The Future of US Healthcare

[4Tran]

Originally Posted by Vexx

The extent of LYING by stakeholders in the status quo is just staggering. We're actually having to import Canadians to explain how their system *actually* works because the misinformation and hate/fear is flying so thick. At the moment you can really tell which Senators are owned by the insurance industry.

What? It wasn't all of the . Kidding aside, there's a lot of momentum that works against the idea of Public Healthcare in the U.S., and it's not something that's going to be overcome easily; and something that I don't think that will be fully overcome for a very long time to come. Instead, it's probably more likely that it'd be some sort of private insurance solution with large subsidies from public funds. It's a very ugly solution, but it'd still probably be better than the mess that's in place right now.

Originally Posted by Vexx

Medicaid is a bit of a mess (mostly due to chronic underfunding and poor execution). Medicare is actually a raving success and is only creaking because of the absurd cap on the medicare income tax (only the first $100K of income is taxed).

Oh sure, but that's not the kind of arguments I've been even hearing about; instead I'm hearing about how Public Healthcare would be a wholly new concept for the U.S., and that we have no idea how horrible such systems can be. What the debate should be, even if it was kept to solely to American experience so far is in studying the hows and whys of the advantages and setbacks of Medicare and Medicaid, with an eye towards using that experience to expand coverage to everyone. And if we take the rest of the world into account, then the solutions become all the more obvious unless American are far worse at this kind of thing than everyone else.

Originally Posted by Vexx

ahh... pbffffft. After a while you're not sure whether to be more appalled at the manipulators or the manipulated.

What's really sad is that a lot of the most vocal voices against adopting a public system are often the ones who stand to gain the most if one were to be implemented. High co-pays and low limits that are endemic to a great number of insurance plans make them all but useless for any serious problems; hence those ugly statistics in that health study.

Originally Posted by Zippicus

To be fair it's not just one side or the other that's lying their asses off, both sides are pretty much full of it. Both sides ignore at best, misrepresent at worst, the known problems with whatever solution they advocate. You can pretty much just insert any generic nefarious force at work behind any politicians decision, because none of them are looking out for you or me (well maybe one or two of them).

You're implying that both sides are equally guilty of misrepresenting their cases, and that they do so to the same degree. However, as far as I can tell, most of the misinformation seems to be coming from one particular position. Is there some major source of misinformation that I'm missing here?

[Zippicus]

Originally Posted by 4Tran

You're implying that both sides are equally guilty of misrepresenting their cases, and that they do so to the same degree. However, as far as I can tell, most of the misinformation seems to be coming from one particular position. Is there some major source of misinformation that I'm missing here?

What I mean is that you have all the various politicians involved supporting ideas and policies that are beneficial different interest groups in the health care industry. Whether it's insurance companies, pharmaceutical companies, doctors, hospitals, lawyers, or whatever. And they're all saying and or doing whatever they have to do to make sure their "side" wins the most concessions. The people that will actually use whatever health care solution are way near the bottom of the list of concerns.

[4Tran]

To go back to Vexx's point about (mis)information about the healthcare system in Canada, here's an article from the Denver Post that tackles a lot of the commonly held myths: http://www.denverpost.com/portal/opinion/ci_12523427. I'm going to post the whole thing since it seems so germane to the discussion (emphasis mine):

Debunking Canadian health care myths

By Rhonda Hackett
Posted: 06/07/2009 01:00:00 AM MDT

Spoiler for Denver Post:

As a Canadian living in the United States for the past 17 years, I am frequently asked by Americans and Canadians alike to declare one health care system as the better one.

Often I'll avoid answering, regardless of the questioner's nationality. To choose one or the other system usually translates into a heated discussion of each one's merits, pitfalls, and an intense recitation of commonly cited statistical comparisons of the two systems.

Because if the only way we compared the two systems was with statistics, there is a clear victor. It is becoming increasingly more difficult to dispute the fact that Canada spends less money on health care to get better outcomes.

Yet, the debate rages on. Indeed, it has reached a fever pitch since President Barack Obama took office, with Americans either dreading or hoping for the dawn of a single-payer health care system. Opponents of such a system cite Canada as the best example of what not to do, while proponents laud that very same Canadian system as the answer to all of America's health care problems. Frankly, both sides often get things wrong when trotting out Canada to further their respective arguments.

As America comes to grips with the reality that changes are desperately needed within its health care infrastructure, it might prove useful to first debunk some myths about the Canadian system.

Myth: Taxes in Canada are extremely high, mostly because of national health care.

In actuality, taxes are nearly equal on both sides of the border. Overall, Canada's taxes are slightly higher than those in the U.S. However, Canadians are afforded many benefits for their tax dollars, even beyond health care (e.g., tax credits, family allowance, cheaper higher education), so the end result is a wash. At the end of the day, the average after-tax income of Canadian workers is equal to about 82 percent of their gross pay. In the U.S., that average is 81.9 percent.

Myth: Canada's health care system is a cumbersome bureaucracy.

The U.S. has the most bureaucratic health care system in the world. More than 31 percent of every dollar spent on health care in the U.S. goes to paperwork, overhead, CEO salaries, profits, etc. The provincial single-payer system in Canada operates with just a 1 percent overhead. Think about it. It is not necessary to spend a huge amount of money to decide who gets care and who doesn't when everybody is covered.

Myth: The Canadian system is significantly more expensive than that of the U.S.

Ten percent of Canada's GDP is spent on health care for 100 percent of the population. The U.S. spends 17 percent of its GDP but 15 percent of its population has no coverage whatsoever and millions of others have inadequate coverage. In essence, the U.S. system is considerably more expensive than Canada's. Part of the reason for this is uninsured and underinsured people in the U.S. still get sick and eventually seek care. People who cannot afford care wait until advanced stages of an illness to see a doctor and then do so through emergency rooms, which cost considerably more than primary care services.

What the American taxpayer may not realize is that such care costs about $45 billion per year, and someone has to pay it. This is why insurance premiums increase every year for insured patients while co-pays and deductibles also rise rapidly.

Myth: Canada's government decides who gets health care and when they get it.

While HMOs and other private medical insurers in the U.S. do indeed make such decisions, the only people in Canada to do so are physicians. In Canada, the government has absolutely no say in who gets care or how they get it. Medical decisions are left entirely up to doctors, as they should be.

There are no requirements for pre-authorization whatsoever. If your family doctor says you need an MRI, you get one. In the U.S., if an insurance administrator says you are not getting an MRI, you don't get one no matter what your doctor thinks — unless, of course, you have the money to cover the cost.

Myth: There are long waits for care, which compromise access to care.There are no waits for urgent or primary care in Canada.

There are reasonable waits for most specialists' care, and much longer waits for elective surgery. Yes, there are those instances where a patient can wait up to a month for radiation therapy for breast cancer or prostate cancer, for example. However, the wait has nothing to do with money per se, but everything to do with the lack of radiation therapists. Despite such waits, however, it is noteworthy that Canada boasts lower incident and mortality rates than the U.S. for all cancers combined, according to the U.S. Cancer Statistics Working Group and the Canadian Cancer Society. Moreover, fewer Canadians (11.3 percent) than Americans (14.4 percent) admit unmet health care needs.

Myth: Canadians are paying out of pocket to come to the U.S. for medical care.

Most patients who come from Canada to the U.S. for health care are those whose costs are covered by the Canadian governments. If a Canadian goes outside of the country to get services that are deemed medically necessary, not experimental, and are not available at home for whatever reason (e.g., shortage or absence of high tech medical equipment; a longer wait for service than is medically prudent; or lack of physician expertise), the provincial government where you live fully funds your care. Those patients who do come to the U.S. for care and pay out of pocket are those who perceive their care to be more urgent than it likely is.

Myth: Canada is a socialized health care system in which the government runs hospitals and where doctors work for the government.

Princeton University health economist Uwe Reinhardt says single-payer systems are not "socialized medicine" but "social insurance" systems because doctors work in the private sector while their pay comes from a public source. Most physicians in Canada are self-employed. They are not employees of the government nor are they accountable to the government. Doctors are accountable to their patients only. More than 90 percent of physicians in Canada are paid on a fee-for-service basis. Claims are submitted to a single provincial health care plan for reimbursement, whereas in the U.S., claims are submitted to a multitude of insurance providers. Moreover, Canadian hospitals are controlled by private boards and/or regional health authorities rather than being part of or run by the government.

Myth: There aren't enough doctors in Canada.

From a purely statistical standpoint, there are enough physicians in Canada to meet the health care needs of its people. But most doctors practice in large urban areas, leaving rural areas with bona fide shortages. This situation is no different than that being experienced in the U.S. Simply training and employing more doctors is not likely to have any significant impact on this specific problem. Whatever issues there are with having an adequate number of doctors in any one geographical area, they have nothing to do with the single-payer system.

And these are just some of the myths about the Canadian health care system. While emulating the Canadian system will likely not fix U.S. health care, it probably isn't the big bad "socialist" bogeyman it has been made out to be.

It is not a perfect system, but it has its merits. For people like my 55-year-old Aunt Betty, who has been waiting for 14 months for knee-replacement surgery due to a long history of arthritis, it is the superior system. Her $35,000-plus surgery is finally scheduled for next month. She has been in pain, and her quality of life has been compromised. However, there is a light at the end of the tunnel. Aunt Betty — who lives on a fixed income and could never afford private health insurance, much less the cost of the surgery and requisite follow-up care — will soon sport a new, high-tech knee. Waiting 14 months for the procedure is easy when the alternative is living in pain for the rest of your life.

Rhonda Hackett of Castle Rock is a clinical psychologist.

Originally Posted by Zippicus

What I mean is that you have all the various politicians involved supporting ideas and policies that are beneficial different interest groups in the health care industry. Whether it's insurance companies, pharmaceutical companies, doctors, hospitals, lawyers, or whatever. And they're all saying and or doing whatever they have to do to make sure their "side" wins the most concessions. The people that will actually use whatever health care solution are way near the bottom of the list of concerns.

That may be true, but it still in no way supports the idea that both sides are equally dishonest.

[Vexx]

Ah, those nagging facts

[Zippicus]

Originally Posted by 4Tran

That may be true, but it still in no way supports the idea that both sides are equally dishonest.

Heh, that article you linked has a nice bit of dishonesty involved. When talking about the wait times in Canada they purposely picked the area that has the lowest wait times and omitted everything else.

Personally I find articles like this or this are a bit more accurate as to wait times. They all know nobody is going to like waiting so this is one of the big ones they try to sweep under the rug.

[Vexx]

And I'll say again... been to an HMO lately? Tried to get an appointment?

---> Wait times of two weeks or more for routine GP appointments. Specialist appointments can take several months.

The "wait time" bogey is a canard. We *already have* the same level of wait time. We also have a triage system of "more urgent gets in front" but its diluted by "most wealthy goes first and gets best" .. and of course, those without insurance simply get nada and those with insurance get financially bankrupted by "out of pocket costs". Also, the article did point out that rural areas have significant wait times in Canada (just like in the US).

My wife had to have some minor surgery last year to stop a problem that was "reducing her quality of life significantly" ... we have one of the best HMOs in the country --- she had to wait over 3 months (14 weeks). Anecdotal, yes.... but reflective of the system as it is currently.

Of course, if you're wealthy this is not a problem. Anyone making less than, say, $400K a year isn't wealthy.

I also note the source of the information for those articles says this:

Esmail said throwing more public money at the problem has been shown to make no difference to wait times.
The cure, he contends, would be to create a privately funded health care system to deliver services alongside the public system.

That's an interesting solution.... *I* would have thought the problem of 'wait time' is availability of resources and the solution would be to invest in additional personnel, equipment, and facilities.

Sounds more like a vendor with a product trying to force-fit it onto the problem

[Zippicus]

Originally Posted by Vexx

And I'll say again... been to an HMO lately? Tried to get an appointment?

---> Wait times of two weeks or more for routine GP appointments. Specialist appointments can take several months.

The "wait time" is a canard. We *already have* the same level of wait time. We also have a triage system of "more urgent gets in front" but its diluted by "most wealthy goes first and gets best". Also, the article did point out that rural areas have significant wait times in Canada (just like in the US).

My wife had to have some minor surgery last year to stop a problem that was "reducing her quality of life significantly" ... we have one of the best HMOs in the country --- she had to wait over 3 months (14 weeks). Anecdotal, yes.... but reflective of the system as it is currently.

Of course, if you're wealthy this is not a problem. Anyone making less than, say, $400K a year isn't wealthy.

Well that was really directed at the article that seemed to indicate that people didn't have any significant wait times in the Canadian system, which was the type of misinformation I was talking about from all parties involved. I wasn't really comparing our system vs. their system. Frankly both have their problems.

About that edit you made, I suspect it was referring to something like this.

[Anh_Minh]

Originally Posted by Zippicus

Well that was really directed at the article that seemed to indicate that people didn't have any significant wait times in the Canadian system, which was the type of misinformation I was talking about from all parties involved. I wasn't really comparing our system vs. their system. Frankly both have their problems.

About that edit you made, I suspect it was referring to something like this.

That's not how I read the article you criticized. To me, it meant that, while there were wait-times:
- they weren't long enough to make it worse than in the US,
- for the most part, they weren't long enough to endanger the patients.

[iLney]

Here is the supply and demand curve. The cost (in terms of capital, not binary digits, not papers pulled out of thin air) is too high. To lower that, it is crucial to increase the demand even more. Guess who are in denial.

[WanderingKnight]

I still can't believe there's people who support the idea of getting indebted for life in order to save yourself from a problem you're very likely not to blame for in the first place.

Especially since the idea of a society implies the idea that we're not here just to fend off for ourselves individually.

But what do I know, I'm a pinko commie bastard.

[SaintessHeart]

Originally Posted by WanderingKnight

I still can't believe there's people who support the idea of getting indebted for life in order to save yourself from a problem you're very likely not to blame for in the first place.

Well Obama is the one getting cheesed here. People are chanting, "The best things in life are free." into his ears thus the plan of "healthcare for everyone".

It is fine to have subsidised healthcare, but free or semi-free healthcare is going overboard when it eats extensively into the nation's reserves.

Especially since the idea of a society implies the idea that we're not here just to fend off for ourselves individually.

Erm, I am afraid that is the case. Everyone seems to want a slice of one another, though there isn't much use in taking another's body or flesh in the name of moral gratification.

But what do I know, I'm a pinko commie bastard.

Then I am a facist pig. Should I click my heels together and scream, "Heil Hitler!"?

It is just an ideology and not equivalent to anything. There is something called the freedom of thought.

[Vexx]

No one is saying healthcare is free, nice try to over-simplify the situation. Really, the only people I hear using that phrase are insurance industry lobbyists and the politicians they own trying to smear proposed solutions.

... Healthcare analysts *are* saying that many can't afford it and that the results of that still cost everyone a lot more money than if we managed the situation. They're also pointing out that even those who do have insurance often discover that their plans are nimble in avoiding paying for illness.
People *WITH* health insurance are also not getting cared for. Their health insurance skips around, runs with loopholes, denies claims just to delay payment, refuses to cover best practices treatment, drops you. Once you are dropped, others deny you coverage.

My wife (pharmacist) deals with patients everyday who have to decide between dying or bankrupting their family because the insurance company ran like a rabbit. A huge part of the cost of operations where she works is just dealing with the several hundred different insurance companies that directly interfere with formulary and treatment decisions of the medical team.

The status quo is broken... we're past that argument. How about some proposals for fixing it rather than just yelling "she's a witch", eh?

And iLney, you've demonstrated in multiple posts that you don't even understand how the current system works, so your credibility is about zero when it comes to shooting at proposals with poorly articulated economic ideology.

[Zippicus]

I think the biggest problem is the over inflated health care costs due to insurance companies and government imposed insurance regulations. Insurance is basically a system imposed that allows costs to exceed the means of the individual users.

Assume for a moment a world where insurance didn't exist, nothing could cost more than people were able to pay, well it could but it wouldn't be able to sustain itself. Once that artificial system collapsed health care costs would have to drop down to reasonable levels.

[Kamui4356]

Originally Posted by iLney

Here is the supply and demand curve. The cost (in terms of capital, not binary digits, not papers pulled out of thin air) is too high. To lower that, it is crucial to increase the demand even more. Guess who are in denial.

No, just no. I'll try explaining this one more time. If you still don't get it, I'll be forced to conclude that you're deliberately trying not to understand.

Ok, not all medical conditions are the same. Further, for a lot of conditions, the earlier you catch it, the quicker, cheaper, and easy it is to treat. Preventitive care is more likely to catch these problems early. Some medical conditions, if caught early require only a visit to the doctor to diagnose and medication to treat it, however, if left to progress may require far more intensive, and far more expensive treatment later. Take atherosclerosis. If caught early enough it can be treated by medication, while if left untreated it can result in a heart attack and may require bypass surgery, while still requiring those same medications after that surgery. This is an added cost to the system and added man hours spent by doctors in treating the condition in a later stage.

Further, a condition caught in the early stages is less likely to cause a signifigant loss of productivity on the part of the patent, which means he keeps working rather than being in a hospital, pumping more money into the economy. What universial healthcare does is shift the focus on healthcare away from the more expensive treatments for diseases further along in their progression and more towards preventing them entirely or treating them as soon as possible, which in either case is going to be more expensive. Thus, a system that encourages preventitive care and makes it accessible to everyone will be cheaper in the long run.

We are not talking about some theoritical system that has never been tried. We're talking about a system used in most European nations that has proven itself cheaper and more effective than the failed for profit system in the US. No, it isn't perfect in those countries, but it works a lot better than the US system.

Also your whole supply and demand concept is being falsely applied. You're assuming all patients require the same man hours and cost for the doctor regardless of their condition. In fact, more severe conditions are going to require a lot more time on the part of a doctor and use a lot more resources than a patient coming in for a check up.

Originally Posted by SaintessHeart

Well Obama is the one getting cheesed here. People are chanting, "The best things in life are free." into his ears thus the plan of "healthcare for everyone".

It is fine to have subsidised healthcare, but free or semi-free healthcare is going overboard when it eats extensively into the nation's reserves.

The thing is the US with its private healthcare system pays more per person than those nations with free or semi-free healthcare and has a lower quality of care than other first world nations. Obviously, something is very wrong with the US system. I wouldn't mind the US paying the most per person if we were top in level of care. If that were the case it'd be money well spent. Even if we were in the top ten it woudn't be bad. However, that isn't the case at all.

[SaintessHeart]

Originally Posted by Zippicus

I think the biggest problem is the over inflated health care costs due to insurance companies and government imposed insurance regulations. Insurance is basically a system imposed that allows costs to exceed the means of the individual users.

Assume for a moment a world where insurance didn't exist, nothing could cost more than people were able to pay, well it could but it wouldn't be able to sustain itself. Once that artificial system collapsed health care costs would have to drop down to reasonable levels.

Your point has merit. But one worry would be that nobody would want to study medicine because it is a seriously difficult course to go through then earn just as much as a normal lab engineer.

The point of having insurance would be to have a bed to cushion a serious fall that can debilitate or disable a person permanently. The money may not be able to get the body part / life back, but it could be a consolation to the rest of the family members.

[Zippicus]

Originally Posted by SaintessHeart

Your point has merit. But one worry would be that nobody would want to study medicine because it is a seriously difficult course to go through then earn just as much as a normal lab engineer.

The point of having insurance would be to have a bed to cushion a serious fall that can debilitate or disable a person permanently. The money may not be able to get the body part / life back, but it could be a consolation to the rest of the family members.

That's true but I don't think anyone would expect that a neurosurgeon would make the same salary as a burger flipper. What I was mainly referring to is that simple things like broken bones can rack up a price tag in the thousands of dollars. There's no way in hell it should cost thousands of dollars to set a bone and slap a cast on it. The only reason they can get away with charging that much is because insurance companies are footing the bill.

I understand the desire to have a sense of security for any possible situation that arises, but it's way beyond that at this point.

[Vexx]

Frankly, I'm almost old enough to remember that world that Zippicus postulates .... a "no-insurance" model or at least one where "insurance" was purely for disaster situations (the ones that bankrupt people). It was fairly workable (though the safety net of Medicaid at the bottom was set pretty low and still is). And believe it or not... we had many doctors and surgeons then who happily entered the profession anyway. They also weren't getting gouged to hell and back by insurance companies selling malpractice (yes, I'm for tort reform if the professions will self-police as they're supposed to). Much of that hideous charge for a broken bone goes to ---> the insurance company who charges the doctor up the ass for liability and malpractice insurance.

Its how to *get* there from the current horribly bloated situation that would be the difficulty. The insurance companies are very comfortably fat leeching the system as it is. Big pharma has gotten bloated -- spending almost as much on advertising as they do on research (count the pharma ads... why the hell do we *have* pharma ads? No, I know the answer and it isn't pretty). They wouldn't like it either.

[Zippicus]

Originally Posted by Vexx

Frankly, I'm almost old enough to remember that world.... a "no-insurance" model or at least one where "insurance" was purely for disaster situations (the ones that bankrupt people) might be workable. Believe it or not... we had many doctors and surgeons then who happily entered the profession. They also weren't getting gouged to hell and back by insurance companies selling malpractice (yes, I'm for tort reform if the professions will self-police as they're supposed to). Much of that hideous charge for a broken bone goes to ---> the insurance company who charges the doctor up the ass for liability and malpractice insurance.

Its how to *get* there from the current horribly bloated situation that would be the difficulty. The insurance companies are very comfortably fat leeching the system as it is. Big pharma has gotten bloated -- spending almost as much on advertising as they do on research (count the pharma ads... why the hell do we *have* pharma ads? No, I know the answer and it isn't pretty). They wouldn't like it either.

I'm almost that old too

I agree that the difficulty is damn near insurmountable at this point. That doesn't make any of the proposed solutions any easier to swallow though either.

[JMvS]

Here in Switzerland our situation is quite different from large countries like USA or Canada: as the country is small, there are no area that really qualify as "isolated and devoid of doctors", also the greying of our population might be more pronounced already.

But we share a federal system, with a traditional "less-state" attitude tinged with european social-democracy.

For us and since 1994 (IIRC), suscribing an health insurance is MANDATORY for every resident.
Those are private companies, and we probably have like a dozen or two in a country with 7 millions inhabitants ( but we are quite fond of insurances here).
The advocated system is mostly free-competition between the companies to grab customers, so they are quite service oriented.
At the end of each years the insurance premiums for the next year are announced, and you are free to change your insurance company. Premiums are mostly determined by which demographic you belong to, and your past health expenses.

Depending on your revenue or precarious financial situation, you might qualify for a subside granted by your State to pay your premiums (That's the social-democratic part).

Now the downside of the system is that premiums keep rising since the system was inaugurated (we were announced a +15% rise for the year 2010...), because the law ask the companies to have huge reserves (which the financial crisis harmed), and also because the cost keep rising.

Rise in costs is part because of our graying population, part because of new health-consumers behavior, part because of medication becoming more and more expensive (Drug companies which are major industries here play a part).

[WanderingKnight]

Erm, I am afraid that is the case.

No it's not. A society is about having a project of what you want your country to be. People aren't alone in the world, the power of the individual is a fantasy maintained by the powers that be in order to keep the rest of the population in check.

It's the same reason why it's important to have public education, public services and public transport facilities.

In this example, I can quote both my own country and a neighboring country, Chile. Luckily enough, we still haven't lost public education, but its quality has lowered so much through the years that it almost seems as we have. Chile, on the other hand, had a much tougher time through the military dictatorship of that son of a bitch, Pinochet, and they lost *every public service*--no public education, no public transport, no public health. International corporations make a lot of money off it, but the general Chilean population... *shrugh*. There's still a sizeable amount of the population that keeps on ignoring the insane violations to human rights during Pinochet's dictatorship, and how his legacy is slowly leading half the country to its doom.

Over here, the loss of public services has impacted our country very badly. What wasn't done in the 70s was achieved in the 90s. Our country is now a disaster in terms of services, both private (in the hands of international corporations) and the few public ones still in the hands of the government (which obviously does nothing about it and keeps on selling itself to its corporate overlords). Public healthcare sucks, and I've been practically forced to get an insurance. And the saddest part is, a lot of people can't have access to both private education and healthcare, and that starts a feedback loop that keeps them in poverty for the rest of their life, and probably their offspring's.

That's a nice project of a country, right there.

Then I am a facist pig. Should I click my heels together and scream, "Heil Hitler!"?

It is just an ideology and not equivalent to anything. There is something called the freedom of thought.

It was a joke. I'm not actually a communist, though few people seem to understand exactly what that word means, and throw it around like candy whenever they see something that goes against their ideas.