Health care problems and solutions in politics

Silverback said:

I don't disagree, that being said, I don't think it will work in the United States. What drags down our numbers is the 10% uninsured, and the 30% Underinsured (high premiums, high deductibles, and high co-pays). The US does not need free healthcare, it needs affordable healthcare...nothing should be free.

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It doesn’t need to be free. Medicare is not free but it is superior to commercial/private insurance plans.

Silverback said:

I don't disagree, that being said, I don't think it will work in the United States. What drags down our numbers is the 10% uninsured, and the 30% Underinsured (high premiums, high deductibles, and high co-pays). The US does not need free healthcare, it needs affordable healthcare...nothing should be free.

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There's no such thing as 'free' healthcare. We pay for our healthcare through taxes. In our case a 10% federal Goods and Services Tax (i.e. a 10% sales tax) which covers hospitals (and education). In principle it's a massive national insurance scheme with everybody insured. Public hospitals are free. Doctors aren't free but the the government provides a standard rebate against the doctor's fee.

OB

comana said:

It doesn’t need to be free. Medicare is not free but it is superior to commercial/private insurance plans.

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Medicare Part B is not so cheap, around $150.00 per month, and if you add on Part D it's close to $170.00 per month. The other issue is the 20% of the bill you are responsible for. Some providers take what Medicare pays and that's good, others do not, so unless you are wealthy, you may need a supplement plan, and they will double what you pay each month in premiums.

Occams Barber said:

There's no such thing as 'free' healthcare. We pay for our healthcare through taxes. In our case a 10% federal Goods and Services Tax (i.e. a 10% sales tax) which covers hospitals (and education). In principle it's a massive national insurance scheme with everybody insured. Public hospitals are free. Doctors aren't free but the the government provides a standard rebate against the doctor's fee.

OB

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Occams Barber said:

There's no such thing as 'free' healthcare. We pay for our healthcare through taxes. In our case a 10% federal Goods and Services Tax (i.e. a 10% sales tax) which covers hospitals (and education). In principle it's a massive national insurance scheme with everybody insured. Public hospitals are free. Doctors aren't free but the the government provides a standard rebate against the doctor's fee.

OB

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Not going to work in the US, people will not wait 12-15 months for a new hip, or hernia repair. So the 60% of our population that are happy with their healthcare plan will want to keep it, and will not want to pay for someone else's healthcare. That was one of the problems with Obama Care, only 50% of Americans pay Federal Income Tax, so they still have to buy their insurance, then pay for someone else as well...that is bologna

Silverback said:

Medicare Part B is not so cheap, around $150.00 per month, and if you add on Part D it's close to $170.00 per month. The other issue is the 20% of the bill you are responsible for. Some providers take what Medicare pays and that's good, others do not, so unless you are wealthy, you may need a supplement plan, and they will double what you pay each month in premiums.

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I am aware of that but commercial insurance is many times more expensive with less coverage or if covered requires pre-approval that is frustrating for providers because they deny it frequently for ridiculous reasons that have to be appealed. Medicare (at least part B) requires no pre-approval. Tricare , ChampVA, and VA(especially Community Care program) are also very good but of course limited as to who can qualify.
We need something available to everyone that has very good coverage, affordable, and without the pre-approval road blocks to receiving care.

Silverback said:

Not going to work in the US, people will not wait 12-15 months for a new hip, or hernia repair. So the 60% of our population that are happy with their healthcare plan will want to keep it, and will not want to pay for someone else's healthcare. That was one of the problems with Obama Care, only 50% of Americans pay Federal Income Tax, so they still have to buy their insurance, then pay for someone else as well...that is bologna

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Based on what I see here on CF I agree that Americans will never accept universal healthcare - but based on faulty logic.

1. any insurance system, including private insurance, means you are paying for someone else's healthcare - that's how insurance works
2.In countries with national schemes the overall cost of healthcare is lower. This means that the cost per taxpayer is also lower on average.

OB

Silverback said:

These views are deeply ingrained in our culture, but cracks are starting to appear with the younger generation, and things may change at some point...maybe. However, when these young people start to hit age 30 or, so, their views start to change a bit and the thought of giving their hard earned $ to people who feel they are entitled to what they work for becomes less palatable, and research, depending on who is doing it, bears this out.

Speaking for myself, I think a single payer system would be a disaster in the US, I lived in Greece from 2001-2003, their single payer system is pretty bad, and last I read it was ranked just above Canada's system (so I will avoid getting sick in Canada at all costs)

Less choice, longer wait times, and worse outcomes would be the result in the US. Even those who get care at free clinics would hate it. Making changes to the affordable Care Act would be our best bet.

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I still am in favor of single payer (as I feel it'd be preferable to the system we have now).

However, there would be some "uniquely American" challenges with it, and I think it's a pipe dream if people think it'll go as smoothly as it has in some other places.

One aspect of it (that being the social/cultural aspect as you referenced above) would certainly play a part, as there are a large number of people who are opposed to the government taking it over.

I don't think the US would necessarily have the same issues as Canada did during their early implementation of their healthcare program, as nations that have very low population densities will always have a harder time working out the logistics of how to provide certain centralized services, and keep them reasonably cost efficient.

Especially when it comes to things that are not needed very often, but still absolutely essential/critical when they are needed.

For instance, an MRI machine isn't part of regular routine medical care in most cases, however, it is an essential piece of diagnostic equipment.

In fact, the rough estimate is that 12-15 MRI machines per 1 million people is considered to be enough to fully satisfy medical need.

So as an example, if I were overseeing a region the size of New Hampshire, that had 500,000 people living in it, it would be quite simple. Strategically place 6 or 7 MRI-capable facilities so that anyone who may need to get one can be to a facility in 25 minutes or less (if there were an emergency).

However, that would be a little trickier if dealing with a region that was 3 times that size, but with only half that population. You couldn't strategically place 3 MRI machines in that region because it's not feasible to expect a person to have to be transported 3 hours to reach an MRI machine in an emergency, so you'd have no other alternative but to essentially "over-buy" certain types of medical and diagnostic equipment on a per capita basis in order to be able to provide critical services in the event it was needed. (unless anytime someone needed one, they had to be airlifted to the nearest one, but helicopters aren't exactly cheap either)

Obviously we have certain areas in the country that are sparsely populated where we'd have to over-buy, but not nearly as many as Canada has.


I think the more challenging aspect would be actually getting people to take their own health seriously, because without that, no system is going to be cost-efficient. If there's a significant number of people engaging in behaviors and lifestyle habits that all but guarantee a higher level of healthcare utilization, it's tough to make any healthcare system run well.

ThatRobGuy said:

In fact, the rough estimate is that 12-15 MRI machines per 1 million people is considered to be enough to fully satisfy medical need.

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I have no idea where your 12-15 MRIs per mill comes from but, if it is accurate, the US appears to be hugely overserviced.

• MRI units density by country 2019 | Statista

ThatRobGuy said:

Obviously we have certain areas in the country that are sparsely populated where we'd have to over-buy, but not nearly as many as Canada has.

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If you look at the chart you'll see Canada has around 10 MRIs per million suggesting (based on your 12-15 per mill) that Canada is underbuying MRIs.

ThatRobGuy said:

I think the more challenging aspect would be actually getting people to take their own health seriously, because without that, no system is going to be cost-efficient. If there's a significant number of people engaging in behaviors and lifestyle habits that all but guarantee a higher level of healthcare utilization, it's tough to make any healthcare system run well.

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A well run health care system also includes a strong focus on preventative medicine including things like health promotion campaigns and free early detection testing. An effective health care system is far more than doctors visits and operations.

OB

Occams Barber said:

I have no idea where your 12-15 MRIs per mill comes from but, if it is accurate, the US appears to be hugely overserviced.

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We are over serviced...

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Breaking News, Analysis, Politics, Blogs, News Photos, Video, Tech Reviews - TIME.com

Too Many Unnecessary MRIs and CT Scans?

In our current healthcare system, CTs and MRIs are easy money makers so there's an incentive to purchase additional imaging equipment and order too many tests.

Occams Barber said:

If you look at the chart you'll see Canada has around 10 MRIs per million suggesting (based on your 12-15 per mill) that Canada is underbuying MRIs.

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That's likely also true,
Management of MRI Wait Lists in Canada

Canada does still currently have longer waiting lists for MRIs, with some people waiting quite a long time to get one.

Occams Barber said:

A well run health care system also includes a strong focus on preventative medicine including things like health promotion campaigns and free early detection testing. An effective health care system is far more than doctors visits and operations.

OB

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Agreed, but it's one thing to provide the preventative information, and it's another thing to get people to actually take it seriously. Getting people to change certain eating habits in the US has been an uphill battle for quite a while.