Socialised Healthcare

[Segnosaur]

But you're implying that the force issue alone is reason enough to invalidate any sort of publically funded system (at least, that's how your and CaptainManacles' comments come across to me).

Well, that certainly wasn't my attention.... I do realize that we cannot have western society existing under anarchy; some government services are necessary and they will be the need for mandatory taxes to support that infrastructure. The problem is deciding what needs to be supported and what doesn't need to be.

The important issue is recognizing that taking tax money (even if its for something as noble as healing the poor sick people) is an example of force being applied.

In which case the question of settling which force is acceptable becomes very important. Why would publically funded health care be unacceptable force but public education or the military or any of a number of government programs be acceptable force?

Well, a general rule would be things that form a natural monopoly are more likely to require government supported taxation. We can't, for example, expect everyone to have their own military, or their own personal set of roads.

Then there are items for which the free market can actually play a part. Health care is certainly part of that. It is my belief that we can and should have services in place to help the disadvantaged (welfare for example); health care certainly falls into that category.

Seems to me there has to be something more substantial to an argument against publically funded health care than using the narrow and exception-ridden force argument.

There ARE a lot of arguments against publically funded health care. There have been a lot of posts about them in this thread.

 

[Skeptic Ginger]

....
Would it really make the U.S. look better? First of all, some people will die while waiting for treatment and/or diagnoses (and not even get counted in the studies). Secondly, from what I've seen, there's nothing in their analysis to account for Canadians being (on average) at a more advanced stage in their illnesses due to slow diagnoses times. ...

Without getting into the discussion here about the Canadian system specifically, wouldn't this just be the difference between who died waiting for treatment, the person who could pay or the person who could not? The uninsured are certainly dying from lack of medical care right now in the US.

 

[Abe_the_Man]

Once again, let me explain (just because you seem to have trouble understanding this)....

Just because a person isn't covered by insurance, does not mean that they will not get health care.. I really don't know how to make it clearer than that.

Ever hear of the term "out of pocket"? Some people can and do pay for their own health care expenses. They would fall into your 15%, yet their health care spending is still counted in the per-capita costs.

I could also point out that many of those 15% people are newly employed, yet not at a point where their health insurance becomes active, so they're not suffering from any sort of long-term lack of coverage.

Ah I see what you mean now. I literally didn't quite understand what you were getting at. I can be a bit thick sometimes. This won't change my opinion but thanks for clarifying.

 

[Skeptic Ginger]

I've found the arguments in favor of this position very unconvincing. Universal healthcare is paid for, in part or in whole, by increased taxation. I might be willing to believe that extra taxes are an acceptable price to pay, but the assertion that they don't qualify as the government taking money from its citizens against their will -- or at least unconcerned with their will -- is frankly ludicrous. That's what taxation is. It's not optional, at least around here.

Another post assuming poor people are getting either no medical care whatsoever (IE dying on the steps of the hospital which happens but only rarely) or the care just magically manifests itself and the payment comes from ??????????????????????

In reality, we are paying for that care. Just because it goes through your health insurer instead of through the tax collector doesn't mean you aren't paying.

Yet I see in post #187, you seem to acknowledge knowing this little fact. So explain to me what your tax argument is in light of the fact the money just comes out of a different pocket?

 

[CaptainManacles]

Another post assuming poor people are getting either no medical care whatsoever (IE dying on the steps of the hospital which happens but only rarely) or the care just magically manifests itself and the payment comes from ??????????????????????

In reality, we are paying for that care. Just because it goes through your health insurer instead of through the tax collector doesn't mean you aren't paying.

A swing and a miss.....

Seriously, your reading comprehension skills are terrible. No where did he make the claim or assumption that we don't pay for our medical care.

 

[Skeptic Ginger]

Sure seemed obvious when congress enacted legislation in the 1970's that created Health Maintenance Organizations (HMO's) as an alternative to traditional medical insurance. Create a type of insurance that encourages people to get their routine physicals and other such "maintenance" treatments. That way we'll catch illnesses earlier and reduce the need for emergency medicine and expensive treatments. Since everyone is healthier overall - this would serve to control the rising cost of healthcare in this country.

Congress really nailed it that time.

Of course now congress considered the error of their ways and enacted legislation that made HSA's (Health Savings Accounts) possible. These operate under exactly the opposite theory. Pay out of pocket for all the reasonably priced little things. As an added bonus - you can set this out of pocket money aside tax free. That way people will be more selective about when it is or is not necessary to go to the doctor. Sure - they have insurance in place in case something catostrophic happens - but they won't be inclined to stop in for a kleenex everytime they blow their noses like that silly HMO idea. This should control the rising cost of healthcare.

But the cost of healthcare is still sky-rocketing. Could be part of the reason why many people aren't so inclined to give them another stab at it.

Back to the government we go. Third time's a charm, right?

HMOs are not bad in concept, only in execution. I belong to one that functions just as it is intended to.

Re the HSAs, that's nothing more than a political gimmick. If people could just pay health care costs out of their savings accounts we wouldn't be having this discussion.

 

[Skeptic Ginger]

...
The 47 million uninsured is also not entirely accurate. 12 million are illegal immigrants, 9 million earn $75,000+ per year, and 12 million are eligible for government programs but do not enroll.
ncpa.org/pub/ba/ba568/ba568.pdf....

Consider the source of that 2 page synopsis, Crisis of the Uninsured: 2006 Update.

National Center for Policy Analysis

The National Center for Policy Analysis (NCPA) is a think tank. It is a "communications and research foundation dedicated to providing free market solutions to today's public policy problems ... [and] prides itself on aggressively marketing its products for maximum impact by 'targeting key political leaders and special interest groups, establishing on-going ties with members of the print and electronic media, and testifying before Congress, federal agencies, state lawmakers, and national organizations.'" -- NCRP, The Strategic Philanthropy of Conservative Foundations

I'm not saying to ignore the claims, but I certainly wouldn't take them on face value either.

 

[Skeptic Ginger]

A swing and a miss.....

Seriously, your reading comprehension skills are terrible. No where did he make the claim or assumption that we don't pay for our medical care.

People who live in glass houses....You didn't read what I said or you wouldn't have mangled the interpretation. What the **** difference does it make if the money comes from pocket A or pocket B? You can't pay for medical care or insurance without being "forced" to pay for the uninsured either.

 

[Segnosaur]

The inclusion and exclusion criteria were listed in the methods section.

I'm not sure where exactly you got the idea that the 'criteria were listed'. Bascially, all I could find about the initial screening of articles was "reviewers independently evaluated titles"... To me, that sounds a little vague.

Which is why multiple people were involved at each step.

Correction... there were 2 people involved at each step. Given the political stance of the lead author of this study (and the nature of this particular peer reviewed publication) I do have to question who exactly was doing the initial screening.

That presupposes that one needs a specialist or an MRI for a diagnosis. And that the timing of the diagnosis has an impact on the course of the disease.

I use MRIs because they are a good example of the problems associated with an all-user-pays system (at least here in Canada)... its infrastructure that COULD be improved by allowing free market participation, but is not because of government rules. That also includes CAT scans, PET scans, and any other diagonstic tools you can think of.

He and others are well aware of how bias can even subconsciously influence results. Which is why they took steps to remove the possibility of influence (such as blinding).

We're skeptics... we should recognize that even if we set out with the best of intentions to remove any bias its just not possible. You can't have a double blind study with people who cannot effectively do any sort of random selection.

Just out of curiosity... did you actually read the results in any detail?

According to their study, they found 14 studies that showed Canada's health care system was better, vs. 5 in the U.S.. Yet if you look at the studies that showed Canada's system was better:
- 5 involved kidney disease. Basically, they were measuring the same thing 5 times. Even if the Canadian system IS better at handling Renal failure, including 5 different studies is a little misleading
- Multiple Studies on cystic fybrosis are also included (2), as are multiple studies (3) covering breast and prostate cancer. (Ironically this conflicts with other studies they've done that how the U.S. system is better at handling certain cancers).
- They've also included a study on AIDS survival rates... however, such results likely depend more on the affordability of drugs rather than the overall health care system, so personally I think that study should be discounted
- Something else I noticed... many of the pro-U.S. studies involved Arthritis, Cataracts, and Heart disease. These are (as far as I know) more common than AIDS and Cystic Fibrosis. So, why is a study of a disease which affects few people given as much weight as a study that affects a lot of people?
Once the 'duplicates' are removed (multiple studies supporting the Canadian system) the Canadian system doesn't exactly look as good.

Lets face it, your 'article' does not so much prove the superiority of the American system, but in the ability of researchers to research articles.

 

[Segnosaur]

Without getting into the discussion here about the Canadian system specifically, wouldn't this just be the difference between who died waiting for treatment, the person who could pay or the person who could not?

I doubt that would be the case. The U.S. (for all the suggestions that its a 'private' system) does have a substantial public component.

The failure of the American system seems to be that some people end up being the 'working poor'... too poor to have their own insurance, to wealthy for public insurance. And in those cases, people tend to go bankrupt rather than die.

The uninsured are certainly dying from lack of medical care right now in the US.

Could you please provide a reference to show a significant number of people dying from lack of health care? Maybe you provided it earlier and I missed it.

 

[IchabodPlain]

Consider the source of that 2 page synopsis, [ncpa.org/pub/ba/ba568/ba568.pdf]Crisis of the Uninsured: 2006 Update[/url].

[sourcewatch.org/index.php?title=National_Center_for_Policy_Analysis]National Center for Policy Analysis[/url]

I'm not saying to ignore the claims, but I certainly wouldn't take them on face value either.

I don't understand your point. They use figures from the census. Are you saying that there are not 12 million illegal immigrants? etc etc the numbers are available and can be verified by anyone.

HMOs are not bad in concept, only in execution. I belong to one that functions just as it is intended to.

Re the HSAs, that's nothing more than a political gimmick. If people could just pay health care costs out of their savings accounts we wouldn't be having this discussion.

Socialism in a nutshell. When we are paying for each others care, I can't literally can't afford for you to be a fat smoker. HMO's were adopted as a way to siphon people away from medicare because the costs were out of control.

Re Re HSA's, in current form are a good business option, and good for younger people, coupled with catastrophic hc. You could save 500-1000 per year starting at 17-18, tax free. This could add up to more than 10K by the time you are 30. You can use it to pay for generic prescription drugs, eye glasses, dentist visit, or any other small purchase. Businesses like Wholefoods have incorporated the HSA option into their coverage. 95% of their employees voluntarily choose it, and Wholefoods cut costs 13% (hrservicegroup.com/NewsV1I6.htm). The opposite of socialised care is having many options for all circumstances and all people.

 

[Skeptic Ginger]

I don't understand your point. They use figures from the census. Are you saying that there are not 12 million illegal immigrants? etc etc the numbers are available and can be verified by anyone.

My point is one can cherry pick all sorts of numbers to support one's point, that doesn't always mean there isn't another side to the story. I'll get back to the actual figures later tonight and see what I think about them with more time to investigate.

Socialism in a nutshell. When we are paying for each others care, I can't literally can't afford for you to be a fat smoker. HMO's were adopted as a way to siphon people away from medicare because the costs were out of control.

You cannot support this opinion with any facts. It shows your preconceived bias and you don't know what you are talking about. I was in health care when HMOs began and the discussion was entirely focused around switching from an illness based system to a wellness system.

Re Re HSA's, in current form are a good business option, and good for younger people, coupled with catastrophic hc. You could save 500-1000 per year starting at 17-18, tax free. This could add up to more than 10K by the time you are 30. You can use it to pay for generic prescription drugs, eye glasses, dentist visit, or any other small purchase. Businesses like Wholefoods have incorporated the HSA option into their coverage. 95% of their employees voluntarily choose it, and Wholefoods cut costs 13% (hrservicegroup.com/NewsV1I6.htm). The opposite of socialised care is having many options for all circumstances and all people.

Wow, 10K, that will cover taking your kids to the ED a couple times and maybe the removal of an ingrown toenail.

HSAs merely discount taxes on the earnings that were an employer to have paid it would not have been counted as taxable income. They are not in any way a substitute for health insurance.

 

[IchabodPlain]

You cannot support this opinion with any facts. It shows your preconceived bias and you don't know what you are talking about. I was in health care when HMOs began and the discussion was entirely focused around switching from an illness based system to a wellness system.


http://arjournals.annualreviews.org...th.20.1.67?cookieSet=1&journalCode=publhealth
http://www.cnn.com/SPECIALS/2000/democracy/doctors.under.the.knife/stories/hmo.history/index.html
http://links.jstor.org/sici?sici=00....0.CO;2-E&size=LARGE&origin=JSTOR-enlargePage
I can link to articles now


Wow, 10K, that will cover taking your kids to the ED a couple times and maybe the removal of an ingrown toenail.

HSAs merely discount taxes on the earnings that were an employer to have paid it would not have been counted as taxable income. They are not in any way a substitute for health insurance.[/QUOTE]

It provides an incentive for more businesses to provide healthcare, and cuts costs. Youth can invest in it to build a 'safety net' for small expenses (which saves you money), or one big caught-me-with-my-pants-down emergency (though that is not what it is meant for). It also can be useful for someone who is self-employed. Tell me, how much does it cost you for a check-up? Eyeglasses?

 

[Fitter]

Here's an article that mentions a small number of Canadians who have either gone abroad (or plan to go abroad) for treatment. So, it does happen.

http://www.cmaj.ca/cgi/content/full/174/9/1247

I'm not saying it doesn't but the 6 people preparing to leave Canada and the 1 who has had treatment out of country are certainly not the numbers I feel are being suggested by those who keep raising this argument. As to associating with who both need and can afford to leave for treatment I suspect my circle of contacts is broader than most. I regularly socialise with people in an age range from mid-twenties to mid-seventies generally middle class.

 

[Fitter]

Secure in the knowledge that should I happen to want one, I can indeed pay a private institution to give me an MRI scan. Also secure in the knowledge that if I can't pay, and I still need one, I will get it, even if not quite as quickly as I might have wished.

Rolfe.

Prior to my knee surgery I had an MRI done by a private service here in Alberta. Ironically it was paid for by my then employer, the Canadian Armed Forces.

 

[Skeptic Ginger]

...I can link to articles now...

Great, now just learn how to use the quote codes.

[ q u o t e ] what the other guy posted [ / q u o t e ]

 

[Skeptic Ginger]

...

[HSA] provides an incentive for more businesses to provide healthcare, and cuts costs. Youth can invest in it to build a 'safety net' for small expenses (which saves you money), or one big caught-me-with-my-pants-down emergency (though that is not what it is meant for). It also can be useful for someone who is self-employed. Tell me, how much does it cost you for a check-up? Eyeglasses?

So What? They are not a substitute for insurance no matter what other benefits HSAs have. You couldn't even pay for a broken leg from your HSA. Who cares what eye glasses cost?

I spend ~$1,000/ month for health insurance. At $12,000/year I have so far paid more than I have used. (I think, because I did have one major surgery and I'm not sure what that would have run.) That doesn't mean I want to insure myself. I also have malpractice, auto, and house insurance and I have one claim on the house insurance when my pipes froze and flooded a room. That doesn't mean I want to insure myself for those potential costs. HSAs have nothing to do with medical insurance needs.

 

[jimbob]

By saying it is force you are implying that it isn't wanted. If the government tried to repeal the canada health act there would be riots. Ask any Canadian if they don't want our free Universal healthcare. I'm not saying it's perfect. I'm not saying that everyone is 100% satisfied all of the time. The system is designed to do the most possible good for everyone. Not just those who can afford it.

Also you didn't respond to my previous post noting tha Canada only pays 10% of GDP for healthcare (about average) to cover 100% of the population with full free healthcare. While the US pays 15% of GDP to provide varying coverage to 85% of the population (the highest cost in the world). So who is having their money ripped away?

Ah, I see that you did post about percentage of GDP used, I did a search for the teerm but couldn't find it.

By saying it is force you are implying that it isn't wanted. If the government tried to repeal the canada health act there would be riots.they would be voted out of office

Fixed your statement for you, (with reference to the later statement abouit mob rule...)

 

[fls]

In terms of quality of service and success, I think the US is either at or near the top in virtually all categories.

Can you specify what you are measuring and provide references, as many/most of the useful measures of quality do not place the US near the top?

http://www.commonwealthfund.org/usr...hltsysdata2006_chartbook_972.pdf?section=4039

In cancer for instance, the Lancet Oncology (thelancet.com/journals/lanonc/article/PIIS1470204507702462/abstract) recently did a study between the US and Europe in survival rates for all cancers and cumulatively ranked the US #1.

Disease-specific comparisons can be useful. Some conditions are sensitive to changes in health services (such as obstetrical care), while some are less-so (such as low-birth-weight which is more sensitive to social and other issues). Cancer outcomes are fairly heterogeneous when it comes to sensitivity to health care. Caution should be used in interpretation. For example, a large portion of the cancers (breast, prostate, melanoma) can show a lead-time and length bias due to screening programs. This can have the effect of artificially improving survival rates without changing outcomes.

22 of the top 50 largest pharmaceutical companies are based in the US, which total 825,000+ jobs
en.wikipedia.org/wiki/List_of_pharmaceutical_companies

The presence of pharmaceutical companies does not necessarily mean that new and useful drugs are developed. In "The Truth About the Drug Companies" by Marcia Angell (former editor of NEJM), a closer look at the source of innovative drugs shows that they are just as likely (if not more so) to come from government, non-profit or non-US-based pharmaceutical companies, as they are to come from US-based pharmaceutical companies. Most of the R & D goes to "me-too" drugs and patent-extending research instead.

We have more doctors, and greater access to new technologies (MRI's, CT scanners, etc) as well as less waiting before we see a doctor, are diagnosed, begin treatment, or undergo surgery.

The US is in the bottom half of the pack when it comes to doctors per capita.

You are grossly over-estimating the impact of new technologies on health care. The assumption that more medical care necessarily means better health is unsupported.

I'm not saying that any particular system is good or bad. It just makes sense to me to try to use accurate and relevant information.

Linda

 

[fls]

Gotcha. That seems like a distinction without a difference to me, though. The word "mandatory" is the part I keep focusing on.

I understand that. But you already make mandatory contributions to health care - more than any other country. So to pretend to a higher ideal is a bit confusing.

Linda