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The Healthcare Bill debate in the US
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Susan/DC



Joined: 26 Mar 2007
Posts: 1665

PostPosted: Mon Sep 07, 2009 9:00 pm    Post subject: US Healthcare Reply with quote

I don't know if anyone else has mentioned this article by T.R. Reid that appeared in The Washington Post a couple of weeks ago, but I think it's a relatively clearsighted overview of some of the issues in the current health care debate. One of the interesting comments he makes is that the US system is actually quite a jumble of public and private sector structures. For example, the US already has a single payer system like Canada's: Medicare. It already has "socialized" medicine, where the government directly runs hospitals and pays the salaries of medical personnel: the Veterans Administration. I hadn't really thought about these aspects of our health care system in those terms, so it was interesting to have him point this out.

http://www.washingtonpost.com/wp-dyn/content/article/2009/08/21/AR2009082101778_3.html
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CD



Joined: 15 Sep 2007
Posts: 665
Location: London, UK

PostPosted: Tue Sep 08, 2009 2:33 pm    Post subject: Reply with quote

That was a really interesting article and really clarified the US health care system for me. The main point for me would be:

Quote:
The key difference is that foreign health insurance plans exist only to pay people's medical bills, not to make a profit. The United States is the only developed country that lets insurance companies profit from basic health coverage.


That's my experience of health insurance in France at any rate.

With all these articles currently attacking the current healthcare system, are there any reasonable articles defending it? Would be interested to hear the other side.
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CD



Joined: 15 Sep 2007
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Location: London, UK

PostPosted: Sun Nov 01, 2009 8:44 pm    Post subject: Reply with quote

An American friend of mine recommended the following radio show on health care to help me better understand the health care system in the US:

http://www.thisamericanlife.org/Radio_Episode.aspx?sched=1320

What I found was really interesting was that it focused not on the problems of getting people insured but on the unsustainable rising cost of health care. They quoted a statistic saying that the take-home pay of a median worker in the US has actually decreased in real terms over the last decade. However, the amount that employers' have paid has actually INCREASED by 25%. The difference is due to the rising cost of health care.

Surprisingly, they don't then go on to demonise health insurers as the culprits but more the unstandable prevailing cultural attitude of "more is better". They mention studies saying that a third of all medical procedures conducted in the US are unnecessary, and then go into details as to the incentives of patients and doctors to demand more care; and why insurers are unable/unwilling to control the resulting mounting costs.

As a British person, this was a complete eye-opener for me. My friend mentioned that if he were to continue his current health care provision after the end of his current contract, he'd have to pay around $500 a month just on premiums since his employer would no longer subsidise him. Granted, since he was working in Haiti the premiums would probably be higher being in a higher risk group - however, it seems pretty extraordinary price to pay just for insurance. When I heard that, I immediately assumed evil insurance companies, but it's interesting to find out that actually isn't the main issue.

Anyway, it was definitely food for thought and, although probably not new to most people in the US, it definitely helped me understand the context of the debate a lot better than I did.


Edit: There's a second part to the programme here which I just listened to focusing on the insurance industry.

http://www.thisamericanlife.org/Radio_Episode.aspx?sched=1321

Interesting look at the war between insurance and pharmaceutical companies, the history of how the US got to the systerm of employer-based insurance schemes, and the idea that MORE competition in the insurance industry would actually increase premiums.

This last was especially thought-provoking as it seemed pretty counter-intuitive but actually made a lot of sense: the idea of that if there was more competition, insurers would actually be in less of a bargaining position vis a vis hospitals and other health-care suppliers.
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Chez



Joined: 03 Apr 2007
Posts: 42
Location: Oz

PostPosted: Thu Jan 07, 2010 3:56 am    Post subject: A perspective from the Australian system Reply with quote

I have read this thread with great interest and enjoyed all the different opinions offered. As someone asked for an opinion from an Australian I thought I might offer mine. As a married mother of two I have enjoyed excellent health care for my family through our "Medicare" system. We have a system that includes a national system for all, but a private system for those that can afford it or prefer to choose their medical practitioners.

There is a safety net for all people requiring emergency treatment and anyone can go to an ER/Casualty and get treatment. You might have to wait if it is non-life threatening, but that's ok as you would kind of expect anyone requiring more urgent treatment to go first. I know that I have spent a few hours waiting around for treatment for such childhood things as cuts requiring stitches etc, while the heart attack patients are treated immediately. Any treatment at a casualty department is free.

Private doctor visits can be either bulk billed (no charge) against the medicare system or there can be a part payment in some practices. This is a personal choice type of thing where you can choose a particular doctor and they may have a part payment charge. These are usually about $10-15. I personally prefer to choose a doctor that does this, but mainly because he is a family doctor that I have had for some time and he knows our family well, having treated us for so long. There have been times though that I have gone to a bulk billing doctor for other urgent(ish) treatment (kids ear infections) if my doctor was away or closed on weekends. I have not had any trouble with these and been happy with the service.

Specialist visits can be either arranged bulk billed, usually through a hospital outpatient system or again, you can part pay a small amount and visit their private rooms. Medicare still pays the bulk of the payment for the specialist and there might be a charge of $20-50 extra. As an example a gyno visit may cost $120 for a first visit, but medicare pays about $85 of that. Second visits are less and the gap smaller. (Personal example again and other experiences may vary)

Medicare does not pay for dental unless you are a pensioner or low income earner, physio or other ancillary care like those. You can pay for private health insurance for these services (again the private insurance may not cover all the cost and there can be gap payments to be made by the patient).

I don't believe our system is perfect, but I would not EVER give it up given a choice. Everyone gets treated, that's the point. There can be waiting lists for some things, but the wait varies from town to town. Strangely waiting lists can be shorter in smaller towns and there is a thriving trade in people hopping on other towns lists and travelling a small distance to "jump" the queue.

Hope this information helps.
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KarenS



Joined: 23 Mar 2007
Posts: 870
Location: Florida

PostPosted: Mon Feb 08, 2010 5:57 pm    Post subject: Reply with quote

Since health insurance legislation may be dying(any doctor available to resuscitate) here is an interesting article by a physician regarding health care. It's also interesting to note where the article was found.

http://www.theoildrum.com/node/6186

The doctor's basic premise is that social issues affect your health more so than the health care you receive. I would disagree on life-threatening injuries but I would tend to agree on chronic health conditions.

That said, I do support Medicare for all. It's already implemented for our seniors so just make it available to everyone. Unfortunately, if we can't pass health insurance reform for all Americans I have come to the conclusion Medicare and Medicaid should be eliminated. Let's be fair about it. No single group should be singled out to receive a benefit that is denied to another group.

I think I have passed into the all-or-nothing thinking realm as I don't feel that older folks should have health care. Why give health care to old farts when they no longer serve any useful purpose except to consume resources. And I will soon be an old fart myself so I am willing to give up Medicare if my kids are going to be denied this benefit.
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Donna Lea Simpson



Joined: 23 Mar 2007
Posts: 249
Location: Canada

PostPosted: Wed Feb 10, 2010 9:07 am    Post subject: Reply with quote

KarenS,

Interesting article, but it doesn't address one thing: stress is a debilitating factor in people's overall health, he admits, and if universal health care (thus, not having to decide on health care or food one particular month, or not having to face bankruptcy because of catastrophic health care costs) brought down the stresses in working people's lives, wouldn't that contribute to a betterment in the social factors that he posits determine longevity?

On Wikipedia's list of countries by life span, Canada's position in the longevity chart is 11th, while the US is 38th. We have similar populations, (lots of differences, I know, in poverty and other social ills) but differing attitudes toward social programs and health care.

I've been pondering this for quite a while and I just cannot wrap my head around it... what are those Americans who oppose universal health care so afraid of? Does it bother them to help fellow Americans out with their tax dollars? Isn't that what taxes are for? Corporate health care seems badly broken; I'm not saying our system is perfect, but I prefer it over US style health care.
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KarenS



Joined: 23 Mar 2007
Posts: 870
Location: Florida

PostPosted: Wed Feb 10, 2010 9:28 pm    Post subject: Reply with quote

Donna Lea Simpson wrote:
KarenS,

Interesting article, but it doesn't address one thing: stress is a debilitating factor in people's overall health, he admits, and if universal health care (thus, not having to decide on health care or food one particular month, or not having to face bankruptcy because of catastrophic health care costs) brought down the stresses in working people's lives, wouldn't that contribute to a betterment in the social factors that he posits determine longevity?

On Wikipedia's list of countries by life span, Canada's position in the longevity chart is 11th, while the US is 38th. We have similar populations, (lots of differences, I know, in poverty and other social ills) but differing attitudes toward social programs and health care.

I've been pondering this for quite a while and I just cannot wrap my head around it... what are those Americans who oppose universal health care so afraid of? Does it bother them to help fellow Americans out with their tax dollars? Isn't that what taxes are for? Corporate health care seems badly broken; I'm not saying our system is perfect, but I prefer it over US style health care.


Donna:

I am just as befuddled as I don't get it either. I have heard the argument that it's too costly for the government to implement universal health care. Usually these are the same people who feel that wars and supporting the military-industrial complex is ok since we are protecting our country. A lot of people are into safety and feel the cost of protecting us from the boogie man is more important than helping Americans. And isn't it interesting there is always a boogie man to be afraid of? So most Americans buy into, don't question it and are happy with the status quo.

There are some that feel Americans don't deserve health care as they bring on their health problems by being obese, over-indulging in drugs and alcohol, engaging in immoral behavior and overall making poor choices in life. So the feeling is these folks deserve whatever happens to them. Sad to say but America tends to be a very religious country and the Judeo-Christian belief system is in full-force. You have some very extreme folks who feel people should pull themselves up by the boot straps with no help from the government. If you do well in life it's because God has blessed you and you are deserving of all good things.

If we were to pass decent health insurance reform we might possibly take out certain corporations(Insurance companies) that deal in human misery and deny them billions of dollars in profit. And since we just love capitalism that will never do. It is the feeling that corporations are more important than people and should be allowed to make a profit at the expense of the American public.

So yes, it's very convoluted. Frustrating totally if you support health insurance reform. Those opposed are gleeful that it won't happen. Right now those corporations that oppose reform are pouring billions of dollars into fighting it. They are expecting payback from those members of Congress they own to vote against it.

All progressive ideas have to be fought for and they never come easy. They are seen as being extreme and harmful to the country because they are different and they shake up the status quo. So we really are a very conservative country that looks after the corporations and the upper 1% of this country. The rest of us are expendable.

Donna, in a nutshell why health insurance reform is so controversial.

Karen
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Donna Lea Simpson



Joined: 23 Mar 2007
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PostPosted: Thu Feb 11, 2010 8:03 am    Post subject: Reply with quote

Our system is not perfect. See this article for a criticism: http://thechronicleherald.ca/Columnists/1166914.html

I do think this fellow is probably a Conservative party shill, but...

But the argument against allowing user-pay clinics is that it could, ultimately, result in a two-tier health care system with the rich again on top and the poor at bottom.

I'm not resolutely opposed, as long as no money is taken away from public health care, but the minute those with the wherewithal start to whine, 'but I shouldn't have to support public health insurance AND pay my own costs', then I'd like to yank the plug. If folks want to pay for private health care, fine, I guess it would just shorten the queue for other folks, but I still want full free universal care for children, the elderly, the poor, the disabled, homeless, working poor, and the rich or moderately well off too... in short, EVERYONE.

Our system is pretty darned good right now, and that's coming from someone with a lot of experience with loved ones and friends having procedures, operations, emergency care, specialists, etc.
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Sterling_95



Joined: 04 Oct 2008
Posts: 212

PostPosted: Fri Mar 05, 2010 7:31 pm    Post subject: Reply with quote

KarenS wrote:

There are some that feel Americans don't deserve health care as they bring on their health problems by being obese, over-indulging in drugs and alcohol, engaging in immoral behavior and overall making poor choices in life. So the feeling is these folks deserve whatever happens to them. Sad to say but America tends to be a very religious country and the Judeo-Christian belief system is in full-force. You have some very extreme folks who feel people should pull themselves up by the boot straps with no help from the government. If you do well in life it's because God has blessed you and you are deserving of all good things.


The problem is, there's a certain cold logic to that and it's a scientific logic. Any person with a background in evolutionary science will tell you that Darwinism is not a pretty process. Survival of the fittest. If it is in the interest of the pack, the old/sick/infirm will be saved, but if not, the gene pool marches on and will be better without your old/sick/obese ass pulling things down. Don't like it? Tough luck - who said nature is fair? The idea that all men are equal is a pipe dream about as realistic as the big man in the sky and with as much scientific evidence.

Not a mindset I believe in or like, but I've heard it. A former friend of mine refuses to marry or have children because he's diabetic and overweight and is going with the Oliver Wendall Holmes that "3 generations is enough". He thinks that health care for those with chronic conditions should be free, but if the chronically ill who accept it for themselves or for their children, they should be sterilized as a requirement. I suppose it makes a certain amount of sense. After all if we say that we're better off euthanizing a person because they have Down's syndrome/a chronic disease/whatever, it's kind of hard to not only let them live but keep on paying for them to live this "inferior" life indefinitely.
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Donna Lea Simpson



Joined: 23 Mar 2007
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PostPosted: Mon Mar 08, 2010 7:56 am    Post subject: Reply with quote

Not sure if this is the actual quote, but it goes something like this...

"A nation's greatness is measured by how it treats its weakest members."

Mahatma Ghandi

Also:

Our society must make it right and possible for old people not to fear the young or be deserted by them, for the test of a civilization is the way that it cares for its helpless members. Pearl S. Buck, 'My Several Worlds' (My italics)
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Sterling_95



Joined: 04 Oct 2008
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PostPosted: Thu Mar 11, 2010 4:26 pm    Post subject: Reply with quote

Donna Lea Simpson wrote:
Not sure if this is the actual quote, but it goes something like this...

"A nation's greatness is measured by how it treats its weakest members."

Mahatma Ghandi

Also:

Our society must make it right and possible for old people not to fear the young or be deserted by them, for the test of a civilization is the way that it cares for its helpless members. Pearl S. Buck, 'My Several Worlds' (My italics)


Well, yes, I personally believe that, but the old issue of passing the buck then arises its' ugly head. Believing that a quadriplegic has a right to a full life is one thing, but it's quite another to change diapers, provide full time care and feed and change them, or to fund them in health care from cradle to grave. I've heard parents of children with Down's Sydrome express fear that their children will become marginalized because now with prenatal testing, 90% of the pregnancies that test positive for Downs Sydrome are aborted. And some countries already - I believe the Netherlands is one - allows euthanasia of a child up to 1 year from birth, given parental request and evidence from 2 sets of doctors that the child would have significant pain and/or reduced quality of life. A lot of times people are reluctant to pass judgment on those who abandon, abort or simply reject those significantly in need - the elderly, children with disabilities, dying relatives - because the sympathy being with the caregiver rather than the person in need. Then there are some who can't see from any focus but their own - they would never want to live on state assistance, or live, period unless they had all their faculties, limbs and were in perfect health with perfect kids and they assume others should live by the same standards. When Sarah Palin had Trig, there were a lot of rude jokes about living proof that she didn't believe in evolution and the like and on the flip side, expressions of horror that she'd burdened the child with life when he obviously wouldn't be able to enjoy it, given his mental state (yes, I couldn't believe they were serious either).
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dick



Joined: 22 Mar 2007
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PostPosted: Fri Mar 12, 2010 10:07 am    Post subject: Reply with quote

Too often, merely being alive, regardless of the state of that life, is held as the ultimate criteria by which to make judgments. I find it ironic that, at the same time as it is being used that way, many others are insisting that choosing to die is also a right. In some instances, when an individual has not developed the reasoning capacity to make the choice himself, I think it's reasonable that those who do ought to make that decision for the individual.
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