a thought about what is fair and what is convenient

[panthera]

I don't usually have much to say about US politics (well, compared to what I think, that is).
But this editorial really got to me.
I know a lot of folks, especially from Virginia and Texas are of different opinions, but really - every other great country on the whole planet has found at least an adequate answer to this problem. I read the supposed "horror" stories which circulate against health insurance in the US and, living in Europe, know they are either untrue or so distorted and taken out of context they are worse than untrue.
Read this, please and give it a thought. What is so Christian and moral and right about this situation?

http://www.nytimes.com/2007/10/23/opinion/23herbert.html?hp

 

[toggleswitch]

What about MedicAid/ MediCare, the US Federal govenment's verison of healthcare assistance?

~I read the supposed "horror" stories which circulate against health insurance in the US.
There is good and bad in everything (and every system) and everyone.
Well, we still see Canadians (who have socialized medicine)come to the US for certain procedures. And I believe we read that in the UK teeth are removed rather than repaired, based on the constraints of their system. (Was it 30 minutes to 60 minutes per appointment? Period.)

I have also seen Greeks come and live here for 30 to 50 uears and return to Greece to retire. A great number come back (I want to say most) in that those who come down with a disease beleive their treatment there sucks. If your are older, the attitude is: "You will dye anyway. bye-bye."

If one knows how to "work" the system, no matter where they are and what system they are under, they can probably get what they need. To wit: Groups who orignally come to the US who are used to bureaucracy and communism/socialism and who seem to have no problem dealing with red-tape and other BS to extract desired benefits. Good for them!

Im not saying I'm against socailized medicine, but in my ridiculous opinion it is not a panacea.

 

[toggleswitch]

I have a problem with the word "fair", in general.

When someone cries "It's not fair(to me)" I get the distinct impression they are saying "I didn't get MY way".

Finding a reasoably equitable solution will probably be difficult. No matter what we do here in the US someone will most-likely bitch and moan. Age-isim, genderism, racism, native-ism, religious groups SOMEONE will cry "foul".

Sadly, fear and greed are great human and corporate motivators. Getting these out of our medical and medical insurance systems while still maintaining a standard of excellence to which to aspire may prove to be difficult.

 

[panthera]

Steve,

We don't have socialized medicine in Germany, indeed most of Europe does not.
What we do have is a (profitable for the investors, by the way) system in which those who can, pay into the system. Those who can not, are helped by the system.
I have been to Greece and, sure - the land is still very poor in many rural areas. But overall and in general, there is no question but what our system of covering everyone has produced lower health costs for everyone...and still given investors a nice return.
I have my doubts about all these horror stories from Canada and the UK. It might seem logical to look at the system in the UK, it being an English speaking set of countries, but the truth is, it is not a system which anyone else in Europe has adopted.
Sure, there are jerks and abusers everywhere. But please, take a look a the reality in the rest of the western world and then at what happens in the US.

 

[toggleswitch]

I am glad to hear of the positives of other systems, and I don't think I'm blindly defending what I know, in that I have been exposed to little else.

Thanks for the education!

 

[andrewinorlando]

Like anything else, it's a matter of getting folks to accept change. Anything different is inherently evil or bad or doesn't work (fill in the blank). It's certainly not that it can't be done. Spreading the risk among all members of the population rather than just select members who can afford to pay for it just makes sense from a pricing perspective. I think that one of the biggest issues we face (and maybe not just here) is this notion that medical care/insurance is a right that should come with citizenship. It's not, and it's never going to be. What we have here in terms of quality is good, but medical care is good in India, too, for a lot less money. One of the biggest problems we face here in the US is the all-too-easy time plaitiffs have had in winning extreme malpractice settlements. Maybe Justice is blind, but someone has had to pay for that, and ultimately, it's the consumer, in the form of much higher prices. Ask any OB-GYN.

Socialized medicine has its benefits, and its pitfalls. Bottom line is that if we had to pay the kind of taxes here that they do in Canada to fund the program, there would be a revolt. But it works for Canada. It may work better for routine illnesses, but, like many other insurance programs, it has its challenges when it comes to long term, chronic or catastrophic illnesses.

If Massachusetts can do it with their Commonwealth-sponsored insurance plans, there is no reason the rest of the US can't. No, it's not free....it's a graduated payment scale, based on income and, I believe, subsidized by the state. But it's available to all who either don't have coverage or can't get it. Like income taxes, the more you make, the more you will pay. But at least it's a solution. The lowest tier pays only $18 a month, for an individual making under $10K or so a year. And it goes up from there.

Toggles put it very well when he said he has a problem with the word "fair", meaning "I didn't get MY way". No system will be "fair" to everyone. And the more diverse this population becomes, the more difficult it becomes to provide one solution that meets all those needs. But with 40M+ people uninsured in the US, and growing, something has got to give somewhere.

 

[~sudsshane]

My only concern with nationalized healthcare is..

The United States covering illegal immigrants. Why should we reward people for breaking the law?..
I am also extremely disgusted with New York Governor, Eliot Spitzer for allowing illegal immigrants to obtain driver licenses. Obtaining a drivers license should never be treated as a right, it is a priviledge.

Andrew~ as usual, you are right on the money.

 

[petek]

I received a spam email a couple of weeks supposedly penned by a disgruntled Canadian that was aimed at US citizens in order to scare them away from universal healthcare. It was rife with outright mis-information and scare tactics some of them absurd embellishments and others downright false.

Because the majority of US hear a lot of false information good and bad about the Cdn system I'll try and explain how it works in the most simplistic terms because I don't know all the in/outs that's for sure. But the basics are..

First off it is not free and the federal government of Canada does NOT run the system, hire doctors, run hospitals, allocate who gets operations, who doesn't etc etc etc. Like the US system, Canada is made up of 12 provinces and territories. Each province like a state governs things like education, taxes, drivers licenses,provincial courts,provincial parks, AND health-care. Therefore each province is responsible for coming up with most of the money to pay for their hospitals, doctors and nurses etc. The federal government allocates a percentage of federal money to each province depending on their needs etc. IE poorer provinces get a bigger percentage to keep them up to a standard close to what a richer province can afford..These are called "equalization payments". Depending on which province you live in the amount you pay through either provincial income tax or bi-monthly payments (BC & Alberta) varies. A rough estimate is about $80 a month for single, $100 for a family of two, and $120 for a family of any size and like I said in BC/alberta you pay that money directly every two months to the provincial health dept. Here in Ontario it comes out of provincial sales taxes etc.

The only thing the federal government does is oversee the legislated Canada Health Act which spells out what are the rights of every Canadian citizen in respect to access to health care, simply put though it is a little more detailed than just that LOL

The main tenets of the CHA is that no Canadian citizen can be denied health care and that it must be made available to them everywhere, ie an Ontarian like myself cannot be denied if I happen to be in BC at the time I get sick or injured.

Secondly "for profit" hospitals are illegal. If a province decided to "open the market" and allow for profit hospitals nothing is stopping them but the voters I suppose but they would no longer fall under the Canada Health Act and the province would no longer receive any federal monies.

Some of the scare stories are:

Lineups for operations, MRI's etc otherwise called "waiting lists". While that is true in some cases it isn't always what it seems and it certainly doesn't apply nationwide. There are in places waiting lists for some operations and only in some areas, for example knee replacements. That being said someone who is in an accident and crushes their knee is not going to be sent home with some pain killers and stand in line, they will have the operation right away. The people who are waiting are people who are not life threatened but do need a knee replacement sooner or later..Naturally they complain because it probably does hurt and they're kept waiting anywhere from a month perhaps to 6 months before they can get their operation.
Lineups for MRI's: Last year in Calgary I went to my doctor complaining about headaches, stress etc. To be on the safe side he ordered up an MRI. I figured that'll be in a month or two.. I had my MRI two days later.

Studies of which there are numerous have shown that the quality of health care in Canada equals that of the US and in many cases exceeds it. The Canadian life expectancy is greater by a few years and infant mortality rates are significantly lower. While some Canadians of means do flock down to the US for quick operations rather than wait there are also many many hundreds of Americans who cross the northern border with faked or borrowed family i.d. to get medical help they otherwise couldn't afford. You don't often hear that side of the story down there but it's true and is now the reason why most provinces are going to start issueing new "smart" i.d. health cards because of that.

 

[petek]

Re paying high taxes. That's also another scare tactic. Tax rates in Canada vary and I believe our highest federal tax rate is lower than the US, I'd have to check that out, but then depending on which group you're in our middle class could be paying a higher rate than say the same group in the US, too many variables such as grants, programs, incentives etc.
The bottom line though is this at the years end, when all the counting is done and people have paid their taxes to their respective governments there is very little difference between what is paid in the US and what is paid in Canada.

Where the difference is is in "spending" power and that is because historically things have always cost somewhat more in Canada than the US for the identical item. Heck even stuff that's made here costs more here than it does down in the US many times. This is becoming a huge issue with Canadians why we are being taken to the cleaners. In fact the minister of Finance is meeting next week with some of the largest retailers and the auto companies to ask them why this is happening and what are they going to do about it. Espcially the auto companies.

 

[~sudsshane]

Petek~

Thanks for posting this! I have heard the same thing about Canada'a Healthcare System from a good friend who is Canadian and lives here. He goes home to Halifax every year for checkups,dental work,.. etc.
I think it is a damn shame the lies Americans have been told by the Republicans in Congress and The Bush Administration regarding Canada's Healthcare System. My hope is Americans are finally beginning to wake up.

Take care.

 

[petek]

There's an article in CR this month about healthcare that's interesting.

BTW, dental and vision care in Canada are not covered by universal health care. It's pay as you go or have a good insurance policy alone or thru your workplace. By vision care I mean eye checkups for glasses etc. An eye disease or injury injury would be covered.

 

[danemodsandy]

Pay Now, or Pay Later

As I see it, the essential problem with healthcare in the United States is that we do not have a system for providing insurance for everyone. The result has been a large number of uninsured, who are then left with no choice but to use emergency rooms for their healthcare needs. This creates several problems. First, by the time someone is sick enough to seek E.R. treatment, they are often sicker by several orders of magnitude than they would be had they been able to get a doctor's appointment for preventive care or early-stage treatment. This is expensive. Second, if someone cannot afford health insurance, it's a damn cinch they cannot afford to pay their hospital bill. This is straining the resources of public hospitals to the breaking point.

In my opinion (I was going to say IMHO, but my opinion is not as humble as all that, LOL), Massachusetts has it right, or at least righter than other states at this point. By making insurance both mandatory and affordable for everyone, resources are brought to bear on both problems I've just mentioned. People who "aren't feeling well" can see a doctor and find out that they're perhaps diabetic before they morph into a E.R. case that costs a public hospital hundreds of thousands to save. And when people receive insured treatment, the care provider has every reasonable expectation of being paid, reducing the strain on public funds.

A lot of people decry the Massachusetts plan, saying that it's "socialised medicine". Anyone who says that hasn't got the first dim-bulb clue what socialised medicine is. What Massachusetts has done is to require insurance that helps keep costs in line for everybody, exactly as is done with automobile insurance. And exactly as with auto insurance, the more people in the pool, the more price competition and the lower rates can be.

At the rate we're going, we're going to see the closure of big-city public hospitals (it's on the brink of happening here in Atlanta), and we could well see a return to the public health problems of the early 20th century, where people died or were permanently disabled or disfigured by the simplest problems. I think we can do better than that.

And I think we'd better do better than that. Anything less than reasonable healthcare access for all means that we will have failed as a nation. The United States was founded by people who believed in genuine morality, as opposed to the mealy-mouthed "family values" posturings of our current crop of idiot politicians. I say it's time to make our healthcare system a place where compassion, morality, and sound business sense prevail.

 

[58limited]

I believe the insurance system in the U.S. needs to be reformed across the board, not just health ins., but all insurance.

I do not know much about medical systems in other countries. We had a similar discussion on this board awhile back and our Australian friends seemed to have a good system. My only worry is if the government decides to start to cap doctor's salaries as part of health care reform and socialization, then there is no incentive for them to excel in their field, and potential doctors might choose other more lucrative fields instead of going to med school.

My mom had a good friend who was from England. Her brother had emphasema and COPD, like my mom had. My mom was provided with an oxygen generator through Medicare. Her friend's brother in England was not. My mom's friend had very little good to say about Britain's medical system and this is the only knowledge I have of it myself, so I'm not going to give any opinion, other than mentioning the incident above. I realize that not every system is perfect and he might not have qualified for the oxygen generator, or maybe a mistake was made.

My mom had very excellent care under Medicare and Medicaid. She couldn't get Medicaid until she was 62, and the paperwork was a pain but I can't complain about the care she received. Prior to that, she had insurance from her employer for awhile until she became too sick to work. Friends and family paid for her prescriptions, which easily reached $1000 a month. And her doctors basically wrote off a bunch of charges. Medicaid covered everything once she was signed up.

I'm 38, single, healthy, and I don't smoke. I just paid $2350 for my 6 month insurance premium - my deductable is $1500. That seems really expensive to me. 8 years ago my premium was $1500 with a $500 deuctable. Don't even get me started on home owner's insurance, which more than doubled because of so many phony "mold" claims in Texas.

 

[petek]

Don't think that doctors and specialists in Canada aren't well paid, certainly they don't make some of the astronomical fortuntes they could in the US but they also don't have to pay such astsronomical mal practice insurance rates either like they do in the US to cover frivolous lawsuits. Where do you draw the line on what is a good wage I don't know but I'm thinking a doctor here is probably pulling in somewhere between 2 and 300k per year.

re your mother getting an oxygen tank and her brother in the UK not getting one. Without knowing eithers diagnosis etc you can't make a valid comparison. What is known is that in the US, doctors are far more likely to prescribe drugs, send patients for unnecessary tests and even operations because it's all profit driven and the hospitals need that money to satisfy the shareholders.

 

[peterh770]

Panthera: "...those who can, pay into the system. Those who can not, are helped by the system..."

Are people forced to pay into the system? What if they don't?

I hate this subject because we are talking about INSURANCE and not HEALTH CARE. Get rid of the insurance company middle people who make their living collecting your money and hoping you don't get sick. Sorry, the government can't do very much right at all, and I sure don't want them between me and my doctor. Every doctor I have been to, I have discussed with them if they would work with me on a cash-and-carry system for my needs and they all said they will. People need to talk to their doctors.

I don't think this "crisis" is near the crisis it's made out to be, and I think a lot of it is just hype from the insurance companies.

 

[neptunebob]

At the very least, somehow health insurance has to be "divorced" from one's employer. I have worked in several places where some of my coworkers were miserable and unhappy on the job but stayed there because of the health insurance. Maybe they would have stayed there just for money but I think the working world would be a much happier place if some people didn't feel "Trapped" in their particular jobs and could do the work they actually want to do. A lot of the premium we and our employers pay to health insurance companies is used for sales management, advertising, marketing, executive salaries, and commercials and not for actual treatment. For Medicare, less than 3% of the funds are used for administration and processing, 97% is actually used for the care. Most of the Presidential candidates want to somehow have the government "subsidize" the premium and keep the health insurance companies in business, with their bloat, commercials, and involvement with one's employer. Dennis Kucinich proposes "Enhanced Medicare For All" House bill 676. That is one reason I am a proud Kucitizen!

The Physicians for a National Health Plan have an informative web site, try it here:

http://www.phnp.org

 

[brisnat81]

Australian View

Hi All,

We've had Universal (Socialised) Health care over here, since the 70's.

I guess the best way to explain how it works, is what it means to me as the consumer:

1) If I go to see a GP, the Average charge is around $55AUD. Through Medicare, I claim back the scheduled fee (Currently around $35) and I'm out of pocket by $20AUD. I can usually get an appt with a doctor of my choice, within 48 hours.

2) Some surgeries Bulk Bill, which means they charge no more than the scheduled fee. They swipe your medicare card and you receive "Free" treatment. It is usually more difficult to get an appointment at a surgery who bulk bills.

3) If I had a car accident, cancer, or any other life threatening illness, I can expect to receive treatment at any public hospital, either in ER or as an admitted patient, at no cost. In Queensland, ambulance costs are covered by a mandatory $22 charge per quarter on our electricity bill.

4) For Elective surgery or non life threatening proceedures, we also have waiting lists. In some cases these can extend up to 2-3 years. These can cover, Hip replacements etc, Dental, Some optical and anything that isnt life threatening, but may be an inconvienience.

5) Should I need to see a Psychologist or Psychiatrist, I am entitled to 10 Government contributed sessions. Govt pays $79 my contribution is $50 and I claim $28 back from my health insurer.

There is also a cap on Medical expenses, be they Medicine or treatment. Its a sliding scale, and once I spend more than $800 per year, I receive and increased proportion back in my tax return (Which I just completed Yay ). For families and couples the amount is $1500.

That is where Private health insurance comes in. PH insurance is not mandadtory, but there are tax incentives to take it out.

The Government provides a 30% rebate on Private Health Insurance. My Premiums paid for the last financial year were $1289 for Hospital and Extra's cover. The cost of the policy was $1846. The Government paid $557

Private health isnt really regulated, so the benefits you receive are governed by the fund you're a member of, but again in referring to my situation, the following outcomes apply.

1) Optical - I can purchase up to $400 worth of contacts for $120 per year, or I can be buy a $400 pair of frames and lenses and be out of pocket by around $120 per year.

2) My last dental checkup and clean, cost me $40, the charge to my health insurer was $180

3) Should I need elective surgery, IE Tonsilectomy, I can elect to have it performed in a private hospital, thus with a doctor of my choice with no waiting. The cost to me is around $900, Health Insurance paid $1800.

4) I receive benefits for Healthy living measures. My insurer pays $20 per month to my Gym membership

5) My Insurer provides a refund on most remedial services, IE Massage, Accupuncture, Physio etc etc. Health insurance pays $28, I pay another $20. This can be obtained through the public system, but there are waiting lists.

The tax Side of the equation
Australia has a reputuation for being one of the most highly taxed countries in the world. We have a 10% GST, Stamp duty on the purchase or property, cars etc and Personal Income tax.
I've attached the tax rates below:

If my income is between $1 – $6,000
My Income tax is Nil

If my income is between $6,001 – $30,000
My Income tax is 15c for each $1 over $6,000

If my income is between $30,001 – $75,000
My Income tax is $3,600 plus 30c for each $1 over $30,000

If my income is between $75,001 – $150,000
My Income tax is $17,100 plus 40c for each $1 over $75,000

If my income is between $150,001 and over
My Income tax is $47,100 plus 45c for each $1 over $150,000

Whilst we have these high Income tax levels, our Government currently runs a budget that is in surplus of approx $10billion AUD each year, and there is a futures fund aside for Federal govt superannuation and essentially a rainy day (Balance currently around $50 Billion AUD).

This mightnt sound very much to those in the rest of the world, but remember Australia has a total population of 20 million people.

Our health systems are currently managed by the States. Funding is contributed Federally and at a State level, together they attempt to provide all the services that they need to. All Medicare processing occurs at a federal level.

On our visit to the US, we hated San Francisco. The sights were pretty, but the poverty, begging and untreated mental health issues were just incomprehensible coming from Australia. We stayed off all public transport other than the cable cars, mainly due to the outwardly disturbed people that constantly frequented the trams and trains. We'd never seen anything like it before, ever. In Australia, those who wished to receive treatment, could've long before their conditions progressed to the state that they were. We never saw that level of poverty again during out time in the US, either in NY or Boston, and we spent a fair bit of time, on foot traipsing accross all 3 cities. I dont know whats wrong in California, but we were horrified enough to never want to go back to SF again.

I'm glad that I live in a country with Universal Healthcare and I'm glad that I have the option to choose how much my healthcare costs.

We have a combined household income of $180K per year, and I take heart in the fact, that my single mother who earns $45K per year, can receive the same level of health care, that I do.

Personally, I think its very wrong, that a supposedly first world country such as the US, discriminates between the rich and the poor, when it comes to the basic requirements of life.

 

[petek]

Peter it isn't all about insurance that's just the half of it. The other half is hospitals operating "for profit". Corporations often as not owned physician groups etc build all these hospitals with the sole purpose of making money. They equip them to the nines and spend a fortune on television and radio advertising how much better they are. They pay a fortune to entice doctors to practice or associate to them. They have to recoup all that money for starters and then make a healthy profit on top of all that to satisfy the shareholders of that corporation. So who ends up paying for it all, you do through astronomical insurance premiums or user fees.
Take for example where I live, we have one hospital, enough for the size of this small city of about 75,000. There are I think 3 MRI machines. Now 2 miles away in Port Huron Michigan, a city slightly smaller,there are numerous hospitals one with a huge MRI clinic of 10-15 MRI machines each costing I dunno a million a piece lets say. Of course you can drop in near 24hrs a day and plop down $600 out of pocket which I'm sure they would love but that's not an option for most people. It's also one of the reasons that doctors in the US over prescribe things like MRI's etc when a regular X-ray would be just as good, they have to fill those machines with patients to pay for those machines, to pay wages, stock dividends etc. The insurance companies know full well these procedures and all these MRI's aren't necessary but what can they do. If they deny coverage to someone or refuse to pay they look like the bad guy so in many instances they just increase everyones premiums to offset their loss.
That's why the whole concept of HMO's began was to get control of some of these runaway costs. Unfortunately it seems to have derailed

 

[panthera]

Peter,

That's a fair question and I will try to answer it as simply as possible.

No one will come and do anything to you if you fail to insure yourself. But you are legally obligated to and there is also an obligation in the sense that we are a community and as such, have a responsibility to each other. A German cop will look the other way if you jay-walk across the street when no children are around. Do it in front of a kid and you will pay for it.

This is the basis of German society - social consensus is what we call it. This system results in a higher ROI for capitalists than the US offers, by the way, so we must be doing something right.

Now, if you can't afford insurance, then of course the tax payers will pay for you. If you could afford insurance, don't pay into it then have to be treated there are two possibilities. One, you pay for the treatment yourself. Two, you can't afford the treatment. The government will pay for it (assuming you want it, if you want to curl up and suffer and die you may here) and then charge you for as much of it as possible.

I see nothing wrong with this. I know you are a strong believer in individual freedom, but I must ask. Where do you draw the line? Is shared infra-structure such as streets, currency, police services, fire department, schooling, tax-free status for churches, required insurance for all motorists ok? Some or all or not?

Each society has to decide where to draw the line. Here in Germany, we decided long ago that it was not morally justifiable to cast off those people in society who are ill - mentally or physically. We believe that children are our highest good - and should be raised with the best health care possible. We firmly believe that old people have a right to live out their last years in their own homes, given the medical treatment needed to live as comfortably and well as possible.

The current US system does not work. You have a crumbling infra-structure. Without that infra-structure, you can not compete in the global economic system. Your social consensus has disintegrated to the extent that you have tens of millions of people for whom there is no medical aid possible. The "well, the hospital has to accept you" theory sounds good, but I have spent too much time in the US to fall for it. Unless you are in danger of dying or losing a limb, you will not be served in Fort Collins, Colorado.

So there it is - your culture lets people have the freedom to suffer and be ill (including children who can't help themselves). Mine provides health care for all, charging (at a profit!) those who can pay and aiding those who can't. We have a much lower rate of abortion, our infant mortality is enormously lower and our life expectancy higher. And our capitalists, as I have mentioned before, make a higher ROI than in the US - and not just right now, but over time.

So I ask, where does the "each man to and for himself" stop? Being a libertarian sounds great in theory...but you have to be realistic. You can't pay the salary of an entire university. You can't do surgery on yourself. When you were a child and had a bad ear infection, one that hurt so much you screamed...did your mom say, well, dear...since you don't have any money, you aren't worth antibiotics?
That is, de facto, the situation in the US right now. And it doesn't have to be that way. Just because "everybody" else is doing it, doesn't make it right...but when the entire rest of the developed world is doing it, has been doing it for many many generations and all the rest of us are more productive and live healthier, longer lives than you do...

Anyway, I know you are not a republican christianist but a serious person. I just think, maybe you should stop and reflect on the situation for people who don't have your resources in the US.

Hope I haven't offended anyone with the above...and really, really wish folks would stop using the term "Socialist". Our health care system is not socialist and, folks outside of the US, please be aware that Americans as a group associate socialism with the worst of totalitarian, Stalinist governments. Most folks in the US have no idea how other democracies work and that word has connotations in the US which it does not have for the rest of us. The system in Australia is not, strictly speaking, socialist.
Off me soap box now.