One does not simply “stop choosing ignorance”… We aren’t talking about willful ignorance here, I don’t know what it is that you think I am ignorant of…
~Max
Well, for starters you unpacked what I said the wrong way, I was responding to your seemingly way of responding in treads like this in a ‘devil’s advocate way’. It does not magically make the argument that I’m making here to be an invalid one.
So, besides your argument from ignorance being contradictory to what this message board is, there is then the reality that the system we have now is not only inefficient, with fewer liberties and more barriers for new entrepreneurs or business to appear, but created almost made to order to fall apart if a pandemic shows up.
The logical thing is not to then “claim to not ignore those impacts” and then for all intents and purposes act as if they can be ignored.
I’m not being a devil’s advocate, at least not in this thread or the other thread about healthcare. The only problem I have with your posts is that I don’t see where you have made an argument. “Willful ignorance” argument aside, you have presented plenty of premises along the lines of, the U.S. system is bad. I haven’t contested those premises. Yet, I get the distinct feeling that you and I disagree about something. I have a pretty good guess as to what it is, too.
Look, I don’t want to clog up Banquet Bear’s thread with a duplicate of my own. We have a thing going on over there. I stopped by in this thread to concede defeat to the challenge in the original post, to point out my own apathy for change, and perhaps provide the perspective of some subset of Americans who think like me. You say this is an argument from ignorance, because it is - I put the burden of proof on he who is against the status quo. Being altogether undecided on the best system of health insurance, I am in no position to convince someone to abandon their present system. I cannot convince Banquet Bear to oppose universal healthcare.
~Max
…this thread has absolutely **nothing **to do with health insurance. It has everything to do with healthcare. Perhaps if you could understand the distinction you would be in a much better place to understand what other people are saying to you in your own, parallel thread.
Apologies, the two terms (as used) are synonyms in my book.
~Max
…the obvious solutions to the problems with the NHS would be to stop the chronic underfunding, wouldn’t you agree?
As I’ve already said: they tried in the 80’s. The only thing that changed was that people had to pay more money out of pocket. The taxes didn’t go down, the waiting lists didn’t go down, the level of service at the hospitals didn’t go down. They abandoned the reforms because they didn’t make anything better and made things worse and harder for the average patient.
What is it do you think would be improved with the US style system?
…its a fundamental difference between what you find in most parts of the world and what happens in America. Do you really not understand that the two terms are not interchangeable?
I don’t have to pay any health insurance premium at all to access the healthcare system here. As outlined in the OP I pay my taxes, I pay for my GP and I pay for prescriptions. If my income was lower I’d get discounts, and there are additional layers of safety net in case my income was lower still.
I can choose to pay additional money for private health insurance. If I did this it would mean that I would probably be able to get a private room. I might be able to jump the queue for non-urgent care. But having health insurance isn’t a matter of life or death here. I’m self-employed and I didn’t have to liquidate my businesses to spend a week in hospital. No co-pays. No minimum payments. No bills after the fact.
There are some universal systems that do rely on mandatory insurance. But those systems, unlike America, are very tightly controlled.
America spends more on healthcare yet has less Doctors than the rest of the OECD. America spent $9,892 per person (in 2016) in comparison to $4,033 for OECD countries and the American system isn’t even universal. 10’s of millions of people miss out. You have to pay taxes and then you have to pay insurance and at best you get the same level of care as other countries while millions of your fellow citizens can’t access the healthcare system at all.
This isn’t apples and oranges. This is apples and a great big container of rotting, festering fruit. You have HUGE gaps in your knowledge. I would suggest that you stop arguing so authoritatively over in your own thread about something you know so little about.
This is going to sound heartless, but I suspect that what is most likely to compel a lot of us to have a paradigm shift is something like…COVID-19. An epidemic could (not necessarily would) expose some of the problems of having a health system that people are afraid to use because they might incur expenses they can’t pay back, and that when you have thousands of people who avoid health clinics during a pandemic, that eventually bites everyone in the ass, regardless of income or wealth.
But honestly, Americans are so individualistic, so brainwashed to embrace individualism and clannishness that I’m skeptical that we’ll ever change unless there’s a shock event so major that it fundamentally terrifies the shit out of all of us - and in those situations there’s absolutely no guarantee that people collectively experience a Eureka moment; they could just as easily strip themselves of grey matter and go back to their inner caveman. This is what scares me right now. I don’t see COVID-19 as necessarily the end of Trumpism; I see it as something that could push European and the American governments - in France, in Germany, in anywhere - into the arms of right wing extremists. The initial reaction may be critical of a Trump, but the real reaction will be that globalism is the problem. COVID-19 was introduced by ‘furriners’. The economic impact is ‘global’. I could easily see people going deeper and deeper into the cave.
But health insurance is a key part of health care. It’s important to understand that to have an intelligent discussion about this.
It’s why it drives me a little nuts when people talking about Canada having a “universal health care system.” It does not. It has a universal health insurance system (well, a number of systems) which enables Canadians to access health care. This isn’t unique to Canada; Germany has universal (multi payer) health insurance. France has national health insurance, too.
Max S’s “the two terms are interchangeable in my bnook” comment is… well, amazing, to put it kindly. Confusing health insurance with health care is like confusing car insurance with a car. But that’s not to say the concept of health insurance is useless here.
Health “insurance” is not a key part of health care.
In the first place insurance is a business, and it’s the business of maximizing returns, or in other words, making money. One really good way to do that is to get millions of people to pay a set amount every month, or quarterly, or yearly. Insurance companies do that. The second thing is not to pay out too much, and insurance companies, particularly health insurance companies, are also very good at that, too. If they take in a lot more than they pay out–and they always do–their owners and executives get bonuses. The top people almost always get bonuses, along with country club memberships, company cars, and expense accounts.
Insurance is not intrinsically a great thing that lots of people want, which is why millionaire lawmakers create laws requiring people to have it (i.e., auto insurance, which almost every state mandates). Insurance is a thing that insurance companies work very hard to make sure people think they want it and need it, and the insurance industry has been very successful. That industry is spending your money to make you think you need its product.
But it has nothing to do with health care. That’s, like, almost a Maguffin, for an insurance company.** The health care is not the product.** The money is the product. The ROI is the product.
Universal health care (or single-payer as it gets referred to) would cut out most of the hierarchy of people standing by to collect small fortunes by virtue of the money people send in to insurance companies.
You can certainly have universal health care without “insurance.” Sure, there will have to be a few non-health-providers in the system who do things like figure out how much staff to hire and obviously there should be some actual health-care providers in the mix–doctors, nurses, technicians–to inform the decision making. What you don’t need is hospital executives whose only function is to be taken to lunch by insurance company executives to discuss how much they can charge for a given procedure.
ETA: What you particularly do not need in universal health care is gatekeepers who decide whether a procedure is necessary and whether it is covered. It is the health-care providers who decide whether it’s necessary and also (I would hope) whether the patient is likely to survive it and whether it’s likely to be beneficial.
I think you mean “non-clinical gatekeepers second-guessing clinical judgement in every individual case”. Our system works on the basis of the GP acting as both gatekeeper (other than for emergency cases) and primary health advisor. You could argue that their central gatekeeping role is the result of a money-grubbing “system capture” at the outset (preserving their existing status and income was a key stumbling block in the politics of setting it all up): but as it happens, over the decades the whole system has tended towards delegating/diverting more and more of the routine bulk of business away from the expensive specialist end towards the simpler, cheaper end, as medical needs and techniques have changed, from specialists to GPs to nurse practitioners to prescribing pharmacists. Which actually reinforces the central position in the system of the GP, to the point where they now have a key position in the local agencies that allocate the bulk of budgets for hospital and community medical services.
Plus, we do have central clinician-led agencies as well as the professional bodies for assessing clinical and cost-effectiveness, but that is to guide practice proactively for the whole system, rather than reviewing every individual case.
This part is identical in Canada and indeed in every country with UHC that I know of. The respected health care economist Uwe Reinhardt once wrote that every doctor in every civilized country in the world would be appalled at the degree of clinical meddling that health insurers do in the US, coming between doctor and patient and second-guessing, downgrading, or denying treatments based on costs and contractual fine print. In Canada, the Canada Health Act mandates that any procedure normally performed by any doctor or hospital must be provided at no cost to the patient if the doctor deems it medically necessary. There are no forms to fill out, and no money is involved. I was in the hospital for the first time in my life several years ago, and I was well aware of the tremendous expenses involved. The ability to just thank the doctors and nurses involved, who had literally saved my life, and walk out the door without spending a dime seemed almost unreal, even to someone like me who was accustomed to never paying for doctor’s visits.
So is health care. Even in a place like Canada. My doctor gets paid, and paid well. Specialists are paid well. Hospitals cost a staggering amount of money to run and any number of companies are making millions. All of it, or 99.9% of it., is paid for by health insurance, mostly the provincial single payer plan, with a little private insurance and money sprinkled in. Health insurance is a big part of delivering health care.
A system without some kind of health insurance would be catastrophically terrible. Health care where people just pay as they receive treatment simply doesn’t make economic sense.
UHC is a form of health insurance. The UHC plan I am covered under literally has “insurance” in the name. It is actually a UHI program. It works.
This part cannot be emphasized enough. In the USA, it’s often the case an accountant decided what health care you get. In Canada, it’s always a doctor. I cannot imagine why anyone would prefer the former. Our system could be improved in a lot of ways but having accountants make health care decisions instead of doctors is not one of them.
I see taxes as being equivalent to a premium, sir. The lack of co-pays/deductible just means you have good insurance. I still characterize universal healthcare as a system of health insurance.
~Max
The two terms I was referring to as synonymous were Banquet Bear’s present system of health insurance and universal healthcare. Again, I apologize to everybody for the confusion.
~Max
Pot, meet kettle… People here have been saying the exact same thing to you, but that’s cool.
Set him straight then. What do you think is the flaw in his arguments?
…stop confusing the issue. Every country is different. Canada can reasonably say that your UHI is a form of insurance. That isn’t the case here. I have stated that some countries do have insurance and that some do not: but insurance is **not **a requirement for a universal system. If this were a venn diagram UHC would be the big circle with health insurance a little one with overlap: not the other way around.
I would just like to note that most Americans do not have “fire insurance” but if they have a fire, a team of experts will show up and put it out. They do not have “police insurance” but if somebody is breaking into their house and they call 9-1-1 police will show up. (Eventually.)
You don’t get all the “okay, here’s a bill from the driver of the fire truck. And here’s a bill from the guy who operated the hose. And here’s another bill from the guy who busted down the door. And we used 65 gallones of water, here’s the bill for that.” There are things fire departments charge for, like if you buy a house and you want to know if there was ever a fire at the house. In my jurisdiction it’s $15 for a report. But they don’t charge you for coming out and investigating if you smell smoke.
So “insurance” is kind of the wrong word for what I envision in health care, which is much the same kind of support. Doctors get paid, but maybe they get paid per person on their roster rather than by individual procedure.
Being afraid to access health care because it will ruin you financially is not a lot better than not having health care at all.
New Zealand has a mixed system, though. There are, in fact, insurance elements.