National Health Care-Obama Plan

[Iain]

Uh-huh. Did I deny that healthcare has costs, or that there is effectively rationing? No, I did not. I do however object to the 'my dad had X, it got sorted here in our marvellous system, but I bet if he was English they'd have turned him into soylent green' school of conjecture. The fact is most of you don't really have a clue about what goes on here. Pretty obvious that the scare stories are swallowed whole.

Let's start with the simple fact that private health insurance in this country is not illegal. It exists. As does your ability to go to a private healthcare provider for your hip replacement, or for you to pay for drugs that are not provided under the NHS. Those that can pay will always get a higher standard of care, everywhere.

Are patients with healthcare insurance in the US ever denied treatment on the grounds of cost? Because I get the funny feeling they are. That of course ignores those without healthcare insurance (and I bet not all of them are mooches who don't want to pay, rather they are 'bad risks') who are effectively receiving what looks like an even shittier form of 'socialised health care' than I get.

[makattak]

Let's start with the simple fact that private health insurance in this country is not illegal. It exists. As does your ability to go to a private healthcare provider for your hip replacement, or for you to pay for drugs that are not provided under the NHS. Those that can pay will always get a higher standard of care, everywhere.

Let's start with the simple fact that private schooling in this country is not illegal. It exists. As does your ability to go to a private school for your child's education or for you to pay for books that are not provided by the Department of Education. Those that can pay will always get a higher standard of education, everywhere.

Like education, though, when the government starts stealing large amounts of money from my paycheck to pay for this service, it is unlikely I will have the money left over to pay for private school tuition or for private healthcare.

UNLIKE eduaction, I don't really have the option of operating on myself like I can homeschool my children in order to aviod the substandard education provided in this country.

CAN you get a good education from public schools? Of course- I am a product of the public schools as well. However, I was not best served in the public school. I was not challenged and did not have options I wish had been available.

CAN people get good care from a public health insurance plan? Of course. Just like in public schools, though, it is those consumers at the margin that will suffer the most under a public health plan.

I'm sure your healthcare is not shooting people. It is rationing and denying service. Every good must be "rationed" as none is available in unlimited quantities. I prefer a system where I do the rationing rather than some government bureaucrat deciding what is best for me.

Honestly, I have no animosity towards people who would prefer a socialized medical system. I wish they would go to a country that already has it, though.

The biggest reason for my animus and hostility for those pushing for it in this country is that I HAVE NOWHERE ELSE TO GO. I don't want socialized healthcare. What first world country is available for me to flee this stupidity?

[Fjolnirsson]

Honestly, I have no animosity towards people who would prefer a socialized medical system. I wish they would go to a country that already has it, though.

The biggest reason for my animus and hostility for those pushing for it in this country is that I HAVE NOWHERE ELSE TO GO. I don't want socialized healthcare. What first world country is available for me to flee this stupidity?

If I may drift the thread a bit here, The above is the biggest problem I have with what is happening in America today. I would rather live and let live. I don't like politics, I don't like keeping an eye on the inner workings of government, I consider it to be a waste of my time. However, every single time I turn around, some government lackey is shoving some new tax or program down my throat, and there's nowhere left for me to go. America is the best thing going, and it's being shoved down the drain. Those of us who just want to be left alone have no option anymore. It used to be a given that America was more free than the rest of the world, now we're becoming just another flavor of socialism, by small degrees.

Socialized medicine of necessity, requires rationing of goods and services. The elderly and poor, who are the very people this plan allegedly is meant to help, will be the most hurt. The elderly, because "you're going to die soon anyway', and the poor because they tend to have more self inflicted health problems.

[Headless Thompson Gunner]

This is the problem with the healthcare debate in America.

The only hard data available show two things:

1. Health care quality is not superior in America (outcomes are equal to or worse than in comparable economies.)

Back up that wild assertion.  You'll need to first define what constitutes superior vs inferior health care quality, then you'll have to demonstrate how our systems succeeds or fails on that definition.

[FTA84]

Are patients with healthcare insurance in the US ever denied treatment on the grounds of cost? Because I get the funny feeling they are. That of course ignores those without healthcare insurance (and I bet not all of them are mooches who don't want to pay, rather they are 'bad risks') who are effectively receiving what looks like an even shittier form of 'socialised health care' than I get.

I just disagree that the result of universal healthcare is to simply provide healthcare for those who cannot afford it.

Right now the free market dictates that a good number of healthy individuals have done a risk assessment and decided that health care was not worth the cost.  On the other hand, unhealthy people (due to choice or poor genetics) are being denied expensive care because the health insurance company needs to make ends meet somewhere.

It seems more to me that they are trying to "spread the pain" by forcing healthy people onto the (government) health care rolls (via taxes), which means more money to pay for other peoples problems.  Then for good measure, they are trying to buy future votes by making sure to insure illegal aliens.

I don't disagree with the premise -- there are hard working poor people that need help to make ends meet.  I grew up so dirt poor we couldn't afford dental visits, much less real healthcare.  I know what it is like to be one of "those poor children" this is aimed at. There are still some people in my family that haven't made any bad choices but do work as hard as they can and still can't afford what they need.

Here's the problem: No one in my family has ever or will ever go on the government take.  Why? Because people who work hard are too proud to just take hand outs, it wastes their feeling of hard work.

Who will take the hand outs? Professional moochers. There are people whose job it is to be on the government take.  I remember being so excited when Clinton "put an end to endless welfare."  I have a sister-in-law who does social services in an urban area.  She says that they all have figured out how to get around any and all of those limitations on welfare.  They swap their dependents on paper every few years and get around working.  These people will use "hard working poor americans" as an excuse, but those "hard working poor americans" can't find time to run through the system when professional moochers clog it up all day long.

[Monkeyleg]

Who will take the hand outs? Professional moochers. There are people whose job it is to be on the government take.

I know a few people who are professional moochers. It's not just welfare queens, it's guys, too. They've got the system down, and they've been working it for decades. In fact, it's the only work they do.

Shootinstudent, you keep saying that the quality of care in the US is inferior to many other countries. First off, let's define "quality of care," and then let's see the proof.

By the way, I didn't just read or hear that there are long delays in the Canadian system. It's been something that's been reported upon extensively, both in the US and Canadian press. If it's just a rumor, it's one hell of a publicized rumor.

[FTA84]

I know a few people who are professional moochers. It's not just welfare queens, it's guys, too. They've got the system down, and they've been working it for decades. In fact, it's the only work they do.

Yep.  I bet the majority of people on some form of SSD are white males.

[ronnyreagan]

You'll need to first define what constitutes superior vs inferior health care quality

First off, let's define "quality of care," and then let's see the proof.

He provided some research a few pages back that has a bunch of different ways to measure quality and relates them to spending. They aren't perfect, but they mean a whole lot more to me than all the anecdotes that come up when this topic is discussed.

Things like life expectancy, mortality rates, medical errors, and how many doctors/nurses/beds per 1,000 population seem to be the most common ways to measure quality. If we are indeed spending significantly more per capita than other countries, we certainly don't seem to be getting the best results for it.

[makattak]

He provided some research a few pages back that has a bunch of different ways to measure quality and relates them to spending. They aren't perfect, but they mean a whole lot more to me than all the anecdotes that come up when this topic is discussed.

Things like life expectancy, mortality rates, medical errors, and how many doctors/nurses/beds per 1,000 population seem to be the most common ways to measure quality. If we are indeed spending significantly more per capita than other countries, we certainly don't seem to be getting the best results for it.

Life expectancy: horrible choice as a gauge of medical quality as too many factors beyond medical care go into it.

Mortality rates: would be a wonderful choice if we had a uniform measure. Unfortunately, too many countries think a child that dies within a day of being born is a stillbirth. The United States classifies that as an infant death. (This is an example of the non-uniformity of measure).

Medical Errors: this may be a good choice. However, I would bet it suffers from similar measurement issues as Mortality rates.

Number of doctors/nurses/beds: Excellent choice. However, as that would be a symptom of government enforced shortages (medical licensure et al...), I don't think that's a good measure of whether a free market works better when it's decidedly NOT a free market.


As for spending, I note our public spending per capita on medical care is ALREADY higher than almost every other country (Iceland, Norway, and Luxemburg the only other exceptions).

If we are already outspending these other countries in government money on healthcare, why not address THAT issue rather than attacking the private spending on healthcare? Let's just expand the VA hospital system and send everyone on any form of government payment (Medicare, medicaid, VA) there.

That way the government can control its own costs and the private healthcare system can go its own way. Change nothing about coverage for anyone else, just "fix" the government side.


But we can't do that, it has to be "comprehensive" reform. The reason is that these people aren't interested in "fixing" things or lowering costs. They are interested in moving this country step by step into a European-style socialist hellhole.

As I have thought many times, I have to wonder: What happens to the world when they finally succeed in killing the goose that lays the golden eggs?

[ronnyreagan]

Mortality rates: would be a wonderful choice if we had a uniform measure. Unfortunately, too many countries think a child that dies within a day of being born is a stillbirth. The United States classifies that as an infant death. (This is an example of the non-uniformity of measure).

The study claims to address this non-uniformity, yet it doesn't help our ranking...

"The United States is one of eight countries that counts very premature
babies with low chances of survival as “live births,” which has the effect of
increasing infant mortality rates over what they otherwise would be. Nevertheless,
among the eight countries that report live births using the same methodology, the
United States has the highest rate of infant mortality. Even with more consistent
methodology, the U.S. ranking — which has been slipping over time — would
probably not significantly improve."

[Headless Thompson Gunner]

So that's the best evidence you can present of how our medical system is broken?  Demographic data on average life expectancies and whatnot, stuff that only has a passing relevance to the quality of medical care we can get here?

 :|

[ronnyreagan]

So that's the best evidence you can present of how our medical system is broken?  Demographic data on average life expectancies and whatnot, stuff that only has a passing relevance to the quality of medical care we can get here?
 :|

I already admitted it's not a perfect way to measure how well our system works but it's more meaningful than a bunch of anecdotes about how long somebody's uncle had to wait for some procedure in Canada. If you have a uniform metric with data available to use in a comparison, feel free to share it.

Besides, Makattak seemed to think mortality rates are a "wonderful" way to measure, so maybe he can explain why it has more than just passing relevance to the quality of medical care.

[FTA84]

I liken this whole conversation to:

"GM is better than Ford" "Every other city has only GM dealers, why do we have only Ford dealers??"

Capitalism (even on a global scale) says this is a good.  If you don't like Ford, you can leave the city and buy a GM vehicle.  If you don't want to do that, move to any other city.

I don't know if our system is bad or good (relative to other systems, as stated, this is hard to measure).  What I do know is that it is different.  People in Canada can come here for treatment that is needed in a hurry and we can go to Canada for drugs not approved here.  When all the countries get the same medical system, there is no choice.

[makattak]

Besides, Makattak seemed to think mortality rates are a "wonderful" way to measure, so maybe he can explain why it has more than just passing relevance to the quality of medical care.

Well, I'm busily looking for the stats that I read that show that babies born SERIOUSLY premature have the best chance of survival in the United States than in any other nation.

When I find it, I'll explain how that's a good measure of medical care.

[cassandra and sara's daddy]

my bleeding heart sister left japan at warp speed when her first pregnancy was a lil complicated. no way he was being born there

[seeker_two]

If Obama-Care is enacted, the mobsters should start sending their children to medical school....because black-market medicine is going to get profitable quick....and it might be a good "business investment".....say, anybody got the phone number for the Cosa Nostra secret hideout?.... 

[Headless Thompson Gunner]

I already admitted it's not a perfect way to measure how well our system works but it's more meaningful than a bunch of anecdotes about how long somebody's uncle had to wait for some procedure in Canada. If you have a uniform metric with data available to use in a comparison, feel free to share it.

Anecdotal?  Did you actually read the report you cited?  Excessive wait times for major surgeries is a real problem under socialized medical systems.  The anecdotes exist for a reason.

The United States is one of eight OECD countries in which
waiting times for elective surgery are reported to be low. Meanwhile, wait times are
considered a serious health policy issue in 12 OECD countries.83 In these 12
countries, wait times of 1 to 1½ months are common for procedures such as invasive
heart surgery, whereas wait times for procedures like hip or knee replacement cluster
around five months. In a recent survey, a quarter to a third of respondents in Canada,
the United Kingdom, and Australia reported waiting more than four months for a
non-emergency procedure, compared with only 5% of Americans.84

I said earlier that I've noticed Europeans complain about their health and their health care systems at a much higher rate than Americans.  My saying so is anecdotal, but the CRS report saying so is not.

As shown in Figure 23, 89% of Americans
report their health as being “good,” “very good,” or “excellent” — the third highest
levels in the OECD.

All in all the report paints a picture that shows that the US system is good in some areas, adequate in others.  It definitely does not show that our system is "broken" or "in crisis" or a "national embarrassment".

[ronnyreagan]

Anecdotal?  Did you actually read the report you cited?  Excessive wait times for major surgeries is a real problem under socialized medical systems.  The anecdotes exist for a reason.

I said earlier that I've noticed Europeans complain about their health and their health care systems at a much higher rate than Americans.  My saying so is anecdotal, but the CRS report saying so is not.

All in all the report paints a picture that shows that the US system is good in some areas, adequate in others.  It definitely does not show that our system is "broken" or "in crisis" or a "national embarrassment".

Waiting time is one of the areas our system has some advantages in, but it's not like we're clearly "The best in the world" by that metric either (unless you limit it to a specific subset like elective cosmetic surgeries. Heaven forbid we wait for those!) I don't think anyone is claiming our results overall are any worse than average, the problem is that we're paying twice as much for it.

[longeyes]

What is going on is the lawyers convincing the American people that it's the doctors who are screwing them over.

Now that's funny.

America, built on the rule of law, has legalized itself into oblivion.  Health care costs are out of control, we are told.  Try the legal costs that are now built into every layer of American activity, at every level.  Doctors make too much money?  Not by lawyer standards, they don't.

If health care's a "right," so is equal access to the law, no?  By collectivist logic, I say yea verily.  Obama is part of the social class that went to law school rather than "make things" because the latter would be declasse' and force them to get their hands rather than their souls dirty.

By the way, I am not "anti-lawyer," but the lawyers of America, especially the trial lawyers, have plenty to answer for.

[makattak]

Waiting time is one of the areas our system has some advantages in, but it's not like we're clearly "The best in the world" by that metric either (unless you limit it to a specific subset like elective cosmetic surgeries. Heaven forbid we wait for those!) I don't think anyone is claiming our results overall are any worse than average, the problem is that we're paying twice as much for it.

AH HA!

NOW we get to the area in which I AM particularly knowledgeable.

IF you think the idea is that we are paying too high a price, the question is, then what is the cause?

Other countries are using monopsony powers to lower prices. Not only that, they threaten to ignore patent protections on drugs in order to lower those prices. As a result, the only place where drug companies can recoup the cost of research is the United States.

Next, we have the government paying for half of our medical care already. Government involved ALWAYS creates inefficiencies: that is the nature of government.

Now, what in the history of government actions makes you think we will get a more efficient product? What makes you think it will be a superior product?

What makes you think we will have MORE doctors when we are lowering their pay?

Lastly: What makes you think there will be any advances in medicine when we remove all reward for those advances?

But hey, so long as you want today's healthcare (just slower) in 50 years, this is GREAT plan.

[Headless Thompson Gunner]

Waiting time is one of the areas our system has some advantages in, but it's not like we're clearly "The best in the world" by that metric either (unless you limit it to a specific subset like elective cosmetic surgeries. Heaven forbid we wait for those!) I don't think anyone is claiming our results overall are any worse than average, the problem is that we're paying twice as much for it.

I don't know about you, but if I needed heart surgery I wouldn't want to have to wait 6 weeks to get it.  If I needed a joint replacement to continue walking I wouldn't want to have to wait half a year.  

At the very least, can we stop pretending that the excessive wait times found in socialist systems are phony anecdotes?

If your gripe is with cost, then that's a different matter entirely.  You need to ask yourself why our system is more expensive.  Then you need to answer your question correctly.

[longeyes]

One of the reasons our system is "more expensive" may well be that we have far more sophisticated delivery systems, medical technology, and pharms.  All that has cost billions upon billions of dollars.  Is it "over-priced?"  Maybe so, but it also probably wouldn't exist unless there were serious profits to be had by making the effort.  Right now we have thousands of biotech companies at work on advanced technology that may or may not pay off, their costs fueled by venture capitalists and ordinary investors who are hoping for a big return.  That's the American system and it's produced medical miracles in the last half-century and will produce far greater ones in the future (if it's not destroyed by the Left).  Where have most of the great medical advances come from in the last century?  We know where.  If most of our best minds end up first partnering with, then joining forces with the Chinese, we'll have only ourselves to blame.

[ronnyreagan]

Now, what in the history of government actions makes you think we will get a more efficient product? What makes you think it will be a superior product?

I am not/will not argue that more government in health care will fix the problem, so far I've only been arguing that there is indeed a problem.

At the very least, can we stop pretending that the excessive wait times found in socialist systems are phony anecdotes?

I never claimed these anecdotes were phony, I just said they are of little use. I can come up with plenty of anecdotes that make gun ownership look terrible, but the statistics that show otherwise are much more meaningful. Horror stories are more publicized than success stories and sharing them makes a great emotional appeal but nothing more than that.

One of the reasons our system is "more expensive" may well be that we have far more sophisticated delivery systems, medical technology, and pharms. 

Sophisticated is nice, but effective would be better. I wouldn't complain if our high costs gave us the best results. Instead we get average results, on par with the "socialist hell holes" that spend less.

Since we have less government involvement (and therefore we're more efficient, correct?) shouldn't we be spending less for the same results as other countries instead of more?

[makattak]

Since we have less government involvement (and therefore we're more efficient, correct?) shouldn't we be spending less for the same results as other countries instead of more?

Non sequitor.

Also, it may not be true.

The government is not PAYING for the totality of healthcare. It is making significant requirements of private insurance and its tax policies are seperating the consumer from the price of the service. The government is REGULATING all of healthcare.

I have a simple solution: get the government OUT of healthcare. If you wish to encourage health insurance, make ALL health insurance tax deductible, rather than only that provided by employers. Encourage medical savings accounts.

It's funny how medical procedures like Laser eye surgery have been going down in price because the consumers are responsible for paying those prices.

We ALREADY have examples of what happens when you let the free market work.

Instead, this plan will kill it because what we have now isn't working. Like all socialist plans it complains about the problems cause by too much government and claims the solution is more government. Why don't we look at the states that have already implemented similar plans before we screw over the country?

[ronnyreagan]

Non sequitor.

Also, it may not be true.

The government is not PAYING for the totality of healthcare. It is making significant requirements of private insurance and its tax policies are seperating the consumer from the price of the service. The government is REGULATING all of healthcare.

I'm sorry, I think you lost me. Are you saying we have about the same amount of government involvement/regulation in health care as the other OECD countries?