Universal Health Care-British Style

Parent Cafe
121

<p>To add to two very cogent posts (118 & 119): Deuling anecdotes about good or bad outcomes under different systems is hardly probative of the relative quality of care under those systems - or even significant except to denote the pre-existing opinion of the poster. And touting the fact that single payer is “free” is false – the care is paid for, just through taxes instead of premiums. Equally phony is expressing horror that under single payer “Your taxes will skyrocket!” Of course taxes would have to go up to fund single payer - offset, of course, by the fact that premiums would go down or disappear. Financially, the net cost per capita of each system is what matters.</p>

<p>The answer to the “care” question is probably impossible to tell. If the US were to institute a significant change in health care financing some people would get better care (quicker, higher quality, more convenient); others would get worse care. How to determine who and how many of each, under what circumstances, is complex. We’re not Canada, France, or England. It would be different here. How different and different how, I don’t know.</p>

<p>The answer to the financial question is more readily addressed. And yes, single payer would cost less per capita than our current system, hands down. The real issues are 1) would we be able to handle the transition so as to maintain or improve the overall quality of care, and 2) even if all rational data point to changing things, is it possible to overcome the resistance of those with a finger in the current pie?</p>

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<p>An additional issue would be whether a single payer would restrict choice of drugs and treatment (the gist of the Daily Mail article). We currently have restrictions, even under the most generous plans; would these restrictions increase? Would the single payer be second-guessing doctors?
In my own HMO, my doctors always made the decisions regarding treatment, though of course aware of insurance companies’ policies. Disputes arose over payment for treatment (that’s how I got to know about the costs of each procedure, as I was sent duplicate bills). In the case described in the Daily Mail article, it seems that there is frequent interference with doctors’ decisions.
Of course, it can be argued that not having health insurance is a huge interference. But the issue is to preserve what is best about US health care and make it accessible to more. If it means reducing the quality of health care already available to most Americans in order to expand coverage, there will definitely be resistance.</p>

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<p>“yes, single payer would cost less per capita than our current system, hands down.”</p>

<p>That is being made with alot and I mean alot of assumptions that really don’t play out. Your going to remove ceo (replaced by national, region and state directors, all well paid, not aenta ceo paid, but paid) I almost look at this as doing away with the Kings, America revolted and did away with the King, was what that replaced the Kings more cost efficent? (congress,senate, president and all their support folks). I don’t like what CEO’s make in this country any more than the next guy, but we tend to replace them with committees, which when you start to add it up…cost, sometimes more. </p>

<p>You’ll eliminate the need for a sales department (cut 5% out of the pie), you’ll still need claims people and customer service people (and the need will increase wiping out the 5% sales force savings) as volume increases (free care). I don’t see this substanial savings that are being touted. </p>

<p>I see utilization going up (unless you restrict via deductible or limited services) I see a greater need for customer service and claims processors. </p>

<p>I don’t think there is any savings to be had. Just a different method, one where if you are unhappy with the plan, you can’t go elsewhere. </p>

<p>And as marite just posted don’t get me started on RX. The Plan B pill right now in my state is a super issue. Can we vote in or out certain medications or treatments? should we? When an insurance carrier restricts or denies coverage where do we go? To uncle bucks. When uncle bucks says “no”, What’s the game plan?</p>

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<p>I’m pro-UHC simply because I’m uninsurable by private insurers and have been since the day I was born. If I don’t have a job (or am not covered by my father’s insurance… up to age 25 in our state), I can only get health insurance through really, really expensive high risk pools and only in the states that have them (a substantial number do not, so it would likely be unwise for me to live in those states). In fact, this even influenced my choice of major somewhat, as I’m choose a relatively practical field in terms of getting a job. </p>

<p>Additionally, it seems like non-group coverage will dig up a “pre-existing condition” or some minute error to cancel the coverage of anyone who gets some expensive disease (see the recent lawsuit on this issue). That just scares and sickens me…</p>

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<p>For the record, those who are saying that there is no free health care and that the decrease in premiums is offset by the increase in taxes - that is true. But it is not true for the poor, since I assume health taxation would be progressive. Thus, those who currently can’t afford care would be able to get it, essentially free.</p>

<p>I recognize that the progressive taxation argument is a major Pandora’s Box, and so don’t really want to open it, but just wanted to point out that for some segments of society, UHC is indeed “free”.</p>

126

<p>Opie, I think you’re understating the combined institutional expenses of a multi-tiered, profit-based organizational structure for delivering health care. More to the point, you’re ignoring the huge cost (direct and indirect) of the constant effort to shift any given expense from one company’s coverage to someone else. Example - hurt in a car crash? Your HMO will try to recover from your auto insurance - and the other guy’s auto insurance - then they’ll fight with each other. Maybe you were working? They’ll try to get it from worker’s comp - which requires yet another trip through another bureaucracy. If there’s no other source to turn to, they’ll try to retroactively find an excuse to “un-issue” your policy. It’s like a huge game of musical chairs, with multiple corporations all elbowing each other aside to avoid being the one left holding the bill when the music stops. Except the “elbowing” costs big bucks. And if they all succeed, once again - the taxpayers foot the bill once you’re broken by the costs, because we don’t just kick sick people to the curb when they’re broke - we provide them with the least efficient and most expensive care possible, at the county hospital. Then they’ll spend more hounding you for the rest of your life, until you file bankruptcy, at yet more expense.</p>

<p>All that goes away with single payer.</p>

127

<p>1of42:</p>

<p>An argument for universal health insurance is that the uninsured do get care, but usually in the very expensive Emergency Rooms. So it is less an argument about health care delivery than the cost of delivery and how it is delivered.</p>

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<p>True, but in a UHC system one can assume progressive taxation and thus that the poor will spend less of a percentage of their income on health care than they do now (currently, health care is regressive) - if they even have enough money to get insurance at all!</p>

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<p>“All that goes away with single payer.”</p>

<p>are you sure? Kluge you are explaining part of the system from your end as a lawyer. The dealing with recovery from fault. The injury of another person by another person. And you’re right if I am injured by the fault of another person, my carrier will go after them(or their insurer) for recovery. Are you sure that would change? It may not. </p>

<p>That’s one aspect or offshoot of health care, admittingly you probably deal with it far more than I do. I think more from a point of view of illness and accident coverage. The situation you describe might involve a drunk driver crashing into me, then was it my fault, should I pay? debatable. </p>

<p>Actually you bring up a point that I haven’t thought about or heard much from anybody else. Would the situation as you describe it (car accident) change under a single payor? Would the government sue the at fault party to recover costs? The government could argue no cost would have occurred, if the person at fault had executed better behavoir or safety. Could they go after assets? </p>

<p>Right now in medicare nursing home situations the government has the right to go back five years and reaccquire assets “gifted” away to help pay for nursing home costs. You raise a good point, except I think it might be in the wrong direction than intended. I don’t think with the cost sensitity of health care costs, they would look the other way in at fault situations. Currently with the “free” care they do provide, they do go after assets to pay for care, even if the kids have em now. If they are successful in that situation, why would they not do the same elsewhere? It would just be a matter of time. </p>

<p>"Maybe you were working? They’ll try to get it from worker’s comp - which requires yet another trip through another bureaucracy. "</p>

<p>Workers comp in WA is already exclusively government owned and operated and is the most expensive rates around. They have a monopoly here. It is one of the reasons small business struggles here. </p>

<p>I guess I don’t see it the way you do, for every person that runs into problems with claims, thousands don’t. Claims are actually paid for the most part quickly and well. The processing part actually works very well. “We” just don’t like the cost and somebody making money. We hate Aetna’s CEO for making millions, but cheer Oprah for doing the same. go figure. One’s luke the other the emperor? </p>

<p>Aetna Ceo and his pay came about as both our political parties allowed him to gobble up smaller insurers, We are working towards a sinle player or as the old clinton plan Regional players in healthcare. Personally I don’t like it. Too much power in too few hands. Another reason I don’t want a single payor system. </p>

<p>I would like to go back a decade plus when I could offer a dozen companies to a business that operated squeeky tight because there was competition. Economics tells us competition drives prices down. I don’t see a single payor as worried about competition or controlling costs. </p>

<p>I would just say we are looking at different parts of the elephant…</p>

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<p>"thus that the poor will spend less of a percentage of their income on health care than they do now "</p>

<p>1 of 42 you may not be aware but most states offer support for hc for the poor now. It is funded through a hc premium tax and other methods. There are systems in place in most states to assist people in need. However, you have to actually go in and apply and prove need. For some that is just too much effort. There are programs that offer housing assistance, food stamps and other social services. Some take the steps to use, some don’t.</p>

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<p>One of the biggest problems I see in health care is pre-existing conditions. </p>

<p>Opie, you explained earlier that you don’t have that problem, but a few people I know have had a problem getting insurance with a pre-existing condition.</p>

<p>tobia_e has mentioned that he has that problem.</p>

<p>What can be done about pre-existing conditions?</p>

132

<p>Opie: My apologies, what I meant and what I said don’t tally very well. To be exact, what I meant was that for the person who does not already qualify for single payer poverty-dependent health care because he or she is just above the cutoff, health care expenditure will dramatically decrease under a single payer program, in line with the (assumed with good basis) progressive nature of health care taxation. This continues on in an analogous way; in a sense, aside from all the other arguments about efficiency (which are entirely separate), this certainly turns health care from a regressive to a progressive good, which I think is something desirable in and of itself.</p>

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<p>“What can be done about pre-existing conditions?”</p>

<p>Legislation… we actually have government controlled health care. In WA if you have insurance you can change plans, no pre ex. Small group (2-50)is guaranteed issue at decent rates and not age banded, actually renewals are going down this year(yea) . Individual is age banded and the rx isn’t as good as group, but they have rx. </p>

<p>For people who are coming in without coverage there is a high risk pool, but it is coverage. Yea you pay 30% more, but you’ve got coverage. It may cost an individual $500 a month, but their million dollar illness is covered. Not perfect but better. </p>

<p>Not all situations are an automatic hr pool case. There is a lengthy questionaire designed in cooperation between insurers and Wa government that scores applicants. Not every pre-ex is a hr pool case. They just revised it for april 1, under it’s scoring, a score of 325 shifts you to the pool. You could google the wa state health questionaire to find out more. </p>

<p>In cases where you aren’t a hr pooler, they use 3 months prior for 12 months after. So even if you have something pre-ex, it would only be for a year. It might mean you foot the bill for a while. Rates aren’t raised individually here. </p>

<p>The system here is far from perfect. However, it is improving. We orginally adopted the old Clinton plan, which meant every insurance carrier stopped selling new individual insurance in WA for several years, even the blues. The compromise between WA and the insurance carriers has recreated an individual marketplace again. The old Clinton plan’s math didn’t work. The compromise reached is working in the right direction.</p>

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<p>“that for the person who does not already qualify for single payer poverty-dependent health care because he or she is just above the cutoff”</p>

<p>but wouldn’t it be much easier and less burdensome to simply raise the cuttoff? That simply putting some air in the tire rather than reinventing it. </p>

<p>I guess my other fear is that they will screw it up. In business when things change the pr people talk to you about a seamless transition… </p>

<p>In case you didn’t know it seamless is business code for fubar… :wink: </p>

<p>The other reason I feel this way was a decade ago visiting my representative who dismissed me outright from trying to discuss HC in WA, he tossed a book at me about the canadian system, which at the time didn’t have the oil revenues to make things as they are now…(back when Canada was mexico north exchange rate wise). I mentioned the problems the Canadian system was having meeting demand and restriction… he cut me off telling me “not a problem” I asked how so? He put his finger to his forehead and said “because we’re smarter than the Canadians ever could be.” Honest to god quote and yes, he still is in office. and yes, he is a moron. But that was his solution… you expect me to have faith in that to make it better? please… the smartest people do not go into government, the ambitious ones do.</p>

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<p>Actually, I’m a “she.” Just so you know… :)</p>

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The thing that gets me, though, is that my “illness” isn’t an “illness,” just major brain damage that occured at birth. It’s not progressive or fatal (thank God for that at least). I haven’t received any treatment for it for years. I want/need coverage in case of serious illness like everyone in the population needs.</p>

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<p>Sorry about that, tobia_e.</p>

137

<p>Via [EurekAlert!](<a href=“http://www.eurekalert.org/pub_releases/2008-06/tct-ypw060608.php]EurekAlert![/url]:”>http://www.eurekalert.org/pub_releases/2008-06/tct-ypw060608.php):</a></p>

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<p>[More](<a href=“http://www.eurekalert.org/pub_releases/2008-06/tct-tay060608.php]More[/url]:”>http://www.eurekalert.org/pub_releases/2008-06/tct-tay060608.php):</a></p>

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<p>In the interests of balance here are the links to the entire articles rather than selective quotes:
[Young</a> patient waited ten months before being diagnosed with cancer](<a href=“http://www.eurekalert.org/pub_releases/2008-06/tct-ypw060608.php]Young”>http://www.eurekalert.org/pub_releases/2008-06/tct-ypw060608.php)
<a href=“Our latest news | Teenage Cancer Trust”>Our latest news | Teenage Cancer Trust;

<p>It’s not as clear cut as it was made to sound.</p>

<p>The NHS has its flaws but Brits are somehow living longer than Americans so it can’t be all that bad. Just looking at the original source of this thread - you might not be aware that the Daily Mail is the UK equivalent of perhaps something like Fox News. It’s nothing like a US newspaper. It’s extremely right wing and scare-mongering (very anti refugees, immigrants and obviously anything to do with the current UK government ) but is also not viewed as a good source of accurate reporting especially on health / science issues. Badscience.net keeps track of some of their more dubious reports:
[Bad</a> Science A rather long build up to one punchline](<a href=“http://www.badscience.net/2007/12/a-rather-long-build-up-to-one-punchline/#more-598]Bad”>http://www.badscience.net/2007/12/a-rather-long-build-up-to-one-punchline/#more-598)</p>

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<p>The British system has a lot of big problems, and most people who are fully insured in the US will get much better care than they would on the NHS in the UK… however for the uninsured or underinsured less than perfect care is still a lot better than no care, and that’s a lot more than we can say here in the US.</p>

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<p>And the US is full of insurance companies yanking the rug out from under you. How about this story: [Insurance</a> Companies Rejecting Women With History Of Cesarean - Women’s Health](<a href=“http://www.emaxhealth.com/4/22838.html]Insurance”>http://www.emaxhealth.com/4/22838.html)</p>