Questions for Americans: Socialised Health Care


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David Marks wrote:
Well, I had a lot written out here, but the short of it is: the housing market and the health care market are two different things, with their values measured differently for several reasons. Basically, your comparison doesn't hold.

Sorry for the confusion, it wasn't a comparison. It was a response to the claim "I'm not sure I've ever seen a median or mode reported for any real world purposes." I was pointing out a place where it is used in a real world purpose. Again, sorry for the confusion.

David Marks wrote:
I do get that extremely high numbers can inflate an average, just as extremely low numbers can deflate it. Are you trying to say you think that is going on here?

I think the US allows greater access to much more expensive procedures then some of the other countries. This will of course in flat the average cost.

David Marks wrote:
See, this is the thing pres. The regulations you say might solve most problems? Yeah, those are totally in the bill that everyone is protesting! I've posted them at least once, maybe twice in this thread.

Except without the mandatory health insurance for everyone, forcing companies to take on additional risk is a pretty bad idea. Like I said, the mandatory insurance for adults is something Obama can't publicly support without seeming as either a flip-flopper or a liar. In either case, he'll lose whatever political capital he has remaining.


pres man wrote:


Sorry for the confusion, it wasn't a comparison. It was a response to the claim "I'm not sure I've ever seen a median or mode reported for any real world purposes." I was pointing out a place where it is used in a real world purpose. Again, sorry for the confusion.

Ah, ok then. Yes, good point, housing prices hadn't occurred to me as such an instance.

pres man wrote:


I think the US allows greater access to much more expensive procedures then some of the other countries. This will of course in flat the average cost.

Perhaps, perhaps not. If we do though, why don't we see better results than countries that supposedly do not? I'd say part of this goes into why some kind of comparative effectiveness study is a good thing, and something that will hopefully be set up.

Secondly, do you think the inflation from expensive procedures theoretically unavailable in other countries makes up for the population of people who don't have any access to health care and thus deflate the average by spending $0 on it? Recall that the other countries we're talking about do not have any citizens not covered, so no one spends $0 on health care a year ...

pres man wrote:


Except without the mandatory health insurance for everyone, forcing companies to take on additional risk is a pretty bad idea. Like I said, the mandatory insurance for adults is something Obama can't publicly support without seeming as either a flip-flopper or a liar. In either case, he'll lose whatever political capital he has remaining.

The bills under review now require mandatory health insurance. As for whether or not Obama has called for it, I'm not sure, but he's largely not the one writing the bills in Congress either. I'm confused as to what you're trying to say here.


David Marks wrote:
... however, I'm not sure why you're so anti-government here Patrick. Non-governmental bureaucracies can also be largely inefficient and bloated. Do you know how the hospital and your insurance currently handles payments? A single-payer or socialized system could seriously streamline that entire process and largely reduce all of that inefficiency.

Well, philosophically, I am against big government. I am not sure why you are so pro-government. I could give you many reasons why I have reached this philosophical conclusion that government doesn't run things as well as the private sector, just as sure as you can give me many reasons why you have come to the opposite conclusion. Government has its uses, I just don't see it doing a very good job with the social safety net we have now, and I am reluctant to allow them into healthcare. As always YOMV.

You are right about one thing, non-governmental bureaucracies can be just as inefficient, but it is mostly large companies that suffer from this, like the electric, cable and yes, the insurance industry. I can't switch electric providers, ergo, when I deal with them I usually end up frustrated. Switching cable companies is impossible as well, but at least I could go to DSL or FIOS if sufficently provoked. Insurance I can't switch, healthwise at least, so yes they can be a pain as well. I can't switch governments, unless I want to go live in Canada, ergo I expect the same level of bureaucratic booyah. However, at least in private sector bureaucracies they don't just expand their staff whenever they feel like it and damn the cost. And although it's money out of my pocket, paying for my health insurance doesn't add to my kids' debt. I feel better about that than getting subsidized health care.

As for whether others will fight the coop plan, of course they will. There are forces arrayed against the Obama administration who are looking to gridlock the process. Sad, but a normal facet of politics in America. As to whether it will work or not, we are all acting from suppositions, and I am just looking for a model that has somewhat of a track record in the US market. I'd prefer a more competitive market, because that would weed out bloat and hopefully bring down costs without government subsidies. It would also allow more choice in the health marketplace.

We can keep quoting info at each other, but I guess we are just going to have to agree to disagree on this one. It's pretty much going to be a done deal anyway, the Democrats have the votes and the muscle to push it through, it's just a matter of time.


Let me be perfectly clear. I am for universal healthcare, but not unfunded (debt creating) healthcare system that right now is all the Dems are putting forth.

None of the current bills really have in them a manner to pay for what they promise to deliever.

But IF they want to be honest about it and actually create a tax specifically to pay for it, I would accept that if it was fully paid for. Like they tried and failed to do wth Social Security they create a tax for it, make the money have to go toward paying for it, and require that the bills all be paid each year. If they did that I am game, otherwise now with all the current debt, no. Sorry when you can't pay your bills it is not a time to create more debt. But I would be willing to pay more taxes for this.


Aubrey the Malformed wrote:
David Fryer wrote:

The argument is that, for example, culturally Asian people have a healthier diet, mainly because red meat was not avaliable in many regions until the 1800's. So is their longer life expectancy and lower incident of some times of diseases due to the fact that they have a universal health care system or is it due to some other factor, such as diet. Comerica we have a diet that is high in fat, cholesteral, and fast food. So any plan that does not address these factors is not likely going to have a substantive positive effect on life expectancy and disease rates, because it is not address the underlying issue involved.

It not so much a matter of American culture or genetics being inferior, it is more a mtter of there being a whole lot more of us. Consider that the United States has the third largest population in the world. The Unitd Kingdom, which is the most often cited as having a good Universal coverage plan has the 22 largest population and is only roughly equal to 17% of the U.S. population. Canada which is the other most commonly cited system ranks #33 and is roughly equal to 11% of the U.S. population. Even Switzerland, which has the best system in the world according to most sources I have read, is about equal to 3% of the U.S. population.

So basically my point is that something that works on a small scale does not always work when scaled up. If it did, we would be running our governmentusing the Athenian Democracy model that works so well in the Rural American Northeast. I believe that we need to find a distinctly American solution, because I am not convined that the ame plan that wrks well for 33 million people, or 61 million people, will work as well for 308 million people. I have found that if something is advertised as one size fits all, it usually doesn't.

I really can't agree with this. The UK isn't some tiny state, there are 60 million people living there, and (I think) in the top ten of the biggest economies in the world. The NHS is a big organisation -...

While I don't like speaking against the NHS, there are a few complications with the idea of an american NHS.

Firstly, the creation or purchase of infrastructure would mean that the formation of an AHS would require a massive initial outlay of funds. If i had to take a wild guess, somewhere in the region of two or three large defense procurement deals. Change over would require a period in which the system was run as a single payer system.

Secondly, while david's claim that the UK's size itself influences the lower per capita cost is hard to justify without evidence or argument as to why this should be, it could be argued that relative population density would be a factor. It is certainly possible that the UK's vast population density means that fewer hospitals can treat more people, however canida, with its lower population density does throw this argument into question.

Dark Archive

Zombieneighbours wrote:

Secondly, while david's claim that the UK's size itself influences the lower per capita cost is hard to justify without evidence or argument as to why this should be, it could be argued that relative population density would be a factor. It is certainly possible that the UK's vast population density means that fewer hospitals can treat more people, however canida, with its lower population density does throw this argument into question.

Well, although the numbers don't show it, the places where Canadians live are densely populated. While Canada has the 2nd largest land mass for a country in the world, most of it is very sparsely inhabited. In fact, acording to Canadan census data, 95% of the population lives within 100 miles of the United States border. (Ah, the useless knowledge you pick up as a geography teacher.) So, while the nation of Canada has a low population density, that population is very dense where people actually do live. For example, Toronto and it's suburbs are home to roughly 1 out of every 4 people in Canada, again according to Canadian census data.

Scarab Sages

Pathfinder Maps, Pathfinder Accessories, Pawns Subscriber; Pathfinder Roleplaying Game Superscriber; Starfinder Superscriber

I know my own problems with the plans is they are looking at the "sucess" of the Mass state healthcare. Yes it's awesome health insureance... but the state is lossing money hand over fist from it. If they make the nation wide one like that, how much more in debt are we going to go??

I'm not against getting health insurance coverage for everyone, I'm against being stupid about planning it. I work for a major health insurance company... the numbers just don't line up...


How does evolution work again?

Only the rich survive?

I like it.


Patrick Curtin wrote:
Well, philosophically, I am against big government. I am not sure why you are so pro-government. I could give you many reasons why I have reached this philosophical conclusion that government doesn't run things as well as the private sector, just as sure as you can give me many reasons why you have come to the opposite conclusion. Government has its uses, I just don't see it doing a very good job with the social safety net we have now, and I am reluctant to allow them into healthcare. As always YOMV.

Would you consider a Swiss style system? The government sets up basic regulations and then lets the market operate under them?


Twings wrote:
Would you consider a Swiss style system? The government sets up basic regulations and then lets the market operate under them?

I would be open to any plan that doesn't create a self-perpetuating array of well-payed sinecures that politicians can disburse to their cronys as payment for favors done. Government regulation is a much easier pill to swallow, one reason I had advocated co-ops.


Abbigail the Glass wrote:
I know my own problems with the plans is they are looking at the "sucess" of the Mass state healthcare. Yes it's awesome health insureance... but the state is lossing money hand over fist from it. If they make the nation wide one like that, how much more in debt are we going to go??

Well, Mass just upped their sales tax 25%, I'm sure that we will either come up with a federal sales tax or perhaps move to the European VAT model.

Massachusetts is still in big trouble despite the added sales tax, but shows no sign of cutting spending, since it is a one party system there really is no way to stop it. The system here is so skewed that the legislature is now pondering reversing the law they pushed through when Kerry was running for president to deny then-Governor Romney the right to appoint his successor (or at least an interim) in favor of a special election law. That was advocated by Ted Kennedy, and now irony of ironies, the new law now interferes with his succession so now he is advocating repealing the special election law and replacing the appointment law, now that a staunch Democrat, Deval Patrick, is governor. >STORY<


Patrick Curtin wrote:
Twings wrote:
Would you consider a Swiss style system? The government sets up basic regulations and then lets the market operate under them?
I would be open to any plan that doesn't create a self-perpetuating array of well-payed sinecures that politicians can disburse to their cronys as payment for favors done.

I've always found the implications of that argument interesting. Since there will be waste (and there will be in any social system), we can have none of it. We can not enable a small amount of inequality (i.e., sinqcures) in order to mitigate much larger inequalities (tens of millions of uninsured). Indeed, never mind the efficiency of some existing government programs (the Forest Service, Postal Service, and Medicare all come to mind).

Patrick Curtin wrote:
Government regulation is a much easier pill to swallow, one reason I had advocated co-ops.

Co-ops, as I understand them, would be toothless and unable to control costs. There's a reason the insurance industry supports them: they won't force them to change.

But I'm glad you would consider something like the Swiss system. In my time in Europe I've learned a lot about the various systems, and it has always struck me as being the most compatible with American prejudices. The industry would never accept it willing of course, which is why public option seemed like a decent alternative, giving them one last chance to prove their worth to the American public. But I do wish it would be talked about more in the public discussion, as it provides another model beyond the false boogyman of "socialized medicine."


Twings wrote:
I've always found the implications of that argument interesting. Since there will be waste (and there will be in any social system), we can have none of it. We can not enable a small amount of inequality (i.e., sinqcures) in order to mitigate much larger inequalities (tens of millions of uninsured). Indeed, never mind the efficiency of some existing government programs (the Forest Service, Postal Service, and Medicare all come to mind).

I'm not sure if those are good examples to point to. The postal service is always running out of money, currently they are talking about closing some postal offices around the country. Medicare is going broke, and even the Prez has admitted that when it does pay, it does pay its fair share, with private insurance getting charged extra from hospitals to make up the difference. The Forest Service has its own financial problems as well.

Twings wrote:
Co-ops, as I understand them, would be toothless and unable to control costs. There's a reason the insurance industry supports them: they won't force them to change.

Co-ops would have as much teeth has large companies. That is because the larger your pool, there more risk an insurance company is willing to take (easier to spread the cost out). That is why individuals buying insurance always get shafted.

Dark Archive

Twings wrote:
Patrick Curtin wrote:
Twings wrote:
Would you consider a Swiss style system? The government sets up basic regulations and then lets the market operate under them?
I would be open to any plan that doesn't create a self-perpetuating array of well-payed sinecures that politicians can disburse to their cronys as payment for favors done.
I've always found the implications of that argument interesting. Since there will be waste (and there will be in any social system), we can have none of it. We can not enable a small amount of inequality (i.e., sinqcures) in order to mitigate much larger inequalities (tens of millions of uninsured). Indeed, never mind the efficiency of some existing government programs (the Forest Service, Postal Service, and Medicare all come to mind).

Never mind of course that, as was mentioned earlier in the thread, that 60% of those who are currently uninsured are already eligable for coverage under existing government insurance programs, and that, according to the President, another 6% would not be covered because of the immigration status. Of those that are left, many of those are uninsured by choice because they believe they have better things to spend ther money on. Also ignore the fact that for all the stated efficency of Medicare, it is millions, if not billions, of dollars in debt right now.

Twings wrote:
Patrick Curtin wrote:
Government regulation is a much easier pill to swallow, one reason I had advocated co-ops.

Co-ops, as I understand them, would be toothless and unable to control costs. There's a reason the insurance industry supports them: they won't force them to change.

But I'm glad you would consider something like the Swiss system. In my time in Europe I've learned a lot about the various systems, and it has always struck me as being the most compatible with American prejudices. The industry would never accept it willing of course, which is why public option seemed like a decent alternative, giving them one last chance to prove their worth to the American public. But I do wish it would be talked about more in the public discussion, as it provides another model beyond the false boogyman of "socialized medicine."

There is also a reason that major industry in the United States favors the public option.

Dark Archive

Here are the statistics I mentioned in my previous post.

Joe Sixpack wrote:

Just one thing to keep in mind. I have seen the number 50 million uninsured being bandied about occasionally. It helps to keep thing in perspective to look at two bits of information. First 50 million means that roughly one out of every seven people you meet each day is statistically uninsured. The second is a study that was commisioned by the Department of Health and Human Services in January and released in May regarding just who is actually uninsured.

According to the study 66% of the uninsured in America Make 200% or less of the federal poverty level. These people are already entitled to health insurance from the government through Medicade and SCHIP but do not for one reason or another access these programs. The federal poverty level is a very fluid number and is dependent on the numbe of people in your family. For example, the average family of four would have to make $44,100 a year not to qualify for one of those programs. My boss who has 14 people in his family would have to make $118,900 in a year not to qualify. The actual numbers can be found here.

15% of the uninsured are what is called temporarally uninsured. These are people who had insurance within the last six monthes and expect to be covered again within the next six monthes. These are typically people who are moving from one job to another.

12% are what is called voluntarily uninsured. These are people who can afford to purchase their own healthcare and choose not too. They also make more than that magic 200% of the federal poverty limit. These people are typically young, between 18-28, and single. Most of them simply feel that they have better things to spend their money on, like PFRPG. ;)

6% of the uninsured are illegal immigrants and would not be covered under any of the current plans. 1% are uninsured for other reasons, such as pre-existing conditions. I hope that looking at these numbers helps to put some of the debate into perspective.


If god wanted everyone to have insurance, he would provide them money to pay for it.

Since, they are poor we can infer these people are not supposed to have insurance.

Enough said.

Similarly, this is why you are not wealthy. You're not worthy.


Nasty Pajamas wrote:

If god wanted everyone to have insurance, he would provide them money to pay for it.

Since, they are poor we can infer these people are not supposed to have insurance.

Enough said.

Poor people already have access to free healthcare, it is called Medicare. As was mentioned above.

As I mentioned before, I've known people who were not rich. Who had serious illnesses, and did not get dropped from their insurance.

Though you are right about the "Enough said" part, I think you've said quite enough.

Dark Archive

Nasty Pajamas wrote:

If god wanted everyone to have insurance, he would provide them money to pay for it.

Since, they are poor we can infer these people are not supposed to have insurance.

Enough said.

Similarly, this is why you are not wealthy. You're not worthy.

I choose to believe that you are making a sarcastic, uninformed, and untrue characature of conservatives. I also choose to believe that this is not the way you really feel. Isn't choice wonderful?


np wrote:
Similarly, this is why you are not wealthy. You're not worthy.

Take for example -Lindsay Lohan- . Now, she is worthy which is why she has a lot of money, and health insurance.

So is -Gene Simmons- . He is rich, and has good health insurance.

The question is, why don't these hypothetically uninsured people have any money? I'm sure we know why.


Pathfinder Adventure Path, Rulebook Subscriber

I'm an Orthopedic Surgeon. The Idea of universal healthcare has tremendous unintended consequences. Many physicians would quit healthcare completely. There are a lot of 50+ year old docs that are sick of government telling them how to treat their patients. Another unintended consequence is that 2/3 of this thing is financed with Medicare cuts. God willing, all of us will be on medicare in the future and you don't want to be part of the algorithm that shuts care to you down. Make no mistake, you can't cut $500 billion out of medicare without making tough decisions (and your doc won't be making that decision BTW). Not to mention that medical companies make profits to subsidize the risk for thier Research and Development. Without the profit motive advancements in medical care would cease.
Real Reform is:

Number 1: Health Savings Accounts (HSA’s) that are tax free, rolled over year to year, 100% portable, and gain interest using safe investments. Your employer invests money into an HSA, tax free, and you, in-turn, purchase your own policy, tax free. (I've done the math this works REALLY well)

Number 2: Open up insurance companies to compete across state lines. This, again, gives the people the choice, the power, and stimulates competition.

Number 3: Allow physicians to deduct a percentage of the Medicare reimbursement when they provide care to those that are uninsured. This would be a very good incentive for physicians to care for the uninsured.

Number 4: Pass National Tort reform. While malpractice premiums only account for a small amount of medical costs, the practice of defensive medicine may be the biggest reason while health costs increase at such a steep rate.

Number 5: Tax credits for those who do not qualify for Medicaid, and do not have access to an HSA through their employer. Those credits are used to buy individual insurance plans

Number 6: Sanction a private company to provide a secure “MySpace” type internet site that personalizes every American’s health record. When you get an x-ray, EKG, or blood test, it gets uploaded and helps eliminate the waste in medicine, and prevents need to do the test again because the surgeon or facility is unable to retrieve one done by your primary care physician just days ago.

Number 7: Maintain competition in the health industry. Any health entity that lacks competition stands to increase the cost of healthcare. This includes pharmaceutical companies, medical device companies, and even hospitals.

I live it everyday. COMPETITION IS THE KEY TO DRIVE DOWN COSTS. Insurance companies would have to compete like never before if individuals, not employers, bought healthcare. Think Geico or statefarm for health insurance. Universal Healthcare is very unpopular among physicians. You will see a mass exodus from medicine from the older docs and most of the younger docs (myself included) will get out when our $250k loans are paid off.


David Fryer wrote:
Zombieneighbours wrote:

Secondly, while david's claim that the UK's size itself influences the lower per capita cost is hard to justify without evidence or argument as to why this should be, it could be argued that relative population density would be a factor. It is certainly possible that the UK's vast population density means that fewer hospitals can treat more people, however canida, with its lower population density does throw this argument into question.

Well, although the numbers don't show it, the places where Canadians live are densely populated. While Canada has the 2nd largest land mass for a country in the world, most of it is very sparsely inhabited. In fact, acording to Canadan census data, 95% of the population lives within 100 miles of the United States border. (Ah, the useless knowledge you pick up as a geography teacher.) So, while the nation of Canada has a low population density, that population is very dense where people actually do live. For example, Toronto and it's suburbs are home to roughly 1 out of every 4 people in Canada, again according to Canadian census data.

I have a little less then 1 in 6 in Toronto, 5 million people in the metro Toronto area (that is the urban expanse around Toronto - City of Toronto proper is 2 1/2 million but such arbitrary lines are useless for our purposes). I could see about 1 in 4 living on the Niagara Peninsula since that would include moderate sized cities like Hamilton and Windsor.

Not sure the 95% within 100 miles stat - the one I'd always heard was 80% within 200 miles. Still keep in mind that its a long border so we are not that super concentrated. In any case I'm not sure how any of this helps us keep costs down. It just means we have to maintain a fleet of helicopters so that we can fly patients from the northern wilderness down to the populated cities where the facilities to treat them actually exist.


In case this hasn't already been posted, here's a simple, informative comparison of several national healthcare systems...right here.


pres man wrote:
I'm not sure if those are good examples to point to. The postal service is always running out of money, currently they are talking about closing some postal offices around the country. Medicare is going broke, and even the Prez has admitted that when it does pay, it does pay its fair share, with private insurance getting charged extra from hospitals to make up the difference. The Forest Service has its own financial problems as well.

Running low on money and running an efficient service are two different things. The postal service has it's hands largely tied behind it's back when it comes to things like rate hikes - and that's one of the things that makes it so efficient. Same is true with the forest service. During the Bush administration the total money allocated to the forest service was cut roughly by half. Yet they have found ways to cut corners and delay repairs such that they can keep the a service running for the public. Medicare has far lower overhead than any for-profit insurance company. I think they all make excellent examples.

The fact they are underfunded in the long run is a separate mater. That is a mater of public decision making, not a reflection on their ability to do a lot with little.

pres man wrote:
Co-ops would have as much teeth has large companies. That is because the larger your pool, there more risk an insurance company is willing to take (easier to spread the cost out). That is why individuals buying insurance always get shafted.

We certainly agree there. But co-ops in the form I've read about would be limited to single states, and therefore unable to leverage across larger pools of risk. In larger states like California this could be okay. But much of the mid-west, and smaller easter states may not offer large enough markets for the co-cops to stay afloat. Doing something at the federal level avoids this problem.


Supes wrote:
I'm an Orthopedic Surgeon. The Idea of universal healthcare has tremendous unintended consequences. Many physicians would quit healthcare completely.

Lets just stop right there, because you are either knowingly being dishonest, or are just misinformed as to your colleagues opinions:

* The Annals of Internal Medicine did a study in both 2002 and 2007 across 2,000+ physicians from diverse fields. Participants were randomly chosen from the American Medical Association Masterfile. 59% supported national health insurance, 9% where neutral, and 32% opposed it. Of that 32%, about half supported incremental reforms similar to what is on the table now instead of complete reform immediately. That's a grand total of ~78% of doctors who support some sort of reform.

It's also worth mentioning that support went up across every category of physician from 2002 to 2007, by as much as 20% in those 5 years. Curiously, surgical specialists were one of three categories that were below 50% in support. (paper here)

* The New Hampshire Medical Society also did a study along with the University of New Hampshire that found 66% supported single-payer, and 81% were for universal coverage, including 94% of general practitioners.(results)

I can quote more such studies if you want. They all show pretty much the same thing in recent years: around 2/3rds of physicians support single payer, and more support universal coverage. For example, the Minnesota Medicine Magazine had results of 64% and 86% on those two quesitons. (results. No doubt there are doctors against reform, but they make up no more than 20% across the field. Saying 50% of physicians will flee is little more than fear mongering. Many of the 20% would doubtlessly stay doctors.


Twings wrote:
Supes wrote:
I'm an Orthopedic Surgeon. The Idea of universal healthcare has tremendous unintended consequences. Many physicians would quit healthcare completely.
Lets just stop right there, because you are either knowingly being dishonest, or are just misinformed as to your colleagues opinions:

So you get to decide what someone means by the word "many"?


Supes is right. Many doctors will stop practicing, though not 50%. Let's say only half of the 20% who are opposed to Universal Medicine stopped, that is around 8,000 doctors. Most would be specialists, that would be crippling for many hospitals. Now add 47 million more patients? Disaster. Well over 75% of the doctors I have asked, (around a dozen) DO NOT support the plan proposed. All of this may be moot anyway, because if a national health plan is passed, and FOCA passes, the US could lose over 600 hospitals. So LOTS of doctors and nurses would be out of work.

On a side note, I find it very refreshing to find out that all of Canada and most of Europe is just as fat, lazy and stupid as us Americans. It's so refreshing to have everyone defend our poor lifestyle. I guess it all depends on the figurehead bolted to the front of the ship.

Contributor

bugleyman wrote:
Nicolas Logue wrote:

Only speaking from personal experience as a guy from America, living in England - Socialized Health Care is awesome. America needs to get its act together and stop gouging the sick. Just my two cents from having health care experiences in both countries as well as talking to doctors in both countries (I come from a family of doctors).

Nick

Amen, brother.

P.S. Thanks for the Diet Coke this morning. :)

Word!

Liberty's Edge

More gratuitous fear-mongering for y'all.


someone wrote:
I saw this on TV so it must be true!

Good = Capitalism = America

Making more money is gooder.. er, better.

Your boss makes more money than you, because he/she is better than you.
If this were not the case, you would make more money.

Now, get back to work before you lose your job, and your health insurance.


David Fryer wrote:
Isn't choice wonderful?

Oh, I think I know what you are trying to say. It took me a while to understand you.

Are you saying you won't get to choose your doctor?

Case 1: (the hippie's song)
- Is this not unlike saying you do not get to choose the police man they send to assist you? Any qualified one will do nicely.
- Even now, all we have to go on are educational credentials, like Dr., PhD., etc.
- "NO! I want the same police man my dad uses."

.

If, however, you are trying to say there is more to it than that, i.e. like if a particular doctor has a history of healing people (he is a good doctor), then by American Capitalism he should be able to charge a higher price for his skill, and profit from it. And, since I can afford a better doctor, than the cheap loser the poor people have to go to, the American constitution grants me this right to select this doctor while others are excluded from this choice! Well then, welcome to my world!

Poor people deserve their lot in life. If it were not so, god would give them more money.


I'd relay my health care experiences and perceptions as a guy from Kansas, but I also believe you shouldn't listen to anyone who claims to speak for other people, unless they're all in the same room together. I do have family who qualify for benefits, but refuse to them due to a combination of ignorance, distrust of the government, and pride.

I can tell you that COBRA is a freaking joke, based on personal experience.

Also, I find it laughable that politicians on both sides of the aisle try their damnedest to prevent Medicare from enacting competitive bidding practices, yet still claim to champion the free market.

Personally, I think all Americans should be given the option to enroll in Medicare Part B and a limited part D that only covers generic meds.

This would do very little for those who get very ill, or need hospital care, but it would provide insurance for basic tests, doctor visits and some preventative care for all Americans, as well as access to some kinds of inexpensive medication. I also think Medicare should be allowed to competitively bid for these services.

People should still be allowed to get insurance through the workplace or private insurers to make up the coverage gaps (similar to how TRICARE works for military retirees.)


b j wrote:


On a side note, I find it very refreshing to find out that all of Canada and most of Europe is just as fat, lazy and stupid as us Americans. It's so refreshing to have everyone defend our poor lifestyle. I guess it all depends on the figurehead bolted to the front of the ship.

My years living in Western Europe and Midwest America lead me to disagree with statement. Perhaps you should visit Kansas City and Paris in the same week sometime?

Wait never mind, you're from Parsons, that explains everything.


David Fryer wrote:
Zombieneighbours wrote:

Secondly, while david's claim that the UK's size itself influences the lower per capita cost is hard to justify without evidence or argument as to why this should be, it could be argued that relative population density would be a factor. It is certainly possible that the UK's vast population density means that fewer hospitals can treat more people, however canida, with its lower population density does throw this argument into question.

Well, although the numbers don't show it, the places where Canadians live are densely populated. While Canada has the 2nd largest land mass for a country in the world, most of it is very sparsely inhabited. In fact, acording to Canadan census data, 95% of the population lives within 100 miles of the United States border. (Ah, the useless knowledge you pick up as a geography teacher.) So, while the nation of Canada has a low population density, that population is very dense where people actually do live. For example, Toronto and it's suburbs are home to roughly 1 out of every 4 people in Canada, again according to Canadian census data.

Okay, well that is fine, their is a potential problem there, but to be honest, any form of healthcare provision will have its costs raised by this.

An AHS would have to deal with the challange, but it the relative difference in coverage and running cost that the NHS model provides might well goble up the difference with ease. It would take some fairly serious research to know for certain.


Nasty Pajamas wrote:


How does evolution work again?

Only the rich survive?

I like it.

Your assuming the Phenotypic characteristic of wealth is also genotypic and there for heritable. Your crediting genetics with just a touch to much, and the ethics of the statement lean towards eugentics.

In otherwords, this is what one might referer to as EPIC BIOLOGY FAIL.

PS. if i have just been taken in by an example of Poe's Law, i am sorry.


pres man wrote:
Twings wrote:
Supes wrote:
I'm an Orthopedic Surgeon. The Idea of universal healthcare has tremendous unintended consequences. Many physicians would quit healthcare completely.
Lets just stop right there, because you are either knowingly being dishonest, or are just misinformed as to your colleagues opinions:
So you get to decide what someone means by the word "many"?

When they say "mass exodus"," and use adjectives that indicate majority several times, yes. Did you look at the surveys?

B.J.: Please post some links to support your 600 hospital claim. Sounds totally unrealistic.


In the UK, we, quite literally, have people queueing up to work as Doctors in the NHS - to the point that they are turning away highly skilled and qualified internationally-trained doctors. A friend of mine is a doctor specialising emergency Medicine - he currently practices in Australia, but really wants to come to the UK to practice here, but can't

So, if you DO get lots of doctors leaving the practice of medicine, I'm sure it won't be hard to replace them!


Loztastic wrote:

In the UK, we, quite literally, have people queueing up to work as Doctors in the NHS - to the point that they are turning away highly skilled and qualified internationally-trained doctors. A friend of mine is a doctor specialising emergency Medicine - he currently practices in Australia, but really wants to come to the UK to practice here, but can't

So, if you DO get lots of doctors leaving the practice of medicine, I'm sure it won't be hard to replace them!

Are we talking about specialists or general practitioners?

Though, it may be a point. In a system where everyone is a government employee and given the evidence that it is hard to fire government employees in general and the government would be responsible for things like malpractice suits. I definitely could see the advantage for some doctors. Not just crappy doctors mind you, but also good doctors that like strong job security.


[quote-pres man]Are we talking about specialists or general practitioners?[both]

Generally both - a common thread amongst the doctors i've spoken to is that they like being able to treat anyone, and not turn people away. other than waiting lists and a small number of hidiously expensive treatments or drugs, they are generally free to treat in the best intrests of the patient. so, take an orthopedic surgion. granny appleface needs a hip replacement. he can see her - she may need to wait for this - and if she needs, say, a hip replacement, he can just put her on the waiting list, and then, when she gets to the top, do the operation. he doesn't need to say "there is an operation that can fix you, but because you are poor, you have to live in pain"

the NHS works on a kind of trust-based system, this is only a brief explanation, but this is how it works

the NHS commissions services on a local level - so, it funds, say "Preston and Chorley trust" to provide health-care in central lancashire. the trust has a contract to provide health-care to a required standard, assessed against a list of criteria, to everyone in that area

some of that will be done directly - so, the trust runs two hospitals. some will be done on a paying doctors to run their own clinics (so, my GP is paid X ammont per year to run his family clinic, he is paid an ammount based on his number of patients, and it's up to him to spend that money as he sees fit, again to a minimum standard), and some is sub-contracted out to private providers

so, in essence, almost noone is employed by the NHS directly - either by trusts, or by private companies, or by small clinics run by an individual doctor or group of doctors.

we have VERY few malpractice suits in the UK - both through our legal system having is "public interest" clause, smaller payouts, good-will towards the NHS

Dental care is where it falls down at the moment - we have a shortage of dentists (make jokes about british teeth) - I see a private dentist, and have private dental insurance (about £17 a month, so that's, what, about $25?) which covers everything other than implants (should i ever need them). now, my dentist does do NHS work, but only to a limited range of clients or emergencies. I decided, when he went private, i'd rather pay for insurance and keep seeing him, rather than find a new dentist, which can be a slog in itself, given the shortage!


This is a basically what is going on with the Catholic hospitals. Right now they are protected from providing abortions, and can still get money from Medicare and Medicaid. Foca, could repeal all of those protections. A national insurance option would mean a larger portion of insurance money would now be "federal money" and tied to government regulations. One fear is that any hospital that receives Fed money would have to provide abortions or abortion counseling. The bishops have stated that they would shut down all of their hospitals before that would happen. This article hits most of the points, but all you need to do is search Catholic hospital in the news and you will get plenty of info.

F33b wrote:

My years living in Western Europe and Midwest America lead me to disagree with statement. Perhaps you should visit Kansas City and Paris in the same week sometime?

Wait never mind, you're from Parsons, that explains everything.

Really? Parsons and Paris ARE exactly alike? Or KC and Paris are full of fat and lazy people, but Parsons isn't? Since I was sarcastically pointing out that most people on the boards were completely discounting our (America's) lifestyle as a reason why our costs were higher and outcomes were lower when compared to Europe and Canada for health care, I can only conclude that your disagreement with my sarcastic comment means that KC/Lenexa and Paris are full of fat and lazy people, but strangely Parsons isn't. Wow, who would have guessed?


New deficit projections pose risks to Obama's agenda

...
The White House budget office and the Congressional Budget Office (CBO), a non-partisan arm of Congress, release updated economic forecasts and deficit estimates on Tuesday, providing further fiscal fodder to opponents of Obama's nearly $1 trillion healthcare overhaul plan.
...
The CBO had previously forecast that deficits between 2010 and 2019 would total $9.1 trillion, generating heat for the White House, which stuck to its original $7.1 trillion forecast earlier this year. The new number will bring White House projections into line with the CBO, the official said.
...


I dont consider the VA as a model to hold up as "exceedlingly" exceptional; to me it is mearly adequate. The problem that I have seen is not so much in the care; but the excessive time that you spend at VA. Really, now I only know about 3 people who go there fairly regularly; but as they need drivers; to take them I or someone else has to take nearly the entire day off; a good 6 hours or so; granted it takes 25 minutes to drive there; but, I find the amount of time spent there is exceedingly long. To me that is a great organizational problem that should be managed and executed differently.

Also, the general American populous could really use some enhancement to their general medical knowledge other than some bogus health class that you get in middle school which is really all about birth control, std's and a bit on dental stuff; least that was what mine was. I know about 15 nurses and about 3 doctors; which granted isnt much; but I have been listening to them for years, as well as a few administrators and it seems their position is that since people have health care; they come in for any slight little thing; slivers; headache; an hour worth of symptoms of sniffles thus completely abusing the care that is available.

So riddle me this: If we give free or very inexpensive health care that we few of the working population have to fund, how are we ever going to actually use the care provided if the system gets even more swamped by even more people who go in for advanced care who dont need it?

I am thinking that here where I work; our healthcare provides a nurseline that I call quite a bit when I have an issue; and when they tell me to go to a doctor; I do; otherwise; I just take their advice and do what they tell me; is a great help and is very handy; I love the 24hr nurseline; I have called it many times for many different things; their great. Also, the poison control center is awesome also that the government runs and both are a huge time and money saver.

I think a lot of healthcare issues would go away if we just gave ourselves more education and how to determine when to go to a doctor and when some other care should suffice.

without this; I have no confidence that any healthcare system will work as planned.


We have NHS Direct, which is a bit like your Nurseline

a few years ago, I caught my finger in a door, which was VERY painfull. we called NHS Direct, and the nurse asked a few questions. she then talked my partner through some checks to see if there was an obvious break, which there wasn't. she then talked him through putting a bandage on it to protect it, which he did, and gave us a list of symptoms, with us urder orders to see a doctor if any of them surfaced

oh, and she asked if I had the three most common symptoms of Meningitis (which they ALWAYS do)


b j wrote:

Really? Parsons and Paris ARE exactly alike? Or KC and Paris are full of fat and lazy people, but Parsons isn't? Since I was sarcastically pointing out that most people on the boards were completely discounting our (America's) lifestyle as a reason why our costs were higher and outcomes were lower when compared to Europe and Canada for health care, I can only conclude that your disagreement with my sarcastic comment means that KC/Lenexa and Paris are full of fat and lazy people, but strangely Parsons isn't. Wow, who would have guessed?

There is nothing to in your previous post to indicate your were being sarcastic. Rather it reads quite the opposite, that you are attacking the EU, without warrant, for having a populace as equally slovenly as the US.

Perhaps you should invest in some [sarcasm] tags next time to clue us in?


b j wrote:

This is a basically what is going on with the Catholic hospitals. Right now they are protected from providing abortions, and can still get money from Medicare and Medicaid. Foca, could repeal all of those protections. A national insurance option would mean a larger portion of insurance money would now be "federal money" and tied to government regulations. One fear is that any hospital that receives Fed money would have to provide abortions or abortion counseling. The bishops have stated that they would shut down all of their hospitals before that would happen. This article hits most of the points, but all you need to do is search Catholic hospital in the news and you will get plenty of info.

F33b wrote:

My years living in Western Europe and Midwest America lead me to disagree with statement. Perhaps you should visit Kansas City and Paris in the same week sometime?

Wait never mind, you're from Parsons, that explains everything.

Really? Parsons and Paris ARE exactly alike? Or KC and Paris are full of fat and lazy people, but Parsons isn't? Since I was sarcastically pointing out that most people on the boards were completely discounting our (America's) lifestyle as a reason why our costs were higher and outcomes were lower when compared to Europe and Canada for health care, I can only conclude that your disagreement with my sarcastic comment means that KC/Lenexa and Paris are full of fat and lazy people, but strangely Parsons isn't. Wow, who would have guessed?

Government money in the US really shouldn't be going to religious organisiations of any kind. sep of church and state and all that good stuff.


Sarcasm tags should NEVER be used. Period.

As to separation of church and state, we have a private health system now, with the exception of Medicare and Medicaid there is no state involvement. Almost every major city has at least one church owned MAJOR hospital. Over 600 hospitals in the US are owned by the Catholic church. About 1 in five people treated get treatment at a catholic owned facility each year. If the Gov. can replace them, fine go for it. Whether or not churches should own and run hospitals is completely moot at this point, because they do. We have to take that into consideration when reforming health care. Due to federal laws regarding emergency medicine, these hospitals would have to shut down their OB/GYN departments AND their ER's, or they could be required to provide abortions. The Bishops have said they would simply ignore the laws, and push a constitutional show down, or just lock the doors. Either way the losers are the patients.


b j wrote:

Sarcasm tags should NEVER be used. Period.

As to separation of church and state, we have a private health system now, with the exception of Medicare and Medicaid there is no state involvement. Almost every major city has at least one church owned MAJOR hospital. Over 600 hospitals in the US are owned by the Catholic church. About 1 in five people treated get treatment at a catholic owned facility each year. If the Gov. can replace them, fine go for it. Whether or not churches should own and run hospitals is completely moot at this point, because they do. We have to take that into consideration when reforming health care. Due to federal laws regarding emergency medicine, these hospitals would have to shut down their OB/GYN departments AND their ER's, or they could be required to provide abortions. The Bishops have said they would simply ignore the laws, and push a constitutional show down, or just lock the doors. Either way the losers are the patients.

Lets set some matters straight. First, the bill that the Church is concerned about is *not* the health care reform bill. It's S. 1173 and H.R. 1964, the so-called Freedom of Choice Act, which never made it out of committee and died in both in the Senate and House last year. It has not been reintroduced this legislative session, and there is no comparable language I am aware of in the current health care drafts. This means the various Conscious Clause acts that States have passed will continue to stand for the foreseeable future (horribe IMHO, but that's not the point here). Liberals in congress have been trying to pass the act for over a decade without success.

So, what you have posted here is pure propaganda, with no relation to the health care reform bill. If you truly are a doctor, please inform yourself about the legislation dealing with your field before spreading misinformation. The whole idea should have seemed suspicious in the first place: do you really believe the Catholic Church would have shutdown 600 hospitals, giving themselves a huge black eye, causing the deaths of thousands? If watching Italian politics and the reaction of the church there to medical regulation means anything, the answer is clearly no. They do some showboating, and then quietly get on with helping people after the politics are done.

By the way, over 50% of humans have a difficult time spotting sarcasm in fact-to-face conversations, much less online. Sarcasm tags can be useful...


Twings wrote:
I've always found the implications of that argument interesting. Since there will be waste (and there will be in any social system), we can have none of it. We can not enable a small amount of inequality (i.e., sinqcures) in order to mitigate much larger inequalities (tens of millions of uninsured). Indeed, never mind the efficiency of some existing government programs (the Forest Service, Postal Service, and Medicare all come to mind).

I guess it all boils down to the 'small' amount of waste and inequality. I have always found the implications of founding massive social programs with no secured funding an interesting take on things. Once again, I think this is a philisophical difference. I don't think that government delivers the services we are asking of it in a cost-concious well-organized manner. You seem to think it does. We disagree EOS.

Just as a clarification: I am arguing against my own self-interest on this one. I am making very little money, and a signifigant percentage of my pay goes towards health care insurance. If this passes as the Dems want, I win. Yippee. My children lose, but I'm sure they'll get used to the inevitable massive tax increases 'down the line', given time. Or perhaps they'll just go on the dole, the temptation is already pretty strong as they come out of high school. Then they won't have to worry about taxes ... or home ownership ... or going to work ...

Twings wrote:

Co-ops, as I understand them, would be toothless and unable to control costs. There's a reason the insurance industry supports them: they won't force them to change.

Taking the profit motive out of insurance isn't a big change? Giving control of the insurance apparatus to the members covered isn't a big change? Why would they be toothless and unable to control costs? Do you have anything to back up that statement? What about the large local health insurance co-ops already running smoothly in certain parts of the country? Why is government the only road to fixing healthcare? I don't get why we couldn't at least try altering the laws governing insurance before we willy-nilly bolt another government-run social program onto our debt load.

Co-ops won't be taken seriously, because neither side wants it: The Left feels it's too little, the Right feels it's too much. So nothing will get done, or, more likely, the Left will get its agenda ratified due to its supermajority status at the moment. The Obama Administration will force the Blue Dog Democrat faction to fall on their political swords for the Party. I'm sure they will land on their feet, there's plenty of new 'czar' jobs opening up, and you don't need to be elected to control one of those bureaucracies.

EDIT: I also think that if Congress and President Obama feel their health insurance will be so great that they should be obligated to participate in it, giving up the nice plan they enjoy as a perk ATM. But, we know how that goes.

Liberty's Edge

Pathfinder Companion, Pathfinder Accessories, Starfinder Adventure Path, Starfinder Roleplaying Game, Starfinder Society Subscriber; Pathfinder Roleplaying Game Superscriber

Just a point, but the current system is arip-off. Purely as anexample, pacemakers that are sold to the European market for $5000 sell to the American market for $35000. That's right. 7 times the cost for EXACTLY THE SAME product. Something's wrong with the system that it allows this. I have no idea if Obama's solution will work, but the status quo isn't exactly good value for money either.

The Exchange

This is also the point which bothers me, particularly with respect to Patrick's point of view. He keeps banging on about how he is worried a state-run system would be wasteful. The US system is horribly wasteful - twice the cost for a lesser outcome. I do not suggest that setting up an NHS-style body in the US is a panacea - it isn't in the UK, actually. But please stop saying how a centrally-funded system will lead to waste and bureaucracy when it clear that it is much, much worse in the US, especially when you consider that we have universal care and you don't. I'm not some leftie but I do appreciate what works. Untrammelled private enterprise is not always the best solution.


Aubrey the Malformed wrote:
This is also the point which bothers me, particularly with respect to Patrick's point of view. He keeps banging on about how he is worried a state-run system would be wasteful. The US system is horribly wasteful - twice the cost for a lesser outcome. I do not suggest that setting up an NHS-style body in the US is a panacea - it isn't in the UK, actually. But please stop saying how a centrally-funded system will lead to waste and bureaucracy when it clear that it is much, much worse in the US, especially when you consider that we have universal care and you don't. I'm not some leftie but I do appreciate what works. Untrammelled private enterprise is not always the best solution.

I never claimed the status quo was good Aubrey, much the opposite. American healthcare has glaring issues, much as Paul outlied above with his pacemaker example. I just feel we could try other options before going the government route. There are other ways about it. And although there is waste in the system, people pay for it directly. A lot of the waste is that health care insurance can't be shopped by an individual, it has to be bought for the most part by a company. There is no competition, ergo there is no impetus to function cost-effectively.

My problem is that you are shifting the responsibility over to the State. We are staring a $9 Trillion, yes a 12-zero figure, debt in the face. Estimates of $75 Trillion in social promises lie in our future. Why can't we keep healthcare in the private sector and work on what's wrong with the system there? Is that so radical?

I will leave you with one last interesting article on the comparison of various countries debt-to-income ratios: >link<.

As it is, I think I am going to have to leave this conversation. Obviously I am 'banging on' and annoying folks, so be it. We shall see what the future holds, for August is almost done, and the debate will reheat right after September dawns. Enjoy your debate folks.

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