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The Healthcare Bill debate in the US
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Juliette



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

PostPosted: Fri Aug 14, 2009 7:15 pm    Post subject: Reply with quote

Donna Lea Simpson wrote:
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.


Thank you Donna, I will never get over it. When Obama was campaigning on the health care issues I would tear up and pray he would win, on that issue alone.

The day he signed the health care bill for all children, the one that Bush vetoed last year, I shouted 'thank God' and cried. Real healthcare that covers all American's would be a dream come true.

My daughter is in the process of getting a divorce, she and my two granddaughters (ages 4 and 2) now live with us. I was watching the kids so she could work, but mainly so she and the girls would have health insurance. My husband's work pulled back considerably on overtime so I had to go back to work myself, and, unfortunately, my daughter had to quit her job because she couldn't afford child care. She's now on Medicaid, and you wouldn't believe how hard it is to find a dentist or specialist who will accept it. She's had chronic lower back pain that her primary doctor can't figure out the cause of, and told her she should see an orthopedic doctor. Now she can't find one that will take Medicaid.

Thank God for your friend caught her cancer in time. I try not to waste my energy and spirit on hateful feelings, but I can't help it, I hate cancer with all of my being.

Life isn't fair, it's true, but making sure all people have adequate health care would make it a little more so. Morally, it's just right.
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Margaret



Joined: 23 Mar 2007
Posts: 878

PostPosted: Fri Aug 14, 2009 9:02 pm    Post subject: Reply with quote

Quote:


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.


I'm not a Palin fan to begin with, and I certainly am disappointed in the manner she uses her son as an example. Just to share my experiences with the medical system here I'll add...

I have a sister and nephew with Down's Syndrome and I've only experienced the best of medical care for them... and in all other areas as well. Not one person in the medical field has ever discriminated or against them...they have always received the same great level of care as any other Canadian.

Recently my husband tore the tendon off his kneecap and was scheduled for surgery in less than a week...my father has colo-rectal cancer( he's 79 now and the doctors priority is extending his life), we had immediate access to cancer treatments.

Everything is covered by the health care system here, we've never needed private insurance...we've worked and paid our taxes...and for whatever reason if you are not working you're still covered. That is a great system.
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Margaret



Joined: 23 Mar 2007
Posts: 878

PostPosted: Fri Aug 14, 2009 9:13 pm    Post subject: Reply with quote

Quote:
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
.


I think it would even out somewhat as resources should increase by 10x (using Canada's population). I'm not sure any plan can be perfect, but hopefully lots of constructive discussions will help.
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Kitkat



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

PostPosted: Sat Aug 15, 2009 5:02 am    Post subject: Reply with quote

norcalgolfer wrote:
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.



norcalgolfer, we don't have a formula to decide who to live or to die? THIS IS SO UNTRUE!!!

Yes, there is a shortage of staff, nurses and doctors and hospitals, but everything is done properly. The shortage of staff is due to low public sector pay rather than shortage of professionals.

The UK government actually improve the system alot over that last 15 years, now if there is a long waiting list you can get treatments not just from next city councils but also across the European Community. For example, there is a mssive shortage of dentist, and a friend who just got his whole set of teeth done in Poland under NHS. I know this is hardly a life and death example, but it illustrates the extend of the health coverage here.

Here is a better case to show the NHS at its best:
BBC reported last month that a woman suffered from Swine flu had a rare complication that needed her blood to be cleaned (or she will die pretty soon), there are only 2 machines and 5 hospital beds in the UK for this procedure and they were all full, they flew her to Sweden on a military plane for treatment all free of charge under NHS.

And yesterday, Professor Stephen Hawking, who has been confined to a wheelchair for decades and relying on his computer to communicate and nursing care for his daily needs, has came out to defend the NHS by saying: I would not be here today if not for the NHS. He was a down on his luck academic at Cambridge University who had little money when he got this disease and relying entirely on NHS for his treatments. It was because of this, he had the chance to become one of the greatest scientists of his generation.
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Last edited by Kitkat on Sat Aug 15, 2009 8:29 pm; edited 5 times in total
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kris



Joined: 23 Mar 2007
Posts: 311
Location: Southwestern Ontario

PostPosted: Sat Aug 15, 2009 7:54 am    Post subject: health care Reply with quote

Just to give a slightly different perspective but I'm a Criitcal Care Nurse here in Ontario and while the system is not perfect, no one is ever turned away. We may have bed shortages at times but a bed is always found. We are the trauma centre for our area and treatment always begins as soon as the patient comes through the doors. As far as other surgeries, anything that is considered an emergency , no matter what, gets treatment right away. My husband had to have surgery in May for a hernia. From the time of his first visit to our family doctor then to the consult with the surgeon and finally the surgery was one month. Medical screenings, lab test, consults, followups are all covered by OHIP. If I break my leg......nothing out of pocket for me and I'm covered at work with full pay for 3 months. If I'm sick beyond that it goes to short term disability. Now I have to agree that MRI wait times can be lengthy but if someone needs one on an emergency basis then it gets done right away. A friend of mine developed leukemia last year and from her first visit to the ER to her diagnosis and starting of treatment was about 4 days. I know there are alot of horror stories being written about the Canadian system but I think alot of them are false or skewed to support special interest groups. This system isn't perfect but I'll never go broke trying to pay for treatment and after working as a nurse for 22 years, I'm pretty proud of what we have.
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kris



Joined: 23 Mar 2007
Posts: 311
Location: Southwestern Ontario

PostPosted: Sat Aug 15, 2009 7:59 am    Post subject: health care Reply with quote

And one more thing, like Kitkat said:if for example we have a burn patient but there are no burn beds available in Ontario, we will send them on to Detroit and OHIP picks up the cost.
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norcalgolfer



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

PostPosted: Sat Aug 15, 2009 9:06 pm    Post subject: Reply with quote

Kitkat wrote:


norcalgolfer, we don't have a formula to decide who to live or to die? THIS IS SO UNTRUE!!!


You are completely correct Kitkat, Britain does not have a formula to decide who lives or dies. I also never said they did, please read again what I said, and carefully this time.

norcalgolfer wrote:


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.


Britain does use a mathematical formula, but not to determine whether someone lives or dies, but whether they are given specific surgeries. I'm not sure why you seem to have been offended by my comments. As I stated previously, I understand why NICE has the standards they have, there is not an unlimited amount of funding available therefore there must be limits in any National Health Care. Hard choices will have to be made, if that were not the case we would have had National Health Care in the U.S. long ago. Many of the horror stories we hear come from the people that fall through the cracks, which is inevitable since no system is perfect. For example, The U.K. has recently had several cases of young women who developed cervical cancer after being denied pap smears by a related health authority, the Cervical Screening Programme, which in order to reduce government health-care spending has refused the screens to women under age 25.

Let me be clear, I support National Health Care, what I am not sure about is the specifics. I applaud both Canada and Britain for already implementing this. I do not feel the systems are perfect, but they are quite possibly the best anyone can hope for, considering anything involving humans will not be perfect. I did not slam the mathematical model as an atrocity, I said I am not sure if I want it, and I brought up reasons why I am not sure. However, as I said already, hard choices will need to be made, any Health plan we come up with will not be a catchall, but merely provide a basic amount of coverage, as well as hopefully lowering the cost of private insurance for those who can afford it and desire additional coverage.

I recommend visiting the NICE website if you still doubt that mathematical models are used for certain types of coverage.

http://www.nice.org.uk/
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Cora



Joined: 12 Mar 2008
Posts: 1127
Location: Bremen, Germany

PostPosted: Sat Aug 15, 2009 10:07 pm    Post subject: Reply with quote

norcalgolfer wrote:
For example, The U.K. has recently had several cases of young women who developed cervical cancer after being denied pap smears by a related health authority, the Cervical Screening Programme, which in order to reduce government health-care spending has refused the screens to women under age 25.


There was one high-profile case - Jade Goody, a woman mainly known for being a contestant on several reality shows - who developed and eventually died of cervical cancer in her 20s. Ms. Goody chose to make her illness very public, which sparked a public debate and caused other women who developed cervical cancer at a comparatively young age to come forward.

Never mind that Ms. Goody, who was not exactly poor at the time of her death, could paid for the test, if she wanted it and the NHS did not cover it.
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Kitkat



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

PostPosted: Sun Aug 16, 2009 12:38 pm    Post subject: Reply with quote

norcalgolfer, I am not offended at all. This is an important subject which generates strong opinions. I do apologised if I did sound over the top.

norcalgolfer wrote:
For example, The U.K. has recently had several cases of young women who developed cervical cancer after being denied pap smears by a related health authority, the Cervical Screening Programme, which in order to reduce government health-care spending has refused the screens to women under age 25.


Yes, smear test is available free for all women from age of 25 and every 3 weeks there after. I agree if budget premit we should screen them much earlier. But no budget is unlimited, and if the risk is low for the under 25s, then money should be better spend elsewhere such as breast cancer screening from age 35 onwards rather than the existing 45 years of age.

Living in the UK, there is limited understanding on a privately geared health systerm like the one in the US. Just out of curiosity, is there a similar cancer screening system in America?

Cora wrote:
There was one high-profile case - Jade Goody, a woman mainly known for being a contestant on several reality shows - who developed and eventually died of cervical cancer in her 20s. Ms. Goody chose to make her illness very public, which sparked a public debate and caused other women who developed cervical cancer at a comparatively young age to come forward.

Never mind that Ms. Goody, who was not exactly poor at the time of her death, could paid for the test, if she wanted it and the NHS did not cover it.


I am sorry for Jade Goody. She admitted that she ignored the call up and didn't bother to go for her smear test provided by NHS at 25 and she regretted that and it was too late. Her illness raised awareness among young women to take cancer screening seriously and not to ignore NHS's call for screening of any kind.
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Last edited by Kitkat on Sun Aug 16, 2009 6:02 pm; edited 2 times in total
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norcalgolfer



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

PostPosted: Sun Aug 16, 2009 2:34 pm    Post subject: Reply with quote

Thanks Kitkat, I'm glad you weren't offended because I really do appreciate yours and the others opinions about the National Health systems you already have in place.

I'm not sure if this is available everywhere in the U.S., but I know that in California we have Planned Parenthood, which does pretty much everything a woman could want with regards to pap smears, birth control, even abortion as well as many other services for women, either free of charge for those who can't afford it, or minimal cost in a graduated scale depending on your income. All this is available to any woman regardless of age or income.

For those of lower income levels, most states if not all have health care available. In CA it is MediCal, and it covers lower income levels as well as pregnant women and the child up to a certain age. Emergency rooms cannot refuse to help anyone, but they will send you a bill if you don't qualify for MediCal or Medicare. For the elderly we have Medicare, which is federal and I believe whether you qualify is simply a matter of being old enough.

When it comes to other types of cancer screenings I'm just not sure, but our cancer survival rates are some of the best in the world. When you look at prostate cancer among black males however, you find a serious disparity in survival rates. This makes me wonder if it is an ethnic issue, or monetary. If a big part of the problem is lack of early screening due to no insurance, national health care should help significantly. The key word there is should.

One of my concerns is that too rigid limits on the health care will actually have a negative effect on cancer survival rates. The reason I am worried about this is because of the not so great survival rates of Britain in comparison to other developed countries. The numbers may have nothing to do with NHS, but I think it is important to note that while survival rates have been improving in the U.K., there is a seriously widening gap between the higher income levels survival and the lower income levels survival. I am concerned that this is because NICE policies have kept those without the means from getting screenings which would allow them to detect the cancer early enough. Another reason I wonder if this is the cause is the fact that Canada has such high survival rates across the board and Canada does not have as rigid policies as those developed by NICE. NHS has limited funds, so the money certainly has to be used where it has the most benefit, and we will have to do the same in the U.S., but I would rather pay a little more in taxes in order to ensure that we are able to have the best preventive care possible. I think preventive care will be the key to keeping costs down, as it is far far cheaper and easier and possible to deal with many medical issues if they are just caught soon enough.

My main concern with national health care is making sure the cracks are as small as realistically possible. There will undoubtedly still be a person here and there that falls through, and that makes me sad, but currently there are about 45 million or so that are potentially falling through, as well as quite a few that have insurance but don't use it because the co-pays or deductibles are prohibitively high. I am excited though that it looks like we will be getting some coverage relatively soon, it will take a lot of worries off my shoulders to know that I can go see a doctor immediately if I have a problem, as well as regular check ups to keep me from having problems.
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Cora



Joined: 12 Mar 2008
Posts: 1127
Location: Bremen, Germany

PostPosted: Sun Aug 16, 2009 10:11 pm    Post subject: Reply with quote

I can't speak for the UK, but even though in Germany certain screenings and tests are free above a certain age limit or there's reason to suspect that there's something wrong, if you are of higher risk for a certain disease, you get regular scans for free even if you are under the age limit.

For example, women are given mammograms every two years from the age of 55 or 60 on. But women with family risk factors get their screens on public health insurance even if they are younger. For example, my mother has been getting regular mammograms for as long as I can remember, because her mother died of breast cancer.

I have many issues with the German system, which basically means that everyone must have public health insurance (private insurance is also available, for those who want to pay for it as well as civil servants). The premiums are a certain percentage of the monthly income. Half of the monthly premium is paid by the employer, half by the insured person. Students, pensioners, unemployed people, etc... pay a lower premium. Non-working spouses and children are covered for free. If you go to the doctor, you pay 10 Euros every three months (additional doctor visits in that period are free), which was supposedly to discourage people from going to the doctor needlessly. You also have to pay a certain daily amount for hospital stays and up to 10 Euros for prescription meds. All these things used to be completely free until the late 1980s, the 10 Euro per doctor visit thing was only introduced five or six years ago. And many people, including myself, hate it, because since we pay insurance premiums, we don't want to pay extra for doctor visits. Never mind that it disadvantages people with chronic conditions that require regular doctor visits or prescriptions.

There are problems with the system, e.g. that viagra, hormone replacement therapy and fertility treatments (within limits) are covered, but contraception, sterilizations and abortions are not. Or that public health insurance only covers amalgam fillings (which are known to contain toxic mercury), if you want the non-toxic variety you have to pay extra. The system also disadvantages single, childless people and freelancers, because if you do not have an employer, your health insurance company bothers you with intrusive questionnaires every year. However, since many small freelancers are not able to afford health insurance at all in the US, it's still better.
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Kitkat



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

PostPosted: Mon Aug 17, 2009 5:19 am    Post subject: Reply with quote

Cora, here in the UK, there has been much talk about charge money to visit a doctor to reduce the chance of people not showing up to the doctor surgeries. My concern is that once you start charging patients for doctor visit then what next? charging for register with a doctor? Should this scheme goes ahead, it would be the people who need medical car, like the elderlys and children, who will suffer most. Already, some council start to fine patients who missed appointments, I heard that the fine is as much as 35 each time.

On seperate note, my cousin-in-law who is a actuaror and a managing director of an international insurer believe that the use of DNA for insurance premium is impossible to avoid in the future. His argument is that insurers are no different from other bussiness, they want to provide the best package to customers, by accurately assess the risk (via DNA), better & cheaper products can be tailored to suit individuals. If people are classify as high risk, then insurers should have a choice to reject them as their customers, it is goverment's job to provide universal coverage not the insurance industry. It is like banks refusing to loan money/ mortgages to people who have high possibility of default, it is up to the government to provide housing for people who cannot afford buying homes. I am not saying I agree with his opinion, but sadly I cannot fault his logic.
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Rosario



Joined: 22 Mar 2007
Posts: 328
Location: Liverpool, UK

PostPosted: Tue Aug 18, 2009 2:27 am    Post subject: Reply with quote

Kitkat wrote:
On seperate note, my cousin-in-law who is a actuaror and a managing director of an international insurer believe that the use of DNA for insurance premium is impossible to avoid in the future. His argument is that insurers are no different from other bussiness, they want to provide the best package to customers, by accurately assess the risk (via DNA), better & cheaper products can be tailored to suit individuals. If people are classify as high risk, then insurers should have a choice to reject them as their customers, it is goverment's job to provide universal coverage not the insurance industry. It is like banks refusing to loan money/ mortgages to people who have high possibility of default, it is up to the government to provide housing for people who cannot afford buying homes. I am not saying I agree with his opinion, but sadly I cannot fault his logic.



That sounds like standard economic theory, only in this scenario (assuming using DNA = insurers knowing exactly the risks faced by an individual), insurers wouldn't reject high-risk individuals, they would charge them premiums that reflect their risk.

Basically, the problem you usually have in private health insurance markets is asymmetric information leading to adverse selection (which means the market can collapse completely in the more extreme cases). With DNA testing (assuming as above, that it can accurately predict an individual's future health) you remove the asymmetric information element. Now insurance companies know all about an individual (exactly what their health risks are), and they can calculate the probable payoff they'll face in the future. They would offer each potential client a premium that reflects this exactly. It means that people in good health and without risk factors would face low premiums, people who aren't in good health and face many risks would face high premiums.

Of course, this makes no consideration of any equity elements. Is it fair that you should face sky-high premiums (which you might well not be able to pay at all, leaving you uninsured) just because you got unlucky in the genetic lottery, or were the 1 in 1,000,000,000 who was struck by a particular disease? That's the sort of issue the government needs to decide about.
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dick



Joined: 22 Mar 2007
Posts: 2477

PostPosted: Tue Aug 18, 2009 10:39 am    Post subject: Reply with quote

Nearly all insurance, whether health, liability, long term care, is a gamble isn't it? The insured pays to relieve the burden of some "possible" in the future. The insurer gambles that the "possible" may never occur and, if it does, tries to reduce the payment as much as possible by the terms of the contract, in order to maximize profits.

As long as profit is involved, I don't think insurance of any kind will be "fair," because insurers have more sources of information than insurees will ever have and can more readily configure the odds in their favor.
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Rosario



Joined: 22 Mar 2007
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Location: Liverpool, UK

PostPosted: Tue Aug 18, 2009 12:45 pm    Post subject: Reply with quote

dick wrote:
Nearly all insurance, whether health, liability, long term care, is a gamble isn't it? The insured pays to relieve the burden of some "possible" in the future. The insurer gambles that the "possible" may never occur and, if it does, tries to reduce the payment as much as possible by the terms of the contract, in order to maximize profits.


Ah, but see, for the insurer it's not so much of a gamble, because there are so many insured in its pool. As long as the insurer knows the probability of the different conditions in general, it doesn't really matter what happens with individual insured. If some end up getting treatments costing more money than they paid in, that will just be compensated by others who'll pay their premiums but never get sick.

For the insured, though, deciding not to get insurance really is a gamble.

dick wrote:
As long as profit is involved, I don't think insurance of any kind will be "fair," because insurers have more sources of information than insurees will ever have and can more readily configure the odds in their favor.


I'm not sure I agree, dick. I'd say insurers know a lot more about health conditions in general, but individuals know more about their own state of health, and they also know more about how they intend to take care of themselves in the future (will they exercise regularly? eat healthy food?).
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