Free health for all.

[Northern_Piper]

@szabrocki

If there is free health for all, Where do all the health care workers come from to help millions more people?

I would challenge you on your opening comment, using the word “free”.

When you have a break/in and call the cops, do you think of it at “free police service” ?

When you have a fire and call the fire service, do you think of it as “free fire protection”?

When you drive on toll-free roads, do you think of it as “free roads”?

When your kids went to public school did you think of it as “free schools”?

All of these are public services, provided by your tax dollars. Adding UHC wouldn’t be “free”, any more than these services.

The question is whether you can start to think of health care as a government service, covered by tax dollars. That changes your perspective, but it doesn’t mean it’s free.

I’ve lived with UHC as long as I can remember, and I’ve never thought of it as free. It’s a taxpayer funded service, and the costs and delivery are regularly debated in the public sphere. Governments run on improving the health system, and I think we’re all conscious that it comes out of our tax dollars.

Calling it “free” implicitly conjures up ideas of profligacy and waste. Who doesn’t want free stuff? But if you’re conscious that it comes out of your pocket, just by a different route, it triggers analysis about it being a public service, and how best to provide it at a reasonable public expense.

I am 60 yo and on Medicare Advantage. It takes me 6 weeks to get a 15 minute doctors appointment. What will happen when we add millions more people to the waiting lists.

If we’re talking anecdotes, I need to go to the doctor for a minor matter, called my clinic today, and got the appointment for Monday. Darn that UHC with its interminable wait times!

[Ravenman]

@szabrocki

If there is free health for all, Where do all the health care workers come from to help millions more people?

As a former Health Care Worker I know that a doctor spends 4 years in college, 4 years in medical school, 4-5 years as a resident, and 2 years getting his/her fellowship.

I am 60 yo and on Medicare Advantage. It takes me 6 weeks to get a 15 minute doctors appointment. What will happen when we add millions more people to the waiting lists.

Where are the nurses, the hospital beds, the medicines?

If wait times are bad now, are you suggesting we get rid of Medicare? That would free up a lot of resources to be used by people who pay for their insurance, and are younger so would get a lot more benefit out of each dollar spent on their own healthcare.

Seems like a perfectly logical proposal: If healthcare is truly scarce, let’s prioritize service for the young who don’t need as much of it, and let others fend for themselves.

[Melbourne]

@Ravenman

Seems like a perfectly logical proposal: If healthcare is truly scarce, let’s prioritize service for the young who don’t need as much of it, and let others fend for themselves.

The English National Health Service was established on the model provided by one of the railway systems, which provided co-operative/mutual health care for their workers and families in a system that was free at the point of care. It was ~ 30 years before they really started spending money on health care for old dying people

[Melbourne]

@Voyager

Excellent idea. I know a woman from Russia, who was a doctor there. When she moved to the US to get married she could not work as a doctor here, but was stuck in doing things way below her training.
Test them. Certify them. Make them do internships. But don’t exclude them.

Well, I wasn’t thinking of Russia Their health care system is significantly different from that in the USA (or was when I knew about such things).

I don’t know why she wasn’t able to get an American medical qualification. It seems to be a lot harder now than it used to be, but I think it’s still test them, make them do internships, certify them. Different in different states, and perhaps different depending on where you got your original qualification from.

[Voyager]

@Shodan

Doesn’t sound familiar at all. Because your first paragraph makes it clear that other countries are doing cost avoidance, and the US is supposed to do cost reduction. So none of the other countries can be used as examples, because they are, in fact, different.

If you need to cut expenses by 25-40%, and the benchmarked companies were able to cut expenses by 25-40%, you could certainly learn from them. If they never spent as much, then not so much.

Regards,
Shodan

Cost avoidance is harder to measure, since it comes in the future. Even in the future, when you review spending, is the current level due to cost avoidance or did you just get lucky and it would be low anyway. However smart companies understand that investing in cost avoidance has a good return on investment, better than waiting for things to fall apart.
Kind of like how people who keep disasters from happening get less recognition than people who save the day after the disaster happens - even one they caused.

As for benchmarking, if you see a competitor spends less than you on something, even without cuts, a competent benchmarker can investigate their processes and find out why. Actually, I shouldn’t say competitor. Our committee in a computer company learned a lot from a similar issue in the wine industry.

BTW we did some cost reduction also, but it was not as common as cost avoidance.

[Cheesesteak]

@Shodan

If you need to cut expenses by 25-40%, and the benchmarked companies were able to cut expenses by 25-40%, you could certainly learn from them. If they never spent as much, then not so much.

Regards,

Shodan

So, you would tell your boss that you can never do your process as cheaply as your competitors because it would involve cost reduction instead of cost avoidance. And you can’t learn anything from their cheaper process either.

Here’s a cardboard box for your stuff.

Sent from my iPhone using Tapatalk

[Hari_Seldon]

@Johnny_L.A

Yes. The U.S. is ‘exceptional’. We are the exception, in that we are incompetent to do what every other Western country has managed.

Why? Because Americans would rather pay more for poorer benefits and results, just so ‘Those People’ don’t get anything ‘for free’.

While there is a lot of truth to what you say, the real reason the US never had government health care is that when other countries were introducing it, lobbyists for the AMA fought is tooth and nail and beat it. This is all described in Jill Lepore’s “These Truths”. My DIL, a family physician, spends an inordinate amount of time fighting with insurance companies, filling out their forms and other time wasters caused by the crazy system used in the US. A lot of doctor’s time would be freed up under a sane system and maybe no one would have to wait six weeks for an appointment. Certainly I don’t in Canada. We put in our system when medical care was a lot cheaper and–to be sure–a lot less effective. But it wasn’t driven by the insurance companies and has simply adapted as medical care has gotten more complicated and expensive.

[szabrocki]

I’ll answer the first two questions.

How are you on medicare if you’re 60?

Do you have kidney failure?

I’m on SSDI.

No.

[Voyager]

@Hari_Seldon

While there is a lot of truth to what you say, the real reason the US never had government health care is that when other countries were introducing it, lobbyists for the AMA fought is tooth and nail and beat it.

I was just a kid at the time, but I still remember the massive amount of TV advertising bought by the AMA trying to stop Medicare.
Not surprising - I read that one of the best ways to get into the 1% in America is to be a surgeon, in a set of specialties.

[Spoons]

@Hari_Seldon

While there is a lot of truth to what you say, the real reason the US never had government health care is that when other countries were introducing it, lobbyists for the AMA fought is tooth and nail and beat it.

As I recall (I was only a child at the time), Canadian physicians did the same. This would have been the late 1960s.

Our family had gold-plated health insurance. This was because my Dad worked for an insurance company–not in the health division–but he got all the benefits of his company’s health insurance. And being the klutzy kid I was, I benefited from Dad’s gold-plated health care family plan. I was stitched up, examined by doctors, x-rayed, and operated on, under Dad’s insurance plan, with a low, employee-discounted, deductible under private insurance.

Then Ontario (and other provinces) instituted single-payer government-run health insurance: in Ontario, it was the Ontario Health Insurance Plan (OHIP). My father railed against it (“How can you call it ‘insurance’ if there is no deductible? No actuaries? No claims adjusters?”), but I continued to be a klutzy kid, and then a klutzy teenager, and Dad found that he never had to pay anything at point-of-delivery when he took me to the ER, which happened more than once. There were no forms he had to fill out; he just gave his OHIP number, and I got taken care of, and claims were always paid. Easy-peasy. It took a few years, but Dad came around to thinking that this was a good thing.

Canadian physicians also came to realize that this was a good thing. No longer did they have to deliver services now, wondering if they would be paid by an insurance company later–they were guaranteed to be paid, since there were no claims adjusters. There were no actuaries, looking at lifestyles, and rating accordingly. There was nobody standing between the physicians and the money they earned. That worked.

Claims paid without question or argument? That’s what worked with Canadian physicians.

[nelliebly]

I think there really are a significant number of Americans who are not getting health care but who would do so if we had UHC. One thing I don’t understand about arguments like Shodan’s is this: You WANT a system that’s predicated on some people not getting health care? That is, you see it as to your benefit that there are many people who can’t access the healthcare system because you think (rightly or wrongly) that your wait times for a non-emergent appointment would be longer?

ETA: OP, you do realize the number of people on Medicare is growing as the population ages, right? And that’s without UHC.