Just saw your post. Thank you very much for the answer.
[quote=“George_Kaplin, post:115, topic:468846”]
If I may beg everyone’s indulgence for a moment, I’d like to ask a few quick hypothetical questions to help me ascertain how medical care is doled out to Americans without insurance. In none of the scenario’s below do I have health insurance.
You suffer. Welcome to America land of opportunities (to suffer)
Until someone more knowledgeable comes along to fill in the details:
I believe you may have access to medicare which will cover part of the surgery, but you may have to suffer till you’re 65.
I hope you didn’t plan on retiring. Because it’s either crippling debt or death for you.
You should fall under medicare and be covered that way.
Thank you for the condescending response. However, in your haste to make a skeptic look like a fool, you missed the high points.
I’m saying that high medical costs are a symptom of much broader economic woes, and that those woes will still be there even if we go to a socialized system.
Malpractice insurance rates will still be massive because we have not addressed the legal issues that surround frivolous lawsuits and tort reform. Not to mention that it’s been said that malpractice insurance rates are also sky-high because insurance companies are defraying the costs of bad investments (which is their main source of income - not premiums).
According to one study by the state of Connecticut, the average yearly malpractice premium is over $23,000. The same study reported that there were 2,800 or so licensed doctors that provide direct medicall care (and thus are required to be insured) in the state, bringing the grand total to (roughly) $65,000,000 per year for Connecticut alone. Won’t that still be there, even with a socialized system? In that case, won’t we, in effect, be socializing much more than the medical industry? Won’t we ALL be paying for bum investments by the insurance companies?
Why would we blithely do that, instead of putting some curbs on frivolous lawsuits and regulating what sorts of costs insurance companies can pass along to patients?
I tend to lean towards the market always being more efficient. But the system in the US isn’t a free market - government already has their hands in the mess distorting it by already socializing certain segments of the population, setting regulations that complicate the job for the medical system and insurance companies, mandate that everyone be treated at the ER and then forcing hospitals to shift that burden around. There’s not some ideal free market in the US where you could move easily from provider to provider based on price and services, or somehow avoid subsidizing other non-insured people while paying your premiums.
I have to wonder if a real free market take on the medical system wouldn’t improve things dramatically. The current system, the psuedo free market with heavy government interference, is probably worse than full on single payer socialized medicine.
So even though I’m philosophically generally opposed to socialize medicine - if we’re going to accept that government is going to play a role in the deal (and it seems unlikely we’re going to reverse that trend) then we should probably aim for the most effective system rather than simply fighting further government encroachment on philosophical grounds.
Government has already fucked the system - we may as well try to make it do it in the least destructive way.
Cultural conditions. In the original post, there were references made to the greater percentage of obese among the American population. You don’t think that’s primarily due to the medical system, do you? If only poor people had doctors to tell them not to be fat, then they wouldn’t be?
Americans, culturally, are apparently prone to fatness. And that alone explains the differences in life expectancy and such.
Infant mortality, I don’t have an answer for that. Anyone want to take a stab at it?
One thing I’m kind of confused about with respect to the universal health care issue in the US: are the proponents of universal health care actually planning to switch us to a system like, say, they have in the UK and canada, where the typical case is that you just get your health care and don’t worry about the billing and how much it costs, or is the plan to leave our system the way it is, but add a “catch all” insurance plan that is provided free-of-cost to otherwise uninsured people?
If it’s the former, great. If it’s the latter, I can’t fathom how it could possibly increase efficiency (and my guess is it would decrease quality of care, since doctors would start worrying about whether PoorAid covers this or that procedure and how well it pays before suggesting a course of treatment).
The funny thing about this whole issue is that I make plenty of money and have health insurance, but I personally feel the need for better health care in this country, simply because every time I go to the doctor’s office, I wonder if six weeks later I’m going to get a bill for $30, $300, or $3000 which my insurance company says they don’t cover. I supposedly have “great” insurance, and yet I still find myself in the awful position of saying to my doctor, “before you tend to my health, let me ask you: how much does this cost? Maybe I’ll opt out.” Because Premera literally sends me statements that look like this:
Procedure Code Phys rate Amt covered Premera paid Your part
Haptic Extraction J* $387 100% $113 $274
*J: for procedures with code J, "100%" is secret code for "not 100%".
So I have to spend time fighting the insurance company and the doctor’s office to find out that this procedure was technically elective even though the doctor told me I needed it (the doctor doesn’t give a shit how much it costs – it’s your health, right? you can’t put a price on your health!), or maybe it is one of the handful of exceptions where the doctor’s rate for this procedure is above what the insurance company decides is “usual and customary”, but of course nobody informed me of that, or maybe just Fuck You, Consumer, what are you going to do, sue us? Usually I just end up paying because I don’t have the time to fight it or the desire to be sent to collections. But what about people who don’t have the option of just paying it to make it go away? Are they just out the $274?
BTW, last time this happened, it was because my wife really wanted me to ask my doctor about my occasional breathing trouble while sleeping, just in case it’s something bad. The doctor examined me and decided that maybe I have sleep apnea, and to find out for sure I’d have to get a sleep study done. So he referred me to the sleep clinic, where they wired me up to expensive machines and watched me sleep overnight, and then charged four thousand goddamned dollars to tell me that, yeah, you’ve got mild sleep apnea, but it’s no big deal, so don’t worry about it. My portion? $800. Hell, I would have declined had I known it was going to cost that much, even if the insurance company covered the whole $4k. That’s just ridiculous.
Somehow, I missed that it was an elderly guy. :smack:
Yes, most of the elderly are covered by Medicare. If our hypothetical elderly man is covered, the bill would be 20% of the Medicare rate for the surgery, plus a little over $1000 for the hospital (it’s a set fee for the hospitalization if it’s one night or several), plus 20% of the Medicare rate for the doctor’s fee, plus the same for anesthesiologist, etc.
Well, your own source indicates that those 3 countries have lower life expectancies than does the United States. So by your logic, the United States would seem to have a superior health care system to those countries.
Firstly, thank you everyone for your answers to my hypothetical questions. I must confess to being rather taken aback by how costly medical treatment is to the uninsured. In the U.K. a root canal on the NHS would cost about 100 dollars. Granted, you’d probably have to wait a few weeks to get it, but you would get it, and when you did you wouldn’t have to worry about how to balance your budget for the next few months.
This is something I’ve heard from a couple of people now and I don’t quite understand the gist of it. If government intervention in the market is destabilising, surely the degree of instability is proportional to the amount of government intervention. Where am I going wrong?
Reading threads on these boards, I get the impression that a lot of people seem to think that UHC is a bad idea partially because they believe people will just let themselves go if they know they’re not going to have to pick up the full tab for their medical bills. I don’t think that the higher proportion of obese people among the general American population is due to the type of health care they receive. However, I do think it effectively undermines the idea that having a privatised health care system encourages people to take better care of of their health.
Does anyone have any comment on my questions about the insurance industry?
Or just die more quickly. The outcome for the free market health-care provider(pay out less in benefits) would be broadly similar and desirable.
I guess the fundamental philosophical question is whether you want to pay for other people’s health care.
I’m more or less healthy and most likely pay much more into out public health care system than I have received. Undoubtedly, someone else in the country less fortunate that I have never met is receiving health care at my expense. You know what, I’m OK with that. 
But I guess some people are just offended by that on a fundamental level. If you agree that not allowing your fellow man to die in a ditch like dogs is a worthwhile policy goal, well, anything beyond that is just disagreement on administrative policy.
Absolutely. If life expectancy is anything to go by, and I believe that it is, the United States does have a superior health care system to Portugal, Denmark, and Ireland.
However, the life expectancy of an average American is lower than that of the average Briton, Canadian, Frenchman, or Spaniard. This fact is quite problematic for those posters who assert, as if it were an immutable universal truth, that “socialised” medicine cannot possibly be more efficient than privatised medicine.
I want someone opposed to UHC on the grounds of efficiency to explain to me why Americans are, on average, dying younger than their British, Canadian, Spanish, and French counterparts when the residents of those countries are having to “make do” with a “socialised” system. Similarly, I want someone to explain why the infant mortality rate in those countries surpasses America’s.
You can also look at if from the perspective that you pay into it more than you receive when you’re young and working, and you take out of it when you’re old. I don’t have a problem with that, either.
My wild guess is that uninsured Americans don’t have access to good pre-natal care.
Capitalism and medicine don’t make good partners. That’s why Doctor’s aren’t allowed to sell pills, conflict of interest. We demanded these two jobs be separated long ago, for our own piece of mind.
I think this “they involve triage.”, was the most important and overlooked thing that’s been said.
In Amerika hospitals aim to make a profit. In Canada they aim to cover costs. It’s a small but significant difference.
In Amerika, if you are part of the top 5%, with great coverage, and you go to see your doctor and say you want a hip replacement. You’ll get one. It borders on pay to purchase. That’s why drug companies advertise directly to consumers.
In Canada, if you go to see your doctor and say you want a hip replacement, he may not agree with your ‘diagnosis’. He may triage your need as a lower priority than people who have actual mobility problems, not just discomfort. The triage makes it less ‘pay to purchase’ and more based on need.
Under universal health care it’s not a bean counting bureaucrat that decides your medical ‘needs’, it’s the doctors.
Of course, within universal health care, there will always be complainers who are not getting prioritized within the system the way they feel they should, thus, wait times for some.
But people understand how triage works in an emergency room setting, but for some unknown reason cannot see how it results in wait times for access to resources in a universal healthcare system.
Thus far Canada has resisted a two tiered system whereby wealthy users can purchase their way to private resources and thereby avoid wait times. And I hope they continue to resist. Let those of means go to another country and buy whatever they want, I say.
My impression from talking with doctor friends, and which is backed up by the bit of Googling I’ve been able to do on the subject, indicates that tort reform won’t actually solve anything:
This is from “Americans for Insurance Reform.”
According to the National Bureau of Economic Research, “the arguments that state tort reforms will avert local physician shortages or lead to greater efficiencies in care are not supported by our findings.”
On the site Insurance Information Institute they say “A February 2006 study, prepared by PricewaterhouseCoopers for America’s Health Insurance Plans, examined the factors contributing to rising health care costs and analyzed where the health care dollar goes. It found that medical liability costs and defensive medicine account for 10 percent of medical care costs. Defensive medicine is when doctors order more tests, prescribe more medication and make more referrals than they believe are necessary to protect themselves from being accused of negligence.”
10% isn’t trivial, but it’s not going to make a big difference in the worst failures of our current system. If someone is going broke because they can’t pay for a $50,000 treatment, they probably can’t afford a $45,000 one either.
I’m certainly open to evidence that tort reform would result in a large price drop for medical care, if someone can find some.
I am for UHC, but I’ll take a couple of stabs at it:
For the infant mortality, I’ve read that American women are less likely to abort non-viable infants, which means they live long enough to be born and then die–therefore being included in infant mortality stats where aborted fetuses are not.
I think the rates of accidental and violent death are higher in the US as well, though I wouldn’t be able to give any sorts of stats.
I agree that the infant mortality rate is appalling, but I don’t see how socialized medicine would drop the obesity rates in a country where we know we are obese but most folks just don’t care enough to do anything about it. One wonders why the folks in the UK aren’t clamoring for the French health care system, given the disparity in life expectancy.
Anyway, my issue with government run health care in the US:
Currently we have a segment of socialized health care determining reimbursement for medical procedures: Medicare. Working with cancer diagnostics, every time there’s a discussion about reimbursement rates and approvals, VPs sit on pins and needles, hoping for good news and fearing the bad.
We’ve got medicines and procedures that save lives, but if our industry lobbyists aren’t doing their job, often many of these get passed over. Health insurers base what they will reimburse on medicare rates, which in turn reflects what providers will pay for the materials they purchase which in turn effects what manufacturers can charge for their product. Costs be damned, it’s all about sales, marketing and bureaucracy.
And God forbid Medicare decides not to cover something. Sure, it may help diagnose cancer but that didn’t get enough votes to pass muster. We constantly have to spend money on educating some of the highest educated people in the country about what new things are in their industry (new includes new technologies from a decade ago in many cases). Socialized medicine isn’t going to save us from this bureaucratic and political nightmare. Hell, PET usage is less per capita in Europe than it is in North America.
If we’re serious about improving health care it’s going to involve overhauling the system at the top and removing the politics and special interests. But that isn’t going to happen.
It’s not as if there are no upsides to socialized medicines or any government programs. It becomes, like everything else, a comparison of benefits and disadvantages. The current system does not use the advantages of the free market very well, but suffers the downsides. It also doesn’t use socialization very well, but suffers the downsides from that too. It seems like we’ve probably got the worst of both worlds, which is why I suggested that moving in either direction - towards the free market or total socialization - would probably result in an overall betterment of the system.
But this isn’t to say that socialized health care is necesarily better. Many people essentially justify government takeover on healthcare by pointing to the current state of things, which are bad in large part because of government meddling. Essentially - government fucked up the system, so let’s give government more control!
It may turn out that that view is better than the status quo, but not because of the inherent superiority of government control - but simply because we’d be doing our best to let the government fuck it up the least.
Already did. You can’t directly correlate life expectancy with quality of medical care. What if one country has trans fats in all their food and the other doesn’t? What if one country is full of smokers and the other country has a social stigma towards smoking that steers people away from it? You can’t say “the country with the best life expectancy has the best medical care” definitively.
I wonder if it has anything to do with a shortage of Ob/Gyns that we’re going through. Their insurance premiums are so much in Illinois that a lot are leaving or closing up shop.