Universal Health Care is French for "Ze Germans".

[Joe Wordsworth]

Actually, I haven't any real relationship to the title of the thread, I just thought it sounded funny.

I was wondering, though, how many people here are actually advocating Clinton's health care plan? And how do you deal with the major criticisms (even from within the Democratic Party)?

 

[JAMESBJOHNSON]

Medicare is about to come unwrapped. Something drastic needs to happen quickly. So Hitlery Care is how you get the working poor out of Medicaid, to buy some time for Medicare.

Her plan is a disguised tax.

 

[Pure]

there are several working 'universal' systems of health care, in advanced Western nations. yes, jbj, they're funded with taxes. these amount to insurance premiums, and outside of the US are not considered evil, if the benefits are satisfactory. all parties in the countries (including conservatives, IOW) support them.

as i understand it both the Hillary and Obama's plans are designed to please health insurance private companies and keep them in business. the result will, of course be higher costs and likely uninsured people or those dumped onto the public rolls (those the companies don't want). indeed, some bastard hybrids may give the worst of possible worlds, between universal and private.

 

[Carnevil9]

Yeah, I want a health care system that's brought to you by the same people who run the Post Office.

If that's too abstract for you, take a look at the state of the VA hospitals. Noooooo thank you.......Carney

 

[JAMESBJOHNSON]

PURE

Here's the deal amigo.

I rarely get sick. I havent required an MD in 3 years. Two MD appointments in the last 13 years. I'm no spring chicken, either.

I dont carry health insurance. I hide $200 under the mattress each month.

Good health is my gift from God. He didnt make me smart or pretty or rich, and he didnt make my dick long and stout. He made me healthy.

So, whats in it for me if I contribute $6000 a year to help the cripples and welfare queens and addicts and hypocondriacs?

 

[Roxanne Appleby]

I've been told that the French system is not too bad from a free-market, consumer-directed health care point of view. They give everyone a certain amount for particular ailments or procedures (don't know which) that's only enough to acquire fairly mediocre care, but you can take the money to whatever provider you want, who can charge as much as they want, and you pay the diff. This is very different from Britain and Canada, where the government is the provider .

 

[Roxanne Appleby]

PURE

Here's the deal amigo.

I rarely get sick. I havent required an MD in 3 years. Two MD appointments in the last 13 years. I'm no spring chicken, either.

I dont carry health insurance. I hide $200 under the mattress each month.

Good health is my gift from God. He didnt make me smart or pretty or rich, and he didnt make my dick long and stout. He made me healthy.

So, whats in it for me if I contribute $6000 a year to help the cripples and welfare queens and addicts and hypocondriacs?

Irrelevant. Americans are not going to step over the wasting bodies of individuals who could be cured except they can't afford health care. The welfare reform model won't work here.

The question is will we have a government-managed system like Britain and Canada, or something that establishes consumer directed health care, and aligns the incentives of consumers and providers with the goals of maximizing value, innovation and efficiency. Those incentives are not aligned under the current mixed system characterized by third party payers. The whole thing is a mess.

Supporters of a socialized system need to realize that Americans won't accept that, either. We'll never ban private providers like Canada, for example. What they're going to end up with is crappy Medicaid for the poor and middle class, and Cadillac-care for the rich. They'll spend the next 60 years whining about it, but it's all quite predictable.

 

[JAMESBJOHNSON]

ROXANNE

I agree. I've been beating your drum when youre busy with other things.

Hillary wont be using Medicaid; she'll have the Cadillac version.

Something the folks dont get is, more and more MDs arent accepting Medicaid referrals. The government keeps cutting their money. And this is how universal healthcare will work, unless you have the Cadillac kind.

 

[oggbashan]

This is very different from Britain ... where the government is the provider .

You can choose NOT to use the NHS; choose to add to the NHS package for specific conditions; buy whatever health services you want privately or through health insurance with a variety of packages of cover; travel to another country for a specific medical condition and pay for it yourself; have health insurance through a trade union or employer's package...

You do not HAVE to use the National Health Service. You and your employer cannot avoid paying for it through taxation. Equally you cannot avoid paying taxes for education even if you have no children...

However the NHS is there for you whenever you need it particularly in an emergency. If you have a life-threatening condition health care will be provided whatever your income of credit status.

Today I visited a physiotherapist. I paid for that myself. My NHS consultant and his staff keep checking me every six months and I can call any day for an urgent appointment if my condition flares up - and I will be seen within hours. My private physiotherapist informs my NHS consultant if there is any change the consultant should know about. The NHS consultant informs my physiotherapist if he thinks a specific set of exercises/manipulations might help. Both of them inform my NHS General Practioner. All I pay for is the physiotherapist's time with me. The cross-referencing is free.

I could claim for the physiotherapy from my private insurance but it isn't worth the paperwork (and increased premium that would follow) but I have cover.

The Health Services in the UK are a mixed economy - public and private - and you can choose whichever you want to use IF you can afford to pay. If you can't afford to pay you will still get health care even if your condition is life-long.

Og

 

[CharleyH]

Actually, I haven't any real relationship to the title of the thread, I just thought it sounded funny.

I was wondering, though, how many people here are actually advocating Clinton's health care plan? And how do you deal with the major criticisms (even from within the Democratic Party)?

Anything Hilary Clinton can do is better than the cold hard fact of debt (including tipping for good treatment) for many people in the current U.S. healthcare system. I advocate and have no criticisms thus far of her plan and I haven't since... oh about the mid 1990's.

 

[Joe Wordsworth]

Anything Hilary Clinton can do is better than the cold hard fact of debt (including tipping for good treatment) for many people in the current U.S. healthcare system. I advocate and have no criticisms thus far of her plan and I haven't since... oh about the mid 1990's.

But there are some very common criticisms, aren't there? That its a mandate, is one. I don't know, I'm just not comfortable with the idea of being forced to pay for things. Doesn't it have the real possibility of making a cold, hard fact of debt for a lot of people?

 

[Roxanne Appleby]

You can choose NOT to use the NHS; choose to add to the NHS package for specific conditions; buy whatever health services you want privately or through health insurance with a variety of packages of cover; travel to another country for a specific medical condition and pay for it yourself; have health insurance through a trade union or employer's package...

You do not HAVE to use the National Health Service. You and your employer cannot avoid paying for it through taxation. Equally you cannot avoid paying taxes for education even if you have no children...

However the NHS is there for you whenever you need it particularly in an emergency. If you have a life-threatening condition health care will be provided whatever your income of credit status.

Today I visited a physiotherapist. I paid for that myself. My NHS consultant and his staff keep checking me every six months and I can call any day for an urgent appointment if my condition flares up - and I will be seen within hours. My private physiotherapist informs my NHS consultant if there is any change the consultant should know about. The NHS consultant informs my physiotherapist if he thinks a specific set of exercises/manipulations might help. Both of them inform my NHS General Practioner. All I pay for is the physiotherapist's time with me. The cross-referencing is free.

I could claim for the physiotherapy from my private insurance but it isn't worth the paperwork (and increased premium that would follow) but I have cover.

The Health Services in the UK are a mixed economy - public and private - and you can choose whichever you want to use IF you can afford to pay. If you can't afford to pay you will still get health care even if your condition is life-long.

Og

Roger all that, Og. It's Canada that's (mostly) banned private providers, which won't happen in the U.S.

There are some tough issues here. First, no one can accept a system in which someone who is just unhealthy for no fault of their own cannot get health care. In the US you can get care through Medicaid, but you have to pauperize yourself to get it. However, every state (I think) has some mechanism like a "provider of last resort" or "risk pools" that allow that unhealthy person to buy subsidized private insurance that is expensive, but not totally astronomical.

Related to that, there is a "moral hazard" issue. Say, an "invincible" 27 year old who can afford it but does not buy insurance until he gets some serious ailment, then expects to walk in and buy the same kind of subsidized coverage. That's not insurance, it's welfare.

Additionally, Americans will not respond well to rationing imposed by the government; when 56 year old Mrs. Jones is told that she can't get a hip replacement (or will have to pay $75,000 for it) because Hillarycaid doesn't pay for that after age 55, this will not go well. (They don't respond well to rationing imposed by any entity, actually, but if they have real choices to pay more for more comprehensive insurance, and have had the consequences of their choices pounded home well in advance, then the system will have the authority and popular support to say "too bad - it's the decision you made, now deal with it." That support won't be there for government fiats.)

Then, both the socialized systems and the current system create very skewed incentives that do not promote innovation, value and efficiency. We know how to maximize those things - real competition and choice in free market system. But this brings us back to the issue of citizens "unwilling to step over the bodies" of ailing individuals (like that "invincible" 27 year old).

I sum up a proposal that I believe solves this thorny eqation in this post: http://forum.literotica.com/showpost.php?p=24207721&postcount=135 . Since it has my name attached to it Pure will probably be along to explain why it's a plot cooked up by Karl Rove and Big Pharma, but it still makes sense to me.

 

[CharleyH]

But there are some very common criticisms, aren't there? That its a mandate, is one. I don't know, I'm just not comfortable with the idea of being forced to pay for things. Doesn't it have the real possibility of making a cold, hard fact of debt for a lot of people?

Forced to pay for what? You are already forced to pay for your personal healthcare, so paying a premium based on income as a citizen or a human being who would help the less fortunate, and yourself? It isn't much of an ask for people with money.

 

[Joe Wordsworth]

Forced to pay for what? You are already forced to pay for your personal healthcare, so paying a premium based on income as a citizen or a human being who would help the less fortunate, and yourself? It isn't much of an ask for people with money.

But, I'm not forced to pay for my personal healthcare. Nobody is making me do it, and should I not want to do it I don't have to. How is that being forced?

And I thought her plan was intended to ask not only people with money... but also people without money. Do I have a wrong understanding of her program?

 

[JAMESBJOHNSON]

Why do the poor always feel entitled to other people's money?

I dont get the idea that nothing should be expected of the poor, and they get first dibs of other people's stuff.

 

[oggbashan]

...Related to that, there is a "moral hazard" issue. Say, an "invincible" 27 year old who can afford it but does not buy insurance until he gets some serious ailment, then expects to walk in and buy the same kind of subsidized coverage. That's not insurance, it's welfare.

Then, both the socialized systems and the current system create very skewed incentives that do not promote innovation, value and efficiency. We know how to maximize those things - real competition and choice in free market system. But this brings us back to the issue of citizens "unwilling to step over the bodies" of ailing individuals (like that "invincible" 27 year old).

...

An "invinicible" 27 year old in the UK still pays for the NHS - which is our basic health care.

As I see it there are two problems with public health care for the US:

1. The general US voting public has a negative view of "welfare" for historic reasons that are emphasised by politicians of both parties. In the UK the welfare state was supposed to help those who cannot help themselves - young children, the disabled, the chronically sick, the very old. There is still a general acceptance in the UK that the NHS and the rest of the Welfare State should care for the weaker members of society. That acceptance does not exist in the US.

2. Healthcare in the US is ruinously expensive by world standards. The reasons are varied but litigation is a significant factor. The healthcare may be high-tech but medical professionals are reluctant to take risks or to leave well alone because they might have to prove they have done their best. Health insurance in the UK is much cheaper than comparable US providers - because the costs are lower and claims are smaller.

I am not suggesting, and would never suggest, that the UK's health service is perfect or even as good as it should be. It's main advantage is simple. It is free at the point of delivery. Even that statement has to be qualified. You have to pay a charge for prescriptions, for dental and optical care unless you are exempt because of low income or chronic illness.

The advantages of the NHS are easily demonstrated:

If I was involved in a traffic accident and I and my passengers were badly injured the NHS ambulance service would be with us in minutes and we would get the best emergency care that the UK can provide with transfer to an appropriate hospital at speed. In theory my car insurance, and that of the other driver, should repay the NHS eventually. Even if the other driver was an unlicensed teenager driving a stolen car I still wouldn't pay a penny for my family's emergency care. That traffic accident wouldn't bankrupt me, no matter how much or how little money I have.

If I were to have a heart attack at home - now - an NHS ambulance would be at my house within 5 minutes. Emergency resuscitation would start immediately and I would be in ER within the hour. I wouldn't have to worry whether I could afford to have a heart attack...

Og

 

[WRJames]

Any plan that does not address the cost structure of the health care industry is going to be too expensive.

Look at some of the factors that are driving up health care costs: the amount of money that drug companies are diverting into promoting their products (and the warping of treating that this is causing); the amount of overhead doctors need to deal with the insurance companies and medicaid; the overwhelming cost of liability insurance (and again -- the number of extra, very expensive medical tests doctors will put their patients through to avoid any hint of malpractice). These three factors probably account for at least half the cost of health care. In addition, doctors know that insurance will only cover a fraction of what they charge, so they up their nominal fees to compensate -- I once receive a bill for over siz thousand dollars for a one hour test proceure -- it was finally settled by insurance for about six hundred.

It you add on top of this how much of our bad health is caused by bad habits -- smoking, metabolic syndrome, etc. -- if there was more emphasis on prevention, we could probably save another fifty percent.

A plan that does not tackle any of those issues is not a plan.

 

[gauchecritic]

Why do the poor always feel entitled to other people's money?

I dont get the idea that nothing should be expected of the poor, and they get first dibs of other people's stuff.

And the poor ask why do the rich feel entitled to deny me the chance of health care?

I don't get the idea of people with money using up vast resources that could be used for the betterment of the society in which they live.

 

[CharleyH]

But, I'm not forced to pay for my personal healthcare. Nobody is making me do it, and should I not want to do it I don't have to. How is that being forced?

And I thought her plan was intended to ask not only people with money... but also people without money. Do I have a wrong understanding of her program?

If you're not forced to pay for your personal healthcare, don't you think you damn well should be? If you cut yourself with a kitchen knife or if your son falls down the stairs, should we, your neighbours, your society, let the two of you bleed to death? And who's going to get rid of the rotting corpses?

 

[Roxanne Appleby]

An "invinicible" 27 year old in the UK still pays for the NHS - which is our basic health care.

As I see it there are two problems with public health care for the US:

1. The general US voting public has a negative view of "welfare" for historic reasons that are emphasised by politicians of both parties. In the UK the welfare state was supposed to help those who cannot help themselves - young children, the disabled, the chronically sick, the very old. There is still a general acceptance in the UK that the NHS and the rest of the Welfare State should care for the weaker members of society. That acceptance does not exist in the US.

2. Healthcare in the US is ruinously expensive by world standards. The reasons are varied but litigation is a significant factor. The healthcare may be high-tech but medical professionals are reluctant to take risks or to leave well alone because they might have to prove they have done their best. Health insurance in the UK is much cheaper than comparable US providers - because the costs are lower and claims are smaller.

I am not suggesting, and would never suggest, that the UK's health service is perfect or even as good as it should be. It's main advantage is simple. It is free at the point of delivery. Even that statement has to be qualified. You have to pay a charge for prescriptions, for dental and optical care unless you are exempt because of low income or chronic illness.

The advantages of the NHS are easily demonstrated:

If I was involved in a traffic accident and I and my passengers were badly injured the NHS ambulance service would be with us in minutes and we would get the best emergency care that the UK can provide with transfer to an appropriate hospital at speed. In theory my car insurance, and that of the other driver, should repay the NHS eventually. Even if the other driver was an unlicensed teenager driving a stolen car I still wouldn't pay a penny for my family's emergency care. That traffic accident wouldn't bankrupt me, no matter how much or how little money I have.

If I were to have a heart attack at home - now - an NHS ambulance would be at my house within 5 minutes. Emergency resuscitation would start immediately and I would be in ER within the hour. I wouldn't have to worry whether I could afford to have a heart attack...

Og

The US population has good reasons to oppose welfare as an "entitlement." It creates moral hazard, reducing the incentives for individuals and entire subcultures to avoid work. Related, few if any Americans oppose welfare for the "deserving" poor - people whose lives are not defined by destructive habits, but who suffer some bad breaks. But there is another class, the underclass, who are defined by destructive behavior, and Americans really resent paying to subsidize that kind of lifestyle in any way. Don't get me wrong, I'm not one of those who pretends that the solution to this problem is simple, but the underclass do not exist because of a "bad economy" or a "jobs shortage."

~~~~~~~~~~~~

The US spends a lot on health for a variety of reasons. For one thing, we have a generally very good system. If you're going to get sick anywhere in the world, you probably want it to be the US. The US also spends a lot for drug and device research, and for all the unprinicipled ire directed at "big pharma" for making lots of money on things like viagra, this expense has arguably been the greatest contributor to human well being since the widespread adoption of public health practices. BTW, we're subsidizing you shiftless Europeans, who through price controls have gutted their own medical research industry, and are 'free-riding' on ours. Anyway, those things repesent real value that we get in return for paying a lot.

A medical malpractice system that's has elements of a lottery raises the cost less than most people think, at least directly. The indirect costs of "defensive medicine" and other skewed incentives probably add more to the cost, however. Enforcing binding waivers of liability between consumers and providers would easily fix it, allowing consumers who really get screwed to collect, and providers who really fuck up to get punished.

We spend too much on extraordinary end-of-life care that is not rational. The solution is to force people to make decisisons on rationing early in life by requiring them to start paying for extra insurance that would pay for it - or not. Such a system really has to continuously pound home the message that if you don't pay the extra money you really are "signing your life away" - but it's probably the smart thing to do.

We have absurd state licensure and scope of practice restrictions on providers that are primarily anti-consumer rent seeking. You may have something similar.

We prohibit individuals from buying insurance from a company not licensed in their state, balkanizing the market, eliminating the potential cost saving efficincies of a national market, and giving state regulators and legislatures room to impose an expensive array of expensive and inefficient "coverage mandates," and in general use health insurance as "sandbox" in which to impose various statist preferences that add to the cost.

Finally, a system of third party payers creates very skewed incentives that do not promote innovation, value and efficiency. We aggravate this with a tax system that allows employers to take unlimited deductions for employee health insurance, but doesn't allow individuals to deduct one dime. Both should be able to deduct, and the deduction should be capped. (Bush actually has proposed this, and if they were true to their principles the Dems would pass it, because it amounts to a big tax break and subsidy for employees at the high end of the compensation scale. Ugly politics makes that not happen.) Socialized systems create the same misaligned incentives in slightly different but similar ways. This is no way to run a railroad - or a health care system.

People turn up their noses at the free marketeer's love affair with "economic efficiency," but all those little inefficiencies and skewed incentives add up into a very expensive health care system, meaning that you and I and all of us are not getting full value for what we spend.

 

[JAMESBJOHNSON]

ROXANNE

I read that the real culprits of inflationary medical prices are MDs.

They buy equiptment they dont know how to use, their fund of knowledge remains what it was when they graduated med school, and many of them buy testing labs they require their patients to use.

 

[Ootpic]

Lets look at a few figures.


Life expectancy

CAN 80.43 years
USA 78 years
MEX 75.63 years

Why is the United States in the 29th position on a list of longevity of population, and why is Canada in the 10th position.



Infant Mortality Rate

CAN 4.8/1000
USA 6.3/1000
MEX 16.7/1000

Why is the US only at the 163rd place out of 195 countries on a list of the countries with the highest risk of infant mortality when Canada at the 173rd position on that same list?



We know the reason for Mexico's position, but does the "Greatest Country in the World" rank so poorly in life expectancy and infant mortality?


And why can't the United States afford universal health care for its citizens, when every other industrialized western power does?

Perhaps this 2004 statistic can shed some light:

Military spending by the World, except US: $500 billion

Military spending by United States alone: $623 billion


Nobody outspends the United States on killing.

 

[JAMESBJOHNSON]

Tell me, why is a 78 year old geezer a good thing?

 

[Ootpic]

Ask me when you are 77.

 

[Joe Wordsworth]

If you're not forced to pay for your personal healthcare, don't you think you damn well should be? If you cut yourself with a kitchen knife or if your son falls down the stairs, should we, your neighbours, your society, let the two of you bleed to death? And who's going to get rid of the rotting corpses?

I don't think being forced is a good thing, no. Isn't it a lot like "should there be a law for seatbelts"? Isn't it, truly, my life? My right to not pay for things I don't want?

I mean, arguments about "your son falls down the stairs" are a little more complicated, but doesn't her plan require single, low-income, unwilling people to spend their money on something they may not want?