Health Care systems

[Pint0 Xtreme]

I'm curious as to the opinions of people on this board as to the different health care systems. The most noticeable comparison is the US and Canada. I know the US is far more privatized and Canadian health care is universal.

Which is more beneficial and which costs more in the long run? My opinion on this has run back and forth so I'd actually like to get some SD.net views on this.

[Cairber]

Ok, I use to think the US system was A-okay...until I was pregnant and gave birth.

First off, pregnancy is considered a preexisting condition in the US. SO! that means that women who find out they are pregnant cannot get indivdual coverage after the fact. i was in the middle moving when i found out, so my choices became 1) no coverage 2) drive back to NY and use my old insurance. HIPAA was passed not too long ago, but that only covers pregnancy under group care...thus, a girl who has moved/ doesnt have group coverage cannot get coverage if they find they are pregnant.

I gave birth in a hospital. it was a completely uncomplicated pregnancy..not even morning sickness! The birth was vaginal and natural...so they gave me no drugs at all. I had no tears of any kind, so no stitches. I stayed in the hospital for only the allowed time and took none of their pain drugs except 2 motrin. The bill: 23,345$. of course thats before insurance..but still....

Lastly, COST. We are currently paying 800 a month for our family's health care because we are waiting for my husbands benefits to kick in at work. But what about familys who dont qualify for the state aid but arent given benefits at work?? 800 is crazy!

Oh and a thing about state aid! i couldnt get coverage because of my preexisting condition with reg insurance AND THEN I couldnt get state aid cuz I hadnt lived here long enough! Then When i had lived here long enough they told me "you have to be without insurance for 3 months before we can cover you." ARRRRRRGGGGGG

[Alyrium Denryle]

I am agaist socialized healthcare, because socialized healthcare has a tendency to shift doctors from being specialized to general practicioners, as well as reduce the quality and rapidity of care considerably.

Though I do favor government assistance for those that cannot afford insurance, possibly expanding the current system.

[Darth Wong]

I am agaist socialized healthcare, because socialized healthcare has a tendency to shift doctors from being specialized to general practicioners,

Bullshit; one of the problems we have in Ontario is a shortage of GPs relative to specialists.

as well as reduce the quality and rapidity of care considerably.

Let me see the vast amount of evidence you provided for this claim ... oh wait, not a shred!

US style health-care is great if you're rich. If you're not, it's shit. Did you know that 75% of all medical expense-related personal bankruptcies in the US involve people who actually had medical insurance?

Oh wait, could that mean insurance companies are not completely honest and might rip people off? Oh no, that's impossible! The free market would never allow that, right?

Pull your head out of your ass.

[Steven Snyder]

US style health-care is great if you're rich. If you're not, it's shit. Did you know that 75% of all medical expense-related personal bankruptcies in the US involve people who actually had medical insurance?

My wife and I recently went through a bankruptcy, one of the factors was medical expenses. I make too much money to qualify for any government assistance and I don't make enough to afford decent healthcare.

At the end of this year I expect to be paying $600 per month for family medical insurance that really doesn't cover anything at all. Unless something really bad happens, I will never meet my deductable and the insurance company pays for almost nothing otherwise.

I used to think that universal healthcare was a terrible thing and the US had it right. Now that I have been through the system, my perceptions on the matter have changed.

[Dahak]

The German system is somewhere between these two extremes...
Here's a relatively compact introduction to the health care system in Germany.

[2000AD]

Despite some problems the NHS works IMO. Certainly worked when my mother needed brain surgery, my brother had some weird hereditory thing requiring surgery and i had continual acid reflux.

Sure our tax is a bit higher, but i'm more than willing to pay it so i don't have to worry being bankrupted by medical payments.

[Darth RyanKCR]

I am agaist socialized healthcare, because socialized healthcare has a tendency to shift doctors from being specialized to general practicioners,

Bullshit; one of the problems we have in Ontario is a shortage of GPs relative to specialists.

as well as reduce the quality and rapidity of care considerably.

Let me see the vast amount of evidence you provided for this claim ... oh wait, not a shred!

US style health-care is great if you're rich. If you're not, it's shit. Did you know that 75% of all medical expense-related personal bankruptcies in the US involve people who actually had medical insurance?

Oh wait, could that mean insurance companies are not completely honest and might rip people off? Oh no, that's impossible! The free market would never allow that, right?

Pull your head out of your ass.

My last open heart surgery cost me a grand total of about $250-$300 for the surgery and heart catheterization and I am no where rich. And my surgeon was the #2 guy for pediatric cardiac surgeon. I just depends on what insurance company and the kind of insurance it is.

[Boyish-Tigerlilly]

I am pro Social health care, but I read a weird story (i dont know if it's isolated) in the UK where a woman pulled out her own teeth because she couldn't find a dentist under the social healthcare system, it said. She also didn't like the quality of the doctors.

I am not sure if this is common, but the PM said they cannot help the shortage of practicioners or something.

It seemslike some people say it's really good, and some people say it's really bad. I can never get any straight answers. It's like my drug education research project where all the information is scarse and highly equivocal.

[Broomstick]

I am agaist socialized healthcare, because socialized healthcare has a tendency to shift doctors from being specialized to general practicioners,

Bullshit; one of the problems we have in Ontario is a shortage of GPs relative to specialists.

Not to mention that merely being certain type of doctor - specialist or GP - does NOT automatically guarantee good/adequate/competant medical care. What is really needed is a balance between the various sorts of doctors. Ideally, most people should go to a GP for most ailments, seeing a specialist only for, well, specialized needs. Someone who requires multiple specialists should still have a GP or equivalent to keep an eye on the overall system and check for things like more than one doc prescribing the same drug, or different docs prescribing incompatible medications. That's the ideal world - which we don't live in.

Having been poor and uninsured in the US, and well insured in the US, I have to say the latter is much, much preferable.

US style health-care is great if you're rich. If you're not, it's shit.

Correction - it's great if you're well insured. The cost of certain ailments are such that even the rich can be bankrupted in short order (unless you're a billionaire like Bill Gates)

Oh wait, could that mean insurance companies are not completely honest and might rip people off? Oh no, that's impossible! The free market would never allow that, right?

Have to agree with some of that - there are some truly skanky insurance companies out there, and the AHP's Bush & Company are trying to push would be even worse because they would be exempted from the state regs that provide what little protection consumers do have.

Free market and health care DO NOT MIX because those most in need of the "commodity" are those least able to pay. Personally, I believe there is a role for non-profit insurance companies, but the for-profit outfits give me the willies.

But don't blame it ALL on the insurance companies - the government and its ever increasing burden of regulations - such as mandating bone marrow transplants for breast cancer which, by the way, was based on data now proved fraudulent (the perpetrator is still serving jail time in South Africa), cost millions of dollars which could have been used for effective treatments for various ills, and, oh yes, killed thousands of women from treatment complications rather than their cancer - forcing companies to pay for unproven or even, in some cases, treatments KNOWN to be less effective - also shares some of the blame. And yes, massive malpractice awards and those companies who have increased malpractice premiums to the point that even doctors with six-digit incomes can't afford to pay their insurance premiums. And doctors who refuse to update their practices as new evidence comes to light. The administrative bloat required by needing office staffs to deal with a bazilliion different insurance companies, all with different requirements and needs. Employers who buy cheap-ass insurance then tell their employees it's the insurer's fault when really it's the employers decisions limiting their doctor choices. Fraud. Doctors who insist on treatments proven to cause harm in populations not meeting strict criteria - among the examples are lung volume reduction surgery for emphysema (only helps 1/4 at best), epoetin therapy for patients not suffering from anemia or who have blood cancers, and a half dozen others I could name. These are very expensive treatments that are being prescribed for patients inappropriate to receive them. Defensive medicine - the vast majority of sprained ankles do NOT need an MRI! But that's become standard somehow. There's a whole bunch of happy horseshit going on in the US's broken down health system that just won't be fixed until one of two things happen:

1) Congress winds up with the same shit choices as the rest of us (don't hold your breath - Congress get a VERY nice package)

2) The average US citizen is no longer able to obtain health insurance at all.

Despite the fact it would probably mean I have to get a different job, I almost welcome the day the whole house of cards comes crashing down and people FINALLY have to face the fucking facts and do something[ to fix the problem. Anyone who thinks the US has the best health care system in the world clearly hasn't had to use it in the last 15 years (at least) and is full of shit. The system IS broken, it's just that parts haven't started falling off the chassis yet.

Yes, technologically we may be in the lead, but that does jackshit for you if you don't have access to it. But, to be honest, the US has had very little innovation in the past decade, which is why the research unit I work for has been working with Canadians and Europeans on various projects these last few years rather than with other Americans. The greed has taken over - the pharmaceutical companies are churning out "me-too" drugs, often for non-lifethreatening conditions ("lifestyle drugs") and outrageous prices, rather than coming up with truly novel treatments - like a better flu vaccine or a new, more effective antibiotic. Medical device manufacturers will buy tech that might potentially threaten their market dominance and, rather than develop it, SHELVE it - an economic, not a medical decision.

The "bottom line" in health care should be HEALTH, not money. But that's NOT the way it is in the US today.

[Wicked Pilot]

The government provides for me free health and dental coverage and so far it's been great. I don't see why everyone else couldn't get the same if we were willing to roll up our sleeves and make it work.

[Thinkmarble]

The "bottom line" in health care should be HEALTH, not money. But that's NOT the way it is in the US today.

A very loaded statement.
Our ressources are finite, so we have to decide in which way to apply them to get the best result for everyone.
This can mean that we forego the best healthcare possible.

[Broomstick]

Thinkmarble, don't presume that by putting health as the first goal you're opening up the piggy bank. That's not what I said.

Fine, limited resources - what's the way to maximize the results, rather than how do we squeeze the pennies out of the system. Making flu vaccine available and affordable (even free) not only maximizes health, it's cheaper over the course the year because you have fewer flu-related hospitalizations and deaths. But even if it wasn't cheaper, it is STILL within our means and resources to do this. The annual US flu vaccine shortage is because there's no profit in flu vaccine... an economic decision. If we put health first we'd pony up the bucks, fewer people would get, those that did get sick wouldn't get as sick, and there you go.

That's just one example

And there are very expensive medical procedures that shouldn't be done, most particularly with end-of-life care. These things shouldn't be done NOT because of costs but because they're bad medicine

Another example is nursing shortages. There's a range of nurse-to-patient ratios that yield the best patient outcomes.... but in the name of cost-cutting there are hospitals that try to hold the ratio lower. Again, an economic and not a medical decision. Our society DOES have the resources to hire adequate numbers of nurses, but does not, putting short term profit over the lives and health of patients. That's the sort of bullshit I'm talking about.

[Prozac the Robert]

I am pro Social health care, but I read a weird story (i dont know if it's isolated) in the UK where a woman pulled out her own teeth because she couldn't find a dentist under the social healthcare system, it said. She also didn't like the quality of the doctors.

I am not sure if this is common, but the PM said they cannot help the shortage of practicioners or something.

It seemslike some people say it's really good, and some people say it's really bad. I can never get any straight answers. It's like my drug education research project where all the information is scarse and highly equivocal.

I haven't looked at that story, but I can tell you that we do have a bit of a shortage of NHS dentists. This doesn't mean that you can't get your teeth looked at, but that you might have to pay if you can't sign on with an NHS dentist.

Labour are doing something to increase numbers, but I don't think they've made it an especially high priority.

Many dentists still find it far more profitable to become private once they've done a few years with the NHS. This is a bit silly, since if NHS nubers were a bit higher, people wouldn't be forced to go private, and going private wouldn't be a sensible option for nearly so many dentists.

Compare with the rest of the NHS, where a very small fraction of people go private, and although you might have to wait a while (hours maybe for some accident&emergency type stuff, months for some sorts of operations), no-one is told that they cannot be seen.

Actually, I'd be quite interested to know how long you have to wait for treatment in the US. Can anyone tell me?

[PainRack]

Question: Should the government stop focusing on the "consumer" and instead focus on cutting the costs of the "supplier"?

Its just an uninformed opinion, but if the subisdy for healthcare is given to the hospitals instead of the people, some of the cons of both private and socialised healthcare seems to be degraded.

For one, the argument that consumption will increase and bankrupt the nation will not be as valid as before, because in this case, what the government is doing is helping keep healthcare costs cheap, as opposed to subsisdising your healthcare. For another, the argument that people can't afford healthcare will then not be as valid as before, because healthcare is cheaper.

The main objection I read about this, without going into statistics and real anaylsis was that such funding may turn out to be an ever-growing albatross, along the lines of fuel and agricultural subsisdies.

[Broomstick]

Actually, I'd be quite interested to know how long you have to wait for treatment in the US. Can anyone tell me?

As a general rule, waiting for healthcare in the US is a matter of hours or perhaps a few days. As a general rule.

If you're in an accident and severely hurt the system will try to get you to the hospital in under ten minutes and you'll receive treatment before they even look to see if you're insured (if you're not insured though, you've probably just gone bankrupt). Ditto for emergency medical conditions - heart attack, continual vomiting+fever+plus other serious symptoms, etc.

If you show up in an emergency room with a non-emergency you will eventually be seen... but the wait might be as long as 16 hours (that's the longest I've heard of)

Routine care - dental cleaning, check up, etc - might be a few days to, in some cases, a few weeks (I had to wait two weeks for a pap smear appointment once). But, really, that sort of routine thing doesn't require immediate service.

Obtaining x-rays/MRI's/CAT scans/etc. ranges from immediate (hospital emergency care) to a couple days if it's something where you can make an appointment at an "imaging center" and go in for your time slot. Rural areas might involve transportation to an "imaging center", which could further delay obtaining these items.

Certain other things, however, may result in a long, long wait. Organ transplants, for example, can involve very long waits because we have to wait for someone able to donate to come along. No amount of money is going to change the current system (although a medical breakthrough might help here and there). Certain new techniques may have limited docs able to do them - when my mother needed coronary artery bypass in 1978 the number of surgical teams performing this surgery in the US was so limited that she was put on a six-month waiting list (she actually only waited four months - a bunch of people ahead of her died before they got the surgery). Today, though, if it's determined you need bypass surgery you're usually wheeled in the OR within 24 hours.

The problem isn't getting emergency care - although paying for such care can certainly be a problem. The problem is someone uninsured (or whose insurance doesn't cover the item) who would be better off with surgery/drug/procedure/whatever but can't pay for it... in which case they usually don't get it until they can somehow raise the funds.

In other words, what most commonly limits care in the US is not the capacity of the medical care systme, but the inability of the patient to pay for care.

[Broomstick]

Question: Should the government stop focusing on the "consumer" and instead focus on cutting the costs of the "supplier"?

Part of the problem is that people don't know who the hell the "consumer" is in these situations.

Health care "consumers", in the sense of the people who actually pay for the insurance that pays for most of the bills, are NOT Joe and Jane Average. MOST Americans do not choose their insurance. Most insured Americans are insured by the policy purchased by their employer, and it is this employer who is the one in control of the choices.

If health insurance was something purchased by the average citizen, who actually made the choices involved, the situation would look very, very different. (Admittedly, it may not be better, but it sure would be different)

So berating the average person to make "better choices" is bullshit because the average person doesn't have a choice. You get what your employer gives you. By the way - employers are NOT OBLIGATED to offer ANY form of insurance. So if your employer doesn't offer health insurance you are fucked. If you aren't employed you're fucked. Because most people can't afford to buy an individual policy and keep the payments up long-term, even if they're healthy and qualify for the lowest premiums. If there is the least little thing wrong with you the costs skyrocket.

[Darth Wong]

On principle, if you have a fixed amount of medical service to provide for the public, you can enhance the quality of care available to individual members of the public by denying it to others. If you make it available to everyone, then you cannot possibly offer the same level of care to those receiving it as you would if you cut off part of the population.

Americans love to point out that those with the Golden Privilege of health-care in the US tend to get better-quality care than those in a typical universal healthcare system. They misrepresent this as a healthcare system that offers better-quality care in general, totally ignoring the fact that for those who are not so privileged, it offers no care at all.

Ultimately, their attitude stems from the fact that they don't give a shit about the underprivileged. It's the result of an appalling lack of sympathy for other human beings.

[RedImperator]

Ultimately, their attitude stems from the fact that they don't give a shit about the underprivileged. It's the result of an appalling lack of sympathy for other human beings.

I don't think most of them even realize how bad the situation actually is for the uninsured. If you're not paying attention and you have good insurance through your job, it's possible to go through life without realizing at all how much health care actually costs.

[Edi]

Comparisons between the US, Canadian and other systems are real eye-openers when you start playing a numbers game.

Health care expenditure per capita, ranking:
United States, #1
Germany, #7
France, #8
Canada, #14
Finland, #16

Top 25

You can get all sorts of interesting statistics from there, and the US health care system gets clobbered at every turn despite spending significantly more than a lot of other first world countries.

Additionally, if what I've heard is true, the US system only covers 60% of the population, because 20% of the population under 65 is uninsured and everyone over 65 (another 20% of pop) is automatically excluded. So at 60% efficiency the US system spends more than twice as much as the Canadian system at 100% efficiency, and over two and a half times as much as the Finnish system at 100% efficiency.

Never mind that those figures are from 1999, and afaik the situation has gotten worse since then.

Edi

[Stark]

Holy SHIT - here in AU, even with universal health care, private cover only costs between one and two thousand... A YEAR. It's trivial - everyone should have it. Americans pay that much A MONTH? FUCK.

[HemlockGrey]

While I do think the American health care system is absurdly broken and I would support a Canada-esque system, America has around 294 million people. Canada has 32 million, Australia has 20 million. That may affect the costs somewhat.

[Stark]

The highest income tax is something ridiculous like 47% here - that'd bring on a revolution in the US

[Uraniun235]

The highest income tax is something ridiculous like 47% here - that'd bring on a revolution in the US

Depends on how it was applied to the tax brackets. As long as most of the electorate saw a minimal change, we'd probably chug along just fine, with a bit of extra bitching from Rush Limbaugh.

But then, the tax scheme in the US has been fucked over for the past couple of decades anyway. The burden of taxation has shifted severely from the corporations and the rich to the middle and lower classes.

[xtashinatorx]

Healthcare costs are crap. My insurance covers so little for me because of all the crap I had to go through with my cancer. The total bill at the end rang up somewhere in the 500k zone. I have to take my dad's company insurance because we can't afford a seperate one. Because of that I get limited dental, eye, and general coverage. The copay for an ERoom visit is $75 up front, before they even do anything, and there is no prescription plan, despite the fact I'm still taking hormone medications. I did get a lot of help from various charities, and that contributed a lot, but I'm still stuck with shitty glasses, and paying over $300 a month in prescriptions.