I'm not sure if you're being snarky or not... but nsfw in the domain is a good reason to give caution while at work, right? There are a lot of terms that, if in a domain name, I would choose not to read at work.
It's not bad, there's just the occasional curse word when dealing with frustration around the loss of a loved one. No photos of scantily-clad ladies parading about.
I was in America, in LA, a few years back (I'm British), when the whole Obamacare thing was being debated everywhere.
The one thing I noticed, and it was a rule that didn't have a single exception, was that everyone I talked to could give at least one example of a time when either they or somebody they personally knew had been faced with a ruinous bill for healthcare. People who'd been bankrupted, people who'd fled to another state or even left the country to get away from a hospital bill.
And yet even after seeing whole families' lives literally torn apart, first-hand, they still were against any healthcare reform.
I tried then, and I've tried in the years since, but I simply cannot understand where they're coming from. How anyone can support a healthcare system in this day & age that can, and does, bankrupt or refuse to treat people.. I just can't understand it.
The system does bankrupt people, but it doesn't refuse to treat people. That is why people go bankrupt - the hospital has to treat everyone, then hands them an immense bill.
Friend at Google with probably the best insurance plan in the country, broke an ankle, and after seeing doctors and physios, still had to pay out-of-pocket close to ten thousand dollars.
Just clarifying your point about the system bankrupting people. Lots of folk outside the US are under the impression that once a person has healthcare insurance everything is hunky dory. The truth is, the current system can bankrupt anybody, regardless of insurance.
I don't believe that this is true, although admittedly I only have anecdotal evidence. I have known several people who otherwise would possibly be alive if they had access to primary care in the earlier stages of their cancers.
Right, but there's no other front line of entry to anywhere else in the hospital. If a person walked to a hospital and demanded to see a brain surgeon they would be turned away even if they had health insurance.
A major issue with the american health care system is there is a severe shortage of front line care outside of the ER. This is a side effect of the way doctors are compensated. There is no financial incentive to be a GP, so there aren't enough GPs.
> Right, but there's no other front line of entry to anywhere else in the hospital.
Yes there is. It's called a "primary care provider", and many of them have their offices right there in the hospital. Though the ones who operate out of separate clinics can often be less expensive, if not more conveniently located.
If you don't already have one, you really should. The emergency department really hates it when people clog up their waiting rooms by going there with non-emergency issues instead of seeing a PCP. And your health insurance (assuming you have it) really hates it when you drive up their costs by going to the ED instead of seeing a PCP. And, if there were any price transparency in the American system, then your fellow citizens would also really hate it when you force the health insurance company to drive up their costs by going to the ED instead of seeing a PCP.
Both of my parents are primary care providers. The offices of GPs usually are not located in a hospital, unless the hospital is part of a large integrated HMO like Kaiser Permanente. There is a trend in the USA of building large medical "campuses" where primary care has their offices in a separate wing somewhere.
If you do not have effective access to care until all they can do is give you a bunch of pain killers, they are effectively "refusing to treat people".
Sort of, kind of. Health care institutions do routinely refuse to treat people - just not when there is an immediate threat to life and limb.
I have a friend (Canadian) who had an internship in the US. He got a major (and quite serious) bout of the flu, and although he was insured (by a Canadian company) absolutely refused to see him until he coughed up a hefty (multi-hundred) deposit - evidently they didn't find the Canadian firm trustworthy enough.
This is a pretty core issue in US healthcare - early-stage care is routinely denied to people, either economically before they walk through the door, or at the door itself. This pushes a lot of health issues to ERs where costs are high and effectiveness reduced.
Actually, it does refuse to treat people quite regularly. Aside from emergency department, health care providers are generally free to refuse care for patients they believe cannot pay except in the case of a life-threatening emergency.
What this means is that in the USA it's common for people to have to allow earlier-stage, less expensive to treat problems develop into serious problems before finally going into the ED to seek treatment. Which increases all of our health care costs overall. Not only does the problem that eventually gets treated end up being more expensive than it needed to be, but the place where the care is provided is also the most expensive option. And since they don't pay, health care providers are forced to raise everyone else's rates to cover the cost of this unnecessarily expensive care that they had to provide.
Long story short, the range of things that health care providers have to treat is much wider in countries with more socialized systems than it is in the USA. And that is yet another reason why the USA has such enormously high health care costs despite providing poorer quality of care.
> Actually, it does refuse to treat people quite regularly.
Let's not play with words like that. People in the US get treatment—you even say so later, despite your ominous lead sentence. They just get it later, via the ED, after prevention goes un-performed. That's abominable enough, and that's what we should talk about, not the (false) specter of non-treatment.
> "They just get it later, via the ED, after prevention goes un-performed. That's abominable enough, and that's what we should talk about"
You two aren't disagreeing.
You say we should talk about the epidemic of people unable to afford primary care, pushing treatment later and later, eventually into the ER where they may not even be able to be saved - and even if they do, suffer long-term health effects due to the delay in treatment.
And he's saying that this is because the system does refuse to treat people - especially at the primary care level.
Yes, that's why my point was to ask that we refrain from falsely hyperbolic statements (people don't get treatment) so we can focus on the myriad true problems that most agree exist, some of which you pointed out.
Now thats playing with words. Do you really think the people on the ground in a US hospital are completely distanced and isolated from the costs that accrue once they admit someone without insurance?
>>Actually, it does refuse to treat people quite regularly. Aside from emergency department, health care providers are generally free to refuse care for patients they believe cannot pay except in the case of a life-threatening emergency.
This isn't actually accurate at all. Hospitals with emergency departments must stabilize patients in an emergency. Thats it. The emergency room has no responsibility to treat the underlying cause. It isn't a loophole that people take advantage of because you still don't get treatment. I suppose you could show up to multiple emergency rooms and hope one treats you but that isn't something you do if you are chronically hurt.
People who can't afford to get treatment or aren't on medicaid or charity care don't get treated period. You can test this by just comparing the emergency room rates in Massachusetts before and after coverage expansion. More people went to the emergency room once they had coverage than previously.
You're right, that's exactly the case. Sorry if I explained it poorly. The spot where this gets really fantastically expensive is when you get to the "wash, rinse, repeat" part of the situation. After all, someone who is just being stabilized and discharged without significant treatment of the underlying cause is much more likely to just get sick again.
There's a hospital in the town where I grew up which managed to shave millions off of the cost of operating their emergency department in a rather instructive way: They identified their most expensive repeat patients, and started just paying to send them in for regular medical care for whatever health problems it was they had. Yeah it meant that they were giving out free health care to these folks, but that turned out to be nothing compared to the cost of having them show up in an ambulance every other week.
Isn't that the same thing? Practically speaking, for many people who'd rather be ill than ruin their family with debt.
The thing that gets me is the attitude is that some people don't deserve free(-at-point-of-use) healthcare. For whatever reason; they haven't paid their taxes, or they've made mistakes in life. It seems unspeakably sad to me. Surely a civilised society should help everyone, regardless? It's the humane thing to do. It's as simple as that.
Most people would rather be bankrupt than be dead.
I agree that a civilized society should help everyone, but don't agree that the USA is a civilized society. There is definitely an attitude that poor people don't "deserve" stuff. That's been an American notion since the first settlers arrived and won't change anytime in the near future.
> Most people would rather be bankrupt than be dead.
True, but what if it's something less serious? Some people would rather be ill than bankrupt. And then what if it gets worse, and then it's too late? People shouldn't have to make that choice, especially because most people--not being doctors--are going to make bad decisions about when something is serious enough to get checked out.
Having lived in the uk for the first 27 years of my life, and then in California for the past 10, I have only one word to describe the way American healthcare feels to me: barbaric.
Long live the NHS, and yay for Obamacare - it seems like a step in the right direction at least.
Everyone requires food, clothing and shelter, and yet we use other mechanisms to insure that our citizens don't go hungry. While not necessary for survival, education is guaranteed by the states, and we use a different model for its delivery.
Neither of those is to say that necessarily Obamacare is the wrong solution but its certainly not the only path.
Food insecurity is not the same thing as going hungry. Changing your food buying patterns, ie foregoing a purchase you might have otherwise made, to buy food is not pleasant, but it is not hunger.
For me there's a very specific, personal, reason. At the end of 2011 I got randomly unlucky and suffered from pneumonia, a stomach ulcer, and a norovirus all in the space of three months. I was hospitalized for the norovirus. After that I was told by more than one insurance agent that I wouldn't be able to purchase insurance at any price, for about 18 months. Obamacare does at least stop that from happening to people. I'd prefer single-payer, but like I said, it's a step.
Well, buying insurance to treat a pre-existing condition would be a little like trying to get a car accident covered by insurance after the fact, wouldn't it?
Yes, but health insurance is not insurance at all. It's really a gross misnomer, and outside of a niche market, no one seriously sells health insurance.
Insurance is designed to protect the policy holder from an unlikely, catastrophic event they cannot afford otherwise - coverage of everyday costs is not insurance. Notice your insurance company doesn't pay to rotate your tires or change your oil.
Health care, no matter which country you go to, is more of the latter than the former. They aren't primarily insuring against unlikely catastrophic events - that's only a small part of their purpose - they are very obvious ways to spread costs around.
You can't treat health insurance like real insurance, even if they share a name.
Well then what's wrong with people simply paying out of pocket for basic services? Insurance would be there to cover the truly catastrophic health issues, but otherwise we would all pay for the level of basic service (maintenance) we prefer to pay for.
We have this - this is what one normally finds in the form of health indemnity. They cover (up to some maximum) only emergency/catastrophic costs, and have no everyday coverage.
They are extremely unpopular for many reasons, which center primarily around paying out of pocket for normal services:
For the purposes of this argument I'm going to use "health plan" to refer to what most people call "insurance" - to avoid confusing the two concepts.
- The out of pocket costs for a no-plan person is extremely inflated. Where your insurance company might pay $60 for a doctor's visit, the cost for someone not on a health plan may be $200-300. This makes the notion of paying out of pocket for routine services unrealistic for the majority of the population.
- These out of pocket costs are expensive because the status quo is for everyone to be on an employer-sponsored health plan. Those who can afford to pay, are on a health plan - the bulk of those who aren't on a plan are financially compromised and likely to default on their debts. This encourages a wild inflation of quoted cost to compensate.
- This further drives people to health plans. Barring the ultra-rich, no one is able to afford health care at "free market" prices, making health plans the only reasonable route forward.
In short, what's wrong with people paying out of pocket for basic services is that "basic services" at market rates will set you back $300 for sore throat.
I've been without a traditional health plan for quite a while. There's actually been a lot of innovation in this space recently.
For example, in some locales you can subscribe to a "direct primary care" practice for a family of four (2 adults, 2 kids) for around $150 per month, and visit your primary care provider as much as you need, paying only for supplies or possibly a token per-visit amount. This, combined with a legitimate "insurance" plan with a high deductible, might set a family back less than half as much as a traditional all-inclusive health plan. (This is what I had in Seattle, with Qliance as my direct primary care provider.)
My son recently needed a physical to start school. As a self-pay patient now located in Denver, I called around to independent clinics in my area and was able to get a fairly good price ($110 total out of pocket, paid up front.) My wife was recently able to be treated for an ear infection for around $80.
If you're actually paying out of pocket it can be a little bit of work, but there are ways to get your costs down to close to "free market" levels.
I recently had my brakes repaired for around $300. $300 for maintenance on my own body seems pretty fair. And perhaps people shouldn't be visiting the doctor every time they get a sore throat.
Sorry, I read your post wrong. At any rate, the analogy still applies - it becomes much more expensive to buy auto insurance after you've gotten into an accident. If you are prone to sickness, I can see why health insurance would also be harder to obtain.
Speaking as someone who's had multiple relatives die at the hands of NHS rationing, I completely disagree.
In a system where you can't sue your healthcare provider for egregious malpractice because they're a governmental body and are thus subject to the same citizen-sues-state rules as law enforcement or any other public service, I fear for the quality of our healthcare.
In one instance in the 1970s I had a great uncle who came into a local clinic complaining about crushing chest-pain, and was told to come back the following day because the attending physician was out for the day. He died on the street of a heart attack while walking home. Why he wasn't immediately rushed to a hospital is beyond me.
More recently, my grandmother, who died in 2004, was wait listed for over a year to get medical imaging and biopsy performed on what she (correctly) assumed was a tumor on her neck. By the time the scan was performed it was determined that she had metastasized lymphoma and the tumor was plainly visible to anyone who could fog a mirror. She died in hospice within a couple of months of being diagnosed.
So what are we to sue for there? Clearly both instances of complete and utter NHS incompetence (and sadly, complacency on the part of my UK relatives) but it's incompetence by omission and rationing, not a doctor embedding a scalpel into someone's tibia.
Had either of my relatives lived in the US, they would have had a much better fighting chance at living than they did at the hands of the NHS.
Both of your examples are tragic and clearly represent failings of the system - some of which have since been fixed, and at least one of which would likely have happened in the US as well.
I hope you'll forgive me if I sound callous in this post - I certainly don't mean to, but I also recognise that this is a touchy subject when talking about someone's own family.
In the case of your great-uncle the problem is likely that it was the 70s and fourty years ago there was nowhere near the same awareness of the symptoms of cardiac arrest amongst non-physicians. If the doctor wasn't there, chances are it wouldn't have been picked up on. Even had he been rushed to hospital, his chance of survival would have been pretty low - heart attacks are still a major killer in the 2010s where even in London, which has the highest survival rate in the UK for heart attacks that occur outside a hospital, the survival rate is only 30%. Keep in mind though that survival rates have increased significantly over the last fourty years with advances in diagnostics and treatment as well as improved defibrillators etc.
Your grandmother's case is a more clear cut case of failure. Waiting times have long been a problem in the NHS, but it's a matter of resource contention, and it's a problem which they're trying to improve with the guarantee that patients should start treatment within 18 weeks of their first appointment and that tests should be done within six weeks. The only, very rough, numbers I can find for the US suggests that scans and tests are normally done within seven to twenty weeks when cancer is suspected. Even in the US, the problem of resources exists - there's only so many hospitals that can perform certain types of scans, and only so many doctors who are capable of properly interpreting the results. The thing I can't comment on is whether or not the physician who saw your grandmother should have treated it as a higher priority or if, given the symptoms that were presented, it would be reasonable to assume that there was a benign cause and it being cancer was pretty remote possibility. If it's the case that his prognosis was obviously wrong given the symptoms, then there's a case to be made for malpractice, or at least a complaint to the GMC and/or NHS trust.
> In a system where you can't sue your healthcare provider for egregious malpractice because they're a governmental body and are thus subject to the same citizen-sues-state rules as law enforcement or any other public service, I fear for the quality of our healthcare.
That's nonsense, hospitals and NHS Trusts are routinely sued for malpractice, along with the doctors involved. There's nothing special about any part of the NHS that makes it impossible for them to be sued - they're not part of the state, they're just state funded. Hell, you can sue most government bodies in the UK since there's no restrictions on suing the state, only against suing the Crown.
It makes your 'multiple relatives' claim seem somewhat suspect.
It's not about autistic biases for me, at least not when the topic is the NHS. All of my father, uncle, aunt and other-half are doctors all of whom work for, at least in part, the NHS and are respectively an oncologist, dermatologist, GP and ob/gyn. As you might imagine, I spend quite a lot of time listening to them talk about the NHS, their particular trusts and their hospitals and the failings of all the above. All of them would much rather live here where you'll be looked after by the NHS, and can also have private care if you're willing to pay for it (though often the only difference is that you get a nicer room and shorter waits for non-emergency operations), than in the US where the patient is merely the mechanism through which you bill the insurance company.
There are many reasons why the system is dysfunctional, and I'm aware of nearly all of them.
Did you know that a round of cancer treatment in the US can cost over $500,000, and even if you are fully insured with a good policy you can have a 20% copay required, meaning that with insurance you still personally have to pay $100,000 or more? That sort of thing is what is bankrupting people and is why most medical bankruptcies involved people who were fully insured.
That's assuming your insurance policy wasn't subject to "recission", which is legal retroactive cancellation of the policy as soon as you have any condition like cancer that would cost a lot to treat.
We have a for-profit medical industry, and a for-profit insurance industry and both are motivated to increase profits, and reducing care is often a way to do it. Even non-profit hospitals will price gouge. Non-profit status does not mean that the executives working there aren't paid large salaries, it doesn't mean that things are delivered at cost, or with minimal mark up.
The "reform" is mandating people buy insurance from for-profit insurance companies, with no cost controls. Thus we end up with policies that can cost a family $20,000 a year in premiums, while still having large co-pays that can bankrupt you. The parts of the law that would have provided socialized care for the poor were gutted by the Supreme Court review, and by the executive office rule directives interpreting the law.
The answer to the problem is single-payer. The reform system is a further bailout for industry and is already driving up costs and reducing the number of insured.
Your posts presents those of us who support a reasonable working solution of single-payer as a position of hypocrisy, inconsistency, and/or ignorance, because we don't accept a non-working solution that retains and increases out of control costs and profits for industry.
Not supporting a specific, bad solution does not mean one does not see there is a serious problem and reform is necessary.
You do realize that Obamacare makes it a lot more likely any single payer plan will be accepted in the future, right? If people are already forced to buy a private plan and medicaid has been expanded then it isn't a leap to just cover everyone and move to a single payer system. This is more true if the exchanges start covering lots of people, in this case, the government has a direct interest that private care is being provided efficiently.
I would briefly point out that the $20,000 a year plans you refer to was an example number that the IRS used to illustrate how the law works and not a projection of the cost of healthcare plans in the exchange.
You may be right about this specific solution, but parent was talking about people opposed to any healthcare reform. Especially a single-payer system, I'd imagine.
Yes, I am inferring, and I am sure correctly, that parent assumed that opposition to PPACA was opposition to any healthcare reform, which supported his preexisting prejudices about ignorant hypocritical Americans, as they are widely promoted in the press. The reason I am sure I am correct about is two reasons. One is that every time I explain problems with PPACA, I am labelled an ignorant health care reform bigot/hater/militant/republitard/teabagger even though I fully support and advocate for single payer. My support for single payer is deemed irrelevant though, all that is important in this debate with most people is that the all concerns with PPACA be dismissed with handwaving, and anyone opposing it is painted an enemy of reform. The second reason is that the majority of people I have talked to who have issues with PPACA also support or are highly positive towards the idea of a single payer system. Therefore I do not believe that every person he talked to who had objections to PPACA was opposed to reform, that was his own inference.
Single-payer is a bit more nuanced than "government pays the bills".
Single-payer means that health care institutions remain private, government does not run or employ any doctors directly, and everything works much like it does today, except pricing is unified and the government pays all bills.
This is different from nationalized health care, especially on paper, where it can preserve market-style competitive pressure that a wholly nationalized system would not. Doctors and hospitals would still be on the hook for attracting customers.
It's different from nationalized health care mostly on paper, because it gives the government monopsony power over the market. The single-payer administration can rule out treatments, mandate questionable treatments, and make for itself important value judgements about end-of-life routine care vs. mid-life cost of emergency care. We have hints of the problems that come from this now with things like the Medicare "doc fix".
Beyond all that, single-payer fixes prices for an industry that represents a huge chunk of the total economy.
No question at all that we badly need a new system of health insurance in the US (I'm hoping that Obamacare, carefully and aggressively executed, will be it), but single-payer health care is a radical change.
I tried then, and I've tried in the years since, but I simply cannot understand where they're coming from. How anyone can support a healthcare system in this day & age that can, and does, bankrupt or refuse to treat people.. I just can't understand it.
I find it curious and odd that you can't understand another philosophy on the role of government and the individual.
I can't understand it. It seems to me to combine selfishness and short-sightedness in equal measure. "I'm all right, I have insurance" plus "I'll never be faced by a health crisis greater than my plans will handle." You might be right, and good for you if you are, but God help you if you aren't.
I guess I understand the philosophical argument, from a purely logical perspective, that an individual must stand or fall on their own. But I don't get how people can seriously hold that opinion without living in a cabin in the woods, or in a bubble.
This is not about the role of government and the individual. This is about healthcare, something fundamental that every human being needs. For which it cannot be predicted when one needs it, and where need can vary greatly through (in by far most cases) no fault of people themselves (an unpredictable unelastic good).
Such matters - often literally of life and death - are not something that ever could be trumped by philosophies about 'roles'.
Yes the market works well in most other spheres, yes economic freedoms are important, but no, economic freedoms (or justice) do not trump human life and death, where avoidable (in a civilized society). Economic freedom is just one of the many things people need for happyness. Health and healthcare are another, that is at least as important. And thus the value of economic freedom needs to be balanced out against healthcare.
The government just is the mediator. Taxing one sphere of life (economic activity) to ensure justice and security in another that fares better if guided by other principles than profit extracted from individual patients.
(individual GPs do profit in the UK system. They, for example, get a bonus if they can make a patient stop smoking, etc. ...speaking of preventative healthcare. They just have less incentive to exploit individual patients (by having them come back later with lung cancer for example) and then charge them to their limit)
I tried then, and I've tried in the years since, but I simply cannot understand where they're coming from. How anyone can support a healthcare system in this day & age that can, and does, bankrupt or refuse to treat people.. I just can't understand it.
Give it 50 years and they'll never go back. The Tories in the UK were opposed to the NHS (AFAIK).
He was a charming, damaged, charismatic, fiercely intelligent, dissolute individual, who lived entirely on his own terms. As a professional gambler, it is unlikely he paid much if any tax in 37 years. He had no will, no funeral plan. He never did fill out the forms necessary to vote in the last election, or the one before that, as I discovered. He just hated forms. I could sympathise. Had he stayed in the US, it is – how you say – dollars to doughnuts he wouldn’t have got it together to fill out the forms, and would have had no health insurance. He considered the US system “absolutely unmanageable”.
However long this goes on for, they'll continue throwing resources at this individual and never show a single sheet of figures to any of his relatives. Not because they'll get anything back, but because this is what the NHS does. It’s free care for throat cancer sufferers who only gave up smoking four years afterwards, for drinkers who were told 35 years ago that if they didn’t quit drinking they’d die. Free care for American immigrants, for jerks and gents. Free care for parents whether they showed up or not. Free care for guys who tried to try. Free care for the only father I will ever have.
So here comes the TANSTAAFL argument: I don't think anyone argues that what the OP describes is a "bad thing"...in fact, I think it's probably the dream scenario that people optimistically assume is the case before they have their first encounter with an emergency room.
But the reason why it doesn't happen is because of cost, plain and simple. And to be concerned about cost is not just the domain of greedy insurers and fat cat cost cutters, but of reasonable people who understand that preventive care is less dramatic than end-of-life care, but is surely as deserving of resources and attention. And both types of care rely on the same limited pot of funding.
It's easy to be emotionally invested in the personal case of a man who is lucky enough to have a loved one so eloquent with words. But what about the hundreds, thousands of routine cases that are treated by NHS with a protocol governed by cost limitations, limitations that will inevitably be imposed by the decision to give blue-chip treatment to the untreatable?
These routine cases don't pull at the heart strings because it is the nature of the human mind not to realize/dwell on how an exam/procedure not scheduled two years ago is the main factor in the chronic disease one suffers today. And yet these people are just as deserving of optimal treatment as OP's Bill. The way that OP judges the value of healthcare, though, means that the Bill's will get a greater share of a finite set of resources. Is this really the way an optimal healthcare system should work?
This is not to say that the U.S. or any other system is currently better than the NHS. It's just to point out that fashion in which the OP (positively) judges the NHS is susceptible to being ignorant of the problems that occur earlier in the pipeline of health.
The problem with the TANSTAAFL argument in this case is that the NHS is far cheaper than the American alternative. It is also far superior at providing preventative care than the American alternative.
Just for the record, I'm not saying NHS is worse than American healthcare. I'm just stating that its possible, in a hypothetical system, in which an efficient and fair allocation of resources will bring about end-of-life care scenarios that are less ideal than what the OP describes. And that its also possible that ideal end-of-life care will end up hurting others (through a disproportionate allocation of resources) and doing so in a way that is hard to dramatize (until it's too late).
This is a tension that keeps effective health care reform from moving forward, but it's still a tension that should weigh as heavily in a debate as an emotional appeal.
As an example of preventive care offered by the NHS. I am registered with a local GP who I hardly ever see (because I don't need to). Two years ago I received an SMS message from them because of my age (over 40) to come in for the NHS Health Check (http://www.nhs.uk/Planners/NHSHealthCheck/Pages/NHSHealthChe...).
The test involved a bunch of basics (weight, exercise, blood pressure, etc.) and two blood tests (for cholesterol and blood sugar level). They will repeat this every five years.
I do not think the NHS is the greatest possible system (in fact, I preferred the French system when I lived there), but by many measures it is good.
Indeed. The US private sector and the US federal government EACH spend more per capita on health care than the UK does. And yet we rank behind the UK on virtually every health statistic that they bother to track.
In 1993 Republicans did an interesting analysis. They found that Clinton's health care plan would work, and would be popular. If it passed, they believed that Republicans would be losing national elections for a generation. But they also figured out that if they derailed it, then they could turn fears about it into a potent election issue. They did, and it was. They tried the same thing with Obama's plan. Whether the other half of their prediction comes true is yet to be decided.
> "They found that Clinton's health care plan would work..."
They found nothing of the sort. Did you even bother to read their analysis at your link? You can disagree with someone without misrepresenting their motives.
You are exactly right and often times the ability to derail a reform plan in the legislature costs it support not only by seemingly discrediting it in the political process but also forcing reform advocates to support a concrete bill that has real consequences while opponents don't need to offer anything and can attack consequences of the bill passing out of context. No one is sure it will pass, so invariably some members waver and the bill is watered down to guarantee support, at which point it becomes compromised and rather ineffective which once again discredits reform.
Its interesting in the post-1945 election in the UK very few voters strongly supported the NHS but once it passed it developed bipartisan support. The chances of a party taking every house of congress a supermajority in the senate and the presidency to have the ability to move legislation is incredibly small in our system as compared to a parliamentary one. I'm not suggesting that our system is always worse but in this instance it certainly is.
Not only that, but as Dean Baker never tires of pointing out, if the US only spent as much as other rich countries do on health care (countries that get better health outcomes), it would have huge budget surpluses rather than deficits.
Of course it's cheaper - the NHS is actively controlling prices. That of course means that doctors get paid less, patients wait longer for certain types of treatments or are denied other types outright, and people do are not granted unlimited resources to fight death at their end of life as they are in our system. You can't just say it's cheaper as a blanket endorsement without analyzing exactly why it's cheaper.
Yup. You can happily pay for private insurance, or pay out of pocket for private care, and you'll be able to get all the drugs that the NHS thinks are too expensive for the benefits they bring, or surgical procedures that are considered experimental.
So why all the hate for socialized medicine? If the rich(er) folks want to have access to the most exotic care, they can still have it. Meanwhile, people who can't afford basic care today will get it. Come on, America.
But the nice thing about a publicly financed health care system is that early interventions become much more likely when people aren't forced to make decisions like "Should I spend my paycheck getting this lump in my breast checked out or should I spend it on groceries for the family."
Exactly. My mom is dying from terminal breast cancer and she avoided going to the doctor for more than a year for chest pains because she had anxiety issues and was too worried about the financial aspects to confirm whether it was anxiety issues or something more serious. It had to turn from chest pains to shortness of breath before she finally set aside the cash to get it checked out. Turns out the breast cancer had metastasized and ended up in her lung, bones and liver by the time they diagnosed the cause. By that point the cancer in her lung was the size of an orange.
Similar case with my uncle and colon cancer. The anxiety of knowing made the situation worse.
For most of us, the money can be attained, as evident by the electronic devices littering our homes and offices.
Related, I've found that many young people don't want to know what their credit card or bank balance is, for fear of seeing how little money they have left (or saved).
"But the reason why it doesn't happen is because of cost"
The most peculiar part of the whole situation is service cost and individual personal wealth is never an issue WRT national military "defense" or police coverage or fire department coverage or admission into a church or the (admittedly failed) K12 education system or EPA enforcement or OSHA enforcement or ... thus the real question is why cost should be a concern almost exclusively for sick care. My point being that you need to convince not merely that cost is an issue, but that cost should only be an issue for healthcare specifically.
I think we have happily gotten over the idea of needing insurance company plaques on your building in case of fire, and soldiers rarely defend only the rich parts of cities.
Note that there are a few townships that provide emergency services free to residents for the first /n/ visits per year, after which some fees are assessed. If you are not a resident, you may receive a bill if that area's emergency services dispenses care or transports you to a hospital.
The author's father, Bill, around age 76, never paid taxes while living for decades in the UK, but was still treated, and died there. The author assumes he wouldn't have had care in the U.S. That's wrong. Even though he never held a recognized job (and probably was a tax cheat), as a senior citizen he would probably receive Medicare and as a poor person he would also potentially be supported by Medicaid for any shortfall. Further, his situation is hardly a model for national policy-- why should someone who never worked, yet apparently has well-off, internationally traveling family, be completely subsidized by taxpayers? Why shouldn't Bill or his family face some of the costs for his care?
For the same reason that you don't go to jail just because your brother robs a bank? Hey it is nice when family helps out, but they shouldn't have the legal obligation.
That's an interesting idea. Directly I'd still say no, they shouldn't, but indirectly via an inheritance tax I'm OK with as I'm OK with inheritance tax in general.
I think the author's point was that his father wouldn't have bothered to fill out the paperwork required by Medicare so the fact that the NHS is automatic allowed his father to have coverage.
"his father wouldn't have bothered to fill out the paperwork required by Medicare"
Having gone thru something kind of similar yet different with my own older relatives, the hospital has a blindingly obvious financial motivation to "help" elderly / senile patients with the paperwork, and therefore there are people on staff walking the halls doing precisely that. Seen it with my own eyes, this is not theoretical. As long as the dollars you can haul in from properly filled out medicare forms exceed the cost of hiring a ombudsman or coordinator or advocate or whatever the job title was...
When my wife gave birth in Europe the 11 hour procedure, which apart from the traditional medical stuff, included massage and acupunture for relaxation, involved a handful of nurses, 3 midwives, 2 doctors, an anesthesiologist etc. After the birth our little family stayed in the 300 square foot private room at the hospital for two days. We never saw any papers except the booklets the hospital gave us about having an infant. It was great and it was free.
Two years later my wife's sister gave birth in a top notch Manhattan hospital and my wife was there for support. Man, the stories she tells about how every part of the procedure was initiated with waivers being signed and questions asked about insurance to her sister who was squirming in pain and was several hours into labour. And how the impatient doctors tried to upsell her sister to a C-section... After that her sister shared a tiny room for a night with some other woman and was then sent home. Luckily, most of the 40,000 dollar bill was covered by her insurance.
OK. It is a quick guess based on the taxes we have paid.
Of course our taxes also went for other things like welfare, education, administration and defense, and as we all know many European governments have run deficits for years.
"This leaves the last theory: do we pay higher prices for the same care? Among prescription drug costs, we pay far more than any other country, at least 20% more than Canada and over 60% more than New Zealand. For the same MRI’s and CT scans, we also pay more: $1,080 is the commercial average cost for an MRI in the U.S. as compared to $599 in Germany; at CT of the head costs $510 on average in the U.S. versus $272 in Germany. For a hip replacement, we again pay the most: $1,634 among public payers and $3,996 among private payers, versus $1,046 and $1,943 respectively in Australia. And physicians’ incomes are the highest: $187,000 on average among primary care doctors in the U.S. versus $93,000 in Australia; and $442,000 among orthopedic surgeons in the U.S. versus $154,000 in France."
Here in the U.S. we pay roughly double FOR THE EXACT SAME PROCEDURES AND SERVICES.
And, probably not coincidentally, doctors make roughly twice as much here as other countries.
It seems we keep going round and round trying to attribute the differences between the U.S. and other systems to some philosophical differences, but the bottom line is we are simple being price gouged by an entire industry.
- I'm really sorry to hear about the author's father's passing.
- While it's heart-warming, it is unrealistic to think that a public program can spend infinite amounts of money on citizens who a) have paid "little or no" taxes and b) "throat cancer suffers who quit smoking four years afterwards". The math just doesn't add up.
- The fact that the US has a pseudo market-based healthcare system is what allows drug / device companies to make money on innovations that ultimately save lives in other countries (like the UK) where these drugs / devices may not even break even. If you create a system in the US where it's impossible to make money in healthcare innovation, we'll see far fewer technological developments in healthcare, which will lead to worldwide increases in infant mortality / decreases in life expectancy.
That said, we should have a way in the US to provide basic healthcare for the uninsured. The answer is not, however, a single-payer system.
They dont spend a literal infinite amount, but to provide a basic healthcare to every person in the country the math(s) obviously does add up, because the NHS does it.
"we'll see far fewer technological developments in healthcare, which will lead to worldwide increases in infant mortality / decreases in life expectancy."
Confusing more or less a 2nd, 3rd or maybe 4th derivative of a value with the value itself.
"unrealistic to think that a public program can spend infinite amounts of money on citizens"
I read the article, and they cut him off virtually everything when recovery was deemed impossible. Tapering off the drugs, non-interference directive when he therefore codes... he was taking up a bed, not much else. Not quite the same as euthanasia (although not too far) but hardly an infinite amount of money, either.
"have paid "little or no" taxes"
In a civilized society, should the police, fire, military, educational, and environmental monitoring organizations cut off poor people as a primary goal, rather than as a scandal when they rarely do it anyway?
- The other modernized nations you speak of are all running deficits, with the exception of small countries with tremendous natural resource wealth (e.g. Scandinavia) and Germany (which has a tremendous manufacturing sector that I don't fully understand.) That said, the US also is running huge deficits, but a lot of that is due to a ridiculously disproportionate military budget.
- Again, the profitability that comes to drug and device companies from the US market largely subsidizes the cost of these goods in other countries. Cut off the profitability in the US, and the costs for drugs and devices go up in every other market.
I would love to see a way for the US to be able to provide full healthcare coverage to all its citizens, but as someone with a graduate degree in healthcare economics who has studied the problem in depth, I just don't see it.
That said, we shouldn't be turning away the uninsured that need basic healthcare. We have to figure out a way to provide that coverage in a more efficient way than the ER.
True. My point, however, was that the author was highlighting the fact that this particular patient did not contribute much to the financial pool from which he was now drawing.
For what it's worth, my father spent a lot of time in hospitals towards the end of his life, died, and the only consideration made towards payment or insurance was when he was first admitted. I honestly don't even remember the details that well, though I vividly remember a lot of other things about it. I also received reams of "explanation of benefits" papers afterwards in the mail, but we never had to pay a dime.
Anyone who gives up a little health liberty for a little health security will obtain neither. Instead they'll get another sprawling centrally-run bureaucracy (in people and rules) managing the health "system" equivalent of "no-child left behind".
The article deifies government. By now I am convinced that the NHS – and I hyperbolise, but only slightly – is the greatest achievement of humankind, the nearest we get to a benevolent deity, a goddamn superhero. Such worship of the state never ends well, starting with large-scale confiscation of private earnings (where do you think the money for this incident came from?) and veiling of failings (having delivered soothing words and relaxed settings for the patient's death, no mention of what life-saving options were available and why not administered). All delivered with non-sequitur jabs at another healthcare system. "I love Big Brother" - Winston Smith
As someone who should be dead four times over, I find the American health care system quite functional, effective, and satisfactory. No worship thereof necessary.
All this noise about the problems of the American "system", ignores the fact that America doesn't have a health-care system yet. If the problem in the United States is high-cost, the solution is tort-reform, so that GPs can comfortably practice general medicine and afford their insurance premiums again.
Unless a central "system" is going to indemnify GPs, there won't be a flood of them entering the pool, since their rates will be fixed by central rate tables (maybe, if they are lucky, adjusted for regional cost-of-living) even if only indirectly by maximum benefits needed to maintain minimal legal coverage levels; if they are to remain privately run and thus administratively independent.
I enjoyed reading this article and I think the choice about how healthcare should be delivered in the U.S. boils down to how we as a society want to spend our (limited) resources. Part of the reason that we spend more in the U.S. than in the E.U. is because in many cases we go to greater lengths to extend someone's life.
I'm not sure that culturally people are willing to accept the idea that we aren't going to do "everything we can" for someone because it isn't worth it to society (the payer). In the case described here, we might have implanted an electronic device to resynchronize the patient's heart and prevent the CHF from trashing the rest of his organs for a few more months (or years) at the cost of $200k.
Are we at a place where people in the U.S. will accept not doing that that?
I think that a single payer with a base level of free care is the right thing for society to do, but the possibility of making private insurance illegal (as it is in some places and some groups in the U.S. are advocating for) is terrifying to me.
The affordable care act basically ensures that we will arrive at a single payer system sooner or later, but how do we change our culture to be more accepting of our own mortality and the limitations placed on extreme measures to extend life?
I enjoyed reading this article and I think the choice about how healthcare should be delivered in the U.S. boils down to how we as a society want to spend our (limited) resources. Part of the reason that we spend more in the U.S. than in the E.U. is because in many cases we go to greater lengths to extend someone's life.
I'm not sure that culturally people are willing to accept the idea that we aren't going to do "everything we can" for someone because it isn't worth it to society (the payer). In the case described here, we might have implanted an electronic device to resynchronize the patient's heart and prevent the CHF from trashing the rest of his organs for a few more months (or years) at the cost of $200k.
Are we at a place where people in the U.S. will accept not doing that that?
I think that a single payer with a base level of free care is the right thing for society to do, but the possibility of making private insurance illegal (as it is in some places and some groups in the U.S. are advocating for) is terrifying to me.
The affordable care act basically ensures that we will arrive at a single payer system sooner or later, but how do we change our culture to be more accepting of our own mortality and the limitations placed on extreme measures to extend life?
126 comments
[ 3.1 ms ] story [ 213 ms ] threadInfo about the venture:
http://techcrunch.com/2011/10/14/vescere-bracis-meis/
Founder reflects on the venture half a year after launch:
http://pandodaily.com/2012/05/07/nsfw-corp-hmtl5/
3000 subscribers at 99 cents per single issue or $26 per 52 issue year as of recently:
http://betabeat.com/2012/09/nsfw-corp-paul-carr-war-nerd-joh...
The one thing I noticed, and it was a rule that didn't have a single exception, was that everyone I talked to could give at least one example of a time when either they or somebody they personally knew had been faced with a ruinous bill for healthcare. People who'd been bankrupted, people who'd fled to another state or even left the country to get away from a hospital bill.
And yet even after seeing whole families' lives literally torn apart, first-hand, they still were against any healthcare reform.
I tried then, and I've tried in the years since, but I simply cannot understand where they're coming from. How anyone can support a healthcare system in this day & age that can, and does, bankrupt or refuse to treat people.. I just can't understand it.
A major issue with the american health care system is there is a severe shortage of front line care outside of the ER. This is a side effect of the way doctors are compensated. There is no financial incentive to be a GP, so there aren't enough GPs.
Yes there is. It's called a "primary care provider", and many of them have their offices right there in the hospital. Though the ones who operate out of separate clinics can often be less expensive, if not more conveniently located.
If you don't already have one, you really should. The emergency department really hates it when people clog up their waiting rooms by going there with non-emergency issues instead of seeing a PCP. And your health insurance (assuming you have it) really hates it when you drive up their costs by going to the ED instead of seeing a PCP. And, if there were any price transparency in the American system, then your fellow citizens would also really hate it when you force the health insurance company to drive up their costs by going to the ED instead of seeing a PCP.
If you do not have effective access to care until all they can do is give you a bunch of pain killers, they are effectively "refusing to treat people".
I have a friend (Canadian) who had an internship in the US. He got a major (and quite serious) bout of the flu, and although he was insured (by a Canadian company) absolutely refused to see him until he coughed up a hefty (multi-hundred) deposit - evidently they didn't find the Canadian firm trustworthy enough.
This is a pretty core issue in US healthcare - early-stage care is routinely denied to people, either economically before they walk through the door, or at the door itself. This pushes a lot of health issues to ERs where costs are high and effectiveness reduced.
What this means is that in the USA it's common for people to have to allow earlier-stage, less expensive to treat problems develop into serious problems before finally going into the ED to seek treatment. Which increases all of our health care costs overall. Not only does the problem that eventually gets treated end up being more expensive than it needed to be, but the place where the care is provided is also the most expensive option. And since they don't pay, health care providers are forced to raise everyone else's rates to cover the cost of this unnecessarily expensive care that they had to provide.
Long story short, the range of things that health care providers have to treat is much wider in countries with more socialized systems than it is in the USA. And that is yet another reason why the USA has such enormously high health care costs despite providing poorer quality of care.
Let's not play with words like that. People in the US get treatment—you even say so later, despite your ominous lead sentence. They just get it later, via the ED, after prevention goes un-performed. That's abominable enough, and that's what we should talk about, not the (false) specter of non-treatment.
You two aren't disagreeing.
You say we should talk about the epidemic of people unable to afford primary care, pushing treatment later and later, eventually into the ER where they may not even be able to be saved - and even if they do, suffer long-term health effects due to the delay in treatment.
And he's saying that this is because the system does refuse to treat people - especially at the primary care level.
These two topics seem to line up just fine.
My primary point was that while most things can be debated, it's absurd to claim that people don't get treated in the US.
This isn't actually accurate at all. Hospitals with emergency departments must stabilize patients in an emergency. Thats it. The emergency room has no responsibility to treat the underlying cause. It isn't a loophole that people take advantage of because you still don't get treatment. I suppose you could show up to multiple emergency rooms and hope one treats you but that isn't something you do if you are chronically hurt.
People who can't afford to get treatment or aren't on medicaid or charity care don't get treated period. You can test this by just comparing the emergency room rates in Massachusetts before and after coverage expansion. More people went to the emergency room once they had coverage than previously.
There's a hospital in the town where I grew up which managed to shave millions off of the cost of operating their emergency department in a rather instructive way: They identified their most expensive repeat patients, and started just paying to send them in for regular medical care for whatever health problems it was they had. Yeah it meant that they were giving out free health care to these folks, but that turned out to be nothing compared to the cost of having them show up in an ambulance every other week.
Implying the NHS refuses to treat people?
The thing that gets me is the attitude is that some people don't deserve free(-at-point-of-use) healthcare. For whatever reason; they haven't paid their taxes, or they've made mistakes in life. It seems unspeakably sad to me. Surely a civilised society should help everyone, regardless? It's the humane thing to do. It's as simple as that.
I agree that a civilized society should help everyone, but don't agree that the USA is a civilized society. There is definitely an attitude that poor people don't "deserve" stuff. That's been an American notion since the first settlers arrived and won't change anytime in the near future.
True, but what if it's something less serious? Some people would rather be ill than bankrupt. And then what if it gets worse, and then it's too late? People shouldn't have to make that choice, especially because most people--not being doctors--are going to make bad decisions about when something is serious enough to get checked out.
Long live the NHS, and yay for Obamacare - it seems like a step in the right direction at least.
That's not to say there aren't horrible things about Obamacare (i.e. terrible business model) but yes, it's a start.
Neither of those is to say that necessarily Obamacare is the wrong solution but its certainly not the only path.
Insurance is designed to protect the policy holder from an unlikely, catastrophic event they cannot afford otherwise - coverage of everyday costs is not insurance. Notice your insurance company doesn't pay to rotate your tires or change your oil.
Health care, no matter which country you go to, is more of the latter than the former. They aren't primarily insuring against unlikely catastrophic events - that's only a small part of their purpose - they are very obvious ways to spread costs around.
You can't treat health insurance like real insurance, even if they share a name.
They are extremely unpopular for many reasons, which center primarily around paying out of pocket for normal services:
For the purposes of this argument I'm going to use "health plan" to refer to what most people call "insurance" - to avoid confusing the two concepts.
- The out of pocket costs for a no-plan person is extremely inflated. Where your insurance company might pay $60 for a doctor's visit, the cost for someone not on a health plan may be $200-300. This makes the notion of paying out of pocket for routine services unrealistic for the majority of the population.
- These out of pocket costs are expensive because the status quo is for everyone to be on an employer-sponsored health plan. Those who can afford to pay, are on a health plan - the bulk of those who aren't on a plan are financially compromised and likely to default on their debts. This encourages a wild inflation of quoted cost to compensate.
- This further drives people to health plans. Barring the ultra-rich, no one is able to afford health care at "free market" prices, making health plans the only reasonable route forward.
In short, what's wrong with people paying out of pocket for basic services is that "basic services" at market rates will set you back $300 for sore throat.
For example, in some locales you can subscribe to a "direct primary care" practice for a family of four (2 adults, 2 kids) for around $150 per month, and visit your primary care provider as much as you need, paying only for supplies or possibly a token per-visit amount. This, combined with a legitimate "insurance" plan with a high deductible, might set a family back less than half as much as a traditional all-inclusive health plan. (This is what I had in Seattle, with Qliance as my direct primary care provider.)
My son recently needed a physical to start school. As a self-pay patient now located in Denver, I called around to independent clinics in my area and was able to get a fairly good price ($110 total out of pocket, paid up front.) My wife was recently able to be treated for an ear infection for around $80.
If you're actually paying out of pocket it can be a little bit of work, but there are ways to get your costs down to close to "free market" levels.
In a system where you can't sue your healthcare provider for egregious malpractice because they're a governmental body and are thus subject to the same citizen-sues-state rules as law enforcement or any other public service, I fear for the quality of our healthcare.
In one instance in the 1970s I had a great uncle who came into a local clinic complaining about crushing chest-pain, and was told to come back the following day because the attending physician was out for the day. He died on the street of a heart attack while walking home. Why he wasn't immediately rushed to a hospital is beyond me.
More recently, my grandmother, who died in 2004, was wait listed for over a year to get medical imaging and biopsy performed on what she (correctly) assumed was a tumor on her neck. By the time the scan was performed it was determined that she had metastasized lymphoma and the tumor was plainly visible to anyone who could fog a mirror. She died in hospice within a couple of months of being diagnosed.
So what are we to sue for there? Clearly both instances of complete and utter NHS incompetence (and sadly, complacency on the part of my UK relatives) but it's incompetence by omission and rationing, not a doctor embedding a scalpel into someone's tibia.
Had either of my relatives lived in the US, they would have had a much better fighting chance at living than they did at the hands of the NHS.
Second clearly sounds like a fuck up. Current "wait to first treatment" target is 2 weeks. What happened when you tried to sue?
I hope you'll forgive me if I sound callous in this post - I certainly don't mean to, but I also recognise that this is a touchy subject when talking about someone's own family.
In the case of your great-uncle the problem is likely that it was the 70s and fourty years ago there was nowhere near the same awareness of the symptoms of cardiac arrest amongst non-physicians. If the doctor wasn't there, chances are it wouldn't have been picked up on. Even had he been rushed to hospital, his chance of survival would have been pretty low - heart attacks are still a major killer in the 2010s where even in London, which has the highest survival rate in the UK for heart attacks that occur outside a hospital, the survival rate is only 30%. Keep in mind though that survival rates have increased significantly over the last fourty years with advances in diagnostics and treatment as well as improved defibrillators etc.
Your grandmother's case is a more clear cut case of failure. Waiting times have long been a problem in the NHS, but it's a matter of resource contention, and it's a problem which they're trying to improve with the guarantee that patients should start treatment within 18 weeks of their first appointment and that tests should be done within six weeks. The only, very rough, numbers I can find for the US suggests that scans and tests are normally done within seven to twenty weeks when cancer is suspected. Even in the US, the problem of resources exists - there's only so many hospitals that can perform certain types of scans, and only so many doctors who are capable of properly interpreting the results. The thing I can't comment on is whether or not the physician who saw your grandmother should have treated it as a higher priority or if, given the symptoms that were presented, it would be reasonable to assume that there was a benign cause and it being cancer was pretty remote possibility. If it's the case that his prognosis was obviously wrong given the symptoms, then there's a case to be made for malpractice, or at least a complaint to the GMC and/or NHS trust.
That's nonsense, hospitals and NHS Trusts are routinely sued for malpractice, along with the doctors involved. There's nothing special about any part of the NHS that makes it impossible for them to be sued - they're not part of the state, they're just state funded. Hell, you can sue most government bodies in the UK since there's no restrictions on suing the state, only against suing the Crown.
It makes your 'multiple relatives' claim seem somewhat suspect.
http://www.bengoldacre.net/?p=45
I have seen people ruined with medical bills.
There are many reasons why the system is dysfunctional, and I'm aware of nearly all of them.
Did you know that a round of cancer treatment in the US can cost over $500,000, and even if you are fully insured with a good policy you can have a 20% copay required, meaning that with insurance you still personally have to pay $100,000 or more? That sort of thing is what is bankrupting people and is why most medical bankruptcies involved people who were fully insured.
That's assuming your insurance policy wasn't subject to "recission", which is legal retroactive cancellation of the policy as soon as you have any condition like cancer that would cost a lot to treat.
We have a for-profit medical industry, and a for-profit insurance industry and both are motivated to increase profits, and reducing care is often a way to do it. Even non-profit hospitals will price gouge. Non-profit status does not mean that the executives working there aren't paid large salaries, it doesn't mean that things are delivered at cost, or with minimal mark up.
The "reform" is mandating people buy insurance from for-profit insurance companies, with no cost controls. Thus we end up with policies that can cost a family $20,000 a year in premiums, while still having large co-pays that can bankrupt you. The parts of the law that would have provided socialized care for the poor were gutted by the Supreme Court review, and by the executive office rule directives interpreting the law.
The answer to the problem is single-payer. The reform system is a further bailout for industry and is already driving up costs and reducing the number of insured.
Your posts presents those of us who support a reasonable working solution of single-payer as a position of hypocrisy, inconsistency, and/or ignorance, because we don't accept a non-working solution that retains and increases out of control costs and profits for industry.
Not supporting a specific, bad solution does not mean one does not see there is a serious problem and reform is necessary.
I would briefly point out that the $20,000 a year plans you refer to was an example number that the IRS used to illustrate how the law works and not a projection of the cost of healthcare plans in the exchange.
Single-payer seems from scan of Wikipedia to be "government pays the bills" - in other words an NHS like solution.
Which seems to me a position the others in the thread are advocating (ie our current system is barbaric, bankrupts people we must fix it)
So I am a little confused why your post seems to be defending itself from posts that as an outsider I would see as firmly in your camp?
Single-payer means that health care institutions remain private, government does not run or employ any doctors directly, and everything works much like it does today, except pricing is unified and the government pays all bills.
This is different from nationalized health care, especially on paper, where it can preserve market-style competitive pressure that a wholly nationalized system would not. Doctors and hospitals would still be on the hook for attracting customers.
Beyond all that, single-payer fixes prices for an industry that represents a huge chunk of the total economy.
No question at all that we badly need a new system of health insurance in the US (I'm hoping that Obamacare, carefully and aggressively executed, will be it), but single-payer health care is a radical change.
I find it curious and odd that you can't understand another philosophy on the role of government and the individual.
I guess I understand the philosophical argument, from a purely logical perspective, that an individual must stand or fall on their own. But I don't get how people can seriously hold that opinion without living in a cabin in the woods, or in a bubble.
Such matters - often literally of life and death - are not something that ever could be trumped by philosophies about 'roles'.
Yes the market works well in most other spheres, yes economic freedoms are important, but no, economic freedoms (or justice) do not trump human life and death, where avoidable (in a civilized society). Economic freedom is just one of the many things people need for happyness. Health and healthcare are another, that is at least as important. And thus the value of economic freedom needs to be balanced out against healthcare.
The government just is the mediator. Taxing one sphere of life (economic activity) to ensure justice and security in another that fares better if guided by other principles than profit extracted from individual patients.
(individual GPs do profit in the UK system. They, for example, get a bonus if they can make a patient stop smoking, etc. ...speaking of preventative healthcare. They just have less incentive to exploit individual patients (by having them come back later with lung cancer for example) and then charge them to their limit)
Give it 50 years and they'll never go back. The Tories in the UK were opposed to the NHS (AFAIK).
He was a charming, damaged, charismatic, fiercely intelligent, dissolute individual, who lived entirely on his own terms. As a professional gambler, it is unlikely he paid much if any tax in 37 years. He had no will, no funeral plan. He never did fill out the forms necessary to vote in the last election, or the one before that, as I discovered. He just hated forms. I could sympathise. Had he stayed in the US, it is – how you say – dollars to doughnuts he wouldn’t have got it together to fill out the forms, and would have had no health insurance. He considered the US system “absolutely unmanageable”.
However long this goes on for, they'll continue throwing resources at this individual and never show a single sheet of figures to any of his relatives. Not because they'll get anything back, but because this is what the NHS does. It’s free care for throat cancer sufferers who only gave up smoking four years afterwards, for drinkers who were told 35 years ago that if they didn’t quit drinking they’d die. Free care for American immigrants, for jerks and gents. Free care for parents whether they showed up or not. Free care for guys who tried to try. Free care for the only father I will ever have.
So here comes the TANSTAAFL argument: I don't think anyone argues that what the OP describes is a "bad thing"...in fact, I think it's probably the dream scenario that people optimistically assume is the case before they have their first encounter with an emergency room.
But the reason why it doesn't happen is because of cost, plain and simple. And to be concerned about cost is not just the domain of greedy insurers and fat cat cost cutters, but of reasonable people who understand that preventive care is less dramatic than end-of-life care, but is surely as deserving of resources and attention. And both types of care rely on the same limited pot of funding.
It's easy to be emotionally invested in the personal case of a man who is lucky enough to have a loved one so eloquent with words. But what about the hundreds, thousands of routine cases that are treated by NHS with a protocol governed by cost limitations, limitations that will inevitably be imposed by the decision to give blue-chip treatment to the untreatable?
These routine cases don't pull at the heart strings because it is the nature of the human mind not to realize/dwell on how an exam/procedure not scheduled two years ago is the main factor in the chronic disease one suffers today. And yet these people are just as deserving of optimal treatment as OP's Bill. The way that OP judges the value of healthcare, though, means that the Bill's will get a greater share of a finite set of resources. Is this really the way an optimal healthcare system should work?
This is not to say that the U.S. or any other system is currently better than the NHS. It's just to point out that fashion in which the OP (positively) judges the NHS is susceptible to being ignorant of the problems that occur earlier in the pipeline of health.
This is a tension that keeps effective health care reform from moving forward, but it's still a tension that should weigh as heavily in a debate as an emotional appeal.
The test involved a bunch of basics (weight, exercise, blood pressure, etc.) and two blood tests (for cholesterol and blood sugar level). They will repeat this every five years.
I do not think the NHS is the greatest possible system (in fact, I preferred the French system when I lived there), but by many measures it is good.
In 1993 Republicans did an interesting analysis. They found that Clinton's health care plan would work, and would be popular. If it passed, they believed that Republicans would be losing national elections for a generation. But they also figured out that if they derailed it, then they could turn fears about it into a potent election issue. They did, and it was. They tried the same thing with Obama's plan. Whether the other half of their prediction comes true is yet to be decided.
For the actual Republican analysis from 1993, see http://delong.typepad.com/egregious_moderation/2009/03/willi....
They found nothing of the sort. Did you even bother to read their analysis at your link? You can disagree with someone without misrepresenting their motives.
Its interesting in the post-1945 election in the UK very few voters strongly supported the NHS but once it passed it developed bipartisan support. The chances of a party taking every house of congress a supermajority in the senate and the presidency to have the ability to move legislation is incredibly small in our system as compared to a parliamentary one. I'm not suggesting that our system is always worse but in this instance it certainly is.
My father in law in the UK got a cataract done privately.
If you have the money, you can get what you want.
The UK also allows you go privately and pay yourself and choose your won doctor and hospital and treatment if you want and have the money.
For most of us, the money can be attained, as evident by the electronic devices littering our homes and offices.
Related, I've found that many young people don't want to know what their credit card or bank balance is, for fear of seeing how little money they have left (or saved).
Terrible way to live.
The most peculiar part of the whole situation is service cost and individual personal wealth is never an issue WRT national military "defense" or police coverage or fire department coverage or admission into a church or the (admittedly failed) K12 education system or EPA enforcement or OSHA enforcement or ... thus the real question is why cost should be a concern almost exclusively for sick care. My point being that you need to convince not merely that cost is an issue, but that cost should only be an issue for healthcare specifically.
I think we have happily gotten over the idea of needing insurance company plaques on your building in case of fire, and soldiers rarely defend only the rich parts of cities.
Thank you, very well put.
Not really. He was fine with other people paying for his hip replacements.
For the same reason that you don't go to jail just because your brother robs a bank? Hey it is nice when family helps out, but they shouldn't have the legal obligation.
Having gone thru something kind of similar yet different with my own older relatives, the hospital has a blindingly obvious financial motivation to "help" elderly / senile patients with the paperwork, and therefore there are people on staff walking the halls doing precisely that. Seen it with my own eyes, this is not theoretical. As long as the dollars you can haul in from properly filled out medicare forms exceed the cost of hiring a ombudsman or coordinator or advocate or whatever the job title was...
There's no tax on winnings while gambling in the UK anyway.
Two years later my wife's sister gave birth in a top notch Manhattan hospital and my wife was there for support. Man, the stories she tells about how every part of the procedure was initiated with waivers being signed and questions asked about insurance to her sister who was squirming in pain and was several hours into labour. And how the impatient doctors tried to upsell her sister to a C-section... After that her sister shared a tiny room for a night with some other woman and was then sent home. Luckily, most of the 40,000 dollar bill was covered by her insurance.
There's a difference.
Our European income taxes are not higher than NYC's combined taxes, though, and European healthcare is vastly cheaper than American healthcare.
I'm not going to defend the US healthcare system, which is a charming mixture of the worst aspects of monopoly markets and socialism.
Of course our taxes also went for other things like welfare, education, administration and defense, and as we all know many European governments have run deficits for years.
"This leaves the last theory: do we pay higher prices for the same care? Among prescription drug costs, we pay far more than any other country, at least 20% more than Canada and over 60% more than New Zealand. For the same MRI’s and CT scans, we also pay more: $1,080 is the commercial average cost for an MRI in the U.S. as compared to $599 in Germany; at CT of the head costs $510 on average in the U.S. versus $272 in Germany. For a hip replacement, we again pay the most: $1,634 among public payers and $3,996 among private payers, versus $1,046 and $1,943 respectively in Australia. And physicians’ incomes are the highest: $187,000 on average among primary care doctors in the U.S. versus $93,000 in Australia; and $442,000 among orthopedic surgeons in the U.S. versus $154,000 in France."
Here in the U.S. we pay roughly double FOR THE EXACT SAME PROCEDURES AND SERVICES.
And, probably not coincidentally, doctors make roughly twice as much here as other countries.
It seems we keep going round and round trying to attribute the differences between the U.S. and other systems to some philosophical differences, but the bottom line is we are simple being price gouged by an entire industry.
- While it's heart-warming, it is unrealistic to think that a public program can spend infinite amounts of money on citizens who a) have paid "little or no" taxes and b) "throat cancer suffers who quit smoking four years afterwards". The math just doesn't add up.
- The fact that the US has a pseudo market-based healthcare system is what allows drug / device companies to make money on innovations that ultimately save lives in other countries (like the UK) where these drugs / devices may not even break even. If you create a system in the US where it's impossible to make money in healthcare innovation, we'll see far fewer technological developments in healthcare, which will lead to worldwide increases in infant mortality / decreases in life expectancy.
That said, we should have a way in the US to provide basic healthcare for the uninsured. The answer is not, however, a single-payer system.
Confusing more or less a 2nd, 3rd or maybe 4th derivative of a value with the value itself.
"unrealistic to think that a public program can spend infinite amounts of money on citizens"
I read the article, and they cut him off virtually everything when recovery was deemed impossible. Tapering off the drugs, non-interference directive when he therefore codes... he was taking up a bed, not much else. Not quite the same as euthanasia (although not too far) but hardly an infinite amount of money, either.
"have paid "little or no" taxes"
In a civilized society, should the police, fire, military, educational, and environmental monitoring organizations cut off poor people as a primary goal, rather than as a scandal when they rarely do it anyway?
- The other modernized nations you speak of are all running deficits, with the exception of small countries with tremendous natural resource wealth (e.g. Scandinavia) and Germany (which has a tremendous manufacturing sector that I don't fully understand.) That said, the US also is running huge deficits, but a lot of that is due to a ridiculously disproportionate military budget.
- Again, the profitability that comes to drug and device companies from the US market largely subsidizes the cost of these goods in other countries. Cut off the profitability in the US, and the costs for drugs and devices go up in every other market.
I would love to see a way for the US to be able to provide full healthcare coverage to all its citizens, but as someone with a graduate degree in healthcare economics who has studied the problem in depth, I just don't see it.
That said, we shouldn't be turning away the uninsured that need basic healthcare. We have to figure out a way to provide that coverage in a more efficient way than the ER.
As someone who should be dead four times over, I find the American health care system quite functional, effective, and satisfactory. No worship thereof necessary.
That is what I took away from this article.
Unless a central "system" is going to indemnify GPs, there won't be a flood of them entering the pool, since their rates will be fixed by central rate tables (maybe, if they are lucky, adjusted for regional cost-of-living) even if only indirectly by maximum benefits needed to maintain minimal legal coverage levels; if they are to remain privately run and thus administratively independent.
I'm not sure that culturally people are willing to accept the idea that we aren't going to do "everything we can" for someone because it isn't worth it to society (the payer). In the case described here, we might have implanted an electronic device to resynchronize the patient's heart and prevent the CHF from trashing the rest of his organs for a few more months (or years) at the cost of $200k.
Are we at a place where people in the U.S. will accept not doing that that?
I think that a single payer with a base level of free care is the right thing for society to do, but the possibility of making private insurance illegal (as it is in some places and some groups in the U.S. are advocating for) is terrifying to me.
The affordable care act basically ensures that we will arrive at a single payer system sooner or later, but how do we change our culture to be more accepting of our own mortality and the limitations placed on extreme measures to extend life?
I'm not sure that culturally people are willing to accept the idea that we aren't going to do "everything we can" for someone because it isn't worth it to society (the payer). In the case described here, we might have implanted an electronic device to resynchronize the patient's heart and prevent the CHF from trashing the rest of his organs for a few more months (or years) at the cost of $200k.
Are we at a place where people in the U.S. will accept not doing that that?
I think that a single payer with a base level of free care is the right thing for society to do, but the possibility of making private insurance illegal (as it is in some places and some groups in the U.S. are advocating for) is terrifying to me.
The affordable care act basically ensures that we will arrive at a single payer system sooner or later, but how do we change our culture to be more accepting of our own mortality and the limitations placed on extreme measures to extend life?