What should "national health care" be in the USA?

Great Debates
81

50 years ago it didn’t cost over $4,000 for emergency care only for a broken leg, which is what it cost me 7 years ago, when I broke my leg while uninsured. Before you ask, I had just gone from one full-time job to another full-time job and was 2 days short of the insurance kicking in on my new job.

I have never collected unemployment in my life; the only times in my adult life I’ve been without a full-time job were when I was pursuing higher education full-time, and even then I always had at least one part-time job as well. Luckily after the 2-day period, my insurance covered preexisting conditions (only because they were required to by IL law), or I would have been facing over $100k in surgeries (4 of them) hundreds of hours of rehab, hospital stays, etc. I would have had to declare bankruptcy. I wasn’t eligible for COBRA, because my employer was too small to be covered (8 employees).

A broken leg is not a terribly sophisticated thing to fix in terms of high-tech equipment; I never even had a blood transfusion through the whole mess. We’re not talking about organ transplants or rationing of sophisticated equipment here. Lots of other diseases, like asthma, are extremely common and cheap to treat, until they get to the emergency stage; a generic albuterol inhaler runs less than $10 retail, and yet kids end up in the ER all the time with untreated asthma attacks, especially poor kids, and even die of something easily and cheaply preventable. Can’t we, as possibly the wealthiest society on the globe, do better?

82

Can you give me a cite for this? I have done some searches and only found a few articles in German which indict that system for having waiting lists. The only comparisons I’ve found have indicated that it is the “private sectors” of these other systems which reduce the waiting lists.

83

If health care were paid for mostly by a government agency under nationalized medicine, would the government, to cut costs, limit the amounts of payouts and attorney fees when malpractice
suits arose? And if so, why doesn’t this happen now? Aren’t high malpractice insurance premiums (as well as law suit settlements) oneof the reasons medical treatment is so high in the first place?

84

Seriously dude, how many times do I have to mention in this thread the times my family went through when my dad was unemployed for a year at a time and we went without health coverage? How many times do I have to mention that I myself go without insurance? I’m not asking anybody to just give me insurance because I don’t have it, I’m not demanding someone provide it for me.

I never said people in hard luck situations were all losers. I said that people in those situations can and do get by just fine without insurance all the time, and cited multiple examples of times that very thing happening to my family, and my own personal situation. Have you been paying attention to this thread, or did you just throw my name in there for kicks?

Guess what, some people have difficult times, tough them out, get over it and move on with their lives. Alot of people seem to think something like “if the successful people only knew what it’s like to be down on your luck, they’d be all for government safety nets.” Even you seem to have a certain conceit about having been dirt poor, as if it gives you arcane knowledge nobody else posesses. I’ve never been as down and out as you, I grant you that, but I haven’t lived in an ivory tower floating in the clouds above some lily white suburb, either.

The knowledge that some people end up in tough circumstances through no “fault” of their own does not automatically clinch the argument that those people should be supported in various ways by the government practicing wealth redistribution.

As for Eva Luna’s point about prevention, I again fail to see why insurance coverage has anything to do with prevention. As I mentioned earlier in the thread, if all you’re using insurance for is to get the co-pay for reduced price regular checkups (thus to prevent disease before it becomes a big cost), then you’re actually losing money buying the insurance. The premiums are more expensive than the checkups. So if prevention is your concern, health insurance isn’t the solution.

The solution would be to set up a series of checkups for schoolkids. Much like school districts offer vaccinations (and sometimes require them) that are given right at the school, the district could also check kids occasionally for signs of asthma, or any other such disease that could easily be prevented. They could have better staffed nurse’s stations in the school, encourage doctors to volunteer a day or two each month for appointments with the kids. Or local government could subsidize some clinics that would offer cheap checkups in poor parts of town. All those would go a long way towards preventing costly disease without introducing a comprehensive government insurance plan.

85

The problem of just relying on your personal accounts is that it makes you to miss the big picture:
http://www.usnews.com/usnews/nycu/health/articles/021014/14uninsured.htm

Again, you are just lucky now RexDart, my point of raising prices for everybody else that does pay insurance, is applied to the uninsured ones that become unlucky; and unfortunately you are from that group. I thing is notorious that people like me are willing to press for universal health care to benefit even people like you when the need will arise.

Your position requires that people like in the article be ignored, problem is, they also have workers that depend on the business they have. As I see from the article: we can add now job losses as a price we are paying for the current lack of national health care.

86

Apologies for merely posting a drive-by, but I feel that with all this talk of freeloaders and deadbeats it should be remembered that it is increasingly the working poor who cannot afford to go to hospital and that, in any case, unemployment is deliberately kept non-zero in order to control inflation, ie. there aren’t enough jobs even for those desperately seeking one and even then you might not afford the healthcare available to the poorest of the poor in any other industrialised democracy.

87

I have to ask for a cite on the first 2 points. I have not been able to find good data on either the failure of the market or 70 million uninsured.

But more importantly, what exactly about socialized medicine would fix ANY of these problems. Can you cite any statistics which indicate that socialized medicine leads to more medical access for working poor or that it does not kill as many jobs (through higher taxes) than in creates? I’ve seen lots of anecdotes in this thread and some numbers regarding life expectancy and infant mortality. But nothing more useful than that. Is anyone able to prove that one populations health is greater than another, and that any of this difference is due to health care as opposed to life style?

Also, I’ve read a lot of anecdotal evidence and personal stories suggesting that health care in America is dying, failing, imploding, or even cruel. But I’ve not seen any statistics besides uninsured numbers to back this up. Can any of you cite statistics indicating that Americans are not able to get health care?

Better than statistics, though, could you explain the mechanism by which socialized medicine would magically make health care cost less? Assume for a moment that a nationalized health care system would not ration care. That it would pay for access for everyone at any time. What are you going to do when the expenditures begin rising? I assume you think this will be an entitlement like welfare or social security? Of course, this means that it would be another huge portion of government spending which is “off the table” as far as cutting expenses is concerned.
From links on this thread and my own googling, I have not found any socialized medicine system which is anywhere near the perfection suggested by advocates. They all have their own problems as big or bigger than ours. The problems are simply more nationalized. That is there are fewer entities to complain to. Of course this also means that there are fewer entities to fail. And fewer entities to take up the slack.
This whole issue is much more complicated than our discussion has let on. The costs of medical care in other countries where it is nationalized are often hidden making them difficul to comapre with those of the US. Meanwhile, our system is so devoid of national management as to make the concept of a US National Health Care system almost a non sequiter. Measuring the effectiveness of a health care system cannot be reduced to life expectancy and infant mortality. Too many other factors influence those statistics. Too much of the argument for socialized medicine has relied on the equation of uninsured with unhealthy, and that is far from proven.

88

The article I linked to stated only 44 million, but that this had, worryingly, risen by 10% (4 million) in just 4 years.

As for the other point, “failure” here is what the entire debate hinges on. That 44 million people effectively have no healthcare is failure itself from a European, Canadian, Australian or Japanese standpoint.

You need a citation which shows that should any British person break a bone, have a heart attack or develop cancer they are guaranteed treatment without incurring any debt? I’m afraid you’ll just have to believe me that this is the case. Granted, the quality of such care might not equal the very best US hospitals, but the differences are small compared to the obvious effect of not having any treatment at all.

Socialised medicine is enormously expensive. As the article states, it would require massive economic upheval in America. But if the option is allowing 44 million people to risk death from treatable conditions or go through the horror of selling one’s house to pay for such treatment, I regard its absence as morally bankrupt.

89

It seems to me that pkbites is playing the typical greedy so-and-so who is clinging to the idea of personal responsibility because it benefits him, and Most Everyone Else are playing the typical bleeding hearts who cling to ideas of social responsiblity and broad cost-benefit equations because they benefit themselves and others.

Why can’t we have a system that addresses both of these values? That is to say, just have a system with certain objective (and arbitrary) rules for who is and who is not deserving. Certainly the devil is in the details and I would never imagine that our Congress could agree on these rules, but let’s just imagine that we could construct some. Let’s further assume perfect information about a person’s life activites.

There’s going to be a spectrum of Deserving Individuals and Undeserving Individuals. Certainly we want to start from a presumption that people ARE deserving, so in emergency situations we make mistakes in favor of saving people. After that, I assume we are going to put someone whose life accomplishments involve twenty liquor store robberies and the habitual murder of his children in the Undeserving category. I further assume that we are going to put someone who works 60 hours a week successfully developing new treatments for heart diesease in the Deserving category.

After setting the bounds of the spectrum, what do we use to fill it in? Where is the line drawn exactly between Deserving and Underserving?

-C

90

GIGObuster, that is a scary article.

Another thing is, often times the insurance one does have is crap. My dad was covered for years under a policy that didn’t cover jack-which is why my teeth are giving me such problems now-no dental insurance, and no way to afford going. I’m DAMN lucky that I’m still eligible for prescriptions under my parents insurance as it is-do you have any idea what it’s like to be Obsessive Compulsive and not have insurance?

We’re talking about people who work their asses off-NOT deadbeats, but good, hardworking people who are just barely scraping by. And then we look at them and sneer and say, “Sorry, not MY problem.” Well, you’re dead wrong. As long as we’re all human beings, it IS our problem.

91

http://www.nap.edu/issues/18.2/realnumbers.html

Here is a surprise: you have to take into account that those numbers come from more than 6 years ago, during better economic times, I am afraid today’s numbers are much worse and that is what I understood from the recent news that appeared in Yahoo news and elsewhere this year.

If you want to concentrate on the ones that do not have insurance, for a longer period of time, other reports mention 45 million; and that number is also is growing and from 2 years ago.

Anyhow, I think it is time to mention also that the big health care companies have other interests other than your health, particularly asinine is the money their CEO’s, get and the money they use to export their very “effective” privatization of health care to Latin America.

Not holding my breath to see defenders of the market complaining about money that should be used for the well being of their customers, used instead to lobby and advertise (most of the “great” defenses of private healthcare are coming from think thanks financed by those companies) to keep the status quo.

And, pkbites, the failure of the market is not something that you will see in a cite, it only becomes apparent after seeing the data: as time goes by, the market is not improving the access to health care.

Guin, I am happy to see that you had a way to keep your prescription going, as you know, a close relative of mine has the same. But in his case -while unemployed for several months- he was not eligible to get prescriptions. It was very hard to deal with that situation. I see the other side keeps ignoring that health insurance is not only for the sick, but also for the family of the afflicted.

92

OK, but where is the evidence that these 44 million people do not have medical care. No insurance, ok but no health care?

Also, it should be noted taht the 40 million number is hugely inflated. I forget which of the links it is, but one of them broke this down to a large number who qualify for aid but are not enrolled and another group with incomes (greater than 50,000) who don’t have insurance by choice for one reason or another. the number left the so called working poor is much smaller around 6 million if I recall.

But what form of treatment is it? If your assertions is that people die because they don’t have insurance, and that nationalized health care would fix it, then you should be able to show me statistics that show the waiting lists in England don’t kill people. I’ve seen a few that indicate otherwise. Particularly in regards to the survivability of certain cardiac procedures.

Well, first of all, I do believe you. I’m just not willing to bet the medical treatment my grandchildren will need on that belief. I need far more evidence.
I’m not contending that the British health care is a little less than American. I am contending that it is woefully inadequate in comaprison.
Of course, you have yet to back up your claim that uninsured get no “treatment at all”. I contend that this is simply not the case. In the absence of such proof, your continued assertions are not aimed at getting medical care. They are only aimed at getting others to pay for it. IOW a little fear mongering in the name of the proletariate :wink:
Case in point :smiley:

I especially liked this from the article you linked from a british periodical:

Because their system would replace this sort of charity with laws limiting the amount of meidcal care such a hospital can give out.

This is an interesting argument by a doctor which mirrors mine.

This is a collection of links and synopsies to articles about the problems with socialized medicine. Anyone who thinks GIGObuster article was scary should look through this.

93

The problem, of course is that the article you linked to had no references at all. And I found this from the synopsis of the book written by the same person who wrote the article.

So which is it? If she is knowledgable enough to write the book and article, how is it that she uses such widely divergent numbers?

I did find one possible source of the confusion. One article I read mentioned that while about 40 million are uninsured, “another 30 million are underinsured.” Maybe some source simply compile these numbers.

94

That’s good. I certainly would not want any medical repurcusions from this debate :slight_smile:

And of course we all know that the governemnt would never wast money or spend it anywere except in the most efficient manner. :dubious:

OK, but America and the Britain have had different systems for abotu 50 years. Surely that is enough time to prove conclusively one way or the other? I contend that it is. Nationalized health care is failing. . We would be worse than foolish to adopt it. Especially since there are so many alternatives.

95

I already mentioned what you get from think thanks, but I already posted better numbers already.

You are just showing that one side has more funding and a bigger bullhorn, it does not follow that what they are promoting is not BS.

You where so predictable that I was ready with a cite from a private insurer that did use those studies:

http://www.id.regence.com/about/uninsured/primer/

And you are just blowing smoke now, all your complaints are based on telling everybody else to ignore the info, it is pathetic. The fact is that your links on the British troubles come from more than 10 and 5 years ago; taking that to today, I can deduce that those articles are overblown. And I conclude this because many of our British dopers have reported that -even with all that- today there is only an effort to reform, not to replace the system.

And pervert: repeating AGAIN the same blog link does not makes it true.

96

I have a number of comments and a number of questions I’d love to have answered.

First, the background:

I’m 32, employed, with good insurance. My husband is 43 and in very bad health. He’s covered on my policy. My employer pays for my premium, plus 75% of my husband’s premium. I pay $250/year, plus 20% coinsurance up to $1000, at which point the insurance kicks in. Prescriptions are a killer. We spend over $400/month on prescriptions, despite having insurance coverage. My husband recently got turned down for one avenue of treatment for his heart disease.

My questions:

What happens with malpractice in a government paid system? (Someone asked this, above.) Are awards limited in any way? If not, who pays the award? Can doctors afford to do business in the US at government rates if they still have to pay for malpractice insurance?

I’ve heard it alleged that some Canadian doctors are practicing in the US because they make more money here, and that this can contribute to things like waiting lists. First, is this true, and second, what would happen if the US became nationalized, since there is no handy privatized country for doctors to flee to?

My comments, most of them self-serving and bitchy:

I have wasted money, hours, days of my life attempting to deal with insurance companies and billing offices. I’ve had nasty little bitches at doctor’s offices submit my account for collection because they didn’t have an address or insurance information on file. I’ve had claims go missing, claims left unpaid, and claims denied. I’ve had the insurance company overpay then demand their money back, and the insurance company underpay and refuse to fix it. So, at this point, what do I want?

I want all of these people to lose their jobs. I want the hassle gone. I am willing to pay for healthcare. I’m just tired of paying these assholes to be assholes. I’m tired of them making mistakes while I’m the one who gets burned. Will a government system help me?

I’ve had charges of $220 for a doctor to sign a paper discharging my husband from the hospital. I’ve had charges of $200 for office visits that were solely to get refills. I’ve had bills from ambulances charging $150/mile. These are ridiculous prices. Will a government system help me?

I’ve been denied a $13,000 treatment when the only option is an invasive $75,000 treatment. Will a government system help me?

My husband is on disability and will be eligible for Medicare in about 16 months. Will a(nother) government system help me?

My employer pays a huge chunk of money on insurance, and since I’m a shareholder and it’s an S corporation, I have to claim that insurance money as income. Will a government system help me and my employer?

Julie

97

I’m still waiting for answers to my questions.

Is some minimal standard of health care a human right? If it is what is the most efficacious way to assure it?

Given that we have Medicaid which pays for healthcare for some of the poor, providing that they can find providers who will take it, we apparently believe that some standard of healthcare is a human right. We just provide for that right in a very inconsistent and haphazard way.

The bizzarest thing is illustrated by the jsgoddess’s post. Those prices are retail; only people who can’t afford it actually have to pay retail.

The insurance companies pay discounted negotiated rates to docs and hospitals and pharmacies and the insured pay their premiums and some fraction or copay of the charge.

You don’t got insurance and you don’t get that discount.

So you want off of full retail then you need insurance. So …

You skilled enough to have a lucrative enough job that you got insurance through your job? Good! Your company has gotten health insurance for you at a group discount. Or are you not so lucky to work for a big enough company or arren’t so skilled as to get a job that has health insurance? You want to buy health insurance on your own? Now YOU"LL pay full retail.

Talk about perverse, perverse.

I can dig and find the numbers I am sure. people put off getting healthcare and get it in expensive ways. But honestly it isn’t worth the effort. National healthcare won’t happen here. There are too many forces lined up against it.

So what are the alternatives? How can some minimal standard of healthcare be assured for all our citizens while allowing others to have a different standard if they so choose? Plans that have no chance of actually happening need not apply.

98

I’m not sure your post was directed at me, but I’m curious about a few things.

I’m sorry, And I don’t mean to be condecending, but I cannot understand these paragraphs. Are you saying that most sources are against socialized medicine? And that this means there is more money against than in favor? Are you dismissing numbers from think tanks? If you posted better numbers earlier I appologize for not seeing them. Could you post the time and date of that earlier post?

Thank you. This looks very much like the link I was refering to. I think the 70 million number is a compilation of the 40 or so uninsured and the 30 million under insured. Especially if you use a certain definition of underinsured. The section on demographics is most illuminating. Of course, the section of “drivers of cost” is even more so.

Especially interesting is the fact that nont of the top 3 issues would be addressed by nationalizing health care. And the 4th and 5th would increase. Can you tell me again how this is going to reduce costs?

This is a much more indepth discussion of health care costs and especially of the idea that 3rd party payers may be the largest problem.
Such as *

I’m very sorry if you got that impression. I don’t think I have ever recomended ignoring any information. I have questioned a couple sources. I tend to try and find sources which at least have bibliographies or mention where they get their information. I never intended to suggest that any of the information you posted should be ignored. If I did so I appologize.

I’m not at all sure where you get this. The last link I posted has a variety of links in it most of which are dated after 2000. And while one of my other links is from 1991, it addressed all of your arguments (and some you haven’t used) and looks at socialized medicine in many more countries.

Yes. But many of the reforms include increasing the privatization of the system.
Of course, the british have some unique proposals:
*

No one anywhere (except here in this thread perhaps) is advocating entirely scrapping a current health care system in favor of a totally new one.

99

Ah, it didn’t even take any work.

100

Well, Dseid,This is a description of the Singa pore system. I’m not sure it is what you are looking for, but it does seem to have many virutes.

For instance:

The link I posted earlier about costs contained this:

And this is a more detailed information about Medical Savings Accounts.