But why should we hypothesize that universal health care in the US will be a strictly uniform and “egalitarian” system, rather than being the sort of two-tiered or multi-tiered combination of public and private insurance that many other developed countries have?
Under a healthcare system like that of the Netherlands or New Zealand, for example, everyone gets the same basic taxpayer-funded coverage, and those who can afford it can buy supplemental insurance at any one of a number of coverage levels from a private insurer. This way, the extra disposable income of the wealthy can still be harnessed to fund expensive and marginal medical innovations that wouldn’t be cost-effective as part of a basic coverage plan.
It mystifies me why so many opponents of universal healthcare seem to think (or at least to argue) that there’s no middle ground between the kind of hit-or-miss for-profit health insurance system that the US currently has and a purely socialistic one-size-fits-all healthcare structure. It’s a false dichotomy.
The National Park Service also does a bang-up job.
People like to talk about how the current system allows competition to flourish, without addressing the fact that once you get sick you essentially can’t change your coverage. If you have a pre-existing condition you better hope you don’t lose your job and you better hope you don’t need to get new coverage, because good luck! Most people are stuck with “choices” of coverage offered by their place of employment, too - I can do a HMO or a PPO but they’re both BCBS.
THis is exactly why I have a problem with government health care. I want a contract specifying the care I get and the conditions under which I get it, and not some government beaurocrat who decides my life isn’t worth the money and gives me a pillow and a pain pill and says “Have a nice death.”
Insurance companies are bound by written contracts to cover treatments that their customers pay for coverage on. The goverment can do whatever it wants, and its primary concern is gonna be on stretching dollars. I don’t want some uncaring governmental agency, dictated to by government beaurocrats, deciding whether my life or treatment is worth the money.
And guess what? The tighter that money gets, the lower the standards become for who gets care and who gets to die!
Anybody who assumes that insurance company claims auditors are necessarily any more “caring” than government bureaucrats is living in a fool’s paradise. Government agencies and for-profit companies are both legally obligated to provide specified services, and government agencies and for-profit companies will both try to shed obligations when their costs rise too high.
In any case, this is another argument for having a system that includes both basic universal coverage and supplemental private insurance options. Once again, we are not automatically constrained to base our healthcare structure either only on government agencies or only on for-profit insurers.
It is very hard to compare last-year-of-life costs across health care systems because a lot of it depends on our culture.
A huge chunk of those end-of-life costs involve long-term (nursing home) care. Not many families in America can pull a capable adult out of the work force to take care of elders, and families tend to be so spread out that they aren’t able to share the burden easily, so a lot of us end up spending our last days in the nursing home. That isn’t necessarily a bad thing; in many instances it probably leads to better care (though it clearly doesn’t in others). It probably ends up prolonging lives, since potentially terminal pneumonias and such are usually more quickly seen and dealt with in the nursing home than they would have been at home. But it adds a lot to our health care costs–I’d say way more than the expensive end-of-life treatments that Sam discusses.
As for those, our culture has turned terminal illness into a “fight”. We’ve elevated the aggressive treatment of terminal disease to the level of a virtue, no matter how futile or nonsensical it becomes. We can’t “give up”. One doesn’t seek treatment for cancer; one “fights a heroic battle” against it. Again, this is not necessarily a bad thing, but it leads to a lot of expensive treatments that squeeze out a few extra months of life, regardless of quality.
There are lots of ways we can cut costs at the end of life, but these two factors will make it tough to cut them significantly.
The detailed answer to that would be threshed out in a thousand committee meetings and legislative sessions. I imagine that the basic overall structure of the universal coverage part would look something like this:
Prenatal, neonatal, and infant/child/adolescent medical care and preventive medicine. Kids as a group are comparatively quite cheap to cover and provide high return on investment in terms of length and quality of life gained due to medical care.
For adults, we’d probably see a comprehensive care system something like the current form of Medicare, but more limited in the range of treatments/maintenance it covers for (a) the terminally ill, (b) the very elderly, (c) the irrecoverably unconscious/unaware such as PVS patients, and (d) situations where the only available treatments are of dubious effectiveness and high cost.
And government bureaucrats (a word which isn’t really much more difficult to spell correctly than incorrectly, by the way) are bound by legal regulations.
Yes, governments can change their laws, but for-profit companies can also change the amount and nature of services that they contract to provide.
I’m not a proponent of universal health care, but having been in the field for a while, I have to say that the amount of time and resources spent on the dying is insane. Most of the time it’s more the family’s fault than it is the recipient of care. The family is selfish, can’t handle the loss of a loved one etc. I’ve seen 90 year olds in the ICU hooked up to machines breathing for them for days when there’s no chance of them coming back, and no chance for any quality of life before they finally die and the vents can no longer compensate for them. Me and my co-workers just shake our heads at these family members because the reality is that they’re unbelievably selfish. Also, I’ve worked in nursing homes and it’s disgusting how often they’ll send these 85 yr olds with dementia out to the hospital to get on thing after another fixed while me and you foot the bill. It’s kind of like a car, at some point fixing it does not make sense any more! And screw being sensitive, I’ve seen enough life an death to know that nine times out of ten death is the better option for most of these people. Nine out of ten of them wouldn’t even know it was happening. That’s why I’m a fan of euthanasia, and I’m no sicko, I’ve just been around the block, and ending someones suffering is probably the best thing to do most of the time. I’m also not an atheist, but the religious factor needs to be tossed out of the argument. Euthanasia should be an option, while religious preference should be respected and honored, there should be a choice. And it would save tonnnnssss of money at the end of the day.
I think I’ve spelled bureaucrat correctly often enough around here to show that I know how to spell it. Sometimes one’s fingers take on a life of their own, but that in no way bolsters your argument.
The goverment can change its policies at will; contracts have to be honored as written. If an insurance company policy gets rewritten, the policy holder has the option of going elsewhere…an option not possible under government health care.
But I’m sure you know that. You just don’t care because you’re emotionally invested in the idea of government health care regardless of the facts.
I’m not talking for **Kimstu **but I don’t think that many are in love of government health care, it is just that it beats the current system that we have, and IMHO it offers more freedom as in practice many do find that preexisting health conditions create a state of servitude or a severe incentive to remain in a dead end job.
Plus, more jobs also flee the US as health costs continue to rise.
Except when the company goes bankrupt, of course (a reality of capitalist commerce that you seem mysteriously oblivious to). Furthermore, insurance companies give themselves a whole lot of latitude in how they interpret their obligations when “honoring” their “contracts”, as many people who’ve had insurance claims denied can tell you.
Moreover, government officials are to some extent constrained by public opinion when attempting to change policies: look at the complete flop of Bush’s efforts to privatize Social Security in the face of widespread public opposition, for example.
In short, your naive image of government as a completely unaccountable autocrat contrasted with uniformly dependable contracting parties in the commercial world is a fantasy. In reality, both entities have a lot of gray areas when it comes to consumer accountability, and only a fool would assume that he can never be screwed over by a for-profit company just because he has a written contract with them.
Only if you stubbornly refuse to recognize that an effective healthcare system can combine both public and private insurance options. As I said, it’s a false dichotomy (and, ISTM, a rather disingenuous one) to insist that we’ve got to exclusively pick one or the other.
On the contrary, I’m well aware of the facts: the facts reveal that socialized systems and for-profit systems both have specific advantages and disadvantages in providing broad-based health care coverage.
You’re the one who’s emotionally invested in extremist anti-government prejudices, and consequently clinging to the delusion that the only workable solution to any problem must be exclusively market-based.
This kind of unthinking worship of market structures is, as I noted, a fool’s paradise. That paradise was a very popular place to hang out during the pre-recession boom years, but recent economic developments have brought a lot of people back to reality. So if you’re wondering where the rest of the market-fundamentalist crowd went, that’s where.
Would artificial hearts and kidney dialysis technology disappear under “socialized” medicine? Maybe it’s time to worry less about developing new medical technology than making existing technology affordable to everyone who needs it.
If you were paying through the nose for prescription drugs, would you be happy knowing that, after you run out of money and die, they money that could have been spent keeping you alive much longer was instead spent on keeping someone else alive just as expensively?
I can tell you one thing that really drives up end of life costs. When religious fanatics try to keep already dead people on life support so God can work a MIRACLE!
This conversation reminded me of Terry Schiavo and the horrendous right-wing circus of nut cases who wouldn’t let her husband exercise his perfectly valid and legally unassailable medical power of attorney.
This idea that I see time and time again, that the rest of the world just sucks on the teet of the US medical industry is just pure bollocks. Maybe part of the problem is that US news is so insular that it doesn’t comment on the medical breakthroughs performed in other countries?
It really is borderline insulting.
Anyway, if we are talking end of life care, perhaps this statistic is worth thinking about: