Why do some consider universal health care the yardstick of progress?

Great Debates
41

In fairness, Fierra is speaking of the UK system, of which she has some large personal experience with, not the Canadian system.

This not is generally correct from our experiences. Fierra herself needed “speedy essential” treatment for her failing kidney and they couldn’t even meet with her to tell her the results of her scan for several months afterwards. And any corrective surgery was to be scheduled so far in advance that it seemed very clear to the US specialists that she was in danger of losing a kidney. Apparently, the NHS doesn’t consider measures to repair a kidney to be “essential”. The way she was treated with her CO poisoning episode and acute kidney infection would have resulted in lawsuits if they happened here in the US. Fierra’s Nan had an “essential” gall bladder surgery delayed for two years, and only was admitted due to it finally being about to rupture, which required an emergency life-saving surgery. However, the health effects she suffered for the two years she waited ended up hurting her so much that her life was miserable, and she was in continual pain for that entire two years. The NHS response? “Sorry - there’s a waiting list. Maybe next year. In the meantime, we can give you more morphine.” :rolleyes:

Second off, people in the US without money do not get “tough shit”. My ex-SO is a doctor at a public hospital who is required by law to treat every single man, woman, and child who entered into the hospital, regardless of money, regardless of citizenship, regardless of status. And yes, this included giving free prescription drugs, and essential surgery. It is her claim to me, which I cannot present as an authoritative web-linked “cite”, that a person who walked in her local public hospital’s door and needed a kidney operation just like Fierra did and who was destitute or without insurance would, ironically, have recieved much faster treatment than a person on NHS in the UK.

In fact, one huge problem that hosipitals in California and Texas face is the large numbers of illegal immigrants who have no money whatsoever to pay for health treatment, yet must be given full treatment when they get to the hospital. CNN just ran a piece on how these hospitals are actually paying to fly illegal immigrants back to Mexico and paying for their full treatment in their local cities, to try to save themselves some of the burden of paying for the rather expensive treatments that are required.

As has been stated again and again, there is in fact a real problem in the US, which concerns the working poor. If you make nothing whatsoever, you are actually better off in some ways than if you fall into the “working poor” category, which, from my observation of years in the UK, perhaps 50% or more of the UK populace would fall into in the US. If you make under $40k or so and don’t have health insurance, you do have a disadvantage under the US system, as you must cover much of the whole cost of treatment yourself, as you have an “ability” to pay it. This may involve, in the case of catastrophic illness, doing such extreme measures as cashing in life insurance, 401k, taking out a second mortgage or actually losing your home. These people truly need some help.

For example - Fierra’s kidney was nearly a $40,000 surgery, after all, and had I not been able to cover her as a “partner” on insurance, we would have had to pay that amount out of pocket, which likely would have involved sales of houses and other bad things. Because we were technically “able” to pay it. This doesn’t mean that her surgery would have been delayed, it only means that payment time would have been a much more grim experience. Thankfully, due to insurance, we barely paid 1/40 of that amount. What did she get for that $40k? She got the best surgeons in the city, a little bitty scar that is less than half the size of the one she would have had in the UK, a recovery time that was less than half what it would have been in the UK, a new, clean room with only one other person in it (as opposed to a ward) with her own TV, phone, and nurse, and an actual hospital experience that was not that scary at all for her.

There is an actual problem with the US system, but let’s not trot out the “tough shit” and imply that treatment will not be recieved in the US.

42

I agree with you about cancer - everyone I’ve known who was suspected of having cancer was seen very promptly, sometimes even next day, by the specialist. But just about everything else takes forever. I’m not just talking about waiting lists for knee or hip operations, I’m talking about kidney operations too, with more & more damage being done to your kidney by the condition whilst you wait for the operation, or for them to send you for “just one more test” before they put you on the waiting list, even though they’ve already told you that you need the op (my personal experience of NHS waiting lists).

FTR, I was talking about the UK, which is where my experience is. I have no personal experience or knowledge of Canada’s waiting list length.

I was pleased to see you mention taxes though - everyone else seems to talk about socialised healthcare as if it were free. It isn’t, you’re still paying for it, just out of your taxes - the difference is that everyone is paying into the same healthcare fund (& since rich people tend to pay higher taxes in most systems, & often opt for a private healthcare fund, they’re subsidising it twice ;)).

The main reason I posted (& everyone please note, this was in GQ when I posted, not GD. I hate GD with a passion ;)), was that everyone was slamming the US system & making it sound as though everyone poor is allowed to die in the streets & the bodies stack up like cordwood for the winter (yes, I know that’s hyperbole, thank you). I lack sufficient knowledge of medicare & medicaid to protest it on those grounds, but I do have enough experience, from the personal end as a patient, and from reading the newspapers & seeing the hospital ranking lists for waiting list lengths, and seeing the scandals breaking about how multiple hospitals keep deliberately bumping people off the waiting list when they approach the 2 year government decided limit for poor performance so that they can meet the targets to know that the NHS is incredibly inefficient, and to believe, that the government’s stated aim of improving performance with those reports is being contradictory in effect - if people are being artificially bumped from the list, they rejoin it at the bottom & something that might have been a 2y 3 mo wait turns into 4 years or longer (& I don’t want to start a hijack on means of monitoring quality of service & targets, that was just an IMHO aside).

And to everyone demanding cites about my statement that the majority of people in the NHS end up on waiting lists for months & months or even for years, I am currently searching for cites on these waiting list lengths & scandals, but I’m not finding the specific ones I was thinking of. I am finding a lot of other more recent ones though -

http://news.bbc.co.uk/1/hi/health/3155940.stm - this one has a statistic in it saying that there are fewer than 200 people on the government records who have been waiting for more than a year to get an operaton, but I wonder when they’re measuring from - whether it’s from the time that they get put on the operation list, or from the time that the condition is comfirmed/investigated. Likewise, since there are other targets for other conditions given on the other news pages I’ve reached, I assume that is a 1 year guideline for that particular op type. The same article also includes this quote about a gentleman flying to India for a knee op as he cannot get it on the NHS in a reasonable length of time:

And this one from September 2003:
http://news.bbc.co.uk/1/hi/health/3132182.stm
where a hospital is refusing to accept any new referrals so that it can meet its government targets for seeing outpatients.

The NHS can work - http://news.bbc.co.uk/1/hi/health/3080124.stm this one shows a private heart hospital being bought by the NHS & reducing its waiting lists - and it now has spare capacity to offer to other hospitals/areas to try to reduce their waiting lists when they’re failing to make targets (target time for heart operations, which surely count as a necessary treatment requiring speedy treatments is 6 months) - sadly, rather than just offer the capacity, senior NHS officials are saying they have to consider it before offering it out.

Here’s another one about waiting times being breached: http://news.bbc.co.uk/1/hi/england/staffordshire/3092079.stm

Here’s an article about doubt over A&E (ER) performance targets being met - http://news.bbc.co.uk/1/hi/health/3122109.stm - I’d take it somewhat with a pinch of salt since it’s by an opposition party, but still. I’d also be interested in knowing what the government’s 4 hour target for someone to be dealt with in ER actually means - does it mean “seen & properly assessed by a doctor”, or does it mean “seen by triage nurse & left to wait & wait & wait”?
Anyway, from the fact that there are tons of articles about official waiting lists of 6 months for heart surgery being breached, ones for 1yr/15mo/2yrs for knee & hip ops & these being breached or patients being legally allowed to seek compensation for getting their operation abroad, I think that’s sufficient evidence to back up my assertion of the majority of people ending up on waiting lists for months & months or even years…

43

emacknight, everyone dies eventually. Universal health care will do nothing to stop that. I think better analogies exist.

44

fierra and Una - Thanks for pointing out that you were talking about the UK system - the previous post lumped England and Canada in together, and I just assumed you were responding about both. Sorry for the misconception.

I’m also sorry to hear that you had such a terrible time regarding your own surgery, and I don’t dispute the studies and claims that sometimes people just have to wait too long for things. It’s unfortunate, but overall, I still feel that the concept of universal healthcare is worthwhile, and we just have to keep banging at the system until we get it to work right, in any country.

I don’t pay a large amount of taxes, since I am a student with a small income. I know my parents are hit quite a bit harder by taxes than I am, especially since they support us three kids in university, and they have a house, etc. Everyone is affected by taxes. But knowing that those taxes allowed me to bring my SO to the ER (15 minute waiting time, and only because there was a shift change in progess!) and have him see several specialists and get surgery without having to look at my bank balance, or call our parents was such a relief. When my mom has migraines that her meds don’t treat, and we don’t even have to think twice about bringing her to the hospital to get her onto an IV so she doesn’t get dehydrated. When my sister’s arthritis flares up, or gets worse, and more doctors are needed to make yet another diagnosis (as happened this past year), I like knowing that this isn’t going to cost more than whatever day’s pay might have been lost - which is a worthwhile amount, under the circumstances.

I guess I just like the safety net, and I’m willing to pay for it. I’m also willing to pay for others, as long as they pay what they can afford too (hence the concept of tax brackets). I hope the system can be improved, and I have the feeling that society here is pretty much demanding it, so perhaps in time - in my lifetime - a system that works can be developed.

Or maybe I’m just too young and naïve for this discussion. There’s a reason I stay out of GD :smiley:

45

Of course, these problems exist in any system where you have insurance at all. In the U.S., everyone with good health insurance has zero or highly-subsidized costs for health care and thus the same incentives to overuse the system presumably happen. And, as a result, there is a form of rationing imposed in the HMO system…whereby the primary care physician serves as a gatekeeper.

By the way, another point that has been alluded to but not stated explicitly is that health insurance issues in the U.S. can be a pain-in-the-ass even if you are relatively well-off if you have pre-existing conditions. Then, if you want to switch jobs, take time off from a job, etc., you have to worry about how you will be covered by insurance. COBRA (passed over the objections of many) certainly helps here by allowing you to buy into the insurance policy from your previous employer for 18 months after leaving a job, but doesn’t completely solve the problem.

Well, it depends what you look at how the two systems compare. While it may be true that the U.S. has whiz-bang technology more widely available, this unfortunately does not seem to translate into better health care outcomes … In many (if not most) of these outcomes, Canada is ahead of the U.S.

It is also important to remember that there are people making a shitload of money under the current U.S. health care system and willing to spend a fraction of this, with excellent return on investment, to give a very one-sided view of the system in Canada or other countries.

46

I don’t mean to sound like I’m dumping on you, mnemosyne. But this is the attituce I absolutely hate about this type of discussion. You are willing to pay for the safety net, but you DON’T! So, what you really mean, is that you like the safety net and your happy for others to pay your way. If those other have a choice, I have no objection. If the money is taken from them by force, I must protest. Your need of a particular good or service does not give you the right to steal the money for it. And it does not give the government the right to steal it for you.

47

You are correct. There are many problems with third party payer systems. Over use of medical facilities is only one of them. I remember a study from several years ago suggesting that even though overall health is improving, perception of wellbeing is declining. That is, we are healthier and feel worse about ourselves.

Medical Savings Accounts have the potential to address some of these problems. They allow for tax incentives to put moneys asside for medical expenses. In conjuntion with catastrophic insurance they allow the patient to be involved with cost control for most medical procedures. They are not without their problems, but they at least attempt to address this third party payer problem.

Has anyone ever seen proposals for a food stamp like system for medical care? It would be something like food stamps. That is, the government would supply poor people with a certain amount of “medical vouchers” which could be used for certain medical procedures (regular checkups, simple outpatient services things like that). Perhaps they could be redeemed for cash or other things at the end of the year. Granted that this would not be a true free market, but it would have more market characteristics than medicaid.

48

pervert, what’s your definition of “poor people”? Aren’t the people who are poor enough to get food stamps already receiving government health care (Medicaid/Medicare)?

49

I assume you are talking about longevity or infant mortality? If not can you illuminate me? With cites if at all possible?

There are many studies comparing longevity and infant mortality amongst nations. I have not seen one yet which corrects for factors other than health care. The numbers I have seen comparing Canada and the US especially never mention the differences in the occurance of behavior related health problems (guns, smoking, overeating etc) which may or may not exist between the two countries. If it turns out, for instance, that Americans die much more often by gun violence than Canadians, would it surprise anyone that Canadians live longer? And if they only live 2 years longer, what does that say about our health care system?

I’m certainly willing to be wrong on this point. If you can reference any sort of study that compares mortality in this fashion, I’d be most grateful.

Please, let’s not stray into ad hominem teritory.

It is also important to remember that the reason you have so much “whiz-bang technology” available is precisely because of this profit.

50

The specific income level or (medical needs to income level ratio perhaps) could be set by legislation. I was not saying that only people who get food stamps should get medical vouchers. I was merely trying to draw an analogy with food stamps. Namely that we don’t nationalize food production to provide sustenance to people who cannot afford it.

More generally I was trying to understand if any idea has ever been floated which does not intend to do away with the free market. I am really trying to gage how deeply ingrained the nationalize or socialize part of socialized medicine is in the minds of the “universal health care” proponents.

51

Well, that’s pretty revealing. jshore’s comment was directed at no-one in particular, as far as I can tell.

That you assume it was directed at you casts suspicion on your motives, where no suspicion might have existed before.

Or else you just don’t understand what ad hominem means.

52

Universal healthcare doesn’t have to mean the government owns all the healthcare providers, only that the government makes sure everyone is covered. The Netherlands is one example of universal healthcare coexisting with private insurers and hospitals.

53

Australia’s another, BTW.

54

This debate is running high here in Iceland wich is running the typical Scandinavian system. The debate is on wether to approach the Norwegian or Dutch system or not to change our system at all. The cost has been rising at about 7% a year but that is somewhat in tune with our rise in GDP so we should be able to cover it for some years to come given the current economic climate. Even the most right wing nuts over here dont suggest the BNA system wich by most accounts twice as expensive and half the quality. Lifestyle drugs and Plastic surgery is not covered by the state but lifethreatening conditions are dealt with pretty quickly. Major surgery is farmed out to Sweden or England.

My uncle is a doctor in the US and he is somewhat critical of the American system. He says a lot of the problems that plague the American system have nothing to do with the system itself but things like the judicial system and the amount paid in malpractice suits. He does think that a state run system that utilises the strong point of competetive system is the best way to go. He suggests a system where the state might buy hospital administration from the free market and fires and hires on how well individual administrators work. Things like that could work according to him but will be impossible to implement in an already privatised system like the one in the US.

55

All outcomes aside, there is the matter of personal liberty. I think it is antithetical to everything the US stands for to force everyone into a single program whether they want to do it or not.

What might be a better idea is to change Medicaid and Medicare into a single insurance program that people can purchase as an alternative to private health insurance if they cannot get it at their job or through private providers. That way, it would be available for everyone who wanted it, and they could choose what they wanted. And those that wanted no insurance could continue to do without it. For many, especially the young, it is far more cost efficient to pay costs out of pocket and only carry catastrophic insurance. Which is what I did until very recently. My health care costs from 1992-2000 averaged about $200/year. It made no sense for me to pay $200 a MONTH for that. I also carried catastrophic and disability insurance for costs I couldn’t handle.

I also think we make a mistake in our semantics here. When we speak of health insurance, we aren’t actually speaking of insurance. We are speaking of health assistance. Nobody buys insurance for normal costs of living, but in health care, most of us do. It’s not insurance if you are always going to be using it.

56

This is the quote you are referint and to which my comment was addressed.

It clearly is a soft version of the argument “private medical companies paid for the studies showing problems with the systems in ‘Canada or other countries’ so they must be flawed.” Unless I am mistaken this is an argument suggesting that the funding of a particular viewpoint is evidence against that viewpoint. Notice that this argument says nothing about the facts. I believe that this is an ad hominem (or at least bordering on it). If you can demonstrate that I am incorrect in my terminollogy I would be grateful.

Also, note, that I did not cast aspertions on jshore. I did not claim that his use of this argument was “revealing”. I certainly did not assume it was aimed at me. I read it as being aimed at the motives of private health care companies in the US and the reliability of information disparaging to universal health care (with a rather broad brush actually). If I misread it, I appologize.

57

But I’m not sure that is true. In America we have something on the order of 40 million people without health insurance for one reason or another. That group breaks down to many millions on the poor end who aren’t enrolled in medicaid or an equivilant for some reason, many millions more who can afford health insurance but don’t have it and several millions who fall between the cracks. (sory, I cannot find the site for this breakdown now, but it leaves something like 5-10 million who don’t have private insurance and who don’t already qualify for public assistance)

So, according to these figures, we should have thousands of people dieing in the streets for lack of medical aid. We don’t , however, partly because anyone who shows up at a hospital is legally entitled to care. But this is not good enough for the “universal health care” crowd.

If anyone who needs care can get it from his local hospital how is that not universal health care?

I am not arguing that the current system is perfect or even desireable. I’m just investigating the stance that “universal health care” is really only about universal health care.

And BTW, I think Singapore has a “universal helath care” system which is much closer to a free market than anythin in Europe.

58

Try showing up to the emergency room and asking for a mammogram.

Sure, if something happens that is life threatening they will stabilize you and worry about paying for it later. Although hospitals are not too aggressive on collecting, you still have to pay the full price and just like any other creditor your house, car, savings, and any other assets will likely need to be sold to pay off the debt. If you are uninsured and not wealthy, any hospital stays or surgery pretty much means you go bankrupt.

But prevenative care? Forget it. Psychiatric care before you start threatening to kill yourself or others? nope. Screening, check ups, and other routine measures? No way. Got a disease that requires a drug regime? Well they’ll treat you when you come in half dead because you couldn’t afford your medications.

59

Ever since it became the one issue that Eurotrash and Eurotrash wannabes could use to beat over the heads of Americans.

Remember, when you want to paint another society as irredeemable and invariably evil, pick on a single issue in which that society is weak and make sure that it is the sole criterion.

60

Hey even sven, you’re right, but that’s what the argument’s about. Not everyone thinks the situation as you describe it is a bad thing.

Could you (and anyone else who’s participated in this thread) please respond to the food analogy that I discussed (and then that pervert revived) above? I’d like to hear your thoughts on it.