# Universal health care and the poor **URL:** \ **Category:** Great Debates\ **Created:** [August 7, 2005, 7:20pm UTC](https://boards.straightdope.com/t/universal-health-care-and-the-poor/316016 "2005-08-07T19:20:33Z")\ **Posts on this page:** 20\ **Page:** 7
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [August 10, 2005, 4:41pm UTC](https://boards.straightdope.com/t/universal-health-care-and-the-poor/316016/121 "2005-08-10T16:41:28Z")
> [@DSeid](#): > > **Q.N. Jones** > > BTW, most Americans are not free to choose whatever doc they want. HMO’s PPOs and plain ole lack of any coverage at all limit choices for most. Yup. Your employer picks your insurance company for you, then your insurance company picks which doctors you can go to, and then your insurance company picks what treatments you are allowed to get at the doctor. Thats not freedom, and I really don’t get where the idea that we are somehow more free because that is how our system works. If anything we are less free, less well covered and pay more than virtually every other developed country on earth. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [August 10, 2005, 4:43pm UTC](https://boards.straightdope.com/t/universal-health-care-and-the-poor/316016/122 "2005-08-10T16:43:33Z")
> [@Q.N. Jones](#): > > As for a single payer system–I do not think that the American public will, at any time in the forseeable future, be willing to accept one. Republicans control Congress and the Presidency; socialism is anathema to their supporters. To continue to advocate for a single payer system in light of this reality seems pointless. It’s time to look for a compromise that both sides will be willing to accept. For the left to dig in and insist on pushing for a single payer system will only delay needed health care reform. One of the ideas was extending medicare to everyone who wants it. Another was to provide disaster insurance to people (a 10k deductible plan) to everyone who isn’t insured. Both of these would help. ---
**Author:** ![Q.N.Jones](https://avatars.discourse-cdn.com/v4/letter/q/3da27b/32.png) [@Q.N.Jones](https://boards.straightdope.com/u/Q.N.Jones)\ **Post date:** [August 10, 2005, 5:03pm UTC](https://boards.straightdope.com/t/universal-health-care-and-the-poor/316016/123 "2005-08-10T17:03:19Z")
> [@DSeid](#): > > BTW, most Americans are not free to choose whatever doc they want. HMO’s PPOs and plain ole lack of any coverage at all limit choices for most. Never said they were. All I noted was that with the plan I described, there wouldn’t be a scaling back of choice. That’s a big concern for most people when we start talking about changing the American health care system. ---
**Author:** ![Gfactor](https://avatars.discourse-cdn.com/v4/letter/g/9de053/32.png) [@Gfactor](https://boards.straightdope.com/u/Gfactor)\ **Post date:** [August 10, 2005, 8:20pm UTC](https://boards.straightdope.com/t/universal-health-care-and-the-poor/316016/124 "2005-08-10T20:20:43Z")
In this [thread](http://boards.straightdope.com/sdmb/showthread.php?t=296776) I posted several links about some no-fault tort regimes. These have a univeral medical coverage aspect to them. Some of the links include detailed reviews of the systems from varyious perspectives. Other’s don’t. YMMV. 😃 ---
**Author:** ![Q.N.Jones](https://avatars.discourse-cdn.com/v4/letter/q/3da27b/32.png) [@Q.N.Jones](https://boards.straightdope.com/u/Q.N.Jones)\ **Post date:** [August 10, 2005, 8:29pm UTC](https://boards.straightdope.com/t/universal-health-care-and-the-poor/316016/125 "2005-08-10T20:29:51Z")
> [@Wesley Clark](#): > > One of the ideas was extending medicare to everyone who wants it. Just a Band-Aid on a system that has far deeper problems. Most of the doctors I know agree that, without massive reform at all levels, our health care system will implode. > [@](#): > > Another was to provide disaster insurance to people (a 10k deductible plan) to everyone who isn’t insured. Both of these would help. This isn’t enough, either. I know people who have only catastrophic coverage. Many of them live with chronic health problems that cost them a lot of money to treat, or that go untreated for financial reasons. In fact, it’s probably chronic health problems that are bankrupting the system, not the catastrophes. ---
**Author:** ![Q.N.Jones](https://avatars.discourse-cdn.com/v4/letter/q/3da27b/32.png) [@Q.N.Jones](https://boards.straightdope.com/u/Q.N.Jones)\ **Post date:** [August 10, 2005, 8:31pm UTC](https://boards.straightdope.com/t/universal-health-care-and-the-poor/316016/126 "2005-08-10T20:31:25Z")
Augh! Hit reply too soon. What I wanted to say is this: those solutions are just “status quo with some fingers in the dike.” They’re not going to address the major problems in the system. ---
**Author:** ![RickJay](https://avatars.discourse-cdn.com/v4/letter/r/bb73d2/32.png) [@RickJay](https://boards.straightdope.com/u/RickJay)\ **Post date:** [August 10, 2005, 9:31pm UTC](https://boards.straightdope.com/t/universal-health-care-and-the-poor/316016/127 "2005-08-10T21:31:40Z")
> [@Q.N. Jones](#): > > I know you have some choice, but I’m not sure how broad a choice it is. Are you able to go to absolutely anyone? Or are you limited by geographic range or other factors? As a Toronto resident I suppose I COULD sign up with a doctor a thousand miles away in Thunder Bay, but that would be kind of insane. 🙂 Having said that, it is not entirely uncommon for a group of GPs in an area to band together as a sort of business unit, and you might be restricted from switching from one to the other. I don’t think this is terribly common, though, as I have only heard of one example. I also know of one case where a friend’s elderly and somewhat dumbass parents were sort of bullied into signing a document saying they would not switch away from their current doctor. ---
**Author:** ![Q.N.Jones](https://avatars.discourse-cdn.com/v4/letter/q/3da27b/32.png) [@Q.N.Jones](https://boards.straightdope.com/u/Q.N.Jones)\ **Post date:** [August 10, 2005, 9:34pm UTC](https://boards.straightdope.com/t/universal-health-care-and-the-poor/316016/128 "2005-08-10T21:34:06Z")
> [@RickJay](#): > > As a Toronto resident I suppose I COULD sign up with a doctor a thousand miles away in Thunder Bay, but that would be kind of insane. 🙂 > > Having said that, it is not entirely uncommon for a group of GPs in an area to band together as a sort of business unit, and you might be restricted from switching from one to the other. I don’t think this is terribly common, though, as I have only heard of one example. I also know of one case where a friend’s elderly and somewhat dumbass parents were sort of bullied into signing a document saying they would not switch away from their current doctor. Thanks to you and matt for the info. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [August 11, 2005, 1:00am UTC](https://boards.straightdope.com/t/universal-health-care-and-the-poor/316016/129 "2005-08-11T01:00:48Z")
> [@Q.N. Jones](#): > > This isn’t enough, either. I know people who have only catastrophic coverage. Many of them live with chronic health problems that cost them a lot of money to treat, or that go untreated for financial reasons. In fact, it’s probably chronic health problems that are bankrupting the system, not the catastrophes. Its definately not enough, but its better than nothing. We need total reform with universal coverage and a single payer public system with private insurance for those who want to opt out. But it’ll take decades for that to happen when healthcare costs get far too high, so band aids are all we can hope for. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [August 11, 2005, 1:40am UTC](https://boards.straightdope.com/t/universal-health-care-and-the-poor/316016/130 "2005-08-11T01:40:12Z")
**Metacom** , Yup. Any particular company would need to offer the same product for the same price to all comers (with the exception of perhaps increases for smoking). This would accom[plish two things: it would remove the need for an employer based system and automatically make healthcare portable; and it would reduce administration burden - both by reducing the number of switches of payors and by reducing the current expense that insurance companies have of trying to out-cherrypick each other. I agree with you **Q.N.** , doing nothing is untenable. Single payor is against my self-interest (all the power on one side of the table with me on the other, I fear balancing the books out of my hide) but I am would be for it for the greater good if it was doable. It aint. Any solution has to be palatable to all the major players. You can’t deal the insurance companies out of business in a plan and expect that it will pass. OTOH, they’d swallow my mandate so long as they all had to compete the same way. As long as they can pass on costs or savings in the same competitive way against each other they are satisfied. The essential bits are universal coverage, administration streamlining, quality improvements, and affordability for all. Beyond that we must be flexible about how we can really get it done. ---
**Author:** ![saoirse](https://avatars.discourse-cdn.com/v4/letter/s/5daacb/32.png) [@saoirse](https://boards.straightdope.com/u/saoirse)\ **Post date:** [August 11, 2005, 1:47am UTC](https://boards.straightdope.com/t/universal-health-care-and-the-poor/316016/131 "2005-08-11T01:47:13Z")
> [@clairobscur](#): > > Doctors can choose to apply the regulate rate (for instance, it’s 20€ for a visit to a GP, 30€ for a home call, more for a specialist) or to charge you more Does “home call” mean what I think it means? ---
**Author:** ![clairobscur](https://avatars.discourse-cdn.com/v4/letter/c/839c29/32.png) [@clairobscur](https://boards.straightdope.com/u/clairobscur)\ **Post date:** [August 11, 2005, 2:01am UTC](https://boards.straightdope.com/t/universal-health-care-and-the-poor/316016/132 "2005-08-11T02:01:01Z")
> [@saoirse](#): > > Does “home call” mean what I think it means? Maybe I got the wrong name. I was refering to the doctor coming at your house. ---
**Author:** ![davenportavenger](https://avatars.discourse-cdn.com/v4/letter/d/5f8ce5/32.png) [@davenportavenger](https://boards.straightdope.com/u/davenportavenger)\ **Post date:** [August 11, 2005, 2:08am UTC](https://boards.straightdope.com/t/universal-health-care-and-the-poor/316016/133 "2005-08-11T02:08:10Z")
> [@clairobscur](#): > > Maybe I got the wrong name. I was refering to the doctor coming at your house. Doctors… go… to people’s… houses? (checking exchange rate) FOR $37??? I don’t know what that would cost here, but I think it would probably be upwards of $500. I am not kidding. ---
**Author:** ![clairobscur](https://avatars.discourse-cdn.com/v4/letter/c/839c29/32.png) [@clairobscur](https://boards.straightdope.com/u/clairobscur)\ **Post date:** [August 11, 2005, 2:38am UTC](https://boards.straightdope.com/t/universal-health-care-and-the-poor/316016/134 "2005-08-11T02:38:52Z")
> [@continuity eror](#): > > Doctors… go… to people’s… houses? (checking exchange rate) FOR $37??? Yes. I just checked the price. My doctor spend quite a lot of time visiting patients at home. Several hours a day, either the morning or the afternoon (since he works with his brother, they swith) IIRC. In the countryside, it’s even a larger part of their work. I think country doctors spend most of their time on the roads. The elderly woman living in some small village hardly can visit a doctor (and for that matter, the elderly woman living in a city can’t, either). One of my neighbors is more than 90 and has a lot of difficulties walking. What would she do, otherwise? Similarily, if I’m bed-ridden with a bad flu, what am I going to do? There’s also always in any area a doctor on call at any time (they take their turn). However, at night, in cities, people generally rather call a doctor from a specialized organism (“night doctors”, “SOS doctors”…). These might charge a little more, I don’t know. > [@](#): > > I don’t know what that would cost here, but I think it would probably be upwards of $500. I am not kidding. I knew it had become uncommon in the USA (though 500$ is a completely ludicrous price for a visit at home. I mean, let’s imagine a doctor visiting only ten people a day, and only for 20 day/month : he would make more than 1 million dollars/year for a part-time job). However, what the kind of people I mentionned (bed-ridden, elderly) do if they can’t have a doctor visiting them? ---
**Author:** ![Metacom](https://avatars.discourse-cdn.com/v4/letter/m/ecae2f/32.png) [@Metacom](https://boards.straightdope.com/u/Metacom)\ **Post date:** [August 11, 2005, 2:40am UTC](https://boards.straightdope.com/t/universal-health-care-and-the-poor/316016/135 "2005-08-11T02:40:54Z")
> [@clairobscur](#): > > One of my neighbors is more than 90 and has a lot of difficulties walking. What would she do, otherwise? Why, she’d hire a medicare attorney to teach her how to shuffle her assets around, sell her possessions, gift the money to relatives, and then spend the rest of her years atrophying in a nursing home that reeks of urine and despair. It’s the circle of life. 😛 ---
**Author:** ![Magiver](https://avatars.discourse-cdn.com/v4/letter/m/4491bb/32.png) [@Magiver](https://boards.straightdope.com/u/Magiver)\ **Post date:** [August 11, 2005, 2:49am UTC](https://boards.straightdope.com/t/universal-health-care-and-the-poor/316016/136 "2005-08-11T02:49:23Z")
> [@DSeid](#): > > **Metacom** , > > The essential bits are universal coverage, administration streamlining, quality improvements, and affordability for all. Beyond that we must be flexible about how we can really get it done. I actually think it’s easier than people think. When HMO’s were established I looked at them with suspicion because it removed the purchaser (employee) from any financial decisions. Very few people will ask a doctor if something is necessary or if there is a cheaper alternative. Where you see this happen most are drug purchases when the consumer actually has to pull out his/her wallet. HMO’s were started as an Act of Congress in an attempt to increase insurance coverage. Despite Federal seed money, they exist, as privately funded competitive versions of a national health care system. All the pitfalls that HMO’s have exhibited will be created on a national scale if universal coverage is enacted. The difference will be the inability to escape the system. What can be changed, on a national level, is a reintroduction of health insurance as a mandatory option to HMO’s. If you’re employer is offering $8,000 of HMO coverage than they would be forced to offer the cash equivalent in the form of health insurance and increased wages. This gives employees the ability to pay doctor bills up front and still be covered by catastrophic health insurance. The goal would be to encourage people to take back financial control of their health care. If this can be done then a national health **INSURANCE** program can be established. It can still be done privately with the exception of federally underwritten float for the traditionally uninsurable. Which would make all insurance portable. I believe this would work because it releases funds traditionally spent on insurance to people who then have an incentive to manage their increased wealth. Since health care represents a sizeable amount of GNP any positive changes would affect the economy similarly. The need for Medicaid would decrease (relative to increased employment) allowing better funding of the remaining uninsured. There are always things that can be done on a federal level to reduce costs. Limits on malpractice payouts, longer patents on drugs/medical equipment, Federal grants for research through Universities and group purchase power. This list is as endless as creative minds make it. In a world of health care needs there are universal ventures that can be funded on a global scale. JM2C. ---
**Author:** ![Sevastopol](https://avatars.discourse-cdn.com/v4/letter/s/cdc98d/32.png) [@Sevastopol](https://boards.straightdope.com/u/Sevastopol)\ **Post date:** [August 11, 2005, 8:20am UTC](https://boards.straightdope.com/t/universal-health-care-and-the-poor/316016/137 "2005-08-11T08:20:57Z")
I know its a lost battle in the US, but a public health system is referred to as “socialised medicine” for the sole and only purpose of poisoning the well. PR firms universally advise their health sector clients to hammer that point and they do, to considerable success. Everywhere that has it calls it a public health system. Socialised medicine would be something altogether different than the range of proposals under discussion. Perhaps the Canadian model comes closest to it though. ---
**Author:** ![Q.N.Jones](https://avatars.discourse-cdn.com/v4/letter/q/3da27b/32.png) [@Q.N.Jones](https://boards.straightdope.com/u/Q.N.Jones)\ **Post date:** [August 11, 2005, 11:37am UTC](https://boards.straightdope.com/t/universal-health-care-and-the-poor/316016/138 "2005-08-11T11:37:23Z")
> [@Wesley Clark](#): > > Its definately not enough, but its better than nothing. We need total reform with universal coverage and a single payer public system with private insurance for those who want to opt out. But it’ll take decades for that to happen when healthcare costs get far too high, so band aids are all we can hope for. I’m concerned that putting Band-Aids on our current system will convince people that we’ve fixed the problem and don’t need further reform. The doctors I know all say they think our system is going to implode within the next decade. Even private health insurance is getting to the point where it’s too expensive. Premiums for my PPO go up 20 percent every year! And, every year, the company I worked for picks up a smaller and smaller percentage of the total amount. My co-workers worry about the cost all the time, and they’re lawyers with much larger than average paychecks. The partners, who have to buy their own coverage, pay an average of $2000 a month for it ($24,000 per year, all out of their own pockets), and that price is climbing, fast and steady. It won’t be long until even the upper middle class thinks there’s a big problem with the system. ---
**Author:** ![Evil\_Captor](https://avatars.discourse-cdn.com/v4/letter/e/f17d59/32.png) [@Evil\_Captor](https://boards.straightdope.com/u/Evil_Captor)\ **Post date:** [August 11, 2005, 12:17pm UTC](https://boards.straightdope.com/t/universal-health-care-and-the-poor/316016/139 "2005-08-11T12:17:52Z")
> [@JustAnotherGeek](#): > > I’d like to think we are neither. I am working for the same goals. I do want to see more people (in theory all) covered. All I disagree with is the means to do it. I simply have a different outlook on how the process will be best accomplished. (I don’t have horns, I swear!) What I see are people crying for help, but who don’t understand the full ramifications of the “simple” answer. From what I can tell, few people hear have a good grasp of the global healthcare market. They see other countries that have a strong socialized medicine program and say “why can’t we have that?” One of the answers is that, in some ways, we are paying for other countries to have their socialized medicine. The money _has_ to come from somewhere, and right now, we are paying for other countries to have good healthcare. I wish I could believe you when you say you don’t have horns, but there are a lot of people out there who THINK they don’t have horns, but who in fact have horns. Frex, I’m sure Karl Rove and Donald Rumsfeld thinks they’re good guys, fighting the good fight for the people of the US. In fact they are disgusting filth who belong in a jail cell … not a nice, clean US jail cell but some filthy hole in Baghram AFB. Now you sit here and offer all kinds of objections to what is one of the simple and clear problems we have in the US. The health care system is busted. Millions of Americans have to do without health coverage, only going to the emergency room when things are desperate. Millions more, especially the elderly, are having to decide whether to buy food or prescriptions every week, even with coverage. Meanwhile, I see all these nice, gleaming buildings being built by HMOs, insurance companies and doctors while all three groups plead poverty… I’ll take concrete fact (literally) over theorizing any day. The reason we don’t have a public health care program in the US is because some people are getting rich off the system we have, and they don’t want to stop. It’s as simple as that. You are allied with people who are profiting mightily by ignoring human suffering, even making it worse. I’d check my forehead real hard for bumps if I were you. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [August 11, 2005, 12:25pm UTC](https://boards.straightdope.com/t/universal-health-care-and-the-poor/316016/140 "2005-08-11T12:25:02Z")
**Q.N.** , I don’t think that anyone who has any real familiarity with the costs and consequences of our current system thinks that reform is not desperately needed. But you begin to sound like those people that you complained of - if the proposed package isn’t all that you think it should be, then it is “just a Band Aid” that might fool people into believing that further fixes are unneeded. So better to do nothing? I know I keep harping this, but that National Coalition for Healthcare Reform paper is remarkable. This is an approach endorsed by powerful people from both sides of the aisle as well as those who have not been near the aisle that concludes that major systemic reform is needed desperately. That affordable universal coverage is essential to any solution and that it would cost us much less than what are currently doing so long as the reform is systemic. Universal coverage is included in their list of options to get there but so are a variety of other approaches. Give me any on that list. What we need now is some political will to get there. Bluntly put, it is much more of a critical problem than fixing Social Security. [Previous page](https://boards.straightdope.com/t/universal-health-care-and-the-poor/316016.md?page=6) [Next page](https://boards.straightdope.com/t/universal-health-care-and-the-poor/316016.md?page=8)