Alternatives to socialized health care

[Happy_Clam]

I just think we are better stewards of our money when it’s closer to hand. With the huge aging population in every industrialized country, I don’t think any system can afford waste/abuse. I have links to UK, Sweden and France citing mega health care budget problems, but I’m tired of doing links.

Interesting…I would argue that we are much worse stewards of our money when it comes to our own health, since A) our decision making is certainly weakened in extremisis (for example, lying in a hospital bed and B) there seems to me to be an unbridgeable dihcitomy between preseving the moral obligation of the physician to provide the best possible treatment and her understandable desire (as well as the desire of all her employers or those for whom she works as a supplier, e.g. drug companies) to make money. In this case, the government’s writing a blank check for the individual’s healthcare seems to me to be a much more sensible position. Then, of course, I would argue that the health service tends towards a natural monopoly- after all, you can hardly choose which hospital your ambulance should go to as you lie dying.

And as for problems of healthcare funding- the current system in America is, in sheer statistical terms, the least efficient in the western world. You may argue that an idealised free-market based system would be more efficient than nationalised medicine, but you cannot argue that the (free-market-based) healthcare system in America right now is less efficient than the (nationalised) healthcare system in, say, Sweden, the UK, France or Canada.

[Happy_Clam]

How’s they’re tax rate compare with our, by the way?

Huge. Sweden is often quoted as being the most taxed nation in the world. I believe the top rate is 60% (I’ll go look for a cite).

But they have excellent healthcare provision.

[MilTan]

@tombigbee

What do you think of this situation?

“Another point to consider is that Spain takes a different view to rehabillitation, convalescence and terminal illness, leaving care in these cases usually to the relatives. There are very few public nursing and retirement homes, very few hospices and convalescence homes.” Hot Topics: Healthcare

A roundabout way of bringing up rationing, doctor shortages, budget-overages, etc. (I’m testing you to see how many cites you request. ) Anyway, socialized systems may spend less per capita because there will always be pressure to keep taxes down, so they do less here and there, and means test some, stuff like that.

Yes, there is rationing in those systems. But that rationing doesn’t exist in a vacuum. Rationing exists in the US too, we just don’t call it that. It exists because tens of millions of people don’t have any health insurance, and their care is rationed in so far as it is non existent (until they have to go to emergency rooms to get treated). It exists because the main way that cost increases were kept in check in the 90s was by moving Americans to managed care. What is a system where you must go to a primary care physician before seeing a specialist, where the set of doctors and hospitals you can go to and the types of procedures you can get are highly regulated but rationing under a different name?

You mention means testing, but what is denying the poor (although not the poorest) health care but a particularly perverse method of reverse means testing? You mention keeping taxes down by doing less here and there, but what is cuts in Medicaid but a method of doing less here and there mainly by denying the poorest in the name of keeping down taxes?

Basically, all the problems that you mention in other systems exist in some form or another in the US as well. We just don’t call it that, and so can feel good about our healthcare system.

[wevets]

I think the US will be forced to go to a single-payer system as health care costs continue to rise (just IMHO).

A lot of people don’t like the idea of government being responsible for it - I wonder what they would think of a quasi-governmental health care system, which would be connected only tenuously to the current branches of government. Something like the Federal Reserve, where governmental influence is somewhat restricted to the appointment of governing board members to 14 year terms. That should keep it relatively out of partisan politics. Or is the objection to government involvement based on something else?

[GIGObuster]

@tombigbee

You’re right. It’s more that Sweden may have problems in the future.

How’s their tax rate compared to ours, BTW? I have no idea.

And still it remains a “may”. Virtually all reports against other systems are prepared by the same chicken little sources (or are made by the governments or local papers of their countries, funny thing is that when that is the case, the reports are made to prevent or warn about the problems. So far they usually take care of them or keep them in check), after more than 10 years in discussions like this (had several like this at UC Berkeley) I’m not trusting reports that usually are coming from the same folks that want to keep the current status quo.

A status quo that includes 45 million Americans that are uninsured and even more are not ensured properly, includes paying more and have less people being taken care off, and also the situation is getting worse:

Medical and health information

American College of Physicians Predicts Looming Crisis In Primary Care, USA

In its annual “Report on the State of the Nation’s Health Care,” ACP focuses on the looming crisis in primary care and why reform of the payment system is essential to prevent this crisis.

There is growing evidence that shortages are developing for U.S. physicians, particularly in general internal medicine and family practice. Previous expectations of an excess supply of physicians have not materialized. Current projections indicate that the future supply of primary care physicians will be inadequate to meet the health care needs of the aging U.S. population.

This decline is the result of the current dysfunctional payment system for physicians’ services. Primary care is under-reimbursed compared to other specialties, and many primary care physicians are struggling to keep their practices open at a time of escalating practice costs and excessive paperwork requirements that take time away from patients. The 4.4 percent cut in Medicare physician fee schedule payments that went into effect on Jan. 1 will only serve to exacerbate this problem.

http://www.dukenews.duke.edu/2006/03/nursing_oped.html

I recently left full-time nursing to help train future nurses and, this past year, to work on health care issues in Washington, D.C., for a leading U.S. senator. I learned in detail about good ideas such as “pay for performance measures” to help monitor quality, and electronic health records to improve efficiency. But I also followed with interest the contentious debate over proposed health savings accounts for individuals.

Proponents say these accounts will harness market forces to expand care for millions of people. Based on research and what I’ve seen personally, however, I don’t see how the accounts will provide much help for countless patients with chronic illness. Patients who lack health care are likely to forego the accounts and spend their money on other needs. Or, if they do purchase basic coverage, the deductibles will be so high they’ll avoid getting routine care.

This may sound like an acceptable trade-off to policy makers, particularly those who believe in market forces and avoiding “handouts” that discourage hard work. But grand policies can look very different when you’re the person worrying about an asthmatic child or a spouse battling schizophrenia. As an ED nurse, I witnessed far too many uninsured patients leaving with prescriptions for critical medications when they could barely afford their bus fare home.

Health care is difficult, both in the field and in the policy arena, but the least we owe people who are struggling is to stop fooling ourselves that we are a compassionate nation where only lazy and immoral people go without health care. That is a myth we are telling ourselves to feel better. It certainly is not the “law of the land” – unless, of course, we choose to make it so.

[Anne_Neville]

@Happy Clam

It sounds more like Victorian England than a modern state, and I would personally pay any percentage of my income (even the 40% top rate current in the UK) as tax to insure that I would not be left by the roadside after a car accident.

That, at least in theory, doesn’t happen under our system of paying for health care.

What does happen, and not all that rarely, is that uninsured or under-insured people go into serious debt due to health care costs. Or the emergency room (which is required by law to treat anyone in need, regardless of ability to pay) becomes their only source of health care. People generally can get health care in an emergency situation, but they may bankrupt themselves in doing so.

I think our current health care system is a disgrace to us, but don’t make it out to be worse than it actually is.

One problem I see mentioned in the context of reforming health care is the expense to doctors of malpractice insurance (and unnecessary tests that can be run to avoid the possibility of a malpractice suit). Does the government in any of the countries with socialized medicine have some way of keeping that expense under control? Or can people not sue doctors in those countries, because the doctors work for the government?

[Shagnasty]

@Anne Neville

That, at least in theory, doesn’t happen under our system of paying for health care.

Correct. No one gets left beside the road or turned away from an emergency room. That is part of the problem from a system design standpoint. Not everyone has insurance but everyone can get care and the financial burden just drops all over the place and it is not designed to handle that correctly.

It is very easy to game the system. If you are poor or just don’t have health insurance you make make a doctors appointment any time you want just by showing up at the emergency room of the best hospital you can find. They treat plenty of colds and sniffles there and while you are there, you can ask about those bunions etc.

If you really do have an emergency, once you are in the system, you are in. You can run up hundreds of thousands of dollars in bills before the hospital knows who is going to pay.

[Anne_Neville]

@Shagnasty

It is very easy to game the system. If you are poor or just don’t have health insurance you make make a doctors appointment any time you want just by showing up at the emergency room of the best hospital you can find. They treat plenty of colds and sniffles there and while you are there, you can ask about those bunions etc.

Exactly, and that’s why the rest of us, who don’t game the system, have to wait so long in emergency rooms.

[spazattak]

@Kimstu

There, there, nobody’s calling you stupid. Der Trihs is just pointing out that medicine is an extremely complex and specialized subject, and the average consumer doesn’t have the necessary specialized training to make wise choices about treatment. See the excerpt from my linked article above:

Lack of specialized knowledge != stupidity, but it can lead to poor choices anyway.

This same logic still applies to my analogies. We go to doctors, friends, family, the internet, etc so that they can enlighten us on making those choices. We [atlease those of us responsible enough] go to similar sources on doing research for any major expenditure. Its our own personal responsibility to make educated choices, even (and especially) in complicated matters. Individually, we’re the only ones qualified to do so.

Nope, the majority of costs come from a minority of the population needing expensive treatments. Again from my link:

Moreover,

So yes, I think it’s probably fair to say that a majority or thereabouts of US health care spending is spent either to save the lives of people with expensive conditions, or to prolong the lives of those who will die soon anyway.

Well this would seem like the main problem with healthcare then, no? You cut the ‘anything to keep them alive’ routine and you dramatically cut healthcare costs - thereby dramatically cutting insurance costs - thereby making it more accessible. Am I wrong anywhere here?

[Anne_Neville]

@spazattak

Well this would seem like the main problem with healthcare then, no? You cut the ‘anything to keep them alive’ routine and you dramatically cut healthcare costs - thereby dramatically cutting insurance costs - thereby making it more accessible. Am I wrong anywhere here?

OK, you run for office on a platform of passing a law saying that anyone who is on life support has to be taken off, and that certain patients should be left to die instead of receiving medical treatment. You’ll piss off the “culture of life” types and the majority of us who don’t think the government should be involved in such decisions. You’ve gotten liberal me to agree with Terri Schiavo’s parents on a political issue- that’s impressive. I think I’ve got a few candidates I’d like you to run against…

[tombigbee]

MilTan I really don’t think it’s fine, but I’d like some reassurances about issues I’ve raised with other systems if possible. Most have problems, similar to ours or different from ours, but problems. Like in Spain, where they rely on families more… It may not be a problem for them, but that will hardly work well here – who can take the time off from work? (On the cite I used it wasn’t clear if families received assistance for caregiving duties.)

This is a post I made to my classmates:
A problem with the American health care system is how to provide adequate long-term care in either an institution or in a home setting. Institutions generally have to watch expenses and follow regimented schedules, which interferes with individualized caregiving.

In presenting the Family and Medical Leave Act, the author [of the textbook] makes this point:

“In addition, the law is problematic because it reinforces the idea that caring for ill and disabled persons is the responsibility of the family–which, in practice, usually means women relatives–rather than the responsibility of society as a whole.”

I tend to agree with sociologist Andrew Cherlin that public policy in America needs to promote the public family because no government can afford (financially) to do the caregiving tasks done by families. He says the main role of the public family is to take care of children, the frail elderly and the ill.

I think one challenge in supporting the work of the public family is in getting men to take on a caregiving role – or sharing it – more often.

The main problem with institutional settings seems to be quality of care – and it’s the same problem seen in public schools and daycare facilities. The people who work in these institutions should make more money and they should have fewer “charges” so they can have more individual interactions. Some might suggest the problem would be solved if government took care of funding, but public schools are non-profit and government-funded, and yet there are still too many kids in many classrooms.

Nursing homes discussed in the textbook had problems with quality of care. The two sections, “Working in Nursing Homes” and “Life in Nursing Homes” reminded me of life in a daycare center. I had to follow certain steps each time I changed a baby’s diaper, and I had to document it. I had no time to play with the babies with all the federally-mandated stuff I had to do. Why? CYA - somehow the public, specialists etc. determined that each step is terribly important – and it probably is. But as the book points out, there is no time for caregiving. In nursing home settings, the book points out that there is also no training for caregiving; I believe the focus in nursing homes is also on doing the steps mandated by federal or state regulations just as it was in the daycare center.

Here’s why I don’t think socialized health care will fix this problem:

Care of elderly a ‘national disgrace’ BBC News

Patients face bill for long-term care BBC News

The government will have to try to be good stewards of taxpayers’ money, so I don’t think the pressure to minimize costs will disappear.

I like the proposed legislation, MiCassa, which would allow Medicaid (and Medicare??) dollars to follow the person so they can choose where they would receive services and support.

I wish there was more tweaking/debating of whomever’s alternate suggestions or discussion on how we can avoid problems in other countrys’ systems.

[GIGObuster]

@tombigbee

Here’s why I don’t think socialized health care will fix this problem:

Care of elderly a ‘national disgrace’ BBC News

Patients face bill for long-term care BBC News

The government will have to try to be good stewards of taxpayers’ money, so I don’t think the pressure to minimize costs will disappear.

I like the proposed legislation, MiCassa, which would allow Medicaid (and Medicare??) dollars to follow the person so they can choose where they would receive services and support.

I wish there was more tweaking/debating of whomever’s alternate suggestions or discussion on how we can avoid problems in other countrys’ systems.

:sigh:

Just like I also said in a previous debate: the people there make reports like this to find solutions for the current problems not to overhaul the system:

From the last link you posted:

Charities are now calling on the government to implement proposals from the Royal Commission on Long Term Care that all care, both medical and personal, should be free.

[tombigbee]

GIGObuster, the site you linked to had this info:

“The number of elderly people has risen substantially-with the greatest rise in the age group 80 years and older. Sweden is seen as having the world’s oldest population, with 18% aged 65 or over. In spite of the democratic principles espoused by Swedish society, there are marked differences in health between different social groups, and these differences are growing.”

Do you have an opinion about how we can avoid this here, or whether it is simply unvoidable?

[tombigbee]

@GIGObuster

:sigh:

Just like I also said in a previous debate: the people there make reports like this to find solutions for the current problems not to overhaul the system:

From the last link you posted:

Right, I understand. Do you think the solutions will cost more money, increase per capita spending? I saw an article about reforms France was proposing for 2004 or thereabouts for “projected overspend this year of eight billion pounds.” I havn’t found an update about how it’s going, if it’s working, etc. Have there been specific reforms in any country that you’ve liked and/or disliked?

[GIGObuster]

@tombigbee

GIGObuster, the site you linked to had this info:

“The number of elderly people has risen substantially-with the greatest rise in the age group 80 years and older. Sweden is seen as having the world’s oldest population, with 18% aged 65 or over. In spite of the democratic principles espoused by Swedish society, there are marked differences in health between different social groups, and these differences are growing.”

Do you have an opinion about how we can avoid this here, or whether it is simply unvoidable?

It is happening here too, where have you been? Just the recent robbery and mishandling of medicines for the elderly should have gave you pause, and no it is not unavoidable, as I saw before, other “dire” problem in Sweden (I think it was people abusing their stays in the hospitals) was solved after a similar report 5 years ago.

Anyhoo… This American irrational health care has gone far enough, too far even for American standards, you want to say that we should take care of our money, well, other systems use less money. Who gets more money in this irrational system that we currently have? CEOs of big farma and insurance. Can you guess were the millions that go to [del]buy[/del] lobby congress to prevent even a discussion regarding the current fleecing of America is coming from? In the end it is not the CEO’s…

[cerberus]

Let’s not jump on the Canadian Model too prematurely:

some of them are shifting to private sources, and private care is alive and well.

At they seem to use the correct number of snakes on their shafts.

[GIGObuster]

@cerberus

Let’s not jump on the Canadian Model too prematurely:

some of them are shifting to private sources, and private care is alive and well.

At they seem to use the correct number of snakes on their shafts.

Good, that was the only big item I had against the Canadian system, virtually all systems in Europe are a mix of private and public health care.

[mr_moonlight]

@Der Trihs

The two fundamental problems that come with mixing capitalism and health care are that it’s too complex and large a field for the layman to grasp ( and therefore make an informed decision ), and that people often have no choice but to buy. People in America pay medical bills that ruin their lives, because the alternative is death. When one side in a transaction has such a huge advantage, capitalism becomes fairly indistinguishable from robbery.

Under any health care system, as a patient you will be faced with several options on how to deal with a health problem, and one or more doctors with possibly conflicting opinions will be advising you. Ultimately you will have to decide for yourself how to proceed. Patients will always have to make their own decisions (informed or not) unless treatments become forced on us, and I doubt anyone here is suggesting that.

Complexity in medicine is universal, and patients have to deal with it the best they can, no matter who is paying the bills. I don’t see how socialized health care makes medicine safe for the ignorant.

[mr_moonlight]

Most (but not all) health problems appear to me to be directly linked to a patient’s lifestyle. Tobacco, alcohol, narcotics, fast food, sedentary lifestyle, etc. all have an obvious effect on one’s health. Genetics plays a role too, but genetics can often be compensated for with lifestyle adjustments, e.g. adult-onset diabetes can be avoided or cured with weight loss and diet modification.

Socializing the costs of medicine appears to me to be a way to transfer the costs of one’s unhealthy habits to others. This seems immoral to me. Can someone explain to me why a fit, non-smoking adult, who chooses to forgo cable TV in order to spend extra money on a diet high in fresh fruits and vegetables should have to pay for the insulin shots of the Twinkie-eating chain-smoking couch potato that lives next door?

Does that same couch potato have the right to rob the healthy next-door neighbor at gunpoint to pay for his diabetes medicines? If not, then why would you believe it is right when a government does this?

(Apologies to any diabetics reading this–I don’t mean to imply that all diabetics fit the above stereotype. I’m exaggerating to make the point.)

[clairobscur]

@Anne Neville

Does the government in any of the countries with socialized medicine have some way of keeping that expense under control? Or can people not sue doctors in those countries, because the doctors work for the government?

I can only speak for France. First, most doctors don’t work for the government, though the majority of doctors working in hospitals do, since the wide majority of large hospitals are public (private hospitals tends to be smaller, more specialized, and to treat less serious conditions, generally speaking).

Until relatively recently, the courts’ jurisprudence made very hard to get any dammage in case of medical error because the mistake had to be exceptionnally egrerious. But over the years, this standart was progressively relaxed, up to eventually accepting to grant damages in some cases when there was no fault at all (for instance harmful treatments prescribed at a time when it was not known they could have negative effects).

This evolution plainly followed societal changes. The french population used to accept the idea that generally speaking doctors were trying to help you, not harm you, that mistakes were unavoidable, and that if something bad happened to you it was unfortunate, but barring malevolence, utter incompetence or stupidity you didn’t have much to complain about. Shit happens, after all. They don’t think this way anymore, and at the contrary (not only in the field of medicine, mind you) I see more and more examples of dubious lawsuits and of the “someone MUST be responsible” mentality that is so often denounced in the USA.
It seems to me that people are still much more reluctant to sue doctors and hospitals than in the USA (actually, much more reluctant to sue anybody), and maybe even have more confidence in healthcare professionnals (completely subjective feeling of mine). However, this evolution of the courts’ decisions nevertheless produced the expected results : the malpractice insurance costs rised significantly and in some specialities like obstetrics, dramatically.
So, no. It has nothing to do with the government trying to keep these costs in check, or people not being allowed to sue doctors, but it’s plainly, IMO, societal. As I already said, courts are just miroring in their decisions the general population’s feelings.