Universal Health Care in the US. Yea or Nea?

[jhunter1163]

I work in the billing office of a large medical practice, and I assure you that universal health care, most likely an expansion of Medicare to everyone, is inevitable in the the US within about 10 years. The health insurers are pricing decent coverage out of reach for all except the largest employers. The latest wrinkle is the HSA (Health Savings Account), whereby money is deducted pretax from your paycheck and deposited in an account to cover your healthcare expenses. Usually, there's an associated high-deductible insurance policy to pick up catastrophic expenses (over $2,000 out of pocket per year).

Health insurers, though, continue to increase premiums 8-10% per year, claiming that healthcare costs are rising by that much. This is false. Physician's compensation is dictated by the insurer; if you want to participate in their network, you're paid what they give you, with no (or limited) recourse against the patient.

So, my prediction is that by 2015 we'll see either universal Medicare or state-funded universal healthcare.

Do I qualify for the MDC?

 

[Toke]

No, I guess the ripoff will be modified slightly to accomodate what people can pay.

 

[Ivor the Engineer]

I had an Action Man like Beerina, except he thought:

"Give me cover"

was the way to go.

 

[Segnosaur]

http://www.chsrf.ca/mythbusters/pdf/myth17_e.pdf
Researchers have also looked at the variation in waiting times within countries, based on the co-existence of public and private care. Studies in both Australia and England have found the more care provided in the private sector in a given region, the longer the waiting times for public hospital patients.ix, x

Ummm.... if you're going to discuss wait times, when why didn't they discuss the average wait times for all patients in the system, both private and public?

I never denied that there would be inequalities when there were both private and public systems...

Secondly, before anyone can comment further, we'd actually have to see the study that this was based on. (The reference does quote an article but does not provide a reference.) The article you quoted didn't go into any details about why exactly that was the case... For all we know, it could have simply been incompetence on the part of public administrators in certain areas of the regions.

This backs up Canadian evidence from the province of Manitoba where, until 1999, patients paid an additional facility fee or “tray fee” if they chose to have cataract surgery in a private facility (the surgery itself was still paid for by the provincial health plan). At the time the fee was in place, the Manitoba researchers found that patients whose surgeons worked only in public facilities could
expect a median wait of 10 weeks in 1998/99; however, patients whose surgeons worked in both public and private facilities could expect a median wait of 26 weeks.vii

And currently the median wait time for cataract surgery in Winnipeg, Manitoba is 11 weeks. Now, is an 11 week wait better or worse than a 10 week wait?

http://www.gov.mb.ca/health/waittime/surgical/cataract.html

Oh, and again, the information given seems to be very sketchy... no discussion on average wait times. At best it just describes the activities of specific doctors rather than of an entire system of treating cataracts.

I could also point out the following article on cataract surgery:

http://bjo.bmj.com/cgi/content/abstract/91/3/282
...The length of wait is influenced by the total expenditure on health, but not by the rate of public expenditure on health

 

[Segnosaur]

Ummm.... just out of curiosity, what exactly is your justification that governments can be more efficient than private industry when their size grows?

How about the cost of healthcare in europe versus the US.
Would that do?

Not really, since:

- As I've already pointed out, the U.S. was rated #1 in responsiveness.. having the capacity to give people quick treatment will be costly, so you'd be comparing 2 different things... a fast private system and a slow public system. Its a little like comparing the cost of a Honda Civic and a Trans Am, while ignoring the obvious performance issues
- Even in a supposedly 'private' health care system like the US, there is still a substantial amount of public money being spent (in terms of Medicare/Medicaid)
- Expenses will also depend (in part) on general population health. The U.S. does have significant problems with things like poor diet which drive up health care costs, but are unrelated to how programs are administered
- At least some of the cost difference may be due to greater court settlements in the U.S. the case of medical malpractice claims.
- The U.S. is itself has a much greater population base than individual European countries

 

[Ivor the Engineer]

http://www.medicalnewstoday.com/articles/76295.php

While the problem has been largely overlooked by the major media, it was quietly exposed by the chief medical officer of Aetna, Inc. late in Aetna's Investor Conference 2007 in March.

In his talk, Troy Brennan conceded that "the (U.S.) healthcare system is not timely." He cited "recent statistics from the Institution of Healthcare Improvement… that people are waiting an average of about 70 days to try to see a provider. And in many circumstances people initially diagnosed with cancer are waiting over a month, which is intolerable," Brennan said.

Brennan also recalled that he had formerly spent much of his time as an administrator and head of a physicians' organization trying "to find appointments for people with doctors."

 

[Toke]

So we are comparing apples and oranges, and the discution is woid.

I still see something like 1/6 of the population without cover for a higher cost than public healthcare.

 

[Segnosaur]

Put it this way... if you were diagnosed with cancer (or some other disease), would you want treatment as quickly as possible, or would you be happy waiting, content in the knowledge that at least others will be waiting just as long as you do?

If 100 other people who were richer than you were also diagnosed with cancer (or some other disease), would you be happy waiting, content in the knowledge that their illness might not be a severe as yours, but that they're getting treatment ahead of you because they can afford to pay more?

It depends...

If those people are using private services then it should, in theory, reduce my wait time. Even if their illness is not as severe as mine, they'll STILL need specialized treatment (Oncologists, MRIs, etc.) and if their extra spending results in an extra MRI machine in the area I'll still benefit, even if I'm not the one actually using it.

 

[egslim]

The problem is, how it relates to the other categories is probably a very personal thing. Some people might think that it is the only category that matters.

They might, but they would for all practical purposes be wrong. Healthcare is like a car, all the parts have to work for it to function properly. A person may value a responsive engine most, but if the tires last only 10km and the petroltank leaks half a liter per hour, only a masochist would enjoy the driving experience.

Put it this way... if you were diagnosed with cancer (or some other disease), would you want treatment as quickly as possible, or would you be happy waiting, content in the knowledge that at least others will be waiting just as long as you do?

In my experience, while we do have waiting lists, we also have priority ques for people who really need care quickly. There is no need for people with a life-threatening condition to wait, even if it means someone has to wait a week longer to get a new hip.

And personally, I wouldn't mind waiting a little longer for my hip if doing so saves someones life from cancer. I prefer a system that prioritises patients based on need, instead of how much they pay.

 

[Segnosaur]

While the problem has been largely overlooked by the major media, it was quietly exposed by the chief medical officer of Aetna, Inc. late in Aetna's Investor Conference 2007 in March.

In his talk, Troy Brennan conceded that "the (U.S.) healthcare system is not timely." He cited "recent statistics from the Institution of Healthcare Improvement… that people are waiting an average of about 70 days to try to see a provider. And in many circumstances people initially diagnosed with cancer are waiting over a month, which is intolerable," Brennan said.

http://www.medicalnewstoday.com/articles/76295.php

Kind of hard to know what to compare it to when they simply talk about '70 days to see a provider'. 70 days for what? A general family physition? A specialist?

As for the second part (people waiting 'over a month' for cancer treatment)... Guess what? It happens in Canada too...
From: http://www.theglobeandmail.com/servlet/story/RTGAM.20061121.wwaittimes21/BNStory/cancer
It was a bold promise backed by billions of dollars in new government funding: Cancer patients should not have to wait longer than four weeks to obtain critical radiation treatment.
...
But figures obtained by The Globe and Mail show a staggering 70 per cent of Canadian hospitals surveyed are unable to meet that standard for prostate cancer patients.
...
For breast cancer patients, the numbers are better but still fall short: Forty-seven per cent of hospitals surveyed are failing to radiate these patients within four weeks of being “ready to treat.

Unfortunately, the article you referred to only referred to people in the U.S. waiting over a month "In many circumstances", so I can't say for sure how long your average wait actually is.

 

[Segnosaur]

Spare us the polemics - if you have a potentially critical condition in Canada you are treated immediately. Period.

And in the U.S., if you're critically injured and you show up at an emergency room, you will get treated too, regardless of whether you have health care insurance.

Non - life threatening situations like hip and knee replacements yes there are waiting lists and yes some very few go to the US or India to get them.

And others (who can't afford to travel to get them) will continue to suffer.

 

[Segnosaur]

So we are comparing apples and oranges, and the discution is woid.

Well, the discussion is void only if you're trying to analyze the effeciency of government systems looking only at the costs. There is value to discussing other factors.

I still see something like 1/6 of the population without cover for a higher cost than public healthcare.

Are you talking about the U.S.?

I've already showed that the number of people who aren't covered and haven't been covered for a significant length of time (discounting those who are rich enough to afford coverage) is less than 5% of the population, not 1 in 6.

 

[Segnosaur]

The problem is, how it relates to the other categories is probably a very personal thing. Some people might think that it is the only category that matters.

They might, but they would for all practical purposes be wrong. Healthcare is like a car, all the parts have to work for it to function properly. A person may value a responsive engine most, but if the tires last only 10km and the petroltank leaks half a liter per hour, only a masochist would enjoy the driving experience.

A better anology might be to compare the importance of the motor to lets say the importance of having a good stereo system. SOME people might consider having a good sound system to be important, but most would consider that the quality of the motor trumps that of the stereo system.

In my experience, while we do have waiting lists, we also have priority ques for people who really need care quickly. There is no need for people with a life-threatening condition to wait, even if it means someone has to wait a week longer to get a new hip.

And in the U.S., they have a rule that if people show up to the emergency room they have to be treated (regardless of whether they have insurance).

And personally, I wouldn't mind waiting a little longer for my hip if doing so saves someones life from cancer. I prefer a system that prioritises patients based on need, instead of how much they pay.

Except that may not necessarily be the trade off. There is no guarantee (in a socialized system) that resources NOT spent on a hip operation will be used to help a cancer patient.

 

[Blue Mountain]

After a quick googling I found the following: http://www.businessandmedia.org/articles/2007/20070718153509.aspx (Note: This is from a 'right-wing' site, so I understand if you're skeptical. But, they are using information from the U.S. Census).

Of the 47 million uninsured....
- Approximately 10 million are not US Citizens (Should illegal aliens be covered under a universal health plan?)

That's a real tough call. AFAIK, in Canada you're not covered if you're not here legally.

- Around 17 million have incomes over $50,000 (should be more than enough to afford insurance)

Then they can also afford to pay into a common fund that insures everyone. Oh, sorry, that's called 'taxation', which in your books is truly a horrible thing.

Almost half of the people earning less than $50,000 but not eligable for government programs will actually be uninsured for less than 4 months.

47 - 10 - 17 = 20 million earning less than $50,000. 20 / 10 = 10 million people who earn less than $50,000/year, are not eligible for the government programs, and may be uninsured for more than four months. That's a lot of people.

And that doesn't even begin to count the people who are underinsured, or those who will become uninsurable after a serious illness, or those who thought they were insured only to learn their carrier found a way to weasel out of their obligations when illness struck.

For something as unpredictable and potentially devastating as a serious illness, I'd much rather know that my health insurance will be there for me, whether I'm riding high on the hog or have been out of work for six months.

With a recession underway and unemployment rising, look for the number of uninsured Americans to climb over the next couple of years. The number of uninsured Canadians and Europeans, on the other hand, is likely to remain stable.

 

[Tsukasa Buddha]

Well, my experience with the US health care system pertains to mental health. A doctor fills out a form for what disorder you have and why you need to be hospitalized. They then send this to the insurance company, who then authorizes a hospitalization for a set period of time that they see fit (usually a week or two). Only after this will the patient get treatment. Then once you are in program, the doctors must justify extending your stay (And everyone needs to stay longer than the amount originally scheduled by insurance).

In my experience, about one fourth of the patients leave the program because the insurance wouldn't pay anymore, in some cases the insurance will only pay for two weeks and not even consider extensions. So a rather significant amount of mental health patients are released from intensive treatment not because of the doctor's judgment of their mental health, but because their insurance wouldn't pay anymore.

Don't know how this would be "fixed" by public health care or mixed or whatever. But it is the only experience I have with the health care system, so I leave my judgment at that.

 

[egslim]

A better anology might be to compare the importance of the motor to lets say the importance of having a good stereo system.

That's a worthless analogy, unless you claim the other categories are as unimportant compared to responsiveness as a stereo system is compared to the motor.

So, do you? The other three are:
1) Overall Level of Health
2) Distribution of Health in the Populations
3) Distribution of Financing

I think of these categories most people would rate 1) as the most important, since that is a health care system's primary goal. Though I suspect reading the report's results would cause a number of Americans to pick "Responsiveness" as most important instead. Just a hunch, mind...

And earlier you mentioned "faster adoption of new technology" as a benefit of greater responsiveness. Only the category of "Responsiveness", as defined in the article, does not include that. Did I miss it, or did you make it up?

And in the U.S., they have a rule that if people show up to the emergency room they have to be treated (regardless of whether they have insurance).

Unfortunately, for many illnesses (like cancer) by the time you're in a bad enough state to get into the emergency room it is either already too late or much more expensive.

Except that may not necessarily be the trade off. There is no guarantee (in a socialized system) that resources NOT spent on a hip operation will be used to help a cancer patient.

Actually it is pretty much guaranteed that in a for-profit system patients will be prioritised based on their ability to pay. The existing universal healthcare systems may not always be succesful in sorting their patients by need, but they're a hell of a lot more likely to succeed at it than any for-profit system.

 

[balrog666]

We've had this discussion before. You seem to believe that of all the countries of the world, the USA is amost uniquely incompetent in this area. Well, it's your country, you should know. But it really does seem a fairly unlikely premise, on the face of it.

Maybe, in your eyes, the US couldn't do that. Because of the aforementioned unique incompetence. However, simple observation demonstrates that this is entirely achievable. Is it genetic stupidity, or do you have to work at it?

I think you've been working quite hard on your own behalf. Because either you have reading comprehension difficulties, or you choose to forget everything said in other threads that doesn't suit your agenda. You mention yet again the concern that a universal system, were it to be adopted, would exclude all other options. That you would be "forced" to rely on this system, which because of the unique incompetence of your countrymen, would (you believe) inevitably be a disaster.

It has been explained to you, patiently and repeatedly, that in many, probably most, of the countries at present operating a universal health-care system, citizens are completely at liberty to access whatever healthcare they choose, either by taking out additional insurance (which is quite inexpensive as it is not required to be so comprehensive as insurance has to be in the USA), or simply by paying for it up front. In Europe, these options include the option to access healthcare in other EU countries.

I even related to you the experience of my mother, who decided not to wait the year she was quoted for cataract surgery, and simply paid for the surgery herself. As a clergyman's widow living on a pension, she was still able to afford this fairly easily from her savings (it cost just over £3,000 for both eyes).

Oh, shock horror, people who choose to do this don't get a tax refund! How inequitable! This is so unfair, it would be better to continue with the present system than consider it!!

Oh come on.

• You wouldn't actually be paying out any more than you are now, to fund healthcare that you can't access. At least under a universal system you could access it if you chose to.
• You don't get a rebate on your education tax, if you don't have children, or if you choose to send your sprogs to private school. You don't get a rebate on your highway taxes, if you choose never to set foot on a road. You don't get a rebate on police costs if you hire a private security guard or detective. And yet, somehow, civilisation survives.

While I was typing this, an advert came on the television for BUPA, the major private health-care provider in Britain. Their insurance isn't terribly expensive, but most people don't bother, because they know the NHS is there and usually manages to cope. The great thing is, BUPA is a luxury, not a necessity.

I honestly can't understand why you'd remain carping on the sidelines rather than even consider the possibillities of a system like this.

Rolfe.

Yes, we have discussed this topic a few times and I value your input to the discussion.

However, the last time this came up as an actual proposal here*, it called for a one-size-fits-all minimalist solution of absolute tyranny, including prohibition from changing medical service plans, severe penalties for both doctors and patients who went outside the New World Order Solution (that's a slight joke BTW), and federal bureaucratic control of all medical colleges, doctor and nurse training, doctor specialization, and GP practices - Medicare for everyone plus extra controls and all but enslaving any practicing doctors.

That is what I want to avoid.

And so does everyone else here except those who already need very expensive medical care at a price of FREE.

ETA: * And by here, I mean the USA not the forum.

 

[balrog666]

Actually, like all such anti-freedom measures, it is a horrible idea.

As more treatments are developed, there's simply more things to buy, and more shiny, new, expensive stuff to buy.

There isn't a "health care thing" you buy. There are thousands of drugs and treatments, with more coming daily, to buy.

High costs should be seen as a sign of phenomenal success of freedom, not as a thing that needs "fixing". If someone produces a cure for cancer tomorrow, but wants to charge $10,000 for it, who the flying hell are you to tell them they can't? You are a dirt-grubbing worm squirming around waiting for people to throw scientific miracles at you. But no, you want to fix it.

But if you "fix" it, you will slow the rate of technological development. This will harm more people than you can possibly conceive of helping. We only have hundreds of large-scale economic experiments last century to demonstrate this beyond a reasonable doubt.

It does, however, have all the necessary properties of a meme that spreads as a parasite, i.e. it harms in actuality, all the while creating a fraudulent representation in your mental model of reality. I notice your religious-like knee-jerking activating the meme's defense mechanisms, the way a religious fanatic resorts to "well, the ways of God are mysterious indeed", when faced with questions like why does God allow babies to be microwaved.

Yes, I know "everyone wants it". Yes, I know "everyone in Canada and Europe are pleased with it." Are these arguments skeptics accept?

No, so if you are intellectually honest, you will reject them as arguments.

​

[qimg]http://www.internationalskeptics.com/forums/picture.php?albumid=139&pictureid=591[/qimg]

Well said.

 

[balrog666]

So we are comparing apples and oranges, and the discution is woid.

I still see something like 1/6 of the population without cover for a higher cost than public healthcare.

They lack insurance not medical care. Ditto for 98% of illegal aliens.

.

 

[Tsukasa Buddha]

Actually, like all such anti-freedom measures, it is a horrible idea.

As more treatments are developed, there's simply more things to buy, and more shiny, new, expensive stuff to buy.

There isn't a "health care thing" you buy. There are thousands of drugs and treatments, with more coming daily, to buy.

High costs should be seen as a sign of phenomenal success of freedom, not as a thing that needs "fixing". If someone produces a cure for cancer tomorrow, but wants to charge $10,000 for it, who the flying hell are you to tell them they can't? You are a dirt-grubbing worm squirming around waiting for people to throw scientific miracles at you. But no, you want to fix it.

But if you "fix" it, you will slow the rate of technological development. This will harm more people than you can possibly conceive of helping. We only have hundreds of large-scale economic experiments last century to demonstrate this beyond a reasonable doubt.

It does, however, have all the necessary properties of a meme that spreads as a parasite, i.e. it harms in actuality, all the while creating a fraudulent representation in your mental model of reality. I notice your religious-like knee-jerking activating the meme's defense mechanisms, the way a religious fanatic resorts to "well, the ways of God are mysterious indeed", when faced with questions like why does God allow babies to be microwaved.

Yes, I know "everyone wants it". Yes, I know "everyone in Canada and Europe are pleased with it." Are these arguments skeptics accept?

No, so if you are intellectually honest, you will reject them as arguments.

​

http://www.internationalskeptics.com/forums/picture.php?albumid=139&pictureid=591

Um, is you're wholly too simplified and insulting post something a skeptic should accept?

All you argued against is... well, I can't quite be sure anything you said could be called a logical proposition.

You are quite right there isn't a "health care thing". But what universal health care is about is universal insurance, which doesn't require someone implementing arbitrarily cheap prices from on high.