a preview of universal health coverage

[Shryke]

It's simple. People like everyone to be treated equal. That's good. The problem is, what people DON'T like to admit is that not everyone starts off equal. Which means, on some level, exactly equal treatment and exactly equal opportunity are mutually exclusive.

[Swordfish]

[quote name='Elrostar' post='1681810' date='Feb 10 2009, 12.07']An obscene amount of money is spent on the final six months of people's lives in the US, of course. But that's a topic that most people don't really want to talk about.
Treatments that may or may not help very much, time spent in the Medical ICU, etc. It's all incredibly expensive, but no-one wants to say "let's let old people die a few months sooner, because it would save an enormous amount of money". I'm not saying we should do that, I'm just saying that it really is where a huge amount of the money goes.[/quote]


And since old people vote, this situation is highly unlikely to change under UHC in this country.

[quote]'m a firm believer that the benefits so society as a whole outweigh any inconveniences that might be caused. The disconnect between what are supposed to be core American values, equality and opportunity, and the fact that health and wellness for all citizens is key to that, which seems to be present in the minds of so many people who fight against any measure which brings us closer to socialized medicine is something I have a hard time understanding.[/quote]


In order to understand opposition to UHC, one merely has to understand the simple concept of operating with limited resources, and observe the way in which our government behaves when offered a big fat book of blank checks.

[Brienne the Beauty]

[quote name='Commodore' post='1680981' date='Feb 10 2009, 05.09']In 2006, a U.K. health board decreed that elderly patients with macular degeneration had to wait until they went blind in one eye before they could get a costly new drug to save the other eye. It took almost three years of public protests before the board reversed its decision.[/quote]

Bad, huh?

However, there is nothing stopping people going private or getting health insurance in the UK. We are not communists!

In the US, you *only* have the option of going private or getting health insurance. Thus a person with macular degeneration and no health coverage in the US would have gone blind in *both* eyes, rather than just one eye.

[Lord of Oop North]

Health Coverage for one and all, free of restrictions, is the [u]only[/u] moral choice. Life, Liberty, and Happiness and all that bullshit, you know?

The fact that anyone can attempt to justify the de-facto denial of health services, which your current health system creates, by it's nature of being tied to the limited supply of money in the hands of the people, is absolutely horrifying. It disgusts me, and honestly, leads me to believe that the most ardent proponents of the current system are generally those with access to wealth.

[Shryke]

[quote name='Lord of Oop North' post='1681923' date='Feb 10 2009, 16.23']Health Coverage for one and all, free of restrictions, is the [u]only[/u] moral choice. Life, Liberty, and Happiness and all that bullshit, you know?

The fact that anyone can attempt to justify the de-facto denial of health services, which your current health system creates, by it's nature of being tied to the limited supply of money in the hands of the people, is absolutely horrifying. It disgusts me, and honestly,[b] leads me to believe that the most ardent proponents of the current system are generally those with access to wealth.[/b][/quote]

The Health Care threads on this board alone help prove that. Or, at least, that those people make up a significant part of those against the idea. It's usually half "I'm ideologically opposed to any hint of socialism" and half "But if we get UHC, my dentist won't give me hand massages anymore!".

[Ixodes]

[quote name='Swordfish' post='1681890' date='Feb 10 2009, 14.58']In order to understand opposition to UHC, one merely has to understand the simple concept of operating with limited resources, and observe the way in which our government behaves when offered a big fat book of blank checks.[/quote]

I don't think this is true in all situations. For example, look at the emergency medical service/fire departments in most larger cities. These are run by the government and do a great job with the resources available. I've never heard someone bitch that the New York City (or insert any other medium-large sized city) fire department does a shitty job even though they are funded and managed by government employees.

Government services can be efficient and effective when managed well. The key is having the right model.

[The Progressive]

Why I am not surprised to see commodore throwing a hissy fit over simple measures to reduce redundancy in paperwork by improving the capacity to share electronic data. The only pockets this would hurt are people who would benefit from giving unnecessary medical tests.

A more radical approach is hidden in the stimulus bill that seek to give Medicare coverage to the unemployed. Some people bitched for years why they keep paying Medicare taxes and won't be able to use it til they're 65, well now they can if they're unemployed.

An even more revolutionary step I foresee in the not too distant future is the selling of basic Medicaid-like health coverage from the state government, or from federally run insurance companies (like AIG), directly to consumers and employers. These plans will probably cost less than what employers are paying right now for similar coverage by private insurers .......... so they'll left en mass and broke the back of the private health care insurance industry. Sure they'll still be able to sell complimentary insurance packages for more exotic procedures to those who'll want to buy them, but their customer base will dramatically decline.

I expect a long and heated lobbying war being waged over this, but in the end UHC will emerge triumphant.

[Swordfish]

[quote name='Lord of Oop North' post='1681923' date='Feb 10 2009, 13.23']Health Coverage for one and all, free of restrictions, is the [u]only[/u] moral choice. Life, Liberty, and Happiness and all that bullshit, you know?

The fact that anyone can attempt to justify the de-facto denial of health services, which your current health system creates, by it's nature of being tied to the limited supply of money in the hands of the people, is absolutely horrifying. It disgusts me, and honestly, leads me to believe that the most ardent proponents of the current system are generally those with access to wealth.[/quote]


Your disgust is duly noted.

I prefer to be disgusted buy the non-pragmatic, irrational optimism of the those who choose to answer concerns about UHC with soapbox arguments about how it's morally imperative and costs be damned. that's a very noble attitude, but ignoring the real possibility of getting int a situation where we are starving one person so that another person can get his cavities filled is, to me, the more disgusting of the two positions.

you simply cannot provide everything for everyone. i wish it were not so, but it is.

to ignore that fact, and paint those who don't as simply inconsiderate, non compassionate rich people is utterly ignorant and lazy. I have no confidence in our elected officials to make the tough decisions required to make such a system work, particularly in areas where it will cost them votes. I also have zero faith in them no co-opting the system for their own expensive, political ends.

If you can't understand why i might have such reservations, then you have not been paying attention to the way our federal government behaves.


[quote name='Ixodes' post='1681980' date='Feb 10 2009, 14.10']I don't think this is true in all situations. For example, look at the emergency medical service/fire departments in most larger cities. These are run by the government and do a great job with the resources available. I've never heard someone bitch that the New York City (or insert any other medium-large sized city) fire department does a shitty job even though they are funded and managed by government employees.

Government services can be efficient and effective when managed well. The key is having the right model.[/quote]


We aren't talking about city government here. We're talking about federal government.

If you want to make comparisons like that, then at least make them comparable.

So, SSI, Medicare, etc... Or look at the bail out bills and how they've been handled, since at least you are talking about similar scale.

[Ixodes]

[quote name='Swordfish' post='1682052' date='Feb 10 2009, 17.00']We aren't talking about city government here. We're talking about federal government.

If you want to make comparisons like that, then at least make them comparable.

So, SSI, Medicare, etc... Or look at the bail out bills and how they've been handled, since at least you are talking about similar scale.[/quote]

OK, how about the VA? See this [url="http://www.time.com/time/magazine/article/0,9171,1376238-1,00.html"]Time[/url] article. Once an example of horrid health care, the VA has transformed into more efficient and effective health care delivery than the private sector. And this is done with federal dollars and oversight. Understanding successes is just as important as understanding failures of federal programs.

From the article:

[quote]The VA runs the largest integrated health-care system in the country, with more than 1,400 hospitals, clinics and nursing homes employing 14,800 doctors and 61,000 nurses. And by a number of measures, this government-managed health-care program--socialized medicine on a small scale--is beating the marketplace. For the sixth year in a row, VA hospitals last year scored higher than private facilities on the University of Michigan's American Customer Satisfaction Index, based on patient surveys on the quality of care received. The VA scored 83 out of 100; private institutions, 71.[/quote]

If you would like a more educated take on UHC in the US, try [url="http://www.medscape.com/viewarticle/576327"]this[/url] from the journal Academic Medicine.

[Aemon Stark]

[quote name='Swordfish' post='1682052' date='Feb 10 2009, 19.00']Your disgust is duly noted.

I prefer to be disgusted buy the non-pragmatic, irrational optimism of the those who choose to answer concerns about UHC with soapbox arguments about how it's morally imperative and costs be damned. that's a very noble attitude, but ignoring the real possibility of getting int a situation where we are starving one person so that another person can get his cavities filled is, to me, the more disgusting of the two positions.[/quote]

Care to elaborate on your bizarre scenario? Who would be subjected to starvation and why? Are you suggesting that a tax increase - of any magnitude - would push someone to starve?

[quote]you simply cannot provide everything for everyone. i wish it were not so, but it is.[/quote]

Funny, I just attended a talk given by our former dean (who has experience in the US) about our respective health care systems. One of his central points was that no system can simultaneously provide care for everyone for everything right now (as in, without some sort of waiting time for non-urgent care). In Canada everyone is covered for most though not all things and receives care timely, though wait times are anecdotally (the data is non-standardized so the extent of the problem is not as clear) excessive for certain elective procedures. In the US, few people are covered everything, many are covered most things, and another sizable number are not covered at all or for enough things. Likewise, few people have access to care "right now", many have access to timely care, and some have limited or no access whatsoever.

Oh, and in the US you have bean counters who can overrule the decisions of physicians to order tests, referrals, or procedures. We do NOT have that here and no bureaucrat - government or not - can overrule a physician's orders. Malpractice is also managed by a single physician-run insurance company (greater pooled risk = lower costs) which vigorously defends against frivolous suits.

[quote]to ignore that fact, and paint those who don't as simply inconsiderate, non compassionate rich people is utterly ignorant and lazy. I have no confidence in our elected officials to make the tough decisions required to make such a system work, particularly in areas where it will cost them votes. I also have zero faith in them no co-opting the system for their own expensive, political ends.[/quote]

And this is why our [url="http://humanities.medicine.dal.ca/jm.htm"]former dean[/url] was pessimistic about serious reform in the US - simple distrust of government. That doesn't mean it can't happen, but it will certainly take a different form than here.

[quote]If you can't understand why i might have such reservations, then you have not been paying attention to the way our federal government behaves.

We aren't talking about city government here. We're talking about federal government.

If you want to make comparisons like that, then at least make them comparable.

So, SSI, Medicare, etc... Or look at the bail out bills and how they've been handled, since at least you are talking about similar scale.[/quote]

Note that in Canada public health insurance is administered at the provincial level. The feds merely set the principles under which it should work and provide some of the funding. Again, I am not suggesting that the US system can simply copy ours, but there is no reason why it needs to be directly administered by the federal government. It could, however, set the parameters for how it would function at the state level.

[DanteGabriel]

[quote name='Swordfish' post='1682052' date='Feb 10 2009, 18.00']If you can't understand why i might have such reservations, then you have not been paying attention to the way our federal government behaves.[/quote]
Reservations are natural, and anyone with two neurons to rub together should have a whole host of them before asking the government to take on a giant program like this.

But the current system is a beast that cannot be fed, it's slowly crushing the life out of us, and I'm ready to let government try being competent again. Part of the reason we're so fucked is because the Republicans have spent thirty years telling us the government can't do anything right, and then proving it. Clearly the free market is not going to save health care. It's time for intervention.

[Guest thebadlady]

My medical bills were over 40K last year. Thats a usual year for me. Fuck old people and go go rationed care. Why should a geezer get a heart/lungs before a 20 year old? Thats crazy talk man.

There is a lot of hand-wringing drama but lets face it - the amount of care our old people get is overboard. People are dying without dignity because their end has been stretched out and they are living for years past what they would have normally. Health care should be a right for everyone, not just the old folks who vote.

[Aemon Stark]

Bullshit. The richest country in the world can't afford to provide health care for all its citizens? Sounds rather implausible that, though I must admit that the caveat of "tax levels remaining the same" seems obviously faulty. Americans have been trying to get more for less for too long and you cannot expect that situation to persist (and, no, Canadians are not at all immune from the illusion that we can have better services and lower taxes simultaneously).

That's not to say you can keep the current non-system and just stick UHC on top of it. It will require fundamental reform of existing managed care and, yes, the crowding out of many of those insurance companies. There's no simple answer.

[Swordfish]

[quote name='Triskele' post='1682097' date='Feb 10 2009, 15.30']Your post seems to imply that you believe that it is possible, just highly unlikely due to flaws in our politics.[/quote]


I think it may very well be theoretically possible. it's flaws in politics and our raging entitlement mentality I think that make it a virtual impossibility.

My rpeference would be to look at fixing medicare, ssi, and COBRA before we create a 7 bazillion pound gorilla that eats all our bananas.


[quote]I believe that it is possible because it is working in other nations. People often come back at this with reason why America is different and there is something to that.[/quote]

My neighbor runs 5 minute miles.

I will never be able to run 5 minute miles, even if i follow his exact rtraining regimen, because we are entirely different entities.

[quote]But keep in mind that most people who have serious discussions about UHC are not advocating a system in which all citizens can get absolutely every procedure they want at all times. We are usually talking about expanding access so that basic items are available to all.[/quote]

Whether or not you are advoating that is not really relevant.

What is relevant is how likely it is to be implemented that way.

As I mentioned, old people vote. Politicians like votes. Medical care for old people is, in some cases, prohibitively expensive.

See the problem?




[quote name='Aemon Stark' post='1682109' date='Feb 10 2009, 15.39']Care to elaborate on your bizarre scenario? Who would be subjected to starvation and why? Are you suggesting that a tax increase - of any magnitude - would push someone to starve?[/quote]


It was a metaphor. if UHC consumes all discretionary spending... that's a problem.


[quote]Funny, I just attended a talk given by our former dean (who has experience in the US) about our respective health care systems. One of his central points was that no system can simultaneously provide care for everyone for everything right now (as in, without some sort of waiting time for non-urgent care). In Canada everyone is covered for most though not all things and receives care timely, though wait times are anecdotally (the data is non-standardized so the extent of the problem is not as clear) excessive for certain elective procedures. In the US, few people are covered everything, many are covered most things, and another sizable number are not covered at all or for enough things. Likewise, few people have access to care "right now", many have access to timely care, and some have limited or no access whatsoever.[/quote]

And?



[quote]Oh, and in the US you have bean counters who can overrule the decisions of physicians to order tests, referrals, or procedures. We do NOT have that here and no bureaucrat - government or not - can overrule a physician's orders. Malpractice is also managed by a single physician-run insurance company (greater pooled risk = lower costs) which vigorously defends against frivolous suits.



And this is why our [url="http://humanities.medicine.dal.ca/jm.htm"]former dean[/url] was pessimistic about serious reform in the US - simple distrust of government. That doesn't mean it can't happen, but it will certainly take a different form than here..[/quote]

that would only be a valid argument if the distrust was unwarranted.

i do not believe it is for reasons i've already described.


[quote name='thebadlady' post='1682128' date='Feb 10 2009, 15.59']My medical bills were over 40K last year. Thats a usual year for me. Fuck old people and go go rationed care. Why should a geezer get a heart/lungs before a 20 year old? Thats crazy talk man.[/quote]

Whether they should or not is less of a concern to me than whether they would or not.

if you don't think the implementation of UHC would be influenced by votes, then we just disagree.

In essence, for such a system to work in this country, politicians would have to make some very difficult decisions regarding who gets what care.

I have seen nothing to indicate they are well equipped, nor willing, to make those kinds of decisions when it goes against their own self interest.

[Cuellar]

I agree with Chats.

We should have universal BASIC medical care provided by the government.

Any routine work that needs to be done is free. Anything more serious than a broken bone, high blood pressure, or you got a cold... you need to rely on separate medical insurance.

Covering the basic preventative and diagnostic medicine alone would pay for itself rapidly in the form of preventing uninsured abusing emergency rooms, pooling of costs for care which EVERYONE needs and uses, along with simple shit like vaccines which are far cheaper than treating illness. Age related diseases, organ failure, and non-standard births should be the individual's problem. If you want to get new kidneys and other organs so you can live to 200, more power to you... the state shouldn't pay for it though.

[Horza]

[quote name='Chataya de Venoge' post='1682167' date='Feb 11 2009, 11.38']It's very faulty, and Americans would shit bricks if we paid taxes at the rates that Europeans do. I have no idea how or if (and I suspect not) Europeans manage to save and invest, as Americans do.

Also, Americans want more for "free" than people in other countries. There was a documentary on CNN a while back about a seriously ill infant whose parents didn't realize there was a $1 million cap on her health care. When they got stuck for an additional $1 million in bills (because they wanted to stop at nothing, although the child was going to die no matter what), the parents naturally had to go bankrupt. CNN implied strongly that "if America's health care crisis was fixed" that at least the parents wouldn't have gone bankrupt (the little girl would have died no matter what).

Great - let the rest of us go bankrupt because people want it all??[/quote]

My friends, these are anecdotes we can believe in.

[Aemon Stark]

[quote name='Swordfish' post='1682164' date='Feb 10 2009, 20.32']As I mentioned, old people vote. Politicians like votes. Medical care for old people is, in some cases, prohibitively expensive.

See the problem?[/quote]

Not really, given that old people are [b]already covered[/b] via Medicare. That would seem to indicate that the "prohibitively expensive" portion of UHC is already taken care of, in which care we might enquire why covering all the cheaper people out there is impossible.

Really. Tell us.

[quote]It was a metaphor. if UHC consumes all discretionary spending... that's a problem.[/quote]

And since it doesn't do that anywhere, I'd suggest you consider problems that actually exist instead of made-up ones.

[quote]that would only be a valid argument if the distrust was unwarranted.

i do not believe it is for reasons i've already described.[/quote]

What reasons? "Government is bad" is not a reason, except insofar as recent governments have (a) believed this and (b) done everything to make it so. Perhaps Americans simply get the government they pay for.

Once again, given the existence of Medicare for elderly people, what do discussions about UHC have to do with end-of-life care?

[Guest thebadlady]

Chats, we sound so Republican. Remember when we told EHK to go Democrat because they have anal sex? I feel so old now.

[Aemon Stark]

[quote name='Cuellar' post='1682169' date='Feb 10 2009, 20.40']I agree with Chats.

We should have universal BASIC medical care provided by the government.

Any routine work that needs to be done is free. Anything more serious than a broken bone, high blood pressure, or you got a cold... you need to rely on separate medical insurance.

Covering the basic preventative and diagnostic medicine alone would pay for itself rapidly in the form of preventing uninsured abusing emergency rooms, pooling of costs for care which EVERYONE needs and uses, along with simple shit like vaccines which are far cheaper than treating illness. Age related diseases, organ failure, and non-standard births should be the individual's problem. If you want to get new kidneys and other organs so you can live to 200, more power to you... the state shouldn't pay for it though.[/quote]

This is utter nonsense - treating the symptoms rather than the disease. Catastrophic expenses are EXACTLY the sort that MUST be covered since these are the things people either can't afford or else find themselves uninsured when their insurance company decides to cancel their coverage.

People don't just "want" new kidneys or other organs - they NEED them. Is this hard to understand or is the warped notion of "personal responsibility" now including renal or liver failure? To take one example, I saw two patients today with autoimmune disorders which cause progressive scarring of the liver. We can somewhat slow this, but certainly not stop it, and within a few years they might be in liver failure and ready candidates for transplants. Neither were seniors - both had families.

Let's suppose these patients lived in the US and lost their jobs (and insurance) thanks to the current downturn - what do you think their chances of being insured now are? Should they suffer premature death because some complaining well-offs don't want to part with their yearly ivory backscratcher purchase? Or simply so that insurance companies can pad their bottom line? (note of course that UHC, insofar as it implies higher taxes, also implies lower insurance costs for the individual - it's a trade off, not an inherent added cost)

[The Anti-Targ]

[quote name='Swordfish' post='1681238' date='Feb 11 2009, 02.30']why, especially after what's been happening the last 6 months, hell the last 8 years, in washington anyone would still believe that our legislators are capable of implementing something as large and complicated as UHC is mind boggling to me.[/quote]

[quote name='Swordfish' post='1682052' date='Feb 11 2009, 12.00']If you can't understand why i might have such reservations, then you have not been paying attention to the way our federal government behaves.[/quote]

I will note, as have others, that these are not arguments against UHC, they are simply arguments against federal politicians being in charge of the design or execution of a UHC system.

[quote name='Chataya de Venoge' post='1682148' date='Feb 11 2009, 13.18']Unfortunately, I don't have time to really get in there and debate this - I can't access the Board from work, and I don't have enough time at home. But I did want to throw this out there:

It's going to seem highly cynical of me, but we (as a country) can't afford this.

*Snip*[/quote]

The hell you can't!

You are the biggest economy in the world, the richest country in the world, if you can't do it, no one can...oh wait we all (meaning every other "western" deomcracy) are, other than you.

Your GDP per capita is $48,000, The GDP per capita of the countries most people refer to in comparison to the USA when it comes to UHC are:
Canada $40,000
UK $37,000
Aussie $39,000

All have UHC.

And my little country has a per capita GDP of $28,000 and we have UHC. Sure it isn't quite as swish as those big 3 I mention above, but it's still a pretty respectable system - no standard dental coverage in our UHC for people over 18, and no specialist dental coverage at all :-(. Over the last decade our government has run budget surpluses, and the economy has grown. We're in the pooh a bit now, but it's mostly your and Europe's fault for your profligate ways, killing off all our export markets and sending commodity prices into the toilet; but that's a different topic.

Now India doesn't have UHC, neither does China. They are countries of much greater population and more comparable to yours in that respect than any of the countries already mentioned. But hang on a mo'! India's per capita GDP is a miniscule $2,900, and China's is only a slightly better $6,100. Now they REALLY can't afford UHC.

If per capita GDP is not an appropriate measure of a country's potential ability to afford a UHC system please feel free to correct me. But it seems to me the wealth of a country in proportion to it's population should give us some indication on how much a govt can afford to spend on socially beneficial programmes like health and education.