Universal Health Care in the US. Yea or Nea?

[kellyb]

Question: If there were laws put into place that prevented patients from being able to demand procedures they didn't need, the medical records system was overhauled/modernized, and laws passed that would prevent filing of bogus lawsuits against doctors, why would someone want to switch to UHC? It'd be cutting per capita spending down to almost the median level of other developed countries.

How do you know that alone would bring the cost down to what UHC is elsewhere? Governments have the ultimate bulk purchase leverage with pharmaceutical companies. That's why Americans get drugs from Canada cheaper. Electronic Health Records aren't evidence-based in terms of being cheaper, either. And regarding laws to prevent patients not being able to demand unneeded procedures...how would that work? Who decides what patient really needs what, legally?

 

[DaN K. StAnLeY]

Dan, you are much politer than the Gnome,

I'm starting to get that you guys are only polite when someone agrees with you. I've repeatedly thanked people for sharing only to get a boat-load of sarcastic comments in return that eventually dissolve into attacks against me. Just because I want to make a different system work doesn't mean I'm irrational.

 

[DaN K. StAnLeY]

Hey, hold on! You now boast that the "socialised" part of your healthcare system "stops people dying". Probably does, too.

But you've said you don't want to contribute to the healthcare costs of other people. This seems to be a hardline position for you. That would mean that the part of your system you just credited with stopping people dying, would no longer exist in your perfect system.

Sorry, but please could you be consistent? It's hard to address your arguments when you continually change your position.

Rolfe.

I'm not boasting anything!?!? I'm saying if America were really as heartless as you seem to think, we wouldn't be footing the bill for Medicare or Medicaid at all. We could vote to stop paying it and let everyone die, but most of us agree that a soc-system is better than mass deaths (that's not saying much that you are second choice to mass death). I think you're idea of Americans is twisted.

 

[Rolfe]

Question: If there were laws put into place that prevented patients from being able to demand procedures they didn't need, the medical records system was overhauled/modernized, and laws passed that would prevent filing of bogus lawsuits against doctors, why would someone want to switch to UHC? It'd be cutting per capita spending down to almost the median level of other developed countries.

Could you rephrase this in a way that might make it easier for me to understand? I'm trying to imagine a change to your system that would make me even consider tolerating it (personally, I mean).

At the moment my taxes are by no means onerous. Even though I pay tax at the "higher rate", I still take home about 73% of my gross salary. For that, among other things I really, really hate having to contribute to (like nuclear submarines and invading other people's countries), I get stuff I really, really like having. This includes the ability, indeed right, to see a doctor any time I feel I need to. And to be treated in whatever way my doctors feel is right for any illness I might have, all without anyone asking for a single penny from me at the point of delivery.

This gives me an enormous amount of freedom. It means that I can change jobs any time I like, without having to worry about the effect on my healthcare provision. It means I can spend a while without a job, without having to worry about my healthcare provision. It means that I don't have to waste a single second of my time comparing different health insurance policies to get a good deal without being screwed. It means that there is no insurance company trying to disallow any treatment my doctor thinks I need. It means that if I was unlucky enough to get something really, really expensive (or a series of expensive conditions) that nobody is ever going to say to me, that's it, you've exceeded your lifetime coverage, no more chemotherapy for you.

And remember, I'm getting all this for less, pro rata, than you're currently paying just to support Medicare and Medicaid.

You seem to think that I should be outraged that I'm forced to pay this modest tax, which gives me such great benefits, just because I can't opt out. Well, I'm not. Of all the elements of my taxation, this is probably the best value for money of the lot. I'm 110% in favour.

You also seem to think that I should be outraged that people like Rab C. Nesbit get the same treatment I get, even though he's a work-shy scrounger. Well, I'm not. I save my outrage in that department for the social security benefits fiddle. If someone is sick, I think they should be treated, even if they are "scum", as Rab likes to describe himself. I'm getting a good deal from the system, and I'm happy to know that those of my compatriots who may work just as hard as I do but who don't have my advantages also will never find themselves without healthcare - why should I cut off my nose (and indeed everybody else's noses) just to spite a few bottom-feeders?

So, explain to me again why the small bits of tinkering you're proposing to your system make it so good that I might be persuaded it was better for me than what I've got already?

Rolfe.

 

[DaN K. StAnLeY]

How do you know that alone would bring the cost down to what UHC is elsewhere? Governments have the ultimate bulk purchase leverage with pharmaceutical companies. That's why Americans get drugs from Canada cheaper. Electronic Health Records aren't evidence-based in terms of being cheaper, either. And regarding laws to prevent patients not being able to demand unneeded procedures...how would that work? Who decides what patient really needs what, legally?

I'm just using numbers projected by the AARP and RAND links I posted earlier. They estimate savings of 380 billion if we went to a more efficient record keeping system, and another 500-700 billion could be saved if we stopped wasteful procedures. The doctor decides what the patient needs of course, but the patient would be responsible for more of the cost so they'd be less likely to get things done they didn't need.

 

[Rolfe]

I'm not boasting anything!?!? I'm saying if America were really as heartless as you seem to think, we wouldn't be footing the bill for Medicare or Medicaid at all. We could vote to stop paying it and let everyone die, but most of us agree that a soc-system is better than mass deaths (that's not saying much that you are second choice to mass death). I think you're idea of Americans is twisted.

No. Some of my best friends are American. They are some of the kindest people I know. I think I said that already.

I'm simply trying to make sense of your own position. You've repeatedly said that you object to being compelled to pay for other people's healthcare. It's perfectly obvious that you are already compelled to do just that, by way of the taxes you pay for Medicare and Medicaid. I therefore conclude that in your ideal system, you would no longer pay these taxes and Medicare and Medicaid would no longer exist.

If that is not your posiition, then could you make yourself clearer?

Rolfe.

PS. For my part, I'm certainly not trying to attack you. I'm just sad that you seem to have backtracked on so much you said before that was reasonable. And I can't help but note that your current position is very similar to that put forward by Jerome da Gnome. His debating style isn't really relevant, but as he was so spectacularly rude, I merely remarked that you're quite different.

 

[kellyb]

I'm just using numbers projected by the AARP and RAND links I posted earlier. They estimate savings of 380 billion if we went to a more efficient record keeping system, and another 500-700 billion could be saved if we stopped wasteful procedures. The doctor decides what the patient needs of course, but the patient would be responsible for more of the cost so they'd be less likely to get things done they didn't need.

It's the doctors proposing these supposedly "wasteful procedures" you mention. And what do you mean by "but the patient would be responsible for more of the cost"? And how does a patient know what they do and don't need?

 

[DaN K. StAnLeY]

It's the doctors proposing these supposedly "wasteful procedures" you mention. And what do you mean by "but the patient would be responsible for more of the cost"? And how does a patient know what they do and don't need?

No, the doctors are doing what the patients tell them to do in many instances. They might take unnecessary x-rays or give extra treatments just because the patient ask for it and the insurance companies pay for it (raising cost for everyone). They do a better job explaining it in the links and the video I posted.

 

[kellyb]

No, the doctors are doing what the patients tell them to do in many instances. They might take unnecessary x-rays or give extra treatments just because the patient ask for it and the insurance companies pay for it (raising cost for everyone). They do a better job explaining it in the links and the video I posted.

No, they're not just doing what the patient demands. Most people go to the doc for the doc's advice on what needs to be done. Can you provide any evidence at all a significant % of our healthcare spending is coming from "patient demanded, but doctor non-recommended" spending?

 

[DaN K. StAnLeY]

I therefore conclude that in your ideal system, you would no longer pay these taxes and Medicare and Medicaid would no longer exist.

In the ideal system they wouldn't be needed or would be needed only on an extremely small percentage of people who "really" need it.

PS. For my part, I'm certainly not trying to attack you. I'm just sad that you seem to have backtracked on so much you said before that was reasonable. And I can't help but note that your current position is very similar to that put forward by Jerome da Gnome. His debating style isn't really relevant, but as he was so spectacularly rude, I merely remarked that you're quite different.

You sure don't sound like someone who is being genuinely helpful unless I concede or agree with you. Almost every question I've been asked so far has been 10% helpful and 90% sarcastic insults on my intelligence. I'm not back tracking because I never agreed that soc HC was the answer, only that I couldn't contribute anything else to defend my position at that time. How you take that as back tracking I'll never know.

 

[Rolfe]

.... it's no secret I'm keeping, that I don't like soc-anything if there is a better way.

You seem to me to be a bit harder-line than that, even. You're vehemently opposed to anything you label as "soc", even if the evidence does indicate that it works. This is ideology, not rationality.

An American acquaintance recently reeled off to me just some of the things that are currently "socialised" in America.

• Schools
• Law enforcement
• the Military
• Firefighting
• Roadbuilding
• Rubbish collection
• Street lighting

And I'm sure that there are more. Now I don't doubt that you'd like to get rid of all of these tomorrow, "if there was a better way."

But is it possible that there isn't? Is it possible that having publicly-funded schools is the best way to ensure that the next generation is at least tolerably educated? Is it possible that having a publicly-funded police force is the best way to fight crime? And so on.

If there were "a better way" in these areas, why is it that the USA hasn't got rid of these dreadful "soc" provisions and embraced this better way?

Now personally, I don't have any great ideological preconceptions here. I just want good and affordable healthcare for me, and for everyone else in the society I live in. Because, you see, I don't believe that anyone should be allowed to die of a treatable illness even if their lifestyle is not one I approve of, and even if that lifestyle may have brought on their illness. And I don't mind in the slightest that this is funded from taxation, because I get great benefits from it.

To screw up such a beneficial system because of ideological objections to paying taxes, or to treating the illnesses of my neighbours who may be unlucky or even foolish and improvident seems to me to be completely senseless.

If a free-market system could provide anything as good as what I've got, I'd be happy, and not be complaining because it conflicted with any ideology I have. Can you say the same?

Remember, I'm a vet. I see in great detail the consequences of a client being unable to afford the costs of necessary healthcare in a completely free-market system. And it isn't lower prices.

Rolfe.

 

[DaN K. StAnLeY]

Can you provide any evidence at all a significant % of our healthcare spending is coming from "patient demanded, but doctor non-recommended" spending?

from AARP link:

Of our total $2.3 trillion health care bill last year, a whopping $500 billion to $700 billion was spent on treatments, tests, and hospitalizations that did nothing to improve our health. Even worse, new evidence suggests that too much health care may actually be killing us. According to estimates by Elliott Fisher, M.D., a noted Dartmouth researcher, unnecessary care leads to the deaths of as many as 30,000 Medicare recipients annually.

 

[DaN K. StAnLeY]

If a free-market system could provide anything as good as what I've got, I'd be happy, and not be complaining because it conflicted with any ideology I have. Can you say the same?

Yes, I can. Whats the point of forums if we aren't going to discuss anything though?

 

[kellyb]

from AARP link:

Where does that say the ineffective treatment was patient-demanded and not doctor suggested?
Also, treatments are usually only effective in some or most people. Few treatments work 100% of the time.

 

[Rolfe]

No, the doctors are doing what the patients tell them to do in many instances. They might take unnecessary x-rays or give extra treatments just because the patient ask for it and the insurance companies pay for it (raising cost for everyone). They do a better job explaining it in the links and the video I posted.

Looking at this from the point of view of someone who works in completely private healthcare, really, I can't see it. And just because a popular TV show claims it happens, doesn't make it so.

The greatest problem is clients being unable to afford as many x-rays as you'd like, to be able to diagnose the problem properly. The second greatest problem is the vet who takes more x-rays than necessary, not because the client asks for them, but because he wants to boost his income. This tends to happen mostly where the client is perceived as being able to afford it, or there is an insurance company which is going to pick up the bill. I don't think I ever in my life came across anyone who demanded more tests of any sort than the vet was recommending.

It makes no sense to me, and I can't see why human healthcare in the USA should operate by such different rules. Indeed, regarding x-rays specifically, the radiation hazards are sufficiently well-known that any excess exposure is likely to be avoided by all concerned, so if it was x-rays in particular that this programme mentioned, I smell someone making it up as he goes along.

Rolfe.

 

[Rolfe]

Yes, I can. Whats the point of forums if we aren't going to discuss anything though?

Fine. But I do find your insistence that you loathe any solution that might be seen as "soc" on principle to be ideological rather than practical. What if a tax-funded universal system just happens to be cheaper and to provide better overall outcomes? Do you despise it on purely ideological grounds?

Rolfe.

 

[kellyb]

If a free-market system could provide anything as good as what I've got, I'd be happy, and not be complaining because it conflicted with any ideology I have. Can you say the same?

Yes, I can.

So you're still unconvinced that American healthcare produces poorer outcomes for twice the cost than UHC does?

 

[Blue Mountain]

Can you provide any evidence at all a significant % of our healthcare spending is coming from "patient demanded, but doctor non-recommended" spending?

from AARP link:

Of our total $2.3 trillion health care bill last year, a whopping $500 billion to $700 billion was spent on treatments, tests, and hospitalizations that did nothing to improve our health. Even worse, new evidence suggests that too much health care may actually be killing us. According to estimates by Elliott Fisher, M.D., a noted Dartmouth researcher, unnecessary care leads to the deaths of as many as 30,000 Medicare recipients annually.

There is nothing in that statement that indicates the overcoverage is the result of patient demand. Two of the alternative reasons put forward are:

• Doctors ordering unnecessary tests because they're afraid of a lawsuit if they miss something
• A situation where a group of doctors purchases an expensive piece of medical technology, and suddenly a significant number of their patients need the treatment

 

[Rolfe]

To be fair, BM, that last is not necessarily evidence of churning. The equipment might have been purchased precisely because it was obviously going to be of benefit to a sizeable proportion of patients. I would compare that with veterinary practices purchasing an ultrasound scanner. Suddenly lots of patients are getting scans they wouldn't have been getting before, and this is a GOOD thing.

These little wrinkles make so much of these arguments difficult to generalise.

Rolfe.

 

[Rolfe]

Dan, could you recap again what your objections as to "soc" healthcare? Seriously. If it's not just ideology, why do you have this inbuilt bias against it?

Rolfe.