Questions for Americans: Socialised Health Care


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Aberzombie wrote:
As an added bonus, I think that any serious discussion of health reform must include tort reform. Sadly, I have yet to see that this time around. It seems the insurance companies aren't the only ones with great lobbyists.....

I have to disagree with you there. It is also not appropriate for the state to set limits on what your injuries are worth. To do so the state takes away the power of citizens to adjudicate civil matters. There is also discusion of ignoring damage caps in cases of "gross negligence" and "catastrophic injuries" but who gets to decide what they are? How is the state better able to do this than the citizens? It is just another instance of giving up rights to the state.

Mind you, I firmly believe our jury-award system is a "lottery" system as it is often called. However, I think less harm is done to our rights by the farcical awards given than would there would be by giving up our right to decide such things. The British system of having the losing side pay the winner's court costs appeals to me as a partial remedy.

In the end, though, I don't think there is a real solution to this and many other problems. Too many people are unwilling to admit that there are no solutions to some problems. I suscribe to the "constrained vision" view that all things are not always possible, we don't all have unlimited potential and there is not a solution to every problem. Sometimes we have to muddle along with what is there. The torts system is one of these problems.


Mairkurion {tm} wrote:
Medical care, as a whole, is something that is beyond the person's acquisition. My appeal is to a natural rights philosophy: everyone has a right to life and health, therefore it is part of the common good, and no one's activity should infringe on someone's property of life/health, as a natural right. Profiteering is infringing on that right.

Loztastic, hopefully you can begin to see the core issues that cause so much grief in America. Mairkurion and I both believe in "natural rights," but we get there through different avenues.

My own belief is that natural rights spring from those rights that exist outside of civilization. I have the right to my life, my liberty, and my property. No one can take those away from me without my permission. Mairkurion lumps life and health together.

To illustrate the problem, how can Mairkurion's right to health not impact my right to liberty? I must respect his right to health, which means I must care for him, even at the expense of my liberty or my property. You will notice that I don't claim anything about a common good, because (in my mind) if a common good is a right, then my life/liberty/property can be infringed. (Example: Housing is a common good, so I may be forced to work Mairkurion's land to build him a house, even if my own family is starving.)

my thought on the right to health care:
I have heard the "right to health care" is a basic right, but I can't understand how that can occur unless we institute a system of enslaving doctors, depriving them of their liberty.

Naturally, with all the talk about "rights" there are those who think their rights are being trampled on. This happens on both sides of the debate, so people are getting a bit louder than polite conduct would normally deem appropriate.

Mairkurion, I don't mean to disparage your point. I wanted to illustrate where the disagreement comes in. Please don't take offense.

And now I'm going to go back to preparing for GenCon . . . and I'm going to try to not respond anymore. :)


Nivek wrote:
It's called "universal health care", but we already have that. Anyone that goes into an ER must be treated regardless of their ability to pay. That's already part of the law for life threatening injuries/illness.

Absolutely false.

We have legally mandated care for immediately life threatening injuries. Chronic illness (cancer, HIV) often goes untreated, often resulting in DEATH. Disagree all you want, but I've watched it happen.


Bill Lumberg wrote:
Aberzombie wrote:
As an added bonus, I think that any serious discussion of health reform must include tort reform. Sadly, I have yet to see that this time around. It seems the insurance companies aren't the only ones with great lobbyists.....
I have to disagree with you there. It is also not appropriate for the state to set limits on what your injuries are worth. To do so the state takes away the power of citizens to adjudicate civil matters. There is also discusion of ignoring damage caps in cases of "gross negligence" and "catastrophic injuries" but who gets to decide what they are? How is the state better able to do this than the citizens? It is just another instance of giving up rights to the state.

Why? The state has always, from the most ancient law codes, set limits to what injuries are worth. They set the boundaries within which citizens and courts operate.


bugleyman wrote:


We have legally mandated care for immediately life threatening injuries. Chronic illness (cancer, HIV) often goes untreated, often resulting in DEATH. Disagree all you want, but I watched it happen.

Okay, I came back. But only to point something out . . . .

Everything results in DEATH. In fact, by being born you have a guaranteed, 100% chance of dying.

That is all.


*sigh*

Historically most peasants at least knew who was screwing them. In our society, on the other hand, we proles have largely been convinced to blame one another. Amazing!


Doug's Workshop wrote:

Okay, I came back. But only to point something out . . . .

Everything results in DEATH. In fact, by being born you have a guaranteed, 100% chance of dying.

That is all.

Irrelevant. The health system's failure to treat certain terminal illnesses is quite obviously not excused by human mortality!


I don't really get how "everything results in death" works as an argument.

As far as entitlement goes, that what rights are, entitlements.


Mairkurion {tm} wrote:
I don't really get how "everything results in death" works as an argument.

That's because it doesn't.


Bugley, that's what my buddy Aristotle was sayin', but I just thought I'd ask...


Some people in this thread seem to think that "liberty" is a synonym for "devoid of responsibility."

Said people wouldn't exist if better men than they hadn't felt differently.

That is all.


Heh-heh...Bugley, I'm still not sure I know where you come out on this...

;)


bugleyman wrote:
Mairkurion {tm} wrote:
I don't really get how "everything results in death" works as an argument.
That's because it doesn't.

I was just pointing out that you used poor language. I'm sorry for offending you.


*Pokes thread with a ten foot pole.*

"Mmmm...Not quit safe yet.


Nobody's offended me, no worries. C'mon Xabulba, the water is nice and warm. What's your worries? splash, splash

Doug, we do, in fact, restrict other people's liberties, when they infringe on the basic, natural rights that are our properties by nature. So the doctor's/drug company's/whoever's right to set their fees are restricted by everyone having access to what is needed for life/health. But that exact same right is extended to everyone involved, so there is no inequity. Just like my right to spend all my money on Paizo products is restricted by the right of the community to self-defense, equally incumbent on all. As far as I see, the natural law perspective clearly favors universal health care or health care conceived as part of the common good/res publica.

Sovereign Court

A few weeks ago I awoke with a pain in my side, it was pretty bad, and after waiting a while to see if it would go away (it didn't) I knew I needed to get to the hospital. I didn't know what was wrong. I'd never experienced anything like this before and the pain was only getting worse. Quite honestly I wasn't sure if I was dying or not. I got my father to drive me to the ER as I was in no shape to operate a vehicle.

Long story short, I had kidney stones, and after they pumped me full of meds to kill the pain, had a doctor examine me, done x-rays to verify their suspicions (and to ensure I'd be able to pass the stone), they sent me home with some extra strength pain killers a sample cup and some filters to collect the nasty little stone.

I live in Canada and their was absolutely no charge for that ordeal. Now if I'd lived in the states and I didn't have insurance I'd also have returned with a hefty medical bill. If I'd been in the top tier with superior coverage perhaps I might have been able to stay overnight and had a nurse strain my urine.

There are wait times at ERs here in Canada, it's a sad fact about our system, but if I only have a twisted ankle I don't mind waiting. If someone comes in on a stretcher I fully expect them to jump to the head of the line. They're clearly having a worse day then I am. I don't mind paying higher taxes knowing that a trip to the doctor won't put me or my family in debt.

I've been to the ER exactly once in the last twenty years but I've had a few scares with my grandfather. When he was young he needed to save money so he could afford a hernia operation.

Personally the clips I've seen on TV of these town hall meetings in the US make me sick. Loud mouths, intent on shouting down anyone and everyone, have taken over these meetings. There's no attempt to debate by these people. They want to disrupt these meetings and to get sound bites for their favorite cable "news" network. That's it. Explain to me how that is even remotely democratic? Angry mobs and rabble rousers should be condemned by all sides. Debate about such an important matter shouldn't be allowed to be derailed by these minority fringe groups.

Sovereign Court

Xabulba wrote:

*Pokes thread with a ten foot pole.*

"Mmmm...Not quit safe yet.

<stands behind Xabulba and decides to keep his distance while biting on his own tongue as he wants to respond to a couple posts but knows no good would come of it and may indeed result in being smacked upside the head with The Banhammer>


zylphryx wrote:
Xabulba wrote:

*Pokes thread with a ten foot pole.*

"Mmmm...Not quit safe yet.

<stands behind Xabulba and decides to keep his distance while biting on his own tongue as he wants to respond to a couple posts but knows no good would come of it and may indeed result in being smacked upside the head with The Banhammer>

You know you're dying to get your tentacles in there!

Sovereign Court

Mairkurion {tm} wrote:
zylphryx wrote:
Xabulba wrote:

*Pokes thread with a ten foot pole.*

"Mmmm...Not quit safe yet.

<stands behind Xabulba and decides to keep his distance while biting on his own tongue as he wants to respond to a couple posts but knows no good would come of it and may indeed result in being smacked upside the head with The Banhammer>
You know you're dying to get your tentacles in there!

Must ... not ... listen ... to ... salad ... of ... doom ...

<goes back to biting his own tongue ... as opposed to biting the tongue of someone else ;)>


This is a bit of flow of consciousness to bear with me.

I caught a bit of Obama's "town hall" meeting today. Didn't watch too much of it once the questions started because it was too much of a lovefest. I mean the first guy to ask a question was a democratic state congressman that basically said, "If the Republicans don't decide to kiss your butt, are you finally going to kick theirs?" Followed by a little girl, "Mr. Obama, why are the mean people trying to scare me." Blah! Ask your own questions, don't have your kids do it. And if a political wants to talk, do it in your own damn town meeting. *deep breathe* Anyway ....

I heard the Prez talking about how there are silly ignorant people that talk about how they don't want socialized medicine, but then say, "don't touch my medicare." Like duh, socialized dummy. (I'll come back to Medicare in a second)

Yeah, pretty dumb, but on the other side of that very same coin is comments like:

Morgen wrote:
I know that I'm totally for universal health care. I pay taxed and get almost no use out of the services that should provide. I think being able to visit a doctor or something should be part of just being a citizen and not something I have to pay a few thousand dollars a year to do even if I don't get sick.

That is how you pay for health care, whether it is universal or private, you still have to pay in even if you are not using it then. And it is more important if the people that aren't sick are the ones paying in, because they are putting money in without taking it out, while the sick people are taking money out (they could still be putting it in as well, but that would be too directional which is less than a single direction in).

And then we have:

bugleyman wrote:
Irrelevant. The health system's failure to treat certain terminal illnesses is quite obviously not excused by human mortality!

Actually treating terminal illnesses is part (certainly not the only thing) that is driving costs up.

Before I saw the Prez.'s "town hall" meeting, I caught the very end of a medical discussion on C-Span. There someone was talking about how it was told to them that the British system was considering not paying for expensive procedures that couldn't significantly increase or improve a terminally ill patients life. And the people on the discussion board pointed out, that makes sense. We often waste alot of money trying procedures that have extremely small chances of making the patient better, and in fact have more statistical evidence of worsing the patient's condition because we feel we have to try something. When if we had just let nature take its course, with trying to make the patient comfortable of course, that money could have been saved and used for other people and actually done some good.

Now here I think the Prez. fell down. In one breathe, he talks about how the reforms are going to drive down costs. And then in the next he says that when they pass the reforms it is going to remove all kinds of spending caps that insurance companies place. But assuming that it actually happened this means that insurance companies couldn't say, "Sorry, there is no scientific evidence that this expensive procedure will actually help this patient. Instead, stick to more cost effective and scientificly proven methods." Without being able to say, No. Which every single adult learns to do at some point, how is this going to drive down costs? We have to be grown ups and be willing to be the bad guys and say no. I'm sorry, we are not going to spend $100,000 on Gramps, just so he can live another week in pain. If you can't prove the procedure would improve the patient's condition, then unless they can pay it out of their own pocket, we have to say NO.

Finally, I promised to get back to Medicare. Here is another place I think the Prez. did a bit of flub. On the one hand he is saying, "You don't believe Socialized Medicine can work, just look at Medicare." Then on the other hand he says, "We need to do something right now, because if we don't then Medicare is going down the crapper in 10 years." So which is it? Should we be looking at Medicare as a shining example or a failed experiment?


Uzzy wrote:
But with UHC, the key thing is that everyone gets treated, and everyone pays into it.

If we could guarantee that, I think it would get more support. Right now we have citizens that work, but don't actually pay income taxes (then make so little that they get all their taxes back). Under UHC, would this mean that would no longer be true? That their "premiums" would be withheld, no matter how little they make for the year?

I'm not hearing that. What I am hearing, just today even, is that the people that are going to pay are the "rich". But I have a feeling that in the end, to make it work, we are going to have everyone that doesn't get a full refund (makes "enough" money) as the payers of the "premiums". Which is part of the reason why people who are not rich, but who are also not so poor either, are still nervous about it. Because once the fatten cow has been slaughtered. Who next on the buther's block?

I would love to see everyone having to pay, at least something. I can stand a little socialism. "From each according to his ability, to each according to his need (or needs)." I don't mind the second part as long as we remember the first part. There is no free ride for anyone.


The way the british system works is, in most cases, fairly flexible - a procedure has to improve the quality or quantity of life, but outside some limits exposed externally, Consultants (British for Attending physician) are allowed to interprit that fairly loosley - and the vast majority do so for the intrests of their patient. and those restrictions that do take place are generally met with massive public outcry

just think of the outcry over the NHS refusing to fund a single cancer drug - Herceptin - that extends life, but was very expensive.

this lead to, seriously, rioting in the streets, people suing the government, and eventually the restriction was lifted, and returned to being down to the clinical judgement of the doctors

RPG Superstar 2008 Top 16

I'm generally against federally-managed health care, for several reasons:

1.) My father shared many tales of frustration from his dealings with the Canadian system when he first lived up there.

2.) Arizona has a health care system for the indigent already in place. It doesn't seem to work all that well, but forms a "safety net" of sorts.

3.) I work in corrections, and the prison's state-managed health care isn't something I would choose for myself. Their bureaucratic inability to eliminate problematic (discourteous, unprofessional, or inept) staff leaves me aghast.

4.) My experiences with the Feds suggest that there's nothing they can't massively screw up.

5.) Now is a terrible time to tackle a major new social program. The government has been hemorraging money for over eight years, so they decide NOW is the time for massive new entitlement programs?

Interestingly, my father's wife has chronic care issues: Her ongoing problems were a factor in their decision to return to Canada (She's a Canadian citizen). Since he owned a small business, her medical costs were very burdensome while they lived in the States.


Just thought of another thing the Prez. said that I thought was wonky. He said that a government program wouldn't eliminate the private companies. As proof he says, "Look at UPS and Fed-Ex and Postal Service. It is the Postal Service that is always in trouble, not UPS or Fed-Ex." So basically he is admitting that government run systems aren't as good as private systems, so that should entice us to have a government system for health care? A system that won't be able to pay for itself and will continue to need government tax money to prop it up?

The Exchange

Pathfinder Adventure Path Subscriber
pres man wrote:
There someone was talking about how it was told to them that the British system was considering not paying for expensive procedures that couldn't significantly increase or improve a terminally ill patients life. And the people on the discussion board pointed out, that makes sense. We often waste alot of money trying procedures that have extremely small chances of making the patient better, and in fact have more statistical evidence of worsing the patient's condition because we feel we have to try something. When if we had just let nature take its course, with trying to make the patient comfortable of course, that money could have been saved and used for other people and actually done some good.

No system is perfect, that's for sure. In Germany, we've similar problems, basically stemming from the changed demography (less children, prolonged lifetime of older citizens) and less money in the system (different reason, waste of money being one of them). And even with socialized health care, there are the lobbyists (maybe not as influental as in the U.S., but quite surely not powerless).

I also agree that not everything should be paid for. Simply because we can't afford to do so. But (and that's the difference for me) with sozialised health care, it's the people (via the legislative organs) deciding what's worth paying for. And if something has been agreed to be paid for, each citizen has the right to get treated, even if he couldn't afford to do so by himself. It's a renegotiatable social contract, so to speak and once in a while, this is exactly what happens.But that doesn't make the system bad in itself.

Without sozialized health care it comes down to what YOU (as a single person) can afford to pay for. Which (given my medical history and the money I (not) have in my purse)is one of the reasons I'm glad to live in a country that has it.

Dark Archive

Aberzombie wrote:
I agree Bill. Furthermore, seeing what a wonderful job the government does running such things as the USPS and the IRS makes me cringe with the thought of them running the health industry.

As a former postal worker, stuff like this annoys me to no end.

The cheapest, fastest and most reliable postal system on the planet (*half* the cost of many other industialized nations, and having to deal with a much larger nation than many of them!), and it constantly gets crapped on. In my years working there, the worst part of the USPS was the nasty union people, who *got paid* to snitch on each other and file grievances against each other. What a collection of miserable people, cheerlessly and relentless maintaining a climate of distrust and oppression. I learned to avoid the union workers, who seemed uniformly negative, angry and surprisingly conservative (since it's 'common knowledge' that all union members are liberal hippie commie queers or something) and it was actually a decent place to work. Better pay than the work warranted, IMO, and pretty easy stuff.

My time at the post office was the only time in my life I had health insurance, so that was nice, too. If I lived in a country more strongly dominated by those of us that give a crap about human life or more committed to living their lives according to the teachings and examples of Jesus Christ (instead of being full of people who invade peoples homes and kill them because they have brown skin, shoot doctors, bomb clinics and federal buildings, tie people to fences and beat them to death with baseball bats, go on shooting rampages in Holocaust museums and VoTechs, cheer the death penalty, justify torture and the abandonment of the rule of law, celebrate the terrifying and irresponsible expansion of the federal governments powers to spy on, detain and abuse it's citizens, rejoice in 9/11 and Katrina as 'God's punishment on the liberals, feminists, environmentalists and gays,' etc.), I'd probably be able to have my heart defect fixed, but I live here, and while I don't love every little thing like some unquestioning zombie, I did make a *choice* to live here and be a citizen of this country, and I stand by that choice. I keep the faith that this country not only is a great place, but that it can be even better. Unlike those who fear taht any attempt at making America even greater will 'ruin everything,' I haven't given up on the old girl yet.

The goverment runs Medicare, which is 30% more cost-efficient than private insurance *and better-rated in customer satisfaction among it's recipients than private insurance is among it's own clientele.* What magic! Who could have predicted such a thing? Only someone who could *read,* I guess.

Happens to be contradictory to what you'll hear coming from Sarah 'OMG, death panel for granny!' Palin, but I'll go with what I know from personal experience, rather than what a separatist from the most-socialized state in the nation says on Fox News (for every $1 that leaves her state in taxes, they reap $4.75 back in federal spending, and that number doesn't count the Alaska Permanant Resident Fund. Not even a *little* bit surprising that the welfare states that take more than they give are the ones that cry about socialism and redistribution of wealth and entitlement and 'welfare queens.' If it wasn't for the redistribution of wealth already happening in this country, they'd be even worse off than they are...).


Loztastic wrote:

The way the british system works is, in most cases, fairly flexible - a procedure has to improve the quality or quantity of life, but outside some limits exposed externally, Consultants (British for Attending physician) are allowed to interprit that fairly loosley - and the vast majority do so for the intrests of their patient. and those restrictions that do take place are generally met with massive public outcry

just think of the outcry over the NHS refusing to fund a single cancer drug - Herceptin - that extends life, but was very expensive.

this lead to, seriously, rioting in the streets, people suing the government, and eventually the restriction was lifted, and returned to being down to the clinical judgement of the doctors

Loztastic, I think that's one of the (several) reasons why people are upset with a government-controlled system. If my insurance company says it won't pay for Herceptin, I can still pay for it myself. However, if the government says it won't pay for Herceptin, it can outlaw me paying out of my own pocket. For myself, I can't understand why I should have to go to court to get medicine.

Also, this particular bill requires that senior citizens receive "death counsuling." Sure, everyone should have a plan for their demise, but couple that with government's general ineptitude, and people start getting their dander up. And that's where rumors of the "death panel" come from. For those who trust government, it's crazy-talk. For those who see government as the Bogeyman, it's Soylent Green come to life. Most people, I think, resent that anyone should come into their home and start telling them that they need to prepare for death. With such a personal, intimate decision, does the government have any business getting involved?

I think there's also resent that efficacy will be determined by government. A procedure might improve quality of life, but it might not. Should it be up to a government to make that call? Many people can accept an insurance company making that decision, since that decision doesn't have the force of law. But when a government starts making that decision, people start getting wary. Remember, the United States was formed because of distrust about what a government was doing to its citizens. We kinda have a "distrust the government" gene built into our national character. Strangely, those who support a public/universal plan distrusted our former president (George W. Bush), while those who trusted our former president now distrust the universal plan.

Dark Archive

The essense of this discussion, and many other left/right discussions, is that it is the choise between doing the just but unsensible thing (right), or the unjust but sensible thing (left).

If you force people to pay for anything, it is an injust infringement on their freedom, be that for law enforcement, national defence, roads, health care, education or bureaucracy.

On the other hand, the "every man for himself" is not the smart solution. in the case of health care, the people who don't receive treatment because they are too poor end up costing society a lot extra, if they end up losing their ability to keep a job, or end up as criminals to pay their bills. Also, the profit that right now goes to insurance companies could go to extra health care. Or tax reductions.

Both injustice and stupidity is intolerable, so the key is to find the spot in between that the citizens can live with. I think the american semi-anarchistic "justice-before-sensibility" is over the edge stupid, and the old eastern germany "injust-but-sensible-planned economy" just doesn't work woth people. But it doesn't have to be one or the other. Go for the middle road.


Something ate my post . . . darned.

An analogy - WOTC and 4e vs the rest of the RPG business.

Not everyone is a fan of 4e. Some people play other games and want nothing to do with 4e. What would happen if 4e was the equivalent of a government-controlled health care system?

Are other RPGs effective? Not a lot of people play "The Mountain Witch," so should that procedure/game even exist? Diceless games, well those are right out. Everyone knows a diceless game won't work.

Think of all the strong opinions on that matter just here on this forum. 4e lovers and haters, and those in between. Strong opinions and words, over a game. At the end of the day, those are just games!

Ratchet that up to something that matters (health care), and you get lots of people very concerned.

Thanks for posting the question.

Scarab Sages

pres man wrote:
Just thought of another thing the Prez. said that I thought was wonky. He said that a government program wouldn't eliminate the private companies. As proof he says, "Look at UPS and Fed-Ex and Postal Service. It is the Postal Service that is always in trouble, not UPS or Fed-Ex." So basically he is admitting that government run systems aren't as good as private systems, so that should entice us to have a government system for health care? A system that won't be able to pay for itself and will continue to need government tax money to prop it up?

As someone who currently works for the federal government, I see first hand how inefficient the operation can be. That's a big part of the problem I have with the proposals going on.

The USPS is a great example. It's been pointed out that ours is one of the best such systems in the world - and I agree. However, that doesn't necessarily mean it's a fiscally efficient system. Much like the rest of goverment, it seems you have to dump in a crap load of money, but you don't necessarily get the best "bang for your buck".


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. It is clear that there is need for some reform, but the vast majority of people already have access to health insurance, if they choose to take advantage of it. We can certainly tighten things up a bit, particularly when dealing with that last 1% and seeing too it that the 66% are helped to the programs that already cover them. However, the radical overhaul proposed by the President and the Congressional majority seems extreme in the face of the facts.

Shadow Lodge

Pathfinder Adventure Path, Lost Omens, Rulebook, Starfinder Adventure Path, Starfinder Roleplaying Game Subscriber

WOOHOO I'm in that 1%!!! Heh


I can share some experience with the state run Dutch system, which by most definitions here is a socialist system.

First let me establish some credentials. I’ve worked for a health insurance company as a team manager in their callcenter. I’ve also worked for a home care provider (extramural healthcare) in a similar capacity. As team manager I was responsible for monitoring the call quality of my agents. This involves establishing whether the agent provides the correct answer to the customer’s question and requires a working knowledge of cost and coverage of the insurance.

The Dutch healthcare system is tiered. The first tier is called the basisverzekering (lit: basic insurance). The coverage of this tier is set by the ministry of public health and covers all essential healthcare, including ER, the General Practitioner (family medicine) and most prescribed drugs as well as all secondary healthcare (anything for which you would normally go to a hospital). Beyond that there are certain additional coverage plans such as a dental plan, a superior coverage plan and a senior citizen plan (which covers additional drugs, certain prosthetic aids and certain additional care). The coverage of these plans are set by the insurance companies rather than the government.

Every citizen over the age of 18 is required by law to have health insurance. Children under 18 are covered by their parents or guardian’s coverage. The cost of the first tier is set by insurance companies. Because the coverage is identical no matter what insurance company you go to, prices don’t vary much. Current prices are around €80,- ($110,-) a month for the basic insurance. Additional coverage adds anywhere between €10 and €50 to the total. Every Adult pays between €1000 and €1600 in insurance fees. On top of that there’s a €155,- deductible and certain types of care either have a partial coverage or have a set limit for coverage. For example, many of the named brand drugs aren’t fully covered. Instead, the insurance covers only the white-label drug with the same active ingredient. The patient has the choice between using the white-label drug or pay extra for the named brand drug. The difference is usually that the named brand drug has a better release or delivery system and usually has fewer or less pronounced side effects.

The cost of healthcare is much greater. In 2008 it was €57,4 billion, about €4800 per citizen over the age of 18. (whereas the insurance costs is between €1000 and €1600). I don’t have exact figures for the total deductible, but an educated guess would be between an average €300 to €500 per insured. The balance is paid for by the taxpayer.

Pricing of individual treatment is done through diagnosis-treatment combinations. Basically, every diagnosis has a standardised treatment plan with a fixed price. For example, a broken arm could cost €1500 (I’m guessing here, I have no idea what individual treatments involve or cost) and consists of 2 x-rays, 3 consultations with the surgeon (15 min each), a prescription for pain medication and an hour of a nurses time to set the arm and make the cast. It does not matter whether the surgeon needs 10 minutes or 30 minutes per consultation, prices are fixed. Most diagnosis are priced this way. For certain non-standard diagnosis the hospital gives a quote which the insurance company has to approve.

I have no comparative data on the total cost of healthcare between the US and the Netherlands. However, I do know that individual treatments in the US are much more expensive than here. We usually told customers to expect a treatment in the US to cost about four times as much as it would in the Netherlands.
I’m fairly certain this is not solely due to the way healthcare is organised. Other factors, such as general health of the population and demographics play a large role.

Now, to answer the OP’s question. This system, although cheaper and much more comprehensive, has a few drawbacks.

Little innovation – As I understand it there is very little incentive for drugs companies or medical practitioners to innovate. New drugs and new treatments are almost never fully covered by healthcare insurance. We depend on treatments invented in other countries for our own progress in the medical field, which means we are always at least a couple of years behind the curve. For example, my father was diagnosed with prostate cancer a couple of years ago. Due to the type and placement of the tumor it was difficult to treat him here. The chemo therapy they suggested was very intensive and had a high risk of complications. Eventually he was treated in John Hopkins in Baltimore with a special focussed radiation treatment invented there. This was almost ten years ago. That treatment is still not available here.
Less interest for the medical profession – A medical practitioner is going to make less in the Netherlands than in most countries with a for-profit healthcare system. The cream is likely to chose a different field or study medicine in a different country. This, coupled with the fact that the number of new medical students is capped means the really good medical practitioners are in short supply.


Entropi wrote:
The essense of this discussion, and many other left/right discussions, is that it is the choise between doing the just but unsensible thing (right), or the unjust but sensible thing (left).

Or "doing the just but unsensible thing" giving everybody their due, i.e., universal health care, versus "the unjust but sensible thing" making everyone fend for themselves,i.e. capitalized health care.

If force is the measure of freedom, then anarchy is the only alternative, because the state is, by necessity, the bearer of force. Then again, if I live in an anarchic community, I am being forced to go without laws, community, etc. So now, whoever removed the state infringed on my freedom.

Oh Doug, you didn't go there! Hee-hee! The edition wars and politics, together in two threads in two days! Braces for impact.
Again, the problem with your argument is you assume that rights only go one direction. There's no way you're going to be enslaved to build my house and your children starve, when they are protected by the same recognition of natural rights as I am.


Ambrosia Slaad wrote:
Lord Stewpndous wrote:
I think it's a case of people fearing what they don't understand. That, and a TREMENDOUS amount of misinformation that's going around. It's hard to get correct info with all the bias in the media.

The for-profit healthcare, medical, and pharmaceutical corporations have excellent lobbyests. Those lobbyests are not limited to working only the US government. With this much money on the line and so few government employees willing to put their necks out, most citizens of the US aren't getting enough facts to begin to properly puzzle this mess out.

For starters, see the Bill Moyers episodes for July 10th, 17th, and 31st: http://www.pbs.org/moyers/journal/archives/archives.php

(I haven't read the whole thread, sorry if someone already posted this)

Rachel Maddow, a journalist on MSNBC, did a great peice on the issue of socialized healthcare and misinformation and the lobby-ists and whatnot.

Rachel Maddow is neat, I think.

Sovereign Court RPG Superstar 2010 Top 16, 2011 Top 32

Why do some Americans fear the idea of socialized medicine? Because they've been conditioned to fear rather than reason by a small cabal of political leaders, wordsmiths and demagogues.

A population in fear is a population that is easy to control, easy to influence. A population in fear can be relied upon to vote as they are told, believe as they told and fear what they are told, because said leadership offers them a mythical return to a time when they did not have to fear. Never mind that said time was in the midst of the cold war or the nuclear age. Never mind that they have been fed nostalgia for a thing that has never existed.

I'm not claiming that the whole of the conservative movement is motivated only by fear, but it is a large and frightening portion of them. And who can blame them?

These people have been told that the rest of the world hates them and wants them dead. They've been told that the other party wants to kill their grandparents. They've been told that their own president is a foreign menace who was elected only to sell them to shady terrorist interests.

And in the interest of "fairness" and "balance" the news media reports these concerns with the same credence as real actual facts. They don't know what to believe and it's always easier to fear than to rationally face your own fears. And in America, we believe in the easy way.

It's sad, but I honestly don't know what will come of it. I expect in the end that we will end up with a form of socialized medicine, probably that covers basic medical service, preventative stuff and the common cold, with a secondary private market for specialized care. I expect that the smart insurance companies will suggest this as a compromise and then move into monopolize the secondary market and end up making more profit than ever.

I don't want to start a flame war. Frankly the conservatives I've seen on these boards are not the ones I describe. But to honestly answer the OP's question, that's what I've got. It worries me, and I don't see a way out right now. Maybe hope will trump fear, but in politics, fear is a mighty big stick to swing.


YeuxAndI wrote:
Ambrosia Slaad wrote:
Lord Stewpndous wrote:
I think it's a case of people fearing what they don't understand. That, and a TREMENDOUS amount of misinformation that's going around. It's hard to get correct info with all the bias in the media.

The for-profit healthcare, medical, and pharmaceutical corporations have excellent lobbyests. Those lobbyests are not limited to working only the US government. With this much money on the line and so few government employees willing to put their necks out, most citizens of the US aren't getting enough facts to begin to properly puzzle this mess out.

For starters, see the Bill Moyers episodes for July 10th, 17th, and 31st: http://www.pbs.org/moyers/journal/archives/archives.php

(I haven't read the whole thread, sorry if someone already posted this)

Rachel Maddow, a journalist on MSNBC, did a great peice on the issue of socialized healthcare and misinformation and the lobby-ists and whatnot.

Rachel Maddow is neat, I think.

The problem with Maddow is that she's a political hack like Olbermann, Limbaugh, and Hannity. Whatever she says you have to take with a grain of salt.


James Martin wrote:

Why do some Americans fear the idea of socialized medicine? Because they've been conditioned to fear rather than reason by a small cabal of political leaders, wordsmiths and demagogues.

A population in fear is a population that is easy to control, easy to influence. A population in fear can be relied upon to vote as they are told, believe as they told and fear what they are told, because said leadership offers them a mythical return to a time when they did not have to fear. Never mind that said time was in the midst of the cold war or the nuclear age. Never mind that they have been fed nostalgia for a thing that has never existed.

I'm not claiming that the whole of the conservative movement is motivated only by fear, but it is a large and frightening portion of them. And who can blame them?

These people have been told that the rest of the world hates them and wants them dead. They've been told that the other party wants to kill their grandparents. They've been told that their own president is a foreign menace who was elected only to sell them to shady terrorist interests.

And in the interest of "fairness" and "balance" the news media reports these concerns with the same credence as real actual facts. They don't know what to believe and it's always easier to fear than to rationally face your own fears. And in America, we believe in the easy way.

It's sad, but I honestly don't know what will come of it. I expect in the end that we will end up with a form of socialized medicine, probably that covers basic medical service, preventative stuff and the common cold, with a secondary private market for specialized care. I expect that the smart insurance companies will suggest this as a compromise and then move into monopolize the secondary market and end up making more profit than ever.

I don't want to start a flame war. Frankly the conservatives I've seen on these boards are not the ones I describe. But to honestly answer the OP's question, that's what I've got. It worries me, and I...

It's a lot more than an "irrational" fear. Socialized medicine has never been the great success that's been preached by the left. If it is so great we wouldn't have Europeans and Canadians coming to the U.S.by the droves to get medical care. I'm afraid we're replacing a broken system that needs fixing with a system that is even worse.

Sovereign Court

pres man wrote:
Uzzy wrote:
But with UHC, the key thing is that everyone gets treated, and everyone pays into it.

If we could guarantee that, I think it would get more support. Right now we have citizens that work, but don't actually pay income taxes (then make so little that they get all their taxes back). Under UHC, would this mean that would no longer be true? That their "premiums" would be withheld, no matter how little they make for the year?

I'm not hearing that. What I am hearing, just today even, is that the people that are going to pay are the "rich". But I have a feeling that in the end, to make it work, we are going to have everyone that doesn't get a full refund (makes "enough" money) as the payers of the "premiums". Which is part of the reason why people who are not rich, but who are also not so poor either, are still nervous about it. Because once the fatten cow has been slaughtered. Who next on the buther's block?

I would love to see everyone having to pay, at least something. I can stand a little socialism. "From each according to his ability, to each according to his need (or needs)." I don't mind the second part as long as we remember the first part. There is no free ride for anyone.

Over here in the UK we pay what's called National Insurance, which everyone who pays taxes does. That money is automatically taken out of your pay packet (along with income tax), and your employer also contributes some. The money raised through National Insurance is nominally saved for social benefits, such as your pension, and most importantly, the NHS. Only those who do not pay taxes do not contribute.

As far as I can tell, an ideal US system should do these things.

1) Make it illegal not to have Health Insurance
2) Set up a public system of health insurance that anyone can join.
3) Set up a means tested system where if you cannot afford to join that public system, you can get up to 100% of it paid for you.

I don't get the argument that public healthcare will lead to less innovation. Over here in the UK, we have plenty of medical research being done, some government funded, some funded through charity, some funded through private companies. People keep getting ill, and as long as someone pays for the research, it'll get done. If there's less money being paid to drug companies for overpriced drugs, just have the government invest more.

Also, the 'death panels' arguments are insulting. The encouragement of living wills and discussion over end of life care has been going on for ages, which, by the way, is a good thing. It will never involved government saying what's right and wrong (unless it's Euthanasia, that is).


James Martin wrote:

Why do some Americans fear the idea of socialized medicine? Because they've been conditioned to fear rather than reason by a small cabal of political leaders, wordsmiths and demagogues.

A population in fear is a population that is easy to control, easy to influence. A population in fear can be relied upon to vote as they are told, believe as they told and fear what they are told, because said leadership offers them a mythical return to a time when they did not have to fear. Never mind that said time was in the midst of the cold war or the nuclear age. Never mind that they have been fed nostalgia for a thing that has never existed.

I'm not claiming that the whole of the conservative movement is motivated only by fear, but it is a large and frightening portion of them. And who can blame them?

These people have been told that the rest of the world hates them and wants them dead. They've been told that the other party wants to kill their grandparents. They've been told that their own president is a foreign menace who was elected only to sell them to shady terrorist interests...

I couldn't have put it better myself.


I just don't get the position that publicly funded healthcare is somehow "socialized" because our taxes would finance it.

Our taxes fund the public school system. No one calls it "socialized" school.

Our taxes fund the military. You can be damned sure no one calls it a "socialized" military.

Our taxes finance the police. No one says we have a "socialized" police force.

Saying that a publicly financed healthcare would be "socialism" is nothing more than partisan propaganda. It's dangerous, cynical,and irresponsible, partisan propaganda. It's clouding the real and important issue of health care reform with poorly conceived, jingoistic rhetoric.

I find the whole thing very disappointing.

Dark Archive

James Martin wrote:

Why do some Americans fear the idea of socialized medicine? Because they've been conditioned to fear rather than reason by a small cabal of political leaders, wordsmiths and demagogues.

I'm getting pretty tired of this.

I don't believe in any entitlement system - generally I would feel that I am in the minority on this one and that's ok, some people feel that they need or want more out of their gov't but you have to accept that many people are opposed to that based upon the facts in hand and that this is just another form of wealth redistribution. It doesn't take political leaders or rabble rousers - if you feel that something is fundamentally wrong, unfair, etc then your intuition is probably correct.

That being said I would be ready to accept another entitlement for people if the government figured out how to pay for the various pyramid schemes it has laid out before. Social security is going to implode like nothing no one has seen. Will all these people clamoring for gov't health care step up and pay for that when that happens? Same with the current medicare medicaid. It's all crap - if you want to talk about conditioned people look to the proles who have their hands out asking the gov't to solve every single problem. That is classical conditioning and that conditioning is perpetuated by a small cabal of political leaders, wordsmiths and demagogues.

Fund other entitlements and I will accept this as a necessary evil to hand out to people who cannot take care of themselves. If you can't fund them, then you should shut your yapper until you can.

It is very easy to come up with TREMENDOUS ideas to help people - give everyone 50,000 and an SUV. Free education, free homes. Unfortunately nothing is free, yet these politicians have their finger in my wallet or on the printing press to print more money to satisfy their unrealistic promises. I wish I could live in that fantasy world where unicorns fart out skittles, and no one goes hungry -everyone has gov't developed solar powered cars and live in energy smart gov't manufactured homes - unfortunately I just can't close my eyes and dream this into existence.


Gary, I don't doubt for one minute that our system works better for those who can afford to use it. The point is, a growing number of our own citizens can't afford to use it.

And yes, there is a ton of fear-mongering going on (even in this very thread). "The government won't let you buy medicine! Old people will be euthanized!" Frankly, the whole thing appears to be a calculated attempt to shut down the system by those unwilling to accept its outcome, which is the principal historical path to fascism. Voicing one's dissent == good; shouting down all opposing viewpoints == bad (not directed at you).

Sovereign Court RPG Superstar 2010 Top 16, 2011 Top 32

Auxmaulous wrote:


It is very easy to come up with TREMENDOUS ideas to help people - give everyone 50,000 and an SUV. Free education, free homes. Unfortunately nothing is free, yet these politicians have their finger in my wallet or on the printing press to print more money to satisfy their unrealistic promises. I wish I could live in that fantasy world where unicorns fart out skittles, and no one goes hungry -everyone has gov't developed...

It is the purview of any government to do what cannot be handled by the market: public defense, roads, public works programs. I believe health care for the whole of the American population falls under this umbrella. Private health care fails because it can exclude anyone it wishes and does so in order to preserve its mandate: profit for its stakeholders. The health of the American people is not its goal and never has been. If we wish to have the health of the American people as a goal, then we cannot use the market.

Your other point is valid: clearly we need to tax more to pay for the obligations we have created. I'm not against this. I believe a system where I pay more to get more is a good system. I realize I am not in the majority on this point, but I believe you get what you pay for is a good rule.


Auxmaulous wrote:

I'm getting pretty tired of this.

It is very easy to come up with TREMENDOUS ideas to help people - give everyone 50,000 and an SUV. Free education, free homes. Unfortunately nothing is free, yet these politicians have their finger in my wallet or on the printing press to print more money to satisfy their unrealistic promises. I wish I could live in that fantasy world where unicorns fart out skittles, and no one goes hungry -everyone has gov't developed...

And I'm getting pretty tired of cynical straw men, which are even easier to come up with than "TREMENDOUS ideas to help people." I'd suggest you start by actually understanding the other side's point, rather than reducing them to a ridiculous caricature becuase it takes less effort. On the other hand, if convinced you're infallible, and just want shout down those who disagree, by all means continue on your present course.

Dark Archive

bugleyman wrote:
Frankly, the whole thing appears to be a calculated attempt to shut down the system by those unwilling to accept its outcome, which is the principal historical path to fascism. Voicing one's dissent == good; shouting down all opposing viewpoints == bad (not directed at you).

Fascism, LOL? Fascistic like gov't entirely taking over various private enterprises or telling them what they can or cannot manufacture based upon a State ideal?

Look to your current president for that guy.

People are amazing.

Dark Archive

bugleyman wrote:
Auxmaulous wrote:

I'm getting pretty tired of this.

It is very easy to come up with TREMENDOUS ideas to help people - give everyone 50,000 and an SUV. Free education, free homes. Unfortunately nothing is free, yet these politicians have their finger in my wallet or on the printing press to print more money to satisfy their unrealistic promises. I wish I could live in that fantasy world where unicorns fart out skittles, and no one goes hungry -everyone has gov't developed...
And I'm getting pretty tired of cynical straw men, which are even easier to come up with than "TREMENDOUS ideas to help people." I'd suggest you start by actually understanding the other side's point, rather than reducing them to a ridiculous caricature becuase it takes less effort. On the other hand, if convinced you're infallible, and just want shout down those who disagree, by all means continue on your present course.

Nice attempt at reduction on your part guy, once you come back with a way to fund the UNFUNDED social security system get back to me.


Auxmaulous wrote:
bugleyman wrote:
Frankly, the whole thing appears to be a calculated attempt to shut down the system by those unwilling to accept its outcome, which is the principal historical path to fascism. Voicing one's dissent == good; shouting down all opposing viewpoints == bad (not directed at you).

Fascism, LOL? Fascistic like gov't entirely taking over various private enterprises or telling them what they can or cannot manufacture based upon a State ideal?

Look to your current president for that guy.

People are amazing.

As is your apparent ignorance of history. But go ahead, assume I don't known what fascism is; as I've pointed out, it's easier on the brain cells.


bugleyman wrote:

Gary, I don't doubt for one minute that our system works better for those who can afford to use it. The point is, a growing number of our own citizens can't afford to use it.

And yes, there is a ton of fear-mongering going on (even in this very thread). "The government won't let you buy medicine! Old people will be euthanized!" Frankly, the whole thing appears to be a calculated attempt to shut down the system by those unwilling to accept its outcome, which is the principal historical path to fascism. Voicing one's dissent == good; shouting down all opposing viewpoints == bad (not directed at you).

"If we don't set up this new system, then the entire situation will explode! You have to accept our new set up and spend less time then people take to pick out a new car to look at the details or everything will explode!"

Yup, there is a lot of fear going on, from both sides. Fear is a powerful tool for everyone to use.


James Martin wrote:
It is the purview of any government to do what cannot be handled by the market: public defense, roads, public works programs. I believe health care for the whole of the American population falls under this umbrella. Private health care fails because it can exclude anyone it wishes and does so in order to preserve its mandate: profit for its stakeholders. The health of the American people is not its goal and never has been. If we wish to have the health of the American people as a goal, then we cannot use the market.

If this is the problem, then why don't we just adjust it. We do this with car insurance. Some drivers are considered such bad risks, that no insurance company would voluntarily insure them (at least without insanely high rates). So the state says, if you want to do business in this state, then you get up on a list and some of these drivers get sent to you to cover. You must do it, so must every other insurance company that wants to do business, thus the risk is spread out. So why not just address the issue directly?

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