# US healthcare reform debate question. **URL:** \ **Category:** Great Debates\ **Created:** [August 9, 2009, 1:52am UTC](https://boards.straightdope.com/t/us-healthcare-reform-debate-question/505792 "2009-08-09T01:52:50Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![conurepete](https://avatars.discourse-cdn.com/v4/letter/c/a88e57/32.png) [@conurepete](https://boards.straightdope.com/u/conurepete)\ **Post date:** [August 9, 2009, 4:40pm UTC](https://boards.straightdope.com/t/us-healthcare-reform-debate-question/505792/21 "2009-08-09T16:40:11Z")
Actually I am sick, and will always be sick, and most of my treatment is covered by my insurance. I do know the costs, because I work in the field, also I can read my bills. The most expensive (and high tech) way to deal with asthma IS the most uncomfy: A. don’t use meds, have a severe attack, get hospitalized, rinse and repeat. All kinds of O2 meters, oxygen, needles monitors and other sexy technology can be inolved. The cheapest (and most effective) is : B. monitor your airflow with a cheap plastic flowmeter, use Rx medications to prevent attacks and have regular allergy shots. It still costs hundreds of dollars a year, and requires the intervention of skilled medical personnel, but why would I change to option "A"even if it was free? High-tech is often invasive and institutional. ---
**Author:** ![Ruminator](https://avatars.discourse-cdn.com/v4/letter/r/b9bd4f/32.png) [@Ruminator](https://boards.straightdope.com/u/Ruminator)\ **Post date:** [August 9, 2009, 4:47pm UTC](https://boards.straightdope.com/t/us-healthcare-reform-debate-question/505792/22 "2009-08-09T16:47:56Z")
> [@DSeid](#): > > either go without this uncovered benefit or pay for it out of pocket; or go without coverage for those services and divert that money to the uncovered benefit. Which choice is rational? If the patient believes the uncovered benefit work help him more (“more” meaning being alive), he will make the “rational” choice. Maybe the covered services are worth 100k and the uncovered (unproven) treatment is worth only 10k. Just because there’s a 90k difference in price value does not automatically mean the 100k treatment is more effective. It’s a case by case basis. Maybe the 100k treatment is probably the best treatment for most people most of the time. However, that aggregate statistic is irrelevant to the particular person who is dying and wants a _choice_. Again, you’ve brought up interesting points regarding the cost-to-effectiveness ratio but you still did not eliminate the logic of why a person wants to retain his choice in medical spending. ---
**Author:** ![Chief\_Pedant](https://avatars.discourse-cdn.com/v4/letter/c/a6a055/32.png) [@Chief\_Pedant](https://boards.straightdope.com/u/Chief_Pedant)\ **Post date:** [August 9, 2009, 4:50pm UTC](https://boards.straightdope.com/t/us-healthcare-reform-debate-question/505792/23 "2009-08-09T16:50:44Z")
It is my personal speculation as a physician that government control of healthcare will not result in a rationing of care. I am of the opinion that we are, as a society, entirely unable to deprive ourselves of anything, even if the cost to provide it is ruinous to future generations. I point to Mr Bush’s and Mr Obama’s profligate spending as proof of this (and I don’t mean to make this overly political–I recognize we are the government and it’s our representatives catering to our selfishness sending them the bills to sign). This society will never ration anything, as the 90 y/o aortic valve replacement mentioned above proves. When healthcare went from being paid out of pocket to being paid by government and other third parties, costs just gradually spiraled out of control. While other countries have been more successful in reigning in costs, it’s a very difficult horse to get back into the barn once it’s left. ---
**Author:** ![adhay](https://avatars.discourse-cdn.com/v4/letter/a/ecd19e/32.png) [@adhay](https://boards.straightdope.com/u/adhay)\ **Post date:** [August 9, 2009, 4:55pm UTC](https://boards.straightdope.com/t/us-healthcare-reform-debate-question/505792/24 "2009-08-09T16:55:10Z")
> [@emacknight](#): > > I’m not exactly sure how to answer this. But In Canada as a general rule the government doesn’t really decide what gets covered and what doesn’t. They have a remarkably hands-off approach to things, and I think that’s what most Americans are unaware of. The government isn’t your HMO or insurance provider. You don’t submit forms for reimbursement or request approval. I know with my health care provider in Minnesota I’m supposed to call a number if I’m getting imaging done, assuming I’m awake and able to get to a phone. > > In Canada, the government collects taxes, and then dishes that money out to the hospitals and doctors (it’s a little more complicated but not needed here). So it’s the hospitals and doctors that make most, if not all of the decisions. If you need x-rays, you’ll get them, if you need to spend 3 weeks in the ICU, you will. There is no overall bureaucracy deciding your fate, other than your doctor and the hospital they work in. > > The only time it becomes an issue is with newer or controversial drugs and procedures, where the government has to decide if it will pay for it or not. I know my mother was part of a drug trial for Avastin. It was initially meant for people with colon cancer, and initially was found to only extend life by less than 6 months. But the cost of the drug was immense, I think upwards of $3000 per treatment. So the government conducted a series of trials to try and determine if the drug was effective enough to make it worth while. > > So the short answer is that there is this drug that _could_ benefit you, but it cost a fortune and may not actually do very much. Wish you were President. ---
**Author:** ![Ruminator](https://avatars.discourse-cdn.com/v4/letter/r/b9bd4f/32.png) [@Ruminator](https://boards.straightdope.com/u/Ruminator)\ **Post date:** [August 9, 2009, 4:56pm UTC](https://boards.straightdope.com/t/us-healthcare-reform-debate-question/505792/25 "2009-08-09T16:56:29Z")
> [@Chief\_Pedant](#): > > This society will never ration anything, as the 90 y/o aortic valve replacement mentioned above proves. I read **athelas** post differently. It sounds like the USA doctor believed Canada would “ration” the care by not allowing the 90 y/o woman to undergo that surgical procedure. ---
**Author:** ![emacknight](https://avatars.discourse-cdn.com/v4/letter/e/3ec8ea/32.png) [@emacknight](https://boards.straightdope.com/u/emacknight)\ **Post date:** [August 9, 2009, 6:40pm UTC](https://boards.straightdope.com/t/us-healthcare-reform-debate-question/505792/26 "2009-08-09T18:40:58Z")
> [@athelas](#): > > When I shadowed a cardiothoracic surgeon, at one point he was doing an aortic valve replacement on a 90 year old. He had worked in Canada for several years, and said that there, this procedure basically would not have happened. It would have been very hard to justify doing a complex procedure that at best could give her a few extra years of life. Last Christmas my 86 year old grandmother had a coronary incident. They found blockages in her coronary arteries and she was originally schedule for open heart surgery, I believe for bi-pass. AND THEN SHE WAS DENIED!!! {dramatic music in the background, sounds of conservatives rushing to their blogs, keyboards clacking away} Oh wait, did I mention she was denied by a team of physicians? A team, as in multiple physicians and specialists, met with my grandmother over a series of days to evaluate her. Their conclusion was that she would never ever recover from the surgery. After talking with her, and her husband, they were able to conclude that she would never participate in the followup treatment. She wasn’t an active person so it was unlikely she’d participate in the rehabilitation process. They explained to my father that it was unlikely she’d ever get out of bed following the surgery. So when you talk about a valve replacement for a 90 year old, I laugh. I know what is involved with that procedure, and I know what is involved with that recovery. Do you really think a 90 year old with a bad heart is going to spend the next two years on a treadmill rebuilding his strength? It seems that within the fear mongering aspect of the health care debate this point is missed. I get the feeling that in the US doctors throw common sense and morals out the window in favour of the all mighty dollar. It seems here that a surgeon just wants to cut, and that’s how he’s paid. 12 year old boob job, 90 year old bi-pass, irrelevant to him. And with respect to the situation with the AIDS patient, there is just way too much snake oil out there, and physicians don’t seem to care. There could ALWAYS been something else you could TRY–experimental, unproven, still in clinical trials, “heard a rumour from a friend.” But all logic and reason is thrown out the window when something _just might work._ Further to that, how many Americans end up flying to Mexico for a treatment the US government won’t allow? Or fly to China for a daily injection of of ground up panda mixed with a bit of tiger. So tell me something, you’re worried about the evil government rationing your care, but are you ever worried about a doctor rationing the care? Incidentally, my grandmother spent 3 weeks in the ICU, do you have any idea what that would cost in the US? And she wasn’t there because she needed to be, or that there weren’t beds elsewhere. But the nurses were familiar with her case, and it made the most sense. ---
**Author:** ![Ruminator](https://avatars.discourse-cdn.com/v4/letter/r/b9bd4f/32.png) [@Ruminator](https://boards.straightdope.com/u/Ruminator)\ **Post date:** [August 9, 2009, 6:49pm UTC](https://boards.straightdope.com/t/us-healthcare-reform-debate-question/505792/27 "2009-08-09T18:49:15Z")
> [@emacknight](#): > > So tell me something, you’re worried about the evil government rationing your care, but are you ever worried about a doctor rationing the care? You are arguing the same point as **DSeid** but it is irrelevant to the question posed by **Nobody**. **Nobody** was confused as to why there would be a difference between UHC and private insurance w/ regards to out-of-pocket expenses. Several have explained the difference. It’s a concrete and mathematical difference. Arguing the “effectiveness” of that difference is irrelevant to the point of consumer choice. ---
**Author:** ![emacknight](https://avatars.discourse-cdn.com/v4/letter/e/3ec8ea/32.png) [@emacknight](https://boards.straightdope.com/u/emacknight)\ **Post date:** [August 9, 2009, 6:59pm UTC](https://boards.straightdope.com/t/us-healthcare-reform-debate-question/505792/28 "2009-08-09T18:59:01Z")
Sure, but I still think the point (with respect to the OP) needs to be made that doctors in the US don’t seem to have any self restraint. Yes, I know that is a very broad brush to paint with. But look at that example of a 90 year old valve replacement case, or [this](http://boards.straightdope.com/sdmb/showthread.php?t=526331) debate about hospice care. For some reason, in UHC countries, the doctors started making more rational choices. They seem to reach a point where “more treatment isn’t more gooder.” Why doesn’t that seem to happen in the US? Why would a hospital allow a surgeon to perform a procedure on a patient in that condition? Why would a surgeon go along with it? Why would the cardiologist push for it? I’m an idiot, and even I know that decision is wrong. And it also seems to happen at the lowest level too. Go into the ER for something, and the emphasis is to run as many tests as they can get away with. ---
**Author:** ![Nobody](https://avatars.discourse-cdn.com/v4/letter/n/94ad74/32.png) [@Nobody](https://boards.straightdope.com/u/Nobody)\ **Post date:** [August 9, 2009, 7:16pm UTC](https://boards.straightdope.com/t/us-healthcare-reform-debate-question/505792/29 "2009-08-09T19:16:54Z")
> [@Ruminator](#): > > It’s math. You cancel the insurance contract to divert the $$$ in premiums paid to an alternative treatment that the insurance doesn’t cover. > > Just “paying out of pocket” does not recover the dollars lost to insurance premiums. Sometimes, you can afford to pay both the insurance premiums _and_ out-of-pocket costs. Sometimes, you can’t. In the situations that you can’t, you have the choice of canceling the insurance and redirecting that money towards whatever treatments the insurance does not cover. “Insurance won’t pay for a prescription or two, so I’ll cancel my insurance. Sure, if I have to wind up in the hospital it will cost me thousands of dollars I don’t have, but at least I can afford to buy my medicine now.” Is that the logic? > [@](#): > > When you pay tax $$$ towards UHC, you _can’t get that money back_ because of government law. Once UHC is in place, you can’t just decide to stop paying taxes towards UHC to fund your own treatment that’s not covered by UHC. That’s one of the differences between mandatory $$$ paid into UHC vs voluntary $$$ paid into private insurance. If we were to go the UHC route I have a huge feeling that the group discount of millions of people would cost us a lot less than what individuals have to pay now. > [@](#): > > The government is paying for medical care that the government approves of. And the insurance companies are paying for medical care the insurance companies approve of. > [@](#): > > It is true that a similar restriction is in place for private insurance. But I hope I’ve explained above that the key difference is that the consumer still has some power left in his own hands because he controls the $$$ paid in premiums. He still has some discretionary power over his money paid to insurance. He has zero discretionary power over his mandatory payment in taxes to UHC. That money is gone. For most of us our insurance choice is limited to what our employer offers us. Most of us can’t afford the hundreds of dollars to buy our own insurance. I’m unemployed right now and have to do without. ---
**Author:** ![Ruminator](https://avatars.discourse-cdn.com/v4/letter/r/b9bd4f/32.png) [@Ruminator](https://boards.straightdope.com/u/Ruminator)\ **Post date:** [August 9, 2009, 7:23pm UTC](https://boards.straightdope.com/t/us-healthcare-reform-debate-question/505792/30 "2009-08-09T19:23:51Z")
> [@Nobody](#): > > “Insurance won’t pay for a prescription or two, so I’ll cancel my insurance. Sure, if I have to wind up in the hospital it will cost me thousands of dollars I don’t have, but at least I can afford to buy my medicine now.” Is that the logic? Something like that, yes. Keep reading the rest of the posts that gets into the nuances of having choices while alive vs zero choices when you’re dead. ---
**Author:** ![Nobody](https://avatars.discourse-cdn.com/v4/letter/n/94ad74/32.png) [@Nobody](https://boards.straightdope.com/u/Nobody)\ **Post date:** [August 9, 2009, 7:29pm UTC](https://boards.straightdope.com/t/us-healthcare-reform-debate-question/505792/31 "2009-08-09T19:29:05Z")
> [@Ruminator](#): > > You are arguing the same point as **DSeid** but it is irrelevant to the question posed by **Nobody**. > > **Nobody** was confused as to why there would be a difference between UHC and private insurance w/ regards to out-of-pocket expenses. Several have explained the difference. It’s a concrete and mathematical difference. > > Arguing the “effectiveness” of that difference is irrelevant to the point of consumer choice. Actually I’m asking about the concerns of rationing some people bring up and how government will decide what to pay for, when the fact of the matter is, is that right now insurance companies ration services and decide what to pay for. Yes, I guess you can say that now you have the choice to go without insurance whereas under UHC you might not have that option, but while going without is an option, it is, in my opinion, extremely impractical and has a danger of hurting you in the long run even if it seems like the right thing to do in the short term. ---
**Author:** ![Nobody](https://avatars.discourse-cdn.com/v4/letter/n/94ad74/32.png) [@Nobody](https://boards.straightdope.com/u/Nobody)\ **Post date:** [August 9, 2009, 7:31pm UTC](https://boards.straightdope.com/t/us-healthcare-reform-debate-question/505792/32 "2009-08-09T19:31:35Z")
> [@emacknight](#): > > And it also seems to happen at the lowest level too. Go into the ER for something, and the emphasis is to run as many tests as they can get away with. That’s probably a CYA measure to make sure they don’t get sued should the patient leave and later find out there’s something wrong that the ER team didn’t catch because they didn’t run every test that they could have. ---
**Author:** ![NinetyWt](https://avatars.discourse-cdn.com/v4/letter/n/cc9497/32.png) [@NinetyWt](https://boards.straightdope.com/u/NinetyWt)\ **Post date:** [August 9, 2009, 7:31pm UTC](https://boards.straightdope.com/t/us-healthcare-reform-debate-question/505792/33 "2009-08-09T19:31:53Z")
> [@emacknight](#): > > Why doesn’t that seem to happen in the US? Why would a hospital allow a surgeon to perform a procedure on a patient in that condition? Why would a surgeon go along with it? Why would the cardiologist push for it? I’m an idiot, and even I know that decision is wrong. > > And it also seems to happen at the lowest level too. Go into the ER for something, and the emphasis is to run as many tests as they can get away with. Could it be fear of lawsuit? CYA, and all that? ETA: Darn you **Nobody**! ---
**Author:** ![Ruminator](https://avatars.discourse-cdn.com/v4/letter/r/b9bd4f/32.png) [@Ruminator](https://boards.straightdope.com/u/Ruminator)\ **Post date:** [August 9, 2009, 7:51pm UTC](https://boards.straightdope.com/t/us-healthcare-reform-debate-question/505792/34 "2009-08-09T19:51:31Z")
> [@Nobody](#): > > Actually I’m asking about the concerns of rationing some people bring up and how government will decide what to pay for, when the fact of the matter is, is that right now insurance companies ration services and decide what to pay for. In post #6, you were specifically confused about, _“Why would you need to cancel your insurance contract? When the pharmacy tells me insurance won’t pay for medicine for my wife I just pay out of pocket.”_ That’s the comment you made I was referring to. You made it sound like out-of-pocket with UHC is identical to out-of-pocket with private insurance. They are not identical. It looks like you do concede they are not identical by responding, _“Yes, I guess you can say that now you have the choice to go without insurance whereas under UHC you **might not** have that option”_ Btw, I would modify your statement from the phrase “might not” to “will not” because the mandatory taxes must be paid (no exemptions I know of) and once they are paid, that money is gone for you to choose how to spend. > [@Nobody](#): > > extremely impractical and has a danger of hurting you in the long run even if it seems like the right thing to do in the short term. Sometimes, you have to do the “impractical” action in the short term SO THAT YOU EVEN HAVE a long run to worry about. There was a [hiker](http://en.wikipedia.org/wiki/Aron_Ralston) that had his right arm pinned by a boulder. He was stuck for 5 days with no chance for rescue. He decided to make the “impractical” choice to amputate his own arm so he’d have a chance to live. We as outsiders could play armchair quarterback and say that the hiker should consider that in the “long run”, he’s going to need that right arm for the rest of his life and that there’s no point in cutting it off to free himself from that boulder. Even if he does cut off his arm, he might lose so much blood that he would pass out and become ineffective and finding help. Those “long run” concerns are only valid if you are ALIVE in the first place. This nuance seems to be missing from some of the comments I read. ---
**Author:** ![NinetyWt](https://avatars.discourse-cdn.com/v4/letter/n/cc9497/32.png) [@NinetyWt](https://boards.straightdope.com/u/NinetyWt)\ **Post date:** [August 9, 2009, 7:56pm UTC](https://boards.straightdope.com/t/us-healthcare-reform-debate-question/505792/35 "2009-08-09T19:56:50Z")
> [@Ruminator](#): > > Btw, I would modify your statement from the phrase “might not” to “will not” because the mandatory taxes must be paid (no exemptions I know of) and once they are paid, that money is gone for you to choose how to spend. But the mandatory taxes are not going to equal the amount of the private insurance premiums. The premiums for the gov’t insurance might. ---
**Author:** ![gonzomax](https://avatars.discourse-cdn.com/v4/letter/g/e8c25b/32.png) [@gonzomax](https://boards.straightdope.com/u/gonzomax)\ **Post date:** [August 9, 2009, 8:05pm UTC](https://boards.straightdope.com/t/us-healthcare-reform-debate-question/505792/36 "2009-08-09T20:05:10Z")
Our health care system is conceptually wrong. The companies increase profits by denying coverage. When they were testifying in front of congress, doctors in their employ told of how their bonuses were predicated on denying coverage. They were very well paid to fight customers . Of course you are paying monthly for coverage. Sometimes you pay for years and then when you need it, they refuse to cover. The companies data mine phamacies and doctors. Every prescription you order is kept, every over the counter medicine is too. Then when you need something covered they can refer to your over the counter medicines as indicative of a pre existing condition. Then you have to fight them. If you want to quit your job for a better position you have to consider your families health as part of the equation. You are likely to wait 90 days before you are covered. If something goes wrong, you could be in real financial trouble. Over half the bankruptcies in America are due to health problems. how fucked up does a system have to be before people broom it? ---
**Author:** ![Ruminator](https://avatars.discourse-cdn.com/v4/letter/r/b9bd4f/32.png) [@Ruminator](https://boards.straightdope.com/u/Ruminator)\ **Post date:** [August 9, 2009, 8:12pm UTC](https://boards.straightdope.com/t/us-healthcare-reform-debate-question/505792/37 "2009-08-09T20:12:48Z")
> [@NinetyWt](#): > > But the mandatory taxes are not going to equal the amount of the private insurance premiums. The premiums for the gov’t insurance might. This discussion wasn’t necessarily tied specifically to Obama’s health care proposal. I was speaking in generalities of UHC. In that case, a “mandatory premium for govt insurance” is the same thing as a mandatory tax. It’s just semantics. One could say that Social Security (FICA) is just an “insurance contribution” and not a tax. Again, it’s semantics. Whether you call it a “tax”, a “contribution”, or a “premium”, it makes no difference what word you use to label it, the key issue is the mandatory aspect. ---
**Author:** ![Nobody](https://avatars.discourse-cdn.com/v4/letter/n/94ad74/32.png) [@Nobody](https://boards.straightdope.com/u/Nobody)\ **Post date:** [August 9, 2009, 8:13pm UTC](https://boards.straightdope.com/t/us-healthcare-reform-debate-question/505792/38 "2009-08-09T20:13:54Z")
> [@Ruminator](#): > > In post #6, you were specifically confused about, _“Why would you need to cancel your insurance contract? When the pharmacy tells me insurance won’t pay for medicine for my wife I just pay out of pocket.”_ > > That’s the comment you made I was referring to. > > You made it sound like out-of-pocket with UHC is identical to out-of-pocket with private insurance. They are not identical. > > It looks like you do concede they are not identical by responding, _“Yes, I guess you can say that now you have the choice to go without insurance whereas under UHC you **might not** have that option”_ > > Btw, I would modify your statement from the phrase “might not” to “will not” because the mandatory taxes must be paid (no exemptions I know of) and once they are paid, that money is gone for you to choose how to spend. > > Sometimes, you have to do the “impractical” action in the short term SO THAT YOU EVEN HAVE a long run to worry about. > > There was a [hiker](http://en.wikipedia.org/wiki/Aron_Ralston) that had his right arm pinned by a boulder. He was stuck for 5 days with no chance for rescue. He decided to make the “impractical” choice to amputate his own arm so he’d have a chance to live. We as outsiders could play armchair quarterback and say that the hiker should consider that in the “long run”, he’s going to need that right arm for the rest of his life and that there’s no point in cutting it off to free himself from that boulder. Even if he does cut off his arm, he might lose so much blood that he would pass out and become ineffective and finding help. Those “long run” concerns are only valid if you are ALIVE in the first place. This nuance seems to be missing from some of the comments I read. I’m sorry but I think that this kind of argument amounts to fear mongering and I don’t see people dying because they couldn’t drop their UHC in order to afford a prescription or treatment that isn’t covered. ---
**Author:** ![NinetyWt](https://avatars.discourse-cdn.com/v4/letter/n/cc9497/32.png) [@NinetyWt](https://boards.straightdope.com/u/NinetyWt)\ **Post date:** [August 9, 2009, 8:16pm UTC](https://boards.straightdope.com/t/us-healthcare-reform-debate-question/505792/39 "2009-08-09T20:16:07Z")
> [@Ruminator](#): > > This discussion wasn’t necessarily tied specifically to Obama’s health care proposal. > > I was speaking in generalities of UHC. In that case, a “mandatory premium for govt insurance” is the same thing as a mandatory tax. It’s just semantics. > > One could say that Social Security (FICA) is just an “insurance contribution” and not a tax. Again, it’s semantics. > > Whether you call it a “tax”, a “contribution”, or a “premium”, it makes no difference what word you use to label it, the key issue is the mandatory aspect. Ah. That makes your argument clearer. I was thinking you were referring to the extra taxation that would come with implementation of a UHC plan. Thanks for explaining. ---
**Author:** ![Ruminator](https://avatars.discourse-cdn.com/v4/letter/r/b9bd4f/32.png) [@Ruminator](https://boards.straightdope.com/u/Ruminator)\ **Post date:** [August 9, 2009, 8:22pm UTC](https://boards.straightdope.com/t/us-healthcare-reform-debate-question/505792/40 "2009-08-09T20:22:47Z")
> [@Nobody](#): > > I’m sorry but I think that this kind of argument amounts to fear mongering and I don’t see people dying because they couldn’t drop their UHC in order to afford a prescription or treatment that isn’t covered. Would a couple of cites really change your opinion? I doubt it. You said you currently don’t have insurance and can’t afford it. To you, all that matters is that folks like yourself go from zero coverage to UHC vs someone with UHC that wants treatment that’s not covered. Maybe in the whole big scheme of things, that should be the best option (the “greatest good for the greatest number” argument) but that’s not what you originally asked. Your first postings were saying the situations were identical. They are not identical. [Previous page](https://boards.straightdope.com/t/us-healthcare-reform-debate-question/505792.md?page=1) [Next page](https://boards.straightdope.com/t/us-healthcare-reform-debate-question/505792.md?page=3)