U.S. health reform

[Vargev]

I have been asked to start this thread as i believe it would make an interesting debate in its own right.

Initially America was contemplating a state funded social healthcare system, very similar to the N.H.S (National Health Service - for those who don't know), that we have here in the U.K.

With all the troubles that president Obama had trying to get his public health bill through congress, ultimately the bill had to be watered down.

However i am at a loss to see why such a system would not be welcome in the U.S. As it would make U.S. health insurance meaningless, since all operations in the N.H.S are funded by the state. Nobody would have to pay for an operation from their own pockets ever again. Thoughts guys?

[Teresa Edgerton]

Having suggested this thread -- which I am sure my fellow moderators are cursing me for, because of its potential to get out of hand -- let me remind everyone who might want to participate to keep it civil. It's been peaceful and friendly around here the last few days, so let's keep it that way. At the same time, it would be nice to put the politics aside and find out what people really do fear if health care reform passes/doesn't pass. And the perspective of people in other countries, who have a government funded health care system.

So for those who are against the health care reform bill in the form it was first considered. It's all very well for some who are against some sort of public option to say they fear socialized medicine, but that's just a catch phrase: I'd like to know from the "against" group exactly what socialized medicine means to them on a practical level. No, I don't want to hear about state interference in people's lives and too much government. I have heard that enough times that I understand that this is a basic concern for some people. Surely there has to be more than a philosophical argument. People are dying for want of coverage. You are fine, decent people, and I don't think you would let this happen over a philosophical question. Theoretically, yes, but not in real life. I want to know exactly what you think would happen if we had socialized medicine in this country. Specifics. Do you think that the quality of care would be worse? Do you think that deadbeats who don't deserve medical coverage would get it? Do you think people would have less options in terms of choosing their own doctors? What do you think would be different for you when you needed medical care?

I know what I fear if things stay the same -- not for me, because my coverage is awesome compared to what I've heard from every single person I know who doesn't have the same coverage. People I know will talk about how good their coverage is or how great their doctor is, but comparing notes, point by point, I can see that what I have is far better and makes much more sense. And theirs is typical of what most people have. So what I fear is that my grown children, and most of all my grandchildren will suffer because they can only afford the coverage supplied by my daughter's employer and it SUCKS. And I also think of all the other people who are denied the care they need while they are going through a nightmare of talking to people on the phone trying to get things sorted out -- and especially the little children who are being denied proper care. And then there are the children of parents who have no coverage at all. How can this be acceptable in a modern, civilized country?

But I also want to know from those who live in countries that do have national health care, what is it like? I mean apart from the not having to pay for your operations aspect. Is it efficient? Is the standard of care high? If a doctor says you need an operation, do you simply get sent to a surgeon and the operation is set up -- or does it have to be approved by some process that can take weeks or months? How does it actually work, and where does it fall down?

[Parson]

Although I am in favor of a nationalized health care system, my friends and relatives are almost without exception opposed to it so I feel I can speak with some authority about the opposition to it.

My dad who is adamantly opposed to a nationalized health care system points to 3 things in particular. (1) When the government does something it is always wasteful and inefficient. (2) The Canadian health care system will not always treat cancer aggressively and if you want elective surgery they will make those people wait, sometimes for years. (He believes this because one of his Canadian friends had the experience with cancer, and "everyone knows" about the second.) (3) We will be taxed unmercifully for this and we will lose some of the benefits we have with medicare, (which is ironic, but he sees some difference here.)

In my part of Iowa if you want to say something is untrustworthy and filled with corruption the words to use are "union" and "government regulation." The prevailing ethic here is one of self help. You take care of yourself and your family. If you aren't doing your part then you really don't deserve anyone's help. But if you are working hard and are still having trouble then your friends and relatives come to your aid. You do not look to Washington to bail you out, because Washington always messes things up.

[dustinzgirl]

Try getting a sick kid to a doctor without health insurance or money up front.

[j. d. worthington]

Originally Posted by dustinzgirl

Try getting a sick kid to a doctor without health insurance or money up front.

A sick child, or even an unforeseen but extreme medical condition of your own. I had such a good many years ago, which darned near cost me my life. I did finally get proper care, but it took me more than ten years to pay off the debt on that, and even then it was a near thing. I'm sorry, but that sort of nonsense is just plain b.s....

[Teresa Edgerton]

Originally Posted by Parson

But if you are working hard and are still having trouble then your friends and relatives come to your aid. You do not look to Washington to bail you out, because Washington always messes things up.

Nice if you have that kind of friends and relatives. In lots of places people don't. They may be good people themselves, but their relatives wouldn't go one step out of their way to help them out. (Not, I hasten to say, my close friends and relatives, who would indeed go many steps.)

I have heard of hardworking people who had medical insurance, who were denied the coverage they had every reason to believe they were paying for and would receive, and as a result had to sell their houses to pay their medical bills when they were hit by catastrophic illnesses or accidents. Could/would their friends be willing to come up with hundreds of thousands of dollars to help them out? I think that a lot of the people who think like your relatives do, Parson, might find themselves without coverage exactly when they need it, and be absolutely ruined for all their hard work and independence, simply because their insurance companies have been ripping them off for years and they don't find it out until it's too late.

And what do they say about the children of people who aren't deserving? What is supposed to happen to them if they get sick.

[Karn Maeshalanadae]

My two cents:

I believe President Obama is doing the absolute best he can with what he was handed. I believe he truly wants to help this country in the ways it needs help.

I truly believe that he wants bipartisanship and for the dual-party warfare to end.

Yet he does not have absolute power. He is not a despot, he is not an emperor, he is not a dictator, nor is he an autocrat. The ones with the power to get bills through are the Senate and the House of Representatives. I was completely in support of a public option of health care. Why, you ask?

There's multiple reasons. Not only am I at risk for certain issues-there's heart disease, of course, and I will venture a hazard to guess that there may be a risk of alcoholism and certain cancers-not only am I at RISK for certain issues, I HAVE medical issues. What might they be, you ask?

I'll start with what my first. In the summer of '08, I had a benign giant cell tumor removed from right above my right knee, a tumor the size of my fist-and I'm a very big guy. Now I have cement in that spot and very little bone to where my femur connects to my shinbone. It is entirely possible I will need a mechanical knee soon.

My second? It happened two months ago, on November 15th. I broke my leg while going Christmas shopping one day. I spent a week in the hospital, three days of which were in traction before a SECOND surgery. Now along almost the entire length of my femur is a metal plate reinforced with screws.

I now need to have semi-annual X-rays and checkups for both problems. I will need them for the tumor for a few more years to come. I have bills for my needed pain medication. Luckily for the tumor OHSU footed the bill. How much would that have been up to now, you ask? I believe it to be over $100,000.

The mall's insurance company where I slipped and broke my leg should cover my medical expenses for the broken leg. They will not do so until I speak with them, and the lawyer I had to hire advised me not to do so.

So there you have it. I am unable to work, I am unable to purchase my own health insurance. My FAMILY is unable to get health insurance. So, I have to say, I was highly disappointed and angry with the politicians-both sides mind you-when the public health option was removed. So what are people like me supposed to do? Go into a debt that can never be repaid?

[Wybren]

Here in Australia we have a health system similar to the NHS. We have what is called Medicare, which covers most of your out of pocket costs (well it is supposed to do anyway). Everyone is entitled to it and we pay a percentage in our tax to cover the cost of the system, and if you dont pay tax your still entitled to it and everyone is able to see a doctor and get surgery here if they need it and no one has to go bankrupt because they need treatment for a medical condition.

We also have private health cover, which wasnt very popular when I was younger but our previous government was a fan of the US health system and started cutting funding to medicare services and then encouraged people to buy private health insurance by charging them extra if they reached a certain pay threshold if they didnt have private cover ( however that extra tax amount is still less than what health insurance costs anyway) How our private health insurance works is we have "funds" and if you choose you can join a fund and pay heaps to help cover the cost of stuff, but you end up paying way more if you have private than if you stick with the public system.

ie
patient A has gall stones, they only have medicare so they get put on a list to see a specialist at the hospital, the wait is determined on the patients need for surgery. If it is determined urgent they usually have surgery within 30 days, they dont get to choose the surgeon but neither do they have any out of pocket expenses.

patient B has gall stones, they have private cover, they pay to see a surgeon and based on the funding they have and who they are with they may be re-embursed the full amount or only some of it, then they get to have the surgery as soon as they can, but as they surgeon knows they are private, they not only get charged the surgeon fee, but the fee for the anaesthetist, the cost of the room plus all other associated costs, then depending on their level of hospital cover they may only get a refund of a portion of the cost of the hospital stay, then ontop of that is the health insurance premiums which can be in excess of $1200 a year. The advantage is you get to choose your specialists and doctors.

I have never been able to understand why people would willingly choose the system that operates in the US currently, how people would happily condemn their fellow countryman suffer without being able to access decent health services, or send their family into severe financial distress just to afford health care because they dont have a job, or their job doesnt have the proper health cover because it has no health care at all. To me it is a selfish choice, its like saying, "I dont care, their problem is not my problem, I have my cover so that is all that is important". This has always made me feel sorry for the poor American people.

[J-WO]

No nation that has chosen to have a national health system has ever gone back to having none. A telling fact, I feel.
American insurance companies sense this truth, too, thus all the lobbying etc.

[drush9999]

Being English, I find the American debate fascinating, we don't even associate the NHS with socialism. In fact many NHS services are in the private sector.
It's a not perfect system however, you still have to pay for medicine, hospital car park fees and dental treatment. Also there are many treatments only available privately, including drugs for terminal illnesses. The waiting list problem seems to have diminished, but you still have to wait months to be seen by a specialist.
I personally have private health insurance through my work, which means I could jump the queue in some situations. Touch wood I stay healthy though

[The Judge]

I think the Parson's Iowan friends are right in one respect -- if something is done by the government, sure enough money is wasted. There is undoubtedly waste in the NHS; there is top-heavy bureaucracy and, among some at least, a culture of 'not my job, mate' which produces inefficiency. Consequently, I don't think that America should follow the NHS model in every particular. But a system which was built from the bottom up, as it were, concentrating on treatment and not official targets, with local responsibility and rewards for true efficiency, that surely can't be beyond the wit of intelligent people (even if we can't seem to manage it here).

There is also, again to be fair to the Parson's friends, some debate about over-usage by the 'undeserving'. How true it is, I don't know, but I have heard it said that Friday and Saturday nights in A&E (ER) depts are just one drunk after another -- there because their drunkenness has got them into bother, or they've had accidents, or they need their stomachs pumped or whatever. That extends into things like, why should we pay for an alcoholic to have a new liver, or for a grossly obese person who cannot move from his bed to receive help?

Human nature being what it is, I am sure there are those who take advantage of the system, not just the drunks but hypochondriacs and general malingerers -- if something is perceived as being free, then it isn't valued to the same extent. There have certainly been reports of medicines being claimed for months under continued free prescriptions yet which have not been taken, or presumably needed, by patients. If the A&E drunks, or the medicine non-takers, had to suffer financially in some way, then perhaps it might prevent them clogging up the hospitals/wasting the cost of the medicines. But again, I'd have thought that this is something which could be worked out on a local basis within an overall scheme.

I think there may well be a difference in attitude of staff, as well, between a nationalised hospital with a history of unionisation, and a private one. But to my mind, this says more about management failures than anything else and again should not be insuperable.

If I'm understanding the debate correctly, I believe that one of the issues for some Americans is the power of the state to determine whether or not a person lives or dies. It is true that under the NICE (National Institute for Health and Clinical Excellence) guidelines, some treatments are seen as not offering value for money and therefore health authorities will not pay eg for cancer drugs which might only extend life by a few extra months. This undoubtedly is terrible for those concerned, but I can't see that it can be avoided to some extent, nor that it isn't present in the current American system. Presumably insurance companies make decisions of that kind as well? And since there is a culture of health insurance with you -- which so far there isn't here -- people could in any event continue their policies so as to ensure they received such top-ups as might become necessary. If there is a concern about dual taxation, then some system could be introduced to give tax relief for such premiums as are paid, since use of private healthcare would relieve pressure on the main scheme.

As to Teresa's questions. Some NHS hospitals are efficient, some not. In some the standard of care is high, in some not. Again, it comes down to local management, to my mind. Apart from NICE issues which I've mentioned, as far as I know, there is no bureaucratic process between a surgeon saying an op is needed, and one taking place, though there can be a long wait for it to happen. But that's not to say ops go ahead always when they should. Unfortunately in recent years there has been a culture of target-chasing. The government has said that a person who comes into A&E must be seen within so many hours; or a person must be seen by a specialist within so many weeks. These are laudable aims, but it means that clinical decisions by doctors can be overturned - a cancer patient can't be operated on today because a non-emergency case has to be taken into surgery, otherwise his X weeks deadline will expire, the target will be breached and there will be a black mark against the hospital.

The NHS isn't perfect, by any means. Don't follow it exactly -- learn from our mistakes and make your system better.

J

[dustinzgirl]

Back on Parson and Teresa's discussion.....

How do you decide who is deserving and who is undeserving of health care?

By your statements, I would be undeserving. As would my children. Since we are considered low income right now and my extended family makes less money than I do. My dad, who fought fires and saved Yellowstone along with many other wildland firefighters would also be undeserving, because he is disabled and can not fight fires anymore and wildland firefighting is seasonal work. If we decide that anyone who can't afford it, or their families can't afford it, is undeserving.....well....thats just sad. And I'm not entirely sure that Jesus would think that was a great way to run a health care system. Pretty sure he healed people regardless of whether or not they deserved it or not. I could be wrong there.

[The Ace]

I wonder if that's the rationale behind American gun-culture, it's cheaper to shoot yourself than to pay for medical treatment.

[dustinzgirl]

We only shoot clay and bambi's daddy.

[Teresa Edgerton]

Keeping in mind, DG, that Parson was relaying the opinions of other people.

I am very carefully keeping the question of religion out of the argument, although it is straining against the back of my teeth to be let out.

Originally Posted by drush9999

The waiting list problem seems to have diminished, but you still have to wait months to be seen by a specialist.

This is true over here for those with insurance. Except that you may have to wait months while somebody in an office mulls over whether you even get to see the specialist or not, and sometimes says no.

Originally Posted by Judge

How true it is, I don't know, but I have heard it said that Friday and Saturday nights in A&E (ER) depts are just one drunk after another -- there because their drunkenness has got them into bother, or they've had accidents, or they need their stomachs pumped or whatever.

Well, for those of us who have group insurance over here, I presume that people like this make our premiums go up.

Originally Posted by Judge

I think the Parson's Iowan friends are right in one respect -- if something is done by the government, sure enough money is wasted.

The thing is, mountains of money is being wasted under the current (lack of) system. Which is another reason we need health care reform. I don't see how even the US government (which is very good at that sort of thing, admittedly) could do a better job of wasting money than the folks who are wasting it now.