why not universal healthcare?

[space fish]

Screw health care reform. Socialize it. Seems to work good in other countries. So don't tell me it don't work. My girlfriend is English and was completely shocked about the lack of healthcare here.

Where as in America one of the richest countries in the world people in need of health care go without it simply because they can't afford it.

Some face death.

Screw Bush and his heath care reform; if he really cared about Americans he'd be pushing for universal heath care.

[What Exit?]

UHC would be a huge help to Business and the working poor. It makes much sense though it has some drawbacks.

A good American HMO appears to offer better services than most socialized healthcare programs. At least the ones that are affordable to the country like Canada's.

Small businesses strain under the burden of providing healthcare or just do not provide any at all.

Medium and large businesses find health care a very large and hard to control annual expense. It would make the life of all businesses much simpler to remove them from the need to provide health care.

The self-employed, have bad choices to make, extremely expensive health-care cost or betting they will not need much health care.

UHC is a sensible solution. Large Corporation could still choose to offer some sort of additional health care service, but our current health care system is broken and fails 43 million people if I remember my statistic correctly.

Our current system only benefits the rich and the insurance companies.

Jim

Welcome to the Straight Dope, Enjoy your stay. Kick the Tires and decide if you might want to stay.

[glee]

Welcome to the world of politics, where you should use two questions:

'will it be popular?'
'who's going to pay for it?'

The UK introduced National Health Care in 1948, but soon there were financial consequences:

'By July 1948, Aneurin Bevan had guided the National Health Service Act safely through Parliament. This legislation provided people in Britain with free diagnosis and treatment of illness, at home or in hospital, as well as dental and ophthalmic services. As Minister of Health, Bevan was now in charge of 2,688 hospitals in England and Wales.
The National Health Service was expensive and in April 1951, the Labour Chancellor of the Exchequer, Hugh Gaitskell, placed a shilling on every prescription and announced that people would have to pay half the cost of dentures and spectacles. As a result of this action, Aneurin Bevan resigned from the government.'

http://www.spartacus.schoolnet.co.uk/Lhealth48.htm

The NHS is popular in the UK. (Note that we also have a private health option, where money gets you a faster service and a private room etc.)
There are complaints about waiting lists and 'postcode lotteries' (where some wealthier regions provide more access to expensive treatments), but all UK political parties recognise that they dare not tamper with the NHS in case a tidal wave of popular sentiment sweeps them away:

'A retired doctor who caused one of the biggest upsets of the last general election by toppling a government minister has been re-elected to parliament.
Dr Richard Taylor, who stood as part of a campaign to save his local hospital from closure, held on to his seat in Wyre Forest with 18,739 votes, giving him a 5,250 majority ahead of Conservative candidate Mark Garnier.
Labour, which had won the seat in the 1997 election when David Lock romped home with a near 7,000 majority, finished in third place.'

Now the US has a different view of many things from the UK, and health care is one of them.
I'll leave American posters to describe things in detail, but from my UK viewpoint it seems that Americans prefer to have less Government schemes than private ones, don't like the word 'socialist' and are content to rely on charity + a 'safety net'.

[BrainGlutton]

Why not?

1. The American medical profession is iffy. Lots of doctors are for it, but all are very aware that doctors in Canada and the UK, while they make good money, don't have the sky-high earning potential American doctors have.

2. The health insurance industry really, really doesn't want it, and has a lot of political clout.

3. There are also a lot of very, very rich and powerful people who, even if they have no direct stake in the HII, oppose socialized medicine on ideological grounds.

4. There are also a lot of not-so-powerful just plain folks who, for complex social and historical reasons, are ideologically in accord with 3.

[Shagnasty]

5) Most Americans have health insurance and are generally happy with the choices and care they are allowed under the current system. There is a real fear that their level of service will tank if the whole system is overhauled just to capture a minority of people without health insurance.

6) The government might take an active interest in the "health" of individuals and use the healthcare system as leverage to control behavior.

[Deaf Geek]

Large Corporation could still choose to offer some sort of additional health care service

Yeah, why can't there be a hybrid health care cost system?

[Celyn]

Originally Posted by glee

...........(Note that we also have a private health option, where money gets you a faster service and a private room etc.).............

Just like my mum got on a purely N.H.S. basis when she had breast cancer, you mean? I swear she was straight to the hospital before she had time to draw breath. * Yeah, all right, I realise not everyone's story is like that but, well, I suppose it's just that I sometimes worry that U.S. people, being aware that people enjoy a good grumble about the N.H.S., might be at risk of thinking it's all really dreadful, whereas it's a bit more the case that, it's like the weather, in that having a good grumble about it is a national hobby. Oh, and public transport probably belongs in that category too.

Good post, though, Glee - I think you hit the nail on the head here

... but from my UK viewpoint it seems that Americans prefer to have less Government schemes than private ones, don't like the word 'socialist' ...

. Indeed, I'm inclined to think, admittedly from a basis of not much knowledge at all, that any plan to set up an N.H.S.-type service in the States could quickly be scuppered merely by those against it muttering the word "socialized" often enough, and letting people imagine statues of Lenin on every street corner or something. O the horror! Or, you know, the sky would fall.


* May contain traces of exaggeration.

[Celyn]

Originally Posted by Shagnasty

..........
6) The government might take an active interest in the "health" of individuals and use the healthcare system as leverage to control behavior.

I'm not sure what you have in mind there. Seriously, I'm not. Do you mean forcibly sending "troublesome" people to locked mental hospitals, or do you mean withholding health care from anyone the government doesn't like? (To be fair, it's sort of past my bedtime, so I'm probably just being a bit dim.)

[Shagnasty]

Originally Posted by Celyn

I'm not sure what you have in mind there. Seriously, I'm not. Do you mean forcibly sending "troublesome" people to locked mental hospitals, or do you mean withholding health care from anyone the government doesn't like? (To be fair, it's sort of past my bedtime, so I'm probably just being a bit dim.)

I am not talking about any one thing in particular. Additional restrictions on smoking, drinking, and fast foods may be easier if people and the government see a direct connection between some people's behavior and how much in medical resources and raw cash are required to support that after the fact. Those are just some examples. This connection already exists of course but the connection becomes more clear if a nanny state decides to take a special interest in people's behavior under the guise of protecting the new system.

I didn't make up this argument and I don't know what the long-term effects would be. Maybe we would just get tax deductions for gym memberships or something.

[BrainGlutton]

Originally Posted by Celyn

Just like my mum got on a purely N.H.S. basis when she had breast cancer, you mean? I swear she was straight to the hospital before she had time to draw breath. * Yeah, all right, I realise not everyone's story is like that but, well, I suppose it's just that I sometimes worry that U.S. people, being aware that people enjoy a good grumble about the N.H.S., might be at risk of thinking it's all really dreadful, whereas it's a bit more the case that, it's like the weather, in that having a good grumble about it is a national hobby. Oh, and public transport probably belongs in that category too.[/i]

This is also anectdotal: I attended the World Science Fiction Convention in Toronto in 2003. At one panel discussion (forget the actual topic, but the question wasn't irrelevant), I asked the panelists (Canadian SF writers and editors) if there was any downside to the Canadian health care system. I was expecting a heated argument, but they all said, one after the other, "No." "No." "No." The room was big and crowded and nobody raised a dissenting voice.

[jsgoddess]

Originally Posted by Shagnasty

This connection already exists of course but the connection becomes more clear if a nanny state decides to take a special interest in people's behavior under the guise of protecting the new system.

Has this happened in other countries? That's something I've never seen anyone comment on.

[BrainGlutton]

Originally Posted by jsgoddess

Has this happened in other countries? That's something I've never seen anyone comment on.

From what I've read, in the nanny-state nations of Europe, restaurants don't even have no-smoking sections. And they drink at least as much alcohol as we do and the state doesn't seem to interfere.

[DWMarch]

As a Canadian, I've noticed in the US when someone needs surgery and has the money to pay for it, they get it and fast. Remember when Bill Clinton had a heart problem? He was being operated on the very next day. If he had been Canadian, he'd still be waiting today.

Money is a huge incentive for doctors. Try to convince them that they can only see so many patients in a day and they can only be paid what the government is willing to give them. Because that's how it is in a socialized system. There is never a (monetary) reward for hard work, just a limit to how much a doctor can make. So where is the incentive to work hard? There is no incentive and IMHO that's why we have such long waiting lists up here.

Don't get me wrong, I like socialized health care as much as any other Canadian but the system does have its drawbacks.

[catsix]

space fish said:
Screw health care reform. Socialize it. Seems to work good in other countries. So don't tell me it don't work. My girlfriend is English and was completely shocked about the lack of healthcare here.

Where as in America one of the richest countries in the world people in need of health care go without it simply because they can't afford it.

I have absolutely excellent health insurance right now, and the last thing I want is to be paying just as much for shittier healt insurance.

As for health care, there's no lack in the USA. We've got all kinds of health care. Hospitals are everywhere, there are millions of doctors, and there's a pharmacy in just about every town. The thing is that someone has to pay for that health care, and right now I pay for really good insurance so that I can get the best.

I like having that choice.

Deaf Geek said:
Yeah, why can't there be a hybrid health care cost system?

Because someone like me who pays for the health insurance they want and are happy with (and I went with the highest cost option I could because it's got the best coverage. It's a matter of priorities, and I chose to not have digital cable and get a less expensive car.) and see absolutely no reason to have their taxes increased to pay for more health insurance that provides less service and that they will never use.

I'm paying for, and getting, exactly what I want right now. I'm happy with what I pay and the service I get. What incentive do I have to go in on the socialist system where I pay for yours too?

[Kiros]

Well, on the one hand, I (and a fairly high percentage of Americans) feel that there's something intrinsically 'unfair' about me - I don't smoke, don't eat fast food, am in the appropriate weight range for my height, I exercise, I don't drink to excess (very often...!), and am generally in excellent health - being forced to subsidize the health care costs of people who don't have such healthy habits.

On the other hand, I (...and a frighteningly small percentage of Americans) freely recognize that I am paying more than enough for inefficiencies in the system that I could probably subsidize all of those people and still come out ahead, if there were some way to streamline the process. At the very least, some fairly drastic reform seems appropriate, even if complete socialization tickles me wrong on an ideological basis.

(On the proverbial third hand, moving from debate to anecdote, the issue of lower income potential has DEFINITELY come up when talking with my Canadian med-student-in-America girlfriend and where she wants to eventually end up working. Even though she is conceptually a lot more comfortable with universal health care than I am, she definitely recognizes the issue.)

Either way, this is not (in America, at least) the one-sided issue that many might seem to think, and it's not the one-sided free-markets-are-perfect issue that the other side would scream about. There are certainly worse places to start than the Massachusetts or California plans, and any start is probably a good one.

[jsgoddess]

Originally Posted by catsix

I have absolutely excellent health insurance right now, and the last thing I want is to be paying just as much for shittier healt insurance.

As for health care, there's no lack in the USA. We've got all kinds of health care. Hospitals are everywhere, there are millions of doctors, and there's a pharmacy in just about every town. The thing is that someone has to pay for that health care, and right now I pay for really good insurance so that I can get the best.

I like having that choice.

And that's super. For you. So what about the people who don't have that choice?

[What Exit?]

Originally Posted by jsgoddess

And that's super. For you. So what about the people who don't have that choice?

Apparently they can eat cake.

Catsix are you self-insured or taking the best plan your company offers? You might want to talk to some families that are self insured about how incredible expensive health plans are.

--------------------------------------------------------------------------------------------------------

I have good health care coverage and I have had good health care coverage my entire adult life. I have nothing to gain with the UHC system.

I just see the huge benefit to small business and their employees. As a good "Republican" I know that what is good for small business is good for America. As a good "Social Liberal Moderate", I find the minority of approximately 43 million Americans having no recourse to medical care except Emergency Room visits to be quite sad in what is suppose to be the greatest country on Earth.

BTW: My stats appear to be dated. According to this report, the uninsured now number 46.6 million as of 2005.

Jim

[Gorsnak]

Originally Posted by jsgoddess

Has this happened in other countries? That's something I've never seen anyone comment on.

It certainly hasn't here. Some provinces are now banning smoking in restaurants and bars and the like, or did so recently, but that seems to be following the trend coming out of the US started by California and such. Nobody even raises the public health dollars as an argument when that issue is being discussed, either, it's all just about second-hand smoke etc. Remember this is still a democracy. Forced gym memberships or bans on hamburgers would be about as popular here as they would be anywhere. That such laws might result in infinitesimally lower taxes would never strike people as a reason to pass them.

[DSeid]

"The art of the possible."

Anything that gets done has to at least be palatable to each of the major players, or it will not happen.

Insurance companies cannot just be dealt out. But they can be regulated ... as long as it keeps the playing field even between competitors and gives them something in return.

Many of us docs would accept a plan against our personal self-interest if it provided a greater good. But organized medicine? No way. Single payor, giving the other side of the bargaining table all the power to unilaterally set prices, nagonnahappen.

Romney and Schwarzenegger each have part of the answer, Blagovich some too, and Bush made a baby step proposal as well. Put it together as such and it might just happen:

• An individual mandate of coverage with documentation appended to tax returns. The uninsured cost us all.
• Decreased reliance on employer sponsored plans. Eliminate the payroll subsidy ($200 billion/yr) and replace it with a graded subsidy based on income level. Those mandated to purchase must be able to afford it. This accomplishes many other goals, not the least of which is decreasing fragmentation of care caused by company changes in coverage and panels of docs.
• Regulation of the insurance industry eliminating cherry-picking. One price per plan all comers pre-existing condition or not, Megacorp or Joe Blow. Alternatively an effective and efficient means of pooling individuals for group purchasing at discounts. Those mandated have to have plans priced fairly for individual purchase and be able to find coverage.
• Expansion of SCHIP programming to provide an adequate safety net for the poor and opening it up for voluntary individual sign-up at a reasonable cost.
• And yes, tort reform. Gotta throw us docs something!

It stands a chance because it provides for healthcare coverage for all, reduces overhead at insurance companies, and keeps everybody still in the game to compete on price and product. Big Business gets the healthcare albatross off their neck. Doctors can still quit any particular payor.

Done.

[Gorsnak]

Isn't that pretty close to some European models?

[kunilou]

Originally Posted by Shagnasty

6) The government might take an active interest in the "health" of individuals and use the healthcare system as leverage to control behavior.

I don't know whether this qualifies as "nanny-statism." Decide for yourself.

Under the plan, patients who kept their doctors' appointments and quit smoking, for example, could get credits to buy dental care or other services.

[Weirddave]

Originally Posted by What Exit?

Catsix are you self-insured or taking the best plan your company offers? You might want to talk to some families that are self insured about how incredible expensive health plans are.

This is a myth. It is not a universal myth, there are places where health insurance is very expensive (New York and New Jersey come to mind), but this is due more to stupid local laws than anything else. I have affordable health insurance. I sell affordable health insurance, and it's not nearly as expensive as everyone thinks. I have great coverage on my family of 4 for about $400/month. Would I like to pay less? Sure. I'd like $.99/gallon gas too. That doesn't mean that what I have isn't reasonable. Not cheep, no, but reasonable. It also doesn't have to be that much, I chose a higher end plan. That was MY choice, and I'm glad to have it.

[Frank]

Originally Posted by Weirddave

I have great coverage on my family of 4 for about $400/month.

At a poverty level income, that would be about 1/3 of gross pay.

[RickJay]

Originally Posted by catsix

I'm paying for, and getting, exactly what I want right now. I'm happy with what I pay and the service I get. What incentive do I have to go in on the socialist system where I pay for yours too?

Lower taxes.

Even after paying for your private health insurance, if you pay an average amount of tax, you actually pay MORE tax to social health programs than the average Canadian does.

Health care reform could offer you a chance to pay less tax and get the same insurance coverage for less additional money. That isn't an incentive?

Originally Posted by Weirddave

I have great coverage on my family of 4 for about $400/month.

Christ, that's a lot of money. Considering you then have to pay a pile of tax to support Medicare and Medicaid anyway, I'm starting to like my situation.

[What Exit?]

Originally Posted by Weirddave

This is a myth. It is not a universal myth, there are places where health insurance is very expensive (New York and New Jersey come to mind), but this is due more to stupid local laws than anything else. I have affordable health insurance. I sell affordable health insurance, and it's not nearly as expensive as everyone thinks. I have great coverage on my family of 4 for about $400/month. Would I like to pay less? Sure. I'd like $.99/gallon gas too. That doesn't mean that what I have isn't reasonable. Not cheep, no, but reasonable. It also doesn't have to be that much, I chose a higher end plan. That was MY choice, and I'm glad to have it.

Hardly a myth for people I know, but I do live in NJ with friends and family in NYC.
I would try $600 to $800 per month for decent coverage.

[Magiver]

Originally Posted by space fish

Screw health care reform. Socialize it. Seems to work good in other countries. So don't tell me it don't work. My girlfriend is English and was completely shocked about the lack of healthcare here.

Where as in America one of the richest countries in the world people in need of health care go without it simply because they can't afford it.

Some face death.

Screw Bush and his heath care reform; if he really cared about Americans he'd be pushing for universal heath care.

This surfaces like kudzu. We already have universal healthcare for the poor. It's Medicaid. Nobody is facing death who would be helped with UHC. Tell your girlfriend that I'm shocked about how long it takes to get a hip replacement or kidney stones removed in England.

As one of the richest nations in the world we can afford private insurance in addition to funding the poor (and one or two illegals). So if you want to pay $7 gallon for gas and live in an apartment then move to England and quit whining.

And as for dying, try getting a heart-bypass done in Canada. They almost killed a friend of mine's father with surgery delays. He had 2 heart attacks waiting on it.

[space fish]

Originally Posted by Magiver

This surfaces like kudzu. We already have universal healthcare for the poor. It's Medicaid. Nobody is facing death who would be helped with UHC.

http://en.wikipedia.org/wiki/Medicaid
Eligibility

Medicaid is a joint federal-state program that provides health insurance coverage to low-income children, seniors and people with disabilities.

Translation if you're an able bodied young adult and poor you're screwed.

As one of the richest nations in the world we can afford private insurance in addition to funding the poor (and one or two illegals).

Apparently not since nearly 1 out 6 Americans lack health coverage.

and live in an apartment

minor nitpick but population density is responsible for that. 1/4 the US population in an area the size of Michigan.

then move to England and quit whining.

explain how I'm "whining". If you can't. I think I'd be justified in asking you to just to stick to the facts. Cause that appears to be "agree with me or leave" and surely you're not that immature.

And as for dying, try getting a heart-bypass done in Canada. They almost killed a friend of mine's father with surgery delays. He had 2 heart attacks waiting on it.

If good ol' American health care is so easily available why didn't he just come down and get some of that?

[sugar and spice]

Originally Posted by Gorsnak

Isn't that pretty close to some European models?

Which ones? If you have the chance to list any places where some of DSeid's bullet points are implemented, I'd be interested.

[Nava]

Originally Posted by BrainGlutton

From what I've read, in the nanny-state nations of Europe, restaurants don't even have no-smoking sections. And they drink at least as much alcohol as we do and the state doesn't seem to interfere.

Incomplete info can be worse than no info, careful there.

In Spain for example, one of the first things the current Socialist government did is pass a new and quite draconian anti-smoking law, which forbids smoking in any workplaces. You can't have a "smoking room" in the office any more... like in the US, people have to go out to the street, which has led to grumblings that "oh, ok, so if I'm taking good care of my lungs I get 2 15-min breaks and if I'm a smoker I get to spend half the day outside? Oh, that's nice!"

Restaurants below a certain size must be non-smoking. Over a certain size, they can be completely non-smoking or have separate areas (they must be physically separated and the ventilation set up so that the smoke from the smoking area doesn't go to the non-smoking). Bars below a certain size have to decide whether they're smoking or non (many bars polled their customers); over a certain size, they must have separate smoking and non-smoking areas. Some bars were only a little bit over the limit and what they did was build a Pladur partition reducing their area ("areas" covered include only the general customer area, not bathrooms, kitchens or storage rooms).

One of the consequences of the new driving license "with points" and of extensive campaigns from DMV has been that people drink less in restaurants; this doesn't affect the real heavy drinkers (after all, a vodka puts you over the limit, so why not have two), but people are a lot more likely to ask for one glass of wine than for one bottle; many drivers have found that it's easier for them to just not drink wine with the meal than to say "ok, I'll have wine but only one glass and no herbal afterward." Many restaurants that didn't use to offer wine by the glass now do. Some are starting to offer the possibility to open "your" bottle (this is for people who eat there often, of course) and keep it for next time, or to BYOB.

The funny thing about this one is that the DMV campaigns have been there forever, but somehow the new license and hearing about people losing it in two days (one count of speeding real high, one count of reckless driving, two counts of alcohol) have shaken the masses. When the new license went in, one of my coworkers at the time, who is one of those guys who consider anything below 150km/h "slow" just gave up the wheel if there was someone else available. And good thing, he got two counts of "holyshit high speeding" on the first weekend that ate up half his points. If the alky-meter had beeped, he would have lost his license for 6 months.

So on one hand less than you said and on the other more.

[catsix]

jsgoddess said:
And that's super. For you. So what about the people who don't have that choice?

Everyone has a choice. It's just that too many people are buying designer clothes and digital cable and going out to eat every day instead of buying health insurance. There's already a program for people who are extremely poor, and poor families in PA at least can get their kids covered for free. People choose to have luxuries over health insurance. Then they bitch and moan that they can't afford health insurance.

WhatExit? said:
Catsix are you self-insured or taking the best plan your company offers? You might want to talk to some families that are self insured about how incredible expensive health plans are.

I pay about 250$ a month for my insurance, for just me. Personally I think if you can't afford kids, and that includes health insurance for them, don't have any.

As a good "Social Liberal Moderate", I find the minority of approximately 43 million Americans having no recourse to medical care except Emergency Room visits to be quite sad in what is suppose to be the greatest country on Earth.

And I think that they chose poorly, and that's not my fault nor my problem.

RickJay said:
Health care reform could offer you a chance to pay less tax and get the same insurance coverage for less additional money. That isn't an incentive?

And the taxes are just magically going to go down despite the fact that the government starts shelling out even more money to provide long waiting lists and less options than I've got now? There's no way that's going to be saving me any money, and no, getting crappier health insurace and not being able to get what I have now is not an incentive.

I don't want someone else deciding what health insurace I have. I don't want someone else paying for it.

Christ, that's a lot of money. Considering you then have to pay a pile of tax to support Medicare and Medicaid anyway, I'm starting to like my situation.

Actually, it makes me like your system even less. I'd prefer a system that's a lot more like car insurance, where it's required by law, but it doesn't cover things like oil changes and annual inspections.

I don't want socialized health insurance because there's no upshot for me at all.

[DSeid]

The catsixs are unreachable.

Facts are immaterial to dogma.

Poor? Don't have kids. You make $30K a year and a family plan costs $7K ... ah you must be buying designer jeans and Starbucks every day. The uninsured going to the ER is not my problem ... nah, the fact that that expensive care that too often never gets paid for gets passed onto all the rest of us in our hospital bills instead isn't my problem, if it was it would have that item on my hospital bill. There is no way another model could cost less and I'll just keep my fingers in my ears and say "LALALA" to anyone who provides the cites that America has healthcare costs worse than other industrialized nations with worse measurable outcomes.

There's no problem here and America's businesss community is not the least concerned about how the costs of the employer-provided healthcare insurance model is handicapping their international competitiveness. Move along now.

[Johnny L.A.]

I'm barely out of bed and haven't read the thread. But coincidentally -- you know how you have bizarre thoughts in the wee hours when you're about to wake up? -- this morning I thought, 'The Republicans should really be pushing for NHC. Everyone would have an NHC card, presumably with encoded information, and it could be a good tool for tracking people and gathering information on them. Hey, terrists get sick, too!' Just one of those strange, cynical waking thoughts.

Anyway, everyone already knows I think we should have NHC so I have nothing to add. Maybe after I wake up...

[What Exit?]

Originally Posted by DSeid

There's no problem here and America's businesss community is not the least concerned about how the costs of the employer-provided healthcare insurance model is handicapping their international competitiveness. Move along now.

Yep, to me this is the heart of the matter. Even middle-sized companies struggle with this problem. I like the idea of helping the working poor. I am really aboard to remove business from the burden of doing what most of the first world considers the government's job.

More small businesses will mean a lot more jobs and probably a lot more jobs that are enjoyable to work at. Maybe we could even keep some manufacturing jobs in the country.

Jim

[Johnny L.A.]

Originally Posted by space fish

Translation if you're an able bodied young adult and poor you're screwed.

What are the current options in this scenario?

You have a job with insurance coverage. You're a single person who is not a senior, living in an apartment or perhaps you have a house and mortgage. Then you lose your job.

You've been making, say, $35,000 before taxes. Call it $25,000 after taxes and deductions. $2,083/month. A one-bedroom apartment in L.A is, say, $1,200/month. $883/month remaining. Utilities (gas, phone, electricity) cost $60/month. $823 remaining. There is no public transportation in L.A. to speak of, so you pretty much need to have a car. You spend $125/month for gas and $75/month for insurance. $623. You've got to eat. Let's say a healthy diet costs $300/month. $323 left. So that covers food, housing and transportation. You can save your $323/month for retirement, or you can spend it on entertainment, or you can do something else with it. Your health insurance has been covered by your payroll deductions.

Upon becoming unemployed you could opt for COBRA. But let's say COBRA costs $450/month. How will you pay that with your remaining $323? Oh, wait. you don't have $323. You're using your unemployment insurance. Instead of $2,083/month, now you're getting $750/month -- that you'll have to pay taxes on later. You're wondering how you're going to pay for your rent. You're wondering if anyone will rent you even an efficiency apartment when you don't have a job. You're trying like mad to find a job that will pay your expenses. How are you going to pay for COBRA? How are you going to pay for any insurance? Even if you've saved money, how long will it last? Now how long will it last if you have to pay an insurance premium?

Health coverage needs to be transportable and independent of employment, and it needs to be inexpensive enough that people can get treatment even if they don't make a lot of money. Going to an emergency room when you run out of medication for [insert your condition here] places an undue burden on emergency rooms. Free clinics are often overworked and understaffed. I personally know people who have been refused medication because of prejudice. Basically it's like this: 'If you're too poor to go to a real doctor, then you're probably a drug addict. You say you're in pain from [insert condition], but we all know that you're going to abuse the drugs if we let you have them.' (Note that this is anecdotal based on people I know.)

It would be better to have NHC so that people will get the treatment they need, instead of a million different schemes based on employment or social status.

[Weirddave]

Poor? Don't have kids. You make $30K a year and a family plan costs $7K ... ah you must be buying designer jeans and Starbucks every day.

That's true a lot more than you might think. A lot of people just chose not to make health insurance a priority. Here is a report by the state of Maryland that Renob posted the other day indicating that 33% of the uninsured in Maryland make more than $44,000/year. At some point you have to say "Hey, wait a minute here" when people claim that they "can't afford" health insurance.

[Ruken]

Let's remember that some people can't get private health insurance. My father lost his job a while back and was trying to get coverage. He's had a LOT of health problems in the past. The insurance companies just didn't want to touch him. You know that first page of the insurance form that asks if you've had any of the following horrific problems? Yeah, lots of checks there. He got another job, so it's all fine now, but he has to make sure that he can get employer-sponsored coverage until he's old enough to qualify for whatever it is that old folks qualify for these days.

[Dinsdale]

Originally Posted by catsix

I have absolutely excellent health insurance right now, and the last thing I want is to be paying just as much for shittier healt insurance.

I know you fear the possibility that socialized medicine would cause you to may as much (if not more) for worse coverage, but what are the facts that prove to you that is an unavoidable outcome? It seems to me that it is at least conceivable that a system could be devised where a certain base level of medical care was universal and funded by taxation, but that also allowed people with means the option of purchasing supplemental coverage.

Is anyone aware of the true economic effects nationalization/socialization would have? Currently there are thousands if not millions of people employed by competing insurance companies, and by health care providers to deal with complexities of insurance. If coverage were "simplified" it doesn't seem to me that all of these folk would find positions in the new system. I tend to be suspicious of our economy's ability to absorb such workers.

In addition to the employees, a bunch of people make money of the insurance companies profits. What effect would socialization have on the markets, individual savings and net worth, etc?

[Sarahfeena]

I think catsix has a very valid point. I would love to see numbers (which would be impossible to compile) showing how many of the not-insured people genuinely can't afford it, and how many don't get it because they don't consider it a necessity, and don't make it a priority. Many people have a lot of trouble considering something a necessity when they don't forsee a reason ever to need it, and while I understand this, it doesn't make everyone else responsible for their short-sightedness. And catsix's concern is completely fair...she HAS made it a priority. Since she has, shouldn't she have the choice to have the healthcare she wants, and not be dragged down into an inferior system because of people who don't make it a priority?

I think health care should be like any other social program...a safety net which one can avail themselves of if they can show a genuine need for the help, and always always the program should have the ultimate goal of helping the person become self-sufficient as quickly as possible.

[What Exit?]

It seems the argument so far seems to be concentrated on "let’s not help those that may well be able to help themselves". (Except Dinsdale who raises an interesting point of displaced workers from the insurance field.)

Would anyone care to address the benefits to business? Please look at it from that side and think about how much it would benefit small businesses and even larger companies attempting to compete in the international market.

Jim

[Voyager]

Originally Posted by Sarahfeena

I think catsix has a very valid point. I would love to see numbers (which would be impossible to compile) showing how many of the not-insured people genuinely can't afford it, and how many don't get it because they don't consider it a necessity, and don't make it a priority. Many people have a lot of trouble considering something a necessity when they don't forsee a reason ever to need it, and while I understand this, it doesn't make everyone else responsible for their short-sightedness. And catsix's concern is completely fair...she HAS made it a priority. Since she has, shouldn't she have the choice to have the healthcare she wants, and not be dragged down into an inferior system because of people who don't make it a priority?

Here's a Census Bureau Press Release:
which includes the following:

Originally Posted by Census Bureau

Race and Hispanic Origin (Race data refer to those reporting a single race only.)

* The uninsured rate in 2004 was 11.3 percent for non-Hispanic whites and 19.7 percent for blacks, both unchanged from 2003. The uninsured rate for Asians declined from 18.8 percent to 16.8 percent.

* The uninsured rate for Hispanics, who may be of any race, was 32.7 percent in 2004 — unchanged from 2003.

. (I posted this in one of the other threads on this.) If being uninsured was primarily by choice, you wouldn't see this ethnic breakdown. Certainly young, healthy people might choose to not buy insurance, since it is on average not a good deal for them. They are part of the problem - not in the sense of suffering the lack of insurance, but in not contributing to fund those people who do need it. Remember, they'll need it also given time.

Given the ethnic breakdown of the uninsured I'd expect far more of the uninsured can't afford it rather than choose not to buy it. Any data to the contrary?

[Sarahfeena]

Originally Posted by Voyager

Here's a Census Bureau Press Release:
which includes the following:

. (I posted this in one of the other threads on this.) If being uninsured was primarily by choice, you wouldn't see this ethnic breakdown. Certainly young, healthy people might choose to not buy insurance, since it is on average not a good deal for them. They are part of the problem - not in the sense of suffering the lack of insurance, but in not contributing to fund those people who do need it. Remember, they'll need it also given time.

Given the ethnic breakdown of the uninsured I'd expect far more of the uninsured can't afford it rather than choose not to buy it. Any data to the contrary?

I don't think your data says what you think it does. It is a broad-brush assumption that low income alone is why certain ethnic groups don't tend to buy insurance. I would grant you that lower-income groups are going to be the ones who are least likely to have insurance, due to the cost and due to the fact that they tend to be working jobs that don't offer it. But that doesn't necessarily mean that they CAN'T afford it, only that it is more difficult for them to.

You are right that you would expect to see younger people as a large group without insurance, and since they are also the majority of minimum-wage employees, then low income must not be the only driving factor behind why certain people don't have it. Cultural factors may be at work here, and I suspect they are.

[RickJay]

Originally Posted by catsix

Actually, it makes me like your system even less. I'd prefer a system that's a lot more like car insurance, where it's required by law, but it doesn't cover things like oil changes and annual inspections.

You want to make it the LAW to buy private health insurance? What's the sense in that?

And in terms of health, it's far more cost effective to cover the routine things - like checkups and routine visits - than the catastrophic things. Health care is cheaper the more preventive the approach.

And the taxes are just magically going to go down despite the fact that the government starts shelling out even more money to provide long waiting lists and less options than I've got now? There's no way that's going to be saving me any money, and no, getting crappier health insurace and not being able to get what I have now is not an incentive.

Let me try to make this as clear as possible; you are paying more money, but getting absolutely nothing for it. Do you actually thhink that's a good state of affairs? You complain about choice, but you're not being given any choices: you STILL have to pay whether you like it or not, and even if you get nothing for it.

This doesn't eliminate the possibility of having private coverage to increase your overall coverage and quality of care. My family gets private rooms in the hospital, because I have private coverage for that. I have dental insurance (which isn't part of Canada's medicare system at all, for some reason) private room coverage, a drug plan, eyewear, so on and so forth. All of that's private; none of it is covered by the public system.

[mks57]

One thing that you need to consider is that people with health problems often lose their jobs, and that nice employer-subsidized health plan, if they were lucky enough to have one. If they can find another job, it is often part-time or lower income, with no health benefits. Then you run into the problem of insurers wanting to ditch anyone with a chronic or preexisting condition.

I think many people would be happier if the uninsured just hitched a ride on the next ice-flow and disappeared, never again to trouble those who have the strength of character needed to avoid major illness.

[Rysto]

Originally Posted by catsix

And the taxes are just magically going to go down despite the fact that the government starts shelling out even more money to provide long waiting lists and less options than I've got now? There's no way that's going to be saving me any money, and no, getting crappier health insurace and not being able to get what I have now is not an incentive.

US governments spend more on healthcare per capita than Canadian governments. In total, Americans spend twice as much as Canadians on health care(counting public and private spending), and get worse care on average.

[Voyager]

Originally Posted by Sarahfeena

I don't think your data says what you think it does. It is a broad-brush assumption that low income alone is why certain ethnic groups don't tend to buy insurance. I would grant you that lower-income groups are going to be the ones who are least likely to have insurance, due to the cost and due to the fact that they tend to be working jobs that don't offer it. But that doesn't necessarily mean that they CAN'T afford it, only that it is more difficult for them to.

It's not a proof of anything, true, but it seems to argue against catsix's claim that lack of insurance is just a free choice, and that those not able to afford it either shouldn't have had kids or were spending the money on something frivolous. Who can say when this moves from being a choice to being effectively impossible. Who can say that parents who choose to save the money for transportation or clothes in the hopes of not having medical expenses are doing the wrong thing? Maybe they know how to go to emergency rooms and then not pay the bill. I think the point of some sort of universal health care is so that these parents don't have to make these kind of choices.

You are right that you would expect to see younger people as a large group without insurance, and since they are also the majority of minimum-wage employees, then low income must not be the only driving factor behind why certain people don't have it. Cultural factors may be at work here, and I suspect they are.

A lot of people on MW, at least according to the claims in other threads, are teenagers covered by their parents' insurance. I don't know if these people get counted as being uninsured - I'd assume they weren't. Two low paid 20 year olds might well choose not to buy insurance, but two low paid 20 year olds with a child are probably not freely choosing to be uncovered.

[catsix]

DSeid said:
Poor? Don't have kids.

What, exactly, is so unreasonable about 'If you can't afford 'em, don't have 'em'?

You make $30K a year and a family plan costs $7K ... ah you must be buying designer jeans and Starbucks every day.

Or maybe people think about health insurance wrongly. Nobody expects their car insurace to buy new tires, brakes, gasoline, and belts. They don't expect their car insurance to pay for the annual inspection or registration do they? Does homeowner's insurance pay for the grass to be mowed, the furnace to be cleaned and inspected, the walls to be painted or the carpet to be cleaned? No, what insurance exists for is a major, unforseen circumstance.

There is no way another model could cost less and I'll just keep my fingers in my ears and say "LALALA" to anyone who provides the cites that America has healthcare costs worse than other industrialized nations with worse measurable outcomes.

Maybe I am paying more, but I'm getting better service and not waiting on a list to see a doctor.

I've said before and I will say again, every penny I spend is worth it.

Dinsdale said:
It seems to me that it is at least conceivable that a system could be devised where a certain base level of medical care was universal and funded by taxation, but that also allowed people with means the option of purchasing supplemental coverage.

I've seen absolutely no evidence whatsoever that this is going to save me a cent. I have no reason to think that it won't cost more than what I pay now.

If you want to make some kind of very basic, catastrophic medical inusrance that covers hospitalization (like if you're admitted) part of unemployment insurance, that's fine with me. What I do not want is socialized health insurance.

Voyager said:
Certainly young, healthy people might choose to not buy insurance, since it is on average not a good deal for them.

Car insurance isn't a good deal until you're in a crash.

RickJay said:
You want to make it the LAW to buy private health insurance? What's the sense in that?

You want to make it the LAW to buy private automobile insurance? What's the sense in that?

Let me try to make this as clear as possible; you are paying more money, but getting absolutely nothing for it.

I'm getting a lot for it. Someone who has chosen not to make health insurance a priority is not getting anything. I'm fine with that system.

Rysto said:
US governments spend more on healthcare per capita than Canadian governments. In total, Americans spend twice as much as Canadians on health care(counting public and private spending), and get worse care on average.

That's nice. How does it prove, at all, that taxes would be lower if we implemented the Canadian waiting list system? It doesn't. Historically, taxes on the whole go UP, not down.

Voyager said:
Two low paid 20 year olds might well choose not to buy insurance, but two low paid 20 year olds with a child are probably not freely choosing to be uncovered.

Then they shouldn't have a kid. Nobody should be having a kid unless they are prepared to take on all of the responsiblity for said kid, including paying for that kid's health care.

[jsgoddess]

Originally Posted by catsix

What, exactly, is so unreasonable about 'If you can't afford 'em, don't have 'em'?

Two words: Shit happens.

[Guinastasia]

Originally Posted by catsix

What, exactly, is so unreasonable about 'If you can't afford 'em, don't have 'em'?

I'm not going to weigh in on the whole insurance debate at this time, but while this advice may sound sensible, it doesn't always work out that way. Birth control fails, and it's often expensive-again, without insurance, it's unlikely for these people to be able to afford the pill, or anything other than condoms, which do break. And not everyone believes in abortion.

Also, sometimes people CAN afford them when they get pregnant, and then somewhere down the line, are hit with hard times and become poor. What then?

[Voyager]

Originally Posted by catsix

Then they shouldn't have a kid. Nobody should be having a kid unless they are prepared to take on all of the responsiblity for said kid, including paying for that kid's health care.

But the kid is here. Do you take it from the parents and give it to someone who can afford health insurance? Abort it retroactively? Or do we, to teach the parents a lesson, arrange things so it doesn't get decent care early, so that it either dies or gets sick in an expensive way which can be prevented early and cheaply.

Ah, for that moralistic paradise of Dickensian London.

[DSeid]

Let's just leave it at the very basic reality check. Try to deal with the facts.

No matter what you think the poor should do, the poor will continue to have families.

The currrent system has individuals with employer-provided plans able purchase healthcare coverage as part of large groups and therefore at sizable discounts and, generally, without regard to pre-existing conditions. These individuals are further subsidized by the tax treatment of that compensation with the result that the most highly compensated get subsidized the most. Fewer get this than before.

Of the other 40% a portion has care through various governmental programs.

9% buy their own coverage. They buy it without the benefit of group volume discounting so they pay significantly more for the same benefits. They are cherry-picked extensively, and any hint of a past problem will result in uninsurability.

And almost 16% have no coverage. For some it is because no company will take them on as an individual. For some it is an unreasonable expense. And some just decide to roll the dice ... money in the pocket betting on continued good health.

What happens to the uninsured? They still get care but it is catestrophic care provided in the most inefficient manner possible and the bills often go unpaid, to be recouped in extra expenses hidden in all of every paying patient's bills. Society will not allow an ER to turn away someone with a heart attack or stroke in progress because they are uninsured. We do not pay for the care that would have prevented the catastrophe but we do pay for the expenses that result, albeit indirectly.

The expense of healthcare coverage for employees is convincing more and more companies to not offer such a benefit and those who do are at an increasing disadvantage in competition, both domestically and internationally.

These are the facts and they do not change because of what any of us think "should" be.

Do we want to live with those facts or can we create a situation that is less irrational? Can we do better for the American business community's competitiveness, for our individual bottom lines, for our nation's health, and for the well-being of all of our citizens? Obviously I think that a more rational approach is possible and that there are options that would also be palatable to the major players. Universal healthcare coverage* is desirable not only out of a sense of social justice but because it is in both society's and our individual's best interests. "Universal" need not mean "single payor" or "national" and, IMHO, those models are nonstarters. There are other ways to do it and your individual mandate proposal should be part of it. But such a requirement is not in and of itself enough.

Hillary Clinton's original incompentent handling of healthcare reform poisoned the well for many years. Bush's proposal of reform of the tax treatment of healthcare coverage benefits may poison that subject as well. But at least the subject is being addressed again.

*Your point about the word "insuruance" is well made. We are not talking about "insurance", we are talking about coverage, of which insurance is one model to provide, but certainly not the only or best one..