[QUOTE=silenus]
A lot of Americans would agree with you. Just not, so far, the majority.
[/QUOTE]
This is an arguable point. It may very well be that a majority, even a large majority of Americans prefer guaranteed health care. If so, it may just be the case that our political system is not currently capable of reflecting majority will at this point.
Somehow I manage to understand quite intuitively that people may not want universal healthcare, I don’t agree with them but their position isn’t unreasonable or insane. I live in a country with single payer healthcare and I like it. You’re the one who needs to relax.
I don’t know who “you” is suppose to be, but I’m illustrating quite clearly that people want things from their goverment aside from healthcare, that’s what.
[QUOTE=Foxy40]
For so many resources to go towards middlemen, gatekeepers, and overhead, instead of to actual care providers…
[/QUOTE]
I absolutely agree. I feel this is where the system is flawed. The insurance companies are making big profits on health insurance and mal practice insurance while the providers struggle with paying overhead. People in the US still think that physicians make huge incomes and that simply isn’t the case. They would be much better off being an executive at Aetna than have patient’s lives in their hands every day. Salary Graph
That being said, physicians still make a comfortable living which is part of the incentive of chosing medicine as a career. If that incentive was taken away, would be still have the best and the brightest?
[/QUOTE]
Our “Best & Brightest” physicians often go into research. Not just lab work–but patient care at institutions that run clinical trials. They are paid quite well–but not as much as they might get in private practice. Of course, private practices can be quite expensive. And many MD’s want to care for patients–not run businesses. Or spend half their time arguing with insurance companies & HMO’s.
(Note: Considerable medical research is done in other countries–not just the USA.)
Not having health insurance does not necessarily equal not having access to health care. The U.S. social safety net — which includes community health centers, public and non-profit hospitals, any emergency room, and charity care by physicians — absorbs two-thirds of the cost of the health care consumed by the uninsured. This safety net, while not a single, unified, easy-to-manage system, essentially functions as a catastrophic health insurance policy. The more health care the uninsured need, the less they pay. Uninsured individuals pay a mere 9 percent of the hospital inpatient costs they incur.
[QUOTE=Walloon]
Not having health insurance does not necessarily equal not having access to health care.
[/QUOTE]
Very true. But of course, it must be noted that the availability of low/no cost care providers varies tremendously depending on location.
In my job I frequently encounter folks who use hospital emergency rooms as their primary health care providers. Doesn’t strike me as the most efficient use of resources.
My suspicion is that the best system would be some sort of a hybrid, providing some relatively modest level of subsidized care to all, with individuals having the option to purchase insurance to provide upgraded care. One of my buddys from north of the border tells me you Canucks are experimenting with this sort of a two-tiered system.
[QUOTE=Book Monster]
Thanks for clearing up the HMO thing and for reassuring me that I won’t be left on the doorstep in an emergency. But I think my main question still remains - why should people have to pay for basic healthcare at all? If you pay taxes, shouldn’t you expect free, basic healthcare from the government?
[/QUOTE]
Well, while what one should or should not expect is cultural, I am terrified of the concept of universal public healthcare. Even though not getting proper healthcare because you personally cannot afford it is a lot more stressful than not getting proper healthcare because it is managed by the government, it still kills you dead just the same.
Yes, malpractice insurance is expensive, and various insurance companies are making a lot of money on healthcare, but I really fail to see how that is a huge problem. I pay my doctors either out of pocket (to be later reimbursed by the insurance company) or by having them bill the insurance company directly for every service provided. If the doctor does something I don’t like, I switch doctors and he or she loses a customer. If they make an extremely careless mistake or do something malicious they are risking their medical license and their malpractice insurance rates. In this case the doctor has the incentive to keep me content with my healthcare as well as be careful.
Socialized healthcare tends to create a problem with both of these incentives. The government is not going to insure its doctors against $10,000,000 malpractice suits, and I bet at worst their risk is that they get fired and lose their license. This risk is greatly diminished by the fact that the government’s incentive is some sort of a promise of guaranteed healthcare, and by firing a doctor, well, they lose one more doctor to provide that bare minimum fulfillment of that promise. The lack of individual responsibility and individual incentive degenerates any sufficiently large system to be on average barely sufficient. Everything else can be compensated with propaganda and the fact that the government establishes the healthcare status quo and the average joe believes he is getting good treatment.
If you believe the purpose of healthcare is to provide the greatest number of people with the feeling that they have good healthcare, then socialized is a lot better than commercial. However, why would the doctor do anything other than the bare minimum required to create an illusion of fulfilling his duties in front of their boss? I am not saying all doctors will be like that, or even most, but there will always be some. The hippocratic oath says to keep the good of the patient as the highest priority, so it is the good of the patient that should be the factor that determines who stays a doctor, or who doesn’t, and it’s the good of the patient that should be the factor that establishes how good a doctor is. Since nobody but the patient, or possibly very close loved ones can establish this good, the primary fundamental property of any medical system should be decisions made by the patient.
I don’t like HMOs because they are miniature versions of socialized healthcare, but perhaps a little more honest. I feel healthcare should not become cheap just because I can’t afford it. Although I did not ask to be born, nobody in society outside of my family asked for me to be born either, and have no duty to sustain my life or make it comfortable. That duty lies with me and to a certain extent my family. For everybody else it should be an option if they themselves feel it is right. Humans are capable of great acts of compassion, but you are not automatically entitled to anybody else’s compassion either. To force it upon the entire society makes it worthless.
If you look at the consumer spending report (warning:PDF) you will note that the average expenditure on healthcare of a consumer unit (family, sort of) is $2.5k for 2004. Compare this to housing ($14k), food ($5.7k) and tranportation $7.8k. Seeing as how entertainment spending is $2.2k from the same report, I cannot consider healthcare to be expensive in the united states. I personally can’t afford to get sick, that’s true, but a lot of people work hard (or inherit) to be able to. I really can’t see how somebody can argue that something that you get rather than are allowed to do is a right. Entitlement or guaranteed luxury would probably be better words, no?
[QUOTE=TimeWinder]
and while “most people purchase insurance” is true, more than one person in six cannot afford it,
[/quote]
Untrue. “Uninsured” does not mean someone cannot afford health insurance. Most of the uninsured are only uninsured for part of the year (likely due to changing jobs) and a good number are above 200% of the federal poverty level.
Not really. The number of uninsured is increasing (although it’s debatable about how “uninsured” this group really is), but the percentage stays pretty steady. Our population is increasing, so naturally the raw number of uninsured is increasing.
[QUOTE=butler1850]
We have other plans where you have a “primary care provider (PCP),” who manages your care (Health Management Organization - HMO). These are less expensive than other plans.
[/QUOTE]
It’s not necessarily cheaper. My employer was recently “acquired” and we had a choice of various medical plans (regular, HMO, etc.). The HMO had a higher monthly premium and other costs involved were not cheap. But in my case, I chose it because various doctor’s of my son’s were in their network and not in the network of the regular (PPO) plans. So it all boils down to who your doctors are, who are “in network” and how often you need to see them. Basically, it’s a gamble.
[QUOTE=Renob]
Untrue. “Uninsured” does not mean someone cannot afford health insurance. Most of the uninsured are only uninsured for part of the year (likely due to changing jobs) and a good number are above 200% of the federal poverty level.
[/QUOTE]
200% of the federal (2006, HHS) poverty level is a little over $22000 for an individual (it scales up for families). My mediocre health coverage (just me, not my wife) would cost $750/month if I were paying for it all, even at group rates. That’s $9000 a year, or 45% of PRE TAX income. If I were over 60, that health insurance would cost over $900 a month, and consume more than half of that income level. Most of the jobs available to the working poor (tens of millions of Americans) are part time and carry poor or no health insurance.
I know it’s a common meme that people aren’t buying health insurance because they’re “cheap,” but it isn’t true. It’s been priced out of the market of a large segment of American society. The majority of Americans simply couldn’t afford it if it didn’t come as a benefit of full-time employment, and while my employer’s contribution rises by double-digit percentages each year, the amount of cost to me also increases every year. Fifteen to twenty percent annal increases in cost can’t continue – almost no one gets a 15-20% raise every year. Go ahead and nitpick about the numbers, sooner or later the system will break. Many of us think it’s broken now, especially for the poor.
[QUOTE=Book Monster]
why do you have to pay for basic healthcare at all? Isn’t that what taxes are for?
[/QUOTE]
Perhaps if we explained the history of health coverage in the United States. During World War II, when there was a shortage of labor in the U.S., employers began to offer many incentives to employees. The main incentive was health insurance coverage. This employment benefit continued after the war, and by the 1950s, virtually all large employers (50+ employees) offered health insurance coverage for their full-time employees. This existing private insurance system, supplemented by federal government programs Medicare (for the elderly) and Medicaid (for the poor) and Supplemental Security Income (for the disabled), relieved the need for a nationwide — or even statewide — health plan.
This fellow is at a fertility clinic to give a sperm sample.
The nurse hands him a cup and a stack of porn magazines, and directs him to room 4.
When he has completed giving his sample, he proceeds back to the nurses desk, and, as he passes room 2, sees another patient getting a blow job from a nurse.
He keeps walking, and confronts the nurse who sent him alone to room 4.
What the hell?, he demands.
The nurse explains that the room 2 patient has a private insurance carrier, and that he, unfortunately, has an HMO.
[QUOTE=ltfire]
What the hell?, he demands.
[/QUOTE]
Here’s an interesting question for GQ someday: Would saliva contaminate sperm samples enough to be unusable? 
Someone explain to me how it is “a good thing” to allow insurance companies to exclude "pre-existing conditions.
As it is, it seems a lot of companies jostling to provide health care to the healthiest and wealthiest segments of the population - arguably the segments least in need of commercial “insurance” against unfortunate developments.
Wow, so much ground to cover in one thread.
Here’s my own, semi-informed take on it.
Once upon a time, the time being the late 19th and early 20th centuries, there were a group of people called Republicans who, thanks to being the ones in charge of winning the Civil War and freeing the slaves, dominated the political landscape. As time went on, however, some of their ideas didn’t pan out quite as well as the whole beating-the-south-and-freeing-the-slaves scheme had gone, and the economy took a major downturn just before the 1930s. This brought the democrats to power, in the form of Franklin Delano Roosevelt and his political allies, who proposed something called the New Deal.
Roosevelt was only able to implement part of the New Deal during his extended administration, but every democratic president since then has made an attempt to finish it. The reason it has been so difficult is because the Republicans think the components of the New Deal will cause communism to flourish in our fair land. Anyhoo, the most recent attempt to complete the last real portion of the New Deal, namely universal access to healthcare, was attempted to some extent by Bill Clinton. It didn’t work.
What we got instead was HMOs. Backtrack a little. Long ago, we had medical insurance, which amounted to what we think of as long-term disability insurance. At some point, various insuring bodies realized that some of the conditions on which they were making big payouts could have been prevented with regular visits to the doctor, so they began covering more basic healthcare. (The government, as we have seen, has never covered most people’s healthcare.)
As medical technology became more advanced, it got more expensive, which made health insurance harder to profit from. So the idea of the HMO was hatched. Some HMOs, like pioneer Kaiser Permanente, are for-profit health companies, which hire their own physician’s and spectialists. Some are simply plans under which insurance companies work out special deals with doctors. The deals work like this: the insurance company tells the doctor they will pay them less than their standard fee for their services. How will the doctor’s keep making money? Volume, volume, volume. Since HMOs are group insurance plans, and their customers can only see doctors the plan has deals with, the doctors will get more patients. To guarantee more patients, the HMOs will recruit huge numbers of payors, who each will pay less than they might under some other plan. Sure, the doctor will have to spend much less time with each one to make the same amount of money they would if the insurance simply paid the regular fee, but this way insurance can be profitable. So the doctors cram their daily schedules with more patients than they can possible see with any sort of actual human concern.
Another way that a doctor might try to make up the difference would be to pad the bill for the insurance company, which might make insurance less profitable, so fortunately the insurance companies have already thought of that. Every time a doctor’s office sends a claim for payment based on services to a patient, they must send along every piece of evidence they have. Lab results, X-rays, notes, etc. are all sent along with the claim. Then the insurance company’s medical experts re-examine all the stuff that made the doctor issue their particular diagnosis and treatment plan, to see if they agree with it. If they do, the claim is paid. If they don’t they may reject the claim entirely, in which case if the patient wants the treatment they will have to pay for it themselves. In other cases, the insurance company will determine that a less expensive treatment would have been sufficient, and so they will pay the doctor the agreed reduced fee for the cheap treatment, leaving the patient to pick up the balance.
All of this ultimately has the effect of doctors not prescribing unecessarily expensive treatments. Of course, it also has the effect of the doctor not prescribing more expensive treatments that might simply result in less pain and more convenience for the patient, but that is a small price to pay for keeping insurance profitable. What if the patient is upset about this? The HMO sometimes tells the doctor they can’t even mention the more expensive treatment if they want to keep getting paid, and the government has more or less rendered HMOs immune to litigation.
There have been other issues with HMOs. In their earlier days, they were known to occasionally drop entire groups of doctors in favor of other groups, so you had a new doctor for every annual physical, to whom you had to recite your entire medical history again. HMOs require enormous amounts of paperwork, to the point that some doctor’s offices now have to have full-time clerical workers who do nothing but handle paperwork, driving prices upward. Some medical groups have refused new HMO patients, because the cost of processing them outweighs the money they’ll get. The lower prices that HMOs were supposed to guarantee for all didn’t turn out to be all that low as far as everyone’s economic outlook is concerned, so many are consequently uninsured. When they get sick, they go to the emergency room, who has to take them in by just about every hospital’s policy. The cost of these uninsured and unpaying patients gets passed on to the paying customers, or more correctly, their insurance companies. Meanwhile, since emergency rooms have to take everyone, the companies that run many hospitals have decided to close these money pits. This leads to situations like here in LA, where a huge percentage of our emergency rooms have shut their doors, which will lead to great fun during the next major earthquake or, lord help us, terrorist attack.
However, again, these are all small prices to pay for keeping the practice of providing health insurance profitable. For if it were to become unprofitable, private-sector companies would stop doing it, leaving people to pay the high cost of modern medicine themselves. Or the government could pay for it, which would be much much much much much much much much much much worse. Really.
I see something that needs correction. Medicad provides for the above 65 adults and handicaped individuals that are below a certain income. It does nothing to provide care for the poor people as a group. The childern of poor parents may be covered in most states, under state programs, but the adults are not.
A pegnant woman will get free prenatal if poor, but is dropped soon after the kid is born.
[QUOTE=groman]
Here’s an interesting question for GQ someday: Would saliva contaminate sperm samples enough to be unusable?
[/QUOTE]
My fertility clinic says yes (warning - pdf).
[QUOTE=Book Monster]
If you pay taxes, shouldn’t you expect free, basic healthcare from the government?
[/QUOTE]
If you pay taxes, shouldn’t you expect free, basic . . .
National defense
Police and fire protection
Courts of law
Education
Public housing
Food
Roads
Clothing
Libraries
Conservation programs
Care for the aged
Farmers’ subsidies
Government expenses and personnel
.
.
.
Somewhere after all these (and many more) is medical treatment. We just haven’t gotten to it yet.
[QUOTE=Walloon]
Perhaps if we explained the history of health coverage in the United States. During World War II, when there was a shortage of labor in the U.S., employers began to offer many incentives to employees. The main incentive was health insurance coverage. This employment benefit continued after the war, and by the 1950s, virtually all large employers (50+ employees) offered health insurance coverage for their full-time employees. This existing private insurance system, supplemented by federal government programs Medicare (for the elderly) and Medicaid (for the poor) and Supplemental Security Income (for the disabled), relieved the need for a nationwide — or even statewide — health plan.
[/QUOTE]
Luckily for me I work for a US company who doesn’t seem to realise that they don’t need to offer medical cover to non-US employees in countries that have a decent public health system. So I get the best of both worlds.
As for the hospital admissions thing: when I got carted in an ambulance to a hospital in Utah I got asked something like 20 times in the first hour what my Social Security number was, while I lay there on the guerney waiting to get admitted. Seems that every individual in the hospital there noticed that field on the admissions form was blank, assumed no-one else had done their job properly, and raced over to ask me it. Not having one really flummoxed them. It was particulaly odd as the town had a major international university in it and they must have had foreign admissions before, but you wouldn’t think so by the procedural problems it caused them.
The standard of care was fine, but I was chased for some years by the ambulance service for the $US75 or so they charged me for the couple of blocks they drove me. They just couldn’t seem to grasp that my travel insurance covered that too; at least the hospital had no problem understanding that much.
[QUOTE=Askance]
Seems that every individual in the hospital there noticed that field on the admissions form was blank, assumed no-one else had done their job properly, and raced over to ask me it. Not having one really flummoxed them. It was particulaly odd as the town had a major international university in it and they must have had foreign admissions before, but you wouldn’t think so by the procedural problems it caused them.
[/QUOTE]
I had a social security number three weeks after I came to this country, so I would imagine most people who live in the US have one, regardless if they’re international students or not.