Health Care
 

Today I was having a discussion about different countries and their quality of living. I have been interested in what living is like in other countries, but haven't had the opportunity to even visit them. I have formed some views on health care systems, taxes, and leadership. However, I'm just venturing into these topics and love to hear what other people have to say about them.

I feel that the US health care system is corrupt. I believe this is due to lobbying of the pharmaceutical and insurance companies. The government is not taking into consideration the best interest of the citizens. Then I hear about Canada, Iceland, France, etc. They have free health care through the government. I know that they are taxed heavily for it though. This leads me to my next question.

If the citizens are getting free health care, child care, extended maternity leave, and other subsidies from the government, are the higher taxes a big issue? I understand that some countries have as high 60%, possibly more, of their income taxed. In the US, we are taxed about 30% of our income, then have insurance and retirement deducted. Plus, we pay out of pocket for health services that aren't covered by insurance. If you have children, you are paying for child care after the approximate 2 month maternity leave is over. Doesn't all that money equal or exceed the higher taxes in those countries?

I feel that maybe the US will never have a socialist system like these countries because it's too big. European countries are comparable to our states. Since it's highly unlikely that the US will ever separate, should states have more power? How would that work?

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Whew. Nice.

And, I'd never thought of it in that way before, shesus, but you make a good point. In all of the hubbub about higher taxes, people never mention all of the services that we pay for now that would be free. DUH!

Excellent point and I really don't have anything to add to it.

I think to start this off you need to call this nationalized health care. The way you posed the question, free makes it sound like you get what you want, when you want, for slightly higher taxes - are you okay with those taxes?

A friend of an acquaintance of mine (ie - not completely personal) relayed this story to me: This canadian walks into receive some "free" health care with very significant neurological symptoms, and a brain tumor on CT. His primary care physician tells him he "could" schedule a biopsy but he's certain its malignant and inoperable, but if he wants a biopsy the physician that would do it is tied up and it's gonna be awhile. And then they can see where they go....

I'll admit I don't know all the details but when I was told the story, the doctors behavior was ridiculous and I couldn't help but think.....there's another dude that's coming here for his health care. Point being: don't take it at face value that Canada's health system it not only as good...but free too. Most of the posters here are younger and probably don't have to deal with significant health issues, but I'd like to hear some real life stories about Canadian Health care other than ..... "IT'S FREE!!!"

BTW - a biopsy is how you get a diagnosis for those who don't know. Not by looking at a CT scan. This doc was essentially telling this guy "Your done", without having a diagnosis of any kind, by looking at a picture.

First off, the term, "free" is not correct. Canadians do pay for their health care but do so through taxes. The result is that we pay around 35 to 45 percent in taxes (depending on your financial situation). As for the ability to get diagnoses done quickly, yes, there are wait lists. Or so I keep hearing about. That said, my own personal experience has been that if it's urgent (i.e. life and death) it gets immediate attention. For example, my father-in-law needed a heart valve replacement. From diagnosis to surgery was no more than seven days.

The Canadian system is in no way perfect... what system is? I have also heard some good things about the French system of health care but don't have any details.

Charlatan, to make it clear, I'm not dissing the Canadian Health Care system - so there's no need for Canadians to get immediately defensive (not saying you were, but I can see it going there). I'm just adding another element to the original question which was way to easy (refer to mixedmedia's response) - are the extra taxes worth the free health care?

I cannot comment on Canada, but will add a few cents worth on Australia - from my limited understanding the two health care systems are quite similar.

I can go to my doctor (GP) and the only time I will be charged anything is if I use their after hours service. With an appointment M-F, 8-5pm, I walk in see the doctor, get my diagnosis and walk out again and don't pay a cent. Same with emergency - 6 weeks or so ago my eldest (4yo) son cut his finger pretty badly and needed stitches. My wife took him to emergency and 3 or 4 hours later they came home, stitched up and didn't pay a thing.

I've been to the doctor for numerous things that needed more info (e.g. Xrays, blood tests etc.). In a lot of these cases, you get sent to a third party lab and you mostly pay for these. It is possible for these to get done for free in a public hospital, but you may not get it same day as you would with the outside lab. In my local area, the General Practice Unit I visit is on the grounds of the local hospital and a great majority of the 'labs' you would need to visit are within a few minutes walk.

Surgery - lets say you damaged knee ligaments. This (again) *can* be operated on in a public hospital and as it is not life threatening is done on a first come first served basis and may require a significant wait to get in. The other option is via a private hospital and this is where insurance comes in (or your deep pockets) whichever you have. Currently, I'm not insured at all and in the (I suppose) low risk case I do have a knee reconstruction, I'll be waiting...

Other points like:
Maternity Leave - at this point there is no paid maternity leave funded by the government, though there is a push for company's to pay this out of their own pocket.
Childcare - when the carer returns to work, there are some rebates that are government funded, but they don't cover the full cost of child care (about 30% I think, and as I'm in a pub, I'm going to run with that figure ;))
Family Allowance - we actually get paid to have kids - not sure how big the payments are but I think it continues until children are 16 (as long as they are still living at home). A portion of this is not means tested (meaning that it is not scaled based on income) and a portion is - no idea on the exact numbers though.

BTW, my income tax is about 1/4 of my income - I'm in the second top tax bracket (75,000-150,000) - you can see the rates here (though not from the pub):
Individual income tax rates

States should get to decide whether to socialize medicine or not. There are a lot of movements in California to get "universal health care" (which is single payer). If it does come to a vote and wins overwhelmingly, I don't want Kaiser or Humana or Blue Cross freaking out and suing the state, tying it up for years.

This would take the state government suddenly growing massive balls and it would take an army of attorneys to make sure it's rock solid.

I know California's government isn't perfect, I mean it owes quite a bit, but if we actually got together and gave it a good shot, and weren't afraid to talk to people who were familiar with the transition like Australians, it'd be good. We could model the transition for other states. If California was successful, Oregon and Washington would likely follow, then New England. If it was a success, then perhaps a change could happen at the federal level.

I'd fully expect there to be a lot of angry conservatives and libertarians, but so long as we demonstrated that it was a success, I can't imagine them having a very good argument.

Obviously since I responded to the post in the way that I did, I believe that the extra taxes are worth the no cost healthcare.

When shesus and I moved to AZ last year, we enrolled for the same healthcare plan we had in Chicago. Since we were in a private school in AZ, we did not receive the same contract-based rates we did in Chicago.

In Chicago, I was paying around $75/month for me, shesus, and our daughter to be covered well. I got my first check in AZ and noticed that for healthcare, the deduction was $374. I was a little taken aback and went to our benefits person to ask about it. "Are we really paying this much a month for our insurance??" I asked in disbelief. Her response was, "No. That's per pay period."

I was going to be paying $750/month for family coverage. That came to almost 20% of my salary. Considering I was paying around 20% of my income in taxes, I am a bit confused by people who say that universal health care will cause an increase in taxes. What does it mean when I'm paying 15% of my income to insurance that doesn't even guarantee that when I use the insurance, they'll approve the charges. From a financial standpoint, I couldn't afford the coverage and had to move to a lower level of coverage just to be able to afford it.

My issue is that we have some amazing doctors and some of the most advanced hospitals in the world, but those don't mean a thing if you can't afford to get in. Yes, emergency rooms will take you, but wouldn't it be a lot cheaper to have preventative health care so someone who is sick doesn't have to wait until it's life and death to be taken care of?

First off, I'm loving this discussion. I'm what you would call a beginner in politics and this is a lot easier for me to understand and get other's points of views. So thank you.

Point taken, no longer will I refer to it as free, but nationalized.

From what I gather, nationalized health care isn't perfect, as Charlatan mentioned. However, are the negatives bad enough to make the US health care a better choice?

My grandmother has been going to the doctor for years because she falls a lot. The doctor said it was age, bad knees, etc. Come to find out this past weekend, the falls were because her heart would stop beating. Her local hospital never ran any tests to see how healthy her heart is even though she is overweight and has blood pressure issues. She found out while out of town because she had fallen at a baseball game. My point being, there are going to be incompetent doctors everywhere.

The downfall I see though is the waiting list for non-life threatening issues. I'm not sure if that happens here, as long as you have insurance. I had heard that not all services were free and now it was confirmed through personal experience. How does that affect people financially? What is the optional insurance like?

Will, California is definitely a forward thinking state. I would expect them to try to pass a health care policy. This would be very exciting as it could be used for a framework. I'll be interested in looking up more information on this.

Oh, and Spindles, feel free to check facts while posting. That is a benefit of this pub. You can research some things and then add it into your thoughts if you wish. I just don't want to have a read-aloud while drinking my ale. ;)

There was just a huge demonstration in SF a few weeks back (maybe a month, now). I believe the organization that organized the event was called "Health Care for All" (I'm sure it has a website). A friend from work was up there and now he's become a health care zealot. It's fun to see people become politically active and fight for what they believe in.

That's awesome, I'll have to look for that. I wonder if people get involved with politics without getting that spark of interest in something that directly affects them.

Alright I checked. Originally when this was introduced it was 30% of cost, now it is 50% of cost, but capped at $7500. It is also means tested, so that if your family income is greater than $127,000 or thereabouts (with one child) you don't receive any rebate at all.
For more info:
Family Assistance Office | Can I get Child Care Benefit?

RE private health insurance - this is quite a big area in Oz as it does not just relate to Hospital Treatment, but also other sizeable ticket items like:

• Dental Work
• Physiotherapy
• Ambulance

These things are NOT covered by Medicare at all (like the labs stuff mentioned above, it is *possible* in some circumstances to get these things done in hospital or the cost waived, but it not relevant at my income level).

Further, private health insurance is also subsidised by the government. This is done with a carrot and stick. Firstly, if your income is greater than a certain amount and you don't have private insurance, you pay more "Medicare Levy" which pays for the public hospitals. Secondly, there is an age introduced scale. This means the earlier you started having private health insurance, the more it is subsidised by the government. This kicks in at age 30:

Department of Health and Ageing - Lifetime Health Cover

And this is the exact reasons that I have chosen to stay in the Corporate workforce. The pay is higher, the benefits greater.

While it isn't the ideal and passion, it gives me greater abilities to do those things that are ideal and passion when it's my free time.

In my youth I worked for Sears, and then Disney, I got screwed by Disney and vowed to never work corporate again.

When I got to small mom pop businesses, the pay sucked, the benefits sucked. When someone went on vacation it was a pain in the ass because no one did their job while they were away as there wasn't enough staff to fill in. I worked long crappy hours for low shitty pay.

I did not go to the doctor at all for any preventative care because it was too expensive in comparison to the ratio earned.

Yes, there I was holding out my pride intact! Go Me!!!

I got offered a job at a major pharmacuetical. I doubled my salary and got many benefits besides healthcare. I've stayed in Corporate America for close to 17 years. I've continued to grow my salary and position which has lead me down a career path that I didn't expect but has rewarded me handsomely. Not only do I have health benefits, but I have retirement 401k, pension, 4 weeks vacation, unlimited sick days, and a lifestyle that I could not have afforded working mom and pop.

Go Me!!!

If I earn more money, I'm happy to pay more taxes. I'm not happy to pay more taxes for the same money earned, which is why I'm not for any kind of nationalized healthcare.

I made my choice, other people have made theirs. We live with the consequences of the choices we make, good or bad.

I'm assuming one of the benefits of your high paid position is medical benefits, right? So if this was paid to the government (as tax) to handle healthcare rather than going to an insurance company, wouldn't you have no difference? It really is just distributing money that is already paid to/for you...

You make it sound like everyone has a choice between one sort of work and another. I think you know that it's not that simple.

If it's the same price, sure. But from what I've read it will not be the same price. Every single time someone told me that this law or that proposition will lower the costs, I have paid more each and every time. Automobile insurance in California, Cable TV FCC deregulation, Telecoms Deregulation...

My mother in law chose to be an artist as her profession. She scrounges for each and every dollar, each and every month. She has access to healthcare via government programs.

No not everyone, but many have choices. I'll be frank, I'm not interested in pulling up other people by the bootstraps. I'm busy taking care of my own self, family, and extended family. I'm not expecting the government to take care of me at all.

I've had friends who've insisted on liberal arts, change the world ideology and careerpath. That's great! How's that payin' ya?

It is a fact of life that money gives one more choices and options.

I'm not saying my healthcare is cheap, by no means. I've spent close to $4,000 out of pocket this year on premiums and copays. We burned through the $1,200 FSA we setup for the year. We've still got more year left and I'm planning on some elective surgery that I don't even have any idea how much it will cost.

When it comes to universal healthcare, I don't trust the government to handle any program effectively. In essence, it should be a private business matter and the customers should be taking it up with their HMOs and Insurance companies. The fact that the government even got involved and created an healthcare lobby is the real issue. If the playing fields were level(i.e. businesses left to self-regulate) those insurance companies that had shitty service and charged and arm and a leg for it would flounder upon the rocks and wither away into obscurity. The simple fact of the matter is that medical care isn't cheap and in the end somebody is going to be footing the bill. I pay enough taxes already, I'd rather pay fewer taxes and have more money to spend on health insurance.

This is an interesting thread for me. I am young and have a chronic illness that would possibly disqualify me for any sort of insurance in the private world. Insuring me isn't likely to be profitable unless my premiums are so high as to be unpayable for me.

What's a guy like me do for treatment in a world where universal healthcare doesn't exist?

The short version of the Canadian (or Ontarian, at least) system is that we pay for prescriptions and the government foots the bill for everything else. Yes, this means that my taxes pay for others. Or, more accurately, that the taxes paid by others are paying for me, since I am relying pretty heavily on that government-issued card. I don't pay for doctor's visits, consults, tests (including x-rays, blood tests and the like), and I didn't have to pay for my surgery which was not elective and is probably one of the main reasons I'm here to type this now.

There it is. My bias, up front and undeniable. I would not be here if it weren't for universal healthcare. I would be too far in debt to even consider something so luxurious as an internet connection. I might be homeless by now.

The thing is, I'm socially liberal. I do what I can to help out those around me, and I consider it a good thing to do for others what they can't do for themselves. Some people can't afford healthcare, and it's not always an issue of choice. I didn't choose to have Crohn's Disease and was unable to finish high school in a timely fashion as a direct result of my illness. College isn't really an option for me, because I can't afford to go now. Jobs for high school graduates don't generally pay very much, and my grades were bad so there's no scholarships for me (also a result of my illness). The banks won't lend to me because I don't make enough and when I applied for government loans to go to college I got rejected.

The odd thing is, I am a firm believer in paying the consequence of one's own actions in most regards. Poor health, however, is not often a choice one makes, or a result of one's lifestyle. Some people just get dealt a bad hand. I don't think I'd be able to sleep at night if I didn't know something was being done for those people, at least in a limited fashion.

Half of my immediate family are social workers. I have a very strong bias on this subject.

Thanks Martian... I suspected you might have an interesting take on this issue.

Ultimately for me, when talking about this with more conservative types such as Cyn or Atredies, it comes down to bootstraps, choices and self motivation. I do understand that position but don't agree with it in all situations.

I like the idea of paying a little more in taxes for peace of mind. I also see pooling resources (i.e. taxes) for the benefit of the wider public as a good thing when it comes to things like health care. I like the idea that some of my taxes help to keep Martian alive.

Perspective is a funny thing. I'd struggle to see how insurance companies would make a buck out of health insurance. People are always getting sick. And if you run it like an other insurance business you knock back a lot of claims - what happens to the patient then? They are left with a fight in court or a large debt (neither of which are hip pocket happy).

One aspect of the British system that I think is a very good idea is that there IS a universal system and it IS free and open to all, and it IS pretty damn good service. And then there's boutique health care providers who charge a fee and do things (electives, plastic surgeries, etc) that aren't and shouldn't be covered under a universal system. As I understand it, there are pay hospitals that offer more specialized or super-high-quality care--and somehow they've managed to have the state system not become the ghetto. But it's like, you can go to the big university hospital for free, or to the Mayo Clinic for pay. I think that's smart, but I'm concerned about America and Americans' ability to not have the free one turn into poor people's healthcare hell.

If national health care made no difference to my net income and didn't affect my ability to get medical care I needed, I probably wouldn't care. The problem is that I don't view the government as the efficient administrator of anything and expect that it would cost me more in the end. I also have a problem with providing assistance to anyone unwilling to support their household, but no problem with those on disabilities that prevent them from supporting their households.

I don't think health care should be free either. I currently have co-pays on any medical bills I have, capped at a few thousand dollars maximum per year. That seems like a fair solution to me. I've heard too many anecdotal stories of people going to the doctor for minor medical issues because they didn't have to pay anything to believe free medical care would work.

I've lived in the UK and experienced their healthcare system, and now I'm living in a country that does not offer socialised medicine so I have to take out private medical insurance. Here is what I have experienced:

I pay much more for the private medical insurance than I paid in the UK for the NHS (National Health Service) - in the UK you can see exactly what part of your tax goes towards paying for health services. This is understandable, as the larger the group you are part of when you engage in any kind of insurance, the lower your premiums are. In the NHS, I signed up as part of the whole country (65 million or so), whereas with private insurance I sign up as one of maybe 1000 people (those in my company).

My deductibles were less in the NHS - far less. Unbelievably less. In fact, in most cases, they were nothing. It was only for prescriptions that I had to pay anything, and even then it was the same amount for every prescription, never mind what the prescription was for.

My mind was more at ease on the NHS than in private medical insurance. I didn't have to worry about whether I was covered for something or not, or whether my claim would be denied, or whether I wouldn't get approval for a procedure because the insurance company found some clause on page 124 paragraph 5 of the small print that they never explained to me (or even showed me) when I signed up that nullifies my policy - I was covered for anything that adversely affected my health (and more), and that was that. Even physiotherapy for a severely sprained ankle, which is obviously far from life threatening, was treated to completion and the treatment started just a few days after the injury (that was on the NHS, by the way).

My choice of hospitals and doctors was greater on the NHS than private insurance. Far, far greater.

There is not a single part of private medical insurance that is better than the NHS. Not one. Nothing.

As an aside, I'd also like to say that the argument against socialised medicine that "I don't want to have to pay for other people's problems" is simply bogus, 100% nonsense, illogical and coming straight from the PR spokesman of the health insurance companies. Whether your healthcare contributions are made in the form of taxes or insurance premiums, you are already paying for someone else's problems. That's the way insurance works. You pay whether you make use of the service or not, you don't get any refund of you don't make enough claims, you don't pay more if you make too many (although that's only strictly true in the case of socialised medicine - you do pay more in private insurance if you exceed your level of coverage). If you don't make any claims and someone else makes loads, your premiums go towards paying for his healthcare (if his claims haven't been rejected anyway). The only difference is in the amount you pay (you pay more in private insurance) and the coverage you receive (worse in private insurance).

Mine's a pint of Guinness, thanks.

I should explain that in Iceland, it's not "free" even when you are paying taxes--and frankly, there is a real shortage of doctors here, which is another problem in itself (and creates the long waiting lists for non-emergency care). I still pay a co-pay when I go to the doctor--though it's never been more than $50, and once I reach an annual cap of paying $200 or so in co-pay, the government will give me a pretty big discount, so that I shouldn't have to pay more than that in any one year. Does that make sense? There isn't a discount in prescriptions, either--but there may be for the elderly (I just don't know enough about that).

But I will say that if I could choose a country in which to get sick and possibly die, the US would not be at the top of my list (unless I had a ton of money to get the best care--but I never assume that that's going to be my case, because it's so rarely the case for the average individual). Sure, it's a great place to work corporate, but what a price to pay! I don't want to have to work for the man just to make sure that I don't go broke taking care of my aging body. That's something that I appreciate about nationalized health care--health care is never something that really impacts your life, here in Iceland. It's just THERE, a net for when you fall. There is no sense of the fear that many Americans have about those life-or-death questions, when someone falls ill--here, you know the state will take care of you. It relieves an immense burden on the psyche, I think.

And yes, I'm willing to pay whatever taxes it takes, to provide that level of national health care, even if I'm in perfectly good health. It's just part of my life philosophy. No man is an island--even in Iceland, they've learned that.

That's an unfair characaterization. I said SOME people.

There are other people who are disabled or have some other chronic or debilitating health issue. They are not the norm. The state has some responsiblity for them, and from what I see and understand there are social programs and NGOs that have stepped in to make up the difference.

I'm speaking about the bohemian who chooses that lifestyle to be carefree. Well part of being carefree has some consequences to that decision. It is not much different than me deciding to stay in the corporate workforce has concesquences to my lifestyle.

Lifebeat the music industry fights against AIDS gives out money to those who've worked in the music industry. They don't give you money for healthcare, they give you money to pay your electricity, rent, and other things.

There are other NGOs like this that operate for cancer patients.

And see you're willing to make that concious choice. You've stated there are drawbacks to living in Iceland. Would you stay there because the healthcare is what it is?

My point is as always, there are consequrences to choices, good and bad. It can't be all good, if it was, then we'd be living in utopia.

No, I am *able* to make that choice, by virtue of our economic circumstances. Honestly, no, we wouldn't stay in Iceland... but I'm not seriously ill or pregnant, nor do we have kids yet. If any of those things were different, I think we might consider staying at least long enough to have the state take care of us--but we have the luxury of that choice, with several passports between us. If I were an immigrant from a poor region in Thailand, with a choice between my home nation that completely ignored my health care needs (Thailand) compared to living in a cold, unfriendly nation who took care of all of them (Iceland), you'd better believe that I'd make the sacrifice to move to Iceland and stay as long as I could, no matter how hard it was.

On the other hand, because I have a European passport, if I felt more at home living in Norway, Sweden, or another of the countries that take the best care of their citizens (unconditionally)--yes, I would want to live there instead of Iceland, because their people and weather are infinitely better than here. The reason why we don't feel obligated to live in Europe for the rest of our lives, however, is because ktspktsp and I are lucky enough to not have to worry too much about those things--health care and all the rest. We can move back to the US because we'll be in a position to not have to worry about those things in the future. We're lucky, and we are very aware of that fact. If we were to become not so lucky in the future, and we were in dire need of health care--you better believe I would take advantage of my Icelandic passport and come back here. I am a citizen, and no questions are asked.

I don't blame anyone who immigrates away from a poor country because it doesn't take care of them, and wants to come to a country that will care for them--it's human nature, if you have no other choices open to you. We all want to maximize our portfolios to avoid risk. For many people, the only way they can do that is by immigrating, since their social capital is much more substantial than their financial capital.

Okay, this guy's had enough. :expressionless:

I can see both sides of the issue. What I find is that people with good health insurance is against socialized health care. Generally, it's the attitude that was posted in here, "I have mine, why don't you get yours?" I find it to be a bit close-minded. My parents are in that camp. My mom has Hep-C and didn't have to pay hardly anything out of pocket for her multiple treatments. What she doesn't see is that if she were to have lost her job, she could be dead because she would have had no coverage.

I am currently without insurance and could be for awhile. This is partly because of my choice, but also partly out of my control. I have not been able to gain stability in the areas I want to teach in. I am always told, "We'd love to keep you, you're one of our best teachers, but the budget got cut and you're low on the totem pole." Granted, I could have stayed in AZ and continued teaching there with insurance coverage, but I made the choice to leave. However if anything were to happen to my health (even a something as simple as a UTI), I would not be able to afford hospital fees. I know there are free clinics and such and that is where I'd go, but if it were more serious, I'd be out of luck. It's sad that unnecessary deaths happen because of this.

I'm for universal health care because people shouldn't have to stress over what will happen to them if they get sick. I found DJ Happy's post to be very informative. I agree that the insurance companies are using PR to discourage people from going universal. I don't blame them, they'd lose a lot of money. What I said in the OP still stands though, we are already spending a lot of money out of our paychecks for health care. Also, as was mentioned, that money is going to help other people. Is it better in your mind to help other people who are paying into the same insurance company as you than to help all citizens?

Yup. Those who benefit from the status quo are usually the ones who are least interested in seeing it change. The same attitude comes up time and again on TFP on topics such as these. That's basically what's happening with my stepdad's mom, who just had a stroke last week and is now in hospice care, waiting for starvation to kill her (with morphine to help pass the time) because really, there aren't enough resources to begin to help where she's at. They are barely a working class family, and no one can really afford coverage. My dad takes his risks by being an independent contractor--he beats his body up on the job every day, and rarely sees a doctor about it (even when he fell off a roof!)--it's his choice, but he's never had a whole lot of options from which to choose. A lot of people can't grasp what that would be like. Very much agreed, as I said earlier in my post. I see it as a nation's obligation to take care of its own, at the very least--it's a human rights issue, and the Scandinavians (for one) have recognized this and made it their national priority. If I didn't have any other choices, I'd definitely settle down in Iceland and figure out a way to be happy here.

The idea stands directly against libertarian ideology, so I can see a lot of people resisting the idea here on TFP. Like I said, though, if a state wants to give it a shot, let them try. Worst case? It doesn't work and reverts to private or someone else tries a different strategy. Best case (in my mind) is citizens pay a lot less in taxes than they would be paying in insurance AND everyone would be covered. It may not be a perfect system, but the idea is to develop the best system possible, right?

I love talking and arguing my points by using analogies. So allow me to offer another one. How many of us see someone struggling to open a door with an armful of packages or groceries and say, "Screw you, you chose to carry that many packages. Open the door yourself"? I'd like to think that we're not like that to our fellow humans. The issue is that it takes little effort to hold a door for someone, so we often do it. I realize that there are those who don't, but for argument's sake, let's pretend everyone here would. Do we change our Samaritan beliefs simply because money is involved? What is that causes someone who would gladly hold the door open for someone who needs help suddenly have a "I got mine" attitude when it comes to healthcare? Am I reading this completely wrong? Can someone help me understand?

On another personal anecdote, my father worked for a large utility company in California for over 30 years. He started as a blue collar worker and ended up in one of the top positions in the company. When deregulation hit and Enron got involved, my dad began to see the writing on the wall and opted for retirement. He had worked there long enough to receive full benefits. My parents used the money they had saved to buy some land and build a very nice home to enjoy their retirement years. A few years ago, an executive decision was made at his company to eliminate the health care coverage from his retirement plan. No discussion, no alternatives, they just eliminated it as a cost-saving device. You all know where this is going, right? Last year he nearly died after a build up of plaque in his intestines caused sepsis. He underwent major surgery from which he is still recovering. Since then, he has been trying to figure out how to not lose the house he built with his own hands at the age of 60 because he can't afford to pay his medical bills.

I don't find the system that results in something like this happening preferable at all.

shesus, that's correct, you are making conscious choices based on realities of the world. I'd love to live in a world where things are different but in a world where there's only so many chairs to sit in, when the music stops, I want to make sure that I can get to a chair faster than anyone else. After I have a chair, I'll be interested in helping someone else find one. What I'm not interested in is giving up a part of my chair for someone else to also sit on.

I need healthcare. I'm middle aged. I could foresake it in my youth. I've had 3 hospitalizations 2 of which were 7 days long, 1 was JustJess' father in law trying to kill me. We'd definitely not be in the financial position we are in had it not been for health insurance.

I've had to make hard choices because of health benefits considerations, staying in a job I didn't like, staying employed, and getting married earlier than desired.

JJ, I agree with the holding the door analogy. So far in my building, which houses 400 people holding the door open for someone has allowed 2 different situations where people were mugged in their own home. I don't know what it means to the analogy, but I do agree that something that simple as holding a door is maybe okay. I'd also say that we're not talking something so simple.

It's that kind of selfish attitude that has gotten us to where we are today. People act as if they got to where they are in a vacuum entirely due to their own choices and hard work. Those that have less just didn't work hard enough. It's BS.

We can't expect people to live an honest hardworking life if that life doesn't even pay for basic necessities.

Any time a member of my family or friends gets sick I thank god that I am in Canada and not in the US. Yes, I pay a little more in taxes but I have the security of knowing my family and friends are taken care of.

It is true, I made the choice to leave my past job. However, with your argument, I should have stayed in a job that did things against my professional ethic in an area that I was not happy in just so I could have a sense of security if I got sick. That may work for some people, but I'm not one of them.

At this moment, I am going through a process of obtaining a job that I really want. It is the position I've been aspiring to reach. However, it has no benefits because it is a contract job. Should I give this up and more or less sell out for a job that is 'safer' just for health care?

I would hop on your train of thought if there were choices. If we have freedom of paying for our own healthcare, there should be affordable choices for those who do not have the corporate perks. I haven't seen these made readily available in our current system.

As for sharing my chair, I would share it with anyone who needed it. I used to be in the camp of privileged folk. I grew up with unlimited health care and benefits. I was against welfare and hand-outs. However, once I got out and started working with less fortunates, I realized that not sharing is not the best choice. I think we will just have to agree to disagree on this point. :)

The bootstrap analogy is not applicable here. It's great when you're talking about jobs - yeah, I can work at a crap job to pay the bills, and so can you. But those same people who are willing to work their asses off can't control their employers' offering of health benefits. Nor can they control getting sick. Less sick people = better economy = richer Cynthetiq, which is all you care about, right? (I should know better than to talk to you about this, you always make me mad!! Gah.)

Anyway... this is my actual contribution:
We will never have nationalized healthcare in the US because the doctors would never allow it. Think about the salaries of doctors now... and after the government is in charge of their pay. One of the simplest reasons for that is that schooling to become a doctor is both grueling and HUGELY expensive. They are several hundred thousand dollars in debt by the time they're done. And they're supposed to be okay with getting paid maybe 100K a year? After all that training? And if pay becomes that limited, we're going to have an even greater shortage of physicians on hand. As it is, it's nearly impossible to get decent care in the inner cities and rural areas (why do you think they created PAs??). So... it costs too much to become a doctor, thus the doctors will never allow a system that limits their salaries. Plus, many people who become doctors aren't in it for the nice feelings... if it's just left to those who want to do something good in the world, then we'll have even less people.

I think we will not have national healthcare until we do something about our university system, at least for medical training, if not for everyone. I know there are state universities that are more affordable... but frankly, it's pretty rare that those schools are as good as the private universities, and they're often turning out less than stellar graduates.

That being said, I do believe both the university systems and the healthcare systems should be overhauled. I very much believe in national healthcare because of our poor working class. They're working their asses off, and they STILL can't get affordable healthcare. They should. They're not lazy or making bad choices, like Cyn implies... they're just working class, that's all. If Cyn had his way, I think we'd all be in a class system in truth rather than just in practice.

Med school costs outside of the US are a lot less, right? But many of them still provide top notch education, which is competitive with the US. Oxford and Cambridge are a lot cheaper than a lot of US med schools that aren't as reputable and may not be as good.

Anyway, as I understand it, there's no shortage of doctors in France. Maybe, through studying the many varied medical systems across the world, we can combine their best attributes into our own system.

I call shenanigans on your claim. I've never heard of a single person being held back because of anything other than their own personal choices. Many of the 4000 kids I went to high school with decided education wasn't for them and partied their way through high school. You want to know where most of them are now? They're working dead end jobs and are utterly miserable with very little. On the other hand, a good buddy's parents are both immigrants and work multiple jobs to keep themselves afloat. He decided to work hard, got good grades, stood out as a tight end, and now has multiple full-ride offers from a handful of prestigious schools like Columbia and Yale.

The real problem is that we've created a nanny state of sorts and instead of creating government programs that help people find work and work for what they need, we instead have created welfare programs that simply give people money for being deadbeats and give them no incentive to better themselves and make a contribution to society. We can't expect people to be honest because as long as people can find a way to do nothing and get some kind of benefits for it, they aren't going to be hard-working and honest.

As for healthcare, medicare and medicaid are quite enough, placing everybody on a government-run system is just asking for problems.

So you're saying that every poor person deserves to be poor? Are you sure you want to make that argument?

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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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".

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.

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.

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?

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.

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

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.

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.

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.

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.

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.

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.

:shakehead:

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.

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).

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.

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.

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.

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.

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.

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.