News Health Care Reform - almost a done deal? DONE

[CRGreathouse]

In the US, it is not 'the government' but private insurance companies that make that decision. So yes, heath care is rationed here in the UK and there in the US.

Absolutely. Further, health care will be rationed in any system. It's literally not possible to do otherwise.

I know which situation I prefer. I don't have to worry about health care. If I'm ill, I go to a doctor – and I'm seen, for free, that same day. There may then be a waiting period as I'm referred to a specialist for free – the system in the UK is by no means perfect, although waiting times have come right down in the last decade – it used to be much worse.

I'll admit, my bad experiences in the UK were about two decades ago, when waiting time for a specialist was typically over 1 year (at least where I was). They've surely improved since!

 

[Sea Cow]

I'll admit, my bad experiences in the UK were about two decades ago, when waiting time for a specialist was typically over 1 year (at least where I was). They've surely improved since!

It has improved, and yes waiting times were pretty awful. A lot more money has gone into health care in the last decade – it was underfunded for ages.

 

[mheslep]

In the US, it is not 'the government' but private insurance companies that make that decision. [...]

Absolutely. Further, health care will be rationed in any system. It's literally not possible to do otherwise.

I disagree with these characterizations, though I know it is often stated that way. Yes of course the insurance company uses my premiums to pay the medical provider, but I selected the insurer after some fairly careful background checking. My firm provided a number of insurer options. The benefits were clearly stated and I get exactly what I chose to pay for, including the care for a critically sick family member. Along the way nothing was denied. There are five-star quality hospital rooms out there which we didn't use and would not have been covered, but again we got what we asked for. I could have chosen a lame-insurer, there was one on the list as I recall, and no doubt I would have had problems.

The point being that if anyone did any rationing in my case (really a misuse of the term), I did it myself.

 

[mheslep]

[..]Here in the UK, the decision how to ration care is taken by a board of health care professionals (not 'the government' – there is a difference) according to clinical criteria. [...]

The staff of http://www.opsi.gov.uk/si/si1999/uksi_19990220_en.pdf". How is NICE not the government?

 

[Sea Cow]

The staff of http://www.opsi.gov.uk/si/si1999/uksi_19990220_en.pdf". How is NICE not the government?

It is odd how you object to there being some democratic accountability for services run in the communal good.

 

[mheslep]

[...]I'll admit, my bad experiences in the UK were about two decades ago, when waiting time for a specialist was typically over 1 year (at least where I was). They've surely improved since!

Yep, agrees with what I've read and heard second hand - both the way it used to be and that the NHS has improved now. Still, NHS was called 'universal' back as now and in my opinion there is nothing 'universal' about a program that would make one wait a year for a specialist.

 

[mheslep]

It is odd how you object to there being some democratic accountability for services run in the communal good.

C'mon, I said no such thing above. Enough with the subject changing strawmen; it simply degrades the conversation. You stated the "decision how to ration care is taken by a board of health care professionals (not 'the government' – there is a difference)". Is the board (NICE) employed and answerable by the government or not?

 

[mheslep]

ETA: A lot of lies were told about the UK system in the run up to these reforms in the US. All I can say is, come here, stand in the street and ask people whether they favour the system we have or some kind of private insurance scheme. You'll be hard-pushed to find anyone, rich or poor, who does not favour our system. Every political party falls over itself to appear the most keen on the National Health Service. Even Thatcher did. Universal health care provided free at the point of need is great. Really. You'd like it.

Ok, fine, I get you like it and NHS does well by you.

But I'm not so hard pushed to find those who disagree who have had first hand experience. I have several friends from the UK who won't touch the NHS. One of them, just back from serving with the UK forces in Afghanistan, visited me here last week. For a more public example, see the UK's MEP Daniel Hannan here:
http://www.youtube.com/watch?v=OAbaMS12aDY&feature=related

 

[CRGreathouse]

The point being that if anyone did any rationing in my case (really a misuse of the term), I did it myself.

I agree. There is rationing -- not everyone could afford to go the the world's best X surgeon for their X problems. I don't think this is bad or inappropriate, and I (as a capitalist) prefer systems that let individuals decide how to ration. For example, I have little money and prefer to severely limit the amount I spend on healthcare. Another person with my income might decide to spend less on housing and more on healthcare than I do. I'm glad to have that choice -- although because I have employer-subsidized health insurance, I still spend more than I would prefer on healthcare.

 

[Sea Cow]

Ok, fine, I get you like it and NHS does well by you.

But I'm not so hard pushed to find those who disagree who have had first hand experience. I have several friends from the UK who won't touch the NHS. One of them, just back from serving with the UK forces in Afghanistan, visited me here last week. For a more public example, see the UK's MEP Daniel Hannan here:
http://www.youtube.com/watch?v=OAbaMS12aDY&feature=related

Yes, Daniel Hannan's appearances on US TV were well covered here. He is considered an extremist right-winger even in his own right-wing political party, the Conservatives – whose leader, David Cameron, disowned him because of his comments. It is electoral suicide here to suggest getting rid of the NHS. I can't watch that clip at the moment as I'm sneaking a view of this at work, but I know the kinds of things he's been saying. Suffice to say that I think, having listened to this idiot, you'd be pleasantly surprised if you then stepped into a British doctor's surgery/hospital. What he does is take examples of isolated incidents and imply that these are the norm. They are not. He also takes examples of things that happened several years ago, problems that have since been solved.

That said, the UK system would be unworkable in the US. The physical buildings are owned by the state and doctors are employed directly by the state. Realistically, you couldn't go from what you have now to this. If I were American, I'd be pressing for a system like they have in France. Hospitals and doctors are not owned/employed directly by the state there. Instead, they have a system of universal national insurance, and they pay fixed amounts for particular treatments. You can then choose to go to a hospital that charges this standard rate or use the contribution as part-payment at a more expensive place, but the hospitals themselves are not run directly by the state. French healthcare is generally very good, although you do often have to pay money up front and go through the hassle of claiming it back.

 

[mheslep]

...If I were American, I'd be pressing for a system like they have in France. Hospitals and doctors are not owned/employed directly by the state there. Instead, they have a system of universal national insurance, and they pay fixed amounts for particular treatments. You can then choose to go to a hospital that charges this standard rate or use the contribution as part-payment at a more expensive place, but the hospitals themselves are not run directly by the state.

I'm aware of the French approach and I'll pass. People keep forgetting the US has effectively had the government paid by and controlled by (if not employed by) system for years for the poor and the elderly via Medicaid and Medicare; the results are that either the care is poor or the costs explode or both. The http://healthcare-economist.com/2007/09/07/wsj-on-the-dutch-health-care-system/" interests me though.

French healthcare is generally very good, ...

No doubt they're good, but my reading shows actual medical outcomes are generally better in the US. The real problem here is cost and access, not quality.

 

[mheslep]

...He also takes examples of things that happened several years ago, problems that have since been solved.

Solved? Perhaps better funded for the moment. I understand that NHS quality has improved quite a bit in recent years, coincident with a http://www.channel4.com/news/articles/society/health/factcheck+is+the+nhs+in+the+worst+financial+health+ever/306547" of the NHS budget from £33bn in 1996-97 to £75bn ten years later. My observation is that government agencies run ok for awhile after being fed by simply growing larger but never really gaining in efficiency, and then they either collapse quality again or explode costs again or both, ending with a problem much more intractable in the end. That's certainly the trend with agencies like the the US postal service.

 

[mheslep]

Yes, Daniel Hannan's appearances on US TV were well covered here. He is considered an extremist right-winger even in his own right-wing political party, the Conservatives – whose leader, David Cameron, disowned him because of his comments.

Hmm, in the Cameron interview I heard, Cameron opposed Hannan's NHS views, but didn't disown him.

 

[Sea Cow]

Solved? Perhaps better funded for the moment. I understand that NHS quality has improved quite a bit in recent years, coincident with a http://www.channel4.com/news/articles/society/health/factcheck+is+the+nhs+in+the+worst+financial+health+ever/306547" of the NHS budget from £33bn in 1996-97 to £75bn ten years later. My observation is that government agencies run ok for awhile after being fed by simply growing larger but never really gaining in efficiency, and then they either collapse quality again or explode costs again or both, ending with a problem much more intractable in the end. That's certainly the trend with agencies like the the US postal service.

Hmmm. Unlike the bloated, extraordinarily bureaucratic, expensive and wasteful US health insurance system, you mean?

It appears that you have fallen for the rather crude propaganda of Fox News when they drag out people like Hannan to tell blatant lies. Look at health care spending in the US. The UK's NHS budget is not that much more than the US's Medicaid programme – about £200billion in 2008 compared to £75billion (US population about 5 times greater than the UK's, so Medicaid is in fact a little cheaper than the NHS, but not much). Yet the UK's NHS provides comprehensive coverage for every single person and Medicaid covers just basic treatment for the poor. You think you're getting a good deal there?

 

[WhoWee]

Hmmm. Unlike the bloated, extraordinarily bureaucratic, expensive and wasteful US health insurance system, you mean?

It appears that you have fallen for the rather crude propaganda of Fox News when they drag out people like Hannan to tell blatant lies. Look at health care spending in the US. The UK's NHS budget is not that much more than the US's Medicaid programme – about £200billion in 2008 compared to £75billion (US population about 5 times greater than the UK's, so Medicaid is in fact a little cheaper than the NHS, but not much). Yet the UK's NHS provides comprehensive coverage for every single person and Medicaid covers just basic treatment for the poor. You think you're getting a good deal there?

It is time to request support for your comments. First, your description of "the bloated, extraordinarily bureaucratic, expensive and wasteful US health insurance system" is misleading. The insurance companies are highly regulated and must maintain a compliance office with each individual state (because their products can't be sold across state lines). Next, the Medicare products differ not only by state, but by COUNTY. Insurance companies - unlike Government - operate with as few departments and employees as possible. The goal of private industry is to control costs - not become a bloated bureaucracy.

As for Medicaid, how much of the budget total is allocated to services such as transportation costs, health club memberships, eyewear, hearing aids, and meals per year (again Medicare related)?

If you want to engage in rhetoric, start first with an analysis of the Center for Medicare and Medicaid (CMS) - not the insurance industry that it oversees and burdens with mandates.

 

[mheslep]

...It appears that you have fallen for the rather crude propaganda of Fox News when they drag out people like Hannan to tell blatant lies.

Look at my last couple posts. Which lie do you contend I'm repeating? Cost?

Look at health care spending in the US. The UK's NHS budget is not that much more than the US's Medicaid programme – about £200billion in 2008 compared to £75billion (US population about 5 times greater than the UK's, so Medicaid is in fact a little cheaper than the NHS, but not much). Yet the UK's NHS provides comprehensive coverage for every single person and Medicaid covers just basic treatment for the poor. You think you're getting a good deal there?

I already stated in https://www.physicsforums.com/showpost.php?p=2659094&postcount=316" that I'm critical of the US Medicaid program.

And I don't agree that government run systems provide 'comprehensive coverage' for every single person, rather they provide the service the government decides you'll receive, good, bad, or indifferent, for every single person.

 

[Sea Cow]

http://ucatlas.ucsc.edu/spend.php"

This link provides some sobering stats regarding value for money in the US system.

Ironic that their relative life expectancies should place the US and Cuba side-by-side in the second graph down.

I find the casual disregard for inequality that some on here show quite mystifying really. I don't judge US health care by the best care available. I judge it by the worst care given to the poorest. By that judgement, it is very poor indeed. That some appear not to feel any responsibility towards the health needs of their neighbours is simply shameful.

 

[mheslep]

http://ucatlas.ucsc.edu/spend.php"

This link provides some sobering stats regarding value for money in the US system.

Ironic that their relative life expectancies should place the US and Cuba side-by-side in the second graph down.

You are simply looking around for what you want to see. Those comparisons have little to do with medical care.

 

[Ivan Seeking]

You are simply looking around for what you want to see. Those comparisons have little to do with medical care.

How are the cost of health care and life expectancy not related to health care?

 

[drankin]

How are the cost of health care and life expectancy not related to health care?

If your lifestyle is not "healthy" then it doesn't matter what your health care is. I do not believe life expectancy is related as much as culture and lifestyle.

 

[turbo]

If you lifestyle is not "healthy" then it doesn't matter what your health care is. I do not believe life expectancy is related as much as culture and lifestyle.

Lifestyle may have a role in depressing the life expectancy of Americans WRT the very high costs we pay, but there's another factor that needs to be taken into account. Many people (especially in poor rural areas and in blighted cities) have no access to regular preventive care, and conditions that might have been detected earlier go untreated until they become serious enough to require emergency care, which is VERY expensive. There may be a rigorous analysis out there somewhere that addresses this situation, but I have yet to find it.

Here is a nation-to-nation comparison of "amenable mortality" - rates of deaths due to untreated or undertreated preventable conditions. I don't have access to the journal Heath Affairs, so I don't know how rigorous the study was, but this summary is a bit discouraging.

http://blogs.consumerreports.org/health/2009/08/amenable-mortality-us-health-care-system-versus-other-countries-.html

 

[Ivan Seeking]

If your lifestyle is not "healthy" then it doesn't matter what your health care is.

Really? I'd like to see you backup that one. My dad just had quintuple bypass surgery and a pacemaker implanted, that saved his life. He was in a perpetual state of heart failure. How is the surgery irrelevant? What IS irrelevant at this point is how he got so bad that he needed the bypass.

I do not believe life expectancy is related as much as culture and lifestyle.

Beliefs are a dime a dozen.

 

[drankin]

Really? I'd like to see you backup that one. My dad just had quintuple bypass surgery and a pacemaker implanted, that saved his life. He was in a perpetual state of heart failure. How is the surgery irrelevant? What IS irrelevant at this point is how he got so bad that he needed the bypass.



Beliefs are a dime a dozen.

Figured you would call me on this. So let's do a little logic exercise:

Group A and Group B have the same excellent health care available. Group A does not have a healthy diet. Group B has a healthy diet and works 20% less than Group A. Which group has a longer life expectancy?

 

[Ivan Seeking]

Figured you would call me on this. So let's do a little logic exercise:

Group A and Group B have the same excellent health care available. Group A does not have a healthy diet. Group B has a healthy diet and works 20% less than Group A. Which group has a longer life expectancy?

But not all groups have the same excellent health care, so your point is moot. Try this one. One critical heart patient has socialized medical care through the Veteran's administration [dad], and another has no insurance or VA benefits, and lives in Watts, California. Who is more likely to survive?

Query: Why are only vets entitled to socialized medicine?

 

[Ivan Seeking]

Actually, since it came up, wrt to the VA, let me put it this way: If government run health care is so terrrible, then why do we impose this on our Vets? Don't they deserve the same care as everyone else? We don't have government run health care under the Obama reforms, but the position of the right is very perplexing in this respect.

Has one opponent of universal health care ever called for the VA medical system to be deconstructed? It almost begs the question: What does the right have against our vets? Or is the problem that their position is completely inconsistent?

 

[WhoWee]

Actually, since it came up, wrt to the VA, let me put it this way: If government run health care is so terrrible, then why do we impose this on our Vets? Don't they deserve the same care as everyone else? We don't have government run health care under the Obama reforms, but the position of the right is very perplexing in this respect.

Has one opponent of universal health care ever called for the VA medical system to be deconstructed? It almost begs the question: What does the right have against our vets? Or is the problem that their position is completely inconsistent?

I like your logic - let's impose VA on ALL Government workers and retirees (including politicians) and abolish TRICARE as well - who needs it when they can have VA.

By the way, how many VA eligible people are on Medicare? I'll look for a link.

 

[turbo]

My father is a WWII vet and gets VA care, as well as Medicare to help with medications, etc. Getting decent care was tough, as the nearest VA hospital is quite distant. Within the last year or so, though, the VA has been offering care in small field offices in rural towns on a rotating basis. That way, he gets to see the same nurses and doctors routinely, when he needs care. Lots of our veterans are getting quite old, and it is a burden on them to have to drive 2-3 hours or more to get the health care they were promised, so this is a welcome change.

Transfer all government officials, elected or appointed, over to VA care, and watch how fast that system would improve. It would get LOTS better very quickly once our cherished bureaucrats had to rely on it for their primary health care.

 

[mheslep]

How are the cost of health care and life expectancy not related to health care?

Of course they're related. The complication is that longevity is related to many things. Thus, a comparison based on a couple years of difference in unqualified life expectancy as a metric for the medical system is invalid. Many things having zero to do with the medical system impact life expectancy, including homicides, car wrecks, gene pools. If one corrects for those factors, the US comes out at or near the top of a longevity ranking.

 

[mheslep]

Actually, since it came up, wrt to the VA, let me put it this way: If government run health care is so terrrible, then why do we impose this on our Vets?

Probably we should not:

http://www.washingtonpost.com/wp-dyn/content/article/2007/02/17/AR2007021701172.html"

Currently they're given no (economic) choice. In the US, the government has set up the system so that one can only get medical benefits economically through an employer. For VA patients, their employer is the US military, and it says you will use the VA.

 

[mheslep]

Massachusetts Care (now Patrick Care) is often compared to Obama care. In response to state price controls, in the last few days health insurance companies decided to stop selling any more new heath policies. In my view this was all too predictable.

Earlier this week, the state’s six largest health insurers sued Massachusetts after nearly all of their requests to raise rates were denied. For several days they stopped offering policies to individuals and small businesses as the dispute intensified.

http://blogs.marketwatch.com/election/2010/04/08/massachusetts-a-harbinger-of-health-law-problems/

The state's insurance commissioner blocked 235 of 274 increases ranging from 8 to 32 percent on policies for small businesses and individuals. Those hikes would have taken effect April.

The insurers say increased costs of care are the problem and lay the blame for the hikes on higher charges by hospitals and doctors. They want a state judge to quash the insurance commissioner's actions.

In reaction to the commissioner's decisions, most of them said earlier this week they would stop offering new policies at the old rates, as the Boston Globe reported.

http://www.npr.org/blogs/health/2010/04/by_scott_hensley_massachusetts.html