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The Healthcare Bill debate in the US
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Kitkat



Joined: 25 Jun 2009
Posts: 142
Location: London, England

PostPosted: Thu Aug 13, 2009 9:28 pm    Post subject: The Healthcare Bill debate in the US Reply with quote

The proposed Healthcare Bill seems to be stirring up a lot of confusing opinions of the British version of NHS in America.

First of all I have to say I feel that the NHS has served us well in the UK. It is a system that help people regardless of social class and status and nationality (foreigner got free services too). I believe the cost is actually quite cheap per person about 20 per year taken from my National Insurance contribution together with my tax deduction.

In the UK, you can walk in to a doctor surgery or a hospital and get free service. My friend's mother had 2 hip replacements in the last 10 years, they were both free. When you get older, you appreciate this free service. For me, I have free scan for breast cancer and smear test every 3 years, and they write letter to remind you to check ups. When I had my son, I walked in and get registered, from scanning to actual birth to after birth care, everything was free, all I need to do is to sign my name, address and that is it.

Yes, the queue is long and the service basic. There is a lot of money wasting programs and many people abuse the system. And it is definately socialist and not very American.

But if you are not happy with the public service, there is always the private options. There are many people in the UK who are covered by private medical insurance used private hospitals and doctors.

The important thing is that there is a healthcare servcie especially for the most needed people, like the elderlys, children, single mothers, the poor people with long term illness. And from this prospective, I support Obama's Healthcare reform.
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Last edited by Kitkat on Sat Aug 15, 2009 6:38 am; edited 1 time in total
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bbmedos



Joined: 26 Sep 2007
Posts: 274
Location: Western Kentucky, USA

PostPosted: Fri Aug 14, 2009 7:38 am    Post subject: Reply with quote

For those of us still reading and deciding, here's the primary bill that everyone is talking and arguing about, H. R. 3200: America's Affordable Health Choices Act of 2009 (Introduced In House).

Still looking for the other four versions floating around. Or it is five now?
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Lee



Joined: 27 Mar 2007
Posts: 215

PostPosted: Fri Aug 14, 2009 10:12 am    Post subject: Reply with quote

Thanks for your perspective, Kitkat. I've just been hearing the horror stories from Canadians, and I was wondering if anyone actually liked the system. I think my major concern is two-fold, and I don't know if you know the answers, but here goes. One, is the treatment available immediately when it's a life-threatening disease such as cancer? Does one waste valuable time waiting for treatment to begin and are there experimental trial treatments available to those who have exhausted all traditional medicines available, like there is available in the US now? And two, when something is not life-threatening, but painful, like your mom's hip replacements, is there a long wait?

Are most working people still covered by private insurance as well as national insurance?
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norcalgolfer



Joined: 06 Jul 2009
Posts: 38
Location: Ranch Cordova, CA

PostPosted: Fri Aug 14, 2009 11:20 am    Post subject: Reply with quote

I haven't decided one way or another yet, but what gives me pause is using the mathematical formula of cost of coverage versus number of years left of life to determine coverage. I understand why they use it in Britain, and why some sort of limits would be needed here as there aren't unlimited funds available. But I personally know people who were "given" a certain amount of time left, and far outlived the time. Some of those people did eventually die, some are still alive. One of the people was a girl who was diagnosed with leukemia at age 11, told she had 6 months to live at 13, and lived till 17. I know some hard choices will have to be made with any national health care plan, and as I am currently uninsured now for the first time in 8 years, it certainly strikes home to me. But is this the way we want to do it? I really don't know.

I have no idea how strict a limit they plan to put on the coverage, but I'm not sure if I can support using a mathematical formula to decide whether someone can live out the rest of their time in comfort or pain, especially if a large part of that formula is based on the opinion of a human who can easily be wrong about exactly how much time a person has left on their clock.

Thanks Kitkat, I appreciate hearing the perspective of someone who has been living with a very similar system to what we are considering.
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Kitkat



Joined: 25 Jun 2009
Posts: 142
Location: London, England

PostPosted: Fri Aug 14, 2009 12:09 pm    Post subject: Reply with quote

Lee wrote:


Are most working people still covered by private insurance as well as national insurance?


Yes, everybody is covered by NHS. In addition, most working people are covered by private insurance provided by their employers, but the self-employed like taxi drivers, waiters and builders are generally on their own. If you lost your job, then you lost your private insurance cover not unless you pay for it yourself. Children & the elderlys who need long term care are the heavy users, they generally haven't got any access to private care.

So, a person who has private health insurance has a choice to choose NHS or private health care or even using both. There is no need to declare to anyone or any organisation that you have private health insurance coverage.

Yes, there are waiting lists for almost everything, waiting list is generally long in big cities like London and Manchester, but rather Ok in the countryside. In recent years, there is some cooperation between NHS areas to cover for each other eg. if treatment is not available in London then you can go to Surrey for treatments. Experimental trial treatments are available depending on what they are, like the Swine Flu drug trial currently undertaken is under the supervision of the NHS. I do know that super expensive treatment for AIDS for example is only available through private care because NHS simply cannot paid.

Also, I lived in Canada for 5 years, my experience for healthcare there was good as well.

My feeling is that no system is fool proof. It really is what you think is best for you and your family.
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Last edited by Kitkat on Fri Aug 14, 2009 12:16 pm; edited 1 time in total
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Juliette



Joined: 26 Jan 2008
Posts: 150
Location: Philadelphia Burbs

PostPosted: Fri Aug 14, 2009 12:13 pm    Post subject: Reply with quote

bbmedos wrote:
For those of us still reading and deciding, here's the primary bill that everyone is talking and arguing about, H. R. 3200: America's Affordable Health Choices Act of 2009 (Introduced In House).

Still looking for the other four versions floating around. Or it is five now?


This is the legislative process, right?

That's why they say its like making sausage. Its how congress works - committees create versions of a bill, they are whittled down to one version for House and Senate and further whittled down to a single bill that gets a final vote and the President's signature. The it becomes law.

I should know, I saw it on Schoolhouse Rock. Very Happy

I keed, I keed . . . but seriously, it's not unusual to have different versions in the beginning of the process. It does, however, make it very confusing for the public and leaves a void where rumors and untruths can be hyped to scare people.

There are, however, some baseline requirements that the President has asked for. Two links:

8 WAYS HEALTH INSURANCE REFORM PROVIDES SECURITY AND STABILITY TO ALL AMERICANS
http://tinyurl.com/nbn5fg

8 COMMON MYTHS ABOUT HEALTH INSURANCE REFORM
http://tinyurl.com/lyxel4
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Donna Lea Simpson



Joined: 23 Mar 2007
Posts: 249
Location: Canada

PostPosted: Fri Aug 14, 2009 12:56 pm    Post subject: Reply with quote

Lee wrote:
Thanks for your perspective, Kitkat. I've just been hearing the horror stories from Canadians, and I was wondering if anyone actually liked the system.


Horror stories from Canadians??

My 87 year old mother fell and broke her hip on February 15th. After evaluating risk factors, she went into surgery one week later (it took a few days to get her stabilized and assess whether repair or hip replacement was the best option; her bones were strong enough, so repair was the least invasive choice) and had a 'plate and pin' operation.

Excellent nursing staff had her sitting on the side of the bed by the next day, and after that, by increments, she was gotten up to walk on her own. After 4 weeks, placement was found in a wonderful rehab facility, and she spent 8 weeks rehabilitating, and she is now living on her own again, with excellent help from a visiting nurse and some homecare.

I have a friend who had two bouts with colon cancer, but is now cancer free due to excellent care, and without owing a penny.

I can't say enough about our healthcare sytem in Canada. I have a wide circle of acquaintances and friends, and have only one friend who complains. Her husband has had a bout with prostate cancer, but due to excellent care is now cancer free. How bad is that? I can't get concrete examples of mismanagement from her, and she complains without specifics. But then she does that about other things, too.

Now, I have to say, up here we are bombarded by horrific examples of the downfalls of the American healthcare system. I can't say if they're true, about people dying because they don't have insurance, or their HMO denying them testing/treatment, but I think it behooves us all to take what we hear about another country's system with a grain of salt if we don't know the whole story.
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Kitkat



Joined: 25 Jun 2009
Posts: 142
Location: London, England

PostPosted: Fri Aug 14, 2009 1:17 pm    Post subject: Reply with quote

Donna, it is interesting to hear what the Canadians think of the Americans healthcare system or lack of. Here in the UK, we also hear many many terrible stories about people dying because they have no money to see a doctor or they are uninsurable hence couldn't get hospital care.

AS for having a government run free system or not. I think the bottom line really is to ask yourself whether it is better for the general public to have a system (if nothing else, as a fall back on what you already got in private care) or no system at all. Perhaps, you may want to consider you may need it one day especially if you lost your job and cannot pay even your mortgage let alnone private healthcare insurance.
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Last edited by Kitkat on Fri Aug 14, 2009 6:27 pm; edited 1 time in total
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Donna Lea Simpson



Joined: 23 Mar 2007
Posts: 249
Location: Canada

PostPosted: Fri Aug 14, 2009 1:32 pm    Post subject: Reply with quote

Kitkat, the sad fact is many Canadians complain, not realizing that with their health concerns in a privately insured system they would either be uninsurable, or insurance would be beyond their means.

I've seen the inside of a hospital a lot these last few years, though, (not just with my elderly mom) and I can't say enough good about our system. Does it have faults? Yeah, and I know wait times for some things are long. We don't have enough MRI machines per capita, for instance. Private clinics are beginning to fill in the gaps so that those who can afford them can take advantage, but lots of people fear it will lead to a two-tier system, with the 'haves' getting better treatment than the 'have nots'.

I'm torn. People who can afford to, send their children to private schools, while still contributing tax dollars to public schools; why shouldn't health care work the same?

My one sure feeling about this is, we all contribute tax dollars to the health care system knowing we may be helping someone else more than ourselves; that's all right with me. I have extremely good health and haven't used a tax dollar for medical care for twenty or thirty years. Take the money I contribute and help the elderly, or the children. That is exactly what Canada stands for, in my estimation, a social net to catch those who fall.

A few years ago the CBC did one of those 'Greatest Canadian' contests, to find out what we Canadians thought was important. The winning figure, with more votes than anyone else, (Celine Dion, Pierre Trudeau, Wayne Gretzky!!!) was Tommy Douglas, who engineered our government medic-aid program.
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Margaret



Joined: 23 Mar 2007
Posts: 881

PostPosted: Fri Aug 14, 2009 1:38 pm    Post subject: Reply with quote

Quote:

I can't say enough about our healthcare sytem in Canada.


I agree completely! What I am tired of is the Canadian healthcare system being used as the bogeyman in US ads...creating a state of fear. Every system has its differences, failures and successes. Canada has a great healthcare system for everyone, as do many other countries.
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Lee



Joined: 27 Mar 2007
Posts: 215

PostPosted: Fri Aug 14, 2009 1:44 pm    Post subject: Reply with quote

Donna, I wasn't taking shots at Canada, believe me. I was just repeating what I've heard, and what's been frightening many Americans. I believe the US needs a national health plan, even though I have private health insurance. It's true - people are dying or living in pain here in the US because they don't have ins. or the money to see a dr. and that is just shameful and unacceptable. I just want to know all the facts, pro and con. Maybe if our political leaders hear the good _and_ the bad, we can eliminate the waste and the wait that seems to exist already in the UK and Canada, and come up with a really good system. Not perfect but really good.
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Juliette



Joined: 26 Jan 2008
Posts: 150
Location: Philadelphia Burbs

PostPosted: Fri Aug 14, 2009 1:45 pm    Post subject: Reply with quote

Kitkat wrote:
Donna, it is interesting to hear what the Canadians think of the Americans healthcare system or lack of. Here in the UK, we also hear many many terrible stories about people dying because they have no money to see a doctor or they are uninsurable hence couldn't get hospital care.

AS for having a government run free system or not. I think the bottom line really is to ask yourself whether it is better for the general public to have a system (if nothing else as a fall back on what you already got in private care) or no system at all. Perhaps, you may want to consider you may need it one day especially if you lose your job and cannot pay even your mortgage let alnone private healthcare insurance.


I'm not saying the American system is the worst, but it does have great big gaping holes that people do fall through.

My family has experienced this first hand. My beautiful sister died of colon cancer in 1999 at the age of 36. She had been laid off from her job, had no health insurance. Before she had been laid off she had been to the gyn for some symptoms, they were vague, I won't go into detail, but she wasn't told to have a colonoscopy, in fact, I don't even think we knew what it was back then. So, she got laid off, her symptoms got worse, but she didn't have the money to go to the doctor, a year and half went by, and we talked her and her long time boyfriend into getting married so his health insurance would cover her, but by then the cancer had spread to her tailbone and liver. It's a highly condensed version of the story, I'll be glad to go into it more, but the bottom line: if we had universal coverage she'd still be alive. People's lives, literally, are at stake.
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Donna Lea Simpson



Joined: 23 Mar 2007
Posts: 249
Location: Canada

PostPosted: Fri Aug 14, 2009 2:18 pm    Post subject: Reply with quote

Juliette wrote:
I'm not saying the American system is the worst, but it does have great big gaping holes that people do fall through.

My family has experienced this first hand. My beautiful sister died of colon cancer in 1999 at the age of 36. .... I'll be glad to go into it more, but the bottom line: if we had universal coverage she'd still be alive. People's lives, literally, are at stake.


Juliette! Oh, I'm so sorry. My friend had colon cancer as well, and she had not had a colonoscopy for whatever reason, but surgery and chemo saved her life.

Lee, I know you weren't taking potshots at Canada... I never thought that! But I agree that... "Maybe if our political leaders hear the good _and_ the bad, we can eliminate the waste and the wait that seems to exist already in the UK and Canada, and come up with a really good system. Not perfect but really good." I'd like us to do the same with the American system - to really examine it openly, without fear - because there are good ideas everywhere.

And Margaret, I agree with you that "What I am tired of is the Canadian healthcare system being used as the bogeyman in US ads...creating a state of fear. Every system has its differences, failures and successes. Canada has a great healthcare system for everyone, as do many other countries." Sarah Palin and her 'death squads' or whatever she called them, (edited to add... sorry, I just couldn't think of what she said so I went and looked it up... it was 'death panels' that she called them) is scaremongering at its absolute worst. In Canada her son Trig would receive the very best of care, and I know this because my mother worked at a hospital that was a child parent resource for those with Downs syndrome and many other physical and emotional childhood ailments. (I went to dances at the hospital when I was a kid!) We have an excellent system and it works for the old, the poor, the frail, the endangered.

Our system is not perfect, but a lot of Canadians take it for granted, as they do our abundant natural resources, clean water and (relatively) clean air. Some people will never pay attention to what we've got until it's no longer there. We're very very lucky people.
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norcalgolfer



Joined: 06 Jul 2009
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PostPosted: Fri Aug 14, 2009 2:41 pm    Post subject: Reply with quote

Preventive care is certainly one area that is a big problem here. Far too many people wait until something becomes a serious problem before going for help, all because they don't have insurance. E.R. care is far more expensive, and sometimes the problem has gone so far that it requires expensive surgery, or has become fatal.

A large burden would be relieved from private insurers as well, if whatever National Health plan we come up with agrees to share the risk with a private insurer if someone is covered by both. This would allow for much lower premiums, which would certainly help the economy. However, I would like to know exactly what both the cost and coverage would be. I don't think we have as much room for error in the U.S., since the population is about 5x that of Britain, and almost 10x that of Canada. I am not sure whether the population differences would have an effect or not though, since the GDP per capita is very close to the same for all 3 countries.

We certainly need Health Care reform, and I fully support the idea of Nationalized Health Care, but I definitely feel we should look long and hard at it before implementing such a huge change. So far I have to say I have seen a lot I agree with in the current plan, and what I have heard against it seems to be pretty weak. I am disappointed that republicans have seemed to me to be twisting Obama's words about his grandmothers hip replacement. He was talking about hard choices, and bringing up one that hit home with him, that is exactly what he should be doing. On the other hand, I don't like Obama trying to ram through the bill without what I feel would be sufficient review. Of course, it's too easy to sit around and talk about something forever, when we really don't know for sure how it will all turn out, and probably won't really see all the effects for 20 years or more.

P.S. I really appreciate hearing the good stories about Canada and Britain from citizens, I have mostly just heard the negative, or perceived negative up until now. I am much more likely to believe something I hear from a "normal" person than something I hear from someone whose job it is to tell people how to think. Plus extremes happen always, and often we must ignore those and look for the "greater good", whatever that may be.
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Kitkat



Joined: 25 Jun 2009
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Location: London, England

PostPosted: Fri Aug 14, 2009 3:03 pm    Post subject: Reply with quote

Donna, I agree with you 100%. The British take the NHS for granted and complain about the poor service etc . What they didn't realised is that the NHS was envy by the many countries for its excellent care of its citizens.

Just to be clear, the level of care provided for NHS is comphensive from cradle to grave, and it includes dental as well as special needs. As a result, it is eating up a massive budget and very complex and difficult to manage. But for all its fault, free & easy access medical care is the key adventage of the British NHS system and that basic daily patient care and disease detection and preventive measures like cancer scanning are widely available hence lead to early diagnoses and save more life.

I used to live in Hongkong which has the British NHS like system but leaner, better run and more efficient (on budget). The system is different form the British one that it concentrates on hospital care (more efficient use of government budget), the general day to day consultation & basic care is left in the hand of the private sector. There is no free service at local level (i.e. local doctor) to handle day to day consultations, hospitals provide limited out-patient sevice. Most people in Hongkong pay for private doctor themselves (or via health insurance provided by their employers) for general consultations like cold and flu etc., but for any thing major they rely mainly for the public run hospitals (unless they are rich or their insurance cover extend to private hospitals). Hospitals charge a small sum for out-patient something like US$5 and for a hospital bed is about US$10 per day to make sure people get good care and fewer abuse. Other than that surgeries and everything else is free. Dental is private mainly. Healthcare is funded by income tax, there is no national insurance. But then, Hongkong is a small place, everything is easier to control. For all the good points, however, the major pitfall of this system is that early detection and prevention is minimum, often patient's condition reaches serious level when they admit to hospital.
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Last edited by Kitkat on Sat Aug 15, 2009 6:30 am; edited 4 times in total
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