Universal Health Care

[Pb]

This reminds me of the Oregon man with cancer I read about a few months ago.  He had the oregon state goverment socialized medical insurance.  They refused to pay for his cancer drugs, as they were too expensive.  They did tell him they would be happy to pay for some drugs he could use to kill himself with.

When the state provides your healthcare, they make all the decisions.

P.S. If I remember correctly, the drug company donated the cancer drugs to the patient when they found out about the decision.

[cassandra and sara's daddy]

Because if you can afford to fly some place outside the US to get treatment, you can probably afford to get it here. I don't think anyone is arguing that we don't have the best system for people who have a lot of money. That seems pretty obvious. The problem people have is that we have the worst system for people without much money.

Part of the problem seems to be that we have a back door to socialized medicine through the emergency room. You don't get turned away there, so people who can't afford the cheaper preventative care wait until it's a more expensive emergency and have us pay for it then. If we're truly going to let the free market work, people who can't pay can't be getting treatment.

many of the folks i saw from other countrys weren't paying for their treatment here.

[Iain]

BTR - somebody always makes that decision, unpleasant as it is. If you can afford the alternatives you can pay for them nearly everwhere, including here. Certain cancer drugs are at present out of reach of the NHS (and they will be out of reach of many insurance policies as well), so you can pay just the additional costs if you can afford it.

Like I say, it seems every system has its drawbacks, and I think I can identify a number in the US system and a number over here. Can't say that I would personally prefer either of them, but I know this system and generally it has done me well.

[Monkeyleg]

The replies (other than Shootinstudent's and a couple of others) lead me to one conclusion: no government is more efficient than another, which makes me apprehensive about universal health plans.

Believe me, I'd like to see some changes, especially when it comes to portability. When my wife and I move to the south in 2010, we'll need health insurance. If it means that she has to take a lousy job to get it, so be it. (We couldn't make the move if it weren't for my job).

[anygunanywhere]

P.S. If I remember correctly, the drug company donated the cancer drugs to the patient when they found out about the decision.

My lovely spouse is an oncology nurse.

The drug companies donate lots of drugs to folks who can not pay. It is built into the cost of the drugs already.

Absolutely nothing in this world is free. Someone always pays for everything, one way or another. That someone is us.

Anygunanywhere

[De Selby]

From New England Journal of Medicine on knee replacement surgery (average wait, 3 weeks from consultation to surgery in the US) - http://content.nejm.org/cgi/content/full/331/16/1068

You're not factoring in the people who wait because the insurance is maxed out this year, or won't pay this year, or because they don't currently have insurance, or because the insurance simply won't approve it.  It's not measured as a wait between scheduling and completion, but it is a delay, and it is common.

[BridgeRunner]

You're not factoring in the people who wait because the insurance is maxed out this year, or won't pay this year, or because they don't currently have insurance, or because the insurance simply won't approve it.  It's not measured as a wait between scheduling and completion, but it is a delay, and it is common.

Yep. I waited eight years for my shoulder surgery.  I had insurance for most of that time.  I couldn't afford to use it.

[De Selby]

Yep. I waited eight years for my shoulder surgery.  I had insurance for most of that time.  I couldn't afford to use it.

Yep.

 And if any of you think a 10 dollar a day payment plan is going to happen....try that with any 100,000 dollar plus bill.  See what the collectors think of your "10 dollars a day for the rest of my life, how about that guys?" deal.

It never happens, and pointing out that you can get care if paid for in the US is misleading, because the costs are so high that virtually no one can pay for it.  You could exhaust a million dollars plus in a single year of life-saving treatment.  What percentage of the population has that kind of cash-flow readily available at a time when the person won't be working due to ill health?

Being able to pay your way through for healthcare is only relevant if a meaningful percentage of the population could theoretically do it, but that isn't so in America.  On the flipside, if I wanted to pay all my healthcare costs here in Australia without relying on government insurance...that's actually realistic, given the enormous difference in price for private care.

[mtnbkr]

On the flipside, if I wanted to pay all my healthcare costs here in Australia without relying on government insurance...that's actually realistic, given the enormous difference in price for private care.

I could afford to buy a policy that pays for everything except a $20 copay (no deductible, no 80/20, etc) if my company would give me the money they put into my healthcare plan in my name.  That plus the $220 I pay out of pocket each month (pretax paycheck deduction) would buy such a plan from Kaiser Permanente.  Well, I might have to make up a small shortfall, but that shortfall would be less than what I've paid out of pocket each year on the costs not covered by the plan they force us to use.  IIRC, the plan for my entire family would be about $7000/year.

Problem is, my company decided in 2006 we will all use United Healthcare instead of the wildly popular Kaiser Permanente plan we had from when I joined them till 2006.

Chris

[Jamisjockey]

Yep.

 And if any of you think a 10 dollar a day payment plan is going to happen....try that with any 100,000 dollar plus bill.  See what the collectors think of your "10 dollars a day for the rest of my life, how about that guys?" deal.

It never happens, and pointing out that you can get care if paid for in the US is misleading, because the costs are so high that virtually no one can pay for it.  You could exhaust a million dollars plus in a single year of life-saving treatment.  What percentage of the population has that kind of cash-flow readily available at a time when the person won't be working due to ill health?

Being able to pay your way through for healthcare is only relevant if a meaningful percentage of the population could theoretically do it, but that isn't so in America.  On the flipside, if I wanted to pay all my healthcare costs here in Australia without relying on government insurance...that's actually realistic, given the enormous difference in price for private care.

Nothing is free, and you're paying for it one way or another.  This I promise.

[Gewehr98]

Nothing is free, and you're paying for it one way or another.  This I promise.

Quoted for truth - and if you aren't paying your share of healthcare costs, that means I'm paying for your share out of my taxes. 

No thank you. 

[Manedwolf]

Problem is, my company decided in 2006 we will all use United Healthcare instead of the wildly popular Kaiser Permanente plan we had from when I joined them till 2006.

My company dumped United and went with CIGNA because United was such a ___-up that they were messing up all the claims, and a growing number of physicians were taking anyone BUT United because they were such a pain to deal with. CIGNA here has an association with Tufts.

I hope you have better luck with that...

[mtnbkr]

They've been a PITA with Emily's birth.  Big mix up regarding a tax ID, so one of the doc's is being billed as "out of network" when everyone knows he is.  They can't change anything because that would be fraud, but the hospital thinks they did things right.  Know how much fun it is convincing a hospital bureaucrat they are wrong?

Chris

[Manedwolf]

They've been a PITA with Emily's birth.  Big mix up regarding a tax ID, so one of the doc's is being billed as "out of network" when everyone knows he is.  They can't change anything because that would be fraud, but the hospital thinks they did things right.  Know how much fun it is convincing a hospital bureaucrat they are wrong?

Chris

Yup! Sounds about right for them. That's why the company dropped United. :|

The local chain of doc-in-a-box places, HealthStop, will now literally take every insurance BUT United!

[De Selby]

I'm not claiming there is a free lunch-but I do think it's relatively well documented that, dollar for dollar, American receive less service than in some other countries for their health care. 

It's the opposite for consumer goods here.  You pay 100 dollars for a pair of pants that costs only 30 in America.  Same product, same brand even....yet you pay more here.

And with medical care its the opposite-you get the same treatment, it just doesn't cost half as much as it does in the US.  That's pretty much the definition of inefficiency-paying more/putting more out for the same results compared to some other system.

[K Frame]

"You're not factoring in the people who wait because the insurance is maxed out this year, or won't pay this year, or because they don't currently have insurance, or because the insurance simply won't approve it.  It's not measured as a wait between scheduling and completion, but it is a delay, and it is common."

So, provide some tangible statistics on that claim.

In your world, how many Americans does that equal?

99.7%? 99.999999999%?



"On the flipside, if I wanted to pay all my healthcare costs here in Australia without relying on government insurance...that's actually realistic, given the enormous difference in price for private care."

That's because the government subsidizes, controls, and mandates enormous portions of the costs of what doctors and hospitals can charge.

Know where the money comes from for that?

From your paycheck.

It's not, by any stretch of the imagination, a free ride.

I always love how so many Europeans tout their health care systems and the pervasive cradle to grave social services network that they receive, and yet they don't have an iota of a clue as to its origin -- the backs of the American taxpayer. The trillions of dollars that the United States poured into European rebuilding after World War II and European defense allowed the creation of the modern Western European social state.

[Manedwolf]

The trillions of dollars that the United States poured into European rebuilding after World War II and European defense allowed the creation of the modern Western European social state.

Which is breaking down. When your nation considers it a normal thing for dozens of cars to be burnt every night in your cities, you're in trouble.

"Discontent" youths attacking police in Paris suburbs, people who have never had jobs. Chav gangs walking up to High Street jewelers in London in broad daylight and smashing in the windows with bats to take the jewels, people who have never had jobs.

It is breaking down.

[Iain]

Quoted for truth - and if you aren't paying your share of healthcare costs, that means I'm paying for your share out of my taxes. 

No thank you. 

The ideological crux. I could tell you that the British public view this very differently, but I won't because that will only deepen the ideological divide.

Instead I'll say this - you do pay for other peoples healthcare everyday. Your premiums, hospital charges and drug charges cost what they do because many many Americans do not pay for the full cost, or perhaps any cost, of their treatment. Hospitals factor in people who can't pay, as do drug companies as highlighted above. But as you say somebody pays.

There are a lot of people like me in America. The only way I will ever be able to pay the full costs of my lifetime medical care needs is if I write something as successful as Harry Potter. In the next thirty years I could need three major organs transplanted. That's the downside of treating people like me with basic things like antibiotics - we live longer and cost more in the long run.

No-one seems to want to address the problem of those who have large medical needs they cannot afford, I suggested that we do on the previous page and no-one has. Could I keep going back to a specialist unit to get arguably non-absolutely-essential drugs, routine check-ups and scans - when that hospital knows that I cannot pay?

I'm afraid your system doesn't match up to the ideological purity test, and mine certainly doesn't. (This next statement will draw the flamers...) So the only thing I am concerned about after that is which one does better for those who live in the real world of lifelong disease and large, regular, medical needs.

I'm still not sure that either is better, but neither is 'pure', and I have a feeling that each screws over someone badly.

[red headed stranger]

Instead I'll say this - you do pay for other peoples healthcare everyday. Your premiums, hospital charges and drug charges cost what they do because many many Americans do not pay for the full cost, or perhaps any cost, of their treatment. Hospitals factor in people who can't pay, as do drug companies as highlighted above. But as you say somebody pays.

I think this is an important point.  The US already has a very socialized medical system.  The free market is not in play in this industry in a meaningful way. If people don't want socialized medicine, they need to get rid of the current government programs that already account for roughly half of all medical spending. Of course, that will be extremely unlikely, as we head into an era where more and more of the US's total population will be eligible for medicare.  People seldom vote themselves fewer benefits.   

[Lee]

Socialized medicine has been here for a long time...it's just never been formalized.  As Ian said, the $1500 my insurance Co. is charged for a minor procedure, pays for my moms by-pass (paid through Medicare).  The $1000 emergency room visit I pay for, pays for the free emergency room treatment of a drug dealer who's been shot. 
Now, we just need to figure out how to reduce costs, or spread them around more evenly, without bankrupting the health care providers or medical manufacturers.   
I'm not a socialist, but I believe as a society we need to develop a new mindset regarding profit levels in the health care industry.  Once upon a time, even in the US, doctors were not all millionaires; Insurance company skyscrapers didn't dominate the skylines of nearly every city; There weren't 20 Corporate conglomerate hospitals per city; and drug companies didn't count profits in the billions of $.
I'm not sure how you balance need/service vs profits, but part of the solution will need to include much stronger governmental protections on liabilities and the protection of intellectual property. 

[Monkeyleg]

Once upon a time, even in the US, doctors were not all millionaires...

My niece is a pediatrician, but doesn't make much as much as I did when my photo studio was doing well. My own GP, who's now in his 70's, is still working because he can't afford to retire. The idea of all doctors being rich is a myth.

As others have pointed out, our technology has outpaced our ability to pay. Many ailments that previously required surgery can now be treated with medications, although the cost of the prescriptions isn't cheap. Conditions that would have been a death sentence even a couple of decades ago can be diagnosed and treated with expensive technology.

I'd be curious to know how many countries make available medications developed in the US without the US pharmaceutical companies getting their cut for R&D costs.

[RaspberrySurprise]

Pull the gummint out of health care and let the market fix things. The less cookie jars the gummint has its mitts in the better.

[Don't care]

There are different "types" of Universal Healthcare.

To one extreme, Germany has an actual communist (Nope, not lying. That's whats it's called) health system. At one time, they experimented with lowering health costs by not supplying linens, towels, wash cloths and gowns. That was the patient's or the patient's family's responsibility. Thankfully, clearer heads prevailed when the phrase, "infection control" entered the conversation.

[De Selby]

Who pays what is a different question-one that is a debate all its own.

However, as a matter of efficiency, the total per capita spending on healthcare is documented.  That figure includes government expenditure on the healthcare program; ie, all those "trillions" in foreign aid that end up spent on the national healthcare systems is included, because the document I posted contains an accounting of total per capita spending on healthcare.

So setting aside the debate of who should pay what, it is clear from the numbers that other countries spend far less money to get basically the same services and amounts of service.  Paying more for the same product tells you that there is an inefficiency you face in getting that product that your lower-paying neighbors don't face.

[Lee]

Have you ever heard of the WIC program? 
http://findarticles.com/p/articles/mi_qa5389/is_/ai_n21401586

I would guess this is what we'll see more of this in health care, across the board.  Half of us get free stuff, while the other half pays double.  The government buys half at cost, and the manufacturer/provider makes their profit on the other half.

Monkeyleg- here's an interesting battle over patent issues overseas. 
http://www.accessmylibrary.com/coms2/summary_0286-13338463_ITM