And apparently at least one of you is incapable of reading for comprehension. I addressed that, too bad you missed it.
“Batting aside” is not the same as “addressing”.
Besides, you largely ignore the crucial factor of efficiency, if moderate health care is delivered early, moderate care can well be all that is required. Available care is more likely to be early care, and early care is vastly more efficient.
You seem to imply that as soon as health care is free, people will suddenly develop a fondness for doctor visits. Expense is one reason why people don’t go to doctors more often, the other is that they don’t want to.
What grave disaster has befallen those who’ve ignored this advice? Other than a healthier citizenry, of course. With all the grim significance of that.
Part of the goal is to reduce the need for urgent care through preventive care, which would absolutely affect the quality and availability of it. Using your own “resources-based” arguments, hospitals could obviously take better care of urgent care patients if they had fewer of them.
Ah bullshit. If you want to wave your hand at the fact that we have rationing and claim it’s not important, but bring it up as some boogie-man for other countries, you’ll get called on it. The problem is that while everyone has rationing of the insured, including the U.S., at least they don’t have also have uninsured. So, adding the uninsured to the insured list would be an improvement, rationed or otherwise.
That’s so basic that it’s again crap. While I’m sure there are hypochondriacs and even a few others that will abuse the system, I’ve never met a single person who goes to the doctor just for fun, even fully insured. There are a finite number of QuikTrips in the nation, and they all offer free air for your tires. I still don’t see huge numbers of cars waiting in line, just because it’s free. People use it when they actually NEED air in their tires.
We have that now. This governing body is called “Greedy-Fuck Insurance Companies” with more emphasis on profit than care.
We have the wait times here as well, as we’ll see in my response to your little anecdote below. Given that, even I’ll admit that some procedures have longer waiting times in Canada than here, but Canada doesn’t spend nearly as much per capita for health as we do. Give them our money, and I’d be willing to bet that they blow us away in wait times.
Again, I have seen zero evidence that our wait times would increase given the amount of money we spend on healthcare. Every single country where wait times are considered a problem spend far less than we do per person, so it’s a crappy comparison. If you have any data that demonstrates how long our wait times would be given our current costs, let’s see it. It will be a first.
Oh come fucking on. Did you get that at work? That’s put together by an organization that is funded by your industry, and directed by a former lobbyist for your industry. Even then, it’s freaking anecdotal.
Yes, it is far from perfect. I wonder how close to perfection they’d get with our money. For the record, many of us here don’t even think our health care system is “very good”, so does Canada win?
I’ll just trade you anecdote (I have no clue who that family is, but I just grabbed someone on the web at random for whom a wait time was easily determined) for anecdote, since you think that’s sufficient evidence. She’s waiting almost five weeks, and doesn’t seem to have any issues with the wait time, nor consider them out of the ordinary.
Some of the “we as a society” are waiting for some proof that things will get all horrible when we switch to the best funded UHC in the world.
Because it has never been proven that this would be an issue in the U.S. Hell, it might actually improve, since we won’t have the Health Insurance CEOs to pay. Want to talk about what McQuire was being compensated? How many people can we insure for a year with $125 million? How much will we save by no longer having to deal with the various stock options scandals? That’s probably in the billions. How many more people can we insure for that? That doesn’t even take into account the profits that are currently being made. I’m betting we could cover a metric shitload of people with that kind of money.
All of that and you brought zero proof to the table that we’d actually experience any of these things?
Look, I realize this is your livelihood. You have to realize that some of the rest of us live in the same country as you, are fully insured with the best plans available to them, and still fight tooth and nail to get what they consider necessary medical care without going bankrupt in the process. Many don’t succeed. If you want to continue to bring up anecdotes, keep in mind that many of us have them as well.
By the way, xtisme, since you have been asking for more specifics, did you read the plan I linked to, and what did you think of it? Also, were you looking for examples of plans, or looking for reasons to move or not to move to UHC? The title and the OP seem to be at odds in this regard, and if you just wanted the pro/con of UHC debate, I’ll happily link to many recent ones.
A laudable goal. In fact, that was the argument used to sell HMOs to the public back in the 80s. How’s that worked out, do you know? Here’s a handy chart from the state of New York showing that about 50% of the time, HMO’s initial denial of payment for claims are reversed. That means that half of all the claims denied by HMOs should have been paid. “Focusing on preventive care” is one of those goals that sounds great on paper but just doesn’t mean much in practace.
You ignore what I am saying. If our current health care is rationed between the insured and the uninsured, (85% of the population and 15%, respectively), proposing as a solution that we instead ration health care for all of them is a pretty piss poor deal for the 85%. Yes, it’s an improvement, FOR THE 15%. This is all about the overall availability of health care after all.
No, that’s so basic that it’s VITAL. You clearly have no understanding of supply and demand, or you are too desperate to admit that it applies in this case as well. If you increase the supply of something (offer it for “free”), demand always, always, ALWAYS climbs. You can sit here and post that the sky is green until you are blue in the face, but guess what? The sky isn’t green.
Blah, blah, corporations are bad, yadda, yadda, yadda. Tell it to the Marines. Corporations are at least answerable to their shareholders and their customers. Replacing “Greedy Fuck Insurance Companies with more emphasis on profit than on care” with “Government bureaucrats focused on their budgets rather than care, answerable to no one” seems to me to be a piss poor choice.
Cost is next, but I notice that you present no evidence that Canada would do better than the US were they to spend more per capita. You’re speculating, just as you accuse me of doing. The difference is that you seem to think money alone will solve any problem, a common failing of people on the left. Each year we spend so much money on poor people in benefits and services (welfare, housing, medical care, food, etc…) that if we simply took the money and split it evenly amongst everyone under the poverty line, they would all be above the poverty line. And yet we still have poor people. Per capita spending on health care is actually immaterial. WHATEVER it is ($3K in Canada and $5K in the US, IIRC), demand for care will rise to that level, at which point more money needs to be spent, or access to care is restricted. You can not get around that simple fact no matter how hard you try. That is the way things work. You’ll have as much luck trying to convince an apple to hang suspended over Newton’s head as you will denying this basic fact.
That a Guilt by Association Fallacy.
Again with the money. You just don’t understand economics do you? No, I don’t think Canada wins. I think Canada does some things we could learn from. I think we do a lot better at some things, and promptness of care for the insured is one of them. Riddle me this: You need to have your knee scoped to remove cartilage that is causing you pain. Would you rather be in Canada or the US? If you’re one of the 15% here who is uninsured, Canada is the no-brainer choice. Most of the 85% of us who are insured would probably rather get it done quickly rather than several months down the line.
You also seem to have a difficulty grasping the difference between an example and something presented as evidence.
All I’m trying to do here is discuss what UHC will actually entail in the real world. I haven’t offered any “proof” one way or the other as to weather I favor or oppose it. Fact: UHC means rationing of non-urgent care. I haven’t attempted to say one way or another weather that’s acceptable or not, in fact I’ve openly acknowledged that the argument can be made that that is a price worth paying, but rationing of care is inevitable and unavoidable with UHC. Your attempts to deny this all boil down to “But…but…but…We spend so much money now! Of course we can give great care if we take money away from evil greedy corporations and put it in the hands of benevolent government bureaucrats”, an attitude that shows a disturbing lack of knowledge of basic economics and, frankly, the real world, and “Welll…so what? Care is rationed now”, which I have acknowledged. The question, the only real question to my mind, is which would be worse?
Actually, from a personal standpoint, I am comfortable now, I expect to be well off within a few years, but if any substantial type of UHC comes about in this country, utilizing what I believe to be the only feasible method (more on this later), I’ll shoot right through wealthy and land smack dab on rich. You seem to be confronting me as if I have said “The system is fine the way it is. Nothing needs to be changed”. I have not. That is not my position. I want what is best for the citizens of the U.S., and by the time I get done with my four long responses, it’ll be clear why I don’t think that that is UHC and what I do think needs to be done. Until then, I can not promise that I will respond to every post the way I have responded to this one, doing so would probably leave me no time to compose those posts, I DO have a life outside the SDMB you know.
Precisely. UHC or no UHC, that finite amount of health care has to be rationed somehow. The question is, is it better for it to be given to the people who are most able to afford it, or the people who need it the most (as determined by medical professionals)?
Well, that seems like a no-brainer to me: the latter. Unless the people making the decisions are utterly, cartoonishly corrupt, letting them allocate health care where they believe it’s needed has got to be better than auctioning it off to the highest bidders.
That conclusion doesn’t follow. The problem you described isn’t a failing of preventative care, it’s a lack of preventative care, brought on by the economic incentive HMOs have to reject as many claims as possible (valid or not).
The one in post #78 (Proposal of the Physicians’ Working Group for Single-Payer National Health Insurance)?
Yes, I skimmed through it. First off, let me say I appreciate the link as this is one of the very few posts in this thread that even attempts to answer the question. I actually wrote up a long post where I quoted the key sections and then commented on them. That post, unfortunately, has been eaten by the giant squid.
Instead I’ll make a general comment and then I’ll quote a couple of things that caught my eye and comment on those. The general comments are: there isn’t a lot of the nuts and bolts detail here on how much some of this is going to cost and how long it will take to implement. Looking at some of their plans, it seems they want to (voluntarily?) take over the existing HMO’s and other for profit providers by paying off the principals for their past investment (at market value?). At that point my understanding is they will join an organization (National Health Insurance) who will:
Coverage will be provided on this basis:
The general comment is, again, there isn’t much detail here. I’m VERY wary of the ‘boards of expert and community representatives’ who would ‘assess which services are unnecessary or ineffective, and exclude them from coverage’. I have a sneaking suspicion that the budget is going to factor in heavily as to which programs are ‘unnecessary’ or ‘ineffective’…and a hinky feeling about those people sitting on those boards making those decisions.
At any rate the devil is in the details…and there are none here, much as I’d love to see them.
THere is a bunch of stuff I’m skipping over at this point so I’m going to go to page 3 (I encourage interested posters to hit the link and read through the whole document and see what you get out of it).
It’s good that they will give people a choice. My guess is I would chose to stay with my current HMO…unless they totally torture me with tons of new taxes (which they imply above) or other hoops and things I’d need to hop through to do so. I wish they gave a ball park figure for what those increases in taxes would be, and if they would really be offset by not paying the current insurance (unless you stick with your current HMO, in which case maybe you have to double pay?).
At any rate I found the link very interesting, and there is some good stuff in there. I was disappointed they didn’t put associated real world costs on some of the stuff they glossed over because it would be interesting to see what they would be. I don’t think that UHC should have to be constrained to what our current costs are after all…we are talking about a radical new system and the initial implementation is going to be expensive (I just wish the UHC types would acknowledge that…it’s almost like it’s a dirty little secret or something). I’m interested in how large those initial costs will be and how the system projects to cut costs in the medium and long term. How the level of service will be overall. How they will deal with things like the disparity between the various hospitals and medical centers around the country today (they aren’t all equal). And if they plan to seriously cut physician’s salaries how they will maintain quality staff.
Definitely looking for plans not reasons to move or stay with the current system. Contrary to popluar belief I don’t think the current system is working well and I think changes need to be made. I would like to see plans from the UHC crowd on how we get from where we are today to a full blown, fully functional UHC system. What would such a system work like for the patients? For the Doctors and other health care personnel? How much would it cost to transition multiple disparate systems who are currently on a For Profit model to one unified system on a Not For Profit model? What kind of tax increase are we looking at initially? And when that tax increase is asked for does that me right at that time we no longer have to pay our HMO’s? Or are we going to have to pay for both for a while until the transition is done? What kind of realistic coverage can we expect? Who is going to make up these boards to review what procedures we can and cannot have? Who will have oversight over those boards to crush them like bugs when they over step themselves? How long will this transition realistically take? A full term of a president? Several? Less? More?
-XT
I’m glad you admit the first part, all too often it seems that people promoting UHC won’t. As to the second, again, again, that was exactly the same reasoning used to sell HMOs in the first place, yet by the end of the last century doctors and patients were practically in revolt because it wasn’t doctors making decisions about patient care, it was bean counters. Every proposal for UHC that addresses this issue seems to count on the benign goodwill of plan administrators to counter this which, frankly, is naive to be charitable. People in Government and people in corporate life are exactly the same: people.
The economic incentive HMOs have to reject as many claims as possible (the profit motive, and hey, BTW, how do you explain that not for profit HMOs do the same thing?) is absolutely no different in practice as the economic incentive government bureaucracies have to reject claims (their budget), and the later will be a hell of a lot harder to overturn. Unless that budget is unlimited, the results will be exactly the same.
Well, I can’t speak for everyone, but I know I’d vote against any proposal to transfer decision-making power from the doctors to the bean counters. Is there a reason to think such a thing might happen?
Those people are subject to different forces, though. The government is not a corporation.
Do they? That seems pretty strange, because they have no incentive to reject any more claims than are necessary. If they do, where does the leftover money go?
It seems a hell of a lot easier to me. If government isn’t doing what it should, we have a chance every two years to throw the bums out. On the other hand, I’ve never even been asked how I like my insurance company, let alone been given a chance to reshuffle its management!
Not to sidetrack this thread, but my part of Canada has been settled with piles of people since the 1500s. Piles.
That said, Canadian style health care works fine in Canada, and would work fine in the US
I think this is an excellent illustration that just because something has competition it doesn’t mean it’s better than a non-competitive situation.
Did you follow the link I provided? From the Union of American Physicians and Dentists:
Now, that press release was from 10 years ago, and some changes have been made, mainly by changing the laws to allow HMOs to be sued if they deny care, but the link in my previous post shows that 50% of claim rejected by HMOs are reversed upon appeal. Half. That’s where “focus on preventive medicine in order to bring down costs” leads.
No, it is not, but government employees are subject to the exact same forces corporate employees are, how could they not be? Please tell me the difference between Jane Doe, Blue Cross claims adjuster and Joe Doe, claims adjuster for the National Health Service. Also, how would their jobs be any different?
There is no “leftover” money. Demand always expands to meet supply.
Currently we have an independent government regulatory body with the power to review and mandate compliance. You would lose that by bringing it all under one roof. And please remember, I’m not talking about elected officials, true you can theoretically “throw the bums out” every two years, but elected officials have nothing at all to do with the day to day administration of health care, that would be run by a government bureaucracy, and that is something that you have no control over. When is the last time you got to vote for the clerks at the DMV, the middle management at HUD or the safety inspectors from OSHA? Never, that’s when, and these people do not turn over when new elected representatives are selected. As for private health insurance, you (or your employer) have the opportunity to switch to a different company whenever you like (or at least once a year). If enough people do this, believe me, the management will be reshuffled. You would have no such opportunity under a government run UHC system.
What you are saying is quite true, but HMOs are not the sum total of health insurance options out there. I have been focusing on them because they most closely resemble what a government run UHC would be, there are other types of plans out there that use other cost containment methods which do not have the same problems, and competition means that you are free to switch to them. With UHC you would not outside of paying twice for the same service by buying private insurance on top of UHC (which, incidentally, is exactly what people with the means to do so do do in countries that have UHC in place).
Some data from that excel file I linked to above.
In 2005, the US had 2.4 practicing physicians per 1000 people. This is the same number as the UK. Canada has 2.2. 2.4 is toward the lower end of the scale, with Belgium having 4.0 as the highest and Korea having 1.6 as the lowest.
In acute care beds, the US is also toward the bottom of the scale. In MRIs, the US is way higher than any other country. In CT scanners, the US is near the top. Life expectancy for females toward the bottom. Life expectancy for males looks to be near the middle. Life expectancy for the total population towards the bottom. Life expectancy females at 65 near the top. Life expectancy males at 65 near the middle. Infant mortality high.
Female deaths from cerebrovascular disease near the bottom. Male deaths from cerebrovascular disease near the bottom. Total deaths from diseases of the respiratory system I think near the middle. Total deaths from diabetes toward the high end, but there’s a lot of missing data.
The US has one of the lower rates of smoking. Toward the low end in alcohol consumption. Near the middle in number of overweight. The highest number of obese.
For what it’s worth.
I didn’t see the relevance, and I still don’t.
When a penny-pinching corporation is in charge, sure. But again, the government is not a corporation: we the people have more control over it than just choosing whether to buy what they’re selling or walk away. If we don’t want UHC denying brain wave tests to brain-damaged children, we can pass a law to that effect, or just fire whoever’s in charge of those decisions and replace him with someone who won’t deny those claims.
One of them is ultimately accountable to shareholders, who are concerned with whether the insurance company is making a profit. The other is ultimately accountable to voters, who are concerned with whether UHC is providing health care to those who need it most.
So, in other words, the non-profit HMOs only deny as many claims as they need to deny in order to stay within budget? What is the problem, then?
BTW, this claim about demand expanding to meet supply has been made before, and I don’t think it holds water. I can go to the doctor any time I want, but I don’t.
They would if there was demand for it.
In other words, I don’t have any control over it, my employer does, and even if I can convince them there’s a problem, all they can do is choose between Coke and Pepsi.