Health care - administrative incompetence

In Singapore, the gov TAKES, AGAINST YOUR WILL, a % of your income to be paid into a HSA and the collectivist insurance plan for large expenditures.
Yes, the gov is always going to take taxes. In Singapore, they take 6-9% as forced savings which is used for your own healthcare and is supplemented by employers. Of course, there is also an income tax in Singapore (much lower rates than the US) and this tax money is used to pay subsidies for lower income people. Not so bad.

How is that "personal responsibility"? How is that not the gov thinking they can spend your money better than you can?
Well, you are saving for your own care. You make all the decisions. You are paying for your catastrophic insurance. The government pays only through the subsidies.

I agree that that's better than what the US has right now. Far, far better. But how is that more "free market" than the current situation in the US?
The government only controls pricing, not what doctors can and can't do health care wise. Patients can see any doctor and go to any hospital in the country. I don't like the price controls but I do like giving patients the freedom to choose.

And how is the NHS a system where " the government has to become your doctor or make your health decisions for you"? WTF?
The doctors in the UK are all employed by the government. The government is your doctor and all guidelines are created by the government. If they say you don't get care, you don't get care unless you are rich.

Do you understand that the entire population in the UK is covered by (per capita) what we pay for Medicare and Medicaid alone?
Maybe, but Singapore pays even less and it's freer.

How can the Singapore system bring down Medicare costs? Or do you want to abolish Medicare? Talk about a pipe dream!
I want to abolish Medicare. What will probably end up happening is a morphing of Medicare, not an destruction of it.
 
First of all, I want to say that I like the Singapore system. I only take issue with it here because I think in the US, the multitude of vested interests would ensure that our health care costs remained inflated.

The doctors in the UK are all employed by the government. The government is your doctor and all guidelines are created by the government. If they say you don't get care, you don't get care unless you are rich.

And US guidelines are created by Vested Interests, too. And you don't have to be rich to get care the NHS doesn't offer. The gov isn't your doctor under the NHS. It just works out (at present) that 99% of the stuff that your doctor might think you might need is covered by the NHS.

Maybe, but Singapore pays even less and it's freer

How is it "freer"?
 
Here's a fairly balanced report of Singapore:

What we can learn from Singapore's health-care model

For starters, adequate savings for retirement and health expenses are mandated by government (employees must sock away 20 percent of earnings each year, to which employers add 13 percent). Public hospitals provide 80 percent of the acute care, setting affordable pricing benchmarks with which private providers compete. Supply-side rules that favor training new family doctors over pricey specialists are more extensive than similar notions Hillary Clinton pushed in the '90s. And in Singapore, if a child is obese, they don't get Rose Garden exhortations from the first lady. They get no lunch and mandatory exercise periods during school.

There's more (including an ample safety net for the poor), but you get the gist: Singapore achieves world-class results thanks to a bold, unconventional synthesis of liberal and conservative approaches. It's further to the left and further to the right than what President Obama or his foes now seek. The island's real ideology is pragmatic problem-solving. It works thanks to cultural traditions that let this eclectic blend flourish. The system is nurtured by talented, highly paid officials who have the luxury of governing for the long-term without being buffeted much by politics.

http://www.washingtonpost.com/wp-dyn/content/article/2010/03/03/AR2010030301396.html
 
xjx388, do you ever intend to address the issue of people with chronic illness?

Bookitty, your story about your MIL was heartbreaking, I am sorry.
 
Holy Crap! :eye-poppi

I take a few days off forum posting for Christmas and missed roughly 8 or 9 pages of debate.

Just one Question for XJX388:

How exactly does Market and Price-fixing by Anti-trust Exempt Oligopolistic Consortiums of Health Insurance, Big Pharma, and For Profit Clinics amount in any way to "Free Markets"? :rolleyes:

The notion that For Profit Health Care and Corporate Capitalism is based on "Free Markets" is a joke.



What Capitalists REALLY mean by "Free Markets" is minimal Government Regulation and Oversight of Corporate Conglomerates, which are then left relatively free to fleece the public while propagandizing us with a pseudo-hyper-individualist ideology.

Talk about Utopian Delusions. Your Ayn Rand Dreamworld is a sham xjx388.

Even Adam Smith understood that Corporatism distorted "Free Market" principles. It should be up to democratic institutions to regulate Capital and prevent Monopolist or Oligopolistic practices by wealthy individuals.

And in large societies, it is as important for democratic governments to enforce strict regulatory controls on Capital and Industry, as it is for them to minimize grotesque inequities through progressive taxation that taxes Profits (the skimming by the Wealthy of the surplus value created by Labour) at far higher rates than Earnings (please learn the difference between Earnings and Profits xjx388).

Then the Wealth created by Labour in a democratic society can be fairly distributed back to those that perform the labour by providing Public Services--such as universal health-care, and subsidizing housing, food, etc, to prevent people from falling into poverty.

Idealistic?...Perhaps. But not nearly as delusional as the Utopian Fantasies of pseudo-"Free Marketeers."

The fact that so many other (small d) democratic nations can manage to accomplish some of the above (when not under attack by Right Wing Plutocrats), is evidence that it is not only possible for socialized economic systems to stabilize the economy; but that it is the best foundation for a stable economy AND a stable political system.

It should be noted that those countries with greater regulatory control of Capital Markets and greater Social Safety Nets have (generally) weathered the "International" Financial Crisis better than those which have less regulation of market penetration by international speculators.

This end of the discussion may seem like a derail to certain pseudo-"Free Market" propagandists; but it isn't, as the "Financial Crisis," and Government Deficits, and Debts are being used by the Right Wing Plutocrats as an excuse to double down on the Depression by slashing Public Services (like Health Care) and impose "Austerity Measures."

To those of you still residing in the UK, for your own sake, put a stop to the Tories' attack on the NHS. The plans they are implementing are steps towards the eventual total Privatization of the NHS.

Besides, if I ever dig myself out of my financial hole created by the Economic Collapse, I hope to return to the UK, not an outpost of the US ;) .


GB
 
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In Singapore, the gov TAKES, AGAINST YOUR WILL, under threat of incarceration or death of you fight back, a % of your income to be paid into a HSA and the collectivist insurance plan for large expenditures.

How is that "personal responsibility"? How is that not the gov thinking they can spend your money better than you can?

I agree that that's better than what the US has right now. Far, far better. But how is that more "free market" than the current situation in the US?

And how is the NHS a system where " the government has to become your doctor or make your health decisions for you"? WTF?

Do you understand that the entire population in the UK is covered by (per capita) what we pay for Medicare and Medicaid alone?

How can the Singapore system bring down Medicare costs? Or do you want to abolish Medicare? Talk about a pipe dream!


Good points.

@xjx

Interesting, they have means testing to determine where you get to stay in hospital:

Means testing in Singapore hospitals

Patients warded in B2 and C class wards in public hospitals with effect from 1 January 2009 will be means-tested to determine the level of subsidy they will be entitled.

* Patient subsidy will be based on the average monthly income received over the last available 12-month period including bonuses for salaried employees.
* Services such as Day surgery, A&E services, Specialist Outpatient and polyclinic visits will not be means tested and standard subsidies rate applied to citizens and PR as usual.
* People with no income, such as retirees or housewives, will have their subsidy rate pegged to the value of their homes.
* All unemployed residents of HDB flats excluding those in executive condominiums (EC) will be entitled to full subsidy.

You pay more if you have money to less if you have none.

I really want to visit Singapore, however, there are traditions in their culture that you just can't get around, like chewing gum is banned, littering has HUGE fines, and there is the death penalty for drug possession.

I am surprised, as a freedom loving American, that you would choose Singapore, as there are quite a few government mandated issues.

Can you imagine what the response from the American public would be if some of the practices, like measuring waistlines, telling the patient they are too fat and have X amount of time to lose weight would be?

As mentioned, children are made to skip meals.

I am not completely opposed to government guidelines and interventions, I do think that some drastic changes are necessary for tackling obesity, but do you really think Americans will go for this?

I think you saw half private, half public and thought it was a good idea.

This is an entirely different cultural mentality, it would never fly in the US.


http://www.msnbc.msn.com/id/6124732/ns/health-kids_and_parenting/
SINGAPORE — The fight against obesity starts young in Singapore. Fat children are separated from their classmates and ordered to do more exercising until they lose weight.

Ten-year-old Mona Siow has been trying to lose weight for the last four years.

Instead of joining her friends at the canteen during recess every day, the fourth-grader and other chubby students gather in the hall and follow a teacher’s instructions to skip rope, run, and dribble a basketball.

http://www.pacifichealthsummit.org/...ol Efforts in Singapore - 2008 Case Study.pdf

Singapore Workplace Health Promotion Programs:

Almost 60 percent of Singaporeans over the age of fifteen years participate in the workforce in some way.10 This makes the workplace a natural and effective setting in which to promote the health and well-being of both employees and management.

To incentivize companies and organizations to start and sustain Workplace Health Promotion (WHP) programs, HPB introduced WHP grants in 2001
.

Any organization can apply for up to SGD$5,000 to help support the development and sustainability of a WHP program. The organization must co-fund the project by contributing an equal or higher amount. The grant may be used by companies and organizations to fund activities such as training for staff to conduct workplace health promotion programs, health risk assessment for employees, and health education activities. Grants may also support the purchase of related equipment and facilities or incentives that increase participation and motivate behavior change.

Government mandates what cooked and restaurant food can be sold to the public

Community-wide Programs

Healthier Hawker Program: Launched in July 2006, the Healthier Hawker Program encourages hawker centers to prepare their signature dishes with healthier ingredients.14 With about half of Singaporeans patronizing hawker centers almost every day of the week, the program aims to provide a healthier food supply to Singaporeans—without compromising taste, accessibility, or cost—by incentivizing vendors to switch to healthier ingredients, such as cooking oil with a lower percentage of saturated fat; fiber-enriched noodles; and low-fat milk in lieu of coconut milk.15 HPB partially subsidizes the costs of some of these healthier ingredients, which are slightly more expensive than the regular ingredients. For example, HPB absorbs about 10 percent of the cost of the healthier cooking oil to make it more affordable to the hawkers.


Participating stalls display the “Healthier Choice Symbol” on their Food Hygiene Certificate. Through public education campaigns, Singaporeans are encouraged to choose participating stalls over others. Since its inception in 2006, the number of vendors participating in the Healthier Hawker Program has increased from 32 to 800.


Healthier Dining Program: The Healthier Dining Program was introduced in 2003 to increase the availability of healthier dishes in restaurants. HPB works with participating restaurants to modify existing dishes so that they contain less oil, salt, and sugar—and include more fruit and vegetables—as well as to introduce healthier new dishes. To encourage patronage of healthy restaurants, HPB runs articles in food magazines and national newspapers and conducts quizzes and competitions. A list of healthy restaurants is published on HPB’s website.16 More than 300 restaurants are currently participating in the program. The proportion of table orders that have at least one healthier dish increased from 35 percent in 2004 to 63 percent in 2008.

Government madates in the food manufacturing industry


Partnerships with Food Manufacturers

HPB’s Healthier Choice Symbol (HCS) Labeling Program was introduced in 1998 to provide a framework for governmental cooperation with the food industry, as well as to improve nutrition labeling and ensure a healthy food supply. Manufacturers with products that meet predefined nutritional criteria set by HPB display the HCS displayed on their food labels.
A weekly running session in the Central Business District for working adults.
12 Obesity Prevention and Control in Singapore
Since 1998, food manufacturers in Singapore have responded favorably to this initiative by reducing salt, total fat, saturated fat, trans-fat, and sugar in consumer products. There is also evidence that good practices by supermarket chains in promoting HCS products at affordable prices have led to a shift in consumers’ preferences and purchasing behavior:
• The percentage of sales of HCS products compared to the total number of products in the same category (e.g., low-fat fresh plain milk labeled with HCS versus all fresh plain milk) increased from 29 percent in 2003 to 50 percent in 2007.17
Based on results fro
m a survey conducted by HPB • in 2004, 67.4 percent of people were aware of HCS labels on food products in the market, and 69.0 percent of these people had used this symbol to assist them in making healthier food choices.18
 
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...snip...

Most people don't particularly enjoy going to the doctor, so I don't see the health care armageddon you predict being plausible. Nothing of the sort happened when the NHS (or any other single payer system on earth) was created, for example.

I've already addressed that part of his bogeymen, we see the complete opposite happening here to what he thinks should be happening. Indeed the NHSs in the UK are trying to get more people to see their GPs more often and earlier rather than later.
 
Please elaborate and show your evidence.
:rolleyes: ¡Ai-yi-yi! . . .
In the UK (Your own source by the way)

The NHS Breast Screening Programme provides free breast screening every three years for all women in the UK aged 50 and over. Around one-and-a-half million women are screened in the UK each year. The NHS Breast Screening Programme is phasing in an extension of the age range of women eligible for breast screening to those aged 47 to 73 starting in 2010. This will be completed in 2012.

Because the programme is a rolling one which invites women from GP practices in turn, not every woman will receive an invitation as soon as she is 50. But she will receive her first invitation before her 53rd birthday.

In the US

The American Cancer Society recommends these screening guidelines for most adults.

Breast cancer
  • Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health
  • Clinical breast exam (CBE) about every 3 years for women in their 20s and 30s and every year for women 40 and over
  • Women should know how their breasts normally look and feel and report any breast change promptly to their health care provider. Breast self-exam (BSE) is an option for women starting in their 20s.

The American Cancer Society recommends that some women -- because of their family history, a genetic tendency, or certain other factors -- be screened with MRI in addition to mammograms. (The number of women who fall into this category is small: less than 2% of all the women in the US.) Talk with your doctor about your history and whether you should have additional tests at an earlier age.

So not only yearly mammograms in the US but MRIs for some rare women. Don't see this advised in the UK . . . I wonder . . . could it be . . .

COST-SAVINGS?

You are comparing apples and pears, the UK part above is what actually happens, the USA quote is a recommendation by a body.
 
Ah. Thanks for clarifying.

Yes. I want a free market and no Singapore isn't a completely free market (not completely closed either, mind you). However, it illustrates that a model very similar to the one I proposed can work. Maybe this is the model we should be trying to improve upon instead of the UK's model?

...snip...

Quite a few of us have mentioned that there are one or two* other styles of UHC the USA could adopt, indeed I doubt anyone on the UK side would recommend that the USA adopts the NHS model. (The NHS model was created in differ net times and I don't think it would be possible today to move a country the size of the USA to such a model.) But there are many more models to choose from, and again they cost less to cover everyone than the USA is paying today to not cover everyone!

(*What was it 40 something?)
 
You are comparing apples and pears, the UK part above is what actually happens, the USA quote is a recommendation by a body.

The NHS is extending the screening program to women who are 47 by 2012.

We are currently screening 73.6% of all women who qualify for screening, and there are public health campaigns for more women to take up screening.

http://www.onmedica.com/newsArticle.aspx?id=935d76a2-b611-440f-9825-4cd5ea8b25ac

In the US, only 50% of the women from 40-50 are being screened, and 60 % of those over 50.

http://www.nhs.uk/conditions/cancer-of-the-breast-female/

Measures of an effective screening programme:

http://www.ajronline.org/cgi/content/full/176/6/1357

People should note that early age breast cancer and high frequency screening for breast cancer (as well as screening for prostate cancer), does not follow at least four of the measures.
 
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Who pays for that screening?

The patient (and the insurance company).

Which is why I linked a few posts ago about prenatal care and breast cancer screening.

If you have no insurance, you won't be getting much of anything in the way of health care, unless you're really, really sick.

You're forced to pay the full costs, find a free clinic, go to the ER, or rely on subsidized help. But the subsidized help (Medicaid, etc.) leaves the working poor out in the cold.

Bookitty: I share in everyone's sorrow for what your MIL and your family went through. As an American, it is a story I know of only too well.
 
@xjx

Interesting, they have means testing to determine where you get to stay in hospital:
<snip>

You pay more if you have money to less if you have none.
Well, a similar thing occurs now in the UK, now, but they don't call it the same thing. If you pay extra for private insurance you get a private room.

I really want to visit Singapore, however, there are traditions in their culture that you just can't get around, like chewing gum is banned, littering has HUGE fines, and there is the death penalty for drug possession.
Yes, I'm quite sure I would end up being caned for some infraction or another!

I am surprised, as a freedom loving American, that you would choose Singapore, as there are quite a few government mandated issues.

Can you imagine what the response from the American public would be if some of the practices, like measuring waistlines, telling the patient they are too fat and have X amount of time to lose weight would be?

As mentioned, children are made to skip meals.
Such things would never work in America. I don't want America to adopt Singapore's government. I want America to look at their model of healthcare and improve upon it here. The model works for them. I think we can accomplish something similar without forcing children skip meals and putting people to death for drug offenses.

I am not completely opposed to government guidelines and interventions, I do think that some drastic changes are necessary for tackling obesity, but do you really think Americans will go for this?

I think you saw half private, half public and thought it was a good idea.
I saw that they fund their healthcare very similarly to how we do (~30% public and ~70% private) yet they are able to provide pretty good healthcare to all it's citizens largely using the model that I and many other Americans already use: Savings + Catastrophic insurance.

As for government mandated interventions, Americans will never go for it. I'm not suggesting they do.
 
Who pays for that screening?

As Emet said, patients and their insurer. Most insurers that we deal with pay 100% for preventive care with no deductibles or copays. Some insurances waive the deductibles and others treat it like a regular medical visit. I imagine there must be some that provide no coverage for preventive, but I've never seen one. Medicaid pays 100%. Medicare pays for yearly screening tests, but not for a "physical" visit (except once, when they join for the first time).

For those without insurance (self-pays) we (our own clinic) charge $75 for a well-woman exam, including the pap. We have an imaging center a few doors down who gives our patients an excellent price on the mammogram (~$85; a bit more for digital, I think). So for about $160 bucks or so per year a woman can get all the recommended screenings they need if they are self-pay. Similar for men without the mammogram costs, of course!
 
You are comparing apples and pears, the UK part above is what actually happens, the USA quote is a recommendation by a body.

In our practice (and most others I'm aware of), the "recommendation" is what actually happens as well; it's the standard of care. No, not every patient of ours comes in for the recommended screenings -despite our friendly reminders. But, not every patient in the UK goes in for their's either.
 
Quite a few of us have mentioned that there are one or two* other styles of UHC the USA could adopt, indeed I doubt anyone on the UK side would recommend that the USA adopts the NHS model. (The NHS model was created in differ net times and I don't think it would be possible today to move a country the size of the USA to such a model.) But there are many more models to choose from, and again they cost less to cover everyone than the USA is paying today to not cover everyone!

(*What was it 40 something?)

Granted, there are a lot of models to choose from. Most Americans are against the idea of the government becoming our insurer. But change is needed, so all models need to be looked at. We can cover everyone Universally without going single-payer.
 

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