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The Revenge of the Health Care Thread [SPLIT]
Feral
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I really would like to know what happened to the attitude that America, being America, can tackle any problem, meet any goal, overcome any obstacle. America sent two men to the fucking moon for God's sake, in the sixties. And now, almost forty years later, America is (according to UHC opponents) rendered helpless in guaranteeing that the most basic of medical needs are met for its citizens, by silly things like geography. America is so vastly wealthier and more advanced than the next runner-up that geography is, at best, a minor obstacle in the way of providing health care to all citizens.
UHC opponents don't typically argue that it's impossible. They argue that it's unfeasible. That doing it would result in a vastly inferior level of care to what we have now, a ginormous drain on the economy, or both. I don't put a whole lot of stock in these beliefs (both the General Accounting Office of Congress and the Congressional Budget Office have found, multiple times, that a UHC system could be implemented without sacrificing care or raising taxes), but at least understand what the counterarguments are.
Also understand that this camp also believes that you folks up in Canada have a bureaucratic clusterfuck of a health care system.
As for "other countries have done it, so can the US," the typical counterargument to this is that the US subsidizes health care for the rest of the world through our awesome pharmaceutical industry - another argument I don't buy at all, but, again, mischaracterizing the counterargument doesn't really help.
ege02 wrote:Seriously, you can be all naive and cynical and bitter about the subject, or you can go and listen to expert, specialized opinion and educate yourself about the harsh realities of providing universal health-care to 300 million people.
Seriously, read the GAO and CBO reports. I can find them if you really want me to.
BTW, is this sliding into another UHC thread?
every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.
the "no true scotch man" fallacy.
the "no true scotch man" fallacy.
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The site is biased, but the reports it references are from nonpartisan sources.
Physicians for a National Health Program - How much would a single payer system cost?
the "no true scotch man" fallacy.
It then gets further reduced by having an increased buying power.
I know people say, "but the government will interfere with it/use it for political gain etc," but that is more a problem of failing to hold elected officials to account.
To me, it sounds like those HMO-nightmare stories ad nauseum ad infinitum. Could someone who is pro-UHC please explain to me how this will be addressed?
If someone is wheelchaired into a hospital with a broken leg, it takes only as long as the X-ray to diagnose and treat. It's not really the same issue.
I'm not talking about receiving treatment. I'm talking about the treatment being paid for. This is the problem with discussions of UHC. People can't separate discussion of expediency of treatment from expediency of the payment of claims.
Look, those are two seperate issues. Believe it or not, no one is denied care in the U.S.A. People are, however, quite often left to foot the bill. To use your example, anyone brought in with a broken leg will be treated at a hospital. It is illegal to deny care. Care can be refused. Heck, the person might not even go to the hospital if they are that afraid of being stuck with the bill. That aside, no one no one no one is denied care. People are often in the position of not being insured against the cost of care.
That is the issue I wish to discuss. The expediency of claim payment.
Will it be more or less efficient than even the most bureaucratic HMO?
Will there be some sort of legal protection for patients while claims are processed?
If the claims take too long, and the care providers cannot seek payment from the patients, how will they stay in business?
Stuff like that. Knock insurance companies for inefficiency all you want, but to say that the federal government of the U.S.A. is capable of being more efficient is laughable.
I don't think there would be as much hold up as there currently is on the patient side, because none of the paperwork directly involves the patient. Currently, when you go to the doctor, they need to check your insurance, make sure you're covered, and yadda yadda. That wouldn't be necessary with UHC, because everyone is covered. Period. And they're all covered with the exact same insurance. The doctors don't need to check or verify anything prior to treating you.
The problem, I would think, would be on the doctors' ends when it comes time to collect their money. If, for example, it takes the government 17 to 31 months to actually reimburse the hospital for the surgery they just performed, I can see health care providers having a very real financial problem. Hopefully it wouldn't be that severe, though.
I can also see potential issues with the government deciding that a certain procedure shouldn't "really" cost as much as it does, and paying out less than cost for certain things, which already happens a lot with programs like Medicare. Doctors are required to accept Medicare, they're required to perform certain procedures, and yet the government only reimburses a fraction of the expense, such that certain doctors are basically required by law to lose money any time a poor person ambles into their office. Hopefully this would be addressed, as well.
The biggest problem, I think, would be in high-cost or high-risk procedures, which most places with socialized health care just flat-out refuse to perform. They don't really have a choice - if you perform a million-dollar procedure on every person with cancer, you'll go bankrupt, and so anything too far removed from "routine procedure" just doesn't happen. This both stymies advancement - those million-dollar procedures don't get used enough to become perfected and cost-reduced - and results in people heading over to places with private care so they can receive treatment. If they can afford it, of course, though you typically don't see too many people lamenting the injustice of rich people flocking from the country to receive their expensive treatments while poor folks sit at home and die. And, of course, this wouldn't even be an option if every place had socialized-only health care - if you got too sick, you'd just have to die, so sorry.
Of course, the above problem can be side-stepped by offering private health insurance or care in tandem with UHC. If you want to have the option for high-risk/high-cost procedures, or just aren't satisfied with public care, knock yourself out.
These are more of what I am concerned with. UHC won't see any real, concentrated support from the health care industry until they know that not only will they be paid in a timely fashion, but paid what they should be paid.
That is a pretty damn big problem. And you should see people "lamenting poor folks sitting at home left to die." To not present that reality of a socialized healthcare system is asking people to vote without knowing all the issues. At least, not all the important ones, considering that it is "poor folks" who seem to be the most supportive of UHC. Would they be if they knew that they would be left to die if they contracted a cureable, but expensive to treat disease?
By the way, outside of Cuba maybe, there are no countries that have socialized-only health care. In all these supposed single-payer-only countries (as presented by advocates of such a system in the U.S.A.), there still remains a great deal of private health care. And it's exactly like you describe. People are either poor and left to die, have private insurance on top of the public stuff, or head to another country receive treatment.
Ok, so now that you bring it up, that last issue of being left to die is in my "top five, in no particular order, problems with the idea of UHC." The whole fucking platform is "no one should be denied care" put in such a way that people think, "hey, with UHC, I won't have to die if I can't afford to be treated for cancer!" Which is bullshit. You'll be left to die.
Can someone explain why these million-dollar procedures cost a million dollars? Perhaps more specifically, why they must cost a million dollars no matter what?
Let's head this one off at the pass and say, "it's not because some doctor with a sense of entitlement feels that's what he's worth."
No one says they must cost a million dollars no matter what. Liken it to when new consumer technology comes out on the market. Costs a shitload more than it does a few years later, doesn't it? Those medical procedures cost so much because because there really is a COST there, and not just an inflated sense of what the procedure should be worth.
Cost of equipment, cost of research, cost of expertise, so on and so forth. All of which comes down with time.
I'll be fine, just give me a minute, a man's got a limit, I can't get a life if my heart's not in it.
Also the fact that certain drugs (mostly cancer that I know of) need to be specialized to each patient.
I buy this up to a point, although my preference would be for totally socialized medicine with rigid price controls. I can see, however, that in a market system that market forces would behave in the way you describe.
That's just...wow....no.
That's why the governments universal health plan isn't the only game in town. There's also a bunch of private health insurance companies that one can sign up with for extra coverage. The idea isn't for the government to provide care for every patient, it's for the government to provide a basic level of care to every one. Above and beyond that, it's up to the patient. In Canada, most jobs give you extra health coverage to supplement the government plans.
The idea that high cost procedures just wouldn't happen under UHC is bullshit.
Price controls are a historically poor way to regulate a market, let alone a high-tech market that pretty much thrives off of free market influence.
Tens, if not hundreds, of thousands of people receive cancer treatment courtesy of the NHS every day. So, really, the "being left to die" option is scare-mongering bullshit.
And roughly 90% of Brits have absolutely no problem with the NHS. Indeed, while specialists can - and often do - private work, the bulk of their money comes from the NHS. Hence, very few consultants work exclusively in private care. There generally isn't enough money in it.
The idea is that they wouldn't happen under just UHC. They would if UHC was supplemented with private care. Which is why I'm sort of on-board with the idea of UHC coupled with private health plans.
UHC strikes me as similar to Social Security. Sure, it's not the only retirement game in town, you can also invest your own money in a private retirement fund and get a small tax break for it. But Social Security is a horrid system for retirement. It ensures that everyone has some income in their later years (or their disabled years), but the actual standard is such that anyone who wants to maintain a decent quality of life is forced to supplement their retirement. Except that now it's harder to do, since 12.5% of their income is already taken for use in a government forced retirement program that yields a rate of return so shitty no serious investor would give it the time of day. Now, why not allow those who want UHC to be their primary and/or sole coverage do so, but leave the rest of us out of it?
"Cancer treatment" isn't what I was talking about. Cancer is practically routine. But there are cases where a million-dollar procedure gives you a 1-in-3 chance of survival, and this is the sort of thing that NHS really doesn't cover. Do you see the government blowing untold millions of dollars trying desperately to save the life of every last person? No, you don't. Because it can't afford to. Some rich dude can, though, because he has the money and the motivation.
Because that's not the way these things work. Everyone throws in tax money for the benefit of all. If I don't own a car, why should I have to pay taxes to maintain roads? And so on. It's a bullshit argument.
Even if true, I think it's more important to cover everyone now and do our best to ensure fairness of treatment access now and risk sacrificing medical progress. Fantastic medical advances lose their luster when only 10% of the population requiring them can afford to have them.
Such cases are comparatively rare. It would be illogical to discount the implementation of an American UHC system because of a relatively tiny group of (possible) patients. This is ignoring the fact that a US-based UHC would almost certainly be far better funded than the NHS, and thus better equipped to deal with such cases.
Private care would still exist, as it does in the UK. Insurance would also help cover costs of treatment, as it does in the UK. The biggest obstacles are political and organisational, not financial. Indeed, one prudent lesson to take from the modern NHS is that bloated, overly-powerful management is to be avoided at all cost.
More than most nations - certainly more than the UK - the US has the money, the manpower and the brainpower required to create a suitably efficient nationalised health care system.
Debateable, but I can see why a rational person would take that stance. It's a defensible position to say the least.
So a question I would follow up with is:
Based on what we know about technology and medicine, though 10% can afford it today, 20% can afford it tomorrow, and the procedure is near routine in a decade. Forced, socialized medicine does not allow for market forces to drive prices to that point, instead creating a) artificially high prices for scarce items/procedures and b) a black market that subverts the original intention of the price controls.
Again, it could be entirely rational to debate that the aggregate cost is worth it, but it's a much harder argument to make.
UHC advocates are trying to move the system towards that inevitability, so it's not a "bullshit argument", it's a reality that must be faced if anyone advocates such a move. You are forcing someone to pitch in for coverage that may likely be less than what they currently have, then asking them to pay an extra premium to get to the coverage level they were previously at.
It's something like your road analogy, but not really. Road mantainence is done in part through taxes levied by the direct use of the road (tolls, gas taxes, dmv registration fees) and if you are a tax-paying citizen, you directly benefit from the use of the roads whether you own a car or not (what % of the commodities you use to survive were not delivered via road?). One could make the argument that raising the health of the nation as a whole through UHC (which is a possibility, but I don't think I've seen conclusive evidence to support that claim) is a ubiquitous benefit to society, but the direct benefits to an individual are the most prominant reasons to support or oppose such a change.
It isn't that they won't occur, its that they are harder for the lowest tier of insurance owners to obtain.
Lets say that I'm getting my HMO entirely from work. Now a UHC system comes into place and I have reduced care. If I'm going to get back to private insurance and my former level of care I need to pay for that private insurance. My work wouldn't provide it for me anymore because the government is already taking care of me, the idea is that they pay into the system and I'm not their problem anymore. So now I can't get the best care anymore, which stinks, not to mention a contradiction of the Hippocratic oath.
I'm not sure if this is the best argument, because it assumes that overhead and funding stay the same, or get worse. That is likely to happen on the funding level though, because if Republicans are ever forced to past UHC they're going to try to doom it in the fine print, and one of the best ways to do that is by underfunding it (not to mention that that's just what Republicans do, NCLB anyone?)
This risks going off-topic as it's a much larger idea, but I'd prefer to see across-the-board socialization of industries. You claim that restriction of market forces would eliminate all incentive to develop new medical techniques, tools, and medications: if that's the case, then I'd have government subsidize these costs, with individual research universities and companies competing with each other for government grants (much like the current system), and much like how corporations like Lockheed-Martin and Boeing compete for NASA and military contracts.
Ok, so how long do they have to wait from the point of diagnosis to the start of treatment? Does treatment start immediately, as it does in the private health care system? Or do they get told, "sir, you have cancer. But you'll have to wait four months to begin treatment."
Don't just sit there saying, "The evidence supporting my point of view is so obvious it doesn't even need explaining." That's why I'm here talking about this stuff. I want to hear people tell me how it works.
It's the same attitude. "I don't use that service, why should I have to pay for it".
Welcome to socialized medicine. Everyone chips in for the benefit of all.
Yes, well, fortunately the US government will not be converting to complete communism any time soon.
Yeah, that would go off topic. Maybe another time.
*BUZZ* wrong
In Canada, every even halfway decent fulltime job provides extra health coverage of some sort. Dental, Vision care, other shit.
Look, the way the system works anywhere I've seen it is UHC provides some basic level of care (covers emergency room stuff, basic treatment, etc) and you pay above that for extras.
Oh, thank you for clearing that up for me.
I realize that, but it doesn't have to be "complete communism" either. Unless you consider military contracts and NASA to be "communist"?
Here's the thing: physicians are still going to become physicians regardless of money. Money's a great incentive, and maybe some people wouldn't become physicians if a "salary cap" was put in place, but most of them would anyway. Similarly, medical researchers will also continue to become medical researchers.
If the issue is making sure that private corporations like Merck and Pfizer are able to stay in business, then it's still possible to tweak the system by centralizing medical coverage and costs and offering tons of government contracts/subsidies to insure competition and innovation.
Actually, that's not the argument I made. My position can be summed up thus:
"That service is inadequate for me, so I have to buy extra coverage anyway, and since my income is already tapped to pay for an inadequate service I'm in less of a position to buy what I already had for less money."
Personally, I don't care for paying a 12.5% premium for shoddy retirement planning that I need to do on my own anyway. I doubt I will care for paying an x% premium for shoddy health insurance that I will need to supplement as well.
See? Now that's something I could get behind. Now how about funding? I've seen graphs that illustrate that the USA spends more on health care than other nations, especially those with UHC. But that's combining public and private health care spending, and saying "well, we'll just increase the tax and the "cost" will remain the same." How about redirecting existing spending within the government. A "you already get enough fucking money from me, how about you start using it wisely" approach, if you will.
$400 billion spent on that bullshit in Iraq? Yeah, don't think UHC will cost near that much. Shit, part of the money we flush down the toilet for Iraq goes to providing them with UHC. Let's fix that, and start spending a good portion of those already existing funds on us.
Okay, but that's exactly the same thing as saying "I don't use roads, so why should I pay for them? My kids are home-schooled, why should I pay for public schools?"
It's sort of a whole-is-greater-than-the-sum-of-the-parts thing. And you do get Social Security benefits whether you want them or not, right?
Instead, issue vouchers to every citizen that are good for $X health insurance premium at the carrier of your choice. You can throw money on top if you would like to.
It's the same debate as public funding for schools. Most agree that the government should pay for some level of education. But the government running schools doesn't seem to give us efficient outcomes.
p.s.: I am using public schooling as an analogy. Please don't turn this into a school voucher thread, as there are tons of additional issues with those. Religious schools, just to name one.