Former anti-UHC nut

[GreNME]

I would not prefer a single payers system like in the UK or Canada, because (1) I have serious doubts that Congress would create an effective one. (2) The wait lists in those countries seem unreasonably long (average 4-5 moths IIRC). I would much prefer a system like in the Netherlands or Switzerland where the health insurance industry is heavily regulated, everybody must purchase it, and those that cannot are assisted.

But the above is probably a pipe dream. It seems that though Congress has no spine whatsoever. They, even the Democrats, seem to care more about the bottom line of their backers rather than the well-being of their constituency. It's a shame. I suppose that I should be glad that I am one of the lucky ones that will (probably) not be screwed over by the current situation.

I couldn't agree more, especially with the bolded part.

Thirded.

Also, dtugg, you should also keep in mind that the current system is not at all a free market, and is in actuality set up in a fashion that benefits the very entities it's meant to regulate. That (and a few other factors) are what have kept the cost of that market rising significantly faster than the inflation rate for many years.

 

[portlandatheist]

I'm totally with dtugg on this one. According to politicalcompas.org, I'm also a "libertarian" although I must add that I can't see myself voting for a libertarian candidate and that I'm a "libertarian" with a very lowercase "l".
All this means is that I generally believe that the private sector does a better job than the public sector but there are exceptions to this. Any sort of cost benefit analysis of the current US health care system shows that we spend more money than our more "socialist" counterparts in Europe. I support efficiency and we have a lot of waste in our current system for a lot of different reasons, many of which have been addressed at various science blogs from people I highly respect. I suggest some of the blog entries at:
http://scienceblogs.com/denialism/

I support reform and UHC of some kind. I don't know what the best solution is, but I fully support Obama's attempt at fixing the problem and cheers to him for his effort. I hope that between the administration, congress, and the various interests groups, we are able to enact real reform that makes health care more affordable, more available, and more efficient that allows us to live healthy long lives.
As many people before me have noted, we actually have socialized medicine in the US(nobody at the ER is turned away for example), albeit a very dysfunctional one.

Lets get everybody covered and do it for cheaper than we do it for now. What is there to lose? Sounds like a win/win to me.

 

[Professor Yaffle]

Drop to a state by state approach, as we do in the EU, which copes with a population that is about 100 million bigger than the USA population.

Brilliant. That one comment put so much into perspective.

The best results are typically achieved in USA with the consensus of the Governors of the States.

Grumble, grumble. It's not like anyone had already said that...

I don't see why population size has to be a problem. You could implement it on a statewise basis, with reciprocal arrangements between states, similar to the arrangements we have in the EU. That way you could even have different models in each state.

Huff.

 

[Fiona]

On the question of waiting times, I would just like to make sure that everyone understands what is being compared, because this quote from dtugg made me wonder

I dunno. But having to wait a few days or go the ER (and I know from first hand experience that the ER sucks, I once had to wait there for 8 hours with a broken hand) sure beats having to wait a few months.

I am not quite sure whether this means that dtugg thinks the waiting times reported in the UK apply to this kind of injury: they don't. Such an injury would most likely be treated at A&E (which is the equivalent of ER and would likely involve a wait the same as he describes).

Serious and life threatening illness or disease is treated quickly here: it always has been. For example, last year my mother was seriously ill. She went to her GP; got an extensive battery of tests and investigations; and was then admitted to hospital within three weeks (it took some time for the test results to come back, but I think that was because of the nature of them.) This is typical for any serious problem, in my experience. Rolfe has given similar information in other threads, I think

The waiting times have varied at different times: but the average always included the whole population and all kinds of conditions

What I would like to know is whether the US Figures are comparable. I ask because I have heard from some American posters here that for less serious conditions they sometimes avoid referring themselves because they cannot afford the associated costs whether those are the excess or because they have no cover.

To be comparable the US waiting times would have to include those periods: but I do not at all see how they can. Are there surveys asking people about this?

If there are not, then it seems to me that health care is "rationed" in both countries: in the US it is "rationed" by wealth and in the UK it is" rationed" by clinical need. (I don't particularly want to get into yet another discussion about whether "rationed" is the right word: I mean that not everyone can have every health treatment they want when they want it) I know which I prefer.

I am not suggesting that our system is the best because the evidence shows that France has the that honour. I am saying that when you make comparisons you have to take more into account than just the recorded figures.
__________________

 

[dtugg]

Fiona, the only reason that I mentioned that story was because I was recognizing that it is hard to get timely non-emergency healthcare (I don't really consider my broken hand an emergency) in the US and that this causes people (or at least it did me) to go to ER. I knew it was broken and it didn't really hurt, the only reason that I went to the ER is because I couldn't get seen at such short notice anywhere else, and I figured the ER would be able to take care of it. As it turns out, the only thing the ER did was take an X-Ray to confirm that, yes it was broken, wrap it up in some ace bandages (I had done that myself already), give me a prescription for some pills (I lied about how much it hurt because I figured I might as well get some drugs out of the deal), and tell me to go to an orthopedic surgeon. If I had known this was going to happen, I would have just made an appointment with the orthopedic surgeon (it took two or three days, I think) a not gone to the ER.

I've been rambling a it, but what I was saying is that it is preferable to have to wait a few days or go to the ER (or go the ER and wait a few days) for non-emergency but urgent treatment because a doctor isn't immediately available than it is to have to wait a few months for general treatment.

So, no I was not trying to say that I think that I would have had to wait a few months for treatment for a broken hand in the UK. Sorry that it seemed that way.

As for the rest of your post, I have no idea if there are wait list surveys in the US and if there are how they are conducted. But I do seriously doubt that I would ever have to wait a few months for treatment (and if I did I would be pissed as hell). And I do not want to move to a type of system where this is the norm. I am willing to pay more, if necessary, for health care reform, but not to get crappier service.

 

[Earthborn]

I've been rambling a it, but what I was saying is that it is preferable to have to wait a few days or go to the ER (or go the ER and wait a few days) for non-emergency but urgent treatment because a doctor isn't immediately available than it is to have to wait a few months for general treatment.

I don't think you quite understand what a waiting list is, and what it is for. You wouldn't need to wait a few months for general treatment, but you may have to wait a few months for a specific complicated procedure if it isn't urgent, because all the urgent cases go first. Looking at average waiting times is meaningless, unless you compare it with earlier or later average waiting times to see if there is improvement. It is not a list of people waiting for their turn, first come first served. It is a list sorted on urgency.

I am also pretty sure that a broken hand would be considered an emergency in any universal health system.

 

[dtugg]

I don't think you quite understand what a waiting list is, and what it is for. You wouldn't need to wait a few months for general treatment, but you may have to wait a few months for a specific complicated procedure if it isn't urgent, because all the urgent cases go first. Looking at average waiting times is meaningless, unless you compare it with earlier or later average waiting times to see if there is improvement. It is not a list of people waiting for their turn, first come first served. It is a list sorted on urgency.

I fully understand that with these wait lists, the most urgent cases go first. I still find it an average wait time of a few months to be outrageous.

I am also pretty sure that a broken hand would be considered an emergency in any universal health system.

Even if so, it really isn't.

 

[Professor Yaffle]

In the UK, what you call the emergency room is called accident and emergency. It caters for both emergencies and pretty much anything like broken bones, sprains (lego up noses) etc. If you had broken something, the place you would be expected to go would be A&E. You wouldn't turn up at your GP, as he would just tell you to go to A&E.

 

[Earthborn]

I still find it an average wait time of a few months to be outrageous.

Sure it is outrageous. In a perfect world everyone would get whatever they need or want immediately. Some of the anti-UHC nuts are right about one thing though: there are shortages in a universal healthcare system (just as there are in a non-universal one). And if you can't jack-up the prices to astronomical heights so that treatments become unavailable to many, some people will have to wait for a long time.

 

[dtugg]

Sure it is outrageous. In a perfect world everyone would get whatever they need or want immediately. Some of the anti-UHC nuts are right about one thing though: there are shortages in a universal healthcare system (just as there are in a non-universal one). And if you can't jack-up the prices to astronomical heights so that treatments become unavailable to many, some people will have to wait for a long time.

From what I understand, in most countries, these outrageous wait lists like that happen in the UK and Canada don't really happen.

 

[Fiona]

Well I do not really think you have answered my question, dtugg: and I know that is because you can't. But I cannot honestly see that waiting times are demonstrably lower in the US, because they exclude those who are genuinely but not urgently ill, but cannot afford to refer themselves. Those are waiting times too

 

[Magyar]

Medicare is only so "efficient" because they don't care if they are defrauded money (it's only tax payer money after all). And the result, of course, is that that is a large amount of fraud.

I'm sorry but this quote MAKES NO sense and only goes to prove my point further! I am well aware of the fraud issues in medicare/medicaid. My wife's been in the industry for decades.

And even WITH all the fraud this system delivers more value per dollar than the private sector. And as far as less fraud in the private insurance - well I guess we would need to define what you call fraud first. To me the first and foremost and one HUGE reason I am for UHC is the total lack of accountability these companies have over our very lives.

I don't have a major horror story of alife threatening nature, but my recent brush with insurance companies is just a typical crap that happens every day.

My 10 year old took a nose dive off a bike and broke both front teeth. Needed a root canal because the nerves were exposed. Bill to the tune of $4000. The insurance company told us that they would not cover the root canal or the caps because it was an unnecessary procedure for a 10 year old to have front teeth for the rest of his life! We've had dental insurance to the tune of $115/month for the past 8 years.

I consider that fraud!

Govt MAY very well prove to be less efficient, But;


1) I keep wondering about the accuracy of this statement! I mean EVERY other 1st world nation has been able to manage to do it, and at the risk of being redundant ( I feel like every one should know this link by now and NO ONE has been able to disprove it's validity )
http://scienceblogs.com/denialism/2009/05/what_is_the_cause_of_excess_co.php
at a far lower cost to cover 100% of their people when we only cover a small portion.

Are all the people saying that the US can't do it now saying that the US govt is SO corrupt
that it is incapable of doing anything remotely right for it's people when all of Europe and others can!? Even IF this statement is true (and it seems that when we get down to brass tack THAT is the ONLY legit reason expressed by those who are against UHC) that is really not related to UHC! At least not specifically.

2) while govt may be as corrupt and innecifient or even more so. At least I have a recognized and clear method of redress. I can vote, and protest.

With insurance co, I get red tape, total lack of transparancy and total lack of free market thanks to Mccarran and Ferguson act.

 

[dtugg]

I'm sorry but this quote MAKES NO sense and only goes to prove my point further! I am well aware of the fraud issues in medicare/medicaid. My wife's been in the industry for decades.

And even WITH all the fraud this system delivers more value per dollar than the private sector. And as far as less fraud in the private insurance - well I guess we would need to define what you call fraud first. To me the first and foremost and one HUGE reason I am for UHC is the total lack of accountability these companies have over our very lives.

When people speak of Medicare's efficiency, they are talking about how much is paid out in claims (including fraudulent ones) vs how much is spent on overhead.

I don't have a major horror story of alife threatening nature, but my recent brush with insurance companies is just a typical crap that happens every day.

My 10 year old took a nose dive off a bike and broke both front teeth. Needed a root canal because the nerves were exposed. Bill to the tune of $4000. The insurance company told us that they would not cover the root canal or the caps because it was an unnecessary procedure for a 10 year old to have front teeth for the rest of his life! We've had dental insurance to the tune of $115/month for the past 8 years.

I consider that fraud!

Govt MAY very well prove to be less efficient, But;

I fully recognize that crap like this happens in the private insurance industry which is why I am in favor of regulating them so that they wouldn't be able to

1) I keep wondering about the accuracy of this statement! I mean EVERY other 1st world nation has been able to manage to do it, and at the risk of being redundant ( I feel like every one should know this link by now and NO ONE has been able to disprove it's validity )
http://scienceblogs.com/denialism/2009/05/what_is_the_cause_of_excess_co.php
at a far lower cost to cover 100% of their people when we only cover a small portion.

Are all the people saying that the US can't do it now saying that the US govt is SO corrupt
that it is incapable of doing anything remotely right for it's people when all of Europe and others can!? Even IF this statement is true (and it seems that when we get down to brass tack THAT is the ONLY legit reason expressed by those who are against UHC) that is really not related to UHC! At least not specifically.

2) while govt may be as corrupt and innecifient or even more so. At least I have a recognized and clear method of redress. I can vote, and protest.

With insurance co, I get red tape, total lack of transparancy and total lack of free market thanks to Mccarran and Ferguson act.

You do realize that not every country with UHC has the government administer it correct? In Switzerland, for example, everybody must purchase health insurance, the health insurance industry is heavily regulated, and those that cannot afford the premiums are assisted. I would prefer such a system because it would give as little money as possible to Congress, still cover everybody, and as was pointed out by Professor Yaffle, be a much easier transition that having the US government attempt to take over the entire health care industry.

 

[Earthborn]

From what I understand, in most countries, these outrageous wait lists like that happen in the UK and Canada don't really happen.

Oh, they exist. In fact for many conditions, you'd be lucky if you have to wait only a few months on a waiting list. If you are diagnosed transsexual and you need a sex change on public expense? Don't expect the operation within a year. You might as well go to Thailand and back, if you have the money (about 1/10 of what it apparently costs to reattach a middle finger in the USA, if you can trust Michael Moore). Same thing with a breast enhancement. Need a nose job, your doctor has assured the insurance company that you suffer considerable psychological distress from the shape of your nose (though nobody else but you sees anything wrong with it), that it is certainly not some misplaced act of vanity, that an operation is really likely to help, and the insurance company agrees to pay... Expect to live with that hideous honker for another 2 years.

Yes, it outrageous, and it shouldn't be. But that's Socialism for you. They call it "prioritisation based on need", but let's just call it what it is: meanie patients who seem to think that just because they suffer physical pain or considerable loss of bodily functions or might die they somehow have a greater entitlement to care than the rest of us.

 

[Ryokan]

I would not prefer a single payers system like in the UK or Canada, because (1) I have serious doubts that Congress would create an effective one. (2) The wait lists in those countries seem unreasonably long (average 4-5 moths IIRC). I would much prefer a system like in the Netherlands or Switzerland where the health insurance industry is heavily regulated, everybody must purchase it, and those that cannot are assisted.

The only reason a queue would shorten is for some people not to be able to get those operations. I'd rather live in a country where everyone would get health care, but some might have to wait a bit, than to live in a country where some of those requiring health care wouldn't get it for some reason, especially if those reasons were monetary.

 

[Ryokan]

Just to add to my last post, the waiting time in Norway at least is only for non-life threatening issues, and every family member and friend I can think of who needed hospital care got it immediately.

The only time I've been hospitalized was the time I got a major infection in my testicles. I crawled to my doctor in pain, saw him immediately and was sent to a hospital by car. Around an hour later I was lying on the operating table.

 

[leonAzul]

Yes, it outrageous, and it shouldn't be. But that's Socialism for you. They call it "prioritisation based on need", but let's just call it what it is: meanie patients who seem to think that just because they suffer physical pain or considerable loss of bodily functions or might die they somehow have a greater entitlement to care than the rest of us.

Let's call it what it really is: triage.