IMHO, the best sort of system I have seen is where the government provides a base level of service and lets the free market sort out the rest. The govt pledges to spend $X per person, and any free market enterprise gets $X subsidies per subscriber. Therefore, you get the level of service you can afford but always have a saftey net in case you are poor.
This is more of a debatable than a factual question, so I’ll move this thread to GD.
bibliophage
moderator GQ
No matter what system you decide on, there are going to be trade-offs. There is no free lunch.
The current system maximizes the supply side. We get the most new drugs, new treatments, and a doctor on every corner, just like a McDonald’s. All of the best doctors want to come here to the US to practice.
On the other hand, not everyone has the access they need.
One solution would be to STOP government interference, not make more. People forget that the government created the HMO mess, and the government created the massive inflation in health care. We should be moving in the direction of less government in health care, not more.
It’s the one thing that hasn’t been tried. We already have the examples of several other countries moving to almost fully government-run systems, or systems of mandatory insurance with it subsidized for the poor. Add in price controls, and a supply problem starts to present itself, and it will only get worse. For one thing, budgets are stretched. Pretty soon, governments will have to start playing God and deciding who lives and who dies.
I hear this all the time when talking about universal healthcare. Why are the waits longer?
- Is it because there are fewer doctors per capita?
- Is it that each doctor sees fewer patients per day?
- Is it that more people have access to healthcare?
- Is healthcare utilized more by people covered?
- Is there some other reason I can’t think of?
The waits are probably caused be a combination of the above, but which is the biggest contributor?
If it’s 1) or 2), then why? Are docors paid less (making doctors less motivated and not drawing the same numbers)? Is there more administrative overhead (making doctors less efficient and driving them away)?
If it’s 3), how would you justify your shorter wait when it’s only shorter because someone elses wait is infinite. (for the record, my uninformed guess is that this is the biggest factor in longer waits which is why I’m for universal healthcare. I don’t feel comfortable telling someone that they can’t see a doctor at all because I want to see one faster).
If it’s 4), then why? Do doctors refer patients to specialists at a higher rate in universal healthcare than the US system?
It’s a simple fundamental law of economics. When prices decrease, demand increases.
In Canada, the price is zero.
Not to mention, doctors don’t make as much money in Canada.
There is also little incentive for an enterprising person to start a business in the health care field, since the risks are much to great and the potential reward is not commensurate with that risk, as it is in the US.
If you can make the same profit opening a burger joint as you could opening a heart clinic, why in the world would you open a heart clinic?
And thus you have 11 heart clinics in all of Canada, compared to over 700 in the US.
Please produce a cite for this, or cease your ignorant rambling.
This is untrue: it neglects the fact that national healthcare systems do not rely on entrepreneurs to start up hospitals, clinics, and health centers (and also ignores the thousands upon thousands of people who work in them of their own free will).
THat’s true of any nationalized industry. And anything that’s nationalized always produces less than a system that is not.
Now, back to the heart clinics thing, while I continue to search for my cite, I do have another one related: MRIs. In short: if you want an MRI in the US, you get it right away. In Canada, you better take a number:
The median waiting time in Canada from referral by a general practitioner to treatment was 16.5 weeks in 2002 – up 77 percent from 1993. For cancer patients, waiting times for medical oncology have increased from 2.5 weeks to 5.5 weeks and for radiation oncology from 6.3 weeks to 10 weeks. In the United States, the waiting time is a week, and that long only because of the need to deal with paperwork.
Canada is even farther behind in other technology. In 2001, Canada had only two functioning PET (positron emission tomography) scanners for its 31 million people, or one for every 15 million residents versus 250 such machines in the United States, or one for every 1.1 million residents. Such scanners are particularly vital to women suffering from breast cancer as they are 80 percent accurate (and even better than MRIs) in determining whether the disease will recur. As Dr. Sandy McEwan, an Edmonton-based oncologist told the National Post back then, “Because there are so many therapies for breast cancer, it is very important that we know exactly where we are managing patients. What is the cancer? Where is it? How is it responding? Because if we get it at the beginning of a failure of response, we can change to treatments that we know work very well.”
As far as prescription drugs are concerned, you can ask the patients who recently took advantage of a bus trip to Maine organized by Consumer Advocare Network and Dr. Tony Lordon of St. Johns, New Brunswick what Canadian price controls have meant to them. Provincial health ministries in effect denied them the treatments their doctors say they need for diabetes, cholesterol, and depression. They were forced to travel to Maine to get them. Other Canadians have waited years for new medicines readily available in the United States to combat such debilitating illnesses as rheumatoid arthritis and hepatitis C because of the way Canada tries to control drug prices.
Supporters of the system say that delays brought about by price controls and other measures are needed to keep health care affordable. “If the costs of hospitals and physicians are to be controlled, there will be continuing complaints about longer hospital waiting lists and the absence of the latest technology. There is increasing evidence that Canada should accept these problems,” wrote Jane Fulton in her 1993 book Canada’s Health Care System.
Perhaps. But only because in many cases those Canadians who can’t afford to wait can cross the border to take advantage of the wonders of America’s health care system. Ontario sent nearly 1,800 cancer patients to the United States over 13 months in 1999 and 2000 at a cost of $20,000 each. Thousands of others make the trip on their own to take advantage of modern prescriptions and diagnostic tools.
Provide the cite you were asked for, or STFU. Don’t dodge the issue.
And your latest quote, which you posted as though you wrote it yourself, is a from a U.S. right wing propaganda organization. Any reason why we should believe it?
if you want an MRI in the US
That in itself is one of the issues. The general philosophy behind state-financed systems is that this is a poor use of resources, and that use of an MRI - or any other expensive procedure - should be assigned on the basis of best clinical judgement of the diagnostic usefulness, not the patient’s self-diagnosis that they want one.
My partner is a physcian from the U.S… We live in a small community in Canada where he has a general practice. He also works in our local ER and takes care of patients in hospital. He is in Canada because he will never have to refuse treatment to a patient who cannot pay.
I manage his office and agree that there are long waiting lists to see specialists and for some scans. If a case is an emergency or considered urgent by the referring Dr. they are often seen within a week. Scans such as MRIs and CAT scans are also assessed and scheduled in order of urgency.
This system is by no means perfect, it can be incredibly frustrating for the patient and the doctor. It also encourages incredible wastefulness. Minor illnesses that our grandparents dealt with effectively at home are now issues for the ER. Earaches, sniffles and ingrown toenails tax our public system. On the other hand each case is assessed equally and no person is denied treatment because they can’t afford it and families don’t mortgage their homes every time they add a member.
Sorry folks, no factual citations, just my thoughts.
One way to look at is is that if a certain level of health care is not available to all, regardless of income or their ability to contribute to society there will be problems such as epidemics that affect even those that earn the most. What is more, if every mother to be has access to good prenatal care and all children have access to some level of health care then there will be fewer people who can’t contribute to society because of the effects of disease. Also some believe that a mother’s health and nutrition contribute to longterm health of her offspring. As a whole, a society may be able to devote less of its resources to health care if it invests in some healthcare for eveyone.
Universal healthcare would mean that fewer people will have their lives ruined because there is an extrordinary health crisis in their family. If Mrs. Jones has cancer and that eats her entire savings, her children may not have enough to go to college or even eat. Suddenly, you have people that could possibly made much greater contributions limited to what they can do without education. They may even suffer malnutrition and chronic ill health from the after affects of malnutrition. People who would otherwise have supported themselves and others are then a burden on society.
10 years ago, the collapse of universal care in industrialized nations was predicted in a discussion I had elsewhere. In a recent discussion, all I found was that all the cites presented against it, only showed efforts to improve those systems; not to eliminate them for a totally private one. I agree: there is no free lunch, and some systems out there are bad, like in Spain, but as in the Spain case, it is mentioned that Spanish people go the Netherlands to get care, guess what they have in the Netherlands?
And this is something many forget in discursions like this one: in many of those countries, like the Netherlands, private health care is there! It is only that there is universal access and less overhead costs. While here, we do not have universal access and we spend more in overhead.
10 years after that discussion, we in the US still have much more than 40 million Americans without healthcare. The cost of diseases not being taken care off in a timely manner (even with the so dreaded delays) is costly for the rest of us.
In addition, in an era were bio terror is a possibility, not being able to identify the focus of infections in a prompt and complete way; may show too late that this idea of opposing universal care, is protected mostly by ideology rather than practicality.
Do we have to go over every detail again? Without health insurance is NOT the same as without healthcare. No one is without healthcare. We simply choose to go, or not, to a doctor while taking into account of the costs of doing so.
Recognizing that healthcare in America is too expensive is NOT the same as proving that the government should pay for it. Certainly government has a role, but saying that 40 million people don’t have health insureance is a far cry from saying that the government should buy it for them.
And you have still not noticed that even acknowledging that, the result is the same: universal care in those countries also doesn’t mean you have to be insured, what counts therefore is if everybody has access to care.
Also, that everybody should not live in fear of the cost when they are forced to get care. And to accept sometimes that care will be denied, but it will then be based on your health condition, not just your economical one.
You can Enron it all you want; it is still a bad deal for all not to have universal health care.
“Universal health care” doesn’t have to mean that the government runs everything. The elderly are universally covered by Medicare, but the government doesn’t run hospitals for old people.
One model that some people point to is the one that U.S. federal employees enjoy now. Federal employees can freely choose their health insurance coverage from among a large number, maybe dozens, of private plans, including a variety of tradtional, preferred provider and HMO choices, and each choice usually offers additional choices of deductibles, exclusions etc. The employee pays part of the premium, but the government picks up a big part of the tab, just as any large (and responsible) employer would. The insurance companies compete to offer the best coverage at the lowest rate, and employees can change their plan every year if they feel like it, which creates an incentive for the companies to keep the customers happy. The government screens the plans to be sure that the companies are legitimate, that the policies meet minimum standards, etc. But the contract is between the insurance comany and the customer.
One of the biggest problems in American health care is that most people receive their medical insurance through their employers. If you are an executive with a Fortune 500 company, you’re probably quite happy with your coverage. But many employers either don’t offer medical insurance at all, or offer one non-negotiable package, or set difficult standards to qualify for coverage, or just charge too much (without naming names, the nation’s largest employer, founded by an Arkansas businessman who died a multi-billionaire, is especially notorious for the way it deals with its employees’ health coverage). The customer can’t shop for medical insurance the way he might shop for car insurance, or for other products and services.
A reasonable solution would be to standardize health care insurance packages and make them available to everyone, much as the federal government does for its own employees. Essentially, everyone would be included in one coverage pool. Let the companies compete for business based on price and service, and let the customer make a contract with the insurance company as an individual, without the employer’s direct involvement. Then subsidize the premiums based on an individual’s income. To hold costs down, the subsidies might be structured to reward people who choose, say, higher deductibles. People with no income would still get to choose a basic policy that would be paid for by the government.
A program like this could be paid for by a tax on all employers, just as all employers pay social security, unemployment etc. This would also reduce the competitive advantage that employers who don’t provide coverage enjoy against employers who do try to provide decent benefits.
This wouldn’t be a perfect system, but it would increase competition among insurance companies and would get everybody covered. And overall, I’m not sure that it would have to cost much more than the system we have now.
If health care should be equal, why not extend that to food? SHould people be denied quality food simply because they cannot pay? How about clothing and shelter?
Of course, even in the US, we make sure everyone has these things. At no point does it involve making sure NO ONE pays for these needs directly. That makes no sense. And it is economically unsustainable. Canada has been cutting service for years, and it will only continue.
Colinmarshill, more accurately, it’s like saying a car is serverely lacking because it only has a **seat belt **for the wealthy driver, and the other passengers have to pay to get their own and accept death if they can’t afford one.
so you prefer having big business playing God and deciding who lives and who dies?
I’d rather suffer pain and wait for 3 or 4 months for a procedure that I cant afford ;it’s better than waiting forever, suffering the pain unitil I die, because I 'm not rich enough for American-style care.
slight hijack–
in the USA, it is common for people to hold a job, not for the salary, but for the health insurance that the company provides.Why do americans all assume that it is the employers responsiblity to give you health care? Your boss doesnt pay your car insurance, or your house insurance, --so why does he have to pay for your health insurance? I have asked several Americans this question, and they were totally shocked–it had never occurred to them that there might be any other system.