single-payer system ... singled out

[Ziggurat]

Does the fact that all the Brits here would take the NHS in a heartbeat as opposed to coping with the vagaries of your system not tell you anything?

Surely you can do better than argument ad populum.

 

[balrog666]

Recent data shows that Medicare costs about $6500 per person covered, most of them old or disabled. It is fully controlled and regulated by the US government.

And it is only partial coverage, albeit a significant portion of same. Large co-pays and deductions are charged, requiring additional (regulated) insurance plans.

If we extend it to cover all US citizens and foreign nationals here illegally, it would cost on the order of $2.4 trillion dollars, which is about the same that we are currently spending, including both taxpayer, insurance, and private dollars.

So, to reduce costs we would still have to ration care and close currently productive hospitals, as well as fire productive doctors, nurses, technicians, etc all of which would reduce currently provided medical services, reduce efficiency, and increase misery.

And it still wouldn't be "free" for anyone involved, even assuming every competent doctor, PA, nurse, et al. in the US would be willing to put in the same hours for less pay. (And higher taxes).

So, where are the savings?

 

[Random]

So, where are the savings?

Considering that other countries are able to cover their entire populations with medical care just as good the US for half the cost, I think the question is, "Where is the waste"?

 

[Architect]

If the majority agree to force someone to pay, that person is still being forced to pay. Hell, they're being forced to pay even if they want to pay. That's why it's tax and not voluntary donation. Do you honestly not understand this? Democracy is a useful check on the powers of taxation, and help ensure that taxation usually is not excessive and is used for purposes that most people will like, which means that taxation in a democracy is far more likely to be justified than under non-democratic government. But nothing about that indicates in any way, shape, or form that taxation isn't still forcing other people to pay for something.

I'm sorry, but you appear to wholly misunderstand democracy. If we, as a people, decide by a majority that taxes should be used to pay for healthcare then it doesn't matter whether a minority object; it's the settled will of the people, exercised through their democratic representatives. If the people don't like the measures, they vote in another party who include dismantling the system in their manifesto.

All these arguments about being "forced" to pay are just bunkum.

 

[Architect]

I have a friend, Martin, who runs a staffing agency. They've got a number of quite lucrative contracts to provide temps to various firms, including the one which provides the meat for Marks & Spencers. The latter category pay they temps minimum wage of £5.73 per hour for what is typically a 40 hour week, or £11-12k per annum. As they're temps, however, they can be dismissed at a moment's notice.

These people have few, if any qualifications. In the current economic climate there are no real alternative employment opportunities. Despite working, and from what I gather working hard, they're at the bottom of the heap.

From this wage, they have to pay for housing, food, and other essentials. And £12k doesn't go far. Fortunately they don't pay much tax, the system being weighted in favour of low earners. In fact, they may also receive social security to top up their family income.

This kind of group are realistically never going to be able to afford healthcare insurance in the kind of system that Ziggy advocates. Even if they could free-up some income, it wouldn't be enough to meet the premiums for a family of (say) 4. And they're not in guaranteed employment, so any cover would be patchy anyway.

I pick this as merely one example of where Ziggy's system falls down. It assumes that, with tax breaks and the like, everyone can afford to pay for their healthcare yet overlooks the fact that there are large proportions of the population in our countries who survive at, or below, the breadline.

In the UK, and indeed most of the developed world, successive governments of all political hues have taken the view that universal healthcare is a right which is necessary if we are to protect the most vulnerable in society. We have effected a variety of systems, some involving the private sector, and these deliver standards of healthcare at least equivalent to the US system and at a fraction of the cost.

It seems to me that Ziggy's objections regarding the ineptitude or otherwise of the US government, his previous claims that the measures used to show that US healthcare wasn't as effective as ours, his comments about "externalities", and so on are no more than crude masks for his political views - they all come back to one point; he shouldn't be "forced" (his term) to pay for healthcare for others and that's the end of it. If someone hasn't procured healthcare coverage, then they're damned.

Ziggy will shout "strawman" but please, everyone, reread the previous threads. It aye comes back to the same point he makes. And, as I've said before, I consider it to be a morally bankrup and inherrently selfish position. The racehorse analogy may be oratory, but the underlying message is as true now as it was in the 1940s and those who cannot see what is wrong with racehorses receiving five star healthcare treatment whilst people - human beings - go without any coverage in one of the richest countries on Earth need to take a long, hard look at themselves.

Poverty. Ill-health. There but for the grace of God go all of us.

 

[quixotecoyote]

Ziggy will shout "strawman" ...

I disagree, I predict he will reference medicare.

 

[dtugg]

I don't think that anybody has a right to health care. Nobody should be coerced, though the threat of force to pay for others' bills. I don't really care if the majority approved it. Government is, or at least should be, set up to protect the minority from the majority. Furthermore, I don't think it's the job of the state to act as your mommy.

That being said, even though I still wouldn't like the idea of universal health care in the US, I would accept it if I thought for a second that the United States Government could properly administer it. The USG has time and time again proven itself to be incompetent. I don't think that it is a good idea to give an entity that needs to borrow trillions of dollars in order to pay its bills a huge amount more money, power, and responsibility.

The health care system works fine for me. And sorry but I am not willing to risk that in order to give a mult-trillion dollar experiment I feel is doomed for failure a whirl. Call me selfish, I suppose I am. So what? I want to have to best health care possible for myself, and I think that's achieved better now than would be through universal health care.

As for why the United States still spends proportionally more on health care than countries with universal care, I think that is largely due to the US using cutting edge/very expensive tests, procedures and drugs much more often. How much of this is due to legitimate medical need and how much is due to doctors, hospitals, and drug companies fleecing patients, insurance companies, and the government, I have no idea. But I would rather have a system where these things are widely available on demand rather than heavily rationed due to their high cost as they are in, for example, Canada.

 

[martu]

Is it really a mystery to you why I might take that as an insult?

Yes - I am very thick skinned myself and often insult people's beliefs without noticing, if someone had said that to me I wouldn't be insulted merely puzzled.

So what was insulting to you? The putting an ideology before people bit? Well you have no rational reason other than government is bad for your position or at least you haven't showed us. I'll take it back when you do.

 

[volatile]

Are you going to claim that this VAT tax is enough to cover your health care costs, or is even as much as one's welfare benefits?

So you should only be able to claim out of the pot exactly the amount you put in? Does this belief of yours also stretch to you shunning private insurance, which has the exact same problem? Are your premiums enough to cover you in the case of a chronic illness?

 

[Matthew Best]

That being said, even though I still wouldn't like the idea of universal health care in the US, I would accept it if I thought for a second that the United States Government could properly administer it.

What are you, an American, or an American't?

 

[volatile]

What choice do you want that we don't have in Britain under our system? I can't think of any. I've even got the choice to pay more if I really, really want to.

Zig, why did you ignore this bit of Rolfe's post?

And why have none of the other anti-UHC posters even tired to explain what "freedoms" they think I don't have that they do?

 

[volatile]

I don't think that anybody has a right to health care. Nobody should be coerced, though the threat of force to pay for others' bills.

So, you are happy that under your ideologically-preferred system - in which no government aid is given to anyone for healthcare needs - the poorest, neediest and most desperate people in your country will die in the streets?

That's your idea of a preferable system?

Oh... I guess it is:

The health care system works fine for me.

ETA: Note also that in no-way does UHC means you have to suffer *worse* care - indeed, you'd probably be able to afford a BETTER level of service (especially when you consider that your coverage will be unlimited) that you can now, for the same amount of money. The experience of UHC systems shows that good healthcare for all most resolutely does not mean excellent healthcare for no-one.

 

[martu]

I don't think that anybody has a right to health care. Nobody should be coerced, though the threat of force to pay for others' bills. I don't really care if the majority approved it. Government is, or at least should be, set up to protect the minority from the majority. Furthermore, I don't think it's the job of the state to act as your mommy.

That being said, even though I still wouldn't like the idea of universal health care in the US, I would accept it if I thought for a second that the United States Government could properly administer it. The USG has time and time again proven itself to be incompetent. I don't think that it is a good idea to give an entity that needs to borrow trillions of dollars in order to pay its bills a huge amount more money, power, and responsibility.

The health care system works fine for me. And sorry but I am not willing to risk that in order to give a mult-trillion dollar experiment I feel is doomed for failure a whirl. Call me selfish, I suppose I am. So what? I want to have to best health care possible for myself, and I think that's achieved better now than would be through universal health care.

As for why the United States still spends proportionally more on health care than countries with universal care, I think that is largely due to the US using cutting edge/very expensive tests, procedures and drugs much more often. How much of this is due to legitimate medical need and how much is due to doctors, hospitals, and drug companies fleecing patients, insurance companies, and the government, I have no idea. But I would rather have a system where these things are widely available on demand rather than heavily rationed due to their high cost as they are in, for example, Canada.

So you are against the Medicare program? What other services would you deny those that can't afford to contribute top them, the Fire Department? Police? Use of public highways?

Your health care in the US is not better than mine in the UK (through the NHS and private health care) and we have the added bonus of it costing less here and everyone is covered. You are paying more for the same service not a better one.

 

[TragicMonkey]

Your health care in the US is not better than mine in the UK (through the NHS and private health care) and we have the added bonus of it costing less here and everyone is covered. You are paying more for the same service not a better one.

There are sometimes a few problems with UK healthcare, particularly in getting expensive drugs that your government decides "may not be worth the cost". Herceptin springs to mind. American women with breast cancer can and do get that drug easily. UK women apparently still have to fight for it. Looks like you can put a price tag on life.

 

[volatile]

There are sometimes a few problems with UK healthcare, particularly in getting expensive drugs that your government decides "may not be worth the cost". Herceptin springs to mind. American women with breast cancer can and do get that drug easily. UK women apparently still have to fight for it. Looks like you can put a price tag on life.

Do US insurance companies provide wildly-expensive, mildly-effective drugs to everyone that asks for them? Or do they cap out coverage at a pre-determined maximum, after which you're SOL?

In other words - how is an insurance-based system, with "co-pays" and maximum-treatment caps, better for someone who needs herceptin but hasn't the means to pay for it herself? After all, Herceptin is a drug of last resort as I understand it, and given that, from what other posters here have explained in the past, chronic and severe illness can eat up allowable coverage amounts even on high-premium policies, I can't see how a British woman and an American woman of similar economic means would be in any different situation - except that the British woman can make a case for entitlement based on clinical need and clinical effectiveness to NICE, whereas the American woman has no recourse whatsoever should the insurance company decide her maximum coverage has been exceeded.

ETA: http://www.herceptin.com/breast-cancer-resources/insurance.jsp proves a point, especially as the drug company pushing this expensive, unproven drug have a whole department dedicated to helping patients fight "denied Herceptin claims"! "Health insurance coverage and reimbursement issues can be confusing and challenging. Herceptin Access Solutions is here to make the process as easy as possible", they say. They even employ "Herceptin Access Solutions reimbursement specialists"! :-O Does that not suggest that desperate, dying US breast-cancer patients demanding herceptin also often face obstacles in getting the drug the advertising (and not the science) has convinced them they need? What was your point again?

Also bear in mind that British women would also have had world-class cancer care (free at the point of use) before Herceptin even became an issue, whereas an American woman with no coverage would possibly have been facing bankruptcy.

ETA2: I also note with some concern, via Wiki, that "Few reporters have questioned the pricing of this drug but when asked, Genentech refuses to give details to explain the high costs" (http://www.scoop.co.nz/stories/HL0602/S00144.htm) and that there are serious concerns regarding its effectiveness.

 

[Rolfe]

There are sometimes a few problems with UK healthcare, particularly in getting expensive drugs that your government decides "may not be worth the cost". Herceptin springs to mind. American women with breast cancer can and do get that drug easily. UK women apparently still have to fight for it. Looks like you can put a price tag on life.

The Herceptin story is an interesting one. The problem is that it doesn't make any difference to most patients.

[Disclaimer: I've probably got the actual numbers wrong here, consider the example illustrative.] It is only useful in patients with a particular form of breast cancer, and its usefulness is to reduce the risk of recurrence. That form can be tested for, so that is OK. However, patients with that form of cancer have an 80% chance of not getting a recovery even without Herceptin, and you don't know which 80% these are. And of the remaining 20% who will get a recurrence, the Herceptin only prevents it in half of these. (ETA: maybe less, some of Volatile's information seems to suggest that it's not even as modestly useful as I'd thought it was.)

The result is that you have to give the drug to an awful lot of women who woudn't be going to get a recurrence anyway, and only about 10% of the treated group are going to experience any benefit. Now my opinion was that it was probably worth it for the sake of that 10%, but I can see why the value was being questioned.

The result was that a huge campaign group sprang up, with women appearing on TV with placards reading
Need
Herceptin
Straightaway
None of them seemed to have any concept of the figures - they all claimed that they would certainly die without the Herceptin, and that the drug would save their lives.

As Volatile has pointed out, it turned out that this was what was termed an "astroturf" group - a fake grass-roots movement actually sponsored and recruited by the manufacturers of the drug. This makes me a little queasy. Especially because the patients suffering from geriatric psychiatric problems and things like that don't have the ability to mobilise that way, and nobody will speak up for them.

Nevertheless, the committees looked at the statistics, and in the end decided that even though the drug was very expensive, and the benefits not nearly as clear-cut as was being claimed, there was a genuine benefit which justified approving the drug. So it was approved. And no, I don't believe anyone "still has to fight" to get it.

Yes, one of the reasons why the US system is so wasteful is that it will pay up huge amounts of money to drug companies with a nice line in marketing, pretty much without question. And yes, trying to police that can get you accused of rationing. But, as Professor Yaffle says, I think you'll find it's a little bit more complicated than that.

But consider the other side of that episode. This was all about the women wanting the state-funded system to pay for their Herceptin. Nobody was preventing them from paying for it out of their own funds. Some women did exactly that. And women with private health insurance were also being treated with it. So in fact, Herceptin was always available in Britain on exactly the same terms as it was in the USA. You pay for it, you get it. The argument was about state funding.

So even if the decision had gone the other way, in what way is this bad? The NHS covers pretty much anything anyone is likely to need. It did finally decide to cover the Herceptin. Yes, there are going to be treatments at the margins of cost-effectiveness that won't be covered. If you're really concerned that this might affect you, then nobody's stopping you taking out private medical insurance - which, as has already been pointed out, is likely to be a lot cheaper than it is in the USA.

This is no sort of argument against universal healthcare. So, maybe a few things aren't covered, and you can still insure against that cost or pay for them out of your own capital. Why is the fact that that might still happen in a few marginal cases a good reason for providing nothing from state funding, and expecting patients to fund everything?

Rolfe.

 

[Rolfe]

Zig, why did you ignore this bit of Rolfe's post?

And why have none of the other anti-UHC posters even tired to explain what "freedoms" they think I don't have that they do?

Balrog did finally try to answer that, but he came up with only two points. One was a freedom that I already have in Britain, and the other was a freedom that he does not have under the present US system.

So no, try again.

Rolfe.

 

[volatile]

A cite for the "astroturf" case, by the way: http://www.guardian.co.uk/society/2006/oct/18/cancercare.health

 

[volatile]

Balrog did finally try to answer that, but he came up with only two points. One was a freedom that I already have in Britain, and the other was a freedom that he does not have under the present US system.

So no, try again.

Rolfe.

I saw that, but doubted it counted as "trying", given how weak it was as an "argument".

Beerina talked about us poor UHC recipients as being "under the gun" - and Balrog nominated him for it. Neither has responded to the really glaring error in their positions - namely, that the idea that we are "less free" or have "less choice" is a complete and utter fallacy.

Either of you - or Zig - fancy explaining what you mean when you're talking about "lost freedoms"?

 

[dtugg]

So, you are happy that under your ideologically-preferred system - in which no government aid is given to anyone for healthcare needs - the poorest, neediest and most desperate people in your country will die in the streets?

That's your idea of a preferable system?

Oh... I guess it is:

In my "ideologically-preferred system" people would be responsible for their own lives. Mommy...I mean the state couldn't rob Peter to pay for Paul. Private charities could help those truly in nee.

ETA: Note also that in no-way does UHC means you have to suffer *worse* care - indeed, you'd probably be able to afford a BETTER level of service (especially when you consider that your coverage will be unlimited) that you can now, for the same amount of money. The experience of UHC systems shows that good healthcare for all most resolutely does not mean excellent healthcare for no-one.

I most certainly would receive worse care in a UHC system than I do now. These systems must ration health care in order to keep costs down. There are drugs and treatments that I could readily get in the US that are not available in the UHC systems because they are too expensive. And waiting lists are unheard of in the US but common place in UHC. It seems as though the typical patient waits months for treatment UHC systems. In 2007 in the UK, more than half of patients were waiting more than 18 weeks for treatment. Canada has similar wait times. I say no thank you to that.