Why don't Americans have universal healthcare?

Jeremy · Post by **Jeremy** » 19 Jun 2007 03:54

HighDemonslayer wrote:Universal healthcare wouldnt really be universal.

You would, no doubt, be required to abide by a list of government-approved lifestyle habits to qualify for coverage.

-n

Australia has "universal healthcare," what list of government-approved lifestyle habits do people need to qualify for coverage? My impression is that all you need is ID, to prove you are who you say you are, and I might be wrong that you even need that (since I've never tried to deal with medical issues without it).

Colin · Post by **Colin** » 19 Jun 2007 07:21

habitat wrote:One time I got cellulitis and I went to a clinic. I told them I was homeless and they fixed me for free. And gave me antibiotics.

GO USA!!

The lie has set you free!

Frank_Sinatra · Post by **Frank_Sinatra** » 19 Jun 2007 09:49

Overly cerebral answer to the question - because health care policy in the US has historically focused on cost at the expense of access. The HMO came about in the 70s, as a means of controlling costs by giving insurance companies greater control over who and what get treated, and to what extent. Read Agendas, Alternatives, and Public Policies by John W. Kingdon for more information.

On a side note, in response to an earlier comment, you already have to abide by a list of approved lifestyle habits to receive treatment in some cases. Whether this demand comes from the government or from a private corporation doesn't make much of a difference to the person trying to get treatment.

Universal healthcare would mean higher taxes, and that's why health care policy is going to continue on the wrong track. It seems likely that we're going to keep passing new 'reforms' that only address individual parts of the overall system - adding layers of bureaucracy, inefficiency, paperwork to guarantee qualification for program X, increased governmental demands, etc.

Personally I'd like to see single-payer, with the elimination of for-profit insurance companies. Taxes would go up, but there's good reason to believe costs could go down due to increased access to preventative care, so overall health care expenditures could theoretically go down.

I'd also like to see the revenue from cigarette taxes, alcohol taxes, and other taxes on items that destroy your health used to pay for the universal healthcare system.

Frank_Sinatra · Post by **Frank_Sinatra** » 19 Jun 2007 10:57

I would also like a pony.

janis · Post by **janis** » 19 Jun 2007 14:17

Frank_Sinatra wrote:Universal healthcare would mean higher taxes, and that's why health care policy is going to continue on the wrong track.

Not necessarily. It's a question of priorities, instead of the military spending $500 on a spanner perhaps it would be better to put some of that money into things like healthcare.

But even if taxes went up a bit, if you did happen to get a serious illness you would be far better off with a system that actually cares about patients as opposed to the size of patients wallets.

Just curious, why do you think that government funded programs are a negative thing?

Frank_Sinatra · Post by **Frank_Sinatra** » 19 Jun 2007 14:50

You're making some incorrect assumptions about my politics, my friend.

I do not think government funded programs are necessarily a bad thing. For instance I said: "I'd like to see single-payer" - meaning we pay taxes into a health care budget, the government pays the health care bills back to the providers.

I think that the political reality right now is that defense budgets aren't going down, and large new taxes aren't going to be enacted. Sure, the military could cut waste, and there are certainly some very expensive and useless programs, both within the military and without, that could get cut (cough missile defense shield cough). Every election, our elected officials promise to cut these sorts of programs, and every year they fail to do so. So while I agree that it should happen and would be a great idea, I'm not holding my breath waiting for it to happen.

Voting to decrease military spending in America is political suicide.

It also seems to me that a lot of the health care reforms that have been proposed recently - particularly by the various presidential campaigns - are just piece-meal reforms with all kinds of bureaucratic hoops to jump through, such as government mandates on individuals with requirements to prove the mandate has been followed, means-testing, tax-rebates, etc.

The reforms that have been floated recently are so heavily qualified and micro-targeted that in order to enact them a great deal of qualification will need to be built into the process. Meaning that if proposal X is an attempt to expand health care coverage for children of families making $40,000 or less, there has to be means testing, which means paperwork and people to process said paperwork. Suppose that this proposal also requires that the family did not previously have insurance, or is not eligible for employer-provided health insurance - this would mean additional proof of this qualification is required, involving paperwork from the family, the employer, previous employers, unemployment documentation, etc.

If proposal Y is an attempt to increase preventative care by having the government reimburse the insurance company for 60% of the cost of preventative care, then an exact definition of preventative care has to be adopted, and paperwork for each checkup, procedure, or prescription that qualifies as preventative care will have to be processed. So who gets the bill if you get a preventative procedure that doesn't fit the definition? Does the insurance company try to pass that on to you? Keep in mind, they've got some grade A lobbyists in Washington making sure their financial interests are not threatened by any legislation.

My argument is that attempts by the government to improve either access or reduce costs within the current system of payment will be inefficient, and highly bureaucratic; that they will basically collapse under their own weight by trying to be very precisely targeted towards specific segments of the population. In the end the programs will be complicated and burdensome and still fail to resolve most of the health care problem.

So I'm saying throw out the current system of payment, and replace it with single-payer. Once again, this is what I think should happen, but I'm not holding my breath until it does happen.

Outsider · Post by **Outsider** » 19 Jun 2007 15:07

Just curious, why do you think that government funded programs are a negative thing?

Well, for one, because government programs tend to do stupid things like spend $500 on a spanner. Private, profit-motivated businesses tend not to make those kinds of mistakes.

Healthcare in the United States IS outrageously expensive... some people say that if it were all paid for by the government spending its (our) tax dollars then the costs of services would climb much much higher. I don't know if thats true or not, but your example of the spanner suggests that it might be.

I've said it once before in another similar topic - (which I couldn't seem to locate in a very quick search this afternoon) - the US government spends about as much money on healthcare for its elderly, poor, and disabled, as it spends on "defense" - hundreds of billions of dollars. Many tens of millions of Americans have health insurance through the Medicare and Medicaide programs. These health-insurance programs are specifically for the elderly and disabled (medicare) and for the poor, or "individuals and families with low incomes or resources," as wikipedia puts it (medicaid).

I'm not going to brag about the relative quality of these programs. I don't really know THAT much about them, except that its common in my country to hear people complain about their healthcare and health insurance in one way or another, whether its private insurance or state-sponsored. The point I'm trying to make is that the U.S. government, in theory, DOES see to the healthcare of its poor, disabled, elderly, etc. I think the theory is that if you're not poor or disabled, then you should be able to go out and get a job that provides healthcare or pay for your own insurance. The problems are beaurocratic ones - who determines what "poor" really is? - there are many people who the government would categorize as having sufficient means to provide for their own healthcare and yet the reality is that just because the government says that they're not poor does not really mean that they can afford that too-expensive insurance. And speaking of beaurocracy, apparently the whole area of medical billing in this country is hopelessly complicated. There are so many different billing schemes, none of them very simple, and any given combination of treatments for a single person can become so incredibly confusing, that nobody really understands what things get paid for by who and how. I think that people here actually go to school for a couple of years specializing in medical billing just so they can be a relatively low-wage medical billing clerk. Another problem is that we're asking a huge bloated beaurocracy (the government) to clean up a system thats a big confusing mess of beaurocratic red tape. I wonder if that is even possible...

Problems, problems... once you start asking what the problems are, you can just start going on and on...

A little more about that medical billing issue - I've read stories about people who wind up with whole rooms of their house devoted to all the boxes of medical bills and receipts and letters, etc., that they must keep track of just for the treatment of one illness. One major illness, to be fair, like a couple years of on-going cancer treatment, but still, whole rooms full of boxes of paperwork and such... ugh. Dealing with all that beaurocratic nonsense becomes like a second full-time job for those people, as though they needed all that BS on top of trying to deal with their illness. What a tangled mess.

Another problem is... well, I don't really feel like going on and on about it all right now... I was just killing some time while my computer ran a disk clean-up. Later.

By the way, Janis, is a "spanner" the same thing as a wrench? We don't use that word here in the U.S. We just say "wrench." Of is it a pair of pliers? Can't remember.

janis · Post by **janis** » 19 Jun 2007 21:42

Frank_Sinatra wrote:I do not think government funded programs are necessarily a bad thing. For instance I said: "I'd like to see single-payer" - meaning we pay taxes into a health care budget, the government pays the health care bills back to the providers.

I think this is a great idea, it has worked very well in Australia for years now.

Private health insurance unfortunatley is about making money, looking after patients becomes secondary.

By the way, Janis, is a "spanner" the same thing as a wrench? We don't use that word here in the U.S. We just say "wrench." Of is it a pair of pliers? Can't remember.

yeah exactly. The point I was making that things like simple tools were sometimes rediculously overpriced.

sergio · Post by **sergio** » 20 Jun 2007 04:42

I don't have a lot of time, so I won't start debating on wether a public or private health system is better, although I'm very sensible to this subject.
But here are some interesting statistics about the cost and quality of health care in OECD countries.

All this information is from the OECD website. I haven't found the exact charts, cause I've had them on my computer. But here's the link to the same information in tables :

http://www.oecd.org/dataoecd/20/51/37622205.xls

Total health expenditure per capita US$ PPP in 2003 :

Life expectancy at birth, 2003 :

Infant mortality rate, 2003 :

No need to say that life expectancy and infant mortality are the most used indicators of the quality of the health care system..

sergio · Post by **sergio** » 20 Jun 2007 04:47

The US health care system is by very far the most expensive, although it is not universal and not of very good quality..

BenRea · Post by **BenRea** » 20 Jun 2007 06:07

So basically those graphs say turkey and mexico are the shittiest places to live.

MatS21 · Post by **MatS21** » 20 Jun 2007 06:38

True, which doesnt mean U.S. is doing good.

Frank_Sinatra · Post by **Frank_Sinatra** » 20 Jun 2007 06:49

Outsider wrote:I think the theory is that if you're not poor or disabled, then you should be able to go out and get a job that provides healthcare or pay for your own insurance. The problems are beaurocratic ones - who determines what "poor" really is? - there are many people who the government would categorize as having sufficient means to provide for their own healthcare and yet the reality is that just because the government says that they're not poor does not really mean that they can afford that too-expensive insurance.

Exactly. There are people who work part time, or have worked full time for less than three months, or who are basically "full time" employees but are technically "independent contractors," and I believe there may also be certain sectors that are exempted from providing insurance to employees. So all of these people are basically on their own to buy private insurance if they can't qualify for a government program.

And even if you have insurance, it doesn't guarantee treatment. Most insurance companies will not cover treatments for preexisting conditions, or anything on the lists they draw up of 'non-qualifying procedures,' procedures beyond a certain dollar amount... I could go on and on.

I don't think the profit motive is really encouraging more efficient processes in providing health care - as was stated, the billing systems are confusing, bureaucratic messes. I think the profit motive is encouraging insurance companies to find new and creative ways of denying coverage and decreasing access to coverage, or at least putting hurdles in the way of access.

I could tell you some horror stories about my last ER visit: I couldn't get ahold of my insurance company (they're closed on the weekends) to find out what hospital I should go to and what would be covered; their "customer service" is just an answering machine and a poorly-functioning website that amounts to an FAQ; I couldn't get ahold of my doctor - I couldn't even find his information using my insurance company's customer service, I found it on the back of my previous insurance card, days later, on accident; I went to a hospital that whose records he can't access, so he couldn't even look at the X-Rays.

Now I've potentially got an almost $900 bill, it's currently a bill the hospital is sending to my insurance company (I guess the hospital wanted me to have a heart attack). If the insurance company doesn't pay in 60 days then they'll try to make me pay it. I've made several inquiries to the insurance company and HR at the company I work for, they tell me an ER visit is covered, but whether the insurance company pays up in 60 days is anybody's guess. I keep wondering what kind of bullshit they'll try to pull to not pay... and that's just a sprained ankle.

When I sprained my foot about five years ago I had insurance, but they didn't pay up until the absolute last day they were required to (by law). So I paid it out of pocket so it didn't go on my credit report, then eventually the insurance company paid, then the hospital refunded my payment. Almost one year after the original injury. An ER visit, x-rays, and crutches cost $212. This recent ER visit, x-rays, and air cast cost $877. Not sure what that extra $650 is going to, but I did get to writhe in pain while my doctor chatted up a nurse about his golf game (priceless).

So even though I have insurance, I'm not sure if my coverage is adequate. And my benefits are just going to keep getting more expensive, and keep providing less coverage, every year.

brinard · Post by **brinard** » 20 Jun 2007 08:23

health insurance must be nice.

i used to be on Tncare. (tennessee poor/diabled insurace coverage). when i turned 18, the bounced me. i havent been to the doctor since, and i only go to the dentist because hollys mom hooks that up.

i had tncare because my mom was disabled in like 1999, and i lived with her a few years later. she finally got her disablity approved in like 2003, and a big check in 2004.

i was in a car accident in 2006, january 10th i think. i was rear ended by some fuck going 50, and i was stopped. i ended up with whiplash and some other neck/back problems. he didnt have car insurance. i had to pay for all my xrays, medicine, and doctor visits a few months later because he stopped paying. i should have sued him, but he was poor too. he had a handicapped kid.

so i was stuck with about 1000$ worth of shit. lame. nice coverage of poor people govt.

---

i think we should have universal health care in the u.s. it makes sense because there are so many who cant afford it, to just fucking help someone out instead of making a few hunderd dollars from it. its retarded.

doctors are assholes. govt are assholes. hospitals are assholes. insurance are assholes.

but im the one getting fucked.

HighDemonslayer · Post by **HighDemonslayer** » 20 Jun 2007 08:56

I don't think our rulers want us to have access to good healthcare.

If a skilled doctor is wasting his time treating a common person, than he cannot be on-call.....waiting to treat a more important elite person and his family.

Politicians talk a good game about health-care, but they probably just want to hold the power of "life-and-death" over the pitiful masses.

Pardon my rant.

-----------------------------------------

Universal healthcare is likely impossible in the U.S. anyhow.

As our population of sick, and soon-to-be-sick people grows exponentially, our "leaders" slide us farther and farther into bankruptcy, inflating the cost of healthcare at every turn.

The U.S. population grows at an non-sustainable rate. Environmental burdens ensure that that more sickness will, in turn, burden the healthcare system.

They could pass a bill, and create a lame-sounding bureaucracy, like "Dept Of Homeland Health"......

BUT ...as an entity,they are probably incapable of actually delivering care to the people.

-n

Bagira · Post by **Bagira** » 20 Jun 2007 10:42

Pengu wrote:That said, the Canadian system does have it's flaws. Organ transplant lists are long and the wait tedious. It is why those with money travel to the US to skip these long waiting lists. However, on an ethical point of view, I support such a waiting list where no one is favoured and everyone treated equally - those with money have to wait just as long as those without.

...

The Canadian system thrives on preventative medicine, something that the HMO cannot accomplish due to costs. In the end, it costs less to treat a person due to early detection than to treat full-blown cancer. If people avoid the doctor unless they feel something is seriously wrong, that's when costs begin to skyrocket. So our doctors and nurses make less money than yours in the US, at least they can work their practice with helping people with the best care they can give instead of denying care for those who can't afford the best.

...

I'm not saying the Canadian system is perfect. I've long been a proponent for a 2-tiered system so that those with money can pay for a shorter waiting period and less cramped hospitals. It has the advantage because a private hospital would also generate tax revenue which could then be fed into the public healthcare system. This would alleviate the waiting times of the public health system as well.

Ok. I'll admit that I've never had the chance to experience the hell of HMOs and whatnot as my family moved up to the rank of upper-middle class quickly after immigrating to the US with nothing. During that time we made use of the unemployment benefits and Medicaid and the rest of the tempoprary benefits conferred to us. So except for that period of around 2-3 years, we've always had health insurance here.

There were generally very few problems with it on its own. Very little paperwork was needed except for claims. That's the case if one has no debilitating illnesses and is around middle class in the US. I'm sure that it's far uglier for those who are poorer.

However, I don't wholly blame the system of private healthcare. Instead, it's general society which strongly impacts health care in the US. Here's another quote of yours from the same post:

Pengu wrote: US citizens expect the government to pay for school for their children, they expect the government to pay for police and firefighters, why shouldn't they expect to have healthcare? People aren't willing to pay higher taxes? It becomes a matter of what's more important: more money or does the fear that a serious illness will bankrupt your family? Isn't it part of the constitution to feel safe?

Technically, the US may as well not have 'free' public schooling for all it matters in densely urban areas. From my own experience it does very little. The curriculi are pathetic on an international scale. Even then, the vast majourity of schools do not have adequate graduation rates. Pretty much everyone here who I've befriended either studied on their own or paid a tutor. Aside from that, public funding for the schools is generally ridiculously spent. The better of public schools in the city have substantial amounts of private funding.

In any case, even that isn't the reason for the problem. It's a description. The reason is that working as a teacher pays too little. It attracts people who can't teach well and don't want to do anything else because teaching is easy and a rather reliable job. In most public schools, nothing short of a CRIME can get them fired.

Medicine is on the other end of the spectrum. the cost of medical care is inflated. It draws too many people who are coaxed into it not because they find the work interesting or are good at it, but because of the money. An allusion is the the dot com bubble in the 90s. Most of my family works in IT profession, so I'm well aware with how things work. In the early 90s, IT professions were demanded highly and thus paid highly, too highly. All sorts of people went to into IT for the money alone. Most of them weren't very good at what they did. Many programmers wrote very clumsy code which was poorly optimized and rather buggy. When the bubble burst, suddenly most of the IT professionals who went into the line of work strictly for the moeny were layed off and those who were the best at what they did and honestly loved the line of work generally remained and problems decreased in frequency. Of course, though, there's a large difference between engineering software and making lives longer than they'd be otherwise.

A second factor is malpractice insurance. Due to the fact that health care costs so much, people are ready to sue for errors or...the taking of risks. Hence all the bureaucratic red tape.

A third reason is the greater influx of those who seek urgent health care. One example is internationals who are rich enough to get ahead of their respective countries' waiting lists. Another is that of crime. Stabbings, shootings. and the like really help fill up ER space.

A fourth reason is that health care is never denied unless it is VERY expensive and out of the ordinary. This means that if one is too poor to afford health care, he can get into a hospital, get treated and not worry about paying the bills. The same goes for illegals, though they can be deported after being treated. In any case, the bills for those patients don't get paid and the system tries to put them on the shoulders of others.

Such a drastic change such as universal healthcare is unnecessary. It just needs to get MUCH cheaper...

Pengu · Post by **Pengu** » 20 Jun 2007 12:10

Even if you are insured, if the bottom line is the agenda for insurance companies, what's to say that they won't deny your 'experimental' bone marrow transplant because it's too expensive to treat your cancer? Even if it is the only thing left to try?

This is why Doctor's in the states are asses. It's because they can't treat their patients to their fullest ability because of the limitations of the insurance companies and deductibles.

The countries with the best infant survival rates are the ones who put the time and effort into preventative medicine. Doctors get bonuses if they get their patients to quit smoking, lower their cholesterol and BP, and just have them live a healthy lifestyle. It's not about living up to a certain criteria to receive coverage, however with more doctor-patient interaction, there is more sway from a doctor to advise someone to live a healthier lifestyle.

This in the long run saves the government money.

On the topic of the poor education system in the US, I believe that your kids can't do math because you're still using the emperial system.

Bagira · Post by **Bagira** » 20 Jun 2007 13:47

1. Experimental treatments are generally free. The point is that you're a test subject and there is no guarantee of your survival.

2. Doctors in the States aren't asses. I explained in my previous post in several points how the whole system is to blame, with the idea that medical insurance is not the root of all evil. It's brought into being by the increasing costs of medicine and further raising them.

3. I hate to be morbid and cynical, but to play Devil's advocate, considering that we live in a capitalist society, isn't it normal and even GOOD that someone is able to get that treatment while another isn't, of which the chances of getting it are determined by their willingness to pay the money demanded of them.

If we want to stay on the topic of health, and hell, even preventive medicine, let's make a brief segue to food. Yes, what we eat. After all, nutrition is part of medicine. In the long run, by eating cheaper food, one reduces his lifespan by some noticeable duration. Think of the trans-fats and whatever other crap that is saturated in the cheaper food. Now, there's another alternative. Some food that is more expensive and provides the correct amount of necessary vitamins and the rest. In short it keeps people alive longer because they won't have malnutrition and loads of crap in their bodies.

Now, resources are limited, the society is capitalist. Is it wrong that someone lives longer because they can afford the better food? Is it wrong that someone richer can afford to keep themselves alive longer than another because they can afford to pay for the treatment necessary while the other can't?

Insurance is a business. It runs on the idea of charging someone some amount of money depending on likelihood that they will fall ill. In the case they do, the insurance company will take care of their medical bill ASSUMING IT DOES NOT GO OVER A CERTAIN AGREED-UPON LIMIT or other restrictions that they can put in the contract.

Personally, I wouldn't be too happy if the government wastes an inordinate amount of money to keep someone alive. That's where I should think that the individual's personal capital comes into play if he wants to live that badly.

Alright, even if we look at this great Canadian system of the waiting list we will see that it's not a simple, black-and-white queue. It's a priority queue (sorry, I think like I'm coding a Comp Sci project). It's a priority queue because someone with more influence or capital can easily cut ahead in the line. Bribery is quite common in our history and no organization is immune to corruption.

Damnit. I'm really cynical now.

4.

Pengu wrote:The countries with the best infant survival rates are the ones who put the time and effort into preventative medicine. Doctors get bonuses if they get their patients to quit smoking, lower their cholesterol and BP, and just have them live a healthy lifestyle. It's not about living up to a certain criteria to receive coverage, however with more doctor-patient interaction, there is more sway from a doctor to advise someone to live a healthier lifestyle.

Pengu, no offence, but can you back up that claim of governments conferring bonuses to doctors who do get their patients to live healthier? In a short search, the closest thing I found was INSURANCE COMPANIES doing that. Probably in hopes that they can charge the same real rates while having lower rates of illness in their set of clients, thus making greater profits...

5. Pretty much every math/science course is taught using metric units ONLY. People tend to understand both the empirical ones and the metrics. Well, most people. I find it much harder thinking in base 12 than base 10 for some odd reason...

Pengu · Post by **Pengu** » 20 Jun 2007 18:58

It's called GP performance pay and it's instated in the UK.

And priority queue means people who need it more get to be higher in the queue. If you're going to die in 3 weeks without a transplant while others have at least 2 months, then the person with 3 weeks left to live and is further back in the queue will get priority. It's illegal to get ahead of the queue by bribery and it's against the CMA's code of ethics.

I believe in a junk food tax just like there are taxes on tobacco which would then be further injected into the public health and school systems to engage youth into a healthy eating and lifestyle habits early.

And your logic that 'good food' is expensive is flawed. It's still cheaper to cook at home and eat at home than to eat out or buy processed foods. It is also healthier to make foods from scratch. I believe home-economics should be mandatory again and more emphasis put on it as an important life skill.

nor shall any State deprive any person of life, liberty, or property, without due process of law

It is part of your constitution that the State does not deprive any person of life. Yet you allow a private company, which is regulated by the state, to deprive certain individuals of life by denying health procedures they don't deem necessary when in fact, they are. And if we use the constitution, denying the best possible treatment for the life and sanctity of an individual can be considered cruel and unusual punishment. It's like letting someone die a slow death even though a cure is possible, just not affordable. None of this justifies putting a monetary limit on the amount of care a person receives.

If an example were that an accident claimed 4 of your fingers and the insurance company says your deductible only is enough to re-attach one, would you be happy with that? Despite the fact that all of the fingers are re-attachable?

There are some people who in their lifetime, can't save up enough to pay for a devastating illness. Even if they are upper middle class, it would bankrupt them if their deductible ran out. Universal healthcare is utilitarian. It benefits the most people and tries to do the least amount of harm.

ASSUMING IT DOES NOT GO OVER A CERTAIN AGREED-UPON LIMIT or other restrictions that they can put in the contract.

Why should Americans leave their health up to a capitalist company out to maximize profit? I thought the saying was doctor knows best; not insurance companies know best. Instead of doctors making medical decisions, it becomes insurance companies making medical decisions.

MatS21 · Post by **MatS21** » 20 Jun 2007 19:09

Really, Peng clarified everything I wanted to. But if you really believe :

isn't it normal and even GOOD that someone is able to get that treatment while another isn't

No, it's not.