a preview of universal health coverage

[mormont]

[quote name='Take on Me' post='1682533' date='Feb 11 2009, 05.48']So the brilliant folks who are appointed to run this system will dictate salaries in the medical community?[/quote]

What a strange suggestion. No: they'll [i]negotiate[/i] salaries in the medical community. Countries with UHC don't just tell doctors 'this is what you're getting, take it or leave it'. They agree salaries with doctors' representatives.

[MinDonner]

Swordfish - why do you assume this 40-100 million people will suddenly all dash to hospital as soon as UHC is implemented? These are [i]uninsured[/i] people, not necessarily sick ones. The ones among them who get sick [i]would go to the ER anyway[/i] under non-UHC, at vastly greater expense. Presumably under UHC you'd have some kind of (compulsory) National Insurance too, so a good chunk of these 40-100 million would be paying at least a little bit into the pot, which they're currently not doing. This could be made easier by the fact that employers no longer need to pay to insure all their workers, so there's more money for wages (and general investment into industry). Framing this as a sudden invasion of millions of sick people is not helpful.

[sToNED_CAT]

NonAmericans shouldn't be so happy about US being closer to UHC now. What many people fail to realize is the fact, that UHC systems in other countries are so effective relatively to US, is because US consumers defacto subsidize them. Just compare the drug prices. Govts of UHC countries limit the price of drugs, so the companies (that find it difficult to negotiate with govts) simply increase the price of drugs in US. The result? US with 3% of world population now has 50% of drug market. EU with population twice the size of US has 25%. So in case US goes UHC and adopts strict drug cost limits, like other countries, you should expect significant drug prices sin Canada, EU, Japan etc., because Big Pharma will no longer be able to cover half of their expenses from US sales.

To UHC in US. I think it cannot work on federal level effectively. Too many interest groups - pharmaceutical companies, old people, doctors and nurses (who will recieve less in UHC system), litigation lawyers (this is especially significant problem, because they basically own Democratic party, so I don't see a way Democrats who are pro UHC will be able to pass some kind of tort reform to limit the litigation costs).
The only he way how to do it is to simply distribute the money to the states and let the states freely choose their healthcare system. That would satisfy people who don't like powerfull Federal goverment and I think that such system would be actually even better than centralized european one, because it would also allow for faster correction of mistakes (if other state has much better healthcare system than you while having the same amount of money per capita you know there's something wrong with your system) Now you ask why the states can't simply increase the state taxes and do the same now without money from Feds? The problem is that big tax increase might lead to the industry&rich people fleeing to more tax friendly states. But if the money are collected by federal goverment and redistributed, there's no "ride to the bottom" problem.
The costs can be also more easily controlled. When federal goverment doesn't have the money they rarely simply borrow or tax people. When state will be out of money and will demand more, the feds can point out to other states where system works well (is there are any) and tell them to GFY, they will have no more money, but should adopt similar system. In this way the possibility that various interest groups (Pharma, unions) will cause the cost to increase too much is limited.

[The Iceman of the North]

I'd agree with Anguy that State run programs, financed by a Federal tax, might work best for the US.

It's not unusual for the actual running of UHC is done on a local level.

[Swordfish]

[quote name='MinDonner' post='1682667' date='Feb 11 2009, 02.14']Swordfish - why do you assume this 40-100 million people will suddenly all dash to hospital as soon as UHC is implemented?[/quote]


I make no such assumption.

[quote]These are [i]uninsured[/i] people, not necessarily sick ones.[/quote]

I understand that.

[quote]The ones among them who get sick [i]would go to the ER anyway[/i] under non-UHC,.[/quote]

If by 'sick' you mean 'require emergency care', then i agree.

[quote]at vastly greater expense. Presumably under UHC you'd have some kind of (compulsory) National Insurance too, so a good chunk of these 40-100 million would be paying at least a little bit into the pot, which they're currently not doing. This could be made easier by the fact that employers no longer need to pay to insure all their workers, so there's more money for wages (and general investment into industry).[/quote]

How is there more money for wages? Again, just because there is UHC doesn't mean that it doesn't have to be paid for.

[quote]Framing this as a sudden invasion of millions of sick people is not helpful[/quote]

It was not my intent to do so.

The point is, the argument was being made that money would be saved because peopel could get preventative care, rather than haveing to wait and go to the emergency room.

I find this claim to be dubious.

Certainly in the case where emergency room visits are precluded there may be cost savings.

However, it is not ONLY the people who avoid going to the ER who add a burden to the system.

Some percentage of that 40 -100 million will also take advantage of services, and yet would never have gone to the ER.

[Usotsuki]

[quote name='anguy' post='1682709' date='Feb 11 2009, 11.47']NonAmericans shouldn't be so happy about US being closer to UHC now. What many people fail to realize is the fact, that UHC systems in other countries are so effective relatively to US, is because US consumers defacto subsidize them. Just compare the drug prices. Govts of UHC countries limit the price of drugs, so the companies (that find it difficult to negotiate with govts) simply increase the price of drugs in US. The result? US with 3% of world population now has 50% of drug market. EU with population twice the size of US has 25%. So in case US goes UHC and adopts strict drug cost limits, like other countries, you should expect significant drug prices sin Canada, EU, Japan etc., because Big Pharma will no longer be able to cover half of their expenses from US sales.[/quote]

US consumers do not subsidize those in UHC systems, that there is a producer surplus extracted from American consumers is nice for Big Pharma, even if to achieve that surplus they have to spend tens of billions of dollars each year on product promotion, it makes no difference to us.

We do not and cannot purchase drugs at less than the marginal cost of production, because pharmaceutical companies will only supply us if and when they can generate a profit on the transaction. The prices paid for current pharmaceuticals will not change if the US moves to a UHC system or even if everyone in the US is suddenly transformed into a banana next Thursday. That's the magic of sunk costs.

[Andriy Czarchenko]

So the problem would be that the plan isn´t real full UHC?

Seriously speaking why do you still give anecdotes that are completely irrelevant to the big picture? Sure there are people who are happy with the current system. The question you should ask is if they would still be happy if they lose their job.

[Inigima]

[quote name='The Iceman of the North' post='1682717' date='Feb 11 2009, 07.02']I'd agree with Anguy that State run programs, financed by a Federal tax, might work best for the US.

It's not unusual for the actual running of UHC is done on a local level.[/quote]
This could be a problem given widespread disagreement over issues like contraception.

[Annelise]

Article on ER overcrowding:

[quote]NEWSWEEK: You looked at some common assumptions about why emergency rooms are so crowded. A lot of them turned out to be untrue. What were these myths, and how did people come to believe in them?
Manya Newton: First, there was a belief that the uninsured are all coming to the emergency department for non-urgent care. That's a tricky one to talk about, because there's no good definition of what "non-urgent care" is—if you have a big cut on your face, or if your baby has a fever and it's one in the morning, that is coded as "non-urgent" by doctors even though it's urgent to you. But when people talk about crowded ERs and the uninsured coming in for "non-urgent care," they're thinking about things like the sniffles, or the back pain these people have had for 11 years. And if you actually look at the uninsured, they're not coming in for sniffles or back pain, because they're the only group that bears the full cost of an ER visit. Yes, a $50 co-pay is painful, but a $5,000 bill is really painful.

So they actually come to the ER less often than people with insurance do?

Yes. They're underrepresented in ERs compared to the overall population—17 percent of people in our country are uninsured, but they account for somewhere between ten and 15 percent of visits to the ER. When they do come in, they tend to put it off until the last possible moment, until they're really sick. So it's not the uninsured who are causing crowding. It's everybody.

Why do you think people came to believe the opposite—that the uninsured were responsible for crowded ERs?

Before the 1990s, at least in the medical literature, it was widely understood that the uninsured were putting off care, showing up sicker [and] showing up less often. But then there were some big changes in the medical system. The Emergency Medical Treatment and Active Labor Act went into effect in 1986. This is the act that's often misquoted as "you can get free care in the emergency department," which is absolutely not right. The fact is that if you show up and you're sick, we do have to treat you—we can't look in your wallet first. But it's not free. You still get billed. Also, there were a bunch of changes at that time regarding managed care, and the result was that ERs found themselves strapped for money. A lot of emergency departments across the country closed, so all the remaining ERs were seeing more patients—and I think the uninsured became our scapegoat.

What people don't understand is that in general, the uninsured are people who are working two or three jobs trying to hold their families together, and none of their jobs offer insurance. There's this presumption that they're choosing not to have insurance—there's a feeling that these people are unworthy, that they'd have insurance if they just worked harder. And we can't make policy based on assumptions like that, because a lot of times what "everybody knows" turns out to be wrong.

So if the uninsured aren't to blame for overcrowding, who is?

It's multi-factorial. The population is getting older and sicker, so more people are coming to the ER for real emergencies. Use-per-person has also gone up, and we're not sure why that's happening. Part of it is because there are fewer primary care doctors now, so it's hard to get appointments. If you call your doctor's office and you say, "I'm super-sick and coughing up green stuff," and they say, "we'll see you three weeks from Tuesday," you might think you need to go to the ER instead. And you might be right.

But you might be wrong, in which case you're in the ER unnecessarily.[/quote][url="http://www.newsweek.com/id/164922/page/1"]http://www.newsweek.com/id/164922/page/1[/url]

[Fatuous]

[quote name='Swordfish' post='1682728' date='Feb 11 2009, 07.30']However, it is not ONLY the people who avoid going to the ER who add a burden to the system.

Some percentage of that 40 -100 million will also take advantage of services, and yet would never have gone to the ER.[/quote]

That's certainly true in my case. With no insurance, I usually perform "light" surgery/First Aid on myself {It's not pretty} when I must. Good thing I have no qualms about blood, eh?

And yes, I am serious.

Here's the ultimate truth about Healthcare and why capitalism will always fuck it up: The point of Healthcare is to keep people reasonably healthy with preventative measures being the best form of that; regular cheap visits being ideal. The only profit in such a system for any Advanced Society should be the general well being of the populace. It's socialism! Oh wait, it's not.

It's common sense?

[The Iceman of the North]

[quote name='Chataya de Venoge' post='1682740' date='Feb 11 2009, 13.52']Because it's the only way it would be palatable to a wide swath of Americans. Obama's health plan promised (from the campaign literature) to be tax neutral, except for replacing the top rate with what we had during the Clinton years (and a 4% increase in the top marginal rate - and additional 4% of anything over $200,000 - is peanuts).

[i]There are a lot of people who are happy with the current system[/i]. They have employer-provided health care, and they don't want to be forced into a government plan, with the possibility of being forced to see a different doctor. They also don't want their tax rates to rise because they're paying for other people's health care coverage.

I don't know how this would affect pay or compensation. I would suspect that it would have little to no effect initially. Taking the Obama plan, companies would have to pay some amount in if they opted not to pay health insurance. Employees would pay their portion health insurance in to a government entity if they were on a government plan, and continue to pay their portion of health insurance to their employer plan if still covered under an employer plan.[/quote]
So what you are saying is that most Americans will stall at paying less for health care if that means that some of what they pay are used for other people?

I guess most people are happy with the current system as long as they don't get chronic diseases or some life threatening condition that causes them to lose their job and insurance.

[Take on Me]

[quote name='Shryke' post='1682631' date='Feb 11 2009, 02.33']Ahh, more of the "The US is a unique snowflake" argument.[/quote]

Unique Snowflake? I think you're getting the wrong idea. We're talking about an industry that generates tens of billions in profit every year. I'm just not seeing a way to introduce major government involvement. Not in the near future. I just don't think we're ready to take it on. Now would be the time though, since the corporate administration/congress is gone.

[Ormond]

[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 simply utterly reject your idea that Americans would not accept a system which pays for basic care for all and leaves "fancy care" to be still covered by individual insurance.

We have elected an African-American President not only in my lifetime but in the lifetime of my 87 year old mother. Only a year ago there were people on this board saying that was impossible.

If we can elect a Black President, we can find a way to cover everyone with basic medical care. Cultural change is not impossible.

[Trebla]

[quote name='The Iceman of the North' post='1682818' date='Feb 11 2009, 08.32']So what you are saying is that most Americans will stall at paying less for health care if that means that some of what they pay are used for other people?

I guess most people are happy with the current system as long as they don't get chronic diseases or some life threatening condition that causes them to lose their job and insurance.[/quote]

*raises hand* Ooh me me me! That was me in 2004! Company said I could not come back with ANY restrictions. As soon as my short term disability ran out, they denied the long term with the classic "Pre-existing condition" and terminated me. [i]Thanks to the gutting of The Americans with Disabilities Act, they were able to do that with my having NO legal recourse. [/i]

I've had 2 back surgeries since and a further diagnosis of Fibromyalgia. I've taken meds that are FIVE TIMES more expensive in the U.S. than other countries. And when I could get insurance it covers only $2500 a year and then I have to pay full prices for meds every month.

So yeah, stay healthy folks! :thumbsup:

edit: fixed confusing sentence

[snake]

Obviously you never worked hard enough Trebla. If you did, none of that would have happened. ;)

[Aemon Stark]

[quote name='Chataya de Venoge' post='1682740' date='Feb 11 2009, 08.52'][i]There are a lot of people who are happy with the current system[/i]. They have employer-provided health care, and they don't want to be forced into a government plan, with the possibility of being forced to see a different doctor. They also don't want their tax rates to rise because they're paying for other people's health care coverage.[/quote]

Surely you are aware that by paying insurance premiums you are, by definition, paying for other people's health care coverage. They may pay more or less in premiums, co-payments, and deductibles, but when they're seriously ill or in accidents or otherwise requiring significant care they become - individually - net costs to the insurer. That these costs are "employer-provided" is really beside the point, since it's equivalent to a sort of payroll tax. Burdening employers with the whole cost of health care drives down salaries, increases costs for employers, and ultimately reduces the competitiveness of American corporations - indeed, this is a significant source of the financial problems of the auto industry.

I should add that it's only because of HMOs and their various restrictions that you are under the illusion that UHC implies a lack of choice of doctors. It does nothing of the sort here and need not in the US.

[TerraPrime]

UHC is not the magic bullet.

What we need, at the same time as UHC, is a reform on pricing of other associated items in healthcare, imo. Something must be done to cost of drugs. If we look at other UHC, there's inevitably some kind of cost control at one part or another. This is because people's great willingness to pay for their health maintenance will have a tremendous driving force on the pricing of services provided, making health care out of reach for the lowest income bracket if not monitored. Just because people are willing to pay a lot for health care, it doesn't mean that the health care should cost that much.

Three months ago, I had a pink eye infection. It started on Saturday night, and I had class on Monday, so I went to the nearest place with doctors on Sunday, a hospital. For a 1.5 hr wait, a 10 min exam, and 1 prescription eye drop, I was charged $538. My insurance, which I obtain from my employment, paid for $430. Now I owe the hospital $103. I do not see how this is even a sustainable system under any light. In HK, it would have costed me roughly $25, out of pocket, if I had gone to a private doctor. If I had gone to a government clinic, it would be about $5, for the eyedrop. For those who have lived in countries with UHC, it's quite honestly unfathomable how the U.S. is unable to pull this off.

[TrackerNeil]

The current system (if I may call it that) is just not sustainable, and people know it. And since we [i]already [/i]pay for the care of the under/uninsured, we may as well just fix the whole damned problem once and for all.

As DanteGabriel pointed out, of course it's scary. There are going to be bumps and failures and
mistakes and false starts, but you don't neglect life-saving surgery just because it means wielding a knife. We invaded a sovereign nation based on flimsy evidence and almost entirely on credit...my gosh, can we really be so fearful of UHC?

[Lord Mord]

TP,

[quote name='TerraPrime' post='1682923' date='Feb 11 2009, 08.01']If I had gone to a government clinic, it would be about $5, for the eyedrop. For those who have lived in countries with UHC, it's quite honestly unfathomable how the U.S. is unable to pull this off.[/quote]


I think it's a corrupt culture. There isn't the sense of civic duty here there is abroad, not in the electorate and certainly not in government.

[TerraPrime]

[quote name='Bill Starbuck' post='1682995' date='Feb 11 2009, 10.43']I think it's a corrupt culture. There isn't the sense of civic duty here there is abroad, not in the electorate and certainly not in government.[/quote]

I'm sad to report that my own experience growing up in HK does show a great sense of civic responsibility of the people living there. I think we're about what you can expect of people living in large cities. There's a modicum of respect you need to have for others because you're piled on top of each other. But in general, I don't think people in HK are that much more civic-minded. I think the issue is that we can see it's working and it's cheaper. Most people with the means to hire private doctors will choose to do that so that they can shorten their wait. But everyone knows that if you need a heart surgery, and you couldn't afford it, you can always get one from the government hospitals. When my father had a mild heart attack, he was scheduled for a sten operation within 4 days. He has since received check-ups twice a year. We pay about $60 for 6 months of medication (2 pills for lowering cholesterol), and nothing for the visit. The quality of care is not the highest. The doctors are usually over-worked, and they rotate in and out quite a bit so that in the 5 years, he's had 4 different doctors. But at least we didn't have to beg and borrow to afford the care.