Socialised health care: Why is it scary?

[uk_dave]

Sarcasm aside, addressing those who do live in a country with UHC, I have to admit that my natural reaction to UHC does include something resembling this sentiment, minus the religious overtones. Thinking about UHC, it does piss me off to think that everyone would be required to pay, for example, for the lung cancer treatments of life long smokers.

For those of you that do live under UHC, does the thought ever gnaw at you or disturb you to think "Damn, we could be doing this alot cheaper if people didn't willfully and knowingly poison themselves smoking, drinking, overeating, etc."?

So, in the US the numbers of smokers, binge drinkers and the obese are significantly lower than in UHC countries?

The thing is, you already pay for other people if they get 'emergency' treatment but then go bankrupt when the bills arrive.

And you pay for financial screening departments in hospitals.

 

[The Mutha]

I'm surrounded by a large group of folk who are rabidly anti-UHC. Their primary reasonings are:

1. "I've paid for my health care all my working life, it's not fair that people who haven't worked and paid for health care to get it free."

and the big one -

2. "UHC will make my personal Doctor less accessible given that he/she will have more patients, so I'll have a longer wait time to see the Doctor and for tests and procedures." The old "personal impact" ploy.

And they all firmly believe that their parents and grandparents will be subjected to death panels...

(I work in Oil & Gas in Houston, Texas. The lies and conspiracies that I hear daily are amazing! One of the drafters yesterday said that the IRS has never audited a Mosque which therefore proves that Obama is a Muslim. This is the same guy who's wife was a career Navy Officer and then went to work for the Feds. He had her take half of her 401k out because he'd heard that Obama was going to take Federal workers pensions away from them. He's a maroon...)

 

[Darat]

...snip...


I've had many visits to the local, private hospital. It's already run like a bad DMV. I have also in my youth spent time in military dispensaries. I have to say that the private hospital suffers in comparison. I doubt that the government would make it worse.

Even in the UK which certainly does not have the best UHC system in the world there is hardly ever any interaction with any bureaucracy for a patient (note that word not a customer), the nearest to bureaucracy is interacting with staff making appointments.

 

[jdp]

They place more weight on the ethical belief that health choices should be handled on a per-family basis. The advantage of a private system, is that if you disagree with the firm's decision, you can elect not to use their service and not pay. If you disagree with everyone's decisions, you can elect not to pay for any healthcare at all.

I basically agree with how you characterize the opposition to UHC in the US but I think that such a belief, as you are describing it, is really an illusion. Private insurers are going to provide service based on a cost benefit analysis just like a public insurer would and it won't be the patient who gets to select what will be covered but the private death panel, as some would put it.

By the time you get around to disagreeing with them on an issue of coverage you're often already sick and wondering why they won't cover a specific treatment. At this point, it's too late to switch insurers anyway. Even if they covered what you were looking to get it would likely get treated as a preexisting condition and you'd be SOL.

 

[Darat]

...snip...

In this case, the ability to make this decision for one's family is more important than the actual health outcome. In extreme versions you see it in the prayer for wealth or prayer for health religious conservatism.

...snip...

But isn't that just a perception of choice, or perhaps better way of putting it an illusion of choice? If so wouldn't be the way to demonstrate to someone with your value system that if choice is important a UHC can increase the real choices you have?

 

[Darat]

Sarcasm aside, addressing those who do live in a country with UHC, I have to admit that my natural reaction to UHC does include something resembling this sentiment, minus the religious overtones. Thinking about UHC, it does piss me off to think that everyone would be required to pay, for example, for the lung cancer treatments of life long smokers.

For those of you that do live under UHC, does the thought ever gnaw at you or disturb you to think "Damn, we could be doing this alot cheaper if people didn't willfully and knowingly poison themselves smoking, drinking, overeating, etc."?

No. The idea that someone could (making up an example) not be considered for healthcare that they need because they smoked for 5 years in their twenties is absolutely abhorrent to me.

 

[Alferd_Packer]

The advantage of a private system, is that if you disagree with the firm's decision, you can elect not to use their service and not pay. If you disagree with everyone's decisions, you can elect not to pay for any healthcare at all.

I question the presumption that a sick person who elects not to recieve any health care places no burden on the rest of society.

 

[Darat]

I basically agree with how you characterize the opposition to UHC in the US but I think that such a belief, as you are describing it, is really an illusion. Private insurers are going to provide service based on a cost benefit analysis just like a public insurer would and it won't be the patient who gets to select what will be covered but the private death panel, as some would put it.

...snip...

And the cost benefit if the insurer is a for profit company is in regards to their bottom line not the most effective or efficient medical treatment. In the UHC in England (that is under terrible threat by our right wingers) we know exactly how such decisions are made and we even have a right to legally challenge such decisions.

I wonder as a test of my surmising above - do private insurance companies in the USA publish their cost benefit analysis so that a customer can make an informed choice between companies? Here is the information from the body in England that is tasked to make such calls: http://www.nice.org.uk/newsroom/features/measuringeffectivenessandcosteffectivenesstheqaly.jsp Those calculations are done by medical professionals not faceless "bureaucrats" .

 

[GStan]

No. The idea that someone could (making up an example) not be considered for healthcare that they need because they smoked for 5 years in their twenties is absolutely abhorrent to me.

Agreed.

But that's not really what I was asking.

 

[Safe-Keeper]

Does it also make you mad that everyone in the US enjoys the free services of the police, fire department, and military, no matter how stupid and dangerous the actions that led them to require such help in the first place?

 

[Sawbones79]

Sarcasm aside, addressing those who do live in a country with UHC, I have to admit that my natural reaction to UHC does include something resembling this sentiment, minus the religious overtones. Thinking about UHC, it does piss me off to think that everyone would be required to pay, for example, for the lung cancer treatments of life long smokers.

For those of you that do live under UHC, does the thought ever gnaw at you or disturb you to think "Damn, we could be doing this alot cheaper if people didn't willfully and knowingly poison themselves smoking, drinking, overeating, etc."?

...or drive cars, walk on slippery surfaces, marry abusive husbands, get born with bad genes and so on and so forth. I get upset at work when I meet people demanding treatment but doing nothing in the way of excersise, handling their medication properly and so on. But as a doctor and a human being a believe everyone deserves the best available medical treatment regardless of how self-inflicted their conditions happen to be.

 

[Darat]

Agreed.

But that's not really what I was asking.

Then I've not understood your question - can you try and rephrase it?

 

[Flo]

Sarcasm aside, addressing those who do live in a country with UHC, I have to admit that my natural reaction to UHC does include something resembling this sentiment, minus the religious overtones. Thinking about UHC, it does piss me off to think that everyone would be required to pay, for example, for the lung cancer treatments of life long smokers.

For those of you that do live under UHC, does the thought ever gnaw at you or disturb you to think "Damn, we could be doing this alot cheaper if people didn't willfully and knowingly poison themselves smoking, drinking, overeating, etc."?

Lung cancer doesn't affect only smokers, drinkers don't all end up with cirrhosis of the liver, many diabetics or victims of heart diseases aren't fat, ...

I rather tend to think "damn, we could be doing this alot cheaper if some companies didn't sell poisonous substances and advertise deleterious ways of life, etc."

 

[GreyArea]

...I have some difficulties understanding the gut-wrenching horror some people seem to feel about providing health care this way. Could anyone kindly explain this viewpoint to me?

One factor that hasn't been touched on much in this thread is U.S. culture.

There is still a powerful thread of Calvinism woven into the culture here. Whether they acknowledge the origins of the belief or have stripped away the overt religious wrapping, a large number of Americans believe that success in the material world is simply an indicator of being a better person, somehow. The older view is that this superiority is based on spiritual "election", a perq for predestined salvation in the afterlife. Today the more common view is the Protestant Work Ethic, the idea that more effort and dedication to one's job yields better material results in this life. Thus, if anyone isn't doing well financially, it's their own fault.

I personally think that this also translates into issues of race. There are still a large number of Americans who don't want to have the money taken from their wallets and the food taken from their children's mouths to support "fake" Americans. There is a long history of panic about the Other here, whether its illegal people or "welfare queens" taking services and money they don't deserve. My perception of Sweden is that you have a stronger ethic of egalitarianism than the U.S. does, and fewer racial and ethnic divisions to exploit in fighting egalitarian policies. Here, most people want to be above their competitors, and many still see non-whites as not quite right. And that's not even considering the few remaining dead-enders who don't even think non-white people are fully human.

There is also the frontier myth of the completely independent, self-reliant individual. The viewpoint that says that "I'm on my own, no one will help me survive, so I owe them nothing" has now defeated the alternative perception that "we're out in the wilderness together, and we must help each other survive or we'll perish one by one". The parts of the country where you Swedes settled in large numbers had more of the latter view, but even that is going away.

Also, as Alferd Packer hinted, part of the opposition to universal health insurance is the fear that some of it will be used to cover birth control and abortion. There is still a massive opposition to reproductive rights in this country. I would say that this is not a primary reason for opposition to universal health insurance, but would be in the top ten.

 

[GStan]

Does it also make you mad that everyone in the US enjoys the free services of the police, fire department, and military, no matter how stupid and dangerous the actions that led them to require such help in the first place?

No, that is not my natural reaction.

 

[jdp]

And the cost benefit if the insurer is a for profit company is in regards to their bottom line not the most effective or efficient medical treatment. In the UHC in England (that is under terrible threat by our right wingers) we know exactly how such decisions are made and we even have a right to legally challenge such decisions.

I wonder as a test of my surmising above - do private insurance companies in the USA publish their cost benefit analysis so that a customer can make an informed choice between companies? Here is the information from the body in England that is tasked to make such calls: http://www.nice.org.uk/newsroom/features/measuringeffectivenessandcosteffectivenesstheqaly.jsp Those calculations are done by medical professionals not faceless "bureaucrats" .

That is a really good question to which I don't know the answer. If I were to guess that information would probably be considered company proprietary. I've never asked them myself but when a service is rendered, I typically get a statement that says basically: charge for service -> payment accepted. Typically it might be something like $100 charged, $25 accepted as settlement. As far as I know the only information the customer really gets is a relatively high level description of what will be covered, what will not be covered, how much, and whether pre-authorization is needed. I don't believe actual figures and analysis are typically presented or even available to the level of detail you're talking about. So you'd see something like: X% of Y treatment or service is covered.

 

[ponderingturtle]

The problem is, essentially, death panels.

State run health care involves making decisions on what services can be covered. If the system is anyway fair, it is a panel of experts. You and I see these as good things. If they paid for every service without regard to efficacy, a lot of people will die from the lack of money going around. However, people do die from not receiving services that are not paid by state health care.

Thus, state run health care takes your money, pays for services you disagree, and when you reach a very personal decision about the best course four your health care, the state will not pay for it. Also, they keep your money and make you keep on paying for it. In a private system, if you disagree with the services, you can quit, and don't have to keep paying.

Unlike other federal government services conservatives hate (IRS, EPA, NLRB), this one is far more intrusive. It is the federal government dictating very personal decisions that affect your family (healthcare), and then dictating how much you will pay for it.

Why are private death panels better than public?

 

[FattyCatty]

Even in the UK which certainly does not have the best UHC system in the world there is hardly ever any interaction with any bureaucracy for a patient (note that word not a customer), the nearest to bureaucracy is interacting with staff making appointments.

You mean you don't get the lady with the clipboard asking if you have an Advance Directive, making sure you sign that you've seen the privacy notice, making you sign permission for them to be paid, signing that they told you this, that, and the other? And the one collecting the co-pay to be seen in the emergency room?

 

[3point14]

For those of you that do live under UHC, does the thought ever gnaw at you or disturb you to think "Damn, we could be doing this alot cheaper if people didn't willfully and knowingly poison themselves smoking, drinking, overeating, etc."?

No, we don't. Or at least, it's not a conversatino I've ever had. I think that's probably a uniquely American point of view, if I'm honest.

In addition, alcohol and tobacco are (horror of horrors, oh the untamed theft of it all, it's all so unfair because it's just wealth redistribution, waaah, waah, waah*) taxed. I'm pretty sure (but I'm open to being corrected) that the taxes collected from ciggarettes more than cover the extra burden on the NHS for the same.







(*Not directed at you GStan!)

 

[GStan]

Lung cancer doesn't affect only smokers, drinkers don't all end up with cirrhosis of the liver, many diabetics or victims of heart diseases aren't fat, ...

I rather tend to think "damn, we could be doing this alot cheaper if some companies didn't sell poisonous substances and advertise deleterious ways of life, etc."

Yes, I'm with you there. I share that feeling, but also think that at least some of the responsibility lies with the individual buying the poisonous substances. I mean, not sure how it is everywhere, but in the US, when you buy cigarettes, it basically says right on the box "These make you sick, really sick."