Government managed health care

Paul Shortrino posted this on Facebook:

When the UK, Canada France and all the countries that have a government "managed" healthcare plan are seeking reform to break out of a terrible system, where amongst other things people die on waiting lists every day, we are struggling to climb into the frying pan. Imagine a trip to the doctor looking like a trip to the DMV - not so funny!

Discuss.

My short answer is it's a bad idea....however, I will keep an open mind and listen to what Obama has to say tonight and get back to you tomorrow.

Oops, I fell asleep during BO's speech...Note to self, do NOT try to pay attention to Obama after being awake for over 24 hours.

People dying on waiting lists, huh? Well, I'm always astonished by tales from the US of people without health insurance with cancer or other serious diseases going without treatment because they can't afford the medication, or leaving their families in huge debt to cover the loans taken out for treatment. I've got a friend in Georgia whose youngest child has a growth hormone disorder that means she doesn't grow. The treatment is simple and well known, she just needs hormone therapy, but the family has six kids and can't afford 10 years of ongoing medical care for her; their health insurance doesn't cover it, and the medicine has a huge profit margin in its cost.

I've had many friends and family members go through cancer treatment; most recent, of course, was my mother. All her hospital bills, her tests, and most of her medication was paid for by Medicare, our free healthcare system here in Australia. She paid $12 a time for her medicine, up to a maximum of $300 and after that it was free. She got good care, but sadly was the one in 10 who didn't survive her cancer type.

How do I feel about it? I was still working when she got diagnosed, but was planning to quit working full time and finally go back to Uni to full time study. Couldn't have done it if we'd had to pay her bills. As an Office Manager I made good money, but I doubt I could have afforded to pay her medical bills without taking out a loan on which I would have had to pay interest. She had private medical insurance, but some of her treatment wouldn't have been covered by that.

Part of the health care system here is that there are limits on how much companies can charge for tests and for drugs. Talking to US doctors working in Australia, something that comes up time and time again is how many fewer tests are done here; the emphasis is on accurate diagnosis and then test, not do a battery of tests to see which one comes out right. I think it's because we don't have a stack of salesmen haunting hospitals trying to persuade doctors to make use of inflatedly expensive tests.

Because going to a GP is around $10 per visit if you work, and free if you are on a low income, on a pension, a student, unemployed, etc, etc, etc, issues are caught much earlier. My best friend's breast cancer was caught when it was the size of a split pea, because she went in to see the doctor about a bad head cold and mentioned she had noticed a hard spot in her breast. If she didn't have Medicare, she wouldn't have gone in about the cold and wouldn't have done anything about the lump until it was much bigger.

I can't speak for other countries, but Australia's health care problems that are in need of reform at the moment come from hospitals that have been begging for money from our previous conservative government that was not given. A few years ago, the six State governments came together and said they needed X million dollars as an absolute minimum to repair and maintain the hospitals across the country. The Federal government offered them less than one tenth of the money needed, and told them take it or leave it. Why? Well, at the time, the Federal government in power was the conservative Coalition, and all of the State governments were Labor, their political rivals. The conservative Federal government quite cynically ran the nation's hospitals into the ground and refused to honour its commitments, then blamed their political rivals for it at the next Federal election.

I think free health care is something that should be considered a right. Is it perfect? No, of course not. Are there abuses of the system? Yes, but that is true of any system. Does it save lives? Absolutely! Am I, a tax payer, happy to pay it? A damn sight happier to pay for that than governmental 'research' trips abroad, television ads telling me the world is full of terrorists and I should be spying on my work colleagues and neighbours, bail outs to
badly run big businesses and banks, foreign wars, and all the other shit governments spend unwisely on.

As for how it is paid for... Mamma was in her 4th year of a full time Civil Engineering degree when she was first diagnosed. She'd given up her first attempt at the degree because she couldn't afford to study as a single mother working part time, but at 50 went back to Uni to get it. She'd worked 33 years, paying taxes the whole time, and as a student worked part time, still paying taxes. She earned that health care. Most students haven't been working that long, but the assumption is that they will pay taxes one day. Does my neighbour who lives down the street, who stays at home to look after her kids, and who has never had a paying job in her life, not deserve free health care? Of course not, because she does work, she doesn't get paid for it. She's a part of my community, a citizen of my nation, and she and her kids have a right to certain basic ammenities, of which free health care is one.

Why the hell should I pay taxes if the money I pay is not going to be spent on the people of my own country, to the real benefit of our lives?

I guess it comes down to this: I believe people have a right to basic medical care, regardless of their income. I also believe people have a right to free education, to free libraries, and that the elderly of our country have a right to expect that at the end of their working lives, their country that they have supported will not let them live destitute, but will support them financially. I also think people have a right to invest in medical insurance, private education, buy their own books and pay extra superannuation, if they can afford it and they wish to. But you shouldn't be penalised and denied those things just because you don't have money.

(But then, I don't believe any government can possibly give me as a right my Life, Liberty and the Pursuit of Hapiness, or my Freedom; I'm the only person who can give them to myself, and it's my responsibility to make sure my country is one where everyone can do the same. )

Some interesting observations. For the record, I have no real horse in this race since I never go to the doctor. I realize the current system in the U.S. sucks, but I am generally against the government running anything. Also, I wonder if a new system was in place that someone like Ted Kennedy wouldn't still get preferencial care as opposed to just being part of the system like everyone else.

My father had a great comment a few months ago:

"If you think Health Care is expensive now? Wait until it's free!"

What gets overlooked very often, is that even in countries where free health care is available, you still have the option of going to a private doctor and paying - you don't have to wait if you have the money.

Thousands of people die in the U.S. each year from lack of health care - they cannot afford their treatments, they cannot afford the medicine - they cannot afford to go to the doctor. So by the time their illness has progressed and worsened they end up in hospital emergency rooms.

Not everyone qualifies for Medicare or Medicaid.

When you retire Medicare kicks in right away.

However, if you are sick and go on disability (which can take two years to get your first check [SSI does not issuie your first check until 6 months after your approval date - that is their rule].

And here is the kicker - Medicare does not kick in for two years after the first check is issued.

Since you cannot really work while on disability (you can earn 900$/month (gross)) that is two years with no medical coverage, no prescription coverage, no health care period.

Yes, some people take advantage of the system - they are the ones who try to take advantage of everything and everyone whether they deserve it or not.

I have a rare, fatal lung disease - and I cannot afford to go on disability- even tho earlier this year I spent part of May and June in the hospital in ICU unconcious and had to learn to walk again.(that was my third hospitalization this year) I am back at work now, however it is very difficult to work everyday - I don't even have the strength to take out the trash when I get home. I have to wait until Sundays - fortunately one of our department chairs sends his housekeeeper over on Sundays to take out the trash, do the laundry (I do what I can during the week by hand in the bathtub and then hang it outside to dry (where pieces have been stolen) and change the litter box.

For me to go on disability, I would have to quit my job, lose my health insurance, not be able to pay for any treatment, drugs or even my oxygen and live in a shelter. Even tho I am fortunate to have a good well-paying job and health insurance, my co-pays are so much I usually go without food for the last week of the month. Thank goodness, because of my oxygen needs, I have a certificate of medical necessity with the electric company.

I am too young to retire - even early retirement.

This is not a pity party or a call for sympathy or prayers - just an example of first-hand experiece - and believe I have been doing my homework on this for the past few years.

A more easily accessable health care system would do wonders for me.

You may find some helpful intormation http://ssa-custhelp.ssa.gov/cgi-bin/ssa.cfg/php/enduser/std_alp.php?p_page=1&p_cv=1.105&p_pv=&p_prods=&p_cats=105


Cat

Ed wrote:Some interesting observations. For the record, I have no real horse in this race since I never go to the doctor. I realize the current system in the U.S. sucks, but I am generally against the government running anything. Also, I wonder if a new system was in place that someone like Ted Kennedy wouldn't still get preferencial care as opposed to just being part of the system like everyone else.

I'd assume Ted Kennedy would have private health care insurance or the personal funds to cover his 'upgrade' to a private room, allow him to 'jump the waiting list' by paying for a private doctor, etc.

I think everyone needs to re-read Cats post again. But this time, in doing so, put yourself in her shoes.

SilverBlack wrote:

Ed wrote:Some interesting observations. For the record, I have no real horse in this race since I never go to the doctor. I realize the current system in the U.S. sucks, but I am generally against the government running anything. Also, I wonder if a new system was in place that someone like Ted Kennedy wouldn't still get preferencial care as opposed to just being part of the system like everyone else.

I'd assume Ted Kennedy would have private health care insurance or the personal funds to cover his 'upgrade' to a private room, allow him to 'jump the waiting list' by paying for a private doctor, etc.

That would be correct Ari. He has the funds and the last name that would put him on the top of any list he needed to be on.

Cat, I think you need to move to Australia or the UK. The situation you describe leaves me utterly gobsmacked! I find it hard to believe that a civilised, wealthy nation allows this to happen to its own people.

Changing the topic slightly - a quick question for Ed; if you are against the government running anything, then what is the point of having one? What does/should it exist to do?

SilverBlack wrote:Changing the topic slightly - a quick question for Ed; if you are against the government running anything, then what is the point of having one? What does/should it exist to do?

Locally - Pave roads, arrest criminals, put out fires, maintain the infrastructure.

Federal - Interaction with other countries (trade ageeements, etc), National Defense

Of course I'm being very general, but you get the point. Living in the state of Maryland I hear the sucking sound everyday of the "machine" constantly seeking revenue.

I say this having worked for the federal government and now a quasi government agency on the local level.

cat wrote:What gets overlooked very often, is that even in countries where free health care is available, you still have the option of going to a private doctor and paying - you don't have to wait if you have the money.

Cat, please do not take this as me making light of your situation. I don't pretend to have all of the answers to this healthcare issue....but I do know that increasing healthcare coverage and (worse) putting in in the coverage of the United States Government is bad idea.

I'd like to call attention to the bold faced comment above as a dreadfully over-simple way to look at this. The devil is very much in the details.

Universal Healthcare will not alleviate the fact that doctors cant currently afford malpractice insurance. It will not alleviate the fact that their costs are so vast that they can't afford to stay in business. It will not alleviate the fact that the very costs to become a medical doctor force doctors into a financial position that is far worse than any other profession.

I have a few dentists and a doctor in the family. All of them, with the exception of my father, are trapped under student loans that would make a lawyer, college professor or accountant break down and cry. What's worse is that their profit margins are so thin that they have to live in sheer poverty just to make payments on their student loans and malpractice insurance.


Universal healthcare plans are looking to shave these razor thin profit margins even more. When this happens, trust me, the experienced doctors will leave the business (as many currently are). What will be left is an inexperienced field of doctors who will get out of the business at their first chance as well.

The laws of supply and demand come into play here. Less doctors mean far more costly medical treatment, not cheaper. This has happened in countries with universal healthcare, like Canada, the UK and France. In addition, the quality of medical treatment has plumeted as well.

Trust me, Natasha Richardson's family didn't rush her to NYC for medical treatment after she sustained a head injury in Quebec merely because they just wanted to get her close to home. They did so because they knew that the Canadian health-care system sucks. When politicians and celebrities of other countries all fly into the US for their healthcare, instead of simply paying for it at home, that speaks volumes.

Let's assume we throw out Obama's utterly stupid definition of a 'rich' person (making more than 250k)....the fact remains that with Universal Healthcare, out of network treatment is going to be FAR out of financial reach of anyone other than the ultra-ultra-ULTRA rich. On top of that, the quality of medical treatment that one can achieve at that price point is going to plummet. There wont be many doctors that will be able to afford to cater to this demographic.


Healthcare is indeed headed towards a crisis (if it's not steeped in one already)....but the answer is NOT to make it 'free' for everyone. Because in the end, someone still has to pay the bills.

You fix malpractice insurance issues by outlawing ambulance chasing by lawyers, amending laws that currently allow people to sue for outrageous sums for issues that are not caused by medical staff but that they were not able to prevent, and you effectively implement better procedures into hospitals and the like by investing in them properly.

You fix massive student debt by instituting interest-free student loans, ensuring that Colleges and Universities can't charge outrageous amounts for degrees, and by providing student medical staff with a student income (provided they maintain a certain grade level) so they can survive without having to live on debt.

I've heard the arguement that universal health care (you are right, it isn't free) drives doctors out of the industry. It didn't actually happen in the UK, (there are more doctors there now than there were prior to the introduction of the NHS), and doctors didn't leave on masse as predicted in Australia when Medicare was introduced.

It's like every issue - there isn't one simple, easy solution that will cure all ills, but there are things that can be done to improve things.

Government running the healthcare system is a terrible fucking idea. Period. Half of these motherfuckers on both sides of the aisle can't even be faithful to their spouses and I'm supposed to trust them with my health?!?! Fuck that. I love my employer's current benefits and Curious George better not fuck with them.

You're way oversimplifying tort reform, education costs and the problems with universal health care.

Even if you get the changes that you suggest in tort reform, it will not reduce malpractice claims by any significant amount. There is medical malpractice in this country....preventing people from suing to claim just damages, will only cause a problem in the tort justice system.

You don't drive down costs in one industry by fixing prices in another. So 'institutionalizing' the education system doesn't work EITHER.

like I stated...this is over simplifying a problem.....


universal health care takes all of the above problems and pours jet fuel in these individual fires...ruining 3-5 different industries just so universal healthcare is a barely passable, workable system is lunacy.

First off, Cat, I am very sorry for your illness and the associated situation you find yourself in. Chronic illness, especially lung disease, is a horrible thing to have to endure. I wish you nothing but the best.

But... I'm not sure (based on my limited amount of knowledge about socialized medicine) that universal healthcare would improve your situation. I would guess that you probably have better coverage under your private plan than you would be granted under a public plan, due to rationing and decisions not to cover cost-prohibitive treatments. In fact, based on BO's comments, maybe he would just tell you to 'take a pill' like he told the woman about her grandmother who needed a pacemaker at a hundred years old (he would allow her to die just because of her age, not considering her quality of life). He said the other night repeatedly that 'if it won't make you better, we won't do it'. That concerns me for treatments like radiation therapy for bone cancer victims, and other "palliative" care needs, hospice, etc. I work in health care, and I know that there are things that should NEVER be done (I have a patient who is an elderly man with hemiparesis from a prior stoke, that has advanced lung cancer, has been on a ventilator for the past month & a half, and has been hospitalized for about 2 months, all because he chooses to be a full code. I'm sorry, I love the man, but he is abusing the system, IMO. He had a relatively good quality of life before his lung CA diagnosis, but will never have that same QOL again.) but we are not yet at a place where we force someone to forego treatment based on what we feel is right.

I honestly have no idea what will happen, but I am afraid in this matter. My mother died of a glioblastoma multiforme, which by virtue of the type of cancer it is and the anatomy of the brain is incurable. However, there are specified treatments that have been proven to enhance quality and quantity of life. My mom was misdiagnosed, and so by the time a definitive diagnosis was reached, it was too late for that treatment. However, in people who are diagnosed much earlier, I have to wonder if that treatment will be unavailable in the future because it is very costly. Many cancers have a 5-year survival rate, at what point will someone say that 5 years isn't enough to make it worthwhile? IDK.

My opinion is that we need to find another way to make this happen. Just because other countries are doing it, doesn't make it the right thing to do. For us.

Anyway, good luck to you.

Thanks DP - I am a survivor and I have done by fighting the healthcare professionals in this country

As far as the doctor doing selective treatments - it is done here all the time now with insurance companies calling the shots.

The doctors here who want to give their patients the best treatment (there are some who do) usually have their hands tied by the insurance companies.

So that part is no different.

The help to me would be in drug co-pays - they would be significantly less.

There is one medicine that would help my a lot - however, the cost is $40,000 (US) a year. The manufacturer will pay the first half, $20,000 - the insurance co would pay approx half of the remainder, $10,000 - that leaves me covering the remaining $10,000 and I do not have it - nothing to sell, nothing to hock.

So I don't get the med.

Many people in the US cannot afford many of the meds they need so they either take it every other day or they simply never get it.

Women die of breast cancer here everyday - never having had any treatment beyond the original diagnosis because there just is no money. They deserve a hand.

Yeah but it's just a bunch of poor minority women so who really cares, right?

As someone who lives with 'socialised' universal health care, I can tell you that doctors select on basis of need, not on basis of preferential outcome. So an ingrown toe-nail is going to be further down the list for surgery than bowel polyp removal which is further down the list than the removal of a cancerous tumor. ALL serious illnesses are treated, even when the outcome is survival=nil. What private health care gets you is a choice in which doctor treats you, a choice of a private hospital over a public one (if you so desire), a private room rather than a ward, and will give you 'elective' surgery when you choose rather than waiting for your turn in the list to come up ('elective surgery being that ingrown toenail, cataracts that haven't made you blind yet, the deviated septum that gives you a permanent blocked nose, i.e. stuff that is annoying and reduces your quality of life, but isn't dangerous, likely to get much worse without immediate treatement, or life-threatening.)

To use Cat as an example, in Australia her medicine would be made available under the PBS and Medicare; once she'd paid $300 her costs for ongoing, repeat medication would be nil. If she has health insurance, they would be asked to pony up some, but she wouldn't be denied that medicine cut-off. Her hospital care would be assured and her treatment guaranteed. The bells and whistles of private care wouldn't be there under Medicare, but her treatment would be.

SilverBlack wrote:
[...] The bells and whistles of private care wouldn't be there under Medicare, but her treatment would be.

A feline can dream....

SilverBlack wrote:As someone who lives with 'socialised' universal health care, I can tell you that doctors select on basis of need, not on basis of preferential outcome. So an ingrown toe-nail is going to be further down the list for surgery than bowel polyp removal which is further down the list than the removal of a cancerous tumor. ALL serious illnesses are treated, even when the outcome is survival=nil. What private health care gets you is a choice in which doctor treats you, a choice of a private hospital over a public one (if you so desire), a private room rather than a ward, and will give you 'elective' surgery when you choose rather than waiting for your turn in the list to come up ('elective surgery being that ingrown toenail, cataracts that haven't made you blind yet, the deviated septum that gives you a permanent blocked nose, i.e. stuff that is annoying and reduces your quality of life, but isn't dangerous, likely to get much worse without immediate treatement, or life-threatening.)

To use Cat as an example, in Australia her medicine would be made available under the PBS and Medicare; once she'd paid $300 her costs for ongoing, repeat medication would be nil. If she has health insurance, they would be asked to pony up some, but she wouldn't be denied that medicine cut-off. Her hospital care would be assured and her treatment guaranteed. The bells and whistles of private care wouldn't be there under Medicare, but her treatment would be.

While I'd love for that to be true, my suspicion is that the medication she is referring to would not be covered due to it's extreme cost. In some of my reading, I discovered that a medication that is commonly used to treat the effects of Alzheimer's Disease (Aricept) is not given in the UK due to it's cost. Relatively-speaking, that medication is cheap compared to Cat's needs.

The problem that I find with what you described above is that while a person may not be 'blind' due to cataracts, it may affect your quality of life enough to make you miserable or unsafe (such as driving). Here in the US, most people have to drive to work, and if unable to drive, some may not be able to work. I guess you get my drift. Insurance generally doesn't pay for a private room, the patient is responsible for the difference in cost between a semi-private and a private (it was about $25/day when I had my kids).

Something else we need to consider in the US is that for the past 10 years of more we have been encouraged as "health-care consumers" to have a say in our healthcare. That means we should be able to expect a certain level of quality from the care that we are paying for. Our expectations may exceed what the government is able to provide for us. Many people have come to expect the 'bells and whistles' because they are paying into a system that tells them they deserve it. It's hard to go back, I believe.

One problem that we have is that illegal aliens clog up our emergency rooms, with really no intention of paying for the care they receive. In order to make up for that lost revenue, the hospitals do stupid stuff like charge $9 for an aspirin. Then we get folks who don't have insurance being charged $9 for an aspirin, and the other fees are exponentially higher as well. Of course, from what I understand, illegal aliens will be granted the same benefits as American citizens in this healthcare plan. People have to be responsible for their own health care needs, and there are too many people out there that just want to sit back and complain and not work for what they need. But oh, boy, I bet they've got the hottest ride around...

Tort reform and cutting waste are too huge areas that if gotten under control, costs would go down. Eliminating pre-existing condition clauses would help too (although there are ways around that). I just happen to believe it's because of our health care system that we have had the advances in medicine that would allow a drug like the one Cat mentioned to be available. We just gotta find a way to pay for it for her.

How about a game of dodgeball...?

I've been following the managed health care discussion both here and on MR and I must say I agree 100% with what DP has said in both forums. Current Medicare/Medicaid is a joke and I can't imagine it being ANY better with universal health care. While I do wish there was a way to offer health covereage to all Americans I think it is nearly impossible. Medicare is nothing but red tape and endless paperwork that results in patients either not getting the care they need or healthcare providers not getting reimbursed. I used to be the director of a home health agency and Medicare is the reason I left (Kudos to you Donna for putting up with them-someone needs to do it!) It was a HUGE headache and I felt like my hands were always tied. On the other hand, I feel Medicaid is highly abused by a small percentage of patients with Medicaid coverage.

Donna also makes a good point about the $9 asprin (although $9 is a bargain). However, government programs contribute to this problem as well. Here's an example. Let's say hospital performs a procedure that costs them $70 to do (I'm using totally random numbers here!) The $70 covers only the cost of supplies, the wages for everyone involved in the procedure-now keep in mind this includes probably at least a couple of nurses, nurses aides, the pharmicist that checks the medications, the receptionst that checks the patient in, the billing department the formulates the bill, the supplies to mail out the bill, the housekeeper that cleaned the room, the laundry service that cleaned the linens, the dietary staff, the IT department that keeps the computers working, the maintenance department that keeps the building in good repair, the biomed department the keeps the medical equipment running well, the lab tech that draws and runs labs, etc, etc, etc....In order to pay all of those people and still make a profit (yes, hosptials are often for profit facilties) the hospital charges $100. OK, so you have a certain percentage of patients who have the procedure done that have private insurance that pay a portion of the bill and the rest is paid by the patient, you have a percentage of patients that have no coverage and some pay all of the bill, some pay a portion and some don't ever pay the bill, and there are a certain number of patients that have medicaid or medicare coverage and the government only pays a certain percent of the bill (substantially less than the total bill) and the hospital is not allowed to bill the patient for the remainder. I can't speak for all states, but in Idaho, Medicaid pays 40% of the bill. So in this scenario, 40% of the bill would only be $40, $30 less than what it costs the hospital to perform the procedure. In the end, most of the patients will end up paying less than the $70 it cost the hosptial to perform the procedure. Now you can see why the hospital must increase the costs....

I don't know what the solution is but I think that giving the government the power to decide how much they will pay will be a disaster.

Very good examples, Natalie, and thanks for the kudos! In my workplace, honestly Medicare pays us better than standard insurance. Medicare pays by resource utilization, whereas many insurance contracts only pay a set dollar amount, regardless of the care provided. For example, I could have 2 patients in a room, getting basically the same amount of medication, therapy, and nursing services (not to mention many of the other things you described), and reimbursement for the patient under Medicare could be $500/day and the patient with BCBS might pay us between $250-350. We LOVE Medicare patients in long-term care. Fortunately, many of the managed care organizations (we call them Medicare Replacement policies here) are shadowing the Medicare formula so we are seeing better reimbursement. As for Medicaid in a SNF... it stinks. But it is what it is, and our old folks need it.

For me, it's not so much having the government decide how much they'll pay, but more a matter of what they'll pay for, and how they'll pick and choose who will get certain services. In your line of work, I wonder how many of those high-risk pregnancies will be carried to full-term because the govt might decide it's too risky and frankly not worth the expense to keep a baby alive. I think of in-utero procedures that are such high risk to start with, and the idea of potentially having a malformed or otherwise handicapped baby; would the govt form a 'committee' to review those cases as well to see which ones are worthwhile? TNC ridiculed me for mentioning that at MR (talking about butchering babies), but here's the thing: we have a government now who thinks it's ok to partially deliver a baby, poke a hole in the back of it's skull and suck the brain matter out with a vacuum. Who's to say that won't be the remedy for these babies???

I'm scared for our country, and moreover I'm scared for our people. I hope someone can come up with some reasonable alternative to universal healthcare solely managed by government committees.