Universal Health Care in the US. Yea or Nea?

[Cobalt]

Perhaps, rightly or wrongly, some folks here in the US think of the joys of waiting in line at the post office, or the thrill that is going to the DMV for...anything, and don't want that to spill its way into their healthcare.

Segnosaur, thank you for bringing up the actual quality and responsiveness of care, which should be the more important concern.

For all the talk of "propaganda," all that's ever brought up are horror stories about the US healthcare system. What you don't hear about is the everyday successes the system does provide. Yes, it is a shame that not everyone has coverage, but if a "universal" system was implemented, my concern would be the quality of care that everyone would get.

 

[Ivor the Engineer]

I never claimed that there would not be financial hardships. I do rather suspect that most people would prefer getting treatment that saves their lives (and perhaps going bankrupt as a result) over NOT getting the treatment (because you're stuck on a waiting list) and dying.

Why would waiting times for medical treatment under a universal coverage system be any longer than they would be under a private system at an equivalent price?

Yet this 'truly awful' U.S. health care system was ranked #1 by the WHO in terms of responsiveness.

Is responsiveness always a good thing?

Well, perhaps I have the 'gall' because I actually live in a country that has a 'socialized' health care system (Canada) which is not functioning as well as you seem to believe.

By the way, I AM referring specifically to Canada's system, where, in almost all cases, any sort of private care is forbidden. I am not referring to the situations in almost every other Western industrialized country, where they have found various ways to mix private and public health care in ways that are better than Canada's or the U.S.

Are you aware private treatment is usually carried out by physicians who work in the public sector moonlighting? If so, why do you think simply allowing private practice will significantly affect the length of waiting lists while keeping the cost constant?

First of all, who are YOU to downplay the suffering that someone may feel if they have to wait a couple of months for non-emergency surgery? Do you think all such surgeries are done for fun? Many people have severe pain, many people have to greatly alter their lives because they can't get the treatment they want in a timely fashion. Are you really willing to tell someone who can't walk because they need a hip replacement and can't get one because they're on a waiting list that their suffering isn't a problem?

Secondly, we aren't just talking about problems just causing inconvenience/suffering... the fact that we have waiting lists can actually risk lives. For example:

- Delays in cancer treatment or delays in diagnosis may mean that in some cases the cancer is allowed to spread further than it should (I've already pointed out a reference which shows most hospitals are not meeting their targets for timely treatment of Cancer). Delays in Cardiac surgery can lead to either death, or situations where there is a strong risk to patients. (See: http://www.cmaj.ca/cgi/reprint/160/10/1469.pdf)

- In the past (not sure if this is still the case) there weren't enough MRIs and PET scanners, and doctors were relying on CT scans as a result (even if PET scans were providing superior diagnostics and the best chance at adequate patient care)

- If people are suffering from chronic pain for long periods of time (because they are on a waiting list for elective surgery), they may be unable to exercise properly, which will lead to further medical complications

- People unable to find a family doctor (Canada has the lowest doctor / population ratio in the G8) will not get the basic health care that they need to handle minor problems before they become life threatening.

The answer is easy; vote for and lobby politicians to spend more on Canada's healthcare system.

 

[Lonewulf]

This is the United States of America, not the Союз Советских Социалистических Республик. This nation was not founded on the idea that Big Brother is there to take care of us all as if we are children.

Yay hyperbole.

Yeap, if it isn't the U.S. system, it's communism.

Nice to see someone still living in the '50s.

 

[lomiller]

Yet this 'truly awful' U.S. health care system was ranked #1 by the WHO in terms of responsiveness.

You are cherry picking the lone bright spot in the WHO assessment of the US health care system. No one but a hard core ideologue is going to buy crap like that. Seriously who cares if some rich person can walk in off the street and get treatment for non-critical problems immediately.

Well, perhaps I have the 'gall' because I actually live in a country that has a 'socialized' health care system (Canada) which is not functioning as well as you seem to believe.

As do I and I can say first hand you’re spouting BS. Health care in Canada certainly isn’t perfect (primarily because of a doctor shortage, which is something that needs to be addressed in the University system) but every objective metric says Canada’s systems does as well or better then the US for ~1/2 the cost.

By the way, I AM referring specifically to Canada's system, where, in almost all cases, any sort of private care is forbidden.

If you are going to argue from self authority at least make a passing attempt to familiarize yourself with the subject matter. Upwards of 90% of health care in Canada is privately delivered. Some provinces have attempted to limit people’s ability to pay for health care out of their own pocket (and essentially buy their way to the front of any waiting list) but the Supreme Court ruled this unconstitutional.

 

[lomiller]

Are you aware private treatment is usually carried out by physicians who work in the public sector moonlighting? If so, why do you think simply allowing private practice will significantly affect the length of waiting lists while keeping the cost constant?

You are putting to much stock in Segnosaur’s version of things. As I mentioned above nearly all Canadian doctors are private sector businessmen so it’s not a case of them “moonlighting”.

On the pro side allowing people to pay out of their own pocket would help with cases where there are facility or equipment shortages. Most Canadian hospitals are non-profit charitable organizations that receive heavy government funding, but there are private hospitals as well. The thought is that allowing people to pay out of pocket would put more money into the system and result in better equipped for-profit hospitals.

On the con side it would allow people to pay individual doctors to put them at the front of that doctors personal waiting list. If the issue of doctor shortages could be resolved this particular problem should drop off the table.

The answer is easy; vote for and lobby politicians to spend more on Canada's healthcare system.

In some cases that would help, but where money needs to be spent is educating and training new doctors. If you pump money into the medical system it will just bleed out the bottom because capacity is limited by the number of doctors graduating university.

 

[Rolfe]

I'm totally failing to understand why Segnosaur's issues with the Canadian system are driving him to champion the US system. Frying pan, let me introduce you to this fire....

Rolfe.

 

[Toke]

One thing that most everyone opposed to "socialized healthcare" misses is the fact (snip)

A reasonable guess, problem is that it will likely be made even more expensive than the current system.
The politicians pasing the laws for it would not want to take income from their campain contributors in the medical/insurance industri.

I think the us will need a revolution/grassroot uprising to change this system to the benefit of the people.

 

[Ivor the Engineer]

<snip>

The thought is that allowing people to pay out of pocket would put more money into the system and result in better equipped for-profit hospitals.

Which is exactly the same as what more government expenditure on healthcare would do, except that with the government doing it all hospitals and patients can benefit, not just private hospitals and those patient rich enough to jump queues.

<snip>

In some cases that would help, but where money needs to be spent is educating and training new doctors. If you pump money into the medical system it will just bleed out the bottom because capacity is limited by the number of doctors graduating university.

So get the government to provide financial help to those people wishing to train as physicians, possibly with a clause that they have to work in Canada for a number of years after graduating.

Like many problems, the answer is basically to throw money at it. The advantage of the government throwing the money rather than individuals is it can be done in an equitable way.

 

[Darat]

Interesting factoid for this thread: http://news.bbc.co.uk/1/hi/health/7859053.stm

 

[Corsair 115]

is there a national ranking for "Standard of living"?

The Human Development Indices used in the Human Development Report issued by the UN each year might fit the bill.

 

[Segnosaur]

Yet this 'truly awful' U.S. health care system was ranked #1 by the WHO in terms of responsiveness.

You are cherry picking the lone bright spot in the WHO assessment of the US health care system. No one but a hard core ideologue is going to buy crap like that.

Do you actually know how the WHO rankings were actually calculated?

You see, of all the factors that they use to determine the rankings, the responsiveness is about the only factor that deals ONLY with how good the health care system is.

Seriously who cares if some rich person can walk in off the street and get treatment for non-critical problems immediately.

Ummm... you DO realize that, even if there are some people who are not insured (the percentage is actually very small), the ability to get treatment immediately applies to more than just the 'rich'... it applies to the, ahem, rather significant number of people who also have health insurance.

And you DO realize that what you call 'non-critical problems' can actually be very serious, either causing serious pain or in some places risking death. (I posted a link early about the risks of being put on a waiting list for certain cardiac procedures.)

As do I and I can say first hand you’re spouting BS. Health care in Canada certainly isn’t perfect (primarily because of a doctor shortage, which is something that needs to be addressed in the University system)

Actually, there are more problems than just the doctor shortage. For example, there is also a shortage in the ability of certain diagnostic procedures (e.g. MRIs).

And yes, part of the doctor shortage is because our university system isn't turning out as many doctors as it might need to. But that is not the only problem... We have also had a 'brain drain' of doctors moving to the U.S. For example, in the 1990s we were loosing hundreds of doctors a year. In some cases, those doctors were leaving because they had more access to health care infrastructure down in the U.S.

http://www.cmaj.ca/cgi/content/full/161/8/1028

If you are going to argue from self authority at least make a passing attempt to familiarize yourself with the subject matter.

I find it quite ironic that you accuse me of not knowing the subject matter, when you seem to have ignored some of the basic facts as well.

Upwards of 90% of health care in Canada is privately delivered. Some provinces have attempted to limit people’s ability to pay for health care out of their own pocket (and essentially buy their way to the front of any waiting list) but the Supreme Court ruled this unconstitutional.

First of all, I do recognize that health care is delivered (in part) "privately". (e.g. doctors acting as their own business, not to mention aspects such as drugs, eye care, etc.) But, in the case of basic doctor care, fees are set by the government, and all money comes from the government. In addition, some infrastructure (e.g. many of our hospitals) ARE directly controlled by the government.

Now, I could have gotten into all this earlier, but ultimately it didn't really matter; whether a clinic is owned and run by the government or by the doctor themselves, the key factor is that everything is payed for the government, who also sets the fees.

Secondly, there was a court ruling, but it applied only to Quebec. To the best of my knowledge there haven't been any rulings against medicare in other provinces. Furthermore, while the ruling did strike down the Quebec medicare law, it wasn't necessarily 'unconstitutional'. (The supreme court actually split on that point.)

Of course, I find it ironic... you keep cheering on the Canadian system, when the supreme court themselves recognizes that there are significant problems.

http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/1118315110253_28/?hub=TopStories

 

[Segnosaur]

I'm totally failing to understand why Segnosaur's issues with the Canadian system are driving him to champion the US system. Frying pan, let me introduce you to this fire....

Ummm.. go back and look at post 134 of this thread, where I stated...

I do not think the U.S. system is perfect. I do not even think the U.S. system is the best in the world. What I do dislike is people claiming an all "socialized" system (only taxpayer funded) like we have in Canada is somehow the best way to go. Its not. I think the best systems are the ones that mix private and public elements, as most Western countries have adopted. I'm only trying to debunk the arguments that people have criticizing the American system that I think are unfounded.

http://www.internationalskeptics.com/forums/showpost.php?p=4391360&postcount=134

 

[Corsair 115]

But, in the case of basic doctor care, fees are set by the government...

I thought the fees were set by the government but after negotiation on a province-by-province basis with each provincial medical association...

 

[Darat]

Do you actually know how the WHO rankings were actually calculated?

You see, of all the factors that they use to determine the rankings, the responsiveness is about the only factor that deals ONLY with how good the health care system is.


...snip...

How do you come to that conclsuion? That is contradicted by what the WHO says about the report you linked to:

...snip...

The U.S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance, the report finds. ...snip...

WHO Director-General Dr Gro Harlem Brundtland says: "The main message from this report is that the health and well- being of people around the world depend critically on the performance of the health systems that serve them. Yet there is wide variation in performance, even among countries with similar levels of income and health expenditure. It is essential for decision- makers to understand the underlying reasons so that system performance, and hence the health of populations, can be improved."

...snip..

That makes it very clear that (what the WHO report defines as) "performance" is the most important indication of how "good" a helathcare system i.e. the USA has a health-care system that is 37th in the world in terms of "how good it is".

 

[Segnosaur]

Do you actually know how the WHO rankings were actually calculated?

You see, of all the factors that they use to determine the rankings, the responsiveness is about the only factor that deals ONLY with how good the health care system is.

How do you come to that conclsuion?

I've seen the discussion about how they come up with the rankings in several places. For example: http://www.who.int/whr/2000/media_centre/press_release/en/index.html
WHO's assessment system was based on five indicators: overall level of population health; health inequalities (or disparities) within the population; overall level of health system responsiveness (a combination of patient satisfaction and how well the system acts); distribution of responsiveness within the population (how well people of varying economic status find that they are served by the health system); and the distribution of the health system's financial burden within the population (who pays the costs).

Of those 5 factors... overall level of health and health inequalities can be affected (in part) by factors outside the health care system (diet/exercise). Distribution of financial burden doesn't really say how good the health care system is. That leaves only overall responsiveness, and distribution of responsiveness as true measures. And even distribution of responsiveness is not a very good indicator (since a system where some people wait 1 week and some wait 2 would score lower than a system where everyone waits a uniform 2 weeks.)

That is contradicted by what the WHO says about the report you linked to:
The U.S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance, the report finds. ...snip...

That makes it very clear that (what the WHO report defines as) "performance" is the most important indication of how "good" a helathcare system i.e. the USA has a health-care system that is 37th in the world in terms of "how good it is".

The problem is, that particular article mentions 'performance' but didn't indicate exactly how that 'performance' was measured. (I think... I've read so much stuff I'll have to go back and double check.)

 

[Darat]

...snip...

Of those 5 factors... overall level of health and health inequalities can be affected (in part) by factors outside the health care system (diet/exercise). Distribution of financial burden doesn't really say how good the health care system is. That leaves only overall responsiveness, and distribution of responsiveness as true measures. And even distribution of responsiveness is not a very good indicator (since a system where some people wait 1 week and some wait 2 would score lower than a system where everyone waits a uniform 2 weeks.)

...snip...

What does it matter if the "responsiveness level" is fantastic if that health care is not available to many of the people in the country - as is the case in the USA?

In the USA the choice is one week or never*. Personally I'd rather have to wait 2 weeks!



(*Slight hyperbole since I know there are charitable organisations, people can always sell all their possession, take out loans and so on if they do not have insurance cover.)

 

[Toke]

This might be news to you Stegnosaur.
Apart from the uninsured, there are also alot of underinsured.

http://http://www.consumeraffairs.com/news04/2005/bankruptcy_study.html

The study estimates that medical bankruptcies affect about 2 million Americans annually -- counting debtors and their dependents, including about 700,000 children

"The paradox is that the costliest health system in the world performs so poorly. We waste one-third of every health care dollar on insurance bureaucracy and profits while two million people go bankrupt annually and we leave 45 million uninsured" said Dr. Quentin Young, national coordinator of Physicians for a National Health Program.

"With national health insurance ('Medicare for All'), we could provide comprehensive, lifelong coverage to all Americans for the same amount we are spending now and end the cruelty of ruining families financially when they get sick."

I still think of the chene in Sicko where a man cut off two fingers, and think "I cant afford to have them sewn back on" He did have money for one of them.

 

[Segnosaur]

What does it matter if the "responsiveness level" is fantastic if that health care is not available to many of the people in the country - as is the case in the USA?

(*Slight hyperbole since I know there are charitable organisations, people can always sell all their possession, take out loans and so on if they do not have insurance cover.)

Yes, I've already admitted that there are some people who do have severe hardship due to medical costs... people too poor to afford insurance and too much income to qualify for medicare/medicade. (Although if you look at the numbers, that applies to only a very small portion of the population.)

Is it any better to have the 'average' person suffering longer than they should (or dying as a result)? Some people, given a choice between financial bankruptcy and severe pain (or risk of death) would choose financial bankruptcy.

In the USA the choice is one week or never*. Personally I'd rather have to wait 2 weeks!

But what if the choice is one week or 6 months? 6 months of horrible pain and an inability to live a normal life waiting for a hip replacement (http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2384274), or 6 months living with a potentially fatal condition because the health system doesn't consider your situation serious enough to give you priority. If you were faced with that situation, would it provide comfort to you just because others would be equally suffering? Or would you consider going into debt just to fix the problem?

 

[Segnosaur]

This might be news to you Stegnosaur.
Apart from the uninsured, there are also alot of underinsured.

http://www.consumeraffairs.com/news04/2005/bankruptcy_study.html

First of all, I fixed your link for you.

Secondly, before you start quoting that particular study, you might want to read this article on factcheck.org that references that data...

http://www.factcheck.org/askfactcheck/what_is_the_percentage_of_total_personal.html


Gail Heriot, a law professor at the University of San Diego, took issue with the relatively low level of out-of-pocket costs that could qualify as a cause of a "major medical bankruptcy." In February 2005, she wrote for the National Review:

Heriot: Buried in the study is the fact that only 27 percent of the surveyed debtors had unreimbursed medical expenses exceeding $1,000 over the course of the two years prior to their bankruptcy. ... ... for most Americans (particularly those with enough at stake to seek the protection of bankruptcy) it is not catastrophic.

In fact, the study said that the out-of-pocket costs cited by those interviewed were "often below levels that are commonly labeled catastrophic." The authors hypothesized that other related factors, such as the loss of a job, helped push families into bankruptcy: "Presumably, such costs were often ruinous because of concomitant income loss or because the need for costly care persisted over several years."
...
...a 2008 study by a business professor at the University of California, Davis, said that while medical issues certainly caused bankruptcy, the bigger problem was that families spent beyond their means, leaving them vulnerable to even minor disruptions. "Although our study supports the notion that adverse events contribute to personal bankruptcy filings, the findings emphasize that excessive consumption probably contributes more to the recent increase in personal bankruptcy filing."

So while some people may be blaming "Medical bills" for their bankruptcy, in many cases its just one of many factors, and the people may not have had that problem if they hadn't had other (often unnecessary) debts as well.

I still think of the chene in Sicko where a man cut off two fingers, and think "I cant afford to have them sewn back on" He did have money for one of them.

Yes, it would be a sad story. Of course, what about the little grandmother who needs a hip replacement in Canada but can't get one because of the waiting list? Is that any less serious?

 

[Toke]

Way I read it, if you are up to your eyeballs in mortage and creditcard debt you can go bankrupt from even a small medical bill.

Just one more reason to make medical care free/taxpaid*.




*Free for the individual in question, paid by taxes.