Convince me about UHC

[Merkwurdigliebe]

Well here’s the deal. Let’s thing about this from a “Making America Competitive” standpoint.

If we do UHC, it will make it less expensive for corporations to do business in the US.
Corporate tax may be raised, but it shouldn’t because that only leads to them passing the prices on to the customers.
So we get employees demanding higher wages because they are taxed higher. Who pays that is a good question. I think the rich should pay more. There’s a lot of bitching and moaning by the rich but really, they aren’t going to leave the country. Let them whine. We have very low taxes here for the rich.

So in the end we get a healthier (read more productive) workforce with preventative medicine. That would be much cheaper.

Who has the real incentive to keep Americans healthy? The individual, yes, but also the business community as a whole.

The question is, would it be as efficient. I would certainly say, yes, because we pay more than double for healthcare here in the US than the rest of the world, and our vital statistics are usually much worse than places like Canada, or England. Sure their systems aren’t perfect, but the only argument you’ll have against them are purely anecdotal (It takes 7 years for a knee surgery!) Ever notice that? They never show data against UHC, only anecdotes.

What do we have now? Medicare. I don’t know much about it, but I know it doesn’t cover enough people. Then we have HMOs which spend as little as possible on patients without getting sued.

Then we have employer based insurance, which many also have. These seem to actually be concerned with the health of their employees.

[Algher]

@Merkwurdigliebe

So in the end we get a healthier (read more productive) workforce with preventative medicine. That would be much cheaper.

Hang on - do you have a cite that shows that nations with UHC have a more productive workforce than the US? How about a cite that nations with UHC are healthier?

[Algher]

@Algher

Hang on - do you have a cite that shows that nations with UHC have a more productive workforce than the US? How about a cite that nations with UHC are healthier?

OK, so I decided to do my own research on this:

We estimate that a one percentage point increase in adult survival rates increases labor productivity by about 2.8 percent, with a 95 percent confidence interval of 1.2 to 4.3 percent. Our result is therefore somewhat higher than, but consistent with, the calibrated value of around 1.7 percent. This supports Weil’s (2001) conclusion, based on calibration, that health plays a large role in explaining cross-country differences in the level of income per worker, a role roughly as important as education.

http://www.stanford.edu/~wacziarg/demogworkshop/Bloom%20and%20Canning.pdf

So health is correlated with worker productivity, as measured in life expectancy and income per worker.

[you_with_the_face]

@Algher

How about a cite that nations with UHC are healthier?

Why would we need to look at other countries to figure out what makes common sense?

Right now, a large segment of the population has zero healthcare. Add UHC into the equation and suddenly everybody has healthcare.

Can you explain the mechanism by which our country could become less healthier under UHC?

[Algher]

@you with the face

Why would we need to look at other countries to figure out what makes common sense?

Right now, a large segment of the population has zero healthcare. Add UHC into the equation and suddenly everybody has healthcare.

Can you explain the mechanism by which our country could become less healthier under UHC?

Health HABITS have a huge impact on healthy living. With fast food, smoking, drinking, sedentary lifestyles, etc. all coming into play - UHC is only ONE factor. When we add in that in the US you get covered in the ER regardless, I would like to know if anyone has done the research on how much healthier UHC makes a nation.

For example, here are the infant mortality and life expectancy tables for nations:

Infant Mortality and Life Expectancy for Selected Countries, 2007

We can see that with UHC, the UK gets .7 more years of life than the US. Ireland, however, is .1 BEHIND the US. The US and Denmark are tied.

[DMC]

@Algher

Health HABITS have a huge impact on healthy living. With fast food, smoking, drinking, sedentary lifestyles, etc. all coming into play - UHC is only ONE factor. When we add in that in the US you get covered in the ER regardless, I would like to know if anyone has done the research on how much healthier UHC makes a nation.

Using your chart, we still look a lot less healthy than most first world countries. While some have the similar life expectancy rates, we seem to suck at keeping babies alive.

[Algher]

@DMC

Using your chart, we still look a lot less healthy than most first world countries. While some have the similar life expectancy rates, we seem to suck at keeping babies alive.

True, though I have seen (sorry - lacking cite right now I admit) that part of the problem with that is that we do a better job of keeping preemies, etc. alive long enough to die. That is, in some nations risky births do not happen (the kids are born dead), and therefore stay out of the statistics. However, I don’t want to stand on this - just bring it up as a possible issue.

I was still focusing on the Life Expectancy table, since that was the primary measure of health from the economist’s article. Why is it that with UHC, the Danes have the same life expectancy as the US? Why are the Danes worse than the Swedes? Since the US is so damned close anyway, is UHC REALLY going to make that much of a difference in productivity? That was the justification that Merkwurdigliebe used.

Mind you, this would be used as a means to SELL UHC to the US. We still have not determined what it would take to migrate the US to UHC.

[wonky]

@DMC

Using your chart, we still look a lot less healthy than most first world countries. While some have the similar life expectancy rates, we seem to suck at keeping babies alive.

I’ve read at least one study that suggests that our infant mortality rate is higher than average because Americans are less likely to abort non-viable fetuses.

[you_with_the_face]

@Algher

Health HABITS have a huge impact on healthy living. With fast food, smoking, drinking, sedentary lifestyles, etc. all coming into play - UHC is only ONE factor.

Well yeah, this is true. So comparing the health of people in England, Switzerland, or France to our health is not a simple exercise, since there are cultural differences at play.

Given this, it makes more sense to compare an America that has no UHC to a theoretical America that does have UHC. And then ask yourself how could UHC result in a less healthier populace.

[wonky]

I don’t have time to look at it, but this site has an excel file with some data on health care resources, life expectancy, risk factors, etc. for various countries: http://www.oecd.org/document/60/0,3343,en_2825_495642_2085200_1_1_1_1,00.html

[Algher]

@you with the face

Well yeah, this is true. So comparing the health of people in England, Switzerland, or France to our health is not a simple exercise, since there are cultural differences at play.

Given this, it makes more sense to compare an America that has no UHC to a theoretical America that does have UHC. And then ask yourself how could UHC result in a less healthier populace.

How it could get worse:

• Reduction in miracle drugs used, and other very expensive life-saving measures. Once the Government pays for it, the willingness to pay too much is reduced. This one would take 15+ years to be felt, however.
• Drop in quality of care. HMOs are already having nurse practitioners do more physician work. I would expect the government to be no better than Kaiser or the VA. While the VA has some good moments, it also has issues like were seen at Walter Wonderful last year.
• Drop in quality of physicians. Once the high payrolls of doctors is gone, I expect to see fewer top shelf students going down the medicine path.

Now, I am making the ASSumption that UHC means no more private care. This is different from my earlier proposal that we simply make Medicare a plan that you can buy into if you are not covered by work or can’t afford a private individual plan.

How it could get better:

• The uninsured get coverege, reducing ER visits as they can now afford to get checked before their health issues get so bad as to warrant an ER visit.
• Prenatal is better managed, reducing that infant mortality number.
• Companies can fire half of their benefits department once everyone is managed by the Feds.

[DMC]

@jsgoddess

I’ve read at least one study that suggests that our infant mortality rate is higher than average because Americans are less likely to abort non-viable fetuses.

The CDC thinks it’s on us.

[you_with_the_face]

@Algher

Now, I am making the ASSumption that UHC means no more private care. This is different from my earlier proposal that we simply make Medicare a plan that you can buy into if you are not covered by work or can’t afford a private individual plan.

And I think that’s an important distinction. The idea that UHC has to eliminate private care is a strawman often used to make the idea seem totally unreasonable and disastrous to even contemplate.

[DMC]

@you with the face

And I think that’s an important distinction. The idea that UHC has to eliminate private care is a strawman often used to make the idea seem totally unreasonable and disastrous to even contemplate.

While I used to be absolutely fine with leaving private care as an option (and I still think there are ways to make it happen), the plan I linked to earlier makes some very compelling arguments for why it would be trouble.

[Algher]

@you with the face

And I think that’s an important distinction. The idea that UHC has to eliminate private care is a strawman often used to make the idea seem totally unreasonable and disastrous to even contemplate.

I would not call it a strawman, since that IS the model followed in much of the world.

However, I also think that we will have to go to some sort of a hybrid system where private care not only exists but is allowed to flourish alongside the government system.

[you_with_the_face]

@DMC

While I used to be absolutely fine with leaving private care as an option (and I still think there are ways to make it happen), the plan I linked to earlier makes some very compelling arguments for why it would be trouble.

Interesting read.

I can easily imagine that UHC, especially if it was implemented well, could render private care obsolete. I can also envision a set up which is the opposite from how it is now with Medicare, in which acceptance of private care recipients is limited to a few providers.

[Algher]

@you with the face

Interesting read.

I can easily imagine that UHC, especially if it was implemented well, could render private care obsolete. I can also envision a set up which is the opposite from how it is now with Medicare, in which acceptance of private care recipients is limited to a few providers.

Here is a bit from the Brits about the intersection of private care with their UHC:

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1118448

The problem with looking at Medicare, is that if you take a Medicare patient you are not allowed to take any additional money from them for services, or to upgrade.

I could see a system where the government pays for the room with 8 beds, but if you want a private suite you can pay for it. The government pays for generic, but if you want the latest pill you can pay for it. The government pays for 2 ultrasounds as part of the standard pregnancy package, but if you want one every visit you can pay for it.

Government sets the bottom, minimal standard and pays for it (taxes - so we all pay of course). You are allowed to purchase above the minimum if you like, and even purchase a policy that pays for your above minimum coverage in exchange for premiums.

[Weirddave]

@xtisme

Take one aspect and go into detail on that and then move on. I don’t mind long posts. Go for it.

That’s great, but you don’t have to type it, all you have to do is read it. Since I can’t type (I’m like the horny drunk co-ed at last call, I’m a hunt 'n pecker), it’s a bigger deal for me than you.

(Actually, I’m going to dictate it to my wife, she types some ungodly high number of WPM)

Here’s my take on the entire UHC discussion. I think there are four main questions that need to be answered with regard to UHC.

The first question is, what would UHC mean with regard to both the availability of care and the quality of care?

The second question is, what would the cost of UHC be?

The third is, for which problems in our current system is UHC being proposed as a cure?

And finally, what are some of the ways that these problems can be addressed, without necessarily going to a full UHC system?

Right now, let me just deal with the first question.

The first question is, what would UHC mean with regard to both the availability of care and the quality of care?

The first thing that I think is important to note is that it’s highly unlikely that a UHC system will affect the quality and availability of urgent care in this country. Let’s face it, even right now, if you don’t have health insurance, if you have crushing chest pains, you can call an ambulance, the ambulance will transport you to the hospital and the hospital will treat you. The question of who pays for the treatment comes up after the fact or possibly when the medical provider is considering whether to run an additional battery of tests or unusual treatment methodologies. In the case of the latter, UHC will probably improve the situation because nobody would have to worry about who is going to pay for this treatment. So again, it’s unlikely that urgent care will be affected much at all. Non-urgent care is a whole other question.

What UHC will mean for non-urgent care is rationing. This is true in every country that has UHC. Some people will argue that rationing of care occurs currently because of the inequities in our system but that’s something of a red herring, we’re talking about what will the situation be with a UHC system in place. What we have now is unimportant because we’re going to abolish it, the question at hand is will UNC be an improvement? No matter who is running the health care system, no matter who is paying for it, there is always a finite amount of care available. If there is no economic restraint on the consumer of that care (they don’t have to pay for it), then demand will always exceed that finite amount. This is basic economics. What happens in countries that have a UHC system in place is that there is some governing body which determines what type of health care is available, who is eligible to receive it, and when they can access that care. Now, proponents of a UHC system claim that this doesn’t matter. Emergency care is taken care of, non-urgent care is just that, non-urgent; and if the patient has to wait a month instead of getting immediate treatment for a non-life-threatening ailment, then so be it. The trade-offs in increased care for a larger segment of the population are worth making. This may very well be true. It is certainly to my mind a legitimate argument. However, when considering replacing our current medical system with a UHC system, the impact of increased wait times for non-urgent care has to be considered, especially the impact on people who are currently insured and do NOT have those wait times. How are they going to react when they no longer have instant access to care?. Long wait times in Britain under the NHS are so common that they have become cliché and are even joked about in the manner of ‘that’s the way things are, what are you going to do about it?’ Here is a video of Canadians talking about just that issue. I think Canada has a very good health care system, but it is far from perfect. My wife had to have her gall bladder removed when she was still living in Alberta. This was done without much fuss, almost six weeks after it was determined that she needed the surgery. She was never in any danger, health-wise, during that time period; but she also was fairly uncomfortable physically until the surgery was done. Here in the US she would have had the surgery within a few days. If UHC is instituted in the United States, the majority of the population that is not currently dealing with such long wait-times for treatment will have to accept that this is the way things are done now. This will be an improvement, of course, for people who do not currently have health coverage, opening up avenues for them to get health treatment that they may not be currently receiving. However, it will be a negative change for the majority of the population who currently have private or employer-sponsored health insurance. Again, let me reiterate: we as a society may decide that this is a worthwhile trade-off to make. I have no problems with that. However, I frequently hear people proposing UHC as a Utopian solution “oh sure, we’re just going to get the government to pay for it, all it means is that everyone can get health care instead of just people with private insurance.” And while that may be true, the impact of rationing of non-urgent medical care on the population is rarely, if ever, mentioned by these same proponents. This is one of big the things that UHC means, and I think any discussion of UHC needs to honestly factor this into the discussion. UHC is NOT “Oh boy! Now everyone can go to the doctor whenever they want, and we’ll all be healthy and happy, and best of all it’s free, free, free!!” That’s a fantasy, and cost is the next thing that I’ll look at.

I’ll get to the other three questions in other posts over the weekend.

[elucidator]

@Weirddave

…What UHC will mean for non-urgent care is rationing…

It already is rationed, the determining factor in that rationing being income level. A lot of us think that stinks.

[XT]

@Weirddave

That’s great, but you don’t have to type it, all you have to do is read it. Since I can’t type (I’m like the horny drunk co-ed at last call, I’m a hunt 'n pecker), it’s a bigger deal for me than you.

To be sure. FWIW, I appreciate it.

-XT