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What does "insurance" really ensure?
Posts
If the public health system had exercised their power to recall doctors from their vacation schedules, then some deaths could have been prevented.
Ironically, in the absence of a single payer system, that power would not have existed at all. This is kind of like arguing that you should build a car without brakes because this one time somebody's brakes failed and people died.
Seol: I agree. Did you think I was arguing against single-payer? I'm a huge single-payer supporter.
the "no true scotch man" fallacy.
"X doesn't work perfectly all the time, therefor it must be torn down" is a pretty common argument against social programs.
Yep, and it is often (as is the case here) dumb.
the "no true scotch man" fallacy.
What the article does point out is that the French government handled the situation badly, refusing to take emergency measures until it was too late, and also for not providing assistance to the lonely elderly in getting help.
If there was a private health care system, would people have gone to the houses of the elderly to check up on them? Possibly, if they had paid for that sort of service.
Ultimately, the government certainly screwed up in not providing emergency assistance to those who needed it during that crisis. That's not necessarily a failing of a public health system, just of governments generally. See, for example, Katrina or the badly handled relief efforts after the earthquakes in various third world countries.
Even if they'd called all the doctors back I have doubts it could have significantly impacted the number of deaths. Every doctor in the country could have been on duty and it wouldn't have done a whole lot for any of the elderly that passed out at home and sadly never woke up.
Maybe I'm missing something but going over the given links I'm not seeing where it's indicated lack of resources to provide adequate care was a major contributing problem. All I'm really seeing is some references to political posturing between the administration(s) and parliment.
Basically this. Every time I see someone mention spending hundreds of dollars a month for health insurance and then getting denied my brain wants to explode.
It also makes me an ass for complaining that my monthly MSP (medical services plan) payment went up to $60. I have regular doctor checkups and a baby on the way, both of which do not cost me a penny more than the monthly stipend.
It is unfathomable to me how any nation can claim first world status when peoples health is subject to entities with a profit motive instead of individual wellbeing.
I mistakenly equated "deductions" with "disbursements" in my head and got my WRBLGRBL higher than it had any right being.
I have no problem with the above as you so politely and helpfully put it and actually think an HDHP plan that is HSA eligible would be a great way to bring single payer to the US.
(Man this thread must have been created with black magic. Everyone is being way too exellent to each other)
hundreds? lol.
Check this out, bro. (I swear it's not a keylogger)
http://www.ins.state.ny.us/hmorates/html/hmonewyo.htm
Individual health insurance rates in New York County, New York.
What the fuck?
Jesus, that's outrageous even for the US.
the "no true scotch man" fallacy.
I'm a good plan ($30 copay for everrrrrything), 32-year-old male, and my monthly premium is $390.
My employer covers the first $250 of the monthly premium. The rest is your typical pre-tax payroll withdrawal.
the "no true scotch man" fallacy.
This is what you get when you don't allow insurers to rate discriminate based on age/health/pre-existing conditions, but don't require an individual mandate.
Interesting note onto this btw if you want to get into really fucked up shit, because of recent regulation no insurance company will write a policy for a child without an adult on the plan. That leaves me paying $600 a month for my son, buying extra insurance for me so that he can get on that plan, or trying to get onto a government plan.
Whooo! Look at those options!
So they charge you 10$ vs 40$, and it made all the difference for their costs. Except now people go "man, its only 10/20$ more for brand name, GIMME DAT" so now the rates are rising again. its not really a money maker, as you see the costs of drugs above. I am highly surprized with how pharmaceuticals are priced, that drug cards/insurance companies can survive at all.
It just happens to suck for the poor where they can only get a brand name item.
No, it is like someone arguing that brakes have never failed, and then me pointing out a time when brakes have failed. Nevermind exercising the power to recall doctors, how about exercising the power to fucking schedule some doctors to be at work. I'm familiar with the French habit of depopulating the country every August... surely someone from the national health service must have thought to check on all the pensioners under their care? A phone call, something? But no. They just fucked off to ibiza or wherever, and came back to discover no one had checked in on memere while the worst heatwave in memory gripped the nation.
This was absolutely a public health failure. More people died in that month in Europe than in 40 years of heat waves in the USA. If you're a supporter of universal coverage national healthcare and aren't willing to demand the government assume the burden of caring for the people you've demanded be cared for, especially if you're someone who claims healthcare is a human right, this incident should be high on the list of things you work to prevent as part of your essential duty to the people.
I haven't taken a position on single-payer or national health insurance at all (though living in Ireland from 2001 - 2005 certainly caused me to form one). I have pointed out some problems I feel are comparable to the profit motive, and some current, past, and potential examples. Don't dismiss me out of hand.
Wait, I'm confused. Why would anyone pay $10-20 more for a brand name drug? This is actually happening? This is like people buying Monster HDMI cables. I still don't comprehend how Monster manages to stay in business, either. But seriously, I wouldn't pay $0.01 more for a "brand name" drug.
Spool maybe this is a better way to go about it-
Do you believe that the government run single payer system contributed significantly to the 2003 heat stroke deaths in France and if so why?
The post references both. A doctor will prescribe the more expensive of these by default usually because its the latest and greatest sold to them by pharm salesmen. This is when its literally the generic, with acetaminophen added (thats the pain killer in tylenol that costs less then pennies for them to add) or some alternative to create a new brand. Unless you ask him for generic, because itill cost you 10-20$ cheaper at the pharmacy, saving your drug card potentially thousands of dollars. If he prescribes you a brand name, you should really ask if theres an equivalent generic(there most likely is), and if there isnt, or if its because this named drug has something extra, figure out if you could pop a tylenol/equivalent instead.
I hear people bitch about copays, but really, its the stopgap that keeps your premiums from skyrocketing even more at the moment.
This is equivalent to why your plan has in and out of network rates and deductibles. They reaaaaaaaaally want you to go to their physicians they contract with, becuase they get cheaper reimbursement rates with the in network guys.
If they removed this part of current insurance, you would pay this amount to the insurance, and their amounts of payouts would skyrocket, raising your premiums by even more amounts.
The Heat Wave deaths were a double blow - the heat wave hit at a time when a large proportion of the country goes on holiday, this included family members who would have otherwise have checked on their relatives. Secondly the integration between social services, primary and secondary care in France isn't as complete or as strong as in, say, Britain. If anything the deaths are more to do with a lack of commie health care provision than too much.
PRE-EDIT: I see much of this has been covered.
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The UK National Health Service (specifically NICE) has been taken to court multiple times in the last few years to get it to fund treatment that it had previously deemed non-cost effective. Basically spool is utterly mis-informed on this one.
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It also seems to be the entire basis for this thread's attack on the U.S. system.
Because paying for medical procedures is their job.
Do you have any other remedial questions knocking around in that noggin of yours?
Similarly, in an insurance model, if a given condition isn't covered by the policy for entirely sensible reasons (such as: no rational actor would enter into a contract where they were liable for significant known costs), then it's entirely reasonable that the insurance company doesn't pay out.
This isn't the fault of either the insurance companies or the doctors, per se. It's a consequence of a system where those providing care (and the funding thereof) are motivated by commercial, not social interests.
Also in the UK you do still have the choice to go private, though a lot of it is focused more on the quality of where you stay (nicer rooms with more facilities, potentially with close contact with medical professionals at a point when you would have been discharged from an NHS facility - so if you wanted you could stay for a day or two extra at a private facility following an operation of giving birth) as opposed to a different level of treatment. Some medical insurance will also let you use it abroad, should you need to go somewhere else for treatment, which is pretty rare under the NHS.
Because society also has a social responsibility to provide for them in return for their aid.
Rare but becoming more common, various pilots and studies have been done on the cost effectiveness of it. Although it's use may drop now the waiting time targets have been dropped.
I made a game, it has penguins in it. It's pay what you like on Gumroad.
Currently Ebaying Nothing at all but I might do in the future.
I buy a lot of medicine. A pharmacist has never, in all my years of buying medicine, failed to ask me if I want the generic version of what the doctor prescribed. The rest of the problems you talk about can be solved with rudimentary awareness of the drugs you're taking and why, and basic questions to the doctor prescribing them.
Another facet of this problem is a doctor who is not looking out for his patient's financial well-being by offering him a range of choices, or the lowest cost choice. Yet another facet is a patient who fails to ask his doctor for the cheapest alternative. A third issue is the convoluted relationship whereby the patient, the pharmacist, and the doctor don't really have a financial relationship with each other. They each pay or are paid by a 3rd entity, so there's no incentive to even be aware of costs.
Swapping "the insurer" for "the government" doesn't seem to solve this collection of problems.
I think the French seem to have concluded that it did. I don't read French, so I'm quite handicapped in searching for a range of opinions. I do, absolutely, believe that the health service is partly culpable for the deaths through their failure to schedule adequate coverage and their failure to recognize the problem and respond to it.
I also believe families are partly culpable, because responsibility for your family should be something that isn't left to government. Someone should have been checking on each of those 14,000 people. That's how we do it here in Texas, with fan donations, local news warnings, hospital outreach, and so on. None of that seems to have happened in France, even as the 2nd week began and the deaths piled up.
I worry that a comprehensive national health system is corrosive to the idea of personal responsibility for active involvement in the health of your family, but I only have anecdotal experience with this mindset and I can't assume it's widespread or inevitable.
My plan has a good way of going about it. They only charge you the higher copay for a brand name drug if there is a generic available. If there is no generic, then they charge you the lower copay. Seems fair to me (even though it means I get the short end of the stick by demanding the brand-name version of my antidepressant).
Generic drugs do not have to be exactly the same as their brand-name counterparts. They have to meet a standard called "bioequivalence" which means there might be small variations between the two. For most drugs (antibiotics, painkillers) I don't care, but for my antidepressant, I can tell the difference.
Bioequivalence is something that I want to go to grad school to study.
Nobody here has claimed that single payer is perfect. You're using a marginally-relevant example to argue against a strawman.
Personally, I think that single-payer should have copays for everything, with limited exemptions for the homeless and very indigent.
No, not really.
I've never argued that private insurance should go away or that we shouldn't let doctors and hospitals practice privately. In fact, I've argued the exact opposite.
I want to see significant modification to the current system - mainly (but not exclusively), that basic care should be covered by a single-payer a'la Medicare or Medicaid for all citizens - but that isn't the same as saying we should tear it down and start over.
the "no true scotch man" fallacy.
There's no reason to believe that the same remedy will be available here. You can't sue the police because they fail to respond in a timely fashion - it's entirely unclear that you'll be able to sue the Department of Health because they failed to approve a treatment, and certainly in the interests of those crafting the regulations to avoid legal exposure whenever possible.
Were any of those suits in the UK effective? I am uninformed... I see the report of xyz travesty, but never the follow-up or the resolution.
I do not have the statistics to hand for all cases but from memory but of the last 3 major cases of patients suing NICE for cancer drugs and I think an Alzheimners treatment that NICE has designated of marginal marginal cost/benefit utility the patients have been victorious.
EDIT: Sorry, an error in my memory - the Alzheimer drugs are still denied but the pharmaceutical companies did win access to the economic modelling which allows them further grounds to appeal if it can be shown to be faulty.
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The NICE policies were liberalised but they still denied a couple of cancer drugs which were then legally contested, Herceptin is the one I specifically remember, the court's initially ruled in NICE's favour but then over turned on appeal.
I made a game, it has penguins in it. It's pay what you like on Gumroad.
Currently Ebaying Nothing at all but I might do in the future.
No the argument against the US system is it consistently performs poorly in virtually every way and that there are better models available that we should use.