Topic: A Great Article on National Healthcare

[Vekseid]

Do we really want the government in charge of our medical rights?  Granted, if you can afford insurance, you're good to go.  You pay your copay, you see your doctor, and take your medications.  If you don't have insurance, then yeah...you're pretty much screwed.  But with things like Medicare and Medicaid, along with the various state sponsored medical coverage for children, ...

The possession of health insurance does not affect bankruptcy rate. The reason for this becomes obvious quickly - insurers take a ~30% cut, and effectively get you a ~30% reduction in medical fees. They are essentially just middle men who add no value to society.

there are options.

This is either a lie or willful ignorance. There are two options for the self employed in the United States.

1) Quit all revenue-generating venture - expenses are not considered by any public system currently available in the United States. Wait six months, get public health care.

2) Commit a crime, go to jail. This way you don't have to wait six months.

Socialism is a bad thing.  Plain and simple.  Its been tried and it has failed!  Time and again, it has never worked, and a little research on the topic will prove just that.

Which explains why the US is a debtor nation to say, Sweden and Japan, has a net trade deficit with them both and inferior life expectancies to both.

Which is actually rather odd - an aging populace should be less productive.

An unhealthy population is apparently even less so.

[Serephino]

Yeah um... what I'm about to say is a rant, but also pertains to this topic....

I received a letter today telling me I no longer have Medicaid.  Why you ask?  My disability income is magically too high now.  It hasn't changed when I was approved April.  But when I called my case worker she said I was approved only because I had a medical bill (a $1200 ER bill). 

Now that was paid for in April.  I continued to have Medicaid all summer, for 5 months.  So really that explanation doesn't add up.  My theory is they were getting pissy because I was getting my teeth fixed.  I still have 5 undrilled cavities, but I guess my teeth will just have to rot.

I was told by a few people that because I'm disabled they can't deny me medical coverage by federal law.  When I pointed this out to my caseworker she asked if I had a certificate of disability.  My response was that the Social Security office obviously believes I am disabled since they're sending me a DISABILITY check every month.  What more proof do they need?  Then of course she asked how much my check was and when I told her I again was told it's too much. 

I really can't stand dealing with them!  I have fantasies of blowing that office into a million fucking pieces with all of those fucking morons in it.  They will use any loophole they can to deny people who really need the help. 

It pisses me off that people with insurance are so willing to leave me here in this hole because a plan I could afford would be too socialist.  What did I ever do to deserve to have all my teeth rot out and get sick and die of something that could easily be treated?  I never asked to be bi-polar.  I tried to work damn it!  I had 7 jobs in 2 months, got fired from all of them, usually on the first day, because I kept having a nervous breakdown. 

Social Security doesn't give me enough to live on, forget paying $120 a month for health insurance.  I could get Medicare, but that would be $109/month, and they only cover 80% of approved procedures, plus a $135 yearly deductible.  That's worse than crap. 

My very good credit was destroyed when I got a gallstone.  My mom keeps telling me I might as well go ahead and declare bankruptcy because it can't hurt my credit much more.  My score went from 712 to 561.    That's what having medical bills you can't pay will do to you.  So what will happen if I get sick again?

I was sick to my stomach when I had to call and cancel my dentist appointment.  I also have TMJ syndrome, but I guess I'll just have to live with it, because treatment costs money I don't have.

 

[RubySlippers]

First off Medicaid in most states does restrict care in Florida you must be a pregnant woman, very poor child, unable to work at least a year after they approve the status or be unexpected to live for at least a year. Besides being poor.

This is why I support the 133% income guideline to get on Medicaid regardless of other factors, just income based. But itw odd your on Federal disability I would think you would be disabled they just don't hand out that status like candy, its alot of hoops to jump through if I'm correct on that.

[Kotah]

I am all for health care reform.

However, Obama's plan isn't the way. It really isn't going to change anything, but if you don't have insurance... You get to pay a neat little fine to the insurance companies. I don't see this as a solution.

What would be the best solution is a single payer system that can be supplemented by normal insurance. What do you get? Everyone has health care, and for the people that want a little extra they can have extra, if they pay extra.

As far as medicare is concerned. Please hope you never have to have it. This is how medicare works. Say you have a stroke. In very small small scale to keep everything simple, let's say the average recovery time for a stroke is 90 days. You spend 10 days in the hospital, and 80 days in a restorative care program. The 80 days include: 40 days of physical therapy, 80 Days of PROM and AROM therapy, yadda yadda. A bunch of therapy happening all at the same time to get you ready to go back to the world.

Day 84 you fall down, and hurt yourself. You now have a sprained wrist. You already have limited mobility because of your age. I.E. You are in a wheel chair. Medicare only pays for you to receive care for 90 days. You better hope that wrist gets better in 6 days. Cause unless you have a few thousand dollars to throw around, your ass is going home.

I have had this happen to countless patients, and I just get to sit around and wait for the time limit to be up so they can come back to us, and try to make them better again... so we can send them home to hurt themselves. We can't do anything to stop it. Why? Medicare only provides for a standardized care program.

[The Overlord]

Socialism is a bad thing.  Plain and simple.  Its been tried and it has failed!  Time and again, it has never worked, and a little research on the topic will prove just that.

Some thoughts to gnaw on here-


Socialism and communism’s main bad rap here is not their inefficiency, but because they’ve been the government of the ‘enemy’. The words invoke an automatic knee jerk reaction from many of us.


Now the reason they don’t work is the same thing that fuels capitalism; basic human avarice.


On paper, a socialist state looks pretty good, because it provides for all, and everyone gets a slice of the pie. In practice it doesn’t work, because inevitably someone who gets into a position of power, influence, or authority decides they’re not just happy with their slice of the pie…they want yours too.


To expand on what I said above; the reason they don’t work is the same thing that fuels capitalism; basic human avarice. Capitalism is fueled and oiled on greed.



…for a little while longer.



 
And that is what I fear we’re seeing right here, right now, with the current financial debacle, knowing how it came to be. We’re finally learning the limits of capitalism.

[Celestial Goblin]

The way the terminology gets used and abused in service of political propaganda is disgusting.

The Euro-Canadian-etc concept of society providing things like healthcare and education to everyone in need is thing A.

The totalitarian system that existed USSR and the rest of the Soviet block is thing B.

Thing A is as apart from thing B as a monarchy is from democracy.

[Kotah]

I agree with Celestial Goblin. There are different types of everything. Canada is obviously no USSR. The difference even goes deeper then socialism and communism. There are different types of communism.

In example, take Maoist China vs. Stalinist Russia. They are both types of communism. Stalinist communism is described as Proletariat Bonapartism. While Maoist China is described as peasantry Bonopartism. Cuba is a strange mixture of the two, but far more closely related to Stalinist Russia then to Maoism.

The difference between the two type of communism are as different as a non-denominational church, and a southern baptist church. They may get along from time to time, and they may agree on some things, but if you really look in to the basic doctrine they are clearly different from each other. Different means to the same end.

That is not to say, however, that Stalin and Mao were not jerks that the world is better off without.

My point is, just because certain type of socialism and communism fail, doesn't mean that everything about them is a failure. Canada, and most of Europe, have some from of national health care that far outdoes the united states. The united states at 37 in the rank for health care. With about 18 countries that have national health care ranking above us. I would also like to note that France, which has national health care, is ranked 1. This ranking is done by the World health organization.

http://www.photius.com/rankings/healthranks.html

[Oniya]

Just to make sure all the facts are on the table, that chart was produced in 2000, and the WHO no longer produces a chart like that, due to the complexity of the task.

[September]

The trouble with that WHO report is that it's not really ranking countries on "health care".  It's ranking countries on various things including "fairness of financial contribution" and "distribution of financing".

If you rank countries on things like "cancer survivability" and "waiting times" and "number of medical breakthroughs" then you would get the countries in a different order.

As with so much in politics I think that in this case you have to really do your own research and not just rely on politicians and bloggers and people on internet forums to tell you what you should think.

[Kotah]

Then to clarify my point. http://ucatlas.ucsc.edu/spend.php

Despite the wide gaps, higher spending on health care does not necessarily prolong lives. In 2000, the United States spent more on health care than any other country in the world: an average of $ 4,500 per person. Switzerland was second highest, at $3,300 or 71% of the US.

If you look at the graph for average life/ pc spending You see that France, who was ranked first, has a better life expectancy, with the universal health care. Where as, America spends the most out of any country. It ranks just above Cube, which spends the least amount in health care.

Another reason some countries achieve high life expectancy with low health spending is that clean drinking water and preventive health care can be provided with little spending. If there is near universal clean water and preventive care, life expectancy rates can be high. In the US, however, nearly 40 million Americans lack basic health insurance, and are therefore less likely to receive preventive care.  In contrast, Cuba has universal health care and one of the highest doctor-to-patient ratios in the world.

These were all made in 2000 too.

http://graphics8.nytimes.com/images/2009/02/28/business/0301-sbn-webHEALTH.gif

1960-2008 US health care spending.

As for waiting times, ect.

Preventable deaths in 2000-03
http://www.allcountries.org/ranks/preventable_deaths_country_ranks_1997-1998_2002-2003_2008.html
Healthy life expectancy
http://www.photius.com/rankings/healthy_life_table2.html

Cancer survival rates highest in France and Japan:http://www.medicinenet.com/script/main/art.asp?articlekey=91106

It's simply easier to link information then try to argue out.

[Kotah]

It posted on accident. The last link is for the 4 main common types of cancer. The highest life expectancies countries are, France, Japan, USA, Canada, and Australia. Not necessarily in that order.

[September]

Respectfully you are kind of illustrating my point by cherry picking certain statistics that support the conclusion you would like everybody else to reach.

Here's a page written by somebody who wants you to draw the opposite conclusion: http://www.ncpa.org/pub/ba649#_edn1

The writer demonstrates that:
- Americans have better survival rates than Europeans for common cancers.
- Americans have lower cancer mortality rates than Canadians.
- Americans have better access to treatment for chronic diseases than patients in other developed countries.
- Americans have better access to preventive cancer screening than Canadians.
- Lower income Americans are in better health than comparable Canadians.
- Americans spend less time waiting for care than patients in Canada and the UK.
- People in countries with more government control of health care are highly dissatisfied and believe reform is needed.
- Americans are more satisfied with the care they receive than Canadians.
- Americans have much better access to important new technologies like medical imaging than patients in Canada or the UK.
- Americans are responsible for the vast majority of all health care innovations.

This issue isn't as clear cut as some people are making it out to be.

[Vekseid]

If you really want to get into the wait time fight, look at Japan.

[RubySlippers]

I'm a lower income AMerican I have no clue what your smoking but on my income of $12,900 last year and chronic medical care is needed trust me I'm fraked in the US. Diabetes care NADDA no drugs, testing supplies or insulin. My related conditions Diabetic Retrinopothy NADDA, Diabetic Neuropothy (bleeding in the eyes) NADDA and Weakened Legs NADDA.

And lets be blunt what the hell good are all the fancy new treatments, care for cancer and other frankly rarer conditions when I and many others can't get fraking basic fraking care for common fraking conditions. Trust me if I go blind, lose my legs or get a horrible infection its going to cost alot more down the road. All PREVENTABLE if I can see a medical doctor, get basic drugs and a specialist or two now and then.

I'm blind I can't work that means social security disability, housing assistance, medicaid anyway and I'm not working and paying for housing and my other needs. Not to mention pain, suffering, losing my quality of life etc. that is right now a real worry.

Can I add one thing in Canada how many people GO FRAKING BANKRUPT over medical debts? In the UK, France, Finland, Netherlands or other nations? In the US a third of bankruptcy cases not due to stupidity (credit card debt etc.) are medical or caused do to medical bills in the main.

Sorry for all the fraking but I'm sick of writers stating numbers when I'm among the working poor and get ignored. And sick of looking at this issue from the use of rarer medical issues over day to day care.

[Kotah]

I would actually disagree. In your like it gives specific statistics that don't fully support that claim.

I'm not going through them all.

Americans have better survival rates than Europeans for common cancers

In breast cancer and prostate cancer. two of the four. Where as  France has higher survival in colon cancer, another of the four, it isn't so far behind in breast cancer either. As per my link above. France is in Europe too. :)

As far as the best innovations...
The pharmaceutical industry has a financial incentive to make sure that these people are repeat-customers, consequently there is very little research being done to find a cure. Most research done by the private sector is centered on finding new anti-retroviral drugs - drugs that patients will have to continue taking for a lifetime.

Meh. DCA has been proven to be effective against many forms of cancer, but it is not being researched as a cure for cancer because, well, DCA is not patented or patentable. It's not getting funding for clinical trials because the only places that are supporting the research are not-for-profit. The can't get enough money to possibly cure cancer.

I'm in health care. I don't have health insurance. Slightly ironic. I

[Serephino]

Lower income Americans are in better health than comparable Canadians.

Really?  Did you not read my rant?  I have TMJ, 5 cavaties, Inflamitory Bowel Disease, allergies, bi-polar disorder, bad knees, insomnia...

I could go on and on.  I am in very bad health, and so is my boyfriend.  He randomly passes out.  We have no idea what's wrong with him.  Why?  Well... One of your points was that Americans have access to better care, but that's only if you can afford it.  We can't. 

I am at very high risk for both heart disease and diabetes.  I should be getting regular screenings for both, but I can't.  Those tests cost money.  I have no idea what my cholesterol level is.  And I could have diabetes right now and not know it.  I could decide to go get an ice cream sundae one day and end up in a diabetic coma.  The last time I was tested was when I was 19 and had insurance.  A lot can change in 5 years. 

As for the wait times in other countries, if you read through this entire topic, members here who live in said countries have said the wait times really aren't all that much worse there in the US.  I think I'll take the word of someone who lives in Canada, Britain, or Australia rather than some Congressman trying to be an ass.   

[RubySlippers]

I looked up the Finance Committees Health Care Bill it also expands Medicaid to those at or under 133% of the Federal Poverty line, strictly income based. I know its not perfect but anyone either working part-time or doing seasonal work will have a chance at getting coverage. And the rest will seem to get help to get coverage based I think off your income levels as a percentage. For families of three over $55k income it would be 13% of their income a month as a target for costs. Lower for lower incomes so it seems like it can work. Combined with other reforms naturally.

[OldSchoolGamer]

Respectfully you are kind of illustrating my point by cherry picking certain statistics that support the conclusion you would like everybody else to reach.

Here's a page written by somebody who wants you to draw the opposite conclusion: http://www.ncpa.org/pub/ba649#_edn1

The writer demonstrates that:
- Americans have better survival rates than Europeans for common cancers.
- Americans have lower cancer mortality rates than Canadians.
- Americans have better access to treatment for chronic diseases than patients in other developed countries.
- Americans have better access to preventive cancer screening than Canadians.
- Lower income Americans are in better health than comparable Canadians.
- Americans spend less time waiting for care than patients in Canada and the UK.
- People in countries with more government control of health care are highly dissatisfied and believe reform is needed.
- Americans are more satisfied with the care they receive than Canadians.
- Americans have much better access to important new technologies like medical imaging than patients in Canada or the UK.
- Americans are responsible for the vast majority of all health care innovations.

This issue isn't as clear cut as some people are making it out to be.

The above may be true...but with an important qualifier:

"...for those who can AFFORD a good insurance plan, or who can pay medical expenses out of pocket."

Trouble is, we've got millions of people who can't afford decent medical coverage, and who therefore do not achieve the outcomes discussed above.

We can't do an apples-to-apples comparison of the American system versus others if we disregard the medical outcomes of those who cannot afford access to the system.  They count too.

[The Overlord]

Hmmm...

The writer demonstrates that:
- Americans have better survival rates than Europeans for common cancers.
- Americans have lower cancer mortality rates than Canadians.
- Americans have better access to treatment for chronic diseases than patients in other developed countries.
- Americans have better access to preventive cancer screening than Canadians.

Other than the claims made in the article, I have seen nothing one way or another on this.

What I can tell you is this- In less than a decade I’ve see two family members go down from cancer. If you’re paying attention at all, an alarming number of celebrities have been taken down by cancer just this year. Perhaps our numbers are better, but if you ask me, a few more statistical percent points than Europe or Canada are small consolation for those of us that have lost loved ones to this evil…cancer is still getting enough of us.

- Lower income Americans are in better health than comparable Canadians.

Really? It’s news to me that any country let alone the US statistically gave a fuck enough about its poor to tally this with any degree of accuracy. ‘Mister Atlas’ will forgive me if I don’t take his word for it.

- Americans spend less time waiting for care than patients in Canada and the UK.
 

Maybe…maybe not. I’d like to see real stats on this. Better yet, any Canadians on the forum that can pitch their two cents?

- Americans are more satisfied with the care they receive than Canadians.

Are they? Once again…

- Americans have much better access to important new technologies like medical imaging than patients in Canada or the UK.
- Americans are responsible for the vast majority of all health care innovations.

Bear in mind that ‘access to’ and actual use of are two different animals, given the inflated medical prices here. No matter how you feel about Obama’s health care reform package, I’d bet my left nut nobody here believes US healthcare prices are sane.


Furthermore- a quick Wiki browse states “The NCPA states that its goal is to develop and promote private alternatives to government regulation and control, solving problems by relying on the strength of the competitive, entrepreneurial private sector.”


This tells me nothing, in fact if anything it makes me wary of the NCPA, because it’s the competitive, entrepreneurial private sector that gotten us to where we are. Of course they oppose meaningful health care…too many of them are getting fat like slugs off the profits. Like the NCPA, they don’t want regulation…business is good, and people are dying to make their profit.
 

[RubySlippers]

I don't understand the problem with the government option we have the US Postal Service and UPS and FedEx and all seem to be happy together.

As for government control we have the VA, Medicare and Medicaid and locally and state run programs all socialized in the common understanding.

As for rationing care with pencil pushers the INSURANCE COMPANIES already do that and far more cruelly than the government likely would, maybe more government oversight is necessary. Its just how its set up that matters.

[Trieste]

I don't understand the problem with the government option we have the US Postal Service and UPS and FedEx and all seem to be happy together.

That seems like it's actually a really good comparison.

[OldSchoolGamer]

I think the best approach to national health care is to utilize the Pareto Principle.

To oversimplify, the Pareto Principle holds that approximately 20% of the population of something is responsible for around 80% of the traffic.  If you have, say, 30 people on your cell phone contact list, you probably call 5 of them every day, the next 5 a few times a week, the third 5 maybe once a week, the fourth five, a couple times a month, the bottom ten, rarely or never.

In health care, there's a relatively small percentage of all the ailments out there that are the primary drivers of health care utilization.  Minor injuries.  Respiratory infections and influenza.  Management of chronic conditions like hypertension, diabetes, thyroid imbalances, pain, depression and schizophrenia.  Caries.  These are conditions that are relatively cheap and easy to treat...yet have the potential to spiral into expensive, debilitating, even (in some cases) life-threatening situations if they are not managed.

This is what a national health care system should focus on: covering everyone for this 80% or so of doctor's office visits.  This would keep the cost of the national coverage down, yet substantially improve the lives of the presently uninsured.  It would also help serve to bring costs down, as it's a lot cheaper to treat a condition with a $50 office visit and a $50 prescription than a $2,500 ER visit.

[Vekseid]

That's entirely unnecessary. We're already doing that. Government spending covers the disabled and the elderly - or tries to. The lack of preventative care is the killer, however. Literally as well as figuratively.

Right now, business self-insurance in the United States costs around $3k/person per year for large companies. Similar coverage would cost $1,500/month for me, if I bought it from an insurance company. There isn't a single situation where it makes sense for me to pay an insurance company - if I got struck with cancer, for example, they would not pay back more than I paid them. That's not insurance, that's a bank account with a negative interest rate.

[RubySlippers]

I pointed out in a Town Hall Meeting that there are ajor issues with the proposals first they are hardly keeping the entire thing simple which is turning people off to the reform bill proposals even if I want to have it happen. The second is that oddly the entire plan group is poorly thought out. There are maybe four things that have to be done:

1. Figure out how much money there really is and what people and businesses can afford to do, and I think all businesses should have to be in the system to some degree.
2. Cover the very poor the Medicaid expansion could do that.
3. Instead of a public option have a basic package that all insurance companies must offer at no propfit, that is low cost and reasonable even if it "rations" care and keep the price at say for an average full time worker earning the minimum wage no more than three days pay. More for a family but I think $150 a month split with an employer is reasonable to ask. The insurers can make money on add-on to basic packages and would have flexibility to provide treatment include exporting patents to foreign hospitals if it saves them and the patient money.
4. Serious electronic recordsreform I should be able to get one card I can take to any provider and they should get all my necessary information with one swipe, ideally. That would also cover insurance coverage and make that streamlined as well.

[Trieste]

It would take an extreme amount of work to get something like that to happen. This is why:

1. Figure out how much money there really is and what people and businesses can afford to do, and I think all businesses should have to be in the system to some degree.

The current system is murder on small businesses - and a system like this would also be murder on them. Small businesses are not expected to turn a profit for the first 2-3 years, for example. So we're talking about either adding the cost of health care for all employees onto whatever small business loan they'll have to take out - and forcing entrepreneurs to repay the cost of employee health insurance with interest when those loans come due - or having employees of small businesses in their first three years go uninsured. Neither option is viable, for various reasons. We have to stop punishing small, private businesses with the healthcare system; they are what drives the underpinnings of local economies.

2. Cover the very poor the Medicaid expansion could do that.

Medicaid is broke, on top of being broken.

3. Instead of a public option have a basic package that all insurance companies must offer at no propfit, that is low cost and reasonable even if it "rations" care and keep the price at say for an average full time worker earning the minimum wage no more than three days pay. More for a family but I think $150 a month split with an employer is reasonable to ask. The insurers can make money on add-on to basic packages and would have flexibility to provide treatment include exporting patents to foreign hospitals if it saves them and the patient money.

If we could trust insurance companies to offer what would be considered fair and affordable, we wouldn't be in this mess in the first place. On top of that, it would be foolish to expect insurance companies to accurately report expenses (and therefore profits) without a ton of oversight. Oversight is costly. If we're going to need to employ an army of healthcare officials, we might as well cut out the middleman and go for public option.

4. Serious electronic recordsreform I should be able to get one card I can take to any provider and they should get all my necessary information with one swipe, ideally. That would also cover insurance coverage and make that streamlined as well.

That way, when a laptop gets stolen from a state secretary in Oregon, the thief can have easier access to a whole lot more information. *thumbsup*