Too often government programs don’t get enacted simply because the public has a hysterical reaction to buzzwords and refuses to study what other countries are doing successfully.
What the economic data show is that other countries have “done something” and it’s working much much better than what we have. From my perspective, it is you who are basing your argument on emotional appeals instead of logic and history.
The US isn’t unique. If something works elsewhere, there’s no reason it can’t work here. What we have isn’t working.
Is the US the only Western country with health care that creates such a debate? And to such polar extremes? Either its completely and utterly adequate or doesn’t provide for everyone.
Yeah, the term “nanny state” seems to follow along not far behind, some sort of strange paranoia perhaps…
Nonsense. Or, perhaps this is the part you hear, and you shut your perception down when others provide you with comparative analyses between the system in place in the US and the systems in place in many other countries around the world.
It really is very simple, and not at all emotional. We pay more in the US and receive a lesser value product. And then we die faster. And we saddle our businesses with the burden, hamstringing them in competition with companies in other parts of the world.
I don’t think it’s really such polar extremes, and “doesn’t provide for everyone” isn’t the rich folks/poor folks argument people make it out to be.
I’m neither poor nor rich. Last year, my health insurance cost about $10,000, and the deductible cost another $10,000 (unfortunately, my wife and I both had some health issues last year). We did our best to mitigate this, running expenses through an HSA (up to the woefully inadequate limit), buying generic meds, and so forth. Still, $20K is a big chunk out of anyone’s income. My actual medical expenses sans insurance would have been considerably less than what I actually paid. I’d say the system didn’t work well for me last year.
Two years ago, I had no health issues. I paid about $8K in premiums and my only medical costs were checkups and a flu shot.
On the other hand, when I had cancer, the insurance company paid all of the bills promptly and without question. That year, it worked.
The healthcare issue isn’t all about health insurance, though. Why are medical costs so much higher in the U.S. than in many other countries? Could liability be a big part of it? I’ve spoken to doctors who have never had a malpractice claim filed against them and still spend close to a quarter of their salary on malpractice insurance. That amount, of course, filters down to us in the form of increased healthcare costs. Are our costs being significantly affected by prescription drugs costing dramatically more here than in other nearby countries?
There are a lot of factors at work. I’ve spoken to Canadians both happy and unhappy about their healthcare system, and ditto U.S. citizens. On the whole, I’d say neither is perfect, but our system in the U.S. is significantly more broken than the Canadian system.
As I understand it, the poor and uninsured’s only option when they have a medical problem is to either endure it or if it gets bad enough, go to an emergency room and hope you will get admitted as an indigent. Preventive medicine and such are not available. So we get socked with a LOT of unnecessary emergency room visits from indigents. The non-stupid solution to this would be to provide free preventive care to the poor, since it’s gnerally one hell of a lot cheaper than emergency room care. The poor get medical treatment, the rest of us pay less for their treatment, overall. Now, that’s smart.
If we could just analyze this thing along the axis of stupid vs. non-stupid solutions instead of getting ideology involved, the answers to health care issues would stick out like sore thumbs.
Perhaps I am mistaken. How widely available to the average person are these national group plans that you get individuals into? Are they the same as “Association Health Plans”? For the “average risk” individual do they really cost no more for the same level of benefit than what Megacorp would pay? Do these plans do it by avoiding pooling in individuals with above average risk and only accepting lower risk individuals? As to the uninsurablity issue however your claim goes against personal experience. I have many families come to me as their pediatrician bemoaning that their child is excluded from their insurance because of a history of an innocent (normal) murmur, or of a resolved ventricular septal defect with a current normal exam. A mention of a minor back curve or of back pain has excluded kids as well.
Health care isn’t the problem. Paying for health care is the problem. And we know how health care should be paid for in general. Like any other case of a risk that needs to be spread, the answer is insurance.
The problem is how to structure the insurance coverage. I’m not an insurance expert, but my understanding is that the larger the risk pool, the more effective insurance coverage is. In the US the risk pool is very splintered. People workiing for large companies, or maybe those who qualify for insurance coverage through a professional society do okay. Companies may subsidize insurance, but that is part of compensation, and my company lets us know every nickel of what they pay so that we can appreciate it (which I do.) People who aren’t covered get dumped into smaller risk pools, and pay more.
I’,m for a single payer plan myself, which would minimize disruption to the delivery of healthcare while increasing the size of the risk pool and improving efficiency. European systems have larger risk pools, and seem more efficient.
Your story about waiting for an operation is actually something different. It’s an example of rationing health care. That happens in the US also, whether by insurance companies refusing to pay for certain procedures or for people who can’t afford them not getting care at all. In the US we ration by money. Other places ration by need. In both cases there are screwups where prorities aren’t set quite as well as they could be, and those who can afford to be at the head of the line in the US don’t want to give up their position, but I think a need-based rationing system can be argued to be at least as fair as a $ based one.
I understand it is a matter of conservative faith that competition is always more efficient, but the evidence doesn’t seem to support that at all.
That’s not really true either. MedExpress is an urgent care facility and will see anyone, but unlike an ER they want paid the day of the visit. There are various neighborhood clinics around here that base rates for all kinds of different care, including blood work, on income. Women can get full gyne care at numerous Planned Parenthood locations in the area and their rates are based on income. So no, it’s not true that ‘preventive medicine is not available’ or that the ER is the only option.
Or they could avail themselves of one of the clinics that does this sort of thing and actually pay for it. And no, it’s not that expensive. For one example, an annual gyne workup at Planned Parenthood of Western Pennsylvania will cost a completely uninsured person who makes about 20,000$ a year about 67$. It costs that much for a car inspection here.
You’ve gotta be pretty freakin poor not to be able to scrape up 5.60$ a month to get an annual.
You might call waiting lists ‘efficient’ but I sure as hell don’t.
That’s not a good price at all. I was looking at getting a class A in my area and it’s closer to $4,500 including a hazmat rating. This is a state college and the driving school has a good reputation among the vendors I dealt with. Look around for something cheaper. If you want to drive on the side you can do just that. We had a guy in Accounting get his CDL and drive on the weekend. He’d pick up an extra $2-$300 for short haul work.
I believe you need a bachelor’s degree to get a teaching job in my area and most schools want a master’s degree. Salary range is $31,500 to $65,000 which correlates with what my friends in the vocation tell me except most start above $35K.
You must be right. I NEVER hear Canadians or Britons complaining about health care. It’s never even a campaign issue anymore! The benevolent hand of government has completely solved the problem for us!
Well, that’s a pretty glib statement. What if you can’t afford all the health care you want? What if the problem is also a lack of supply of doctors and nurses?
Canada’s single payer system is not working out so well. Canadians are schizophrenic on the issue - on the one hand, most of them support Canada’s health care system if you just ask them that basic question. But it gets more complicated when you get into specifics. If you ask them if our waiting lists are acceptable, most will say no. If you ask them whether they would support a two-tier system, a significant minority will say yes. If you ask individuals about their personal experience in the health care system, you’ll hear a lot of bad stories (and some good ones). Canada’s health care system isn’t horrible, but it’s far from perfect. And it, like other countries, benefits from a strong free-market health care system in the U.S. that helps drive innovation and offloads some of our health care burden because rich people still go to the U.S. for treatment. So a lot of the toughest, most expensive cases don’t even have to be handled in the country. We also benefit from U.S. drug research and the trickle-down effect of the research and development paid for by the rich in the U.S. which eventually makes it down to the rest of us.
Right. Serious, fact-based objections to your socialized medicine desires can be simply hand-waved away as ‘hysterical reaction to buzzwords’. That way, you don’t actually have to engage in the substance of the argument. Good work.
I don’t know where to start with this. First of all, countries are not the same. What works in some does not work in others. Second, the statistics for things like infant mortality and life expectancy which are often trotted out as ‘proof’ that socialized health care is better fail to control for demographic and lifestyle differences in various countries. A better way to look at the situation is to consider what happens to people after they enter the medical system.
Consider cancer survival rates. Accordin to the European Journal of Cancer, the 5-year survival rate for all types of colo-rectal cancer in Europe is 43%. In Canada, 56%. In the U.S., it’s 62%.
This is an interesting article, because it shows the consequences of both sides of the arguments. America may have better health care facilities, which would account for the better treatment people get after having a heart attack. Also, U.S. hospitals are forced to treat heart attack patients regardless of their ability to pay.
But one year later, the surival rate is about equal, possibly because the free Canadian system encourages patients to continue with chronic care of their heart condition, whereas in the American system once the patient is stable and back home they have to pay for treatment, so they may not seek the treatment they need. Neither system is perfect. Just be careful not to throw the baby out with the bathwater.
Much is also made of the money the U.S. spends on health care. But what generally isn’t considered is whether the U.S. spends more money on health care because it’s inefficient, or because Americans simply get better and more treatment. You can really see this in surgeries that are not life-threatening but have serious quality of life impact. In rationed health care systems (socialized medicine), these are the first treatments to be rationed. In the U.S. things like hip replacement surgery are common and done quickly. In other countries, elderly people can languish in pain for years on waiting lists before getting relief.
In Ontario, the current waiting lists for hip replacement surgery are averaging 190 days. Many people are waiting two years or more.
And other joint replacements are worse. In Canada as a whole, only half of patients requiring knee replacements get their surgery within 7 months. Many wait for years. If you look at the poorest provinces, the numbers go up substantially from there. Saskatchewan’s median wait time for joint replacement surgery in 2001 was 23 months!
And I wonder how much greater it would be if the richest Canadians, who tend to be older and wealthier, don’t often opt out of the queues by seeking treatment in the U.S.? If you switch over to a Canadian style system, who will offload that burden for you?
It’s not even rich patients going. Some companies are actually providing funding to send employees to the U.S. for joint surgery, because otherwise they are paying disability to them for years while they sit on waiting lists.
You might want to read this before crowing about how much better socialized medicine is than the U.S. system.
Of course it’s unique. Every country is. What works in a small European country with a homogenous population may not work in the U.S. What works in a country with a young population may not work well in one that has a large elderly population. And don’t forget, any criticism of the current U.S. system must take into account that there is already heavy government involvement in the form of Medicare and Medicaid. If the U.S. system is broken, it’s not obvious that the answer is more government.
I believe you need a bachelor’s degree (at least) almost everywhere. I was responding to Magiver’s statement that “In the United States you can stumble out of High school without learning a thing and still get a job starting at $30,000/year the very next day.” The starting salary for a brand-new teacher with no experience and a BS or BA degree here is $19,500 plus healthcare benefits. Unskilled construction work is around $9 to $11 per hour. Very few kids “stumble out of high school” into a $30K job here unless they’re very talented at something or they know somebody. If there’s a good $30K job, they’re competing with people that have degrees and/or years of experience to get it.
That’s why it chaps me when people gripe about the local economy being so bad, and then go shop and Wal*Mart; shipping their money off to Arkansas instead of keeping it here (not to mention supporting the destruction of local business that supported our economy).
Usually on any discussion of this kind, when I read the complaining reports, the context usually is for the critics to demand that the government do more, better or change the way an item in their health care is not working the way it should be.
The last thing they want is for the government not working on granting all their citizens access to at least basic health care.
Do you really think all that will disappear if there is change here? The reality is that the change will not be as dramatic, but change will happen. Having health care to be provided for the employer might have worked in the past, but in today’s global economy (that will get more disruptive for local business) it is a silly path to continue.
I do. (Before you reply, you also did what many misleadingly do in discussions like this, the reports are focused on finding a solution for those items, not a call to change the whole system.
Even with a wait at least then I would know that I would get treatment. Right now, because I go to college, I do manage with a part time job; but they do not offer a health plan, so hooray! No wait list for me, but no access either. :rolleyes:
I echoed your phrasing. You hand-waved serious, fact-based objections to “free market” medicine as based on emotion.
You’re coming at this from a political idealism perspective where if it’s free market, it’s better. I’m coming at this from a pragmatic perspective where if it works, it doesn’t matter if it’s a free market, socialism, tutti-fruttism, or hoodoo.
When you really really really really really really want the facts to fit your ideology, you can generally make them fit. When you don’t care about the ideology, the facts look a heck of a lot different.
Fact: The US spends more money per capita on healthcare than other developed countries.
Fact: The US has more people without coverage than other developed countries.
Fact: The US infant mortality rate is higher than many other developed countries.
Fact: The US life expectancy is lower than many other developed countries.
Fact: All Americans pay when any American defaults on medical bills.
Fact: Under or uninsured Americans still consume healthcare dollars.
Fact: The US already has rationing in place through skyrocketing pricing and specialist waiting lists.
Fact: Rates of diseases like diabetes are rising.
Fact: Our baby boom generation is going to consume enormous amounts of healthcare dollars.
Fact: A hefty percentage of people declaring bankruptcy every year have been bankrupted by healthcare costs.
Fact: Of those bankrupted by healthcare costs, a hefty percentage had insurance coverage.
Fact: Tying health coverage to employment reduces employer and employee flexibility.
Will you even admit that the US has a problem? Or will you sit in the 12th ranked country for life expectancy and tell those of us in the 48th that we should just learn to love it in the name of freedom?
Come on, Sam. There’s certainly a case to be made for letting market forces play a larger role in the Canadian health care system, but the Fraser Institute and the Heritage Foundation aren’t exactly objective reporters on the matter.
It would be refreshing to see right wing market ideologues admit that the inelasticity of demand for health care has the potential to lead to a distorted market in the absence of significant government interference, but I’ve never seen that admitted. Instead I see cherry-picked data about the waiting time for some procedure in one province 5 years ago.
Yes, the Canadian system needs to be improved. Yes, it’s possible that two-tier might solve some of the issues, depending on how it was done. But I for one would far rather try to solve the problems in Canada’s system than the problems in the US’s system. Those problems are by and large far more acute than ours.
Hey, you might want to go back and read the first long message I posted. The second half of it talks with admitted market failures in providing private health insurance. The proposal I put forward has universal, government-provided catastrophic health insurance and subsidies for the poor for gap insurance. I’m not the free market zealot you’re painting me as. On the other hand, I’m not hearing a lot of people on your side willing to admit that there are serious problems with socialized medicine.
And if you really really really really really really want to use ‘facts’ to back up your argument, you can offer ‘factoids’ that sound good but are meaningless without deeper analysis.
Which could just mean Americans have more money to spend on health care. Or it could mean that Medicaid and Medicare, both government programs, are badly mismanaged. Or it could mean that there are other problems in the U.S. that cause increased health spending - demographics, large poor communities, poor eating habits, health care liability and litigation, etc. It could also be that the U.S. has a higher population of very rich people who seek ‘gold standard’ health care.
And as I’ve shown, other countries keep their health care costs in check through rationing. Is that what you want?
This is true. But it says nothing about what the correct solution is.
And again, once you get past the sound bite, the situation gets far more complex. For example, the U.S. has a much higher rate of premature births than other countries, primarily due to the increased use of in-vitro fertilization and the subsequent risk of multiple, premature births. The U.S. also has a higher percentage of people over 40 having children, which carries other health risks to the baby and mother. There is also a serious problem in the African-American community, where infant mortality is horrible. You can make an argument that here is an example of the consequence of non-universal health care, and that’s partially true. But other poor communities don’t have anywhere near the level of infant mortality. So there’s something else at work here. Crack babies? Too many very young mothers? A general lack of fitness and health care? I don’t know. But it’s not a simple issue.
Again, you’re treating life expectancy as equal to ‘quality of health care system’. That’s a gross simplification. Life expectancy has a lot of do with things that have nothing to do with the health care system - eating habits, exercising habits, intrinsic health of the population, work habits, sleep habits, drug use, etc. If you want to measure the actual health care system, look at the life expectancy for the subset of people who are actually IN the system. Cancer survival rates, heart attak survival rates, average length of life for people diagnosed and treated for diabetes, etc. And in those kinds of measures, the U.S. is usually at the top of the charts.
Fact: All Americans pay for government-provided health care.
Fact: Insuring them means they still consume health care dollars.
But the market moves extra dollars into areas where there are supply shortages, which helps ease the shortage. That’s how the market works, and why the U.S. almost universally has fewer waiting lists than almost any other country.
Fact: Diabetes can’t be cured by a doctor. Rates of diabetes say absolutely nothing about the health care system. If you want to look at how the health care system handles diabetes, you have to look at treatments for diabetics. And again, once you do that, the U.S. looks pretty damned good.
Fact: This is true no matter what kind of health care system you have. Do you think including these kinds of irrelevant ‘facts’ in your list makes your case stronger? Or does it just make you look like you’re reaching?
Which is why my proposal includes universal catastrophic coverage.
Then why did they go bankrupt? Is it because of high deductables? Or because of inadequate coverage? Or what?
Is it possible that they went bankrupt in part because they couldn’t work? If so, that really has no bearing on the health care discussion.
Fact: Single-payer health care ELIMINATES personal flexibility.
Of course the U.S. has a problem. EVERY country has a problem. Health care is getting increasingly expensive, because the population is getting older, and because improved health care technology has expanded the number of treatments available. Years ago, you had a heart attack, you died. Now, you have a heart attack, you get a quintuple bypass. Then you get expensive drug treatments. Then you live to a ripe old age where you start needing cataract surgery, hip replacements, cancer treatments, etc. The problem isn’t going to go away.
We all know there are problems. What we are debating is the best way to solve them.
Will you admit that there are serious problems with government control of health care? I outlined a bunch of them earlier - rationing by fiat, moral hazards, inability to efficiently distribute resources, health care decisions being made for political reasons rather than based on need (any bets that if you live in the district of a senator on the health care appropriations committee you’re likely to get a nicer hospital than the people who have a greater need, but less political clout)?
The U.S. health care system is not perfect. But countries that have implemented the most rigid forms of state health care are also in big trouble. Go read that Fraser report I linked to. Tell me how you’d like to spend the last few productive years of your life in a wheel chair because you have to wait years for a hip? Tell me how you’d like to be one of the people in Britain to be told that according to the government evaluation checklist, you don’t rate life-saving surgery? How would you like your career to be destroyed because you blew out a knee in an accident and the government won’t let you have a replacement for three years?
How would you like to be crippled for life because you blew out your knee in an accident and you can’t afford an operation to repair it?
I know how we can solve this problem. Forget universal health care, that will never happen. The federal government should provide each citizen with a Death Savings Account, which would allow them to make tax-free contributions towards the cost of a funeral and disposal of the body. Rebates would be offered to those who choose disposal at an Energy-Star certified biofuel plant.
It would have been nice if you had responded to my point about rationing. It’s interesting that the study you mentioned compared Canadians to people in the US on Medicare - our socialized medicine, which seems to work reasonably well, though I think there is an issue with cost and not paying doctors enough. I wonder how the study would have come out if randomly selected people, a percentage of whom did not have access to good healthcare, were chosen. Like I said, any rationing system can be improved. It’s not surprising that the US rationing system is thought to be great by those with all the green ration coupons.