Broken Record

[RJM2096]

I apologize for sounding like or broken record or a one issue contributor, but last night Frontline on PBS did a hour show on medical care in five democracies. Watching this may shape your opinion. Here is a link that allows you to view the program.

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/?campaign=pbshomefeatures_2_frontlinebrsickaroundt heworld_2008-04-16

http://i259.photobucket.com/albums/hh310/RJM2096/HealthyMan.jpg

What amazes me is that we are such a powerful hard-working country, we spend over 16% of GDP on health care (which is more than double what other advanced countries spend), yet deny 25% of our population healthcare, have the highest infant mortality rates of these countries, and are generally unhappy with the system.

[jimfastcar]

At the risk of starting a tempest, and while we enjoy "free" healthcare in Canada, there are many structural issues that will need to be addressed by both our countries over the next couple of generations - Not just Healthcare, but add to the list:

Social inequity
Pollution
Competitiveness of the workforce
Resource usage
The cost to your economy to be the world's policeman

I could go on and on, but a lot of systemic issues that will some day need to be resolved in the face of the rise of BRIC (Brazil, Russia, India and China)

:lurk

[BeemerMike]

yet deny 25% of our population healthcare

This will probably quickly get political and be banned, but I would just note that we do not DENY HEALTHCARE to 25% of our population. The most recent figures I've seen are claims that 42 million people (or 14% of the total population) do not have HEALTH INSURANCE. I'm not saying there is no issue to address, but that is a big difference in how to frame the issue for discussion.

[Belquar]

My father-in-law's prescription for kytril (anti-emetic) used for chemo patients was 2k for 7 pills. Tell me there isn't something way wrong with that.

[lamble]

From a Brit's perspective, now living here, it does seem that the system is open to blatant profiteering. The abstraction of the real costs, via the intermediary insurance schemes, seems to enable this to thrive.

Our concerns are that even with medical insurance it's delusionary to believe that your medical expenses will be covered. Insurance is no insurance against fiscal dilemnas arising from illness.

Our feeling is, we'd have to move back to the UK, should either of us fall seriously ill, and use the National Health Service, which although much maligned, is still as good as the medical care available here.

[BeemerMike]

use the National Health Service, which although much maligned, is still as good as the medical care available here.

:confused: Really?! I wonder what the stats are on people throughout the world who travel to the UK for healthcare vs. those who travel to the U.S. for healthcare. Does anyone know?

[Mika]

:confused: Really?! I wonder what the stats are on people throughout the world who travel to the UK for healthcare vs. those that travel to the U.S. for healthcare. Does anyone know?

I think your missing his point. In terms of patient outcomes the systems are comprable. They would move back in his example because they could access it in a way he is suggesting he could not in the US.

No matter how you slice it or rationalize the system is very expensive, profit driven, rationed either through expense or time, and focused on crisis management not patient health.

[The_Veg]

I saw that show and it was very enlightening. I found it very interesting at the end when the host illustrated the ways in which our system was similar to some of the other ones presented, and the things we could learn from them to fix ours. All of the systems presented had some great ideas that if carefully applied could really help us.
I also found it interesting that most of the countries they showed are much more mature societies than USA. Hmmmmm...

As an aside, I have a good friend who gets all of her news exclusively from Fox and she is convinced that Britons are getting sicker and dying left and right because of the NHS making them wait for care.

[BeemerMike]

I think your missing his point. In terms of patient outcomes the systems are comprable. They would move back in his example because they could access it in a way he is suggesting he could not in the US.

No matter how you slice it or rationalize the system is very expensive, profit driven, rationed either through expense or time, and focused on crisis management not patient health.

Possibly, but if I'm missing his point, maybe it is because he did define what he means by "good". Does he mean access (including the ability to pay for it) or does he mean the quality of care once you get access? The distinction is important. A high quality system that I cannot afford probably does me no more "good" than a low quality system that I have easy and free access to . . . but the solutions to the two situations are very different.

I was assuming by "good" he meant the quality of the healthcare. I figured one indicator of that kind of "good" would be which system do people choose when they have essentially equal access to both.

[Mika]

My response was based on the pharse "medical care" being equally as good. Thus my focus on patient outcomes as the measure of acceptability, the rest of the post seems to imply the option would have to be exercised because expenses would be prohibative.

[darcym]

US Health care is profit driven by the insurance companies - and yes, they earn more money for denying care, so even if you have health insurance it doesn't mean you're going to get the care. At the risk of being labeled a left wing socialist, see Michael Moore's "Sicko". Sensationalist yes, but with nuggets of real world experiences that demand a long hard look at the way we handle health care here in the USA.

My ex worked as a mental health care facilitator for a major health care insurance company. His job was to talk to crazy people and decide if they needed care or if they had additional benefits ... over the phone ... he was supposed to make a decision on this ... he was not a psychiatrist.
:hide

[riderR1150GSAdv]

"Free" health care is a myth. Just watch all forms of taxes go up when this gets implemented here. Look at Europe. Want to pay $ 8 for gas?? We will too, when this 'utopia' gets pushed through. Do you really want to wait 3 years for an operation, or will you go to another country to get medical attention like some Canadian minister did a few months back...
My cousin in New Zealand had to wait for an operation and now is on meds for life, because it took too long to get the treatment he needed.. Wonderfull isn't it all that 'free' stuff the government provides??? It is free for a fee folks, dream on :snore

[BeemerMike]

My response was based on the pharse "medical care" being equally as good. Thus my focus on patient outcomes as the measure of acceptability, the rest of the post seems to imply the option would have to be exercised because expenses would be prohibative.

I don't mean to be argumentative, but what he said was the [U.K.] National Health Service was as good as the "medical care available here" [in the U.S.]. I read "available" as meaning the quality of the actual medical care (i.e., doctors, nurses, hospitals, etc.) that is available in the U.S. if you can pay for it compared the medical care provided by the NHS. Maybe he can clarify what he meant . . . i.e., the actual medical care itself or the combination of the actual medical care itself and the ability of the population to use it by being able to pay for it (via insurance, government-supplied, personal funds, or a combination) . . . so we don't talk across each other. We need to be clear if we are talking about the actual medical care by itself or if we are talking about the overall health care system (including how people access it and pay for it).

[BreadMan]

Let's stay un-political....

Thanks,
BM

[Bill Burke]

Let's stay un-political....

Thanks,
BM
You can't with a topic like this. It's a philosophical dilemma. Is healthcare a right or a privilege? If we live in a society that concludes it's wrong to have untreated sick humans stumbling around, healthcare is a right. If we live in a society that believes in "the survival of the fittest" healthcare is a privilege. As the woman on the way to her breast augmentation appointment drove her Cadillac Escalade past the tubercular bag lady, she remembered that her dinner engagement at the Ritz would conflict with her appointment at the psychiatrist's office. That's politics.

[BubbaZanetti]

As an aside, I have a good friend who gets all of her news exclusively from Fox and she is convinced that Britons are getting sicker and dying left and right because of the NHS making them wait for care.

believe it or not, i was able to have a doctor come to my apartment to take a look at me a few weeks after living in scotland (apparently, i was not resistant to whatever strain of flu northern irish girls carry:laugh ) within a few hours. got a prescription and paid a few bucks. as someone who currently does not have health insurance, that level of protection is comforting, even if its not always as efficient as our "pay" system. what really depresses me is the idea that i could get in an accident with my bike, break an arm and be out thousands and thousands of dollars which will nag me for years. you can't go on living in a bubble just because insurance costs are so high (i do get on the new job's insurance next month, thank god).

[kreinke]

What amazes me is that we are such a powerful hard-working country, we spend over 16% of GDP on health care (which is more than double what other advanced countries spend), yet deny 25% of our population healthcare, have the highest infant mortality rates of these countries, and are generally unhappy with the system.

I was instructed to edit the sentence that previously occupied this space out because a moderator was offended because I quoted a politician about sometning he said last week but can't be repeated because he didn't mean what he said. I on the other hand, meant what I said and stand by my original post but am deleting it so I don't get banned from this [most of the time] fine forum.


There's nothing denying these weiners health care. They can go get a job (pronounced yob) that provides health care.

I don't have a problem providing nationalized healthcare but if the government controls it there won't be any cost controls (who polices the government....no one).

:deal
OK I'll bite on the whole nationalized health care thing providing recipients have to pass a drug screen like I, and most people, had to pass to get a decent job and health insurance. That will eliminate some of the useless miscreants.

Smokers need not apply unless they want a larger co-pay.

[BeemerMike]

Let's stay un-political....

Hard to do with this subject . . . but we can at least be civil. Thanks for the reminder. :thumb

[RJM2096]

I am interested in this topic for several reasons:

My Aunt was laid off from her job at about age 45. While she was unemployed she found she had cancer. She had to wait until she finally found work to have the tumer removed and take chemotherapy. By that time it had clearly mastasized and she died a 2-years later a horrible dealth.

OK what I normally hear is why did not she buy COBRA. The premiums for COBRA were more than she being unemployed could afford (COBRA is way more than regular policy premiums???). Maybe she should have got the surgery and treatments and then made payments to the doctors. I can't answer that without being in her shoes.

I also have a friend that cannot retire until he is 65 (medicare) and prays he does not get laid off. He has had prostrate cancer and cannot obtain any health insurance now beyond what is provided beyond his job.

I have another friend that is self employed and 52. He buys single insurance at about $350.00 a month with a $5000.00 deductible. He just messed up his back and had to pay the $5000.00 while the insurance company paid out about $800.00. I understand a policy to cover him with $250.00 deductible is about a $800.00 per month.

So you know how I am personnally affected, I am semi-retired (57) and have a goverment pension and complete health care coverage at little cost. That is what I think everyone should have the opportunity to enjoy. I might add that any change in medical care laws might reduce my benefits or increase costs.

I think everyone should ask themselves, "Do I want to retire at age 60 (or younger) or am I going to have to work full time to keep my insurance (if I can find/keep that kind of job) until I can get Medicare at age 65 1/2. :wave

[Mika]

I'm one of these gun totin' small town people who supposedly cling to religion that B. Hussein Obama railed about last week.


There's nothing denying these weiners health care. They can go get a job (pronounced yob) that provides health care.

I don't have a problem providing nationalized healthcare but if the government controls it there won't be any cost controls (who polices the government....no one).

:deal
OK I'll bite on the whole nationalized health care thing providing recipients have to pass a drug screen like I, and most people, had to pass to get a decent job and health insurance. That will eliminate some of the useless miscreants.

Smokers need not apply unless they want a larger co-pay.


I can fit your description also and come to some different conclusions.

Are you implying that people are lying around and doing nothing and that is why they don’t have health care coverage? What about people who have lost their jobs and their healthcare to foreign competition for example. They may not be able to readily find another job with health care in their current market and are unable to relocate for a variety or reasons even if they are willing.

As a sometimes small business owner, why is it a company’s responsibility to provide health care?

My view is shaded by reading the preamble to the constitution and what it says about why we formed ourselves into a nation and society. We can legitimately debate how health care is delivered (publicly funded, private pay in some form or a hybrid) and the goals of health care (preventative v remedial), but right now I do not believe the public or private sector are meeting the needs of the nation.

[535is]

There's nothing denying these weiners health care. They can go get a job (pronounced yob) that provides health care.

OK I'll bite on the whole nationalized health care thing providing recipients have to pass a drug screen like I, and most people, had to pass to get a decent job and health insurance. That will eliminate some of the useless miscreants.

As one of those "useless miscreants" (a sole practitioner of bankruptcy law), I have to say that it is clear to see that you have never borne the burden of the entire cost of your family's healthcare insurance - as I do. I would therefore respectfully suggest you have no idea what you're talking about.

[OfficerImpersonator]

Wow - we can have a political discussion without politics and thus without risking banishment - way to go forum!

One thing about the debate that's always stuck out for me has been the cries by American corporations that inflation in the cost of providing health care to their employees has risen so dramatically over the last 20 years (and way out of proportion to overall inflation) that they are slowly being bled dry by the expense.

For example, General Motors argues that they must add $4,000 to the price of each vehicle simply to recoup the costs of providing health insurance to employees and pensioners.

If the burden of providing health care was switched to the federal government from employers, GM could theoretically charge $4,000 less for each vehicle, instantly making them more competitive with foreign competitors.

I realize many individual tax payers are reluctant to take on the burden of paying for everyone else's health insurance premiums, but you pay for everyone else's health insurance premiums anyways as it is when you buy goods and services from companies that provide health insurance to their employees.

It is my opinion that streamlining the process by replacing myriad for-profit insurance companies with one non-profit organization will save money in the long run.

It is my opinion that the savings realized through the elimination of profit and the redundancies inherent in multiple companies providing identical services can be used to pay for coverage for the uninsured.

It is my opinion that access to quality health care in a fully developed country is a right and should not treated as a privilege only available to those lucky enough to get coverage through their employer.

[BeemerMike]

So you know how I am personnally affected, I am semi-retired (57) and have a goverment pension and complete health care coverage at little cost. That is what I think everyone should have the opportunity to enjoy. I might add that any change in medical care laws might reduce my benefits or increase costs.

Hmmmm . . . I wonder who pays for your "government . . . complete health coverage at little cost"? Oh, yeah . . . that would be ME, and all the other non-government-employed taxpayers out there!

You're welcome.

And when the "government" takes over and starts providing (or paying for) everyone's healthcare, as many advocate . . . and since the government surely won't be like the evil profit-motive insurance companies, the government will never deny anyone any health care or claim . . . how much will all that cost and who will pay for it? The "rich people"? ;)

I think everyone should ask themselves, "Do I want to retire at age 60 (or younger) or am I going to have to work full time to keep my insurance (if I can find/keep that kind of job) until I can get Medicare at age 65 1/2.

Excuse me, but is it your contention that everyone now has a "right" to retire at 60 (or younger), and let the younger people who ARE still working pay for the retirees' healthcare and pension? Just curious.

[Mika]

Hmmmm . . . I wonder who pays for your "government . . . complete health coverage at little cost"? Oh, yeah . . . that would be ME, and all the other non-government-employed taxpayers out there!

...


Keep it civil, we all pay for the insurance program you sight, even governmental employees as part of their taxes, as a benefit we offer to the employees of our government as part of the incentive to work in government.

If you have problems with how we do it attack the issue not the person.

[BeemerMike]

Keep it civil, we all pay for the insurance program you sight, even governmental employees as part of their taxes, as a benefit we offer to the employees of our government as part of the incentive to work in government.

If you have problems with how we do it attack the issue not the person.

Excuse me, but I am keeping it civil. I am not calling anyone names or using abusive language (a little sarcastic, maybe, but not abusive). I am not attacking the person, and I am addressing the issue. I am addressing his assertion that he has government health insurance "at little cost". My employer also provides me health insurance as an incentive for me to work for them, and my employer's part of the total cost (much larger than my part) is passed on to everyone who buys their products, as does every other employer who provides health insurance for their employees.

The difference is that I understand that my health care insurance is not provided "at little cost", even though my part of the total cost may be relatively small. It is provided "at big cost". And that is the fundamental fact that people gloss over when they dream of the uptopia of the central government providing (or paying for) everone's health care.

What will government-run health care cost, and how and who will pay for it, IS the issue.

[Mika]

Agreed the cost of health care and how those cost are shouldered is one of the major issues in this discussion. Access and level of access to what forms of health care are other key issues that I believe need to be addressed in addition to cost.

I do not believe that government run health care is the only answer on the table, nor should it be.

I also do not assume that people do or do not have a concept that health care costs more than what ever portion they pay in a employer provided system. That is a point to clarify in any discussion. Sarcasm is a great tool in many forms of communication. I have found it does not work well on the forum. If I miss understood your words please forgive me. If I have given offense I apologize.

[r11rs94]

Want affordable insurance, then get the goverment out of the medical business. The state of Mass just made it mandatory for everone to purchase medical insurance. So far complience is not to good. Its to expensive due to too many goverment mandates. Let the free market take care of this and you will see the prices fall. IMHO

[RJM2096]

Hmmmm . . . I wonder who pays for your "government . . . complete health coverage at little cost"? Oh, yeah . . . that would be ME, and all the other non-government-employed taxpayers out there!

You're welcome.

And when the "government" takes over and starts providing (or paying for) everyone's healthcare, as many advocate . . . and since the government surely won't be like the evil profit-motive insurance companies, the government will never deny anyone any health care or claim . . . how much will all that cost and who will pay for it? The "rich people"? ;)

Excuse me, but is it your contention that everyone now has a "right" to retire at 60 (or younger), and let the younger people who ARE still working pay for the retirees' healthcare and pension? Just curious.

Other well developed contries spend less than 10% and have full access for everyone (including Guests/Tourists). The USA spends 16% and has less have full access.

I agree that most governmental programs leave much to be desired, but would you scrap the post office? After all one could make a case that remote areas(high governmental cost) don't deserve mail deliveries because they chose to live in remote areas. Surely Fede-Ex or UPS can deliver the mail and charge these people a more reasonable fee for delivery.

No. I don't see that everyone has the right to retire early, but anyone who is older than 40 or has chonic health issues such as asthma, diabetes, cancer, back- pain, hyper-tension, arthritis, etc is at serious risk of finding insurance unattainable. If you are 50+ and laid off, the free market will abandon you.

I am a little superstitious. I do not want to cancel my life insurace policy, even thought I really do not need it anymore, because I think I would die immediately. I also do not want to say I want it left to private insurers to decide whether I live or die. It would be my luck to then get seriously sick and loose everything I had saved up for.

[BeemerMike]

I also do not assume that people do or do not have a concept that health care costs more than what ever portion they pay in a employer provided system.

I don't assume it, but when somebody asserts that their government health care is provided "at little cost", I assume they mean what they say, because I have found that there are far too many people out there who honestly believe that government-run health care would just fall from the government health care tree, and all we would have to do is just pick it up off the ground. ;)

Sarcasm is a great tool in many forms of communication. I have found it does not work well on the forum. If I miss understood your words please forgive me. If I have given offense I apologize.

You are right about sarcasm on this forum. I'll try to be more careful.

No offense taken . . . no apology needed. :thumb

[OfficerImpersonator]

I don't assume it, but when somebody asserts that their government health care is provided "at little cost", I assume they mean what they say, because I have found that there are far too many people out there who honestly believe that government-run health care would just fall from the government health care tree, and all we would have to do is just pick it up off the ground. ;)

Mike,

You are already paying for everyone else's health care whether you realize it or not.

If you fly on an airplane, the price of the ticket includes health care for the pilot, the flight attendants, the chef who made the meal, the guy who made the tiny bottle of gin, the people who built the airplane - the list is almost infinite.

Those costs are indeed hidden, but that doesn't mean you're not paying them.

At least with a government run plan, all those costs are out there in the open for everyone to see. At least with a government run plan, you can get the airline or aircraft manufacturer out of the health insurance business, which saves money for the airline and aircraft manufacturing industries.

Earlier posters have pointed out that we pay 16% of our GDP towards health care and there are 40,000,000 Americans without health insurance. Many other developed democracies (most of Europe and north east Asia) pay less than 10% of their GDP towards health care, and yet provide coverage for everyone.

Heard a story on NPR the other day about the health care system in Taiwan. Every resident is issued a smart card with their insurance identification and health history embedded in the card. When you get sick, you show up at a doctor's office and your medical records are contained within your card so no need to fill out health history forms every time you switch doctors. Apparently Taiwanese culture frowns against "gate-keepers", so you can pick any specialist you want to see without having to get a referral first. If you want to see an orthopedic surgeon about your aching shoulder, you can go see an orthopedic surgeon that same day.

The United States should not delude itself with the notion that our health care system is not worth reforming. With the amount we spend per capita on health care in the U.S., we could provide top-notch care to everyone without having to spend more. In fact, the evidence is out there that we can provide top-notch care to everyone and end up spending less than we do now on a per capita basis.

[Mika]

I don't assume it, but when somebody asserts that their government health care is provided "at little cost", I assume they mean what they say, because I have found that there are far too many people out there who honestly believe that government-run health care would just fall from the government health care tree, and all we would have to do is just pick it up off the ground. ;)


As an attorney and engineer you seem to parse words with great precision. That is necessary in these discussions because as you pointed out it is easy to make the wrong assumption about the true cost of health care as opposed to out of pocket expense for one’s share of the expense in the form of deductions or in co-pays for example. In this setting we both need to clarify and confirm our underlying assumptions before drawing sweeping conclusions about what is being said.

OfficeImpersonator makes an excellent point in that we pay for many peoples health insurance through expenses built into prices to cover employees or by providers to cover their expenses in providing care to the un-insured and the like. These could be described as the hidden costs of our healthcare system we all shoulder.

My take on the opening post was to point out two related issues. First the disparity between what we, as a country, pay for our health care and patient outcomes, as compared to other countries and their expenses v their patient outcomes. Secondly to point out problems with the outcomes we are receiving for what is paid.

[BeemerMike]

Mike,

You are already paying for everyone else's health care whether you realize it or not.

If you fly on an airplane, the price of the ticket includes health care for the pilot, the flight attendants, the chef who made the meal, the guy who made the tiny bottle of gin, the people who built the airplane - the list is almost infinite.

Those costs are indeed hidden, but that doesn't mean you're not paying them.

If you read my earlier posts, you will see that I specifically DO recognize that.

At least with a government run plan, all those costs are out there in the open for everyone to see. At least with a government run plan, you can get the airline or aircraft manufacturer out of the health insurance business, which saves money for the airline and aircraft manufacturing industries.

The fundamental problem with a government-run plan is it is subject to decisions based on politics instead of economics. The airline and aircraft manufacturer will pay for the healthcare that the government provides and/or pays for, just in a different way. People just assume that the amount will be less than they are paying now, but we all know that government entitlement programs (which is what this would be) inevitably grow and grow over time, with ever higher costs.

Earlier posters have pointed out that we pay 16% of our GDP towards health care and there are 40,000,000 Americans without health insurance. Many other developed democracies (most of Europe and north east Asia) pay less than 10% of their GDP towards health care, and yet provide coverage for everyone.

Heard a story on NPR the other day about the health care system in Taiwan. Every resident is issued a smart card with their insurance identification and health history embedded in the card. When you get sick, you show up at a doctor's office and your medical records are contained within your card so no need to fill out health history forms every time you switch doctors. Apparently Taiwanese culture frowns against "gate-keepers", so you can pick any specialist you want to see without having to get a referral first. If you want to see an orthopedic surgeon about your aching shoulder, you can go see an orthopedic surgeon that same day.

But no one has yet discussed WHAT people get for their 10% of GDP compared to what we get for our 16%. And I hope you are not implying that in Taiwan there are no "gatekeepers" at all, and that people have unlimited access to any healthcare services they want. There have to be limiters in the system somewhere.

The United States should not delude itself with the notion that our health care system is not worth reforming. With the amount we spend per capita on health care in the U.S., we could provide top-notch care to everyone without having to spend more. In fact, the evidence is out there that we can provide top-notch care to everyone and end up spending less than we do now on a per capita basis.

No one has said (certainly not me) that the U.S. cannot improve its health care system. The issue is HOW do we improve it.

[BeemerMike]

As an attorney and engineer you seem to parse words with great precision.

Cute, but incorrect. I do not parse words with great precision for the purpose of coming up with meanings and interpretations that were not what the author intended (a la Bill Clinton in the 1990's sense). I try to read things complete, and in context, to determine the author's real intent, if the intent is not otherwise clear.

When RJM says he has government complete health care coverage "at little cost", without explaining what he means, it seems to me there are two possible meanings:

1. His government health care coverage provides his health care at a low overall total cost, considering both what part he pays and the remainder that others pay (via premiums and taxes).

or

2. His government health care coverage provides his health care at a low cost to him personally, because it lets others pay for most of his actual health care costs.

Since #2 seems a little self-centered and cynical (i.e., give me a system that results in other people paying for my health care), and #1 seems to have a little more compassion and concern for your fellow man, and also addresses what should be the core question of what is the overall economic costs to society to provide for health care, I picked #1. If he really meant #2, then I made a bad assumption. Maybe he can clarify which he meant, or if he had another meaning.

That is necessary in these discussions because as you pointed out it is easy to make the wrong assumption about the true cost of health care as opposed to out of pocket expense for one’s share of the expense in the form of deductions or in co-pays for example. In this setting we both need to clarify and confirm our underlying assumptions before drawing sweeping conclusions about what is being said.

Agreed. Which is why I picked #1.

OfficeImpersonator makes an excellent point in that we pay for many peoples health insurance through expenses built into prices to cover employees or by providers to cover their expenses in providing care to the un-insured and the like. These could be described as the hidden costs of our healthcare system we all shoulder.

Agreed. But, whether the costs are "hidden" or are "transparent", and whether they are paid by the government, a private insurance company, or directly by the patient, the costs are the costs . . . and are paid by someone. And the total cost (i.e., 16% of GDP) is essentially the result of what services are provided and consumed (again, either paid for by the patient or paid for by the "insurer") and what is charged for those services.

My take on the opening post was to point out two related issues. First the disparity between what we, as a country, pay for our health care and patient outcomes, as compared to other countries and their expenses v their patient outcomes. Secondly to point out problems with the outcomes we are receiving for what is paid.

And this raises one of the key problems in the discussion of health care. Terms such as "equivalent outcomes" are not self-defining, and I suspect mean different things to different people, so it is a little difficult to understand what the "disparity" really is. How is "patient outcomes" being determined to be able to compare one country to another? Average life expectancy for the entire population? Overall infant mortality? Average cancer survivial rate and time after detection? And, of course, how much more (or less) is society willing to pay for a better (or worse) patient outcome?

Another key problem is that I know for a fact that many people think that a health care system run by the federal government (i.e., a single payor system) will provide them with essentially whatever health care they want or feel they need, at little or no extra cost to them other than the taxes they pay (taxes they think will likely be paid mostly by the "rich" people, and not them). And people do not really judge the health care system by overall "patient outcomes" statistics. They judge it by what health care services and treatment they and their family receive personally. A lot of people believe that when the federal government takes over health care, if they get a cut, a cold, or cancer, they will be able walk into a clinic and get whatever medical science has to offer to try to cure them without anyone saying "no".

Of course, I, and I suspect also you, know that is not what would happen. We need to be honest with people. If someone believes that a particular reform would lower the cost of health care, or make it more available, or make it easier to pay for, then they need to explain why they think that would happen. Otherwise, they are just making bald assertions that are not very helpful in progressing the discussion.

And before you ask, I don't know what the specific reforms should be, because I don't know enough about how health care is delivered and where the costs are in the health care system to be able to judge where savings and increased efficiencies are possible. Anecdotally, I have read that in the U.S. we spend a large portion of our total health care costs on "end of life" treatment, maybe more so than other countries, so maybe that is one place to evaluate options. However, what I do know (or believe) is that in general letting free market competition have a role in something directionally results in increased efficiency, better service, and lower costs, so eliminating free market competition completely from the system seems to be the wrong answer. The government certainly has a role (for example, to avoid some of the inequities that have been discussed), but having the government completely run the health care system (either directly or via single payor) does not seem to be the right answer.

[Mika]

Was not trying to be cute, just making an observation on what I have read in your posts, how you conduct your end of the discussion and the perspective I take from your profile. No value judgment, just observation.

I don’t think we are that far apart in how we approach the issues; the conclusions may take a bit of work. And that work will have to be saved for another day. I have an early call in the AM.

[kreinke]

OK so let's talk about equivalent outcomes.

There will never be such a thing...nor should there

We first need to look at it constitutionally.
Everything we need to know is right there in black and white, so to speak.



"We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the
United States of America."

Note that is says promote welfare....not provide. (at the time the constitution was written welfare referred to health and presperity).

Health care is a commodity. A "goods and service." We have no problem paying for insurance for our cars in case of a fender bender. People with more money can afford better insurance. Why do we have such a problem paying for insurance for ourselves?

What's more, should the government be in the business of providing collision insurance for everyone's car from a '77 Gremlin to my Jeep Commander?

The pursuit of happiness.......
Our society needs tiers to make it the great. If there are no tiers, if everyone is given everything right off the bat, then there's no incentives for people to try to better themselves.

Everyone is created equal with equal opportunity. Opportunity is just that. You have the opportunity so succeed in this country. Seize it. It won't be handed to you. But if you achieve success, money, good health, happiness, it will be sweeter if you climbed the ladder and earned it.

To just provide these things to people who have not earned it by taking from people who have, is condescending and patronizing to the former and demeans and insults the hard work of the later.

[Mika]

...To just provide these things to people who have not earned it by taking from people who have, is condescending and patronizing to the former and demeans and insults the hard work of the later.

I could find accommodation for all your points up to the end. Then you loose me. You are making what I believe to be an erroneous judgment based on a gross stereotype and thus are the one insulting and demeaning in the process.

There are public and preventative health care issues that need to be addressed for the safety and protection of all people. Many diseases don’t recognize your work and wealth equals health equation. I can live with many forms of a tiered access system but to ignore basic universal public health and preventative care is folly.

[Rod Sheridan]

Perhaps being Canadian, I have a different perspective on government provided healthcare.

I have always felt the healthcare should be provided by the government, paid for by taxes.

In my opinion, the measure of a civilization, is how those who cannot care for themselves, are cared for.

Universal healthcare, un-employment insurance, workers compensation, police, fire departments, these are a few of the benefits that society provides to citizens, through their taxes.

All of us hope not to use the above services, however having them available to all equally, is simply civilised.

None of us would like to be asked for our Visa card when we need the services of the fire department.

None of the above services are free, it costs a lot of money to provide the complicated, highly technical services that we expect in this age.

The issue always is to provide these services with the greatest efficiencies to reduce costs, and all services whether private or publicly funded need to constantly address this issue.

My belief is that these services are part of a civilization, and that taxes based upon income are a fair method of financing them.

regards, Rod.

[DarrylRi]

Health care is a commodity. A "goods and service." We have no problem paying for insurance for our cars in case of a fender bender. People with more money can afford better insurance. Why do we have such a problem paying for insurance for ourselves?

What's more, should the government be in the business of providing collision insurance for everyone's car from a '77 Gremlin to my Jeep Commander?
Although the government may not need to provide insurance for everyone's car, the government does require everyone to obtain minimal insurance for their car -- somehow. In California at least, the state requires insurers who sell in the state to also provide a special category of insurance for those that cannot obtain it otherwise (called "assigned risk").

This is what Massachussetts is trying to do for health care.

[BeemerMike]

I have always felt the healthcare should be provided by the government, paid for by taxes.

Certainly a valid political/philosophical position, but of course one that is open to honest disagreement about the proper role of government. Can you let us know your feelings about HOW MUCH and WHAT TYPES of healthcare the government should provide, since that affects the total costs and amount of taxes needed to support it?

[kreinke]

I could find accommodation for all your points up to the end. Then you loose me. You are making what I believe to be an erroneous judgment based on a gross stereotype and thus are the one insulting and demeaning in the process.

There are public and preventative health care issues that need to be addressed for the safety and protection of all people. Many diseases don’t recognize your work and wealth equals health equation. I can live with many forms of a tiered access system but to ignore basic universal public health and preventative care is folly.

Apologies. What I meant was that just giving people things without them earning it to patronize them smacks of "Let them eat cake".

The fact that I worked full time at a greasy supper club kitchen to buy text books and get a technical degree to get a decent job and make good money, then to have it taken away and given to someone who didn't go through effort decreases the value of what I earned. That's why it's insulting to me.

The fact of the matter is that I have to work well in to May for the leviathan known as the government. That really steams me.

Why doesn't it make anyone else mad?

O.K. I am selfish.

I'd like to have more money. I'd probably buy a new boat. Maybe even a shiny new BMW.

What's more I might even spend the money on tuition and more textbooks so I can start a new career and make even more money and......wait for it....better myself.

In the end, I work at a company but I work for me and mine. I just don't see why I have to work for everyone else too.

[OfficerImpersonator]

The fundamental problem with a government-run plan is it is subject to decisions based on politics instead of economics. The airline and aircraft manufacturer will pay for the healthcare that the government provides and/or pays for, just in a different way. People just assume that the amount will be less than they are paying now, but we all know that government entitlement programs (which is what this would be) inevitably grow and grow over time, with ever higher costs.

You mean like an annual health care costs inflation rate of around 25%, which is what we have with the status quo?

But no one has yet discussed WHAT people get for their 10% of GDP compared to what we get for our 16%. And I hope you are not implying that in Taiwan there are no "gatekeepers" at all, and that people have unlimited access to any healthcare services they want. There have to be limiters in the system somewhere.

Thanks for reminding me of an important component of Taiwan's system. The plan's central computer keeps track of how many times you see the doctor. If you see the doctor 15 times a month, a case worker comes to visit you to see what's going on. Similarly, if doctors see the same patient too frequently, or prescribe questionable amounts of certain prescriptions, an administrator will investigate to see if anything unethical or illegal is taking place.

No one has said (certainly not me) that the U.S. cannot improve its health care system. The issue is HOW do we improve it.

Agreed. We should seriously look at what other developed nations have done. To casually dismiss the experiences of other nations out of hand because it's "socialized medicine" or given some similarly loaded but perhaps not quite accurate label doesn't give the subject matter the respect it deserves.

[Mika]

It took me six years to receive my four year degree. When they handed it to me I owned it as a result of working my way through at a wonderful variety of jobs. On that level I can understand where you are coming from.

As to the government leviathan and how long we have to work to feed it each year, there are many reasons. The ones that come to mind in relationship to this topic, and give us our largest increase in life expectancy are public works and health projects such as water treatment, sewage systems, sanitation, mosquito controls and things like this. Dollar for dollar the biggest bang for the buck.

Government may or may not be the best provider for all forms of healthcare. In these examples government may make sense as the provider of these services to all.

[Rod Sheridan]

Certainly a valid political/philosophical position, but of course one that is open to honest disagreement about the proper role of government. Can you let us know your feelings about HOW MUCH and WHAT TYPES of healthcare the government should provide, since that affects the total costs and amount of taxes needed to support it?

Hi Mike, I hope I was clear that it was my opinion, and certainly not the only opinion.

We have universal healthcare, so if I go to my family doctor, the visit is paid for by the health plan. The same is true if I need surgery, or emergency medical treatment at a hospital.

I'm by no means an expert on our medical system, so I couldn't answer specific questions.

My feelings on the matter are that expenses for necessary care, operations, emergency services, doctor visits etc should be paid for by the state. I'm not advocating that discretionary items such as elective surgery be paid for.

It's a great conversation topic, we're always talking about it in Canada.

Regards, Rod.

[BeemerMike]

Hi Mike, I hope I was clear that it was my opinion, and certainly not the only opinion.

We have universal healthcare, so if I go to my family doctor, the visit is paid for by the health plan. The same is true if I need surgery, or emergency medical treatment at a hospital.

I'm by no means an expert on our medical system, so I couldn't answer specific questions.

My feelings on the matter are that expenses for necessary care, operations, emergency services, doctor visits etc should be paid for by the state. I'm not advocating that discretionary items such as elective surgery be paid for.

It's a great conversation topic, we're always talking about it in Canada.

Regards, Rod.

You were perfectly clear that it is your opinion, and that it is not the only possible opinion. Unfortunately, not everyone is so clear or accomodating of other opinions. ;)

I have a Canadian friend just down the street. We have this "discussion" all the time. :whistle

[BeemerMike]

You mean like an annual health care costs inflation rate of around 25%, which is what we have with the status quo?

First, annual health care costs are NOT increasing at 25% per year, although they are increasing much faster than the overall rate of inflation. But, how do you think the federal government running the health care system would change that? That's the question that no one answers.

Thanks for reminding me of an important component of Taiwan's system. The plan's central computer keeps track of how many times you see the doctor. If you see the doctor 15 times a month, a case worker comes to visit you to see what's going on. Similarly, if doctors see the same patient too frequently, or prescribe questionable amounts of certain prescriptions, an administrator will investigate to see if anything unethical or illegal is taking place.

I did not know that about Taiwan. And yet, the same people (in general) who advocate the federal government running a national universal health care system, scream to high heaven about a federal/national drivers license as equivalent to "Nazi papers". "Why is that, Captain Ron?" ;)

Do you really think people in the U.S. would accept the concept of the "government" knowing every little detail about their medical history and having it in some central government database, and more so, having government workers come to their house to question them if their medical history falls outside of the government "norm"? Don't you think somebody MIGHT raise a privacy objection to that?

Agreed. We should seriously look at what other developed nations have done. To casually dismiss the experiences of other nations out of hand because it's "socialized medicine" or given some similarly loaded but perhaps not quite accurate label doesn't give the subject matter the respect it deserves.

Well, I personally have never said we should casually dismiss anything. I've only said that we should carefully look at other systems IN THEIR ENTIRETY before we just jump to the conclusion that they are "better".