Debating Health Care (Long OP)

[Prannon]

Ok, long post is long, and it's largely covering issues that are being addressed in many threads in N&P right now, so if the mod feels that this thread is redundant then I welcome a lock. That said, I've gone through and highlighted a few key points in case you don't feel like reading absolutely everything typed out here.

I recently wrote a very long argument against private health care as it exists in the US and for some form of public health care, and I posted it on facebook. I mostly argued using knowledge that I've gleaned through my lurkings of this board and some personal experience, and I try to use logic to support my argument rather than constant references to evidence. It's kind of a concise combination of many opinions that I've read from here, as well as my analysis and understanding. My parents - who are staunch conservatives and W supporters to the end - have taken me to task, and I was wondering if anyone had any thoughts on my argument and on their responses.

Alright, let's talk about health care for a little bit. Disclaimer: I don't fully understand the Health Care industry, so what follows is only my limited understanding and may be subject to mistakes.

The United States has a private system of health care from the insurance to the doctors to the medicinal manufacturers and so on. Usually this health care is provided through your employer. For example, let's say that I'm hired by Jiffy Lube. Jiffy Lube offers me a health care package with their preferred insurance provider, and whenever I get sick I can take this insurance with me to the doctor's office or the hospital and get taken care of. This insurance, depending on the package, can provide for doctor's fees, prescriptions, treatments, and so on. Of course, the employee is responsible for paying a certain percentage of this insurance while the employer covers the rest, and this is often called a "Premium."

Private health care ensures a certain level of quality through competition and rewards. Insurance providers try to provide products of high quality to their customers so that they will remain with them. Doctors are highly trained professionals to ensure high quality of care (and prevent malpractice lawsuits). Pharmaceutical companies try to produce good, quality medicines.

All of this makes private health care sound like a healthy, functioning system. In some ways it is, since it generally provides superior quality care...but in many more ways it is a fundamentally flawed system.

Intrinsic to private health care is the need to compete. This means that there are many competing doctors, hospitals, pharmaceuticals, and insurance companies. Even within insurance companies there are competing health care programs to provide potential customers with choices between plans. This is attractive in any private system, but all of this competing increases the level of redundancy. What that means is that there are many insurance companies doing the same thing when they don't have to. This does increase the options for the customer, but it also increases the waste. Consider that each insurance company has to employ large bureaucracies to operate, and their employees have to be paid. This is often called an "overhead" or an "operating" cost. What could be a relatively low overhead cost for one task is now multiplied by the fact that many companies perform that one task. The same can be said for all the other players in health care, including doctors, hospitals, and pharmaceuticals.

So we come to one general principle of private healthcare. More entities exist to compete and provide choice. If more entities perform a task that could easily be performed by one entity, then overhead costs - and the cost of health care - are increased.

Also intrinsic to private health care - or any private endevour - is the need to profit. In order to be successful you have to have a certain profit margin to invest in expansion and maintain confidence in your firm. What this can mean sometimes is that an extra percentage is tacked onto your fee to ensure that profit margins are met. This translates to a higher cost for insurance coverage, a higher cost for pharmaceuticals, and a higher fee for doctor visits among other things. Now, this isn't necessarily a bad thing since many aspects of American society operate on a profit motive and society obviously isn't collapsing. However, there are a few monkey wrenches thrown into the machinery. There are malpractice lawsuits, which cost great sums of money for doctors who lose. Even the risk of lawsuits carries a cost for there is malpractice insurance for doctors to help offset the cost of losing. My brother once explained to me that this leads many private practitioners to increase their prices since malpractice insurers routinely increase theirs. There is also just plain greed, where poorly regulated enterprises charge a great deal more than necessary to ensure an exhorbitant profit margin. Certainly this is not true in all cases, but I think it's fair to say in light of the recent financial crisis - which was caused in large part by short sighted greed in some of the most vital parts of the economy - that such an element does exist, even in health care.

So we come to a second principle of private health care. If entities must make a profit, then an additional fee will be tacked onto the original fee and the overall cost for health care is increased still further. A corollary to this principle is that profits are subject to liability and greed, which increase costs further since liabilities must be offset and greed must be satisfied with even higher prices.

Using the string of logic from the first and second principles, it's fair to say that private health care tends to cost more than government owned health care. Well, that's alright so long as the quality of health care is greater, right? Indeed, private health care ensures a quality motive. However, there is an additional caveat to private health care that must be considered. Health care is a service industry, and like any service industry the providers of the service can deny said service to those who can't pay for it. For example, let's say that you walk into a What-a-burger and order a #1 cheeseburger, but when you dig into your wallet you find you don't have enough money. What-a-burger is going to tell you to get lost. Same thing in health care. Furthermore, health care providers (insurance companies in particular) will often assess your future liability to them. How much will you cost if they provide you with insurance? Again, there is a profit motive and a liability factor, and if it is determined that you will cost too much and create too much of a liability on the company then their services to you will be denied.

To illustrate this, imagine someone with a chronic illness such as heart disease or something like that. He applies to an insurance provider. Whenever the insurance company assesses this person for liability they conclude that he will cost the company a great deal of money in the future since he will need regular treatments and drugs to combat the illness. To ensure the profit margin, they increase the applicant's premium. Automatically, because this person is theoretically more in need of health care than the average person, the cost he bears is increased. Convenience is reduced. If this person is wealthy, then the additional cost is no big deal, but what if the person is poorer? This doesn't necessarily mean dirt poor or in-poverty poor (although such people certainly do exist). What about middle class earners? The per capita income of the US is around $40000 last I checked, and although this is relatively high it is not considered a truly middle class income. That honestly doesn't provide much breathing room to cover additional costs when housing, utilities, and luxuries are taken into account. If you don't have the money at all then you don't get the service, and you have to live with your illness and the increased chances of mortality as a result.

So we come to a third principle of private health care that is based on the second. This is the principle of deniability. If at any point a person cannot afford the service or is deemed too great a liability on the profit margin, then services are denied to said person.

Thus, there are three principles intrinsic to private health care. Redundancy, Profit and Liability, and Deniability. The first two increase costs, while the third denies the service to those who cannot afford it. This can hardly be considered a good mix. I've experienced some of these in person as a college student. I had to go to the doctor twice while I was at university, both times with insurance that the doctor's office wouldn't take. Since my insurance was a hassle to work with and would have cost too much time and money for them, I had to pay out of pocket. Again, the profit motive and deniability principle at work. Also very inconvenient for me.

The first time I had an extremely debilitating case of flu. I could barely sleep, and I couldn't attend my classes. It cost me $128 to see the doctor (visit and lab test fees), and then another $40 or so for the prescriptions. The other time I had a very bad heart burn that was keeping me awake at night and had persisted for several weeks. It cost me about $60 to see a nurse, and then maybe about $20 for over the counter antacids. Had I been unable to pay, I would not have been able to have access to health care for these simple, but agonizing, problems. Even though I was able to pay for these services, it was almost more cost effective to just suffer through an illness and convalesce naturally, all while exposing contageons to others and generally wasting time and energy. It doesn't take much of a stretch in logic to assume that most Americans would rather take this route than go to the doctor. Imagine what it might be like for those with even more serious conditions and not enough money to pay for care.

The US health care system fails to provide services to a significant portion of the population, and is extremely inconvenient for most of the rest. From what I remember, about 16% of Americans are unable to receive any sort of health care at all because they are uninsured and cannot afford to pay out of pocket. If you think that health care is a privilege rather than a right, then this may not seem like a big deal. However this is a significant failing because one must also consider health risks to the general population and the costs that businesses, families, and individuals bear when people get sick or injured. Naturally, if someone gets sick, then they are a health risk to the rest of the population. If someone is badly injured, they either cannot work or their work is impaired, which costs their families and their businesses great deals of time and money. So, in private health care even greater costs are foisted on individuals and companies in the form of lost time, and this on top of the additional costs created by redundancy, profit, and greed. For example, if we look at the US auto manufacturers and their recent troubles, a lot of it has stemmed from having to pay skyrocketing health care costs for their employees.

There are still more flaws in a private system. Because health care has grown so expensive, employees are reluctant to switch jobs if their current health care package is good. This isn't a problem for people who enjoy their jobs, but what if the person wants to advance to a new career, or what if a person hates their current job but absolutely needs the health benefits it provides? Having already seen the consequences of deniability, it would be disastrous to switch jobs if the benefits are poorer. Thus, many employees are immobilized by the private health care system, which goes against the very essence of "The American Dream." Opportunities to advance in life are lost.

The system of broken, and a solution is needed. What should replace it? Obviously, something that does not suffer from too much redundancy and waste, an overbearing profit motive, or the principle of deniability. The easiest answer to point to is government provided health care, which if done right would centralize health care provision and reduce waste, would eliminate the profit motive entirely reducing costs further, and would be unable to deny services to anyone since governments exist to service their populations. In fact, governments historically exist to provide order in society, and good health is part of that order. With government provided health care, the average person would no longer have to worry about carrying the costs of their care straight from their wallet, increasing convenience and putting minds at ease. Poorer people would at the very least have access to health care where they did not have access before. Although the quality motive would be lessened, in general there would be electoral pressure to ensure that the system functions well enough to provide the care that people need.

There are questions however. Aren't governments intrinsically wasteful? Wouldn't public health care create less of an incentive to work since it technically rewards poorer people with care even if they don't work as hard? What about wages for doctors? Wouldn't they flee to another place where their wages would be higher, thus reducing quality by leaving only substandard doctors behind? Wouldn't the government have to raise taxes to fund all of this?

I don't have the knowledge to address all of these questions adequately, but I can address a few. While it is true that governments are big and bulky bureaucratic empires, it is not necessarily true that they are wasteful in providing health care. Currently, the US spends approximately 15% of its GDP on providing a flawed health care system, while countries such as France, Canada, and Germany spend closer to 10-11% on a universal, government provided system that everyone has access to. When talking about whole countries, especially one as wealthy as the US, 4-5% is a very, VERY big difference. On unearned rewards, the key concern of health care is that everyone has access to it to reduce the costs that society bears, and this includes individuals as well as corporations. Also, just because someone receives health care for free does not mean that they will suddenly work less hard; indeed, I would continue to work just as hard as before and more so, since I am a generally healthier employee. Addressing taxes, it is very true that the government would have to increase taxes to offset the costs. However, anyone who understands the US budget and the mountainous US debt should understand that the current US tax paradigm is unsustainable. Taxes will have to be raised eventually. Considering that public health care would entirely remove those costs out of the private sector, more revenue would be available for taxation, so perhaps the additional tax burden would not be more than was bearable.

Ultimately, it is clear that the current system is broken and ought to be replaced. I have argued for a government provided health care system because it is the easiest way to eliminate the flawed principles inherent in a private system. If this does not convince you then I do not hold anything against you, but I do hope that you are less ignorant of the problems and issues than you were before.

Mother responds:

in a perfect world, government health care might be the answer. but our governmental system is just as broken or more so than healthcare. tell me one thing the government runs well and efficiently. i think most of your Canadian cousins would tell you that Canada's healthcare system sucks!i think there are very long waits for almost everything. i think at present, it is illegal to turn away anyone coming in for emergency care. so those of us who do pay insurance premiums have to cover this cost as well. i agree that something needs to be done, but not by the government. there have been things written already that would deny certain people, especially the elderly any treatment and necessary meds if the government deemed it too costly to provide such things to those they consider "unproductive" and old.

I respond back:

"tell me one thing the government runs well and efficiently."

Don't try to corner me with this mother. You know better since I've extensively studied government in college. I'm gonna come across as combative here, but your statement isn't grounded in facts more than it is in blind Reaganism.

1) The roads. The government runs, funds, maintains, and builds our roads. I drove them every day, and one conclusion I came to was that our roads were very easy and well built. Not in every case, so obviously there was some waste and inefficiency, but they were still there. Moreover, even if there is waste and inefficiency here, it would be impossible for a private company to do all of these things. Even if one could, it would charge me and everyone else for using it.

2) Waste management. Again, the government funds waste management, and it's universal. Everyone gets it. And again, it's not going to be perfect because we obviously see trash in places we wish we didn't. But I challenge you to tell me that a private company could do it better on its own. What if I couldn't pay for it, espcially if I was poor and lived in a poor part of town? That part would smell to high heaven in no time.

I could go on with that one point you tried to make, but it is clear to me that you take many services from your government for granted if you say that everything is run poorly. So what if it is? The government has to do it because no private company can be entrusted with that service, and I would argue that is true also for health care.

"i think most of your Canadian cousins would tell you that Canada's healthcare system sucks"

And most of my Canadian cousins are from Alberta, which is a conservative province if there was one. I've also heard Canadians praise their health care system for being less expensive and for providing some kind of care to all of their citizens, not just the ones who can afford it.

"i think there are very long waits for almost everything"

If I had a choice between a long wait or not being able to get the service because I couldn't pay for it, then I'd choose the long wait. The issue here is not whether the wait is long or not, but accessibility. The US health care system fails because it is very difficult to access, even for those with insurance as you may well remember when you tried to help me with my doctors visits.

"it is illegal to turn away anyone coming in for emergency care"

Yes. I could have gone to the ER for my flu if I needed to. I would've waited for hours too. The insured receive priority. Then again, I didn't need to go to the ER for the flu. I needed to see the doctor, which could have been easy if it were free.

" there have been things written already that would deny certain people, especially the elderly any treatment and necessary meds if the government deemed it too costly to provide such things to those they consider "unproductive" and old."

This sounds more like theory than actual truth. Do you have any evidence to back this up? An article? Don't tell me that it's something well known or that you just heard about it or that I should just trust you. That's not evidence.

She responds then:

our federal govenment is not run efficiently, from the postal service, which has never run at a profit, to the IRS, and military..to name a few. they can't even run a cafeteria cost effectively, as one either in the Senate or House was very badly managed! and i am not just talking one side or the other...i am speaking of the whole, whatever party is in power at any given moment.

1. the roads...many are maintained by each state, not the federal government. the funds needed for this are taken from the inspection sticker and registration sticker fees that we pay. private contractors bid on the jobs of big projects. you see their signs at every major renovation of the roadways...giving names and addresses. we do have a state highway dept. that does smaller ongoing maintainance and repair. you are definitely charged for using said roads by the fees i just mentioned and any of the tollways you choose to take.certain roads are also maintained by the county or city. you can tell who is doing a good job spending the tax dollars that come in for that by the condition of the roads. some are good and some are horrid...the horrid ones show a lack of good city or county government management.
2. i don't know what state or neighborhood has waste management funded by the government. whenever we have lived in Houston, our waste management has been paid for thru homeowners association dues and/or our water bill. it has never been expensive and as far as i know...has always been privately owned and operated.
3. your Canadian cousins do not all live in Alberta...we have many in BC as well as some in Toronto. many of them are extremely liberal in their views.
4."If I had a choice between a long wait or not being able to get the service because I couldn't pay for it, then I'd choose the long wait. The issue here is not whether the wait is long or not, but accessibility."
"Yes. I could have gone to the ER for my flu if I needed to. I would've waited for hours too. The insured receive priority. Then again, I didn't need to go to the ER for the flu. I needed to see the doctor, which could have been easy if it were free."
under government healthcare, you still might not have been seen with the flu. it may have been considered not critical. a long wait is a long wait, son, whether you choose to go to the emergency room for the flu or have to wait a long time at some government run clinic.
5. when you get to be our age, you too may tire of others who won't work or are in this country illegally benefitting from all your hard work. i have just recently had a friend whose son was very critically ill. he had to go to the emergency room, with no insurance and a life threatening health situation. he had just started a new job, thus no insurance coverage as yet and a brand new baby to boot! i was more than happy to think that any insurance premiums or tax dollars we might have paid could have gone toward his very expensive treatment. Health care costs for some are indeed deducted from our paycheck for Medicare and Medicade.
6. i have sent you a link to an article concerning some of the government restrictions on treatment. i will look for more. but i do know that Tom Daschle said specific things about treatment and meds for the elderly. i read the quotes..i just need to find them.

I respond again:

"the roads...many are maintained by each state"

...which is a government. It doesn't have to be the Federal Government to be the government. That it is the state government that largely maintains and funds the road system does not change the fact that it is the realm of government, and not private companies, to do this. Even if the government contracts private companies to do the work for them, that does not change where the money comes from. In that case, it is the government's responsibility to pay for it, and if it is funded through registration and inspection tags, then I am happy to pay those taxes so I can have nice roads. Even then, US Highways and Interstate highways are paid for mostly by the federal government (Interstates favoring the Feds by 90%). That money is allocated to state governments, which then do as we have already discussed. Finally, since it is the government that does this, roads are public, meaning anyone can use them since we all technically pay for them through our taxes.

"i don't know what state or neighborhood has waste management funded by the government."

I did a little research, and I couldn't find any evidence supporting what I said. Some municipalities handle their own waste, I concede that point, since I had hastily assumed that waste management was handled by the government.

"your Canadian cousins do not all live in Alberta...we have many in BC as well as some in Toronto. many of them are extremely liberal in their views. "

I am hoping and planning to go visit a friend in Edmonton in July, provided that plane tickets aren't sold out. I just might get the chance to visit with them. I'd also be curious to know their points of view on their health care system specifically.

"under government healthcare, you still might not have been seen with the flu. it may have been considered not critical. a long wait is a long wait, son, whether you choose to go to the emergency room for the flu or have to wait a long time at some government run clinic."

You caught my contradiction, but I need to clarify what I meant. If someone needs surgery and could have gotten it immediately in a private system, but was unable to because they couldn't pay for it, they are certainly a little better in a public system where they have access to that surgery even if there is a long wait. I'll make the assumption that they're not pining for the American system so much as they are trying to figure out how to improve their own public system. Again, my point is that having access to health care is more important than being able to get it immediately, particularly if it is something that can wait. For me, if I really had to, I could take my flu home and convalesce, although I'm a little surprised that you would say that the government might not deem it important. It does stockpile flu vaccines after all, and we did have a recent swine flu scare. Flu is a big deal.

Also, I didn't get the link to the article you mentioned. Did you forget to post it in there?

"when you get to be our age, you too may tire of others who won't work or are in this country illegally benefitting from all your hard work."

And more than likely I'll meet only a very few of these people who suck off of my teat and never make an honest living. Perhaps you've met many in your lifetime. However, I think you're taking a very large group and painting them all one color unjustly. Remember, there are approximately 15-16% of Americans without health insurance for at least part of the year. That comes to about 45 million people. That's certainly a larger number than the current unemployment rate, so there's a goodly portion of these people who work, and they probably work hard so that they can make ends meet. Many are probably down on their luck or in transition or trying to get out of a rut, kind of like your friend. Certainly there are those who choose not to work and just leech off of society, but likely not all or even most. So to say that you don't support government provided health care because you grow tired of people benefiting off of your contributions without having earned it kind of sounds like stereotypical prejudice to me.

Ultimately I have to make this point, and it's one that you seem to have missed. Government has certain responsibilities that cannot be adequately performed privately: roads, monetary policy, military and other forms of defense, etc. Even if a private entity could perform these responsibilities, they would suffer from the profit/liability motive and the deniability factor, plus it would increase inconvenience for the average citizen. Thus, those responsibilities are better placed in the hands of the government, even if their only fingerprints are on the money used to pay for them. Health care ought to be one of those responsibilities for the reasons I mentioned in my original note, because even if government performed health care inefficiently, it would perform it better than our purely private one would.

I haven't received the article that she mentioned yet.

My father also took me to task, saying:

what happens with the thousands of insurance workers who no longer have jobs because in your quest to reduce competition you destroy maybe half the insurance companies in the USA. Draconian measures for the good often have side effects that are bad. The cure can be worse than the disease.

I responded:

You once told me about coal miners in the UK who were obsolete, yet the government was obligated to help them stay employed so as to avoid increasing unemployment and avoid a political backlash. Yet now your first argument against my position is that the government should not take steps to create a public system (to reduce the waste of so many bureaucracies) because it would risk the jobs of what would become an obsolete industry? Do you not also think that a new public health care insurance provider would need employees and that they could fill in the gap?

Furthermore, a man can lose his job and find a new one. A chronically or terminally sick/injured man generally doesn't have the option of a second chance without some kind of health care. Your initial argument doesn't really move me yet.

I'll see what my father says eventually, and most of what either of them have said has been the typical anti-government, long waits, substandard care mantras that I've become familiar with over the years at home and here on the board. However, one argument caught my eye and has left me with a blank. My mother argues that government health care can deny services to people arbitrarily if their case isn't important, if they are too old, or if they are unproductive. I know nothing of this, and it honestly sounds like some sort of right wing "government is eeeevil" rumor that's been floating around. Does anyone have anything I can look at that addresses this objectively and satisfactorily? Also, does anyone have any criticisms of my original argument or anything I can add to it to make it stronger? Thanks in advance!

[Darth Wong]

I hate the way these people lie about Canadian health-care. Yes, we have conservatives here who rant about health care and want it changed to an American-style system, and true to form, they tend to massively exaggerate its problems in order to make their point. But if the majority of Canadians are so unhappy about their health-care, why was Stephen Harper forced to promise that he would not gut socialized health care in favour of an American-style system in order to get elected?

The conservatives are simply lying. The vast majority of Canadians are not just happy with our health care system, we are terrified of it ever becoming like the American system. You can't judge Canadians' feelings by what you read on message boards or hear reported by FOXNews' cherry-picked interviews. The general election showed what we actually think. Even our CONSERVATIVE party had to pledge not to weaken socialized medicine.

As for the long wait lists, she's simply full of shit. Some people do go on long waiting lists for various reasons, but most people don't. And I will compare the ratio of people here who go on long waiting lists to the people in the US who have no coverage at all, anyday.

[Darth Wong]

i think most of your Canadian cousins would tell you that Canada's healthcare system sucks!i think there are very long waits for almost everything.

Pure and outright lie. She's a goddamned liar who states completely unfounded water-cooler nonsense as if she's actually bothered to research it.

To be honest, I suspect that most of the people who are posting on message boards claiming to be Canadians unhappy with our health care system are either American trolls or Canadian ideologues who have never actually NEEDED health care. The things they say are so massively different from the things people say here on the street, in social settings, newspaper feedback, or even talk radio.

[Prannon]

Yes, we have conservatives here who rant about health care and want it changed to an American-style system, and true to form, they tend to massively exaggerate its problems in order to make their point. But if the majority of Canadians are so unhappy about their health-care, why was Stephen Harper forced to promise that he would not gut socialized health care in favour of an American-style system in order to get elected?

The conservatives are simply lying. The vast majority of Canadians are not just happy with our health care system, we are terrified of it ever becoming like the American system. You can't judge Canadians' feelings by what you read on message boards or hear reported by FOXNews' cherry-picked interviews. The general election showed what we actually think. Even our CONSERVATIVE party had to pledge not to weaken socialized medicine.

As for the long wait lists, she's simply full of shit. Some people do go on long waiting lists for various reasons, but most people don't. And I will compare the ratio of people here who go on long waiting lists to the people in the US who have no coverage at all, anyday.

This is reassuring. I'll do some research to see what the poll numbers were exactly and get some quotes.

Something is still egging at me though. My father responded again this morning with:

Besides under national health care the terminally ill will be cost effectively(sp) terminated and the chronically ill will be denied treatment deemed to expensive then they will become terminally ill. NO JOKE

This is essentially what my mother was saying, and while I'm still convinced that it's just fear mongering of some sort that they must have picked up from somewhere, I haven't heard anything about it on this board. Any thoughts? My mother did send me the article that she mentioned, but it was from the Heritage Foundation. I'll try to read it later and post it here if anyone is interested.

[Stark]

Are you honestly bothering to investigate a baseless claim that universal health care = execute terminal patients?

[Darth Wong]

Stark is right; you should demand their evidence. They're making completely absurd claims without a shred of evidence. There would have to be 5 MILLION people in Canada on long waiting lists to create a situation as proportionally dire as the US has with its massive uninsured population. Instead, all they find is the occasional anecdote, as if millions of those can't be found in the US.

And the bit about dropping patients to save money: what does he think every for-profit health provider in the US has a direct incentive to do? In the US, it's not just a possibility: it's a reality. Health insurers deny claims in order to save money and increase their profits.

PS. Here's a medical irony for you: my wife's uncle-in-law lived in the US. He completely bought into all of the conservative bullshit about Canadian waiting lists (nobody's a bigger expert on Canadian waiting lists than Americans who have never had direct experience with one). Whenever he came to visit in Canada, he would rant about our terrible health care system with its mythical waiting lists. A while ago he suffered a heart attack and went to hospital ... where he was made to sit in the waiting room. He died while waiting for somebody to come look at him. Ironic for someone who continually lambasted Canadian "wait lists", no?

Of course, nobody would blame that on the US system. If that happens in Canada, it's because of socialized medicine. If it happens in the US, it's "blame the victim" time. He should have said something more urgent, he should have had better insurance, blah blah blah.

[Prannon]

Are you honestly bothering to investigate a baseless claim that universal health care = execute terminal patients?

Given that this belief is entrenched in my conservative parents, and that I like to have specific knowledge blasting it out of the water, yes. I am. They're telling me this as though it were the truth, and the unquestioned truth at that.

Now, I already know that private entities routinely deny services to patients because of the profit motive, but they're essentially telling me that national health care is no better because they'll deny services for practical reasons. It makes sense to them, but it doesn't make sense to me. I'm sure that Canadian health services don't look at a sick old person and say "oh...you're old. Sorry, no time for you!" There'd be people in the streets over that.

[Darth Wong]

You can't prove a negative. You're going to have to force your parents to back up their claims.

And yes, there would be massive political repercussions over any such behaviour. That's one of the nice things about socialized medicine: the people actually get a say in it. Mistreatment becomes a direct political issue. In America, mistreatment by private insurers gets ignored in politics because politicians have no direct control over that anyway, and the vaunted consumer market is worthless for forcing change because it is extremely difficult to switch insurers. Most middle-class people get health insurance through their employers: no choice. Others are "locked in" because any health issues they may have developed since last signing up would be considered a "pre-existing condition" by a new insurer. This means they have almost no real incentive to care if individual customers are unhappy. They are far more interested in their shareholders' opinions than in their customers' opinions, most of whom are "locked in".

How much of a say do you have in the operations of your health insurance conglomerate? How much do you think they care about public opinion? Most people hate them already; why should they care if they add one more? And American politicians get to foist off responsibility for bad practices upon individual health insurers, rather than taking any responsibility for bad health coverage themselves.

[Twoyboy]

Besides under national health care the terminally ill will be cost effectively(sp) terminated and the chronically ill will be denied treatment deemed to expensive then they will become terminally ill. NO JOKE

This is essentially what my mother was saying, and while I'm still convinced that it's just fear mongering of some sort that they must have picked up from somewhere, I haven't heard anything about it on this board. Any thoughts? My mother did send me the article that she mentioned, but it was from the Heritage Foundation. I'll try to read it later and post it here if anyone is interested.

Here in Australia we have nationalised health care... and people all over the country are fighting the government for the right to die. Far from terminating the too old and too sick, they go to great lengths to keep everyone alive, whether they want to be or not, forcing people to protest for the right to euthanasia.

And here in Australia we have long wait lists... for elective procedures. Anything life threatening or which puts someone out of work is considered urgent and dealt with straight away. You need to make it clear that the public health system works on triage, unlike our, and I'm guess the United States', private health system. You can't compare the elective surgery wait list in other countries to the overall US wait list.

[Rahvin]

Here's another personal anecdote.

A person very close to me has HIV. In California, she is unable to get coverage from private companies. No waiting list, no red tape, no bureaucratic inefficiencies, simply no coverage and an eventual death sentence. The only way for her to be covered is to either 1) get a job with excellent drug coverage (the antiviral cocktail is expensive) or 2) rely on government programs.

This quite flatly disproves your parents' silly notion that terminally or chronically ill patients will receive reduced care due to their cost-ineffectiveness, while simultaneously illustrating one of the largest failures of the US "healthcare" system.

If she loses her job, she loses her prescriptions.

Until recently, she was young enough to be covered as a student on her mother's health insurance. This still required supplemental insurance on the order of hundreds of dollars per month in order to keep her well-covered - in addition to her co-payments for regular checkups, frequent liver/kidney/blood testing (antiviral medications aren't exactly good for you), and the drugs themselves (which alone are close to $100 per month with insurance).

People who aren't sick literally have no basis for comparison when evaluating the US healthcare system. I'm not sick - the healthcare system works jsut fine for me, because I never need it to do anything. But the moment you are sick, the moment you become cost-inefficient for the private, profit-driven company that provides your coverage, they'll do anything they can to drop you or deny coverage.

The most ridiculous aspect of anti-universal-healthcare idiots is that they're projecting the failures of private healthcare (namely life-threatening wait times, denial of coverage, etc) onto public healthcare.

Frankly, your parents simply don't understand the most basic fact about public/private healthcare.

A private insurer's incentive is to make more money. This is done by accepting premium payments from as many people as possible while giving out the absolute minimum amount of care.

The incentive of a public healthcare system is to ensure the health of the population. Money is a concern only inasmuch as the program will have a finite amount of funding - but that's no different from private providers. Public healthcare is not concerned with making money, or restricting care, but rather with making sure that the population is as healthy as possible, and making the frequent, preventative appointments so accessible that they can work to prevent catastrophic, debilitating (and more costly) complications later.

The bare fact is that the US currently pays far more per capita for healthcare than any other first-world nation, while receiving the worst results.

From here:

* The Taiwanese health care system is recognized as one of the best - it allows choice, easy access, and only costs about 8 percent of GNP.
* The United States health care system is recognized as one of the worst - 48 million are uninsured, 25 million are underinsured, and health care expenditures are high at 16 percent of GNP.
* Prescription drug prices in the USA are about 30 percent higher than they are in Canada or Europe.

We're paying a whole lot more and actually receiving a whole lot less.

According to the WHO (sorry, this is from a user-generated table on their website, no direct link and no copy-pasting, I simply went .[MBD].Members]here and selected Canada, the US, and the UK for comparison):

In 2006, the adult mortality rate per 1000 individuals (adult classified as a person between 15 and 60):

Canada: 72
UK: 80
US: 109

The age-standardized mortality rate for non-communicable diseases (2002 data):

Canada: 388
UK: 434
US: 460

Yeah, private healthcare is doing wonders for us. Those "socialized" countries have it much worse.

We get to pay 16% of our GNP for healthcare that is < 80% as effective as the UK/Canadian versions (according to adult mortality rates) that pay 7.7%/10.7% of their GNP, respectively.

Anyone who can look at those statistics and say that the US system is superior, that "socialized medicine" is bad, is mentally deficient.

[mr friendly guy]

I don't think those conservatives understand the difference between palliative care and euthanasia. For the record we palliate patients because they are dying despite best treatments / don't want further treatment etc and palliation minimises suffering. Even in countries where euthanasia is legal, its done with patient's consent (they don't even need to be in hospital at that stage) because the patient wishes and not to save the health system money.

[Surlethe]

A couple of thoughts. First, one reason health care costs in the US are so high is because doctors, who get paid on a per-procedure basis, have an incentive to recommend patients receive care they don't need. They don't have an incentive to minimize costs, they have an incentive to push them up.

Second, you don't need to accept any bullshit ab initio arguments about the free market "efficiently distributing" health care. That is a complete and total falsehood. Any argument about the free market reaching efficient distribution makes the assumption that the amount people will pay is proportional to the amount they want a good. In the case of health care, that assumption is simply not true.

Others are "locked in" because any health issues they may have developed since last signing up would be considered a "pre-existing condition" by a new insurer.

Let me finish with an anecdote of my own speaking directly to this. A good friend of ours - my wife's maid of honor, in fact - was born with her belly not fully formed (bladder exstrophy). She required major reconstructive surgery and still needs surgery every couple of years; in fact, last summer, she had a surgery to pin her uterus to her spine because it was falling out of her vagina.

The only way her family can afford this is because she is currently covered on her parent's plan. When she is old enough to be on her own, there is no way any private insurer would cover her. This is a potentially life-threatening condition, and she will ultimately be forced into bankruptcy unless she moves to a civilized country. Which, coincidentally, is part of her life plan.

[Mayabird]

A huge part of the high costs is the expensive end-of-life care that many people receive, often unwillingly. I've seen a number thrown about that 50% of terminally ill patients with DNR orders have them ignored, extending their lives (and greatly increasing the costs) against their wills. Unfortunately my Google-fu today is weak and I've been unable to find definite statistics on it. Some of the problem seems to be the patchwork of laws on what is allowed and not allowed on DNR orders and how they're interpreted.

[Prannon]

Sorry to necro the thread, but the debate has continued in the mean time and my dad has thrown some new shit at me. I thought I had him checkmated with life expectancy and infant mortality figures from the CIA World Factbook showing that countries with public health care have better results. However, he wrote me this email:

Your Aunt nearly died in Great Yarmouth because they would not treat her blood poisoning until her condition was critical. Until she was critical they would not move her ahead of any patients already in line. [I know how to proceed on this point. For every waiting list horror story, there are probably 10 denied healthcare claim horror stories, plus he doesn't say that she never received treatment, which is far worse than being made to wait.]

As for the stats you have to ask a few questions. How were they calculated did they include all deaths or just natural deaths. For instance the US has a disporpotionate rate of deaths related to traffic compared to most other nations in the world. Partly because we do not haave the public systems suh as the UK and Europe.He defeats his own point. You should no that from you trip to Germany. Also, the US is the Drug related death capital of the world. The vast majority of drug related deaths are pretty young people. How do they do the numbers are they statistical formulae? Are they all done the same? I am surprised that you missed one very important evaluation. What was the life expectancy over time? We know that the average life span has been increasing over the last 150 years in most countries - not all - So you should evaluate the just before, say, ten years and the ten years just after the nationalization of health care. So you have some homework to do before those numbers begin to mean anything to me. Good start though....

It's a little infuriating, because he really sees me as only a child in this debate, whose arguments are easily swatted away like so many mosquitos. One of his previous points was that I was merely an unexperienced and unwise child and that one day I WOULD SEE THE LIGHT because I'M DAD and I'M WISE!!!

Anyway, I was wondering if anyone else felt like he was proving anything, and if anyone could point me in the right direction on life expectancy statistics for Western Europe since they nationalized health care.

[Samuel]

How were they calculated did they include all deaths or just natural deaths. For instance the US has a disporpotionate rate of deaths related to traffic compared to most other nations in the world. Partly because we do not haave the public systems suh as the UK and Europe.

All deaths. Of course, this has nothing to do with infant mortality.

You should no that from you trip to Germany.

Germany has the autoban

Also, the US is the Drug related death capital of the world. The vast majority of drug related deaths are pretty young people.

Proof that drug us is worse in the US than any other country?

How do they do the numbers are they statistical formulae? Are they all done the same?

Yes. LE is the average age people die and infant mortality is the death rate under a certain age per number of infants.

What was the life expectancy over time? We know that the average life span has been increasing over the last 150 years in most countries - not all - So you should evaluate the just before, say, ten years and the ten years just after the nationalization of health care.

If only there was a country we could do that for... a nation were the change was entirely due to the nationalization of health care...



I need to find a reputable source, but they give 58.8 years before the revolution and 78 years now.

[The Jester]

I know that this might be a strange request, but does anybody know where I might be able to find healthcare statistics for minorities in France?

I know there has been claims of this in the past, but does anybody have a link on infant mortality in US ghettos?

[Vendetta]

As for the long wait lists, she's simply full of shit. Some people do go on long waiting lists for various reasons, but most people don't. And I will compare the ratio of people here who go on long waiting lists to the people in the US who have no coverage at all, anyday.

Wait times in Canada are quite long, though the US isn't exactly the world leader in wait times for primary care (though it does well on specialist care). Population demographics, especially geographical distribution, are part of the reason for Canada's long wait periods though.



However, Canada has nowhere near the incidence of denial of care that the US has.



Easy to keep waiting lists down when you turn away 51% of patients because they can't afford treatment.

[Samuel]

So we want the German health care system?

[Darth Wong]

So we want the German health care system?

Germany's advantage is extremely simple: in addition to a relatively concentrated population thanks to their small geographic size, they have a much higher number of doctors per capita than Canada or the US. Doctors in Canada and the US are paid more than they are in Europe, which may help explain part of the discrepancy. It's obviously easier to hire more doctors when you pay them less.

[Serafina]

German doctors are regulary demonstrating for higher payment, going as far as declining non-critical treatment (e.g: annual checkups).
Our system is far from perfect, and there are some problems with having not enough doctors for some areas.
Specifically, there is a lack of general practicioners in remote areas. But then again, do you even HAVE those in the U.S?
In Germany, you generally see your "Hausartz" (~ general practitioner) if you feel sick (unless you know exactly what problem you have - say, a broken leg). He will do the overall diagnostic and treatment and, if necessary, send you to a specialist. Around 1/3 of german doctors are general practitioners. You normally have one in every town above ~1000 inhabitants, and they are quite imporatant for the medical system.
Does it work similary in the US?

s for the stats you have to ask a few questions. How were they calculated did they include all deaths or just natural deaths. For instance the US has a disporpotionate rate of deaths related to traffic compared to most other nations in the world. Partly because we do not haave the public systems suh as the UK and Europe.He defeats his own point. You should no that from you trip to Germany. Also, the US is the Drug related death capital of the world. The vast majority of drug related deaths are pretty young people. How do they do the numbers are they statistical formulae? Are they all done the same? I am surprised that you missed one very important evaluation. What was the life expectancy over time? We know that the average life span has been increasing over the last 150 years in most countries - not all - So you should evaluate the just before, say, ten years and the ten years just after the nationalization of health care. So you have some homework to do before those numbers begin to mean anything to me. Good start though....

You can not take those numbers for most countries - Germany had nationalised health care since the end of WW2 - as long as it exists in its current form. Besides, what are those comparsions good for?
While he is right that various factors influence statistics when you compare various countries, the same is true if you compare it over a long period of time.

Besides, drug related deaths are a medical problem. You can prevent them with good healthcare.

In general, this seems horribly hipocritical to me - he is asking YOU for evidence to back up your arguments (which is fine), but he is providing no evidence on his own.


I would focus on the following:
Someone who is in regular need of medical care has NO CHANCE at all to get a decent private insurance (unless there are govermental regulations) - what is he going to do?

This is easily solved with public insurance. Take me as an example: I am transsexual, which means that i will cost my insurance a shitload of money (up to ~700.000$). No sane private insurance would give me an insurance, unless they are forced to do so or i lied to them. And yet, i HAVE an health care insurance - i signed the treaty two weaks ago.
While transsexuality is not life-threathening, not getting an insurance could easily prove fatal.

Its the same for chronically ill people. Unless they are rich, they have no chance for decent care with private insurance.
Which means they are going to die, just because theys are poor.
And even if they ar not going to die immedeatly, they suffer - either because of their illness, or because other problems are not going to be treated.

[Prannon]

Sorry to necro again, but I'm running into a new claim by a friend who works in Korea like me. He says that he did a lot of research into health care for his thesis back in college and that he compared countries across the OECD area. His specific argument is that anyone in the US who has a pressing need can simply go to the ER to get treatment, and that the ER can't turn them away. Specifically his words were:

"Whereas in the states he probably wouldn't have been able to see a doctor and afford any treatment to begin with, what with copays and fees"

Simply untrue. You can go to almost any emergency room in the US and get affordable service, higher quality service, and timelier service. Why do you think the illegal Mexicans do it? Check your facts.

Can anyone give me some comments on this? Does ER service really fill in for UHC like he says it can?

[The Spartan]

So... if I walked into an ER because I was in agonizing pain and they came back and said that it was because I had cancer, they'd spend a year or more treating me gratis if I didn't have insurance?

Get my shovel!

[Samuel]

“Because Cuba, a country under blockade, has a higher life expectancy than the US and lower infant mortality. As does the rest of the civilized world.”

It’s already been explained that “Quality of medical care does not — by itself — determine life expectancy. For example, deaths from accidents and murders are much higher in America than in other developed countries. Texas A&M health economist Robert Ohsfeldt and health economics consultant John Schneider calculated that if accidental deaths and homicides during the ’80s and ’90s were removed from the calculations, life expectancy in America would have ranked at the top of all developed countries.

As for infant mortality, a 2007 study by economists June and David O’Neill found that low birth weight drastically increases an infant’s chance of dying. They compared U.S. infant mortality (6.8 per 1,000 births) with Canada’s (5.3). Teen mothers are far more likely to have low-weight babies, and America’s teen motherhood rate is three times higher than Canada’s. They determined that if Canada had America’s low-weight birth distribution, Canada’s infant mortality rate would rise from 5.3 to 7.06. If America had Canada’s low-weight birth distribution, our infant mortality rate would fall from 6.8 to 5.4.”

Anyone have a rebuttal?

[Prannon]

So... if I walked into an ER because I was in agonizing pain and they came back and said that it was because I had cancer, they'd spend a year or more treating me gratis if I didn't have insurance?

Get my shovel!

I'm asking if they're gonna keep serving you if you don't pay and you keep coming, again and again and again. I had a friend whose mother had to go to the ER or clinics or somesuch regularly without insurance and no way to pay. I recall that she was eventually told not to come back again. It's an anecdote, but it puts me in doubt of his statement.

The argument he and I have had is actually really long. He argues that UHC won't work in the US because it's too different from other countries. He implies that it's too big, has too many people, can't pay for it, has an eroding economy, and culturally it isn't acceptable because it's SOCIALISM and comparable to Russia, China, Venezeula, Cuba, and he lists Poland for some reason. He believes that the better solution is to reign in insurance companies through strict regulations and serious oversight. He also derides me as being ignorant and not understanding how the political system works, and implies that I didn't learn a thing at college.

I'm arguing that even though quality of care is lower in places like Canada and the UK, it's more accessible. I'm also arguing that Korean Public Health Care is better because it's more accessible, even if it's comparitively lousy (he cites a friend of his who has an injured hand, who's been to several doctors, and can't get it fixed). I've cited Life Expectancy figures from the CIA World Factbook, polls from this article, and the article from Bill Moyer's interview with Wendell Potter.

I still believe that UHC is the better option to solving this whole mess. Heavily regulating the insurance industry is almost the same as creating a public option anyway, based on my limited understanding of how this stuff works. His argument that the uninsured can just go to the ER for treatment made me trip up though. I argued that one can't get specialized treatment at the ER. He dismissed that saying that virtually no GP offers specialized treatment. In hindsight, that wasn't really a rebuttal. You need insurance to see a specialist for things like cancer.

[Dillon]

It’s already been explained that “Quality of medical care does not — by itself — determine life expectancy. For example, deaths from accidents and murders are much higher in America than in other developed countries. Texas A&M health economist Robert Ohsfeldt and health economics consultant John Schneider calculated that if accidental deaths and homicides during the ’80s and ’90s were removed from the calculations, life expectancy in America would have ranked at the top of all developed countries.

He assumes that many of these accidental deaths aren't a result of poorer health care availability. Perhaps many of them wouldn't have been deaths and only injuries if more Americans had access to better health care. Also, does he have a source for that last claim?

As for infant mortality, a 2007 study by economists June and David O’Neill found that low birth weight drastically increases an infant’s chance of dying. They compared U.S. infant mortality (6.8 per 1,000 births) with Canada’s (5.3). Teen mothers are far more likely to have low-weight babies, and America’s teen motherhood rate is three times higher than Canada’s. They determined that if Canada had America’s low-weight birth distribution, Canada’s infant mortality rate would rise from 5.3 to 7.06. If America had Canada’s low-weight birth distribution, our infant mortality rate would fall from 6.8 to 5.4.”

Ask him how he addresses America's higher Under Five Mortality Rate.

Additionally, keep in mind that Canada isn't the only nation with UHC which does better in these statistics than America does. There's the UK, Singapore, New Zealand, Germany, etc...

And again, does he have a source for all these studies he cites?