So the way I am seeing it now is that if a universal health care plan is applied in the U.S., it would have more of a dispersion effect of services, i.e. balanced between poor and rich?
Also, whoever said "no patient left behind" has a valid point (about government programs' inadequacy), but hopefully the next president will have more sense than the current one.
I'm baffled you've had it that bad. The last time I needed to see a specialist I called 3 doctors in my ppo directory provided by my insurance and found one who could fit me in less than 24 hours. I was able to walk to his office from work. I took an extended lunch.
Yeah, you know, mine is similarly awesome. I happen to live in a city with a major medical research center and a butt-ton of hospitals and doctors. That doesn't make ours the standard experience, though.
ElJeffe on
I submitted an entry to Lego Ideas, and if 10,000 people support me, it'll be turned into an actual Lego set!If you'd like to see and support my submission, follow this link.
I live in what is arguably the best medical city in the nation, and my mother's worked in advising health insurance providers, but we still have tons of trouble from our insurance (we deal with the a lot because we have autism in the family and the company loves fucking with people in the area of drug copays).
OK, I agree that the current situation is bad. My mother is a doctor, and I do her billing, and there are some good companies that are forward-thinking, well managed, and fair (Aetna), and some that are godawful to deal with (Blue Cross Blue Shield and United are standouts). My mother loses money on every vaccination she does for Blue Cross patients. And for some reason, people think that doctors are gouging them, and that is why their insurance rates are high. The reality is that the insurance companies arbitrarily decide how much to reimburse doctors, and doctors have no recourse against them. Blue Cross, for example, pays about 70% of what is charged of them when they do pay, and they reject about 20% for unfathomable reasons. We end up having to resubmit those, and when they are rejected, spend twenty minutes per claim figuring out the problem trying to deal with their phone system.
The reason the good companies aren't separated from the bad is that the people who pay/select the insurance companies (the payors) aren't the same ones that the insurance companies deal with in a business sense (the physicians). They have no incentive to be efficient, well run companies as long as the people keep paying them. This is why the free market isn't working in this case. Doctors are generally willing to put up with this crap because they don't want to hurt their patients, and their only recourse (dropping the insurance company) makes it harder for the patients.
And Medicare/Medicaid are the absolute worst. You think the US government can put together a comprehensive universal health care system? They can't even create good programs for segments of the population.
What we have found is that when we stop taking an insurance company because it is costing us too much, and we ask that the patients pay at service time and get reimbursed with a claim that we provide them, they are shocked at how terrible an experience they have trying to get their money back. Then they switch to one of the good ones.
What benefit is there from having a myriad of individual insurance companies rather than a single, democratically accountable institution providing medical care? I know it's a bit of a loaded question, and for that, I apologize. But there seems to be a whole lot of downsides to having a bunch of individual insurance companies, and, to be honest, I'm completely unaware of any upsides.
Free Market won't work for shit in Health Insurance. There's not enough freedom for people to shop around. You can't be in the ambulance, gushing blood, saying "No, not that hospital, the other one. I've got a good del with them for cheaper rates". And that's just 1 facet.
This is possibly one of the WORST areas to leave to the free market.
Kevin, everything you say about Canada, regarding healthcare, taxes, everything, is wrong. Every single thing. Just stop talking about Canada, please. You have no idea what you're talking about.
Would you care to be more specific? Are the wait times not greater to see specialists? Everything I have read on the subject admits this.
You can't intelligently make this statement because there's no comparable data on wait times in the US. It's not just like comparing apples to oranges, it's like comparing apples to invisible unicorns.
Feral on
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.
As a sidenote I would just like to say that I would never expect the US to adopt a Universal Health Care because the people are far, far to afraid of their own government. There is no trust there anymore, besides perhaps the die hard gun toting patriots of lore.
Scalfin: Our "gun-toting patriots of lore" were much more afraid of government than the US citizenry of today, who demand more and more of their government every year. The founding fathers sought to limit the national government's power in every way they could, with the idea that when people are allowed to live without restriction, then they can live their life as best as they can. There will be more variability in experience than a welfare state or a communist state, but the average experience will be much higher. In capitalism, there are some that are poor, in communism, everyone is poor.
However, local and state concerns like education should have homogenizing national standards in order to promote interoperability, so that people can move easily from one state to another, but the specifics should be left to the state/local governments, or to the parents of children. There should be some nationwide standards instituted in healthcare to make the informational overhead lower and reduce the bureaucratic waste.
And free markets are so much more efficient and less forgiving to bad businesses than top-down solutions. Universal health care in this country just isn't a very good idea... we have far too many people, and we are far too diverse. It's easy to compare us to Canada or France or any of these other countries, but the fact is that we are far more populous than any of them, our system would have to be much more extensive and complicated, and the complication of a system with respect to its size is nonlinear. Sorry, it just won't work here without some very clever system, and I don't have nearly that much faith in Washington. Read the mythical man month or do some programming (the number of bugs increases roughly with the square of the number of lines in a module) to understand why. There is a reason we have state and local governments that have traditionally been in charge of more complicated things like education, roads, and so forth. Just like the central government in Soviet Russia wasn't smart enough to control the whole economy, the central government in Washington doesn't have anyone smart enough to devise a national health system that doesn't lean heavily on the states to do the gruntwork.
Yes, because drug companies have already discovered cures for diabetes and cancer but they're just holding out on us to drive up profits.
:roll:
/sarcasm
Actually, there's a legitimate argument to be made that the nature of profit-driven drug research has slowed work on cures for major diseases. Time you spend working on that new erectile dysfunction medication can't be spent on curing cancer or diabetes.
The first pharmaceutical company who comes up with a cure for cancer or diabetes would find themselves swimming in so much cash it would put Bill Gates to shame.
You're right, there are limitations to the for-profit research model. It's highly risk-averse, which is why very little exploratory research is done by for-profit companies. Governmentally-funded institutions like NIH and grant-funded universities do the initial research; the kind where they discover new proteins, new mechanisms of actions, new metabolic pathways, new types of receptors... then the pharma companies take those breakthroughs, come up with hundreds of thousands of molecules that might potentially target those markers, and weed out the ones that don't work very well until they're left with a small number of potential drug candidates. Universities discover, pharma companies refine. We need them both.
Feral on
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.
As a sidenote I would just like to say that I would never expect the US to adopt a Universal Health Care because the people are far, far to afraid of their own government. There is no trust there anymore, besides perhaps the die hard gun toting patriots of lore.
Scalfin: Our "gun-toting patriots of lore" were much more afraid of government than the US citizenry of today, who demand more and more of their government every year. The founding fathers sought to limit the national government's power in every way they could, with the idea that when people are allowed to live without restriction, then they can live their life as best as they can. There will be more variability in experience than a welfare state or a communist state, but the average experience will be much higher. In capitalism, there are some that are poor, in communism, everyone is poor.
However, local and state concerns like education should have homogenizing national standards in order to promote interoperability, so that people can move easily from one state to another, but the specifics should be left to the state/local governments, or to the parents of children. There should be some nationwide standards instituted in healthcare to make the informational overhead lower and reduce the bureaucratic waste.
And free markets are so much more efficient and less forgiving to bad businesses than top-down solutions. Universal health care in this country just isn't a very good idea... we have far too many people, and we are far too diverse. It's easy to compare us to Canada or France or any of these other countries, but the fact is that we are far more populous than any of them, our system would have to be much more extensive and complicated, and the complication of a system with respect to its size is nonlinear. Sorry, it just won't work here without some very clever system, and I don't have nearly that much faith in Washington. Read the mythical man month or do some programming (the number of bugs increases roughly with the square of the number of lines in a module) to understand why. There is a reason we have state and local governments that have traditionally been in charge of more complicated things like education, roads, and so forth. Just like the central government in Soviet Russia wasn't smart enough to control the whole economy, the central government in Washington doesn't have anyone smart enough to devise a national health system that doesn't lean heavily on the states to do the gruntwork.
Free Market won't work for shit in Health Insurance. There's not enough freedom for people to shop around. You can't be in the ambulance, gushing blood, saying "No, not that hospital, the other one. I've got a good del with them for cheaper rates". And that's just 1 facet.
This is possibly one of the WORST areas to leave to the free market.
I was talking about insurance companies, and decreasing the amount they skim off the top, and the maximum amount of bureaucratic spending they can tolerate before they're no longer competitive.
Limiting fee schedules on hospital and other urgent care may be a good idea for the reason you say. Then again, different hospitals might be of different quality, and personally I'd much rather go to a Mayo Clinic than a US Govt.-run hospital.
Universal health care in this country just isn't a very good idea... we have far too many people, and we are far too diverse. It's easy to compare us to Canada or France or any of these other countries, but the fact is that we are far more populous than any of them, our system would have to be much more extensive and complicated, and the complication of a system with respect to its size is nonlinear.
Moving to single payer would result in, under the worst case scenarios, an overall 5-10% increase in health care spending nationwide. Some analyses have shown that spending would actually decrease due to the elimination of the astronomical administrative costs associated with having multiple payers with a plurality of paperwork requirements.
Feral on
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.
As a sidenote I would just like to say that I would never expect the US to adopt a Universal Health Care because the people are far, far to afraid of their own government. There is no trust there anymore, besides perhaps the die hard gun toting patriots of lore.
Scalfin: Our "gun-toting patriots of lore" were much more afraid of government than the US citizenry of today, who demand more and more of their government every year. The founding fathers sought to limit the national government's power in every way they could, with the idea that when people are allowed to live without restriction, then they can live their life as best as they can. There will be more variability in experience than a welfare state or a communist state, but the average experience will be much higher. In capitalism, there are some that are poor, in communism, everyone is poor.
However, local and state concerns like education should have homogenizing national standards in order to promote interoperability, so that people can move easily from one state to another, but the specifics should be left to the state/local governments, or to the parents of children. There should be some nationwide standards instituted in healthcare to make the informational overhead lower and reduce the bureaucratic waste.
And free markets are so much more efficient and less forgiving to bad businesses than top-down solutions. Universal health care in this country just isn't a very good idea... we have far too many people, and we are far too diverse. It's easy to compare us to Canada or France or any of these other countries, but the fact is that we are far more populous than any of them, our system would have to be much more extensive and complicated, and the complication of a system with respect to its size is nonlinear. Sorry, it just won't work here without some very clever system, and I don't have nearly that much faith in Washington. Read the mythical man month or do some programming (the number of bugs increases roughly with the square of the number of lines in a module) to understand why. There is a reason we have state and local governments that have traditionally been in charge of more complicated things like education, roads, and so forth. Just like the central government in Soviet Russia wasn't smart enough to control the whole economy, the central government in Washington doesn't have anyone smart enough to devise a national health system that doesn't lean heavily on the states to do the gruntwork.
But keep dreaming. You'll see.
Doesn't China have a universal medical system?
If they do, do you seriously think it works at all?
Odd, I haven't been monitoring D&D in weeks, but didn't we have this exact same thread relatively recently?
I am in favour of public healthcare, though as a Canadian, the US should really look at other models if it wants one to follow. Ours has its fair share of issues.
What benefit is there from having a myriad of individual insurance companies rather than a single, democratically accountable institution providing medical care? I know it's a bit of a loaded question, and for that, I apologize. But there seems to be a whole lot of downsides to having a bunch of individual insurance companies, and, to be honest, I'm completely unaware of any upsides.
Luckily, the two are not mutually incompatible. A number of countries (notably France, Germany, Australia, and Switzerland) have hybrid systems where a governmental payer operates alongside private payers. Citizens can opt for the public healthcare or they can get private insurance (or both.)
While not quite as efficient as a full single-payer system, it eliminates most of the Kevin-Nash-ish arguments about wait times. Personally, that's the system I'd like to see adopted - alongside laws mandating (or providing economic incentives for) the standardization of claims and records documentation; the adoption of electronic medical records systems; decoupling of health insurance from employment; and malpractice reform. A multifactorial problem deserves a multifaceted approach, and there is every indication that it is not only possible but imminently necessary to provide a basic level of care for all Americans while simultaneously maintaining a comparable level of overall spending or even reducing nationwide spending on healthcare.
(Not really the answer to your question, I know.)
Feral on
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.
Universal health care in this country just isn't a very good idea... we have far too many people, and we are far too diverse. It's easy to compare us to Canada or France or any of these other countries, but the fact is that we are far more populous than any of them, our system would have to be much more extensive and complicated, and the complication of a system with respect to its size is nonlinear.
Moving to single payer would result in, under the worst case scenarios, an overall 5-10% increase in health care spending nationwide. Some analyses have shown that spending would actually decrease due to the elimination of the astronomical administrative costs associated with having multiple payers with a plurality of paperwork requirements.
You're right, it would be great to have a homogenous system for submitting claims. The NPI numbers are a step towards that. However, government management of organizations leaves a lot to be desired, and their heavy handed policies even more so. For example, if a healthcare provider chooses not to participate with Medicare, and an elderly patient who goes to that doctor submits something directly to medicare for reimbursement, the doctor is liable for a $10,000 fine per incident. Edit: Unless they get a signed release form stating that they've instructed the patient not to do so.
What benefit is there from having a myriad of individual insurance companies rather than a single, democratically accountable institution providing medical care? I know it's a bit of a loaded question, and for that, I apologize. But there seems to be a whole lot of downsides to having a bunch of individual insurance companies, and, to be honest, I'm completely unaware of any upsides.
There are few downsides for the patient, except that if the government system is mismanaged and ends up costing the government a boatload, the patient/citizen doesn't really see the effects of this except through reports of massive spending overruns, and higher taxes. There is very little informational transparency compared to a system where they get a bill, and they see exactly how much it is costing them.
The largest downsides are for the doctors, because for them, suddenly, capitalism can be made illegal. The government can mandate that there can be no fee-for-service models (like at a car shop, if they repair something, you pay them on the spot). Even if it is legal, not taking the governmental provider means that you have to do fee for service: there are no other insurance companies to support. Your patient base could leave you. The government can decrease fee reimbursement to balance their own budget. The government can take away their paycheck based on their desire to buy more guns. Fewer people go through the hassle of becoming doctors, and in a few years, there are longer and logner wait times to see a doctor. Based on what I've seen in my mother's practice, there already is a dearth of doctor selection, because the waitlist to become a patient is years long.
Oh noes! The government will steal my children! They will take way my fourth SUV and my multi million dollar home!
What!? You say that I cannot work for a profit driven organization instead that gives me a cut every time I spew a drug recommendation that my superiors paid for, and instead a government run institution that rewards its doctors for keeping a patient healthy!? Fuck that, I'm going to law school.
I for one would never, ever want to be treated by such a doctor. A doctor should be interested in his line of work because of the role he/she plays in improving someones like (or saving it), not which one of his/her BMW's they want to drive to work tomorrow. I am not saying the government is immune to mistakes or corruption, only that in privatized systems the corruption lies in every doctor, nurse and insurance agency willing to take your money.
What benefit is there from having a myriad of individual insurance companies rather than a single, democratically accountable institution providing medical care? I know it's a bit of a loaded question, and for that, I apologize. But there seems to be a whole lot of downsides to having a bunch of individual insurance companies, and, to be honest, I'm completely unaware of any upsides.
There are few downsides for the patient, except that if the government system is mismanaged and ends up costing the government a boatload, the patient/citizen doesn't really see the effects of this except through reports of massive spending overruns, and higher taxes. There is very little informational transparency compared to a system where they get a bill, and they see exactly how much it is costing them.
This is actually exactly the opposite of the truth. Having been on the receiving end of bizarre insurance claim denials, let me tell you - there is no informational transparency in the current system. None.
Moreover, all the evidence suggests that the private insurance system is less efficient than Medicare, by a wide margin. Holy crap, what happened to free market efficiency? Well, it turns out that insurance companies can deny enough claims and obfuscate enough to the point where the consumer can't differentiate between the products of the various providers. Advertising becomes the most effective means of competition.
The largest downsides are for the doctors, because for them, suddenly, capitalism can be made illegal. The government can mandate that there can be no fee-for-service models (like at a car shop, if they repair something, you pay them on the spot). Even if it is legal, not taking the governmental provider means that you have to do fee for service: there are no other insurance companies to support. Your patient base could leave you. The government can decrease fee reimbursement to balance their own budget. The government can take away their paycheck based on their desire to buy more guns. Fewer people go through the hassle of becoming doctors, and in a few years, there are longer and logner wait times to see a doctor. Based on what I've seen in my mother's practice, there already is a dearth of doctor selection, because the waitlist to become a patient is years long.
This is complete bull. If this hypothesis were true, we would expect the doctor-to-citizen ratio in the US to be significantly higher than that of France, the UK, Canada, or other single payer nations. In fact, the US ratio is slightly higher than that of the Canadians or British, and dramatically lower than that of the French.
What benefit is there from having a myriad of individual insurance companies rather than a single, democratically accountable institution providing medical care? I know it's a bit of a loaded question, and for that, I apologize. But there seems to be a whole lot of downsides to having a bunch of individual insurance companies, and, to be honest, I'm completely unaware of any upsides.
There are few downsides for the patient, except that if the government system is mismanaged and ends up costing the government a boatload, the patient/citizen doesn't really see the effects of this except through reports of massive spending overruns, and higher taxes. There is very little informational transparency compared to a system where they get a bill, and they see exactly how much it is costing them.
This is actually exactly the opposite of the truth. Having been on the receiving end of bizarre insurance claim denials, let me tell you - there is no informational transparency in the current system. None.
Moreover, all the evidence suggests that the private insurance system is less efficient than Medicare, by a wide margin. Holy crap, what happened to free market efficiency? Well, it turns out that insurance companies can deny enough claims and obfuscate enough to the point where the consumer can't differentiate between the products of the various providers. Advertising becomes the most effective means of competition.
The largest downsides are for the doctors, because for them, suddenly, capitalism can be made illegal. The government can mandate that there can be no fee-for-service models (like at a car shop, if they repair something, you pay them on the spot). Even if it is legal, not taking the governmental provider means that you have to do fee for service: there are no other insurance companies to support. Your patient base could leave you. The government can decrease fee reimbursement to balance their own budget. The government can take away their paycheck based on their desire to buy more guns. Fewer people go through the hassle of becoming doctors, and in a few years, there are longer and logner wait times to see a doctor. Based on what I've seen in my mother's practice, there already is a dearth of doctor selection, because the waitlist to become a patient is years long.
This is complete bull. If this hypothesis were true, we would expect the doctor-to-citizen ratio in the US to be significantly higher than that of France, the UK, Canada, or other single payer nations. In fact, the US ratio is slightly higher than that of the Canadians or British, and dramatically lower than that of the French.
Read my previous posts, they agree with you somewhat. I've said that the current insurance system is broken, and the free market isn't doing anything to help it currently. I work in insurance billing, I agree, there is tons of obfuscation when dealing with the private insurance companies. That is usually on the doctor's side, not on the patient's side. When we turn it over to the patients, they are stunned by how difficult most insurance companies are to deal with.
Since most insurance companies don't deal directly with patients, who are the ones who actually pay them, there is little advantage for the better ones like Aetna. Aetna is much better than Blue Cross, at least in Maryland, but the patients would never know it, because for the most part, Blue Cross is very nice to patients, and horrible only to doctors. I spent half an hour on the phone with Blue Cross today trying to get them to issue a payment check that "got lost in the mail", like they often do.
The solution, however, is not to replace broken private insurance companies with a likely to be broken national one. The solution is to make the payers the same ones that deal with the companies, because then they will migrate towards the more cost efficient/honest ones. Right now, Blue Cross can be massively inefficient and simply pay doctors less to make up the difference. Aetna pays closer to 100%. It's not a fair playing field for the ones with honest business practices. And the patient's don't know what goes on behind the scenes.
And Medicare sucks. Please don't tell me it's good.
I would only expect the ratio to be higher here than over there if the system were better for doctors here currently than it is over there. It is FUBAR'd here, so if it's at the same level in Canada and the UK, then their universal systems are FUBAR'd there. What's your point?
France might have done it better. Or maybe it's that University educations are free there so the cost of becoming a doctor is less.
Would you care to be more specific? Are the wait times not greater to see specialists? Everything I have read on the subject admits this.
Taxes? They are higher in Canada when you factor in marriage and kids, US taxpayers pay less. If you figure in provincial rates even more so.
Where am I wrong? Please prove it.
Seeing specialists is assigned by triage. By need. If you're sick and your doctor determines you need to see a specialist, you see a specialist within a reasonable time frame - same day for real emergencies, or within the week if you can wait. Never five weeks. In fact, the provincial governments have agreements in place to ship patients to other provinces or states (free of charge to the patient) in those rare occasions when the specialists become too busy and the patients cannot see one right away. So the scenario you describe is legally impossible.
In 2005, the median waiting time was about 4 weeks for specialist visits, 4 weeks for non-emergency surgery, and 3 weeks for diagnostic tests.
Do you understand what the word triage means?
Yes but apparently you don't know what the word "median" means.
I wasn't talking about people with gunshot wounds or appendicitis I was talking about the population as a whole seeing specialists.
Read my previous posts, they agree with you somewhat. I've said that the current insurance system is broken, and the free market isn't doing anything to help it currently. I work in insurance billing, I agree, there is tons of obfuscation when dealing with the private insurance companies. That is usually on the doctor's side, not on the patient's side. When we turn it over to the patients, they are stunned by how difficult most insurance companies are to deal with.
Since most insurance companies don't deal directly with patients, who are the ones who actually pay them, there is little advantage for the better ones like Aetna. Aetna is much better than Blue Cross, at least in Maryland, but the patients would never know it, because for the most part, Blue Cross is very nice to patients, and horrible only to doctors. I spent half an hour on the phone with Blue Cross today trying to get them to issue a payment check that "got lost in the mail", like they often do.
The solution, however, is not to replace broken private insurance companies with a likely to be broken national one. The solution is to make the payers the same ones that deal with the companies, because then they will migrate towards the more cost efficient/honest ones. Right now, Blue Cross can be massively inefficient and simply pay doctors less to make up the difference. Aetna pays closer to 100%. It's not a fair playing field for the ones with honest business practices. And the patient's don't know what goes on behind the scenes.
I don't see that as a solution. What you're describing is the ability of the insurance companies to play patients off versus doctors and vice versa. Changing which side does the paperwork doesn't change that. Moreover, the approach you suggest is very bad public policy. Doctors and hospitals have the resources to fight insurance companies. Individual patients are going to find that much more difficult. Moreover, most individual patients don't choose their insurance provider: their employer does.
Let's face the facts here. The private system is supposed to be more efficient than a government run system. That is the purported advantage. Yet, the United States, which has the most private healthcare system among major industrialized nations, pays a great deal more per capita for health care than countries with a government-run system, like Canada or the UK, and receives inferior care, if we use life expectancy and infant mortality as our measures. It's just not more efficient.
And Medicare sucks. Please don't tell me it's good.
Medicare has its problems, but in terms of percentage of revenue dollars spent on health care, it is far more efficient than the private sector. If we expanded Medicare to the entire insured population (presuming Medicare maintained its current rate of efficiency), the average American's cost of health care would go down. That, to me, is a scathing indictment of the private system.
To summarize my argument: where are the supposedly lower costs of privatization?
I would only expect the ratio to be higher here than over there if the system were better for doctors here currently than it is over there. It is FUBAR'd here, so if it's at the same level in Canada and the UK, then their universal systems are FUBAR'd there. What's your point?
That implies that a nationalized, universal system doesn't necessarily discourage people from becoming doctors, as you previously argued it did.
France might have done it better. Or maybe it's that University educations are free there so the cost of becoming a doctor is less.
This doesn't make sense. I know people who couldn't get into medical school, not because of cost, but because of grades or whatever. That implies that cost isn't the main factor keeping people out of the medical profession - the medical schools' admissions criteria is.
In 2005, the median waiting time was about 4 weeks for specialist visits, 4 weeks for non-emergency surgery, and 3 weeks for diagnostic tests.
This figure is entirely irrelevant unless we can compare it with the median wait time for the insured in the United States.
I'll agree with that but you have to use PPO stats since that's kinda the whole point of them. Better quality and better service. People telling me their HMO sucks isn't news.
In 2005, the median waiting time was about 4 weeks for specialist visits, 4 weeks for non-emergency surgery, and 3 weeks for diagnostic tests.
This figure is entirely irrelevant unless we can compare it with the median wait time for the insured in the United States.
I'll agree with that but you have to use PPO stats since that's kinda the whole point of them. Better quality and better service. People telling me their HMO sucks isn't news.
No, you can't pick and choose which parts of the system to examine and which not to examine. That defeats the purpose of comparing the two systems. People in HMOs are in there for a reason, and I'll bet you the reason isn't that they're incredibly stupid.
Actually, that's very interesting, now that you mention it. If PPOs are universally better and universally (or near-universally) available, and people aren't choosing them, doesn't that refute the basic premise for why private systems are better - rational choice of the consumer (at least in the case of healthcare)? If it really is too complicated for people to choose well, then a government system might well be more efficient in theory as well as in practice.
Of course, that's all irrelevant because people aren't that dumb, and if PPOs were universally better and universally available, they'd be in them.
Actually, speaking of taking systems as a whole, we should try and figure some way to account for the "wait times" of the millions of Americans without insurance.
In 2005, the median waiting time was about 4 weeks for specialist visits, 4 weeks for non-emergency surgery, and 3 weeks for diagnostic tests.
This figure is entirely irrelevant unless we can compare it with the median wait time for the insured in the United States.
I'll agree with that but you have to use PPO stats since that's kinda the whole point of them. Better quality and better service. People telling me their HMO sucks isn't news.
No, you can't pick and choose which parts of the system to examine and which not to examine. That defeats the purpose of comparing the two systems. People in HMOs are in there for a reason, and I'll bet you the reason isn't that they're incredibly stupid.
Actually, that's very interesting, now that you mention it. If PPOs are universally better and universally (or near-universally) available, and people aren't choosing them, doesn't that refute the basic premise for why private systems are better - rational choice of the consumer (at least in the case of healthcare)? If it really is too complicated for people to choose well, then a government system might well be more efficient in theory as well as in practice.
Of course, that's all irrelevant because people aren't that dumb, and if PPOs were universally better and universally available, they'd be in them.
Actually, speaking of taking systems as a whole, we should try and figure some way to account for the "wait times" of the millions of Americans without insurance.
Probably next to nothing if they can afford to pay out of pocket. Actually it's probably even faster if you don't go through insurance.
PPO's are sometimes not available because they are more expensive and some businesses don't want to pay for them. HMO's basically exist instead of cheap PPO's as a result of subsidization by the government in the 70's.
Also, the US doesn't have a "private system" I consider it "corporate care" because individuals pay taxes on coverage and businesses do not.
In 2005, the median waiting time was about 4 weeks for specialist visits, 4 weeks for non-emergency surgery, and 3 weeks for diagnostic tests.
This figure is entirely irrelevant unless we can compare it with the median wait time for the insured in the United States.
I'll agree with that but you have to use PPO stats since that's kinda the whole point of them. Better quality and better service. People telling me their HMO sucks isn't news.
No, you can't pick and choose which parts of the system to examine and which not to examine. That defeats the purpose of comparing the two systems. People in HMOs are in there for a reason, and I'll bet you the reason isn't that they're incredibly stupid.
Actually, that's very interesting, now that you mention it. If PPOs are universally better and universally (or near-universally) available, and people aren't choosing them, doesn't that refute the basic premise for why private systems are better - rational choice of the consumer (at least in the case of healthcare)? If it really is too complicated for people to choose well, then a government system might well be more efficient in theory as well as in practice.
Of course, that's all irrelevant because people aren't that dumb, and if PPOs were universally better and universally available, they'd be in them.
Actually, speaking of taking systems as a whole, we should try and figure some way to account for the "wait times" of the millions of Americans without insurance.
Probably next to nothing if they can afford to pay out of pocket. Actually it's probably even faster if you don't go through insurance.
I was thinking more in terms of lifelong waits (i.e. not getting care at all). To show why this is relevant, envision a system under which only I get healthcare. My wait time could be literally zero! The average wait time of people in my system would be zero, too! But the system would still be a very bad one.
PPO's are sometimes not available because they are more expensive and some businesses don't want to pay for them. HMO's basically exist instead of cheap PPO's as a result of subsidization by the government in the 70's.
Ah. So PPOs aren't costless after all. The cost is hidden by a lower wage (since, presumably, your employer would pay you the extra money directly if they just used an HMO). Well, then, we would be foolish to exclude HMOs from our calculation of wait times, wouldn't we?
Also, the US doesn't have a "private system" I consider it "corporate care" because individuals pay taxes on coverage and businesses do not.
Corporations are private entities. Even conceding that the US system isn't 100% private (after all, Medicare does exist), the United States is still much more private than, say, France, the UK, or Canada. And yet our per capita cost is much higher, to no readily discernible benefit. How odd.
Some people here seem to imply that when using a UHS, the goverment will be the one solely responsible for the healthcare. This is incorrect. In a lot of countries, the same companies who offer private insurance, also have to offer a basic healthcare option. Basically, the government sets up a number of forms of healthcare that are part of this basic option and sets a limit on the amount of money the insurance companies can ask for it.
If insurance companies are bitches about it, they are fined. But I suppose that would violate the treasured free market principle in the US.
If insurance companies are bitches about it, they are fined. But I suppose that would violate the treasured free market principle in the US.
While the systems in the UK (only place I have lived outside the US) aren't perfect, they are better than nothing. I think the main thing is, it should be done. Socialization of healthcare, that is. But you have made a great point -- Americans are afraid of loss of free market, even when it will do them good. Well, it will do some of us good. For some of us, things will be the same either way, minus the market freedom.
My fellow Americans are fine with health care skyrocketing in price as long as they can afford it, but they don't give a shit about the person next door who can't (or in my case, the person next door who hovers between two states but is not a legal resident of either one, technically speaking).
I never cared about this issue until I found myself uninsured and unable to get insurance last year. How telling, I suppose.
If insurance companies are bitches about it, they are fined. But I suppose that would violate the treasured free market principle in the US.
While the systems in the UK (only place I have lived outside the US) aren't perfect, they are better than nothing. I think the main thing is, it should be done. Socialization of healthcare, that is. But you have made a great point -- Americans are afraid of loss of free market, even when it will do them good. Well, it will do some of us good. For some of us, things will be the same either way, minus the market freedom.
My fellow Americans are fine with health care skyrocketing in price as long as they can afford it, but they don't give a shit about the person next door who can't (or in my case, the person next door who hovers between two states but is not a legal resident of either one, technically speaking).
I never cared about this issue until I found myself uninsured and unable to get insurance last year. How telling, I suppose.
You know, we Americans get a bad rap as far as caring for each other. The last thirty years or so haven't been so good on that front, but before Reagan we were as good as anybody. Social Security, the EPA, Medicare, the Civil Rights Act, these are all collective American efforts to help the powerless.
This unhealthy obsession with deregulation and the free market, which has led directly to so many of our present problems (the most obvious example being Enron) is only really a recent thing. Barry Goldwater was saying a lot of the same stuff in 1964, and the American people sent him packing.
With respect, I did use the search function, and deemed my topic to be different enough to post. Most other posts deal with the speed of healthcare (universal vs. private), not the full spectrum of positives vs. negatives.
Also, it appears that people still want to debate it.
Matrijs: My whole point was that if you made the patients interact with their insurance companies instead of having the doctors shield them from the whole experience like they do now, they would move away from the bad ones and go to the ones that treated the people they were paying fairly. Once some insurance companies, like BCBS, can no longer get away with reimbursing 70% of the charges and losing a quarter of the claims/reimbursement checks, they will have to compete on an even playing field, and they will have to charge accordingly. Then, the inefficient ones like BCBS will have to charge more for the same service, and people will migrate to the more efficient ones. BCBS keeps costs low by representing a large proportion of a doctor's patients so they don't want to drop them, but then by not reimbursing those doctors. Hospitals might be able to fight the insurance companies, but Doctors absolutely do not have the time.
As you said, it is often employers that choose health plans, but employers die without their employees, so if all the employees are demanding different health coverage, they will listen.
This is an example of how the free market can fix the situation. Right now, the free market is stuck in a rut, and it will need some shaking up to correct itself. The government needs to see that the industry is rotten, think about how it got itself into this position, and then right it and let it go on its merry way.
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Irond WillWARNING: NO HURTFUL COMMENTS, PLEASE!!!!!Cambridge. MAModeratormod
edited January 2008
I won't lie - making the system easier or more profitable for doctors isn't much of a concern for me in and of itself. It's only ancillary to the fair and effective provision of health care.
I also think there's something fundamentally perverse about basing peoples' access to basic care upon their ability to pay. I believe in the concept of social insurance. I just don't believe there is any moral dimension to the free market, feel fairly confident that under any "new" regulation-free or regulation-lite systems there will be just as many inefficiencies and infuriating aspects as there are currently, and am about 99% certain that whatever "regulation-lite" system is put in place will be immediately wrapped around the pole by collusion by the prime actors.
Irond WillWARNING: NO HURTFUL COMMENTS, PLEASE!!!!!Cambridge. MAModeratormod
edited January 2008
So what I'm reading is that our "free market" solution discourages primary care, Medicare has imposed some regulations meant to decrease "gaming the system" that need to be reassessed, and that UHC the world over invests heavily in primary care.
A compelling argument to bring Thunderdome to health care.
Also, whoever said "no patient left behind" has a valid point (about government programs' inadequacy), but hopefully the next president will have more sense than the current one.
The comparisons to the crap that is our education system aren't really accurate. Our education is pretty spotty, because many - if not most - schools flat out suck. They're mismanaged and ineffectual from the ground up.
Our health care system under UHC won't be government run on all levels. Everything about it will still be privately run and for-profit, except for the fact that the government will be paying for it. That's more or less the extent of their involvement - they cover the bill after all is said and done. (Yes, they're more involved than that if you want to be nit-picky, but they won't be more involved under UHC.) And right now, actual health care in the US is great. It's just a matter of getting access to it.
And honestly, UHC may allow for increased competition amongst doctors. Currently, most people are very constrained in their choice of doctors, assuming they even get a choice. For a lot of people, you go to the hospital your insurance tells you to, you see the doctor who happens to be there, and you hope he's not a quack. If every one was basically operating under a government-paid-for PPO system, the quacks would soon find themselves with no patients. Yay, competition.
There wouldn't be any price competition, sure, but there's no meaningful price competition now, anyway.
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The largest downsides are for the doctors, because for them, suddenly, capitalism can be made illegal. The government can mandate that there can be no fee-for-service models (like at a car shop, if they repair something, you pay them on the spot). Even if it is legal, not taking the governmental provider means that you have to do fee for service: there are no other insurance companies to support. Your patient base could leave you. The government can decrease fee reimbursement to balance their own budget. The government can take away their paycheck based on their desire to buy more guns. Fewer people go through the hassle of becoming doctors, and in a few years, there are longer and logner wait times to see a doctor. Based on what I've seen in my mother's practice, there already is a dearth of doctor selection, because the waitlist to become a patient is years long.
In most UHC countries, the organization that represents doctors negotiates salaries, payment schedules, and basically every fee you can think of with the government on an annual basis. If the government tried to reduce doctors' salaries or "take away their paycheck" or other such nonsense without consultation, the doctors would get extremely pissed off and withdraw services, and the government would lose assloads of credibility. Kind of like what you're doing by not researching the topic at all and just coming in here and parroting 50-year-old right-wing propaganda that has no factual basis. Why don't you go listen to your Ronnie Reagan records some more.
The largest downsides are for the doctors, because for them, suddenly, capitalism can be made illegal. The government can mandate that there can be no fee-for-service models (like at a car shop, if they repair something, you pay them on the spot). Even if it is legal, not taking the governmental provider means that you have to do fee for service: there are no other insurance companies to support. Your patient base could leave you. The government can decrease fee reimbursement to balance their own budget. The government can take away their paycheck based on their desire to buy more guns. Fewer people go through the hassle of becoming doctors, and in a few years, there are longer and logner wait times to see a doctor. Based on what I've seen in my mother's practice, there already is a dearth of doctor selection, because the waitlist to become a patient is years long.
In most UHC countries, the organization that represents doctors negotiates salaries, payment schedules, and basically every fee you can think of with the government on an annual basis. If the government tried to reduce doctors' salaries or "take away their paycheck" or other such nonsense without consultation, the doctors would get extremely pissed off and withdraw services, and the government would lose assloads of credibility. Kind of like what you're doing by not researching the topic at all and just coming in here and parroting 40-year-old right-wing talking points that have no factual basis. Why don't you go listen to your Ronnie Reagan records some more.
It's capitalism, dude. Sorry, but making doctors lives more miserable, be it through decreased pay, decreased prestige, greater annoyance, or what have you, WILL MAKE FEWER PEOPLE BECOME DOCTORS. That's not a right-wing talking point, that's common sense. Where my college friends in previous years might have gone to become doctors, instead, they've gone to become investment bankers, traders, and consultants. Even my friends who majored in CS have largely abandoned their chosen field and have gone on to more lucrative fields.
My example used hyperbole - ie "take away their paycheck". Sorry, I'll be more exact next time. Of course they would erode it slowly, so as not to cause too many waves. As long as it's only a little less than last year, no one is going to bother complaining, until they get used to it, and they can decrease it some more.
And what are you talking about, researching the topic? Do you work in healthcare? Do you have any contact with the US healthcare system, even as a patient? I am coming at this from the idea of the US making a UHC system, not looking at how things are in other, more socialist countries. I am looking at the US's track record with socialist programs, and the fact is, we're bad at making programs that don't suck/hemorrhage money.
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Also, whoever said "no patient left behind" has a valid point (about government programs' inadequacy), but hopefully the next president will have more sense than the current one.
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Yeah, you know, mine is similarly awesome. I happen to live in a city with a major medical research center and a butt-ton of hospitals and doctors. That doesn't make ours the standard experience, though.
The reason the good companies aren't separated from the bad is that the people who pay/select the insurance companies (the payors) aren't the same ones that the insurance companies deal with in a business sense (the physicians). They have no incentive to be efficient, well run companies as long as the people keep paying them. This is why the free market isn't working in this case. Doctors are generally willing to put up with this crap because they don't want to hurt their patients, and their only recourse (dropping the insurance company) makes it harder for the patients.
And Medicare/Medicaid are the absolute worst. You think the US government can put together a comprehensive universal health care system? They can't even create good programs for segments of the population.
What we have found is that when we stop taking an insurance company because it is costing us too much, and we ask that the patients pay at service time and get reimbursed with a claim that we provide them, they are shocked at how terrible an experience they have trying to get their money back. Then they switch to one of the good ones.
Free markets could solve the issue.
What benefit is there from having a myriad of individual insurance companies rather than a single, democratically accountable institution providing medical care? I know it's a bit of a loaded question, and for that, I apologize. But there seems to be a whole lot of downsides to having a bunch of individual insurance companies, and, to be honest, I'm completely unaware of any upsides.
This is possibly one of the WORST areas to leave to the free market.
You can't intelligently make this statement because there's no comparable data on wait times in the US. It's not just like comparing apples to oranges, it's like comparing apples to invisible unicorns.
the "no true scotch man" fallacy.
Scalfin: Our "gun-toting patriots of lore" were much more afraid of government than the US citizenry of today, who demand more and more of their government every year. The founding fathers sought to limit the national government's power in every way they could, with the idea that when people are allowed to live without restriction, then they can live their life as best as they can. There will be more variability in experience than a welfare state or a communist state, but the average experience will be much higher. In capitalism, there are some that are poor, in communism, everyone is poor.
However, local and state concerns like education should have homogenizing national standards in order to promote interoperability, so that people can move easily from one state to another, but the specifics should be left to the state/local governments, or to the parents of children. There should be some nationwide standards instituted in healthcare to make the informational overhead lower and reduce the bureaucratic waste.
And free markets are so much more efficient and less forgiving to bad businesses than top-down solutions. Universal health care in this country just isn't a very good idea... we have far too many people, and we are far too diverse. It's easy to compare us to Canada or France or any of these other countries, but the fact is that we are far more populous than any of them, our system would have to be much more extensive and complicated, and the complication of a system with respect to its size is nonlinear. Sorry, it just won't work here without some very clever system, and I don't have nearly that much faith in Washington. Read the mythical man month or do some programming (the number of bugs increases roughly with the square of the number of lines in a module) to understand why. There is a reason we have state and local governments that have traditionally been in charge of more complicated things like education, roads, and so forth. Just like the central government in Soviet Russia wasn't smart enough to control the whole economy, the central government in Washington doesn't have anyone smart enough to devise a national health system that doesn't lean heavily on the states to do the gruntwork.
But keep dreaming. You'll see.
The first pharmaceutical company who comes up with a cure for cancer or diabetes would find themselves swimming in so much cash it would put Bill Gates to shame.
You're right, there are limitations to the for-profit research model. It's highly risk-averse, which is why very little exploratory research is done by for-profit companies. Governmentally-funded institutions like NIH and grant-funded universities do the initial research; the kind where they discover new proteins, new mechanisms of actions, new metabolic pathways, new types of receptors... then the pharma companies take those breakthroughs, come up with hundreds of thousands of molecules that might potentially target those markers, and weed out the ones that don't work very well until they're left with a small number of potential drug candidates. Universities discover, pharma companies refine. We need them both.
the "no true scotch man" fallacy.
Doesn't China have a universal medical system?
I was talking about insurance companies, and decreasing the amount they skim off the top, and the maximum amount of bureaucratic spending they can tolerate before they're no longer competitive.
Limiting fee schedules on hospital and other urgent care may be a good idea for the reason you say. Then again, different hospitals might be of different quality, and personally I'd much rather go to a Mayo Clinic than a US Govt.-run hospital.
The Congressional Budget Office and General Accounting Office (and pretty much every major non-partisan study ever done on the subject) all disagree with you.
Moving to single payer would result in, under the worst case scenarios, an overall 5-10% increase in health care spending nationwide. Some analyses have shown that spending would actually decrease due to the elimination of the astronomical administrative costs associated with having multiple payers with a plurality of paperwork requirements.
the "no true scotch man" fallacy.
If they do, do you seriously think it works at all?
I am in favour of public healthcare, though as a Canadian, the US should really look at other models if it wants one to follow. Ours has its fair share of issues.
Luckily, the two are not mutually incompatible. A number of countries (notably France, Germany, Australia, and Switzerland) have hybrid systems where a governmental payer operates alongside private payers. Citizens can opt for the public healthcare or they can get private insurance (or both.)
While not quite as efficient as a full single-payer system, it eliminates most of the Kevin-Nash-ish arguments about wait times. Personally, that's the system I'd like to see adopted - alongside laws mandating (or providing economic incentives for) the standardization of claims and records documentation; the adoption of electronic medical records systems; decoupling of health insurance from employment; and malpractice reform. A multifactorial problem deserves a multifaceted approach, and there is every indication that it is not only possible but imminently necessary to provide a basic level of care for all Americans while simultaneously maintaining a comparable level of overall spending or even reducing nationwide spending on healthcare.
(Not really the answer to your question, I know.)
the "no true scotch man" fallacy.
You're right, it would be great to have a homogenous system for submitting claims. The NPI numbers are a step towards that. However, government management of organizations leaves a lot to be desired, and their heavy handed policies even more so. For example, if a healthcare provider chooses not to participate with Medicare, and an elderly patient who goes to that doctor submits something directly to medicare for reimbursement, the doctor is liable for a $10,000 fine per incident. Edit: Unless they get a signed release form stating that they've instructed the patient not to do so.
There are few downsides for the patient, except that if the government system is mismanaged and ends up costing the government a boatload, the patient/citizen doesn't really see the effects of this except through reports of massive spending overruns, and higher taxes. There is very little informational transparency compared to a system where they get a bill, and they see exactly how much it is costing them.
The largest downsides are for the doctors, because for them, suddenly, capitalism can be made illegal. The government can mandate that there can be no fee-for-service models (like at a car shop, if they repair something, you pay them on the spot). Even if it is legal, not taking the governmental provider means that you have to do fee for service: there are no other insurance companies to support. Your patient base could leave you. The government can decrease fee reimbursement to balance their own budget. The government can take away their paycheck based on their desire to buy more guns. Fewer people go through the hassle of becoming doctors, and in a few years, there are longer and logner wait times to see a doctor. Based on what I've seen in my mother's practice, there already is a dearth of doctor selection, because the waitlist to become a patient is years long.
What!? You say that I cannot work for a profit driven organization instead that gives me a cut every time I spew a drug recommendation that my superiors paid for, and instead a government run institution that rewards its doctors for keeping a patient healthy!? Fuck that, I'm going to law school.
This is actually exactly the opposite of the truth. Having been on the receiving end of bizarre insurance claim denials, let me tell you - there is no informational transparency in the current system. None.
Moreover, all the evidence suggests that the private insurance system is less efficient than Medicare, by a wide margin. Holy crap, what happened to free market efficiency? Well, it turns out that insurance companies can deny enough claims and obfuscate enough to the point where the consumer can't differentiate between the products of the various providers. Advertising becomes the most effective means of competition.
This is complete bull. If this hypothesis were true, we would expect the doctor-to-citizen ratio in the US to be significantly higher than that of France, the UK, Canada, or other single payer nations. In fact, the US ratio is slightly higher than that of the Canadians or British, and dramatically lower than that of the French.
Read my previous posts, they agree with you somewhat. I've said that the current insurance system is broken, and the free market isn't doing anything to help it currently. I work in insurance billing, I agree, there is tons of obfuscation when dealing with the private insurance companies. That is usually on the doctor's side, not on the patient's side. When we turn it over to the patients, they are stunned by how difficult most insurance companies are to deal with.
Since most insurance companies don't deal directly with patients, who are the ones who actually pay them, there is little advantage for the better ones like Aetna. Aetna is much better than Blue Cross, at least in Maryland, but the patients would never know it, because for the most part, Blue Cross is very nice to patients, and horrible only to doctors. I spent half an hour on the phone with Blue Cross today trying to get them to issue a payment check that "got lost in the mail", like they often do.
The solution, however, is not to replace broken private insurance companies with a likely to be broken national one. The solution is to make the payers the same ones that deal with the companies, because then they will migrate towards the more cost efficient/honest ones. Right now, Blue Cross can be massively inefficient and simply pay doctors less to make up the difference. Aetna pays closer to 100%. It's not a fair playing field for the ones with honest business practices. And the patient's don't know what goes on behind the scenes.
And Medicare sucks. Please don't tell me it's good.
I would only expect the ratio to be higher here than over there if the system were better for doctors here currently than it is over there. It is FUBAR'd here, so if it's at the same level in Canada and the UK, then their universal systems are FUBAR'd there. What's your point?
France might have done it better. Or maybe it's that University educations are free there so the cost of becoming a doctor is less.
Yes but apparently you don't know what the word "median" means.
I wasn't talking about people with gunshot wounds or appendicitis I was talking about the population as a whole seeing specialists.
I don't see that as a solution. What you're describing is the ability of the insurance companies to play patients off versus doctors and vice versa. Changing which side does the paperwork doesn't change that. Moreover, the approach you suggest is very bad public policy. Doctors and hospitals have the resources to fight insurance companies. Individual patients are going to find that much more difficult. Moreover, most individual patients don't choose their insurance provider: their employer does.
Let's face the facts here. The private system is supposed to be more efficient than a government run system. That is the purported advantage. Yet, the United States, which has the most private healthcare system among major industrialized nations, pays a great deal more per capita for health care than countries with a government-run system, like Canada or the UK, and receives inferior care, if we use life expectancy and infant mortality as our measures. It's just not more efficient.
Medicare has its problems, but in terms of percentage of revenue dollars spent on health care, it is far more efficient than the private sector. If we expanded Medicare to the entire insured population (presuming Medicare maintained its current rate of efficiency), the average American's cost of health care would go down. That, to me, is a scathing indictment of the private system.
To summarize my argument: where are the supposedly lower costs of privatization?
That implies that a nationalized, universal system doesn't necessarily discourage people from becoming doctors, as you previously argued it did.
This doesn't make sense. I know people who couldn't get into medical school, not because of cost, but because of grades or whatever. That implies that cost isn't the main factor keeping people out of the medical profession - the medical schools' admissions criteria is.
This figure is entirely irrelevant unless we can compare it with the median wait time for the insured in the United States.
I'll agree with that but you have to use PPO stats since that's kinda the whole point of them. Better quality and better service. People telling me their HMO sucks isn't news.
No, you can't pick and choose which parts of the system to examine and which not to examine. That defeats the purpose of comparing the two systems. People in HMOs are in there for a reason, and I'll bet you the reason isn't that they're incredibly stupid.
Actually, that's very interesting, now that you mention it. If PPOs are universally better and universally (or near-universally) available, and people aren't choosing them, doesn't that refute the basic premise for why private systems are better - rational choice of the consumer (at least in the case of healthcare)? If it really is too complicated for people to choose well, then a government system might well be more efficient in theory as well as in practice.
Of course, that's all irrelevant because people aren't that dumb, and if PPOs were universally better and universally available, they'd be in them.
Actually, speaking of taking systems as a whole, we should try and figure some way to account for the "wait times" of the millions of Americans without insurance.
Probably next to nothing if they can afford to pay out of pocket. Actually it's probably even faster if you don't go through insurance.
PPO's are sometimes not available because they are more expensive and some businesses don't want to pay for them. HMO's basically exist instead of cheap PPO's as a result of subsidization by the government in the 70's.
Also, the US doesn't have a "private system" I consider it "corporate care" because individuals pay taxes on coverage and businesses do not.
I was thinking more in terms of lifelong waits (i.e. not getting care at all). To show why this is relevant, envision a system under which only I get healthcare. My wait time could be literally zero! The average wait time of people in my system would be zero, too! But the system would still be a very bad one.
Ah. So PPOs aren't costless after all. The cost is hidden by a lower wage (since, presumably, your employer would pay you the extra money directly if they just used an HMO). Well, then, we would be foolish to exclude HMOs from our calculation of wait times, wouldn't we?
Corporations are private entities. Even conceding that the US system isn't 100% private (after all, Medicare does exist), the United States is still much more private than, say, France, the UK, or Canada. And yet our per capita cost is much higher, to no readily discernible benefit. How odd.
If insurance companies are bitches about it, they are fined. But I suppose that would violate the treasured free market principle in the US.
While the systems in the UK (only place I have lived outside the US) aren't perfect, they are better than nothing. I think the main thing is, it should be done. Socialization of healthcare, that is. But you have made a great point -- Americans are afraid of loss of free market, even when it will do them good. Well, it will do some of us good. For some of us, things will be the same either way, minus the market freedom.
My fellow Americans are fine with health care skyrocketing in price as long as they can afford it, but they don't give a shit about the person next door who can't (or in my case, the person next door who hovers between two states but is not a legal resident of either one, technically speaking).
I never cared about this issue until I found myself uninsured and unable to get insurance last year. How telling, I suppose.
You know, we Americans get a bad rap as far as caring for each other. The last thirty years or so haven't been so good on that front, but before Reagan we were as good as anybody. Social Security, the EPA, Medicare, the Civil Rights Act, these are all collective American efforts to help the powerless.
This unhealthy obsession with deregulation and the free market, which has led directly to so many of our present problems (the most obvious example being Enron) is only really a recent thing. Barry Goldwater was saying a lot of the same stuff in 1964, and the American people sent him packing.
With respect, I did use the search function, and deemed my topic to be different enough to post. Most other posts deal with the speed of healthcare (universal vs. private), not the full spectrum of positives vs. negatives.
Also, it appears that people still want to debate it.
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As you said, it is often employers that choose health plans, but employers die without their employees, so if all the employees are demanding different health coverage, they will listen.
This is an example of how the free market can fix the situation. Right now, the free market is stuck in a rut, and it will need some shaking up to correct itself. The government needs to see that the industry is rotten, think about how it got itself into this position, and then right it and let it go on its merry way.
I also think there's something fundamentally perverse about basing peoples' access to basic care upon their ability to pay. I believe in the concept of social insurance. I just don't believe there is any moral dimension to the free market, feel fairly confident that under any "new" regulation-free or regulation-lite systems there will be just as many inefficiencies and infuriating aspects as there are currently, and am about 99% certain that whatever "regulation-lite" system is put in place will be immediately wrapped around the pole by collusion by the prime actors.
A compelling argument to bring Thunderdome to health care.
The reason primary care isn't failing in countries with UHC may just be that people can afford to go to them.
I don't see UHC as a cure-all, but it fixes a helluva lot and it gets us on our way to a truly great healthcare system.
The comparisons to the crap that is our education system aren't really accurate. Our education is pretty spotty, because many - if not most - schools flat out suck. They're mismanaged and ineffectual from the ground up.
Our health care system under UHC won't be government run on all levels. Everything about it will still be privately run and for-profit, except for the fact that the government will be paying for it. That's more or less the extent of their involvement - they cover the bill after all is said and done. (Yes, they're more involved than that if you want to be nit-picky, but they won't be more involved under UHC.) And right now, actual health care in the US is great. It's just a matter of getting access to it.
And honestly, UHC may allow for increased competition amongst doctors. Currently, most people are very constrained in their choice of doctors, assuming they even get a choice. For a lot of people, you go to the hospital your insurance tells you to, you see the doctor who happens to be there, and you hope he's not a quack. If every one was basically operating under a government-paid-for PPO system, the quacks would soon find themselves with no patients. Yay, competition.
There wouldn't be any price competition, sure, but there's no meaningful price competition now, anyway.
It's capitalism, dude. Sorry, but making doctors lives more miserable, be it through decreased pay, decreased prestige, greater annoyance, or what have you, WILL MAKE FEWER PEOPLE BECOME DOCTORS. That's not a right-wing talking point, that's common sense. Where my college friends in previous years might have gone to become doctors, instead, they've gone to become investment bankers, traders, and consultants. Even my friends who majored in CS have largely abandoned their chosen field and have gone on to more lucrative fields.
My example used hyperbole - ie "take away their paycheck". Sorry, I'll be more exact next time. Of course they would erode it slowly, so as not to cause too many waves. As long as it's only a little less than last year, no one is going to bother complaining, until they get used to it, and they can decrease it some more.
And what are you talking about, researching the topic? Do you work in healthcare? Do you have any contact with the US healthcare system, even as a patient? I am coming at this from the idea of the US making a UHC system, not looking at how things are in other, more socialist countries. I am looking at the US's track record with socialist programs, and the fact is, we're bad at making programs that don't suck/hemorrhage money.