Who should pay the healthcare costs of the uninsured?

[gravenewworld]

Semiconductors. $216B. 5 orders of magnitude improvement in 30 yrs.

Oh so the same market that the US government regulates so that advanced semi conductor technology is not allowed to be sold to China under the Wassenaar Arrangement?


Once again, not an entirely free market.

Also entire 1st 140 years of US economic history government was involved in only 10% of the economy

LIke the Captain pointed out, the same 140 years of economic history in which vital consumer services like oil, communication, and transportation were DOMINATED by huge conglomerates like Standard Oil, AT&T, and railroad monopolies?



Once again, the free market is overrated.

 

[baywax]

Think about it TVP45. Let's say someone you supported going to public university is the person that invents how to cure and prevent asthma. And the invention ends up costing $12.99 at Walgreens. That's worth a few years of taxes, eh?

And how about the community you're living in. Do you want to live in a community where most people are not educated? You don't want the majority of people to have no clue as to what asthma is. You might have to rely on one or two of those people in the community to be sophisticated enough take care of you if you're caught off guard.

My taxes keep people in school, working on the roads, blowing dead satellites out of orbit and saving blue babies and comforting the elders. My taxes make my community somewhere I like to live because its a place where people take care of each other (and ultimately themselves). That's directly benefiting my life and there are fewer people running around burning down my embassy etc... because of it.

 

[TVP45]

Think about it TVP45. Let's say someone you supported going to public university is the person that invents how to cure and prevent asthma. And the invention ends up costing $12.99 at Walgreens. That's worth a few years of taxes, eh?

And how about the community you're living in. Do you want to live in a community where most people are not educated? You don't want the majority of people to have no clue as to what asthma is. You might have to rely on one or two of those people in the community to be sophisticated enough take care of you if you're caught off guard.

My taxes keep people in school, working on the roads, blowing dead satellites out of orbit and saving blue babies and comforting the elders. My taxes make my community somewhere I like to live because its a place where people take care of each other (and ultimately themselves). That's directly benefiting my life and there are fewer people running around burning down my embassy etc... because of it.

That was my point about the social contract. Civilization comes with a price. I am willing to pay my share.

 

[baywax]

That was my point about the social contract. Civilization comes with a price. I am willing to pay my share.

Sorry, I missed your point! Its a huge responsibility that boils down a few hundred dollars off a cheque. Not too mention the responsibility of solving our own health issues without burdening the system. Its all a good idea but it also gets pretty abused.

 

[mheslep]

...If they successfully incentivize doctors and other health care workers to increase quality in these national health systems there are equivalent ways to incentivize the patients of the healthcare system to pursue lower costs...

I've lost you here, sorry its a long discussion and I've been away. How exactly are doctors to be incentivized to increase quality? Are you referring to some specific national system in existence? For that matter, are you suggesting in general a country that should be closed copied as a model for the US?

 

[CaptainQuasar]

I've lost you here, sorry its a long discussion and I've been away. How exactly are doctors to be incentivized to increase quality? Are you referring to some specific national system in existence? For that matter, are you suggesting in general a country that should be closed copied as a model for the US?

In Sicko it claimed that in the U.K. there are a specific set of metrics which doctors are evaluated for: how many patients of hers stopped smoking, how many patients had a so-and-so percentage reduction in cholesterol levels, etc., for which they earn a yearly bonus. I've heard that certain HMOs in the U.S. do similar things, though I'm not sure how the bonus or incentive or whatever would work since the doctors are not employees of the HMOs.

I'm not suggesting that any country should be closely copied. Incentivizing performance is a straightforward concept that isn't limited to healthcare. I think it's more important to vigorously and consistently implement a plan to incentivize the performance of health care professionals than it is to incentivize reduction of costs.

I also mentioned that we should incentivize citizens to improve and maintain their own health. I proposed that perhaps a program like this could be based on the frequent flyer miles programs airlines use, which have obviously been affordable and effective for them in incentivizing all sorts of different behaviors in their customers.

⚛​

 

[mheslep]

I'm not suggesting that any country should be closely copied...

I don't understand. I didn't mean exactly duplicated. Given the above posts in favor of national health care, surely you could likewise point to one or more examples elsewhere and defend it as worth of, what, emulating? Seems to me that otherwise we spend a lot of time discussing something that's purely conceptual and as such will be amorphous and impossible to evaluate.

 

[CaptainQuasar]

I don't understand. I didn't mean exactly duplicated. Given the above posts in favor of national health care, surely you could likewise point to one or more examples elsewhere and defend it as worth of, what, emulating? Seems to me that otherwise we spend a lot of time discussing something that's purely conceptual and as such will be amorphous and impossible to evaluate.

What - the way you're offering up an example of a pure free market healthcare system for me to critique? Like you're not relying on something purely conceptual that's amorphous and impossible to evaluate! Half of your responses have been “That totally doesn't count, the U.S. system isn't really a free market!”

The fact that there have been widespread, citeable and referenceable successes across many countries with socialized medicine is half the argument in favor of it.

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[mheslep]

The fact that there have been widespread, citeable and referenceable successes across many countries with socialized medicine is half the argument in favor of it.

Then it should be easy. Name one or two such.

 

[CaptainQuasar]

Then it should be easy. Name one or two such.

Don't be silly. That's what this entire thread is about. Don't you try to prove I can't argue a certain way (i.e. without claiming that a specific country should be the model) and I won't do the same to you.

⚛​

 

[baywax]

Then it should be easy. Name one or two such.

For starters, let's get the list of countries with a national health care program:

Afghanistan*, Argentina, Austria, Australia, Belgium, Brazil, Canada, Chile, China, Cuba, Costa Rica, Cyprus, Denmark, Finland, France, Germany, Greece, Iraq*, Iceland, Ireland, Israel, Italy, Japan, Luxembourg, the Netherlands, New Zealand, Oman, Portugal, Russia, Saudi Arabia, Spain, Sweden, South Korea, Sri Lanka, Ukraine and the United Kingdom
*Universal health coverage provided by United States war funding

http://www.gadling.com/2007/07/05/what-countries-have-universal-health-care/

Note that in order for the United States to supply universal medical coverage to you, you have to have been under attack by them or occupied by them.

Keep in mind: this is a simple list of countries that have some sort of publicly sponsored health care system. For instance, Sri Lanka may be far from having a true, working universal health care system like France, but prescription drugs are provided by a government-owned drug manufacturer. This qualifies as "some sort of publicly sponsored, universal health care system."

{same source}

Here's one of the "most successful models of universal health care" according to some folks.

Singapore has a highly privatized universal health care system with an emphasis on individual fiscal responsibility. Overall spending on health care amounts to only 3% of annual GDP. Of that, 66% comes from private sources.[7] Singapore currently has the lowest infant mortality rate in the world (equaled only by Iceland) and among the highest life expectancies from birth, according to the World Health Organization.[46] Singapore has "one of the most successful healthcare systems in the world, in terms of both efficiency in financing and the results achieved in community health outcomes," according to an analysis by global consulting firm Watson Wyatt.[47] Singapore's system uses a combination of compulsory savings from payroll deductions (funded by both employers and workers) a nationalized catastrophic health insurance plan, and government subsidies, as well as "actively regulating the supply and prices of healthcare services in the country" to keep costs in check; the specific features have been described as potentially a "very difficult system to replicate in many other countries." Many Singaporeans also have supplemental private health insurance (often provided by employers) for services not covered by the national programs.[47]

http://en.wikipedia.org/wiki/Universal_health_care

Actually, that whole page has great info on each country with the system.

 

[mheslep]

Thanks for posting your find.

For starters, let's get the list of countries with a national health care program:

http://www.gadling.com/2007/07/05/what-countries-have-universal-health-care/

Keep in mind: this is a simple list of countries that have some sort of publicly sponsored health care system. For instance, Sri Lanka may be far from having a true, working universal health care system like France, but prescription drugs are provided by a government-owned drug manufacturer. This qualifies as "some sort of publicly sponsored, universal health care system."

Then by this definition the US also has a 'national' heath program, not like France, but in the form of the multi hundred billion dollar medicaid and medicare programs.

 

[baywax]

Thanks for posting your find.

Then by this definition the US also has a 'national' heath program, not like France, but in the form of the multi hundred billion dollar medicaid and medicare programs.

Yes, I've always seen it as such. But what else is happening is the de-regulation of hospitals, clinics and individual doctor's offices. De-regulation means less stringent guidelines and less (he's going to say it again) congruency. If we could count on medical associations to act on behalf of the patient rather than the shareholder then there wouldn't be as many patients going "Enron" on us.

 

[mheslep]

Here's one of the "most successful models of universal health care" according to some folks.

Ok on to Singapore. I am a little wary of comparing the US to Singapore, as its population https://www.cia.gov/library/publications/the-world-factbook/geos/sn.html#People" is more comparable to Los Angeles than the entire US, but if there are good ideas to be found why not.
Here's Wiki's direct source for Singapore, thehttp://www.watsonwyatt.com/europe/pubs/healthcare/render2.asp?ID=13850"

Impressive stats there, only 3% of GDP total health spending and they get high life expectancy and high infant survival.

So how does Singapore achieve such impressive results?

The key to Singapore’s efficient health care system is the emphasis on the individual to assume responsibility towards their own health and, importantly, their own health expenditure. The result is a system that is predominantly funded by private rather than public expenditure.

Then I see they cover more people w/ private means than does the US (table 2). Seems very similar to the Netherlands.

The public system has some interesting parallels to the US:

Eldershield

The Government has also recently introduced Eldershield, an extension to the ‘3M’ system. Eldershield is a private insurance scheme designed to help fund future medical expenses incurred in the event of severe disability, particularly at advanced ages.

= Medicare?

Medifund
Medifund is an endowment fund set up by the Singapore Government to assist those in financial hardship in funding their medical needs.

=Medicaid?

Wish there were more details on how exactly the govt. care executes the universal coverage.

 

[gravenewworld]

Interesting story on 60 minutes tonight on how the US is basically reduced to using a 3rd world program for health care.

http://www.cbsnews.com/stories/2008/02/28/60minutes/main3889496.shtml

ne of the decisive issues in the presidential campaign is likely to be health insurance. Texas and Ohio vote on Tuesday, and those states alone have nearly seven million uninsured residents; nationwide, 47 million have no health insurance. But that's just the start: millions more are underinsured, unable to pay their deductibles or get access to dental care.

Recently, 60 Minutes heard about an American relief organization that airdrops doctors and medicine into the jungles of the Amazon. It's called Remote Area Medical, or "RAM" for short.

As correspondent Scott Pelley reports, Remote Area Medical sets up emergency clinics where the needs are greatest. But these days, that's not the Amazon. This charity founded to help people who can't reach medical care finds itself throwing America a lifeline.

Isaacs saw Marty Tankersley, the man Pelley had met in the parking lot who'd driven 200 miles. It turned out Tankersley had two heart attacks and heart surgery a few years back, but almost no follow up since.

The Tankersleys live in Dalton, Ga., and fall into the underinsured category. Marty's a truck driver and has major medical insurance through his employer. But the deductible is $500, really unaffordable. And the dental insurance costs too much.

So how can a program like this treat 17,000 people on only $250,000? That's what happens when doctors don't have to deal with all the HMO/insurance/etc. BS that is driving up the cost of health care.


America has great health care! ..........if you can afford it.

 

[D H]

So how can a program like this treat 17,000 people on only $250,000? That's what happens when doctors don't have to deal with all the HMO/insurance/etc. BS that is driving up the cost of health care.

I call BS.

Think about this for a second. Physicist salaries are paid over six figures, on average, according to https://www.physicsforums.com/showthread.php?p=1632227#post1632227". Medical doctors are paid even more. $250,000 would barely pay the yearly salary for two general practitioners in the US. Two general practitioners cannot provide adequate health care for 17,000 people. Even if they could, there would be no money left over for specialists, facilities, medicine, nurses, labs, equipment, and the list goes on.

So, "how can a program like this treat 17,000 people on only $250,000?" Simple. With donated time, donated equipment, donated laboratories, donated staff. Lack of liability and lack of red tape are secondary compared to all these real costs (paid for by people in the advanced world). It's a sham to compare these costs to the costs of medical care in the US. Its fallacious to blame the cost differential on HMO/insurance/etc. Finally, its completely ludicrous to think that a government-run system would bring health care costs down to $14.70 per person per year.

 

[gravenewworld]

I call BS.

Think about this for a second. Physicist salaries are paid over six figures, on average, according to https://www.physicsforums.com/showthread.php?p=1632227#post1632227". Medical doctors are paid even more. $250,000 would barely pay the yearly salary for two general practitioners in the US. Two general practitioners cannot provide adequate health care for 17,000 people. Even if they could, there would be no money left over for specialists, facilities, medicine, nurses, labs, equipment, and the list goes on.

So, "how can a program like this treat 17,000 people on only $250,000?" Simple. With donated time, donated equipment, donated laboratories, donated staff. Lack of liability and lack of red tape are secondary compared to all these real costs (paid for by people in the advanced world). It's a sham to compare these costs to the costs of medical care in the US. Its fallacious to blame the cost differential on HMO/insurance/etc. Finally, its completely ludicrous to think that a government-run system would bring health care costs down to $14.70 per person per year.

http://content.nejm.org/cgi/content/abstract/349/8/768

Results In 1999, health administration costs totaled at least $294.3 billion in the United States, or $1,059 per capita, as compared with $307 per capita in Canada. After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada.

Liability costs?

http://www.cbo.gov/ftpdoc.cfm?index=4968

Evidence from the states indicates that premiums for malpractice insurance are lower when tort liability is restricted than they would be otherwise. But even large savings in premiums can have only a small direct impact on health care spending--private or governmental--because malpractice costs account for less than 2 percent of that spending.(3) Advocates or opponents cite other possible effects of limiting tort liability, such as reducing the extent to which physicians practice "defensive medicine" by conducting excessive procedures; preventing widespread problems of access to health care; or conversely, increasing medical injuries. However, evidence for those other effects is weak or inconclusive.

What is ridiculous is the amount of waste that goes to paying for the overhead to deal with private insurance companies.


What is ridiculous is the fact that the US has to resort to 3rd world programs to treat its citizens, EVEN CITIZENS THAT ALREADY HAVE SO CALLED HEALTH INSURANCE.

 

[wildman]

The problem in the US is that we spend WAY too much money for WAY too little health care. The US spends more per capita than Canada for Government care, never mind private insurance, and Canada gets Universal coverage for its money. Either we should be spending less or we should be getting more, but to spend more and get less? Someone must be skimming a lot of money here...

 

[Schrodinger's Dog]

I did a thread on this ages ago, but the usual vision that national healthcare is socialism/communism prevailed. It's kind of bizzarre because all in all as a US citizen you pay 14%GDP, UK 7%GDP. And in fact will probably pay way more in insurance, taxes to cover it in your life, and yet In 2000 the US was ranked in 38th place 20 places below the UK, based on a wide range of factors, not least of which was infant mortality, lack of coverage for 1/6th of the population, and a lower mortality than most countries in Europe including the UK. Cut in that 50% of the costs are in insurance and legal claims, and you quickly get the idea, that what they don't want is having to pay less for something better for everyone. Slightly and mildly insane if you ask me, but that's socialism for you, it is and always will be evil to provide universal health care. Amen. Not only that but I've lost count of the number of times I've been speaking to an American on line and they've said, I would get it checked out but I can't afford it? Strangely nonsensical system if you ask me. What's even more embarrassing is that Cuba's healthcare system is only one place below the US's according to the figures in 2000 from the WHO.

http://www.photius.com/rankings/who_world_health_ranks.html

Overall Level of Health: A good health system, above all, contributes to good health. To assess overall population health and thus to judge how well the objective of good health is being achieved, WHO has chosen to use the measure of disability- adjusted life expectancy (DALE). This has the advantage of being directly comparable to life expectancy and is readily compared across populations. The report provides estimates for all countries of disability- adjusted life expectancy. DALE is estimated to equal or exceed 70 years in 24 countries, and 60 years in over half the Member States of WHO. At the other extreme are 32 countries where disability- adjusted life expectancy is estimated to be less than 40 years. Many of these are countries characterised by major epidemics of HIV/AIDS, among other causes.

Distribution of Health in the Populations: It is not sufficient to protect or improve the average health of the population, if - at the same time - inequality worsens or remains high because the gain accrues disproportionately to those already enjoying better health. The health system also has the responsibility to try to reduce inequalities by prioritizing actions to improve the health of the worse-off, wherever these inequalities are caused by conditions amenable to intervention. The objective of good health is really twofold: the best attainable average level – goodness – and the smallest feasible differences among individuals and groups – fairness. A gain in either one of these, with no change in the other, constitutes an improvement.

Responsiveness: Responsiveness includes two major components. These are (a) respect for persons (including dignity, confidentiality and autonomy of individuals and families to decide about their own health); and (b) client orientation (including prompt attention, access to social support networks during care, quality of basic amenities and choice of provider).

Distribution of Financing: There are good and bad ways to raise the resources for a health system, but they are more or less good primarily as they affect how fairly the financial burden is shared. Fair financing, as the name suggests, is only concerned with distribution. It is not related to the total resource bill, nor to how the funds are used. The objectives of the health system do not include any particular level of total spending, either absolutely or relative to income. This is because, at all levels of spending there are other possible uses for the resources devoted to health. The level of funding to allocate to the health system is a social choice – with no correct answer. Nonetheless, the report suggests that countries spending less than around 60 dollars per person per year on health find that their populations are unable to access health services from an adequately performing health system.

In order to reflect these attributes, health systems have to carry out certain functions. They build human resources through investment and training, they deliver services, they finance all these activities. They act as the overall stewards of the resources and powers entrusted to them. In focusing on these few universal functions of health systems, the report provides evidence to assist policy-makers as they make choices to improve health system performance.

The World Health Report 2000 (1) consists of a message from the WHO’s Director-General, an overview, six chapters and statistical annexes. The chapter headings are "Why do health systems matter?", "How well do health systems perform?", Health services: well chosen, well organized?", "What resources are needed?", "Who pays for health systems?", and "How is the public interest protected?"

 

[CaptainQuasar]

I did a thread on this ages ago, but the usual vision that national healthcare is socialism/communism prevailed.

Socialism yes, but not communism in general (though point taken on Cuba). After the end of the Soviet Union many aspects of Western medicine became all the rage in Russia. They were like - wow, anesthetics with dentistry? Brilliant! (Just kidding... they understood anesthetics, of course, but there were shortages of almost every sort of medical supply under the Soviet system.)

⚛​

 

[Schrodinger's Dog]

Actually it's neither really it's a basic societal need, in spite of my tongue in cheek observation of how the US feels about socialism; Hitler had some of the finest medical care in the world. Nationalised health care isn't socialism, it's common sense, it might look like it would be more expensive but it isn't. For a start people are less likely to sue the government, particularly when they realize that the money is coming out of their taxes, so less frivolous law suits and wastes of time. No insurance costs to handle yourself, all that is handled by government, and thus it is centralised and cheaper, you might pay a little more tax, but of course when your saving from GDP, that may well not be the case. And that's a massive amount of paperwork and bureaucracy gone for a start.

Healthcare providers do not run like ordinary businesses, because if they screw up people die, so people who work their tend to be a lot more job focused and a lot more careful, people are less likely to go off sick, more likely to work over time and more committed and less likely to leave that career choice. There really is no reason why you can't have both nationalised and private healthcare running at the same time for those that can afford it. And France is number one with a GDP of 9%. That's 5% less cost and the finest medical care in the world. That's kinda sad really.

 

[baywax]

Healthcare providers do not run like ordinary businesses, because if they screw up people die, so people who work their tend to be a lot more job focused

We could say the same thing about about a brake shop or aircraft engineers or anyone with peoples lives in their hands. The difference in health care is that the practitioners are handling people, not brakes or "O" rings. They have the people right there to talk to, deal with and get to know.

and a lot more careful, people are less likely to go off sick, more likely to work over time and more committed and less likely to leave that career choice. There really is no reason why you can't have both nationalised and private healthcare running at the same time for those that can afford it. And France is number one with a GDP of 9%. That's 5% less cost and the finest medical care in the world. That's kinda sad really.

Yes it is. There's more UK citizens retiring in France because of this. It may be that with a bit more consistency between each nation's health care systems, there will be less migration and less of a burden on those countries with a good system. Also, we see more and more doctors and nurses heading south for the higher pay offered by privatized health care. If we can somehow equalize our systems we wouldn't have the shortages of family physicians we have today. There are people who have gone without a family doctor for 3 years of being on a waiting list. Its not the norm but its a reality for them.

 

[mheslep]

Nationalised health care isn't socialism, it's common sense,

If that's not socialism then what is socialism?

it might look like it would be more expensive but it isn't.

That presumes you are paying for the same thing. Given the UK rationing - wait times, etc, do you believe it is the same thing?

 

[gravenewworld]

If that's not socialism then what is socialism?

Social security checks, medicare, and medicaid.

That presumes you are paying for the same thing. Given the UK rationing - wait times, etc, do you believe it is the same thing?

How could they be the same thing? Millions in the US don't even get to go to the doctor at all because they have 0 insurance or are underinsured.

 

[turbo]

As I have pointed out before, much of the cost of medical care in the US comes from the very convoluted coding requirements of the insurance companies and their incentives to deny payment over and over again. The longer they can deny payment, the more money they make on their investments. If we went to a single-payer system, the coding requirements for health-care providers would be cogent and unified, and a MAJOR expense of health-care providers would be alleviated. First, they wouldn't need to hire as many coding specialists, and secondly, they wouldn't have to face week after week of delay in payment by the insurance companies (who will eventually pay for treatment, but delay in order to maximize their profits). My cousin is a coding specialist for a pediatric ophthalmologist and all three of us used to work for a very large ophthalmic practice (I was the network administrator) and I can attest to the fact that medical practices are under great pressure from banks to get the age of their receivables reduced so that the practices can borrow against future payments. They are also driven to over-staffing in their coding people so that claims submitted to the insurance companies have a higher chance of being paid the first time out.

Insurance companies make money by denying/delaying payments on claims. This forces medical practices (who need to buy expensive equipment, supplies, insurances, etc) to borrow money to maintain their cash flow, and they have to pay interest on that. They also have to pay staffers to meet convoluted insurance company rules on referrals, second opinions, etc, or they won't get paid. The health insurance industry is the biggest drag on the US health care system, and they need to get written out of the system. We are paying far to much for far too little.

 

[CaptainQuasar]

I must agree with mheslep that nationalized healthcare would be socialism. But it's socialism in the same way that a nationalized military or a publicly-funded firefighting or police force is socialism. Whether that's “real” socialism or not, I don't particularly care personally.

⚛​

 

[vanesch]

I must agree with mheslep that nationalized healthcare would be socialism. But it's socialism in the same way that a nationalized military or a publicly-funded firefighting or police force is socialism. Whether that's “real” socialism or not, I don't particularly care personally.

⚛​

Haha, it seems that "socialism" is a scare-word in the US, in as much as "capitalism" is in France

In fact, nationalized health care is a kind of imposed health insurance with some solidarity. That is, with taxes you take the 'insurance fee' and the solidarity mechanism is then such that the fee is somehow more or less proportional to your income.

 

[Schrodinger's Dog]

Haha, it seems that "socialism" is a scare-word in the US, in as much as "capitalism" is in France

In fact, nationalized health care is a kind of imposed health insurance with some solidarity. That is, with taxes you take the 'insurance fee' and the solidarity mechanism is then such that the fee is somehow more or less proportional to your income.

In the UK the amount we pay in National insurance, is in almost all cases never more than we get out. The rest is made up from taxes, a small amount of which will come from the tax payer. Of course though when your system only costs 7% GDP, that is a lot cheaper than otherwise it would be.

It's not imposed health insurance, you can opt out in some systems and go private if you like, that's the point of running both systems, everyone is covered to the standard they would want?

This is what I find really bemusing, it's not the fact that there are any problems with the system, after all I believe 3 states employ it rather successfully already, so on a state by state basis, where is the issue? It's the notion of having to pay an average that covers everyone. That somehow you're paying for the poor's health care too? Instead of getting what is essentially nationalised and subsidised health care whenever you need it, and for all but cosmetic reasons.

Don't get me wrong there are problems with nationalised/private health care, even in France. But they don't even begin to approach the problems with a purely privates system, that shoots itself in the foot.

Is supplying every person with lighting, heating, education, pensions subsidies, socialism? Yes technically I suppose it is. But what is wrong with socialism when it actually is less costly than the alternative? The only people who suffer here are the insurance companies and the lawyers. And to be frank, if they had all their eggs in one basket, then there looking at a serious profit cut, not a very sensible idea anyway.

Do you know that you actually pay between 3 and 4 times more GDP towards health than towards your military budget? That's quite ironic don't you think?

Socialism like Democracy has it's positives and its flaws, it's about time people realized that, instead of imagining the "socialist" boogeyman as an evil spectre lurking under the bed.

EDIT: it's actually \simeq 3.58 times as expensive.

 

[ShawnD]

I think I see a trend. Americans in this thread seem to be under the impression that they're wealthier than they really are. Given that the top 10% of incomes pay something like 90% of total taxes, people need to admit that they are already leeches on the system with their respectable $50,000 income. You leech when you use the roads, you leech when you send your kids to school, and you leech when you call the police. Those are all paid for by people much wealthier than yourself. To think that using money from progressive taxation would cost more out of pocket than using a flat cost (pay for your own) is ignorant at best. The only exception would be if you truly are in the top 10% of incomes, which starts somewhere in the ballpark of $250,000.

 

[mheslep]

...Do you know that you actually pay between 3 and 4 times more GDP towards health than towards your military budget? That's quite ironic don't you think?...

Didn't use to be that way as pointed out in https://www.physicsforums.com/showpost.php?p=1608851&postcount=32". I suggest its due to the employer based tax exemption US federal law passed just after WWII. Before that health care was much cheaper.

 

[mheslep]

...But what is wrong with socialism when it actually is less costly than the alternative?...

Again this assumes that the nationalized systems are providing the same service; I think its clear they do not. Its suggested the wide spread adoption of auxiliary private care in previously all state run systems is evidence that nationalized + private is the way to go. Another possible view of those facts is that the nationalized health care system is failing badly and is being propped up by the private system. As I've stated in this thread there are several problems w/ the existing US system (which btw is anything but all private, to the tune of $600B/yr govt. monies spent) including cost/service and those that can't access the system. I don't see evidence that nationalizing the system is the remedy.

 

[Schrodinger's Dog]

Again this assumes that the nationalized systems are providing the same service; I think its clear they do not. Its suggested the wide spread adoption of auxiliary private care in previously all state run systems is evidence that nationalized + private is the way to go. Another possible view of those facts is that the nationalized health care system is failing badly and is being propped up by the private system. As I've stated in this thread there are several problems w/ the existing US system

That's what I said, that's what we have in the UK. And that is indeed what many countries have.

It's not imposed health insurance, you can opt out in some systems and go private if you like, that's the point of running both systems, everyone is covered to the standard they would want?

There you go.

(which btw is anything but all private, to the tune of $600B/yr govt. monies spent) including cost/service and those that can't access the system. I don't see evidence that nationalizing the system is the remedy.

So why are nearly 1 in 6 not covered? nearly 50 million Americans without health cover? It's because the poorest are covered, the wealthy are insured and those somewhere in between? Well it depends if they can afford it.

Like I say since out of that list I gave you virtually all the top 30 healthcare providers are a mix of national and private, or have a generally higher social mobility that allows full nationalisation. Then it's quite obvious to me, that the situation in the US, isn't exactly functioning very well. Most medically advanced country in the world at number 38, we know the reasons, but what are the solutions. Like I said some sort of state by state partial nationalisation. Seems the only losers will be insurance companies and lawyers.

 

[mheslep]

Man you're up late in the UK

...So why are nearly 1 in 6 not covered? nearly 50 million Americans without health cover? It's because the poorest are covered, the wealthy are insured and those somewhere in between? Well it depends if they can afford it.

That number is the uninsured which is not the same as saying they don't can't get get health care. Twenty percent off the top qualify by lack of means for medicaid but don't use it or don't know about it. (Mass. Romney care found this out). Another very big chunk are the 20 somethings that believe they're invincible and don't want to cut into pub money for some cheap insurance (little less than the cost of food in their case). They walk into clinics or emergency rooms all the time. This group is big in the news here lately as Sen Clintons health plan will force the 20 somethings to pay and play where as under Sen. Obama's plan its optional. The remainder include the chronically ill with some means but no employer* coverage. Note that for all these cases you can still go into an emergency room most places even w/ out insurance though that's a lousy option - big debts, not preventative, etc. - its discussed way up thread. Again this situation needs to be fixed but I don't think the mantra of 50m no insurance leads to a good outcome.

*thats the problem. Fix by eliminating the dang employer tax exemption.

 

[Schrodinger's Dog]

Actually it was only 20:58 when I posted that. Now it's 22:48 and you're right that is late, but a bit of free time atm.

Anyway I'll take a look at how universal healthcare works in the few states where it happens and get back to you. I'm sure that would provide an insight into possible solutions, being we know they can work.

Well there's also the problem of people saying, well it'll cost me if I get it sorted out so I'll leave it until it's really bad. Where as over here, you can contact web sites or phone services, if your concern is minor and get live access to qualified medical staff. GP service is free, so if you have a genuinely serious or even not so serious problem you don't have to worry. Plus of course all your prescription are at a blanket charge of about $13, or free if you are unemployed. So no matter how expensive your medication, you still pay the same. Leaving people less likely to forgo expensive treatment because of cost. These are all things that would be improved if people felt they could get access to medical care regardless of financial concerns.

 

[mheslep]

Anyway I'll take a look at how universal healthcare works in the few states where it happens and get back to you. I'm sure that would provide an insight into possible solutions, being we know they can work.

I'm fairly sure there's no universal health care offered at the US State level; I expect you've heard of instead Massachusett's Romney plan which mandates everyone buy insurance. The insurance is still private but it has a single state level clearing house that works out the terms of the policy w/ the companies; the theory being the state keep costs down by pooling large groups of people. (https://www.physicsforums.com/showpost.php?p=1616495&postcount=117") A couple other states have been closing watching the Mass plan, esp. California's Govenator who proposed something similar but was shot down by his legislature for costs. So far the Mass program is having difficulty as they're base plan is still very expensive, but yes it certainly bears watching.

Well there's also the problem of people saying, well it'll cost me if I get it sorted out so I'll leave it until it's really bad.

Exactly

Where as over here, you can contact web sites or phone services, if your concern is minor and get live access to qualified medical staff. GP service is free, so if you have a genuinely serious or even not so serious problem you don't have to worry. Plus of course all your prescription are at a blanket charge of about $13, or free if you are unemployed. So no matter how expensive your medication, you still pay the same. Leaving people less likely to forgo expensive treatment because of cost. These are all things that would be improved if people felt they could get access to medical care regardless of financial concerns.

Here's where we part company. I don't think it should be free, I think it should and can be much cheaper than it is in the US. I'm skeptical that its no worry in the UK even if its free at the point of service (obviously someone pays for it in VAT or whatever over there). Anything that's free eventually has to be rationed because of pressure from both patients and the providers. The patients, since its free, overuse the service:
o UK: "A Hypochondriac's Paradise", New Statesman, Sept 18, 1998, pg 28
o UK: "Girl, 12, to get Breast Implant", Guardian, Nov. 9, 1998, pg 6.

and the providers cut back on the quality and quantity because the price/pay is fixed:
o http://www.oecd.org/dataoecd/5/27/26781192.pdf"
o 10,000 people in UK waited 15 mos for surgery. Economist magazine of London, pg 55, April 13, 02
o UK woman whose cancer surgery was postponed until it had to be canceled because it became inoperable during delays. Economist, Nov 24, 2001, pg 52.
o http://www.theaustralian.news.com.au/story/0,25197,23178213-2703,00.html" - "Among the 277,000 doctors registered in Britain, roughly half are from Commonwealth nations"

 

[mheslep]

The issue of malpractice costs has been raised. Direct costs 2% or ~$29B. Another issue was the cost of defensive medicine brought on by these suits which is hard to quantify. Found this http://www.tigerdroppings.com/rant/MessageTopic.asp?p=6969549&Pg=5" for what its worth:

Just a note about defensive medicine from a MD...

It sure does exist. Here is an example that many of us have been faced with over and over. A male in his late 30's/early fortys comes to the ER complaining of chest pain. He has a cough or some other reason to have some chest pain (nothing points to cardiac disease) but since he said the magic words "chest pain", we now feel obliged to order the full workup to protect us from the 0.001% chance that this may represent heart disease.

He gets an EKG X 2 (probably $100)
He gets cardiac enzymes drawn X 3 (probably $150)
He gets other routine labs (maybe $150 total)
He gets a chest X-ray ($100)
He gets admitted to a medical/cardiac telemetry floor 24 hour observation ($1200)
He may get a stress test if he had any risk factor at all ($750)
He gets discharged with a follow up appointment with his PCP ($75)

So, about $2500 is spent when the only thing needed was $2 worth of Motrin. Happens every day unfortunately.

 

[ShawnD]

I've experienced that preventative medicine problem in Canada too.

I regularly have chest pain, right around where the heart is. I've always had this problem, so I don't really see it as a big deal. I've been tested in every way you can think of, including the stuff about heart tracing, EKG, normal blood testing, arterial blood testing, urine testing, breathing tests, hearing and vision testing, etc. Nothing has ever been found, so it's probably not a big deal. Even after all of that has been done, people still tell me I should see a doctor every time I groan and grab my chest. I don't even want to think about all the money those people waste. In Canada they waste tax money, and in the US they waste insurance money, which means everyone pays higher premiums.

Hypochondriacs are a problem for all of us.

 

[Schrodinger's Dog]

I'm fairly sure there's no universal health care offered at the US State level; I expect you've heard of instead Massachusett's Romney plan which mandates everyone buy insurance. The insurance is still private but it has a single state level clearing house that works out the terms of the policy w/ the companies; the theory being the state keep costs down by pooling large groups of people. (https://www.physicsforums.com/showpost.php?p=1616495&postcount=117") A couple other states have been closing watching the Mass plan, esp. California's Govenator who proposed something similar but was shot down by his legislature for costs. So far the Mass program is having difficulty as they're base plan is still very expensive, but yes it certainly bears watching.

Did you know that the US is the only wealthy Western country without some form of nationalised health care. That's the trouble with primarily being concerned with profits, although you can make a system work, it would be seen as limiting drug companies profits (although obviously if the government is paying for it, then that is not the case) and lawyers, and health insurance companies. And heaven forbid they lost money. AFAIK drug companies in this country make substantial profits, despite the NHS, so I'm not entirely sure why people think this.

Here's where we part company. I don't think it should be free, I think it should and can be much cheaper than it is in the US. I'm skeptical that its no worry in the UK even if its free at the point of service (obviously someone pays for it in VAT or whatever over there). Anything that's free eventually has to be rationed because of pressure from both patients and the providers. The patients, since its free, overuse the service:
o UK: "A Hypochondriac's Paradise", New Statesman, Sept 18, 1998, pg 28
o UK: "Girl, 12, to get Breast Implant", Guardian, Nov. 9, 1998, pg 6.

Rationed? I don't think so, nothing like that happens here, there are some extreme cases where health authorities have had to make the choice to deny certain treatments because the cost was prohibitive, and the outlay would mean denying funding elsewhere (so the patients had to resort to funding it themselves) This was on Avastin btw, the drug that got repackaged and went up 1000% in price after they discovered it was being used to treat things other than were covered by the research. I'm not sure what you are referring to here. National insurance and tax pays for it. But then with a GDP of 7% that would work out less anyway. The government of course pays for the treatment, whatever that happens to be. Cosmetic surgery is not covered under the NHS normally, unless it's reconstructive surgery for burns etc. NHS Direct, means instead of burdening health services with minor complaints people can now contact trained professionals of any level 24/7, this has had the result of reducing the problem of hypochondriacs.

and the providers cut back on the quality and quantity because the price/pay is fixed:
o http://www.oecd.org/dataoecd/5/27/26781192.pdf"

Old statistics, waiting times have improved in most hospitals. It does vary from place to place though, which means under a new incentive, patients are free to chose healthcare at a place that will treat them sooner, or even in some circumstances another country. The hospital where I worked, waiting times for consultant oncologist was much less. As were the waiting times for most operations.

o 10,000 people in UK waited 15 mos for surgery. Economist magazine of London, pg 55, April 13, 02

Not any more, I believe these are also falling in most places.

o UK woman whose cancer surgery was postponed until it had to be canceled because it became inoperable during delays. Economist, Nov 24, 2001, pg 52.

Anecdotal but obviously dreadful, this is far from the norm.

o http://www.theaustralian.news.com.au/story/0,25197,23178213-2703,00.html" - "Among the 277,000 doctors registered in Britain, roughly half are from Commonwealth nations"

Yeah we have a Dr shortage, this is because of a long term problem with Dr's working too many hours and pay issues, this has now been rectified, but atm we are importing quite a few Dr's. We had the same problem with nurses at one point until we bought in a total restructuring of pay schemes, under the Agenda for Change (meant to tackle the issues with employee retention and other work issues) This appears to be helping.

Like I say there are problems with nationalised health care, but it's better than the alternative. And let's face it if you want I can put up more than a few horror stories about the US, patients being asked what fingers they can afford to save and so on. Or you could watch that film Sicko, although I've not seen it.

By the way the US GDP is now 15.4%. See http://www.who.int/whosis/database/core/core_select_process.cfm?countries=all&indicators=nha" statistics for details.

Your table placings have improved though. After they removed certain cases which weren't necessarily treatable or self inflicted such as smoking, diet, accidents and suicides (not sure I entirely agree with this but still) Sweden is now top.

http://www.guardian.co.uk/society/2003/nov/14/politics.medicineandhealth

Since we've slipped down from 18th place to 18th place, I'm not sure that news report is very accurate to be frank. Although the table is correct.

1)Sweden
2)Norway
3)Australia
4)Canada
5)France
6)Germany
7)Spain
8)Finland
9)Italy
10)Denmark
11)Netherlands
12)Greece
13)Japan
14)Austria
15)New Zealand
16)United States
17)Ireland
18)United Kingdom
19)Portugal

EDIT: To be honest I'm also a bit dubious about you saying 1 in 6 not receiving health cover is not significant either. Whatever the cause having 50 million people not receiving treatment is abysmal to be honest.

 

[vanesch]

Again this assumes that the nationalized systems are providing the same service; I think its clear they do not. Its suggested the wide spread adoption of auxiliary private care in previously all state run systems is evidence that nationalized + private is the way to go.

This is the way it is in many European countries (again, with some having the pointer more on one side, and others more on the other). You have a nationalized health care and imposed "taxation" (part of your social security contributions), and then, if you want (and many people do) you can take an extra private insurance. You can go to a public hospital, or you can go and see a private clinic. In the last case, you will have to see how much they charge, and how much you are covered for this by the public insurance, and by your supplementary private insurance.
So if you want the "minimum", you just pay your social security, and get (almost) free care in public hospital. You can get more, if you want to, in the private sector, but this minimum is imposed to everybody.

 

[mheslep]

EDIT: To be honest I'm also a bit dubious about you saying 1 in 6 not receiving health cover is not significant either. Whatever the cause having 50 million people not receiving treatment is abysmal to be honest.

I didn't say it wasn't significant, just the opposite: 'lousy'. What the 50m either can't afford or choose not to afford is insurance. Again, that doesn't necessarily mean they necessarily don't 'receive treatment', most everyone can get treatment, though at the last minute and inefficiently.

 

[mheslep]

Rationed? I don't think so, nothing like that happens here, there are some extreme cases where health authorities have had to make the choice to deny certain treatments because the cost was prohibitive, and the outlay would mean denying funding elsewhere (so the patients had to resort to funding it themselves).

Cutting out here so that you don't have to cut back there is rationing. The most notable examples are the wait times referenced below.

o http://www.oecd.org/dataoecd/5/27/26781192.pdf"

Old statistics, waiting times have improved in most hospitals.

That OECD chart (fig 3.9) is from a 2004 survey.

Like I say there are problems with nationalised health care, but it's better than the alternative. And let's face it if you want I can put up more than a few horror stories about the US, patients being asked what fingers they can afford to save and so on. Or you could watch that film Sicko, although I've not seen it.

By the way the US GDP is now 15.4%. See http://www.who.int/whosis/database/core/core_select_process.cfm?countries=all&indicators=nha" statistics for details.

I see two problems under discussion that have very different compositions: (1) the quality of health care for the majority in the country (those that can afford it), and (2) getting care to all the hard cases (chronically ill, limited means, etc). These two problems are often muddled together at the expense of clarity. The WHO report is a good example. To determine the ranking it mixes the life expectancy metric with others like "inequality", "fairness", "dignity", and "Distribution of Financing". The latter are important but they're not good for measuring top flight medical treatment. If I am looking around the world for top flight medical care - cardio work, cancer - I don't look at the WHO list and jet off to Sweden or France. I stay right here and go to Johns Hopkins or the Mayo clinic. Same w/ Sicko type comparisons. People falling through the cracks are the ugly side of the US system but that is a different problem from the quality of the care of the US insured, of whom ~70% say they're very happy w/ the their care. (They also say its far too expensive). I see some role for government in covering (2), the hard cases. I don't see evidence that nationalized heath is the best way to do that given the problems list above. Note that for that 15% of GDP figure cited, nearly half of that is government spending now. No, I'm more inclined to fix the current private system so that is affordable to everyone. We do it with food.

 

[Schrodinger's Dog]

Cutting out here so that you don't have to cut back there is rationing. The most notable examples are the wait times referenced below.
That OECD chart (fig 3.9) is from a 2004 survey.

Nonsense. You are suggesting that all hospitals have to cut back? That is simply not true. And I have already said that patients are free to seek treatment in another hospital or even if none is available are funded to do so in another country. So yes there are a small amount of cases where treatment is denied because of the extraordinary costs (usually the fault of the pharmaceutical companies) but these are hardly the norm. And I'm not sure why after I gave those explanations above you seem keen on pursuing this, given that your assumptions are faulty, and based on small amounts of cases, mostly anecdotal.

I see two problems under discussion that have very different compositions: (1) the quality of health care for the majority in the country (those that can afford it), and (2) getting care to all the hard cases (chronically ill, limited means, etc). These two problems are often muddled together at the expense of clarity. The WHO report is a good example. To determine the ranking it mixes the life expectancy metric with others like "inequality", "fairness", "dignity", and "Distribution of Financing". The latter are important but they're not good for measuring top flight medical treatment. If I am looking around the world for top flight medical care - cardio work, cancer - I don't look at the WHO list and jet off to Sweden or France. I stay right here and go to Johns Hopkins or the Mayo clinic. Same w/ Sicko type comparisons. People falling through the cracks are the ugly side of the US system but that is a different problem from the quality of the care of the US insured, of whom ~70% say they're very happy w/ the their care. (They also say its far too expensive). I see some role for government in covering (2), the hard cases. I don't see evidence that nationalized heath is the best way to do that given the problems list above. Note that for that 15% of GDP figure cited, nearly half of that is government spending now. No, I'm more inclined to fix the current private system so that is affordable to everyone. We do it with food.

Of course you don't see evidence, after all it's not like the centralising of beaureaucracy works elsewhere, that the termination of need for huge arrays of insurance companies, and the reduction of legal costs work anywhere else do they?

I'm not saying nationalisation doesn't face its own problems, what I am saying is that it seems to work more efficiently, without sacrificing efficacy (ie it covers more people not less) given the vast amount of evidence from other countries (which you conveniently don't trust) that says so. That is all I am saying. The only real problem with implementing it on a state by state basis, is the damage to profits of certain companies (not pharmaceuticals, demand is still the same, the bill merely passes to the government). Insurance companies and lawyers - who frankly I'm not that bothered about, if they have all their eggs in one basket then that's their problem - which can still provide insurance to those who want to go private anyway, as for the lawyers? Well I'm sure they'll survive, even with a reduction in frivolous law suits.

 

[Schrodinger's Dog]

1)Sweden
2)Norway
3)Australia
4)Canada
5)France
6)Germany
7)Spain
8)Finland
9)Italy
10)Denmark
11)Netherlands
12)Greece
13)Japan
14)Austria
15)New Zealand
16)United States
17)Ireland
18)United Kingdom
19)Portugal

EDIT: To be honest I'm also a bit dubious about you saying 1 in 6 not receiving health cover is not significant either. Whatever the cause having 50 million people not receiving treatment is abysmal to be honest.

EDIT 2: Actually this table only included Western industrialised nations. Thus the statistics are only meant to be indicative of health care in the Western wealthy nations.

Sorry that's kind of misleading. This is an independent study removing the factors the US considered biased the WHO tables (mortality statistics). Such as smoking, obesity, suicides, homicides, etc.

They say that diebetes is preventable and treatable, but what they don't say that is obesity is one of the biggest risk factors associated with diabetes, and heart disease and cirrhosis of the liver interestingly enough. So I hope they took account of that too.

 

[mheslep]

Nonsense. You are suggesting that all hospitals have to cut back?

Again, I didn't say that. I'm saying its fair to call the description you provided above about 'cut backs' to save money, in a word, as rationing.

And I have already said that patients are free to seek treatment in another hospital or even if none is available are funded to do so in another country. So yes there are a small amount of cases where treatment is denied because of the extraordinary costs (usually the fault of the pharmaceutical companies) but these are hardly the norm. And I'm not sure why after I gave those explanations above you seem keen on pursuing this, given that your assumptions are faulty, and based on small amounts of cases, mostly anecdotal.

Hardly. The OECD 2004 data of 220 days is hardly anecdotal nor is it based on my assumptions. The average wait for surgery in the UK in 2004 was 220 days, period.

Of course you don't see evidence, after all it's not like the centralising of beaureaucracy works

Says who? Where's the evidence that says nationalized part of EU systems 'works'. Why is it not more plausible that the recent addition of private carriers to these system is responsible for any success?

I'm not saying nationalisation doesn't face its own problems, what I am saying is that it seems to work more efficiently, without sacrificing efficacy (ie it covers more people not less)

I see little evidence of that. I see again and again national + private systems grouped together offered as proof that the national part is great.

given the vast amount of evidence from other countries(which you conveniently don't trust) that says so.

Which mixes together many unrelated numbers and makes some relatively meaningless ranking. Sweden is number one in what? I doubt any clear statement can be formed from the numbers WHO aggregates.

 

[Schrodinger's Dog]

Why are the WHO's statistics inaccurate, I presume they ask countries for relevant information, and proceed from there. Also this is an independent study, so I presume they are working from the best available information. If the US statistics are erroneous, then that no doubt is because the US has supplied erroneous statistics when asked for them, I presume though they do some checking into any data supplied by a particular country.

I also think you have to take into account that some non serious medical operations, are not considered to be priority, and so the statistics don't take into account serious medical problems. For example, the bench mark for cancer is a consultant appointment in 3 months maximum, something that is usually achieved. Such a blanket statistic is misleading. And tends to infer that even serious cases are likely to warrant 7 or so month waits. As I said before if you wish you can ask to be treated in a place which could see you sooner. So again if the problem is serious, there is provision for you to be seen sooner, something that your statistic misses, and which is also a recent proviso that came in after 2004.

As for evidence it works, try the top performers, who have partial private and nationalised, without the limiting factors previously mentioned, such as diet and suicides and smoking and so on - which of course tends to rule out a vast swathe of the population where you can't look at the treatment for such cases because they are not accountable - so that in itself raises issues. If independent studies aren't going to convince you, then nothing is, it's obviously some sort of conspiracy.

Again note I'm not saying we don't have our share of problems, or indeed going on that table that we are doing better. For years the NHS was underfunded, staff underpaid and there was a serious brain drain to other countries such as the US because of this. The labour government has introduced a rather short sighted policy of jumping through hoops, but it at least is better than it was in the early 90's when the conservatives almost ran the NHS into a crisis. The NHS is now looking at more private options to help with the nationalised side of its operations, it's also gone from the insular mentality of the 90's to a more business like approach. Hopefully this will have favourable results. Of course it's not going to go fully private though, that would be even worse, and no doubt we'd end up with the same problems you have.