guyy

Private insurance is a kind of 'socialised' medicine. It's just controlled by private interests instead of people who supposedly represent the public as civil servants or elected officials. (Not that these are the only options -- i can imagine other arrangements for distribution & control) Private insurance is socialised through higher prices for goods rather than through taxes, but in either case, the society as a whole pays for it in the end. We also pay for health care on the cheap through lower productivity. Sick or dead workers are not good workers. There are different winners and losers under different arrangements, and in the US sorting that out is a major part of today's political struggle.

thespian86

Let it begin.

Aside from my smart ass comment:

I have a card with a picture of the hopewell rocks on it. Some numbers, my name. I can show up anywhere in Canada and they will help me. I love that card. If someone tried to take that right away from me, I would probably riot.

My ex-girlfriend came from Wales. She paid nothing. Ever. Nothing.

I know this is probably unfair but it's pretty much a line between how selfish you are. I'm willing to lose eighty dollars from my paycheck (since everyone else is) so that I can have the right to live comfortably. When I hurt my knee, and needed surgery, and the more surgery, then months of physiotherapy, then lots of drugs; it would of cost more then the 80 bucks I've lost over the past few years.

Thanks Canada; I appreciate it.

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Cynthetiq

No, I don't imply they are lazy or making bad choices. I'm stating they are making choices and accepting the trade offs and consequences both good and bad. Shesus and abaya make for a good examples. They both make the choice understanding the consequences associated.

I'm understanding of that and believe that there should be something to assist via some privatized NGO. Grants happen all the time. Memorial Sloan Kettering one of the best cancer hospitals gives out free treatment to a handful of people every year.

I know someone personally who lost out on health benefits due to choices and got lucky that she knew someone at MSK who helped her get the treatment she needed. She's alive today because of that benevolence.

I'd be willing to concede that if you work full time (40 hour work weeks) then you should have some sort of basic health coverage.

What I've been always stating is that the percentage of people who make lifestlye choices that include "not wanting to work for the man", "I can't be tied down by a 9 to 5" or "I need to be free to live my life." One has to take some responsibilty for those choices. I'd rather see more NGO as part of the process to address those with specialized needs and requirements.

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abaya

Yes, but the big difference is that we HAVE the choices in front of us. Not everyone does.

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guyy

The doctors made their own guild and they more or less control who gets in to their guild. They themselves are largely responsible for contriving the shortage. There are other ways of training doctors, and it's by no means certain that the way it's done now is the best.

As for doctor pay, let me say this:

Fuck 'em.

The AMA was a major reason why the US doesn't have a better health system. They ran a big campaign against Truman's scheme back in '48-'50. They thought that if they could keep the gummint out that they could all buy Cadillacs & 2nd homes & golf club memberships in sunny Florida. Well, live by the capitalist sword, die by the capitalist sword. HMOs and insurance firms aren't interested in doctors making a lot of money. You join up with HMO and accept what they throw you, or you're on your own with patients, who as a group, are less able to pay.

abaya

Another bonus about the way things are done in the Nordic countries: practically free education, as far as you want to go. For those who can get into the University of Iceland's medical school, their educations are still basically free. The problem there is that they have not changed their admissions quotas since the beginning of the program, despite the population's natural increase and a demand for more doctors. So more medical students are going abroad (if they aren't accepted here) for their educations, and often end up staying there afterwards. They need to figure out how to keep those students in the country, so that they have enough doctors to keep the waiting lines down.

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MSD

This is odd. Usually universal healthcare threads are full of horror stories of waiting 6 months for a hospital to treat a necrotizing infection and people who really needed surgery but didn't get it in time. This time it's all butterflies and rainbows. I don't live somewhere that allows me to observe it firsthand, so I don't know what to think now.


The thing that leaves me wavering on the issue is that I want the most people covered with the least overhead. A government-run system is prone to corruption, pork, and inefficiency. On the other hand, the current system is about nickel and dimeing people to make the most money possible. In either case, frivolous malpractice suits and excessive visits drive costs up as well as hospitals getting away with overbilling because they know insurance will pay for it and the patient won't complain.

I don't see a private system providing coverage for everyone, especially the people who are genuinely disadvantaged and poor through no fault of their own. I don't see a government-run system that isn't in it for the money covering people for a lower cost than a private system. I want a happy medium, but I don't know where it lies. Single-payer with non-profit watchdog oversight? Private with government oversight? Some sort of hybrid? I don't know, I'm not an economist. What I do know is that I don't want myself or others being ripped off and I don't want to see my fellow man dying because he can't afford to go to the doctor.

dc_dux

I dont think we will be seeing a universal single payer system anytime soon in the US...the will is just not there, as relfected in some responses here.

IMO, the quality of the US health care system is second to none the world...the goal should be making it more affordable and accessible.

In the short term, that probably means relying mostly on employer-based programs.

I'd like to see reform in making these programs more equitable for employees through some time of means-testing (higher paid employees should pay more than the average employee) and I'd like to see some type of enhanced employer tax benefits so that the they (the employer) is incentivized to bear more of the cost.

For small companies that currently do not provide health benefits, we need regulatory reform at both the state and federal level to let such companies create health insurence "pools" that aggregate their employees to make it more affordable.

For others w/o insurance, particularly children, the government role should be expanded through the SCHIP program.

And finally, Medicare reform is critical, particularly with the baby boomers approaching medicare eligibility....but I dont have a clue how that can be accomplished.

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shakran

What she also doesn't see is that if her illness requires unusual treatment or lasts long enough she will either be denied coverage or blow through her insurance before she is better.

Cynthetiq

Isn't that the reason why ADP is such a large employer? They pool the resources in order to get cheaper health care coverage for small shops. There is still a cost to the small employer but the benefit to the employee is reasonably priced health coverage.

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Willravel

If we skip the next few wars, it's possible. I think the first step is a big national dialogue that doesn't feature the words "privatization" or "broken".

shesus

This type of thinking is flawed also. There are many hardworking people who get bad breaks. You can't blanket people. Also, the thinking that people are lazy and making poor choices, therefore they deserve to suffer and not receive decent health care is something I can't wrap my head around. Maybe I am more empathic than some. I feel that as a society, we put too much stress on working hard and working long. Work and you can get anything. I call bullshit on that notion. I would prefer to enjoy living. And those dead end high school education jobs you speak of, they are needed people in society. Where would you go to eat, shop, etc?

I'm curious as to how much interaction you've had with people in these situations. I don't say that as an attack, but you seem to have a lot of prejudiced notions. I know this because about 5 years ago, I would have agreed with you. However, after working in inner cities and volunteering at food pantries, my eyes were opened. While there will be deadbeats and people working the system, that is not how everyone is. There is a generational problem that is deeper than that. There are medical bills that causes people to lose everything. Then there are people who want to work, but actually make more getting welfare.

I agree with Jess. I don't believe socialized medicine will occur here for a long time, if ever. There are too many problems in our current system. To continue education after high school is very expensive and must be compensated after graduation with a decent wage. Also, people have a bitter feeling toward government subsidies. There are many proud Americans. It has been seen in this thread. We are a boot-strap nation and to accept any help is seen as a sign of weakness. Change needs to start within the people's perceptions followed by education. If this can occur, there may be hope for a change to help citizens.

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guyy

Unlike the rest of us, you have a direct line on the general will, yes?

Your post takes the "sober realist/reformist" stance, but what is so realistic about employer based plans in this economy? Old industrial capital (GM, Ford) wants out of company welfare schemes, and the New Economy firms (*$, Walmart) never had them in the first place. Employer based schemes aren't going to get off the ground unless workers have more power vis-a-vis capital. However, if workers did have more power, given the experiences of the past 30 years, why would they settle for the same broken arrangements? Health care is one area where gentle reform is completely utopian.

jorgelito

So then, how do we provide high quality care for all without abuse of the system and not busting the bank or raising taxes? How do we make it equitable so that the hard workers aren't paying for the free riders?

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dc_dux

guyy..I have a line to the same data as everyone else.

But I'm playing the pub scenario and the "sober (and realistic) stance" is that somewhere around 2 out of every 3 persons in the US w/health insurance receive such insurance through employer-based programs (I'm not verifying for accuracy since I would not have that capability at a pub)...and, by most measures, the vast majority of those millions of insured Americans are satisfied with the level and quality of care provided...the complaint is with the cost as the costs borne by employees are rising faster than wages/salaries.

So the short-term solution for me is NOT to replace employer-based plans (which does not have widespread support), but rather to contain the cost to employees. And this can be accomplished to some degree through more risk pooling, tax incentives to employers, and at the more extreme, price ceilings set at by state regulation.

In the longer term, universal, single payer, is a better option..but you cant get there from here without significantly disrupting the current system and most likely, increasing costs.

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Willravel

Who me? I'm not a general. Yet.

dc_dux

jorge...I've mentioned several ways....state regs to enable more risk pooling by small employers who dont provide coverage to employees, dedicated taxes (like the cigarette tax that funds the SCHIP program), and dramatically improving the efficiency of the current system (mostly through technology).

Hard workers are already paying for the free riders in the amount of $billions of costs of providing emergency (and other) services to the uninsured (who generally refrain from the less expensive option of preventive care) that are borne by hospitals and local governments and passed on in the form of premium increases and/or taxes. You pay now or pay later.

And never forget, today's hard worker could very well be tomorrow's free rider. That change of circumstances does not make that person less "qualified" to have access to basic health care.

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Atreides88

I understand that there are a goodly number of people who fall by the wayside because bad luck, but there are also many who actively choose to be shitbags, and I have no sympathy for them. We have governmental programs that provide aid to those who do work their asses off and still can't make ends meet. As much as I'd like to say that they shouldn't and everyone should be responsible for themselves, I also think unemployment aid and medicaid are perfectly reasonable compromises for either extreme. I do not like the notion of rewarding those who refuse to help themselves.


Fair enough. I went to public school my entire childhood in Los Angeles, CA. My middle school and high school both bused kids in from all over the city, and my high school was located in the middle of Van Nuys, a largely hispanic and lower middle class/ upper lower class, both parents work menial jobs to support their families kind of neighborhood. I had friends from all walks of life. I'll be honest, I was probably among the most affluent of my friends, but I don't think that it mattered. And while there were some who chose to make something of themselves, there were plenty of others in my class of 581 who did not and work dead end jobs, got locked up, got strung out, or are simply cruising through life with the least effort possible.

I don't think that taking a government hand-out is seen with as much disdain as it used to be. I know plenty of people who will take money from wherever it comes from, and see welfare as just another way of getting paid. This seems to be predominantly in inner-city communities among single parent homes, and among the black community. I know, I'll probably be deemed a racist for saying it, but there it is.

I've also known plenty of people too proud to accept hand-outs. Mainly among my buddies who were first-generation immigrants from Mexico et al, who would rather scrap and survive and build themselves up on their own merit rather than somebody else's.

I guess the point I'm trying to make is that somebody's socio-economic status is largely dependent upon their attitude and the choices they make in life. While luck plays a large part of it, I don't think that everyone is poor simply because they had a run of bad luck; and therefore government programs should exist for those willing to help themselves. If you refuse to work and contribute to society, then it is unfair and outright selfish for you to expect society to provide you with anything.

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Martian

My evidence is entirely anecdotal, but I have never had to wait long for an essential service. Non-essential tests and services are sometimes delayed for a couple of weeks, but when I've needed treatment I've always gotten it. The only thing I can think of that even begins to come close to what you're describing is one of my more recent hospital stays. I was seen in the ER, but had to wait overnight for the internist to show up; the on-call doctor treated me with fluids and painkillers while I was waiting.

The whole idea of the months-long wait times seems to be a myth, from what I've seen personally. Never been there, never known anyone who has.

There's more I want to say here, but I'm having a very hard time separating my personal feelings from this discussion, so I will get to it later if at all.

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abaya

Yep, same thing here in Iceland. If you need medical attention ASAP, you will get it, no question. If not ASAP, then yes, there's a waiting line... simply because there are not enough GP's in the system.

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flstf

I believe that we in the US spend more per capita for health care than most other industrial countries. I also believe that the middle class and poor are not as well off health care wise as those in countries with universal systems. I think we are beginning to see that health care in our country does not operate well under capitalism and like national defense is something that will have to be provided on a nationally funded basis. Like national defense health care is becomming too expensive for individuals to afford on their own.

kutulu

I don't know why this concept is so hard for people to realize:

THERE ARE NOT ENOUGH GOOD JOBS IN THE US THAT PROVIDE ADEQUATE HEALTH CARE BENEFITS!! Plain and simple. We can give anecdotes about this guy that worked so hard or that guy that was lazy but in the end it makes no difference. If 150 people are competing for 100 jobs there will be 50 jobless ones.

The fact is that SOMEONE has to be there to run the cash registers at Wal Mart. Someone needs to serve us our food when we go out to eat. Someone needs to do all the unskilled jobs out there. It doesn't matter how much the individual applies himself or herself. The individual may move on to a better job but that job will remain and needs to be filled by someone.

It is a total cop out to lay out the standard "those people don't work hard enough". That canned response totally ignores the reality of the situation.
-----Added 24/7/2008 at 06 : 30 : 13-----
That's right. The darkies just line up to take welfare but the Mexicans just won't have any of that.

Atreides88

I never said that those who work dead-end jobs aren't useful or don't serve some need of society, I just said that they are doing so because of a choice they made at some point in their life. I'm glad that there are people to stock shelves at Wal-Mart, really I am, but I'm also happy that I am not one of them because I decided to work hard and get an education that has a need and application in life.

It would be a bit ignorant for you to paint all hispanic immigrants as Mexicans, many are El Salvadorians, Guatemalans, Nicaraguans, etc. And just as there are those that supersede a stereotype, there are also those that set it.

And if there are not enough options for healthcare providers already, what do you expect will happen when there is only one healthcare provider(the US Government)? Where will you go if the government denies your request for surgery? Would you trust a government to provide you with healthcare when it seems that you cannot even trust it to run a war properly? What about the people who don't pay taxes, will they be turned away or should the rest of the citizens of this country foot the bill?

And again, I do not under any circumstances, trust the US Government to run an effective healthcare system. I would rather seem multiple healthcare providers in competition, instead of only a few monopolistic private companies providing healthcare along with the special interest groups and lobbies being kicked out of Washington.

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flstf

I expect it to be very expensive just like now but people may be protected from having a serious illness or accident totally wipe them out financially and loose everything they and their family own. If the government denies a claim I guess it wouldn't be much different then now when an insurance company does.

Everyone who consumes already pays taxes. All the taxes in the distribution chain are built into the prices for goods and services.

The problem is that there is not much competition in health care costs. Hospitals charge sometimes outlandish prices and a short visit can wipe many people out financially. Since this is a pub setting I can't look up examples but I have read about some ridiculous charges like $150 for mucous removal devices (kleenex), etc.. Also if you are in an accident etc.. you are in no position to shop around for cheaper hospitals (if there is one in the area).

Charlatan

I think you missed the point here... Regardless of choice, there will *always* be a need for someone to fill these sorts of low paying jobs. Always.

You can talk about going to school and working hard all you want but for many, even working hard is not going to earn them a break to a new level on the economic ladder.

Someone will be left behind.


As for the government refusing surgery. I can say from experience that I do not know, nor have I ever heard of anyone being turned away at a Canadian hospital.

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jorgelito

Yes, I've seen the small business pooling suggested here and there. I don't see why not. I think it's a good idea regardless. I don't know why they don't do it. It's not hard. Dedicated taxes would be tricky. I think you would have a fight on your hands from the special interest groups you're taking money away from. Cigarette taxes seems like a logical source. But I would rather not count on it.

How would you propose improving the efficiency of the current system? The only thing I can think of would be a centralized data base, or specialization of facilities so not everyone is buying the same equipment.

I would like to see more of a blend. At least for now. If you go national health care, I would like to see some user incentive as well. For example, a lower co-pay for healthy people and more incentive to stay healthy like cheaper basics: yearly physicals, cholesterol screenings. Maybe even corporate incentives like gym memberships that are tax deductible. i think that's a good start compromise and could lead to other things. I don't know, something like that.

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Willravel

I'm buying this man a friggin' drink. This is exactly and totally right.

Maybe we should ask Canadians, Brits, French, etc. members if there are a lot of deadbeats that cheat the system. They can provide us with real information instead of baseless hypothetical guesses.

Charlatan

There are always stories of people who abuse the system. But there are also stories of people who almost never use the system. I see it as a wash.

The key is the philosophy behind it all. That you give a little more in taxes for the benefit of everyone.

Once that's decided it's just a matter of efficiencies.

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jorgelito

Then it becomes a matter of trust. I feel as if I pay enough in taxes already. Over 33% plus sales taxes etc. For me, this is way too much. If the gov't could earn my trust that they would govern in good faith and not flush my hard earned dollars down the toilet like the varsity sport it is now, then I would be more amenable to a slight raise in taxes if I could be sure of it's return (in the form of services, public benefit and good). I would also like an assurance that the burden isn't dumped on one group but rather spread out equally among everyone. Assuming certain BASIC services provided (health, education, public works), then an equitable tax structure should work accordingly. Maybe a 15-20% flat tax across the board.

I'm ready for another drink. I think it's Will's turn to buy.

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spindles

In Oz, upfront going to University is free, though you accumulate a HECs debt (though this can be paid upfront at a discount). This is actually paid off through the taxation system once you are earning over a set amount, so here at least the training to become a doctor is not hugely expensive.

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