nurses, RT, TPN, pressors, antibiotics, intensivists - they cost $$$. But that's the mentality currently of a lot of people in America - and as a result, it increases healthcare expenditure beyond the maxium return for the money spent ... into inefficiency range

Just because they want it doesn't mean the system will be able to provide it to them. Granted, politicians frequently promise more than they can and do deliver. However, I still prefer a single-payer system as a baseline, much as I prefer having public education and public roads available as a baseline (with private options available at extra expense).

There are many reasons as to why it is a good investment of public effort and dollars. Having a public healthcare system could improve the health of our population, help prevent bankruptcies due to health conditions, and improve the competitiveness of our companies in the world. Plus, it's considered to be a moral and ethical standard by many to have healthcare accessible to the general population.

 

[OncoCaP]

With respect to the concern that "well of course our health care bills are 2X the average because our people are really unhealthy" here are a couple of things to consider:

1. Americans do not smoke more than the rest of the world (actually our men smoke less -- thanks to in part to anti-smoking campaigns):
http://www.who.int/tobacco/en/atlas5.pdf

2. Even though we have more obesity and this is VERY troubling, it's not like we are getting more care for all those obese people. We are still more or less delivering the same amount of care as other countries, just paying a lot more than they are:

 

[Jejton]

It is illegal.

Not in Canada.

 

[3dtp]

With respect to the concern that "well of course our health care bills are 2X the average because our people are really unhealthy" here are a couple of things to consider:

1. Americans do not smoke more than the rest of the world (actually our men smoke less -- thanks to in part to anti-smoking campaigns):
http://www.who.int/tobacco/en/atlas5.pdf

2. Even though we have more obesity and this is VERY troubling, it's not like we are getting more care for all those obese people. We are still more or less delivering the same amount of care as other countries, just paying a lot more than they are:

And I saw a lot of fairly hefty Bavarians in Southern Germany, most of whom had a pitcher or two of beer at their table and a cigarette in hand. Looking at the numbers in the table, I have a question: How much does the "private" health insurance cost the average Brit or Canadian? Canada is fairly new at this game, and the issue of "private" health insurance and how much it would shunt money out of the public health system was very much the buzz at the First Minister's Conference on Health Care in Halifax.

So, government run health insurance in Canada costs $2,722, add a supplemental health policy for say, $2,400/year brings the numbers to $5,122, which is not too far removed from the US costs. And here you can get your MRI in about 48 hours and not 17 weeks, which will allow the lung cancer brain met to be found and treated before it causes destruction of critical path ways. And I doubt the PET/MRI unit wil be available anytime soon there.

Infant mortality statistics for the US are indeed worse, much worse in many cases than many other countries. Why? Could it be that a PTL 23 weeker in the US is given a chance in the NICU costing $100k in the first months of life and then dies of preterm birth complications? Happens fairly regularly and many survive. Definition of Infant mortality includes these that in other countries would be counted as stillborn/miscarriage. Perchance the definition of infant mortality is dated or flawed?

What price quality of life? Your life?
A lottery for health care resources? Or a revolver with 2 bullets in the chambers, Russian roulette style? I think not! I know we can do better.

 

[deleted4401]

The amount we pay just privately per capita (55% of $5200) is more than the amount that the UK pays in total ($2160)! More evidence that those countries are underfunding the system.

The rationing of health care in those other countries is directly related to the fact that they spend half as much money as we do. Why would we expect any country to have an MRI on demand if they spend half as much money as we do? It's not rocket science. It's not that their system is broke or ours has these great market mechanisms. We spend 2x as much money as they do, what do you expect? If we spent it efficiently and rationally, eliminating the CEOs huge stock options and golden parachutes, allowing PCP access instead of ED overtreatment, cutting out all the extra paperwork, we'd have more money for more medical care or for research or to pad our salaries a bit.

It's not just the subsidization of research and high priced pharmaceuticals. Any system with the paper overhead we have is going to be wasteful. Any system that has the CEOs of health care systems making enough money to insure every child in America twice over is wasteful. If we spend this much money per person, we should have at least equal outcomes or equal access. We have neither.

-S

 

[NDESTRUKT]

I always had the impression that the system in Canada was basic provisions and on top of that, people could have private insurance.

Besides, doctors in Canada may be paid less than US docs but they're still making over 100K a year...which in my opinion is good enough.

 

[dutchman]

I always had the impression that the system in Canada was basic provisions and on top of that, people could have private insurance.

Besides, doctors in Canada may be paid less than US docs but they're still making over 100K a year...which in my opinion is good enough.

Only difference is that in the U.S doctors take loans up the ass. Canadian doctors are making that much because the U.S is a part of their labor pool, they have to pay well to keep their doctors. Not going to be the case when both systems mirror each other.

 

[dilated]

Yes, true. Depending on the health of our population and efficiency of a single-payer system, there might need to be rationing of the public health care dollars by some lottery or whatever, and I'm actually in favor of private health insurance available as a supplemental for those who can & want to spend extra money on their health.

So the 85% of Americans with health insurance should have to pay twice to get decent care so the 15% who don't want to pay for it don't have to (and I don't buy that they can't afford it with the presence of Medicaid)? Saying "you can have private insurance" is a pretty lame argument for single payer. Yay, I can pay for universal health care AND still pay for private insurance to get the same (extremely high) level of care I get now? Sign me up.

 

[3dtp]

The amount we pay just privately per capita (55% of $5200) is more than the amount that the UK pays in total ($2160)! More evidence that those countries are underfunding the system.

As I understood the table, this number is what the government provided health care costs. Brits who value their health buy the private insurance on top of that to go to the doc/hospital of their choice. This is the key number, and one which is indeterminate. But, based on talking to a broker here in the states, I suggest that $200/month might not be out of line and is consistent with medicare supplemental insurance that many medicare beneficiaries in the states have. That number may be a bit on the low side, but I suspect its in the ball park. Therefore, the true cost of the British system is more like $2160+2400 = $4560 which is in the ballpark of what we pay, assuming my guess is close. It may be low and the true expense might be closer (or even more) to what we pay.

And besides, you know why gas costs $5/gallon in Germany and the UK? Because they use a goodly portion of that tax to pay for health care and social welfare.

 

[DiveMD]

Just the idea of having to wait 6 months for a particular surgery or medical visit should be enough to discredit "Universal Health Care".

 

[OncoCaP]

As I understood the table, this number is what the government provided health care costs. Brits who value their health buy the private insurance on top of that to go to the doc/hospital of their choice. This is the key number, and one which is indeterminate. But, based on talking to a broker here in the states, I suggest that $200/month might not be out of line and is consistent with medicare supplemental insurance that many medicare beneficiaries in the states have. That number may be a bit on the low side, but I suspect its in the ball park. Therefore, the true cost of the British system is more like $2160+2400 = $4560 which is in the ballpark of what we pay, assuming my guess is close. It may be low and the true expense might be closer (or even more) to what we pay.

And besides, you know why gas costs $5/gallon in Germany and the UK? Because they use a goodly portion of that tax to pay for health care and social welfare.

Those numbers are TOTAL, not out of pocket expenses. In other words, in the U.S., we spend around $5K/person on average (I think current numbers are closer to $6K/person), and private financing pays 55% of that (insurance, copays, cash, etc.). The rest (45%) is paid by Medicare, Medicaid, CHIP, etc. Of course, it's very uneven, with some people spending $20K on health insurance and benefits, while others are not contributing anything and are not even using the healthcare system because they can't or don't need to.

The numbers for the Brits are also TOTAL $2K (on average), including out of pocket AND including their private health insurance. Once again there may be some variation. So, yes, on average, the Brits could spend more and get better care, but they choose not to.

Both the brits and we use around the same number of nurses and physicians per capita, so its not that we are getting more care. Our healthcare just costs more because our system is overpriced and wasteful.

 

[EctopicFetus]

ahh the beat rolls on. again.. Health care is not a right.. If someone passed this law or right please find it for me.

 

[dutchman]

ahh the beat rolls on. again.. Health care is not a right.. If someone passed this law or right please find it for me.

It is definitely not a right, maybe a reasonable expectation, but not a right. It could not be a right before food and shelter, which are both not garaunteed by law.

 

[OncoCaP]

Agreed. Not a right, but an expectation. We provide food and shelter to those unable to provide it for themselves. I guess healthcare is next.

 

[sirus_virus]

Agreed. Not a right, but an expectation. We provide food and shelter to those unable to provide it for themselves. I guess healthcare is next.

Huh! where was the government when I almost got evicted from my apartment 5 years ago? You ever heard of homeless people?

 

[NDESTRUKT]

maybe listening to "heal the world" by michael jackson will inspire you guys to change your minds.

ok, i was just kidding, please don't take what i said seriously heh

 

[Jejton]

But, based on talking to a broker here in the states, I suggest that $200/month might not be out of line and is consistent with medicare supplemental insurance that many medicare beneficiaries in the states have. That number may be a bit on the low side, but I suspect its in the ball park.

I dont know where you got that figure from but here in NY that wouldnt get you much. Right now we are no a plan through my wife's school so it is supposedly discounted. We pay a little over $500/month for the two of us ( baby is on a separate plan ). That doesnt take into account the copays which range from $20 - $50 per visit ( depending on the service), the pharmeceuticals co-pay, the $1000/person deductible for IN-NETWORK services, and the $2000/person deductible for OUT-OF Network services. Oh, and then the doctors will still bill us for whatever percentage the insurance decides not to pay for. So this insurance ( which is not the top but is pretty good ) actually ends up costing me close to $700/month averaged over a year.
Now I make too much to qualify for government programs such as Medicaid but if you factor all my other expenses in - and I dont live a high-end lifestyle but a pretty average middle-class recent graduate with one baby
lifestyle - such as rent, food, electric, phone, gas, car-related, school loans, etc. - I wouldnt be able to afford this insurance, especially if we were paying full price ( we have some help from family for the health insurance ). So what are my options? Well I am lucky enough to get some help from family for this, but most people either have to lie about their incomes to qualify for government assistance or be honest about their incomes and forgoe health insurance. Now most middle-class folks that I know of dont live luxuriant life styles so to say that you should just not go on that monthly cruise in order to afford health insurance -well thats not realistic. Yes there are people who splurge on other things rather than buy necessities but I highly doubt they are the norm ( at least from my limited personal experience ).

This also does not take into consideration the people who have insurance that does not adequately cover them but which they are unaware about until a catastrophe happens.

 

[3dtp]

I dont know where you got that figure from but here in NY that wouldnt get you much. Right now we are no a plan through my wife's school so it is supposedly discounted. We pay a little over $500/month for the two of us ( baby is on a separate plan ). That doesnt take into account the copays which range from $20 - $50 per visit ( depending on the service), the pharmeceuticals co-pay, the $1000/person deductible for IN-NETWORK services, and the $2000/person deductible for OUT-OF Network services. Oh, and then the doctors will still bill us for whatever percentage the insurance decides not to pay for. So this insurance ( which is not the top but is pretty good ) actually ends up costing me close to $700/month averaged over a year.
Now I make too much to qualify for government programs such as Medicaid but if you factor all my other expenses in - and I dont live a high-end lifestyle but a pretty average middle-class recent graduate with one baby
lifestyle - such as rent, food, electric, phone, gas, car-related, school loans, etc. - I wouldnt be able to afford this insurance, especially if we were paying full price ( we have some help from family for the health insurance ). So what are my options? Well I am lucky enough to get some help from family for this, but most people either have to lie about their incomes to qualify for government assistance or be honest about their incomes and forgoe health insurance. Now most middle-class folks that I know of dont live luxuriant life styles so to say that you should just not go on that monthly cruise in order to afford health insurance -well thats not realistic. Yes there are people who splurge on other things rather than buy necessities but I highly doubt they are the norm ( at least from my limited personal experience ).

This also does not take into consideration the people who have insurance that does not adequately cover them but which they are unaware about until a catastrophe happens.

Agree. The figure I got was a guess on what someone in UK or Canada might pay for supplemental insurance to see if the tables others have quoted hold water when the full costs are put together. Another poster said that the roughly $2k allocated to the Brits in the table includes private health insurance premiums for those who do not want to wait for a slot in the gov't system. I truely don't know how to find out what the price of a private supplemental insurance policy in, say London or Cambridge would cost or what the true total government (ie citizens) pay via the various taxes/fees.
So I based my guess on what a reasonably healthy 67 year old would pay for a private supplemental health care policy in the US for a MEDICARE eligible patient. The specific policy is called a "medigap" policy and is, at least in theory supposed to cover non-office visit charges that are not covered by medicare. I might add that the Clark government attempted and the Trudeau government in Canada put an additional CDN$ 0.50 gas tax to cover the health care there, then added the PST/GST to help cover shortfalls, and later Cretien and Mulroney spun off essential government services (air traffic control, park rangers and administration) and created "user fees" which they claim are not taxes, but nonetheless remove money from the general economy to pay for their national health plan. I think the true costs of these plans are so well obfuscated by the layers of entrenched bureaucracy and budget shuffling that we'd have an easier time figuring out the true budget for the CIA.

I pay my employee premiums in a business I own. We pay on the average, $572 per covered life on a 90-10 PPO plan with a $20 office visit co-pay. This policy has a $5000 stop loss limit and a lifetime non-accidental payout limit of $1M. That amounts to $6864/year, and we've got a couple of medical high risk patients in the company. It amounts to about 1/4 - 1/3 of our gross salary budget. This business is primarily low tech, and relatively low wage industry and I am one of the few nationwide that do provide health insurance for my hourly employees. When I can't afford the insurance, we'll close the business and let the Chinese take over, but as long as I am on the board, we will provide health insurance. Note that this is in addition to the 1.2% Medicare tax I pay on the payroll and the worker's compensation tax I pay for OTJ injuries. Figure those costs in and the %-age of gross salary budget goes up further.

We do not provide maternity coverage through an insurance company because we will not cover voluntary abortions as a matter of policy and these policies are extremely expensive in exchange for what they pay in benefits. Most insurance companies lump abortion and pregancy into a "reproductive health benefit."

So, for our female employees who are pregnant, we pay all costs (self-insure). They find the ob-gyn of their choice, and have them bill the company directly. We pay the bill. If the OB won't accept direct billing, we give them a check made out jointly to the OB and the employee for the amount of the charges. The only restriction on this was that we insisted that the NOB visit was within 30 days of the first indication of pregnancy and proper prenatal care was continued throughout the pregnancy. Our first pregnant employee went to a well established OB who couldn't figure out that we didn't need/want ICD9 codes CPT codes or any other codes or claim information. Just a number. How much to put on the check. Our accounts payable clerk had him call me to explain it to him when his medical biller refused to believe we didn't want all that paperwork. And we saved a lot of money over the years. One OB went so far as to give us a nice discount because we paid the bill on the Friday following the day we receive it and no paperwork. C-sects and MFM services are coverd under the regular policy medical and surgical indemnity.

Can't speak for NYC, though. My cousin lives there and pays a king's ransom for a 900 sq ft 2 bedroom house in the burbs that wouldn't bring in enough to pay the property taxes further down the coast where we are.

 

[dutchman]

Connecticut has joined the gang rape.

"lawmakers considering a 3 percent tax on doctors' revenues to help pay for universal health care"

http://www.courant.com/news/politic...237386.story?coll=hc-headlines-politics-state

At what point will physicians start fighing for the right to be normal citizens?