Healthcare Debate (in Debates)

I was just thinking about this. Now, I know I'm asking for it.. as it seems most of the people I've talked to on CB are strict constitutionalists when it comes to politics. That means, yes there seems to be no compromise on most issues. This is the question and debate I'm looking for: If you were playing sim-government, and your little citizens were asking for universal health care, what kind of health care solution would you give them and why? Please try to put the WHY part into your response as I've heard enough simple-minded opinions explaining this or that as being terrible, or the best ever, and not enough of the why behind what they are thinking.

P.S. I'm asking you to make a leap here. That leap is to assume that the citizens in your sim-government already have a health care system similiar to ours. It's currently expensive, inconsistent, inefficient and largely ineffective at keeping the majority of citizens healthy.

We comrades get universal health care. Bundle package with the free cookies and dental.

If I were a sentient deity capable of manipulating existence and I heard the cries of my followers begging for guaranteed health care I would...

a) punish them for the insolence to assume I wanted them to live a longer more pain free existence

b) inspire my prophets to cry and wail and gnash teeth claiming the end of liberty is upon us

c) ponder the merits of the assumption that Homo sapiens have an inherent right to life

d) believe that the perceived desires of the masses are capable of overwhelming the likely effects of natural law on the resulting misery caused by people getting what they want

e) take one look at Europe and Canada and say "well they're not dead yet"

http://danielmiessler.com/blog/conservative-cognitive-dissonance-on-public-healthcare

Won't someone think of the children!?!?!

Basically:

one health care plan for everyone, lets call this the basic package
that pays for hospital bills, doctor visits and medicines.

Everyone pays for this one each month for fixed fee, doesn't matter if your unemployed or not. But one draw back, you have to have a house address or residence in order to get this.

If you want more then just that, you can always add other packages to the basic package; like dental, alternative medicine, etc

Limited to cosmetic surgery.

With this system everyone has basic health care, the insurance companies can still compete with each other trying to sell additional packages and you need less cash from the goverment pumped in the health care system.

I wouldn't even argue on the merits of the actual bill, or items presented in it.
The fact that the government cannot run Social Security, MediCare, and Veterans health-care should be ample evidence that such a public option would be insanity. Even more so if we trusted our currently elected (or if you're a czar, unelected) leaders.
Consider that the average waiting period to see a doctor in veteran's health-care is over 4 months!
Medicare and SS have run up deficits of over $100 trillion dollars. (Which, even by today's standards, is a lot.)

As Thomas Paine said, government is a necessary evil. The less of it, the better.

While reform of some sort is obviously needed, I highly doubt this is the type.

"You cannot legislate the poor into prosperity by legislating the wealthy out of prosperity. What one person receives without working for, another person must work for without receiving. The government cannot give to anybody anything that the government does not first take from somebody else. When half of the people get the idea that they do not have to work because the other half is going to take care of them, and when the other half gets the idea that it does no good to work because somebody else is going to get what they work for, that my dear friend, is the beginning of the end of any nation. You cannot multiply wealth by dividing it."*
Adrian Rogers, 1931

i think that if the government wants to compete with private insurance, let them. they could set it up as a not for profit and try to make just enough money to pay for the program. if they can do all of that and offer cheaper premiums, then they will naturally do well and there will still be room for private insurance to offer more for those that can afford it. i think that is the extent of what i would like to see happen first along with some regulation perhaps.

nov:
I think that both you and this Daniel Miessler guy make the incorrect leap that Christian = conservative and Republican = Christian. Neither of those categorizations are universally true, and I'm a little bit tired of being told that that's the way it is.
Furthermore, his argument basically amounts to "I don't understand your reasoning, and it must therefore be faulty and inconsistent." This is a baseless assumption.
Thirdly, of course the issue is in implementation -- no one is arguing otherwise. If a method were proposed that let everyone stay exactly how they are and keep everything they have right now, and people just got health care for free, I don't think anyone except employees of the private insurance companies would be upset.

I also think that the points brought up by Marlfox and Ranger are quite excellent. I would add public education to Marl's list of government services that come up wanting.

I would however like to clear up one misconception about the number of uninsured people in America:

"It turns out that 253.4 million Americans -- or a whopping 83% of the country -- have health insurance, whether it's through private insurers, employer-based coverage, a government program or Medicaid/Medicare. The majority, 202 million of the 253.4 million, pay for private insurance.

And as a number of clever skeptics have recently pointed out, breaking down the 45 million number reveals that far fewer folks are actually uninsured. Nearly 10 million of those 45 million aren't even American citizens, and nearly 17 million of them can easily afford insurance, but choose not to get it (these folks will be taxed under Obamacare for opting out.) When the numbers are crunched, it turns out that only 11 million legal American citizens who would like health insurance don't have it, and even that figure is likely high. If we take it at 11 million, that's less than 4% of the country."

Do we need to insure those 11 million? Certainly. Do we need to massively overhaul the industry to do it? NO.

Do we need to keep costs down? Certainly. Can we do it without some sort of tort reform? NO.

I am sorry but those 10 million who are not even citizens should not be entitled to healthcare. If they can pay for it, great. If not, get their country of origin to pay for it. Send them a bill.

The 17 million that can afford it, simple, tax them the amount it would be for a simple health plan. Most of those 17 million are healthy but choose not to buy coverage and instead go on vacations, drive a BMW or buy that plasma TV.

The other 11 million could be covered with an expansion of medicaid. And of those 11 million, some estimates state 25-50% are eligible for medicaid but have not for some reason filled out the myriad of paperwork needed.

Crisis? NO. This is yet another "the world will end tomorrow if you do not do as I, Obamasan, state you should do" type scenario. Just like he stated with the spendulus package, and like he did with the auto industry.

He should have the nickname of Chicken Little Obamasan.

follow this link for some context on ranger's numbers:

http://www.factcheck.org/2009/06/the-real-uninsured/

it does not appear to be as black and white as presented in my opinion.

Ok, forgive me in advance for the length. But this kind of thing gets me going. And I've included examples below, so read for yourself.

It's fairly simple to me, this plan is one more step towards tyranny. Since Obama/Democrats have tipped the balance their way, we've seen nothing but government expansion and invasive controls. And this health care plan is just an extension of that. It's happened with banking, the stock market, the auto industry, and now it's an attempt at health care. I'm not against every American having access to some kind of health care, but this is not the answer. The administrations proposal is simply too much, too fast, with too many controls, and would be a major step in the wrong direction. Here's a few examples of what I'm talking about:

Page 22 mandates the Government will audit books of all employers that self insure.

Page 30-Sec 123 there will be a government committee that decides what treatments and benefits you get.

Page 29 lines 4-16 your health care will be rationed

Page 42 The Health Choices Commissioner will choose your health care benefits for you.

Page 50 Section 152 health care will be provided to ALL non US citizens, illegal or otherwise

Page 58 Government will have real-time access to individuals' finances and a National ID Healthcard will be issued

Page 59 lines 21-24 Government will have direct access to your banks' accounts for election funds transfer

Page 65 Sec 164 is a payoff subsidized plan for retirees and their families in unions & community orgs (ACORN).

Page 72 Lines 8-14 Government is creating a health care exchange to bring private health care plans under Government control.

Page 84 Sec 203 Government mandates all benefit packages for private health care plans in the exchange

Page 85 Line 7 Specs of benefit levels for plans. #AARP members - your health care will be rationed.

Page 102 Lines 12-18 Medicaid-eligible individuals will be automatically enrolled in Medicaid. No choice.

Page 124 lines 24-25 No company can sue government on price fixing. No "judicial review" against government monopoly.

Page 127 Lines 1-16 Doctors and the American Medical Association - The Government will tell you your pay.

Page 145 Line 15-17 An Employer must automatically enroll employees into public option plan. No choice.

Page 126 Lines 22-25 Employers must pay for health care for part-time employees and their families. No choice.

Page 149 Lines 16-24 Any employer with a payroll of $400k and above who does not provide public option pays 8% tax on all payroll

Page 150 Lines 9-13 Businesses with payroll between $251k & 400k who don't provide public option pays 2-6% tax on all payroll

Page 167 Lines 18-23 Any individual who doesn't have acceptable health care according to Government will be taxed 2.5% of income, as deemed by government committee.

Page 170 Lines 1-3 Any non-resident alien is exempt from individual taxes. (Americans will pay)

Page 195 Officers and employees of government health care administration will have access to all Americans financial and personal records.

Page 203 Line 14-15 "The tax imposed under this section shall not be treated as tax."

Page 239 Line 14-24 Government will reduce physician services for Medicaid. Seniors, low income, and the poor affected.

Page 241 Line 6-8 Doctors will all be paid the same, regardless of specialty.

Page 253 Line 10-18 Government sets value of doctor's time, professional judgment, etc.

Page 265 Sec 1131 Government mandates and controls productivity for private health care industries

Page 268 Sec 1141 Fed Government regulates rental and purchase of power driven wheelchairs

Page 272 SEC. 1145. Treatment of certain cancer hospitals. Cancer treatments will be rationed.

Page 280 Sec 1151 The Government will penalize hospitals for what it deems preventable readmissions.

Page 298 Lines 9-11 Doctors who treat a patient during initial admission that results in a readmission will be penalized by the Government.

Page 317 L 13-20 prohibition on ownership/investment. Government tells doctors what/how much they can own.

Page 317-318 lines 21-25,1-3 prohibition on expansion- Government is mandating hospitals cannot expand

Page 335 16-25 Page 336-339 - Government mandates establishment of outcome based measures. Rationing

Page 341 Lines 3-9 Government has authority to disqualify Medicare Advance Plans, HMOs, etc. Forcing people into Government plan

Page 354 Sec 1177 - Government will restrict enrollment of special needs people. Special needs such as down syndrome, autism, etc will be rationed.

Page 379 Sec 1191 Government creates more bureaucracy - Telehealth Advisory Committee. Healthcare will be handled by telecommunications before consultation.

Page 425 Lines 17-19 Government will mandate instruction and consultation regarding living wills, and durable powers of attorney.

Page 425 Lines 22-25, 426 Lines 1-3 Government provides approved list of end of life resources, guiding you in death, euthanasia.

Page 427 Lines 15-24 Government mandates program for orders for end of life, life support, vegetative state, comaﾒs, etc.

Page 429 Lines 1-9 An "advance care planning consult" will be used frequently as patient's health deteriorates

Page 429 Lines 10-12 "Advance care consultation" may include an order for end of life plans. (see above)

Page 429 Lines 13-25 - The government will specify which doctors can write an end of life order.

Page 430 Lines 11-15 The Government will decide what level of treatment you will have at end of life

Page 489 Sec 1308 The Government will cover and determine marriage & family therapy.

Page 494-498 Government will cover mental health services including defining, creating, rationing those same services.

ok, wow, sorry, that was way to long =/

i received that scare email as well revs, what i haven't been able to find is the text of the bill it is referring to. could you please link the bill or give us a number or something to see that?

Here's a few sources for you:

Peter Fleckstein - Twitter (source of the scaremail you're probably referring to).

Actual bill:

http://patientsunitednow.com/?q=node/233

PDF of entire health care reform bill, all 1018 pages of it:

http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf

i checked five or six of those, all i had time for, and they were all taken out of context, dropped from the current legislation or clarified in a much less menacing manner.

most are also not direct quotes from the bill but are stated very differently from the actual bill text. i highly encourage people to check for themselves though!

active legislation can be seen here:

http://www.senate.gov/pagelayout/legislative/b_three_sections_with_teasers/active_leg_page.htm

scroll down to the h section and you should see the bill under "health care reform."

To answer the question directly, I would give them exactly what the majority was opting for.

Why?

Because a government is supposed to give the people what they want. Elected officials are supposed to be representing the people who elected them, and if the people want it, it's the job of the elected officials to reflect and act on that want or need.

The government (as established in America) is not supposed to "give people what they want"!
The government is there to solve disputes regarding law, and to protect its citizens from foreign attackers.
In America, you can succeed or fail as YOU choose, and it is not the governments responsibility for your happiness.

What about those people who pay a great deal for insurance and yet get substandard care from doctors who care only about getting patients in and out of their office as fast as possible by simply prescribing them the first thing that comes to mind that 'might' help them. Or even going so far as to just "go along" with what the patient thinks their problem is, and thus missing the real problem that the patient might be suffering from?

As I understand it, doctors are in it to try and help people and make money. In many cases, the "making money" part is not dependent on people truly being helped. Case in point: I've switched doctors a couple times now because many times I would go to a doctor, they would pretty much agree with whatever the hell I told them in order to prescribe me some pain pills, or something else equally unnecessary to make it seem as though they're doing something to help. They would do very little in the way of their own independent diagnosis. We're freaking people, not fast food orders. That is the system in place right now, as we speak, in this country. I want a system that gives doctors a selfish reason to make sure that all of their patients are ACTUALLY healthy all the time. All semantics aside, in the big picture I want doctors to get paid based on how healthy their patients are. That kind of system does not mesh well with our current system.

As a side note, I've read about tort reform proposed by health providers, it sounds all well and good in theory, but once the legislation is on the table, it's full of all kinds of goodies for the health providers that do nothing but screw the injured patient over. This guy pretty much nails it: http://www.americanprogress.org/issues/2008/06/malpractice.html

That's just not true. That may have been the case at some point, but the reality is that the government here is constantly giving organizations and individuals what they want.

Medicare guarantees that the eldest of our citizens won't suffer and die regardless of how hard they worked. The idea that simply by being alive you have a right to health and treatment for sickness is pretty universal in society today. We are a people who hate to see a fellow human suffer needlessly, and if it's convenient even the laziest among us would wave a magic wand (single payer health care).

It's not "the natural order of things" as we have known it, but it may be the order of things to come.

Verifex,

I can personally tell you that I see 25-40% of all the radiology studies done as "defensive" medicine.

Studies that in no way help the patient, but HAVE to be done to prevent one from being sued.

Where I live, in South Florida, it is so bad most doctors refuse to carry malpractice insurance. As a Radiologist I am force to by the hospital I work.

Try to find an OB that will see new patients, you cannot unless you have an in, like my wife does. They pay over 200k a year for insurance, if they have it.

I personally pay 53k per year for 250k in coverage. Now of course I do not pay that money, but it is reflected in how much we try to bargain with the insurance companies for prices. Which in turn is reflected in premiums going up.

It would be great if doctors can spend time with patients. However to turn any profit they have to get them in and out as fast as possible. Now you may think your internist or pediatrician makes a lot of money, but they make about 125-150k a year. Yes, that may sound like a lot, however, take into account all the years they went to college (4), medical school (4), and internship/residency (3+) to get where they are.

So please do not chat with me about tort reform saying it is screwing the patient over. I right now have a lawsuit against me for something I read correctly. However, since I have insurance and the other docs on the case do not, guess what. I am likely going to have to settle. Why? My insurance company thinks it will be cheaper to give them 20k than all the legals costs of going to trial.

ANY reform HAS to include tort reform. Not for those seriously injured by MALpractice. But there is a difference between MALpractice and a bad outcome. Now, docs get sued for both.

The problem is that the divine one is a lawyer himself and is looking after his friends special interests.

Well you just hit the nail on the head:

It would be great if doctors can spend time with patients. However to turn any profit they have to get them in and out as fast as possible. Now you may think your internist or pediatrician makes a lot of money, but they make about 125-150k a year. Yes, that may sound like a lot, however, take into account all the years they went to college (4), medical school (4), and internship/residency (3+) to get where they are.

The focus my friend, is not on treating the patient, but on turning a profit. And that is by no fault of your own, but the fact that the system you operate in demands that you do so. You cannot operate a business as a doctor without working under the exact same system that the hardware store or grocery store works. The problem is, in order to provide good business, you have to spend time with them, and that is not incentivized properly, IMO.

Did you read that article I linked? Too many people have their fingers in the medical establishment it seems, and if you go to reform medical malpractice without changing some of the incentives and other practices at the same time, you've got the clouds of medical catastrophe forming. I would think that a good, truly independent (not owned or funded by the health provider or insurance), arbitration committee should be there to govern which malpractice cases could move forward. Kinda like a medical small-claims court.

Nov: The idea behind medicare is indeed a noble one, but it has been so poorly implemented that it is bankrupting the country.

One has to turn a profit to stay in business.

In Britian or Canada, student physicians pay little if anything for their medical school.

In American debts of over 200k are not uncommon. Someone has to repay those loans.

I went to a public school in my home state and still had over 50k in student loans/debt.

Of course doctors need to make money. If you really think 125k is a lot for all the time physicians put into their practice, you're very mistaken.

Consider all the nights they spend at the hospital caring for their acutely ill patients. All the hours on the phone with patients answering questions and their families questions. All the weekends they have to work being on call.

There have been many attempts to change tort medical law in Florida. Including setting up impartial arbitration committees. In fact, almost all doctors would welcome this change. But the trial lawyers at all turns fight such a change. They cry that it will be unfair to patients and their rights.

Again, any change to the current medical system has to include tort reform.

But if we go to a universal system as the Divine one wants, it will certainly drive the brightest and best physicians out of medicine. Why spend all that time becoming a doctor, accumulating all this debt and not be able to at least benefit from your knowledge?

Unfortunately people are not altruistic. Which is the only way a socialist society can succeed.

As Gordon Gecko said "Greed is good".

Easy way for doctors to make money and still treat the patients properly: charge by the hour, like mechanics do. Then we might actually get some progress on the healthy state of the US. I mean your car is running fine, right?

Easier said then done Tal.

The government via Medicare and Medicaid pay per the visit, depending on the level of care given. Typically on a 1-5 scale.

Private insurance companies then typically follow the governments lead with their own pricing schedules.

If the paid by the hour, there would be no incentive to see more patients and with the current severe shortage of primary care doctors, people would never be seen.

Wouldn't more people want to be doctors knowing that they could charge anywhere from 100-500 an hour + parts(meds)? That would alleviate the shortage right?

Yes,

But people will not or cannot pay that much for a MD visit.

Right now I see people complaining about a 20 dollar co-pay when they have to visit their internist. Bitching and moaning about how it should be free.

The problem is people want the best care money can buy but not have to be the one paying for it. And they want it yesterday.

They would rather go out and take a vacation, buy a plasma TV or a new car rather than pay their doctor for the time they put into taking care of their problems. I see it all the time.

If we go to Obamacare, people will be in for a huge shock. But by then it will be too late.

I agree with your sentiment, Verifex: incentivizing quality medical care is key. However, I don't know how to approach that from a policy standpoint. The goal is clear, but the steps there are still muddy in my mind.

nov:
The purpose of government is to uphold the rights of its citizens. That's one of the basic tenets of post-enlightenment political philosophy. Charity is great, but it's the domain of charity organizations. Similarly, health insurance is the domain of health insurers. Car companies are the domain of anyone who has run a business before, etc.

"The idea that simply by being alive you have a right to health and treatment for sickness is pretty universal in society today."
And if someone poisons you or otherwise violates your right to health, the government is to intervene. If your body breaks down because that's what bodies do, the government doesn't have to cure you. There's a difference between violating someone's rights and not assisting someone in exercising them.
A guaranteed right is not the same as a guaranteed continual service for life without any monetary output on your part. Otherwise, I want to call in my Second Amendment rights and get my government-subsidized free guns (and knives and crossbows) for life.

Tal and Ranger:
That's way complex of an issue. I'll try to think about it more.

Then Ranger what you are saying is that todays society is full of morons? I see that, but if I had the money I would pay for the healthcare that I'm receiving, but I don't. It's the same reason why I fix my own car, because I don't have the money to pay for a mechanic to stare at it for 2 hours and spend 5 minutes fixing the problem. Too bad I can't fix myself eh?

Maybe this is a convincing argument for a government-run program:

Yes, the insurance company status quo rocks. I learned recently about something called the "loading fees" of insurance companies. That's how much of every health-care dollar gets spent by insurance companies on things other than the medical careﾗpaperwork, marketing, profits, etc. According to a University of Minnesota study, up to 47 percent of all the money going into the health-insurance system is consumed in "loading fees." Even good insurance companies spend close to 30 percent on nonmedical stuff. Sweet.

-Source

And the government will be any better?

marl, the military is pretty darned inefficient as well. keeping americans and their interests safe could also be said to be bankrupting the country. are you suggesting that should be privatized?

Not nescessarily a bad idea, Dude. But, keeping America safe from enemies is one of the responsibilties of *our* government, providing health care for its citizens is not.

where is this list of responsibilities of our government? does the list also state that it is conclusive? why have any government if private corporations can always be more efficient? do you really trust corporate america that much or are you just anti government?

dudemus is completely right. Government fills in the gaps the private sector can't. Much of the time this is safety, but it's perfectly acceptable in other roles.

For example if there was no fire department, the private sector has a lot of trouble filling this role. Imagine if fire fighters charged you every time they went to put out a fire at your house. Not only would that be incredibly inefficient, imagine waiting for your credit card to go through while your house burns, but other problems arise as well.

If your house is on fire, your neighbor doesn't want it to spread to his house. Well, if your neighbor is willing to pay for the fire department to put out your house, why should you?

If socialized medicine gives an overall benefit to society, it is worth doing. That said, it may not be, but there is no set role for government. It truly depends on the values of the society that it operates in.

Despite all the criticism of the government run BBC I've read, it is _a_ solution to copyright infringement. It does raise questions about freedom of speech, but there is a reason to have such a system.

Ever been to a VA hospital?

I have.

Ever read about the care from a VA hospital?

I have.

Would I ever go to one for my care?

I would certainly never.

This is what universal health care in America would be like in a U.S. government run system.

I can tell you horror upon horror stories of gross malpractice in the VA system.

Run away from the concept of Universal Health Care run by the government. Run away as fast as you can.

I have talked to many Canadians about heath care there. My X-wife and her family for starters.. They have many issues with their system: They have top wait in LONG lines to get seen by a doctor, many good doctors move to America so they can actually make money, Doctors offices are few and hard to get into since their lack of heath care is much worse than ours. Also their taxes are VERY high so the citizens are paying for health care even if they don't use it and even if they go to America to see a 'good' doctor who can help them. So many of the problems you have complained about in our system are much worse there.
Tort reform and malpractice insurance lowering concepts are plausible solutions. My opinion is that Lawyers need to quit interpreting and twisting the laws, so progress can be made on these issues. They are greedy to 'protect' their interests (in making money) of their large clients and insurance companies and those suing for big money for malpractice issues.
Government in America is usually quite inefficient in governing anything - so if you want more bang for your buck, there is a better way... Not exactly sure what it is, but trusting government to be frugal and efficient is WAY too trusting and bordering on plain ridiculous. They have proven themselves to be quite the opposite.

There should at least be minimal universal health care IMO.

Take the example of the fire department, and extend that to a contagious disease. You can think of that as purely preventative for the entire population.

1. Just because something is socialized doesn't make it inherently bad. It doesn't have to be identical to another country's system.
2. For every horror story I've heard, there are at least just as many if not more people who are perfectly satisfied.

Couple of quick points...
1) Canadian Health care isn't really 'run' by the government... it is a single payer system. Not the same as the British model.

2) I agree with Ranger's comment about people would rather pay for the latest game system than quality health care... the same holds true for education IMHO.

3) I am actually pretty socialist in my views on health care...

I don't just mean that doctor's trips should be covered. I'm talking provisions being made for vitamins and food being made available through schools and various other preventative measures meant to bolster the health of the population. Now this would necessitate some further societal changes (good by pop machines in school!) but ultimately would produce better standards of living and lower health care costs.

Very complicated and I haven't done near enough to present it clearly, however, time was limited on this post.


Oh, and as far as comparing Canadian and US health care, there is a good wiki page on it (well cited):
http://en.wikipedia.org/wiki/Canadian_and_American_health_care_systems_compared

You might be interested to know:
"Total government spending per capita in the U.S. on health care was 23% higher than Canadian government spending"
and
"In 2006, per-capita spending for health care in the U.S. was US$6,714; in Canada, US$3,678"

So it would seem that our 'way higher taxes' are not exactly being used to fund the health care system.

No,

But you get this little thing called rationing in Canada.

Something not seen in the US.

Our healthcare costs are higher because people expect instant care with the best doctors with the best technology.

Well that costs money.

I have people go to the doctor with knee pain and 1 hour later they are sitting in the MRI machine. Something that would take months in Canada or England.

One can go to a single payer centralized system, however, people will certainly have to sacrifice speed and efficiency of care.

I think it is more a scarcity of supply than deliberate 'rationing'.

And I bet the 45mil Americans without any coverage love the quality of care they get.

Though I did forget to agree with you on the whole suing thing... but I don't think the ridiculous litigiousness in the US is limited to medicine. The wiki page I referred to earlier points out that malpractice costs are less than 1%... however it seems to gloss over the fact that it isn't spread easily.

Just to be clear, I am by no means stating that the Canadian system is perfect or that the US system is horrible. Just noting some differences between the two.

45 miilion uninsured is a gross overestimate.

The true number is 15-20 million.

I can quote articles if you want.

I'll stick with the numbers from the US census bureau as they seem to be people who should know these things.

(2007 census)
http://www.census.gov/hhes/www/hlthins/hlthin07/hlth07asc.html

"Both the percentage and number of people without health insurance decreased in 2007. The percentage without health insurance was 15.3 percent in 2007, down from 15.8 percent in 2006, and the number of uninsured was 45.7 million, down from 47.0 million. 1"

http://www.foxnews.com/opinion/2009/07/21/se-cupp-obama-healthcare/

http://contractwiththeconstitution.com/241/45-million-uninsured/

Ranger, out of curiosity, do your numbers count state-insured individuals as insured? I have a feeling they do, but in the context of universal government healthcare, they probably shouldn't.

from above:

"follow this link for some context on ranger's numbers:

http://www.factcheck.org/2009/06/the-real-uninsured/

it does not appear to be as black and white as presented in my opinion. "

Rather than arguing the numbers and making claims of inability to get service...

I think the question comes down to this, do you believe that people have a right to health and treatment when health fails?

Yes []

No []

If the answer is yes, you're on common ground with the majority or people in the world and you're likely just as clueless as everyone else about how to achieve this lofty goal.

If the answer is no, you're likely a Randian protege and would advocate for a return to putting the elderly out on the ice flow when they can no longer work.

Fighting over the details just helps the people making money off the blood of the masses. Medicine as a business is pretty much a complete failure, the hippocratic oath should be revised to reflect the new ideal of "do no harm to the bottom line".

Health should not be dependent on wealth, I think most sane human beings can agree on this regardless of your placement on the political ideology spectrum. I respect those who believe otherwise, but I also fear for your future.

Novice,

It is not that easy, far from it.

Let us say you have a 90 year old with failing kidneys. The average life expectancy is about 18 months. Without dialysis that person will die in less than 2 weeks.

Dialysis is 30k a year. Is it worth it? Considering this person does not contribute anything anymore to society?

As I understand in Britain this person would not qualify for dialysis. In America of course they get it.

Yes, health care is a right.

However, how fast, how good and how efficient is determined by cost and cost analysis.

So, would you deny dialysis to that 90 year old?

"If the answer is no, you're likely a Randian protege and would advocate for a return to putting the elderly out on the ice flow when they can no longer work."

Funny, who do you think will get "rationed" when we go to universal health care?

And that about says it all!!

we have rationing going on now, you've got a 50% chance of being turned down by insurance you PAID for if your ailment is serious enough that it'll cost real money. The existing system is so frightening that whatever evils a simple payer system might bring seem like a fear mongering fable designed to scare children.

s/simple/single

In reality novice that is not the truth.

If you have an insurance plan, it covers most major illnesses. I have yet to hear of people being turned down for coverage of most conditions.

The ones you hear about are the experiments things such as bone marrow transplants in cancers where it has not been proven but suggested to work.

The 50% you quote is quite high. If anything it is more like 2-3% at most.

I see people covered for all things from knee surgery to open heart surgery.

http://tinyurl.com/kuslaw

I realize I'm linking to stuff on the net...

Article too long, head going to explode.

But the 50% is if you file a massive claim?

I fail to believe that as I know, from work, many people who have cancer and other life long expensive conditions that continue to get excellent medical care paid by the insurance companies.

Half of the insured population uses virtually no health care at all. The 80th percentile uses only $3,000 (2002 dollars, adjust a bit up for today). You have to hit the 95th percentile to get anywhere interesting, and even there you have only $11,487 in costs. Itﾒs the 99th percentile, the people with over $35,000 of medical costs, who represent fully 22% of the entire nationﾒs medical costs. These people have chronic, expensive conditions. They are, to use a technical term, sick.

An individual adult insurance plan is roughly $7,000 (varies dramatically by age and somewhat by sex and location).

It should be fairly clear that the people who do not file insurance claims do not face rescission. The insurance companies will happily deposit their checks. Indeed, even for someone in the 95th percentile, it doesnﾒt make a lot of sense for the insurance company to take the nuclear option of blowing up the policy. $11,487 in claims is less than two yearsﾒ premium; less than one if the individual has family coverage in the $12,000 price range. But that top one percent, the folks responsible for more than $35,000 of costs ﾖ sometimes far, far more ﾖ well there, ladies and gentlemen, is where the money comes in. Once an insurance company knows that Sally has breast cancer, it has already seen the goat; it knows it wants nothing to do with Sally.

If the top 5% is the absolute largest population for whom rescission would make sense, the probability of having your policy cancelled given that you have filed a claim is fully 10% (0.5% rescission/5.0% of the population). If you take the LA Times estimate that $300mm was saved by abrogating 20,000 policies in California ($15,000/policy), you are somewhere in the 15% zone, depending on the convexity of the top section of population. If, as I suspect, rescission is targeted toward the truly bankrupting cases ﾖ the top 1%, the folks with over $35,000 of annual claims who could never be profitable for the carrier ﾖ then the probability of having your policy torn up given a massively expensive condition is pushing 50%. One in two. You have three times better odds playing Russian Roulette.

---

The last paragraph is key. For the top 1% of claims, the denial rate is close to 50%. The truly sick are being denied care because it hurts the bottom line.

Ok,

I fully and 100% agree with provisions that prevent this type of activity.

Why do we have to blow up the whole healthcare system, one that over 80% of people like and make a whole new one?

There are things we can do to cover the 10-20M uninsured. Like making it a law one has to purchase insurance instead of gambling and spending that money on cars or vacations. Or subject them to a heavy fine/tax.

Of course those that cannot afford it, would get vouchers to purchase insurance they want.

http://www.heritage.org/ is a great conservative site with plenty of ideas to improve our current system without the complete overhaul that the liberals want.

To keep choices in our hands and out of the government.

That was my point a few posts back... that by in large there is a LOT of agreement on both sides of the invisible fence people cling to with all their faith.

Overhauling the system from the ground up is seen as the only solution because that's what's been done elsewhere with enough success that it looks attractive. Arguing about the differences and ideology isn't getting us (or the folks actually trying to solve the problem) anywhere.

Based on that article, I think I'm going to get into the business of health insurance, it's like a legal racket, and if this health care bill gets neutered by big business lobbyists (like most every possible game-changing legislation does), then I'm sitting pretty.

It seems that there is a good representation of people here who would support me here. I mean come on, I can get people to give me money for the "good faith" that I'll pay off their bills if they have them in the future. It's like gambling, except that rather then win or lose, it's win-win for me. All I have to do is make really confusing and hard to fill out insurance forms, then when the house (me) loses a bet on someone being healthy, I can just call a technicality on them and not have to pay out, beyond that I can even cancel their policy without any penalties for me. Bam, that is good ol' fashioned capitalism for ya, and I love it.

I had no idea the medical healthcare system worked like that, man you get better returns on investment in that then you would get in stocks, real-estate or just about anything else, no wonder these guys don't want the system to change.

I personally however, would not call the Canadian system a success.

Nor the British.

The American one, the only free market one is.

People get seen fast, get studies fast, get surgeries they need fast, get end of life care, and there is little rationing.

i was not renewed once when using temporary type health insurance when i was put on one round of oral steroids for asthma. i had used that type of insurance for 24 months with no claims until that one.

my wife is a public school teacher and her insurance is awesome but it is way too expensive to put my daughter and i on that. it is actually cheaper for me being self-employed to get my own insurance for us.

it does seem to be a racket to me and a very frustrating one at that.

What is too expensive for you and your family to be on your wife's insurance?

we have to pay for part of her insurance already. it would cost too much to add my daughter and i to her policy. teachers aren't paid too well in texas and the benefits aren't all that great.

i think it was going to be over 800 more bucks a month to add both of us to her policy through her school district. it costs me around 250 bucks for both of us for insurance that has no deductible but will cover half of everything.

So either 3k a year for 50% coverage or 10k a year for almost 100% coverage.

Either way you have a choice. It may be expensive, but you will get the best care in the world in the US.

Little if any wait and fairly quick results.

While a system that is universal like Canada/England may see tempting, remember you will have to wait and wait for non-essential things. Which as you get older, you develop. Like back pain, knee pain, high blood pressure, cataracts, etc... Those you will see will subject you to long lines and many delays.

And, opposed to what the government is now saying, everyone, not only the "rich" will have to pay for it. There is not enough money on the "rich" people to do all Obama wants.

Ranger, Canada does NOT have the same system as the UK... please stop referring to them as equal.

"While some label Canada's system as "socialized medicine," the term is inaccurate. Unlike systems with public delivery, such as the UK, the Canadian system provides public coverage for private delivery. As Princeton University health economist Uwe E. Reinhardt notes, single-payer systems are not "socialized medicine" but "social insurance" systems, because doctors are in the private sector."

i think my wife's pays about 90 percent. but those percentages are only good on what they choose to cover.

i have to pay fully for an mri last year to determine that i have arthritis in three vertebrae of my upper back. i was having upper back pain and the doctor ordered the mri. my insurance basically said that they wouldn't cover that.

we do have insurance and we can go to the doctor when needed. all of that doesn't lessen the fact that i feel the medical insurance industry is a glorified and legal racket though.

also, if you read my first post on this topic, the only suggestion that i had for revamping the healthcare system in the u.s. is to let the government compete with private insurance companies for our dollar. if they can't do a better job and offer better coverage as a non-profit, then they certainly do not need to be managing anything greater than that. ; )

Ranger, the point is that paying an insurance company an exorbitant amount of money does not equal the best health care in the world. It means the most expensive health care in the world. If I paid $175k a year for insurance, and lets say this is the BEST INSURANCE IN THE COUNTRY for arguments-sake, yet I was routinely denied full coverage, and instead got partial coverage for a ludicrously expensive treatment that I needed to stay alive. I couldn't afford the treatment without full coverage insurance, so instead of living I die. Would you still claim it is the "best healthcare in the world"?

Now, if I go ahead and charge you $200k a year for health insurance through my new health insurance company, clearly it is now the best health care in the country.

The arguments that care needs to be rationed assume too much, first it assumes that we are just going to create a system identical to existing systems instead of boldly creating a new better system. Who's to say that we couldn't have a government sponsored roving band of nurses and maybe a doctor or two to give basic medical care to people in need. Much like a circus, except with more stethoscopes, needles and dentist drills.

Government sponsored health care could offer us different plans depending on our needs. Instead of 47% of our insurance dollars going to administration and billing costs, we have much more going to the doctors. You can look at the VA and say it's a terrible system, but you can also look at the VA and say there is an opportunity to improve on that and make something better.

Here in America we have both the most expensive care, and the best health care, but that does not mean that the most expensive care IS the best care. If we had low cost preventative care check ups among other common sense low-cost health care provided to us by the government, the entire system would have a lot less people in it to begin with. The idea is not to have everyone in the country at the doctor every week.

Survival rates for most major diseases including cancer are among the highest in the USA.

When I state Canada and England I am typing about a single payer system opposed to a free market one. But you are correct the methods are different.

Without competition they is no incentive to do your best.

"So, would you deny dialysis to that 90 year old?"

I'm not trying to be horrible or play devils advocate. I truly think there should be limits on how much we do spend to keep someone alive through a public system. It's sad to think about, but everyone dies sometime and if letting a 90 year old die 1.5 years earlier allows 10 other people to extend each of their lives far more then it's not so simple a problem.

If the 90 year old can pay for it themselves with their private insurance, that's perfectly fine, but I don't think such a problem under socialized health care is simply black and white. That said, it does not seem like anyone is trying to take private healthcare options off the table, so if someone is scared of such a situation, they don't have to opt in. If the person didn't have a private insurance in the current system, they'd be just as screwed, so I don't see how that's really an argument against providing a public backup.

If we put all our effort into extending everyone's lives as long as possible, we'd lose sight of the younger lives being lost. This is off topic:, but I recently watched a documentary about a man who is raising money for anti aging research expecting to be able to make people live forever. He raises money by promising people that his ideas will let them live forever, and it almost seemed like a cult. I do think people who are trying to live forever are missing the point.
When it's time to move on, it's time to move on.
Warning: The man this documentary focuses on is a nutcase, and the host is oblivious to this. He seems smart enough to be respected by some, but he's definitely also a nutcase.
http://www.documentary-log.com/d303-do-you-want-to-live-forever/

I think the idea of a public insurance program would be to allow a basic level of care to people, and 1. I think if any country can have an effective system, this country should be able to come up with something halfway decent, and 2. I think it's probably a worthy investment to provide a basic level of care to everyone.

I'm glad Cube brought it up, because it's something quite obvious that needs to be taken into account: people die, anyway.

There is a point at which it makes no sense for a community trust of any kind, whether a private insurance company or a government-run one, to continue excessively expensive medical care of an individual whose physical body is at the point where something else will just go wrong the next week, at the expense of resources that could provide care that will significantly affect duration and/or quality of life of another individual. Basically, as long as an insurer does not have unlimited funds, they need to be apportioned responsibly. At the point where someone is taking more than their fair share out of the communal plate and depriving someone else of benefits they deserve just as much, it is reasonable to cut them off and make them pay for their own care, if they so wish and can so afford.

Think about the other types of insurance we have: automobile insurance, fire insurance, flood insurance. The reason these exist is because accidents happen. In the same way, medical insurance exists, I think, because accidents happen. It's there in case I fall off the monkey bars or don't land a kick flip, because there are real solutions to whatever situation may arise from this. By contrast, 90 years of wear-and-tear on a human body is not something that can be fixed. Your body doesn't come with a warranty. Think about it: if an auto insurance provider promised to pay for all the repairs that needed to be done to your car over the course of your ownership, they would be foolish. Sure, at the beginning, it would just be collision insurance. But drive it for 25 years and to 300,000 miles, and they'll have to buy you a new transmission the week after your engine fails. And then, they'll have to transplant it all onto a brand new chassis, when your old one's rusted through.

There is a point, I think, where surgery and transplants cease to be medical care, and begin to be wasteful foolishness. This point is where the body in question will gain no appreciable survivability by the procedure.

As for the role of government, it is this: to protect the rights of the citizens. For the (federal) government to legitimately get into the health insurance business would require that health insurance is a right, which it isn't.
Health care is a commodity. It requires labor, which is exchanged for money. Saying that someone has a right to health care is like saying that someone has a right to food: no one can lawfully deprive them of it, but it is no one else's responsibility to provide it for them.

That is all great to say.

But when it is your mother needing dialysis and the government says no, your will change your opinion.

Ranger, the government would say that they wouldn't pay for it, not that it can't happen. If you have the money, you'd still be able to get it. That and personally, my mother is a strong woman and can handle it when her time comes, and knowing that I expect I can handle that though I know it's not easy for most people when their parents die. That's still a horrible argument (scare tactic) because anyone in anguish over a dying parent is only thinking emotionally.

You also do realize there are limits when it comes to private health care as well... They likely would be more strict within a government program, but it would be an OPTION. An affordable OPTION that you would not be forced to choose. No one should be given or is given a 'we'll do everything in our power' guarantee even in current private systems. Such a program would provide basic everyday care! For many people this would be far better than no option for most circumstances. In fact, it'd at least promise independence of health care from your employer.

CC, very nice description of why there have to be limits on healthcare. I'd frame it and put it on a wall. I still do disagree on the role of government. We do provide a basic level of food for the needy, Food stamps etc. I think we can also provide a basic level of care too. No one has a right to unlimited health care, but it'd be ridiculous to just turn away people with problems that are simple to fix if we're willing to feed them too. Many free clinics in the US DO exist to provide this, but they aren't well supported because they aren't government funded in most cases, but I think they do important work that would warrant government support.

The idea behind a health care program would be to provide an OPTION.. If it's as horrible as you say, no one will opt into it and the point will be moot... So why be so violently against it? Also, if you think our system is the best in the world then why is our health coverage tied to the employers? Some people have to make specific job choices because of health coverage, and that is a blatant inefficiency. If anything the shear complexity of health care should hint that reform is needed because I'm sure there's no one out there who could explain to me every single nook and cranny of the industry.

There are a lot of people that are addicted mentally or emotionally messed up, or have other 'needs'- that walk into hospitals everyday in the US and get care for free. There is good and bad in this. They have no insurance and still get care. The nurses deal with these people as best they can but many continue to take advantage of our 'free medical if you THINK you are dieing' policy. This drains the system of vital resources for actually sick people. What can either fix do for this waste of time and money? And if a person with a fatal disease is diagnosed, a lot of the time (I think - correct me if I am wrong) they can walk in a hospital and the staff is forced to care for them. At least for a while... This is fine . But the pseudo sick people are given the same care for a while till they are told they have to leave, and they can't have more oxycotton or morphine and they are OK. Anyway, with the Obama system I think more people would be allowed to do this regularly and continue receiving unneeded care, because the new system would take decisions away from the source, and wrap it in red tape, so Hospital Admins would basically be governmentally controlled. Taking decisions away from the source is usually very inefficient - especially for Government.

Because of the awesome lobbying job done by the big health insurance companies, my new health care business is going to be very successful. Check it out: http://www.businessweek.com/print/magazine/content/09_33/b4143034820260.htm

I think I'm going to call my company HealthSecond Inc.

Well I guess Ted Kennedy, a well known and very respected Democrat should have gone to Canada for treatment of his brain tumor.

But NO, he went to Duke. Why? The best medical care in the WORLD is in the U.S.. Lack of incentives and lack of competition leads to complacency and a degeneration in the quality of care.

And another fact.

A Republican amendment in one of the committees that stated members of congress would have to join the new "single payer" system being created was resounding defeated by that committee. I guess if it is not good for Congress, it is good for the American people.

Flawless logic there...

I honestly don't see how either of those facts are remotely relevant.

Relevance:

If the new single payer system is not good enough for our elected officials, why should it be good enough for us, the common people?

I had thought that point was quite obvious.

Elected officials are typically wealthier and able to afford a better standard of care. What is optimal for them hardly represents, what is best for the average person.

Do we make sure every bill Congress passes affects each of them personally?
No, because it'd be a waste of time.

I thought _that_ was obvious.

I don't think anyone is debating the fact that we have the best medical care in the world here in the US.

I think the problem is that we have insurance companies who charge lots of money, then fail to deliver a service, and then can continue failing to deliver a service and still be considered a business. These people are selling a false peace of mind, they aren't selling a service. For a health care business to continue being a business, they HAVE to sell a false peace of mind, if they were selling a service, they would go out of business. If a health care provider really provided a good solid health care to it's customers, it would go out of business in a week. Which is why the government would be ideal to run this system better, as they can afford to run it as a service.

The government is good at running crucial loss-leader type services. That doesn't mean that the people who perform the medical services can't compete for the government's money, oh no, it just means that it's not profitable to provide good health care coverage to a populace. What Ranger says is correct, we have the best health care in the world, just that it's currently paired with the most inequitable system of dispensing that care, practically, in the world.

Single payer system = rationing

Fine and good in theory, but wait till it's your relative that gets rationed out of heart surgery or cancer treatment.

And one of the reasons we have the best care in the world is the incentive to succeed. A single payer system removes that. Or do your want the pizza delivery guy making more than your surgeon?

if by rationing you mean that people needing the care do not get it, then that is going on under the current system as well. you also have people who get the care and then lose everything else they have to pay for it.

rationing has become the new fear-mongering tool used to sway public opinion much like terrorism and communism have been used in the past. it may end up working as fear often drives human decision. this particular political tool usually ends up hurting those wielding it though. once that fear is turned on it is very hard to ever shut it down.

Tell me how you currently get unrestricted/unlimited coverage. I'm curious.

Under my PPO plan, I have coverage.

Never been denied.

And have had numerous claims. Even a couple surgeries.

Nobody in my company has been denied coverage or been told their insurance has not been renewed.

I am not saying the current system has flaws. Ones that need to be fixed.

I am stating that going to a single payer system is 100% wrong.

If Obama's plan gets passed, there will be a government plan running beside private insurance. As we know, the government can afford to run a plan at a loss since they can just tax people/industry to supplement that income.

Private industry cannot. Therefore in such a scenario, the private industry cannot compete. Leaving, after a time, only the government plan.

Once that happens, incentive to do ones best is gone. And with that the brightest and best of the industry leaves.

Ever go to the DMV or post office? See the long lines with employees just sitting there chatting ignoring you? I have.

When incentive is gone, so does the quality.

Sure, everyone will be covered, however the quality will sink. Far far below how excellent the current care is now.

People want the best coverage in the world, they want it immediately, and they want the best results (IE the ability to sue if something goes wrong), but want only the "rich" to pay for it.

Well, we all have to make sacrifices. Instead of taking that trip to Disney World, or even buying a new TV, spend the money on insurance. Not crappy one, good one.

If you cannot go to dinner that week since your money is paying for healthcare, so be it. But if you want quality one has to pay for it.

"Private industry cannot. Therefore in such a scenario, the private industry cannot compete. Leaving, after a time, only the government plan."

if they continue as in the past, they can compete by charging premiums yet denying service. i feel that the government program will have major trouble simply because they will cover what they agree to up front.

you also leave no room for a "social security" type scenario. if people can live off of it, they get their monthly checks. i would hazard a guess though that most of us here have some type of supplemental retirement set up.

there is also room for the health insurance industry to compete on expanded or better service. this would force them to change without legislation and increasing the power of the federal government.

it doesn't have to mean doom and gloom.

Ranger, your position that quality care costs money seems to implicitly imply that people who cannot afford quality care should get crappy or no care. I'm pretty sure that you are talking about the system we currently have, I don't think it's doing a very good job and would welcome a change to it.

Your vision of the DMV is a popular talking point I've heard before, and I'm sure it sticks in peoples imaginations quite well, especially when it's trying to attach a negative connotation to something. The problem is, even if there was health care rationing, which all signs don't seem to point to anyways, most people would rather have to wait in line for something as important as health care then not get it at all. Your appeal to peoples prejudice against being inconvenienced is a nice one, but I'm hoping most people see through it. Waiting in line to get a stupid card that says I can drive a car is not even in the same universe of inconveniences as waiting in line to get a tumor removed, or are you saying that it is? Forget the fact that right now, all the time in the world waiting in a line won't get you basic health care.

Under whatever system they propose, I have no doubt that there will always be a system that accepts money for expedient high quality care though, so I wouldn't worry about it.

I see it everyday. People do nor want to wait for care. Not here.

Wrong Ranger, people will wait for important things.

Did you read that link I posted up there? http://health.yahoo.com/news/afp/healthpoliticsussociety_20090729160143.html

Some slept overnight in their cars in the grass parking lot in front of the Wise fairgrounds, where some 1,700 medical professionals had set up dental chairs, mammogram stations, panoramic X-ray machines and more, ready to diagnose maladies, numb mouths, pull teeth and take pap smears for Americans down on their luck and battered by economic realities.

Sorry for bringing this one back from the dead, but I thought this was a pretty interesting and educational slideshow for those who care to see it.

Healthcare Napkins

What's the point of that slide show Fex? To inform 12 year olds with a certain slant on the subject?

A little point: Ranger makes the point that student doctors/medical staff pay little or nothing for their training/education/qualifications in the UK. That actually isn't true anymore. Now when you study at university and upwards you take out loans to enable you to study which once you are working you pay back.

My wife doing a standard three year degree left university with debts totalling 40,000 pounds sterling - which equates to nearly 100k USD. Doctors, studying for five or six years can end up when qualified owing 200,000 pounds sterling, or nearer to 400k USD.

And yet we still have free medical care. Well not free, we pay for it from our wages in National Insurance payments: I pay over ﾣ100 pounds sterling a month and have done for years.

But if I broke my leg in 4 places I would be able to be cared for in hospital, with all the treatments and after care and physio without being asked for a penny. The bill for the same treatments in the US cost a friend of mine nearly 500k USD...