What lessons do we need to take from other countries in nationalizing US health care?

[Magiver]

@Euphonious Polemic

You already have rationing; The US system rations on the basis of who can pay for the care. If you can pay, or if you have insurance through your employment, you’re OK. If you do not, you can wait for care (or in many cases, you can get no care) Other countries ration on the basis of medical need.

No, that’s not rationing. That’s being poor, or planning poorly depending on the circumstances. As has been pointed out in this thread, people get the treatment they need and then are handed a large bill. Nothing was rationed. As I’ve already stated, this is a discussion of the near-poor adult who has trouble getting insurance.

@Euphonious Polemic

And this ad hominem: “Yes comrade”

has no place in a rational discussion. This is not the 1950’s and you don’t have to be afraid of a Red under the bed.

don’t like it, too bad. It was in response to the idea of reallocation of resources by government fiat. It fits perfectly with the 1950’s mentality it was meant to portray. But you are right in that reallocating resources has no place in this discussion.

[Digital_Stimulus]

I came across this (rather skimpy-on-fact) article from ABC News: The Health Care System I Want Is in France. Just tossing it in here as related info.

[carnivorousplant]

@Magiver

No, that’s not rationing. That’s being poor,

A rose by any other name. I want poor folks to have health care. I do not want them to go into debt for it.

[Euphonious_Polemic]

@Magiver

No, that’s not rationing. That’s being poor, or planning poorly depending on the circumstances.

Ya, those foolish people that forgot to plan to have a job with insurance. Losers.

@Magiver

don’t like it, too bad.

Actually, I don’t like it because it points out that you are an inept debater. But if that’s OK with you…

[Magiver]

@Euphonious Polemic

In British Columbia, An individual who needs emergency surgery does not go on a waitlist. (I know this from personal experience)

I think that’s a given. Emergency surgery is taken care of in all countries. Triage is the driving force behind delays when there is a shortage of care.

@Euphonious Polemic

Among the non - emergency surgeries:

97% of Urological surgeries were completed after a 3 month wait.

Hip replacement? 47% completed after 3 months

Cardiac surgery? Half of all heart or cardiac surgery in B.C. is done on an emergency basis and without delay. For the rest, median wait of 7.9 weeks.

surgical wait times

I wonder if you could point me a site listing wait times for patients in the United States who do not have private insurance? My google-fu does not seem to be helping me here. I guess that’s another benefit for having public healthcare - the public in BC TOLD the Government to post waitlists for all hospitals so they could be accountable.

Well, it’s tough to post delay’s if they don’t exist or they’re so short as to not be a point of contention. I’ve never had a procedure delayed, ever. That’s not to say they don’t exist but the stuff you posted above is not necessary. 8 weeks for non-emergency cardiac operations? What the hell is a non-emergency cardiac operation?

I’ve had delays getting to see certain specialists but in such cases I just reschedule with someone who can see me right away. I expect really unusual surgery to be limited to the first wave of surgeons to learn the technique but the stuff you listed above is routine. I had to wait an hour for my urology surgery. A friend of mine is getting gall bladder surgery in less than a week of scheduling. I don’t know anyone who’s had to wait for a medical procedure that is anything like you’ve listed above. But your non-emergency wait of 7.9 weeks almost killed a friend of mines father in-law (Canadian)… They dicked around and he had 2 massive heart attacks. All he needed was by-pass surgery.

There aren’t that many truly uninsured adults in the United States. These are the people we need to concentrate on and I think the process, if done right, will bring down costs for everybody. The poor won’t care how much it costs but I suspect a national health insurance policy will remove Medicaid and produce something more streamlined. It will be a win-win to get them out of the emergency room for routine care.

[Magiver]

@carnivorousplant

A rose by any other name. I want poor folks to have health care. I do not want them to go into debt for it.

Well so do I. Where did I say I didn’t.

[Magiver]

@Euphonious Polemic

Ya, those foolish people that forgot to plan to have a job with insurance. Losers.

No, I mean the people who go through life without doing any financial planning. If you want to assign names to them go ahead. But I still want them to be able to pay for health insurance. Thus the discussion. Here’s an idea, why don’t you post something useful to discuss such as methods of controlling costs or mitigating drug contracts. I might actually talk to you instead of at you.

@Euphonious Polemic

Actually, I don’t like it because it points out that you are an inept debater. But if that’s OK with you…

If using iconic words to express a concept bothers you then there is nothing to be said besides too bad.

[Ravenman]

@Magiver

$20 for the doctor, $4 for the prescription.

When I was in Britain, I paid five pounds for prescriptions, and I don’t recall ever paying a doctor’s bill.

Roughly $8,000/year

Which is not only 40% higher than the per capita cost of healthcare in the US (congratulations, you’re already subsidizing other people’s doctor visits!), but a hell of a lot more than the $1,800 per capita cost of healthcare in the UK.

Yes/no By law I’m guaranteed coverage options for 18 months.

As long as you can afford both your share and your employer’s share of the premiums.

changing insurance, yes.

Wow, it would suck if a sick person had to change jobs and health insurance. Since the UK’s system has virtually no copayments, is substantially more cost efficient, doesn’t have massive cost changes for the insured if they lose their job, and doesn’t allow people to be denied coverage because they may be sick, how can you say that your insurance is superior in every way to the NHS?

I have immediate access to a large choice of doctors, specialists and hospitals. I think the main difference in argument is cost and availability.

If someone who lives in suburban or rural America says that he paid $300k for a 12,000 square foot house with a four car garage and swimming pool, and then goes on to claim that because of this, housing in the US is superior to anywhere else in the world, he should be laughed at. I’m not saying you have a bad health care plan (though I think you and your employer are probably paying far too much), I’m saying that just because you enjoy decent health care doesn’t mean that there isn’t a hell of a lot of room for improvement.

The goal should be affordable health care. People hear UHC and think it’s free. It’s not. Let’s put the cost on the table, make it affordable, and let people choose their policy.

The goal of health care should not be limited to low cost, otherwise Mexico and Cambodia would feature perfect health care systems. There’s also the moral goal of making sure the sick are helped in an economical and humanitarian way. As it stands, the US pays roughly 50% more in health care costs than the next highest-spending country, and more than twice of the average highly developed nation. That’s not economical at all, in fact, it speaks volumes that the concept of using market forces to promote access to care isn’t working. And I challenge you to find anyone who says that universal health care is free. That strawman is attempting to obfuscate the easily understood notion that universal health care has a different funding mechanism that doesn’t require people to buy surgery like might a commercial product.

No, that’s not rationing.

Health care is a scarce resource. Scarcity has to be managed in some manner. In the US, it is by cost. In other countries, it’s generally managed through priority lists. And, as far as I recall, there’s nothing prohibiting people in Britain from spending their hard-earned cash to buy private insurance that’s better than the NHS. If you don’t want to pay more, you’re guaranteed a certain, pretty high standard of care. If you want to pay more, knock yourself out, and you can get all the doctors you want to buy. What’s wrong with that system?

[Magiver]

@Digital Stimulus

I came across this (rather skimpy-on-fact) article from ABC News: The Health Care System I Want Is in France. Just tossing it in here as related info.

Well that’s about what my doctor charges for the same service. I did go to an emergency room years ago for stitches and the cost was substantially more. Now we have urgent care centers that partially fill the gap between doctor’s hours and I’ve also gotten stitches there too but I don’t remember the cost. I’m assuming it’s somewhere in between.

If Medicaid is rolled into a national payor plan then emergency rooms would be less crowded (which currently is a result of a limited number of doctors accepting Medicaid).

[Magiver]

@Ravenman

When I was in Britain, I paid five pounds for prescriptions, and I don’t recall ever paying a doctor’s bill.

OK, either you didn’t pay taxes and you were poor (which we cover in the US) or you paid taxes and did pay for the service.

@Ravenman

Health care is a scarce resource.

Not in the United States. No way.

@Ravenman

f you want to pay more, knock yourself out, and you can get all the doctors you want to buy. What’s wrong with that system?

I think if you’ve read through my posts I’m interested in a system that streamlines costs, covers everybody, and maintains the same standard of care. I can’t imagine waiting months to get kidney stones removed or heart by-pass surgery. I had a friend who had that surgery and he looked like death warmed over when he was diagnosed. He was in and out in a week after diagnosis which in itself was less than a week.

[Euphonious_Polemic]

@Magiver

Well, it’s tough to post delay’s if they don’t exist or they’re so short as to not be a point of contention. I’ve never had a procedure delayed, ever.

Just to be clear - are you saying that someone on medicaid has exactly the same access to medical facilities and procedures as someone with top-notch private insurance? That there are no delays for things like hip replacements for medicaid patients? Because you’re never had a procedure delayed, therefore wait lists in the US don’t exist for anyone?

Ravenman was quite correct in saying:
“Health care is a scarce resource. Scarcity has to be managed in some manner. In the US, it is by cost. In other countries, it’s generally managed through priority lists.”

(and I don’t think calling someone “comrade” in a debate is similar “using iconic words to express a concept”. ha! that made me laugh!)

[Magiver]

@Euphonious Polemic

Just to be clear - are you saying that someone on medicaid has exactly the same access to medical facilities and procedures as someone with top-notch private insurance? That there are no delays for things like hip replacements for medicaid patients? Because you’re never had a procedure delayed, therefore wait lists in the US don’t exist for anyone?

I’m not aware of delays in medical treatment regarding Medicaid beyond whatever the government thinks is necessary treatment. Since Canada and the UK control the treatment protocol it would be safe to say the faster care found in the United States is better for the poor on Medicaid. I’ve also never heard of a Medicaid patient being turned down for procedures due to weight as the UK does for hip replacement. And no, someone on Medicaid does not have the same access to medical procedures than my private insurance. They are restricted by government protocol. I am not. I have a choice in the free market. Which is what I’m advocating in a national system.

@Euphonious Polemic

Ravenman was quite correct in saying:
“Health care is a scarce resource. Scarcity has to be managed in some manner. In the US, it is by cost. In other countries, it’s generally managed through priority lists.”

No, that’s not an accurate statement. If medical aid is rendered, then it is not rationed nor is it scarce. You’re confusing cost with availability. People from Canada and the UK travel to the US to get services that are delayed unnecessarily in their country. If you have to go a year before getting a hip replacement that is a scarce resource. If you get it taken care of in short order and charged for it without insurance that is a financial burden. They’re both painful in their respective ways. And again, for the umpteenth time, I’m advocating a better system than what is currently available in the US.

[Gorsnak]

Health care in the US is most definitely scarce in the sense used in economic discussions. People want more than they’ve got. Virtually everything is scarce in the economic sense, and is rationed in one way or another - in most western countries for most goods, simply on the basis of “you don’t get if you aren’t willing to pay for it” which is rationing of a sort. Most western countries have chosen to ration health care differently, though, and even in the US it’s not quite that straight forward.

[Voyager]

@Magiver

We already take care of the poor, the elderly, and the children of the near-poor. Plenty of care to go around. If the near-poor are required to purchase insurance then the overall cost should go down which will benefit us all.

So, you’re denying that there is a problem? Are you saying that the working poor don’t purchase insurance out of obstinacy or something? Generally, the reason for requiring insurance of everyone is to include younger, healthier people who can afford insurance but are willing to bet that they don’t need it in the pool. For the working poor, the proposals are to subsidize their insurance, which will not be cheaper. They also often have families, who will use up at least their share.

That people are forced to go to emergency rooms for normal care, or put off care entirely, shows that we are rationing care.

Yes comrade, I object to government allocation of resources. It leads to rationing which is completely unnecessary. There is no reason why I shouldn’t be able to purchase health care at market prices. The point of this discussion is really about the near-poor adults who have problems getting catastrophic health insurance.

The best solution would be for every person to get all the coverage they want at reasonable prices. But, not being either a Commie or an equally unrealistic radical right winger, I know that won’t happen. Plus, offering catastrophic care insurance but not preventative care insurance is just stupid, since it means problems that can be solved cheaply explode into expensive ones. We need both types of coverage.

[Voyager]

@Magiver

No, that’s not rationing. That’s being poor, or planning poorly depending on the circumstances. As has been pointed out in this thread, people get the treatment they need and then are handed a large bill. Nothing was rationed. As I’ve already stated, this is a discussion of the near-poor adult who has trouble getting insurance.

Rationing definition, from google define: rationing

The allocation of product among customers during periods of short supply. When price is used to allocate product, it is allocated to those willing to pay the most.
schools.cbe.ab.ca/logistics/r.html

Hmmm.

don’t like it, too bad. It was in response to the idea of reallocation of resources by government fiat. It fits perfectly with the 1950’s mentality it was meant to portray. But you are right in that reallocating resources has no place in this discussion.

Oddly enough, I was a registered Republican until two years ago, and 2000 was the first year I voted for a Democratic candidate - and I voted for Nixon in 1972. I was a long time subscriber to the National Review, and I worked for Conservative Party candidates in NY in 1966 and 1968. But it has become clear that conservative dogma just screws our economy and our people, so I’ve seen the light. So keep your snark to yourself in GD.

[Voyager]

@Magiver

No, that’s not an accurate statement. If medical aid is rendered, then it is not rationed nor is it scarce. You’re confusing cost with availability. People from Canada and the UK travel to the US to get services that are delayed unnecessarily in their country. If you have to go a year before getting a hip replacement that is a scarce resource. If you get it taken care of in short order and charged for it without insurance that is a financial burden. They’re both painful in their respective ways. And again, for the umpteenth time, I’m advocating a better system than what is currently available in the US.

Gee you said yourself

@you

If Medicaid is rolled into a national payor plan then emergency rooms would be less crowded (which currently is a result of a limited number of doctors accepting Medicaid).

Emergency room care is more expensive. Waiting for hours to be seen is going to keep some people away, not to mention that no one is going to go to an emergency room for a checkup. Looks like rationing to me.

BTW, you are paying more taxes for healthcare support than Ravenman.
Cite

@article

In 2005, per-capita spending for health care in the U.S. was US$6,401; in Canada, US$3,326.[5] The U.S. spent 15.3% of GDP on health care in that year; Canada spent 9.8%.[5] In 2004, almost 70% of health care spending in Canada was financed by government, versus 44.7% in the United States. Total government spending per capita in the U.S. on health care was 23% higher than Canadian government spending, and U.S. government expenditure on health care was just under 87% of total Canadian spending (public and private).[6]

So, we’re spending almost $3,000 a year of our tax money on health care, and another $3,000 in private costs, each almost double what the UK spends in total. I got it. Like Mr. Bush, you are a big government advocate in sheep’s clothing.

[Magiver]

@Voyager

Rationing definition, from google define: rationing

Quote:
The allocation of product among customers during periods of short supply. When price is used to allocate product, it is allocated to those willing to pay the most.
schools.cbe.ab.ca/logistics/r.html
There is no shortage of health care and therefore there is no premium cost associated with a shortage of health care. To say there is a shortage of care implies that hospitals are full. That may be true in Canada or the UK where rationing actually occurs, but not in the United States. No amount of semantic word play changes that fact. A person who does not qualify for Medicaid but doesn’t have insurance still gets the medical care necessary to survive. They also get a hefty bill due to the lack of insurance. Which, ironically, is the point of this discussion. Your party affiliation may have some relevance in another thread but it’s really not germane to this one. What we’re discussing is health insurance for everyone. Not care, insurance. The care already exists.

[Sevastopol]

That the private health providers and other organs of profit will fight tooth and nail using every underhand and devious tactic in preference to defeat the introduction of a public health system.

Plus, once its in, everybody sees the sense and nobody seriously discusses repealing it. And the vociferous opponents? They’ve moved on to other PR clients.

[Ravenman]

@Magiver

There is no shortage of health care and therefore there is no premium cost associated with a shortage of health care. To say there is a shortage of care implies that hospitals are full.

Look, every goddamn thing on earth is a scarce resource. Water. Diamonds. Cocaine. Humans. Doctors. The scarcity is managed by prices. It costs a lot of money to become a doctor, so not everyone can become a doctor, so doctors generally get well paid because not everyone is a doctor.

If you can’t acknowledge that health care is a scarce resource then you seriously need to take economics 101. And if you are so uninformed of economics, why should anyone take seriously your circular argument about “if can’t change anything about the US other than to magically lower costs, then everyone will have health insurance so long as they buy it!”

[Euphonious_Polemic]

@Magiver

I’m not aware of delays in medical treatment regarding Medicaid beyond whatever the government thinks is necessary treatment. Since Canada and the UK control the treatment protocol it would be safe to say the faster care found in the United States is better for the poor on Medicaid.

I think we’re talking apples and oranges here.

You seem to be saying that there is no delays for EMERGENT medical care for anyone in the US. This is not surprising, and it is good. I’m sure that there are very few cases of people in the US left to die after a car accident because they have no insurance.
There are also no wait lists for emergent care in Canada. Have a heart attack? You get treatment right away.

However, I’m talking about wait lists for other, non emergency procedures. There is lots of discussion in Canada about waiting lists for these procedures. There are now sites that list wait times for various procedures in hospitals (see my previous cite)

What I want to know is: What are the wait lists for non-emergency procedures for people in the US with no insurance? Procedures that improve quality of life, such as Cardiac valve replacement, hip replacement, prostate surgery for incontinence, etc. I really cannot find any information about this. I don’t believe that someone with no insurance gets the same access to these treatments as someone without.

I get a little ticked when people trot out "wait lists’ as an argument against universal health coverage, but then do not compare equivalent wait lists in the US.