Universal Health Care for U.S., Yes or No?

[45408]

At the end of the day, America pays more per capita than any other nation. Now take that money and eliminate the middle man that costs hospitals billions in wasted time. Then take both of those and add in preventive care which would save further billions by reducing incredibly expensive last-minute emergencies, and you could treat far more patients currently are.

And the likelihood of our federal government increasing the efficiency and equity of this system.....pretty darn low, I believe. Would I like to see coverage provided for nearly everyone? Yes. Do I think the federal government is the best solution? NO.

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[Begaster]

And the likelihood of our federal government increasing the efficiency and equity of this system.....pretty darn low, I believe. Would I like to see coverage provided for nearly everyone? Yes. Do I think the federal government is the best solution? NO.

While the government certainly has a bad knack of wasting insane amounts of money and being inefficient, governmental programs are not always terrible. NASA, for example, is pretty efficient with the budget it is given. In the end, you just need a few dozen smart people and a lot of transparency to avoid corruption.

 

[Begaster]

oh boo hoo, the knife is turning in my heart... not that i can understand what the hell you're saying.

Wow, you really are an *******.

This guy comes and tells you that he cannot afford medical insurance and to feed his family, and you still babble inanely about personal responsibility. What exactly do you expect him to do? Make money grow on trees? Get a higher paying job that doesn't exist? Stop taking care of his brothers? Are you that sheltered or merely that stupid?

 

[45408]

While the government certainly has a bad knack of wasting insane amounts of money and being inefficient, governmental programs are not always terrible. NASA, for example, is pretty efficient with the budget it is given. In the end, you just need a few dozen smart people and a lot of transparency to avoid corruption.

Look into the history of the space shuttle. It was not designed to have such a lengthy turn-around time and extensive maintenance (the heat-resistant ceramic tiles are incredibly time-consuming to replace and their delicacy is probably the reason that the Columbia disintegrated on re-entry). It was supposed to be cheap, re-usable, and a stepping stone to a better device. It's barely fulfilled any of those. It was supposed to launch EVERY WEEK. Private industry has been much more successful (see Burt Rutan). I think the health care system needs revision, and I think that states should play a larger role in that revision, and I think the federal government should be almost completely out of the picture.


for your reading pleasure - http://en.wikipedia.org/wiki/Criticism_of_the_Space_Shuttle_program


As an interesting aside, the solid rocket boosters on the shuttle are amazingly powerful - http://en.wikipedia.org/wiki/Space_Shuttle_Solid_Rocket_Booster

 

[Begaster]

NASA's definitely not perfect. Don't even get me started on the Space Shuttles (what disasters they have been).

At the end of the day, though, their successes far outweigh their failures. A current example are the Mars rovers which have currently lasted 13 times longer than they were projected to and are still fully operational. The Hubble telescope which has allowed us to see the universe in ways previously impossible.

Corporations thrive on competition, I agree. But this competition is directed towards profit. In the case of space travel, suborbital pleasure cruises (and maybe even hotels in the near future) will undoubtedly be pushed forward by companies trying to make money. At the same time, NASA will always be required to field the projects that have no short-term (or even knowable) gains. While competition to build the first lunar hotel will maximize profits, it will not generate the foundational science needed for us to travel to new planets or better explain the universe. It's simply outside of the scope of the profit model competition is so excellent for. This is what the government and NASA in particular are for. It's the same reason we have places like the NIH functioning.

What has this to do with anything? Well, I see health care in a similar fashion. Competition will undoubtedly maximize profit and efficiency, but it's not profit we're actually after in this case. Because profit and efficiency are vehicles for the insurance companies to succeed, not for their beneficiaries to do so. A profitable, efficient insurance company is the one which is best at rejecting people who will potentially get sick, finding loopholes to use for denial of service, and, if all else fails, actually paying for medical expenses. Providing excellent health care for the sickly is not in the best interests of the corporation. They're, above all, there to provide the illusion of excellent health care for the healthy.

At the end of the day, regardless of whether the government or the insurance companies are in control, you're going to see a rationing of care. The amount of rationing is what will differ. While government oversight will have to limit people to stay within its budget, insurance companies will have to limit people not only to stay within the budget, but to actually make a profit. On the same sized budget, you're going to be looking at far more rationing. Add to that the needless layers of bureaucracy and the wasted time on filling out the multiple insurance forms to avoid fraud, and you have a problem. Health care must have a non-profit solution, or it's the sick who end up getting hurt. I think the government is the best vehicle to do this, though, as I said, it will require many gifted minds and a lot of transparency to achieve.

 

[45408]

At the same time, NASA will always be required to field the projects that have no short-term (or even knowable) gains. While competition to build the first lunar hotel will maximize profits, it will not generate the foundational science needed for us to travel to new planets or better explain the universe. It's simply outside of the scope of the profit model competition is so excellent for. This is what the government and NASA in particular are for. It's the same reason we have places like the NIH functioning.

That's why I'm a big fan of the NIH and the NSF. If I were president, the budget for both would get a big boost.

While government oversight will have to limit people to stay within its budget

I think our government has shown that it actually cannot do this. Here and there, we manage to balance our budget, but it's clearly in terrible shape now, and the solution is to print more money and devalue our currency even more.

Health care must have a non-profit solution, or it's the sick who end up getting hurt. I think the government is the best vehicle to do this, though, as I said, it will require many gifted minds and a lot of transparency to achieve.

I think the people who DO need government-supplied care are those who cannot ever get insurance - like someone with severe cerebral palsy or spina bif, and they can work to get a job to provide insurance, and their condition requires significant care (the average lifetime cost of CP is nearly a million dollars - it's the second most expensive condition you could get) SHOULD have state-subsidied or state-provided insurance. Key word being the STATE. A state-sized bureaucracy is going to be 2% of the size of a federal beast, and if one state's solution is working out better than others, people can either move to another state or petition for a modified system. And while I don't think it's ideal, I think we're past the point of no return for providing health care for the elderly. I don't think it was a good idea for a lot of reasons, but I'm certainly not going to pull it now (and any politician who suggests that would never be re-elected - the elderly come out in droves to vote). I would also like to convert that to a state-based system.

 

[badasshairday]

no

 

[scarletgirl777]

What has this to do with anything? Well, I see health care in a similar fashion. Competition will undoubtedly maximize profit and efficiency, but it's not profit we're actually after in this case. Because profit and efficiency are vehicles for the insurance companies to succeed, not for their beneficiaries to do so. A profitable, efficient insurance company is the one which is best at rejecting people who will potentially get sick, finding loopholes to use for denial of service, and, if all else fails, actually paying for medical expenses. Providing excellent health care for the sickly is not in the best interests of the corporation. They're, above all, there to provide the illusion of excellent health care for the healthy.

At the end of the day, regardless of whether the government or the insurance companies are in control, you're going to see a rationing of care. The amount of rationing is what will differ. While government oversight will have to limit people to stay within its budget, insurance companies will have to limit people not only to stay within the budget, but to actually make a profit. On the same sized budget, you're going to be looking at far more rationing. Add to that the needless layers of bureaucracy and the wasted time on filling out the multiple insurance forms to avoid fraud, and you have a problem. Health care must have a non-profit solution, or it's the sick who end up getting hurt. I think the government is the best vehicle to do this, though, as I said, it will require many gifted minds and a lot of transparency to achieve.

The part of the problem that everyone is conveniently ignoring.

 

[45408]

The part of the problem that everyone is conveniently ignoring.

No, I'm not. Are you worried about your car insurance provider making a profit? How about the grocery store? Food is pretty necessary. It's not right to profiteer when you're providing food for the hungry.

 

[scarletgirl777]

No, I'm not. Are you worried about your car insurance provider making a profit? How about the grocery store? Food is pretty necessary. It's not right to profiteer when you're providing food for the hungry.

There's nothing wrong with making a profit. The problem is that health insurance is unlike any other good. The best way to make a profit off of food is to make as many people buy it as possible. The best way to make a profit off of health insurance is to restrict sick people from buying it so that we don't have to pay for their expensive health care. The best way to get cheap health insurance is to hide your risk factors, medical history, and family history from the health insurance provider. This is setting up a situation where both sides are trying to game each other and the system is not transparent. I don't blame the insurance companies--this is the only way they can act in the current situation. That's all that the bolded statement was saying.

Again, I really don't care who gets rich off this process. I do care if people are being denied coverage because they are sick, or having to pay premiums they can't afford because they are sick, or if people do not join the system until they are sick. All of this works together to wreck the system. And no one who is fighting universal health care is coming up for a way to prevent these things from happening. If you are going to tear down a solution, then you should come up with another one.

 

[45408]

There's nothing wrong with making a profit. The problem is that health insurance is unlike any other good.

I noticed that you skipped the car insurance comparison. Health insurance is not unlike any other good - it's JUST like all the other types of insurance.

 

[scarletgirl777]

I noticed that you skipped the car insurance comparison. Health insurance is not unlike any other good - it's JUST like all the other types of insurance.

OK, let me try again. Car insurance is NOT like health insurance. In car insurance, there is a driving history. Driving records are pretty centralized and easy to get in this country as compared to medical records (which we intentionally keep decentralized for privacy's sake). Driving records also take information about you that is pretty hard to lie about like age, gender, car color and make statistical models about who will crash and who will not. Those models are very good. There is a great deal of transparency in car insurance (technical term for this that I can't remember)

No one's found a great way to predict who will suck up a lot of health care dollars. If you already know someone has an expensive condition, that's a surefire bet. But sometimes you don't know (and the person does!) Or the person has risk factors that you don't really know about but that the person does know about. So health insurance companies' attitude for the individual market (and if you don't have a good job, or you're an independent contractor, that's what you go to) is: hmm, this person wants health insurance. They must want health insurance because they think there's a better than average chance that they'll need a lot of coverage. Let's raise the price to account for that. So the person buying the insurance says hmm, this is really expensive and either thinks "I'm healthy so I won't buy it. or "I'm high risk or averse to being uninsured, so I will buy it." But that makes the pool more concentrated high risk, so the insurance company has to raise the premiums again, pushing out more people on the healthy end of the spectrum, and the cycle continues till the system collapses.

This is why it is next to impossible to get people affordable health care in the individual health insurance market (and why I doubt that John McCain's plan will work). Group insurance is absolutely necessary, but those groups need to be large enough to escape this trap. There are some good economics focused books I read about this, but I can't remember the titles right now and don't care to track down the titles.

So no I"m not ignoring you, frankly I knew this would require a long post...I hope this explains why health insurance really is different from the typical good, including car insurance.

EDIT: Also, the more I think about it, the more your last response confuses me. Your first response to me was focusing on profit and was saying, why demonize people based on their profit-making capability? You weren't saying that car insurance and health insurance were equal on all these complex levels, just in their profit-making ability. Or if you were, your point was not well elaborated.

 

[jsydc]

Universal health care is like democracy, it's the worst system out there, except for all the other ones.

I'll give you two scenarios I've come across recently that hammered this point home for me. One of them is a relative of a friend, a successful banker with reasonable insurance coverage in Oregon. His eight year old daughter is now suffering from leukemia, and insurance covers about 80% of the bills. He is likely to default on his mortgage within the next few months, after 1 1/2 years of treatment. (Look up the statistics on health related bankruptcy in the US, it's an entertaining picture.)
The other one was a graduate from my current program who was headed to a lucrative new job in Missouri. He and his wife were moving from Montreal to Missouri, he was driving the moving truck and she was driving their car. She was T-boned at an intersection and air-lifted to a hospital, where she spent several months in recovery. His insurance coverage didn't start until the next day, his first day of work. He got to start out with a nice 6 figure salary and with $300K of debt.

How many families suffer from health-related financial crisis in Canada? France? The UK? We may wait a little bit longer in line, but at least we have a proper social safety net. That's worth a lot more to our economy than the opportunity to profit from healthcare.
If you don't believe in a socialized medical system, you should do an elective in Canada, and see what it's like when doctor's don't have to spend 1/3 of their efforts working out creative billing strategies, or better yet, come here and practice.

 

[167649]

And the likelihood of our federal government increasing the efficiency and equity of this system.....pretty darn low, I believe. Would I like to see coverage provided for nearly everyone? Yes. Do I think the federal government is the best solution? NO.

In my opinion, this is beyond likelihood. Per capita,our public health care spending is already about the same as Canada and the UK, yet while their systems covers everyone, ours only covers a minority. We loose a ton through inefficiency.

So even the present evidence, with our current programs, shows that our government is terribly inefficient. And some people think we should have them cover everybody.

I think the people who DO need government-supplied care are those who cannot ever get insurance - like someone with severe cerebral palsy or spina bif, and they can work to get a job to provide insurance, and their condition requires significant care (the average lifetime cost of CP is nearly a million dollars - it's the second most expensive condition you could get) SHOULD have state-subsidied or state-provided insurance. Key word being the STATE. A state-sized bureaucracy is going to be 2% of the size of a federal beast, and if one state's solution is working out better than others, people can either move to another state or petition for a modified system. And while I don't think it's ideal, I think we're past the point of no return for providing health care for the elderly. I don't think it was a good idea for a lot of reasons, but I'm certainly not going to pull it now (and any politician who suggests that would never be re-elected - the elderly come out in droves to vote). I would also like to convert that to a state-based system.

Bingo.

I actually like the idea of a health insurance voucher issued by the government. This is like the idea in the Kotlikoff book we were discussing earlier, but instead of being done at the federal tier (as he suggested), I think it should be done at the state level. Combined with a type of health savings account system, I think it would be a good start.

 

[Begaster]

No, I'm not. Are you worried about your car insurance provider making a profit? How about the grocery store? Food is pretty necessary. It's not right to profiteer when you're providing food for the hungry.

There's nothing wrong with profit, necessarily. In the case of insurance, though, one needn't look much further than Katrina to see what they're willing to do to avoid making payments. How many people lost their homes and were unable to claim their insurance due to loopholes and overall bull****. Health insurance is no different.

Car insurance is an interesting example. If you're a terrible driver who has been in multiple accidents, you will not be able to get insured. This is frighteningly similar to the AIDS, cancer, or heart attack patient who loses his job and can no longer find an insurance company willing to be his provider (for less than what the disease will cost them).

Again, I think you agree with me for the most part. Your question is how we can trust the government to be efficient. Honestly, it's a good question. I think it'd be doable if there was enough political pressure. I don't know enough about the methods you proposed to have any opinions on them, but at the end of the day, I don't really care if there's universal health care on a state-by-state basis or at the federal level.


Rooter, America's per capita spending is much greater than Canada's.

 

[armybound]

Car insurance is an interesting example. If you're a terrible driver who has been in multiple accidents, you will not be able to get insured. This is frighteningly similar to the AIDS, cancer, or heart attack patient who loses his job and can no longer find an insurance company willing to be his provider (for less than what the disease will cost them).

Not having insurance doesn't mean you can't get healthcare. It's just subsidized healthcare at a lower cost burden to you. Medicine is ultimately a service that you have to pay for. It's not insurance's fault if you can't afford the treatment you need, even if that treatment is necessary for you to keep living.

If we go in 50/50 on dinner and I buy the $100 7 course meal and you pick up $5 Taco Bell, are you going to want to pay my tab? How many of your friends can you get to come to dinner with us if they keep getting $5 meals, yet have to split our $105+5x dinner tab?

Insurance companies work the same way.. they could insure people who require $250,000+ in payouts per year, but they'd have to raise costs for everyone to cover that payout. Who's going to go with the $1000/mo health insurance when there's a $200/mo option that gives you the same coverage? Insurance companies have to attract low-payout customers to keep the whole system going.

We should note that even "good" plans for normal payers have a lifetime payout limit. I know a family that pays $3,000/mo for health insurance and there's still a limit to how much the insurance company will pay out in their lifetime.

 

[167649]

Rooter, America's per capita spending is much greater than Canada's.

Well there ya go then!

 

[45408]

OK, let me try again. Car insurance is NOT like health insurance. In car insurance, there is a driving history. Driving records are pretty centralized and easy to get in this country as compared to medical records (which we intentionally keep decentralized for privacy's sake). Driving records also take information about you that is pretty hard to lie about like age, gender, car color and make statistical models about who will crash and who will not. Those models are very good. There is a great deal of transparency in car insurance (technical term for this that I can't remember)

All based on generalizations that would anger people if they were used in other situations. A very safe and responsible 18-year old male will pay a fortune if he wants to drive a new STi. The insurance doesn't know if you speed but use a radar detector, or if you've committed a hit and run, etc.

hmm, this person wants health insurance. They must want health insurance because they think there's a better than average chance that they'll need a lot of coverage. Let's raise the price to account for that.

Where are you coming up with this conclusion? Most people have health insurance, and somehow the insurance company thinks that if you want health insurance, you must be high risk? I guess we're all high risk then. Homeowner's insurance doesn't assume you're going to torch your house just because you want coverage.

 

[45408]

Rooter, America's per capita spending is much greater than Canada's.

Which sets off massive alarm bells in my head. If we increase access, costs will NOT go down. We have to control costs on multiple levels before we open the floodgates of access. Our current obligations for Medicare and Social Security already are far beyond our ability to pay, even in the next 20 years, let alone beyond that.

 

[armybound]

you guys dragged me into this thread.. I wasn't going to get involved.

I meant just to tell you guys to keep this thread civil or it will be locked or moved.

 

[45408]

you guys dragged me into this thread.. I wasn't going to get involved.

I meant just to tell you guys to keep this thread civil or it will be locked or moved.

We're being civil. It always helps when people realize that other people see the role of government/health care providers as different than other people's ideas. I just hate it when people assume that I don't care or that I hate poor people based on what I'm trying to say.

 

[scarletgirl777]

All based on generalizations that would anger people if they were used in other situations. A very safe and responsible 18-year old male will pay a fortune if he wants to drive a new STi. The insurance doesn't know if you speed but use a radar detector, or if you've committed a hit and run, etc.


Where are you coming up with this conclusion? Most people have health insurance, and somehow the insurance company thinks that if you want health insurance, you must be high risk? I guess we're all high risk then. Homeowner's insurance doesn't assume you're going to torch your house just because you want coverage.

I'm not sure if the first paragraph is commentary or an argument? If it's an argument against any point I've made, I don't know what point you are trying to refute. Regardless, they are very good generalizations and they help insurance companies, on a grand scale, predict how much money they will pay out (of course, it's a probability game, so not every male high school dropout with a red car will get into a car crash). Speeding and using a radar detector I imagine is quite rare. And if you are convicted of a hit and run they definitely will find out.

Most people have health insurance, but most of those people have it through a GROUP not through INDIVIDUAL HEALTH INSURANCE. See, it IS difficult to be sure my point will be understood in long posts, this is a crucial distinction here. My explanation shows why it's hard for people who are self-employed, unemployed, or independent contractors and it will ALWAYS be hard for them under our current system. There will always be people who are uninsured or crappily insured under this system, and I am of the opinion that it is not fair. This can also apply to small businesses, as many small businesses do not have insurance because it is expensive, so if a small business makes the step to do so then there's an increased probability that there's some kind of reason for this, possibly the owner's own health situation.

Where am I getting this from? A health care policy class. Again, do not remember the titles of my old textbooks.


AGAIN, ALL OTHER TYPES OF INSURANCES ARE DIFFERENT. There is crucial information that the buyer of health insurance potentially knows that the seller does not. When you have home insurance/car insurance/travel insurance/whatever insurance, this just does not happen to that extent.

 

[jsydc]

Which sets off massive alarm bells in my head. If we increase access, costs will NOT go down. We have to control costs on multiple levels before we open the floodgates of access. Our current obligations for Medicare and Social Security already are far beyond our ability to pay, even in the next 20 years, let alone beyond that.

So basically what you are saying is that American government bureaucracy can never hope to achieve anywhere near the efficiency of any of the other countries that offer socialized healthcare. I'd like to think American's are smarter than that.

 

[armybound]

So basically what you are saying is that American government bureaucracy can never hope to achieve anywhere near the efficiency of any of the other countries that offer socialized healthcare. I'd like to think American's are smarter than that.

I'd like to think we're not dumb either, but we definitely are.

 

[OB/GYN Sim]

To all those people that say no universal healthcare:

Do you say no because you think it will have bad implications on the healthcare system, or is it because you fear a drop in health-related job salaries? I'm pretty sure, deep inside, a lot of you are saying no for the second reason. You fear that your $200,000+ salary may go down to $150,000+. Don't you feel ashamed to put your personal gains at a higher priority than societies' gain as a whole? Of course, you will say that having universal healthcare will higher taxes and burden citizens with other people's problems; you don't realize that the majority of the American public would rather not pay hundreds of dollars a month to insurance companies who only care for their money. Most Americans are average/below-average income earners. They can't afford to pay insurance companies hundreds of dollars of month.

I do not agree with you at all, this program will 100% lower the quality of care. Do you think the government would fund people's anti depressants or A.D.D. medicine or frivolous test on things they can live with. The goverment will fund only the most neccessary of things bringing the average health care provided to a cost conscious not patient conscious form of being. This system is not going to help give people without care the kind of care people who pay for it have, it will have them meet at a much lower level

 

[Begaster]

Not having insurance doesn't mean you can't get healthcare. It's just subsidized healthcare at a lower cost burden to you. Medicine is ultimately a service that you have to pay for. It's not insurance's fault if you can't afford the treatment you need, even if that treatment is necessary for you to keep living.

For all intents and purposes, it does. It means you will have to rely on governmental assistance by declaring bankruptcy. Let's not play semantics, please. No middle-class family can afford healthcare without insurance. As the rest of your post says, it's not the insurance companies' faults that they want to make a profit - that's the model they're built on. It's America's fault, though, that such a system has been allowed to thrive. Washing your car is a service. Healthcare is a right, through and through. America is the only civilized country in the world to still not understand that, and most Americans are all the poorer for it.

Ob/Gyn, antidepressants and Ritalin are pretty common place in Canada and France.

Prowler, per capita costs are so explosively high for a few reasons. Three big ones off the top of my head are frivolous lawsuits, administrative costs, and, most importantly, a lack of preventive care. A women without health insurance who feels a lump won't go and get it checked out if it costs her money she doesn't have. Instead of being able to immediately ameliorate the breast cancer, it'll spread until she ends up in the ER and costs you hundreds of thousands of dollars over the few weeks she survives in critical care. Her family, of course, can't afford this - they default, taxpayers and hospitals shoulder the burden.

There is a plethora of information out there on the money-saving aspects of preventive care. America isn't far and away less healthy than Canadians. It may be the fattest country, but Canada is a close second. Culturally, the two countries are the same. The difference in per capita costs can be attributed less to lifestyle factors and more to the systems set in place.

 

[nu2004]

Wow, you really are an *******.

This guy comes and tells you that he cannot afford medical insurance and to feed his family, and you still babble inanely about personal responsibility. What exactly do you expect him to do? Make money grow on trees? Get a higher paying job that doesn't exist? Stop taking care of his brothers? Are you that sheltered or merely that stupid?

i agree with most of the points you are making in this thread, so i don't see why you are taking time from your otherwise productive argumentation to be a butthead. that guy was spouting off idiotic ramblings about car insurance that made no sense to me whatsoever, and ended with an emotional "FU" that was supposed to be his big argument winner.

i've worked myself ragged to get where i am, and i still believe that my (many) tax dollars should go to help those less fortunate than myself.

stay focused.

 

[45408]

So basically what you are saying is that American government bureaucracy can never hope to achieve anywhere near the efficiency of any of the other countries that offer socialized healthcare. I'd like to think American's are smarter than that.

So would I, but I don't. It is completely obvious that the US is already spending far more than other countries on health care. We blew through $2.1 trillion in 2006, I believe, which is around $7000 per person. The UK spends about a third that much. This is the part of the situation you can not get around: if we INCREASE access, cost will NOT decrease unless you change a lot of other things first. Right now, our country DOES NOT HAVE the money to pay for anything remotely near single payer coverage. Our dollar is declining terribly (see here - http://www.urbandigs.com/us-dollar-vs-euro.jpg ), oil is soaring, people are losing their homes at a record pace, and no one has savings, but they sure have credit card debt.

The first thing we need to do is stop spending so much on health care. We are not getting a return on our expense. There is only a weak correlation between dollars spent and the quality of health attained. That will happen when you blaze through tens and hundreds of thousands of dollars with cases like this:

http://pandabearmd.com/blog/2006/11/24/dawn-of-the-dead/
http://thehappyhospitalist.blogspot.com/2008/05/im-so-busy.html

 

[45408]

Prowler, per capita costs are so explosively high for a few reasons. Three big ones off the top of my head are frivolous lawsuits, administrative costs, and, most importantly, a lack of preventive care. A women without health insurance who feels a lump won't go and get it checked out if it costs her money she doesn't have. Instead of being able to immediately ameliorate the breast cancer, it'll spread until she ends up in the ER and costs you hundreds of thousands of dollars over the few weeks she survives in critical care. Her family, of course, can't afford this - they default, taxpayers and hospitals shoulder the burden.

Lawsuits, yes, but more so because they scare doctors and hospitals into excessive prevention (e.g., let's do a CAT scan on what seems to be a pretty obvious tension headache - it's not indicated by my clinical judgment, but we can't afford to miss it).

Honestly, your example of untended conditions progressing to worse ones is a serious problem for the individuals it affects, but I'd like to know what kind of basis you have for thinking it causes our total costs to be $4000+ higher per capita than the UK. I think the much, much larger glutton of dollars are scenarios like Panda's Dawn of the Dead entry that I linked above and the endless "just in case" diagnostics.


Edit - since I read too much in the medblogosphere, I found this one - it's got a number of suggestions (many are good, IMO) about how to cut costs - http://thehappyhospitalist.blogspot.com/2007/12/my-black-jack-21.html

 

[Begaster]

Yup, fear of lawsuits leading to unnecessary tests was what I was referring to as well. Likewise, I've read quite a bit of Panda's blog and I agree with much of it, including what you've linked. Futile care needs to be defined and stopped (for moral, as well as economic, reasons).

There's no shortage of things that can be fixed to bring the per capita costs under control. This is unrelated to universal healthcare. Solving these problems and creating a standard of care for every American citizen are not mutually exclusive options.

 

[ryandote]

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[ryandote]

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[ryandote]

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[Begaster]

I'm not convinced you have the whole story, Begaster:

1) Most middle-class families CAN afford routine healthcare. $4 dollar prescriptions and office visits CAN and PROBABLY SHOULD be paid for out of pocket. The concept of insurance should not apply to routine primary, preventative care that we all know we will need each year. Insurance is to smooth consumption/loss in the case of unexpected shocks.

As a student, I'm required to have one of the school-offered programs that distorts healthcare consumption. My wife is not, and considering that she is generally healthy, we opt for a much lower premium and pay for her primary care from our checking account.


2) Technology advances are BY FAR the biggest driver for increasing costs over the last 20 years. That's fairly well-documented, and hopefully that won't change even with a socialized system. Remember that we do all the R&D for pretty much everything and probably don't even extract marginal cost when we export it to other countries.

3)America is quite a bit less healthy than Canada. Gregory Mankiw is a pretty good economist (In interest of impartiality, I'll tell you up front that he was Bush's lead economic advisor for awhile) and has a few ideas about things that need to be explored before we can simply point to infant mortality and life expectancy as how much more "bang for their healthcare buck" Canada is getting than the US. Mankiw in NYT

1) I'm talking about emergency situations - car crash, chronic disease, etc. As I said, the average family cannot afford healthcare without insurance.

2) I'd need to see sources for this. While R&D is incredibly important, I find it very unlikely that it makes up even a fraction of total healthcare spending.

3) Good read.


I don't find car insurance to be a good model to base health insurance on. I wrote this before, but will repeat because everyone skipped by it. Car insurance is an interesting example. If you're a terrible driver who has been in multiple accidents, you will not be able to get insured. This is frighteningly similar to the AIDS, cancer, or heart attack patient who loses his job and can no longer find an insurance company willing to be his provider (for less than what the disease will cost them).

 

[ryandote]

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[scarletgirl777]

scarletgirl777: you are subscribing to an insurance theory called "Adverse Selection." It's definitely one possibility... but don't think you've got the problem pegged by any means. I assume your policy class also addressed "Moral Hazard" ? - If not, you ought to look it up. It's another price driver that a lot of economists are concerned about. As with all economics problems, it's unlikely that either of the theories perfectly models the problem, but it is intellectually dishonest not to address other ideas.

Hey, thanks for the technical term that was eluding me. I'm not an economist by any stretch of the imagination, and it looks like i was only presented the first theory--I was made to understand that it was not a theory but a fact, so I'm sorry if it's not.

I don't know how well car insurance works, and I hate to comment on things that I don't know a lot about. I do know that a lot of people usually just try to get the cheapest insurance possible even if it doesn't cover much and often try to pay expenses out of pocket to keep premiums low. Plus, there's never a situation where taxpayers are expected to pay catastrophic car care because you failed to get regular tune-ups. But I really don't know how it's working.

I trust market forces when the only goal is saving money. But this is a situation when there are other goals. So I guess just like many people distrust govt innately, i distrust corporate america innately. No complex logic to it, just gut reaction.

 

[scarletgirl777]

I do not agree with you at all, this program will 100% lower the quality of care. Do you think the government would fund people's anti depressants or A.D.D. medicine or frivolous test on things they can live with. The goverment will fund only the most neccessary of things bringing the average health care provided to a cost conscious not patient conscious form of being. This system is not going to help give people without care the kind of care people who pay for it have, it will have them meet at a much lower level

This doesn't have to be a bad thing. People with money, much as they do now, can have private health insurance that will get them the boutique care they are used to. Even in Canada, there is still private health insurance, and employers still use it as a job perk.

Also, i'm not sure of antidepressants can be considered frivolous. I would think a bunch of bureaucrats would get together and decide what treatments are necessary for extending and maintaining life and pay for those.

 

[ryandote]

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[nu2004]

creating a free ride actually hurts some people who use it when they don't need it.

i agree, but this still happens (let me rephrase - it's rampant) under the current system

 

[Orthodoc40]

the VA is hardly free universal healthcare. Each member have to be "service connected" to a certain degree based on a panel of people deciding whether or not the illness that a veteran experiences is military service connected. It's not like all the veterans get a free ride for the rest of their lives.

Has no one here seen the movie, "Sicko"??
I think he takes on both sides of the argument pretty well.
He goes through several of the "proposed" reasons Americans think Universal Health Care would be scarey bad - and proves that they are based on myths. As seen from the pharmacists standpoint (cost of meds), the patient's who laugh at the concept of waiting 4 hours in the ER, laugh at what we pay from perscriptions, whether someone is going to cover a procedure that we need to have immediately... Doctors in England live quite well actually - they aren't doing as badly as people would want to believe. ("Oh getting paid by the government means we'll be scraping by like everyone else!!!") Take a look at it.

Drug Companies, lobbyists and insurance companies will never let go of their grip on controlling US Healthcare. No one will willingly give up their control, or power, or money - to put a better system into place!! They will try to scare and convince everyone that it will be like living in a third world country, with no access and long waits. Look around - it isn't like that out there!! Canadians & Europeans laugh at our healthcare system.

People have to see who is actually in charge, and target the flaws at that end. The lobbyists have to get out of DC, and that's not going to happen any time soon. Too much for THEM to lose, profit wise.

 

[Begaster]

but then again, you and I are possibly working from a different fundamental theory: I don't believe that the full arsenal of modern health care is a right.

Then this discussion is fully pointless. There's simply nothing I can say to convince you that you're wrong, and vice versa.

 

[45408]

Has no one here seen the movie, "Sicko"??
I think he takes on both sides of the argument pretty well.
He goes through several of the "proposed" reasons Americans think Universal Health Care would be scarey bad - and proves that they are based on myths.

No, he does not at all go through both sides of the argument. He makes opinion films, not documentaries, and this was no exception.

 

[Orthodoc40]

He takes a bunch of propaganda thrown at americans that they have taken at face value and finds out that they are full of B-S. He shows viewers a clearer picture of what it is actually like outside of America. He leaves you free to draw your own conclusions.

 

[Begaster]

I've never seen Sicko, but I feel people are allowing their dislike for Moore's previous works to cloud their judgment on his movie.

Hell, Fox News said that it showed his "maturity as a film maker" and let the content do the talking.

http://www.foxnews.com/story/0,2933,273875,00.html

Fox ****ing News!

 

[167649]

Has no one here seen the movie, "Sicko"??
I think he takes on both sides of the argument pretty well.

He shows viewers a clearer picture of what it is actually like outside of America. He leaves you free to draw your own conclusions.

Sometimes I can't tell if someone is naive or just sarcastic, but this couldn't be further from the truth.

 

[orrghead16]

He takes a bunch of propaganda thrown at americans that they have taken at face value and finds out that they are full of B-S. He shows viewers a clearer picture of what it is actually like outside of America. He leaves you free to draw your own conclusions.

I have seen most of his movies. Generally, I am more left of center, so you can predict how I feel about most of his work. Some of the movies I agree with, others I don't. But never once have I felt completely free to draw "my own conclusions" after watching one of them. Sicko included.

There are exactly two thoughts you can get after watching one of his films: either "Hell, yeah! This man is right on." or "That is the biggest load of BS I have ever heard."

The fella has an agenda, and if you can't sense that after watching one of his movies, I don't know what to say.

 

[45408]

He takes a bunch of propaganda thrown at americans that they have taken at face value and finds out that they are full of B-S. He shows viewers a clearer picture of what it is actually like outside of America. He leaves you free to draw your own conclusions.

Hmmm, no, not at all.

 

[ryandote]

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[ryandote]

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