Universal health care and the poor

[RickJay]

@grienspace

Canadian here. Years ago I was offered a job in Hawaii. The company would cover my health care but not my wife’s. :rolleyes:

My stepmother, on fixed income, recently has had cataract surgery, knee replacement and last week a mammogram. We both live in the boonies by the way.

She has no complaints about the health care even though she’s a bit of a whiner.

To weeks ago I had a catscan. It took three days after the requisition.

I pay $112 USD per month to cover my family’s healthcare.

What do you pay?

grien, if you’re still in Canada you pay more than that. In 2001, health expenditures were about $3,000 per Canadian. One way or another that’s what every Canadian pays, mostly through taxation - that’s about $250 a month per person, so your family’s coughing up about $750 a month (assuming it’s three of you.) Or in US dollars, about $600 a month.

[Evil_Captor]

@JustAnotherGeek

I am not saying and have not said that what we have is perfect. It needs work. **A lot of work. ** I am saying that as one of the last profitable markets for healthcare industries, if we socialize, things will not go * in the long run * as well as we would like.

I want the same effects as most posters here do. It is a joke that in one of the world’s richest countries that people don’t get enough healthcare. And I freely admit that the insurance companies are not telling us the whole story about their finances. But saying the healthcare system will be better if completely run by the government is like saying the legal system would be completely better if all lawyers were civil servents.

So, we’re supposed to stick with a horribly inefficient, clearly failing system because the alternative, in your opinion, might not work out so well in the distant future? I got an idea: let’s fix the problem now and deal with too much socialism when and if that gets to be a problem. Your argument is actually one of the best arguments for switching to single payer/socialized medicine whatever, because it’s coming from someone who doesn’t realize he’s making it.

Thanks!

[treis]

@RickJay

grien, if you’re still in Canada you pay more than that. In 2001, health expenditures were about $3,000 per Canadian. One way or another that’s what every Canadian pays, mostly through taxation - that’s about $250 a month per person, so your family’s coughing up about $750 a month (assuming it’s three of you.) Or in US dollars, about $600 a month.

According to here Canadians pay $1,826 per capita in public funds for health care while Americans pay $2,051 per capita in public funds for health care. For comparison’s sake, France pays $1,785 per capita, the UK pays $1,429 per capita and Italy pays $1,497 per capita. Here is the complete list and as you can see the United States spends the 3rd most amount of public funds on health care in the world. You are incorrect about grienspace paying more in taxes for health care, he would actually spend more if he moved to the US. (Assuming similar taxing scheme which I am not sure of)

[DoctorJ]

If I had a nickel for every time I’ve heard a story like that of Sam Stone’s mother, right here in the USA, I’d be out of this medicine game.

I wanted to clear up one misconception that I used to have, that seems to be floating around the thread–you do not get Medicaid simply for being poor. You do have to have an income under a certain minimum, but you also have to fall into a category of need. In general, you have to be:
–over 65
–a dependent child, or the parent of a dependent child
–blind
–pregnant, or
–disabled.

A middle-aged person with no dependents who has a ton of chronic diseases but is still well enough to work at a crappy job if one becomes available is out of luck. He just has to wait until he gets too sick to work, and then, maybe, the government will step in. The disability determination is often a safety valve for state spending; if they decide they’ve spent too much in a particular year, they just drastically slow down the processing of disability claims.

In my residency program, we saw most of the indigent patient population in our area, and one thing I always tried to figure out was how they fell through the cracks. I’ve probably heard a thousand people in the last three years who are broke and clearly sick but somehow not eligible for Medicaid.

It’s also true that a hospital cannot turn you away because you can’t pay, but that doesn’t mean you don’t get billed. You can often make arrangements to keep yourself out of trouble, but that debt follows you around until it’s paid. It’s hard to get out of the emergency room for less than $1000, and it goes up sharply from there; to the uninsured person trying to pull himself up by his bootstraps, that’s one more huge obstacle.

[clairobscur]

@tomndebb

This thread is intended to argue the merits of various scheme to fund medical services, not to voice personal opinions regarding the general nature of other posters’ political, economic, or philosophical beliefs. Let’s keep the personal comments out of this, please.

[ /Moderator Mode ]

Costa Gavras did it. Don’t ask.

[davenportavenger]

@DoctorJ

A middle-aged person with no dependents who has a ton of chronic diseases but is still well enough to work at a crappy job if one becomes available is out of luck. He just has to wait until he gets too sick to work, and then, maybe, the government will step in. The disability determination is often a safety valve for state spending; if they decide they’ve spent too much in a particular year, they just drastically slow down the processing of disability claims.

In my residency program, we saw most of the indigent patient population in our area, and one thing I always tried to figure out was how they fell through the cracks. I’ve probably heard a thousand people in the last three years who are broke and clearly sick but somehow not eligible for Medicaid.

Um, hi, welcome to my life.

Believe me, I’ve looked into applying for Medicaid. I don’t think most people realize what stringent guidelines there are, and how few people actually qualify. To qualify you have to go see a ton of doctors and sometimes lawyers, all of which takes money that I don’t have. And it puts a huge stigma on your work history, one which will haunt you for the rest of your life. But maybe it’s for the best because if I got Medicaid people like some of the posters on this thread would hate me for it. Because I should be getting a kickass job that has insurance. Which I can’t get because I can’t drive because I’m disabled. But not disabled enough for Medicaid. Damn I wish I could get on a Canadian waiting list so I could wait five months to see a doctor, because that would be a hell sight better than not being able to see one at all.

I’m with clairobscur, many economic libertarians are wholly ignorant of the reality that many of their fellow citizens live in. At least, I’d like to think they’re being naive. It’s better than thinking a large chunk of my fellow citizens are purposefully cruel.

[RickJay]

@treis

According to here Canadians pay $1,826 per capita in public funds for health care while Americans pay $2,051 per capita in public funds for health care. For comparison’s sake, France pays $1,785 per capita, the UK pays $1,429 per capita and Italy pays $1,497 per capita. graph

Your numbers are six years old and in US dollars, plus I got my numbers from the government of Canada, which is a pretty reliable source:

http://www.fin.gc.ca/facts/fshc7_e.html

Here, I’ll actually do math this time; this cite claims that government expenditures alone amount to about $2683 per person per year; $83 billion in Medicare spending plus $5 billion in direct federal medical expenditures, divided by 32,800,000 Canadians.

At current exchange that’s about $2200 per person, but of course Canadians do spend private money on health care; dentistry ($6 billion a year, most of it private) eyewear, etc. are not covered by the single payer system, nor are prescription drugs for most people (drugs alone are about $8 billion of private money according to this report. Obviously, the costs are substantial.

You are incorrect about grienspace paying more in taxes for health care, he would actually spend more if he moved to the US. (Assuming similar taxing scheme which I am not sure of)

I said nothing of the kind.

I corrected his figures. I didn’t say he’d pay less in the United States. He would obviously pay more.

[RickJay]

Boy, that looks ugly. I lost half my post AND screwed up the coding.

I did all kinds of research, too, with cites. Shit.

[treis]

What the heck did you do Rick? You broke the Dope!

[RickJay]

Uh oh.

[even_sven]

@JustAnotherGeek

And I have also pointed out one consequence of lowering the price of drugs in the US. Just as you are paying for the consequences of other, the US is paying for the other countries to have lower drug prices. If we socialize medicine and lower drug prices to the point where the world market is no longer profitable, what to you think will happen to the drug supply to Somalia, South Africa, etc.?

Fuck if I know and at this point fuck if I care. If this argument wern’t merely a distraction, I’d counter by saying that I’m not going to trade suffering Somolians for suffering Americans. I believe we do have obligations to the world community, but that obligation does not include putting up with an expensive rediculous broken system that leaves so many of our own out in the cold on the theory that some of this will somehow trickle down to Somalia.

[Magiver]

@continuity eror

I’m with clairobscur, many economic libertarians are wholly ignorant of the reality that many of their fellow citizens live in. At least, I’d like to think they’re being naive. It’s better than thinking a large chunk of my fellow citizens are purposefully cruel.

I’ll accept the premise that I lack the full reality of your situation. However, When I found out my company was shutting down next year I went home that night and researched insurance coverage (NOT HMO’s). That was my only immediate concern. I believe I can fund the necessary catastrophic insurance and make up the difference in either credit or liquidation of assets. Maybe I’m talking out my ass and the stuff I looked at is total crap. Time will tell. I’ve always been risk averse in my adult life and have given up many of the “goodies” to maintain my financial safety. To this day I don’t have cable or a speedy internet connection. My cell phone will be next on the chopping block. I deleted all the examples of my financial planning to avoid sounding preachy. I see too many people ignoring their future and I don’t fully understand why. I’ll end by conceding (from personal experience) that it is possible to fall through the cracks.

[RickJay]

@JustAnotherGeek

If we socialize to try to force the cost of healthcare in this country down, we run the risk of jeopardizing the future of healthcare. The reason why I say this: The US is the single largest profitable market for healthcare companies (represents over half of the profit for companies). Other countries forcing their own wishes on the prices of pharmaceuticals have forced prices here in the US to rise.

That simply defies logic.

First of all, we’re talking about medicare, not pharmacare - they’re different - but why on Earth would drugs being cheaper in Belgium or Canada cause them to be more expensive in the United States? That doesn’t even pass Econ 101 logic.

Look; suppose the price of drugs is set by market conditions in the United States. If that’s true, why would the price of drugs in, say, Canada, where they’re slightly lowered due to the monopsonistic approach the government takes, affect U.S. prices? The prices in Canada don’t affect the supply or demand in the United States. The drug companies still make money off Canadian customers - if they didn’t they would not sell drugs in Canada - so why would Canadian prices affect U.S. prices? (Nowadays you have back-sales from Canada, of course, but that’s a minor effect, and obviously isn’t relevant if we use pretty much any other country as our example.)

Please, please don’t tell me “because they have to raise prices to make that extra profit.” If you raise prices beyond the equilibrium price you make LESS profit, not more. Either they’re charging the market-clearing price for a drug, or they aren’t. Pfizer cannot make up “lost profit” from Canada by charging U.S. customers more than the equilibrium price.

[DSeid]

First off, some of what should be required reading: www.nchc.org/materials/studies/reform.pdf - A nonpartisan analysis of the problem with chairs including former Presidents Bush, Ford and Carter - none of this Cato Institute you know the conclusion they’ll reach before they ever look at a bit of data crap.

16% of America is uninsured. This not only results in poor health and economic outcomes for the uninsured but impacts the costs of healthcare of others-

The impacts of uninsurance are not confined to the uninsured. First, family members, neighbors, and colleagues at work are adversely affected by the incapacities that befall the uninsured. Second, as the number of uninsured Americans increases, so does the cost-shift for uncompensated care built into the insurance premiums of those who purchase coverage. Third, the high incidence of uninsurance generates losses throughout the economy, due mainly to the lower productivity of uninsured (and, on average, less healthy and functional) workers. The Institute of Medicine has estimated that total economic losses attributable to uninsurance amount to between $65 billion and $130 billion per year.

Costs of healthcare are rising rapidly and are hampering our economy.

Overall, the United States spends much more on health care than any other nation. According to the Centers for Medicare and Medicaid Services, national health expenditures in the United States will reach $2.6 trillion in 2010 — more than double the total in the year 2000. On a per capita basis, health care costs in the United States are more than twice the median level for the 30 industrialized nations in the Organization for Economic Cooperation and Development (OECD) — even though 15 percent of our population has no health coverage at all (and even though the health outcomes associated with our higher spending are no better and, by some measures, worse than outcomes in nations that spend much less).

As these costs rise, they eat into corporate margins, reducing the capacity of firms across the economy to grow their businesses by investing in research, new plant and equipment, and product development. Health care cost increases slow the rate of job growth by making it more expensive for firms to add new workers. They suppress wage increases for existing workers by driving up total compensation costs. They compromise the viability and vitality of pension funds and offset increases in pension benefits for retirees. And double-digit premium increases — on top of what are already the highest per-worker health care costs in the world — put American firms at a steep and growing disadvantage in global markets, where they must compete against companies with much lower health care costs.

Their prescription? Healthcare reform must be a priority. It must include healthcare for all. Cost must be contained and meaningful quality improvements must be included. It must be financed equitiably. And administration must be simplified. (“The United States spends more than any other nation — nearly $300 billion per year — to administer its health care system.”)

The Coalition has no problem with mandating coverage and providing tax credits on an income basis. They prefer group purchasing and here I differ - I’d scrap the employer model and make it individual with the proviso that insurers be mandated to offer the same product for the same price to all comers, whether you are an individual or Microsoft, pre-existing condition or not. They are also open to other approaches including National Health Insurance.

The Coalition has identified a range of viable options for insuring all Americans:
• employer mandates (supplemented with individual mandates as necessary).
• expansion (and perhaps consolidation) of existing public programs that cover subsets of the uninsured (such as the State Children’s Health Insurance Program).
• creation of new programs targeted at subsets of the uninsured.
• establishment of a universal publicly financed program.
Legislation incorporating any, or a combination, of these mechanisms
• should include adequate subsidies for those who are less affluent.
• should assure continuity of coverage for those who move from one form or context of coverage to another.
• should facilitate enrollment by all those eligible for coverage.
• should require individuals to establish — for example, by appending documentation to their annual tax returns — that they have coverage.

As these three former Presidents conclude:

Consider: Unless we improve the quality of care, we will not be able to manage costs or afford universal coverage. Unless we manage costs effectively, we will not be able to achieve equitable financing or cover all Americans. And unless we assure coverage for everybody, we will be unable to make the system less complex, establish a level playing field without cost-shifting, or create a truly competitive health care marketplace. (In fact, many of those who first advanced the market-based reform hypothesis called managed competition warned that a market for health care cannot function efficiently or effectively in the absence of mandatory universal coverage and government oversight.) Second, the status quo — clearly, undeniably — is not working. It leaves tens of millions of Americans with no health insurance at all. It allows costs to skyrocket year after year, putting coverage out of reach for millions of Americans and compromising the vitality of our economy and its capacity to create and sustain jobs. And it jeopardizes the safety of patients because of widespread sub-standard care. The status quo is not acceptable. It is time — it is past time — to change it. The readers of this report can have a tremendous impact on the prospects for reform and the shape of reform. We hope that you will work with us in this important effort.

[Magiver]

@RickJay

That simply defies logic.

First of all, we’re talking about medicare, not pharmacare - they’re different - but why on Earth would drugs being cheaper in Belgium or Canada cause them to be more expensive in the United States? That doesn’t even pass Econ 101 logic.

If you restate your premise it makes more sense. It’s not more expensive in the United states, it’s cheaper in Canada. Canada allows 20 years on drug patents. A drug company can afford to sell it cheaper there. Which is an idea that should be applied in the US.

[pand]

@JustAnotherGeek

I actually believe (in an ideal world) that all people should pay the same percentage of their salary for healthcare (maybe with some idiot taxes on dangerous habits like smoking, driving, rock-climbing, etc.). We are all prone to the same illnesses and should all have the same benefits of medicine to cure said illnesses; and should all be thankful of the technology and people who restore that portion of our lives. I simply do not have enough faith in our governement to create a fair, competant system to regulate our healthcare.

-Geek

You actually pulled me out of lurk mode because of your response.

Firstly, because you’re the first person I’ve come across who seems to think - similarly to myself - that what a person pays for healthcare coverage should be linked to lifestyle choices (smoking, etc.).

Secondly, if we are all prone to the same illnesses - if there are average illnesses - then we are all potentially subject to the same average costs. Paying the same percentage of a salary does not equal the same contribution. Someone making 100k is going to pay substantially more than someone making 15k, perhaps 2-3 times the ‘potential cost’ amount. This is hardly a fair burden.

While I do not want to see a fully socialised health care system in the US, I think far more could be done to promote basic healthcare, health education, preventative healthcare and rehabilitation. Perhaps a hybrid system…

But this, unfortunately, would mean turning the current system on its head whilst reeducating health-care providers on actual prevention, cause and cure, as opposed to our current mode of diagnose, treat and maintain.

[MAGunter]

If a person has completely maxed out on private medical insurance, and he does not have the means to pay on his own, he is a candidate for federal programs such as Medicaid and Medicare. His family is not AFAIK required to fund his care. Hospitals cannot throw you out due to financial issues if you still need care. Hospitals by me have big signs in them about this, including who to contact for help with the process. If you’re in the U.S., you’re already paying money to support these and other programs, including ones to help the elderly and the needy to obtain prescription medicine, dental care and eyeglasses.

AFAIK, they cannot let you die so long as you need immediate care. However, they’re under no obligation to do anything once your condition is stabilized and you can physically walk out the door.

[pullin]

@Magiver

Doctors can offer direct reductions in office visits to patients who pay cash.

Was the intent of this statement that Dr’s can reduce prices for cash payers? Is so, I can back this up with personal experience. When PullinSon needed corrective orthopedic surgery (we were without health insurance) I offered to pay the surgeon cash up front. Surgery(ies) took place immediately, and at a 25% reduction in the normally charged price. He (surgeon) said he spent at least that much in administrative costs. (Also said my $$ was immediate; As opposed to waiting up to 3 months to collect from ins. co.)

Doper Drs (or anyone in medical field), is this typical for overhead costs?

[Barbarian]

Damn, my whole post from page 1 got swallowed, and I only noticed today.

Having had health care in Canada and the U.S., I have to say that both countries have their good points and bad. In Canada there’s a shortage of GPs, which means too many people end up going to emergency rooms instead of having regular doctor’s visits. In the U.S., there is way too much technology used during an average GP visit. I get an EKG when I go for my annual physical in New York, and that’s just a waste of cash.

I’ve heard it said that the U.S. system spends a lot more on administrative costs than other countries (17% v. 10% in Canada, but damned if I can find an exact figure again) and seeing the amount of paperwork I’m sent by my own HMO after every visit I’m not surprised.

And as for drug R&D, one thing you absolutely have to take into account is the incredible amount of money spent in the U.S. on direct-to-consumer advertising-- something that is effectively banned in Canada. I swear every second or third ad on TV in New York is for prescription medicine. That’s a hell of a lot of money being spent in the U.S., and that’s an expense that just doesn’t exist north of the border.

Yeah, there are some loopholes in Canada, but drug advertising is severely restricted and non-existent compared to the U.S.

[DSeid]

Go to http://www.nchc.org/materials/studies/index.shtml and click on the first report - Impacts of Health Care Reform: Projections of Costs and Savings - for the Coalitions analysis of expenses and savings. Overall most savings comes from a national healthcare insurance, but all scenerios save compared to the status quo while improving outcomes.