Universal Health Care in the US. Yea or Nea?

[Darat]

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.)

...snip...

This is a site with a declared interest but the figures do seem to be substantiated:

http://www.nchc.org/facts/coverage.shtml

Nearly 46 million Americans, or 18 percent of the population under the age of 65, were without health insurance in 2007, the latest government data available.1

That does not seem a very small proportion 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.

...snip...

I think many of us would be, however in the USA that is not the spectrum of the choice, many people simply cannot afford the treatment in the first place. And you seem to be treating health care and medical treatment as a "one-off" charge, that is very rarely the case.

Say I manage to scrape together enough to pay for my initial radiation therapy to treat my cancer, but that ends up bankrupting me. How do I now pay for all the follow-up and support treatment I require? What happens if I require yet more radiation therapy or now require chemotherapy or surgery? Again the choice has ended up being "never".

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?

See above. Plus, as I see it, it is very unlikely that any treatment for any condition that was so serious that you would be willing to face bankruptcy to have treated is going to be treated and paid for by a "one-off cost". For example most people requiring hip-replacements require a lot of follow-up treatment such as physiotherapy, without which the effectiveness of having a hip-replacement (I assume) is going to be severely reduced.

 

[Rolfe]

If we actually look at the OP, the question is, should the USA adopt a system of universal healthcare. I think Segnosaur's posts are going a bit off-topic. He seems mainly to be saying that Canada should abandon its universal system and adopt the US system. Now that might be debatable, but it's not really what the thread is about.

Given that there are all sorts of universal systems in the world, including (most of them) that still allow you to bankrupt yourself in order to be treated ten days earlier than the tax-funded system is prepared to treat you, if you want to do that, and given that many of these systems seem to cost the taxpayer (pro rata) no more than the US taxpayer is at present shelling out for their non-universal tax-funded care, what was your point again, caller?

And I'd still like someone in the USA to have quick look at their January pay slip and tell me what proportion of their gross income they actually got to keep, after compulsory tax deductions.

Rolfe.

 

[Segnosaur]

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.

Of course, you'd probably have to raise taxes in order to pay for that 'free' health care, which in turn might make it a bit harder for people who don't even have medical problems to pay their bills.

Plus, if you read the factcheck article, some of the people who blamed bankruptcy on the medical system did so because their illness made it impossible to work. So making medical care 'free' for those people won't help them. (And if you went to a Canadian-type system, it might be even worse since the longer waiting lists will make it even more difficult to keep a job.)

Instead of blaming medical bills (which may just be a drop in the bucket), why not concentrate on changing the rules which allow people to pile up non-medical debt? If you're so concerned about people's finances, wouldn't that have more effect on the rate of bankruptcies?

 

[Rolfe]

Of course, you'd probably have to raise taxes in order to pay for that 'free' health care, which in turn might make it a bit harder for people who don't even have medical problems to pay their bills.

Why do you keep saying that? Why? After all the confirmation that several/many/most countries with univeral systems spend less on them on a pro-rata basis than the USA currently spends on Medicare/Medicaid.

No "probably" about it.

I'm still waiting for someone in the USA to tell us what proportion of their gross income they get to keep, after tax has been deducted. And then we can look at the likely cost of medical insurance, and see who's more likely to be having difficulty paying their other bills.

Rolfe.

 

[Segnosaur]

Of course, you'd probably have to raise taxes in order to pay for that 'free' health care, which in turn might make it a bit harder for people who don't even have medical problems to pay their bills

Why do you keep saying that? Why? After all the confirmation that several/many/most countries with univeral systems spend less on them on a pro-rata basis than the USA currently spends on Medicare/Medicaid.

But as I've pointed out, a good part of the reason that the U.S. system is so expensive is because it is the most responsive. Having the ability to get almost instant access to treatment means that you have to have excess capacity, which drives up the costs.

Is that a good thing? Well, I think whether you consider it a good thing or bad is a personal decision... there's no right or wrong answer, just opinion.

Its a trade off... Try lowering the costs, and you start to have to deal with waiting lists (for diagnostics, treatment, and basic access). And that is independent of whether you're dealing with an all-private or an all-public system.

 

[Segnosaur]

This is a site with a declared interest but the figures do seem to be substantiated:
Nearly 46 million Americans, or 18 percent of the population under the age of 65, were without health insurance in 2007, the latest government data available.1

That does not seem a very small proportion of the population.

I've already dealt with that issue in this thread, post 85.

Of those 46 million 'uninsurred'...
- Many (10 million) are illegal immigrants (I doubt such people would be covered under most universal systems)
- Many (17 million) have incomes over $50,000, so they can afford insurance; they just choose not to get it.
- Only about half of the remaining people have been (or will be) uninsured for more than a few months. (Many people get insurance through work, but it may take a little while for their insurance to 'activate'.)

So, the number of people who cannot afford insurance and who truly need it is much smaller than the '46 million' you quoted. (More in the range of under 5%, rather than 18% of the population.)

And you seem to be treating health care and medical treatment as a "one-off" charge, that is very rarely the case.

Not sure why you think I'm treating it as a "one off" charge. I realize that medical treatments often require followups. I also realize that there may be costs associated with treatments that wouldn't necessarily count as "medical bills" (things like taking time off work.) It just means that whatever money a person needs for the treatment, they have to make sure they borrow enough to handle all the followups.

 

[Toke]

Of course, you'd probably have to raise taxes in order to pay for that 'free' health care, which in turn might make it a bit harder for people who don't even have medical problems to pay their bills.

Looks like you have overlooked alot of posts here.

 

[Segnosaur]

If we actually look at the OP, the question is, should the USA adopt a system of universal healthcare. I think Segnosaur's posts are going a bit off-topic. He seems mainly to be saying that Canada should abandon its universal system and adopt the US system. Now that might be debatable, but it's not really what the thread is about.

Jesus christ on a pogo... how many times to I have to repeat myself?

Go back and look at post 134...

I do want to emphasize something that I mentioned a long time ago but might have been lost... 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.


This is the 3rd time I've made the same statement.

In my first posting in this thread, I questioned the original poll.. I pointed out that simply calling for 'universal' health care was vague, since it can include an entirely taxpayer-funded system, as well as one featuring a mixture of private and public funding.

I also pointed out the problem of asking people if they want a 'universal' health care system since such surveys don't necessily ask "do you want universal health care, if your taxes go up because of it".

I'm still waiting for someone in the USA to tell us what proportion of their gross income they get to keep, after tax has been deducted. And then we can look at the likely cost of medical insurance, and see who's more likely to be having difficulty paying their other bills.

Ummm.. why should income tax deductions be the only relevant measure here? Not every dollar that's taken off on income tax goes to health care, and not every government dollar spent on health care comes from income tax.

Here in Canada, health care funding often comes out of general revenue, which is a big pot that comes from things like income tax, sales tax, customs duties, etc.

You could look up 'tax freedom day'... In the U.S., approximately 31% of all income goes to the government in taxes (this includes income tax, sales tax, etc.) In Canada, the percentage is closer to 45%.

http://en.wikipedia.org/wiki/Tax_Freedom_Day

 

[Segnosaur]

Of course, you'd probably have to raise taxes in order to pay for that 'free' health care, which in turn might make it a bit harder for people who don't even have medical problems to pay their bills.

Looks like you have overlooked alot of posts here.

What do you think I've overlooked?

I've seen so many people point out how health care is cheaper in other countries in the world than it is in the U.S. I've said the same thing each time... Much of the difference in cost is because the U.S. has overcapacity (in order to allow near-instant access). Any system that has a comparable level of availability will likely be expensive.

 

[Rolfe]

I don't think you've got anywhere near proving that the high cost of US healthcare is all (or even mostly) due to keeping sufficient capacity to allow instant access.

How would you get on, for example, if you eliminated all the insurance companies, their staff, their overheads, their advertising and so on? And then eliminate everyone in the healthcare system whose job it is to figure out the exact sum each patient is due to pay, bill them and recover the money. And then eliminate everyone whose job it is to determine whether or not any individual is actually entitled to any particular treatment.

How much "responsiveness" could you have for all that?

And is nobody ever going to tell me what proportion of their gross January salary they were allower to take home to spend? Mine was about 74% (if I can remember back about five pages, during which I've still had no answer).

Rolfe.

 

[Ivor the Engineer]

What do you think I've overlooked?

<snip>

1) The US healthcare system does not have "near instant access".

2) The costs associated with insurance company bureaucracy are a large part of why the US system is so expensive.

3) If Canadians were prepared to pay as much for their healthcare as people in the US currently do, availability would improve and waiting times would come down.

 

[Rolfe]

"Any system that has a comparable level of availability will likely [sic] be expensive."

But you're continuing to ignore the hybrid systems, where availability for non-urgent treatment might not be instantaneous under the universal provision, however patients still have the option of choosing private treatment (insurance or self-funded) if instant treatment of a non-urgent complaint is so important to them.

Why areyou so opposed to such systems?

Rolfe.

 

[Segnosaur]

I don't think you've got anywhere near proving that the high cost of US healthcare is all (or even mostly) due to keeping sufficient capacity to allow instant access.

How would you get on, for example, if you eliminated all the insurance companies, their staff, their overheads, their advertising and so on? And then eliminate everyone in the healthcare system whose job it is to figure out the exact sum each patient is due to pay, bill them and recover the money. And then eliminate everyone whose job it is to determine whether or not any individual is actually entitled to any particular treatment.

Yes, there is overhead with the insurance companies.

But then, if you are dealing with government-run institutions you also have overhead... rather than insurance companies figuring out the bills, you'll have government workers trying to arrange payment to doctors. And government employees are often unionized (giving them higher wages than private sector workers without the unions). Plus, without any sort of profit incentive, there is no motivation for managers to reduce overhead within a government organization.

Now, I have no idea of the 2 of these actually offset each other. I doubt anyone actually knows. But you seem to imply that its only the private sector (insurance companies) has any sort of overhead, and that obviously isn't the case.

And is nobody ever going to tell me what proportion of their gross January salary they were allower to take home to spend? Mine was about 74% (if I can remember back about five pages, during which I've still had no answer).

Umm... would you be any better off if you got to take home 100% of your salary, but the government instituted a 100% sales tax?

 

[Segnosaur]

What do you think I've overlooked?

1) The US healthcare system does not have "near instant access".

It has faster access than the Canadian system (where we have a significant problem with waiting lists). And please note that I put the word 'near' in with instant access. Yes, I'm aware that there may actually be SOME people who do wait for some procedures, but again the problem is less pronounced than in Canada

2) The costs associated with insurance company bureaucracy are a large part of why the US system is so expensive.

And a system that is based only on public funding administered directly by government bureaucrats would also have overhead. Except in the case of a government bureaucracy there's no incentive to lower costs.

3) If Canadians were prepared to pay as much for their healthcare as people in the US currently do, availability would improve and waiting times would come down.

I never denied that that would happen.

My issue is with people who constantly crow about how 'expensive' the U.S. system is, without acknowledging the fact that part of that 'cost' goes towards infrastructure that allows waiting times to be shorter.

 

[Segnosaur]

"Any system that has a comparable level of availability will likely [sic] be expensive."

But you're continuing to ignore the hybrid systems, where availability for non-urgent treatment might not be instantaneous under the universal provision, however patients still have the option of choosing private treatment (insurance or self-funded) if instant treatment of a non-urgent complaint is so important to them.

Why areyou so opposed to such systems?

Well, at this point, I have to wonder if you're just being a troll (unlikely given the number of posts) or you're retarded.

Sorry to be so insulting, but Jesus Christ on a pogostick... I'm getting tired of saying the same thing...

Go back and look at post that I made earlier at 06:39 PM. Go back and look at post 134. In those posts I say...
I think the best systems are the ones that mix private and public elements
So no, I'm not opposed to such hybrid systems. I actually think they're the best way to go. I'm opposed to a single, all tax-payer-funded system like we have in Canada.

Once again (for anyone who happens to be brain damaged and can't remember anything that happened more than 2 minutes ago), I don't think the U.S. has the best health care system; I just don't think the criticisms leveled against it are accurate.

 

[Ivor the Engineer]

"Any system that has a comparable level of availability will likely [sic] be expensive."

But you're continuing to ignore the hybrid systems, where availability for non-urgent treatment might not be instantaneous under the universal provision, however patients still have the option of choosing private treatment (insurance or self-funded) if instant treatment of a non-urgent complaint is so important to them.

Why areyou so opposed to such systems?

Rolfe.

One reason to be against such a mixed system is because it dilutes the feedback about the quality of the universal system. Those who are best able to articulate their dissatisfaction with the service they are (or are not) receiving just pay for the inconvenience to go away, leaving those less able to put up with sub-standard care.

 

[Ivor the Engineer]

BTW, "responsiveness" w.r.t. the WHO report is defined as:

A third goal – responsiveness to people’s expectations in regard to non-health matters – reflects the importance of respecting people’s dignity, autonomy and the confidentiality of information.

So the US healthcare system is No.1 in the world when it comes to being nice to the customer.

I wonder why that might be?

 

[Segnosaur]

One reason to be against such a mixed system is because it dilutes the feedback about the quality of the universal system. Those who are best able to articulate their dissatisfaction with the service they are (or are not) receiving just pay for the inconvenience to go away, leaving those less able to put up with sub-standard care.

But wouldn't that in itself be a form of feedback?

After all, if more and more people are shunning the 'free' public plan in favour of the 'user pays' private plan, it should be a good indication that something is wrong with the public plan. On the other hand, if nobody uses private plans, its a pretty good indication of that your public plan is doing a good job.

On the other hand, if you had a system that was all public/taxpayer funded, the only way you could tell how "happy" people were with the system is thorough surveys, etc, which only have limited value. (i.e. they don't measure how much people are truely willing to give up for better access.)

 

[Bob Blaylock]

Well, I live in a system where we pay 50+% income tax in return for free education and healthcare. …

The basic idea is "to each according to need, from each according to ability" or something like that.

Your government owns more of the fruits of your labor, than you do. This means that your government owns more of YOU than you do. This makes you a slave, not a free person. Perhaps you are a well cared-for slave, but you are still a slave.

An advantage of slavery is that you don't have to take responsibility for your own needs. That's your master's responsibility.

Here in the United States, most of us prefer to take responsibility for our own needs, rather than sell ourselves into slavery as you and your countrymen have done.

 

[Lonewulf]

Your government owns more of the fruits of your labor, than you do. This means that your government owns more of YOU than you do. This makes you a slave, not a free person. Perhaps you are a well cared-for slave, but you are still a slave.

An advantage of slavery is that you don't have to take responsibility for your own needs. That's your master's responsibility.

Here in the United States, most of us prefer to take responsibility for our own needs, rather than sell ourselves into slavery as you and your countrymen have done.

As a fellow citizen of the United States of America, I say:

BWAHAHAHAHAHAHAHA!

Also:

http://www.reuters.com/article/latestCrisis/idUSN31432035

50% of doctors support Universal Health Care.

Also: http://abcnews.go.com/sections/living/US/healthcare031020_poll.html

In an extensive ABCNEWS/Washington Post poll, Americans by a 2-1 margin, 62-32 percent, prefer a universal health insurance program over the current employer-based system.

Yes; "most" Americans consider health care to be slavery.

Another link, just to throw some fire into the water:

http://cthealth.server101.com/the_case_for_universal_health_care_in_the_united_states.htm

# Fact Two: Repeated national and state polls have shown that between 60 and 75% of Americans would like a universal health care system (see The Harris Poll #78, October 20, 2005)