Questions for Americans: Socialised Health Care


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bugleyman wrote:
Brian E. Harris wrote:
Then, of course, there are those that oppose the agenda of those who talk down to them.
Because that's an excellent basis for opposition...

Didn't say it was rational.

I simply pointed out that some people don't like being talked down to by smarmy, self-righteous people who tell them that their beliefs are wrong, or insinuate that they're stupid, and such behavior engenders distrust in whatever the opposition is trying to sell.


bugleyman wrote:

The authoritarian followers have been told that health care reforms is Socialist(tm).* No, they can't define it. But it's SCARY and BAD.

The "authoritarian followers" that you speak of know what a Socialist is. Regardless of what you believe, there are many people on the right who have a brain and can think. I really don't understand this demeaning attitude that people like you have towards others who don't share your point of view.


bugleyman wrote:

The authoritarian followers have been told that health care reforms is Socialist(tm).* So when they aren't busy administering ostensibly lethal shocks in sociology experiments, they're shouting down dissent and shutting down debate. Then, they get removed, they cry "help! help! I'm being repressed!"

Fortunately, "repression" aside, freedom of speech doesn't extend to the "right" to drown out everyone else. That is the behavior that has to be stopped; That is "Unamerican."

* No, they can't define it. But it's SCARY and BAD.

Actually trying to drown out everyone else is QUINTESSENTIALLY American, Bugley. Citizens and politicians have been doing it since the Founding. Democracy is an ugly,sweaty bloody process. Throwing in descriptive qualifiers like 'authoritarian followers' around doesn't add to the debate. Really, it's all as bad as the whole 'Surrenderist' crap of the Bush years. Name calling and unwillingness to listen just inflames the discussion, although that has a long American pedigree as well :P

As for debate, let me throw this out there into the forum: Since we have some people from Blighty around, can you enlighten me as to how the NHS system handles medical malpractice?


Uzzy wrote:

No, of course not. My point was that in that particular example, the person protesting against changes to Health Insurance that would significantly improve the situation for themselves, didn't have Health Insurance in the first place. Why not? Because he was unemployed.

This makes me wonder exactly they are protesting, and what they think Obama's plan is. They've probably been influenced by the scaremongering of Palin, Beck and Limbaugh.

So, he may go against his own interests some of the time. So what does that have to do with him getting attacked? This is meaningless red herring to distract from the fact that he was attacked. His personal situation is not relevant, unless it is ok to attack people that are acting against their own best interest. In that case, get all the folks that voted for Obama and make more than $250,000 a year. Can we beat the crap out of those folks? Nope? Then drop the meaningingless red herring.

Uzzy wrote:
I also noticed you didn't respond to my point about Payroll Taxes, Pres Man.

This was about the illegal immigrants? Yeah, I'm not going to hold my breathe on insurance getting paid through them. Heck, as you point, they could be paying it right now, nothing is stopping those employers from offering their illegal workers insurance. So I fail to see how this addresses the issue.


bugleyman wrote:
If you'll excuse me, I'm off to implement my agenda of seducing Middle America's innocent, god-fearing children into a life of drugs, atheism, and homosexual depravity. Muahahahaha!

You should sell t-shirts. "I'm an innocent, god-fearing Middle American that got seduced into a life of drugs, atheism, and homosexual depravity...and all I got was the drugs, the free thought, the sex, and this t-shirt. Ask me how!"

For extra points, put a big apple on the thing.


Garydee wrote:


The "authoritarian followers" that you speak of know what a Socialist is. Regardless of what you believe, there are many people on the right who have a brain and can think. I really don't understand this demeaning attitude that people like you have towards others who don't share your point of view.

Actually Gary, they don't. But I didn't say everyone on the right was one...you came up with that one all by yourself. I merely said that those who are trying to drown out the debate generally aren't thinking for themselves.

The academic concept of the authoritarian follower is independent of political party or affiliation. They exist on the left as well as the right. Do some research...or don't, and just assume you know everything there is to know about "people like me."

Hmmmm...

The Exchange

Pathfinder Adventure Path Subscriber
pres man wrote:
His personal situation is not relevant, unless it is ok to attack people that are acting against their own best interest.

I think that's actually the whole point. It's naturally not ok to attack people but nonetheless it happens.

But it's also not ok that someone who is attacked has to resort to begging because he can't afford to get the necessary medical treatment.

So given, that the first is possible and the second may be the consequence, I also see the irony in fighting a change probably improving your situation.

But I guess the poor man feels better knowing that at least no one will call him a socialist.


Patrick Curtin wrote:

As for debate, let me throw this out there into the forum: Since we have some people from Blighty around, can you enlighten me as to how the NHS system handles medical malpractice?

My dad's girlfriend works in the NHS, I will do some research and get back you. Have to say, I have never meet anyone who has needed to make a claim.

The Exchange

In legal terms, medical malpractice is handled by going to a lawyer and then making a claim in court. Much the same as in the US, I imagine. There is also the General Medical Council which regulates whether a doctor should be allowed to practice, and I imagine that there is a similar body (or bodies) in the US too. It isn't terribly different, actually, in the UK - we even have private medicine here. The difference is that you use private medical cover to get minor surgery quicker - I had my gall bladder out on my medical cover a few years ago and had it done in a private hospital. If I hadn't had the cover, I would have got the thing done on the NHS, but maybe in a few months rather than a few weeks. And if I had anything serious or life-threatening, I would go straight to the NHS and they would treat me quickly.


Aubrey the Malformed wrote:
In legal terms, medical malpractice is handled by going to a lawyer and then making a claim in court. Much the same as in the US, I imagine.

But the Devil, as they say, is in the details. Is there a limit to how much a plaintiff can ask for in a suit? Could someone go for millions of pounds over a simple mishap or a missed diagnosis? Are there any regulations to the process? And how do British doctors pay for malpractice insurance? Are they subsidized by the state or do they have to pay it themselves?

Aubrey the Malformed wrote:
There is also the General Medical Council which regulates whether a doctor should be allowed to practice, and I imagine that there is a similar body (or bodies) in the US too. It isn't terribly different, actually, in the UK - we even have private medicine here. The difference is that you use private medical cover to get minor surgery quicker - I had my gall bladder out on my medical cover a few years ago and had it done in a private hospital. If I hadn't had the cover, I would have got the thing done on the NHS, but maybe in a few months rather than a few weeks. And if I had anything serious or life-threatening, I would go straight to the NHS and they would treat me quickly.

So what I am hearing is that in the NHS system you can still have private insurance, but its sole reason is to expedite minor surgery. How expensive is 'medical cover'? Is it within reach of normal workers? Or is it an expensive perk? How much red tape do you have to wade through to get the NHS to pony up for minor surgeries?


Health insurance:

Most people choose not to have it. It is relatively expensive, it would be about £672 a year for me(assuming i use bupa and have no excess). Given that the same surgery is available free at point of use from the NHS, with the only requirement being that you have to wait a little longer, most consider it an unnecciesary expence. My family is very comfortably middle class and we have never bothered getting it. There is no paper work to go through to get the same, other than the usual, booking of appointments with doctors and perscripions.

Dental and optomitry is often covered by the individual as needed, unless your on a benifit, in which case it is free.

The Exchange

Patrick Curtin wrote:
Aubrey the Malformed wrote:
In legal terms, medical malpractice is handled by going to a lawyer and then making a claim in court. Much the same as in the US, I imagine.
But the Devil, as they say, is in the details. Is there a limit to how much a plaintiff can ask for in a suit? Could someone go for millions of pounds over a simple mishap or a missed diagnosis? Are there any regulations to the process? And how do British doctors pay for malpractice insurance? Are they subsidized by the state or do they have to pay it themselves?

I'm not an expert, but this is basically how it works. In UK tort, if you are negligent but basically carrying out your duties in accordance with your job description, your employer is liable. So if a surgeon is negligent and is working for the NHS, the NHS is who you sue.

However, senior speciailist doctors may qualify as consultants (specific term) in a particular discipline (note: not all specialists, or even most, are consultants, only the most senior/talented - most specialists in the NHS are not consultants, although the heads of departments are). A consultant may have a private practice in addition to working for the NHS, and it is the consultants who carry out private procedures in private hospitals. Under those circumstances, if a consultant operating under his private practice was negligent, you would sue the consultant (and/or possibly the private hospital if they were negligent). Consultants will buy professional indemnity insurance for their private practice, I would imagine, but I would be amazed if the state subsidised that.

The cost of a suit will depend, but basically the awards in the UK to a plaintiff are much less than they are in the US. There are a number of reasons for this (and as I say, I'm not a legal expert) but at least one is that the point of suing someone in the UK law is not to punish them but to obtain compensatory redress - i.e. you can only claim for damage you have suffered, not to punish the negligent party. Also, the judges set the compensation and there are guidelines as to what is appropriate. The chances of being sued for millions is basically low, though you might be sued for tens or (just maybe) hundreds of thousands for something utterly heinous (i.e. rare). Some compensation has been in the form of ongoing care, the cost of which racks up, but that is only where you are effectively disabled.

In addition, a doctor can be struck off (i.e. prevented from practicing) if a complaint is made to the General Medical Council and the Council finds against them (though they have other less severe sanctions too). The GMC is not a government body as far as I am aware, but a self-regulatory body.

(The public/private practice arrangement was a sop to the surgeons when the NHS was set up to get them on-side, as they were otherwise very unhappy at the prospect of losing lucrative private practice.)

Patrick Curtin wrote:
Aubrey the Malformed wrote:
There is also the General Medical Council which regulates whether a doctor should be allowed to practice, and I imagine that there is a similar body (or bodies) in the US too. It isn't terribly different, actually, in the UK - we even have private medicine here. The difference is that you use private medical cover to get minor surgery quicker - I had my gall bladder out on my medical cover a few years ago and had it done in a private hospital. If I hadn't had the cover, I would have got the thing done on the NHS, but maybe in a few months rather than a few weeks. And if I had anything serious or life-threatening, I would go straight to the NHS and they would treat me quickly.
So what I am hearing is that in the NHS system you can still have private insurance, but its sole reason is to expedite minor surgery. How expensive is 'medical cover'? Is it within reach of normal workers? Or is it an expensive perk? How much red tape do you have to wade through to get the NHS to pony up for minor surgeries?

My cover coasts a few hundred pounds a year, but obviously it depends on how big a risk you are. Also, mine is provided by my employer as a benefit in kind (i.e. it is treated as pay and I pay the tax on it) but it is generally professional-type jobs which get it rather than every guy with a job. In other words, it isn't a must-have, it is a nice perk. My parents pay for private healthcare out of their pensions, but they are relatively well-off and it is a continuation of cover they had when my father was still working. As Zombieneighbours says above, most people don't bother as the NHS will cover you.

If you want to have a private consultation, you need a letter from your general practitioner. Under the NHS, primary care is done by general practitioners (GPs) who are basically NHS employees (these are not like the consultants, who are hospital doctors). Each area will have a GP practice and you would go to the GP with your general ailments and so on, and they will prescribe drugs or refer you to a specialist. The GP is basically your interface with the NHS.

If you want to go privately, you still need to be referred by your GP. However, they won't refuse to do that. They send a letter, you arrange to go and see the consultant, and it all goes from there. It is pretty hassle-free.

If, on the other hand, you need the same thing but don't have insurance, they would refer you to a specialist at a hospital. And the process is much the same. The main difference is that you might have to wait longer for the procedure, depending on what resources are available to deal with it in your area. And there are some things the NHS is not keen on doing, like elective cosmetic surgery or fertility treatment, as they might be a waste (relatively, depending on competing demands) of resources.


Steven Tindall wrote:
I realize this may seem like a off topic discussion ...

Do not start off-topic threads within a thread in the off-topic section. It's a bad breach of etiquette; like cheating on your mistress.


SO as the tally goes:

Socialized medicine:

Pros:

  • taxpayer funded, thus no out-of-pocket costs at use.
  • everyone is covered
  • no red tape, just appointment making.

Cons:

  • Taxpayer funded, so everyone pays for it.
  • Lengthy wait for 'minor' surgeries unless covered by 'medical cover'

A few more questions, to make sure I have my monkey noggin around the issue: How does the system handle folks at the extreme end of life? Are 'heroic measures' used, or is it more a 'medicate the pain and let them go' scenario? Is there any difference between how a 45-year-old is treated for cancer and an 85-year-old? How is the quality of doctor care? Is there a shortage of doctors under this system?

How large is the bureaucratic apparatus for this system? How much does it cost the average taxpayer? Do poorer folks pay a higher tax level because of it or are the costs soaked up by the wealthy?


Aubrey the Malformed wrote:


I'm not an expert, but this is basically how it works. In UK tort, if you are negligent but basically carrying out your duties in accordance with your job description, your employer is liable. So if a surgeon is negligent and is working for the NHS, the NHS is who you sue.

This is the sticking point I have in this debate. As the current healthcare reform stands here, doctors will still be directly sued by plaintiffs. You cannot sue the government. Thus while lots of folks wont have to pay for health insurance anymore, doctors here will be paying higher and higher premiums for their malpractice insurance. At the same time, the 'public option' in the name of 'cutting costs' will cap the payments doctors are allowed for their proceedures. Ergo, over time the costs of being a doctor will increase, and the incentives to practice medicine will decline. Taking a long-term view, I believe this will lead to an inevitable shortage of people entering the medical field, unless this issue is addressed.

Now, either the new system subsidizes malpractice insurance for doctors under the public option, which I cannot believe will save us any money, or the system of malpractice must be revamped in some fashion to keep insurance costs down. If this isn't addressed, why would any smart person want to practice medicine in the US?

The Exchange

Patrick Curtin wrote:

SO as the tally goes:

Socialized medicine:

Pros:

  • taxpayer funded, thus no out-of-pocket costs at use.
  • everyone is covered
  • no red tape, just appointment making.

There are some minor charges - presciption costs and the like, but they are a few pounds. And there is plenty of red tape, but probably not much more than there is for a private procedure.

Patrick Curtin wrote:

Cons:

  • Taxpayer funded, so everyone pays for it.
  • Lengthy wait for 'minor' surgeries unless covered by 'medical cover'

The cost of the US system is greater in terms of share of GDP. Also, to some extent if you are poor and/or unhealthy then you get something of a free ride as richer/healthier people pay for you - whether that is good or bad depends on your health or wealth. There is an argument that that is right and proper in a civilised society, where the state offers a safety net. That, arguably, is the socialised bit that has everyone so exercised.

Also, one of the problems is that these "minor" surgeries may be to deal with some quite debilitating complaints. My gall bladder had a habit of flaring up in the small hours of the morning and then calming down just in time for me to go to work. A few months of that would have been very unpleasant. And sometimes the procedures aren't that minor - cancer ops and the like. But a lot of money has been spent on the NHS to deal with that.

I have had close contact with the NHS a few times recently - once in respect of my mother's hip operation (where she was crippled permantly in a private hospital and had her life saved in an NHS one), once when my dad had a suspected heart attack and was rushed to Accident and Emergency, and once in respect of my aunt who had pancreatic cancer. I'm not really aware of any very bad experiences - my aunt died, but she was effectively on a death sentence anyway and she had very good care in a specialist hospital and her life was significantly extended (no - no death panels) - although I guess the softer side of the care is less than in a private hospital (i.e. they run things to their convenience rather than yours, though by and large the staff are fine and caring). Also, there have been some issues in hygeine in some hospitals where cleaning services have been outsourced (though this is not a general finding - where my mum had her leg done the hygeine was exemplary, but where my dad was it was a bit iffy).

Patrick Curtin wrote:
A few more questions, to make sure I have my monkey noggin around the issue: How does the system handle folks at the extreme end of life? Are 'heroic measures' used, or is it more a 'medicate the pain and let them go' scenario? Is there any difference between how a 45-year-old is treated for cancer and an 85-year-old? How is the quality of doctor care? Is there a shortage of doctors under this system?

See my comments regarding my aunt above. They operated and gave her chemotherapy, but the prognosis was always pretty dire. But that said, she lasted a pretty long time after the initial diagnosis and longer than normal. But in the end there wasn't much they could do. "Heroic measures" in such circumstances are of moot value anyway - maybe they would have lengthened her life a bit, maybe not, and then what about her quality of life? I wasn't that close to it, but from what I have heard there was no complaint about her treatment. In the end they told her she was terminal (she joked about it, in fact: she walked in to see the consultant in his office for her appointment and saw her file on his desk, on which was written in big letters "TERMINAL" - I understand her comment was along the lines of "So it's not good news, then?"). Her final days were spent in a hospice with her family around her and she weant peacefully. I have no concerns that she received sub-standard or inappropriate care or that the NHS didn't do enough for her, nor do her family. For reference, she was 67.

There is probably a degree of shortage but not dramatically so - in general terms, you earn pretty good money as a doctor, and can earn a lot as a consultant. It is certanly a respected profession. One of the other problems with the NHS as a place to work is that it is subject to upheaval based upon the whims of government. As such, there can be some uncertainty about what exactly you could end up doing (and lots of complaints about bureaucracy and increasing weight of administration) as various reforms go through. However, as a counterbalance to that, the medical profession(s) have a lot of political clout arising from their position of trust in the community (see comments above about the BMA).

Patrick Curtin wrote:
How large is the bureaucratic apparatus for this system? How much does it cost the average taxpayer? Do poorer folks pay a higher tax level because of it or are the costs soaked up by the wealthy?

It's big. It was the biggest employer in the world after the Peoples Army of China (though I don't know if that is still the case, or indeed if that was ever really true). We don't hypothecate taxes much in this country so it is hard to say how much it costs per person, but it takes up about 7% or so (I have seen quoted) of GDP in the UK. One of the problems with the US system (15% of GDP) is that it is actually much more expensive that our Owellian bureaucracy. Richer people pay more tax (relatively and absolutely) so I guess there is an implicit subsidy for the poorer.

The Exchange

Patrick Curtin wrote:
If this isn't addressed, why would any smart person want to practice medicine in the US?

For the money - that is what professional indemnity insurance is for. The same with most professions, including the one (accountancy) I am familiar with. I see no shortage of people wanting to be partners in such firms, despite the possible risks, because the potential rewards are very great. A friend of mine has a cousin in the US who is a doctor - he says this guy is totally loaded, and my mate is hardly short of a few bob or two.


Patrick Curtin wrote:

SO as the tally goes:

Socialized medicine:

Pros:

  • taxpayer funded, thus no out-of-pocket costs at use.
  • everyone is covered
  • no red tape, just appointment making.

Cons:

  • Taxpayer funded, so everyone pays for it.
  • Lengthy wait for 'minor' surgeries unless covered by 'medical cover'

A few more questions, to make sure I have my monkey noggin around the issue: How does the system handle folks at the extreme end of life? Are 'heroic measures' used, or is it more a 'medicate the pain and let them go' scenario? Is there any difference between how a 45-year-old is treated for cancer and an 85-year-old? How is the quality of doctor care? Is there a shortage of doctors under this system?

How large is the bureaucratic apparatus for this system? How much does it cost the average taxpayer? Do poorer folks pay a higher tax level because of it or are the costs soaked up by the wealthy?

Basically you have it about right.

There are other issue, which fall into the Con section, related to efficacy of drugs. If your interested in that, i can try and explain the issue.

With regards to how elders are treated. As i understand it, they get the same treatment anyone else would reseive. It is largely focused around the wants of the patient. Some of the drug efficacy issues that i mentioned might come into play in some of these cases, but it is rare.

We do have issues with the size of the NHS' bureacracy, but as i said, earlier in the thread, it certainly seems to me that we are paying less for the NHS than the average than U.S. citizens does for less certain care. This is something that is currently keenly in the public eye.

You missed one of the pro's of the NHS: Unlike insurance, you will never be turned down for your treatment.

We manage to source all the doctors and nurses we need, though there is an issue with the leechs of the NHS, aka medical agencies.

The NHS certainly isn't perfect, but i still believe, that on the balance of evidence, it is a relatively good option.


Patrick Curtin wrote:
Aubrey the Malformed wrote:


I'm not an expert, but this is basically how it works. In UK tort, if you are negligent but basically carrying out your duties in accordance with your job description, your employer is liable. So if a surgeon is negligent and is working for the NHS, the NHS is who you sue.

This is the sticking point I have in this debate. As the current healthcare reform stands here, doctors will still be directly sued by plaintiffs. You cannot sue the government. Thus while lots of folks wont have to pay for health insurance anymore, doctors here will be paying higher and higher premiums for their malpractice insurance. At the same time, the 'public option' in the name of 'cutting costs' will cap the payments doctors are allowed for their proceedures. Ergo, over time the costs of being a doctor will increase, and the incentives to practice medicine will decline. Taking a long-term view, I believe this will lead to an inevitable shortage of people entering the medical field, unless this issue is addressed.

Now, either the new system subsidizes malpractice insurance for doctors under the public option, which I cannot believe will save us any money, or the system of malpractice must be revamped in some fashion to keep insurance costs down. If this isn't addressed, why would any smart person want to practice medicine in the US?

If money is what incentivises you to become a doctor, you probably shouldn't become a doctor. Being smart is compatible with being altruistic. One potential for insurance under those conditions is mutualised system run by medical organisations. Remove the need for profit, and the Insurance system suddenly becomes far cheaper.


we also don't have scenes like this.

Sovereign Court

It's probably a language thing, or perhaps how the debate is being framed in the US, but I am a little surprised that the NHS is being used as a comparison.

I am happy to be British and have access to the NHS but I get the impression that the US model being presented by Obama is more like the healthcare system in France or Germany.


Zombieneighbours wrote:
If money is what incentivises you to become a doctor, you probably shouldn't become a doctor. Being smart is compatible with being altruistic. One potential for insurance under those conditions is mutualised system run by medical organisations. Remove the need for profit, and the Insurance system suddenly becomes far cheaper.

Money, unfortunately, is the incentive for a lot of folks. Altruism and a need to help others will motivate some to enter the medical field, I'm sure, but many will turn to 'safer' persuits, like the legal profession, laboratory work, etc. etc. It's not just the money, it's the fear of being ruined by spurious lawsuits. Why would you slog through decades of schooling and residency for a job that leaves you open to financial and professional ruin?

A mutualized malpractice system is fine, but the costs will still increase over time without some sort of cap on malpractice judgements. Also, the current US debate has no mention of mutualizing malpractice insurance. If you want to look for a big lobbying bloc, check out Big Legal. Not only do they throw wads of cash at both sides, most US politicians ARE lawyers by training.

Here's a link: Lawyer political contribution stats


GeraintElberion wrote:

It's probably a language thing, or perhaps how the debate is being framed in the US, but I am a little surprised that the NHS is being used as a comparison.

I am happy to be British and have access to the NHS but I get the impression that the US model being presented by Obama is more like the healthcare system in France or Germany.

OK I'll bite, how do those systems handle the issues we are discussing?


Patrick Curtin wrote:
Zombieneighbours wrote:
If money is what incentivises you to become a doctor, you probably shouldn't become a doctor. Being smart is compatible with being altruistic. One potential for insurance under those conditions is mutualised system run by medical organisations. Remove the need for profit, and the Insurance system suddenly becomes far cheaper.

Money, unfortunately, is the incentive for a lot of folks. Altruism and a need to help others will motivate some to enter the medical field, I'm sure, but many will turn to 'safer' persuits, like the legal profession, laboratory work, etc. etc. It's not just the money, it's the fear of being ruined by spurious lawsuits. Why would you slog through decades of schooling and residency for a job that leaves you open to financial and profession ruin?

A mutualized malpractice system is fine, but the costs will still increase over time without some sort of cap on malpractice judgements. Also, the current US debate has no mention of mutualizing malpractice insurance. If you want to look for a big lobbying bloc, check out Big Legal. Not only do they throw wads of cash at both sides, most US politicians ARE lawyers by training.

Well, do something about the litigious nature of your culture might be a good place to start :P

I don't have all the answer, especially on the fine details of american malpractic law. But I am certain that there is a workable system to be found.


Patrick Curtin wrote:
GeraintElberion wrote:

It's probably a language thing, or perhaps how the debate is being framed in the US, but I am a little surprised that the NHS is being used as a comparison.

I am happy to be British and have access to the NHS but I get the impression that the US model being presented by Obama is more like the healthcare system in France or Germany.

OK I'll bite, how do those systems handle the issues we are discussing?

I believe they are nationalised insurance schemes.

The Healthcare providers remain private, while everyone pays into the insurance pot, which is invested and then used to pay for illness amongst the population. Many such systems seem on paper to have many of the benifits of both the NHS and the american system.


Zombieneighbours wrote:
Well, do something about the litigious nature of your culture might be a good place to start :P

Umm .. that's kinda my point. But that's not on the table.

Zombieneighbours wrote:
I don't have all the answer, especially on the fine details of american malpractic law. But I am certain that there is a workable system to be found.

I'm sure there is too. I just want it discussed in a little more of a slow manner, not firesaled through Congress. When members of Congress don't even understand what they are voting for, that scares me. We can reform the system, and it DOES have its problems, believe me I am intimately wrapped up in healthcare. HOWEVER, the current 'we have to get this done in three weeks' attitude isn't doing us any good. Neither is the 'everything is fine, leave it alone' attitude. We need to debate this and come to a compromise that may not suit everyone, but that we can all live with.

As an aside, the Democratic Party doesn't need any Republicans to vote for this reform bill to pass it. The resistance is coming from their own moderates. So when looking for 'authoritarian followers', look towards the Blue Dogs. They're the ones holding up the legislation.


Patrick Curtin wrote:
Zombieneighbours wrote:
Well, do something about the litigious nature of your culture might be a good place to start :P

Umm .. that's kinda my point. But that's not on the table.

Zombieneighbours wrote:
I don't have all the answer, especially on the fine details of american malpractic law. But I am certain that there is a workable system to be found.

I'm sure there is too. I just want it discussed in a little more of a slow manner, not firesaled through Congress. When members of Congress don't even understand what they are voting for, that scares me. We can reform the system, and it DOES have its problems, believe me I am intimately wrapped up in healthcare. HOWEVER, the current 'we have to get this done in three weeks' attitude isn't doing us any good. Neither is the 'everything is fine, leave it alone' attitude. We need to debate this and come to a compromise that may not suit everyone, but that we can all live with.

As an aside, the Democratic Party doesn't need any Republicans to vote for this reform bill to pass it. The resistance is coming from their own moderates. So when looking for 'authoritarian followers', look towards the Blue Dogs. They're the ones holding up the legislation.

Out of interest; how would you feel about a more NHS style health system, in the US?


Zombieneighbours wrote:
we also don't have scenes like this.

Obviously an emotional scene. But ask yourself this: Why is it most American doctors no longer feel comfortable donating their time and expertise to free clinics as many did in previous years? Because their legal liability is the same no matter what they do. Also, recipients of free care are more likely to lodge malpractice suits.


Zombieneighbours wrote:
Out of interest; how would you feel about a more NHS style health system, in the US?

Well, politcally I am a Libertarian. We stand for small government as a rule. But I will conceed that ourcurrent system needs fixing. I just don't think that if the axle breaks in your car you swap out the motor and say 'it's all better now!' Let's look at the real underlying issues of why insurance costs so much and address them first before we throw baby out with the bathwater.


Patrick Curtin wrote:
Zombieneighbours wrote:
Well, do something about the litigious nature of your culture might be a good place to start :P

Umm .. that's kinda my point. But that's not on the table.

Zombieneighbours wrote:
I don't have all the answer, especially on the fine details of american malpractic law. But I am certain that there is a workable system to be found.

I'm sure there is too. I just want it discussed in a little more of a slow manner, not firesaled through Congress. When members of Congress don't even understand what they are voting for, that scares me. We can reform the system, and it DOES have its problems, believe me I am intimately wrapped up in healthcare. HOWEVER, the current 'we have to get this done in three weeks' attitude isn't doing us any good. Neither is the 'everything is fine, leave it alone' attitude. We need to debate this and come to a compromise that may not suit everyone, but that we can all live with.

As an aside, the Democratic Party doesn't need any Republicans to vote for this reform bill to pass it. The resistance is coming from their own moderates. So when looking for 'authoritarian followers', look towards the Blue Dogs. They're the ones holding up the legislation.

As usual Patrick you are the voice of reason. A lot of the "paranoia" going on about this bill is caused by the Dems PR. Trying to shove it through so quickly and having the attitude that "we haven't read the bill but trust us this is a great thing for a America to do" isn't helping the situation any. As you said, the Republicans can't do a thing to stop this, it's the Blue Dogs holding it up. Perhaps spin doctors like Madow needs to go after her own party instead of attacking protesting senior citizens.


Patrick Curtin wrote:
Zombieneighbours wrote:
we also don't have scenes like this.
Obviously an emotional scene. But ask yourself this: Why is it most American doctors no longer feel comfortable donating their time and expertise to free clinics as many did in previous years? Because their legal liability is the same no matter what they do. Also, recipients of free care are more likely to lodge malpractice suits.

Cause aside, it should not be happening. I think we can all agree that scenes like this, which are relatively common in the united states, speak volumes as to the state of the US healthcare system, and it's ablity to provide basic healthcare for all.

I would not be suprised at all, if a similar corrilation which showed the more often you came into contact with a healthcare professional, the less likely you are to sue for medical malpractice.

Malpractice is something that needs to be in place, people have a right to redress when something goes seriously wrong. But yes, i also think reform of damages awards would likely be a good thing.


Patrick Curtin wrote:
Zombieneighbours wrote:
Out of interest; how would you feel about a more NHS style health system, in the US?
Well, politcally I am a Libertarian. We stand for small government as a rule. But I will conceed that ourcurrent system needs fixing. I just don't think that if the axle breaks in your car you swap out the motor and say 'it's all better now!' Let's look at the real underlying issues of why insurance costs so much and address them first before we throw baby out with the bathwater.

Well, i think that demends.

If the cost of repairing the axel is greater than the resale value of the car, perhapes your better off just selling it for scrap. Especially if you need to get to work, rather than faf about getting it road worthy. At the momment, the system seems to be utterly f*!$ed, i understand i speak as an outsider, but from what i can see it is the case.

While the political games go on, from both sides, people are cueing up in car parks of the 'fly over states' being treated by overstretched charities. In the mean time, over here, those same people would be being treated.

Does your divotion to the ideas of small government, or your compassion have greater sway.

I understand your position, and i do share some of it. But on the issue of education, healthcare and basic research, how can you allow a political ideal to outway need?


Patrick Curtin wrote:


OK I'll bite, how do those systems handle the issues we are discussing?

Yes, Geraint is right, the current proposals for reform look nothing at all like Britain's NHS (which IS socialized medicine). For that matter, they don't look all that much like France or Germany (which is single-payer). They are a more unique American thing, to be honest, mostly because socialized medicine or a single-payer system would be very very tough sells in this country. I've put up at least one post talking about the different methods, but I'll try explaining again.

First though, one point. Britain's NHS system is cheap. Unbelievably, insanely cheap. Cheaper than France, than Canada, than Germany, than Japan. Each year, America spends $7290 per person (obviously, averaged out). Britain spends $2992. That's a $4298 difference. And their costs are rising slower than ours, so that difference gets bigger every year. Plus, they have universal health care for all (as our limey posters have kindly provided information on ... thanks guys!)

But, anyhoo, no the current proposals are nothing like Britain's NHS, or like France or Germany's single-payer system. At best they are perhaps a first step towards something like France or Germany, but really, the current proposals are nothing at all like them.

In France or Germany you have a single-payer system. Essentially everyone receives health insurance through the government that pays for their health care with private doctors. Canada is similar, except Canada outlaws the ability to get private care, France and Germany do not.

Again, the reforms we are currently trying to get are mostly private insurance reforms. Here is a list of the big ones:

  • No excluding coverage for preexisting conditions
  • Capped yearly out-of-pocket expenses
  • No lifetime coverage caps
  • No dropping coverage due to illness
  • No gender discrimination
  • Preventative health care fully covered
  • Children eligible for family coverage until 26
  • Guaranteed renewal if you pay your premiums

The other two big reforms (insurance exchanges and public option) are aimed towards the individual insurance market, where people without job-based insurance are left to shop. Currently it is a giant mess, and the aim is to help it out by creating exchanges. Exchanges would be a place where individuals could purchase health insurance in a regulated competitive marketplace. Exactly what form they'll take isn't hashed out yet, some options are

  • National vs Local
  • Open to all vs Open to poor

Likewise, the public option is simply an insurance plan only available through the exchange. Some possibilities are


  • Open to all on exchange vs Open to poor on exchange
  • Automatically available vs Available is other plans to not meet given requirements

Lots of people on the left (me included!) wish health care reform went further; much further! But we toned down the extent of the changes because we knew the right opposed them. And apparently our concessions didn't do us any good. Sigh.

RPG Superstar 2009 Top 32

Patrick Curtin wrote:
As an aside, the Democratic Party doesn't need any Republicans to vote for this reform bill to pass it. The resistance is coming from their own moderates. So when looking for 'authoritarian followers', look towards the Blue Dogs. They're the ones holding up the legislation.

I need to fix your quote though.

Patrick Curtin wrote:
... The resistance is coming from their own moderates. So when looking for 'authoritarian followers', look towards the Blue Dogs. They're the ones RIGHTLY holding up the legislation.

As I understand it, the "Blue Dog" position is:

  • We despirately need Health Care Reform.
  • We need to figure out how we are going to pay for it ... without (a) Borrowing or (b) "Printing" Money.
    To me that is a sensible position.

    Many of our current problems come from the Republicans doing exactly what the Democrats are now trying to do - Forcably ramming something through without due consideration (most notoriusly the Iraq War and the Patriot Act).

    It was wrong then, just as it is a bad idea now.


  • David Marks wrote:
    Patrick Curtin wrote:


    OK I'll bite, how do those systems handle the issues we are discussing?

    Yes, Geraint is right, the current proposals for reform look nothing at all like Britain's NHS (which IS socialized medicine). For that matter, they don't look all that much like France or Germany (which is single-payer). They are a more unique American thing, to be honest, mostly because socialized medicine or a single-payer system would be very very tough sells in this country. I've put up at least one post talking about the different methods, but I'll try explaining again.

    First though, one point. Britain's NHS system is cheap. Unbelievably, insanely cheap. Cheaper than France, than Canada, than Germany, than Japan. Each year, America spends $7290 per person (obviously, averaged out). Britain spends $2992. That's a $4298 difference. And their costs are rising slower than ours, so that difference gets bigger every year. Plus, they have universal health care for all (as our limey posters have kindly provided information on ... thanks guys!)

    But, anyhoo, no the current proposals are nothing like Britain's NHS, or like France or Germany's single-payer system. At best they are perhaps a first step towards something like France or Germany, but really, the current proposals are nothing at all like them.

    In France or Germany you have a single-payer system. Essentially everyone receives health insurance through the government that pays for their health care with private doctors. Canada is similar, except Canada outlaws the ability to get private care, France and Germany do not.

    Again, the reforms we are currently trying to get are mostly private insurance reforms. Here is a list of the big ones:

    • No excluding coverage for preexisting conditions
    • Capped yearly out-of-pocket expenses
    • No lifetime coverage caps
    • No dropping coverage due to illness
    • No gender discrimination
    • Preventative health care fully covered
    • Children eligible for family coverage until 26
    ...

    Thank you, David.

    It is nice to see so much of what is being planned in one place. I am slightly shock, I thought the reforms wen't much further than that.


    Patrick, I did some looking into medical malpractice points you are making and found some interesting things.

    (I have found the list tag, and it is good.)


    • The total of all malpractice insurance premiums amounts to 0.56% of health care costs.
    • The CBO has examined the idea of defensive medicine. They found no difference in practice between states with limits on tort settlements and those with no limits.
    • There is no correlation between the price of malpractice premiums and the amount given out in malpractice settlements.
    • The price of premiums does (anti) correlate with interests rates.
    • If you take all the money given out in malpractice settlements over $250,000 in NJ ( a state without caps) in a year and give it to physicians, each doctor would get $15.

    This link might provide you with more reading from a left PoV on the malpractice issue.

    Now for the fun (although terrifying) fact of the day. How many people die every year in traffic accidents? How many die in hospitals from preventable causes? Which do you think is bigger, and what do you think the relationship is?

    Ready? Car crashes cause 40000~50000 deaths a year. Preventable deaths within a hospital on the other hand are on the scale of 100000 for just infections caused by improper sterilization. That's over double the number for car crashes and five times the number of homicides. If you include blood clots post-surgery, the number increases by another 200000. Common wisdom is that medical malpractice insurance is a highly onerous burden, but my first look into the matter is suggesting common wisdom is wrong here.


    Zombieneighbours wrote:


    Especially if you need to get to work, rather than faf about getting it road worthy. At the momment, the system seems to be utterly f&&#ed, i understand i speak as an outsider, but from what i can see it is the case.

    Not really. Our system has a lot of problems and faults but it's not nearly as bad as it shows on propaganda films. There have been conservatives that have made propaganda films that makes nationalized healthcare look like a total disaster as well.


    David Marks wrote:


  • If you take all the money given out in malpractice settlements over $250,000 in NJ ( a state without caps) in a year and give it to physicians, each doctor would get $15.[/list]
  • This would put insurance within a mutual organisation considerably more viable than even I considered it to be.

    Ofcause, I should hardly be supprised given the nature of insurance companies, but hey.


    Garydee wrote:
    Zombieneighbours wrote:


    Especially if you need to get to work, rather than faf about getting it road worthy. At the momment, the system seems to be utterly f&&#ed, i understand i speak as an outsider, but from what i can see it is the case.

    Not really. Our system has a lot of problems and faults but it's not nearly as bad as it shows on propaganda films. There have been conservatives that have made propaganda films that makes nationalized healthcare look like a total disaster as well.

    Panorama isn't a propiganda film, it is a documentry from an institution with stated political neutrality. While there is a slight institutional bias towards the socially liberal left, the problems raised by the film are genuine and as bad as shown. This wasn't made by a political party to prove a point.

    There is a marked difference between showing hundreds of people who can't get basic healthcare, and an interview with one or two people with especially rare cancers who are upset, because they cannot get a drug that is unlikely to even help them, on the NHS.

    I have seen the films to which you refer, and they arn't up to the BBC's standards, on research, or anything else.


    Lord Fyre wrote:


    As I understand it, the "Blue Dog" position is:

  • We despirately need Health Care Reform.
  • We need to figure out how we are going to pay for it ... without (a) Borrowing or (b) "Printing" Money.
    To me that is a sensible position. (Note that it actually DOES allow for raising taxes! - not that any of the "Blue Dogs" actually like that option.)

    Many of our current problems come from the Republicans doing exactly what the Democrats are now trying to do - Forcably ramming something through without due consideration (most notoriusly the Iraq War and the Patriot Act).

    It was wrong then, just as it is a bad idea now.

  • The problem with the "Blue Dog" complaints is that while complaining about the need to control spending, they consistently vote against all proposals to control spending! It's hard to control spending to their desire while fighting them over spending control. It's one of those democracy sucks except for all those other options things.

    TL;DR - "Blue Dogs" are incredibly frustrating because they don't seem to be arguing in good faith. Sure I'll support you if you do X. But I won't support your attempts to do X. Sigh.


    Zombieneighbours wrote:
    Panorama isn't a propiganda film, it is a documentry from an institution with stated political neutrality. While there is a slight institutional bias towards the socially liberal left

    You're kidding right? The film that I saw was not slightly left leaning. It was a left-wing propaganda tool.

    Quote:
    left the problems raised by the film are genuine and as bad as shown.

    No, it isn't. This comes from an American who has first hand experience not having health care insurance.


    Garydee wrote:
    Zombieneighbours wrote:


    Especially if you need to get to work, rather than faf about getting it road worthy. At the momment, the system seems to be utterly f&&#ed, i understand i speak as an outsider, but from what i can see it is the case.

    Not really. Our system has a lot of problems and faults but it's not nearly as bad as it shows on propaganda films. There have been conservatives that have made propaganda films that makes nationalized healthcare look like a total disaster as well.

    The problem, I think, is that the American system has been setup to hide its problems VERY well. There are so many insulating layers between the actual system and its normal users that no one really knows whats going on.

    Our reliance on employer based health insurance puts our corporations at a disadvantage against corporations from nearly every other country in the world, where there is no such reliance. Hell, our entire domestic auto-industry is choking and dying over this very thing as we speak. Small businesses have no small amount of trouble for the same reasons, not to mention that the owners have the terrible task of buying from the individual market, something I wouldn't wish on my worst enemy.

    Even if you have insurance you have no guarantees that they will cover your problems, or that they won't drop you as soon as you become sick. If you lose your job you lose your health care. If you become sick without health care it is nearly impossible to get covered again. Babies have been denied coverage because their birth defects were preexisting conditions ... how can that be appropriate or tolerated?

    And then there is the simple fact that despite spending more on health care than nearly any other country (any other? I'd need to go see if there is even another that spends as much as us) the results of our care are generally equal to slightly inferior! We're paying a huge amount more and getting worse results. But again, how would the average person have any clue to this?


    Adventure Path Charter Subscriber
    Garydee wrote:


    You're kidding right? The film that I saw was not slightly left leaning. It was a left-wing propaganda tool.

    Differing perspectives and all that. I'm probably as skeptical of your assessment of so-called left-wing propaganda tools as you are of my assessment of Fox News as part of the irresponsible, right-wing, Republican noise machine.


    Bill Dunn wrote:
    Garydee wrote:


    You're kidding right? The film that I saw was not slightly left leaning. It was a left-wing propaganda tool.
    Differing perspectives and all that. I'm probably as skeptical of your assessment of so-called left-wing propaganda tools as you are of my assessment of Fox News as part of the irresponsible, right-wing, Republican noise machine.

    Very true. Just as I see CNN and all of NBC's ten zillion channels as irresponsible, left-wing Democrat noise machines. It's all perspective.


    Garydee wrote:
    Zombieneighbours wrote:
    Panorama isn't a propiganda film, it is a documentry from an institution with stated political neutrality. While there is a slight institutional bias towards the socially liberal left

    You're kidding right? The film that I saw was not slightly left leaning. It was a left-wing propaganda tool.

    Quote:
    left the problems raised by the film are genuine and as bad as shown.
    No, it isn't. This comes from an American who has first hand experience not having health care insurance.

    Firstly, your politics is squeed out onto the right so far it can't see where the rest of the world lies. Your on the socially liberal(if memory serves) right, in a country that's left of where englands centre right sits. So i am hardly supprised centrist reporting from just about anywhere else is going to look biased to you.

    You say it isn't that bad? So there weren't real people who had travelled hundreds of mile to be there? So there where not people who had not seen doctors in years? So there wasn't a charity who does 60% of there total work in the U.S. providing free healthcare? Do 23,000 americans a year really not die from lack of basic healthcare? If you think these claims are false, HERE is the contact info for OFCOM, your welcome to make a complaint. If you believe the documentry is misleading, you have a right of reply.

    The Exchange

    Pathfinder Adventure Path Subscriber
    Zombieneighbours wrote:
    Firstly, your politics is squeed out onto the right so far it can't see where the rest of the world lies. Your on the socially liberal(if memory serves) right, in a country that's left of where englands centre right sits.

    I whonder where it makes us Germans sit. I guess, Karl Marx would be proud of his countrymen. :D

    But I have to admit that I thought the same; if that is left-wing propaganda, then there's no right wing in Germany.


    WormysQueue wrote:
    Zombieneighbours wrote:
    Firstly, your politics is squeed out onto the right so far it can't see where the rest of the world lies. Your on the socially liberal(if memory serves) right, in a country that's left of where englands centre right sits.

    I whonder where it makes us Germans sit. I guess, Karl Marx would be proud of his countrymen. :D

    But I have to admit that I thought the same; if that is left-wing propaganda, then there's no right wing in Germany.

    I don't know, on somethings your left of us, on others right. I am sad to say, my overall knowledge of modern german politics is not what it should be.


    So, having read every post, I now realize something: for Americans, health care is not the issue under debate. It's just more of the same old "us" vs. "them" Republican vs. Democrat crap. Anyone in favor is obviously a communist. Anyone opposed is obviously a right-wing extemist. There are no Americans anymore; just two mutually antagonistic camps, always happy to cut off a nose to spite the face.


    Kirth Gersen wrote:
    So, having read every post, I now realize something: for Americans, health care is not the issue under debate. It's just more of the same old "us" vs. "them" Republican vs. Democrat crap. Anyone in favor is obviously a communist. Anyone opposed is obviously a right-wing extemist. There are no Americans anymore; just two mutually antagonistic camps, always happy to cut off a nose to spite the face.

    That is an uncomfortably close description of what it's like over here. Sigh.


    WormysQueue wrote:
    Zombieneighbours wrote:
    Firstly, your politics is squeed out onto the right so far it can't see where the rest of the world lies. Your on the socially liberal(if memory serves) right, in a country that's left of where englands centre right sits.

    I whonder where it makes us Germans sit. I guess, Karl Marx would be proud of his countrymen. :D

    But I have to admit that I thought the same; if that is left-wing propaganda, then there's no right wing in Germany.

    I would not have said that if the film was more balanced. They could have mentioned the good things about the American system with the bad or they could have mentioned the problems with national healthcare. No, it was all about bashing American healthcare. As I said before, we have conservatives who pull the same thing. There was a recent film about how slow ERs move in Canada and how you might die waiting. I condemn them as being irresponsible as well.

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