Seriously thoughtful American Health Care

[BillSmithBooks]

As an American, I am *sooooo* frustrated with our system.

The only reason we do not have national health care is because our Congress critters work for the corporations (who provide their campaign donations) instead of actually working the citizens of this nation. Surveys show a large majority of Americans want universal coverage but the conservatives like to pretend that there is actually an issue to be debated.

The "debate" is showing TV clips of people all wound up by inaccurate news coverage ranting and screaming, while thousands of people every year are forced to declare bankruptcy and lose their homes because of huge medical bills.

People here in the states seem to forget that health insurance companies exist to make money. They make money by charging high premiums and then doing everything they can to deny coverage when you actually get sick and want to use the "insurance" you've been paying for all along.

Conservatives are opposed to national healthcare until they get sick and don't have the means to pay for coverage.

I live about 10 miles from the Canadian border and the opinion I consistently hear from my enlightened neighbors to the North is "You Yanks are crazy for tolerating that system."

[Moejoe]

Originally Posted by Sparrow

But where does 'healthcare' begin and end?
There's a debate in the UK about whether IVF should be provided free.
Some people don't think the NHS should provide tattoo removal, or other cosmetic procedures.

My take is that anything that 'betters life' should be provided free. If governments can spend billions on murdering people in faraway lands and taking the sons and daughters away from families, then they can pay for some of the good stuff too. If that's IVF, then good, if its tatooo removal, then great. I'd rather my taxes were spent helping a couple have a child than fund death and pain. First, do no harm.

[Halk]

Originally Posted by Moejoe

My take is that anything that 'betters life' should be provided free. If governments can spend billions on murdering people in faraway lands and taking the sons and daughters away from families, then they can pay for some of the good stuff too. If that's IVF, then good, if its tatooo removal, then great. I'd rather my taxes were spent helping a couple have a child than fund death and pain. First, do no harm.

Well, I couldn't be more against tattoo removal or some other cosmetic things.

Some forms of cosmetic surgery should of course be included, but tattoos are self inflicted. If the state starts paying for tattoo removal, then won't that just encourage people to get that stupid tattoo they are thinking about, because they can always get it lasered off afterwards?

As well as that, there's better things they could be spending my money on. Or better yet simply spending less of our money. The UK government already spends a huge proportion of my income.

[alecE]

As a UK resident, I can provide examples of healthcare provision:
1. The NHS for medical issues - one emergency response following a road accident, one surgical intervention and one minor surgical intervention - all free, all high quality treatment;
2. Dental care - NHS dentistry is a mess, I have not been able to get an NHS dentist, so I go private. Spent £240 this week for routine appointment, de-scaling and (the biggie) extraction of some root fragments;
3. Eye care - I spend about £15 every two years for a bog-standard eye test, plus whatever I care to pay for spectacles.

Ultimately of course I do pay for the 'free' NHS treatment via my taxes, but at least taxation is proportionate to income. If I had to pay the full cost of medical treatment or had to have private health insurance, I believe I would be in worse health and much worse financial shape.

What really puzzles me is why there is any debate about this at all in the USA. Why should healthcare be made available *only* to people who can cough up the dosh for it? If the argument is followed to a logical conclusion, then presumably the same should be done for (say) education, clean water, refuse collection?

[Halk]

Originally Posted by BillSmithBooks

People here in the states seem to forget that health insurance companies exist to make money. They make money by charging high premiums and then doing everything they can to deny coverage when you actually get sick and want to use the "insurance" you've been paying for all along.

That's part of the key arguement that UK politicians opposed to the NHS, or far more common who want to make significant changes make.

That the private sector is enormously more efficient than the public sector. Over here we try to learn from the best of US hospitals and health care to try to apply it to the NHS.

To my great dismay there is a stigma attached to saying anything negative about the NHS.

It's perfectly ok to criticise hospital managers, administrators, cleaners etc. It seems that they're all nasty people wasting our money and stopping it going to the nurses and doctors - all of whom are saints.

However should anyone criticise doctors or nurses, or say the NHS isn't all that great then all sides of the major political spectrum assault them.

The end result is we have the NHS we have, for better or for worse, and like other touchy issues there seems to be no chance of a worthwhile debate taking place.

From my own personal viewpoint I believe the NHS, by and large, to be an enourmously brave undertaking, but one that has been a massive success. There are changes that can be made, but by and large the system works.

I caught part of a debate on Radio 4 the other night. I'm not sure of all who were involed. I know that Tony Benn and Lord Heseltine were on it, and I was very interested to hear what politicians who aren't trying to spin for votes were saying. I keep meaning to listen to the whole thing on iplayer. Here's a link for anyone that can use iPlayer.

[Moejoe]

Originally Posted by Halk

Well, I couldn't be more against tattoo removal or some other cosmetic things.

Some forms of cosmetic surgery should of course be included, but tattoos are self inflicted. If the state starts paying for tattoo removal, then won't that just encourage people to get that stupid tattoo they are thinking about, because they can always get it lasered off afterwards?

As well as that, there's better things they could be spending my money on. Or better yet simply spending less of our money. The UK government already spends a huge proportion of my income.

We may be stretching it a little with tattoo removal, but the logic you're using would have us cherry-pick treatment because of how the patient acted, or bad decisions they might have made in their life. What about disturbed youngsters who self-harm, do they get no treatment because they knew it was harmful? How about smokers? People who eat too much? Drug-addicts?

Our system might not be perfect, but I can sleep safe tonight knowing I and my family can get treatment without having to worry that we'll go bankrupt in the aftermath. It's just not civilised to charge for medical care in the year 2009. To me, the American system is downright barbarous.

[Halk]

Originally Posted by alecE

2. Dental care - NHS dentistry is a mess, I have not been able to get an NHS dentist, so I go private. Spent £240 this week for routine appointment, de-scaling and (the biggie) extraction of some root fragments;
3. Eye care - I spend about £15 every two years for a bog-standard eye test, plus whatever I care to pay for spectacles.

Ultimately of course I do pay for the 'free' NHS treatment via my taxes, but at least taxation is proportionate to income. If I had to pay the full cost of medical treatment or had to have private health insurance, I believe I would be in worse health and much worse financial shape.

What really puzzles me is why there is any debate about this at all in the USA. Why should healthcare be made available *only* to people who can cough up the dosh for it? If the argument is followed to a logical conclusion, then presumably the same should be done for (say) education, clean water, refuse collection?

I have an NHS dentist, who gives me a great standard of care and it's very inexpensive. I do not understand though the justification why dental and optical care are not free. I went to the optician a few weeks ago for the first eye test I've had in at least 10 years, and was surprised to see that the Scottish Parliament had used it's devolved powers to make eye tests free in Scotland.

I'm not against optional private care. I don't see any reason why someone can't opt to pay more to have a choice over what time their operation is at, or to have it nicer surroundings, with nicer meals etc. I also can agree with allowing people to pay more money to have an operation faster - as long as that operation is in no way time critical.

Something you mentioned is what standard of health you would have if you had to pay for it yourself...

Let's now imagine that everybody could afford healthcare. Let's have a system where everybody has to pay for healthcare, but the cost is entirely dependent on income.

Since the government is no longer providing it, benefits will increase accordingly, and taxes will reduce. Anyone paying for health care will be exactly in the same position they are now in. In other words someone on 50 benefits a week will now be on 60, and healthcare will cost 10. Someone earning 5,000 a month will be taxed 1,000 less, and healthcare will cost 1,000.

The major problem I see there is that a great number of people will choose not to pay for healthcare.

The reason why I believe this? I used to work directly with people applying for credit in a bank. A great number of people are stupid, lazy and selfish. They will spend every penny they can get their hands on, and struggle financially as a result. They would phone the bank when they ran out of money to ask for more. Or worse still, they would ignore letters and telephone calls from the bank until the bank stopped paying their bills, then they would phone the bank begging or demanding more money.

My job has changed and now I deal with pensions, life assurance, mortgages etc. I now find that the people on the lower end of the income scale are the least likely to properly protect themselves with insurance or pay into a pension. A huge number start the pension with too low an amount and cancel within the first 18 months. They justify it by saying money is too tight and they can't afford it. Somehow that makes it ok for them. Sadly when they reach the age of 65 (up to 68 for some now) they will be unable to retire and will have to work until they die. If they become too infirm to work, they face abject poverty. Whatever the case though the state will have to provide extra support, because they chose not to pay into a pension.

Sadly income insurance/life insurance in the UK is underwritten based on medical circumstances/post code/age/job etc. As a result of that it's not a level playing field and someone with poor health simply can't get insured. I believe it's the same with health insurance in the US.

I used to be ultra liberal towards pensions/money in general/state services. But as a result of these experiences I've moved slightly towards what would be called "socialist". I'm certainly no Red Ken though.

But to finally bring this long post back to the subject.... (I did have it in mind the whole time).... this is the reason why I support "free" health care for all.

Simply because if it's not free then idiots will choose not to pay for it, which will result in some people unfairly paying more than others, and or people suffering because of it.

There's a very good example of that which has come out in the news in the UK this week. The UK Government foolishly decided to instead of paying housing benefit to the claimants landlord, pay it to the claimant. The result is that landlords aren't getting the money. The knock on result is evictions. Another is that landlords won't take on tenants on housing benefit. Quite simply if you give people the freedom to make stupid choices then they will make stupid choices.

That's why some things simply have to be provided by the state, and why control has to be removed from people.

[Halk]

Originally Posted by Moejoe

We may be stretching it a little with tattoo removal, but the logic you're using would have us cherry-pick treatment because of how the patient acted, or bad decisions they might have made in their life. What about disturbed youngsters who self-harm, do they get no treatment because they knew it was harmful? How about smokers? People who eat too much? Drug-addicts?

Our system might not be perfect, but I can sleep safe tonight knowing I and my family can get treatment without having to worry that we'll go bankrupt in the aftermath. It's just not civilised to charge for medical care in the year 2009. To me, the American system is downright barbarous.

You make a very good point. What you are saying is it's very easy to single out one treatment and label it as something the state should not provide, but right next to it is another treatment that is less clear.... In other words where should the line be drawn?

I do not like the idea of fat people (I am a little overweight sadly) being banned from eating cheese. I'm also a smoker, but I elect to pay the UK price for cigarettes rather than import them from the continent because I strongly believe that in paying my fair share of taxes, and since it's fairly likely I'll be a burden on the state due to smoking related illnesses then it's reasonable for me to pay for that in the way of taxes.

Self harm I think can be taken out of the list, since that's the result of a mental disorder, very far removed from tattoos.

Perhaps though I should pay a little more tax because I'm a little overweight. I couldn't really disagree with that. Although I'd want to pay less tax on cigarettes, because I know I'm paying more than I cost the NHS.

I'd argue against a tax on tattoos to cover NHS removal costs, because not everybody who gets a tattoo will want it removed, and why should they have to pay for people who make stupid mistakes?

I must say I'm very much enjoying this thread. For once a discussion on t'internet without people trying to score points, or look good.

[alecE]

Originally Posted by Halk

I now find that the people on the lower end of the income scale are the least likely to properly protect themselves with insurance or pay into a pension.

That is precisely why the state has to make provision, whether of healthcare or unemployment insurance (pioneered by that well-known socialist Otto Bismark). Just because some people make stupid life-style choices does not invalidate the principle.

[Elfwreck]

Originally Posted by Halk

Some forms of cosmetic surgery should of course be included, but tattoos are self inflicted. If the state starts paying for tattoo removal, then won't that just encourage people to get that stupid tattoo they are thinking about, because they can always get it lasered off afterwards?

I suspect that the number of people who get tattoos, and then want to have them removed, is very small, and that the hassle of providing them the care they want at the same convenience level as any other non-essential healthcare (anti-smoking drug prescriptions? acne treatments? scar removal surgery? wart removal?) wouldn't be a great drain on the system.

For any system, there will be someone who scams it--some former rich teen punk who tattoo'd half his torso and both his arms, who later realized that his foolish history is going to cost him the ability to get a job, who would cost the healthcare provider thousands of dollars to remove the evidence of his careless youth. However, there will also be plenty of ex-gang-members, who got a cluster of small tattoos in prison, and would now like to try to hold down a straight job, but have trouble getting one with a knife tattoo on the back of one hand.

The question is not, "do they really NEED this service?" Obviously, nobody NEEDS to have tattoos removed. On that same vein, nobody NEEDS straight teeth, either. Nor any teeth. Dentures are less expensive than multiple root canals, so anyone with bad teeth should have them all removed, right? Erm.

The question isn't even, "should they have to pay for it themselves?" If fairness and "should" were a part of the debate, smokers would have no coverage for lung problems, and people who don't exercise (regardless of weight) wouldn't be covered for high blood pressure treatments. By that logic, prenatal care shouldn't be covered, either. (And hey, that's the American system! "You got yourself into this trouble; now you deal with it.")

The relevant question is, "what are the pros and cons of covering this treatment?" For tattoo removal, the cons are (1) it costs money (always an issue) and (2) it might encourage some level of recklessness. However, I doubt it'd cause much; tattoos are painful, and the number of them isn't likely to dramatically spike if removal is potentially free.

The pros are (1) people who are stigmatized because of foolish decisions in their youth might be better able to get good jobs, and be more productive; (2) people who regret one of their past choices might be more confident, less ashamed; (3) the rest of us wouldn't have to look at as many ugly tattoos; (4) people actively trying to "clean up" their former rough lifestyle get a boost in that direction.

I don't know the exact money costs involved, but they'd have to be pretty extensive to overbalance those, in my mind.

[GraceKrispy]

Originally Posted by Elfwreck

There is not basic healthcare for all. There is basic healthcare offered for the most impoverished, after much hassles with forms & paperwork to prove they are impoverished. This may or may not include dental or vision services, depending on the state. If, however, they have a job, that "right" to healthcare vanishes--they either get it through their jobs (I pay about 30% of my wages for health insurance for my family), or they go without.

I get to choose between healthcare, and the ability to afford rent in a neighborhood where car windows don't get smashed regularly. (I suppose there are safe and friendly neighborhoods at my current rent level... that are so far from my job in downtown San Francisco that I'd lose the same level of money paying for transportation.) So far, I've chosen health care; next year, I think I'll go the other way, and hope nobody in the family is badly damaged by that choice.

Emergency health services are available to everyone, at the cost of possible bankruptcy later. Hospitals have to supply it, but they bill you; if you can't pay, you can go bankrupt. Between half and 2/3 of the bankruptcies in the US are caused by medical bills.



A lot of us are boggled that health care isn't considered the same as education of our children--something that used to be reserved for the wealthy elite, and is now extended to the general public because we have the resources & technology to allow it, and the nation as a whole is enhanced by having it freely available.

We are forced to think of health care as a commodity of the wealthy, which is offered to the less-wealthy if they're willing to make sacrifices to get it, and offered to the poor as charitable hand-me-downs which may not fit well, but at least is better than nothing.

I won't pretend to be nearly as well-informed on healthcare issues as I should be, however even I have some opinion.

I agree with a lot of what's been said here by elfwreck. I was confused by the quote (not included) about a basic level of healthcare provided in the US. As elfwreck mentioned, the only basic healthcare if provided to people who meet poverty guidelines. We met those guidelines at one point, and the healthcare provided was more comprehensive and FREE, as compared to my current situation where I pay about 25% of my check each month to health care for my family. Then I still pay 20% of all office visits and minor surgeries, etc. it would be a lot cheaper, in all likelihood, if I didn't have insurance and just paid out of pocket (the docs usually charge a less expensive rate for self-pay than insurance billings) for visits. However, I'm sure that the minute I did that, I'd need major surgery and I'd be next in the bankruptcy line. There is a good portion of society that is worse off than those in poverty; the working poor. With no public assistance, and having to pay insurance, etc, they actually take home less *with* working their full-time jobs than those who are on welfare. I think that is one messed-up system. Where is the impetus to get off welfare? Then taxes go up for the rest of us.

I agree that many Americans do believe health care is a right, not a privilege for the lucky few. However, I have seen that money speaks louder than anything else in this country, and those who have the money have other concerns besides health care.

I do believe there are some things so right about America. And then there are those things that are oh-so-wrong.

[formerroadie]

Originally Posted by Halk

As I understand things in the USA there is very basic healthcare for all. On top of that anyone can purchase a separate plan, although most people buy into corporate schemes which are significantly cheaper.

If money is no object the standard of health care in the USA is fantastic. However taking the whole country into account the standard is very poor compared to GDP.

The problem in the USA is that there isn't enough money to go around to give everybody the excellent standard of health care that the rich enjoy. As a result it would lead to either decreases in quality of care for some people, or enormous tax increases.

Americans do not view health care in the same way that Brits and Europeans do. Over here I think we view healthcare as a basic human right and the system in the USA to be mind boggling. Americans view health care in the same way as material posessions, in that it is something to strive to earn money for in order to purchase. I think that's probably exaggerating things a little, to say all Americans feel that way.

Is that in any way correct?

Interesting. There is not "health care" for all. Health insurance companies often drop coverage at the site of a serious condition and then the person ends up paying astronomical prices for said care. You can get excellent health care if you are well off, but even those with health insurance in the middle class can have substandard health insurance (myself included in that). The poor can go to an emergency room and get care, but it is often substandard and clogs the system for serious cases.

I believe it's a human right, but for some reason, my fellow Americans don't and the insurance companies here have millions upon millions of dollars, so they usually get their way by buying off politicians.

No, I think you are correct about the earning money for health care as a possession.

I envy my Canadian and European brothers and sisters in this regard.

[formerroadie]

Originally Posted by vivaldirules

I'm among those who would like to see government run healthcare here but I can only laugh at the thought that it would provide free IVF or tattoo removal! I'm pretty sure that whatever system we adopt, those won't be included.

I agree with that. Cosmetic surgeries should not be included. No UHC for breast implants please.

[formerroadie]

Thanks all! I appreciate the comments. My impression of others looking on the American system is - "Stupid Americans." Honestly, many of us inside think that ourselves. A majority here want UHC and our politicians continue to play footsies with the Health Care industry. Basically, we have a legal way to bribe politicians and we just can't get rid of that because they will never pass a law that takes away their money. I never had debt til I moved to my current state where Health Care is in the bottom 10 amongst the states. My health care covers nothing that I need. It's basically there in case I break a bone or something. Frustrating.

Anyway. Great discussion. I figured people who read are going to give more nuanced arguments than I get from political forums in the states. Breath of fresh air.

[Kostas]

Originally Posted by formerroadie

Interesting. There is not "health care" for all. Health insurance companies often drop coverage at the site of a serious condition and then the person ends up paying astronomical prices for said care.

Thanks formerroadie, interesting discussion indeed.
I don't want to launch a contentious debate, but there's something I cannot understand.
While media are reporting fierce battles about an annouced/launched health care reform in the states, reading what you wrote one gets the impression that nothing's gonna or is about to change... So pessimistic?