<p>I’ve posted before that from my personal experience, British health care is not all that wonderful and that people find it necessary to go private. But even that option is limited:</p>
<p>Those Who Pay for Private Care Are Testing Britain’s Public Health System </p>
<p><a href=“http://www.nytimes.com/2008/02/21/world/europe/21britain.html?pagewanted=2[/url]”>http://www.nytimes.com/2008/02/21/world/europe/21britain.html?pagewanted=2</a></p>
<p>Yeah well Britain is a great example of the failures inherent in socialized medicine…
Everyone I know with masters degrees in public health will tell you the same thing - socialized medicine is not a good system, and healthcare would suffer if we changed to a socialized structure.</p>
<p>Icarus, the British model is not the only one out there. Every other nation manages to provide universal coverage. Try taking a look at the German system, the French system, or any of the others. </p>
<p>Why is it that some people insist upon talking as if systems in other English-speaking countries–ie, Canada and the UK–are the only alternatives?</p>
<p>Our system devours the highest percentage of GDP and provides WORSE outcomes. I think that we’ve conclusively proven that a system based on employment-linked, for-profit insurance is the “failure.”</p>
<p>Also, while “socialized medicine” is a demonized concept, note that Medicare, VA, and the Federal Employees Plan are all “socialized medicine.”</p>
<p>Also note that “single payer” does not equate to “socialized medicine”; “single payer” is simply a consolidation of administrative and financing methods.</p>
<p>Many terms have become fighting words; we need to define what we really mean when we speak of these things.</p>
<p>Let the fighting begin!</p>
<p>I want to see as many people insured as possible; but some of the comparisons between the US and other systems are not founded on extensive knowledge of the pros and cons of each.
I don’t know about the German system to comment on it. I do know something about the French and British system. In fact, I had read about this woman’s case in the British press earlier.</p>
<p>If you are self-employed in France and going through a bad patch ,and therefore unable to pay into the Medical Insurance, you have to pay for your own medical care. In other words, the least able to afford to pay for expensive medical care such as surgey have to pay for it. It happened to one of my relatives.</p>
<p>While a single payer system would undeniably save a huge amount in paperwork and money, there is the temptation to impose specific choices. My company has switched drug providers. My GP had to switch me from a previous drug to another in order to enable me to maintain my co-pay at the previous rate (admittedly quite reasonable). The drugs are not totally interchangeable. I was allergic to the first one prescribed when I first was put on medication. Remembering this, the GP got a researcher to find out which of the approved drugs was closest to the one I had used effectively.</p>
<p>It’s the math that won’t make it work folks. It’s the math. You can’t continue to pay the increasing cost of services, reduce prices and add people for free. Sure I hate aenta ceo and his millions, but really mathmatically he is a fly f art in the mix. The real cost is utilization, you will not cut 20% off the top by going private, that’s a lie. You might knock 5% off. Remove the CEO fine, you can’t remove the people who process claims, you’ll have to hire more and process more. Claims won’t disappear, diagnostic codes won’t disappear, the need to track claims for legitimacy won’t disappear… </p>
<p>While I hate all ceo’s and question their compensation levels across the board, eliminating them in health care doesn’t really change the math of supply and demand. </p>
<p>But you all go ahead and show me the math. How you are going to provide more services, pay better wages and insure more people at no cost. </p>
<p>America is not willing to find a real solution to health care. We only want somebody else to pay for our treatment after we push our luck.</p>
<p>Consolation: Do you happen to know if the French system covers non-residents, or non-EU members?</p>
<p>
</p>
<p>My H is self employed. If we do not pay our premiums we also will have to pay for our own medical care because our insurance company will cancel us.</p>
<p>^^Yes, of course. I wanted to point out that universal health care can mean less than universal health care. And the US has lots more self-employed folks than most European countries. Something to think about.</p>
<p>“…the British model is not the only one out there. Every other nation manages to provide universal coverage. Try taking a look at the German system, the French system, or any of the others.”</p>
<p>The German model is at least as lousy as the British model.</p>
<p>
This is a key point. Medical care procedures have changed and costs have risen dramatically in the last 60 years. 60 years ago there were no $1M+ MRI machines, organ transplants, expensive-to-develop anti-cancer drugs, total joint replacements, angioplasties, massively prescribed anti-depressants, cholesterol lowering drugs, etc. What might have been economically feasible 60 years ago might not be (and isn’t in this case) today. </p>
<p>As Opie said - it’s the math.</p>
<p>Yes, it’s the math. We spend MORE NOW and get WORSE outcomes than other industrialized nations. It’s the math.</p>
<p>The existing single payer system–Medicare–has lower administrative costs than private insurance. There is no reason to expect that this pattern would not continue if single-payer were extended to cover everyone. The administrative costs of medical providers such as doctors and hospitals would also be slashed, since they would need to deal with only one entity, not many.</p>
<p>There have been numerous studies showing that it currently costs more to provide care to the uninsured and under-insured, partly because they don’t receive routine or early care so their conditions become more severe, and partly because some of them have no place to go but emergency rooms when they have issues that the insured would simply take to their primary care physician.</p>
<p>IMHO it’s a matter of quasi-religious faith for some people to believe that nothing can be done right by “the government.”</p>
<p>
</p>
<p>And who is everyone? Because from where I’m sitting, coming from a family in which both parents are heavily involved with public health in Canada (mother is a hospital executive), and worldwide (father works on public health in the developing world - and has an MPH from Yale, for what it’s worth), I see the exact opposite. The vast majority of public health experts I’ve ever met say that it is key for a country to have universal healthcare in some form - generally single payer is seen as the most efficient. Then, on top of that, you allow private care for whoever wants it, and go from there. That allows the best of both worlds - coverage for everyone, and market competition between the private and public options.</p>
<p>It is worth noting, that at #37 for healthcare outcomes in the world, while nonetheless spending huge amounts of money, with every country from #1 - #30 using the model of public/private care, maybe America could learn from the other countries just a bit.</p>
<p>ucsd<em>ucla</em>dad: True, costs have increased. But they’ve increased for all the countries spending less and getting better care than America, too. It’s not like it’s only America that got all these cool treatments and attendant higher costs. So how is it that America is paying so much more than other countries with better care?</p>
<p>Consolation: I agree. One thing that America does horribly in healthcare is preventative and ongoing care. I suspect it is partly because the system discourages “unneeded” care - with all the insurance companies not providing enough compensation for it, etc. People don’t get the care they really should be until they’re really sick, increasing costs - an ounce of prevention really is worth a pound of cure.</p>
<p>“The existing single payer system–Medicare–has lower administrative costs than private insurance. There is no reason to expect that this pattern would not continue if single-payer were extended to cover everyone. The administrative costs of medical providers such as doctors and hospitals would also be slashed, since they would need to deal with only one entity, not many.”</p>
<p>Cons, no offense you really don’t know how the government is as a payor do you? I work with home health agencies that finally sold their government licenses away becuase they could not afford to wait a year or longer in some cases to be paid for services rendered. Less paperwork? Why do you think they call it government red tape? 
</p>
<p>The problem the pro UC people have is some sort of polyanna view of how the government processess claims. They aren’t especially good at what they have now. A practice has to be willing to float the costs of providing care NOW to get paid later… Talk to people in healthcare that handle billing, uncle bucks is not head and shoulders above the rest in ontime payment for services, they are especially bad about forms… </p>
<p>As far as admin costs for hospitals being slashed how so? one entity over others? REALLY? So when you enter the payor/provider code (say… six digits) into your computer is how much of a savings? Because after that what will change? Diagnostic codes will still be filed as they are universally on claim forms. I think from my old health care classes it was sometime either late 60’s or early 70’s that a common claim form was created. The hospital will still go with the understaffed AR departements they currently have.</p>
<p>
But I don’t think that the costs have increased the same for all healthcare systems. There are longer waits in some universal healthcare systems for things like MRI’s, other diagnostics, medications, consultations, surgeries, etc. which lowers the costs in those countries but sometimes to the detriment of the individual. And I’m not convinced that the other countries have ‘better care’. It certainly doesn’t seem to be true for the situations cited in the article. Any stats ‘ranking’ healthcare systems would need to have the criteria finely scrutinized by me before I’d be willing to accept it based on my circumstances.</p>
<p>…so basically what you’re saying is that you think America spends more because its care is better, in spite of many studies showing the care ends up worse? That’s an interesting and largely baseless opinion.</p>
<p>“I agree. One thing that America does horribly in healthcare is preventative and ongoing care. I suspect it is partly because the system discourages “unneeded” care - with all the insurance companies not providing enough compensation for it, etc. People don’t get the care they really should be until they’re really sick, increasing costs - an ounce of prevention really is worth a pound of cure.”</p>
<p>1 of 42,</p>
<p>everyplan I have to offer has preventative care either covered in full or waives deductibles to encourage preventative care. I would ask you this question is it insurance plans that do poorly with preventative care or Americans? </p>
<p>Right now many plans offer free immunizations, mamagrams are covered in full as preventative, physicals and other preventative testing are covered usually up to $300-500 a year depending on the plan. The coverage is there in the vast majority of cases. Because there is an economic benefit to preventative. </p>
<p>Don’t you folks look at your own plans? I keep reading so much here that just isn’t so. Open your plan summaries and look at what is or isn’t available for you. </p>
<p>As far as “unneeded care” I think that falls directly on the individual, including myslef. You can blame the system all you want, and never leave your lazy boy. </p>
<p>Me? I had 100% preventative coverage for decades, but if it wasn’t broke or had blood gushing out… why in the heck would I go in? What would my coach say? “Opie stop being such a wimp…” </p>
<p>It wasn’t insurance companies that taught us not to use preventative, it was our culture, I mean I’m a guy why on earth would I go for a physical? I mean I’m fit, and nobody’s going to tell me I need to cut back on my BBQ… </p>
<p>Then at 40 Hypertension, 42 Diabetes. Now I sit in a docs office at least 4 times a year with people 30 years older than me as they are my health equals. Did private insurance do this to me? Should I blame them? I am one of the 50% of Americans whose “choices” have created my health problems. </p>
<p>Really deciding who gets our insurance premiums (private or government) isn’t the problem. The real problem we aren’t as a culture, willing to face.
We want to be able to indulge in all the excesses life has to offer and then get all the outcomes of those choices “fixed” for free. We aren’t willing to change ourselves to improve the system and it’s costs. We just want everything we do wrong to our bodies to be fixed for “free”. Of course “free” means a 50% lowest tax bracket, but hey it’s just math.</p>
<p>Opie: It might be cultural. But the culture of a nation’s healthcare is as important as the letters on the plan contracts. And as you said, you wouldn’t go in unless there was gushing blood or something broken… and you’re not alone. I’m sure that’s a large contributor to high healthcare costs.</p>
<p>
[quote]
And as you said, you wouldn’t go in unless there was gushing blood or something broken… and you’re not alone. I’m sure that’s a large contributor to high healthcare costs.[/q]</p>
<p>Yes, and more importantly, it’s also a large contributor to the results of the health outcome studies that provide “evidence” that Americans pay more $ for less health.</p>
<p>I’m not sure why but there seems to be a presumption that health care is an entitlement. I think of health care as a service available for purchase. I don’t expect maintenance and repair of me, or my car, to be taxpayer funded. There’s nothing intrinsically special about humans that suggests it’s in our collective best interests to keep every body as optimally functioning as medically possible. Some cars are lemons and some people have bad genetic luck, and while individual friends and families are affected by the loss of individual people, society collectively absorbs the loss of individuals effortlessly, even when the person who dies is prominent. There is an “it could be me” factor that leads everyone to desire access to health care, but it isn’t practical in a society of 300 million plus people to provide health care equitably to all. </p>
<p>Tough decisions, about who is “entitled” to which treatments, come with any health care rationing plan i.e. “universal health care.” It seems dangerous to leave those decisions to governments. Treating health care as a consumer good would allow everyone to decide how much of their income they wish to dedicate to health care, and how much risk they are willing to assume. If health care were a consumer good, one could still purchase insurance, and physicians would be apt to charge more reasonable costs knowing that payment would be made at the time of service. Yes, treating many cancers and some chronic disease would be cost prohibitive for many, but health care spending must be limited and perhaps those with great need who are unable to meet their need would have to do without. This would be equitable because it would treat poor and middle class individuals alike (the wealthiest among us will always have options.) </p>
<p>These rationing choices are always unpleasant but they will have to be made, and ignoring the problem leaves it in the hands of politicians, most of whom are ill-equipped to be make such decisions.</p>