DC
Banned
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only around 40% is payd by taxes. The rest is payd by the monthly fee we pay.
http://en.wikipedia.org/wiki/Healthcare_in_Switzerland
and still no end in sight for our democracy.
Universal Health Care in the US. Yea or Nea?
- Thread starter applecorped
- Start date
only around 40% is payd by taxes. The rest is payd by the monthly fee we pay.
http://en.wikipedia.org/wiki/Healthcare_in_Switzerland
and still no end in sight for our democracy.
inquiringone
Student
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- 40
I'd be curious about how the numbers would change if people were asked "Do you want a single-payer system, but to fund it we will rais your taxes".[/QUOTE]
We need national health care. 47 million people in the USA lack health insurance. I am aware my taxes would be raised. However, I figure that is better than paying $100+ a month for some useless plan that covers only 20% of the cost of a doctor's visit (I'm speaking of your basic yearly checkup.) My work only offers that plan.
Luckily, there's a clinic across town that charges based on a sliding scale, so I'm going to them. Next year, I'm dropping that lousy health insurance and finding something better or go without. BTW, I am a healthy 34-year-old. If healthy adults are paying expensive premiums for insurance that doesn't even cover anything, I'd hate to think of what the sick and unemployed are going through.
We need national health care. 47 million people in the USA lack health insurance. I am aware my taxes would be raised. However, I figure that is better than paying $100+ a month for some useless plan that covers only 20% of the cost of a doctor's visit (I'm speaking of your basic yearly checkup.) My work only offers that plan.
Luckily, there's a clinic across town that charges based on a sliding scale, so I'm going to them. Next year, I'm dropping that lousy health insurance and finding something better or go without. BTW, I am a healthy 34-year-old. If healthy adults are paying expensive premiums for insurance that doesn't even cover anything, I'd hate to think of what the sick and unemployed are going through.
Health care is a very complex topic, but the two big issues in US healthcare are that insurance is primarily gained through employment--which is in turn based upon the tax structure the federal government set up, which makes it cheaper for your employer to provide you with insurance (or pay most of the cost of your insurance) than for them to pay you the amount of additional salary it would take for you to buy your own--and that, although America is one country, it is comprised of 50 states which are highly autonomous.
It's very hard for someone in, say, a Nordic country to understand how many different laws, sub-cultures, traditions, worldviews, and social mores exist in "America". So there are some US states that have a state-provided (or subsidized to be low-cost) health insurance with means-testing; some that require universal health coverage; some that have good state/county public health care available on a sliding-scale basis; and some that are very laissez-faire.
One of the things that could greatly lower the cost of health care would be to standardize the forms/documentation requirements between different providers and insurers, so that a family medicine clinic doesn't have to have one full-time employee who does nothing but manage the insurance billing problems. (I'm not making this up.)
Regardless of what one thinks is ideal, it is now probably inevitable that some form of "universal health care" is coming to the US, and the interest of every American is to try to persuade the Powers That Be to install a system that leaves some private options. A multi-tier system, where everyone is covered (by the State or by themselves) at a certain minimum level, but higher levels of coverage are still allowed to be bought, would be better than a One Size Fits All system. People differ in their assessment of risk; some would rather take the chance and pay less, some would rather hedge that bet with higher coverage. (An analogy might be found in auto insurance. I believe all states in the US require that you have some minimum level of liability insurance -- yet many people decide they want much more than that. Private companies compete for the chance to insure those higher-paying customers, and in order to be allowed to operate in the state in question, they must agree to be in a 'pool' where they will be required to insure a certain number of bad risks. Thus we have a private system, but government-mandated minimum coverage must be made available at a reasonable (albeit, not cheap) rate.)
Several states are experimenting with different approaches to getting universal coverage, and it would be a good idea to let those live experiments have a couple of years to see how well they work, and how much they cost, before the Federal Government mandates it.
I don't know how we solve the problem of people who aren't getting health care because they don't want to deal with it. For example, my brother has serious problems with his teeth, and hasn't seen a dentist for, oh, maybe 15 years. I asked him if he had looked into what kind of sliding scale or publically-funded benefits might be available, and he said, "I got better things to do with my time than get jerked around by bureaucrats." He certainly counts as an uninsured/underserved American -- but when he hasn't even gone to find out what benefits he can get, what program will reach him?
I'm not saying, or implying, that there are not problems with healthcare delivery in this country. I'm just trying to remind the ideological arguers that there is a lot of gray area in this.
For instance, the only way to get rid of "defensive medicine" is to amend the tort system so that doctors can't be found guilty of malpractice--or even sued for it--if they have made a reasonable decision. Just because a specialist in the area of medicine the patient's illness turns out to belong to would have recognized the condition does NOT mean that a general practitioner should be able to. If the doctor took reasonable caution and went with the 99% likely solution, that's got to be good enough. (Note: I am not saying that medical mistakes should not be held liable; I am saying that not being omniscient is not a mistake.)
So, as I see it, the whole issue of "healthcare delivery" has to deal with:
Making doctors'/nurses'/clinicians' jobs less mired in red tape;
Making insurance more widely available, with some form of minimum insurance likely provided by or subsidized by, the State;
Amending the malpractice and liability laws to make it harder to get gigantic awards, especially the "pain and suffering" and "punitive" damages;
Developing some form of assessment of what therapies, tests, and interventions are effective, and which are not;
Allowing those who wish to spend additional funds the right to purchase additional services (or insurance for additional services); and
Finding a means of tracking physician performance.
Oh, and eliminate direct-to-public advertising by the drug companies, both to discourage 'medicalization' of common complaints, AND to make TV viewing more enjoyable for all.
Just my thoughts, Miss Kitt
It's very hard for someone in, say, a Nordic country to understand how many different laws, sub-cultures, traditions, worldviews, and social mores exist in "America". So there are some US states that have a state-provided (or subsidized to be low-cost) health insurance with means-testing; some that require universal health coverage; some that have good state/county public health care available on a sliding-scale basis; and some that are very laissez-faire.
One of the things that could greatly lower the cost of health care would be to standardize the forms/documentation requirements between different providers and insurers, so that a family medicine clinic doesn't have to have one full-time employee who does nothing but manage the insurance billing problems. (I'm not making this up.)
Regardless of what one thinks is ideal, it is now probably inevitable that some form of "universal health care" is coming to the US, and the interest of every American is to try to persuade the Powers That Be to install a system that leaves some private options. A multi-tier system, where everyone is covered (by the State or by themselves) at a certain minimum level, but higher levels of coverage are still allowed to be bought, would be better than a One Size Fits All system. People differ in their assessment of risk; some would rather take the chance and pay less, some would rather hedge that bet with higher coverage. (An analogy might be found in auto insurance. I believe all states in the US require that you have some minimum level of liability insurance -- yet many people decide they want much more than that. Private companies compete for the chance to insure those higher-paying customers, and in order to be allowed to operate in the state in question, they must agree to be in a 'pool' where they will be required to insure a certain number of bad risks. Thus we have a private system, but government-mandated minimum coverage must be made available at a reasonable (albeit, not cheap) rate.)
Several states are experimenting with different approaches to getting universal coverage, and it would be a good idea to let those live experiments have a couple of years to see how well they work, and how much they cost, before the Federal Government mandates it.
I don't know how we solve the problem of people who aren't getting health care because they don't want to deal with it. For example, my brother has serious problems with his teeth, and hasn't seen a dentist for, oh, maybe 15 years. I asked him if he had looked into what kind of sliding scale or publically-funded benefits might be available, and he said, "I got better things to do with my time than get jerked around by bureaucrats." He certainly counts as an uninsured/underserved American -- but when he hasn't even gone to find out what benefits he can get, what program will reach him?
I'm not saying, or implying, that there are not problems with healthcare delivery in this country. I'm just trying to remind the ideological arguers that there is a lot of gray area in this.
For instance, the only way to get rid of "defensive medicine" is to amend the tort system so that doctors can't be found guilty of malpractice--or even sued for it--if they have made a reasonable decision. Just because a specialist in the area of medicine the patient's illness turns out to belong to would have recognized the condition does NOT mean that a general practitioner should be able to. If the doctor took reasonable caution and went with the 99% likely solution, that's got to be good enough. (Note: I am not saying that medical mistakes should not be held liable; I am saying that not being omniscient is not a mistake.)
So, as I see it, the whole issue of "healthcare delivery" has to deal with:
Making doctors'/nurses'/clinicians' jobs less mired in red tape;
Making insurance more widely available, with some form of minimum insurance likely provided by or subsidized by, the State;
Amending the malpractice and liability laws to make it harder to get gigantic awards, especially the "pain and suffering" and "punitive" damages;
Developing some form of assessment of what therapies, tests, and interventions are effective, and which are not;
Allowing those who wish to spend additional funds the right to purchase additional services (or insurance for additional services); and
Finding a means of tracking physician performance.
Oh, and eliminate direct-to-public advertising by the drug companies, both to discourage 'medicalization' of common complaints, AND to make TV viewing more enjoyable for all.
Just my thoughts, Miss Kitt
quixotecoyote
Howling to glory I go
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A little off topic, but I'd disagree with this. I don't want doctors to be charged with a crime for making a mistake, but I want them to he held liable, just like any other professional I visit; it might be completely understandable why they broke/misfiled/mismanaged my property/paperwork/money, but now that they have, they should take steps to make it as right as possible, with civil law as a club to make sure it happens.
Bob Blaylock
Forklift Operator
So Switzerland is a nation of suckers and fools. What does that have to do with the United States?
If you had read the posts above you would notice that it is a answer to the claim of democracy failing on people voting for free everything with no regard for the economy.
DC
Banned
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no doubt we have alot suckers and fools here in Switzerland, but i doubt that we have procentually more than the USA or any other country.
you had a point beside the bigotery?
Ivor the Engineer
Penultimate Amazing
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If a country has universal healthcare this happens automatically. No need to get lawyers involved unless you believe a medical professional's behaviour which resulted in harm was malicious or grossly negligent.
quixotecoyote
Howling to glory I go
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Sure, if our hypothetical system has built in compensation then it would be unnecessary.
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quixotecoyote
Howling to glory I go
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Thought that exchange needed to be pulled out for clarity.
"We macho anti-commie/pinkofags don't need your anti-democracy medicine! If we did, democracy would collapse!"
"Uhhh, we have it over here and we're still a democracy.."
"Well it's not my fault you're a bunch of idiots, what's your point anyway!!"
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Rolfe
Adult human female
Just saying, that's the first time I've ever read through a long post of yours. I found it interesting, thoughtful, and informative.
Maybe you posted stuff that good before, but mauve serifed font wasn't really a good vehicle.
Rolfe.
Nice 
As for incentive systems.
Economist tend to make up some more or less ingenius economic movitational systemes and ignore the concept of professinal pride as it relates to self respect and the respect of your peers and colleges.
As for incentive systems.
Economist tend to make up some more or less ingenius economic movitational systemes and ignore the concept of professinal pride as it relates to self respect and the respect of your peers and colleges.
Francesca R
Girl
Who ignores that? Perhaps you mistake a "reluctance to rely on the voluntary expression of professional pride and self-respect as the only possible motivator in every case" for ignorance. After all, wouldn't that be rather wishful thinking?
We have a "universal health care" program as government policy here in Australia. So I will use it as a practical example to compare.
Medicare is Australian government policy. What is that policy goal?
FYI, Medicare was introduced by a staunchly conservative government, so you can drop any future references to "socialist paradise dreamers".
What does it cost me? The Medicare levy (name implies NO relation at all to US Medicare) is about 1.5% of my gross salary, removed from my pay just like tax, which is tolerable compared to US equivalent costs. This levy covers most of my medical prescriptions on "on-list" medications, otherwise not. It gives me immediate and free access a GP, and to public hospitals for emergency and most common non-elective surgery and care (which is usually good quality - but that's an ongoing bun-fight between state and federal governments...whatever). The majority of such costs (the procedures price-list is fixed) are reimbursed by the government, either as cash or by the doctor or hospital "bulk-billing", i.e. getting reimbursed directly for many treatments in one go.
That is, the cost of the vast majority of medical requirements for Australians - GPs, medicines and basic hospital cover - is covered in the most part or wholly by Medicare.
How does it work on the ground? My levy is deducted when I get paid so I don't miss it. I, and most Australians, have a Medicare number and card (we have a family one). When I go to the doctor or hospital, I produce that card, and the payments are rebated more or less automatically. I may have to pay an amount over and above the rebate for some treatments.
For example, for some specialist treatments, I pay the specialist's bill myself, but then take the receipt to the Medicare office be reimbursed the "standard fee" for that consult in cash. That is, Medicare "helps" by paying "some" of my specialist medical bills. Again, this is an area that is bun-fight territory.
Does this mean everything is covered? No. Not all medicines or procedures are covered (more political bunfights as to what is and is not at budget times, etc). There are indeed private hospitals and insurance schemes here...if I pay extra insurance. I can "top up" my medical cover (known as "gap cover"), at my cost, with private insurance, to get the doctor of my choice, private hospital care, elective and plastic surgery cover, acupuncture, aromatherapy, homeopathy, etc. While ambulance is not covered by Medicare, insurance coverage for that is relatively cheap.
Is this system perfect? Certainly not! Rorts and rorters were part and parcel of the scheme, especially in the early days. But nowadays they tend to be far more the exception than the rule. And there is always ongoing hubbub about the level of coverage for new medicines and procedures (that usually cost astronomic hills of dollars unless covered in some way, putting them out of the reach of all but a few brazillianaires otherwise).
Of course, I have greatly simplified this to keep this post under the size of a phone book. But the above link will take you into the fun-park that is our own reasonably acceptable government-run medical support system. Many other countries have similar schemes adjusted to their politics and environment (Australia's is a cousin of the Canadian one from which it was copied, incidentally).
So before you start to go off on tangents about how it would not be acceptable in the USA, consider just how different the USA isn't from most other developed countries, often a fraction of the size of the USA, that do have successful universal medical coverage of some sort running on a much lower GDP. The only issue I can see is the lack of mental flexibility in some quarters to take on new paradigms.
Consider: Put yourself in Rob Lancaster's bed...and read RSL's Better Half's ongoing battle with medical coverage and insurance. Wouldn't it be heartening to know that those types of petty but tiring battles are rare elsewhere? And that universal medical coverage at least paid a good part of the costs of getting better? Isn't such a scheme worth having if just a few less worthless and pointless battles never had to be fought to get someone like Rob back on his feet? Yeah, I know - argument from pity. So sue me.
Medicare is Australian government policy. What is that policy goal?
http://www.medicare.gov.au/about/index.jsp
FYI, Medicare was introduced by a staunchly conservative government, so you can drop any future references to "socialist paradise dreamers".
What does it cost me? The Medicare levy (name implies NO relation at all to US Medicare) is about 1.5% of my gross salary, removed from my pay just like tax, which is tolerable compared to US equivalent costs. This levy covers most of my medical prescriptions on "on-list" medications, otherwise not. It gives me immediate and free access a GP, and to public hospitals for emergency and most common non-elective surgery and care (which is usually good quality - but that's an ongoing bun-fight between state and federal governments...whatever). The majority of such costs (the procedures price-list is fixed) are reimbursed by the government, either as cash or by the doctor or hospital "bulk-billing", i.e. getting reimbursed directly for many treatments in one go.
That is, the cost of the vast majority of medical requirements for Australians - GPs, medicines and basic hospital cover - is covered in the most part or wholly by Medicare.
How does it work on the ground? My levy is deducted when I get paid so I don't miss it. I, and most Australians, have a Medicare number and card (we have a family one). When I go to the doctor or hospital, I produce that card, and the payments are rebated more or less automatically. I may have to pay an amount over and above the rebate for some treatments.
For example, for some specialist treatments, I pay the specialist's bill myself, but then take the receipt to the Medicare office be reimbursed the "standard fee" for that consult in cash. That is, Medicare "helps" by paying "some" of my specialist medical bills. Again, this is an area that is bun-fight territory.
Does this mean everything is covered? No. Not all medicines or procedures are covered (more political bunfights as to what is and is not at budget times, etc). There are indeed private hospitals and insurance schemes here...if I pay extra insurance. I can "top up" my medical cover (known as "gap cover"), at my cost, with private insurance, to get the doctor of my choice, private hospital care, elective and plastic surgery cover, acupuncture, aromatherapy, homeopathy, etc. While ambulance is not covered by Medicare, insurance coverage for that is relatively cheap.
Is this system perfect? Certainly not! Rorts and rorters were part and parcel of the scheme, especially in the early days. But nowadays they tend to be far more the exception than the rule. And there is always ongoing hubbub about the level of coverage for new medicines and procedures (that usually cost astronomic hills of dollars unless covered in some way, putting them out of the reach of all but a few brazillianaires otherwise).
Of course, I have greatly simplified this to keep this post under the size of a phone book. But the above link will take you into the fun-park that is our own reasonably acceptable government-run medical support system. Many other countries have similar schemes adjusted to their politics and environment (Australia's is a cousin of the Canadian one from which it was copied, incidentally).
So before you start to go off on tangents about how it would not be acceptable in the USA, consider just how different the USA isn't from most other developed countries, often a fraction of the size of the USA, that do have successful universal medical coverage of some sort running on a much lower GDP. The only issue I can see is the lack of mental flexibility in some quarters to take on new paradigms.
Consider: Put yourself in Rob Lancaster's bed...and read RSL's Better Half's ongoing battle with medical coverage and insurance. Wouldn't it be heartening to know that those types of petty but tiring battles are rare elsewhere? And that universal medical coverage at least paid a good part of the costs of getting better? Isn't such a scheme worth having if just a few less worthless and pointless battles never had to be fought to get someone like Rob back on his feet? Yeah, I know - argument from pity. So sue me.
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Francesca R
Girl
Regarding a not-atypical US response to the universal health care debate . . . it does seem that a lot of Americans accept that their health provision is inadequate and too expensive, but when (usually) Europeans argue that some European systems are superior, that is just too hard to swallow for many Americans. More fool them.
Rolfe
Adult human female
Is that so inevitable? In another thread like this, people did some research into current expenditure. It was discovered (much to everyone's general astonishment) that the proportional tax take on US citizens which pays for Medicare and Medicaid (which most of those paying the taxes cannot personally access) was actually slightly greater than the proportional tax take on UK citizens which pays for the whole NHS, which everyone, taxpayer or not, pauper or millionaire, can access.
Now obviously the NHS is not the only system. You have a fair variety of systems to choose from when deciding how to fix your healthcare. But it certainly seems that at least one of these systems can deliver universal care for slightly less money (per skull, or as a percentage of GDP) than you're currently paying for your very limited-access safety-net provision.
Rolfe.
Ivor the Engineer
Penultimate Amazing
- Joined
- Feb 18, 2006
- Messages
- 10,642
IIRC, almost all universal healthcare systems are less expensive as a fraction of GDP than the far from universal US healthcare system*.
*'System' always seems like the wrong word to use when describing what constitutes healthcare coverage in the US. 'Shambles' seems more appropriate.
Rolfe
Adult human female
A guy I was talking to in America last year said, "We live in a socialist country. We have socialist education, we have socialist policing, we have socialist firefighting, we have socialist highways, and lots of other things. But for some reason the idea of socialist medicine really presses some people's buttons."
Rolfe.
Rolfe.