Universal HealthCare Discussion

[Magnus_the_Red]

Didn't see a thread on this, so I figured to kick one off.

Pretty much interested in hearing why you believe it is/is not a good idea.

If it weren't for the insurgency of the Tea Party, I would just be fine to label myself as a libertarian, but the word has been bastardized (I wonder if that will get past the filters) so I've stuck with "Social Minarchist" for the time being.

Health Care is actually where I branch off from the libertarian archetype. It is one of the few cases where it has been demonstrated that the market is incapable of delivering in an effective way. America pays more and gets less for it's health care compared to most other first world nations.

I little platitude came to me in a dream which started me seriously mulling over this topic. It went something like "The Bill of Rights is useless to a corpse."

I interpreted my subconscious' Aesop fable to mean that the amount of freedom gained by saving a life is greater than the amount of freedom lost by an increase in tax.

 

[jayem]

My favorite subject. I work in health care, so I deal with this every day.

The real issue isn't universal health care. What we lack is a rational system of universal health insurance. And there are 3 problems that must be addressed:

1) Our biggest structural flaw is the linkage between health insurance and employment. 60% of Americans are covered through employer-provided group health plans. That's fine as long as one is employed, but the policy belongs to the employer, not to the employee. People lose coverage if they're laid off, or change jobs, or go on strike. In the first 3 months of 2009, when the full-force of the recession hit, over a million people lost their health coverage. That's crazy. Your health insurance should belong to you. Just like your homeowner's and car insurance. Not to mention this is an enormous burden for American business, and puts us at a competitive disadvantage with foreign companies operating in places with national health plans. We talk about tax cuts and job growth, but that's a flyspeck. The single best thing we can do to stimulate business growth and job creation is to remove the need for American employers to be insurance providers.

2) Adverse underwriting by carriers. This ties in with #1. Employer based group plans must insure all employees. Enrollees can't be denied coverage due to health status (though waiting periods may apply.) And premiums are based on the entire group risk, and can't be raised for any one individual. But for someone who loses his group coverage, he may face terrible problems getting insurance, especially if he, or a family member has pre-existing illness. After his 18 months of COBRA, his premium can be completely unaffordable. State laws differ, but in general, carriers are allowed to be much more restrictive in covering individuals, than in covering an employee group. Only about 9% of Americans have coverage in the individual market. Again, it's kinda crazy that companies can refuse to sell their product to those consumers who need it the most. This must change.

3) Cost. Several factors are at work here. The largest is technology. Unlike most other industries, advancing health care technology raises cost, rather than lowering it. Example: 75 years ago, if you had kidney failure, you'd be put on a low sodium, low protein diet. Not much else could be done. Very simple and cheap, but you'd probably die of uremia in 6 months. Now you can get a transplant ($50K or so) or go on dialysis ($60-70K a year.) You can have years more of productive life, but at a huge cost. The other big cost factor is our expectations. Americans want technologically advanced care, and we tend to be high utilizers. We also look to insurance to cover most all of our health needs, rather than reserving it for catastrophic health expenses. We like low deductibles, which further remove us from the actual cost of care. Finally, we have great resistance to price controls on health care, which are used in some countries to lower costs. And we're even more resistant to "utilization managment," a euphemism for rationing by medical need, which is used to some degree in other places. Shifting the costs of care for the uninsured onto those with insurance is also a factor. As is medical liability costs. But I think these are lesser factors than technolgy and expectations.

There is also a philosophic problem. Some people do not see universal health insurance as a necessity of modern life, or even as socially desireable. It's opposed even when it can be shown that universal coverage can be achieved in the private sector, without a huge tax-funded government bureaucracy. But health coverage is as much a necessity as police and fire protection. Lack of universal health insurance hurts the quality of life for everyone. There is a non-governmental solution. But that's for later. This post is long enough.

 

[Steve Petersen]

How would universal health care reduce the separation between users and the payer?

 

[QuestionAsker]

How would universal health care reduce the separation between users and the payer?

I was wondering that as well...

Anyway, if certain states want to have a public option for health insurance, I'm fine with it. I'm adamantly against the federal government providing a national one, however, if only because we are simply too populous and diverse of a country to insure everybody properly.
Note that people in England use the NHS more than 2,150 times each on average, and our population is roughly 6x that of England according to Wikipedia. If a public option is offered, most people are going to eventually use it instead of a private option since competing with the government in an expensive field like health care would be extremely difficult. The federal government doesn't need to add even more to its debt, not to mention that I'd argue it's unconstitutional to force states to accept a federal plan according to the 10th amendment.

 

[grasping the after wind]

Didn't see a thread on this, so I figured to kick one off.

Pretty much interested in hearing why you believe it is/is not a good idea.

If it weren't for the insurgency of the Tea Party, I would just be fine to label myself as a libertarian, but the word has been bastardized (I wonder if that will get past the filters) so I've stuck with "Social Minarchist" for the time being.

Health Care is actually where I branch off from the libertarian archetype. It is one of the few cases where it has been demonstrated that the market is incapable of delivering in an effective way. America pays more and gets less for it's health care compared to most other first world nations.

I little platitude came to me in a dream which started me seriously mulling over this topic. It went something like "The Bill of Rights is useless to a corpse."

I interpreted my subconscious' Aesop fable to mean that the amount of freedom gained by saving a life is greater than the amount of freedom lost by an increase in tax.

America pays more for and gets less for its Educational system than most other first world nations and that is funded in the way you think we should do health care. Perhaps you might wish to re think this and come up with something that might have a chance to actually improve things?

 

[Magnus_the_Red]

How would universal health care reduce the separation between users and the payer?

The user IS the payer, through taxation. Everyone pays for everyone's health.

Givers of care send an invoice to the feds/state. They get compensated for their costs of business.

 

[Magnus_the_Red]

America pays more for and gets less for its Educational system than most other first world nations and that is funded in the way you think we should do health care. Perhaps you might wish to re think this and come up with something that might have a chance to actually improve things?

There is not correlation between education and health. You're making an assertion that there is one. Prove that their is, and this criticism may be valid.

Education is a little more nuanced than medicine, and I can't conceive of why you wouldn't agree.

 

[oldbetang]

Didn't see a thread on this, so I figured to kick one off.

Pretty much interested in hearing why you believe it is/is not a good idea.

If it weren't for the insurgency of the Tea Party, I would just be fine to label myself as a libertarian, but the word has been bastardized (I wonder if that will get past the filters) so I've stuck with "Social Minarchist" for the time being.

Health Care is actually where I branch off from the libertarian archetype. It is one of the few cases where it has been demonstrated that the market is incapable of delivering in an effective way. America pays more and gets less for it's health care compared to most other first world nations.

I little platitude came to me in a dream which started me seriously mulling over this topic. It went something like "The Bill of Rights is useless to a corpse."

I interpreted my subconscious' Aesop fable to mean that the amount of freedom gained by saving a life is greater than the amount of freedom lost by an increase in tax.

I'm curious as to what you have against the Tea party. Is it just that they are opposed to Universal healthcare or it it something else?

 

[[serious]]

1. Since emergency rooms must provide care regardless of ability to pay, we have universal healthcare
2. If we have universal healthcare, the focus should be on increasing the equitable contribution to the cost of it and delivering it in the most efficient way
3. Emergency care is the most expensive way of providing health care
4. Allowing earlier intervention and preventative care for those who have no ability to pay will decrease healthcare spending on that population.
5. Allowing earlier interventions will improve outcomes for those populations
6. decreased costs of providing care to populations who cannot pay will increase the equity of costs

Hence, universal care will:
reduce the separation between users and the payer
improve outcomes
reduce overall costs

everyone gets what they want.

 

[Magnus_the_Red]

I'm curious as to what you have against the Tea party. Is it just that they are opposed to Universal healthcare or it it something else?

They didn't exist under the 8 years post-Bush when he was destroying the constitution with stuff like the Patriot Act.

They are more or less Neo-Cons. I dislike Neo-Cons.

The birth certificate thing. YES,Clinton started it as a campaign tactic, but these guys have been on about it ever since. No other President has been given this much trouble over it, and I honestly have to question the root reason behind it.

They have a lot of social conservatives. Unlike social conservatives, I like personal freedom.

I have issues with a few points in the "contract from america"

I can elaborate in more detail, if you want. These are just the ones off the top of my head.

1. Since emergency rooms must provide care regardless of ability to pay, we have universal healthcare
2. If we have universal healthcare, the focus should be on increasing the equitable contribution to the cost of it and deli...

Indeed.

 

[QuakerPete]

1. Since emergency rooms must provide care regardless of ability to pay, we have universal healthcare
2. If we have universal healthcare, the focus should be on increasing the equitable contribution to the cost of it and delivering it in the most efficient way
3. Emergency care is the most expensive way of providing health care
4. Allowing earlier intervention and preventative care for those who have no ability to pay will decrease healthcare spending on that population.
5. Allowing earlier interventions will improve outcomes for those populations
6. decreased costs of providing care to populations who cannot pay will increase the equity of costs

Hence, universal care will:
reduce the separation between users and the payer
improve outcomes
reduce overall costs

everyone gets what they want.

You have access to universal emergency healthcare. Does that cover every eventuality or what are the exceptions?

 

[oldbetang]

They didn't exist under the 8 years post-Bush when he was destroying the constitution with stuff like the Patriot Act.

So, you hated them before they even existed?

They are more or less Neo-Cons. I dislike Neo-Cons.

Please explain what you mean. In what way are they neo-cons? Give some examples.

The birth certificate thing. YES,Clinton started it as a campaign tactic, but these guys have been on about it ever since. No other President has been given this much trouble over it, and I honestly have to question the root reason behind it.

The birth certificate thing is not a Tea Party thing.

They have a lot of social conservatives. Unlike social conservatives, I like personal freedom.

In my experience, social conservatives are for a great deal more personal freedom than social liberals are. It's not the social conservatives who would have the government tell you who to associate with and what services that you have to provide, and to who you have to provide them to. It's not the social conservatives who would have the government seize your guns. It's not the social conservatives who support government sponsored discrimination (affirmative action). It's not the social conservatives who are pushing to have sexual deviancy pushed on school kids as being normal and healthy, with no allowance for any opposing view. Just a few that come to mind.

I have issues with a few points in the "contract from america"

And that is a deal breaker for you? What are the points that you have issues with?

 

[Magnus_the_Red]

You have access to universal emergency healthcare. Does that cover every eventuality or what are the exceptions?

You got one step into his argument and stopped, apparently.

So, you hated them before they even existed?

Their timing is poor. They only seem to have an issue with the constitution being sodomized when it's a democrat doing it. Bush started it, and Obama is continuing it.

Please explain what you mean. In what way are they neo-cons? Give some examples.

Their economics are strongly Pro-Corpatist. iirc, they have a strong support of Isreal. They are simultaneously isolationist and for the two wars. The Arizona immigration means the fourth amendment doesn't apply to brown people.

The birth certificate thing is not a Tea Party thing.

I'm not even going to touch this.

In my experience, social conservatives are for a great deal more personal freedom than social liberals are. It's not the social conservatives who would have the government tell you who to associate with and what services that you have to provide, and to who you have to provide them to. It's not the social conservatives who would have the government seize your guns. It's not the social conservatives who support government sponsored discrimination (affirmative action). It's not the social conservatives who are pushing to have sexual deviancy pushed on school kids as being normal and healthy, with no allowance for any opposing view. Just a few that come to mind.

Social conservatives want to control what people can ingest. The FCC's censorship was mandated by conservatives, not liberals. They wish to deny the same tax breaks to homosexuals as they do heterosexuals. They justify violations of privacy in the name of fighting terrorism.

Affirmative Action and banning guns is foolish.

And that is a deal breaker for you? What are the points that you have issues with?

The energy policy, cap and trade and the health care stance.

It's a combination of this and other things.

Honestly, on the whole I just find the Tea Party to be republicans with a different name tag.

 

[QuakerPete]

You got one step into his argument and stopped, apparently

You're right, I did start and then realised I didn't really know what was meant by universal emergency cover and so then posed the question immediately.

I'm genuinely interested to know what is covered - ok, I can see car accidents, stabbings and shootings and the like being treated, but what about those suffering from the various cancers? Is there a specific list of treatments the emergency centres will or won't treat?

 

[thaumaturgy]

If the healthcare debate actually had anything to do with $$$ you could summarize it easily:

The conservatives don't really care about the "economic sensibility" of our healthcare system.

Why do I say that? Well, Americans pay the most per capita for healthcare and yet do not get the best results overall. We pay almost 2 times what our nearest "competitor" nation pays per capita for healthcare yet we don't have the longest lifespans and we don't have the lowest infant mortality rate of developed nations.

What kind of economic sense does that make?

(SOURCE)

In the New England Journal of Medicine we are reminded that in 2006 while we paid more than any of the developed nations in per capita healthcare costs we ranked 39th for infant mortality, 43nd in adult female mortality and 42nd in adult male mortality.(SOURCE)

So I'm quite curious why social medical systems (not necessarily "socialize medicine" but more like "single payer") are considered so horrifying to some Americans.

Because the economic argument is DOA. Must be something else. I suspect it is "fear". Fear of losing your freedom. Everyone in the U.S. thinks they'll be rich and can buy whatever they need. But most aren't going to be rich and in fact they are far, far more likely to be forced into bankruptcy by one or two really bad health crises.

So maybe that's why we have the debate.

 

[lordbt]

^Why dont you try a valid comparison rather than the phony one you just put forth? Compare the results of things for which medical care is directly responsible, like cancer survival rates. Life expectancy has too many other variables to put it all on quality of care or cost.

 

[QuestionAsker]

^Why dont you try a valid comparison rather than the phony one you just put forth? Compare the results of things for which medical care is directly responsible, like cancer survival rates. Life expectancy has too many other variables to put it all on quality of care or cost.

That is an excellent point; I'd never really thought of it that way.

 

[[serious]]

^Why dont you try a valid comparison rather than the phony one you just put forth? Compare the results of things for which medical care is directly responsible, like cancer survival rates. Life expectancy has too many other variables to put it all on quality of care or cost.

Cancer is hard to normalize across cultures due to a variety of factors such as environment, different types of cancers, etc. I will say that cancer is one of those things we do pretty well, largely due to an aggressive screening program catching them early. Many european countries If you want a treatment outcome comparison, I'd do something more universal like femur fractures, strokes, and hernia repair surgeries. Now, I have absolutely no idea what the data would show for that, so it isn't me picking things to support my own view.

 

[QuestionAsker]

Cancer is hard to normalize across cultures due to a variety of factors such as environment, different types of cancers, etc.

As is life expectancy, though.

I will say that cancer is one of those things we do pretty well, largely due to an aggressive screening program catching them early.

I agree; especially recently, we've really emphasized "better safe than sorry" with screenings.

Many european countries If you want a treatment outcome comparison, I'd do something more universal like femur fractures, strokes, and hernia repair surgeries. Now, I have absolutely no idea what the data would show for that, so it isn't me picking things to support my own view.

That's a good idea. The only thing that might be skewed is that, obviously, the Western World (especially North America and the UK) has such dangerously high obesity rates, contributing to strokes and heart attacks.

 

[thaumaturgy]

^Why dont you try a valid comparison rather than the phony one you just put forth?

Phony? So you are telling me that the way many groups compare healthcare outcomes that don't make the US SHINE are ipso facto "phony"?

I highly suggest you take that up with the big phonies at the New England Journal of Medicine.

You guys are a hoot!

Compare the results of things for which medical care is directly responsible, like cancer survival rates. Life expectancy has too many other variables to put it all on quality of care or cost.

What about female and male adult mortality? That seems like a good indicator?

I guess if you fish around enough you can find an attribute in which we don't do badly. We do do well with cancer survival rates. Among the top.

But interestingly enough the life expectancy at 65 years of age in the U.S. is actually better than many probably because of MEDICARE. How's that fo irony? It sucks to be an infant in the U.S. you don't have the best shot at survival, but if you make it to 65 and get medicare you have a good shot at a longer life!

Look, I understand you will never yield that someone else somewhere in the world could get anythign as right as the U.S. SO I understand that no amount of data will ever convince you so long as there is one or two data points that confirm your bias. (Even the U.S. medicare system has advantages which disconfirm the bias against social medicine! The military Tri-Care system is one of the most beloved programs! All these social programs in your own beloved country! How could such creeping communism infect your beloved free market utopia? Just as a shot: ask a military person to give up tri-care because you don't like social medical systems. As grandma to give up medicare and then pay for her medical bills yourself...or let her do it! Fun, fun fun!)

And again, in my travels around the world I've seen some of these places in Europe and I do NOT see people in misery.

The U.S. system would have to be better on just about every single metric to justify why we pay so much more than any other developed nation per capita for healthcare.

Not just one or two or finding a few points where we don't rank 39th or 37th.

If I sold you a car that occasionally ran really, really well, but cost you twice as much as a car that usually ran really really well would you accept that as a bargain?

Apparently all our so-called fiscal conservatives would. Which makes me think that you have totally redefined "conservative".