a preview of universal health coverage

[Shryke]

[quote]This is how America works.[/quote]

THe poor die because they can't afford medical care. It's the American Dream.

[Aemon Stark]

[quote name='Chataya de Venoge' post='1682180' date='Feb 10 2009, 20.46']I could definitely live with that. Keep in mind that some of this (vaccines) is already done by county health departments - you can get many childhood vaccines free or on a sliding scale at most county health departments, and very reasonable prices on other vaccines. I got my travel vaccinations to Mexico for only $40 at the county health department, and that was the full cost.[/quote]

Note that you still pay for travel vaccinations here. Why would the public insurer subsidize your foreign travel costs?

[quote][b]Aemon[/b] - the problem of all-consuming cost DOES exist. Please remember that Medicare and Social Security alone are predicted to be 100% of the federal budget (at current revenue levels, which means no changes in the tax code) by 2040.[/quote]

We have the same projections here and they're no less ridiculous. Why the fuck would revenue levels remain static for 31 years into the future? That's not to say that getting costs under control is not desirable.

[quote][b]Horza[/b] - this was coverage of the "health care crisis" on CNN, a respected journalistic source. Strong implications that we can save people with heroic measures at essentially no cost (when the costs are huge) are ridiculous, and I can't believe a credible news source was spouting that drivel.

Had the baby been in a true UHC system, I suspect she would have just been sent home to die peacefully. Costs have to be managed somehow.[/quote]

Or perhaps if there'd been better prenatal care the baby would have survived. Who knows?

I should add that "heroic measures" include little more than CPR. Now, I'm of the mind that major interventions should not be done if the patient has little chance of acceptable recovery or quality of life. If something is likely to fail, it shouldn't be done (that this would cost less is incidental). Of course, in an environment where the threat of a devastating malpractice suit is ever present, doctors are much more likely to do "everything they can" regardless of whether it serves any useful purpose.

I find it disturbing in the extreme that all these arguments are couched solely in terms of money rather than any actual principles.

[The Anti-Targ]

[quote name='Chataya de Venoge' post='1682198' date='Feb 11 2009, 13.57']Pretty good, if they had the sufficient savings they should have to pay for COBRA - essentially buying coverage on their former employer's plan for the employer's price. Coverage on COBRA lasts for 36 months, so even if there is a waiting period at a new job, they can still be insured.

Their chances of being able to afford COBRA are pretty shitty if they assumed that everything would be hunky-dory forever, and bought a house that they couldn't afford and so have no savings.

This is how America works.[/quote]

So you're meant to spend the rainy day savings money on health insurance? What about food, electricity, clothes, kids school fees, rent/mortgage, you know all that day to day stuff?

[EHK for Darwin]

[quote name='Chataya de Venoge' post='1682219' date='Feb 10 2009, 19.23']That's what UHC boils down to. It's about cost, frankly. All the moral good in the world is a noble goal, but if no one has any money to pay for it, it's rather pointless.[/quote]

Than based on the cost principle alone, why don't you support universal healthcare? It is substantially cheaper than our current system, in some countries costing half as much, yet it covers everyone and provides a good quality of care.

[Aemon Stark]

[quote name='Chataya de Venoge' post='1682219' date='Feb 10 2009, 21.23']They really didn't - Hepatitis A and B are not specifically travel vaccinations, although the CDC recommends them for people traveling to Mexico. So I had them. The point is that these and other vaccinations, including all childhood vaccinations, [i]are already widely available[/i] at a very low cost, and sometimes free (in the case of childhood vaccinations).[/quote]

Right. So things that are extremely low cost and already widely available should be subsidized by the government as an alternative to things that a smaller group of people can't afford? Vaccinations are not individually expensive, but inoculating an entire population is very much so.

[quote]That's what UHC boils down to. It's about cost, frankly. All the moral good in the world is a noble goal, but if no one has any money to pay for it, it's rather pointless.[/quote]

What part of "richest country in the world" is not clear? Heck, if Americans could afford to fight two wars and lower taxes on the rich, then they can afford anything. Some people - quite obviously - have the money to pay for it. I guess they feel they should maintain their private affluence directly in the face of masses of "have-nots".

[Shryke]

[quote name='Chataya de Venoge' post='1682219' date='Feb 10 2009, 20.23']Shryke - the American dream has a wonderful upside as well as a considerable downside. It's why we are the "land of opportunity".[/quote]

The land of Opportunity .... unless you need serious medical care. Then your fucked.

PS - How's that wealth gap doing for ya?

[Ormond]

[quote name='Chataya de Venoge' post='1682148' date='Feb 10 2009, 18.18'][i]We can't afford it[/i].

The counter-argument is that it would lower costs, more preventative medicine, etc - but I doubt that. First of all, the major advances in preventative medicine are already widely available for low cost (vaccines at county health clinics, for example).

Second, I've seen first-hand the effects of a nearly bankrupted state government that attempted Hillary Clinton's version of universal health care back in the 90's. Google "Tenncare". Imagine that at the Federal level.[/quote]

And as I pointed out before, Tennessee was among the three states with the lowest overall tax burden during the whole time in had TennCare.

Why couldn't Tennessee have afforded it if they had been willing to raise taxes above 48th rank?

A national system would avoid the political "let's have lower taxes to attract business" game that state governments have to deal with.

And a national system would lower costs not just because of preventative medicine, but because a single payer system would greatly reduce the paperwork bureaucracy involved with physicians and hospitals having to deal with many different insurance providers with different rules.

If every other developed country in the world can afford it, we can too. The USA just isn't that "special".

[Kalbear]

[quote]They really didn't - Hepatitis A and B are not specifically travel vaccinations, although the CDC recommends them for people traveling to Mexico. So I had them. The point is that these and other vaccinations, including all childhood vaccinations, are already widely available at a very low cost, and sometimes free (in the case of childhood vaccinations).[/quote]Vaccinations are not the sort of issue that needs focus from UHC. It's not the kind of preventative medicine that people talk about. Poor people don't die because they didn't get a polio vaccine; they die because they get poor nutrition, have advanced ailments that could have been treated two years ago but weren't seen to, and are forced to use emergent care as their primary care provider.

The notion that the US already has enough preventative care is easily shown to be false; the US has the worst life expectancy and infant mortality rates of any 1st world nation. In fact, some 3rd world nations have better life expectancy than the US. And shockingly..they've got UHC as well. Not necessarily a causation, but it's a much better anecdote than 'stupid family goes into bankruptcy' on Oprah.

Preventative care is having routine checkups, monitoring basic health on a regular basis and finding out about problems before they become serious. This is exactly where the US absolutely fails, and vaccinations aren't going to help unless you can vaccinate against heart disease, diabetes and cancer.

[Swordfish]

[quote name='Aemon Stark' post='1682174' date='Feb 10 2009, 16.41']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.[/quote]


Um... Medicare is a disaster. Why do you think that is?

Are you advocating KEEPING medicare AND implementing UHC?

Good lord.



[quote]Really. Tell us.[/quote]

I have already done so, and you provided a wonderful example of this by pointing out medicare.

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

:rolleyes:

I've already addressed this.

[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.[/quote]

And the government we are currently paying for is not up to the task of UHC, IMO.

i don't even really know what argument you are trying to make here.

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

it was an example of an area where difficult decisions need to be made.

And continually trotting out medicare as as an exmple in support of UHC is beyond moronic, considering the condition that medicare is in. you are arguing against point.

[quote name='Aemon Stark' post='1682190' date='Feb 10 2009, 16.52']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?[/quote]

If we fixed COBRA, the chances would be quite good that they would be insured.


[quote]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)[/quote]

Well, that really depends on the individual, doesn't it?

[quote name='The Anti-Targ' post='1682199' date='Feb 10 2009, 16.58']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]


And? I have never suggested otherwise.

there is no substantial difference really once you get beyond the hypothetical.

[quote]I find it disturbing in the extreme that all these arguments are couched solely in terms of money rather than any actual principles.[/quote]

i find it disturbing that people ignore the concept of limited resources.

So, why don't you tell us exactly what you cut to come up with a couple extra trillion dollars to fund UHC.

I'll wait.

[Ormond]

[quote name='Chataya de Venoge' post='1682243' date='Feb 10 2009, 19.45']Raising taxes would have been political suicide for the administration that attempted it. Classic case of "want it all but don't want to pay for it".


[b]Aemon[/b] - with the whole vaccination thing, what I am trying to say is that we already have one of the major widespread, low cost, preventative health mechanisms in place. We don't need UHC so that kids can have access to vaccinations - it's already there.

Clearly, we cannot also afford to fight two wars and lower taxes on the wealthy. This has already caused severe problems, including the risk of loss of our credit rating, and less ability to borrow when in a severe financial crisis.[/quote]

So who is saying we STILL want to lower taxes on the wealthy? Haven't you noticed we have a new administration in Washington?

It looks to me like the general American public is in a place where it will NOT be "political suicide" on a national level to move toward a national health insurance system.

And go back and read what Kalbear said. He pointed out that we really do NOT have easy access to low cost preventative health mechanisms for uninsured persons. Regular check-ups by physicians are something which is not available to uninsured people, and that's much more important in terms of preventative medicine than vaccinations. Vaccination is one of the more minor parts of preventative care.

[Shryke]

Um, he's pointing out that since Medicare already covers Old People (who are the most expensive group by MILES to cover), that covering everyone else will not quadruple or even close to it.

[Shryke]

[quote name='Ormond' post='1682253' date='Feb 10 2009, 20.59']So who is saying we STILL want to lower taxes on the wealthy? Haven't you noticed we have a new administration in Washington?

It looks to me like the general American public is in a place where it will NOT be "political suicide" on a national level to move toward a national health insurance system.

And go back and read what Kalbear said. He pointed out that we really do NOT have easy access to low cost preventative health mechanisms for uninsured persons. Regular check-ups by physicians are something which is not available to uninsured people, and that's much more important in terms of preventative medicine than vaccinations. Vaccination is one of the more minor parts of preventative care.[/quote]

Aye, the number one killed in pretty much all 1st World Countries is Heart Disease, is it not? No vaccine for that.

[The White Wolf]

[quote name='Swordfish' post='1682248' date='Feb 10 2009, 19.52']Um... Medicare is a disaster. Why do you think that is?[/quote]

What can (reasonably, remembering that old people vote) be done to fix medicare?

[Shryke]

UHC is cheaper then what you have now.

[Aemon Stark]

[quote name='Swordfish' post='1682248' date='Feb 10 2009, 21.52']Um... Medicare is a disaster. Why do you think that is?

Are you advocating KEEPING medicare AND implementing UHC?

Good lord.

I have already done so, and you provided a wonderful example of this by pointing out medicare.[/quote]

It needn't be kept in its current form. The point is that given its existence end-of-life care for the elderly is not relevant to whether some form of coverage should be extended to everyone else.

[quote]it was an example of an area where difficult decisions need to be made.

And continually trotting out medicare as as an exmple in support of UHC is beyond moronic, considering the condition that medicare is in. you are arguing against point.[/quote]

Not at all. UHC does not cover everything anywhere. Implementing it would naturally change existing programs.

I should add that these difficult decisions are made all the time, and often the most appropriate humane choices - by the family or patient through an advanced care directive - are those which do not prolong life needlessly. This occurs in ICUs where cost is not the major factor (or even a significant one) in deciding to take a patient of life support.

[quote]If we fixed COBRA, the chances would be quite good that they would be insured.[/quote]

Uh-huh. How does that solve the problem of arbitrary de-insuring by HMOs? Or the fact that few after job losses can afford such premiums?

[quote]i find it disturbing that people ignore the concept of limited resources.

So, why don't you tell us exactly what you cut to come up with a couple extra trillion dollars to fund UHC.

I'll wait.[/quote]

Who's ignoring limited resources?

[Lord of Oop North]

[quote]Than based on the cost principle alone, why don't you support universal healthcare? It is substantially cheaper than our current system, in some countries costing half as much, yet it covers everyone and provides a good quality of care.[/quote]
This. I was just about to say that.

UHC Doesn't have to cover [i]everything[/i]. Travel vaccinations, Vision, Dental, Chiropractic, Ultrasounds, Penis Pumps, whatever. Moving towards a system like this [i]does not[/i] mean that everybody and their uncle is going to be plopping their fat ass on one of those vibrating chairs and getting a cock enlargement on the house. The key is [i]preventative care.[/i] The American model fails utterly at this. The better model is meant to provide an adequate to good quality of care in a [i]responsible manner [/i]to a large number of people, at a much lower cost then the current system. Which. It. Does.

I can't walk over to the Doc and just demand whatever the fuck I desire. Some Anti-UHC proponents seem to believe that we can. Hell, they wouldn't even operate on my Grandfather this past year because the costs outweighed the benefits. The surgery was unlikely to have any effective long-term benefit, and I'm sure it probably entered into their minds how prohibitively expensive it was. I can understand that. It just wasn't worth it, and made no sense to go forward, if only for the undue stress it would have put upon an old man in his last days.

Maybe I'm just bitter because I would definitely be one of the have-nots, who is somehow supposed to squeeze COBRA for the non-existent employer-insurance plan, to pay for the ridiculously expensive medical bills, and am somehow still supposed to pay for the everyday requirements of life. I guess the [i]forty-six odd million[/i] people like me are just shit out of luck eh? Too bad, so sad. You were born to the underclass and don't deserve jack shit. Work harder and you'll be able to save for the impossible to predict medical catastrophes, you dumb fuck! It's not [i]that[/i] much. We rich folk can afford our bills and we can't afford to pay any more for it! No sirree! Can't have that, now can we? This is the [i]land of opportunity[/i]! We're [i]special[/i] and we can't afford to do what every other industrialized nation has done, despite being the richest country in the history of the Earth and possibly the Universe. We need our hand-warmers and our monopoly on entitlement! America, Fuck yeah!

What a silly lower-class scumbag, I am, deigning to think that providing equal health care to all is a noble and possible goal! Obviously, [i]We Can't Afford It[/i]. Such powerful words. Simple, Bold, and Direct. Just like that, we can magically write off reform. That's odd, because it seems like every other nation pays [i]less[/i] then you currently do. What a strange coincidence! Inconceivable! I wonder how they can afford such ridiculously expensive systems? But maybe that doesn't mean what we think it means, right? Paying less might actually means paying more, right? Right!?! That is some strange calculus.

[Lord of Oop North]

[quote name='Chataya de Venoge' post='1682278' date='Feb 10 2009, 21.18']LooN - I respect your position; however, the American systems currently in place (Medicare and Medicaid) do cover penis pumps, power chairs, and other frivolous shit. I don't see how moving towards UHC would change anything other than to make these fripperies available to even MORE people. Which. We. Can't. Afford.[/quote]
Maybe that should be reformed then? I don't understand why that is an argument against reform, at all. If anything, it seems to be a sign that reform is [i]necessary.[/i]

[Shryke]

[quote name='Chataya de Venoge' post='1682269' date='Feb 10 2009, 21.11']Um, yes. Food, electricity, mortgage, clothes are not all that much. You live in a different country, I gather, so you may not realize how little we pay in taxes. Since we don't pay that much in taxes compared to other countries, we also don't have the "safety net" that other countries do. We are responsible for our own health care and our own retirement (for the most part - social security is there to keep people from starving; it's not meant to be a true pension).

Most of us in the US prefer it this way.[/quote]

:lol:

[quote name='Lord of Oop North' post='1681923' date='Feb 10 2009, 16.23']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]

*cough*cough*

[quote]It's called diet and exercise.[/quote]

Yeah, fuck those people. They deserve to die.

[Lord O' Bones]

So, we can't afford basic healthcare for all of our citizens because Americans in particular are assholes?

[Guy Kilmore]

[quote name='Chataya de Venoge' post='1682263' date='Feb 10 2009, 20.07']We have Medicaid. This should cover all that is needed - if you're truly poor, you have access to health care.[/quote]
Amongst my clients, getting them on any sense of Medicaid is difficult, those that qualify for basic medical care really only looks at emergency care and not preventative care. My clients are all homeless and a diagnosis of some kind of mental illness. Most have been homeless for years.

Those that manage to scrape by enough and lose access to this kind of limit care are generally worse off because they are unable to afford any kind of care, housing (apartment rent) costs suck out alot of people's income.