National Healthcare - Theoretical Problem. - Tilted Forum Project Discussion Community

aceventura3 · 01-30-2006, 04:01 PM

I have some mixed feelings about national healthcare. If I can get over this theoretical problem I would support it. I am just curious about what some of you think.

Lets say you are going to die ( no doubts), the cost to keep you alive for the next 30 days is going to be $1 million. If it is your money and you had the choice of spending the money for another 30 days to stay alive in the hospital, or leaving the money to your children what would you do?

Using the same scenerio, but it is the governments money. Would you elect to have the money spent so you could stay alive for another 30 days, or would you choose to save the government $1 million dollars.

There you have my problem with national healthcare. If it is my money I make one decision about my health; if its your money, I make a different decision.

I don't know, long-term, how any national health plan will work, unless you eventually have a government pencil pusher making health related decisions rather than the individual and doctor.

How do you decide on pain medicine? If I am spending my money I might tolerate a certain level of pain that I would not tolerate if it is someone elses money. What would you do?

Am I making a bad assumption about human nature? I think almost everyone would have the government spend as much money as possible, but if they were spending their own money they would make different choices carefully balancing the costs and the benefits

aswo · 01-30-2006, 04:24 PM

I think national healthcare works in theory, but like you say when you actually anaylze the amount of money and the beauacracy that it would create is the plan still worth it. And with that being said could there be a politician that would stand up for those principles?

guy44 · 01-30-2006, 05:11 PM

Actually, national healthcare works not just in theory, but in fact - and far more efficiently than in the U.S. Try Switzerland, Germany, Canada, Japan, and the U.K. for example:

Quote:

The U.S. spends more than other countries on health care, both in absolute dollars and in the share of total economic activity. Health spending per capita in the U.S. was over $4,600 in 2000, more than twice the average of about $2,000 for the other industrial nations belonging to the Organization for Economic Cooperation and Development (OECD). Health spending in the U.S. was 13 percent of gross domestic product, compared with Switzerland (10.7%), Germany (10.6%), Canada (9.1%), Japan (7.8%), and the United Kingdom (7.3%). Although many might equate high expenditures with excellent medical treatment, the health of the average American, as measured by life expectancy and infant mortality, is below the average of other major industrialized nations. This is due to a variety of factors, including diet, physical activity levels, births to teenager mothers and deaths from violence.

http://www.allhealth.org/sourcebook2002/ch8_8.html

The U.S. could save lots of money by switching to nationalized healthcare:

Quote:

ABSTRACT

Background A decade ago, the administrative costs of health care in the United States greatly exceeded those in Canada. We investigated whether the ascendancy of computerization, managed care, and the adoption of more businesslike approaches to health care have decreased administrative costs.

Methods For the United States and Canada, we calculated the administrative costs of health insurers, employers' health benefit programs, hospitals, practitioners' offices, nursing homes, and home care agencies in 1999. We analyzed published data, surveys of physicians, employment data, and detailed cost reports filed by hospitals, nursing homes, and home care agencies. In calculating the administrative share of health care spending, we excluded retail pharmacy sales and a few other categories for which data on administrative costs were unavailable. We used census surveys to explore trends over time in administrative employment in health care settings. Costs are reported in U.S. dollars.

Results In 1999, health administration costs totaled at least $294.3 billion in the United States, or $1,059 per capita, as compared with $307 per capita in Canada. After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada. Canada's national health insurance program had overhead of 1.3 percent; the overhead among Canada's private insurers was higher than that in the United States (13.2 percent vs. 11.7 percent). Providers' administrative costs were far lower in Canada.

Between 1969 and 1999, the share of the U.S. health care labor force accounted for by administrative workers grew from 18.2 percent to 27.3 percent. In Canada, it grew from 16.0 percent in 1971 to 19.1 percent in 1996. (Both nations' figures exclude insurance-industry personnel.)

Conclusions The gap between U.S. and Canadian spending on health care administration has grown to $752 per capita. A large sum might be saved in the United States if administrative costs could be trimmed by implementing a Canadian-style health care system.

http://content.nejm.org/cgi/content/short/349/8/768

I'm not saying we should jump immediately into a healthcare system exactly like any other country, or that those systems are not without problems. But socialized healthcare costs less, and provides more, on balance, than our godawful frankenstein of a health care system. We should probably try to find a way to get there while still providing access to private doctors/hospitals and encouraging new drug development.

P.S. Although that last point, drug development, would be solved if we simply forced Big Pharma to spend its advertising budget on research...

Ustwo · 01-30-2006, 05:16 PM

Quote:

Originally Posted by guy44

Actually, national healthcare works not just in theory, but in fact - and far more efficiently than in the U.S. Try Switzerland, Germany, Canada, Japan, and the U.K. for example:

http://www.allhealth.org/sourcebook2002/ch8_8.html

The U.S. could save lots of money by switching to nationalized healthcare:

The US could save a lot of money by switching to a nationalized healthcare system. The US could save even more money but refusing all healthcare for those over 70. How much money one saves should not the the primary focus.

NCB · 01-30-2006, 05:20 PM

We have a national healthcare system in place alreasy in the forms of Medicare and Medicaid. It's being run into the ground and is rampant with fraud. But yet, eventhough that the current program represents 10-20% of the gen pop, the US would be far better off under a single payer system whcih covers 300 million people.

alpha phi · 01-30-2006, 05:38 PM

Quote:

Originally Posted by NCB

We have a national healthcare system in place alreasy in the forms of Medicare and Medicaid. It's being run into the ground and is rampant with fraud. But yet, eventhough that the current program represents 10-20% of the gen pop, the US would be far better off under a single payer system whcih covers 300 million people.

If you look at it like an insurance company the answer is yes.
You have more people in a larger pool of customers
That lowers the overall risk and therefore the cost per person.
corruption and abuse aside (yes it is a problem)
medicade/medicare is failing because the people using it are sick or old
A program that every citizen is involved in looks much different.

To the origional question.....30 days to live
I would not choose to live my last 30 days in a hospital
I have made arangements to not be in a nursing home,
or convelessant care.
It could be just me....I don't know
I don't want to live in that condition

aceventura3 · 01-30-2006, 09:33 PM

Quote:

Originally Posted by guy44

Actually, national healthcare works not just in theory, but in fact - and far more efficiently than in the U.S. Try Switzerland, Germany, Canada, Japan, and the U.K. for example

In fairness, when comparing per capa costs in the US vs other countries shouldn't we exclude cosmetic surgery. I bet if we excluded breast implant surgery just from state of California or LA County the US per capa cost would be at least 25% lower, as well as the average breast size.

pan6467 · 01-30-2006, 10:45 PM

I am for a nationalized healthcare, however, I don't believe it should be government that pays 100%.

I think all healthcare should be provided equally but on a sliding scale equal to one's income and ability to pay.

In other words if I make $30,000, $50,000 or so on a year I should be entitled to the same medical resources as one who makes a million or 10 million. But for that care I should pay the same percentage of my income. With the only considerations being dependants, if I have 5 kids, I should pay less of my income percentage than someone with no kids or dependants.

Also, one could opt for a low cost government type insurance that would help cover costs.

You cannot keep allowing something that is vitally important to EVERYONE to keep raising prices exponentially faster than inflation. Our current system is bankrupting us.

I truly believe the 3 most important things to keep a society prosperous and moving forward are:

Education - an educated workforce = higher paying jobs = better tax base

Healthcare - a healthy worker is a productive worker and it takes the burden off the companies that are losing their asses trying to pay medical insurance for their workers and retirees.

Manufacturing - a company that manufactures what they need and relies less on other countries is far stronger and more stable than one who has to buy and runs into debts with another country.

I think if we can control healthcare, make it possible for people to afford and companies to not worry about that expense, jobs may come back to the US. But as long as a company has to worry about their medical insurance rates going up 16-25-50% a year, they are hurting and can never truly realize their hiring potentials.

aceventura3 · 01-31-2006, 08:34 AM

There has been a couple of references to our current system of insurance and medicare/medicaid, and how costs are out of control.

I think those problems are consistent with my original concerns. Whenever you have a third party paying the bill, people don't care about controlling costs. Whether the third party is big government, or big insuance it seems people won't care about anything other than their immediate needs no matter what the cost. That will lead to either more and more restrictions or the bankruptcy of the system.

In Canada, there are long waiting lists for care. And you have people (those with money) coming here for care. Is that system going to stand the test of time? I don't think it will.

Charlatan · 01-31-2006, 08:56 AM

Quote:

Originally Posted by aceventura3

In Canada, there are long waiting lists for care. And you have people (those with money) coming here for care. Is that system going to stand the test of time? I don't think it will.

This is only half true. There a long waiting lists for certain procedures (i.e. MRI scans). There are also increased wait times in Emergency wards, but this is true just about everywhere in the western world.

The wait times for elective surgeries can also be longer (though the statistics are not solid on this because different provinces use different methods of tracking wait times). Elective surgery is not a priority comparied to heart surgery, etc.

The ones who are going to the states are those who have the money to pay for elective surgery and don't want to queue.

The Canadian system saves money by having much less bureaucracy and by having one buyer (well, 10 buyers actually -- each province is responsible for healthcare, the Feds just set the general policy).

roachboy · 01-31-2006, 08:56 AM

i am not sure how cost-benefit analysis gets understood as the principal consideration in thinking about this. nor do i see where the assumptions come from that inform ace's "theoretical" problem---which relies on some unspecified notion of "human nature" that is bandied about as if it was coherent and as if there was agreement on a definition. the "theory" seems to me circular: to get it started you presuppose certain types of behaviour that you remove from the aalytic problem by attributing them to this nebula called "human nature"--then you develop an abstract scenario that is fit to it, and you present it as a hypothesis.

i am not sure that the main issue in the question of universal health care is or shouldbe financial. this seems to me to already be heavily encoded politically. it seems to me that you could more directly and easily frame this as a kind of system obligation to the well being of the people who are used by and who use it. something like a human right.

the second usual move in this kind of thread is to assume that only the anglo-canadian model is operative as an alternative. you might think about france, where the state underwrites basic health care--and so the system is highly proactive, emphasizing preventative measures, etc.: there is a highly regulated private insurance sector that underwrites the costs of more major medical procedures---citizens are required to get such private insurance. but the costs are kept low.

if you have something like this model in mind, then you might consider the question of universal health care differently.

just saying.

btw: how would refusing medical care to people over 70 not amount to a kind of extermination program for the elderly?
seems like a barbaric idea.
but i suppose it would make sense from a pure cost-benefit viewpoint.
which points to the problem with the cost-benefit viewpoint, doesnt it?

Bill O'Rights · 01-31-2006, 09:54 AM

Quote:

Originally Posted by pan6467

I am for a nationalized healthcare, however, I don't believe it should be government that pays 100%.

I think all healthcare should be provided equally but on a sliding scale equal to one's income and ability to pay.

In other words if I make $30,000, $50,000 or so on a year I should be entitled to the same medical resources as one who makes a million or 10 million. But for that care I should pay the same percentage of my income.

Ok...I can climb on board with that.

Quote:

Originally Posted by pan6467

With the only considerations being dependants, if I have 5 kids, I should pay less of my income percentage than someone with no kids or dependants.

Nope...ya lost me here. Having 5 kids was yourchoice...not mine. Why do you get a "break", or any type of compense, for that matter. You want a lot of kids? Great. I'm all for it. Knock your socks off. Just don't expect me to pick up any of the cost.

Quote:

Originally Posted by pan6467

I truly believe the 3 most important things to keep a society prosperous and moving forward are:

Education - an educated workforce = higher paying jobs = better tax base

Healthcare - a healthy worker is a productive worker and it takes the burden off the companies that are losing their asses trying to pay medical insurance for their workers and retirees.

Manufacturing - a company that manufactures what they need and relies less on other countries is far stronger and more stable than one who has to buy and runs into debts with another country.

Ok...lets address this by point;
Education. Yes...to a point. As an employer, I do not need a "bolt turner" to have a college degree, earning 60K per year. As much as we may hate to admit it, we will always need those that are incapable of, or unmotivated enough, to do anything more than utter "You want fries with that?". Nor do I feel that these people should have a degree in English Lit, or Philosophy, or what-have-you, commanding higher salaries thus driving up the cost of my Big Mac.

Healthcare. No argument there. I agree. I want my "bolt turner" concentrating on turning bolts, not worrying about how he's going to pay for a family member's illness.

Manufacturing. You're being far to simplistic to get into here. There is a much broader picture to this painting, and you're focusing on a single brush stroke.

Quote:

Originally Posted by pan6467

I think if we can control healthcare, make it possible for people to afford and companies to not worry about that expense, jobs may come back to the US. But as long as a company has to worry about their medical insurance rates going up 16-25-50% a year, they are hurting and can never truly realize their hiring potentials.

Again, that's just one facet of the overall problem, albeit a very large facet.

flstf · 01-31-2006, 11:46 AM

Quote:

Originally Posted by aceventura3

I think those problems are consistent with my original concerns. Whenever you have a third party paying the bill, people don't care about controlling costs. Whether the third party is big government, or big insuance it seems people won't care about anything other than their immediate needs no matter what the cost. That will lead to either more and more restrictions or the bankruptcy of the system.

Those are good points but in most cases even if you are concerned about controlling your medical costs there is little you can do about it. When you are taken to the hospital after an accident or serious illness there doesn't seem to be much you can do to negotiate how much they will charge you. There seems to be little or no competition in the medical industry.

The only cost controls seem to be determined by insurance companies (if you have insurance). Having insurance executives determine our healthcare costs does not seem to be working very well for many of us.

aceventura3 · 01-31-2006, 02:56 PM

Quote:

Originally Posted by flstf

Those are good points but in most cases even if you are concerned about controlling your medical costs there is little you can do about it. When you are taken to the hospital after an accident or serious illness there doesn't seem to be much you can do to negotiate how much they will charge you.

When some people are injured on the job or in an auto accident, for example, it seems they can extend treatment for years.

A football player can break a bone and play the next week, but a clerical worker with a sore back from an auto accident might be classified as permanently disabled. One has a major incentive to get back to work, the other doesn't I am not suggesting that middle age women suck it up and become like football players, but I have seen some extreme abuses of the system. I have also seen the opposite, where people suffer in silence while doing the best they can. I hate the thought of good people paying for others who abuse the system.

01-30-2006, 04:01 PM	#1 (permalink)
aceventura3 Junkie Location: Ventura County	National Healthcare - Theoretical Problem. I have some mixed feelings about national healthcare. If I can get over this theoretical problem I would support it. I am just curious about what some of you think. Lets say you are going to die ( no doubts), the cost to keep you alive for the next 30 days is going to be $1 million. If it is your money and you had the choice of spending the money for another 30 days to stay alive in the hospital, or leaving the money to your children what would you do? Using the same scenerio, but it is the governments money. Would you elect to have the money spent so you could stay alive for another 30 days, or would you choose to save the government $1 million dollars. There you have my problem with national healthcare. If it is my money I make one decision about my health; if its your money, I make a different decision. I don't know, long-term, how any national health plan will work, unless you eventually have a government pencil pusher making health related decisions rather than the individual and doctor. How do you decide on pain medicine? If I am spending my money I might tolerate a certain level of pain that I would not tolerate if it is someone elses money. What would you do? Am I making a bad assumption about human nature? I think almost everyone would have the government spend as much money as possible, but if they were spending their own money they would make different choices carefully balancing the costs and the benefits __________________ "Democracy is two wolves and a sheep voting on lunch." "It is useless for the sheep to pass resolutions on vegetarianism while the wolf is of a different opinion." "If you live among wolves you have to act like one." "A lady screams at the mouse but smiles at the wolf. A gentleman is a wolf who sends flowers."

01-30-2006, 04:24 PM	#2 (permalink)
aswo Crazy	I think national healthcare works in theory, but like you say when you actually anaylze the amount of money and the beauacracy that it would create is the plan still worth it. And with that being said could there be a politician that would stand up for those principles? __________________ People who love people

01-30-2006, 10:45 PM	#8 (permalink)
pan6467 Lennonite Priest Location: Mansfield, Ohio USA	I am for a nationalized healthcare, however, I don't believe it should be government that pays 100%. I think all healthcare should be provided equally but on a sliding scale equal to one's income and ability to pay. In other words if I make $30,000, $50,000 or so on a year I should be entitled to the same medical resources as one who makes a million or 10 million. But for that care I should pay the same percentage of my income. With the only considerations being dependants, if I have 5 kids, I should pay less of my income percentage than someone with no kids or dependants. Also, one could opt for a low cost government type insurance that would help cover costs. You cannot keep allowing something that is vitally important to EVERYONE to keep raising prices exponentially faster than inflation. Our current system is bankrupting us. I truly believe the 3 most important things to keep a society prosperous and moving forward are: Education - an educated workforce = higher paying jobs = better tax base Healthcare - a healthy worker is a productive worker and it takes the burden off the companies that are losing their asses trying to pay medical insurance for their workers and retirees. Manufacturing - a company that manufactures what they need and relies less on other countries is far stronger and more stable than one who has to buy and runs into debts with another country. I think if we can control healthcare, make it possible for people to afford and companies to not worry about that expense, jobs may come back to the US. But as long as a company has to worry about their medical insurance rates going up 16-25-50% a year, they are hurting and can never truly realize their hiring potentials. __________________ I just love people who use the excuse "I use/do this because I LOVE the feeling/joy/happiness it brings me" and expect you to be ok with that as you watch them destroy their life blindly following. My response is, "I like to put forks in an eletrical socket, just LOVE that feeling, can't ever get enough of it, so will you let me put this copper fork in that electric socket?"

01-31-2006, 08:34 AM	#9 (permalink)
aceventura3 Junkie Location: Ventura County	There has been a couple of references to our current system of insurance and medicare/medicaid, and how costs are out of control. I think those problems are consistent with my original concerns. Whenever you have a third party paying the bill, people don't care about controlling costs. Whether the third party is big government, or big insuance it seems people won't care about anything other than their immediate needs no matter what the cost. That will lead to either more and more restrictions or the bankruptcy of the system. In Canada, there are long waiting lists for care. And you have people (those with money) coming here for care. Is that system going to stand the test of time? I don't think it will. __________________ "Democracy is two wolves and a sheep voting on lunch." "It is useless for the sheep to pass resolutions on vegetarianism while the wolf is of a different opinion." "If you live among wolves you have to act like one." "A lady screams at the mouse but smiles at the wolf. A gentleman is a wolf who sends flowers."

01-31-2006, 08:56 AM	#11 (permalink)
roachboy Super Moderator Location: essex ma	i am not sure how cost-benefit analysis gets understood as the principal consideration in thinking about this. nor do i see where the assumptions come from that inform ace's "theoretical" problem---which relies on some unspecified notion of "human nature" that is bandied about as if it was coherent and as if there was agreement on a definition. the "theory" seems to me circular: to get it started you presuppose certain types of behaviour that you remove from the aalytic problem by attributing them to this nebula called "human nature"--then you develop an abstract scenario that is fit to it, and you present it as a hypothesis. i am not sure that the main issue in the question of universal health care is or shouldbe financial. this seems to me to already be heavily encoded politically. it seems to me that you could more directly and easily frame this as a kind of system obligation to the well being of the people who are used by and who use it. something like a human right. the second usual move in this kind of thread is to assume that only the anglo-canadian model is operative as an alternative. you might think about france, where the state underwrites basic health care--and so the system is highly proactive, emphasizing preventative measures, etc.: there is a highly regulated private insurance sector that underwrites the costs of more major medical procedures---citizens are required to get such private insurance. but the costs are kept low. if you have something like this model in mind, then you might consider the question of universal health care differently. just saying. btw: how would refusing medical care to people over 70 not amount to a kind of extermination program for the elderly? seems like a barbaric idea. but i suppose it would make sense from a pure cost-benefit viewpoint. which points to the problem with the cost-benefit viewpoint, doesnt it? __________________ a gramophone its corrugated trumpet silver handle spinning dog. such faithfulness it hear it make you sick. -kamau brathwaite