Stossel Solves the Health Crisis with Capitalism

[DaN K. StAnLeY]

But this isn't Utopia, so even though we have fully answered all these points, certanly to the stage where Dan went away declaring he would think again, we now have to start again.

Plus, I mostly left because you guys/girls are [rule 10]-holes. I still don't agree that we need to switch to UHC to have better HC. The more I'm reading, the more I find out how crappy systems like Canada's are. I don't see people dying in the streets here yet, so I still have time to ponder.

 

[Earthborn]

I don't think it is unreasonable to ask for alternatives to switching completely to a UHC system.

The only alternative to Universal Healthcare, is non-Universal Healthcare. If you want the latter, you should have an idea who should be excluded.

The point of the thread was to brainstorm ideas that could lower the cost of the US health care without switching to a soc-type system.

There are lots of systems that would lower the cost. They would all make healthcare more accessible, and therefore closer to universal.

I still don't agree that we need to switch to UHC to have better HC.

You can have better healthcare without Universal Healthcare. But if it isn't universal, it would not be better for everybody.

 

[Rolfe]

I don't think it is unreasonable to ask for alternatives to switching completely to a UHC system. The point of the thread was to brainstorm ideas that could lower the cost of the US health care without switching to a soc-type system. The Stossel video had some ideas that I hadn't thought of before and I'm hoping others might be able to contribute similar ideas.

Do you think you've had any useful input?

Personally, I draw a complete blank on how to reduce the price of the top-of-the-range Rolls Royce (so to speak) so that even people on the minimum wage can afford one. Particularly if maintaining the income of healthcare professionals is any sort of a consideration. Which it really has to be if you don't want every doctor on the country to leave.

I didn't see anything useful in the Stossel video. I saw misrepresentation of universal healthcare systems, I saw cherrypicking of examples, and most importantly I saw no attempt to address the very real problems highlighted at the start of the programme. While a couple of minor improvements to the present US system were suggested, these still left patients worse off than patients in universal systems. And, crucially, there was no attempt to explain how these very limited innovations might be extrapolated to big-ticket items.

I'm still not sure why you want alternatives to switching to a completely universal system. I know you've tried to explain, but it doesn't make a lot of sense. You're compelled to pay for other people's healthcare in your present system, and it actually looks as if you're more compelled, and pay more, than people living with universal sytems. And you still haven't squared the circle of how on one hand you are so opposed to anyone getting something for nothing, yet on the other you don't want anyone to be left to die in the street.

You did say something very telling, several pages ago, You said that you didn't want to embrace a universal healthcare system if there was a better alternative. No kidding, Sherlock! I don't want to embrace anything if there is a better alternative. But are you being completely honest here? Is it not that you don't want to consider a universal healthcare system if there is even the slightest chance that something else even borderline tolerable can be cobbled together?

I'm not seeing the vaguest hint of a suggestion that there's a better system than some form of universal provision. I'm not even seeing any real evidence that there's even a possible candidate in the "borderline tolerable" category.

And yet, still you seek. I do think you might benefit from examining again your reasons for this ideological position.

Rolfe.

 

[oggiesnr]

Plus, I mostly left because you guys/girls are [rule 10]-holes. I still don't agree that we need to switch to UHC to have better HC. The more I'm reading, the more I find out how crappy systems like Canada's are. I don't see people dying in the streets here yet, so I still have time to ponder.

Because Canada's system may be crappy (and overall the jury is definatly out on that one, think of the hatchet job that could be done on the US system to prove insurance don't work) doesn't mean they all are. Suggest you look at the NHS and other european models and compare them to your own.

For as long as the predominant system in the US is insurance based and there is not universal coverage for all then you're going to have a crap system. For as long as you are determined to pay more for that crap anywhere else and believe that taxation is theft/slavery then there is no incentive for any change.

If you add in a litigation system that says all medical deaths are woth a lawsuit then you have a true no-win situation. And for as long as "documentaries" made by idjits like this are taken seriously you haven't a prayer. May you always be in good health, insured or rich enough for it not to matter.

Steve

 

[Rolfe]

Plus, I mostly left because you guys/girls are [rule 10]-holes. I still don't agree that we need to switch to UHC to have better HC. The more I'm reading, the more I find out how crappy systems like Canada's are. I don't see people dying in the streets here yet, so I still have time to ponder.

I'm sorry you feel that way. I don't think this debate has been noticeably more robust than many others in this forum. I realise you were very offended by the many posts which accused you of being comfortable with the idea of leaving the poor or the foolish or the improvident to die without medical treatment. However, this was simply the logical conclusion of the position you were adopting at the time, even if you hadn't realised that yourself.

I would agree that I've read some things that make me feel Canada's system is not one of the best. However, I also note that even Stossel, who is clearly as biassed as they come, admitted that the majority of Canadians are happy with their system. I also note what Triangleman said a page or so back.

As an aside, while I would never claim that a Canadian health care system is the most amazing healthcare system ever, I do think that most Canadians highly value universal health care.

Any Canadians here remember the CBC's Greatest Canadian series a few years back? Remember who won?

So who won?

Rolfe.

 

[Blue Mountain]

Plus, I mostly left because you guys/girls are [rule 10]-holes.

Ad hominem noted.

I still don't agree that we need to switch to UHC to have better HC. The more I'm reading, the more I find out how crappy systems like Canada's are. I don't see people dying in the streets here yet, so I still have time to ponder.

It has been pointed out many times in this very thread and in this thread (currently at 26 pages) that Canada's system is not the only model available for extending health insurance to more people.

Without extending the scope of health insurance, I don't see how the situation in the US can be improved. We've considered and rejected the idea of trying to make it less expensive (won't work due to poor economies of scale) and using charities (won't work due to their spotty nature.)

 

[Rolfe]

Suggest you look at the NHS and other european models and compare them to your own.

I suppose it's natural to look at Canada, it being right next door and all. But anyone examining the matter seriously has to look beyond that. In Europe (and Australia and New Zealand) there are a number of different systems, some retaining the insurance companies as an integral part of the universal system, and some not. Each has different advantages and disadvantages. If you're designing something for a new implementation, then surely you look to incorporate as many of the advantages as you can.

I think what much of it boils down to is money. People don't like paying taxes, and when the tax man calls, they don't usually sit down and think, rationally, about all they are getting for the money they're paying. No, they bitch and moan. So, obviously, governments have a tendency to court popularity by promising to reduce taxation. When they deliver on those promises, services get squoze. And if healthcare is one of those services, then it is liable to get squoze.

That, to me, is the principal (and possibly the only valid) objection to universal healthcare. And I don't think it even gets to the starting blocks as a reason to consider not having universal healthcare.

However, pretty much all the problems Dan (or anyone else) will find with universal systems are direct consequences of this. To suggest then that the USA, which currently spends about double the amount other countries do on healthcare, couldn't avoid these problems by ensuring that any system they introduced was better funded, is simply perverse.

Or, more concisely, there's nothing wrong with (e.g.) the NHS that throwing a bit more money at it wouldn't fix - and at the moment the USA is throwing mindboggling amounts of money at healthcare, so they should at least be able to address that one.

Rolfe.

 

[Rolfe]

I have a friend who is an NHS doctor. She is married to an NHS consutant. Dinner at their house would be music to Dan's ears. Every frustration in the system is teased out and worried over and damned to the fires of hell. One evening, remembering threads like this, I said, you know, it's astonishing how defensive you get of the NHS when you start debating with Americans.

My friends started to laugh, and went on laughing for quite some time. Indeed, they agreed, no matter how much they might moan (and who doesn't moan about their work from time to time), they wouldn't have the US system at any price.

Rolfe.

 

[Rolfe]

I've noted that the drawback to the NHS model is that because of its funding being from general taxation, there is a danger of underfunding by politicians looking for the popularity that comes with tax-cutting.

Let's look at the advantages.

For the patients who choose to use the NHS (damn, I've been over this already, where do I start....)

• Free at point of need
• Cheap by any standards
• No lifetime upper limit on amount spent on one individual
• Past "claims" record does not affect the level of service offered in the future
• No coupling to employment, and so no interference with career goals
• Preventative medicine encouraged
• Prioritisation by clinical urgency
• Free choice of provider (within the system), unrestricted by insurance company contracts
• Healthcare needs decided by healthcare professionals cannot be vetoed by insurance company
• Entitlement to care means that victims of system failures have redress

For patients who choose not to use the NHS

• They choose to spend money to get extra service, they are not compelled to do it to get essential care
• The NHS is still there for them if they run out of money
• The NHS is there for them if they become an emergency (accident or sudden severe injury)
• The NHS is there for them if the private system screws up or can't cope with their needs
• The NHS allows them to assess the quality of the private provider they may be choosing (quality being directly linked to rank achieved within the NHS)
• The NHS is looking after the hoi polloi, thus leaving their swanky private clinics as havens of upper-middle-class respectability
• While they still contribute to the NHS through their taxes, they also retain their right to benefit from it (see points 2, 3 and 4 above), and the cost is barely noticeable in the general tax take anyway

For the doctors

• A very good salary level indeed
• The professional satisfaction of dealing with the most challenging cases irrespective of the patient's ability to pay
• The ability to take each case as far as clinical need dictates, without funding restrictions from an insurance company
• The right to run a private practice alongside one's NHS position
• The advantage to that private practice conferred by the kudos of having secured a high-status NHS position

And for society

• The comfort of knowing that no member is going to be left without entitlement to healthcare
• The public health benefits of having the whole population eligible for preventative healthcare
• The facilitation of mobility of labour
• The absence of any cost to businesses of their employees' healthcare
• Bulk buying contracts allow very favourable economies of scale
• A comparatively very cost-efficient system, despite all the accusations (many justified) of wasteful bureaucracy

There are more, but that's enough for now. Like I said, what's not to like?

Rolfe.

 

[Tsukasa Buddha]

Okay, my fear is that under a government funded system the pressure to control costs will lead to excessive regulation of personal lifestyles as they pertain to health.

That's my potential downside.

 

[Policenaut]

Is there any point at which a universal health care system becomes impossible to pay for? By this I mean regarding an ageing population. The longer people live the more medical treatments they are going to need. And with fewer younger people would there be tipping point where there just aren't enough people paying into the system to support the population? I mean isn't this the reason why medicare is trillions in debt?

 

[Francesca R]

Yes as a population ages then the financial burden of any type of healthcare increases regardless of how it is funded. But the demographics of the US are somewhat more favourable than those of Germany and Japan and no worse than the UK and France, so that by itself does not account for the higher cost of the US system.

 

[TriangleMan]

Is there any point at which a universal health care system becomes impossible to pay for? By this I mean regarding an ageing population. The longer people live the more medical treatments they are going to need. And with fewer younger people would there be tipping point where there just aren't enough people paying into the system to support the population? I mean isn't this the reason why medicare is trillions in debt?

The wiki article on Medicare says that the government examination of the problem indicates that rising medical costs are the chief reason why the cost to maintain Medicare is getting more and more difficult, the aging population is also a factor but not as significant. But rather than rely on a wiki article if you're concerned about the issue search some government websites (GAO?) to see if there are published studies.

 

[Darat]

Okay, my fear is that under a government funded system the pressure to control costs will lead to excessive regulation of personal lifestyles as they pertain to health.

That's my potential downside.

Dan mentioned something similar in another thread and the answer to that is to look at long established universal health care systems and see if that is indeed the case. When you look at the NHS you do not see, despite it existing for 60 years, any evidence of such an approach. What you do see is co-ordinated attempts to address national health issues.

In the UK we had a lot of media attention focused on some NHS trusts a couple of years ago because of those trusts' decisions (for example) to state that someone needed to lose weight or stop smoking prior to undergoing some surgical procedures. This was presented as being "Fatties denied treatment" or "Smokers left to die", this however was typical mass-media misrepresentation. What was happening was that based on clinical and medical assessments the medical staff were trying to ensure the best outcome for the patient. And sometimes that meant it was clinically very important that as part of their treatment they should lose weight or stop smoking prior to the next stage of their treatment.

 

[oggiesnr]

Is there any point at which a universal health care system becomes impossible to pay for?

The same could also be true of an insurance based system. The money paid (plus profit) has to be paid for by the money going in.

Steve

 

[Rolfe]

I've been thinking about the experience of the beginning of the NHS (there was an interesting episode of Doctor Findlay's Casebook which covered this by the way), and the breaking of the dam of pent-up unmet need. (The TV show dealt with a middle-aged woman who had had a fistula for 19 years, since the birth of her daughter, who was at last able to get the surgery she needed.) But it seems to me that this flood was dealt with fairly quickly, and of course once it was done it was done. Any new fistula cases were operated on as they happened, for example.

I wonder how this compares to Medicare eligibility in the USA? I'm not sure what age this kicks in, is it 60 or 65 or what? Anyway, is there a permanent phenomenon of people hanging on to chronic, non-life-threatening conditions until they reach the Medicare eligibility age, and then getting them seen to? And does this cause problems for the system?

I have a cousin who has just turned 65. She had a hip replacement two years ago. In fact she was bounced up the queue because her condition deteriorated rapidly, and only had a very short wait. She's fine now, at least in that respect. However, if she'd been in the USA, I wonder if she'd have tried to hang on the extra two years until she was entitled to free treatment. Presumably she'd have been a lot worse by then, and probably a worse surgical risk.

I haven't heard anyone mention this as a problem in the US, but I wonder if it happens.

Rolfe.

 

[Rolfe]

Okay, my fear is that under a government funded system the pressure to control costs will lead to excessive regulation of personal lifestyles as they pertain to health.

That's my potential downside.

As Darat said, you need to look at countries which have had government funded systems for many years and see what happens in this respect. We've had the NHS for more than 60 years, and I can assure you that I am entirely free to take no exercise, smoke 60 fags a day, and exist on an exclusive diet of deep-fried Mars Bars washed down with cheap gin if I want to.

The government is likely to spend a bit of our money to try to persuade me not to do this. I'm likely to be offered help to quit smoking. There are prime-time TV ads aimed at that, for a start. I'll be urged to eat five portions of fruit and vegetables a day, and restrict the number of units of alcohol I consume in a week. But it's all persuasion, and information, and carrots. There are virtually no sticks. If someone is determined to ignore all attempts to help them improve their lifestyle and so their overall health, then I'm afraid they will do just that.

You surely don't think the government shouldn't try to improve public health in this way? What is it you're actually afraid of? Your doctor telling you you need to lose weight if you want to reduce your chance of having a heart attack? I'd be surprised if US doctors weren't already doing that.

Heck, I think our ban on smoking in enclosed public places came after similar bans in the USA - the experience in the USA of implementing such bans was part of what informed our decision to go for it!

As Darat said, the only area where it might seem as if some compulsion was going on, is the cases where patients have been told to lose weight or stop smoking or stop drinking before they can have particular surgery. This is because the outcome of the surgery will be vastly improved if it is performed on a patient who is a normal weight, or a non-smoker, or a non-drinker. Would you really prefer a system where the patient could just tell the doctors to go to hell at this point and insist on getting surgery with no lifestyle alteration?

Rolfe.

 

[Francesca R]

Heck, I think our ban on smoking in enclosed public places came after similar bans in the USA - the experience in the USA of implementing such bans was part of what informed our decision to go for it!

This can be justified on the grounds of stopping externalities, rather than "for the smoker's own good" (that is--the smoker is still entitled to trash their health but not do something objectionable for others against their wishes). Although that doesn't make the case clear cut of course. But it reminded me of one of the earliest threads I got involved with, which was fun.

(Nothing to do with this thread)

 

[ponderingturtle]

I don't think it is unreasonable to ask for alternatives to switching completely to a UHC system. The point of the thread was to brainstorm ideas that could lower the cost of the US health care without switching to a soc-type system. The Stossel video had some ideas that I hadn't thought of before and I'm hoping others might be able to contribute similar ideas.

And there is an easy answer, go all victorian and throw people who can't pay out on the street to die. Look at the case of that kid with the lip bitten off by the dog. They forced doctors to treat him with out pay stealing from them, and removed his future career in begging.

 

[ponderingturtle]

Plus, I mostly left because you guys/girls are [rule 10]-holes. I still don't agree that we need to switch to UHC to have better HC. The more I'm reading, the more I find out how crappy systems like Canada's are. I don't see people dying in the streets here yet, so I still have time to ponder.

But people dying in the steets is good, it means that they are not running up health care costs.