No one in the US lacks health insurance

[Angie Gallant]

Well, according to this asshole. (http://www.dallasnews.com/sharedcontent/dws/bus/stories/DN-Uninsured_27bus.ART.State.Edition2.4dce428.html)

But the numbers are misleading, said John Goodman, president of the National Center for Policy Analysis, a right-leaning Dallas-based think tank. Mr. Goodman, who helped craft Sen. John McCain's health care policy, said anyone with access to an emergency room effectively has insurance, albeit the government acts as the payer of last resort. (Hospital emergency rooms by law cannot turn away a patient in need of immediate care.)

"So I have a solution. And it will cost not one thin dime," Mr. Goodman said. "The next president of the United States should sign an executive order requiring the Census Bureau to cease and desist from describing any American – even illegal aliens – as uninsured. Instead, the bureau should categorize people according to the likely source of payment should they need care.

"So, there you have it. Voila! Problem solved."

The government paying for ER trips when you default on the debt is not at all the same as having healthcare coverage.

[wildpokerman]

So if you're willing to go bankrupt you'll get lifesaving care?

Thank God we live in a country where we can get care like this as long as we're willing to spend every penny we have first:

http://www.msnbc.msn.com/id/19207050/

Good to see McCain's name linked to this, I was needing a reason to vote Obama after the stupid FISA vote.

[magnet]

insurance

You keep using that word. I do not think it means what you think it means.

[Adree]

http://img144.imageshack.us/img144/5379/lebowski3ahe8.jpg???

[Greatatlantic]

Paul Krugman responded (http://www.nytimes.com/2008/04/11/opinion/11krugman.html?_r=1&oref=slogin)to this "observation" back in April, made at the time by Bush.

How can such things happen? “I mean, people have access to health care in America,” President Bush once declared. “After all, you just go to an emergency room.” Not quite.

First of all, visits to the emergency room are no substitute for regular care, which can identify and treat health problems before they get acute. And more than 40 percent of uninsured adults have no regular source of care.

Second, uninsured Americans often postpone medical care, even when they know they need it, because of expense.

Finally, while it’s true that hospitals will treat anyone who arrives in an emergency room with an acute problem — and it’s wonderful that they will — it’s also true that hospitals bill patients for emergency-room treatment. And fear of those bills often causes uninsured Americans to hesitate before seeking medical help, even in emergencies, as the Monique White story illustrates.

[Nellie]

Finally, while it’s true that hospitals will treat anyone who arrives in an emergency room with an acute problem — and it’s wonderful that they will
??? It's the absolute very least I'd expect from a healthcare system.

What happens when you get a slowly progressing, ultimately terminal but treatable condition that wouldn't warrant tying up casualty?

[Robert Sharp]

I've been without medical insurance for the last couple of months. My insurance at my new job starts on September 1st. In the meantime, I've been cowering in my corner in a fetal position hoping to stay healthy. From time to time I run over to my keyboard to post on Qt3, but I just don't feel safe at this moment.

Glad to know I have a safety net though!

[Chris Nahr]

??? It's the absolute very least I'd expect from a healthcare system.

Well, they could carve you up into quivering organs instead which are sold to the highest bidder. Have you considered that? I bet you haven't!

[Eric T Cheng]

As a Canadian I find the lack of universal health care coverage in the US very alien. Granted that it's not true "universal" since dental, optical and drugs aren't covered. But I don't have to worry about being billed or which doctor I can or cannot see.

I see having universal health care as a necessary social programme as primary/secondary education, the fire department and the police. Things that are necessary for a healthy society.

Currently I'm unemployed (I got laid off almost two months ago when my studio was shut down) but I am still covered by the provincial government. In fact it's the law that everyone in the province is covered. When I was employed the provincial health care insurance premium was invisibly deducted from my paycheques but now that I'm unemployed I am billed bi-monthly for $55 a month. If I was making below the poverty line (which is around $22,000 a year I think...) I could have applied for social assistance and the government would waive the premium.

About five years ago I had a bike accident where I went over the handlebars of my mountain bike and I got a concussion from landing on my head. An ambulance arrived and drove me to the hospital. Since I was riding my bike during a break from work I didn't have my wallet with me. The hospital clerk just needed my name and address (which I barely recalled due to the concussion) and from that the hospital would find my health insurance number and bill them. The only bill I got was for the ambulance, which was $25.

So when I hear/read horror stories where American families spend thousands of dollars on medical bills or get turned down for procedures by their insurance companies, I don't mind paying a bit more in taxes. I'm shocked when I hear/read Americans saying they don't want universal health care because they don't want their tax dollars pay for "lazy" Americans who can't afford health care insurance but have no qualms of spending hundreds of billions of dollars in Iraq.

[WarrenM]

There are some benefits though, Eric. Like, when scheduling procedures you don't have to wait upwards of a year to get it done. Down here, you usually get in pretty quick because it isn't free.

My little brother and I needed to get some genetic testing done last year and while mine was done within a month, he (still in Canada) waited 6 months before they could accomodate him.

[Marged]

Was that genetic testing urgent?

[Eric T Cheng]

There are some benefits though, Eric. Like, when scheduling procedures you don't have to wait upwards of a year to get it done. Down here, you usually get in pretty quick because it isn't free.

My little brother and I needed to get some genetic testing done last year and while mine was done within a month, he (still in Canada) waited 6 months before they could accomodate him.

True. But the long wait is usually for non-life threatening procedures. There have been medical clinics that offer procedures for those who have the money, and thus avoiding the months long wait period. However, the provincial governments are wary of them because they don't want a two tier health care system (one for everyone and one for the rich).

Sadly though, the provincial governments do recognize the limitations of the Canadian health care system. For example, here in BC there is a shortage of neonatal intensive care beds (http://www.canada.com/vancouversun/news/story.html?id=236a7234-03bf-4d68-8979-117b660b6ba8&k=78782) and medical staff, so many pregnant women are sent to either Alberta or Washington state.

The provincial government spent $8 million to send 111 women out of province in the fiscal year ended March 31. In all 78 of these women went to Washington state where medical costs are significantly higher. The other 33 went to Alberta -- 19 because they live close to the Alberta border and 14 because there were no beds in B.C.

Alberta is the first choice destination for B.C. because health costs are comparable.

PBS's Frontline has a great documentary, Sick Around the World (http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/), on the different types of universal health care systems in various first world countries (Great Britain, Switzerland, Germany, Taiwan, and Japan). When the Taiwanese government decided to have an universal health care system, they looked at other countries' systems and took the best from each.

[WarrenM]

Was that genetic testing urgent?
It wasn't immediately life threatening, no. That's a valid point though and I don't have any data on life threatening situations.

[Jason McCullough]

What happens when you get a slowly progressing, ultimately terminal but treatable condition that wouldn't warrant tying up casualty?

You frantically scramble to find someone else to pay for it, or you die. The stories I've heard about tend to have a lot of fund-raising campaigns or trying to get poor enough to qualify for Medicaid.

[MarchHare]

That's a valid point though and I don't have any data on life threatening situations.

According to a recent study conducted jointly by Canadian and American researches, patients in both countries have very similar outcomes when diagnosed with the same condition. This despite the fact that US citizens pay nearly twice as much as Canadians per capita on healtcare despite not having a universal system.

http://www.cbc.ca/health/story/2007/04/18/health-canada-us.html


"In looking at patients in Canada with a specific diagnosis compared to Americans with the same diagnosis, in Canada patients had at least as good an outcome as their American counterparts — and in many situations, a better health outcome," said one of the 17 authors, Dr. P.J. Devereaux, a cardiologist and clinical epidemiologist at McMaster University in Hamilton.

"And that is important because in the United States, they're currently spending a little over $7,100 per individual on health care annually, whereas in Canada we're spending a little over $2,900 per individual annually," he said in a telephone interview from Brantford, Ont

[...]

"Overall, Canada did better, and in fact we found a statistically significant five per cent mortality advantage [of survival] to people with diagnoses in Canada compared to their counterparts in the United States," Devereaux said.

[...]

Few uninsured patients in the United States, who probably suffer the worst quality care, were included in the studies examined.


Emphasis added.

[Tim James]

You frantically scramble to find someone else to pay for it, or you die. The stories I've heard about tend to have a lot of fund-raising campaigns or trying to get poor enough to qualify for Medicaid.If I were ever in this situation, I'd probably ask Hillary Clinton to spot me some cash.

[Taranis]

There are some benefits though, Eric. Like, when scheduling procedures you don't have to wait upwards of a year to get it done. Down here, you usually get in pretty quick because it isn't free.

My little brother and I needed to get some genetic testing done last year and while mine was done within a month, he (still in Canada) waited 6 months before they could accomodate him.
I would like to share a story of some examples of the two systems, I live near the Canadian border close enough that I had my house built in Canada and shipped to the US and its not unusual for Canadians to move to our area.

I have a close coworker that in fact married a women from Manitoba and she now lives in the States and is a American citizen. Her mother who still resides in Canada had a bout with breast cancer resulting in a amputation many years ago, she recovered and was cancer free for serveal years. But a few years ago she found a lump in her other breast, went to the doctor and was told that the earliest they could preform an biopsy was four months. Her and husband couldn't afford to go to a private clinic or have it done in the States so they just waited for her appointment, after the procedure was done the results were as they feared and worse yet it had spread to other organs. They tried to treat her but it was to far gone and she died rather young less then year after being diagnosed. Now she might have had the same results even if she was able to get a biopsy right away but that's just speculation it was a life threatening situation from a person with a history of cancer there's no excuse not to get her in right away.

I would also like to add that this same coworker had complications with there second child, complications (that according do his wife's sister who's a nurse in Canada) would had most likely gone unnoticed and would have a very little chance of success in delivering in Canada. But thankfully it was found during their pregnancy and they were referred to the Children s Hospital in the Twin cities . They were treated by some of the best doctors in the county and everything went perfect. But the delivery and treatment was an enormous cost around $2 million, fortunately they had insurance and had to only cover the deductible of $1,500. I dont know what the case would be if they hadn't been insured, but they did say there were several low income families there with them in the hospital and they didn't believe all of them had insurance. Unfortunaly this example can be countered with far to many cases that ended not so well.

I think we have the best broken health care system in the world, I dont want socialize heath care but rather I think we need to fix the system we have now. Lawyers, Insurance and drug companies are breaking the back of our system and somthing needs to change. Hopefully in the future there will be a way that everyone can be covered that doesnt lower the quality of care or require you go bankrupt to recieve it!

[Matthew Gallant]

The McCain campaign has said that "they do not consider this guy to be an official adviser" after the fact.

[Adam B]

The Childrens' Hospital in St. Paul is amazing. Saved my young life. Anyway...

Lawyers, Insurance and drug companies are breaking the back of our system and somthing needs to change.

Like, maybe, making it so that denying treatment isn't incentivized any more? That might be a start, I don't know...

[Dirt]

I would also like to add that this same coworker had complications with there second child, complications (that according do his wife's sister who's a nurse in Canada) would had most likely gone unnoticed and would have a very little chance of success in delivering in Canada. But thankfully it was found during their pregnancy and they were referred to the Children s Hospital in the Twin cities . They were treated by some of the best doctors in the county and everything went perfect. But the delivery and treatment was an enormous cost around $2 million, fortunately they had insurance and had to only cover the deductible of $1,500. I dont know what the case would be if they hadn't been insured, but they did say there were several low income families there with them in the hospital and they didn't believe all of them had insurance. Unfortunaly this example can be countered with far to many cases that ended not so well

Wonder what would have happened if they didn't have insurance?

[MarchHare]

(Story about woman dying of cancer)

While that anecdote is indeed very unfortunate, as you know, the plural of 'anecdote' is not 'statistics'. As per the link I posted earlier in this thread, it's been demonstrably proven that, on average, Canadians receive healthcare outcomes that are as good or even better than what is given to (insured) Americans, all for a fraction of the cost.

[Robert Sharp]

It will always be a trade, but I think the statistics are very interesting. I've always been against universal healthcare on the basis of not wanting to pay for others, etc. You know, typical American reasons. But if the evidence suggests that I could pay less than I am paying now and receive healthcare of the same or better level, I'd be a fool not to want that, for both personal and societal reasons.

I actually teach medical ethics, and doing so has swayed my views a bit as well. It's not just the horror stories, because you'll find those on both sides. It's the raw data. Now, personally, I'd prefer a two-tiered system, as long as it didn't corrupt the lower tier (i.e. as long as it didn't lead to poor medicine for the universal aspect). I have no problem with rewarding people for being wealthy, but two-tiered systems often lead to inequities that can essentially ruin the lower tier by leading the better doctors to go for the money of private clinics. If some rules could be put in place to ensure equitable treatment, so that all the wealthy people were getting is faster care on largely optional procedures, I would have no problem with that.

[MarchHare]

I've always been against universal healthcare on the basis of not wanting to pay for others, etc. You know, typical American reasons.


Being the lefty/commie/hippy/socialist Canadian that I am*, I find this attitude more than a little strange. Are you also against universal police and fire protection, public schools, etc. because you don't want to pay for others?

From an economics perspective, I'm also curious if anyone has ever done a study to determine if the competitiveness of American businesses is harmed since most of them must purchase private health insurance for their employees. I have absolutely no data to support this claim, but I suspect it costs GM (for example) less to employ a unionized autoworker in Southern Ontario than it does in Michigan because the Canadian employee already has basic medical coverage (extended coverage such as vision/dental is another issue, but insurance for that would need to be purchased in either country).

*I'm actually more a less a centrist on the Canadian political spectrum

[Talisker]

Providing a medical plan for employees is brutally expensive for most small businesses.

[Robert Sharp]

Being the lefty/commie/hippy/socialist Canadian that I am*, I find this attitude more than a little strange. Are you also against universal police and fire protection, public schools, etc. because you don't want to pay for others?


You have to remember that police, fire protection, and schools directly benefit me. I 'use' all of them. So no, I've never been against them. If there were no police, people could come rob my home. If there were no doctors for other people, they wouldn't come to me.

Now obviously you could argue on the basis of stopping epidemics or something. But if you break your leg or eat like crap and get a health problem or whatever, I'm not really responsible for that. And yet, you expect me to help you pay for it, and if I make more money than you, you expect me to pay more.

Basically, that's how the thinking works. As I said, I'm starting to change my mind on some of this.

[Talisker]

But if you break your leg or eat like crap and get a health problem or whatever, I'm not really responsible for that. And yet, you expect me to help you pay for it, and if I make more money than you, you expect me to pay more.
But if you have an electrical short or smoke in bed and your house catches fire or whatever, I'm not really responsible for that. And yet, you expect me to help you pay for the fire department, and if I make more money than you, you expect me to pay more.

[Dirt]

I have no kids. Yet, I pay for schools.

[MarchHare]

You have to remember that police, fire protection, and schools directly benefit me. I 'use' all of them. So no, I've never been against them. If there were no police, people could come rob my home. If there were no doctors for other people, they wouldn't come to me.

Now obviously you could argue on the basis of stopping epidemics or something. But if you break your leg or eat like crap and get a health problem or whatever, I'm not really responsible for that. And yet, you expect me to help you pay for it, and if I make more money than you, you expect me to pay more.

Basically, that's how the thinking works. As I said, I'm starting to change my mind on some of this.


I just don't understand the logic behind being in favour of publicly-funded police, fire protection, and eduction services but being opposed to publicly-funded healthcare. Yes, you're obviously not responsible if someone breaks his leg, but you're also not responsible if someone lights his kitchen on fire or has his car stolen, nor are you responsible for providing an education to other people's children.

[Thrag]

First, universal health insurance is not socialized medicine. It seems in these debates there is constant obfuscation between the two. Nobody in America in any position to make anything happen is proposing socialized medicine.

Our system is massively broken. We pay a much higher cost for our care. Administrative costs alone in America are 31%. Just think about that, 31 cents of every dollar you spend on health care goes to administrative costs, extra assistants to deal with all the different insurance forms, CEO salary and bonus for the insurance company, marketing costs, the low level functionary whose job it is to find way to deny as many claims as possible to keep the profit margin up. 31%, given that we spend about 16% (and rapidly rising) of our ~$13 trillion dollar GDP, that's like 650 billion dollars on useless administrative bullshit.

Just to make that 31% seem even more ludicrous, other nations with universal care range from 2% (Taiwan) to 5-6% (France, Germany, etc.) in administrative costs. Compared to most industrialized nations we pay between 1600% to 500% of their administrative costs.

If we can get our administrative costs alone down to levels comparable to that of others nations who have more comprehensive health insurance systems we can save some 500-600 billion dollars on those costs alone. That's just administrative costs. It doesn't even factor in how cost goes down as availability of preventative care goes up and other factors.

It's absolutely ridiculous that we still have the most inefficient health insurance system possible.

[Reldan]

But if you have an electrical short or smoke in bed and your house catches fire or whatever, I'm not really responsible for that. And yet, you expect me to help you pay for the fire department, and if I make more money than you, you expect me to pay more.

It's not in your best interest for his house to burn, and then since no one is putting the fire out it spreads and burns half the city down. You directly benefit from the fire being put out quickly and efficiently as you really don't want these things to rage out of control.

Fire is similar to an epidemic, which he already noted is an exception case in his thinking. Except Fire is ALWAYS like that whereas most health care is not actively stopping the spread of an acute epidemic.

If we do adopt universal health care and I have to pay for everyone else's care, would that legitimize the persecution of obese people for burdening the system with their increased health care needs?

[tronnc]

You have to remember that police, fire protection, and schools directly benefit me. I 'use' all of them. So no, I've never been against them. If there were no police, people could come rob my home. If there were no doctors for other people, they wouldn't come to me.

Basically, that's how the thinking works. As I said, I'm starting to change my mind on some of this.

I don't think your rational is applicable for schools. In fact if schools weren't already provided by the government and we were debating on universal education instead of health care I think you would be making the same arguments against universal eduction.


Now obviously you could argue on the basis of stopping epidemics or something. But if you break your leg or eat like crap and get a health problem or whatever, I'm not really responsible for that. And yet, you expect me to help you pay for it, and if I make more money than you, you expect me to pay more.


Isn't that how health insurance in the US works now. The jobs I've had with health benefits never had some sort of grading payment scale based on your health and habits. My coworkers can eat like crap and do whatever and they are paying the same amount as the healthy guy.

I'm very much in favor of universal health care I see not having it really hurting the economy, in that smaller companies simply don't have the resources to compete with big ones because providing health care is just too expensive. Its considered by most workers a necessary benefit for a full time job and if your company can't afford it your not going to keep those workers around.

[Lh'owon]

But if you break your leg or eat like crap and get a health problem or whatever, I'm not really responsible for that. And yet, you expect me to help you pay for it, and if I make more money than you, you expect me to pay more.

That's right. It's a part of living in a civilised society, in my opinion.

You aren't responsible for for pretty much anything that would cause someone to seek health care... I don't know where you're coming from there.

[Thrag]

You have to remember that police, fire protection, and schools directly benefit me. I 'use' all of them. So no, I've never been against them. If there were no police, people could come rob my home. If there were no doctors for other people, they wouldn't come to me.

Now obviously you could argue on the basis of stopping epidemics or something. But if you break your leg or eat like crap and get a health problem or whatever, I'm not really responsible for that. And yet, you expect me to help you pay for it, and if I make more money than you, you expect me to pay more.

Basically, that's how the thinking works. As I said, I'm starting to change my mind on some of this.

I've never understood how a nation that started with such wonderful notions like "better ten guilty men go free then one innocent man go to jail" ended up with notions like "better millions go without health insurance than one deadbeat get his twisted ankle wrapped up on my dime!".

Yes, you can argue on the basis of stopping epidemics and even non epidemic diseases. If everyone had access to health insurance and care TB and other infectious diseases wouldn't be making such a strong comeback. A high standard of health care benefits us all. A healthy workforce is a more productive workforce. A healthy society fears epidemics less.

[wisefool]

I have no kids. Yet, I pay for schools.

That's when you lobby for lower property taxes (which fund schools).
Actually that's probably a good point to explain to the Canadian. We have 50 states and a 3077 counties (http://en.wikipedia.org/wiki/County_(United_States)) in the USA. I'm going to guess police, schools, and fire protection are paid for from local taxes.

Health Insurance is difficult to pin down in the US.

There's private insurance paid for by employer (tax deductible) and partially by the employee. There's government medicare (federal budget, mostly senior citizens). There's medicaid (poor people, paid for state and federal, managed by state.)

My only hope is whatever system they decide to implement, it reduces bureaucracy and administrative waste. 20% and god knows how many trees.


http://64.233.169.104/search?q=cache:bNpfLNUIU6MJ:www.getfilings.com/o0001047469-99-013081.html+sg%26a+unitedhealthcare&hl=en&ct=clnk&cd=8&gl=us&client=firefox-a

Medical Costs to Premium Revenues 87.2%(3) 84.3% 84.6%

SG&A Expenses to Total Revenues 17.1% 20.0% 21.5%

[Taranis]

My biggest problem with socialized health care is I don't want the Government telling me what procedures I can and cant have, which is why I don't like our current system that gives that power to corrupt insurance companies. I also am afraid that socialized medicine will limit much money will be spent on procedures with low success rates such as the case of my coworker, would the Canadian system be willing to spend say $2 million on a procedure that has a 30%-40% success rate? I've read about stories in other systems like in UK where the answer is no, and in the case of complicated pregnancy the baby is usually aborted unless the mother has enough money to get private care.

[Talisker]

My biggest problem with socialized health care is I don't want the Government telling me what procedures I can and cant have, which is why I don't like our current system that gives that power to corrupt insurance companies.
There's always the option to pay for the procedures yourself.

[Thrag]

My biggest problem with socialized health care is I don't want the Government telling me what procedures I can and cant have, which is why I don't like our current system that gives that power to corrupt insurance companies. I also am afraid that socialized medicine will limit much money will be spent on procedures with low success rates such as the case of my coworker, would the Canadian system be willing to spend say $2 million on a procedure that has a 30%-40% success rate? I've read about stories in other systems like in UK where the answer is no, and in the case of complicated pregnancy the baby is usually aborted unless the mother has enough money to get private care.

Nobody is proposing socialized health care.
Universal health insurance is not socialized health care.

Your insurance company already makes these decisions for you. There's already a guy who is calculating not how effective the procedure might be for your health, but the impact on the insurance companies profits.

In several nations with universal health care access to specialists and procedures is better than it is here in the US. In most private insurance plans in the US a "gatekeeper" is required to give you permission to even see a specialist. Generally you have to have permission from your GP. In other nations that have adopted universal health insurance you can just go see whatever doctor you want. Access to care is actually better than here in America due to the non-existence of gatekeepers.

[Taranis]

Nobody is proposing socialized health care.
Universal health insurance is not socialized health care.

My mistake, I've been confusing the two terms.

[Eric T Cheng]

*I'm actually more a less a centrist on the Canadian political spectrum

Which is equivalent of far-left in the US.

[Dirt]

It's absolutely ridiculous that we still have the most inefficient health insurance system possible.

$$$$$$$

[Shadarr]

You have to remember that police, fire protection, and schools directly benefit me. I 'use' all of them. So no, I've never been against them. If there were no police, people could come rob my home. If there were no doctors for other people, they wouldn't come to me.

Now obviously you could argue on the basis of stopping epidemics or something. But if you break your leg or eat like crap and get a health problem or whatever, I'm not really responsible for that. And yet, you expect me to help you pay for it, and if I make more money than you, you expect me to pay more.

Basically, that's how the thinking works. As I said, I'm starting to change my mind on some of this.
I think you should look at it like this: young people don't get sick as much as old people. You will eventually be old. In a universal system, your health care costs are amortized over your lifetime--you pay the same amount when you're young and healthy and working as when you're old and sick and living off a pension. In a totally free market system, you would have insurance through your employer when you're young and don't need it, and then when you're old you wouldn't have either insurance or an income to pay for care out of pocket. In the US, you have private insurance for the young and socialized care for the old. So as a young person you are simultaneously paying more for care you won't use and subsidizing the care of old people through your taxes.

[Nellie]

on a slightly different track how does the system work when it comes to long term conditions? I'm paying $20 a month for my health care insurance, my partner's paying the same and we have a kid who has CF or Down's syndrome or something. Do we get the treatment for the kid in month one and then find our premiums shoot up to $30 a month now we're going to be a burden on our insurance company for the next 20 years? how does it work?

[wisefool]

on a slightly different track how does the system work when it comes to long term conditions? I'm paying $20 a month for my health care insurance, my partner's paying the same and we have a kid who has CF or Down's syndrome or something. Do we get the treatment for the kid in month one and then find our premiums shoot up to $30 a month now we're going to be a burden on our insurance company for the next 20 years? how does it work?

You're UKish right? You're asking how it works in the US?

It would depend who's paying for your kid's treatment.

If it's government you're ok.
If it's employer (20 employees or more?), you have group-health insurance. there's laws that specifically cover your ass in this aspect. if you lose your job you have the right to continue paying for insurance for about 18 months (COBRA) (http://www.dol.gov/ebsa/faqs/faq_consumer_cobra.html)

This is very important. if you do not, and you have just about any sort of condition and just one day of lapsed coverage, you're looking at a nightmare in paperwork to cover anything beyond a common cold.

See: Preexisting condition. If I was to lose my job today, and my wife is about 8 months pregnant, and I did not pay for Cobra, and I got a job with health insurance next week, the insurance company would still want me to find a way to prove my wife was not impregnated within that 24 hours I had no coverage.

If it's private insurance I think they have the right to raise premiums commensurate to your condition. IE A LOT.

[TheTrunkDr]

If it's private insurance I think they have the right to raise premiums commensurate to your condition. IE A LOT.
Yep, the mother of a friend of mine was retired and had private health insurance. She had a bout of breast cancer, survived it, her premium shot up to $600 a month.

[Robert Sharp]

I think you should look at it like this: young people don't get sick as much as old people. You will eventually be old. In a universal system, your health care costs are amortized over your lifetime--you pay the same amount when you're young and healthy and working as when you're old and sick and living off a pension. In a totally free market system, you would have insurance through your employer when you're young and don't need it, and then when you're old you wouldn't have either insurance or an income to pay for care out of pocket. In the US, you have private insurance for the young and socialized care for the old. So as a young person you are simultaneously paying more for care you won't use and subsidizing the care of old people through your taxes.

I'm familiar with this argument, and I think it's a very good one, actually. Eventually, we all need health insurance, unless we immediately die for some reason. Of course, we have that in the current system, with medicare. So you can still have elderly care without having universal healthcare, just as you explain. And yes, I'm paying for my private healthcare right now. And yes, the system is corrupt, so that I'm probably paying more than I should under a better run system. Can the state provide such a system? If so, I'm ready to see it.

To tronnc and Lh'owon: First, schools are something I benefit from. I went to school. We all do. That's the law. Second, there have been LOTS of civilized societies that don't have universal healthcare, so I don't get how it's an obvious part of a civilized state. Some people will use the healthcare system more than others. Yet those others will still have to pay the same amount, an amount that will be increased by the extra use the first people are getting.

Put another way, if I started a society of only people who took care of themselves, and we started our own universal healthcare system, that would be relatively fair; relative, in this case, to a system where the health conscious people have to pay higher taxes to support people who don't take good care of themselves.

It's a tricky situation though; I've already admitted that. I think there's a big tension between personal responsibility and social responsibility. We have both as citizens, but the question is where to draw the line. Some of you think healthcare is on the social side. I've always felt it's on the personal side (as much as possible). It's just a disagreement. I understand your side on this. I'm sure some of you understand mine. Some of you don't seem to, however.

I guess it's all about where to draw that line. My taxes help pay for student loans. I see that as an acceptable social responsibility because it's part of the social contract. We all benefit from living in a better educated state. We also benefit from living in a contagious disease-free state, so taxes should be used to fight disease. But I'm not sure we all benefit from having every disease covered, or every wound, injury, etc. That's all I'm saying. I'm not sure which side of the line healthcare falls on because suspect that some of it falls on one side and some on the other.

So right now, I would support minimal decent healthcare plans, but not full universal healthcare.

[Robert Sharp]

I'm very much in favor of universal health care I see not having it really hurting the economy, in that smaller companies simply don't have the resources to compete with big ones because providing health care is just too expensive. Its considered by most workers a necessary benefit for a full time job and if your company can't afford it your not going to keep those workers around.

Sounds like you have more experience with this in a work setting than I do. If you are right, that sounds like a good reason. Again, I would absolutely support universal healthcare if it turned out to be a better system for all involved. Who wouldn't? But I think there are likely to be trade-offs that have to be considered.

[Gordon Cameron]

That's right. It's a part of living in a civilised society, in my opinion.

What Lh'owon said.

It's called civilization imo.

[Robert Sharp]

Seriously? You guys are just going to play the barbarian card against me?

[Tim James]

You civilization guys are basically saying that it didn't exist before the Progressive movement.

[Thrag]

So right now, I would support minimal decent healthcare plans, but not full universal healthcare.

You're going to have to define those terms. If by "full universal healthcare" you mean everyone gets whatever care and procedures they want regardless of price or any other factor, nobody is proposing that.

[Robert Sharp]

Sorry, I meant that minimal decent healthcare would provide for life-saving procedures (which admittedly would need some defining, since some procedures are life-saving in the long run but not in the short term) but not just any procedures. By full universal, I mean that it would cover all procedures, with the exception of truly optional procedures (like a nose job for purely subjective cosmetic reasons).

So, for example, a broken bone would NOT be covered under minimal decent healthcare, but it would be covered under universal. Minimal decent would be like a safety net, but not the kind of net that requires you to declare bankrupcy before you can even use it.

[Tim James]

Actually, if I could just make a lazy post here: do universal health insurance proposals cover everyone in the US (i.e. no more employer or private insurance for anyone unless they seeked it out), or just people that don't currently have it and want to apply to the government for it?

[Robert Sharp]

Usually the idea is that it's universal, meaning available to everyone regardless of income. We already have medicaid in the U.S. which covers people who can't get healthcare in other ways and can apply to the government.

[wisefool]

Interesting, I had assumed Canada was government spending, but according to these numbers (http://www.cga.ct.gov/2006/rpt/2006-R-0289.htm) the government only pays for 70% (below the 72% OECD average).

Anyway, these are the numbers I was looking for:

2003 AD
Per Capita As percentage of GDP % publically funded
US $5,635 15% 44.4
Canada $3,003 9.9% 70.2

These numbers are also interesting: ([url=http://content.nejm.org/cgi/content/short/349/8/768]Abstract NEJM)

Results In 1999, health administration costs totaled at least $294.3 billion in the United States, or $1,059 per capita, as compared with $307 per capita in Canada. After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada. Canada's national health insurance program had overhead of 1.3 percent; the overhead among Canada's private insurers was higher than that in the United States (13.2 percent vs. 11.7 percent). Providers' administrative costs were far lower in Canada.

It seems that the only "fat" to be squeezed from the system is administrative costs. After that, there's two ways - reducing amount paid to providers (which if it means less fear of lawsuits they'd go for), and reducing services (mostly by implementing queues or criteria.) This is the tough one. Someone who has money wants the MRI for back pain but criteria says you don't need one, or have to wait 3 months. Very difficult to tell an American that you can't buy something. It's an affront to the flag.

[jfletch]

"Minimal decent" as you defined is pretty inefficient and silly. I am reminded of a case last year where a poor black kid couldn't get a dentist because no dentist took Medicaid. Well, the kid fricking died because he got an infection that went to his brain, but not before Medicaid paid for a last-ditch brain surgery to try to save him, which ended up costing over $200,000. Money that could have been saved had he gotten the $2000 or whatever root canal.

That is one of the main problems with the whole "emergency room" line of thought - yea, the government is there to pay for true emergencies, truly important and life saving procedures, but not for the cheap, basic care that is used by people (with insurance) to avoid those situations or catch them before they blossom into such an emergency. It's wasteful.

[Tim James]

reducing amount paid to providers (which if it means less fear of lawsuits they'd go for)Whoa, is this tossed around as a serious part of universal health insurance proposals, like from Obama? That might actually reduce the level of frivolous procedures. You'd still have people going in for stupid stuff because the co-pay is cheap, but if doctors don't have to over-test and over-prescribe to avoid lawsuits, that'd be great.

Not sure how that would ever fly with the trial lawyer special interests though.

[Nyx]

"Minimal decent" as you defined is pretty inefficient and silly. I am reminded of a case last year where a poor black kid couldn't get a dentist because no dentist took Medicaid. Well, the kid fricking died because he got an infection that went to his brain, but not before Medicaid paid for a last-ditch brain surgery to try to save him, which ended up costing over $200,000. Money that could have been saved had he gotten the $2000 or whatever root canal.



Sounds like the problem there was with the dentists who didn't accept medicaid. I don't think there's an EMTLA equivalent in the dental world.

[jfletch]

Right, and actually most people's dental coverage is pretty crappy. But I was just using that an example to try to illustrate how a lack of quality affordable care in the beginning can easily turn into a much worse, and more expensive situation.

[Shadarr]

I'm familiar with this argument, and I think it's a very good one, actually. Eventually, we all need health insurance, unless we immediately die for some reason. Of course, we have that in the current system, with medicare. So you can still have elderly care without having universal healthcare, just as you explain. And yes, I'm paying for my private healthcare right now. And yes, the system is corrupt, so that I'm probably paying more than I should under a better run system. Can the state provide such a system? If so, I'm ready to see it.
I think a big part of the reason US healthcare is disproportionately higher than other countries is that you have all the overhead of a taxpayer-funded system and a private system. Whether or not a government-run system is more efficient is largely irrelevent because you're already paying for the government-run system. The overhead is not going to increase dramatically if it starts covering younger people who don't use the system that much anyway. And meanwhile you're eliminating all the costs associated with the parallel private system.

Quality of care shouldn't change because you'll have the same number of doctors and hospitals. And furthermore, a single-payer system has a lot of clout to hold costs down. That's why group insurance plans exist. You can negotiate better terms with 100 people together than each on their own, and better still if there are 10,000. If everyone is in one plan it becomes Walmart and can dictate terms to the suppliers. This is why drugs are cheaper in Canada. It's the equivilent of an HMO with 30 million members.

[Robert Sharp]

Right, and actually most people's dental coverage is pretty crappy. But I was just using that an example to try to illustrate how a lack of quality affordable care in the beginning can easily turn into a much worse, and more expensive situation.

No doubt. There will always be exceptional cases like that. But we can't work in examples; we have to work in statistics when talking about national healthcare? Don't we?

[Robert Sharp]

I think a big part of the reason US healthcare is disproportionately higher than other countries is that you have all the overhead of a taxpayer-funded system and a private system. Whether or not a government-run system is more efficient is largely irrelevent because you're already paying for the government-run system. The overhead is not going to increase dramatically if it starts covering younger people who don't use the system that much anyway. And meanwhile you're eliminating all the costs associated with the parallel private system.

Quality of care shouldn't change because you'll have the same number of doctors and hospitals. And furthermore, a single-payer system has a lot of clout to hold costs down. That's why group insurance plans exist. You can negotiate better terms with 100 people together than each on their own, and better still if there are 10,000. If everyone is in one plan it becomes Walmart and can dictate terms to the suppliers. This is why drugs are cheaper in Canada. It's the equivilent of an HMO with 30 million members.

Interesting. Sounds like a question of government efficiency, too. We have a government that apparently spends in very inefficient ways. Can we trust them to be more fiscally responsible with a public system? I don't think many elderly people are very happy with medicare as it exists right now, but they MUST use it. Would the system really become MORE efficient if we all used it? I'm not convinced. Of course, that might be a practical problem rather than a theoretical one, but that doesn't make it any less real.

Good point about buying in bulk and dictating costs by having only one buyer. That's certainly one of the advantages of the plan. My conservative aunt would argue that drug companies would no longer fund important research under these conditions though. How many new, good drugs are developed in Canada due to government research spending vs. the private spending of companies that can profit from breakthroughs? I honestly don't know the answer, but if anyone has a good source, hit me with it.

[jfletch]

Would the system really become MORE efficient if we all used it?

I think there's an argument to be made for it. Right now, the government pays for coverage for the least insurable and most expensive people in our country. The elderly and very poor. This leaves the more profitable people to private companies. A private company would not last long if they had the same insured as the government. Integrating those healthier, younger, wealthier people into the risk pool can indeed make things more efficient.

Of course, this cannot happen without an effective way to control costs integrated into the system right off the bat, because right now our health care system has virtually no controls and that is why costs are skyrocketing and have been skyrocketing for years (what has it been, three or four times the rate of inflation?).

[Jason McCullough]

Of course, this cannot happen without an effective way to control costs integrated into the system right off the bat, because right now our health care system has virtually no controls and that is why costs are skyrocketing and have been skyrocketing for years (what has it been, three or four times the rate of inflation?).

I'd say the costs are skyrocketing because of an adverse selection death spiral (http://www.quartertothree.com/game-talk/showthread.php?t=9991) in the insurance pool and our terrible pay-for-procedure (http://www.quartertothree.com/game-talk/showthread.php?t=35278) incentives. There's also the cool new treatments, but we piss away a ton of money.

This (http://www.kff.org/insurance/snapshot/chcm010307oth.cfm) has some interesting international comparisions.

[Eric T Cheng]

Good point about buying in bulk and dictating costs by having only one buyer. That's certainly one of the advantages of the plan. My conservative aunt would argue that drug companies would no longer fund important research under these conditions though. How many new, good drugs are developed in Canada due to government research spending vs. the private spending of companies that can profit from breakthroughs? I honestly don't know the answer, but if anyone has a good source, hit me with it.

I posted this earlier and I'll post it again because I think every American who questions universal health care should watch it.

PBS's Frontline has a documentary called Sick Around The World (http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/), about five different types of universal health cares in five western countries (http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/) -- the UK, Switzerland, Germany, Taiwan, and Japan. Each type of universal health care system shown has its pros and cons (when the Taiwanese government decided to have an universal health care system for its people it researched the various types and picked the pros from each, avoiding the cons).

WATCH IT (http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/view/main.html)!

[Anders Hallin]

You civilization guys are basically saying that it didn't exist before the Progressive movement.
Democracy didn't exist before the feminist and civil rights movements, so fair enough.

[Tim James]

Democracy didn't exist before the feminist and civil rights movements, so fair enough.Constitutional republics were still around, so right back at ya! :)