Canadian Heathcare system sucks!!

[volatile]

"Other countries do it"?

That's IT?

Where are the savings, volatile? What spending can we eliminate? Do tell. Because apparently Congress can't figure it out.

Every other country that has tried it. You're pretending that there is some unique condition of America - a condition which is unidentifiable, to boot - that prevents economies of scale, negotiated bulk drug-purchasing, administrative streamlining, treating sooner rather than later and refusing to pander to the ill-informed patient who wants 5 MRIs when his physician deems one to be sufficient from working in the same way they do on the rest of the planet.

Congress is hog-tied by the mendacious rhetoric of the self-interested insurance industry, their well-remunerated lobbyists and the politicians and voters on the ideologically-dogmatic right who swallow the nonsense they're fed because it better fits their world-view. It's people like you, ironically - the useful idiots - who are stopping the USA from being a world-leader in effective, successful universal healthcare provision.

Tell me, Ziggurat - what on Earth makes you think that a UHC system cannot work in America as well as it does in the rest of the world under any circumstances? What kind of exceptionalism do you need to believe in to think that an experiment that has produced consistent results in dozens of demographically-similar countries won't work in America?

 

[Rolfe]

Americans do not demand the same things from our healthcare system that others demand. We demand access to the newest drugs (something many single-payer systems refuse outright to keep costs down), lots of high-tech diagnostics like MRI's, and expensive end-of-life care. You can argue that we are wrong to do so, that we don't get worthwhile care for the dollar, but the demand is there. And that demand won't go away under any universal health care system.

There are a number of misconceptions here.

First, it seems to be a common misconception that patients in other countries are denied "the newest drugs". While there are specific instances of very expensive new drugs with questionable cost-benefit taking time to be approved in the NHS, this affects only a tiny fraction of patients. The vast majority of people go through their entire lives and never have anything their doctor thinks they need denied to them.

Second, there seems to be no reason to assume that a universal system must inevitably provide every single thing Americans want (as opposed to need) from healthcare on a whim. While of course a system that provides very limited care would be a really bad idea, why assume that more MRI scans than are needed to make the diagnosis, or astronomically expensive drugs that might only extend life by a couple of weeks, would inevitably have to be provided?

Third, why assume that people would be unable to indulge their whims to have unnecessarily complicated and expensive healthcare interventions if they wanted them? If a good level of effective care were provided, and citizens were free to take out insurance (or just pay) to have additional items on top of that, it would be interesting to see what the uptake of that insurance was after the first decade or so.

Declaring that some people want excessive care, which is why we shouldn't try to provide the basic essentials for everybody, seems a bit perverse.

Rolfe.

 

[Rolfe]

Perhaps because we do not want, and will not accept, the same healthcare system as other countries. As I said, we make different demands. Whether or not we are right to make such demands, whether or not it's worthwhile to make such demands, doesn't change the fact that we make such demands and will continue to do so.

But who is "we"? It seems to me that the USA is a very diverse society. At the top we have the wealthy, who are able to make arguably unreasonable demands for healthcare provision because of their economic muscle. At the bottom we have people like KellyB, spending 50% of her household income on health insurance, and other posters we've heard from in this and other threads who can afford only poor and limited cover, or no cover at all. We have all the people who are having their insurance cover denied because of some minor inadvertent error when filling up a form years ago. We have the people whose employers find themselves unable to continue insuring.

Do you think the latter group of people would say that "we" will not be satisfied with a universal healthcare system because it will not meet our demands for far more tests than we need, and hugely expensive drugs that might keep us alive for an extra couple of weeks?

Rolfe.

 

[ponderingturtle]

Well, it depends. In Scotland, we have "free" personal care for the elderly, which isn't entirely free, and some local authorities have been criticised for operating waiting lists (declared to be unlawful), but covers quite a lot. In effect, people judged to be in need of such help are given a grant for what the government thinks nursing home care should cost. Which doesn't always cover the entire amount that's being charged. This isn't the NHS though, it's social services.

In England, it's kind of like you stated above. Wait till they run out of money and then pay for their care.

That's talking about people who aren't medically ill, though, just old. People whose need is due to a medical condition are theoretically covered by the NHS. I say theoretically, because the system isn't great. There are instances of relatives having to fight tooth and nail to have a sick person designated as eligible for such care. If they're not so designated, then yes, the system will keep taking their money until they run out of it and then just go on caring for them anyway.

Personally, I'd be in favour of paying higher taxes to improve coverage in this area, but the democratic will isn't there to make it happen.

Rolfe.

ETA: I should maybe make this clearer. Medical care is provided by the NHS, and everybody is eligible. It is not means-tested. Care of the elderly or long-term disabled is provided by Social Services, and this is means-tested. That means you pay for it yourself until you run out of money, then Social Services will step in. There is obviously some grey area here, which is subject to dispute.

I can say that I did not run into any people in nursing homes who didn't have real medical problems.

 

[Ziggurat]

Every other country that has tried it.

And did they achieve significant healthcare savings? Or was their healthcare spending simply lower to begin with?

You're pretending that there is some unique condition of America - a condition which is unidentifiable, to boot - that prevents economies of scale, negotiated bulk drug-purchasing

Here's a clue about bulk drug purchasing: it only works to lower the cost if you're willing to not purchase the drug. Easy to do with generics. New drugs? You tell me.

administrative streamlining,

Some room here. Not enough to close the gap.

treating sooner rather than later

I've seen no evidence that this will provide a significant overall savings. I like the idea of doing that, because it should improve medical outcomes, but significant savings? Nope. I've seen nobody provide evidence of that. Take smoking, for example: I've heard various arguments in favor of taxing it on the basis that smokers put a burden on the public system because of their health problems. But because they die younger, smoking actually produces a net savings to the public.

and refusing to pander to the ill-informed patient who wants 5 MRIs when his physician deems one to be sufficient

In other words, deny treatment. Such denial may be justified, but that's still what you're doing. Now, can you quantify the potential savings this could provide? Maybe you can, but you haven't.

It's people like you, ironically - the useful idiots - who are stopping the USA from being a world-leader in effective, successful universal healthcare provision.

Oh please. Spare me the self-righteous ad hominems.

Tell me, Ziggurat - what on Earth makes you think that a UHC system cannot work in America as well as it does in the rest of the world under any circumstances?

I've already told you why I think that's the case. Maybe I'm wrong. Good chance of that, in fact. But the reasons are ultimately irrelevant: either we can, or we can't. Where's the evidence that we can? Where's the evidence of actual, achievable, and huge spending cuts that don't dramatically cut services as well? Where, in our total healthcare spending budget, can you point to something and say, "this is where we can cut X dollars, and this is how we can do it"? And I'm not a "useful idiot" for being unwilling to radically overhaul the system from top to bottom without seeing where such savings will come from.

 

[ponderingturtle]

I imagine it would depend on the balance of competing priorities. If they're rushing someone to hospital with a serious heart attack and they see someone with a broken leg, probably not so much. If they're on their way back to base after responding with blue light flashing to some brain-dead prank call and they see someone being pulled unconscious from a lake, quite probably.

Pretty much the same then.

What would an ambulance be doing at a restaurant?

Getting lunch. YOu know that at least here if you are on an ambulance you do not get a lunch break. It would be more likely a deli or fast food place though. Also here even 911 ambulances can do things like go out shopping while on duty as long as they have radio responce and are near enough to their ambulance to respond in a prompt fashion. Do your police and such never stop for coffee and donuts(or what ever)?

You sound as if you have personal experience as ambulance crew. In that case, you can probably work out the answers as well as I can. An NHS ambulance is there to deal with the casualty it has been called to attend to, but if another casualty shows up, they'd be expected to do what was reasonable. So far as I know.

I worked as an EMT for a year and a half, and vollenteered on 911 ambulances for several years as well. That is partialy why this is of interest to me, as ambulance care is the part of medicine that I am most farmiliar with.

 

[ponderingturtle]

There are a number of misconceptions here.

First, it seems to be a common misconception that patients in other countries are denied "the newest drugs". While there are specific instances of very expensive new drugs with questionable cost-benefit taking time to be approved in the NHS, this affects only a tiny fraction of patients. The vast majority of people go through their entire lives and never have anything their doctor thinks they need denied to them.

Also they are not denied the drugs, the NHS just refuses to pay for them, they are free to pay for them themselves. I have also heard that if the drug is aproved they will be reimbursed.

Of course distributing medicine by ability to pay doesn't seem to bother Zig about the american system.

 

[Ziggurat]

But who is "we"? It seems to me that the USA is a very diverse society. At the top we have the wealthy, who are able to make arguably unreasonable demands for healthcare provision because of their economic muscle.

Sorry, but that makes no sense. Why would a health insurance company care if you're wealthy, if you aren't paying more for what they're providing? And if you are paying more, then it's not unreasonable to demand more, wealthy or not.

It isn't the wealthy who have gotten congress to place so many requirements on specific procedures that insurance companies must provide coverage for. It's the vast middle class. Except insofar as they are often employers and taxpayers (and in both roles, the incentive is to press for lower total costs), health care policy issues have diminishing impact on the wealthy. Unlike the middle class, if insurance doesn't cover an expensive procedure, they can just pay out of pocket. So no, the pressure is most assuredly NOT coming from the wealthy.

Take your class warfare blinders off.

 

[Rolfe]

and refusing to pander to the ill-informed patient who wants 5 MRIs when his physician deems one to be sufficient.

In other words, deny treatment. Such denial may be justified, but that's still what you're doing.

Excuse me? You're torturing definitions here. Since when was the patient the person who decides how many MRI scans he needs to arrive at a diagnosis? Since when has not funding interventions not recommended by the patient's physician been denial of treatment?

Declaring that such ridiculous excess cannot (or should not) be provided to the Great Unwashed, therefore those at the bottom of the heap should not have any state-provided or state-finded healthcare seems a bit of a stretch.

News flash. If you want 5 MRI scans in Britain when you only need one, you will probably be able to get them. You only have to go to the right door in Harley Street and be prepared to pay. And yet somehow we manage to allow this, while at the same time providing a good standard of actual necessary healthcare to everyone, including the one MRI scan they actually need.

Rolfe.

 

[volatile]

What she said.

 

[Rolfe]

Sorry, but that makes no sense. Why would a health insurance company care if you're wealthy, if you aren't paying more for what they're providing? And if you are paying more, then it's not unreasonable to demand more, wealthy or not.

It isn't the wealthy who have gotten congress to place so many requirements on specific procedures that insurance companies must provide coverage for. It's the vast middle class. Except insofar as they are often employers and taxpayers (and in both roles, the incentive is to press for lower total costs), health care policy issues have diminishing impact on the wealthy. Unlike the middle class, if insurance doesn't cover an expensive procedure, they can just pay out of pocket. So no, the pressure is most assuredly NOT coming from the wealthy.

Take your class warfare blinders off.

I'm not the one with the class warfare problem. You are speaking as if the people who can afford comprehensive healthcare insurance coverage are the only people who matter in this debate. "We" won't allow good basic healthcare to be provided universally, because "we" demand more than that for ourselves, and we're not even going to talk about the people who can't afford any of it.

Rolfe.

 

[pgwenthold]

Excuse me? You're torturing definitions here. Since when was the patient the person who decides how many MRI scans he needs to arrive at a diagnosis? Since when has not funding interventions not recommended by the patient's physician been denial of treatment?

See my post above. They don't want medical decisions made by the doctor, but they want to make them themselves.

 

[volatile]

And did they achieve significant healthcare savings? Or was their healthcare spending simply lower to begin with?

What are you talking about?

Currently,pretty much every country that wants to provides a universal system that is at least as effective medically as the USA system, but for lower cost.

Better cover, equivalent helathcare outcomes, lower costs. If you want to compare "healthcare spending" of the UK in 1947 with today, be my guest, but I don't know what you'll think you're proving.

And how about we run the thought experiment in reverse? Imagine the UK ditched the NHS, and switched to the US system tomorrow. Would we achieve "savings", now that we have 8 times as many staff, a profit motive, means-testing and A&Es being used as GPs offices?

Here's a clue about bulk drug purchasing: it only works to lower the cost if you're willing to not purchase the drug. Easy to do with generics. New drugs? You tell me.

If you buy more, your unit price is lower. Basic economics. Universal healthcare providers buy more drugs than individual hospitals, or HMOs or whoever it is who buys drugs for the private patients in the USA.

Do the economics of bulk purchase not work for drugs? Even if your point is correct - that is to say, if manufacturers of wonder drugs will simply charge whatever they wish because they have no competetion - someone buying at volume will still be able to buy cheaper.

I've seen no evidence that this will provide a significant overall savings. I like the idea of doing that, because it should improve medical outcomes, but significant savings? Nope. I've seen nobody provide evidence of that. Take smoking, for example: I've heard various arguments in favor of taxing it on the basis that smokers put a burden on the public system because of their health problems. But because they die younger, smoking actually produces a net savings to the public.

In other words, deny treatment. Such denial may be justified, but that's still what you're doing. Now, can you quantify the potential savings this could provide? Maybe you can, but you haven't.

Rolfe covered that one already. Since when did a physician denying medically-superfluous procedures become a BAD thing? Anyway - I thought you guys were all against "free riders" and often potted out the argument that if healthcare were free at the point of use, people would demand everything and anything, like kids in a candy-store?!

Oh please. Spare me the self-righteous ad hominems.

You've been here long enough to know what an ad-hominem is, Ziggurat. That isn't one.

Fact is that you've swallowed the talking points of the ideological right - talking points that, it turns out, are fed directly to right-wing politicians by financially-interested insurance companies - hook line and sinker. The impediment to the system working is you, and those like you.

I've already told you why I think that's the case. Maybe I'm wrong. Good chance of that, in fact. But the reasons are ultimately irrelevant: either we can, or we can't. Where's the evidence that we can? Where's the evidence of actual, achievable, and huge spending cuts that don't dramatically cut services as well? Where, in our total healthcare spending budget, can you point to something and say, "this is where we can cut X dollars, and this is how we can do it"? And I'm not a "useful idiot" for being unwilling to radically overhaul the system from top to bottom without seeing where such savings will come from.

I told you, and plenty of others have done the maths. The fact is you're pretending that this is some great unknowable; that the expierment hasn't been done. It has - there are no fundamental barriers to the implementation of a well-functioning UHC system on a par with those of Europe and Canada. The only barrier is misguided ideology and lies.

 

[pgwenthold]

I'm not the one with the class warfare problem. You are speaking as if the people who can afford comprehensive healthcare insurance coverage are the only people who matter in this debate. "We" won't allow good basic healthcare to be provided universally, because "we" demand more than that for ourselves, and we're not even going to talk about the people who can't afford any of it.

It was interesting last year when my wife was pregnant, and I was interacting with lots of other pregnant women who were about at the same stage. They were constantly asking the question, "Why won't my doctor do an ultrasound? She will only do one, at about 20 weeks. I would feel so much better knowing everything was ok."

I was like, "Um, because you don't NEED an ultrasound, not even to 'know everything is ok.' Why should your insurance company pay for an unnecessary procedure? Heck, even if you want to pay for it yourself, why should the doctor/tech waste time doing it when they have medically necessary appts to fulfill?"

There was even talking of faking a problem (aka insurance fraud) just to get an ultrasound.

Now, we, in fact, did have an early ultrasound because my wife had some bleeding, and they wanted to check into it. So whenever these moms would say, "I wish I could get an early ultrasound, too," I would tell them, trust me, getting the early ultrasound was absolutely NOT worth having to see a diagnosis that says, "Abortion: threatened."

I guess my point is that there is a big difference between what patients want and what they actually need. I have no problem with insurance denying things that aren't needed, as long as it is covering things that are.

 

[Ziggurat]

I'm not the one with the class warfare problem.

You scapegoated the wealthy for a problem created by the middle class.

You are speaking as if the people who can afford comprehensive healthcare insurance coverage are the only people who matter in this debate.

No I'm not. But the middle class are the primary drivers of large healthcare costs, because they're consuming most of that healthcare. Rather elementary logic, Rolfe. And it's got nothing to do with how much I care about the health care situation of the poor, but nice try at inserting a strawman.

"We" won't allow good basic healthcare to be provided universally, because "we" demand more than that for ourselves, and we're not even going to talk about the people who can't afford any of it.

And yet again, the inability to distinguish between a description of the way things are and preferences for the way things should be.

 

[volatile]

And yet again, the inability to distinguish between a description of the way things are and preferences for the way things should be.

How should things be, in your opinion?

 

[Ziggurat]

If you buy more, your unit price is lower. Basic economics.

And you achieve economies of scale by spending more in total. Economies of scale don't lower total costs. Basic economics.

Do the economics of bulk purchase not work for drugs?

They can. But the power of bulk purchase agreements aren't based upon economies of scale. It's an issue of negotiating power, which is why a bulk purchasers can get better prices than small-volume purchasers, even though they both benefit from the same economies of scale. And you can't get negotiating power unless you're willing to forgo purchasing. In the case of generics, that's all well and good, because you can forgo purchasing from one vendor in favor of another. But for new drugs, that's not an option. To exert your negotiating power, you must be able to credibly walk away from a purchase if the price isn't low enough, otherwise the vendor has no incentive to lower his price. And how do you make that credible? You have to actually do it, at least some of the time. Which means that in order to get bulk purchasing price advantages from new drugs, you'll have to forgo buying them sometimes. That's the economic reality. You tell me whether or not you want to ever forgo buying new drugs, but if you don't, you won't get any price advantage.

Rolfe covered that one already. Since when did a physician denying medically-superfluous procedures become a BAD thing?

I never said it was.

You've been here long enough to know what an ad-hominem is, Ziggurat. That isn't one.

Calling me a "useful idiot" isn't an ad hominem? That's rich.

 

[Rolfe]

I have no real problem with people paying for extra care that they don't actually need. People do it all the time in Britain, to get a private room, and better food, and altogether treated as if they're in a swanky hotel. If someone wants to take them for even more to do extra MRIs on them, so long as the capacity exists in the system, I don't honestly care. (I wonder what Zig would say to the patient who demanded extra x-rays though?)

I also have no real problem with people taking up insurance policies that offer over-the-top coverage, if that's what people want, and there is capacity in the system, and they actually do pay a higher premium for this.

What I don't understand is insurance companies allowing insured patients to demand more expensive options than necessary. If I crash my clapped-out 11-year-old car, my insurance company won't give me a brand new top-of-the-range model in recompense. If my cat shreds my Ikea furniture, my insurance company isn't going to replace it with Ercol.

But even if health insurance companies are doing this, for whatever reason, there is no need to mandate that a universal system does the same. But at the same time that would still leave the wealthy individuals free to purchase whatever extras they could persuade their provider to supply.

It seems to me that most people who favour a universal system are largely coming from the belief that those on low incomes should be able to access better healthcare in the USA than they can at the moment. That healthcare should not be so intimately tied into employment. That uninsured people should not be required and encouraged to commit fraud in order to access emergency treatment. And so on.

To encounter an argument that these goals as as nothing, because those wealthy enough to afford comprehensive health insurance demand that the universal system should support the gross over-provision that they want for themselves, is positively surreal.

Rolfe.

 

[Rolfe]

You scapegoated the wealthy for a problem created by the middle class.

No I'm not. But the middle class are the primary drivers of large healthcare costs, because they're consuming most of that healthcare. Rather elementary logic, Rolfe. And it's got nothing to do with how much I care about the health care situation of the poor, but nice try at inserting a strawman.

And yet again, the inability to distinguish between a description of the way things are and preferences for the way things should be.

You misunserstood what I meant by "wealthy". Wealthy enough to afford comprehensive healthcare insurance.

So, you've decided the problem is insoluble? That it is simply impossible to get out of the situation you describe?

Cease to lament for that thou canst not help, and study help for that which thou lamentest.

Rolfe.

 

[Ziggurat]

So, you've decided the problem is insoluble?

I've decided there are no realistic options which can dramatically reduce our total healthcare spending. That does not mean improvements cannot be made, in terms of efficiency, distribution, or quality.