Is American health-care amazing?

[Speaker for the Dead]

I'm putting this in Great Debates because I know it'll turn into an argument. I'm lacking the time and the inclination to really argue either side, but I really want to see what people think.

There's a very large segment of people here and elsewhere who hate the idea that government could be providing their health-care. The arguments vary, but it comes down to the idea that they will be forced to pay more for worse service. Okay.

I live in Canada, in a system that is continuously criticised by our citizens for being slow, expensive, and inefficient. While my personal experiences don't bear that out, I'm willing to concede that it's true, if only for the sake of discussion. The solution, some argue, is privatisation.

Now, I know next to nothing about the American system, which is the classic example of private health-care. Because I know so many people who want to move in that direction, it must be a pretty great set-up.

What makes it great? I'm ignorant. My goal isn't to secretly have people realise flaws or anything. I'm genuinely curious what draws so many to privatisation, since I've never experienced private care.

[Jackmannii]

Now, I know next to nothing about the American system, which is the classic example of private health-care.It's a bit less than "classic", seeing as there are large components of publicly-funded care, including Medicaid, Medicare and the Veterans Administration system.

As to problems in the Canadian system, about which I know little, maybe you can explain what the major complaints are (delays in specialized/primary care? Rationing?) so we can decide if the current American system is doing better.

[Speaker for the Dead]

Sorry, by "classic," I meant that it's the system that gets pointed to when people are promoting (or defending) privatisation. Are there other famous private systems?

From what I understand, people don't like paying the levels of taxes that they do for the health-care they receive. Waiting lists, especially for "non-essential" surgeries, can get excessive--years long, in fact. Rural services are rapidly decreasing, at least in the prairies.1 Plus, a lot of alternative treatments, like acupuncture, aren't covered, so you have to pay for them yourself. That's a few off the top of my head, anyway.


1. This might be more of a personnel issue than a public/private one.

[Thudlow Boink]

There's a very large segment of people here and elsewhere who hate the idea that government could be providing their health-care.Talking about "the government providing health care" makes it sound (at least to me) like the government would take over what the doctors and hospitals are currently doing, or at least be in charge of them, which is a scary thought. What's actually being proposed (which makes a lot more sense) is to have the government take over what the private insurance companies, and/or what the private employers who provide health insurance as a benefit to their employees, are currently doing.
What makes it great? I'm ignorant. My goal isn't to secretly have people realise flaws or anything. I'm genuinely curious what draws so many to privatisation, since I've never experienced private care.Do you have a car? Have you experienced private care for your car? That is, when it needs maintenance or service or new tires or whatever, do you take it to the place of your choice and pay out of pocket? If you don't like the job they do, can you easily take your business elsewhere? Can you decide, based on your own priorities and values, how much money is worth putting into your vehicle? If you drive like a maniac or cheap out on regular maintenance, do you have to foot the bill for costly repairs?

I think that, at least in theory, the advantages of "private care" in medicine are supposed to parallel the advantages to "private care" in something like auto service. (If this doesn't apply to you, you might replace something else, like computer service or veterinary care or even daily food, for automotive service in my analogy.)

I'm not saying I personally buy the analogy or that I'm a big advocate of privatization in health care, but it's an interesting perspective.

(Even more far-fetched analogy, though it does speak to America's tradition of rugged individualism and self-reliance: America has never had a national health service just like America has never had a national church.)

[Attack from the 3rd dimension]

I work in Canadian healthcare and while I have minor issues with it, in general I find it excellent. The people with whom I work constantly mention the following priorities when discussing what to do: Best patient care, cost, standard of practice, safest thing to do for the patient.

I have participated in the US system as a patient. I found one portion of it to be excellent, which is the military delivery of healthcare, which is very similar to Canadian healthcare. In my limited exposure US civilian healthcare has been adequate, but not impressive.

[athelas]

The problem with the current system is not that we have a free market in healthcare, but that our market is far from free. The incentive systems are all screwed up. Patients have to go with the insurer that their employer mandates, regardless of how they are treated. Insurers try their best to avoid paying for medical procedures, but it's doctors who are harmed by this, not the patient. Doctors try to do as many procedures as possible, but it's the patient, not the insurer, that takes the fall.

Basically, you have the patient, the insurer, and the doctor. In every combination, A gets to decide how much B screws over C, rather than having his actions feed back on himself. No wonder the market is screwed up.

One way to fix this would be to have doctors bill by time, not procedure, and have insurance be an after-the-fact reimbursement of a percentage of the costs. If a doctor does too many procedures, they eat the costs and the patients go elsewhere. If the insurer fails to pay up on time, the patient picks another insurer. THAT's the way the free market is supposed to work.

[gonzomax]

http://www.ourfuture.org/blog-entry/mythbusting-canadian-health-care-part-i This is a comparison of American and Canadian. We are buying myths.

[Attack from the 3rd dimension]

http://www.ourfuture.org/blog-entry/mythbusting-canadian-health-care-part-i This is a comparison of American and Canadian. We are buying myths.

This blog is generally in line with what I find. Also, I didn't write it. :)

[Jophiel]

The problem with the current system is not that we have a free market in healthcare, but that our market is far from free. The incentive systems are all screwed up. Patients have to go with the insurer that their employer mandates, regardless of how they are treated. Insurers try their best to avoid paying for medical procedures, but it's doctors who are harmed by this, not the patient. Doctors try to do as many procedures as possible, but it's the patient, not the insurer, that takes the fall.That's the crux of it for me. Every "How horrible would it be if the government made health decisions?" falls flat for me considering that I have never had any medical procedure done for me of greater complexity than prescribing amoxicillan for a throat infection that wasn't dabbled in by the insurance companies.

Doctor thinks I need a test done? Insurance doesn't think it needs to be done. They won't pay for it because they don't agree with it. Doesn't matter what the medical professional you chose thought -- insurance says "nope" unless you want to shell out for the whole thing out of pocket. Of course, those prices are set with the assumption that insurance will be picking up the lion's share of it.

Doctor wants to prescribe a medication? Insurance doesn't think you need that medication. Despite what the doctor thought was best for you, the insurance company thinks you need to first try this medication over the counter followed by this cheap knock-off prescription medication. If those don't work, come back in six months and we'll discuss the one your doctor thought you needed.

Over and over, it's the same thing. The insurance companies are in it for one reason only -- to make money for themselves. Which is a perfectly valid reason to open a business (arguably, it's the only reason to open a business). But I haven't heard a good reason yet why entrusting my medical care to an industry whose only goal is to squeeze as much profit out of me as possible is better than entrusting it to the government.

[athelas]

Over and over, it's the same thing. The insurance companies are in it for one reason only -- to make money for themselves. Which is a perfectly valid reason to open a business (arguably, it's the only reason to open a business). But I haven't heard a good reason yet why entrusting my medical care to an industry whose only goal is to squeeze as much profit out of me as possible is better than entrusting it to the government.

Theoretically, Jophiel, it could be good, if insurance companies competed with each other to reduce costs. But the current system has you stuck with whatever insurer your company provides. In this system you can't switch to Awesome Insurance Group if you wanted, no matter how Awesome they may be. So companies have no incentive to provide good service. (Instead, they wastefully compete with each other to woo corporate clients, which is inherently a zero-sum game).

That's why many non-UHC supporters think that simply delinking healthcare from employment would make a big difference, making insurers compete in customer satisfaction rather than sweet-talking corporations. Sometimes a change in incentives is all it takes.

(This wouldn't, unfortunately, remove the wasteful adversarial relation between doctors and insurance. One thing at a time.)

[athelas]

One good model for healthcare is Singapore (http://econlog.econlib.org/archives/2008/01/singapores_heal.html), which with its usual technocratic zeal has a system of universal insurance but high co-payments (up to a point). This means that if you spend on medicine, you will pay part of the cost, and gives consumers an incentive to only get the healthcare they need, fighting price inflation. Under the current system patients don't really pay for their own procedures; it's all covered by insurance. So they have no incentive to refuse any medical procedures, however quackishThe Singapore government spent only 1.3 percent of GDP on healthcare in 2002, whereas the combined public and private expenditure on healthcare amounted to a low 4.3 percent of GDP. By contrast, the United States spent 14.6 percent of its GDP on healthcare that year, up from 7 percent in 1970... Yet, indicators such as infant mortality rates or years of average healthy life expectancy are slightly more favorable in Singapore than in the United States...international experts rank Singapore's healthcare system among the most successful in the world in terms of cost-effectiveness and community health results.

* There are mandatory health savings accounts: "Individuals pre-save for medical expenses through mandatory deductions from their paychecks and employer contributions... Only approved categories of medical treatment can be paid for by deducting one's Medisave account, for oneself, grandparents, parents, spouse or children: consultations with private practitioners for minor ailments must be paid from out-of-pocket cash..."
* "The private healthcare system competes with the public healthcare, which helps contain prices in both directions. Private medical insurance is also available."
* Private healthcare providers are required to publish price lists to encourage comparison shopping.
* The government pays for "basic healthcare services... subject to tight expenditure control." Bottom line: The government pays 80% of "basic public healthcare services."
* Government plays a big role with contagious disease, and adds some paternalism on top: "Preventing diseases such as HIV/AIDS, malaria, and tobacco-related illnesses by ensuring good health conditions takes a high priority."
* The government provides optional low-cost catatrophic health insurance, plus a safety net "subject to stringent means-testing."

[SenorBeef]

Plus, a lot of alternative treatments, like acupuncture, aren't covered, so you have to pay for them yourself. That's a few off the top of my head, anyway.



This is a good thing. I would be infuriated if my government were paying for ineffective psuedoscientific bullshit. And I'd be annoyed if my insurance company attmepted to steer me away from legitimate medical treatment to try to give me a cheap placebo.

In Britain they have government-run homeopathy clinics that do nothing useful, but it saves the government money when idiots choose to use those rather than demand actual medical treatment. That Canada has the decency not to succumb to that sort of bullshit is to its credit, not detriment.

[athelas]

Meanwhile here's (http://www.marginalrevolution.com/marginalrevolution/2007/03/french_health_c.html) a takedown of the French healthcare system, one usually touted by UHC proponents:Note that France still spends more than all or most other European systems, namely about 11 percent of gdp.

When comparing health care outcomes, France only does slightly better than many Mediterranean countries with obviously non-enviable health care systems. It is not obvious that France does better on health care outcomes than Japan, again a country with non-enviable health care institutions. In other words, France spends lots of money making people feel good about their health care processes, with only very marginal measured health care results. The United States also spends money on customer comfort, albeit in a more expensive and less egalitarian way.

It is easy to argue that the French system is better than that of the United States. But a defender of the French system must, in reality, fight "a war on two fronts," to paraphrase Derek Parfit. The French system does not, by the standards which have been erected in the debate, appear noticeably better than many other cheaper systems around the world. It does spend more money producing "customer satisfaction" and papering over some of the obvious inhumanities of the cheaper systems[IE the ration-happy UK system, where you get great emergency care but you wait years for a cancer operation]. That's why it is easy to hold up as a model.

Remember that healthcare costs are partly a result of lifestyles and genetics. Countries benefit not just by having good healthcare systems, but from having a healthy population (see Japan, which has a crappy universal healthcare system but a population that it's cheap to treat in general.) US healthcare-bashers like to quote infant mortality statistics, but the fact is that if you compare the white US population with Europe, the US comes out ahead. Blacks, for genetic reasons, have a higher incidence of miscarriages and infant mortality, and if you make the demographics proportional the critics' case collapses. It's more fair to compare Scandinavia to, say, Minnesota, than it is to compare it to the US as a whole.

[tetranz]

I have a question for the Canadians here. This might be a silly question but do you have private health care at all in Canada? Do you have such things as "private" hospitals who serve those with insurance or can afford to pay for it themselves?

I was familiar with the New Zealand system (although luckily never really needed it) until I moved to the US. In NZ you can buy private health insurance which supplements the public system. I used to have a policy with Southern Cross (http://www.southerncross.co.nz/). It mostly meant that if I needed surgery I could get it done quickly at a private hospital rather than having to go on a waiting list (depending on urgency) to get it done for free at a public hospital. I don't know what it costs today but it was very cheap compared to US standards, something like $40 NZD per month. I signed up for it because it was part of a package from my employer at the time and then I continued to pay for it myself after I left.

Various things I've read suggest that Canada is different in that "public" health care is the only health care. That might be complete nonsense so I'd appreciate clarification.

[Laudenum]

Now, I know next to nothing about the American system, which is the classic example of private health-care. Because I know so many people who want to move in that direction, it must be a pretty great set-up.
.

The Singaphore system is probably a better example, my understanding of the American system is that it's a botched patchwork with huge government intervention, just in different areas then normal.

[caligulashorse]

http://www.ourfuture.org/blog-entry/mythbusting-canadian-health-care-part-i This is a comparison of American and Canadian. We are buying myths.

What a bunch of garbage. No one with a functioning brain cell would have read that beyond the first "myth":


1. Canada's health care system is "socialized medicine."
False. In socialized medical systems, the doctors work directly for the state. In Canada (and many other countries with universal care), doctors run their own private practices, just like they do in the US. The only difference is that every doctor deals with one insurer, instead of 150. And that insurer is the provincial government, which is accountable to the legislature and the voters if the quality of coverage is allowed to slide.

This guy failed economics and basic logic. "I'm not a thief. I stole nothing. I was just borrowing that money. I even left an IOU."

[Declan]

I have a question for the Canadians here. This might be a silly question but do you have private health care at all in Canada? Do you have such things as "private" hospitals who serve those with insurance or can afford to pay for it themselves?

I cant speak for the other 9 provinces, but its never been nessasary in Ontario to have a private clinic and pay per visit. We simply go to New York or Michigan and step into one of the facilities there. People were getting MRI's and other long wait time items in Ontario, at that time* and the American doctors would email the results to the Canadian facility.

* I had heard this sometime in the nineties , I assume its still ongoing but cant cite it.

Declan

[thirdname]

Why is it that people get health insurance through employers in America, anyway? I don't understand that. We don't have to buy food from a company store. We get money, and we spend that where we want.

[GIGObuster]

Why is it that people get health insurance through employers in America, anyway? I don't understand that. We don't have to buy food from a company store. We get money, and we spend that where we want.
As this simplified time line shows, paradoxically the New Deal created an opening for private insurers to appear and industry found that it was not only convenient, but it also helped control workers more IMO.

http://whatifpost.com/heath-care-history-the-beginning-1929
1933-1938
The beginning of Kaiser Foundation Medical Care Plan: A physician at Kaiser Co.’s California dam construction site convinces the Kaiser owned construction workers’ insurance company to pay him in advance per employee for providing medical care on-the-job rather than send workers with serious injuries to medical facilities 200 miles away. This kind of prepaid care allows employers to better predict costs. Kaiser also arranges for voluntary salary deductions to cover off-the-job care for the workers and their families.

Employer insurance expanded to cover families at employees’ expense.

1934
Hospital costs rise to nearly 40% of a family’s medical bill. Health care spending rises.

The AMA adopts principles to protect physician right to set rates based on patient income and to supervise voluntary insurance; declares it unprofessional for doctors to seek profits in practicing medicine.

1935
President Franklin Roosevelt bows to the AMA, the insurance industry and business and removes national health insurance from his proposal for Social Security Legislation before presenting it. 2nd attempt at national health reform: national health insurance / Blocked by: Doctors, Insurance Companies, Employers (see 1915)

Doctors commit to independence from private health insurance.
The reason why I say that nowadays the current health care that we have can be appreciated only by a medieval feudal lord, is that as soon you or a member of your family develops a condition, you become in practice a serf to your company.

Because as soon as you decide to change jobs for any reason it is likely that you will not get the same coverage elsewhere. And we have not touched on the fact that anyone going to business on their own gets hit with higher health care costs than if he or she would by continuing to work in a large company.

Just for freedom reasons alone, I say that we need to have at least an optional government health plan that allows Americans the opportunity and the freedom to start their own companies.

[athelas]

Just for freedom reasons alone, I say that we need to have at least an optional government health plan that allows Americans the opportunity and the freedom to start their own companies.

Why does it have to be a government plan? Why don't we get rid of employer health insurance tax credits, so that they won't have an incentive to cover their employees, and people will have their pick of private insurers?

[GIGObuster]

Why does it have to be a government plan? Why don't we get rid of employer health insurance tax credits, so that they won't have an incentive to cover their employees, and people will have their pick of private insurers?
Well, I would had expected that solution to appear a long time ago, but IMHO private insurers and corporations just do not have the interests of the people in mind. They had plenty of time to show their effectiveness in relation to the health care that other developed nations have.

[SenorBeef]

Why is it that people get health insurance through employers in America, anyway? I don't understand that. We don't have to buy food from a company store. We get money, and we spend that where we want.

I've read that during WW2 there were government-mandated wage freezes that dictated what employers could pay employees. So to attract the best and brightest, they tried to offer other benefits than better wages - including covering their health insurance, and it stuck. Sort of a quirk of history.

It's sort of ironic that the current system that small government advocates (of which I am one, but I'm coming to change my mind on our current health care system because it's not set up to respond to free market pressures) advocate maintaining the status quo which was originally created by obtrusive government intervention into the markets.

[Attack from the 3rd dimension]

What a bunch of garbage. No one with a functioning brain cell would have read that beyond the first "myth":


1. Canada's health care system is "socialized medicine."
False. In socialized medical systems, the doctors work directly for the state. In Canada (and many other countries with universal care), doctors run their own private practices, just like they do in the US. The only difference is that every doctor deals with one insurer, instead of 150. And that insurer is the provincial government, which is accountable to the legislature and the voters if the quality of coverage is allowed to slide.

This guy failed economics and basic logic. "I'm not a thief. I stole nothing. I was just borrowing that money. I even left an IOU."

Don't see where you're going here.

Canadian doctors see patients, and bill the provincial health authority for the service they provide. For instance, a radiologist reads a chest X-ray, dictates a report, and drops the requisition for the x-ray in a tray. A secretarial person picks up the requisition and bills the provincial health authority for 1 chest x-ray interpretation for patient Jane Smith, ID number 123456789. The province then coughs up the money and the radiologist pockets it. A family doc does the same thing and bills the province for a physical examination, or whatever, and gets paid a fee for the examination.

[Desert Nomad]

Why does it have to be a government plan? Why don't we get rid of employer health insurance tax credits, so that they won't have an incentive to cover their employees, and people will have their pick of private insurers?

One problem is the profit motive of the private insurers make them decide not to cover people that might need to use the insurance. I am self-employed and have a pre-existing condition. Thus, I have been declined by every insurer licensed in my state. I moved overseas 7 years ago to get insurance.

[tetranz]

I cant speak for the other 9 provinces, but its never been nessasary in Ontario to have a private clinic and pay per visit.

It sounds like something that just doesn't happen but if a Canadian doctor wanted to open a private clinic which does not participate in the public health system and only treats paying patients, is he legally allowed to do that? Somehow I got the impression that it was not permitted which rather surprised me but ... I might have heard it from an unreliable source.

[jtgain]

Why does it have to be a government plan? Why don't we get rid of employer health insurance tax credits, so that they won't have an incentive to cover their employees, and people will have their pick of private insurers?

Because, unless something changes, private insurers are tremendously expensive, and won't cover you if you had a cold within the last five years (hyperbole).

The problem isn't the market, but the fact that the market has been usurped by massive government intervention via Medicare, Medicaid, CHIP, VA, etc.

I generally like the market solution, but here is my big criticism of it. Let's say that we had a pure market system and it worked like we hope it would. Then you have a 7 year old girl with cancer. Her parents either didn't buy insurance, can't afford the operation, or whatever. The operation costs $XXXX and her family can't afford it. It seems as if efforts to raise the money in the community are falling short.

This operation has a 100% chance of curing her if she gets it, but she will definitely die if she doesn't get it. What does the market say to this little girl?

[sishoch]

Here's an example of the wonderful American health car system.

My doctor's office exists to maximize profits for their investors. The doctors are scheduled weeks in advance, to maximize the throughput of the office. To get care, I have to call and schedule an appointment, typically 3 or more weeks in advance.

So if I need treatment right away, I am directed to the ER at the local hospital and I'm treated by the ER staff, that does not have access to my medical history. This is for any immediate treatment, even during office hours.

So any acute care costs me $150 for the ER plus $75 for each doctor I see, unless they are out of my PPO, in which I'm completely responsible. The cost to my insurance company is probably on the order of $1000 to $3000, depending upon the service.

So, if you feel sick in America, please have the courtesy of scheduling it well in advance.

[Attack from the 3rd dimension]

It sounds like something that just doesn't happen but if a Canadian doctor wanted to open a private clinic which does not participate in the public health system and only treats paying patients, is he legally allowed to do that? Somehow I got the impression that it was not permitted which rather surprised me but ... I might have heard it from an unreliable source.


From wikipedia on Canadian Healthcare:
http://en.wikipedia.org/wiki/Health_care_in_Canada

" The Canadian system is for the most part publicly funded, yet most of the services are provided by private enterprises. Most doctors do not receive an annual salary, but receive a fee per visit or service.[1] According to Dr. Albert Schumacher, former president of the Canadian Medical Association, an estimated 75 percent of Canadian health care services are delivered privately, but funded publicly.

" "Frontline practitioners whether they're GPs or specialists by and large are not salaried. They're small hardware stores. Same thing with labs and radiology clinics...(snip)

The Canada Health Act of 1984 "does not directly bar private delivery or private insurance for publicly insured services," but provides financial disincentives for doing so. "


You open your own shop. People come, you treat them, you charge their insurance company. Everyone has the same insurance company, which is from the province. Most people have some additional insurance to cover dental and glasses.

It would be tough to set up as a private for-cash provider, since the exact same service is offered essentially for free everywhere else.

The other benefit is that anybody and everybody is covered, to include homeless, drug addicts and other non-mainstream groups. In all the places where I have worked the homeless guy is in the next bed to the professor in the ER.

[Speaker for the Dead]

Don't see where you're going here.

Canadian doctors see patients, and bill the provincial health authority for the service they provide. For instance, a radiologist reads a chest X-ray, dictates a report, and drops the requisition for the x-ray in a tray. A secretarial person picks up the requisition and bills the provincial health authority for 1 chest x-ray interpretation for patient Jane Smith, ID number 123456789. The province then coughs up the money and the radiologist pockets it. A family doc does the same thing and bills the province for a physical examination, or whatever, and gets paid a fee for the examination.I agree. While some of our doctors (especially our teaching ones) are salaried and paid directly by the provinces, the rest run things how they want to and get paid by what amounts to a government-run insurance company. As Attack says, it's "fee for service."

[XT]

Now, I know next to nothing about the American system, which is the classic example of private health-care.

Um...first off the American system isn't a good example (classic or otherwise) of a private health-care system. Our system is a kludged up cluster fuck of a system half way between a quasi-private system and a government controlled system. Part of our problem is our system isn't one thing or the other but sort of straddles the fence.

Because I know so many people who want to move in that direction, it must be a pretty great set-up.

Who want to move towards the American health care model? They are nuts then and should be locked away. Our system is a complete cluster fuck. The wonder is that it still functions as good as it does.

What makes it great?

We are a rich nation and so are able to attract top talent into our system. Also, our system pays doctors and such very well...which also tends to attract top talent. We also have a lot of money for some truly fine medical colleges and universities...again, which attracts top people from around the world.

On the user side...if you have a job that gets you health care then our system is VERY good. For instance I am typing this from the doctors office atm. I hurt my shoulder yesterday when I fell at the air port lugging my stuff off the plane. I called my health care provider, told them I hurt my shoulder and asked to see a doctor. They told me to come right over. Doctor looked at the shoulder and sent me off for an X-Ray and an MRI (which I'm waiting for the results right now, freezing my backside off in one of these stupid hospital gown thingies). Total elapsed time since I called this morning...2 hours and 22 minutes. Prescription cost for the 3 I was given...probably something like $15. My out of pocket cost for the visit (co-pay)? $10.

So...if you HAVE insurance in the US it's usually (in my own experience) very good. If you don't...well then it's not so good. My sister has no medical insurance through a company, for instance. Nor does many of my relatives who are generally quite poor. For them it's medicare and the emergency room.

My goal isn't to secretly have people realise flaws or anything. I'm genuinely curious what draws so many to privatisation, since I've never experienced private care.

You'd need to look at some other country than the US if you want to compare Canada to a real privatized system. The US doesn't have anything close to a privatized health care system. Honestly I don't even know of a country that DOES have a true privatized health care system off the top of my head.

-XT

[Speaker for the Dead]

Who want to move towards the American health care model? They are nuts then and should be locked away. Our system is a complete cluster fuck. The wonder is that it still functions as good as it does.I was inspired to ask this question after reading some recent threads in which a number of posters wrote in the most doom-and-gloom rhetoric about the losses the American health system would suffer if it were no longer private.

[XT]

It hasn't been private for a long time. My guess is they were talking about the losses if we went from what we actually have to a fully public system (UHC). There is a lot of debate as to what the conversion to such a system would cost, both in the initial costs and in the recurrent costs. There is also some discussion on the overall level of service we could expect....for instance, if everyone has access to the same care would that mean that a minority of people would get better care than today (especially those who get little or no care today) while the majority of people who DO have care today would get lesser care? There are only so many resources to go around and all that.

But if they were lamenting the demise of private care in the US they were decades late.

-XT

[tetranz]

From wikipedia on Canadian Healthcare:
http://en.wikipedia.org/wiki/Health_care_in_Canada

" The Canadian system is for the most part publicly funded, yet most of the services are provided by private enterprises. Most doctors do not receive an annual salary, but receive a fee per visit or service.[1] According to Dr. Albert Schumacher, former president of the Canadian Medical Association, an estimated 75 percent of Canadian health care services are delivered privately, but funded publicly.

" "Frontline practitioners whether they're GPs or specialists by and large are not salaried. They're small hardware stores. Same thing with labs and radiology clinics...(snip)

The Canada Health Act of 1984 "does not directly bar private delivery or private insurance for publicly insured services," but provides financial disincentives for doing so. "


Thanks, that's interesting. It's a bit confusing but, after reading that Wikipedia page (and the discussion attached to the page), I think it's true to say that a provider in Canada is prohibited from providing a service for a fee if the patient could get that same service through the government insurance system. It's obviously a plan to stop someone with money jumping the queue. I'm not saying it's a bad thing but it is different to what we have in New Zealand where someone with money or insurance can certainly get surgery quicker by "going private".

[Chronos]

Quoth athelas:Blacks, for genetic reasons, have a higher incidence of miscarriages and infant mortality, and if you make the demographics proportional the critics' case collapses.Could we have a cite for this, please? Preferably one that controls for socioeconomic conditions? Because I suspect that all this comes down to is "American health care is great for the rich, and only sucks for poor people".

[athelas]

Quoth athelas:Could we have a cite for this, please? Preferably one that controls for socioeconomic conditions? Because I suspect that all this comes down to is "American health care is great for the rich, and only sucks for poor people".

Nope; covered it over in the other UHC thread (http://boards.straightdope.com/sdmb/showpost.php?p=11151143&postcount=37), though I should have crossposted it for completeness. Among other reasons, blacks have a higher proportion of premature births, which contributes to infant mortality but is not obviously a result of medical incompetence. From the March of Dimes PDF (http://www.marchofdimes.com/files/AA_PTB_Report_FINAL(1).pdf):Compared to non-U.S.-born, U.S.-born residents have been shown to have higher rates of preterm birth and low birthweight. While race is often discussed as proxy for socioeconomic status, differences in preterm birth by race/ethnicity cannot be attributed exclusively to differences in socioeconomic status.

Black infants also have a greater chance of being born very preterm (less than 32 completed weeks of gestation) (Figure 2). In 2004, 4.1% of black infants were born very preterm, compared to 1.8% of Hispanic infants, 1.6% of white infants, 2.2% of Native American infants and 1.5% of Asian infants.This kind of thinking is a bit counterintuitive because many of us have been steeped in the whole "race is just skin deep" dogma, which does not allow for biological differences between races, or the existence of race in a scientific context. But in fact both forensic pathologists - who can detect race from skeletal morphology, and doctors, who see genetic differences in disease burden, have to actually grapple with such differences on a daily basis.

Relevant to this debate, it means that we can't compare countries' disease burdens without comparing countries' populations. (Otherwise people can cherry-pick facts, ie seeing Israel with crazy-high Tay-Sachs disease incidence and conclude it has crappier healthcare than Cambodia.)

[Zoe]

I lived in Denmark for a short while and even though they were paying a 40% tax, they were so proud of their excellent health care system that they said that it was worth every penny. They did not have to worry about expensive treatments, how they would take care of themselves in their old age, the complications of having a child with disabilities and many other such problems.

American made medicines were less expensive there than they are here in the USA!

Also, products cost less because you were not paying the store owner or factory owner extra so that he could pay for his employees' insurance.

The government also mandates five weeks of paid vacation for every working citizen.

There is a very strong work ethic there. I saw no poor people. None.

[Desert Nomad]

I lived in Denmark for a short while and even though they were paying a 40% tax, they were so proud of their excellent health care system that they said that it was worth every penny. They did not have to worry about expensive treatments, how they would take care of themselves in their old age, the complications of having a child with disabilities and many other such problems.

Agreed. At this very moment I am sitting at a US airport on my way to a doctor appointment in the Czech Republic. The cost to see my doctor there will be about $50, whereas in the US it'd be $2,000 or so.

I just wish I could buy health insurance in the US so I didn't have to fly to Europe every couple months when I am visiting the US... it'd be nice to be able to live in my own country again too without having to be worried about medical costs driving me into bankruptcy.

[QuanSu]

What a bunch of garbage. No one with a functioning brain cell would have read that beyond the first "myth":

This guy failed economics and basic logic. "I'm not a thief. I stole nothing. I was just borrowing that money. I even left an IOU."

I don't follow your analogy. Would you mind explaining your logic?

To Admin: How can a "banned" account get to continue to post?

[black rabbit]

What does the market say to this little girl?

"Sucks to be you."

That's the beauty of the market.

[Markxxx]

Basically I have found through my readings and work with the U of Chicago hospitals (I complied and administered research questions for them), the American system is miles ahead of the world in areas of forefront research but lacking in everyday or "routine" procedures.

For instance, routine transplants (such as kidney), or heart attacks or even everyday doctor visits, child immunization and chronic problems like high blood pressure, systems in place such as Canada and Europe and Aussie/NZ do a much better job. This is probably because people in those countries are able to get the treatments ASAP and don't put things off. Obviously it's easier to cure things when they are small.

But for forefront medicine, and complex things, the American system just outshines the rest of the world. This is because there is a lot of incentive to go for these goals and they can use the everyday procedures that make money to fund these experimental and "offbeat" researches.

The military research and military command has stated the biggest deficiency in American medicine isn't practical but visional. They fail to see the danger in "tropical" disease or other such communiable illnesses that can be brought in by travelers to this country. In otherwords, if it doesn't effect us now we won't worry about it till later.

[foolsguinea]

No, it's not great. If it were great, I think public funding would be more attractive. But who wants to be forced to pay for an unliked institution?

[Foxy40]

Here's an example of the wonderful American health car system.

My doctor's office exists to maximize profits for their investors. The doctors are scheduled weeks in advance, to maximize the throughput of the office. To get care, I have to call and schedule an appointment, typically 3 or more weeks in advance.

So if I need treatment right away, I am directed to the ER at the local hospital and I'm treated by the ER staff, that does not have access to my medical history. This is for any immediate treatment, even during office hours.

So any acute care costs me $150 for the ER plus $75 for each doctor I see, unless they are out of my PPO, in which I'm completely responsible. The cost to my insurance company is probably on the order of $1000 to $3000, depending upon the service.

So, if you feel sick in America, please have the courtesy of scheduling it well in advance.

The reason you have to schedule well in advance is because you are going to a physician that is in a network plan. In order to participate in such a plan, they agree to take huge discounts off of their regular fees. Therefore, they must see more patients within the same amount of time to meet overhead.

You'll find much less wait times in private physician offices if you are willing to pay up front.


The BILL to your insurance company may be $1000-$3000 but the payment is probably about one tenth of that. I have been working in the industry for over 20 years and when I started answering phones as a receptionist while going to school, the doctor charged $60 for an office visit and the patient wrote a check. Now Medicare pays less than $40.00 for the same service. Your PPO probably doesn't reimburse much better than that.

The reality is the doctors aren't making the money. The insurance company executives are and that is what has to change. The people that provide the care need to be paid for it, not the people that REJECT the claims.

[Gaudere]

To Admin: How can a "banned" account get to continue to post?

He was banned at some point after making that post. So no point continuing to talk to him, he can't answer.

[Foxy40]

This is because there is a lot of incentive to go for these goals and they can use the everyday procedures that make money to fund these experimental and "offbeat" researches.



The incentive is to make a profit. When you remove the financial incentive out of R and D will it still be as fierce and competitive to create that new wonder drug, procedure or test?

I don't know but I am throwing it out there...

[gonzomax]

http://www.photius.com/rankings/healthranks.html The US has been down on the list of health care quality for a long time. I know senators, congressmen and the rich have access to great health care. The people not so much. People in rural areas have even more spotty coverage. We do not deliver very good care to the masses.
Drugs are researched in universities. and independent labs . When it looks promising the industry takes over. R & D is expensive ,but profits are incredible. Countries without stem cell banns have been grinding away trying to come up with the next big thing. Our politicians put us behind in that race.

[XT]

The US has been down on the list of health care quality for a long time.

Well, you do realize that the WHO report you linked too was from 2000...right? Also, they rank based on a number of criteria. For instance, life expectancy is one of the things they base their ranking on. The US has one of the highest (if not THE highest) level of obesity in the world, which tends to bring our LE down. Flogging my memory from a thread on this from years ago, I also seem to recall that one of their ranking criteria is Financial Fairness, which brought down our over all score. IIRC though the US did very well on several (I believe we were number 1 in Responsiveness or something like that).

You have to take studies like that with a grain of salt gonzo...and you have to look at the methodology used and what criteria they are using to create their ranking system.

And actually if you look at your report, the WHO 1997 report had us ranked at 72...so, we actually came up quite a bit from there. I haven't tried to find if they have a more recent ranking system as I think their rank system is flawed in any case. Feel free to do so if you like that...9 years is kind of a long time and we might have gone up or down since then.

I know senators, congressmen and the rich have access to great health care.

How are you defining 'rich' there exactly? I'm not saying that the plight of the uninsured isn't a problem, but they are definitely in the minority, with the majority of citizens having access to good (if costly) health care through their employers. Unless you define 'rich' as 'middle class and higher'.

We do not deliver very good care to the masses.

How are you defining 'the masses'?

-XT

[sqweels]

How much does health insurance typically cost for someone who does not have an employer-provided plan? Let's say a 40-year-old with no pre-existing conditions.

[Desert Nomad]

How much does health insurance typically cost for someone who does not have an employer-provided plan? Let's say a 40-year-old with no pre-existing conditions.

I am 37 and pay $190/mo for two people (my wife and I). I do have pre-existing conditions. Note that this insurance is from a private UK insurer and is valid everywhere in the world except the USA. I had to leave the USA to get it... and can't return.

In the USA because of pre-existing conditions, I was told no amount of money would get me insurance as I was declined by every insurer in the state.

Most my self employed friends in the US pay about $700/mo.

[Rumor_Watkins]

How much does health insurance typically cost for someone who does not have an employer-provided plan? Let's say a 40-year-old with no pre-existing conditions.

That is a near impossible question to answer. For someone in my age range, health insurance can range from 50-250 a month (i am in a very cheap-to-insure age band); it entirely depends on the deductible, co-insurance amount, out-of-pocket limit, if there are co-pay options for routine visits, if there is drug coverage

i shudder to know how many more people would be considered "underinsured" - those that have some base health insurance but with relatively high deductibles and/or poor coverages.

[Rumor_Watkins]

The other unsung issue regarding privately-insured healthcare is the sickening choices people are forced to make when determining their own care... it encourages you to accrue high-cost treatment-based medical services versus lower-cost preventative services

have a high deductible plan? maybe you shouldn't get that stomach checked out until it's really bad
petrified of getting diagnosed with something in case you wind up blackening your medical history so as to wind up with "prexisting conditions" limitations? yeah, don't go see the doctor!

people shouldn't have to manage their lives around their physical ailments - it constrains people and it makes you feel immesurably crappier about life (i've lived in a country with social medicine, and i live in the US)

this aspect of private insurance can not be mitigated - private insurers cannot form a risk pool large enough to insure everyone without selectively discriminating who they will insure.

[athelas]

The other unsung issue regarding privately-insured healthcare is the sickening choices people are forced to make when determining their own care... it encourages you to accrue high-cost treatment-based medical services versus lower-cost preventative services.

This NYT article (http://www.nytimes.com/2007/08/08/business/08leonhardt.html?ex=1344225600&en=d7df12bae3f08026&ei=5090&partner=rssuserland&emc=rss) says preventative care isn't the cost-saving cure-all that reformists wish:The great hope of every health care reformer is that better care will mean cheaper care.

The theory goes like this: By practicing preventive medicine, doctors can keep many people from getting sick in the first place. Those who do end up with a chronic illness will be closely tracked so that fewer of them develop complications. These steps will result in less illness, which in turn will require less health care. With the savings, the country can then lower its medical bills or provide health insurance for the 40-odd million people who lack it — or maybe even both.

No one really knows whether preventive medicine will save money in the long run, let alone free up the billions of dollars a year needed to help pay for universal health insurance. In fact, studies have shown that preventive care — be it cancer screening, smoking cessation or plain old checkups — usually ends up costing money. It makes people healthier, but it’s not free.

“It’s a nice thing to think, and it seems like it should be true, but I don’t know of any evidence that preventive care actually saves money,” said Jonathan Gruber, an M.I.T. economist who helped design the universal-coverage plan in Massachusetts.

Any effort to promote health has its own costs. Doctors and nurses need to spend time with patients to persuade them to change their behavior. (Ever tried to get someone to stop smoking or drinking?) For a new program to work, it has to reach people who are not being helped by whatever exists now — and who thus will be among the most difficult and expensive patients to treat. The program would also have to treat a whole lot of people who never would have gotten sick.

As Dr. Mark R. Chassin, a former New York state health commissioner, says, preventive care “reduces costs, yes, for the individual who didn’t get sick. But that savings is overwhelmed by the cost of continuously treating everybody else.”

[Rumor_Watkins]

This NYT article (http://www.nytimes.com/2007/08/08/business/08leonhardt.html?ex=1344225600&en=d7df12bae3f08026&ei=5090&partner=rssuserland&emc=rss) says preventative care isn't the cost-saving cure-all that reformists wish:

no, i'm talking about not going to a doctor for a $200 consult because you'd have to pay out of pocket for it (because your deductible is $1000) and hoping that it heals itself. then it doesn't, and you're facing 5k worth of medical bills

[Cyberhwk]

How much does health insurance typically cost for someone who does not have an employer-provided plan? Let's say a 40-year-old with no pre-existing conditions.I'm a 26 year old non-smoker. Never had any serious conditions ever. In fact I spent about $700 this last year on medical treatment (apart from dental), and that's easily more than I've spend in the last 5 years combined.

Only two plans on eHealthInsurance have deductibles that would have caused an insurance company to contribute a single cent of my premiums to my own care. One costs $145 a month, the other $281. If I want prescriptions covered at all, that would jump to at least $172 (after a $1000 deductible that I've never hit in 26 years :smack:).

So basically, I fork over $100-$150 a month and they'll never pay a single cent in benefits unless I wrap my car around a tree. Catastrophic plans are marginally cheaper but then even wrapping my car around a TREE may not hit the deductible and I'm still in the hole $10,000+.