hiredgun

Back before the primaries, when Governor Dean spoke at my school, one of his grievances about current policy was the state of healthcare. He lambasted the United States as the only civilized country with such a large portion of its population adrift without access to medical care.

At the time, I was emotionally compelled to agree with him, but I realize that I don't know very much about the subject. My question is, what would be the benefits (or costs) of a universal healthcare system in the US?

Some of the things I'd be interested in learning about and discussing:

I've heard it said that despite a "more efficient" private system, the US spends more per capita than, say, Canada, on healthcare. Is this true? If so, what role do litigation and insurance play in these costs?

What about the quality of health care? In the 21st century, is it still true that the US has the best healthcare in the world (albeit, only for those who can afford it?) How do countries with nationalized healthcare measure up?

Finally, what are the political prospects for a radical change in healthcare within, say, the next decade? (My uneducated guess would be that there are rather low odds.) Do you suppose that healthcare is an issue that, like taxes, Kerry can focus on domestically since his Iraq policy will basically be identical to Bush's?

BigBob234

The FIRST question should ALWAYS be..

What/How does the Constitution say/apply to this situation. If you don't know the answer to that, then you ask, "How did the founding forfathers deal with that situation?"

It's true that libs and cons don't like these questions, but they are (or rather, should be) the basis on which we have government in this country.
BB

meepa

We live in a different world than the founding fathers. It's time to make decisions for ourselves and stop wondering all these what-ifs for people long-since dead.

tecoyah

In my opinion the detriment in a universal healthcare system would be put upon the drug companies, and major healthcare corporations. These entities would stand to lose an enormous amount of profit should the government go from legislating in favor of uncontrolled profit, to forcing a bidding war for government contracts to supply the population.
Another downside would be a likely slowdown in technology, and drugs development, in the short term (10-20 Yrs.) as profits became more sparce.
The upsides might include a healthier population, as standard treatment and professional diagnosis became available to all. The lessening of endless paperwork, and dimissal of claims. And the boost to the economy as the rediculous health insurance premiums were back in the hands of the wage-earners, although some of this (not all) would go into the tax increase needed to fund the program in the first place.

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roachboy

the american constitutional system uses the consitution as a general framework the elaboration of precedent.
this feature probably explains why the americans are not on their 5th or 6th constitution by now.

it is anachronistic at best to ask "what would a bunch of 18th century people do?" to addres social problems they had no conception of.
it is as if you are operating in a civil law tradition, not common law

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BigBob234

Have fun with whatever party you support. May you win over the other party trying to gain power.

Your theories are all based on how you feel that particular day. Good luck with all that.
BB

ARTelevision

I'd like to see this hammered into shape. tecoyah sums up some possible pluses and minuses. It could well be time for the drug companies to be legislated into greater social responsibility. They will find numerous ways to survive and prosper. Operating at too great an advantage causes them to be relatively unmotivated by keen competition and to spend exorbitant amounts of capital on some quite needless promotions of their products.

The pluses, as summed up here by tecoyah, would improve the overall status of human capital of our nation. Human capital is the basis for all capital creation.

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Rodney

Private industry says they can do it more efficiently, but the profits leave the system; they aren't reinvested. And since the major goal of modern corporations is to maximize profit, and since most corporate execs are not creative geniuses, there will always pressure from the board (not in some many words) leading them to cut corners, make service more difficult to get, and so on. They don't get bonuses for providing good health care; they get bonuses for big profits.

Drug companies do spend a lot of money developing drugs, but a lot of them are "me, too" drugs, and a lot of the cash they really spend is for marketing -- huge amounts, both to the public and to doctors. And there isn't a lot of research into drugs for more obscure illnesses, because there's no money in it.

Corporations have always depended on the government to fund or subsidize major research; Cold War military research brought us advances in aerospace, computers, materials, and a zillion other things that now are in use everywhere, and cheaply. I say, let the government or some semi-independent government-chartered agency fund devlopment of drugs and therapies for the most serious needs -- heart disease, cancer, vaccines for infectious diseases, and then offer them free to all drug companies to market at modest cost. It would be like a Manhattan Project. The drug companies would be free to create any frivolous treatment they like and charge top dollar, as with Botox or Viagra (not frivolous for some, I realize). But the stuff that people actually need to stay alive and in reasonable comfort would be developed by somebody who didn't need to make a profit, and didn't worry about whether the new drug would cut into profits from older drugs.

hiredgun

Tecoyah, I wonder whether your point about a slowdown in technology would really come to pass. I do think that the emergence of collective goverment-directed action in drug research (rather than multiple groups independently vying for profits) might actually increase productivity. Rodney pointed out a good analogy when he mentioned the Cold War and the Space Race - in that instance, strong government support brought results that profits would never have justified. (Beyond satellites, what significant dollar profit has any corporation gained from space exploration?)

Another plus of removing profit as a primary motivation would be the re-prioritization of critical life-saving technologies. Cosmetic medicine has enjoyed a boom because its generally affluent clients are able to pay top dollar for treatments such as Botox, which now has a handful of copycat cousins (like HydroDerm, which is applied dermally rather than by injection). These efforts misdirect a great deal of attention towards relatively unimportant endeavors, and they often consume the resources of not one but several competing labs.

I suppose the bottom line, as always, would involve how we would pay for a more regulated system, and how in fact such a system would work.

roachboy

some of how you might think about universal health care is a function of the model that you have in mind for it.
usually, for some reason, people refer to the uk and canada--but i would think something more on the french model would be better to consider---basic health care provided from social security taxes for all citizens, combined with private insurance companies that cover needs above that---drug price controls, an extensive proactive basic health care emphasis as a way to reduce stupid interactions with the institutions---extensive choice with reference to physicians, types of care, etc.

basic information:
http://www.afii.fr/France/Living/Health/?l=en

more detailed:
http://www.oecd.org/LongAbstract/0,2..._1_1_1,00.html

a comparative analysis (not prescreened by me except in a cursory manner)
http://www.cmwf.org/programs/interna...survey_299.asp

a neoliberal-style critique of the french system from the oecd:
http://www.oecd.org/dataoecd/15/26/1885750.pdf

this is not to say the system is perfect--but as a mix of public and private that renders most most of the right's a priori objections to the idea of it, this is an interesting example.

(you just cant do anything about the folk who think that universal health care is a step on the road to stalinism---there is simply nothing to be said to them...)

__________________
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spinning dog. such faithfulness it hear

it make you sick.

-kamau brathwaite

roachboy

one more thing--here is a link to the world health organizations 2000 report, which ranked the us medical system 37th in the world.

http://www.who.int/whr2001/2001/arch...0/en/index.htm

and an article about the report, focussed on the rating of the american system:

http://www.ama-assn.org/amednews/200...8/gvsa0828.htm

enough for now, methinks......

__________________
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spinning dog. such faithfulness it hear

it make you sick.

-kamau brathwaite

Journeyman

People wondering if it's time to let go and move on from following a 200 year old document for guidance in the law are going to have a hard time convincing everyone else, when you consider the amount of people who still clasp to a 2,000 year old document for guidance in the law.

Just putting some context in there.

roachboy

journeyman--i think the arguments came in reponse to the "what would the founders think" matter, which is simply irrelevant in the kind of constitutional system they put into motion.

hell, you can read an autobiography written by someone you know and still not be able to figure out intent exactly.
the original intent approach to american law is as goofy as it gets.

__________________
a gramophone its corrugated trumpet silver handle
spinning dog. such faithfulness it hear

it make you sick.

-kamau brathwaite

KMA-628

BB,

The U.S. spends more per capita on health insurance than every country, not just Canada.

The facts are in a book of mine that I referenced in a different thread. If anybody disputes this I will try and find online documentation.

My argument then was against throwing more money at a system that is already the biggest in the world.

As much as I am against Universal Healthcare, I wonder why other countries can do it with significantly less per capita spending. I would be open to the idea....

/roachboy, pull out that hat again

....if we could design a system that encompassed the entire population with a lower per capita rate then we have already. This would probably be the rare case where roach and I could agree because we both would see our ends met. For me, I am against spending more money because it would involve a "new" tax or more taxes. That is why I am open to consider a lower per capita system, because the net effect on me would be lower.

so......

we would have to sit down and spend a lot of time looking at the pros and cons of the various successful programs throughout the world. Then we could see if we could design a similar or better system utilizing the current funds (or less if I had my way).

/tells roachboy to plug his ears

I would still want the ability to purse a private health insurance carrier, even with the "free system". So as long as both conditions are met, for me, I would throw my support behind it.

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roachboy

kma--this last point is exactly why i thought the french system might be a more interesting example to think about than that of the uk, for example.....

forefinger to the hat.

__________________
a gramophone its corrugated trumpet silver handle
spinning dog. such faithfulness it hear

it make you sick.

-kamau brathwaite

KMA-628

I know, I know...

But I got that whole French paradigm thing going.

__________________
Before you criticize someone, you need to walk a mile in their shoes. That way, if they get angry at you.......you're a mile away.......and they're barefoot.

KMA-628

roachboy,

Of your links, which has the best, concise, overview of the model?

I'm being lazy tonite.

Edit: I - I'm

__________________
Before you criticize someone, you need to walk a mile in their shoes. That way, if they get angry at you.......you're a mile away.......and they're barefoot.

fuzyfuzer

If you tell a doctor how much he can bill and pay him next to nothing for extra work does not work. look at doctors in canada you think apointments are bad now look up there doctors only work half there time because they can't be paid the other half, stupid system. This system will not protect the doctors from lawsuits so there is no benifits to them.

I don't know but maybe it's time to respect doctors a little more, i mean they did give up their life for you, and stop trying to take all there licenses away.

__________________
"The difference between commiment and involvment is like a ham and egg breakfast the chicken was involved but the pig was commited"

"Thrice happy is the nation that has a glorious history. Far better it is to dare mighty things, to win glorious triumphs, even though checkered by failure, than to take rank with those poor spirits who neither enjoy much nor suffer much, because they live in the gray twilight that knows neither victory nor defeat." Theodore Roosevelt

ARTelevision

Yes. I think the US is in a position that a universal health care initiative is in order. This would begin by a study of possible models and the creation of a set of alternative proposals. These could be implemented through the administrative and legislative processes after a positive national dialog on the subject. This dialog would certainly contain the points made pro and con by contributors to this thread.

The process initiated by the Clinton administration early in its tenure can serve as a model for how and how not to accomplish this. It had a great deal of value and bears reinstituting in a new and better form.

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roachboy

the best of the links (most info in least psace) is probably in the first post---this one (i'll just repost it)

http://www.oecd.org/LongAbstract/0,2..._1_1_1,00.html

i hope i can ask this without sending the thread off into another space:
but i was living in france for most of the first clinton term and never really got a handle on what the problem was with his effort to develop a universal health program..could someone give me an idea?

__________________
a gramophone its corrugated trumpet silver handle
spinning dog. such faithfulness it hear

it make you sick.

-kamau brathwaite

cj22009

Ill keep it short and sweet iff we go with a universal health care system that just another way for the goverment to be in our lives. I dont like big brother to be in my life much

KMA-628

roachboy,

blocked by the Republicans.

For the obvious reason and probably others that I am not aware of.

__________________
Before you criticize someone, you need to walk a mile in their shoes. That way, if they get angry at you.......you're a mile away.......and they're barefoot.

ARTelevision

roachboy, the answer is mired in partisan disagreement.
There are left and right wing explanations.
These links are pretty informative. The second one goes into the politics of the situation fairly extensively:

http://students.washington.edu/aed/a...get/980203.htm

http://my.netian.com/~pynchon/doc/healthcare.htm

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pan6467

If a drug company spends millions on finding a "cure" for yellow toenails, yet hasn't come close to anything that fights cancer, there is a problem where their research money is going. (Lamactisil (sp))

We must ask why drug companies are coming out with what I consider cosmetic drugs, and not true drugs that fight true diseases.

We must ask ourselves how we can justify overprescribing drugs such as Ritilin to our children.

We must ask why the drug companies visit doctors to push newer and far more expensive medications, when the older ones work just fine.

We must ask why drug companies find it necessary to advertise their drugs, if you truly suffer from yellow toenails, then when you see your doctor should he not know how to treat it, without having a commercial on tv every 30 minutes.

We must ask why all the psyche drugs to help us cope.

We must ask how and why doctors can get away with charging insured patients and their companies a discounted price and those uninsured a higher price.

We must ask why if we truly are the greatest country so many have no insurance, others lose insurance mid-illness and the rest who are insured don't want to find ways to help those that need it.

As for the Constitution, I do not believe the founding fathers could ever foresee the medical industry as it is today. But IMO the preamble could be used as a start "promote the general welfare"... When one industry controls so much of the economy, can bankrupt millions, can determine who gets treated and who doesn't, then the general welfare of the nation is at risk.

We have drugs for everything now except the true diseases that cause long illnesses (cancer, AIDS, heart disease, diabetes, etc.).

As long as we have insurance companies paying for overmedicating people with truly inane drugs and there is money in treating and drawing out for extended lengths serious diseases, there is no reward and ambition to research and find cures to the serious diseases.

In the end because of unregulated medicine researching what they want, and keeping prices as high as they want, we will continue to see more junk drugs and more psyche drugs "to make us happy or numb us into oblivion" and fewer and fewer drugs for the true diseases that truly hurt the overall economy but is the health industry's bread and butter.

__________________
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?"

kutulu

pan,

You spoke my mind talking about the drug companies. So much money is being wasted on unneeded drugs and marketting. I'd like to know how much they spend on marketting compared to R&D.

That has always struck a nerve with me. Doctors should be perscribing drugs based on the potential benefits to the patient. Getting kickbacks from a drug company should be so illegal. The

My wife is pregnant and last week we were at the Dr's office for a monthly visit. We saw this young hot woman leaving and my wife commented that she must be a drug rep (since most docs are older men they are suckers for young hot women). Sure enough, she was and sure enough my wife got a new perscription that day (luckily we were able to get a generic of it).

One of the hurdles with getting to a universal HC system is that only one side wants it. In order for it to be an effective system, it needs to be properly planned out. The planning will take a few years and there will be several years implementing it and ironing out the kinks. It's more that what could be accomplished by even a two term President. Hopefully, one President could get the foundation built and a second can implement it.

ARTelevision

Absolutely realistic ideas here. Just about every single comment has been on point. Yes, I think it's doable.

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seretogis

While "doable," I think that such an infrastructure would be as much or more of a massive failure as the public school system. I don't think that the federal government is either responsible for or capable of providing a national healthcare system. Premium healthcare is a service, not a right.

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no one to blame always the same, open my eyes wake up in flames

ARTelevision

I would never say it is an easy thing to do. However, I think the effort is in line with the charge to promote the general welfare in the interest of life, liberty, and the pursuit of happiness. We are a wealthy nation and can afford to do more than we are doing in the interest of the health of our citizens.

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Zeld2.0

Much of this also comes down to whether its a worthy investment in the future or not.

A healthy productive country could pay off great in the large run - longer life, healthier bodies, better market and production.

That of course is in the long-term and in the short-term, we have our sacrifices to make.

Of course, that comes down to whether people are willing to sacrifice in the short term.

seretogis

..but is it really the responsibility of the federal govenment to provide healthcare? You wouldn't support the federal government branching out into a national car-care service or a national roofing service, would you? Why is healthcare an exception?

The constitution doesn't protect your "right" to a cast and crutches if you break your leg.

__________________
seretogis - sieg heil
perfect little dream the kind that hurts the most, forgot how it feels well almost
no one to blame always the same, open my eyes wake up in flames

kutulu

People can live just fine without their cars. In most metropolitan areas there is ample (if still inconvenient) public transportation.

Health care is an exception because it is directly tied to your life. It is your health and well being and people's ability to seek adequate care has been reduced to the bottom line at an investor's meeting. Doctors are giving you meds based on what rewards they get back rather than giving you one that works just as well and is cheaper but doesn't have the kickbacks for the Dr.

People also are very limited in their choices of healthcare. It's basically what your employer offers or paying up the ass to insure yourself. The system is fucked.

ARTelevision

I think it is a noble cause and worthy of our best humanistic tendencies, such as compassion, empathy, and caring assistance. The examples given are nowhere near so crucial to human life and welfare.

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pan6467

Taxpayers already pay billions every year for those who have no insurance and cannot pay their medical bills.

We pay by either subsidizing *sub-par* life or death procedures, or we pay because people cannot afford their bills and they go into collection, that in turn raises prices for those of us without insurance and who pay cash to see a doctor. (Most doctors won't even give you the time of day if you do not have insurance, even if you can pay cash, we won't get into the specialized medicine doctors.)

By sub-par I mean a hospital has to, by law, treat you in life or death cases. What this means is, that they will quick fix you and get you out the door as fast as possible. They treat the symptom not the disease.

It is my belief, that with a truly regulated UH system in place, people will be healthier in spirit, physically and in mind.

This will increase productivity and lessen sick days.

This would take away a MASSIVELY large expense on major industries and employers who provide benefits. Thus allowing them to hire more employees and at better wages, thus increasing the workforce, thus increasing disposable income, thus increasing the marketplace thus moving the economy forward much faster than it has in the last 20-30 years (which amazingly enough is when healthcare became unregulated and pharmaceutical companies were able to charge what they wanted, and HMO's and insurers were able to dictate the needs of the patient.

What's the difference between an insurance company dictating what treatment you can or cannot have and the government doing it.

There will be trial and error and waste at first, but long term benefits far outweigh those.

For the past 30-40 years, we have lived for today and as a whole not done much to preserve or make sure that the future generations have better oppurtunities.

If anything we are insuring future generations (except those of the very wealthy) a worse oppurtunity.

Also, there is another serious question we must ask, that those who do not support UH can not answer and that is: how can countries that have socialized medicine charge much less for meds?

Answer: the pharms come here develop inane cosmetic drugs and charge whatever they can get away with, while using the FDA to prevent any real drugs that fight real disease from getting approved.

How can we even pretend that is a free enterprise that is market driven. Because they set the market, they set the prices and they use insurance companies and the FDA to prevent competition.

You don't want UH then find a way to fix the system so that the playing field is not detrimental to everyone except the present system.

__________________
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?"

wilbjammin

Proactive vs. reactive systems of intervention almost always save by large margins in the long-run as well as prevent other problems from occurring. Blaming the victim and having a distain for the common person will only enforce reactive systems... you will pay more to take care of those who aren't covered by health insurance than those who are in the long run.

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Innominate.

roachboy

other factors that have not been discussed so far:

what i saw from reading the links posted earlier that surprised me is the average doctors salary in the states, in 2000, was 191k.

the average.

191,000 dollars/year.

that is about twice the average from countries with universal health care.

i would imagine that something would have to be done about the massive amounts of loan debt that people acquire to pass through med school...that the problem would arise at the point of instituting the system. but it would have to be addressed.

the other major cost in the american system that i have so far been luck enough to not know about first hand is per-day rates in hospitals, which are outrageous. and far far above what is charged in other countries.

insurance carriers. i expect that a combined system, one that would leave space for private carriers, could be forced onto the insurance industry without much problem. what i do not know is the size and power of the industry lobby at the moment. that would have to be broken.

pharma---i do not see why these corporations could not function just as easily in either kind of system. for research funds, thje state could direct resources at them. japan for example has used highly focussed state funding of important industrial sectors for years as a spur to r&d--not to mention as a spur to job creation,etc. it does not seem to have induced anyu radical inefficiency in japanese industrial organization.


as for social benefits, i see no plausible argument against universal health care. folk above have said it better than i could.

o, thanks for the links art--they were informative.

__________________
a gramophone its corrugated trumpet silver handle
spinning dog. such faithfulness it hear

it make you sick.

-kamau brathwaite

ARTelevision

Sure thing, roachboy.
I believe the second link makes it clear that it was not simply a right wing rejection of the initiative's proposals - many Democrats refused to sign on as well. Also the united powers of the health care, insurance, and other industries were too strong and their lobbying efforts too vast. By the time it was near ending, the American people opposed it all as well - such was the reach of the forces pitted against it.

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kutulu

That is so fucked up. IMO the arguement that they deserve that money because of what they paid in school costs is so high is BS. Everyone spends a ton of money on school and racks up loans. The difference is that most people come out of school and are happy to get a job that even pays 40k/yr and gets a 5% raise ( measly $1/hr).

What do most teachers start at. 30k?

fuzyfuzer

so your saying that a person who works about 80 hours a week and has to listen to fucking morons bitch at them all day does not deserve a good income and should have to fight for a 40k/year job......... that makes sense

__________________
"The difference between commiment and involvment is like a ham and egg breakfast the chicken was involved but the pig was commited"

"Thrice happy is the nation that has a glorious history. Far better it is to dare mighty things, to win glorious triumphs, even though checkered by failure, than to take rank with those poor spirits who neither enjoy much nor suffer much, because they live in the gray twilight that knows neither victory nor defeat." Theodore Roosevelt

seretogis

Doctors generally don't work 7-10 hour days and get three months off. Teachers don't generally have to make life and death decisions, ever.

__________________
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perfect little dream the kind that hurts the most, forgot how it feels well almost
no one to blame always the same, open my eyes wake up in flames

roachboy

i am really not sure how this diversion either got started or makes any sense, given that what prompted the whole thing was the fact that doctors salaries in the outrageous when compared to those of any other country in the world. and that salary level does not reflect a more equitable health-care system, and is obviously a symptom of the opposite being the case in the states.

look at the data and make a relevant argument.

for myself, i am not interested at all in reading fatuous potshots aimed at teachers in general, and particularly not when they are irrelevant ....

__________________
a gramophone its corrugated trumpet silver handle
spinning dog. such faithfulness it hear

it make you sick.

-kamau brathwaite