a preview of universal health coverage

[Shryke]

[quote name='Lord O' Bones' post='1682290' date='Feb 10 2009, 21.25']So, we can't afford basic healthcare for all of our citizens because Americans in particular are assholes?[/quote]

Fairly close to the usual arguments.

In the end, any argument AGAINST UHC in the US starts with having to assume that the US is special in a way that makes it untenable there, unlike everywhere else.

[MOD Edit - Personal comment removed]

[Aemon Stark]

Concerning the OP, it should be fairly clear that lots of "rationing" occurs in the US system. HMOs will de-insure people who develop chronic diseases or whose risk status increases, and they will also dispatch bureaucrats to second guess and even reject tests, procedures, or referrals ordered by physicians.

[Security Squish]

[quote name='Chataya de Venoge' post='1682278' date='Feb 10 2009, 21.18']It's called [i][b]diet[/b][/i] and [i][b]exercise[/b][/i].

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.

Other countries are willing to essentially "ration" health care, to afford their UHC and keep their costs down. Americans don't go for that.[/quote]

Oh that's rich, I'll rember to tell that to my patients with heart disease who have a balanced diet and exercised regualrly for most of their lives. HA!

[The_BlauerDragon]

[quote name='Commodore' post='1680981' date='Feb 9 2009, 22.09'][url="http://www.bloomberg.com/apps/news?pid=20601039&refer=columnist_mccaughey&sid=aLzfDxfbwhzs#"]Bloomberg [/url]uncovers some interesting stuff in the stimulus bill:
Unreal.[/quote]

And so it begins... Is there a country in the world that still practices the policies of Freedom, equality, justice for all, etc? Truly? I want a country where the doctors handle medicine, the teachers handle education, the people have a voice in all things (and majority rules), and the government is limited to simply governing.

[Security Squish]

[quote name='the Blauer Dragon' post='1682320' date='Feb 10 2009, 21.47']And so it begins... Is there a country in the world that still practices the policies of Freedom, equality, justice for all, etc? Truly? I want a country where the doctors handle medicine, the teachers handle education, the people have a voice in all things (and majority rules), and the government is limited to simply governing.[/quote]

What if the majority wants UHC?

[Lord of Oop North]

[quote name='Chataya de Venoge' post='1682288' date='Feb 10 2009, 21.22']I am all for reform, but I am not a politician and could never be one (colorful background prevents this). So far as I know, taking away old people's penis pumps and power chairs has never been seriously discussed. Instead, we want to give them MORE (see Medicare, Part D).[/quote]
I understand that you are. Who wouldn't be, after all? But you also give the impression that you are diametrically opposed to reform that will in all likelihood save hospitals in the United States millions upon millions of dollars. Examples like that Tennessee Aid system are sort of ridiculous because they were underfunded in the first place. What exactly did they expect would happen? Magical success? You gotta spend it to earn it.

We don't want to give the old people [i]more[/i] penis pumps (I'll remember to ask my Doctor about that one as it never hurts to give the old slugger a leg up). We want to give more people access to medical care. Specifically, preventative care, which will help to keep costs down. I don't think the penis pump falls into that category. Unless having a small penis will lead me to become stressed or depressed, and have a stroke, anneurism or cause bodily harm against myself, but I digress.

I'll leave the specifics to experts like Aemon and Triskele. I'm more of an idea and principles man and that's what my kind of people pay their kind of people for, to provide expert advice, which basically says - Your System is Le Fucked. That's even worse then normal fucked. That's french fucked. Second Republic style.

[The White Wolf]

[quote name='the Blauer Dragon' post='1682320' date='Feb 10 2009, 20.47']And so it begins... Is there a country in the world that still practices the policies of Freedom, equality, justice for all, etc? Truly? I want a country where the doctors handle medicine,[/quote]

That is certainly not here, my wife can tell many a story of calling up insurance companies to argue whether a procedure is necessary or not. Her current strategy is to ask for names and threaten to put them on the medical chart since they insist on making medical judgments and should bare responsibility for them. It doesn't do a whole lot of good but the people she talks with sometimes do squirm a little.

[quote name='the Blauer Dragon' post='1682320' date='Feb 10 2009, 20.47']the teachers handle education,[/quote]

This has never been the case, parents have been butting heads with teachers since the advent of education.

[quote name='the Blauer Dragon' post='1682320' date='Feb 10 2009, 20.47']the people have a voice in all things (and majority rules),[/quote]

So, if the majority of people wanted to say outlaw inter-religious marriage would that be ok?

[quote name='the Blauer Dragon' post='1682320' date='Feb 10 2009, 20.47']and the government is limited to simply governing.[/quote]

Please list the details of the responsibilities that governing entails and why those are responsibilities.

[Security Squish]

[quote name='Triskele' post='1682332' date='Feb 10 2009, 21.53']For a better example we should talk about people with autoimmune disorders which someone mentioned upthread, I think Aemon. These nasty diseases come from unknown origins. We don't know what causes them. It's quite possible that everyone who gets them simply got the short end of the stick.[/quote]

A very good point. We know a lot about disease prevention, but we sure don't know everything about it. What do you say to the person with idiopathic liver failure and no insurance. Sorry dude, you got a death sentence.

[Lord of Oop North]

[quote name='Chataya de Venoge' post='1682345' date='Feb 10 2009, 22.02']I think it's very interesting that the people "in the know" whom Triskele knows are split 50/50 on the UHC issue. Triskele, could you say what the main arguments are for and against (say, the top 5 of each)? Have we gone through them thoroughly here already?[/quote]
I would be interested in hearing this myself.

[Shryke]

[quote name='Chataya de Venoge' post='1682345' date='Feb 10 2009, 22.02']I can see autoimmune disorders being the (bad) luck of the draw.

To ignore diet, exercise, and smoking history in causation of heart disease for most cases is to just be willfully ignorant. Sure, there are people out there who get heart disease who have always exercised, never smoked, and eaten a balanced diet - but it's not the majority.[/quote]

You do realise you pay for these people right now right? You just do it when they come to the hospital in an ambulance after having a heart attack. That way, it's more expensive!!

[quote][b]Squish[/b] - a person with ideopathic liver failure would probably get no treatment under UHC as well, if care was deemed too expensive, etc.[/quote]

You've got proof of this I assume?

[The_BlauerDragon]

[quote name='Security Squish' post='1682325' date='Feb 10 2009, 19.49']What if the majority wants UHC?[/quote]

Then I would be happy to either move to a more intellectually enlightened society... or shut up and suffer until such time as the majority have seen the error of their ways (assuming that would ever happen).

[Shryke]

[quote name='the Blauer Dragon' post='1682356' date='Feb 10 2009, 22.10']Then I would be happy to either move to a more intellectually enlightened society... or shut up and suffer until such time as the majority have seen the error of their ways (assuming that would ever happen).[/quote]

So your moving to Zimbabwe then.

[Angalin]

[quote name='Kalbear' post='1682239' date='Feb 10 2009, 19.43']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.[/quote]
As in Canada, a lot of gaps in care could be reduced simply by having more general practicioners. The field has to be made more attractive though (read $$$ or extra write-offs), because the loans get paid off a lot faster if a junior doctor takes up a specialty instead.

[quote name='Chataya de Venoge' post='1682278' date='Feb 10 2009, 20.18']Other countries are willing to essentially "ration" health care, to afford their UHC and keep their costs down. Americans don't go for that.[/quote]
I dunno. If what the government was offering was a reasonable amount of basic care for everyone and the option to go private (as in the UK) for those who wanted extras, that should be satisfactory as long as there's a good PR program pushing it.

eta: by which I mean, if that's what the gov't plans to introduce, they're going to have to explain it to people who otherwise won't pick up on it, sell the reluctant ones on the merits, etc etc as part of the overall introduction of the program.

[Lord O' Bones]

[quote name='the Blauer Dragon' post='1682356' date='Feb 10 2009, 19.10']Then I would be happy to either move to a more intellectually enlightened society... or shut up and suffer until such time as the majority have seen the error of their ways (assuming that would ever happen).[/quote]
You do realize that every industrialized western nation has a functioning form of universal healthcare. Except us. Believe me, we're the knuckleheads here. Or we're "special," or whatever.

[The_BlauerDragon]

[quote name='The White Wolf' post='1682336' date='Feb 10 2009, 19.56'][b]1.[/b]That is certainly not here, my wife can tell many a story of calling up insurance companies to argue whether a procedure is necessary or not. Her current strategy is to ask for names and threaten to put them on the medical chart since they insist on making medical judgments and should bare responsibility for them. It doesn't do a whole lot of good but the people she talks with sometimes do squirm a little.

[b]2.[/b]This has never been the case, parents have been butting heads with teachers since the advent of education.

[b]3.[/b]So, if the majority of people wanted to say outlaw inter-religious marriage would that be ok?

[b]4.[/b]Please list the details of the responsibilities that governing entails and why those are responsibilities.[/quote]
1. I'm glad to hear that she's made a few squirm. My mother almost died once, because her insurance agency did not want to approve an MRI (which ultimately allowed the Dr.s to find her problem without a moment to spare). I imagine that putting the govt. in charge of HealthCare would be like having the most uptight, ignorant, and uncaring Insurance company humanly imaginable.
2. True enough. Still, I think a little less govt. regulation and a little more letting the teachers teach would go a very long way. The No Teacher Left Standing Act wasn't a bad idea... until the Govt. got their hands on it.
3. Actually, in a free democratic society, I would have to say Yes. If it happened, I could see campaigning to have people change their minds, but that law should be obeyed until such time as it is changed.
4. Play fair. You're baiting me into an argument that is so open ended that if I were to strike out from the point that you've offered, then there is no possible end to it (other than my eventual surrender). Let's just say that I think we should try putting our constitution into use and then see where it goes from there.

[quote name='Lord O' Bones' post='1682366' date='Feb 10 2009, 20.18']You do realize that every industrialized western nation has a functioning form of universal healthcare. Except us. Believe me, we're the knuckleheads here. Or we're "special," or whatever.[/quote]
Perhaps my zest for overstatement has bitten me again...

I'm not saying that UHC cannot be done. I'm saying that the U.S. govt. cannot do it. Unless there is a radical reform of our entire political system and a thorough cleaning out of the corruption first, then I do not want our government getting within 1,000 miles of my health care.

[Adelle Tully]

I'm not really all that versed in the different health care systems.

I lived in the US for most of my life and the health care costs were disgusting! The prescriptions were insanely expensive (or you paid the insurance and then more on top of that for the drugs).

Now I live in Australia. I had to get a prescription a few months back. I went into the pharmacist, prepared to shell out massive amount since I don't have private insurance and was charged 6 bucks. That's right, $6.

If we want to consider cutting medical costs, why doesn't the US start by advising the hospitals that cable television in every room isn't* a necessity. Then they can quit giving rectal exams to everyone with the slightest cough or spinal taps to someone with a nose bleed. Oh and one puke pan never truly cost a hospital $300 (that was a charge on my bill for when I gave birth).

The hospital is somewhere you shouldn't WANT to be so why make it a fun place to go? I can understand making it bearable but no one has ever died from boredom.

[Aemon Stark]

[quote name='Chataya de Venoge' post='1682345' date='Feb 10 2009, 23.02']I can see autoimmune disorders being the (bad) luck of the draw.

To ignore diet, exercise, and smoking history in causation of heart disease for most cases is to just be willfully ignorant. Sure, there are people out there who get heart disease who have always exercised, never smoked, and eaten a balanced diet - but it's not the majority.

[b]Squish[/b] - a person with id[b]i[/b]opathic liver failure would probably get no treatment under UHC as well, if care was deemed too expensive, etc.[/quote]

Family history is just as important with respect to heart disease. I'm not really sure what you're saying though - people don't choose to have poor diets or sedentary jobs or lifestyles. These are not problems that are solvable by a simple matter of will and "personal responsibility". Some people will simply make bad choices, and they'll "pay" for them regardless of what kind of health care they have access to. They're no less deserving of treatment because they started down a bad course 20 or 30 years earlier.

And, for the record, patients with idiopathic liver failure absolutely get treatment under UHC here. Those I mentioned above (who may go into liver failure later on) come to see the hepatologist twice a year, receive ultrasounds and MRIs annually to check their disease progression, and will probably be good candidates for transplants in the not-too-distant future.

On the other hand, if they were alcoholics, they would never get on any liver transplant list - they'd be poor candidates.

I must ask - why the hell would care be deemed too expensive? The transplant aside, the costs are little more than the odd diagnostic tests and scans and a couple visits to a specialist. Should transplants be rationed according to whether a recipient can pay for it? If the alleged rationing of UHC is so awful, why is it tolerated in the US?

[Swordfish]

[quote name='The White Wolf' post='1682260' date='Feb 10 2009, 18.04']What can (reasonably, remembering that old people vote) be done to fix medicare?[/quote]

I have no idea really.

But if the federal government can't fix it, then i would suggest that they certainly are incapable of implementing successful UHC, wouldn't you?

Let me put it to you another way. Would you be comfortable if the federal government we've endured over the past eight years were dictating your health care policy?



[quote name='Aemon Stark' post='1682268' date='Feb 10 2009, 18.10']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]


And?

I have never suggested it is relevant to whether some kind of coverage should be given to everyone.

[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]

I have no idea what this has to do with the sorry state of medicare or the actual answer to the question of what would prevent UHC from the same pitfalls that have made it such a disaster.

Or even what the correlation is between ICU doctors and family members making these decisions, and the federal government being qualified or capable of doing so.


[quote]Uh-huh. How does that solve the problem of arbitrary de-insuring by HMOs?[/quote]

Why would my response answer a problem you did not raise?

You asked specifically about the unemployed.


[quote]Or the fact that few after job losses can afford such premiums?[/quote]

I will suggest again that if the federal government cannot implement a way to resolve this relatively simple isuue, then they are certainly unqualified to implement UHC.


[quote name='Lord O' Bones' post='1682290' date='Feb 10 2009, 18.25']So, we can't afford basic healthcare for all of our citizens because Americans in particular are assholes?[/quote]


Pretty much, yeah.

Do you disagree?

[Aemon Stark]

[quote name='Angalin' post='1682365' date='Feb 10 2009, 23.18']As in Canada, a lot of gaps in care could be reduced simply by having more general practicioners. The field has to be made more attractive though (read $$$ or extra write-offs), because the loans get paid off a lot faster if a junior doctor takes up a specialty instead.[/quote]

I think it's getting better. Interestingly, a GP could easily pay off the loans faster than, say, a neurosurgery resident since she'll be done residency four years earlier. So I'm not really sure what the incentives are like in practice.

(I'm not personally that interested in family med, but I can't absolutely rule out that changing.)

Also, I am NOT an expert by any stretch! (I spend only about a day in the hospital per week, and while I know some anatomy, physiology, biochem, and bits of immunology and microbiology, it sounds like far more than it actually is. To paraphrase So-crates, first-year students are wisest by virtue of their knowledge that they don't know anything.)

[Lord O' Bones]

[quote name='Swordfish' post='1682386' date='Feb 10 2009, 19.30']Pretty much, yeah.

Do you disagree?[/quote]
It's getting hard to.