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Health Care

What are the supposed benefits to government-subsidized health care? I know I have plenty of bleeding-heart friends. Seriously, all I hear is the same old over-dramatized crap from my boss, so argue it for me.

Personally, I don't know enough to care either way. But boy, everyone else seems to think they know why it's a bad idea, and I have a hard time believing someone who supported Huckabee.

Further counter-points are welcome as well. I just can't find non-colored advice on this issue.


( 24 comments — Leave a comment )
Jun. 10th, 2008 08:34 pm (UTC)
(warning: this isn't as organized as i set out for it to be)
you know, i'm stumped on this one too. i read up on it the other day out of curiousity and learned that the US is the only "wealthy, industrialized nation that does not provide universal healthcare":


i don't know if that's a good thing or a bad thing. my general instinct about our federal government is that it is slow and inefficient in solving the problems it sets out to tackle and i'd prefer to see private industry step in and solve the problem creatively. unfortunately, that avenue has it's own path to corruption and won't even happen unless there's money to be made, so i'm starting to think more moderately. a friend of mine recently told me that her non-huntsville friends don't have health benefits with work and that healthcare is virtually non-existent in her home town. this tells me that i'm a bit isolated from the problems that are raising this issue.

Should our government do something? I'm willing to try it, I guess, but there are plenty of wrong ways a government can try to solve a problem.

Conceptually, I like the idea of government policies and legislation that spurs innovation (yes, I realize how idealistic this is). By placing a restriction or incentive, the government can help shape the way industry provides healthcare to more people. The problem with this approach, as seen in environmental regulations, is that if the restriction or policy is too limiting, businesses will simply leave the US and go global. Globalization, in my own limited perspective, has helped many companies avoid laws they don't like. On the other hand, if a policy or restriction is too soft, there is no net gain.

another approach our government could take in solving the healthcare problem is Nationalization, which might work if the government institution/agency created to execute universal healthcare was run by elected officials. maybe that would promote a well-run organization. maybe.

then there's this middle ground; this realm of "subsidies". how much do tax payers pay? my question would be "how much is currently needed and what is it needed to cover?" also, what is the net benefit of government subsidies? in other words, of those currently uninsured, what is the dollar amount necessary to cover 10, 20, 30% of those uninsured and what impact will that have on industry?

Those are my thoughts. I'm not much for debate at the moment. Read the wikipedia article, though. Especially the sections on Economics and Politics. Good stuff.
Jun. 10th, 2008 08:52 pm (UTC)
Re: (warning: this isn't as organized as i set out for it to be)
I've read the Wiki article before, but it just seems to muddy things more for me.

I'm starting to "think more moderate" as well. I don't know what the answer is, but I just don't see it on either side of the dichotomy. It's such a complicated problem that people want to simplify too much.

If you're too poor to afford health care, that's what we have Medicaid for, right, and if it's not working (which I hear it is not), then we need Medicaid reform. But if the middle class can't afford health care (like we're led to believe), then that's a symptom of a larger problem, and aid is out of the question. I'm lucky. I work for a company that provides a way for me to have quite affordable health insurance. But if I were self-employed, or employed by a company that didn't, I don't know if I could afford it. I hear people I know saying they pay $700 a month for insurance. I pay under $200. I don't have $500 extra a month, so I can definitely see the problem there.

What I really want to know is what UHC is really like for people that have it... Germans, Brits, and Canadians. Do they really have to wait in line 3 months to have someone deliver their baby? I hate having to filter people's views through their political agenda so much that there's nothing left to consider.
Jun. 10th, 2008 09:34 pm (UTC)
Re: (warning: this isn't as organized as i set out for it to be)
i don't know. my friend Morgan (not the one Dave & Kanthi know) lived in Canada for a while, and she really liked the way Canada does things. i can't remember her specific points at the moment, but i do know that she was a single mother at the time and did have to interact with that system. if i can get some juicy facts from her i'll let you know.
Jun. 11th, 2008 02:20 am (UTC)
Re: (warning: this isn't as organized as i set out for it to be)
What I really want to know is what UHC is really like for people that have it... Germans, Brits, and Canadians. Do they really have to wait in line 3 months to have someone deliver their baby?

From all the furriners I've spoken with... No. That's dumb. Triage exists even in government health care.

I can send some of my flist your way if you like- I know a few of them are in UHC nations.
Jun. 11th, 2008 04:15 pm (UTC)
Re: (warning: this isn't as organized as i set out for it to be)
Triage exists even in government health care.

See, my boss, insisted that this wasn't the case. Even after I put forth very vocal skepticism about it, he said that his "friend" (that lives in Australia) said that if your wife gets pregnant, you better learn how to deliver your own baby.

I can send some of my flist your way if you like

Sure. I'll publicify the entry first.
Jun. 12th, 2008 06:48 am (UTC)
Since you asked...
Hi, here via furikku.

What I really want to know is what UHC is really like for people that have it... Germans, Brits, and Canadians. Do they really have to wait in line 3 months to have someone deliver their baby? I hate having to filter people's views through their political agenda so much that there's nothing left to consider.

I'm an American living in Japan, currently enjoying the benefits of Japan's universal government-subsidized healthcare system. My experience so far? It's near total freedom. I can go to any hospital or clinic that I want to, and see any doctor that I want to, as long as they're covered by the National Health Insurance System. Theoretically there are private medical institutions that I could visit, but - hah! - none really in the area where I live. However, there are many and varied choices available to me under the NHI system. I live in a village of 2000 people, and despite our small population, we have three excellent clinics to choose from. There's a big government-run hospital, thirty minutes away, for emergencies. As for waits, the longest I've ever had was forty-five minutes in an emergency room. I once waited four hours in an emergency room in the United States. So yeah.

My health care is so freakin' affordable, it's ridiculous. Currently I'm taking a daily prescription medication. It's a brand-name, not generic. I pay twenty dollars for a two-month's supply. I also pay five dollars for each of my monthly visits to my podiatrist. Last year I had a rather dire medical scare that necessitated a trip to the emergency room, an ultrasound, and a breakfast delivered via IV drip. I can't remember how much that all cost, but I do remember that it was negligible. Like thirty dollars or thereabouts.

As for beauracracy, there's basically none that I've had to deal with. I got a nifty national health insurance card on my first day of employment. When I go to a hospital or clinic, all I do is hand over my card. I don't have to fill out any paperwork. I'm sure that there are reams of paperwork to be filled out by hospital and clinic employees, but patients don't have to deal with any of that. I have a "health insurance book" that I'm supposed to keep with me, but I'm not exactly sure what it's for, since in over two years and many doctor visits I have never once been asked to hand it over for any reason.

Now of course all of that has to paid for somehow, and that's where the taxes come in. Yes, the Japanese pay a lot more in national taxes than Americans do. But it's still a more-affordable-than-not solution, at least for me. In my income bracket, that would mean paying a couple hundred dollars more per year than I do in the States. (Granted, I am in a low income bracket, making a public school teacher's salary. I'm sure the difference would be more in a higher income bracket.) And I say "would mean paying" because there's a Japan-US treaty that declares that US nationals living in Japan pay US taxes for the first couple years, not Japanese taxes. So I get all of the benefits from the Japanese system without having to really buy into it, so to speak. It's practically cheating.

Anyway, that couple hundred dollars per year is chump change compared to the $900 bill I was stuck with after an emergency surgery that my insurance refused to cover, back when I lived in the States. That was more than a month's salary for me, at the time. And that was hardly the only time that I ended up paying through the nose for basic, even life-saving, health care. I know that my insurance plan was crap, but it was all that I could afford, and it was better than nothing.

Why yes, I am incredibly biased about this issue. I didn't feel so strongly about it, though, until I had the chance to experience both types of systems. I am deeply convinced that a system in which health insurance companies are businesses run for profit is profoundly, unfixably, fundamentally wrong. I have seen that a government-run system can work. Obviously there is vast and great potential for things to go terribly wrong - just look at HMOs - but the point is, there are countries were the system works, and I feel very strongly that the US should look into emulating some of that.
Jun. 12th, 2008 07:01 am (UTC)
Re: Since you asked...
Edit - Upon further recollection, I think I *was* asked for my health insurance book one time. That was the time that I visited the emergency room. I think. I wasn't exactly in the most coherent state of mind at the time, so my memories are fuzzy.
Jun. 12th, 2008 02:57 pm (UTC)
Re: Since you asked...
Thank you so much! That sounds like a glowing recommendation. Let's just hope the U.S. doesn't screw it up as much as, well, I expect them to.
Jun. 13th, 2008 05:07 am (UTC)
Re: Since you asked...
Now, to be fair, I don't want to sound like I think the Japanese system is perfect, because I know it's not. There's a fair amount of sexism built into the system (i.e. birth control not being covered), and I've heard that it's insanely difficult to get the NHI to cover medical expenses that Japanese citizens/residents rack up should something unexpected happen while they're abroad, even though technically the NHI is supposed to take care of some of that too.

Finally, I'm not really sure how the money flows. I know that my prefecture (state), Nagano, is quite wealthy. However, I also know that my little neck of Nagano is quite rural and low-income, a good three hours' drive away from the wealthy tourist areas to the north. However, like I mentioned previously, somehow my little village of 2000 people ended up with three *excellent* NHI clinics. And I say *excellent* because they strongly remind me of the classy, expensive clinics that service wealthy suburban areas in the United States. All three of them are a far cry from the low-cost clinics that I used when I lived in Minneapolis. But either way I'm not sure why my poor rural area has ended up being basically over-served by the NHI.

I also don't know how the NHI clinics/hospitals compare to Japan's private hospitals. With the great care I've been getting through the NHI system, however, I've never felt the need to seek out private care. And in my area there are no private clinics so that's not even an option anyway. I might very well be singing a different tune, however, if I had a more dire medical condition like cancer, or if I got pregnant.
Jun. 10th, 2008 10:11 pm (UTC)
1. Healthcare these days is expensive and most people without insurance cannot afford even basic care. Medicaid helps the indigent, Medicare covers seniors, but a lot of people in between fall through the cracks. Some people go to emergency rooms. Hospitals eat this cost and make it up with higher charges to everyone else. But the vast majority simply don't go to doctors.

2. Health insurance in the US is almost all paid for by employers. It puts US companies at a competitive disadvantage in the global market, because companies from virtually everywhere else in the industrialized world do not carry this healthcare burden.

Jun. 11th, 2008 02:18 am (UTC)
Health insurance in the US is almost all paid for by employers.

And those of us employed by small employers end up uninsured because non-employer insurance costs way too much.

I'd like to be not in debt for most of my life because I get into a car accident or something and have to go to the hospital.
Jun. 11th, 2008 02:45 pm (UTC)
I don't know if you ever read the annual wish-list that the paper prints around Thanksgiving, in order to line up donors by Christmas. A lot of the people who write in are just looking for a handout, but there are a lot of really sad stories, people saying all they want is a used bed for a child to sleep in, or a used washing machine.

In many cases these are working poor, people who aren't eligible for Medicaid but who have staggering medical debt for themselves or for a relative they support. It's kind of a myth that the uninsured get treated for free. Yeah, if you break your arm you can go to the emergency room and get treated and then not pay, and they'll eventually write it off, but only after they've tried to intimidate you into selling your car to pay your bill, or threatened going to collection.

But if you have a chronic condition, individual doctors and clinics and labs are less forgiving. If you want to continue getting treated you better make an attempt to pay. There are free clinics, but they are swamped, and the quality of care is variable at best. For somebody making eight bucks an hour and trying to stay current on rent and put food on the table, paying down that medical bill is pretty much out of the question. A lot of people go without treatment because they simply can't afford it.

Private industry has had its shot at the problem. Insurance companies are doing well. Doctors make really good money. Look at all the construction around Huntsville Hospital. What other business in town has a train to carry people from building to building? They're doing fine. Profit motive doesn't solve this problem.

A large portion of our medical-care cost goes to support insurance companies, a huge industry that cures no one.

One advantage of our current system is that hospitals compete to have the most current equipment and treatment. Medical innovation starts in the US. You can get treatment here that's simply not available, or is available only after a long wait, in Europe. No matter how we change the system, we don't want to lose that. If you are well insured, the US is the best place in the world to be sick.

The working poor is just one problem. If you've ever had cancer, don't think about changing jobs, because the insurance at the new job may refuse to cover you, or may exclude cancer. If it comes back, you're on your own.

Healthcare is social infrastructure, just as highways and bridges and airports are commercial infrastructure. Medical debt ties people to poverty, people who could otherwise rise into middle class and be productive consumers.

I'm not a big believer in big government programs, but I do believe that the purpose of government is to do things for people. This is a function that government should step up to. In designing a plan, we can draw on the models and learn from the mistakes of hundreds of national health plans around the world.

I don't have a lot of international friends, but I do have an LJ friend, jdquintette, who has joint Canadian and US citizenship. He also has a chronic health condition. He currently lives in the US, after many years in Canada. He strongly prefers the Canadian health system. And I've encountered people in communities who seem happy with their health care in places like Australia. I hear a lot of American talk about how many problems there are with health care in, say, England, but the English seem fine with it. I suspect that what I'm hearing from Americans is more politics than health care.

Jun. 11th, 2008 04:24 pm (UTC)
Private industry has had its shot at the problem.
A large portion of our medical-care cost goes to support insurance companies

That's where I'm not so sure, though. Private industry has had a shot, but they've been so regulated and have been forced to insure themselves so thoroughly that they're forced to pay doctors that much for anyone to want to compete in that market. I'm not saying we should do away with regulations, but maybe cutting down on the frivolous lawsuits could give private enterprise a better chance. It seems we're letting an industry run in an incentive-based system, but cutting down the major incentives.

Jun. 11th, 2008 05:26 pm (UTC)
I used to know some malpractice attorneys, and I heard some stories. Doctors make mistakes, some understandable, others irresponsible, like flipping the x-ray and removing the wrong kidney. Any doctor might make a mistake, but a small number of doctors make the vast majority of mistakes, and removing these guys is fought by the medical community.

Frivolous lawsuits are mostly a myth. Anything really frivolous gets thrown out long before it gets to trial. Judges and juries aren't stupid. When somebody gets a big award, it's almost always because he's entitled to it.

The costs for this are built into the price structure, just as it is in any other business.

I know a doctor who complains about his malpractice cost. It is high; he's in a high-risk specialty. But every other year he buys a new Escalade.

I'm not sure what regulation you're talking about. But anyway, my point was that there is no additional profit to be made by covering the working poor, and school kids, and employees of small businesses. The insurance companies and doctors are doing fine, thank you, and they'd just as soon keep the status quo. Medical coverage for everyone is a social goal, and profit alone is not going to drive the solution.

Jun. 11th, 2008 02:47 pm (UTC)
I heard on the radio recently that labor leader Walter Reuther petitioned the government to start providing health care assistance back in thelate 40's or early 50's. In the anti-communist anti-socialist mood of that time, that was not about to happen. So he went after the auto companies to offer comprehensive healthcare for their union workers. Today, US automakers are burdened by huge healthcare costs, while the Toyotas of the world don't pay for health care at all.

And, I heard that the state of Alabama may release terminally ill prison inmates. This is painted as a humanitarian gesture, but it's really about saving money. Who will pay for the treatment for these sick people? A guy who has been in prison for ten years doesn't have health insurance, and if he has cancer he's not going to get any. The families, who in many cases probably don't particularly want the guy back in the first place, will be stuck with huge medical bills.

Jun. 11th, 2008 04:24 pm (UTC)
And, I heard that the state of Alabama may release terminally ill prison inmates

Wow. Cause we all know crimes are never committed by people with nothing to lose.
Jun. 11th, 2008 05:05 pm (UTC)
My understanding is that these are not murderers and rapists. A sizeable portion of our prison population is nonviolent drug offenders stuck with long mandatory sentences, and three-time losers, petty career criminals. And, they're pretty sick.
Jun. 11th, 2008 06:14 pm (UTC)
I'm a big fan of not jailing most non-violent and non-repeat offenders.
Jun. 11th, 2008 06:50 pm (UTC)
Me too.
Jun. 11th, 2008 05:54 pm (UTC)
Hey! UK citizen here - directed from furikku. I think the main difference is, we can see a GP for free, have essential medical care for free, emergency treatment and transport for free. Quite a few people do go for private hospitals, which they or their insurance pay for, or occasionally certain jobs offer medical insurance that allow private care.

The big difference is that anyone and everyone who pays taxes - or is legitimately exempt, like children or students - is entitled to essential medical care and checkups without paying or being insured - it all comes out of taxes, instead, which is more or less insurance in itself. I don't think all prescriptions are free, though. I haven't been to the doctor in ages, but I'm fairly sure you have to buy them - possibly unless your income is low enough to have them subsidized? That's usually the way it works.

I'll ask my parents, anyhow, they'll know more. I'll get back to you!
Jun. 11th, 2008 06:51 pm (UTC)
That is interesting. So there are public and private hospitals/practices? Are private ones required to accept "government insurance" and get reimbursed by the gov't? Or can they decide not to accept the government sponsored plans at all?

Am I making any sense?
Jun. 11th, 2008 07:03 pm (UTC)
Well, there are both public and private hospitals - private mainly for wealthier people who want a comfier stay, or not to wait as long for nonessential procedures, say, and they tend to use medical insurers such as BUPA.

I'm... not sure what you mean by government insurance. id fine this article, however. Apparently the government does pay some private hospitals to cut National Health Service waiting lists, but in general, I'm fairly certain they're seperate entities. For example, my grandmother had her hip replacements done privately, but when my friend got into an accident, it was all done in a public hospital.

I'm very fuzzy on the actual requirements made of private hospitals, but they are mainly an alternative for those willing to pay for more comfort/speedier treatment. Everyone else gets stuff done in order of necessity.
Jun. 11th, 2008 07:26 pm (UTC)
I'm... not sure what you mean by government insurance.

Yeah, that didn't make sense.. I mean, everyone pays taxes, so everyone has "insurance" through the gov't, but they can't "use" that to go to a private hospital, unless, under the circumstances you said, where the gov't could try to cut down on waiting lists. I think I mainly understand it.

See, the way UHC is pitched over here, it sounds like every hospital would be public, which is a huge reservation for me.
Jun. 11th, 2008 08:10 pm (UTC)
Aha! *Nods* Yes, that's right. UHC isn't perfect, but it's a huge advantage for those that can't afford insurance, as I understand it - and we've always had the private alternative for those that are willing and able to pay for their medical care.
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